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Keeping the Possible Always in Mind

How Does the Communication of Pre-verbal Children Work?

When working with autistic or ‘non-communicating’ children, it is important to understand how very young babies communicate, long before they know or understand words. It helps our thinking to stay alive and creative, providing us with a model for interaction with a pre-verbal and/or non-communicating person. When a tiny baby cries, most adults feel the baby’s distress, pain, frustration, anger or loneliness inside themselves as if it were their own: they just know the baby is ‘saying’ that he is hungry or tired, dirty, frustrated or bored. They know what it feels like by relying entirely on their own inner emotional response. The mother clearly regards this as a communication from her child, asking for her to come and help him. With his crying the baby seems to ‘park’ his unbearable and painful feelings inside his mother in order to get her to understand what it feels like, and to get her to make ‘it better’. (Making another person suffer by letting them feel what we have suffered, by ‘giving them a cold shoulder’, for example, is of course familiar to all of us as a form of silent, but very powerful, communication.) Because mother can see things in perspective, she can think, and talk, about what he may need or want, and respond in appropriate ways to reduce his frustration.

Infant Research: Babies Are Born Able To Hold a Conversation

Early communication between a 3-month-old baby and her mother, or an adult and a 3-year-old autistic child whose communication is delayed at a mental age of around 3 months, is both very simple, and yet quite complex if studied in detail, as described below. They are the very ordinary moments that normally happen many times during the ordinary course of the day of a young baby. They are of a purely social nature and usually last only a few seconds or minutes. But the repeated experience of such social communicative experiences is vital for a baby to learn how to relate to other people. This is how he first learns about relationships and what it is like to be with another person. What his early and repeated experiences of this are, will lay the foundations of what he expects the world to be like. It will colour all subsequent relationships with people and his world. How much does his mother or caregiver adapt to his attempts at communication? How much can he himself adapt or change and influence the nature and feel of their interaction? Does it feel nice and safe and satisfying to be and communicate with another person? Or does it tend to be frustrating and difficult, or even painful, because the baby’s attempts are often misunderstood or ignored or frustrated? I will quote the communicative interaction of 4 minutes between a 3½ month old baby and his mother, beautifully described by Dr. Daniel Stern, one of the main infant researchers, in his book “The First Relationship. Infant and Mother”.

“A mother is bottle feeding her 3½ month old boy. They are about halfway through. During the first half of the feeding the baby had been sucking away, working seriously and occasionally looking at his mother, sometimes for long stretches (10 - 15 seconds). At other times he gazed lazily around the room. Mother had been fairly still. She glanced at her baby periodically, sort of checking, and every now and then looked at him with a good long look (20-30 seconds) but without talking to him or changing the expression on her face. She rarely said anything when she looked at him, but when she looked away toward me she often talked, and with much facial animation.

Until this point, a normal feeding, not a social interaction, was underway. Then a change began. While talking and looking at me the mother turned her head and gazed at the infant’s face. He was gazing at the ceiling, but out of the corner of his eye he saw her head turn toward him and turned to gaze back at her. This had happened before, but now he broke rhythm and stopped sucking. He let go of the nipple and the suction around it broke as he eased into the faintest suggestion of a smile. The mother abruptly stopped talking and, as she watched his face begin to transform, her eyes opened a little wider and her eyebrows raised a bit. His eyes locked on to hers, and together they held motionless for an instant. The infant did not return to sucking and his mother held frozen her slight expression of anticipation. This silent and almost motionless instant continued to hang until the mother suddeny shattered it by saying ‘Hey!’ and simultaneously opening her eyes wider, raising her eyebrows further, and throwing her head up and toward the infant. Almost simultaneously, the baby’s eyes widened. His head tilted up and, as his smile broadened, the nipple fell out of his mouth. Now she said:’Well hello! ...heelló...heeelloóoo!’. so that her pitch rose and the ‘hellos’ became longer and more stressed on each successive repetition. With each phrase the baby expressed more pleasure, and his body resonated almost like a balloon being pumped up, filling a little more with each breath. The mother then paused and her face relaxed. They watched each other expectantly for a moment. The shared excitement between them ebbed, but before it faded completely, the baby suddenly took an initiative and intervened to rescue it. His head lurched forward, his hands jerked up, and a fuller smile blossomed. His mother was jolted into motion. She moved forward, mouth open and eyes alight, and said, ‘Oooooh ... ya wanna play do ya ... yeah?...I didn’t know if you were still hungry...no... nooooo . . . no I didn’t . . . ‘ And off they went.

