a year but no articulated words… “Give them more time before you worry. They are probably just late bloomers” had told him the boys’ pediatrician (actually quite in line with Dr. Martin’s opinion).
But Dr. Trist was not satisfied with just give them time. He knew of Dr. Martin as a trusted and knowledgeable specialist and he had referred to him his own patients with various issues. So he asked him to take a look at his own twins when they were 18 months old. He knew they were already developing too slow and he needed to get a diagnosis that would at least put his and his wife’s fears at rest one way or another.
Dr. Martin greeted his colleague Dr. Trist in his waiting room. The Trist twins, both boys, were sitting in a double, interconnected stroller that was being pushed by mom. Right in the waiting area Dr. Martin noticed that they were not focusing their eyes on any of the many colorful distractions -figurines and paintings- that were in all his walls with wooden toys and stuffed animals purposely strewn all over the floor. They were not looking at him either even though after the initial hand shake to the parents Dr. Martin was quickly trying hard to engage the boys’ eyes. That was really all it took Dr. Martin to nail the diagnosis of autism right in his waiting room, though he had already suspected it when Dr. Trist himself had called him on the phone two days earlier with his concerns and had made the appointment to bring them to him.
In his consultation room, with blankets laid on the floor by their mom, as with other infants checked for developmental concerns, the boys were placed on their bellies. Dr. Martin was given the kids’ perinatal history -the planned C-Section in the 8th month- their birth weight -about 4 lbs each-, that they were up to date in their shots without unusual reactions, and the family history. Dr. Trist did volunteer before his wife that SHE had a niece in her teens who was ‘just a pinch slow in school.’ Dr. Martin’s guessing by the girl’s age, her grade and the Special Ed she was attending, he judged that her IQ probably hovered in the 60s; she had no precise diagnosis; they were just told that ‘perhaps she had a touch of C.P.’
Dr. Martin wanted to see how the boys crawled or scooted around. But they didn’t. On their bellies, they did not prop themselves up on their elbows to look at things or at each other. After a while, they did roll over on their own without help -a 3 to 4 month milestone-; but they were already 18 months old!… They did not move around once they were on their backs. And the room was quiet, without giggling or a child’s words or laughter; only the adults’ intermittent talk was heard. The hard findings of the physical and neurological examination were normal. The twins did not have odd facies, unusual muscle tone or reflexes, their heads were not too big or too small, they had no birthmarks, their eye grounds were fine and in a still photograph they would have looked like a perfect pair of adorable young toddlers… But they did not show visual interest or face-to-face focusing. They were clearly autistic to Dr. Martin. No doubt. And moderately so, unfortunately. And so he told the parents.
“I feared that,” said his colleague Dr. Trist. “I was guessing they might be autistic but I kept talking to myself out of it. I did not want to scare my wife. Any ideas what might have caused it?”
“That is a contentious point this days,” said Dr. Martin. “There is so much talk in the Media about it being caused by this and that event during the pregnancy, especially by a case of subclinical maternal Rubella… and now specially by the Pertussis immunization… But I don’t believe that. You may know perhaps that the British doctor whose research pointed in the 1980s to the Pertussis vaccine as the cause of autism was disbarred, his research discredited as having much of its data been made up… I’ve entertained myself for a long time that it is nearly exclusively genetic, but this is also sensitive issue to tell everybody… I have seen over a hundred cases in all these years, and have no other theory as for its cause. I have my case load all charted out and I’m ready to publish a paper with my findings, but I am not sure I will send it…”
Dr. Trist and his wife got quiet, without words. A subtle air of defensive hostility to such comments was sensed by Dr. Martin. After a while, they asked him about Early Intervention and he told them of the many programs available through the local public schools, especially at Sandwell Elementary. He also mentioned for them the out of town centers specialized in autism, one in the state, two hours to the west; the other at 4 hours drive south of the border. He did not share with them his skepticism of the value of such programs… He thought that in time they would judge that themselves.
Dr. Trist did not have much else to say before they left, but a day later he called Dr. Martin to thank him for the visit and to share with him his own conviction that it all had been caused by ‘just complications of a twin pregnancy with so much fluid’…
Until then, Dr. Trist used to send his patients for a neurological consultation to Dr. Martin. But that stopped then. He never sent him another patient though his own G.P. colleagues continued to do so regularly. Ah well… Another enemy?…
5-E: Not too long ago Dr. Martin heard of a new wave of instruction and communication with- and for autistic kids. It was called ‘Eased Communication’ (or ‘Helped, Facilitated’ or something like that). It was shown by the local Media with actual demonstrations about how well autistics -who otherwise had been left as unapproachable- could communicate, even at a high intellectual level. The local University had its psychologists so enthused about such ‘eased’ interaction with autistics that it had created a whole new department with full space facilities in one of its buildings that had been till then underused.
A 19 year old autistic, Henry Duffy, was being a phenomenon and proof of remarkable progress with such new communication and one Spring, the local TV showed one of his sessions and how he was graduating ‘from regular high school’ (wow!) and he was even heading for college with the assistance of Eased Communication.
[Case repeated here as in Dr. Lee’s painting #19 in the book “FRANKLY,” to which this is its Sequel]
This entailed his special ‘communicating aide’ to work with him one-to-one by his side at all times and a special small word processing lap-top computer (with a screen and a key board, of course). The idea was that, as the student, sitting with his right hand over the key board, his aide, by simultaneously ‘supporting’/guiding his right elbow, Henry would tap the correct key he needed to answer on the screen questions posed to him. In this format, Henry had shown quite a proficiency. He was ready to graduate and even go to college! Wow!
But Dr. Martin was skeptical of the whole thing. He thought the whole ‘Eased Communication’ thing might just be a made up hoax, just wishful thinking. The issue had come up in one of the regular monthly meetings of the local county pediatric society that Dr. Martin attended regularly. A colleague of his, a Dr. Ellen Rose, had mentioned to him that she knew Henry Duffy as he was a pediatric patient of hers in her part of town. In fact, she reminded Frank Martin that HE too had evaluated Henry a few years back and had even been the one who had diagnosed him with Autism.
“I wonder if I can attend one of his ‘eased’ sessions in school, just as an observer.
Do you think, Ellen that I can call the school psychologist and inquire about that? Perhaps you can ask his parents if that would be OK with them.”
“I think that’s a great idea, Frank. I am all sold into this ‘Eased Communication’ and it will be great for you to have one of those sessions with Henry to convince you.”
They set up one day for Dr. Martin to come to Henry’ school to attend a demonstration. The doctor happened to know in that school also the Henry’s supervising psychologist, a woman whose kid with ADHD had also seen Dr. Martin a couple of years earlier and was for that taking Ritalin.
In an empty classroom, in the middle of a long bench table was an open and ready to be used ‘easing’ communication computer. There were two chairs in front of it, one exactly in front of it, the other to its right. Henry was sat in front of the machine and his special ‘easing aide’ sat to his right and supported with his own hands Henry’s right elbow. Dr. Martin had given his aide written questions to ask –and asked the aide to write HIS answers in a separate piece of paper. So the session went:
“How