Why does stimming help me think?

For some years now, the so-called vulnerability-stress coping model has been an important approach to explaining personality and schizophrenic disorders. At the same time, it serves as the basis for therapeutic interventions and psycho-educational support measures. In view of its advantages, the approach is also popular in educational work with people who are said to have behavioral problems in addition to learning difficulties. The aim of this article is to show that the approach can also be fruitful for supporting people from the autism spectrum. To this end, the issue of vulnerability is first addressed. Then it is about the stress of autistic people and self-determined forms of coping taking into account resilience. Conclusions for practice round off the article.

On the vulnerability of people from the autism spectrum

While it was customary to differentiate between different clinical pictures of autism (e.g. early childhood autism, Asperger's syndrome, atypical autism), today a spectrum view based on the knowledge that there are more similarities than There are differences in terms of autistic characteristics (cf. Theunissen 2014; 2016). Furthermore, there are increasing voices to view autism not per se as a disease or mental disorder, but as an expression of a human being. In people from the autism spectrum, this is characterized by neurological peculiarities that distinguish those affected from non-autistic people.

The starting point of the vulnerability concept presented here is a so-called psychosocial predispositionwhich covers social risk factors especially in early childhood, for example frequent hospital stays, abuse, trauma, emotional neglect, rejection, unfavorable family and educational circumstances. The more unfavorable the external conditions and influencing factors, the greater the likelihood of developing a high level of vulnerability on a psychosocial level. This can be seen, for example, in the autobiographical writings of Donna Williams (1994) or Gunilla Gerland (1998).

The degree of predisposition can therefore vary individually depending on environmental factors. However, a high level of vulnerability due to certain gene mutations, epigenetic influences and their effects on the functional architecture of the brain beyond social risk factors must also be taken into account.

Current explanations regarding autism (see in detail Theunissen 2016) - for example the "theory of the intensely experienced world" (Markram & Markram 2010), the "Hypothesis of Imbalanced Empathy" (Smith 2009), the "model of the imbalance between inhibition and arousal" (Rubenstein & Merzenich 2003), the "theory of neural hyperconnectivity" in childhood (Supekar et al. 2013) as well as the "model of extended perceptual functionality" (Mottron 2014) - are to be located at this point. What they have in common is the assumption, based on research findings, of excessive neuronal sensitivity and reaction to sensory stimuli or emotions. In this respect, a high level of vulnerability can be based on an "inherently" (Mottron) determine changed neural architecture in people from the autism spectrum. This is confirmed by many autistic people.

"When I was in college," writes Temple Grandin (2006, 63) with autism, "my roommate's hair dryer sounded like a jet plane taking off"; and the autistic woman Gunilla Gerland (1998, 114) says: “When I was eight years old, I developed an oversensitivity to combs and hairbrushes. I resisted combing my hair. Suddenly I couldn't stand the pain that came with combing. It was as if a synthetic fire was burning all over the head and neck. ”It is not uncommon for autistic people to report that after a short time they experience the noise level in a discotheque or the atmosphere at a birthday party as overwhelming, uncomfortable and stressful . "My sensory hypersensitivities ensured that loud music and basses caused massive earaches," says the autistic Florian P. (quoted in n. Aspies e. V. 2010, 113). 

Closely related to this vulnerability, which is characterized by over-sensitivity, is a so-called filter weakness, which some people from the autism spectrum report and complain about: All the different noises entered me unfiltered and I could not identify the individual sound. When it got too much, I just screamed "(Zoller 2001, 62). Quite a few of those affected find it difficult to distinguish between “meaningful” stimuli and “irrelevant” ones on the basis of increased neuronal excitation. The autistic Tito Mukhopadhyay (quoted in n. Bogdashina 2010, 31): “For a moment you look at a picture, and at the same time you become aware of the pink wall that surrounds the picture, and then you also hear Jack's voice explaining something about the picture. In the next moment you look at the light reflection through the glazing of the picture. This reflection rivals your attention, which you are directing to the picture at the same time. ”According to autistic Nicole Schuster (2007, 20), such situations can often create“ constant stress ”that has to be managed just as much as the increased sensory sensitivity described above .

To sum up, it can be said that research findings show that for many autistic people with high vulnerability sensory stimuli, which are usually barely perceived by non-autistic people, already generate stress. In doing so, it is of course important to consider individual peculiarities: For example, “an autistic child can love the noises of a vacuum cleaner while another is afraid of them. Some (autistic children, GT) are attracted to the sound of flowing or splashing water and spend hours flushing the toilet, while others panic when their pants get wet because they hear the flushing noises like the roar of Niagara Falls "(Grandin 2006, 63).

On the other hand, what is described here as a supposed problem under vulnerability can also be a strength. There are good reasons to believe that people on the autism spectrum, with regard to the recognition of details, “extremely gifted in perception“ (Grandin 2008, 75) are: “My autism gives me a perception that is fragmented and extremely detail-oriented. Because of this, one of my childhood favorites was Where’s Waldo, which requires a keen eye for detail. To this day, I regularly discover misspellings and other subtle errors on the pages of a book or newspaper. When I walk into a room for the first time, I often feel dizzy with all the fragmentary information my brain registers in my head. Details precede the objects that make them up: I first see the scratches on the surface of a table before I see the whole table, first the reflected light on a window before I see the whole window, first the patterns a carpet before the whole carpet comes into view "(Tammet 2010, 199f.). It seems that people on the autism spectrum with increased perceptual abilities are more likely than non-autistic people to recognize and identify tiny details, differences, errors, hidden, subtle patterns or figures. This can be recognized as a form of "autistic intelligence" (cf. Theunissen 2016).

