HELP FOR PARENTS OF CHILDREN WITH ASPERGER'S & HIGH-FUNCTIONING AUTISM

Education and Counseling for Individuals Affected by Autism Spectrum Disorders

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How to Deal with Obsessions and Rituals

Question

Dear Mr. Hutton,

I appreciate all the newsletters, and have come to think that you might be able to offer advice. My son (KW- I will use his initials) is 14, and although my husband prefers to call him "normal", for me, it’s a little more reasonable to say that he has AS (as was diagnosed). I'm around him more. I see the tendency to rock, and the need to hold something in his hand, etc. There are a couple of symptoms that he does not have like having "meltdowns" in public or extreme reaction to loud noise. But he does have enough symptoms that generally I think he may have it. Whether he does or not, the advice for AS is right on the nose for him.

This is my dilemma - KW saw spit coming out of my mouth when I was speaking forcefully about his homework, and from that time has developed a sort of theory that whenever I talk I spit. From there, he started spitting in order to get rid of the germs that he thought went into his mouth. (I really apologize if this is a bit too gross). So now he softly allows saliva to fall onto his clothes or book or whatever.

I of course told him that spitting in that fashion was not ok and have gone to great lengths to tell him only babies spit, or "you did not do that when you were 12, why do you do it now?" I tried many different things, including explaining that his practice does not aid in getting rid of germs. But it is such a habit at this point. Also, along the same line of reasoning, he covers his food with his hand whenever I come near to avoid getting my germs on it. This really breaks my heart. But that’s what "he's into" at the moment.

He also was becoming obsessed with some sort of problem with his face. He's a genuinely good looking boy. However, there is something that he finds unacceptable. He was getting very upset and started looking at himself in the mirror and yelling something like "NO, no, no." Anyway, I tried to tell him that he was handsome but he would not accept that. He was really very upset and even cried. Then I told him something about hormones at his age causing the trouble. Anyway, he came up with another "theory" of sorts that his life is devastated because he is forced to accept something about himself that he cannot accept.

Up until he found out there was not going to be a spiderman 4, he was into blogging about Spiderman on the internet. But when he found out it was over, he lost his area of interest. Now he has no hobby and I think that these issues have become his hobby.

I wish I had been more wise a few years ago and that I could still hug him, but that is not the case. He will initiate conversation with me when he has something to say, but so often the conversation I initiate is centered around the daily task of getting homework done, or picking up or something. I am practically like his enemy. But the problem is that if he does not talk to me, then he spends his whole time at home just daydreaming, which is getting worse in terms of the amount of time and he is really tuning out.

I am thinking that maybe he needs counseling. When I went to a counselor a couple years ago he told me that if my son has AS, (no diagnosis back then) then the only counseling he could do is to help the parents. But at school there is a really great special ed teacher who works with KW on various social situations and is making some progress. I thought maybe someone could help him come to terms with these issues. My husband is not able to face it right now. And I have blown my relationship with KW by pushing him to get through the daily tasks.

This is my third attempt to write this letter. No matter how I write it, it seems like something that is not reasonable to send. Yet I keep trying. So I am going to send it as-is this time and not rewrite it again.

Thank you for your time.

J.

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Answer

I see two issues here: (1) obsessions/rituals and (2) low self-esteem.

Rituals and obsessions are one of the hallmarks of Aspergers (high-functioning autism). In order to cope with the anxieties and stresses about the chaotic world around them, kids often obsess and ritualize their behaviors to comfort themselves. While some kids may spend their time intensely studying one area, others may be compulsive about cleaning, lining up items or even doing things which put them or others in danger.

Here are some suggestions to help:

1. Be prepared for resistance by arming yourself with suggestions and alternatives to your youngster's behavior. A great way of doing this is by creating a "social story". Carol Gray's Social Stories site is a great resource for parents and educators alike to create books which will modify behavior in kids with autistic spectrum disorders.

2. Choose your battles wisely. Breaking an obsession or ritual is like running a war campaign. If not planned wisely or if you attempt to fight on many fronts, you're guaranteed to fail. Not only is it time consuming and tiring, it means you can't devote 100% to each particular area. So, if you have a youngster with a game obsession, a phobia of baths and bedtime troubles, choose only one to deal with. Personally, and I have had that choice, I dealt with the bedtime troubles. Using logic, a sleep deprived youngster certainly isn't going to deal with behavioral modification in other areas well. Plus, it was having an effect on his overall health. Deal with the worst first!

3. Communicate with your youngster to explain the effect that his or her ritual is having on your family as a whole. My child's 2am wakeup calls were affecting me mentally, emotionally and physically, and I told him so. I pulled some research off the internet about sleep needs and discussed this with him.

4. Speak to professionals for advice. Contact your pediatrician for recommendations for behavior therapists. Your local parent support groups and national associations, such as the National Autistic Society, will not only provide you support but the information you need to move forward with your youngster.

5. When breaking an obsession or ritual, examine the ways that you may have fed into this. With my child's bedtime activities, I found I was too tired to fight his waking up at 2am. While dealing with this ritual, I ensured I was in bed early myself so I had enough sleep in me to knock his night owl tendencies on the head.

6. When tackling any problem with any youngster, Aspergers or not, it's always best to remain calm at all times. Kids can feed off your anger, frustration and anxiety, so keeping a level head at all times is essential. If you feel a situation is escalating and elevating your blood pressure, take a step back and collect yourself.

Some Practical Tips to Build Healthy Self-Esteem—

1. Always comment on any procedure that is done well, but aim not to comment when it is poorly done!

2. Ask permission to comment on their progress from your perspective.

3. Ask permission to work with them on any improvements they think might be necessary.

4. Avoid using words that denote something is ‘bad’, ‘rubbish’, ‘a mess’, ‘awful’, ‘could be better’, ‘poor’, or ‘incompetent’. Individuals with AS can be quick to pick up on all that they are not, rather than on what they are or could be!

5. Discuss with your child/spouse how they view their own achievements and/or progress.

6. Focus in on the successes, not the failures, mistakes or ‘could be improved’.

7. If they think they are ‘the best’, ask them to explore their reasoning with you.

8. If they think they are ‘the worst’, ask them to explore their reasoning with you. Be careful not to use ‘why’ questions and always frame or structure your question so that they have a framework to respond in. Avoid open-ended questions -- we don’t know how to answer them!

9. Never assume that your comments for their improvement will be welcome, either ask to be invited to comment or share your own experience with them, if allowed to, being careful NOT to compare yours to theirs. Just state the facts.

10. Offer lots and lots of positive reinforcement. I don’t mean bribes, but well-timed approval is terrific. Not only does it let us know that we are OK, but it's’ useful in teaching us what the most appropriate response might be. An example taken from personal experience is: "He always monopolizes the dinner table conversation, so one day I waited for a pause as he was eating, and I said, ‘you know Kyle, you talk much less at the table than you used to, and sometimes you listen to what others say and follow the dinner conversation’."

Good luck,

Mark

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