2 weeks ago



William 91 “And then

William 91 “And then the brownish going north went into Bloor and then the yellowish going south came into Bloor. And I saw the brownish go north through the windows of the yellowish going south. And I let the yellowish going south go by.” “You let another one go by?” “And then it went into a tunnel. And then you know what happened?” “No.” “The yellowish going south came in all over again!” “I imagine you were quite late getting home.” “And then the brownish going north came in again. And I saw the brownish going north through the windows of the yellowish going south. The yellowish going south on that side and the brownish going north went outside. And then the new subway going south came into Davisville. And it had a trip arm sticking out of the front. And the doors are a lot bigger in it.” “Is that good?” “And there’s windows and there is a wheelchair sign on it. That’s why the doors are bigger.” “To allow the wheelchairs to go in?” “No. And then you know what happened?” “No.” “It stopped, and I let it go by because I wanted brownish. And it left. The new subway going south left Davisville. And the new subway going south went outside. Then the other subway with yellowish going south came into Davisville again.” And then I see! I can finally picture in my mind what is going on. Imagine William’s perspective as he stands on the subway platform. He is waiting for a particular train to come in, and he lets other trains go by as he waits for the right one. The “right” train is a particular combination of direction, shape of window, and color of upholstery. He sees various trains come into the station, some with square windows, some with round windows. Some trains have yellow upholstery, some have brown. He watches as the trains move past each other, one going north, one going south. Through the square windows of one train going north he sees the round windows of the other train going south. It is a kaleidoscope of shapes and colors going in both directions. From William’s perspective the entire conversation makes sense. It is no use forcing my perspective onto his conversation. I have to see things just as he does, then I can have a conversation with him. But without that imaginative leap

92 A MIND APART on my part, I understand nothing. I have to see the world as William does. He cannot make that imaginative leap to me; I have to construct a metaphor of his world in my mind and then interpret what he says. Only in this way can we play the same language game. I must have a hypertrophied theory of mind to bridge the gap that separates us. To appreciate the context, I have to see and imagine the world as experienced by William, standing on the platform, waiting for the subway to arrive. * * * William’s parents have asked me on several occasions whether these difficulties in initiating and sustaining a conversation can be improved. I rather reluctantly tell them that very little research has been done on this topic. Speech therapy is certainly an effective form of treatment for very young children with ASD and, in particular, those who are nonverbal and are just beginning to speak and to communicate their needs and wants. But once speech develops, there are no standard interventions that can improve the social use of language in conversation. But having a conversation with William does suggest certain strategies that might be helpful. These are based on the notion that the conversational difficulties of people with ASD are caused by the difficulties in theory of mind, the inability to use certain linguistic devices that are typically used to initiate and sustain a conversation, and by the deficits in executive function and weak central coherence that are so characteristic of children with ASD (see Chapters 4 and 5). It is of no use to try to teach children with ASD the use of metaphor or to have them practice what they can’t do. Instead, we can teach them the specific rules they need to get by in conversation with others. Slowly over time, the capacity to hold a coherent conversation with another person improves as the child’s social skills improve as well. This usually happens during the teenage years, and it may be worthwhile to hold off implementing some of these strategies until that time. The intervention consists largely of having a conversation with the adolescent, making sure that a shared context is explicitly present for the conversation and practicing the rules that govern social intercourse. This involves encouraging the child to use certain simple linguistic devices that make conversation coherent. The focus is not on the use of grammar or vocabulary or the meaning of individual words but on the initiation and sustaining of a conversation. The objectives are to help children become consciously aware of the listener’s needs in the conver-