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Share by Temple Grandin, Ph.D. Assistant Professor Colorado State University Fort Collins, Colorado 80523, USA (Updated June 2000) Introduction In this paper, I will describe my experiences with autism. The main areas I will cover are visual thinking, sensory problems, and difficulties with communication. After I describe my experiences, I will discuss th e similarities and differences between myself and other people with an autism diagnosis. There is probably a continuum of autism subtypes that vary in the pattern of neurological abnormality and the severity of neurological problems. Sound and Visual Sensitivity My hearing is like having a sound amplifier set on maximum loudness. My ears are like a microphone that picks up and amplifies sound. I have two choices: 1) turn my ears on and get deluged with sound or 2) shut my ears off. Mother told me that sometimes I acted like I was deaf. Hearing tests indicated that my hearing was normal. I can't modulate incoming auditory stimulation. I discovered that I could shut out painful sounds by engaging in rhythmic stereotypical autistic behavior. Sometimes I "tune out". For example, I will be listening to a favorite song on the car radio and then later realize that I tuned out and missed half of the song. In college, I had to constantly take notes to prevent tuning out. I am unable to talk on the telephone in a noisy office or airport. Other people can use the telephones in a noisy airport, but I cannot. If I try to screen out the background noise, I also screen out the voice on the telephone. Autistic people with more severe auditory processing problems are unable to hear a conversation in a relatively quiet hotel lobby. Autistic people must be protected from noises that hurt their ears. Sudden loud noises hurt my ears--like a dentist's drill hitting a nerve (Grandin 1992a). A gifted, autistic man from Portugal wrote: "I jumped out of my skin when animals made noises" (White and White 1987). An autistic child will cover his or her ears because certain sounds hurt. It is like an excessive startle reaction. A sudden noise (even a relatively faint one) will often make my heart race.
I still dislike places with many different noises, such as shopping centers and sports arenas. High-pitched continuous noise, such as bathroom vent fans or hair dryers, are annoying. I can shut down my hearing and withdraw from most noise, but certain frequencies cannot be shut out. It is impossible for an autistic child to concentrate in a classroom if he or she is bombarded with noises that blast through his or her brain like a jet engine. High-pitched, shrill noises are the worst. A low rumble has no affect, but an exploding firecracker hurts my ears. As a child, my governess used to pop a paper bag to punish me. The sudden, loud noise was torture. The fear of a noise that hurts the ears is often the cause of many bad behaviors and tantrums. S ome autistic children will attempt to break the telephone because they are afraid it will ring. Many bad behaviors are triggered due to anticipation of being subjected to a painful noise. The bad behaviors can occur hours before the noise. Common noises that cause discomfort in many autistic individuals are school bells, fire alarms, score board buzzers in the gym, squealing microphone feedback and chairs scraping on the floor. When I was a child, I feared the ferry boat that took us to our summer vacation home. When the boat's horn blew, I threw myself on the floor and screamed. Autistic children and adults may fear dogs or babies because barking dogs or crying babies may hurt their ears. Dogs and babies are unpredictable, and they can make a hurtful noise without warning. Children and adults with extreme sound sensitivity may also fear the sound of water flowing or waves (Stehli 1991). Children with less severe auditory sensitivity problems may be attracted to sound and visual stimuli that more severely impaired children tend to avoid. I liked the sound of flowing water and enjoyed pouring water back and forth between orange juice cans; whereas another child may avoid the sound of flowing water. I liked the visual stimulation of watching automatic sliding doors; whereas another child might run and scream when he or she sees an automatic sliding door. A loud vacuum cleaner may cause fear in one autistic child and may be a pleasurable fixation to another child. When I look at moving sliding doors, I get the same pleasurable feeling that used to occur when I engaged in rocking or other stereotypical autistic behaviors. Some autistic individuals can see the flicker of florescent lights. Coleman et al. (1976) found that florescent lights increased repetitive behavior in some autistic children. Tactile Experiences During my travels to many autism conferences, several parents have reported to me that holding therapy was beneficial. It is not the "cure" that some of its proponents tout, but it has a beneficial affect o n some children. In my opinion, the benefits of holding therapy could be obtained through less stressful methods. I cringed when I watched the BBC show, "The Visit," and I am glad I did not have to endure forced holding. Fisher (1989) describes a gentler approach to holding that worked with her daughter. One mother told me that she gently encouraged her child to tolerate more and more holding, and he
but then when somebody held me. the therapist will also work on improving speech and . Small itches and scratches that most people ignored were torture. Autistic Tactile Problems I pulled away when people tried to hug me. I wanted to feel the comforting feeling of being held. the effect on my nervous system was overwhelming. New underwear causes great discomfort. It was an approach-avoid situation. It took several days for me to stop feeling a new type of clothing on my body. Strong encouragement and some intrusiveness may be used. It is a physiological sensory process that has nothing to do with mother bonding or anger. During the activities. stated that touching was not painful. but sensory over stimulation caused the avoidance. It also helps to decrease stereotypical and self-injurious behaviors. A scratchy petticoat was like sand paper rubbing my skin raw. Many people with autism prefer soft cotton against the skin. Hair washing was also awful. Gradually. the boy was released. I completely disagree with Welch (1983) that the child has to become severely distressed for holding to be effective. Even intrusive activities are kept fun. and eye contact in some children. The sensory activities are done gently as fun games and are never forced. Autistic children have problems modulating sensory input (Ornitz 1985). affection. not anger or fear as Richer and Zappella (1989) suggest. I also liked long pants. because being touched sent an overwhelming tidal wave of stimulation through my body. I believe that the beneficial effects of holding in some children are due to desensitization to touch of the autistic child's nervous system. The sensory problems of autism are often overlooked. As soon as crying was reduced. Many autistic people are over sensitive to both sound and touch. because I disliked the feeling of my legs touching each other. I also had problems with adapting to new types of clothes. but it was overwhelming and confusing. and I have to wash it before I can wear it. Powers and Thorworth (1985) found that eye contact and interest in people improved after a gentler behavioral method was used. whereas a normal person adapts to the change from pants to a dress in five minutes. In one case. but it has increased speech. Sensory Therapy Therapists have helped many autistic children through gently applying tactile and vestibular stimulation (Ayres 1979. but a good therapist knows how far he or she can intrude before the stimulation becomes so overwhelming that the child starts crying. This is not a cure. the amount of holding time was increased. One effect of this stimulation is to desensitize the tactile system. An autistic man.responded with increased affection and improved eye contact. a young boy was held in a light hug until crying lessened. my scalp hurt. When mother scrubbed my hair. interviewed by Cesaroni and Garber. King 1989).
