Special Needs Trust: A Public Service Announcement

Mirror Neurons

Marello Dapretto PhD http://faculty.bri.ucla.edu/institution/personnel?personnel%5fid=46838 spoke today about how mirror neurons are abnormal in those with ASD-autism spectrum disorder. It was one of those lectures where I felt like I already knew this, and so I was not learning anything, but at the same time, she was demonstrating with pretty fMRI pictures that what I/we have suspected for years, is finally being proven with our imaging technology. That is, we now can demonstrate that those individuals with ASD have a defective wiring in their ability to imagine what others are thinking or imagining. In other words, their “theory of mind” is impaired, and the level of their impairment matches the level of defect in their mirror neurons. In other words, this is a continuum of damage, resulting in the “S” or the spectrum concept. Sure, there are workarounds to the mirror neuron system. Children can learn to understand human behavior and they can learn empathy, but they will have to bring in another neurological system since their mirror neurons do not fire properly. For years, in my training from 1986-1991, we told families of those with ASD that there was a “wiring problem” without any specific knowledge about what that wiring problem might be. We felt certain that parents should not blame themselves for the social awkwardness of their children, but at the same time, parents can help fix the problem. Listening to Dr. Dapretto today, confirmed what we told parents, back in the day. Phew!

Social Awkwardness

Ned, thirty-three, “stiffens up” as he relates to me how his wife describes his behavior. “Well, we were watching a play, and we had to sit separately since my wife could not get two seats together. She always has me hold her cell phone. I don’t know why. She got three text messages during the play, so as soon as the play was over and we came together, I told her that her phone was going off. She got upset with me that I did not connect with her about the performance, or that I did not ask her how her seat was. She said I was socially awkward.” “Did you agree with her?” I asked, thinking that I am sympathetic to the wife’s point of view that she was probably anticipating reconnecting with her husband after the show and he was hyper-focused on making sure she knew she had messages to attend to. I could well imagine that this conflict of expectations created a large amount of tension, which had Ned been more socially astute he could have handed her the phone and asked her about the play at the same time. “Yes, of course, I am socially awkward,” Ned, readily agrees, “but I don’t know what to do about it.” Ned says with the innocence and sweetness of a child. “So, it was not intuitive for you to try to emotionally connect with her after seeing a show,” I ask, knowing the answer. “Yep, it was not intuitive,” Ned says with a confused tone as to how something like that would be intuitive. “Maybe you need to keep in mind that the moment of reconnecting, after a day’s work, or after any separation for that matter, is a sensitive time, and you should take extra care  to be attentive to your wife as a whole person, and not get so focused on one issue.” I say, stating what is obvious to most people, but what seems to need to be spelled out to Ned.

As I describe this interaction with Ned, I imagine my readers asking me about his diagnosis. Do I think Ned has Asperger’s? I imagine Shelly and Jon asking me. I think that social skills, like all skills are on a continuum, as are athletic skills, musical skills, math skills, etc. Ned’s social skills are weak, but I would not extend that to say that he has a social communication disorder. Ned is, for the most part, happily married, a father of two young children, and successful socially at work in that he gets along well with his colleagues. His issue is that he lacks social intuition that is helpful in close relationships.  However, he understands his deficit and so he is religious about coming to psychotherapy. He is motivated to make his wife feel more comfortable with him. Psychotherapy may help him be more socially conscious,  in a wooden way at first, in that he may sound rote, rather than warm, but over time, the warmth will be added to his reactions and so I am hopeful for the future of their marriage.