I’ve often wondered if the great number of autism diagnoses were misdiagnoses of children who just had a different way of looking at the world, didn’t conform, or patients of doctors who believed the criteria were absolute and not a matter of early childhood training getting in the way of whatever some medical council has declared “normal” should be.
Is the huge spike in autism statistics a matter of awareness (i.e. “We have a name for it now!”), the aforementioned misdiagnoses, or an ACTUAL change in the behavior of our children for the worse (due to whichever popular evil du jour, be it excessive stimuli of our day and age, vaccinations, BPA, power lines, or chemtrails)?
Before you power up your flamethrowers, I believe autism is a real thing, and that there really are children who have it, and I’m glad there is so much awareness and help for it today to make parents’ lives easier.
I just don’t think MY child has it.
Yes, he’s a little wild sometimes; he doesn’t care to play by the rules; he tends to think outside the box, play alone, and say whatever comes to mind, ignoring your questions completely; and he doesn’t hold your gaze for the magical amount of time doctors want while things are going on around him or he has a bunch of new things to look at. But how much of that is due to the fact that I might be sub-par at training him to develop according to the standards, and how much is due to the fact that he’s only three years old?
Here are the criteria for diagnosing autism. The doctor (the developmental specialist at the hospital we go to–who specializes in autism, no less) circled (a) and (b) of (1); (c) and (d) of (2); and (b), (c), and (d) of (3).
(a) of (1) says there is a “marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze,”–(the latter underlined by her)–“facial expression, body postures, and gestures to regulate social interaction.” When we went to see her, we were in a brand new room, with lots of toys and a person he didn’t know. He busied himself with the toys, and rarely met my eyes because he was busy with the toys. He didn’t meet her eyes, either, because, like I said, he was busy with the toys (and he didn’t know her and she was kind of a severe person who scared even me). That, apparently, is what she considered to be a processing problem. There’s so much to see and do, that he can’t pay attention to the person talking to him. I was kind of in listening mode and processing mode, myself, so it didn’t occur to me till later to mention that HE’S THREE. And he’s A BOY. It took me a long time and lots of courage to meet the eyes of people I didn’t know (and even those I did), especially if I had other things going on around me. Goodness, maybe that makes ME a candidate for autism!
But a “marked impairment“? He doesn’t try to avoid your gaze, he just doesn’t look at you when he’s busy. He has LOTS of facial expressions that convey what’s going through his head. And he gestures all the time. If he doesn’t have the word (or want to say it), he points. Then he points more emphatically. Then he says something (or whines) and points. He’s communicating well enough for a busy three-year-old.
I’d also been watching him lately, and I’ve realized that he meets my gaze very well, especially when being defiant. To get the attention of another child he tries to catch their eyes and say hello. Which brings me to (b) of (1), which says “failure to develop peer relationships appropriate to developmental level.”
I will admit failure on that part. Again, he’s THREE, and we live in the boonies. It’s not like he can pick up my cell phone and call his playtime buddy, or jump in the car and drive to the Imagination Station for some peer-to-peer interaction whenever he wants to. But when the next door neighbor’s grandchild comes over to play, Pie is thrilled. He runs and screams and plays with other kids, wherever we are, whether he knows them or not, and he talks about his cousins (one of whom is six weeks younger than him) all the time. If I got out of the house more often to play with other kids, he would have more appropriately-aged children to play with. But let me tell you: The fact that he’s played with kids who are older than him has led him to be more resilient, and the fact that he’s played with younger kids has helped him be more nurturing and gentle. Just because I have failed to create a regular cohort for him (or enroll him in preschool already) does not mean this criterium applies to him. When we were meeting at a playdate once a week, he never clung to me or sat by himself the whole time, but preferred to get into stuff, play with toys, and scream and run with the rest of them.
(d) of (2) is kind of weird. Pie has the toys he’s familiar with, and he will do all sorts of things with them: Act out his favorite movies, use them for purposes unintended for them (he has a travel alarm clock that is apparently his Blues Clues PDA, and the battery compartment is the perfect size for a broken crayon–that seems pretty imaginative and spontaneous to me), or make stuff up like any normal child. When faced with a new toy, or bunch of unrelated toys, he wants to see how they work first. He doesn’t just jump into expected patterns of play behavior because he’s exactly three years and seven months, and that’s what a child of his age should be doing.
