"Others Actions Stop Me": Nonverbal Communication and Autism

“Have I ever told you how the actions of others stop me from talking? It is as if their hand movements, their eyes or their tone of voice stops me from talking. I find myself focusing on their behaviors and forgetting what I should say in response. It is as if their behaviors become more important than their words. For example, when my mother raises her eyebrows at the same time she raises her voice, I find I cannot move or talk. It feels like her behaviors are a sign for me to stop and I can't go beyond that. I see my sister yell back at my mother at times like that, but I can't. I see that my sister gets into trouble for responding back. Maybe my way isn't so bad, but I wonder what makes me stop and not have the ability to respond? I feel like my body just won't let me respond. At other times, when my mother is in a good mood, I see happy behaviors - her eyes twinkle, her tone of voice is mellow and soft. At times like this, I say to myself I need to capture this moment and try to fit in all my words. Don't they say ---it's all in the timing?"

What is this autistic boy telling us? He seems to be entrapped by others’ nonverbal gestures. He can see that this does not stop his sister from talking back to their mother. He wonders why it stops him. He also realizes that if his mother is in a good mood he has more of a chance in using words (if he has them).

Let’s take a moment to focus on this area of nonverbal communication. It seems that our autistic boy has no choice but to focus on the nonverbal gestures of others and in turn feels manipulated by their nonverbal gestures. The behaviors of others stop or propel him to talk. From the perspective of an Incomplete Attachment, we can possibly make sense of what is going on here.

Let’s take a step back and think about nonverbal communication and nonverbal gestures. From my point of view, the definition of nonverbal communication is the body’s way of unconsciously communicating feelings and emotions. Sometimes a typical person may not have access to his emotions so that person may not be consciously in touch with a specific feeling and thus cannot verbally express a particular feeling. Fortunately, our bodies always are in touch with our emotions and those feelings come out through our nonverbal gestures/communications. The person with autism does not have access to words, but his body retains the memory of his emotions. Thus the unconscious child with autism is tuned into nonverbal communication much more than he is tuned into verbal communication. That is why our autistic boy focuses on the nonverbal gestures of others. Typical individuals are simultaneously unconsciously and consciously aware of what others (this will depend on the individual and their level of consciousness of nonverbal gestures) are saying nonverbally. If we think of the individual with autism as unconscious, he would by definition be more attuned to nonverbal communication versus verbal communication.

Another point to remember here is that not only is our autistic boy more attuned to nonverbal communication as compared to the typical person, but he also has no way to access his feelings and subsequently communicate those feelings (lacks self-agency). Thus he is left to only focus on the nonverbal communication and feel manipulated by others’ gestures.

Finally, as this autistic boy develops, gains an attachment, has access to his feelings, develops self-agency and is less dissociated he will not only be able to read others nonverbal gestures, but also will be able to verbally express his feelings like all typical people do. Thus as the person with autism develops, we see a change in his ability to function in the world. Autism is seen on a continuum from low functioning to high functioning to Asperger’s. I think there is a good reason to look at autism in this way. The child does develop. The child can actually move off of this continuum and become as typical as others.

Living Without Boundaries-the Autistic Experience

God, I reach out and I cannot feel myself in time and space. It is as if I am floating in air without any boundaries. It feels like I am in a state of never-ending hell like living in a black hole with no exit. I want to scream, but I cannot talk, I cannot move my mouth, I cannot tell anyone of my dilemma. This hell has become my secret and my secret alone. God, you share my secret. Will I ever find a way out of this hell? God, I am screaming. I am screaming without words. God, these are loud screams, but silent screams. Do you hear me God? Do you hear me?

This is one autistic boy’s communication of a boundary-less existence. This child is talking about what it is like to not be able to place himself into “time and space.” He seems to also feel like he is floating in space with nothing solid below or around him to hold onto. He seems suspended in an existence without any means to communicate his predicament. What does he mean by these comments? I believe he is saying, “I do not feel like I exist. Time and space have no meaning for me. I live in a ‘psychological’ world with no anchors and continuity of being (internal stability). I am terrified by this state of existence.”

