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triad of impairments - imagination - new info

(51 Posts)
ArthurPewty Mon 22-Oct-12 13:33:55

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phoebus Mon 22-Oct-12 14:02:29

Thanks Leonie, that IS a useful clarification. That hasn't been made at all clear in the past, has it ....? - my DS does have a good imagination in many ways; yet I'd agree that he isn't great at predicting the outcomes of SOCIAL interactions. 'Imagination' is a wide-ranging skill/concept, and I think they should have been a lot more specific about exactly what they meant by that with regard to the triad of impairments. Lots of kids with ASD actually have incredible imaginations, though most probably in 'non-social/RL' ways....

bochead Mon 22-Oct-12 14:05:53

& a wee light bulb goes off in my head wink

DS only started role play type play of any description at 7.5 which I noticed and this links to his rule based approach to social skills really well for me. He has friends etc, but unless you know him, you'd have no idea of the binary computing type thought process his mind goes through to maintain these friendships. His new TA & teacher have both found it very intriguing to get their heads round this year as it can look so normal till he makes the odd comment that totally gives himself away.

FangsForBloodyNothing Mon 22-Oct-12 14:09:15

Actually Leonie I have always thought it odd that my ds has a great imagination. I didnt realise it was more about social imagination.The example you gave on the other thread about the girl looking fat was a good example for me.Thanks for sharing thissmile.

ArthurPewty Mon 22-Oct-12 14:10:31

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ArthurPewty Mon 22-Oct-12 14:11:40

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SallyBear Mon 22-Oct-12 14:13:24

Thank you Leonie. I have always struggled with the imagination thing, as DS1's imagination is huge and his story telling is amazing yet he cannot predict how something in RL might end.

mummytime Mon 22-Oct-12 14:25:15

Thanks Leonie, I will try this on my DD after school. She has great imagination (can use random stuff to represent other things), but I'm not sure she can predict the social consequences, it will be interesting.

swanthingafteranother Mon 22-Oct-12 14:33:26

I had a very good example of this at family therapist with Ds2. FT asked ds what he thought of his brother, and ds2 came up with very imaginative (I thought) example of two bricks one red one green, and then put the bricks together to say his older brother was a bit red and bit green in his behaviour, sometimes nice sometimes nasty.
We then asked him some questions about other things, and he used the brick description again shock. It was almost as if, having thought up an original and imaginative solution to the problem it was worth using it again and again, no point thinking of a new theory. Very fixed.

Both my sons will write quite long fantasy stories, but struggle to make them convincing accounts of RL emotions and actions. I see that soaps like Downton are actually very useful to them because it is a quite simple explanation of why people react in certain ways in certain situations. Ds2 dislikes drama on telly, much prefers factual programmes or funny fantasy programmes. Even Harry Potter is too realistic for him, in terms of people's preoccupations and motivation, whereas Star Wars and LoRings is very exciting and interesting to him, as it is not so pyschological. I think he is going to find "drama" (like Tracy Beaker, say) interesting in the end, but it is almost like a delayed developmental stage, he is more interested in the ideas than the people ifysim.

swanthingafteranother Mon 22-Oct-12 14:39:04

Ds2 is very literal, yet he derives immense pleasure from "funny things". So the jokes in Horrible Histories are reenacted again and again for us, and he loves all the jokes in Percy Jackson books. So it is an imaginative world of a sort; I suppose he delights in the oddness of others, at at home with people who are a bit less NT...

AlwaysInWonder Mon 22-Oct-12 14:39:49

This is really interresting.
Because ds2 seems to have a lot of imagination and can play with ds1 quite a lot. Except it's always a copy of what ds1 does or based on a cartoon/film he has seen.

He is just starting to get some cartoons like Tom&Jerry but even then he has actually started to ask ds1 why things have happen.

I have discovered this blog and I though it is giving a nice explanation about imagination too.

AlwaysInWonder Mon 22-Oct-12 14:42:38

Describing people emotions.... ds2 had to do that for a 'big write'. He never went further than the 2 emotions the teacher had talked about....

bialystockandbloom Mon 22-Oct-12 14:53:49

To be fair (and pedantic wink) the diagnostic classification of impairment in social imagination has always been there. But good that the NAS have clarified this, as there has been confusion about this (witness the number of people here saying "but my dc has great imagination"!).

I think it's often the case, though, that the absence/impairment of social imagination is very subtle and hard to see, especially in young children 2/3/4yo. Which is why diagnostic tools (and advice given generally about the triad) for young children tends to ask questions about imaginative or pretend play. In a 2yo that kind of imaginative play is an early indication that social imagination, and ability to anticipate and sequence, will follow later.

