Authors: Debra Ginsberg
Raising Blaze (15 page)
Once again, I took Blaze to the center for school problems to visit the same psychologist we’d seen when Blaze was in kindergarten. My reasons were fairly simple; I’d been in total agreement with Dr. F.’s assessment of Blaze the first time around, for one thing, and for another, money was still an issue. I just couldn’t afford to take Blaze anywhere else.
I was spared filling out another medical history form as Dr. F. decided to refer to his original notes. I felt much less optimistic than I had when I’d brought Blaze in four years before. I told Dr. F. about Blaze’s success in first grade, decline the following year, and the mess he was in currently. I shared my fears about Blaze’s social development and the fact that he didn’t seem to have made any social connections, much less friends, in his peer group. I blamed his teachers. If they were better equipped or more empathetic, I said, they would be able to reach Blaze. It couldn’t be that difficult, could it?
Dr. F. spent less time with Blaze than he had the first time around.
After half an hour, I was summoned into his office. Blaze was sitting in the doctor’s chair, playing with the computer.
Dr. F smiled broadly as he spoke to me. In his opinion, he said, there was nothing really
wrong
with Blaze, although he was certainly unusual and had a unique angle on the world around him. My son, he told me, was also a gifted manipulator and had created several strategies to avoid performing tasks he felt were too difficult. Blaze had difficulty with his handwriting, Dr. F. said, and also showed some difficulty with complex addition and subtraction. Dr. F. believed that these difficulties were somehow related to Blaze’s endocrine problems, but he couldn’t tell me how. When I told him that Blaze’s endocrinologist steadfastly maintained that there was no connection between the medical and learning problems, Dr. F. shrugged. “We doctors are not always in agreement,” he said. I certainly agreed with this and with almost everything else that Dr. F. said, just as I had the first time. Dr. F. promised to write a helpful report for the school and offered one last opinion about our situation.
“You realize,” he said, “that if you were very wealthy, Blaze would probably just be considered charmingly eccentric.”
I thought that this was one of the most insightful observations I’d ever heard from a professional, but I didn’t see how it would provide any concrete help unless I discovered a quick way to become rich.
I received Dr. F.’s written report a week later and, once again, I shared it with Dr. Roberts and Sally. This time, even the normally reserved Dr. Roberts had difficulty concealing her disdain, telling me that it was one of the most unprofessional reports she’d ever seen. For one thing, there was no mention of any tests, Dr. Roberts said. Did Dr. F. even administer any? The report was carelessly written and rife with spelling errors and incorrect dates. All of this showed a basic inattention to the assessment, she said, not to mention that the body of the report said nothing useful.
Blaze is a young boy of above average intelligence
, the report said,
who
presents with a moderate dysgraphia and mild dyscalculia the nature of which suggests these parts of his development “stopped” at roughly the same time his growth curve flattened. These deficits are not extraordinary, however, and in and of themselves should not pose a difficult remedial issue. Rather, it is this examiner’s opinion it is Blaze’s personality in combination with these difficulties that are proving confusing to his educators.
Both Dr. Roberts and Sally felt that this was a vast understatement of Blaze’s problems. Sally, especially, was irritated that Dr. F. had not interviewed her by phone as he had the first time and hadn’t taken into account any of the school’s evaluations. But it was Dr. F.’s final summary that irritated them the most.
Blaze’s neuropsychological profile is that of a bright young boy who has profited from parts of his educational experience but remains “frozen” in other domains. It may be that this is related to the same factors affecting his growth curve but whatever the etiology, it is clear he has developed little in visual-integrative tasks or in specific areas of motor function.
In and of themselves, these academic problems should not prove overwhelming. It is this examiner’s opinion that the consternation occurs in trying to tease out behavioral versus cognitive contributions to his academic problems. He is by personality a highly eccentric, idiosyncratic youngster whose approach to common problems is anything but common. While this creativity can be a gift, it is also used to hide from situations he finds uncomfortable, particularly those that highlight his weaknesses.
It is suggested to all concerned that Blaze’s greatest need is in the area of self-esteem. He perceives himself only as a problem and has little but his imagination as proof of his competencies. He sees himself as inferior to those around him and is rapidly evolving into a school phobia unless the cycle is broken.
“I really think he’s done you a disservice,” Sally said. “This is an oversimplified report and gives us nothing to go on.”
“What about the dyscalculia and dysgraphia that he talks about?” I asked Sally.
“All that means is that he has trouble with math and writing,” Sally said. “We already know that. He hasn’t said anything about what’s really going on with Blaze.”
In other words, I thought, there was still no definitive diagnosis and a diagnosis was what everybody seemed to want. I couldn’t entirely disagree with Dr. Roberts’s and Sally’s assessment of the report. It was true that the report contained many errors, all of which led me to believe that it had been put together very quickly with little attention to detail. I also wondered if, in the absence of his own tests and evaluations, Dr. F. had relied too heavily on
my
reports of what was going on at school and the way I shaded descriptions of Blaze’s behavior with my own interpretations. It was plain that Dr. F. had seen Blaze’s native intelligence, I had no doubt of that. But I wondered if he just took me at my word for all the rest and “phoned in” his report without really delving deeply below the surface. It was this doubt, combined with the school’s disgust at the report, that drove me to yet another psychologist.
This time, I obtained a referral to the psychiatric department of our HMO and made an appointment with Dr. C., a clinical psychologist. I decided that I would be as open and trusting of this new psychologist as possible. I would be completely honest about Blaze’s behavior at home as well as delineating, impartially, his problems at school. I brought copies of Blaze’s records and filled out yet another medical-history form. I brought Maya along to the interview so that the doctor could get a clear view of Blaze’s family situation. I cautioned Dr. C. that Blaze was likely to be resistant to tests. He had seen so many different psychologists, I explained, that he was becoming hip to the game and was starting to offer up what he thought the examiner wanted to hear. Please take this into consideration, I begged. Don’t let Blaze know that you are testing him or else you won’t get accurate results. I fought to trust Dr. C. although I had many misgivings. We had two sessions. For the first, Dr. C. interviewed me and Maya for
over an hour. For the second, he interviewed Blaze for forty minutes and all three of us for a half hour.
