Hot, Hot, Hot: On Being Brave

Routine is important for Dylan, but he also responds to variety. Routines can be comforting, but the more routinised Dylan’s care is, the more scope there is for Dylan to become upset when things don’t happen as he expects. Much better, perhaps, to surprise Dylan with a new experience about which he has no expectations and around which no routines have had chance to form.  This Christmas I was reminded of some of the benefits of that.

Chatsworth House

On the run up to Christmas, Dylan started collecting leaflets for ‘Christmas at Chatsworth’.  Dylan makes piles of leaflets to show us what he’d like to do. They’re his way of putting in a request. It took me a while to realise this is why Dylan picks up leaflets when we’re out and about, but once I did it made good sense.  Now, Dylan has his own leaflet rack in his apartment, where he can sort and store flyers and brochures.

When I looked at the ‘Christmas at Chatsworth’ leaflet I had my doubts. The event involved a tour of the House, a Christmas Market, and an illuminated garden walk. While the event looked lovely, it wouldn’t fit with Dylan’s routines. We are regular visitors to the Chatsworth estate, but Dylan’s routine doesn’t include the House. The illuminated walk around the gardens would almost certainly not follow Dylan’s usual route. What if the Maze was closed?  The café would be too busy or not serving Dylan food.  The Market Stalls would be noisy with people. It was after dark. Really, there was nothing to recommend it. 

But feeling brave one morning I booked tickets anyway. I was sceptical about our allotted 18.15 admission to the House (teatime) and unsure how long to allocate for pre-House activities. With transitions between activities needing to be smooth and perfectly timed, I approached the event with low expectations and some trepidation. However, it was a perfect evening. There is something about the dark, perhaps, which helps us try new things.  Dylan adored the outdoor Market. He danced to a rag ‘n’ skiffle band, browsed the market stalls, and enjoyed a street food tea. He followed the illuminated walk happily, even though it ran counter to his usual route and omitted his favourite places. Other things seemed to become magically possible for him: Dylan stood for a long time watching a sound and light show unfold a storybook narrative on the façade of the House. 

Inside the House,  Dylan made his way through the rooms in amazement, lingering over paintings and staircases, eyes popping at the advent decorations hanging from ceilings and walls.  We’ll come back soon, I promised Dylan, as I encouraged him from the House.  I suspect we’ll also return next Christmas: from such experiences, Dylan’s routines form!

Disney on Ice

A change of email address meant I didn’t get the usual notification for Disney on Ice and by the time I’d realised there were few options left.  The idea that Dylan wouldn’t go was unthinkable: all year, driving past the Sheffield Arena, he reminds me. I spent a frantic hour on the website. There were a few likely seats, but I couldn’t see a way of booking Disabled and Carer, as I usually do.  Why is it that these are so often not selectable online? I decided it was more important that I snapped those tickets up while I could. If I kept fiddling with the website, trying to find accessibility options, I risked losing them. 

The only problem, I realised after, is that I hadn’t been able to book disabled parking for Dylan.  Our routine, each year, has been that we drive to the Arena and have a pre-show meal in Bella Italia.  Dylan loves this, it seems, as much as the ice dancing. ‘Di-ne-i-pas-ta’ he chants when we drive past the Arena. But Disney on Ice with pasta is dependent on precise timings and transitions which I had no intention of attempting to orchestrate without a parking space. What was I to do?  I decided we would use the tram. Although the logistics meant there would be no meal, I hoped the novelty of a tram ride would be compensation enough.  Happily, this proved the case.  Dylan’s joy on the  tram was a joy to witness. 

We can get ourselves boxed into over-preparing for a vulnerable adult.  It’s great to have the option of Blue Badge parking and useful to have access to private transport when things go wrong.  Essential, you could say, when a vulnerable person becomes distressed while out and about in the community.  However, it can also limit the opportunities for joy. I suspect I may hear a new song this year when we drive-by the Arena: ‘Di-ne-i-tram’.

Polar Express

Over-preparing may have its shortcomings but so does under-preparing.  I accused myself of this on the platform at Sheffield station, waiting for a train to Birmingham, Dylan flapping with excitement on my arm.  I had only just noticed that our tickets didn’t include reserved seats.  I’d been so keen to save money I’d selected an offer which left seats open. Friday, late afternoon, on the most popular office party day of the year. How foolish of me.

Dylan had been collecting leaflets again. Like many childlike souls, Dylan is obsessed with the Polar Express.  Let me see that, Dylan, I said to him one day, when he greeted me clutching a wad of flyers. ‘Press’ he said (meaning Polar Express).  But this is for Birmingham, I exclaimed. Too far away.  Sorry. No.  But Dylan kept finding these leaflets somewhere. Every time I picked him up he came clutching a thicker wad of Polar Express leaflets.  Call me soft but after one home visit, when he’d carried  the leaflets with him everywhere, I relented.

Perhaps I booked the tickets at high speed before I changed my mind? I remember it was quite complex. Tickets for the Polar Express ride on Saturday morning. A Premier Inn booking for the night before.  Pizza Hut reservation for tea.  Return rail Sheffield to Birmingham. Maybe by then I was too weary to check the T & Cs. At any rate, here we were on the platform, waiting for what would no doubt be a standing-room only train. I booked the trip believing but didn’t feel so brave now.

I was wrong not to believe. The truth is British people are lovely. I’m sure people are lovely everywhere but let me celebrate the British public on the train that day, and particularly the woman in the powder blue coat who swapped her seat to make space for us.  Also, the couple on the even-more-packed Birmingham to Sheffield train the next day who let us have their seats because they were ‘only going as far as Derby’. Blessings on you lovely people. And let me never forget that nine times out of ten, when I’m out and about with Dylan, members of the public are understanding, helpful and kind.

The train journeys there and back would have been exciting enough for Dylan, by themselves, but these were only the bookends of our trip. We arrived in Birmingham to find the biggest Christmas Market ever.  The city centre was a heaving sea of people. Dylan held tight to my hand as if in a dream. We rode the carousel and big wheel, ate pizza, walked canal towpaths, and stood for over an hour watching people ice skating, Dylan laughing and shouting: Whoops, Whoops, O Dear!

Arriving at Moor Street Station for the Polar Express ride the next day, I was amused to discover we were virtually the only people not wearing pyjamas. A humongous queue. Lots of little people. Maybe this wasn’t such a good idea. Except beside me, Dylan was waiting patiently.  ‘Press!’ ‘Press!’ he shouted, squeezing my hand. Against all odds I would have hazarded, Dylan stood in that long line until we were through the barrier, then danced to the live music and song while we waited to be boarded. 


Believe in what you feel inside
And give your dreams the wings to fly
You have everything you need
If you just believe

On the train, they were handing out cookies and hot chocolate. My son won’t drink his, I said.  Still, they poured him some. Dylan transferred it into the ceramic mug he’d been given. Careful, I said. It’s hot. Dylan paid attention to the actors and dancers, listened to the story, and helped turn the big book pages. He ate my cookie and shouted ‘Steam! Steam!’ as our window turned white. What was there not to like? Only the hot chocolate, really. 

Hot! Hot!
Ooh, we got it!
Hot! Hot!
Hey, we got it!
Hot! Hot!
Say, we got it!
Hot chocolate!

Why don’t you try it, Dylan, I said.  It’s only chocolate milk. Leave it to cool if you want.  And to my surprise, Dylan picked up his Polar Express mug and drank it up. Back at Moor Street, with time to spare before our journey home, I headed back to the Christmas Market. There was something I needed to check. Come on Dylan, I said. I’d seen people walking around with little red cups earlier. I hunted down the stall.  Hot chocolate, Dylan, I said. To my amazement, he drank it.  At almost 30, Dylan has added a hot drink to his repertoire. 

The Sea

Between Christmas and New Year my car let me down twice.  I had to wait two hours for recovery from the short stay car park at the railway station where I’d gone to say goodbye to my daughter, returning to London. Freezing. Hungry. No money. Miserable. At least I didn’t have Dylan with me, I told myself.  A couple of days later, when I left my friend’s almost new year party, my car wouldn’t start again.  I abandoned it and got a cab. At least I wasn’t with Dylan, I told myself.  

And then I realised I might be. Dylan and I always go to the coast for New Year.  It’s what I call a tradition (rather than a routine). Cleethorpes, in Lincolnshire, happens to be the nearest sea to Sheffield so that’s where we go.  We walk the coastal path to the Humberston Fitties where Dylan checks on all his favourite chalets before heading back to town for a chip supper. The thought of Dylan and I stranded in Cleethorpes preoccupied me the whole of the next day, even when my friend assured me he’d found and fixed my car problem. And then, a solution. If Dylan had accepted Disney on Ice by tram, perhaps he would accept Cleethorpes by train? Providing, I told myself, I could reserve seats. 

On the website, I found something even better:  First Class tickets at a not unreasonable cost. So, we travelled in style through fields of dykes and winter cabbages under a bright sky, the carriage to ourselves and Dylan in his element listening to Adele on his iPad and admiring the curtain at our window and the table lamp, while I got to relax. On the return journey I vowed that (providing the prices weren’t silly) I would always book First Class when travelling with Dylan in future.  The next day, however, hundreds of people were reported to be stranded at Doncaster Station as the line was flooded, and services cancelled. First Class rail might be better than driving, but only if the trains are running. It seems we got lucky.

                                                                        *

The things Dylan and I enjoyed most this holiday season were twists on familiar activities or new experiences which required one or both of us to be a bit brave. These might seem like very small challenges, but if your needs are as complex as Dylan’s then they are enormous achievements.  This Christmas, Dylan tasted his first hot chocolate.  That it’s still possible to introduce Dylan to new experiences and activities gives me hope.

 https://www.youtube.com/watch?v=sc6IHUdl3V8

Blue Mind

Last weekend, we were battered by Storm Babet. My city sits within a basin of five rivers inside a circle of seven hills. In the southeast, the Don burst its banks and flooded Catcliffe.  In the southwest, the Porter plunged my local park underwater and turned my cellar floor black. I climbed up and down the steps to my basement, checking for damp.  

