Playing Detective

 

When I was a kid, I loved reading The Happy Hollisters series of books in which a family of five young siblings somehow finds themselves involved in mysteries they need to solve. Perhaps I was initially drawn to this fictional family because the oldest daughter is also named Pam, but I stuck with the series, reading every one I could find at the public library, fascinated by the ways these kids put together the clues to get to the bottom of the mysteries. Little did I know that as an adult, I would be solving mysteries of my own.

Because not enough is known about autism and because Alex’s communication skills are weak, I often find myself sifting through clues, trying to discern why he does some of the things he does. By putting together the research that I have done over the years––especially medical research––with careful observation of Alex, I can usually come up with potential reasons that have reasonable validity. Sometimes, however, I must sort through a wide variety of clues before I know the real reason.

Recently, Alex has been a little off. While his behavior has not been that bad, he just doesn’t seem quite like himself. Because we never want behaviors to escalate, we always try to get to the bottom of the problem right away. After having such a wonderful summer where he was content and cooperative, we didn’t want him to regress. Therefore, I went into detective mode and tried to figure out what was causing small changes in Alex.

Usually the culprit for behavioral challenges is yeast overgrowth in his digestive system, namely thrush, which makes his mouth and throat sore, causing him to be irritable. After dealing with yeast flares for more than three years, we recognize the symptoms and know that we must treat him immediately with antifungal medication to ease his discomfort and to prevent increasing agitation. Our experience has also taught us that yeast flares bring “abcd” symptoms: acne, behavior issues, coating of tongue, and dandruff. Fortunately, we didn’t see any of the telltale signs this time. Moreover, Alex seemed to be his usual pleasant self in the evenings, so an ongoing problem like yeast seemed unlikely. Therefore, we crossed yeast flare off our list of potential causes.

Another reason for Alex to be irritable is change. From past experience, we know that changes in routines can cause negative changes in his behavior. Although we considered that our returning to our teaching jobs after the summer off work might have bothered Alex, he seemed to be adapting to the transition reasonably well. In addition, he had maintained his afternoon schedule throughout the summer: Tuesdays with Jennifer for behavioral therapy, Wednesdays with Jessica for respite, Thursdays with Noel for music therapy, and Fridays with Jennifer for recreational therapy. Since his schedule had stayed the same, he didn’t have to adapt to any changes. In addition, we had not made any changes to his medications or supplements, so we couldn’t point to those as potential triggers for his being a little different.

After ruling out obvious causes, I then focused on potential environmental changes. While Alex doesn’t show typical seasonal allergy symptoms, such as sneezing, runny nose, or watery eyes, he has in the past acted irritable during allergy season. After checking the Weather Channel website and discovering that weed pollen has, indeed, been moderate to high in our area the past couple of weeks, I suspected that pollen could be bothering Alex. However, he usually does not want to be outside when pollen bothers him, and this week he has specifically requested to go outside in the yard, enjoying the fresh air. In fact, being outside seems to put him in a good mood, so pollen is probably not bothering him. Also, I suspected that some of the weather we’ve had lately could have affected him because he is like a human barometer who senses every change in air pressure, often acting irritable when the pressure is very high or low. Despite thunderstorms and a deluge of rain, he didn’t seem bothered by the weather.

Aside from the natural environment, Alex can also be annoyed by changes in the economy. Since he watches the business news channels faithfully, he is aware of oil and gas prices, stock market trends, and interest rates. At times, he has been very upset by high oil and gas prices and drops in the stock market. However, he has learned to take economic news in stride and not let changes upset him. In fact, he often compares various fluctuations to the stock market, knowing that things naturally go up and down, making observations, such as, “Temperatures are like the stock market; they go up and down.” Since Alex has come to realize that the economy fluctuates and watches the news without getting upset, we decided that he was not affected by the stock market, either.

After ruling out all of the usual suspects, I had to look deeper to figure out more clues and see what might be behind them. First, we noted that he typically seemed irritable in the morning and late afternoon, and he was at his best in the evenings, especially after a big dinner. During these times when he seemed off, we noted that he was anxious, impatient, fatigued, mentally foggy, and shaky. Although he has been getting a good night’s sleep every night, he still seemed tired in the morning. However, he would be energetic and active physically and mentally every evening. I wondered if he needed for his morning medications to take effect, but even when they should have been helping, he still was not quite himself. Moreover, when he was at his best every day, his medications would have been wearing off. I even considered that some of these symptoms could be side effects of some of his medications, especially the tremors that go along with lithium that he takes to regulate his moods.

Another factor I considered was the change in Alex’s waistline. Since Alex weighs himself every night before he goes to bed, I noticed that he has lost some weight. Although he looks quite healthy and has lost the belly weight caused by some of the medications he takes, something has caused him to drop those pounds. In thinking about his eating habits, I realized that once his obsessions about eating for set amounts of time or insisting upon three servings of food every meal had passed, he wasn’t eating as much as he used to eat. In addition, he didn’t seem interested in eating breakfast, nor was he snacking as much as he used to. Not wanting to force him to eat, we trusted that he knew what his body needed, but perhaps this was the culprit.

