In a Different Key

by John Donvan

  Wolf and Risley had left the lenses out of the frames on purpose, concerned that it might be too intense an experience for Dicky suddenly to see things in sharp focus. But then lenses were added to the frames, and the prescription was ramped up, from weaker to stronger, all in separate sessions, and all of it shaped by spoonfuls of positive reinforcement for every right move. It took months, but in the end, before he went home, Dicky was wearing his glasses twelve hours a day. This small achievement was, in fact, a stunning outcome.

  Over the next several months, Wolf and Risley continued working with Dicky, trying to teach him to talk. Working with pictures of objects, along with plenty of rewards, they gradually shaped his echolalic speech into something more obviously practical. At the beginning, his speech was no more than rote recitation—words for ice cream. But over more months and then years, with his parents joining in as teachers, Dicky’s verbal skills improved to the point where he was able to ask for the things he wanted.

  Having that amount of language—and being able to see—changed Dicky’s life. Eventually, he was able to go to school, and then, as a young adult, to get a part-time job as a janitor and to live on his own in an apartment, with occasional supervision. The team from the University of Washington hadn’t cured Dicky’s autism, but they had helped him find a place in the world.

  —

  WOLF AND RISLEY got through to Dicky, in the end, with ice cream. A positive reinforcer. A reward. Actually, a frozen dessert also made a fleeting appearance in that May 1965 LIFE spread about Lovaas’s project at UCLA. The text specified that the program relied overwhelmingly on positive reinforcers, especially food—including sherbet—and that in Lovaas’s lab, the kids were shown “persistent and loving attention.” A few pictures even showed kids being hugged, validating the last word in the article’s title: “Screams, Slaps & Love.”

  But the article also revealed that the kids were kept hungry to keep them working hard for that food. And the overall impact of the pictures probably left most readers thinking that, at the heart of Lovaas’s program, the children were being punished for having a condition that was described in relentlessly bleak terms.

  Autism, LIFE explained, was a “special form of schizophrenia,” which resulted in “utterly withdrawn children whose minds are sealed against all human contact and whose uncontrolled madness had turned their homes into hells.” Living with autism was “a nightmare” and an “appalling gallery of madness.” Certainly, it sounded worse even than the misery depicted in Lovaas’s lab.

  The lead-off photo shows Billy, a three-year-old who could not speak, with tears rolling down his face, as a man in a necktie, his face twisted in anger, bellows at him. The man pictured was not Lovaas but Bernard Perloff, a fellow researcher. It is Perloff’s open palm that comes up against the left side of Billy’s head, either grabbing it or smacking it. Either way, he appears to be furiously berating the boy. The text explained why: during a speech lesson, Billy’s attention had wandered, and Perloff hit him to get him focused again. In the third picture in the sequence, the two of them are so close together, they’re nearly touching noses, and Billy, though his lower lip looks like it’s trembling, is looking Perloff straight in the eye.

  The girl seen getting shocked with electricity is identified as Pamela, a nine-year-old. She, too, had just become distracted from the task at hand—a reading lesson with Lovaas.

  By this time, Lovaas was in his second or third year of experiments using ABA with autistic children. But he was not trying to discover the nature of autism. As LIFE put it, “The team conducting the experiment at UCLA is not interested in causes.” Instead, “by forcing a change in the child’s outward behavior,” according to the article, Lovaas hoped to force an inward change as well. He was trying to teach them to make eye contact, to form and use words, to read, to hug.

  The work, LIFE made clear, was worth the time and the suffering. ABA worked. LIFE’s readers were told that Billy, for example, had been taught to say his own name, remarkable for a child who before had only grunted and squealed. Rewarding Billy with a steady stream of hugs and food, Lovaas had spent days teaching him to bring his lips together as if to produce the b sound. That achieved, the next phase was to prompt and then reward Billy for bringing his vocal cords into it—to make the silent b into a full-throated “Buh.” If Billy’s attention strayed for too long, Lovaas would slap his face. And on it went, through the rest of the sounds that made up his name until he could say “Billy” on his own—a triumph in a single word.

  Over the next twenty years, Lovaas would continue to refine and experiment with his method, but a key pillar of it was on display in the LIFE layout: the breaking down of any task into small, teachable, learnable performances of behavior. The LIFE story left readers on an upbeat note, thanks to a sequence of pictures Grant took of one of the mothers who had come by the lab and was watching her son from inside a darkened room, behind a one-way mirror. On that day, her son was being taught to embrace one of the other boys, in something that at least resembled a real hug. In the dimness, she is seen biting her thumbnails as the lesson unfolds. Then the hug happens. Delighted, she throws back her head and laughs, clapping her hands at the same time. She is “overjoyed at what she sees,” the caption says. In that brief instant, at least, what Lovaas was doing seemed well worth whatever tears were being shed along the way. As LIFE summed up the work: “Lovaas hopes he has found a way to help any child with a broken mind more quickly and simply than with methods now used.”

  —

  THE MOTHER WHO laughed and clapped her hands was behind a one-way mirror, invisible to Lovaas. In fact, though, he needed parents like her. Their support for what he was doing was his best protection against the criticism that the methods he was developing were extreme, cruel, or unethical.

