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How NOT to Raise a Social Pariah

Social skills classes started as a way to treat serious problems like autism. Now nearly every affluent parent in town with an unpopular kid is scrambling to sign up. Is the Bay Area overreacting-or just ahead of the curve?

Looking at my friend Helen Carter*, a gregarious, svelte physician with a comfortable home in the city's desirable 94118 ZIP code, I find it hard to believe her claim that she was ever "a fat kid with glasses" who wasn't invited to birthday parties at her small private girls' school back East.
B­ut in junior high, in a makeover I used to think was possible only in teen films, she sensed instinctively why kids weren't responding well to her, went on a diet supervised by her mom, and blossomed into a thin, articulate extrovert. By ninth grade she was elected to Student Council; she attributes her high marks on med school evaluations to her popularity and ability to connect with patients. "I am way up the Richter scale on being comfortable with people in any situation," Helen says matter-of-factly. Before they had kids, she and her husband, who is retired from a marketing position at a financial firm, agreed in discussions on child rearing that emotional intelligence—the ability to identify your own feelings and consider other people's—was a key factor in how well people do in life. Though academics would be important in their kids' upbringing, they vowed that they'd emphasize social success just as much.

Only fate threw them a curveball. Instead of raising a sandbox superstar, the Carters found that their first child, Jackie*, a languid, slightly awkward girl with curly brown hair, stood out for the wrong reasons. Her eyes wandered, and she wouldn't look at people directly. To me, she seemed artistic but spacey. Both her parents and teachers observed that she moved to a slower beat than the other kids did. By the time she figured out what her peers were playing, the group had moved on. Jackie regularly barged into groups, pissing off the other kids, who in turn rejected her. When she was five, another child jumped her during circle time. "It seemed ironic that our kid was flunking with a big F in the EQ department," Helen says.

She reacted the way many well-off parents here would have, spending thousands of dollars on tests and evaluations, including an MRI that showed part of Jackie's brain was underdeveloped. The finding was deemed "incidental," and a diagnosis proved elusive. Thankfully, Jackie didn't have autism, a diagnosis given to kids who can't fully communicate and connect with others, which has more than quintupled in frequency in California in the past decade. Still, the worried Carters paid for Jackie to undergo a round of therapies at California Pacific Medical Center (CPMC), just off Laurel Village and near the Carters' home. Nothing seemed to help her socially. Then one day before Sunday school, the five-year-old asked, "Why don't kids like me?" Her mom was weeping inside.

Looking for answers, she came across a book by UCLA psychologist Fred Frankel, Good Friends Are Hard to Find. Frankel's theories on the importance of friends to a child's development and future success resonated strongly with Helen. She sought out CPMC's "social skills" groups, a new therapy originally designed for kids with autism that's rapidly being adapted to help children like Jackie, who don't have a diagnosis but still have trouble fitting in with their peers. Some of these classes set as a goal making friends in the outside world; others focus on helping kids find a friend within their social skills group. The idea is to catch kids' social problems and—with no side effects, and at relatively low cost—"fix" them early. According to Frankel, social acceptance for children is usually established by second grade. Absent any therapy, he says, "kids who are rejected at age 8 tend to be rejected at age 18." These kids seem to emit some kind of offensive social pheromones. When children who have been rejected in one situation are placed in a new group, Frankel says, it takes only about 15 minutes for them to be rejected by the new children, too.

Helen was sold. She immediately put Jackie on the wait list for one of the 14 social skills groups operating at CPMC. A year and a half later, a slot opened up, and Jackie found herself in weekly "playgroup" classes with five other kids. It wasn't an easy fix. Initially, Jackie fared no better at group than she did at preschool. "I thought Jackie was going to get kicked out of social playgroup!" Helen says.

Some $3,000 and 18 months of classes later, however, Helen sounds seriously relieved as she describes how Jackie has benefited. "She's made such amazing progress," Helen says, although she is foggy on what actually takes place in the classes and what prompted the improvements. Still, Jackie, now a first grader at an exclusive private school, is beginning to read, plays basketball on her class team, and has a friend in both her own grade (a boy) and kindergarten (a girl). "She's not the center of the universe, but she plays with different kids and seems to get along." Was it really the classes or just growing up that made the difference? Helen can't be sure. All my friend knows is this: "You can't neglect how much better it makes parents' lives when things are going better for their children."
I know just what she means.

