Motor Delays and Autism – And Seeking Competence

In the last week, there has been press about a study on very young autistic children. The study claims to show that both gross and fine motor skills are delayed in autistic children. This is neither a surprising finding nor a new finding – although looking at children this young (14 to 33 months!) may be. One does wonder how a 14 month old child can be diagnosed with autism.

A soccer (football) ball. This is something I could not interact with in any sort of interesting way. I still can't. Licensed GNU Free Documentation License 1.2. Credit goes to Sir James and Christopher Bruno via Wikimedia Commons.

A soccer (football) ball. This is something I could not interact with in any sort of interesting way. I still can’t.
Licensed GNU Free Documentation License 1.2. Credit goes to Sir James and Christopher Bruno via Wikimedia Commons.

But, regardless, it’s well known that autistics usually aren’t particularly athletic or coordinated. Certainly, not all autistics (there probably are autistic professional athletes), but enough of us are un-athletic and uncoordinated that it’s part of some diagnostic criteria.

For me, I know I can personally speak of two issues I have – the first is simply getting my body to do what I want it to do, in response to sensory input, fast enough.  That’s always been an issue, which I believe affects my fine motor skills in particular.  But my second issue is something I suspect may be less common among autistics (but certainly not unique to just me) – a general lack of any reasonable voluntary “fast twitch” type of muscle movement.

The first is why it took years for me to handle handwriting (I’ll note that when I started getting the hang of it and started learning cursive, I actually got rebuked by a teacher for learning a letter that I wasn’t formally taught yet – and people wonder why our education system stinks!).  The second is why, to this day, I can’t do anything that requires fast movement, even if it doesn’t also require processing lots of sensory input.  For instance, I can’t hit a punching bag hard or kick something hard.  I certainly can’t throw anything.  I was always last in my class for running.  I can’t jump high or long or whatever else.  Yet, at least for my lower body, it isn’t because I lack strength – I have very strong legs.  It’s because I can’t do anything with muscle movement quickly.  When you combine sensory processing and fast movement – hitting a ball with a baseball bat – I am hopeless (I’ve never done this – and I did try!).

There’s also a third issue – my upper body is extremely weak, and seems to resist muscle mass building (I spent three years lifting weights – never progressing on the upper body, despite good training advice and plenty of change in my lower body).

I was sort of lucky, in that I had lots of what would now probably be called sensory integration therapy as a child to help with coordination and such. I’m not sure how much it did or didn’t help me, but certainly I had lots of it. But they missed something: there were things I was good at.  I wasn’t miserable at everything, just miserable at pretty much everything you might do on recess or in physical education class.

But I was good at some things – I’ve always been good piloting pretty much any type of vehicle. It took me a while to learn how to ride a bicycle (probably because I believed people’s explanations on how to do it – which research has shown conclusively is generally not only hogwash, but which is actually impossible to do – read about countersteering – and never mind training wheels encourage this bad learning). And certainly with other vehicles, there was a learning curve – it’s complicated to learn to drive, for instance. But I learned at a fairly typical pace. And this is true with other vehicles too – I can do basic plane flight (and did a substantial portion of my flight training, but, sadly, ran out of money at that stage of my life!), motor boating, motorcycling, ATV riding, etc.  I can tow – and reverse – a trailer better then most people I know.  Obviously these things require motor skills.  So why can I do this?

Well, a lot of this is stuff that doesn’t require a lot of fast movement. That said, the countersteering movement needed on a bicycle or motorcycle is a pretty quick movement. But, in general, slow and smooth is better for these things. Sadly, I think the common expectation is that someone with poor coordination couldn’t possibly drive a car (and certainly couldn’t fly a plane!). This coordination thing is seen as a global sliding scale, applicable to all areas of coordination. Yet I remember learning to ride a motorcycle in motorcycle training – I had significantly less trouble than many of the other students, despite the fact that it was likely that every one of them would be rated as having more coordination than me, in a general sense.

