When I first learned my daughter had serious developmental problems I was, of course, devastated. I was also in denial. How could a child who looked so adorably normal have so many problems? When extensive testing revealed that there was absolutely nothing physically wrong with her eyes, ears, limbs, genes, metabolism or brain structure, I was further dismayed. What was this insidious, invisible syndrome that was making my otherwise healthy daughter so different from other children?

The experts supplied a name -- Pervasive Developmental Disorder -- a euphemism for autism, and I was supplied a definition of the syndrome's core symptoms: qualitative impairment in social interaction, communication, imagination and range of interests and activities. But the experts could not tell me how my daughter had come by these crippling deficits. Nor could they offer me any real hope of treatment. Instead, I was left to wend my way thorough a mind-boggling maze of interventions, medicines and educational methodologies. Some worked -- others didn't. I learned.

I read every book and publication about every aspect of the syndrome I was able to lay my hands on. In doing so I learned a great deal about how to help Meaghan along but garnered little understanding of exactly why she was the way she was. All the books, reports and articles agreed on the biological-neurological pathology of autism, but none was able to pinpoint the exact point at which the information processing of autistic individuals goes askew. So I did some additional reading on the brain and nervous system and on sensory integration and, bit by bit, the pieces started falling into place.

I certainly don't claim to be an expert on how the mind and body work but, by piecing together some neurological and biological fundamentals with what I know about autism I have been able to make sense out of most of my own daughter's autistic limitations and propensities. I have come to understand how she perceives the world around her, how she interprets what she perceives and how her unique perspective influences every aspect of her being.

In the "What's Going On" sections below, I have done my best to explain the "whys" of autism. I have tried to keep the terminology as basic and straightforward as possible. The ideas and insights I propose are intended to be understood by laymen, by those who have a personal or professional interest in the development of a child with autism (although they might afford a good jumping off point for more in depth research by those in the medical or psychiatric community.) For the sake of simplicity and clarity, I make no distinctions between mild, moderate or severe spectrum diagnoses. References to 'children with autism' may be taken to include individuals with PDD and aspergers as well.

I am assuming that those who read this already have some basic understanding of what autism is and understand that it affects different children along a wide spectrum of levels. Those at the higher end of the spectrum are generally diagnosed with aspergers syndrome, while those at the lower end, who have the most pronounced symptoms along with mental impairment, are said to have severe autism. Pervasive Developmental Disorder (PDD) is just a catch-all phrase that is often used by doctors who don't want to commit themselves to the more specific diagnosis of autism.

OK, now that we have that straight, let's get started with...

Why are toddlers with autism able to walk but not talk?

The simple answer is that not all the actions or movements we learn to make require conscious attention or volition. Sitting up, crawling, standing and walking are reflex motions or postural reactions that are centrally programmed into the brains of most toddlers.41 When their nervous systems reach a certain level of maturity, they are automatically able to do these things because these movements do not require complex sensory processing; they do not require conscious attention. Talking, on the other hand, and in particular learning to talk, requires very complex motor planning and concentration.42

How might the early or late onset of autistic symptoms influence whether or not a child speaks?

Temple Grandin has posed an intriguing theory about the timing of sensory processing problems that result in autism. She hypothesizes that "oversensitivity to touch and auditory scrambling prior to age two may cause the rigidity of thinking and lack of emotional development found in (children with) Kanner type autism."43 These children begin to recover the ability to understand speech between the ages of two and three and generally go on to develop some language.

On the other hand, children who develop relatively normally up until the age of two before regressing into autism are less likely to re-acquire the language they lost. They may be more emotionally normal, however, "because the emotional centers in their brains have had an opportunity to develop before the onset of sensory processing problems."44

In short, if autism manifests itself in infancy, early parent-child bonding is most disturbed, affecting a child's ability to form emotional attachments. If the syndrome manifests itself in toddlerhood, when sensory systems are more mature, the parts of the brain that control the acquisition of language are most affected.

Why is autism often so belatedly diagnosed, and how can you tell if a child is at risk for developing autism?

Autism is an invisible handicap. There are generally few obvious outward manifestations of this neurobiological phenomenon. Even the most sophisticated neuro-imaging machines often fail to detect any abnormality because the underlying problem is most likely chemical rather than structural. Also, the syndrome usually doesn't manifest itself in any diagnosable way until a child is old enough to have developed a repertoire of abilities. Some children develop those abilities just fine and then wake up one morning and they're gone, never to return. But whether autism creeps in stealthily or invades by precipitating a sudden regression there are some unmistakable tip-offs that some force is at work disrupting the way a child thinks and perceives the world around him in the way he behaves.

You may have a problem if, by age two, your toddler:

1. Isn't looking at you in the eyes with communicative intent;

2. Isn't recognizing and responding consistently to his/her name or the names of others in your household;

3. Isn't very interested in speech or in learning to talk;

4. Is more alert to sounds than to voices;

5. Isn't laughing or smiling in response to praise;

6. Isn't pointing or otherwise attempting to solicit your attention;

7. Isn't wholeheartedly reciprocating your affection;

8. Is content to play autonomously most of the time without seeking out your praise or approval;

9. Is showing a preference for one or two toys and ignoring the others;

10. Isn't vocalizing or babbling to his/herself when he/she plays;

11. Isn't missing you when you leave the room;

12. Isn't showing an interest in the activity of his/her peers;

13. Isn't imitating simple gestures or words;

14. Isn't responding to simple yes or no questions with a nod or head shake;

15. Is evidencing finicky or peculiar eating preferences or habits.

How does the autistic thought process differ from the norm?

What and how we think is a function of the meaning we give to the sensations we experience. It takes a fully functional neural connection network to fully understand what we see and hear. If this network is lacking in any way, the meaning of visual and auditory information would be distorted or diminished and, if this crucial distal information is incomplete, our thought process as a whole would be incomplete.

Most peoples' thoughts move from the general to the specific but the reverse seems to be true with autism. Temple Grandin claims that her thoughts move from video-like specific images to generalization and concepts.45 This difference may be attributable to the level of associative processing. In the 'normal' brain association tracts are well established, allowing impulses to complete the full processing circuit before an idea or perception is formed. In the autistic brain, sensory impulses may get held up in one lobe or another before being released and relayed in a haphazard way on to other lobes, accounting for the restrictive or fragmented nature of autistic thoughts.

