Auitsm and Echopraxia

Greetings Earthlings! 🙂

Leading on from my previous post on echolalia, this week I’d like to briefly discuss the phenomenon echopraxia.

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Yes I know, it’s another mouthful, but what exactly is echopraxia?

Echopraxia (also known as echomotism or echokinesis) is a type of tic disorder characterized by involuntary imitation of another persons actions e.g. waving a hand, touching your nose, kicking something, even facial expressions. Echopraxia is one of the core features of Tourette’s syndrome, however it has also been found to occur in ASD’s. It is often paired with echolalia, but it has been known to occur independently in autists.

I know what you’re thinking- imitation of actions is critical to early development in childhood and perfectly “normal” behaviour, so it seems like echopraxia might be reading into things too much. However, when this behaviour persists and becomes reactionary rather than a learning tool, then it can be viewed from a pathophysiological  perspective. As such, it can be very difficult to diagnose this behaviour in children. 

So what does the science have to say about echopraxia and autism?

There’s very limited research in this area, however experts believe that echopraxia is related to damage or dysfunction within the frontal lobe known as the action cortex of the brain- an area that is often implicated in autistic behaviours. Other’s have theorized that abnormalities in the mirror neurons located here may be responsible.

Nope, I’m afraid mirror neurons are not quite this exiting- mirror neurons are in fact a particular type of nerve cell that fires when a person or an animal acts and witnesses another person complete the same action. This type of behaviour has been particularly observed in primates, giving new meaning to the phrase ‘monkey see, monkey do’.

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In general, echopraxia is considered harmless, however if it starts to interfere with social functioning, then behavioural modifications, medications and psychotherapy are possible treatment options 🙂

Hope you enjoyed this post dear Earthlings! 😀

Have a lovely weekend!

Aoife

 

Autism and Catatonia

Greetings Earthlings! 🙂

So this week I’d like to talk about a rare condition that affects approximately 12-18% of autistic adults- autistic catatonia.

But what exactly is this when it’s at home?

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Autistic catatonia is a neuropsychiatric condition that causes abnormalities in behaviours, speech and motor functions with varying degrees of severity. In other words, it’s a form of autistic breakdown- one that is often misdiagnosed.

There are over 40 symptoms associated with the condition, many of which overlap with autistic symptoms and traits, so it can be quite challenging to diagnose- even for the most experienced professionals in the field. Symptoms may include mutism, hyperactivity, immobility, stupor, agitation, odd repetitive movements and echolalia. Due to the overlap in symptoms, it’s thought that this condition may be far more prevalent among autists than we realize.

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But what causes it?

As with autism, it’s cause too remains a mystery, however it is thought that vitamin deficiencies, trauma, infection and co-morbid disorders such as schizophrenia and biopolar disorder may contribute to it.

So how do we treat it?

There are currently no cures for autistic catatonia, however a number of therapies have been used to manage symptoms such as antidepressants, muscle relaxers, benzodiazapines (such as Lorazepam) and anti psychotics. Electroconvulsive therapy (shock therapy), brain stimulation and NMDA receptor antagonists (a class of anesthetic drugs that are often used recreationally e.g ketamine, nitrous oxide, PCP and the heroin substitute methadone) have also been controversially used to treat catatonia.

There is limited research in this area at present as to how best to treat autistic catatonia, however a psychological approach to treat underlying stress and anxieties which may trigger catatonia is thought to be the best.

Whilst there is no cure, as in the case of autism, with early detection and intervention the condition can be managed 🙂

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Hope you enjoyed this post dear Earthlings and that you’re Christmas preparations are coming along nicely 🙂

Aoife

 

Levels of Autism

Greetings Earthlings! 🙂

Leading on from my previous posts about the different forms of autism (lesser known ASDs; Asperger’s Syndrome (AS); Broad Autism Phenotype (BAP) etc.), I’d like to talk about some changes in the classification of autism that have taken place since the introduction of the all encompassing ASD in 2013.

To recap- an autistic spectrum disorder (ASD) is an umbrella term to describe a range of neurodevelopmental disorders (such as AS, classic autism, PDD-NOS etc.).

