Lessons from the Front Lines: Helping a Student with Autism
Darian and his mother review his progress with Carol Amato
"We need you. Please come."
Speech-language pathologist Carol Amato vividly recalls
hearing this plea from a teacher the first time she walked the
halls of Paterson Public School #2.
Another speech-language pathologist and friend, Robin Kanis,
asked her to visit for a day. Kanis hoped Amato would consider
coming to work at the autistic program at the inner-city school
in Paterson, New Jersey.
Amato was immediately impressed by the respect the teachers
showed her colleague. Too often, she knew, speech-language
pathologists felt misunderstood or isolated in the schools where
they worked. But here, the teachers clearly valued her profession
- and wanted her help.
And so, four and a half years ago, Amato joined the staff at
School #2. Today she is part of a four-person speech-language
pathology team that works with nearly 60 children with autism and
over 40 children with communication and language disabilities. As
evidence of the school's commitment to the program, which was
the first of its kind in the school district, Amato and three
other speech-language pathologists have individual offices in the
school's speech suite - the kind of professional setting many
school-based speech-language pathologists must forgo. The program
also enjoys strong support from the school's principal,
Felisa Van Liew, herself a former speech-language
Above all, says Amato, the work is rewarding - and inspiring.
One of the children who has most inspired her is 10-year-old
Carol Amato and Darian at work
Darian started the autistic program at Paterson Public School
#2 when he was three years old, three years before Amato joined
the staff. The program works with students all along the
continuum of autism spectrum disorders, from those with very
severe and limiting forms to those who are high functioning, with
forms such as Asperger's syndrome-that's where Darian
falls on the scale.
When Darian entered the program, his autism had the upper
hand. At age three, Darian was highly resistant to learning and
did not talk. He was aggressive toward his peers and would
communicate by screaming and throwing severe tantrums. Based on
these behaviors, the school provided Darian with individualized
Darian made significant progress during his first year at
Paterson. Despite his many challenges, he was learning and
retaining information, and before long, he was able to take part
in a small group.
When Amato started working with him, six-year-old Darian still
had major problems focusing his attention on one thing and
displayed very limited social communication skills. Despite his
obvious intelligence, Amato knew it was unlikely he could be
placed in an inclusive classroom.
Fast-forward to Darian in fourth grade: This past year, Darian
was able to move out of a full-time placement in a severe
language-learning disabilities class and be part of the general
fourth-grade class, where he studied math, science, music, art,
physical education, and health. He's performing at grade
level in math and science, and is making good academic
How did he make this remarkable journey?
Carol Amato and Darian at work
The Power of Collaboration
Amato is quick to stress that collaboration has been key to
Darian's progress. "His success is an example of the
great things that can happen when an entire school community
works together in active support of student achievement,"
Amato says. "Not only do we have high expectations for our
students, but we have high expectations for each other."
Amato and her fellow speech-language pathologists collaborate
on all their cases, drawing on each other's education and
experience to find the best methods for each child in the
program. In Darian's case, Amato has relied heavily on
Celeste Mancinelli, a speech-language pathologist and friend she
recruited to work at School #2 who has expertise in dealing with
children with Asperger's syndrome. Another indispensable
resource is Barbara Brooks, the learning consultant who has been
Darian's service coordinator for more than six years.
Darian's parents, who are first-generation immigrants from
the Dominican Republic, are also essential to his impressive
progress. Their commitment is reflected in a decision they made
on their own when Darian was diagnosed with autism: they would
speak to him only in English. They knew he would face huge
challenges when it came to acquiring language skills, and they
felt it would be too difficult for him to learn both English and
"Carlos and Leonor Dominguez are loving, supportive
parents who have always advocated on their son's behalf.
They've done whatever was necessary to ensure his
success," Amato says. "Kids can fly when they have
their parents behind them. Darian is a perfect example of
With limited resources and so many children needing help,
speech-language pathologists are often under pressure to limit
the number of parent meetings they attend. However, Amato insists
on being at every meeting with parents. "The information I
learn is invaluable," she says.
