The Autistic Spectrum Disorder: Highly Sensitive Children Part 3
By Dr Raoul Goldberg BSc (Med), MB ChB (Wits), CEDH (Hom)
Simon aged 7 years would not talk to me or any other strangers, or make eye contact with me. His exquisitely carved features and large blue haunting eyes spoke of knowing another world. He was socially controlling, obsessively possessive of his toys, passionate for details, and highly sensitive to noise and tactile stimuli. His mother reports on frequent past ear infections treated with numerous antibiotics and digestive disturbances. He feels the rain falling on his skin like pins and needles. He notices when a single piece of Lego is missing. He was diagnosed as an Asperger’s syndrome child. This is one of a growing number of highly sensitive children whose behaviour and development are very different from the typical child.
Then there are other children whose development suddenly becomes atypical and can even become arrested. James was developing completely normally in a healthy home environment until about 2.5 years when he suddenly stopped talking, his behaviour changed, he became withdrawn, lost contact with his parents, started to rock intermittently and was diagnosed as autistic.
These and other conditions, ranging from relatively normal functioning children to severely disabled care-dependent children, and characterised by abnormal behavioural patterns and specific social and communicative impairments have been classified as autistic spectrum disorder (ASD). This range of disorders appears to represent the more extreme manifestation of the very broad spectrum of highly sensitive children that was described in parts 1 and 2 of this article.1,2 In these articles some aspects of the constitutional disposition of the highly sensitive child was described together with a picture of the first two categories, i.e. the functional sensitive child and the sensory dysfunctional child. This article describes the second two categories: namely the highly functional autistic disorder known as Asperger’s syndrome and childhood autism, collectively known as ASD.
In recent years there has been a worldwide explosion in autism affecting 1 in every 150 to 200 children under the age of 10 years in first world countries. Boys are affected 4 times more frequently than girls, and the increased prevalence is occurring in every job category and socio-economic class. Autism present from birth is still fairly infrequent occurring in 1 or 2 children in every 10 000 births. However, it is regressive autism, which usually appears in the second or third year that is on the explosive increase. In the past decade there has been a sevenfold increase in ASD,3 and if we include attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) in ASD, because they show similar features, it is clear we are in the middle of an epidemic.
Autism has a very interesting origin. In 1933, two boys were born 6 months apart on opposite sides of the Atlantic Ocean, Donald in Mississippi USA and Fritz in Vienna. Donald, aged 5 years, was the first of a number of children with specific behaviour disorders to be seen by the famous American child psychiatrist Leo Kanner who later in 1943 coined the name autism to describe these children. Autism takes its name from the Greek word auto = self because these children were all essentially involved in themselves to a much greater degree than in the surrounding world. Fritz at 6 years of age was the first of four children with similar but less severe characteristics studied by the Austrian paediatrician Hans Asperger to which the name Asperger’s syndrome was given in 1944.
How does autism present?
High sensitivity seems to be the hallmark of this disorder, for all these children are extremely sensitive to sensory impressions. The child allows the world of sense impressions to enter his experience through the doorways of 12 senses that awaken sensation. This sentient awareness exists in close proximity with the feeling life of the child. The words sensing and feeling are often interchangeable. For example, the child feels/senses his hair being cut and experiences fear that he might be hurt. This feeling now conjures up some imaginative picture or thought through the activity of thinking, and finally will activity comes into action as the child screams and runs out of the hairdresser. A description of these 12 senses was given in issue 19 of the Journal,1 and even more so than the first category, these autistic children are extremely sensitive to many sense impressions.
In a course of lectures on remedial education for mentally/intellectually-impaired people in 1924,4 Rudolf Steiner described a certain type of child as having a vulnerable or wounded soul life. Just as the skin that is grazed is searingly sore when it grasps some object, so the wounded soul is sore and therefore hypersensitive to every contact with the external world. It is so sensitive because the child meets the world too vigorously with his sensing soul – he therefore touches and takes hold of things delicately as though he has been wounded, and has difficulty in making contact with the external world.
This heightened sensitivity manifests in autistic children in three major ways depending on the level of the disorder.
Oversensitivity frequently leads to withdrawal, which is a major component of autism. Such children appear to have withdrawn into their own world, out of reach of other human beings who they seem to regard as objects. They therefore avoid eye contact, appear cut off from people, and yet remain connected in their own unique way to a world of objects or materials to which they are obsessively fixated. Therefore they may focus their attention on some toy, or special object, turning, spinning or moving it possessively in ways that seem to give comfort or pleasure. Taking it away from them can lead to excessive responses, such as screaming tantrums. However, they will accept infantile contact such as cuddling when there is no verbal or eye contact expected of them, e.g. with their backs towards the cuddler. Autistic individuals have difficulty understanding how other people react, a condition called mind blindness resulting frequently in confusion and isolation from social interactions.
