Understanding Autistic Behaviors: Improving Health, Independence, and Well-Being

Understanding Autistic Behaviors: Improving Health, Independence, and Well-Being

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Overview

Individuals with Autism Spectrum Disorder usually receive a diagnosis when certain behaviors negatively impact their health, independence, and quality of life. These behaviors are evident across the lifespan. A correct diagnosis of ASD is an essential first step in navigating this journey, but the next question is "What now?"


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Product Details

ISBN-13: 9781946824141
Publisher: INDIEGO PUBLISHING LLC
Publication date: 03/23/2018
Pages: 122
Sales rank: 1,210,805
Product dimensions: 6.00(w) x 9.00(h) x 0.29(d)

About the Author

Dr. Regan is that rare combination of adult neuropsychologist (specialist in brain-behavior relationships), parent of a child on the spectrum, and Certified Autism Specialist. She has worked with adolescent through geriatric patients in medical settings for over 25 years. She is a Certified Autism Specialist through the International Board of Credentialing and Continuing Education Standards (IBCCES) and the director of the Adult Diagnostic Autism Clinic at OSF Saint Francis Medical Center in Peoria, Illinois.

Janet Angelo has been a freelance book editor since 2005. She is the founder and publisher of IndieGo Publishing, a company she formed in 2011 to help independent authors achieve their publishing goals and dreams. She has several repeat clients and enjoys working in collaboration with her authors to publish top-quality books.

Read an Excerpt

CHAPTER 1

Understanding the Brain-Behavior Link

Historically, the realization that some individuals are unable to learn certain life and work skills even with extra instruction and training emerged in the 1800s. Although for many years this diagnosis was referred to as mental retardation, clinicians now use the term intellectual disability (ID). Indeed, the needs of individuals with ID have become well- integrated into formal policies and community programs. In comparison, however, there remains a significant lack of understanding that, in addition to neurologic conditions of intellect, there are also neurologic conditions of behavior. One such condition is developmental and is called autism spectrum disorder (ASD).

In a related string of thought, the late 1800s and early 1900s saw breakthroughs in the understanding of biology and genetics. For example, it became scientifically apparent that parents pass on certain characteristics to their offspring. This understanding became the basis for movements such as social Darwinism and eugenics, which had an impact on immigration and other policies during that period.

Understandably, in response to the destructive thoughts and policies that were instrumental in WWII, public opinion changed from emphasizing genetics ("nature") to emphasizing environment ("nurture") as being of primary importance in personal outcomes. Today, remnants of the strong emphasis on the impact of environment, motivation, and personal character as being of primary or sole impact on personal outcomes echo through topics of parenting and education, and in various community policies. This emphasis brings with it the suggestion that anything is possible if you work hard enough — a worldview that is not actually true — and carries additional baggage that hinders our complete understanding of biological influences on behavior.

Consider the following scenarios:

• The mother of a ten-month-old boy is told that his crying "disrupts the class" at infant daycare. She is asked to "fix him" before bringing him back to the program. Is she a bad mother?

• A twenty-seven-year-old young man who graduated high school without becoming a functional reader is driving a school bus to make ends meet because that's the only job he can find. He feels guilt and shame for his inability to master reading and to understand basic academic concepts. Did he not work hard enough while he was in school?

• A fourteen-year-old girl explodes when she is jostled in the bus line moments after learning that her usual bus monitor is out sick and has been replaced by a new person. The school tells her parents that this explosion is "one too many," and her "erratic behavior and noncompliance with rules and authority" gives them no choice but to suggest a residential behavior program to "teach her the consequences of her bad behavior." The school administrators also recommend that the girl's mother and stepfather take parenting classes. Is the girl "noncompliant" at school? Are her parents lax about teaching behavioral boundaries at home?

The most difficult aspect of understanding challenging behavior is that the nature versus nurture question has no clear categorical answer. Neither genetics and biology nor environment and motivation are solely responsible for behavioral outcomes. It is sometimes baffling to consider the complexity of how one's inherent nature and one's environment impact expressions of emotion, thought, and behavioral regulation. In truth, we all have a biological substrate, an area of boundary from which we cannot deviate. It is from within our biological starting point that we can impact and influence our environment and behavior, but we cannot achieve behaviors that are beyond the capacity of how our brain is "wired" uniquely and individually for each of us.