*****

My entrée into the Bay Area's thriving child therapy world came when we adopted a toddler from the Ukraine five years ago. When Lara came to us at two years, four months old, she had no language, due to neglect and chronic ear infections, and was just learning how to climb stairs. Between those developmental delays and a birth defect that left her without a right forearm, she qualified for speech and occupational therapy. We later discovered she suffered from severe, sometimes weeklong migraines. After having two healthy daughters, who left me free to exercise a relatively laissez-faire parenting style, I gained a daughter whose deficits could be quantified and whose journey through life needed to be guided and managed. As we worked to bring Lara's skills up to her age level, I became one of those parents whose mission is to fix their child, to make her whole. Even when she had made tremendous progress, I strove to have her achieve that last 10 percent.

My ears, then, were attuned to new therapies for "bumpy kids" (a global term I've come to like for kids having trouble fitting in). If I hadn't tried one, I had at least looked into it, whether it was biofeedback, acupuncture, cranial-sacral therapy, or play therapy. I first heard about social skills groups from Helen, but by last summer it was hard to go a week without running into friends and acquaintances who had taken their children to a group or considered one. As I began reporting this story, even professionals whom I phoned as sources would, at the end of the conversation, tell me about the social skills group their child was enrolled in. I had to wonder whether it was a fad, like est, or an overkill treatment, like megadoses of vitamin C.

Still, you can see the broad appeal of a "cure" for unpopularity. Studies indicate that kids with friends grow into healthier, smarter adults (one showed that having a close friend at age 12 is the strongest indicator of good mental health at age 20). But social skills classes weren't originally designed to smooth out bumpy kids. Early groups were developed to impart basic survival skills—joining a game, ordering at a café—to autistic and Asperger's children. Kids with either disorder have significantly impaired social interaction, though children with Asperger's, often considered a milder form of autism, tend to have normal verbal skills and longer-than-normal attention spans, albeit for limited, obsessive interests. A generation ago these same kids might have slipped through life undiagnosed or would have been shunted into special ed programs. They were the loners, tucked away in corners eating lunch by themselves, or the nerds who stood too close or seemed to have a language of their own. Over time, some grew up to be the odd eccentric scientist or reclusive artist. Others simply matured into adult loners, leading functional lives with bare-bones social interaction.

While the origins of autism and Asperger's are unknown, there is a genetic component in most cases. In 2001, Wired magazine attributed the local spike in the disorders to the fact that Silicon Valley engineers, many of whom show Asperger's-like symptoms themselves and might otherwise have led hermetic lives, are meeting kindred spirits in their more diverse workplaces, marrying, and reproducing. There are now enough Asperger's and autistic kids in the Bay Area to support dozens of private clinics, all of which have a social skills component.

Other clinics, however, have recently been aiming their services at less impaired kids, spawning a brand of social skills lite—the logic being that if a therapy or medication can help the severely afflicted, then the more moderate cases surely can benefit. Suddenly, all roads for every kid with an issue—from shyness to bullying, dyslexia to hyperactivity—seem to lead to skills training. Centers are springing up with marketable names like Girl Space in the city and FriendSmarts in Palo Alto. Other classes are run from speech therapists' homes; no specific credential is required. At the downtown Berkeley YMCA, there's a free Friday night pizza-and-social-skills group. Even local schools are incorporating skills training into their curricula. 

Could it really be that we are raising a generation unable to relate to each other? Society seems an easy culprit. Today, children's lives are highly structured and micromanaged. Between homework, commutes to school, playdates, and piano lessons
—not to mention the pull of TV and video games—there is little opportunity for them to learn life's lessons by trial and error. A recent New Yorker cartoon captured this sentiment brilliantly when it depicted a teacher explaining to a set of parents, "We've created a safe, nonjudgmental environment that will leave your child ill prepared for real life."

More worrisome than a lack of cul-de-sac basketball games, though, is an all-too-familiar upscale parenting dynamic that's obsessed with creating the perfect childhood, if not child. Despite our reputation for tolerance, people here actually are not any more comfortable raising "quirky" or "different" children than those anywhere else. Word of the new "new cure" travels fast; it's easy to feel negligent if you haven't checked out the latest therapy for your own kid. And the buzz about social skills is everywhere. One parent of a child with Asperger's, a true believer in the benefits of skills training, has been proselytizing with the fervor of a born-again Christian. "As I look at it, 50 to 60 percent of typically developing kids in schools could benefit," she told me.
"I don't see kids coming to the playground with these skills."