Communication and language
The sensitive autistic child avoids communicating, or shows his discomfort in communicating. Some 40% of classically autistic children never speak or show that they understand or hear what is said to them. When they speak they use bizarre language playing with words like toys or objects. Their most common word is often No. They often transpose pronouns, referring to themselves by name or you, and to others as I. And while they may not speak, some may be gifted singers. On the other hand, the Asperger child may be over-talkative, holding long speeches on abstruse matters in which no one is interested.
A highly sensitive autistic child will display a wide range of psycho-emotional disturbances, i.e. his cognitive development may be limited by rigid thought patterns, lack of imaginative capacities and poor understanding of everyday concepts. However a small percentage (6%) of autistic individuals referred to as savant autism have highly developed cognitive abilities as was displayed in the Dustin Hoffman movie Rainman (1988) that first brought autism into public awareness. Behaviour that is often determined by frustrations, anxieties and self doubts may be aggressive (in self protection), self injurious (biting or head-banging where pain can block out overwhelming sensory bombardment), repetitive (rocking, spinning, and flapping hands), obsessive (objects may not be moved from set positions), resistant (to the smallest change), or bizarre responses (sudden laughing or crying for no obvious reason). Unevenness in gross and fine motor abilities may lead to diverse impairments, but also highly unusual abilities such as extraordinary gifted musical abilities as portrayed in the movie Shine. There may be intense interest and curiosity for mechanical things and great skill in manipulating them.
Physically these children appear normal and some of them have particularly beautiful features, but they do not make proper use of their bodies. If we remember that the physical body is fundamentally the earthly instrument for soul and spirit to carry out earthly tasks, it will not appear strange that these children may not be able to use their bodies in normal ways. Depending on their degree of autism, they may move in bizarre ways without particular focus or purpose. They frequently have other problems. Apart from sensory disturbances, many of these children suffer from sleeping disorders, appetite, feeding and dietary irregularities, gastro-intestinal problems, food allergies, hyperactivity and a range of psycho-emotional problems such as depression, obsessive-compulsive disorders and various levels of anxiety.
Autism is diagnosed according to specific diagnostic criteria, which through lack of space here can be obtained from the reference list.5
What causes autism?
Three factors determine the health or ill health of human beings. Firstly, heredity handed down via the genetic material of fathers and mothers through the generations influence the physical constitution of the child. Secondly, the environment, the specific location where life and destiny places the child, has a profound effect on the child’s health. The third factor is the spiritual factor. Every human being comes into life with a unique soul and spiritual disposition that has nothing to do with his genetic makeup. Mozart composing at the age of 3 did not acquire his genius from heredity; it came from the core of his essential being.
Contemporary scientific research generally agrees that ASD is the result of genetic and environmental factors. The spiritual factor, which usually is not acknowledged by mainstream scientific research, is sadly left out of the equation.
Autism has long been thought to be a genetic disorder – it tends to run in families, if one identical twin is affected, there is a 60% chance that the other will also be autistic and more than a 75% chance that the other will exhibit some autistic trait. Thus far genetic research has not identified a specific genetic defect and different degrees of disability point to multiple genes.5,6 Biochemical and neurological deficiencies, which often co-exist, may have a genetic origin.7
• Toxic chemicals – A great deal of scientific literature links learning disabilities in children with exposure to toxic chemicals.8 Many types of toxic chemicals have been incriminated that can cause a wide range of physical and behavioural impairments including polychlorinated biphenyls (PCBs) and organophosphate pesticides. Millions of children in all developed countries have toxic lead levels that have been linked in numerous studies to learning disabilities, ADD/ADHD, and other cognitive and behavioural impairments.9 Mercury is one of the most neurotoxic chemicals known.10 Exposure may occur from industrial pollution of fish eaten, residues from batteries, cosmetics, medicaments, pesticides and other industrial products. The mercury contained in the amalgam of dental fillings in pregnant women is another possible source of exposure.11 There seems to be a close correlation between autistic traits, mercury poisoning and autoimmunity. Mercury is also a component of thimerosal, a preservative in vaccines.3
• Vaccination – Live viruses in vaccinations are thought by some researchers to trigger autism in susceptible children and contribute to its epidemic development. Children in South Africa before the age of 2 years have had over 30 vaccinations, some given in multiple combinations. In 1998 Andrew Wakefield, a British gastroenterologist, claimed he had found a possible link between the measles vaccine and autism. Studies of intestinal tissue in ASD children demonstrated measles virus in the tissue removed.12 Other researchers have refuted these claims. There are other studies that have also linked the onset of ASD with the measles virus in the intestinal lining and peripheral immune white blood cells.13 Measles is a devastating infectious illness that claims the lives of a million children worldwide every year. It is administered as a combination vaccine together with mumps and rubella, the so-called MMR vaccine. There is no doubt that the measles vaccine saves thousands of lives mostly in underdeveloped countries, but some workers believe that it also induces autism in thousands of children in more developed countries. To date there is no causal link between vaccination and autism, yet epidemiologic data supports the connection.
