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20

It’s May and I get to cry about my little brother turning 20.

31646765_10156283477410030_4157660885218754560_nI was in Cyprus 2 weeks ago and everywhere I went people talked about how good he is, how handsome, how they miss him and how much they love him. You might think that me writing this is what makes the difference but it’s not. It’s all of my family and how they raised him, how they treat him, how they flaunt him and how much they love him. He has become someone people want to know, and want to know more about.

I took over his room while I was visiting. He didn’t barge into his room to wake me up before 8am even though I could hear him being awake from 7am. He didn’t tell me to fold my clothes, or pick up stuff off the floor of his room, even though the rest of the house had to be spotless. When I couldn’t find the honey – he showed me where it was. When I wanted to drink one of his juices he kissed me and gently took the juice away. When I wanted to watch something, he let me even though it was his time to watch cartoons. When I wanted to watch a DVD he set a time for me and him to watch it together, even though he has this thing about not watching DVDs unless the stars align.  He let me bite off bits of his food even though Christos doesn’t share food. He let me pinch his cheeks and chin repeatedly despite his sensory overload.  When we said goodbye at the airport he hugged me for one second longer, because he knew I would ask for it anyway. He knows I’m a guest and he lets me be one. He has allowed me to float in and out of his life for 10 years.

10 years.

I asked mum if she thought he knew I was his sister or whether he thought I was some girl who showed up 10 days a year to annoy him. She said I was crazy.

But I have lived in a different country for half his life. Yes, there are many things I can say to myself to make it sound ok but right now I am just a girl in a foreign land waiting for him to have another birthday – from which I’ll be absent.

So, I write a blog post instead of a card, I ask mum for pictures instead of skyping and I try even harder to be better. I think of the years I was there and how I was a part of his smiles, his laughter, his crying, his bedtime rituals, his repetitiveness, his speech therapy, his tantrums, his education, his homework, his first steps, his first words, his transition, his moves, his development. And I want, with all of my being, for that to be enough and for him to know that I am his sister.

20 is the theme of May but I don’t know why and I don’t know how I’m gonna pull it off. Let’s figure it out together.

In other, less gloomy, news it was an eventful Autism Awareness Month this year. Here are some interesting reads in case you missed them:

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April 2018: 2 Science Headlines

1/ Social pressure

A drug is being tested which claims to help people on the autism spectrum with social skills. Balovaptan, said drug, acts on receptors. Receptors are located on the outside of cells and communicate commands to the inside of the cell. There receptors receive a hormone called vasopressin, which is a hormone from the brain which influences social behavior. Balovaptan is designed to block a receptor of a specific vasopressin, which might be linked to social anxiety says Larry Young, professor of psychiatry at Emory University. Basically, the brain sends vasopressin to cell receptors and some of these hormones affect social behaviour. This drug might be able to prevent the hormones affecting social anxiety. Behavioural “symptoms” of autism can be identified (but not limited to) as trouble in communication and interaction.

The idea of using drugs to change characteristics of people on the autism spectrum to “fit in” to a neurotypical society is worrying. That being said, it is important that such medication is available for the safety of the people that need them and for the mental well-being of the people that make the decision to take them.

We all have some form of social anxiety. Whether its tapping fingers, playing with your hair, flapping arms or other forms of stimming. People on the spectrum are under pressure to behave neurotypically to avoid bullying, rejection, discrimination – referred to as ‘masking’. This may be a solution for some but there’s a better one – it starts with ‘aware’ and ends with ‘ness’.

2/ Genes

Remember the MSSNG project which highlighted “an additional 18 gene variations linked to the development of ASD. Nature Neuroscience Journal, published a report on this project which found that the 18 newly-identified autism genes can be instrumental in understanding the pathways in the brain that affect how cells ‘talk’ to each other.” (The Biology of Autism)?

