is to work with bo the child anthe parents, combining individual counseling, mily therapy, and parent training to t and develop a more stableamy structure. mike used to be in control when things went bad. now i'm back in control. i'm the mom. it useto be i wod cry, and he wouldn't. now he ces. i n't. i am icontrol. if it wasn't for the pot system, i wouldn't know how to be mother. the way we talk out kids and parents, going from the pt we ato the kid.le arrows the pant does something, and that changes the kids. inact, our longitinaltudies e ing tharrows argointh ways, which mplyeans that the is also impacting the parent. so if you' got a boy 9, 1o, 11 ars of

that you've let get some out of control-- they push you very hard, so thayou become more and morphysic, more and more negative, more and more authoritarian. you really look terrible. anit's not that you started that way, but this stuff going back and forth or a time-- you come out looking like a real heavy over re. you are. you're hitting the kid. you're tryinto pin him down on the flr keep him om going out sometes. also oks bad, but you put eather there over a lg peod of time. so wt patty d maon are doing in these groups is training pares- u're both up here. you're reallangry. u're frid ofach other. hodo youet idown he wherit is rmly? we fig a little t.

it takes time to do that--mont. it's not a weeke therapy. untreated, conduct disorder can have iact nojustn d s fami, studs dicathat b 5o%o% onhe ofuvilcrime is committ byng people with conduct disorde his prior school history indicates th tre is a ior sty tru anthate was a naproblem. kids w susly ndt sorder, you n't get out tt pattern. ny longitudinal studies show the prognosisor them in adulthood is pretty grim. theye incarcerated more often. they have reraffic accints, divorce. they don't hold down jobs. alof their relatnships are unstable. theynd up in mental stitutions. about ery bad outcome thatou can think about, these people have. tesix months of living with his fosr faly

bo bveas aedetur mr. teyre people have. for hang uer xpienc 's n a repyour behr'. a little behind on mewo r beg ck yeah. buife do it, we're ok, i think. we're able tmmunicat whlotter d get along bett-- beblto talitut, rk it t without scamin and him going to rob a hou because sustr. e dends lot what i. and shn't, li, get all uptight d say, "that's not true," "lie," ju stuff like that. i mean, sic, typical mom. there arseral emotional sorders of cldho. one of the most common is separatanxiety disorder.

it's normal for childr to experience the pangs of separation from a lov o, but a child's inability eventually overcome thosfeelings is nonormal and is csidered an etial disorder. about 3% of chilen are likely to have separation anxiety disorder at some point in their lives. with sepation anxiety, we're talking about a child who almost every minute of every day has extreme anxiety, extreme fear, thoughts of being separad from mom, thghts of loved ones being jured or hurt. d this is not an isolated incident. these children, if theseymptoms peist for a twweek period of time, are ry likely to be laled or diagnosed as sepatioanxiy. the elings are ha to explain because they were just kind of like bterflies thugh ur who body inour stac

justel, "i don't wto dth. "don't make me do this i don't like doing it. i n't want to." i was always upset, ng when didn't and it was just diffict to devng. is is aman s nose on aty dder severayears ag she was extremely uncoortae being sepated from herother, and ov a perof te, this generalized many situations. she never waed to go to school, a resta a moe, a iend's house. r three ars, amanda has been under e caredr. rachelle. sepation anxty comes abnoal when iinrferes with the kind of behavior exct fm chd that 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. agn,outart reazing en you look ck onhehings at she useto do, and you realize weren't such normal things. if we went into restaura and was downstair e didn't want to go in. and i never kn why beuse she felt closed in anit made her rvous. ing on vacation, even though we we together, beushoshe felt closed in becausshe was away from home we went disneyworld. disneyworld wasclosed in becaa nightmare for her.home she s afid of evein she was afraid othe fey and e tram she was afraid oeverythi. e thsymptoms of separation y arnot always consistent among children, making a diagnis can beifficult. 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 onl- 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 everying he or she is supposed to do, but be miserable in the process, or uncomfortable. there are degrees from mild discomfort very severe discomfort. on the other hand, there are chdren with separation anxiety who become dysfunctional and who en 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 elings that you described? they were so strong that i couldt do anything. i'st brk do and cry. 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-- thatn factt helps to ensure survival of the spies. when the infant is helpless anneeds parental care, thats awarenesoss to ensure survcaes anxietyspies. that lds to cryi, which ings the parent to help. but what explains the intee fears a sepation any 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