Uta Frith aptly uses the metaphor of a jigsaw puzzle persisting as fragments or a bunch of pieces even when put together to characterize the autistic mind-set.46 For people with autism, meaning is derived from parts of sensory experience rather than from the whole. They are able to make simple, concrete connections and associations but have a hard time fathoming abstract ideas and concepts. The degree to which some individuals with autism are able to advance to the conceptual thinking stage may well depend upon how actively and often the final-stage associational circuitry is engaged.

What is a theory of mind, and how might the lack of it affect the autistic thought process?

One abstract concept a child must figure out early on in order to develop a normal personality is the concept of other minds. Normal toddlers instinctively understand that others have a mind capable of thinking and comprehending things the same way as their mind does.47 This belief, or theory of mind, is notably absent in autistic children, because their fragmented circuitry only allows them to carry the thought process of others' minds as far as their own thought processes take them. As Uta Frith puts it "autistic children make no distinction between what is in their mind and what is in anybody else's mind."48

At an autism conference I attended a while back, one of the lecturers related an experiment he conducted relating to this theory of mind. He brought several high functioning autistic boys into his office and showed them a band-aid box. When he asked them what they thought was in the box, they naturally responded "band-aids." He opened the box and showed them that there were crayons inside, not band-aids.

He then closed the box and returned with the boys to the reception area where their parents were waiting. He showed the parents the box and asked the autistic children what their parents would say was inside. Each one thought his parent would say "crayons." Because they knew the secret of what was really inside, they assumed that their parents would know as well--regardless of the fact that their parents logically had no way of knowing that a substitution had been made.

How might a lack of or limited theory of mind cause or compound problems with interaction and communication?

Look into the eyes of young children with autism and you won't find much expression. As a rule they don't use their gaze to communicate, to either convey what's in their minds or to try to read the minds of others, because they don't understand the minds of others. Neither do they bother to point things out to their caretakers because, lacking a theory of mind, it simply never occurs to them that there is any need to do so. Presumably, the other person is already aware of what's on their minds. By the same token, children who believe that others have the same thoughts and feelings as they do would feel little compulsion to communicate anything beyond their basic wants and needs.

As autistic children mature, many of them do develop a limited theory of mind. They figure out that others think and feel, even perceive things differently, but they often fail to appreciate that others might have different interests or intentions. They don't assess or evaluate what they hear, nor do they infer, intuit or grasp intangibles. A person with autism could have a genius I.Q. and yet be unable to tell a story or get a joke. People with autism tend to take everything at face value. Nuances, shades of meaning or hidden meanings, irony and witticisms generally escape them. Their expression of language is concrete and instrumental, their comprehension, excessively literal.

How does the fragmented processing of sensory impulses factor into the restrictive and repetitive behavior and thought patterns characteristic of autism?

The author Uta Frith theorizes that "repetition is the natural setting for (the sensory) input and (motor) output systems (in the brain), and that they are normally stopped from repeating when their products are acknowledged by a high-level central monitor. Such acknowledgment signals for the input device to start processing new information and for the output device to change to a new action."49 But, if we assume sensory impulses are short-circuited at the association level in the autistic brain, they might never reach the "higher level context using mechanism" so that they can be "switched off." They might just keep looping around and around the dysfunctional circuitry, causing thoughts and actions to get stuck in a repetitive, restrictive mode.

Fragmented perceptions continuously looping around poorly established association tracts might result in a thought pattern that is not just perseverative, but is excessively associational as well. Temple Grandin postulates that it is the inability to stop endless associations (rather than the inability to associate) that causes more severely impaired autistics to have difficulty keeping their minds on track.50

What is the nature of the autistic spectrum and how does knowing where a child falls on the continuum help to determine prognosis?

Temple Grandin writes: "It appears that at one end of the spectrum, autism is primarily a cognitive disorder, and at the other end, it is primarily a sensory processing disorder.... At a midpoint along the spectrum, autistic symptoms appear to be caused by equal amounts of cognitive and sensory problems. There can be mild and severe cases at all points along the continuum."51 She goes on to suggest that there is a continuum of visual and auditory processing as well, which goes from fractured, disjointed images at one end to a slight abnormality or oversensitivity at the other.52

This would certainly explain why every child presenting with autism is unique. The latitude of variations in symptoms, not to mention the behavioral manifestations of those symptoms, would be broad indeed given such an all encompassing spectrum. But, if one can pinpoint where an autistic child falls on the continuum, it might prove a useful indicator of how much educational intervention is required or how useful or successful that intervention might be. Put another way, the level of cognitive functioning and sensory scrambling has a direct bearing on how well interventions work.

For example, young autistic children with severe sensory scrambling would have to work so hard to make sense of what they saw and heard that the temptation would be to give up the struggle and just tune out--or act out in frustration. If these children were severely retarded as well, there might be little you could do to help them cope and connect with the world around them. But, if they were not seriously impaired cognitively, it would be possible to reach them through education. They could be taught to use their intelligence to control and accommodate their sensory processing limitations, as Donna Williams was able to do.

Children with mild to moderate sensory distortion and mild to moderate retardation would need more intensive education and intervention to achieve this control and accommodation but, with hard work and the right type of training, it could be done.

Children with high functioning autism or Asperger's syndrome probably have mild to moderate sensory problems with normal to above normal I.Q.s. These children generally fare pretty well in school. Many even excel in the classroom because much of academic learning is concrete. Facts are facts, and the autistic mind is able to process facts with relative ease. The problems of high functioning autistics generally manifest themselves later in life when they attempt to make a go of it out in the real world, where "people skills" count for much more than mere intelligence.

As smart as she was, Temple Grandin had to fall back on the use of concrete symbols to understand such abstract concepts as getting along with people and moving on to different stages in her life.53 To understand and get along with others, a mind must be able to access and make rapid associations among a wide range of ideas and experiences, and this is where the processing of even the highest functioning autistic falls short.

What neurological factors influence early learning in both typical and autistic children?

As infants and young children explore the world and discover the parts of their bodies, the sensory and motor impulses flowing through their immature neurons cause axons to sprout and branch out toward the dendrites of other neurons.30 Eventually, these axons and dendrites link up to form functional connections. This connection forming process is rapid and on-going during a child's early years.

Every sensori-motor experience stimulates neurons to connect with each other. But if early sensori-motor experience is lacking or not being properly registered, due to poor modulation or integration, this connection forming mechanism cannot operate efficiently to form and hard-wire crucial neural connections. Fewer connections are made to key processing points and many of those that are made are not working in an effective way.

