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Repetitive Thoughts in Children on the Autism Spectrum

Question

What about being sensitive to the tone of voice of people, and then having the conversations looping or repeating in my son's (high functioning autistic) head? He said they loop through his head for hours, and he has to keep going over that portion of the conversation where the tone was too loud.

Answer

A potential source of sensory overload for a youngster with High-Functioning Autism (HFA) or Asperger's is voice – especially tone of voice. The child may analyze voice-tone first, and then decode the words used by the speaker later. Any voice inflection by the speaker that remotely conveys a negative attitude (e.g., sarcasm, irritation, criticism, etc.) may be detected by the child - and taken personally.

A negative tone can be hurtful to an HFA or AS youngster, particularly if he or she is not sure why the speaker is employing a particular inflection (e.g., “Is she upset with me?” … “Did I do something wrong?” … “Why does she sound mad?”…etc.). A loop effect can occur in the child’s thinking process (i.e., mulls over the comment made by the speaker long after the conversation has ended). Anxiety, agitation and fear increase as the child attempts to analyze the motives of the speaker.

What we’re really referring to here is the child’s obsessive way of thinking. One of the most bothersome traits of the disorder may be the tendency toward repetitive thoughts (i.e., ruminations). While the ability toward extreme focus can be a strong point for many of these kids, it’s a problem when they can’t shift away from thinking about things that are not of their choosing. Often, the youngster gets caught up in worries, dwells on past slights from others, ponders their own mistakes, or has problems letting go of past hurts.

How to Deal with Ruminations: Tips for Your Child—

1. Don't put yourself down because you are thinking this way. Old habits are hard to break. You might find yourself making notes more than you would like, but keep doing it. If you have to replace a thousand negative thoughts with positive, just do it. Pretty soon that will become habit instead.

2. Identify your triggers. Determine the best possible reaction to them and keep this in mind. In addition, it may be necessary to remove the trigger from your life, if it is affecting your well-being and sanity.

3. It may be necessary for you to receive counseling from a trained professional to determine if there are some deep rooted issues causing your obsessive thinking patterns.

4. Keep an open mind about taking medication for your condition. There are many options available to help you get back on track.

5. Make mental notes of things that are being done as they are done. Write it down if necessary. While standing in front of the oven, turn it off, say to yourself "Now I am turning this oven off, I see myself doing it, I see that it is now off, I'm OK."

6. Maybe negative thinking has become an obsession for you and maybe you have thought negatively for as long as you can remember. If you find yourself thinking negatively stop and ask yourself "Is this really true what I'm thinking?"

7. Once you find yourself obsessing over a given issue, stop yourself immediately and begin to observe your thought process. You may find it necessary to record your thoughts on paper. You could become surprised at how often you are slipping into a bad thought process.

8. Realization is an important step in gaining control over obsessive thinking. One must be able to identify and realize when the thought process is getting out of hand.

9. Remember that most obsessive thinking also involves doubting. That is why OCD is also called "the doubting disease". When needing to check things over and over again, realize that you are doubting yourself; when you feel the need to recheck, doubt has crept in. By beginning to stop and take mental notes of what you have already done, you can begin to convince yourself not to recheck. Remember, checking and rechecking is a known symptom of OCD.

10. Think about what you know to be true and compare that to your negative thought. Immediately replace the negative thought with something positive.

[Please share the suggestions above with your child.]

There are two primary courses of treatment for obsessive thinking:

The first line of defense is behavioral therapy. This involves gradual conditioning of the person to tolerate anxiety and abstain from compulsive behavior. This is believed to be the most effective treatment for treating obsessive thinking and anxiety.

Medication includes selective serotinin reuptake inhibitors, benzodiazepines, serotonergic antidepressants, trycyclic antidepressants and natural drug treatment like St. John's Wort and so on. In severe cases, electro-convulsive therapy has been found to work effectively on obsessive thinking.


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What to Expect When Taking Your Child with Autism to the Dentist

Dr. Greg Grillo (emergencydentistsusa.com)

Going to the dentist can be an overwhelming experience, especially for patients with autism. There are bright lights, loud noises, and strange tastes and smells. These sensory elements can make going to the dentist hard for children and patients with additional needs. Luckily, knowing what to expect for their dental appointment can help lessen some anxious feelings your child may have.

It’s important that you begin taking your child to the dentist from an early age, to prevent future dental emergencies. However, if your child does experience a dental emergency you can receive the help you need here. I have been practicing family dentistry for 17 years and know how important it is for your child to have a positive experience at the dentist office. That’s why I have come up with a list of what you can expect when taking your child to the dentist, and how to prepare to make it a positive experience.