Consider these examples of biological starting points:

• Because of the parameters of my genes, I will grow within a certain range of height. Certain environmental factors can influence my final height including deficiencies in childhood nutrition and variations in growth hormones. However, it is not true that I can become ten feet tall just because I have good character and strong motivation.

• We each have influence over many aspects of our health, but we cannot entirely prevent every disease or physical problem in our bodies. Many times, we do everything we can and still have physical problems such as arthritis, organ failure, and cancers. We start with a physical body, we do what we can to live a healthy life, but in the end, we cannot live entirely outside the limitations of our genetics.

• A two-year-old is able to learn many things in normal development. She is taking in huge amounts of new information every day. However, if I ask her to sit down at a desk and learn nuclear physics, I have taken her beyond what her brain is capable of doing. Her failure to learn the material is not a result of noncompliance, poor motivation, or lack of effort. She does not lack character because she won't sit still "and at least try." She is working within her biology and is learning what she can accomplish at that age of development.

Getting back to the context of this book — autistic behaviors across the lifespan — while it is not true that the ASD individual has behaviors that are predetermined and unchangeable, it is also not true that he can show complete, flexible, and consistent control over his behaviors at all times. Nor is it true that explaining why he should behave differently — relying on reasoning, facts, and encouragement — will produce the lasting change we hope to see even when he puts forth his best effort.

Think again about the example of height. You could repeatedly explain to me that if I were taller I could reach the top shelf in the kitchen cabinets, but this doesn't mean that I can become taller by good intentions and effort. Rather than cycling through repeated discussions about why change is important, the ASD individual will require strategies and specific supports that fit her own individual strengths and challenges.

We all live within the constraints of certain limitations and areas of influence. To the extent to which our goal is to positively influence behaviors and emotional regulation, we must understand what the limits and influences are for an ASD individual in his or her particular season of life. Never start working toward behavioral change outside the boundary of what the individual is capable of doing at that time. Limits and abilities are unique to the individual and should be understood as clearly as possible before undergoing an effort toward behavioral change.

In the same way that I will not ask a two-year-old to be a nuclear physicist, I will not ask you to accomplish behavioral goals you are not capable of reaching at this time. To do so would be to set the stage for failure, frustration, anxiety, and shame. You would essentially experience failure and sometimes punishment as well (e.g., "If you aren't a nuclear physicist by the end of the year, the consequence will be ...").

Instead, I will be a detective to figure out what your strengths and challenges are. I will help you make positive changes by asking you to do something within your range of abilities and with appropriate support. I will use strategies to make the expected behavioral outcomes attainable and practical. The interventions will be strategy-based with the specific ASD individual in mind.

Let's set the stage with a list of terms we will return to again and again in this book:

Detective

I invite you to consider yourself a detective rather than a police officer as you discover workable methods to bring about positive behavioral change with the ASD individual in your life. Understand that all behavior is communication. When you see a certain behavior in someone, consider that it reveals the internal state and capacities of the individual at that time. Gather information about what behaviors you see, when they occur, and in what environments. You are not here to police others' behavior. Instead, you are a detective on a fact-finding mission. Welcome to your new role. Fact-finding is the first step toward strategic behavioral interventions.

Strategies

Next, I invite you to always think strategically in response to behavior. Again, you are not a police officer. You have gathered information as a detective. You understand that the behavior reflects the individual's internal state. Can you put the pieces together to make strategies for intervention? Approach the goal of behavior change with a strategic mindset rather than a mindset of complaint, impatience, policing, or shaming. You are a detective who interacts strategically with the individual to produce positive change and to improve both internal comfort and external behaviors.

Self-Regulation

You will see the word "regulation" quite a bit in this book. To regulate is to manage the strength, speed, or flow of something. A regulator may increase or decrease a particular quality of something, such as to regulate the temperature of a room, the flow of a river, or the rate of metabolism. Something that is regulated is kept at an even keel, kept in check, kept at a level that is healthy and comfortable.

