She pulled one of them straight and flipped it over, so that Zachary could see the red button recessed in the back. An inkling of what Nancy was telling him crept into Zachary’s consciousness. All of the guards and aides with boxes on their belts. Boxes with pictures of the residents stuck to them. Not pill boxes. Not schedules. Not keys. A single button that did only one thing.
“That’s how you give them shocks?”
“Yes.”
Zachary just stared at it. He had thought it was sweet, each of the staff members carrying with them the pictures of the kids they helped care for. He couldn’t have been farther off base.
He went back over what Nancy had said last in his mind, rewinding the track and replaying her words. “And Quentin understood what it did. If you showed him your remote, he knew you were going to shock him.”
She nodded.
“And that kept him from attacking anyone.”
“If he got upset and started to show threatening behavior, seeing the remote would stop him in his tracks. Usually.”
“So… him being violent like he was when he was at home… that wasn’t a concern.”
“Not usually. Though he’d had some issues lately. We were usually working on more complex issues.”
“Like…” Zachary thought back to his interview with Mira, “speech.”
“Speech is one of the most important social skills. If he could have become more adept at communicating with others… it would have been a huge step for him.”
“Was that something he could learn to do?”
“He was definitely showing progress. He was able to engage in short conversations.”
“His mother said something about them being scripted.”
“That’s how we start. Getting them to repeat phrases. Learning that one response generally follows another in conversation. It’s very complex and takes a long time to teach, but broken down into the smallest building blocks…”
Zachary nodded slowly.
“His mother said that he’d been agitated on her last few visits. Had you noticed any difference in his behavior?”
Nancy ran her fingers through her hair again. “I would say… he’d been having some issues. Maybe hormones. Teen moodiness. More aggression with a boost in testosterone.”
Zachary flipped back several pages in his notebook. “She said that when he got agitated, he picked his skin and flapped. He made noises and didn’t want to sit down. And banged his head.”
Nancy gave a little shrug. “Those are all pretty common behaviors for kids with autism. We try to break them of stims.”
“Stims?”
“Self-stimulating behavior. Repetitive, self-soothing behaviors that children with autism often have. Lovaas dictated that all behaviors that make them appear different need to be eliminated, so that nothing will set them apart from their peers and they can become full members of society.”
“But… is that really possible?”
“Some of our kids have gone on to become very successful. You really can’t tell, looking at a young child, which ones will be successful and which ones will limit themselves. A child that you would have thought was low-functioning leaps over hurdles, and one that you thought was high-functioning and really didn’t have that far to go just can’t seem to get any movement at all. We tell parents that the younger they can get their kids into the program, the better their chances are. That’s just emphasized when you get a child like Quentin, who’s basically been allowed to do whatever he wants to for the first twelve years of life and is being asked to work at something for the first time.”
“His mom made a mistake not getting him into a program sooner?”
“Yes. He hadn’t had any discipline, any consequences. She had babied him. So the program was quite a shock for him.”
Zachary grimaced at her choice of words and bit his lip to avoid saying ‘literally.’
“You said that he liked to stay in his room and didn’t wander at night, so his sleep was pretty good?”
“Most of our kids have some sleep issues. Especially if they’ve been taking sleep aids for years before they come here. We find that a strict schedule, with no variations in lights-out and wake-up time on weekends and holidays is the best remedy.”
“They didn’t get negative consequences—aversives—if they had sleep problems?” The institutions Zachary had lived in had been pretty strict about any nighttime activities that varied from the prescribed sleep and wake time. No getting out of bed. No wandering. No trips to the bathroom. No complaining about having nightmares. Even having nightmares was considered bad behavior. So was sleepwalking.
“We tried to keep things calm and relaxed after lights-out,” Nancy hedged. “You don’t want to be upsetting the residents at bedtime, when they’re supposed to be settling down.”
“No shocks after lights-out?” Zachary ventured.
“Well… not usually.”
Zachary scratched his head and wrote a couple of lines in his notepad. It was obvious Nancy didn’t want to make things sound any worse. Zachary decided to back off a little. If he wanted her to answer any more questions, he was going to have to take it easy and not back her into a corner. She was currently his only cooperative information source.
“Tell me what happens after lights-out. Bed checks? What’s the night-time supervision like?”
“The security staff make sure that everyone is in their rooms and accounted for. Some of the kids pace or stim for a long time before going to sleep, so there’s no rule that they have to be in bed, just in their rooms. There is someone on the unit all the time, making sure there are no problems. Security does rounds a few times each night.” She pulled one of the binders out of the stack and flipped pages to find the night that Quentin had died.
Zachary studied the initialed spaces. The initials were not readable, but the same squiggly mess was on each of the lines. Two hours apart. Which meant that Quentin’s death should have been noticed on three separate checks.
“And the guard who signed off on these checks is no longer with Summit?”
