Autism Now: How Should We Address Deepening 'National Health Emergency'?

As part of PBS's Autism Now series of reports, former NewsHour anchor Robert MacNeil interviewed Rima Ritholtz, principal of Bronx autism charter school PS 176, on the schooling and treatment options for those with autism. In honor of National Autism Awareness Month, here is an extended transcript excerpt, edited for length, relevance and clarity, from that interview

ROBERT MACNEIL: What is the ratio, on average, of teacher to pupil in this school?

RIMA RITHOLTZ: Most of the students who come into the school come in with the ratio on their IEP, the individualized education plan, of in a class with one teacher and one para-professional. That's the typical ratio. As they stay with us and as students improve, we move them to a less-restrictive option, a less-restrictive ratio. And we move them into classes with the size of eight students in a class, one teacher and one para.
And then if they do well in that ratio, we have the opportunity to move them into class size of 12. We're trying to approximate the general education programs and eventually we'd like our students to return to general education.

RIMA RITHOLTZ: I would say a very small proposition. A small proportion return to general education.

ROBERT MACNEIL: Small being?

RIMA RITHOLTZ: Out of 700 students I would say maybe 10 students return to general education. And of some of those students that we have sent out to general education programs, some of them come back.

ROBERT MACNEIL: Define a para-professional.

RIMA RITHOLTZ: A para-professional is basically a teaching assistant. It's a person in the classroom who assists the teacher.

ROBERT MACNEIL: And is he or she on the way to becoming a teacher?

RIMA RITHOLTZ: In some cases they are. That's not a criteria of the job, but in some cases we hire para-professionals who have become teachers. But that's not a requirement.

ROBERT MACNEIL: You say that as children improve they can move from the six and a class to eight in a class or 12 in a class. How do you measure that improvement?

RIMA RITHOLTZ: Well, we work very hard at thinking of ways to measure it. And to learn how to measure, we've taken from the world of ABA, of applied behavior analysis. But we've taken from other programs that we've had in the school over the years.

And basically we assess students. When students come to us, they've been assessed by a committee on special education. But when they get into our school or any district 75 school, they are assessed by the teachers. And here we either use the Briganz assessment inventories or we use the Able's. That's another assessment that is really for students with autism.

The Able's only goes up to about age five or so - five- or six-year-old skills. The Briganz is broader. Neither is a perfect instrument, and we're always looking for that perfect instrument. But they do give us a lot of information on students.

Once we assess the students, we get our goals from those assessments. And the teachers monitor on a daily basis, on a weekly basis, on a monthly basis, on a yearly basis. They monitor how the students are doing on those goals in addition to their IEP goals. We monitor how the students are doing, and we're constantly assessing.

ROBERT MACNEIL: What are you limited in because of funding or resources?

RIMA RITHOLTZ: Well, I'm limited in that I want more of everything that we have here. We have a lot of great programs. And we have a lot of great material. And I'm limited in that I have to buy it piecemeal. Today we're talking about the iPad, and we think this is going to be a very valuable tool to use with students on the spectrum. We have a certain number of them. We don't have the money to buy more. Our PTA is busy holding bake sales and raffles and things like that in order to get us more of these.

ROBERT MACNEIL: How many have you got so far?

RIMA RITHOLTZ: I've got 23 for 103 classes. Over 700 students.

ROBERT MACNEIL: And the idea would be?

RIMA RITHOLTZ: The idea would be to get one for every student, but certainly our more immediate goal is to get one for every classroom.

ROBERT MACNEIL: Okay. If you had more resources, more money, would you improve the teacher-student ratio? Would you make it close the one-on-one and one-on-two or something like that?

RIMA RITHOLTZ: No, I really wouldn't. I think the class sizes do the students justice. I think that students both need to learn how to work individually with a teacher, but students need to learn in groups. That's part of life.

ROBERT MACNEIL: If you had more money, would you have more classes with a ratio of one teacher to one student?

