Part I: Opening Act
I am sitting directly across from him. I mention something about the rain outside. He briefly looks up and responds affirmatively, but just as quickly he diverts his attention to the object in his hand. He seems fixated on it, and as I attempt further small talk, I sense that he is somewhere else. I ask him how his week has been. He says “okay.” His facial expressions seem muted and to be honest, I am not sure if he is annoyed or unaffected by my presence. His eyes remain downward as his thumbs and fingers glide quickly over the device in a repetitive manner. Although seemingly fidgety and uneasy during a previous conversation, his body language remains quiet. I start to engage him in another line of conversation, but stop, feeling as if I might be the only one really interested in talking. Silence pervades the room. I wait. There is no response. I wonder if he will engage, but I get the feeling there are things of greater interest on his mind. I figure it’s time to move onto something else.
When youth are referred for evaluations to assess for a possible autism spectrum disorder (ASD), one of the most well-researched tools to assist in the process is the Autism Diagnostic Observation Schedule (ADOS), now in its 2nd edition. The ADOS uses a semi-structured format in which the examiner attempts to engage a child or adolescent in a variety of play and conversational tasks. The purpose is to elicit social interaction regardless of the amount of language someone has in order to determine how developed the skills are. These skills include, but are not limited to, the spontaneous use of gestures, meaningful eye contact, facial expressions, amount/quality of social responses, initiation, and/or insight into relationships.
Many of the skills that are assessed usually become evident at an early age. Anyone who has ever been around a typically developing eight-month-old child recognizes just how social he or she is. Children do this without the aid of words—most are months away from this stage of development. So they use their eyes, their smile, their facial expressions, their hands, and their entire body in what is a remarkably synchronized display of one major thing: interest in you. Even those children who exhibit an anxious temperament clearly gauge their surroundings, and when they feel secure, they seek out those around them. It is not just for need (e.g., for food), or because of discomfort (e.g., dirty diaper), but it is for that deeply ingrained need for an attachment. Years of research and observation led Erik Erikson, one of the foremost developmental psychologists, to surmise that the first year of life was defined by the development of basic trust versus mistrust. This was based largely on just how well the child could learn to trust that the parent was a stable, consistent provider of not just the necessities of the body, but also the requirements of the heart.
Further studies would confirm the importance of attachment to another human being beyond simply providing for a child’s needs. As described in the book, The Happiness Hypothesis by Jonathan Haidt, a researcher by the name of Harry Harlow and his students uncovered a striking finding when young rhesus monkeys were given two options for a surrogate mother. For decades, behavioralists had indicated that young clung to their mothers to get their basic needs (e.g., milk) met. But when these monkeys were offered two options, a “wire mother” with milk and a “cloth mother” without, the results changed the course of psychology. Every monkey spent almost all their time clinging, crawling, and climbing over the folds of the “cloth mother.” For these monkeys, like us humans, the ability to connect in a very personal, intimate way, was the seed of happiness. Without this connection, no matter how much they were fed or groomed, the monkeys always seemed discontent.
Which leads us back to children with an ASD. Many parents will say that the biggest challenge in raising these children is that they struggle to develop a consistent, social-emotional connection with these children in the way that seems natural with most kids. While other two year-olds may routinely try to comfort someone who is hurt, or follow a parent’s eyes when they look towards an object of interest, most of those with ASD struggle mightily with these basic skills. And because of this, parents of these children often feel exasperated because what they always knew to be true about raising kids seems to be turned on its head. In other words, the social-emotional connection, which is the seed of all discipline and learning in addition to happiness, suddenly lacks a clear connection. Without this, parents are often left to wonder how to motivate, how to redirect, how to inspire, and at times, how to even simply provide for their child’s basic needs.
Two of the most important social communication skills that ASD children struggle with are joint attention and theory of mind. Theory of mind and its connection to autism was first introduced by Sir Simon Baron-Cohen and colleagues in 1985. Simply put, it is the idea that I am my own being, with unique likes, experiences, and characteristics, and that each person around me also exists in this way. The understanding develops even in infancy. Children become more sensitive and aware of each other’s needs, wants, and desires, as they learn to empathize with another. It is the precursor to emotional intelligence. Many researchers and theorists beyond the ASD world feel it is one of things that makes humans unique from other living organisms. Joint attention is experienced more concretely, and is best represented by thinking of a triangle. Even before the age of one, children recognize that when two people are looking at an object, they generally look back to each other to see what the other person’s reaction is, thereby forming a visual triangle. So if dad points to a bird in the sky, we would expect dad and the child to look at the bird, then look at each other, and recreate this over and over. Joint attention manifests itself in many ways, but it is critical to mutual sharing and learning. Taken together, deficits in joint attention and theory of mind make basic interaction, and thus deep relationships, very difficult to develop.
