356. Secure attachment in autism: How to help neurodiverse kids build joy, confidence, and connection with Dr. Peter Vermeulen

Dr. Peter (00:00:00):

We were a little bit obsessed with the labels. The moment the child gets a label like autism or ADHD or whatever label, one of the dangers is that we reduce the child to the label and that we forget to see all the other things.

Dr. Sarah (00:00:20):

Hi, welcome to Securely Attached. I’m Dr. Sarah Bren, a mom of two and a clinical psychologist specializing in child development, emotion regulation and attachment. In this podcast, we bring together research and real world experience to help parents translate psychology and science into everyday strategies and tools that build deeper, healthier connections across the entire family system. And this is especially important when you are parenting a neurodiverse child. The strategies that support connection and wellbeing may look a little different, but the goal is the same, helping your child feel seen, safe and supported for exactly who they are. And joining me this week is Dr. Peter Vermeulen, a psychologist, author, and internationally recognized expert on autism. He’s the founder of Autism and Context and has worked in the field for over 35 years, consulting with schools, families and clinicians around the world. Peter has written more than 15 books, including Autism as Context Blindness and Autism in the Predictive Brain. And when most people hear the word autism, the conversation often focuses on challenges, therapies, or deficits. But what if we shifted the lens? What if instead of asking how to reduce struggles, we asked how to build happiness, meaning, and fulfillment. And that’s exactly what Peter and I are going to be covering this week on Securely Attached.

(00:01:46):

We have Dr. Peter Vermeulen. I’m so excited to have you here today. Thanks for coming on the show.

Dr. Peter (00:02:01):

Oh, it’s a pleasure, Sarah. I’m excited about this and I really love to be on the show here.

Dr. Sarah (00:02:07):

Great. So you have dedicated your career to working with people who have autism. And when most people hear the word autism, oftentimes the conversation really goes straight to challenges or difficulties that this population often faces. But one of the things that I really admire about your work specifically is you really very intentionally shift the focus to something that we don’t talk about nearly enough, which is happiness and wellbeing and what it means to live a meaningful life with autism. So just to start off, can you share a bit about how you came to focus on happiness and meaning in autism and why this such an important lens for families and educators and clinicians to integrate?

Dr. Peter (00:03:00):

Well, it all started actually with the workshop I was doing many, many years ago on stress management and autism because autism comes along with a lot of stress, both for the child and the parents and the family. Let’s be honest about it, autism is not a gift, it’s not a present. But I was doing this workshop and I developed an 11 page questionnaire where parents could fill in all the stresses for their child, like he’s stressed by certain textures in food, he’s stressed by unpredictable changes and so on. And that was a two day workshop. And day one was filling in the questionnaire. And at the end of the questionnaire I looked at my audience, my participants, 20 parents and some professions, and they all look so depressed. And I thought, Peter, you’re not doing a great job here because the autistic children, the last thing they need in order to move forward in their life and to thrive is depressed parents and professionals.

(00:03:59):

So I thought, what am I doing here? I’m putting the spotlights on all the things that are difficult, but these children do not only have difficulties and problems or deficits, they also have something that can give joy. I’m pretty sure that every parent of an autistic or another neurodivergent child can also say, oh, yesterday we had so much fun. I thought, why don’t we put the spotlight on that one? Too often we only pay attention to children in classrooms, in families. When something bad happened, why don’t we have meetings to celebrate what went well and to learn from that? And then I realized it’s not just about autism or the deficit, it’s about how happy can you be? And that made me change. And again, I do not ignore the difficulties, but I was as many people, I’ve thought that you cannot be happy if you have a label, if you are neurodivergent and the country is true, to be honest. And this is a hopeful message for all the parents listening here and all the mothers I know more happy autistic adults than I know unhappy autistic adults. And I think what we should do is instead of doing research only on the unhappy children, the children who are stressed, who are anxious, we should do more research on those children who thrive. We can learn from that, don’t we?

Dr. Sarah (00:05:33):

Yeah. I appreciate that you are calling out that we’ve seen a movement, I think in the world of research and psychology into this sort of positive psychology like reverse engineering resilience, reverse engineering happiness and wellbeing. But we seem to have left out this group of people in a lot of that research. I think that is something you have put your finger on and said, we are missing. Why are we leaving out this group when we’re looking at that research?

Dr. Peter (00:06:08):

Well, we left out the group because we were a little bit obsessed with the labels. The moment the child gets a label like autism or a DHD or whatever label, one of the dangers is that we reduce the child to the label and that we forget to see all the other things. And that’s one, yeah, I did a lot of research myself into the difficulties in autism, into the autistic brain, and maybe we will talk about it, but that did not make me forget that there’s more to the story of a child than the label. And that even things that are so-called characteristic for autism and that are usually seen as a symptom or something that is not positive could also be a positive thing. If we only look back at history, many models will probably know. But hot is was first described in the thirties and the forties of the former century, and then very soon we talked about stereotyped interests of children. What I’ve learned now is a stereotyped interest is not just a symptom of autism. It’s often where the talents of a child lie. And so rather than trying to get rid of stereotyped interest and obsessions, we should do something with it.