The problem is not that autistic brains are lacking in the neurons necessary to make connections. In fact, babies who turn out to have autism are born with approximately the same number of neurons as typically developing children. Some studies indicate they may even have slightly more neurons in some regions of their brains. The problem is that many of these neurons do not thrive, do not sprout as many fibers or as many complex connections as the neurons of other children.

Is the core neural connection forming problem in autism a prenatal or postnatal occurrence, and what might cause it?

If the problem in autism is pre-natal in origin, as most experts have theorized, than it most likely occurs between the eighth and sixteenth week of gestation, when the fetal brain is growing at a remarkable rate and neurons are in flux, arranging and rearranging themselves before finally taking up their places in developing structures.31 If this neural migration process is interrupted, or if too many of too few neurons migrate to certain locations, this could account for the formation of an abnormal connection mechanism.

On the other hand, if the core problem occurs or is compounded after birth, there could be a host of explanations. Assuming children who turn out to have autism are exposed to the same sensory stimulation as their non-autistic peers, either something impedes these sensory impulses from triggering the growth of neuronal fibers -- or the fibers form but the synapses don't -- or the synapses form but fade away due to disuse.

Either one or all of these scenarios could account for a shortage of connections to key processing points. Also, failure to register, modulate or integrate sensory input (due to some vestibular or thalamic dysfunction) could impede the connection forming process, particularly to the areas of association which are crucial in assigning meaning to sensation.

As far as education and autism, is earlier necessarily better?

The neurological reasoning behind the rush to educate is a valid one. The premise is that, if you get to a child early enough, it's possible to form new connections or to transfer the functions of parts of the brain that aren't working properly to parts of the brain that are fully functional. It's possible to retrain undamaged neural circuits to take on new roles, especially in a child's early years while his brain circuitry is still in its formative stage.

Though neurologically sound and encouraging (especially to the parent of a child diagnosed with "funny wiring") this idea of being able to rewire faulty circuitry has its limitations. For one thing, messages transferred through re-routed channels are unlikely to be processed by the brain as smoothly and efficiently as those flowing through properly formed and well organized neural connections.32

For another, if the condition of autism is caused by some defect in the connection forming mechanism, and if this defect is exacerbated by an imbalance in one or more brain chemicals than, unless or until this core defect can be corrected, any new connections that are formed might well be subject to a degree of the same neurological damage as their predecessors.

This is not to say that new connections or synapses can't form in autistic brains. They definitely can -- at any age -- which is why constant stimulation is so important. But, if we assume a chemical deficiency or imbalance in the connection forming process, than we must assume that young children with autism have fewer functional synapses to work with early on, and that the formation of new connections and interconnections is going to take some time. Certainly the learning necessary to form the all important association tract synapses is bound to be a time consuming business for children who are constrained by being unable to focus and attend to more than one thing at a time.

Actually, the degree and type of help an autistic child gets probably has a greater bearing on positive outcome than the specific timing of that help, although I will not quarrel with the fact that sooner is better as far as getting started. Earlier is better up to the point that basic skills have to be combined into complex, coordinated actions or interactive thoughts and abilities. The more complex learning is, the more neural organization, cooperation and communication it requires, the longer it will take for children with serious processing deficits to form and hardwire the necessary interconnections.

Simply put, experience is darn hard to come by for autistic children and, because it takes them significantly longer to accumulate and generalize knowledge and to incorporate it into the broader context of experience, I believe it's unreasonable to expect too much too soon.

How do the special needs of autistic children differ from the norm in regard to early intervention?

The primary difference is in the intensity of the intervention that is needed, as few autistic children are able to keep themselves positively occupied for long. Thankfully, the days have passed when these seriously misunderstood children were regarded as "hopeless" and put away in institutions where so little was expected of them. The furious rocking, hand stimming and bizarre stereotypical behavior they often engaged in was, I believe, their way of coping with mind-rending sensory deprivation.

Children with autism should never be underestimated, nor should they ever be left too long to their own devices. "When left alone," Temple Grandin writes, "I would often space out and become hypnotized."33

Just because they may have no desire to do things and may have no fun doing them at first, doesn't mean they shouldn't be made to do them. Those who care for autistic children must constantly challenge, stimulate, foist learning upon them, so that the circuitry in their brains continues to develop almost in spite of itself. The more education and experience autistic children get -- at any age -- the better off they will be.

What type of early education is most effective for young autistic children?

The only way to break through the barriers of the processing limitations that cripple the development of the autistic brain is to constantly introduce new activities that will stimulate the formation of synapses and facilitate the brain's ability to integrate and effectively use sensory input.34 This is the premise behind sensory integrative therapy, and I believe any educational or therapeutic program for autistic children worth its salt should include a sensory integrative or vestibular stimulation component, especially in the early childhood years.

The type of training an autistic child receives early on is very important in influencing how well he/she makes the adjustment to the education process. There majority of very young autistic children benefit significantly from behavioral modification training. A one-on-one or one-on-two component is also important in the preschool years, so that the instruction can be more intensive and individualized. A program that requires a child to constantly interact with his teacher, so that he cannot withdraw into his own world, is most effective.35

The easiest way for a child with autism to learn is through step-by-step, repetitive skill training. On the one hand, the more familiar a task is, the less the child will resist it. Also, from a neurological standpoint, the more a skill is repeated, the easier it becomes to internalize. The more a signal is sent, the stronger the travelling pulse along an axon, the greater the likelihood that it will make it across a synaptic gap.36

A repeated succession of nerve signals crossing a synapse activates that synapse, so that less neural energy is needed to carry out the process each time until a neural memory is formed. Each neural memory a child forms adds to his repertoire of perceptions or abilities and expands the communication network within his brain, making him more capable of learning.37

A home component too is a significant plus to any early education program because of the absolute need for consistency. All children, but particularly autistic children, need parents and teachers to set firm boundaries and to make clear expectations--and to stick by them. They must be able to depend on our consistency in the inconsistent world that confronts them daily.

What type of educational program is best for older autistic children?

First off, you must accept that no program or placement is probably going to be ideal. You will always have to weigh the pluses against the minuses. Bear in mind, however, that the foremost goal of any educational program should be for a child to attain self-confidence and independence. For this reason I believe that the one-on-one teaching style, so effective in the preschool years, can become more of a hindrance than a help from the elementary years on up.

If we assume a fundamental problem with autism to be a lack of a sense of self, than any educational program that doesn't succeed in fostering this, regardless of how much else the child may be learning, is not doing the most important job. Because children with autism have such a fragile grasp of who they are, what they feel and what they can do, they often have little or no basis for knowing what they think.