Remember the research published by Princeton University and Simons Foundation researchers where they analysed the human genome to try and predict which genes are likely to cause autism? They had linked about 2,500 genes to autism; we have an approximate total of 24,000. (Mr Autastic)

WELL: Researchers have found alterations of the gene thousand and one amino-acid kinase 2, known as TAOK2, which is so much fun to say out loud. The alterations found are thought to play a direct role in neurodevelopmental disorders, including autism.

Karun Singh, study co-author and researcher with McMaster’s Stem Cell and Cancer Research Institute said: “This is exciting because it focuses our research effort on the individual gene, saving us time and money as it will speed up the development of targeted therapeutics to this gene alone.”

img_6972Science is on its way to delivering answers to what causes autism. They are closer to finding out how to predict autism, and, as a result, closer to finding a way to prevent it. In the  meantime, it’s up to you to ask questions, to include to shatter stereotypes and to embrace the people around you.

 

 

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The “Normal” Cult

29830733_10156190751535030_853762012_oIt’s autism awareness week if you hadn’t noticed & I read this article on BBC about women on the spectrum – It all made sense when we found out we were autistic . These women are teachers, PhD candidates, artists, comedians, psychologists and they are inspiring (& autistic).

About 700,000 people in the UK are on the autism spectrum, according to the National Autistic Society. That’s approx 1.05% of the UK population.

In a one-hour special for Channel 4, tonight 28 March 2018, trainee human rights lawyer Georgia Harper and artist Sam Ahern, who both have autism, aim to uncover the true face of autism in the UK today. I hope you’ll be watching.

Autism awareness isn’t just about the future of autism, it’s also about the past and present. It’s about every person who feels they don’t “fit in”, all the times it feels like everyone else was given a manual on life, a ‘lost generation’ of thousands of adults going through life without a diagnosis. Autism awareness is about informing, spreading knowledge, sharing stories, finding new ways, and removing the stigma imposed by a system that doesn’t understand.

Autism awareness isn’t spread only by those living with autism. It’s a plague – a good plague. Awareness is born out of love, it spreads with our voices and makes an impact with our actions. It starts with sharing a story with another mum, or with children asking questions, with major airports introducing measures to help passengers with autism, shops introducing ‘autism hours’ and employers investing in autism training for staff. All the milestones we have witnessed in the world in the 5 years started with a voice.

The biggest obstacle to understanding autism is the expectation to look ‘normal’, the imposition of being ‘neurotypical’ and the social bullying that makes us dismiss and disable anything outside this fictional realm of “normal-ness”. We are programmed to treat anything different differently but what happens when you can’t see the difference? We grow up judging books by their covers and learn to condemn them when the cover doesn’t match what we thought should be inside. You ask someone,”Why is it weird if someone won’t make eye contact?”. Unless it’s a cultural trait, no one can think of an answer except a variation of “It’s not normal”.

You see someone and they look ‘normal’, they speak ‘normalish’, their lives seem ‘normal’ – they have a PhD, or a job or a family and they fit in your category of ‘normal’. As soon as you find out they are on the spectrum your perception shifts. You think, “how? why? really?”.

Autism awareness aims to infiltrate and destroy the ‘normal’ cult we subscribe to. It wants to shatter illusions of what we are supposed to do, it wants to expand our horizons and adds new words to our dictionaries. Just like all the once outcasts of this made up and exclusive society of “normal” the autism awareness movement is working. One in 100 people in the UK are diagnosed with ASD, teachers and police officers are trained, there are groundbreaking findings in ASD research and major channels invest money in documentaries, series and autistic actors/presenters (or muppets).

Autism is becoming a regular headline and it all starts with a voice. April is Autism Awareness day/week/month: here are some things you can do to help – Until everyone understands ; Wear Blue ; 30 things to do in April .

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Bru-mance

On 4th January 2016 I relocated to Brussels on a 3 month secondment. In those 3 months I made lifelong friends, we had lols for days, hangovers, a detox diet, so much pizza, I gained 10 kilos, launched an autism awareness project, took LPC exams and witnessed a terrorist attack.

I fell in love with Brussels because it’s such a weird place. You can find anything you want but it is organised chaos. You only have to walk around for 20 minutes and you are bound to go through european, residential, touristy, historic parts of the city. It’s a small town playing dress up as a big city.