(00:07:33):

Why don’t we make jobs out of a stereotyped interest? And case number one, who was described by Leo Conner in 1943, if people can get access to the article, it’s a wonderful article. Well, his parents, and in those days, if he got a diagnosis of autism, it was not because you were an easy child, but his stereotyped interest was turned into a job. He became a bank clerk because he was interested in numbers. And most people would say, oh, you should limit that. Let him not talk all day about numbers. And the parents said, let’s make a job of it. Then indeed, you also structure it. There are certain hours a day you can, and I think this is great, isn’t it that we can turn a so-called autistic problem or a symptom into a job? Isn’t that nice? So even so-called characteristics of autism in themselves are neither positive or negative. It all depends on what we do with it.

Dr. Sarah (00:08:32):

And I think there’s something so much more profound to this, not just I think I’m getting your larger core of your work here, but it’s not just, oh, well this person needs to figure out a way to contribute to society and be independent. So we need to figure out a way to get them to be able to join the workforce so that they can feel like a productive member of society and not be so dependent on, I think there’s been this real behavioral approach to autism of like, we need to teach them all these skills so that they can kind of move through the world the way other people do. It’s that no, in finding, in turning a stereotyped interest into a vocation, you are also helping that person make meaning, find purpose, be seen in their own mind as someone who shares value with another person.

Dr. Peter (00:09:31):

Exactly. And that’s the whole quarantine. Being productive does not necessarily have to be an economical thing. We are now setting up a project over here in Belgium where we try to connect autistic individuals to people who are in homes for the elderly who often are bored because there’s not enough animation and entertainment in those homes because of lack of staff. And then you have autistic people who love to talk about a certain topic. We put them together and that’s not the job. Or we have autistic people who love to do quizzes. Well, why don’t they do a quiz in the home for the elderly or for another family? I think that I remember an autistic boy who loved theater and opera and he’s now helping in the local shows hanging out the coast from people that’s not economical productivity, but he’s in a theater. He loves theater and well, he can help and he feels indeed that he’s meaningful towards other people. And I think that’s the biggest needs all people have, even children have that need.

Dr. Sarah (00:10:51):

Yeah, to be a participant.

Dr. Peter (00:10:51):

And it’s a misunderstanding that we are, yes. And too often autistic children Here you need me, me as a parent, me as your teacher, me as your therapist. How often do autistic children here, wait a minute, I need you.

Dr. Sarah (00:11:10):

Yeah, I would imagine so.

Dr. Peter (00:11:11):

And isn’t nice to hear from another person that another person says, I need you. I see children really flourish when they hear that because then they’re only on the side of receiving help and support. We can all do something to help and support another person, and it’s about time that we make that start looking at children who are neurodivergent, whatever their label is as children who also have something to offer. And that doesn’t have to be a big thing. Happiness is not a Zeppelin. It’s a bunch of little balloons.

Dr. Sarah (00:11:53):

I love that. Yeah, I know a lot of people have obviously, and I would love to hear a lot from you about how the autism brain does work Amazingly, it unique and it’s often associated with savant or these little pockets of genius. While that’s awesome, it’s also not the case for everybody who experiences who has autism and also I don’t know that that’s necessarily the correlate to what we’re talking about, which is happiness and meaning making. It’s being able to follow an idea, follow something that lights you up, and being able to complete that intention in a meaningful way that could, like you said, that could be a little balloon. It doesn’t need to be this massive genius thing.

Dr. Peter (00:12:51):

No, and that’s one of the things that happened with autism, that the portrayal of autistic people in the media is either a genius or it’s a very weird disordered person. Well, the majority of the autistic children, and I’m going to use a strange word now, are pretty normal children.

(00:13:11):

I mean normal in a positive way. I mean, you don’t notice immediately that they have autism and they do nothing spectacular, but why should they as if you can only have a meaningful life if you do something spectacular, if your child helps you emptying the dishwasher, I think that’s spectacular. Especially if your child, for instance, have problems with, and now we’re talking about brains here, the difficult word executive functions getting ordered in your behavior. Well, I think it’s spectacular. If a child that has a DHD or autism man who seems to have executive dysfunctions can help you empty the dishwasher, and that could be a good moment to celebrate. Look what you do for me. Thank you. Even if it’s only one plate, and that I think is important, we should start to celebrate the small things in life and too often, and that’s putting a pressure on a lot of children that, oh, I’m autistic, so I should be able to say what Tuesday, September the 14th in 1954 was, no, you’re not. You don’t have to be that spectacular, but that doesn’t mean that you cannot be meaningful to me and that I cannot use your talents. And many people think talents have to be spectacular. No talent is something that you’re good at and that you love doing. And that could be anything that could be even running away. What if your best talent is running away?

Dr. Sarah (00:14:49):

Tell me more about that.

Dr. Peter (00:14:50):

I think any athletics club would love to have you as a member. And that’s what I did with the family. There was a boy and he was always running away, and the parents, they were kind of, oh, what should we do with this? I said, if he loves running, okay, we need to prevent that. He runs away and gets onto the street where it’s dangerous, but if he loves running, make sure that he has enough running during the week. So they enrolled him in the athletics club. He’s still in there and he’s a very good run. He can run half a marathon. He doesn’t do the small talk before and after the race because he’s autistic. But you know what? They love him at the athletics club because he made the ranking of the club go up such a good runner. So even what we see as challenging behaviors, try to see the potential in there.

