Flat affect/facial grimaces

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My 4 yo daughter's official diagnosis is PDD-NOS. She actually does rather well socially...at least her attempts are good. But she does have a marked lack of expression. She has genuine smiles when she is very happy, but other than that her non-verbals just aren't really there. She also often does a "grimace" that stands out in the crowd, and looks to the side a lot. I think it sometimes puts other kids off.

Is there any way to work on this? One of her therapists had suggested the possibility of videotaping her and pointing it out to her, but then added to be careful because it might hurt her feelings or make her too self-conscious. Any thoughts?

I grimace when I smile, even when I am very happy.
I just hang out with people that aren't judgemental about that sort of thing.

Merle

Where can I find those kind of people?

right here on WrongPlanet, jonahsmom. We are mostly Asperger's autism but there are alot on the autistic spectrum, too. No one worries about how my face looks or where my eyes are looking. That's why this forum was made, so people like us could be accepted as we are.

Merle

Don't turn it into a control issue with your daughter. Teach her, do not make her do things. Set limits, but do not be abusive.

No worries. I don't get frustrated with her lack of expression. There was a time (before her dx) when she would hurt her little sister with no apparent feeling or remorse, and I do have to admit it worried me. With my son autism was so apparent because he displayed all of the classic early childhood red flags, so I understood what was going on. With my daughter that wasn't the case. Her social skills all developed on time, she has no "special interests" or splinter skills and she really didn't stim...even now lack of non-verbals and needing some extra time to process language and get her words out are the only things that really show, and most people don't even notice those things in a 4yo.

The reason I'd like to help her with it is that she wants to play with other kids and feels baffled when they don't accept her into their play. In some ways it would be easier if she didn't care. But she does.

My son is the same (just turned 4yrs, PDD-NOS/Aspergers) has quite a flat expression. He will grimace also, but he tends to do this when he doesnt like something. Maybe lots of love and kisses that went on too long for him.

Sometimes the approach of his little sister would make him do it, if he isnt in the 'mood' for her. For him it usually means he is uncomfortable with something, emotionally I think.

Temple Grandin found hugs very difficult, not just because of the tactile issue of touching, but the overwhelming feel of emotion that comes with it, she found this difficult to cope with. I think my son might be a bit like that.

Hey sorry Im rambling on here ! !, in answer to your query, I dont think I would be able to stop my son from doing the grimace thing, I dont think he is aware of it. But I think its good for me to be able to identify when things are getting too much for him. Therefore I see it a way of communication. But its kind of different if your daughter is doing it when happy.

But like everything else, it will probably pass in time and there will be something else in its place ! !

You must be a vey busy Mum, we have three kiddies and we never get a minute. Its nice to down tools, and have a chat here now and again. xx

and there's the rub of being Asperger's autistic. We are on the borderlands between two marvelous consciencenesses, neurotypical and autistic. I think we (Aspies) are rather unsuited for both. We care about things we are unsuited for, and don't care about things that matters to others. This next sentence should be full of love and hope with suggestions of practical application that would alleviate the issue, but I don't know of any that are universally successful. I learned (after 58 years) to be hyper kind and gentle with people, and although it is difficult to sustain over extended time. People respond to it positively, despite my grimace that passes for a smile and me consciously remembering to not stare into another person's eyes.

Merle

oh, and by the way, I have a friend that is AS that has that 'flat' aspect. She grew up and went to medical school and became a fine ER room physician because she was cool in crisis, unemotional while others were falling apart. She wasn't diagnosed until she was in her late 60's (because . . . well they just didn't know until 1995 or so, anyway.) She is married (to a physician that is ultra social, a usual trait in AS spouses according to Tony Attwood) and has three children( that are adults, now) and travels the world now that she is retired.

"flat effect" and grimicing/lack or facial expression aren't necessarily connected.

I was often asked "Are you ok?" or "what's wrong?" and still do sometimes. I had trouble smiling or displaying the "correct" emotional response. I had to learn that, and it is put on.

One thing is the muscles in may face where not used to smiling, I won’t sure if I was when I couldn't see myself in a mirror. Physically too. If your muscles in the face are hyper tenses due to stress and anxiety it can difficult to smile.

You can scrunch all the muscles in you face up tight and then let it go under its own momentum. It is kind of like the face you make when taking a dump (sorry to be crude). If you repeat this several times, you might find it easier to smile. I can explain how it works if you like.

Nowadays I am emotionally blunted in many respects but can fain emotion quite well, compared to before when I was more emotional.

I think there is also a medical condition that can result in flat or seemingly inappropriate facial expressions. Apraxia? I'm not sure if I remember that correctly, but a friend's son was diagnosed with it. In his case, he cannot learn to make a different face, since the issue is neurological. I would consider asking about it, just so you know what she's up against.

This may sound silly, but the kids probably just need to know her a little better.

My suggestion, have her "bring the ball". Let her be the one to bring a cool group toy somewhere there are other kids, and that should draw the kids in enough that they will want to play with it. You be there so that when the other kids come over wanting to play with the new toy you can invite them into the game (making sure to say would you like to play with "x"'s toy too, it's really fun!). After a while of playing with her they will be more used to her expressions/lack thereof, and should be just willing to play.

Sounds really shallow, but we are still little here.

I also make facial expresions. I'm not sure if this was always the case but when I was younger I would do a funny cough every few minutes (like ahem). Any way, I know I do it but cannot control it very well. I try not to do it in public places but when I viewed my brothers wedding video I noticed I was pulling faces while they were cutting the cake (looked like I was making fun of them). How embarassing!!
I think it helps if the child knows they are doing it (they can't try to stop it if they don't know) but not to make a big issue of it. My 8 year old niece also does it and I smile at her (she knows I do it too) when I remind her but I also tell her, if she can't help it, to turn the other way and do a big one to relieve the pressure.
Good luck and try not to let you child think it is bad. There's a lot worse...your child could be a biter or a bully (even normal children do that ).

This doesn't sound silly to me at all ... in fact, it seems totally sensible.

And I really dislike the artificial smiles that I see a lot of people put on.

I'm mostly expressionless, and have (in my opinion) a pretty ugly smile (no pun intended). In my late teens, strangers would come up to me in the street and say "Smile", and I would think at them "F*** off ... I am smiling".

But we are not alone in this. I spent two years in New Guinea, where the natives are mostly expressionless, particularly the highlanders. Someone might have been involved in a car accident and have a horrific leg injury that would have a caucasian writhing in agony, but the native would just sit there with a blank look on his face and say "LEK BILONG ME I PEN" ("My leg hurts").

I think tolerance and understanding is the key. Please don't make her do anything that is unnatural to her.

How, then was she diagnose with pdd-nos/autism? I'm confused.

A friend trying to help me showed me how to practice in front of a mirror. Pretty much a monkey see, monkey do exercise but it helped me shape my face more appropriately in many situations.

Motivation is generally my problem.

My younger sister practiced a LOT. She's really pretty good at applying an appropriate facial expression but still comes across as aloof... It helped her a lot socially and professionally.

Starting at a young age would probably help. I think it's about learning how it feels to use muscles to create an expression and then mirroring others to fit in better.

rj