They generally have a low degree of confidence in their own minds, which is why it's often so difficult for them to take the initiative. They feel safer following the lead of others, letting others do the thinking and planning for them. Although it is one of the hardest lessons for them to learn, children with autism must be taught to trust in themselves and in their abilities.

If a child is able to function independently in a public school setting, as many high-functioning PDD or Aspergers children are able to do, than mainstreaming is the way to go. If, on the other hand, a child requires intensive, individualized guidance just to get through a school day without incident, I question the merit of mainstreaming initiatives. Unless the child has made many friends and is having lots of social success, he/she might be better off in a private placement where style of learning is taken into consideration and the focus is on becoming more self-reliant.

It is important to know when to cut your losses. Autistic children are anything but predictable and consistent and certainly they are going to have their share of 'bad' days at any school, but when the bad days start outnumbering the good something is wrong. You are doing your child a serious disservice if you grow complacent with any educational placement. The school or classroom might be the finest of its kind in the area and might have been ideally suited to your child's needs at the time of enrollment, but children's needs change. If a program cannot adapt to or keep pace with these changing needs, or if too much staff reshuffling changes the caliber of the teaching or classroom management, it's time to consider moving on.

Why does learning sometimes become easier as an autistic child gets older?

The older an autistic child gets, the more he or she is generally able to accommodate his or her brain's sensory distortions and processing deficits, making learning easier. And the easier learning becomes, the more intricate the cerebral connection and interconnection system becomes, the more neural memories a child acquires.

Conversely, the more neural memories a child acquires, the more he is able to organize information into meaningful experience, the more he is able to learn and understand. Because it takes children with autism a longer time to build neural interconnections and memories, I believe it is unwise to put a time limit on their learning and development.

Improvement can only come when a child has had sufficient time to absorb and integrate experience with his/her slowly built up store of knowledge. Temple Grandin writes: "My life was a series of incremental steps...There was no single breakthrough that enabled me to adapt to autism...At age forty seven I (now) have a vast databank, but it has taken me years to build up my library of experiences and learn how to behave in an appropriate manner."38

She says that for her every experience built upon the visual memories she carried from prior experiences, and in this way her world continued to grow. She claims that her ability to modify and build upon the visual images in her brain helped her to become less rigid in her thinking and to learn to generalize.39 She has been able to expand her thought process because she has been able to keep expanding the connection network in her brain through on-going education and experience.

What is the core cause of the social impairment in autism?

In her book, Autism: Explaining the Enigma, Uta Frith writes: "The puzzle we must solve is why, despite an adequate level of intellectual development, there is communication impairment, and why there is no pretend play and what this has to do with social impairment.131 The answer might be that the triad of impairments that define autism: social, communicative and imaginative, all require that neural processing not only be well organized and highly sophisticated but that it be comprehensive as well.

The principle problem with social behavior is that it is driven by complex feelings rather than logic, and people with autism have a limited understanding of complex emotions (perhaps because of the immature cells and stunted connections in their limbic systems).

If neural impulses do not complete the full processing circuit then resulting perceptions might be adequate to allow for the mastery of some academic learning, but they will not allow for the ultimate self knowledge, the consciousness of self, that is necessary for any kind of successful interaction with others, be they real or imaginary.132 The ability to be aware of one's own thoughts, beliefs and emotions and to distinguish these from the thoughts, beliefs and emotions of others requires an intelligence that can only be achieved through the active engagement of every cell and circuit in every area of the brain.

What specific handicaps do people with autism have to overcome in order to cope and find acceptance socially?

For people with autism all behavior has to be learned and social behavior, because it does not follow a predictable pattern and cannot be practiced in a step-wise manner until it is gotten right, is the most difficult behavior to learn. Beyond this, people with autism often have little self-consciousness, so they rarely feel any sense of shame or guilt over their actions. It rarely occurs to them to alter or inhibit what they feel like doing just because they are out socially.

Social interaction is another hurdle to overcome because autistic individuals don't really understand other people. Their minds simply can't effectively or efficiently grasp, analyze and interpret a broad range of "people" information in a coherent and flexible manner. And, without an understanding of how others are the same or different from themselves, they have no solid basis for either interaction or conformity. It's hard to "act like everyone else" if you can't figure out the ways in which you are acticin differently.133

Social interaction is further complicated by the physiological problems many autistics have with rapid attention shifting between auditory and visual stimuli. Their narrowness of focus and mono-channel processing makes it exceedingly difficult for them to follow, much less actively participate in, rapidly changing conversation and social intercourse.134

Flexibility and adaptability, two traits that are essential to achieving any degree of social success, are in fact, the very antithesis of what autism is all about. As a rule, people with autism prefer sameness, routine, familiarity and predictability in all things; preferences that invariably put them out of sync with the transient social world.

Is there a difference in the social behavior of a child with autism and a child with PDD?

Autistic children frequently demonstrate little awareness of other people; they are often characterized as being "aloof" or "in their own world." PDD children, on the other hand, are aware of others, they just have no idea how to relate to them.135 You'd think, because of their interest in people, PDD children would fare better in social situations than classically autistic children, but actually the reverse is often the case -- at least in their younger years. Being essentially oblivious of others, many autistic children tend to just focus on amusing themselves when they are out socially, or they might isolate themselves either physically or mentally, by simply tuning out what is happening around them.

PDD children, on the other hand, want to be part of the group, so it is all the more frustrating for them that they can't figure out how to do so. Temple Grandin writes that, in social situations she felt like "a scientist trying to figure out the ways of the natives. I wanted to participate, but I didn't know how." She always felt "like an observer... like someone who watches from the outside."136 Because PDD children cannot understand the intentions people have, the emotions they feel, the reason people act the way they do or say the things they say, they are apt to feel confused and overwhelmed by it all. For many, the stress of wanting to belong but being intrinsically unable to do so results in negative behavior.

How does a lack of empathy compound the problem of learning to behave acceptably?

Perhaps the biggest stumbling block individuals with autism must contend with in their struggle to cope and find acceptance socially is their inherent lack of empathy. "What empathy requires is the ability to know what another person thinks or feels despite the fact that this is different from one's own mental state at the time. Empathy presupposes a recognition of different mental states."137

Imagine how difficult it would be to get through a day if you could not read minds. Whether we are consciously aware of it or not, we all do this all the time -- not just when we look at and talk to each other -- but when we are simply around others. In large part we base our behavior, our thoughts and feelings, on the behavior, thoughts and feelings of those around us.

