Showing posts with label self-regulation. Show all posts
Showing posts with label self-regulation. Show all posts

Why Do So Many Autistic People Flap Our Hands?

Maxfield Sparrow
unstrangemind.com


[image: rainbow colored hands in silhouette,
upraised and reaching out with joy.]
The saying goes, “if you’ve met one Autistic person, you’ve met one Autistic person.” That was really hammered home for me today as I watched a short video in which an Autistic man explains why Autistic people flap our hands … and pretty much nothing he said matched up with my own experience. A few of the things he said even bothered me.

My intention is not to erase what he said, however. His view of why he used to flap his hands is just as valid as my view of why I still flap my hands. There are many ways of being Autistic.

(Since the video was not captioned, I took the time to make a transcript of it for those who can’t hear or understand it. That was fortunate as the original video was removed from YouTube.) The video explains,
“It comes down to repetition. When we, as people with Asperger’s, are in a really unknown situation or we’re in a situation where there’s a lot of anxiety […], there’s a lot of stress, the way that we manage that, is because generally it’s overwhelming we do repetitive motions, because then we at least know, hey, if I do this I have complete control over it. And I know that whatever I do, I have complete control and it’s going to happen the same time every time. Therefore, I get a little bit of comfort from it.”
This does not even begin to describe why I flap my hands or make other “Autistic movements.” Yes, I flap in stress. I flap in overwhelm. I flap when I get hurt. The video presents hand flapping as if it only occurs as a result of stress or anxiety, however, and that is not at all true for me.

I flap my hands when I am happy. I flap them when I am content. I flap them a lot when I get excited about something. I have as many different ways of flapping and twisting and ruffling and fluttering my hands as I have emotions and emotional combinations that wash over and through me. My hands are like barometers of my emotional climate.

There are plenty of things I do to try to increase the amount of control in my life, but flapping my hands is not really one of those things. I don’t flap my hands to have something reliable and constant in my life. I fill that need with other things, like small stuffed animals I carry in my pocket or ritual ways of doing certain things. For example, there is a little ritual to how my boyfriend and I say good night in the evening and that ritual comforts me, gives me a sense of stability and predictability in my life, and helps me to make the transition from visiting with him to being alone again. I do other things like always removing the ice cube trays from the freezer in the same order, always putting the same number of ice cubes in my glass, always walking or bicycling the same route to get places, always brushing my teeth for the same number of minutes every night, and so on.

These things serve my need to have a predictable, orderly world that is under my control as much as possible. The more I am able to feel a sense of control over my life, the calmer and happier I am. I suspect this is true for most or all people, but it is quite extreme in my case. Something small, like not getting my usual seat, or having the water turned off for twenty minutes in my apartment building in the middle of the day with no warning, can make me feel like my world is coming to an end.  I am always fighting back the forces of chaos. But I do not wage this war with hand flaps.

The most common reason for me to flap my hands is that I am very happy and excited about something. My boyfriend told me that he loves to see my hands flap because there is a lovely joy that goes along with it that is fresh and appealing, without guile or artifice. If I recall correctly, he used the word “childlike” and meant it in a beautifully loving and respectful sense. Over the month of December, we went through a Jacquie Lawson advent calendar together every morning right after having breakfast together and he got to see lots of hand-flapping on the days when the calendar surprise was a steam locomotive or a peacock spreading his bright tail feathers, or a mansion kitchen staffed entirely by giant teddy bears.

I’d see these things that made me really happy and excited and there would go the hands. By the time I was aware that I was flapping my hands, they’d already been going wild all on their own without my awareness. My hand flapping is so often an expression of sheer, unadulterated joy—pretty much the exact opposite of what is being taught in the video, when Asperger Experts says, “it’s basically a giant signal saying, “hey! I’m not comfortable right now. Things are too much pressure or too much, just, overwhelm of sensation to the point that I need to do something to feel better about it.”

Yes, I can feel pretty overwhelmed by joy! But the kind of flapping I do when I’m not comfortable and suffering is another kind of hand flap. It’s a whole language of flaps and twists and shifts and strokes and claps. My hands speak my emotions so clearly, but only to those who are willing to learn what they are saying. My hand flapping is not a single message of suffering. It is a multi-faceted expression of my complex and beautiful emotional life.

