An interesting set of correspondences that lead to a wild couple of days

(warning: this is a good post for those of you who are fans of all things speech-language pathology...)

A few days ago, I received this very nice email:

"Dear Sir/Mm Amy Levin, 

I am Dr.Q  from CanTho city in Vietnam. It is too impolite when I connect to you directly. I have got your email from Dr.P. I think my daughter is autistic child. In Vietnam, we have a little information about this situation. I am very please to introduce you with children and their parents in the same situations if you agree. I will try all my best.
Thanks God give you to us.

The Best Regards,
Q L"

Dr. P is the pediatrician that we work with at the Can Tho Pediatric Hospital. I replied to Dr. Q to let her know that I would be happy to talk with her. She responded:

"Dear Dr Amy Levin,

Thank you for your reply. I can gather 10 children and their parents
at my house, a place next to Children hospital. If it is possible,
could you come with us? I think the autistic children are afraid of
hospital. Maybe you will understand when you come there.
Again, thanks for your help.
Q L
Yours sincerely."

Ready for the challenge! I responded that I would be happy to meet the children and parents, and we started  to get a time together to meet. She responded:

"Hello Dr.Amy. I am very glad to hear you've just come CanTho. Could you go
to my house at 2pm to take a view and help me how to prepare for  the
meeting with them (25patients). I think you  talk about your plan to
dr.P.
I wil arrange and connect all of them. My house is a clinic for
children.  I will meet you at the hotel first.
Q L"

Eeeps! 25 patients? WOW! OK, we can give it a shot. Needless to say, by the time I sat down with Dr. Q, her list of patients with Autism was 30 children long. I encouraged her to pare down the consultations to half, given the time that we had to work together. I also let her know that I Am Not A Doctor (dodged that bullet! phew!).

I wasn't sure what to expect from this plan-- in the past, there has been a lot of difficulty and what I would consider misdiagnoses of Autism in Vietnam when a child actually appeared to present with seizure disorders, congenital syndromes with both physical and cognitive consequences, or often, significant cognitive impairments. I wasn't sure if a diagnosis of Autism would even be appropriate for the kids that were going to come in, including for Dr. Q's own daughter. (this post is so suspenseful, right?!)

Well, in case you had any doubts, children with Autism in the Mekong Delta look a whole lot like children with Autism in Chicago! In the last couple of days, I have been able to work with families and kids all over the Autism Spectrum, with one child with Aspergers Syndrome thrown in for good measure!

However, while the range of levels of functioning have been similar to the kids I work with in Chicago, there were some striking differences (some technical talk here):

• There do not appear to be any consistent or reliable Vietnamese-language resources for parents about what Autism is 
• There is no Early Intervention therapy or school support for the kids, and many leave school after a couple of years of kindergarten
• Most of the children I saw were not identified as being on the Autistic Spectrum until after age 4
• Cultural norms in Vietnamese do not consider independence in some of the domains as important for children that are considered important in the US-- including feeding, dressing, moving around, or trying to get an adult's attention.
  
  The main observation that the parents share is that they first became concerned when their child did not speak at -age 3 or 4-. There seems to be more of an expectation that a child will learn and develop through observation of others, rather than through consistent practice and interactions with others. This works out OK for most typically-developing kids in Vietnam, but for kids on the Autistic Spectrum, the results are lousy.
  
• As a result, the kids that I saw here that were 4, 5, or even 9 years old had almost no interaction or communication strategies, and their parents admitted freely that they had no idea how to "make him pay attention" or how to "help her enjoy being with the family." Of course, these are things that all parents everywhere want, but we are usually able to help establish some basic foundation for kids with Autism for interaction and engagement by age 2 or 3 in the US-- but here we were in Vietnam, with kids with 5, 6, or 9 year old brains. A different story, to be sure. 

Many thanks to Translators Hoa, Hanh, and Trieu for helping me repeat and demonstrate strategies for starting to "get something cooking" with these kids and their families. It was a good start!

Fortunately, there are a million ways to model these strategies, and I think many of the parents got to practice some ideas that they will continue to work on. My primary goal was to continue to train Dr. Q to help her observe and interpret what the kids are doing, and to help coach parents to work with their children.   Baby steps. 

Here are some of the terrific kids and families that I got to work with--

The balcony was as far as this little girl would come into the clinic. 

This little girl sang to herself for the entire hour with me without interacting with anyone, including her parents. We finally made a connection when I imitated part of her song-- it got her attention, then she sang me another part that she waited for me to imitate. We all cried a little bit. (lots of emotion in this group!)

This little guy TORE the room apart! Whoa! I think we finally helped him get
a little more regulated by swinging him in a blanket. 

Another treat was getting to meet Bao, an 11 year old boy who would probably best be diagnosed with Aspergers Syndrome. He has taught himself English through watching television, and he is the only person in his family that speaks English-- he is quite a puzzle to them. His family is concerned that he speaks Vietnamese "with a bad accent", and you might notice that his English doesn't have the typical intonation, either. 

I have tons of other video of these kiddos and their families. I can selectively thrill you with those on a more one-on-one basis, if you're interested!  We had a great culinary send-off from Can Tho before leaving for Ho Chi Minh City-- coming soon!