Since I started meditating, my skills have gotten better and I have learned to focus more on the moment and what is happening at that time right in front of me. At work or around the house I am able to see what is happening for what it is and not what it used to be or what I want it to be. What has continued to allude me, however, has been an ability to enjoy that moment for what it is worth and to not worry about what is to come when it comes to my kids.
As with any parent of a child with Asperger's, this would be an especially useful skill. In truth, with our children the highs are exceptionally high and can be truly amazing moments where we are surrounded by both love and happiness. But all too often, the joy of the moment is missed because I'm so focused on the next problem, the next looming disaster, the next low. And our lows can be exceptionally low.
To some extent, the reality of our lives dictate this approach. Our lives take A LOT of preparation. When we've been successful with the children, it has often been the result of an incredible amount of planning, forethought and preparation. Without properly preparing the boys for events and transitions, things are likely to go horribly wrong.
In an effort to focus my attention on the reality of the present moment and not get trapped on the runaway train of my thoughts, I purchased the "It's Now" watch designed by and featuring the calligraphy of Thich Nhat Hanh. The watch features the word "It's" written in the middle, surrounded by the word "now" at the 3, 6, 9 and 12 locations on the face. It is truly always NOW, and serves as a constant reminder throughout the day that I need to remember that fact. After only a week of having that reminder on my wrist, I found myself more able to carry the mindfulness I was so diligently practicing on my medication pillow every morning and evening with me to work, running errands, and around the house.
One night, however, not long after I started wearing it the watch, unknowingly, presented me with a challenge. I was outside with the boys enjoying the first mildly warm evening of the year. Danny and I were playing a primitive version of tennis while Kenny served the triple role of rule-maker, score-keeper and net. The deck was clearly stacked against me as Kenny admitted to "making sure my friend Danny wins." I lost by a strange and confusing score of 11,000,003,011 to 32. It was a wonderful time--just plain fun. The closet therapist that I had become was thrilled with what seemed like the five social development milestones that had been met. And, as always, my mind was on the clock.
It was close to bedtime and I knew I had to start giving my pre-corrects (technical term for telling them what was expected of them before you actually expected them to do it) and following them up with a time warning, usually something like "Five minutes until it's time to go inside and use the bathroom, take a bath, brush your teeth and put on your pajamas." This would then be repeated at T-minus 4, 3, 2 and 1 minutes. Like most children with Asperger's, the boys don't typically handle transitions well and that is an understatement. To avoid a meltdown, we needed to go through this routine of time warnings and pre-corrects and it was even more important in the evenings when the boys would be tired and less likely to comply.
Unfortunately, issuing a pre-correct is by definition not "living in the moment." To be issuing a pre-correct means that your mind is occupied with what you see as a potential disaster ten minutes in the future. The ironic difficulty is that the greater the joy in the activity, the greater the need for the pre-correct. How do you live in the moment with children who need to be told what is going to be happening in the future?
Walking this balance is where I found myself. My watch reminded me that the time was NOW and it was a time to embrace and cherish. But it also told me that it was time to prepare the boys for the end of that fun. And maybe that's the answer. NOW was the time to issue the pre-correct. However, NOW is but an instant. After the warning was issued, that NOW was gone and the new NOW that demanded my attention was how to recover from an 11 billion point deficit in a game that didn't have any rules.
31 March 2011
Attention! Attention!
In Aldous Huxley’s last novel, Island, he writes of an idyllic society that combines the best of Buddhism and modern science. In many ways the book stands in opposition to his far more famous novel, Brave New World, in which Huxley describes an attempt by humans to create a utopian world, only to see that world turn soul-crushingly bad. Whereas, in the Island Huxley's utopian world seems to thrive for the benefit of all, at least for a time. Among the many experiments the Island’s initial leaders attempted was the training of Mynah birds to utter the phrases “Attention! Attention!” and “Here and Now, Boys! Here and Now!” to serve as constant reminders to the island’s inhabitants to pay attention to the present moment.
In raising the boys, I’ve often felt like that mynah bird. “Pay attention to what you’re doing” is a constant, but useless, refrain in our house. For the boys the inability to focus is certainly severe enough to be clinical and there is no doubt that if a previous diagnosis of autism wasn’t already on the books they’d surely be diagnosed with ADHD (Attention Deficit and Hyperactivity Disorder). Their ability to be distracted from the task at hand is mind-boggling. The pull towards any written word is overwhelming. It is rare that either one of them can get dressed without taking a pause at some various stage of undress to grab something to read. I’ve seen them climb a ladder and go down a slide while reading, brush their teeth while reading, and if it was up to them, they would always eat and read. You name it, they’ve done it reading. Despite our constant pleas to “do one thing at a time” they don’t. They seem completely unable to focus on a single task.
