“Are you sure he has Autism? He’s so friendly…”. While there are more nuanced aspects now to the criteria, failure to develop peer relationships appropriate to developmental level is one of the defining and most obvious diagnostic identification for children with autism. Interest in people in general, desire for friendships and loving behavior can muddy the diagnostic waters and confuse people about what autism is and what autism isn’t. Disconnectedness, aloofness and lack of desire to be touched does not always translate as a lack of desire for relationships. The desire is there, the understanding for how that happens is not. It can just be easier to be by yourself. A1 can tell you that. Indiscriminate friendliness, hugs and kisses to those he loves and the compulsive desire to be around a lot of people doesn’t always coexist with developmentally appropriate social skills. A2 probably would tell you that part…if…
I get asked often what I think caused my child’s Autism. I believe it is completely counterproductive to even consider it until such a time that there is solid evidence. They are here now. I love my kids fiercely. Our struggles would be the same whether or not we knew the ‘why’ part.
Infection in mother during pregnancy, vaccine accidents, overweight in mother during pregnancy, gestational diabetes, inadequate iodine, diagnostic ultrasounds, prenatal stress, advanced paternal age at time of conception, pesticides both before and after gestation…I’ve read those all. And they all have the same message: “Dad….Mom (but more likely Mom)…you did something…IT’S YOUR FAULT.” These theories are also part of what drives the Neurodiversity movement. That is, that individual differences and biological diversity are a normal and natural part of evolution and Autism is no different, so it is not something to be treated. Behavioral disruption is misunderstood communication and all the comorbid conditions such as GI/bowel issues, intellectual impairments, mental health issues are just that. Something not related directly to Autism (a whole other can of worms within our community….).
Regardless of your belief system…there is only one thing we know for absolutely certain: NO ONE KNOWS WHAT CAUSES AUTISM.
To demonize parents who make decisions you would not necessarily make is also counterproductive.
As parents we have an instinct to protect our children. When a parent watches the baby she knows slip away into a world of of silence or pain in front of her very eyes and no one can tell her why or really what to do..well….just take a moment to let that sink in regardless of your parenting/political/medical stance. I don’t have to agree, I just have to have empathy.
Here is what we do know. There is a genetic component to Autism and it is likely paired with an environmental trigger. Just like Type 2 Diabetes. You can’t develop this unless you have the genes. You make it far less likely to get it if you get your butt up off the couch, exercise regularly and do not eat like a regular American.
We just are not 100% certain what that common genetic component or the environmental one in Autism. I am not going to even pretend to know anything about genetics. The best I can do is tell you:
Picture a city with 20,000 streets.
Now lets figure out which streets have public mailboxes, one way traffic, standard poodles and single mothers living on them.
Only some people who travel down those streets buy mandarin oranges (not regular naval) and we need to find those people.
(But what about the naval orange buying people!? Those are a lot like mandarins!)
That is what it is like trying to figure out the common genetic factor and environmental trigger together. When I had a discussion about this with a pediatrician 12 years ago she said to me: “Autism is caused by a genetics. Period. To consider anything else is ridiculous.”
I sat for a moment and thought about that. I then I wondered out loud, “Can you tell me another genetic epidemic in history that unfolded like Autism?” Crickets. I’m a pretty moderate parent…however it is no wonder that many parents are suspect of the medical system with that kind of definitive statement when the bottom line is WE DON’T KNOW.
Does it mean my husband and I have Autism? No, not necessarily…but who knows? If we do carry that genetic material and we combined it….we no more caused the autism than we “caused” their big gorgeous brown eyes or fact that they may need to wear glasses one day. Their eyes could have almost just as easily been blue instead all things considered. And if environment did play a role and all the Fruity Pebbles I ate during pregnancy kicked those genes into overdrive as the environmental trigger, there is not a damn thing I can do about that now.
I have never felt the “shame of blame”…and I don’t think any parent should.
We are wired to procreate and continue population. We can just hope that this kind of information will one day find the link that allows children who suffer in silence or physical or emotional pain to grow to be independent and happy…just like all parents want their kids to do.
A response to an internal stimuli such as hunger, illness or exhaustion.
