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 don't. i am in control. if it wasn't for the posystem, i wouldn't know how to be mother. the way we talk about kids and parents, we always ha little arrows going from the part to the kid. e pant does something, d that cnges the kids. int, our longitudinal studies e ing the arro argoing th ways, which mplyeans that the k is also impacting the pant. so if you' got a boy 9,o, 11 years ofge that you've let get mewh 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 th way, but this stu going back and forth over a time-- you come out looking like a real heavy over here. you are. you're hitting the kid. you're tryinto n him down on thr to keep him om going out sometimes. also looks bad, but you put ea otherhere over a lg period of time. so what patty and marion are doing in these groups is training pares- u're both up here. you're reallangry. u're frited of each other. hodo youet idown he wherit is ly? we fig a lite t. it takes time to do that--mont it's not a weeke therapy. untreated, conduct disorder can have impact not ju on th s fami,

uds cate that b 5o%o% ofuvile crime is committ byou pple with conduct disor his prior school hiory indicates that t ia io hiory of trucy and the wasa naway prlem. ds who are susly nduct sorder, and the wasa naway prlem. you n't get out of tpattern. many longitudinal studies show the prognosis for them in adulthoods pretty grim. theye incarcerated more often. th have re traffic accints, divorce. they don't hold down jobs. all of their relatnships are unstable. theynd u in mental stitutions. about ery bad outcome thatou can think about, these people have. after six months of living withis fosr faly bo bieveeturn mr. trese people have. for hang uer xpience. 's n b report.yo beh. a little behind on mewo

for beg ck yeah. buife do it, we're ok, i think. we're able to mmunicat whe lotter d get along bett-- beblto talit, rk it t without scamin anhim going to rob a hou beushe strat. e derstands lot what i. and she don't, li, get all uptight and say, "that's not true," "lie," ju stuff like that. i mean basic, typical mom. there arseral otional sorders of childhood. one of the most common is separatn anxiety disorder. it's normal for children to experience the pangs of separation from loved one, but a child's inability to 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, extre fear, thoughts of being separad from mom, thoughts of loved ones being red 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 separatioanxiety. the elings are ha to explain because they were just kind of like butterf thh who bod in your stach. i stelt li, "i don't wto dth. "don't makme do is i don'like doingt. i don'want to." i was always upset,

and it was just diffict to deverng. is is amanda. waagnosed tionty dorr severayears ago. she was extremely uncoortae being sepated fromerother, and over a perioof time, this generalized many situations. she never wanted to go to school, a restaur a movie, a iend's house. r three ars, amanda has been under the caredr. rachel kle. sepation anxiety cos abnoal when iinrferes withhe kind of behavior exctm chd at age. not that it shouldn't occur, but it occurs to a degree that impairs the child's ll-being. yoknoweverything.utious about everything she did. again, ytart reazing when you look ck on thehis th ssed to do, and u reize weren't such nmathings.

if we went into a restaurant and was downstairs, e didn't want to go in. and i never knew w because she felt closed in anit made her neous. going on vacation, even though were together, becawas a hoorlt closed in becausshe was ay from home. we wt to disneyworld. disneyworld was a nightmare for her. she afid of everything. shwas afraid othe fey and the tram. she was afraid of everythi. bee thsymptoms of separation anxiety arnot always consistent among children, making a diagnis can be difficult. some children experience thfeelings 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 ty are-- go to schooldo everying 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 children with separation anxiet who become dysfunctional and o 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 the evening, staying with relatives, even going on trips where you go away from home. how did it stop you from doing things that y waed to do-- those elings that you described? they were so strong that i couldt 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 separatioanxiety has adaptive value 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 fes a sepation anxiy disorder? parental behavr is one psibity. childr whoave experienced unpredictab unavailable, or rejecting parent have been observed to be prone to more intense separation anxiety. in addition, parents who become anxious when they ave the child may invertently teach the child to modheir own aie. learning theory would explain the development of separn anxiety

by suggesting that it's reinforceditaftermath. a mother hastens back to 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 and more prone to anxiety. sometimes these temperamental differences n ad parents to react nativel this can then increase the separation anxiety. but parentalehavior is n the onlexplation. a long iness, traua death in the family, ev an extended parent vacation-- may serate the chi from a loved one and exacerbate normalhildhood fears. some psychodynamic theorists see at the hea ofnscious sepaonnxiety disdeents the any wishes n becomeo intense, the children fear the pant will actually die or go aw.

