4

Evaluating Kai

The doctor studied her.

“Maybe your son isn’t the one with the problem,” he said.

“Maybe it’s you.”

Some diseases take hold suddenly. A flu or a virus, a sore throat or stomachache strikes you down, and you feel miserable. But those are rarely the worst ailments.

Other diseases creep up on you. Terrible ones: cancer and heart disease. They also seem to appear out of the blue, but if you’re vigilant and lucky, you can catch them early. They have precursors: tumors that grow, blood vessels that clog. They can be screened for or felt by a doctor’s knowing hands.

Afflictions of the mind creep up on you even more insidiously. One cannot screen for them or palpate to find them. They remain invisible long after they’ve developed. They come disguised as a quirk, a tic, or a minor discontent. No one worries when you wash your hands a bit too much, until it proves to be compulsive. No one is alarmed when you’re sad, until it turns out to be depression. Everyone laughs when you lose your keys again, until one day you no longer find your way home. These invisible, incomprehensible illnesses are, in some ways, the worst.

Kai’s autism sneaked into their lives so quietly and subtly that even Henry, the neuroscientist, and Anat, his vigilant wife, didn’t recognize the severity of what was happening to their son. None of the doctors they consulted set them on the right track. They all saw individual symptoms, never the full disorder. They saw puzzle pieces rather than the big picture.

Kai’s stunted speech was the first thing that worried them. He was three years old when they settled in Rehovot, yet he hardly spoke. This was counterintuitive because Kai was more outgoing than anyone else in the family. Unfortunately, he still communicated almost exclusively with his hands. People didn’t understand that very well, and Kai’s attempts at reaching out grew ever more frustrating. Try as he might, he either got no response or a deeply unsatisfying one. His face contorted. He was inconsolable.

“Maybe it’s because you speak English to Kai and your wife speaks Hebrew,” one doctor said.

What nonsense, Henry thought.

They started looking for a therapist. They went to one, then another, then a third, but Kai, otherwise happy and friendly, couldn’t stand any of them. He looked at the men in their white coats and fell silent or just walked out of the room. Finally, they found a doctor he liked, who was willing to treat him. She practiced words and sentences with Kai, and his tongue started moving, even if he still garbled syllables. Here we go, Henry thought.

Language delay is a sign of autism, but no one considered that possibility.

Kai started covering his ears. His family took him to the movies to see The Little Mermaid, but Kai blocked out the noise and wanted to leave immediately. The next time, he refused to go altogether. “That doesn’t mean anything,” said the doctors. “He’s just a bit sensitive.”

He was clumsy too. Kai stumbled more often than either of his sisters had at his age. He climbed up a bookshelf and tumbled off backwards. He ran through a windowpane, blood spewing everywhere, and had to get stitches. Again and again, he scratched the scar open. Here, too, the doctors might have noticed something. Motor difficulties, compulsive behavior—but they said nothing.

Anat wouldn’t be deterred. She knew it from the beginning. His eyes!

She visited countless doctors with Kai. The recurring question: What brings you to me? The recurring answer: There’s something wrong with his eyes. The doctors shone their flashlights into Kai’s eyeballs and studied them with microscopic glasses. They measured the distance between his pupils, the pressure on his eyeballs. They used drops and mirrors, but in the end, they would always say, “Nothing’s wrong.” One doctor had Kai undergo an MRI, sedating him so he would lie quietly. The verdict: All good. Autism reveals itself in the eyes—affected babies often look only out of the corner of their eyes, as their pupils respond more slowly to light—but the doctor hadn’t figured that out. When Anat insisted, the doctor studied her. “Maybe your son isn’t the one with the problem. Maybe it’s you.”

“What do you know?” Anat huffed. “You’ve got your books. I have my motherly instincts. I know my child better than anyone.”

In retrospect, that’s the big lesson she drew from that time: “Other mothers often ask me what to do. The first thing I tell them is, Trust your intuition. You probably know better, even if you don’t have the words to express it. Young parents, especially, hesitate to trust their feelings. They do research online, in books. And if a doctor tells them everything is fine, they believe it, because a doctor is supposed to know. But that isn’t always the case. Parents have their own perspective, and it’s important. I tell them: listen to your feelings, until you find a doctor who really knows better.”

Anat gave up on regular doctors. She brought Kai to a world-famous practitioner of Chinese medicine who was visiting the Weizmann Institute. “Well-observed,” the woman said. “Something is wrong.” Anat’s heart skipped a beat. “I can’t do anything for Kai,” the doctor said. “But I know a colleague in China, a real master. He specializes in patients like Kai. He sticks little needles into the patient that have to stay there for hours.”

Anat felt a surge of hope. The professor wanted to try inserting a few needles herself. Kai fidgeted, couldn’t sit still. “Is he always like this?” the doctor asked.

