Sharon Reeve is in her element, which happens to be a schoolroom floor. You spend a lot of time on the floor if you teach kids with autism—especially if, like Reeve, you are a practitioner of Applied Behavior Analysis. Pioneered in the 1960s, ABA is a therapeutic and educational approach to autism treatment that defies easy explanation. When I ask Reeve to define it for me, she says, “You really have to see it in action to understand what it’s all about.” So that’s what I’m doing now, visiting the Somerset Hills Learning Institute, a private school in Bedminster for children with autism. The session I’m watching looks at first like an everyday exchange between two typical preschoolers.
Carter, dressed in T-shirt, jeans, and sneakers that blink red when he moves, sits among the Legos spread around him like a plastic pond. He’s intent on Jason, his playmate (dressed similarly, without the high-tech shoes), who’s holding what might be a Lego plane or a souped-up surfboard. Carter’s sneakers blink up a storm as he scoots around the floor. “Hey, Jason,” he asks, “what are you doing?” Receiving no answer, he picks up a Lego vehicle and says, “Excuse me, Jason? Here’s your truck.” Jason accepts the truck, and his teacher, Elena Garcia-Albea, instructs him to “say thanks.” As he does, she gently pats him on the back. She’s on the floor, too.
All the while, Reeve—slim and blond, with an easy smile and vast stores of energy—is kneeling behind them, making sure that the kids and their teacher get it right. Reeve’s presence is the tip-off that there’s very little that’s typical about this moment. The “classroom” is really an approximation—a place designed to get autistic students accustomed to a school setting. And Carter is not a fellow student; he’s a volunteer, enlisted to help Jason learn to interact with other kids by playing with him as if he were a schoolmate. Garcia-Albea is a teacher (or more precisely a student teacher), but her primary job is to instruct students like Jason in the rudiments of behavior that, to the majority of kids, comes naturally: responding when he’s spoken to, making eye contact, playing. To achieve those ends, she rewards Jason (in this case, with praise) when he exhibits the right behavior and gently redirects him when he does not.
That, Reeve tells me, is ABA in action. The discipline has its roots in the work of psychologist B.F. Skinner, who believed that the most efficient way to effect change in human beings is to focus on their behavior. The aim of ABA in the treatment of autism is to improve what are considered socially significant behaviors—actions like looking other people in the eye, eating communally, and speaking when spoken to (or simply speaking).
ABA is not the only therapy used to treat children with autism. The Picture Exchange Communication System uses a series of picture cards to improve communication skills—since some autistic children seem to learn better through visual, rather than verbal, cues. Sensory Integration Therapy employs neurosensory exercises in an effort to help the brain repair itself. And TEACCH (Training and Education of Autistic and Related Communication Handicapped Children) focuses on the child’s physical and social environment in the belief that greater structure can help autistic children learn more efficiently.
No one therapy is considered right for all autistic children, and all autism therapies have their critics. But ABA, says Reeve, is the only therapy for autistic children that can boast results backed by peer-reviewed research. In fact, some studies have shown that half of all children enrolled in an intensive ABA program may lose the diagnosis of autism entirely. It is not surprising, then, that in a state with an often-cited high prevalance of autism diagnoses—1 in every 94 8-year-olds in the Garden State has been classified as autistic—there are not nearly enough ABA-trained teachers to meet the demand. But thanks, in part, to Reeve and her husband, Ken—both associate professors of psychology at Caldwell College—New Jersey’s supply of autism educators is increasing. In 2004 the couple founded the state’s first master’s program in ABA at Caldwell. And this fall, as a result of their efforts—and the clamor of prospective students—the college hopes to introduce the Garden State’s only PhD. program in the discipline, pending state approval.
In 1991, Sharon Reeve was a doctoral candidate in psychology at the Graduate Center of the City University of New York in Manhattan, with only the most fundamental knowledge of ABA. “This was back before Rain Man,” she says, “and most people didn’t really know what autism was.” Her education in the disorder had its start when she volunteered at an autism program—underfunded and held after- hours in a public school in a less-than-savory neighborhood in Queens. Reeve was instantly smitten with the work. “I had no idea how rewarding it could be to teach children with autism—you might be the first person to hear them speak.” A year later she met Ken, also a PhD. candidate, and swayed him with her enthusiasm for autism education. Eventually, they both received doctorates in ABA from CUNY.
In 2000 they were hired as adjunct professors at Caldwell College, a Catholic liberal-arts institution in Essex County whose 2,300 students include about 1,100 adults pursuing degrees part-time. At the time, Sharon was teaching statistics, and Ken, child development. But no one is more determined to ferret out expertise than parents of autistic children, and the Reeves began to receive phone calls beseeching them for help.
