By Sherry Posnick-Goodwin
Amanda Adams watches student Angeline Molina work with Karlye at CSU Fresno.
Dominic, 5, sits inside a tiny room for some one-on-one time with Elizabeth Milan, a psychology graduate student at CSU Fresno. He converses with her just like any child his age, but flaps his arms once in a while when he’s excited.
“Grab the dice,” says Milan when this happens. The youngster holds on to the dice and calms himself as he continues the conversation.
His occasional “stimming,” or flapping, is barely noticeable to the casual observer. But when he first arrived for therapy at the Central California Autism Center (CCAC) at the college campus, it was a different story. He would “stim” or engage in repetitive, self-stimulating body movements constantly. He had difficulty paying attention and interacting with his peers because he lacked communication and social skills.
Amazingly, after intensive therapy at the CCAC, Dominic has lost his autism diagnosis.
“We can’t say that he is cured, but we might say he’s in recovery from autism,” says Amanda Adams, the California Faculty Association member who founded the program three years ago and oversees its operation. “After intensive work with us, he no longer qualifies for an autism diagnosis.”
Five other graduates of the program have also lost their diagnosis, she says proudly.
Adams, a Board Certified Behavior Analyst, joined the Fresno State faculty in 2006 as an assistant professor in the Psychology Department. Prior to that, she spent a decade working with children who have autism in a variety of settings, including university programs and school districts. As the director of CCAC, she conducts research in autism and trains students at Fresno State in using Applied Behavior Analysis (ABA), so they can provide early intervention to autistic children.
Adams and her cohort of trained students work intensively with preschoolers as young as age 3 who have been diagnosed with autism.
“With autism, the earlier the intervention, the better,” says Adams. “Research has shown that early detection and behavioral intervention are the most important things when it comes to treatment. It’s important to do screening right away. Parents may fear a false positive, but even if these kids went into treatment without being autistic, it’s like going into a superpowered preschool program. And no harm can come of that.”
Some children spend eight hours a day at the clinic to learn language, communication and emotional recognition. Children “copy and model” their student therapists while playing games, using manipulatives, answering questions and other interactions. It seems like fun and games, but they are learning how to communicate, take turns, and “read” emotions and moods in others. There are no sensory break areas here; instead therapists try to “redirect” a child in positive ways before that child has a meltdown.
“Eight hours a day may seem like a lot of time here for a very young child, but research shows that up to 40 hours a week of intervention delivers the best outcome,” says Adams. “Our goal is to help them catch up, and we can’t waste time.”
The program offers treatment for children on all levels of the autism spectrum using ABA, which grew out of the work of psychologist B.F. Skinner and uses reinforcement to encourage learning. Therapists break down skills ranging from simple to complex into repeated practice, usually in a one-on-one setting. When a child performs a task well, he or she is rewarded with a cracker or other incentive, such as being able to use the computer or play with a puzzle.
ABA has been criticized as a treatment that is harsh or robotic. However, Adams says, ABA has evolved over time, and at her clinic the interaction between youngsters and trained college students is playful and enjoyable. Graduate students working with the children are indeed very affectionate during their sessions, and make the behavioral therapy seem more like playtime.
“Lots of research now shows that neurological abnormalities can change, and that neurons in the brain can actually change when exposed to different kinds of teaching,” says Adams. “It’s not unlike a brain injury that people can recover from. We don’t know if a child would have gone through these changes neurologically and improved on their own, but teaching in an ABA structured manner increases the speed of their skill acquisition.”
Even when the youngsters answer questions correctly — about shapes and colors, for example — the question is asked again and again. The reason, says Adams, is that sometimes children with autism give “rote” answers without being aware of their meaning.
A little girl named Karlye, for example, was practicing to recognize facial emotions, such as angry, happy, sad, scared and surprised. When she answered a question correctly she was rewarded, but she forgot the correct answer within minutes.
“A regular child may take 10 times to learn the color red, while it may take an autistic child 100 times,” says Adams. “Parents who seek out our type of program are not looking for a quick fix.”
Parents meet in groups weekly and individually with therapists every other week to learn how to integrate ABA into a child’s life at home. There is also a component for siblings, so they learn positive ways to interact with their brothers and sisters.
“Our center-based model not only delivers high-quality treatment, but gives parents support and a place to go,” says Adams. “Sometimes parents of children with autism feel isolated. Here, they can meet other families with similar experiences and help each other deal with the stress and challenges of having a child with autism.”
While the student therapists conduct intensive one-on-one therapy with the children, graduate students watch behind one-way mirrors to supervise the activities and record their observations. Their observations are providing research as to which strategies — reinforcement, building rapport and pre-exposure to concepts — yield the best results.
“We definitely need to find out more about autism,” says Adams. “The figures show that we are dealing with an epidemic, and it looks like the disease is going to be a mystery for a while.”
To learn more about the Central California Autism Center, visit www.csufresno.edu/ccac.