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Can’t start – can’t stop
Another problem autistic individuals experience is ‘inertia’ (Dekker 1999) – difficulty in starting, stopping, planning and changing activities.
Initiation difficulties are often physical: despite knowing what to do (and how to do it), they just cannot start doing it. One of the possible causes can be an inability to control their bodies or other movement impairments.
We don’t even have proper control of our bodies. Both staying still and moving when we’re told to is tricky – it’s as if we’re remote-controlling a faulty robot (Naoki Higashida).
Sometimes the motor difficulties and inability to initiate even simple physical actions resemble mild forms of catatonia or catatonia-like phenomena (Shah (2019).
Do you have to remember to plug your eyes in order to make sense of what you’re seeing? Do you have to find your legs before you can walk? Autistic children may be born not knowing how to eat… (Jim Sinclair).
Thus, they have a great difficulty to initiate an action, but once they start, they find it hard to stop until they finish.
Alex cannot stop doing something until he has completed the task, no matter how tired he is. He will cry or throw things from the desk but continue with the activity until he completes it.
Alternatively, some autistic individuals may have difficulty persisting at a task and move quickly to other things. Deficits in planning, inhibition of prepotent responses, flexibility and working memory are known as deficits in executive functions. Executive function impairment has been proposed as a potential underlying deficit of autism because the symptoms demonstrated by those with prefrontal cortical dysfunction are similar to autistic behaviours (Ozonoff et al. 1991). [One of the difficulties with this hypothesis is that autism is not the only condition with potential executive function deficits.]
Deficits in executive function are also reflected in speech and language impairment. For non-autistic people, this process seems to be almost automatic. However, for a person with executive dysfunction, it is a difficult process, involving many stages to come through. Thus, a thought has to be held in working memory while the response is being organised and produced. Autistic children may have something to say, but they have difficulty in finding the words they want and getting them formed and produced. Generally, they have less difficulty in familiar environments with familiar people and situations, but they may not be able to do it in other environments, with unfamiliar people or situations, though they know how to do it.
What it is like...
Buckle et al. (2021) explored 'autistic inertia' by gathering qualitative data directly from autistic people who were able to express their internal experiences in words. They identified four themes which describe core characteristics of participants’ internal experiences of inertia: (1) tendency to maintain one state, (2) lack of voluntary control, (3) difficulty finding the first step and (4) disconnection between intention and action. They also describe in detail the actions they have difficulty with, what makes it easier or harder to act, and the impact on their lives.
Difficulties with planning, and with executing a plan, were a major issue. Some had difficulty breaking down a task or formulating a plan. Others expressed difficulties to do with prioritizing or finding a starting point. They often needed the help of another person to work out how to approach a task.
For some initiating an activity was more difficult than sustaining it. Routines can help because they don’t have to think about it but do things a bit more on autopilot (Lisa), while trying to convince themselves to act was usually ineffective.
Interruptions of both the state of activity and inactivity could be helpful or harmful, for instance, for someone who was unable to start, an interruption could trigger initiation of an action. On the other hand, once inertia was ‘in motion’, a disruption would make it very difficult (if not impossible) to re-start the task. Besides, irrelevant movement and background noise were usually distracting and stressful.
Conventional organization / memory tools (e.g., alarms, lists, reminders) are seldom helpful; practical assistance is far more beneficial.
The most helpful intervention for getting unstuck was prompting from another person in their presence, or even having someone working nearby without interacting. On the other hand, misdirected prompts or excessive demands and pressure could cause stress which would exacerbate issues.
Interestingly, they found it easier to do anything for somebody else, and most difficult – to do something only for themselves. For some, a sense of urgency could be effective as well (Buckle et al. 2021).
Buckle et al. (2021) emphasise that often, autistic people are considered non-compliant, unmotivated or lazy when they fail to act. However, it is ‘autistic inertia’ and not voluntary task avoidance or lack of motivation that prevents them from acting.
People just don’t understand how stressful it [being unable to act] is. I feel constantly exhausted, overwhelmed and useless. I know what needs to be done and I know that I am able to do it, but more often than not -- I can’t! (T.)