whenhey ave the child may inadvertently teach e child to modheir own aie. learning theory would explain the development of separn anxiety by suggesting that it's reinforcedits aftermath. a mother htens bac the child that has had separation aiety, 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 n ad parents to react negativel this can then increase the separation anxiety. but parental behavior is not the onlexplation. a long illness, traua death in the family, even an extended pare vacion-- may serate the chi from a loved one and exacerbate normalhildhood fears. some psychodynamic theorists see chdren's uncscio ger at tir parents

at the hea of sepationnxiety disorde the any wishes n become so intense, the children fear the pant will actually die or go aw. others, such as those of the obje-relations school, vi separation anxiet others, arisingthose of the from child'searschool, that it caot lieve itowpain-- that saration will literal cause annihitionf the self. whatever causes sepation anxiety disorder, arequir attentn treatment. treatment paon anxiety dier can involve traditional play thepy, fami therapy-- in which the whole family system is investigated-- plus traditional exposureherapy, which involves a supervised, st-by-step process of encouragi the cld conont the situations that catanxiety this was an important part of dr. klein's trapy with amanda. that essentially helps e child le

th in a situation of separation, hs ok. becauswh happens tse children is that they're afraid toe away from theint then they develop the fear when they're not separated that once separated, someinterrible will happen. so the aual experience of being without their parents isctive in many cases, but ju talking about how bad you fe, iny expeence, is not. pants aren't try to keep the children wh them. what seems to be more typ pantishey can'ty to keep ing themselvesh them. to i pai 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 slee at other kids' houses? all the me. ist fun? yes. ok. i wot ask you whaton. yes.t ask. ha ha ! is is wesley. he hasism, a pfod developmental disorder what's tt word? dede. does that fit? read it. rl ianother chil with am, alough her condi ucss severe. "...what i wan tis a perplexing disorde t juor pe with autm and theimilies, but for psychogist d researchers, as well. typically, aism ines three differt sytoms. the first is a lack of responsiveness to other people. r example, this young boy is seemingly unconcerned that his father has left the room.

a normal respoe in a child his a ikely to be this-- fierce cryg til thparent returns. the mpairedsymptom unicion skil, boerbaannonverba [a! aah!] manyththirsympm is that, mchdren with ausm respond to a limit number of sti. some may sit and stare for hours, rocking back a forth endlessly. some prefer a rigid sameness in their activities and dospd well chaesn thr ves. it is the hallma of autm at allhese types of symptompear verearly, ofwithin the first 3o months, d theyay range from mild to sever mostxperts agree that what's common to all people with autism is that the disorder is organic. anne donnellan has written about

and researched autism extensively. autism is a tremendous deficit, a profound deficit in t-way social interaction and communication. there probly 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 pson in thearenting role. and that early interaction, that tuning, that wonderful dance that goes on between the parent and the child, teaches the child esselly everything they need to know about being socially competent in a particular culture. somehow these kids seem unable to do that, and you end upith mebo who's ki of two-dimensional, doesn't have the depth and e richness which kes for being a socialuman bei. out of that, you not only have somebody with lanage 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 the words affect other people, and a lot more than that. one problem in recognizing autism in a child ha early life, the symptomsan be extremely sule yet he tra, they are present. dr. donnellan videotaped two young boys. one, callu was suspeed of havg 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 triedo demonstrate some of ththings that we see in the older kids, even on into adulthood, that seemed inadequate or impaid in some y. we're comparing him in these films

