From the moment parents absorb the shock that their child may be autistic, they enter a dizzying world of specialists, therapists and, alas, purveyors of snake oil. Getting the right help quickly is paramount, but it is hard to make good decisions when you are in a panic or fighting despair.
For the past 20 years, the dominant way to work with autistic children has been based on Applied Behavior Analysis. ABA derives from the classic work of psychologist B.F. Skinner, who showed--mostly in animals--that behavior can be altered with carefully repeated drills and rewards. In 1987, Ivar Lovaas at UCLA published a small study with huge repercussions. He reported that 9 out of 19 autistic children taught for 40 hours a week with behaviorist methods had big jumps in IQ and were able to pass first grade; only 1 out of 40 in control groups did so. It was the first bright ray of hope in autism.
Recent years have brought questions about the ABA model. When Lovaas protégé Tristram Smith tried to replicate the 1987 findings in a 2000 study, he got a more modest success rate on academic measures and virtually no gains in social behavior. Others, meanwhile, have devised new ways of working with autistic kids. One of the best known was developed by child psychiatrist Stanley Greenspan, who spent 15 years studying infant development at the National Institute of Mental Health. His method, called DIR (developmental, individual-difference, relationship based), has as its premise the idea that an exchange of emotional signals, initially between mother and infant, form the basis for learning in childhood. Greenspan trains parents and teachers to engage the emotions of even the most withdrawn toddlers by getting down on the floor and entering the child's world, helping turn repetitive acts like lining up blocks into playful interactions. He describes the method, also called Floortime, in a new book, Engaging Autism.
While the majority of U.S. programs for autistic children are based on ABA techniques, DIR has made inroads, and many programs now mix elements of both. How do the techniques differ in practice? To find out, TIME visited two schools, each a model for one school of thought.
ALPINE LEARNING GROUP
IT'S EASY TO SEE WHY A PARENT would fight to get a child placed here. Who wouldn't want this calm, orderly world for an anxious child with all the sensitivities of autism? Alpine, in Paramus, N.J., has 28 students, ages 3 to 21, in six gleaming, light-filled classrooms. The staff-to-child ratio is 1 to 1. The $72,223 tuition is covered by the state--federal law requires a free education for children with disabilities in an "appropriate" setting.
At Alpine, every goal, every lesson, every response is carefully documented in binders that track each child's progress. That is the rigorous heart of ABA, explains executive director Bridget Taylor, who co-founded the school in 1988. "I'm a scientist-practitioner; I need data," says Taylor, a certified ABA therapist with a Ph.D. in psychology. The binder for Jodi DiPiazza, 4, is easily seven inches thick, though Jodi has been at Alpine less than a year. Like most other children at the school, she started ABA therapy at home as a toddler.