Do I see non-speaking autistic patients?

When parents call my practice to inquire if they can schedule an appointment for their child, there’s a common question I receive.

“We’re sorry to ask this, and it’s kind of embarrassing. Do you see non-speaking autistic children?”

I’m always puzzled by this question because of the line that usually follows it...

“We’ve been unable to find a psychiatrist who will see them because they are non-speaking.”

My surprise likely springs from the personal experiences I’ve had in my own family. Finding alternative ways to communicate with a non-speaking person is all I’ve known since I was a small child. 

SIBLING SUPPORT

My younger brother, Andy, was diagnosed with autism when he was two years old. We were only one year apart. And we weren’t just close in age – we had a strong bond. As we grew up together, I became his communicator, interpreter, playmate and advocate. 

Andy spoke minimally for much of his childhood and young adolescence. His difficulties were compounded by verbal apraxia, a motor speech disorder that causes the person afflicted to struggle with saying sounds correctly. 

Despite this supposed obstacle, I never had a hard time communicating with Andy. I always knew that despite the alternative methods he used to transmit messages to me, it didn’t mean he had little to say. Far from it. We forged a rich and rewarding sibling relationship that was nuanced, loving, and based on mutual understanding. Non-speaking does not mean non-thinking or non-feeling.

KID INTERPRETER 

Along with his speech difficulties, Andy suffered from sensory issues and was an extremely picky eater. It was hard for my parents to understand what he wanted to eat. I was around him so much that I would step in and say, “Oh, he wants this kind of ice cream,” or “He’s asking for this kind of chicken nuggets.” Andy would smile. He saw me as more than just his sister – I was also his best friend and he was mine.

As Andy developed and grew, it never occurred to me that if he needed to see a doctor, they wouldn't treat him because of his limited speech.

DOCTOR DETECTIVE

When I went to medical school and became more entrenched in the world of academia, I learned there is almost no formal training for doctors when it comes to communicating with non-speaking autistic patients. Over the years, I’ve come to realize how fortunate I am for the early experiences I enjoyed with my brother Andy. It gave me the deep background and tools I needed to work with a wide range of communication styles in autism. 

Many doctors won’t see these patients. Their reluctance is rooted in their own anxieties. They don’t feel capable of communicating with nonspeaking patients, so it is easier to turn them away. 

It’s true that it takes some good doctor detective work to figure out what is going on when the patient can’t tell you. It also requires an intuitive ability to connect, empathize and recognize someone’s personhood even when they don’t speak verbally. But there are many ways to understand the needs of a patient, including speaking with their families and getting teacher feedback. We can also use visual symptom checkers, art therapy, and augmentative and alternative communication (AAC).