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THE AUTISTIC CHILD LEARNS TO READFrank M. Hewett Ph.D. aa Assistant Professor of Education and Medical Psychology and Principal , TheNeuropsychiatric Institute School , UCLA, Los Angeles, CaliforniaPublished online: 07 Jul 2006.

To cite this article: Frank M. Hewett Ph.D. (1966) THE AUTISTIC CHILD LEARNS TO READ , The Slow Learning Child, 13:2,107-121, DOI: 10.1080/0156655660130207

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THE AUTISTIC CHILD LEARNS TO READ*

Frank M. Hewett, Ph.D., Assistant Professor of Education and Medical Psychologyand Principal, The Neuropsychiatric Institute School, UCLA, Los Angeles,

California.

Autistic children present a number of therapeutic and educationalchallenges. Psychotherapy with them is notoriously frustrating andoften unsuccessful because of their interpersonal distance, preferencefor self-oriented rather than other-related activities, poorly developedor non-existent communication skills and bizarre, stereotyped behaviourpatterns. The essential therapeutic ingredient of a meaningful relation-ship between therapist and child is often extremely difficult if nottotally impossible to establish. For this reason many autistic childrenundergo years of intensive and expensive therapy for naught, andexamples of therapeutic successes with them are conspicuously absentin the literature. Formal educational training of autistic children hasoften been postponed on the premise that a psychotherapeutic inter-vention must necessarily come first in order to enable the child laterto efficiently devote his energies to learning.

While the logic of this premise can be supported, its practicalvalue for autistic children may be seriously questioned. Many suchchildren are excluded from speech and academic skill training duringcritical early childhood years when they may be more readily access-ible and when establishment of communication skills may greatly alterthe course of their future psychosocial development. Rimland8 hasreported that as many as half of all autistic children may fail todevelop speech and the studies of Kanner and Eisenberg7 and Brown2

suggest that if speech has not been acquired by age five the autisticchild probably will never learn to talk or measurably improvepsychosocially.

Merely implementing a traditional speech and educational trainingprogramme, however, does not offer an easy solution. Speech teachersand educators have often been as frustrated and unsuccessful as thepsychotherapist in enlisting the attention and cooperation of theautistic child. Yet the possibility of harnessing and directing the oftenconsiderable intellectual potential of autistic children has fascinatedspecial educators over the past decade and the search continues formore effective educational techniques.

* The author is indebted to Irene Kassorla and Roslyn Stewart, who served asteachers and research assistants in the programmes for Kate and Patrick.

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Attention and cooperation are essential in all learning situations.These can be elicited from every child, autistic and normal, if aclearly defined and readily attainable task is presented, a sufficientmeasure of learner gratification provided, and a degree of teachercontrol maintained. Recently an educational approach emphasisingthese task, gratification and control variables has been explored withautistic children at the Neuropsychiatric Institute School at theUniversity of California, Los Angeles (UCLA). The approach is basedon principles of operant conditioning as described by Skinner. It hasbeen successful in assisting a non-verbal 4i-year-old autistic boy toacquire beginning language skills4 and a non-verbal autistic boy of 11to learn reading and written communication.5

Operant conditioning holds promise for initiating speech develop-ment in young non-verbal autistic children who heretofore have beeninaccessible to such training. However, for those autistic childrenwho do not acquire speech or for those who do and use it only as abizarre extension of autistic behaviour, the acquisition of reading skillsmay prove to be of considerable adaptive value. This paper describesthree reading programmes undertaken with verbal and non-verbalautistic children at the UCLA Neuropsychiatric Institute School.

The significance of reading for all children can be summarised inthree statements: The child who reads learns about reality; the childwho reads is in a favourable position to interact with others aroundhim; and the child who reads is valued by his environment. The addedsignificance of each of these statements for autistic children is obvious.

Lack of awareness and interest in the real world are fundamentaldeficits found in these children. The symbolic link between the printedpage and real world objects and events can bring autistic children intocloser reality contact. In addition the process of learning to read ishighly social. Teacher and child continuously interact while under-taking the task of reading instruction. Parents and others may findthat listening to the autistic child read aloud provides one of thefew opportunities for an interaction between them. Finally, autisticchildren may exhibit all too few socially-valued characteristics forwinning approval and esteem. Despite our best intentions it is difficultto lavish acceptance and praise on those with whom we cannotcommunicate in some meaningful way. The process of reading canbecome such a communication.

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It should be pointed out, however, that acquisition of readingskills does not cure autism and that some autistic children learn toread without training of any kind. The purpose of this paper isto emphasise the important link reading may provide between theautistic child and his environment, particularly if he has not acquiredspeech, and to encourage teachers and parents to focus on establishingthis link.