relaxed muscle tone. (1988) found that a mute child will often start making speech sounds while he or she is swinging in a swing. and non-contingent vibration will reduce stereotypical behavior (Murphy 1982). Takagi and Kobagas (1956) found that pressure applied to both sides of a person's body decreased metabolic rate. Many parents have told me that their children get under the sofa cushions or mattress.establishing eye contact. pulse rate. steady application of pressure had a calming affect on me. Research has also shown that vigorous aerobic exercise reduced maladaptive and stereotypic behavior (Elliot et al. If a treatment method is going to be effective with a particular child. A slow. Rubbing and gently pinching a cat's paw will decrease tonic activity in the dorsal column nuclei and the somatosensory cortex (part of the brain that receives touch sensation) (Melzack et al. 1981). Good results can often be obtained with less than an hour of sensory treatment per day. Very light touch should be avoided because it increases arousal and excites the nervous system. 1994). Pressure gently applied to both sides of a pig in a padded V trough will induce sleep and relaxation (Grandin et al. Many autistic children will seek deep pressure. Swinging stimulates the vestibular system and the defective cerebellum. Gently pinching a rabbit's skin with padded clips creates a deactivated EEG reading. Spinning in a chair twice a week helps to reduce hyperactivity (Bhatara et al. Squeeze Machine I craved deep pressure stimulation. and muscle tone. Zisserman 1992). but I pulled away and stiffened when my overweight aunt hugged me. Ray et al. and a sudden jerky motion tended to cause arousal (Grandin 1992b). I describe a squeeze machine I constructed to . Deep pressure stimulation is also calming (Ayres 1979. 1969). Hypersensitivity to touch can be desensitized through firmly but gently stroking a child with different cloth textures (Ayres 1979). Self stimulatory behaviors can be reduced by having an autistic child wear a garment that applies pressure (McClure et al 1991. 1989). and drowsiness (Kumazawa 1963). Vestibular and sensory stimulation also have a beneficial affect on improving affection and social behavior. The effectiveness of sensory treatment will vary from child to child. The pressure must be firm enough to stimulate deep pressure receptors. Spending hours and hours each day is not required. it will bring about improvement with reasonable amounts of effort. In my two books (Grandin and Scariano 1986 and Grandin 1995). Tactile Research Both human and animal studies indicate that deep pressure is calming and reduces arousal in the nervous system. King 1989) Therapists often roll the children up in mats.
Experiencing the comforting feeling of being held makes nasty or mean thoughts go away. Touching every part of the animal's body is an important component of the taming . A partial explanation for the lack of empathy in autism may be due to an oversensitive nervous system that prevents an autistic child from receiving the comforting tactile stimulation that comes from being hugged. There are two methods that can be used tame a wild horse: 1) forced holding and 2) gradual taming. Activities involving touch become pleasurable when the nervous system becomes desensitized. Animal Reactions My reaction to being touched was like a wild horse flinching and pulling away. Gradually I was able to tolerate the machine holding me. It is important to desensitize an autistic child so that he/she can tolerate comforting touch. For example. I had to comfort myself before I could give comfort to the cat. I often touch the animals because it helps me to feel gentle towards them. Forced holding is quicker and more stressful than the somewhat slower gradual taming process. The machine was designed so that I could control the amount and duration of the pressure. Both methods work.satisfy my craving for the feeling of being held. The over sensitivity of my nervous system was slowly reduced. The animal is securely tied or held in a livestock restraint device. children who cannot tolerate tooth brushing can be desensitized through gently rubbing them around the mouth. It is held tightly and is unable to kick or thrash. A stimulus that was once overwhelming and aversive had now become pleasurable. An activity that was initially aversive and overwhelming gradually becomes pleasurable. The procedure is done as quietly and gently as possible. It was lined with foam rubber and applied pressure over a large area of my body. Therapists have found that some hyperactive and autistic children will immediately use the machine. When I handle cattle. and others are so oversensitive to touch that they initially avoid the machine and other activities involving touch. care is taken to avoid excitement. When forced holding is used on animals. I learned how to pet our cat more gently after I had used the squeeze machine. The process of taming a wild animal has many similarities to an autistic child's reaction to touch. Several squeeze machines are now in use at sensory integration clinics in the United States. the trainer pets and strokes all parts of the animal's body and talks gently to it. Good horse trainers only use forced holding on extremely young horses. During the restraint period. Using the machine enabled me to tolerate another person touching me. I have found that if I use my squeeze machine on a regular basis that I have nicer images in my dreams. The reactions of an autistic child to touch and a wild horse may be similar. Over sensitive children are gently encouraged to engage in tactile activities that they initially avoided. such as finger painting or being rubbed with different cloth textures.
