Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by challenges with social communication and restricted, repetitive behaviors. Some autistic individuals may experience episodes of “freezing” or going still for periods of time. This freezing behavior has intrigued parents, educators, and clinicians who support autistic children. In this article, we will explore what is currently known about freezing in autism.
What is meant by “freezing” in autism?
Freezing refers to instances when an autistic individual’s entire body goes still for a period of time. This is different from simply being still or pausing; in freezing, the individual seems “stuck” and unable to initiate movement voluntarily. The freeze may last for seconds or minutes. The person remains aware during the freeze but may appear disconnected or non-responsive.
Freezing can occur in response to a variety of triggers, both external and internal. Some common triggers include:
– Sensory overstimulation – e.g. loud noises, bright lights, crowds
– Anxiety or stress – e.g. social situations, transitions, unfamiliar environments
– Processing demands – e.g. complex instructions, open-ended questions
– Fatigue – e.g. after a prolonged period of concentration or social interaction
The freeze response is thought to arise from dysregulation of the nervous system. In particular, abnormalities in the parasympathetic “rest and digest” and sympathetic “fight or flight” branches may contribute to freezing episodes.
How common is freezing among autistic individuals?
There are limited epidemiological studies quantifying how prevalent freezing is across the autism spectrum. Most research has relied on parent reports or clinic observations. These have estimated that:
– Between 30-50% of autistic children may experience some freezing behaviors.
– Freezing may be more common among lower-functioning individuals, although it does occur across the spectrum.
– Freezing typically starts during preschool years but may persist into adulthood for some.
– Autistic girls may be slightly more likely to freeze than autistic boys.
So while precise prevalence remains unknown, it appears a substantial minority-to-majority of individuals on the autism spectrum exhibit freezing to some degree. However, severity and duration can vary greatly between individuals.
Are there different types of freezing?
Experts have proposed that there may be multiple subtypes of freezing seen in autism:
– **Tonic immobility** – A sustained, motionless freeze lasting 30+ seconds. May be triggered by situations of danger or extreme stress. Similar to “playing dead”.
– **Transient paralysis** – Brief freeze of muscle groups, lasting less that 10 seconds. For example, speech arrest where they freeze mid-sentence.
– **Fragmented movement** – Interrupted, jerky motions rather than smooth, fluid movement when initiating actions. Hands may “stall” when reaching.
– ** Magnetic motion** – Appearing “stuck” in doorways, corners, or edges of furniture. May occur when transitioning spaces.
– **Attention fixation** – Visual fixation and failure to disengage gaze and shift attention. Can manifest as staring blankly.
While these categories provide a helpful conceptual framework, in reality, many autistic individuals demonstrate aspects of multiple freezing subtypes. The underlying brain mechanisms likely overlap despite variations in behavioral presentation.
What causes freezing in autism?
Research into the underlying neurological basis of freezing in autism remains limited. Based on current evidence, several factors may contribute:
– **Amygdala dysfunction** – The amygdala regulates threat detection, fear responses, and emotional-behavioral reactions. Differences in amygdala structure and activity could disrupt appropriate fight-flight-freeze reactions.
– **Prefrontal cortex differences** – This region controls complex planning and body movements. Altered prefrontal cortex connectivity could impact initiation of voluntary motion.
– **Imbalance between excitatory and inhibitory signaling** – Excitatory (glutamate) and inhibitory (GABA) neurotransmitters must be balanced. Disruption in this balance could cause temporary “seizures” of brain activity.
– **Cerebellum abnormalities** – The cerebellum coordinates motor output. Irregularities here could impair smooth, flowing movements.
– **Regression** – Loss of language, social skills, and motor control. Regression may increase risk of motor freezing.
– **Genetic factors** – Many genes associated with autism affect neurological systems involved in movement control.
Ongoing research is still needed to clarify the complex interplay between these factors. Both environmental and genetic elements are likely at play.
When should freezing concern parents, teachers, or clinicians?
In general, occasional, brief freezing is not necessarily alarming on its own in someone with autism. However, the following scenarios may warrant concern:
– Freezing is increasing in frequency and/or duration
– Freezing begins happening in new environments or situations
– Previously learned skills begin regressing around the same time as freezing intensifies
– Freezing is leading to self-injury (e.g. collapsing to the ground)
– The individual appears distressed or panicked during/after freezing episodes
– Freezing is significantly interfering with learning and participation
Sudden onset or worsening could signify an underlying medical condition requires assessment. Epilepsy or neurological disorders should be evaluated as a potential cause. Ongoing freezing with regression may also necessitate medication adjustments or additional therapeutic supports.
What are some strategies to help an autistic child who is freezing?
When freezing occurs, the objective should be to gently reorient the child and make them feel secure, not threatened. Some supportive strategies include:
– Remain calm and avoid drawing attention or anxiously hovering over the child.
– Limit overstimulation by turning off loud music, moving to a quieter spot, or having extraneous people leave the area.
– Talk to the child in a soothing, relaxed tone of voice to reassure them. Using their name can help re-establish connection.
