Cuddly Black-and-White Bears, or Blood Sucking Worms?

PANDAS. I have a gut feeling. It sounds like PANDAS,” said my friend Stacey.

“But he’s never been a PANDAS kid,” I replied. “Plus, it didn’t come on that fast. The doctor thinks it’s parasite-related, thinks he picked up something new in Costa Rica. He’s always been susceptible to parasites.”

“Doctors can get stuck on one idea and want to make you fit that box. All I’m saying is to make sure you also look into PANDAS.”

“I hear you,” I said. “Can you get me the info on which tests to run for PANDAS? I’ll see if I can get them done before our appointment.”

This discussion, which could only have taken place between biomed parents, was about what’s been going on with Martin. Poor Martin is not in a good place. The troubles (the exciting new troubles, atop the quotidian troubles) started in Costa Rica, maybe halfway through July. I began to notice that Martin wanted to go to the bathroom all the time. Sometimes he would go to the bathroom, brush his teeth to leave, then need the bathroom again before we could get out the door. He started spending a long time on sitting on the toilet, too. Near the end of July he developed a tic: He thrusts one index finger simultaneously into each nostril—briefly, with no rooting around or picking, thank heavens—and then immediately puts his fingers into his mouth. The whole action is over within a couple seconds, but it’s noticeable, and recurring, and out of Martin’s control. Next came the eye rubbing. Since our return to the States, Martin has been rubbing his eyes compulsively. He asks, “Why is this happening? Why can’t I stop rubbing my eyes?” As we made our way into September, he started night-waking, and having trouble getting to sleep.

None of the symptoms dissipated as the new ones arose. As of today, Martin is sleeping poorly, rubbing his eyes till they look red and sore, patterning his index fingers into his nose and mouth constantly, and using the restroom multiple times per hour, sometimes staying in there 10 minutes or more.

Wait—did I mention touching his private parts? Now he’s doing that, too. If we gently remind him to watch his hands, he complains that it is hard.

I’ve already received several reports from school. Martin seems distracted (even more than usual, I assume). Martin walked into a wall. (Yes. That was one report.) Martin is signing out of the classroom to go to the bathroom several times an hour.

When the bathroom issues and first tic arose, in Costa Rica, I thought that oxalate sensitivity might be at play. I reduced oxalates in his diet, which was not easy, as he loves potatoes and sweet potatoes, and making a meal for the whole family (I’m vegan) usually means using some nuts, or legumes. A few weeks of reduced oxalates brought no change, unless you count a worsening of the symptoms.

Back in the States, I brought Martin to his pediatrician, to rule out a UTI. His urine showed no trace of problems. The pediatrician thought Martin might be constipated, which can cause frequent urination, so I worked prunes and pears into his daily diet. No change.

Martin is prone to parasites, so I gave him a course of Alinia, which has worked in the past. No change.

I called Martin’s primary doctor for autism issues. She suspected parasites also. Together, we decided to move Martin’s previously scheduled appointment from the end of October to this coming Monday.

Then I went out to dinner with Stacey, and we had the conversation with which I began this post. I agreed to get testing done for PANDAS, but to be honest, I was skeptical. Martin has never been a PANS or PANDAS kid. I can’t recall flares, or his behavior changing those few times when he’s been on antibiotics. Later Stacey texted me a link to basic information on PANDAS and wrote: “Seriously please read this because it does state urinary frequency as a sign of PANS and/or PANDAS. I would really look into this as a potential cause. I could be totally off base but I have just a gut feeling.” I opened the link, and one specific reported symptom of PANDAS struck me: poor handwriting.

Though I hadn’t thought much about it, or connected it to the urination and tics (probably because I’m bone-headed), I’ve noticed that Martin’s handwriting has been abysmal since he returned to school. Not just shaky or unplanned, as his handwriting usually is, but truly abysmal. Almost illegible.

PANDAS? Stacey’s gut feelings tend to be reliable.

Parasites? Martin’s doctor for autism issues knows him pretty well.

His mother’s opinion? Confused.

