Tuesday, November 28, 2006

Lists



Sweet M sorts the words she knows. (September 2006)


Over here at Autism's Edges we keep a lot of lists.

We have lists of Dolch words Sweet M has learned; lists of things that Sweet wants Santa to bring her for Christmas (she still believes); lists of schools we've looked at and found inappropriate and lists of schools we've applied to which have found her inappropriate. We have lists that constitute diagnostic criteria, and we have lists of educational attorneys.

Some days we try to keep lists of things we feel grateful for, as this is recommended as a way to boost one's sense of well being. And other days we have lists of situations that we feel are hopeless, as this seems to keep us firmly grounded in reality.


Apparently over at Sweet M's school they are also keeping lists. I am told by the psychologist who cannot make a diagnosis — the one who read us the list of diagnostic criteria from the DSM-IV-TR — that Sweet M's school is keeping a log of anything that suggests that she is not appropriate for their setting. So she doesn't really have to do anything spectacular to be booted out. She just has to pick her nose. Or not talk to another kid. Or only eat pasta for lunch. Or prefer to play alone at recess.

Earlier this year, in a meeting with the principal of the school, the principal explained to me that Sweet M has different teachers for reading, math, social studies, writing, and so on. (Sweet M is in third grade, but has six teachers, one for each subject — six different people she has to figure out.) She said we have her working with many different people because "we want to have a lot of eyes on her."

Not a lot of hands to support her, or hearts to embrace her, but a lot of eyes to assess her.

The social theorist Michel Foucault compared this sort of surveillance to the panopticon, a structure where those in power have a sightline on every subject. Think here of prison watchtowers, or professors at a podium who can view every student. The panopticon is a form — sometimes concrete and architectural, but most often social and bureaucratic — that focuses power in much the same way that the lens of magnifying glass can focus light.

There are times when one feels one is becoming paranoid. One is even tempted to check the DSM for the diagnostic criteria for various paranoid states. But then one remembers that joke turned adage: just because you think someone is out to get you — or, in this case, your child — doesn't mean you're paranoid.

Monday, November 27, 2006

PDD-NEK

In the continuing saga of diagnostic ambiguity —

Last week the psychologist who had previously taken her copy of the DSM-IV-TR off her shelf and read the diagnostic criteria for autism to Fathersvox and I, told me that Sweet M doesn't have autism. Now she says that Sweet M has PDD-NOS. Atypical autism.

But, she says, she still can't make the diagnosis because she didn't do the developmental history.

So we're back to PDD-NOS. Atypical autism. Sort of.

I knew Sweet M wasn't neurotypical. And now it's confirmed, she's not even typical in her autism, in her atypicality.

I find all of this sad, and funny, and tiring. Very very tiring. It reminds me of the problems of thinking of neurodiversity as a linear spectrum that is being discussed over on Autism Vox and elsewhere.

The entire catagory of Pervasive Development Disorder needs to be rewritten. It's a mess.

I think that what Sweet M and many of us are suffering from isn't PDD-NOS, it's PDD-NEK: Pediatric Diagnostic Disorder – Not Enough Knowledge.

Thursday, November 23, 2006

How Many More?

Twelve-year-old Ulysses Stable was slashed to death in the bathtub by his father, a sole caregiver who was home schooling his son in their Bronx apartment. Ulysses was described by the New York Times as "severely autistic."

How many more autistic children will be murdered by their parents before people wake up and see that there is an urgent need for good schools for our children, support services for families, and respite care for caregivers?

I wish I had an upbeat Thanksgiving Day post, but I can't get this story out of my mind.

I am heartbroken to read about this on Thanksgiving morning: while more fortunate families line the Thanksgiving Day Parade route to see playful cartoon characters on a giant scale, buoyed on their way, somewhere in the Bronx in a cold florescent-lit morgue there is the body of a boy slashed to death by his father who could carry on no longer. Nothing was keeping them afloat.

Saturday, November 18, 2006

Silence = Death

Special Focus asked me to write a something about privacy and posting. I'm grateful for her request because Autism's Edges is almost a year old, and it's time for me to think about where all of this is going, and what I will make of it in the coming year.

Deciding when to speak and when to remain silent has all sorts of implications, both practical and moral, interpersonal and political. Every person of conscience who starts writing bumps up against this dilemma at one point or another, whether they're writing a blog, or a journal, or a book.

