Today’s column will take you inside the complex and confusing world of Autism Spectrum Disorders. ASD is a broad term for a range of childhood developmental disorders which, in order of severity, go like this: Autism, Pervasive Developmental Disorder, to Asperger’s Disorder. ASD’s cause impairments in 3 areas: Social relationships, verbal and non-verbal communication, and in the regulation of behavior. The primary goal of intervention for children with ASD’s is to identify and treat problem behaviors that are a part of this diagnosis. (American Academy of Pediatrics, vol. 145, issue 1, Jan/2020)
Before becoming too scientific, let’s see what this disorder looks like, from the perspective of a mother who has brought her son in for a diagnostic evaluation for possible ASD.
Mrs. Wilson has brought her son Nate,10, to the office for an evaluation of possible Asperger’s Disorder (Asperger’s is a relatively newer subtype of Autism, found only in children whose intellectual abilities are normal. These children struggle because they can’t make healthy social relationships due to a lack of communication skills, and a very narrow range of interests.)
Mrs. Wilson sits directly across from me. Her small, delicate hands, a perfect match to her petite frame, lie clenched and locked together on her lap. Her white knuckles are a testimony to tension born by nightmares only mothers can dream: “Since Nate was 2, I knew in my gut that something was wrong. But I denied it, hoping and praying that he’d grow out of it. But he only got worse. Am I a bad mom for waiting so long?”
This is the first time Mrs. Wilson has openly allowed herself to speak these words. As the meaning of her words — something is wrong with my son — dawns upon her, her honey-toned voice breaks apart and anxiety begins to seep into the gaps between her thoughts. Within seconds, her heart is swept away by fear, which in turn floods her eyes, turning them into overflowing puddles of tears. “Can you help my son?” she pleads.
After composing herself, she continues, “Nate has never had a single friend. When he starts a conversation with someone, he dominates it. He has no understanding of how to take turns in conversations. So, he confuses the kids at school, and they keep their distance. He is also obsessed with specific topics. For example, when he was 5 years old, he became fascinated with trains. He memorized the routes of every Amtrak train. Next, at 6, he became locked into an obsession about storms, from tornadoes to hurricanes. His current obsession is Civil War battles, especially Gettysburg.”
Mrs. Wilson continued, “Nate also has school problems. He’s very bright, but he is not motivated. Homework is left undone, daily class work piles up. His teacher called yesterday to tell me Nate was staring out the window, daydreaming, and was leaving his seat without permission. I know in my heart that Nate can’t do the tasks most normal boys can do. If he is pushed even a millimeter outside his comfort zone, he has a huge meltdown. Why does he do these things?”
I tell Mrs. Wilson to bring Nate into the children’s playroom. As Nate enters the playroom, he is instantly drawn to the soldiers I have placed in tubs on the floor (like Nate, I am a fan of the Civil War).
When I greet Nate, he responds with, “Hey, you have any cannons?” As I put the miniature cannons next to him, he begins to talk in an unusual voice that has a sing-song quality. He chatters on about why the troops must be placed in a wedge-shaped pattern and then, like a college professor, he opens up into a full throttle lecture about the Civil War. After 10 minutes of continuous talking, I tell Nate to stop and listen to me. He looks up at me, then he starts back into his lecture. When I stop him again, he explodes and stomps on the soldiers. Mrs. Wilson tries to re-direct Nate, but his meltdown goes volcanic and he erupts: “I hate you. You are the worst mother in the world.”
Nate will be diagnosed as a boy who has Autism, specifically, Asperger’s Disorder. He will receive a range of treatments and his mother will be trained in specific child-management skills so that she can help her son develop better social skills, more flexible thinking patterns and better control over his behaviors.
Autism can be a highly complex and confusing disorder. However, there is no confusion about the following: The earlier a child is identified as autistic, the sooner treatment can begin. The sooner treatment begins, the better the child’s chances are of developing those skills which can connect them to the world.
The content of this article is for educational purposes only, not treatment. The characters in this story are not real. Names and details have been changed to protect confidentiality.
Dr. Richard Elghammer contributes his column each week to the Journal Review.
