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1.
I am first and foremost a child. I have autism. I am not primarily “autistic.”
My autism is only one aspect of my total character. It does not define me as a person. Are you a person with thoughts, feelings
and many talents, or are you just fat (overweight), myopic (wear glasses) or klutzy (uncoordinated, not good at sports)? Those
may be things that I see first when I meet you, but they are not necessarily what you are all about.
As an adult, you
have some control over how you define yourself. If you want to single out a single characteristic, you can make that known.
As a child, I am still unfolding. Neither you nor I yet know what I may be capable of. Defining me by one characteristic runs
the danger of setting up an expectation that may be too low. And if I get a sense that you don’t think I “can
do it,” my natural response will be: Why try?
2.
My sensory perceptions are disordered. Sensory integration may be the most difficult aspect
of autism to understand, but it is arguably the most critical. This means that the ordinary sights, sounds, smells, tastes
and touches of every day that you may not even notice can be downright painful for me. The very environment in which I have
to live often seems hostile. I may appear withdrawn or belligerent to you, but I am really just trying to defend myself. Here
is why a “simple” trip to the grocery store may be hell for me: My hearing may be hyper-acute. Dozens of people
are talking at once. The loudspeaker booms today’s special. Musak whines from the sound system. Cash registers beep
and cough, a coffee grinder is chugging. The meat cutter screeches, babies wail, carts creak, the fluorescent lighting hums.
My brain can’t filter all the input and I’m in overload!
My sense of smell may be highly sensitive. The
fish at the meat counter isn’t quite fresh, the guy standing next to us hasn’t showered today, the deli is handing
out sausage samples, the baby in line ahead of us has a poopy diaper, they’re mopping up pickles on aisle 3 with ammonia
… I can’t sort it all out. I am dangerously nauseated.
Because I am visually oriented (see more on this
below), this may be my first sense to become over stimulated. The fluorescent light is not only too bright, it buzzes and
hums. The room seems to pulsate and it hurts my eyes. The pulsating light bounces off everything and distorts what I am seeing
-- the space seems to be constantly changing. There’s glare from windows, too many items for me to be able to focus
(I may compensate with “tunnel vision”), moving fans on the ceiling, so many bodies in constant motion. All this
affects my vestibular and proprioceptive senses, and now I can’t even tell where my body is in space.
3.
Please remember to distinguish
between won’t (I choose not to) and can’t (I am not able to). Receptive and expressive language and vocabulary can be major challenges for me. It isn’t
that I don’t listen to instructions. It’s that I can’t understand you. When you call to me from across the
room, this is what I hear: “*&^%$#@, Billy. #$%^*&^%$&*…” Instead, come speak directly to me
in plain words: “Please put your book in your desk, Billy. It’s time to go to lunch.” This tells me what
you want me to do and what is going to happen next. Now it is much easier for me to comply.
4.
I am a concrete thinker. This means I interpret language very literally. It’s
very confusing for me when you say, “Hold your horses, cowboy!” when what you really mean is “Please stop
running.” Don’t tell me something is a “piece of cake” when there is no dessert in sight and what
you really mean is “this will be easy for you to do.” When you say “It’s pouring cats and dogs,”
I see pets coming out of a pitcher. Please just tell me “It’s raining very hard.” Idioms, puns, nuances,
double entendres, inference, metaphors, allusions and sarcasm are lost on me.
5.
Please be patient with my limited
vocabulary. It’s
hard for me to tell you what I need when I don’t know the words to describe my feelings. I may be hungry, frustrated,
frightened or confused, but right now those words are beyond my ability to express. Be alert for body language, withdrawal,
agitation or other signs that something is wrong.
Or, there’s a flip side to this: I may sound like a “little
professor” or movie star, rattling off words or whole scripts well beyond my developmental age. These are messages I
have memorized from the world around me to compensate for my language deficits because I know I am expected to respond when
spoken to. They may come from books, TV, the speech of other people. It is called “echolalia.” I don’t necessarily
understand the context or the terminology I’m using. I just know that it gets me off the hook for coming up with a reply.
6.
Because language is so difficult
for me, I am very visually oriented. Please show me how to do something rather than just telling me. And please be prepared to show me many times. Lots
of consistent repetition helps me learn.
A visual schedule is extremely helpful as I move through my day. Like your
day-timer, it relieves me of the stress of having to remember what comes next, makes for smooth transition between activities,
helps me manage my time and meet your expectations.
I won’t lose the need for a visual schedule as I get older,
but my “level of representation” may change. Before I can read, I need a visual schedule with photographs or simple
drawings. As I get older, a combination of words and pictures may work, and later still, just words.