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In 2013, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders or DSM-5 as it is more commonly known, changed the previous diagnostic criteria to effectively subsume all previous separate diagnoses under the one term- ASD. As such, these separate diagnoses no longer exist in the eyes of psychologists.

However, in using the umbrella term without these separate diagnoses, it is difficult to determine levels of functionality among autists.

So how do we break it down?

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Autism is now classified using 3 different levels:

  • Level 1 Autism: Requiring Support- These autists have noticeable issues with socializing and communication skills. This level is characterized by:
    • decreased interest in social interactions or activities
    • capable of social engagement but may struggle with conversational give-and-take
    • difficulty with planning and organizing
    • struggles with initiating social interactions, such as talking to a person
    • obvious signs of communication difficulty
    • trouble adapting to changes in routine or behavior
  • Level 2 Autism: Requiring Substantial Support- Symptoms for these autists are similar to level 1, but more severe as they often lack both verbal and nonverbal communication skills which can make daily activities difficult. These autists may also exhibit a number of behavioural problems
  • Level 3 Autism: Requiring Very Substantial Support- This level is where you will find the most severe cases of autism. These autists experience extreme difficulties with communication and also exhibit more signs of restrictive and repetitive behaviours than may be observed in the other levels.

The behaviours at each level can be broken down a little further than this, but these are the nuts and bolts of how autism is classified under this system.

Until recently, these updates have mainly applied to the American classification system, however in the last few weeks the global updated version of the “International Classification of Diseases” (ICD-11) now mirrors it’s US counterpart, dissolving all separate diagnoses of autism in favour of the all encompassing ASD.

So how do I feel about the dissolution of my own diagnosis?

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In many ways, this new classification system is a good thing as it will greatly benefit autists who experience greater challenges. It also allows clinicians more flexibility in that the clinician determines if a patient is on the spectrum using their best judgement rather than the patient fitting a specific combination of traits/reaching a set number of traits, which may benefit borderline/masking autists who are highly functioning enough to pass just under the diagnostic radar.

However, I am concerned for higher functioning autists. I would classify as Autism 1 under the new system, however, whilst I fit some of the bill for this level in my childhood, it does not describe me as well as my original diagnosis. In fact instead of benefiting an aspie, to my mind, it could in fact disable them further as the very word ‘autism’ infers a greater level of need than Asperger’s Syndrome.

Yes AS is a form of autism, but it is worlds apart from many of the lower functioning forms. If an employer for example were to hear the word’s ‘autism level 1’ or ‘high functioning autism’ rather than Asperger’s, this could have a serious disabling effect in their perception of the autist before them. Indeed, in recent years we have become a more inclusive society and are better educated about the spectrum, but for many the ‘A word’ still rings trouble.

On the other hand, the vagueness as to what classifies as support is concerning for autists at each level. Sure, this generalized approach widens the spectrum net, but we also cannot ignore the finer details and traits that ultimately determine the needs of the autist- every case is unique after all.

Hope you enjoyed this post dear Earthlings- enjoy the weekend! 😀

Aoife

Autism Management- Cognitive Behavioural Therapy (CBT)

Greetings Earthlings! 🙂

Today I’d like to briefly examine one of the most commonly recommended therapies for autism management- cognitive behavioural therapy or CBT.

So let’s all lean back in our chez long as we dive in! 🙂

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First off, what exactly is CBT?

Originally designed as a treatment for depression, CBT is a form of psycho-social intervention (i.e. counselling/psychotherapy) that is widely used to help improve mental health. Unlike other forms of therapy, CBT focuses on developing coping strategies to target our problems and to change unhelpful patterns in emotions, attitudes, negative behaviours,  and thought patterns.

In other words- CBT aims to change negative ways of thinking or cognitions in order to improve behaviour.

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As a result, CBT is widely used to treat anxiety, depression, eating disorders, OCD and a range of other psychological issues- many of which are co-morbid with an ASD diagnosis. It’s thought that CBT can be a particularly useful tool to treat anxiety and to help develop emotional recognition in autists.

CBT was personally recommended to me following my initial diagnosis in order help me to better understand autism and to conquer my social anxiety.

So what did I make of it?