Hives

Martin is allergic to horses. He didn’t always present as allergic to horses. When he was four and five years old, he did hippotherapy weekly, without problems. When he was eight years old, on a visit to Costa Rica, we went horseback riding on the beach: Martin, Adrian, my brother-in-law Pancho, and I. We rode for an hour. I was second in line; Martin, wearing shorts and a small t-shirt, was third. Every few minutes I turned around to glance at him, make sure he was still riding comfortably. I saw no issues. But when we arrived back at the stables, and I was able to see Martin up close, I could see that he was covered in a red rash. Rashed on his arms. Rashed on his legs and, I soon discovered, on his chest and belly. Most of all, rashed on his face, which was red and bumpy. “What’s wrong with me?” he exclaimed and burst out crying. I checked his breathing (it was okay), took him back to our rental house, and put him in the shower. With good scrubbing and an antihistamine, the rash dissipated.

After the Costa Rica experience, I asked Martin’s allergist—a mainstream doctor, not focused on ASD—to test Martin for a reaction to horses. The doctor agreed, though he had to order a special skin test. When it was finally available and administered, the test left no doubt: Martin’s forearm immediately swelled into a red bump. No more horses.

On that same Costa Rica trip (August 2016), we discovered Martin had become allergic to red meat.Sixteen months earlier, in February 2015, in South America, Martin was eating beef with roast potatoes when a red rash formed around his mouth.(That trip, however, he’d ridden horses with his cousins, no problem.) Still I didn’t realize that red meat, which he rarely ate, was the issue; of the Costa Rica trip, I wrote: “He had two allergic reactions, one to a horse that left his face bumpy and itchy, and one to an unidentified food irritant (restaurant) that caused a rash to spread from the corners of his mouth down his neck.” Subsequently I put the pieces together and stopped letting Martin eat beef—but it would be more time yet before I figured out that all red meats were problematic, not just beef. (That discovery, in a “bison incident,” is described here.)

This summer, in Costa Rica again, Martin’s day camp was having an activity in which the kids rode horses to a remote waterfall. I wondered: The allergy came on when Martin was already six (or seven? or eight?) years old. Does he still have it? These Johnny-come-lately allergies—do they stick around? I wanted Martin to be able to participate in the horseback-riding activity, and not to experience one more factor differentiating him from other kids.

So I acted recklessly. (Maybe?) I told the camp director that Martin is allergic to horses. I told her about Martin’s reaction two years earlier, also in Costa Rica. I said I was going to dress Martin in long sleeves, long pants, and high socks, and send him to camp. I asked her to let Martin give the activity a try and see what happened. I reminded her that Martin always carries antihistamine in his backpack, just in case.

Mid-morning, I received a message from the camp director. Martin had only been on the horse a few minutes when he got a terrible rash. She took him off the horse immediately and administered his antihistamine. The reaction was severe enough that she also took him directly to a shower to wash. Thankfully, he was better within a short time.

That’s that. Martin has become allergic to horses, possibly permanently, just as he has become allergic to cats and dogs and has become allergic to red meat.

I am, of course, back to pondering why Martin has developed allergies as he continues to heal. I still think the most likely explanation is that he had these allergies (with the possible exception of red meat, which may or may not be related to Lyme disease) all along, but previously his immune system was neither strong nor responsive enough to mount the proper response. Whereas allergies themselves represent flaws in immune function, perhaps one day Martin’s full recovery will mean the allergies dissipate along with the remaining vestiges of autism.

Today, let’s not dwell on the allergies, and what they might mean. Instead, let’s focus on this: According to the camp director in Costa Rica, Martin didn’t freak out, not even when he was covered in a rash and pulled away from the other kids. She said he was upset for a minute or two, then calmed down. Two weeks later, when the activity again was horseback riding, I offered Martin a choice: He could go to camp and play games or surf while the other kids rode (the director had offered this alternative), or he could take the day off and go to the beach with Uncle Eddie. Martin contemplated for a while, then chose to take the day off. It seemed like a reasonable choice, and it wasn’t a big deal.

Because now, not everything has to be a big deal.