1. Experiencing nerves

Your child may be feeling anxious about visiting the dentist, especially if it’s their first time. This is expected, so don’t worry. There are thankfully many ways to work to overcome these nerves your child may be feeling and avoid other issues. A couple of things that you can do to work on these anxieties are role-playing dental visits at home and telling stories or watching videos about dental checkups. There are many ways to work through the nervousness surrounded with going to the dentist. Work together with your child to find which methods work for you for working through nerves and preparing for their dental visit. You want it to be a positive experience for your child, and your dentist does too.

2. Meeting new people

One thing you can expect with visiting the dentist is meeting new people. You will quickly be getting to know the office and staff members at your dental clinic. You and your child have an amazing opportunity to establish a positive relationship between you guys and the staff at the dental office. They will be working closely with your child so having this relationship is important.

If your child is feeling especially nervous towards visiting the dentist, try setting up a meeting ahead of time for them to visit the dental office. This will give them the chance to meet the office and staff before any work is done. They can also see what the office looks like which will make it more familiar when your child comes back for their appointment.

The staff members at your dental office are going to work to make your child’s experience as comfortable as they can. Let them know ahead of time any special accommodations you’d like to be made. These can include things such as specific toothpaste flavors or reducing waiting room time. Think of you, your child, and your dentist as a team. Collaboration and teamwork are essential in assuring the success of your child’s dental visit.

3. Preparing for what’s next

After your child’s initial dental visit, you can expect to prepare for future visits. It’s recommended that your child visits a dentist once every six months. Your child’s first visit is going to be the most difficult, but as you start to visit the dentist more often and figure out what works for you and your child, the more comfortable they will become. Find out what went well in their first visit and what can be improved upon. It’s going to be trial and error but enjoy the learning process.

One thing that will help make future visits run more smoothly is if your child can work with the same staff each time. As mentioned before, establishing that relationship with office and staff members will be beneficial in the long run. Your child will be more willing to visit the dentist if they can be around people they are familiar with. It will help ease any anxieties your child may have previously had and make sure of great and positive dental visits.

Knowing what to expect when you bring your child to the dentist is the first step in overcoming any nerves or anxieties your child may be feeling. Always keep conversations around the dentist positive and encouraging. Visiting the dentist is a great learning experience for you and your child. Remember that proper dental care is essential to your child’s health and well-being. Embrace the learning experience completely as you help your child become comfortable at the dentist.
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How To Tell If Your Child Has High-Functioning Autism

"How can you tell if a child has ASD Level-1 (high-functioning autism)? And should we take him to a specialist to have him formally diagnosed?"

I'll answer the second question first: Yes, if you suspect High-Functioning Autism (HFA), then by all means seek a diagnosis so you will know for sure. It's better to know than not to know. If your child has the disorder and doesn’t know, it affects him anyway. If he does know, he can minimize the negative impact - and leverage the positive. Without the knowledge that you have it, you will often fill that void with other, more damaging explanations (e.g., I'm a failure, weird, a disappointment, not living up to my potential, etc.).

Here are some of the traits of High-Functioning Autism and Asperger's. If these characterize your son, then strongly consider consulting a professional:

1. Cognitive Issues-- Mindblindness, or the inability to make inferences about what another person is thinking, is a core issue for kids with an autism spectrum disorder. Because of this, they have difficulty empathizing with others, and will often say what they think without considering another's feelings. The HFA youngster will often assume that everyone is thinking the same thing he is. For him, the world exists not in shades of gray, but only in black and white. This rigidity in thought (i.e., lack of cognitive flexibility) interferes with problem solving, mental planning, impulse control, flexibility in thoughts and actions, and the ability to stay focused on a task until completion. The rigidity also makes it difficult for an Asperger youngster to engage in imaginative play. His interest in play materials, themes, and choices will be narrow, and he will attempt to control the play situation.

2. Difficulty with Reciprocal Social Interactions-- Children and teens with the disorder display varying difficulties when interacting with others. Some have no desire to interact, while others simply do not know how. More specifically, they do not comprehend the "give-and-take" nature of social interactions. They may want to lecture you about the Titanic, or they may leave the room in the midst of playing with a friend. They have difficulty comprehending the verbal and nonverbal cues used in typical social interactions. These include eye contact, facial expressions, body language, conversational turn-taking, perspective taking, and matching conversational and nonverbal responses to the interaction.

