Frequently Asked Questions about Autism
Temple Grandin, Ph.D.
How do I know if my child has problems with sensory over sensitivity?
Sounds or visual stimuli that are tolerated by normal children may cause pain, confusion and/or fear in some autistic children. Sensory over sensitivity can vary from very slight to severe. If your child frequently puts his hands over his ears, this is an indicator of sensitivity to noise. Children who flick their fingers in front of their eyes are likely to have visual sensitivity problems. Children who enjoy a trip to a large super-market or a shopping mall usually have relatively mild sensory sensitivities. Autistic children with severe sensory sensitivities will often have tantrums and other bad behavior in a shopping mall due to sensory overload. These children are the ones who will most likely need environmental modifications in the classroom. Older children and adults, who remain nonverbal and have very little language, often have more severe sensitivities than individuals with good language. Children with auditory or visual sensitivity will often have normal hearing and visual acuity tests. The problem is in the brain, whereas the ears and eyes are normal.
What sights and sounds are most likely to cause sensory overload or confusion in the classroom?
Every autistic child or adult is different. A sound or sight, which is painful to one autistic child, may be attractive to another. The flicker of fluorescent lighting can be seen by some children with autism and may be distracting to them. It is mostly likely to cause sensory overload in children who flick their fingers in front of their eyes. Replacing fluorescents with incandescent bulbs will be helpful for some children. Many children with autism are scared of the public address system, the school bells or the fire alarms, because the sound hurts their ears. Screeching electronic feedback from public address systems or the sound of fire alarms are the worst sounds because the onset of the sound can NOT be predicted. Children with milder hearing sensitivity can sometimes learn to tolerate hurtful sounds when they know when they will occur. However, they may NEVER learn to tolerate UNexpected loud noise. Autistic children with severe hearing sensitivity should be removed from the classroom prior to a fire drill. The fear of a hurtful sound may make an autistic child fearful of a certain classroom. He may become afraid to go into the room because he fears that the fire alarm or the public address systems may make a hurtful sound. If possible, the buzzes or bell should be modified to reduce the sound. Sometimes only a slight reduction in sound is required to make a buzzer or bell tolerable. Duct tape can be applied to bells to soften the sounds. If the public address system has frequent feedback problems, it should be disconnected.
Echoes and noise can be reduced by installing carpeting -- carpet remnants can sometimes be obtained from a carpet store at a low cost. Scraping of chair legs on the floor can be muffled by placing cut tennis balls on the chair legs.
Why does my child avoid certain foods or always want to eat the same thing?
Certain foods may be avoided due to sensory oversensitivity. Crunchy foods such as potato chips may be too loud and sound like a raging forest fire to children with over sensitive hearing. Certain odors may be overpowering. When I was a child I gagged when I had to eat slimy foods like jello. However, some limited food preferences may be bad habits and are not due to sensory problems. One has to be a careful observer to figure out which foods cause sensory pain. For example, if a child has extreme sound sensitivity, he should not be required to eat loud, crunchy foods; but he should be encouraged to eat a variety of softer foods. When I was a child my parents made me eat everything except the two things which really made me gag. They were under-cooked slimy egg whites and jello. I was allowed to have a grilled cheese sandwich everyday for lunch, but at dinnertime I was expected to eat everything that was not slimy.
To motivate a child to eat something he does not like, it is recommended to have a food he really likes such as pizza right in front of him along with the food he dislikes. He is then told that he can have the pizza after he eats a few bites of peas. It is important to have the pizza right there in front of him to motivate eating something he does not like.
How do I toilet train my autistic child?
There are two major causes of toilet training problems in children with autism. They are either afraid of the toilet or they do not know what they are supposed to do. Children with severe hearing sensitivity may be terrified of the toilet flushing. The sound may hurt their ears. Sometimes these children can learn if they use a potty chair which is located away from the frightening toilet. Due to the great variability of sensory problems, some children may like to repeatedly flush the toilet but they are still not trained. The thinking of some autistic children is so concrete that the only way they can learn is to have an adult demonstrate to them how to use the toilet. They have to see someone else do it in order to learn. Some children with very severe sensory processing problems are not able to accurately sense when they need to use the bathroom. If they are calm they may be able to feel the sensation that they need to urinate or defecate, but if they experience sensory overload they cannot feel it. This may explain why a child will sometimes use the toilet correctly, and other times he will not.
Why do some autistic children repeat back what an adult has said or sing TV commercials?
Repeating back what has been said, or being able to sing an entire TV commercial or children's video is called 'echolalia.' Echolalia is actually a good sign because it indicates that the child's brain is processing language even though he may not be understanding the meaning of the words. These children need to learn that words are used for communication. If a child says the word 'apple,' immediately give him an apple. This will enable the child to associate the word 'apple' with getting a real apple. Some autistic children use phrases from TV commercials or children's videos in an appropriate manner in other situations. This is how they learn language. For example, if a child says part of a breakfast cereal slogan at breakfast, give him the cereal.