Seriously. Just 4 reasons anyone does anything. Think about it–you won’t come up with a 5th. I have tried.
Of course, if it were that simple we would all live in harmony. However, there are some times it gets tricky. For instance, when a behavior is triggered by something internal, it can be incredibly difficult to identify. So if a child with autism likes to clap his hands near his ears is it because he likes the sound? Or is it because he likes how his hands feel when he claps them together? Or is it because it creates a little wind near his face which he likes? To make matters even more complicated…a behavior can change function midstream and without warning. So that same kid who liked hearing the sound of his own clapping next to his ear and his parent rushes over to him and holds his hands and tells him “stop! Lets play instead”….her reaction may have just inadvertently changed the function of the child’s behavior from internal reasons to external. Perhaps it becomes a great way to get his parents’ attention now too. Such is the nature of human existence…including humans on the Autism Spectrum. It is easy to judge others without understanding when looking at their behaviors through our own lenses. So next time you see a child having a tantrum in public or seems out of control, bear in mind that the function of his behavior may not be attention like you might be used to from a bratty kid. He may be responding to sensory overload and needs to leave or perhaps if you hang out long enough you may come to find it may be screams of joy because he has no other way to express it.
“Why does he do that?” A common question for parents of children with autism. There is no easy answer for that in a global sense given each child with autism is as unique as any child without autism. Many times it’s because the wires are crossed neurologically causing some kids like A2 to perceive things in the world differently. Licking a basketball before he shoots it, flapping his arms whenever he is excited or anxious or hooting loudly when he sees something interesting….try thinking instead taste sometimes is like balance, repetitive movements are calming to the body and noise is quicker that coming up with words. Sometimes the quirk comes because the part of the brain responsible for things like memory, the time it takes to process information and the ability to take another persons’ perspective has a blip and experiences the world in the same way much like A1. Someone just said to me “I always thought he just marches to the beat of his own drummer”. And he does. They both do. My kids are as they are and as they should be but at the same time they do need to be functioning and hopefully contributing members of society. Sometimes though, to watch the struggle of loneliness because others don’t understand is painful and hope that I am projecting my own anxiety and that they are more resilient than I give credit for. This unique and quirky nature of autism makes my guys who they are…..and they are perfect to me. Perfect…and different, not less….
P was hard because there are so many things P can be for us. Passion, Pediasure, potty training, poop, persistence (in a good way). But if this is about awareness, this is critical.
Early conversations over time had with doctors about both A1 and A2:Me: “He’s sitting up already but his hands are still in fists and he can’t grab anything-something doesn’t feel right. ”
Doc: “Wow. He’s just really uncoordinated.”
Me: “He can say way more than I think he understands-so I had a speech therapist look at him and she validated that, what is that?”
Doc: “That’s impossible. That therapist doesn’t know what she’s talking about.”
Me: “Since our move I’ve noticed he doesn’t babble in his crib any more and he only smiles at the microwave and the lamp, but not me.”
Doc: “You just moved…he’s getting used to his environment don’t worry about it (at 8 mos. old).”
I wish I could say that we just had a doctor who was incompetent (and no, the picture is not of the ACTUAL doctor which would potentially explain how things would be missed), but I hear things just like this in my private practice all the time.
All. The Time.
If your gut feels off about something and you are dismissed by your pediatrician, get a second opinion. Seek out information online about early symptoms of autism. All the research points to early intervention as the key component to long term success with the symptoms of autism. There are programs that are now identifying autism in infants. Lack of eye contact, failure to meet developmental milestones (especially language), lack of responsiveness to their name, repetitive motions such as flicking hands in front of their face are just a few. Even outside of classic symptoms, there are some not so classic ones.
Both as a social worker, but also a mom, if you have a nagging gut feeling….”let’s wait and see if he grows out of it” may waste precious time.
