3 weeks ago



Sally, Ann, and Danny

Sally, Ann, and Danny 115 The pregnancy itself was uneventful, although Joan experienced quite a bit of morning sickness. The triplets were born early by C-section amid much joy and celebration. All three weighed under four pounds. After the birth, the babies did well in the neonatal unit and were off the respirators in twenty-four hours. They were in the hospital for only nine weeks and then were sent home. There was quite a lot of fuss among the nursing staff, and everybody was amazed at how well the babies had done. When the family left the hospital, they were showered with presents and given a big send-off. Even the local community newspaper was there taking pictures. At home, the parents tried to cope with the demands of caring for triplets. Joan read everything she could about multiple births, searched the family tree for other twins born to relatives, and enlisted the help of her parents and friends at the earliest opportunity. They had regular appointments with the family doctor and the pediatrician and followed all directions meticulously. Joan and Dave became concerned with the children’s development at around eighteen months, when they noticed that their babbling was not progressing to speech. At their two-year appointment in the clinic the pediatrician wondered whether the triplets might have autism based on their social behavior and lack of interest in communicating. The parents were shocked and alarmed. The pediatrician asked whether I could see them as soon as possible. * * * The children wander around the room, picking up Lego pieces but not really playing with them. The boy sits quietly in his mother’s lap, asking for nothing. One girl falls down accidentally but does not cry or go to her mother. The children approach their parents infrequently, and when they do, there is little response to parental communication. At age twenty-four months, only one of the girls is showing any communicative intent by bringing a plastic container to her parents and asking for help in opening it to see what’s inside. The three children mill around us, largely oblivious to me and to their parents. Joan speaks their names, one by one, but they do not turn around to see who calls them. Danny bumps into me as if I were not there, Sally lines up some action figures and babbles to herself, Ann is fascinated with the light on my power bar. There is little in the way of social interaction among the children and little desire to communicate either with me or with the

116 A MIND APART parents or grandparents, who now include me in their anxious gaze. At home, the girls like to watch old Disney videos, Fantasia especially, and Barney. Danny loves to jump on the couch for hours on end. At the conclusion of the interview the parents and grandparents want to know only two things: Do the triplets have ASD, and what possibly could have caused this tragedy? How is it possible that three children born into the same family and at the same time all have ASD? I tell them it is perhaps too early to tell, but we should do some assessments of communication and cognition, get them into day care, and follow them closely. I will see them again in three and then six months. I tell myself that it’s likely they have autism, but I know that a diagnosis at twenty-four months of age can be difficult, especially in twins, who are often speech delayed, so I decide to wait a bit. In any case, they will receive useful interventions in day care, so there will be no real delay in receiving services. * * * Another couple, Ron and Carol, ask me to see their son, Robert, who is now ten years old. I saw him for the first time some six years ago for a diagnostic assessment, but the purpose of this current appointment is to discuss possible causes of his autism. They have two younger children, ages four and five, both of whom are doing very well, and there is no history of autism on either side of the family. Carol and Ron, who are both lawyers, have seen many physicians about their son’s autism. I vividly remember the history from the first time I saw the family. Apparently Robert developed very nicely until age eighteen months. He had about fifty words, was always smiling, responsive, and engaging. All this could be seen from the videotape of his first birthday that his parents kindly supplied me. It showed him happy, blowing out the candles, clapping his hands, and laughing at all the goings-on. But a few weeks after his vaccination needle at eighteen months, he became quite ill. One night he developed a high fever and had a prolonged convulsion that terrified his mother. He turned blue and started shaking as she held him tenderly in her arms. Carol described this night as if it were yesterday—the layout of the bedrooms in the house, the cries that awoke her in the middle of the night, the frantic scramble to find the phone and call an ambulance. She was convinced he was going to die. Robert was rushed to the hospital, but thankfully he did not have any more seizures. A few weeks after he came home from the hospital, how-

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