Autistic children also use echolalia to verify what has been said. Some children have difficulty hearing hard consonant sounds such as "d" in dog or "b" in boy. Repeating the phrase helps them to hear it. Children who pass a pure tone hearing test can still have difficulty hearing complex speech sounds. Children with this difficulty may learn to read and speak by using flash cards that have both a printed word and a picture of an object. By using these cards they learn to associate the spoken word with the printed word and a picture. My speech therapist helped me to learn to hear speech by lengthening hard consonant sounds. She would hold up a ball and say "bbbb all." The hard consonant sound of "b" was lengthened. Some autistic children learn vowel sounds more easily than consonants.
How should educators and parents handle autistic fixations on things such as lawn mowers or trains?
Fixations should be used to motivate schoolwork and education. If a child is fixated on trains, use his interest in trains to motivate reading or learning arithmetic. Have him read about trains or do arithmetic problems with trains. The intense interest in trains can be used to motivate reading. It is a mistake to take fixations away, but the child needs to learn that there are some situations when talking about trains is not appropriate.
The idea is to broaden the fixation into a less fixated educational or social activity. If a child likes to spin a penny then start playing a game with the child where you and the child take turns playing with the penny. This also helps to teach turn taking. A train fixation could be broadened in studying history. A high-functioning child would be motivated to read a book about the history of the railroad. One should build and broaden fixation into useful activities. My career in livestock equipment design started as a fixation on cattle chutes. My high school science teacher encouraged me to study science to learn more about my fixation.
High functioning autistic and Asperger teenagers need mentors to help them develop their talents into a career skill. They need somebody to teach them computer programming or graphic arts. A local computer professional could serve as a mentor or the individual may be able to take a programming class at a community college. Many parents wonder where they can find a mentor for their teenager. Try posting a notice on a bulletin board at a university computer science department or strike up a conversation with the man in the supermarket checkout line who is wearing a badge with the name of a computer company on it. I found one of my mentors in the business world when I met the wife of his insurance agent.
What is the difference between PDD and autism?
Autism and PDD are behavioral diagnoses. At the present time there are no medical tests for autism. Autism is diagnosed based on the child's behavior. Both children diagnosed with autism and PDD will benefit from education programs designed for autistics. It is essential that children diagnosed as PDD receive the same education as children diagnosed with autism. Both autistic and PDD children should be placed into a good early education program immediately after diagnosis. Children diagnosed with PDD tend to fall into two groups: (1) very mild autistic symptoms, or (2) some autistic symptoms in a child who has other severe neurological problems. Therefore, some children diagnosed as PDD may be almost normal; and others have severe neurological problems such as epilepsy, microencephaly or cerebral palsy. The problem with the autism and PDD diagnoses is that they are NOT precise. They are based only on behavior. In the future, brain scans will be used for precise diagnosis. Today there is no brain scan that can be used for diagnosing PDD nor autism.
Why is Early Intervention important?
Both scientific studies and practical experience have shown that the prognosis is greatly improved if a child is placed into an intense, highly structured educational program by age two or three. Autistic children perform stereotypic behaviors such as rocking or twiddling a penny because engaging in repetitive behaviors shuts off sounds and sights which cause confusion and/or pain. The problems is that if the child is allowed to shut out the world, his brain will not develop. Autistic and PDD children need many hours of structured education to keep their brain engaged with the world. They need to be kept interacting in a meaningful way with an adult or another child. The worst things for a young two to five year old autistic child is to sit alone watching TV or playing video games all day. His brain will be shut off from the world. Autistic children need to be kept engaged; but at the same time, a teacher must be careful to avoid sensory overload. Children with milder sensory problems often respond well to Lovaas-type programs. However, children with more severe sensory processing problems may experience sensory overload. There are two major categories of children. The first type will respond well to a therapist who is gently intrusive and pulls them out of their world. I was this type. My speech therapist was able to "snap me out of it" by grabbing my chin and making me pay attention. The second type of child has more neurological problems, and they may respond poorly to a strict Lovaas program. They will require a gentler approach. Some are 'mono-channel' because they cannot see and hear at the same time. They either have to look at something or they have to listen. Simultaneous looking and listening may result in sensory overload and shutdown. This type of child may respond best when the teacher whispers quietly in a dimly illuminated room.
A good teacher needs to tailor his/her teaching method to the child. To be successful, the teacher has to be gently insistent. A good teacher knows how hard to push. To be successful, the teacher has to intrude into the autistic child's world. With some children the teacher can jerk open their "front door;" and with other children, the teacher has to sneak quietly in their "back door."
Why does my child want to wear the same clothes all the time?
Stiff scratching clothes or wool against my skin is sandpaper ripping off raw nerve endings. I am not able to tolerate scratching clothes. Autistic children will be most comfortable with soft cotton against their skin. New underwear and shirts will be more comfortable if they are washed several times. It is often best to avoid spray starch or fabric softeners that are placed in the dryer. Some children are allergic to them. [Note: Caretakers and teachers should also avoid the use of perfume because some children hate the smell and/or they are allergic to it.]
Even today at the age of 49, I have had to find good clothes and work clothes that feel the same. It takes me up to two weeks to habituate to the feeling of wearing a skirt. If I wear shorts during the summer, it takes at least a week before long pants become fully tolerable. The problem is switching back-and-forth. Switching back-and-forth can be made more tolerable by wearing tights with skirts. The tights make the skirt feel the same as long pants.