Hostile, withdrawn and terrified, the autistic child might as well be living on another planet. Until recently there was little hope for them. But now, in a Japanese run school in Boston, Massachusetts, children like these are being helped to find a way out of their isolation and into the 'real' world.
March 13, 1988
REPORT BY MARJORIE WALLACE
Coming out of the shadows
At first sight it is a ceremony familiar to all parents: a stately head-mistress in front of the microphone, a row of distinguished governors and, behind the scene, violin cases lying open on the grass, uniforms bundled into neat piles and the flurry of last-minute adjustments to lines of children about to take their place on stage.
But as they march on to the podium, with its frilly valance and striped backcloths, you notice there is something a little strange. The children are immaculately turned out in white T-shirts, shorts and trainers but the younger ones, who come on first, are linked one to the other in groups of five or six led by athletic Japanese men and women who run backwards, pulling along these fragile human chains. Other teachers dart among them like ball boys, picking up those who have stumbled or strayed, encouraging the hesitant or removing those who appear too distressed to move.
Even hefty or gangling youths of 18 or more clutch on to the T-shirt of the one in front and constantly have to be nudged into line. Others do not seem able to hold on. Their eyes search helplessly around them, they move on their toes with an uneasy gait, their shoulders hunched, their arms flapping by their sides, their wrists bent and hands splayed inwards as though afraid even to touch the air.
The opening ensemble begins; a tape of It's a Small World choruses through loudspeakers. Many of the children cannot speak or sing so most of the sound and action must come from the Tannoy and the teachers. Whistles are blown, hands clapped, arms raised. There are frequent war cries of encouragement. Behind each chain of marching children a teacher is crouched, physically manipulating those children who remain remote from the razzmatazz, fixed in one spot, with gauzy expressions on their faces. It is a cross between a military parade and a slightly drunken ballet, but to the parents sitting in the audience, the sight of their children on a stage, moving with other children, is more than they had ever hoped for.
The Higashi School opened last September in Lexington, a suburb of Boston, Massachusetts. It is the result of the efforts of doctors, including Jerome Kagan, professor of developmental psychology at Harvard University; Dr Paul Millard Hardy, a behavioural neurologist from the New England Medical Centre and parents and teachers, to import a new method for the education of autistic children.
The method, known as the Daily Life Therapy, was developed in Tokyo by Dr. Kiyo Kitahara, a 62-year-old law graduate who 23 years ago married and started a private kindergarten school. There she came across four-year-old Masao, her first case of an autistic child. She took him home with her, lived and even slept with him in an effort to understand what paralysed his mind. She successfully transformed his behaviour and, now in his twenties, Masao is talking, reading, writing and leaving school to become a potter. Other autistic children followed. Gradually, as her success was recognised by the authorities, her private kindergarten expanded into an elementary school, the Musashino Higashi Gakuen School, with 1800 pupils, of whom 500 had been diagnosed as autistic and educated in her kindergarten. Three years ago she formed an international division with 30 children from other parts of the world, including Ireland, Korea, the Philippines and America.
Dr. Kitahara (left) appears to have a soothing effect on even the most disturbed child. 'Everybody seems to love me,' she says with pride. But she does not claim to work miracles.
Severe autism affects five in 10,000 children. The symptoms can be present in young babies but usually they are not obvious until the first two or three years of life. It is more common than blindness and is four times more likely in boys than girls. It is also one of the most eerie and profound disorders we can imagine; human beings who are unable to recognise and identify with other human beings and for whom relationships have no meaning. Some fundamental error in the wiring of their brains; possibly a minor chemical error; a vulnerability which may be genetic or triggered by a traumatic event before or shortly after birth, has left them disconnected to the world around them.
They are like extra-terrestials stranded on a planet which they cannot route, map or shape into meaning; nor can they communicate their bewilderment and distress. As babies or young children they may avoid eye contact with their mother; they become rigid when held, turn away and cannot be consoled. These are the children who cry all night or who scream when an object to which they have become attached is removed. Objects seem safer to relate to than people. Lost in a shifting and incomprehensible world, any change in the environment can be intolerable.
