Making Contact

After hearing Jane's excited recollection of Steven requesting Skittles by handing a wrapper, I knew we had hit on something important.  Whatever cognitive mechanism mediated Steven's ability to interpret symbols was different than that of a typical child's.  Hence, the symbols we used had to be very clear, and very specific.  Building these symbolic communication skills required creativity and persistence.         

We started by creating a list of highly preferred food items that had discrete specific features on their wrappers:  M&Ms, goldfish crackers, gummy worms, apple juice.  Next, we removed the wrappers from these items, ensuring that their logos were visible.  We pasted the wrappers onto identical white cards.  We organized the food items into a small plastic container with dividers. Then we began to systematically introduce each item in our therapy sessions.  We paired each target wrapper with a neutral distractor, such as a white sock photo.  Steven learned quickly that if he handed me the "sock" card, he would enthusiastically be given a sock. This annoyed him greatly, and he would protest by scrunching up his face and whining. 

As I sat across from Steven, following a trial of "Goldfish," he appeared to stare right through me.  Sometimes I wondered if he could see things I could not.  What transfixed him so thoroughly?  Did he see spirits?  Why was it so difficult for him to meet my eyes in that uniquely human way?  Eye contact communicated joint attention, shared emotion.  I felt that to truly reach Steven, I had to find him, lost deep in the depths of the oceans that rippled in his eyes.  I had to sustain eye contact, and pull him to the surface, to take shared breaths of healing oxygen.  

I took his chubby, toddler hand and led him to the bathroom where we worked on self-help skills.  Currently, we were chaining the "wash hands" behavior.  A behavioral chain is a series of related behaviors that are broken down into smaller, more discrete behaviors.  Steven was learning to do "water off".  I stood behind him as he perched on the tiny wooden stool, just barely able to reach the faucet.  I prompted him through each step of "wash hands" until we reached the last step:  "water off."  I placed Steven's hand on the faucet and for the first time, he made an effort to turn the handle in response to my instruction.

After reinforcing him by ruffling his hair, I realized that something was different.  I stared, mesmerized into the mirror.  Through the looking glass, Steven's blue eyes met mine and held me in a timeless moment.  Whatever prevented him from making eye contact was warped in the glass and rendered ineffective.  In a flash of insight, I understood that the infinite amount of information passed in a single glance overloaded Steven's brain.  The mirror reflected some of this information away, and enabled Steven to see out, without the pain caused by the over-stimulation.  Perhaps the sensation was similar to fingernails on a chalkboard, or the high-pitched scream of feedback from a microphone.  This epiphany was so profound that it brought tears to my eyes.

Steven reacted to my sudden, stark display of emotion.  As he dissolved back into the sea of his being, I was left bereft, as though I had glimpsed a mermaid or a unicorn and then it was gone. However, like the rainbow that appears only during particular conditions, I knew Steven would come back to me.  All I had to do was recreate the circumstances that summoned him.