In addition, there are autistic people who are less sensitive to sensory stimuli, but appear vulnerable in social situations due to a hyper-reactive amygdala ("fear center" in the brain) and, for example, already low demands, time pressure, conversations, praise, sudden ones Experience changes or unforeseen events as stressful.

“When I was four years old, I actually watched TV regularly. Always the same station, always the same time: 9 a.m. At some point the airtime was postponed, which made me mad, ”writes the autistic Miggu (quoted in n. Aspies e. V. 2010, 14). 

Another example, which extends to an unfavorable interaction of certain factors such as time pressure, tactile hypersensitivity, motor clumsiness or executive functional problems in everyday demands, comes from the autistic Matthias Huber (2014, cited n. Theunissen 2016): Imagine that an autistic person with tactile hypersensitivity should accept a glass of liquid (juice, water, beer ...). She probably has considerable difficulty in grasping the glass at first because she cannot bear it with her overly sensitive palms. Only after several tactile attempts and hand positions does she succeed in finding a sensory acceptable handle that is suitable for her.

That vulnerable people have problems with time pressure or lack of time can also be seen in the following example: It relates to the brushing of teeth, which is carried out by an autistic boy in a very specific way. If he is interrupted (e.g. by saying "Hurry up, please"), he gets stressed and starts the procedure all over again. Because to be interrupted in his process (routine) is unbearable for him.

Oliver Sacks (2000, 276) also reports difficulties in enduring change: The autistic savant artist S. Wiltshire “could not bear any disappointments or changes in everyday habits or the environment. If they did, however, he responded with a desperate, angry roar ”. The following situation, which an autistic man told me, moves in a similar way: When he first entered the office of his boss, he immediately registered many details: eight bookshelves, two cupboards, one window sill with three plants, two window sills without plants, four chairs around a round table ... Another day he had to go back to the office. As soon as he entered the room he noticed a change, namely two plants on a window sill. Then he was completely irritated and "got into stress". He had asked himself: is it the boss's office or is it the wrong room? Am I possibly lost? Due to his “data storage and focus on details” he found it difficult to think globally and to intuitively call up a prior understanding (expected and context-driven concept of “boss's office”).

Such a lack of "intuitive prior understanding" (Klicpera & Innerhofer 1999) corresponds to the “impairment of unconscious group communication and interaction”, which Bernhard Schmidt (2015, 32) identifies as a “central symptom and problem” of autistic people. He refers to the results of brain research, according to which there are two neural networks, a "default mode network"(DMN) and a"task positive network"(TPN), which, among other things, are extremely important for interpersonal communication, social orientation and navigation (cf. Jack et al. 2013). If the DMN dominates in non-autistic persons, which presumably stands primarily for an intuitive, emotionally guided, socially synchronized orientation (empathy) and functions as a kind of energy-saving "autopilot", autistic persons would rather move in the TPN, which is primarily for the rationally controlled, goal-oriented handling of tasks (systematisation) is responsible. Since many autistic people have weak neural connectivity in most areas of the DMN (cf. Monk et al. 2009; Weng et al. 2010) the "autopilot" is missing, there is a high energy consumption in the form of vulnerability, which is difficult to bear under certain conditions such as restrictions, rejection or exclusion and promotes distress. In addition, a weak DMN is likely to result in the development of the "intuitive pre-understanding" (Klicpera & Innerhofer) or the "unconscious group communication and interaction" (Schmidt) make it much more difficult to cope with social situations, which creates additional fears. If the environment reacts inappropriately and fails to recognize the strengths associated with the TPN (e.g. intensive discussion of a matter, often a special interest), increased insecurities, low self-confidence or self-esteem, withdrawal, anxiety or depressive disorders must be expected become.

Finally, it should be mentioned that a vulnerability is fundamentally difficult to measure and objectify. Rather, it is a hypothetical construct that can be reconstructed and processed through observations and narratives, external and internal views.

Stress and stress coping

As the examples have already shown, there is a close relationship between vulnerability and stress. Since the term stress is often used without reflection in everyday life and is not infrequently used in different ways, it is important to define it first.

A look at various definitions and attempts at definition leads to the conclusion that, beyond differentiations, two aspects are of central importance: On the one hand, stress becomes psychological and physical reaction viewed on challenges, and on the other hand, the term denotes a psychological and physical Status under an internal or external situation that is experienced as challenging (cf. Lazarus & Folkman 1984; Nitsch 1981). 

Although stress is mostly associated with “negative” (distress), it can also have “positive” effects on performance. In addition to experiencing momentary moments of happiness, long-term resources or inner potentials such as control, perseverance, self-confidence, self-esteem or self-image can be strengthened. This so-called eustress, however, has its limits when it comes to mental and / or physical overreaction and overuse.