Dr. Sarah (00:15:42):

And let’s talk about this family for, because it was a real family that you really worked with and assuming they came to you because something was becoming really problematic, if this kid is in a dysregulated state running away, this was probably obviously a safety concern, a stressor for the family. It probably limited their world because they had to constantly, when you have these legit safety challenges with the impulsivity related to some of these disorders, I think one of the first things that happens is the family’s world gets very small because they just feel like they can’t go out, they can’t do things. They have the need for safety is so frat is so critical, but is so difficult to maintain that it becomes the only focus. My guess is this family is probably coming to you very depleted, very stressed, very worried, probably at their wit’s end. I’m assuming you didn’t immediately say, let’s just think about their strengths. How do you create a sense of validation that this is really challenging and build that capacity to create safe structures and then build on the strength so that it can be used in a way that works for everyone in the family system?

Dr. Peter (00:17:05):

The first thing I always do is something I learned in the United States because I was trained by the people from the famous teach division, North Carolina, and the first thing I learned about autism, autism, but this is true for all children, not just autistic children, was the metaphor of the iceberg. What you see is the behavior, but there’s a lot of things underneath that you don’t see and you need to know what’s underneath. In other words, you need to know why does the child do this? And there’s always a reason. It’s not always easy to find that you sometimes need to be a good detective as a parent to find it, but there’s always a reason. And then my knowledge about autism comes in because the traditional reasons do not always apply to neurodivergent children. For instance, why would the child run away? One of the typical explanations could be, well, he’s not interested in what’s happening here, so he just runs away. For autistic children, it could be that there’s too much noise there and the child cannot filter out the sound. And the best thing then is to make sure that your body is in another place. Or it could be that the child had, there’s a sudden change that the child cannot cope with and then the child runs away because this is not what he thought that would happen.

(00:18:27):

And then I use my knowledge about the autistic brains. Many challenging behaviors in autism have to do with unpredictability, and that’s the first thing I did with the family. Of course, I did not say enroll him in the athletics club. I said, why would you run away? I think maybe we should think about did something happen that was unpredictable? Did something happen that he did not expect? Was the environment maybe too difficult for him in terms of sound, temperature, whatever, sensory things? That’s what I do. Do I always analyze? No, because sometimes you will never find the altruism as a mother, or sometimes the answers are a little bit more complicated than one thing.

(00:19:14):

Sometimes parents ask me, does he do this because of his personality or is it because of his? And then I say, I don’t know. But what I do know is what if we would look for solutions and solutions are always like, okay, this child probably does not feel safe, otherwise he would not run away, he would stay. How can we increase the safety of the child here? Safety could be not just safety in terms of relationship, which is important, but also safety in terms of predictability.

Dr. Sarah (00:19:45):

Like environmental control?

Dr. Peter (00:19:48):

Yes. So I started with the family. What if we would look at the moments where he runs away and then try to make those moments more predictable for him, predictable in terms of what am I going to do? What is expected of me, what will happen? And that’s how we started. And that did help. So that’s one thing. The other thing is sometimes children run away because they are very upset. And then we try to figure out can we not create moments? Because when children get upset, usually that’s, we have a saying in Belgium here, the one drip that makes the bucket flow over.

(00:20:29):

And parents often focus on that moment where the bucket flows over. I say the bucket fills up from the morning. What if we would put in moments during the day that your child can empty a little bit? Its stress bucket. Because many times parents focus only on the difficult moments. What happened just before that, but sometimes is just result of all the things that happened through the day. And that’s another thing I did with the family. Let’s go through the day and see can we insert moments that he can relax, that he can unwind, that he can get rid of a little bit of his stress.

Dr. Sarah (00:21:09):

It’s so interesting. I know you do this so exclusively with kids with autism, but this sounds exactly like what I do with families in my practice no matter what the child is dealing with, right? Because a lot of times, I mean, most people come to work with me often because their child is having some sort of emotional or behavioral dysregulation. So obviously that’s going to happen a lot in kids who have autism. It’s going to happen a lot with kids who have any type of neurodiversity and just regulation challenges. It also just happens with little kids because little kids just don’t have a very well developed prefrontal cortex and they get dysregulated pretty easily. And so I feel like a lot of these strategies, this idea of looking, zooming out, looking at the pattern throughout the day, looking at the child’s nervous system regulation throughout the day, not just at the, I call it the before, during, and after, I think we over attend to the during and very little is really, there’s very few tools that work in the during other than just crisis management tools, but the before and the after, there’s so much more utility in there as a parent to get in there and do something with the kid to shift the patterns. That just reminds me a lot of what you are describing.