others, such as those of the object-relations school, vi separatioanxiet others, asings those of the from the child's frhool, that it caot lieve itowpain-- that saration will literal cse annihitionf the self. whatever causes separation anxiety disorder, it aquir attentn d treatment. treatmt paon anxiety dier can involve traditional play therapy, fami thera-- in which the whole family system is investigated-- plus traditional exposureherapy, which involves a supervised, step-by-ep process of encouragi the cld conont the situatio that cate anxiety her. this was an importa part of dr. klein's therapy with amanda. that essentially helps e child learn th in a situation of separation, he's ok. because wh happens hesehildren is that ey're afraid to be away from theints. then they develop the fear when they're not separated

that once separated, sothinterrible will happen. so the aual experience of being without their parents isorrective in many cases, but st talking about how bad you feel, iny expeence, is not. parents aren't tryg keep the children wh them. what seems to be mo typic ishey can't ing themselves to infain onheirhild, sohen the child doesn't want to separate, they can't say, "tough. that's how it will be." they ple. they reason. they...they lose it. but i have yet to see a mother who was resentful of her child's progress. if she were hanging on to the child, she should really be resentful of the fact that the child is cured, and i've never sn a ther be destroyed by that. you slee at other kids' houses? all the me. ist fun? yes. ok. i wot ask you whats on.

yes.t ask. ha ha is is wesley. he hasism, a pfod developmental disorder what's tt word? dede. does that fit? read it. carl is another chil th am, "...what i wan r alou heronditi isss severe. tis a perplexing disorder, t justor pe with autm and theimili, typically, autism invoes the different mpto.ell. the first is a lack of responsiveness to other people. example, this young boy is seemingly unconcerned that his father has left the room. a normal response in a child his age likely to be this-- fierce cryinl thparent returns. the second symptom of autism mpaired unicion skil,

boerbanonverba [aah! aah!] many childn with autism, liesley, ththirsympm is that mchdren with autism respond to a limit number of stili. some may sit and stare for hours, rocking back a forth endlessly. some prefer a rigid sameness in their activities and dospd well cesn their ves. it is the hallmark of autism thatllse types of symptompear verearly, ofwithin the first 3o months, and theyay range from mild to severe. mostxperts agree that what's common to all people with autism is that the disorder is organic. anne donnean has written about and researched autism extensively. autism is a tremendous deficit, a profound deficit in two-way social interaction and communication.

there probably isn't anything more profound as a deficit because most of us come neurologicallhot-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 pare and the child, teaches the child esseially everything they need to know about being socially competent in a particular culture. somehow these kids seem unable to do that, and you end upitsomebody who's ki of two-dimensional, doesn't have the depth and the richness which makes for being a social humanei. out ofhat, 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 tt ely life, the symptomsan be extremely subtle, yet he tined eye ey are present. dr. donnellan videotaped two young ys. one, callu was suspeed of having the di 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 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 yetalking. it's pretty dramatic. you can see it. he looks pretty good ome of the scenes.

for example, 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 attention to. thfact that his parents or somebody else is there-- he's just oblivious tohat. he looks pretty good, hover, until you see the other child, ryan, who gets the shaving cream, is also delightewith 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, 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.

