Like many people who teach film theory, I’m fascinated by the power of language. You can deconstruct all day (we do!), but like The Dude, language abides; words on paper (and even online) define things, and it becomes hard to separate those things from those words.
For this week, I thought I’d present an excerpt from Dr. Terry’s report, the first time a doctor told us Dar has autism. This was written when he was 26 months old, half his lifetime ago. Getting this report was rather the double-edged sword. On the one hand, it proved that my wife and I weren’t crazy. On the other hand, it also suggested that our child might be.
The report was very, very, very long and detailed; I’m cutting to the chase (the italics are also written by the doctor):
[Dar] did or did not meet each of the criteria for Autistic Disorder in the following ways (checked boxes indicate [Dar] has that trait or characteristic):
A total of six or more items from 1, 2, and 3, with at least two from 1, and one each from 2 and 3:
- 1. Qualitative impairment in social interaction as manifested by at least two of the following:
[checked box] a. Marked impairment in the use of multiple nonverbal behaviors such as eye gaze, facial expression, and gestures to regulate social interaction. Although Dar does look at others on his terms, it is often fleeting and very inconsistent. He is not using other nonverbal behaviors to regulate the back and forth interaction.
[unchecked box] b. Failure to develop peer relationships appropriate to his developmental level. This area is difficult to judge given Dar’s young age and even younger developmental level. However, this examiner is concerned with Dar’s reported lack of (or very limited) interest in peers and suspects this area is also impacted. Dar should continue to receive support in this area.
[checked box] c. Lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g. a lack of showing, bringing, or pointing out things of interest). Dar was reported to very rarely bring things of interest, but is not sharing his interests in any consistent way overall and seems content enjoying this on his own most of the time (although he likes to have his parents nearby).
[checked box] d. Lack of social or emotional reciprocity. Dar is responsive most of the time and clearly enjoys the attention of his father, but does not know how to maintain interactions as would be expected. Interactions often feel effortful or one-sided, as he can be just as interested in objects or doing his own thing. His challenges are more noticeable with other adults and peers.
- 2. Qualitative impairment in communication as manifested by at least one of the following:
[checked box] a. Delay in the development of spoken language. Dar has a documented speech delay.
[unchecked box] b. In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others. Language too limited to judge.
[unchecked box] c. Stereotyped and repetitive use of language or idiosyncratic language. Language too limited to judge.
[checked box] d. Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level. Although Dar’s developmental level is too young to assess make-believe play, his lack of social imitative play is more clearly impaired.
- 3. Restricted repetitive and stereotyped patterns of behavior, interests, and activities as manifested by at least one of the following:
[checked box] a. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus. Dar often becomes preoccupied with atypical interests (his father’s shoe, tossing balls or blankets in the air, opening and closing cabinets/doors). He also has restricted interests in balls, books, and blocks.
[unchecked box] b. Apparently inflexible adherence to specific, nonfunctional routines or rituals. Dar was not observed or reported to meet this criterion.
[checked box] c. Stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements). Dar was observed to watch his fingers and walk in circles briefly. He was reported to engage in some going up and down stairs, spinning (while looking at the ground), walking around his father (while looking at his shoe), rocking (mostly to music), walking the perimeter of the yard, and running back and forth.
[checked box] d. Persistent preoccupation with parts of objects. Dar was observed to engage in visual examination of objects and parts throughout the assessment, and was reported to pile toys, stack blocks, and otherwise have interest in details such as shoelaces.
I am sincerely and absolutely thrilled that most of you reading this never had to get a report card like this one. And let’s face it, looking at this criteria, Dar might have easily scored 11 of 12 on the reverse SATs. (It’s true he’s never been very “stimmy” as we say in the community. He’s less of a spin-in-circles roulette ball, more of a scatter-on-the-bumpers pinball.)
So, yeah, the report. Who wants to look a beautiful 2-year-old and find all these flaws? Who wants to deal with information like this? Not us. But we’d be crazy not to. Dr. Terry assured us that we didn’t need to come back to her when he turned 3 for the sake of the school district (which needs to know, then); she promised to confirm his autism by email a year later. This was presented as a favor to us.
Perhaps you’re wondering how much of Dar’s condition has changed in the two years since this report. The answer is…not much. But wait, you say, what about all the intervention and therapy that this report was written to trigger? Well…I will save my opinion of the efficacy of such things for another post. What I will say now is that when wifey was in her third trimester, my neighbor, a mother of three kids over the age of three (at the time), said innocuously, “Whoever they are when they come out, that’s who they are.” I love my neighbor and I know she didn’t mean anything hurtful by that. But those words still linger in my cerebral cortex like a rock I can’t get out of my shoe. I probably have 30 rocks like those. Including a 30 Rock episode where Kenneth says, re New York City, “Where are all the baby pigeons?” Growing up in Berkeley, I was used to seeing adults in the manner that this report describes. Not toddlers. I’ve got a baby pigeon here.
Speaking of Fey-Dratch projects, let’s not leave this entry like Debbie Downer. Some things have improved – though not so much in these categories. Through trial and error, we’ve found things he seems to love, like jumping, spinning, car rides, swimming, and just time watching the trees outside. When he can, he now grabs things he wants, which is an improvement over screaming when he didn’t have them. And…after a long time, his interest in certain things has revived, particularly things that his younger brother does or likes. Considering this is the first time I’ve mentioned his brother to this blog, that is a part of the story which will wait for another entry to be continued.