After some easy exchange the pace and excitement increased to a higher level at which the interaction assumed the form of a repeating game. The cycles in the game went something like this. The mother moved closer, leaning in, frowning, but with a twinkle in her eyes and her mouth pursed in a circle always on the edge of breaking into a smile. She said, ‘This time I’m gonna get ya,’ simultaneously poising her hand over the baby’s belly ready to begin a finger-tickle-march up the baby’s belly and into the hilarious recesses of his neck and armpits. As she hovered and spoke, he smiled and squirmed but always stayed in eye contact with her. Even the actual tickle-march did not break their mutual gaze.

After the finger-march had reached the neck and was punctuated with a final tickle, the mother moved back and away rapidly in her chair. Her face opened up and her eyes wandered off as if she were thinking of a new and even more irresistible plan for her next approach. The baby emitted a just audible ‘aaah’ as he watched, captivated, as she let her notions pass freely across her face, as if it were a transparent screen flashing the changing pictures in her mind.

Finally, she rushed forward again, perhaps a bit earlier and with more acceleration than the times before. His readiness had not fully settled yet, and he was caught a split second off guard. His face showed more surprise than pleasure. His eyes were wide and his mouth open but not turned up at the corners. He slightly averted his face but still held his end of the mutual gaze. When she moved back at the end of that cycle she saw that it had missed somehow - not quite backfired, but missed enough. The pleasure had disappeared. She sat back in her chair for several seconds, talking aloud to herself and to him but with doing anything, just evaluating. She then resumed the game. This time, however, she left out the tickle-march part and established a more regular and marked cadence in her actions. She moved in, more evenly, with her eyebrows, eyes, and mouth in dramatic changing displays that promided, but with less threat, to do what she said, ‘I’m gonna get ya.’ The baby’s attention was again riveted to her, and he began to show an easy smile with his mouth partly open, the face tilted up, and the eyes slightly closed.

During the next four cycles of the renewed and slightly varied game, the mother did pretty much the same, except that on each successive cycle she escalated the level of suspense with her face and voice and timing. It went something like: ‘I’m gonna get ya’ . . . ‘I’m gonna get ya’ . . . . ‘I’mmmm gooonaa gétcha’ . . . . .‘I’mmmm gooooonaa gétcha !!’ The baby became progessively more aroused, and the mounting excitement of both of them contained elements of both glee and danger. During the first cycle the baby stayed captivated by his mother’s antics. He smiled broadly and never took his eyes off her face. During the second cycle, he averted his face slightly as she appproached, but the smile held. At the beginning of the third sortie by the mother, the baby had still not resumed the full face-to-face position and had his head turned slightly away. As she approached, his face turned even further but still he kept looking at her. At the same time, his smile flattened. The eyebrows and the conrers of his mouth flickered back and forth between a smile and a sober expression. As the excitement mounted he seemed to run that narrow path between explosive glee and fright. As the path got narrower, he finally broke gaze with mother, appearing thereby to recompose himself for a second, to deescalate his own level of excitement. Having done so successfully, he returned his gaze to mother and exploded into a big grin. On that cue she began, with gusto, her fourth and most suspenseful cycle, but his one proved too much for him and pushed him across to the other side of the narrow path. He broke gaze immediately, turned away, face averted, and frowned. The mother picked it up immediately. She stopped the game dead in its tracks and said softly, ‘Oh honey, maybe you’re still hungry, huh . . . let’s try some milk again. ‘ He returned gaze. His face eased and he took the nipple again. The ‘moment’ of social interaction was over. Feeding was resumed." (Stern 1977)

The mental age of the autistic child is like that of a young baby, and so is his communication. What a child makes the other person feel (e.g. bored, helpless, lost, desperate, angry, etc.), can then become a crucial clue for understanding for any preverbal or ‘non-communicating’ children: making the other person ‘feel what I feel’. This may be an autistic child’s main way of communicating. Monitoring our own feelings, and what it feels like to be with a particular child, can give us vital information, and help to keep us in touch. Feelings of boredom or frustration in the adult may in part be a reflection of the child’s feelings. This thought-process can relieve a great deal of the adult’s sense of helplessness, providing her with something like a measuring-tape against which to check whether the repetitive activities of some autistic children are perhaps signs of boredom, of frustration, or designed to wind up the adult to force her into communicative (although negative) interaction. She can then test her hypothesis and suggest an alternative to the child, which the child may confirm and take up, - or not.

