This time he had to go. There was no time to think about where.
Connor Biscan was biking along the driveway of the group residence for boys where he lived when he realized what he needed to do. He’d noticed something tangled in the branches of a tree: A deflated balloon.
It spoke to his heart. Connor adored balloons and always had. There was no explaining it and no need: They just made him feel happy, and comforted. At home he could have as many as he wanted — or at least it felt that way. Here, at the house the 13-year-old shared with eight other boys with needs like his, balloons were forbidden. A choking hazard.
Enough. Connor felt a familiar electric surge of anger and began to pedal furiously. He quickly outpaced the teachers who sprinted after him, and rode out of the residential Hopkinton neighborhood into the August evening. Taking a right on busy Route 85, he passed gas stations and restaurants, cemeteries and woods, riding in the road when the sidewalk ran out.
Only as the sun began to sink, did he pause. He didn’t really want to be out in the dark. It was time to turn back.
But by then Connor Biscan was lost.
He is easy to love, affectionate, and friendly.
He is moody and unpredictable.
Vulnerable, sweet, devoted to family.
Impulsive, strong, and overflowing with emotion.
Dreaming of home, always.
Never quite at home, anywhere.
This is Connor, a puzzle his family and caregivers have worked long and hard to solve, a boy who lives at the intersection of autism and mental illness. It isn’t so much a rare place — as many as half of autistic children suffer from mental health problems — but it can be a deeply baffling one. The overlap between these afflictions is hard to untangle; diagnosis and treatment can be very difficult. And a health care system meant to help can instead be frustrating, even harsh.
Connor’s family gave a Boston Globe reporter and photographer rare access into his world and their struggles, believing it might help other families if the reality of caring for children like him were more broadly seen and understood.
Over the years, they have tried everything to help him. Often, in his young life, the least suitable option seemed the only one.
Three years ago, Connor spent eight long days in a windowless emergency department room at Newton-Wellesley Hospital. He was in crisis, possibly hallucinating, and needed admission to a psychiatric hospital, but there were no beds free — nothing unusual in a state that faces a chronic shortage, especially for complicated cases. There were then just 121 psychiatric beds in Massachusetts for children; today, there are 135.
Or, perhaps, there was a bed free that day, but no hospital wanted to take a child who would clearly require major resources. It happens more often than anyone wants to admit.
The emergency room was no substitute for specialized care; Connor’s family felt the doctors and nurses, while well-meaning, lacked the time and expertise to care for him. The ER staff didn’t disagree. This was no place for a distressed child to spend a week. Everyone knew it.
Connor had been sent there after he’d spun out of control at the Walker, a school in Needham, which offers academic instruction and a crisis treatment program for children with special needs. Convinced two classmates were teasing him, he exploded, hitting staff, spitting, banging his head against the wall. He was being weaned off his antipsychotic medicine at the time; there was nothing to calm him. Over four hours, he was restrained 13 times.
There was another worry: Connor had a history of talking to imaginary friends and even to objects like trees and lamps, and these conversations were growing more frequent.
Arriving at Newton-Wellesley Hospital after midnight, he began those eight lonely, baffling days. There were no windows. No baths. No going outside. A security guard stood at the door.
He watched television and videos most of the time, and family visited.
Connor was 10.
He just wanted to go home.
Connor sat at the long wooden table in his mother’s kitchen, his knees pulled up under his chin. Almost two years had passed since his long emergency room ordeal, and still the memories pursued him.
“I never want to go back there, ever, and you can’t make me,’’ he told his mother, as a reporter listened. “You can’t make me. Even if I was being really unsafe, I am still not going back there.’’
“I wouldn’t take you back there, I promise,’’ Roberta Biscan replied.
“Even in an ambulance!’’
“Nope, I wouldn’t let the ambulance take you back there either,’’ she affirmed.
“Even if I was acting really unsafe!’’
“Even if you were acting really unsafe.’’
