Paediatrics (Part 1/5, RETROSPECTIVE POST)

Following O&G was CAH (Child and Adolescent Health, ie Paediatrics). Of the 9 weeks, I spent about 6 weeks in total at the Paediatrics Department of my Clinical Hospital, and the 3 other weeks at RCH (Royal Children's Hospital) for lectures and a mini-attachment. Paediatrics was the first Clinical Rotation that I REALLY enjoyed and was enthusiastic about, of which there were multiple factors. I temporarily felt “ALIVE” and “SWITCHED ON” which was a huge contrast to my very low state the previous Semester. Another thing that made this Rotation memorable was that all the supervising Paediatricians knew about my AS and were amused by it given its relevance to Paediatrics. None of them were patronizing or treated me like a child. I didn't experience any repercussions in disclosure and knew in advance that it would be taken well.

The Paediatrics Department of my Clinical Hospital was very small compared to RCH, there were about 18 beds, and about 1/3 of them were for Eating Disorders. Being male and not a Paediatrician involved in their care, I was advised to avoid speaking to patients with Eating Disorders (all teenage girls). Most of the rare and complex cases would've been transferred to RCH, so the remaining Case-Mix at the Peripheral Hospitals (including this one) were very “Bread-and-Butter” - Pneumonia, Bronchiolitis, Gastroenteritis, Dehydration, with a bit of Epilepsy. Because there were so few Inpatient beds, I actually spent more time at the Paediatric ED which although had even fewer beds, but had much higher turnover, and hence more opportunities to practice Clerking and Physical Exams.

Like with Women's Health, we had a PBL (Problem-Based Learning) Tute each week at the Clinical Hospital and opportunities to attend Outpatients, along with morning Ward Rounds (including on the Weekends if we'd like).

PBLs were mostly on “Bread-and-Butter” cases. However there were two Tutes that stuck out in my mind, the first one regarding a fictional 4 year old boy who was being assessed for ASD / Fragile X Syndrome. Somewhere in the text it said that the boy had frequent “Tantrums”, particularly coz he wasn't able to communicate his ideas owing to his Speech Delay. I wasn't happy at the term “Tantrum” being used coz it brought the connotations of being naughty, rebellious, and/or manipulative (in reference to NT children, eg at the supermarket wanting something but not getting it), when he was anything but. 

In the Tute, I said I found the term offensive and misleading and that the more appropriate term for such an ASD child would be a “Meltdown” due to his current neurological deficits being unable to meet his personal needs, leading to massive frustration and vulnerability. And that the approach to his “Meltdown” (Education, Accommodations, minimize Sensory Overloads) would be completely different to that of a “Tantrum”, which we were taught to just “ignore the child until they stop whining, to give them the message that their Tantrum isn't working or acceptable”. I feared that parents would treat ASD children having Meltdowns inappropriately, which would just exacerbate the situation and cause more mental scarring. However the Tutor insisted that it was still a “Tantrum” in the literal sense, and was thus appropriate. This incident was very frustrating and ironic to me, given that ASD people like me supposedly take things more literally (relative Frontal Lobe deficits), and have an impaired ability to comprehend language pragmatics (including subtle connotations), and yet it was the Tutor (NT) who took it literally.

The second memorable Tute was about a Teenage girl who had several psychosocial issues to be addressed in conjunction with Epilepsy management, including Smoking, drinking Alcohol, teenage Sex and possible Depression. IIRC, in the passage regarding her Past History, that she “Tried Sexual Intercourse a few times last year but didn't enjoy it, so hasn't had it since.” This phrase was particularly interesting to me, coz it was only then I realized that sometimes, in order to dislike an activity, you have to give it a try first. I literally told the Tutor that “In order to know that she doesn't like Sex, she has to try it first,” in which he concurred. 

It may sound really obvious to others, but it helped influence my approach in life, that part of personal growth involves getting out of one's comfort zone (or narrow interests / repetitive activities) and experiencing new things temporarily, which would assist with developing one's perspective too instead of relying on preconceived notions or fear. I now see it as collecting more data to analyze. Sometimes there are strangers who I'm interested in speaking to, and whilst I used to be too anxious about approaching them at all, now I'm more forthcoming and curious, thinking it's “It's either I speak to them now, or never and continue to wonder what it's like if I had spoken to them”.

ASD and Getting Bullied - BULLYING IMPACT (Part 5/7)

Getting bullied has lifelong consequences for many people, even more so for ASD people coz of their strong episodic memories. I’ve yet to meet an ASD person (especially Aspies/HFAs) who didn’t get bullied at some point in life. In retrospect, while the bullying incidents were pathetic on the bullies’ part, my impression is that the reduced repository of coping mechanisms at the time in conjunction with less life experience, education and practice of “social frameworks” increases the adverse impact of such incidents.

I feel more level-headed (albeit super cynical) compared to the past, but previous incidents have permanently moulded various aspects of my behaviour and attitudes.

Ever since I was framed and punished for sexual harassment, I interact with females on a much higher guard compared to males, as they can easily “destroy” me. I have to follow intellectualized algorithms (on “appropriate behaviour”) that approximate acceptable NT interactions, and implement extra mechanisms to reduce the risk of subsequent false accusations:

- I’ve very rarely touched females apart from doing so for medical purposes (physical exam) with their consent in the presence of another professional.

- I never hug females unless they initiate it.

- I try to respect their personal space by following proxemics, increasing the physical distance between us (50+ cm) by standing behind a chair or a table when talking to them.

- Any vague answers to my requests are automatically interpreted as “No”/”I don’t want to”/”Stop it”/”I’m not comfortable with this topic”, in which I cease pursuing it lest I aggravate them.

- Never discuss R18+ topics unless you know them very well or they mention it first.