This is where stress theories come in physical stress reactions highlight (Selye 1953). In addition to symptoms such as increased pulse or blood pressure, sweating, rapid breathing and increased muscular tension, this applies to the increased excretion of norepinephrine and adrenaline, which set mechanisms in motion that usually lead to increased motor activity and even aggression. If the hypothalamus-thyroid-adrenal cortex axis is activated, a process usually begins that leads to helplessness and loss of control and, if the cortisol level increases due to increased glucocorticoid secretion, it paves the way for depressive symptoms or disorders. According to Janssen, Schuengel and Stolk (2002), there also appears to be a connection between increased cortisol levels and self-harming behavior in stressful situations, which was found in (institutionalized) people with severe cognitive impairments. Furthermore, the mentioned stress hormones, increased concentrations of adrenaline, noradrenaline and cortisol in the blood, are associated with (psychosomatically significant) disease risks, especially with an increased susceptibility to colds or infectious diseases, damage to blood vessels, back pain, sleep disorders and gastrointestinal problems. It should also be mentioned that with persistent stress, learning and memory performance decline as the hippocampus begins to shrink as organizer and working memory.

In addition, there are stress theories that one cognitive stress management put in the foreground (cf. Lazarus & Folkman 1984). They assume that the confrontation with situations or events results in different evaluation processes. First of all, a situation is assessed to determine whether it is stressful at all. If the person comes to the assessment "non-stressful", the situation can be ignored. Otherwise, there is a secondary evaluation process that focuses on the question and opportunities for dealing with the situation. Situations that are perceived as threatening lead to an increased experience of stress. It is all the more important to cope with them. The secondary assessment is thus followed by the search for a solution to the problem, an assessment and assessment of resources, the selection of a strategy that is considered appropriate, which then emerges as coping. Lazarus and Folkman (1984) differentiate between two approaches: one problem-focusedthat aims at a positive change in the challenging situation and a emotion-focusedwhich should lead to an improvement in emotional wellbeing. Strategically, different types of coping attempts can be distinguished, for example forms of relief or compensation (e.g. physical relaxation, break, retreating into a niche, sporting or aesthetic activities), information search as a direct action, cognitive visualization and positive reassessment, cognitive distancing, Self-control or suppression of actions, assumption of responsibility and confrontational coping, escape and avoidance or search for social support. In the context of the selection and use of such possibilities, a third evaluation process in the sense of a process evaluation and re-evaluation becomes more important. In this respect, it is assumed that assessments and coping strategies can change transactionally in the course of events due to internal and external influences.

For coping with stress in autistic people

In principle, these general findings also apply to people from the autism spectrum who are said to be more vulnerable. It can be assumed that affected persons react with extremely high sensitivity to so-called stressors (e.g. with physical stress reactions, especially an increased cortisol level) and have to mobilize a high level of energy to cope with them.

Stressors include external and internal factors that trigger a “negative” or “positive” stress reaction or a stressful state. The range of potential stress factors is wide: it ranges from the smallest demands in everyday life, from tasks that a person has to cope with every day, to deadline pressure, medium-term work that requires planning and self-developed solutions, exams, shortage of money, unemployment, bullying, social expectations or conventions, noise, shopping centers, long queues, train stations, overcrowded buses, physical discomfort or relationship problems, severe crises, unforeseen, critical or drastic life events (e.g. death of a loved one, accident, separation through divorce).

If extreme events lead to a trauma experience, a post-traumatic stress disorder must be expected in addition to what has been said so far. Which factors ultimately cause stress can only be determined individually. Two aspects are decisive here: On the one hand, it depends on the interaction of vulnerability, situation or event, cognitive evaluation and subjective experience, whether a stressor is present and has to be dealt with. On the other hand, the cognitive evaluation process and the subjective experience are moderated by a resource that, as resilience, has a considerable influence on the coping options.

On the importance of resilience

The term resilience at this point refers to a psychological resilience, life energy or strength that proves to be helpful in coping with challenging situations or events. In addition, resilience is "perceived as an unexpected positive development" (Fingerle 2011, 124), referring to critical living conditions or stressful situations that usually lead to a negative development or are rated highly for failure or a severe crisis. Resilience can thus, as it were, as an "antidote" to vulnerability, help cushion psychosocial risks or stresses, avoid a crisis, failure or psychological decompensation, maintain a perspective on life and ensure personal well-being (cf. Garmezy 1991). 

The development of resilience is determined by the interplay of predisposed and acquired disposition, whereby learning and development processes under favorable socialization conditions in early childhood are of central importance. Living environments that promote resilience or are favorable are those that enable a stable, trusting relationship with at least one caregiver, especially in the first two years of life, which can also be found in later years through the availability of a confidant (e.g. family member, teacher, friend, neighbor) for emotional support in stressful situations, which allow space for self-determined, meaningful activities and experiences and which pay attention to an involvement in emotionally supportive and development-promoting communities.

Such conditions enable and facilitate development individual protective factors, on which resilience is based; this includes in particular physical health and resilience, perseverance, perseverance, trust in one's own resources, even being able to cope with life crises or stresses, optimism or confidence, humor, good-naturedness, sociability, open-mindedness towards the environment, a positive self-concept, self-efficacy expectations, problem-solving skills, control conviction Achievement motivation, emotion regulation and impulse control, a positive attribution style, goal-oriented attitude towards life, flexible adaptation to upheavals, belief in the meaningfulness of one's own life and intelligence.

Although this ability is auspicious, it does not have to be protective per se. Depending on the situation, a protective factor can even become a risk factor or can only be protective for a limited period of time. This means that the factors mentioned must not be set absolutely, neither from given situations or challenging living conditions, nor from the assessment competence of the person concerned. In addition, the synergy effect for resilience is greatest when a person is also on social protective factors or Environment strengths can fall back on. In addition to a material basis (financial security for livelihood), important protective social factors are favorable infrastructural living conditions, a person of trust and, in particular, social networks (e.g. relatives or self-advocacy groups, neighborhoods, leisure clubs) if this is positive for the person concerned, for example be experienced as psychosocial relieving, emotionally holding, relaxing, stimulating and supportive.

