978-1572305441

William 81
am as confused as I am. In spite of this difficulty in carrying on a
conversation, it’s remarkable that his grammar and vocabulary are excellent;
he uses past tenses appropriately, his sentence construction is
perfect—in fact, there is nothing wrong with the more formal aspects of
his language. Yet I don’t have a clue what he is talking about. There is
slippage between the words and the communication. The philosopher
Ludwig Wittgenstein wrote that the meaning of language is a function
of the “language game” in which it occurs, a function of the context of
communication in social discourse. Words have no meaning outside
their use. I know we are playing a language game, only the rules are
William’s own invention and he either won’t, or can’t, share them with
me.
* * *
I first saw William when he was four years old, some ten years ago.
His parents asked me to give them a second opinion about his diagnosis.
Along with his medical records, they brought in a diary they kept
when he was an infant. The delight and joy they experienced as parents
fairly jump off the page. Each accomplishment is recorded with pleasure
and pride. “William sat up today,” “William took his first steps today,”
“William pulled my hat down over my eyes and laughed.” One entry
at eighteen months mentions that when the family was traveling in
the car, he insisted on going to their usual station to buy gas rather than
a new one, even though the new one was much more convenient. Reading
the document, I searched for other hints and clues of early signs of
ASD but found only the missing bits as potentially ominous. There was
no mention of gestures or imitation, pointing or showing things of interest
to his parents. No words appeared until eighteen months and no
phrases until two years. There was no mention of seeking out other
children with whom to play. This inclination to play by himself was
brought to the parents’ attention by the nursery school staff when
William was three years old. They recommended an assessment be completed
as soon as possible. The first diagnosis by a pediatrician was autism,
but this did not fit with the parents’ perception of what a child
with autism was like, so they sought a second opinion.
I saw him a little later. At that time, he was able to talk fluently but
showed little inclination to do so. He seemed to understand everything
his parents said to him, and he would point without any difficulty but
still did not use gestures to communicate. There were also some exam-