JOURNAL OF THE NATIONAL ACADEMY FOR CHILD DEVELOPMENT
1986 Volume 6, No. 11
The Autistic Child
Robert J. Doman, Jr.
Children labeled as "autistic"
have been enigmas since they were first identified. Fortunately,
some questions surrounding these children are being answered.
Many "autistic" children (children with sensory
dysfunction) are now being helped, and some are achieving
"normal" function. As a result of NACD's work with
"autistic" children, we have also gained a better
understanding of sensory function. This understanding has
had implications and applications to our work with all children.
Historically, the parents of "autistic" children
have suffered more (if such suffering can in fact be measured)
than the parents of any other group of children. The classic
"autistic" child was viewed as a child with a severe
emotional problem, or as a child with childhood schizophrenia.
Often, this emotional or psychiatric condition was attributed
to maternal rejection. In addition to society's punishment
of the parent (particularly of the mother for supposedly rejecting
her child), was the child's behavior, which often appeared
to others as rejection of people in general, and to the mother
as a rejection of her in particular. Add to this the child's
often rather bizarre, and in some cases, destructive behavior,
and you have a description of a very untenable situation.
Such is one's introduction to the world of the "autistic"
child. Fortunately, as with many of the mystiques built up
around unanswered questions, the view of the "autistic"
child as an emotionally disturbed child is based upon supposition,
not fact. Suppositions that we strongly question.
The Isolated "Autistic" Child
Generally, descriptions of "autistic"
children are rather similar. They are essentially descriptions
of symptoms, leaving the questions of cause and cure open.When
Fenichel (1960) described children with "childhood schizophrenia"
he described the "autistic" child as follows: "They
have little or no speech, they rarely display any effective
awareness of people, and they maintain a level of activity
that has the barest relation to objects or events in the real
world." Fenichel then subdivides "autistic"
children into two groups: "those who have been retarded
in maturation from birth, and those children with a history
of regression."Kanner, in 1958, established criteria
for infantile autism as the following: "An extreme self-isolation,
or an inability to relate themselves in the ordinary way to
people or situations from early in life," and "an
obsessive insistence of the maintenance of sameness."
Children who have been diagnosed as
"autistic" function within a very broad range. On
the mild end of the spectrum are children who in many ways
look and even act rather "normal," but who may have
some perseverative or repetitious behaviors such as rocking,
humming, or repeating verbatim what is said to them (echolalia).
At the other extreme are children whose behavior appears to
fit many people's perception of a severely emotionally disturbed
individual. Such children are characterized by behavior that
can be very hyper (active) or hypo (inactive); they can be
destructive, self-destructive, and at times aggressive. All
such children can generally be described as exhibiting some
degree of self-isolation.
A Problem of Perception
The "autistic" child can
be perceived as an emotionally disturbed child without a great
deal of difficulty. They are often in their own little world,
and they essentially do reject others to varying degrees.
They may strike out at others, at their environment, and even
at themselves as though consumed by some inner emotional force.
But if we view these behaviors through other eyes, they can
begin to make even greater sense.Why do many "autistic"
children have perfectly "normal" siblings? Why do
many "autistic" children have warm, loving mothers?
Why do some children begin life "normally" and regress
into an "autistic" condition a year, or two, or
three after birth? These questions cannot be easily answered
with the "emotional" model; however, they can be
answered with the "neurological/sensory" model.
Autism: Sensory Dysfunction
Years ago, work with brain-injured
children began with the "cerebral palsied" child
and the traumatically brain-injured child (mechanical injury,
i.e., auto accidents, etc.), and widened with ever expanding
concentric circles as implications derived from the obviously
brain-injured had application to other children. Such implications
expanded to include the "autistic" child.Many obviously
brain-injured children exhibit some behaviors that are often
used to characterize the "autistic" child. Severely
brain-injured children, as their sensory awareness develops,
engage in hand waving, fascination with light, rocking, repetitious
noise making, "spacing out," self-stimulation, and
in some cases, self-destructive behaviors. Are these children
"a little autistic," and as they progress and improve
their sensory function and these behaviors are eliminated,
do they get over being a "little autistic?"NACD's
perception of the "autistic" child follows the neurological/sensory
model. A child who has been labeled as "autistic"
is viewed not as an emotionally disturbed child, or as a child
with a psychiatric problem, but as a child with sensory dysfunction
whose abnormal behavior is a reflection of abnormal perception.
Typically, a child given an emotional/psychiatric label is
not examined or evaluated beyond the parameters of the problem
as it is perceived. However, NACD has had the opportunity
to examine the results of full neurological workups of "autistic"
children. The results of such workups indicate that "autistic"
children are brain-injured. Examining the "autistic"
child as a brain-injured child clarifies many aspects of their
development and function. Referring back to Fenichel, he subdivided
"autistic" children into those who were retarded
in maturation from birth and those with a history of regression.
