Tag Archives: cognitive ability

The learning profile associated with autism

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The learning profile associated with autism

Autistic children have an unusual profile of learning abilities that can often be recognised in very early childhood. Some pre-school autistic children have reading and numeracy abilities above the level of their peers. Such advanced literacy and numeracy abilities may have been self-taught through watching educational television programs, computer games and YouTube videos. There are autistic children who appear to easily ‘crack the code’ of reading, spelling, or numeracy; indeed, these subjects may become their special interest at school. In contrast, some autistic children have considerable delay in academic skills and an early assessment of learning abilities suggests the characteristics of dyslexia and dyscalculia. There seem to be more autistic children than one might expect at the extremes of cognitive ability.

Teachers soon recognize that the autistic child in their class has a distinctive learning profile, often being talented in understanding the logical world, noticing details and patterns and remembering facts, and the artistic world with a talent for drawing or music. However, the child can be easily distracted or distressed by sensory and social experiences, and when problem solving, appears to have a ‘one-track mind’ and a fear of failure.  As the child progresses through the school grades, teachers identify problems with organizational abilities, flexible thinking, and group projects. End of year school reports often describe a conspicuously uneven profile of academic achievement with areas of excellence and areas that require remedial assistance.

It is extremely important that teachers and parents know the learning profile of an autistic child to improve his or her academic achievement. This is especially important as children usually have two reasons to attend school – to learn and to socialize. If the autistic child is not successful socially at school, then academic success becomes more important as the primary motivation to attend school and for the development of self-esteem and self-identity. 

Verbalizing and visualizing

Valuable information on an autistic child’s learning profile can be obtained from formal testing using a standardized test of intelligence and tests of academic achievement. Standardized tests of intelligence have at least ten sub-tests that measure a range of intellectual abilities. Some sub-tests measure specific components of verbal reasoning, while others measure components of visual reasoning.

Some autistic children have relatively advanced verbal reasoning skills and may be colloquially described as ‘verbalisers.’ If such a child has difficulty acquiring a particular academic ability in the social and sensory interactive ‘theatre’ of the classroom, then his or her knowledge and understanding may be improved by solitary and quiet reading about the concept. If the autistic child has relatively advanced visual reasoning skills, a ‘visualizer’ then learning may be facilitated by observation of the teacher’s actions rather than listening to their instructions and learning from a computer screen. Learning from a computer screen significantly reduces any difficulties with social and conversational abilities. The ‘verbalisers’ may eventually be successful in careers where verbal abilities are an advantage, for example the legal professions or being an author, and ‘visualizers’ may be successful in careers such as engineering or the visual arts.

Attention

Psychologists divide attention into four components: the ability to sustain attention, to pay attention to relevant information, to shift attention when needed, and to encode attention – that is, to remember what was attended to. Autistic children appear to have problems with all four aspects of attention. The duration of attention to schoolwork can be an obvious problem but the degree of attention can vary according to the level of motivation. If the child is attending to an activity associated with his or her special interest, the level of attention can be excessive. The child appears to be oblivious of external cues that it is time to move on to another activity or to pay attention to the comments, requests and instructions of a teacher or parent. The amount of sustained attention can also depend on whether the child wants to give the attention to what an adult wants them to do. The autistic child may have his or her own agenda for what to attend to.

Even when the autistic child appears to be attentive to the task set by the teacher, he or she may not be attending to what is relevant in the material in front of them. Typical children can more easily identify and selectively attend to what is relevant to the context or problem. Autistic children are often distracted and confused by irrelevant detail, and they don’t automatically know what the teacher wants them to look at.  They may need specific instruction at to exactly what to look at on the page.

Some academic activities require the ability to shift attention during the activity and focus on new information. Unfortunately, autistic children can have difficulty ‘changing track’ while engaged in a ‘train of thought’. There can also be problems with memory processes such that the recently learned information is not stored or encoded as well as one would expect. Autistic children may not remember what to attend to when they encounter the same problem again. This characteristic can affect social situations. Autistic children process social information using intellect rather than intuition and can have problems remembering what the relevant social cues are and changing their conversation ‘track’ when interacting with more than one person.

The autistic child often has considerable problems switching thoughts to a new activity until there has been closure, i.e., the activity has been successfully completed. Other children appear to have the capacity to pause a thought or activity and to easily move to the next activity. In the classroom, autistic children can resist changing activities until they have completed the previous activity, knowing that their thinking cannot as easily cope with transitions without closure. A teacher or parent may need to provide multiple verbal indications when an activity is going to change, perhaps counting down and if possible, allowing the autistic child extra time to finish the task.

Executive functioning

Autistic children and adolescents often have problems with executive function. Perhaps the best way to understand the concept of executive function is to think of a chief executive of a large company, who can perceive the ‘big picture’, consider the potential outcomes of various decisions, is able to organize resources and knowledge, plan and prioritize within the required time frame, and modify decisions based on results. Such executive function skills may be significantly delayed in autistic children and adolescents.

In the early school years, the main signs of impaired executive function are difficulties with inhibiting a response (i.e., being impulsive), working memory and using new strategies. The autistic child can be notorious for being impulsive in schoolwork and in social situations, appearing to respond without thinking of the context, consequences, and previous experience. By the age of eight years, a typical child can ‘switch on’ and use his or her frontal lobe to inhibit a response and think before deciding what to do or say. The autistic child can become capable of thoughtful deliberation before responding, but under conditions of stress, or if feeling overwhelmed or confused, can be impulsive. It is important to encourage the child to relax and consider other options before responding and to recognize that being impulsive can be a sign of confusion and stress.

Working memory is the ability to maintain or hold information ‘online’ when solving a problem. The autistic child may have an exceptional long-term memory and is perhaps able to recite the credits or dialogue of his or her favourite film but has difficulty with the mental recall and manipulation of information relevant to an academic task. The child’s working memory capacity may be less than that of his or her peers. Other children have a ‘bucket’ capacity for remembering and using relevant information, but the autistic child has a working memory ‘cup’ which affects the amount of information he or she can retrieve from the memory ‘well’.

Another problem with working memory is a tendency to quickly forget a thought. One of the reasons autistic children are notorious for interrupting others was explained by an autistic child who said he had to say what was on his mind to his teacher because if he waited, he would forget what he was going to say.

Impaired executive function can include difficulties with flexible thinking.  Typical children can quickly react to feedback and are prepared to change strategies or direction with new information. Autistic children tend to continue using incorrect strategies, even when they know their strategy isn’t working, as they have difficulty conceptualizing different thoughts and reactions.

