Adi’s Unique World: Finding Order Amidst the Chaos
In a recent encounter at my clinic, I met 4 year old boy named Adi.
Adi appeared completely uninterested in the plethora of toys around him.
Instead, he was fixated on arranging coloured pencils meticulously on the children’s table. Each pencil had a designated position and consistent spacing between them.
Completely absorbed in his task, Adi seemed oblivious to the existence of the outside world and its inhabitants. Despite lack of facial expressions on his face , I could sense his immense joy.
Observing her son’s behaviour, Adi’s mother earnestly requested, “Please, doctor, do not disturb the arrangement, it upsets him!” With a reassuring smile, I responded, “I understand.” I have come across many children with similar “rituals”.
In addition to his affinity for arranging objects, Adi displayed an intense interest in shape puzzles. Despite our efforts in presenting him with various toys in an attempt to entice him with alternative games and toys, clinic nurse and I faced a resounding defeat .
As a last resort, we discreetly hid the puzzle under a bag beneath the children’s table. Astonishingly, within a fraction of a second, Adi, who had barely made eye contact with me, darted towards the bag, driven by an unwavering determination to retrieve his beloved puzzle. He insisted on playing with the puzzle he had played with countless times before.
Diagnosing Adi
After conducting a comprehensive assessment based on Adi’s medical history, clinical observations, and evaluations, he was diagnosed with Autism Spectrum Disorder (ASD)with language impairment level 2 ( requiring substantial support) for social communication impairment and restricted repetitive behaviours.
Autism In Short
Autism Spectrum Disorder, commonly referred to as autism or autism spectrum, is a neurodevelopmental disorder characterized by core symptoms such as social impairments, communication difficulties, and repetitive or restricted behaviours or interests.
Autism : A Closer Look At Diagnostic Criteria
Adi’s symptoms and behaviours aligned with the diagnostic criterias outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5TR):
Criteria A (deficits in social communication and interaction) and Criteria B (restricted, repetitive patterns of behaviour, interests, or activities).
Specifically, Adi met three out of the four criteria in criteria B:
- engaging in repetitive, stereotyped motor movements, use of objects and speech ;
- displaying an insistence on sameness and inflexible adherence to routines or ritualized patterns of behaviour;
- demonstrating highly restricted and fixated interests with abnormal intensity.
- The fourth criteria is hyper or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment.
Autism Worldwide: Prevalence And Variations
It is estimated that approximately one in every 100 children worldwide is affected by autism, although reported prevalence rates vary across studies.
Typically, more rigorous research reports yield higher numbers, while prevalence rates in middle-income and low-income countries lack precise estimation (1).
For instance, the Centers for Disease Control and Prevention (CDC) released a report on autism prevalence on March 23 this year. According to the 2020 statistical analysis, the prevalence of autism among 8-year-old children in the United States has risen to 2.76%, indicating that 1 in 36 of 8-year-olds is diagnosed with autism (2).
Autism In Malaysia: A Growing Concern
Data from the Malaysian Ministry of Health indicates a steady increase in the diagnosis of Autism Spectrum Disorder (ASD) over the past decade.
The latest annual data from 2021 reveals that 589 children aged 18 and below were diagnosed with ASD, signifying a 5% increase from the 562 cases reported in 2020.
The Quest For Regularity In The Chaotic World
In a world that is inherently unpredictable, undeniably individuals like Adi find it a challenging journey.
In their quest for regularity and self awareness in the midst of worldly chaos, they embed themselves in a self-established realm of order.
While adaptability to changes comes naturally to most children, for children with autism, their rigid cognitive minds make it a daunting challenge.
Unlocking the Purpose of Rituals in Autism
Do ritualistic behaviour and rigidity lack purpose and are dysfunctional?
Research suggests otherwise.
An interview study conducted with adult patients diagnosed with autism sheds light on the personal significance and underlying reasons behind their engagement in repetitive behaviors in daily life.
The participants identified five major functions associated with these behaviors:
1. attention regulation,
2.sensory regulation,
3.emotion regulation,
4.providing a sense of security and coping with unexpected changes in daily routines,
5. managing social communication and interaction.
The research findings underscore the importance of reducing ritualistic behaviors when they interfere with individuals’ daily functioning. However, behaviours that serve positive functions for individuals with autism should be accepted (3).
The way I see it , these rituals offer solace, grounding individuals with autism by providing a buffer against the overwhelming stimuli.
Obsession With Details , A Friend or Foe?
Besides, obsession with details , and intense fixated narrow interest, a trait seen in some children with autism, though often seen as a limitation, can be harnessed as a strength.
The intense focus, perseverance, and meticulousness they display can be channelled into fields that demand precision, like programming, mathematics, and scientific research.
Temple Grandin: Turning Obsession Into Innovation
Temple Grandin, a well-known individual with autism, is a great testament to this.
Temple has severe ^sensory processing disorder, leading to heightened sensitivity to touch and sound. It was only at the age of forty that she could tolerate her mother’s embrace.
During a vacation on her aunt and uncle’s farm, Temple developed a profound fascination and interest in cows. This subsequently led her to a career in animal husbandry, which was an unusual bold move then, as it is a career path predominated by males. However, the rest is history.
Her obsession with animals turned into a unique ability to understand animals . Paired with meticulous attention to detail, and the ability to think in pictures, she revolutionized livestock handling with her innovative designs with focus on humane treatment of animals. (4)(5).
Embracing Adi’s World : A Path to Integration
Returning to Adi, his unwavering devotion to arranging items meticulously is his source of comfort and stability.
Instead of hastily labeling this behaviour as negative, it is imperative that we shift our perspective and explore it more deeply.
Adi could greatly benefit from our support in honing adaptive skills that facilitate his integration into society, all the while acknowledging and respecting his unique preferences and rituals.
Celebrating Neurodiversity
Embracing neurodiversity enriches our world and empowers individuals like Adi to shine uniquely.
‘In diversity, we find not only beauty but also strength.’ – Maya Angelou
Annotation
^1 Sensory processing disorder is a neurodevelopmental condition that affects people’s ability to process and integrate sensory inputs. Patients may be oversensitive or undersensitive to sensory stimuli and may have uncomfortable reactions to sensations such as touch, light, sound, taste, smell, and more. It is commonly observed in patients with Autism Spectrum Disorders.
REFERENCES :
(1) Zeidan, J., Fombonne, E., Scorah, J., Ibrahim, A., Durkin, M. S., Saxena, S., Yusuf, A., Shih, A., & Elsabbagh, M. (2022).
(2) Global prevalence of autism: A systematic review update. Autism Research, 15(5), 778-790. https://doi.org/10.1002/aur.2696 (2) Data and Statistics on Autism Spectrum Disorder | CDC. (2023, April 4). Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/autism/data.
(3) Goldfarb, Y., Zafrani, O., Gal, E. (2021). “It’s in my Nature” – Subjective Meanings of Repetitive and Restricted Behaviors and Interests Voiced by Adults with Autism Spectrum Disorders. In: Gal, E., Yirmiya, N. (eds) Repetitive and Restricted Behaviors and Interests in Autism Spectrum Disorders. Autism and Child Psychopathology Series. Springer, Cham. https://doi.org/10.1007/978-3-030-66445-9_2
(4) Grandin, T., & Scariano, M. (1986). Emergence, labeled autistic. Novato, CA, Arena Press.
(5) Grandin, T., & Johnson, C. (2005). Animals in Translation: The Woman Who Thinks Like a Cow. Houghton Mifflin Harcourt.