“Get the banana,” the young teacher told the 3-year-old student at the Alpine Learning Group, a private school for children with autism located in Paramus, N.J.

Daniel is one of only 28 students at the Alpine Learning Group, a school devoted exclusively to teaching kids with autistic spectrum disorder using costly methods that require intense teacher attention to individual children. Although the highly regarded Alpine school has a waiting list of 600 children, its long-term future is uncertain.

In contrast, the Valley Program, a public special education program for children with autism that serves 36 towns in northern New Jersey, has been forced to grow rapidly to meet the needs of the increasing number of children diagnosed with the disorder. The Valley Program, started a decade ago for a few autistic students, now teaches 122 children, ages 3 to 14, in 17 classrooms.

The rapid expansion of the public program is the result of three converging factors: the swelling population of kids with autism, federal legislation aimed at improving the lives of children with disabilities and fiscal pressures on local school districts to reduce costs.

The challenge the Valley Program faces is maintaining the quality of its program while coping with public school budget constraints, especially if the number of children with the disorder continues to escalate.

Explosion of Autism in the United States

There is no consensus on the cause of the explosion of autism in the United States. In 1993, fewer than 20,000 children were diagnosed as autistic. But by 2002, there were 120,000, an increase of 500 percent over 10 years. The Centers of Disease Control and Prevention now estimates that autism affects one out of every 166 children.

In the 1970s and 1980s, the first pioneering treatment centers and private schools devoted to children with autism were founded. But when Congress passed the Individuals with Disabilities Education Act in 1975, the landscape of special education began to shift away from private to public programs. The bill, referred to as IDEA, mandated integrating disabled children into schools with their non-disabled peers to the greatest extent possible. This was more readily accomplished with public schools.

“There’s always pressure to open more public programs,” said Dr. John McKeon, director of the Valley Program.

Private programs devoted only to autistic children are now considered segregated, and consequently discouraged by both federal legislation and recent New Jersey court decisions.

Integrating into Public School Programs

“I agree with the mandate to always consider inclusion. But it requires a lot of undoing. There are many fine private schools,”
McKeon said.

Compounding the federal pressure to integrate children with autism is the high cost of their specialized education. Local school districts bear the cost of educating autistic children whether they attend pricey private schools or less costly public programs. Tuition for Alpine’s 11-month private program is close to $70,000, compared to about $50,000 for Valley’s public program. In comparison, average spending per pupil in the state of New Jersey is about $12,000.

“Is a district going to be able to do as good a job as the Alpine Learning Group?” asked Art Ball, director of government affairs for the New Jersey Center for Outreach and Services for the Autism Community. “Probably not. We have found that when districts say they’re going to bring kids back, they’re only doing it to save money.”

Ball added that most local districts don’t have the same experience that private schools devoted to the treatment of children with autism have been able to accumulate.

Since 1975, when autism was first recognized by the state of New Jersey as a mental disorder, 13 private schools like Alpine and nine public programs were created to serve the special needs of autistic children.

Alpine Learning Group

The Alpine Learning Group was founded in 1989 with only four autistic students. By 1998, the school had moved into its own spacious, modern building with six classrooms, a cafeteria, a gym and grounds designed for its children.

On a wintry morning this past March, the children and teachers in the Alpine Learning Group used exhaustive behavioral modification techniques to overcome the limitations posed by autism, a biological disorder of the brain.

“You’re so smart! Give yourself a sticker,” the teacher directed Daniel after he brought her the banana.

Daniel stuck a plastic butterfly onto a laminated chart. He and his teacher repeated this exercise until a full row of plastic butterflies flew across the bottom of his chart.

“What do you get now?” she asked cheerfully. Daniel did not respond or appear interested in her question. “TV!” she answered herself. She tried to settle Daniel into a white wooden chair in front of a TV. Instead, the small boy carried the blue plastic chair
out of the cubicle, while she switched on a videotape that showed actions matched to words.

Daniel, like many children with autism, struggles with normal social communication and interactions. He often firmly resists change, clinging to a familiar object or routine.

Disorder of Autism

The diagnosis of autism is usually made before a child reaches the age of 3. The severity of the disorder varies widely among the affected children. Some children may avoid eye contact and the touch of others, and speak little or not at all. They might stack blocks precisely. But they are unlikely to pretend that they can fly like a bird, create magic with the wave of a wand or climb a wall like Spider-man.

A cure for autism remains as elusive as its cause. Current research suggests that a complex interaction between genes and the environment disrupts normal brain development and function.

