Rigidity of thought

Post Reply New Topic

Hi, my 5yo daughter is currently being assessed for an ASD. The feedback we have had from the Drs is that it may be a working diagnosis as there isnt enough evidence for "rigidity of routine". I just wanted to ask what that means exactly and how that manifests? I may be missing examples of this and just wanted to be clear on what this means before we get the final diagnosis. Thanks

I think they're telling you a load of rubbish.

My 8yo was diagnosed and she had no rigidity of routine. She does like things to happen as she's used to to a certain degree but this certainly wasn't a focus of the assessment, and they even said to me that despite her special interests they didn't appear to prevent her changing focus and doing other things. She demonstrated poor social communication skills (literal thinking and failed the ice cream test and inability to keep conversation going etc.) and I spoke about her special interests and habit of collecting things. They already knew she had challenging behaviour and meltdowns because I was phoning them up begging them to move her assessment forward. Can you give more information, what did they say she did have that demonstrated autistic traits?

Yes I think you are right, well we will see it through and get a second opinion if necessary. Thanks

We have meltdowns, anxiety resulting in teeth grinding, biting and hitting herself, low self esteme. She cannot sit still or be quiet, constantly on the go.
Socially she is overly friendly, tells strangers she loves them etc, talks over people, doesnt know when to stop, talks about her fave things to the point of boring people. But very confident and chatty, a mature vocabulary.
Not very well coordinated, clumsy, heavy handed.
Cant interact with peers, tends to scare them off by being too forward.
Overly loud, no volume control. Monotone voice.
Lack of spacial awareness.
Trouble with facial expressions and displays lack of empathy.
She also collects things, and is overly attached to objects like old bits of string off the floor etc.
She plays by lining things up, never plays tea parties of anything, just lines cups up.
Now starting to show anxiety about going places and leaving places.
Shes doing really well at school, we are starting to see her excel in maths which is great
Shes always been different even as a baby, never liked being hugged.

The things we have put in place that have benefitted her are the weighted blanket we made, stops her waking in the night from kicking about, no more bruises. Teeth grinding has stopped at night. Better behaved in the day as she sleeps better now. We have been treating her as though she has AS and she has responded to this positively and things have improved.

One thing that bothers her is that sometimes her Dad takes her to school, but its not a neat pattern, its not every other day. Shes not bothered who takes her, just the odd order of who takes her! I gave this as an example.

Lining things up can be an example of rigidity.

DS was pretty extreme with rigidity when he was younger - for instance, if I parked on the other side of the school from where I normally do, he'd freak out. However, there are all kinds of ways that rigidity can manifest.

Black-and-white or all-or-nothing thinking is a type of rigidity.

Overreaction or meltdowns when things change unexpectedly can be a type of rigidity.

Having to do things "just so" or doing them over and over until they are "right" (e.g. erasing holes in paper)

Not trying because you can't do it perfectly the first time

Perfectionism can be tied to rigidity

Wearing the same clothes, or same type of clothes, or same colors - when it isn't something to do with a sensory issue - can be rigidity.

She sounds sooo autistic, I cannot believe they are getting hung up on one element.

I think you need to point out to them (print out some research to show them if necessary) that as it's a spectrum, different individuals have different balances of the traits. Some could have none of one but all of the others, or any combination for instance.

You're in the UK aren't you? It makes me mad, I'm having this problem with my 11yo at the moment, inconclusive diagnosis with further evaluation needed. They are blaming her high scores in some parts on her OCD. CAMHS make my blood boil. If you have a problem let me know and I will tell you who to get in contact with higher up (outside of CAMHS) to kick them into touch. I'm going through this at the moment.

My google-fu informs me that "Rigidity of Routine" involves a strong need to have everything done the same way every time - the same cup for juice (but not water or milk), the same bowl for cereal (but never soup or salad), the same clothes for for church (but never school or grandma's), and so forth.

In other words, "Rigidity of Routine" is almost like having every event scripted just a certain way, and that any deviation from the script results in anxiety (at the least) or a meltdown (at the worst).

Some Aspies have this, and some don't ... when you've seen one Aspie, you've seen just one Aspie.

Your child may benefit from seeking a second professional opinion - we're just a bunch of ordinary people here.

I would point out, however - while rigidity IS one of the diagnostic criteria, it doesn't have to express itself only in routine. Like I said, lining up blocks exactly the same way every time and only playing with a toy one way should meet this criterion.

