"don't make me do this i don't like doing it. i don't want to." i was always upset, ying when didn't and it was just difficult to devything. is is amanda shs nose on aty dder severayears ago. she was extremely uncoortae being sepated from herother, and ov a perioof te, this generalized many situations. she never waed to go to school, a restaan a movie, a iend's house. r three ars, amanda has been under caredr. rachel kle. sepation anxiety cos abnoal when iinrferes with the kind of behavior exct from chd at age. not that it shouldn't occur, but it occurs to a degree that impairs the child's ll-being.

yoknow--everything.ious about everything she did. again,outart reazing en you look ck on the things at she useto do, and you realize eren't such normal things. if we went into restaura and was downstair e didn't want to go in. and i never kn w beuse she felt closed in anit made her rvous. ing on vacation, even though we together, waho becausshe was away from home we went disneyworld. disneyworld was a nightmare for her. e s afraid of eveing. she was afraid othe fey and e tram she was afraid of everythi. are not always consistent of samong children, making a diagnis can be difficult. some childreexperience the feelings of anxiety, but never show it or act on it. other children beha very differtly. e child with separation anxiety can have only--

let's say, worries, and not show any evidence of it in his behavior. so a child could have a great deal of concern about the welfare of his parents--where they are-- go to school, do everything he or she is supposed to do, but be miserable in the process, or uncomfortable. there are degrees from mild discomfort to very severe discomfort. on the other hand, there are chdren with separation anxiety who become dysfunctional and who then refuse to experience the kind of separation that we take for granted in children of their age, such as going out to play, sleeping over at children's houses, letting the parents go out for thevening, staying with relatives, even going on trips where you go away from home. how did stop you from doing things that you wa to do-- those elgs that you described?

they were so strong that i couldt do anything. i'd st brk do and c. i codn't go. so what did you do? i would say, om, please dot let me go." most of the time, she'd make me do it. ma psychologists lieve that separation anxiety has adaptivealue in the evolutionary process-- that in factt helps to ensure survival of the species. when the infant is helpless anneeds parental care, thats awarenesossps to ensure survcauses anxietyecies. that lds to crying, which brings the parent to help. but what explains the intense fears a sepation anety disorder? childr who have experienced unpredictable, unavailable, or rejecting parent have been observed to be prone to more intense separation aiety. in addition, parents who become anxious when they ave the child

may inadvertently teach the child to modheir own aie. learning theory would explain the development of separanxiy by sgesting that it's reinforced bits aftermath. a mother htens bac the child that has had separation anxiety, and the child learns anxiety is a useful tool in getting what it wants. experts also generally agree that some children are temperamentally different om bir and more prone to anxiety. sometimethese tempamental differences can ad parents to react negativel is can then increase the separation anxiety. but parental behavior is n the only explation. a long illness, traua death in the family, even an extended parental vacation-- may separate the chi from a loved one and exacerbate normalhildhood fears. some psychodynamic theorts see chdren's unconscio anger tir paren at the hea of sepationnxiety disorde

the angry wishes n become so innse, the children fear the pant will actually die or go aw. others, such as those of the obje-rations school, vi separation anxiet others, as arisingose of the fromhe child's fear, that it caot lieve itowpain-- that saration will literally cause annihitionf the self. whatever causes sepation anxiety disorder, arequir attentn treatment. treatment paon anxiety dier can involve traditional play therapy, fami therapy-- in which the whole family system is investigated-- plus traditional exposureherapy, which involves a supervised, step-by-step process of encouragi the cld conont the situatio that catanxiety this was an important part of dr. klein's therapy with amanda. that essentially helps e child le th in a situation of separation, hs ok.

beus happens tse children is that they're afra to be away from theipant then they develop the fear when they're not separated that once separated, something terrible will happen. so the aual experience of being whoutheir parents isctive in many cases, but just talking about how bad you fe, iny expece, is not. pants aren't try to keep the children with them. what seems to be more typic pantishey can'ty to keep ing themselvesith them. to in onheirhild, sohen the child doesn't want to separate, they can't say, "tough that's how it wille." they ple. th reason. they...they lose it. but i have yet see a mother who was resentl of her child's progress. if she were hanginon to the child, she should really be resentful of the ft that the child is cured, and i've never seen a th be destroyed by that.