My wife has a theory – and I have to agree: that we’re often good at things that people expect to need to be taught, but bad at discovering how to do things on our own that other people might learn “automatically.” Obviously, I know I can’t be taught some things, and I’ve also made plenty of discoveries – how to walk, for instance (I started walking at a very young age – the only milestone I met early).  Bicycling is another one that I learned by discovery on my own (much like most people do), albeit years slower than my peers (my peers figured out countersteering subconsciously, as I eventually did too, but it took a lot longer). But riding a motorcycle was a quick and easy process for me. So was learning the basics of flying a plane. I did better than average at both.  I could succeed – and actually get quite good at these things.

I think this is where the adults in my life failed when I was a child. There were things I was or could be good at. In Junior High, I remember running a mile and a half in a time that beat the vast majority of my classmates – as a result of personal conditioning I was doing at the time. I wasn’t the fastest kid, but I wasn’t the slowest either. Because the teacher was so used to seeing me in last place in everything, he actually accused me of cheating and made a point of counting laps the next time we ran (he found I was being honest; no, he didn’t bother apologizing). He assumed that because I couldn’t sprint, I couldn’t run longer distances – yet I had plenty of strength, endurance, and an efficient cardovascular system. I had what was needed for long distance running – not at a highly competitive level, but certainly substantially better than average. This was missed. So were so many other possible areas where I could be successful.

That’s part of my concern with the idea that autistics are just uncoordinated. Maybe we are. But that doesn’t mean that we are in everything. I would hope that when parents, teachers, and therapists work with us, they would not only look at our weaknesses, but also our strengths. For children with low confidence and too many failures, having an adult recognize someone’s strong abilities is important. Giving us a chance to, if not win, at least make a good showing is important. I was last in pretty much every sport – because the sports I was good at weren’t what we did in school. That sucks – it certainly (along with PE teachers that shouldn’t have been anywhere near a child) made me hate athletics with a passion.

Fortunately, I made these discoveries on my own – I do have skills that were unrecognized, and which I developed despite neglect by people who should have been able to see them. It’s my hope that one day it will be the goal of adults in the lives if children to not only find things where the autistic child does bad, but also find those areas to grow and nurture where there is natural talent and ability. There is a lot more here than too many adults & professionals think. And of course this is true well beyond simply athletic ability.

The Evil of Driver’s Licenses

I’m seeing a lot of concern among autistics over a proposed Virginia bill that would allow individuals to add an indication that they are autistic onto their driver’s license and ID card (among other things, like designating an emergency contact – not printed on your license – so that if police find your dead body, they know you want your wife to know). I recognize not everyone has a license, but I’m going to use that term throughout below, so if you have an ID card, just know I know you exist too and the below applies to you too.

There’s some concerns that I’ve seen.  Some are legit.  Most, however, are fear of not what the law does, but what the law could do should something else happen. A lot of these fears are similar to fears about Obama Care (“Death Panels! Rationing!”) – not things that the law actually does, but things people fear could happen. It’s important to be skeptical of claims that the government will harm, just as it’s important to be skeptical of claims the government will help! We need to be careful what conclusions we jump to, and ensure they are based in fact.

So, what does the bill do? That’s simple. In addition to allowing the person (not their parent, not their spouse, not their doctor) to designate an emergency contact voluntarily in the computer records law enforcement can access (this is similar to laws in most other states, and, again, you don’t have to list anyone), you can voluntarily indicate you are autistic and provide proof. You don’t have to volunteer. You can, but you don’t have to.

Here’s the section:

When requested by the applicant, and upon presentation of a signed statement by a licensed physician confirming the applicant’s condition, the Department shall indicate on the applicant’s driver’s license that the applicant (i) is an insulin-dependent diabetic, or (ii) is hearing or speech impaired, or (iii) has an intellectual disability, as defined in § 37.2-100, or autism spectrum disorder, as defined in § 38.2-3418.17.

