What follows is the continuation of a story of my work with a little boy with autism and his family. To learn more read the first post and participate in the conversation in the comments below!
This morning I came into Jay’s playroom and he immediately went out. He had been playing on the floor with a volunteer Kristin, but given the open door he ran out. He ended up outside playing on the swing – and who can blame him? On a beautiful sunny day I would have wanted to be outside at 10 years old, too.
Jay’s mother coaxed him back inside, upstairs after I had set up the room and begun checking in with Kristin about out the morning had gone (smoothly, quietly). Mary continued the conversation and explained that Jay had a melt-down earlier in the morning, which lasted an unusually long time. She seemed fine with what he had been doing, though of course it was her preference for him not to be shouting and screaming. With someone less experienced at handling meltdowns calmly I might have coached or asked some loving questions about her experience. As it was, I turned my attention back to Jay.
Jay was pacing the room with a degree of frenetic energy and making a loud, piercing wailing sound. He didn’t look especially uncomfortable and was not asking for help, but judging just from his noises it certain sounded like he was uncomfortable. I began by joining him physically in his standing position, with my hands on his hips from behind. I immediately noticed that he paused in his wailing to note what I was doing. As I continued with my hands on him, his gaps of silence increased steadily until he was no longer making noise. Only then did I turn to Mary and inquire if he was unhappy. She explained that he was imitating, probably someone he had heard crying previously. For a reason known only to Jay, he was making the expression of someone in pain without actually experiencing that discomfort himself. It is very useful to make this check-in – is a child or adult actually experiencing what they seem to be expressing? We can’t know for sure, without checking but there did seem to be a disconnect between the noises Jay was making and the rest of his affect. By asking the person who knows Jay best (his parent) I confirmed that he wasn’t actually upset, but using the imitation as a form of self-regulation.
Jay has developed a habit of flopping down on his bed or my table, which I take as a sign of consent and even enthusiasm for continuing our work. He did this three or four times during the course of the session. Over time I will encourage him to express more and more clearly when he does (and does not) was movement. Like yesterday, when he moved my hand from his calf to his ankle, I will continually invite him to express himself clearly. However, even just by being persistently inviting and taking anything that is not a “no” as a “maybe, yes” I find that we continue to move forward.
One interesting thing Jay asked for twice during the lesson this morning was for us to lift up his mattress, whereupon he crawled underneath it, and said “Close.” On the one hand I enjoyed making forts as a child (and sometimes still do!) and have always found pressure (tight sheets, weighted blankets, etc.) to be comforting. On the other, this new activity had me asking myself the question: “How come?” I don’t know why Jay wanted to crawl underneath the weight of the mattress but it is useful to speculate. I know, for example, that the physical release of the movements I apply can result in feeling emotionally vulnerable. Perhaps Jay is hiding because he feels stressed or insecure. Especially given the extended tantrum his mother mentioned earlier, this is a useful viewpoint to consider.
While Jay was underneath the mattress I invited Kristin to come onto my table for a session herself. I began, as I always do, by asking about her physical history: injuries, chronic pain, etc. and explained that I expected everything we were going to do to be very comfortable, to please let me know if it was not. She described falling down while wearing heels and tearing her ACL – a ligament in her knee. Knowing this would then affect how I would give her a lesson, specifically but not targeting that knee and moving especially slowly around anything that could affect the site of injury. Actually, I started as far from the site of injury as possible – at the opposite shoulder.
As I began to work with Kristin Jay crawled out from underneath the bed, sat and then cuddled up next to her. Then he began to crawl on top of her with his knees on her belly. I have not yet found a way with Jay to teach him when he is hurting someone. Without meaning to, both today and yesterday I have observed him causing pain and completely unaware of the effect of his actions. This sort of teaching has to be done very carefully because it is so easy to react angrily when we are hurt, but it is also possible to completely put aside that personal discomfort for the “greater good” of helping Jay. For example, as I was walking up the stairs to his playroom he threw back his head and hit my nose quite hard. It hurt quite a bit but as he was completely unaware of what he had done it would have caused no positive learning for him to recognize the effects of his action. So, instead, I relaxed into the pain of my nose, made sure I wasn’t going to start bleeding, and then moved forward with our work. I didn’t think about or feel pain in my nose until after we had finished together. This sort of resilience training is an essential part of working with children with autism. Still, though, the question remains, how do we gradually teach Jay of the impact his actions without turning our reactions into something that Jay enjoys and thus does more of?