Archive | September, 2010

Fix Autism?

28 Sep

If we could fix Autism, would we?  I recently attended a conference where a geneticist presented some very exciting advances in current autism research – leading to just that possibility. 

Dr. Alexander Kolevzon, from the Seaver Autism Center at Mount Sinai School of Medicine, stated that scientists have identified the gene responsible for Fragile X Syndrome (FXS) – a rare genetic variation which accounts for about 2% of autistic cases[1].  Fragile X is tied to a single gene mutation whereas, many other Autism Spectrum Disorder (ASD) types may be more complex and based upon a combination of genes acting together.  Dr. Kolevzon proceeded to say that researchers are currently able to identify the genetic causes for up to 40% of all autism cases.  (Autism, defined here, includes all ASD, including Autism Disorder, Aspergers, PDD-NOS, etc. ) 

Within the autism research community, autism is generally accepted to be a genetic condition with environmental risk factors.  This genetic predisposition to autism, coupled in some cases with one or more environmental factors (yet to be determined…perhaps maternal factors, infections or toxins) at key points in the growth of the fetus and young child, may lead to the development of autism.  So, there is a long way to go before all the causes are understood, but identifying the underlying genetic components is a huge step forward.

The Fragile X gene (FMR1) is a DNA mutation which in effect, turns off the gene.  “Normally protein products of FMR1 act to dampen the synthesis of proteins at synapses…  Without the brake provided by FMR protein, synaptic protein synthesis is excessive and connections [within the brain] do not develop normally.”  Researchers are now developing medication to restore “normal synaptic protein syntheses and improve function.”[2] 

Based on this ground-breaking research, Fragile X medication is currently undergoing trials in humans with promising results.  Medication and/or genetic therapies for other types of autism will presumably follow thereafter…

How very exciting – I was thrilled to hear about the progress!!!  I choked up, thinking about some of those parents who now have hope that within the foreseeable future, they might be able to ‘reach’ into their severely autistic child’s locked-in world and perhaps communicate with him or her for the first time.  And how amazing it would be for the child (by then probably an adult) to finally be able to break out of his/her shell and interact with the world at long last.  I can’t imagine anything more thrilling.

But then I started to think more deeply about the implications.  Upon initial hearing, one might think, “Fabulous!  Let’s ‘fix’ things!”  However, aside from the significant moral and ethical considerations of gene therapy (which I won’t go into here…), these autistic individuals would be dramatically changed at a very core level – they may lose or change the very essence of themselves – potentially resulting in a radically different personality, skill set and perspective on the world.  Would they want that?  It might be great for the parents to finally have a neurotypical child, but given the choice, would the autistic person choose this for him/herself?  Would that even be a good thing – for the individual?  For the family?  For society?   

Would I want Gregory to undergo a similar therapy to correct his Aspergers?  Sure, he might become more ‘normal’ in his behaviors.  And yes, life would most certainly be less confusing and difficult for him, but he wouldn’t be ‘Gregory’ any more.  Now, I’m sure the NT version of Gregory would still be a great kid, but I would miss my lovable, quirky, funny, amazing Aspie son.  No, I decided quickly, I would NOT want Gregory to undergo gene therapy, if and when it becomes available.  (Having said that, the choice would ultimately be his to make.  I would respect his decision, but I would mourn the loss of ‘my’ Gregory if he opted to try it.)

So, there is no ‘right’ or easy answer and each situation would need to be evaluated on its own merits.  For parents of severely autistic children – those who are non-verbal and not able to function within society to any significant degree, perhaps genetic therapy would provide significant benefits.  But for individuals on the high-functioning end of the autism spectrum, this genetic ‘fix’ may not be the best choice.  It is an intensely personal decision and the trade-offs, risks and rewards of gene therapy would need to be carefully weighed.

Many Aspies don’t feel that their Aspergers is a disability at all, but more of a difference – if not an outright strength!  (See Wrong Planet.com)  Entire forums are dedicated to accepting and appreciating the Aspie brain – for all its unique powers and perspectives – not trying to FIX it!!!

Dr. Temple Grandin, the renowned autistic author and animal scientist, believes that we, as a society actually NEED Aspies among us.  These are the people who are able to look at the world ‘differently’ and come up with new solutions to problems.  They are the individuals whose analytical, detail-oriented, precise talents and single-mindedness can hyper-focus on specific problems in order to research and solve complex technical or scientific issues.  In fact, it has been said that most of the technology (e.g. Bit Torrent) we enjoy (or hate, depending on your perspective!) today would not exist, were it not for AS.