On 22nd March 2016 I went to work super early because there was a lot going on. It wasn’t until 9am that I sat down, switched on my PC and looked at my phone which kept getting messaged and missed calls that a colleague said to me – there’s been an explosion at the airport. We knew a group of people from our institution that were travelling that day so we immediately began trying to contact them. It wasn’t until the second explosion hit the news that I stopped and thought that this was something I should worry about. We had colleagues stuck on trains and being diverted, colleagues trying to come back and others trying to leave because they had to get to their children. Our building was in lock down and we had to do inventory to figure out if we would be okay to stay the night. When we were finally allowed to leave, we walked through the city to our neighbourhood, it was such a sunny day. Three days of mourning followed.

I wasn’t scared that day. I couldn’t be scared because we were burdened with so much responsibility. In the weeks that followed, we retold the day’s events so many times and I always remember not being scared. I credit this to that one colleague who was my rock that day, and who stayed late with me when I offered to walk people home. I was scared that afternoon when I had to go buy enough supplies to get me through the next few days. I was scared when I locked the door to my flat and I was alone. For the next few days, every time I heard a police siren I checked the news. Two days after the attack a friend called to say there’s a march and we should go.

The Bourse was overflowing with people, flowers, candles, song, laughter and life.

I love Brussels because there’s surprise at every corner; you never know if the car will stop at the zebra crossing, or what kind of amazing cuisine you’ll uncover during a stroll.   love Brussels because their landmark is a small bronze sculpture of a naked boy urinating.

I love Brussels because it was were I started my autism awareness project for Christos’ 18 birthday (#Project324). It was from there that I asked the team if they wanted to be part of the project, it was there that the cards were printed, cut and mailed to 18 countries. I am so proud that my brother’s 18th birthday project is associated with the city of Brussels.

In a short 3 months, I loved, I lived, I drank, I ate, I campaigned, I advocated, I worked, I helped, I was scared, I was angry, I lolled, I studied, I cried, I learned, I got a pink elephant hat. Most importantly, I was inspired. On this day, two years ago 32 people died, hundreds were injured and millions were inspired. Millions around the world were inspired by the fearlessness of humans.

#jesuisbruxelles

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The Sri Lanka Diaries

Christos, Dad and I are in Sri Lanka for 13 days. Note that this is the first time Christos has travelled without my mum. The prospect of travelling with an autistic adult who towers over both his father and sister was daunting. However, the only restless Pereras were the neurotypical ones. Christos cruised through the airport security, the airplane, the food, the transit and the overnight flight.

He adjusted to life in Sri Lanka just like a true traveller. All he asks is what the schedule is for the day. At our number one hotel we had a suite, a pool and 3 buffets. The staff were curious about Christos and keen to help in any way possible. By day two, everyone knew who he was. They knew what breakfast he liked and what ice cream he preferred. They even learned that ‘Efharisto’ means ‘thank you’ in Greek. Christos has no reservations when it comes to being in Amaya Lake. Even though it’s been 7 years since he last visited, he remembers it as if he has been there this whole time. His memory is impeccable.

The way of life, the culture is the first thing you notice when you get off the plane. Everyone is smiling, everyone wants to talk, help, and everyone stares. I can speak for Cypriots and Brits when I say that staring is not ‘polite’ and not encouraged. However, here it’s unavoidable. Staring here is not malicious because if you have an issue with someone you will sort it out immediately. Staring is education. It’s a revelation how little it bothers us here in comparison to Europe. The chasm between these two continents is evident in its people.

We talk about how lucky we are with Christo every day. There are families that can’t even dream about a vacation with autism. Yet, here we are. Talking to people who don’t know the word and explaining to them what this spectrum is all about. We are literally walking, talking, breathing awareness. Just by walking in a room Christos captures their attention, he evokes questions and he bestows new knowledge. This information will be talked about with friends, with family, and it will change someone’s life; maybe not here, maybe not now but one day.

