Chris is 19 years old, weighs 180 lbs, and stands 5’10” tall. He wears on unkepmt beard and cares little about his dress. Whereever he goes, Chris carries two overstuffed bags containing his essential items: 1 battered Ukulele, 1 portable DVD player with charger, 1 digital camera with spare AA batteries and a memory card, a small folder holding burnt DVDs, noise cancelling headphones for the bus, a snack of orange soda and a pastry, and other miscellaneous items picked up over the years. The contents are never parted with and if anything goes missing…a severe escalation in anxiety and frantic pacing always ensues. These objects move with Chris from room to room, place to place, and activity to acitivity. Typically, the DVD player is out and playing some variation of “Scoobee-Doo”. Often the digital camera is playing (a recorded television show) simultaneously.

Chris takes comfort in his things. He knows his cartoons by heart and will routinely play a short clip over and over again while acting the scene out for himself and occasionally for those around him to see. His mannerisms mime those of the characters in his cartoons as closely as humanly possible. He feels more comfortable sitting on the floor than in a chair and will choose the far corner of a room if its available. When a room gets loud and crowded with people, Chris will try to further partition himself from others, by way of a curtain, coat rack, or other objects that act as a barrier.  The feeling of others encroaching on his space seems to make him more uncomfortable than anything else. In times like this, Chris will begin rapidly packing his things and run for the closest exit, unwittingly knocking over people and things that may stand in his way. He will scream while running through the crowds and not stop until he reaches another safe corner in another quiet and partially-abandoned room.  This physical reaction to others proximity is not uncommon for Chris. When confronted or addressed, especially in an aggressive or coercive manner, (trying to transition him from one activity to the next before he is ready) or without warning, this need to flee always results.

Chris will bang his head on the wall, hit if he is restrained from running out of a room (sometimes into the street), and scream when he feels unsafe or uncomfortable with those around him. His behaviors are not exceptional to individuals with autism, but they are severe.

Chris is a smart boy. He knows his way around a computer and loves music. He will occasionally perform when the environment is right – soothing, unconfined, and accepting of his eccentric manner – and when he does, he really shines.

Chris’ anxiety and inability to adequately articulate his needs when in a group setting leaves him isolated for the majority of the day. Reciprocal interactions are rare, but it does occur if the practitioner/peer is willing to meet Chris at his level. In one-on-one settings, Chris is able to keep a closer proximity to others and carry out short, on-topic exchanges.

The environmnent around Chris holds so many different sensory triggers. Like with any individual on the spectrum, these triggers needs to be identified and implemented into the work one does with Chris, as sensitively as possible. Chris’ anxiety in social settings and his response to feelings of overstimulation (tactile, sound and visual in particular) are things that must be strongly considered and respected when attempting to engage with him. If a menauingful relationship is to be built, understanding someone like Chris is the first step.

Engaging with Chris and helping him reduce feelings of anxiety works best when he is given a meaningful, semi-structured task (like helping to wash dishes or preapre snack). For engagement and skill building, one-on-one work is key. It helps when others allow Chris to have his essential items close by. Like a child’s transitional object used on the first day of preschool, Chris’ things bring him comfort in unpredictable new settings. A soft voice and slow body movements help Chris to interact with others with more ease and closer proximity. Music and movement activities, with small groups and open exits feed into Chris’ passion for self-expression through song and dance.

I encourage parents and practitioners to write a small case study like the one above. You will be amazed at what you know/what you’ve forgotten you know. It will ultimately help you relate to your child in a deeper and more informed way.