hippocampus. but gradually it will start relaxing when stroked. touching that was initially aversive becomes pleasurable. but I concentrated on the sensory aspects because these are often neglected. Cognitive Versus Sensory In this paper I have concentrated on the sensory aspects of autism and have not discussed behavioral and cognitive (thinking) factors. These areas are involved with learning and memory. Horse trainers have found that nervous horses become easier to handle if they are rubbed and brushed frequently. 1997). Li ke the autistic child. self-injury. At first the horse may flinch. 1989). and Bauman and Kemper 1994). Animals confined to a barren environment are excitable and engage in stereotypies. such as concrete thinking and unusual visual spatial skills.procedure. Brain scans have revealed that some of the circuits between the frontal cortex and amygdala are not functioning normally (Haznader et al. Cerebellar and brain stem abnormalities are a probable explanation of many sensory problems. and disturbed social relations (Grandin 1989b. amygdala. This may possibly explain why treatments that stimulate the cerebellum and certain sensory treatments often improve overall behavior. Sensory Deprivation Symptoms The symptoms of sensory deprivation in animals and many autistic symptoms are similar. 1989). but they would not explain cognitive differences. Brain wave (EEG) studies indicated that autistic children have severe abnormalities in their capacity to shift attention between visual and auditory stimuli (Courchesne et al. The taming approach is done more gradually. The animal is released when it is not resisting. Further research has shown that the amygdala (emotion center) in the brain is underdeveloped.. Cognitive and behavioral aspects are important. Autopsies of nine autistic brains revealed abnormalities in the cerebellum. The cognitive differences between autistic and normal children are probably due to other brain abnormalities. An animal in a barren . Sessions seldom last more than one hour. At first they just stood in it and then pressure was applied for increasing amounts of time. Mason 1960. and differences in cognitive processes may explain others. The sheep were gradually introduced to the device. Brain structures that control attention shift are connected to the cerebellar vermis. This may force a person with autism to use intellect and logic to make social decisions instead of emotion cues. Harlow and Zimmerman 1959). and other parts of the limbic system (Bauman 1991. I have trained sheep to enter a device similar to my squeeze machine repeatedly (Grandin. hyperactivity. Sensory processing problems may explain some autistic behaviors. A stimulus that was once actively avoided is now actively sought out. Abnormalities in attention shifting may be the basis of perseverate (repetitive) behavior and some social deficits. A disadvantage of this procedure is that forced restraint is stressful. This may explain some of the social deficits of autism.
This abnormality is relatively permanent. Perhaps it would be beneficial if autistic babies were gently stroked and "tamed" when they stiffen and pull away. Why would a leopard in a concrete cell at the zoo and autism have similarities? From my own experience. Tactile stimulation is vital for babies and aids in their development. When noise and sensory over stimulation became too intense. They are asked to access their memory of . It is like playing different tapes in a video cassette recorder in my imagination. I think totally in pictures. Animal and human studies show that restriction of sensory input causes the central nervous system to become overly sensitive to stimulation. In pulling away. The possibility of secondary damage to the central nervous system may explain why young children in early intervention education programs have a better prognosis than children who do not receive special treatment. Loud noise hurt my ears. Placement of a small cup on a person's forearm for one week to block tactile sensations will cause the corresponding area on the opposite arm to become more sensitive (Aftanas and Zubeck 1964). Autopsy studies indicate that cerebellar abnormalities occur before birth (Bauman 1991. However. 1965). Possibly there are secondary central nervous system abnormalities that happen as a result of the autistic child's avoidance of input.environment engages in stereotypies in an attempt to stimulate itself. if I would have been less "nervous" as an adult. Puppies reared in barren kennels become hyperexcitable. I was able to shut off my hearing and retreat into my own world. Trimming the whiskers on baby rats will cause the parts of the brain that receive input from the whiskers to become oversensitive (Simon and Land 1987). I would like to suggest a possible answer. Bauman and Kemper 1994). Possibly the autistic child creates his or her own self-imposed sensory deprivation. The brain areas were still abnormal after the whiskers had grown back. The initial sensory processing abnormalities that the child is born with cause the initial avoidance. I often wonder if I had received more tactile stimulation as a child. Auditory and tactile input often overwhelmed me. What is Visual Thinking? Thinking in language and words is alien to me. The brain waves of autistic children also show signs of high arousal (Hutt et al. Handling baby rats produces calmer adults which are more willing to explore a maze (Denenberg et al. and their brain waves (EEG) still showed signs of over arousal six months after removal from the kennel (Melzack and Burns 1965). The effects of early sensory restriction are often long lasting. 1962. Ehrlich 1959). the limbic system which also has abnormalities is not mature until the child is two years old. I used to think that everybody thought in pictures until I questioned many different people about their thinking processes. I may not have received stimulation that was required for normal development. I have conducted an informal little cognitive test on many people.
There is a possibility that these systems may be expanded to compensate for deficits in language. A gifted autistic . one part can take over and compensate for deficits in language. My "cat" concept consists of a series of "videos" of cats I have known. I can run test simulations in my imagination of how the systems would work with different size cattle. This method of thinking is slower. Discussions with other autistic people have revealed visual methods of thinking on tasks that are often considered sequential and nonvisual. For me. In autism. One totally verbal professor told me that facts just come to his mind instantly with no visual image. the systems that process visual-spatial problems are intact. Studies of patients with brain damage indicate that one system can be damaged. To access spoken information. An object that is not in the person's immediate surroundings should be used for this visualization procedure. When I do this. It takes time to "play" the videotape in my imagination. I can put snow on the church roof and imagine what the church grounds look like during the different seasons. or an engineer. For example. Many "normal" people will see a visual image of a cat. I see in my imagination a series of "videos" of different churches or cats I have seen or known. These systems may work either together or separately to perform different tasks. parent of an autistic child. people with certain types of brain damage can recognize objects with straight edges. Drafting elaborate drawings of steel and concrete livestock stockyards and equipment is easy. The brain module that recognizes irregular shapes has been damaged (Weiss 1989). one part can take over and compensate for a damaged part (Huttenlocher 1984). The brain is designed with modular systems. I can visualize a video of the finished equipment in my imagination. They usually don't see a series of vivid cat or church "videos" unless they are an artist. Some people access their "cat" knowledge as auditory or written language. Using Visualization Visual thinking is a great asset in my career as a livestock equipment designer. there is no language based information in my memory. There are some brilliant people who have little visual thought. Zeki 1992). A functional MRI study by Ring et al. (1999) indicates that people with autism depend more on the visual parts of the brain on an embedded figures test. A brilliant autistic computer programmer told me that he visualized the entire program tree in his mind and then filled in the program code on each branch. but it is a sort of generalized generic cat image. and I have become internationally recognized in this field. while another system may be normal.church steeples or cats. I have to read them off a visualized page of a book or "replay the video" of some previous event. If I keep thinking about cats or churches I can manipulate the "video" images. The nervous system has remarkable plasticity. There is no generalized cat. To retrieve facts. I replay a "video" of the person talking. Research findings indicate that verbal thought and visual thinking work via different brain systems (Farah 1989. The nervous system has remarkable plasticity. but they cannot recognize objects with irregular edges.