*****

Michelle Garcia Winner's Center for Social Thinking, the unofficial hub of the social skills movement in the Bay Area if not the country, takes up much of the second floor of a low-rise office building on Stevens Creek Boulevard in San Jose. When I arrive on a Monday afternoon in November, what looks like a much-too-large waiting room is empty. A wall of windows fitted with shelving displays brilliantly colored glass vases and plates, courtesy of Garcia Winner's brother, a professional glassblower in Portland. But as schools let out around the Bay and families from as far away as San Francisco and Monterey make their way to the clinic, the waiting room becomes as jammed as any airport terminal and seemingly as chaotic. Garcia Winner, a slim woman with short dark hair, is just back from the East Coast, where she ran several conferences. She opened her clinic in 1999 after working with autistic children in public high schools. Six years and two books later, Garcia Winner has trained scores of social skills teachers. Every day, she fields some 50 emails from parents, educators, and others seeking help.

At the center, her seven therapists see some 200 kids a week. Most have some diagnosed disability, though labels don't matter much to Garcia Winner. "Plenty of kids who come in don't have a label but don't have any friends and are depressed," she says. Few of them have a good friend, and for some, that goal will take years to achieve. "I would love to say it's a 16-week program," she says. "But the brain needs time to adjust and process the information. I can make it sound simple, but it's very complicated to teach."

At first blush, the kids in the waiting room seem like any other group, casually chatting with each other. Upon closer inspection, though, one can see their social skills are a little bumpier. There's the runny nose that is never wiped, the awkward gesture, the fidgeting, the nervous hair twirling. Broadly speaking, Garcia Winner and others say, the kids fall into two categories: those who don't get peer interaction and don't get that they don't get it (typical of Asperger's and autism), and those with ADHD (Attention Deficit Hyperactivity Disorder) or other social deficits, who get it but can't behave appropriately because they lack impulse control. Either way, these children must learn about the social experience from the ground up, the same way a liberal arts major would tackle organic chemistry. Coming up with relevant things to say or ask a stranger is extremely difficult for them, as is thinking about what it might be like to be in someone else's shoes. Classroom exercises to develop these skills can quickly turn frustrating, as can "field trips" to the nearby 7-Eleven and Barnes & Noble, minefields for testing newly acquired skills on innocent store clerks.

The group I sit in on is made up of mostly fourth and fifth graders. One fourth-grade boy with glasses, an eager smile, and large teeth that he is still growing into is one of the most earnest, sweetly geeky kids I have ever met. I think of him as eminently huggable. Across the table is his opposite: Ted*, a wiry, exceptionally neat blond boy in the third grade, has a short fuse and talks incessantly. When Garcia Winner hugs him from behind and gives him a friendly pat on the chest, he lets out a yelp, accuses her of hitting him, and strikes her.

Today's first task involves taking a tour around the multi­story building, without talking. Ted is instantly put off. "I thought this was a communications class," he grumbles. The children need to use their "listening bodies and listening eyes" to pay attention to Garcia Winner, follow her silent directions and gestures, and above all, stay with the group. By not talking, the kids can focus on what usually trips them up—their ever-busy bodies and waning attention spans. Each time a child does something right, Garcia Winner rewards him or her with an index card that can be cashed in later to ask me questions during a group discussion.

With some reminders, most of the kids do pretty well. Except for Ted. By the time we reach the end of the first hallway, he's crashing. He walks far ahead of Garcia Winner, making it impossible for her to give him direction. As the others fall in line, she begins handing out cards for being quiet, for keeping up, for standing up straight and not leaning on the wall while walking, and for not bugging the kid next to them. The cards seem as plentiful as the Valpak coupons you get in the mail.

When Ted finally rejoins the group, Garcia Winner hands him a card. Ted discovers he has fewer than the others and launches into a tirade. She continues with the exercise, silent. Ted keeps complaining. He throws his energy into counting cards and blaming Garcia Winner. She gives him cards for the brief moments he is quiet. As the drama unfolds, I'm a little nervous, the same way I feel when some weird guy gets on my Muni car and starts talking to himself. Suddenly, I'm glad Ted is short for his age and that I'm not the object of his ire.