I’ll go into the details of this adventure in later posts. For now, let me just remind you to respect and understand each other. We are only here for a limited time, and in that time we can make wonders happen. Remember that you may be the missing piece to a puzzle we all want solved.

Happy Holidays from the Pereras.

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The A word – Acting

Image result for travis smith the a word

Episode 1 of Season 2 introduced us to Mark. He is cast as the son of one of the mums in the autism support group that Joe’s parents attend. He holds his plate and tea and stands in the background while mum has a conversation. You can’t miss him, even in the background, his TV mum jokingly mentions that he’s 6ft3. He doesn’t sit until his mum asks him to sit down and tells him exactly what they will do; he will sit and have his tea while mum has a conversation and then they will get on the bus and go home. He repeats this back to her.

For a lot of people this interaction will mean nothing. For me, this interaction is why I will be watching The A word again tonight. That moment is our entire life with Christos. Telling him what the plan is, every hour is accounted for. It started with pictures (Picture Exchange Communication System) on a board, then printed out schedules on the fridge, and finally it became a conversation. I remember my mum putting together this schedule for him every night; at 6.30am we wake up, at 6.40 you brush your teeth, at 6.45 we get dressed, at 7.00 we drink tea and at 7.15 we get in the car to go to school.

image (17)We used to have the whole week planned out and changing the plan was a nightmare. As his speech therapy progressed we put pictures and words together and formed sentences which he had to say before he got what he wanted. I found some examples which you can see in this picture. Once he familiarised himself with all the pictures and the sounds, he didn’t need them anymore. He could form sentences all by himself and name anything in the house. Now he has a weekly plan. He knows months off by heart and has a sense of how far away or close they are. So, for example, when I will visit again, or when he’s going to start going to the beach, which days he stays with my mum or dad and which days he goes to my grandparents etc.
Travis Smith, who portrays Mark, is an actor with autism and this episode was his acting debut. Travis is working at ABLE Radio through an initiative which aims to boost the employment prospects of 1000 young people with a learning disability and/or autism. Engage to Change. He secured the ABLE Radio placement which has been helping him develop his skills, and is working towards realising his dream of acting and singing for a living. “There is nothing else that matters when I am acting,” Travis says. “Just before I do it, I am petrified but, once I am singing or acting, I lose myself.”
Joe is not the kind of autism I grew up with, but Mark is. A gentle giant that is shy and loves a plan. I feel that we will be seeing more of Mark as the show goes on, and I hope that we will see many more representations of autism. When you watch tonight’s episode of The A Word (BBC One at 9pm GMT) look at the details, don’t just listen to the words. Notice the hidden looks, the things parents do that look like routine to them but aren’t routine for you. Look out for Mark and you might see a bit of Christos in him too. It is breathtaking to get to witness a young adult with autism do what he loves. It is inspiring to watch Travis break free from the stereotypes of what people on the spectrum can and cannot do.

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Christos’ dental journey

I recently got a message from Christos’ dentist, Ioanna, to tell me about his most recent visit and the progress he has made. I also wrote about one of his visits in 2015 – Back to the Dentist. I asked Ioanna if she would be willing to contribute to this blog and here is the result.

My first encounter with autism was 15 years ago when Christos was referred to me by his family dentist. He was the first child on the autism spectrum I had in my private practice as a young pediatric dentist. I knew nothing – as I realised later – about autism, but Christos inspired me to get involved and learn as much as I could.

And that’s how I was introduced to the world of autism. I am so lucky to have had the best guides! Unique Christos and his special family!

He was only 4 1/2 years old when I met him. His dental problems, the behavioral restrictions due to his young age and the difficulties due to autism made it easy to choose a full dental treatment under general anesthesia. The first goal was achieved. Our next goals – and most difficult ones! – were helping Christos brush and have good oral health as well as gaining his trust and cooperation for the frequent dental visits over the upcoming years.