Dr. Peter (00:22:41):

Yeah, let’s not wait until things get difficult. Let’s do things that increase the wellbeing of a child, even at moments that you think, but why should I do now? He’s calm now. Exactly. That’s the time when the child is still open for maybe a walk out or a relaxation breath or anything else that could calm the child down. And parents too often say, but he’s calm now. If you wait until a child is upset, then you need to, and especially with autistic children because they have difficulties making transition from one activity to another. So if you wait until let’s say the child is already too aroused, then it’s too late. And that’s why also I focus on the wellbeing. I think you should not wait working on wellbeing until the moment that you see signs of lack of wellbeing. You should do it throughout the day, little moments that you enjoy together and that will help the child survive the whole day. Because often we see that we only intervene when things go again when a child explodes or when a child has a shutdown or a meltdown. Well, that’s often then very hard for parents then to co-regulate because when a child is upset, probably as a mother, that affects you too. So you are going to be upset too. So that’s the two of you who have to regulate. The moment the child is not yet upset and you’re not yet upset. That’s the moment that when we should do the emotion regulation activities.

Dr. Sarah (00:24:14):

Right?

Dr. Peter (00:24:18):

Exactly. If you would wait to fuel your car until the moment that you notice, oh, now it’s completely empty, you fueled your car before, don’t you?

Dr. Sarah (00:24:30):

Exactly. Or I use hangry as a very common example of this. I mean, at least I don’t, I’m constantly trying to feed my kids that mom. But we all can say, okay, we try to feed our kids a lot so that we try to never hit hangry. It’s like we should be co-regulating with our kids all the time so that we never hit the bucket is completely full and overflowing. Now obviously sometimes the bucket doesn’t fill in tiny little drips and drips and drips, and sometimes it’s like some monsoon just dumped a ton of water and that gets bucket and it happens so fast. But I do think more often than not, we can sort of pre regulate, help them just reset.

(00:25:35):

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(00:27:03):

And to that line of thinking, it makes me think of another question for you because human beings, and I’m curious, how do you articulate this with people who are working with kids with autism, but all human beings? We are social creatures. We use other humans nervous systems to help us identify are we safe, are we not safe? How do we move into threat? Or how do we move down into safety and connection? We are brains are constantly doing this automatically with reading facial cues, reading body language, reading tone, reading, other things happening in the environment. And we use relationships to regulate. I imagine that autistic children still do this. They just might look different, right? There’s not an absence of connection, it’s just Can you talk a little bit about how it’s different, but what’s the same?

Dr. Peter (00:28:12):

That’s one of the biggest misunderstandings in autism, that it was originally defined as a kind of social disorder, still the first criteria mentioned the persistent deficits in social interaction. And that made people think that autistic people do not need social connection so that they don’t long for bonding, they don’t need attachment. And that’s one of the biggest misunderstandings they do because autistic children are human beings and human beings are indeed social animals. We all need other people, and that’s equally true for autistic children. The only difference is that they don’t show the traditional signs that we can pick up to know there’s right now a need for attachment. Now is a need to connect. This child now needs me to regulate him or her because some children, you don’t see it in their facial expressions. Some children, they don’t express their need. Some children because they don’t have the language to do.

(00:29:17):

But even in the ones who often are very articulate when they need help, they’re not the ones who are going to ask for it because they’re often very unsure about, how can I ask? Is this the right moment to ask? So we do not knew. On the other hand, they also have difficulties reading the attachment behaviors of the people around them. And that leads to what I would call misunderstandings in attachments. That’s not less attachments or less connection. Those are misunderstandings in connection. So for autistic children, one of the things that I’ve learned is that for instance, being predictable is something that helps the bonding because, and I want to talk about the autistic brain. What we’ve learned about the autistic brain is the biggest problem for an autistic brain is that an autistic brain is inherently uncertain about the world. The world is very volatile and unpredictable, and therefore it’s important. When I meet people that autistic children, I make my behavior predictable. So I say what I’m going to do before I do it, and that helps building up a relationship because then I take away the cause of their stress, namely the uncertainty, the social difficulties. And also have to do with the fact that human beings are the most unpredictable creatures on this planet.

(00:30:46):

Objects are more predictable than people. If I have a cup in my hand right now and if I would open my hand, what direction would it go? Well, laws of gravity, that’s all it can obey to. People don’t know what obey to laws. The one rule about social interaction is that there are no rules. Well, no fixed rules anyway.

(00:31:09):

And autistic children love absolute fixed things, and that makes it a little bit, let’s say more challenging to work around relationship. But the need is there. The need is universal. The way to make it work is can be different. Lemme just give one example of how we sometimes misunderstand this. There was this young boy who was always standing alone in the corner of the playground. He never joined. The other kids never played with them. So the teachers thought, oh, poor, poor little boy. He must be lonely. You know what? Let’s help him. Let’s teach him how he can walk up to the other kids and ask, please, can I join? Can I play with you? So they made a nice social story because that’s a tool that we often make for children, social stories, telling them how to do things. And the boy looked at it and said, do I really have to do that? And the teacher said, but you must be very lonely. And he said, no, I enjoy it watching all the kids play, and I feel very safe here because nobody can suddenly pop up behind me and touch me so I feel safe. But that for him was a social activity that was for him belonging. He did not have the feeling that he was excluded.

(00:32:27):

But if he would, because sometimes that’s what they do in schools. They say, oh, that’s an autistic child. Probably the playground is too noisy, too crowded. He can stay inside. And that’s then probably denying that child to make connection to the other kids. But making connection does not necessarily mean that you have to be actively involved.

Dr. Sarah (00:32:48):

Right? But he is actively involved in his form of participation, which is observing.

