Thoughts on Autism and Behavior Modification

As I said yesterday, autism sucks sometiems. This doesn't mean it needs to be eradicated. Then again, not eradicating it doesn't mean not pursuing treatment for its bothersome symptoms. I would pursue treatment for certain symptoms even in an ideal society. For example, I take medication for irritability and anxiety and see no reason not to.

Where it gets trickier is when I'm forced by circumstances to pursue treatment, and others dictate what kind of treatment I get. I may legally be an adult, but I am not in a position to live without supports, which in essence creates a power dynamic in which my staff largely determine whhih of my symptoms get treated and how. Behavior modification is staff's favorite treatment modality, and even though originally, behaviorists tended to include the environment in their assessments of behaviors, B-mod has largely gone down to ignoring and/or punishing "negative" behaviors and sometimes rewarding "positive" ones.

I put these two between scare quotes because, what is perceived to be a positive or negative behavior, is not always (or rather, is rarely) objective, and even when a behavior is by most perceived to be positive or negative, the way it's handled may still vary depending on people's perceptions of what is behind said behavior (which, I might say, the original behaviorists didn't care about). For example, as long as I'm not acting out aggressively towards others (which icnludes mild verbal aggression), I can exhibit as much self-directed violence as I need to. I assume the idea behind this is that I'm borderline and borderlines need to be responsible for their own behavior and its consequences. I've had people seemingly more annoyed at the fact that they had to take care of my physcal wounds than concerned at the fact that I'd inflicted them.

Now we've moved past the times when cognitions, emotions etc. didn't exist. Lay behaviorists (ie. most staff) have taken just what they want out of behaviorism. I remember in 2008 my diagnosing psychologist recommended a functional bheavioral assessment on my meltdowns. This includes close observation of behavior, antecedents and consequences, in order to hopefully find the stimuli that trigger the aggressive response. Now I've not yet figured out what I think of this, but I never got to, since such an assessment never took place. The staff introduced seclusion, used it as a threat when I became even slightly irritable, noticed that made my behaviors decrease and decided this was the cure.

Now let me tell you: autistics have as much emotion, cognition and sensation as neurotypicals, we just experience it differently. If you wouldn't want to be subjected to harsh behaviorism yourself, then don't subject an autistic to it. If you want to eradicate a behavior, observe its situational context closely and consider how you would respond in this situation. Is the autistic perhaps trying to communicate the same that you would in this situation, only using a different modality? Are they perhaps responding to sensory overload the same you would, only experiencing this overload differently than you would? If so, consider meeting the autistic's needs beofre you attempt to modify their hehavior. If you want to modify their behavior anyway, consider whether you would want your preferred B-mod method used on yourself. I think everyone who has the power to seclude, restrain or tranquillize another person, needs to have expierenced it themselves first. Lastly, don't assume that just because the autistic isn't displaying behavior that annoys you, it means that they're coping fine.

Autistic Processing Difference vs. Cognitive Distortion

Today, I experienced a combination of emotional turmoil and sensory overload. Which came first is hard to tell, as I was having oversensitivities already for an hour or so, but the actual reaction, which is either a meltdown or an emotional breakdown, was caused by frustration. Given that both autism and borderline personality disorder come with distress tolerance issues, it is hard knowing which is to blame. It doesn't really matter, except that the two require different approaches. BPD treatment involves skills training in distress tolerance, learning to shift your idea that you can't handle frustration to the idea that you prefer not to get furstrated. Autistic distress tolerance issues involve an increased need for routine and time to adapt to a sudden change in that routine.

When sensory overreactivity comes into the equation, it gets more complicated. If this is assumed to be an emotion regulation or distress tolerance issue, people need to learn to accept that sometimes there's noise they don't like. When people still didn't acknowledge my autism, I was often told that it's other people's right to make noise, as if I was depriving them of that right with my reaction to overload. In autism, however, noise can be painful, and the right approach is to allow the autistic quiet time away from the overloading stimuli.

Now that I write this, I notice that I'm connoting that the treatment I assuem is perceived to be right tfor BPD is really not that right at all. In fact, I believe that you cannot assume that a problem with distress tolerance is ever true unwillingness to accept that things can't happen on your terms all the time, which is what is assumed in personality disorders. There are some people who are truly unwilling to take others' feelings into account, but this si much rarer than the assumption that people are unwilling to take others' feelings into account. I realize that cognitive distortions are not necessarily willful, and that the thought that you can't handle any frustration is not the same as the thought that the world revolves around your need for gratification. What I mean to say, however, is that most people, and especially autistic or otherwise neurodiverse people, do not just think they have difficulties. We genuinely do process stimuli differently, and this means that "can't" is not just a cognitive distortion most of the time. That doesn't mean that autistics doon't have cognitive distortions, too. What it means is that you need to take into account autistics' genuinely different processing style when assessing or treating cognitive distortions. As I was being told for the umpteenth time that my daily living skills deficits are largely due to fear of failure, I begun to wonder whether NTs can truly evr make such a judgment.