“Some of our world’s finest minds, inventions, art and ideas belong to people with autistic traits.”[3] Among those fine minds that are thought to have had AS are:  Albert Einstein, Vincent Van Gogh, Gregor Mendel, Thomas Jefferson, Carl Sagan, Wolfgang Amadeus Mozart, H.G. Wells, Charles Darwin and Isaac Newton – very good company indeed!

In spite of having significant challenges with social skills, physical coordination, emotional regulation and sensory integration, Gregory is a remarkable, bright and talented person.  He is potentially one of those ‘great minds’ of the future.  He has many strengths and ‘uniquenesses’ that I would be loath to ‘normalize’ by fixing his Aspergers.  And Gregory too, is quite happy with his AS.  Yes, he acknowledges that it does make certain things more difficult, but it makes some things easier too.  He has accepted his condition with grace and dignity – focusing on the strengths it provides.  We love Gregory the way he is – in all his quirky glory….and so does he.

So, after weeks of focusing this blog on the challenges facing Gregory and our family, today I celebrate the many strengths and unique perspectives of my Aspie.  I wouldn’t change him for the world…


[1] Alexander Kolevzon, MD, “Advances in the Genetics of Autism:  Implications for Treatment”, 1st Annual JCC Rockland & Parent Support Network Conference:  Current Autism Research:  Practical Strategies for parents and Professionals – Meeting the Needs of Children and Youth on the Spectrum, (West Nyack, NY, 2009).

[2]Clinical Tests Begin on Medication to Correct Fragile X Defect,” US Department of Health and Human Services, National Institutes of Health, November 2, 2009.

[3] Fitzgerald & O’Brien, 2007 

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The Hidden Curriculum

21 Sep

In the Autism/Aspergers world, I’m what is known as a neurotypical or NT, while my son is known as an Aspie or Aspergian.  Although some (like my older brother!) might argue that I am anything BUT ‘normal’, my brain does function fairly typically.  The brains of people with Autism and Aspergers however, do not, and this enables them to see the world in atypical ways.  As such, in my efforts to parent successfully, I’ve had to adjust my NT thinking, to try to see the world through my son’s eyes…with his Aspie brain and unique perspectives on life.  And this has taken some getting used to….

Without realizing it, neurotypical folks constantly, instantaneously and seamlessly survey the written rules or ‘hidden curriculum’ of every environment and every person [we] encounter, to make decisions about how to proceed successfully within a given context.[1]

The hidden curriculum refers to a set of rules or guidelines about social behavior that are often not directly taught.  It is assumed knowledge that helps lubricate the cogs of society and enables groups of people to live, work and interact together harmoniously.  These rules are wide-reaching and complex, covering a variety of topics from table manners to slang words, dating protocol to classroom etiquette…and much more.  Virtually every aspect of our daily lives is based upon a foundation of hidden curricula – widely-held assumed knowledge that we probably don’t even remember learning.

We don’t recall learning most of these rules, because “everybody just KNOWS that!”  We NTs are unconscious social navigators and learn naturally through observation and intuition.  We take it for granted that all relatively smart people should be able to acquire these skills in the same manner.  Unfortunately, for those with Aspie brains, these skills are not acquired naturally.  In spite of being potentially brilliant in other intellectual arenas, they have what is called social-cognitive learning disabilities when it comes to the hidden curriculum

An example of this lack of common understanding occurred recently in our home.  Gregory had been dared to do something stupid [my words!] by another boy, so he did it.  When I questioned Greg about why, he answered, “because he dared me…I had to.”  But, instead of reprimanding him for making a bad decision, I backed up and reconsidered.  “Greg, just because someone dares you to do something, doesn’t mean you HAVE to do it.  You can CHOOSE to accept the dare or not.”  Greg looked at me in amazement…”You can?”   He had totally misunderstood the social rule and believed that there was no option with a dare – no matter how stupid.  I shudder to think what might have happened if he still believed that ‘rule’ into his teenage years…Yikes!!!

So, this deficit can create significant problems.  The inability to develop adequate social skills and interpret social nuance of those around them brings life-long challenges to Aspies.  We, as NT adults in society, are willing to explain and excuse social ‘misbehaviors’ in very young children, but as they get older, kids and certainly adults are expected to know these unwritten, unspoken items of general understanding.  How do we react when someone breaks the ‘social code’?  We are shocked, upset, angry and perhaps even disgusted.  “How rude!” or “Weirdo” or “Can you believe this guy?” rings through our heads.  Because, breaking a hidden curriculum rule can make that person a social misfit or even a social outcast. 