Phoebus i totally agree, I think dc with asd often have amazing imaginations - but the ability to distinguish between reality and non-reality (eg tv programmes) can make things even more confusing for them.

ArthurPewty Mon 22-Oct-12 15:02:39

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ArthurPewty Mon 22-Oct-12 15:02:46

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ArthurPewty Mon 22-Oct-12 15:03:31

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bialystockandbloom Mon 22-Oct-12 15:12:42

Yep Leonie we had that too, with hulk, spiderman, etc. Ds flipped out when he saw the Scooby Doo film (non-cartoon version), I realised it was because he couldn't compute that the characters looked different (ie real instead of cartoon) so wouldn't accept they were the same characters.

Though actually that might be a problem with generalising.. which is probably related to social imagination somewhere too... hmm.

Ineedalife Mon 22-Oct-12 17:24:13

Interesting stuff leonie, Dd3 definitely cant predict the outcomes of social interactions. She says what she wants to say, doesnt listen to the other person and thats it, interaction overgrin

She also struggles with understanding how real people are on TV, She gets very involved with certain series and seems to think that it is actually happening.

troutpout Mon 22-Oct-12 18:35:38

That explains it perfectly doesn't it.
So many of us have said in the past " but he/she has a good imagination!"
This definition is perfect

ArthurPewty Mon 22-Oct-12 18:51:42

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ilikemysleep Mon 22-Oct-12 20:40:41

Sorry, I commented on another thread but it might bear repetition. Us in the diagnostic field tend to use 'unusual in scope, intensity or duration' as our definition of imagination ( we also refer to 'flexible thinking' in this part of the triad). This 'unusual' definition includes the odd, the too much as well as the too little. We recently diagnosed a 12 year old who 'tells lies' all the time, pointlessly. Things like saying hid dad is in the circus or he has been to America. It isn't done 'for attention' and we were all confused, but we have concluded he simply doesn't understand the difference between 'fantasy' and 'truth'. We also concluded it's a fundamental misunderstanding of communication; he hasn't grasped that one of the fundamentals of a non-jokey conversation is that the information you exchange is basically correct and truthful.

I have also noticed that the 'pda' type kids tend to be on the 'too much' end of the imagination spectrum....but massive flexible thinking difficulties...

AlwaysInWonder Mon 22-Oct-12 21:00:44

What do you call the pda type kids?

HotheadPaisan Mon 22-Oct-12 21:15:22

We had no idea everything was pointing towards autism for DS1, we thought his language and play were absolutely fine for example, it was sensory issues and interactions that were big problems. Then at a diagnosis meeting the paediatrician asked lots of questions about his play and it suddenly dawned on me that DS1 always played the same game, always, for hours. It looked imaginative to me but was copied from just two TV progs. He didn't colour, he didn't do jigsaws or any other kind of play. Agree, his complete inability to predict or see consequences is a big issue.

He's very PDA-like, can spin a story for hours, and hours, and hours.

TheCreepingLurgy Mon 22-Oct-12 21:26:58

Interesting, Ilikemysleep. I always took the imagination leg of the triad to refer to the restricted interests and repetitive behaviours, and lack of cognitive flexibility, which could also be explained by the "unusual in scope, intensity or duration" you mention.

I find it slightly odd that Judith Gould now explains imagination to refer to social imagination, because how would this explain the repetitive behaviours and restricted interests?

HotheadPaisan Mon 22-Oct-12 21:29:29

Another characteristic? Not essential to a diagnosis but points in that direction when seen with the three social difficulties?

HotheadPaisan Mon 22-Oct-12 21:30:15

Could fit in with social communication and interaction, or lack of.

ArthurPewty Mon 22-Oct-12 21:35:50

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ArthurPewty Mon 22-Oct-12 21:38:16

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ArthurPewty Mon 22-Oct-12 21:42:29

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ilikemysleep Mon 22-Oct-12 22:09:13

Creeping lurgy*: I was at the same conference (and might even have sat next to Leonie without ever knowing!) and I think it's important to make the point that the clarification was specifically in relation to *girls on the spectrum. I think she was saying that girls may not have the same amount of restricted interests / repetitive behaviours/ lack of cognitive flexibility as are seen in many boys, but may still be on the spectrum, and that is where the clarification that 'social imagination' "counts" for diagnostic purposes and may be what you see in women and girls on the spectrum.

My pet theory is that in diagnosing girls you need to take a long term view; you may not see anything unusual in one meeting or one conversation ( or you may...but not always) but the social and relationship history will hold the clues. I don't think the ADOS works so well for girls, for example...

