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MADELEINE BRAND, host:

This is Day to Day from NPR News. I'm Madeleine Brand.

ALEX CHADWICK, host:

I'm Alex Chadwick, with the final part in our series, the Autism Chronicles. We've spent time with Amy Thompson this week, a single mother of four-year-old Olivia and six-year-old Kollin. He has autism.

BRAND: Today, producer Dan Collison joins Amy and Kollin as they visit an autism specialist. They're hoping to get a more detailed medical diagnosis and some ideas for effective and affordable treatment.

Unidentified Woman: Walk right back here.

Dr. RICK SOLOMON (Director, P.L.A.Y. Project, Ann Arbor Center for Developmental and Behavioral Pediatrics.): OK, come on in. Hey, Bud. how are you?

Mr. KOLLIN THOMPSON (Autistic Child, Niles, Michigan): Hi.

Ms. AMY THOMPSON (Single Mother, Niles, Michigan): We are at Dr. Solomon's office.

Dr. SOLOMON: Want some toys? Would you like to play with toys?

Ms. THOMPSON: And we're here for Kollin's appointment, to evaluate him and get a complete medical diagnosis.

Dr. SOLOMON: So, welcome.

My name is Rick Solomon, and I'm a specialist in autism. I'm a developmental behavioral pediatrician.

Hey, Kollin.

Mr. THOMPSON: Hi.

Dr. SOLOMON: Hi. All right, you guys ready?

My training, before I got into medical school, was to work with kids with autism, on the floor, playing.

You see how that works? Put your hand in it, like this. Oh, that's cool, isn't it?

So, a parent can actually come to my office, and I can do a play intervention and get to know the kid, and within a very short period of time, usually.

Can I ask you a question? Can I ask you a question?

I think it was interesting in the way we tested him. It took a long time to get him engaged.

Can I ask you a question?

Mr. THOMPSON: I don't know.

Dr. SOLOMON: Uh-huh.

Ms. THOMPSON: Kollin.

Dr. SOLOMON: Every parent wants the connection to their own child, which they don't have, a lot of times, in autism, where their children reject them, or appear to reject them, because the parent hasn't figured out how to join the child in their comfort zone.

What do you love? What do you love to do? What's your favorite thing?

He was off playing by himself for a long time. Then, finally, we got him engaged.

Take that. Take that. The sword, get your sword.

And then, finally, we started doing some more, I think, challenging types of interaction.

Mr. THOMPSON: Guess what I'm drawing.

Dr. SOLOMON: What are you drawing? Well, don't tell me. Don't tell me. Let me guess. You're drawing...

And there, you could see he had no idea how to give hints.

Mr. THOMPSON: It's made out of plastic.

Dr. SOLOMON: Made out of plastic. So, it's a thing. It's big. It's made out of plastic. I know.

It was really, actually, kind of cute.

Airplane.

But not really.

Mr. THOMPSON: Jelly beans!

(Soundbite of laughter)

Dr. THOMPSON: They're not big. That's not fair.

To me, this speaks to the subtlety of working with a lot of these kids. We, who are typical, don't understand how difficult it is to socialize, and how subtle the cues are for socialization. And as soon as you just drop out a few of those abilities, just a few, it's amazing how quickly the kids pick up on this.

Oh, the bag was plastic.

By the time you're six or seven, kids are talking to themselves and saying, oh, he's different.

Ms. THOMPSON: He'd hide under the table, rocking in his chair.

Dr. SOLOMON: Oh, he hid under the table.

Ms. THOMPSON: Yes, all the time.

Dr. SOLOMON: That is a classic sign.

So, I think he's different, you know. I think Kollin has definite issues, and the school picked up on it. He was doing pretty bizarre behaviors in the school setting, and I feel completely comfortable making the diagnosis.

His language is actually pretty good. He can communicate when he wants to. He sometimes tries to be social.

Ms. THOMPSON: Sometimes.

Dr. SOLOMON: Yeah, but he doesn't really know how.

Ms. THOMPSON: Yeah.

Dr. SOLOMON: And he definitely has dominating interests. So, he's on the autistic spectrum, but I believe that his condition would be called high-functioning autism.

I'm saying he has a mild case of an autistic-spectrum disorder.

Kollin has got a very, actually, a very nice personality.

