I remember the first time my grandson took a plane to visit me. Unfortunately, so does everybody who was on the plane with him. It was two and a half hours of the loudest non-stop screaming that you have ever heard. Quite a spectacle: arms flailing, fighting not to be held, and face swollen from the crying. I say spectacle as he apparently captured the attention of everybody on the plane, and yes, everybody had an opinion about my grandson and how my daughter was handling the situation. This is an autism meltdown. My daughter did her best to remain calm, but after arriving at our home it was clear that she was completely exhausted, drained of every ounce of energy from her body. From then on, my daughter has taken her family trips preferably by car.
In terms of autism, I often wonder if meltdowns and temper tantrums, may be part of a larger set of traits whose confluence is presently unrecognized by the medical profession. Could this really be an expression of a failure to control impulses? If so, could this help explain other symptoms like food preferences, social interactions, money management, and sexual behaviors?
During social intercourse people are very careful about the information that they share with each other. They often mimic or interact with one another in order to establish strong bonds. Saying whatever comes to mind may be either refreshing or rude depending on circumstances. People who don’t follow conventional rules or lack self-control are usually judged as being rude.
Pica is the persistent eating of substances that have no nutritional value. Institutionalized patients have a high prevalence of pica. According to Lynn Cole, pica is very common in children and adults with autism and other developmental disabilities. The cause(s) of pica have been argued as to whether this behavior is due to a craving for sensory stimulation or the need for specific nutrients such as iron. Whether it is dirt or Cheetos, research now shows that autistic individuals are five times more likely to struggle with eating disorders as compared to typically developing peers. These behaviors may lead to complications such as tooth decay, constipation, and weight changes. Behavioral modification has been the first line of defense against eating disorders. It is possible that restraining our impulses and exerting self-control may help limit maladaptive eating habits.
Sexual behaviors and passion have a lot to do with self-control. People who lack self-control get stuck in the beginning phase of relationships- the one that is the most passionate one. This prompts sexual behaviors, because they are always new in a relationship that is not moving forwards.
Self-control has sometimes been compared to an energy reservoir inside a bag. We have a limited capacity for the same, restricted to whatever is available within the bag. Certain circumstances may cause us to exhaust all of the self-control that is available to us. When this happens, it crosses boundaries and we may lack restraint in multiple facets of our lives. The good news is that self-control is also like a muscle; the more you use it, the bigger it gets. In this regard whether we exert self-control by being lawful citizens or following a dress code may help us in managing our money or in making us more attune in carrying a conversation. Also like a muscle, self-control requires energy to exert itself. It is easier to lose our self-control when we lack sleep of have missed one of our meals.
Self-control has two important components that are regulated within the brain. One is the prefrontal lobes that provides a restraining role to our actions. Damage to this part of the brain may prompt a person to become impulsive, become a risk taker, and disrupt goal directed behaviors. This part of the brain is also important for executive functions (e.g., theory of mind) that have been claimed to be affected in autism. The other part of the brain that deals with self-control is the cingulate gyrus. You may consider the cingulate gyrus as the traffic control tower within an airport; among other functions it monitors ongoing behaviors.
My laboratory has studied the function of the cingulate gyrus in autism. Our studies have shown that autistic individuals show a reduced sensitivity to the detection and ability to institute corrective actions. This may result in reduced error awareness and a failure to adjust when dealing with situations where erroneous responses may occur. In autism, the anterior cingulate gyrus that seems malfunctioning in self-control may also be somehow related to perseverative behaviors. Abnormalities of the cingulate gyrus have also been reported for obsessive compulsive disorders and for attention deficit hyperactivity disorders.
It is highly interesting to speculate about the interrelationships between all of these symptoms in autism and hope that someday they will be tackled in a controlled research environment. The resultant findings may be of great importance to affected individuals. The ability to exert self-control and delay gratification is a trait of longevity. Indeed, self-control is observed in other animal species where its presence is an evolutionary preserved trait that has helped in their survival.
Personally speaking, from my experience, I have heard that ADHD/Autism can be associated with a reduced prefrontal cortex, which is also important for self-control.
«The prefrontal cortex, part of the frontal lobe, helps the brain sort through stimulation and decide what information is relevant and what to ignore. Dr. Avis Brennan and Dr. Amy Arnsten of the the Yale University School of Medicine note that this brain region helps regulate movements, works to inhibit inappropriate behavioral responses and controls impulses, language, attention, decision-making and error correction.» (https://www.livestrong.com/article/174722-adhd-the-frontal-lobe/)
I have had a lot of those issues before I received the botox injections in my forehead. I am not sure if the forehead muscle size reduction caused by the botox injections somehow gave my prefrontal cortex an opportunity to grow in size, and if so, how that would happen. I would have had to do MRI scans, but they are pretty expensive.
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The involvement of the frontal lobes in ADHD is well known and there are multiple studies in this regard. However, I am not be able to link the Botox injections to any changes in the frontal lobes. Infections can travel from the skin of the face through draining going in the orbits of the eyes into the skull causing flebitis in the sinus drainage of the brain. Maybe if there was seepage of the Botox outside the muscles a very small amount could get in., but now I am strectching my imagination. Thanks for the comment.
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While my autism was more severe than my sister,my sister was the one that has the prolonged,dramatic meltdowns.My sister was first diagnosed as a child,with bipolar disorder,unusual in 1980,and much later with autism as an adult.My sister has some,but not all,of the same medical issues I do,especially GI disease and seizures.Manic episodes in bipolar can be similar to autistic meltdowns.Bipolar-autism comorbidity may be more common than we think.
School age children,like my sister was,are now being diagnosed with bipolar much more frequently.I don’t know how common the screening is today for both,if a child has one diagnosis or another,but certainly we need screening across the two conditions.
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