It is important to take this autistic boy seriously. He is telling us how he exists. The first step to helping him feel that he has boundaries and to feel ‘alive’ is to believe in his state of existence. An autistic individual’s development is based on how well we can understand his predicament. The better we can understand him, the more he has a chance to exist like any “typical” person. Many people work with autistic individuals by trying to change the child’s behavior. I believe the work needs to be exactly the opposite. We need to change how we understand and treat the autistic person. When we emphasize their need to change than they may never feel validated and are left in a boundary-less existence. In essence when we want him to change we are in fact saying “there is something wrong with you which we do not like.” I do not think this is the message that we want to be sending. I believe that autistic people have a hard time ‘existing’ because people are always reflecting back to them a message that does not reflect how they feel. Thus it is not the autistic person that needs to change, but it is how we understand their predicament that needs to change.

Goal III - Development of a Repertoire of Practical Techniques - Part I

This blog is a continuation of the goals of Relational Therapy. In this discussion I will emphasize how the caregiver or therapist can set out to develop a repertoire of practical techniques while utilizing Relational Therapy with individuals with Autism Spectrum Disorders. Part II of this blog will be a continuation of a discussion of practical techniques that one might use in working with those with autism.

Goal III: The development of a repertoire of practical techniques (Techniques to be used when working with a person who does not have access to use herself in relationship to an other – lacks self-agency)

A. Do not try to extinguish the “behaviors” that the child uses to communicate. This is their only means of communication. This is important for the following reasons: 1) Without the use of oneself, the child exists at the mercy of the other, 2) Without the use of oneself, the child’s body responds to the ‘other’ as if the other controls them, 3) The child is inseparable from the ‘other’ – if the mother says something, the child feels they now have been given permission to exist. This is a very fleeting experience. The child does not have a mind to use with the other. The only thing the child can do is exist as the other. 4) If you do not have any use of yourself in relationship to others, you forget yourself when you are in relationship with an ‘other’. The other ‘other’ becomes like the boss of ‘you’. You cannot make a move unless the other moves first. Your body will not let you move on your own. You are at the will of the other. This is a very good example of being in the waiting position – waiting to attach. 5) Everybody on the outside becomes that “hoped for person” to attach to. Your body acts as if this is the person to attach to and 6) It is important to understand that the child does not have any control over these behaviors or their bodies.

B. Do not force eye contact. As the child can use “I”, the child will use “eye” contact.

C. Interpret the behaviors the best you can back to the child. In doing this, you are letting the child know that you understand what is going on.

D. Understand that the “autistic behaviors” are communications of an unconscious child who uses his body as a means of communication.

E. This type of communication is not nonsensical. It just needs to be understood as one might understand a dream. Also the child talks in metaphor that is like a mystery that needs to be understood

F. It is your job to make meaning of the communication by using words that symbolize the autistic child’s/adolescent’s behavior and or communication. The child does not have the ability to symbolize words and use them as a typical child might. Thus we need to be the intermediary in helping to put words to their actions.

G. All the behaviors of an autistic child are important and need to be understood by the therapist or caregiver so the child can feel understood and recognized.

H. In whatever way you can, let the client know that you see and understand him.

I. The child may or may not let you know that they feel understood.

Next week we will continue this discussion which will include more techniques you can use when working with your autistic child.

Autism and Dissociation

Through the lens of an “Incomplete Attachment” I have described that the autistic child is experiencing dissociated states. What does this mean? From my perspective, the child has many parts of himself that have not become integrated as a whole. These aspects of the self have not been validated and recognized by “an other” so the child, in turn, cannot use and see himself. Thus the different parts of this child become dissociated and cannot work together to the benefit of the child. We can say that this child does not have the ability to go from one part of himself to another. The child also cannot go within himself to retrieve these dissociated parts.

