Having found her voice (or having been given a new, temporary one by the wonderful ENTs at CHOP), Hallie has turned into a chatterbox lately. We love it. She still has conversational skills that are well behind those of her peers, but she's making progress and we are so grateful for this and I think that Sharon and I know that there is no going back--we need to make sure that Hallie keeps her voice.
Anyway, since Hallie is talking more, she is also providing us with greater insight into how she thinks about the world. She had the following conversation with Sharon last night which is interesting on a couple of different levels:
Setting: Sharon came home late from work last night after running a couple of errands related to our little family party for Lea today. So there had been no time for dinner (and I suspect that Sharon did not have much time for lunch, either, since she was catching up on work having spent the prior two days dealing with doctors visits, sick kids, lost car keys that led to a major crisis that was ultimately resolved when we discovered that Lea had hidden the car keys in our nanny's mitten, and a bunch of other fun stuff like that). So Sharon was starving and her stomach began to growl a lot as she was reading Hallie her stories before bed.
Hallie looked over at Sharon sympathetically and said: "Mommy, you have a tummy ache! Don't worry mommy, I will get you some water and you will feel all better!"
Hallie proceeded to get out of bed, run over to the bathroom, climb up and get down a dixie cup and fill it with water, bring it over to Sharon and ask her to drink it. Sharon, of course, complied.
Hallie, satisfied, declaimed: "There you go mommy! You will feel all better. You won't have a tummy ache anymore."
This was such an interesting conversation. First, it shows how empathetic Hallie is. She notices when others are in need and she really tries to help them. She is constantly getting things for Lea (and Lea, having learned at the feet of the master, reciprocates by getting stuff for Hallie all the time. This of course does not prevent them from having knock down, drag out fights over stuff just like any other healthy sibling dyad). And she uses her own experience to try to figure out how to help others, which makes perfect sense (though down the road I suspect that we will need to work with her on that ever important theory of mind issue to help her figure out that others might want something different from what she desires).
But this was really interesting on another level: it is clear that, when Hallie says that her stomach hurts, she means (or at least sometimes means) that she feels hungry. But she has no idea that this is what is going on with her body. It may also be clear now why it is that she constantly requests water. She drinks tons of water, all day long. This is a great thing for her body in general, but not a great way to satiate hunger.
One interesting thing that lately has struck me about autism, or at least Hallie's version of it, is that the communication deficit that is so central to this condition is not just related to communication with the outside world. Rather, Hallie has trouble communicating with herself. And if you cannot interpret the signals that your own body is sending you, of course you are going to have problems communicating with others and interpreting their body language, right? This may be why professionals have noticed that sensory integration problems are prevalent in autism.
Anyway, while all of this is extremely interesting from an intellectual standpoint, what I want to know is how to help Hallie make those connections so that she can feed her hunger appropriately. Conventional feeding therapy doesn't really do the trick (and it's certainly not going to teach her how to interpret hunger. It kind of does the opposite). If anyone has any ideas about how to do this, please let me know!