Dental treatment doesn’t differentiate between people on the autism spectrum and other patients. Rather we have to be aware of behaviour management and accommodate the needs of the patient. This is a real challenge! Sensory disorders make it even more difficult. What I’ve learned, in the last 15 years, is that I have to be armed with patience, understanding, persistence, flexibility, creativity and love when I work with people on the autism spectrum…and with people in general!

In the beginning, I used to see Christos every 2-3 months. This was to help him become familiar with the dental office and, of course, with myself. I could see how hard it was for him to adjust and take in all those new things; smells, lights, doors, drawers!!!!  I must admit, it was hard for me too. I had to interpret his behaviour and the only reason I managed to do it was because of the great help of his parents. I felt them to be some kind of translation between me and my patient!

It took Christos 3 visits to finally sit on the dental chair and open his mouth. I tried to teach him and his parents how to brush. His mum and dad were so brave to fight that battle at home! (I think Dora described it once in one of her articles – Thinking about the things you don’t think about: b) Attack of the Toothbrush). You can see why brushing can be a real struggle for people on the autism spectrum! After that we managed to put some fluoride varnish – that’s one with the strange taste! – on his teeth! 2 1/2 years later we managed to do the fissure sealants on his newly erupted first permanent teeth! That meant that he would have to sit for a significantly longer period of time with his mouth open, tasting too many strange things with odd tastes and feeling all the weird textures. But we made it!

A moment I won’t forget is when I got a phone call from Christos’ dad one weekend. He was so happy and proud that Christos said my name while showing his moving tooth!!! This was Christos’ way of explaining that something was going on with his tooth and it was his dentist’s job to take care of it. It was another milestone in his personal progress and I was so excited and happy for him!

Another memory I have is of how anxious I was when we decided to extract two teeth to make space for the new ones. We needed to make sure the teeth settled and were arranged well as it wouldn’t be possible for Christos to have braces. I had to give him local anesthesia with an injection. However, once again Christos surprised me. He acted like it wasn’t a big deal at all! His parents and I were so relieved and so proud of him!

Step by step, Christos knew he had to accept and follow my rules; but I also had to follow his! I couldn’t break some of his routines. I had to accept and try to understand many strange (to me) behaviors and obsessiveness, especially at the start. For example, he wanted to drink water immediately after the fluoride application and throw the plastic cup in the dustbin. During every appointment I would try to convince him not to do that and …guess what? We made it last time!!! After 15 years!!! What did Christos teach me? Never give up on my goals! Keep trying!

His last visit also came with some very interesting parts. Christos took on the role of a role model for another special boy! The boy who had the appointment before Christos came back into the room when he saw him entering my office. I asked for Christos’ permission first but he didn’t look bothered by this other new person in the room. From Christos, this is a permission! If he didn’t want someone there, he would make it very clear! At the end of our appointment, I asked Christos’ mum if we could take a photo to send it to his sister with his progress. To my surprise, she had already done it!!! Not only that, but after the appointment I also got a warm sms from Christos’ dad! The people around him are so sharing, so loving and so alert.


A couple of years ago, I was part of an internet conversation with colleagues from other parts of the world to share useful experiences and knowledge about autism and dental treatment. I got a message from one of them saying “You don’t want autistic patients!” His words shocked me. I thought about my long journey and realised how valuable it was for my career, my personality, my view about people and life to meet Christos.

One of the interesting parts of my job – and it’s one of them that I love! – is that I can follow the changes in the life of my young patients and their families. It’s amazing! I had the chance to see Christos growing, starting to talk, improving his communication skills, being happy after his trips to meet his sister, being a teenager with a big change in his behaviour and becoming an adult. His family shared some of their worries, some of their endless efforts to give support to their hero, some of their philosophy about life with me.

Christos gave me the first piece of the autism puzzle and it is a precious one! I want to really thank him for it!

Thank you Ioanna for your words. But mostly, thank you for your patience, kindness and love over the time my family has known you. I can only say that I hope you are a role model to your colleagues in the same way that you are an inspiration to those around you.

PS: The green thing Christo is holding in the photo is a mirror so he can watch exactly what Ioanna is doing. Did someone say control-freak?