Saturday, 3 September 2016

The shame of it: Why do we still tolerate columnists who harass disabled children in public?

The rage of the privileged is an unedifying spectacle. I suspect most parents of disabled children have been confronted by someone like Tess Stimson, who wrote in the Daily Mail recently that people with special needs should not be allowed out in public until they've learned to mimic the rest of us. The object of her ire was a young boy – in her description 'about eight or nine', though Tess, as we'll see presently, is not the most reliable of observers – who was hitting a spoon against a restaurant table. He and his family had had the sheer bad luck to be seated beside Tess and her friend. After about 40 minutes of 'mounting frustration' at having her conversation interrupted, Tess leaned over and snapped at him to stop. At which point the boy's mother, who until then had been serenely unaware of the presence of a Daily Mail columnist at the next table, found herself dragged into a depressingly familiar scenario.

'The child's mother... stormed over, incandescent,' writes Tess. '”My son is disabled”, she shouted, pushing her face aggressively into mine.' I can only speculate, but perhaps the tone of this exchange was set by Tess 'pushing her face aggressively' into the boy's a few moments earlier. The mother then goes on to point out that her son is in a wheelchair. 'I must admit I hadn't noticed the wheelchair and did feel a pang of guilt,' Tess writes.

There is perhaps no finer metaphor for privilege than this upside-down response to a child's disability. The boy's family will certainly have noticed the wheelchair, every time they have to take the long route to enter a building, or wait for the next bus because another pram or wheelchair is taking up the next space, or phone a restaurant to make sure they get an accessible table. Accommodating the wheelchair is woven into the fabric of their everyday lives. But in Tess's eyes these challenges are eclipsed by the inconvenience of listening to a spoon striking a table for 40 minutes.

Just as hunger pangs are quickly banished by snacking on chocolate, so Tess dispels her fleeting sense of guilt by bingeing on self-righteousness. 'Criticising another's offspring, however anti-social their behaviour, has become a taboo in our child-centric society,' she laments. 'Particularly if the child has 'special needs', be that anything from ADHD to a broken leg.' Or perhaps we've learned the rule that if you have a problem with the way a child is behaving you should raise it with their parents first.

We do not learn from Tess exactly what the boy's specific needs were, and she doesn't seem especially interested. What we do learn is that she has a curious, 'one size fits all' understanding of disability, as seen from the equivalence of ADHD with a broken leg. Co-opting the 'some of my best friends are black' argument, she informs us that one of her children has Type 1 diabetes and has to inject insulin at mealtimes, but proudly observes that 'never once has this led to bad behaviour in a restaurant.' Now, Tess clearly has the advantage of me in her knowledge of diabetes. My understanding is that it's a serious condition that requires rigorous management, but never before have I seen it compared to a neurological condition. Children whose whole system of thinking is fundamentally different can't be compared with those whose mood is knocked off kilter by a sugar deficiency.

Tess insists that she sympathises 'deeply with the parents of any disabled child', but the mask soon slips and she exposes herself as that most tiresome species of hypocrite, a crusader for traditional parenting. The assumptions come thick and fast, but mostly thick: modern parents are 'lazy' and let their children 'run amok' 'because it's hard work enforcing rules'. 'Enough with the the kid gloves,' she declares; 'If someone can't control their child, they should leave them at home with a babysitter.' She extols the virtues of her own parents, who brought her children up to be seen and not heard, and declares that children with disabilities 'have the right to be treated like able-bodied children and that includes being disciplined when they misbehave'. She cites the example of her own daughter, who at the age of eight 'was discreetly giving herself insulin shots out of sight beneath a restaurant tablecloth'.

This last detail is telling, I think. Tess applauds her daughter for coping with her disability, but for masking it. The disabled must not look or act disabled, is the implicit attitude. They are welcome in society on condition that they stay discreet. If they are suffering, if they are isolated or overwhelmed, they should stay home rather than burden the rest of us with it. If this is sympathy, I'd rather go without it.

In the end Tess gets her way, as the privileged always do. When her sharp reproach stuns the boy into a hurt silence, she comments: 'Sometimes a firm, sharp word from a stranger can be far more effective than yet another empty threat from an overwhelmed parent'. Yes, it's easy to bully people into silence, particularly when they lack the verbal skills to stand up for themselves. But it takes a rare degree of boorishness to crow about it in the pages of a national newspaper. For Tess picking on the vulnerable is not merely justified, it is a courageous response to the forces of political correctness. 'No wonder no one dares open their mouth any more,' she says, directly after boasting of doing exactly that to assert her privilege over a disabled boy.

