Loving Our Neighbors as We Love Ourselves – Part 2
Welcome back to our three-part exploration of autism spectrum disorder (ASD) as a diagnosis as well as how we can all live alongside our neurodivergent neighbors in a way that is honoring and accepting of who they are and how they may interact with us.
As mentioned during our first installment, we can begin living alongside our neighbors with ASD by first understanding the diagnostic criteria an individual must meet to be diagnosed with ASD and how those criteria may manifest. It is crucial to understand that, as it is currently understood and diagnosed, ASD is a disorder that primarily impacts social interactions. Diagnostic criteria are broken into two categories, with associated subsections. During the first installment of this series, we reviewed the first category, which focuses on the specific social difficulties an individual with ASD may encounter.
Today we will focus on the second category, which outlines the restricted and repetitive behaviors that also manifest as part of an ASD diagnosis. In the Diagnostic and Statistical Manual (DSM), four kinds of restricted and repetitive behaviors are listed. To meet criteria for a diagnosis of ASD, an individual must meet all of the diagnostic criteria reviewed in our last installment as well as two of the four types of restricted and repetitive behaviors we will be reviewing today.
The first kind of restricted/repetitive behavior noted in the DSM includes stereotyped and/or repetitive motor movements, use of objects, or speech. This can manifest in many different ways depending on the specific individual. For example, one child might line up cars, another might play with a mobile phone in an atypical manner (i.e., using it as a comfort object instead of as a technological device), and yet another might play repetitively with a cause-and-effect toy long after it would be developmentally appropriate to do so. Individuals who meet this criteria may also engage in echolalia, that is, repeating words or phrases they hear.
The second section under restricted/repetitive behavior includes insistence on sameness and inflexibility associate with routines, among other things. Similar to other diagnostic criteria for ASD, this can manifest in many different ways. Individuals who meet this criteria might become extremely upset if forced to take a new route to work or school, if asked to make a change to their daily routine, or if plans change at the last minute. Individuals who meet this criteria may also insist on eating the same limited foods every day or on wearing the same clothing every day.
The third section under restricted/repetitive behaviors includes intense and/or atypical interests. A young child, for example, might develop a strong interest in a specific war ship from World War I and become unwilling to consume media or converse about anything outside of that specific interest. Another individual might because fixated on a particular television show or book. While love of literature and/or devotion to a particular television series in not uncommon in the general population, for an individual who meets criteria for ASD, these fixations are significantly more pronounced.
Last, but certainly not least, the fourth section under restricted/repetitive behaviors address sensory issues, which are common among individuals with ASD. These sensory issues could manifest as sensory sensitivities or as sensory-seeking behaviors. An individual with sensory sensitivities may find certain sights, smells, sounds, tastes, or physical sensations intolerable or even painful. This may cause the individual to avoid eating certain foods, wearing certain clothes, etc. Individuals who engage in sensory-seeking behaviors may desire exposure to more intense sights, smells, sounds, tastes, or physical sensations. For example, they may request bear hugs to feel deep pressure or may listen to music and television programs at very loud volumes.
As mentioned during our last installment, it is important to remember that an individual with ASD who refuses to eat certain foods or wear certain clothing, who gets upset because the car is taking a different route than usual, or who talks about the same topic repeatedly is not “being difficult” on purpose. An individual who meets criteria for a diagnosis of ASD is simply perceiving and experiencing their environment in a very different way than a neurotypical peer. Some of these perceptions and experiences are not only noxious but painful, and so the individual with ASD may be avoiding them for a very good reason!
April is a good time for us to consider whether or not all aspects of behavior exhibited by an individual with ASD need to be addressed. For example, if an individual with ASD has a strong aversion to wearing a certain fabric or eating a certain food, do those options need to be forced onto them? If a child who meets criteria for ASD would like to discuss minor details of the war ships utilized during World War I, does that interest need to be squelched? Or can we encourage that fascination with war ships and imagine a future where that child can become a noted historian? Can we, as a society and as a community, tolerate individual differences even when those differences may make us uncomfortable or seem atypical?
As April continues, the invitation is that we would each continue to practice love, joy, peace, patience, kindness, goodness, gentleness, faithfulness, and self-control so that we can continue to create spaces in which every person can be celebrated for being exactly who they are.
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