- If they show a frown/angry/suspicious facial expression, ask yourself if you’ve said or done something to offend them within reasonable limits as defined within your database.

So far it’s been somewhat reassuring; I’ve been able to have neutral/positive interactions with many female patients, students and retail staff without complaints. I’ve seen or examined some vaginas and breasts (in Obstetrics/Gynaecology rotation) without getting into trouble. Clearly the absence of complaints following short encounters doesn’t mean they’re my friends, but at least I haven’t done a total blunder. Tbh, a lot of my motivation for interacting with females is to show myself how much improvement I’ve made with regards to complaints as a %age of all interactions with females in a year. In that respect, I treat it as a game, aiming for near-0 complaints within a year.

And this is just the tip of the iceberg; I’ve created other algorithms/rules following other types of bullying and unpleasant interactions (eg being sworn at).

My major concern however is how to respond when I’m bullied for the first time through another mechanism, in which I predict I’ll have to respond by first principles (which I unfortunately haven’t designed yet) and reading other people’s experiences online…

ASD and Getting Bullied - ASD VULNERABILITY --> BULLYING: EXAMPLE (Part 4/7)

The Aspie’s initial “empty slate” regarding the facial expressions, tone of voice + body language disadvantages him. Insufficient recognition of such social cues in others, along with other differences (eg statistically reduced verbal fluency) predisposes him to bullying and/or manipulation by others.

Story of me being framed:

I skipped a grade and joined a class whose classmates I’ve seen numerous times, but never interacted with much before. I used to hang around by myself a lot, but I thought I’d feel more comfortable if I could be included. I used to say to the girls in that class, ‘Can I play with you?’, and they’d always say ‘No, you’re not old enough.’

This time though...

‘Ok, you’re in our class so you can join us. Let’s play tag.’

‘Ok.’

‘Ok, you're it. Count one two three before you go.’

‘Ok.’

The girls ran away, but I was relatively fast even though I was still kinda clumsy at the time. I tapped one of the girls on the shoulder.

‘You touched my butt!’

‘No I didn’t , I touched your shoulder.’

‘No, you touched my butt!’

‘No I didn’t, I touched your shoulder over here.’

The other girls who were playing tag, went up to the two of us.

‘Ken just touched me on the butt! Let’s go tell on him!’

I remember seeing the girls having angry/frowny facial expressions. I knew it meant angry/frowny coz I saw it in cartoons multiple times, and managed to associate it with the context. I didn’t understand WHY they were angry, even though I knew it was factually true that I touched her on the shoulder. 

They dobbed on me, and the teacher on recess duty told me that touching a girl’s butt is sexual assault, and for me not to do it again.

The next day, I wanted to play tag with them again, and they said I could join them. They made me ‘it’ at the start again.

I didn’t understand their intentions at the time. They made the game a little different.

‘This time because you run so fast, we’ll make you count to 10.’

‘Ok.’

               
I counted to 10, and ran after one of the girls hiding behind the school hall. I tapped her head.

               
‘I tagged you.’

               
‘You touched my butt! Didn’t Ms. Kogan tell you not to touch girls’ butts?!’

               
‘But I didn’t touch your butt, I touched your head. Your head is not your butt. Your butt is located down here.’

               
‘No, you touched my butt, and I’m telling on you.’

She told the other girls, followed by my class teacher, who already formed a negative impression of me, coz I was apparently smart but immature, and that I didn’t behave like a 5^th-grader.

He said to me ‘Ken, follow me into this room.’

The room was pleasantly dark, and he didn’t switch on the lights, but I didn’t know why.

He told me that the girls have reported multiple incidents of me touching their butts when playing tag and that it is illegal to touch that region, because it is sexual harassment, and in the adult world can be punishable by a jail term, and he use to work with juvenile criminals, many of whom have been convicted of sexual assault and rape. He said that what I did was wrong, and that he would give me several detentions, and physically segregated me from the rest of the females in the class for all activities, including computer skills, to think about my wrongdoings.

‘But I didn’t touch their butts.’

‘Yes you did, the girls said so.’

‘But I didn’t, they keep saying that when I touched their shoulder and heads.’

‘The girls have come up with the same story about you, so I’m inclined to believe them. You know what you did is wrong, and you are not going to get away with it.’

‘But I didn’t touch their butts, I didn’t actually touch their butts.’

‘Don’t lie to me Ken, I don’t want to set you up for failure when you become a grown up so you need to learn things now. See me after school at 3 PM.’

‘I really didn’t touch their butts, you don’t believe me.’

‘Stop talking about it. Now go back to Maths.’

All of my persistent claims of innocence were said with my usual flat affect and relatively monotone voice. At the time, I thought that because what occurred was factually true by my accounts, that I would be believable. But this wasn’t the case.

In retrospect, I realized that I was supposed to show facial expressions of anger, and be more vocal and eloquent about my innocence. I didn’t know what he knew, or the cause of incongruence between factual events and false accusations, which is related to the TOM deficit.

               
I didn’t know what sort of body language to show. And yet the girls were trusted coz they showed the typical facial expressions, body language and vocal tones of innocence and indignation. ‘HE TOUCHED ME HERE! HOW DARE HE!’

These girls can further fine-tune their manipulative/framing qualities over time, and could easily target an Aspie’s initial trustworthiness, and get him fired from jobs, arrested, or divorced (if married) with the settlement (+/- child custody) hugely in favour of her due to his apparent “abusive behaviour”.

I didn’t see the BIG PICTURE, that they didn’t want me to play with them, coz I was focusing on the DETAILS, such as counting to 10 instead of 3.

Of course, some Aspies may commit sexual harassment without realizing it, but that wasn’t the case in my situation.