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November 29, 2012

Stimming Issues in Autism

Award Winning Non-Fiction Blogs - BlogCatalog Blog DirectoryThere are a lot of unique challenges that come with living with a non-verbal, severely-autistic person. One of them is vocal stimming, such as incessant humming, whistling, echolalia (repeating words or phrases), moaning and/or shrieking.

Primary reason for vocal stimming in autism is rooted in self-soothing attempts to calm an overactive nervous system. Imagine how you’d feel after seven cups of coffee. That’s how some autistic people feel all day, everyday. And they can’t tell you. Nor can they process what is happening. To mitigate this hyper-arousal, the autistic person may actively vocalize to physically release calming endorphins.

Other times, vocalizations can be rooted in pain or discomfort. You can discern reasons for stimming by knowing baseline of the autistic person. For example, if the person stims in the absence of others, it’s not for attention, it’s a coping mechanism.

Remember if an autistic person normally vocalizes a few hours a day, but suddenly the pitch, duration and tone changes, as if in distress, consider underlying infection and look for signs and symptoms of an illness. Or a minor cut or scrape on body that is stinging or itching. Treating an underlying medical issue often resolves the sudden dramatic increase in vocalizations.

To mitigate chronic vocal stimming try music therapy. For instance, if my son’s vocalizations become too loud, and seem rooted in boredom, we place an IPOD on with soft music playing. This re-directs his brain from being stuck on internally driven sound and offers him a soothing external auditory input.

Other types of stimming include visual, tactile, vestibular, gustatory and olfactory stimming. Here are some examples seen in my severely-autistic son:

Visual: He often sits on his back on his bed and stares at a map on the ceiling. Other times he fixates on trees blowing in the wind. This seems to calm his overactive mind. He loves stripes and geometric patterns. Also loves to fixate on colors red, blue, black, white and green.

Tactile: He sometimes taps drums, taps his pillow, taps his legs or taps on people when they are too close to him. The tapping can be hard and misconstrued as an outburst or aggression by those who don’t understand tactile stimming in autism. Another tactile stim my son has is rubbing his fingers together or grabbing hold of someone’s hand or arm tightly. Sometimes he’ll pinch you, so you have to re-direct his hands. He is also obsessed with rubbing his hands over rugs, grass and artificial turf. I recall once he rubbed hand on a carpet that had a staple in it. Ouch. This triggered self-injury. So be careful what they use for tactile sensory needs is safe. An oral tactile example rooted in presenting as hypo-sensitive while eating is seen when he swallows food whole. To avoid the dangers of this sensory behavior, we mince or puree most foods and then switch back to whole foods when he’s out of this “phase.” This can switch back and forth several times in one day.

Vestibular: He bounces on his bed daily. Sometimes he bounces on trampoline. This of course requires close supervision. When he sits he may rock or cross his legs and move one foot up and down. He also likes to be on swings. And ride in cars.

Gustatory: Chews on a sensory tube daily. We have to frequently check and toss tubing if he rips it with teeth to avoid aspiration. An Olfactory component of gustatory is when he holds food or saliva in mouth (also can be a sign of oral sensory defensiveness if he isn’t in mood for particular texture, SMELL, temperature or taste of food he’s offered). A simple remedy is to offer a different food (like slipping a strong smelling, salty, crunchy cracker in mouth to get him chewing) or get him to take a drink to encourage him to swallow. What is a strong smelling cracker? Any cracker with flavoring, as opposed to, let’s say, a saltine cracker. If that doesn’t work, you have to gently scrape out food with a toothbrush, re-direct him to another room or activity and try feeding later.

A daily sensory diet is critical for severely-autistic individuals, especially those who can’t communicate their needs. Sadly, some people don’t get it. For instance, I had to recently fire a new nurse for getting angry at my son for doing things he can’t control and which he uses to self-soothe. The nurse thought he was doing things “for attention” despite the fact my son does these things when he doesn’t think anyone is looking. The key to treating autism is learning the individual and doing things for them are that are known to help.

It can be time consuming. Some people aren’t cut out to work with autistic individuals. They become easily frustrated are too lazy or inconvenienced by the demands to implement therapeutic interventions. That’s fine. They should find another job. To work well with an autistic person who requires constant support, one must have good observational skills, be willing to learn, work hard, be creative and have empathy for and patience with the autistic person.

I have met many people who have a natural ability to help autistic people. And they remain a critical part of any team of individuals working to better the lives of the severely-autistic child or adult. 

1 comment:

Anonymous said...

thank you so much

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