“Sabrina’s Parents Love Her. But the Meltdowns Are Too Much”: A Letter to the Editor
An article recently published in the New York Times shares the story of Sabrina Benedict—an autistic teenager from Homer, New York suffering from increasingly violent and chaotic outbursts that often resulted in emergency room visits. How might we attempt to explain her behavior? How can a psychodynamic approach help? What can residential schools do for children like Sabrina? Doctor Sherkow responds to the article—and these questions raised—in a Letter to the Editor format below.
To the editor:
Re “An Autistic Teenagers Spiraling Meltdowns” (June 5, 2022, Section MB, Page 1)
The description of Sabrina, a child on the autism spectrum, suffering from increasingly frequent, seemingly random, and terrifying aggressive outbursts is becoming a familiar story. How might we explain this? The answer is: the onset of puberty!
Autism Spectrum Disorder (ASD)is a neurodevelopmental disorder that impacts the developmental trajectory by persistent deficits in social interaction and communication, alongside restricted, repetitive patterns of behaviors and interests, or hypo/hyper-reactivity to sensory stimuli. ASD is highly heritable and is caused by a combination of genetic and environmental factors. It impacts how the brain is wired to one degree or another— hence, “the spectrum”. Puberty impacts a brain that already is compromised, also to one degree or another, in its ability to manage aggressive impulses. The new surge of hormones packs a wallop of sexual urges and exacerbates aggression.
During puberty, the peer group naturally replaces the parents as the source of structure and control. For example, structured and supervised activities, such as sports and clubs, can provide this support as well as external role models, such as teachers, coaches, parents of friends, and peers. These resources provide a safety net.
Teens on the autism spectrum, however, do not have these options for two reasons: they lack adequate social skills that are necessary to cultivate peer relationships in the first place.
Most communities aren’t equipped to recognize the importance of creating social success for this population. The frustration of being marginalized consequently results in hours spent instead on depersonalized forms of support, such as iPads, that create further distance between the teens and their opportunities for engagement with people.
We have learned that a developmentally-informed psychodynamic approach to these children with ASD can help integrate the emotional brain with the cognitive brain, starting from the earliest possible stage of development. This process is foundational for wiring control of impulses of all kinds.
In addition, this approach can help the family organize around new models of predictability, scaffolding anger management through building agency and ego, strategizing “hanging on” and letting go of parents while developing independence. We can learn from this story that residential schools can catalyze this wiring as well as rescue Sabrina from conflict with parents, offer peer support, provide structure, and teach new internalizations that facilitate safe independence.