All kids can be defiant. All kids can be persistent. Most can be both at one time or another…..however the persistence of a person with Autism can sometimes be far outside typical willfulness of even the most obstinate of kiddos. Most of this stems from intense need for familiarity, order and sameness of routine. This rigidity is part of the diagnostic criteria of Autism Spectrum Disorders. Sometimes I have no idea what will trigger A2 into a 3 hour long battle of wills. What can be a 5 minute routine one day can take 2 hours the next even when he knows that routine ends in something he enjoys. A1…no matter how much punishment, berating or time outs he got, he would get right back up and do the same thing over again. One summer I decided to ‘put my foot down’ and send him to the time out step after every single infraction. No warnings. That should teach him! After about a week of this, there was a day that I had sent him 17 times all before my husband got home from work. And he went willingly. Every. Single. Time. Something was very wrong and thankfully I had a moment of clarity. I got a clear cup, drew some lines across it and found a bag of marbles. Every time I caught him doing the right thing, I would throw a marble in the cup with the caveat that he couldn’t point out to me how good he was being. Unless he hurt someone (which he never did), there was no more time out step. Every time we filled the cup to a line, he got to pick what we did next in our day. If we got to the top (by the end of the day), he could get a dessert after dinner.
Just. Like. That. Everything was different. He would listen the first time and look out of the corner of his eye to see if I was digging for a marble. He got double marbles if he initiated social interactions. Before long, we were engaged in pretend play in the basement.
I had someone close ask “Don’t you think it might not be autism? Don’t you think it is could be his personality?”.
“Well, ” I indulged “if everything we do serves a function, what function do you think his behavior served that week?” Without much hesitation, she drew her hand up as if she was grabbing something and said “To have a ‘gotcha’ moment!” I thought for a moment. “What 4 year-old would rather sit on a step over and over, day after day instead of playing just to get under his mother’s skin? Isn’t a week long enough to learn that without the behavior increasing?” A four-year-old. Clinically, that would be a much, much bigger issue than autism.
Before that, I used to joke about how even a dog can learn to salivate to the sound of a bell when paired with food over time, yet I could not get my child to understand how his behavior had anything to do with the consequence he would receive. It’s one of the most bewildering and frustrating parts of parenting because regular consequences do not work. Though A2 may connect consequence to behavior in the moment, the pathology outweighs all and it is likely that he may not learn from his behavior for the next time. A2’s Childhood Apraxia of Speech required us to do drill work with cards for sounds and words over and over. Did we create some of this rigidity with him because of this? Probably. Did I have any idea that would be possible then? No. But the trade off was that he learned to try to speak and can make some needs known so that people other than me and my husband understand. Was it worth it? As a parent with limited understanding and resources I would have to say “yes”, because he displayed rigidity before that. Even as I add to this blog post from the original version written two years ago, I realize how much I have learned to even question if this was possible. We have lots to continue to learn.
In the month of our 15 year anniversary, I can confidently say we have embarked on a journey neither of us could have expected.
In some ways I wonder if our trek is easier than others since we never had musings of what our unborn children would be like or what kind of parents we would be.
…or if we would be parents at all….
I believe in a judicious balance between predestination and free will. Sort of like walking into a movie complex. You can pick the movie you will see, but once you choose it, the plot and ending remain the same. It is up to you if you decide to leave the theater to get popcorn or simply decide that movie is not for you and you should have never listened to Siskel and Ebert’s reviews to begin with.
All marriages require a gentle balance between cohesiveness and independence….and especially with families like ours. Stress is a constant, sleep deprivation a given, and child rearing? Well, throw out everything you ever thought you knew about that. Not everyone can do that. Usually, the stronger is left holding the bag on their own. I know too many families like that and watch in awe as the parent left behind carries the weight of her world.
Through thick and thin we give each other the space we need, recognizing we are in for the long haul. Our children are who they are supposed to be. We make the same mistakes as every other parent in every other union, but with the knowledge we must be united as forever parents, even long after we are gone. And for that, perhaps we are luckier than most.
This breakfast is 8 years in the making. A2 eats a total of 9 different foods..all presented in a certain way.–all brand specific. Starting from 0. He has worked so hard to get to this point and I feel a weird balance of pride, frustration and futility when I see this plate. Feeding issues in autism are common and are outside of “oh, all kids can be picky eaters” or “just tell him if he doesn’t eat dinner, he won’t get anything later–it’s not like he’ll let himself starve”. Because actually….he will. Many children with autism have serious food aversions and feeding issues. The reasons are varied but tend to be due to sensory, texture, medical or obsessive-compulsive issues. Behavioral issues become deeply ingrained in these kiddos when eating is paired with physical pain due to gut issues so common in kids with autistic disorders and can last a lifetime. So-the next time you are out to dinner and see a mom letting her kid eat Poptarts or a huge mound of fries for dinner–she may not be spoiling her kiddo….that dinner may also be 8 years in the making.
