The Near-Normal Autistic Adolescent (1)
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The Near-Normal Autistic Adolescent (1)

What are the characteristics and problems of a mildly autistic child in the difficult years between puberty and adulthood? A correspondence panel of parents and professionals from the British and American National Society for Autistic Children(2) attempted to bring together some observations on this topic. Parents drew on first-hand experience at home and in their work for NSAC. The professionals considered pupils or patients whose mildness of handicap seemed to call for special management or education techniques.

Altogether, approximately 50 children were compared. The majority of these were boys, of whom 11 are now adults, but none was well known to panel members. Information on a larger sample of near-normal autistic adolescents of both sexes in a full age range could alter the conclusions that the panel reached. 

The near-normal autistic person has some adaptational advantages over his severely autistic counterpart in terms of potential for education and employment. Yet it is a mistake to assume that he therefore has few problems. His autistic handicap threatens the successful outcome of every undertaking which involves people. It is a controlling factor in his life regardless of how well he adjusts to his limitations or compensates for his disabilities.

The following report is a summary of characteristics described by the panel for the near-normal autistic adolescent. It includes the areas of language, human relationships, awareness of disorder, and special talents, as well as some management problems observed in each of these areas.
 
Language
Nonreciprocal Speech

Although some autistic children do not talk at all, mildly autistic children are often handicapped by a tendency to talk too much when they are exceedingly interested in a topic. It does not occur to them that listeners may not share their enthusiasm. So they talk on, concentrating on what they are trying to say, without any reaction to signs of boredom. Such a monologue is not easily interrupted or changed in its course by the comments of others: therefore, the to-and-fro of normal conversation is missing. At best, the autistic person is a poor listener, and sometimes he seems to be completely unaware of the fact that somebody is trying to talk to him. If a listening handicap is basic to autism, and it may well be, then the autistic person is no more helped by scolding, “Listen, will you!” than a blind person is helped by the shout, “Look out!” Such warnings alert them to error but do not offer guidance.

Parents often report that the mildly autistic child needs several moments to process any remarks he hears. It may be wise to teach him to explain this when he cannot understand somebody at a normal rate of speaking.
 
(1)  Mrs. Margaret Everard, Coordinator, Mrs. Judy Ackers, Dr. Hazel Baker, Mrs. Margaret Dewey, Mrs. Sybil Elgar, Dr. Elizabeth Newson.
 
Even if full comprehension is impossible at social gatherings, he can often get away with practicing the art of listening while others talk. But he has to learn that in some situations, such as on a job, it is necessary for him to speak up when he fails to understand and ask for written instructions.

In school, he may get along by memorizing lessons in advance, but this technique applied socially makes him a bore because he tries to steer the conversation to the topics he has anticipated.

With training in using whatever listening skills he can acquire, the autistic person may eventually improve his ability to converse, but he will always be uncertain whether he has said too little, enough, or too much for the needs of a certain situation. Such awareness comes from being able to interpret responses of others as one is speaking. This is most difficult for the autistic person, who can heed only one thing at a time and tends to be lost in his own thoughts.
 
Literalness
Literalness in an autistic person goes far beyond the literalness that is associated with young children or retarded individuals. It results from the underlying communication disorder, which makes him unable to understand the shifting meaning of words in changing situations. In addition, he tends to persevere in his first impression rather than discarding it to test other meanings.

For example, one young adult who is a musician called his parents to find out what would be suitable to clean the keys of his piano. His mother suggested he use a moist rag with plain Ivory soap. Some time later, he called back to say that he had searched a catalogue of piano supplies without locating this special soap for ivory. No ordinary person raised in the atmosphere of American advertising would so long have overlooked the brand name of a common household soap.

Some literalness is based on a phrase or sentence rather than a word of several possible meanings. This was the case when an autistic young man at the 1970 conference for the National Society for Autistic Children in San Francisco would answer such questions as “Do you have a hobby” with a simple “Yes.” No more, unless another question followed. A different question might bring out a longer answer than was wanted. For example, somebody asked an autistic teenager how he learned to type. Instead of just indicating the source of his instruction, he said, “For the first lesson I practiced the letters f and j.” No doubt, he would have covered the entire keyboard if he had not been stopped after he had described several lessons in detail.

Since it is impossible to teach an autistic child every innuendo of speech as well as nonverbal cues and multiple meanings, he may eventually compensate in such ways as the following: 
  • By becoming precise in language, seeking words which have a definite concrete meaning.
  • By concentrating on subjects in which he can be exceedingly well informed.
  • By reading extensively for information rather than pleasure, preferring fact to fiction.
  • By developing any nonverbal talents he may have to the point where they can earn him the social approval he craves.
Not every autistic child compensates in the same way, but these were typical responses of the children considered by the panel.

As a result of his literalness, the autistic person is an easy victim of those who like to make fun at his expense. If he reacts with anger to trickery, his problem is compounded. Even if he is philosophical about being teased, literalness is a decided handicap in school and on the job because most people communicate with a kind of shorthand speech, which is not to be taken literally.
 
