Child development is, quite utterly, a miracle. A baby is born as wailing little bundle of flesh with nothing in his brain but the instinct to eat and sleep, some primitive reflexes like squinting at bright light, and basic movements like suckling, waving limbs in the air, and crying when hungry or cold or otherwise interested in drawing attention. Two years later, that same boy will be running around, naming objects and speaking in short sentences, following commands and asking questions, playing with other kids, gesturing at his parents, laughing, pouting, defying, engaging. Walk into any preschool or daycare and watch the little kids do their thing. I’ve never really thought of such a scene — chaotic, messy, noisy, and maybe a bit smelly — as a miracle, but it really is. We should marvel at all toddlers learning anything at all, not just the precocious ones.
Because on Monday, I got to observe a classroom-based intervention at the Center for Autism at Westchester and by golly was it jarring.
I watched from an observation room behind a two-way mirror when 4 clinician/teacher/staff people led in 4 young boys, ranging from 2 to 3 years old. Each in turn was led to the sink and asked to wash their hands. The motions were not too convincing and probably not too hygienic, especially when one boy hopped off the stool and started playing on the floor, but I sensed that the handwashing was was meant as a social ritual. They sat at a tiny table right in front of me — their corresponding clinicians ringed right behind them — and thus began snacktime.
Normally, a group of 2-year-old boys would laugh and babble each other, share food, or maybe just throw throw food at each other. I don’t know; I confess I don’t pay that much attention at daycares to describe one. But this table… you’d just know… something was off. It was as if the table were divided by invisible but impenetrable social force-fields. No verbal communication happened. No eye contact. No spontaneous gesturing, or efforts to meet gazes, or attract attention. One boy had a lot of strange stereotyped movements going on — grimacing, flapping, writhing, looking up at the ceiling — and I don’t know why. I’m not sure if he knew why either. Another boy grunted and barked a lot instead of eating.
But this was snacktime, and this classroom was one aspect of a prized Early Intervention program organized by NYP Westchester for kids “on the spectrum,” so snacktime was going to be educational for how to interact properly in the context of food. The kids were frequently redirected to make them stop leaving their chairs and rolling around the ground or covering up their faces with their shirts or doing whatever else. One kid was at the level where he would pick up a container, turn around, and hand it to his clinician and look pleadingly at her. She would acquiesce and hand him a piece of cheese. Then, he would do the same for a cracker. One kid seemed to be permanently nonverbal, so he had a velcro book with little cards with images of things like bananas and juice and bread on them. When he wanted an item, he selected the corresponding card from his book and placed it on the table. His clinician would then exchange the card for a piece of food. Another younger boy was being introduced to the concept of image books, being shown cards as he grabbed at food items.
After snacktime was playtime, and it was pom-pom day! One boy ran over to that side of the room, following his clinician, and it was becoming clear that his autism was not as severe as the others’. She waved a pom-pom in his hair and he backed up with a look of befuddlement on his face. When she held out a second pom-pom, he accepted the offer and proceeded to wave it in his clinician’s face. She laughed in response. Meanwhile, the other kids did not fare so well.
Autism, on the extreme end of the spectrum, is striking. At some point, it seems as the neural wiring that enables typical kids to learn social skills is, quite simply, missing. One continued barking and grunting — still not sure why — while staring off to the side of the room, then the ceiling, then the side of the room, then the ceiling. One boy found a note binder with papers and starting grabbing at the pages, seeming to enjoy the sound of the pages. When handed a pom-pom, he grabbed it without looking at his clinician, tried to rip it into pieces, then threw it at the ground, then started jumping up and down on it. Once, he leapt of his teacher’s foot (ignoring his yelp of pain) because… I don’t know why. The last boy stood between them and just started wailing. Loudly, hysterically, just standing in the middle of the room complaining of who knows what. But the reaction of those two boys flanking him less than arm’s reach away was so poignant: they did nothing. The boy doing the glancing finally looked back at the opposite wall and wandered off. The boy bouncing on his pom-pom started playing with the binder again. It was as if they were separated by invisible but impenetrable social force-fields…
The morning concluded with the strangest little sing-along sound ever. It was strange because a couple kids were entirely nonverbal so none of the boys actually sang along. They were supposed to wave goodbye to each other in sequence — I suppose that’s the therapy aspect of that routine — but the clinicians often had to grab their arms and help them wave in the general direction of the respective kids, and so they waved without even achieving any semblance of eye contact. Yeah, weird.
I was only present for the last 30 minutes of the 2-hour session; the parents also had a concurrent class; the session happens 3 times weekly; there are private home visits totaling to more than 20 hours of treatment per week. This program is intense but proven therapy. Such intervention might seem extreme, but It’s necessary to act when the kids’ brains still possess that extreme plasticity that of infancy. One of the clinicians mentioned to me in passing that once they leave this intense 1-on-1 therapy, the kids sometimes never progress further.
Moments after everyone left the classroom, in ran one of the boys. Apparently he knew his mom often waited there for him. She wasn’t yet, so he just plopped down down straight onto the floor in front of me and the other observers who had arrived (a resident and another family member) and rubbed his face against the carpet. Gross, but up to him, I guess. Then he started crawling his way around the floor, ending up underneath a desk. He arose quickly and banged his head on the edge audibly (I’d saved him twice, but missed this time). He immediately clutched his head in pain, but he made not a sound. No cry, no ouch, just silent clutching. So. Weird. Even when mom entered the room, he just continued crawling around. However, when she touched him a certain way and gestured for a hug, he rose up and gave his mom a huge embrace.
(Hmmm, not the most fulfilling ending to a post ever, but gotta run! Yes, seeing this confirmed my interest in autism research. I’m looking forward to next year)