In 2015, you would have found me sitting in the NICU in Austin, TX writing my first mental letter, “Dear Logan, I know we had a rough start, but everything will be better now.” No sooner did I set that intention did I learn my son had a stroke. For context, I'm the parent you hear in the background calling, “Be safe! That’s not safe! Let’s be safe! That’s good; that’s safe!” So I felt I failed to keep him safe for some time after this news only to rapidly discover all my well laid plans for future safety were going out the window, too, albeit for good reason.
Like most parents, I never wanted him near the stairs, but I learned as he tirelessly pursued them that the stairs organized his movements for crawling. When we tried to force the use of his affected arm with a sling for his unaffected side, I learned the slower I made him move to avoid falling the easier it was for him take it off. So there I was, endorsing stairs and later chasing my son around the house while also ready to dive to catch a potential fall. Graduating to literal stabbing, we started acupuncture 2-3 times per week and encourage further movement. He never fell with his sling on, and he grew to have full use of all his limbs and hardly any spasticity. It became more about finding what worked for him than desperately clinging to safety.
I'm also the kind of person who looks to books for any and every challenge. Logan autistic along with 1 in 59 children and 75 million people overall and counting,[i] and if you look up autism, you will find no shortage of “deficiencies” and “deficits.” Publications indicated that 20 hours of therapy a week were needed for improvement. I questioned what impact a part-time job worth of therapies trying to “reach milestones” would have on a child and why our milestone goals were based on neurotypical children. I couldn’t help but wonder what was reasonable for a stroke survivor, and the unknowns[ii] ate at the back of my mind as we hit a wall we just couldn’t climb: speech
I switched gears. I sought articles and trainings in the latest research and approaches and articles by neurodivergent authors. I discovered my worries of Logan one day feeling “broken” were founded, and I wasn’t alone in my concerns around a small child having the equivalent of a part time job in therapy, often finding I identified more with autistic parents than neurotypical parents in the process. Logan showed significant anxiety going to occupational therapy (OT), pacing, moaning, crying, whereas he was running joyfully through the door to get to speech therapy office. I was told to stick with it. In fact, they were pushing for more therapy, and I had a child in clear emotional distress. I asked the occupational therapist if she could speak to her outcomes history or that of the facility for children with any similarities to my son, and she was visibly shocked. I was and am still a proponent of therapies when they are a good fit,[iii][iv] but I gave myself permission to diverge from the semi-beaten path. I started observing Logan more as a researcher, and I noticed some interesting things.
Logan seeks out opportunities to play with and develop balance. Recent research indicates that autism is associated with lower blood flow to the cerebellum, a portion of the brain that well known balance.[v][vi] Beyond balance seeking behaviors, he repetitively taps his head when learning, but not just any part. He taps right over specific areas of his prefrontal cortex, which play a strong role in learning.[vii][viii] He babbled more with exercise, and when I took that as a cue to consider speech as a coordinated movement, I found research was trending in a similar direction and a speech therapist on the east coast who published a case report in her book on speech therapy for autism detailing exercise as a cornerstone of her approach. Both exercise and speech increase blood flow to the cerebellum and basal ganglia, which are proposed to go beyond planning and controlling movements to include cognitive components as well.[ix] Logan may not have been speaking, but he was seeking the things that he needed at a neural level no one had taught him and only surfaced on PubMed recently.
For years, I’ve had neurotypical friends suspect I’m on the spectrum while some neurodivergent friends have described me as a translator. After feeling like I consistently identified with autistic parents in forums, I finally took the RAADS-R assessment this year. I score well above the threshold for “autism suspected.” I’ve wondered if maybe our story is about finding some translational, integrative path, but what I think our story reveals is something else. If we can release what isn’t happening along with some perhaps ill-fitting expectations, we might learn more in the embrace of divergence.
“Dear Logan,
Thank you for making me think differently. Thank you for your attention to detail and love of routines. You make grown adults better versions of themselves and have a smile I could stare at all day.
Love,
Mom”
[i] Baio J, Wiggins L, Christensen DL, et al.Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014. MMWR Surveill Summ. 2018;67(6):1–23.
[ii] Malone, L. A., & Felling, R. J. (2020). Pediatric Stroke: Unique Implications of the Immature Brain on Injury and Recovery. Pediatric neurology, 102, 3–9. https://doi.org/10.1016/j.pediatrneurol.2019.06.016
[iii] Kuhaneck H, Spitzer SL, Bodison SC. A Systematic Review of Interventions to Improve the Occupation of Play in Children With Autism. OTJR (Thorofare N J). 2020 Apr;40(2):83-98. doi: 10.1177/1539449219880531. Epub 2019 Oct 23. PMID: 31642399.
[iv] Friedman, L., & Sterling, A. (2019). A Review of Language, Executive Function, and Intervention in Autism Spectrum Disorder. Seminars in speech and language, 40(4), 291–304. https://doi.org/10.1055/s-0039-1692964
[v] Bruchhage MMK, Bucci MP, Becker EBE. Cerebellar involvement in autism and ADHD. Handb Clin Neurol. 2018;155:61-72. doi: 10.1016/B978-0-444-64189-2.00004-4. PMID: 29891077.
[vi] Becker EB, Stoodley CJ. Autism spectrum disorder and the cerebellum. Int Rev Neurobiol. 2013;113:1-34. doi: 10.1016/B978-0-12-418700-9.00001-0. PMID: 24290381.
[vii] Bartolo R, Saunders RC, Mitz AR, Averbeck BB. Dimensionality, information and learning in prefrontal cortex. PLoS Comput Biol. 2020 Apr 24;16(4):e1007514. doi: 10.1371/journal.pcbi.1007514. PMID: 32330126; PMCID: PMC7202668.
[viii] Hiser J, Koenigs M. The Multifaceted Role of the Ventromedial Prefrontal Cortex in Emotion, Decision Making, Social Cognition, and Psychopathology. Biol Psychiatry. 2018 Apr 15;83(8):638-647. doi: 10.1016/j.biopsych.2017.10.030. Epub 2017 Nov 20. PMID: 29275839; PMCID: PMC5862740.
[ix] Silveri MC. Contribution of the Cerebellum and the Basal Ganglia to Language Production: Speech, Word Fluency, and Sentence Construction-Evidence from Pathology. Cerebellum. 2021 Apr;20(2):282-294. doi: 10.1007/s12311-020-01207-6. Epub 2020 Oct 29. PMID: 33120434; PMCID: PMC8004516.
Trauner, D. A., Eshagh, K., Ballantyne, A. O., & Bates, E. (2013). Early language development after peri-natal stroke. Brain and language, 127(3), 399–403. https://doi.org/10.1016/j.bandl.2013.04.006
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