Téa too was relieved that Sam calmed down and agreed to observe Adam's first formal session. Yet, Téa could not shake the uneasy feeling she had. It was not only Sam's "new" closeness to Blair, 'something really bad is happening to Sam,' Téa thought as a sudden chill ran down her spine. Téa had a bad feeling and felt afraid for Todd. 'Sam loves Todd more than his own life. He would never do anything that would hurt him,' Téa said to herself, trying to shake her fears away. Téa looked at Sam as he looked at Adam. She saw so much love pouring out of his eyes. 'No, Sam would never do anything to hurt him,' Téa thought. Still the uneasy feeling remained. Téa thought back to the sight of Adam's smile and the sound of his laughter. 'No! No matter how Sam feels he would never, not even unintentionally, do anything that would hurt Adam or any of them, Téa told herself firmly. She hoped all would go well with Adam's first formal session.
*****
Susannah knew they had to get Adam to her office to begin his first training session. She tried something. She took Adam's hand to see if he would walk with her. He pulled it back and hit the TV screen again, hoping Toy Story would come back on. Susannah did not want this to turn into a tantrum. She took the videotape out of the VCR so she could take it to her office. She realized that, for today anyway, it was a powerful reinforcer.
"Let's go play," Susannah said to Adam. "Let's get him to my office," she instructed Frank and Don.
Frank put his hands on Adam's shoulders and gently nudged him away from the television. Don followed close behind. Adam started to cry, but not tantrum. He toe-walked out into the hallway with Frank guiding him. He was crying all the way, however he was not resisting. His blanket, still clutched tightly in his left hand, dragged behind him as he walked.
Blair, who had not seen him toe-walk yet, stared in astonishment. Once outside the day room Adam remembered his favorite ritual. He ran for the nurses station and slapped his hands on it and then ran to Susannah's office and slapped his hands against the door. Susannah allowed him two rounds of this behavior. When he made it back to her office door for the third time she had Don guide him into her office.
Adam started to cry loudly. Susannah slipped the Toy Story tape into the VCR in her office. The TV in Susannah's office rested high on a TV stand coming out of the wall and was out of Adam's reach. Adam started to bite his own hand. Frank took Adam's hands and held them down as Don continued to hold him by his shoulders. Frank held his hands for a few seconds. "Good hands down, Adam," Frank praised. As soon Frank said this Susannah turned on the TV and the movie. Adam immediately turned to the TV when he heard the sound of Toy Story. Susannah allowed him to watch for a few seconds and then shut it off.
Adam dropped his blanket and began to jump up and down and cry at the top of his lungs. He started to slap the sides of his head. Once again, Don held him by his shoulders and Frank held his hands down, this time for ten seconds. Adam continued to cry. "Great quiet hands, Adam!" Frank said loudly and enthusiastically. Susannah turned the TV and movie back on. Adam immediately stopped crying and gave the TV his full attention. Susannah allowed him to watch for another few seconds.
When Susannah shut it off Adam started to cry, but not as loudly and he did not hit or bite himself. "I love those quiet hands," Susannah praised, and turned the movie back on again for a full minute. Adam stared at the screen, intently, with his sideways stare. This time when she shut it off he only protested with a loud "aaahhh."
"Aaahhh. I like your voice Adam," Don praised.
Adam plopped down on the floor and grabbed his blanket. He began to suck on it and rub it against his face. He made a humming sound. Susannah allowed this behavior for now.
Susannah, Frank and Don all smiled. They knew he was starting to "get it." Viki, Téa, and Kevin were too nervous to smile. However they did realize that something good had happened. Adam made a connection between his behavior and the reinforcer. Blair and Sam stood as stiff as statues. Both their faces set in stone. Sam hated Adam being forced into submission. Of course he didn't want to see Adam hurting himself, but he reasoned the only reason the child was engaging in self-injurious behavior was because they were stopping him from doing what little in life gave him pleasure. Blair just plain hated seeing Adam being forced to do anything. She was afraid of how far they were going to go with this.
Susannah walked over to where Adam's family stood. "We're still at the assessing stage. I'm going to try to get him to stand using a receptive language program and a one step command. Most likely he is not ready for that yet; nevertheless we need to find out. After that we are going to try to get him near the chair. He won't be asked to sit in the chair, just to come near it." Susannah wanted to make sure there would be no surprises. She could see that everyone was nervous.
Susannah took the remote and walked to the table. She sat in one of the two chairs, not before telling Frank to try "stand up" with Adam. Susannah put a chart in front of her and picked up a pen.
Frank sat down on the floor and faced Adam. He tried to get Adam's attention by passing his hand in front of Adam's gaze and bringing his hand to his own eyes. Adam paid no attention to him. Frank took out a yellow M&M and passed it in front of Adam's sideways stare and brought that to his own face. This time Adam moved his head. Frank knew Adam was looking at it peripherally.