Of the many benefits I hoped to reap by teaching the boys mindfulness meditation, this was near the top of the list. I am hopeful that this effort might bear fruit based on what I’ve seen in my own personal life. To a lesser degree, I was like the boys when it came to giving my full attention to a task. For a long time, although I recognized that it did cause some problems, I largely viewed this trait as positive. I could easily send an important work email while talking on the phone about something else entirely. I could talk to my family on the phone while taking out the trash or folding laundry. I could participate in meetings at work while making a list of things I needed to do before the next meeting (during which I was likely in charge of recapping the last meeting in which I wasn’t fully attentive). Today’s western culture highly regards and often requires multi-tasking.
Despite viewing this as an attribute it did cause problems (to which my wife would surely attest). I often found myself missing important details from conversations and in extreme instances found myself realizing I had just committed myself to something without being exactly sure of what it was I was expected to do. This of course led to the embarrassing task of having to ask for clarification, or more likely spending a significant amount of mental time and energy to devise a way to uncover what had been said without making it clear to my colleague that I hadn’t been paying a lick of attention to what they had been saying for the last twenty minutes or so. It had even gotten to the point where I couldn’t even manage in meetings to pay attention to answers to questions that I myself had asked.
A large part of the appeal Buddhism held for me was the practical ways in which it was applied. Although I was looking for some sort of larger change in my life, I couldn’t help being a practical person by nature and when I first began to meditate the small practical improvements were what struck me the most. Notably the ability to pay attention to and therefore enjoy a mundane task like doing the dishing. Still, at first mediation was very difficult for me. I couldn’t get comfortable. My knee hurt, my back hurt, even my lungs hurt from all the breathing (I wasn’t sure how I normally breathed so much in a given day). And that was nothing compared to what my brain was doing. Some days, I would throw in the towel, completely exhausted, after just five minutes. But, it did get better, albeit slowly, and it was clear to me that meditating was literally exercise. Brain exercise to be exact and I had to keep at it in order to build up my ability to use my mind to be aware of my breathing. In this way I recognized that “paying attention” was a real skill that had to be nurtured, one that I had been willfully neglecting over the years in favor of multi-tasking.
Eventually I saw that skill paying off with benefits in my everyday life. I was able to actually drive to work as opposed to getting to work solely on autopilot while my thoughts raced about in different and often terrible directions. At first I found myself making a very conscious effort to give my attention to employees coming to me with problems far from the top of my list, but as I worked at it (and as I built up the “paying attention muscles” in my brain through meditation) I found that I was able to do it more naturally and more frequently, benefiting not only myself but also those who were asking for my attention.
It is my hope that through mindfulness meditation this skill can be cultivated in the boys. Right now it seems an awfully big hill to climb. But, with perhaps greater effort, we’ve been able to conquer other hills. It took real work and effort with an occupational therapist for the boys to be able to dress themselves (and jump!). It took real work and effort with a speech therapist for the boys to be able to ask a question and make a request for even the simplest of necessities. With the boys nothing has been gained without effort, regardless of whether it appears to be incredibly simple or monstrously difficult. Paying attention should be viewed no differently.
However, given the impact of Asperger’s I do believe they have an extra hill to climb that most beginning meditators do not face. While my mind may move fast and have difficulty settling, theirs moves faster—a lot faster. Faster by a factor of ten. And it is clear that it craves input. Without input, without constant stimulation they go quickly off the rails. Because of this they often crave all sorts of sensory input, crashing into things just to feel the pressure for instance. And, of course, they read. In any new situation the first thing they will look for is a book, to provide that input and I suppose a sense of safety.
Despite those hurdles I believe that through the hard work of meditation they will be able to cultivate that skill and be able to at will to focus their mental abilities on “just one thing.” And I believe that learning to focus will bring with it the potential for them to far surpass my ability to be in touch with the world around me.
In raising the boys, I’ve often felt like that mynah bird. “Pay attention to what you’re doing” is a constant, but useless, refrain in our house. For the boys the inability to focus is certainly severe enough to be clinical and there is no doubt that if a previous diagnosis of autism wasn’t already on the books they’d surely be diagnosed with ADHD (Attention Deficit and Hyperactivity Disorder). Their ability to be distracted from the task at hand is mind-boggling. The pull towards any written word is overwhelming. It is rare that either one of them can get dressed without taking a pause at some various stage of undress to grab something to read. I’ve seen them climb a ladder and go down a slide while reading, brush their teeth while reading, and if it was up to them, they would always eat and read. You name it, they’ve done it reading. Despite our constant pleas to “do one thing at a time” they don’t. They seem completely unable to focus on a single task.