The new section is iii.  The part about being an insulin-dependent diabetic (probably added in response to police questioning the presence of syringes) or hearing/speech impaired (to explain why the person didn’t respond to police), they are allowing someone to designate themselves as autistic with a doctor’s note (required in a different section) saying they are. Again, you don’t have to say this. If you don’t want it on your license, should you live in VA, and should this law pass, simply don’t ask for it! It won’t show up if you don’t request it to.

Here’s what I’ve seen people say about this law (paraphrased):

  • No autistic adults were consulted about this
  • It’s going to limit employment opportunities for autistics
  • It’s establishing a registry of autistic people, presumably for evil purposes (think Nazi Germany)
  • Police won’t know what to do with a license that says “autistic” and may either discriminate or simply do whatever this was intended to prevent police from doing since they don’t understand autism
  • Take the control of who you disclose to out of your own control
Not a real Virginia license, so don't try stealing her identity!

Not a real Virginia license, so don’t try stealing her identity!

Let me address these.

First, I agree about the first item – if no autistic adults were consulted, this is a bad thing. We should be consulted! There’s plenty of easy-to-find autistic adult groups. Now, I don’t know if autistic adults were consulted or not, but we should have been if we weren’t.

For employment, I don’t think this law will have significant effect. First, most employers don’t require a driver’s license for interviews or applications. I’ve probably applied for 100+ jobs in my life and interviewed at 20 or 30, including delivery jobs. I’ve never been asked for a driver’s license to do so. I have been asked for a driver’s license number, but not the license. I believe this is to show I have a license, although I question why they ask for the number – it’s not useful without additional permission from me to access the drivers’ license history database. But, regardless, the number won’t disclose I’m autistic should I indicate such on the license. I think this is a relatively small issue – sure, if you use the ID after employment to validate your identity (note you can use other forms of ID), then they may know, so, yes, you should consider that when you ask for your license to indicate you are autistic. But the risk is relatively low (yes, it needs to be evaluated, and, again, if you don’t want the risk, don’t put it on your license!).

I’ll also add that, for some people, disclosure of being autistic may help them get a job. I’ll get to this in a minute, but being seen as autistic, by an employer that believes in diversity, is a lot better than being seen as, say, high on drugs. Not everyone has the privilege of passing as a “typical” person, and the wrong label may hurt even more than the right one.

And, finally, for someone who needs employment or other accommodations, having a state-issued document that says, “YES, this person is autistic!” could be very useful – it makes it a lot harder legally for someone to say, “Well, I didn’t have documentation that they were disabled” if it was shown to them. I can see this helping in all sorts of things, from employment accommodations to being questioned about a service animal (which is illegal – the questioning that is – in most cases, but which happens nonetheless and different people may want to have different responses, such as showing documentation rather than arguing or leaving).

As for establishing a registry, again, each person needs to consider that. If you answer the questions about mental conditions on the application for a driver’s license and indicate you are autistic, then, yes, the state knows. That’s independent of whether or not you also request the driver’s license say you are autistic. If you don’t answer that question with information that you are autistic (and I don’t – I don’t believe it has any impact on my ability to drive, which is why they ask; they want to know what impacts my ability to drive, which, for me, is things like my eyesight). Very likely, if you are on medicaid, the State also has your information. So does your school district if you were on an IEP. So does Social Security if you get SSI/SSDI. So does Medicare if you get that. So, while we should be concerned about data collection by government, and the uses of this collection, we should also be realistic that for many autistics, this information is already in their hands, and disclosing on the driver’s license doesn’t do any additional harm – you’re not telling the state something they don’t already know. That said, again, it should be up to the individual. Again, it is.

I’ll get to the police issue in a minute. But I want to address the last bullet point first – that this limits control of information. We do show licenses or ID cards frequently in this society, and, obviously, anyone who sees a license that says you are autistic may see that and now know you are autistic. This is a valid concern and needs to be weighed against any possible benefits from having them know. If you feel the benefits don’t outweigh the problems, don’t have them add it on your license!