As an alexithymic, I’m not usually aware of my emotions. So I even watch my own hands flapping away to help me understand what emotions I’m experiencing. I am “blind” to my emotions—I have emotions, usually very strong ones, but I am unable to know what I am feeling so I have to play detective and watch my body for clues.

My hands are always telling me what I am feeling. Without my hand flaps, I would not be anywhere near as connected to my inner life. Without my hand flaps, I would struggle so much more every day, just trying to understand what my body and spirit were experiencing. My hands are my teachers and they educate me about my deepest self every day.

While I feel as if my three-dimensional experience of hand flapping is described in a very one-dimensional way in the video, that’s not what really bothered me about the message. I was bothered by the way hand flapping was presented as something bad, undesirable, ridiculous looking, and mainly restricted only to small children. The video admitted that hand flapping is necessary, but presented it as something annoying and embarrassing that should be substituted as quickly as possible with something less visible, like repetitive thoughts:
“You shouldn’t just try to stop it because then they’re just going to find some other way of gaining comfort. […] All of a sudden, they might gain a tic, like [clicks tongue several times] and then that’s just even more annoying.”
No.

You shouldn’t try to stop hand flapping because it is part of who we are. Would you like it if everyone were trying to make you stop smiling? Or tucking your hair behind your ear? Or putting your sunglasses on top of your head? Or crossing your legs when you sat? That is what people are doing to us when they try to make us stop flapping our hands: they are trying to force us to stop moving in ways that are natural, healthy, and comfortable to us.

(And when I say “we” and “us,” I mean those of us who do flap our hands or otherwise naturally move in different ways from the rest of society. Not all Autists move in the same ways and that includes the fact that not all of us rock or flap or spin (although the vast majority of us do) so don’t assume someone is not Autistic because you don’t see them moving in different ways. Or they speak. Or hold a job. As I always say, there is no one way of being Autistic.)

The Asperger's Experts video presents hand flapping as a necessary evil—something that is annoying but has to be tolerated because we do it to soothe anxiety, and might end up doing something even more annoying if we’re forced to stop. In my opinion, hand flapping is a fundamental manifestation of the native nervous system of those who flap. It is how we are built, it is what we do. The focus should not be on whether it “might look ridiculous” or whether it’s better to “[transition] into listening to the same song over and over again, [or]  say the same thing in [one’s] mind over and over again.” the focus should be on building a society that understands that we don’t all move our bodies the same way and that’s okay.

“You know, you don’t see many people that are forty doing this [waves hands].” I am fifty and I flap my hands. Many of my friends who flap their hands are older than me. I know people in their twenties, thirties, forties, and fifties who flap their hands and even someone in his seventies who flaps his hands. It’s okay to move differently from others. It’s okay to have a different neurology and it’s okay to be who you are.

There is a much worse risk that comes from trying to suppress hand flapping than developing an “annoying tic.”

When I was a child, I felt like there was no place that was safe, no place where it was okay to be who I am, no place where I could just relax and be myself. Everybody was trying to give me the advice of “just relax and be yourself,” but when I would actually do that, I would be yelled at, criticized, punished, bullied. I lived in fear and anger because nothing I did, no matter what, was ever right or good enough. At school, I was bullied by the students and even by many of the teachers.

At home, I was blamed for the bullying and told I was bringing it on myself. In a misguided attempt to shape me into someone who would not deserve to be bullied so much, all my mannerisms and stims and quirks were under attack. I felt like I was constantly picked apart for behaviors like walking on tiptoe, clearing my throat, flicking my fingers, spinning around, talking too loudly, grunting instead of talking, and so on. I spent … wasted … so much energy and focus on trying to make my body and face and voice do all the proper things. But no matter how hard I tried, I kept always doing something wrong, and getting called out for it.

As a result, I was filled with so much anger toward everyone around me and so much self-loathing. I felt like nothing I did was ever right and I had no place to relax – school was filled with bullies and home was filled with picking apart my stims. I grew to hate everyone and often would lose myself in bitter daydreams with imagery I don’t care to re-visit now. My whole life was torment and I was in agony. This is the reason to let Autistic people be, not the fear that they might develop new behaviors that are even more annoying to the people around them.