Missing Pieces

When my sister and her daughters were visiting us in Costa Rica, I got to take care of my almost-two-year-old niece, Julie, for a half-day. My sister, her older daughter, my brother, and Martin were taking a long canopy tour. We dropped them off at 1:30 pm. I carried little Julie as she waved bye to the canopy-tour crew, then strapped her into her car seat and drove to our local supermarket, a noisy cement-floored warehouse kind of place. Julie let me set her in the grocery cart’s child seat and “helped” me shop. I handed her boxed or bagged items, which she clutched (sometimes gnawed) until she tired of them, then tossed into the cart and stretched her arms out to ask me for something new. I saw a yogurt drink my sister gives Julie, so I bought one and letter her have it on the way home. She and I laughed together when we arrived home and I discovered most of the yogurt drink on her shirt.

I didn’t want to rummage through my sister’s suitcases to find a clean shirt, so I let Julie run around shirtless. Julie seemed to do only charming things. As I used the food processor to julienne vegetables for an Asian chopped salad, she pushed a cardboard box around the floor like a train. She put items in the box and unloaded them elsewhere in the house. Whenever I announced I was putting a new vegetable into the food processor, she marched into the kitchen and demanded a sample. We went out back to swing in the hammock and dip our feet in the pool. I put a motorcycle helmet on Julie, sat her on the rugged ATV I kept for short trips through the jungle, and took photos to send her (mildly overprotective) father back in the States, to freak him out. Julie was a good sport, smiling and posing. When, after four hours of fun, it came time to pick up the canopy-tour crew, I put one of Martin’s t-shirts on Julie. It was of course wildly oversized, like a dress that brushed the floor as she tried to walk. Julie delighted in this. She giggled and danced as she lifted the shirt to her knees.

I’ve written before about the fact that I will never parent a typically developing child through the earliest years. Spending the afternoon with Julie shifted made me think less about my own loss and more about Martin’s. As I watched Julie explore her world, learn from touch, and interact with and imitate me, I grieved for Martin. He was just about turning two when Adrian and I finally realized (first-time parents!) that he was not progressing on the same track as his peers. Martin did not investigate; he stimmed by pushing a car back and forth. I did not get to prepare dinner while Martin played train with a box and stopped by the kitchen out of curiosity; if I needed to occupy him, I pulled the upright vacuum to the center of the living room. Honestly. The way to occupy Martin for an hour was to let him stare at the vacuum from different angles. Martin did not delight in new experiences, or play with me; he screamed with terror when he transitioned activities, and bolted from my grasp.

Even today, Martin cannot smile intentionally for a photograph. Instead, he grimaces and presses his tongue against his front teeth. When we try to practice for photographs, he says, “Smiling is hard. Do all kids have trouble smiling?”

Months ago, I had this exchange with a friend whose son is recovering from ASD and whose daughter, her younger child, is typically developing. They live in another country, so we don’t see each other much. She wrote of her experience parenting her daughter:

My friend:

Neurotypical development is mind blowing—the kids learn all the time & all on their own at a rapid pace

Parents do zilch compared to what we do for our ASD kids

[My daughter] thinks & speaks in 2 languages, knows so many songs & rhymes, colors, etc.

Vocabulary, questions, observations

Unbelievable

I didn’t respond. When my friend prodded me, weeks later, I wrote:

I have been meaning for a while to respond to your last set of messages. Honestly, they got me down a little bit. Martin is still not as far along as [my friend’s recovering son], but in many areas it feels like we are getting so close to typical, and I have faith that we will be there eventually. It is difficult to hear about these differences between neurotypical kids and ours, because it makes me feel that no matter how successful recovery is, there may always be differences, simply based on the developmental milestones that were lost along the way

And of course I want to believe that once he is fully recovered, it will not be evident that so much of his childhood was spent recovering from this disorder

[ . . . ]

I think what is tough for me is the idea that other children can be constantly learning. I worry that they will outpace him

My friend:

It is heart-rending to watch the [NT] language acquisition, social & attention

Just like a button is always on

By listening to me talking on the phone she will guess who I am talking to and contribute to the call

It seems to flow without effort

Even making puzzles etc., learns by watching the other kid

Me again:

I get it! That’s the type of stuff that makes me feel sad

My friend:

I get it—though both are mine I feel sad a lot for [the older]

That’s it. I feel sad. Martin has missed so much. He’s already 10 and, even as he becomes ever-more typical, has missed the chance to experience the world with a toddler’s wonder. To learn simply by playing, as learning should occur.