Autistic children develop rituals which cannot be broken, they become fixated on things or obsessed with one subject. Many are so withdrawn they never learn to talk, but those who do usually repeat back what is said, or recite their obsessions such as train timetables or ask the same question over and over again. They take special routes to avoid their parents or other children or will simply walk over them as if they did not exist.
Such indifference and hostility is very hurtful to parents, who cannot understand why a child who often looks physically normal and can show unusual abilities should behave in such a bizarre way.
In the classroom there is an air of urgency. Only the teacher's voice and the strength of his gaze stop the children slipping back into the remote darkness of their own lost worlds.
Autism was first identified by an American child psychiatrist, Leo Kanner, in 1943 and although autistic children may have normal or even superior intelligence, they are still frequently mistaken as simply mentally retarded. In most schools in the USA, as in Britain, there are few special programmes for them.
Dr. Kitahara does not claim miracles--or even cures. She sees herself as an educator, not a doctor. She believes she has developed a system which can calm and organise the brain of even the most severely damaged child so that he or she is able to learn the skills of basic living, become independent both physically and emotionally and, in some cases, achieve exceptional results in music, art or academic subjects. Dr. Kitahara believes that once the instability of their emotions is under control, and a pattern and rhythm established in their lives, autistic children can learn to look after themselves and take their place in society.
Moreover, unlike the current medical belief that two thirds of autistic children are also mentally retarded, she believes that autism is a separate condition: the autistic child can learn but is blocked from learning by his or her fear.
"First he must sit still and attend to be able to receive education appropriate for his age level. Then it takes at least three years for a student to get better," she says.
Eighty per cent of the around 500 autistic children she has educated in Japan have been able to achieve the first goals and become emotionally stable and able to look after themselves. Sixty percent have made so much progress that their behaviour is nearly normal, as is their ability to learn in school. They have been mainstreamed with the non-autistic children and the majority have left with sufficient qualifications for employment.
The remainder, she believes, have improved but have not done as well as the others, either because they came to the school after their bizarre behaviour was firmly established, or because they also suffer other handicaps such as severe mental retardation or epilepsy.
By the time the parents have reached Dr. Kitahara most of them have been told that there is no cure for autism, that they must not expect too much, and that they must resign themselves to seeing their child in an institution or dependent on others for the rest of his life. They are more than willing to raise the $47,000 (f27,600) a year which the therapy can cost, either from their own resources or from fund-raising.
So it is not surprising that this opening ceremony, with all its splendour and extravagance, is an emotionally charged occasion for the parents, who have come from all over America as well as other parts of the world just to be here.
A group of children bring on a decorative egg which is opened by Dr. Kitahara to release flocks of balloons which disappear like flying Smarties into the grey clouds above. "These balloons contain our 'hopes and dreams' the loudspeakers bellow.
The music starts again and the children, wearing protective orange helmets, roller-skate in formations across the stage. Older girls, mainly Japanese, wearing shiny blue leotards and waving yellow pom-poms, give a dancing display. There are lines of children riding bicycles while holding hands, unicycles, pogo-sticks. The youngest, in shimmering space suits, bounce across the stage on green Hoppas to the strains of Superman.
The majority do make the journey across the stage on their own and the rest either carry their Hoppas or sit looking remote but happy until their instructor's hands guide them ahead. There is a performance of Snow White and the 10 Dwarfs (sic), and a display of Kendo, the Japanese martial art. All the time the pupils are marked by their teachers, who anticipate their movements as though enacting some carefully choreographed shadow-play.
The highlight of the morning: all the children are on stage playing various instruments from violins and drums to the keyboard harmonica, an accordion-like keyboard operated by blowing through a tube. This must be the world's first orchestra made up entirely of autistic people.