What can we do to help those with social-cognitive deficits?  These individuals must learn the hidden curriculum by direct instruction versus intuition.  Parents and educators must become ‘social anthropologists’ to first determine various hidden curriculum items and then find ways to teach them.  This is not an easy task, because we assume everyone knows the assumed knowledge!  We literally don’t know what to teach them, because we don’t know what we know…

One of the primary ways to recognize an example of hidden curriculum is when an error occurs.  When a teenager addresses the principal as “Dude” or when a young man at the urinal drops his pants all the way to the floor.  When a girl texts using ALL CAPS and the receiver thinks she is shouting at her.  When a man in an office talks over his boss to correct the boss’s ‘error’.  When a woman talks loudly in church or during a movie….you name it  – There are rules for just about every interaction we have on a daily basis.  And when a rule is broken, people notice.

To make things even harder for Aspies, the hidden curriculum is not just vast, but it is complex and elusive as well.  The rules change across age, gender, who you are with, culture, environment, etc.  And to add another layer of complexity, most Aspies have difficulty generalizing, so what they have learned for one situation may or may not be carried over to a similar situation – the hidden curriculum rules must be explicitly taught for each scenario!

There are a variety of methods that may be used to help your child acquire unwritten social knowledge, many of which you can read about in available reference material.  One fabulous book, from which I gained my first insights into this area, is called The Hidden Curriculum by Brenda Smith Myles.  Here are a few methods from the book that I have employed successfully with my son:

1.  Safe Person

Identify one or more ‘safe people’ at home, school, camp, etc. who can help your child with Hidden Curriculum questions.  Your child should trust this person and be willing to ask about social questions.  This parent, teacher, mentor or close friend should understand the deficit and be willing and able to provide accurate, clear clarification to the meaning of words, phrases and situations.

2.  Social Narratives

Social narratives describe social cues and appropriate responses to social behavior and are useful in teaching a new social skill in advance of the situation.  Social narratives often use pictures or cartoons to promote self-awareness and self-management.  The most popular social narrative type is Social Stories by Carol Gray, which prescribes a specific framework for the narrative.

3.  Social Autopsies

The renown educator Richard Lavoie developed the concept of social autopsy to help students understand social mistakes – after the fact.  This method clarifies what exactly happened and then enables the child to see the cause/effect relationship between his behavior and people’s reaction to it.

4.  Direct Instruction

The direct instruction method is the one that I use most frequently in our daily lives, albeit informally.  Through direct instruction the teacher models (or states) correct behaviors and the students practices correct or alternative behavioral responses.  One great tool for direct instruction is the Hidden Curriculum One-A-Day Calendar for Kids by the Blackwell Family.  For each day of the calendar year, there is one specific need-to-know lesson.  In our home, we read the calendar item at dinner time and then use it as a jumping off point for discussion and explanation.

 

These days, I often explain situations and teach the unwritten rules of our daily lives.  I am never sure how much Greg has absorbed about the hidden curriculum on his own, so I explicitly try to help him “navigate body language and social mores in the uncharted areas between the words.”[2]  I guess I’ve been a bit over zealous lately however, because the other day Greg groaned and said, “Mom, can you please stop making everything into a lesson!”  Note taken!

Understanding the hidden curriculum is vital to the acquisition of good social skills, independence and a fulfilling life.  Most of us learn these rules naturally, but Aspies need a road map to our complex, elusive NT social world.  So please – let us all practice tolerance.  Let’s open our NT minds and try not to judge ‘misbehaviors’ too quickly…. That ‘rude’ person may just be an Aspie – seeing the world a little differently.


[1] Brenda Smith Myles, The Hidden Curriculum:  Practical Solutions for Understanding Unstated Rules in Social Situations (Autism Asperger Publishing Co., 2004), p. 1.

[2] Stephen M. Shore

Little Comedian

14 Sep

“Mom, do you want to hear a construction joke?” asks my then 9-year-old Aspie.  “Sure!” I say indulgently.  “Hmmm….I’m still working on it.” he says, with perfect deadpan delivery.  I pause a moment, waiting… and then burst out laughing!  I never saw that one coming….very funny!

Shortly after figuring out Greg’s diagnosis, I read that among the many challenges faced by Aspie’s, being too literal and social deficiencies are typical.  After giving these issues some thought, I decided to implement a Joke of the Day program.  My objectives were three-fold:  1) Send a little ‘love note’ for my son to find during his school day; 2) Use jokes to encourage him to think ‘outside the box’ and not see only the literal interpretation; and 3) Give him a tool to grease the wheels of social interaction with his peers.