For both of us, some pieces will remain missing.

I took this our last evening in Costa Rica. That’s Martin, on the left, going a different direction.

When in a Rut, Turn to the Little Things

I wrote yesterday that Costa Rica isn’t boosting Martin as much as I’d hoped. I’m going to console myself today with more musings on the little things.

About Martin’s birthday-party weekend, I wrote recently:

Although Martin’s Friday-afternoon birthday party was likely the highpoint of his weekend, it was not the highpoint of mine. . . . Sunday morning, . . . Eddie took Martin to the birthday party of a classmate (!) at an indoor sports facility. They arrived 10 minutes late, and the kids were already organized into groups for a game. According to Eddie, as soon as he and Martin entered the facility, a boy yelled, “Hi, Martin!” and another yelled, “Come join our team!”

Hearing that report, dear readers, was the highlight of my weekend.

A week before the birthday party, Adrian and I had attended the third-grade concert at Martin’s school. The third-grade orchestra performed. Martin is not part of the orchestra; he has opted to wait until fourth grade and join the band instead. (He’s been selected to play baritone! Get a load of that!) After the orchestra’s two songs, the third-grade chorus took the stage. Every third grader, about 90 of them, sings in the chorus, Martin among them. Per the instructions we’d received, Martin wore a white dress shirt and a tie. Actually, it was a bow-tie he’d chosen himself from the selection of several neckties and bow-ties I’d offered. He stood very still, in the back row with the taller kids, no fidgeting, a serious expression on his face. He sang every word. When the recorder portion of the concert arrived, each third grader lifter a recorder to his or her lips, and so did Martin. He didn’t accidentally drop his recorder; that happened to a kid one row in front of him. Martin played the recorder notes as carefully as he’d sung. He was brilliant. What’s more, the kids performed one of my favorite songs, Louis Armstrong’s “What a Wonderful World.” I almost cried.

So what was my favorite part of the third-grade concert? Martin’s beautiful notes, raised in flawless timing with the other young voices? The way he took ownership and picked his own tie? The solemnity with which he executed the performance?

No. None of that. After the concert concluded, when the parents were rising from their seats, when the teachers were entering to claim their charges, and the third-graders were kind of milling about the stage, I watched Martin casually start talking to the boys on either side of him. I recognized the two boys as friends from Martin’s classroom, and I felt certain they’d been placed together by design—exactly the type of detail to which Martin’s wonderful teacher attends. There they were, three boys together, talking to each other. Like all the kids were talking to each other. That’s when I actually started to cry. I lowered my head in embarrassment and brushed away tears. (When I saw Martin’s teacher a minute later, she was brushing away tears of her own and said, “I can’t even.”)

Last night, we went out to dinner. Martin waited for me and my mother (she’s visiting) to place our orders. Then, by himself, speaking in Spanish, he informed the server that he can’t eat gluten, dairy, or soy; placed his order; and asked the server to confirm that the appetizer and entrée were appropriate for his diet. He capped the production by making eye contact and saying, “Gracías.”

This morning, when I dropped Martin at his day camp in Costa Rica, a boy exiting the car behind us called, “Hi, Martin!” and Martin turned to respond, “Hi, Zach!”

When things aren’t going so well, as generally they aren’t right now, I have a weapon against frustration: I have the way in which Martin’s recovery has transformed into joy the moments that most parents take for granted.

I mentioned that Martin has been chosen to play baritone in band next school year. Each student who’s joining band gave the music teacher three instrument choices, and auditioned on each instrument for the teacher to decide which fit best. Martin has taken two years of trombone lessons and (at his insistence) one year of drum lessons, so I was surprised when his three choices were saxophone, clarinet, and baritone. To me, he said only that he thought those would be best for him.

Subsequently, Martin’s psychologist told me what he’d disclosed to her: That he knew trombone, and especially percussion, were two of the most popular choices for third-graders. He was worried that, with his prior lessons, he might get percussion, and then other kids would be angry or upset with him if he took the very popular choice and did not do the best job.

This was the first time, Martin’s psychologist added, that she’d seen him exhibit such foresight, and put himself so directly in the minds of his classmates. This, she assured me, was a leap in social advancement.