Behaviour is a Language

The thinking of this book does not follow a behaviourist model, which believes that behaviour is predominantly learnt by imitation and can be changed through behaviour modification, reinforcement and other training. Instead, this book takes the view that all human behaviour is the result of complex processes in a person’s mind, whether adult, child or baby. Children bring and develop, already as newborns, their own ideas, theories, anxieties and expectations in their mind, whether autistic or not. A person’s behaviour is an emotional language with conscious and unconscious meanings. It is never just a superficial manifestation of symptoms that can be changed, modified or corrected, as with a machine or when programming a computer. One of the most powerful movers (and stoppers!) of mind is of course anxiety: how the newborn, baby, child, and adult manage to deal with the frightened feelings assaulting them from within, determines their behaviour and mental development.

Understanding of this comes from a detailed observation of a child’s responses and behaviour over time and in different situations, together with psychological understanding of how a young child sees and experiences himself, the world and other people at particular stages of his mental-emotional development. The observer takes a wider view on the child’s behaviour, keeping in mind what she knows of the child’s previous life-experience, his expectations of the world, how he has reacted to difficult events in the past as well as his developmental level. The focus of this book is on careful observation with a ‘wide-angle’ view and a keen interest in the workings of a person’s mind.

Addressing the Autistic Child at his Level of Developmental Delay

If development has slowed, stopped or never started, the child may be delayed or arrested at a certain chronological point in his or her development, which may look like organic deficit and may even be diagnosed as non-specific brain-damage, or of genetic causation. But judging the ‘developmental age' of the child is crucial for seeking opportunities to amplify traces of communication, vestiges of play, glimmers of social curiosity. Explanation based on close observation,and careful monitoring of the emotional atmosphere and any changes in it, allow for a differential diagnosis. Children with superficially similar behaviour and symptoms may be more, or less, 'on the side of life': of two autistic children with bizarre stereotypical behaviours, one may quite happily, even gratefully, accept our invitations into a more communicative world of people and relationships (Patrick, Jazzy, Ryan, Wesley), while another may steadfastly refuse to have anything to do with it (Tim, Kofi, Adrian). Some symptoms which seem to be primary (not responding, not hearing, not looking, stereotypical movements, obsessions, rituals, etc.) may in fact be secondary, and in response to an earlier developmental disturbance or event. The mental and emotional age of many autistic children with a chronological age of 4 or 5 years, or older, is usually like that of a baby between 4 and 9 months: while the autistic child looks like the 4-year-old he is, his mentaldevelopment is delayed, and like that of a 4 month old. It is from this early level of development that the autistic child needs help to catch up with some of his delay.

All development is a process of growth that follows a certain natural course where each new achievement builds onto the previous one. No plant can flower without first having grown roots and leaves, no animal can run before having learnt to stand on its own feet, and no human can learn to speak without first having been received into the loving arms of a close-enough relationship, where he learnt how to relate to other people and to take turns. If certain developments have stopped at the age of 3 or 5 months, we need to know what we can reasonably expect a baby of this age to be, biologically and mentally, capable of doing. We can then decide on reasonable expectations in terms of social behaviour, play and language: which play-activities, games and toys are appropriate, and where the adults' language to the child should be pitched. Understanding of this kind, including the notion that all developmental levels (from newborn to actual age) may be present at the same time, can lead to effective therapeutic interventions by parents and professionals together. We may then be able to take the child, slowly and step by step, a little further along the developmental path. How far we can go, and how much of the delay may already have become a deeply engrained habit of life, remains to be seen. But knowing how to communicate with very young babies puts us at least in the right frame of mind to communicate more sucessfully with an older child with the same mental age.

There are Non-Autistic Aspects in Every Autistic Child

Fundamental to this book is the conviction that in any person, adult or child, whatever their difficulties, disturbance, disability or developmental delay, there will always be, by definition, at least, traces of healthy human potential for being the social animals with complex emotions and fantasies we are ‘designed’ to be. In every human being there will always be non-autistic aspects, - even in the most autistic child. Somewhere there is a reachability in every human being. But with the autistic child, it may be up to us adults to find the points where he can be reached, to promote this non-autistic human potential, and to help him to expand and develop this as much as is possible.

