Making Friends with Autism

Nate and Joshua's special relationship has taught them lessons that will last the rest of their lives.

BY CECILIA CAPUZZI SIMON, Parents magazine, November 01, 2009

Nate Pinkler and best buddy Joshua Linton, both 3 ½ years old, stand at the top of a paved incline at the playground of their preschool in Baltimore, Md. They are negotiating how to get their “rainbow car,” a big plastic car that one of them can ride in, down the hill in the fastest and most fun way possible. Nate takes the wheel, and Joshua pushes his buddy the whole way down, both laughing until they topple into a grassy patch at the bottom. Then they drag the car back up the hill and do it all over again.

To anyone who knows 3-year-olds, this scene might seem unremarkable. But to Nate’s parents, Tara and David Pinkler, and Joshua’s parents, Stacy and Obi Linton, it is an extraordinary—and satisfying—sight. A year and a half ago, Nate spoke few words and didn’t know how to play with toys, says his mom. He’d take a toy car, turn it upside down in front of his face, and spin its wheels—over and over and over again. Joshua, who had spent the first three years of his life at home with his work-from-home dad, had not learned to channel his energy or natural leadership skills, or to be around other children. 

Nate has autism; Joshua does not. But the friends attend the same preschool at the Kennedy Krieger Institute, a center known for its work with children with brain disorders, and for its research and advocacy of early intervention in treating autism. Their integrated classroom, started last January, includes three highly trained teachers and eight carefully screened students—five on the autism spectrum and three who are “typically” developing. 

Educational “mainstreaming”—integrating autistic and other special needs children into a regular classroom—is not new. But bringing typical kids into an autistic classroom is unusual. The goal  is to encourage autistic children to model the social habits and language of normally developing peers in order to prepare them for the rigors of regular elementary school—and for life, says Dr. Katherine Holman, Ph.D., director of the autism early intervention programs at Kennedy Krieger.  

Autism has many symptoms, including language delays, repetitive behaviors, and extreme attachments to objects and routines. Ultimately, the disability intrudes on a person’s ability to form social attachments. What the latest research from Kennedy Krieger and elsewhere shows is that early diagnosis and intervention can make a world of difference in an autistic child’s future. With the increasing prevalence of the disorder—1 in 150 children are autistic, and four times as many boys than girls are diagnosed—Dr. Holman and others at Kennedy Krieger also hope that including typical children in autistic classrooms will teach them tolerance and acceptance of those who are different.  

The effortless friendship that has grown between Nate and Joshua is a testament to that potential. “The more positive experiences typical children have with autistic children early on,” says Dr. Holman, “the more positive impact there will be on those children’s future relationships”

That’s the hope of Joshua’s mom, Stacy, who happens to work with older autistic children in a nearby public school system. She has been asked many times why she enrolled Joshua in an integrated classroom. Her answer: “Why not?”  When she visited the preschool before enrolling him, she saw that her son would get a quality learning experience with highly trained teachers and lots of individual attention. And that has happened.  Since starting preschool, Joshua’s vocabulary has grown and his sentences have gotten more complex. He knows the rules of the classroom. But she also hoped her son would learn from his classmates. Joshua may be too young to know—or care—that some of them need extra attention, she points out. To him, Nate and others in his class are simply  friends. 

“As he grows up, we will talk about his preschool,”  says Stacy, who also has a 19-month-old son she hopes will attend Kennedy Krieger as a typical peer. “I think Joshua will be better equipped to accept people at face value, not worrying that they have a label or not. But that’s what he’s doing right now! He’s choosing his friends for who they are and because he likes to play with them.” 

Joshua concurs: “I like to play with Nate,” he says. “Nate is my friend!”

As Tara Pinkler sees it, “Nate and Joshua are part of a “generation of kids that has to break down the stigma and stereotypes associated with autism, if for no other reason than there are so many kids on the spectrum.” 

Three years ago, the Pinklers never imagined that their child would be one of them. For the first year of his life, Nate was a happy, normal baby. He was babbling and hitting all of the developmental milestones.  But around the time he turned 1, he became silent—except for a high-pitched scream and a lot of crying. At first Tara blamed herself. A former school teacher, she had decided to stay home after Nate’s birth and had a second baby 14 months later. She was tired and felt conflicted splitting her attentions between her children. Boys are late to talk, she rationalized; perhaps he had regressed in response to the birth of his sister. 