Parents who have put their children through hours of therapy, tried all manner of specialist interventions and cheered every hard-won scrap of progress, are understandably upset when they are branded lazy and irresponsible by adults who can't control their sense of entitlement. I doubt if Tess gave a moment's thought to the effect of her intervention on the family she upbraided, but many parents wouldn't dare to take their children out in public for months after that kind of setback. Tess, presumably, would see this as a triumph for civilised values.

I've never sought to 'control' my children. I'm not even sure I want to know what that means. I want them to grow up to be polite, thoughtful and considerate towards others, all qualities I find wanting in Tess Stimson. They mostly behave well in public these days, as long I keep two steps ahead of any potential setbacks. But even getting to this point has involved years of painful trial and error, and at every step of the way there have been Stimsonites chasing us out of museums, glaring at us in restaurants and humiliating us in the supermarket queue. My successes have been in spite of, not because of, these people's unsolicited advice and hectoring stares. To give up would be to collude in stigmatising my own children.  

Wednesday, 30 January 2013

Ditch the bungee rope: on 'growing out' of autism

A few weeks ago a study came out that appeared to make a startling claim: some children are capable of "growing out of autism". The phrase was widely used across the media and intended, presumably, to confer hope on parents sitting at home desperately trying to coax a few words, or a fleeting moment's eye contact, out of their children. It implied that there was still hope that your autistic child might one day become normal. I've always had a fancy for rewriting the Pinocchio legend in terms of autism, and these articles certainly gave me plenty of material.

On closer inspection there are a number of problems with this assertion. Firstly, as Emily Willingham points out, nowhere in the original paper in The Journal of Child Psychology and Psychiatry is the phrase "growing out of autism" actually used (though the journal's editorial does talk about 'recovery'). The scientific analysis is best left to people who, like Emily, know how to do it. I'd merely observe, from my experience as a parent, that while both my children have made good progress over the last few years, neither of them are any less autistic than they were as toddlers. And here's where we approach the real core of the issue.

Underpinning the notion of growing out of autism is an unhealthy presumption that autistic people can only make progress if we can somehow engineer them to be less autistic - to "grow out" of the condition. We want to tie them to a bungee rope and drag them back towards normality. (Having sprained an ankle the only time I tackled a bungee rope, I am only too aware of the full implications of this metaphor). Rather than valuing their abilities, we focus on their disabilities and how we can eradicate them. It's indisputably a good thing if we can teach a non-verbal autistic person to speak - or, failing that, to communicate by other means - but this doesn't mean they've become less any autistic. It simply means that they've learned a new skill.

And this is the truth about how autistic people "grow out" of autism: they don't. Autistic adults who integrate into society - and there are many who thrive - will talk about how they learned to cope. They develop strategies so they can 'pass' regular society. They learn to wear masks. Like emigrants who develop the ability to speak a second language fluently, they can be adept with their acquired skills even if they never truly resemble a native. In situations of extreme stress, or where they are forced out of their learned routine, the autism can become as debilitating as it was when they were children.

I question why this obsession with growing out of autism persists even when we have agreed to stop assuming that people "suffer" from autism. It suggests that we still have a way to go before we accept what autistic people can contribute to our society and stop viewing them, tacitly, as retarded or disadvantaged. The full name of the condition is Autism Spectrum Disorder: the focus of the treatment should surely focus on the last word of that phrase. There are plenty of examples of people who are on the autistic spectrum and lead an orderly life. They should be celebrated not because they have grown out of their autism, but because they have grown into it.

Saturday, 20 October 2012

The hardest thing to say

Seven weeks ago Magteld was diagnosed with breast cancer. It was a shock that ruptured the fabric of our family all over again. The first examinations indicated a fibroademona, but she was given a hospital appointment just to make sure. The day of diagnosis was my birthday. We would go to the appointment, then head out for lunch to celebrate the lifting of the shroud of fear from our shoulders.

And then two women we’d never seen before came into the consultation room and delivered the devastating news. They were a cancer surgeon and a breast care nurse, and the tumour was anything but benign. At that moment the future disintegrated.

The surgeon warned us, among other things, to be wary of people peddling miracle cures on the internet. We smiled wearily and explained that we were already well aware of that pitfall because of the children’s autism. Nevertheless, one of the first dilemmas we faced was how to break the news to the children. There were books available on how to explain cancer to children of various ages, but not ones with communication difficulties. How would we know if the message had got through to them, and how would they respond?