Okay, on police, which I suspect is the main reason someone is proposing this. I agree that police need better training – they have no idea how to deal with autism, mental illness, or any number of other things (heck, they don’t generally know how to de-escalate situations). And we do need that training. This bill doesn’t prohibit training. Rather than opposing a bill that says nothing about training, it’s probably better to focus on a bill that would create better training. That’s more likely to actually accomplish the training! Stopping this bill won’t suddenly cause police to be trained.

But here’s the reason why I would support this bill: some people don’t have the privilege of being considered “normal” if autism isn’t disclosed. Too often, these people are assumed to be rude, aggressive, drunk, high on drugs, dangerous, or combative when they are not any of these things. While an officer, employer, or other person might not know what “autism” means regarding these things, at least some – who don’t understand the term autism – will still respond by giving the person the benefit of the doubt, precisely because they know they don’t know (at the risk of sounding Rumsfeldian – see the video below – although I’ll add that Rumsfeld was logically correct, and, sadly, most people were not logically sophisticated enough to get his point).

Even better, this is validated. Maybe it’s not validated well (people can and do forge doctor’s notes, and we can also debate whether or not doctors should be gatekeepers on an autistic label). Maybe doctors shouldn’t do the validation. But doctors are trusted, as is the state DMV, at least by most police. Maybe this is unwise, but it’s the current state of the world. So, when this is on a driver’s license, it’s going to be assumed correct. If I hand the person an autism card, tell the person I’m autistic, or don’t communicate my label at all, the other person may either not believe me (“You are trying to use this as a get-out-of-jail-free card”) or may attribute my motive to something else (“You’re drunk” or “You’re an ass”).

Here’s the example. Let’s say I’m sitting on a bench on a city pedestrian mall, and the local PD comes up to me to find out if I’m (1) in need of assistance and (2) drunk. If I’m in need of assistance, they’ll likely get it for me, but the real point is probably #2 – they want to know if I’m drunk, and, if so, remove me from view of tourists “for my own good.” This has happened to me several times. Now, if I can talk, I can simply say, “I’m fine” and maybe be believed. But something led them to believe I was drunk – they don’t question everyone sitting on that mall! So maybe they believe me, maybe they don’t, particularly if I have a speech issue. I could hand them an autism card (which might not be a bad idea). And maybe they’ll believe it, which would be awesome. Or I could hand them my driver’s license that indicates I’m autistic. Maybe they won’t know what to do with it, maybe they’ll still haul me off to the drunk tank (I’m trying to think of a worse place for an autistic to end up), but maybe, just maybe, they’ll say, “OH! This person might not be drunk.”

Now, is there downsides to having your license say you are autistic? Of course. That’s why it’s important that it be an individual choice. But you don’t create choice by taking away a choice (preventing me from putting my label on my license won’t respect my self-determination!).

I don’t oppose it. I would tell people to think about it carefully. And if unsure, you can decide NOT to request it be added to  your license (shouldn’t take any actual work by you – they only put it on there if you ask for it). You should also be able to get it removed, much like you could decide you want to remove the organ donor status on your license, should you change your mind.

This is not the big evil in the world of autism right now. Now, if you want to talk police training, I’m all for that, and I think we should get moving on that.

The Risks of a Neurotypical Driver

A road sign reading "Watch Out" with a cartoon car heading directly towards a cartoon bike heading the opposite direction

Watch Out <> By KEVIN, Licensed CC BY-NC-SA 2.0

First, I’ll start by saying this: if a person would be at a high risk of killing or injuring themselves or someone else while driving a car, they should not drive.  But note that I didn’t say “if a person would be a dangerous driver,” as that’s a slightly different statement and would bar just about every teenager from driving.

Second, I’ll state that this post is US-centric.  I know other countries have different rules for getting driver’s credentials.  I don’t know what those rules are, nor do I know if they are better or worse than the USA’s.  So you’re warned.

