Monday 6 May 2019

Triad of Impairments Part Three - Restricted and Repetitive Behaviours, Activities and Interests.

Earlier this year, I was asked to present at a professional development session for early childhood educators. The presentation? All about Autism and Sensory Processing Difficulties.

The presentation was received so well that I thought that I would use part of my presentation on my blog as I'm often asked questions about Autism and O and L. So here goes!! 

This is Part Three in which I'll focus on Restricted and Repetitive Behaviours, Activities and Interests.

You can access Part One - Communication Impairment here and Part Two - Impairment in Social Interaction here!

Individuals diagnosed with Autism have difficulties in three main areas. These areas are known as the Triad of Impairments.

3. Restricted and Repetitive Behaviours, activities and interests.

Before I begin to discuss the third area, Restricted and Repetitive Behaviours, Activities and Interests, please keep in mind that many of these traits are present in typically developing children. The difference in those diagnosed with ASD is the intensity in which these traits present. In a child with ASD, the traits are much, much more intense and they are ongoing. I’m going to refer to children with Autism but all of these traits may be present in Autistic adults as well.

Individuals diagnosed with Autism often have a restricted and repetitive range of behaviours. Again this can be present in typically developing children, the difference is the intensity.

Children may play with objects in an unusual way. Children may show repetitive interest in spinning the wheels of a toy car, rather than playing with it in an imaginative way or pushing it along the ground. They may line objects up or arrange objects in groups – L likes to line objects up, O likes to group objects which makes life very interesting and very loud at times when they’re lining and grouping the same set of objects.

Children diagnosed with Autism may not play “pretend” games, they may not imitate others or use toys in creative ways, however, be mindful as these traits can also be seen in children without Autism. They may prefer to stack objects rather than play with them in a more traditional way. They may prefer to play with toys that are not necessarily age appropriate.

They may only play with a few toys – for example, L’s interest has always been all things superheroes. Almost any game that he plays will always be with his superhero figurines, toys and cars. And if he starts off playing a game that doesn’t involve superheroes L will invariably be turned into a superhero game. Individuals may have a restricted interest in a very narrow topic area - O’s interest is all things space – she can tell me anything and everything about moons, planets, stars, asteroids and so on, yet will struggle to tell me about her day at school.

Children diagnosed with Autism may repeat the same actions or movements over and over again, such as flapping hands, rocking, twirling, they may wriggle their fingers, stroke their hair over and over, walk on tippy toes, bounce on the spot, spin on the spot and so on. This is known as stimming and it is a self-regulatory behaviour. Stimming is how individuals manage their own emotions and quite often an individual will present with different stims for different emotions.

Children diagnosed with Autism may have repetitive speech patterns or echolalia. Individuals may say particular phrases or words that they’ve heard over and over. When answering a question they may repeat the question back to you before answering the question. They may be able to echo back to you or mimic words that you ask them to say. Below is a clip of L and his echolalia.

L was non-verbal up until the age of three. At the age of three when he was diagnosed with ASD he voluntarily could speak a grand total of 20 words however if you asked him to say a word like “dog,” he could usually repeat it back, however, these words were never used in his day to day vocabulary. Even now he will revert to using echolalia when stressed. 

Keep in mind that echolalia is developmentally appropriate for young children – think of babies babbling. Babies will babble mimicking their parent's tone of voice and sounds that they hear. This is echolalia. When a child echoes back to you what you’ve just said, they are recalling a memory in their brain on how to reply to you. Echolalia gives a child time to process what you have asked of them. 

A child with Autism may also use Scripted Speech – they may recite lines from movies or television shows word for word and they’ll often recite particular phrases at particular times. Scripted Speech is often associated with emotions – if they’ve heard something when they are sad, they may repeat the phrase each time that they are sad.

Many prefer routine and will do the same thing the same way each and every time. They may have difficulty in flexibility with these routines. Children with Autism have a strong preference for routine and predictability. They may resist an activity that they are not familiar with. Many children with ASD thrive in environments that have routine, schedules and structure as they are predictable. If their world operates the same way every day, they feel safe.

Individuals may display unusual distress or unusual reactions to everyday sights, sounds and movements - which is Sensory Processing Difficulties!

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