978-1572305441

112 A MIND APART
pairment and improving functioning seems to be more effective than
trying to eliminate autistic symptoms alone. The first things to improve
in young children with ASD are attending to instructions, simple language
skills, compliance with simple commands, and later on skills of
daily living such as dressing, eating at the table, going out into the community,
and so on. These improvements show up in both treatment
studies and those that describe outcome, independent of any particular
treatment. Autistic symptoms, particularly those that reflect the social
reciprocity impairment and restricted interest legs of the autistic triad
(see Chapter 1), rarely disappear completely; they often became more
subtle, more private, or more circumscribed to a specific time and place.
It seems easier to improve IQ scores than autistic symptoms themselves.
The autistic symptoms seem to decrease on their own as functional
skills in communication, social interaction, and play improve. Working
on these functional skills becomes an important avenue for further
community inclusion in school, on soccer teams, in Scouts, and elsewhere,
which in turn improves the child’s daily living skills even more.
It was certainly true that parents who advocated forcefully on their
child’s behalf to be included in these types of community activities and
settings had done better in my outcome studies, as shown by the story
of Hershel.
Another important lesson is that there is a false dichotomy between
teaching the child a new skill to improve functioning and doing something
to the environment to accommodate to those deficits. Most often,
the environment includes people with whom the child interacts or the
rules and regulations that govern their interactions in school or other
community settings. The key is to get those people to readjust their expectations
and to work around the limitations that having ASD imposes
on the child. Changing the child cannot occur without changing the environment;
a continuous dialogue occurs between those two poles.
Once the environment (or people) accommodates to the child, it’s easier
to intervene with the child, which in turn changes people’s attitudes to
be more accepting of eccentricity.
I saw Sean and Melody some months later for a follow-up appointment.
Teddy was now in a special day care, he was receiving speech
therapy and help in playing with peers, and was enjoying going to
school. Sean and Melody were much more relaxed about his situation
and were willing to give this intensive approach a chance. They had
come to appreciate small gains in his development and were very
pleased with each new word that Teddy seemed to understand. A smile