Of sleep, physicality, language, attention, and behavior, I find myself least satisfied with Martin’s progress in language.

When Martin first started to talk, he marveled us with his vocabulary. He proved himself able to absorb and retain most any word or phrase, and to apply it properly. Fork. Book. Brick. That’s not a telephone. Goal! He grasped sophisticated concepts like possessives. Mommy’s desk. The bicycle of Lola’s father. What’s more, we’re raising Martin bilingual, so he did all this in both English and Spanish, never mixing the two. English for Mommy. Spanish for Papá and Samara, the nanny. Perro. Pato. Baño. Samáforo. Oy, ¡que tráfico! When friends came to visit from Germany, he added Keksen and Donnerwetter! into the mix.

We were proud. As first-time parents who have limited experience with young children, Adrian and I equated a large vocabulary, and the ability to repeat phrases, with exceptional language skills. We showed him off, pointing from object to object. Martin, what’s that? And that? That?

Only later, after it was explained to us, did we realize what was missing. Martin stuck to single words, almost invariably nouns, and to parroting series of words. He never concocted sentences. He never combined his words into original thoughts. He never asked questions.

He never said, “Yes.”

In fact, Martin was echolalic. He knew which words attached to which things, but he had no concept of language’s interactive use. “I” versus “you” was foreign to Martin. His conversation was limited to repeating what he heard last.

Martin, would you like some water?

Some water.

Martin, do you want a cookie?

You want a cookie.

Martin, may I kiss your tummy?

Kiss your tummy.

After six months of biomedical intervention, and almost nine months of five-times-weekly language therapy, not enough has changed. Martin has started using sentences, and also making original observations. Mommy is wearing a necklace. The house has a floor. And he can answer questions with yes, albeit sometimes on the second try.

Martin, do you need help?

You need help.

Martin, do you need help?

Yes.

But although Martin now seems to listen to, and comprehend, what others say, he has not achieved fully interactive conversation. He has not yet ever asked a question, other than regurgitating what is asked of him. What are you doing? What are you doing? He does not use the command form; in its place he substitutes either a declaration—Mommy is going to play the guitar, instead of, Mommy, play the guitar—or a phrase he associates with the outcome he seeks, such as Kiss your tummy! when he wants his tummy kissed. He can’t use pronouns correctly. You want to watch Johnny Cash means, I want to watch Johnny Cash. (If you’re wondering why my three-year-old son wants to watch Johnny Cash, just let it go.) Often he refers to himself in the third person, as if he were Elmo from Sesame Street: This is Martin’s bed. Martin is doing pee-pees. Martin is drinking kombucha. (If you’re wondering why my three-year-old son is drinking kombucha, probably best to let that go, too.)

So I am disappointed with Martin’s language at this time, because it just doesn’t seem to be developing at the same clip as, say, his behavior. I hope that, six months from now when I post a one-year review of his recovery, I’ll have better language news to share.

Until tomorrow, then. I’m off to kiss your tummy!

Martin’s body has changed. Before we changed his diet, Martin was lanky with a slightly distended belly. He hovered around the 90^th height percentile for his age but only the 50^th weight percentile. With the dietary changes Martin began to fill out. At last check he was in the 92^nd height percentile and the 78^th weight percentile. His belly, meanwhile, deflated. Now I wish for abs like Martin’s.

Martin’s head circumference was and remains large, and I don’t expect that to change. I understand large head circumference to be common in kids on the spectrum. I will, however, point out that my own father has a ridiculously giant noggin—well above the 99^th percentile, I know because a geneticist at the Big Imposing Hospital asked me to measure it, which I did with my yellow plastic sewing tape. Moreover, a person would be hard-pressed to declare Adrian small-headed either, figuratively or literally. So I figure that, with giant noggin-ness on both sides of his family, Martin was headed that direction from conception.

We were surprised to learn, when Martin first was diagnosed, that he had low muscle tone; he always had seemed able to run and climb, and it’s easy to mistake those actions for strength. But a neurologist at the Big Imposing Hospital said, and Martin’s excellent Track Two doctor confirmed, that his muscle tone was low. In fact, Martin’s trunk strength was so lacking that he slouched whenever he sat. The muscle-tone issues now have almost completely resolved. Martin’s physical therapist recently said that his muscle tone has become more or less indistinguishable from that of a neurotypical child.

Martin used to cycle in and out of lethargy. About three-quarters of his waking hours he spent in Tasmanian-devil mode. The remaining time he collapsed on the floor, maybe pushing a toy back and forth, without the energy to rise. I cannot recall the last time we experienced lethargy—Martin’s, that is; I’d be happy to enumerate the dozen or so times today when I felt lethargic—that was not connected with a sleepless night.

Until this spring, Martin did “posturing,” from discomfort: He clutched his stomach and leaned forward or squatted. He fell asleep posturing, in a quasi-fetal position or with his backside thrust skyward. He even postured while running, which might cause him to pitch forward and slide headlong across our hardwood floors. Though it seemed inappropriate from me and Adrian to laugh, we did. Occasionally.

Martin used to do a lot of “tip-toe walking,” or ambulating by shuffling his feet, heels off the ground. These days he uses a conventional heel-to-toe step, except on bad days when he reverts to tip-toe walking. Then a few reminders to do “big-boy walking” usually snap him back to heel-to-toe.

