He was fascinated with Jimmy, an exotic-looking boy with dark eyes and straight, jet-black hair. Like many others with autism, he liked routine; changes often lead to tantrums. At the same time, I recognized that the carefully orchestrated interruptions to routines expected of him provided a stimulus for Jimmy to initiate communication. To use this intervention effectively, his state of mind and his current coping ability needed to be continuously monitored. Jimmy needed to know that he could trust me to be alert to his current coping skills and provide a safety net while I tried to push him 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 he felt he could handle at that particular moment.

For example, when I first met Jimmy, he refused to brush his teeth. I started by explaining that all he had to do was put the toothpaste on the brush. When that was no longer a threat, I asked her to touch her front teeth with the toothbrush. When he was comfortable with that, I asked him to move the toothbrush up and down once or twice. Little by little, I increased the quantity and directionality. It took months for Jimmy to brush his teeth correctly, but taking it easy and telling him what was expected in acceptable increments built trust. This strategy eased his anxiety as he learned to tolerate an uncomfortable but necessary sensory experience. Once tooth brushing was no longer a problem, I carefully interrupted the routine. For example, with appropriate communication images in view, I hid the toothbrush or toothpaste from him to encourage him to start an application. For him, the built-in reward was completing the routine. I used these same sequence interruption techniques in other mastered routines to stimulate the initiation of communication. Signs, gestures, verbal or choice of images/words of communication were acceptable.

Jimmy had minimal functional language skills and required visual cues: real objects, sign language, or pictures in a communication book. He was taught to make requests for desired foods or school supplies by pointing to communication images 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 to ______”. Over time, Jimmy was able to memorize the answers to the personal data questions I taught him. He started by reading the answers and then the words were finally removed. After many repetitions, he was able to recite his name, address, phone number, the name of his parents and 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 matched to the corresponding picture cards. Having the word and picture cards divided into categories and parts of speech seemed to help him organize and access information. Jim showed me that he could match the words to the appropriate pictures and could answer questions about them. Soon, he seemed to have an extensive vocabulary of sight words and he also began to read books at a primary level. Although he knew that children with autism have difficulty transferring skills to new situations or people, he was not prepared for the enormity of the discrepancy.

I usually worked with Jimmy in a small group. I naively assumed that he could answer questions from memory and read for others as he did me. One day I asked Cathy, one of my assistants, to read with him. He told me that Jimmy couldn’t or wouldn’t read to her. I walked over to him and he began to read aloud. When I walked away, he was speechless. He was confused. I asked another assistant to try it. The result was the same. He wouldn’t or couldn’t read to any of them if he pushed me away.

Curious about this anomaly, a few weeks later, this same astute assistant, along with a former teacher of Jim’s, asked her questions about her personal data that she had repeatedly heard him answer for me. For each of them, she just made the “I” sound. This was a constant sound she made when she couldn’t seem to respond. Hearing the familiar “I,” I looked across the room at Jimmy and said, “What’s your name?” He replied, “Jim Logan.” Next, Cathy asked him where he lived. She again she just replied “me”. From across the room, I asked the same question. She looked at me and replied, “845 West End Avenue.”

After a few more tests that came up with the same results, Cathy motioned for Jim to look at me while he asked the questions. “What is her mother’s name?” Jim looked at me and replied “Jim Logan”. He continued to be able to answer her rote questions only if she looked at me while she was answering them. Determined to get to the bottom of this, Cathy asked me to go into the hallway and stand by the door, out of sight. She motioned for Jim to face the door and proceeded to ask him the same questions from memory; he was again mute except for the “me” sound. She then told me to put my hand on the door frame 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 he continued to question her about his personal information. Once again, Jimmy gave the correct verbal responses. I was blown away!

Lessons Jim taught me:

o Develop confidence. Make sure the child feels safe. Don’t take anything for granted.

o Demonstrated proficiency in 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 a variety of situations.

o Certain people can serve as a catalyst for the demonstration of language and academic proficiency. Only the appearance of my hand about eight feet away gave Jimmy the impetus to respond. Why? I can only speculate.