The Asperger's Expert video’s reason for tolerating hand flapping was all about what makes other people feel okay or uncomfortable and had almost nothing to do with what the Autistic person wants and needs. Hand flapping almost had to be defined in that very one-dimensional manner, because if hand flapping is nothing but a comfort for excruciating anxiety, it is easier to decide to tolerate the “annoying” and “ridiculous” behavior, but if hand flapping is something that can be a sign of happiness as well as of more difficult emotions it’s harder to justify allowing people to be “annoying” just because they are happy.

But the problem is not with the hand flapping. The problem comes when the decision has been made that hand flapping is annoying or weird and not natural and adorable (which happens to be how it appears to me. I love to see people hand flapping! It makes me happy to see someone making a happy hand flap.)

The makers of the video may be Asperger’s Experts, but they are most surely not Maxfield Experts, because I’m not at all like what was portrayed in that video and I have many Autistic friends who are similar to me. Of course some Autistic people must resemble the portrait that was painted by the educational video purporting to explain hand flapping because that is how those two young men experienced their own Autistic movements. I don’t want to erase their voice when raising mine. But I also want to make sure their message is not the only one available to people.

So, as I said, the lesson here is that if you’ve met one Autistic person, you’ve met one Autistic person. There is not just one way to be Autistic. I’m sure the makers of the hand flapping video were expressing the truth about what being Autistic is like for them. Just be careful to remember that no one (including me!) speaks for all Autists. It is a pretty safe bet that there are also Autists out there who aren’t like the description in the video but aren’t like me, either.

So when you see someone flapping their hands, don’t make assumptions about what it means. There are some meanings that are more likely and some that are less likely, but better than guessing—better even than statistically-backed guessing—is getting to know the individual Autist and learning what hand flapping means for them.  Engaging with humans is almost never a one-size-fits-all scenario. We Autists are individuals; it’s good to learn general autism data, but “at the end of the day” there is no substitute for learning the language, including the body language, of the special person in your life. Or of yourself, if that’s how it’s all playing out for you.

But no matter what the flaps mean where you are, I do hope you will take one thing seriously that I said: don’t hate on the flaps, don’t be afraid of them, don’t judge them so harshly. Learn to live with the hand flaps because they are a good and useful thing for Autists, no matter what purpose they serve for each individual Autistic person. And, who knows: if you don’t already, there may come a day when you begin to see the beauty in hand flaps. Hand flapping and other Autistic stims are quite exuberant and lovely if you remember that they are a person’s heart and spirit made visible in time and space for all to behold.

(Note: A version of this post was published at unstrangemind.com in 2014.)
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Autism and Biowearables: An interview with Matthew Goodwin at IMFAR 2017

Carol Greenburg and Matthew Goodwin at
the IMFAR 2017 Press Conference

[image: White woman with short platinum hair
and glasses posing with a taller white man
with a shaved head and goatee.]
Northeastern University researcher Matthew Goodwin gave an IMFAR 2017 keynote speech about his work on "Wearable Sensor-Based Physiological and Physical Activity Biomarkers for Use in Laboratory and Naturalistic Environments to Assess Arousal and Repetitive Motor Movements in Individuals with Autism Spectrum Disorder." Thinking Person's Guide to Autism's Carol Greenburg and Shannon Rosa, and Autism Women's Network's Corina Becker, spoke to Goodwin after the IMFAR press conference, about the real-life applications of his work, and how they can benefit autistic people.

Carol Greenburg: What constitutes a behavior, insofar as it’s something that needs to be mitigated? A behavior like flapping or other “stims” may mean something different to the person who’s doing the intervention, as opposed to the autistic person themselves. What I consider a behavior is different than what you consider a behavior, and therefore the treatment, intervention, or mitigation may differ. Does that make sense?

Goodwin: Perfect sense, and philosophically, we’re aligned. It’s actually a pet peeve of mine that in the clinical arenas, we refer to challenging behaviors as “behaviors” with a negative connotation. Because everything we do is a behavior! All the positive things are behaviors. So, A) I wouldn’t define behavior only by negative consequences. And B) I’m actually more interested in determining the function of these behaviors, assuming that they are purposeful and regulatory, and that there’s a reason, and it’s just our failure to understand what that is. Even things like aggressing to other people, or self-injury. I would rather suppose that that is something of a stress response, or a fight-or-flight response, or a panic response, in the absence of being able to cope or communicate with other people than assume it’s oppositional, or defiant.