This book aims to address and reclaim potential non-autistic aspects in a child who lives somewhere on the autistic continuum. It is a bold attempt to find such non-autistic pockets, to kick-start the engine, to speed up the tortoise where it has slowed or come to a halt. It tries to re-kindle, enliven, strengthen and develop aspects essential for ordinary development, to get the momentum going and to re-awaken the developmental process where it has stopped, slowed, gone askew or off course. The adult’s task is like that of the traffic-police waving one line of cars (the ‘non-autistic’ ones) to go, to get going or to speed up, while ordering another line of cars (the autistic ones) to stop, slow down, to go away. Similarly, some of the child’s non-autistic potential may need encouraging because it is age-appropriate and in the service of his or her mental development (even though it may be challenging for the adult), while other behaviours must not be endulged and firmly discouraged. Firm and clear boundaries are as important for the autistic as for any other child, if not more so. But the autistic child needs so much more adult-activity.

The adult’s role has also been compared to that of an orchestra-conductor, having to keep his eye and mind on a large number of different instruments and players all at the same time. Skillful attention and total concentration are required to keep in mind each player’s part in the score: to pull together the different instruments, to moderate, regulate, envigorate, alert, temper, curb, some or all simultaneously. The acoustics of the hall, the nature of the audience, and the occasion also need to be borne in mind. Some of the underlying, and complex, mental mechanisms of autism can be understood, moderated, and in some cases remedied. Such an approach can offer some modest hope, and perhaps be a life-line, from the despair that comes with the diagnosis of ‘autism’. While there is no way of predicting what the outcome will be, with increased understanding quality of life for all concerned can at least be enormously improved.

The autistic child needs to be enticed into human communication and interactive games, before idiosynchratic behaviours become rigid and marked. We want to whet his appetite for more of this typically human social ‘stuff’ called communication, interaction, play and games. We need to show him how much fun it can be! Perhaps he had never realised it before! Just before the cognitive spurt that occurs through biological maturation around the age of 5 years, much of the foundation needs to be laid for all later development to build on. It is in these early years that habits are formed, that the points are set, that determine the course of a child’s further behavioural development. The autistic child who gets used to lolling around all day without ever being challenged into more purposeful activity may come to believe that this is how life is meant to be. When he is 6 and asked to hold a pen at school, he is likely to feel cruelly bossed about and asked to do unbearably hard work. Try changing his view of the world then! He’ll fight you tooth and nail! And what is worse, he is likely to win!

What Can I Do With That Glance, That Sound, That Nod?

The ideas in this book are based on the strong belief in the benefits of being pro-active, with a strong conviction that play is growth-promoting. Always tugging lightly (or at times more strongly) at the child’s potential to join in and to enjoy some communicative interaction with another person, this book has the possible always in mind. Alongside careful and attentive observation, there is always the question “What can I do with that?”: there may be a glance, some sounds, a movement of the child’s hand or foot, which can be echoed and turned into a little interactive game by the adult. Running away can be made into an interactive “I’m gonna getcha!”-game of the toddler-sort, or a less pushy version of “I can still see you!” for those children who get too scared by someone following, catching and tickling them (see chapter 26). Even repetitive activities, like lining up cars can, with a little imagination from the adult, be turned into a more purposeful, meaningful and interactive activity.

With Ryan I spent what felt like hours stuffing fallen leaves into the cracks between the paving-stones in the garden. Although this did not ‘achieve’ anything useful, it turned his aimless running into a shared purposeful and cooperative activity, with me pointing out or handing him leaf after leaf and together looking for spaces to fill.

In Ryan’s case there was a marked relief in doing something less aimless, but this is not always so with all the children. To some the pull back into their hypnotic world of self-stimulation seems almost unsurmountable and needs much patience, sensitivity and perseverance from the adult.

