Facial Behavior and Daydreaming

Welcome to the September edition of Ask Dr. Emily! We often receive questions that we want to share with all our readers. To help with this, Dr. Emily Rastall, a clinical psychologist at Seattle Children’s Autism Center, will share insights in a question and answer format.

My son is 7 years old, and he has autism spectrum disorder. When he watches television, he makes faces with his eyes closed and lips out. Is that part of autism?

 One of the diagnostic criterion for autism spectrum disorder is described as this facial behavior that you describe sounds to me like it fits the description of a “stereotyped or repetitive motor movement,” one of the diagnostic criteria for autism spectrum disorder. These behaviors can be present when one is excited, relaxed, and/or upset.   

I am an individual with autism. I want to touch on daydreaming. When I was in school, my biggest hurdle was “zoning out.” If I didn’t understand a topic, I would “check out” until the instruction ended. This sounds awful, but my family sometimes has to snap at me to bring me back to reality. I “pass” as typical, but every day is an exhaustive process of trying to stay focused and “in touch” with what’s happening around me. Is this something that happens with autism spectrum disorder?

Thank you for writing in and for sharing your experiences. Executive functioning (like paying attention, planning, thinking ahead, switching attention or tasks) is often affected (to varying degrees, of course) for individuals with autism spectrum disorder. This can make it challenging to maintain attention, multi-task, and stay present, especially in overwhelming, chaotic environments. It can be even more challenging to stay focused on topics or people that we don’t find especially interesting or appealing.

 My son is 12 and has high functioning autism. He has also been diagnosed with anxiety, skin picking, ADHD, and we recently discovered he has two genetic duplications as well. He has had some real challenges at school: Social challenges (cannot read social cues from others, oversteps boundaries with peers, had trouble fitting in), behavioral challenges (aggression towards peers, incontinence), and emotional challenges (verbal outbursts, threats of harm to self and property). He was expelled from public school last year; he now attends an alternative school, but things have not gotten better. What should we do?

 First, let me empathize with how hard this must be for you, your son, and your family. His profile appears complex with his recent genetic findings, mental health symptoms, behavioral issues and potentially a number of medical and mental health providers involved. Might his primary care provider be “the quarterback” of his care/education team, with a coordinated comprehensive evaluation and treatment plan? This would hopefully shed some light on the function of his behavioral challenges and inform treatment next steps.