How to Treat Autistic Kids

Five years ago Janine Casoria was a 10-year-old bent on self-destruction. She habitually yanked out clumps of her hair, banged her head on the floor and pinched her face and arms until they were covered with open sores. Diagnosed as an autisitc, Janine was beyond the reach of teachers at many special-education programs in New York. Her parents turned in desperation to the Behavior Research Institute (BRI), a school in Providence, R.I., for young people with severe behavior disorders that fights violence with violence. After putting Janine through a battery of rewards and punishments, BRI therapists determined that one spank on the buttocks whenever she injured herself was enough to make her stop. And indeed, after five years there, the screaming little girl has grown into an affectionate adolescent with a full head of hair.

Parents of some profoundly afflicted children like Janine have come to see BRI's "aversive" therapy as their only hope. But the Massachusetts Office for Children (OFC) holds a different view: that BRI's brand of treatment wouldn't be tolerated toward animals or prisoners. In July 1985 a 22-year-old student died while wearing a helmet and mask emitting staticlike "white noise" as part of his aversive therapy.An autopsy could not establish that the treatment contributed to his death. But the OFC, which entered the case because several BRI group residences are in Massachusetts, has campaigned ever since to close the school, pitting the agency against director Matthew Israel and all but two families with children currently enrolled there. So far, six different Massachusetts judges have ruled in favor of the insitute, allowing it to remain open and authorizing aversive thereapy on a case-by-case basis. The final legal showdown is scheduled to begin this week, when the school will not only seek to remain open, but demand $ 15 million in damages from OFC director Mary Kay Leonard.

Behavioral therapists are divided over the use of punishment to treat autism, an incurable mental disorder that ususally strikes in early childhood and is characterized by extreme withdrawal and sometimes dangerously aggressive behavior. BRI's opponents claim that even extremely disturbed autistics can be treated with positive reinforcement alone, and many handicapped groups and parents of other afflicted children see no reason to resort to aversives. "It's a question of empirical research," says Gary W. LaVigna of the Institute for Applied Behavior Analysis in Los Angles. "People who use aversive treatment do so from lack of knowledge."

But the BRI parents say they have learned the hard way that their only choice is aversive therapy -- or some forgotten ward in a state institution. "Oh, there are alternatives all right," says Bill Martin, whose son had been rejected by other schools before landing at BRI. "There are rubber rooms, straitjackets and drugs." After the bleak state hospitals, parents are cheered by the carnival atmosphere of BRI's "reward room": a hallway lined with stuffed animals and pinball machines that students can visit in exchange for good behavior. But the punishments are also intimidatingly visible. Trained therapists squirt lemon juice on the tongue of misbehavers as a "taste" aversive or give a quick pinch to the palm of the hand. A booth equipped with arm restraints and an automatic water spray aimed at a student's nose is particularly shocking.

Director Israel believes that aversive therapy allows the possibility of actually educating, rather than merely warehousing, the severly mentally handicapped. Through a program of rewards and punishments, says Israel, students can learn tasks from sorting buttons to using a computer, or to refrain from relentless rocking. Aversive treatment is not performed until positive reinforcement has failed. In the begining, students are punished as often as they abuse themselves -- in Janine's case, as many as 700 times a day. Conversely, if the student manages, say, to sit still for an entire minute, he may be rewarded with a cookie. With time, the child might go for several weeks without punishment.

Bittersweet victory: While the program does not claim to cure autistics, its advocates say it has at least penetrated the deep silence cutting these youngsters off from the world. Massachusetts probate Judge Ernest Rotenberg observed that Janine, who had regressed when a court order banned aversive punishment, thrived when it was reinstated. "This judge was greeted and hugged by this formerly desperate child," Rotenberg wrote last June. "This is an experience this judge will carry with him for the rest of his life." Given the many rulings against it, OFC finally may be ready to settle out of court. For the BRI parents, it will be a bittersweet victory. "It's not that we're sadists, but a spank is so much better than watching Janine practically killing herself," says Carlo Casoria. "This program has brought dignity to my child."