• Viral causes – Research data links viral infections with ASD. These children are susceptible to viral infections, 30% respond favourably to antiviral drugs, certain viruses, e.g. herpes viruses are known to cause features of ASD and the measles virus has been linked to autism. However, the co-existence of a virus does not prove that it is the cause; it may just as likely be the result of the autistic condition.
• Allergy factors – Many ASD children show allergic tendencies. ASD children frequently produce antibodies to their own nervous systems.14,15 Autistic children like allergic children lack an efficient protective barrier function resulting in a hypersensitive and over-reactive overcompensation.16
• Food sensitivity factors – Many autistic children have food sensitivities, especially to gluten (a protein contained in wheat and other grains) and casein (a milk protein). These food sensitivities as well as frequent antibiotics for recurrent ear and upper-respiratory infections, mercury compounds from vaccinations and other drugs are believed to cause the digestive dysfunction and gastro-intestinal inflammation that is frequently found in many ASD children.17,18 With impaired immune function, this in turn leads to fungal/yeast infestations whose overgrowth further damages the intestinal lining. The result is an over-permeable gut lining that can flood the system with toxic substances overloading the liver and other immune barriers (leaky gut syndrome), leading to neuro-sensory and immune system damage.19
• Psychosocial factors – Earlier findings that the parental home was cold, distant, over-intellectual, or dysfunctional in any way have not been substantiated. Yet there is no doubt that an autistic child responds negatively to any psychosocial stressors.
Sensitivity has to do with the child’s soul-spiritual nature. What is it that makes the child highly sensitive? Imagine a child who was well adjusted, happy and content in his home, school and social life who suddenly becomes highly sensitive to loud noises, unexpected events, sudden changes and who cannot confront strangers. We will immediately suspect that the child has had some unpleasant experience that has frightened him and made him feel very insecure. If we enter into the inner world of such a child, we may sense that either the child’s natural protective boundaries have been weakened, or that the child has experienced some kind of threat that frightens and unsettles him, leading to heightened sensitivity and all the sequels that follow.
What danger does the child sense? Before a child has named himself I (usually in the third year of life), i.e. before he is conscious of himself as an individual with a separate I-consciousness, his I-awareness is centred in his surrounding world and he is still far more connected with his psycho-spiritual environment. For example, children at this age are extremely sensitive to the tone of voice or body language of their parents. It is only when he becomes aware of himself as an I that he becomes the centre of his world; he can now call himself I, no longer me or Ben. This ineffable threshold in every child’s life is an unconscious act of courage for he unconsciously makes a choice to leave the secure supportive world of nature and spirit in which he was previously embedded, and to enter the harsh and limited reality of earthly consciousness. Fortunately, the child does not stop to think of everything he has to learn and confront because he cannot yet reflect in this way. Before this moment occurs, children who are filled with fear and trepidation of what they have to face, may shy away from taking this step into their I-hood and choose unconsciously not to enter it fully. They avoid this confrontation with self. All the phenomena associated with ASD can be understood as an avoidance of confrontation with self. When the real owner, the I is not at home, the other tenants, the sensing, the feeling, the wilful or the rigid thinking soul, may fall out of line, and cause functional plumbing or maintenance problems. They will then remain more connected with the universe around them, and less aware of their own bodily nature. The majority of children who suddenly become autistic do so between 2 and 3 years of age, i.e. before the child becomes aware of himself as a separate individual.
Is it a co-incidence that autism was first recognised in two children who were born very close together on opposite sides of the Atlantic Ocean at the very time when the fearful spectre of Nazism had begun to spread its shadow over the world? Is it possible that certain children are unconsciously aware of those powerful forces, which in our times, permeate our culture and threaten to destroy the very essence of the human being, the human I, that potentiality of freedom that strives to carry humanity forward towards the highest principles of brotherhood, equality and freedom, and ideals which underpin a free and wholesome culture. There are forces working into human souls that diametrically oppose these high ideals and foster egoism, which separates us from our fellow human being, discrimination of all kinds that creates inequality, and enslavement to materialism, technology, addictions, etc. that prevent us from becoming free people with free choices.