Irrelevant Speech
Irrelevant speech is, by itself, harmless or even amusing. It is significant, however, as a symptom of inattention and inability to recognize the flow of ideas. For example, an autistic boy who seldom spoke at the dinner table would sometimes perk up when he heard a familiar name and comment on that person’s voice. Thus, whether an individual had been mentioned for winning a science prize or crashing his motorcycle, this boy would be apt to make such a comment as “I remember he had a high soprano voice until eighth grade when it changed to tenor.” If an autistic child can be trained to “tune in” with the aim of making his contributions to conversation more relevant, he will have improved his ability to get along in so many situations. 

There is no quick and easy way to teach an autistic child what is relevant. If he comes from a large and expressive family, he may be made aware of his problem with irrelevancy before he has learned how to correct it. One mildly autistic boy prefaced his remarks with “By the way” to protect himself from the groans, which sometimes met his comments otherwise. Reproaches may do harm by making the autistic person anxious so that he becomes even less able to pay attention to what others are saying. By commenting favorably on relevant remarks, the parents and siblings of an autistic individual can build his confidence in his ability to listen with understanding.
 
Relationships
Love and Friendship

The autistic individual can become deeply attached to another person, but he is not likely to form the kind of emotional relationships, which result in being well tuned to the thoughts and feelings of others. Just as he is better able to talk to people than to converse with them, he can more readily express affection by being loyal than by responding appropriately to another person’s feelings.

Friends of his own age are rarely attracted to the young autistic child because of his behavioral immaturity. He must be met more than halfway, and it is a rare playmate who knows how to respond to this need or cares to repeat this experience often.

As the autistic person grows up, he may find some true friends among people who share his interests, although his interaction with them will usually be limited to the hobby or work they have in common.

When an autistic child speaks of having friends, he is usually referring to friendly people of any age who know him well enough to greet him by name. He is apt to return this friendship by remembering not only their names, but also such data as their telephone numbers and birthdays. Lacking the ability to judge the depth or sincerity of friendship, he may sometimes be the victim of unscrupulous people who wish to take advantage of him. This may be particularly unfortunate in the case of a physically mature girl.

The autistic person does not easily grasp hints that his friends have had enough of his company, and therefore he is often puzzled and hurt because people seem to have lost interest in him. Not all autistic people are “loners.” Some just seem so because of their painful uncertainty of how to interact with others. For those who are basically sociable, recreation groups offer a chance for shared pleasure. Planned activities and supervised trips are a welcome relief to an autistic person who is fearful of doing the wrong thing in the company of others.
 
Social Awareness
One of the charming qualities of an autistic person is his unawareness of social class and status in other people, although he may have been taught his own position in society and have a fixed idea of his proper goal. When he speaks of “Fred Martin,” he can mean a janitor, poet, or mayor. The clues of age, race, income, occupation and education are not immediately noticed by him as he concentrates on his tremendous efforts to please or impress them. Generally, he likes them according to whether they have been kind to him and favorably impressed by him.

Because he cannot easily alter his manner of speaking to resemble that of his listener, the autistic person will seem less peculiar when he is among people of background similar to his. If he has a talent, he will naturally be most appreciated by those whose education permits them to recognize it. But perhaps he will find more genuine acceptance among those who live at the fringe of social acceptance themselves.

Since the autistic person is not bothered by class distinctions, his family can accept this as a blessing which widens his chances of finding a place in society, although the experience may be a humbling one for them.
 
Sexual Relationships
Autistic people tend to be naïve, immature, and inexperienced in matters concerned with sex. Problems of sexual delinquency are not as great as might be expected from individuals who have such a poor social adjustment. Probably this is because the handicap of autism sets up a barrier at the first stage of intimacy, the sending and receiving of subtle messages which stimulate interest.

The absence of overt problems does not mean that all autistic people are happy with their sexual adjustment, although most seem to be comfortably celibate. For a portion of their youth, autistic adolescents are upset because their approaches to the opposite sex are rejected. Unfortunately, it is not easy to explain how to initiate friendships, which can lead to socially acceptable sexual relationships.

What is desirable in one situation can alarm people in a slightly different setting. In time, the autistic person learns by unfortunate experience that it is safer not to yield to his impulses to follow, touch or speak to a person he finds attractive. When even tentative expressions of yearning cause trouble, it is no wonder that most autistic people eventually decide that sexual fulfillment is not for them.
 
Marriage
The possibility of marriage for an autistic person is a matter for speculation. Kanner (1969) has indicated that one of his original autistic patients eventually married, but nothing has been reported about the success or duration of that union. Marriage partnerships are formed for many reasons, including convenience as well as love. The autistic person’s lack of empathy and his inflexibility make him an unlikely choice in any event, but it is possible that certain autistic individuals will have redeeming qualities in the eyes of very special people who desire to look after them for a lifetime. Among such qualities could be an attractive appearance, an admirable talent, or almost saintly guilelessness.
 
