Often I am asked by families how they should tell their child diagnosed with ASD difficult news. Sometimes, as in this episode, the news is about illness. Other times, it is about divorce, death, a move, financial problems or some other difficulty. It has been my experience that presenting information in an age-appropriate, factual manner is the best way to help children diagnosed with ASD cope with whatever is happening.

People diagnosed with ASD struggle with what is called a "theory of mind." Simply put, and believe me it is really much more than this, a theory of mind is the ability to place one's self in another's shoes. In working with kids on the spectrum, I have noticed that they are not able to think of themselves (or their emotions) as a person in the future. In other words, their future self is another person, another mind, so to speak, and that self in the future is as much a mystery to them as anyone else. Facts, then, are needed by people with ASD to anticipate what is going to happen so that they can be as ready as possible to meet the events emotionally. They need things to be as predictable as possible. I have learned that this approach seems to help them avoid being overwhelmed and shutting down or acting out emotionally.

In this episode, Max has clearly decided to educate himself on breast cancer and what to expect. This is his way of protecting himself from the fear of his mother's illness. He can't really know how she may feel - or how he may feel - as her disease and treatment progress. But he can be armed with the facts, and the facts make more sense to him than emotions. This is in clear contrast with Amber, who is operating on a more emotional level in this episode. She wants and needs emotional reassurance and is less focused on the "facts" of the situation; in fact, she doesn't even learn about Kristina's cancer until it is revealed by Max.

Does this mean Max doesn't really care about his mother? I don't believe so. I do believe the caring is different from that experienced by people not diagnosed with autism. From observing interactions and listening to people on the spectrum, I get the sense that the caring is, to a great degree, about how the situation or incident will affect them. Not that this is much different from most of us not on the spectrum; this sense of "what is this going to do to me" is always part of any emotions felt during difficult situations. However, those without ASD also have the sense of how the other person might be feeling, and this colors our emotional state. I don't think that is true for people diagnosed with autism.

What Max is doing is giving his mother information, so she can make good decisions. He is letting her know that if she is hurt that will not be good for him, because she is important to him. It doesn't matter how he conceptualizes that importance. It is enough for his parents to know that she is important to him and that importance is a kind of caring. It may not be that he "feels" for his mother and her pain and fear, but he is aware that she is important to him and that he needs her. For most parents, that is more than enough.

Written by Roy Q. Sanders, M.D.

To learn more about breast cancer, visit the CDC's Basic Information about Breast Cancer page.