But, if you lacked this basic 'mentalizing' propensity, this innate ability to intuit or interpret the minds of others, as people with autism do, if other people were merely physical presences in your midst, you would be at a loss as to how to react or conduct yourself in many situations. It wouldn't occur to you to alter or adjust your behavior in response to its effect on others, as you would have no way to judge what others were thinking about you. You'd be unable to intuit the expectations and pick up the social cues that would allow you to fit in and participate.

Beyond this, if you lacked the ability to conceptualize states of mind, to make sense out of what motivates people to do and say and feel the things they do, than you would have no basis for comparing or reflecting on your own mental state.138 And, if you had so little consciousness and confidence in your own self as an individual, it would be mighty hard to relate to others in any meaningful way.

Why do people with autism often have such difficulty recognizing and understanding emotions?

For every emotion there are three elements. How we feel subjectively, how our body responds and the behavior we associate with how we feel.139 This latter association element is where autistic emotional processing (like the cognitive processing) breaks down. The right parietal lobe is the processing center for the perception of emotions.140 This is where the association aspect of emotion comes into play, the point at which processing switches to a response mode. If there is damage to this lobe of if it is not getting consistent sensory input and feedback, a child would have difficulty reading facial expressions, recognizing tone of voice and interpreting and reciprocating feelings.

It all comes back to an impairment in the limbic system, particularly in the amygdala and portions of the thalamus. If these structures in autistic brains are failing to signal to babies the importance of faces early on, then the babies become biased to look at things rather than people, and this early preference shapes their developing brains.141 Because they are not paying attention to faces, using the Temporal lobe fusiform gyrus, brain circuitry to and from this area is not developed and built upon, resulting in diminished affiliative drive and social orientation.142

Temple Grandin speculates that because humans have larger cortexes in their brains and therefore have greater abilities to precess information, their expression of emotion is more complex that that of animals.143 But, if the neural communication network in a human brain is atypical or dysfunctional, as it is in autism, this might result in a more limited processing of information, which would, in turn, reduce emotional interpretation and expression to a basic form more akin to that of animals.

For people with autism there is little or no relating or comparing of emotional memories, ideas or experiences. Each emotion triggering stimulus is dealt with on its own merit, and most often, because of a lack of modulation, that stimulus is either mitigated or exaggerated by the time it reaches the limbic system and parietal lobe. This is why the emotions of people with autism are often so unbalanced. If they are frightened or upset, they are intensely frightened or upset. Or they might be laughing crazily one moment and weeping uncontrollably the next. Their arousal level, dictated by the unbalanced modulation of input, fluctuates from one extreme to another. And people who have so little control over their emotions are going to have little control over the behavior those emotions elicit.

What strategies are most effective in helping individuals with autism with social adaptation?

Temple Grandin writes that she struggled in the social arena until she latched onto a concrete visual corollary for the abstraction of "getting along with people."144 She used symbols of doors and windows. Each time she faced a new experience or social challenge she would visualize herself opening a door. The symbolic action of going through the door helped her to fact and overcome her fears and anciety about changes and new people in her life.

This type of symbolic crutch may help some individuals with autism, however, not many are as clever, creative and confident as Temple Grandin. Most are plagued by considerably more uncertainty in social situations. They need social cues and "people" reactions to be spelled out for them, so they can grasp the reasons for behaving or not behaving in certain ways. In Temple Grandin's words: "Teaching a person with autism the social graces is like coaching an actor for a play. Every step has to be planned."145

For those individuals who can read, social stories and rule cards can be helpful in making people and social situations more predictable and understandable. Social stories are simple stories that focus on a single behavior and suggest positive alternatives or define a desired social skill and explain why it is important. As Carol Gray's guidelines recommend, these stories should be written entirely in the first person, thereby validating the perspective or point of view of the autistic reader, while at the same time trying to put an instructive spin on things.146

Rule Cards consist of a single rule written in bold print on an index card. For literal-minded autistic children rules can be very effective. They might not pay a lot of attention when you remind them over and over not to do something, but if you put those reminders into official looking visuals (even going so far as to circle in red and draw a black line through the word "No") they tend to take them very seriously indeed.

For higher functioning autistics, those who are smart enough to discern their social deficits, family, friends or teachers can serve as valuable role models and guides. At a conference I recently attended an extremely intelligent and disarming autistic adult recounted how, as a teenager, she used to go around asking her friends and acquaintances pointblank what she did that they found bothersome or annoying. As bright as she was, she couldn't fathom this most basic information nor ascertain how the things she did were perceived by those around her. But the explanations and constructive criticism she got in response to her frank queries helped her to make sense of much of what was a mystery to her and to adjust her actions and behavior accordingly.

Temple Grandin also attributes the gains she has made in social adaptation to long discussions with friends and relatives, who were able to serve as translators of the emotions underlying interactions. She no longer needs to rely on visual symbols to get her through social situations because of the advise she has gotten and the knowledge she has garnered from reading and experience. But it took her four decades to learn enough to feel relatively comfortable around others. How much easier a time might she have had if she had found more acceptance and help along the way.

What changes must society make in order to better accommodate its autistic population?

Certainly, there is no substitute for real life experience. Unfortunately, this experience is not easy to come by, especially for less able autistics who need more support and supervision. Because of the level of monitoring they require, the vast majority of children with autism experiences only the sheltered, highly structured and predictable existence they are accustomed to leading at their schools and residences for the first two decades of their lives. They are given few opportunities to participate with typical peers in social, recreational and vocational arenas, so most reach adulthood with tragically little real life experience.

Part of the problem is that, as things stand, people with autism are expected to do all the adapting or remain shut off from the world. Cities, towns and individual communities are not doing their part. Segregated special needs groups and activities do not fill the bill. There must be more genuine acceptance, more opportunities, more education and support, regardless of cost of inconvenience, and social instruction and inclusion must begin early enough in an autistic child's life to make a difference.

What obstacles do autistic children need to overcome in learning to use language conventionally?

As I see it there are four main obstacles impeding autistic speech. 1. Very young autistic children are often "word deaf;"109 2. They lack concern for meaning; 3. They don't like to have to think much, especially about what they are saying and, 4. They don't understand the process of communication, the pragmatics of carrying on a conversation. These problems are interrelated in the way they affect autistic speech, but for the purpose of clarification I will deal with them separately.

What factors contribute to early word deafness?