On the resilience of autistic people

In working with people from the autism spectrum, the topic of resilience has so far been rarely addressed. This is presumably related to the assumption that autistic people can hardly develop resilience. A central aspect of the development of psychological resilience ("emotional resilience") relates to attachment experiences in early childhood (cf. Schore 2014). The experience of a reliable, secure, trust-building relationship within the framework of everyday interactions with at least one caregiver is seen as constituting resilience. In order to make such experiences possible, it depends on the sensitivity of the central reference person to perceive signals in the child's behavior, to understand them and to react appropriately to them.

In the case of autistic features, in particular the assumed dominance of the TPN, the perceptual peculiarities and the peculiarities in social communication, caregivers are undoubtedly faced with a great challenge to adequately recognize, interpret or understand the child's signals, behavior and experiences in order to be appropriate to be able to communicate (Rutgers et al. 2007). 

Autism therefore represents a risk factor with regard to developing a secure bond (cf. Grzadzinski et al. 2012, 86; Schore 2014, 6ff .; Sivaratnam et al. 2015). It is doubted, however, whether people from the autism spectrum, in view of their specific difficulties in interacting with other people and understanding social communication, generally lack a need to bond or develop an insecure bond that undermines the development of protective factors.

According to previous knowledge, no general statements on the quality of attachment and thus on the development of a secure attachment or attachment disorder in autistic children are permitted. There are empirical studies that have found no significant differences in terms of social behavior and reactions to separation situations between autistic children at the age of 24 months and non-autistic children of the same age (cf. Chandler & Dissanayake 2014; Grzadzinski et al. 2014). On the other hand, according to reviews by Sivaratnam et al. (2015, 225) and Rutgers et al. (2004; 2007), secure ties tend to occur less often in autistic children, whereby the reciprocity of the relationships, in particular the inner attitude and stress of the central caregivers, play an important role. There is also evidence that additional cognitive impairment (intellectual disability) is a risk factor for stable, secure attachment.

According to autobiographical reports, there are also people from the autism spectrum who report positive experiences in spite of typical autism-related abnormalities in their social behavior, who already felt an (emotional) reliability of a caregiver (mother) in their early childhood and were able to develop trust. It is undisputed that such early experiences promote resilience (cf. Schore 2014).

On the other hand, some people from the autism spectrum have had negative experiences, for example due to a lack of sensitivity, emotional rejection, ambivalent, irritating or even aversive, violent behavior, which have led to insecure or disorganized-disoriented forms of attachment behavior. At the same time, we would make it too easy for ourselves to deny autistic people the chances of developing resilience in this case. Such possibilities are not limited to early attachment experiences. Protective factors can also develop at a later point in time, whereby the role of cognitive abilities, special talents and the focus on special interests should not be underestimated. According to B. Schmidt (2015), the dominant TPN in autistic people results in a potential of skills (e.g. perseverance of thinking, enthusiastic perseverance and creativity in problem solving) that - if valued - for the development of resilience could be beneficial.

It cannot be that the "restricted repertoire of interests and activities associated with repetitive or stereotypical behaviors", which are said to be associated with autistic people, are associated with "abnormal" intensity or focus according to DSM-5 (cf. critical Theunissen 2016), represents resources that promote resilience? Can it not be that over the years traditional autism research has misunderstood the value of special interests and, with its deficit interpretation of the corresponding activities and with its devaluation of repetitive or stereotypical behaviors, has done far more harm than good to people from the autism spectrum? The following examples demonstrate that through an understanding view of autistic traits and behaviors, a rethink about autism appears urgently needed.

First of all - according to the autist N. Higashida (2013, 31) - it is important to recognize that people from the autism spectrum “think of things that non-autistic people do not think of, that do not interest them. That means that what we enjoy or what we like at the moment does not fit what the other is thinking of. We have special interests that we think about, that we also unwind in our memories and that we enjoy ... In what we think, however, non-autistic people cannot participate because they do not know what this is about ”.

This assumption is fully confirmed in many places in the very readable book "Der Funke" by K. Barnett (2014). Even in his early childhood, the autistic boy Jake Barnett was interested in light, shadow and geometric shapes. For hours he could “sit completely motionless and stare at a shadow pattern on the wall or on the floor without making a sound” (ibid., 48). From a functional point of view, this was already an expression of a scientifically exploratory behavior. In spite of all the irritations in his social behavior, Jake's sensitive mother had first intuitively, then clearly recognized "how important it was that we had not taken everything from him that he used for self-stimulation in those early years" (124).

Incidentally, O. Sacks also notes that early interests and focused behaviors can be subjectively significant when he writes in the foreword to Temple Grandin's book “Thinking in Pictures” (2006, XV) that she was highly concentrated and isolated from her in her early childhood The outside world spent hours paying attention to a few grains of sand and the patterns on her fingertips. According to O. Bogdashina (2010, 77ff.), Such behavior is an expression of “intellectual sympathy” in which a person is so gripped by something, especially attracted by its sensory stimuli and properties, “that it merges with it and becomes one "(Williams quoted in ibid., 77).

