3 weeks ago



Justin 39 “insistence

Justin 39 “insistence on sameness” as a coping mechanism for the anxiety that accompanies their dementia. But, while it’s true that some people with autism and AS are anxious in social situations, many people with true anxiety disorders do not show the preference for repetitive stereotypic interests and activities that people with autism show. Moreover, children with autism and AS will engage in repetitive activities even when they are not feeling stress. On balance, therefore, it seems that these first two theories are not comprehensive enough to be helpful in explaining the origins of repetitive behaviors. A third hypothesis is that these behaviors actually represent a type of OCD. It’s true that people with OCD perform many rituals and engage in repetitive activities as well. OCD is an anxiety disorder, and there are many similarities between ASD and OCD, but these are more apparent than real. People often say that a child with autism is “obsessed” with spinning wheels. This is not precisely true. A true obsession is experienced as uncomfortable, recognized as nonsensical by the person enacting the behavior. Rituals in OCD are engaged in as a way of avoiding the obsessive thought, and, as a result, that ritual is also experienced as distressing. But most repetitive activities are experienced as pleasurable by children with autism and AS. It is fun, not something to be avoided. Indeed, many parents wish their child would avoid some of these activities. This is quite different from the emotion experienced by people with true OCD. Some people with ASD do develop true OCD over and above the ASD. But that may be quite a different phenomenon and often does not occur before adolescence. Two other theories are perhaps more plausible and help to explain why children with autism and AS have such difficulty in imaginative play. Uta Frith and Francesca Happe note that people with autism have great difficulty in integrating perceptual information from a variety of sources but are better than ordinary people in seeing details. We see figures against a background and integrate information from both to generate meaning. In contrast, people with autism and AS pay more attention to the figure and ignore the background. The Embedded Figures Test clearly illustrates this ability. The person taking the test looks at pictures composed of many dots. Those who don’t have ASD tend to realize that some of the dots make up a recognizable figure only upon looking very closely. Much more quickly than the rest of us, people with autism see those figures embedded in what, at first, looks like a meaningless tangle of dots. Frith and Happe interpret this ability as a preference for local information processing over global processing. This

40 A MIND APART means people with autism cannot see the forest for the trees, but they see the trees in exquisite detail! This weak central coherence (as they call it) leads to an inability to extract meaning from the context of a situation. So people with autism and AS are stuck repeating the same stereotyped responses to the environment because they cannot integrate information from other sources to modify their behavior. They cannot use their knowledge of the forest to find a path through the trees. Imaginative play requires the ability to think of this plastic object as a doll and in turn to pretend that it is a real baby. The child has to go beyond the thing in front of her and imitate a repertoire of behaviors illustrated by a parent. That imitation integrates information from another time and place with the object in front of the child’s eyes. Without that ability to imitate and integrate, the child is stuck with the thing itself, and the pleasure associated with play becomes attached to it. The other popular theory proposed to explain repetitive stereotyped behaviors and interests is that people with autism suffer executive function deficits. Executive function is a general term referring to the voluntary control, monitoring, and execution of behaviors and actions. It allows the person to disengage from the immediate focus of attention in order to pursue a goal, taking into account all available information. In some sense, executive function represents the supervisory aspect of cognition. The ability to monitor one’s attention to attain a goal resides in the frontal lobes of the brain. It is a complicated cognitive skill and is composed of many constituent parts. One important part is the ability to shift attention voluntarily and effortlessly from one setting or stimulus to another. My colleague Susan Bryson has pointed out that people with autism have extraordinary difficulties in shifting attention from one thing that catches their interest to another stimulus, even if that stimulus is also of interest. This difficulty is apparent at a very young age and is often remarked on when parents say their child spends a lot of time staring at the mobile in the crib or at the TV. It may also explain why children with autism spend so much time in front of the computer or playing with the same objects over and over: Their attention gets “stuck” in the moment, becomes locked into a particular stimulus, and the ability to easily shift attention to something else is not available to them. This difficulty in disengaging attention (particularly visual attention) could lead to the child doing the same thing over and over again and becoming fascinated with perceptual detail. A child who cannot shift attention will tend to repeat behaviors and activities without variation.

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