Well, being honest (as we aspies must be 😛 😉 ), my opinions are slightly mixed regarding CBT. Whilst initially I found it helpful as it taught me a lot about autism and the reasons behind my behaviours, after a time, I felt that I didn’t really need it- especially given that I was in my twenties and had already overcome many of the challenges associated with ASD’s. In many ways, simply knowing and understanding Asperger’s Syndrome was enough to assuage much of the mental anguish I had inflicted on myself for being different 🙂

Nevertheless, I did find it beneficial to have a neutral party to talk to in those first initial months post diagnosis. It’s quite a lot to take on board, so it was nice to have that outlet to help guide me through the fog.

All in all, I felt that perhaps CBT may be better suited for a younger person with autism in helping them to develop lifelong coping mechanisms that will enable them to thrive. Had I better understood myself earlier in life through CBT intervention, many things could have been so much simpler 🙂

So if you think CBT may help you or your child, why not give it a try- get out your phone, book an appointment and take a seat on that couch (it’s surprisingly comfy 😉 )

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Enjoy the weekend everyone! 🙂

Aoife

Autism and “Stimming”

Greetings Earthlings! 🙂

Today I’d like to touch on one of the most commonly observed autistic behaviours- “stimming”.

So what exactly is “stimming?”

Self-stimulatory behaviour, (also known as stereotypy or “stimming”), refers to many of the repetitive behaviours often exhibited by autists. Examples of these behaviours include scratching or rubbing the skin, noise making, smelling objects and the classic examples of rocking and  hand flapping, although in my experience it’s a lot more like ‘Jazz hands’ than flapping!

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There are two psychological theories as to why autists stim:

  • As a response to overwhelming sensory stimuli
  • As a means of relieving stress and anxiety

From a physiological perspective, there are a number of possible biological reasons.

Some researchers believe that stimming provides the autist with sensory stimulation. Contrary to common belief, many people with autism have a reduced sensitivity to certain sensory stimuli. Dysfunctions in the circuitry of the brain mean that the body craves sensory stimulation, and so we adapt repetitive behaviours in order to stimulate and excite our nervous system.

Deficits in dopamine levels in the brain can also interfere with our reward pathways, leading autists to engage in behaviours, such as stimming, which will provide the extra hit of dopamine that the brain needs.

So that’s why I’m drawn to fluffy things! 😉

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Aside from being drawn to stimulatory texures, I have a particular tendency to fidget with the silver chain around my neck. I just find something oddly soothing about the rough sensation of the metal against my skin! 😛

In my experience, I also find that stimming isn’t always a response to stress, but born from a need to keep my hands busy.

As I’ve discussed previously, research shows that autists have higher levels of excitatory neurotransmitters such as glutamate, and lower levels of calming neurotransmitters in the brain. As a result, we are often hyper-stimulated. Stimulation of the brain’s reward system, i.e.  dopamine release through “stimming” behaviour, causes a decrease in glutamate levels, effectively calming the brain!

This would explain why I’ve often found that stimming sometimes helps me to concentrate and clear my mind by channeling any excess energy into a physical action. I find this particularly helpful when I’m studying, or writing, and for some strange reason while I’m waiting for the microwave to ping! 😛 #excitedforfood

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Stimming can also be considered a form of self injurious behaviour, but I’ll write a separate post on this topic at a later stage 🙂

So is there anything that can be done to control this type of behaviour?

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  • Try replacement behaviours– if the stim is not socially acceptable or harmful, as in the case of biting behaviours, attempt to replace the stim with another one such as a fidget toy or chewing rubber
  • Exercise– there is evidence to suggest that exercising can decrease the frequency of stimming behaviours, although the research is unclear why
  • Cognitive behavioural therapy (CBT)– is thought to be useful as self stimulatory behaviour operates in a similar way to OCD tendencies which are often managed through CBT techniques
  • Medication– Seems there’s a pill for everything these days! Medications can be used to help modify compulsive behaviours such as stimming, but I personally would not advocate this route

So there we have it Earthlings, a brief insight into stimming behaviours in autism! 🙂

Enjoy the weekend everyone! 🙂

Aoife

Repetitive Behaviours- Skin Picking

Greetings Earthlings! 🙂

Today I’m going to give you an insight into a particular form of repetitive behaviour- skin picking.

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Ok- I know it sounds disgusting, but it is common for those with autism! The statistics are limited, but as many as 14.8% of autists exhibit this type of behaviour.