Not anticipating the storm event, I’d put Ladybower Reservoir on Dylan’s programme for a Saturday afternoon trip. Dylan’s visual schedule is important to him, but we can make changes when necessary. Dylan listens carefully if we tell him that something is ‘broken’ or ‘closed’, then he gets his felt tip pen and puts a cross through it.  Thanks to Storm Babet, this is what I would have to do. 

But the drive to Dylan’s care home, north of the city, wasn’t so bad. I figured the high road over the moors to Ladybower might be passable. The Snake Pass would be closed, for sure, but perhaps we could get to the dam. And while we wouldn’t be able to do the walk I’d planned, there would be something there today that I knew would thrill Dylan.

*

Up on Strines moor, in the Dark Peak, I drive slowly across the streams and waterfalls fording the tarmac. Storm water is a force from the hills, tumbling through woodland and between the crevices of drystone walls, gushing across fields and over roads, down into the valley below. The reservoirs are brimming tears today, but the rain has stopped.  The sky is brightening. ‘Splash’ says Dylan as I drive down the centre of the road, water spraying around the car.

At Ladybower, as predicted, The Snake is closed, but there are parked cars and a small group of people gathered around the spot I’m heading for.  We pull on wellies, extend our walking poles, and head for the dam.  As we approach, Dylan squeals and jumps into the air.  He has pieced it together. Mummy has brought him to see the plugholes. 

Today, they are a riot of churning water. Dylan jockeys his way to the front and hooks his arms over the wall. He greets the reservoir, splicing the air with his hands in a water-worshipping gesture of respect. He scrunches his eyes. Goes ‘bah bah bah’. He will stay there now for maybe 40 minutes, doing what he does.  Counting, I think.  Following the journey of a single drop, perhaps.  Committing the water into his visual memory. I stand behind him, keeping an eye. I smile at other visitors. Explain or apologise if Dylan is blocking a photograph. I encourage him to take a step sideways, let someone else in.

Most people are understanding. The majority are probably here for similar reasons to me and Dylan. On pilgrimage. Men with enormous lenses and recording equipment, settling in. Dylan won’t allow me to take photos. I try to think of as many ways of describing the foaming water with words as I can. Top of a Guinness.  Cherry Meringue Pie. Chantilly Lace.  Old Snow.

 *

Not everyone is so understanding. Recently, I had an email from the care home to say there’d been an incident. Dylan had tried to bite one of his carers while on a trip to the Yorkshire Sculpture Park. I read the email a few times before it made any sense. The park is Dylan’s favourite place in the world. He has been going there since he was a baby. He held his 21st Birthday Party there. It’s where he goes to celebrate and rejoice. There shouldn’t be any problem taking Dylan there, providing staff stick to the drill. This, of course, means allowing Dylan the time he needs at the weir. 

I emailed to ask if the incident had happened there. Perhaps staff had tried to move Dylan on before he was ready. You must let Dylan work through his water ritual. Counting or following water droplets or becoming one with the water or whatever it is. He will be ready in his own time. If Dylan’s in the zone, he must not be disturbed. I’m sorry he tried to bite, but interrupting Dylan’s water-watching will make him frustrated. If there isn’t time to let him stand at the weir, better not to take him at all. 

As I wait for Dylan by the plug hole, I remember this exchange. How long will we be here today I wonder.  I get out my book. I carry a slim volume to pass the time when Dylan halts at water or doesn’t want me to talk. Today, it’s Coleridge’s The Rime of the Ancient Mariner. ‘Water, water everywhere’ I say to Dylan. Eventually, he peels off and we wade through rivers of rain to a bench with a view of the reservoir. Dylan gets out his sandwiches. Gazes ahead, at the water.

*

Recently, I came across a reference to ‘Blue Mind’, a phenomenon first recognised and named by Wallace J. Nichols in 2014. Martinez (2022) describes Blue Mind as a mildly meditative state. ‘Water in the ocean, rivers, lakes and even baths’, she explains, ‘can make us feel calmer, increase well-being and boost creativity.’  Could Blue Mind Theory explain Dylan’s relationship with water? I read on with interest.  

Alexandra Benedict reports that a review of 35 studies investigating Blue Mind (by BlueHealth2020) concluded there is a positive association between proximity to water and improved mental health. Martinez (2022) identifies some of the ways in which Blue Mind acts on us physically and mentally:

  • Bodies of water trigger involuntary attention, which is essential to problem-solving and creativity.
  • Water increases the neurotransmitters dopamine, sometimes called the feel-good hormone; serotonin, also known as the happiness hormone; and oxytocin, described as the cuddle hormone; and decreases cortisol, described as the stress hormone.
  • Water is a source of awe that expands a person’s compassion.
  • The color, sound and feel of water can lower pulse rate and increase feelings of calmness.

These claims could offer plausible explanations for the way Dylan experiences water.  Certainly, water absorbs his attention. The concentration with which he focuses puts my own attempt at study to shame. I don’t know whether Dylan is more creative and logical as a result, but I’d be surprised if these attributes weren’t part of the water-gazing process. Happiness?  Check.  Awe?  Check.  Compassion?  Not sure. 

This feels like something and nothing, but I’m intrigued enough to read on. Blue Mind Theory, according to Martinez, enables people to improve their well-being through the use of water.  We can experience Blue Mind, she argues, by going for a swim; having a bath; visiting an aquarium; or drinking a glass of water.  Staying hydrated is good sense whatever colour your mind, but what of the other suggestions? 

As it happens, Dylan loves them all, deriving significant benefit from bathing, swimming, and trips to sea life centres. Other favourite activities, such as hot tub sessions and visits to museums which feature water installations (Eureka, the Children’s Museum of Science in Halifax, and Magna, the Science Adventure Centre in Rotherham, for example), may well come under the category ‘Blue Mind Theory’. As, would Dylan’s love of splashing in puddles, walking by rivers and reservoirs, and trips to plugholes.

This is hardly a Eureka moment. I noticed Dylan’s love of underwater scenes in Disney movies when he was a small child. He adores Ariel the mermaid (coincidentally, his second name). He is happiest in the sea (can it really be coincidence that Dylan means ‘son of the sea’?). He hunts for watering cans, bottles, hoses, and cans to upend or spray (concentrating carefully or squealing with delight). He points to the activities on his weekly schedule demanding: ‘wa-er, wa-er, wa-er’.  No, the fact that Dylan likes swimming, bathing, underwater worlds and walking by water is not new.   

What is potentially helpful, however, is a language for this. If we have a way of talking about Dylan’s love of water (Blue Mind) it’s easier to understand and explain it.  And if there’s a theory about why this might be beneficial to Dylan, there’s more chance that water-based activities will be systematically planned. That’s got to be a good thing, not just for Dylan but for all Blue Mind Babes. Now where did I put my swimming costume?

Sources:

All images are freestock.

Benedict, A. (2023) The Writer and Nature. https://www.rlf.org.uk/showcase/alexandra-benedict-wan/

Martinez, S. (2022) What Is Blue Mind Theory? https://www.mibluesperspectives.com/stories/mental-health/what-is-blue-mind-theory

Nichols, W.J. (2014) Blue Mind

The Shaking Man

Or, as happens to be the case, The Unshaking Man.  Happily, Dylan hasn’t had a seizure since June 2021 when he received a diagnosis of epilepsy following three generalised tonic clonic seizures within six months. At least, as far as we know he hasn’t. 

Straws & Water 

‘Could you remind staff to offer Dylan extra fluid’, I emailed his care home during this week’s heatwave. One connection that was made, during Dylan’s previous seizures, was with hot weather. Another observation that was made, at the time, was with coronavirus. Dylan, like many young people with autism, found lockdown difficult.  There is evidence that epileptic seizures can be brought on by anxiety, something worth considering in relation to a young man whose lack of capacity and speech often leave him with extreme anxiety. This was almost certainly made worse by the pandemic. 

At least, that seems a reasonable assumption. It’s not easy to make claims about the medical and social impact of the coronavirus pandemic. While I don’t go looking for hypotheses or urban myths, I trip over a fair few in my real and parasocial lives (although as I’ve recently closed my social media accounts, I should encounter fewer in future). I tend to ignore these and would certainly not want to be responsible for spreading disinformation. 

However, something that I’ve been struck by (and hope someone somewhere is investigating) is sudden onset of epilepsy in adults following covid infection. I’ve spoken to several people (in clinical and other settings, as I’ve been supporting Dylan or accessing services myself) who’ve mentioned an adult family member who had an epileptic fit during the pandemic. These were described as one-off incidents that hadn’t developed into regular seizures, as seems to have been the case with Dylan. Maybe I’m clutching at straws, but the possibility that Dylan’s fits were triggered by a covid infection reassures me.  I suppose because it would reduce the likelihood of it happening again.  

Still, best keep that water bottle topped up.

Scales & Granules

‘How has Dylan put on a stone in weight?’ I asked the care home manager.  I already had a suspicion that he wasn’t getting enough exercise (which I’ve written about here). Now the possibility that Dylan’s sweet tooth had outwitted the support workers presented itself. We set up a Food Diary to identify any unhealthy habits. When nothing emerged, it occurred to me that Dylan’s weight gain might be linked to the daily 800 mg of Epilim Chronosphere granules (a form of sodium valproate) he has taken since his epilepsy diagnosis. A call to the GP confirmed this was likely: ‘lifestyle changes would need to be made’, the doctor advised, ‘to offset the long-term impact of the medication’.

‘Lifestyle changes’ in relation to food for someone who is autistic and who lacks capacity (and for whom food is a key interest and pleasure) are not easy to make. In fact, they are rather difficult for Dylan and likely to make him unhappy. Clearly, however, it is in Dylan’s best interest to maintain a healthy weight. If it is the Epilim granules that are raising the reading on the scales, then we must support Dylan to make those lifestyle changes. ‘Just one trip a week to Costa for millionaire’s shortbread, Dylan’. 