But at Nate’s  15-month check-up, Tara says she was “hit cold.” When the pediatrician asked a battery of pointed questions about his development, her answers raised red flags. Nate no longer made eye contact, he had problems with gross motor skills, he didn’t play with anything, he had no vocabulary, his expressions and affect were blank. The doctor referred Nate to the county’s infant and toddler program, which evaluates children and provides intervention services to those with developmental disorders. He told Tara he was probably being overly cautious. 

But Nate declined quickly. “Between 15 and 18 months, he became a completely different child,” Tara says. He became “terrified” of the grocery store, so she had groceries delivered. The music class he had loved and attended since he was 5 months old became a nightmare. The noise, the people, the feeling of being trapped in the music room would work him into a tantrum. He’d brace himself against the door frame and refuse to go in. Tara would make him, anyway, believing the class was good for him.

But ultimately it grew too difficult for her, too. “You get the looks and the stares from the other moms. It was embarrassing,” she says. “I’d go home and be depressed the rest of the day.”  

The Pinklers’ ensuing problems are familiar to many couples with autistic children, 80 percent of whom divorce. Home life became “hell,” says Tara. But though the situation was tough on their marriage, Tara and husband David became partners in tackling Nate’s disabilities. They spent evenings in bed alternately crying and supporting each other. They worried about his future. Would he be able to fit in? Would his social issues negatively impact his sister? Did he even know they loved him? 

With a new baby and a troubled toddler, they stopped going out. Eventually Tara didn’t leave the house at all. Friends told her she needed to “break him,” but she quickly discovered that normal rules did not apply to Nate. Instead, she spent most days on the floor of her home holding Nate as tightly as she could and rocking him for hours at a time while he was “climbing out of his skin.”  When he was 16 months old, an occupational therapist came to the house to evaluate Nate and witnessed the scene. “Honey,” she said to Tara, “you need help.” Developmentally, Nate rated at the level of an 8-month-old. 

The Pinklers wasted no time getting him that help. They lined up occupational and speech therapy, and special education for social, cognitive and motor skills. They were referred to the University of Maryland for an evaluation for autism, but the wait was 6 to 12 months. They turned to Kennedy Krieger, feeling fortunate that the renowned clinic was an easy commute from their home outside Baltimore. But insurance would not cover the $2,400 evaluation there, money they judged better spent on Nate’s therapies. 

The Kennedy Krieger connection paid off in another way. When he was 2, they enrolled him in a research classroom for toddlers called Early Achievements, where his autism was confirmed. The class was “pivotal” in starting Nate’s turnaround, says Tara. With four other 2-year-olds and three specially trained teachers, including Cathy Walton, who is also the preschool’s lead teacher, the class provided intense intervention and socialization. It focused on what is known in autism circles as “joint attention.”  That’s the ability to notice others around you and to share with them interest in a shared object, like a toy, or an activity—like riding down a hill in the rainbow car. 

“Once Nate got the joint attention,” says Tara, “I knew we were getting him back.” 

Dr. Holman credits the early therapeutic interventions Nate received for making the difference in his prognosis. He was ready for the integrated preschool, and watching him now in his class, it is hard to imagine the distance he’s traveled.

“Joshua, I want you to come!” he says to his best friend. The two are sitting next to each other in circle time, and Joshua is leaning into Nate. Cathy Walton, or “Miss Cathy,” as she is known in the class, tells the children to line up to sing a counting song about dinosaurs, this week’s classroom theme, and Dr. Holman is amazed by Nate’s initiative. “They love to be silly with each other,” she says. 

That, and their propensity for being “boisterous boys,” as Tara says, drew Nate and Joshua to each other the first week of school. The teachers noticed that Nate would look for Joshua at the start of each class and save a seat for him—typical preschool behavior, except for autistic children, who usually focus on their own location in a classroom, and favor objects over classmates. 

Creating relationships in the classroom is “part of the plan,” says Miss Cathy, and friendship is a constant classroom theme. But even she was surprised by Nate and Joshua’s quick bonding. “It’s what we hoped for,” she says, “but we didn’t necessarily expect it.” 
Joshua’s “all loving” personality appealed to Nate: “Nate saw that Joshua noticed him and was open to playing with him, and so Nate turned to Josh,” says Miss Cathy.