In the high school years, problems with executive function can become more apparent as the school curriculum changes to become more complex and self-directed, and teachers and parents have age-appropriate expectations based on the maturing cognitive abilities of age peers. In the primary school years, success in subjects such as History can be measured by the ability to recall facts such as dates. By the high school years, assessment in history has changed, and requires that the child shows ability in writing essays that have a clear organizational structure, and that he or she can recognize, compare, and evaluate different perspectives and interpretations. Autistic adolescents with impaired executive function have problems with the organizing and planning aspects of class work, assignments, essays, and homework.

There can also be problems with self-reflection and self-monitoring. By the high school years, typical children have developed the capacity to have a mental ‘conversation’ to solve a problem. The internal thinking process can include a dialogue, discussing the merits of various options and solutions. This process may not be as efficient in the thinking of an autistic adolescent as it is in typical peers. Many autistic adolescents ‘think in pictures’ and are less likely to use an inner voice or conversation to facilitate problem solving. The autistic adolescent may need the teacher or parent’s voice to guide his or her thoughts.

One strategy to reduce the problems associated with impaired executive functioning is to have someone act as an ‘executive secretary’. The child’s mother may have realized that she has already become an executive secretary, providing guidance with organizing and planning, especially with regards to completing homework assignments. The executive secretary (a parent or teacher) may also need to create a time schedule, proofread draft reports and essays, colour code subject books, encourage alternative strategies and create ‘to do’ checklists, with a clear schedule of activities and the duration of each activity.

Such close monitoring and guidance may initially appear to be excessive for an adolescent or young adult with recognized intellectual ability. A parent who provides the support as an executive secretary may be labelled as overprotective by school agencies and family members, but that parent has learned that without such support, the autistic child would not achieve the grades that reflect his or her actual abilities. We encourage a parent or teacher to take on this very important role of executive secretary. We hope that this will be a temporary appointment as the autistic adolescent and young adult eventually achieves greater independence with organizational skills.

Coping with mistakes

The learning profile of autistic children can include a tendency to focus on errors, a need to fix an irregularity and a desire to be a perfectionist. This can lead to a fear of making a mistake and the child’s refusal to commence an activity unless he or she can complete it perfectly. The avoidance of errors can mean that autistic children prefer accuracy rather than speed, which can affect performance in timed tests and lead to their thinking being described as pedantic. An autistic girl complained that her teacher frequently asked her to hurry up but said that if she did hurry up, she might make a mistake.

It is important to change the autistic child’s perception of errors and mistakes. Autistic children often value intellectual abilities in themselves and others, and young children can be encouraged to recognize that the development of cognitive ‘strength’ is like that of physical strength, in that the brain needs exercise on difficult or strenuous mental activity, that includes making mistakes, to improve intellectual ability. If all mental tasks were easy, we would not improve our intellect. Intellectual effort makes the brain smarter.

Adults will need to model how to respond to a mistake and have a constructive response to the child’s errors, with comments such as, ‘This is a difficult problem designed to make you think and learn, and together we can find a solution.’ It must also be remembered that while there can be a fear of making a mistake, there can be an enormous delight in getting something right, and success and perfection may be a more important motivator than pleasing an adult or impressing peers.

Cognitive talents

There are autistic children and adults who have cognitive abilities that are significantly above average and are sometimes described as gifted and talented. This can provide both advantages and disadvantages to the child. The advantages include a greater capacity to intellectually process and learn social cues and conventions. Advanced intellectual maturity may be admired by a teacher and winning academic competitions can lead to greater status for the child and school. Academic and artistic success can raise self-esteem and contribute to social inclusion; their social naivety and eccentricity can be accepted as part of the ‘absent minded professor’ or artistic genius image. However, there are disadvantages.

Autistic children are more socially and emotionally immature than their peers, which contributes towards their being socially isolated, ridiculed, and tormented. Having considerably advanced intellectual maturity in comparison to one’s peers could further increase social isolation and alienation. The child may have no peer group socially or intellectually in his or her classroom.  Having an impressive vocabulary and knowledge can lead adults to expect an equivalent maturity in social reasoning, emotion management and behaviour; they may be unjustly critical of the child who is unable to express these abilities as maturely as his or her age peers.

We have recently recognised that the learning profile associated with autism can also include alexithymia, which can affect the expression of academic talents. Alexithymia is a difficulty converting thoughts into words. The autistic child’s conceptualization or solution perhaps to a mathematics problem may be extraordinary. However, while the autistic child knows their solution is perfect, they may have genuine difficulty explaining how they achieved that solution.

Summary

Autistic children and adolescents have a different way of thinking and learning. This can lead to academic talents and difficulties. Teachers and parents need to be aware of the autistic students personal learning profile and to modify the classroom curriculum to accommodate their distinct learning profile. This can include identifying learning talents and to recognise that autistic people can produce a new perspective on the problems of tomorrow.

How does an autistic child learn?

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How does an autistic child learn?

Autistic children have an unusual profile of learning abilities that can often be recognised in very early childhood. Some pre-school autistic children have reading and numeracy abilities above the level of their peers. Such advanced literacy and numeracy abilities may have been self-taught through watching educational television programs, computer games and YouTube videos. There are autistic children who appear to easily ‘crack the code’ of reading, spelling, or numeracy; indeed, these subjects may become their special interest at school. In contrast, some autistic children have considerable delay in academic skills and an early assessment of learning abilities suggests the characteristics of dyslexia and dyscalculia. There seem to be more autistic children than one might expect at the extremes of cognitive ability.

Teachers soon recognize that the autistic child in their class has a distinctive learning profile, often being talented in understanding the logical world, noticing details and patterns and remembering facts, and the artistic world with a talent for drawing or music. However, the child can be easily distracted or distressed by sensory and social experiences, and when problem solving, appears to have a ‘one-track mind’ and a fear of failure. As the child progresses through the school grades, teachers identify problems with organizational abilities, flexible thinking, and group projects. End of year school reports often describe a conspicuously uneven profile of academic achievement with areas of excellence and areas that require remedial assistance.

It is extremely important that teachers and parents know the learning profile of an autistic child to improve his or her academic achievement. This is especially important as children usually have two reasons to attend school – to learn and to socialize. If the autistic child is not successful socially at school, then academic success becomes more important as the primary motivation to attend school and for the development of self-esteem and self-identity.

Verbalising and visualising

Valuable information on an autistic child’s learning profile can be obtained from formal testing using a standardized test of intelligence and tests of academic achievement. Standardized tests of intelligence have at least ten sub-tests that measure a range of intellectual abilities. Some sub-tests measure specific components of verbal reasoning, while others measure components of visual reasoning.