There is arendering of Beethoven's Ode to Joy, held together by the blowing of
whistles and some fierce conducting; a performance of Mendelssohn on the piano by a 14-year-old Japanese autistic student. Then Edmund Lyons, a 22-year-old who came to the school three years ago after becoming too violent to handle, takes the microphone and sings in a flat monotone, but with great panache, a version of Home on the Range.
Many of the parents are in tears; even the sphynx of Japanese bankers in the front row (who have been invited, no doubt, to support the school) cease leafing through their business cards and applaud.
Farewells are traumatic, especially for the parents, who may not see their children for several months. Nicol (above left) joined Dr. Kitahara's Tokyo school at three. 'She was like a merry-go-round! says her mother. 'Nothing would calm her.' The family received regular video reports showing Nicol's progress, from her struggles to learn to feed herself, to her shaky attempts at rollerskating. Nicol's flaccid muscles and her physical frailty gradually disappeared during the months of training. 'Most important of all, she greets and hugs me now,' says her mother Diann. 'Before she treated me as no different from a dog.'
In the dormitory (left), their restless energy burnt up by the hours of exercise, the children are at last at peace, if only in sleep.
A lull in the classroom, and Mimi and Chloe (right) lose their tenuous grip on reality.
Suddenly the children disappear and the parents are left waiting about on the grass, realising as time goes by that the sight of their child on stage is to be their only access that day. The harsher and more worrying aspect of the Daily Life Therapy is that Dr. Kitahara does not like the children's programme to be disrupted by the parents. She insists that the parents do not visit for at least the first three months. Thereafter contact must be arranged only at the discretion of the staff and is often conducted under strict and uncomfortable conditions such as 15 minutes standing in the school hallway.
Unlike other methods of treating autistic children, Dr. Kitahara does not expect or want the sacrifice of the parents. She believes that programmes which involve the mother in a 24-hour routine only destroy family life -to no avail.
"Autistic children are unstable and make their parents weary," she says. "It is important that the parents cut themselves away at first. If they are happy, then that will make the child happier and make the relationship better.'
Being forced to put total faith in one person is painful for many parents, who have dedicated years of their lives to their child. They feel that the lack of clear guidance and the tendency for the Japanese to say Yes when they mean only Maybe places the family under undue stress.
It is Sunday, the day after the opening ceremony, and by now most parents have been allowed to spend varying amounts of time with their children. But it will be Christmas before many of them will see their sons and daughters again.
Two school vans are lined up in front of the Boston Higashi School. Distraught parents and relatives are giving their children a final embrace. No one disobeys the rules. At 3:30 pm, Mr Suzuki and other Japanese teachers start taking the children from the arms of their parents and putting them into the vans.
Some go quietly; others scream and cling. Even the most controlled-looking fathers are now near tears; one man is sobbing. "I'll collect you, I promise. We'll go on vacation," he cries out as his fair-haired boy, no more than four or five years old, disappears behind the sliding door. As the van pulls away, taking the children to the dormitories, be runs after it, still shouting. "I love you. I promise. I'll come."
Other parents are more resigned, leaning on each others' shoulders or encouraging one another with a mixture of limited hopes and high dreams. "You're lucky, your daughter might be semi-independent. She could live in a group home," says the mother of a severely autistic 12-year-old. "Our boy may be able to have a sheltered job. That's our dearest wish'
“My name is Gershon and I'm OK,” he says over and over again. The gifted son of a cellist and a singer, Gershon's early talents turned to withdrawal and self-abuse. After 14 years of struggle his divorced mother is counting on Dr. Kitahara.
The working day at the Higashi School is tightly structured with blocks of time spent in the classroom learning to sit still interspersed with physical activities or team sports. Looking out of the window of the school at any time you will see energetic Japanese teachers in tracksuits and Harvard T-shirts jogging alongside a group of children, throwing baseballs or doing strenuous gymnastics.