Dr. Peter (00:32:56):

Exactly.

Dr. Sarah (00:32:58):

That’s an active involvement in his experience, right?

Dr. Peter (00:33:01):

In his experience. He’s part of the group.

Dr. Sarah (00:33:04):

Now, in a situation like that, I mean, my thought goes to like, well, could we ask him what he wants before we just assume this is the problem to solve? What if a kid is less verbal or can’t explain? How do we help parents get curious and also get, extract information from their child about Yes, don’t assume, but also how do we verify?

Dr. Peter (00:33:34):

Okay, with the children who are too young or who do not have spoken language as a mean for communication. What we do is I call it we do little experiments because they will tell in their behavior.

Dr. Sarah (00:33:47):

Yes.

Dr. Peter (00:33:48):

For instance, when a child comes home, does the child immediately wants a hug or not? The children are able to talk. You could ask, but even then, my experience is that even very articulate children, autistic children have difficulties expressing their needs even though they have the language. What you can do is saying, I think you might need a hug and approach a little bit, but do that slowly. If the child really doesn’t want to hug at that moment, you will see it in his or her behavior. He will turn around, turn away from you. And that’s what we need to learn. For younger children and children who are nonverbal to read their behavior.

(00:34:30):

Then we need to, because behavior is also communication.

Dr. Sarah (00:34:33):

Yeah.

Dr. Peter (00:34:34):

It’s always communication. You cannot not communicate. And that’s what we need to do. But we can do experiments and some people think, but if your child has autism or another form of neurodivergence, they are very vulnerable. I don’t think so. Well, maybe they’re a little bit more vulnerable, but even autistic children can survive a small experiment as long as we don’t really force them to do things. And again, make it predictable, rather than just saying, okay, I’m going to try out whether he would appreciate a hug when he comes home and give the hug, I would say, I’m going to give you a hug and already open your arm so that the child can read your behavior and give the child time to process. But you can set up an experiment if you sometimes parents say, I don’t know what I should do with my child. And for many years I was frustrated when parents or even autistic children, when I asked them replied with, I don’t know. And now I have learned to embrace the I don’t know answers. I love them because not knowing. Then I think, okay, you don’t know. I don’t know. That makes two of us. That’s a wonderful research team.

(00:35:52):

Let’s find out together. And because especially if one of the basic needs of autistic children for attachment and bonding is predictability, the moment you start doubting yourself, you’re probably going to be very unpredictable in your behavior. So saying, okay, I don’t know, but I will do this experiment. I’m going to try this with my child, and I try to learn from it because my child will tell me whether it’s a good thing, but don’t be hesitant and start doubting and move forward. No, maybe I should not give him a hug. Yeah, maybe I should. Then you will become very unpredictable for the child. So it’s better to do something and afterwards learn, okay, that was not a good thing, but next time I’ll do something else. That’s much better than hesitating and be somewhere in the middle in your behavior.

Dr. Sarah (00:36:47):

And I mean, again, it’s so funny, everything you used to describe, I’m like, well, that would work for pretty much any kid. I could think of that instead of assuming what they need to. I used to talk about this a lot with parents of babies, and I would say, okay, infants totally not verbal, don’t understand what you’re saying to them at all. Language wise. I still talk to them and I tell ’em what I’m going to do, and then I pause and I give them a second to process what I said. So for example, I would always say to my daughter, when she was an infant, I’d say, I’m going to pick you up now. And then I’d wait a beat and then I’d go pick her up. And obviously I know she does not know what the words I’m going to pick you up now mean.

(00:37:41):

But what she would, and I didn’t like this isn’t come from me necessarily, came from actually the work of Magda Gerber who developed this parenting philosophy called R. She, I’ll have to link episodes to R episodes. It’s just a parenting philosophy that really is really all about attunement and the parent-child relationship. But this idea that when you say to an infant, I’m going to pick you up now, over time, they would open their arm, they would get ready to be picked up, they would ready their body, they understood. And it’s not that they knew what the language meant, it’s that they started to learn that when mom does this thing and then picks me up, I’ve learned to sort of, I know what that means. I know my body knows what that means. And so not to say that we need to treat autistic kids like they’re infants, but I think this is just about treating human beings like they’re human beings and giving them a minute to take in what we’re saying and then do the thing that said we’re going to do that helps create that predictability. And that is a really great way to build these subtle attunement rhythms with our kid. And that builds the bond and builds the trust and deepens the attachment security, I would imagine.

Dr. Peter (00:39:14):

Exactly. Because attachment is all about feeling secure with another person, and security comes from predictability largely. And also with younger children or infants or autistic children. By giving them time to process your communication, we should slow down more. And to be honest, maybe if they don’t understand your language, probably you also had your arms already open. And so it’s not just the verbal language, it’s your whole body language as well. Or what I also often advise to parents, both of younger children or autistic children who are a bit older, use objects to communicate because many young children can read objects, although they cannot understand spoken language. So rather than saying, we’re going out, I’m going to put on your jacket, most mothers and parents do that intuitively, what do we already do? We already have their jacket in front of them, and it’s the jacket that tells them, oh, my mom is going to put my jacket around me. The slowing down and using of all means of communication, like objects, your body language is very important and be predictable there. Giving time to process so that things become predictable.

