Hope is all that’s left when you’ve tried your best and nature takes its course.
It was early morning, mid-May, on an unseasonably gray day. Sheets of rain were clattering on my car as I drove to my client’s house. The drive to M’s house was always a thoughtful one, and I was anxious about what I was going to say when I got there.
I enjoyed the in-home therapeutic sessions I did with autistic kids, without exception. I thrived in an environment that was at times improvisatory and at times highly structured, and I spent my nights and weekends devising appropriate and meaningful interventions to help them reach their goals. We always made progress together. The families I worked with looked to me in different ways — as a counselor, a teacher, a confidant, a sitter — and, following all scientific evidence, all available resources, and my body of clinical experience, I attempted to impart lessons about building relationships, enhancing quality of life, and maintaining a growth mindset.
It wasn’t just about identifying patterns, sequencing stories, or saying please. It was always about teaching exceedingly complex and particular ideas that could open new pathways of communication and understanding for them and their family.
M’s case was a particularly difficult one, which is why I was chosen by the agency to work with him and his mom, G. My experience and multidisciplinary approach, along with my patience and compassion, would be needed. G’s primary concern was that her teenaged, autistic son was missing a lot of school, “throwing tantrums” (her words) right before he had to get on the bus. I’d been working with M for a few months on creating a consistent routine, using musical cues to prompt and reinforce him through donning his shoes and jacket, and eliciting conversation about things that might happen during the day. Our efforts were variably successful — we might build a streak of eight school days, but the “tantrums” would return.
In cases like these, it was important to look at the antecedent and reinforcing behaviors — what was leading up to and what was following — M’s seemingly sudden, strong refusal to go, which, when paired with both G and M becoming agitated, then led to a meltdown.
There are myriad factors that influence every decision, action and reaction for an autistic person. These are in addition to the physiological reactions they may experience at greater or lesser magnitudes than their neurotypical counterparts, and in addition to the potential difficulties identifying or communicating their needs, preferences, and anxieties. If, like M, they struggle to verbally identify their needs, environmental controls are put in place to narrow down what may be leading to the issue at hand, in conjunction with attempting new pathways of communication and creating or enhancing a sense of self (self-awareness.)
To my most objective observations, there was one clear and unfortunate obstacle to M building a consistent routine and finding regular comfort and success with the primary objective.
G was that obstacle, the only reason the case was so difficult for me, and the cause of my concern as I drove to session that day. A parent’s impact on their child is always complicated and difficult to view objectively, but I’d already seen and heard too many markers for concern.
For all of the time I spent explaining to G that her son was capable of learning, that he had shown signs of improvement, and that progress would at the very least require her to maintain emotional stability during the transitional time, G showed very little desire to learn or adapt. She would listen raptly through my explanations, then immediately launch into an unrelated story about how difficult M could be, how he’d made a mistake earlier in the week, or how she’d had to miss work again. M and I could be having a peaceful conversation at the breakfast table, when G would enter the room, complain loudly that M “better not pull something today”, and then lay out a complicated series of punishments and prizes he could expect depending on how he acted.
It was baffling and deplorable. I struggled to steady myself as I neared the house. Five miles to go. Deep breaths. More presence of mind. It would be a difficult conversation. As a therapist, it was my job to maintain objectivity, a professional demeanor, and an emotional distance, all while advocating for M. Focus on the particulars, not the ideals. Move one tree at a time, don’t attempt to demolish the entire forest in a sweeping overaction. Four miles to go.
In some ways, G was treating her teenaged son like a forever-baby and worse. She believed he would never learn, never cease “throwing tantrums”, and never be anything less than her burden to bear. She jumped in to speak for him when he hesitated, so he often remained silent when she was around. She spoke about him in the third person while he was in the room. She refused to teach or let him learn about his changing, teenaged body, and she allowed him to cuddle beside her in her bed on a regular basis.
In other ways, G seemed to think M should act like an adult.
“He’s doing this to challenge me,” she’d say at the top of her voice, while he jumped under her covers in her bedroom to escape the bus.
“I know you know what you’re doing to me,” she’d cajole, as he lay face-down on the carpet in the foyer.
“Lori (me) is very mad at you,” she’d growl, while I stared at her incredulously, shaking my head vigorously and making x’s with my arms.
“If you don’t go to school today, I won’t let you have your iPad on Saturday, which you earned yesterday for doing such a good job, and then Lisa (sitter) will be very upset with you and she won’t take you to play basketball like I promised yesterday,” she’d threaten and bribe simultaneously.
Then, when he inevitably missed the bus, G would wring her hands and wax happily nostalgic for a time when he was smaller, easier to carry around, easier to control, and not so challenging. G knew M was listening, hiding at the top of the stairs or in the next room, but could not see that her own attitude might be creating the problem at hand, or at the very least complicating it.
On this bleak and brisk day, I was going to insist that G remove herself entirely from the situation for the foreseeable future. M was capable of waking up, getting dressed, brushing his teeth, and eating breakfast independently. I’d be there to help with his shoes, jacket, and getting on the bus. I rehearsed the words in my head over and over again on the drive that day.
