David’s Story

David was transfixed. He stood still and the room was silent except for the faint licking sound, if you listened carefully. He stood a few feet away facing me but wouldn’t let me come near. I moved a step closer. He moved a step away. He avoided physical touch and closeness for the most part. With the exception of his mother, with whom he had a very special rapport, he remained what could appear to be aloof to his family and therapists. David was 9 years old and diagnosed with severe autism. He was non- verbal and lacked the social skills to interact in any meaningful way. He had no language with the exception of one particular word, “chips”, which he used ubiquitously to mean everything from “food” to “go away” to “yes” and “no”. “Chips!” He was tall and lanky with noticeably slouched shoulders and held his jaw slightly too forward.

His fix was intense. He looked serious and anxious. Although he wouldn’t look in my eyes, he followed my every step and didn’t turn his back on me for even a second. Yet, we remained completely disconnected. For much of the day, David was fully engaged in his unique repetitious behaviour. He would hold his fingers right up to his mouth, almost touching his lips, and alternate between licking and blowing just on the tips of his fingers. David had spent so many hundreds of hours doing this over and over that the tip of his tongue darted in and out so quickly you had to look for it to see it. He moved his hand across his lips from right to left and back again, as if he was playing a harmonica, licking and blowing each individual finger tip. By any measure, it looked obsessive and compulsive like he had no choice but to do this. David’s family was extremely warm and caring. They had chosen to get training and support from the Son-Rise Program® in Massachusetts because the fundamental positive attitude of acceptance and hope which the staff teach was aligned with how the family wanted to treat David. His mother was particularly devoted to her son’s wellbeing. She followed the Son-Rise Program’s strategies to try and improve David’s social skills. These started with a commitment to not judge his repetitious licking behaviour and by a technique called Joining. Rachel, her husband, and David’s therapists were supported by Son-Rise trainers to discuss any negative feelings they had about his aloof and unusual behaviours. Rachel practiced acceptance and patience that allowed her to remain hopeful and willing to try again each day with David, even during the most difficult times when he retreated and completely shut her out. She was extremely grateful to have found a treatment center that not only taught her educational strategies for her son, but also supported her and the family through the stresses and intensity of running a home-based program.

The family had decided to not see the finger licking and blowing as bad. They believed David was doing it for a reason. Accepting the behaviour doesn’t mean they just sat back or walked away, however. The Son-Rise trainers taught them a technique they call Joining that helps to gain more eye contact, better joint attention and promotes imitation skills. The idea of Joining is to do exactly what the child does in his repetitious rituals. As if they were a mirror, they would copy David’s behaviour. When he raised his fingers to his mouth, they did the same with their fingers. When he started to lick and blow his fingers tips, they did too. They did this for months and months. The therapists practiced for so many hundreds of hours with David that they got in perfect synch; Starting when he started and stopping when he stopped, like it was pre-choreographed. Sure enough, like the research shows 1,2, Joining built social-rapport. It led to even more eye contact and he allowed the therapists to stand closer. It seemed they had formed more trust by allowing David the freedom to do the behaviour and seeing therapists sincerely “join” in.

After several months of Joining him, David was less anxious and smiled more often. The family was hopeful. Working as a Son-Rise Program Family Trainer at the time, I spent several days with Rachel and the therapist team which included a few one-on-one sessions with David. One of the benefits of doing what someone else is doing is you get to learn more about it. When I joined David by licking and blowing on my own finger tips, I suddenly became aware of the cooling sensation I created by first touching my tongue to a finger tip and then blowing some air over it. Through my own experience of actually doing it, the behaviour was transformed from unusual and purposeless into a sensation I could relate to. It felt cooling. Why was he doing this? What purpose could the behaviour serve?

Later that evening, I sat alone reflecting on my experience of Joining David and brainstormed. “Why would a person want a cooling sensation on their skin?”, I asked myself out loud. “If you burned yourself…or if it felt like it was burning.”, I answered. David hadn’t burned himself though, so I wondered why else could he want to cool his skin. I thought back to my basic physiology and neuropsychology course work. Some kinds of skin rashes can feel like burning. Internal inflammation can feel like burning. When a nerve is pinched it can lead to a numb feeling like pins and needles or a burning sensation (doctors call this paresthesias). I jotted down these guesses and took them to the family the next day. Along with continuing to use Joining as a strategy to build rapport they were interested to investigate a possible biological cause. They went through my list. There was no sign of a rash and there hadn’t been an accident to cause any inflammation that they knew of. David wasn’t very active most days. A few weeks later, they went to a doctor of osteopathy who confirmed that David had chronic tension in his jaw (called Temporomandibular joint disorder) and identified a specific area in his upper neck that was misaligned where the nerves that extend through the shoulders down to the finger tips were compressed. This may have contributed to his posture too.

They scheduled osteopathy twice a week for almost a year at the end of which the repetitious behaviour had completely stopped. We were amazed that after just a few months, David’s finger licking and blowing had decreased from seven or more hours a day to no more than ten minutes. Today, he’s 27-years old, and his mother tells me he no longer does it at all. Sometimes now he rubs his thumb and ring finger together very softly. He explained through typing that it’s calming and he has no problem stopping when asked.

My experience with David illustrates two main approaches to RRBs that can be used in combination: Imitation which addressed the social-rapport aspect (more eye contact and trust) 3 and analysis of his physical. Although not widely accepted in the field as a mainstream technique, imitating is used with great success in several social-development based programs such as the Intensive Interaction program in England, The Adam Shelton Center in France, the Floortime program, and Reciprocal Imitation Therapy (RIT). Each of these of these programs developed independently from one another with their own techniques for how to imitate and theories of why it works.