See how that works? My kid was unjustifiably too worried to request the instrument he really wanted—and I get a victory out of the deal.

This Ain’t Nicaragua

Last summer in Nicaragua, Martin flew. He soared. He matured. He grew. If I could have found a way to stay in Nicaragua without being separated from Adrian (whose job in New York sustains our travels and biomed), I would have done so.

Now cut off, for safety’s sake, from Nicaragua, I brought Martin to Costa Rica and assumed he would soar again.

But not so much.

He’s spending too much time in tiny-dictator mode: objecting to every idea, listening carefully for plans to complain about, agitating me because he can’t release his own emotions. He’s trying to prescribe who’s allowed to speak Spanish, or English, and when. And crazy opposite-talking, constantly. Yesterday, upon discovering that he was having coconut-banana tostada for breakfast instead of smoked salmon, he launched into a tirade directing me never to give him smoked salmon again.

For sure, it took several weeks for Martin to hit his stride last summer in Nicaragua. Nevertheless, by the end of July—I just ran through my contemporaneous posts—I was noticing improvement. Today is August 1, and Martin does not seem improved since we arrived here a month ago.

I don’t know why not. He’s constantly in saltwater, as he was last summer. He attends day camp. Although his diet isn’t great (corn, juices, way too much rice at camp, just like in Nicaragua), I stuff him with fresh local fruits and vegetables when possible. We’re doing herx water and dry brushing. (And what we are dealing with right now looks more like anxiety than the silliness I associate with detox.) We continue his Lyme- and parasite-fighting protocol, and the only pills I’ve run out of so far are HistDAO, i.e., enzymes for breaking down dietary histamines. (Had more sent to a friend, who will bring it next week when she arrives for a visit.)

Possibly some environmental factor is agitating him, like hidden mold in our rental house, or airborne allergens. The climate, flora, fauna here in Guanacaste resemble southwestern Nicaragua (fewer butterflies, though), but of course nothing is exact. We might have happened, last summer, upon a magic combination of factors, from jungle to supportive community, that cannot be replicated elsewhere. Of course, I can’t discount the simpler explanation that Martin’s current protocol is burdening his system, or that he’s just in a different place in his recovery process than a year ago. He’s always in a different place, right? This morning on Facebook, a friend with a severely affected child referred to “playing pin the tail on this donkey of a medical mystery.” That’s apt.

We keep plugging on.

Tomorrow Martin is signed up for his first-ever surf lesson.

Because why not?

IMG_1421

Martin versus the world. Or at least the ocean.

Yeast Defeated (?), Another Beast Rises (?)

On the offhand chance you haven’t been tracking this yourself, I can tell you that these are the most recent mentions, on this blog, of yeast:

  • the 20 April 2018 post on detoxing, when I wrote that yeast was not causing Martin’s silliness;
  • the 22 February 2018 post on current issues, when I asked whether yeast might be implicated in skin rashes (apparently, it wasn’t); and
  • the 25 October 2017 post on meal preparations, when I noted that fruit no longer seems to cause yeast issues for Martin.

Years ago, I wrote about yeast constantly. I called it the “yeast beast” and lamented its repeated torment of Martin. Every time I thought we had yeast under control, I’d see a “fluffy” bowel movement, or the characteristic rash would emerge again.

Martin still takes Candex, which was the product that (I think) finally subdued his candida. I’m not ready to add yeast to the So Far Gone list, but for now, it’s gone enough.

Parasites think the disappearance of candida has given them an opening to fill.

Martin passes a lot through his skin. As of late, a lot of what passes through Martin’s skin looks like parasite activity is involved.

On the morning of June 10, just after we returned from a few days in California, Martin woke with a collection of strange bumps on his left forearm, many of which he’d already scratched raw. They looked like tiny insect bites, as if a single bug had crawled onto Martin, wandered about a small area eating its fill of flesh, and disappeared, or as if a bunch of bugs had assembled, used the arm as a buffet, then dispersed and gone home.

Martin’s arm hadn’t shown any evidence of this the night before. I tore apart his bed, searching for a spider nest or other den of revulsion. I found nothing.

By breakfast, when the fresh scratches had faded, the bumps started to look like a rash.

