In June, 2006, I first met Sam at Hermano Pedro Orphanage in Antigua.  It was apparent that Sam had autism.  His case was not typical, however.  While he would spend literally hours in his crib banging his head, when he was taken from bed he immediately calmed.  He loved walking around the courtyard, tossing fabric into the air and watching it float to the ground.  While unable to speak, he could readily make his wants known to anyone who took the time to “listen.”  Sam was also remarkably affectionate. A communication system could have greatly decreased his frustration. When returned to his crib, his head banging would resume once again. This sound haunts me right up until today.