Expert: James Michael Roan - 11/9/2006

Question
Thank you for answering my question so quickly and helping me to understand and to confirm that this is a common trait of AS children.  (The school has mentioned more than once that most of their AS kids don't have meltdowns or tantrums, I began to question myself on my understanding) I do have a follow-up question/s in response.  I had met with the school about two weeks ago to implement some preventative approaches.  We did create a plan for him to be able to have an acceptable escape area with a five minute timer and a bag full of sensory toys.  Although this is effective some of the time, Andrew seems to become more fixated on his concern or need being answered or met right at the moment he dictates.  Even though we explained to him that he is not allowed to go to the bathroom or sharpen his pencil in the middle of a lesson and then explained when he could do these things.  He still seems to use these things as avoidance of what ever task/subject he dislikes and when it fails he does in fact escalate out of control.  He also seems rather fixated on the rules of first grade vs the rules of second grade.  I think from the way he talks he believes that his teacher now is not following the rules.  I also have a concern that now that he has been home for over a week and is firm about the fact that he does not want to go back to school we may have worsened the problem. UGH!  What do you think about all this?  And by the way why do some "experts" out there insist that children that "just" have AS are only socially weird and eccentric and that if they are having anything else such as Andrew they believe the child must have another diagnoses along with AS? how frustrating that they seem not to be looking into the whole neurocognitive picture and how it might make a child respond.   I completely agree with you and it makes perfect sense.  His aggression seems to come more out of frustration and lack of understanding,as well as, the fact that he seems to "get stuck" on an idea. I just don't know if I am explaining things to him in a way that is helping him to truly understand what he not understanding. Again thanks for your clear answer.  It was very helpful. Sorry to pick your brain, but you are the first person we have gotten a clear explanation from.  

Sincerely,
Courtney  
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The text above is a follow-up to ...

-----Question-----
My 7yr 11month old son has AS.  We are having great difficulty with him since the start of second grade.  This year he is having daily meltdowns and tantrums.  Hiding under desks, flipping over desks or chairs in the classroom, and becoming very disruptive to the point of needing to be physically escorted from the classroom.  In between the tantrums he is pleasant for the most part.  The school is now deciding to send him home each time one of the episodes starts, which means everyday. So we began to homeschool him temorarily.  WE are having a terrible time finding someone who really knows what they are talking about concerning AS, and we keep getting the run around by all "help" involved.  I have been told by some that tantrums, meltdowns, aggressive behavior, and rigidity are not related to AS, where as by other professionals I am told that it is a direct connect.  Which is it?  

Frustrated and overwhelmed,
Courtney Smith
-----Answer-----
Hi Courtney;

Those behaviors are very highly correlated with AS. They are avoidance and escape behaviors that should be communicating to the school adults around him to leave him alone and that the social climate is too much for him at the moment. They should read the behavior for what it is: communication and not something to be "fixed." If they were to provide your son with a means of communicating his escalating anxiety, if he is able to recognize that in himself yet, and to then provide a means of acceptable "escape," then the behaviors will all but disappear.

The "rigidity" is due to the concrete thinking style, which is a core difficulty in AS. Some explosive behavior is in response to the stress from social anxiety while other meltdowns come from misinterpretation of information around them. The misinterpretation is automatic and quick. Eventually, your son will get better at controlling these episodes, but for now, the school staff must educate themselves about AS and a literal thinking style.

Kind Regards,
James

Answer
Hi Courtney;

You are more than welcomed to ask as many questions as you like.

Pencil sharpening is a common activity of children with AS. I assume it has a stress modulating/calming effect. Many children with AS engage in it during stressful times like open-ended writing assignments or during a lecture. Remember, that very little is conveyed/communicated on the basis of speech alone (see: http://nonverbal.ucsc.edu/). Nonverbal forms of communication such as facial expression, body language , prosody (rhythm and intonation of speech), eye contact, etc. provide well over 85% or more of the communicative intent of the speaker. These are just the skills that a child with AS lacks. Lectures are boring to most of us, but imagine what they must be like for a child with AS?! To make things worse yet, children with AS typically have low understanding of language on top of this. Even though much of what your son hears, speech-wise, may be lost to him, it is still extremely stressful for him. He needs to be given appropriate consideration and be allowed to deal with stress in ways that work for him and not necessarily the teacher. This having been said, it is still very difficult to find a teacher willing and/or able to do this. I often remark at these kinds of meetings on just this topic that: "let's be sure we are not asking our children to do what we ourselves are unable or unwilling to do under comparable circumstances." This is not about learning to be compliant, it is about surviving, and we cannot deny children that which they need most in order to survive.

"Rule fixation" is really an expectation that things should be predictable from day to day. What is a cow or a chicken today should be a cow or chicken tomorrow and that the value of "cowness" should not be situationally determined, it should be a given. That is why kids with AS gravitate to numbers and an engineering environment: numbers always maintain their value under any circumstance, and thus they are predictable. A life that is filled with unpredictable events is terrifying at best. I think your son is probably correct in thinking the teacher has broken the rules. As adults without AS, we understand that rules can be situationally determined. To a child with AS: The rules are the rules, regardless of the circumstances.

The response to anxiety, over time, is depression followed by aggression. Sometimes obsessive-compulsive behaviors (OCD) appear as a means of attenuating the anxiety. Most children on the autism spectrum, AS included, struggle from varying degrees of executive dysfunction, which includes attention, organizing and initiating activities, etc. Where I am going here is that children with AS are often misdiagnosed with these secondary conditions and may get diagnoses of ADHD, ADD, OCD, anxiety disorder, and/or depression.

Good luck Courtney and stay in touch. I will be unavailable for the next few weeks starting Tuesday the 15th. I have a crisis to attend to.

Kind Regards,
James