How do we speak our own truths without trampling on the privacy of others, whether they're our children, their caregivers and educators, or other family members? Where does our right to share our experiences bump against another person's right to not share their own? How can one be honest and forthright yet not set off a series of detonations that destroy every relationship in sight?

Blogs are particularly challenging. Remember how diaries used to have locks and be kept under mattresses so that one could pour out the contents of one's heart and then seal it away? Well, the blog, despite having the appearance of a diary or journal, is actually like a diary on steroids. It's as though it's being read aloud on the most popular radio station in your vicinity and then kept on replay, over and over. In other words, it's not a diary at all.

The best bloggers are acutely aware of the distinction between diary and blog. While a blog may look like a diary, in the best cases, that's a formal conceit.

Blog entries from autism parents are typically dispatches from our private worlds, but usually they are not our innermost thoughts. They're an edited version of our innermost thoughts. Self-censorship — aka editing with an eye to how others will understand us and what we've written — is critical. Though, once again, I think that some of the best bloggers create the illusion that what they've posted is spontaneous, immediate, and their innermost thinking.

For almost a year I've been posting about all sorts of medical, psychological, and educational issues related to Sweet M's neurological a-typicality. But I've been writing under a pseudonym, and have almost always hidden the identities of the care providers who've appeared in various stories. Once, when I was praising one extravagantly, I listed her name. But retrospectively, I wish I hadn't because she could google herself, come across the site, and bring it to the attention of others who did not get such enthusiastic reviews. Sometimes I've used initials, and other times I've just changed people's names, but I've been careful to avoid what might roll over into the arena where one could be accused, however unjustly, of libel.

When we had a particularly egregious experience with a psychiatric professional, I didn't post about it. I held back because I could not provide the full dimensions of the story without writing something that had the potential for time-consuming blowback. That doesn't mean I won't write about it in the future, but for the moment, I have kept that private.

Once I wrote a post that Fathersvox thought cast him in a poor light, and he was really annoyed. (Obviously I won't link back to it and add insult to insult.)

And I put up pictures of Sweet M, which I've sometimes regretted. While it seemed important to put a face on autism's edges, it's also important for her to have her privacy. Fathersvox was fairly unhappy about my using her image, and I may go back and delete those photos. Not that anything ever posted can be completely deleted. Once it's out there, it's out there.

Sometimes I wish I'd felt I could be 100% "out about aut," as Kristina Chew is, and puts it so well. But since Sweet M's diagnosis has been ambiguous, and her school placement has depended, in part, on her not being labelled autistic, I didn't think it was prudent to be completely out. And as bad as it's been this year, it was pretty great last year, and, unfortunately, is still the most appropriate option available to Sweet M.

Of course being out is a political issue, but being out for someone else is a rather more complicated question.

In the early HIV-AIDS activism of the Gay Men's Health Crisis, groups like Gran Fury and Visual Aids made it clear that taking control of the representation of being HIV-positive and/or gay, was a central part of the struggle for securing funding for AIDS research, healthcare funding, and social services. To win support for AIDS research and social services, activists had to stand up and say it loud, I'm HIV-positive and proud. Silence = Death became one of the most quoted mottos of late 1980s and early 90s. Initially having AIDS was so closely associated with the stigma surrounding being gay — AIDS was called "the gay plague" — that one wasn't necessarily dying of HIV, but rather from the maligning and hatred that stigmatized gays and limited medical care and research.

But with autism, it's slightly different.

HIV-AIDS is a disease. People with HIV-AIDS have a high likelihood of getting sick, and without treatment, of dying of other illnesses due to a compromised immune system. But being homosexual — which as recently as 1973 was considered a disease or psychiatric disorder — no longer is. That change is due entirely to activism on the part of gay women and men who basically stood up and said, I'm gay, and I'm okay — there's nothing sick about it.

Autism is similar and different. One doesn't get sick and die from being autistic. But the social difficulties of autistic people do create very real health risks. Autistic individuals have a much higher chance of being abused and/or murdered by parents who can no longer cope with both the stigma that continues to be associated with autism and woeful lack of support for autistic individuals and their families than do their neurotypical peers. There are remarkable dangers in coping with institutional authorities, for example, the police. And there are the potentially long-term implications of certain kinds of self-injurious behaviors.