“Dr. Abato said he should have noticed Quentin’s death some time before it was discovered. So… he was asked to resign his position.”
“To take the fall. So that it would look like Summit was taking this seriously.”
“He should have noticed something was wrong,” Nancy said.
Zachary nodded. He tried to visualize everything in his mind. He had seen the bedroom. He had seen the pictures of Quentin’s body in the bedroom before it was removed. He had spent many hours locked in rooms like that, peering through windows like the one in Quentin’s door. The viewing angles were limited. A child lying on the floor might be difficult to see clearly.
“The person who found him in the morning. Was that… you?”
Nancy nodded. She looked tired. Like she had seen too much, and she just didn’t want to see any more. Too much sadness. Too many kids in pain. Too much loss.
“Yes. I went to see why he hadn’t come out for breakfast. He’d been on Contingent for so long, he was always one of the first ones out, looking for something to eat.”
Zachary refrained from pointing out that they would then refuse to give him breakfast because he wasn’t able to demonstrate all of the proper behaviors. He waited for Nancy to gather her thoughts and tell him what had happened.
Nancy stared off into space, looking past Zachary.
“I thought maybe he was sick. Or maybe he’d just given up after the night before. I opened his door and I saw him on the floor.”
“Did you know right away…?”
“I didn’t want to accept it. I imagined he was still sleeping or not feeling well, or that it was some kind of prank or joke, and someone was watching to see what my reaction would be.”
Zachary had been in that type of situation before. There was always the initial moment of disbelief. The moment when his brain refused to believe what he was seeing and sought any other explanation.
The pictures from the police hadn’t shown that. The blanket had been removed from his throat in order to check his pulse or administer first aid.
“How was it positioned? Did it look like he could have done it himself? The twisted ends… were they in the front…? Not the back?”
Nancy nodded. Her hands moved of their own accord, as if she were untwisting the blanket. Fingers gentle.
“I couldn’t believe it. I kept thinking that it was all a mistake. A nightmare. But there he was, stiff and cold. Like he was made of wax.”
“I’m sorry. That must have been very hard on you.”
She nodded, blinking tears.
“I have another question for you, and I know it’s very difficult. But… did he have the ability to form the intent to commit suicide?”
“I’m not sure what you mean.”
“Just… this is a child who couldn’t carry on a real conversation. Who lashed out when he was upset. Who banged his head. Did he… did he have the ability to decide he wanted to kill himself and then devise a plan like this to strangle himself, and then to follow through with it? I would think… those are some sophisticated thought processes. Could he do more than just react to a stimulus? Did he have the ability to think all of that out?”
Nancy looked at him. She stroked the smooth cover of one of the binders.
“I don’t think I’m qualified to judge,” she said finally. “So often, I would think that a child wasn’t paying any attention to me. That they hadn’t even been aware of the fact that I was talking to them, much less actually paying attention and able to understand what I had said. Just to have them do something that proved me wrong. I think that difficulty with speech is the most disabling thing for our kids… No feedback into what’s really going on in their brains. Quentin might have been brilliant; I have no way of knowing. He was definitely adept at resisting a stimulus. He proved that to us time and time again. But was it evidence of higher reasoning abilities? Or just stubbornness? Or maybe he had no idea what we wanted him to do. Maybe it was an accident. Maybe he was just soothing himself with deep pressure, and then it was too tight, and he couldn’t get it off.”
“Who was here that night and had access to his room? If his door wasn’t locked, then that includes anyone with access to the unit.”
“That would include practically everyone at Summit. We can all go from wing to wing and unit to unit with very few restrictions. I can give you a list of the people I know were here that night. But everyone who might have been here? Like I said. Anyone.”
“Was there anyone who had a problem with Quentin? Someone he got into fights with? Or who resented him? Someone he had hurt or made to look bad in one of his violent outbursts?”
“No,” Nancy shook her head. “It’s not like that. We’re just here to do a job. Sure, it’s stressful and some of the residents can be miserable to deal with. But at the end of the day… we go home, and they stay here.” She shrugged. “As far as any of the other residents doing something to hurt him… no, no one in the unit would do that. We have other kids at Summit too, kids who have mental illness or are delinquent rather than developmentally disabled and they’re different… I’m sure some of them would be able to do something intentionally violent or evil. But our kids with autism, no. All of the children in this unit are the same. They are all developmentally delayed, not mentally ill or delinquent. They don’t make enemies with each other. Mostly, they’d rather just be left alone.”
Zachary nodded and made a couple more notes. “Did he have any particular friends?” he asked. “Do any of them develop friendships…?”
“Of course, yes. Even those who are the most socially awkward still seem to be able to transcend language and social convention and hit it off sometimes. It can be quite sweet. I know that Quentin had one little fellow who was quite attached to him. They went to therapy one after the other, so they would pass in the hallway or waiting area. Started noticing each other and waving. This little guy gave Quentin a hug one day. And another day, Quentin spontaneously tries his ‘hello, how are you?’ script on him. So cute.”
