Free Carly’s Voice by Arthur Fleischmann

frenetic-like activity. She has developed some compulsions
     including touching things and tapping people on the head. She is unable to sit still
     and is in constant motion. She has an increase in stereotypic and repetitive behavior
     including grinding her teeth, increased sensitivity to noise, increased self-injurious
     behavior including head-banging . . . she has also experienced some emotional liability
     manifested by crying for thirty minutes to one hour at a time. There is more restlessness
     and she has developed significant foraging behavior. She will often rummage through
     the kitchen looking for food or iffood is out anywhere, she will go through the boxes looking for different items. She
     does eat some of this food, but really it is more the looking around for food that
     is problematic as opposed to overeating.
FORMULATION
    We had a long discussion with Carly’s parents regarding which were the most important
     target symptoms at the moment. We agreed that her repetitive behaviors and increased
     restlessness and activity were the most concerning . . . we have recommended the decrease
     in the dose of Luvox . . . we discussed the use of two other medications . . .
    From Carly’s eighth to tenth years, her education once again became a frayed patchwork
     of in-class and homeschooling. Howard needed time off during the day to complete additional
     college courses and was only able to work with Carly in the afternoons and weekends.
     A fight ensued with the school board over who would take over his job with Carly at
     Crestwood Heights. Our position was that a suitably trained ABA therapist was critical;
     ideally, someone that we selected and trained. The board’s position was based on union
     seniority, and they thought that a thirty-five-year-old male accounting clerk who
     worked in the school system and wanted to work in the classroom was an appropriate
     choice. The winds that had blown favorably for the previous two years had clearly
     changed direction.
    Tammy called to complain that Carly required ABA to learn and that putting her in
     a classroom for developmentally handicapped children with an untrained worker was
     negligent, if not criminal. “We have written reports from Carly’s psychologist and
     developmental pediatrician stating that she requires ABA to learn new skills,” she
     told the school superintendent. He resisted, claiming that ABA was the “flavor of
     the month” in treatment of autism andthat Tammy had no right to interfere with the implementation of special education
     in the Toronto District School Board. “You do not get to determine how we teach children,”
     he said, and hung up.
    A series of pointless emails of escalating anger followed. As we sunk deeper into
     the bureaucratic quicksand, I decided to call the board directly and set up a face-to-face
     meeting. We agreed that Tammy wouldn’t attend and that we’d try a good-cop/bad-cop
     approach. Tammy had already declared which one she was and carried a grudge as a form
     of exercise. I could at least fake tolerance.
    I was led to a small conference room in the sprawling maze of cubicles and offices
     at the board of education. I gathered my thoughts and channeled calmness as I prepared
     to explain that their staffing plan was a misguided idea and would not be in Carly’s
     best interests.
    The superintendent did not attend, instead sending one of his direct reports. A woman
     in her late forties entered.
    After a few pleasantries, I came right to the point. “Carly has been making real progress,”
     I said, hoping that a positive start would ease the conversation. Keep it all about
     the student, I reasoned. “I’m sure we all want what’s best for her. Tammy, our doctors,
     and I just don’t think it’s best for her to have someone without the right training.
     Kids with autism need the stability of routine, and her ABA program is her routine,”
     I pointed out.
    “Union rules are unequivocal,” she