The Good Doctor

As most people know, the US churns out hospital-based TV shows by the bucketload. This year I heard about a new one, and it obviously interested me. It centres around Dr. Shaun Murphy, a young surgical resident starting his first placement in a leading-edge hospital. The twist is that he has autism spectrum disorder and savant syndrome, which means he’s brilliant at what he does but sometimes has difficulty communicating with his colleagues.

It’s an intriguing concept, and certainly a brave one. ASD is already pretty poorly understood by the general public, and as it’s such a wide spectrum, there was a great risk that an unsympathetic performance might simply reinforce the stereotypes.

Thankfully, Dr. Murphy is being played by a brilliant young actor, Freddie Highmore. Like all the best actors in US TV procedurals, he’s British putting on an accent. So a British neurotypical actor is playing an ASD/savant American doctor. And it works.

It’s made by the same people who created House. However, Dr. Murphy isn’t played like House was: he isn’t arrogant in his superior knowledge, he isn’t deliberately abrasive with his colleagues. He’s flawed, yes, but he’s also funny – sometimes deliberately, other times not so much – and I suspect many of us can relate to what he’s going through.

While most episodes are thought-provoking, the one we watched most recently was even more so. Spoilers follow, so skip the rest of the post if you haven’t seen the episode “22 steps” yet.

Dr. Shaun Murphy (from abc.com)

In this episode, Shaun treats a patient suffering from ASD. However, his symptoms differ greatly and Shaun struggles at first to relate to this patient (as he’s never met another person with ASD). The situation the patient is in is obviously stressful, and Shaun eventually connects with him using numbers – hence the title – as a way to help him self-calm.

The thought-provoking part of the episode for me was how the patient’s parents coped with the situation. They took all the decisions about his treatment, including trying to get Shaun excluded from the surgical team because they were afraid that his “limitations” would put their son’s life in danger. They were so focused on what their son couldn’t do that they’d stopped seeing what he could do.

It made me wonder. Do I do the same thing with Antony? Do I limit him because there are things I don’t think he’s capable of doing right now? I make sure to hold his hand whenever we walk by a road; should I let him be more independent and walk on his own? Should I allow him to choose his lunch at school even though I don’t think he really gets the concept of it? Should we let him decide what to wear or when it’s time to go to bed?

I don’t want to be that controlling dad who prescribes everything that Antony does. I want more than anything for him to be independent, but I worry that giving him that independence might be the wrong thing to do. What if he runs into the road and I’m not quick enough to catch him? What if he chooses a meal and it’s not what he wanted and melts down when he can’t change it later? What if he chooses to wear just his underpants and melts down when we try to explain how impractical that is? What if he chooses to stay up all night watching the same episodes of Paw Patrol over and over?

Every parent goes through this, I’m sure. There’s no handbook for parenting but I think it’s reasonable to say that there are rough guidelines. I don’t think even that exists for children with ASD as they’re all so different. You get to know your child and their “limitations”, and act accordingly. But what this episode brought into sharp focus for me was that I’m not going to accept that Antony is limited forever. I accept that there are certain things that are problematic right now, for definite, but I’m not going to lead with the assumption that it’ll always be the case. So yes, I’m going to continue holding his hand until I’m sure that he isn’t going to run into the road. But also, I’ll give him the chance to choose his meals and if he melts down we’ll back off and try again later. I don’t think it’s right to insulate him from the things that make him anxious, but I also don’t think it’s right for them to be right there in his face if there’s an alternative.

Language development

I’m not an expert on language, and certainly not on bilingualism. Sofi is far more qualified than me to talk about this. However, I have some observations on how Antony’s language skills are developing and how I think that it works in his little brain.

There isn’t an awful lot of literature about bilingualism in autistic children. What there is shows what you might expect: it tends to vary. Studies on bilingualism in general tend to show that as long as the child is immersed in both languages, there’s no reason why they should suffer a language delay (though, like all children, some bilingual children do have delayed language).

One of the first signs with Antony that there might be something different going on was that he didn’t hit many of his communication and speech milestones. He was late pointing at things, late with his first words, etc. He used a lot of babble instead of real words. So when he actually started forming syllables (‘da’, ‘ma’, etc.) it was a relief for us. Unfortunately his communication development has been a slow and sometimes frustrating process.

He has a lot of vocabulary. He’s always been good at identifying objects, animals, people. He’s particularly good at remembering names. I’m pretty sure that he understands what we’re saying most of the time. Most vocabulary he has in English he also has in Spanish, and vice versa.

What I find really interesting is that when Antony learns vocabulary it tends to come in both languages at the same time. This is particularly obvious when it comes to abstract concepts. An example:

Every day when I pick up Antony from school we walk home. As part of that routine in an attempt to help him communicate, I ask him certain things about his day. These are questions like: “Did you have a nice day at school?” and the response is usually “Nice time at nursery”. These are phrases that Antony has learnt rote and that he tends to fall back on. I also ask what he’s done during the day and I’ll sometimes get one-word answers like “glueing”, “painting”, “slide”, etc. So to try to elaborate I go further: “Did you play out today?”. Usually I just get a “ye” answer or silence. But earlier this week, out of nowhere, Antony answered “not play outside today”. Mind blown. Where did that come from?!

This abstract concept that Antony had just switched on (being able to say what he hasn’t done rather than what he has) played on my mind until I got home. I wanted to see if it was available in Spanish too. So, arriving home, I asked Sofi to ask him if he had played outside. I phrased my question so that she wouldn’t get where I was going — it’s really easy sometimes to give Antony prompts and not allow him to work it out for himself. So, she asked something along the lines of “Antony, jugó afuera?” [my apologies to Sofi if I got that wrong!]. He answered “no jugó afuera”.

Now, he still hasn’t got the hang of his tenses yet so tends to just repeat the tense as per the question, but wow! he applied the same concept of not having done something. This is new and it happened in both languages at exactly the same time!

The way I like to think of this is that rather than having one language centre in his brain like monolingual children, Antony has formed a more complex structure. He effectively has two ‘bins’ – one for English vocabulary and grammar and one for Spanish. On top of that, he has an abstract concept processor which deals with things like “not having done something” in a language agnostic way. His clever little brain code switches to the appropriate language / bin, picks out the grammatical construct and vocabulary for that language and then drops out a fully formed sentence. To me this makes a lot of sense. It also makes sense that it’s this abstract concept processor that Antony’s brain has trouble with, and that’s where his communication delays are. It must be incredibly frustrating to understand what you’ve been asked but have no way of framing a response.

I wish we could get inside his head to know what he’s thinking…