Connor was the first grandchild on both sides of his family, and with that came special status. There were sleepovers at the homes of his mom’s two younger sisters, Shawna Bickford and Danielle Quinn. Dinners at Floramo’s Restaurant in Chelsea where the adorable blond baby in the high chair took turns trying all the adults’ entrees. Trips to Laconia, N.H., where his father’s parents owned a condo.
When visiting his paternal grandmother, Donna Biscan, Connor would jump at the chance to go to Mass. The music and ritual enchanted him, and drew out his natural compassion. One Sunday, he spotted a little girl who was suffering from a disfiguring medical condition. Connor’s eyes filled with tears. When the priest called on the congregation to exchange a sign of peace, Connor darted out of the pew, ran to the front of the church, crawled across laps, and hugged her.
But there was another side of Connor, and always has been.
Roberta Biscan knew early on that something was wrong. As a toddler, Connor didn’t talk much or make eye contact. He had obsessions and private rituals — counting ceiling fan blades in his Aunt Shawna’s house, opening gas tank covers on cars parked at family cookouts, and, of course, balloons. It had been his first word — balloon.
Roberta had taken him for an evaluation when he was 2, even though her mother thought she was overreacting.
“He was my first grandchild and I saw nothing but perfection,’’ said Karen Francis. “Unfortunately, she was right and I was wrong.’’
Connor was diagnosed with “pervasive developmental disorder’’ — the multifaceted and heartbreaking manifestation of abnormal brain development we know as autism — and entered a special education preschool class in the Wilmington public schools. He made progress and seemed to thrive on the classroom routine, but his mother was constantly battling the school system for services.
Over the next few years his behavior problems began to fully emerge and deepen, as they often do as children like him mature. He could not take no for an answer. He would get extremely silly and then, almost always, aggressive. His confusing conversations with no one in particular had grown more insistent, especially those with an imaginary friend whose name is also Connor.
“He is stuck in my head. There is no way to get him out. No way,’’ the boy explained.
Doctors diagnosed a mood disorder on top of the autism, but clarity about his case was elusive. At different points, Connor also has been diagnosed with bipolar disorder, anxiety, sensory processing disorder, and ADHD. His conversations with himself have been called a sign of psychosis and also a healthy way for him to work through problems or confusion on his own. Is his unpredictable anger due to frustration over his autism? Or is it a completely separate disorder? For kids with overlapping symptoms it can be hard to tell.
In third grade, things began to fall apart. After he spun out of control once too often, the public schools would not accept him back, his mother said, and he was at home, out of school, for five months until a spot opened at the Walker, in Needham.
By then, his parents had divorced, and Connor spent every other weekend with his father, Billy Biscan.
Connor’s twin siblings, Will and Ayla, who are two years younger, couldn’t have friends over. Will was diagnosed with anxiety; he shared a room with Connor, whose noisy struggles to fall asleep kept Will up. Ayla secretly made a behavior chart to try to help her older brother — an adult task her mother felt should not be her burden. Family parties became about keeping Connor calm as much as about celebrating birthdays and holidays. There were tense discussions between his mother and her youngest sister, Danielle Quinn, about whether Connor should be allowed to play with Quinn’s daughter, whose hair he continually yanked.
“We had some rough moments,’’ Quinn said. She privately wondered if Connor could control his behavior, but eventually realized that he could not.
It was time to consider a residential school. To send Connor away.
It was a decision that cleaved the family.
Connor’s father was adamantly opposed and fought the move. Connor’s behavior was often better with him, so he took the boy to live with him and unsuccessfully sued for full custody.
“Just the thought of him being brought up through strangers . . . It broke my heart,’’ Billy Biscan said.
The court battle was painful and draining, but there was hope in this: When they divorced, the Biscans had decided that if they ever disagreed about Connor’s care, they would follow the recommendations of his teachers and doctors. And they did. In September 2016, Dr. Christopher Keary, Connor’s doctor at Massachusetts General Hospital, wrote, in a letter Roberta provided the court, that, “Connor is likely to be among the most difficult students to provide safe education as compared to the other children I care for.’’
