While writing this blog I find myself attending an international autism congress in Burgos, Spain. Thus far all of the lectures have been excellent. I have enjoyed the hospitality, the sites, and the tapas. An added bonus has been getting to meet many attendees that had befriended me through electronic contact but had yet to meet personally.
My own 2 lectures at the congress were very well received and I was subsequently approached by many parents having different concerns about their autistic children. One couple from Argentina expressed concern about their daughter, now a young lady, who was recently “stiffening up”. She was holding her arms by her side and her motor movements were described as rigid. There did not appear to be pain involved, but the patient was nonverbal. This was not the result of seizures. Although diagnosed with epilepsy, her convulsions were under control and her most recent EEG’s were all normal. In addition, it seemed that the events were not related to medications.
It is difficult to give advice when you do not know many things about the patient, it is a complex condition, and you have not been able to review the rather extensive medical record. However, it seemed to me that an element of anxiety could be considered. Anxiety is a common occurrence in autism. Some series report that up to three quarters of autistic individuals have an anxiety related disorder. Anxious patients may become stiff, lash out, and become irritable. In this particular case there were no environmental elements or changes in life events that could account for her possible anxiety.
I was asked about the possibility of medications for anxiety, but I answered this would be my last resort. I would try first some alternative type of approaches, some of which are related to the fact that patients may become anxious when they “lose the position of their body part” in their mental map.
Tito Mukhopadhyay says something to this regard in his book: “How can I talk if my lips don’t move?” In explaining some of his problems in learning to play badmington, he says, “I could not tolerate the game for longer than fifteen minutes. My body would feel scattered and my head would be dizzy, which happens even now when I have to be outdoors for long. My body feels more grounded indoors, protected by the four walls of a room. Standing in front of a mirror helps secure my scattered senses.” The explanation also revels why he feels more at ease indoors, in a familiar surrounding, and proposes a type of intervention offered by the security of his reflection in a mirror.
The idea of a shattered body plan was first conveyed to me by Mel Kaplan, an optometrist as he was examining one of his patients. When the patient became irritable Mel used to calm the patient down by putting a beanie bag on top of his head (note: a beanie bag is a small sack filled with dried beans). Other people may use a pressure jacket or a squeeze machine for the same purpose. Some autistic individuals have told me of how they improvised a squeeze machine by wiggling themselves into the space between their boxspring and mattress. I have also recommended swimming therapy for children, as a way of distributing pressure around their bodies. All of these efforts seemingly decreased anxiety in autistic individuals.
The figure illustrates small beanie bags, such as the ones used by Mel Kaplan to “center” the patient. The idea of centering the body plan was eloquently described in “The Center Cannot Hold: My Journey Through Madness: by Elyn Saks.
Figure: I would recommend hydrotherapy in the treatment of many autistic individuals.
Tito Mukhopahay’s mother instituted an exercise that may have beneficial effects on reconstituting the body map of an autistic individual. In this exercise TIto had to close his eyes while she tapped different parts of his arms and legs with a pencil. Tito had to tell her how many taps she made and whether they were a tap, scratch or a rub. This exercise allowed TIto to become more in tune with his body; for example, to be more conscious of an upset stomach or a pain in his bones.
It is my belief that a faulty body schema in autism is in some ways related to an inability to plan motor movements. This inability is called dyspraxia. I will write more extensively on this connection in a future blog.