Realizing that he was at his best after eating a large dinner, I began to wonder if Alex was off whenever his blood sugar was low. After some quick research, I discovered that symptoms of low blood sugar include the following: fatigue/sleepiness, shakiness/tremor, anxiety, irritability/impatience, mental confusion, and dry lips. Alex had all of these symptoms. Consequently, I decided we needed to change his eating habits to see if eating more would alleviate the symptoms we’d been observing.

This week, Ed has been fixing Alex breakfast that includes fresh fruit every day, and we have increased the amount of food he eats for lunch, as well. In addition, we have been offering him healthy snacks, such as hummus, tomatoes, and bananas, all of which he especially likes. After just a few days of this new healthy diet, he already seems better. He has been more active mentally and physically in the mornings, and he doesn’t seem as anxious and irritable in the afternoons. Thankfully, he can afford to gain some extra weight, so we can feed him more without worrying about that consequence. Hopefully, we have figured out the problem and the solution, both of which are fairly simple. While I’m thankful that my childhood reading habits taught me the value of looking for clues and trying to solve mysteries, I’m even more grateful that God shows us the way and gives us the wisdom to help Alex be his best.

“Listen as Wisdom calls out! Hear as understanding raises her voice!” Proverbs 8:1

Smell and Taste Sensitivity in Autism

 

In last week’s blog entry, I discussed the issue of sound sensitivity, which is quite common in people with autism, and how listening to the EASe CD with modulated music helped Alex overcome his difficulty with loud noises, such as vacuum cleaners and hair dryers. This week, as I was reading various research articles from The Great Plains Laboratory, Inc. Facebook page, I ran across two interesting studies related to other types of sensory issues found in autism. Although Alex’s sensory issues have primarily focused upon hearing, sight, and touch, apparently many people with autism also have overly acute senses of smell and taste, as well.

A news report entitled “Study: Kids with autism don’t react to odors” describes research in which thirty-six children, half of whom had autism and half who did not, were presented with various smells through an olfactometer. [To read this article, please click here.] This tool delivered various scents through the nostrils and then measured how the children responded to those smells by how much they sniffed. Typical children breathed in longer for pleasant smells, such as roses, and breathed in a shorter time for unpleasant smells, such as rotten fish. In contrast, children with autism breathed in the same amount of time, no matter what scent they smelled.

The study notes that the response from the children with autism may be linked to a difference in perception of odors, or this may be a physical issue in that they cannot control their breathing in response to different stimuli. Either or both of these theories seem reasonable, since children with autism typically have sensory and motor issues. Whether this sniff response has possibilities as a diagnostic tool for identifying children who have autism is uncertain, but researchers noted that the observed responses might explain the problems many children with autism have with eating, since the sense of smell is closely linked to the sense of taste. However, as one autism researcher noted, the problems with eating may also be linked to motor problems in swallowing and chewing.

Although I’m not completely certain how well Alex can perceive smells, he will comment when he smells something unpleasant, telling us, “It’s too stinky!” and even leaving the room to avoid the smell he doesn’t like. Moreover, he will tell us to spray air freshener, saying, “Need Oust in here!” if the smell is mild. If the smell is too offensive, he’ll say, “Need to spray Lysol!” Also, he has recently begun to make comments comparing one smell to another, remarking, “It smells like french fries in here.” Consequently, he seems to deal with his smell sensitivities because he can verbalize ways to describe them and or even ways to eliminate those he finds offensive. Perhaps his control over smells is one of the reasons he is not a picky eater like many people who have autism.

In another article posted on The Great Plains Laboratories’ Facebook page this week, the Simons Foundation Autism Research Initiative recently published the summary of a research study entitled “Picky eating sways parents’ views of children with autism.” [To read this article, please click here.]  This study from Italy found no differences in behavior or physical issues, such as gastrointestinal problems, in children with autism who were picky eaters versus those who were more willing to eat a variety of foods. However, parents of children who were picky eaters perceived their children to have more behavioral problems and more stress.

Interestingly, the article notes, “the root cause of picky eating in autism remains unknown.” However, the article fails to address sensory issues that likely would impact the child’s eating habits. If the food smells strange or the texture does not appeal to the child, the child won’t want to eat it. Moreover, as the autism researcher in the previous article mentioned, difficulties in chewing and swallowing often found in autism would certainly play a role in eating problems. While this article focuses upon parents’ perceptions of picky eaters, underlying issues beyond the behavioral and physical components they examined are clearly at work.

