The first night with Rhythm
I recently introduced a new client– 7-year-old Rhythm, who has diagnoses of autism and epilepsy. He lives with his parents, older sisters, and a rambunctious young dog whom I’ll call Bounce.
My first night caring for Rhythm was rough on him. His mother scheduled me to come a bit early and eat dinner with the family, to give him a chance to get used to me before they left him alone with me, but he was obviously unhappy when I showed up, and retreated across the room. His mother tried to get him to come over and say hi to me, but I reassured them both that he didn’t need to engage with me right away.
There is, I have found, a fairly universal rule with children, which is that you can win them over if you’re willing to sacrifice your own dignity. In short, I have yet to meet a child who isn’t enchanted by some form of silliness. I don’t necessarily mean over-the-top clowning around here (I remember, as a child, being acutely embarrassed on behalf of any adult who acted too goofy, to the extent that it made me feel horribly uncomfortable around them). But children have good senses of humor, and they are different from adult senses of humor. Children also enjoy themselves with utter un-selfconscious abandon, and appreciate adults who are willing to do the same: to get wet or messy or muddy in pursuit of a good time, to break the rules of decorum, to ignore “you should” in favor of “let’s see.” It’s a different philosophy of life.
I have no objection to sacrificing my adult dignity in order to make a child feel more at ease, but it’s a little harder to do with the child’s parent’s around, as adults can misconstrue too much goofing around as a sign of immaturity or irresponsibility. The presence of Bounce, however, gave me a good starting point. Win over a kid’s pet, and chances are the kid will start trusting you, too. I don’t know whether animals actually are good judges of character or not, but people tend to trust their judgement. And I have yet to meet a cat or dog that I couldn’t get to love me.
So I petted Bounce and scratched behind her ears while Rhythm watched solemnly. Then I got down on all fours and played with her as if I were another puppy, complete with waggling rear end. Rhythm smiled. I let Bounce roll me over onto my back and place her paws victoriously on my chest, and was rewarded with a genuine giggle from Rhythm (granted, I had just let Bounce declare herself dominant to me, which was something I would have to fix if I ever wanted her to obey orders from me, but I figured we could sort that out later).
As the family prepared for dinner, I noticed Rhythm kept tipping his chin down to his chest and looking at me with his mouth pursed into a little “o.” His mom explained “he wants you to look at him over your glasses. He had a teacher who did that.” I obliged, mimicking his expression, and when that got a good response, threw in a few more funny faces. He clapped and said “ay!,” which I took to mean “yay.” His mom laughed. “She’s discovered your secret, buddy! You just love funny faces.” (By now, he has me trained in a regular repertoire of favorite faces to make, him prompting me to each one with a specific facial expression or motion of his own).
The family crated Bounce for the evening, ate, and headed out while Rhythm was still determinedly chasing food around his plate with his fork (he eats with fork or spoon, but slowly and a little messily due to poor motor control). Afterward, we went out to the back yard for a bit. He seemed pretty happy at first, looking at things, and generally ignoring me except for grabbing my hand whenever he needed stabilizing (he walks comfortably on level ground but needs to hold onto something or someone when climbing steps, etc.).
I don’t know what precipitated his unhappiness. Perhaps he asked for something and I wasn’t aware of it, or maybe it was just getting late, but he suddenly ran into his parents’ room and threw himself down on their bed. I followed him in and found him giving little hiccuppy sobs into the pillow. At first I was afraid he was hurt or felt sick, and asked what was wrong.
“Mama?” he said plaintively to me, “Mama?” I explained, in various words, that his parents were out and would be back after he went to bed (I gave him both that general statement and the specific time they would return and exactly how long that was from now, in case he had that kind of time/number awareness). I told him I’d stay with him until they came back. I asked if there was anything he needed. I offered videos or ipad use. He just kept repeating “mama” at intervals and sniffling. Remembering that his mother said he found touch calming, I tried stroking his back, but he pulled away from me and scrunched himself further into the bed.
I texted his mother to fill her in and ask if there was anything I could do for him. She suggested offering dessert and a bath (dessert was actually a requirement, as it contained his evening anti-seizure medication). The offer of a bath was what got him to finally stop crying. He didn’t seem happy, but he let me lead him into the bathroom, undress him, and help him into the tub, where he cheered up a bit. I fed him ice-cream while he sat in the bath, and he seemed much mollified, and even let me brush his teeth a tiny bit afterward.
While bathing, he took my hand and put it into the bathwater, moving it back and forth to create waves. He wanted me to continue doing so for quite some time, firmly grabbing my hand and getting me back on track if I stopped or tried a variation he didn’t like. He sometimes clapped along, at the rate he insisted I stick to for making waves– slightly faster than once per second, which I have come to think of as “his rhythm” and the inspiration for his nickname. He will often request that I clap, make waves, or do other things at that exact pace, for long periods of a time. I think if I cared for him more often I might risk of a repetitive strain injury!
We played like this for a long time– me leaning over the side of the tub to manipulate the water to his exacting standards. I experimented, too, with using the different settings on the hand-held shower-head to make different patterns of waves, and even made him laugh a few times by smacking my hand down into the water to make it fountain up against the side of the bath. A few times he got up and sat on the edge of the tub to see the water moving better. Finally, he seemed to be tiring. I let out the water and toweled him off, then had to chase after him as he ran off into his parents’ bedroom bed again. The whimpering and “mama’s” came back. Finally, I coaxed him into pull-ups and pajamas, and tucked him in with his pacifier, at which point he settled down to sleep.
I felt terrible, honestly. Apart from babies, I’d never had a child crying twice in one evening unless they were sick or injured. But when Rhythm’s parents came home and I anxiously described his evening, afraid they’d be upset at me for not keeping him happier, they told me that it sounded like a pretty typical night, and that he often got sad even with them around. Mom reassured me that he’d get more used to me, and also be much happier when they settled into their new home (they were new to this area) and were able to get all his belongings out of storage. Given how different this house must be from what he’s used to, I think he was actually handling things remarkably well! Autistic children are famous for going to pieces when something is different from what they expect, but it’s also been my experience with them that a few reassuring samenesses can go a long way towards helping them feel safe even in the midst of big changes.