Of the many benefits I hoped to reap by teaching the boys mindfulness meditation, this was near the top of the list. I am hopeful that this effort might bear fruit based on what I’ve seen in my own personal life. To a lesser degree, I was like the boys when it came to giving my full attention to a task. For a long time, although I recognized that it did cause some problems, I largely viewed this trait as positive. I could easily send an important work email while talking on the phone about something else entirely. I could talk to my family on the phone while taking out the trash or folding laundry. I could participate in meetings at work while making a list of things I needed to do before the next meeting (during which I was likely in charge of recapping the last meeting in which I wasn’t fully attentive). Today’s western culture highly regards and often requires multi-tasking.
Despite viewing this as an attribute it did cause problems (to which my wife would surely attest). I often found myself missing important details from conversations and in extreme instances found myself realizing I had just committed myself to something without being exactly sure of what it was I was expected to do. This of course led to the embarrassing task of having to ask for clarification, or more likely spending a significant amount of mental time and energy to devise a way to uncover what had been said without making it clear to my colleague that I hadn’t been paying a lick of attention to what they had been saying for the last twenty minutes or so. It had even gotten to the point where I couldn’t even manage in meetings to pay attention to answers to questions that I myself had asked.
A large part of the appeal Buddhism held for me was the practical ways in which it was applied. Although I was looking for some sort of larger change in my life, I couldn’t help being a practical person by nature and when I first began to meditate the small practical improvements were what struck me the most. Notably the ability to pay attention to and therefore enjoy a mundane task like doing the dishing. Still, at first mediation was very difficult for me. I couldn’t get comfortable. My knee hurt, my back hurt, even my lungs hurt from all the breathing (I wasn’t sure how I normally breathed so much in a given day). And that was nothing compared to what my brain was doing. Some days, I would throw in the towel, completely exhausted, after just five minutes. But, it did get better, albeit slowly, and it was clear to me that meditating was literally exercise. Brain exercise to be exact and I had to keep at it in order to build up my ability to use my mind to be aware of my breathing. In this way I recognized that “paying attention” was a real skill that had to be nurtured, one that I had been willfully neglecting over the years in favor of multi-tasking.
Eventually I saw that skill paying off with benefits in my everyday life. I was able to actually drive to work as opposed to getting to work solely on autopilot while my thoughts raced about in different and often terrible directions. At first I found myself making a very conscious effort to give my attention to employees coming to me with problems far from the top of my list, but as I worked at it (and as I built up the “paying attention muscles” in my brain through meditation) I found that I was able to do it more naturally and more frequently, benefiting not only myself but also those who were asking for my attention.
It is my hope that through mindfulness meditation this skill can be cultivated in the boys. Right now it seems an awfully big hill to climb. But, with perhaps greater effort, we’ve been able to conquer other hills. It took real work and effort with an occupational therapist for the boys to be able to dress themselves (and jump!). It took real work and effort with a speech therapist for the boys to be able to ask a question and make a request for even the simplest of necessities. With the boys nothing has been gained without effort, regardless of whether it appears to be incredibly simple or monstrously difficult. Paying attention should be viewed no differently.
However, given the impact of Asperger’s I do believe they have an extra hill to climb that most beginning meditators do not face. While my mind may move fast and have difficulty settling, theirs moves faster—a lot faster. Faster by a factor of ten. And it is clear that it craves input. Without input, without constant stimulation they go quickly off the rails. Because of this they often crave all sorts of sensory input, crashing into things just to feel the pressure for instance. And, of course, they read. In any new situation the first thing they will look for is a book, to provide that input and I suppose a sense of safety.
Despite those hurdles I believe that through the hard work of meditation they will be able to cultivate that skill and be able to at will to focus their mental abilities on “just one thing.” And I believe that learning to focus will bring with it the potential for them to far surpass my ability to be in touch with the world around me.
Tips for Implementing Mindfulness Meditation in Children with Asperger’s
- Begin by teaching the child to take deep calming breaths.
Start with a visual prompt, such as numbered picture cards the child can flip through as he/she counts breaths. Alternatively, they could move marbles from one cup to another with each breath.
- Provide a dedicated space free of distractions for use in meditation.