Is it any wonder that certain souls will either refuse to enter this harsh reality, or will struggle to hold themselves in it in the face of such an onslaught? Are we seeing in autistic children, individuals who are more acutely aware or even fearful of these pervasive anti-evolutionary forces, who have become sensitised to these powerful cultural adversaries of our time?
How can we help these children?
Early diagnosis can have a critical impact on the long-term outcome. Most Asperger children are often overlooked until primary school. Parents frequently remember in retrospect that their babies or infants displayed typical autistic tendencies. A worldwide public health campaign should aim at informing parents, teachers and health care professionals of the earliest signs and the need for earliest possible intervention.
Steps in caring as described in Part 2 in the previous issue are even more relevant for the more extreme range of autistically inclined children.2 There are in addition other attitudes and approaches that may be of value to these children.20
A few indications
• Understanding the nature of the highly sensitive child engenders respect, compassion and tolerance for their differences, and promotes endurance in the caregiver
• Avoid direct confrontation, address them looking in another direction rather than looking directly into their eyes
• Speak gently and non-forcefully
• Avoid anything that may cause even a slight shock to the child
• Try to maintain sameness in the child’s environment, any changes or modifications must take the child into account
• Be tolerant of their obsessions or fixations, there is no value in trying to eliminate them, and one can use them creatively in hobbies and crafts
• The needs of the caregiver should also be acknowledged so that she can live realistically together with the autistic child without undoing the optimally supportive environment
• By working closely with him, doing things with him, following his movements with your movements, the child will feel that his inabilities and inadequacies are supported by what you are doing
• Simple games can foster contact
• Socialising with normal children is very helpful for healthy orientation, this needs sufficient tolerance and understanding.
Expert professional support is vital to maximise diagnostic and therapeutic options. ASD is clearly a complex disorder of our times resulting from the interplay of psycho-spiritual, constitutional, genetic-biochemical and environmental factors. All these factors need to be con-sidered in the diagnostic and therapeutic evaluation. This requires detailed information about the child’s family history, development, vaccination, nutritional, medical, social-environmental and personality profile. Currently there is a range of tests available in the USA and UK that can assist in the diagnostic and therapeutic workup. A multidisciplinary approach generally proves to be the most effective.
• Dietary support and nutritional supplementation
• Individually prescribed natural dynamic medication (anthroposophical/homeopathic) to strengthen the constitution as well as specific vulnerable organ systems such as the gastro-intestinal system, immune system and neuro-sensory system
• Heavy metal detoxification and chelation therapy3
• Music therapy may be of special value as the initiating point for communication
• Therapeutic eurhythmy, light therapy, and expressive therapies such as drama, painting, drawing, etc. are very helpful.
• Puppetry has a unique way of enticing children out of their isolation
• A variety of modern learning techniques such as Floortime which stresses personal interactions, TEACCH which uses children’s individual interests to motivate them to learn in a structured environment, PECS which helps build communication skill through the use of pictures and communication with a type board, organises the brain to understand what goes on in the world. There are many personal heart-rending narratives of autistic individuals who have been able to share their hidden world through the use of a computer.21,22
Autistic children can awaken us to those hidden forces that have infiltrated our everyday life and our innermost souls that would obstruct us from our highest ideals. They can help us find the courage through our awakened I to resist these forces which would dull us to sleep, cut us off from our brothers and sisters, make us into egoistic and superior beings, and enslave us to powerful masters who seek to control our destinies.
The Mifne Centre
The Mifne (turning point) is the first model of early intervention for autistic children in Israel that recognised the importance of individual therapy, intensive treatment and parental participation. The basic concept underlying the therapeutic model practiced at Mifne views the family as an organic unit. The therapeutic environment, based on principles of a bio-psycho-social model, attempts to encourage gradual evolution of the child and each family member towards individual and mutual growth. The ability to accept the child as having a potential that awaits realisation is made a condition for treatment. Seventy-three per cent of the children who have been treated at Mifne are attending mainstream schools. In terms of their development, ability to learn and communication, most of them function quite highly. Twenty-seven per cent of the children, who have been through the Mifne programme, are not capable of integrating and require special care. Most of them did not follow the aftercare programme, due to their parents’ choice. Some of them had self-limiting cognitive potential. To find out more go to the website www.mifne-autism.com
A copy of the references is available from the Journal office tel. 021-880 1444.