Researchers think that intense intervention may help a young child’s brain ‘rewire’ itself and that the earlier a child begins to receive treatment, the better.

Daniel’s communication and social skills are limited, but the intense treatment he gets at school gives him the best chance to recover from autism.

“Our children are not natural learners,” said Linda Meyer, executive director of the Alpine Learning Group. The school’s autistic students do not instinctively imitate other people’s actions. Although the school strives to help its students move to general education settings, it will not recommend that a child move to a mainstream classroom until the school sees that he can learn in a group.

However, New Jersey, which has the third highest percentage of autistic-only schools for children in the nation, is out of step with the national trend to include autistic children in mainstream classrooms.

Last summer, New Jersey declared a six-month moratorium on the opening of new private programs like Alpine, which serve about 20 percent of Bergen County’s 900 autistic children, ages 3 to 21. Although the ban has expired, the state tightened the licensing requirements for private programs, which has made them more difficult to found.

For now, Daniel and all students at the Alpine Learning Group receive coveted one-on-one intervention throughout their school day. Instructors rotate among the students in their classroom every half-hour. Two lead teachers who are certified in handicapped instruction preside in each classroom. Other classroom teachers have, at the minimum, a college degree in psychology or social work.

The treatment method the school uses is applied behavior analysis, commonly called ABA, developed more than 30 years ago by a California psychologist.

In the 1970s, Dr. O. Ivar Lovaas, a psychologist at the University of California, Los Angeles, began an experimental therapy with autistic children for 40 or more hours each week. He rewarded an autistic child with food, praise or a hug for social interaction and learning new skills, but he also withheld these rewards if the child continued to avert his face or flap his arms repetitively,
for example.

Applied Behavior Analysis

“ABA is the only proven model that helps kids with autism,” Meyer said. Other treatments, such as music, diet and medical therapies, have not been able to show the consistent improvement in behavior and learning that applied behavior analysis has demonstrated.

However, the success of the model depends on how rigorously the teachers adhere to its principles.

At the Alpine Learning Group, the staff works with the family to set each child’s educational goals, which often focus on life skills rather than traditional schoolwork. Over the school day, each child at the Alpine Learning Group follows a daily schedule broken down into a series of activities to be learned and practiced. Teachers painstakingly chart how the children perform on their activities to track their progress, which can sometimes be incremental.

Across the hall from Daniel’s classroom, the methods are put to work with older children. Zeke (See “ Zeke Rodriguez: A Teenager on the Spectrum”) sat at a desk in a class for four teenagers and rotated a Rubik’s cube in his hands. His teacher stood in front of his desk and held her clipboard.

“Good quiet, Zeke,” she praised. “Give yourself a point.”

She made a notation on her chart while Zeke added a Velcro dot to his laminated chart.

He worked to fill his chart with dots. Then he would receive one of his favorite rewards – free time to listen to his CD player.

Zeke, tall and sandy-haired, continued to sit and rotate the cube in his hands, although he did not try to solve the puzzle of the cube.

“Good quiet, Zekey,” she repeated. “Give yourself another point.” The teacher walked around behind him and patted his back in encouragement. And again, she recorded his behavior on her chart.

After Zeke worked for a few minutes, he and his teacher left the classroom for a walk in the hall. The break from the classroom work routine gave him an opportunity to practice skills he has already learned. Zeke’s teacher prompted him to say hello to people they met in the hall.

Zeke, Daniel and all children with autism in New Jersey have a legal right to an education provided by their home school district. The district and the child’s parents negotiate an individual education plan, called an IEP, for the child. If an autistic child’s home school district cannot provide an appropriate program, it must bear the cost to send the child to a private school or another
public school district.

At the Alpine Learning Group, the one-to-one ratio of teacher-to-student, the advanced educational qualifications of its staff and its facilities designed specifically for children with autism all combine to make the school effective, expensive and a highly sought-after placement.

“Alpine Learning Group is the Cadillac of schools for autism,” said Frank Fiore, father of a 15-year-old autistic son who has never attended the school.

The youngest students at the Alpine Learning Group have the greatest chance to overcome some or all of their autistic behaviors and return to their home school districts.

“We can make the most changes with our littlest guys,” Meyer said.

Since its inception the school has taught 44 students. It has helped 10 of its autistic students make a transition back into a less restricted setting—a regular classroom with an aide devoted solely to the child with autism, for example.

“But most of our kids will age out here,” Meyer continued. The majority of children on the spectrum will need varying levels of
lifelong assistance.