I do it non . As a child and as a young adult." I am unable to instantly access my memory. Visual thinking is not a fast method of thinking. Intellectual giftedness is common in the family histories of many persons with autism. When the drawing was finished I could "play the video" and "test" the equipment to see if it would work. physical doors that symbolized major changes in my life. The doors were a visual language for expressing ideas that are usually verbalized. I bought a pencil just like his. such as graduations. dyslexia. Einstein's family history includes a high incidence of autism. At night. Faraday and Maxwell were visual thinkers (West 1991). I had actual.sequentially. In my own family history. my drafting ability suddenly improved after I watched a skilled draftsman. and musical talent. high intellectual aptitude. I had to actually walk through it. and the details are added in a non-sequential manner. a person can tell that the puzzle has a picture of a house on it. When I was in high school and college. One sister is dyslexic and is brilliant in the art of decorating houses. Other great scientists such as Leonardo de Vinci. Relationships must be approached gently because barging forward too quickly may shatter the door. I climbed through a trap door on the roof of the dormitory to sit on the roof and think about life after college. The process is like trying to figure out what the picture on a jig saw puzzle is. When I think about abstract concepts. An accountant with autism wrote to me and explained th at he had to think slowly at his desk. such as relationships with people. food allergies. His theory of relativity was based on visual imagery of moving boxcars and riding on light beams. Thinking about the door was not enough. When I design equipment. my great grandfather on my father's side was a pioneer who started the largest corporate wheat farm in the world. The trap door symbolized graduation. It takes time to "play" the "video. Albert Einstein was a visual thinker who failed his high school language requirement and relied on visual methods of study (Holton 1971-72). a hazy whole or gestalt is visualized. When I solve a scientific problem or review the scientific literature. and then each section of it becomes clear as I add details. such as a sliding glass door. In all these cases. . I often have a general outline of the system.an astute reader can find evidence of them in Einstein and Einstein (1987). and he himself had many autistic traits . but it took time to learn how the sym bolic lines on a set of engineering drawings related to the "video" of a house or a piece of equipment that was in my imagination. but he could solve problems that were difficult for other accountants. when only some of the pieces are put together. I could then instantly translate the symbols on the drawings into a visualization of the finished structure. and then I copied his style. I use visual images. I was good at building things. Visual thinking is also associated with being intellectually gifted. After I learned to read engineering drawings. A piece is put on one corner and then another corner and after about one fourth of the pieces are in place.composer told me that he made "sound pictures". When I was 28. but the drawing I made was a new design.
Visual and associational thinking would explain Frith's observation that a child may say "French toast" when he or she is happy. New thoughts and equipment designs are combinations and rearrangements of things I have previously experienced. Donna Williams (1992). they are associational" (Hart 1989).Park and Youderian (1974) also report use of visual symbols. "The power and the glory" were high-tension electric towers and a blazing rainbow sun. such as reversing numbers and mixing up similar sounding words such as over and other. the name Dick was used to refer to painting. The autistic person's visual thinking methods may explain some of the "Theory of Mind" problems that Frith (1989) outlines. If verbal directions contain more than three steps. and I mix up steps in the sequence of doing a problem. Children with autism perform best with written instructions that they can refer to. to describe abstract concepts. Like me. Many autistics have problems with remembering the sequence of a set of instructions. For example. Learning statistics was extremely difficult. I had to work with a tutor and write down the directions for doing each test. I cannot remember the sequence for doing the calculations. I visualize the word trespass as a "No Trespassing" sign on the neighbor's tree." Park (1967) also explained that her daughter learned nouns first. which require remembering a sequence of steps (Boucher and Lewis 1989). but I still have to relate a particular relationship with something I have read or experienced. Every time I do a statistical test. an autistic woman from Australia. I have a need to see and operate all types of livestock equipment because that programs the "visual computer. I have many dyslexic traits. Nouns are easy because they can be associated with pictures in one's mind. It is easy to understand the principles of statistics. because I can visualize the normal or skewed population distributions. I still have difficulty with long str ings of verbal information. such as doors. Charlie Hart summed up autistic thinking with this statement about his autistic son Ted: "Ted's thought precesses aren't logical. because I am unable to hold one piece of information in my mind while I do the next step. Inappropriate words are often used. describes similar difficulties. because I can't make a visual image. All my memories are visual images of specific events. I no longer use sliding doors to understand personal relationships. She was unable to learn math until she watched the teacher write out each step. This happened because Park's daughter saw a picture of Dick painting furniture in a book. a fight between my neighbors was like the United States and Europe fighting over customs duties. compared to verbal instructions or a demonstration of a task. I have to use notes. The problem is. She thinks her name is you because that's what people call her. Algebra is almost impossible. Visualization enabled me to understand the Lord's Prayer. For example. I have to write them down. she had to see every step written on . Park (1967) also describes why her daughter had problems with pronoun reversal and won't use the word I.