Take into account any sensory issues the child might have when you set up the space. For instance, instead of using a beeping timer to indicate the end of meditation time you may want to consider a visual method of timing such as an hour-glass or a light if the anxiety of potentially loud noises could adversely affect the child.
- Write out clear and literal instructions (or use pictures) to describe how to do the meditation.
Written rules or pictograms are extremely helpful as teaching tools for children with Asperger’s who are visual learners. Post the instructions in the meditation space to remind the child of the expectations daily since success one day doesn’t always guarantee success the next without a helpful reminder.
- Make meditation a regular part of the child’s daily routine.
Children with Asperger’s respond well to routine and while in some cases we attempt to limit their dependence on routine, in this case we can utilize this inclination of theirs to establish a lasting daily practice.
Start with a visual prompt, such as numbered picture cards the child can flip through as he/she counts breaths. Alternatively, they could move marbles from one cup to another with each breath.
- Provide a dedicated space free of distractions for use in meditation.
Take into account any sensory issues the child might have when you set up the space. For instance, instead of using a beeping timer to indicate the end of meditation time you may want to consider a visual method of timing such as an hour-glass or a light if the anxiety of potentially loud noises could adversely affect the child.
- Write out clear and literal instructions (or use pictures) to describe how to do the meditation.
Written rules or pictograms are extremely helpful as teaching tools for children with Asperger’s who are visual learners. Post the instructions in the meditation space to remind the child of the expectations daily since success one day doesn’t always guarantee success the next without a helpful reminder.
- Make meditation a regular part of the child’s daily routine.
Children with Asperger’s respond well to routine and while in some cases we attempt to limit their dependence on routine, in this case we can utilize this inclination of theirs to establish a lasting daily practice.
Mindfulness: A Promising Approach to Overcoming the Challenges of Asperger’s Syndrome
After years of a casual academic interest in Buddhism created mainly by reading popular books written by the Dalai Lama, my interest turned more serious about a year ago and I began to practice meditation on a routine basis. The daily stress and constant worrying associated with the raising of twin boys with special needs (Asperger’s Syndrome) combined with uncertainty in my career had taken a toll. I could sense that my mind was out of control with a despair and negativity that was both foreign to me and unhealthy. I had to take control of my thoughts. My relatively limited background in Buddhist reading led me to believe that I needed to make a serious effort to meditate on a daily basis and make the attempt to incorporate the precepts of Buddhism into my daily living. Like almost everyone, I still have far to go. However, the initial benefits were encouraging and pushed me to study more.
Surprisingly, what struck me the most in my studies was how much the practice of mindfulness could potentially benefit my children. My boys were diagnosed with Asperger’s Syndrome at the age of three. They both possess incredible brains—that much is clearly evident to anyone who has interacted with them. Their reading skills, amazing memory and recall, innate sense of music and uncanny ability to detect patterns are rare if not unprecedented. And yet, they are disabled by a host of sensory issues, anxieties, obsessions and misunderstandings of the world that threaten to disable them and keep us from participating in even the simplest childhood activities. As their father, I feel a tremendous pressure to guide their amazing potential into useful lives, and through the study of mindfulness I think I may have found a path to help them.
Intuitively, I can tell I’m on the right track. Several times over the last year the boys have confirmed the rapid fire nature of their minds and the need to bring some order and control. One of the boys once told me that he “rocked in his bed” so that he couldn’t hear his mind, which was keeping him awake by racing off downstairs. (When asked what his mind was saying he replied, “I don’t know. I don’t speak brain.”) And recently my other son told me that he has difficulty sleeping because he can’t stop thinking about his nightmares and that “the part of the brain that lets other people not think about their nightmares must be broken in my brain.”
What Is the Current State of the Science?
While I’m a believer in listening to and following one’s gut instincts, I’m also a biologist by training and so I was interested in the science of what’s going on here. Recently I read two seemingly unrelated books that both spoke to the potential benefit of studying the effects of mindfulness meditation on individuals on the autism spectrum. The first was Animals in Translation by Temple Grandin, an amazingly successful individual with autism who was featured in the award-winning HBO film “Thinking in Pictures.” The book discusses some of the physiological characteristics of the autistic brain and how the responses to stimuli in individuals with autism are similar to the responses seen in Dr. Grandin’s decades of work with animals.