RIMA RITHOLTZ: No, not necessarily. If I have more money, I would not make the ratio higher. I think that we're able to get the kind of staffing that we need for the students. I would not spend the money that way. I would use the money for more resources, more supplies, more materials. I would also use the money for more enrichment activities to give kids the opportunity to do more things that make them a more well-rounded student.

ROBERT MACNEIL: Like?

RIMA RITHOLTZ: Like I would take students to camp. We've done that. We do that with parents. And our students have never been out of New York City, quite a few of them. Some of the parents have never been out of New York City.

And we go to Camp Ramapo in Reinbeck, N.Y. And when they come off the bus, people, the students and the parents are amazed at what it looks like. And then we have a day of hiking and biking and arts and crafts and swimming. And it's a fabulous experience. This past summer we took some of our high-school students up there for an overnight. And it was great.

And if I had more money, because the busses cost a lot of money -- the coach busses. The camp costs money. I would also buy more materials. Teachers wouldn't have to share one math program for three classes or a reading program. You know, you have it in the morning, I have it in the afternoon. That's what I would use the resources for.

ROBERT MACNEIL: With all the talk of budget cuts, nationally, state-wide and in New York City, how is that impacting you?

RIMA RITHOLTZ: It has impacted us. The fact that we've had to give certain money back, last year and this year. As I said to you earlier, it's like waiting for the other shoe to drop. We're always on the high alert that you're not going to have this money, you're not going to have it next year, you're not going to be able to do certain things. And it's really very, very frightening because we don't know where to cut it from.

ROBERT MACNEIL: When the peace on Earth chorus was singing, one of your teachers said to me, who would ever imagine that you'd have children with autism holding their lines and working together. How was it achieved?

RIMA RITHOLTZ: It's beautiful. That's what makes our job so wonderful. When we see children who we've known since they are five years old -- now we have a preschool. We know them from when they're 2.5. They come in and they can't even be next to someone else. They certainly can't stand next to someone or even sit in a chair.

And we see the behaviors change through the years. Through the routine and the structure that the school has, through the use of pictures and the use of the talking machines. Such as the iPad will be. We see them improve.

And the richness of the experience they get here really makes them very well rounded. And to think that those students were once five years old and couldn't sit in a seat, and a lot of them couldn't speak. And a lot of them had behaviors that were very, very challenging. And to see them like that -- it's just wonderful.

But for me personally, I am very happy to see the students like that. That gives me great joy. But the biggest joy for me, speaking from the heart, is when I know that the parents are happy. When a parent comes over and says my child's teacher has changed his life, that is the greatest thing to hear.

And I tell that to staff. You ask people, do you remember your first grade teacher? Do you remember your high school teacher? Hands go up. And I say to the 400 people on staff, and can you think of one? And everybody raises their hand.

And I say, well, what was it about that teacher? Well, she gave me extra time. She really cared. She brushed my hair because she knew it didn't look good. I say to them, you are that person to this child. Maybe the child can't articulate that. Not yet anyway. But you are that important in the child's life. And then when the parent comes and says to us, this person is so important and has helped made my child make such gains, there's nothing better than hearing that.

ROBERT MACNEIL: Could you just enumerate the life skills that you teach here?

RIMA RITHOLTZ: Well, we teach the simplest of life skills. And probably the most important life skills starting with toilet training. If you're not toilet trained, you're immediately put on a toilet-training school. Our preschool students, the overwhelming majority of them become toilet trained. And as students go up through the years, they become toilet trained.

Other life skills such as being able to care of one's belongings -- we do that as part of our routine day. Being able to zipper. Being able to button. And then life skills such as taking care of your own tray and your own -- opening things. Food.

And being able to go to a movie, wait in line, hand the ticket over. And being able to go to a restaurant or a McDonald's and order what you like. Part of the life skills is the language component of it. So we do it all here.

ROBERT MACNEIL: You were telling us about travel training. You mentioned a particular problem...

RIMA RITHOLTZ: We have a travel training program where students receive many weeks of training to see if they can eventually travel independently, because if you can travel independently, that's a tremendous, tremendous skill to have.

