COMMENTARY

Vocal Cord Operation on Constantly Screaming Autistic Teen?

Arthur L. Caplan, PhD

Disclosures

November 04, 2013

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Hi. I am Art Caplan from the Division of Medical Ethics at the NYU Langone Medical Center.

What if you had a child who screamed at the top of his lungs 1000 times or more a day? What would you do to maintain your own sanity, to be able to take that child out, to enable that child to interact with other kids, and to keep some semblance of peace in the home for your children?

A Wisconsin family faced this dilemma recently. Their twin teenaged sons suffer from autism, and one of them, Cade, began yelling and screaming at the top of his lungs a few years ago, 1000 times a day or more. It is not clear that he is yelling or screaming because something is bothering him. He seems to do it in many different environments.

His parents and his doctor have speculated that he does it because he is obsessed with or compulsive about the sound. He hears it, he likes it, he does it more, and, as sometimes happens with people with autism, he is taken with hearing that huge noise and does it again and again because it is rewarding to him. So it is not as if he is in pain or suffering from something.

Efforts to change the behavior, such as rewarding him for not screaming, did not work. He seems compelled to do this screaming. His twin brother, who does not do this, clearly is made anxious and nervous by the screaming. The parents find it impossible to take the boys out anywhere because the screaming is obviously disruptive to any social setting, and it is not good socially for Cade himself, because who wants their own teen hanging out with someone who is screaming all the time?

The parents finally decided to handle the screaming problem by submitting their son to surgery. An opening was made in Cade's vocal chords; they were widened a bit so that the air moving through had a bigger space to rush through, which reduced and softened the sound of his screaming. He still likes to yell, but he cannot yell nearly as loudly, and it is not disruptive and bothersome to others. In fact, after the operation Cade seems less interested in yelling. It appears that some of the behavior was motivated by the huge volume of sound, so he seems to be doing it a lot less, he is quieter, and the environment for his brother and his parents is much more livable. Still, this operation drew criticism.

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