Viki noticed that Sam just picked at his. She was very worried about him. She was about to call him to aside to talk to him when Angelo stuck his head out the door. "I think he's starting to wake up." They headed for Todd's room, to find out if it was Adam or someone else waking up.

*****

Adam was starting to move around. He was still positioned on his stomach. He had taken his thumb from his mouth and he was turning his head to the left and then to the right. He whimpered and pushed the blanket off of him. Susannah didn't want him overwhelmed by so many people the second he woke up. She asked Don and Connie to stay in the room and asked everyone else to step outside.

Viki and Sam were not pleased by Susannah's request, but waited with Téa and Kevin in the lounge area near Todd's room. Susannah stood on one side of the bed and Don and Connie on the other. Adam turned his head in Susannah's direction and opened his eyes.

Susannah immediately knew this was the same child. His eyes shifted as far to the right as possible. He did not even seem to notice Susannah standing there as he jumped off the bed. Susannah held her hand up to let Don and Connie know she wanted to see what he was going to do before anyone approached him.

As he had earlier, he ran across the room. He seemed a little wobbly on his feet. Susannah realized it was most likely do to the sedative he had been given. "Aaaaaah! Aaaaaah!" He called out and rubbed his hand along his thigh. Susannah remembered that gesture and wondered if that meant he was hungry. She knew it was not that common for children with autism to exhibit hunger this way. They would more likely stand in front to the refrigerator or a kitchen cabinet and cry or jump up and down. This child could not do this, so perhaps this was his way. Susannah also knew Adam being able to make even these vowel-like sounds was encouraging. It was a step toward language, and any vocalization needed to be reinforced. It could also be helpful to repeat the sound the child had made. "Aaaaaah! Great talking!" Susannah praised and held out a Goldfish cracker to him." Adam didn't attempt to sniff it or have anything to do with it. For now, these crackers were not a reinforcer to this child. Susannah needed to find out, what, if anything, Adam would eat.

"Connie, will you please order a grilled cheese sandwich and a peanut butter and jelly one too. Also, please order some chicken fingers, fries, macaroni and cheese or alphabet pasta . . . and get some milk and different flavors of juice boxes and cookies from the pantry and please order enough adult meals for everyone. Oh, and bring a couple of sippy cups." Usually the parents of a child with autism were able to tell the therapist what kind of food the child liked or would at least be willing to eat. That was not possible in this case. Susannah was not sure what this little boy's taste preference was so she wanted to make sure to try to have several things he might eat. Although, sometimes the child's preference was not what you'd expect. Susannah remembered one little girl she worked with who would only work for extra hot barbecue-flavored potato chips and a little boy who would only eat olives.

Adam continued to run back and forth across the room. He began to make clucking sounds. Then, as if just noticing it, he headed for the window and started playing with the shade, the way he had in Susannah's office. Susannah approached him. She spoke soothingly to him. She tried contacting Todd and then one of the adult caretakers, finally some of the other child alters. Her attempts were once again unsuccessful. Adam continued to play with the shade. Cautiously, Susannah placed her hand on his back. He jerked away, but not as vehemently as he had earlier in her office. Susannah was hoping that he was not as oversensitive to touch as she had feared. Perhaps because he had just come out for the first time touch was more frightening than uncomfortable to him. Susannah hoped that would be the case, because lots of hands-on therapy would be needed with Adam.

This time he tired of playing with the shade on his own and started to run across the room again. Susannah opened the door allowing him to leave his room, if he chose. He didn't seem to notice. He was getting a little short of breath. She did not want to have to restrain or sedate him again. Considering Adam was not a typical child with autism and since it was possible that he had been in the system, observing the other's engage in life's activities, Susannah decided, to see if he could do some of the more advanced skills. If not, she would know that his programs had to be started at the most basic level. Susannah called Kevin in. "You want me to go in before mom and Sam?" Kevin was surprised. "I want you to sit on the floor with some toys and play with them. I want to see if he will willingly come over to you?" Susannah understood how unlikely this was, nevertheless, she needed to assess this child.

Kevin came into the room and sifted through the toy box. He pulled out a truck, a puzzle, Mr. Bear and a bright yellow ball. Except for the truck most of the toys were Timmy's. Susannah had gone down to the gift shop earlier and had gotten some Skittles and M&M's along with the Goldfish crackers.

