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Free ebooks ==> Sharon 77 current social and communication skills are essential in any treatment approach. To divorce social skills from systematic attempts to improve communication and play skills will reap fewer benefits, and time must be devoted to treating all components of the autism triad. * * * In the end, I could not give Sharon a diagnosis of AS. To qualify for that diagnosis there has to be substantial impairment. Sharon’s insight into her own predicament was just too good and her accomplishments too impressive. However, there were two other possibilities worth considering. One of the findings of the genetic research in ASD is that some of the relatives of children with autism themselves have ASD-like traits that fall short of a diagnosis. Parents sometimes report that they are, or a more distant relative is, socially awkward, with difficulty initiating and maintaining friendships or being empathic and intimate with others. Some relatives even develop intense interests in esoteric subjects such as astronomy, census data, election results, or computers and math problems, hobbies that occupy them to the exclusion of other family activities. It was conceivable that Sharon had these traits, although there was no family history of autism among her relatives. What she described to me was certainly analogous to the experiences of people with ASD. We know that these traits exist in the general population, perhaps as frequently as five to ten percent. It may be that the genes that give rise to autism are not all that uncommon in the general population. Maybe the symptoms of all the ASDs appear along a continuum and that subclinical cases—those without true impairment in functioning— exist in the general population. Perhaps as these ASD-like traits become more severe, the capacity for insight diminishes as well, until a certain threshold is crossed, or a level of impairment is reached, and a diagnosis of ASD is made. Another possibility was that Sharon had had AS as a child but had now recovered to such an extent that, even though she might have some symptoms, she did not have any associated impairment. Some people with AS and autism do recover to a remarkable extent (see Chapter 7), though it is, admittedly, uncommon. I have followed some children with AS from early childhood (where it was clear they had an ASD) into adolescence and adulthood. Some of the children with AS (about twenty percent) were functioning in the average range on their social

78 A MIND APART and communication skills, though in private they still might engage in repetitive, stereotyped behavior. Perhaps Sharon was one of these people with AS who was able to “recover” to a remarkable degree? The existence of ASD-like traits among the general population also gives us an opportunity to realize that maybe ASD is not an all-or-none phenomenon. Perhaps some ASD-like traits are present in all of us, though for a variety of reasons and at different times in our development. It is a humbling thought, but it does encourage us to appreciate the precious opportunity that empathy and having a theory of other people’s mind gives us and the obligation it entails. Being socially competent carries a responsibility to do some good in the world. It is not something that is given once and for all but a skill that needs to be affirmed and continuously rehearsed during the traffic of human discourse. From time to time, we all experience the fault line in our natures that separates what we intend to do from what we actually do— what we say in the heat of the moment and what, upon reflection, we wished we had said. But unlike people with ASD, we have a choice, and with that choice comes the responsibility to perform many small acts of kindness. * * * I set up a final appointment with Sharon and shared these thoughts with her. In fact, she agreed with these two possible explanations of her difficulties. I believe she was relieved to have a name for her predicament and that whatever possibility was the right one, it did not constitute a “true” disorder (even though she might have had one as a child). Once some complex human problems have a name, the magnitude of the burden diminishes. I had given her a language for her predicament. But she had given me something more important: the language to understand the inner world of people with autism and AS. I do not think it was a fair trade, to be sure. I was in her debt, but I hoped that her initial act of courage in sending that letter had not been in vain. As I said good-bye, my eye happened to catch the lilac tree outside my window. I went out to see if the afternoon mail had arrived, in hopeful anticipation of other gifts that might come my way.