Autism and the Fascinating Power of Associative Thinking

And what happens when your mind doesn’t think in a linear way

Dog headDiego, my 26-year old son with autism and intellectual disability, loves the word “similar”.

On one of our runs the other day, he began to recite this litany of similarities between movies:

“Holes is similar to Indiana Jones”, “Talladega Nights is similar to Elf”, ” “Slum Dog Millionaire is similar to Jungle Book,” “Aquaman is similar to The Little Mermaid, ” “Alice in Wonderland is like 13 going on 30…”

He would’ve gone on indefinitely had I not interrupted him to ask, “How’s movie X similar to movie Y?”

Holes and Indiana Jones are similar because “they both dig”. Talladega Nights and Elf are both comedies. Slum Dog Millionaire and Jungle Book are both in India. Aquaman and The Little Mermaid are both in the Atlantic.

And, my favorite, Alice in Wonderland and 13 going on 30 are both dreams.

Diego’s psychiatrist calls Diego’s recitations “flights of ideas”. I call it “associative thinking”. The following are a few more examples of how it works:

A few months ago, as I was paying for repairs on my car, Diego saw a stuffed duck toy on a counter. He took his cell phone out of his pocket and said:

“I’m gonna take a picture of the duck. I love it. I’m gonna take a picture of the duck because I eat duck from Costco. I like Donald Duck. I like Daffy Duck from the Looney Tunes. I saw Donald Duck in Disney.”

Here’s the silly little duck that triggered the associations:

Little duck stuffed animal
Duck on a counter at Toyota dealership and shop. Image by Author

Images are often instant sources of associations, and Diego always takes pictures of them.

We were in the lobby of an apartment building the other day and Diego noticed a big coffee table book with an image of a black feline on it. As expected, he whipped out his cell and took a photo as he voiced his thoughts out loud:

“I’m taking a picture of the panther. The Black Panther from Africa. Chadwick Boseman was the Black Panther. Chadwick Boseman passed away. He was in 42. He was African American like Denzel Washinton from American Gangster”


On yet another run, Diego and I came upon a young woman and her dog. Diego stopped and looked at her straight in the eye and said, “Cane in Italian.” What in the world does he mean? I wondered. Usually, I can tell what he’s referring to.

Suspecting the girl might feel uncomfortable about a random guy on a run abruptly stopping, staring at her, and uttering, “Cane in Italian”, I interjected, “This is my son Diego. What’s your dog’s name?”

I needn’t have worried. Like almost everyone we’ve ever encountered, the girl sensed Diego’s goodness.

After a few exchanges, Diego stated, “You were in Italian class.”

“Oh, yeah, I remember,” she said (though I’m not so sure she actually did).

Turns out she and Diego had been in the same Italian class in high school a decade ago. Diego had recognized her right away. Seeing her dog, the sentence “Cane in Italian” just came out of his mouth.

“Cane” is Italian for “dog”. Should’ve been obvious, don’t you think?

And here’s one more example: 26 minutes into a hike in Camden, Maine, Diego noticed an ant on the trail and said: “Look. An ant from Bug’s Life. It’s Flick.”

Such animal/ movie character associations happen all the time when we’re out and about. A rabbit is instantly Thumper (Disney’s Bambi) or Lucky Jack (Disney’s Home on the Range), a deer is either Bambi or Faline (both from Bambi), and a seagull is Orville (Disney’s The Rescuers Down Under).


In Diego’s brain, a visual stimulus often begets an association which begets a second association which begets a third association, and so on. It all happens quickly and the amazing thing is he can put it into words as it’s happening.

I usually know what Diego’s talking about when the stimulus is visual, even if I may not understand the association’s source. The original stimulus need not be visual, however. It can be a thought or an event.

When it comes to thoughts, the anxious kind renders Diego’s “associative thinking” most evident.

I know an anxious thought is tormenting him when he begins this recitation associating various anxious memories:

“Airplanes get grounded due to bad weather. I’m already 26. It’s a New Year. Let’s pray: Our Father….”

“Airplanes get grounded due to bad weather” refers to the time our flight to visit my sister was canceled due to, well, bad weather. “I’m already 26” and “It’s a New Year” are things I’ve said to him to try to get him to calm down. Praying is what Abuela and many others do to feel happy.

As to events, here’s a recent example of “associative thinking” at work. Some weeks ago, Diego’s friend Owen called with the sad news that the family dog, Gus, had passed. After saying he was sorry for the loss, Diego reminded Owen that he’d be seeing him soon, and suggested: “We’ll watch Coco and All Dogs Go to Heaven.”

Get it? The death event elicited Coco, while the death-of-a-dog event triggered All Dogs Go to Heaven. Both movies prominently feature dogs, death and the afterlife.

Diego’s often hard to understand because his speech can be slurred and rushed and because what he says sometimes doesn’t seem to make sense. But if you dig deeper, you’ll find there sure is meaning behind everything Diego says.