Martin said the bumps didn’t hurt, and didn’t itch (anymore?), but he wouldn’t let me touch them or examine them too closely. “It’s fine. I’m fine,” he said, tugging his arm away.

What the heck? Martin wakes with an odd collection of angry bumps, within a few square inches of skin, with no evident cause, which he then claims are not bothering him? In usual circumstances, I would attribute this to a mystery insect and move on. This year hasn’t been usual circumstances, though. At least not when it comes to parasite activity.

A week before the mystery bumps, I had posted about the condition of Martin’s arms and legs. With his skin such a mess, I was forced to consider whether parasites could be at work—again—already—just a few months after the anti-parasitical drug Alinia had reduced Martin’s itching and his inappropriate comments. I took Martin back to his New York biomed doctor, who agreed with my assessment. Parasites. Dad-blasted parasites. The doctor prescribed another round of Alinia. I avoid using any pharmaceuticals with Martin—we used nystatin once, for yeast, and it made Martin’s behavior bonkers—but the Alinia had worked so immediately, earlier this year, that I agreed to try the drug again. We did a first round while still in the States, and the second round here in Costa Rica.

If anything, Martin’s limbs are looking worse than in June. These are current photos of his legs:

  

Martin is picking at his skin compulsively. He’s also putting his fingers into his nose and mouth. Not picking his nose, thank goodness. More like rubbing and poking, as if his nose and mouth are irritated.

Do these symptoms mean Alinia isn’t doing the trick, this time? That whatever parasites are plaguing Martin are unaffected by Alinia? Or that parasites aren’t the problem? Or that parasites are the problem, and they’re trying to escape through Martin’s legs?

We spent years getting candida under control. I’m hoping parasites don’t mount that kind of protracted offensive. So many factors are at play. The New York doctor contends that we need stronger chelators, that parasites cannot be finished off while the body carries too great a heavy-metal load. (We know, based on hair analysis and other testing, that Martin has trouble excreting heavy metals. We use chelators including prescription DMSA, oral Liposomal EDTA, algas, and Bioray NDF Plus. I’ve never agreed to IV chelation because I consider it too harsh.) Heavy metals may be playing a role, but I also need to look at the ways I enable parasites to infiltrate Martin’s defenses. I try to be careful about what products we use for cleaning, and certainly Martin doesn’t have amalgam fillings, as I once did (and probably passed a significant portion of my toxicity to poor Martin). But Martin still eats fish, lots of fish (even if I am continually trying to keep him off raw fish). My friend Stacey re-washes vegetables labeled “triple-washed.” I don’t do that. I let Martin play in tide pools and swim just about anywhere, like at the river mouth with his day camp. And no amount of modeling, instructing, helping, begging, or pleading has yet got Martin to wash his hands properly. He prefers to make an impatient mess by rinsing his hands and shaking the water off.

In short, there are ways I can step up my parasite-prevention game, even as I keep on my parasite-elimination game through, for example, regular use of diatomaceous earth.

Two months later, Martin’s forearm still shows the remnants of the many bumps. Metaphorically, that means I’ve got to roll up my sleeves and get to work.

How It Lingers

My sister is visiting us, here in Costa Rica, with her two daughters:  Mandy, who is Martin’s age, and Julie, who is about to turn two years old.

Sunday we took a day trip to a nearby beach town. When we arrived, the kids got fruit smoothies. Then we hit the beach. The waves were pretty strong. We adults (my sister, my brother Eddie, and I) took turns going into the surf with the kids. I try to get Martin as much salt-water time as possible. I consider the ocean a health spa.

Martin had already had several solid days with Mandy. She attended camp with him. The two of them fussed and played for hours each afternoon. They put together evening concerts: Mandy wrote an emcee script for Martin to perform, and then, using five-pound dumbbells for microphones, the two sang Uptown Funk!, A Million Dreams, even a jazzy version of Happy Birthday to send to Adrian, who’s in New York. The songs were accompanied by the kids’ original choreography, which resembled running crisscross while high-fiving each other at each pass.

And now, Sunday, everyone was having a great time, as far as I could tell, even if Martin did start to get anxious as lunchtime neared.