The doctor had him sit in one spot and brought out several groups of toys in quick succession, trying to engage him in some imaginative play defined by her. The first was a baby, some birthday paraphernalia (plate, fork, knife, small dowels for candles, napkin), and play dough. The doctor wanted him to help her make a cake, then put candles on it, then sing Happy Birthday, cut the cake, and feed it to the baby. Pie, who doesn’t do food, just wanted to play with the play dough. If the candles really were on fire (or even looked like candles), he might have sung Happy Birthday and then helped her blow out the candles (he’s done that before). If there really was juice in the cups, he would have helped her clean up a spill. As it was, he was interested in touching everything first (which, for a kid with a touch of tactile defensiveness, is actually kind of commendable). By the time he might have engaged with her, she was already putting things away and getting out something new. She wasn’t even giving him time to use his imagination. I mentioned that he really loves to see how things work, and is very mechanical in nature. I thought that was a good thing, but, to her, it meant he wasn’t playing at an age-appropriate level (I guess because it seems to fall under (3)(d)).
As for spontaneity, he recites and acts out his movies at the drop of a hat, sings random songs he knows and hums tunelessly, and every day objects become toys if he wants them to. His favorite toys at the moment are his hands stuffed into a couple fake salt and pepper shakers that came with his kitchen that are nested inside cups that also came from his kitchen. He looks like he has hooves instead of hands, and, to him, they’re endlessly entertaining. Soon, he’ll drop his interest in those for some other occupation. As I said, he’s a busy kid. (After writing that paragraph, I hung out with him and Beanie in his room, where he entertained himself building with blocks, crawling through his tunnel, and making pizza in his kitchen (making microwave sound effects, no less)–which, of course, he did not pretend to eat.)
Sure, he has some rigid adherence to certain routines and activities, but, in case I didn’t mention it before, he’s THREE. I’m not a terribly structured individual, so his need to have routines amongst my daily chaos seems pretty normal to me.
There is much to his behavior that, admittedly, could be attributed to lackadaisical parenting on my part. I told the doctor that some parental training would probably have to be involved to see better results from him.
I stewed over this diagnosis for days. That first day, I felt pretty emotional and weird, because I was warring against a professional opinion (she’s a specialist, after all!) and my opinion as a mere parent (heh). Later, my husband said he couldn’t see it. Pie’s OT said she could see some trademarks, but nothing about him screamed “autistic!” to her, and she’s been seeing him for almost a year now. The Pediatric GI doctors got fifteen minutes with him and didn’t see anything peculiar about his behavior. The audiology tech seemed perplexed by the diagnosis, as well, and said Pie merely seemed stubborn (and he was less cooperative with that guy than with the specialist). A speech therapist friend of mine has had dealings with this doctor and said that she (the doctor) is prone to diagnose a large number of children who come to see her as autistic, and it would be best to get a second opinion.
So, we’re going to seek a second opinion. Fortunately, the specialist is NOT the boys’ pediatrician. I’m hoping the pediatrician, whenever she comes on staff, is not likely to bend to the will of the specialist or the diagnosis, and give me her genuine professional opinion. Then I hope to get referrals to a new therapy group in Tacoma that was recommended to us by the GI doc, who said they have seen more progress in behavioral issues from them than where Pie is going right now, and evaluations from a local special-needs preschool in the district.
I feel better now than I did a week ago, now that I’m armed with more knowledge and know better what to look for to counteract the doctor’s knee-jerk diagnosis.
It seems to me that rushing into such a diagnosis really detracts from the severity of true autistic children, who need those resources more than kids with mild behavioral issues, like mine. It sours the need for autism awareness when children who really need a little extra consistency in their lives are diagnosed with such a weighty label. It seems that someone who specializes in autism should know that, and be a little more careful in her diagnoses.
But, as the saying goes, when all you’ve got’s a hammer . . .