These games have in common the same framework of how one would invite and engage a baby into playful communication. They almost always start with the adult surprising the child, perhaps with an unexpected movement, or talking to him in a way that creates a definite sense of suspense and anticipation which the child cannot affort to miss, perhaps claiming and holding his attention through urgency in the tone of voice. In this way the adult can not only focus the child’s attention, but also hold and direct it by the use of her voice. Timing and regulating are crucial, as is the building of rhythms, perhaps slow or more enlivening, depending on each individual child, but usually only ‘a little bit different’: if too different the response is often avoidance. But ‘a little bit different’ is usually acceptable, needing to be measured with the child’s, not the adult’s measure of length. In this way the emergence of structure, memory, anticipation, expectation, friendliness, intentionality, fun, curiosity, meaning, etc. can be encouraged.

Counteracting Anti-Developmental Tendencies By Holding On To Common Sense Boundaries

Common sense measures like clear boundaries and expectation are crucial if we want to help the autistic child take a bigger share in our world of relationships and people. But with the onslaught of the desperate or furious tantrums of a small child who seems hell-bent to do exactly as he wants, it is easy to lose one’s common sense. The autistic child in fact needs clear limits in his life like any other child, only more so. He may have fallen prey to his own anti-developmental tendencies, that boycott the development of his non-autistic potential. Such anti-developmental tendencies have an astounding tenacity. Their addictive powers are huge, and he may not have the inner strength to resist them by himself. He needs a great deal of adult help to learn to resist the stickiness of his habitual repetitive activities or withdrawals, and to rechannel his mental functioning into more developmentally promising ways. Clear boundaries, administered with clear but gentle firmness, are essential here. It is a marked autistic tendency to insist that you can do whatever you like and that, if only you keep pushing, you can force the world to let you do it your way. While this seems a powerful thing to do, it does of course back-fire. It is important for the adults to try to protect the child from feeling afraid of his own power back-firing on him: a 4-year old’s tantrum is an extremely upsetting experience for any adult. But how much more frightening for the child to experience himself turning into a ball of uncontrollable fire and rage! People sometimes forget about that! We need to step in beforehe explodes, before he slips into the limp boggy world of mindless nothingness, like Tim and Robby!

It is here that carefully thought-through and sensitive intervention can not come early enough, in order to prevent the development of too limiting a behaviour-pattern and, at the least, a further slide into the addictive autistic world. Repetitive and sensory activities have a hypnotic effect that is used to reduce the amount of stimulation coming from the outside. The self-soothing or enveloping effect of this way of dealing with the world, which has no need for a caring relationship with another person, is one of the autistic child’s core-features. Many autistic children are indeed very sensitive and easily overwhelmed by too much stimulation, others however need more. But all need an adult who is sensitive to their individual levels of tolerance of, and need for, stimulation to gently pull them out of their reduced world of auto-stimulation into a less sensual and more alive animated human relationship.

An Autistic Child is Always Surrounded By Lots Of Feelings

There is generally little written about the autistic child's emotional life and experience in a way that adds real depth of meaning to explaining some of what he does. Despite his uncommunicativeness, there can be no doubt that the autistic child is full of wantings, longings, fears and anxieties. Naming the feelings becomes all important not only for the child but also for the adults, because ‘naming is taming’ (see chapter *13).

Autism evokes a very powerful response in any fellow human being. With some children we feel we are confronted by a cold determination to stay withdrawn and to keep us out. We may be overcome with a terrible sense of tiredness and boredom when watching the ever same habits or rituals, we may be angry about being ignored so insistently, or as determined to make him cooperate as he is not to. These are painful feelings to acknowledge. It makes us feel so bad. But once the adult can name and tolerate the feeling, puts her in a position to think about it, especially ‘Who does this feeling belong to: myself or the child? Who is bored, me or him?’, and to find ways of making constructive use of it. All this is often easier said than done, as owning one’s feelings when with certain autistic children may lead one to become aware of nothing more unthinkable than hating him because of his autism, or hating his autism and feeling sorry for the poor afflicted child, or hating oneself for being so ineffectual at working with him. Anyone living or working with an autistic child is bound to feel incompetent, helpless and useless much of the time, to the degree that one may feel that there is no point in trying, that it is all too much, and that the enormous effort, that would be required to get through to this child, is not worth making. The hopelessness which comes with this, bears the risk that the adult misses genuine spontaneous (tiny) communicative moments slipping into a mental attitude similar to the autistic child’s ‘mindlessness’. But keeping an alive mind, against the autisitc impact that aims to deaden the mind, is crucial for the well-being of all involved.