I screamed every time my teacher pointed the pointer towards me. if she did not push enoug h. My speech and language problems were similar to the loss of speech that occurs in children who have had brain surgery to remove tumors in the cerebellum and cerebellar vermis (Rekate et al. I screamed. I often screamed. I would have a tantrum. Even highly verbal people with autism can often express themselves better using the written or typed word. I feared that the pointer would poke out my eye. If she pushed too hard. Donna also became frustrated because her calculator did not have an "of" button for finding percents. When I started to speak. MRI brain scans revealed that my cerebellar hemispheres are smaller than normal. The ability to understand speech remained normal. When adults spoke directly to me.? .paper. Word processors should be introduced early to encourage writing. the only way I could communicate my desire not to wear the hat was to throw it on the floor and scream. If something bothered me. Asperger's Syndrome. Many autistics have motor control problems that result in messy illegible writing. there was no progress. I was afraid because I had been taught at home never to point a sharp object at a person. Written language is easier to understand than verbal language. 1985). During recent visits to autism programs. Courchesne et al. She would hold up a cup and say ´ccc u ppp.µ Vowels are easier to hear than consonants. She knew just how much to intrude. When adults talked among themselves. my words were stressed with an emphasis on vowel sounds. The children lost speech and then regained their ability to speak a few stressed words at a time. She would gently hold me by the chin and make me look at her and then ask me to make certain sounds. it sounded like gibberish. This was the only way I could express my displeasure. I had the words I wanted to say in my mind. "bah" for ball. My speech therapist stretched out the hard consonant sounds to help my brain to perceive them. Words that have no concrete visual meaning such as "put" or "on" need to be seen in written form in order to be heard and remembered (Park 1967). I have observed this technique being used in many different types of programs. etc. a high percentage had either an undersized cerebellum or abnormalities of the cerebellar vermis. Autism. If I did not want to wear a hat. When I want to describe how I really feel about something. Autism Subtypes What is the difference between PDD (Pervasive Developmental Disability). The speech therapist had to put me in a slight stress state so I could get the words out. The visual image of all the written steps is essential. Communication I screamed because it was the only way I could communicate. In my own case. the autistic mind will be stumped. Being unable to talk was utter frus tration. (1989) found that in moderate to highfunctioning autistics. it was like a big stutter. For example. (1988) and Murakami et al. If the smallest step is left out. but I just could not get them out. I can express myself better in writing. When my mother wanted me to do something. Typing is often easier than hand writing. I could understand everything they said.
Kanner/Asperger Type Asperger's Syndrome is probably a milder type of traditional Kanner type high. . hippocampus. 1992) at the University of London indicates that they can solve a simple "Theory of Mind" problem that traditional high-functioning autistics fail. From a treatment standpoint. Fragile X. An example of Theory of Mind problem is: "Peter thinks that Jane thinks etc. Research by Bowler (et al. and Bauman and Kemper 1994). An interview with Margaret Bauman indicated that both types have the same pattern of brain abnormalities (Bauman 1991. Most people with autism are visual thinkers. Thinking in Pictures(1995). Kanner/Asperger types can range from individuals with rigid thinking patterns and a relatively calm temperament to people with more normal thinking patterns with lots of anxiety and sensory sensitivity problems. known fetal damage and damage due to high fevers are not included. Talks with parents indicate that they both have the same family history profile (Grandin 1992a). 1991) indicates that both types do poorly on the Wisconsin Card Sorting Test which is a test of flexible problem solving. Even though the different types of autism are on a continuum the characteristics of the different types can be different. It is likely that there is a continuum where each diagnostic category merges into the next one in many varied shades of gray. People with Asperger's syndrome can often function better in the community and have more normal speech and thinking patterns. describes the second type. Many of the individuals have flat affect. emotions may vary from a lack of affect to more normal emotions. During her autopsy studies. facial recognition. and cerebellum. Testing at the University of Denver by Ozonoff (et al. describes examples of the first type and my book. As one moves from one end of the subtypes spectrum to the other. but from a neurological standpoint. It is well known that different types of autism respond differently to various drugs." Both the Kanner and Asperger types have deficits in flexible problem solving. Possibly the different clinical symptoms between the two types can be explained in subtle variations of brain abnormality within the larger framework of a basic abnormality in the limbic system. the differences may be less distinct. The different subtypes of autism may also differ from an emotional standpoint as well. During talks with hundreds of parents and reading in scientific literature I have divided autism diagnosis into two broad categories: 1) Kanner/Asperger Types (named after the doctors who discovered autism) (Kanner 1943 and Asperger 1944) and 2) the Epileptic/Regressive Types. and Annabelle Stehli's (1991) book. amygdala. Both types probably have a strong genetic basis. Charlie Hart's (1989) excellent book. but there are some people with Asperger's syndrome who are good with numbers and have poor visual skills.It is doubtful that there are black and white boundaries between the different diagnostic categories. and fine motor speed coordination. she examined both types. Retts Syndrome.functioning autism. Without Reason. they are apples and oranges. Sound of a Miracle.
A good rule of thumb is that a medication should have an obvious. My speech became more modulated. One must always balance risk versus benefit. If the effect of an antidepressant appears to wear off and anxiety or bad behaviors returns do not raise the dose. Medications given when the brain is developing may possibly have a permanent effect on the development of neurotransmitter systems. Research has shown that very young autistic children have abnormally low levels of serotonin in their brain compared to normal children (Chugani et al. and their ability to understand speech is often poor. restlessness. At this time nobody knows if fluoxetine is good or bad for young autistic children. the dose must be immediately lowered. Some medications may be very harmful.. Remain on the same dose and the antidepressant will usually start working again after the relapse period passes. Find the lowest dose that works effectively and NEVER raise it. Fluoxetine is recommended if the EEG shows abnormalities because it is less likely to cause an epileptic seizure. These side effects are caused by an overdose of the antidepressant. 1999). 1992). Fluoxetine and other antidepressants should be used very sparingly in children. Maybe this would be good for the young autistic brain. and I became more social when the anxiety eased. Low doses of antidepressant drugs must be used to prevent problems with agitation and irritability.Medications for Kanner/Asperger Types At puberty. 1999). I remained on the same dose and the drug started to work again several weeks later. there were problems with insomnia. and if they occur. I had severe problems with anxiety. Anecdotal reports from other adults with autism indicate that fluoxetine improved their lives. On the worst days I felt li ke I was being stalked by a gunman. I have been on the same low dose for twenty years. The individuals with anxiety and nervousness problems are likely to respond well to small doses of antidepressant drugs such as clomipramine (McDougal et al. and sensitivity to touch and sound. Another advantage of fluoxetine is it has fewer uncomfortable side effects. they may not be able to hear . and agitation. Rat research has now shown that fluoxetine may promote the development of serotonin circuits in the brain (Wegerer et al. When the dose was raised. Proper use of the right medication changed my life. The use of powerful medications in young children is a controversial area. but there is also a possibility that some may be beneficial. 1993) and fluoxetine (Cook et al. The anxiety felt like a constant state of stage fright for no reason. fairly dramatic effect. nervousness. Several papers I have read on the use of antidepressants in autism have stated that the beneficial effect of the drug wore off in several weeks or months. Medications such as fluoxetine and other serotonin reuptake inhibitors will increase serotonin levels in the brain. Even though they may pass a standard pure tone hearing test. When I first stated taking antidepressants. Regressive/Epileptic Type These individuals often have more obvious neurological problems. 1992 and Gordon et al.. the effect wore off in four months and the anxiety returned.