Happily, once we’d introduced a few changes Dylan quickly shed the excess weight and he is back to his lithe and lovely self. The potential impact of his medication on general health and wellbeing, over the longer term, does raise some questions for me, however.

  • Is the Epilim preventing Dylan from having epileptic seizures? 
  • What if the seizures Dylan had were due to covid or lockdown anxiety? 

If the absence of seizures is a result of effective prescribing, an associated weight gain seems an acceptable price to pay. But neither weight gain nor requiring Dylan to make distressing lifestyle changes are justifiable for unnecessary medication. The only way to test for this (controlled reduction of the medication) carries risks.  It’s harder to argue the case to trial this with someone else, than for yourself. 

Best keep giving the granules, then.

Epilepsy & Empathy 

In June 2021, when Dylan had his third and most dramatic seizure, I happened to be reading The Shaking Woman by Siri Hustvedt. The book had been recommended to me by a colleague who suffers from migraines. He had found Hustvedt’s story helpful in managing what had become for him an almost debilitating condition. Reading it might help me to understand my daughter’s severe attacks and to feel more able to support her, he said.

Hustvedt’s story begins in 2006 at a memorial service for her father at the American University where he had been professor of Norwegian until his death in 2004. Siri (an experienced public speaker) is about to deliver an address:

Confident and armed with index cards, I looked out at the fifty or so friends and colleagues of my father’s who had gathered around the memorial Norway spruce, launched into my first sentence, and began to shudder violently from the neck down.  My arms flapped.  My knees knocked. I shook as if I were having a seizure.  Weirdly, my voice wasn’t affected. It didn’t change at all.  Astounded by what was happening to me and terrified that I would fall over, I managed to keep my balance and continue, despite the fact that the cards in my hands were flying back and forth in front of me.  When the speech ended, the shaking stopped. I looked down at my legs. They had turned a deep red with a bluish cast. (p.3)

Epilepsy is ‘the most famous of all the shaking illnesses’, but Hustvedt’s convulsive illness differed in that it did not interrupt her awareness or speech. The medical center which treated her following the incident diagnosed vascular migraine syndrome. Hustvedt (who had suffered from migraines since childhood) reflected:

Whatever had happened to me, whatever name could be assigned to my affliction, my strange seizure must have had an emotional component that was somehow connected to my father. (p.7).

To make sense of the condition, Hustvedt (who experienced further episodes) embarked on a journey through neurology, psychiatry, and psychoanalysis. What strikes me about Hustvedt’s carefully researched account is the close link it makes between migraine and epilepsy. I began the book in a quest to understand my daughter’s migraines but kept stumbling into my shaking son. Also striking is the possibility that the emotions (specifically empathy) play in role in both conditions. 

The nervous overload which triggers migraine attacks and convulsions, it is suggested, could arise from ‘excessive empathy’. Through this lens, a migraine attack or epileptic seizure may be the result of a sufferer identifying too closely with the experience of others. We might describe this as being ‘over-sensitive’ to the feelings of others or (more positively) as emotional intuition. Could it be the case that an awareness of the emotional state of others (in a family, social or professional environment) may lead some people to experience a migraine or seizure?  Thinking about the stories in Hustvedt’s book, and my observations of my children and colleagues, I wouldn’t rule out the possibility.

Autistic people, we are sometimes told, are not capable of empathy, but this is an increasingly discredited narrative and one which I have countered in several posts. Now, when I think back to the pandemic years, it strikes me as quite plausible that Dylan (without language or the capacity to comprehend events) relied on his emotional antennae to process what was happening at the time. Although we tried to conceal our anxiety and uncertainty from him, more than likely Dylan will have picked this up from those around him.

Best try to be a zen mum, then 🙂

Notes:

Siri Hustvedt, The Shaking Woman or A History of my Nerves (Hodder & Stoughton, 2011)

Sex Education and the Learning Disabled

I had assumed that sex was something I wouldn’t blog about, thinking the topic too personal to discuss in relation to someone who lacks capacity. However, my increasing frustration with the lack of resources and support aimed at autistic adults with intellectual disability has persuaded me that this is exactly the sort of issue I should be writing about. It’s a topic with significant implications for the lives of the learning disabled and my observations from personal experience will, I suspect, be relevant to others in a similar situation.

*

I should clarify that I’m referring specifically to male masturbation and not to the wider sex education curriculum (such as menstruation and where babies come from). Education for adults who are diagnosed with intellectual disability should be responsive to need and masturbation is (so far) the only topic of direct relevance to Dylan.

I was a little anxious, when Dylan hit puberty, about what might lie ahead and how well I would cope, as a single mother. I had heard various second and third hand stories from parents.  One mother, I was told, was mortified to discover her son masturbating in the Food Hall of Marks and Spencer (fruit and veg aisle). Another mother reported a fondness for public transport.  As adolescence approached, I was on high alert.

In the event, this turned out to be something I didn’t need to stress about. I caught Dylan humping the sofa a few times but he quickly learned that this was something for ‘private time’. Can you go and do that in your room please, Dylan?  I tried to follow the advice to keep my voice matter-of-fact and to disapprove of the location, not the activity. It wasn’t long before Dylan was taking himself upstairs quietly (almost, it seemed, discreetly) and closing the bedroom door firmly behind him.

*

Enabling an adult who lacks capacity to have privacy is not easy, particularly when there are comorbid conditions such as epilepsy.  Bathing is a context, for example, in which the safety of an adult with intellectual disabilities has to take precedence over the aspiration to provide private space for personal care routines.  Allowing an adult with an intellectual disability the privacy required for masturbation may not pose the same level of risk, but it does still raise difficulties.  Without language, someone with a disability can’t call out ‘just a minute’; at what point is it reasonable for a concerned parent/carer to open a closed door and check that the vulnerable person is alright (and not having a seizure, for example)?

After initial errors and stumbles I learned to knock softly on Dylan’s door and call Are you OK Dylan?  We developed an understanding that if Dylan responded OK I wouldn’t disturb him.  OK, in this context, is a request for privacy. If this ‘call and response’ doesn’t work, I knock again, more loudly. Can I come in Dylan?  This is Dylan’s second chance to reassure me and to ask for privacy, and he will do this either by saying No(which Dylan sometimes uses correctly in response to a direct question) or, more commonly,  OK (‘yes I’m fine, please go away’ not ‘ yes come in’). This mostly avoids any misunderstanding or awkwardness.

*

It’s easy to misread a situation, however. If we make assumptions or project our own feelings onto a disabled person we are likely to get things wrong. Dylan puts up with our misunderstandings sometimes (a lot, perhaps) but he has his limits. His protests, over the last two or three years, have become more frequent and increasingly forceful to the extent that ‘challenging behaviour’ is now a fundamental part of his profile. Recently, concerned by an escalation of incidents involving ‘ripping’, I asked staff to keep a log of the behaviour, noting the time of day; location; activity; environment; and item ripped. Based on these records, It seemed to me that the ripping incidents were associated with masturbation.

It can’t be easy for adults in residential homes.  Care homes are busy places. They involve levels of support which may feel like surveillance. Even with sympathetic routines and staff, regular checks need to be made on vulnerable residents. Non-verbal adults who lack capacity may find it particularly difficult to protect their private space in such a setting. But it ought to be possible, I argued to Dylan’s care home manager, to make sensitive adjustments to care so Dylan could have the space he needs. If it was his frustration at being interrupted that was resulting in the incidents of challenging behaviour, any attempts by staff to follow schedules and routines would be counterproductive. Could the visual checks be suspended at such times?  And could the cleaner wait until Dylan gets up? 

*

Such adjustments seemed to me a reasonable and sensitive way of providing Dylan with some privacy and I was optimistic this might reduce the behaviours that appeared to be linked with masturbation.  Still, it occurred to me, it might be useful to also offer some sex education. Adults with intellectual disability need support to negotiate the skills and practices of daily living, which includes masturbation. Dylan had shown no interest in a book about puberty when he was younger, but perhaps he was ready for more information now: a short film would be good, as this is the format he engages with and processes most easily. 

My first step was to request resources and support from the National Autistic Society, as this is the organisation which provides Dylan’s care. They had some material for parents and professionals but nothing aimed at autistic people themselves – or rather nothing aimed at autistic adults who have an intellectual disability. I wasn’t particularly surprised as this is often the case with the NAS; MENCAP tend to be a much better source of support. When that also drew a blank, I had to widen my search. After hours of googling YouTube clips and educational videos, however, I had found nothing suitable.  There are plenty of materials for parents and professionals, and some aimed at autistic adolescents who don’t have an intellectual disability and who can read, but nothing for young men such as Dylan.  This is yet another way in which adults with an intellectual disability are either made invisible or perceived not to have the same feelings, desires and needs as other adults.

*

What is a mother to do?  Ideally nothing at all; this is one thing I would prefer not to have to take responsibility for. But in the absence of any intervention or resource from the care provider (or anyone else in the sector as far as I could tell) parental support was probably better than nothing. Too bad there wasn’t a father around, but I’d managed pretty well on my own so far and I’d sort this too. Still, my commitment wavered as I searched for appropriate resources.  Trying permutations of requests for a video brought up endless porn and dating sites. My search history made me blush. ‘Don’t be going missing now’, I told myself, alarmed at the thought of someone analysing my laptop for clues about my life.

When a search turned up an ‘anatomically accurate model’ one day, the word ‘educational’ in the description was a relief after so much of the other material. I wasn’t quite sure how it might be used to support Dylan, but ‘objects of reference’ had been helpful in the past and at £24.22 it wasn’t too expensive. As I still hadn’t been able to find an appropriate visual resource for Dylan I decided to order it. I didn’t pay much attention to the manufacturer but I wasn’t particularly surprised, when I received the confirmation email, to discover that my package would be coming from Rotterdam.  The customs fee, however, was a shock. There was no way that I was going to pay that; it would have to be left to languish at the sorting office I told myself.  So, I was surprised when my postman turned up at my backdoor with it one day; I smiled at him and crossed my fingers he wouldn’t ask what was inside. 