In terms of where we have room for improvement, of course I’d like to see the elimination of all tip-toe walking, unless Martin is, well, consciously tip-toeing, like in a game of mischief.  His coordination still needs work, too. I think we’ve come a long way since the Big Imposing Hospital scored him in the bottom 1% for manual dexterity. Nevertheless, his pincer grasp and objection manipulation still lag. Also, Martin is a klutz. (I blame this, like the big head, on Adrian. I won’t say “klutz” about Adrian, but the term “penguin feet” does come to mind.) If Martin is going to fulfill my—I mean, his—dream of playing the U.S. Open tennis tournament by age 20, we’ll need to stomp out the klutziness.

Finally, one additional aspect of physicality is appearance. And dagnabbit if throughout this entire process Martin hasn’t been getting cuter and cuter.

Or perhaps that’s just the mommy in me talking.

My last post, about my sleeping, alarmed folks. I received a number of concerned messages from friends and family. Even a phone call from my brother-in-law, who lives 5,000 miles away and wanted to tell me everything will be all right. Thank you, readers. I know that everything will be all right. And in fact, following through on my plans to get myself more rest just like I tackle Martin’s needs, I slept eight hours last night. Eight hours!

In celebration, I’m going to post about sleep again. Martin’s sleep, that is.

It was late January/early February 2011 when Adrian and I changed our plans for Martin and decided to treat his autism biomedically. From that point we needed about a month to get up and running—to convert his diet, to locate and visit a Track Two doctor, to find a professional to guide us through recovery.

That means we’ve been at this for about six months. I think now is an appropriate time to review how far we’ve come and to acknowledge what we still need to work on. I’ve divided Martin’s development into five areas: sleep, physicality, language, attention, and behavior. Over the next five days I will post about each of these areas, beginning with sleep, which is where we saw the fastest and most dramatic change.

Sleep was an issue from very early in Martin’s life. At about seven months old he woke erratically and cried sporadically throughout the night. I remember one particularly devastating week when Adrian was in Europe, six hours ahead of New York, on business. He was trying to concentrate on morning meetings while receiving middle-of-the-night emails from me, two and three per hour, complaining that Martin was up again, that I hadn’t even fallen back asleep since the last time. As soon as Adrian returned from that trip, we “sleep trained” Martin, using the Dr. Weissbluth method. The sleep training was tough (more specifically, tough love), but we got Martin sleeping through the night.

The success was short-lived. Not long after his first birthday, Martin developed even more severe sleeping problems. He became unable to settle himself, rustling about for 90 or even 120 minutes before he could fall asleep, then waking during the night or very early in the morning. Back then Martin slept in a large oval-shaped crib. When he started walking, he would rest his hand on the crib’s rail and run, around and around and around the crib’s interior until he dropped from exhaustion.

Once Martin moved to a toddler bed, the best chance we had was to restrain him physically. Either Adrian or I would sit next to the bed and pin Martin’s ankles to the sheets, to prevent him from goose-stepping in place. Martin would respond by thrusting his arms into the air until we held them down as well. Thus confined, Martin would flap his hands, wiggle his fingers, roll his head from side to side. He had to move. When he finally slept, it was in an odd position, often bent, his face pressed into the mattress and his backside aloft like a mountain peak.

The Big Imposing Hospital misdiagnosed this as “restless leg syndrome” and put Martin on iron supplements that stained his teeth. When the sleeping trouble continued unabated, they conducted an overnight sleep study, wired him up with brainwave sensors and breathing monitors. They found nothing.

By January 2011 Martin took one-to-two hours to fall asleep and most nights was awake, restless, for a three-to-four-hour window sometime between midnight and 6:00 a.m. On average, he slept through the night only once or twice each week, and in those instances he awoke at 5:00 or 6:00 a.m., unable to sleep again. Daytime naps didn’t help the situation; napping gave him the energy to keep himself awake even longer at night, sometimes until 11:00 p.m. or later. (His bedtime generally has been, and remains, 7:00 p.m.) We tried a weighted blanket, to no avail. He spent his days in bleary-eyed misery.

Almost as soon as we eliminated carbs (and sugar, and starch, and most everything else delectable) from Martin’s diet and added supplements, he began to sleep. As of late March, just for or five weeks into his recovery, Martin was falling asleep in 45 minutes or less and sleeping eleven-to-twelve hours through the night, five or six days a week. We still dealt with night waking one or two days a week, but the compulsive pitching about the bed ceased. Instead, Martin either lay still and chatted to himself or else laughed and acted drunk from his body detoxing.

As of today we more or less count on Martin sleeping through the night. If you’ve been reading this blog regularly, you know that we still have bad nights, and that we sometimes have two or three bad nights in succession, almost always related to Martin lumbering through a detox phase. But by and large, he falls asleep, and he stays asleep.

The quality of the rest has changed, too. He used to continue moving throughout the night. His head would be at the foot of the bed, then hanging off the side, then wedged against the headboard. Attempting to keep him covered was a fruitless endeavor. Now his head stays on the pillow, or at least in its vicinity.

Is there room for improvement? Always. I’m looking forward to the day when the detox nights end, so you don’t have to read posts like yesterday’s. I would like it if we could reduce Martin’s fall-asleep time to 15 minutes or less. And I’m sorry that we can’t allow Martin to nap. There are days when he looks like he could use an hour or two zonked out at midday. Can’t happen, though. Even a 30-minute nap keeps him awake until late into the night, and we lose precious hours of sleep.

Martin’s sleep is good, and getting better. My sleep is miserable, but hope springs eternal.