When viewed as brain-injured, those children with delayed
development match the expected pattern of a child with injury
that affected various levels of the brain, while the child
who has regressed fits the pattern of a child with an injury
to only higher levels of the brain; levels that the child
might not attempt to utilize until months or years following
birth. This picture is not dissimilar to that of the cerebral
palsied child who develops normally for the first few months
before exhibiting the cerebral palsy symptoms resulting from
injury to the mid brain. The rather classic picture of the
"autistic" child who is attractive in appearance
with only minor motor problems, or with no motor problems
at all, but who is very self-stimulating, self-isolated, and
who lacks speech, is a picture of a child with what generally
turns out to be mild-diffuse cortical brain injury that does
not seriously affect motor function, but does seriously disorganize
sensory integration and the cortical function of language.
Sensory Dysfunction
NACD refers to the "autistic"
child as a child with sensory dysfunction. Our work with these
children begins by evaluating function in order to determine
the degree and type of abnormal sensory function. That is
to say, by looking at how the child reacts, it is possible
to make a determination as to how the child perceives the
world, which then makes it possible to assess the child's
problems in the various sensory channels. How we see the world
is determined by how our brains interpret the information
that comes through our five senses. How a "normal"
individual perceives the world is not always as it is. For
example, how loud do your children yell? If you are wide awake
and relaxed, they do not yell too loudly. If you are tired
and grumpy their yelling seems too loud; and if you have a
migraine headache, the sound is intolerable. All the same
volume, but perceived differently. The way we see the world
is determined by how our brains interpret it.How does the
brain of the child with sensory dysfunction perceive the world?
Carl Delacato, in his book "The Ultimate Stranger,"
classifies each sensory channel as being hyper, hypo, or being
disrupted by "white noise" or interference within
the system. Each sensory channel can be affected in a different
way: For example, a child can be hypo-visual, "white
noise" auditory, hypo to tastes and odors, and hyper-tactile.
Each child needs to be considered on an individual basis.
Evaluation of an individual is complicated by the interaction
of the five sensory channels.
The Emergence of a Pattern
Through our work with children who
have sensory dysfunction, a pattern has emerged into which
more than half of the "autistic" children appear
to fit. This pattern includes the following: hyper-auditory,
hypo-central vision, hyper-peripheral vision, hyper-touch,
hyper-pressure and temperature, and hypo- taste and odor.
The abnormal perception produces what is termed sensory agnosia,
or an inability to attach meaning to sensory impressions.
Much of the input coming to these children appears to create
antagonism between input, with the child's ultimate interpretation
being determined by the interplay between the various dysfunctional
sensory channels. Let's examine a typical/atypical child with
severe sensory dysfunction.
Hyper-Auditory
Being hyper-auditory, sounds in the
child's environment seem much louder to him than they do to
us. Because of the acuteness of his hearing and what appears
to be a particular sensitivity to high sounds, the hyper-auditory
child lives in a very confusing and often threatening auditory
environment. He is bombarded with sound. As we attempt to
talk to such a child, he is not only hearing our distorted
voices, but a buzz from the fluorescent light overhead, the
conversation in the next room and the traffic outside. The
greater the quantity and volume of these sounds, the more
difficult the interpretation. Depending upon the severity
of the problem, such children will act confused, intensify
their activity level and increase their degree of disorientation
as the volume increases, or they may simply, turn off auditorially
just to survive. As many of these children begin to improve
auditorially, they understand much of what is said, but they
do not hear clearly or cleanly enough to reproduce speech
normally.
Hypo-Central Vision and Hyper-Peripheral
Vision
The central, or macular vision of these
children is hypo, or depressed, and the peripheral vision
is hyper, or agitated. The result being that such children
use their peripheral vision instead of their central vision
to see. These children tend not to look directly at things;
they do not make good eye contact, and they tend to reach
for things without apparently looking at them first. These
children often engage in self-stimulating visual play; they
have a fascination for lights, reflections, and spinning objects;
and they use, rather than play with, toys. The antagonism
that exists between the agitated peripheral vision and the
depressed central vision tends to perpetuate the problem until
such time as direct remediative measures can be imposed.
Hyper-Touch, Hypo-Pressure, and Temperature
Many things seem to create a pleasure/pain
conflict with these children; their tactile systems often
epitomizing this conflict. Often children with sensory dysfunction
are hyper, or super-sensitive to touch. The touch receptors
of the skin are so sensitive that the child may pull away
from touch with fear and pain. The same child, however, if
grasped firmly and deeply massaged, enjoys the sensations
that this deep pressure produces. This sensitivity to touch
complicates the teaching of manual skills. The self-destructiveness
of some "autistic" children (biting, banging of
their heads, etc.) provides them with pleasure/pain experience.
