Expert: Dr. Sharon A. Mitchell - 10/18/2007

Question
My child is 5, he is non-verbal, he was diagnosed with autism when he was 3, he doesn't want to put any clothes on except for his summer shorts and t-shirts; it's getting cold and it seems like i can't make him wear anything warm. he is going to a special childrens school now, they know the problem there, but they say can do nothing either. should i keep him at home for some time in a hope that it'll dawn on him that it's necessary to wear your warm outfits. i am at loss what to do - he may stay home for a long period of time - he doesn't care if he sees the outer world of not. i've already deprived him of his favorite toys and all the movies, but he seems not to care at all...

Answer
No, I don't think you should keep him at home until he realizes the need for wearing other clothing. For one thing, that would severely restrict your life and that of your family if you could never leave the house all together in cooler weather.

For another thing, I think you might wait a long, very long time.

For a typical 5 year old, depriving him of his favorite toys may work as a means getting him to fall in with your wishes. It was certainly worth a try but does not sound like enough of an inducement to get your lad to alter his mind.

Since I don't know your boy, I'm guessing at what his objection likely is. Sometimes it's necessary to make an educated guess, especially with a nonverbal child. His aversion does not seem directed just at the school as you mention he does not care to see the outer world.

There are two other possible reasons that come to my mind:

- fear of the unknown
- sensory issues

First, though, it never hurts to see a doctor for a physical. There may be a physical reason for his refusals. Even a low-grade infection could put him out-of-sorts enough that contemplating something new or different can put his stress level over the top.

Fear

Kids with autism have trouble making sense of their world. Because of that, they feel much more comfortable with routine and rules and change is unsettling. He's used to being home with you. He was used to wearing just certain clothes and now you're asking him to change. Unfortunately this is a problem that will crop up again and again in your son's life. But he can learn to deal more easily with change.

That's where you come in. As his mom, you'll find that life for all of you gets much easier when you run your home around routines. These routines will have to be much more firm that you'd regularly use.

A word of warning, first. Kids with autism become used to certain ways of doing things and can be pretty inflexible when you want to change this pattern. So before putting a routine in place make sure that this is a routine suited to your family's lifestyle, one that will carry you through for a number of years and one that is age appropriate for your child.

That said, it's not difficult and much of this routine stuff you're probably doing instinctively.

For instance, you could create a routine around getting up in the morning. Since your son is nonverbal, I'd strongly suggest that you make these routines visual. Create a visual schedule of what you want him to do. You might post a chart in the bathroom with a picture of a toilet, then handwashing, face washing, brushing teeth, etc. On his bedroom wall could be a getting dressed visual chart with pictures of his clothing in the order you'd like him to put things on. The first picture may be of underwear, the second of his socks, then pants, etc. This chart is useful if he attempts to dress himself or if you're assisting him/teaching him how to do this on his own. (It can help if you have the clothing laid out for him ahead of time).

You can create similar visual schedules for mealtimes, bedtime, getting ready to go outside to play, cleaning up toys, etc. Also, a visual schedule of what will happen in his day (or morning or afternoon) can also help.

It can help if you think of autism as a processing disorder. It's difficult for the child to process more than one bit of incoming sensory information at a time. We often live in noisy, multi-tasking environments that are hard for kids with autism spectrum disorders.

Most people with autism have trouble with auditory processing. While their hearing may be just fine, listening to what is said, making sense of it and then taking appropriate action in response can be a difficult thing. And the more tense, stressed or confused the person is, the more difficult it becomes to process. Your son is nonverbal. That does not mean that he has equal difficulty understanding spoken language but there is a good chance that he has delays in this area as well.

So, when you talk to him, he may well not be getting all that you say. And when he is upset (and you're upset), he may process even less. In fact, when he's upset a lot of verbiage directed his way may even increase his anxiety.

That's why it's so important to use visuals as I described above when I talked about routines. These visuals do not have to be beautiful line drawings or elaborate. There are free pictures available at the following site: http://www.do2learn.com At this site you'll also find grids to use for creating your visual schedules and good explanations as to why visuals work and how to use them.

I have often seen unwanted behaviors seriously decrease with the use of visuals. They aren't hard to create and use. Persist in using them for a couple weeks to see how well he does once he's come to anticipate their use.

Your demands that he wear heavier clothes is a change and may have something to do with his confusion about what's going on around him, what will happen next and what's expected of him. Visuals may help with that.

Sensory

My strongest guess though is that he wants to only wear his shorts and t-shirts due to sensory sensitivities. The clothing demands that change with the seasons can be very hard on kids with sensory sensitivities. They get used to the feel of the sun and the wind on their arms and legs. Then, you try to make them put these heavy fabrics on their arms and legs.  The weight, the rubbing, the sounds the fabric makes can all make a big difference to a sensitive child.