As was stated earlier, operant conditioning procedures provide asimple basic framework for gaining the autistic child's attention andcooperation and teaching him to read. To illustrate these proceduresthe task, gratification and control variables mentioned earlier willbe considered in the context of reading instruction with a normal child.

In the instruction of the task the teacher provides a cue (dis-criminative stimulus) for the child to respond to (holds up a wordcard with "house" on it). The child must learn to say the word"house" (response) when he sees this cue because his eventualgratification (positive reinforcement) in the learning situation (e.g.,teacher approval) is contingent on such correctness and is under thecontrol of the teacher. In the event he fails to give the correct responseno gratification will be forthcoming (negative reinforcement) and hewill be punished (withholding of teacher approval).

Learning can be defined as acquisition of correct responses whichare elicited in the presence of defined cues and which lead to gratifica-tion and avoidance of punishment. While normal children readilyrespond to discrimination tasks associated with word recognition, andattend and cooperate for the promise of teacher approval, autisticchildren must be dealt with on a more basic level at first. Althoughthe eventual goal is to get the autistic child to say "house" whenthe word card is presented, to enjoy his success and to value theteacher's praise, simpler tasks and more concrete gratification mustbe presented at first (e.g., getting the child to sit in a chair by theteacher and immediately rewarding him with candy if he attendsand cooperates).

The operant conditioning approach is in direct contrast tothe psychotherapeutic approach mentioned earlier. Stemming frombehaviouristic theory it focuses on bringing the child's behaviour intoline with minimum standards required for learning, rather thanconcern with inferred or unobservable events such as the child's

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psychological status. Its directness and simplicity orients teacher andchild around defined tasks rather than diffuse relationship goals.

Reading instruction undertaken in the operant conditioningframework just described has positively contributed to the realitycontact, increased interaction and improved social status of threeautistic children enrolled in the UCLA Neuropsychiatric InstituteSchool — Jimmy, Kate and Patrick.

Jimmy was 11 years old when he entered the NeuropsychiatricInstitute. Despite an early diagnosis of infantile autism (age 4~),multiple diagnostic evaluations, special school placements and psycho-therapy he was completely non-verbal and intellectually untrainedupon admission. His days were filled with head banging, shrieking andavoidance of human contact. He was an insatiable explorer of hisenvironment, seeking mechanical, repetitive activity (e.g. puzzlemaking) but refusing to be drawn into teacher-directed tasks. Jimmyhimself provided the first cues that led the author to consider theprospects of increasing intellectual skill training with heretoforeuntrained autistic children.

Jimmy appeared fascinated with the large letters on the side of atoy gasoline truck kept in the ward to which he was admitted.Without prompting, he tried to copy these letters on a blackboard.Since Jimmy was enrolled in a free-play nursery school programmehe was allowed to pursue this in his own way. When it becameapparent that Jimmy had not only the perceptual-motor ability toduplicate the letters but also the retentive capacity to reproduce themfrom memory, it was decided to capitalise on this and attempt toprovide means for increasing Jimmy's contact with reality, interactionwith others and opportunity for genuine social approval.

A word board was constructed with a small box covered by aglass door built into it at the extreme right. Grooved rails ran thelength of the board from right to left on two levels. The board wasdesigned to enable Jimmy to learn to match words with pictures ofthe real world objects they represented. An operant conditioningapproach was decided upon because of the previous failure of tradi-tional educational programmes undertaken with him. The teacherwas determined to set a task simple enough to guarantee Jimmy'ssuccess, to provide truly meaningful gratification for him, and tostructure the learning situation so that only responses given on theteacher's terms would earn desired gratification.

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The initial task was to get Jimmy to sit down and pay attention.Meaningful gratification for the boy was pragmatically discovered tobe biological and candy gumdrops were used as positive reinforcementfor correct responding. During the initial stages of the programme,it appeared Jimmy was oblivious to the traditional educationalrewards of teacher approval and task success.

The first day of the reading programme Jimmy was brought intoa small room with the teacher and immediately shown a candy gum-drop. Despite the fact that he usually avoided paying attention toanyone, Jimmy was drawn to the candy. The teacher gave him severalgumdrops and then sat down by the table on which the word boardhad been placed. Jimmy quickly followed, attempting to grab theteacher's pocket and locate the source of the desired gumdrops. Thiswas not permitted and the teacher took a gumdrop out of his pocketand dropped it into the box on the board behind the glass door.The door was held shut and Jimmy could see but not get the candy.He squealed with frustration, but the teacher did not open the door."Sit down, Jimmy," the teacher said, "Sit down." Jimmy refused atfirst but upon seeing that the candy was not to be directly obtained,he half-heartedly made a move to lower himself into the chair acrossfrom the teacher.

