I was fascinated with Jimmy, an exotic looking boy with dark eyes and straight jet black hair. Like many others with autism, he liked routine; change often lead to tantrums. At the same time, I recognized carefully orchestrated disruptions of his expected routines provided a stimulus for Jimmy to initiate communication. To use this intervention effectively, his mood and current coping ability needed to be continuously monitored. Jimmy needed to know that he could trust me to be alert to his current coping ability and to provide a safety net as I attempted to push him to the next level. It was best to alert Jimmy prior to an activity if there would be a change and what that change might entail. Degree of difficulty was dependent on what I felt he was able to handle at that particular moment in time.
For example, when I first met Jimmy, he refused to brush his teeth. I began by explaining all he had to do was put the toothpaste on the brush. When that was no longer a threat, I had him touch the toothbrush to his front teeth. When he was comfortable with that, I had him move the toothbrush up and down on his teeth one or two times. Steadyly, I increased the amount and directionality. It took months before Jimmy was brushing his teeth appropriately, but taking it slow, and telling him what was expected in acceptable increments generated trust. This strategy relieved his anxiety in learning to tolerate an uncomfortable, but necessary sensory experience. Once the tooth brushing was not a problem any longer, I carefully disrupted the routine. For example, with appropriate communication pictures in view, I hid his toothbrush or toothpaste to encourage him to initiate a request. For him, the built in reward, was the completion of the routine. I used these same sequence interference techniques in other mastered routines to stimulate initiation of communication. Sign, gesture, verbal, or selection of communication pictures / words were all acceptable ..
Jimmy had minimal functional language skills and needed visual cues-actual objects, sign language, and or pictures in a communication book. He was taught to make requests for desired food items or classroom supplies by pointing to communication pictures as he verbalized, “I want ______.” His speech was slow and labored and his intonation was flat. He could not initiate communication without a visual stimulus nor could he express himself beyond “I want ______.” Over time, Jimmy was able to learn rote responses to questions about personal data that I taught him. He began by reading the responses and then the words were promptly removed. After much repetition, he could recite his name, address, phone number, parents and sibling's name.
I taught Jimmy to read by using an ESL (English as a Second Language) program, which used a series of word cards that could have matched to corresponding picture cards. Having the word and picture cards divided into categories and parts of speech, appeared to help him organize and access information. Jim demonstrated to me that he could match the words to the appropriate pictures and could answer questions about them. Soon, he seemed to have an intensive sight word vocabulary and He also began reading books at a primary level. Although I was aware that kids with autism have difficulty transfering skills to novel situations or people, I was unprepared for the strength of the discrepancy.
I usually worked with Jimmy in a small group. I naively assumed that he could answer rote questions and read for others as he did me. One day, I asked Cathy, one of my assistants, to read with him. She told me that Jimmy could not or would not read for her. I walked over and he started to read out loud. When I stepped away, he became mute. I was confused. I asked another assistant to try. The result was the same. He either would not or could not read for either of them if I walked away.
Curious about this anomaly, a few weeks later, this same astute assistant, along with a former teacher of Jim's, asked him about his personal data that she had heard him answeredly answer for me. For each of them, he just made the sound “je”. This was a consistent sound he made when he appeared not to be able to respond. Hearing the familiar “je”, I looked over at Jimmy from across the room and said, “What is your name?” He answered: “Jim Logan.” Next, Cathy asked him where he lived? Again he just responded “je”. From across the room, I then asked the same question. He looked at me and responded, “845 West End Avenue.”
After a few more trials that presented the same results, Cathy instructed Jim to look at me as she asked the questions. “What is your mother's name?” Jim looked at me and responded “Jim Logan.” He continued to be able to respond to the rote questions she asked him only if he looked at me while he was answering them. Determined to get to the bottom of this, Cathy asked me to go into the hall and stand to the side of the door, where I was not visible. She taught Jim to look at the door and proceeded to ask him the same rote questions; he again was mute except for the sound “je”. She then told me to put my hand in the doorway with my face and the rest of my body out of sight. I did so with my palm facing Jim. Cathy taught Jim to look at my hand as she continued to ask him about his personal data. Once again, Jimmy cave the correct verbal responses. I was blown away!
Lessons Jim taught me:
o Develop trust. Make sure the child feels safe. Take nothing for granted.
o Demonstrated competency of a skill for one person may not transfer to others. Make sure that once a skill is learned, that the child demonstrates it to a variety of people in diverse situations.
o Certain people may serve as a catalyst for demonstration of language and academic competency. Just the appearance of my hand about eight feet away brave Jimmy the impetus to respond. Why? I can only speculate.