conventions. We were impressed with his pioneering work with autistic children, but we were also complacent. We’d already managed to teach toileting and self-help skills; we’d come a long way with language. Did we need this? Did Jessy?
But Jessy wanted that counter. We followed her lead, and she led us, all unknowing, as close as we’ve ever come to that thing so often claimed, so seldom found, a breakthrough.
The program had two elements: points for desirable behaviors (leading, if the number agreed on was reached, to a Popsicle at the end of the day), and a written contract.[33] It was important, I think, that Jessy was involved in both, that the process was not entirely imposed from without. It was Jessy who awarded the points, or subtracted them for such behaviors as hitting and screaming, whether or not I was present. Sometimes she made her own bar graph of the week’s numbers, in coordinated colors (lemonlemonlemon lime!). The day she reached 145:/2 when the goal was only 100, I realized that for mathematical Jessy not the Popsicle but the points themselves were her reward. The Popsicles were dropped unnoticed.
Even more important, Jessy and I negotiated the contract together. Shared attention! We made of our Sunday contract sessions a social occasion, both actually, as we sat side by side on her bed and reviewed the successes and failures of the past week, and theoretically, as I took the opportunity to talk about people’s behavior in general. Her enjoyment was obvious; much as she resisted reading, she loved reading the contracts, which I kept easily within her own vocabulary and comprehension.
One day, after more than a year of this, I set a long-term goal.
I had taught Jessy to swim in the usual way, without points, but she would still not go out of her depth or swim more than the two or three feet necessary to reach my outstretched arms. If we contracted for 1000 points for swimming the length of the pool, I thought, we’d have something to work up to during the next year. What happened? That very night she walked up to the deep end of the pool, jumped in, and swam the 75-foot length eight times.
Another incident, though less spectacular, had greater significance for social development. At this time, though Jessy was friendly, even affectionate with people she knew well, we had been unable to persuade her to make the simplest greeting: no hello, no smile, no looking in the eye. On the contract, then, went «Hello» (1 point). Plus a proper name: «Hello, Mrs. Smith» (2 points). Plus eye contact (3 points). Plus a fourth point for doing it all «spontaneously»; in Jessy’s words, «without told. Suddenly we began to get reports from school; from Mrs. Smith and Mrs. Jones and the speech therapist whose father was a London psychoanalyst and who had been working with Jessy for more than a year. „Hello, Mrs. Smith“. The click-click-click-click was hardly noticeable. And the new greetings, of course, elicited smiles and delight; Mrs. Smith and Mrs. Jones did not have to be programmed to deliver social reinforcement. Jessy was learning far more than mechanical greeting behavior. She was learning something even more foreign to her — to enjoy approval, since points and approval went together. If Jessy can now say, „I’m proud of myself“, and mean it; if she can repeat, „If at first you don’t succeed, try, try again“, and understand it, it is the result not of deep therapy that penetrated fourteen years of autistic refusal, but of clear behavioral specifications and that little counter.
Autistic refusal. It had been with her from the beginning, that hidden, withheld quality of so much she did and didn’t do, so that again and again we had to lure, almost trick, her into performing even activities that were clearly within her capabilities; so that again and again „couldn’t“ and „wouldn’t“ seemed indistinguishable. I had thought of that inertia as autism’s core, its deepest, most fundamental, most massive handicap.
I could scarcely believe, then, how shallow were its roots. The counter opened up an alternative explanation, less poetic than an existential refusal but closer to the facts of our experience. The contract worked because it showed Jessy exactly what to do and gave her a reason for doing it. The counter worked, with this child who counted before she could talk, for whom numbers possessed mysterious significance, because it provided for the first time a truly significant reward for effort. The tasks of development are hard; hard enough for normal children, harder for Jessy. She had not only to acquire ordinary self-help skills, but to surmount her communication handicap, to attend to speech and practice it, and to control her bizarre anxieties and the bizarre behavior that accompanied them. Why should she try to do these things? What motivates a child to grow?