He recommended a residential facility. That helped settle the matter, and the family began visiting schools. Everyone wanted to make sure their Connor was well taken care of.
On Nov. 28, 2016, Connor’s mother dropped him off at the Guild for Human Services in Waltham — one of three residential programs the Wilmington school system recommended. Roberta had heard positive reviews from another mom and it wasn’t too far from his parents’ homes.
Finding a stable school situation for children with autism and mental illness can be incredibly hard and disheartening. Some children move from school to school, desperately trying to find a good fit — and one where the reality of care matches the marketing. At first, Connor adjusted well to the Guild.
The Guild’s residential staff promised that Connor would be too busy out in the community, bowling, and visiting playgrounds to miss home. But to Roberta and Billy Biscan and their families, it seemed he was spending too much time on his iPad or watching television and not getting enough exercise. Once, when his roommate choked him, leaving angry red fingerprints, staff did not seem to Roberta to have sufficient answers about how it happened.
“I could not go to sleep some nights thinking (of him),’’ his mother said.
Connor was growing up fast. Time was outrunning the search for a place he could live and learn, safely and happily.
On a cloudy day last May, Connor became a teenager — often a fraught transition for children with autism. It was his first family birthday party since he had moved out, and it didn’t start well.
Tall and slim, handsome and strong, Connor bounded out of his grandmother’s car holding four balloons. She had picked him up at school, and they had stopped at a store on the way home. He had chosen ones with colorful “happy graduation” message because, he reasoned, he was moving up to adolescence. Happily, he tied them to a kite string he found in his mom’s garage and flew them high above the soaring treetops.
One blew loose, and he shook his head. “It’s gone, dude, it flew up to heaven.’’
Connor’s aunts and uncle, cousins and grandfather arrived and he excitedly hugged each one. He tied the balloons to a grill and opened a card from his Aunt Danielle and Uncle Matt. $30. Connor shrieked with delight.
And then the trouble began.
Connor did the mental math. Balloons cost $1 at the dollar store. Thirty would be sweet.
He asked his mom. She said that was too many; the Guild would not let him bring them back to school.
“It’s my birthday and you are ruining it,’’ Connor screamed.
Roberta Biscan rushed inside to fetch a toy catalog to distract him. Connor grabbed it and crumbled it into a ball. She offered to play basketball with him. Connor slapped her arm before speeding away on his electric scooter, alternately laughing and swearing and threatening to crash and kill himself.
Danielle Quinn went after him. For 20 minutes they sat in chairs by the fire pit, apart from the others. As Connor slumped in a lawn chair, she asked him to close his eyes and envision the things that made him happiest.
It did the trick. He was still mad at his mom, but calm enough that the family could head inside for pizza and a chocolate ice cream cake with 14 candles — one for good luck. Connor became his best self again, charming his family with his pure joy over the sweets. His mom cut him the first piece.
“I am really happy you pulled it together so we could get to the ice cream cake. Thank you,’’ his grandmother said, watching him eat.
“You’re welcome, Nana.’’
Later that night, the guests gone, Connor changed into red pajama bottoms and sank into his mom’s deep brown sofa to reflect on the day. Coco, the family dog, rested her head on his lap. Despite his yearning to be home, Connor knew that he would be going back to school in the morning.
“You still have to be safe and that’s not happening right now,’’ he said to himself, and promised to change.
“You said that a bunch of times man!’’ he exclaimed, sounding like a skeptical parent. “How can I believe you? I am not going to believe you until you prove to me you can be safe!’’
Roberta Biscan drove Connor back to the Guild the next morning. He cried and refused to get out of the car.
She got a text from him at 4 p.m.: “I don’t believe anything you say. I am never going to come home again.’’