Some autistic children have relatively advanced verbal reasoning skills and may be colloquially described as ‘verbalisers.’ If such a child has difficulty acquiring a particular academic ability in the social and sensory interactive ‘theatre’ of the classroom, then his or her knowledge and understanding may be improved by solitary and quiet reading about the concept. If the autistic child has relatively advanced visual reasoning skills, a ‘visualizer’ then learning may be facilitated by observation of the teacher’s actions rather than listening to their instructions and learning from a computer screen. Learning from a computer screen significantly reduces any difficulties with social and conversational abilities. The ‘verbalisers’ may eventually be successful in careers where verbal abilities are an advantage, for example the legal professions or being an author, and ‘visualizers’ may be successful in careers such as engineering or the visual arts.

Attention

Psychologists divide attention into four components: the ability to sustain attention, to pay attention to relevant information, to shift attention when needed, and to encode attention – that is, to remember what was attended to. Autistic children appear to have problems with all four aspects of attention. The duration of attention to schoolwork can be an obvious problem but the degree of attention can vary according to the level of motivation. If the child is attending to an activity associated with his or her special interest, the level of attention can be excessive. The child appears to be oblivious of external cues that it is time to move on to another activity or to pay attention to the comments, requests and instructions of a teacher or parent. The amount of sustained attention can also depend on whether the child wants to give the attention to what an adult wants them to do. The autistic child may have his or her own agenda for what to attend to.

Even when the autistic child appears to be attentive to the task set by the teacher, he or she may not be attending to what is relevant in the material in front of them. Typical children can more easily identify and selectively attend to what is relevant to the context or problem. Autistic children are often distracted and confused by irrelevant detail, and they don’t automatically know what the teacher wants them to look at. They may need specific instruction at to exactly what to look at on the page.

Some academic activities require the ability to shift attention during the activity and focus on new information. Unfortunately, autistic children can have difficulty ‘changing track’ while engaged in a ‘train of thought’. There can also be problems with memory processes such that the recently learned information is not stored or encoded as well as one would expect. Autistic children may not remember what to attend to when they encounter the same problem again. This characteristic can affect social situations. Autistic children process social information using intellect rather than intuition and can have problems remembering what the relevant social cues are and changing their conversation ‘track’ when interacting with more than one person.

The autistic child often has considerable problems switching thoughts to a new activity until there has been closure, i.e., the activity has been successfully completed. Other children appear to have the capacity to pause a thought or activity and to easily move to the next activity. In the classroom, autistic children can resist changing activities until they have completed the previous activity, knowing that their thinking cannot as easily cope with transitions without closure. A teacher or parent may need to provide multiple verbal indications when an activity is going to change, perhaps counting down and if possible, allowing the autistic child extra time to finish the task.

Executive functioning

Autistic children and adolescents often have problems with executive function. Perhaps the best way to understand the concept of executive function is to think of a chief executive of a large company, who can perceive the ‘big picture’, consider the potential outcomes of various decisions, is able to organize resources and knowledge, plan and prioritize within the required time frame, and modify decisions based on results. Such executive function skills may be significantly delayed in autistic children and adolescents.

In the early school years, the main signs of impaired executive function are difficulties with inhibiting a response (i.e., being impulsive), working memory and using new strategies. The autistic child can be notorious for being impulsive in schoolwork and in social situations, appearing to respond without thinking of the context, consequences, and previous experience. By the age of eight years, a typical child can ‘switch on’ and use his or her frontal lobes to inhibit a response and think before deciding what to do or say. The autistic child can become capable of thoughtful deliberation before responding, but under conditions of stress, or if feeling overwhelmed or confused, can be impulsive. It is important to encourage the child to relax and consider other options before responding and to recognize that being impulsive can be a sign of confusion and stress.

Working memory is the ability to maintain or hold information ‘online’ when solving a problem. The autistic child may have an exceptional long-term memory and is perhaps able to recite the credits or dialogue of his or her favourite film but has difficulty with the mental recall and manipulation of information relevant to an academic task. The child’s working memory capacity may be less than that of his or her peers. Other children have a ‘bucket’ capacity for remembering and using relevant information, but the autistic child has a working memory ‘cup’ which affects the amount of information he or she can retrieve from the memory ‘well’.

Another problem with working memory is a tendency to quickly forget a thought. One of the reasons autistic children are notorious for interrupting others was explained by an autistic child who said he had to say what was on his mind to his teacher because if he waited, he would forget what he was going to say.

Impaired executive function can include difficulties with flexible thinking. Typical children can quickly react to feedback and are prepared to change strategies or direction with new information. Autistic children tend to continue using incorrect strategies, even when they know their strategy isn’t working, as they have difficulty conceptualizing different thoughts and reactions.

In the high school years, problems with executive function can become more apparent as the school curriculum changes to become more complex and self-directed, and teachers and parents have age-appropriate expectations based on the maturing cognitive abilities of age peers. In the primary school years, success in subjects such as History can be measured by the ability to recall facts such as dates. By the high school years, assessment in history has changed, and requires that the child shows ability in writing essays that have a clear organizational structure, and that he or she can recognize, compare, and evaluate different perspectives and interpretations. Autistic adolescents with impaired executive function have problems with the organizing and planning aspects of class work, assignments, essays, and homework.

There can also be problems with self-reflection and self-monitoring. By the high school years, typical children have developed the capacity to have a mental ‘conversation’ to solve a problem. The internal thinking process can include a dialogue, discussing the merits of various options and solutions. This process may not be as efficient in the thinking of an autistic adolescent as it is in typical peers. Many autistic adolescents ‘think in pictures’ and are less likely to use an inner voice or conversation to facilitate problem solving. The autistic adolescent may need the teacher or parent’s voice to guide his or her thoughts.

One strategy to reduce the problems associated with impaired executive functioning is to have someone act as an ‘executive secretary’. The child’s mother may have realized that she has already become an executive secretary, providing guidance with organizing and planning, especially with regards to completing homework assignments. The executive secretary (a parent or teacher) may also need to create a time schedule, proofread draft reports and essays, colour code subject books, encourage alternative strategies and create ‘to do’ checklists, with a clear schedule of activities and the duration of each activity.

Such close monitoring and guidance may initially appear to be excessive for an adolescent or young adult with recognized intellectual ability. A parent who provides the support as an executive secretary may be labelled as overprotective by school agencies and family members, but that parent has learned that without such support, the autistic child would not achieve the grades that reflect his or her actual abilities. We encourage a parent or teacher to take on this very important role of executive secretary. We hope that this will be a temporary appointment as the autistic adolescent and young adult eventually achieves greater independence with organizational skills.

