The Case of henry Smith: Part two
With respect to Henry's development of collaboration skills, he is capable of contributing as a partner or group member in the formulation and attainment of common goals only when he is in agreement with his partner’s perceptions, ideas, and preferences. He is also capable of collaboratively negotiate roles and organizing role relations, but can only do so if he is in full agreement with his partner or the group as a whole. Henry has a very difficult time finding a common ground for sharing and integrating perspectives, ideas, memories, and feelings. He also struggles to balance his personal needs with larger group needs when he is in conflict with the group.
As is been noted in previous reports Henry has yet to develop a visual field of communication. Henry relies exclusively on spoken or verbal communication in order to understand relationships. Henry does not take in nonverbal communication and thus misses significant information/data. Henry does not focus on facial expressions, gestures, body position, or prosody. He simply focuses on words and has a very narrow definition of the meaning of words. Henry does not check to determine the nonverbal reactions of his peers to assess the appropriateness of his conduct, nor does he scan his environment to determine the emotions of social partners so that he can take appropriate action.
Recreation/leisure skills remain a profound problem for Henry. As is the case with so many high functioning autistic teens, he relies on his family for socialization and focuses on areas of special interest when he is with his family. The degree to which Henry is able to maintain his emotional equilibrium and derive pleasure from engaging with his family engaged in areas of special interest creates an obstacle to engaging in recreational/leisure activities that contribute to a sense of belonging to a social community. Since Henry continues to engage within a very limited sphere of socialization, he does not participate in recreational activities that contribute to his self-esteem.
Henry is certainly old enough and sophisticated enough in his thinking to be able to conceptualize barriers to community integration, but due to the fact he is content with his current recreational framework, he has yet to develop the kind of self-awareness that is necessary for change. Henry has certain skills in place such as the capacity to identify an appropriate peer, plan an activity that would accommodate appears interests, as well as make contact with a peer independently. The difficulty for Henry and his family is that he lacks motivation to utilize his skills. As he has grown older, his motivation has decreased. The speed and complexity of adolescent peer interaction overwhelms him. His coping mechanism is to withdraw into his family and rely on his family for socialization opportunities. It is truly unfortunate that Henry has cut himself off from friends that he had in middle school. Friends often attempt to reach out to Henry, but his anxiety, lack of social motivation, and ritualistic patterns of behavior create a barrier. Henry is popular within our socialization program and is sought after when group ends, but Henry consistently comes up with reasons why he is unavailable and then retreats to the safety of his family.
Henry represents one of many teens within our group program who has found a way to protect himself from the emotional consequences of social isolation. By remaining connected to his mother and father, and by remaining focused on areas of special interest, Henry can effectively protect himself against loneliness, rejection, and social anxiety. Although these emotions are certainly painful and difficult to manage, they also create a level of discomfort that can produce the willingness to take risks and make changes.
Henry's capacity to find meaningful community integration continues to be a problem that requires ongoing support and guidance. Henry is capable of approaching a group of peers in a school setting, but has great difficulty being flexible and receptive to new activities that would serve to increase his community integration. Likewise, Henry continues to have problems minimizing discussion of areas of special interest and continues to be reliant on electronic forms of entertainment rather than community-based outings. On an intellectual level, Henry understands the importance of being in community-based groups, of planning community based activities, and independently initiating community-based interactions with his peers. However, Henry is fearful and overwhelmed by the complexities of interacting with peers in community-based settings and as such he opts to withdraw and remain in a protected state with his mother and father.
Henry's parents continue to have significant difficulties motivating him to expand his recreational range of interests and increase his community involvement. Henry's parents continue to have difficulty understanding the core deficits of autism as well as Henry's struggle with obsessive-compulsive disorder. To make matters more complex, from a cultural perspective, it is spending time with family on the weekends is consistent with their norms and values. As a member of a collectivist culture, they do not see Henry’s independence as an essential part of his maturation. Although the consequences of long-term isolation from his peers has been discussed and reviewed with his parents, they continue to have difficulty setting limits with Henry and requiring him to leave the safety of his family and to explore his broader social community.
Additionally, Henry parents, like so many parents of teens with ASD, simply do not know how to effectively cope with the emotional fallout from setting limits. Henry’s parents do not know how to motivate him to engage with peers or engage in novel activities. When Henry becomes resistant and avoidant, he shuts down and refuses to talk or negotiate and becomes resistant to their guidance if they pursue the issue of recreational outings with peers. Henry's focus and dependence on electronic entertainment, particularly films, represents a barrier that his parents have not been able to remove or decrease.
It is difficult to overstate the degree to which teens like Henry are dependent on self isolating behaviors that deliver high degrees of pleasure. Teens like Henry can anesthetize themselves from negative affective states such as loneliness, rejection, and alienation by remaining close to home and by engaging in repetitive and pleasurable electronic activities. When Henry is confronted in group sessions about his behaviors of self-isolation, he states he is content watching films and spending time with his family. Henry will argue the point that spending time with his family is positive and rewarding and therefore he does not need change his routine. Henry will also argue he sees his friends at school and, therefore, does not see any point in seeing the same friends on the weekend. Henry also states that on the weekend he is tired and wants to relax, which means being plugged into electronic entertainment while spending time with his parents.
Henry has an extraordinary knowledge base with respect to film history and popular culture. This knowledge base is often seen by adults within his environment as a strength that will serve him well as he develops. In fact, Henry's “inch wide mile deep” knowledge base does not serve him currently nor will it serve him in the future. The acquisition of static knowledge only perpetuates static thinking, static behavior, and social isolation. For Henry to truly experience new activities, which would in turn stimulate new brain activity, he would need to be placed in new and challenging environments. He would need to be presented with opportunities for cognitive and emotional discoveries and growth. Henry’s parents are willing to accept that he needs to expand his horizons, but they do not know how to motivate Henry to move past his long-standing patterns of thinking and behavior.