*

I’m writing this around three months after delivery. For most of that time, the model penis has been in Dylan’s drawer. When it arrived, I showed it to Dylan in a matter-of-fact way;  he looked slightly askance at me and pushed it away. Although there has been a decline in the number of challenging incidents associated with masturbation, my sense is that any improvement in the situation is due to the adjustments to routine and environment that have been made, rather than any attempt to address the issue directly with Dylan.

We continue to search for resources on this topic; NHS Leeds, for example, have produced a useful document, Puberty & Sexuality for Children and Young People with a Learning Disability. These materials are designed, however, to be used in a classroom context with an educator, rather than accessed individually. For older adults in residential settings, an individual resource such as a short film would be a more appropriate intervention. Surely it can’t be too difficult, especially in this era of animation and AI, to produce, such a thing? I cannot believe that I am the only parent or professional who has identified this as a need. If anyone is aware of a resource which might be suitable, please let me know!

Resources:

NHS Leeds (2009) Puberty & Sexuality for Children and Young People with a Learning Disability.

Kate E. Reynolds (2014) What’s Happening to Tom? A book about puberty for boys and young men with autism and related conditions. Jessica Kingsley.

Images:

The first two images in the post are of the cover and an inside page from the book by Kate Reynolds.

Steps Count: walking with Dylan

The annual report I have to submit as Dylan’s Court of Protection Deputy is due so I’m reading through my ‘Dylan book’, noting the significant things that have happened in the last 12 months. I’ll need to explain the decisions I have taken on Dylan’s behalf and the issues I anticipate having to respond to in the future. Although the reporting process is a bit onerous, it’s a useful exercise in that it requires an evidence-based review of Dylan’s life.  

Re-reading the report I submitted In October 2021 is helpful in establishing a milestone against which to measure progress. I might otherwise have forgotten that I was concerned enough about Dylan to bring him home to live with me last year. It was the run-up to Easter and the country was still locked down, in the grip of Covid. Dylan’s behaviour was erratic, alternating between violent outbursts and days when he was horribly withdrawn.

Even before the pandemic I’d been concerned about Dylan. There had been incidents at the care home (never with me) that suggested Dylan might be unhappy. I wasn’t sure if Dylan’s increasing distress last year was a sign of his continuing unhappiness at the care home or a temporary consequence of lockdown, but I was confident that if anything could settle him it would be spending time at home with me. I had to juggle working with caring for Dylan but we found a rhythm and Dylan seemed less anxious when he returned to residential care.

Actually, it’s not true that I might have forgotten this. The lessons I learned during that time are still with me, shaping the way I care for Dylan. What the report reminded me was that when Dylan was distressed, I’d stepped up and been prepared to act. Recently, there have been two significant incidents (one of which I’m still struggling to process) and Dylan’s behaviours in his residential setting continue to suggest extreme anxiety. Am I doing enough, I ask myself? Or at least all that I can?  Sudden realisation:  the report I’m writing is as much a review of my advocacy for Dylan as of him. Another reason why every adult who lacks mental capacity should have a Deputy.

The difference between how Dylan is with me at weekends and his behaviours during the week is stark. There are regular reports from Dylan’s residential setting of behaviours which are considered challenging, but I rarely witness these myself.  As it’s not appropriate or possible for me to care full time for Dylan, I need to identify the aspects of home life which promote Dylan’s well-being and happiness in order to apply these in his placement setting. 

Last year, when Dylan lived with me, I made detailed records of Dylan’s routines and moods, hoping to share the best of Dylan’s home life with the residential setting.  At the end of the six-week period, the practice I picked out above all others was walking.  During Dylan’s stay we had developed a routine of taking a four hour walk every afternoon. This seemed to have a calming effect on Dylan. If we missed a day, I could sense Dylan’s tension rising. 

This is not so surprising. The therapeutic effects of walking  – physical and psychological – are well-documented. Everybody, it is suggested, should take 10, 000 daily steps to maintain a healthy weight, promote cardiovascular fitness and build strength. Equally important, however, regular walking Is known to improve mood, cognition, memory and sleep, reduce stress and tension and improve balance and coordination.

Through a Dylan-shaped lens, these benefits are significant.  Like many autistic people, the sixth and seventh senses appear to be as important to Dylan’s functioning and well-being as the other five. Vestibular processing(movement and balance) and proprioception (awareness of where the body is in relation to others) are sensory mechanisms through which we can regulate stress and anxiety. Walking is an excellent way for Dylan to do this. 

You don’t have to be autistic to feel the therapeutic benefits of walking of course. Research suggests that walking benefits our mental as well as physical health because it promotes ‘sideways communication’.  People talk more freely, it is suggested, when they can’t see the listener’s face. This is why we may speak more openly in a taxi cab or Confessional. Now that sounds as if we might be back in the world of autism doesn’t it?  Perhaps Dylan enjoys walking so much because it doesn’t require him to make eye contact? 

So, when I returned Dylan to his care home last Easter, I explained how beneficial physical exercise appeared to be to Dylan and asked whether his long afternoon walks could continue. My sense was that walking helped. Could Dylan please do as much as possible, preferably between his preferred hours of 2 and 6pm?  

It wouldn’t be possible for Dylan to adopt his home-based routines at the residential setting, I was told, because activities were dependent on the availability of staff and transport, the needs of other residents and (crucially) shift pattern.  This means Dylan’s activity window is in the early part of the day and closes at 3pm when day staff hand over to late staff.  All residents had to be back at the care home at this time. I shouldn’t worry about this, however; Dylan was normally out by mid-day and had plenty of time for exercise.

As I couldn’t be entirely sure what was triggering Dylan’s anxiety and distress, or whether walking might be the silver bullet I’d dreamed, I didn’t push it. Not long after, the complicating factor of an epilepsy diagnosis emerged. Dylan’s behaviour at his care home continued to suggest distress but, as the professionals involved in Dylan’s care pointed out, now wasn’t the time to introduce changes to his life. What was needed was for Dylan to be supported by people who knew him and could monitor and observe for seizures. 

Happily, a year later, lockdown is over, and Dylan is seizure-free. Less positively, the distressed behaviour at Dylan’s care home (never with me) has continued. When the situation escalated this summer and Dylan was involved in two distressing incidents  (as mentioned earlier) I realised it was time (again) for me to step up, be prepared to act.

The challenge of advocating for a young man who ‘lacks mental capacity’ and who doesn’t use speech to communicate is understanding what his behaviour signifies and working out how best to respond. Hunches about what might be distressing Dylan may be interesting and sometimes accurate but difficult (or impossible) to confirm with data. While I quite often act instinctively, I much prefer firm (or even soft) ground for my decisions.  In this respect, Dylan’s daily care (not just my annual report) is based on evidence. What other way is there to figure out what is in the best interest of someone non-verbal who lacks capacity?

So this summer I decided to develop last year’s hunch about walking. While Dylan was living with me, I had made a general observation that long daily walks seemed to be beneficial for him physically and emotionally. Now, I wanted to find out whether I could correlate walking with behaviour more confidently by collecting systematic data.  Specifically, I was curious about whether the differences in Dylan’s behaviour at home and in residential care might be reflected in step count data associated with the two locations.

Dylan won’t carry a smart phone or other digital tracking device so the simplest and most effective way of collecting data, I decided, was by pedometer. Dylan doesn’t like things in his pockets but always carries a backpack (for sensory comfort) so a pedometer in his pack would take a reliable reading of steps outside (though not inside) his accommodation.  I discussed the pedometer with the care home and introduced it to Dylan during a ‘Health Awareness’ week, showing him how it worked and where to keep it. 

It is highly unlikely that Dylan understands what the pedometer is or its function so it could be argued that this raises ethical consent issues.  The method of counting steps is not intrusive or harmful to Dylan, however, and the step count is of potential benefit in that it could facilitate an evidence-based review of care.  

In the early weeks of Dylan carrying the pedometer I doubted the reliability of the data. Some of the care home readings seemed implausibly low. I emailed the care home manager at the end of July, expressing surprise that Dylan was averaging only 3,000 steps a day during the week compared to 11,000 a day with me. That seemed unlikely.  What might be the explanation?  Was Dylan using a different bag during the week? Were staff re-setting it perhaps? I removed Dylan’s spare bags and moved the pedometer to a secret pocket.

DatesLocationTotalDaily Average
03/09 – 04/09Home22, 51511, 257
05/09 – 06/09Care8, 9114, 455
07/09 – 08/09Home36, 23618, 118
09/09 – 13/09Care13, 6362, 727
14/09 – 15/09Home18, 3029, 151
16/09 – 22/09Care8, 7081, 244
23/09 – 25/09Home28, 4179, 472
26/09 – 30/09Care24, 5554, 911
01/10 – 02/10Home25, 16312, 581
03/10 – 07/10Care7, 9721, 594
08/20 – 09/10Home14, 5737, 286
10/10 – 14/10Care14, 2012, 840
15/10 – 16/10Home27, 76413, 882

Home-based daily average:    11, 678
Care-based daily average:       2, 961

As it turns out, the summer numbers I thought untrustworthy were probably not.  The data collected subsequently replicates the initial readings, suggesting a clearly differentiated step pattern in the different settings. This may or may not be related to patterns of behaviour in Dylan’s two locations. I haven’t mapped the step data against the incidents of ‘challenging behaviour’ in the care home but that would be the thing to do to fully explore the relationship between walking and well-being for Dylan. 

What is perhaps evident from the data, however, is that the structure and routine of residential care limits the opportunity for Dylan to walk as much as he likes to, and as far as may be healthy. This would probably be the case in any setting where care is delivered to a number of residents by shifts of support workers working across the organisation.  Even in relatively small residential settings, it seems, care cannot be completely individualised because it is organised and managed to meet the needs of a group.

There are potential advantages to this. Staff can support each other. Residents have contact with a range of professionals rather than being dependent for care on (and therefore vulnerable to) a few. Resources that couldn’t be offered to an individual can be made available to a group. But these benefits may not offset the disadvantages for everyone. Might it be the case that Dylan would prefer an environment which was more like home? That he would respond to contact with fewer staff, especially if it included someone who shares his love of walking and the outdoors?   Could Dylan flourish in an environment where he was able to take long walks in the afternoon and spend the evening in the pub?

