11 months ago



Sharon 61 of things

Sharon 61 of things cannot be denied. They may be understood and manipulated cleverly, but they never go away.” This was a fascinating insight. I wondered if she thought in pictures, much like Temple Grandin. Temple is an adult with autism who received her PhD in animal husbandry and became quite famous for designing a special cattle chute. She has written several books about her experiences growing up and what it was like to have autism. These books have had quite a beneficial impact on the public’s understanding of autism. I have met her and heard her talk about how she thinks, not in words, but in pictures. This talent, an intrinsic part of her autism, allowed her to develop a career that made use of her disability. To even call it a disability is, in her case, questionable. In some individuals, the distinction between a disability and a gift or a talent is hard to establish. Was it possible that the author of the letter was an accomplished architect precisely because she could visualize the material world to a remarkable degree? If so, I could learn a great deal about how people with AS understand, perhaps in pictorial terms, their dealings with others and what strategies they use to overcome these problems. Though I don’t usually see adults clinically, I knew it had taken an enormous amount of courage to write and then mail the letter. Sharon said the letter had stayed on her computer for months before she mailed it. If I determined that she had AS, she might find a support group, and her sense of isolation might lessen. If not, I might be able to direct her toward more appropriate treatment or to other sources of support. I gave her an appointment with the intention of taking a skeptical approach. I would assume she did not have AS and would look for other reasons for her social difficulties. For example, she might be depressed, and that might lead to a negative way of perceiving her interactions with other people. Or she might have some form of anxiety disorder. Some people who are very anxious feel uncomfortable in group situations. They are constantly monitoring their social skills, which are never quite good enough in their eyes. Some people are a little rigid; they may lack facial expression and are sometimes criticized by those close to them for being unresponsive or aloof. Differentiating high-functioning ASD from other conditions can be quite difficult, more difficult than if the child has a developmental delay. The most difficult situations occur among children who are quite bright but have an anxiety disorder and a specific developmental problem in

62 A MIND APART language or visual–motor coordination. The combination of the anxiety and the specific developmental delay can lead to social isolation as a result of shyness and poor social skills. Because they have nobody to play with, they develop a restricted range of interests that, of necessity, are pursued in isolation. The best way to distinguish these conditions is to search for difficulties in social relationships with parents and other family members that appear very early (before four years of age). The diagnosis of ASD is on firmer ground when children do not share interests and emotions with or demonstrate empathy for their parents. If all other explanations failed, I would entertain the possibility that Sharon had some form of AS. Perhaps she had some of the symptoms of AS but was very adept at compensating for her difficulties. Sharon could be an invaluable resource because she would be able to articulate what many people with ASD cannot express. If we could learn how she was able to compensate for her deficits, we might be able to teach the same techniques to children with ASD. That would be a valuable learning experience for me. If I could help her in return, so much the better. * * * Sharon arrived at the office well before her appointment time and was reading in the waiting room when I introduced myself. My first impression was that she was quite apprehensive, but she greeted me skillfully and with grace. She was tall, well dressed but wore no jewelry (I learned later that she also never wore clothes with patterns, as these were distracting and made her nervous). After we settled some preliminary details, I began to collect the information I needed. I learned that she was forty-one years old, was happily married to a teacher, and had a young son. Her son was doing well in school and had lots of friends. Obviously he did not have ASD. Sometimes parents of children with ASD have ASD-like traits themselves, such as lack of social interests, poor social skills, difficulties in initiating and sustaining a conversation, or unusual hobbies pursued with remarkable intensity and interest. Here the link is genetic (see Chapter 8), and if Sharon’s son had ASD, the nature of Sharon’s problem might have been more obvious. However, that would have been too easy! I asked Sharon why she thought she might have had AS. She took a deep breath and then proceeded to tell her story. She had always thought of herself as having very poor social skills and as being quite