“No Climbing, Max!” and “What Else Can Max Do?”: An Interactive Example:

To illustrate the above points here is an interactive example of 4-year-old Max at his nursery. His nursery-workers were desperate. New children were being settled in, an unsettling time for everyone. Every adult was needed to make each new child, and their parents, feel comfortable and welcome. But without a constant one-to-one Max just wrecked the place. He also did dangerous things like climbing, and anti-social things like throwing sand, and upsetting other children by pulling toys from them or messing up their work. What would the new parents think? This small nursery had recently received an excellent Ofsted report. But staff talked about feeling useless and incompetent. So I volunteered to be the one-to-one person Max needed. By the end of the day, I knew only too well what the staff meant:

Max arrives appearing lost. He wanders around, grabs the odd toy, throws it. He wriggles away from any attempts at involving him to play with a toy, in order to climb on the cupboard. Standing on a wobbly pile of books for height, he is about to climb on top of the gerbil-cage. I lift him down, telling him gently but firmly “No climbing, Max!” He screams, walks off, swishing toys off a table, and climbs onto the drawing table. “This is climbing, Max! You need to come down!” I tell him, thinking that he may not understand what is meant by ‘no’, by ‘climbing!’ and by ‘no climbing’. He slips on some paper, catches himself as not to fall off. A box of pencils goes flying everywhere. I lift him down repeating “No climbing, Max!” When I turn round, he has climbed onto the cup-board again and is about to stand on the gerbil-cage, ... (and so on...) ...

A water-tray is set out for him especially. He is no longer allowed to play with the taps, as he has flooded the bathroom so many times. He fills up a play-beaker and puts it to his mouth, so the water flows both into his mouth and down his face and onto the floor, again and again. I show him about pouring, but he shrugs off any interference angrily and successfully, to continue to drink and spill the water. The beaker is taken away, to allow him to use his hands to play with the water. He grabs another one, with more water pouring onto the floor. The beakers are put away. He sucks the water from his hands, and then begins to climb into the water-tray. He is stopped, and screams, insisting to climb in. He is lifted down, and goes to the bathroom. He is brought back to the water-tray. He makes for the bathroom again. “Sorry, Max! But you can’t play with the taps today!” As soon as no-one is looking, he sneaks into the bathroom to turn on the taps full-blast filling the sink to the brim, letting it overflow and sticking his finger up the tap squirting water everywhere.

He is taken to the other room, where paint and glue have been put out. He grabs a glue-pot and, quick as lightening, he sucks glue from his fingers before anyone could stop him. Reluctantly he accepts to sit down. While I tell him “Look, Max, here’s a spreader”, handing it to him, he has grabbed another glue-pot to eat more glue. When I take it to put the spreader into his hand instead, he screams, kicks back the chair and reaches for another child’s glue-pot. The child screams in protest, Max grabs harder and screams too ... Taken away from the glueing-activity, he runs away and pushes a child off the chair she is sitting on, to climb onto the drawing-table again. She resists and screams, Max pulls her harder, and I intervene: “Sorry, Max. But there’s no climbing!” A teacher comes to comfort the little girl. Max drifts over to the sand-tray. Before I can get there (and I am pretty fast!), he has thrown 2 handfuls of sand into the room and over other children. The children scream, the new mother rushes to brush the sand off her little boy, his key-worker apologises. I hand Max a bucket and spade, keeping my eyes on his hands and my hands within an inch of his. He screams when I stop him from throwing more sand, and chucks bucket and spade instead. ‘It’s a good opportunity to practice my patience’, I think to myself, feeling exasperated, helpless and not far from wanting to strangle him or run away myself. Then I think of Max and what he may be feeling. The same exasperated frustration, maybe? “Gosh, it’s frustrating! What can Max do?’” I offer in an attempt to catch and contain both our feelings in words. I feel I have been chasing after him for hours, but when I check the time, only an eternal-feeling 25 minutes have passed!

