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The Fourth R*

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“My son is always happy when it’s raining, because on those days he has indoor recess.” The mother of my patient — a 10 year old boy with normal IQ, mild autism, and anxiety — continues: “When he has indoor recess, there are different activities for him to do, like drawing, reading, or working at the computer. When there’s outdoor recess, all he does is walk around the perimeter of the playground, pacing and talking to himself. Recess is such a stressful time for him. Plus, he does things that call attention to himself. It would make such a difference if the school would put out some things for him to do at recess, like Legos. They already have the tables. They could go to a few yard sales and pick up Legos for next to nothing.”

For kids on the spectrum, unstructured time is a nightmare to be endured, rather than a respite from academic toil – the complete opposite of the way children with neurotypical development react (“Free at last! Free at last!” – if only until the bell rings). In fact, the hardest “subjects” for the child with ASD are not “the three R’s” (reading, ‘riting, and ‘rithmetic), but the fourth R: Recess. Also, cafeteria, school bus, and lavatory (what we used to call the Boys’ Room and Girls’ Room). For children with ASD, who struggle with “Theory of Mind” (inferring the emotions of others) and “Central Coherence” (the ability to see the big picture), ordinary tasks such as joining a group of kids at play, are daunting. (The chain link fence may not be a lot of fun to play with, but the geometric pattern is invariant, and soothing. Not like my peers, who can be inscrutable and unpredictable. Better to pace the perimeter of the playground, where I am safe.)
So…Lego Table on the playground? What a great idea! I wish I’d thought of it. The best I can do is pass it on, here. The only obstacle that I can see is institutional inertia by school systems… something that energized parents can probably overcome.
*With a tip of the hat to Z’s mom

Dr Coplan discusses his book

Making Sense of Autistic Spectrum Disorders: Create the Brightest Future for Your Child with the Best Treatment Options

In this authoritative and empowering book, one of the world’s leading experts on early child development gives caregivers of children on the autistic spectrum the knowledge they need to navigate the complex maze of symptoms, diagnoses, tests, and treatment options that await them.

For more than thirty years, James Coplan, M.D., has been helping families cope with the challenges posed by autistic spectrum disorders (ASD). Each family that walks into his office, he knows, is about to begin a journey. With this book, he lays out the steps of that journey. Dr. Coplan brings you into the treatment rooms and along for the tests and evaluations, and provides the kind of practical hands-on guidance that will help you help your child with ASD through every phase of life.

At a time when ASD has become the subject of wild theories and uninformed speculation, Dr. Coplan grounds his recommendations in reality. He helps you understand for yourself where your child may be on the spectrum that includes autism, Asperger Syndrome, and Pervasive Developmental Disorder-Not Otherwise Specified. His clear, comprehensive, and compassionate advice prepares you to make informed medical decisions, evaluate the various educational and therapeutic alternatives, and find answers to such fundamental questions as

• How do I optimize my child’s long-term potential?
• Which interventions will best serve my child?
• How do the various therapies work, and what is the evidence to support them?
• What is the best way to teach my child?

This book empowers you to be an expert advocate for your child, so that you’ll know when to say no to an ill-advised therapy or medication and can make with confidence the hundreds of important decisions you will face in the years ahead. For every parent who has made the painful transition from “Why did this happen?” to “What can we do to help our child?,” here is the indispensable guidebook you’ve been waiting for.


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