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Routines, Rituals and Obsessions in Kids on the Autism Spectrum

“My 5 year old son is high functioning autistic and has an obsession for fans, and it’s been going on almost 6 months now. He talks and even draws a table fan constantly. He calls anything round a fan (even though he knows the real name of the object), but he imagines it to be a fan and moves those objects like a top. He can spend hours playing with them. He will collect all the fans in the house and line them up like toy soldiers. I am concerned that his passion for fans has turned into an obsession. In fact, now he knows more about them, the hand fan, ceiling fan, table fan, exhaust fan, and so on. This is the only ‘peculiar’ issue I have with him (for the moment anyway). What does all this mean? Should I be concerned? Should I do something about it? If so, what?!”



Rituals and obsessions are one of the hallmarks of High-Functioning Autism (HFA) and Asperger’s (AS). In order to cope with the anxieties and stresses about the chaotic world around them, these children often obsess and ritualize their behaviors to comfort themselves. While some may spend their time intensely studying one area, others may be compulsive about cleaning, lining up items, or even doing things which put them or others in danger.

Some kids with HFA develop a resistance to (or fear of) change, that then involves being rigid in their approach to their environment. Insistence on sameness, routines and rituals begin. For example, certain items must be placed in particular places and not moved, certain routes must be followed to and from familiar places, objects may be stacked or lined up in a repetitive manner, or particular silverware and plates must be used - or the youngster refuses to eat or drink.
 
==> How to Prevent Meltdowns and Tantrums in Children with Autism Spectrum Disorder

Confusion about coping in a world that is overwhelming influences this behavior, so the youngster with HFA responds to this uncertainty by being in control of their immediate environment, the objects in that environment, and the people in it. Repetitive motor mannerisms may occur when autistic kids are excited, anxious, or worried. For others, sensory sensitivities and the physical enjoyment may drive repetitive jumping, arm flapping, twiddling of fingers in front of their eyes, and covering ears and eyes with their hands.

The memory of a youngster with HFA is no better than that of “typical” children, but the huge collection of facts he knows (in this case, about fans) usually represents the amount of time and effort that has gone into accumulating knowledge on the subject to the exclusion of much else. The obsessions are not necessarily characterized by memorization of data alone.

The term “systemizing” applies to the “fascination with data” that has inherent networks (e.g., maps, weather patterns, airline schedules, etc.). Although it is commonly thought that obsessions can be strengths that can be utilized in the educational process, these obsessions can interfere significantly with other important daily functions. Children with HFA are more interested in systems that can be described as “folk physics” (i.e., an interest in how things work) versus “folk psychology” (i.e., an interest in how people work).

Repetitive behaviors and mannerisms in HFA children is a somewhat neglected area of research. In the past, these behaviors were associated with lower levels of functioning, because repetitive motor mannerisms are also seen in kids with intellectual disability who do not have an autism spectrum disorder. These behaviors were also thought to increase during the preschool years. There is now some evidence that repetitive motor mannerisms develop differently to “insistence on sameness,” and these behaviors follow different paths over time.

Restricted and repetitive behaviors show different patterns of stability in HFA kids based partly on the ‘subtype’ they belong to. Young kids with low NVIQ (i.e., non-verbal IQ) scores often have persistent motor mannerisms. However, these behaviors often improve in kids with higher nonverbal IQ scores. Many autistic kids who do not have “insistence-on-sameness behaviors” at a young age acquire them as they got older, and some who had these behaviors sometimes loss them.

Obsessions aren't always so bad, especially if they have some educational or healthful value. But, when mixed with the mental makeup of a child on the autism spectrum, problems may arise. Kids with HFA and AS have trouble with social and emotional development and understanding the nonverbal cues in a conversation. While they are more than happy to start discussing their subject of obsession to another person, they won’t notice whether or not the other person is interested.  They may not get the hint of a person's disinterest or lack of time to talk. They may instead proceed to follow another person around continuing to talk on and on about their area of fascination. They may go right up to someone else already engaged in conversation and interrupt them to begin associating their topic of interest with their obsession, or they may take over a conversation and talk endlessly not leaving much time or room for any feedback from the other person.

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

Kids with HFA and AS may become so obsessed with a particular item, toy, game, or subject, that they may push friends away unknowingly. They may leave little time for anything else, thus homework and chore assignments often suffer. Also, they may become too easily distracted, always thinking back to their obsession and unable to stay on task.

Examples of obsessive, ritualistic behaviors include:
  • cleaning rituals
  • compulsion to make lists and/or schedules
  • counting rituals
  • feelings of excessive doubt and caution
  • hoarding and collecting things
  • obsessive need for cleanliness
  • ordering or arranging objects
  • perfectionism (that may sometimes interfere with task-completion)
  • preoccupation with order and organization
  • preoccupation with remembering and paying attention to minute details and facts
  • repeating rituals (e.g., going in and out of doorways, needing to move through spaces in a special way, rereading, erasing, rewriting)
  • rigid following of rules and regulations
  • rigidity or inflexibility of beliefs
  • rituals to prevent harming self or others
  • rituals to undo contact with a "contaminated" person or object
  • stubbornness
  • touching rituals
  • unreasonable insistence that others submit to his way of doing things



How parents can deal with rituals and obsessions in their HFA:

1. Promote social skills— A youngster with HFA does not learn the social norms and common sense ideas the same way “typical” kids do. He may never completely understand the reasons why things matter socially. He may not see any reason why he shouldn't devote all his time to his one major fascination. Moms and dads can take consideration for their child’s passion, but also help him become a more socially rounded person. It is important, however, if a child fixates on a particularly bad habit or inappropriate subject matter, that the parent put an end to it immediately.