By sheer coincidence the next book I happened to read was Buddha’s Brain: The Practical Neuroscience of Happiness, Love, and Wisdom by Rick Hanson (with Richard Mendius). The book discusses the physiological changes that can be brought about in the brain through the practice of meditation. I was struck by the similarity in the areas of the brain discussed in these two books. For instance, much of Dr. Grandin’s book talks about the fear response and inability of the frontal lobe to control the immediate fearful response of the amygdala, resulting in a near constant state of fight-or-flight response in individuals with autism (a situation I’ve seen in my own children). Buddha’s Brain discusses the dampening of this response by activation of the parasympathetic nervous system with deep breathing exercises. Additionally, both books discuss the negativity bias and the history of brain evolution among other aspects of anxiety and stress.
I was quite pleased to see my scientific reading match what I was intuitively feeling my boys most needed. Encouraged, I set out to see what research or writing was available discussing this exciting possibility for help for individuals with autism. I was shocked by the results. I found only one book, Asperger’s Syndrome and Mindfulness by Chris Mitchell. It is an insightful book written by an individual with Asperger’s which confirmed this as a possible path to resolve many of the difficulties I see my children facing. However, it was only one book.
Knowing that the scientific study of meditation was increasing rapidly and becoming more and more accepted in mainstream scientific circles I searched Pubmed, the National Institutes of Health (NIH) database of peer-reviewed research articles. A search for meditation yielded 2,060 articles. Autism: 16,983. But autism and meditation combined yielded a grand total of ZERO. I was stunned. I checked my spelling. I tried other words. The results were the same: Zero. But yet, many of the problems that confront individuals with Asperger’s were there. Meditation and anxiety: 293 articles. Meditation and cognition: 245. Meditation and OCD: nine. These are all recognized problems in the ASD population, yet no one appears to be tackling them with meditation within that population. And it isn’t because they aren’t considered important problems. A review of NIH grants showed 228 active grants for the study of autism and the 2008 Federal Interagency Autism Coordinating Committee report showed that $54 million dollars was spent on treatment and intervention research grants. However, none of the research is currently employing meditation or mindfulness, with the exception of one using mindfulness-based stress reduction for parents of children on the spectrum. Much of the research focus seems to be in the effort of pharmacologically medicating these problems into submission, but I’d much prefer the meditating approach to the medicating one.
How Can Mindfulness Help?
Specifically, I can see four main areas of struggle for people with Asperger’s that could be helped through the practice of mindfulness meditation, although I anticipate as the practice evolves numerous other benefits would become apparent. I would love to see more extensive research in the following areas:
• Emotional Regulation: Functional and structural abnormalities of the amygdala have been identified in individuals with autism and Asperger’s leading to difficulties recognizing and regulating emotions. The emotional pinball “game” that results in wildly inappropriate highs and devastating lows often leads to anger, anxiety and sadness. Mindfulness meditation can achieve some level of control over the fast-response of the amygdala by creating parasympathetic activation to dampen the sympathetic nervous system/hypothalamic-pituitary-adrenal axis feedback loops. Research by Dr. Nirbay Singh, which is currently in press and soon to be published by Research in Autism Spectrum Disorders (which will soon bring the Pubmed search total to ONE), demonstrated that adolescents with Asperger’s syndrome can successfully use a mindfulness-based procedure to control aggressive behavior.
• Executive Function: Impaired executive function in individuals with Asperger’s can result in the person being uninhibited and impulsive, often causing behavioral challenges that make school and workplaces difficult. Deep-breathing exercises have been shown to activate the prefrontal cortex which is responsible for executive function. This is the basis of deep-breathing exercises currently recommended by psychologists to calm individuals having attacks of anxiety. The ability of mindfulness meditation to activate the prefrontal cortex might be capable of increasing the executive function of individuals with Asperger’s by preventing meltdowns and panic attacks before they begin.
• Empathy: One of the most commonly identified deficits in children with Asperger’s Syndrome is a lack of empathy, which has been linked to insufficient mirror-type networks and a limited ability for Theory of Mind. Research into mindfulness meditation has identified that increased awareness of your emotional and bodily states can activate your insula and anterior cingulate cortex and allow for an increased awareness of others’ feelings and emotions. Additionally, increased prefrontal and temporal lobe activity might be able to improve the ability for Theory of Mind. Perhaps just the practice of taking time to think about the feelings of others may increase prefrontal cortex activity and assist in the development of true empathy.
• Sleep: Parents of children on the autism spectrum frequently report that their children have difficulty sleeping. One of the most common nutritional interventions recommended among children on the spectrum is the use of melatonin to aid in falling asleep. Recent studies, including several by Dr. Malow at Vanderbilt University, have shown success in treating insomnia in children with autism with the use of melatonin supplementation. It has also been shown that long-term meditators have a higher baseline level of melatonin, suggesting that meditation might be able to aid in a major quality of life issue for children with autism and their families.