When I say that autistic children are "word deaf," I don't mean that they don't hear words. I mean that, when they are very young, they are not very interested in nor do they always understand words as words. If the process of sensory integration is not being followed through to completion, so that information from the eyes and ears is processed and interpreted smoothly and conventionally, they might simply fail to 'tune in' to the right auditory input. Or they might find it difficult to 'tune in' because their hearing is over or under selective.

Temple Grandin writes that her ability to process and attend to one voice against the background of another was severely impaired. It was difficult for her to screen out one voice and listen to the other.110 When adults spoke directly to her as a child, she could understand them. But when they talked among themselves it sounded like gibberish.111

Temple goes on to say that her ears were like microphones, picking up all sounds with equal intensity.112 In fact, for most very young children with autism, speech has no more significance than other noise, and many are more attentive and responsive to environmental sounds than to words. They often find rhythm and music preferable to speech because the mathematical relationships of the frequencies or pitch are more pleasing and harmonious to their immature auditory perception.113

Another explanation for early word deafness might be that spoken language simply isn't salient or relevant to children who feel little or no desire to communicate; children who lack the ability to associate language with the larger picture of emotional expressiveness and social interaction.

Also, due to their gestalt processing style, many children with autism are unaware of the differentiation of words early on. Because they do not discern the separate parts of a sentence, individual words and word combinations are never--or are belatedly-analyzed and understood in and of themselves. This early tendency to process sentences as a whole, rather than as a grouping of separate words with distinct meanings, makes it very difficult for autistic children to acquire an expressive or receptive vocabulary. Many cannot pick individual words out of a sentence unless they see them written first.

How do autistic children overcome word deafness?

As they gain experience with their bodies and with tangible objects, and as they are exposed to pictures, children with autism begin to understand that things have names. They begin to attach meaning to some words and to 'tune in' to these words. The first words autistic children generally attend to are nouns and verbs, because they have visual referents. Then come letters and numbers, because of their predictability. Gradually, they begin to grasp adjectives, prepositions and relational words, as these too can be represented visually.

At this point there is usually a big leap in receptive understanding, but expressive speech often remains awkward and rudimentary. It remains this way because the functional connecting words that are necessary to smooth it out are the hardest for children with autism to comprehend. There are no pictorial analogues for adverbs, articles or conjunctions.

Temple Grandin writes: "As a child I left out words such as "is," "the" and it," because they had no meaning by themselves. Similarly, words like "of" and "an" made no sense. Eventually, I learned to use these words properly because I mimicked (my parents) speech patterns."114 For many autistics, my daughter included, these words only become recognizable as words after they learn to read and are able to recognize them in print.

How does the lack of concern for meaning or sense-making impact autistic speech?

In her book on autism, Uta Frith writes of an exercise in which groups of normal and autistic children were tested to recall a slowly read out string of words. The study revealed that autistic children not only recalled the end of the string better, regardless of whether it made sense or not, but that they were also less inclined than normal children to re-order the scrambled words into something more meaningful or grammatical.115 The implication is that sense-making is not a very significant factor in the way autistic children process information. Unlike the rest of us, they do not feel the need to put words or bits of information into some relevant, coherent pattern or context.

The implications of this lack of concern for sense-making and coherence for language learning are obvious. How does one learn to properly order words in sentences if meaning cannot readily be applied to the sequencing? In other words, if I'd said to my young daughter, "Car ride go for a with Daddy do you want to," she would have probably responded "Yes" without giving the scrambled phrasing of my question a second thought. As long as she heard the relevant words "car ride" and "Daddy," the random sequence of the rest of the words was immaterial.

Because young children with autism do not pay much attention to the meaningful sequence or grammatical structure of words in a sentence, learning to order their words and talk in coherent sentences is that much more difficult for them.

What might account for the lack of originality and spontaneity in autistic speech?

To quote Uta Frith, "the autistic child selectively attends to speech and translates heard speech proficiently into spoken speech. However, this processing seems to bypass the involvement of central thought."116 Numerous factors play into the difficulty individuals with autism have in applying original thought to what they say. First, their predilection for sameness and predictability bolsters their reliance on rote language acquisition and expression. Also, their gestalt processing tendency makes it difficult for them to use words in a flexible, creative manner, because they often fail to assign meaning to the individual parts of the syntax.

Or it might be that the fragmented or dysfunctional neural circuitry within the autistic brain causes a breach between the auditory processing system and a central cognitive mechanism concerned with coherence and meaning. Bryna Siegel postulates that "in autistic children the growth of auditory memory (of sounds heard) proceeds at a fairly normal rate, but the ability to comprehend (digest information) lags behind."117

To compensate for lack of comprehension, children with autism use their stronger, more reliable auditory memories to try and make up for their processing limitations. This results in echolalia -- the rote repetition of the speech of others. Ms. Siegel postulates that children with autism engage in echolalia in order to better understand what is being said.118 They might also use echolalia because their brains are deficient in the complex interconnections that would allow them to apply more sophisticated thought processing to what they hear and say.

The combination of lack of concern for meaning and reluctance to combine thoughts and words explains most of the peculiarities of autistic speech--the stereotypic, rehearsed, situation specific language, the early omission or reversal of pronouns, the perseverative preoccupation with a narrow range of topics, the tendency to be excessively literal--the inability to say what others say in the manner in which they say it.

Why do some people with autism never develop speech?

Even when autistic children do begin to attend to speech, there is no direct link between hearing and talking. What we hear has to be properly integrated with other types of sensory input at the brain stem level and has to wend its way through many complex neural channels before it is finally conveyed to the temporal lobe auditory cortex where sounds are decoded and brought into our conscious awareness.119

If auditory information is intermingling with distorted or un-modulated reticular and vestibular information right at the start, making sense out of that information -- understanding language -- would be a complicated and confusing business. And if the information wending its way up to the cortical auditory processing centers arrives skewed or incomplete, the odds of efficiently translating heard language into meaningful speech diminish further.

Temple Grandin writes that she was able to learn to speak because she could understand speech, but low-functioning autistics may never learn to speak because their brains cannot discriminate speech sounds, or because not enough speech gets through their dysfunctional auditory systems.120 She speculates that children who are echolalic may be at a midpoint on the sensory processing continuum. Enough recognizable speech gets through for them to be able to repeat what they hear, but not for them to be able to apply sense-making to their speech.121

In fact, there is considerably more to talking than merely having the vocabulary to do so. Talking requires not only the ability to command and initiate a motor act, it requires the ability to arrange the sequence of oral movements to make sounds form a word.122 Enunciating or articulating even simple words requires very precise placement of the mouth, tongue and lips and this requires good proprioception and sophisticated sensory processing. Talking also requires the ability to decide the order in which words should be uttered to make communicative sense.123 This is a lot to ask of children with significant processing difficulties, but particularly of children whose attention to the meaning and sequencing of individual words is significantly impaired.