Regressives may just hear a jumble of noise. but others may receive a low-functioning label because their sensory processing problems make communication difficult. Recently there has been a concern about the safety of clonidine in children. whereas Kanner/Asperger Types have good receptive speech and can understand what people are saying. 1987). Dr. with no receptive speech. rage or self-injury. Joe Huggins has been working for years with teenagers and adults to find effective medication regimes for very severe aggression and rage. Dr. magnesium. Sands and Ratey (1986) describe this as the concept of noise. Ratey has also found that risperidone will control aggression and rages which may not respond to other medications. Many of these children have signs of subtle epileptic seizure activity. Many regressive/epileptic children are labeled low functioning and have low IQ scores. Gillberg. which may be as low as one quarter of the normal starting dose. Very low doses. An interview with Dr. One bad side effect of risperidone. Conversations with many parents indicate that this group is most likely to have a favorable response to vitamins B6. valproic acid and propranolol. Huggins indicated that he has three basic medications that he uses in low-functioning adults and teenagers who have difficulty managing aggression. Both reports from parents and a report by Ricketts (1993) indicate that fluoxetine is useful for reducing selfinjury. 1986). An extremely low dose will only affect the serotonin system. They are risperidone. Dr. Allen and Rapin 1993) state that children with autistic behavior that are totally mute. in some people with autism. Dr. and it will stay out of the dopamine system. Serious behavior problems sometimes occur at puberty and autistic teenagers and adults may have severe rage or aggression. have to be introduced to language through the visual modality. 1991). is high weight gain. are recommended. Both report that clonidine is beneficial for behavior problems. Xyprexe (olanzapine) has worse weight gain. 1985. Ed Cook reports that clonidine wears off in several months if it is given continually. Anticonvulsants such as valproic acid or ethosuximide may be useful in improving speech and the ability to understand speech in three to five year old nonverbal autistic children (Plioplys 1994. (1993). . This medication affects both the serotonin and dopamine systems in the brain. (Rimland 1988) or DMG supplements (Rimland 1990). Beta blockers such as propranolol are effective for reducing severe aggression in adults (Ratey et al. He recommends using it only when needed to help a child or an adult sleep and not giving it during the day. Researchers in France have documented that B6 and magnesium supplements are effective (Martineau et al. Fankhauser et al. Huggins reports that risperidone must be give in very low doses to be most effective." Some of these individuals may have sensory jumbling and mixing.complex speech sounds." Volkmar and Cohen (1989) were the first researchers to identify the regressive or "late onset" form of autism. such as staring and "spacing out. Some may be retarded. He uses these three medications either singly or in various combinations. Dr. (1992) and Jaselskis et al. One must always balance risk versus benefit. Some of these children may learn to speak when they are taught to read. Some of them cannot follow a simple command like "put the book on your head.
Aurora. When a medication is used.Bitemarks. Huggins publications can be ordered by calling 416-449-5511 or 416-445-3032 (also. Ontario. For high functioning teenagers and adults with autism. 1989. such as Prozac (fluoxetine). Paroxetine (Paxil) and fluvoxamine (Luvox) interact badly with risperidone. tooth . Calcium supplements may help prevent severe self-abuse such as eye gouging (Coleman 1994). such as fluoxetine or one of the other SSRIs. Huggins has had success with beta blockers such as propranolol.Huggins recommends very low doses of 0. Look for ear infections. valproic acid or divalproex sodium (Gedye et al. one of the SSRIs. Huggins has also reported that a combination of a reduced sugar diet and propranolol was more effective than propranolol alone. www. As I stated before. his basic choices for medication for controlling severe behavior are: one low dose risperidone. is often the best medication to use where a single medication can be used to control both depression and anxiety. Dr. To avoid dangerous drug interactions consult. In non-verbal or poorly verbal people with autism. careful observations should be made to determine if it is really effective. Huggins prefers celexa (citalopram) if an SSRI has to be mixed with risperidone because it is the SSRI with the fewest problems with interaction. If the aggressive outburst follows a cycle where they come and go. It interacts badly with certain medications.com). These seizures (epileptic episodes) are often difficult to detect on an EEG (Gedye 1989. Huggins avoids most of the SSRIs. Most other types of aggression or rage are usually triggered by some event such as frustration with communication.. L4G 1W9. Outbursts of aggression in autistic teenagers and adults are sometimes caused by frontal or temporal lobe seizures. Canada. Dr. Dr. a careful medical examination is recommended to look for hidden painful medical problems which could be causing either self-injury or aggression. Huggins will often prescribe valproic acid. 1991).5 to 1. valproic acid and propranolol. Grapefruit juice should be avoided. due to problems with interactions with risperidol. For beta type rage which is diffuse and not directed at a specific target. one must balance the risk against the benefit. PDD. 1991). Many high functioning people are doing very well on a single SSRI such as Prozac (fluoxetine). Seizures should be suspected if the rages occur totally at random. and DD Populations' can be obtained by contacting: Kerry's Place. the teenager may respond positively to either carbamazepine. One must ask the question: Does this medication provide sufficient benefit to make it worth the risk? In a nonverbal individual. painful sensory stimuli or an unexpected change in routine. Risperidone is most effective for alpha type rage where the rage is directed at a specific person. Dr. Too high a dose is less effective for reducing anxiety. Dr. If epilepsy is suspected. 34 Berczy St. Suite 190.5 mg of risperidone for controlling rage in autistic teenagers and adults. consult Graedon and Graedon (1995). Rage and other Hyperadrenergic Behaviors in the Autistic. to prevent it from getting into the dopamine system. The maximum dose of risperidone is 2 mg. For the lower functioning people with autism. People that are hot and sweaty often respond well to propranolol. His spiral bound booklet titled `Diagnostic and Treatment Model for Managing SIB. Dr. Fax: 905-841-1461.