Immediately the teacher opened the glass door and made the candyavailable to him. After quickly devouring the gumdrop, Jimmy lookedaround for another. When he saw another one placed in the boxbehind the glass door he looked at the teacher. This time when thedirection to "sit down" was given he readily complied and the gum-drop was immediately given to him.

From these initial stages, Jimmy and the teacher entered into atwo-year reading written language programme which progressivelymoved from simple requests (e.g. "Give me the ball"), drawingpictures of concrete objects (e.g. ball, box, cross), labelling pictures ofthese objects by sliding word cards on the bottom rail of the boardunder the picture cards on the top rail, learning to match consistently75 words and pictures, spelling these words through gradual masteryof the alphabet and finally to writing simple phrases expressing hiswants (e.g. "I want candy, I want water, I want pool," etc.).

That the reading programme had contributed to Jimmy's realitycontact was demonstrated when after the first year he spontaneouslyassembled several picture cards of a mother, father and various animals

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and tried to communicate to the teacher that his parents had takenhim to the zoo the previous week-end. His increased interaction withothers was evidenced by repeatedly daily contacts with ward personnelwho patiently waited for him to write out his simple phrases beforegranting requests. Jimmy's improved social status was reflected bythe increased number of these contacts initiated by members of theward staff. In addition Jimmy's parents reacted very positively to hisnewly-acquired communication skills. The specific steps in Jimmy'sprogramme have been described elsewhere.5

Jimmy's programme was a highly individualised one and as addi-tional autistic children entered the Neuropsychiatric Institute schoolan attempt was made to develop a more standardised set of proceduresfor undertaking reading instruction. Kate was 10 years old when shewas admitted. Despite various diagnoses of neurological impairment,mental retardation and childhood autism the latter was seen asprimarily responsible for her bizarre echolalic speech, extreme self-destructive head banging, flatness of affect and uninvolvement withthe environment. Kate had never learned to read; indeed she hadnever acquired any academic skills although there were indications shehad sufficient intellectual capacity. Kate, like Jimmy, would simplynot attend to any teacher-directed task. She had also developed theskill of "looking through, around, over and under" stimuli presentedto her but seldom directly at them.

During the time Kate was in the hospital the NPI school staffdeveloped an experimental reading programme6 based on principlesof programmed instruction and related to a previously establishedreading programme created for institutionalised retardates by Bijou.1

The NPI programme consisted of a five-part daily reading lessonwhich systematically presented the child with words from the voca-bulary of a standard basal reader on a teaching machine, reviewedthese words, included actual reading in the basal reader with compre-hension questions and used extrinsic motivators (e.g. candy). Theentire lesson was done in a one-to-one tutoring relationship betweenteacher and child. In addition detailed records were kept by theteacher of each response the child made and a total correct responsepercentage was calculated for each lesson. If a 75% correct rate wasnot achieved, the lesson was repeated.

While this programme had proved consistently successful with anumber of seriously disturbed, mentally retarded and neurologicallyimpaired children it was a complete failure with Kate. She would not

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look at the teaching machine items, became confused when confrontedwith the basal reader and reverted to bizarre behaviour and speechwhen pressured for accuracy despite the continual use of candyreinforcers. It was finally concluded that the tasks expected of Katein the programme were entirely too complex and that she was notable to make the discriminations and follow the directions involved.As a result a lower level reading programme was devised which utilisedprinciples of errorless training, a recent area of investigation bylearning theorists.3-10

Errorless training is an example of operant conditioning principlesof shaping and successive approximation on an extremely simple level.The child is only required to make responses which are practicallyimpossible to fail. Each response is generously rewarded and the childexperiences a sizeable success for even minimal attention and effort.In the NPI school errorless training reading programme, colour andform discrimination were the minimal tasks required for success.In other programmes, discrimination of size and light intensity hasbeen utilised.

The programme designed for Kate and presented frame by frameon a teaching machine with confirmations of correct choices immedi-ately appearing after the child's response was in three phases. Phase Iemphasised consistent discrimination of solid colours, solid forms andlater, colour and form outlines.

Phase 1 : Colour and Form

(a) Colour Only

(red) (blue)

Teacher: "Find the red box"

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(b) Solid Form Only

(red) (red)

Teacher: "Find the red box"

(c) Colour Outline Only

(red) (blue)Teacher: "Find the red box"

(d) Form Outline Only

(red) (red)Teacher: "Find the red box"

A similar series in which the discriminations centred around finding ablue ball was also used. Many repetitions of each item were made andthe correct choices alternated to control position effect.

