Lessons from the Front Lines: Helping a Student with Autism Soar

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 pathologist.

Above all, says Amato, the work is rewarding - and inspiring. One of the children who has most inspired her is 10-year-old Darian Dominguez.

Carol Amato and Darian at work

Darian's Journey

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 instruction.

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 progress.

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 Spanish.

"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 this."

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 addressed.

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 desk.

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 topic.

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 doesn't?

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 awards ceremony.

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 'speakatologists.'"

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 you."

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 included.

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 crying."

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 says.

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 School #2.

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.