Introduction

In this third episode of "A Gentle World from the Perspective of Children with Developmental Disabilities," I will explain about children with autism spectrum disorders (ASD) and the world surrounding them. It is important to think about what we, as adults, can do for children with developmental disorder tendencies because the world seen through the eyes of these children is palpably different from the one seen through the eyes of adults. To support children with ASD, considering their standpoints, we should adequately understand their behavior patterns and feelings, based on their respective characteristics. In this episode, I will discuss how we can understand and help children with ASD tendencies, based on my research studies and school counseling experiences.

As I have mentioned in the previous episode, children with ASD will likely develop secondary symptoms if we fail to provide appropriate environments for them. I will first explain the characteristics of secondary symptoms typically associated with children who have ASD. Then, I will introduce one case study describing the behavior patterns of a child with ASD and his peers at school and the viewpoints of each of the children, parents, and the supervising teacher. I hope this episode will help the readers deepen their understanding of children with ASD.

ASD characteristics and secondary symptoms

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association，2013) integrates conventional terms of "autism," "high-functioning autism," and "Asperger syndrome" into "autism spectrum disorder (ASD)". The word "spectrum" means a continuous sequence, which implies that whether or not the person has the characteristics of ASD is not based on clear standards, but is based on a gradual scale of continuity (Kamio, 2017). In addition, their behavioral patterns will be affected by interactions with the surrounding environment (Nakanishi & Iida, 2014). Such an expression pattern caused by the interaction between genes and environment is called a "multifactorial disorder" (Neuman et al.，2007).

According to the DSM-5, which is used for diagnosis, the characteristics of ASD are roughly divided into the following two categories:

• Deficits in social communication and social interactions
• Restricted, repetitive patterns of behavior, interests, or activities

The first category of "deficits in social communication and social interactions" includes the following characteristics:

• Deficits in social-emotional reciprocity, reduced sharing of interests, emotions, or affect (for example, to have casual conversations and respond to social interactions)
• Deficits in nonverbal communicative behavior patterns used for social interaction (such as body language and hand gestures)
• Deficits in developing, maintaining, and understanding relationships

The second category of "repetitive and restricted behavior and interest patterns" includes the following characteristics:

• Repetitive behavior and speech patterns, use of unique phrases and descriptive words
• Insistence on sameness, inflexible adherence to routines
• Restricted or fixed interests, hyperreactive or hypesthesia to sensory stimuli (such as sound, light, and texture)

As I have explained in the previous episode, considering these developmental characteristics as core symptoms, secondary symptoms are disorders acquired due to environmental factors. Secondary symptoms can be roughly classified into "secondary problems" and "secondary disorders." In the case of ASD, for example, secondary problems include physical problems (such as headaches, abdominal pains, inappetence, and tics), mental problems (such as anxiety, dysphoria, school absenteeism, and social withdrawal), and behavioral problems (such as verbally abusive language and violence). Meanwhile, secondary disorders include panic disorder, anthrophobia, attention-deficit hyperactivity disorder (ADHD), specific learning disorder (SLD), depression, anxiety disorder, developmental coordination disorder (dyspraxia), epilepsy, sleep disorder, and avoidant/restrictive food intake disorder (extreme picky eating).

Then, how can we support children with ASD to avert the occurrence of secondary symptoms? First of all, we should try to understand how children with ASD characteristics would feel and think in situations they encounter every day. However, it does not sound so easy, especially when they participate in group activities with peers.

A brief squabble between children during break time

When I visited a classroom of fifth graders at an elementary school, I happened to notice a small quarrel between some children.

"Can you move your desk a bit further?"
"No!"

This quarrel occurred at the end of the third period. The class teacher told the children to divide into several groups and organize their desks by group before the fourth period started.

"Can you move your desk over nearer to the window side?"

The children had already formed groups of four, facing each other in pairs at the rear half of the classroom. But one group was stuck in a narrow space sandwiched between the other groups, and two students could not turn their desks around to fit in that small space to form their group. One of them was Maki, who asked Takuya to move further because she couldn't fit her desk in. Even to my eyes, Takuya's group, which should have been located near the window side, was too close to the center of the room. So, Maki asked Takuya to move back to the window side, while the teacher called out, "Move your desks into groups, quickly!"

However, Takuya immediately replied, "No!" Maki said, "What? Please move back to the window side." Then, Takuya said again, "No!" Finally, Maki gave up trying to persuade Takuya to do what she asked, muttering, "Why... you are too close to the center..." and asked the members of the corridor-side groups to move their desks further. These children fell silent for a moment. They probably thought, "Why should we move to the narrower space? It is the window-side group who is wrong; they are too close to the center!" However, when they looked at the members of the window-side group, they seemed to understand the situation. They moved their desks as close to the wall as possible without saying anything.
The teacher did not notice this event as she was too busy preparing for the next class and talking to other students near the blackboard.

Now, let us look at this situation from the viewpoints of children, the teacher, and parents.

