A third of the children at the Walden Lab School have autism and benefit from playing with typically developing peers.

Achieving normal: Emory Autism Center aims for early intervention

A red fire truck and crackers with grape jelly are more than just diversions to keep students happy at the Walden Lab School. They’re also educational props for the staff, who rely heavily on “incidental teaching” in the preschool’s four classrooms to engage the children and encourage interactions.

The fire truck sparks a conversation between a curly-headed boy in a cowboy hat and his animated teacher about the color red, the purpose of fire engines—and sharing, after another child makes a grab for the shiny toy.

“We try to capitalize on kids’ natural curiosity, teaching social skills as well as age-appropriate play,” says Sharon Hynes, who coordinates the Emory Autism Center’s early childhood programs.

The center, which opened in 1991, is part of the Department of Psychiatry and Behavioral Sciences and has become a national model for the diagnosis and treatment of children and adults with autism spectrum disorders. Also known as pervasive developmental disorders (PDD), these include autism, PDD-Not Otherwise Specified, Rett syndrome, childhood disintegrative disorder, and Asperger syndrome.

Children with autism make up a third of the students who attend the Walden Lab School at the Autism Center, located in a large brick building on Emory’s Clairmont Campus. The remaining students are “typically developing” children, without disabilities or delays, who serve as peer models.

“We embed intensive instruction for the children with autism into a typical classroom setting,” Hynes says. “The other children show what kids this age should be doing, saying, and playing with.”

Visitors are able to observe from behind large windows that look into each classroom. From the durable tables to the activity centers stocked with books, stuffed animals, and puzzles, the lab school resembles every other high-quality preschool.

But behind every similarity lies a strategic intent.

Tiny portions of drinks and snacks—on this summer day, grape jelly on crackers and small plastic cups of milk—coax the students to ask for seconds, which encourages interaction and language use.

When a toddler refuses to pick up and put away a game she has left on the floor, the teacher places her hands over the girl’s hands and redirects her, picking the toy up and returning it to its place.

Although the lead teachers in each classroom have bachelor’s degrees, many of the staff are Emory students or interns. They are a young, energetic group with more men than are usually found among preschool teachers.

“We get a lot of positive comments on the diversity of our teachers. A lot of them are psychology majors, but we get other majors too—theater, religion, pre-law,” Hynes says. “It’s an interesting student job that provides intensive on-site training.”

Autism is a developmental disorder ranging from mild to severe that appears during the first three years of life. Children with autism tend to exhibit difficulties in verbal and nonverbal communication, social interactions, and play; they may rock in place, seem “in their own world,” and avoid eye contact or touch. Four of five autistic children are boys.

In the 1970s, about four or five in 10,000 children were diagnosed with autism; now, it may be as high as one in 166 children, according to the Centers for Disease Control and Prevention (CDC).

“The increase is an international phenomenon,” says Gail McGee, director of the Autism Center. “Is this all accounted for by improved diagnosis or a broader definition of autism? We just don’t know. The CDC and researchers around the world are working on it.”

Parent groups who suspect that mercury in childhood vaccines accounts for some cases of autism have received considerable attention in recent years, but scientific evidence of a link has not been established. Some studies have shown that high levels of mercury in the environment correlate with high levels of autism in the area.

A genetic component has been established through twin studies—in identical twins there is about a 75 percent rate of both twins having autism, while in fraternal twins, this rate is about 3 percent. The fact that identical twins do not share the disorder in all cases, however, points to multiple causes.

A recent study has shown that men older than forty have a higher chance of fathering an autistic child.

Part of the center’s mission is to investigate autism’s causes, indicators, and potential cures, and its staff partners with researchers from the departments of genetics, psychiatry, and psychology, as well as the Yerkes National Primate Research Center.

Assistant Professor of Psychiatry Opal Ousley, for example, has done research on screening tools for autism in early childhood, possible biomarkers (physical indicators) of autism, and other genetic disorders associated with autism, such as Fragile X and 22q11 deletion syndrome.

“It would be difficult to do research without a clinical setting,” Ousley says. “The families here are interested in the biological underpinnings of autism, because it might lead to earlier diagnosis. That makes recruitment a lot easier.”

The center sees children as young as eleven months who are thought to have an autism spectrum disorder, although a follow-up diagnosis is recommended if the child is younger than three.

“Certainly both parents and pediatricians are detecting the symptoms at a younger age. We’re seeing about twenty-five children a year under two years old,” says McGee. “This number used to be zero.”

In general, the younger the diagnosis and earlier the treatment, the better the outcome. Walden Lab School has proven highly effective in preparing its students for inclusion in public schools—more than 90 percent of its graduates with autism have been transitioned into local kindergarten classrooms (with various levels of support) and more then 92 percent exit the program with functional verbal skills.

“We’ve seen huge improvements,” says Wendy Faber, whose four-year-old son, Andy, was diagnosed with autism as a toddler and has attended the Walden Lab School for two years. “He went from having two or three words to using four-word sentences, and we’re finally seeing a lot of spontaneous language.”

Faber drives more than eighty miles each way from the family’s home in Ellijay, Georgia, five days a week, to bring Andy and his sister, two-year-old Irena, to the preschool.

“There aren’t any resources where we live,” she says. “It’s a long drive, but it’s well worth it.”

The philosophy of educating children with autism has changed dramatically in the last ten years, from keeping autistic children in separate settings with specialized teachers to immersing them in as normal a life as possible, at home and at school.

“Many children with autism are left to sink or swim with no support in school. In that case, they almost always sink. We want to make sure that doesn’t happen,” says Sheila Wagner, assistant director of the Autism Center and coordinator of the center’s MONARCH school-age program.

The center’s tutoring program offers individual instruction in reading decoding and comprehension, written expression, math skills, and social skills; teacher training workshops are held during the summers.

Strategies that work with autistic students, says Wagner, include breaking tasks down into concrete steps, giving frequent breaks and reinforcement, and creating schedules and transition tools—such as a checklist showing “what has been done” and “what still needs to be done.”

In its family training program, the center offers hands-on, practical instruction to parents and other family members, taking trips to grocery stores and simulating a home environment.

“It’s easy as a professional just to say, ‘Go home and try this,’ ” says Toni Thomas, adult and family programs coordinator. “We try to go one step more, setting up a daily routine in as natural a setting as possible.”

When working with autistic adults, the center enhances social skills through support groups.

“Our group members often feel as if they’ve missed out on friendships and just ‘hanging out’ with people. They want that, but they don’t know how to keep it going,” Thomas says. “We’ve had poker nights and Mary Kay parties, we’ve gone to coffeehouses for games and activities. Just having people celebrate their birthday as a group means a lot to them.” —M.J.L.



 © 2006 Emory University