Progress in Autism: Self awareness and regulation, a worthy challenge
Progress in Autism: Self awareness and regulation, a worthy challenge
A new study out of Stanford has compiled available evidence to try and map the brain circuits impending a full fledged state of self awareness in autism. The study points to the prefrontal cortex as the seat of self awareness or lack thereof. This is not surprising given the inordinate amount of funds going toward deciphering this particular part of the brain. This is not saying that the prefrontal cortex is not involved. To the contrary, I am only pointing to the overly narrowed focus on specific area of the brain at the expense of other equally important areas such as the midbrain limbic system, nucleus accumbens abd others. Having said that let us go back to a more practical approach to self awareness. Autistics, asperger's and highly sensitive individuals are not lacking in self awareness per se. However in social situations they appear to be. In private, when alone however most people on the spectrum are completely self aware and present. It is in the company of others, in the context of interpersonal interaction that the self awareness mechanism seems to fail, and fail it does, often miserably. As many adults on the spectrum can tell you, they are mostly self aware in private unless they are in sensory overload (immediately following social exposure). And therefore the pattern emerges, self awareness dissolves when an autistic is confronted with a demanding or novel social situation and is promptly reconstituted once that social situation and it's aftermath resolve. This leads me to pay attention to a functional system in the brain, which many are calling the behavioral inhibitory system. This system is present in every living human being for the purpose of self preservation. This is the system that prevents us from jumping in front of a speeding bus or touch a naked electric wire. In short the purpose of the inhibitory behavior is to prevent self harm. This system is highly responsive to danger. Once a dangerous situation is discovered objectively or even just perceived, the inhibitory system kicks in and exercises restraint over our activities and behavior to ensure preservation of the person's life, and prevention of injury.
For individuals on the spectrum, this inhibitory mechanism is so powerful, it operates on the least possible trigger. This is why autistics are famously aware of impending danger and possible threats well before any neurotypical person is. Autistics are not only aware of danger in advance but are also aware of milder degrees of danger that neuroptypicals may never have considered significant. Among the dangers that an overactive inhibitory mechanism considers is the presence of strangers or being in a social situation where an autistic has no way of assessing the intentions of the crowd. So to reframe that problem of self awareness. There is NO global or persistent problem for individuals on the spectrum to see themselves and control their own behavior. On the other hand there is a differential and circumstantial self awareness problem where seeing one self and controlling one's behavior is sacrificed in favor of perceived self preservation drive in the context of a threat. The threat being anything from a loud noise to being present in demanding social situation and so on... From a pattern and a recharacterization of the problem, we move to our natural hierarchy, self preservation trumps social composure and posturing. Therefore when self preservation is threatened, self awareness and appropriateness go out the window in favor of preventing self harm.this is the natural order and it is present in all people, autistic and neurotypical alike. It is just way more tilted in favor of self preservation in autistics. It is also well tilted in favor of social composure and interactivity in neurotypicals. Let us move on to practical solutions based in the natural hierarchy of human priorities. You simply cannot ask a person on the spectrum to maintain self awareness and self control when this person is perceiving a threat to her existence. I am mindful most care givers will say but there is no threat that we can sense. Yet, this is the difference between you and the autistic person you care for. While you see opportunity and excitement in meeting people and being in a crowd, the autistic to your side is seeing threat and danger from the same environment. It is a perceived threat, but it is as real as it gets to a person on the spectrum. Being mindful of and validating perceived threats that autistics feel is the first step. The second step is measured and very very step wise exposure to anything that seems to trigger this threat sensation. Then comes trying to dismantle the components of the threat. Of course engaging by example on the side of the care giver can be very helpful. Yet, more helpful would be to guide an autistic person through what you think makes this situation safe. Pointing out a multitude of smiling faces or peaceful expressionless faces as a sign of safety can be easily done. Pointing out that you know everyone around is also helpful. And so on and so forth as a care giver you have to breakdown the environment and point out all the favorable components in it to put an autistic person at ease. And always remember, no matter what you do, never ever invalidate a feeling of perceived threat as "just in your head" or "just anxiety that requires some meds". Such comments cause the autistic person to further lose self control and possibly become agitated in indignity. The above are practical solutions but the ultimate solution is to create a situation where the person on the spectrum is the center of attention. This is the ultimate way by which autistics gain full self control and the only way by which honest Abe was able to lead a divided nation out of the civil war and preserve the union. Rami Serhan, MD
consultant@sovereignresearch.org
http://sovereignresearch.org/psychesmartautismtm
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