When Magteld took to bed after the first round of chemotherapy the boys seemed unaffected at first. As long as someone was making the sandwiches all was well. We put a huge emphasis on maintaining as much of the old routine as possible. But this could only work up to a point. Magteld had to cancel a trip to Hamleys one Saturday because she was too tired to take the boys into town. We knew that if we couldn’t explain these unscheduled setbacks properly, we would only be storing up more trouble for ourselves.

I first tried explaining it to Adam as we walked to school. I told him mummy was very sick and would sometimes be tired, but he could help her by not disturbing her and doing things by himself like getting dressed for school.

As the weeks went by he became more difficult and agitated. His top lip went raw from his nervous habit of sucking it down into his mouth. In turn I grew irritated with him for being disruptive while his mother was lying in bed feeling wretched.

One morning he told Magteld not to bring him to school because she was sore. A little detective work by her brought out the revelation that he saw her as a different mummy. It was only then that I realised that he was rebelling against the cancer rather than his parents. He hated the fact that his mother was sick. He wanted her to be the strong person who was always able to pick him up. And so every time one of us mentioned her illness he would froth with anxiety. He was agitated and confused, like a fly trying to escape a room through a shut window. She explained to him that she was very sick but was taking medicine to get better. The change of emphasis, from illness to recovery, began to settle him. It became the backbone of our discussions about cancer.

With Euan acceptance was more gradual. I expected him to understand that his mum was seriously ill, but how would he deal with it? His school found some materials about cancer and I discovered a series of superhero comics about serious diseases that tied in neatly with his Batman obsession. But for a while he seemed to showed no interest in either the comics or his mum’s state.

Euan often responds better to sensory clues than verbal information, and so it proved here. The turning point came when Magteld’s hair started to fall out. Every night when he came home from school he would her take her hat off and rub her head. One night Euan came up to me one supper time and said ‘Mum’s not well’. It was hard to hear from him, but it was also a good sign that the message was filtering through.

The other day he asked her if her hair would come back when she was better. Euan rarely asks questions, so I took his curiosity as a sign that he was moving towards acceptance. Then he asked: ‘In April, when Mum’s better, can we go to Hamleys?’ The aborted trip had gained a kind of totemic status in his mind, a yardstick of his mother’s sickness. And perhaps perversely, it became the conduit for reassurance: the cancer was no longer a vast, shapeless threat that made his parents sad and angry, but the thing that had stopped him going to the toy shop. The promise of a deferred visit once the treatment was over reassured him on two fronts: he could concentrate on his mum getting better, and the disruption to his routine had a measurable end-date.

Then came the final breakthrough. The next day Euan took out his diary, where he plots the upcoming events in his life - birthdays, school holidays and respite dates – turned to April 1 and wrote: ‘Mummy get better.’ And under the following Saturday he wrote: ‘Go to Hamleys’.

The hardest thing to say has not been that Mummy has cancer, but that Mummy will take a long time to get better. Sickness in a child’s mind is meant to be a fleeting thing. Slowly they are coming to understand that it’s a process that will still be going on long after Christmas. It would, of course, have been a different story if her cancer had been more advanced, but those kinds of hypothetical worries are for adults, not children. The main lesson I’ve learned in these first weeks has been not to add to their burden by heaping all our adult fears about cancer on top of their own.

Euan asked me another question just before he opened his diary: ‘In April, when Mummy’s better, will everybody be happy?’ Answering that, I reckon, will involve a bit more fieldwork.

Sunday, 13 May 2012

Do not adjust your set

Saga Noren, the lead character in Scandinavian TV crime drama The Bridge.
Autism today has reached epidemic proportions. I don't mean in real life. There are complicated but sound reasons why the rate of diagnosis has increased. But there is one place which suddenly seems to be teeming with autistic people: the television.

We have become used to seeing autism on the cinema screen in the 25 years since Dustin Hoffman donned an ill-fitting suit to play Raymond Babbitt. Rain Man takes a lot of flak these days, some of it deserved, but the problem was not so much the film itself as the fact that for many years it was the only reference point available. People assumed that all autistics were like Raymond - that is, limited verbal ability, highly rigid, fixed on routine and given to intense fits of anxiety. If you didn't comply with that formula, you weren't 'really autistic'.

