Coping with the reality of severe autism
General concepts for supporting emotionally fragile
individuals who display maladaptive patterns of
How are care providers to support a person who
is not connected to others, who lives in-the-immediate
moment, who reflects and magnifies other's emotions,
and who has little continuity of experience?
1. Vulnerability to "meltdown."
The inner place where a person's emotional attachments
were formed is the place that people "come
back to" when there is nothing else happening
Who are you when there is no one else around?
A person who is comfortable with yourself? A person
who can fill your time with personally meaningful
activity? A person who has to fill the quiet moment
with frantic activity? A person who is worrying
about all the unanswered questions in your mind?
A person who is anxious about whatever may be
happening next? Where do you go in your mind when
there is nothing outside of you to organize your
thoughts and actions?
A. What is it like to be connected to others in
space and time?
If you have the experience of being real, validated,
and attached, you have a system of core beliefs
that sustain you and allow you to regulate your
thoughts and actions. You know how to consider
options and know what the operating principles
are in the world. You can priorize and organize
your thoughts and activity. You can plan things
for the near and distant future. You can postpone
things and get back to them later. You can change
your mind. You know how the pieces of your thought
and memory fit together in a fabric with a past,
present and future.
B. What is it like to be lost in interpersonal
space and time?
If you have developed no sense of being real,
validated, and attached, you do not have a system
of core beliefs that sustain you. You have no
sense of predictability and cannot regulate your
thoughts and actions. You cannot consider options.
Your immediate experience takes precedence over
all other thoughts. You cannot priorize your thoughts
and activity. You cannot plan for the future.
You cannot postpone anything, because as soon
as you are not thinking about or continuing to
act on what is on your mind, your immediate thought
You can't let go and change your mind because
to do so causes you to feel that you have "lost"
your mind. (And, for the moment, you truly have
"lost" your mind because you cannot
reconnect to your previous thought unless someone
assists you to bring it back into mind.) You have
no sense of how all your pieces of thought and
memory fit together. You have a past, but it is
not connected to your present. You have a present
but it is not connected to your past or future.
You live in a state of vulnerable reflection your
immediate, momentary sensations.
Where do you "come back to" if you
don't have an experience of continuity and real
connection to others? If you are alone, and you
don't have core feelings to rely on, you experience
momentary nothingness (the existential VOID).
Without an organizing sense your empty moment
is one of vigilant threat. Your unconnected moment
is filled with the primitive emotions of flight
C. What is it like to be an emotional mirror?
When a caregiver is in your presence and projects
positive feelings you are able to reflect positive
feelings and can feel secure and calm. When a
caregiver is in your presence and projects feelings
of distress you reflect feelings of distress and
may flee or defend yourself from these uncomfortable
If you are alone and you do not have feelings
of others to reflect you may protect yourself
from your feelings of emptiness. You may do any
number of impulsive actions to stifle the aversive
feeling experience of having nothing to reflect.
You may do addictive actions to fill the void.
D. What is it like to be unable to regulate
your own strong emotions?
Some individuals become highly emotionally aroused
when they experience any strong emotion (positive
or negative.) Impulsive, acting out, rejecting
and oppositional behaviors may be extreme.
In the person's attempt to self-regulate internal
emotions that are out of control, the experience
of emotional distress can be so intense that a
wide range of maladaptive behaviors may be accidentally
learned. When individuals act out maladaptive
patterns, no matter how disturbed these may appear,
they are doing the best they can to give themselves
a sense of control, and to test whether or not
their world is a safe place to be. If they confirm
it is not safe they may escalate into an extreme,
Nathan E. Ory, M.A.
Nathan Ory is a psychologist with the Island Mental
Health Support Team,
Reality of Severe Autism (pt 2)
Reality of Severe Autism (pt 3)