Zachary nodded. “Who was his friend?”
“Raymond. Ray-Ray, they call him.”
“I met him. So does that mean Sophie was Quentin’s therapist too?”
“Yes.”
Would Sophie have seemed like a big, scary woman to Quentin as much as she did to Ray-Ray? Remembering how dogged she had been about getting Ray-Ray’s compliance, Zachary had to wonder how she got the compliance of the bigger, stronger, more violent boy.
But he knew how.
With sixty shocks in one session, as recorded in Quentin’s log book.
Chapter Twelve
Z
achary had planned on getting a good night’s sleep. It had been a long, emotionally taxing day, and it would have been best if he could have gotten in a full night’s sleep for once and woken up refreshed in the morning, ready to take on the day.
But he’d emailed Margaret Beacher when he got back to Bowman’s apartment, asking for some more information and she had emailed back some reference material. He didn’t want to go to bed until he’d had a chance to look over what she’d sent.
He skimmed over articles by adults with autism who echoed what Margaret had said about ABA and similar therapies causing long-lasting problems such as PTSD and other issues that the ABA practitioners had never anticipated. Margaret’s was not a lone voice.
One of the files she sent him was a book by Ivar Lovaas, whose name Zachary had heard several times in connection with ABA. He opened it up, expecting that it would be filled with a lot of clinical studies and dense medical language, but it was written as a guide for parents and was quite readable. Zachary started to skim over the introduction, then stopped and went back to the beginning to read it carefully. He checked the copyright page. The copyright was 1981, not the Victorian Era. He used his cursor to highlight a few of the lines in the introduction.
No one has the right to be taken care of, no matter how retarded he is. So, put your child to work; his work is to learn.
They have no right to act bizarrely.
No right? Zachary’s mind immediately went to Margaret Beacher talking about being punished for who she was. According to Lovaas, she had to be trained to act like everyone else. Lovaas gave instructions to parents on managing their child’s weight, clothing, hair, and appearance to make sure they couldn’t be differentiated from their peers.
Zachary went on to read the next chapter, outlining the basics of the program. He read about the reward system he had already seen in action, using small treats and praise to encourage the desired behaviors. Then the references to punishments started to pop up. Zachary read on.
By becoming firm with your child, and perhaps making him a little upset or scared by yelling at him or hitting his bottom, your social rewards (saying “Good” and your kisses and hugs) become almost immediately more important and effective for him. It is as if he appreciates you more, once you have shown him that you also can be angry with him.
Zachary put his hands over the words and looked away from the page. He closed his eyes, breathing evenly.
Zachary was intimately familiar with the phenomenon Lovaas referred to.
‘Traumatic bonding’ resulted when the victim was alternately abused and rewarded by the perpetrator and was most effective when the perpetrator controlled the necessaries of life, such as food and freedom of movement. It was the abuse/remorse cycle that made battered wives and abused children cling to and defend their abusers. In kidnap situations it was referred to as Stockholm Syndrome. It was the method cults used to brainwash their victims and gangs used during initiation to gain the loyalty of their members.
Of course, Lovaas hadn’
t intended the parent to traumatize the child. He apparently didn’t anticipate that his training methods would cause PTSD. Spankings were not commonly considered abuse in the eighties. But what looked ‘a little upset’ to an adult could actually be an expression of trauma in a child. A few pages later, in recommending that adults practice hitting friends to see how hard was hard enough, Lovaas reported, “We have heard about children who have been hit or pinched so hard that their skin is dramatically discolored. It seems quite unnecessary to use such strong physical aversives.” Well, bully for him.
Zachary left the document on his screen and got up to pace across the room. Lovaas’s words made him physically ill. He was nauseated. He tried to focus on the movement of his body and not slide into flashbacks. He wasn’t sure how many more times he could read words like “Use as much physical force as is necessary to make him complete the task” before he succumbed.
He returned to his computer and went on to the next page, hoping it would be less offensive, and found:
You may have to exert considerable physical force to help him comply. You may at such times run the risk of bruising or physically hurting the child, or the child you are working with may be physically so big that you can’t budge him. This is a serious drawback.
Zachary clicked ahead to the next chapter. It was, unfortunately, titled “Physical Punishment,” so he had a pretty good idea it wasn’t going to be any less upsetting. He went into the kitchen and made a pot of coffee. He would have preferred alcohol, but he couldn’t combine that with his meds.
With caffeine and Xanax on board, Zachary paced for a few more minutes, then went back to the book. Lovaas made a good argument for putting a stop to life-threatening behaviors like self-injury, extreme aggression, chewing on electrical cords, and running in front of traffic. Any parent could see the importance of eliminating the activities that could get their child killed. Zachary could almost see the justification for using aversives in those cases. But then Lovaas threw the baby out with the bathwater in advising:
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