Then on June 18, the New England Center for Children called to say it had a spot for Connor.
This time, his mother thought, it had to work.
Based at a campus 25 miles west of Boston, NECC prides itself on taking the most challenging autism cases in the world. The school’s influence reaches far — hundreds of schools use its curriculum. Parents can spend years fighting to get their public school systems to pay the $250,000 to $350,000 yearly tuition for NECC’s residential school, whose 130 students live in 17 group homes scattered through five suburbs.
Connor’s trial visit to the school went well. He showed off his reading and math skills, behaved perfectly, and was beyond excited to tour the pool. Social and verbal — a master negotiator, really — he is one of the higher-functioning students.
Other schools may try a range of treatments, but NECC is wedded to applied behavior analysis, a patient but firm approach that breaks down desirable conduct into steps and rewards the child with something they badly want — like iPad time — for completing each one. It is an approach that has its critics, who think it too rigid, but here it seems often to work.
On July 13, a Thursday, Roberta Biscan drove Connor to his new school. He would not be allowed to visit home for six weeks, a common rule at residential programs, meant to help the newcomer settle in. A video screen in the lobby showed a colorful kite and read “Welcome to NECC Connor!’’ “Cool,’’ he said.
He and his mom snapped a selfie. Four employees descended the stairs to greet them. “You ready?’’ Roberta said to her son.
“Yup,’’ Connor said with a big smile.
Right from the start, Connor began asking to go home, but no one expected him to run. But then, about a month after he arrived, the balloon in a branch caught his eye.
Center staff dialed 911 and local police officers spread out to search for the boy on the bike. No one knew where he was headed, so Hopkinton officers alerted four surrounding towns and State Police. A police helicopter searched from the air and a Milford officer began to scour the waters at the local quarry. His mother issued a frantic Facebook appeal for help.
“Please!!!!! Anyone that lives or knows someone who lives in HOPKINTON MA PLEASE!!! Share this post!!!’’
Hundreds of readers clicked the share button.
Witnesses began to call in, allowing police to home in on his route. Two hours after Connor left, and 8 miles from his group home, an off-duty Milford police officer spotted Connor pedaling near the town center.
When Roberta Biscan arrived at the station with her sister, she hugged her eldest child tightly but tried not to give him too much attention. She did not want to encourage running away. The three of them were crying. “I love you, but never, ever do that again,’’ she told him.
“I love you too Mom,’’ he said. “I almost got hit by a car once. Good thing I wore my helmet!’’
Everyone’s goal is the same: For Connor to return home. But no one has any idea how long that will take. Keeping him in a school is the first step, and not an easy one.
“We are not a maximum security prison,’’ said Vincent Strully Jr., founder and chief executive of NECC, who drove with Connor from the police station back to his group home that night. “We are seeking independence for the child. We rarely give up, but we’re not successful 100 percent of the time. We don’t have a crystal ball.’’
On a hot sunny morning, five days after Connor’s escape and return, the boys in the house on Ursla Drive started the school day in the leisure center, where even playing video games is an opportunity for instruction.
Then Connor headed to his classroom, a plain pale yellow room with an old desk and two chairs, where he worked alone. His teacher for the 11 o’clock hour was Kaitlyn Kuss. Teachers rotate students every hour or two in part so kids learn to respond to different people, and teachers get breaks from especially challenging students, Connor among them.
A buzzer sounded. “Can you move to your desk?’’ Kuss asked brightly. He did and she marked a check on a white laminated worksheet. “Can I have my DVD player back?’’ Connor said. Kuss replied that they were going to do a “little work’’ first.
Applied behavior analysis starts small and moves slowly. First, teachers use rewards of iPad time to get Connor to ask politely for the device. He earns a check every time he cooperates with the teacher’s command. The demands gradually increase. He can trade in each check for two minutes of a chosen activity near the end of the school day. For Connor, it’s often screen time.