But as with any story, there is always hope. This time, though, hope often comes in a different way, and I have been blessed to experience it many times firsthand. Hope sprouts during those early days in which eye contact—real, meaningful, communicative eye contact—begins to emerge. Often through hours of intensive interventions, reciprocal smiles start to show. And then the pointing, and the first time a child pretends that a doll is more than just a doll. What parents of ASD children know better than anyone else is to appreciate the very thing that we all need and deeply desire, grounded in the little things we do in each other’s presence. It is a connection with each other.
Which brings me back to the vignette that opened this article. When you read it, what scenario did you think I was describing? Was it my interaction with an adolescent texting on his mobile device? Or was it my attempt to evaluate a youth with an ASD? What you might find striking is that it was actually both. It involved two seemingly different people with different profiles, both missing basic social behaviors needed to provide a basis for everything else. It makes us wonder what is to come.
Part II: Lost Conversations
In 1976, Sherry Turkle started her career at the Massachusetts Institute of Technology. Early on, she wrote about the promises that technology held in revolutionizing many of our practices and assisting those with various struggles. But as the years progressed, a more sinister side began to materialize. As the subtitle of her most recent book, Alone Together states, she noticed that people were expecting more from technology and less from each other. Instead of assisting others in progressing with relationships and a particular calling, it became clear to her that technology, such as mobile devices and gaming, seemed to provide a way for people to avoid conversations and dive into a virtual world much different from their own.
The story of Alone Together is the intimate look at this cultural shift through the disclosures of youth and adults alike. In her book, Ms. Turkle takes an in-depth examination into the world of robotics, internet, mobile devices, gaming, and other devices in an attempt to tie the emerging research to the words of those who have come to depend on the technology itself. What is most striking is that while clear evidence exists about the ways in which technology can be used strategically, most teens in her book acknowledge the complications that it has brought into their lives. Sheepishly, a few of those interviewed admitted to spending inordinate amounts of time either making their Facebook page appear just in the way they wanted to (often distorted from who they are) or posting on the “walls” of many others so that others will do the same on theirs. Others intimately disclosed the challenges of “friending” or “defriending” and the pressures of feeling that they are never allowed to be disconnected from others for fear of what it will do to their social lives.
Beyond this, though, what becomes clear in the book, and what has become increasingly clear in many other arenas, is that technology itself provides a way for youth to avoid working through many of the basic relationship challenges that will not leave them for the rest of their lives. As one individual puts it, World of Warcraft always delivers. Relationships do not. In various ways, whether through the use of texting or immersion in online virtual worlds, such as Second Life, Alone Together details how all of us are increasingly able to sidestep direct interaction with another human being. But for youth, this becomes a very salient issue given that their brain is particularly primed to learn all of these nuances. After their mid-20’s, the ability to learn much of the intricate social world becomes extremely difficult largely because their brain stops undergoing new development. Said another way, if the primary ability to have a conversation and sustain deep, meaningful relationships is not acquired in the first twenty-five years, the prognosis is not good.
What has emerged, and is increasingly seen by mental health practitioners (including myself), is a seeming decline in empathy. As she noted,
…increasing number of patients who present in the consulting room as detached from their bodies and seem close to unaware of the most basic courtesies. Purpose-driven, plugged into their media, these patients pay little attention to the world around them. In others, they seek what is of use, an echo of that primitive world of “parts”. Their detachment is not aggressive. It’s as though they just don’t see the point.
This “primitive world of parts” sounds much like what many parents of ASD children describe at times. Although they know that desires for attachment and closeness exist, there is a sense of detachment, a feeling that their child is not empathizing with the challenges they feel. It is as if parents of both sets of children, those with ASD and those immersed with technology, are often left wondering if their youths’ relationships of the future will possess a true mutuality necessary to sustain any commitment that is made.
