Monday, December 9, 2013

Autism: Cured or Misdiagnosed?

As JC continues to make great progress I am often asked "do you think he will be cured?" or "well maybe he was misdiagnosed". Here are my thoughts on those possibilities:

Let me start by saying that I am not a believer that Autism can be cured, because after all it is not a disease.  It is, in the simplest terms, a difference in the way the brain functions and processes information. There is no "cure" for that, nor is one needed. The aspects of autism that we as a society seek to "cure" are the symptoms of this brain functioning difference.

What do I mean by "symptoms"?

Sensory issues impede and can severely limit everyday life, so we try to desensitize the body to various stimuli.  The stereotypical repetitive movements (flapping, rocking, jumping) all come from a need for sensory input and an attempt to regulate the body in some way.
Trouble with communication and speech results from various components of the brains operation. For example, some may not be able to process speech and emotions at the same time.  Others may not be able to speak at all because the process to formulate an idea or response, process the appropriate way to express that idea or response, and then plan the motor movements needed to say the words is a very un-natural process that requires so many steps, each of which produces an opportunity for error and break-down. In many cases, a child is non-verbal not because they have nothing to say but more because they simply can't say it with words.    
Rigidity and inflexibility can result from an overwhelming sense that the world is unsafe. Imagine if everything you touched, heard, smelled or saw was scary and painful. You would want to have as much predictability in your life as possible to reduce the unexpected and thereby limit the assault on your body.  Requiring a strict routine or method of doing something becomes a coping mechanism so that the child can function on a daily basis.
Social issues arise from a variety of reasons as well.  Maybe because of sensory issues a child doesn't like to have others in "his space". Or maybe the effort to communicate is so in-natural that a child would simply prefer not communicate with others.  Or perhaps the unpredictability of social situations makes the child uncomfortable thus leading to a need to control and be inflexible in play. This inflexibility and need for control can cause difficulties in social  situations because the child doesn't understand or seek to understand others emotions or desires.  In many cases I think they are simply trying to preserve their own sense of comfort rather than avoiding acknowledging others.

These are just snapshots of certain circumstances, specific to what I have seen with my own son.  As we understand the reasons behind the behaviors, we can better understand how to deal with these "symptoms".  In our situation with JC, we have focused on early intervention therapies that seek to deal with the root cause of the behaviors, therefore eliminating the need for the behaviors.  As a reminder, JC entered sensory integration therapy at 16 months old, speech therapy began at 23 months old, and he was diagnosed with ASD (Autism Spectrum Disorder) at 30 months old.  Throughout that entire timeframe, we were focusing on these behaviors very early, even though we didn't know they were related to autism. We began implementing strategies to overcome challenges and tried to provide him with appropriate coping mechanisms.  But I think the biggest success of our endeavors has been that we gained a better understanding of him, of how his brain functions, and of WHY he reacts or behaves a certain way. It is only with that realization that we have been able to help him overcome the challenges that have made his life so difficult.

Does Progress = Cure?

I often talk to people and I will share how well JC is progressing.  His speech has made marked improvements even just over the past months. His rigidity and inflexibility have subsided somewhat as we are more able to understand his "triggers" and help him navigate through the world.  He is showing great improvement in social skills as he learns to share and take turns. He has even made great strides in emotional awareness and I have been brought to tears more than once over this accomplishment.  Just the other day, I scolded him for doing something and he looked at my face, saw that I was upset, thought about it for a second and then said, "sorry mommy". That was such a huge moment!  It showed that he understood the expectations, knew that he failed to follow them, acknowledged that it had an affect on me, and then accepted the responsibility by saying he was sorry. This seems like such a trivial thing to those who haven't dealt with autism first-hand, but let me tell you it was like "first words" all over again!

As you can see, JC has made enormous leaps in the development and progress.  The child who once screamed rather than communicating, refused anything outside his "norm" and made us all walk on egg shells for fear we would "trigger" a meltdown has become a very happy and somewhat well-adjusted little boy.  Much of this progress has taken place over the past 6 months. Of course, there is a lot of normal developmental progress that goes into the time between 2.5 and 3.5.  But I don't think it is a coincidence that the progress peaked after his diagnosis with autism. Why? Any diagnosis is just a label but it is with that label that you begin to understand.    It validated the challenges and encouraged the progress. Knowing that there was a reason for a certain behavior gave me a place to start and from there, we were able to "re-build".  Studies show that early and intensive interventions can make all the difference in children with Autism. Their brains are still developing and it's the best time to "re-wire" those connections.  After JC was diagnosed, I spoke with the neuropsychologist who did his evaluation.  I asked if JC could "outgrow" autism.  After all, I knew he was high functioning, I knew he was very smart, and I knew we had already made such great progress.  His response was this: "autism isn't something one grows out of.  But a child can develop coping mechanisms and learn to better navigate the world so that the signs of autism aren't as noticeable or debilitating.  JC has a very good chance of being one of those children who, learns to function and manage his Autism."  That became my goal: For JC to develop coping mechanisms and an ability to self-regulate so that his issues wouldn't interfere with daily life as much as they had at one time.

So do I believe JC was misdiagnosed?  No, I have always known that his brain works differently. Autism is a spectrum of symptoms and severity. JC started on the milder end of that spectrum so every little bit of progress leads to a more manageable life.  It doesn't mean things will ever come naturally to him, but he can learn to adapt.

Imagine walking through a maze with obstacles at every turn. That's what life was like for him (and us) before the diagnosis. Having an evaluation and a diagnosis was like giving us a map to the maze. We knew there were going to be obstacles, but we learning to navigate through them and in some cases avoid them altogether.  There are days when we have new challenges or things regress a bit, so we pull out that map again (maybe we go back to basics with visual schedules or social stories).  But having that understanding provides a comfort that we did not have before his diagnosis.  Some day we will be so accustomed to traveling through the maze that we will be able to do it without a map. And one day, JC will be able to navigate the maze on his own.

So do I think JC will ever be "cured"?  As I said before, I don't think Autism can be "cured" nor does it need to be. As I see it, some children can "develop through" autism, and JC is showing great progress in doing just that!

Here is a video of Daryll Hannah speaking about her life with Autism.  What a powerful testimony of what it was like for those with Autism years ago.  Her mother was told to institutionalize her!  And now she functions very well as an adult.  As she describes, she still struggles but has gained the ability to overcome much of it.  THAT is my goal for JC!

1 comment:

  1. I like how you’re looking at these things with complete sagacity. For one, it’s a good thing you didn’t believe JC is misdiagnosed, or that is his condition is uncurable. Like you said, his case is a ‘progress’, and thus needed to be continually worked on. I guess accepting that will sort of ease up your way towards your goal for JC’s life. Thanks for inspiring us with your story!

    Sabrina Craig @ The Law Offices of Joseph M. Lichtenstein

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