Experiences of this kind, in which things are explored in a sensory-intuitive way, through intensive, detail-focused viewing, but also through repetitive, stereotypical or excessive sniffing, touching, pressing, moving, knocking, turning, making noises, etc., serve to develop and Appropriation of the world. At the same time, they demonstrate a self-determined, exploratory behavior, perseverance and concentration as well as a devotion to one thing (see Amanda Bagg's YouTube video “In My Language”). Furthermore, they offer opportunities for communication with the environment, and they help to orientate oneself in the world and to feel safe. They can also pave the way for creative processes, for the further development of individual interests as well as for an in-depth discussion of special things, questions or topics. At this point at the latest, when it is possible to pursue individual special interests to develop performance motivation and specific skills (e.g. problem-solving skills), experiences of self-efficacy and control, as well as a "sense of coherence" (Antonovsky) the manageability, comprehensibility and meaningfulness of things in which the person concerned is interested.

All in all, within the framework of the outlined preoccupation with special interests, we are dealing with the development of a repertoire of strengths that are associated with resilience. Since the development of special interests or special strengths is an autistic characteristic independent of cognitive impairments (cf. Theunissen 2014), we can assume that there are fundamentally opportunities for all people on the autism spectrum to develop resilience in the course of their early life. Undoubtedly, this has received too little attention in autism research and when considering autism.

However, it is not enough just to appreciate the acquired repertoire, it must be examined more closely how it is used by a person concerned as a more or less successful coping strategy in challenging situations or events, beyond dealing with special interests. For example, does it help to relax, calm down or compensate for stressful situations that are not related to interests? The following examples show how we can imagine this:

“The most important thing in my life are books. Technical and non-fiction books on historical, economic or political topics. Those are my real passions, I put everything else on the back burner. When I feel bad, I don't go to the pharmacy, but to a bookstore "(Florian P., quoted n. Aspies e. V. 2010, 121). Also interesting is the remark by S. Wepil (2016) that as a toddler he “did not look at colorful picture books, but always books by Wilhelm-Busch and Zille with black-and-white pen drawings; probably because these images were very clear and therefore less stressful for the sensitive perception ”. Both examples show how valuable the appropriate handling of special interests can be: on the one hand in relation to the prevention of psychosocial stress, on the other hand to avoid stress in the face of increased perceptual abilities (vulnerability). Both strategies imply evaluation processes - be it consciously, be it intuitively reshaped.

Other forms of coping that arise from dealing with special interests or special abilities or are promoted by this are social withdrawal, looking for niches or situations that serve to calm down or relax.For example, T. Grandin (2006, 60ff.) Used her visual thinking to build a “squeezing machine” to prevent or compensate for stress.

What is also noteworthy is the "strategy of 'planned flexibility" mentioned by P. Schmidt (2013, 214), according to which, in addition to a plan A, there is not only a plan B, but also other pre-conceived scenarios, plans C, D, E and F gives ”. Since not every disorder or sudden change can be planned, he is also based on the slogan: “Take it as it comes!” The creation of such plans corresponds to the so-called systematisation ability of many people from the autism spectrum, which is often in When dealing with special interests comes into play. Furthermore, P. Schmidt's attempt to plan and accept the so-called “worst case” is also interesting. This speaks for a certain degree of cognitive flexibility, which autistic people are often denied.

For example, people on the autism spectrum often have difficulty getting interested in things beyond their special interest because their memory skills are only focused on their personal area of ​​interest. For example, someone interested in historical events is "far less able to record a poem than a list of historical dates" (Tammet 2010, 73). Some also find it difficult to transfer perceived situations or things learned to other, similar objects or contexts. T. Grandin (2008) also mentions the danger of over-generalization, in which fears “spread from the original trigger to other objects or situations that are actually harmless” (ibid., 248).

Stimming

Such fears are caused by the hyperfunctional amygdala (fear of change) in the course of the increased perception of differences or incidental matters (tiny details). This is where vulnerability comes into play, which creates stress and cannot be overcome by dealing with special interests alone. For example, an emotion-focused approach can be helpful, as shown by T. Mukhopadhyay (2005, 103): “I myself react more sensitively to people's attitudes. When I know that someone is watching me with curiosity, I feel uncomfortable. My body reacts to it immediately. I become hyperactive and wave my hands to at least partially vent my stress ”; and in another situation he tried to block out loud noises made by children “by waving his hands at a higher frequency” (ibid., 21). Self-stimulating or repetitive behavior thus has an important function that needs to be recognized. Autistic people speak in this context of so-called stimming, which, from a functional point of view, primarily serves to create a pleasant feeling, self-regulation, calming, relieving fear or stress and coping with negative emotions.

G. Vero (2014, 238) shows us how effective stimming can be, in addition to the possibility of physical forms of expression (e.g. rocking, flapping hands, repetitive knocking), which can be observed especially in autistic people with cognitive impairments , the mental strategy highlights: Mental stimming can be used anytime and anywhere, and it enables me to stand relatively calmly in front of my audience during my lectures, to look at people and to be able to speak to them. So while I am talking about my autism, I count back bilingually in my head or say leap years, count the ceiling panels or keep moving my toes in the shoes. This preoccupation with or concentration on known stimuli enables me to regulate myself in such a way that the stress that such a situation inevitably brings with it remains at a level that enables me to remain in the situation. Stimming, regardless of whether it is socially adequate or not, fulfills extremely important functions. It reduces the absorption of stimuli and thus prevents sensory overload. Only with the help of stimming is it possible for me to put myself in situations with other people. "

The following example of coping with overstimulation through mental stimming follows a similar path: “As soon as several people get together, I no longer know which conversation statements to follow. Too many stimuli crash into me. I always try to calm myself down through conscious breathing "(Carsten quoted n. Aspies e. V. 2010, 220).