For higher functioning autistics, those that have the mental capacity and motivation to overcome all the aforementioned obstacles, the problem may be simply that they don't understand the purpose of speech. Jim Sinclair explains "speech therapy was just a lot of meaningless drills in repeating meaningless sounds for incomprehensible reasons. I had no idea that this could be a way to exchange meaning with other minds."124

Even if they do appreciate the reasons for speech, some autistics might simply choose not to communicate. Because much of the sensory input to their brains does not complete the final association processing phase, their thought processes and patterns are too limited to allow them to tell stories. They cannot make things up. They might be able to relate what happens to them in their day but often see little reason to do so. They don't ask questions because there is not much that they are interested in knowing. Indeed, I think the reason some bright, self-sufficient autistic children do not use language to communicate is because they are quite capable of getting their needs met without it. They do not need to make instrumental requests and, lacking a theory of mind and the ability to ruminate or empathize, they have little incentive to use speech for any social or interactive purpose. So they simply do not need to speak at all.

Why is carrying on a conversation the ultimate challenge for individuals with autism?

The simple answer is that they lack the basic instincts that make communication a natural process.125 In order to converse with unfamiliar others, people with autism have to struggle hard to order their words in a meaningful, coherent sequence and to think about what they are saying. Conversation requires commenting and commenting requires the application of original thought to speech. Comments cannot be practiced or rehearsed; they are subject to the whim or intent of the speaker.

Also, conversational commenting often requires the use of lots of incidental or colloquial words in a variety of combinations. People with autism rarely feel comfortable enough with their language to use is so creatively and flexibly. Even if they do succeed in coming up with an original, spontaneous comment, they then have to come up with another one quick on its heels in response to the reply to their conversational overture, and this type of rapid verbal exchange strains the limits of their processing capabilities.

Autistic individuals also struggle with the protocol or non-verbal part of an expressive exchange; things such as using eye contact or gestures to punctuate meaning or signal agreement, understanding verbal reciprocity or turn-taking, knowing how to stay focused or elaborate on a topic or when to change it, being able to judge whether a listener is interested in what you are saying. As these pragmatic skills require social as well as linguistic competence, they are extremely difficult to master.126

Also, most of what people with autism have to say revolves around themselves. This inherent egocentricity makes it very difficult for them to contribute to or share in topical conversations. They are seldom motivated to ask questions about anything or anyone else because they are simply not that interested.

OK, these are four of the What's Going On? Sections I have included in a unique book I have written about this intriguing syndrome, entitled: Funny Wiring: Living With and Piecing Together the Puzzle of Autism.

The other What's Going On? sections cover such topics as:

Sensory Processing, Behavior & Memory

Body Senses and Motor Responses

Distal Senses and Lateralization

Brain - Body Biochemical Link

GastroIntestinal - Secretin Link

Neuropeptides and Supplements

Piecing the Autism Puzzle Together

I suppose I could have just written a book based on these "What's Going On?" sections, but I elected to tell my daughter Meaghan's story as well, because I believe the living and learning ramifications of this disorder can only be told from a personal perspective. If you are interested in reading this book or learning more about it, you can find it here: www.aboutautism.com

My daughter's is not an unqualified success story. She has not recovered from this crippling syndrome, nor has she made such exceptional progress that she defies the odds. But she has come a mighty long way. We both have. We still have a way to go, but I have chosen to write our story now because I know that a lot of what I have learned can be of real help to others. I have not stinted on specifics, particularly in regard to teaching techniques, because I know from my own experience how important this knowledge is in living with and effectively working with a child with autism.

I know that my daughter will probably never cease being autistic, but her autism need not disqualify her from leading a full life. It is merely part of her uniqueness as an individual. Over the years, I have reached an accommodation with that uniqueness, and it is my hope that others who read this book will do so as well.

Along these lines, I am by no means reconciled to the view that autism is incurable. In fact, in autism, processing systems up to the level of the brain stem are intact and fully functional, so it is basically a brain anomaly that we have to contend with. Granted, it is a whopper of an anomaly, but scientists are learning more about the brain daily as technology makes possible ever more intricate imaging and diagnostic techniques. I believe that medical research could very well solve the mystery of autism, they probably already have the tools to do so. They just need to apply those tools conscientiously and systematically toward finding a cause. And that once a cause or causes are found, a cure, or at least a palliative, is not out of the realm of possibility.

The problem is that, as the affliction is not degenerative or fatal, society feels little compulsion to contribute to remedying it. Millions of dollars are spent annually to fund research for other types of syndromes, injuries or diseases, but children with autism are left to struggle, to suffer daily with sensory distortion and mind-rending anxiety, compulsivity and insecurity, to live lives that will never reach maturity or fulfillment, because there is little sense of urgency where autism is concerned. True, these children are not dying of their disorder, but neither are they truly living.

Fortunately, some private organizations, like the Autism Society of America, have taken up the slack and are making great strides with important projects like DAN (Defeat Autism Now) but I can't help but feel that individuals with autism have been treated by our government and health organizations as second-class citizens for far too long. Hopefully, now that the media is starting to take note of the rising incidences of autism in this country, more dollars will be spent on research and more treatment options will soon be made available.

If you read my book you will realize that a great many of the clues to solving his puzzle are already here. They are just so widely scattered that unless or until an open-minded and ego or agenda-free inter-disciplinary team of medical, microbiological and psychological as well as educational professionals can be rounded up to piece them together, it may be many, many more years indeed before the puzzle comes close to completion.