When we talk about behavioral symptoms, we are pointing out areas in which the individual lacks appropriate behavioral or emotional regulation. Typically, our brains should be effective at understanding the state of the body, regulating emotional and physical experiences accordingly, and expressing behaviors that are calm, effective, safe, and healthy. Someone who struggles with self-regulation is said to be emotionally or behaviorally dysregulated.

Over-Reactive

If there is one state that an autistic may lean toward, it is the state of feeling overwhelmed by her external and/or internal environment. Many individuals in the spectrum describe the world as feeling too intense. Synonyms for "overwhelmed" include swamped, buried, deluged, flooded, or inundated. The word can be used to suggest that someone is defeated by an opponent, routed, conquered, or overcome. Someone may feel overwhelmed when they are given too much, as in being inundated with input. The brain of the ASD individual does not process information and stimuli efficiently enough to prevent a feeling of inundation from incoming messages. Individuals with ASD may be overwhelmed by memories, details, emotions, and sensations. The intensity of the world can lead to an overwhelmed state that manifests in dysregulated behavior. The individual may behave in an over-reactive manner to qualities of the environment that neurotypical people consider common or normative (e.g., criticism from others, loud noises).

Dysregulated Behavior

Many people mistakenly think that dysregulated behavior only manifests as an outburst or meltdown, but this is not the case. There are three variations in behavioral responses in which dysregulation can be present:

• Fight. Fight responses signal the presence of an overwhelmed state. This is perhaps the most recognizable category to observers. The autistic individual who is overwhelmed by change may react in a fight pattern; as an example, he shouts and has an explosive episode when his physician's office calls unexpectedly to cancel a scheduled appointment. An ASD individual who feels trapped on a school bus because of too much noise, the close presence of other raucous students, and the ups and downs of hills on the road may seem to "snap" by shouting and pushing people away. These fight responses are often defensive in nature, an effort to "push away" the offending stimuli, to make the world stop its invading inputs.

• Flight. Perhaps a less frequently noticed response to environmental intensity is a flight response. A person may figuratively "fly away" from an overwhelming work situation — being corrected by a supervisor, feeling pressured to meet a deadline, told to participate in a meeting — by walking out and going home rather than staying at work to finish his shift.

Another ASD individual may show flight when she puts the bed covers over her head while her husband is talking to her about a difficult topic. These are considered flight responses because they exemplify the urge to escape a situation that feels overwhelming.

• Freeze. The autistic may also "freeze" all behaviors as a coping mechanism and even appear catatonic, such as sitting and staring for an hour without responding to the questions of family members. Another may talk to himself and rock forward and backward when he learns that his dog has passed away, for example. This freezing behavior has a "stuck" quality because the person lacks appropriate interaction with the environment, and sometimes seems immersed in his own internal world.

Although each of these types of behaviors may be seen in one individual, it may also be that the individual leans toward one or two categories of dysregulation more than to others. One individual may be prone to outbursts while another exhibits escaping and freezing behaviors.

Although these reactive behaviors can be seen in all individuals, whether in the spectrum or not, this tendency toward dysregulation is much more noticeable in the autistic individual than in his or her neurotypical peers.

Under-Reactive

In contrast to the over-reactive individual who experiences the world as intense and therefore seeks ways to stop the intensity by fight, flight, or freeze reactions, there are under-reactive ASD individuals whose lack of awareness or reaction to the environment produces a different set of behaviors. Being under-reactive is common in autism and may be seen in the individual who appears disinterested, passive, or disengaged from what is happening around her. In this case, she is not overwhelmed because of heightened awareness. Instead, she is under-aware of what is going on in her environment. She is apt to miss information from the environment and to experience the world as under-whelming, too subtle, and not compelling in any significant way. She may seem "spaced out" or in her own world.

In contrast to the individual who freezes in an intense environment, the under-reactive individual misses important information, such as being unaware of pain during a medical emergency and thus not calling his doctor, or when he misses other sensory cues that should prompt him to bathe, brush his teeth, eat on a regular basis, drink water, and wear clean clothes. The under-reactive individual misses social cues and lacks a response to the environment that typically would compel an individual to meet goals and fully engage in life.