I feel both of us need cheering up: I throw him in the air and catch him. He laughs with excitement. ‘Oh, good!’, I think, ‘now we’ve got a game!’ I put him down. He wants me to do it again. I wait for him to ‘ask’. I am prepared to wait for a long time, but also to accept any genuine communicative attempt from him. He tugs on my clothes. “Oh, you want me to do it again?”, I say and, pretending to be a quite a bit slower in understanding than I really am: “What exactly do you want me to do?” Speaking in a dramatic and larger-than-life manner I manage to attract him to look at my face and I make all the effort I can to hold his attention firmly with my eyes and responsively smiling face. I take his hands and ask him “What is it you want?” and “What can Max do?”, while playfully pulling him to and fro in a rhythm, in what the famous child-development expert Gesell calls ‘gross-motor humour’ (reference). Max laughs and looks at my face. This is the clue I had been waiting for, and I throw him up again. ... For the first time today, it feels good being together. We play like this for a little while. Then he wanders off, towards the bathroom. I say a playfully threatening “I am watching you!?!” He turns to give me the briefest of grins, and walks to the easel instead. I am stunned.

The day continues much as above, but with one big difference: Max and I now have a shared understanding of a mutual game, that even Max finds more fun than his lonely climbing, throwing or water-play. While at first he had appeared so lost, wandering around, throwing something here, climbing somewhere there, in a world without meaning, with nothing in it he really seemed to enjoy, now something does make human sense! Where, before, nothing seemed to make sense, where he seemed driven just to get away from whatever was on offer by climbing, not settling and walking away, where he was driven to get rid of whatever could have occupied him by swallowing or throwing, where nothing seemed to be worth paying attention to or playing with, - there is now our shared game of ‘gross-motor humour’, that makes sense just because both of us know and understand our game: he knows that I know that he knows what our shared game is. I know what is likely to catch his attention and make a big effort to hold it, and he gradually realises that I think that he can play a more actively communicative part in our game, than he had come to think. Suddenly, during those little interactive moments, ‘getting rid’ of ‘it’ is not the most pressing thing for Max anymore (chapter *). Suddenly it is more important to keep this game going, to get me to do whatever just made him laugh again. This means he is motivated to communicate with another person. What a change from the boy from before, who was so intent only to get away and get rid of whatever ‘it’ was!

With his little backward glance, that so clearly was a communication addressed to me, Max had also shown, how much he needs someone to keep him in mind, to keep their eyes on him and to remind him that he is not alone. It also indicated how much Max is aware of, and appreciates it, when someone keeps him ‘live company’! But before I could do so, I had to stand in his way in order to make enough of an impact for Max to take note of me. Had I not done so, I would just have become another ‘it’ to be brushed away and got rid of. Only once he had come up against the wall which was me, blocking him again and again from climbing, throwing, eating glue, flooding the floor, and other essentially mindless ‘get rid of’-activities, was he able to notice that I was there, and had some unsuspected human uses. But I had not just confronted him with a brick-wall. I had shown him that, while there were firm and solid boundaries, e.g. ‘no climbing’, ‘no throwing’, ‘no flooding’, he was safely held and contained by the firm focus of my mind on him, not unlike an unborn baby by its mother’s womb (see chapter ... inside baby). Every time he came up against me or happened to look into my eyes, he found me totally focussed on him. This helped Max in turn to focus and to manage to pull himself together, as can be seen in his little backward glance at me. It felt as if he in fact wanted me to stop him from mindlessly trying to get rid of everything, and to show him something else to do. This I managed eventually by inviting him into a social game. It is important not to leave such a young child alone with the boundary we set and the ‘no!’, but to facilitate the transition for him. In this way, Max may learn a little of what it takes to deal with the unfamiliar rather than just getting rid of ‘it’. Needless to say, I was exhausted. But had it not been worth it?!

For the autistic child events and occurrances have not become meaningful in the same way we take so absolutely for granted. His world does not make sense. His mind is ill-equipped to deal with the emotional content it relates to. His feelings are not meaningful to him, nor is what other people do, think and feel. His world is dominated by appearances, which he clings to like a ship-wrecked sailor to a wooden plank. If he feels thrown up and down by inner waves of unnameable feelings, he clings even more ferociously to his plank. If dark shapes appear somewhere in the distance (or glue and paint on the table) or something feels sharp to the touch of his hands or eye (like sharp-looking legs sticking out of play-animals), he bites and swallows what he thinks might attack him, he screams to scare off any frightening persecutor (including his mother and key-worker when they want to protect and play with him!), he struggles to get away, he fights (or runs or climbs!) for his life! He does not, he cannot, deal with it, think about it, find other ways of dealing with it. He does not realise he could hitch a ride on the fishing-boat, or the dolphin that keeps playing around him, - or sit down and play with that adult who has been trying to make contact with him, unsuccessfully, all this time.