Obsessions in Children with Aspergers and High-Functioning Autism

"Why is my 6-year-old Aspergers son so engrossed in Pokemon, and how can I tell if it is an unhealthy obsession rather than just a fun time activity for him?"

The intensity and duration of the child’s interest in a particular topic, object or collection is what determines whether or not it has become an “obsession.” Children with Aspergers and High-Functioning Autism will often learn a lot about a thing they are obsessed with, be intensely interested in it for a long time, and feel strongly about it. There are several reasons why these kids may develop obsessions, including:

• they can get a lot of enjoyment from learning about a particular subject or gathering together items of interest
• those who find social interaction difficult might use their special interests as a way to start conversations and feel more self-assured in social situations
• obsessions may help children cope with the uncertainties of daily life
• obsessions may help children to relax and feel happy
• obsessions may provide order and predictability
• obsessions may provide structure

 

Many children with Aspergers have sensory sensitivity and may be over- or under-sensitive to sights, sounds, smells, taste and touch. This sensitivity can also affect children’s balance ('vestibular' system) and body awareness ('proprioception' or knowing where our bodies are and how they are moving). Obsessions and repetitive behavior can be a way to deal with sensory sensitivity.

Although repetitive behavior varies from child to child, the reasons behind it may be the same:

•  a source of enjoyment and occupation
• a way to deal with stress and anxiety and to block out uncertainty
• an attempt to gain sensory input (e.g., rocking may be a way to stimulate the balance or vestibular system; hand-flapping may provide visual stimulation)
• an attempt to reduce sensory input (e.g., focusing on one particular sound may reduce the impact of a loud, distressing environment; this may particularly be seen in social situations)
• some adolescents may revert to old repetitive behaviors (e.g., hand-flapping, rocking if anxious or stressed)

Reality to an Aspergers child is a confusing, interacting mass of events, people, places, sounds and sights. Set routines, times, particular routes and rituals all help to get order into an unbearably chaotic life. Trying to keep everything the same reduces some of the terrible fear.

Many children with Aspergers have a strong preference for routines and sameness. Routines often serve an important function. For example, they introduce order, structure and predictability and help to manage anxiety. Because of this, it can be very distressing if an Aspergers child’s routine is disrupted.

Sometimes minor changes (e.g., moving between two activities) can be distressing. For others, big events (e.g., holidays, birthdays, Christmas, etc.), which create change and upheaval, can cause anxiety. Unexpected changes are often most difficult to deal with. 

Some children with Aspergers have daily timetables so that they know what is going to happen, when. However, the need for routine and sameness can extend beyond this. You might see:

•  a need for routine around daily activities such as meals or bedtime
• changes to the physical environment (e.g., the layout of furniture in a room), or the presence of new people or absence of familiar ones, being difficult to manage
• compulsive behavior (e.g., the child might be constantly washing his hands or checking locks)
• rigid preferences about things like food (e.g., only eating food of a certain color), clothing (e.g., only wearing clothes made from specific fabrics), or everyday objects (e.g., only using particular types of soap or brands of toilet paper)
• routines can become almost ritualistic in nature, having to be followed precisely with attention paid to the tiniest details
• verbal rituals, with a child repeatedly asking the same questions and needing a specific answer

Children's dependence on routines can increase during times of change, stress or illness and may even become more dominant or elaborate at these times. Dependence on routines may increase or re-emerge during adolescence. Routines can have a profound effect on the lives of children with Aspergers, their family and care-takers, but it is possible to make a child less reliant on them.

Obsessions versus Hobbies—

Most of us have hobbies, interests and a preference for routine. Here are five questions that can help us distinguish between hobbies/interests versus obsessive behavior:

1. Can the child stop the behavior independently?
2. Does the child appear distressed when engaging in the behavior or does the child give signs that he is trying to resist the behavior (e.g., someone who flaps their hands may try to sit on their hands to prevent the behavior)?
3. Is the behavior causing significant disruption to others (e.g., moms and dads, care-takers, peers, siblings)?
4. Is the behavior impacting on the child’s learning?
5. Is the behavior limiting the child’s social opportunities?

If your answer to any of the questions above is 'yes', it may be appropriate to look at ways of helping your youngster to reduce obsessive or repetitive behavior. Think about whether, by setting limits around a particular behavior, you are really helping your youngster. Is the behavior actually a real issue for him, for you, or for other people in his life?

Focus on developing skills that your youngster can use instead of repetitive or obsessive behavior. Try to understand the function of the behavior, then make small, gradual changes and be consistent. Here are some ideas to help you:

1.     Coping with change: If unexpected changes occur, and your youngster is finding it hard to cope, try re-directing them to a calming activity, or encourage them to use simple relaxation techniques such as breathing exercises. You could use praise or other rewards for coping with change. In the long term, this may help make your youngster more tolerant of change.

2.     Explore alternative activities: One way to interrupt repetitive behavior is for a youngster to do another enjoyable activity that has the same function (e.g., a youngster who flicks their fingers for visual stimulation could play with a kaleidoscope or a bubble gun;  a youngster who puts inedible objects in their mouth could have a bag with edible alternatives that provide similar sensory experiences such as raw pasta or spaghetti, or seeds and nuts; a youngster who rocks to get sensory input could go on a swing; a youngster who smears their poop could have a bag with play dough in it to use instead).