The basis of Dr. Kitahara's method is that physical effort releases the intense anxiety felt by autistic children. When they panic and lose control a bout of exercise reduces their fear and calms them. Organised sport, especially in groups or teams, is therapeutic because it helps to create a sense of order, identity and companionship in the lonely exile of their minds.
Thus, developing the physical strength and stamina of the children is one of the first goals of Daily Life Therapy. When they arrive most of the children are weak, with flaccid muscles. Many flop about like rag dolls. Dr. Kitahara has proved this muscular frailty is unnecessary. One of the first things that a new pupil will learn is to run. Marathon running strengthens the child's muscles, improves his health and gives the confidence necessary before further learning can take place. "When we arrived at the school in Tokyo; says Fran Malin, mother of 18-year-old Stephen, "they took him to join a group and said 'Run’. Stephen had never run before--and would never have obeyed such a command. But they repeated it again and again: 'All the others are doing it. You must run.’ And he did.'
"It is said a man begins to weaken from the legs," says Dr. Kitahara. "Building up of physical powers fosters a strong spirit with a power of endurance.”
Dr. Kitahara's tiny figure, neatly resplendent in a pink jacket and trousers, white embroidered shirt and bedroom slippers, wanders from one class to another, smiling, observing or helping out a teacher who has a difficult pupil. Her soothing effect on even the most disturbed child is extraordinary. They all know her, put their arms out to her or let her cup their cheeks in her hand. Those who can speak repeat her name again and again. She responds with pride. "Everyone seems to love me;' she says.
We sit at the back of one of the kindergarten classes. At first sight it could be anywhere. Ten children between three and four years old are sitting on small yellow plastic chairs, gazing at the blackboard. All the time music is playing from one of the tape recorders that sit on windowsills in every corner of the school. Takamatsu, the teacher in charge, is drawing a lion and singing. As he does so, his eyes tirelessly scan, search and spark contact with the vacant little faces in front of him. There is a sense of tension, urgency; if he falters for a moment, his power over them will vanish. They are there, holding onto a safe, real world by their fingertips and only his voice and the strength of his gaze will stop them slipping back into the darkness of their own lost worlds.
"Hey, what's this?" He completes his lion. "Monkey, Monkey," shouts one little boy. The rest remain silent. That is another difference between this and an ordinary kindergarten; there is none of the usual chatter. Those who do speak just repeat the same words over again or echo what the teacher has said. It is strictly a dialogue for one voice.
"Hands up;” says Takamatsu. One or two raise their hands. The second teacher who crouches behind the row of little chairs swiftly raises the arms of the others, lifting them again and again if they drop down. The use of helpers as physical prompts is integral to the Kitahara system. It may take months, even years before the child will raise his arm for himself--but, eventually, he will. Until then a prompter will raise it for him.
Most of the younger (and even the older) children who come to the school are incontinent. Dr. Kitahara takes away the nappies and insists every child learns to go to the toilet. Nothing is said about accidents. But the child is taught to wash his own clothes and change himself. In each classroom there is an alcove with a toilet. Chloe, aged 7, is terrified of it but mid-lesson she is led there by the helper. For 10 minutes she screams and moans but the lesson continues and she returns. There is no compromise and no fuss.
"We had one boy who came to us at the age of 14 who was still incontinent. He was very hyperactive. But after three months he was calm and able to look after his own needs. “Be a gentleman; I would say to him" says Dr. Kitahara.
Similarly with tantrums and anti-social behaviour. Dr Kitahara feels that the autistic child is not kicking, biting or screaming to draw attention--more that such actions are an expression of inner confusion and terror. She is supported by well-known neurologists, such as Dr Paul Millard Hardy, who believe that autism in children is related to panic disorder and phobias in adults, which appear to be inherited and affect between 2 and 4 per cent of the population.
Imagine yourself in the situation you most dread. For me that would be being trapped in a lift or tunnel--or lost in a crowd. Imagine, moreover, that you cannot understand why you are sealed in there, scratching at the doors, or walls, shouting through the glass panes, fighting your way through a mass of distorted shapes. There is no way out; nor do you have the language to call for help or the understanding to make contact with other human beings. Everything is terrifying, fragmented and unreal.
