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  • Writer's picturedocschleg

In Your Face

The good news is that ASD individuals seem to be enjoying more and more choice when it comes to work and education these days. The bad news is that they are often entering areas of society that have a very limited understanding of how ASD individuals experience and interact with the world. As a result, I am sometimes asked to educate and train various groups of professionals.

One of my favorite stories for such training is actually one of my biggest clinical missteps. I was running a social skills class for ASD teens and there were a couple teens in the group who were talking out of turn and generally being distruptive. As is often the case in these groups, the prudent route was to remove the person from the group for a moment rather than take the group's time to encourage (force) the individual to behave. Sometimes this can act as a "reset", and the individual has a chance to try the process of joining the group again.

I gave one student a break (i.e., step out and come back in 5 minutes, which he did) and the other I told to sit outside the group in a place where I could see him. Order was restored, etc., etc. The individual I sent out to sit promptly fell asleep, and I made the decision to leave him that way until the end of the group. After the group was finished and the teens had been dismissed, I woke the sleeping teen who then stood up and grabbed his things as if to leave. Like any therapist who has some group home training on his resume (me), I physically blocked the door and started to ask him rhetorical questions (Where do you think you are going?), and make obvious statements (You were disrupting my group.).

Here was my reasoning. Rehtorical questions and obvious statements were my second attempt to force the teen to acknowledge my authority (my first attempt was to send him out of the group; unfortunately, his falling asleep suggested I failed at this). It would have been nice at this point if he had immediately stated he was sorry, told me what he was sorry for (e.g., disrupting my class, calling my authority into question, perhaps activating some old memories in me of times I felt out of control), and proposed a plan for how he will do better in the future. He instead responded with a blank stare.

My training kicked in again, and without touching him I got right up in his face. By this time in my career I had developed an approach where I could get in a person's personal space, make solid eye contact, and keep my voice very calm while I gave them options for their next behavior (e.g., You might consider apologizing for your behavior; Why don't you have a seat so we can talk about this more; Would you prefer to talk about this at greater length in my office?). The teen responded with the best blank expression I had ever seen in a teenager. There appeared to be no emotional response, no angst, no anger, no frustration or satisfaction-totally blank. In fact, there was absolutely no movement whatsoever. I was astounded (infuriated) by his poise. I was clearly losing this battle of wills.

What I said next was probably the best choice I made since the interaction began. I said, "Go to your next class and I will find you later to talk about this." My group home training told me I had just lost all credibility with this teen, but my recent training in working with teens on the Spectrum suggested I was working with a teen who was overwhelmed and had just shut down. Had I contributed to this?

I had created a boring environment for this teen (the group), allowed him to fall asleep, woke him up, asked him questions he was not supposed to answer, made statements about things that were obvious and only partially true, and got in his personal space. I cannot know which of these did the trick, or what combination of events put him in this shut down state, but all of these behaviors are sufficient to contribute to an ASD teen's dysregulation. If there is enough sustained dysregulation, many ASD individuals can have a "shut down" response where nothing one says or threatens will be sufficient to make the ASD individual do what you want. The shut down seems to be an adaptation, a neurological response to the overwhelming torrent of sensory information and other data in the brain.

My final request to this student worked because I said, "Go to your next class..." (it activated a routine/habit) and "...we will talk about this later" (offer for more effective social reciprocity, learning of social skills, etc.).

There was a lot going on in this interaction, including mistakes in both expressive and receptive language (in both players), sensory mismanagement, problems with social skills, organizational deficits, and, of course, misbehavior (which was the thing I was focused on in that interaction). This interaction did, however, give me one of the clearest views I have had into the experience of ASD individuals, and specifically that teen.

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