“Yes,” Anat admitted. “After two days in kindergarten, they wanted to kick him out because they needed one teacher just to keep up with him.”

“If that’s really the case,” said the doctor, “even the master can’t do anything for him.”

Kai’s urge to move, his constant running, jumping, climbing, was overwhelming. He couldn’t remain on task. There wasn’t much that could hold his interest. He built LEGO towers, looked for buttons on electric tools. Technology fascinated him, in particular the vacuum cleaner, but even that couldn’t keep his attention for long. He was constantly in motion, en route to look at something, fetch something, hug someone, talk to the person, run away again. It was so obvious that something was wrong. Even the neighbors asked if they had taken him to see a psychologist.

It took them awhile to get that coveted appointment with one of Israel’s best-known child psychologists. Henry already had a diagnosis in mind but didn’t want to intervene in the process. The best doctor should look at Kai. He would identify what was going on. Soon Kai would be talking like the other children, learning patience, finding calm.

The psychologist sat before them with a look that reflected his sense of importance. Anat told him she had had mixed experiences with doctors. The doctor raised his eyebrows and took a book off the shelf. “I have written a couple of books, standard works. You can find them in every medical student’s room.” He inscribed it and handed it to Anat. “How can I help you?”

Language delay, huh? Well, well.

Can’t sit still? Well, well.

Runs up to strangers and hugs them? Well, well.

Loves technology? Well, well.

Touches everything that lights up? Well, well.

Who have you seen so far?

Oh, a bioenergetic therapist? Well, well. And he said that Kai recognizes complex geometric structures? Well . . .

He studied Kai. “He actually seems a bit stunted to me. Younger than his age. Anyway, let’s give it a shot.”

He sat Kai down at a table and laid out pictures before him. Kai had invented a new game over the past few weeks. He would stare at adults long and hard. That made them all jittery.

The doctor showed him one picture after another.

Point to red please.

Point to the circle.

Point to the carrot.

How many corners does the hat have?

Please place the triangle on the picture of the triangle.

Kai returned to his favorite pastime. He took the triangle, settled his gaze on the doctor, and just waited. He waited for a reaction, a surprised look, an impatient gesture, an admonishing sentence. But the doctor didn’t do him that favor. He didn’t say or do anything. If he glanced over at Kai, it was only cursorily. Not getting any reaction, Kai turned the game up a notch. He moved the triangle very slowly and placed it intentionally in the wrong place, in the hope of eliciting a furrowed brow, a reprimand, anything whatsoever. Kai was focusing on the doctor rather than the task. But the old man hardly looked up from his notepad. He monitored Kai’s activity only from the corner of his eye, over his glasses. The only thing that interested him was whether Kai placed one triangle on another, and how long it took him.

So, you think you can evaluate Kai? Anat thought. He’s evaluating you.

“The matter is simple,” the doctor said, after inviting Henry and Anat into his meeting room. “Kai has attention deficit disorder. You know what that is?”

“Yes,” Henry said. ADHD. The brain’s frontal lobe has trouble filtering out unimportant stimuli. The child is overwhelmed, and has trouble staying on task.

This is what Henry had suspected. He had already researched how people feel when they suffer from ADHD. They never find any peace of mind. They feel like banging their head against a wall. They can’t help but run and jump around.

“I’ve also concluded that Kai’s development is stunted,” the doctor declared. “His language capabilities, his motor functions, but also his intellectual and emotional development are a good year behind. He is functioning on the level of a three-year-old.”

“And what do you suggest we do?” Henry asked.

“We are talking about a mild case, so medical treatment won’t be necessary.”

No Ritalin, then. Henry was relieved to hear this. Ritalin can certainly help, but it can be bad for a growing body.

“I recommend taking Kai out of kindergarten and sending him to a preschool for special needs children.”

“Will I have to change kindergartens?” Kai asked on the drive home.

“No,” Henry said.

A special needs school could be helpful, but Kai would feel stigmatized. Attending a special needs school makes it hard to ever return into the “normal” system. Anyway, mild ADHD wasn’t such a big deal. Every class has someone with ADHD in it. Didn’t Albert Einstein have it, too? Henry himself was a bit fidgety, compulsive.

“Kai got a lot from me,” Henry says. “When I wake up, I am instantly at top speed. Our girls woke up very slowly by comparison. I’m instantly on. Kai was like that too. He wasn’t afraid of anything. When I said, ‘Kai, let’s do this or that,’ he would jump up, instantly on fire—he had this incredible energy. I was happy to finally have someone who said, ‘Yes, let’s do this. Let’s conquer everything.’”

Henry laid out his parental strategy accordingly. If Kai was bursting with curiosity, needed to move, then they wouldn’t slow him down—they would encourage him. They would show him what he wanted to see, teach him what he wanted to know. Take off, conquer, discover the world: It would be so wonderful. He had no idea how much this would harm Kai.