Perhaps I’m dreaming. Maybe no such place exists.  Not for someone with needs as complex as Dylan’s, anyway.  And, in any case, the escalation in challenging behaviour probably suggests a setting aimed at adults with high need rather than a more relaxed supported living environment. Nonetheless (and aside from my commitment to evidence-based reflection) this is my gut-feeling, my hazard, my wild hunch.

Death and The Queen: explaining to Dylan

Dylan and I were on the canal tow path near Bingley on Thursday 8th September when my phone pinged. I had taken Dylan on an overnight visit to see the 3- and 5-Rise locks on the Leeds-Liverpool Canal. Dylan loves water and is fascinated by engineering so I figured the locks might capture his interest (and mine).  We had walked to Saltaire that morning and were heading back for a late lunch at the 5-Rise café when my phone interrupted us. 

‘Muss’, Dylan said, meaning ‘message’.  I have taught this word to Dylan since he developed camera phobia so I can reassure him I’m not getting the phone out to take a photograph if it pings.  ‘That’s right Dylan’, I said.  ‘A message. Let me see who it’s from’.  When I saw  my daughter’s name I decided I’d better open it. She knew I was away with Dylan and that I don’t use my phone while I’m with him. ‘It’s from sister’, I said to Dylan as I clicked on the message.  ‘Have you heard the news about the Queen?’, my daughter asked. 

*

One of the presenters of my favourite podcast happened to mention in a recent episode that she had received the news that Princess Diana had died two hours before it was made public. She had been due to present a radio programme that day and needed to be informed in order to prepare.  It had been strange, she reflected, living with the news of something so momentous while others were unaware the day was about to be shattered.  

Now, scanning the BBC news, I remembered that podcast. A debate about the energy crisis – the first substantive Commons business since the appointment of a new Prime Minister – had been interrupted by messages passed to leaders on both sides of the House. They had left the Chamber. Could the Queen already have died?   Were politicians and TV presenters running through protocol and procedure, perhaps, changing their clothes to black?  

After a life of service, lived in the public eye, there is an unusual privacy about the moment of a royal death. Although it hadn’t yet been reported, I felt sure the Queen was already dead. As I walked with Dylan along the tow path I wondered if it showed on my face. Members of the public sometimes look at us with curiosity, especially if Dylan is holding my hand, but passers-by seemed to be looking at me with concern, as if on the verge of asking if I was alright. I would make a terrible politician, I thought to myself. I can’t hide anything.

I can’t hide anything from Dylan, that’s for sure. It is said that people on the autistic spectrum lack empathy but my experience suggests the opposite may be the case.  Dylan is hyper-empathic and can detect the subtlest shifts in my emotional state. Now, Dylan tightened his grip on my arm. He was getting anxious, sensing that I was distracted. I felt a need to explain the situation to him but wasn’t sure what (if anything) I should say. 

*

It’s difficult to explain death to someone with a learning disability.  My dad passed away at the end of June and I still haven’t told Dylan. I decided that Dad’s death wouldn’t have a significant enough impact on Dylan’s life to justify attempting this. Dylan and my Dad weren’t close. Dad never visited Dylan at his care home so the only time they saw each other was when I took Dylan to visit Dad. Dylan seemed comfortable enough with this arrangement but Dad (and more to the point, his wife) didn’t find the visits easy. 

I would tell myself, sometimes, that it was Dad’s age that meant he struggled to understand that Dylan behaved as he did not because he was ‘naughty’ or had been badly brought up (by me) but because he was autistic. This is nonsense of course. It isn’t generational.  My mum was marvellous with Dylan. Some people are good at adapting to Dylan but others can’t help wanting Dylan to be something else. Dylan just didn’t fit into the model my dad and his wife had for how grandchildren should behave.

As dad got frailer I stopped taking Dylan to visit. Dylan is very strong and quite physical. He loves to shake hands, pumping a greeting with his iron grip. In the last year, Dad became too weak for me to risk Dylan unintentionally hurting him. Dad never asked about Dylan and, if Dylan ever thinks about my Dad, he doesn’t have the language to ask about him.

*

Living alongside Dylan it is easy for me to realise that language (by which I mean communication with words) is a privilege and not a right. Witnessing my son’s attempts to find alternative ways to communicate reminds me that I’m fortunate to be able to read, write, speak and understand the spoken word, but also makes me wonder whether I would be as inventive and resilient as Dylan, should I find myself suddenly without words.  

Since midsummer, when Dad died, I’ve found myself thinking about the impact on a person of the absence of words.  Death is a hard thing for us to talk about. In the last couple of months, when I’ve tried to write about it, I’ve found myself face-to-face with an unmarked page or crossings out. Death is hard to explain. Perhaps this is part of the reason I haven’t told Dylan his Granddad has died?  It is too difficult a concept for even me to grasp. 

*

Philosophers, psychologists and writers (Bertrand Russell, Lev Vygotsky and Oscar Wilde to give an example from each) have argued that our capacity for thought is related to language use. I don’t agree that the absence of language limits our thinking, necessarily, but as we tend to address complex ideas through language-based means, Dylan has had to find alternative ways to build his understanding of death. 

From experience, Dylan knows that death makes him want to walk very quickly with his eyes closed tightly, swinging his arms (small animal deaths we encounter in the countryside). From his films, Dylan quite possibly believes that after you have died you talk from the sky (Lion King). Also that death is beautiful and temporary, like a sleep, and involves glass and roses, a handsome prince on a horse and a kiss (Snow White). 

One of the beliefs about death which Dylan seems to have developed is that when people die we put them in photograph frames. I wasn’t aware of this seven years ago, when Dylan moved to his care home, so I put framed photos of family members in his new room. Dylan wouldn’t accept the photos of myself and my daughter, I was told.  He turned them face down or put them away in his drawer. Only the photo of my late mum was acceptable to him.  At the time I was  hurt but I subsequently realised that Dylan is uncomfortable with photos of any living person being on display.  [As I write this post I am wondering whether Dylan’s resistance to photography could be connected with his apparent beliefs about death].

Last week I sorted through photographs for a picture of dad to put in a photo frame I’d picked up in a charity shop. Perhaps when I find one I’ll be able to use it as a prop to explain  to  Dylan about Dad’s death. I don’t think I’ll be taking the same approach with the Queen, however. A jubilee crest on a kitsch mug is as much as I can cope with in the house 🙂

*

I tried really hard, when Dad died, not to let Dylan see that I was feeling sad. I wonder if perhaps I didn’t tell Dylan about Dad because I didn’t want Dylan to see my grief, rather than because I thought Dylan didn’t need to grieve himself?  Now, at the thought that the Queen might have died (or might it have been at the memory of Dad?) I found myself fighting back tears. Just how was I going to explain this to Dylan? I turned my face quickly away, quickened my step on the tow path.

Something that puzzled me after Dad died was that I couldn’t cry, even though I felt desperately sad. Equally puzzling was that, at the same time, I found myself crying at reports of the deaths of minor public figures who I’d never met and hadn’t even cared for, particularly. Why couldn’t I cry for dad but I could for these others?  

I’ve written elsewhere that Dylan doesn’t cry tears and have speculated about why this might be. Dylan can be wracked with physical emotion – his chest heaving with sobs and the air filled with his howl – but there are never tears. Perhaps deep grief wracks us dry, unable to cry?  I think Dylan understands that tears mean someone is feeling sad but I have no doubt that he is also capable of feeling my tearless grieving for my Dad.

*

I checked my phone again as we got to the locks.  No change. Even so, I could feel a tearing behind my eyes and a sense of being distracted.  Others would feel it too, I thought to myself, as the news developed and filtered through. Just how was I going to explain the show of public grief to Dylan?  I decided I couldn’t pretend anymore. I would have to try.

‘Mummy is feeling a bit sad because the Queen has died’, I said to Dylan. 

Here I was, suddenly, talking about death after I’d studiously avoided the subject in relation to Dad.  I watched Dylan trying to process what I was saying. I can see when Dylan is thinking.  He thinks with his eyes.  Now, they were flickering anxiously.

‘Don’t worry, Dylan’, I said.  ‘It’s OK. She was very old. It was time for her to die.’

Dylan looked unsure. Perhaps the fact the Queen wasn’t particularly meaningful to Dylan would mean it wouldn’t upset him, but I didn’t want to take the risk. What if it led Dylan to have difficult feelings about his beloved Gran or to worry about other people that he loves? These things will come to Dylan one day. Now wasn’t the time. I decided to reassure Dylan by looking forward instead. 

‘We are going to have a king now’,  I said.

‘ King’, Dylan repeated after me, his eyes smiling. ‘King’.

Swords and Dinosaurs: Dylan reminds me (again) to listen carefully

Recently – by which I mean in the last half year or so – Dylan has been excited and shouty each time we pass the city of Leeds by road or rail. On the approach to Leeds railway station, Dylan would point and shout what sounded to me like ‘Gar, Gar‘ followed by what I heard as ‘Saur, Saur’. Skirting the city on the M1, Dylan would scan the skyline before declaring: ‘Gar!  Saur!

When Dylan tries to use speech to communicate, however indistinct his pronunciation, I try and respond with praise and encouragement. I know his sounds and vocalisations pretty well and can usually figure out what Dylan is trying to communicate through contextual clues.  This time, however, I was stumped, not least because I had never taken Dylan to Leeds.  Whatever could he see? Was it something he recognised from a film or TV?

Dylan tends to produce only single syllables so will typically cut a word down to a key sound. As far as I was aware ‘Saur’ means dinosaur so I tried that. On one occasion: are there dinosaurs there Dylan?  How exciting. Another time: That’s right Dylan, dinosaurs.  Except that wasn’t right of course.  My attempts to respond positively to Dylan’s attempts to communicate elicited dejection and disappointment. 

