Question: I am a grandmother with custody of my two grandsons, 6-year-old twins. Because of behavior problems at home and school and difficulties relating to other children (they play and communicate with one another just fine), they have been diagnosed with autism. What is your opinion of the diagnosis and what can I do to help them? Their therapist has told me that usual means of discipline won’t work but has yet to give me something that does.
Answer: As opposed to a verifiable physical disease such as cancer, all psychiatric or mental health diagnoses, including autism — or, more accurately, autism spectrum disorder — are based not on “hard” data but on third-party description. As such, a diagnosis of autism spectrum disorder is a construct and subject, therefore, to unreliability. One psychologist may render a diagnosis of autism while another may render, for the same child, a diagnosis of, say, childhood bipolar disorder or oppositional defiant disorder.
There are several theories concerning autism that attribute its origin to genetics and other biological factors, but none of them have been proven conclusively. The dispute, mind you, is not over what people are reporting — behavior — but speculative notions regarding etiology, or cause.
For the above reasons, I don’t pay much attention to diagnosis. In the first place, in today’s health care environment, insurance providers require that mental health professionals assign one or more diagnostic labels to anyone they see. A psychologist won’t get reimbursed if he tells an insurance company that he is counseling so-and-so because of “problems in relationships.” Reimbursement depends the psychologist diagnosing so-and-so with a recognized mental illness like depression.
It is not uncommon for twins during early childhood to develop a “secret language” that they only use to communicate with one another. The phenomenon, estimated to occur with nearly half of all twins (including fraternal), is called cryptophasia. With or without cryptophasia, however, idiosyncratic, twin-to-twin behaviors can also develop that may ultimately interfere with normal peer relationships during early and middle childhood. In most cases, these difficulties are eventually “outgrown,” but this phenomenon should be taken into account when evaluating young twins who are having difficulty socializing with other children.
If my hunch is correct, then what people are seeing may not be autism — suspending for the moment any question concerning the validity and reliability of the diagnosis. Regardless, the notion that “normal means of discipline don’t work with autistic children” is pure balderdash. That says more about the person making that claim than it does your boys. I’ve worked with a good number of parents of children diagnosed with autism spectrum disorder. These kids are not a different species; they are human. As such, the same principles that govern the successful discipline of any human child, applied properly, will work.
What does not work with autism spectrum disorder kids is acting like the diagnosis requires that they be handled with kid gloves. The proper discipline of a child, diagnosis or not, requires adults who are ready to step up to the plate and deliver unequivocal authority.
Kid gloves just won’t do.