Skin picking, also known as neurotic excoriation or dermatotillomania  (I really do like the sound of these terms! 😀 ), is characterized by excessive rubbing, scratching, digging, squeezing and gouging of healthy skin. In chronic cases, the urge to pick and scratch can lead to scarring, tissue damage and infection.

If I were you though I probably wouldn’t look the condition up…some of the pictures of these chronic cases are disgusting!

In my own experience, I have a mild tendency towards skin picking. I prod and poke at bites and burns, pick at cuts and scabs etc., but squeezing my skin would be my biggest issue- I find it so addictive and it can be quite hard to stop! I also have a particular tendency to press hard against injured skin, like pinching an infected finger or pressing a sore toe against a hard surface- for some odd reason I find it comforting! It hurts, but I feel better about the injury after doing it. I suppose it must link back to the calming sensation of deep pressure stimulation or something!

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Now before we call the men in the white coats, let’s see if there’s a physiological reason for all of this! 😛

Research suggests that the dopamine pathway may play a particular role in this behaviour.

Dopamine is involved in reward motivated behaviours in the brain. Drugs such as cocaine and methamphetamine activate dopamine, which is thought to contribute to the sensation of skin crawling and subsequent picking often experienced by addicts. So experts believe that dopamine dysfunction may be at play in this behaviour.

As I’ve discussed in other posts (sleep, ADHD, curiosity, inside the autistic brain etc.) dopamine is often dysregulated in the case of autism, so it stands to reason that this neurotransmitter may play an important role in skin picking behaviour in ASD’s.

Other experts point to a psychological reason for the behaviour as there is a strong link between skin picking and co-morbid psychiatric diseases. Skin picking is thought to act as a form of  communication in times of stress in the case of autism and is believed by some to act as a sensory outlet for sensory stimulation and or soothing.

Furthermore, as I’ve previously discussed, we autists tend to have more sensitive skin than the average person, this too could influence our tendency towards picking and scratching our skin.

Ah- so I’m not crazy after all! 😉

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But is there anything we can do to manage it?

Dermatologists and physicians find this one particularly difficult to treat and often seek drug and behavioural interventions to counter skin picking.

For me personally, this is difficult to advise as the reasons for picking differ from person to person, annnnnnd I tend to indulge the behaviour rather than avoid it 😛

However, I have been making conscious attempts to reduce the frequency in recent years to help protect my skin, and to avoid looking like a weirdo in public! Don’t want people thinking I have fleas if I persistently keep scratching myself!

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The best advice that I can give is to keep your hands busy- if they’re occupied, you won’t pick! Gaming and crafting I find can be useful to keep my hands from wandering 🙂

So there we are Earthlings! 🙂 Hope I didn’t disgust you all with this post! 😛

Enjoy the weekend everyone! 🙂

Aoife

 

Autism on Screen- Sesame Street: Meet Julia

Greetings Earthlings! 🙂

Earlier this week, popular children’s TV show Sesame Street officially debuted a new puppet with a twist- a puppet with autism! 😀 The character of Julia was introduced as part of Sesame Street’s autism initiative, first appearing on Monday to rave reviews from fans, experts and parents everywhere.

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Whilst only making the news in recent months, Julia has in actual fact been around since 2015, having first appeared in an online storybook about autism as part of ‘Sesame Street’s’ autism initiative- ‘Sesame Street and Autism: See Amazing in All Children’.

The creators of Sesame Street established this initiative in 2015 in order to promote better understanding of the condition after a study revealed that children with autism are more than five times more likely to be bullied than their peers!! This initiative was developed in partnership with autism workers, advocates, parents and autists themselves in order to ensure that the topic is handled in the best possible way.

You can find out more about the initiative here:

http://autism.sesamestreet.org/

It’s a nifty little website providing videos for kids, videos for parents, daily routine cards and loads of other useful materials for children and adults alike 🙂

So what is Julia actually like?

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Julia first appears onscreen quietly painting with her friends Elmo, the fairy Abby Cadabby and Alan. When Big Bird comes on the scene, Julia largely ignores him, completely engrossed in her painting. The other puppets are engaging in finger painting, but Julia makes noises of disgust and uses a paintbrush instead, with Abby remarking that Julia hates the feeling of paint on her fingers.