How Can We Bring Mindfulness Meditation to Children on the Spectrum?
Once research has identified the potential techniques and benefits of mindfulness, how will we bring these strategies to the larger community of children, adults, and professionals? The support of licensed therapists and neuroscientists will be critical. In addition to any cultural sensitivity individuals might have about the practice of mindfulness meditation, often times parents have already been down many avenues to try and help their children. They are just plain tired and worn out from the battle and before they commit to another avenue they want to see some evidence. It will be the job of the scientific community and the community of therapists who already have an understanding of the difficulties and challenges this population faces to come together and provide that research and guidance.
For example, the practice of mindfulness is being used to teach concentration, attention and empathy to students in the San Francisco Bay Area by the Mindful Schools program; additionally, the Mind Body Awareness Project is teaching mindfulness in Oakland area juvenile detention centers, and both programs are reporting positive results. Expanding programs already in place to target individuals with Asperger’s Syndrome would be one option for how to carry this work forward and offer even more benefits to the greater community.
Within the mainstream mental health community, control of the mind and body through deep-breath relaxation is already a commonly used tool. My boys’ mainstream psychologist in our exceptionally conservative North Carolina town has already taught them how to take ten deep breaths (what he calls “turtle breaths”) in stressful situations or to reset themselves following a meltdown. This technique has been taught to and embraced by their teachers in the classroom setting and hopefully the professionals involved with helping them, including teachers, administrators, and specialists, will see these as tools to be tried with other children experiencing similar issues.
Ultimately, though, it will up to the parents. For this approach to be successful I believe it will have to be a family venture. It will need to become more than just the latest attempt at a fad therapy for the kids, but a way of life for the whole family. In the process, the parents, like my wife and I, will see that not only can this help their children, but they themselves can benefit from mindfulness.
Over the last year, I have introduced the concept of meditation to the boys through my own example and with the help of two good children’s books (Peaceful Piggy Meditation by Kerry Lee Maclean and Each Breath a Smile by Thich Nhat Hanh). At the age of six it is much too early to speak to the success of my venture. In fact, it has yet to truly begin, but they have started to take deep breaths on their own in order to calm themselves. They are also quick to remind me that I should be meditating instead of yelling, demonstrating that they at least understand the concept and benefits.
The next step for my own children will be to cultivate awareness that this principle of mindfulness could be deployed beyond its current use as a response to troublesome situations. We will next try to teach them to use these techniques to exert some control over their thoughts and their racing minds in order to avoid these “emergencies.” Accepting the fact that there will be struggles, mindfulness will also help them to move beyond the meltdowns, anxiety and stressful situations and learn to live more within the current moment, not dwelling on the past or worrying about the future.
Spreading the practice of mindfulness to persons living with the challenges that come with having Asperger’s Syndrome will truly require a great collaborative effort. So, to anyone teaching mindfulness meditation or studying the neuroscience of mindfulness meditation, I urge you to seek out individuals with Asperger’s Syndrome. Research into using mindfulness meditation to impact emotional regulation, executive function and empathy in these individuals would be a fantastic beginning, but certainly not an ending. I believe strongly that a great benefit could be achieved by a significant number of people and that much could be learned about the human brain in the process. Children and adults living with Asperger’s Syndrome have a tremendous amount of potential good to offer the world and a tremendous amount to teach the world as well.
Let’s help them help us.
Surprisingly, what struck me the most in my studies was how much the practice of mindfulness could potentially benefit my children. My boys were diagnosed with Asperger’s Syndrome at the age of three. They both possess incredible brains—that much is clearly evident to anyone who has interacted with them. Their reading skills, amazing memory and recall, innate sense of music and uncanny ability to detect patterns are rare if not unprecedented. And yet, they are disabled by a host of sensory issues, anxieties, obsessions and misunderstandings of the world that threaten to disable them and keep us from participating in even the simplest childhood activities. As their father, I feel a tremendous pressure to guide their amazing potential into useful lives, and through the study of mindfulness I think I may have found a path to help them.
Intuitively, I can tell I’m on the right track. Several times over the last year the boys have confirmed the rapid fire nature of their minds and the need to bring some order and control. One of the boys once told me that he “rocked in his bed” so that he couldn’t hear his mind, which was keeping him awake by racing off downstairs. (When asked what his mind was saying he replied, “I don’t know. I don’t speak brain.”) And recently my other son told me that he has difficulty sleeping because he can’t stop thinking about his nightmares and that “the part of the brain that lets other people not think about their nightmares must be broken in my brain.”