Back in our group room, Garcia Winner checks in with each child about his or her day. When we get to a quiet, slight Asian American girl, her thick black shoulder-length hair in a ponytail, who has come late to the session, she hangs her head and opens her mouth in a long, silent sob. Tears stream down her face. I'm stunned. "Bad day, huh?" Garcia Winner says as she goes over to give her a hug and get some tissues. Now I am frightened for this poor girl, who must face a session with Ted. But she manages to compose herself and participate. At the end of the session, Garcia Winner decides that Ted and the girl will not remain in the same group; Ted is too volatile, and the girl is too delicate.

Later, I speak with Ted's mother, Cathy*, a stay-at-home mom in West San Jose. She tells me that Ted was easy to parent as a younger child but by age six was having tantrums that worried her. His older brother has Pervasive Developmental Disorder Not Otherwise Diagnosed (PDD-NOS), which indicates a severe impairment of social and communication skills that doesn't meet the criteria for other identified maladies. Cathy worried that Ted was mimicking his behavior. Their psychologist said it was "just a sibling thing, the middle-child syndrome." But by third grade, Ted was correcting people on nearly every subject. And once, when they went Christmas caroling with their church group, Ted had a meltdown and ran off screaming because the children "weren't singing the song the right way." Miraculously, he has friends, including a compassionate boy who rubs Ted's back whenever he becomes upset at school.

It was their church's youth minister who had read Garcia Winner's Thinking About You Thinking About Me and recommended the clinic. "There's usually such a long wait list, I thought I would never get in," says Cathy. Since Ted joined last January, the clinic has been teaching him "perspective taking." But Ted still has flipped it around. With his black-and-white reading of the Golden Rule, Ted treats others as badly as he perceives they treat him. He still has little tolerance for others, particularly the new boy in his two-child group, who has Asperger's. "Why do I have to spend an hour with this annoying boy?" he asks.

Yet Ted, who was diagnosed with Asperger's himself, has made progress. Recently, at school, there was a "ketchup incident." An older girl whose job it was to help the younger students in the cafeteria pumped three squirts of ketchup on Ted's hamburger. Usually, Ted would explode. Not this time, though. "No, Mom, I didn't get angry," Ted told Cathy. "She didn't know I didn't like that much ketchup. She thought I liked it as much as she did."

"Oh my God," says Cathy, who had her doubts about the clinic. "This is working."

*****

Victoria Casciato, a Laurel School third grader who usually sports stylish glasses with turquoise frames, gets more social skills training than any of the other elementary schoolers I met. In addition to what she learns at school, Vic attends two groups. At five, she began a co-ed group at CPMC that now meets at a private therapist's home. More recently, she joined an all-girls group. Her mother, Regina, a good-humored woman who zips around in a minivan with her cell phone set to speakerphone, refers to her daughter as a "social skills queen." Vic also has a full-time aide, Scott, to help with academic and social issues, both in the classroom and on the playground. Her family spends $8,000 a year on Vic's social skills groups alone. And it's clear they are prepared to spend any sum (Regina's family motto, she jokes, is "Go forth and bill") to make sure Vic has the best shot at success in life. Vic's hours after school are a whirl of appointments with specialists—learning specialist, occupational therapist, voice therapist, social coaches.

Vic is the third child in her family, and both of her older brothers have issues. While the family dealt with them as best they could, in hindsight, it was only after Vic was born and phrases like "sensory integration dysfunction," Vic's diagnosis, were bandied about that they had a fuller understanding of her brothers' issues. The oldest had similar sensory issues, as well as problems dealing with his emotions. The middle boy, Sam, 14, a freshman at Sacred Heart Cathedral Prep, has dyslexia and is so overwhelmed by sights and sounds, he often has difficulty concentrating. His high school entrance exam essay was a tribute to his learning specialist (formerly known as a tutor) and how she has changed his life.

And so when Vic showed signs of trouble at age four—interacting with others by reciting lines from Disney movies and berating herself and slapping her forehead repeatedly when she made mistakes—Regina stormed into action. Evaluation, then therapy, therapy, therapy. Regina never had illusions her daughter would join the other uniformed, beribboned lassies across their street at Katherine Delmar Burke School for girls. (You can see one of the school play yards from their family room window; a more restful view of Baker Beach stretches out in front of the formal living room.) She is grateful that her attorney husband makes enough so they can afford all the therapy they think the kids need and she can stay home to manage it all.