But even so, it's not altogether clear that ASD — particularly as the DSM-IV-TR currently describes it — is a disease. It's actually more of a disposition or neurological variation onto which a psychiatric framework has been applied. At the end of the day, autism is more similar to homosexuality than to HIV-AIDS— it's a psychiatric category, not a disease. People once spoke of curing people of their homosexuality, much as they now speak of curing people with ASD of their autism. (Sadly some still speak of curing homosexuality, but that's a post for another day.)

So being out about being aut is more similar to being out about being gay than it is to being out about being HIV-positive. By saying "I'm autistic" one is claiming membership under the rubric that is defining one as diseased rather than different. One is, at least provisionally, accepting the language of psychiatry that inscribes one as not only different, but aberrant. The gay rights movement rejected the psychiatric label of "homosexual" and used the label "gay." The autism rights movement has come up with "autie," "aspie" (from Lianne Holliday Willey), and "neurological diversity" or "neurodiversity" (Judy Singer).

And then to further complicate the matter, many people posting about autism aren't autistic themselves — many, like me, are the neurotypical parents of autistic children. One finds that one can get into all kinds of scraps writing as a neurotypical parent. There are debates about speaking on behalf of one's child, speaking for one's child, and speaking about one's child. These are nuanced, but important differences. When one is writing about one's child one is "outing" someone who hasn't had any choice about it and who might, one day down the line, say "how could you write about me like that?"

But at the end of the day, and the end of this post, I have to say that writing about being a parent of an autie child (whether Sweet M is ultimately diagnosed as autistic or not, I'm quite sure she's autie) is among my most important work. It's vital for me because, as Mom-NOS so aptly described, it provides me with some sort of local coherence. I get to work out a sense of how to think about my daughter, myself, our family, and the social and political institutions that shape our lives in a place where I have to think things through, where people comment and support, where people offer advice, and feedback and guidance.

In the early women's movement — which I'm not quite old enough to have been a full-fledged participant in — there were consciousness-raising groups where women spoke intimately about the abuses they experienced both at home and in the wider world. The idea that the personal is political was born. But these groups were not listservs or bulletin board posts or blogs. They were intimate spaces where women could speak from their lived experience to build some sort of political analysis and action in dialogue. The internet provides a space where some of this can happen, but it's never a private space, which is its difficulty. But on the other hand, it reaches out from our living rooms, or laptops in airports, or lunch breaks in offices, and allows us to connect, to consider, and to contemplate the most crucial issues in our lives.

In the end, then I think that silence for me would equal death. On some days that feels like a literal use of death and on others a more literary or metaphorical use. And I know that Sweet M, for whatever privacy she may want at some later point, she also wants and needs an alive, active, and engaged mom who can advocate on her behalf. It's a balancing act. There may be missteps along the way, but that's one of the edgy things about living at autism's edges.

Monday, November 13, 2006

Nine Years



















A couple of months ago, in anticipation of her birthday, Sweet M made this drawing. It's short a few candles — since she's just turned nine — but don't you love the symmetry of it, and the flatness? And that cheery cherry topping it off?

Sunday, November 12, 2006

Diagnostic Ambiguity

Apparently there are a lot more parents and children living in Diagnostic Ambiguity than we could have ever imagined. According to Saturday's New York Times, Section 1, page 1, above the fold, multiple and conflicting diagnoses are part and parcel of child psychiatry.

So we're not alone, although we have certainly felt that way many a day. Perhaps all of us living in Diagnostic Ambguity should get together, elect our leaders, and establish our own system of governance.

Thursday, November 09, 2006

U-Turn

After my last series of posts, Fathersvox pointed out that I was omitting one of the qualifying remarks made by the clinical professional with whom we met earlier in the week.

Fathersvox recalled, correctly, that the psychologist didn't exactly say that Sweet M has ASD. Rather she said, "It would be unprofessional of me to not point out that she fits the diagnostic criteria for autism spectrum disorder, but since I did not do the developmental history I can't actually make the diagnosis."

Yes. It's true. She did say that.

So, Fathersvox points out, accurately, that we still don't actually have an ASD Dx. We have a child who fits the diagnostic criteria.