  It could only have been heartening to Lovaas, therefore, when, within days of the LIFE article’s appearance, parents from all over the country called and left messages via the UCLA switchboard, or sat down and wrote urgent, beseeching letters, seeking a spot in his program for their own child. Lovaas was not equipped to handle such a sudden volume of interest, and so he passed on all the letters and names to a recent acquaintance of his named Bernie Rimland. They had met several months earlier, before the LIFE story, in late 1964.

  Rimland had yet to become a major figure in autism, since his historic book taking down the refrigerator mother had only just come out. As ever, he was continuing to track down any sort of new research that touched on autism, scarce as that was. That autumn, having heard informally about Lovaas’s early punishment studies, he showed up in Lovaas’s office in UCLA’s Franz Hall, and introduced himself. They spent the rest of the day together, with Lovaas showing Rimland how he was teaching nonverbal children to use words. Rimland was astounded and told Lovaas as much, then he invited Lovaas to a dinner he was attending that evening.

  When Rimland told Lovaas that they would be joined by a number of couples, all parents of children with autism, Lovaas immediately made his excuses. As he later confessed, he could not stand being around the parents of the kids brought to his lab. It was not that he blamed mothers for causing their autism; yes, he had at one point espoused that belief, but had long since rejected it on his own. Yet he could not help finding the parents he met to be depressingly glum, withdrawn, or vaguely hostile. As a rule, he tried to avoid them. So he declined Rimland’s invitation.

  Rimland, however, persisted, and turned on the charm, telling Lovaas that the parents would be dazzled by hearing what he was doing with kids like theirs. Finally, Lovaas gave in.

  That night marked the turning point in Lovaas’s relationship with the parents of the children he studied. The group he met, over red wine and plates of pasta, was not at all what he had expected. Away from the laboratory and their children, they impressed him as relaxed, charming, and engaging. They asked good questions. They laughed at one another’s jokes. The next morning, when Lovaas returned to his lab, a new thought to
ok shape in his mind: These people would make excellent allies.

  That insight would prove true, again and again, in the years ahead. But in May of 1965, when the LIFE story appeared, it was already to Lovaas’s advantage that Bernie Rimland personally was so enthusiastic about his work on ABA. Lovaas forwarded the contact information of all the parents clamoring to get into the UCLA program to Rimland, and Rimland, as he always would, reached out to every single one of them, writing long, personal, thoughtful letters.

  The timing was perfect for Rimland as well; he was just then starting to recruit members for the national autism organization he was forming. In the coming months, he would be on the road often, meeting with parents in living rooms and church basements. He wanted to give them hope, so he talked often about the work in Lovaas’s lab. Not every parent was convinced. Some had seen the pictures in LIFE and would ask, “But isn’t that the place where they beat up the children?” Rimland was ready for that one. He told them that punishment was minimally used, and that positive reinforcement was the backbone of the method. He also vouched, again, for how well it worked, and he vouched for the man—the UCLA researcher—himself.

  Lovaas, Rimland told all, was “one of the only professionals who really cares about these kids.”

  At the time, that was mostly true.

  And in 1965, Lovaas was still just getting started.

  20

  THE AVERSION TO AVERSIVES

  In 1981, Lovaas had squeezed everything he had figured out about teaching children with autism into thirty-eight short, simple chapters, put them between a set of soft covers, and published them. He had spent a decade and a half refining his method, and his book represented the culmination of that work. It was called Teaching Developmentally Disabled Children, but would always be better known by its quirky subtitle, The ME Book—a nod to the child who stood to become more fully himself, more fully “me,” through correct application of the contents. It was a do-it-yourself handbook for parents who wanted to practice ABA on their own, and it was the first of its kind. In his preface, Lovaas told readers they would be practicing the very same techniques he used in his lab: breaking complex skills into small components, reinforced by frequent rewards and occasional punishments.

  With The ME Book, Lovaas followed through on his insight that parents would make good allies by making them a vital part of their children’s therapy. Doing so solved a number of problems at the same time. He had discovered, for example, that in order to make progress, children needed to be in a full-time teaching environment—as in, every waking hour. In other words, the adults in their lives needed to construct every moment so as to reinforce the lessons being taught. Lovaas had always regretted that this wasn’t possible with the first groups of children he had studied in the 1960s—children like Linda, Gregg, and John, all of whom likely relapsed when they returned to the institutions where they lived. Parents, however, could reinforce lessons daily.

  Additionally, Lovaas’s data told him that most children needed ABA instruction on the order of twenty to sixty hours per week. Even if the state hospital had permitted him to start an ABA program on its premises, it is unlikely that the administration would have provided enough staff to work intensively with even one child for anything close to that amount of time. But a motivated mother, he reasoned, would spend all day working with her child, if that was what it took.

  Lovaas had also found that location mattered. While children could master certain skills when sitting in one of his small, bare experimental rooms at UCLA, some of them proved unable to reproduce the performance in any other setting. They could point to all the chairs in the room when asked to “point at chair,” as long as they were in the same lab, with the same chairs, where they had learned the lesson. But when asked to do the same in another building, with different chairs, they failed to grasp the task. In behavioral terms, they had not “generalized” the chair-recognizing skill sufficiently to use it in changed circumstances.