F is for Food…Part 2….Behind the kitchen door
There was this moment when my then preschool aged child and infant and I were sitting at the dinner table. I had my plate of one protein, one complex carb and leafy greens, napkin unfurled neatly in my lap, fork down after every bite. My prescribed Xanax appetizer was working as I sat there all June Cleaver-like smiling, asking about finger-paint and sandbox filled days, modeling healthy eating, modeling appropriate mealtime behavior…like I tried to every single day with little to no success. Dinner was cuisine and varied every night but there were 3 different dinner plates on the table. A1 wasn’t growing well and complained every mealtime that his stomach hurt. It would take him about 1/2 hour to eat even 50% of his meal but a big part of this was because he could not stay seated , would play with his shoes or get up to get a toy.
“Where are you going?”
“Did you have fun with your friends at school?”
“4 more bites.”
” You love buttery noodles, remember?”
“Don’t lick your shoes.”
“The timer hasn’t gone off yet.”
“I love this picture you made, tell me more about it.”
While this was going on, A2 sat strapped in to his high chair at the table with mounds of “power packed” foods. Macaroni and Cheese made with extra cheese, heavy cream and special calorie powder stirred in, crackers, whole milk with carnation instant breakfast. I was taking him to the doctor every several days for weigh ins because he was not growing or gaining weight with any normalcy. His Help Me Grow case worker taught me how to increase his calories…something that his dietician did not show me…or even suggest. He was eating about 1000 calories a day which was about the same amount I was eating to maintain pudgy and yet he still he would only gain ounces over the course of a few weeks. It made no sense. Most evenings he would sit in front of his food and not initiate eating so between my own bites I would a cajole him into letting me stick a Mickey Mouse spoon between his lips. He chewed funny. It did not look like he enjoyed eating, but generally he never fought it. But not this night. He turned his head from me and giggled at A1 who was now slowly sliding out of his chair, disappearing under the table. A2’s last weigh in he had dropped 4 ounces but we had no idea why. (Maybe I needed to put more of that Nestle Additions stuff in his milk? Should I switch to Boost? I think that has more calories. I wish he liked doughnuts!). In that moment, I experienced PXF (Parental Xanax Failure) and June Cleaver went bye bye. The underlying and increasing anxiety I was having at mealtime that caused me to medicate so I remained calm and cheery sprang to the surface and yelled “Ta da!!! Here I am everyone!!” I snapped at A1 to sit in his chair immediately and accused him of distracting his brother to the point of not eating….and his stomach is fine….so finish that spaghetti and garlic bread! I got out an assortment of spoons hoping A2 would pick one he liked better. He did not. As he sat thrashing his head from side to side and mooshing his lips together to avoid any possibility of the airplane making an emergency landing in his mouth I began bawling and begging him to eat like some bad drama actress from the 1940s. Meanwhile, A1 got up from the table to poop. What the hell was I doing wrong? Kids just eat, right?
About a year later, I dusted off that MOTHER OF THE YEAR trophy I earned that day and dropped it in the trash. A1 started losing weight and his pediatrician started taking his constant loose stools seriously. He had an elevated EMA (antibody test that is specific to gluten…as in that stuff found in spaghetti and garlic bread). After a week of no gluten he had his first normal looking poop of his life and soon after no more complaints at mealtime. A2 phased out all solid food before he turned 2 but was increasing the amount of Pediasure he drank. Within the month of being on a self-induced liquid only diet, he started sleeping much, much longer stretches, started walking and got consonant sounds. Sure, he projectile vomited 3 times a day but he seemed much happier. His head never spun around even once so we were fairly sure we were not going to have to call for an exorcism. To save money we switched to the a big box, El-Cheapo version of Pediasure. What we saved in monthly bills, we spent in clean up costs and therapy bills for A1 because the vomiting seemed to increase–as did his target range. And like fine wine connoisseurs, my husband and I decided the bouquet of El-Cheapo vomit was not as pleasant as Pediasure vomit. A1 and his hypersensitive sensory system were traumatized. (see exhibit A)
EXHIBIT A: Things he likes to smell: Perfume. Things he doesn’t like to smell: Vomit
Through deductive reasoning, I concluded that El-Cheapo brand was making it worse, we switched back and he improved. A few years later he improved even more when an integrative medicine doctor suggested he couldn’t digest dairy and thought he should be on a “pre-digested” prescription version of the same thing. “Oh…no. We had him tested, he’s not allergic to dairy…and our GI said its probably just a mito thing”. But sure enough within a few weeks of switching again, A2 stopped vomiting. Completely. And he was willing to play with and then even taste a few foods.
