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LOVING A BOY FROM A DIFFERENT WORLD
July 12, 2011I told him I love him. Many times. Over and Over.
All he could do was stare at my direction blankly,
as if I wasn’t there at all.
He has a world of his own and seldom do our worlds merge. Meet Jacque. He is just one of the kids who need special help in the Center for Mental Health where I work. Every child experiences feelings of sadness, anger, suspicion, excitement, withdrawal and loneliness, but what separates the normal from a disorder is the degree to which these feelings become so powerful that they interfere with the child’s activities, causing him to suffer.
AUTISM is a disorder in which a child fails to develop normal social relationship, uses language abnormally or not at all, behaves in compulsive and ritualistic ways and may fail to develop normal intelligence. The cause of autism is multifactorial such as genetic or chromosomal abnormality, viral agents, metabolic disorders, immune intolerance, perinatal anoxia or drug intake by mother during pregnancy.
Symptoms are evident at the age of two until three years old. At two years old, a child should demonstrate interest in others, possess an ability to learn from the environment and communicate verbally.
Jacque is not mentally retarded, although many children who have autism have both. Those with IQ of less than 50 often also develop seizures before reaching adolescence.
While symptoms become apparent at age two, there are observable peculiarities that may heighten suspicion for autism: peculiarities in gaze, hearing and play. Children with autism shows lack of interest in play that requires social interaction. They may gaze briefly and out of the corner of the eye, and since they do not respond to sound stimuli, they are first suspected of being deaf. While they do not respond to loud noises, they may react to certain sounds that are fascinating or distressing to them.
Jacque does not want to be cuddled and avoids eye or facial expressions to social contacts. The other day, he was upset for being separated from his parents, but he does not turn to his parents for security like other children do. At one time he had tantrums, he stiffened when his older sister tried to hug him. I told her she should give his favorite toy instead and take him to a less stimulating environment in order to provide reassurance and comfort.
Everyday, I help Jacque establish self-boundaries by calling him by name and correcting him when he addresses himself in the third person. I maintain consistency by providing him with his security blanket (attachment to inanimate objects), same activities and avoiding demands that is out of his routine.
Children with autism like consistency and sameness. Jacque usually has tantrums, giggles, acts as deaf and fears no danger. At times, he is insensitive to pain; wants blocks not balls; points to anything and is resistant to normal teaching methods.
He is very resistant to changes. In fact, he often repeats certain acts such as rocking, hand flapping and spinning of objects. At one time, he injured himself by banging his head and biting himself. Anti-psychotic drugs such as respiridone is given to reduce self-injurous behavior, but there is a risk of movement disorder (as one of the side effects).
I always encourage physical contact with him although I know his tendency is to push away. I tell him stories even if he remains unresponsive. I ask him to paint and help him learn new skills. I read him poems because he responds to rhyme in poetry due to sameness of sound.
About 70 percent of children with autism have some degree of mental retardation, an IQ less than 70. Their performance is uneven but they do better in motor and spatial skills . Some children have idiosyncratic or “splinter” skills such as the ability to perform mental arithmetic and advanced musical skills. Jacque has learned to play the piano beautifully when he was just 4 year old!
Those with lower IQ, meantime, manifest severe motor clumsiness. Some children also increase withdrawal by refusing to eat. Though they do not experience delusions, hallucinations or illusions, they may, however, develop schizophrenia and seizures.
As with other children in the Center, we observe Jacque closely in the playroom setting. Childhood Autism Rating scale help us in the evaluation. Doctors also try to look for underlying treatable or inherited medical disorders like hereditary disorders of metabolism or fragile X syndrome, a DNA abnormality that leads to mental retardation (besides the famous Down syndrome).
For now, we subject him to behavioral modification techniques and psychotherapy to help him cope up with his social difficulties. Drug therapy cannot change the underlying disorder but certain selective serotonin reuptake inhibitors (SSRIs) like fluoxetine, paroxetine and fluovoxamine are often effective in reducing his ritualistic behavior.
Autistic children are also given neuroleptics to control destructive behavior, stimulants (Ritalin) to stimulate responsiveness, and lithium for convulsions. Time limits and verbal reprimands are most often effective rather than punishing that may worsen self-aggressive behavior. When he does something worthy of praise, I usually give him tangible reward than verbal praise. I see to it to intervene before his tantrum outbursts.
Jacque is aware only of himself so he is engaged in self-stimulated acts and plays alone. But there are instances, too, when he advances to parallel play. Older autistic children in the Center also are unable to form close personal relationship and cannot interpret the moods and expressions of others.
About 50% of children with autism never learn to speak. Jacque though has learned to speak but in an unusual way such as talking in the third person and speaking with unusual rhythm and pitch. He fails to differentiate himself from the environment so he constantly repeats what I say and he often uses “you” when referring to himself. He finds it difficult to process external stimuli and apparently needs help in feeding, dressing and toileting.
Jacque will have the symptoms throughout his life. The prognosis is strongly influenced by how much usable language he will acquire by age seven. However, those with IQ of 50 would definitely need full time institutional care as adults.
Just before I left the Center this morning, I told him again that I love him. I handed him his favorite toy — his security blanket – to reassure him of that love…
even if he does not respond to it.