There’s a lot of autistic people old enough to have driving credentials, but who haven’t obtained them.  I’ve seen a lot of reasons, with the most common being:

  • They feel they would be a danger while driving a car
  • Their parents feel they would be a danger while driving a car
  • They have no desire whatsoever to drive a car

I’d add I think there’s a forth reason: Learned helplessness.  And also a fifth reason: different expectations for autistic people than neurotypicals.

Certainly some people shouldn’t drive.  Including some autistic people.  I agree 100% here.  And if someone tells me they would be a danger while driving, I’ll take their word for it and not try to convince them otherwise.

But I’d like to look at the forth and fifth reasons.  First, let’s look at what I mean by learned helplessness.  I know that’s a triggering phrase and that it has a lot of pop psychology meanings.  I ask readers to put those aside and allow me to explain what I’m meaning by that.

Many of today’s young adults had the fortune – or misfortune – of having an autism diagnosis from an early age, accompanied by IEPs, special education, therapies, specialists, etc.  Through all this special labeling and treatment, it’s easy for one thing to be made clear to an autistic person: you’re different, and the normal way of doing things won’t work for you.  It’s also easy to make it clear that the experts know all about your autism, so you should listen to them.  While I agree early diagnosis and appropriate services are good, I think it’s easy to teach you’re not as capable as others.  It’s easy to teach the person that they don’t have social skills, don’t have the ability to plan things, have motor skill issues, have sensory issues, and can’t concentrate.  And from there it is easy to guess that these same difficulties would manifest in certain ways while driving.  Of course this isn’t 100% true – shouldn’t these same difficulties make something like climbing a tree difficult?  Yet I know tons of autistics that were frequent climbers (to their parents’ horror) at early ages.  I think the difference is nobody told them their autism would make tree climbing hard.  Many individuals are used to being told what will be difficult for them, so why would driving be different?  Why would they disagree, even if it wasn’t true?

That’s how we get to the fifth reason: different expectations for autistic people and than neurotypicals.  What’s the expectation (in the USA) for a 16 year old getting a drivers’ license (or whatever age is legal where you are), other than demonstrated competence (to some degree) behind the wheel?  If the child is neurotypical, the expectation seems to most often be two-fold: “Get good grades” and “be born long enough ago.”  If the neurotypical meets these two criteria, they can begin to gain the skills to demonstrate competence as a driver.

But…are these neurotypicals always good, safe drivers on day one of drivers’ education?  Of course not.  They accidentally run red lights, they drive the wrong speed, they miss cues from other vehicles, they don’t realize that that kid standing by the side of the road might run into the road.  Simply put, they have a hard time putting together the whole picture and all sensory inputs, and figuring out the social rules of driving.  At this point, people think, “Oh, autistic people have trouble with big picture thinking, sensory inputs, and figuring out social stuff.  So they’ll do even worse.”

There’s a few problems with this logic, however.  The first problem is that research doesn’t seem to bear this out!  This article cites some research that shows 12% of teenage autistic drivers with autism have received a ticket, compared to 31% of teens in general.  It also shows autistic drivers are less likely to have wrecked – 12% of autistic drivers vs. 21% of teen drivers.  It’s not a stretch to say that the autistic teens may be twice as safe as non-autistics.  That said, I haven’t read the study itself (no academic affiliation right now), and it does sound like the study had a small sample size and may have some selection bias.  But, regardless, I couldn’t find one link from Google about an autistic driver to causing a fatal accident (I did find some very young autistics who aren’t old enough to be a license but who did cause property accidents).  I did note I found many about autistic people (typically pedestrians) being victims in accidents, however.  In fact, in addition to those with a high “functioning level” (roughly meaning being in a typical school classroom and planning on going to college), two other things stand out as being associated with whether or not an autistic person has a license as a teenager: the experience of their parents in teaching teenagers to drive (the more experience, the more likely the autistic is to drive) and the presence of driving skills in a student’s IEP.  Imagine that: if you teach a person to drive, they are more likely to become a licensed driver!

