December 1st, 2011

Work with Asperger’s children highlighted

For children with Asperger’s disorder, along with parents, educators and mental health professionals who work with them, establishing relationships can be difficult and frustrating but not, as it turns out, impossible. For years, the professional line on children and adults with Asperger’s and autism was that they were not capable of certain levels of emotional connection. But the people on the front lines knew differently from working with individuals with these conditions and recognizing their uniqueness.

Richard Bromfield, Ph.D., a faculty member at Harvard Medical School and a clinical psychologist with a practice in Brookline, Mass., has worked with Asperger’s children for more than 30 years and has experienced first-hand the type of emotional relationships that are possible with them. He spoke with New England Psychologist’s Catherine Robertson Souter to discuss several new books he has written (including “Embracing Asperger’s: A Primer for Parents and Professionals”) about his work with children both on the autism scale and those who are just dealing with the pressures of modern life.

Q: You say that conventional scientific thought on the treatment for Asperger’s is basically wrong. Why?

A: Many years ago Bruno Bettelheim (1903-1990), the director of the University of Chicago’s Orthogenic School for disturbed children, made a fatal mistake. He said that emotionally cold mothers caused the autism of their children. This theory was tragic and cruel and wrong [but it became the leading theory in treatment].

Then came an important understanding that autism is based in neurology and not in bad parenting. That led to all kinds of changes in education and intervention. But the pendulum swung so hard in the other direction that it denied the child with Asperger’s even has an inside, with feelings, emotions, thoughts, yearnings for closeness or any social interests. Thus, any therapy that was based on understanding and talking and feelings was tantamount to quackery.

In my experience working with children for the past 30 years, they have insides just as rich as anybody else. If it is true that these children have basic neurology which creates limitations that make communication and social interaction difficult, why wouldn’t those experiences need to be considered and confirmed or affirmed as much as anyone else’s?

Q: This does not sound like groundbreaking theory. It sounds obvious.

A: It’s funny because my view seems basic but it is kind of maverick compared to the conventional wisdom of the past 40 years. For instance, The Journal of Autism and Developmental Disorders was founded in 1970 and one of its missions is to look at anything related to the treatment of autism and autism spectrum. Last summer, I tallied up 2,300 articles and there was not one about doing therapy with these children.

For a lot of front-line therapists, this is old news because they have been working with people like this and forming strong healthy relationships with them for years even if experts will tell you that is impossible or imprudent.

Q: Is it more difficult to make connections work?

A: You have to make some accommodations but they long for relationship attachments as much or more than anyone else. This is the ironic cruelty: when you are built this way you get deprived of the very kind of experiences you need because you are not as good at the emotional stuff and people avoid you more. Often adults get frustrated because they can’t reach you in the way they want to. That’s quite a burden for the child because they can feel that people around them are not happy with them. They can’t articulate it like that but they can tell something is wrong.

I think that is why a lot of children withdraw into solitary activities. It is exhausting going through daily life with pervasive misunderstandings.

So, the whole heart of my books is about the need for physicians, parents and educators to try and be empathic, to really understand and feel what this experience is like for these children, including what it feels like to be with you.

Q: Is your work based on studies?

A: I don’t do studies; I am a clinician. People who do studies may see thousands of children with Asperger’s but they are only seeing them for a very short time, whereas I’m someone who sees a small number of children for thousands of hours. Some say my experience is just anecdotal but I don’t buy that. If you traipse through a jungle you will not see anything in an hour or two. But, if you sit for weeks or years, animals will come up to you and trust you and you will learn all about them, how they live, how they communicate.

Hopefully, science will help us understand what causes autism and will find ways to alter things, with medications etc., but nothing will replace the significance of having a relationship with another human being who cares about them.

Q: Have you heard any feedback from parents?

A: I did a piece in the Huffington Post and we got letters from parents who say, “Finally, someone who understands that my child is a real person with something going on inside them.”

Even more moving were letters and comments from adults who said that they have gone through their lives feeling like no one gave them credit for being real people. There have been a whole flurry of books written by talented adults that describe growing up with autism and being denied what they felt was meaningful.

Q: You have worked with kids since 1981. What have you seen these children grow into?

A: Well, one classic example was a child who was aggressive and they said was maybe retarded but as he grew up, he turned out to be gifted. He went to a top engineering school and has become self-supportive, has close friends and a significant career and is a member of the community.

What is remarkable is the places where they thrive as adults, places related to creativity. They can be found in medical schools and financial centers and Silicon Valley. Look at any kind of life that requires creativity and you will find a lot of people with Asperger’s who are extremely creative.

Q: You have also written “How to Unspoil Your Child Fast.” That title must have gotten a lot of attention.

A: Actually, the title is not so good for selling it. I know someone who is a marketing professor and he said to me that the title stands out, it is so grabbing but you can’t recommend the book to anyone. It makes it look like you’re telling someone their kid is spoiled.

The book is not saying that it’s really so much that parents are doing a bad job, but that society is making it harder not to have spoiled children.

When I grew up in Revere, it was easier for parents to say “no.” It was easier because everyone’s parents were saying no and there weren’t as many choices, either. For instance, there were Jack Purcell sneakers and there were white or black. Now it is stressful to go get running shoes. There are thousands of choices.

And it’s not that parents back then were so great and now they are not. We are all products of our society. We are all struggling with a world so affluent and in our faces.

The book is about learning how to fend off pressures that are so big and beyond us.

Q: So, what are the solutions? How about having them help pay for the shoes they really want?

A: Any time you involve the child in bearing the responsibility of cost or working for things, they have more meaning for them. A lot of it is common sense. If you get everything you want, you can’t learn gratitude. If you get all you want the second you want it, you don’t learn patience.

We may think we are giving our child gifts but we are really taking away bigger gifts. Resilience is confidence in knowing you can deal with life. 

By Catherine Robertson Souter

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