To the general eye, the Kennedy Krieger classroom looks like a “cute little preschool,” says Dr. Holman. “That’s a good thing!” she adds. Bean-bag chairs, a sand table, books, play kitchen, cubbies and a road-map rug line the bright room. But each child was selected for this class. The autistic students are high-functioning and, like Nate, came out of the Early Achievements class. They are able to be attentive and participate. The typical students, like Joshua, are extroverted, good at playing and communicating, and easy-going. 

Likewise, the school day—four hours a day, five days a week-- is carefully planned. Embedded in every aspect of the classroom, from activities to seemingly casual dialogue, are lessons and strategies to socially engage the autistic child and to encourage typical classmates to behave and speak in ways they want autistic students to imitate. 

The teachers coach the children—both autistic and typical—in their expectations of each other, but they do not point out that a child is autistic. What they may say is “Everybody is different, just like there are different kinds of dinosaurs.” Typical preschoolers can be fast-paced, impatient and unpredictable. This can be intimidating to autistic children, who tend to like order in their world. Typical peers are taught to slow the pace, or to get the attention of friends who may seem uninterested by looking directly into their eyes when talking to them, or by gently tapping the friend’s shoulder. The children might role play, taking turns looking happy or sad, and then showing how they express those emotions. So if a child is too loud, a teacher might point out how that bothers another child. “Does Abby look happy when you make that sound?” Miss Cathy might ask. 

Teachers also try to repeat the language that typical peers use, drawing attention to what was said and how a child said it, hoping it will be imitated. “Did you hear that friends? Joshua says dinosaurs are as big as a UPS truck!” Miss Cathy says. Games, activities and seemingly simple interactions are created in the classroom to get children to do the things teachers want autistic students to learn. The teachers pay attention to children’s personal strengths, what motivates them and what’s going on in their lives, and then draw them out by creating classroom themes and lessons—doctors’ visits, bedtime, cars, insects—around them. 
“Everything the teachers do is intentional,” says Tara. One day, Nate—who tends to be loud and act out when he gets excited—was annoying classmates with his noises, she and Miss Cathy recall. The teachers noticed Joshua playing with an airplane, making it blast off loaded with animal passengers going to Disney World. They redirected Nate’s attention to Joshua’s activity, hoping not only to modify his behavior at the moment, but to teach him how to play pretend, something autistic children are not good at and that he did not know how to do. At first one of the teachers helped direct him, while Joshua showed his friend how to play. The next day, Nate initiated the game on his own.

“It was a huge deal,” says Tara. “If I had tried to teach him that, it would have taken a month. Joshua did it in a matter of minutes, and got to be the big kid while doing it.”    
Every child can benefit from teaching liked that, as Stacy Linton points out. The best preschools (and Kennedy Krieger’s staff visited many of them before designing their classroom) generalize specific lessons to activities throughout the day. The Kennedy Krieger classroom, with its low student-teacher ratio, and teachers trained to reach even the most resistant students, may do it better than most. 

As this school day winds down, the children set up to play a favorite game: the classic “Duck, Duck, Goose!”, which, during dinosaur week, has become “Stegosaurus, Stegosaurus, T-Rex!” The teachers love it, too, because it encourages autistic children to touch and to create relationships, and it teaches all of them about turn-taking. 

One of the typical children, Abby, learned the game from her older sister and, using “rich” 3-year-old language, as Dr. Holman says, explains it to the other children and shows them how to play. Meanwhile, the teachers constantly direct the children’s attention to her: “Look how Abby is touching the children’s heads!” says Miss Cathy. 

Joshua and Nate seem particularly eager to play. For Joshua, his favorite thing to do at school, he says, is “running.” Lucky for him that his best friend loves to be chased. So it is no surprise that as the game goes on (and on), and becomes ever more silly, that Nate and Joshua keep picking each other to chase around the circle—squealing the whole way.  

Next year, Joshua will return to Kennedy Krieger as a typical peer. Nate will move on to a private typical preschool to put his newfound skills to use in the bigger world. 

“He’s ready for the next step,” says his mom. “And if he’s not, we have to give him the chance to struggle.” 

But he and Joshua will stay in touch, say their moms. After all, as Nate says, “My favorite friend is Joshua.” 

“They are little buddies,” says Tara, smiling and watching them play. “But I feel the need to say, why shouldn’t they be?” 

"Normal rules did not apply to Nate. Tara spent most days on the floor of her home holding him as tightly as she could and rocking him for hours at a time while he was 'climbing out of his skin.'”