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My Finger Picking Compulsion Feels Just Like an Addiction

The emotional consequences of body-focused repetitive behaviors

fingers
Image by (El Caminante) from Pixabay

I’ve been a finger picker for 37 years. I was in middle school when I began to notice and pull out flakes of skin around my fingernails.

I can’t remember how long it took for finger picking to become both habit and problem. What I do know is that I was hiding it by the time I was in high school.

Still, once in a while someone would notice a ravaged finger and ask, “What happened to your finger?” I’d come up with excuses like getting burned or having picked at it just once and then getting an infection.

I began putting on a bandaid when a finger looked noticeably damaged — a great solution since the bandaid both hid the injury and gave credibility to my explanation that I’d accidentally cut myself. I’d pick under the table or when my back was turned to others.

While still in high school, I managed to limit my picking to my index fingers and thumbs. Over the ensuing decades, I’ve been able to further narrow down my self-mutilating behavior so that my left thumb is now its only target.

My left thumb became my sacrificial finger.

I don’t want to minimize the gravity of drug, tobacco, or alcohol addiction, but finger picking strikes me as similar in some ways. In fact, I often think I know what it must be like to have a substance abuse problem.

Finger picking has caused me shame and a measure of self-hatred, just as any addiction would.

Like an addict, I strive to hide my habit from others. My husband marvels at how I was able to conceal my mutilated thumb and index finger from him for months before he noticed them. I knew how to perfectly angle my hand so my ugly fingers wouldn’t show when I rested it on a surface or used it to stir, clap, hold, scratch, or whatever.

Like other addictions, finger picking carries some risk since the possibility of infection is real. Unbelievably, it also interferes with daily activities, like when I just have to peel off a bit of skin while driving or when I must be done removing a flake before turning off the stove.

Finally, there’s the question we always ask about addiction: Why, for the love of God, can I not stop?

My failure to stop picking exasperates me. I mean, even people addicted to crack, alcohol and tobacco can manage to quit.

Still, I’ve always sensed killing this habit is harder than I usually admit to myself and that the behavior is associated with my family’s strong genetic predisposition for depression, anxiety, and obsessive-compulsive disorders.

How could there not be a genetic component when three of my five sisters have engaged in serious body-focused repetitive behaviors, as behaviors such as skin picking, nail-biting, and hair-pulling are known in the literature? There has to be a genetic component to my habit.

Every now and then, I bring up finger picking with my sister Lole — whose habit is as bad as mine — and we’ll give each other suggestions. I’ll tell her, “My finger picking’s out of control lately. I need to do something!” Recently, Lole said she’ll squeeze her finger hard ten times and tell herself, “My finger doesn’t want me to do this to it.” She’s esoteric like that.

Last year, I came across an article in The New York Times that explored body-focused repetitive behaviors such as mine. The piece, Fighting the Shame of Skin Picking (9/5/2019), could not have described my experience more aptly:

“These repetitive behaviors typically emerge around the onset of puberty, though they can begin earlier, and are more common in girls and women. They tend to occur along with mood disorders like anxiety and depression, or with obsessive-compulsive disorder. Patients report feeling an urge to pick or pull, followed by a physical sensation of relief or gratification while engaging in the behavior itself.”


The way I feel about my finger picking habit has changed. Though I don’t go around showing people my damaged finger, I’m no longer ashamed. If someone asks what happened to it, I’ll say I have a bad picking habit.

If the person’s really curious, I’ll explain that my thumb looks the way it does due to a decades-old self-injurious behavior. I might also tell them my compulsion, also known as excoriation disorder, actually appears in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), classified as an “obsessive-compulsive and related disorder”.

As all obsessive-compulsive behaviors, skin picking is extraordinarily hard to eliminate. The longest I’ve gone without doing it was around five years ago when I printed out a chart to mark the days I didn’t pick. I told myself that if I managed to go 30 days in a row without picking, I’d give myself a reward. I had to start over many times but eventually got to 30 consecutive days of no picking.

I cannot even remember what the reward was. The habit, though, was not forgotten. It resurfaced. “Just this once” became” just today” until it was back in full force.

The reason I’m writing this piece now is that I’ve been picking in earnest over the past couple of weeks, and have become impatient with myself for my inability to mitigate my compulsion.

I’ve even thought of a terrible punishment technique: For every time I pick, I must donate $1 to the National Rifle Association. This could add up to a sizable donation to an organization I’d love to see defunded. Effective as this plan sounds, I just can’t do it. The thought of it makes me want to pick!

Skin picking disorder feels like an addiction and is more common than you’d think. According to the Harvard Health Blog, it affects at least five million Americans.

If you’re one of them, knowing it’s not just you might make you feel better. It did for me at least. If you’re not, keep in mind that that close friend or family member who picks their skin to death is not weak or totally lacking in will.

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