After years of working with autistic boys, Simon Taylor questions the efficacy of diagnosing mental disorders in children.
I love kids. I want to be a father so much I’d even trade my iPhone for a uterus.
This desire was a major motivator behind my work with children with autism and Asperger’s syndrome during university. Throughout my psychology studies I got a job with a reputable autism care centre. I was one of two males working there out of about forty staff. The job required me to visit family homes to administer one-on-one behavioural therapy in their living rooms. I’d look after kids as young as two and as old as nine. I fed, taught and refrained from stealing those adorable little critters.
It was fulfilling and meaningful work that I continued for over three years. During that time, my understanding and attitude towards the diagnosis of Autism Spectrum Disorder (ASD) changed in a dramatic way.
The most poignant of the many catalysts was my time with 4-year-old Jason. I best recall us playing with his Thomas the Tank Engine train set in between bouts of learning exercises. Jason would quote the television series and make up his own hilarious stories, narrated in silly voices. My favourite was his Fat Controller impression. He had the accent down and all.
Alas when it came time to pack the toys away, Jason’s charm was wiped out from his disposition by a wave of tantrums. Lunging, scratching, whaling, biting. Chairs would fly across the room when play time was over.
The care centre’s instructed response to these behaviours was called overcorrection. As a psychological consequence for Jason overreacting, therapists had to give the instructions “Stand up” and “Sit down” over and over again. These two commands would be repeated for at least 10 minutes regardless of Jason’s response. The hardest part was ignoring his sobs and pleas as he forced himself to follow the relentless task.
I hated overcorrection. It didn’t make sense to me but I was new to the job at this point and didn’t feel confident enough to even question it.
During the height of one of Jason’s emotional meltdowns one day, after months of therapy, I began yet another overcorrection. The moment I began to speak, Jason leaped back crying, put his hands over his ears and screamed, “I’M NOT A DOG, I’M A BOY!”
As tears streamed down my face, I found myself questioning the whole system.
The truth is autism is in fashion. Many children are being diagnosed with ASD for a number of symptoms. The process is complex given that ASD can be diagnosed based on varying symptom combinations. When a disorder is defined in such broad terms it becomes easier to make it fit with any child, in the absence of neurological testing.
Autistic symptoms, in essence, are normal behaviours in abnormal proportions. For this reason it is difficult to determine where the cut-off is. For example, criteria like how much yelling a child has to do before being deemed autistic is subjective to the point of being almost arbitrary. Part of the issue is that sometimes the academic outlook is that if a child can’t sit still in a classroom, then there is something wrong with them.
Ten years ago ADD or ADHD was in vogue. Now it’s autism. Sure, many children do have mental disorders, but it seems to me that personality can be misconstrued as pathology.
I’ve visited many family homes during my autism work. I’ve seen the lingering grief in parents’ faces as they look upon their child, forever labelled as disordered. Diagnostic labels are a helpful tool for healing and adapting to the mental challenges that a child may experience. Yet in some cases, I saw this label perpetuating a ‘sick child’ framework that prevented their natural personality from being recognised and embraced.
I still visit Jason now, four years on, even after his parents’ decision to discontinue therapy when he turned five. No one outside the family seems to notice his autism. He’s treated as a normal developing boy. For me, however, Jason’s unremitting ability to move people with his charisma and powerful words is something else. It’s better than normal.
Read more from the special section on mental illness
Photo: Lance Neilson/Flickr
I actually want to take your opinion further Evan and add something people forget. Autism is just a processing system, a different way of thinking and learning. The examples the Author signals out from working with Jason is just like any human being who is afraid and ignored: The boy was merely expressing discontent and fear due to, as the author observed, repeated overcorrection. The problem is, we spend so much time looking at the behaviour and correcting it without digging in deeper. Because those “Behaviours” don’t come from out of nowhere. If there’s a serious issue going on, whether… Read more »
I wonder if you think the way in which we have medicized people’s behaviours and cognition has caused more harm than good? I.e. people who are viewed as being outside the norm aren’t just considered ‘weird’ or ‘strange,’ but now we think we can ‘cure’ or ‘fix’ them too. We treat it like it’s a defect or a flaw that can (and should) be corrected.