Consequences for practice

To summarize, it can be stated that people from the autism spectrum often show a high degree of vulnerability, which extends to sensory stimuli and social situations, and creates fears and stress. Whether it comes to critical forms of coping through tantrums, short-circuit actions, panic-like reactions, self-harming behavior, external aggression, dissociative behavior or other psychosocial abnormalities is due to the interaction of vulnerability, given living conditions, subjective event perception and evaluation as well as the available individual and social protective factors . The fact that autistic people develop resilience and can use their own strengths and social resources to cope with stress should be beyond dispute according to the above. Traditional autism research has so far ignored these opportunities.

Resilience research, on the other hand, leads to a rethinking by no longer looking for failure, inability, deficits, problematic behaviors, misconduct or incompetence, but focusing on the question of how people succeed in spite of high vulnerability, critical or challenging life circumstances, To survive crises or stress and not to decompensate psychologically. A self-developed and used coping strategy of autistic people consists, for example, in stimming.

Of course, this optimistic and encouraging view should not hide the fact that people from the autism spectrum often find it difficult to use their available resources to cope with stressful situations, sensory overload or psychosocial problems. In addition, autistic people are often prevented from resorting to self-developed coping patterns. Furthermore, some are not even aware of their existing strengths, so that they are not used to solve problems. Others, on the other hand, have barely found opportunities in the course of their lives to develop individual protective factors or resilience to psychosocial coping because they have been subjected to a tightly knit norm adjustment through behavioral control measures. In addition, there is sometimes a lack of social protection factors or environmental strengths that can be used in critical situations. Furthermore, for some individuals on the autism spectrum, their autistic traits combined with vulnerability seem so overwhelming that they stand in the way of self-initiated development of resilience in terms of flexible temperament traits, impulse control, emotion regulation, and socially responsible or appropriate behavior.

Against this background, it is understandable when those affected refer not only to resources, but also to more difficult ways of compensating for stress as well as limited or inadequate coping strategies, which they relate above all to accompanying psychological disorders such as anxiety or depression.

In view of this, I would like to conclude with a look at the previous discussion and highlight seven central aspects that can be considered important from the perspective of those affected and with a view to educational options for successful stress management:

(1) Prevention of stress and psychological side effects (fears etc.)

The corresponding range of options is wide: it ranges from avoiding time pressure, reducing sensory stress through aids (e.g. colored glasses, earplugs), structured and visualized daily or work processes, timely transfer of information and preparation for changes or transitions, about creating opportunities to retreat, using niches for interest-related activities, resorting to social histories, special interests, acquiring and using relaxation techniques (e.g. autogenic training, meditation) or relaxation opportunities (e.g. walking a dog), "squeezing machine" at the right time Calming and relaxation, sensory integration for body awareness, active maintenance of a recovery time, regular (two to four days a week) sporting activities such as jogging or swimming up to group activities (e.g. drumming and singing together, team rowing, dancing ) to the A Initiation of intuitive synchronization and development of self-esteem, training programs for coping with stress, special aids for self-awareness and self-observation, self-developed forms of coping with stress or strategies (stimming), which were mentioned in the previous sections in the context of several examples.

In individual cases, with high anxiety-related crisis susceptibility, anxiety disorders or even stress, accompanying medicinal treatment can be helpful, which of course "cannot replace appropriate educational or social programs" (Grandin 2006, 131). As an alternative to psychopharmacotherapy, Thompson, Thompson and Reid (2009) favor prevention and intervention through neurofeedback, which they evaluate positively, particularly with a view to building and stabilizing the anterior cingulate cortex (including an instance for regulating emotions) in people with the so-called Asperger's syndrome to have. Similar to physical activities (e.g. jogging, swimming), neurofeedback must be used over the long term in order to be preventive.

(2) coping with stress

If a person is already in an unbearable stressful situation, there is also the possibility of making the situation more bearable through self-determined coping strategies, for example through a relaxation exercise, through stimming, through physically strenuous, especially sporting activities (jogging) a short break (change of room, walk), through an interest-related activity, through a relief offer from the aesthetic area (making music, listening to music, painting) or through the use of an "autistic card" (Vero), on which important process steps and information are recorded. If the person is unable to do this, assistance is required. The strategies mentioned can be used here, but special methods also seem helpful, such as the “paradoxical intervention” that G. Vero (2013) uses when her autistic, severely disabled son is in a stressful situation. The effectiveness of the method results from the fact that what is said by the intervening person must relate to (consciously) false (provocative) statements in the area of ​​the special interests of the autistic child or adolescent, so that the person concerned feels challenged to correct the answer. At that moment there is an interruption of the previous stressful situation, and there is a chance to shift attention based on interests.

(3) Offers of stress management training

are undoubtedly useful in order to be able to deal better with challenging situations or stresses. In terms of content, the focus is on psycho-educational programs, recognizing one's own resources, practical problem-solving techniques, relaxation exercises and cognitive strategies (e.g. problem awareness, rethinking, mental stimming) for self-management.