3. Impairments in Language Skills-- Kids on the autism spectrum have very specific problems with language, especially with pragmatic use of language, which is the social aspect. That is, they see language as a way to share facts and information (especially about special interests), not as a way to share thoughts, feelings, and emotions. The youngster will display difficulty in many areas of a conversation processing verbal information, initiation, maintenance, ending, topic appropriateness, sustaining attention, and turn taking. The youngster's prosody (i.e., pitch, stress, rhythm, or melody of speech) can also be impaired. Conversations may often appear scripted or ritualistic (i.e., it may be dialogue from a TV show or a movie). They may also have difficulty problem solving, analyzing or synthesizing information, and understanding language beyond the literal level.

4. Motor Clumsiness-- Many kids on the spectrum have difficulty with both gross and fine motor skills. The difficulty is often not just the task itself, but the motor planning involved in completing the task. Typical difficulties include handwriting, riding a bike, and ball skills.

5. Narrow Range of Interests and Insistence on Set Routines-- Due to the youngster's anxiety, his interactions will be ruled by rigidity, obsessions, and perseverations (i.e., repetitious behaviors or language) transitions and changes can cause. Generally, he will have few interests, but those interests will often dominate. The need for structure and routine will be most important. He may develop his own rules to live by that barely coincide with the rest of society.

6. Sensory Sensitivities-- Many HFA kids have sensory issues. These can occur in one or all of the senses (e.g., sight, sound, smell, touch, or taste). The degree of difficulty varies from one child to another. Most frequently, the child will perceive ordinary sensations as quite intense or may even be under-reactive to a sensation. Often, the challenge in this area will be to determine if his/her response to a sensation is actually a sensory reaction or if it is a learned behavior, driven mainly by rigidity and anxiety.


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==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook
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The IEP Process: What Parents of Kids on the Autism Spectrum Need to Know

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Gaze Avoidance in Children on the Autism Spectrum

Question

I have a student with autism (high functioning) who always appears to be staring off into space. I have asked him to look me in the eye when trying to get his attention - and he will make eye contact for a split second - but then look off again. Is there some way to get through to him and help him focus?

Answer

It is rarely the case that the High-Functioning Autistic (HFA) student who is actively avoiding eye contact is also purposely avoiding paying attention. Rather, this student is more likely (a) engaging in a form of stress-reduction and (b) facilitating his own cognitive processing of what he is hearing.

Teachers have been taught that it is essential to get the student’s attention before starting class and to recapture attention to task when the student’s demeanor suggests that his attention is waning. To accomplish this task, teachers often first attempt to get attention by cuing, "Look at me." They also often assume that they have the student’s attention when they "get eye contact" and that those who do not conform cannot be paying attention. Thus, when the "special needs" student seems to avoid looking into the eyes of teachers with whom he interacts, the strategy that comes most naturally and is often pursued quite intently is the verbal cue, "Look at me."

If the HFA student fails to respond within what is viewed as a reasonable length of time, the cue may be repeated more forcefully. If the student continues to fail to look as directed, misinterpretations of why he isn't "complying" may fuel futile power struggles that only frustrate everyone concerned and further thwart the abilities of the child to respond. Whether “demanding eye contact” is a wise approach to focusing attention depends both on the youngster and on circumstances surrounding the expectation.

“Gaze avoidance” (sometimes called “gaze aversion”) is when a person’s eyes don't quite meet the eyes of the other person when having a conversation. Some people call this "shifty eyed" – but for some children and teens on the autism spectrum, this is a necessary coping strategy to avoid being overwhelmed by the other person's direct eye contact. Gaze avoidance could be a central component of the social phobia sometimes experienced by individuals with the disorder.

These individuals appear sophisticated in their use of gaze avoidance and will instinctively avert their gaze from potentially distracting stimuli during a conversation. Also, the amount of time spent engaged in gaze avoidance has been shown to increase as the level of social discomfort increases. So, gaze aversion appears to function as a method to short-circuit a stress-response.

Research suggests that having access to non-verbal language (e.g., facial expressions, eye gaze, lip movements, gestures, etc.) benefits communication and social interaction. Visual cues also play an important role in everyday communication (e.g., can enable a listener to recognize ambiguous utterances), in addition to playing an important role in conversational turn-taking. However, because visual cues serve as such rich sources of information, they also have the potential for over-whelming the HFA individual who may have sensitivities to certain social stimuli.

When a child on the spectrum processes facial expressions during complicated cognitive activity (e.g., listening to the speaker, being asked to respond to a question), performance will suffer because some ‘fixed attentional limit’ will be exceeded. Thus, the child looks away from faces to avoid cognitive overload. This perspective is supported by the finding that, as task difficulty increases, so too does the use of gaze avoidance.