you sleep at other kids' houses? all the me. ist fun? yes. ok. i wot ask you whaton. yes.t k. ha ha ! is is wesley. he hasism, a pfod developmental disorder what's tt word? decide. does that fit? read it. rl ianother chil with am, alough heronditi ucss severe. "...what i wan " tis a perplexing disorder, t juor pe with autm anthmilies, t for psychogists d researchers, as well. typically, aism ines three differt sytoms. the first is aack of responsiveness to other people. for example, this young boy is seemingly unconcerned that his father has left the room. a normal response in a child his age

ikelto be this-- fierce crying til thparent returns. the mpairedsymptom mmunication skil, bobanonverba [a! aah!] many chin with autism, likeesley, ke appently meaningls sods. [a! aah!] manyththirsympm is that chdren with ausm respond to a limit number of sti. some may sit and stare fohours, rocking back a forth endlessly. some prefer a rigid sameness in their activities and dospd well chaes in thr ves. it is the hallmark of autm at allhese types of symptompear verearly, often within the first 3o months, and theyay range mostxperts agreeer that what's common to all people with autism is that the disorder is organic. anne donnean has written about and rearched autism extensively.

autism is a tremendous deficit, a profound deficit in t-way social interaction and communication. there probably isn't anything more pround as a deficit because most of us come neurologically hot-wired as infants to learn about social information through our parents or person in thearenting role. and that early interaction, that tuning, that wonderful dance that goes on between the parent and the child, teaches the child essentlly everything they need to know about being socially competent in a particular culture. somehow these kids seem unable to do that, and you end uph mebody who's ki of two-dimensional, doesn't have the depth and e richness which makes for being a socialuman bei. out of that, you not only have somebody with language problems, social problems, and lots of things that come along with it,

but you have somebody who doesn't understand the effect of their behavior, doesn't understand what communication means-- even if they have words, don't always understand how those words affect other people, and a lot more than that. one problem in recognizing autism in a child ist early life, the symptomsan be extremely sule, yet he traye, they are present. dr. donnellan videotaped two young boys. one, callu wasuspeed of having the dier the other, ryan, is a ild with more normal behavior. because ds with autism look so go in infancy, they very seldom get diagnosed early. we tried to demonstrate some of the things that we see in the older kids, even on into adulthood, that seemed inadequate or impaid in some way. we're comparing him in these films a normal child who's just slightly younger

who's not yet talking. it's pretty dramatic. you can see it. he looks pretty good some of the scenes. for ample, when you see him with the shaving cream, he's not ignoring it. 's that single stimulus kind of thing. when he pays attention to that shaving cream, that's all he pays tentioto. the fact that s parents or somebody else is there-- he's jusoblivious tohat. he looks pretty good, however, until you see the other child, ryan, who gets the shaving cream, is also delighted with i buimmediately turns to show mom. he gs to be st othe show, which is his major function at that age. what is devastatingly clear to me, comparing ryan to callum, is that ryan, in an hour's worth of film, has a word or two but essentially isn't talking yet,

has all the communication he needs. he's doing fine. so when the language, the communication drops in, it's like computer-programmed perfectly for it. whereas callum, in the same situations, while he attends and he cperates and he does very wel he doesn't know how things happen. it's rooted in just one experience at a time, seemingly. then in the scene where he-- his parents leave. in both cases, the parents leave the room. callum is clearly concerned. he goes from where he is to the person filming. he sees trousers. i think he thinks it's his dad. he loo for them, but thers no change in his expression, essentially. whereas in ryan, in 1o seconds, it goes from "oh, no, they're not really leaving me" to "my god, they're gone and he's crying. sooas they come back in, he's comforted. it's all there in those tapes.

you casee the essence of autism. the inability to understand means and ends, causality, how to make thing happen and happen again, all that kind of investigatory behaviors, and most importantly, of course, the use of other people make the wholthing work for them, the depth and richness-- it's real painful to watch. nce tism was first described, several theories re put forth toxpin t disorder. r 15, 2o years, tycay, ople blamethpants in oneayr anot focausine ausm, which caused tremendous tredy. ward enough t toe blamild withnot ow why...s and it was an awful circle that was most unfortunate because there were no data to suprt that. anybody who's knowledgeable in the field believes it's an organic cause.

codn't be arou theskids and not know. that breakdown was not because of the parents' inadequacies, but because of the child's inadequacy. he didn't brinhis part to the dance. like many chilen with autism, carley is able to live very functional life at home. the first hurdle was her parents' accepnce. we really focus on what she can do more than what she can't en she was first agnosed, i feel like i went through all the steps of grieving that i did when mfather died. i was really angry-- why was this happening to me? why her? tt was the big thing--w her? and the denial. just, "how can this be happening? how can i have a child who has a disability?" and then gradually accepting it. she looks at the wld a little different than we do. sometimes think her thght processes are different.