Nowadays it seems no serious TV drama is complete without a character who is either autistic or displays pronounced autistic traits. Sherlock. Lisbeth Salander. The surgeon in Holby City. Tireless, single-minded, highly focused individuals whose minds are so innately fascinating that they can dispense with trivial things such as friendship. ‘Oh God, what is it like in your funny little brains?’ wails Sherlock at one point. ‘It must be so boring!’ The latest such lead is Saga Noren in The Bridge, summed up by one critic as “a woman endowed with all the logical brilliance of Mr Spock but with even fewer people skills”. On reading this I realised why these characters were starting to disturb me. It’s the consolation of genius writ large: the myth of the ‘contented autistic’ who never feels sad or lonely and whose behavioural quirks are endearing, or empowering, rather than isolating. Most autistic people I know value the company of others, even if they find it hard work, and dislike people assuming they prefer Garbo-like brooding solitude to a night in the pub.

It is crime drama, a genre traditionally brimming with flawed geniuses, that seems to have jumped on the autism bandwagon with greatest enthusiasm. Autism has taken over from heavy drinking and divorce as a metaphor for unconventional, misunderstood brilliance, but without the failings implied by broken marriages and withering livers. Which brings me on to a wider problem about autism in fiction: a fully-fledged autistic character is a hugely difficult thing to achieve. One of the perplexing things about autism in real life is that the more you learn about it, the less you seem to know: as the cliché goes, once you’ve met one autistic person, you know one autistic person. Yet characters in fiction, even the best ones, are necessarily incomplete. We see them for a couple of hours, in a context where their personality is in service to things like the plot. Hans Rosenfeldt, head writer of The Bridge, has said of Saga Noren: “We never diagnosed her, but we got a lot of positive response from the Asperger community. They really, really liked her because we showed her as functional and great at her job, even though she was a little strange.” Which is nice, but in terms of exploring the complexities of autism does it really take us any further than Rain Man?

Perhaps the most fertile territory, then, for an autistic character to flourish is a soap opera. The closest we have is Coronation Street’s Roy Cropper, whose development over the last decade says much about how autism has evolved in television drama. Initially Roy was a cardboard cutout 'lone psycho' character who was meant to last a few weeks before departing in ignominy, probably after garrotting his neighbour's cat. Having dodged that particular bullet he hung around in the background for a few years, doing little other than making people feel uneasy, until one of the screenwriters decided to reshuffle the pack. Roy's obsessive traits were made endearingly quirky rather than frightening, fans warmed to him and in time he was rewarded with that soap-opera badge of honour: a partner. Though Roy’s evolution reflects well on the show, even today the words autism and Asperger’s go unspoken in the Corrieverse. He hasn’t been diagnosed, and I can’t be alone in having conflicting views about whether it would be a good thing if he was.

Seeing autistic characters on the screen, doing admirable things in lead roles, has undoubtedly raised awareness of the condition, and that has to be a good thing. I wonder, though, how far it has raised understanding. When Louis Theroux broadcast his documentary ‘Tough Love’, about families raising autistic teenagers and young adults, I was mildly shocked to see how many people on Twitter expressed sympathy for the parents. I long ago passed the point of feeling like someone who needs or deserves anyone’s pity: my children are the way they are, sometimes brilliant, sometimes tear-your-hair-out frustrating, sometimes terrifying, but always lovable. But perhaps this reflects the gap that still needs to be closed between the brilliant, self-contained autistics on screen and the autistic person living in your street. I can’t speak for every one of them, but if I had to guess I’d say they want to be understood far more than they want to be admired.

Thursday, 15 March 2012

Out of their depth: What the Metropolitan Police should learn from the case of the autistic boy in the swimming pool

It is a matter of immense regret that Bernard Hogan-Howe, the commissioner of the Metropolitan Police, is seeking leave to appeal in the case of ZH, the autistic boy who was restrained, placed in leg irons and put into a police van, confused, dripping wet and terrified, after diving into a swimming pool in north London. This case ought to be a turning point in the way the police deal with autism and disability, one that ultimately benefits all concerned. Its lessons are plain to see, but sadly Hogan-Howe’s preferred course of action is to bury his head in the sand.

The commissioner seems personally slighted that ZH’s family were awarded the fairly modest sum of £28,250 for this ordeal: of this, £750 covered loss of liberty and pain and distress during the 40 minutes he spent bound hand and foot in a police van. Hardly a ruinous amount. The greatest share, £12,500, was for the exacerbation of ZH’s other condition, epilepsy.

A folk version of this story has grown up since the judgment was handed down suggesting that the police are the victims in this case. They were, after all, dealing with a 16-year-old boy who was fully clothed, unable to swim, and a danger to himself and other pool users. Almost all of this narrative, however, is flatly contradicted by the facts of the case as set out in the judgment. I accept, by the way, that the police officers who responded to the call were not negligent or careless in the exercise of their duty. They were simply out of their depth. This, though, is precisely the problem that Hogan-Howe fails to grasp.