whereacallum, in the same situations, while he attends and he cooperates and he does very well, 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 thinhe thinks it's his dad. he lks for them, but there's no change in his expression, essentially. whereas in ryan, ino seconds, it goes from "oh, no, ey're not really leaving me" to "my god, they're gone and he's crying. sooas they me back in, he's comforted. it's all there in those tapes. you can see the essence of autism. the inability to understand means anends, 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 to make the whole thing work for them, the depth and richness-- it's real painful to watch. nce tism was first described, several theori we put forth toxplain t disorder. for 15, 2o years, tycally, ople blamee pants in one wayr anot focausinthe autism, which caused tremendous try. ople blamee pants ward enoughanot but toe blamedd withannot ow why... 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 orgac cae. codn't barnd theskids and not know. that breakdown was not because of the parents' inadequacies, but because of the chd's inadequacy.

he didn't bring his part to the dance. like many chilen with autism, carley is able to live very fctional at home. the first hurdle was her parent accepnce. we really focus on whathe can do more than what she can't. en she was first diagnosed, i feel like i went through all the steps riing that i did when my father died. i was rely angry-- why was this happening to me? why her? tt was the big thing--why her? and the denial. just, "how can this be happening? hocan i have a child who has disability?" and then graally accepting it. she looks at the world a little different than we do. sometimes i think her thght processes are different. there's nothing i can show you, but when you talk the it's like you can see the wheels grinding sometimes.

the process is a little different than rs. [kathleen] there are many things she can do. it dsn really bher me thathe mightct differently than some childrenngs she can do. soum...i think i we've always loved her the way she is. we don't love her in spite of her autism 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. trtmfoautism mutc to teverity of t behavior. carley is une cae her auti is matough to all her to be mainstream into a school district. nancy negri is the districtoordinator forley'srogr. shwould fa io the rae ofeople thatll morable individuals with autism.

i think her autism is fairly clasc. looks, you kn, to bthat way. her cleast problems are with sech and lauage, but she doesn't have severe kinds of aing-out behaviors at other kids have. she has language. 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've worked with and supported students who ve gone on ior llege. they sti need support athat level. ey neesome help, especial with sociallls, and sometimes some adaptatio fothe academs en it's a lecte foat, t they certainly ha thatentia we know peoplehoavph.s and alsoe autism. carley. is it nine? is inine? how many people think carley's right?

yeah. if carley's autism would be considered mild to moderate, wesley is in the moderate to seve category. becausof his inabili to commucate in any meaningful way, wesley was assumed to be retaed, t adnces in the underanding of autism now raissome questions. are the people lacking in intelligence? arthey simply unable to counicate 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 sang 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-- 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 ever gave any indication of from their affective, observable behavior, and theyan use the written word to communicate, when nobody ever taht them to read. the method of communicating is a small electronic keyboa that can display typed meages, a device often used by people who have lost their ability to speak. inhis videotaped session, ey was able, ov aioof t to comnite hishoughts to the outsiorld. whened wt he wldike leching to know, he ted this... the biology course he mentis is aigh-school-level program in which he excels e markableact outh hat wesley was neformly taut to read write. somew, he was le torn on his own.

no one knew he could read evenne wor 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 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 arn 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 autism have had an opportunity to use the communicator. much remns unknown asr.ouautism suggests, as a rt of brethroughs like wesy and others likhi using the communator

or from children like carley, who intain a high degree of indnt ling when given the proper sture. i' never seen a person with autism or any developmental disability, given the reasonable supports, who uldn'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's far simpler. we know what people need. if the supports are there, ey can have jobs, they can have relationships. theye 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 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 remember, however, that not all sh havior is symptomatic of deep abnormal proems. that not all sh havior s. symptomatic ainly the e nos, but i think it's importanto ow at children deate from them, and when children deat fromhe norm, th d'tecessari mean pyschhology, doesn't necessarilmean underlying etial disorder. itould simply me developmental la it cld mean the chilsimply isn't ready to talk and that with proper nurturance, prope refoemen paence on the part of the pen, ange agents,

th child is very lely develop to a great child, very likely to develop into a very normal, appropriately functiong individual. captioning performed by the national captioning institute, inc captio copyright 1991 n h. perlmutter

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