Heck, Fehr in Das automanische Heimweh: Thesen zum Autozeitalter, stated that cars essentially turn drivers into autistic people, relating to how they isolate themselves from others while driving.  So it’s okay for neurotypicals to drive, even if they  become autistic while driving (according to Fehr!), but not okay for an autistic to do something associated with neurotypicals.  Interesting indeed.

Regardless of Fehr’s statements (which I don’t agree with), I do believe that autistics are held to a different standard.  When mom or dad puts their neurotypical teen into the driver’s seat for training, they don’t expect the teen to be a good driver.  But they do expect him to be able to learn.  So when he blows through a stop sign, slams down hard on the brake, and nearly runs over the curb, it’s attributed to lack of training.  When an autistic kid does the same thing, it’s proof of lack of aptitude.  Thus, the expectation for the autistic kid – too often – is “Show that you are a ‘safe’ driver and we’ll teach you to drive.”  How can that happen without training?

Of course there are variations in abilities.  Some autistic people really will not ever be able to competently drive a car.  Of course some neurotypicals fit in this category too.  And some autistics could earn a living from driving, whether it’s a taxi, 18-wheeler, or race car.  Everyone should be evaluated individually, but the standard shouldn’t be “can they drive ‘safely’.”  It should be: With training, could this person become a competent driver?  That’s a different question entirely.

It’s different due to the definition of “safe driver.”  What’s a safe driver?  It turns out that many accidents have little to do with skill of operating vehicle controls.  What causes fatal accidents?  The NHTSA has a bunch to say, using their 2009 statistics:

  • 38% nationally involved at least one driver with a BAC > .01%.  Clearly drinking and driving is bad (32% of accidents involved at least one driver with a BAC > .08%).
  • 31% of fatal accidents involved speeding
  • 54% of fatalities were not wearing seatbelts (note that > 50% of people wear seatbelts, so non-seatbelt use is significant in fatal accidents)
  • 16% of fatal accidents involved distractions (such as cell phones or food)
  • Early morning driving is particularly deadly (2:00 AM – 2:59 AM has 3x the number of fatal accidents as 7:00 AM – 7:59 AM; note this is absolute number, not percentage compared to number of miles driven or cars on the road at those times)

Of course operator skill and ability reduces accidents as well as not driving drunk, not speeding, and avoiding distractions.  That’s why everyone driving should get good driver’s education.  But autistics may be at an edge, particularly if we follow the law.  Everything in the above list, except early morning driving, is illegal.

I’ll also throw out my experience.  I’ve been a licensed motorcyclist for the last 5 years, and got my automotive license at age 16.  I’ve driven cars, driven trucks, riden motorcycles, riden ATVs, ridden scooters, driven RVs, pulled trailers, flown planes, piloted boats since a young age.  I’ve also done some flight education (dropped that due to money, not ability as I had no problem managing tasks such as maintaining altitude, speed, fuel mixture, engine RPM, and compas direction).  My wife (also autistic) was licensed at 16 for cars and is motorcycle license.  She’s driven just about everything with two or more wheels on it since she was a young teen, including scooters, motorcycles, early automobiles, tractors, and plenty of others.  We both have driven sticks, including vehicles that required double clutching or other complex actions (such as manually advancing the timing).  Neither one of us has had a serious accident, and we’ve only got a handful of tickets (speeding!) between us.

I took to driving very quickly, as did my wife.  I’m pretty sure either of us could drive almost any vehicle out there.  Some things took me a bit to learn (loading a boat onto a trailer in 40 MPH cross-winds is difficult.  For anyone).  But I learned.  I was given the chance to learn.  (edit: I’ll also add that both of us believe driving is much easier than things like walking, as far as motor skill requirements; the car does what I want, my legs don’t always)

If you can’t drive, that’s fine, please don’t.  But I encourage people to not immediately dismiss the idea of an autistic driver.