What Is the Current State of the Science?
While I’m a believer in listening to and following one’s gut instincts, I’m also a biologist by training and so I was interested in the science of what’s going on here. Recently I read two seemingly unrelated books that both spoke to the potential benefit of studying the effects of mindfulness meditation on individuals on the autism spectrum. The first was Animals in Translation by Temple Grandin, an amazingly successful individual with autism who was featured in the award-winning HBO film “Thinking in Pictures.” The book discusses some of the physiological characteristics of the autistic brain and how the responses to stimuli in individuals with autism are similar to the responses seen in Dr. Grandin’s decades of work with animals.
By sheer coincidence the next book I happened to read was Buddha’s Brain: The Practical Neuroscience of Happiness, Love, and Wisdom by Rick Hanson (with Richard Mendius). The book discusses the physiological changes that can be brought about in the brain through the practice of meditation. I was struck by the similarity in the areas of the brain discussed in these two books. For instance, much of Dr. Grandin’s book talks about the fear response and inability of the frontal lobe to control the immediate fearful response of the amygdala, resulting in a near constant state of fight-or-flight response in individuals with autism (a situation I’ve seen in my own children). Buddha’s Brain discusses the dampening of this response by activation of the parasympathetic nervous system with deep breathing exercises. Additionally, both books discuss the negativity bias and the history of brain evolution among other aspects of anxiety and stress.
I was quite pleased to see my scientific reading match what I was intuitively feeling my boys most needed. Encouraged, I set out to see what research or writing was available discussing this exciting possibility for help for individuals with autism. I was shocked by the results. I found only one book, Asperger’s Syndrome and Mindfulness by Chris Mitchell. It is an insightful book written by an individual with Asperger’s which confirmed this as a possible path to resolve many of the difficulties I see my children facing. However, it was only one book.
Knowing that the scientific study of meditation was increasing rapidly and becoming more and more accepted in mainstream scientific circles I searched Pubmed, the National Institutes of Health (NIH) database of peer-reviewed research articles. A search for meditation yielded 2,060 articles. Autism: 16,983. But autism and meditation combined yielded a grand total of ZERO. I was stunned. I checked my spelling. I tried other words. The results were the same: Zero. But yet, many of the problems that confront individuals with Asperger’s were there. Meditation and anxiety: 293 articles. Meditation and cognition: 245. Meditation and OCD: nine. These are all recognized problems in the ASD population, yet no one appears to be tackling them with meditation within that population. And it isn’t because they aren’t considered important problems. A review of NIH grants showed 228 active grants for the study of autism and the 2008 Federal Interagency Autism Coordinating Committee report showed that $54 million dollars was spent on treatment and intervention research grants. However, none of the research is currently employing meditation or mindfulness, with the exception of one using mindfulness-based stress reduction for parents of children on the spectrum. Much of the research focus seems to be in the effort of pharmacologically medicating these problems into submission, but I’d much prefer the meditating approach to the medicating one.
How Can Mindfulness Help?
Specifically, I can see four main areas of struggle for people with Asperger’s that could be helped through the practice of mindfulness meditation, although I anticipate as the practice evolves numerous other benefits would become apparent. I would love to see more extensive research in the following areas:
• Emotional Regulation: Functional and structural abnormalities of the amygdala have been identified in individuals with autism and Asperger’s leading to difficulties recognizing and regulating emotions. The emotional pinball “game” that results in wildly inappropriate highs and devastating lows often leads to anger, anxiety and sadness. Mindfulness meditation can achieve some level of control over the fast-response of the amygdala by creating parasympathetic activation to dampen the sympathetic nervous system/hypothalamic-pituitary-adrenal axis feedback loops. Research by Dr. Nirbay Singh, which is currently in press and soon to be published by Research in Autism Spectrum Disorders (which will soon bring the Pubmed search total to ONE), demonstrated that adolescents with Asperger’s syndrome can successfully use a mindfulness-based procedure to control aggressive behavior.
• Executive Function: Impaired executive function in individuals with Asperger’s can result in the person being uninhibited and impulsive, often causing behavioral challenges that make school and workplaces difficult. Deep-breathing exercises have been shown to activate the prefrontal cortex which is responsible for executive function. This is the basis of deep-breathing exercises currently recommended by psychologists to calm individuals having attacks of anxiety. The ability of mindfulness meditation to activate the prefrontal cortex might be capable of increasing the executive function of individuals with Asperger’s by preventing meltdowns and panic attacks before they begin.