I heard nothing from Dr. C. for weeks. Frustrated, I called his office several times. When I finally reached him, he promised to send his report to the school.
“No,” I told him, “I want a copy of the report. I don’t want the school to see anything before I’ve had a chance to look at it.”
It was two months before I received Dr. C.’s report. When I opened it, I was immediately startled by the heading.
Psychological Evaluation
, it stated.
This report was prepared as a professional-to-professional communication and is not for release to the patient or his family.
By the time I finished reading, I understood quite clearly why I would not be the intended recipient of this particular evaluation.
INTERVIEW DATA:
Blaze’s mother was interviewed prior to testing. On a second date, she and her sister were again interviewed and they brought in some extremely interesting videotapes of Blaze singing his favorite songs, which he has written himself.
Blaze’s mother says, “The chain of his logic, the way he thinks is different.” She says Blaze will say things such as “The floor hurts me,” when he means that sitting on his bottom hurts. She doesn’t suspect that he hears voices, but he has often heard music in his head, and that he has even gone so far as to ask her to put her ear against his head, so that she could hear the songs inside his brain.
Blaze is described by his mother and aunt as being extremely inquisitive and wanting a great number of details about certain subjects. For example, he perseverated for several weeks
on the death of a spider which has been living in his room. He asks “endless” questions about his mother’s life as a little girl. He appears to perseverate, asking the same questions again and again and again.
Blaze has written a number of songs which he accompanies by rhythmically strumming a guitar. He has given these songs names, and he sings them in the same order each time. Songs include “Nerve Night,” “Catch the Broken Timer,” and “Give Me Back My Note.” Many of his songs focus on disturbing events which have happened at school.
Blaze has been with the same teacher for years. She says that he “is a little stranger this year than he was before.” [She] describes him as having a lot of perseveration, particularly being afraid that frightening noises might happen, that somebody might use a blender, or that some other frightening thing would occur.
When he first came to the classroom, he had no language whatsoever. It was extremely difficult to get him to engage in any type of classroom activity, and the present goals are to keep him in the social arena, to help him stay calm in class, and to help him stop screaming and throwing things.
When Blaze becomes agitated, he screams, runs around the room, and makes siren noises. His teacher says he cannot accept any change in school and becomes upset when there is any alteration in the pattern. He is extremely resistant to anything which he perceives as a demand. He sits in reading group but will not make any attempt to read, and indeed
must be assured before reading group starts that reading will be expected. He will not do any work in a journal because “he’s afraid of his journal and he throws it.” He will do the same work on paper, but it needs to be plain white paper with blue lines.
When Blaze doesn’t want to participate in class, he will say things like, “I’m making a video now and I’m on mute. It’s about the United States of America.” At this point, he will sit and talk to himself, but will not interact with anybody else.
Because of his social limitations, [his teacher] considers him one of the more disabled children in the classroom. She says, “He wouldn’t think to find himself if he got lost.”
TEST DATA:
Interviewing Blaze was an interesting experience. Mostly he appeared to be giving me stereotyped responses which he had included in many conversations before. His first comment on sitting down with me was, “My mom decided to name me Blaze. I like parties with balloons.” There was nothing in the context on the interview which I was aware of which might have elicited this comment.
Asked about school, Blaze says, “I like to run and make siren noises, siren noises,
roo-oo-oo
…” He was unable to name any friends at school. I asked him if he had enemies and he said, “A little of them.”
Later he said, “If there’s any noise, loud noises, I’d have to run away, or scream really loud, or make a siren noise.” It was
quite evident that Blaze was simply describing his coping mechanisms. This was not an attempt at display. He was telling me what it is that he does.
TEST DATA:
Perhaps the most interesting test data came on the Rorschach, although the Rorschach was unscorable. Confronted with the first two cards, Blaze simply repeated, “I don’t know,” again and again and again. Finally, when presented with the third card, he said, “I’m on the phone, I can’t talk now. I’m on the imaginary phone.” This appeared to be the same behavior described by his teacher, in that he enters a role-play world in order to avoid complying with demands.
On the Peabody Picture Vocabulary Test, Blaze attained an IQ of 40, which is in the lowest one percentile of the population. I judge this to be an underestimate of his actual intelligence, because of the interference of his emotional disorder with his test performance.
Blaze’s drawings were of extremely poor quality, showing the drawing level of a 4- or 5-year-old child. This is somewhat in line with the measured intelligence of the PPVT, but again I would be extremely reluctant to overinterpret any findings about his intelligence.
DIAGNOSTIC IMPRESSION:
Blaze meets the diagnostic criteria under DSM-IV for an autistic disorder. He has marked social impairment and stereotypical responses which interfere with his capacity to interact socially and gain academic skills. While he lacks the
stereotypic movements often associated with autism, he certainly has stereotypic and repeated verbalizations which more than meet the criteria for this diagnosis.
RECOMMENDATIONS:
Blaze will no doubt continue to need to be in a sheltered classroom setting. For a child bearing this diagnosis, he is fairly high-functioning. Although it is quite evident that he has significant academic and social limitations which are likely to be continuing, it is unlikely that Blaze will respond to psychotherapeutic interventions. It may be helpful to assist his mother in managing his behavior at such points as it becomes difficult.
It is certainly worthy to note that Blaze’s mother is extremely supportive, and Blaze appears to have a family which provides a warm and loving context.