Ms. THOMPSON: Yeah.

Dr. SOLOMON: So, I don't know, whatever you've done has really been helpful for him.

Ms. THOMPSON: Well, thank you.

I was glad to hear somebody appreciates what I'm doing with my kids, because I don't hear it often, hardly ever.

Dr. SOLOMON: So, if I were going to have the ideal program for him, it would be not letting him be off by himself, engaging him in the human relationship. That's called the P.L.A.Y. Project. I would do speech and language therapy because he's ready for it, occupational therapy to address the motor - planning, those types of things.

Ms. THOMPSON: While I was sitting there, I was very concerned about how I was going to pay for that office visit. When all else failed, I have an overdraft protection on my checking account, and that's what I was going to use to pay for my appointment. So, it made it harder to concentrate on what was going on in the office there.

Dr. SOLOMON: And if you do what I'm talking about, I really think that within a couple of years - it takes years, it takes years.

Ms. THOMPSON: Oh, yeah.

Dr. SOLOMON: Within a couple of years, he should be a much more social guy, with a much more diverse range of interests and the ability to problem-solve and think for himself. Those are my goals for him, in a nutshell. And I believe he has that capacity.

Ms. THOMPSON: How expensive is the stuff that...

Dr. SOLOMON: The P.L.A.Y. Project over there? At the Logan Center? I don't know. You'll have to check. But I think they have a sliding-fee scale, and they may have scholarships. And we have some scholarships, too, so we should be able to patch something together for you.

Ms. THOMPSON: OK.

Dr. SOLOMON: OK? OK. That was a lot. You're feeling a little overwhelmed?

Ms. THOMPSON: Very.

Dr. SOLOMON: I'm sorry. Where's my Kleenex? Can you tell me what you're feeling?

(Soundbite of crying)

Ms. THOMPSON: Aside from working almost every day, and trying to help him the best that I can, and Olivia's climbing the walls, and...

Dr. SOLOMON: Well, you've got time.

Ms. THOMPSON: You know, and...

Dr. SOLOMON: You've got some time. I mean, there's no giant, giant hurry here, you know? He's doing well overall.

Ms. THOMPSON: You know, I've had to entertain the idea of having a second job because they gave me a pay cut in my job.

Dr. SOLOMON: Oh, no.

This is a family that's extremely stressed. I was very sensitive to that.

Did Pat discuss any payment arrangements or anything like that, or we agreed not...

Ms. THOMPSON: She said to talk to you when I came out here.

Dr. SOLOMON: Oh, OK. OK. So, we'll just give it to you.

Ms. THOMPSON: Are you sure?

Dr. SOLOMON: Yes, sure.

(Soundbite of crying)

Ms. THOMPSON: I was absolutely astounded. I actually started crying because, you know, I was so overwhelmed with the thought of having to come up with that much money, and what would that do to, you know, pay my rent, and pay my car payment, and pay the insurance and you know, all the utilities, and I still didn't have groceries. So, it was very much a relief when he waived the fees.

Dr. SOLOMON: She's just an example, one out of thousands and thousands of people in this country, who can't afford appropriate interventions for their kids with autism, where the same type of interventions paid for, for other conditions - medical insurance doesn't cover speech and language, or occupational therapy. Intensive interventions are only covered routinely in a handful of states. Her situation is not uncommon.

Ms. THOMPSON: So...

Dr. SOLOMON: OK. So, what I'll do then is I'll get a report out to you, and...

The possibility that learning about therapeutic approaches could overwhelm her and immobilize her is there, but you know, you ask yourself, what are the choices? And I think the one that I'd given her is doable, but not easy.

OK, all right. Bye.

Ms. THOMPSON: Thank you very much.

Dr. SOLOMON: You're welcome. You're welcome.

Call me if you have any questions.

Ms. THOMPSON: Thank you.

BRAND: The Autism Chronicles, produced by Dan Collison and Elizabeth Meister for Long Haul Productions, in association with Chicago Public Radio. And you can hear earlier stories in this series by going to our website, npr.org.

CHADWICK: Which is something we say after a lot of stories that we play. I just want listeners to know that we've have gotten tremendous email response to this at daytoday@npr.org. It's really a series worth hearing, and I hope you will.

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