Frank stood up and as he stood he said, "This is standing up." Then Frank quickly reinforced Adam. "Wow! Awesome looking Adam!" Frank held out the small candy. Adam sniffed it, and shoved it in his mouth. Using the M&M to gain Adam's attention Frank once again modeled standing up. This time Frank remained standing. He used the candy once more to get Adam's attention. Frank gave the Sd "stand up."
Frank waited a couple of seconds. Gently, and careful to keep his arms away from Adam's mouth, he lifted Adam to a standing position. "That's standing up!" Frank spoke in cheerful animated voice and Susannah turned on Toy Story.
Adam immediately turned his attention to the TV. Susannah allowed the tape to play for a few seconds and shut if off.
As expected, Adam protested with a loud "aaahhh!" Adam plopped back down on the floor and began to rub his blanket against his cheek.
This time when Frank passed the M&M in front of Adam's gaze and held it up to his eye level Adam paid no attention. He began to chew on his blanket as he continued to rub it against his cheek. He was obviously in need of sensory input and self-soothing.
Frank gently lifted Adam's face by placing his index finger under his chin. "Look at me!" Frank instructed. Adam didn't make eye contact with him but Frank was hoping he was seeing him peripherally. "Stand up!" Frank gave the Sd. He waited a couple of seconds and when Adam didn't comply he once again gently lifted him to his feet. "Wow! Adam's standing!" Frank verbally reinforced while Susannah simultaneously turned the movie back on. Since Frank couldn't manipulate the remote and lift Adam at the same time Susannah wanted to make sure the powerful reinforcer, the movie, was associated in Adam's mind with Frank's praise and his compliance of the skill.
Adam plopped back down to a cross-legged sitting position on the floor and kept his attention on the TV. Susannah allowed him to watch for thirty seconds.
When Susannah turned the movie off Adam started to cry. He lifted his blanket with his right hand and began to stim with it again. He also began to flap his left hand.
Frank ignored the crying and stimming and once again gave the Sd "look at me!'' He physically prompted by turning Adam's face towards his. "That's great looking Adam!" Frank offered only verbal praise. "Stand up!" Frank tried for the third time just to makes sure Adam was not ready for this yet.
Adam did not respond. He continued to cry, and stim. Frank lifted Adam to his feet, blanket and all. Adam's crying increased and he started to scream.
'Ay dios mio,' Téa thought to herself. Tears came to her eyes. It was killing her to see Adam so unhappy. As much as it did, Téa was determined to stay strong and help him.
"That's great standing, Adam!" Frank praised, but Susannah did not turn the movie back on as that would reinforce his extreme behavior.
As soon as Frank let go Adam plopped down on the floor. In addition to crying and screaming, he started to kick his feet. Frank stepped away from Adam. He didn't acknowledge his behavior and he motioned for the others to do the same.
Viki quickly looked towards Sam. She could see tension mounting in his face. His body looked like one tight muscle.
"Viki please. Make them stop doing this to him!" Blair pleaded. Blair turned to Susannah. "How can you just sit there calmly writing notes while making them torture him this way!" Blair started to cry.
Before Susannah had a chance to answer Adam stopped tantruming. He stood up on his own. He was still crying and whimpering slightly.
"Terrific quieting down, Adam," Frank praised as Susannah turned the movie on. They worked smoothly as a team.
Adam ran closer to the television. He seemed absorbed in the movie when out of nowhere he echoed "uh oh" in exactly the same way Kevin had said it earlier. This time there was no correlation that they could see, between his use of the phrase and what was happening. Still they were happy to hear him say it.
"Awesome talking, Adam!" Frank praised and held out an M&M to him. Adam sniffed it and put it in his mouth.
"Let's try the chair," Susannah suggested. Susannah shut the movie off again. Adam started to cry, but not tantrum. "Come here," Susannah instructed. Adam continued to stand there and cry and hold onto his blanket.
Frank guided Adam to the chair. The second they reached it, even though Adam was still crying, Susannah verbally reinforced, "Great coming to the chair, Adam!" Susannah turned the movie on. "Go watch TV."
Adam quickly turned toward the television. This was repeated another nine times. Adam cried through some of them and protested with an "aaahhh" through some of them, but he did not tantrum. By the tenth time, his time near the chair had increased to twelve seconds before Susannah told him to go watch TV.
Susannah could hear the sighs of relief coming from Téa, Viki and Kevin. She knew they had anticipated something much worse, even though she had tried to give them a picture of what the beginning program was like.