One of those calls came from Mary Beth Walsh, a resident of Maplewood and an adjunct in Caldwell’s theology department. Her son, Ben, had been diagnosed with autism at the age of two and a half. After the call, says Walsh, “Sharon all but moved into my house.” She set up an intensive ABA home program for Ben, recruiting, hiring, and training four teachers and working with him herself. The effect on Ben’s behavior, says Walsh, was apparent almost immediately. Like most autistic children, Ben exhibited a host of stereotypical behaviors; every time he and his father, John Hack, walked through downtown Maplewood, Ben had to step on the same sidewalk grate, touch the same lamppost, flip open the same mailbox slot. One of his most vexing habits was entering the local King’s supermarket only to leave immediately through the exit—a maneuver he’d repeat ad infinitum if allowed, thanks to his passion for automatic doors. If Hack tried to take him farther into the store, he’d throw a tantrum.
Luckily, Ben had another passion: popcorn. Reeve made it his number-one reward, offered only when he behaved in a manner deemed appropriate. Entering King’s, Hack would tantalizingly wave some popcorn in front of Ben; if he didn’t make a move toward the exit or start to melt down, he got the treat.
Eventually, Ben’s parents were able to phase out (or “fade,” in the parlance of ABA) the popcorn and replace it with praise. Today, Ben, now 10, is a student at Reed Academy, an ABA school in Garfield, and a fixture around downtown Maplewood. “He walks into town with us, and he goes into whatever stores you want him to,” says his mother. “He can wait in line, he says ‘Hello’ to people, all the merchants know him—he’s a real part of the community.”
As the Reeves continued to field calls from parents like Walsh, they realized there simply were not enough trained ABA professionals to meet the demand. The solution, they agreed, was to launch a program training others in ABA. For Sharon, this was nothing short of an epiphany: “I was teaching 25 kids, and there were thousands of kids with autism. To get more trained professionals out there became a kind of calling for me.” The couple labored for weeks on a proposal, then made an appointment to pitch the program to Caldwell’s dean of academic affairs, Paul Douillard. They were prepared to mount a fierce defense, but after they handed over their weighty information packet, Douillard was immediately sold. “Oh, sure, my daughter works with kids with autism,” he told the Reeves. “I think that’s a great idea.”
The program was up and running by 2004, and the response has been extraordinary. Ken Reeve uses the phrase “bursting at the seams.” Currently, there are more applications than slots, many of them from people who have been personally touched by autism. Kathleen Moran, for instance, was drawn to the program in part because her brother Michael, 22, suffers from Asperger’s syndrome, a form of autism.
She regrets that he could not have gotten the kind of intervention she is learning to provide to her young students at Cedar Hill Elementary School in Basking Ridge, where she works as an instructional aide. But she is still heartened that she can help others. “I’m teaching a girl who didn’t speak when I first met her,” she says, “and now she asks for things, says people’s names. Every day I see improvements in these children that amaze me.”
Of course, ABA does not come cheap. Federal law requires that public schools offer every special-needs student—including students with autism—an appropriate education, but since not every district has the wherewithal to provide an ABA program, many arrange to transport students to other districts or to private programs. Private schools charge roughly $90,000 to $110,000 a year, with public school districts picking up about 80 percent of the cost. (Busing represents up to an additional $40,000.)
Public programs, which are also paid for by the local district, generally cost less—about $50,000. Parents dissatisfied with the options in their district have sued for the cost of tuition in their preferred program—and most have won. The state offsets some of these costs; in 2007, the state budget allocated $15 million to support district autism programs, with an additional $4.5 million in special grants. But costs aside, even districts with well-funded programs don’t always provide ABA, often for a lack of qualified instructors.
Caldwell’s doctoral program in ABA should help alleviate that shortage. Like its master’s program, it is essentially a response to unmet demand. “People who weren’t even enrolled in our master’s program started writing letters to the president demanding a doctoral program,” says Sharon. At one point, Sister Patrice Werner, president of Caldwell College, confronted the Reeves. “She pulled us aside, showed us a stack of letters, and said, ‘Ken and Sharon, are you responsible for this?’ I told her I wished we’d been smart enough to think of it,” Ken says.
The Reeves are looking pretty smart these days. Since 2005, the program they founded has graduated 45 students, with 25 more expected to graduate each year—and that does not include the doctoral candidates. Starting this fall, Rowan University in Glassboro will become the second school in the state to offer its own master’s program in ABA. But while the National Academy of Sciences, the American Academy of Pediatrics, and the Surgeon General all endorse ABA as an effective treatment, its use remains surprisingly rare.
According to the Association for Science in Autism Treatment, a not-for-profit organization advocating higher standards in autism care, fewer than 10 percent of autistic children receive ABA, either in a private or public school setting, because there simply aren’t enough teachers to meet the demand. In response to that particular statistic, Sharon Reeve offers her own mathematical insight: “Every doctoral student that we produce can affect more than 100 kids with autism; if you do the numbers, that means we’re helping thousands of kids.” In a state where more than 8,000 children carry an autism diagnosis, that’s a formula for hope.
Leslie Garisto Pfaff reported on charter schools in the September 2008 issue of New Jersey Monthly.