When I talk to Vic, she doesn't strike me as having serious social issues that warrant aggressive treatment. She's extremely chatty, just the sort of girlfriend you'd want for a day of shopping, lattes, and a little gossiping. She admires your things, laughs at your comments, asks about your kids (right down to wanting to see wallet snaps), and revels in individual attention from adults. Of course, Regina reminds me that we "didn't push any of her buttons" and that I'm seeing her after she's made significant progress. She also still needs to apply her skills with children, who can be far less forgiving than adults.

Regina tells me that for parents like her, the new labels such as "social cognitive deficit" come as a relief. "I'd much rather have people say she has a social skills problem than she's an odd kid," she says. She says many of her friends with typical kids are also worried about their children's social lives. They fear their kids have some hidden deficit—say, a slight visual problem they are unaware of—that the parents could be helping them with. "We all think, my God, what are we missing? All these mothers, they have that Münchausen syndrome by proxy. I'm guilty of that. I never judge it." At least she laughs about it. "We are hyperfocused on our kids. What more can we tweak, what more can we fix to give them that edge?"

Enter the Laurel School, a small K-8 private school in the Richmond district, where social skills training is part of nearly every subject, every day. Today, in Vic's last class, taught by Andrea Schine, the subject is not math or reading but games designed to improve the children's communication skills. As with many of Garcia Winner's exercises, it is nonverbal. The children pretend to throw their voices into a pitcher with a lid that sits behind Schine and complete the exercise in silence. The challenge is to take the three wooden blocks given each of them and without speaking build a tower. The twist is that they don't build with their own blocks. Using visual cues, they instruct their classmates how to place one of their blocks on the growing structure. To earn a turn, a child must be looking at the builder, who gets to choose which child goes next. The abstract skill they are mastering in this exercise is flexibility.

Soon after the game starts, Vic falls out of focus. Already, the only other girl in the class, who sits next to her, has had to tell her she is too close. Vic is squirming in her chair and drumming her fingers on the table, endangering the tower. To gain a turn, Vic stares in an exaggerated, desperate fashion at each builder. The rest of the group ignores her. The parent in me understands Vic is spiraling out. Her behavior is deteriorating because she hasn't had a turn, but she hasn't had a turn because her behavior isn't acceptable to the group. It is a bit too Darwinistic for a novice like me. Most parents, at this point, would step in and say, "I see Vic still has two blocks. Let's give Vic a turn." But it is precisely that Darwinistic effect, accomplished under the watchful eye of the teachers, that experts hope will show kids like Vic the consequences of their behavior.

The game ends, finally. All of the kids except Vic seem to have enjoyed it. Schine debriefs them and sends them on their way. I can't see any "aha!" moment for Vic. I only feel sorry that she had to end her school day on this note, that she had to endure what seemed a really painful process to acquire skills most kids have instinctively.

Drained and defeated, Vic now must tackle a piano lesson, with me, a stranger, watching her.

*****

The popularity of the groups, and the fact that less impaired, perhaps simply unhappy children are attending them, is beginning to lead to some doubts, even among their fans. Pamela Wolfberg, now an assistant professor in the Department of Special Education at San Francisco State, wonders if, for kids with no identifiable disability, we've taken the social skills movement too far. "We're not letting kids be kids anymore," she says. "They may not need these groups at all. Maybe they need to play, to have fun." She paused. "If there is a chronic problem, then there is reason for concern. But we are so quick to fix kids who aren't broken."

Barbara Goldstein*, an involved stay-at-home mom, would certainly agree. Her daughter Emily* is a shy first grader who's much like an only child because her considerably older sister no longer lives at home. At Emily's private school, teachers had commented on her "flat affect," meaning that she doesn't use much facial expression, and seemed concerned that at a school birthday celebration, Emily didn't smile or react during a game in which other girls in the class took turns complimenting her. The teachers felt Emily's temperament was preventing her from getting the most out of what the school had to offer and encouraged Goldstein to consider enrolling her in social skills classes.