Coping with mistakes

The learning profile of autistic children can include a tendency to focus on errors, a need to fix an irregularity and a desire to be a perfectionist. This can lead to a fear of making a mistake and the child’s refusal to commence an activity unless he or she can complete it perfectly. The avoidance of errors can mean that autistic children prefer accuracy rather than speed, which can affect performance in timed tests and lead to their thinking being described as pedantic. An autistic girl complained that her teacher frequently asked her to hurry up but said that if she did hurry up, she might make a mistake.

It is important to change the autistic child’s perception of errors and mistakes. Autistic children often value intellectual abilities in themselves and others, and young children can be encouraged to recognize that the development of cognitive ‘strength’ is like that of physical strength, in that the brain needs exercise on difficult or strenuous mental activity, that includes making mistakes, to improve intellectual ability. If all mental tasks were easy, we would not improve our intellect. Intellectual effort makes the brain smarter.

Adults will need to model how to respond to a mistake and have a constructive response to the child’s errors, with comments such as, ‘This is a difficult problem designed to make you think and learn, and together we can find a solution.’ It must also be remembered that while there can be a fear of making a mistake, there can be an enormous delight in getting something right, and success and perfection may be a more important motivator than pleasing an adult or impressing peers.

Cognitive talents

There are autistic children and adults who have cognitive abilities that are significantly above average and are sometimes described as gifted and talented. This can provide both advantages and disadvantages to the child. The advantages include a greater capacity to intellectually process and learn social cues and conventions. Advanced intellectual maturity may be admired by a teacher and winning academic competitions can lead to greater status for the child and school. Academic and artistic success can raise self-esteem and contribute to social inclusion; their social naivety and eccentricity can be accepted as part of the ‘absent minded professor’ or artistic genius image. However, there are disadvantages.

Autistic children are more socially and emotionally immature than their peers, which contributes towards their being socially isolated, ridiculed, and tormented. Having considerably advanced intellectual maturity in comparison to one’s peers could further increase social isolation and alienation. The child may have no peer group socially or intellectually in his or her classroom. Having an impressive vocabulary and knowledge can lead adults to expect an equivalent maturity in social reasoning, emotion management and behaviour; they may be unjustly critical of the child who is unable to express these abilities as maturely as his or her age peers.

We have recently recognised that the learning profile associated with autism can also include alexithymia, which can affect the expression of academic talents. Alexithymia is a difficulty converting thoughts into words. The autistic child’s conceptualization or solution perhaps to a mathematics problem may be extraordinary. However, while the autistic child knows their solution is perfect, they may have genuine difficulty explaining how they achieved that solution.

Summary

Autistic children and adolescents have a different way of thinking and learning. This can lead to academic talents and difficulties. Teachers and parents need to be aware of the autistic student’s personal learning profile and to modify the classroom curriculum to accommodate their distinct learning profile. This can include identifying learning talents and to recognise that autistic people can produce a new perspective on the problems of tomorrow.

We have been training teachers in recognising and supporting autistic students for the majority of our combined 80 years of specialisation in autism.

To learn more about this increasingly important area we encourage you to attend our next teacher training in autism broadcast via live webcast:

LIVE WEBCAST And Live In Townsville: Autism In School – 17 June 2022 – Attwood and Garnett Events 

10 Challenges your autistic teenager likely faces every day

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10 Challenges your autistic teenager likely faces every day

Introduction

If you live with, teach or work with an autistic teenager, it is very likely that you have noticed that many days seem to be characterised by struggle. They often experience very strong emotions, including anxiety, stress, depression, and anger. On some days even the smallest trigger, for example, looking at the person, can trigger a meltdown. They come home from school catastrophically tired, seeming to need hours in the bedroom lying on the bed to recover, or disappearing into a computer monitor, only to emerge in a worse mood than they went in with. What is going on? Why are our autistic teenagers struggling so much with life? In this blog we cover 10 likely challenges your autistic teenager faces every day, with a hope to increase your understanding of why your teenager is struggling so much. We find that when we can understand the reasons for the struggle, that understanding can provide a roadmap of how to better assist our teenagers.

1. Being different

An autistic person often experiences that they are different from other people from an early age, but commonly does not understand why they are different. Within this gap of understanding they can insert many self-derogatory labels, like “weird,” “psycho,” or “stupid.” It is very difficult to be different at school, especially socially. You will remember from your own experiences of high school just how critical, rejecting and punishing teenagers can be to each other. One of the developmental milestones of adolescence is to individuate, that is to become an individual separate from your parents, to gain a sense of self. The individuation process is often characterised by trying to fit in with peers. It is very difficult to fit in with peers when you are socially different. The other kids know you are different, you know it, but you have no idea what to do about it. The result can be very low self-esteem, a poor sense of self and a sense of hopelessness, leading to depression and suicidality. Some teenagers react by denying that there is a problem, and overcompensate with an inflated self-esteem, or arrogance, and blame others. They often have anger problems.

2. Self-regulation

Autism is a frontal lobe condition, which means that it affects the frontal lobes of the brain, which are responsible for executive functioning. In fact 3/4 of people with autism also have attention deficit hyperactivity disorder (ADHD), a condition characterised by poor executive functioning. Executive functioning abilities include the capacity to focus on the right thing at the right time, transition between events, organise ourselves and our time, plan and prioritise, hold a problem in our mind while we are solving it, and to inhibit first responses. An autistic teenager is often struggling with each of these abilities, which truly impairs their ability to regulate their emotions and behaviour. They often ricochet between emotions, acting impulsively, becoming defensive, and avoiding situations that make them anxious. This pattern allows no space to sense themselves, to process what is happening, to learn, or to problem solve. Without self-regulation, your teenagers feels out of control, and increasingly anxious. When someone cannot control themselves, they usually start to try to control other people.

3. Sensory challenges

One of the defining features of being autistic is that there are sensory challenges. Often noises are too loud, light is too bright, and the person can be very distressed by certain aromas, textures and tastes. Having a different sensory system can also affect the person’s ability to register pain and temperature. The consequences of a different sensory system include persistent hypervigilance, exhaustion and sleep problems. There can be difficulty with concentration and focus during the day because of the background stress of trying to process sensory experiences.

