The psychologist has laid out an impressive array of toys across the office space: on a child sized table, on the floor, and more toys in a bin. I smile awkwardly, not wanting to disappoint her efforts, but knowing that R won’t care for any of them. R doesn’t play with toys. She smiles warmly at him and gets down on his level to say hello. He ignores her and the toys, and begins climbing the two chairs pulled up to her desk. “He loves to climb,” I say. She tells me we can finish some of the parent report questions she has while R settles in, and then she will start the assessment with him. She asks me a series of questions- does he recognize himself in a mirror? Can he stack 3 blocks? Does he understand the word “no”? Can he follow a one-step direction? No, I answer, no, again and again and again.
She sits on the floor next to R, who is clutching a pen he found on her desk and mouthing it. She tries to interest him in several toys but he ignores all her attempts. She decides to try using the pen, since it is the only thing he seems interested in. She take the pen from him and he bursts into tears. “Look R, can you find the pen?” She hides it under a cloth. Still crying he throws the cloth off and grabs the pen back, then settles down. She tries again, this time hiding it in a clear box that you must reach into from the side. R doesn’t know what to do and cries until we give him the pen back. She brings him blocks, showing him to stack one on top of another. He wanders away. She shows him a small mirror, which he turns over in his hand and mouths. She brings out an infant shape puzzle consisting of two knobbed shapes and the board where they fit. He puts the knob in his mouth but will not engage the puzzle beyond that. And on it goes. She brings out a wind up toy, she blows up a balloon, but he ignores all of this. Instead he mouths his pen and wanders the room. More than 2 hours pass in this way. Finally she brings out bubbles and begins blowing them. This is something that truly interests him. He steps closer to her, eyes locked on the bubbles as they float toward him. He is fascinated, watching wide-eyed, though he doesn’t try to reach out and touch the bubbles. She stops, pauses, and waits expectantly. Later she explains that she wanted to see if he would indicate a request for more in some way- whether by eye gaze, vocalization, or gesture. He waits too, and when he realizes she isn’t blowing any more bubbles, he bursts into tears with that heart-wrenching, hurt-feelings cry. I scoop him up and whisper soothing things in his ear, rub his back. The psychologist tells me she has enough, we can finish. She tells us to sit and relax while she writes a few things up. My husband and I glance at each other, silently wondering if we are going to have the result right now. R is restless so my husband begins tickling him and blowing raspberries on his belly. He laughs hysterically, an enormous grin stretching his little mouth, adorable dimples popping into view. Relief settles over me, this is my boy, this is exactly him, this is right. Forget the puzzles and blocks, the words and gestures. Him getting tickled, him laughing, this is my son. The psychologist comes over to sit with us, hands folded in her lap. She tells us our son has Autism. She goes over the assessments, explaining what she had been doing, what each part was looking for. Though we had been sure when we walked into the office that morning that this would be the result, it still seems unreal somehow. We ask inarticulate questions. We don’t know exactly what we are trying to ask. I think we just want to know if he will be okay. We ask if it’s mild, moderate, severe? She hesitates then says “Moderate to severe right now, but that can change. He is very young.” We leave with a diagnosis letter, the promise of a full report in the mail, and the instructions to start therapies and return in a year to check his progress.