So although Goldstein believed Emily simply had performance anxiety about school and learning and was putting up barriers to protect herself, she agreed to a privately run social skills class, albeit one with a less aggressive approach than Garcia Winner's. Unlike most kids in such classes, Emily strikes me as frighteningly perceptive about the world around her; she understands and internalizes things most kids ignore. The girls talked about their feelings, did cooking projects, and played board games. Emily's group included four "overly social" girls, including two from her school. "They learned how to be less obnoxious to each other," Goldstein explains. But it was a horrible fit for Emily, and her mom pulled her out. Goldstein is now wondering whether joining the Girl Scouts would give Emily the same benefits.

Worse, Goldstein feels everyone around them is trying to change Emily's personality rather than accept her as a shy kid. "People seem so worried about this. But Emily participates. The group put on a play, and Emily was in it. She wasn't afraid." Emily has a best friend at school, Margaret*, and the girls have frequent playdates and sleepovers. "She will play individually with other kids, and now in small groups. What's wrong with that? We are pushing them socially to speak up and be heard. But we need the quiet, introspective kids. Jonathan* [Emily's dad] and I were both shy kids. There are so many things we are doing to try to make our children perfect. What's wrong with one friend? Why do we need 25 superficial friends?"

Kids like Emily and Jackie may just be late bloomers. "Social skills acquisition doesn't stop at a certain age," acknowledges Dr. Barbara Bennett, developmental behavioral pediatrician and medical director of CPMC's Child Development Center. "Some kids may seem odd in high school, and you see them at the end of college, and they have matured and figured out a lot of stuff. There isn't a milestone." Some kids and parents have even been run over in the rush to diagnose disabilities and start treatment as early as possible—clearly one key to successful outcomes for severe cases. One Pacific Heights parent told me how her child was labeled autistic, only to "test out" of the diagnosis as he hit age five, albeit with serious intervention. (Medically, autism is a lifelong disorder.)

Some observers have also started to wonder why demand for the groups arose in the first place. While therapy-smart, hyperalert parents are a factor, more kids today do seem to need some help with their social skills. "There are more quirky kids now," says Leslie Roffman, director of the Little School in San Francisco and a preschool educator for nearly three decades. "Year after year, I meet more kids with greater sensitivities, more kids who seem to have a harder time just navigating comfortably in the world."

Children are also often held to a higher standard than adults. We expect them to excel in everything, whereas adults can play to their strengths and avoid the tasks that are more difficult for them. (Don't ask if I can program my TiVo.) "Kids are no longer simply odd or quirky; they have symptoms of a possible disorder," says Dr. Lawrence Diller, a Walnut Creek behavior and developmental pediatrician, frequent critic of the pharmaceutical industry, and author of the controversial book Running on Ritalin. "Oddly enough, in the name of protecting self-image and self-esteem, we categorize variations of normal as pathology and then medicate them."

Then again, there's money to be made off of parental guilt and the pathologizing of unpopularity. A "neuropsych" evaluation of your child will set you back anywhere from $1,500 to $2,500 and is the basis for referral to most therapies. Kvetch about your kid long enough and someone is bound to suggest you get an evaluation, just to put your mind at ease. "It is a wonderful demonstration of how the industry has risen to create and meet a perceived demand," says Diller. "A good special ed teacher can do the same thing in half an hour."
   
*****

To this day, the effectiveness of the groups remains difficult to determine. Frankel, for one, claims 70 percent of the children in his groups in L.A. are successes, as measured by surveys of teachers, parents, and the kids themselves. He attributes his groups' effectiveness to the mandatory parental involvement. But one overview study that reviewed scores of studies involving a wide range of kids in social skills classes found that the groups showed little improvement, at least when it comes to rote skills, such as making eye contact when spoken to. Experts are also unsure what amount of improvement is considered practically significant.

Garcia Winner and Bennett, however, point out that the studies show only how little and how improperly the nascent field has been examined. Most parents are unwilling to allow their child to be in a control group that does not receive treatment. And most studies look for progress over a 6- to 12-week period, which both professionals say is too short a time to see true improvement. Kids naturally pro­gress as they develop and are also getting multiple therapies, which complicates attempts to appraise the classes.

