Understanding Autism

Until we know how to prevent autistic disorders, the challenge will be to help people compensate for them. The parents of autistic kids often swear by unconventional remedies (secretin, facilitated communication, auditory integration, special diets), but the benefits are unproven at best. Tranquilizers and antidepressants can help ease the anxiety and compulsiveness that autism causes, and stimulants such as Ritalin can help affected kids shift their attention more easily. But no medication can correct the disorder itself, and none is likely to take the place of intensive schooling.

The standard approach, known as Applied Behavioral Analysis (ABA), involves conditioning kids through constant reinforcement to behave appropriately. That's the technique at Sacramento's ABC School, a day school that boasts four teachers to every five kids. Whatever the task at hand-- using words, recognizing facial expressions--the teachers break it into discrete units and drill the kids repeatedly. Every success earns a token, and six tokens earn a cookie. To help nonverbal kids communicate, teachers give them notebooks filled with icons. When 4-year-old Chris hands teacher Jessica the icon for cheese, she gives him a piece and says, "I want cheese," linking the phrase with the reward. Over time, 70 percent of the kids using this Picture Exchange Communication System (PECS) learn to make simple utterances.

These routines are a godsend for kids like Kyle and Ian Brown of Long Beach, Calif. The 8-year-old twins have never been easy. They climb furniture, leap from stairways and scale six-foot fences. Ian once made his way onto the nearby freeway. Lauren, their 9-year-old sister, displays only fondness as Kyle slaps his cheek rhythmically and Ian circles the kitchen table, clicking his tongue as he tries to snatch a can of soda. "But it's hard here," she says. "Everything's locked--even my room." Late last year the twins' parents thought they'd have to place them in an institution. But when an ABA-oriented school opened in Huntington Beach, they signed the boys up. Six months later both are starting to brush their teeth and dress themselves, and Kyle is saying things like "I want to go for a walk" instead of banging his head in frustration. Ian's language is limited to mimicking words, but he uses PECS to express needs. Dinners out are still unthinkable. But now, so is sending them away.

The ABA approach isn't right for everyone. Educators can often help higher-functioning kids build on their own skills and interests. Six-year-old Jack Guild of Greenwich, Conn., can be hard to reach, even though he has no trouble with language. "As a baby he was not loving or responsive," his mother, Cathy, recalls. "And as he got older the tantrums got worse. Every transition--bed to breakfast, home to school--was a flash point." When Jack started seeing caseworkers at the Greenwich Autism Program last year, they didn't drill him on getting dressed. They helped Cathy devise routines that would heighten his sense of control--simple things like letting him finish a favorite video in the morning, then driving him to school instead of coaxing him to walk. The results have been dramatic. "I feel like I have my kid back," she says. "A kid who can learn and develop."

As different as they sound, both strategies rest on an understanding that autistic kids are not willfully misbehaving, just trying to navigate a world they're not equipped to fathom. As Dr. Fred Volkmar of Yale wrote recently, the worst possible fate for such a child is to be placed in a program for troublemakers. When that happens, he says, "a perfect victim" is surrounded by "perfect victimizers." If the new autism awareness accomplishes nothing else, it should spare many children that fate. With luck, it will also get them recognized early, when special interventions can still help. Only 10 percent of the autistic children entering the celebrated Princeton Child Development Center after age 5 go on to enter mainstream schools--yet half of those recognized earlier end up making the transition. Until autism can be prevented or cured, that's a goal to strive for.

With DONNA FOOTE IN LOS ANGELES AND HEATHER WON TESORIERO IN NEW YORK

© 2000