Dr. Sarah (00:40:34):

And simplifying things too, I would imagine.

Dr. Peter (00:40:36):

Yes, exactly.

Dr. Sarah (00:40:37):

Yeah, I mean, I just think these are strategies that would help with everything, especially with little kids. I’m curious because we were talking about predictability, having that support basically the bonding, the relationship, the sense of safety, that security. I wanted to ask you a little bit about this, and I know we spoke a bit before we hit record, but in preparing for this conversation with you, I was like, oh, I want to see what kind of research is out there on attachment and autism. And I was really surprised to find, well, maybe I wasn’t that surprised, but I’ve found that there’s just really not a lot there. And I was curious. I think the most important takeaway from my very cursory search on I could find on autism and attachment research is that there is a slightly less attachment. Secure attachment is a little bit less prominent in autistic populations than the general populations, meaning they’re more likely to have a less secure attachment style than non-autistic people, but not by a particularly large amount.

(00:41:59):

And that was important for two reasons. One, that they might be more vulnerable to less secure attachments. So we have to pay attention to that. We have to understand why, but why is kind of unclear. And the other thing is that it’s proof that there is absolutely secure attachment in people who have autism, which means that the capacity for a secure attachment relationship is available. It’s not precluded by the diagnosis at all, which I think feels very important to understand. And I’m just curious what your research has, how your research has butted up against attachment research or blended with it or where you find the gaps to be.

Dr. Peter (00:42:46):

There’s indeed not much research, and one of the reasons is that the very beginning of the autism history, parents were blamed for their autism. They even spoke about refrigerator models, models who deiced just enough to conceive and to give birth. That was very harsh on them. Research has shown that models of autistic children are as loving and caring models as all models are. There’s no difference from their side. So there’s no risk for insecure attachment on the side of the models. There’s no inability for autistic children to attach as well. So the capacity to have a secure attachment is there. What makes it a little bit more difficult, and that’s why we see indeed these research results of sometimes a later secure attachment or lesser degree of attachment, is that in order to attach, you need to be able to read each other’s behavior, especially the bonding behaviors.

(00:43:55):

And on top of that, again, the autistic thinking, the autistic brain, autistic brains, they develop different models of the world. They have different concepts. Just to give an example, when a child takes a bus from home to school, for most children, the number on the bus or the destination is giving enough security for an autistic child. It’ll be the bus, the brand of the bus, the type of tires the bus has, the driver. And if it’s a man and suddenly one day it’s a female bus driver, then for that child that’s not the bus going to school. So all security suddenly drops. One time a child, his mother, for the very first time had her hair in a ponytail. And when he saw her in the living room, he asked her, are you my mom? And it’s that what makes the attachment more difficult for autistic children? Because if their mom one day starts wearing glasses or has her hair in a ponytail, for some autistic children, they don’t recognize it as their mom or they do recognize, but they are not sure it’s their mom.

Dr. Sarah (00:45:11):

The doubt, that feeling of uncertainty and doubt.

Dr. Peter (00:45:14):

It’s that doubt that of course takes away a little bit of the security of mom. And then it’s not about just her hair. It’s like, how can I know when I wake up tomorrow and I calm down how my model will look like? That’s the insecurity. It’s not, I don’t like my mom anymore, not my mom is not taking care of me. It’s how will she look like tomorrow and any other childhood? Immediately a model of mom is, well, moms, especially women, they can have their hair in all kinds of colors and fashions for autistic children, that is also taking away a little bit of the security.

Dr. Sarah (00:45:57):

Interesting. So because what I’m thinking of is an internal working model or an internalized object. So what that means is when I am a baby, when I’m little, my mom is my mom. When she’s right here next to me and if she leaves the room, she’s not, I don’t where’s mom? And then over time we have this idea of object permanence and the idea of I can hold my mom in mind when I don’t see her. She still exists inside of my mind or inside of me. And eventually as we get older, our concept of our internalized objects, our attachment figures becomes more fluid, robust, complex, nuanced, and it becomes dynamic, but it still is inside of us. So I could at sleepaway camp at 10, if I was feeling homesick, I could remember moments with my mom and soothe myself and all that fluidity. But sounds like with the autistic brain, the ability for that nuance and flexibility of the internalized object, they’re still internalizing an object, but it’s a little bit more rigid. It’s almost like it’s got to match exactly this one version I have. And if it doesn’t, I might know. I know that’s still my mom, but my felt sense, it feels a little off. It’s just something doesn’t feel quite right, can’t settle into that feeling.

Dr. Peter (00:47:31):

Exactly. That’s the whole thing. And indeed, they also internalized models of their mom, but for instance, as you said, Sarah, I’m homesick. Well then I can think of my mom and then I know my mom is loving me and she will be there when I get back, but an autistic child might have difficulties, but how do I have to imagine my mom now? Would she already be wearing her pj’s or not? And would she be cooking now?

Dr. Sarah (00:48:01):

They can filter. They’re not able to filter out the extra stuff that’s not the important part of the memory here.