there's nothing i can shou, but when y talk to her, it's like you can see the wheels grinding sometimes. the procesis a little different than rs. [kathleen] there are many things she can do. it doe't ally bher me thathe might act differently than some children soum...i think i-- we've always lov her the way she is. we d't love her in spite of her tism but because she is the way she is. i know that if there were a cure found tomorrow, we'dertainly have it given to her, but our lives aren't in despair because of her situation. we think wvet prd. trtmfoausm mutcd toeverity of the behavio carley is rtunat becae her au is me ough to allow her to be mainstreamed into a school district.

nancy negri is the district coordator shwould fa io the range ofeople thatll morable individuals with autism. i think her autism is fairly clasc. it looksyou know toe that way her clrest probls are with speh and language, but she doest have severe kinds of acting-out behaviors that other kids have. she halanguage. she can use language to communicate. it's not easy for her, but it's there, which is not true for all kids with autism. we know those kinds of students can continue to progress and to learn academically. i'veorked with and supported students whhave gon to junior llege. they sti need support that level. ey need some help, escially with sociallls, ansometimes some adaptations fothe adems wh it's a lecture form, t they certainly have that potential.

know people who hph.d.s and alsoe autism. carley. is it nine? ist nine? how many people think carley's right? yeah. if carley's autism would be considered mild to moderate, wesley is in the modate to severe category. because of his inabili to communicate in any meaningful way, wesley w assumed to be retarded, t adnces in the underanding of autism now raise some questions. are these people lacking in intelligence? arthey simply unable to communicate in ways that are understandable? or is it both? this is a magic moment inome ways because if you had asked that a year ago, i would have said that the literature and experience tells us that most people with autism, certainly 75%, have the additional problem of mental retardation. i'not saying that isn't true.

i'm saying we don't know what that meananymore cause many of the young people with autism who have been given a visual-- a written-word means to communicate demonstrate that they have fairly good symbolic ability. they're ch more e of what's going on than they er gave any indication of from their affective, observable behavior, and they can use the written word to communicate, when nobody ever taught theto read. thmethod of communicating is a small electronic keyboa that can display typed messages, a device often u by peopl who have lost their ability to speak. inhis videotaped session, ey was able, ov aioof t to communi his tughts to the outsiorld. when aed whe wldike ople wching to know, he ted this... the biologcourse he mentis is a high-school-level program in which he excels. the remarkableact about this ishat wesley

wanefoally taught to read or write. somew, he was able to l on his own. no one knew he could read even one word. now we have somebody who is typing clear, coherent messages to his mother and other people. we don't know what that means. and so far, every young person with autism with whom it has been tried that i know of was able to do something, things we didn't en know they could do. everybody's sort of ying, "what is this phenomen?" i don't believe that it's the magic key. it is a communication device, but they still need to learn all the other things th need to learn, just like rley, who has reasonably good language still needs to learn the rest. only a small number of children with autism have had an opportunity to use the communicator.

muchnew insighnown asr.e g masmanuggests, as a rult of brethroughs like wesley and others like hi using the communicator or from children like carley, who intain a high degree of indende ling when givenildren the proper sucture. i've never seen a person with autism or any developmental disability, given the reasonable supports, who couldn't be maintained in the community. even the most physically fragile kids, kids who are on total life supports, can be maintained in the community. autism--it'sar simpler. we know what people need. if the supportare there, they can have jobs, they have relationips. they're going to need all kinds of help, from just those people who need somebody watching over their shoulder when they're signing contracts to those who need a lot of help managing everyday life. but given the right supports, every person with autism can live, work, and recreate

as a functioning person in their community. it's cheaper. it's better. it's more humane. on a very personal level, i figure that one day i' become disabled, if i live long enough. i'd like a society that treats people better than we have historically treated people with autism. have concentrat in this prram on those children who show dysfctional behavior. it's important to remember, however, that not all sh havior is symptomatic of deep abnormal problems. that not all sh havior s. symptomatic ainly the nos, but i thin it's importanto thathildren deate from them, and when children deviate from the norm, that doe'tecessarily mean pyschhology, doesn't necessarilmean underlying etial disorder. it could simply mean developmental la it could mean the chilsimply isn't ready to talk

and that with proper nurturance, wi prope reforcemen patience on the part of the pents, ange agent this child is very lely develop to a great child very likely to develop into a very normal, apopriately functiong individual. captioningerformed by the national captioning instite, inc captions copyright 1991 aln h. perlmutter

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