It should be noted that a combination of over-reactivity and under-reactivity can be seen in the same ASD individual. Sometimes this is sensory specific — the individual may overreact to touch and under-react to sound. There may also be variability across times of day and days or weeks. Many autistics describe that they have varying experiences over the course of time, and may share comments such as, "I know what kind of day I'm having when I try to brush my teeth but I can't because it hurts or annoys me, or it makes me gag." They may describe having had a rough couple of months before feeling better regulated for reasons that are hard to pin down.

For those who observe the ASD individual's behavior and find this dynamic of over- and under-reactivity confusing, especially when considered in tandem with the variety of symptoms that manifest over time (sometimes seemingly disparate symptoms), let's consider some comparisons.

Pregnancy may be one such example. When I was pregnant, my sense of smell was greatly heightened and led to quite a bit of nausea and avoidance of certain environments. It was amazing to me that a simple hormonal change meant that my brain had this heightened reaction to even "nice" smells such as flowers, foods that I typically enjoy, and soap. These were now strongly aversive to me. By the middle of my second trimester, my hormones changed again, and my smell aversions were gone. I experienced a season of over-reactivity and then a change back to my baseline state because of a hormone change. This experience helped me understand that biology itself can lead to variations in how one experiences and reacts to the world.

Another comparison may be the experiences of those who become intoxicated from alcohol and then are hung over after a night of drinking. We know that the state of intoxication occurs because alcohol impacts brain function. The individual who is intoxicated shows imbalance while walking, says and does things she ordinarily wouldn't say or do, makes unsafe decisions, slurs her speech, and has amnesia for portions of events. The next morning, she complains that lights are too bright and sounds are too loud, and the slightest movement makes her feel like she's spinning. These changes in sensation and behavior are related to the physiological impact that alcohol has on brain function. The experience of being hung over from alcohol is yet another common example of how changes in biology can change the way an individual experiences and reacts to his or her environment.

(Continues…)



Excerpted from "Understanding Autistic Behaviors"
by .
Copyright © 2018 Theresa Regan.
Excerpted by permission of Indiego Publishing LLC.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Table of Contents

Understanding Autistic Behaviors

Table of Contents

Introduction: Setting the Stage . . . 9

Chapter 1 – Understanding the Brain-Behavior Link . . .15

Detective

Strategies

Self-Regulation

Over-Reactive

Dysregulated Behavior

Under-Reactive

Practice the Concepts Learned

Chapter 2 – The Physics of Behavior . . . 35

The Pull Toward a Behavioral Default

Inertia: Difficulty Switching Behavioral Gears

Behavioral Pushback or Resistance to Change

Momentum: The Tendency Toward Behavioral Repetition

Acceleration: Gaining Behavioral Intensity

Magnetism: Forces of Behavioral Attraction

Practice the Concepts Learned

Chapter 3 – Begin at the Beginning . . . 53

Step 1: Assess the ASD Individual’s Strengths and Challenges

Step 2: Filling and Draining Activities

Step 3: Big-Picture Assessment

Step 4: Create Appropriate Behavioral Goals

Identify What a Good Outcome Will Look Like

Balance Filling and Draining Activities and Stimuli

Practice the Concepts Learned

Chapter 4 – The Consequences of Consequences . . . 69

The Physics of Kari’s Behavior

Inconsistent Behaviors

Avoidant Behaviors

Emotional Manipulation

The Problem with Punishment

Logical Consequences

Practice the Concepts Learned

Chapter 5 – Self-Monitoring and Planning . . . 93

Tools for Monitoring Internal States

Noticing Trends

Practice the Concepts Learned

Chapter 6 – Adding Definition and Decreasing Intensity in Daily Life . . . 101

Offer Specifics when Communicating

Offer Specific Choices

Offer Additional Time and Space

Utilize Rehearsal and Social Stories

Keep a Record of Unexpected Occurrences

Make a Schedule

Create Rules and Guidelines

How Big Is this Problem?

Practice the Concepts Learned

Chapter 7 – Creating Momentum . . . 127

Sensory Inputs

Structure, Contingencies, and Rewards

Practice the Concepts Learned

Final Thoughts: Successful Outcomes . . . 141

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