2. Choose battles wisely— Breaking an obsession or ritual is like running a war campaign. If not planned wisely, or if parents attempt to fight on many fronts, they are guaranteed to fail. Not only is it time consuming and tiring, it means the parent can't devote 100% to each particular area. So, for example, if you have a youngster with (1) a game obsession, (2) a phobia of brushing his teeth, AND (3) bedtime troubles, choose only one to deal with. Deal with the worst problem first!

3. Consider multiple therapies— Many children can do well with behavioral therapy alone, while others will need a combination of behavioral therapy and medication. Therapy can help your youngster and family learn strategies to manage the ebb and flow of symptoms, while medication often can reduce the impulse to perform rituals. Behavioral therapy, also known as cognitive-behavioral psychotherapy (CBT), helps children learn to change thoughts and feelings by first changing behavior. It involves gradually exposing children to their fears, with the agreement that they will not perform rituals, to help them recognize that their anxiety will eventually decrease, and that no disastrous outcome will occur.
 
==> How to Prevent Meltdowns and Tantrums in Children with Autism Spectrum Disorder

4. Limit special interests— Moms and dads need to take care to allow their HFA youngster to be passionate about certain subjects, but to not let it entirely rule his life. If, for example, he is overly obsessed with playing video games, it is appropriate to give him some time to play, but the time should be limited. Even if the subject of fascination is reading books or doing science experiments, it is still important that time be given to other subjects, or just to get out to get some exercise.

5. Use the “special interest” as a learning tool— Moms and dads should take some time (emphasis on “some”) to listen to their child as he talks about his special interest, and even learn about what is so fascinating. For example, a parent who will take the extra initiative to go visit a planetarium for their child interested in space, or take a trip to a dinosaur museum for the child obsessed with dinosaurs, will give their child the extra support and assurance he needs.

6. Weigh the pros and cons— Parents should ask themselves the questions “How much of a problem is it?” …and “Who for?” The answer is often that these behaviors are a problem for parents and teachers rather than the youngster himself (who is very happy to be preoccupied with his favorite activity). Thus, it is unlikely that the youngster will want to change his behavior. The rules of thumb when making decisions about whether or not to intervene or change routines and rituals are to ask yourself the following:  Does the behavior endanger the youngster or others? Does the behavior increase the likelihood of social rejection or isolation? Does the behavior interfere with or preclude participation in other enjoyable activities and an education program? If the answers to these questions are “yes,” then an intervention is highly recommended.

7. Find the right therapist— Repetitive rituals and routines can sometimes worsen if it's not treated in a consistent, logical and supportive manner. So, it's important to find a therapist who has training and experience in treating this issue. Just talking about the rituals and fears has not been shown to help repetitive rituals, and may actually make it worse by reinforcing the fears and prompting extra rituals. Family support and cooperation also go a long way toward helping a youngster cope with repetitive rituals.

8. Teach self-talk methods— Some treatment plans involve having the youngster "bossing back" the repetitive rituals, giving it a nasty nickname, and visualizing it as something he can control. Over time, the anxiety provoked by certain unwanted stimuli in the environment and the urge to perform rituals gradually disappear. The youngster also gains confidence that he can "fight" repetitive rituals.

9. Remain calm— When tackling any problem with your youngster, it's always best to remain calm at all times. “Special needs” children will feed off the parent’s anger, frustration and anxiety. So, keeping a level head at all times is essential. If you feel a situation is escalating and elevating your blood pressure, take a step back and collect yourself.

10. Provide predictability— If your HFA youngster has trouble managing his mood and behavior when changes in his daily routine occur, try to provide him with as much predictability as possible. This can be accomplished by creating a highly structured environment where daily tasks take place in a certain order, and things are physically in order. For example, (a) warning your child ahead of time of upcoming changes in order to help prevent upset, or minimize it; (b) providing lists, charts and calendars on the wall to help your youngster see what will happen each day; and (c) using bulletin boards with individual cards for each task that you can move around with pins, calendars you make on your computer, or dry-erase boards that will make it easy for you to post the changes without having to recreate the list every time there is a change.

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

While many young people with an autism spectrum disorder display inflexibility and rigidity, sometimes the symptoms are extreme and may warrant an additional diagnosis of Obsessive-Compulsive Disorder (OCD). If your child’s obsessions negatively affect daily functioning (i.e., interferes with school work or personal hygiene, compromises social interactions, produces a sedentary lifestyle, etc.), then consider seeking advice from a professional who is an expert in autism spectrum disorders.