Often they appear to simply enjoy feeling.
Hypo-Taste and Odor
Many of these children are hypo-responsive
to tastes and odors. They do not appear to be aware of the
tastes of most foods or the odors in their environment. Being
hypo-taste can produce a variety of food preferences, or lack
of such. Some of the children will eat anything and everything,
including harmful substances. Some will only eat foods with
very strong tastes strong enough so they can taste something.
Others will find a taste they can recognize and will not eat
anything unless it is this one taste.
Assessment of the Individual
Although there are some patterns being
identified in "autistic" children, general assumptions
should not be made about individuals. Each child must be observed
as the unique individual he or she is. Knowledge of children
with similar problems, however, can provide insights that
can greatly assist in the diagnostic and therapeutic processes.
Treatment
Treatment of the child with a sensory
dysfunction is multifaceted, including components of neurological
organization, specific sensory training, design of a protected
sensory environment, behavior management, as well as general
medical and nutritional care. The sensory environment is of
utmost importance for these children. Coupling these problems
of hyper, hypo, and agitated responses with antagonism between
incoming sensory input, produces the vital need for a controlled
sensory environment. Many "autistic" children, when
placed in a controlled environment, respond immediately to
the new non-threatening environment. For example, the hyper-auditory
and hypo-central, hyper-peripheral vision children spend as
much of their day as possible in an environment void of all
extraneous auditory and visual input Auditory input is provided
via earphones so as to avoid interference from other sounds.
The physical environment is as sparse as possible so as to
avoid stimulation of the overactive peripheral vision. Blacklight
rooms are utilized, which eliminate the entire peripheral
world (only white and fluorescent objects can be seen in blacklight).
Fluorescent toys are introduced to help stimulate the central
vision and teach the children how to play appropriately. Such
controlled sensory environments are an integral part of the
NACD Centers, and they are major factors in assisting these
children in achieving their full potential.
The "Autistic" Genius
The hyper sensory function found in
most "autistic" children can be changed from a negative,
inhibiting function to a positive, contributing function.
There is numerous documentation of "autistic" children
with unusual capabilities: children who, given a date, can
immediately tell you upon which day of the week it had fallen,
or will fall; children with incredible memories for trivia;
children who can instantly calculate complex mathematical
problems. Most of these children were never taught how to
do these things, and for the most part could only do one such
exceptional thing. We have learned however, that many "autistic"
children can be taught to do many things exceptionally well.
Learning How We Learn
Most of our children with sensory dysfunction
read before they speak. Some of them read better (faster and
with better comprehension) than their "normal" peers.
And a few read better than anyone would have thought anyone
could read. Some compute mathematics exceptionally well and
some learn foreign languages virtually overnight. We have
learned to use teaching as a therapeutic tool to help these
children "tune in."Thirteen year old Bruce did not
talk nor respond to anyone talking to him. He just floated
around, and he looked no harder at people than he did at pieces
of furniture. Bruce was totally in his own world. Bruce was
hyper-visual and auditory, and had turned the world off. To
help Bruce, we started flashing word cards at him very rapidly
(l/2 second intervals). These rapidly flashing cards attracted
Bruce visually as rays of sunlight or steam had previously.
Bruce watched the cards. As they were flashed, they were named.
Bruce began to listen to the names and to associate the names
with the words. Soon Bruce noticed the hands holding the cards,
and the person attached to the hands his mother. Bruce began
to learn faster than we could develop materials. Bruce was
able now to learn something and remember it after having seen
it only once, for l/2 a second. Within two years, Bruce could
read, understand, and remember everything he read and he could
read an entire page in a glance! He also remembers everything
he hears; he computes mathematics instantly and understands
six different languages. Bruce is very affectionate and has
a good sense of humor. But Bruce is not "fixed"
yet. His verbal language is still delayed, and sensitivity
in his hands makes him reluctant to manipulate many things
as he should. But he is well on his way!There are others.
Some who began at levels above Bruce, and others below. But
many of their abilities to learn have been shocking and eye
opening. Rapid, clean (free of extraneous stimuli) presentation
has been the key. The same key we have discovered that turns
on the "normal" preschool child; the same key that
enables many other children who supposedly couldn't learn,
to learn. We have ascertained things about perception and
sensory function from our "autistic" children that
are helping us understand more about the entire learning process.It
is unfortunate that we live in an age of specialization, rigidity,
and segregation when there is so much we can learn from each
other. As our insights become clearer, hopefully more doors
will open, and we can help more of these children come closer
to achieving their full potentials.
Reprinted from the Journal
of the National
Academy for Child Development
Back to Top
|
