Michael, an autistic boy living in New York City, started scratching and picking at his face when he was about seven years old. Before long, he was gnawing on the side of his thumb. Along the bottom of his stomach, he tore cuts so deep that they scarred.

Over the next five years, a series of psychiatrists prescribed psychotropic medications to correct the self-mutilation. But nothing seemed to help. By age 12, he'd been taken out of school because he was a constant disruption. Though his parents wanted him to live at home, they decided he could be better cared for in a residential facility.

"These kids just live in a very fine balance. And when anything is off, they regress."
As they prepared to move Michael to the group home, his family was referred to Dr. Kara Margolis. Margolis, 36, is a pediatric gastroenterologist at New York Presbyterian Hospital and a researcher at Columbia University Medical Center. She speaks with contagious enthusiasm and the slightest hint of a Brooklyn accent. By the time she met Michael, bloody scabs dotted his face, from the tender skin below his eyes to the tips of his ears. He'd chewed his thumb down nearly to the bone. There was blood everywhere, Margolis recalls as she describes their first visit. He screamed and paced the room throughout the brief exam.

Until recently, psychiatrists have mainly been handling these kinds of behavioral changes. "A lot of these kids, before they see me, have been trialed on many different psychotropic drugs to try to relax them, to calm them down," Margolis explained on a Wednesday morning in April, as she sat at her cluttered desk in the gastroenterology research lab at Columbia. "Sometimes they work and sometimes they don't."

Dr. Kent Williams, a pediatric gastroenterologist at Nationwide Children's Hospital in Columbus, Ohio, agrees that many doctors are reluctant to consider other possibilities. "My heart goes out to the parents, because this is a daily struggle," he said. "Some physicians don't know what to do, so they give up."


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