So, when is a “special interest” simply a “special interest,” and when is it legitimate OCD?

OCD is a chronic illness, a type of anxiety disorder characterized by obsessive thoughts and compulsive behavior. Unlike other anxiety disorders, the youngster knows that such thoughts and behaviors are irrational and silly, but can’t prevent himself from having them.

With OCD, there are obsessions. Obsessions are defined as “distressing ideas, images or impulses that repeatedly intrude into the child’s awareness.” These thoughts are typically experienced as inappropriate, anxiety-arousing, and contrary to the child’s will or desires. Common obsessions include (a) the need to have things “just so”; (b) the need to tell, ask, or confess; (c) contamination (e.g., fear of germs, dirt, etc.); (d) excessive religious or moral doubt; (e) forbidden thoughts; (f) imagining having harmed self or others; (g) imagining losing control of aggressive urges; and (h) intrusive sexual thoughts or urges.

However, obsessions are not the only telltale sign for OCD. Another symptom of OCD is compulsions. Compulsions are "repetitive behaviors or rituals that the youngster performs to counteract the anxiety and distress produced by obsessive thoughts." Common compulsions include checking, counting, hoarding, ordering/arranging, praying, repeating, touching and washing.
 
==> Parenting System that Reduces Defiant Behavior in Teens with Autism Spectrum Disorder

Some of these compulsions are easily witnessed, but this is not always true. Not all compulsions are obvious; many are mental processes (e.g., counting, praying) and harder – if not impossible – to notice. Typically, the compulsions correspond to the obsessions. For example, (a) aggressive, sexual, religious and somatic anxieties result in checking; (b) an obsession with hoarding leads to collecting; (c) fears of contamination are accompanied by hand washing and cleaning; and (d) the need for symmetry produces ordering, arranging, counting and repeating rituals.

If your HFA youngster really has OCD, he will recognize that the obsessions or compulsions are excessive or unreasonable – he knows that what he is doing makes no sense. Many people who developed OCD did so as a child, and report knowing that there was something different (or wrong) about them in comparison to other kids.

Bottom line: If you have your child tested for OCD, and the professional has ruled that out, then you can "rule in" the fact that your child's "obsession" is likely to be a temporary phenomenon.

More resources for parents of children and teens on the autism spectrum:
 



 COMMENTS:

•    Anonymous said… It will change. Unless he's going to stick his fingers in it I would worry to much. My son is now 15. His obsessions changed, I find that with are kids you really need to pick and choose you battles.
•    Anonymous said… It's multi-sensory. That's so interesting. I love fans too and used to think it was so much fun to talk into them!
•    Anonymous said… My 12 year old son has been obsessed with Apple products, cars and now his new obsession is music. Chances are his interest will change and in the meantime he is learning. My sons obsession with music has lead to a desire to learn the guitar.
•    Anonymous said… My son has a similar "obsession" but his collections are small electrical that he takes apart and puts back together and most recently rubiks cubes. I love it. Sounds silly maybe but I love watching him focus so intensely. He lines up his rubiks cubes also and plays with them one at a time. He can solve every one of them and it just amazes me the way his brain works.
•    Anonymous said… My son has been obsessed with fire alarms for several years. It began after a fire drill at his preschool and I'm guessing its his way to cope with the fear.
•    Anonymous said… my son too- how good it feels to know there is another boy out there that is the same- my son is 13 and collects them and knows all about them and even has his own fire alarm panels, alarm and strobes!
•    Anonymous said… Oliver is 6 and has a growing collection as well  🙂 I had no idea there were so many different kinds and systems. We have friends in the fire department who are arranging for him to go on one of their inspections.
•    Anonymous said… With my grandson, we went through Thomas and all things train, weather/storms, and now as a teen he's settled on WWll and history. These things change over time.
•    Anonymous said… Wow I had almost forgotten about my AS daughter's similar obsession with fans! Good article.
•    Anonymous said… Your son has a creative and scientific mind- he may change his interests but will likely still only ever like similar electrical items. My son started off with plugs and cables and taking things apart when he was 3. he is now 13 and has collections of all kinds of things electrical and has enough knowledge to go into the electrical business now. Encourage it, don't take it away, just be sure to set limits as it does take over. Objects are as important to him as you are, you might not like that, but it will be part of his life and you have to respect it too. Best wishes.
*   Bev said... Thank you so much for sharing these experiences. My grandson is 2 years 6 months now and has been obsessed with fans since he was about 6 months old..... He's so different to other toddlers, so advanced - his intellect and vocabulary is on another level and he is just brilliant and observant, and yet we worry about the social negativities associated with As. To us he is incredibly special and wonderful, but the world can be so cruel. Thank you all very much for sharing about your unique children too, it helps to know that my grandson isn't alone in being different. 
 
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Crucial Strategies for Parents of Challenging Kids on the Autism Spectrum

    Resources for parents of children and teens on the autism spectrum :   ==> How to Prevent Meltdowns and Tantrums in Children ...