ASD Recovery Six-Month Review: Attention

As I described in a previous post, Martin almost always had sleeping problems. The Big Imposing Hospital fired a variety of diagnoses at the sleeping issues—Restless Leg Syndrome, anxiety, improper home environment—hoping one would stick. No one there connected Martin’s inability to settle himself with autism, and neither did we.

No, the beacon of Martin’s real issue, for me and Adrian, was instead his attention. Or rather, his lack of attention.

Sitting and paying attention is difficult for a two-year-old. For Martin, it was infeasible, for any length of time. Unless lethargy overcame him, or he was strapped into a high chair or stroller, he simply could not stop moving and sit down. In the event he was able, with the “assistance” of an adult, to sit, he lasted only moments before becoming agitated. His toddler soccer class, which consisted mostly of toddlers scattering, gamely accommodated his unique style of participation. His pre-pre-school class for two-year-olds, on the other hand, kicked him out. Martin required an extra teacher to keep him from disturbing the class, they said, which was an amenity they were not willing to provide.

Back then Martin lacked joint attention. He did not engage with other children. He did not follow what they did. He did not imitate. He did not involve his parents or Samara in what he was doing. He commented on what he saw—Airplane! Moon! Mailbox! —but the soundtrack seemed to be for his own amusement; he made no effort to make sure we shared the experience. Indeed, he spent much of the day in Martinland, a private island of his own making, inhabited only by him, in his own head.

He responded to his name maybe 20% of the times we called it. On a good day.

He often drifted about the perimeter of the room, running his hand along walls and heat registers, apparently aimless. He kept his obsessions (musical instruments) constantly in hand. Other toys and books, however, he yanked from the toy chest and then dropped after no more than a second or two. We never saw him play with those toys in the manner in which they were intended, or in any manner. A toy truck might as well have been a stuffed zebra, from Martin’s perspective. They both ended up discarded.

And of course he had the shifty gaze. He avoided eye contact. If I forced him to meet my eyes, if I cupped his face to mine and used my palms as blinders, he cried immediately. One day last fall, before the official diagnosis, a girlfriend of mine squatted to address Martin in his stroller. Though she was no more than 18 inches from him, Martin gave no indication that he saw or heard her. He looked to some distant point, in a kind of fog. My friend asked, not unkindly, “Why is he doing that? Is something wrong?” I responded that we really should get going.

As of today, Martin seldom visits Martinland. The aimless wandering has stopped. He responds to his name 80% of the time, I estimate. Eye contact is regular and routine. As for joint attention, he has not advanced to typical three-year-old behavior, which would be calling Mommy! Mommy! or otherwise seeking my attention before he speaks. But he has started to look at me (or Adrian, or Samara) when he does speak, to make sure that we’re listening. He no longer releases comments into thin air. He now directs them toward someone. For example, if he’s watching Sesame Street and someone dives into the water, Martin shouts, “He’s in the water!” and then turns to make sure we saw it too.

Slowly he has begun to engage with other children. Usually the other child has to initiate the play. Once that’s accomplished, Martin joins in happily, such as chasing and seeking to be chased, or sitting in a playhouse. He shows an interest now in what others are up to. Last week he played for some minutes with a girl he knows, climbing playground equipment and running together. The fun stopped only when she wanted to catch and throw a ball, which is a physical skill Martin is yet to acquire.

Despite the improvements, attention is an area with room to grow. According to the teachers at his last school, Martin continues to have difficulty “attending,” which seems to be the official word for “doing what the rest of the kids are doing.” When the class sat in a group, Martin required constant redirecting to the task at hand. And the gulf still stretches between Martin and other kids when it comes to wanting others to see what he sees. I await the day when Martin approaches me with Mommy! not because he wants a cracker or drink or cuddle, but because he wants to tell me something, to relay some observation, be it earth-shaking or trite.

Overall, though, it is fair to say that over these past six months Martin has become more present. He is more with us, more in our world.

We couldn’t be happier to have him.

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