3.     Intervene early: Repetitive behaviors, obsessions and routines are generally harder to change the longer they continue.  A behavior that is perhaps acceptable in a young Aspie may not be appropriate as they get older and may, by this time, be very difficult to change. For example, a youngster who is obsessed with shoes and tries to touch people's feet might not present too much of a problem, but a teenager doing the same thing - especially to strangers - will obviously be problematic. It will help if you can set limits around repetitive behaviors from an early age and look out for any new behavior that emerges as your youngster gets older. Making your youngster's environment and surroundings more structured can help them to feel more in control and may reduce anxiety. If anxiety is reduced, the need to engage in repetitive behavior and adhere strictly to routines may also, in time, be reduced.

4.     Pre-planning: You may be able to help your youngster to cope with change, or activities and events that could be stressful, by planning for them in advance.  Change is unavoidable, but it can be really difficult for many children with Aspergers. You may not always be able to prepare for change a long time in advance, but try to give your youngster as much warning as possible. Gradually introducing the idea of a new person, place, object or circumstance can help them cope with the change. Try to talk about the event or activity when everyone is fairly relaxed and happy.  Presenting information visually can be a good idea, as your youngster can refer to it as often as they need to. You could try using calendars so that your youngster knows how many days it is before an event (e.g., Christmas) happens. This can help them feel prepared. Your youngster might also like to see photos of places or objects in advance so they know what to expect (e.g., a picture of their Christmas present) or a photo of the building they are going to for an appointment. Using social stories could also be helpful. These are short stories, often with pictures, that describe different situations and activities so that children with Aspergers know what to expect.  Pre-planning can also involve structuring the environment. For example, a student with Aspergers might go to use a computer in the library at lunchtime if they find being in the playground too stressful – or if a youngster has sensory sensitivity, minimizing the impact of things like noises (e.g., school bells) or smells (e.g., perfumes or soaps) can help them to cope better.  It is possible that more structured environments may reduce boredom, which is sometimes a reason for repetitive behavior. You might prepare a range of enjoyable or calming activities to re-direct your youngster to if they seem bored or stressed.

5.     Self-regulation skills: Self-regulation skills are any activities that help your youngster to manage their own behavior and emotions.  If you can help your youngster to identify when they are feeling stressed or anxious and use an alternative response (e.g., relaxation techniques or asking for help), you may, in time, see less repetitive or ritualistic behavior.  Research has also shown that increasing a child’s insight into an obsession or repetitive behavior can significantly reduce it. This includes children with quite severe learning disabilities.

6.     Set limits: Setting limits around repetitive behavior, routines and obsessions is an important and often essential way to minimize their impact on your youngster's life. You could set limits in a number of ways depending which behavior concerns you. For example, you can ration objects (e.g., can only carry five pebbles in pocket), ration places (e.g., spinning only allowed at home), and ration times (e.g., can watch his favorite DVD for 20 minutes twice a day). Everyone involved with your youngster should take the same consistent approach to setting limits. Have clear rules about where, when, with whom and for how long a behavior is allowed. You could present this information visually, with a focus on when your youngster can engage in the behavior. This may help if they feel anxious about restricted access to an obsession or activity.

7.     Social skills training: Teaching social skills (e.g.,  how to start and end a conversation, appropriate things to talk about, how to read other people's 'cues') may mean someone with Aspergers feels more confident and doesn't need to rely on talking about particular subjects (e.g., a special interest). 

8.     Understand the function of the behavior: Obsessions, repetitive behavior and routines are frequently important and meaningful to children with Aspergers, helping them to manage anxiety and have some measure of control over a confusing and chaotic world. For others, the behavior may help with sensory issues. Take a careful look at what you think might be causing the behavior and what purpose it might serve.  For example, does your youngster always seem to find a particular environment (e.g., a classroom) hard to cope with? Is it too bright? Could you turn off strip lighting and rely on natural daylight instead?

9.     Visual supports: Visual supports (e.g., photos, symbols, written lists or physical objects) can really help children with Aspergers.  A visual timetable could help your youngster to see what is going to happen next. This makes things more predictable and helps them to feel prepared. It may lessen their reliance on strict routines of their own making. Visual supports like egg timers or 'time timers' can help some children with Aspergers to understand abstract concepts like time, plan what they need to do, when in order to complete a task, and understand the concept of waiting.  Visual supports can also be useful if your youngster asks the same question repeatedly. One parent wrote down the answer to a question, put it on the fridge and, whenever her son asked the question, told him to go to the fridge and find the answer. For kids who can't read, you could use pictures instead of words.

10.   Make use of obsessions: Obsessions can be used to increase your youngster's skills and areas of interest, promote self-esteem, and encourage socializing. You may find you can look at a particular obsession and think of ways to develop it into something more functional. Here are some examples:

• A child with a special interest in historical dates could join a history group and meet others with similar interests.
• A child with knowledge of sport or music would be a valuable member of a pub quiz team.
• A strong preference for ordering or lining up objects could be developed into housework skills.
• An interest in particular sounds could be channeled into learning a musical instrument.
• An obsession with rubbish could be used to develop an interest in recycling, and the youngster given the job of sorting items for recycling.

The Aspergers Comprehensive Handbook