their voices a pattern of sounds" (Painter 1992). Her sensory processing also becomes more normal when she is relaxed and is focusing on only one sensory channel. Donna may be half way along the continuum between the Kanner/Asperger Type and the Regressive Epileptic Type. I needed to be jerked out of my autistic world and kept engaged. If she is distracted by the visual input of somebody looking in her face. regressive/epileptic people with autism. Bauman and Kemper 1994). The tendency of some autistic people to constantly touch themselves and objects around them may be an attempt to stabilize body and environmental boundaries. Donna told me that she sometimes has difficulty determining where her body boundary is. a man with autism. "Sometimes the channels get confused. as when sounds came through as color. she is unable to perceive a cat jumping up on her lap. she can't hear the words. Cesaroni and Garber (1991) also noted problems with locating a tactile stimulus. consisting of rubbing her skin with brushes. it was like a twilight state. They will often respond best to gentler teaching methods such as whispering softly to the child in a room free of florescent lights and visual distractions. Some children with more severe sensory problems may withdraw further because the intrusion completely overloads their immature nervous system. Other people with autism have explained that they had a difficult time determining that speech was used for communication. Therese Joliffe. She realized a black thing was on her lap. then speech perception is blocked. Educational Strategies and Subtypes A teaching and therapy program that worked well for me may be painful and confusing to some nonverbal lower functioning. digestive problems. If she attends to the cat. "their words become a mumble jumble. further exp lained that if somebody looked him in the eye. Jim. headaches and sinus problems. She explained that if she listens to the intonation of speech. Patterns of Neurological Abnormalities Both Kanner/Asperger Types and the Regressive/Epileptic Types have abnormalities of the cerebellum (Bauman 1991." He also said that touching the lower part of his face caused a sound. Even though she disliked the tactile input from the brushes. She states when people spoke to her. Donna told me that sensory integration treatment. explained that it was easier to learn by touch because touch was her most accurate sense (Joliffe et al. an autistic woman. She can use only one sensory channel at a time. Cerebellar abnormalities may explain the sound and touch . she reported that it helped her different sensory systems to work together and become more integrated. she can't hear them. Donna Williams (1994) explained that forced eye contact caused her brain to shut down. "My mind went blank and thoughts stop. 1992).aches. Kins. but she did not recognize it as a cat until she stopped listening to her friend talk. My speech therapist forced me to look at her." Cesaroni and Garber (1991) also describe confusing and mixing of sensory channels. explained. Only one aspect of incoming input can be attended to at a time. has helped. If Donna is listening to somebody talk. a man with autism.like sensation.
Individuals with autism process information very slowly. . he has signs of serious sensory processing problems. Parents often ask. Children and adults who enjoy shopping in big stores usually have less severe sensory problems. Gillingham (1995) contains an excellent review of autistic sensory problems. the more severely impaired Regressive/Epileptic Type autistic people have much greater sensory processing problems. Myelin forms the fatty sheaths around neurons. Most Kanner/Asperger Types do not experience sensory jumbling. (1992) also found that low-functioning individuals were more likely to have abnormal results on a central conduction time test. McClelland et al. and they must be given time to respond. (1988) found that many high-functioning Kanner/Asperger autistic people have abnormalities of the cerebellar vermis. Courchesne et al. such as Williams (1993) and Cesaroni and Garber (1991).sensitivity problems observed in most forms of autism. The "space out" and jumbling may be due to miniature epileptic seizures that occur between the poorly myelinated neurons. Jim. He does not have the rigid thinking of a typical Kanner Type. and they can attend to simultaneous visual and auditory input. Some individuals with very severe sensory processing problems may take several hours to recover after experiencing sensory overload. In more severe cases. Possibly. ¶how can I tell how severe my child·s sensory problems are?· Children and adults that have tantrums every time they go in a large supermarket or shopping mall usually have severe sensory processing problems.evoked potentials in older autistic children. theorizes that certain frightening sounds can act as a trigger for disorganization of processing. The degree of sensory processing problems will vary greatly from case to case. and touch. one of the autistic people that Cesaroni and Garber (1991) interviewed. sensations from the eyes and ears can mix together. This would account for the frequent occurrence of epilepsy and abnormal brain stem. Stimulation of the cerebellum with an electrode will make a cat hypersensitive to both sound and touch (Chambers 1947). this may be due to brain stem abnormalities in addition to the cerebellar abnormalities. (1992) believe that autistic people have a defect in myelinization. Nonverbal adults will process sensory input more slowly than verbal adults. similar to epileptic seizures that a flashing light can trigger. MRI scans of my own brain indicated my cerebellum is 20 percent smaller than normal. Research on rats indicates that the vermis of the cerebellum modulates sensory input (Crispino and Bullock 1984). which is a measure of brain stem function. and he understands the give and take of conversations. However. It is like insulation on electrical wires. Lewis (1993) describes her son who may be mid-way between Kanner Type and Regressive/Epileptic Type. As discussed previously. McClelland et al. Hashimoto et al. It can vary from m ild sound sensitivity to sensory jumbling and mixing. Kanner/Asperger Types may also have a smaller than normal cerebellum. vision. The cerebellum may act as a volume control for hearing. (1992) found that low-functioning autistic people with low IQ scores had smaller brain stems. and an autistic computer genius with ultra classical Kanner Type autism has a cerebellum that is 30 percent smaller than normal. The lack of myelinization may also account for the mixing of sensory input from the eyes and ears and mind blank outs that occur when an autistic person becomes excited. because he does self-stimulatory behaviors in nearly every sensory modality.