Kevin looked up at Susannah. "Just go ahead and play with them," Susannah instructed. Kevin felt a little silly at first. He picked up the truck first and pushed it along the floor while making truck sounds. Adam paid no attention to him. He continued to run back and forth. Kevin picked up the stuffed bear and danced him along the floor. Not knowing what else to do, Kevin sang some of the Yogi Bear theme song that he remembered from one of his favorite childhood cartoon shows. Adam stopped running and stood still. He cocked his head in Kevin's direction. Kevin kept singing as he looked towards Susannah for instruction. "Keep singing," Susannah requested. "Yogi Bear is smarter than the average bear. Yogi Bear is always in the ranger's hair . . . " Kevin began the song again. They could not tell if he was seeing Kevin or not. "Ehhhh, ehhhh," Adam called out. Susannah smiled. He seemed to like the singing. "Ehhhh, I like the way you're talking and standing nicely!" Susannah quickly praised. Her voice was animated and her smile broad. She reached into her pocket and randomly pulled out a yellow M&M. Although he appeared to be looking nowhere near Susannah's hand, he obviously was. He sniffed her hand and the candy in it and grabbed it and shoved it in his mouth, as he had done with the Kiss.

Susannah was very pleased. No doubt, at least for now, chocolate was an excellent reinforcer for this little boy, singing and music might be too. Susannah was about to tell Kevin to start singing again when the child plopped himself down on the floor and began stimming. He held his hands up near the sides of his face and started wiggling his fingers. He also began to make a squeaking, almost, mouse like sound. Susannah knew this too was common.

"What's he doing?" Kevin asked, as he stood up and approached Susannah. "Is he okay?" "Yes, he is self-stimulating. It may be his way to self-calm or he may be bored or frustrated or telling us to reduce our demands or remove his source of frustration. You did great with the singing," Susannah praised Kevin. "Too much time in front of the TV as a kid," Kevin joked. "Well, you see, it paid off," Susannah joked back. "Kevin, will you please ask your mom and Sam and Téa to come in here now?" Kevin headed for the lounge.

Sam, Téa and Viki were waiting anxiously when Kevin told them it was all right for them to go to Todd's room. They immediately followed him back there. "How is he?" Viki asked on the way. "He's seems a lot calmer. He was running around again, but when Susannah opened the door he didn't try to run out. I don't even think he noticed. He seemed to like a cartoon jingle I sang to him." "Did he look at you?" Téa asked. "I'm not sure. I don't think so. It's pretty hard to tell with him keeping his eyes to the side the way he does," Kevin answered.

They headed to where Susannah stood. They watched this child for a few minutes. He seemed lost in his own world as he continued to wiggle his fingers and make squeaking sounds. "I've ordered some food for him. I think he may be hungry." She told them she also ordered some food for them and asked them if they would sit down and have some dinner when the food came. She wanted to observe his behavior in that situation. Susannah then told them that she called to the adult caretakers, the children, and tried to call Todd to the front and got no response, but that she really didn't expect one at this time.

Susannah turned to Viki. "Since I was not able to get through to any other alter or to Todd I think this would be a good time to give him his name. Viki, why don't you approach him and try out his new name. Don't say 'your name is Adam' to him. Say 'what's your name?' and then model the answer for him, with the instruction 'say' by saying, 'say, my name is Adam.' See if he responds to you. Please don't feel discouraged if he doesn't. He has not responded to anyone yet. I'm sure this is way too advanced for him. I don't think he's anywhere close to handling conversational skills or open-ended rote questions like 'what's your name.' I just need to make sure of that."

Viki knelt down beside him. He made no move to get away from her. He did not acknowledge her presence in any way either. Viki stared at him. She was amazed at the youthfulness and innocence of his face. He clearly looked younger than even Timmy did. She wondered if he was able to see her. His sideways stare was off-putting. Viki wanted to hold him so badly her arms ached. She knew she couldn't, yet. "What's your name? Say, my name is Adam!" Viki spoke cheerfully. Adam didn't respond. Viki tried again. No response. Viki gently stroked his arm and whispered, "I love you Adam." He continued to stare at his wiggling fingers. Susannah walked to where Viki knelt and put her hand on Viki's shoulder. She knew that despite her words of caution, Viki was disappointed Adam had not responded to her. Viki stood up and walked over to where Sam and Téa stood.