And yet, sometimes you meet a kid who reminds you, in a way no statistic ever will, that an individual can and sometimes does defy destiny, that social skills classes can help. For me, that kid was Erika Peterson, and I met her in one of Garcia Winner's classes. A Mountain View sophomore, Erika, 16, looks like any other teenaged girl, with her long hair in a ponytail and her black hoodie. Only she has Asperger's, has been in the skills track for years, and has become friends with Ritalin, Prozac, Zoloft, Lexapro, and now, Effexor and Adderall. She doesn't feel connected to people, and unlike many other "Aspys," she feels a profound sense of loss over it. So much so that she says she has a party once a year, "so that I can tell myself that I went to one birthday party."

School was a roller coaster of good years and near disasters. Erika cycled between having friends and having none. In eighth grade, when she had no friends, her parents got a dog. As a freshman in a new school, she again had no friends. "This last year was pretty pathetic," says Sandy Peterson, her mother. Erika wouldn't even go to the cafeteria.

Erika was "a bull in a china shop," says Garcia Winner, when she first arrived at the clinic. Even when she wasn't overtly aggressive, she had such a dark, contorted expression on her face you assumed she was furious. To top it off, she was using her Asperger's label as a get-out-of-jail-free card to excuse her behavior. "She would throw up her arms and yell, ‘I can do this because I'm special, I'm unique, I'm Erika!' " Garcia Winner says it basically meant "fuck you."

I got to talk to Erika after one of her sessions. It turns out she is extremely articulate and has a high IQ. "School is weird," she says. She tells me she does her homework at lunch to avoid interacting with others. She describes herself as a "satellite," always orbiting and never included. "It's like there is this whole world and I'm not really there, almost." She lives with what sounds like constant anxiety.

Erika corrects me when I say her life sounds sad. "My life isn't sad. I have more connections with things." She likes to be in nature and with animals, she says, and she likes being around her dog, a Norwegian Buhund. "I feel closer to my dog than to my friends," she says. Erika also explains that there have been "a lot of money issues" as her parents have tried to treat her Asperger's. "This is $85 a session," she says. "People have to be pretty desperate to come here. I used to think it was a bunch of baloney." As it turns out, she has a very sophisticated understanding of Garcia Winner and her methods, philosophy, and role. It's like talking to a grad student. And then I realize that's what's wrong. This is the longest conversation I've ever had with a 16-year-old. You're not supposed to have long conversations with 16-year-olds. They are supposed to relate to their peers, not adults.

Somewhere along the way, though, Garcia Winner's groups began helping Erika. She used to close her eyes when she spoke to people. Now she returns your gaze in a seemingly comfortable way. Recently, she was befriended by a flamboyant gay student, who gave her the courage and know-how to order food in the cafeteria. She's been invited to and attends parties. It seems once someone can reach out to her, Erika can reach back. Sandy thinks that while Erika may have to start at a two-year college, she could be happy in research and, given her success in her AP classes, could very well earn a PhD like her grandfather, a brilliant biochemist who likely had Asperger's.

I think a lot about Erika's parents and the debates they undoubtedly have had (echoes of discussions I've had with my husband about Lara) about which therapy to pursue, when to quit, how to judge if an intervention or medication has been effective. Therapy is a double-edged sword. It sucks because it reminds you and your child there is something wrong with him or her, but it then eases that pain with the consolation that you are doing everything you can to help. If charting Erika's progress is a slow process, her parents can be reassured that at least when the phone rings, every once in a while it's for Erika.

As for my friend Helen, well, her family's social skills journey is only just beginning. Now that Jackie's graduated from her first group, her name is on the waiting list for a more intensive skills class. "The feeling I got was that she has gotten what she could have out of these [initial] groups," Helen says. CPMC has been vague about quantifying Jackie's deficits, and Helen seems equally in the dark. "It's difficult to know whether Jackie understands social dynamics or simply has trouble expressing that she understands," Helen says. Either way, Jackie's peers will soon have advanced, and she will be left to catch up again.

Helen seems realistic about Jackie's future social prospects. "She may never be an all-star kind of kid, will likely never go to Yale and row crew," she says. "But she has great artistic talents, which I hope her peers will appreciate as she grows older." Of course, whether Jackie's progress came from the social skills groups or naturally, we'll never know. But Helen's not taking any chances.

"When all you have is a hammer, all the world is a nail," she says. "But hey, we could all use help with social fine-tuning." 

Susan Kostal is a regular contributor to San Francisco. Her last feature was on the collapse of the law firm Brobeck, Phleger & Harrison.