It breaks my heart not to be able to respond as Dylan wants to his attempts to communicate. I think he has a strong sense of his own limitations and is easily discouraged by our failures to understand him. Dylan’s typical response in such a situation is to say something that he knows will be understood (as if to recover a slither of self-esteem from a positive interaction) before falling silent.  To avoid this, I try really hard to remember every permutation of sound Dylan makes and their possible meanings.

Is there really a dinosaur museum here? I asked Dylan a couple of weeks ago, as we waited at Leeds station on our way back to Sheffield from Durham. Heading north on a train the previous day Dylan had shouted and jabbed with his finger at the skyline,  trying desperately to get me to see (and name) what he could see.  Oh yes, I had said. I see (although I couldn’t).  This hadn’t satisfied Dylan and now he was trying again:  Gar, he shouted  at me. Then Saur!  Saur!

I’m not sure there is a dinosaur museum here,  I said. If you are a regular reader of this blog you’ll recall that Dylan has developed an anxiety about cameras and phones so I’m not able to use these when I’m out and about with him. Because of the need to show e-tickets and e-passes, however, I’ve worked hard to get Dylan to accept that I will sometimes need to get my phone out in public places. I’ve also had some success in using my phone for mapping and information searches while I’m with Dylan. I had an idea but needed to make sure that it didn’t make Dylan anxious. Maybe I can find the dinosaur museum on my phone, I said.

I didn’t have long. Dylan was looking uncertain, on the verge of protest. I typed ‘Ten best things to do in Leeds’ into Google. The page was still loading when Dylan (keeping a close eye on proceedings) pointed to one of the first images to appear, shouting excitedly:  Gar! Gar!   The Royal Armouries! It was the Royal Armouries!

I have never been myself but staff from Dylan’s care home had taken him once or twice in the pre-pandemic past.  With his wonderful recall and geographical knowledge, Dylan had remembered those trips and had tried every way he could to communicate that he would like to go there again.  He had pointed at the museum when we travelled through Leeds. When I didn’t recognise it he had tried to reproduce the sound he hears when it is named (‘Gar’ sounds like ‘Arm’ in ‘Armouries’). When I still didn’t understand, Dylan had explained what we would find there (swords not dinosaurs).

I don’t know who was more relieved as the train pulled out of Leeds:  me, at having finally understood what Dylan was communicating, or Dylan at having finally received the correct response.  We talked about the Royal Armouries all the way home. I would, I told Dylan, get tickets and take him myself the following weekend. 

We had a wonderful day. Dylan quite clearly remembered the museum from his previous visits and led me around confidently.  I could see why the building appealed to Dylan (tall with picture windows and a glass elevator) but the exhibits he picked out intrigued me. Dylan liked the ‘Hunting’ zone because there were animals (as long as they weren’t being obviously hurt) and especially enjoyed a display of a man in a punt.  I was surprised when Dylan chose to attend a live performance of a monologue by an actor (with sword). Dylan was absorbed by the event, as if listening carefully. I found this humbling. I had, once again, learned something about language from my ‘non-verbal’ son.

iPad Sabotage: Dylan Loses His Music

In my last post, Selfie Sabotage, I reported that Dylan seemed anxious about people taking photographs by camera or mobile phone. This is now written into Dylan’s care plan so he is no longer exposed to photography at the care home or while he is with me.  Although this has involved a change in practice, I have found it surprisingly easy to put my phone away while I’m with Dylan. Last week I took Dylan to Marske-by-the-Sea for his summer holiday. As well as spending time on the beach we visited places I would previously have photographed but which I didn’t even consider getting my camera out for. It’s reassuring to me that habits can be quickly and painlessly changed when necessary.

My impression is that the ban on photographs has made Dylan more comfortable and I’m pleased I spotted that this was an issue for him.  Something that struck me last week, however, is that anxiety about photographs could, in time, be replaced by something else. Because I wasn’t able to take photographs, I made written notes about our trips and the places we visited instead.  By the end of the week Dylan was shouting ‘pen, pen’ at me every time I got my notebook out. 

Turkle and Technology

I was minded of Dylan’s phone-phobia recently while reading a Jonathan Franzen essay on Sherry Turkle (a ‘technology skeptic who was once a believer’). Children, Turkle writes,  ‘can’t get their parents’ attention away from their phones’. The decline in interaction within a family, Turkle suggests, inflicts social, emotional and psychological damage on children, specifically ‘the development of trust and self-esteem’ and ‘the capacity for empathy, friendship and intimacy’.  Parents need to ‘step up to their responsibilities as mentors’, Turkle argues, and practice the patient art of conversation with their children rather than demonstrating parental love (as Franzen puts it) ‘by snapping lots of pictures and posting them on Facebook’.

Turkle’s points about the impact of technology on child development could perhaps also apply to Dylan. If patience is a necessary quality when engaging a child in conversation, this is even more the case when communicating with someone who is non-verbal. Although Dylan is an adult in terms of chronological age, cognitively he is around five years of age (according to best attempts to assess this). Certainly, I would identify the development of empathy, trust and self-esteem as relevant to his nurturing and care. 

If there is any chance at all that exposing Dylan to technology could be limiting his opportunities for development then of course I should follow Turkle’s advice.  But perhaps Dylan intuitively knows this?  His protests about my phone were maybe because he wants my undivided attention – in which case, having to wait while I write in my notebook might be just as irritating to him as waiting for me to take a photo. Reading Franzen’s essay brought to mind another technology-related issue that I’ve had to deal with in relation to Dylan’s care recently. Rather than Dylan being the one protesting about the technology (as with phones and cameras) however, in this instance I have been the one doing the sabotaging.

Dylan’s iPad

Dylan has been using an iPad for years, primarily to access CDs and films he has purchased and downloaded and which he can watch offline. Previously, Dylan had portable DVD and CD players for this purpose but the iPad proved a better option practically and for promoting independence. Although initially intended for use during journeys and holidays, Dylan became increasingly attached to his iPad and built it into his daily routine, often preferring it to his TV or over other activities.

Recently, however, a problem emerged. On a number of occasions, Dylan managed to ‘lose’ the music he had purchased. This happened every three months or so, always while Dylan was at his care home.  Staff didn’t notice Dylan’s music had disappeared but they did report ‘challenging incidents’ for which there was ‘no apparent trigger’. Dylan would, however, show me that his music was missing when he came on a home visit and I would then have to set about fixing the problem. This was more complicated than Dylan merely ‘hiding’ the purchases (for which there are retrieval instructions) and required Apple technicians recovering the music so that it could be re-downloaded to Dylan’s iPad. The technicians were always professional, efficient and impressively competent but the process was time-consuming and frustrating. 

After the third fix, I asked if care home staff could provide more support to Dylan while he was using his iPad and suggested that they check it regularly, particularly if Dylan seemed frustrated or upset. When Dylan presented me with the problem again, just a week later, I decided a different solution was required.  Fair enough to fix something once or twice, but Dylan’s iPad seemed to have become a source of stress rather than a resource. How had this problem developed and why was it happening more regularly? I checked the stats to see how long Dylan had been spending on his iPad. Quietly aghast, I opened my secret drawer – the one where Dylan doesn’t know to look – and slipped the iPad inside. 

Intellectual Disability and Technology

It is very hard to remove something from an adult, even when they lack the capacity to make decisions and need someone to act in their best interests. Dylan had been using an iPad for years and it had a key role in his life. I was aware that in removing it I could create more problems than I solved. The iPad, however, was itself the source of some of the difficulties which Dylan was encountering.

Tech companies do not have intellectually disabled adults at the forefront of their mind during research and design and, as consequence, even the most intuitive apps and products are not always accessible, particularly to those adults who do not use speech to communicate (i.e. who are not literate and who cannot process spoken language). Although there are some great pre-school and pre-linguistic resources on the market, Intellectually disabled adults are not pre-linguistic children, they are adults who do not (and probably are not going to develop) spoken and/or written language. 

Like the school curriculum, technology is language-based and thus inaccessible to people who do not use language to communicate. It is sometimes possible to adjust a setting on a device so that it uses visual information. For example, Dylan is perfectly able to choose between the album covers of his music downloads. Apple’s default setting, however, is to display his music alphabetically, by artist/CD name. Dylan cannot read the text so he has no idea where to click. If his iPad defaulted to the text-based rather than visual setting (which it did, with every upgrade) Dylan would become disoriented and distressed. 

This has always been an issue for Dylan, but the problem seems to have become more acute since January when Apple rolled out a major upgrade to their music streaming service. Of course, what Apple want is for people to use their Music streaming service rather than purchase albums as Dylan does.  However, Dylan is not able to use the streaming service because it is language-based.  He needs his pre-purchased music, visually displayed. When it isn’t available to him in accessible format, Dylan tends to press keys and click icons and hit whatever message (language-based, which he can’t read) appears on the screen. I assume that it is at these times that Dylan manages to alter his settings and services.

The Apple Scruffs (my affectionate name for the wonderful telephone support guys) are happy to support me to recover Dylan’s music as often as he needs, but clearly it would be better if he wasn’t able to lose it in the first place.  One of the Scruffs advised that I send some feedback to Apple, suggesting that they put an option for preventing the removal of downloaded music on Parental Controls. I never had a response to that request  – presumably it isn’t a priority as Apple want to encourage the use of their subscription streaming service rather than downloaded purchases. So, as things stand, Dylan has hundreds of pounds worth of films and music which he has bought via iTunes, but which he cannot use. These will, of course, remain his personal purchases and at some time in the future, hopefully, he will be re-united with his iPad and able to enjoy these again. At least, that’s what I’m telling myself …

Support and Technology 

What the recent problem with the iPad has demonstrated is that, given the built-in obstacles in the technology, Dylan requires support to use it. Dylan generally recognises when he needs support with something language-based and will request this.  However, the personal usage data suggests that Dylan had been spending significant amounts of time on his iPad. The reality is that if staff are not available (or able) to support Dylan with the technology, rather than a resource it becomes a source of frustration and anger, leading both the technology and Dylan to breakdown.

