April 24, 2009

Autistic Boy Seeks Extravagant Chocolate

Attacking a child's personal space is never a good way to get him to cooperate. So taking a lot of time to let a child, especially an autistic child, get comfortable can be valuable. It also gives him the opportunity to assess the comfort of his parents. The less verbal the child is, the more essential it is to take the time to observe his self-directed behavior.

Today I met Robert for the first time. His parents said he had a few words sometimes, but mostly doesn't speak. Purposefully, I spent about an hour getting a history from his parents as he and his sister explored my office and found my toys. I noticed a few important things. He looked for and found toys on his own. We kept an eye on him, but my office is reasonably kid-safe and he didn't wander randomly. He was very happy with a couple of the interactive toys, generally intended for younger kids. They're fun when you haven't tried them before, and his sister played with them too. As the minutes dragged on, and the grown-ups talked about interventions and techniques and help organizations, he kept himself occupied and smiling, sometimes laughing. Even when his sister took a toy that he was playing with, he didn't lose his cool but found another toy or somehow got the original toy back from her.

She told me that she was worried about the future, and wanted him to be happy and enjoy all that life could offer. She shared a few anecdotes about him.

His mother said that one day, Robert came upon her eating a chocolate truffle. He gestured to her in a way that unambiguously meant that he wanted one. She said, 'if you find me a picture of one of these, I'll give you one.' He thoroughly searched his picture books, and found a photograph of a chocolate chip. Showing this to his mother, he got the truffle.

I didn't know what the future would bring, of course, and I couldn't guess how much language he will eventually acquire. But I believed, and I told her, that there were a couple of signs that made me optimistic. First, he was generally happy. It's hard to make someone happy who isn't. We have very helpful antidepressants which can, for some, relieve despair. But the medication doesn't induce happiness. A joyful, playful, happy child who delights in his world has something I would wish on everyone.

And the truffle story said a lot. I broke down the story for her. Many kids on the autistic spectrum have very inflexible ways of thinking. If you ask them to bring you the book from your table, they won't bring you the book if it's next to the table. If you ask them to say 'hello,' they might say the word but not to the person to be greeted. This is a type of concrete thinking. So it's very creative, intelligent, abstract thinking that can make a conceptual leap from truffle to chocolate chip. The story is more than evidence of abstract thinking. He also had to make a plan. His mother didn't tell him what to do. She gave him a sort of hypothetical situation. All by himself, he first decided on a goal he wanted to achieve (getting the truffle). Then he had to figure out how to reach that goal. He decided to call his mother's bluff. He used the resources at his disposal (books) and skills he was comfortable using. When faced with objective failure (he never did find a photo of a truffle), he didn't give up or become frustrated. He either had faith in the flexibility of his mother or faith in his own nonverbal negotiation skills. He found a picture that was as close as he could find, brought this over to his mother, and received his prize.

As the complexities of our lives and social interactions increase, abstract thinking and goal-oriented strategic planning become critical life skills. He had some of these critical skills already. The story also told me that his hearing was probably OK, that his auditory processing was pretty good, and that nobody should be eating chocolate around him unless they were prepared to share. I liked him.

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Please let me know what you think. Do you know a child or situation like this?