Dr. Peter (00:48:07):

No, that’s the exact thing. So the object permanence is there. And we’ve done research, so children, autistic children also have object permanence, but their picture of the object is the exact object at the first moment they saw it. And it’s not like, okay, there’s an object. For instance, you could have this cuddling toy, the furry thing for an autistic child. It needs to be maybe in that exact position in that box. And if it’s not in that box, it doesn’t help me. It doesn’t suit me. So details become much more important because their models, they have, the internalized models are very precise and very absolute. That’s one of my latest books I called Autism Absolute Thinking in a Relative World. And that’s the biggest problem for autistic children that the world doesn’t do in absolutes. Your mom could look differently tomorrow, but she’s still your mom. And for autistic children, that doesn’t give them enough security if it’s not the exact absolute thing there.

Dr. Sarah (00:49:14):

So how do you help parents, one, just understand this so that they don’t take this rigidity as rejection or a sign their kid doesn’t want to or can’t connect with them, but that they’re maybe flooded by something else that’s a byproduct of the way their brain is working this thing out, but that they can still try to work with their kid to find, okay, how do I help my kid feel soothed by my presence when I am not showing up with the same hairstyle or same clothing? How do we help work with that attachment relationship in this unique dyad?

Dr. Peter (00:49:53):

Okay, autistic brains have a tendency to see the differences. What you can do is to point out the similarities, saying, yeah, mom has her hair in a ponytail today, but I’m still going to tuck you in, but I’m still going to sing a song. So you point out all the things that do not change. So because that’s sometimes called that the context blind is in autism. Most non-autistic children, they see, okay, my mom has her hair in a different shape, but the context is the same autistic children. For them, the context is the exact sum of all the details there. And if one detail changes, then for them it’s a complete new context. And we can, by describing the similarities, tell them, look, that’s the only little thing that changed. I’m still here. I’m still going to sing a song. I will still tag you and so on. That’s what we need to do. And as you said before, maybe the child does not understand every single word that you see, but by your behavior and showing, going back to the regularities in your behavior that you otherwise do makes the child feel, oh, okay, she looks differently, but she still puts on my pajama. Yeah, that’s fine.

Dr. Sarah (00:51:12):

I would just wonder if it would be helpful if you’ve ever tried this with families to help them develop some type of ritual or symbolic, whether it’s a transitional object or some sort of secret inside joke or inside behavior that they do to almost correct for those moments when something feels out of sync. So it’s like, for example, my kids don’t have autism, but I’ve always done this with them. Whenever we would go away from separations, I would draw a little heart with a marker on a little one inch square paper and I’d give it to them, right? I’d put it on their pillow before I left for a work trip or I’d tuck it into their pant pockets or whatever. This sort of became this almost like inside thing we have where when on the first day of school, I’ll put a heart in their pocket. So there’s this almost this physical thing that represents our relationship so that they can have something concrete to hold onto when something isn’t feeling like it’s exactly the way they had pictured in their mind.

Dr. Peter (00:52:23):

But that’s a wonderful idea, Sarah. And the most why I like this in particular is, as you say, it makes the relationship concrete because relationships are very abstract things. If you can make it concrete, the heart is, is thinking of you. I love you. I remember with one autistic that was a young lady, she was already 15, she was very anxious at school, and they asked her, but what would really help you? She said, well, I miss my mom. If my mom would be next to me, then maybe I would survive school. Now, I don’t think neither in Belgium nor in the United States or no place in the world, you’re allowed to bring your mom to school. But what they did is, and that was one that was saying, oh, but would it help if you could look at the picture of your mom? And on the backside, moms wrote, I’m thinking of you, honey, you will survive. And that helped her. That’s almost like the hearts that you drew for your children. That’s exactly the same. And that is what we call very autism friendly. You make things so concrete that it is something that you can literally hold in your hands.

Dr. Sarah (00:53:37):

And I think we have a really good handle on making things concrete for kids who have autism in terms of the visual schedules and building the skills and social stories, and that’s all great, but I think sometimes we forget that we need to create relational bonding and attachment based physical concrete things.

Dr. Peter (00:53:59):

Of course. Just one other example, a mother complained about the fact that her daughter came home from school, never gave her a hug. What she did is she put it in the schedule coming home, hanging away your coats, putting away your backpack, giving mom a hug, and she got a hug every day. And it’s not that the child did not want to hug her mom, it’s just like, it’s not in my schedule, so I don’t do it. And mom expected the child to do it spontaneously. And she said, but I want a spontaneous. I said, that’s autism. Just put it in the schedule and maybe one day the schedule will be so much internalized that it’ll be in her routine and she won’t need a picture anymore. She’ll give you a hug. But then, yeah, is it still spontaneous? Well, how many of my behaviors are spontaneous? I learned a lot of these behaviors also through learning processes, but she got a hug and that’s the most hug. And it was a real hug. It was a real hug.

Dr. Sarah (00:54:59):

No, I think, I mean, I could literally talk to you about this for so many hours. I wish we could go on forever. So many questions for you. But one thing that I feel like is so important acknowledge is that especially when you are not on the spectrum and you have a child who is, I know for a fact I talked to a lot of parents, the amount of grief of just not having that reciprocality in that matching of how you want to express connection and love and soothing, not having a child who shows it in the same way. It’s really hard because it’s not just about the misunderstandings of the bonding that you were talking about earlier for the child, but the parent too. And so I feel like it has to be named. It can be so hard as the parent to adapt, and you have to process your own grief and give yourself permission to grieve it.

