Matthew Reynolds is playing with his friend Takshal on a Saturday afternoon
when he darkens and knits his brow. He sees a large Lego in the set of
smaller ones and it puts him on edge for a second, then he pulls it out
and his cheerful face returns. Patricia Prelock is watching.
were so flexible there Matthew; Im proud of you, she tells
him, because another day not so long ago, the incident might have gone
otherwise. But whats remarkable about this story is not that this
talkative little boy has a room full of toys carefully stored away in
their designated bins, its that Matthew Reynolds is playing with
his friend Takshal. Matthew has autism spectrum disorder, or ASD, a neurological
condition that can make forming the most natural interpersonal connections
such as playing a painful, baffling prospect.
with ASD, even verbal ones like Matthew, struggle with social interaction
and communication, says Prelock, professor and chair of communication
sciences and a 2004 University Scholar. They may have difficulty making
eye contact, finding appropriate words, and may exhibit odd, inflexible,
or repetitive behaviors. For a child with autism, seeing another persons
perspective (like, say, wanting a turn with a toy or to try another game)
is simply not part of their wiring, nor are abstractions like pretend
play. Trains, blocks, maps, these are predictable and controllable and
therefore more comfortable than people.
the need for human connection, for friendship, is as real for those with
ASD as for anyone else. Kids who have successful social relationships
have better long-term outcomes in terms of being satisfied and successful,
says Prelock, whose aim is to give autistic children the normal stuff
of childhood, complete with birthday party invitations, playdates, and
sleepovers. How to make that possible is a challenge that keeps her working
seven-day, 70-hour weeks.
most unusual about this research is that it takes place in the home of
the autistic child. Similar projects have been done in school settings,
but Prelock believes that by working in a childs home, within his
comfort zone and with his own toys, they are maximizing the chances of
success, defined, in carefully coded analysis, by the ways the kids interact
and the amount of time they spend mutually engaged. Its also unique
to train both the child with the disorder and the typically developing
peer. Other research has focused exclusively on one or the other.
study takes place over 15 weekly playdates, with follow-ups after three
and six months. The first three sessions are the hardest, for the children,
the interventionists, and particularly the parents. During this baseline
phase, the kids are videotaped with no coaching to see how they interact
on their own and the results can be heartbreaking. Often the children
play in separate rooms or act as if no one else is there.
hard for the parents to see, says Prelock, that their children
didnt really have a way to connect.
then get ten weeks of coaching, with the intervention removed after five
sessions, and then again after the tenth, so Prelock and her team can
assess the progress. Are the children initiating play? Are they responding
to their names? Are they taking turns? Not surprisingly, the social behavior
dips after the first few weeks of intervention. But after ten weeks, the
work is showing results.
you saw the videotapes, its dramatic, says Prelock. I
think thats what blows people away. You can actually see this dramatic
change in the kids ability to communicate with each other.
Matthew and Takshal, who were one of Prelocks earliest pairs. In
the beginning, she says, Matthew was reserved and echolaliac, parroting
back peoples speech.
play was very limited, Prelock says. He didnt know how
to use objects and only wanted to do repetitive things. As Takshal
played pirate ship, walking a small figure up a rope, Matthew would sit
and watch, and look to the interventionist. But with coaching, he gradually
began to get it. Two years later, on the day of the Lego incident, the
pair shared a pretend game of doctor and patient and Matthew was well
versed in the language of taking turns, speaking, at times, more like
therapist than child.
were given the words to use, says Giovanna Reynolds, Matthews
mom. They learned to share; they learned to wait; they learned to
ask; they learned to help each other. It was concrete and it got through
to him on his level.
had hoped, the social behaviors have extended beyond the home setting
and with children other than the trained peer. Hes more confident,
reports Reynolds. Before I had to drag him to playgroups and now
he asks to go. He asks kids to come over.
been to those all-important birthday parties. Matthew wants to do
everything every other kid does, Reynolds continues. This
way, I think he learned how to be a friend. Not what a normal kid would
do or be, but hes a lot better than he was.
is limited to children between the ages of four and six who have language
skills at least at a 30-month level. Within those guidelines, there is
a range in the severity of autism cases. Matthew is a highly verbal child
with high cognitive function and he was diagnosed early, an important
factor in his favor. But Prelock has had successful outcomes with children
whose disorder is much more severe. In fact, the personality of the typical
peer may be a better indicator of success.
has completed five dyads and she started three more in January. Its
a demanding process, involving extensive travel, painstaking data analysis
(each half-hour play session takes four to seven hours to code) and enormous
sensitivity in dealing with vulnerable families. But its gratifying
work. Prelock regularly gets calls and emails from grateful families like
the Reynolds who credit her with their childs progress.
also adds a note of caution. Because she makes the needs of the children
and their families paramount, this is not a strictly controlled study.
I cant tell families they cant have any other interventions,
Prelock says. Thats just not appropriate. And she wont
withhold the intervention either, so theres no control group. But
by consistently replicating her results with these single-subject designs,
Prelock says its possible to draw some powerful conclusions about
the efficacy of the intervention.
HEART OF A SCIENTIST
developed by autism educator Carol Gray, uses a short narrative to describe
a social event (like greeting somebody), offer a child cues as to how
others feel (if you spit on them thats bad) and what to do
when hes in a similar situation (say hello). The stories are individualized
depending on the issues a child and his family are struggling
with. The hope, Prelock says, is that this simple change can help children
overcome some of the obstacles that prevent them from making valuable
want Matthew to be independent, to have what everyone has, a family and
friends around, Giovanna Reynolds says. I want him to find
work that hes comfortable with and to show empathy for others, to
be there and help people out, not just me, me, me all the time.
wants to help kids like Matthew get as far towards those ends as their
unique situations will allow, but she also wants the world to meet them
always been intrigued by the unique way children with autism approach
their world, Prelock says, noting that many people who are uncomfortable
or afraid believe that people with this disorder dont know how to
communicate. Yes they do, she says, and we need to do a better job of
means trading fluorescent lights for lamps in schoolrooms, organizing
the day with a schedule and visual supports so a child with autism knows
whats going to happen next, if it means taking sensory breaks for
the whole class so a child who needs to spin around wont look weird,
then, Prelock says, its worth it, and it might just help other kids
her work is the chance to build a small bridge between two worlds that
seem so foreign to each other, the languages of which she knows by heart.
For the families caught in between, its a lift out into the light.
dont expect miracles, Reynolds says, but even the tiniest
change just gives us hope and more strength to