In a sense this is a distinction without a difference, and I have the feeling that we are still roaring along into autism's wide open spaces, but I wonder why I heard her wrong.

I think I am just tired of diagnostic ambiguity, with all the possibilities it presents for people making claims that Sweet M is oppositional, or just doesn't listen, or doesn't try, or can't be bothered. And by inference that we are bad parents who can't control our child, haven't socialized her adequately, and who have no regard for others.

I guess I'm at the point where I long for the certainty that would allow me to say "She's autistic. What's your excuse?" (as do some of the great t-shirts that Kassiane pointed to over at Cafe Press.)

Wednesday, November 08, 2006

Signs Along the Way















I wish this automatic sign-generator program had a lovelier landscape for the background, as I know Autism to be a much lusher landscape. But I couldn't resist getting our new road sign generated.

Tuesday, November 07, 2006

Whether to Laugh or Cry

This blog only started a year ago, but we've been living at autism's edges for six years.

For six long years we have been consulting specialists -- supposedly some of the best in the country -- and, with the exception of the school psychologist, who once (erroneously) suggested that Sweet M has Aspergers, no medical professional has ever told us that Sweet M has autism spectrum disorder. Her psychiatrist once called her "spectrumy" -- but when asked if she was ASD said no.

I have a $3,000 neuropsychological evaluation done just over a year ago (that I still haven't finished paying for) that says unequivocally that Sweet M doesn't have ASD.

Of course from our own research, and from reading dozens of wonderful blogs, we knew that all arrows were pointing to ASD, but no one ever stepped up to the plate and said ASD.

Yesterday, finally, a psychologist said the words, "Your daughter has austism spectrum disorder." She even pulled out her well-worn, yellow-highlighted paperback edition of the DSM to go through the diagnostic criteria with us.

Sometimes it's hard, even for we neurotypicals, to know what the appropriate response should be. On one hand, I felt like laughing and saying, "Ah-duh, tell me something that I didn't know." And on the other hand one wants to burst into tears:

• of relief for having someone see the full complexity of Sweet M's issues
• of rage for having been dragged along with partial views for so long
• of grief for the time we may have lost in not having an adequate Dx and getting Sweet M all the supports and assistance that she needs

We've slipped right over the boundaries of autism's edges, into a new-old, familiar-unfamiliar terrain with our new Dx, our new visa. And yet everything is still the same: Sweet M is still delightful, dazzling, and sometimes difficult.

I feel as though there ought to be a road sign: Welcome to Autism. You are now leaving Diagnostic Ambiguity.

Saturday, November 04, 2006

Discipline

One of the things that alarmed me when I went to parent-teacher night at Sweet M's school was that they've instituted something called "responsibility room."

If a child doesn't finish his or her homework — or if, in the estimation of the teacher, hasn't done his or her best work — then they go to responsibility room instead of going to recess.

These kids are 8-year-olds. With learning disabilities. With sensory processing issues. Many with multiple psychotropic medications.

Responsibility room?

I can understand having a study hall or homework make-up room — though I'd question even that for 8-year-old LD kids. I can understand having a breakroom or a "crash room" if you don't feel like going to recess. But responsibility room?

Onto the fact that someone is having some sort of troubles getting their work done, the school is loading a whole load of assumptions — and guilt — about individual agency, about individual self-control. Contrary to popular delusions, humans actually don't have a lot of self-control. We are creatures of habit and creatures of instinct, and exercising self-control is something that is far more difficult than any of us are willing to say. But we are a culture that has large-scale fantasies about individuality and self-control and self-making. And Sweet M's school has bought into that idea big-time.

When I expressed my concern about responsibility room, I was told that our kids need some sort of discipline.

Fair enough. But if you're like me you've probably noticed that the word "discipline" comes from "disciple." The root of any sort of discipline worth engaging is a relationship, a loving, engaged, affective and sometime passionate relationship.

But something happens when the relationship is not a loving relationship, but a relationship of bureaucracy to individual, or institution to individual. Then discipline is anything but loving. Instead it is punitive.

If I'd felt that Sweet M's teachers had a loving and engaged relationship with her I might have been less alarmed about this construct, but seeing what I've seen so far, responsibility room looks like the first lesson in Kafka's Metamorphosis, the first lesson in acquiescing to institutional power.