*Always in wonder*: 'PDA type' kids are kids on the spectrum who are 'actors' rather than 'reactors'. Rather than melt down in response to a situation or show anxiety by worrying or crying in anticipation their extreme anxiety prompts them to act to avoid the situation. The behaviours they will engage in to avoid are often devoid of social boundaries so very hard to cope with (one kids pees on his mother's bed, for example). I don't like the PDA label myself (can't be diagnosed by a psychiatrist as isn't in the DSM IV, for starters, which makes parents feel we are fobbing them off) as I think it's just an 'active - avoidant' form of autism. Never met a PDA kid who wasn't on the spectrum. No doubt at all the manifestation exists, but my view is it is definitely part of the spectrum. Just my opinion of course. Thank my lucky stars on a daily basis that my boy is a reactor (--even if he did melt down yesterday for 20 mins, aged 11, because there was no custard left--)

rabbitstew Mon 22-Oct-12 22:09:41

My ds is a girl with aspergers grin.

ilikemysleep Mon 22-Oct-12 22:10:04

Leonie - apols, crossed several of your posts there smile

HotheadPaisan Mon 22-Oct-12 22:16:19

DS1 does both ilike. I agree PDA is just a form of autism, it's very useful to have the specific things about PDA pointed out though, DS1's diagnostic report talks about demand avoidance a lot.

ilikemysleep Mon 22-Oct-12 22:19:37

Yeah, that is what we often do too - we talk about a demand avoidant pattern of behaviours in an autistic profile. I agree the reframing of behaviours as 'anxiety based' rather than 'naughtiness based' is very helpful indeed.

rabbitstew Mon 22-Oct-12 22:26:37

I've always wondered about anxiety and aspergers, and the fact that people can suffer from anxiety without having aspergers, yet most people when they are colossally anxious behave in a more "autistic" way (eg become more self-focused and incapable of dealing with external distractions, because they are having a hard enough time coping with their own concerns and just feel even more panicked if they try to think about anything else). Is the difference that the highly agitated/anxious person without aspergers is fully aware of the fact that they are closing down to a certain extent, and doing it deliberately in order to cope with their anxiety, whereas someone on the autism spectrum is unaware of that process taking place, because they have no state of non-anxiety with which to compare their behaviour???!!!!!

HotheadPaisan Mon 22-Oct-12 22:39:38

I hadn't thought about it like that, maybe. Anxiety is the number one problem for DS1, it's awful.

ilikemysleep Mon 22-Oct-12 22:47:24

Rabbit - this is just my opinion, others may well have different opinions. I think the nub of it is the 'different in intensity, scope or duration' just like the imagination thing.

Fact - there is no 'autistic' behaviour. Behaviour which people think of as 'autistic' is normal behaviour triggered in a context that would not usually trigger it in an NT person. For example, screaming meltdown involving total loss of control followed by rocking in a corner with head over hands - triggered by sudden death of partner in a road crash - absolutely appropriate. Same meltdown caused by lack of custard to go on apple pie (as in my house yesterday) - not appropriate.

So the anxiety responses you describe above are 'ordinary' responses to extreme stress - but the extreme stress is triggered by something much 'less stressful' (to the NT eye) than 'deserve' such a response - such as going to work a different way or having a supply teacher in the classroom, rather than having to give a major presentation in front of the entire management team, upon the outcome of which your job is dependent.

I don't think the processes are any different or possibly even any more 'deliberate', but they are triggered by 'smaller' or 'trivial' stressors.

That's how I think of it, anyway...

mariammma Mon 22-Oct-12 23:05:58

Ilike, great description

This whole thread is brilliant... thanks Leonie

rabbitstew Mon 22-Oct-12 23:17:41

Thanks, ilike - that's really helpful. Although it sort of confirms my feeling that when my ds was younger, his behaviour was more apparently "autistic" than it is now because he was highly anxious but did actually have good reasons to be anxious... I don't see how a child could fail to be anxious if he was considerably delayed in learning to move as a result of low muscle tone, extreme hypermobility and poor motor planning skills, and so had no real control over his environment at an age when he was hyper aware of what was going on in his environment and had all sorts of genuinely unpredictable threats (eg toddlers his age) coming over to him and knocking him over (from which position he could not get up without help) without having any means to defend himself! I know if I were an adult stuck on the floor, unable to reach what I wanted or get myself from lying back to sitting, unable to express myself clearly verbally, unable to defend myself or get away from people invading my space and unable to express my free will in any meaningful way, I would be very anxious and might start soothing myself with repetitive activities which could be done without moving, like counting repetitively, etc...

TheCreepingLurgy Mon 22-Oct-12 23:40:08

ilikemysleep, thanks for your clarification. It is so true that the female expression of autism has not had the attention it deserves until recently, and that the current diagnostic criteria are based on males. Good that it is finally changing! But it may take a while before it is established, what with the view of Baron-Cohen's 'extreme male brain' being quite prolific in the media.