Phase II presented two words, "Tom" and "ride," in the red boxand the blue ball and offered the colour and form cues as aids to makethe child's choices "errorless."

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Phase II : Two Words with Colour and Form Cues

(a) Matching

(red) (red) (blue)

Teacher: (points to box on left) "The -word in the red box is'Tom.' Find the word 'Tom' in the red box over here" (points tochoices).

(b) Directed Choice

(red)Teacher:

(blue)

'Find Tom in the red box"

The same sequence was followed for matching and choosing "ride"in the blue ball.

This series was intended to introduce the word "Tom" in associa-tion with the red box and "ride" in the blue ball and the teacher'scolour and form cues were utilised to make it virtually impossible forKate to fail and to relieve her initially of the responsibility for anyactual word discrimination, or retention skills. In addition Katereceived continuous extrinsic gratification from tiny bits of chocolateplaced in her mouth by the teacher following each correct response.

Phase III was the final stage in the errorless training programmeand involved gradual fading of the colour and form cues used inPhase II.

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Phase III : Fading of Colour and Form Cues

(a)

Teacher: "Find Tom'."

The actual programme also used the matching items and was dupli-cated using "ride" and the blue ball.

Kate readily responded to the colour and form errorless training,although she took almost two months to achieve consistent functioningon the desired 75% correct response level. While during the standardreading programme she had regressed and been inattentive she nowcooperated well and appeared to enjoy thoroughly her guaranteed

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( r e d ) (blue)Teacher: "Find Tom' in the red box"

(b)

' Tom , * r i d e ,

(red) (blue)

Teacher: "Find Tom' in the red box"

(c)

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successes. Figure 1, Section A shows Kate's correct response rateduring the colour and form training in Phase I. Section B of Figure 1reports her rate during Phases II and III and illustrates her con-sistently high level of correctness which was maintained even whenthe colour and form cues were removed.

COLOUR&FORM COLOUR/FORM COLOUR/FORM BEGINONLY WITH WITH STANDARD

TWO WORDS 3rd WORD PROGRAMME

A B C D

Figure 1. Correct Response Rate for Errorless Training andStandard Programme (Kate)

Where initially Kate had been unable to discriminate these words,she now learned them even though colour and form cues were utilisedmuch of the time. This incidental learning of complex discriminationduring errorless training is extremely interesting. Rather than merelyxely on colour and form supports indefinitely to the exclusion of any

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attention to the word symbols inside, Kate and other autistic childrenenrolled in the NPI school programme definitely acquired worddiscrimination skills.

Section C of Figure 1 represents Kate's correct response ratewhen a third word, "Betty," was introduced in a cross. No colour cueswere utilised at this point and the form cues were quickly faded.The three errorless training phases including the introduction of athird word consumed some 7 months. While only 48 sessions arereported in Figure 1 and Kate was actually scheduled on a three timesa week basis, interruptions due to illness, teacher absence, school vaca-tions and the like extended these sessions over a 7-month period.

The most dramatic portion of Kate's reading programme is illus-trated in Section D of Figure 1. Following the 7 months of errorlesstraining, Kate was reintroduced to the standard reading programmeunsuccessfully attempted earlier. This programme presented her withsome six new words each week, none of which was introduced withcolour or form cues. While her overall correct response rate initiallydropped during the programme she steadily improved and was soonefficiently learning twice as many new words each week as she hadbeen able to acquire during the entire previous seven months.

Reading for Kate provided many opportunities for increasedreality contact. Once she was able to read in the basal primer sheengaged in discussions of the pictures, names of characters and eventsdescribed. She took the book home with her and willingly read formembers of her family in what was one of her first appropriate inter-actions with them. It was evident they were extremely impressed byher newly developed skill and the opportunities it provided for inter-action and genuine praise.

Patrick, the third autistic reading candidate, was 11 when hebegan the programme. Patrick, like Jimmy described earlier, hadnever acquired speech although from time to time he mouthed a fewwords in hollow whispers. He was a large, infantile-behaving boy whoshut his eyes when others approached and roamed aimlessly aroundon his toes with a peculiar gait. Patrick, unlike Jimmy and Kate, wasextremely passive and resistant to stimulation of all kinds. He waseven a poor eater and the promise of food or even candy appearedonly mildly rewarding to him. This type of autistic youngster isperhaps the most difficult to mobilise in a training programme becauseit is difficult to provide the essential gratification leverage necessary

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for learning. Nevertheless the teacher approached Patrick with theerrorless training programme designed for Kate, offering him bits ofa particular kind of candy he had shown some interest in. Becauseof his passivity the teacher had to maintain strict control at all timesand spoke to him in a loud and direct manner. At the time ofPatrick's participation in the reading programme he was also enrolledin a speech and social behaviour training programme conducted byDr. O. Ivar Lovaas of the UCLA Psychology Department who hadachieved some success with the boy through maintenance of strictlimits. His preliminary work with Patrick was largely responsible forgetting the boy ready for the reading programme.