"These children are encased in fear' says Dr. Hardy, "I have come to believe that autism has a physiological basis involving the hormones which control anxiety." Dr. Hardy, a remarkable, caring man in his early forties, first came across autistic children 11 years ago when he worked in a school for the mentally retarded. "I was so overwhelmed by the self-mutilation of some of the children-the headbanging, the biting of their own flesh--I felt sure there must be a neurological basis.' He observed that 200 of the autistic patients he treated suffered from similar physical reactions--raised blood pressure, accelerated heart rate, sweating--as people experience under extreme stress. He also found that drugs which are used for panic disorders (the tricydic antidepressants, beta-blockers and the benzodiazepines (Valium-like drugs) were more effective than the heavy doses of tranquillisers normally prescribed.
"They are made speechless with anxiety he says. This would explain why some children, later diagnosed autistic, have started to speak but then lose the ability. It could also be the reason why they "acquire" retardation. "If your hands are sweating, your heart thumping and you are restless, you can't learn," says Hardy.
The theory also fits the comforting effect of strenuous exercise and self-mutilation. "Any process involving great pain or activity or excitement involves the release of endorphins in the brain," says Professor Richard Shader of Tufts University School of Medicine. "It is the release of endorphins which calms people down.'
Other disturbing features of autism are explained by the biological anxiety disorder hypothesis. Many autistic children become profoundly attached to some familiar object such as a piece of string or cloth which they twirl round or flick endlessly for reassurance. Or they become absorbed for hours in rubbing their own fingers a few inches in front of their eyes, or rocking their bodies or banging their heads on the floor or wall. They are often obsessed by certain rituals such as stepping over a particular stone on a path and become uncontrollable if one stage in a familiar routine is altered. Anything which changes in the outside world, such as an ornament put in a different place, will induce, literally, convulsions of terror.
Dr. Kitahara's method tackles this insecurity by working with groups of children. Everywhere in the school you see children coupled one to the other in lines, shunting back and forth through the corridors like toy trains. "It makes them feel happier to know where they are," she says.
In this respect her approach goes against the intensive one-to-one teaching used by many educators, whose methods rely on strong communication between the child and its mother (or teacher). But making contact with one person does not, according to Dr. Kitahara, prepare him for participation in normal play or in the classroom. "Autistic children are like wild horses the parents don't know how to control," says Dr. Kitahara. "If we have them 24 hours a day we can tame them, and then teach their parents how to deal with their behaviour."
Critics of the Daily Life Therapy have suggested that the school does not take those children who are most severely affected. But a visit to the class for new pupils quickly dispels such doubts. The children here are elementary age, 10 to 12 years olds. They have come from all over America, most of them brought by parents who have watched every other method of teaching fail. So far the children have spent three weeks under the Japanese system and those who are boarding are, I am told, still disturbed by their parents' visit for the opening ceremony.
Grace before dinner: graduates of Daily Life Therapy prove Dr. Kitahara's belief that with their fears dispelled, even the most disturbed child can be tamed.
Mr. Okubo is teaching English in the elementary class. During the 40-minute period he never goes beyond the first three sentences in the Good News text book. The pupils' stubborn and bizarre behaviour could be amusing if it were not so tragic. Some of them, like Clark, a tangle-haired 12-year-old, cannot yet hold a pencil. He whimpers and his knees chatter noisily below the desk top. When the teacher guides the boy's fingers to grasp the pencil Clark fixes his gaze on his watch. When Okubo perseveres Clark becomes so agitated he has to be held down by the shoulders.
Meanwhile another boy, Gary, is tearing up his worksheet. "What have you done?" Okubo points his finger sternly in front of his eyes and gives him another. This pattern is repeated throughout the lesson, with firm admonishments but no physical punishment. Gary wanders about, hissing and over-breathing himself into a hysterical state. The helper quickly removes him from the room to release his energy in a physical activity-–a walk or a jog.