Greenburg: Or of frustration that one is not getting through what is perfectly obvious to the autistic themselves, and cannot express, especially because we often don’t understand that other people are not sharing our definitions, or frame of reference.

Goodwin: Correct. And that’s another thing that I like about the physiological measures, is that even when you have a difficult time in articulating to me what might be stressful, or disorganizing, I can record it from your body. I can view it objectively, and I might have a little bit more empathy and compassion for you as a result of that, than assuming you’re not having that issue or because you can’t explain it means that it’s not having some negative consequences.

Greenburg: It is a presuming competence issue at its core.

Goodwin: Yes. And we live in a social world, with norms, and if those norms are violated, we say, “There’s something wrong, get in line,” instead of thinking “What would the world be like for someone who is neurodivergent, and then trying to think about “How do I interact with that person?” So the neurotypical might adjust their behavior to be more complementary in reaction to someone on the spectrum.

Greenburg: The whole idea or norms, it just seems to me that there’s a hierarchy of norms that are important to me, and that hierarchy is radically different for educators, for example, or for professionals, than they are to us as autistics.

Goodwin: I’m not interested in trying to shape anybody’s behavior, unless they tell me they want it shaped themselves. Or a parent is saying it is somehow preventing well-being, learning, or independence for their child.

Greenburg: Well the question is, whose agenda is it? Is it the parent’s agenda? Is it the child’s agenda? Who is benefiting? Who is writing the subtext here?

[Goodwin nods]

Goodwin: I agree. I mean, I don’t know if biosensors are going to solve that problem but if it's another source of information to reflect on yourself and share with other people and to think about, I do see value in it.

Greenburg: Well, pattern detection is always important and pattern detection is what wearable devices are all about so I can certainly can see great value in that.

Goodwin:  So you have the FitBit.

Greenburg:  I’m surprised that my heart rate is so low. At IMFAR, in this conversation.

Goodwin: So let’s see if it’s different -- I’m at 77, where are you at?

Greenburg: I’m at a mere 69.

Goodwin: not that far out.

Greenburg: Mine should be topping 100, given how I feel.

Goodwin: Do you track how many steps you take? Do you track what your heart rate is doing periodically?

Greenburg: I track how many steps I’m taking. I track my heart rate more because I want to see how upset I am compared to how upset I was before what I was feeling.

Goodwin: Fantastic. So you’re getting some self-insight and self-awareness.

Greenburg: I am using my FitBit for feedback on aspects of my autism, specifically. I also use the meditation function when I start to feel myself hyperventilating. I meditate quite a bit and so I’m able to use it and it’s an invisible way to meditate and self-soothe without doing anything that will necessarily draw attention to me, at a time when it would not be practical for me to draw attention to myself. So instead of rocking or stimming or doing something else while I’m starting to get overloaded I can trigger this and it’s an invisible way of my self-regulating.

Goodwin: You should come work for me. You said that better than I could have said that.

Greenburg: How much are you paying?

Goodwin: We’ll go off record [laughing]

Shannon Rosa: We actually did get questions at Thinking Person’s Guide to Autism on Twitter, when you mentioned alexithymia, asking, “what can I do? How can I do it?” It sounds actually, Carol, like you just explained what people can do.

Greenburg: I mean, in general autistics spend their entire lives—all of us, no matter how much spoken language we have or not—we spend our entire lives in regulating and work-arounds. It’s all about work-arounds. Everything. So the minute I get any new device, the minute I get a new hat, I think of it in terms of,  “How is it going help me as an autistic? is this going to shield me from light better than another type of hat?” So of course when I got a Fitbit, it didn’t even occur to me not to figure out, “okay how do I use this?” It’s a little surprising to me to hear a non-autistic point of view saying, “wow, it's really great that you use this as a work-around!” I’m like, “how could I not?”

Goodwin: So here’s where I really would love to learn from your community about the ways that you're using this so that we can provide it to people who can't afford it or have not thought about using it. I mean it's one thing that I can give you that, but the sensor itself is not enough. You have to then take that information and turn it into meaning.

Rosa: Right. Tools are tools.

Corina Becker: I don’t know how usable it is nowadays, but I had an idea a couple years back of developing an app that was basically an alarm system for an autistic person to self check themselves on how they’re feeling.