The Attention-Seeking Theory of BPD

There is lots of stigma surrouding mental illness. Borderline personality disorder is no exception. In fact, it is among the more stigmatized illnesses. Particularly, people believe borderlines act out to gain attention, while there's evidence they do it out of a need to regulate emotions.

I am very thankful that I didn't have the BPD diagnosis when I was first hospitalized in 2007. I had done something that can with good reason be seen as attention-seeking - made a suicidal threat in public -, but I was realy not thinking of the attention I'd get with this. Besides, the kind of attention I got, did matter quite a bit. It is not purely for attention, even though my threat had a signaling function.

In like 2006, before any mental condition had been diagnosed, I was talking to my named support worker at an idependence training facility about my recurrent meltdowns. At one point she concluded that I did it for attention. "So we won't give you attention anymore. Don't think you can do this for attention." In reality, the majority of my meltdowns and acting-out behaviors have the function of either regulating emotions or overwhelming stimuli.

Another thing with the attention-seeking theory is that nothing really is wrong with attention-seeking. Of course, having a meltdown for attention is not appropriate, but it is not like ignoring the person is going to make them better. It will just lead to them giving up and developing learned helplessness. Rather, professionals and others need to help the borderline by providing the right kind of attention before behavior escalates. I strongly disagree with the ida that borderlines need to be left to solve their own problems. We lack skills in emotion regulation, and need to actually be taught these skills. When other conditions, like autism, come into the equation, it gets more complicated, because we truly do not have the ability to process ordinaryy stimuli. I, for one, have a hard time communicating when overwhelmed, so I can't get across my needs in an appropriate manner. It is further reinforcing learned helplnessness to just ignore me in such a state.

Autism and Justified Anger

On my autism treatment and acceptance, Autisticook commented by saying that anger in an autistic is often justified. She compared it to the situation where a wheelchiar user gets angry because they are faced with yet another two-step staircase that wasn't necessary and where nobody thought of installing a ramp. This made me think: are we overpathologizing anger in people with developmental disabilities (and mental illness)? Are we incorrectly assuming that anger is part of the disorder, while it's just a response to a lack of accommodations? This is obviously not a scientific discussion, as what is a reasonable accommodation depends on your perspective.

I just a few days ago heard about cognitive accessibility, where people accommodate their language, for exxample, for understanding by people with learning difficulties. I'm trying to find an accessible and understandable explanation of this, but can't seem to find one. What I understan dit to mean, includes for example using simple, straightfoward language. With autistic people, you may need to refrain from using figures of speech, for example.

What if you were dropped in a country where you didn't speak the language and everyone refused to speak English? Would you get angry? Quite likely you would. Now understand autism as communicating in a different language, too. Is it strange then that the autistic gets angry when you routinely refuse to make an effort to speak their language?

Autism is not just a communication disability. It's in a way a sensory disability, too. Imagine, again, being in that foreign country and everyone shouting at you for whatever reason. They also randomly shine a flashlight at your eyes for whatever reason. In addition, this country is rich on insects, and they crawl over your body all the time. Would you get frustrated? Sure you would!

We do not medicate wheelchair users for getting frustrated at the umpteenth staircase. You would not want to be put on medication if you were in the aforementioed country. So why do we medicate autistics who are irritable? It's probably because accommodating them requires a radical paradigm shift in what we always thought access was all about. Is it a more radical shift than the shift towards wheelchiar accessibility? I am not sure.

Autism and Selective Mutism Symptoms

I have not yet finised reding or even scanning Aspergirls, but I know that in it is a part on mutism in (Asperger's) autistics. I also recall that in 2003 or 2004, I was on an autism discussion board and selective mutism was regularly discussed. Not necessairly in the context of autistic kids or adults, but as a similar disorder.

Indeed, many autistics, myself included, have symptoms that could minmic selective mutism, where a person is able to speak in certain situations but not in others. A person cannot technically be diagnosed with both selective mutism and an autistic spectrum disorder, since when a person is autistic, their selective mutism symptoms are chalked up to that.

I do not know what the literature says about this, so I can only speak for myself, but I often get "locked up inside" out of anxiety. For example, in high school, when my tutor raised topics that hit too close to home, I shut down. However, I can also experience mutism when my thoughts get interrupted or I'm overloaded. Then, my brain shuts down in another respect.

So what can parents and teachers do about selective mutism in an autistic? What they did to me, both my parents and my teachers, was force me to speak. I remember one night when I was about sixteen, being made to stay up until I'd told my parents a certain rather personal thing. Let me say, thhis is not the way to go. Anxiety may play a factor in selective mutism symptoms. When you use force, this anxiety will only get worse. Also, if your child does not trust you enough to talk to about personal issues, that's something to work on first.

When the root of the mutism is not anxiety, still, force will not work. When a person is overloaded, the words and actions you use to make them speak, will often only overwhelm them more. Let them quietly think for a bit instead. You might want to ask what the autistic needs - quiet time to process, an alternative communication modality, etc. -, and the person may be able to indicate this in a way even if they don't use words. Sometimes, asking questions will help, at least with me, but sometimes, this will distract me only further from what I wanted to say.