Installment two of...

[Guest guest]

A Tale of Two Schools...

From the moment parents absorb the shock that their child may be

autistic, they enter a dizzying world of specialists, therapists

and, alas, purveyors of snake oil. Getting the right help quickly is

paramount, but it is hard to make good decisions when you are in a

panic or fighting despair.

For the past 20 years, the dominant way to work with autistic

children has been based on Applied Behavior Analysis. ABA derives

from the classic work of psychologist B.F. Skinner, who showed--

mostly in animals--that behavior can be altered with carefully

repeated drills and rewards. In 1987, Ivar Lovaas at UCLA published

a small study with huge repercussions. He reported that 9 out of 19

autistic children taught for 40 hours a week with behaviorist

methods had big jumps in IQ and were able to pass first grade; only

1 out of 40 in control groups did so. It was the first bright ray of

hope in autism.

Recent years have brought questions about the ABA model. When Lovaas

protégé Tristram tried to replicate the 1987 findings in a

2000 study, he got a more modest success rate on academic measures

and virtually no gains in social behavior. Others, meanwhile, have

devised new ways of working with autistic kids. One of the best

known was developed by child psychiatrist Stanley Greenspan, who

spent 15 years studying infant development at the National Institute

of Mental Health. His method, called DIR (developmental, individual-

difference, relationship based), has as its premise the idea that an

exchange of emotional signals, initially between mother and infant,

form the basis for learning in childhood. Greenspan trains parents

and teachers to engage the emotions of even the most withdrawn

toddlers by getting down on the floor and entering the child's

world, helping turn repetitive acts like lining up blocks into

playful interactions. He describes the method, also called

Floortime, in a new book, Engaging Autism.

While the majority of U.S. programs for autistic children are based

on ABA techniques, DIR has made inroads, and many programs now mix

elements of both. How do the techniques differ in practice? To find

out, TIME visited two schools, each a model for one school of

thought.

ALPINE LEARNING GROUP

IT'S EASY TO SEE WHY A PARENT would fight to get a child placed

here. Who wouldn't want this calm, orderly world for an anxious

child with all the sensitivities of autism? Alpine, in Paramus,

N.J., has 28 students, ages 3 to 21, in six gleaming, light-filled

classrooms. The staff-to-child ratio is 1 to 1. The $72,223 tuition

is covered by the state--federal law requires a free education for

children with disabilities in an " appropriate " setting.

At Alpine, every goal, every lesson, every response is carefully

documented in binders that track each child's progress. That is the

rigorous heart of ABA, explains executive director Bridget ,

who co-founded the school in 1988. " I'm a scientist-practitioner; I

need data, " says , a certified ABA therapist with a Ph.D. in

psychology. The binder for Jodi DiPiazza, 4, is easily seven inches

thick, though Jodi has been at Alpine less than a year. Like most

other children at the school, she started ABA therapy at home as a

toddler.

In her classroom, Jodi sits quietly at a small table with a teacher.

They take turns looking at photos and using a complete sentence to

describe the scene ( " The girl is riding a bike " ). Each correct

answer earns Jodi a sticker on a chart; with enough stickers she can

choose a reward. ABA was once famous for its M & M rewards, but better

programs now tailor positive reinforcement to the child's

preferences--a favorite activity, a hug or, in the case of one

Alpine student, a packet of ketchup. Though Jodi didn't talk at all

until age 3, she speaks well and is mastering skills quickly with

the help of two hours of tutoring in the evening. " From the moment

she wakes up till she goes to sleep, everything is structured, " says

her mother , who is thrilled with Jodi's progress.

says 29% of her students, most from ages 5 to 8, get

mainstreamed into regular schools, generally with an aide. Many who

remain at Alpine have limited language skills; some of the older

students use electronic devices to express basic desires. The

ritualistic behavior that is characteristic of autism is strongly

suppressed. " Hands down, " says a teacher to a child who begins to

flap. " We're not a culture that accepts that, " says . " Fifty

percent of the battle is addressing behavior to look good. "

In a classroom with four teenage boys, the focus is on life skills.

athan learns to type a grocery list, which he and an instructor

will later take shopping. Another boy, learning to use a camera,

asks visitors whether he may take their picture. He uses the same

words and intonation each time he asks.

Robotic behavior, lack of emotion and inability to use trained

skills outside school are some of the shortcomings critics attribute

to ABA. A boy who has learned to play Nintendo games at Alpine, for

instance, reverts to simply switching the game on and off when at

home. Proponents concede certain weak points, but they also note a

long record of results. Says Tristram of the University of

Rochester: " Anything outside ABA is basically experimental at this

point. "

CELEBRATE THE CHILDREN

THIS IS NOT A QUIET SCHOOL. The hallways are filled with the sounds

of kids talking and playing. The walls are festooned with banners,

photographs and artwork. Parents always ask whether it's too much

stimulation, says director Osgood, but the school wants its

students to adapt to the " real world. " Celebrate the Children (CTC),

which costs $47,856 a year--paid by the state--is one of a growing

number of DIR schools. It opened its doors in Stanhope, N.J., in

January 2004 with just three students. It now has 41, from toddlers

to teens, and is still expanding fast.

CTC emphasizes the expression of emotion and spontaneous thinking.

Rather than work on a highly specific skill, DIR activities tend to

include complex social interactions that build many skills at once.

In a classroom for 5-to-9-year-olds, eight kids sit in a circle

playing a game in which they pick an activity card and a card

showing a classmate's face. Children earn cheers as they perform the

designated activity with that classmate (giving Olivia a high five,

hugging ). Instead of tangible rewards, shouts of encouragement,

a sense of accomplishment and what Greenspan calls the " warm,

pleasurable feelings " that come from human interaction serve as a

reinforcement for learning. In a classroom of 11-to-14-year-olds,

kids are asked to stand in a narrow row between two strips of blue

crepe paper representing water. The challenge: to arrange themselves

in height order without stepping over the lines and falling " off the

boat. " The task combines communication skills, problem solving and

visual, spatial skills. Teachers at CTC are trained to work on

sensory issues and use the principles of occupational therapy

throughout the day, Osgood explains, rather than in a separate

program.

At the core of CTC is Floortime, one-on-one, child-directed play

periods. In one such session, , 6, goes down a slide again and

again. Each time he reaches the top of the ladder, a teacher

playfully blocks his way, leading this very passive child to make

eye contact and make his wishes known. " She wants him to move her

hand or say 'Move' and be intentional, " explains Blaszak,

CTC's assistant director. " She's got an agenda; he doesn't know it.

He keeps going back for more because it's fun. " Building social

interactions this way, she says, will make it easier for to

join circle games at school and sit at the dinner table at home.

Osgood worked in an ABA program for six years. " It does a great job

with skills, " she says, " but the kids lacked the ability to think on

their feet, to problem solve and to engage socially. " She also feels

that the ABA emphasis on " looking normal " doesn't address the

reasons for behaviors like flapping and rocking: " Those are

organizing strategies to cope with anxiety. Our philosophy is not to

say 'Don't do that.' In DIR, we respect them for who they are but

give them the tools they need for successful lives. " Sometimes

literally: Osgood tosses a boy a Koosh ball when he asks for

something to fiddle with in his hand. Knowing to ask, she says, is

part of learning to regulate oneself.

While Greenspan has published impressive long-term results, his

critics say there's an absence of controlled, randomized studies. He

is responding with a series of studies just getting under way at

York University in Toronto. Among them is work that should help

illuminate choices for struggling parents: imaging studies that will

compare the brains of DIR kids with those treated with ABA.

With reporting by With reporting by Amy Lennard Goehner