Paradoxically, though, there is another side intimated by Ms. Turkle. Quite the opposite from detachment is the trap of enmeshment. It is a world in which teens and young adults increasingly seem unable to handle even the simplest of decisions and moments of isolation or separation on their own. Recently I had a conversation with a family member who works at a Midwestern University. He told the story of a freshmen orientation, when parents and newly graduated high school students were split for part of the daylong process. At one point after less than an hour of separation, the facilitator asked the incoming freshmen if any of them had exchanged texts with their parents. Almost all raised their hands. What Turkle found, and I have certainly seen, is that when many teens are faced with the smallest of decisions or brief moments of uncertainty or solitude, they immediately resort to sending a text in hopes of getting an immediate response. Before the emotion has even registered, and the process of discerning the feeling itself and deciding what to do has occurred, a message has been sent. In many ways, it is as if the text and the anticipated response define the experience before the experience itself is fully unveiled. Strikingly, what maybe most lost beyond opportunities for self-reliance and intrapersonal reflection is the solitude itself. Many teens appear to view moments without connection as something to be avoided and filled. And yet in thinking about solitude in Ms. Turkle’s words as she reflects on her own offspring,
solitude…the kind that refreshes and restores. Loneliness is failed solitude. To experience solitude you must be able to summon yourself by yourself; otherwise, you will only know how to be lonely. In raising a daughter in the digital age, I have thought of this very often.
In a poignant way, Alone Together closes with a few personal reflections. One of these occurs through a homily given by the author’s rabbi as he discusses the importance for each of us to talk to close ones who have passed away. It was suggested that we have four things to say to them: I’m sorry. Thank you. I forgive you. I love you. This is what makes us human, over time, over distance.
Often, these are not easy things to say. The more our relationships are strained by the inevitable challenges of adult life, whether they be finances or work or kids or health problems, the harder they may become. But they cannot be avoided. For when they are, relationships crumble and lives are torn. And they cannot be faked. While a text that says “I’m sorry” may bear some truth, it can never replace the process of true healing that must occur over and over, often through painstaking conversation and direct attempts to make amends for the wrongs that have been done.
I worry, like Ms. Turkle, that we are robbing our youth of many daily opportunities to learn these skills while their brain is still able to receive. I worry that we are promoting the art of avoidance and minimizing the value of solitude, in exchange for one more detached measure of momentary reassurance. And I worry that our youth are not coming to know that the seed of happiness lies in the intimate, yet often difficult and vulnerable, experience of immersing yourself in the true and complete presence of another human being without worrying that the rest of the world is passing you by. It is certainly what youth and parents affected by ASD would love to feel.
Just ask that eight-month-old child smiling and staring back at you. This they already know to be true.
Part III: For Better or for Worse
A few months ago, my wife and I took our kids to an annual reunion at Lincoln State Park on Memorial Day. For a variety of reasons, this was the first time that our kids had been able to attend a gathering that was started more than thirty years ago by my grandparents and a few of their friends. Since the early days, they had rented the only lakeside shelter adjacent to the swimming area. On this particular celebration, the blue skies shone brightly on what turned out to be a gorgeous, early summer day. We had learned from my relatives that it would be the last Memorial Day spent here as those who had started the tradition were now into their late 70’s and early 80’s. As my grandmother joked, they had managed to continue all these years without any deaths, with only weddings and births, and they figured it would be good to go out on top*.
As I talked more with grandma about this celebration, she recalled days past when the weather had not been so hospitable, especially before the shelter had become part of the tradition. She laughed at comments made by my uncle decades ago, seated just a few yards away, about all the “fun” they were having on one particularly cold, rainy Memorial Day. But when I asked my grandmother if they had ever missed a year, she looked at me with a hint of subtle pity, and quickly responded “Oh no” as if the question itself suggested there was much I did not understand. As I thought more about this conversation throughout the day, I also noticed the unique absence of something I had grown much accustomed to at many other gatherings. Despite a smattering of ages, no mobile devices could be seen or heard (although surely were present), and in its place, seemed rather lively conversation amid quiet moments of reflection on the trails and lakeside. Some of these people saw each other frequently, others almost never, but what was clear by the end of the day is that few were ready to say goodbye to this tradition three decades in the making. It had been a commitment born in the company of each other and it would end just the same. Surely the conversations had been awkward and repetitive at times, but there was little doubting that they, like the tradition itself, had maintained a genuine humanness all the same.