Maki's viewpoint

Maki probably thought Takuya would understand the situation immediately when she asked him to move his desk closer to the window to make enough space for her. The space occupied by the corridor-side groups, consisting of eight children, was already narrow. To make enough space for her, they all had to move their desks further from the center of the room. In contrast, the window-side group, consisting of only three children, including Takuya, occupied a wider space close to the center of the room. Therefore, it was reasonable for Maki to ask Takuya to move back to the window side. However, Takuya immediately rejected her requests, twice. Maki's words, "Why... you are too close to the center..." clearly indicated her confusion.

I could see her confusion and frustration, but Maki gave up with arguments and asked the members of the corridor-side groups to move. This small incident occurred due to Takuya's unreasonable rejection of moving. It was seemingly resolved at the expense of other children's frustration and surrender.

Takuya's viewpoint

For other children, it is natural to think that "Takuya's group is too close to the center of the room" and "his group has only three members so that they can move quickly." Nevertheless, Takuya was angry. Later, I tried to ascertain the reason for his anger.

I assume that Takuya might have thought this way:

"What is she talking about? We already set up a group and properly positioned our desks. Why can't she ask other groups? Why does she always come to me?"

Takuya could not understand Maki's intention and felt angry with her because "she only asked me and not others several times!" under the situation where either of the other two groups had to move their desks. Takuya might have thought Maki did not care about his feelings at all, so he was upset and immediately rejected her requests.

Teacher's viewpoint

After this incident, I had an opportunity to talk with the supervising teacher. I explained the incident to her from the standpoints of both Maki and Takuya.

"I have noticed Takuya sometimes has trouble with friends. It seems that his difficulty in understanding friends' feelings causes such trouble. Fortunately, some children have known him since daycare center, and all the children in the class understand his characteristics and probably do not care too much about these incidents. I try to explain to him the feelings of the opposing children whenever possible. Every time, Takuya replies," I understand," but the same thing happens repeatedly. So I have no idea what to do with him. I'm also worrying about his future in junior high and senior high school. I wonder whether people there will understand him appropriately..."

Parent's viewpoint

The following is what Takuya's mother commented to the teacher when she heard about the incident:

"Teachers have told me several times that my son causes trouble with classmates because he can't understand their feelings. But I think it is natural for children to quarrel. They will learn something through quarrels. In the first place, it is not appropriate for adults to determine who is right and who is wrong in children's quarrels. I understand my son may be wrong from time to time, but every time a quarrel occurs, why is it always my son who is judged as wrong? I want an unbiased judgment."

It seems that the accumulation of small matters caused quarrels between Takuya and his classmates. When I interviewed people with ASD characteristics in my counseling sessions, almost all of them said, "Honestly, I want to make friends," and "I wish I could have a close friend with whom I can talk openly."

Based on my counseling experiences, I recognize their friendship trouble is quite serious. They cannot talk openly with anyone. Therefore, we, adults, should carefully listen to the feelings they cannot express and think it through together about how to solve their problems. This will be the first step forward. By supporting them step by step in building trusting relationships with others, they will gradually become able to build a desirable friendship.

This is a major challenge for adults who are interacting with children with ASD.

References

• Kamio, Yoko. 2017. "Jihei supekutoramusho no ekigaku - soukishindan shien ni mukete [The epidemiology of autism spectrum disorder: early diagnosis and support]". Seishinka Rinsho Legato, 3 (3): 132-136.
• Nakanishi, Yoko & Iida, Junzo. 2014. "Attention deficit hyperactivity disorder." Kanba,Shigenobu. (chief editor)，Kamio,Yoko (editor)．Interpretation of DSM-5 vol.1: Psychiatric diagnosis of a new era based on traditional psychopathology, DSM-IV, and ICD-10, relating to neurodevelopmental disorder, feeding/eating disorders, excretory disorder, disruptive, impulse control and conduct disorders, and suicide. 75-85. Tokyo: Nakayama Shoten.
• Neuman, R. J., Lobos, E., Reich, W., Henderson, C. A., Sun, L. W., & Todd, R. D. 2007. "Prenatal smoking exposure and dopaminergic genotypes interact to cause a severe ADHD subtype". Biological psychiatry, 61, 1320-1328.
• American Psychiatric Association. 2014. "DSM-5 Seishin shikkan no shindan toukei manyuaru [Diagnostic and Statistical Manual of Mental Disorders 5th edition]." (Translation supervisors: Saburo Takahashi & Yutaka Ohno; translators: Toshiyuki Someya, Shigenobu Kanba, Norio Ozaki, Masaru Mimura & Toshiya Murai). Tokyo: Igakushoin.
• Sunami, Naomi. 2022. Hattatsu shougai keikou no aru kodomo no ibashokan jikokouteikan wo hagukumu kakawari [Interpersonal interactions that nurture a sense of belonging and self-esteem among children with developmental disorder tendencies]. Tottori: IMAI PUBLICATION.