When I confiscated Dylan’s iPad I was aware this would be difficult for him. I told Dylan the iPad was ‘broken’ (which Dylan knew because he had shown me that the music had disappeared). This time, I told him, it had to ‘go to the shop’ to be fixed, but for how long would he accept that story? Confiscating the iPad would also be challenging for support staff. Not only would they have to field Dylan’s questions and manage any incidents arising from my removal of the iPad, they would need to find something else to occupy Dylan’s time. Turkle might approve of what I had done, but I wasn’t sure the care staff would.

I held my breath as I explained to the team leader that I was returning Dylan to the home without his iPad. To my surprise, she reacted positively; she’d had a hunch, she said, that many of the ‘incidents’ involving Dylan were caused by his frustration with his iPad. Perhaps removing it would reduce Dylan’s stress and mean there were fewer incidents of ‘challenging behaviour’? 

Dylan and Technology

At the time of writing (11 weeks after I confiscated the iPad) there is some evidence to suggest that the iPad had become a source of distress for Dylan rather than a support; certainly there has been a reduction in the total number of incidents when Dylan has become upset at the care home. I’ve been most struck, however, by the ease with which Dylan has accepted the change. Just as I quickly got used to life without my camera phone, so Dylan has adapted to life without his iPad. He asked about it a few times in the early days but hasn’t mentioned it (at least to me) for weeks. 

Going on holiday last week presented me with a dilemma, however.  Dylan would need access to his music and films while we were away. Should I produce his iPad (music restored)?  If I did, Dylan would expect to keep it on our return from holiday and the cycle would begin again: staff not available to supervise –  Dylan spending too much time on his iPad –  music lost –  Dylan frustrated – challenging behaviour –  me back on the phone to the Apple scruffs. Nothing about that felt positive. So instead, I bought a portable DVD/CD player for Dylan to take on holiday with a selection of discs.  Old technology it may be, but it worked a treat.

In terms of new technology, the dream for the future is that tech companies give more thought to designing (or adapting) products so that they are accessible to adults who are non-verbal with intellectual disability. Perhaps that’s a pipe dream. In the meantime, it surely isn’t too much to ask that all disabled adults in care receive the support they need to access technology safely and effectively?

Notes:

The photos of Sherry Turkle and the iphone are free stock images. The other photos are of Dylan’s iPad and were taken by me. The final photo is the view from a window of our holiday cottage in Marske-by-the-Sea, taken opportunistically one morning while Dylan was still sleeping.

Johnathan Franzen, ‘Capitalism in Hyperdrive (on Sherry Turkle)’, pp 67-74, in The End of the End of the Earth:  Essays (Farrar, Straus and Giroux, 2018)

Selfie Sabotage: Dylan Develops Photo-Phobia

It didn’t take long, following Dylan’s autism diagnosis, for me to realise that visual images – photographs, symbols, videos – would play a central role in his life. One of my earliest memories of that time is of walking around the village where we lived, photographing places we visited to add to the communication book I was making. It was 1996 and Dylan had just turned two.  Digital photography and mobile phones had not yet landed.  I shot rolls and rolls of film in those early years and (with an industrial camera which made my shoulder ache) produced numerous home videos –  not to record, celebrate or share our lives, as is the case today, but as teaching resources for Dylan’s home education programme and communication aids to support our family life.

Such visual supports are helpful for any child who receives an autism diagnosis but for Dylan, who has remained non-verbal, they are essential. The visual world is Dylan’s language, his ‘mother tongue’. At 28 years old, Dylan has a vast visual vocabulary, supported by thousands of photographs taken over the course of his life. Dylan processes, organises and records visual information at astonishing speed. He can scan an environment and log it visually within minutes.  When Dylan is given his visual programme for the day, his eyes flick quickly through the images, absorbing the information.  If he encounters an unfamiliar symbol or photograph, he scrutinises it intently, looking for clues, before asking for more information or (sometimes) becoming anxious about what he doesn’t understand.

The photos developed from hundreds of rolls of analogue film have, of course, been superseded by digital images stored on various devices: computers, lap tops, iPads,  iPhone and USB sticks. These technological developments may not have been made with disabled people in mind but they have helped to meet Dylan’s needs as a non-verbal autistic man with an intellectual disability. In particular, phone-based photography has given Dylan access to a portable archive which he uses for a range of purposes. Dylan browses the photos on my phone to communicate, for personal pleasure and for reassurance. Sometimes, multiple functions are served at once; while having a drink in a pub, for example, Dylan will scroll through the images on my phone while I read, the pleasure and reassurance he finds in this activity punctuated by conversations about selected images.

Not only have these advances in photography helped me to create a visual archive for Dylan, they have enabled the production of instant images. Being able to record Dylan in the landscape and share this with him immediately has strengthened his sense of place and helped him to develop a sense of identity and belonging. This has been further helped by the ‘selfie’ option, which has allowed Dylan to locate himself in the landscape with others and has enabled him to take photographs himself, with minimum support. How marvellous that there have been all these developments in Dylan’s lifetime, I used to think to myself. Used to?  Yes, because this has all changed. Suddenly (I suspect) and recently (I think). Although I can’t be sure – maybe I only noticed suddenly and recently and it had been brewing a while?  I am having to re-think everything. This post is part of that process…

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My mobile phone is packed with photos, the vast majority involving Dylan in some way. They are records of places we have visited, mostly landscape but sometimes featuring one or both of us (sometimes ‘selfies’ but more often not) generally taken by me but a few by Dylan, my daughter or friends. The gallery is added to on a weekly basis, when Dylan comes for home visits, and more often during holidays and trips. But here’s a thing. The most recent photo of Dylan on my phone is a selfie of us at Cleethorpes, taken on New Year’s Day. Dylan has made numerous home visits, since then, and we have been on overnight trips and spent a week in Wales. But, except for one landscape shot taken in Wales on 21st April, there is no record on my phone of these visits.

The photo in Wales (on the left) was taken to see if Dylan would allow me to use my camera phone after months of him objecting. How many months? At least five, maybe more. I can’t pinpoint exactly when it started. I wish I could because then I might be able to work out why. Looking back at the photos of Dylan on my phone immediately before New Year’s Day, he seems to be smiling and happy. There are fewer than in previous years, perhaps. Now, as I search my online records, I see that on 26th December I reflected to friends that Dylan seemed to ‘have become camera shy’ and reported that I’d shaved him in case he disliked his full  beard. So, Dylan was already feeling uncomfortable about phone photographs in December? 

And now I think about it, perhaps that could explain the day I had to report an ‘incident’ during a home visit (such a rare occurrence that the care home manager commented to me that she was surprised to see the report). Dylan and I were completing a familiar and much-loved walk when he became distressed and started jumping wildly (one of Dylan’s anxiety behaviours) at the edge of a steep path. It was a difficult situation for me to manage and I was badly shaken, especially as I didn’t know what had triggered it. But now I remember that I had taken my phone out to photograph the valley. According to my diary that was 17th October. Could Dylan really have been anxious about photos as long ago as that? How much discomfort might I have put him through before he managed to communicate this to me?

Now, because I’m alert to Dylan’s discomfort, he only has to say ‘no, no’ and wave his hand. I thought that I had always asked Dylan for his consent before taking his picture, but I realise now that I probably did this in the same way that I ask my dad or daughter for permission to photograph them. Dylan needs to be given more opportunity to communicate consent or refusal than a neurotypical person because he doesn’t have access to the usual strategies, such as spoken language. Obviously, since Dylan has refused to be photographed I’ve stopped sharing pictures online and I’ve been giving some thought to archival material (such as on this blog) and reflecting on ethical and other implications. However, I’m not convinced that whatever is underlying this is quite as straightforward for Dylan…

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Dylan’s current objection to photography goes beyond my taking his picture; he objects to my taking any photographs at all. There are only 16 shots In my mobile phone gallery since I photographed the two of us on New Year’s Day. With the exception of the photo in Wales, they were all taken when Dylan wasn’t with me. Even if I reassure Dylan that I am not going to take a picture of him, he still says ‘no, no’ and waves his hands if I get my phone out. Sometimes he tries to grab the phone from me and once or twice he has become distressed enough for this to threaten to lead to the jumping which signals anxiety. 

Obviously, this is a risk I have not been prepared to take for the sake of a photo of, for example, Devil’s Bridge at Pontarfynach. Our visit there at Easter was the highlight of Dylan’s holiday. Dylan was utterly transfixed by the chaos of water and stone and he lingered at the Punchbowl and viewing platforms on Jacob’s Ladder as long as I would let him.  Previously, Dylan would have wanted me to photograph this magical place so that he could return to images of it whenever he wanted. ‘Do you want me to take a photograph of the water for you, Dylan?’ ‘No, no, no’.  Of course, I could not risk Dylan jumping into the Mynach Falls. Serendipitously, on this occasion, a print of Devil’s Bridge was hanging in our holiday cottage and every evening Dylan would stand before it, entranced.  Since we returned from our holiday I have bought a copy of the print (Clever Girl) and a sister piece (Spring) by the same artist, Chloe Rodenhurst, so that Dylan can continue to enjoy the visual world that speaks so eloquently to him (if no longer via photographs).

I might not have risked photographing the Mynach Falls but I did conduct an experiment that week. One of the theories I’ve developed is that Dylan dislikes me using my phone rather than the phone camera. Could he be trying to sabotage my conversations with his sister? Maybe he doesn’t like the effect of speaker phone on language. Or perhaps Dylan resents any time I spend on my phone (checking for news and email) and wants my attention to himself. Quite right too. Or (a wilder hypothesis) could he have developed anxiety about my phone as a result of a specific incident?  Dylan may, for example, have made a connection between my mobile phone and a Lateral Flow Test he had to take for Disney on Ice (due to a problem with the notification).  That was in December which might fit with the Christmas/New Year dates (but wouldn’t explain the October incident I’ve recalled while writing this blog). To test whether Dylan’s protest is about my phone or my photography, I took my old digital camera on our trip to Wales.