I wondered how our current generation of youth would have viewed this tradition. In a world where teens routinely make their plans on the fly, where calls and texts are screened, and where technology provides an opportunity to opt out or cancel at the latest of hours if the conditions don’t seem just right, I found myself curious of what the word commitment means to youth of today. I am curious even more about the capabilities of our teens in managing conversations and unfamiliar situations without the aid of their mobile sidekick, as we already know that social abilities (see the series Cultivating Our Future) have declined in the past thirty years.
As we have immersed ourselves in technology, and more importantly have encouraged our youth to do the same, it seems that we have sideswiped two massive, logical issues. The first issue that I initially raised in the January 2013 edition, Linked-In, involves the capability of youth in managing all that technology has brought. We live in a country where many restrictions are placed on youth (regardless of your opinion) whether it be in driving, gambling, smoking, signing financial commitments, and providing medical consent among other things. There was a time where youth were allowed to engage in some of these practices. But over time, both due to research regarding their capacity to handle, and costs incurred to the community (both financially and in lives affected), it was felt that it was not prudent to allow youth to participate. Most recently, since I received my driver’s license years ago, the state of Indiana has increased the legal age of driving and added many restrictions because the cost of not doing so was just too great. It appears the same is true for much of our technology when it comes to our youth. For all the supposed advantages that it may afford to them, I have become increasingly convinced that they do not, and will not, possess the mental and physical capabilities to manage it all, just as I feel that under-aged drivers are not consistently able to handle the demands of operating a motor vehicle. Although I am not currently advocating any major legal shifts (although I think there are options to consider), I do feel that we as parents need to take a serious look at the cultural perspective regarding youth and technology. We need to ask ourselves why we think our children can figure out how to use it responsibly anymore than the other privileges outlawed for their age.
The other logical question is one of simple conditioning. Thousands of research studies have demonstrated that patterns practiced early in life are most often recreated as adults. Although many will set out to make changes for various reasons, these changes do not occur easily. Most often adults fall back into patterns similar to those when they were young. As Farmer Joe, the director of a local co-op once said in a paraphrased way, “I hated gardening when I was younger and vowed I would never do it again. But it was in my blood, and I found myself drawn back and so here I am.” By allowing our youth to be immersed in technology, we are in essence making this choice for them as adults. We are not providing consistent opportunities to learn how to entertain, to socialize, to manage emotions, and to make decisions, without a mobile device at their side. Most adults acknowledge the addictive qualities that technology carries. Although they recognize the dependence that it encourages, most feel they have little option. Think, then, what option will our children have if their existence was defined online? I have little doubt that those who used technology sparingly and strategically as youth can do so as adults, despite the clear temptations to immerse that exist. But I have great doubt that those who never knew a life without it will see any other option when they grow up. Those of us who were privileged to grow up before technology became a lifestyle appear to really be the ones who grew up with an advantage.
What I learned that Memorial Day spent in Lincoln State Park, as I have from many of those from older generations, is that traditions worth keeping are founded in the relationships that span the ups and downs of our lives. Relationships of mutual appreciation, even in the midst of personal differences, take a lot of face time—real face time—even when the rains come and make for an otherwise dreary day. Even the best of songs grow old quickly if they are played over and over. It takes an album composed of tunes of varied degrees, to really appreciate the person for which the songs represent. So it is with us. When youth experience others in a compartmentalized, censored, filtered way, the reality is that they are not experiencing the person as a whole, both in their imperfections and their strengths. Their reality becomes distorted. Some may argue this is a safer way to go, and that this generation can learn to co-exist more peacefully than those before. I, for one, do not feel that the move from humanity, in its rawest form, to something made in this world can ever be a step in the right direction. Moving in this direction removes the value from each other. It translates us into commodities to be dispensed and stored. We can learn to deal with even the worst that humanity can bring. We cannot recover from the gradual loss of humanity as a whole. But I worry that our youth are already marching forward in this way.
* As an interesting side note, I found out weeks later from my grandmother that the tradition would, in fact, live on after all. She told me that members of the younger generations that day decided it was too important of a tradition to allow to dissolve, and so they would take over all the responsibility of making it happen for years to come.