There is nothing more instinctual to a mother than nourishing her child. Our species would not survive if this were not the case. When your child has feeding issues it is normal to doubt your instincts, to question what you are doing wrong, how you are messing this up. Have I had to drop a few $20s into the therapy jar for later due to my own reactions? Sure. I am human and I find there has been almost nothing more unnerving than my child not eating or feeling sick when they eat but no one can tell me why. And when someone finally figures something out and they get better to start questioning EVERYTHING. Make sure you are being honest with yourself. Are you trying the best you can? Are you revisiting eating with your child? Are you trying to create a more relaxed environment at mealtimes? Can you, especially as a woman in this society put your own food issues aside? Pat yourself on the back if you can answer “yes” to those questions because your child will continue to thrive because of you. Breathe….and most importantly, enjoy your meal.
“Check water first”. The most terrifying emergency directive a parent can hear….and this is the protocol for children with Autism who go missing. Elopement, wandering, bolting, fleeing. 48% of children with autism elope. Drowning is the leading cause of death in kids under 14 with Autism. We are lucky-A2 only gets distracted and wanders to find things that are interesting without regard to safety or whether a familiar adult is nearby–but he does not run from us–which prevents so many families from being able to go in public safely with their child. One of the things that makes A2’s non-elopement complicated as that he is not a risk…. until he is. He can go a full year with staying in eye shot and then one day out of no where he will simply leave the house. With no warning. He also cannot tell anyone his first and last name with consistency or clarity. He does not know his address or phone number despite years of practice. He knows my full name, but unless you are a trained listener. you will not understand him. We all know to approach a young child who appears to be lost, but most would not think to approach an older child or young adult. Be aware–this is one way we can all be a village to our families!
Unfortunately, there are limited ways to actually prevent elopement behaviors. When we assume the function of behavior is escape we may be missing out on other factors. Does he bolt and laugh while doing it as he watches you chase him (attention)? Is he fascinated with streetlamps or water or heavy equipment and feels intense compulsion to go check it out (access or internal attenuation)? Does he seem to leave only in specific situations or with specific people? If you have a child that is a runner, consider tracking the behavior for antecedents and response or consequence (even when unintended), track the time of day and what was happening around him at the time. Track WHAT the elopement looks like…does he run or is it more like walking away? Does it change what it looks like based on the situation? Besides lockdown and direct supervision, understanding your child’s behavior through data collection is your best preventative defense.
As far as what else you can do if your child is an elopement risk…again, limited but both high and low technology options can be lifesavers. If your county or police department have a special needs registry, register your child. There is a national initiative and grant called Project Lifesaver that your police department can utilize and get wristbands with gps or radio signal your child can wear. Keep an up to date photo of him on you at all times. Create a card he can carry with him with his information and use discrete trial training to teach him to hand it to someone if he cannot find you. Consider a cell phone and GPS tracking or the Find My iPhone App. There are tracking devices like http://www.angelsense.com available for a monthly fee. These attach to the inside of clothing. Go online and search for other high and low tech options they are out there.
List of tracking, ID and safety products (not an exhaustive or all inclusive list): https://www.autismspeaks.org/family-services/resource-library/safety-products
It is easy not to move forward because we do not want to assume the worst…..but like for so many of us in many aspects of our lives with our kiddos…we have hope for the best…but plan for the worst.
Running through Water 