I was able to take 14 photographs that week, including one of Dylan under the Jubilee Arch at Hafod (which I won’t share). I would say that Dylan wasn’t super relaxed but he gave consent and seemed happy enough. It was for this reason I attempted to take a photo with my mobile phone on 21st April. Having used my Fujifilm all week, how would Dylan react to the iPhone? I took the shot but Dylan wasn’t at all happy about it and, given the terrain, I put my phone away. What do I surmise from this? It may be the phone, rather than the phone camera, which makes Dylan anxious, but I need more evidence. If it is the phone, then I have a not-insignificant problem. I need to be able to use my mobile in emergencies and for navigation. I should be able to take calls from friends and family if they need me. I have to be able to use digital apps (railcards for example) when we are in the community. And, importantly, I need to be able to record medical and other incidents for Dylan’s records. 

Recently, for example, Dylan sustained a cut on the head which I asked him if I could photograph with my phone. Dylan refused and the cut had to be photographed without Dylan’s consent by the care home. While not ideal, there will be other incidents and injuries, particularly given Dylan’s epilepsy, which need to be recorded in this way. I’m told that care home staff photograph Dylan using a variety of devices, including iPhones, but I don’t know whether this is with Dylan’s consent or if he has ever protested about it. Is it only my phone that Dylan objects to?  I need more information. Meantime, I am trying to stay alert and open enough to hear what it is Dylan is trying to communicate and work out why. I’d be glad to hear from anyone who has experienced anything similar or has new ideas and fresh eyes. 

Images:

The images of the mobile phone, roll of analogue film and view over Bradfield Valley are free stock. The images of Clever Girl and Spring are by the artist, Chloe Rodenhurst.The other images in the post are by me, except for the photo of me which was taken by a friend. That photo, and the photo of the ceiling fresco, were taken at the Watts Gallery at Compton in Surrey. The photo of Cleethorpes beach was taken on New Year’s Day with my mobile phone. The photos in Wales were taken at Easter and include the Gothic arch at Hafod (mobile), a waterfall at Hafod (digital camera) and a view of Aberystwyth (digital camera).

Better Safe Than Sorry

In my last post I recounted some of the challenges involved in teaching Dylan to say sorry and to understand feelings of remorse. The following week I found myself in the car park of Dylan’s care home gesturing, gesticulating and trying to communicate, in simple terms,  the enormity of an incident which – I told him, shaking my head and wagging my finger – he must never, ever do again. He stood stock still, staring intently at me.  ‘Sorry’, he said.

But Sorry is not enough this time.  The thing is to be safe…

Telephone Call

By chance I was ten minutes away from Dylan’s care home when I took the call. I had arranged to meet a friend at the cinema that night.  ‘I’m just going to check all is well with Dylan’, I said to her as I arrived.  ‘I missed a couple of calls while I was driving’. ‘At least we’re nearby if not’, she replied, rolling her eyes. 

In the pub, before the film,  I kept trying the care home number.  It’s always difficult to get a pick-up in the evenings. Finally, success. The reassurance of ‘Don’t worry, Dylan is safe’ quickly gave way to numbness at the realisation that he could as easily (more easily) have not been. ‘Dylan could have been killed’ I exclaimed as the full implications dawned on me. My friend raised her eyebrows at me, quizzically. 

I was glad she was there and that we had plans for the evening. Otherwise, I would have spent the time upsetting myself by going over and over what I’d been told or rushed to the setting to fetch Dylan home. Neither of these would have been helpful. Dylan was OK. But he could so easily have been hit by a car in the busy rush hour traffic on the road which he (inexplicably) crossed having (inexplicably) run from the garden, across the car park and (inexplicably) down the driveway of the home. Totally unexpected. Unpredictable. Inexplicable.  

But there would be time to look for explanations later…

 Little Boy in a Green T-Shirt

In the seven years he has lived at the care home Dylan has never attempted to leave the setting. He doesn’t have a history of running away although he will run towards something he wants and can see (sweets, for example, or DVDs). Although Dylan isn’t technically an ‘absconder’, the risk of him running from carers is written into his care plan. 

Caring for an autistic child or adult with learning disability develops a custom and practice alongside a care plan. It’s important to consider all the possible scenarios while risk-assessing and developing plans.  In everyday practice, however, many of the policies are not required. Routines become familiar. Safe practices are  embedded.  We establish a norm. What made Dylan break that norm? Why, out of the blue, did he run away from the setting instead of taking the few steps from the garden back into the home? 

In the pub, trying to process the phone call,  I remembered the little boy in a green t-shirt. He would have been ten years old perhaps.  The doors were locked. Early evening. Not long home from school. His mother was busy preparing his tea. Veggie sausages and chips maybe.  Something the little boy liked.  She still doesn’t know what made her walk away, leaving an unguarded pan on the stove.  She wouldn’t normally have done that.  She could find no explanation later (just luck) for why she had walked into the front room. There was nothing she needed there.  Nor could she tell why she had walked to the bay window and looked out of the window and down the road. But when she did she noticed a little blond-haired boy in a green t-shirt across the road, heading down the street.  ‘That little boy looks like Dylan’, she thought to herself.  Then ‘Dylan! Dylan! Dylan!’ she screamed.

Afterwards,  – after I had gone screaming out of the house then had the presence of mind not to shout Dylan’s name –  not  to startle him or do anything to make him run – after I had composed myself enough to calmly call  ‘Wait Dylan. Stay there’, then dashed across the road to scoop him in my arms – after I had said ‘never, never’ and tried to communicate what he must not do again – after I had not just locked the door but removed the key too (so, he can turn it now, I thought to myself) –  Afterwards, I had asked myself why Dylan would leave home while I was cooking tea? Surely that should be the least likely time?

But with someone like Dylan, you have to be ready for the out of the blue…

‘Dylan Won’t be Coming Next Week’

Later, I remembered that there had been another time. I don’t have a strong memory of it because the details reported at the time were sketchy. Enough to terrify me though – enough for me to have blocked the memory, buried it deep in my core. While I don’t recall exact dates, I’m pretty sure Dylan still had that green polo shirt. Eleven years old perhaps? My ex-husband and I were not long divorced.  I was working full time and struggling to get chores done. I couldn’t take Dylan to the supermarket.  No online shopping back then. My daughter to get to Stagecoach too. I just couldn’t manage Saturdays. So, I enrolled Dylan in a play scheme at a local Inclusion Centre.

The Centre came highly recommended by parents and professionals and the shadow visits seemed to go OK.  I had the usual anxieties about leaving Dylan to the care of others when the time came, but no reason to doubt the processes in place or my decision. But when I collected Dylan that day – just two hours after I had left him for the first time – I was told (casually? or is that a false memory?) that Dylan had managed to give play workers the slip and leave the setting by a side door. It was alright, I was told – Dylan had been recovered from the Penistone Road, kept safe by passing police.

The Penistone Road. Everyone in my city knows the nose-to-tail horror of that mad arterial road north out of the city, past the Sheffield Wednesday football ground.  When the children were small we drove that road daily for work and school and friends and family.  Once, I had found my young daughter and step-daughter with Dylan’s cars lined up bumper to bumper through the house – starting at the back door then through the kitchen and dining room, into the lounge and up the stairs. ‘What’s going on here, girls?’ I’d asked them, picking my way through the cars. ‘Does Dylan know you have these?’.  ‘We’re playing Penistone Road’, my step-daughter replied.  I remember telling my ex-husband, worrying about the amount of time the children spent commuting.  That’s where Dylan was found that day.  Wandering on the Penistone Road…

It’s hard to hear something critical in the presence of Dylan. Because he picks up my mood I have to stay calm while I’m supporting him, however I feel inside. This can be a battle sometimes.  It means I have to push upsetting news on the radio or telephone out of my head and smile. It means that discriminatory members of the public (fortunately rare) rarely feel the cut of my sharp tongue. It means care workers can deliver difficult news without facing difficult scrutiny or question, at least at point of delivery.

But I was shaking as I delivered my parting shot that day.

Three Lives

The child in a green t-shirt.  The boy on Penistone Road. The young man running from the care home. Dylan has used up three of his lives, it seems. On each occasion he was being supervised by a parent or professional who believed Dylan was safe. Each time, he evaded their care, placed himself at risk. How do we keep children and adults who lack capacity safe? How can we plan for the unpredictable and unexpected – the ‘never before’ – without leaving life a dull and limited thing, removing the space a person needs to breathe?

No one ever thought that the large and heavy gate at the entrance to the care home was necessary before Dylan squandered his third life on the road that day. Now, it is kept firm closed against the unexpected and unpredictable. A holding measure against runaways. A reasonable restriction on freedom. It brings peace of mind,  but for me the more interesting boundaries are not physical but in the mind. Why did Dylan tacitly consent to observe the boundaries without a gate for seven years?

The thing is, I told myself, to try and understand what caused Dylan to run away. So, I looked at the number and type of ‘incidents’ recorded for Dylan in the previous three months. There were some patterns. Dylan’s most serious incidents seemed to happen in the car park, a place of transition where physical and psychological boundaries are less clear. More permeable. Perhaps an activity hasn’t ended as Dylan expected or he isn’t ready to move to the next. Maybe there are too many or not enough cars. Carers may be differently preoccupied or behave differently. The wind might blow a memory of another day.  Different possibilities and opportunities may present themselves. Perhaps some of these things lined up for Dylan that day.  Or maybe there is something else I need to take away?

Only writing this today has it occurred to me that the little boy in the green t-shirt and the boy in the traffic on Penistone Road might have been reacting to disruption in the aftermath of a divorce. Why, I wonder, didn’t I consider this at the time? I know from my daughter and step-daughter how painful the breakdown of a marriage is for children.  We watch our neurotypical children and teenagers behave in unexpected, unpredictable and sometimes unsafe ways at such times. Why not Dylan? It seems entirely plausible to me, now,  that his leaving the family home and running away from Saturday Club could have been expressions of his confusion or unhappiness at the time.

But what, I wonder, might Dylan be expressing now?