Measuring Progress

Measuring the progress of a child with autism is as frustratingly complex as the disorder itself. The severity of the disorder varies widely. Some severely affected children may never learn to speak or interact much with other people. They may resist any change in routine or their environment and engage in repetitive actions, such as spinning objects. More mildly affected children may demonstrate affection and have the ability to learn in a group setting with the help of an aide. But they might show an unusual fixation on a certain narrow subject.

The wide variability means there are no standards that can judge a child on the spectrum’s achievements.

The general public may consider the children who return to regular classrooms in their home school districts to be the greatest success stories of the Alpine Learning Group.

But for the parents of an autistic child, the most remarkable progress may be that the school has taught their child to sit through an entire meal quietly without springing up from the table and pacing ceaselessly.

“It is a huge relief each day to be able to send Zeke to this wonderful school where I know he will learn as much as he can possibly learn and will be well cared for and loved,” Zeke’s mother, Kim Rodriguez, wrote in an email. “With autism, in a sense, a school like the Alpine Learning Group takes the place of a lifesaving doctor.”

The Valley Program

Like Alpine, the public Valley Program also enrolls and tries to meet the needs of children at every level on the spectrum using applied behavior analysis.

Public programs, however, operate with a higher teacher-to-student ratio for less tuition. For $49,500 per year, Valley strives to provide a ratio of student-to-staff of better than two-to-one. It requires its classroom aides to have only a high school diploma. And it rents available classroom space in northern New Jersey.

“Staffing is my biggest issue,” said Kathy Vuoncino, assistant director and principal of the Valley Program. “The assistants leave – they decide the job isn’t for them – or they become teachers. I don’t know if Bergen County will ever keep up.” At least 40 percent of the Valley Program assistants leave each year, although the teaching staff is stable.

Moreover, the cost of educating autistic children far exceeds New Jersey’s average per pupil spending for general education. A local school district may try to meet the needs of its autistic students itself. Englewood, for example, has a self-contained classroom for four children with the disorder, ages 3 to 5 years old, housed in a local elementary school. The principal of the Quarles School did not respond to phone calls, e-mails or to visits to the school’s office to allow this reporter an opportunity to observe its public special education classroom for autism.

If the numbers of children diagnosed with the disorder continues to accelerate, so will the fiscal pressures to integrate these children in regular classrooms or make do with less intensive and individualized attention.

However, the fine public Valley Program is modeled after the Eden Institute, founded in Princeton in 1975. Eden is considered among the best treatment centers in the world for autistic spectrum disorder. One of its consultants visits the Valley Program twice each month to work with its teachers and assistants.

Applied behavior analysis breaks down desired skills into small tasks and grants rewards for successful performance of the tasks. When a child is young or learning a new skill, the rewards are immediate and primary – a piece of popcorn, a hug, or a ‘high five.’ When a child makes more learning progress, the rewards take longer to earn and become more individualized, such as free computer time, listening to music or watching a video.

A Transitional Classroom

“If you’re in my group, touch your heads,” a young teacher in the Valley Program said to three boys, ages 9 to 11, seated at a semicircle of desks. “Now stamp your feet! Now ‘high five’ your friend sitting next to you!”

The boys, who have all been diagnosed with autism, turned and slapped hands with each other.

“Now ‘high five’ your teacher!” said Justin Saxon, the 26-year-old teacher, stretching his arms wide, nearly belly-flopping onto the boys’ desks as he strained to touch their hands. He mined every chance to connect with his autistic students, striving to keep them engaged both educationally and socially.

The 10 boys in Saxon’s class range in grade levels from third to fifth. Next door to Saxon’s room is another Valley Program classroom for younger children, whose grade levels range from kindergarten to second. Both Valley classes are housed in the local Harrington Park elementary school.

The children in the two Valley classes in the Harrington Park school are considered higher functioning. They can learn from others in group settings, and they can be motivated to learn new skills with rewards – free time on a computer or a class party, for example. They have been placed in transitional classrooms so that they can participate in general education classes with Harrington Park school children, if possible.

Despite the fact that his class is called transitional, most of Saxon’s students will never be fully mainstreamed into regular classrooms.

On a wintry March morning, Saxon rolled a soft, purple exercise ball in his hand. He squeezed it hard as he talked about the effort it takes to direct and coordinate the work of his five assistants and other support staff, such as speech and occupational therapists, who help him meet the goals outlined in his students’ 10 individual education plans.