So I went about pulling together all sorts of cute, simple, kid-appropriate jokes.  I typed them up, and then printed them out on slips of paper. (I made 2 copies, because I decided to include my older son in on the project too.  My daughter couldn’t read yet… much to her chagrin!)  Then, each morning I took one joke slip each, folded it up and put it into their lunch boxes.  Gregory and Daniel often wanted to check out the joke ahead of time, but I always made them wait until snack or lunchtime…building the anticipation, just like any great raconteur!  I suggested that after they read the joke themselves, they should try it out on their classmates.  And later over the dinner table, I would ask one of the boys to tell us the Joke of the Day.  This meant that they got to practice their joke telling skills and we could then explain it, if the ‘funny’ aspect wasn’t clear to their literal minds.  “Ohhhhh…I GET it!”

It started out a little slow, but within a couple of weeks, my boys were clamoring to see what the next Joke of the Day was.  As hoped, Greg started to tell the joke during snack to the kids around his desk.  I guess the laughs started getting attention, because before long, snack time found Gregory standing in front of his 3rd grade classroom, clearing his throat and waiting for quiet (luckily the teacher was supportive!)  It became part of the daily snack ritual for Greg to tell a joke to the entire class – to mutual groans or giggles – and the kids started asking him for it.   This was all great, until I forgot to include a joke one morning….doh!  (Greg gave me a firm ‘talking to’ that afternoon, let me tell you!)  Apparently, the class was very disappointed until Greg saved the day by resurrecting some ‘old material’ (thank goodness for his fabulous memory!)   He was able to offer his classmates their daily chuckle, in spite of my failing!

At the playground after school, I would smile to myself when I would hear one kid telling another kid my Joke of the Day!  Sometimes the joke didn’t quite make the translation….sort of like that old “Telephone Game”, but it did show my plan was working.  One mother even told me that her child was upset that she didn’t get a Joke of the Day in her lunchbox too!  Clearly we were on to something…

What I hadn’t anticipated was how well Greg took to it….he is a natural joke teller (who knew?)  His timing and delivery are spot on, and he frequently incorporates different voices, accents or inflections to add to the comedic value.  He is really very funny.  My little comedian was born! 

Greg doesn’t rely on my meager offerings anymore.  Now, he reads joke books all the time, gathering his own material, in order to regale his classmates and family members with impromptu ‘stand up’ on a daily basis.  He loves making people laugh and has gained a bit of fame and status among his peers for his comedic prowess.  Gregory has also expanded his repertoire to include not just jokes, but funny stories and tv show scenarios too (along with all the applicable voices, of course!)   These days, some boys actually vie to sit with him at lunch, because as the kids tell their mothers (who in turn tell me), “He is so funny!”

I’m thrilled that my informal ‘curriculum’ has proven so successful.  It has enabled Greg to expand his mindset to see alternate interpretations to a phrase or situation.  It has enabled him to lighten up and not take himself (or life!) too seriously.  It has laid a ground work for successful social interaction and it has given him a source of success and self-esteem.  Objectives met!

So with that, I’ll leave you with today’s Joke of the Day:  Did you hear the one about the clown fish?  Or is it a mollusk?  Oh darn….I forget…   Oh well, as my husband will tell you, I am the worst joke teller ever –  I’d best leave the funnies to my little comedian!

P.S.  If you would like a copy of my jokes to start a Joke of the Day program of your own, please let me know….I’m happy to share!  They are corny, but effective!

Going Public

7 Sep

Have you ever seen the guy who proposes to his girl in front of thousands via the Jumbo-tron at the sports stadium?  Or the family who willing allows cameras into their home to film the good, the bad and the ugly of their daily lives for a reality tv show?  These types of things hold a morbid fascination for me….why, on earth, would anyone want to DO that????  Why do people willingly expose their private, personal moments to the world?  I just don’t get it….     

As I first contemplated starting this blog (at the instigation of my husband Barry – see first post), I struggled with sharing very personal information about my family with the world at large.  I just couldn’t make our lives a reality show for the internet!   I knew that Barry was fine with sharing details, because he already had his own blog going (Houldsworth’s Random Ramblings.)  And while I am never exactly keen on giving out my personal experiences, I decided I was willing to share in the hope of helping another family.  But still, I didn’t quite feel comfortable with ‘exposing’ Gregory in the same way…it is his life, after all.    

Unsure about whether or not to proceed, I drafted the first post to see if I could even pull something like this blog off.  I used initials instead of our names to camouflage our identities and didn’t mention anything that might be used to specifically identify us…, but the story failed to ‘move’ – we came across as too anonymous.  Not pleased with the progress of the draft, I abandoned it on my computer screen and left to take care of some beckoning chore or child.  When I returned to my desk, I was surprised to find Gregory sitting in my chair, avidly scanning the draft of the first post [A is for Aspergers, B is for Blog].  “What IS this?” he asked, bemused.  My heart sank as I struggled with how best to handle this tricky situation.     

