Updated: Dec 4, 2019
In my work with individuals diagnosed with Autism Spectrum Disorders (ASD), I have learned so much. These children, teens, and young adults ranging in age from two years old through their early 20s are my teachers. I find our sessions so rewarding because, despite having the same diagnosis, each child is different, and so are their experiences.
I predominately work with children and adolescents with ASD who are verbal and often referred to as “high functioning.” My quotations here are intentional because while these individuals appear higher functioning than individuals with ASD who have less verbal language, they can still have significant impairments in other areas, such as emotional regulation and sensory integration. Unfortunately, I sometimes hear from these "high functioning" students' teachers, “Are you sure he has autism?” or “She doesn’t look like she has autism.” There is no “look.” There is only individually specific brain wiring that impacts social and emotional development in unique ways. You can't "see" it, which is why we have to work harder to understand.
These children and teens may check a similar profile of diagnostic boxes, but they have their own individual differences including a variety of symptoms, severity levels, and strengths.
In fact, they often have heightened strengths compared to their neuro-typical peers. This inconsistent developmental profile means that many are a "moving target"of concerns that can only be fully understood with a deep dive into an analysis of their individual differences and strengths.
The General Overview
Even if you know just a little bit about ASD, you likely understand that these children struggle with communication and social interactions and often have heightened interests. Many have language delays relating to using and reading nonverbal communication (gestures and facial expressions) and the social use of language, referred to as social pragmatics. For instance, a child with ASD may repeat the language heard around them, known as scripting or echolalia, but this language might not have much communicative intent. Another child with ASD may read at a very young age but not comprehend what they are reading.
Many have motor and coordination delays where they have difficulty navigating their physical world, even from before 12 months old. Many children with ASD have strong rote memory skills, or specialized skills like remembering dates, numbers, and facts. This is a very different skill than remembering where they put their water bottle, which tends to be weaker since children with ASD are prone to distraction.
Many have sensory sensitivities or sensory seeking behaviors, although this is not unique to ASD. One characteristic that is unique to ASD is repetitive motor movements, referred to as stimming. Some children will rock their body or flap their hands while others might demonstrate small hand movements when excited or upset. Again, no two children check the same boxes with the same severity. While it is the constellation of symptoms that lead to a diagnosis of ASD, it is a thorough evaluation of these individual differences that leads to an understanding of each child.
Connecting the Dots
All humans are wired for a desire to belong. In order to do that, we need to connect with each other. But what if making that human connection was your weakness? My number one priority in working with children with ASD is to build trust and connect. Building a connection with a child is every therapist’s goal, but it’s a bit more challenging with children with ASD.
You know those art-by-number drawings we used to do as a kid? I cannot see what the drawing is as a whole until I connect those dots, so I’m motivated to connect them. I also know how to connect the dots. Because I'm motivated and I feel like I can do the task, I get started. But, what if each dot was super interesting to me and I really had no desired to share it with anyone else because it was so interesting. And, since it’s so interesting, I got stuck thinking about it all the time and when someone asked me to stop thinking about it, I was irritated because I'm having such a good time thinking about it. The motivation is not in connecting the dots, it’s in learning about the dot I'm on.
I see this when playing with children with ASD. They are very interested in a detail and not the play as a whole. My job as a therapist is to show them how fun it is to connect. That is why I use DIR/Floortime to help teach parents how to connect with their children who do not connect within the expected developmental timeframes. When you see a parent and child smile at each other for the first time and connect, that child’s brain is getting all the yummy feelings of connection (and so is the parents’ brain) and they will come back for more. But first, they have to know there is something outside of the super-exciting dot.
How is ASD different from Social Anxiety?
Many individuals with ASD also experience high levels of anxiety. Anxiety comes from a perceived threat to our nervous system. We are all wired for anxiety to avoid or fight danger in order to stay alive. Because so much of the world is unknown to children with ASD, it makes sense that they experience high levels of anxiety, especially in social situations. Because anxiety happens to all of us when our brain is flooded with a perceived threat, people without ASD can also have social anxiety. Here's the difference: Individuals with ASD often struggle with social situations because they do not know HOW to smoothly enter a conversation or they struggle with reading the nonverbal cues of others, which impacts communication in friendships. Individuals with only social anxiety know WHAT to do to engage socially, but the task appears overwhelming so they may avoid it.
How is ASD different from ADHD?
In young children, ADHD can be difficult to diagnosis if the child also has ASD. Many children with ASD also have an ADHD diagnosis simply because they also check the boxes of ADHD. Many children with ASD have sensory differences that manifest as hyperactivity and impulsivity. Many have hyper-focused interests that result in them being distracted by their inner-thoughts (which can be very entertaining!) so they appear forgetful to the outside world. In contrast, many children with only ADHD are more impacted by external distractions, like someone talking around them while they are trying to work. However, just to add to the confusion, many children with ASD have sensory sensitivities that allow them to have superb hearing. If you can hear something really far away, that is likely very distracting as well. Some teens with ASD have explained to me that they are distracted both by their inner-dialogue as well as distractions in their environment. Think about how this can impact learning, play, and socialization.
Teaching connection is crucial. If children can connect with us, they can notice our gestures, notice our reactions, and notice our language. And they will learn from what they see. When they connect, they can also belong. If they can belong, they will feel wanted and validated, which is the foundation of everything else.
**All content provided is protected under applicable copyright, patent, trademark, and other proprietary rights. All content is provided for informational and education purposes only. No content is intended to be a substitute for professional medical or psychological diagnosis, advice or treatment. Information provided does not create an agreement for service between Dr. Emily W. King and the recipient. Consult your physician regarding the applicability of any opinions or recommendations with respect to you or your child's symptoms or medical condition. Children or adults who show signs of dangerous behavior toward themselves and/or others, should be placed immediately under the care of a qualified professional.**