4. People

If you ask an autistic teenager what is the biggest problem of their life, they often will tell you that it is people. What they mean is that people are confusing, it is difficult to read them and to know what they expect, and they can also be punishing and rejecting. Research tells us that over 90% of autistic teenagers will have received cruel bullying, including peer rejection, by the time they reach 14 years old. Often our autistic teenagers decide quite early that people are “toxic,” and they prefer to avoid them to stay safe. The problem with this is that they have overlearned the lesson. Not all people are toxic, and your autistic teenager needs people in their life, including friends, mentors, parents, siblings, professionals and teachers. As one autistic teenager said, “I would choose to be alone but I can’t stand the loneliness.” We know from research and clinical practice that having just one friend can protect an autistic teenager from poor mental health outcomes.

5. Double empathy problem

Autistic people struggle to read other people, to infer their expectations and intentions. This problem is called “theory of mind,” or cognitive empathy. It is important to point out that autistic people do not lack empathy, they usually have an abundance of affective empathy, as discussed below. However, they do struggle to “read” people, to have cognitive empathy. We now understand that the problem goes both ways. As much as autistic people struggle to read neurotypical people, neurotypical people struggle to read autistic people. The unique social communication style of an autistic person, which may include less eye contact, facial expressions and body gesture, can lead that person to be misinterpreted and even perceived unfavourably. Similarly, an autistic person can misperceive certain facial expressions, gestures and tones of voice as being negative, and thus perceive the person unfavourably. On each side, whenever an unfavourable impression is made, the person perceiving the unfavourable impression is less welcoming, leading to the autistic person to both reject other people and perceive that they themselves are not welcome (Mitchell, Sheppard & Cassidy, 2021).

6. Overthinking

Due to problems with both social confusion and executive functioning, the person tends to overthink many situations as a coping mechanism. Autistic people often highly value intellect and can utilise their intellect to overcome their problems. This is a very valuable skill, but when overused we call it overthinking. Overthinking one’s problems can lead to both exhaustion and “analysis paralysis,” where the person becomes overwhelmed and avoids the problem. You know your teenager is avoiding the problem when they spend a lot of time in bed or in front of a screen. This avoidance is called thought blocking and leads to much greater levels of distress. Overthinking is also associated with being disconnected from the body and hence from processing one’s emotions. We need to feel to heal.

7. Empathy overarousal

We have talked about cognitive empathy and we mentioned affective empathy. Affective empathy is when the person feels other’s emotional distress as if it were their own. They may not be able to understand how to describe that distress, or why the distress is occurring, but they feel it as if it were their own. Research has shown that many autistic people experience other peoples’ pain more intensively than neurotypical people do. This has been called the “empathy over arousal hypothesis.” Autistic teenagers and adults describe that they often feel overwhelmed by other peoples’ emotional pain, and have no idea how to deal with it, either how to help themselves, or how to help the other person.

8. Alexithymia

Up to 80% of autistic people also have alexithymia. Alexithymia literally interprets to “a” – a lack of, “lexi” – words for “thymia” – emotions. It also includes difficulty sensing bodily sensations associated with emotions, or problems with interoception. When someone cannot detect the early signs of an emotion, or find and words for that emotion, they are severely under equipped for managing the emotion. Alexithymia is one of the reasons many autistic teenagers rise from 0 to 100 in half a second on their Anger Thermometer. Unfortunately, having alexithymia is a risk factor for developing clinical levels of anxiety and depression.

9. A different learning profile

When an autistic person completes an Intelligence Quotient (IQ) test it is very common for them to show a great deal of variability between the various subtests that make up the IQ test. This means that they often have great strengths in their cognitive learning ability, but also areas of great difficulty. Because of their uneven learning profile they can really struggle with new learning tasks, even if they are very intelligent or even gifted. We call this the different learning profile of autism. Being a different learner can be very challenging in all contexts, including school, but also in social situations and within the family and community. Despite good intellect, your autistic teenager may feel that they are stupid, and can feel very depressed and hopeless about that.

10. Trauma or the effects of past trauma

It is unfortunately the case that autistic people are both more likely to experience a traumatic event and are more likely to have a traumatic stress reaction, for example, to develop PTSD, after trauma. It may be that your autistic teenager is suffering current trauma, for example, being bullied or abused, or has developed PTSD, but the condition is undiagnosed. A person with PTSD will experience high levels of hypervigilance throughout the day, distrust of people, flashbacks to the traumatic event, and nightmares that interrupt good quality sleep. If you suspect that your autistic teenager has developed PTSD or is suffering a current trauma, we highly recommend seeking professional assistance for them immediately. Fortunately, PTSD is treatable, and if we know about ongoing traumatic experiences, we can keep our autistic teenagers safe by stopping them.
Summary

The teenage years are challenging for typical teenagers, however our autistic teenagers face unique challenges that can amplify the typical challenges of the teenage years. Over the many years we have specialised in autism, we have discovered that understanding specific challenges that our autistic teenagers face is the most important first step in knowing how to support and assist our teenagers. The 10 challenges we list in this blog are ones that we commonly discover in our clinical practice, and have further understood with research and clinical practice. Hopefully your autistic teenager is not experiencing all of these challenges, but we encourage you to continue to explore and understand the challenges they face. It can be painful to tune in and listen, or to lean in and observe closely. We ourselves may have faced similar issues and have not yet healed. However, one of the most consistent findings across research on what helps to maximise the best outcomes in autism is support. When we provide ongoing support and understanding for our autistic teenagers, we give them the best opportunity to succeed.
What Next?

If your autistic teenager, student or client is experiencing any of these challenges and you are uncertain about next steps, we encourage you to come to our next Succeeding with Autism in The Teens Live Webcast on Friday 22nd July, 2022.

More information is available on our website:

https://attwoodandgarnettevents.com/product/succeeding-with-autism-in-the-teens/

References

Mitchell, P., Sheppard, E. & Cassidy, S. (2021). Autism and the double-empathy problem: Implications for development and mental health. British Journal of Developmental Psychology, 39, 1-18. DOI: 10.1111/bjdp.12350

Nonverbal autism and visual intelligence

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Nonverbal autism and visual intelligence

The term nonverbal autism is used to describe an autistic child or adult who has little or no spoken language. However, does that imply the person is also intellectually disabled? When the cognitive abilities of nonverbal autistic children are assessed on standardised assessment scales such as the Wechsler Intelligence Scale for Children (WISC-IV) there can be great difficulty ensuring the child understands the instructions and has the attention span and motivation to complete the test items. This can result in an assumption the child’s cognitive abilities are untestable, or they are clearly severely intellectually disabled. This contrasts with the experience of parents and teachers who have sometimes been astounded by the nonverbal autistic child’s ability to complete complex puzzles.