Autistic traits often show up in a mild degree in the parents. 1990. such as Rubella or other viruses. Treatment programs that are appropriate and beneficial for one type of autism may be painful for other types. 1990. There is a high correlation between Asperger's syndrome and manic depression (Delong and Dyer 1988). There is a continuum from normal to abnormal. Landa et al. and alcoholism (Narayan et al. They may respond better to a gentler approach using only one sensory channel at a time. Possibly a small amount of these genetic traits confers an advantage. Brain autopsy research (Bauman 1991. Conclusions Teachers. Other studies have shown that lower functioning people with autism also have abnormally slow transmission of nerve impulses through the brain stem (McClelland et al. At ages two to four. Certain areas of the brain. such as the limbic system and cerebellum are immature. siblings. Dr. panic attacks.Cause of Autism Autism is a neurological disorder that is not a result of psychological factors. insults to the fetus. and individuals like Donna Williams and Therese Joliffe who require a gentler approach. A structure called ¶the superior olive· is missing in the brain stem. 1993) and immature EEG patterns (Cantor et al. many autistic children will probably respond well to gently intrusive programs where the child is required to maintain eye contact with the teacher. Lovaas (1987) has documented that roughly half of young children will improve sufficiently so they can be enrolled in a normal first grade at age six or seven. Her research has shown that there are defects in the developing brain stem that happened near the end of the first month of pregnancy. such as high intelligence or creativity. shyness. and close relatives of an autistic child (Narayan et al. In summary. Tourettes (tic disorder). It is likely that the children who did not improve in the Lovaas program were experiencing sensory overload. A complex inheritance of many interacting genetic factors cause most cases of autism. depression. 1992). Some of the tra its that seemed to be associated with autism are: intellectual prowess. anxiety. 1988. 1986). Patricia Rodier (2000) explains that the brain abnormalities that cause autism occur very early in the developing embryo. This may explain the lack of cerebellum development in autism. learning disabilities. This may be a possible explanation for why some autistic people have enhanced visual and savant skills. and high fevers at a young age. As children get older they tend to separate into two groups. Sverd 1991). autism is a disorder in which some parts of the brain are underdeveloped and other parts may be overdeveloped. Children like me who can be "jerked" out of the autistic world and asked to pay attention. Hashimoto et al. therapists and other professionals who work with autistic people need to recognize and treat sensory processing problems in autism. The prognosis of both types of children will be improved if they receive a minimum of 20 hours a week of good educational programming between the ages . 1992) indicate that people with autism have structural abnormalities in the brain. Bauman and Kemper 1994) and MRI studies (Courchesne et al. too many of the traits will cause problems (Clark 1993) Other causes of autism are the Fragile X gene.
Bauman 1991. but may be attracted to other sounds and visual stimuli. Canter et al. Stehli 1991. 1986). Fluoxetine has fewer uncomfortable side effects and is preferred by many individuals. More likely to be mute (Volkmar and Cohen 1989). When they be. Bauman 1991). McClelland et al.tact. They have to be kept engaged so that their brains can develop more normally. May have more normal t hinking and emotions (Cesaroni and Garber 1991. Intrusive teaching methods that work with young Kanner/Asperger Teenagers and adults often respond to low doses of anti .cause they hurt the ears. Both types of young autistic children MUST be prevented from shutting out the world. In severe cases. no common sense. Afraid of certain noises be.pramine and fluoxetine. such as children may cause confusion and pain.zures. In children. such as forced eye con. Very slow sensory processing (Gillingham 1995). For one type of child the teacher can "jerk open the front door. 1993).depressant drugs. or visual stimuli (Grandin and Scariano 1986. Respond poorly to intrusive methods due to sensory overload (Williams. Bemporad 1179).come stressed or overstimulated. Painter 1992). Cesaroni and Garber 1991. Volkmar and Cohen 1985. 1988.tion should be presented to only one sensory modality (Cesaroni and Garber 1991. 1992.velopment (Gedye 1991. clonidine. 1992l 1995. Hart 1989. May have dif .viduals. Volkmar and Cohen 1985). and some three -year-old children respond well to intense intrusive methods (Lovaas 1989. 1986). Teenagers and adults with rage and aggression tend to respond best to inderal. but some Asperger Types tend to be clumsy. and lack of affect (Kanner 1943.ing the toilet.ture central nervous system de . Rigid concrete thinking. but may have cerebellar abnormalities (Courchesne et al. clomi." Table 1: Autism Subtypes These subtypes are on a continuum that merges together. fluoxetine and buspirone.of two and five. 1995. Give them letters and objects to feel. Sensory information from the diffe rent senses my jumble and mix together into noise or pat. No receptive speech (Allen and Pain. May learn best by touch. and imma. Clomi.times . Brain stem development is more normal. Information in the table is based on scientific literature and interviews with autistic people. 1994). Kanner/Asperger Type (High Functioning) Regressive/Epileptic Type (Often Low Functioning) No obvious motor problems. Young children respond well to gently intrusive teaching methods. Some individuals may have severe anxiety problems (Grandin 1986.ficulty determining speech is used to communicate (Joliffe 1992). Often have epileptic sei. undersized brain stems. 1992). Williams 1992. such au." and for the other type. Sensory over-sensitivity to sound. They repeat phrases because they only hear parts of them. B6 and magnesium and DMG are some . the teacher must "sneak quietly through the back door. incoming stimuli becomes jumbled and mixed together. Will actively avoid sounds and stimuli that may be attractive to less severely afflicted indi . 1993). Seldom have epileptic seizures and EEG readings are usually normal. Hashimoto et al. 1992. Epilepsy medications such as carbamazepine and valproic acid are also helpful. abnormal EEG readings. Bemporad 1979). incoming speech may be a jumble of sound. Some individuals have severe anxiety problems. touch.terns (Sands and Ratey 1986. During teaching. Asperger 1944. Have receptive speech and can understand what is said to them (Grandin. Sometimes have obvious body movement problems or difficulty with stopping and starting hand movements. teachers and parents. These medications are usually not recommended in children unless there is a severe behavior problem that does not respond to sensory May be able to attend to only one sensory channel at a time. distractions should be minimized and informa.tomatic sliding doors or flush. Bauman and Kemper 1994. or incoming s peech sounds may fade in and out. Many children with partial receptive speech are echolaic.pramine is the recommended first choice if the individual has severe obsessive-compulsive symptoms. Williams 1993). Grandin 1992. while others are calm (Hart 1987).
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