By Professor Tony Attwood and Dr Michelle Garnett
Affection in childhood
It can be difficult to manage emotions, but we generally think about the management of emotions such as anger, anxiety, and depression, not necessarily the emotions that are considered to be more positive, for example, excitement, joy, liking and love. This blog will focus on the difficulties that can arise in relationships and for autistic people due to difficulties with affection.
Within families and friendships, there is an expectation that there is a mutually enjoyable and reciprocal regular exchange of words and gestures that express affection. From infancy, children enjoy and seek affection from their parents, and young children are able to read the signals when someone expects affection and recognize how much and the type of affection that would be appropriate. One of the early signs that clinicians use to diagnose autism in a young child is a lack of appearance of being comforted by affection when distressed and comforting others who are distressed with affection. An autistic child may be confused as to why a parent or friend responds to his or her distress with a hug which is perceived as an uncomfortable and restricting physical sensation. As an autistic adult said, ‘How does a hug solve the problem?’
Autistic children may also not recognize the social conventions regarding affection; for example, the young autistic child might express and expect in return the same degree of affection with a teacher as they would with their mother. There are also gender differences in the expression of affection between friends, with typical girls anticipating that affection will be integrated into their play. The absence of affection in the play of an autistic girl can be a barrier to friendship, and appearing indifferent or aloof to the affection of peers can inhibit social inclusion and contribute to the loss of a potential friendship.
An autistic child may enjoy a very brief and low-intensity expression of affection but become confused or overwhelmed when greater levels of expression are experienced or expected. However, the reverse can occur for some autistic children, where they need almost excessive amounts of affection sometimes for reassurance or sensory experience, and often express affection that is too intense or immature. The autistic child may not perceive the non-verbal signals and contextual cues in order to know when to stop showing affection, leading to feelings of discomfort or embarrassment in the other person.
When a parent expresses his or her love for an autistic child, perhaps with an affectionate hug, the child’s body may stiffen rather than relax to match and fold into the body shape of the parent. The child may also not be soothed by words and gestures of affection when distressed. When an expression of love and affection is rejected or is not effective, parents may wonder what they could do to repair their autistic child’s distress, or whether their son or daughter loves or even likes them. A mother of an autistic girl said that her daughter’s lack of affection for family members was ‘basically breaking her father’s heart, he’s devastated.’ Another parent said, ‘It really hurts that you can’t have the relationship you wanted.’ If affection is not reciprocated, a parent may try to elicit a greater degree of affection by increasing the intensity and frequency of his or her expressions of affection. This can lead to even greater withdrawal and mutual despair.
When it comes to expressing affection, autistic children often have a limited vocabulary of actions and gestures, tending to lack subtlety, and in the case of adolescents, be inappropriate or immature for their age. Their expression of affection and of liking or loving someone may be perceived by family members or friends as too little or too much – drought or flood. An autistic adolescent explained, ‘We feel and show affection, but not often enough, and at the wrong intensity.’
Each person has the capacity for expressing and enjoying affection. For a typical person, this capacity can be conceptualized as an affection bucket, but for an autistic person, the capacity is a cup that is quickly filled and slow to empty. If the parent fills the affection cup to capacity, the autistic child or adolescent can feel saturated with affection and be unable to return the same degree of (or sometimes any) affection.
Affection in adolescence
An autistic teenager may not understand the value within an adolescent friendship of mutual exchanges of appreciation and affection that range from liking to loving. Autistic teenagers may have learned a vocabulary of words and gestures to express affection when very young and then not modified their actions in recognition of maturity and the current social conventions of their peers. For example, he or she may invade personal space and not know which parts of someone’s body are now inappropriate to touch. The autistic teenager may also not know how to progress beyond a reciprocal but platonic friendship, or how to express deeper feelings of affection. There can also be a problem when an autistic adolescent develops a ‘crush’ on a peer. The expression of interest and affection can be perceived as too intense, and the adolescent may not recognize the need for mutual consent or age-appropriate social conventions and boundaries.
Psychologists use the term ‘delayed Theory of Mind’ to explain that autistic children and adults are delayed in the ability to conceptualize and reflect on the thoughts and feelings of other people as well as their own thoughts and feelings. Thus, a friend or acquaintance’s act of kindness may be misinterpreted as having a more significant meaning than was intended. The autistic person may assume that the other person’s feelings of affection are reciprocal, and may persistently follow the other person, seeking more acts of kindness. This can result in allegations of stalking and the destruction of the friendship.
