Monday, May 24, 2010

How to Understand the Person With Autism's Need to Check and to Keep Things in Order

"I have to check everything before I leave the house. If I deviate from my specific process, I have to start all over again. If anyone interrupts me in the process of checking, I have to start all over again. I am afraid if I do not follow the 'checking rules' something bad will happen. When I do not do things in order it feels like I am doing something wrong. I cannot deviate from what I think of as my order. Order makes me feel comfortable. It relaxes me. Also I am not equipped to explain myself if I am going out of order. I do not have a way to defend myself. Order is my way of knowing what to expect and to know what comes first, second, etc. I cannot use myself so how can I explain if things get out of order?"

What is this autistic boy telling us? He checks and keeps everything in order and cannot deviate from his process. This reminds me of another autistic boy who would line up letters of the alphabet. If I took a letter and put it in the 'wrong' place he would immediately change it back to its proper place. Both these boys are telling us that keeping things in order and checking helps to keep them calm and relaxed. They are self-regulating. They are both very fearful if things are out of order and not in their proper place. This autistic boy is aware that he does not know how to express his concerns about order. He is obsessed with this need for sameness and order.

Checking and order seem to provide as the autistic boy told us a way to calm himself down and self-regulate. Infants learn to self-regulate through the mutual regulation that takes place between mother and child during the attachment process. The child with autism has an incomplete attachment so can only rely on himself for methods to self-regulate. Each child with autism will find methods to self-regulate. As the child completes the attachment process, he will learn other methods to self-regulate through the interaction with a caregiver or a therapist. As this occurs he will start to also feel less anxious and will be able to give up coping strategies that were developed to manage his anxiety and stress

I also think that other things are going on that we might speculate about. From the perspective of an Incomplete Attachment this child is trying to keep things in order because 1) He feels no order from within. In other words, he lives with a chaotic internal world, which is dissociated and does not allow him to have access to his words (lacks self-agency), 2) if he had access to his words then he could live without fear and 3) be able to respond to spontaneous situations and allow things to be out of order. Spontaneity from this perspective comes out of being sure of oneself which comes out of the ability to have access to ones feelings and to express those feelings freely.

This autistic boy may be checking for multiple reasons: 1) it provides as mentioned previously a way to feel calm, relaxed and regulated and 2) from the perspective of an Incomplete Attachment, the autistic child is dissociated and can never be sure of 'what has just happened'. He is never sure that what he has just experienced has really happened. He has no way of 'testing reality' by asking questions especially if he is low functioning. Thus he is left to his own devices to try to figure out what is going on. In a dissociated state nothing feels stable and he cannot be sure of what is happening at any point in time. Thus the checking is his way of making sure that everything is stable and that what he really saw did actually happen.

Karen Savlov is a psychoanalyst and Marriage and Family Therapist with a private practice in West Los Angeles, California. My specialty is Autism Spectrum Disorders, anger, dissociation, depression, anxiety and relationships. For new and creative ways to think about autism read and follow my blog at I can also be followed on Twitter at Autism Thoughts.

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