Thursday, 26 January 2017

What the..? - A Sherlock Autism Mystery

Over the last few days, Alex's behaviour has drastically deteriorated.  He's headbanging, bolting, whining, taking/doing things compulsively that he's not supposed to.  It's at school and at home (but not, curiously, in the van).

My first thought is that something is bothering him, that perhaps he's getting sick.  He can't always tell us when his head hurts or something like that.  But there's no fever, no swollen glands and no other sign of illness.  Giving him a painkiller doesn't make any difference.

Next thought, maybe something sensory bothering him.  A buzzing light, a prickly clothing tag, a rough spot in his shoes, all of these have triggered behaviour bursts in the past.  But I can't find any sign of something I know to be a trigger.  So either it's a new trigger (unlikely and difficult to find or prove) or that's not it.

Okay, has there been a shift in his environment?  This one is trickier because things are always changing and it's almost always a combination of things.  His grandparents are away, he's due to have a substitute teacher today, we had a snow day on Tuesday... that doesn't seem like enough to trigger this level of problem but it can't be ruled out.  It also can't be fixed, which makes this a useless conclusion.

Is he frustrated?  He hasn't been earning rewards for behaviour or toileting lately.  Rather than 3 screentimes, he's usually only earning one.  And he hasn't had a successful BM in the toilet for over a month, meaning no trip to Montreal on the horizon.  Again, not much I can do about that if this is the triggering problem.  To be effective, the rewards have to be consistent.  And the timing doesn't match up.  If this was a gradually building up behaviour problem, then this would be a more likely answer, but it's really dropped out of the blue.

This is the challenge in figuring things out for Alex.  Not only do we have to look at a wide variety of possible causes, but we also have to be careful to evaluate them realistically.  It's like a differential diagnosis (for House fans).  We can't just find what matches the symptoms, we also have to make sure that all of the expected symptoms for a particular cause are there before we make a diagnosis.  And we need a diagnosis before making any changes or else we risk making the situation worse.

This particular Sherlock Holmes level mystery isn't presenting itself with any solutions as yet.  And unlike in fiction, we may never know what the actual answer was.

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