How can I recognize dissociation in an autistic child? Dissociation is easy to recognize. We all have aspects of dissociation, but it is more profoundly seen in Autism Spectrum Disorders. The following are examples of dissociation: 1) reduced sense of pain – the child may burn himself, but not demonstrate any outward behaviors that say, “I am hurting.” The pain is there and he feels it, but he is split off from his ability to claim it and name the feeling, 2) Exceptional savant skills – such as extraordinary ability to remember days of the week of birthdays and dates associated with events, ability to do mathematical calculations that others can only do with the help of a calculator or great musical and artistic abilities. These abilities seem to coexist with what appears to be severe disabilities. Most people observing such a mixture of behaviors would be confused and conclude that there must be something “wrong” with a person who on the one hand has great musical ability or artistic ability, but cannot talk. I would say this is an example of dissociation in that the emotions are split off from the intellect of the person, 3) Cannot shift thinking from one subject to another – this is an example of not being able to go from one part of the self to another. The individual is demonstrating on the outside of himself what is occurring on the inside of him. In other words, his inability to go from one part of himself to another, and 4) the child can think through mathematical problems, but cannot think through and understand social interactions – the child has access to his intellect, but no access to the emotional parts of himself. The emotional side is harder to access if you have never had an attachment. It is through an attachment that one feels understood and seen and in turn can talk and have access to the emotional parts of one’s self.

These are only a few examples of what I think about when observing the autistic person through the lens of dissociation and an “Incomplete Attachment.” When one thinks about autism from this perspective than one can have hope that the child can develop into an integrated person. The work with the autistic person is to help them to become more conscious of the split off parts. This includes helping them to name their feelings along with the development of a trusting relationship with “an other.” As they become more conscious of themselves their dissociated parts will begin to work together.

Autism and Communication

Getting one’s needs met and to exist happily in one’s family, community and beyond is dependent on the ability to communicate. As non-autistic individuals we can use ourselves to communicate our needs and express our feelings. The autistic individual depending on their functioning level, has anywhere from extremely limited (nonexistent in some) to some ability to ask for their needs to be met. Some people with autism seem to communicate by perseverating on a topic that seems to not relate at all to whatever the topic might be. For example, one child may become fixated on televisions and only be able to talk about this subject, no matter what else is being discussed. It is not unusual for autistic individuals to seem to come out of "left field" with what they might say. For example, the topic may be "going to the grocery store and what will be bought at the store." The child may say, “you are pretty.”

There are also individuals who are nonverbal, those who use echolalia and still others that can only express their needs by reversing their pronouns. When they want a cookie to eat, instead of saying “I want a cookie,” the child may say, “you want a cookie.”

Let’s make sense of what is going on. If as I am suggesting the child has not had the benefit of an attachment, lacks the ability to use him/herself in relationship to others and is also in a state of dissociation with varying degrees of consciousness then I would continue to propose that the child’s ability to communicate is going to be compromised. Let me explain how these different elements contribute to not only problems in communicating, but also relating to others.

It is important to remember that the autistic individual wants to communicate and in fact is always communicating about himself even though he may be nonverbal, echolalic or reversing pronouns. He is like any human being in that he has a need to communicate. Unfortunately, because he has had an incomplete attachment, he cannot identify his feelings, which are dissociated, and therefore cannot use those feelings to express his needs. In other words, he has not developed to a level where he has self-agency. This means he literally cannot ask for anything for his own benefit. This is not a physical problem, but instead a “developmental problem” that can change over time.

It is my opinion, that what one sees with the nonverbal autistic child is the reverse of what one sees with a “typical” child. I call this phenomenon “Inside out, upside down.” In other words, the unconscious part of the child is on the outside and the conscious part is in the inside. That is why some nonverbal autistic children seem out of control and low functioning, but with the use of a computer can communicate beautifully in writing. This is a very good example of the split or dissociation of the self. Most people are unfamiliar with seeing the ‘unconscious.’ Because most people are unfamiliar with the workings of the unconscious, autistic individuals are constantly misunderstood.

The phenomenon of echolalia is also something that can be understood. One first needs to remember that the autistic child has minimal and varying (depending on their functioning level) ability to use oneself in relationship to others. Also it is important to remember that a lack of attachment precludes one from being able to use one’s self. Thus echolalia is the result of not being able to use one’s self. The child only has access to what they hear. They may hear “do you want a cookie?” Developmentally all the child can do is mimic the other person. There is no awareness and ability to use the self in response to the other. Thus the end result is a repetition of what the child heard.

