He was fascinated by Jimmy, an exotic-looking boy with dark eyes and jet-black straight hair. Like many others with autism, he liked routine; change often leads to tantrums. At the same time, I recognized that the carefully orchestrated interruptions to his expected routines provided a stimulus for Jimmy to initiate communication. To use this intervention effectively, your current mood and coping ability must be continuously monitored. Jimmy needed to know that he could trust me to be alert to his current coping ability and provide a safety net as he tried to take it to the next level. It was best to alert Jimmy before an activity if there would be a change and what that change might entail. The degree of difficulty depended on what I felt he could handle at that particular moment.
For example, when I met Jimmy, he refused to brush his teeth. I started by explaining that all I had to do was put the toothpaste on the brush. When that was no longer a threat, I asked him to touch his front teeth with the toothbrush. When he was comfortable with that, I asked him to move the toothbrush up and down over his teeth once or twice. Steadily increased quantity and directionality. It took months for Jimmy to brush his teeth properly, but taking it easy and telling him what was expected in acceptable increments built confidence. This strategy alleviated her anxiety as she learned to tolerate an uncomfortable but necessary sensory experience. Once toothbrushing was no longer a problem, I carefully interrupted the routine. For example, with appropriate communication images in view, I hid his toothbrush or toothpaste to encourage him to initiate an application. For him, the built-in reward was the completion of the routine. I used these same sequence interruption techniques in other mastered routines to stimulate the initiation of communication. Communication signs, gestures, verbal or image / word selection were acceptable.
Jimmy had minimal functional language ability and needed visual cues: real objects, sign language, and pictures in a communication book. She was taught to make requests for desired food or classroom supplies by pointing to communication pictures while verbalizing, “I want ______.” His speech was slow and laborious and his intonation was flat. He could not initiate communication without a visual stimulus nor could he express himself beyond “I want to ______”. Over time, Jimmy was able to memorize the answers to the personal data questions I taught him. He started by reading the responses and then the words were finally removed. After much repetition, he was able to recite his name, address, phone number, parents, and the names of his siblings.
I taught Jimmy to read using an ESL (English as a Second Language) program, which used a series of word cards that could be combined with the corresponding picture cards. Having the word and picture cards divided into categories and parts of speech seemed to help him organize and access the information. Jim showed me that he could match words to the right pictures and that he could answer questions about them. Soon, he seemed to have an extensive vocabulary of sight words and began reading books at a primary level as well. Although he was aware that children with autism have difficulty transferring skills to new situations or people, he was unprepared for the enormity of the discrepancy.
Usually he worked with Jimmy in a small group. I naively assumed that he could answer questions from memory and read to others as he did to me. One day I asked Cathy, one of my assistants, to read with him. She told me that Jimmy couldn’t or didn’t want to read for her. I walked over and he started reading aloud. When I pulled away, he was speechless. I was confused. I asked another assistant to give it a try. The result was the same. He wouldn’t or couldn’t read to any of them if I walked away.
Curious about this anomaly, a few weeks later, this same crafty assistant, along with Jim’s former teacher, asked her questions about her personal details that she had repeatedly heard answered for me. For each of them, he just made the “heh” sound. This was a constant sound he made when he seemed unable to respond. Hearing the familiar “heh”, I looked at Jimmy from across the room and said, “What’s your name?” He replied, “Jim Logan.” Then Cathy asked him where he lived. Once again, he replied “I”. From across the room, I asked the same question. He looked at me and replied, “845 West End Avenue.”
After a few more tests that yielded the same results, Cathy motioned for Jim to look at me while I asked the questions. “What is your mother’s name?” Jim looked at me and replied “Jim Logan”. He continued to be able to answer the memory questions she asked him only if she looked at me while I answered them. Determined to get to the bottom of this, Cathy asked me to go down the hall and stand next to the door, where I was not visible. She motioned Jim to look at the door and proceeded to ask him the same questions from memory; again he was mute except for the “heh” sound. He then told me to put my hand on the door with my face and the rest of my body out of sight. I did it with my palm facing Jim. Cathy motioned for Jim to look at my hand as I continued to ask him questions about his personal details. Once again, Jimmy gave the correct verbal responses. I was amazed!
Lessons Jim taught me:
o Develop confidence. Make sure the child feels safe. Don’t take anything for granted.
o Demonstrated competence of a skill for one person cannot be transferred to others. Make sure that once a skill is learned, the child demonstrates it to a variety of people in various situations.
o Some people can serve as catalysts for the demonstration of linguistic and academic competence. The very appearance of my hand about eight feet away gave Jimmy the impetus to respond. Why? I can only speculate.