And this particular young man did not pass the travel training program. And when we asked him why, he said, I have a very bad habit. And we said, well, what is it? He said, I like to talk to beautiful women.

And that is why he failed. He did not pass the test because part of the training is that they sabotage the route. And they had someone come over to him and try to keep him off the right track, and he fell for it. So he did not pass.

Eventually he did pass. And that's very, very liberating. And we have a number of students who come to school by themselves, and our oldest students go to their job sites by themselves.

ROBERT MACNEIL: Where are the students you teach on the autism spectrum?

RIMA RITHOLTZ: The students at PS176 are on the entire autism spectrum, with some students being severely challenged all the way to students who have less challenges and spend the large majority of their day, if not all of their day, in classes of general education with our support.

ROBERT MACNEIL: And what is your educational philosophy for these kids?

RIMA RITHOLTZ: Well, my educational philosophy is that they're children first before they're children with autism. And they deserve the exact same quality of programming and professionalism that any student would get anywhere in any school in New York City or anywhere else. That's the first and foremost philosophy that I have.

The second is to work really hard with the three main constituents. And these constituents are the students, of course. And to bring the best methodology and strategies and state-of-the-art programs and practices to them. That's one of the constituents.

The second is working with parents, because we are working with the entire family. And we're making an impact on the entire family. And the third is teachers and staff. We know that in order to have the teachers give the best education in the classrooms, we have to provide a lot of support and a lot of follow up to our teachers. And that's what we do here.

ROBERT MACNEIL: And which of the recognized programs for teaching children with autism do you employ?

RIMA RITHOLTZ: We have had training by an ABA consultant, Applied Behavior Analysis -- this consultant who has worked with students and staff through the years. We've worked with the TEACCH program from North Carolina. T-E-A-C-C-H. Don't ask me exactly what it stands for; even they can't remember when they come and train us.

We've worked with Dr. Michelle Dunne. She's a neuropsychologist who has developed a social skills program. Her program is primarily for students with more capability, but we have adapted that program to work with students who have less language and more challenging behaviors as well.

So those are some of the programs. Other programs are various reading programs that are used both in our schools in district 75 and in this school, and also they are used in general education such as the Fundation's reading program, everyday math program. Then there are programs that we use that are developed specifically for children with autism or children with disabilities. What comes to mind is the Ed Mark reading program or the Equals math program.

ROBERT MACNEIL: How many hours would a student here get of ABA in a week?

RIMA RITHOLTZ: ABA is sometimes confused with one-to-one instruction, and ABA does not necessarily mean one-to-one instruction. ABA means that you are following a certain scripted curriculum. And I'm not an ABA expert, and I don't profess to be, but just in laymen's terminology, the scripted program is paired with a very good breakdown of how the skills are learned by that particular student.

So if I'm trying to teach you how to brush your teeth or if I'm trying to teach you how to distinguish colors, it might be different for you than it would be for someone else. It doesn't necessarily mean that the instruction takes place one-on-one.

And in our school we do one-on-one instruction, but we also do small group instruction and large group instruction. Those are the directions that we give to the teachers: that every student has to get one-to-one instruction and has to get large group instruction.

And we're taking data on it -- data on all kinds of skills from the daily-living skills that we mentioned to reading skills to how they're doing in math. We're also taking data on how students are doing in terms of their behavior.

We're charting it. We're taking data on if a student has an outburst. How often? When does he have it? What came before it? What came after the outburst? And we have something that we use that gets at what's motivating that student to have that outburst. So we do a lot of collecting of data. And then we look at the data. And from that data we then plan our next instructional moves.

ROBERT MACNEIL: As a professional with a long experience in this, where do you think we are in understanding autism?

RIMA RITHOLTZ: I myself want to know about medically and physically where we are. I don't know. I've heard professors speak, doctors speak. We have a very good relationship with a doctor, the director of pediatrics, I believe, Dr. Kyram. He's come to the school many times. He's an expert on autism. He's one person. We've had people from Yale come. I think they are making inroads in finding out what causes it.

