5 Obsessional and ritualistic behaviours
USING OBSESSIONS
Although obsessional behaviours may, if not adequately controlled, become the source of considerable disruption, they can play an important role in providing the person with autism with comfort, self-occupation or entertainment, which, because of their lack of other creative, social or imaginative skills would be almost impossible to obtain by other means. Longer-term outcome, too, can be positively affected by the way in which obsessional interests develop. Leo Kanner, in his 1973 follow-up of young adults with autism, found that many of those who had made most progress had done so via their obsessional interests. Special interests in music, memory or mathematics had, in a significant number of cases, led to the development of valuable work-related skills; others with a fascination for topics such as chess, history, politics or transport, succeeded in building a range of social interactions around these.
Asperger, too, reports on cases where early obsessions led to later success in life. For example, one individual with a childhood fascination with mathematics subsequently became an assistant professor in a university Department of Astronomy, despite severely impaired social skills, after having proved a mathematical error in Newton’s work.
Similarly, in a London-based follow-up of young adults (Goode, Rutter and Howlin, in preparation) several individuals who had done particularly well had made use of their earlier obsessions. Danny had, ever since he was a small child, been fascinated by angles and directions and from about the age of 3 his drawings consisted almost entirely of room plans or the angles made by doors or furniture. By his mid-twenties he was successfully employed in a cartographer’s office and despite some problems was a popular member of staff. His popularity was also enhanced by his input to the company’s sporting team, because of his remarkable skills in orienteering. Maurice, who had been fascinated with collecting scientific facts from an early age, had managed to obtain a Master’s degree in chemistry and was currently working as a scientific officer for a major chemical company.
From a personal point of view, Temple Grandin (1995) also stresses the value of using obsessional interests.
Fixations are powerful motivators. It is a mistake to try to stamp out fixations… When I was in high school many of my teachers and psychologists wanted me to get rid of my fixation on cattle shutes… I have made a successful career based on my fixation with cattle squeeze shutes. I have designed livestock handling systems for major ranches and meat companies all over the world.
Even if special interests do not lead to occupational success they can play an important role in developing hobbies or other activities to fill otherwise empty hours. Clara Park, writing of her daughter Jessy, tells of how her unusual artistic skill was put to little use until she discovered that it brought her money, one of the few items she did have a particular interest in. Although art for art’s sake held little meaning for her, art for money’s sake did, and by the age of 20 painting and drawing had become an important and fulfilling part of her life. Many other people find their obsessional activities a source of comfort if they are anxious, or tired, or have to cope with novel or stressful experiences. Others use their obsessions in order to relax. Jonah, who works as an accounts clerk in a busy company, spends an hour or so at the end of each day at his local railway station, collecting train numbers. Caroline, who was always fearful of the dark when younger, now reports that it is much easier for her to sleep if she has managed to watch the moon in the sky for half an hour or so on clear nights.
Obsessions can also offer support at times of severe stress or loss.
Dennis, who worked for his father in their small family firm, was the victim of a vicious attack, in which both he and his parents were shot and wounded. Although unable and unwilling to talk about his
suffering or fears after this incident, his obsession with collecting and drawing a particular make of old-fashioned radio clearly gave him some relief. Over time his desire to talk about his obsession over-rode his avoidance of social contacts and eventually it became possible for him to make some use of professional counselling.
Sometimes, too, obsessions may serve to reduce anxiety as well as proving productive in other ways. Temple Grandin first constructed a
‘squeeze machine’ to reduce her own anxiety and obsessional fears but this later became the basis for her later, and highly successful, cattle restraining devices, which have won acclaim in the field of animal psychology.
Finally, particularly for less able individuals with autism, whose range of interests and abilities may be very restricted, the opportunity to indulge in obsessional activities can be an important means of increasing other skills. David Premack, in 1959, was one of the first psychologists to show that the use of ritualistic, obsessional, or other apparently meaningless activities, as a reward for more appropriate behaviours, may be a very effective strategy in increasing behavioural repertoires. Since then many other studies have shown how stereotypic, obsessional or attachment behaviours can be used to increase more constructive activities in people with autism. (Wolery, Kirk and Gast, 1985; Sugai and White, 1986).
Whilst such strategies do not aim to eliminate obsessional or ritualistic behaviour, they can be highly effective in reinforcing and encouraging short periods of alternative behaviours, with the result that the obsessions themselves gradually diminish in frequency or intensity.
As the examples above illustrate, dealing with obsessions and routines is by no means an easy task and successful interventions will require time, patience and often the implementation of several different strategies in tandem. The principal guidelines for success, however, are early intervention; a graded approach to the introduction of change; the provision of a more appropriate or stimulating environment in order to encourage other activities; the establishment of basic rules about where, when, with whom or for how long ritualistic or obsessional behaviours may take place. The aim should generally be not to remove the obsession entirely but to ensure that the behaviour no longer intrudes in a distressing or unacceptable way into the life of the person with autism or that of his or her carers. Once an acceptable level of control is reached, obsessional behaviours or interests may actually have many beneficial effects.