A recent research study explored the cognitive abilities of six- to twelve-year-old nonverbal autistic using the WISC-IV and three standardised assessments of visual intelligence (Courchesne et al. 2015). The 30 nonverbal autistic children who participated in the study attended two special schools in Montreal, Canada and their intellectual abilities were assessed using the five WISC-IV subtests that do not require a verbal response. The subtests were block design, matrix reasoning, picture concepts, coding, and symbol search. None of the 30 autistic children could complete all five subtests with only six completing any of the five subtests of the WISC-IV. All the autistic participants would be considered as intellectually disabled according to their response to the WISC-IV.

The children were also assessed using the Raven’s Colored Progressive Matrices (RCPM), the Children’s Embedded Figures Test (CEFT) and a visual search task (a predetermined target to be found within a field of distractors). An age matched control group of 27 typical children were also assessed on the same instruments.

The RCPM is a test of general and fluid intelligence. The researchers chose the board or ‘puzzle’ form given the age of the children in the study. The board form is a one-format 36 item test divided into three sets of 12 items which increases in difficulty and complexity within and across sets. Each item is composed of a pattern or two-by-two matrix with the last piece missing, leaving an empty hole or space in the board. There are six movable pieces underneath, among which the one that best completes the matrix must be chosen to fill the empty space. All three cognitive assessments minimize or eliminate the need for spoken instructions and for pointing and are better suited to measure autistic cognition that can include a talent for identifying patterns.

The administration of the three assessments were observed by each child’s teacher who anticipated that the child’s attention and performance would be dependent on reinforcers as used in their education programmes. However, the nonverbal autistic children often ignored or refused reinforcers while being tested. There was an intrinsic motivation to solve the puzzle.

Although none of the 30 nonverbal autistic children could complete the five WISC-IV subtests, 26 (87%) could complete the RCPM. Their scores ranged from the 2nd percentile to the 90th. Seventeen (65%) of the 26 children with RCPM scores performed in the normal range of intellectual ability, as measured by the RCPM, and eight autistic children performed at or above the 50th percentile and three (10%) were at the 90th percentile.

27 autistic children also completed the visual search task, while 26 completed the CEFT on which the autistic children were faster than the RCPM-matched typical children. Autistic performance on the RCPM, CEFT and visual search were correlated.

The conclusion of the study was that nonverbal school aged autistic children are at risk of their cognitive abilities being underestimated with important implications for intellectual assessment and attitude. For nonverbal autistic children, an absence of speech does not automatically imply an absence of intelligence.

Summary

There can be an automatic assumption that lack of speech in an autistic child means that they are also intellectually impaired. The result is that the child or adolescent can be under stimulated, leading to anger, frustration and/or depression. As the above study shows, and certainly in our clinical experience, many children with nonverbal autism have at least average intellectual abilities.

What Next?

If you are interested in further exploring the intelligence of your nonverbal autistic child, student, or client, for the purpose of better supporting them, consider using the Raven’s Colored Progressive Matrices. A psychologist with knowledge of autism can administer the test. Understanding their intellect will assist in goal setting and programme planning.

If you are interested in learning more about nonverbal autism to better understand and support your you nonverbal autistic child, student, or client, we are presenting a full day workshop live. The recording will be available to you for 60 days after the event. Click here to find out more.

References

Courchesne et al (2015) Autistic children at risk of being underestimated Molecular Autism 6:12

Managing an autistic meltdown

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Managing an autistic meltdown

Why do meltdowns occur?

Autistic people often have a different way of:

sensing internal and external stimuli

problem-solving

learning and organizing information

understanding and relating to

The daily challenges inherent in these differences can lead to the buildup of stress which can eventually be released as a meltdown.

To avoid and manage a meltdown, we need to determine:

the causes and triggers for stress and mental and/or physical tension

accommodations and modifications to the causes and triggers where possible

the signs of an imminent meltdown at the early and middle stages

best ways to support a person through a meltdown

activities for the person to safely release tension and stress

ways to facilitate emotional recovery for all those involved

The causes of a meltdown

The primary causes of a meltdown are stress from sensory sensitivity, cognitive overload, and aspects of social engagement.

Sensory sensitivity

One of the diagnostic characteristics of autism is hyper- or hypo-reactivity to sensory input. Clinical experience, autobiographies and research has confirmed that autism is associated with a different profile of exteroception and interoception. Exteroception is the perception of the external sensory world and interoception is the perception of the internal sensory world. We know that autistic individuals often have extreme sensitivity to external sensory experiences within the auditory, tactile, visual, and olfactory sensory systems.  The sensitivity is much greater than with typical individuals, and sensory experiences that are often not noticed and easily accommodated by non-autistic people, are extremely intense and distressing, if not actually painful, for an autistic person. We are also recognizing that autistic people may have an extraordinary sensitivity to negative emotions in other people. This can be someone’s agitation, disappointment, and anxiety. Negative emotions can be acutely and accurately perceived and ‘infect’ the autistic person, becoming a contributary factor for increased stress and a potential trigger for a meltdown.

While an autistic person may have a sensory system that is overly sensitive to external sensory and emotional experiences, there can also be a lack of perception of their internal sensory world, that is, a difficulty with interoception. This can include not being aware of the internal signals of hunger or needing to go to the toilet, body temperature, injury or imminent vomiting. Difficulties with interoception in autism can include difficulty perceiving and being consciously aware of increasing stress, especially emotional distress. There can be a mind and body detachment, and the internal signals of impending meltdown may not be recognized. Non-autistic individuals can perceive low level indicators of physiological and psychological stress and can also easily communicate and moderate their internal emotional state. An autistic person, on the other hand, may have alexithymia, that is, a difficulty explaining thoughts and feelings in words to communicate to someone that they are reaching breaking point. Eventually the level of distress is so intense that it is recognized, but at an intensity that is too great to be effectively controlled by the autistic person, or by those trying to moderate the degree of distress.

Cognitive overload

Autism is associated with a distinct profile of cognitive abilities that can contribute to increasing stress and frustration, leading to agitation and a meltdown. The cognitive profile includes less mental flexibility, or a ‘one track mind’. This means not knowing what else to do to solve a problem, quickly becoming frustrated and ‘hitting the panic button’. There can also be a difficulty mentally adjusting to change and transitions especially to a novel situation without a ‘script’ of what will happen, how to behave or what to do and say. Another cognitive cause of overload is having to cope with unclear instructions or expectations, and a need for prolonged processing time for information. This leads to a difficulty working at speed and coping with time pressure. Another cognitive characteristic of autism is stress from having to choose from multiple options, with a fear of making a mistake and being judged. There is also the potential of increasing stress due to ruminations over past slights, injustice, social rejection and bullying.