Susannah approached the family. "Adam will have a three minute break and then we'll get him back to the table." Susannah then turned to Téa. "I'm really happy you brought this movie for him. For now it's a very powerful reinforcer."
Viki turned to Sam. "Honey, see it isn't so bad."
"It isn't so bad! What the hell the point to any of this? They're manipulating and torturing that child and for what! So some day, maybe years from now, he'll become part of someone who is even more unhappy than he is."
"Come on Sam. He stops crying as soon as he gets his reinforcer. He was only kept at the table for a few seconds. He even stopped tantruming on his own when no one paid attention to him. I think this program is working already. I also think Adam is a lot smarter than we figured," Kevin pointed out.
"You don't have to tell me he's smart, Kevin!" Sam snapped. "I know that! I never believed otherwise. I don't see why that child has to be made to cry before he is given what he wants. Why not just let him watch the damn movie! He was sitting quietly in the day room. He wasn't hurting himself or behaving inappropriately in any way. For no reason he was dragged in here and made to perform." Sam turned to Susannah and the techs. "What the hell did his coming to that chair accomplish except to prove that all of you are stronger than he is and have power over him. He doesn't need to learn that lesson. Peter Manning already taught him that!"
"Honey, please, it seems to me that Adam is already learning and. . . ."
Viki, I can't stop you from doing this to him, but I will not be a party to it." Sam cut Viki off. He turned and started to leave.
Viki grabbed his arm. "Sam please, just give it a chance. Just give it a little time." Viki hated seeing Sam so upset, however she was determined to do what she believed was right for Adam and for Todd.
Sam understood that Viki believed this was best, he just could agree less. "I'll be outside if you need me," Sam told Viki, as he tried to control himself. He knew if he didn't get out of there soon he would not be able to keep himself from running to Adam when he cried and taking him from the room.
Viki let go of him. She knew that he had to want to stay on his own because he believed this would help Adam and not because she had asked him to.
Blair waited a few minutes so no one would suspect she was leaving to get Sam alone. When Adam started to cry again once the TV was shut off Blair saw her chance to leave. "I really need to step outside for a few minutes myself. I still want to be here for him when he does this program. I-I just need a break," Blair said and excused herself.
The others exchanged looks but only Viki wondered if Blair was leaving so she could get Sam alone. Viki thought of following her out there, then thought better of. Not only did she want to stay for the rest of Adam's session, she still believed that Sam just needed some time and when Adam made some progress he would start to come around.
Blair found Sam in the now empty day room. He was staring out the window. "Are you okay?" Blair asked.
"Do you think he'll ever be a part of that again?" Sam pointed to the world outside the window.
"Sam you know I do. We can make that happen. We can take him out of here."
"I don't just mean for him to physically be out in the world," Sam began to explain. "Do you think he'll ever be able to function again? Will he be able to take care of Starr and run his newspaper? Hell, will he ever be able to take care of himself?" Blair did not see the tear that trickled down Sam's cheek when he asked that question.
Blair placed her hand on Sam's shoulder. "Sam, I not only think it, I believe it with all my heart. I know that Todd is not as bad off as he seems. They are making him worse here. I've been saying that for weeks and no one will listen to me. Todd needs to be home where he's safe, where there are only people who love him. He needs to stop being poisoned with all those drugs. My God, Sam, how could anyone think straight with all those drugs in their system?"
Sam turned around and faced Blair. "Viki wouldn't allow anyone to hurt Todd. She loves him. She loves him more than her own life."
Blair took a deep breath. "I know Viki loves Todd. I know she would never deliberately do anything to hurt him, but Viki constantly has Doctor Hanen and Téa and Kevin advising her and telling her what they think is best for Todd."
Blair hesitated for a moment before she spoke again. "Sam, is Viki really going to have you appointed co-guardian. Are you going to have as much say in what happens to Todd as she does?"
"Viki says she wants that. She's worried that if anything were to happen to her it would be too hard on Téa to have to make all those decisions."
There were a million things Blair wanted to say to that. She held her tongue. She knew she had to play this carefully. Instead she said, "Sam, maybe Viki is right. No one could ever accuse me of saying Téa was my favorite person, but I don't think I would wish having to make those kinds of decisions on her."
Sam thought for a moment then responded. "Isn't that what you want, to be the one making all the decisions for him?"
"No! Sam that isn't at all what I want. What I want is to get Todd and all of them away from the drugs and restraints and to get Adam away from this torture. That little boy should be allowed to do what he wants. If he wants to watch a movie all day why not? If he wants juice or candy why shouldn't he have it? Sam, I would hate having to decide things for Todd completely on my own. Oh Dorian could help with some medical advice, but the person I would really want to help decide things is you, Sam."
