Dr. James MacDonald 332 Mimring Columbus, Ohio 43202 Phone/Fax 614 447-0768 macdonaldj86@gmail.com

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The following is a report on three years of the ECO program with a mother and a highly resistant autistic boy. Andrew is now 8 and talking in sentences. He is still sensitive to over stimulation but is becoming to be more spontaneous and conversational in his language,

Andrew, at age two-and-a-half years, came to me after being diagnosed by a team of a psychologist and a pediatrician as autistic. When I observed Andrew in our clinic, he was non-verbal, non-interactive, highly perseverative in actions and sounds, and highly resistant to touch and language. Andrew screamed intensely for from two to ten hours a day. He resisted personal contacts as if they were violent abuses. He was extremely sensitive to sounds and to almost any unexpected event. He refused to allow me to approach him. In order to calm him, I talked with the mother from a distance of about fifteen feet. I learned early to read Andrew’s boundaries and to enter them only very slowly.

So, I asked myself, can I help a child who won’t allow me near him? Soon, I realized the answer was yes, because Pam, his mother, was very open to learning how to play in Andrew’s world. She had no question that Andrew could do much more. She realized he knew many things but also knew he responded to many traditional teaching approaches with noisy, frightened retreat.

A major problem here was that Andrew had such a low rate of interaction with people and such a narrow range of activities that he appeared locked in a world that kept him from learning anything from others. My first task was to explain to Pam (and provide related readings) that language comes from close back and forth contacts with people; and that Andrew needed many skills before we could address talking directly. He needed to stay in interactions with people who were willing to act in ways he could and who placed no demands on him other than to stay in back and forth contact. He needed to learn he could survive interacting with people.

Pam soon understood that for Andrew, staying in interactions was as critical for his coming into relationships as insulin is for the health of a diabetic. In my view, the world for Andrew was over stimulating to the point that he not only tuned out, but imposed such violent self stimulation that he was rendered out of perceptual contact for up to several hours. So, the dilemma was how to keep Andrew in interactions that seemed to put him into a state in which he could not hear, see, or cooperate enough to learn anything but to escape.

Once Pam realized that Andrew had to stay in interactions, she learned a few things: how to act like him, to reduce her language and her demands and keep just one goal in focus--to keep Andrew physically interacting back and forth more frequently and for a little longer as time progressed. Pam practiced as I sat fifteen feet away coaching her to do the following: act like Andrew then wait, gently keep him with her, wait for him to do anything positive, even the smallest steps in sound or action, then do it like him and wait again to repeat the cycle. The activities involved exchanging any sounds, actions or physical objects (like a doll) back and forth, teaching him three things: one, that he could survive interactions; two, that there was no option to staying; and three, that if he did just a bit more he would be free to explore as he wished.

A major breakthrough came in about four months when he started staying without being physically held, and initiating exchange games on his own. He was still interacting with some anxiety and resistant to staying with people, but he was staying and his mother was experiencing for the first time that she could have some effects on him and that he would finally give back some of her playful contact.

Pam’s attitude was inspiring to watch. Andrew vehemently resisted for several months, but Pam took the smallest gains and expected more. She often said something along the lines of "I don’t care what he does, but he’s going to do more of it and he’s going to do it with me."

A unique and forceful feature of Pam’s was her non-judgmental humor. She didn’t take his rejections personally and she frequently laughed when she kept him with her as if to say "I know you don’t want to stay, but I’m going to be so entertaining that you will." Pam learned to ignore much of Andrew’s disruptive behavior and persisted in getting him to respond in any way he could. She did not view Andrew as doing anything wrong; rather she saw it as her responsibility to get him into her world by first getting into his.

When I commended her on her persistence through months of plateaus, setbacks, and downright disturbing periods, she said "I’m going to do whatever I have to--I know there is a bright little boy in there and I don’t expect it to be easy."

And it clearly wasn’t easy. New people, situations, activities and most changes would invoke setbacks and sometimes monumental disturbances in their family of five. When I noticed Pam pushing herself without much response from the boy, I prescribed a break for her. Then she learned that forgetting about interacting for a while led her to see how much she had learned to do habitually. She was pleased to see Andrew initiate and keep her interacting when she took a little vacation from focusing on it.

Once Andrew began to stay in interactions, that is, to take turns both imitatively and with behaviors of his own, I encouraged Pam to begin to hold out for more sounding. When he took a turn, by clapping hands or rolling a ball, Pam would wait for any sound before she took her turn. We discussed how effectively Andrew had been communicating with her with tugs and pulls and soundless signs. He needed to learn that sounds are more effective communications. For now, he made sounds more for apparent self stimulation than to communicate. Until then, he didn’t know the powerful positive effects sounds could have. And sounds were not quick to come. It took much waiting and prompting as well as having Pam coach the family into the habit of imitating all of Andrew’s sounds even if he was in a separate room. It took months to show Andrew that sounds got people’s attention most efficiently. By now, he was choosing to play with his brothers and parents, of course briefly and often on his own terms. But he was joining the family.

Pam continued to map Andrew’s progress on forms much like the ECO Basics. She regularly monitored both how he was doing and how she was doing. Once her watching, waiting and keeping him there were stable habits, I began to teach her how to help him move from sounds to words. She learned to treat his sounds and movements as his own special language and her job was to translate his actions and nonverbal communications immediately into single words. She learned that the exact the time he was doing something or communicating with someone was the best exact time for him to learn a word for it. We had to do some work to keep the family from asking too many questions which simply did not show him how to talk. We practiced talking to Andrew not just to be understood but to show him what to say at that moment. Andrew was understanding increasingly more words, but he was not using them. Pam taught her family to reduce their questions and long sentences and to become a family of translators as if Andrew was a visiting foreign-speaking child.

Now, three-and-a-half years later, Andrew is five and still coming into the world of his family and peers at school. He’s talking more frequently and appropriately; he now needs to learn to stay in conversations. He responds much less with fight and flight but he still needs to learn about people boundaries as he can be a pretty rough play partner. Recently I visited with Andrew and his father. His dad admits not seeing the problems his wife experienced. He is excited with Andrew’s social gains and feels they have a strong, playful relationship in which he, the dad, gets a lot from Andrew who used to be a stranger to him.


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Dr. James MacDonald 332 Mimring Columbus, Ohio 43202 Phone/Fax (614)447-0768 macdonaldj86@gmail.com