them to look into his own eyes or smile and giggle. He thought at their age that was very worrisome.
Dr. Martin was particularly a stinker about pulling out of her mouth -nearly with forceps- health and ‘social function’ of as many relatives as she knew going back to second cousins. She seemed clearly reticent about giving all that history, probably guessing where Dr. Martin was leading to. And yes, she had a maternal first cousin with Down’s syndrome, another who had been a bit slow in school and only did menial jobs and her husband had an aunt said to have had C.P…
Dr. Martin was frank with her and told her that all three were autistic, especially worst, the girl. Mom had heard the word but no one had ever mentioned to her that her kids were so… He suggested to her to just keep loving them and holding them and talking to them often and also to give them time. ‘If they one day ‘pop out of the shell and open up, becoming normal kids -as some do- they will do so on their own,’ not with intensive therapy and stimulation though such was available in a number of places. He even gave mom the name and addresses of a couple of such centers specialized in autism (as in the previous case) if she wanted to contact them herself. He would send her and her pediatrician his consultation, so she could bring his notes to wherever she went.
She did call the center specialized in autism at the University of Chichester, a good three hours away from her home. They wanted his consultation before she went there, not knowing that she was going to bring it along; they called Dr. Martin in person to ask him for it. They were concerned -to get paid, one presumes- ’that she had not been referred by a physician’ as mom had just made the appointment on her own.
“Don’t you think those kids badly need our special services?” they asked him.
“Well, I’ll leave the judgment of that to you; after you see them and work with them,” he answered in a brief phone conversation with the center’s intake clerk.
Dr. Martin was aware already that his negative feelings about extraordinary intervention for autistics were already known in Chichester… He was also aware of the organization ‘Autism Blabbers’ (or something like that, and that TV-aired commercials emphasize how crucial it was -for successful intervention- for autistics to be diagnosed ‘as early as possible.’ The average diagnosis then was usually made at age two. Yet Dr. Martin could detect it much earlier, as in the Moulder triplets, but did not think it was so crucial to find it that early. In his opinion, if an autistic child pops out of his isolation shell at some point, he does it on his own, regardless!
The Director of the Center for Autism of the U. of Chichester had already reported Dr. Martin to OPC, the State Health Department, The Wolves, as dangerous!
Some four years later Dr. Martin would hear from Mrs. Moulder that her triplets were still ‘slow’ (still autistic), several years behind in their speech… He’d been right!… But The Wolves -or elementary schools- would never accept that…
5-D: Dr. Trist was a known G.P. who lived and practiced in a suburban town not far from Dr. Martin. He too, as the Moulders above, (5-C) had in his family a set of autistic twins. Both had been delivered by a C-Section that otherwise went on uneventfully. Things went well for them in the first six months or so, but Dr. Trist, their father, began to be concerned after that when they were slower than his charts said they should as far as not sitting by six months, crawling by nine, standing by ten or walking by 12 to 15 months. They were making some sounds by a year but no articulated words… “Give them more time before you worry. They are probably just late bloomers” had told him the boys’ pediatrician (actually quite in line with Dr. Martin’s opinion).
But Dr. Trist was not satisfied with just give them time. He knew of Dr. Martin as a trusted and knowledgeable specialist and he had referred to him his own patients with various issues. So he asked him to take a look at his own twins when they were 18 months old. He knew they were already developing too slow and he needed to get a diagnosis that would at least put his and his wife’s fears at rest one way or another.
Dr. Martin greeted his colleague Dr. Trist in his waiting room. The Trist twins, both boys, were sitting in a double, interconnected stroller that was being pushed by mom. Right in the waiting area Dr. Martin noticed that they were not focusing their eyes on any of the many colorful distractions -figurines and paintings- that were in all his walls with wooden toys and stuffed animals purposely strewn all over the floor. They were not looking at him either even though after the initial hand shake to the parents Dr. Martin was quickly trying hard to engage the boys’ eyes. That was really all it took Dr. Martin to nail the diagnosis of autism right in his waiting room, though he had already suspected it when Dr. Trist himself had called him on the phone two days earlier with his concerns and had made the appointment to bring them to him.
In his consultation room, with blankets laid on the floor by their mom, as with other infants checked for developmental concerns, the boys were placed on their bellies. Dr. Martin was given the kids’ perinatal history -the planned C-Section in the 8th month- their birth weight -about 4 lbs each-, that they were up to date in their shots without unusual reactions, and the family history. Dr. Trist did volunteer before his wife that SHE had a niece in her teens who was ‘just a pinch slow in school.’ Dr. Martin’s guessing by the girl’s age, her grade and the Special Ed she was attending, he judged that her IQ probably hovered in the 60s; she had no precise diagnosis; they were just told that ‘perhaps she had a touch of C.P.’
Dr. Martin wanted to see how the boys crawled or scooted around. But they didn’t. On their bellies, they did not prop themselves up on their elbows to look at things or at each other. After a while, they did roll over on their own without help -a 3 to 4 month milestone-; but they were already 18 months old!… They did not move around once they were on their backs. And the room was quiet, without giggling or a child’s words or laughter; only the adults’ intermittent talk was heard. The hard findings of the physical and neurological examination were normal. The twins did not have odd facies, unusual muscle tone or reflexes, their heads were not too big or too small, they had no birthmarks, their eye grounds were fine and in a still photograph they would have looked like a perfect pair of adorable young toddlers… But they did not show visual interest or face-to-face focusing. They were clearly autistic to Dr. Martin. No doubt. And moderately so, unfortunately. And so he told the parents.
“I feared that,” said his colleague Dr. Trist. “I was guessing they might be autistic but I kept talking to myself out of it. I did not want to scare my wife. Any ideas what might have caused it?”
“That is a contentious point this days,” said Dr. Martin. “There is so much talk in the Media about it being caused by this and that event during the pregnancy, especially by a case of subclinical maternal Rubella… and now specially by the Pertussis immunization… But I don’t believe that. You may know perhaps that the British doctor whose research pointed in the 1980s to the Pertussis vaccine as the cause of autism was disbarred, his research discredited as having much of its data been made up… I’ve entertained myself for a long time that it is nearly exclusively genetic, but this is also sensitive issue to tell everybody… I have seen over a hundred cases in all these years, and have no other theory as for its cause. I have my case load all charted out and I’m ready to publish a paper with my findings, but I am not sure I will send it…”
Dr. Trist and his wife got quiet, without words. A subtle air of defensive hostility to such comments was sensed by Dr. Martin. After a while, they asked him about Early Intervention and he told them of the many programs available through the local public schools, especially at Sandwell Elementary. He also mentioned for them the out of town centers specialized in autism, one in the state, two hours to the west; the other at 4 hours drive south of the border. He did not share with them his skepticism of the value of such programs… He thought that in time they would judge that themselves.
Dr. Trist