to a normal child who's just slightly younger who's not yelking. it's prettdramatic. you can see it. he looks pretty good some of the scenes. for example, when you see him with the shaving cream, he's not ignoring it. it's that single stimulus kind of thing. when he pays attention to that shaving cream, that's all he pays tention to. thfact that s parents or somebody else is there-- 's jusoblivious tohat. he looks pretty good, however, until you see the other child, ryan, who gets the shaving cream, is also delighd with i buimmediately turns to show mom. he gs to be st othe show, which is his major functio at that age. what is devastatingly clear to me, comparing ryan to caum, is that ryan, in an hour's worth of fi, has a word or two

t essentially n'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 d 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 ro. 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 there's no change in his expression, essentially. whereas in ryan, in 1o seconds, it goes fromoh, no, they're not really leaving me" to "my g, they're gone and he's crying. sooas they co back in, he's comforted.

it's all there in those tapes. you can see the essence of autism. the inability to understand means and ends, causality, how to make thing happen and happen again, all that kind of investigary 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 disde r 15, 2o yea, tycay, ople blamethpants in oneayr anot focausine ausm, which caused tremendous tredy. t toe blamedild witht ow why...s and itas an awful circle th was most unfortunate because there were no data to suprt that.

anybbelievess knowit's an organic cae.ld codn't be arou theskidsnd not know. that breakdown was not becse 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 fctional fe 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 whenfather died. i was really angry-- why was this happeni to me? why her? twas the big thing--w her? and the denial. just, "howan 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 procses are different. there's nothing i can shou, but when y talk to her, it's likyou 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 that she might act differently th some children soum...i think i-- we'valways lov her the way she is. we don'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 whavet prd. trtmfoausm tc toeverity of the bavio carley is rtunat becae her au is mough to allow her

to be mainstreamed into a school district. nancy negri is the district coordator forley'srogr. shwould fa io the rae ofeople thatll morable individuals with autism. i think her autism is fairly clc. it looks, you know toe that way her clrest probls are th speh and language, but she doest have seve kinds of aing-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 they still need support that level. ey need some hel escially with sociallls, ansometimes some adaptatio fothe adems wh it's a lecturform,

but they certainly havehatential. we know people whoph.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 moderate to severe tegory. becausof his inabili to communicate in any meaningful way, wesley w assumed to be retarded, t adnces in the underanding of autism now raissome 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 lirature and expeence tells us thatost 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 much more e of what's going on than they er gave any indication of from their affective, observable behavior, and they canse the written word to communicate, when nobody ever taught them to read. thmethod of communicating is a small electronic keyboa that can display typed meages, a device often u by peopl who have lost their ability speak. inhis videotap session, ey was able, ov aioof t to communi hisughts to the outsiorld. when aed whe wldike le wching to know, he ted this... the biologcourse mentis is a high-school-level program in which he excels.

e markable fact about th hat wesley was nefoally taugh to read or write. sow, he was ab to lrn on his own. no one knew he could read even one word. now we have somebody who is typing clear, herent messages to his mother and other people. we don't know what that means. and so far, every young person with autism th 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 carley, who has reasonably good language still needs to learn the rest. only a small number of children with aism have had an opportunity to use the communicato

muchnew inns unknown asraarg mamlanuggests, as a rult of brethroughs muchlike wesleyknown and others likhigests, usinthe communator or from children like carley, who intain a high degree of i 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 total life supports, can be maintained in the community. autism--it'sar simpler. we know what people need. if the supports are 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'll become disabled, if i live longnough. i'd like a society that treats people better than we have historically treated people with autism. have coentrat 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 nes.ymptomatic ceainly the e nos, but i thin it's importanto know thathildren deate from them, and when children deviat from the norm, that doe'tessarily mean pyschhology, doesn't necessarilmean underlyingtial disorder. itould simply mean developmenl lag. it could mean the chilsimply isn't ready to talk

and that with proper nurturance, wi prope refoemen patience on the part of the pents, ge agent th child is very lely develop to a great child very likely to develop into a very normal, appropriately functioning individual. captioningerformed by the national captioning instite, inc captions copyright 199 aln h. perlmutter

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