Goodness, I hope that made sense.
I can’t speak to the sum total of good outweighing the sum total of harm, but there certainly are cases where medication is warranted. I am not anti-medication, just where it is used inappropriately. I think the guiding principle is: does this improve the recipient’s quality of life? In the cases of genuine mental illness such as depression and schizophrenia it can absolutely be a powerful tool to help them cope. (Often along side other treatments such as therapy, meditation, exercise and such. Sometimes these other treatments by themselves may be a better solution without medication. Everyone is unique.) As… Read more »
By medicized I more meant…that we have classified our cognition as part of the medical profession…so we’ve patholagized it. That might be a better word. Yeah, I didn’t mean to suggest that medication can’t help with actual mental illness…I was just wondering whether you and Eagle thought that having autism classified as a medical condition is part of the problem. If we see it as medical, we can end up seeing it as a disorder or a disease…….instead of just viewing it as different society can end up viewing it as something to be treated.
I suspect our contexts are too different. I’m in Australia, not USA or UK, so “part of the medical profession” I think has different nuances. Autism is not something that can be cured as such, because it is a part of who they are. But early intervention and education makes it manageable and helps them feel less isolated. That is a form of treatment. It’s not a matter of trying to make them “normal”.
Hmm perhaps. Perhaps I’m also not being clear in what I’m saying.
I think this is a very interesting point. Many people with sociopathic tendencies are hired by corporations because they are less sympathetic to people and more capable of focusing on the bottom dollar.
Worth exploring further, I feel. Nice one.
Simon, I’m not sure where you make the leap from being autistic to having sociopathic tendencies, so am holding back the impulse to just decide you are an ignorant hick and tell you to piss off.
Autistic does not mean they don’t care about other people, are totally self-centred or have no conscience. An inability to communicate in a way you find acceptable does not mean those things.
So if you really feel this is “worth exploring further”, tread carefully, least you find yourself unfairly labelled as well.
Sorry, Evan. I see the issue and where the misunderstanding of my comment has come from.
That comment was meant to go under HeatherM’s first comment.
It should have also included a more information such as: “well Heather, an example of mental illness not being treated like a flaw, but rather an advantage is… sociopathic tendencies in a corporate context….”
Wrong placement, poor clarity. Sorry about that one, I just had a half-baked thought I wrote in haste.
Autism is not a mental illness and it is not appropriate to include it in a “special section on mental illness” which propagates this misconception. It is considered a developmental disorder. See here for more information: http://www.nimh.nih.gov/about/director/2009/autism-progress.shtml Not a mental illness, more like a different operating system. That being said, it certainly does seem to be in vogue, although that may be my perception given my involvement in a support group for families that have children with Autism Spectrum Disorders such as my family. Also bear in mind that knowledge and understanding of higher-functioning variants of ASD such as Asperger… Read more »
And came across this article today: Is autism getting more common, or does it just look that way? – http://jerobison.blogspot.com.au/2012/03/is-autism-getting-more-common-or-does.html
I’m tutoring a boy with aspergers who received similar treatment in high school. He is a fully functioning individual obviously capable of higher processes, but they insisted on keeping him in special education, not including him in regular classes, and he never took high school level English. If you talk to this boy, you will not think there is anything wrong with him, other than he is impatient. They judged his learning capabilities based on a standardized test–so basically, what he didn’t know–rather than if he would actually be able to learn what he did not know. And yes, he… Read more »
I’m sure if they had been over diagnosing stuff when I was growing up my sister would have been labeled ADD. Nope she was just wicked smart, and so she got bored in class. I agree that personalities are construed as pathologies because it would be easier for parents to deal with their children. I’m not saying that autism etc don’t exist, but people want an easy way out. Some kids are just harder.