• Empathy: One of the most commonly identified deficits in children with Asperger’s Syndrome is a lack of empathy, which has been linked to insufficient mirror-type networks and a limited ability for Theory of Mind. Research into mindfulness meditation has identified that increased awareness of your emotional and bodily states can activate your insula and anterior cingulate cortex and allow for an increased awareness of others’ feelings and emotions. Additionally, increased prefrontal and temporal lobe activity might be able to improve the ability for Theory of Mind. Perhaps just the practice of taking time to think about the feelings of others may increase prefrontal cortex activity and assist in the development of true empathy.
• Sleep: Parents of children on the autism spectrum frequently report that their children have difficulty sleeping. One of the most common nutritional interventions recommended among children on the spectrum is the use of melatonin to aid in falling asleep. Recent studies, including several by Dr. Malow at Vanderbilt University, have shown success in treating insomnia in children with autism with the use of melatonin supplementation. It has also been shown that long-term meditators have a higher baseline level of melatonin, suggesting that meditation might be able to aid in a major quality of life issue for children with autism and their families.
How Can We Bring Mindfulness Meditation to Children on the Spectrum?
Once research has identified the potential techniques and benefits of mindfulness, how will we bring these strategies to the larger community of children, adults, and professionals? The support of licensed therapists and neuroscientists will be critical. In addition to any cultural sensitivity individuals might have about the practice of mindfulness meditation, often times parents have already been down many avenues to try and help their children. They are just plain tired and worn out from the battle and before they commit to another avenue they want to see some evidence. It will be the job of the scientific community and the community of therapists who already have an understanding of the difficulties and challenges this population faces to come together and provide that research and guidance.
For example, the practice of mindfulness is being used to teach concentration, attention and empathy to students in the San Francisco Bay Area by the Mindful Schools program; additionally, the Mind Body Awareness Project is teaching mindfulness in Oakland area juvenile detention centers, and both programs are reporting positive results. Expanding programs already in place to target individuals with Asperger’s Syndrome would be one option for how to carry this work forward and offer even more benefits to the greater community.
Within the mainstream mental health community, control of the mind and body through deep-breath relaxation is already a commonly used tool. My boys’ mainstream psychologist in our exceptionally conservative North Carolina town has already taught them how to take ten deep breaths (what he calls “turtle breaths”) in stressful situations or to reset themselves following a meltdown. This technique has been taught to and embraced by their teachers in the classroom setting and hopefully the professionals involved with helping them, including teachers, administrators, and specialists, will see these as tools to be tried with other children experiencing similar issues.
Ultimately, though, it will up to the parents. For this approach to be successful I believe it will have to be a family venture. It will need to become more than just the latest attempt at a fad therapy for the kids, but a way of life for the whole family. In the process, the parents, like my wife and I, will see that not only can this help their children, but they themselves can benefit from mindfulness.
Over the last year, I have introduced the concept of meditation to the boys through my own example and with the help of two good children’s books (Peaceful Piggy Meditation by Kerry Lee Maclean and Each Breath a Smile by Thich Nhat Hanh). At the age of six it is much too early to speak to the success of my venture. In fact, it has yet to truly begin, but they have started to take deep breaths on their own in order to calm themselves. They are also quick to remind me that I should be meditating instead of yelling, demonstrating that they at least understand the concept and benefits.
The next step for my own children will be to cultivate awareness that this principle of mindfulness could be deployed beyond its current use as a response to troublesome situations. We will next try to teach them to use these techniques to exert some control over their thoughts and their racing minds in order to avoid these “emergencies.” Accepting the fact that there will be struggles, mindfulness will also help them to move beyond the meltdowns, anxiety and stressful situations and learn to live more within the current moment, not dwelling on the past or worrying about the future.
Spreading the practice of mindfulness to persons living with the challenges that come with having Asperger’s Syndrome will truly require a great collaborative effort. So, to anyone teaching mindfulness meditation or studying the neuroscience of mindfulness meditation, I urge you to seek out individuals with Asperger’s Syndrome. Research into using mindfulness meditation to impact emotional regulation, executive function and empathy in these individuals would be a fantastic beginning, but certainly not an ending. I believe strongly that a great benefit could be achieved by a significant number of people and that much could be learned about the human brain in the process. Children and adults living with Asperger’s Syndrome have a tremendous amount of potential good to offer the world and a tremendous amount to teach the world as well.
Let’s help them help us.
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