Notes to Atypical Development & Thought Process

49 Robert Schultz, Ph.D (Yale Child Study Center), "Neuroimaging Studies of Autism: Static to Functional," Current Trends in Autism Conference (Oct. 1999).
50 Robert Schultz, Ph.D, "Neuroimaging Studies of Autism," Conference notes, p. 25-26.
51 Temple Grandin, Thinking in Pictures, New York (1996) Vintage Books, p. 28.
52 Uta Frith, Autism: Explaining the Enigma, Cambridge, MA (1996) Blackwell Publishers Inc. p. 112.
53 Bryna Siegel, The World of the Autistic Child, New York (1996) Oxford University Press, p. 45.
54 Uta Frith, Autism: Explaining the Enigma, Cambridge, MA (1996) Blackwell Publishers Inc. p. 147.
55 Helen Tager-Flusberg, Ph.D, "Language Acquisition and Theory of Mind," Current Trends in Autism Conference (Oct. 1999)
56 Alex Michaels (Educational Consultants of New England, Cambridge, MA), Current Trends in Autism Conference (Oct. 1999).
57 Alex Michaels, Current Trends in Autism Conference (remarks).
58 Alex Michaels, Current Trends in Autism Conference (remarks).
59 Alex Michaels, Current Trends in Autism Confreence (remarks).
60 Uta Frith, Autism: Explaining the Enigma, p. 117.
61 Temple Grandin, Thinking in Pictures, New York (1996) Vintage Books, p. 25.
62 Alex Michaels, "Executive Dysfunction," Current Trends in Autism Conference (Oct. 1999) Notes, pp. 152-156.
63 Alex Michaels, "Executive Dysfunction," Conference notes, p. 155.

Notes to Early Learning and Education

35 Bryna Siegel, The World of the Autistic Child, New York (1996) Oxford University Press, p. 199.
36 Temple Grandin, Thinking in Pictures, New York (1996) Vintage Books, p. 44.
37 Jean A. Ayres, Sensory Integration and the Child, Los Angeles (1991) Western Psychological Services, p. 46.
38 Temple Grandin, Thinking in Pictures, New York (1996) Vintage Books, p. 56.
39 Susan A. Greenfield, The Human Mind Explained, New York (1996) Henry Holt and Company, p. 63.
40 Jean A. Ayres, Sensory Integration and the Child, Los Angeles (1991) Western Psychological Services, p. 95.
41 Alex Michaels (Educational Consultants of New England, Cambridge, MA), "Bateson Therapy," Current Trends in Autism Conference (Oct. 1999) Notes, p. 157-58.
42 Alex Michaels, "Bateson Therapy," p. 157-58.
43 Temple Grandin, Thinking in Pictures, New York (1996) Vintage Books, p. 137.
44 Temple Grandin, Thinking in Pictures, p. 38.
45 Temple Grandin, Thinking in Pictures, p. 58.
46 Temple Grandin, Thinking in Pictures, p. 78.
47 Temple Grandin, Thinking in Pictures, p. 33.

Notes to Social Behavior, Empathy and Emotion

131 Uta Frith, Autism: Explaining the Enigma, Cambridge, MA (1996) Blackwell Publishers Inc., p. 61.
132 Bryna Siegel, The World of the Autistic Child, New York (1996)
Oxford University Press, p. 45.
133 Temple Grandin, Thinking in Pictures, p. 95.
134 Diane D. Twachtman, "Methods to Enhance Communication in Verbal Children," Teaching Children with Autism (Quill), New York (1995) Delmar Publishers Inc. p. 135.
135 Temple Grandin, Thinking in Pictures, New York (1996) Vintage Books, p. 138.
136 Temple Grandin, Thinking in Pictures, p. 129.
137 Temple Grandin, Thinking in Pictures, New York (1996) Vintage Books, p. 134.
138 Uta Frith, Autism: Explaining the Enigma, Cambridge, MA (1996) Blackwell Publishers Inc., p. 169.
139 Susan A. Greenfield, The Human Mind Explained, New York (1996) Henry Holt and Company, p. 154.
140 Elizabeth A, Murray, "Hemispheric Specialization," Sensory Integration: Theory and Practice, Philadelphia (1991) F.A. Davis Company, p. 184.
141 Robert T. Schultz, Ph.D.(Yale Child Study Center),"Neuroimaging Studies of Autism: Static to Functional," Current Trends in Autism Conference (Oct. 1999) Notes, p. 26.
142 Robert T. Schultz, Ph.D, "Neuroimaging Studies of Autism," Conference notes, p. 26.
143 Temple Grandin, Thinking in Pictures, New York (1996) Vintage Books, p. 86.
144 Temple Grandin, Thinking in Pictures, p. 36.
145 Temple Grandin, Thinking in Pictures, p. 101.
146 Carol A. Gray, "Teaching Children with Autism to 'Read' Social Situations," Teaching Children with Autism (Quill), New York (1995) Delmar Publishers Inc., pp. 222-232. (Also, The New Social Story Book, Jenison, Michigan (1994) Future Horizons)

Notes to Communication and Conversation

79 Temple Grandin, Thinking in Pictures, New York (1996) Vintage Books, p. 50.
80 Temple Grandin, Thinking in Pictures, p. 50.
81 Bryna Siegel, The World of the Autistic Child, New York (1996) Oxford University Press, p. 105.
82 Temple Grandin, Thinking in Pictures, New York (1996) Vintage Books, p. 68.
83 Temple Grandin, Thinking in Pictures, p. 55.
84 Temple Grandin, Thinking in Pictures, p. 68.
85 Susan A. Greenfield, The Human Mind Explained, New York (1996) Henry Holt and Company, p. 98.
86 Temple Grandin, Thinking in Pictures, New York (1996) Vintage Books, p. 31.
87 Uta Frith, Autism: Explaining the Enigma, Cambridge, MA (1996) Blackwell Publishers Inc., pp. 92-93.
88 Uta Frith, Autism: Explaining the Enigma, p. 124.
89 Bryna Siegel, The World of the Autistic Child, New York (1996) Oxford University Press, p. 55.
90 Bryna Siegel, The World of the Autistic Child, p. 55.
91 Susan A. Greenfield, The Human Mind Explained, p. 96.
92 Temple Grandin, Thinking in Pictures, New York (1996) Vintage Books, pp. 53, 72.
93 Temple Grandin, Thinking in Pictures, p. 54.
94 Jean A. Ayres, Sensory Integration and the Child, Los Angeles (1991) Western Psychological Services, p. 120.
95 Jean A. Ayres, Sensory Integration and the Child, p. 120.
96 Temple Grandin, Thinking in Pictures, New York (1996) Vintage Books, p. 72.
97 Helen Tager Flusberg, Ph.D. "Understanding the Language and Communicative Impairments in Autism," International Review of Research on Mental Retardation, Special Issue on Autism (1999). Current Trends in Autism Conference (Oct. 1999)
98 Helen Tager Flusberg, Current Trends in Autism, pp. 59-60..
99 Helen Tager Flusberg, Current Trends in Autism, p. 64.
100 Helen Tager Flusberg, Current Trends in Autism, p. 72.
101 Temple Grandin, Thinking in Pictures, New York (1996) Vintage Books, p. 134.