“At this point, and given everything we’ve seen, the treatment team has decided collectively on a path moving forward.” I planned to pause here, and take a breath. Then, “To understand M’s needs and challenges while transitioning to the bus, we need you to remove yourself from the environment. You can stay in your room with the door closed, or take a walk in the neighborhood, or sit in the backyard obliviously. But under no circumstance can you continue to be present in the kitchen, foyer, or living room while M and I are in session. Mothers have a very powerful effect on their children, and it would be good to know how your presence may be influencing him.” I expected she would be distraught about this and argue, but thought I might be able to get her to commit to being absent on a trial basis to gather data.
I knew M wouldn’t automatically cease having trouble boarding the bus, but I absolutely needed to control for the most caustic and unpredictable variable in the room. I was confident that if she would allow for this change, I could begin to understand the situation.
I was shaken from my rationalizing suddenly. The black SUV several car lengths ahead on this busy, suburban street hydroplaned and skidded to a stop. Into the SUV’s driver’s side door, an American Robin (AMRO) dove with spectacular force, turning to his side at the last minute. Even with my radio on and the sound of the pelting rain on my car’s roof, I heard the collision.
Flying in the rain is particularly dangerous for birds for two reasons. Smaller birds risk trapping water among the air pockets of their feathers and contracting hypothermia. Larger birds struggle to get enough aerodynamic lift in the dense air of low-pressure systems. I suspect that this robin was suffering the latter on this rainy, spring day.
My heart was breaking. I slowly drove past the robin as he lay in the center of the road. I didn’t know if he was alive or dead, but I knew that he could easily be crushed by someone swerving to avoid the poorly draining shoulders. One short block past, panicked, I pulled a tight U-turn. I’d never be able to forgive myself if I didn’t go back. He didn’t deserve to die in the street like that. I threw my hazards on and jumped out into the road.
Drenching in the downpour, I scooped up the robin in canvas I normally used for school supplies. The AMRO was alive, stunned but present. I wrapped him carefully, held him gingerly, and drove with one hand to the nearest side street. I snapped a quick pic and texted a friend who owned a few canaries (They did not respond in time to assist.) I’m not a veterinarian or bird expert by any means, but the Amro seemed to be alright. His feet and wings all seemed in tact and at the proper angles. Though he was stock still, his eye blinked occasionally and seemed to follow my face. With no time to take him to a hospital, I made the difficult decision to place him between a bush and a giant oak tree, nestled between the visible roots. I jumped back in my car, shaken, and dried off as I drove the last mile or so to M’s house.
I wish I could say that I successfully communicated the plan to G, but M was already beginning to make refusals when I arrived. I gathered myself, apologized for my lateness quickly, and succeeded in helping M calm from a screaming wail to a slow sob as the bus pulled away. He had chosen independently to go to his own room, rather than his mother’s bed, and I was optimistic that the sessions might be having a positive effect.
When I returned to the kitchen, G had some news. Due to M’s many absences, she’d been informed that he would have to repeat his current grade level. The school had recommended he continue attending for the remaining month or so, for stability. To minimize her stress, she whispered, she’d decided just today, just now, to remove him from school entirely and start fresh in the fall. She couldn’t do it anymore. She’d already been in the process of buying a new condo in another state. A new school, a new state, and new friends would do M good. Wouldn’t that be nice, to start over? She was musing, I was fuming.
For a teenager that had difficulty transitioning from his home to the bus, I wondered what made her confident that he would transition easily from his home to another, newer, far away home, a new school, and entirely new people. I managed to gently mention something to that effect, despite the bile that was rising within me. She pretended not to hear me and said she was looking forward to selling their current home. Then, she terminated our sessions.
Typically, I insisted on several sessions prior to termination, in order to help ease the transition. It could be very harmful to simply pull a kid from his therapist, then his school, his friends, and his home. He should be offered the opportunity to prepare himself for the change and to say goodbye properly. G announced it would be unnecessary. He would not be taking the bus any longer, so my services were no longer required. I did my best to say goodbye to M, who did not understand that it was the last time he’d ever see me. G lifted his wrist and shook it back and forth to approximate him waving, something he had done many times on his own.
The hottest, most enraging tears mingled with the bone chilling rain as I returned to my car, defeated.
After taking notes and informing the team of what I’d learned, I drove back to where I’d placed the AMRO. I’d only been at M’s house for 20 minutes. Perhaps I could bring the AMRO to the wildlife vet or check to ensure he was still breathing.
I approached the oak tree slowly, careful not to shock him. I crouched down over the root system to find… nothing. There was no trace of him. If he’d been eaten, there would have been feather fragments or tracks. In my heart, I knew he had survived. Perhaps he’d hopped into the bushes nearby or even found a crevice in the enormous oak in which to wait out the rain.
I’ll never know if G went through with her grand reinvention, or if M ever found ways to cope with the changes, or with his self-centered, deluded mother. I am hopeful that as he grows up some of what we did together will stay with him and help him along his path.
We may help save a life with our smallest acts of compassion, but we may never know the full effects of what our actions have wrought.