Coping with the reality of severe autism
General concepts for supporting emotionally fragile individuals who display maladaptive patterns of adjustment.

How are care providers to support a person who is not connected to others, who lives in-the-immediate moment, who reflects and magnifies other's emotions, and who has little continuity of experience?

1. Vulnerability to "meltdown."

The inner place where a person's emotional attachments were formed is the place that people "come back to" when there is nothing else happening around them.

Who are you when there is no one else around? A person who is comfortable with yourself? A person who can fill your time with personally meaningful activity? A person who has to fill the quiet moment with frantic activity? A person who is worrying about all the unanswered questions in your mind? A person who is anxious about whatever may be happening next? Where do you go in your mind when there is nothing outside of you to organize your thoughts and actions?
A. What is it like to be connected to others in space and time?

If you have the experience of being real, validated, and attached, you have a system of core beliefs that sustain you and allow you to regulate your thoughts and actions. You know how to consider options and know what the operating principles are in the world. You can priorize and organize your thoughts and activity. You can plan things for the near and distant future. You can postpone things and get back to them later. You can change your mind. You know how the pieces of your thought and memory fit together in a fabric with a past, present and future.

B. What is it like to be lost in interpersonal space and time?

If you have developed no sense of being real, validated, and attached, you do not have a system of core beliefs that sustain you. You have no sense of predictability and cannot regulate your thoughts and actions. You cannot consider options. Your immediate experience takes precedence over all other thoughts. You cannot priorize your thoughts and activity. You cannot plan for the future. You cannot postpone anything, because as soon as you are not thinking about or continuing to act on what is on your mind, your immediate thought disappears!

You can't let go and change your mind because to do so causes you to feel that you have "lost" your mind. (And, for the moment, you truly have "lost" your mind because you cannot reconnect to your previous thought unless someone assists you to bring it back into mind.) You have no sense of how all your pieces of thought and memory fit together. You have a past, but it is not connected to your present. You have a present but it is not connected to your past or future. You live in a state of vulnerable reflection your immediate, momentary sensations.

Where do you "come back to" if you don't have an experience of continuity and real connection to others? If you are alone, and you don't have core feelings to rely on, you experience momentary nothingness (the existential VOID). Without an organizing sense your empty moment is one of vigilant threat. Your unconnected moment is filled with the primitive emotions of flight or fight.
 
C. What is it like to be an emotional mirror?

When a caregiver is in your presence and projects positive feelings you are able to reflect positive feelings and can feel secure and calm. When a caregiver is in your presence and projects feelings of distress you reflect feelings of distress and may flee or defend yourself from these uncomfortable feelings.

If you are alone and you do not have feelings of others to reflect you may protect yourself from your feelings of emptiness. You may do any number of impulsive actions to stifle the aversive feeling experience of having nothing to reflect. You may do addictive actions to fill the void.

D. What is it like to be unable to regulate your own strong emotions?

Some individuals become highly emotionally aroused when they experience any strong emotion (positive or negative.) Impulsive, acting out, rejecting and oppositional behaviors may be extreme.

In the person's attempt to self-regulate internal emotions that are out of control, the experience of emotional distress can be so intense that a wide range of maladaptive behaviors may be accidentally learned. When individuals act out maladaptive patterns, no matter how disturbed these may appear, they are doing the best they can to give themselves a sense of control, and to test whether or not their world is a safe place to be. If they confirm it is not safe they may escalate into an extreme, retributive meltdown.

Nathan E. Ory, M.A.
Registered Psychologist
Nathan Ory is a psychologist with the Island Mental Health Support Team,
Victoria, B.C.

challengingbehavior@shaw.ca

The Reality of Severe Autism (pt 2)     The Reality of Severe Autism (pt 3)