“We want the kids to be able to tolerate those times when what they want or need is not available,’’ said Jessica Sassi, the school’s clinical director. “Because that’s what the rest of us do to succeed in life.’’
In just a month, Connor has made progress. At first, he would have a tantrum if a teacher took his iPad and put it on the desk just feet away. Now, that’s no problem.
But he’s still got a long way to go.
By 11:30 a.m., he was curled up in a ball in the cushioned chair and didn’t move when the timer sounded. Kuss pleasantly asked him to sit at the desk, and he eventually complied, though he was obviously cranky about it.
A month later, Ursla Drive was serene — at least from the outside. The morning sun lit up the majestic trees in the expansive front yard.
Inside, Connor ate French toast sticks and gulped milk at the kitchen table. He placed his dishes in the dishwasher and then moved to the living room to watch a movie. There was something off about him that day; he didn’t greet visitors with his usual exuberance.
When schoolwork began, Connor’s teacher Matt Souza began to erase the checks on Connor’s behavior chart with his sleeve. “Why are you erasing those checks?’’ Connor asked. Souza explained that they were yesterday’s.
Connor scowled and walked out the door to his next class. Then, with no warning, he whipped around and swung at Souza, aiming for his mid-section.
Souza, with the help of two other staffers, urgently pushed Connor back into his classroom and shut the door. They heard him pick up a chair and throw it. They opened the door slightly and Connor threw a chair in their direction.
Connor curled up on the floor, under the desk. Souza started to head back in but Connor screamed at him so he retreated. Then he headed in again, with a new approach.
As Connor cried under the desk, Souza explained that this day would be the first time he would see Connor swim. He was a varsity swimmer at Hartwick College in upstate New York, he told the boy.
“Really?’’ Connor asked. He stood up and started to gather the school papers he’d thrown around the room.
The moment had passed.
By December, Connor’s tolerance for schoolwork had grown — he could do a full hour now — as had his ability to withstand delays and denials. At the house, he was no longer always on a screen; he also made brownies and did laundry and other chores.
The goals for Connor at this point are simple yet hard for him — move him into a classroom with other students and reduce his level of teacher supervision.
Connor, too, was feeling good about himself on this Thursday. He had earned a trip to Toys R Us. He headed straight for the stuffed animal section, where he argued passionately for both a huge brown bear and a massive white unicorn. But he ended up with a small white and gray dog, a plaid Christmas ribbon around its neck. He was thrilled.
At school, Connor’s good humor and loving side are often display. But there is also an underlying sadness that can break through unexpectedly.
Connor had recently returned from Thanksgiving break — his longest stretch at home since entering NECC. It hadn’t been easy for him or for his mom; replicating the structured patterns of the center at home is just about impossible, and Connor sometimes turned aggressive in his frustration. His weekend overnights with his mother and siblings would be reduced from two nights to one.
Navigating the routine at the center had come to seem easier. On that Thursday in November, the boys had gym class in the afternoon. They sat on scooters that they propelled with their feet, racing to navigate an obstacle course of cones while pushing a ball with foam hockey sticks.
After his turn, Connor retreated to a low bench, pulled up his knees, put his head on his arms, and began to cry. Souza came to him.
“I want to go home,’’ Connor mumbled.
“You’ll be going home on the weekend, buddy,’’ Souza said gently.
“I want to go home every day,’’ Connor said.
“If you cry, I am going to get upset,’’ Souza said. He started to blubber in a playful way. It was a daring move and at first it was unclear how Connor would react. He lifted his head. And smiled. “You’re faking!’’
“This is supposed to be the most fun part of day,’’ Souza told him. “Let’s not worry about home. Let’s cheer on our teammates.’’
Connor paused as if consulting his inner voice. His eyes wandered the room, and then he seemed to settle on a decision — one he could live with for now.
He turned toward the game.
Liz Kowalczyk can be reached at firstname.lastname@example.org.