ZH - or Josh, as he was called by the family’s solicitor - was at the pool with a group from his special needs school. Five children and five staff were on the trip, which was designed to familiarise them with the pool environment as preparation for learning to swim. However, there were no plans to go swimming and so the children were in their day clothes.

The lifeguards became concerned when Josh became fixated on the water and refused to leave the poolside. His carers were trying to lure him away with the promise of food and bananas. The carers had told the lifeguards that ‘if you touch him, he will jump in’ and advised them to give him time to step away. One manager called the police and told them there was a boy who was ‘getting aggressive’. In point of fact he wasn't. This was the first mistake and one which coloured the police’s response.

When the first two police officers arrived Josh was not in the pool. He had spent the previous 40 minutes standing by the edge and gazing into the water. There was no sign he wanted to dive in, but there were fears he might fall. One of the police officers consulted the carers about the nature of Josh’s disability. Unfortunately, it was at this point that her colleague went up to Josh, introduced herself and tapped him on the back. This was the second mistake. As predicted, Josh plunged in.

The point where he jumped into the water was near the place where the shallow end slopes away into the deep end. The water here came up to his chest. Josh at first showed no signs of distress and splashed about playfully. There was, though, legitimate concern because of his poor sense of danger. He began wading towards the deep end. By this time three more police officers had arrived. None of them, according to the court, consulted the carers on what course of action to take. Communication between the police and the people best qualified to advise them was now non-existent. This was the third and, I would argue, the most grievous mistake.

Three lifeguards jumped in at the deep end. One took Josh’s jacket off and together they ushered him back to the shallow end. Josh was no longer in danger - the water here was beneath his waist level and he was surrounded by police officers and lifeguards. It should have been an easy matter, if perhaps a time-consuming one, to lead him out of the water, with the support of his carers. Instead the police, who were by now not speaking with the carers, unilaterally chose to physically restrain him. This was the fourth mistake, and the one that escalated a bad situation into a disaster.

What’s aggravating about this episode is that the top brass at the Metropolitan Police seem wholly unwilling to learn the lessons of that day. The court recognised that the officers did not act out of malice or brutality; otherwise they would been hit with punitive damages. Rather, as a telling sentence from paragraph 129 puts it, ‘They were simply caught up in a process which they had started, continued to be involved in and felt unable to stop or control.’

The response of the police officers in Josh’s situation was clouded by ignorance. Their training was wholly inadequate for the situation they faced. They made little attempt to consult Josh’s carers on how best to handle him or what the precise nature of his disability was. They were not helped by the swimming pool manager who told them Josh was being aggressive when in fact he wasn’t. Every decision the officers took aggravated a situation which, right up until its final stages, could have been resolved with no great trauma. The carers must share some of the blame for not supervising Josh more closely and failing to intervene. But the essential problem was that the police opted for a procedure - emergency physical restraint - designed to deal with aggressive and threatening individuals, not disabled teenagers standing in the shallow end of a swimming pool.

A little liaison with Josh’s carers at any of at least three stages could have prevented an entirely avoidable outcome. The police at the swimming pool felt they had no alternative but to restrain Josh and throw him, in his wet clothes, into the back of a van. That is a dreadful reflection on the level of training they receive on dealing with disabled people. But far worse is the Met commissioner's dismissal of the need to improve on it. If the Met need lessons in dealing with autistic people, they need only pick up the phone to their colleagues in Scotland, where autism-related training, has been devised in collaboration with the National Autistic Society.

The phrase ‘institutional racism’ has been much abused since it was coined in the Macpherson report. It was devised in recognition of the fact that tackling racism was not simply a matter of changing the attitudes of individual officers. Often the problem was that the systems and procedures used by the police were inherently discriminatory, regardless of the officer’s intentions. The ZH case has exposed a similar problem with the treatment of people with disabilities, especially a disability such as autism, which varies widely and is often invisible.

It took a violent death for the police to face up to the problem of institutional racism and learn the necessary lessons. We can only hope that they can tackle the institutional ignorance of disabled people’s needs at an earlier stage. As the last paragraph of the judgment states: ‘The case highlights the need for there to be an awareness of the disability of autism within the public services. It is to be hoped that this sad case will help bring that about.’ As long as Bernard Hogan-Howe keeps his head in the sand, however, those hopes will be forlorn.