– Provide motivating sensory input like a fidget toy, soft blanket, or rhythmic rocking to help “unstick” frozen muscles.
– If safe, consider brief light touch on the shoulder or back to stimulate motion. But avoid forceful grabbing or shaking.
– Give adequate time for the freeze to resolve rather than demanding immediate response. Patience is key.
– Afterward, reflect on triggers that may have caused the freeze and make adjustments to prevent recurrence.
Additionally, addressing anxiety, sensory regulation, communication challenges, and coping strategies through occupational therapy, speech therapy, and ABA therapy can help minimize future freezing episodes.
Are there any medications used for freezing in autism?
Currently, there are no medications FDA-approved specifically for treating freezing in autism spectrum disorder. However, in some cases, certain medications may provide relief:
– **Alpha agonists** – Clonidine and guanfacine act on noradrenergic alpha receptors. Potentially helpful for sensory-triggered freezing.
– **SSRIs** – Selective serotonin reuptake inhibitor antidepressants like fluoxetine. Could improve freezing related to anxiety.
– **Naltrexone** – Blocks opioid receptors. Shown to reduce freezing duration in small studies.
– **Antipsychotics** – Atypical versions like risperidone may decrease freezing from severe distress.
– **Anti-convulsants** – Medications like valproic acid used for seizures could stabilize excitatory/inhibitory signaling.
As always, benefits and side effects must be carefully weighed. It is vital to work with the prescribing doctor to closely monitor effects and adjust dosage and medications as needed. Alternative therapy approaches should also be considered where possible to lower risks of medication use.
Does freezing get better over time as an autistic child develops?
The natural developmental trajectory of freezing behaviors in autism is variable:
– For some, freezing does naturally improve with age, perhaps due to maturation of motor control and coping skills.
– However, freezing often persists into adulthood for many on the spectrum, especially if co-occurring conditions like anxiety or epilepsy are present.
– Severe, chronic freezing with regression may remain stable or progressively worsen in a subset of individuals.
– Transition periods like entering school, adolescence, or living independently may exacerbate freezing initially before stabilizing.
– Life events can prompt recurrence even if freezing has resolved. Ongoing support is often beneficial.
While prognosis depends on the individual, parent education, evidence-based therapies, and clinician guidance can maximize opportunities for learning skills to overcome freezing challenges over the long-term.
What are some autism-friendly ways to set up the home, school, or therapy environment to prevent freezing?
Small adjustments to spaces where autistic children live, learn, and play can make a big difference in minimizing triggers that provoke freezing episodes:
– Reduce clutter and distracting decorations to limit overstimulation.
– Use soft lighting and mute bright colors on walls. Install dimmer switches.
– Eliminate flickering fluorescent bulbs which can cause visual stress.
– Insulate rooms and play calming music to absorb loud ambient noise.
– Maintain consistent, predictable routines and furniture arrangements.
– Post visual schedules depicting daily activities and transitions.
– Ensure adequate spacing between furniture to prevent feeling trapped.
– Set up quiet corners with pillows, blankets, and fidget toys to self-soothe if overwhelmed.
– Keep walkways and entrances free from obstructions for smooth transitions.
– Avoid busy, chaotic environments like malls, stadiums, or festivals which may trigger freezing.
– Permit the use of noise-cancelling headphones, sunglasses or other tools to manage sensory input.
Taking preventative measures to accommodate sensory needs and minimize uncertainty and disruption can help make home and school more secure. This fosters self-confidence and independence which protects against freezing.
Are there any therapies or interventions designed specifically to treat freezing in autism?
Currently, there are no evidence-based therapies uniquely developed to eliminate freezing in autism. However, components of broader autism interventions may offer benefits:
– **Applied Behavior Analysis (ABA)** – Reinforcing alternatives to freezing through differential reinforcement. Can shape skills to manage anxiety triggers.
– **Cognitive Behavioral Therapy (CBT)** – Developing coping strategies and replacing catastrophic thinking patterns about freezing events.
– **Sensory Integration Therapy** – Regulating sensory systems and responding adaptively to input that provokes freezing.
– **Speech Therapy** – Improving expressive communication skills to describe internal states rather than freeze.
– **Social Skills Training** – Building capacity for social problem-solving to reduce anxiety responses.
– **Physical/Occupational Therapy** – Enhancing motor control and promoting fluid, flexible movement patterns.
– **Art Therapy** – Using creative arts to express and reframe emotions about past freezing experiences.
A combination approach tailored to the individual leveraging multiple therapies typically delivers the greatest improvements. Consistency across home, school, and community settings also boosts progress.
Conclusion
Freezing affects a sizeable proportion of children on the autism spectrum to varying degrees of severity. While sometimes concerning to observers, these involuntary episodes arise from neurological differences beyond the child’s control. By taking proactive steps to structure accommodating environments and develop adaptive coping strategies, families, educators, and clinicians can help mitigate freezing. With compassionate support, autistic children can learn to navigate situations triggering freezing and build self-confidence. Ongoing research promises to further unpack the brain mechanisms underlying freezing which will inform future targeted interventions.