The child who reverses his pronouns and uses ‘you’ to mean ‘I’ is beginning to use his self with others. The child uses ‘you’ because it is safer than ‘me or I.’ The autistic child does not feel safe in the world. Everything is confusing, awkward and anxiety producing. The use of ‘you’ as it refers to the self is another example of dissociation. As I mentioned before the child is split. As the child develops and he becomes less split and gains more agency, he will then move to using the pronoun ‘me’ and finally as he has more and more access to himself, he will be able to use ‘I.’ There seems to be a direct correlation to the use of ‘I’ and ability to know and access feelings and use them in relationship to others.

Now lets look at why the communication of autistic individuals appears inappropriate. First of all, I believe that an autistic individual is always communicating his state of existence. Unfortunately, most perceive these communications from their own experience, which includes having completed the attachment process. In working with autistic individuals, many try to extinguish the “odd” behaviors of the child. In doing so, we are not understanding the message the child is trying to communicate through his strange behaviors. We in a sense are helping them feel misunderstood versus understood and not seen versus seen. Instead these communications need to be understood within the context of a child who has never attached and cannot use the self to communicate. Every behavior that the child uses can be understood and must be understood so that the child can gain understanding and recognition, which are precursors to being able to attach. Our work with the autistic person is to understand, validate, accept and recognize the autistic person. If the caregiver or professional can recognize and see the child, then the child can start to see him or herself.

Examples may help you to understand what I am communicating. I visited a three-year-old nonverbal boy, who had never seemed to play appropriately with his toys. In observing him, I noticed he was picking his lips. Instead of telling him not to pick his lips, I said, “you are telling me that something is going on around your lips and your inability to talk.” He looked at me and then played appropriately with a toy. Another example will help to highlight this point. I worked with another boy who liked to watch videos. He had certain ones he wanted to make sure I saw. One day, he showed me a video, which explained a complicated family dynamic. I interpreted the dynamic as it related to his family. As I was able to do that, he could begin to talk about his own personal experience. These are examples of how one interprets and uses projection with autistic individuals to gain access to their feelings (I will discuss how this is done in another blog).

In concluding this blog, I want to restate that the perseverations, the out of context communications, the use of pronoun reversal, echolalia, nonverbal communication, to name only a few, can be understood through the lens of an “Incomplete Attachment” which leaves the individual in a state waiting for the completed attachment and without access to self or what I call self-agency.

An Incomplete Attachment and Understanding Autistic Behaviors

What does an incomplete attachment look like? One only needs to look at any child, adolescent or adult on the autism spectrum continuum to answer this question. The behaviors one sees with such individuals seem to be confusing and do not make sense. No two individuals with autism seem similar or manifest the same behaviors. If one thinks about autism from the perspective of an incomplete attachment then the developmental delays and the children will make sense.

From this perspective, the child has not had the benefit of a completed attachment. As all infants, she is born into the unconscious ready to be brought out in relationship to the caregiver, but this does not happen. The child is in a waiting state. He or she is waiting for a completed attachment. Thus the behaviors that one sees in the autistic child are the result of not having had a completed attachment. The behaviors are what can be called “coping” and “state of existence” behaviors. Each child will cope differently to the circumstance and thus will have different behaviors as compared to another child. A key point to mention is that because of the incomplete attachment the child is left without the ability to use herself both in body (lacks self-agency) and mind (lacks theory of mind). The ability to use one’s self will vary from child to child. Some children will be more conscious of him/herself and thus have more access to use themselves in relationship to others. Thus we have a continuum of ability, which is typically known as the functioning level of the individual on the spectrum (low functioning, high functioning and Aspergers).

To explain it in a little more depth, the behaviors one sees in autistic individuals are unconscious behaviors that have been dissociated or separated within the child. It is like the child is of two minds, the conscious mind and the unconscious mind. This is true of all human beings. Within the autistic child they are more dissociated and split from their emotions than others who appear to develop “typically.” Dissociation does not give us the complete picture. From a broader perspective, one can say that the child on the autism continuum has a lack of a completed attachment, has a dissociated sense of self, has developed coping mechanisms to manage the situation, is unable to use one’s self in relationship to others, seems to lack the knowledge of their own emotions and is unable to access those dissociated emotions and finally uses indirect mechanisms to grow in relationship to others. The treatments that seem to help this population are actually helping the child to become more and more conscious and integrated as a human being. Below I have compared the developing autistic child to the developing “typical” child.

