Sunday, 24 November 2019

Anxiety & Anger in Autistic Children and Young People

This is a diagram I made about some of the reasons why an autistic person may curse and swear, or show distress behaviour, during periods of high anxiety, stress or distress. 

Anxiety, depression, trauma, OCD and other mental health situations are common amongst autistic children and young people.  Not because of autism, but because they spend a lifetime being told they are a disaster, a deficit, not the child anyone wanted.  They spend a lifetime being coerced into pretending they're not autistic, punished for brain events outside of their control, bullied and ostracised by non-autistic children and young people around them.  Frankly the only miracle is that the mental health crisis doesn't affect 100% of them.

Failing to understand autistic distress behaviour has led to a lot of poor outcomes.  I see some people misunderstanding the reasons for 'acting out', and assuming that it's directed aggression, at a particular person within earshot, for reasons of nastiness or prejudice.

It rarely is.

Autistic processing, sensory and social differences mean that autistic responses are also different.  It is vital to be able to decode what's happening, if someone is in a crisis situation and using some lively or offensive language.  It's preferable, of course, to have enabled life to be as pain-free and stress-free as possible for that person.  But, we'll start from that worst-case scenario where there they are in distress, swearing.

First, you are going to ask them what's wrong, yes?  I hope so. That's always the starting point.  Asking, using communication they can understand, and giving communication methods and time for them to respond.  All whilst ensuring you use skills to check for immediate safety for them and others of course.  All whilst thinking about getting them to a place where they can be calmer, a pre-organised quieter space with some loved safe things. Whilst avoiding eye contact, and keeping body language, voice tone and face expression slow and caring, not fast and aggressive.  That planning should always be part of any de-escalation process.

1. Are they in physical or brain pain?  Yes, brains are physical things, but a lot of medics assume those are two separate features.  Check for pain.

Physical - a lot of autistic people have co-occurring chronic pain conditions. is a starting point for you.  If you're in pain all the time, and people aren't helping you with that, what is your mood going to be like?  Are you just a nasty person?  Nope.  There's also research that swearing is one way to reduce pain levels. is a starting point.  Not sure about that?  Go watch some matenity ward shows where there's videos of people giving birth.  That language isn't polite, eh.   You ever drop something heavy on your foot?  Did you say, "Gosh, well well, oh I say!"  I doubt it. 

Brain 'pain' from approaching meltdown or shutdown is very real, and a number of autistic people may use swearing as a way to warn people, or cope.  Disastrously, instead of retreating, people may stay and get confrontational.  Wrong approach entirely.  Remember, autistic meltdown may be an actual brain event caused by electricity 'spiking' in the brain.  Here's your starting reference

2.  A response to an actual dangerous person around them.  Ever been really scared of someone?  Ever thought of using strong language to tell them to go away?  Autistic people are a highly targeted group.  Lots of good research on that sobering fact.  We all like to think that all those around more vulnerable young people are nice, kind individuals. But we also read the newspapers and watch TV.  "We didn't know. They seemed so nice.".  If a young person is reacting strongly to someone being near them, don't make your only response to blame the autistic young person.  Check what's been happening. 

3.  Delayed response to earlier events.  Maybe way, way earlier.  Autistic people are at increased risk of trauma responses, from awful things done to so many. is your starting point for that.  Trauma responses may include flashbacks, and may be nothing to do with who's in the room right now, or what's happening right now. 
Autistic people may also have delayed processing of emotions, so a scary or angry-making thing from earlier may take a while to process....then whoosh, there's the anger or fear, and there's the swearing.  Think about those possibilities.

4.  Sensory and social overload causing a blockage in the brain's ability to process stuff. Meltdown, shutdown.   Ever been stuck in the worst gridlock ever on the roads, everything round you jammed solid, no way to move. (shutdown) You're tired, you need the loo, you have things to do and you are Stuck In That Traffic?  How do you feel?  You may want to swear. How about when you are desperately hungry?  Are you calm?  Or do you get 'hangry' - in a bad mood until you can eat something?
Read  about Roundabout Hypothesis by Chris Memmott.  Many have said that is a very helpful tool for thinking about autistic behaviour and responses.  Our job as allies to autistic people in our lives is to unjam that brain's 'roundabout'.  Signals like hunger, thirst etc may be confusing or painful mysteries in the 'traffic chaos'.  A simple checklist of 'what do I need right now' might help.  So does that quiet space to let the traffic get sorted out.  Once that 'roundabout' in the brain is cleared, we can function again.  Shouting at us during peak traffic is doomed to failure.

5.  Mistaking who's who.  Lots of autistic people are faceblind. (Prosopagnosia is the formal word for this).  is one piece of research discussing this.  In other words, we may have difficulty seeing which person is which, from their faces.  We might recognise them only when they have a particular neutral expression.  Or when their voice is calm.  Or when they are wearing particular clothes, or have a particular hairstyle.  Perhaps the response was meant at a completely different person, and they have mistaken one person for another?  Check this.  

6. Responding to a conversation in another room or space nearby.  Autistic hearing can be extraordinarily sensitive.  It's quite possible for many to hear conversations that are inaudible to others.  For example, people discussing the autistic person in a dismissive way, in another room nearby, feeling sure that they can't possibly hear.  They probably can.  That needs some thought, because the and 'behaviour' that may result from that may look as if there's no cause.  Or may look as if it's aimed at the people in the current room.  Check.  And - be aware that if you ask whether an autistic person can 'hear voices', they are going to be honest about how many people they can truly hear, chatting, all over the building and outside.  Some have mistaken it for a sign of mental ill health.  Nope.

7. Tourette's Syndrome or Tics.  Quite a few autistic people also have tic syndromes, which may involve saying random words or phrases, which may include swear words.  Especially when stressed or in sensory difficulties, it seems. Worse still, for some, the more they think about not saying a particular word, the more their brain uses that word as the 'tic'.

Here's an example. A Venn diagram of the overlap between autism (ASD), ADHD and tics (TD).

It's from this research paper

So, are they really being prejudiced?  Or is it a brain event where it can't stop itself saying the one thing it's not supposed to say?

8.   Copying others.  If an autistic person has heard lots of other people saying it, perhaps they think it's OK to say.  Trying to work out what situations are OK, who is OK to say it in front of, and when to say it, is all very complex.  Autistic social communication and social 'ranking' is very different, so this may be a genuine set of misunderstandings between the autistic person and the person trying to explain the rules.

9. Exhaustion.  More and more research happening, showing that autistic people are desperately short of sleep in today's busy, noisy world.

This is just some of the possible reasons for distress behaviour, anxiety and anger.  There may be others. 

It could well be that an autistic person really doesn't like someone and indeed is really intending to be angry at them.  Or maybe they just like swearing.  Some people do.   After all, we're all human.   But that's rarely my first thought.  Whilst autistic people have their own straightforward social communication system, most autistic are polite when it's appropriate and possible to be polite, and very keen to follow whatever rules they can cope with.  So, investigating is really important.

Get expert advice in to decode situations that have become serious, before they become catastrophic for the person.  Misunderstandings can so easily escalate, and the young person may find themselves in deep trouble because people haven't understood what was actually happening.

Thank you for reading, and learning to be the best allies you can be.