Saturday, May 21, 2011

The Need to Control a Physical Space

The following question was submitted via the "Ask a Question" page:
My 9 year old son has PDD/NOS and gets very upset when his room is clean and organized. He told me tonight that it makes the world feel all wrong, and makes him very unhappy to the point of tears. When I say messy, I mean there are toys on every spot on the floor, flat spaces and even old papers jammed anywhere. Can you possibly explain why this is comforting to him? Thank you so much!
Disclaimer: I'm a language education specialist, not a psychologist — I have the minimal required background in psychology for special education. I'll have to discuss this question with a colleague in the future so I can answer more completely. I can offer only what I do know with caveats.

Many of the students and adults I have met with autism spectrum disorders have been diagnosed with co-morbid conditions such as OCD, PTSD, SAD (social anxiety disorder), and GAD (generalized anxiety disorder). While other conditions are also commonly diagnosed (ADD/ADHD), the situation described above by the mother seems most similar to the anxiety responses some with ASDs experience.

There is some debate as to whether anxiety is a component of autism, caused by autism, or co-morbid. This is an academic debate, since the treatments for the anxiety symptoms remain the same regardless. The most common treatment for anxiety is now medication, accompanied by counseling. Unfortunately, parents and students tell me the treatments have limited success. Sometimes, the results are amazing, so they are worth a try.

Why does anxiety lead to apparent chaos in the child's surroundings? That's a bit easier for me to address, because I can relate to the underlying impulse.

People with extreme anxiety try to establish control over their environments. In extreme cases, they turn to trying to "control" their bodies — we find "cutters" and those with eating disorders have high levels of anxiety according to various measures. Self-harm or self-injurious behavior (SIB) is often a sign of one of the anxiety disorders (such as PTSD or OCD), and we know that self-harm also accompanies autism across the entire spectrum. Depression, which also has an elevated rate among people with ASDs, can also lead to self-harm and OCD-like symptoms.

When there is nothing else to control, there is the self. I've wondered how feeling pain can be relaxing, but it is for many people. Sadly, caged animals engage in similar behaviors. I wonder if there's a sense of being trapped by circumstances; it's impossible not to feel trapped or limited at times with an ASD.
Controlling objects or your space seems a better response to anxiety than SIB. Controlling a space can range from obsessive arrangement of items to hoarding. I've met some autistic teens and adults with an impulse to maintain perfect order. A common example is counting items and aligning them repeatedly. These behaviors create a sense of order and control.

Collecting or hoarding is also employed to restore a sense of order and calm. By spreading items about a room, often on the floor, but it isn't uncommon to place items everywhere and anywhere possible, this puts everything within sight. The individual has total control because everything is within his or her domain.

I need order. I have to feel organized or I cannot relax. There are days when I inventory my books, pens, notepads, or other possessions. Spreading items out on a table or the office floor is reassuring.
The need to see everything might pass as the young boy ages. If not, then an evaluation for anxiety should be considered. There's nothing unusual about anxiety accompanying an ASD. The treatments often address not only the spatial control, but might help relieve other symptoms associated with the ASD.

A family counselor, ideally an autism specialist, might have additional suggestions for dealing with the spatial control impulse. Some treatments include slowly concentrating where items might be placed. Other treatments try to shift the hoarding to more "acceptable" organizing habits. (I use "acceptable" because really this is only a change in how the anxiety is expressed — but one other people find less disturbing.)

As an education expert, I'd ask the parent what other spatial control behaviors are present. Does the child organize food? Does he count or engage in other repetitive routines for comfort? Does he panic when schedules aren't rigidly respected? Are there any physically repetitive routines, such as tapping or rocking (often called self-stimulation)? These are all potential signs of anxiety.

If there is anxiety, it might also be advisable to determine if there is a cause or trigger beyond the ASD. For me, sensory overload can trigger stress, leading to anxiety, and then I start organizing my workspace. It's a cascade of events that leads to the organizing impulse.

My wife appreciates it when I have the impulse to clean. At least spatial control can be useful in some way. In extreme moment, though, my need to organize can be disruptive and cause even more anxiety.

1 comment:

  1. I actually had similar problems as this child most of my life---still do in some areas( it seems for me each space needs to be dealt with in an individual fashion and takes time to work up the courage to accept alterations in it) but am gradually working around to changing that. By amazing luck I found an organizational consultant who specializes in ASDs because it runs in her family. She helped explain what I could not articulate even to myself, which is that when things are placed out of sight, I am unable to visually remember where they are and become distressed( and also end up purchasing duplicates and filling up yet more space). Additionally, because of my tendency to hyperfocus on small spaces, the large open areas of clean space sometimes feel overwhelmingly huge and barren, but it DOES seem that I can adjust to this to an extent if I make myself deal with it for a little while, though I may never enjoy really minimalist decor.
    The solution that works well for me is to use clear plastic storage containers and open shelving where possible, and clearly label everything as to its contents so I can picture the location of the label in my memory and know where to find things easily.

    We also had a bonus breakthrough about why I could never learn to use a dayplanner---most of them are made in fairly conservative monotone colors and the way my visual processing works, they vanish as soon as I set them down. A few spirals of glitter paint added and all is well!

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