(00:55:55):

But I think it’s so critical that we still understand. We check that understandable tendency of ours to say, this is a rejection. They don’t want my love. They don’t want to, don’t need it. It’s like, no, we know. And all that we’re talking about really emphasizes they do want connection. They do want love. They feel it. They have all the same feelings and all the same needs that neurotypical feelers have, but you have to find it in different ways. But you’ve got to look for it if you think they don’t want it because you feel rejected and in your your grief, you owe it to the relationship to figure out how to set that to the side, work on it in your own space, in your own time, and figure out how to find these connections that are meaningful and mutually meaningful to the two of you, and be willing to say, it’s going to look totally different than I imagined it would look, and it’s still good.

Dr. Peter (00:57:03):

And I think this is one of the things that we need to learn, all that we need to learn that good enough is okay, nobody can offer a perfect relationship even without diagnosis. Nobody is the perfect partner for another person. Nobody’s the perfect daughter. Nobody’s the perfect mom. Nobody’s the perfect dad. So autisms is one of the many imperfections, okay? It’s a different form, but the moment you start thinking, okay, nobody’s perfect, and it’s not about indeed love, it’s about I’m imperfect in showing my love to you, or I don’t use the traditional ways of showing my love to you. Most children, most, I don’t even know any autistic person who does not give love or who does not love another person. They all are capable of love and they’re all loving people only the way they show it, and that’s what they did in the attachment studies when they compared autistic to non-autistic children. What we noticed is that the autistic children, the moment a mom came in, because that’s the traditional setup of the attachment procedure, mom, yes, mom goes away. Moms come back. What we noticed is that when the mom came back, even autistic children were happy that their mom was back. The only difference was they didn’t get up and start hugging their mom. But when we saw in their reactions and we did physiological measures, we saw that indeed the cortisol…

Dr. Sarah (00:58:34):

Went down.

Dr. Peter (00:58:34):

Was down. Yes, the stress response. So they were happy to see their mom only. They didn’t say that. If you learn to see that, then okay, there’s attachments, but maybe, and it’s not that the child does not want to, but probably the child did not know, how can I show that I’m happy that my mom is back? It’s insecurity again, not knowing how to show love. It’s not about not loving. It’s not knowing how to show love. And as a mother, as a parent, you can say, okay, honey, let’s make indeed some rituals that we do to show that we love each other and saying, when you come home, you give mom a hug in your schedule. It was love, but it’s not the most traditional way. No, it isn’t.

Dr. Sarah (00:59:26):

Yeah, you got to learn each other.

Dr. Peter (00:59:28):

But yes, I’ve learned that love and relationships and anything. That’s what I learned in my career with autism. There’s the neurotypical way of doing things, and then there’s so many other ways of doing the same. And actually, that enriches my life. That’s what I got back from working with autistic people. They taught me that there’s not just one way of doing things in life. There’s many ways, and one way is not better than another. It’s just different. And now we come back to the beginning: differences.

Dr. Sarah (01:00:05):

Yeah.

Dr. Peter (01:00:08):

What could be called a deficit could just be reframed as well. This is, let’s say, a very creative way of showing you love.

Dr. Sarah (01:00:16):

Oh, that seems like the perfect punctuation point to end this conversation on. Oh, I’ve enjoyed this so much. Thank you for coming on.

Dr. Peter (01:00:27):

You’re welcome, Sarah. It was my pleasure.

Dr. Sarah (01:00:30):

If people want to follow your work, learn more about all the incredible books that you’ve written and the research that you’re doing, how can we connect them with you? Where should we send them?

Dr. Peter (01:00:41):

The easiest thing is my website, and that’s my name with Be for Belgium. One of the things, for instance, I have developed a good feeling questionnaire. I talked about the stress management questionnaire. I developed the opposite, a good feeling questionnaire. It’s developed for autistic individuals, but it can be used by all parents. It’s just filling in, for instance, what gives my child sensory pleasure? When is a good day for my child? What is important for my child in relationship? What gives my child, and it’s for free and it’s available in more than 15 languages.

Dr. Sarah (01:01:17):

Oh, that’s an incredible resource. And certainly something I might actually just start using in my intake paperwork.

Dr. Peter (01:01:23):

Yeah, I do these Happy Coach training, which is all about making an individualized wellbeing plan. But the good feeling questionnaire is for free out there, because I think all children are entitled to have a good feeling profile.

Dr. Sarah (01:01:41):

Yes. Oh, I so agree.

Dr. Peter (01:01:43):

I think that, and parents could make it together with their child or they could make it about their child, and then for instance, give it at school so that teachers, because some children are not able to express what they need to feel good, and then parents can fill it in.

Dr. Sarah (01:01:59):

Okay.

Dr. Peter (01:02:00):

There’s so many reports about children and all of them are about the difficulties and the deficits. I thought there should be reports about good feelings.

Dr. Sarah (01:02:07):

I agree. I agree. Go find the good. I will put links to all that in the show notes and the show, so people will be able to find that. Thank you so much. I’m so glad.

Dr. Peter (01:02:19):

Thank you very much.

Dr. Sarah (01:02:26):

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