Children of Autism

Excerpted from
Through the Glass Wall; A Therapist's Lifelong Journey to Reach the Children of Autism
By Howard Buten, Ph.D.

I know a young man, Alain, who is autistic. His autism falls into the category of "high-functioning." As mentioned before, autism looks different on different people. Many autistic people test out as mentally retarded. One wonders, though, to what extent we can trust IQ and other intelligence tests that were never meant to be administered to such unusual subjects. Putting stock in the results of inquiries and tasks solicited from people who tend to act as if they don't even see you, let alone hear your questions, has always seemed dicey to me. We professionals are constantly being amazed by the seemingly profoundly retarded person who suddenly, quite by accident, starts doing advanced calculus whereas he can't even tie his shoes, or the special-gift genius autistic who can name every subway station in Paris but is incapable of saying his or her own name. In daily institutional life we tend to behave as though every customer (as in "the customer is always right") understands everything we say, but we never count on it.

Alain is thirty years old, comes from a good family, speaks well, has a normal IQ. To the naked eye his stereotypical behaviors seem more eccentric than pathological. When Alain gets bored, which he frequently does, he moves his fingers in a certain way, as if he's doing a car's cradle with no string. This gesture, he says, makes the time go by. As we've already seen with Temple Grandin, many high-functioning autistic people, as well as those with Asperger's Disorder, a subcategory of high-functioning autism, understand figurative language in a literal way. As far as Alain is concerned, time literally goes by as a result of this finger movement; if he did not move his fingers in this way, he believes, time would actually stand still.

High-functioning autistic people have complex, structured, communicative language (as opposed to those who simply repeat, immediately or afterward, what they hear, a phenomenon called "echolalia"), but it may be otherwise eccentric: in tone, flat on the one hand, weirdly musical on the other, or in syntax, as in "I love popcorn ultimately, very so much!" These people are often capable of becoming autonomous or semiautonomous - taking the subway alone, buying a sandwich, making their bed. Some, not all, of them may also be autistic "savants," possessing special gifts, like the character Raymond in the film Rain Man who could calculate enormous numbers instantaneously and memorize complicated statistics at the drop of a hat. Some are able to tell you what day of the week your birthday falls on twelve years from now, or draw in perfect detail the edifice of a Spanish mansion that they saw once, for five minutes, six years ago. (Such gifts, even more amazingly, sometimes appear in low-functioning autistics too.)

People with Asperger's Disorder are almost always autonomous in daily life by the time they are adults. But though they seem normal to the naked eye in every respect, upon further inspection we notice in them a subtle quality, a distance: the "air of aloneness" that Leo Kanner described, the glass wall. This wall may be thicker or thinner from one individual to another, but it is always there. Asperger's Disorder is also characterized by the literal mind-set mentioned above: upon hearing someone described as being "sharp as a tack," the Asperger's person might immediately assume that touching the person in question will result in a puncture wound. But unlike more classically autistic people, those with Asperger's Disorder often learn to control, or at least compensate for, their condition. The fact that many are capable of talking about it also helps.

I know of a case of a severely autistic infant who, thanks to constant treatment by family and professionals for over fifteen years, has grown up to be a normally functioning wife, mother, poet and painter. Though still somewhat eccentric in her manner of speaking and reacting to others, she lives a rich, productive life. Question: Can we say that her autism has been cured? Has her severe childhood autism simply transmuted itself into high-functioning autism? Does she now have Asperger's Disorder? If so, how did she get it? High-functioning autistic people seem to have normal intelligence levels, though the manifestation of this intelligence, their personal style, may be so eccentric that we don't recognize it as such. Conversely, we may be tempted to attribute superior intelligence to autistic people who don't truly possess it (at least in terms of IQ), so fascinated are we by their originality. Just or unjust, originality is not a criterion for intelligence.

Where do we draw the diagnostic lines? (I would be interested to know where the line is drawn concerning people who experience Beatles songs as three-dimensional geometric shapes and people who don't, for example.) It would be relatively safe to say that high-functioning autistic people still display various symptoms of standard autism, such as insistence on sameness, stereotypical gestures and postures, and occasionally extreme emotional states, whereas the typical Asperger's person tends to present a flat emotional state, almost no stereotype, and less serious or no obsessive-compulsive behavior.

Alain sees people in a special way. Each human being reminds him of a car-a specific automobile, brand, model and year. Alain also has a personal lexicon. It is made up of invented adjectives that describe the way people are. These words have no semantic roots, no reality-based onomatopoeia (like choo-choo, which describes a train), and though Alain can spell his words, it is clear that what's important is not the way the word looks written down. Alain's words are invented strictly for their sound. For example, the word cbatygreaksken describes "the way the Renault Dauphine was in its time." Alain has informed me that I, too, am chatygreaksken. To Alain my way of being is like a Renault Dauphine.

It seems reasonable that a person's morphology-his or her physical shape-could resemble that of a certain car. How, though, can the vocalized sound of a nonexistent word, with no semantic root or reality-based auditive reference, be used to describe a human being?