With their paintings finished, Abby gives Julia’s painting huge praise (it was easily better than Abby and Elmo’s efforts), remarking that she is very creative- casually demonstrating the talents that autists possess without veering into savant stereotypes. Big Bird tries to hive five Julia for her efforts, but still she ignores him, making no eye contact. When Julia hops off to play tag with the other puppets, Big Bird questions whether Julia likes him or not. This leads Alan to explain autism to Big Bird so that he understands that Julia does things a little differently, “in a Julia sort of way“- but she’s also lots of fun! 🙂

Later in the episode, Julia hears nearby sirens and covers her ears in response to the noise, needing to go somewhere quiet for a bit, subtly demonstrating how an autist can struggle with sensory sensitivity. Julia also carries around Fluster, a rabbit toy which she strokes to help her calm down, showing the audience ‘stimming’ in action.

The primary focus of this segment is to demonstrate that although Julia has autism, she can play and be your friend just like everyone else. After Big Bird remarks that Julia is not like any friend he’s ever had before, Elmo and Abby point out that none of them are exactly the same, bird, monster, fairy- they are all different, but are friends regardless. Julia talks a little differently, repeats sentences, flaps her arms when she gets excited- but she’s just another playmate, however different, at the end of the day 🙂

You can watch Julia’s debut in full in the video below  🙂 :

My school life would have been so much easier had other children been better able to understand and accept me as the other puppets accept Julia, but with initiatives like this at work I have great hope for the next generation 🙂

This episode was handled both sensitively and intelligently to provide children everywhere with an insight into autism. All behaviours are explained, little is left for the audience to guess at. Julia is different to the other puppets yes, but the episode normalizes her differences so that when children encounter real people like Julia, they will be treated with acceptance and understanding 🙂

Here’s a behind the scenes look at how the character was brought to life:

Fun Fact: Julia’s puppeteer (who can be seen in this video thumbnail) is a mother to an autistic son in reality!

This was a pleasure to watch and I look forward to seeing all of Julia’s future adventures in the show! 🙂

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Aoife

Autism on Screen- Adam

Greetings Earthlings! 🙂

Today we’ll be taking a look at the representation of Asperger’s syndrome in the 2009 (although filmed in 2005) romantic drama film ‘Adam‘ starring Hugh Dancy and Rose Byrne.

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Adam‘ focuses on the relationship between Adam, a man with AS, and Beth, his neurotypical next door neighbour, as they embark on a romantic relationship. The film charts their relationship from unorthodox origins (Adam unwittingly asks Beth if she is aroused one night when struggling to read her emotions) to (**SPOILER ALERT**) strained ending, as both parties endeavor to better understand the other.

Check out the trailer below:

So how does ‘Adam‘ rank in it’s depiction of autism?

Scientifically speaking, ‘Adam‘ presents the audience with many of the classic characteristics of AS, providing insight into the emotional, sensory and social issues which many of us deal with on a daily basis, such as Adam’s struggles with job interviews.

One of the finer details in the film that stood out for me was how Adam separates different foods on his plate so that nothing is touching. This can be seen in the screenshot below:

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I remember reading ‘The Curious Incident of the Dog in the Night-Time‘ by Mark Haddon as a teenager and identifying with how Christopher does not like his foods to be touching as ‘Adam‘ demonstrates here.

For me, certain foods that touch contaminate flavours and textures so I often endeavor to separate them on my plate. It’s a logical thing- I’m not crazy, I swear!!! 😛 😉

Ironically, I never put two and two together about having AS myself! 😛

The film is flawed however, in that the character of Adam is a highly intelligent electronic engineer with a photographic memory, further perpetuating the rare savant stereotype…

Dear film makers/screenwriters-enough with the savant skills already! It’s been done to death! 😛

In addition to this, there is one slightly insulting moment in the film wherein Adam is not considered “dating material” in Beth’s social circle. Granted, Beth largely ignores the advice of friends and family to pursue a relationship with Adam, buuuut (* *SPOILER ALERT**) ultimately agrees that they are from two different worlds and cannot make the relationship work.