Sometimes the child has a behavioral plan, as well. The plan is created when a child’s behaviors might harm himself or others, interfere with his learning or restrict his access to normal social settings.

Seven out of the 10 boys in Saxon’s class have behavioral plans in addition to their individual education plans.

“Behavior takes precedence over academics,” Saxon remarked, because it not only limits the child’s learning, but may also
disrupt the class.

A new boy in Saxon’s class this past fall used inappropriate language loudly. He repeatedly interrupted the class. Saxon and his class’s behavioral consultant devised a plan where the boy has a timer attached to a plastic sheet with Velcro dots. The timer is set for an amount of time. If the boy can control his language until the timer goes off, he earns a reward – free computer time, for example.

Timers go off for different boys all day long

Saxon maintains a complicated daily schedule in his class for autistic children. His boys shift across groups and change assistants depending on their mastery of the skills being taught. Saxon adjusts their schedules to those of their general elementary school peers’. A couple of boys from Saxon’s class go to regular gym class and another one of his students goes to several third grade classes every day.

Saxon believes in the benefits of inclusion. His kids eat at their own table in the elementary school’s cafeteria, but he has made it his mission to invite other kids to eat with them. Now some of the Harrington Park schoolchildren eat with Saxon’s boys of their
own volition.

But the mandate for inclusion becomes complex in practice. Some of Saxon’s higher functioning kids have the capacity to become increasingly aware of the differences between them and the other schoolchildren who share the same elementary school.

Saxon pointed out a boy in his class who recently asked his parents if he would outgrow autism, or if there is a medicine he could take to cure it. The boy withdrew from a touch football game with his Harrington Park elementary peers after he fumbled a play and stood off at the side, despite Saxon’s encouragement to continue.

Across the street from the Harrington Park elementary school, the Valley Program rents eight classrooms from the Our Lady of Victories Catholic church, which no longer operates a parochial school. The children in these classrooms are more severely affected by the disorder than the children in the Valley transitional classes. Their names have been changed.

A Contained Classroom

In Susan Levitt’s classroom of six boys, ages 6 and 7, two children are nonverbal.

James uses a small computer to communicate. He touches an icon for eating when he is hungry, for example, then chooses an icon for a meal or snack and finally opts for a picture of a specific food.

Todd uses a picture system to communicate and wears a laminated booklet of pictures snapped to his waist.

This past March, Todd at sat a small table with an assistant and a classmate. He worked on the task of learning to unscrew a small plastic bottle with a white cap. His teacher and parents chose this goal because Todd cannot open his lunchbox or his drink at lunchtime, which the children eat in the classroom with their teacher and aides.

Todd screeched in frustration as he tried unsuccessfully to unscrew the bottle, and Levitt noted the sound is his only vocalization. Todd’s assistant patiently helped him, while his classmate waited passively.

The challenge of motivation is apparent in Levitt’s classroom. Applied behavior analysis relies on a system of rewards and reinforcements to teach new skills. But finding a motivator for children who are severely affected by autism can be difficult.

The most primary reinforcer is food, used for very young children with autism and to teach new, difficult skills to autistic children of any age. A child with little or no appetite, though, is difficult to reach.

Alex, the other student paired with Todd, is thin and quiet, although he can speak. He sat while Todd struggled with the bottle, but he didn’t reach over to help or fidget or talk or tease. He simply sat.

Although the children in Levitt’s classroom do not move into general education classrooms, the Valley Program helps them adapt to everyday life experiences.

Once a week, Levitt, the aides and the children in her class take a field trip to the mall, supermarket or park. The goal is to help the children learn to control their autistic behaviors in public settings and prepare them to lead as normal a life as possible.

Frank Fiore’s 15-year-old son has now aged out of the Valley Program.

Fiore has been an active parent advocate for public education programs for autism since his son was young. He and his wife moved to Montvale from central New Jersey so that their son could attend the Valley Program. Fiore believes it’s the best public school program for autism in New Jersey, despite the ongoing difficult challenge it faces of maintaining quality while accepting new autistic students and controlling costs.

At home, Fiore called his son into the kitchen. The nonverbal teenager, severely affected by the disorder, does not make eye contact and paces restlessly around the house. Only a Disney movie captures his attention and keeps him seated for a short period of time.

Fiore wanted to demonstrate the fundamental safety skill the Valley Program had successfully taught his son.
“What is your name?” he asked.

In response, the teenager paused to absorb the question, pulled out a wallet, opened it and showed his identification card.