7.
Please focus and build on what
I can do rather than what I can’t do. Like
any other human, I can’t learn in an environment where I’m constantly made to feel that I’m not good enough
and that I need “fixing.” Trying anything new when I am almost sure to be met with criticism, however “constructive,”
becomes something to be avoided. Look for my strengths and you will find them. There is more than one “right”
way to do most things.
8.
Please help me with social interactions. It may look like I don’t want to play with the other kids
on the playground, but sometimes it’s just that I simply do not know how to start a conversation or enter a play situation.
If you can encourage other children to invite me to join them at kickball or shooting baskets, it may be that I’m delighted
to be included. I do best in structured play activities that have a clear beginning and end. I don’t know how to “read”
facial expressions, body language or the emotions of others, so I appreciate ongoing coaching in proper social responses.
For example, if I laugh when Emily falls off the slide, it’s not that I think it’s funny. It’s that I don’t
know the proper response. Teach me to say “Are you OK?”
9.
Try to identify what triggers
my meltdowns. Meltdowns,
blow-ups, tantrums or whatever you want to call them are even more horrid for me than they are for you. They occur because
one or more of my senses has gone into overload. If you can figure out why my meltdowns occur, they can be prevented. Keep
logs noting times, settings, people, activities. A pattern may emerge. Try to remember that all behavior is a form of communication.
It tells you, when my words cannot, how I perceive something that is happening in my environment. Parents, keep in mind
as well: persistent behavior may have an underlying medical cause. Food allergies and sensitivities sleep disorders and gastrointestinal
problems can all have profound effects on behavior.
10.
If you are a family member, please
love me unconditionally.
Banish thoughts like, “If he would just …” and “Why can’t she …” You did not fulfill
every last expectation your parents had for you and you wouldn’t like being constantly reminded of it. I did not choose
to have autism. But remember that it is happening to me, not you. Without your support, my chances of successful, self-reliant
adulthood are slim. With your support and guidance, the possibilities are broader than you might think. I promise you –
I am worth it.
And finally, three words: Patience. Patience. Patience. Work to view my autism as a different ability
rather than a disability. Look past what you may see as limitations and see the gifts autism has given me. It may be true
that I’m not good at eye contact or conversation, but have you noticed that I don’t lie, cheat at games, tattle
on my classmates or pass judgment on other people? It may also be true that I probably won’t be the next Michael Jordan.
But with my attention to fine detail and capacity for extraordinary focus, I might be the next Einstein. Or Mozart. Or Van
Gogh.
They had autism too.
The answer to Alzheimer’s, the enigma of extraterrestrial life -- what future
achievements from today’s children with autism, children like me, lie ahead?
All that I might become won’t
happen without you as my foundation. Think through some of those societal ‘rules,’ and if they don’t make
sense for me, let them go. Be my advocate, be my friend, and we’ll see just how far I can go
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Press Release
CONTACT:
Cecilia Breinbauer,
MD, MPH
cbreinbauer@icdl.com
(240) 350-6907
April 23,
2007
New Guidelines Promise Earlier Identification of Autism
CDC/ICDL Working Group Releases New Report during Autism Awareness Month
Washington, D.C.,
April 23, 2007 (ICDL) – Leading experts on child development
today presented a new framework for identifying children at risk of Autism Spectrum Disorders (ASD) and other developmental
challenges, saying that current guidelines fail to identify many children who need and would benefit from early intervention.
The framework
is contained in a report by a special working group formed by the Centers for Disease Control (CDC) and the Interdisciplinary
Council on Developmental Learning Disorders (ICDL), co-chaired by Dr. José Cordero, former Director of the CDC’s National
Center on Birth Defects and Developmental Disabilities and currently Dean of the School of Public Health of the University
of Puerto Rico, and Dr. Stanley Greenspan, chair of the ICDL.
The framework
presents newly formulated indicators to identify at-risk children in the first and second years of life, components for a
comprehensive evaluation of infants and children determined to be at risk, and essential elements of a successful early intervention
program for ASD and other developmental disorders.
The authors
say the new rubric casts a wider net than current common practice in an effort to identify all children at risk of developmental
disabilities.
“Children
identified with developmental or behavioral disabilities earlier have a better chance of reaching their full potential,”
said Dr. Cordero. “We believe this framework improves our ability to identify infants, young children, and families
at risk and to organize truly comprehensive, developmentally-based intervention efforts.”