At one point last year, Darian seemed to be regressing. Amato
and her colleagues weren't sure why. At his next parent
meeting, Darian's mom told Amato that he had been very upset
when he came home one day to discover that his bedroom had been
rearranged. Darian's disorder often causes him to need things
around him to be arranged in a particular way. For instance, when
he was younger, he sometimes didn't want to get in bed at
night because he didn't want to mess up the covers.
"While this might be a small thing to other kids, it
really traumatized Darian and affected his performance for
several weeks," Amato explains. "Once I knew what
triggered the problem, I was able to work with his parents and
teachers to get him back on track."
Focusing on Sights and Sounds
Autism manifests itself in many ways, and the developmental
needs of every child are different. When Amato began working with
Darian, her first goal was to help him focus on the important
instruction going on in the classroom, rather than on all the
other things that tended to capture his attention. To begin with,
he had a number of sensory issues that needed to be
For instance, a common symptom of autism affecting Darian was
the inability to filter sounds. Amato worked with the
school's audiologist, Dee Boiselle, to set up sound-field
enhancement - a device that works like an FM radio, helping
amplify the teacher's voice so that Darian can focus.
Darian also tended to flap his hands, a repetitive pattern of
behavior displayed by many children with autism. One of the first
objectives that Amato established was to help him overcome these
physical outbursts, and she worked with the occupational
therapist to help Darian learn to use a squeeze ball under his
At the same time, Amato began to work on Darian's social
skills. Initially, she used the pairing technique to get him to
interact with her. "In pairing, you make yourself the
purveyor of wonderful things, so that the child starts to
associate you with good things and slowly starts to connect with
you," Amato says.
"For instance, Darian is drawn very strongly to letters
and numbers, and he tends to focus on text rather than
people," she says. "So I would get his attention with
something in print and then shift his attention to interacting
with me - from looking at the book to looking at me."
Darian could verbalize when Amato started working with him,
but had a very difficult time expressing his thoughts. He
struggled with fragmented language and tended to talk "in
circles" rather than maintaining a consistent thought or
So Amato often uses concrete visual descriptions to help
Darian think about how he is communicating. To help him
understand the abstract concept of interrupting others and the
importance of taking turns, she showed him a drawing of two
people talking, with cartoon bubbles running into each other.
Now, when he interrupts, she tells him, "Your words are
crashing into my words," while tapping her fists together to
remind him of the bubbles in the cartoon.
Another effective approach has been to use music and movement
as memory strategies. Amato relies on a number of CDs designed
specifically for use by speech-language pathologists, as well as
creating chants to help Darian remember basic concepts.
"It's important to tap into all Darian's senses
to push him forward, especially with his social communication
skills," she says. "He has responded well to songs
about looking people in the eye when you communicate,
understanding cause and effect, and how to make and keep friends,
just to name a few."
Amato's work has made a world of difference. Darian is
thriving in his general education placement - academically and
socially. In fact, a visitor to his classroom wouldn't be
able to pick him out. With a round, friendly face and tousle of
dark hair, Darian seems like any other kid his age. He might get
distracted or act silly sometimes, but what ten-year-old
One-on-one, Darian's autism becomes more evident. But even
then, the average person probably wouldn't pinpoint the
source of some of his behaviors. His speech is intelligible, but
he still has problems with social communication.
"He has a tendency to talk excessively, so we've been
teaching him to look at the listener and get feedback,"
Amato says. "If he sees that the person looks interested,
then he knows it's okay to keep talking."
Darian's Big Day
In December 2005, Amato nominated Darian for the New Jersey
Speech-Language-Hearing Association's 2006 Distinguished
Achievement Award. When Darian won and was invited to Atlantic
City to accept the award, Amato spearheaded a fundraiser so that
his extended family could attend along with his parents.