(4) The availability of a constant reference and confidant

is an important social protection factor. People you trust can act as so-called "buddies" or "godparents" (Preissmann 2012, 43), friends, siblings, neighbors, supporters, teachers, therapeutic forces, work colleagues, life partners, parents or grandparents. "What helped me a lot during these years (school days, G. T.) were my parents, especially my mother, who accompanied, supported, encouraged and comforted me" (Dietsch quoted in ibid., 23). Of course, friends or family members are not protective per se. They are only so if they are experienced as calming, reliable and emotionally supportive.

Sometimes it is difficult to establish and shape appropriate relationships. For this purpose, especially with a view to autistic people with severe communication impairments, non-directive, interest-stimulating approaches and the method of "mirroring" are recommended, for example by talking about special interests, strengths, preferred things and games of autistic people (arranging, sorting of pearls, puzzles ... ) Contacts are initiated and relationships are established (cf. Theunissen & Schubert 2010, 143f .; Williams 1994, 274). 

(5) social networks

also have a protective function if they are experienced by their members as emotionally holding, protective and supportive. This also applies, for example, to critical and constructive feedback on one's own behavior, which some autistic people want. It is therefore important to promote self-advocacy or self-help groups as well as informal networks through neighborhoods, clubs, shops and people in public life.

(6) Education and information about autism as a form of human being

is essential and cannot be overestimated to understand the behavior of an autistic person or to prevent misunderstandings, incorrect reactions, crises and critical situations (teasing, bullying). Such discussions and corresponding consultations should take place above all in living environments and social systems in which non-autistic people are committed to inclusion or are obliged to work together or live together (children's group, school class, workplace). Ultimately, it is crucial to sensitize non-autistic people to accept people from the autism spectrum in their being (including their increased vulnerability) and to support them in such a way that they can realize their lives in a satisfactory way.

(7) Requirements for the professional support staff

In order to be able to take into account the aspects outlined above, a target group-related professionalization of the support persons is required. First of all, it is important to understand autism as a form of human being and, if necessary, to say goodbye to pathologization.

With regard to coping with stress and crises, suggestions by J. Janzen and C. Zenko (2012) offer valuable help. Your program is based on the functional problem view and implies on the one hand short-term help for prevention or crisis intervention and on the other hand long-term positive behavioral support for autistic people. In order to be able to support or intervene professionally, knowledge of the functional significance of stress and autistic behavior, of the course of a crisis, of a functional assessment and of forms of intervention in the sense of the concept of positive behavioral support, in particular of context-changing and behavior-building measures, is essential considered (inquiries about relevant training courses: [email protected]). In addition, there are specific competencies, for example in relation to the early recognition of behaviors that signal increasing stress or an impending crisis. In order to be able to correctly assess such "early warning signs", precise knowledge of the person's behavior is required, especially his communicative forms of expression, since the early signs are often "subtle communication signals" (ibid., 113f.).

In addition, general and special rules of conduct (assisting aids) for the prevention and intervention of crises are mentioned (e.g. taking a calm demeanor, taking back requirements, reinforcing behavior that is problem-solving, giving small help or tips, providing "translation assistance" for Encourage self-help ...), which should be used in a controlled and professional manner (precisely tailored) in a specific situation. Ultimately, however, it also depends on the personality of the specialist - no matter how good a program is, if the support person lacks empathy, sensitivity, tact, diplomacy, creativity or flexibility, the chances of helpful support are rather low.

literature

Antonovsky, A. (1997): Salutogenesis.To demystify health, Tübingen

Aspies e. V. (Ed.) (2010): Cracks in the universe, Berlin

Barnett, K. (2014): The spark. The story of an autistic boy who showed everyone, Munich

Bogdashina, O. (2010): Autism and the Edges of the Known World, London (Jessica Kingsley)

Chandler, F .; Dissanayake, C. (2014): An investigation of the security of caregiver attachment during middle childhood in children with high-functioning autistic disorder, in: Autism, Vol. 18, 485-492

Fingerle, M. (2011): The vulnerability of the resilience concept - and its benefits, in: Sonderpädagogische Förder heute, Vol. 56, 122–135

Garmezy, N. (1991): Resiliency and Vulnerability to Adverse Developmental Outcomes Associated With Poverty, in: American Behavioral Scientist, Vol. 34, 1991, 416-430

Gerland, G. (1998): Be a real person, Stuttgart

Grandin, T. (2006): Thinking in Pictures, London (Bloomsbury) (2nd ed.)

Grandin, T. (2008): I see the world like a happy animal, Berlin

Grzadzinski, R. L. et al. (2014): Attachment in young children with autism spectrum disorders: An examination of separation and reunion behaviors with both mothers and fathers. In: Autism, Vol. 18, 85–96, online: DOI: 10.1177 / 1362361312467235 (accessed: June 24, 2015)

Higashida, N. (2013): The Reason I Jump. The Inner Voice of a Thirteen-Year-Old Boy with Autism, New York (Random House)

Janssen, C. G. C .; Schuengel, C .; Stolk, J. (2002): Understanding challenging behavior in people with severe and profound intellectual disability: a stress-attachment model, in: Journal of Intellectual Disability Research, Vol. 46, 445-453

Jack, A.I. et al. (2013): fMRI reveals reciprocal inhibition between social and physical cognitive domains. In: NeuroImage Vol. 66, 385–401, online: DOI: 10.1016 / j.neuroimage.2012.10.061 (accessed: June 25, 2015)

Janzen, J. E .; Zenko, C. B. (2012): Understanding the Nature of Autism, Austin, TX (Hammill Institute on Disabilities) (3rd ed.)

