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Autistic Spectrum Conditions
Published in Cathy Laver-Bradbury, Margaret J.J. Thompson, Christopher Gale, Christine M. Hooper, Child and Adolescent Mental Health, 2021
Less intellectually able individuals may present with repetitive behaviours, e.g. hand flapping, rocking, finger and whole body twisting and spinning and rhythmic vocal utterances. These are believed to serve self-stimulatory functions, often known colloquially as ‘stimming’.
Mental Masquerades
Published in Marc D. Feldman, Gregory P. Yates, Dying to be Ill, 2018
Marc D. Feldman, Gregory P. Yates
One of Natalie’s uploads, titled “In My Language,” remains popular to this day, having been viewed over a million times, and shared widely across social media. The video begins with clips of Natalie performing a series of repetitive, seemingly purposeless movements: bouncing a slinky, slapping a piece of paper, jangling a necklace, and the like. These movements resemble the “stimming” behaviors often described in cases of autism, and they are accompanied by an intermittent humming. In the second half of the video, Natalie narrates her experiences to the viewer via a speech synthesizer, beginning with an account of her “existence, awareness, and personhood”: [M]y language is not about designing words or even visual symbols for people to interpret. It is about being in a constant conversation with every aspect of my environment, reacting physically to all parts of my surroundings. … Ironically, the way that I move when responding to everything around me is described as being “in a world of my own” whereas if I interact with a much more limited set of responses, and only react to a much more limited part of my surroundings, people claim that I am “opening up to true interaction with the world.”
Anthony’s Story
Published in Elizabeth B. Torres, Caroline Whyatt, Autism, 2017
Repetitive behaviors, aka “stimming,” are a hallmark of autism and appear to be linked to sensory processing. Repetitive behaviors seem to occur as a coping mechanism and can be observed in times of boredom and understimulation, happiness and excitement, or in the presence of novelty and stress. Anthony has gone through a series of repetitive behaviors, which also tend to occur in stages, sometimes lasting months or years. The only one of these which really had me concerned was when he would repetitively tap hard objects against his teeth. This occurred for nearly a year and, after a lot of interference, was thankfully replaced by banging his hand—this was usually with softer objects. Currently, his obsession is swinging long objects around, such as cords or tubes, and manipulating them with his hands. He could enjoy this activity for hours and is often a lot more comfortable in novel environments when allowed an object to “stim” with. I personally, see nothing wrong with allowing stimming to occur as long as it is bringing the individual joy, is not harmful to themselves or others, and is not interfering with their learning. I think people should be more understanding of individuals on the spectrum, letting them cope in their own way, instead of trying to make them fit the mold of societal expectations.
The Benefits of Experience Greatly Exceed the Liabilities
Published in The American Journal of Bioethics, 2023
Ethan Bradley, David Wasserman
Resolving this autonomy violation is complicated by several features of ABA patients. Autism often limits a person’s ability to communicate their treatment goals, it is often comorbid with other disabilities that may impair a person’s medical decision-making capacity (DMC), and ABA is typically practiced on children too young to consent. For those who lack DMC, we can look to the testimony of autistic adults, both those who have experienced ABA and those who have not. Their testimony could inform debates about what (if any) behaviors associated with autism warrant modification when the patient cannot consent. For instance, if autistic adults generally report that self-stimulating behavior (stimming) helps rather than hinders them, it would be presumptuous to attempt to eliminate similar stimming in autistic children. If there is any way to practice ABA ethically, it requires the inclusion of autistic voices, both at the clinical level and in academic bioethics.
Interviewing individuals with an autism spectrum disorder in forensic settings
Published in International Journal of Forensic Mental Health, 2018
While eye contact avoidance may be obvious at the beginning of an interview, other sensory issues may not. Where possible it is therefore very helpful to establish beforehand an individual’s “sensory profile.” For example, by asking relatives for information and asking the individual to complete a sensory profile questionnaire (e.g., Brown & Dunn, 2002). The information derived from these assessments may allow appropriate environmental adjustments to be made. On meeting an individual, it is also wise to avoid any initial body contact such as a handshake unless one is offered and safety allows. When an individual’s sensory functioning is unknown prior to an interview, it can also be helpful to ask them directly at the beginning of the interview if there is anything that might bother them in the room and which could potentially be altered to reduce sensory discomfort. For example, where possible it is useful to determine whether particular noises such as from fans, strip lights, computers, or other environmental features are distracting or interfere with an individual’s ability to focus and engage with the interview. When an individual may have difficulties with close physical proximity and other sensory sensitivities, seats may need to be arranged at an appropriate distance, artificial lighting avoided and distractions from noise minimized (e.g., select a quiet time of the day where noise outside of an interview room will be minimal). In other situations, even the fabric of chairs or carpets may be an issue and if possible require use of a different interview room. Keeping an even and calm tone of voice throughout the interview is also beneficial. Failing to consider an individual’s possible sensory hypersensitivities by not creating a “low-impact environment” could restrict an individual’s ability to engage with the interview process and potentially result in high anxiety and distraction, with the result that an individual is less able to provide or retain information. Where appropriate and safe to do so, it may also be helpful to allow an individual to have access to a sensory “aid”—so-called “stimming” (e.g., Sims & Hughes, 2016). For example, some individuals seen by the author in less secure settings like to keep their hands occupied during interviews, which appears to contain anxieties (e.g., playing with a toy “tangle” or a piece of cloth).