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Autism Case 1: Donald Triplett

Neurology Research
By Ronit Molko, Ph.D., BCBA-D

Donald Triplett was born in 1933 to Mary and Beamon Triplett in Forest, Mississippi. At that time, no one had ever identified the behaviors he exhibited as an infant and toddler. The Tripletts understood that their son was encyclopedic in certain areas but emotionally distant and violently opposed to minute changes in his daily routines. A year after institutionalizing Donald on their doctor’s advice, the Tripletts made the monumental decision to bring their four-year-old son back home. It was a decision that changed his life — and put him on the path to helping revolutionize our understanding of autism.

The Tripletts brought their son to renowned child psychiatrist Leo Kanner at Johns Hopkins. Kanner had seen other children with similar symptoms — children mesmerized by things and numbers but disconnected from people. Donald joined Kanner’s study of 11 children with, what he called, “autistic disturbances of affective contact.”

He labeled Donald “Case 1.” Donald Triplett is still autism case 1 today, at the age of 85, a testament to the dual powers of science and love.

The story in between is a remarkable journey of failure and ultimate triumph. Advantaged by a wealthy family and a supportive, tight-knit hometown, Donald has lived a happy life, learning to care for himself in the house in which he grew up. He graduated from high school and college and works at the bank his family owns. He has traveled the world and learned to show interest in others, even if it’s in his own quirky ways.

The road to acceptance and understanding for children with autism has been bumpy and winding. The 30s and 40s were the heyday of eugenics, which called for the sterilization — or worse — of people with mental disabilities and often led to institutionalization. Early researchers, including Kanner, blamed mothers for withholding affection. In the 90s, vaccinations were erroneously linked to autism, sparking widespread fear in parents — a fear that lingers with parents to this day.

Even today, the care and education of individuals on the autism spectrum remains inconsistent and fragmented. People employ methods designed to achieve outcomes that don’t always reflect real-world needs or apply to managing adulthood successfully. Most autism services end at age 18, leaving many adults isolated and unable to participate in society.

The case of Donald Triplett, Case 1, demonstrates that successful integration into society is possible through awareness, accommodation, and acceptance from the community. Of equal importance is an education focused on the skills needed for success in adulthood. It is instructive that Donald was taught to drive, but not until age 27, long after education ends for most people with autism.

Though Donald Triplett may have been the first recognized case of autism, the care and support of his family and his community is strikingly modern — a model for all the children who have followed him.

The Social Intelligence of Autistic Individuals, Part 1

Selfie Of Young Smiling Teenagers Having Fun Together. Best Frie

If a perfectly intelligent American were to find themselves catapulted into a foreign world with its own traditions, customs, culture and language, all totally unfamiliar to the person transported there, it would not be surprising for the people of this world to consider their visitor unintelligent, viewing intellect through the narrow lens of their own experiences.

Not only would our American visitor be unable to communicate verbally, but he or she also would not be particularly adept socially, unfamiliar as they would be with the cultural norms of this utterly alien place.

There is a certain analogy here with individuals along the autism spectrum. In my recent interview with Dr. Sue Fletcher-Watson, a developmental psychologist at the University of Edinburgh, she noted we often evaluate intelligence via a test that measures only very specific functions that don’t play to the strengths of those on the spectrum. But how would we view people with autism differently if we employed autistic-centric criteria?

Fletcher-Watson and her team of researchers conducted experiments using a familiar tool – the game of telephone, where a story is passed orally from one person to another down a chain of people until it hardly resembles the original story. This is called a diffusion chain and the rate of degradation in the story is fairly predictable.

The researchers conducted this experiment with a group of neurotypical subjects and with a group of autistic subjects and the rate of message degradation was the same for the two groups. But something very different occurred when the neurotypical and autistic individuals were mixed. The story degraded at a much faster rate.

For autistic individuals, “the issue is not that they don’t have social skills. It’s more that there’s a mismatch between their style of sociality, and the style of the kind of neurotypical majority,” Fletcher-Watson told me.

Another issue that those with autism face is the inadequacy of average. A neurotypical person with average intelligence is simply viewed as average, just an ordinary person with friends and loved ones, weaknesses and strengths.

Because people with autism are often stigmatized as anti-social savants, those lacking the savant element are simply stigmatized as anti-social, when in fact, they have much more in common with ordinary people of average intelligence.

In fact, high-functioning, highly-verbal autistic individuals are in some ways the most debilitated. Autistic individuals who can navigate the intellectual world but come unglued in overwhelming sensory environments might score high on an IQ test but would have difficulty navigating life without support. Indeed, highly verbal adults with autism have a suicide rate eight times the average for neuro-typical adults.

When we take an asset-based approach and focus on the strengths of autistic people and their ability to function on their terms, we give them a much greater opportunity to succeed.

“I know a man who doesn’t speak. He’s in his 30s. He doesn’t read or write, but he owns his own sandwich-making business,” Fletcher-Watson told me. “Everyone buys those sandwiches from him for lunch, and he makes a good living, and obviously he has someone to help him with the paperwork.”

“But, you know… he passes his hygiene inspections because he’s very good at following rules.”


You can read further on this topic and more in my book, Autism MattersAnd make sure to connect with Dr. Sue Fletcher-Watson for more of her expert insights and updates on her work!