Chapter Six

Autism and Asperger’s Syndrome

The people who bring their children to us have typically exhausted all other resources. They have consulted pediatricians, pediatric neurologists, psychiatrists, or psychologists.

Our first task is to understand the case as completely as we can, including family history, early experiences, the possibility of head injury, the exposure to infectious diseases, Lyme disease, diet and nutrition, and what has already been done, including regimens of medication, and what the child’s reaction to each intervention has been. We may refer the family for a further workup or a neuropsychological evaluation if it seems appropriate. We then do our own diagnostic evaluation including a LENS map, a qEEG, or ideally, both--because each yields different kinds of information.

A course of treatment is then planned based on the child’s unique makeup and sensitivities. The early treatments usually involve a “toe in the water” type approach, in which a fairly conservative treatment intervention is tried and the results carefully evaluated.

A quick initial response to the treatment, the “honeymoon phase” is a wonderful thing, but as we often say, “Don’t worry, it will pass.” Then we settle down for the long, hard work of treating and watching the responses. There will always be ups and downs, because of variables over which we have no control. But the goal is to hold on to the gains as long as possible, and, with the parent as cotherapist in the child’s healing process, to coordinate with other modalities such as behavior therapy or cognitive therapy for learning disabilities, socialization training, etc. Our philosophy is that since the child’s autism is probably not a “single-cause” disorder” there is probably not a single cure. Rather, through mobilizing the child’s central nervous system as an ally rather than an antagonist, all of the other activities and learning opportunities in the child’s life will support the changes being made.

The following is an example of working with an autistic child, Emily.

At four years of age, little Emily is impossibly cute. She is petite, quite a bit smaller than her (fraternal) twin brother, Chris, blonde, and wears tiny wire-rimmed glasses that only she herself may touch. She is still in diapers, not toilet trained, while her brother was trained years ago. When she sees that my office is full of sandplay toys, she is visibly excited. In one corner of the room, behind the couch, I also have beautiful antique Czechoslovakian handmade puppets that are only for older children to play with carefully, but she makes a beeline for these again and again, despite (and likely because of) being told no.

When she is pulled back repeatedly from the only forbidden ones by her parents, she throws a fit, kicking and screaming and rolling on the floor.

“Ah,” I say wisely to the parents, “another practitioner of tantrum yoga,” and the laughter dispels the tension a little.

The first neurofeedback session is quite an ordeal because she is also quick and clever to rip the electrodes off her head as quick as they are put on. Her screams of “no no! NO!” fill the therapy center. Rich and Lola, her devoted parents, are very concerned but determined that she will indeed get a treatment, because they don’t know what else to do--they are at their wit’s end.

Just after birth, Emily and her twin, Christopher, were both healthy and normal. Emily was the “second one out” and quite a bit smaller. As the months of the first year passed, she crept and crawled and soon stood and toddled, as he did. She began to talk, as he did; and then by the end of that year she inexplicably began to slide backward developmentally. He went on to toilet train, she did not; he did interactive play with other children; she did not.

Her parents visited every highly regarded pediatric psychiatrist and neurologist up and down the East Coast. Finally an entire team of therapists at a Connecticut center confirms the terrifying word they have been hearing at almost every place they have been: autism!

When she comes to see me, Emily’s mood is quite unstable; she is restless, easily frustrated, highly willful. It will take us months of treatment to make an initial brain map, as I am using the “stim” map because I suspect seizure activity to be present. When we finally obtain one, the amplitudes and standard deviations are “off the charts.”

On the subjective symptom rating scale, Emily has “10s” in the categories we will be tracking during treatment: mood instability, no language, no cooperative play, no toilet training, willfulness (followed by a tantrum when restrained or denied in any way). She does not make eye contact with adults and ignores questions or instructions that are offered to her. There is also a visual category given by her opthalmologist: strabismus, where the eyes often wander independently of each other and will not track or focus together.

Course of Treatments and Cotreatments

After fifty-six sessions spread over three years, in conjunction with other therapeutic modalities, reports begin coming back from her school and play sessions that Emily is making more eye contact, saying more words than No! In classroom settings she joins activities rather than sitting apart.

Emily’s parents and I both notice it is easier to get her in the chair; her tantrums are a little shorter and seem more manageable. She selects sandplay objects more carefully and seems to be developing themes around her play. She is asking for things by name, or pointing at objects and saying their names.

By January 2009 Emily is putting together more words and sentences. She names people. She hears the word “pink” and is able to spell it. She is able to say what she wants. Toilet training is “almost complete.” She can dress herself and write her name. In February she wins “student of the month,” and her picture appears in the school newspaper.

Emily is coming of age.