Kids with autism are generally over or under sensitive in one or more of the following areas:

- tactile - sense of touch and how things feel on your skin

- olfactory - sense of smell

- gustatory - sense of taste

- visual - seeing

- auditory - hearing

- vestibular - sense of balance

- proprioceptive - feedback on where your body is in space, how much force to use

While a sweater tag rubbing the back of your neck may be just a minor annoyance to you, to someone with tactile sensitivities, that sensation may seem overwhelming. Or a sock twisted of your foot. Or a loose sweatshirt brushing your shoulders.

I've written some articles about using sensory solutions to interpret and alter behavior. You can look under the Answers and FAQ areas of these sites:

http://www.autismsite.ca/html/faq.html

http://www.autismsite.ca/html/hands_in_pants.html

Does your school have access to an Occupational Therapist? OT's are of great help in situations such as yours. They can help detect your son's sensory sensitivities and device a sensory diet and therapies that can help him feel calmer and his body more regulated. He'd then feel less stressed and be more open to the possibilities of change.

Below are a couple short books by Brenda Myles (and where to find them on Amazon) that might help you. Even though the title has the label Asperger's Syndrome in it, the explanations and suggestions still apply to your son. Asperger's falls within the umbrella term of autism spectrum disorders.

Asperger's Syndrome and Sensory Issues: Practical Solutions for Making Sense of the World (http://www.amazon.com/dp/0967251486?tag=autismhelpf0e-20&camp=14573&creative=327...)

Asperger Syndrome And Difficult Moments: Practical Solutions For Tantrums, Rage And Meltdowns (http://www.amazon.com/Asperger-Syndrome-Difficult-Moments-Practical/dp/193128270...)

Another highly readable and useful book is by Linda Hodgdons called "Solving Behavior Problems in Autism (Visual Strategy Series" (http://www.amazon.com/Solving-Behavior-Problems-Autism-Strategies/dp/0961678623/...)

She's also written "Visual Strategies for Improving Communication : Practical Supports for School & Home" (http://www.amazon.com/Visual-Strategies-Improving-Communication-Practical/dp/096...)

The book, "A Treasure Chest of Behavioral Strategies for Individuals with Autism" might also answer some of your discipline concerns (http://www.amazon.com/Treasure-Behavioral-Strategies-Individuals-Autism/dp/18854...)

Now, here's something more radical to consider. Although he does not want to wear warmer clothes, you know that it's for his own good. As the adult, you make other decisions for your son when you know it's in his best interest, even when he may not like your plan.

As his mom, you don't want him becoming locked in the house all the time. That would stunt his development.

Since he's only 5, is it possible for you to pick him up and take him to school, even if he does not wish to go? Would the school then help him cope with being there? Is it possible for him to continue to wear his t-shirt in the classroom? Is the classroom too cool for shorts?

Could he start by continuing to wear his t-shirt, but switch from shorts to longer pants? You might need to experiment with textures and fabrics. Perhaps the fleece of sweatpants would feel less restrictive to him. Or, he may prefer the sturdier fabric of corduroy or denim. Some jeans are snug fitting; some cargo-type pants are loose. maybe pants with roomy pockets would provide storage space for small, favorite toys to go along with him to school.

Again, an Occupational Therapist could guide you in this process. Possibly, getting him used to the feel of something on his legs would help. Rub his legs while he watches TV. Or place blankets or towels over his legs to get him accustomed to the weight. Try similar things with his arms.

Offer him choices. Have tops and pants in his favorite colors. Or with the cartoon character he likes. But his choice would be between say the blue pants and the brown pants. You're in charge. The shorts would not be an option, just those two pairs of pants.

To help in this process, use a social story. Social stories are brief explanations of what is going to happen.

It sounds simple, but using them is a surprisingly effective strategy that can decrease negative behaviors. For instance, a social story about going for a walk might help.

Carol Gray, who started the term social stories, has written a number of books such as this: http://www.amazon.com/dp/188547766X?tag=autismhelpf0e-20&camp=14573&creative=327...

You can find examples of social stories at sites like :

http://www.polyxo.com/socialstories/

http://www.frsd.k12.nj.us/autistic/Social%20Stories/1social_stories.htm

http://www.adders.org/socialstories.htm

http://www.autismnetwork.org/modules/social/sstory/index.html

Along with the social story about getting dressed and going to school, be sure to use a visual schedule of his day. You might want to include photos taken of his classroom, his teacher and activities he enjoys at school.

This might all seem overwhelming. And, it is more work than most parents of 5 year olds have to do. But it's worth it. Take it a little bit at a time. Start just by looking at the www.do2learn.com  website for some suggestions on how to get started.  Helping your son learn to handle change is a huge, lifelong gift you can give him. It's work, yes, but the pay off can be tremendous.

Best of luck,

Sharon A. Mitchell, B.A., B.Ed., M.A.
www.autismsite.ca