As I have mentioned in previous blog posts, we are blessed that Alex has always been a remarkably good eater, willing to try any food. Moreover, despite the limitations his food sensitivities present that restrict him to a diet free of glutens and milk products, he eats a wide variety of foods. For most of his life, the only three foods he would not eat—other than those not permitted on his gluten-free casein-free diet, which he follows faithfully––were popcorn, broccoli, and mashed potatoes. In the past few years, he has even taken two of those foods off his list and now likes broccoli and mashed potatoes prepared without milk products. We suspect that his former dislike of those two foods was more from a texture standpoint than a taste and smell aspect. At this point, the only food he will not eat is popcorn, which he tells us is “too salty and too crunchy.” Needless to say, we are delighted that he is such a good eater; in fact, he eats a more varied diet than either of his parents. He loves seafood, which I despise, and he happily eats peas, carrots, and mayonnaise, which Ed avoids. Apparently, Alex does not have the smell and taste sensitivities that many people with autism have, and we are thankful for that.

While a great deal about autism remains a mystery, sensory issues, such as sound, smell, and taste sensitivity obviously impact daily life. If these hyperacute senses create stress, the person may either avoid uncomfortable situations or may react in ways to cope with the unpleasant stimuli. Often therapists who work with children who have autism will note, “Behavior is communication.” Meltdowns may be the only way some children with autism can communicate how overwhelmed they feel when they are assaulted with sounds, smells, and tastes that are too strong to handle. As parents, we need to find ways to help our children cope with the world that is often too much for them, and hopefully, research will find better methods to allow children with autism to enjoy the variety of sensory experiences in life so that they can live life to the fullest extent.

“Taste and see that the Lord is good. Oh, the joys of those who take refuge in Him!” Psalm 34:8

Recent Trends

Although I’m almost afraid to comment for fear of jinxing things, Alex’s obsession/anxiety/frustration about the computer game Monopoly Junior seems to be fading. On Friday, we took him to McDonald’s, where large posters advertised the current Monopoly sweepstakes, yet he did not seem fazed by the reminder of the game that currently annoys him so much. On top of that, as I waited in line, I saw promotional placemats with the Monopoly character Uncle Moneypenny and decided to get one for Alex, stupidly forgetting that his former love of the game has turned to hatred. As I brought him the placemat depicting the Monopoly logo and main character, Ed shot me a look as if to ask, “Are you crazy?” Trying to avoid the wrath of Alex, I suggested that I hold the placemat for him, but he seemed amused by the placemat rather than incensed. Thankfully, he accepted the Monopoly placemat in the spirit I had intended and didn’t hold my foolish gesture against me. However, that placemat found a home in the garbage soon after we came home—I wasn’t taking any chances that reminder might upset Alex.

Besides being pleased to hear less complaining about Monopoly Junior, we’re also happy to see that Alex has completely returned to his energetic self. During his bout with lethargy in the late spring and early summer that his chiropractic internist diagnosed as allergic shutdown, Alex would sleep twelve hours every night and lie on the couch most of the day, too tired to do much of anything. Over the summer, he gradually regained his former energy levels and now sleeps normally at night and acts as though he feels much better, bouncing through the house as he did before. Despite these positive changes, we’re also somewhat perplexed by some other recent trends we’ve seen in Alex. For example, his eating habits have changed a bit. Specifically, Alex has always savored his food, taking his time to enjoy a meal. We figured this was a trait he inherited or learned from Ed, who also takes his time to eat a meal. As one who eats rapidly (which I blame on childhood years of eating in the school cafeteria, where I had to inhale my food to make sure I finished lunch in the short amount of time we were allotted), I find myself constantly waiting for Alex and Ed to finish a meal. Lately, Alex has also taken to eating rapidly, downing his food as though someone might steal it from him, then looking earnestly at Ed to gain permission to be excused from the table. I’m guessing that he hurries to eat so that he can go do other things he wants to do, such as watch television or use his computer. Although we’re surprised by this sudden change, we’re thankful that he has a hearty appetite, eats a good variety of foods, and never complains about what food is put before him.

The most surprising difference in Alex has been his current aversion to grooming. Previously, Alex loved being groomed and seemed to crave the sensory stimulation he gained from having his hair combed or his teeth brushed. He actually enjoyed having me cut his hair, even asking for haircuts long before he ever needed them. In addition, he liked getting a shave, to the point he would smile so much as I used the electric razor that I had trouble getting his upper lip shaved. Currently, he is in need of a haircut and a shave, which gives him sort of a rumpled look. Thankfully, he willingly bathes daily and will barely tolerate brushing his teeth, which I insist he must do. As for the shaggy hair and whiskers, I’ve decided this battle isn’t worth fighting so long as he keeps his hair and face clean. While I tend to attribute most trends to autism and sensory issues, I suspect he is probably just engaged in some form of teen rebellion with regard to his hair and beard, and the less we say, the better. I guess it could be worse; I’ve seen pictures of Ed when he wasn’t much older than Alex, and his hair was much longer, or he could be like my nephew, whose mother wasn’t thrilled when recently shaved part of his head to create a Mohawk for his senior football season. Fortunately, phases usually don’t last long with Alex, so I’ll try to wait patiently until he decides that he’d like a haircut and a shave, just so long as he doesn’t start talking about Monopoly Junior again.

“Gently instruct those who oppose the truth. Perhaps God will change those people’s hearts, and they will learn the truth.” 2 Timothy 2:25