  The ME Book program was designed to address these problems. It called for teaching the kids at home, with their mothers and fathers taking the lead, guided by the book and by a set of videotapes Lovaas had produced, which showed his students running ABA sessions. He warned parents that it was probably too much to take on the job alone, so he recommended they recruit high school and college students in order to put together a team of four to eight teachers, who would work with the child in shifts. The recommended program required twenty to sixty hours per week for two to three years early in the child’s life. That, in essence, is what came to be called the “Lovaas Model” of applied behavior analysis.

  —

  THE LOVAAS MODEL faced strong headwinds when The ME Book arrived in 1981. The problem could be found in a single sentence on page 16: “A swat on the behind is almost always effective, if it is hard enough so that it smarts.” In short, Lovaas was still advocating the use of “aversive therapy,” what behaviorists also called “punishment.” To be sure, The ME Book regarded this as a tool to be used sparingly. On an early page, a warning to readers appears inside a black box: “the authors and publishers wish to emphasize that the training programs related to aversive therapy contained herein should not be undertaken without professional guidance.”

  The book was also adamant that punishment be used in as calculated and scientific a way as possible: “You have to keep a record when you use strong discipline to make sure that the behavior you punish is decreasing. That is the only justification for using aversives.” Lovaas pointed out that punishment did not necessarily have to be physical to be effective. A sharp “no” counted too.

  These recommended measures seemed a good deal less harsh than the slaps across the face Lovaas had sanctioned in the 1960s—but that did not rescue his method from facing harsh criticism. As it happened, The ME Book arrived just as the opening salvos were being fired in the coming war over aversives. The year of its publication, 1981, was the same year that the Association for the Severely Handicapped (TASH) became the first national group to adopt an official position against the use of behavioral punishment in the education of children or adults. Other groups followed suit, in a campaign that increasingly made pain-for-progress a losing argument.

  On this score, ABA had a serious image problem. It was the hangover effect of Lovaas’s Hot-Shot—the cattle prod he had used on those first kids—and everything it stood for. Even Bruno Bettelheim had once attacked Lovaas by name, saying that his methods turned children into “pliable robots…reduced to the level of Pavlovian dogs.” Throughout the 1980s, the so-called aversives issue, which centered on ABA’s willingness to use punishment to change behavior, was the most controversial aspect of the practice. It nudged aside the refrigerator-mother argument—which lost steam throughout the 1970s—to become autism’s next great defining conflict. In Science, Louisiana State University psychologist Johnny Matson would call it “perhaps the single most frequently discussed issue in the field of developmental disabilities.”

  The conflict began, and persisted, primarily as a battle among professionals, although parents were dragged into it too. Insults were hurled and friendships destroyed, as well-intentioned people on both sides went to war over one of the most fundamental ethical dilemmas: When do the ends justify the means? This was reframed, in the autism argument, as an urgent and inseparable pair of questions: Was it wrong to use punishment to treat severely disabled people who are hurting themselves? Or was it wrong not to?

  Bernie Rimland weighed in on the topic in 1988: “While the use of electric shock on an autistic person is repugnant to me also, it is not nearly so repugnant as some of the things self-injurious people do to themselves, such as causing blindness, fracturing skulls, and in one case, chewing off both thumbs.” If his own son Mark had been self-injurious, he said, he would certainly have considered using aversives to stop it.

  For Mooza Grant, the original president of the National Society for Autistic Children, the debate was not theoretical. She had tw
o teenage girls with autism—the younger of whom, Linda, had mauled her own ears into permanent scar tissue by constantly slamming her head onto hard surfaces. Both parents were determined to keep their girls at home. “I couldn’t envision sitting with roses growing outside my house and my child being in an institution,” Mooza once said.

  But Linda was violent every minute of every hour. Considering it cruel to keep her in restraints full-time or sunk inside a drug-induced fog, Mooza’s husband Leslie Grant went down into the basement of their home in Chevy Chase, Maryland, and built a prototype shock-dealing device of his own design. He built a helmet with sensors inside, so that whenever Linda hit something hard with her head, the sensors would activate an electrode strapped to the girl’s arm or leg, giving her a shock powered by a nine-volt battery, the intensity of which he compared to being smacked with a hard-hit tennis ball. In the 1970s, the Grants reported that their daughter, who had been hurting herself for fifteen years, stopped doing so within days of the helmet being fixed into place on her head.

  Seeking to refine the device, they recruited a team at the Johns Hopkins Applied Physics Labs. Over four years, the team managed to build a more compact version with a remote-control and a counter to keep track of the number of shocks during any given time period. The resulting product, which went into small-scale commercial production at a plant in Florida, was called the SIBIS—the Self-Injurious Behavior Inhibiting System. As of 1988, some twenty-five children were reported to have worn the SIBIS—all with positive results. Rimland told parents that self-injury was so successfully suppressed in six of these early SIBIS wearers that they no longer needed to wear the device.