978-1572305441

Sharon 73
attention from the physical world, as described in Chapter 3. These are
the types of repetitive stereotyped behaviors and the restricted range of
interests that are so characteristic of the disorder and may arise from
weak central coherence or difficulties disengaging attention from objects
that catch one’s interest. Sharon described other types of lapses in
attention, but usually in a social context. “I could never maintain a narration
or any form of conscious control over my language use while another
person was present,” she said. She could always be alert and focused
in the presence of physical objects, but this sense of awareness
would leave her whenever she came in contact with another person. She
simply could not focus her attention on people without considerable effort
and then only momentarily. She felt like she was in a fog, not part of
the real social world. What held her attention were the stones, the
stuffed animals, the science fiction fantasies, and, more recently, problems
of design. “I made a conscious decision to feel the world in a sensory
way, to focus on the now. I craved alertness.” I thought her metaphor
of being in a social fog was very evocative. Only when the
responses of others were very pronounced or exaggerated could she see
the outlines of a social interaction looming through the fog. It would lift
momentarily, then descend again. At these times she had to use her considerable
powers of logic to make sense of other people’s minds.
* * *
After three of four sessions, I had a lot of information about Sharon
but no definitive conclusions. AS can be difficult to diagnose, especially
in adults when there is no corroborating information about early child
development. To make a diagnosis, I would have to rely on her developmental
history and on her present predicament—the same foundation
on which all children with ASD are diagnosed. There is no blood test or
brain scan that will tell us who has ASD and who does not. In fact,
Sharon’s story brought up virtually all of the peculiarities that can make
diagnosing ASD challenging.
One difficulty that I had with evaluating Sharon was that most of
the adults with autism and AS I had seen were much more impaired
than Sharon. They had few if any friends as adults, they had tremendous
difficulty in finishing high school or college and even more difficulty
finding and keeping a job. In spite of having many symptoms of
AS, Sharon showed remarkably little impairment. She had completed
high school, gone to college, and graduated with a degree in architec-