“Typical” Child
1. On a continuum – from partial sense of self to a well integrated sense of self
2. Attachment has occurred
3. Ability to use oneself to get needs met. The degree that the individual can do this will vary widely
4. Knowledge and ability to know one’s emotional feelings
5. On a continuum has access to use one’s emotions in response to the other
6. Transference occurs in the relationship in a way that is typically understood
7. Can use the relationship to grow

Autistic Child
1. Varying degrees of dissociated sense of self
2. Lack of a completed attachment
3. On a continuum - from no ability to use oneself in relationship to another to ability to use oneself on a limited basis
4. Lacks knowledge of one's emotional feelings
5. Does not have access or ability to use dissociated emotions
6. Transference expressed in ways unfamiliar to most (indirect). Transference is fragile
7. Does not directly use the relationship to grow (indirect usage)

In my next blog, I will take the behaviors of the individual on the autism spectrum and make sense of them.

Relational Therapy and an Incomplete Attachment: A New Look at the Etiology and Treatment of Autism Spectrum Disorders

Autism is like being trapped in an enclosed maze. Within this maze it is dark and scary. You can see out, but no one can see in. You are in a perpetual state of terror with no access to others or a way out. You feel the walls closing in and can do nothing about it. You are screaming inside, but nobody can hear your screams. You are frantic. You keep running in circles to no avail. Alas you run out of steam. It is futile, hopeless and depressing. It is no use. No one can see you. You have become a lost child forever. You have become forgotten. Lost in a never-never land. It is a never-ending hell on earth. The only thing you can do is wait and hope that you will be discovered.

Mystery and controversy surround the etiology and clinical work with children diagnosed with an Autism Spectrum Disorder. Although the etiology by many is considered to be unknown, the majority of professionals working in the field of autism and parents of autistic children consider autism to be a neurological disorder. From this perspective, the clinical work with this population focuses primarily on techniques such as Applied Behavioral Analysis, modeling and social skills development. The work done thus far with this population should be commended and not discounted. We are now ready to augment the present state-of-the-art work with this population by introducing Relational Therapy. This therapy is similar to Floortime in that it emphasizes the relationship between the child and the therapist or caregiver. The major difference is that Relational Therapy introduces a treatment process (plan) that at its core is based on understanding the etiology of autism. Once the etiology is understood, then the therapist or parent can understand how to engage with the child.

From this alternative perspective it is my belief that children on the spectrum have not had the advantage of a completed attachment. I call this perspective “Incomplete Attachment.” Thus it is my belief that what one sees when observing children on the spectrum is a child who is waiting for the attachment process to be completed. The child is doing the best he/she can to cope with this predicament. All the behaviors such as flapping arms, nonverbal communication, echolalia, lack of responsiveness to others or inability to communicate one’s needs, can all make sense when taken from this perspective.

These writings will go into detail about this perspective and how one works with children, adolescents and adults from this perspective. It is my belief that Autism Spectrum Disorders can also inform our understanding of psychological development in general and specifically Theory of Mind. Autism Spectrum Disorders can be viewed as a window into the understanding of how all “typical” individuals develop psychologically. It is my hope that these writings will lead to a beneficial dialogue within the autism community and beyond.

As a point of reference, I am presently working as a marriage and family therapist in West Los Angeles. I specialize in Autism Spectrum Disorders, depression, anger management, assertion training, anxiety and primitive states. I have worked for many years with children, adolescents and adults on the autism spectrum continuum. I have also provided trainings and support groups for parents of children with autism. I am now running groups for college age students with developmental disabilities. And finally I have made presentations on this subject at numerous conferences and meetings.

My next blog will discuss the Incomplete Attachment in more depth and begin to discuss the meaning of “autistic behaviors.”