Aswad
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Joined: 4/4/2007
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quote:
ORIGINAL: DomKen
I'm sorry but the autistic who is completely nonverbal and amost completely nonsocial who has bouts of violence against themselves and against caregivers certainly needs more treatment than coping strategies.
I disagree. The lack of coping strategies is frequently the cause of said bouts of violence, in my experience. I am vaguely reminded by the excellent, if dated, story 'Little Lord' by J. Borgen, whose protagonist smashes his own hand because of the frustration building to a point where- having no appropriate outlet- he is unable to contain it.
Last I ran into one at a nonverbal, nonsocial level of functioning, he sought contact with me, calmed down and started spontaneously sharing in an age appropriate but nonverbal manner (still quite intelligible). Parents were befuddled, of course, as he was terrified of strangers and took ages to get used to them. My impression was he had been alone a long time and was very happy for the opportunity to break out of his isolation.
Are you saying that's indicative of a kid that merits e.g. "antecedent-behavior-consequence" programming?
The perversity of medical ethics is that one cannot learn, adapt and develop in a systematic manner, because one cannot obtain informed consent, so it is somehow better to use established methods of torture and anecdotal strategies to foster essentially unfounded hopes in parents that keeping their kids in a nonfunctional situation will result in function. While some parents trust their own instincts and have the resources to find out what works for their kid, most are too weary of dealing with the friction and default, or too concerned with integration.
Well, guess what?
You can't grow up for them. You can't develop for them. They have to grow up. They have to develop. And the best way to do that is with the assistance of parents, adults that have succeeded at similar circumstances, and peers. Sometimes, it will be necessary to use less than optimal means to aid in this process, but the process cannot be built on that aid alone. Coping skills are how you lubricate and pad the difference, to reduce the friction with the world at large and make up for deficiencies while capitalizing on strengths, bringing them to the point where they can decide what course to stake out, set goals and pursue a life that they can be content or even happy with.
Every autist or aspie I've encountered has at some point been in enough pain to resort to self-injurious behavior as a way to alleviate that pain or distract from it. It resolves with coping skills that limit the pain, and knowledge that explains the causative relationships that result in that pain. It does not improve by taking away the only outlet available. And I would say it's not an exclusively ASD trait to use one pain to lessen another. Taking away the possibility is a technique used in interrogative torture to eliminate relief and thereby intensify the experience of the torture while leaving headroom to do more. It's also a technique frequently used in treating the distress of parents who focus on the harm the kid is doing, not the pain that is the reason for it.
If self-injurious behavior is a problem, it is frequently possible to show them less destructive approaches to distract from pain. Clenching an ice cube is painful, but rarely causes lasting effects. Punching a wall with the thumb tucked aside and the wrist held in rigid alignment is also painful, while also venting aggression, but is usually not going to cause a lasting injury, or indeed anything beyond bleeding knuckles. Both can be taught to most who are able to learn anything at all. It will be distressing to watch, to not be able to reach out and take away the causative pain, but therein lies comprehension of one of the reasons the behavior exists: the inability to reach out to stop it.
For that matter, a parent may want to try it themselves, to see what the child does in response. Chances are the child will empathize and reveal its expression of comfort, which parents can use as a means of comforting that the child intuitively understands the meaning of. Or the child may grasp how their behavior is causing distress, motivating them to bear more pain before resorting to such behavior, whereas intervention modifies the behavior in a manner that they're less likely to understand. I'm not saying it will always be productive, just that making an attempt on their own terms is usually better in my experience.
And, quite frankly, when none of this does work at all, I'm inclined to think ASD usually isn't the main problem, just a factor that complicates addressing the main problem. That may be selection bias in my exposure, granted, but it's what I can contribute to the debate: my experience from my exposure to several ASD spectrum kids and adults, growing up with an anomaly that is undecidable but likely at the very least related (and parents that intuitively handled it much as the best (IMO) programme out there), living for more than a decade with a sub gf with a diagnosis of Asperger's, and dealing with people with and without ASD that have engaged in self-injurious behavior.
Just some unsorted thoughts on the matter.
Health,
al-Aswad.
_____________________________
"If God saw what any of us did that night, he didn't seem to mind.
From then on I knew: God doesn't make the world this way.
We do." -- Rorschack, Watchmen.
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RE: Autism breakthrough (maybe) - 
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