"Our lesson is about the Sun, Moon and the Water. Many years ago the Sun visited the Earth..” says Mr. Okubo. This time Gershon, a 14-year-old, becomes excited and shouts "Moon, moon” over and over again. His neighbour deliberately breaks his pencil and stabs the point into his own palm. The girl behind rocks and examines her fingers. Stephen sits with an empty, angelic smile on his face.
Undeterred, Okubo tells the children to wait, hands on knees, while pieces of paper are handed out for them to trace the pictures and copy the sentence underneath. Frankly, there seems as much hope of achieving this as there would be in expecting unfed lions to ask permission before attacking their prey. But the class motto, taped above the blackboard, is "Progress" and the lesson goes on.
By this time Gary, who has returned from his jog, has become worked up again. He eats the paper he is given, bites on his own arm and throws over his chair. When Okubo approaches he punches him in the jaw. Okubo is temporarily stunned but remains cool and professional, sits Gary down and opens his book. It is only by constant repetition of the routine, by physical prompting of every movement, by the teacher guiding the pupil's hand on the pencil time after time, that tracks for future learning can be laid.
Hopeless though these struggles to lay the tracks may seem, they evidently do eventually succeed. After a year or two in the school the children are calmer and more studious and the classes less chaotic. Academic success is variable and often slow. "If it takes a normal child 10 repetitions to learn something, it may take 100 or 1000 for an autistic child. But, eventually, he will learn," says Dr. Kitahara.
"There is no student we have been unable to control."
Those Japanese adolescents who have been taught the therapy since kindergarten are Dr. Kitahara's testimony to the effectiveness of her methods. Urura Kamachi, a pretty 12-year-old with a squarish face framed by a bob of black hair, sits with the students who have come to Boston from the International School in Tokyo. She, like the 40 other Japanese high school students, has been brought over to Boston for two months to encourage the new pupils.
We are shown videos of Urara when she first arrived at the kindergarten, rushing around like an enraged animal, fighting all attempts to come near her. Over the next months we see her taking off her shoes and placing them in a locker, greeting her mother with a smile.
"In educating autistic children," says Dr. Kitahara, "you have to catch them in the springtime when they are ready to grow." Today Urara talks vivaciously and answers my questions in stilted English.
In the art class Urara is drawing the roofs of the building opposite, her pencils and crayons sharpened and neatly stacked beside a creditable sketch. Some autistic children show unusual talents for art and music which are encouraged by the school, despite its emphasis on group rather than individual activities.
Great care goes into the selection of teachers. All are graduates, and take on the job for life. "No teacher has left” says Dr. Kitahara. “We pay them a high salary (£11,000-£17,600 a year). They are expected to work 230 days of the year from 8 am until 5 pm. A separate staff looks after the children in the dormitories.
The school's regime of monitoring and military discipline goes on when the children return to their living quarters for the evening. The school vans move in convoy down a leafy driveway and pull up at the entrance of the converted monastery which Dr. Kitahara has bought in Natick, a nearby Boston suburb. Here in the atmosphere of arched windows and echoing stone staircases, imbued with the solemnity of its previous occupants, the children seem more vulnerable. They sit on chairs around the edges of the vast day-rooms, still under the evervigilant eyes of instructors. The television is on and there is music from the tape-recorder. Again you notice the lack of ordinary playful sounds and spontaneous chatter. You know that if the television and the tape recorders were switched off and the staff left the room silence would descend, disturbed only by the moans and echolalia of these lost human beings.
As though staving off this doom the staff rush around, trying to stimulate the children. In one corner of the day-room the teacher lays out some games. Stephen makes desultory moves on a snakes and ladders board. A football is kicked into the room by another member of staff. "Come on!" he exhorts, but only one boy kicks it back. "Let's dance!" says another helper, taking a floppy girl by the hand.