Susannah picked up the large yellow ball. She approached all of them so they could all hear what she had to say, but directed her request to Téa. "Téa, will you please sit on the floor, about three feet in front of him. I want you to hold the ball at his eye level then bring it down to the floor to try to engage his attention. Eventually we may gently tap his cheek or turn his face in our direction. He may begin to understand that he needs to pay attention and look if we just hold our hand near his face or he may begin to understand phrases like 'look at me' or 'you're not paying attention.' Even then we don't like to use these and other verbal cues like, 'hands down' or 'sit quietly,' excessively. We would reserve those for extreme inattentiveness. They can easily become a habit that is difficult to break. We want him to develop internal control instead of us giving him external control through cues. It is best to use differential reinforcement of good performance and good attending skills. We also don't use the child's name when giving the instruction. They can begin to think of their name as part of the instruction if we do that. Another thing, if you decide to allow me to use ABA with Adam, new skills would not be taught under these conditions, meaning, in his room, on the floor, with so many people, objects and toys around. They would be taught at a table and in isolation. The table would be off in a corner and there would be nothing around to distract him. Later on, when the skill is learned we would have him demonstrate it in a more naturalistic setting, like this room "

Susannah once again, spoke directly to Téa. "Once you've passed the ball in front of him, give him the instruction 'do this,' then roll the ball to him." Susannah addressed all of them again. "This is most likely too advanced for him. He doesn't have the necessary attending or imitation skills to comply. He may not even have the necessary motor skills. I just need to be sure of that during this assessment. We will do it three times, as one time is never enough to be sure if he already knows a skill." Susannah explained this so they wouldn't become disappointed or anxious if Adam could not comply at this time. She once again addressed only Téa. "Now, since you are the one asking him to do this task you need to be the one to reinforce it if he does it. Even if I have to physically prompt him and even if he is crying, the second he complies you give him verbal praise and the edible reinforcer at the same time. Remember, we always pair a secondary reinforcer, which is the social praise, with the primary reinforcer, in this case the M&M." Susannah handed Téa the bag of M&M's. "Just one at a time for this, unless he complies on his own while giving eye contact," she cautioned. Susannah addressed all of them again. "You can also praise by letting him know what skill he just complied with. For instance if you just prompted him to stand, you could say, 'That's standing up!'"

Téa sat cross-legged, facing Adam. He paid no attention to her and continued to wiggle his fingers and make the mouse like sounds. Susannah positioned herself behind him. "Okay, Téa," Susannah cued her. Susannah placed her hands on Adam's forearms and brought his hands down from his face to his lap. Adam did not like having his stimming interrupted. He started to cry, but not tantrum. Téa passed the ball in front of Adam's line of vision and placed it on the floor. "Do this," Tea instructed, gently but firmly. She rolled the ball to Adam. Susannah waited a couple of seconds to see if he would comply on his own. She really didn't expect him to. She realized he would, most likely, have no idea what to do. Since this was his first trial at rolling the ball and he had no understanding of a correct response, Susannah used a full physical prompt and gently manipulated Adam's hands into pushing the ball. Adam continued to cry as Susannah did this.

"Great job Adam! I love the way you rolled the ball!" Téa praised, exuberantly. Téa had his reward ready. By chance, she had pulled two yellow and one red M&M from the bag. She handed him one of the yellow M&M's as she praised him. Adam's crying lowered. He sniffed the candy and quickly popped it in his mouth. Adam started to stim again. Susannah motioned for Téa to repeat everything she had just done. Susannah once again brought Adam's hands down to his lap. His crying increased. "Do this," Téa instructed. Again, Susannah needed to use a full physical prompt. She manipulated Adam's hands into rolling the ball. "Terrific Adam! That's rolling the ball!" Téa praised and smiled brightly as she held out another M&M. She had randomly chosen the last yellow M&M in her hand. Adam's crying lowered as he sniffed the candy and shoved it in his mouth. They did it for the third time. Adam still needed a full physical prompt. Téa praised and held out the last M&M's in her hand, the red one. Adam didn't sniff it. He started to cry louder. He began to scream. He lay down on the floor and began to kick his feet. They were shocked by his sudden tantrum.

