Sunday, July 8, 2018

A New Approach to Interpreting Autism Behaviors

Because impaired social skills are usually associated with autism, researchers have often concluded that most people with autism prefer not to interact with others. However, a fascinating research article recently published online in the journal Behavioral and Brain Sciences contradicts previous assertions that people with autism lack motivation to engage with others socially. In “Being vs. Appearing Socially Uninterested: Challenging Assumptions about Social Motivation in Autism,” psychology professors Vikram Jaswal, the father of a daughter with autism, and Nameera Akhtar provide a fresh and informed perspective as to why people with autism engage in behaviors that may appear anti-social.

In their 84-page article (which can be accessed by clicking here), these researchers examine four behaviors commonly seen in autism and previously attributed to a lack of social interest: limited eye contact, infrequent pointing, repetitive body movements, and repeating phrases, or echolalia. As they conducted their research, they used interviews of children and adults with autism and their families, considered alternative reasons for behaviors, and examined unique ways people with autism use to express their interest in socializing. Explaining their novel approach, they note, “These steps are crucial, we believe, for creating a more accurate, humane, and useful science of autism.”

Previous scientific studies asserted that people with autism preferred not to interact socially. To demonstrate this view, the authors cite earlier research in which people with autism are described as “confined in their own world,” possessing a “powerful desire for aloneness,” and having “little or no social interest.” In contrast, the authors point out that behavior does not always truly reflect thoughts and feelings, providing the examples of people who smile when they’re sad or people whose Parkinson’s disease affects their speech that could make them appear aloof. While some behaviors in autism may be deliberate, such as avoiding eye contact due to anxiety, others can’t be controlled, such as repetitive hand movements. The authors assert, “These unusual behaviors do not have any necessary relation to social motivation, and some may constitute adaptive responses to the unique circumstances of being autistic.”

The first behavior discussed in this article, eye contact, is often considered lacking in autism. As the authors note, eye contact varies even among typical people, depending upon their personalities and their cultures. Too much or too little eye contact can give the perception of being rude. In addition, “gaze aversion,” or looking away, proves helpful for typical people as well as those with autism to help them concentrate and solve difficult problems. In their interviews with people who have autism, the authors discovered that people with autism might avoid eye contact because they find it easier to focus on what the other person is saying. Also, some people with autism find eye contact overwhelming or uncomfortable. They want to engage with others, but looking them in the eyes may be stressful, so they avoid eye contact, which may help them better focus on what the person is actually saying.

Another behavior that may be lacking in children with autism is pointing to obtain things or to share experiences or to draw attention to something. While this lack of pointing has been thought to be an indicator that children with autism do not wish to engage in social behavior, the authors instead conclude that motor impairments are the true reason. In interviews with people who have autism, they revealed difficulties in being able to move the ways they wanted. One adult with autism commented, “I had very little sensation of my body.” Consequently, pointing may not be an issue with social motivation but instead caused by motor and sensorimotor deficits. In addition, people with autism may have different interests than others and have different opinions as to what is worth sharing. As one adult with autism noted, ‘I’m not entertained by the ordinary things that most people enjoy.”

Along with lack of eye contact and pointing, repetitive body movements in autism have been connected to a lack of interest in socialization. These stereotypical behaviors include hand flapping, spinning, rocking, and finger flicking. For people with autism, these self-regulatory behaviors often act as coping responses to anxiety. As the authors note, all people engage in these types of behaviors; typical people might twirl their hair, bite their nails, or drum their fingers when stressed or bored. In people with autism these behaviors may be involuntary or intentional, but the authors emphasize that none of them have anything to do with social connections.

The fourth category of behaviors commonly associated with autism, echolalia, deals with the verbal repetition of words and phrases. These utterances may be dialogue people with autism have heard on television or in movies, or they may repeat words and phrases they have heard others say. Typically, researchers have deemed echolalia as meaningless, and this type of language is discouraged in children with autism. However, the authors reject the notion that echolalia serves no purpose; rather, they compare it to early language development in small children. They state, “But just because a listener is unable to decipher the meaning of an utterance in a particular context does not mean that the speaker did not have one in mind.” For some people with autism, echolalia conveys anxiety and may help with stress, just as a typical person repeats a mantra. Some may use echolalia to get others’ attention by using phrases they can say easily, and what others perceive as “nonsense” may be a phrase misunderstood because of difficulty with pronunciation. Therefore, the authors emphasize the need to find meaning and make connections in echolalia because this behavior indicates the person with autism needs and wants to interact through communication.

By re-examining these four behaviors common in autism, the authors conclude that people with autism want to interact with others, but they have different ways of showing this interest in socialization. Moreover, they contradict previous views of autism behaviors as deficits in social motivation by offering valid alternate explanations, supported by interviews with people affected by autism. Finally, they point out that the previous perception of people with autism lacking social motivation negatively affects research and intervention. For example, therapists, teachers, and parents often encourage children with autism to make eye contact and discourage them from using repetitive motions and echolalia. These attempts to change behaviors may leave the child with autism frustrated and anxious, and the child’s “motivation to engage with someone might diminish.” Ironically, in trying to make the child more social, these methods may make them less social. In addition, some therapists, teachers, and parents may mistakenly believe that children with autism do not want to interact with others and leave them alone. Again, in misunderstanding the behaviors, they may not provide precisely what the child needs and wants––social interaction with others.

With Alex, we have witnessed how the common behaviors of autism have faded over time. His eye contact has improved as his anxiety has subsided, but if he is concentrating on something, he may need to look away. When he was little, he had trouble pointing to things, and would use his flat hand instead to point out something. Clearly, his fine motor delays hindered his ability to use his index finger as a pointer. Over time, he has gained a bit more control and can point to things, usually words (often on signs) he wants us to see or insects he wants us to remove from his vicinity. Although Alex doesn’t repeat lines from television or movies, he does have certain pat phrases he repeats throughout the day. Several times a day, he tells us about “young voices” he heard on television or dates that have special meaning for him or certain events he remembers. When he’s really upset, he’ll complain about gas prices or not wanting to use a typewriter. Though these comments may seem out of place, he has trouble expressing himself, especially when he’s anxious, and he knows these phrases will cue us he’s concerned. Speech has always been a struggle for him, and he relies upon phrases he’s perfected through many repetitions to get our attention, share experiences, and convey his thoughts and feelings. He obviously wants to interact with others, but delays in language and motor skills, along with sensory issues, make socialization difficult. Nonetheless, Alex shows perseverance and continually works to overcome these obstacles of autism.

While autism may remain a mystery to many, those of us who parent children with autism have learned many of the secrets they hold in their minds that process the world differently than the rest of us. That the father of a child with autism would pursue the real reasons for common behaviors, despite how they contradict the tenets held by most autism researchers, doesn’t surprise me a bit. When all the pieces of the so-called autism puzzle are finally found and assembled, the workers around the table are likely to be parents of children with autism, striving and seeking to find ways to make their children’s lives the best that they could be.


“There is no speech and there are no words, yet their voice is heard.” Psalm 19:3

2 comments:

marjorie said...

This is such helpful info. Thank you!

Pam Byrne said...

Thank you, Marjorie, for your nice compliment! Hope you and your family are doing well.

Fondly,
Pam