Klicpera, C .; Innerhofer, P. (1999): The world of early childhood autism, Munich (2nd modified and expanded edition)

Lazarus, R .; Folkman, S. (1984): Stress, appraisal, and coping, New York (Springer)

Markram, K .; Markram, H. (2010): The Intense World Syndrome - a unifying theory of the neurobiology of autism, in: Frontiers in Human Neuroscience, Vol. 4, 1–29 (online: www.frontiersin.org)

Monk, C.S. et al. (2009): Abnormalities of intrinsic functional connectivity in autism spectrum disorders, in: Neuroimage, Vol. 47, 764-772

Mottron, L. (2014): Enhanced Perceptional Functioning, in: Theunissen, G. et al. (Ed.): Handlexikon Autismus-Spektrum, Stuttgart, 119–121

Mukhopadhyay, T. R. (2005): The day I found my voice An autistic boy tells, Reinbek

Nitsch, J.R. (1981): Stress - theories, studies, measures, Bern

Preißmann, C. (Ed.) (2012): Asperger's - life in two worlds. Those affected report: That helps me in my job, partnership and everyday life, Stuttgart

Rubenstein, J. L. R .; Merzenich, M. M. (2003): Model of autism: increased ratio of excitation / inhibition in key neural systems, in: Genes, Brain and Behavior, 2, 255–267

Rutgers, A. H. et al. (2004): Autism and Attachment: A Meta-analytic Review, in: Journal of Child Psychology and Psychiatry, Vol. 45, 1123–1134

Rutgers, A. H. et al. (2007): Autism, Attachment and Parenting: A Comparison of Children with Autism Spectrum Disorder, Mental Retardation, Language Disorder, and Non-clinical Children, in: Journal of Abnormal Child Psychology, Vol. 35, 859-870

Sacks, O. (2000): An anthropologist on Mars, Reinbek near Hamburg

Schmidt, B. J. (2015): Autism and Society. An angry change of perspective. Volume 2: Help for people with autism? Norderstedt (Books on Demand) (quoted after uncorrected preliminary version)

Schmidt, P. (2013): The boy from Saturn, Ostfildern

Schore, A. N. (2014): Early interpersonal neurobiological assessment of attachment and autistic spectrum disorders. In: Frontiers in Psychology, Vol. 5, 1–13, online: 5. DOI: 10.3389 / fpsyg.2014.01049 (accessed: June 25, 2015)

Schuster, N. (2007): A good day is a day with savoy cabbage, Berlin

Sivaratnam, C.S. et al. (2015): Attachment and Emotion Processing in Children with Autism Spectrum Disorders: Neurobiological, Neuroendocrine, and Neurocognitive Considerations. In: Rev J Autism Dev Disord 2, 222–242, online: DOI: 10.1007 / s40489-015-0048-7 (accessed: June 25, 2015)

Smith, A. (2009): The Empathy Imbalance Hypothesis of Autism: A Theoretical Approach to Cognitive and Emotional Empathy in Autistic Development, in: The Psychological Record, Vol. 59, 480-510

Supekar, K. et al. (2013): Brain Hyperconnectivity in Children with Autism and its Links to Social Deficits, in: Cell Reports 5, Nov. 14, 738-747

Tammet, D. (2010): Cloud Jumper. Learning from a genius with autism, Munich

Theunissen, G. (2014): People on the autism spectrum. Understand, accept, support. A textbook for practice, Stuttgart

Theunissen, G. (2016): Understanding Autism: Outside Views and Inside Views. Stuttgart

Theunissen, G .; Schubert, M. (2010): Strong art by autistic people and savants, Freiburg

Thompson, L .; Thompson, M .; Reid, A. (2009): Functional Neuroanatomy and the Rational for Using EEG Biofeedback for Clients with Asperger’s Syndrome, online: Springer Science + Business Media, LLC Appl Psychophysiol Biofeedback DOI 10.1007 / s10484-009-9005-0 (accessed: June 16, 2013)

Vero, G. (2013): “Autism from the point of view of an affected person”, unv. Lecture and Powerpoint presentation to students of rehabilitation education at the chair “Mentally handicapped pedagogy and pedagogy for autism”, Philosophical Faculty III, Education, Martin Luther University Halle-Wittenberg on June 16, 2013

Vero, G. (2014): Compensation strategies, in: Theunissen, G. et al. (Ed.): Handlexikon Autismus-Spektrum, Stuttgart, 237-239

Weng, S.-J. et al. (2010): Alterations of resting state functional connectivity in the default network in adolescents with autism spectrum disorders. In: Brain Research 1313, 202–214, online: DOI: 10.1016 / j.brainres. 2009.11.057 (accessed: June 25, 2015)

Wepil, S. (2016): Focused thinking and pronounced interests in special areas - the strengths perspective, in: Theunissen, G. (Ed.): Autismus im Dialog. External and internal views, Stuttgart

Williams, D. (1994): I could disappear if you touch me Memories of an autistic childhood, Munich

Zöller, D. (2001): Autism and Body Language, Berlin

 

 

Georg Theunissen, Prof. Dr.

Chair for mentally handicapped pedagogy and pedagogy for autism, Institute for Rehabilitation Pedagogy, Philosophical Faculty III, Educational Sciences, Martin Luther University Halle-Wittenberg, 06099 Halle

[email protected]