Startled, Téa stood up. "What happened? What did I do!" She asked frantically. Why is he so upset?" Viki asked, worriedly, heading over to Adam. "I'm not sure," Susannah responded honestly. "Téa, Viki, let's walk over here. Susannah headed to where Sam and Kevin stood. Téa handed the bag of candy back to Susannah. Sam started to go to Adam. Susannah placed her hand on Sam's arm. "Sam, please, don't go and try to comfort him now." "I thought this was just observation," Sam responded angrily. "Yes, it is, but you are going to reinforce this behavior if you go to comfort him. It will be sending him the wrong message." Susannah tried to reason with him. Adam kept screaming, crying and kicking.

"Look Susannah! I don't remember hearing Viki give you permission for this program or whatever the hell you call it. You are just supposed to be assessing him." Sam was getting angrier by the second. He turned to Viki. "Are you going to allow her to ignore him!" Sam was not only speaking loudly because of his anger, but to be heard over Adam's high pitched, childlike cries and screams.

Viki didn't know what to do. She wanted to comfort him as much as Sam did, maybe more, but she also wanted to do what would help him in the long run. "VIKI!" Sam shouted, in pure anger this time, "FOR GOD'S SAKE!" "Maybe he just wanted more candy than I was offering him?" Téa suggested, trying to think of something. "Maybe that's it," Sam agreed. He turned to Susannah. "Let me have that package of M&M's." "Sam, I don't think that's a good idea. Please, allow him some time to calm on his own." "Susannah give me the damn candy or I'll take it from you!" Sam threatened.

They were shocked. No one could imagine that Sam would ever speak to anyone that way, let alone Susannah. Viki, Téa and Kevin shared uncomfortable looks. Viki was more afraid for Sam at that moment than she was for Adam. "Susannah, please, we really haven't decided to allow the ABA program yet. Let Sam try to calm him, just this once. Adam's just a baby and he's only been out for a few hours. Surely it can't hurt just this once," Viki pleaded. Susannah realized that Viki had the final say when it came to treatment and she had promised this was just going to be an assessment. However, she knew that comforting this child during his tantrum would just be making things more difficult for him, but she handed Sam the candy.

Sam rushed over to Adam, whose tantrum was not letting up in the least. "Don't put your hands near his mouth," Susannah cautioned. Sam held up the bag of candy near his face. "Adam look! Here, you can have all the candy you want. Shhh, it's all right." The tantrum continued. Sam poured some of the colorful candies in the palm of his hand. He held them out near the right side of Adam's face. Adam's crying lowered. He stopped kicking and sat up. He sniffed the candies in Sam's hand and then picked out only the two yellow ones. He quickly shoved them in his mouth.

"My God, he only wanted the yellow ones. All that fuss because of the wrong color candy!" Téa was amazed. "Susannah, do you think that was it?" Viki asked. "That would not be the most typical reaction, but in this case, yes, in this case I do believe that was what this tantrum was all about," Susannah sighed and added, "Unfortunately, Adam had just been taught that tantruming is a great way of getting what he wants."

"Damn it, Susannah! He should get what he wants. Hasn't Todd and all of them been through enough. So what if he wanted some yellow candy! I'll buy him a whole factory of yellow candy if it will make him happy!" Sam voice was still filled with anger.

Susannah understood Sam. She knew his guilt was driving his behavior. Hearing the alters talk about the abuse they endured was bad enough, but hearing Todd remember it and seeing what it did to him was too much for Sam. He was desperate to stop all the pain for them any way he could.

Adam had given his attention back to the ball. He started to spin it. "Hey pal, you want me to play with you?" Sam tried to roll the ball away from him with the intent of rolling it back. Once again Adam started to scream and cry. Sam quickly gave him back the ball. He just as quickly stopped tantruming and went back to spinning the ball.

Connie and Don shook their heads. They knew that Sam was reinforcing this child's inappropriate behavior, yet their hearts broke for the torment they knew Sam was going through.