A book is placed in Clark's hands, but he only flaps and fans it, compulsively, in front of his eyes. He occasionally circles the room on his toes like a crazed gazelle, before being led back to his chair. An adolescent boy puts his hands down his trousers and starts to masturbate. He is quickly spotted and his hands removed.
In the dormitories, without the dignity of their uniform, it is the older teenagers who seem most helpless. Although many are improved, for them time and hope are running out. Edmund Lyons, aged 22, came to the school when he was 19, having been so violent he could no longer live at home. Tonight he has had a shower and is ostentatiously using a hairdrier. Stephen, 19, who might well have been a high-flying student, just sits. Billy, another 22-year-old, kicks him and grins.
Somehow all the effort to sustain their good behaviour and involve them in games and activities seems overwhelming; so huge and unremitting an outlay to invest in such damaged minds.
The younger children, tired now from the day's regime, look like plants who could fall away from their support at any moment. All too easily, one feels, in the hiatus of the evening hours between supper and bedtime, they could follow their own inner demons back into a perpetual mental twilight.
That is precisely what Dr. Kitahara believes must be fought, whatever the cost. She knows that when her students return home they will inevitably slip back into their odd behaviours. But years of training will eventually win.
Among the most poignant sights in the canteen at Natick is the row of kindergarten children struggling to feed themselves. Mimi, a pale, fragile six-year-old with pebble-dark eyes, rolls them upwards and chews steadily on a piece of stewed meat. She was one of the first American children to go to the International School in Japan, two years ago. She had been unable to eat except through a tube connecting her mouth to her stomach. Katy, eight, another frail beauty, with wispy blond hair and solemn expression, used to drink only from a bottle. It took two weeks to wean her on to a cup. Nicol still finds it hard to eat normal food, but we watch her slowly scoop up pieces of meat and rice.
Manners are insisted upon and the children must say or gesture thank you at the end of the meal, as they must at the end of each lesson. Every child, no matter how young, is expected to clear away his or her own tray. Immediately after supper squads of the older Japanese children move in to clear up, meticulously wiping every crumb from the seats and stacking the chairs. Dr. Kitahara is proud of the fact that her pupils keep the classrooms and dormitories clean and even mow the lawns.
Back in the dormitories the Japanese students, brought over to demonstrate the success of Daily Life Therapy, gossip in their quarters as they prepare for bed. I am told that they have improved so much that they are able to relate to each other, to swap watches, and even to exchange confidences. There are two or three students to a room. Most rooms are tidy. The windows stay open by the bed.
Nowhere is there a need for unbreakable windows, as I have seen in homes for autistic people in Britain and the USA. Ornaments are placed on low tables, posters have been put up. There are no locked doors, no protective helmets to prevent damage from head-banging--no seclusion rooms and no drugs.
Many autistic children are hyperactive and if left untreated stay up all night, rushing around the house or destroying furniture and mutilating themselves, but sleep is not a problem here. The hours of marathon running, roller-skating, cycling, gymnastics and team sports have burned up the energy that might be turned to destruction and, according to Dr Kitahara's theory, dispelled the child's fear.
By eight o'clock the International students and the new American boarders are in bed. A Philippino helper wades among the dozens of mattresses on the floor of the makeshift dormitories set up in the day-rooms. She replaces hands that stretch out over another mattress and returns the last wanderers to bed. Soon they are all asleep.
"This programme offers the best outcome of any I have seen," says Dr. Hardy. He is supported by Professor Richard Shader: "In the past not much emphasis has been put on the role of anxiety in treating autism'.
But if the Kitahara school is successful in improving many of its autistic pupils, could the techniques be used more generally? The near-military methods Kitahara uses are accepted in Japan where schoolchildren are anyway highly regimented. But would they transfer to the more lax and individualistic American and British societies? And would western teachers be prepared to work with the dedication and life-long commitment Dr. Kitahara expects from her 200 Japanese staff?
