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Saturday, February 26, 2011

Feeling understood is as important as being understood

Individuals with autism who lack the skills to communicate with the larger world are often upset. Part of that upset comes from the inability to predict everyday events and to express basic wants and needs. But a deeper cause of the upset is often the feeling that others don't truly understand their thoughts and emotions and why they find a certain situation difficult or intolerable.

School recess was often a distressing time for Adam - too many kids, too much action, too many interactions. We frequently dealt wih post-recess upsets during his early school years, with Adam unable to calm down or say what was wrong. In grade 4, we had a break-through. A classmate of Adam's came in after recess and told the teacher that she had seen another boy harassing Adam at recess. I sat down with Adam, and drew a picture of the boy kicking him. Adam was crying and nodding his head and repeating "no kicking". I drew a red circle with a stroke through it over the picture, reassuring him that this was not allowed, and that the teacher would make sure that it didn't happen again. For the first time that school year, he was able to calm down and do his afternoon school work. What was key in this situation was the clear visual communication to Adam (through drawing) that we all knew what had been happening on the playground, and the follow-up message (transmitted through the red circle over the picture) that it was against the school rules and that the other boy was in the wrong. The relief that Adam felt over finding out this information was palpable.

And the post-script to this incident was also very interesting. Adam went home that night and drew the following two pictures, showing him taking his revenge on the boy (I love the cartoon lump on the boy's head and the motion marks indicating him spinning around - I also love the clearly expressed emotions on the cartoon faces):

In real life, Adam never touched the boy, never acted out what he drew - but the drawing of these pictures seemed to give him closure on the incident, and he was able to move past it. We are all familiar with this type of mental problem-solving (the "why I oughtta ...!") and it helps us to function in our daily lives without clonking all the people who annoy us on the head. This is a higher level function of communication than simply transmitting basic wants and needs. It reflects the use of imagination to work through something mentally so that it doesn't remain an insurmountable problem in the real world.

Later that same school year, Adam was once again showing regular post-recess distress. This time however, he was able to spontaneously draw out was was upsetting him:

The picture he drew shows several boys chasing Adam - the boys thought it was a fun game - Adam thought he was in mortal danger. The teacher's reaction in this situation was terrific. Once Adam drew the picture, she handled it in the same way that she would with any recess altercation with any other student. The boys who had been chasing Adam went to talk to the principal, and that discussion helped them to understand why he was upset. Then the boys drew apologies to Adam:

The drawn apology helped Adam to become calmer about the situation, because it confirmed for him that people understood his point of view, he had rights and the school rules would protect him. At the same time, the other students and teachers gained respect and understanding for the feelings and perspective of the real person behind the silent exterior.

Real communication is so much more than pointing to pictures of objects and activities, and being able to indicate "yes" and "no". The strength of drawing for communication is that it gives non-verbal ASD individuals a way to express more subtle and higher level thoughts and feelings. This type of communication builds confidence and a real sense of control and belonging in a world that is too often arbitrary and unpredictable from the ASD perspective.

Friday, February 11, 2011

Getting Perspective

When you live or work with a person on the autism spectrum, you need to develop good problem-solving skills. Upsets happen on a regular basis, and they can often be "show stoppers". Many times, we are asking the ASD individual to understand the perspective of the "rest of the world" and giving them the message (intended or not) that they have to "get used to it" and "that's just the way things are". But why should the social majority get to define the solution and say what's right?

Perspective is an important part of problem-solving - if we're going to find a workable solution, I want you to see my point of view and you need me to understand where you're coming from. It has been my experience that if you really want an effective and lasting solution to a challenging behaviour or upset, the place to start is to see the situation through the eyes of the person with autism. This can be a difficult proposition, especially if the person with ASD has weak (or non-existent) expressive communication skills. Keep in mind that even an individual who can usually express themselves verbally can find that their language skills desert them when emotions run high.

To get around the expressive language weakness, drawing is an excellent tool.  Following is an example from Adam's life where expressive drawing was useful in solving a real-life problem:

When Adam was in junior school, a program was put in place to teach greetings – he panicked in the hallways and was very distressed when other students greeted him. We wanted to find out why he was upset, so I drew the first picture (setting up the situation) and he drew the next 3 unprompted.

The girl says “Hi” – the locker door slams. The third picture is, I think, the most interesting – it took us a little bit to figure out the perspective – that’s Adam hiding inside the locker looking out at the scary “greeting girl” through the locker vents – note the clearly expressed emotion. At last, the girl gives up, and Adam is relieved and free to leave. We didn’t know why the greeting interaction was so scary for him, but we respected the fact that it was, and dropped the program. Interesting that several years later, in high school, he spontaneously started to greet people. He was ready, the situation made sense to him, and most importantly, his perception had developed to the point where he could reliably tell one person from another.

Real solutions happen when all of the individuals involved in a challenging situation feel that they have been heard and understood, and where the resolution shows respect for each person's point of view. People with autism have their own way of looking at the world, their own slant on events, their own ideas about what would make things better. Our job as parents, teachers and therapists is not to make ASD individuals do things just like everybody else, it's to help them find a way to be comfortable and cope with a world where the social rules were not made by them or for them - when both sides give a little, it tends to work out better in the end.