Bjarke Mousten-Nielsen, 13, sits on a couch, listening to a musical game show at his home in Aarhus, Denmark. It wasn’t until Bjarke and his twin brother Sigurd were around two-years-old that his parent’s noticed Bjarke’s mental development was stalling. Identified with autistic behaviors, Bjarke now spends half his time at home and half at an institution for children with disabilities. Once 18, it’s likely he’ll live at an institution for the rest of his life. Though the parents say there’s sadness connected with their circumstance, they’ve come to accept it.

Bjarke sits in the backyard as his father Carl-Johan Nielsen and brother Sigurd, 13, try to encourage him to ride a tandem tricycle for a family bike ride. Though he mostly doesn’t like to be outside, Birthe says once he’s riding the bike he enjoys it.

Birthe and Bjarke share a moment of embrace on the bathroom floor after finally getting Bjarke’s last article of clothing on. The family recognizes daily routines for Bjarke take time, patience and understanding. “You can run or you can work with it,” Carl said. “We stayed.”

While at school, Bjarke lays on the ground as an educator tries to get him interested in the day’s education exercise. Birthe said it takes Bjarke more time than other children to learn and accept new things. “But it’s not the same thing as he doesn’t like it,” she said. After years of working with puzzles Bjarke likes them now, though he wouldn’t have had he not been introduced over and over again.

When Bjarke is away from home, whether at school or the institution, his parents have a journal for whoever is with Bjarke to write about their day with Bjarke.

The family goes on a bike ride to a near-by lake on the weekend. As Bjarke has aged, the time he spends away from his family at the institution has increased from a few days to an entire week. “It’s an issue we can only decide partly because it’s paid by the municipality, so we’ve got to have a grant to have him at the institution.”

Space is made for Bjarke’s toy at the dinner table while he eats with social worker Carina Jeppesen, left, Carl and Birthe. Bjarke is very thin for his age so it’s important for him to get enough food each day. “You might say the way normally parents talk about their children they would like them to have healthy food,” Birthe said. “When we talk about Bjarke we would just like for him to have food.”

Bjarke runs through the house to get his toys to bring back to the bathroom while Carina get’s him ready for bed. “He’s strongly repetitive in his behavior and it gives him a satisfaction to be occupied with something he knows already,” Birthe said.

Bjarke searches for toys in his room. While the bunk bed Bjarke and Sigurd used to share remains, Sigurd now has his own room on the other side of the house. Though twins, Birthe said there wasn’t ever much of a relationship between the two boys. “They live in parallel worlds,” Birthe said. “With the small addition once in a while when Sigurd has this brotherly feeling where he helps Bjarke and wants to take care of him.”

The family sits on a couch in the house for a portrait. Birthe said having Bjarke separated from the family every other week is something family has gotten used to. “Think of a family where one of the parents for instance is a business person and is away all the time,” she said. “I mean it’s fairly easy once you get used to it and that’s just the way it is.”