Dr. Kitahara is only one of those who are trying to unlock the mind of the autistic child. In Twickenham, south-west of London, a widowed mother, Jasmine Bayley, is grappling with them in a different way. She practises the "holding therapy" invented by the animal behaviourist Nico Tinbergen and his wife, and developed by Martha Walsh, a New York psychiatrist.
This therapy is also based on the belief that fear and panic lie beneath the child's rejection of people and the outside world. According to this theory, the only way of making the child come out of his withdrawal is by intrusion; by forcing a way through to him to make him respond. This involves the mother holding her child for at least an hour a day: firmly, often against his will, and by relentless pressure of her conversation, she demands he look her in the eye. Usually the child begins to struggle and scream, a frightening and distressing experience to observe and exhausting for them both. But it is only through the release of the child's terror that the vital communication can be forged.
Another approach uses behaviour modification. It aims to eradicate unacceptable behaviour, such as self-mutilation, violence, self-stimulation and lack of contact, by a system of rewards and punishments.
The rewards are praise and sweets and treats. Punishments may be no worse than ignoring the behaviour, or leaving the child for varying amounts of time in a seclusion or "time out" room. But sometimes more radical techniques, developed by behavioural psychologists using experimental animals, are used. If a child does not do a task, or starts rocking or head-banging, a whole system of punishments is used against him. He may be given electric shocks, be sprayed with ammonia, hosed with cold water and subjected to white noise and blindness.
There is no proof that any of these approaches works although all of their advocates claim at least some improvement in a child's behaviour. There are 20,000 school-age autistic children in Britain but most of them do not experience any special method of treatment, and there are only 1150 places in specialist schools. "Dr. Kitahara is a brilliant teacher” says Lorna Wing, Britain's foremost expert in the field. 'We have similar teachers. But whatever they do they are working within the limits of the handicap' Everyone agrees, however, that, at worst, any attempt to treat an autistic person is more effective than giving him heavy doses of antipsychotic drugs and leaving him, unstimulated in an institution. At best some children become like the older Japanese students, able to function in society.
But the mystery of autism still eludes all the efforts of those who try to find its cause and cure. Even Dr. Kitahara, with all her confidence and enthusiasm, admits that however successful an autistic child becomes, the empty spaces remain.
THE DAY THAT STEPHEN STARTED TO SING
Stephen Malin was an awkward baby. “When I held him he would stiffen and push me away,” says his mother Fran. “He cried incessantly. It made no difference whether I was there or not.” At two years old he went to nursery school. “He looked adorable,” says Fran. “But he would come back as spotless as he went. He was the first to read, but he never talked.” There was dearly something wrong with Stephen. Experts recommended a form of behaviour therapy in which he was rewarded when he was socially acceptable, punished when he was not “I hated smacking him,” says Fran, “and he became even more withdrawn.” As the years went by his behaviour grew worse. He developed a habit of tugging at his ear and letting out blood-curdling cries. The therapists treated these outbursts by the 'time out' method, leaving him in a room alone for four or five hours. By the time Stephen was 14 years old the family was exhausted. 'I would ring up from work,' says Larry Malin, his father, 'and I would hear Stephen screaming. He was still screaming when I came home. He had hit himself and us so often that he had wounds which were permanently re-opening. He broke three protective helmets and we had to restrain him by tying his hands.' The Malins looked all over the United States for a residential home for Stephen, but none proved suitable. It was at this time that they read about Dr. Kitahara's Daily Life Therapy. Four days later they were in Tokyo. Stephen was accepted by the school on condition his parents did not visit until Dr. Kitahara felt he was ready. They left him in October and watched his progress on video. The following February the school invited them to their annual performance. The Malins took their seats in a Tokyo theatre and watched the son who had always been so remote from them walk on to the stage to sing the school song 'Talk to me...I've been watching, waiting wondering...' 'We had left a maniac,' says Larry. 'Now there he was singing and searching for us across the footlights.'