Social engagement

A core aspect of autism is a difficulty understanding people. Stress can be due to simply being with too many people, especially in crowded situations such as a shopping centre, station, or playground. There can be stress due to being in the presence of people who are not perceived as ‘autism friendly’. There is also stress from people making broken promises, such as saying, “I’ll be back in two minutes” and then not returning for four minutes and thirty seconds.

In social situations, there is an expectation that people are able to read facial expressions, tone of voice, gestures and social cues, while an autistic person may be able to intellectually process and ‘read’ this social information, it is exhausting for them. There is the potential to be confused by mixed messages, as in sarcasm, and determining the more subtle thoughts and intentions of others. There will be limited capacity for the duration of social engagement, and once that capacity has been reached, there is a risk of further social experiences being intolerable, which could contribute to a meltdown.

Social situations can also be associated with many aversive sensory experiences, such as being accidentally touched, the noise of shouting or applause, and the smell of perfumes and deodorants.

Signs of an imminent meltdown

Each autistic person will have a signature pattern of thoughts, behaviors and actions that indicate an imminent meltdown. The early warning signs may include knowledge that the person has probably come to the end of their ability to tolerate aspects of their sensory, cognitive, and social experiences. Signs of a more imminent meltdown can be a determination to escape the situation, engage in certain routines and rituals that serve to reduce anxiety and agitation, and avidly seeking access to a special interest as a thought blocker and energy restorative. Other signs can be increasing the volume of speech, and the use of obscenities, agitated gestures, refusing help or needing excessive reassurance. Talking about a specific topic or past injustice, or fragmented and incoherent thoughts and speech can also be signs of the level of agitation that precedes a meltdown.

Due to problems with interoception and alexithymia there may be few, if any warning signs perceived by the autistic person themselves or observed by others. A series of events may increase stress levels, lowering the threshold for a meltdown, and it may be one superficially trivial event that becomes the breaking point for the release of a build-up of stress over many hours or days.

A meltdown will be heralded by an increasing heart rate; a sports watch can be used to measure a person’s heart rate to indicate a meltdown is imminent. Another early warning system can be an Autism Assistance Dog or even the family dog. Animals may be able to perceive that a meltdown is about to happen sometime before the autistic person and their family members. The dog may seek the autistic person’s attention and become a distraction or engage in behaviour known to sooth the autistic person, thus reducing the likelihood of a meltdown.

How to manage a meltdown

There are two types of meltdown: one is outwardly directed, an explosion of emotional energy that is destructive, with feelings of rage and actions of destruction; the other is an implosion, with energy that is inwardly directed and expressed as intense despair, self-harm and suicidal thoughts. There is a potential third meltdown, or ‘shut down’. This is behaviour that acts as a means of self-protection. The person is physically immobilized, or ‘frozen’, and may even fall asleep as a means of ‘switching off.’

A meltdown is a psychological crisis, and there are recommendations regarding what to do and what not to do when a meltdown occurs. The following suggestions can help to minimize the depth and duration of a meltdown. The following suggestions are strategies to use in an outwardly directed explosion, or rage attack.

What to do in a meltdown

One person should take control of the situation.

The support person must remain calm, reassuring, and confident.

Affirm and validate the depth of emotion and explain that the feeling will eventually go.

Use calm, slow body language.

Use minimal speech.

Try to minimize eye contact for both of you.

If possible, be alongside the person rather than facing each other.

Keep other people away or encourage the person to take a position where other people are not visible to them.

Suggest a calming or distracting activity, such as an iPad, looking at information related to a special interest; or a mesmerizing activity, such as spinning and twiddling toys.

Accept restless behaviour, as this is a constructive means of discharging the energy inherent in a meltdown.

Praise compliance and calmness.

Suggest something to look forward to, or an enjoyable memory.

Suggest going to a quiet retreat area or separate room, or perhaps go outside in nature if possible.

An alternative option is to engage in a physical activity that constructively releases emotional energy, such as star jumps or press ups, or crushing items from the recycling bin.

Remember the meltdown can have a constructive function in releasing compressed stress and re-setting the emotion regulation system.

Wait patiently until the emotional storm has passed.

What not to do in a meltdown

Try not to:

Talk about punishment, consequences, damage, and cost.

Use reason when the person is too emotional to be reasonable.

Interrogate, that is ask for an explanation as to why the person is so agitated or distressed.

Encroach on personal space.

Turn the situation into a lesson.

Make sudden movements.

Correct agitated behaviours.

Match the person’s mood with your speech.

Criticise the person for being overly dramatic or selfish.

Use physical restraint.

Make critical, demeaning, or patronizing comments.

Facilitating emotional recovery

Eventually, the despair and agitation will subside. The autistic person may subsequently experience remorse or embarrassment and engage in self-criticism. In extreme cases, the person may have no memory of what happened, being confused and in a state of denial when a ‘post-mortem’ is conducted on their behaviour.

It will help to suggest a practical way of restitution and repairing feelings, for example, by asking the autistic person to clear up any mess or complete a household chore as a means of recompense.

When calm, the person may be able to give a coherent and logical description of why the meltdown occurred, preferably without fear of incrimination or increased consequences, which would inhibit an objective evaluation. There may need to be penalties that are mutually agreeable, and a focus on appropriate rewards for self-control in future situations when a meltdown may occur. It will also be important for everyone to learn from the experience, and to draw up a plan for preventing and managing a future meltdown. The plan will include more effective ways of perceiving, communicating, and expressing stress in the future.

The support person will also need to emotionally ‘debrief’ and express their thoughts and feelings in a non-judgemental conversation with someone who can express compassion. The conversation needs to focus on how well they managed the situation, and any new information that has been discovered that may reduce the frequency and intensity of meltdowns.

Recommended reading: From Anxiety to Meltdown (2011) by Deborah Lipsky, London, Jessica Kingsley Publishers.

Understanding challenging behaviour in classic autism

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Understanding challenging behaviour in classic autism

Classic autism is a term we use to describe our original conception of autism. A child or adult who has significant and conspicuous social, language, learning and behavioural impairments. We now use the term Autism Spectrum Disorder Level 2 or 3 to describe this expression of autism. Challenging behaviour can occur due to difficulties with communication, a distinct profile of cognitive and social abilities, sensory sensitivity and difficulty regulating emotions. There can also be movement disorders and medical factors that affect the behaviour of those who have classic autism.

