“He allowed the examiner to engage in his play and followed along but did not expand upon the plot. Eye contact was generally reduced in quality and quantity. Nonverbal communication was also generally reduced or limited…He required prompting and support to engage with the toys presented to him (blocks, Legos). He built a wall with the Legos, but preferred to play with a car by moving it back and forth on the desk. He did put his head on the desk and closely visually inspect the car as he moved it back and forth in front of him…on the basis of his behavior during the ADOS assessment, (Howie) met the behavioral criteria for a diagnosis of autism spectrum disorder.” – Howie’s diagnosis report, December 2009
“These are not the droids you’re looking for.” - Obi Wan Kenobi, Star Wars, May 1977
Hang on, those quotes will make sense in a moment.
It feels like a lifetime ago but I remember it so clearly. A gray December day, sitting in the small office of the developmental pediatrician. I was in the back of the room while the doctor was administering the ADOS (Autism Diagnostic Observation Schedule) to Howie. Every once in a while she’d quietly tell me what she was doing, but her eyes stayed on my son the whole time. The doctor tried to engage him in the construction activity, but he just took the pieces he wanted and did it his way. He had almost zero interest in the Birthday Party activity. And the tea party? Forget it. He was more interested in the cars in the parking lot.
I had no idea what she was looking for or why these activities were so important. The words “joint attention” and “pretend play” weren’t part of my vocabulary at all. I just thought my kid liked to line up cars and drive them. I didn’t know these were red flags.
“See how he’s watching the wheels on the car as it drives back and forth?”
I saw it. The report was clear. I got it.
Fast forward to August 2011.
I’m sitting in a different, yet very familiar looking, office watching the doctor administer the ADOS to Lewis. We’re there because his speech is still delayed and his therapist thought there might be something more going on. I watch him engage with the doctor as they play with an airplane. He mimics the doctor’s play skills, but doesn’t take them further.
They take out a birthday cake and try to have a party. He plays along but refuses to blow out the pretend candles.
In my head I’m screaming, urging him on. We do this at home! Lewis, it’s just like the Lego Duplo cake we make!
They hand him a doll and ask him to feed it. He just holds it. They ask him to set a table. He stares blankly.
I KNOW what they are looking for.
At our follow up appointment for Lewis, the doctor mentions all these things as “red flags” for autism. I argue with her a little. I tell her that he’s the youngest of three boys. We have no dolls in our house and he’s never seen anyone feed a baby. How would he know what to do?
And the table setting? Have you seen our house? It’s a miracle if we all sit down to eat together.
And let’s not forget that a little knowledge can be a dangerous thing. I have been hypervigilant about the pretend play with Lewis. Hell, I even wrote about it.
But I didn’t push it with the doctor. There was enough other “stuff” that qualified him for the PDD-NOS diagnosis.
In my head, though, I never let it go. This felt like more of an indictment on my parenting skills and not his actual play skills.
Fast forward to May 2012
I’m sitting in our TV room answering some e-mails. Howie and Lewis are scurrying around in the other room, building something with blocks. The conversation is flowing between them. They are giggling.
“Let’s get a red block and put it here!”, yells Lewis
“Perfect,” says Howie. “Now, we just need a blanket.”
A few minutes pass.
“Mom! Come see what we made!”
I walk into the other room to this:
They took their “baby Stormtrooper” and made him a crib. Lewis grabbed the dish towel from the kitchen for a blanket.
“Shhh…we fed him breakfast and now he’s sleeping.”
Take that, ADOS.
Yes, this is the result of much therapy and attention to play skills and conversation. Both of them have these goals not only at school but in their home therapy as well.
But it struck me that maybe it wasn’t so much a lack of pretend play skills but rather a lack of the “right” pretend play skills.
Or perhaps: “These aren’t the pretend play skills you’re looking for.”
My kids will always beat to their own drummer. You could hand them a doll today and they may or may not know what to do with it. They still like to look at the wheels of cars and will tell you the name of a car just based on its logo. They will build elaborate structures with their Legos but prefer to drive their Hot Wheels through it rather than pretend that people live in it.
But they are playing. Together.
I’ll take that over a fake birthday cake any day.
Those seem like the “right” skills to me.
“Rock-a-bye baby, in the treetop
When the wind blows, the cradle will rock
When the bough breaks, the cradle will fall
And down will come baby, cradle and all.” – Rock-A-Bye Baby nursery rhyme (and a pretty scary one if I say so myself)