In addition to the potential cognitive influences on gaze avoidance, we should also consider the social constraints on prolonged gaze during conversation. Gaze plays an important role in expressing a variety of emotions (e.g., intimacy, dominance, social competence, etc.). Given that there exist social constraints on patterns of gaze behavior in conversation, gaze avoidance might occur during a particular interaction to reduce heightened feelings of social anxiety or embarrassment. An increase in gaze avoidance in response to a demand for attention, a request for eye-to-eye contact, or increasingly difficult questions could therefore result due to an increase in feelings of self-consciousness.

Eye contact is a form of non-verbal communication, and we assume a person is giving us his attention if he looks at us. However, understand that the HFA student experiences difficulty with eye contact – it is extremely difficult for him to focus his eyes on a person for any extended period of time. Limited eye contact is a part of the disorder. It is recommended that teachers do not demand that the "special needs" student look them in the eyes as they are talking to him.

What appears to the teacher to be behavior illustrating a lack of attention on the part of the student may not be that at all. In fact, the HFA student who is engaging in gaze avoidance may actually be trying to focus on what the teacher is saying. The student is unaware that, non-verbally, he is communicating to the teacher that “I'm not interested in what you’re saying” … “You are boring me.” You might simply ask the student a simple question to check if he was listening.

 
Resources for parents of children and teens on the autism spectrum:
 

==> Videos for Parents of Children and Teens with ASD
 
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COMMENTS:

