May 09, 2013

App Thursday: Piecing together a puzzle: Early educational therapy gives autistic children hope


(South Carolina, USA) He sits at the edge of a rainbow jigsaw mat in caramel corduroys and a pair of lace-up suede dress shoes. He’s humming a song from earlier in the day and squirming out of his teacher’s arms with a determined smile stretched across his face.

“Polar bear, polar bear, what do you hear?”

At just 3 1/2 years old, Blake Ravenell reads every word of the picture book — the flamingo, the zebra and the walrus.

He kicks his legs a few times and hops up and over to the bookcase full of color-coded bins, each holding dozens of books. Tan is for winter books, green is for music. Ravenell effortlessly pulls them out of their cubbies, takes a peak over the front edge and pushes them back into their spot.

He settles on an iPad and leads a few of his peers — hogging most of the screen time in what his teachers call “The Blake Show” — in a game of “Go Away, Big Green Monster!” His fingers swipe from side to side, in and out of applications.

Ravenell is far ahead of his age group on the learning curve: He can read, he can count to 50 (and probably further if they let him go on, his teacher said) and he can reorganize your iPhone into a zoo of rubber duck games and sound board pianos given the chance.

Ravenell also has autism.

He was diagnosed when he was 2 years old — in a yearlong process full of pediatricians, early interventionists and speech therapists — and has been at The Therapy Place in Columbia for almost a year. The center marries his educational and therapeutic worlds in a larger scale of applied behavior analysis therapy, the most common treatment for autism.



Children with autism face a whole new, much more complex world of early education. It goes further than elite preschools and the best-districted neighborhoods for kindergarten. With a goal to mainstream autistic children back into traditional classrooms, parents, teachers, doctors and therapists have prescribed this dual world of classroom learning and behavioral therapy.

Autism lives on a broad spectrum. All children show different symptoms and levels of severity, but there are common themes to an official autistic diagnosis: impairments in language, impairments in social interaction and repetitive behaviors. Children have to show issue in all three of those areas to have an autism diagnosis, said Sarah Ravan, the projector coordinator for an autism study in the University of South Carolina’s School of Medicine.

The cause of autism is still unknown and while genetics most likely play a role, researchers at the National Institutes of Health also believe that there is an environmental component to the disorder.

The feasibility and effectiveness of a future in mainstream classrooms, through this educational and behavioral hybrid model, also depends on the diagnosis. Some children have some level of mental retardation with their autism diagnosis, Ravan said, and a traditional classroom just won’t be a part of their future.

Ravenell’s journey started with a speech delay. When he was 2, he was going to a traditional preschool. He wasn’t talking much, he was picky about what he ate and he would play by himself a lot.

That’s when his mom, Dianna Ravenell, took him to his pediatrician. The road to an official autism diagnosis took a full year, and by the recommendation of his doctor, Ravenell started at The Therapy Place in a summer program.



“When we first brought him here, he was, for lack of better words, all over the place. Now he’s in a routine,” Ravenell said.

Erin Bellinder, the program coordinator at The Therapy Place, teaches Blake Ravenell to share, to communicate the right way at the right time and to work on a schedule. He would prefer to have his needs met non-verbally, she said.



When he first started at the center, if he was thirsty, he would go get a juice box and put it in Bellinder’s hand. Now, he practices complete sentences with flash cards. There’s a sentence card, an “I” and a pair of eyes to set up the “I see.” Bellinder then runs through drawings of pineapples, a Popsicle and cereal.

“I see cereal,” Ravenell spat back.

“He knows what the food is, but now we’re trying to get him to use the full sentence,” Bellinder said.

This environment is ideal for children with autism, even those with no plan to bridge to a mainstream classroom. It’s the treatment prescribed for the disorder, but also a treatment that’s far too expensive for a lot of families.

Lorri Unumb’s 12-year-old son, Ryan, was diagnosed with very severe autism when he wasn’t quite 2 years old. At the time, Unumb and her family lived in Washington, D.C. Ryan Unumb was diagnosed at Johns Hopkins University and confirmed at both Georgetown University’s hospital and Children’s National Medical Center.

They all prescribed the same treatment: ABA therapy.

“All of them,” Unumb emphasized.

Unumb and her husband are both lawyers, they’ve been paying premiums their entire lives. It was assumed their health insurance would cover their child’s treatment.

But, it didn’t.

In 2007, Unumb was the driving force behind “Ryan’s Law” in South Carolina, a law that extended health insurance coverage to treatment for autistic children. It’s still not complete reform — private policies are exempt, as are some government-provided policies. Even those who are covered don’t get all of their financial needs met.

Still, South Carolina was the second state in the nation to adopt any kind of insurance reform to include autism. It’s a continuing fight, but a big step toward more comprehensive coverage.

“If you want this generation of children to have a chance to try and get back into a mainstream environment, to try to be able to work someday and become taxpayers, you have to invest in them now,” Unumb said.

Unumb took the investment a little further. She opened the Autism Academy of South Carolina in 2010 that targets ABA therapy in a more direct, in terms of student to teacher ratio, manner than The Therapy Place.

All of the kids at the Autism Academy have one-on-one instruction, and their days are flexible to their interests. Over the lunch hour, twin girls smear Nutella sandwiches across their faces and pass on heart-shaped, chocolate-covered pretzels to scribble on a white board decorated with the “Cat in the Hat.”

They’re all smiling — they smile as a mini bouncy castle blows up in the center of the playroom and they smile when they scoot down the red slide. Those smiling moments, laced together with piano lessons and math problems and reading, don’t come cheap.

A full-time, five-day week at the Autism Academy is $4,200 a month or $50,400 a year. Tricare, a health care plan for the military, provides the biggest chunk of coverage under Ryan’s Law, $36,000 a year. That still leaves parents paying more than $14,000 out of pocket.

“I can’t sleep at night thinking how it must feel to be a parent of a child with autism who needs this treatment so badly, and you know it’s out there, and you know the success rate is really good, but you can’t get it for your child because you’re just not wealthy enough,” Unumb said.

The Autism Academy, too, hopes to get their students back into a traditional, public school program.

At The Therapy Place, Blake Ravenell is looking toward that transition in a little over a year. He’s playing board games to learn sharing. He has a Velcro activity wheel where his teachers line up his daily schedule: bathroom breaks, reading and snack.

“The goal of going through this program is so when he gets ready to start kindergarten, he’ll go to a regular kindergarten class instead of a special needs class,” Dianna Ravenell said. “But he’s so smart we think he’s probably going to be bored in a regular kindergarten class.”

His favorite reward, outside of the iPad, is a puzzle.

During coloring time, he can’t stay put. He throws those suede shoes up on top of the table and slinks back in his chair. His teacher, Bellinder, sends him to the front playroom, any little kid’s paradise.

He runs to the rock wall, touches one of the yellow notches, and sprints back to the balance beam. He chases after balls escaped from the multicolor ball pit and catches bubbles in the air, all the while humming out a few words from his favorite songs.

It’s just another hour of “The Blake Show.”

(Source:thecherawchronicle.com)

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