Rosa: There’s an education point of this regular FitBit that needs to be adapted.

Goodwin: So you’d like to set a threshold and if it was crossed or if you’re getting close...

Becker: Yeah, and basically it would check in and be, “okay, how are you feeling? Are you overwhelmed?” and basically then it would come up with a script that they had developed and say, “do you need help? Here’s a script to present to someone to ask for help.”

Rosa: That would be amazing.

Goodwin: We’re working on that. We really are trying to build that.

Becker: A FitBit version of a five point scale, in the beginning at least. How anxious am I? And from there if it could give me a script, that would be really helpful. It was a very simple app, it was this script: check list of here's what I'm feeling, here are my symptoms, go.

Rosa: Carol and I are both parents of very high support young autistic men and I've been texting my son’s teacher about his regulation throughout the press conference.

Goodwin: Great way of saying that.

Rosa: High support? We’ve been working on that phrasing for a long time.

Goodwin: It’s good terminology. I say severely impacted but that still feels a little pejorative.

Greenburg: Severe. Severity equals, in my experience, how obvious it is to non-autistics which has limited value to actual autistics.

Goodwin: Yeah, great point. I’ve never heard it phrased in terms of support needs.

Rosa: That’s the language that we try use.

Goodwin: Great. I’ll try to do that.

Rosa: Yay! We can go on now.

Greenburg: We've reached one person!

Rosa: I would like to hear more about what kind of outcomes have you seen so far in being able to support people. In high support people, or people with communication disabilities? Have you been able to determine thresholds? Have you seen actual success in being able to detect when people were getting aroused before it would typically happen without your system?

Goodwin: Yes. So for the challenging behavior, the aggression to other people, very concretely, in inpatient units, we’re finding that the biosensor data is predictive of an event about a minute before it happens.

Rosa: Wow, it’s like an early earthquake system, right?

Goodwin: Perfect analogy.

Rosa: It’s actually better because I think they only have earthquakes up to seven seconds now.

Goodwin: Part of what we need to do is try to increase the accuracy of the prediction and give more time to give the warning so there’s more time to prepare for it. But I think as we get more data and there’s more signal processing of that data we might be able to do that.

Greenburg: What I’m wondering is what would that warning look like to the professional? In other words, it’s a very different thing to say, “okay, I’m getting a warning that there’s about to be something happening.” If that’s an actual aggression, if somebody’s going to come up and hit you, it’s useful to know so you can duck. But there’s a way in which it has to be more qualitative. It’s not just that something is coming. What is it that’s coming?

Goodwin: And what should we do about it?

Greenburg: And what should we do about it that will most benefit the autistic person, once again, and not necessarily benefit my ability to control the autistic person’s behavior. That’s another underlying philosophical issue.

Goodwin: I agree. I mean, we’re just alerting. So then the next phase is stakeholder groups. So, you being the autistic person, your people who care about you and who you’ve agreed to have care for you on your behalf—what’s effective for each of those stakeholders in that situation?

Becker: I want you guys to get scripts. Scripts are really helpful!

Goodwin: They’re like safe words, right?

Becker: Yeah, they are like safe words. They are very easy to memorize. I don’t speak as well as I appear to speak because I spend most of my life scripting. Scripts would be very, very helpful to you. Every time the alarm goes off for X thing that’s coming up, if you have a script of how to respond to me quickly, then that’s going to be very helpful to me.

Greenburg: Even a routine. You know this is happening, okay this needs to happen in order to at least decrease the severity or at least help get into position. That would help.

Rosa: We’ve been doing workshops with developmental pediatricians and also autistic people who work in high support young adult groups, on understanding autism and aggression—including potential medical reasons. My concern, and one of the things they talked about, is that sometimes when behaviors decrease and so are "mitigated" from the carer or family member’s perspective, that actually means that the autistic individual is sick or unwell. So I think there are a lot of ethical issues.

Greenburg: I don’t want to be mitigating when my son is already in distress. This is something I don’t want to be mitigating. I want to clarify.

Goodwin: Yes, or some seizures, or gastrointestinal pain, or reflux, or some aversive sound in the environment that nobody else is having a response to. I mean… all I can tell you is the physiology is changing and there’s an association between physiology and behavior. What in the environment is changing the physiology and what the individual and their supports can do about it, that I can’t predict.
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