•    Anonymous said… Asking her to look toward your facial area is completely different than having to give eye contact
•    Anonymous said… Don't force eye contact that's horrible.
•    Anonymous said… Eye contacted is very difficult for these children. However it doesn't mean there not listening.. My son won't give eye contacted but usually hears every thing. Ask the child if he has heard what you have asked.
•    Anonymous said… First and foremost educate yourself on common spectrum traits/behaviors so that you don't force a circle into a square box! A child with aspergers does not need look you in the eye to be focused...it can actually causes them additional issues that make it worse and them more unable to focus! Many times the more "unfocused" they appear...is when they are actually absorbing the most! Communicate with the student and his parents and by all means educate educate educate yourself so that you and the child will be more successful!
•    Anonymous said… He IS concentrating and focussing on what you say but finds eye contact uncomfortable. Just leave him be - he'll perform a lot better if you're not stressing him by forcing him to do something he's not comfortable with.
•    Anonymous said… How best to explain this to a NT? Here goes...You want eye contact from a person with autism? Try this first....have a conversation whilst staring at a VERY bright light to the point it makes your eyes water. No, you can't look away, you have to keep the eye contact, it's just plain rude if you don't. Yup, that's the only way I can describe eye contact for me. It literally makes my eyes water. Also, if I am not making eye contact, it's because I'm not having a good day and having hard time filtering out visual input. If I am not even looking at you at all, then it's even more so not a good day, and finding it harder to filter out visual input. If I am literally closing my eyes, then I know what you have to say is important to listen to and probably can't filter out visual input at all and if you were to make me look at you, much less force eye contact.....nope, no clue, AT ALL, what you just said, because my brain switched between processing the visual and audio input, and I lost too many vital bits of conversation, whilst it was processing the visual input. Now please stop forcing eye contact with those who have autism. It's very rude, ignorent and cruel.
•    Anonymous said… I had the same issue with my son. I told him about staring contests and he wanted to try to beat me. It helped him to keep eye contact better.
•    Anonymous said… I'm 'neurotypical' and I hate making eye contact. Just let the kid look where they like.
•    Anonymous said… Just 1 question, WHY WOULD YOU FORCE ANOTHER PERSON (because thats what he his) TO LOOK YOU IN THE EYE? Especially a person with autism, from my daughters perspective she says its very, very painful
•    Anonymous said… Kinda like the eye contact. It catches his interest.
•    Anonymous said… Maybe when you're talking to him, put it in a subject that interests him.
•    Anonymous said… My son is 6 and newly diagnosed I wouldn't encourage making hom make eye contact as with him it seems like the way he keeps control over himself is not to make eye contact now he does make eye contact with me and those he feels most confident around but not always I started years ago before even being diagnosed with encouraging eye contact when he and I were talking about his interests and over time he's learned or maybe feels safe to make eye contact with us he is not able to attend school yet we tried in August and to me I would have been mad if they tried making him do that as it is so uncomfortable for whatever reason and would just make things harder every kid is different my son does not hold eye contact with his therapist and really doesn't engage in conversation with her either he will play in the room or doodle on the white board but yet he's paying attention because if either of us say something he doesn't agree with he's quick to add his opinion out of the blue and some of the things his therapist suggests to me to help him at home he will talk about it later so hes able to pay attention even when it appears he isn't
•    Anonymous said… Please don't continue to demand eye contact! Consult with his parents or experienced school officials to deal with, what actually is your problem.
•    Anonymous said… Please research and study. Your student will never give you eye to eye contact as a normal child would. It is a part of being Aspergers. He will always have a short attention span with direct eye contact. He will have habits, rituals, and obsessiona that you can not control. You have to learn to be patience and work with the student. In time it may get better. I suggest you read, study, utube, or join a support group to know more about Aspergers.
•    Anonymous said… Stop torturing him. I actually have it written in my child's IEP that eye contact/watching the teacher is not necessary. He looks like he's not paying attention, but ask him a question and he can answer it…he follows along with the topic in his own way  ;)
•    Anonymous said… That is cruel and almost painful to force a child with Aspergers to look at you! If you plan on teaching children with Aspergers you need to educate yourself a little better. You would have known not to force this.
•    Anonymous said… That's fantastic progress and shows he feels relaxed and comfortable in your presence. I can make eye contact when relaxed, and with people I know well and feel comfortable with, even if I can't maintain it. But quite often, I find with people I don't know well, or at all, just looking at them is a nightmare. Then I become aware that I either seem disinterested or a bit odd or even a shady character, as I look down at the ground, or up at the sky, or pretend to be looking at anything rather than look at the person. This sends my anxiety through the roof, and I'm less able to look at the person. I have tried to force myself to make eye contact and it's literally made my eyes water, feels kinda like eye strain, or like staring at a bright light. Sorry it took so long to get a diagnosis for your son. The first of my sons was diagnosed at four. My eldest son wasn't diagnosed till he was almost 18. I'm glad that your son is making such good progress. You are obviously doing a great job with him.
•    Anonymous said… The desire for eye contact isn't always about trying to force someone to be more typical. As I explained to my daughter, the reason I need her to look at my face when I am conversing with her is so that I can understand her responses better (my hearing is kinda off these days). She usually tries to look in my general direction, and that is enough. She prefers to pace when I read to her. I know she is processing the story, even if she isn't making eye contact. I think the key differences are in the style of interaction. Extended listening times should not have to involve eye contact. It is necessary to encourage it while conversing however, as the practice allows one to learn to catch more nuances of expression and attitudes through body language, not just the tonal interpretation.
•    Anonymous said… the eye contact is purely for your benefit at the point of making your son uncomfortable, possibley even feeling pain. Please stop.
•    Anonymous said… This issue really annoys me. Especially with teachers. Eye contact os very difficult for children on the spectrum. No reason to force it. My son once received a bad grade for a presentation because he didnt have good eye contact. Teachers really need to read up on the differences if they have a child with aspergers in their class.
•    Anonymous said… This was before there was a dignosis. I never thought that he was in pain looking into my eyes. I made it a game when he was 4-5 and it was fun. He was diagnosed at age 7. We dont ask him to look at us when he is talking anymore but rather he does at least look us and acknowledge we are trying to talk to him. before he did not.
•    Anonymous said… When looking at someone we (ND) are bombarded with too much information. It's easier to listen whilst staring at the floor. I glance occasionally to let people know I'm listening. Please don't force. My d learnt to look without focus because her dad wanted eye contact when he spoke. I can see the glaze and she's hiding inside terrified. And hears nothing because she's been overloaded  😞
•    Anonymous said… Whether your student looks you in the eyes or not I can guess that what you wish him or her to learn is been processed by the student my son has aspergers and could understand his teachers when he was at school let the child be a kid for heavens sake it's not really important that he has eye contact or not the do go into their own world it is part of the condition of aspergers the trick is to find a gentle way of slowly bringing him back to the present time find out what he's interested in and build on that subject you will be amazed at the reponse you might get it takes time and patience to work with these special individuals don't rush him
•    Anonymous said… Why force eye contact? Seriously. Not all cultures place value on it, it's not really a sign of avoidance/lying. With my son and the kids I work with, we offer a focal point...chin, shoulder, cheek. Somethings should be left alone and this is one of them in my opinion. It's the same with trying to control stimming etc...it's not hurting anyone by not making eye contact (or stimming) let it go. Sometimes trying to change things to make people with ASD (or asd people depending on if you prefer person first language or not) appear more neurotypical can actually increase or create behaviours of concern.
•    Anonymous said… Your student is actually focusing less if he or she is forced to look at you. I love this book for teachers have have given to a few along our journey. It has a great section for teachers.

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