An 8-year-old boy bounces down the hallway, covered head to toe in a stretchy, royal blue stocking. A weary 11-year-old swings back and forth in a hammock hung from a doorway. An active 9-year-old dons a weighted green vest.
Far from being punitive restraints, these and other sensory stimuli are aids that the 26 boys and 1 girl attending [the] Monarch School for Children with Autism often request. They help the kids pay attention while they’re having lessons; as rewards for completing a task, the stimuli provide the pressure and sensation they crave.
Monarch School, for children ages kindergarten to 22, opened in 2000 with a language-based educational program. That’s because language and communication are the biggest deficits in children with autism…
…Ryan Strozniak is learning the concepts of under, in, and behind. Most children spontaneously learn the meaning of these relationship phrases in the course of acquiring language. But Ryan, 8, like other children with autism, has trouble processing language.
To teach the concepts, speech pathologist Kristi Lambert uses visual cues: photos of Ryan standing in a basket or under a basket or next to a basket. As Ryan selects the proper photo to illustrate each specific prepositional phrase, he attaches a velcro-backed sticker to a chart that reads, “I am working for computer time.”
Photos, drawings and 3-D models abound at Monarch. Kids with autism have good visual processing; auditory skills do not work as well. Through pictures, gestures and written words, teachers try to break through the wall of autism.
Each child follows an individual schedule, illustrated with pictures. There’s a photo of the teacher posted at the entrance to each classroom, which matches the photo on the schedule. Teachers and students use visual icons to communicate instructions, feelings, desires and needs.
At lunch, children select a picture of a specific item they want to eat. The teacher reinforces the word by verbally repeating the choice. The theory is that eventually the child will use the spoken word. While most schools for autistic children employ visual aids to facilitate learning, Monarch emphasizes the method much more than other programs, says Dr. Howard Shane, a Harvard Medical School professor and part of a team of Boston professionals that collaborates with the Monarch staff.
“Some children eventually learn to compensate for the visual process,” says Shane. “Others will always need the visual assist.”
Visuals are an adjunct and a substitute for language, Ratner says. But they are not everything. “If a kid (who doesn’t talk) can point to a (picture) of a glass of water, that’s wonderful. That helps parents. But that does not a life make.”
“Giving kids and their families a life” is a phrase echoed by many Monarch staff members. The school focuses not just on teaching a child a specific task or lesson, but also on translating that to the larger goal, an improved quality of life.
…At Monarch, all teaching is concept-based, rather than skill-based. This means children can use what they’ve learned in the real world.
For instance, an autistic child in speech therapy can answer questions of “What is it?” or “Who is that?” 80% of the time. But outside the classroom, if you ask that child to identify, say, a chair, he can’t…
So Monarch teaches the concept of chair, that it encompasses rocking chairs, restaurant chairs, and overstuffed recliners…
…To train the students to tolerate change, teachers at Monarch try to build flexibility into their lessons. For instance, during a math lesson, a teacher will ask a child to add four numbers and then have him compute with three.
…Danny Ordillas, 9, is learning to read. Special education teacher Marcie Timen points to a picture of a toy in a book and asks Danny to say the word. Repeatedly babbling a variety of unrecognizable sounds, Danny finally manages to say “toy.” As a reward for his success in the pre-kindergarten reading readiness class, he gets to play for a few minutes with a toy called Light Brite, a board with light-up pegs. The sounds Danny makes comfort him if he’s not getting a lot of hugging and holding, says Timen. “He’s creating his own sensory stimulation, the vocalizations.” A group of four boys, working with a speech pathologist and two special education teachers, are singing a song, “There’s something in my bag.” The teacher puts an object in a sack and asks the boys, “What is it?” Or “Who is it?” Through the game, the boys are learning how to talk to each other and to interact with their peers…
Ten-, 11-, and 12-year-olds, all of whom talk and read pretty much at grade level, go on frequent field
trips, taking the rapid to Tower City, visiting the planetarium, going bowling. They go horseback riding
once a week.
…The field trips help the children translate the lessons learned in the classroom into daily life.