Affection to repair feelings
We have found that the three most effective emotional repair strategies for an autistic person are being alone, being with animals, or engaging in intense interests. This may explain why an autistic person may choose to leave alone or avoid his or her parent or friend who is distressed. Another response that can be perceived as uncaring or annoying and indicative of lacking empathy, is to try to engage in a conversation about their intense interest. The autistic person is not being callous but actually showing compassion: in other words, if it makes me feel better, it would work for you.
Autistic children and adolescents seem able to relate to and express affection and love more easily to animals than to family members. Thus, parents may observe that the child or adolescent can and often does, express affection for a pet to a level far greater than is expressed for a parent. This can lead to feelings of envy for the pet and resentment that the person can express love but not for a parent. From an autistic perspective, people have complex needs and can deceive or tease you, interrupt and prevent you from engaging in your preferred activities. In contrast, animals are loyal, respectful, predictable and so pleased to see you, and it is easy to make them feel happy.
Frequency of affection
We anticipate compliments and frequent words or gestures of love and affection to confirm and consolidate a relationship or friendship. For the autistic person, this can be perceived as a reiteration of the obvious and a waste of time. Once a statement has been made, why should it have to be repeated? A mother complained to her adolescent son that he never said that he loved her. He became confused and replied that he had said he loved her when he was six years old, asking her why would he need to say it again and if she was developing signs of dementia.
Sensory sensitivity and affection
It is important that family members and friends recognize an aspect of autism that will affect the ability to enjoy and express affection, and that is hyper- or hypo-reactivity to sensory experiences. For example, some autistic children and adults have tactile sensitivity such that light touch on their skin can be perceived as an extremely unpleasant sensory experience. This will obviously affect the enjoyment and response to gestures of affection, such as touching a person’s hand or arm during a conversation to emphasize a point or express compassion. Unanticipated touch, due to not reading the signals that this is about to occur (such as a pat on the back or a hug from behind), can elicit a startle response. A kiss can also be perceived as an unpleasant tactile sensation. There may be olfactory sensitivity, such that when experiencing a hug, the autistic person can be hyper-aware of someone’s perfume or body odour, perceiving it as an extremely unpleasant sensation that is best avoided. All this can explain why some demonstrative family members are avoided.
Psychologists recognize that affection is essential for physical and mental health and an important means of initiating and maintaining friendships and relationships. Although clinicians are rarely asked to help a typical person express liking or love for someone, parents and specialists in aautism are increasingly recognizing that autistic children and adults need information and guidance in the understanding and expression of affection.
The From Like to Love CBT programme for affection
Michelle and Tony designed and developed an emotional education and therapy programme to help autistic children and adolescents discover how expressing and experiencing affection can improve friendships and relationships, to identify not only their own comfort and enjoyment range for gestures, actions and words of affection but also those of friends and family members (Attwood and Garnett 2013). The programme also helps parents and friends understand the challenges faced by an autistic person in reading the signals that indicate when expressions of affection are needed and appreciated. The From Like to Love programme has been evaluated using a randomized controlled study (Andrews et al 2013; Sofronoff et al 2011).
We have applied the strategies used in Cognitive Behaviour Therapy, such as affective education, to help the autistic person understand the concept and feelings of affection in themselves and others; cognitive restructuring to change thinking and behaviour associated with affection; and desensitization to reduce the anxiety, confusion and frustration often associated with feelings of affection. The intention is to gradually increase the person’s enjoyment of affection, as well as their ability and confidence in expressing affection, ranging from like to love in a friendship or within the family. As the new skills of expressing and enjoying affection are practised, they become self-reinforcing. Becoming more aware that the autistic person is liked and loved by friends and family leads that person to feel greater self-acceptance and self-confidence in social situations. Greater engagement in friendships and family becomes possible and provides important preparation for future relationships.
References
Andrews, L., Attwood, T., and Sofronoff, K. (2013) Research in Autism Spectrum Disorders 7, 1568-1578.
Attwood and Garnett (2013) CBT to Help Young People with Asperger’s Syndrome to Understand and Express Affection. Jessica Kingsley Publishers, London
Attwood and Garnett (2013) From Like to Love Jessica Kingsley Publishers, London
Sofronoff, K., Eloff, J., Sheffield, J., Attwood, T. (2011) Autism Research and Treatment 2011, Article ID. 214317.