Then I remembered my mantra that “knowledge is power’, and decided to be upfront about what I was considering doing.  Following on in the mode we’d previously established, I once again shared information with Gregory and allowed him to have a say when things impacted him.  I told him about blogs, comparing them to one of his favorite tv shows.  “This is like what Carly does on her web show iCarly, but in written form.”  (He totally got that…)  Then I told him about my blog specifically.  I said it was about him, and our experiences with AS, and that we were hoping to help other families in a similar situation.  Hesitantly, I asked, “What do you think of the idea?”    

To my surprise, he smiled broadly and said, “Great!”  Then I asked him if I should use his real name, use initials or make up another pseudonym.   Gregory instantly stated that I should use his real name, “of course!”  He is not ashamed of his condition and is in fact, proud of how far he has come…so why not use our real names?    

Gregory Speaking at "Shining the Light on Autism" Conference

 

I guess I shouldn’t have been surprised. Unlike me, Greg has no qualms about ‘stardom’.   He loves the limelight and is a true ham at heart.  For example, last spring the program director of his Asperger’s Social Skills Therapy group approached us to see if he would be willing to be one of the panelists at an upcoming autism awareness conference.  Greg was over-the-moon, “Yes!  I would LOVE to!”  And he did a fantastic job, speaking in front of a large audience, answering questions and even ad libbing a joke!  Greg was the youngest panelist presenting that night, but you would never know it….he handled it like a pro!  He was open about his issues, forthcoming with his opinions and enjoyed sharing his experiences.    

And last year during a school assembly focused on tolerant acceptance of differences, the presenter was talking about the upcoming “Buddy Walk” in support of Down Syndrome.  At Q&A time, Gregory waited his turn, then proudly got up in front of the entire school and announced, “I have a syndrome too.  It’s called Asperger’s Syndrome.”  And then he smiled with satisfaction as the kids in the audience applauded with warmth and the adults looked at one another with tears in their eyes.      

Anyway, the rest is history, as they say.  With Greg’s enthusiastic ‘go ahead’, I put aside my misgivings and started the blog, using our real names, and laid it out there for all the world to see.  Each week I invite Greg to read my post before it goes out.  He has a phenomenal memory and can remember many of the quoted conversations verbatim, so he is a great resource.   I am happy to solicit Greg’s input, but most importantly, I want to make sure he feels comfortable with what I am writing.  In truth, this blog has become a joint effort by the two of us….it is ‘our story.’    

Some of the things I’ve written have been news to him too; opening his eyes to a few behind-the-scene aspects of our story.  For example, after reading my second post [Date Night Diagnosis], Gregory exclaimed with wonder, “Wow….I had a really bad case of AS when I was little, didn’t I?”   I concurred and then highlighted how much he has accomplished since then…He beamed with pride (and so did I!)    

But I still worry about exposing him too much.  After all, this blog goes out on Facebook, Twitter, forums and email, etc.  (Jumbo-Tron anyone???)  At some point, some of his peers will read all about his most personal ups and downs.  Will he be OK with that?  Does he really understand the magnitude and implications of what he is agreeing to?    

So a few weeks ago, I shared with him my blog statistics as they stood at that point.  I showed him a graph which displayed how many people viewed my pages each day and then I pointed out the total number of views, wondering how he would feel.  “You mean, 380 moms have read these stories” he asked in amazement?  I nodded.   “And they told their kids about me” he questioned?   I responded that, “Yes, I’m sure some of them have.”  He smiled and nodded, “We’re helping a lot of kids!”     

Once again, Gregory’s openness and acceptance just floored me.  In his mind, sharing his story means spreading understanding… ever expanding his support circle of acceptance.  That has certainly been the case to date, so maybe Gregory does know best!    

I’ve read a great book, School Success for Kids with Asperger’s Syndrome by Stephan M. Silverman and Rich Weinfeld.  It promotes educating other students about AS and about the child’s unique strengths and challenges.     

By educating classmates and schoolmates about the challenges of the individual child, a climate of understanding and support can be cultivated…  At older ages, the student with Asperger’s may self-advocate, as she helps educate her classmates about her own strengths, challenges, and needs.     

With that in mind, we’ll continue with the blog – working together on ‘our story’.  Future posts will feature Gregory, highlighting his strengths and special talents.  There might even be a post by ‘The Man’ himself and I hope you all come to see what a wonderful, open, extra-ordinary human being he is…  Oh…and BTW – does anyone have the number for that reality tv show producer???  😀

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