…After Monarch School was underway, Susan Ratner approached Shane, director of the Communication Enhancement Center at Children’s Hospital Boston. The school needed some expertise, and Ratner wanted to build a long-distance collaboration.
With the relationship now in its third year, two or three people from Harvard Medical School, Children’s Hospital Boston, and Massachusetts General Hospital are at Monarch about one day a week. Team members talk to one another and their colleagues at Monarch almost daily.
“We know all the children,” says Shane. “We know their needs, the issues, we’re involved in programmatic changes, new hires.”
Monarch was an exciting opportunity, says Shane, who holds a doctorate in speech and language pathology, because of its commitment to language and communication. It has five speech pathologists for the 27 children, which he calls far more than is typical. The school also has served as a laboratory for some of the Boston professionals’ ideas.
“The foremost thing was having a curriculum that makes sense, one that is carried over at home,” he says. “We wanted to package this and export the model to other programs. There’s a sudden upswing in children with autism. Every school system in the country is overwhelmed. Families and schools are desperate for strategies so children make progress.”
Above all, Shane wanted to make sure Monarch’s approach was humane. The school’s staff use aspects of applied behavior analysis (ABA), a repetitive, one-on-one approach that teaches social and language skills in very small steps. Each proper response is rewarded with a small snack, hug or kind word.
But unlike some practitioners of ABA, who include negative stimuli like bending a child’s arms behind his back or pinching, Shane says Monarch uses only positive incentives.
…Ohio has curriculum standards every teacher needs to follow. At Monarch, the staff develop language modifications to help the children meet these standards.
…Most autistic children do not pass the regular grade level proficiency exams mandated by the state.
Instead, they take an alternative assessment developed for youngsters with special needs.
…Monarch has begun to develop templates of their teaching methods and materials that can be replicated and used by teachers across the country.
But before Monarch staffers can share these ideas, they have to make sure the concepts work.
Data collection is key. For instance, to measure if a student grasps the concept of “in,” teachers will keep track of the number of times a student correctly places an object in a cup rather than beside or under the cup on successive number of days.
At Monarch, teachers measure not just accuracy, but also the child’s participation, Shane says. “We want to understand how independently he can accomplish the task. Did the teacher have to give verbal, gestural or physical assistance? Did the teacher point and say ‘go ahead’?”
…While experts disagree over the treatments for autism, they concur that intensive early intervention offers the best hope of raising a productive adult.
…Parents whose offspring have spent time at other special-education programs say they are pleased at their children’s progress at Monarch.
…Autism is a puzzling neurological disease. It’s called a spectrum disorder because there’s a broad range of developmental problems involving communicating and interacting with others. Autism also has a wide variety of symptoms. Some children don’t talk but will hug their parents and play with others. Some can’t stand to be touched. Others engage in harmful, repetitive behaviors, like banging their head against a wall. Some can’t tolerate subtle background noises, like the buzz in a fluorescent light. Frequently, children with autism have below normal intelligence or mental retardation. Autism can seemingly strike overnight. Sometimes, around age 2, a child’s behavior and language skills begin to regress. He descends, as one parent of an autistic son describes it, into a deep well.
…At Monarch School for Children with Autism, 20% of the students are Jewish. Although no one knows why some children have autism, scientists recognize heredity as a major factor. It occurs more often in children with a sibling diagnosed with the disease. While there’s no genetic test as yet, scientists have identified several chromosomal clusters that may lie behind autism. Others suspect environmental influences, like infections or childhood immunizations. Parents of children with autism vary diets, eliminate certain foods, try homeopathic remedies, and travel to Mexico and elsewhere for alternative treatments.
…Monarch Boarding Academy, the only residential facility in Ohio dedicated solely to children with autism, opened this past year and is currently home to four boys, ages 7 to 12. Two of the boys speak; two do not…
…Everything the school does, the academy continues, in 30-minute structured activity sessions. Each child’s individual schedule lists such activities as arts and crafts, chores, computer lab, reading and treadmill. The staff rewards desirable behavior with nutritious snacks, time with a favorite toy, or a session in the padded sensory room. Staffers record each child’s daily progress…