We left the beach to walk to an outdoor fresh-preparation food stand (everything gluten- and dairy-free! pura vida!). Along the way we stopped at a souvenir shop, where Martin selected an inexpensive carved frog. I spoke to the proprietor in Spanish. Martin refused to look at the man. Instead he put his face near mine and whispered, “Mommy, pretend you don’t know a word of English!” Martin’s picked up an odd obsession lately: He tries to dictate who can speak which languages, and when. He even manages to impart his angst into the topic. If he finds out we are going out to dinner, he demands to know in advance whether I plan to speak Spanish or English to the waiter and tells me to guess whether he plans to do the same. In the souvenir shop, I said, “Martin, that’s silly. He can tell I have a North American accent. Why don’t you say hi?” The proprietor then greeted Martin, in Spanish, and asked how he was doing. Martin turned away as if he hadn’t heard. Covering, I apologized and said that my son does speak Spanish but is shy about doing so.

As soon as Martin and I were back on the sidewalk—Mandy and the others had wandered to another shop—Martin started to meltdown. His meltdowns are so infrequent these days that I don’t anticipate them like I used to, and this one caught me of guard. Martin asked, “Why did you do that? Why did you tell him I speak Spanish?” His words quickened as he said, “Why did you try to make me say hi? I didn’t want to do that. Why are you so mean? You’re the meanest mom in the whole world.” He was crying as he descended into nonsensical opposite-talk: “I hate you. I don’t love you. I wish you weren’t my mom. I don’t speak English anymore. I’m never speaking English again. New rule: I have to talk to everyone we meet!” He thrust his jaw forward (that old trick again!), clenched his fists, and motioned as if to punch me, though he did not make contact. (He never does, thank heavens.)

I stood by him and let the meltdown run its course. When the opposite-talk subsided, I tested the waters. “Martin, were those the things you really wanted to say?”

Still not in control, he answered, “Sorry, Mommy. I didn’t mean it. I did mean it! I hate you!” He air-punched again, then hugged me, sobbing.

Mandy approached, accompanied by my sister and Julie. Mandy asked, “Why is Martin crying?” Her question pained me, for two reasons. First, the obvious reason: Especially in the moment, I have no effective means to convey to a nine-year-old that her cousin is crying because anxiety has been collecting inside him until a random, almost undetectable social pressure knocked him into a netherworld of confusion. Second, the less obvious, more painful reason: In visits past, Mandy tended to ask mequestions about Martin. “Does Martin like watermelon?” “What time does Martin get up?” I would have to remind her that she could ask Martin, even if he didn’t always answer immediately. This visit, until the meltdown, had been different. Mandy had been asking all her Martin questions—even questions about food allergies and what he can eat—to Martin, and he’d been answering. As he returned to meltdown mode, however, she stopped relying on his ability to speak for himself.

I said, “He’s having a tough time right now. Why don’t we walk to lunch?”

Cheerfully, my sister said, “Great idea! Let’s walk.”

We continued to the lunch joint, Mandy casting suspicious glances at Martin as he tried to get himself under control. By the time we sat at a picnic table, Martin had stopped crying enough to manipulate me. He said, “I think what would help me calm down is your iPhone.”

Adrian and I don’t usually allow screen-time at meals. Nevertheless, I gave in. I wanted to distract Martin from whatever was bothering him before Mandy witnessed any additional meltdown.

A day trip with his favorite cousin, to a beach he knows and enjoys, with the promise of lunch at a food stand he likes, and then, pow!, a meltdown. The frustration! Sometimes it feels like no much Martin’s health and behavior improve, the remnants of autism hide inside him, ready to interrupt paradise with their ugly ways.

My survival tactic is to remember to look for the silver lining. Sunday, allowing Martin to play with the iPhone did the trick. By the time our food arrived (25 long minutes later, pura vida), Martin was ready for limited participation in lunchtime discussion about the waves and fun we’d had in the ocean. On the drive home, strapped into the third row of our SUV, he beatboxed with Mandy. Almost as soon as we arrived back at our rental house, a brother and sister showed up for a play date (these arrangements were Mandy’s doing), and Martin participated decently. Mostly he followed the brother around spouting Minecraft strategies—but hey, that’s a form of socializing.

Martin melted down.

He bounced back.

I take what I can get.

Martin and Mandy, in the waves.