Family Relationships
The experiences of parents of autistic children have been well documented elsewhere (Eberhardy, 1967; Schopler, 1971). They may feel guilty, angry, or deeply sad. It is a fortunate autistic child whose parents are not too crushed by frustration and disappointment to develop self-reliance in guiding him to better behavior. As long as parents can have hope that they are dealing with temporary developmental problems, they are willing to accept some disruption. They may seek professional help in assessing the child’s potential so that they are neither overprotective nor pushing him beyond his capacity. Yet, at times, parents have been better judges of a child’s potential than the advisors who saw him only in brief conferences. In the past, many near-normal autistic individuals grew to adulthood without any label, guided only by the intuition of their families.
 
Siblings
The autistic child is a potential source of embarrassment to his brothers and sister. This is especially true when siblings reach an age when they desire to be conformists. If nobody has explained autism as a genuine handicap rather than mischief and stubbornness, they may become antagonistic, resenting the attention the autistic child requires, as well as his stigmatizing behavior. On the other hand, some siblings have proven to be invaluable therapists because they are well informed or instinctively sympathetic. By interacting patiently with the child, they help him to get along with his own generation.

This positive attitude is more likely to occur when the autistic child is younger than his siblings or of the other sex. Parents can increase the chance of acceptance in the following ways: 
  • Give other children their fair share of attention
  • Explain the disability of autism (Whether so labeled or not)
  • Suggest ways that brothers and sisters can bring out better behavior and reward it.
  • Express appreciation for the help of the siblings, and always remember to be sympathetic with their problems, also.
Awareness of Disorder
The decision about whether or not to tell a child that he is autistic will vary from one family to another. In some cases, the child will be happier to have an explanation for his problems. Many parents, themselves relieved to learn about autism, want to spare their child the agonies of uncertainty. Others feel that autism is a term which prejudices people more than a mild case warrants. Whatever their decision in this regard, parents should at least explain the symptoms of mild autism in such a sympathetic way that their growing child will not feel tortured with guild at his puzzling inadequacy. As in sex education, too much can be told too soon, resulting in morbid preoccupation. This is no excuse for totally avoiding the issue when an adolescent wants answers to his questions and, indeed, needs some knowledge of his problem in order to learn to help himself.
  
Values and Problems of Talent
What about the autistic child who shows outstanding talent in one particular area? Few people would say that he should not be encouraged to develop his gift for the pleasure it gives him as well as the possibility of contributing to society. Yet, to the uninformed, it may appear that the eccentricities of a talented autistic person are the result of his parents’ attempt to create a genius. This is the interpretation which parents must be prepared to hear if they stress talent from an early age. Few people will believe them when they protest, “We just helped him do what he insisted on doing.”

No doubt, hours of daily concentration on numbers, scientific charts, or music will divert the child’s attention from social learning but there is no assurance that if he is denied the chance to develop his talent he will fill those same hours with social experiences. In fact, it is likely that the degree of acceptance he wins with his talent will increase his social contacts. The responsibility of parents is to see that the child does not feel he is so talented that he is entitled to special treatment in all matters.

It should be possible to teach acceptable social behavior without neglecting talent. An autistic child must learn to accept criticism, practice modesty, and not feel slighted when others wish a little attention. In addition, he should grow up with a realistic attitude toward his talent, so that if he is unable to make a living by it he will be able to adjust to a more humble occupation without feeling that fate has insulted him.
 
In summary:
 
Against stressing talent:
  • The child whose confidence in his ability is build up excessively may have a breakdown if his intended goal is not reached.
  • The child whose talent is stressed from an early age may rely on it for approval and feel no need to modify other behavior.
  • Parents of a child whose talents are highly stressed may be considered abnormal.
In favor of encouraging talent:
  • The autistic child’s talent may be the most helpful single tool for leading him to a more active life.
  • A child who knows he is talented because of the attention he has received may resent lack of appreciation within the family and abruptly remove himself from his parents while he still needs their guidance.
  • A child whose talents are played down by frequent reminders of his social immaturity may lose all confidence in himself.
 In short, this is a matter of sensitivity, balance, and re-evaluation at each stage of a child’s development.  

Implications
Assuming that the panel’s observations are found to be supported by those of others, near-normal autistic children would benefit in the following areas from recognition of their condition as a separate category of autism: 
  • Research directed at the basis of disabilities which persist in the near-normal.
  • Studies of teaching methods about the nature of mild autism to the general public, including law officers and doctors.
  • Realistic vocational guidance and placement, with employer incentives during the apprenticeship period.
  • Opportunities for sheltered employment and supervised living.
  • Dissemination of management recommendations to agencies that serve individuals in time of crisis.
By Margaret A. Dewey
Chairperson, Adult Programs
National Society for Autistic Children
(American)
Ann Arbor, Michigan
 
And
 
Margaret P. Everard
Editor, COMMUNICATION
National Society for Autistic Chilren
(British)
Whiewell, England
 
This article was published in the Parents Speak Column of the Journal of Autism and Childhood Schizophrenia, December 1974, Vol. 4, No. 4, and is reprinted by permission of the publisher, Plenum Press, New York, for distribution by the Information and Referral Service of the National Society for Autistic Children (American) 306- 31st Street, Huntington, W. VA., 25702. Tel: 304-697-2638

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