The CDC-ICDL
framework is based on current understanding of healthy developmental patterns and is designed to detect all possible deviations
from those patterns. It uses risk indicators designed to detect a lack of mastery of age-expected emotional, social, and cognitive
milestones during a child’s first 2 years of life. These include the inability to:
- Be calm and focus on sights and sounds by 2 months of age
- Initiate and sustain warm, joyful interactions with caregivers by 4 months of age
- Exchange emotional and social gestures (using different sounds), reaching, exchanging, back-and-forth smiling, looking,
and searching by 8-9 months of age
- Engage in shared social problem-solving and playing, including taking a caregiver’s hand to find a toy or favorite
food; playing with a toy and caregiver together with lots of back-and-forth exchanges of sounds; and social gestures such
as smiles, looks, and pointing by 12-16 months of age.
Early identification and preventive intervention for ASD and other developmental disorders have been long-standing goals,
yet until now there has been no widely accepted framework for determining which infants and young children are at risk and
the best ways to intervene. The new framework is intended to fill that gap to help more infants and young children overcome
early challenges and acquire the foundations for healthy emotional, social, and intellectual development.
The CDC-ICDL report, which is being released during Autism Awareness Month, comes at a time when concern about autism
and other developmental disorders is growing. A recent CDC study showed that an estimated 1 in 150 children in the United States has autism, a rate much higher than
previously thought. Moreover, nearly 17% of U.S.
children present a wide range of developmental challenges, including autism and other learning disabilities, that require
early identification and preventive interventions. However, less than 50% of these children are identified as having a problem
before starting school.
In presenting the new framework, the CDC-ICDL Working Group Report cautions against evaluations that are limited to
specific behaviors or diagnostic criteria. During infancy and early childhood, all children who do not demonstrate mastery
of the newly formulated healthy development milestones should receive early diagnostic evaluation and early intervention,
the report says.
A comprehensive evaluation must include assessment of social, emotional, cognitive, language, motor, and sensory functioning;
parental and family patterns of interaction; and availability of community support, says the report. It recommends that intervention
programs focus on infant-parent relationships, family functioning, and overall social-emotional, cognitive, motor, and sensory
functioning. The report concludes that narrowly focused intervention programs that target specific behaviors or symptoms may
increase risk in infancy and early childhood.
“This report is important to the future of children and families all over the country,” said Dr. T. Berry
Brazelton, founder of the Child Development Unit at Children’s Hospital Boston and the Touchpoints Center
and member of the CDC-ICDL Working Group. “Without it, many adults would be thrust on our society with untreated autism that might have
been effectively treated had intervention been started early in their childhood. We know that the earlier in childhood --or
even in infancy-- treatment begins, the more likely people affected by autism can adapt to society and the workplace.”
Brazelton added, “With the frightening rise in the incidence of autism, we are facing a costly epidemic. The ICDL
has been working to identify these babies early and to introduce therapeutic intervention as early as possible. This therapy
works to increase the process of social and neurological organization that help these children learn to function, to help
parents understand their role with them, and to assist the children themselves to reach out for the world they would otherwise
shut out. This report is like a lifesaver thrown into a drowning society. We should all be grateful.”
Dr. Greenspan also announced that the CDC-ICDL Working Group will periodically review early detection and intervention
programs and the degree to which they are consistent with these new principles. “Early identification and intervention
programs that occur early in life can have long-term effects and should receive the same rigorous long-term scrutiny as any
pharmacological intervention does,” he said.
Work group members included: Co-Chairs - José F. Cordero, M.D., M.P.H.
(former Director, National Center
on Birth Defects and Developmental Disabilities – CDC) and Stanley I. Greenspan, M.D. (Chair, Interdisciplinary Council
on Developmental and Learning Disorders). Members - Margaret L. Bauman,
M.D. (Massachusetts General Hospital), T. Berry Brazelton, M.D. (Harvard Medical School), Geraldine Dawson, Ph.D. (University
of Washington), Barbara Dunbar, Ph.D. (Georgia State University), Peter C. Mundy, Ph.D.
(University of Miami), Ruth Perou, Ph.D. (National Center on Birth Defects and Developmental
Disabilities – CDC), Keith
G. Scott, Ph.D. (University of Miami), Stuart G. Shanker, D.Phil. (York University, Toronto, Canada), and Ruth E. K. Stein,
M.D. (Children’s Hospital at Montefiore).
The Interdisciplinary Council on Developmental and Learning Disorders (ICDL) is a non-profit organization dedicated
to improving the prevention, assessment, diagnosis, and treatment of emotional and developmental disorders in infancy and
childhood by promoting dialogue and integrating knowledge from different disciplines.
For the complete report and more information, please visit www.icdl.com or contact Cecilia Breinbauer, M.D., M.P.H. at cbreinbauer@icdl.com |
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