ArthurPewty Tue 23-Oct-12 07:18:36

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ArthurPewty Tue 23-Oct-12 07:19:04

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rabbitstew Tue 23-Oct-12 10:15:17

I'm not sure it's fair to call it the "female" expression of autism, either, though. My ds is a boy, but according to all these descriptions, has an incredibly female expression of his autism!

HotheadPaisan Tue 23-Oct-12 10:32:14

I was thinking that about DS1, and I would be considered to have 'male' traits. I can see we want to address the underdiagnosis of girls but I don't like things being grouped by gender.

It has taken me a year or two to understand ASD and I've been immersed in it. I am still learning, not sure how you get the info out there in a simple enough way for people to grasp whilst not discounting the responses of some kids with 'well, it can't be autism because...'

I missed the anxiety-based reframing/ reference point. Nearly all of DS1's difficult behaviours are driven by an anxiety-led need for control and fear basically, with a neurological root. Punishing him for this and not understanding is just cruel.

TheCreepingLurgy Tue 23-Oct-12 12:35:21

I agree rabbitstew, that "genderising" autism is not helpful to anyone. For one, it reinforces stereotypes about what is considered male and female behaviour. Only in the short term it may help with acknowledging the way some people (perhaps the majority of which is female?) express autism is indeed autism (and not OCD for example). But in the long term it will do more damage than good.

BsDad Sun 04-Nov-12 07:51:45

I too had a lightbulb moment when reading this thread. It inspired me to write a blog post about it which you can read here:

I've said it before, but Mumsnet is such a lifeline in helping us to make sense of, and understand, our son's condition. Thanks everyone.

Handywoman Sun 04-Nov-12 13:22:41

Yeah. This is a great thread.
Love this place.
Handy xxxxxxx

KeepOnKeepingOn1 Sun 04-Nov-12 13:56:17

DS1 used to have a meltdown regular as clockwork every Saturday morning when it was time to leave for karate culminating in him lying on the floor in a foetal position covering his ears. But I was unable to end it by cancelling karate as he would then have another meltdown ending the same way about not going to karate. Catch 22, damned if you do, dammed if you don't. I understand his behaviour better now but I don't know how to deal with extreme demand avoidance other than not making demands. When I tried short communication a la 'how to talk to kids..' eg 'DS, washing-basket' he had no idea what I meant ('yes, Mum, its a washing-basket') and needed literal step by step instructions.

HotheadPaisan Sun 04-Nov-12 16:15:54

Extreme demand avoidance, bane of our lives smile

I've just gone back to the PDA Contact Forum as things are desperate again (DS1 is only 6), I signed up there two years ago, I keep deluding myself that things are better, they're not, DS1 just can't refuse in quite the same way as he used to and he knows it. Once he cottons on that he can in fact we're doomed.

porridgelover Mon 05-Nov-12 12:47:29

Excellent thread.

One of the most insightful things I have done since starting on the ASD thing is to attend a talkability programme with our SaLT.
The big thing that I got out of it, was the role of playing imaginatively and socially with my DS.
I had not really realised how he cannot do this until it was spelled out for me.
For example, I was playing with DN 3yo while on the course. We had a chat about his tractor which he was playing on. I pretended to fill it with diesel. He pretended to pay me. I asked if I could check under the bonnet. He agreed and pretended to open it for me.
Here's where it jumped from what DN can do at 3 to what DS cant do at 7.
I said 'what this underpants doing in your engine? and pretended to pull one out. DN stopped, roared laughing, then got with the change in the game, and said 'thats where I keep my underpants!''. grin grin
Since then, I play with DS and constantly try to introduce this flexibilty but he hates it. Gradually, as I keep trying this, he gets better. But I cant do it if he's upset or tired.

Handywoman Tue 06-Nov-12 09:57:26

My DD2 (8 in March) had a mahoosive meltdown after spilling paint on her night dress on Fri (as described in the latest Friday night thread!). This happened while her friend was over for a play date. DD2 was screaming in her room and would not come down to say goodbye. Moments later, her friend had gone home (at the planned time) and DD2 tucked into her dinner like literally nothing happened. About an hour or two later I asked her gently and openly: "how do you think your friend felt when you were upstairs screaming and would not come down and say goodbye?". Her answer was a very innocent and genuine, "I don't know". She literally had no idea. Is this lack of social imagination? Lack of empathy? I have trouble figuring out the difference.

Either way I reckon this is not to be expected for a child of her age? Both the lack of awareness of the effect on people around... or the inability to even recognize how your friend might feel?

HW x

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