If they don't offer you a diagnosis because she doesn't fit a singular way of looking at a general issue, they're doing it wrong and you will have a case against them.

Here is the criteria in that subsection from the DSM-IV, note that routines are one of four options to ding the behavior part of the section

(3) Restricted repetitive and stereotyped patterns of behaviour, interests and activities, as manifested by at least two of the following:
a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
b) apparently inflexible adherence to specific, non-functional routines or rituals
c) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)
d) persistent preoccupation with parts of objects

From what you've written here, she definitely seems to qualify in several areas (and the fact that a change in who takes her to school bothers her should ding the routines thing.)

Also found these that you may be aware of already, but since they may be of help; there's a phone number listed: http://www.nhs.uk/Livewell/Autism/Pages ... dhood.aspx

And the National Autistic Society in the UK lists lining up toys under the behaviors section as well http://www.autism.org.uk/About-autism/A ... utism.aspx

...even on the crappy NHS website it says this:

http://www.nhs.uk/Conditions/Autistic-s ... ptoms.aspx

I totally agree with everything that has been said.

As Momsparky said, meltdowns are often a sign of rigidity. I have found this to be true especially if there are no signs of any sensory issues or obvious points of frustration at the time of meltdown. Rigidity can hide here because autistic kids can be very selective over what they define as an important routine. If they are going by some stereotypical checklist of routine breaks that "should" bother your kid,, they are likely barking up the wrong tree. My child is very annoyed by simple things like people using the "wrong font" that no one would guess if he wasn't so vocal about it. Before he starting communicating better, I guarantee you, no one would guess that.

Rigidity can be brought out by stress, too, so it can be hidden beneath regular stressers also. And if your child is not communicative, it may be hard to pick up the pattern. Lining things up and collecting things, being averse to leaving home are all signs of rigidity, in my mind. I also thought that stims are often looked at as rigidity in addition to being sensory, depending on cause. (I am not sure I am remembering right on that one, but I believe that stims can be for repetition and can bring about calming through repetition.) Also the fact that she doesn't always require a particular routine doesn't make something not a routine. As stated, if she is in a good mood she may be able to tolerate divergence from routine better than other times.

Routine is used to try to create order (and therefore a safe feeling) out of chaos and unpleasantness. Also, with girls (as well as boys) it also will show up as perfectionism. So if your child has those tendencies, that would count also.

whirlingmind - Yes we are in the UK, we bypassed CAMHs as we were not getting anywhere with them so demanded to be referred directly to Midlands Psychology who so far have seemed a lot more informed, but Im starting to doubt that now :/

momsparky & whirlingmind - thanks for the links I will check them out

Its also possible that we are already adapting to or blind to her routine because we have been aware of her AS tendancies for some time despite a lack of dx. We have been trying for a dx for nearly two years now and going around in circles. We started using recommended techniques long ago and behaviour has improved greatly. She is now in a private school which has sall classes, good firm routine and has accepted her difficulties brilliantly. They have been working with her on a one to one basis too, despite no dx.

Fnord - "In other words, "Rigidity of Routine" is almost like having every event scripted just a certain way, and that any deviation from the script results in anxiety (at the least) or a meltdown (at the worst)." I cant say that we really have that as such so maybe this is why they think there is no evidence of rigidity :/ At least now I know other things she does come under the catagory and I can point this out when I next see them.

ASDMommyASDKid - Yes we seem to have a heck of a lot of stress reactions! She is very vocal. She cries over a lot of seemingly silly things like today her sister got the hello kitty plate and she got a plain one....

Forgot to mention we may also have a little bit of Tourettes thrown in too, that was brought up at the last meeting. I thought it was verbal stimming but Drs not so sure. Her word of the moment is "CHEESE!! !", she shouts it out all the time. We have also had broccoli, concrete, Scotland, eyeballs and bogeys.... Love her to bits, she cracks me up!

LOL - she sounds awesome!

I going to add that fixating on a word is perfectly consistent with an ASD diagnosis. It is often idiosyncratic speech, delayed echolalia, or a combination thereof.

Delayed echolalia is NOT Tourette's. My son does this very same thing with different words, sometimes whole phrases, and I do believe it is considered a repetitive behavior. He did it much more often at your child's age but he still does it. We do not have a Tourette's diagnosis.