When Darian received his award, he told Amato he was proud and
happy, but that he wasn't quite sure what a
"Distinguished Achievement Award" meant. Amato broke it
down word by word and then explained what would happen at the
Darian looked at her and said, "So Mrs. Amato, you mean
that I am a special stand-out success because of my improvement
in my communication and I'm getting a prize for this, but
it's not a real prize, it's an honor, oh - and a plaque.
And there will be all kinds of communication experts there -
therapists, speech teachers, speech specialists, language
specialists, 'hearatologists,' audiologists, and
At the dinner, Darian gave a speech in front of more than 100
people, including his parents, grandparents, and cousins. His
teachers and teaching assistants helped him practice his speech,
which had been typed out with special symbols reminding Darian
when to look at the audience and when to smile - making this
special night yet another teachable moment in his ongoing
acquisition of communication skills.
Darian also had a special surprise for his mom and dad. While
Darian hasn't yet tackled learning Spanish, the staff helped
him practice reading a special "thank you" in his
parents' native tongue:
"Mommy and Poppy, you have devoted your lives to helping
me succeed in school and in life. Thank you for teaching me how
to behave, helping me with my school work, and encouraging me to
always try harder. You are my most important teachers, and I love
When he came back to school from the awards ceremony, Darian
wanted to celebrate his achievement with classmates from both his
special education and general education classes. So Amato and his
teachers arranged a pizza party.
In order to prepare the students to interact with each other,
Amato presented a social skills lesson for the fourth-graders,
talking about things like body language, how to be friendly, and
what to expect from peers who have trouble with social
communication. She also explained that the most important thing
was to make Darian and the other students visiting the class feel
At the party, Amato put on some music that her 12-year-old
recommended - the sound track from High School Musical, a popular
Disney TV show. She was concerned that some of the special-needs
students would feel awkward participating, but the students rose
to the occasion.
"One by one, with encouragement from the general ed
students, everyone was dancing and singing," Amato says.
"The most touching moment was when all the students danced
around Darian, shouting his name and cheering for him.
Darian's mom and I just stood there hugging and
Bigger Dreams for Darian
Fortunately, Amato has been there to help Darian soar.
"What I've done is to explain his strengths and needs
every step of the way," Amato says. "I helped his
teachers and classmates and parents understand Darian, so that we
could all work together to help him learn."
The next big step for Darian will be making the intellectual
connection between the concrete and the abstract. This is the
stage in the developmental process that proves difficult for many
children, but his autism turns it into a daunting challenge.
"It will take a tremendous amount of time, but I have some
ideas about how we can help him make the leap," Amato
Amato also worries that Darian may have a harder time fitting
in as he gets older, so she's intent on focusing even more
energy on peer relationships. She wants to give Darian the skills
and understanding he will need to navigate the world beyond
Carol Keeps Learning, Too
Even after 30 years in her profession, Amato still finds
herself learning every day as she responds to each child's
unique needs. She readily admits she is sometimes outside her
comfort zone. "It can be overwhelming, and it's a lot of
work, but I find it wonderfully rewarding," she says.
According to Amato, the greatest lesson she has learned in her
five years at School #2 is the importance of involving herself in
the classroom. Traditionally, speech-language pathologists have
been trained to work in the "pull-out" model - taking
students out of the classroom for one-on-one or group sessions.
Amato knows that it's hard to change this model, but she
thinks it's critical.
"Many people call it 'push-in services' - but I
really dislike what that implies. I prefer the term integrated
services, or in-class services," Amato says. "With a
student like Darian, understanding his classroom setting is
essential. I can assess the expectations he has to fulfill and
the skills he needs to be a group learner, and I can pull in
other specialists when I see a learning obstacle where they can
make a difference."
Amato also looks at the curriculum and state standards so that
she can set goals for Darian that will help him succeed. Most
important, she works in partnership with the teachers at School
#2, who continue to be as welcoming as they were when she made
that first visit to the school, nearly five years ago.
"The most important factor is that everyone here respects
and values what I do," Amato says. "I work in a
fabulous environment. That's what keeps me here."
That, and children like Darian.