In terms of educating students with autism, I think we're at a great place. I think there are a lot of programs to choose from. If you can assess a child and you know where they are and you know what makes them learn or how to help them learn, I think we have a large variety of programs to choose from and activities to do that will enhance their lives. I think we're in a great place right now.

ROBERT MACNEIL: Even with earlier diagnosis now and early intervention, which is so much valued, is a diagnosis of autism now a prediction that individual is going to need support for their entire life?

RIMA RITHOLTZ: You know, I don't know if that's necessarily so. The students that we meet, we meet them at age 5, and then they leave us at age 21. We do get to know them for a long time, but I know young people. I know a person who the student was diagnosed at an early age, and he went to college. And he has a job in the business world, last I spoke with the parents. You don't know. It's an exciting world. It's -- you saw, there's a lot of great things.

ROBERT MACNEIL: Absolutely.

RIMA RITHOLTZ: Really the follow-up are the people there -- I mean the teachers and the assistant principals that follow through.

ROBERT MACNEIL: You were saying that they're the important -- teachers?

RIMA RITHOLTZ: They are, really. And the teachers and the para-professionals who every day -- we really work as a team in hammering all this out. It doesn't come like this. We've been doing it a long time. And every facet of this, every nuance, we've discussed amongst ourselves and...

ROBERT MACNEIL: Have you visited other public schools teaching kids with autism across the country?

RIMA RITHOLTZ: No. No, I haven't. I haven't visited across the country. I'm very busy here. This is keeping me very busy for the last 30 years. I haven't visited the other schools across the country. I've visited a few private schools in the tri-state area. Not too many.

ROBERT MACNEIL: How do you think you compare with them?

RIMA RITHOLTZ: I think we're great, but I'm a little partial. The proof when sometimes people say to me, how do you know you're successful? How do you -- aside from the data? And the answer to that, again, is when the parents tell me that the staff has made such an impact on this child's life. That's how I know I'm successful.

When parents say, we could never take this child anywhere. We couldn't go to church. We couldn't go to the movies. We haven't been to the movies since this child was born. That's what they say. You'll hear that from the parent.

They'll say that every relative that they have weighs in on, oh, your child is spoiled, and you know, you're a terrible parent. Let alone when people do that when they're out in the street. They weigh in. You know, people will come over to these parents and say, you're spoiling your child. And the parents find themselves saying, he has autism. But why do they have to explain? So when a parent says, now we go every Sunday morning. We go out to lunch or we go out to brunch with the child. And he has friends and he goes to camp. That makes us feel good.

ROBERT MACNEIL: So in addition to having an effect on the child and his future, you're really treating the family?

RIMA RITHOLTZ: Yes. We really are. And we have monthly parent activities. Sometimes we have between two and three activities in a month for parents. We have a support group that runs every six weeks for parents. And we have parent workshops on a variety of topics for parents every single month.

ROBERT MACNEIL: How-- you say you've been doing this for 30 years?

RIMA RITHOLTZ: I think it's 30. I lost count.

ROBERT MACNEIL: You don't look it.

RIMA RITHOLTZ: Oh, you are the best.

RIMA RITHOLTZ: I am putting my DVR on your program and taping forever.

ROBERT MACNEIL: But it's hard work, I'll bet?

RIMA RITHOLTZ: Yes. It's hard work. But when I see the things that other people do, they work very, very hard too. In certain fields that they have to make decisions -- the president, you know, the kind of decisions, I wouldn't want those.

But this is enjoyable work. This is great work, because it's a human service business. And when you see the results of your work, when I go into classes and I say, hey, we talked about that last week. We talked about that. And now I see a teacher implementing it? And look how much the students are getting from it? That's great.

ROBERT MACNEIL: Do you think the understanding of autism in the community has changed in the time you've been doing this?

RIMA RITHOLTZ: I do think it has. There's much more recognition of it and acknowledgment of it. Whether there's understanding, I don't know. But you can't live without finding somebody who has a child -- a nephew, a daughter, a neighbor -- who has autism. My mother told me once that we are all only temporarily able. So we are a society that really needs to take care of our members.