Insistence on same is a term often associated with autism. I was with a family recently; a wonderful, supportive family of a child with autism, and I heard the word ‘control’ tossed around a lot. This word tends to cause problems in our field, partly because it’s really difficult to define. But maybe you have an idea of the types of behaviours to which I’m referring. And I think it’s an important conversation to have.
Autism and the insistence on same
Individuals with autism tend to feel most at ease when things are predictable and routine. This may be traveling the same route to school, eating the same lunch every day, or even insisting during meals that dad sits at one end of the table while mom sits at the other, and never the two shall meet. Of course this will vary from person to person. Some individuals may be quite flexible, but an ‘excessive adherence to routines, and resistance to change’ is clearly listed among the diagnostic criteria. And some reflect this quite intensely..
But everyone likes to have a bit of control, essentially the ability to make choices about their environment and how they interact with that environment. Most people, autism or not, have strong preferences about something or other, or practice particular routines; maybe workout or bedtime routines. So is insistence on same a problem?
When is insistence a concern?
Generally speaking, structure and routines can help us be more organized and efficient. It’s much easier to find your car keys when they are reliably returned to the same location. But most people won’t launch into a sense of panic if they see that they’ve been left on the kitchen table. So when does an insistence on same or reliance on routine become ‘controlling’ or a problem? Well, we typically worry once it begins to interfere with learning or participation in activities of daily living, and particularly when we see an intense response from the child or person if he or she is prevented from engaging in the behaviour, and if things aren’t exactly as they’re meant to be.
A closer look
Consider the example of a child who insists on the interior doors remaining shut. Each time he sees the door open, he shuts it. So, mom comes by and opens the door to keep an eye on little sister from the other room. He goes back and shuts it again. Mom comes back again and opens the door, and the child attempts to shut it again. Mom finally opens the door, stays at the door, firmly insisting it stays open. The child tries again, screeches and stomps his foot, heads off to his room, and is happily looking at a book when mom checks in 5 minutes later. In this instance, he’s been challenged and expressed his displeasure, but was able to find a way to cope. He retreated to his room and mom is able to accomplish what she needed while able to monitor his sister in the adjacent room. In this instance, we tend not to worry too much, although we do still recommended periodically mixing things up and expanding routines to ensure a child continues to have opportunities to practice flexibility and coping.
Let’s consider the same example, but in this instance, the child drops to the ground, begins screaming and crying, escalates and persists for 15 minutes until mom becomes so worried that she leaves her activity to remain in the room and shut the door. In this instance, this insistence is disrupting family routines. We would say this is a situation that requires some attention.
Let’s think about fears and phobias for a moment. Some people get a sense of panic about small spaces, others maybe snakes or wasps. While we may not relate, we can typically recognise the genuine sense of fear or distress. We see that the individual will engage in a whole range of behaviours to avoid places where they will encounter those things, and the accompanying feelings.
We don’t often view these ‘controlling’ behaviours similarly, but for some, and I’m by no means suggesting all, can be viewed in a similar way. The idea being that for some, the routine, ritual, or sense of order is safe. Interference with the routine or order causes a sense of panic; resulting in a fight or flight response (e.g. intense behaviours) to restore things back to order and end the feeling of dread.
Let’s break this down
So what do you do now?
Maybe you’ve learned that your child is one who seems to struggle with insistence on same and behavioural rigidity (a term we might use rather than control). Change and interference with routines seem to cause genuine, intense distress. Sure, you can try to avoid all triggers and stressors, but life happens and the outside world is not always as accommodating. Others may not recognise the triggers or know how to ‘fix’ things as they happens. So it probably is important that your child learn to cope when surprises happen or things don’t go just right.
There are certainly things you can do to help support your child to cope and increase flexibility. And we look forward to reviewing these strategies in our next blog, Part 2 of ‘Control, Rigidity, and Insistence on Same’