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7 months ago

978-1572305441

autism

Sophie 179 their own

Sophie 179 their own thoughts. As they turned down their street, all the neighbors came out of their houses to greet the new parents. A large banner was hung on the oak tree of their property: “Welcome home, Sophie!” They drank champagne, congratulated Greg and Marianne, celebrated the arrival of a new child on the street, a playmate for all the children, who were eager to play with Sophie. Only Sophie, at three years of age, could not yet walk, could hardly sit up and roll over, and weighed but fifteen pounds. The neighbors expected to see a cute pudgy baby, cooing, smiling, and responding to adults that ogled her. Instead, Sophie shook, made no eye contact, and steadfastly refused to acknowledge her new neighbors. Marianne had to learn quickly how to care for the child, who acted like a baby, but was in fact a toddler. The multidisciplinary team at the local child development center was very helpful. They came out to the house and gave Marianne advice on how to stimulate Sophie, how to get her to talk, to handle objects, move her limbs, and so on. Marianne had to learn to change diapers to accommodate her hip dysplasia and to feed Sophie. She could not chew solids, having been fed liquid only, so breakfast could take over an hour. She slept a lot and, when awake, Marianne took her outside in the fresh air. She changed her and fed her according to routine. Greg and Marianne held her close and exercised her limbs. She gained weight, and her motor skills seemed to develop nicely. She stopped shaking, started to hold her head up, sit, and even pulled herself to a standing position. Soon Sophie went every day to the local child development center for physiotherapy and for the opportunity to interact with other children. Everybody was confident that love, food, and a stimulating environment could bring her out of this predicament. But Sophie did not reward these efforts; she disliked being hugged, she pushed Greg and Marianne away and never looked at them. She never cried for anything even if she were wet, hungry, or cold. To occupy herself she would crawl over to the wall, rock back and forth, and sometimes bang her head against the wall. She would rock in her crib or else pull herself to a standing position and stare at the door without making a sound. Marianne and Greg reasoned to each other that Sophie had chosen to withdraw into her own world. It would take a long time to entice her out of it. As the months went on, she became more and more distant, not less so. She also started to make funny noises. After a full year in treatment, she still was not talking, and her pediatrician wondered whether the deprivation was indeed the cause of her delays in speech

180 A MIND APART and social interaction or whether something else was standing in the way of her progress. “Did you ever hear the word ‘autism’?” her pediatrician asked one day. “I am not saying she is autistic; only that we should consider it as a possibility. Sophie is still not talking and not relating to other people.” Marianne knew next to nothing about autism and asked if autism could be caused by the experiences in the orphanage. If so, surely it could be resolved? Love and support could overcome any obstacle, couldn’t they? * * * I was asked to see Sophie at this point to try to determine whether her poor communication skills and her lack of social interaction were due to the deprivation or whether she might have autism. This was a difficult issue to resolve, and it meant sorting out which behavioral characteristics could be explained by living without proper nutrition and stimulation for the first three years of life and which, if any, could be due to autism. Before the appointment, I reviewed the literature on early deprivation and its effect on child development. There were some interesting and informative case reports of children who had experienced terrible deprivation in their formative years. When these children were released from these appalling conditions, they did indeed have many “autistic” characteristics. They were often speech delayed, showed little social interaction, were extremely withdrawn, and demonstrated little capacity for play. However, these autistic-like behaviors attenuated with the provision of a loving environment. It was true that some of the symptoms never completely disappeared. Speech certainly improved, but some of the social oddities persisted. Their social and communication skills seemed to approximate those of younger children, consistent with their overall developmental level. My task was to see if Sophie’s social interaction was even more severely delayed than her overall cognitive development. If it was, it would be hard to argue that early deprivation was the only cause of her current difficulties. Social and nutritional deprivation do not cause such uneven development, where some skills are almost age appropriate (like walking and feeding) whereas others (like social–communication) are so delayed. When I saw Sophie, she was dressed all in red, wore eyeglasses, and darted around the room. She was certainly tiny for her age, and her thick curly brown tresses cascaded onto her shoulders. Her parents car-

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