Patrick was a slow starter in the programme and appeared tohave difficulty with the colour discrimination at the easiest stages.Some additional work was therefore required using concrete objects(e.g. actual coloured boxes) to assist him. Following this he began theregular errorless programme and his functioning is reported in Figure 2.

COLOUR COLOUR STANDARD& FORM FORM WITH PROGRAMME

WORDSA B C

Figure 2; Correct Response Rate forErrorless Training and Standard

Programme (Patrick)

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He was a much quicker learner once under way than Kate, althoughhis three times a week programme was also subject to similar inter-ruptions and some 16 training sessions in Phases I, II, and III covereda period of three months. His correct response rate during Phase Iis shown in Section A of Figure 2. Once the colour and form cues werepresented with the words and later faded in Phases II and III heresponded with an increasingly correct rate as seen in Section B,Figure 2.

During Phase III it was found that Patrick would give breathyverbal approximations of the two words on cue and the possibilityfor combining the reading programme with increased emphasis onspeech development arose. When he entered the standard programmedescribed in Section C of Figure 2, Patrick was willingly attemptingto pronounce each of the new words introduced to him. Thus thereading training provided a valuable adjunct to the speech programmealready under way.

Patrick's gain from the reading programme was similar to thatmade by Kate with the important addition that a systematic means•of furthering his use of speech had been provided. His parents wereable to interact regularly with him through reading and this new skillbrought Patrick increased recognition and deserved praise.

Jimmy, Kate and Patrick are still autistic children. They had allreceived varying programmes of traditional psychotherapy and someeducational training before the reading programme described in thispaper was undertaken, but they had not changed dramatically in theirlaehaviour or had previously learned to read. The point of the dis-cussion presented here is not that acquiring a reading skill solves theautistic child's major problems, but rather that it offers a tool forincreased reality contact, social interaction and approval. Such a tool•was extremely useful in assisting the three children described, althoughthey acquired it fairly late in their childhood.

If such training could be provided autistic children early in theirdevelopment the degree of autistic functioning manifest in later yearsmight well be altered. While the validity of this statement is yet tot e established special educators should focus their attention ondevising reading instructional programmes and offering them to autisticchildren as early as possible. It is the author's contention that whileics causes remain a mystery and demonstrated psychotherapeuticsuccess is almost non-existent, educational programmes using the-operant conditioning approach hold unique promise for interveningin the psychosocial deterioration associated with autism.

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References

1. Bijou, Sidney W. "Application of Operant Principles to the Teaching of Reading,Writing and Arithmetic to Retarded Children." Address given at the Forty-thirdAnnual Council for Exceptional Children Convention, April, 1965, Portland,Oregon.

2. Brown, J. "Prognosis from Presenting Symptoms of Preschool Children withAtypical Development," Amer. J. Orthopsychiat., 1960, 30 : 382-390.

3. Goldiamond, I., and Moore, R. "Errorless Establishment of Visual DiscriminationUsing Fading Procedures," Journal of Experimental Analysis of Behaviour, 7, 3,269-292, May, 1964.

4. Hewett, F. M. "Teaching Speech to an Autistic Child Through Operant Condi-tioning," Amer. J. Orthopsychiat., 1965, 35 : 927-936.

5. Hewett, F. M. "Teaching Reading to an Autistic Boy Through Operant Condi-tioning," The Reading Teacher, 17 : 613-618.

6. Hewett, F. M., Mayhew, D., and Rabb, Ethel, "An Experimental Reading Pro-gramme for Neurologically Impaired, Mentally Retarded and Severely Emotion-ally Disturbed Children." Paper presented at the Annual Meeting of the AmericanOrthopsychiatric Association, San Francisco, 1966.

7. Kanner, L., and Eisenberg, L. Notes on the Follow-up Studies of Autistic Childrenin Psychopathology of Childhood. New York: Hoch and Zubrin, eds. Grune andStratton.

8. Rimland, B. Infantile Autism. New York: Appleton-Century-Crofts, 1964.9. Skinner, B. "Operant Behaviour," American Psychologist, 18 : 503-515.

10. Terrace, H. S. "Discrimination Learning With and Without 'Error'," Journal ofExperimental Analysis of Behaviour, 6, 1, 1-27, January, 1963.

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