Communication

One of the primary causes of challenging behaviour is frustration from not being able to effectively communicate thoughts and feelings. There is usually extremely limited speech which has not been replaced with a complex gestural communication system as occurs with deaf children. We are exploring the origins of the lack of speech which may be an expression of apraxia, that is a difficulty getting the brain into gear with the mouth and body. New therapies such as PROMT are designed to encourage speech by the specially trained speech pathologist using their hand to encourage jaw, lips, and tongue movement. There are also Apps to encourage vocalization and speech as well as advances in communication from Music Therapy and alternative and augmentative communication systems. It is important to remember that lack of speech does not automatically imply a lack of intelligence, and that for some classically autistic children, they learn to read before learning to speak.

When there is extremely limited speech, the signature mannerisms of autism are an effective means of communication. Parents and teachers often ‘translate’ the behaviour as thoughts such as “I can’t cope” or “I need help” or feelings such as jumping for joy or ‘in a flap’. These mannerisms can also be used as an early warning system of signs of distress and agitation.

Cognitive abilities

The cognitive profile associated with classic autism includes a range of characteristics that can affect behaviour. There can be a fear of making a mistake and a lack of cognitive flexibility such as not knowing what else to do. The overriding priority is to solve a problem rather than satisfy the social or emotional needs of others, with self-esteem from intellectual achievements. The learning style can be a ‘visualizer’ with a preference for a silent demonstration of what to do, and learning cognitive abilities and language from a computer or television screen. There can also be a talent and interest in identifying patterns and sequences and enjoying symmetry. However, there can be a very limited tolerance of frustration, with a tendency to quickly ‘hit the panic button’, having an intense aversive emotional reaction and giving up quickly to end the ‘pain’.

Social abilities

One of the central diagnostic criteria for autism is a deficit in social-emotional reciprocity, reading non-verbal communication and making and maintaining friendships. The social context can cause confusion, stress and feeling overwhelmed for autistic children and adults, leading to avoidance and escape behaviour. There are several relevant social dimensions such as the number of people in a room, intrusive peers and adults, and the duration of socializing. For an autistic person, socializing is emotionally and energy draining, rather than refreshing and enjoyable. There is a need for regular ‘oases’ of solitude, with a preference for solitude as an emotional restorative and for learning.

A characteristic of autism is to be extraordinarily sensitive to another person’s negative mood such as disappointment, anxiety, or agitation. There can be an avoidance of some social situations and specific people due to a perception of ‘negative vibes’ and quickly determining if someone is ‘autism friendly’. Some parents, teachers and therapists have an intuitive understanding of autism and facilitate social engagement rather than withdrawal.

We now have a range of programmes to encourage social abilities and confidence such as Social Stories developed by Carol Gray and ensuring social engagement, especially in a learning situation, that can be fun together.

Sensory sensitivity

Another diagnostic criterion for autism is sensory sensitivity. Specific sensory experiences are aversive and often painful. Repeated exposure does not automatically reduce the degree of sensitivity, but we can encourage endurance and develop avoidance and barrier strategies, such as vacuum cleaning the house when the child is at school, or using ear plugs or noise reducing headphones in the classroom or playground. The sensory profile associated with autism is complex including being overly sensitive to external sensory experiences such as sounds, lighting, touch, and smell, but lacking sensitivity to internal sensory experiences such as needing to use the toilet, hunger, and body temperature. Occupational Therapists have developed sensory assessment questionnaires for parents and teachers and strategies to moderate sensory sensitivity such as Sensory Integration and Processing Therapy.

An autistic child or adult lives in a world of terrifying sensory experiences and may have discovered a coping mechanism of being mesmerised by a repetitive action or sensation that ‘blocks’ the aversive sensory experience. Temple Grandin described how: “Intensely preoccupied with the movement of the spinning coin or lid, I saw nothing or heard nothing. People around me were transparent and no sound intruded on my fixation. It was as if I was deaf. Even a sudden loud noise didn’t startle me from my world. But when I was in the world of people, I was extremely sensitive to noise.”

The sensory profile associated with autism can also include craving specific sensory experiences, often avidly mouthing, touching, sniffing, or spinning objects.  The experience is perceived as enjoyable but can be distracting and disruptive in a school or community setting. Sensory Integration and Processing Therapy may also help with this type of challenging behaviour.

Regulating emotions

From early infancy, an autistic child or adult may be notorious for having intense anxiety, anger, or sadness, that seems to be an ‘on/off light switch of brilliant light rather than a gradually increasing dimmer switch. When extremely distressed the autistic child or adult is not responsive to reason, distraction, or compassion. There can be a meltdown that is outwardly directed and an energy explosion, or inwardly directed implosion. We are developing strategies for a meltdown that include a parent, teacher or caregiver not interrogating the autistic person as to why they are distressed, nor becoming emotional -especially expressing anger or affection and focusing on punishment and consequences to end the meltdown. It is important to affirm and validate the emotion, confirm the feeling will eventually go, to keep other people away, and perhaps using a special interest as an ‘off switch’.

Nearly all autistic individuals have high levels of anxiety throughout their day and intense anxiety associated with specific situations. This includes anxiety created by change, transitions and the unexpected, as well as the anticipation of aversive sensory experiences and abandonment (separation anxiety). To cope with anxiety an autistic child or adult may become very controlling of others and events in their daily lives, being oppositional and not complying with simple requests. Another coping mechanism is developing routines and rituals as a calming mechanism or engaging in a favourite activity as a thought blocker. An alternative effective coping mechanism is an explosion or melt down to discharge the emotional energy and to reset emotion regulation. There are strategies for each type of coping mechanism that becomes a challenging behaviour due to anxiety that includes the concept of an ‘Emotional Toolbox’ with a range of tools to regulate emotions and emotional energy. This can include regular physical activities, encouraging relaxation and self-awareness using mindfulness, mediation, and Yoga. There are additional tools in terms of medication for anxiety and depression.

Movement disorders and medical factors

Autism is associated with dyspraxia, a range of involuntary tics and akathisia or motor restlessness. These movement disorders will affect daily living skills and motor coordination and potentially cause frustration, stress, and distress. Advice may be sought from an Occupational Therapist or Physiotherapist. There are also medical factors that may affect behaviour and abilities, such as epilepsy, auto-immune disorders and poor quality and duration of sleep. Thus, the management of challenging behaviour in classic autism requires a multi-disciplinary approach, an understanding of autism and the function of specific behaviours.