Indeed, relationships can be hard for us, but that does not mean that we are incapable of making them work (I know several neurodiverse-neurotypical romantic pairings). One of the biggest problems in the relationship between Adam and Beth is that Adam is unable to tell Beth that he loves her. Believing that Adam sees their relationship practically and not emotionally, Beth makes the decision to break up with him as a result.

As previously discussed (Discussion: Love and Romance), saying ‘I love you’ can be quite difficult for an autist, but that does not mean that love isn’t there. I may struggle to say the words to the ones I love, but love them I do.

In watching the film, it’s obvious that Adam loves Beth, he just has a different way of showing her- something that parents, friends and significant others alike should be aware of. We do love you, it’s just hard for us to show it sometimes 🙂

All in all, ‘Adam‘ is a quirky affair that balances both the positives and negatives of life on the spectrum to give a relatively (we’ll let the high IQ/memory slide this time) realistic insight into the autistic experience 🙂

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Aoife

Autism on Screen- My Name Is Khan

Greetings Earthlings! 🙂

In the next part of my autism on screen series, I’m going to explore the portrayal of autism in the Indian drama film ‘My Name Is Khan‘ (2010).

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A dual Hindi and English language film, ‘My Name Is Khan‘ follows Rizwan Khan, a Muslim man with Asperger’s syndrome, who set’s out on a journey across America to tell the president that he is not a terrorist following a sectarian attack on his family in the wake of the events of 9/11.

Check out the trailer below! 🙂

So how does this film measure up in it’s portrayal of the realities of AS?

The film opens with a disclaimer stating that the film makers have endeavored to depict AS as authentically and sensitively as possible, however, as this is a work of fiction, they acknowledge that certain creative liberties were taken in the portrayal of autism- so as with ‘Rain Man‘, take the film with a grain of salt!

That being said, I found this film to be generally quite accurate from a symptomatic perspective. Granted, Khan appears slightly weirder than the average person with AS and many of his symptoms are exaggerated, but overall I felt that this was a solid onscreen portrayal of autism.

In particular I felt that this film gave a good representation of repetitive behaviors and sensory sensitivity.

Throughout the film, Khan can be seen fiddling with some stones in a repetitive manner.

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I may not carry stones around with me, but I am constantly fiddling with my jewelry in a similar manner. It’s a compulsive action- I have this constant need to reach out and feel my chain between my fingers. There’s something incredibly soothing about the motion, especially when you’re particularly stressed. Actions such as these are referred to as stimming or self stimulation. I’ll dedicate a post to stimming at another stage 🙂

As regards sensory sensitivity, I thought that the film presented more of a normalized and subtle reaction to sensory stimuli than most films featuring autism, particularly in relation to Khan’s sensitivity to the colour yellow (there’s a particularly funny moment where he changes direction on the street to avoid looking at someone wearing a yellow top!).

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When I first watched this film, I thought that this had to be an exaggeration, but in actual fact, as I mentioned in the last post, boys with autism really struggle to process the colour yellow! Scientists think that this may result from a sensitivity to luminance in autists. Alternatively this may occur as yellow is one of the most heavily sensory loaded colours, as it engages multiple colour detection cells (called cones) in the eye.

Comparing this film to ‘Rain Man‘, there is quite a difference in how autism is portrayed. There was a far greater focus on everything that is good about Khan rather than areas of disability in his life, which can often be exploited in film for dramatic effect. Unlike ‘Rain Man‘, modern films about autism, such as this, have the added benefit of over twenty years of research and observation of the autistic condition, leading to more accurate depictions/attitudes to difference on screen.

Unfortunately however, Khan is depicted as quite intelligent (even called a genius), with superb memory and a savant-like ability to fix any mechanical item known to man, further promoting the stereotype of the autistic savant. These traits however, are somewhat muted in comparison to ‘Rain Man‘, giving a slightly more realistic portrayal of autism.

So there we are- hope you all enjoyed this piece 🙂 I would highly encourage you all to watch this film at some stage. Autism aside, this is an amazing film- one of the best I’ve seen in a long time! In the latter half of the film, you start to forget that Khan is in any way different, finding yourself swept up in this powerful story of love, loss and acceptance. Having watched only the trailer to re-jog my memory, I really want to see this film again myself! 😀

Weekend plans sorted! 😉

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Aoife

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