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8 months ago

978-1572305441

autism

Sharon 69 This certainly

Sharon 69 This certainly fit with the kinds of social difficulties I had seen and read about in adults with AS and very high-functioning autism. Eventually such individuals desire social interaction and friendship even though they might act otherwise, particularly as young children. But the desire for attention and affection grows with maturity. I had seen many times the divide that Sharon described between what she desired in terms of relationships and what was observed and experienced by others. It was like a fault line running through the experience of the self. It was remarkable to me that Sharon was describing exactly the kinds of difficulties in TOM that people with ASD demonstrate. But what was different in her case was that she had such exquisite insight into her own difficulties. People with autism and AS lack a theory of their own minds as well as the minds of other people. Sharon was acutely aware of her own lack of understanding, and this was inconsistent with what is usually experienced by people with ASD. Many children and adolescents with ASD are unaware of the way they come across to other children, how and why they are perceived as eccentric by others, and what they do to sometimes irritate their parents and siblings. They also have trouble putting into words how they feel, why they were motivated to do certain things, and why they felt an emotion in a given situation. But perhaps Sharon’s acute insight into her emotional life was true only upon reflection. With the aid of logic and with time for reflection, the social world made sense to her, but not in the heat of the moment. Perhaps she was able to compensate for her lack of a TOM with reason and reflection, but she could not do so at an intuitive, preconscious, automatic level. That is the level at which a TOM must operate in the real world. I was beginning to wonder whether Sharon might have a pure and very specific deficit in TOM but was able to maintain her insight and to use her considerable powers of logic to compensate for it to some extent. Perhaps that was the reason for the social rules she had set for herself as an adolescent? It was also true that Sharon did not appear eccentric to me in the course of the interview. Her conversation was logical, her meaning clear. Yes, she did not always look at me when speaking and did not tend to use gestures to accentuate and emphasize her words, but there was little that was odd or ASD-like in her demeanor. This was perhaps inconsistent with AS in childhood and adolescence. However, in some of the studies our group has conducted, I have seen young adults with AS and even autism (see Chapter 7) whom I had known (or had seen

70 A MIND APART the records of) as children and adolescents and who had shown the same characteristics as Sharon. Observations of the impression she made during the interview were of little help to me in deciding whether or not Sharon might have AS. It is also true that there are many other reasons that a person might lack a TOM. Sharon clearly was very intelligent—that was readily apparent—and had no difficulty with verbal expression. She did not seem depressed, but a type of anxiety about social interaction was certainly a possibility. The only way to tell was to see if these difficulties in TOM were present at a very early age—or had they perhaps arisen later on in the course of her development? If she had a mild form of ASD, it should be apparent by at least four years of age. If this were a more recent problem, I would have to look for another explanation, like an anxiety disorder. It would also be important to look for evidence of the third part of the autistic triad, the preference for repetitive, stereotyped interests, activities, and behaviors that we saw in Justin and discussed in Chapter 3. If that too were present early on, the evidence for ASD would be strengthened. To obtain this information, it would have been helpful to interview Sharon’s parents, but that would not have been appropriate under the circumstances. Sharon felt this would only be distressing to her mother, so we decided to explore her early history from her own perspective. We scheduled a couple of appointments in the next few weeks to go over this information in detail. * * * Sharon has little memory of the faces of people that were important to her as a child. She is aware of her mother’s presence only through the memory of her feet beyond the table on the carpet. She does not remember her grandmother’s face, only her hands potting plants in the gardening shed, making a pie crust, sewing, and knitting. She never sees her mother’s or grandmother’s face, but only their hands and bodies. She remembers their faces only from photographs. In contrast, typical babies will preferentially pay attention to a human face within days of birth. Was Sharon describing the inner experience of lack of eye contact so commonly seen in children with ASD? She does remember having one or two friends from her neighborhood before kindergarten, but then none until her teenage years. As a young child, Sharon hated physical affection and would struggle to free herself from the hugs of her parents and grandparents. She was lonely,