Why even ask the question? Growth is „natural“, a child develops», its potentialities «unfold». The words themselves, in their root meanings, proclaim inevitability. We think about the process only when it fails to occur. But consider the child born to autism, able to understand unvarying shapes, routines, rules, but lacking the ability to interpret the constantly shifting, interlocking, mutually dependent appearances that make up the contexts in which human beings carry on their lives. Such a child will have no reason to master those hard developmental tasks. The normal child has strong social reasons to undertake them, to use the toilet like Daddy, to tie its shoes like Katy, to say words, elicit smiles, hugs, approval. Praise encourages it to do what comes naturally even to our cousins the apes, to imitate and join the life around it, to grow independent, to grow up. Children want to be like other people, and when they fail they are embarrassed or ashamed. But Jessy had no idea what it was to be like other people; she was as immune to embarrassment as she was to emulation. Praise had been meaningless to her; it came at her out of the inexplicable universe of what other people think and want. When praised she had tuned out, or worse, stopped the behavior that elicited it. Now, in her fifteenth year, it began to take on meaning — as a side effect of abstract numbers, of the mechanical reinforcement of a golf counter.
One Friday, after a year and a half of contracts, Jessy’s teacher called; she had something important to tell me. «Jessy and I have made a decision. Jessy’s not going to work for points anymore, she’s going to work for praise». And Jessy echoed, «Work for praise!» I was surprised at the suddenness of this unilateral decision, yet I understood it. The school had had nothing to do with administering the contract; Jessy had credited and debited herself, with the autistic, rule-bound exactitude that knows no possibility of cheating. But with her astonishing penchant for categorization, she had subdivided her list of behaviors, originally consisting of a few simple items, into a proliferating complexity ol subitems, and true to form was now in danger of occupying herself more with counting clicks than with the behaviors themselves. I had tried to «fade the prompts», to reduce the number of items — they now covered two full pages — but the system was Jessy’s, and it had taken on an autistic life of its own. Now I was told that Jessy and the teacher had decided to go cold turkey — no points, no contract. I didn’t think it would work; I anticipated a hellish weekend and a return to contract security, but I always support the teacher, and I said, «Fine».
But it did work. All the behaviors were maintained. Jessy kept on setting the table, taking out the trash, washing her underwear — all the simple, concrete acts that the contract had first rendered possible, then automatic. And of course with every one, we praised. We smiled, we hugged, we said, «Jessy, that’s good, that’s wonderful!» And after each instance Jessy, now smiling in open pleasure, chirped, «Is this praise? Is this praise?» The counter had taught her to enjoy praise, she had agreed to work for it, and she didn’t even know the meaning of the word. Mathematical abstractions might be obvious, but not this kind of abstraction — social, relational, taking all its meaning from human interaction. I recalled an earlier lesson the contract had taught not her but me: that Jessy had no idea what I meant when I included such items as Saying Something Interesting or Doing Something to Help. I’d learned to specify, say, six helpful behaviors, to define subjects of conversation that might conceivably be considered interesting. From those specifics Jessy could begin to grasp the social generalization, even, over the years, recognize new examples of the simple social category that practice had rendered familiar.
Behavior modification worked miraculously at the swimming pool, when there was no real resistance and only motivation was lacking. It worked miraculously with concrete actions that Jessy could understand, that she could do easily if she would. Doing Something to Help, for example, brought in a host of new activities. Jessy, it turned out, was perfectly willing to wash, to iron, to vacuum the whole house, and soon did it «without told». For things like these, the word «breakthrough» was entirely appropriate, and the gains were both permanent and significant. Every new occupation, after all, was an alternative to her sterile fallback activities, to sifting silly business or rocking.
In addressing the handicaps of autism, however, no break-throughs occurred. As the months passed and behaviors like Hitting and Screaming and Touching People’s Clothes remained on the contract, or more discouraging still, were dropped only to reappear weeks later, it became clear that behavior modification was a method, not a magic bullet, a method whose limitations were as significant as its powers. It was too much to imagine that complex social concepts could be built up piecemeal from a collection of imperfectly understood examples. Jessy