"Me! Blair I've done nothing but make the wrong decisions for Todd from the day I met him. On that very first day I saw bruises and I believed every lie he made up to protect Peter. My God! I remember thinking 'someone hit this child' the second I laid eyes on Todd. I didn't lift a finger to help him then and now you think you could trust me to do better by him. I don't think so Blair. That is why I'm thinking of telling Viki not to go through with it."
Blair was shocked. She never imagined that Sam would turn Viki down. Blair thought quickly. 'Yes!' She thought, 'I know I can get Sam over to my side if. If he were also Todd's guardian the courts would have to allow him to take Todd out of here if he thought it were best. At the very least he'd have as much chance as Viki would for keeping him here.'
"Sam, I understand how you feel. I hurt and betrayed Todd too. In some worse ways than you did. I lied to him. I used him. I hate myself when I think of all the ways I made him unhappy, but also like you . . . Sam, I never stopped loving Todd. I think you know that. I'm not saying we will ever be husband and wife again. I know he loves Téa." Blair didn't really believe this. She knew Sam still did. She didn't want him to think that she just wanted Todd out of there so she could eventually get him back as a husband. "I love him like you do Sam. I want to help him and do what's best for him and keep him safe and get him well. I believe with all my heart that will never happen as long as he's in this hospital being drugged and forced to do these programs. He will never get well as long as there are people around him who may not be looking out for his best interest." Blair believed the last few things she said with all her heart."
Blair could see that Sam looked confused. He was, there was still a part of him that knew how dead wrong Blair was, yet a growing part of him was beginning to agree with her. "Sam, I don't want to make decisions for Todd by myself. I want you to be there with Todd and me every step of the way. I want both of us to take Todd home. It'll be a chance for you to do right by him this time, Sam! Adam can't ask, but you know he is calling out to you to take him away from all this suffering. Todd thinks of you as his father. You can give that to him. You can give him the kind of home life he always wanted. Sam, I know you never meant for him to get hurt. You didn't realize what was happing to him. This time you do. This time you know he's being harmed. Don't turn your back on him again, Sam. It may cost Todd his life if you do it this time."
Sam's mind was spinning. Yes, he did believe Adam was being harmed. He also hated the thought of all those different drugs effecting Todd's brain and body. "Maybe if I were Todd's guardian too I could get them to reduce his medication and stop this ABA program . . . maybe Todd would do better in a home environment . . . maybe . . ."
Sam shook his head to clear it. "No! He could die! What if he had seizures or something happened to his heart. What if stopping the medications leaves him even more suicidal than he is or more psychotic . . . no! What about Viki? My God! She loves that boy. She thinks of all of them as her child, her baby . . . I . . . no! I can't do that to Viki."
Blair sighed. Sam was getting so close. "Viki can be a part of Todd's life all she wants. I would never keep Viki out of his life. I know she considers him her child. Sam, once Viki saw how well he was doing she would be so happy that we took him out of the hospital. She's afraid to take that chance. She believes in Doctor Hanen one hundred percent. She has absolute faith in Kevin. She doesn't believe Téa would ever hurt or betray Todd. She forgets that Téa turned him over to the police. She forgets the lengths Kevin and the Buchanan’s went through to hurt Todd."
Sam stared off into space as he listened to Blair. He felt disconnect. He felt like he was floating through his life and in a panic at the same time. His heart was racing. "What about Starr? You know it would kill Todd to have Starr see him this way, not to mention what it would do to Starr," Sam stated.
Blair's own heart started to race. She knew Sam was getting closer and closer to helping her to help Todd. "I thought of that Sam. You know I would never expose Starr to anything that would hurt her or make her see Todd in a confusing light. I thought this through. I think it would be best if Starr stayed with Dorian for the first couple of weeks, if Todd were to come home. Once he starts to improve she can come visit and them move back home. Oh Sam, I just know Todd will get better and better if he's home with us."
"Us?" Sam echoed.
"Yes, don't you remember? I told you. I want you to come to the penthouse and stay with Todd. You can have the room next door to him or you can stay in his room with him if you like. Sam, I want you to give Todd the kind of home and father he always dreamed of."
Sam remembered how many times he and Viki discussed the kind of home they wanted to make for Todd. Everything was out of kilter. It was Viki he was supposed to be making a home for Todd with, not Blair. Todd was supposed to come home because he was getting well, not because he was getting worse. Todd was supposed to be with his daughter when he came home, not have her sent away from him. Nothing was as it was supposed to be. It was all mixed up and Sam's thoughts were becoming more confused. The one consistent thought Sam had was, 'I can make it up to Todd. I can be the father to him I should have been when he was a kid.'
"Will you do it?"
"What?" Lost in his own thoughts, Sam didn't hear Blair ask him if he would agree to become Todd's co-guardian.
"I asked if you would become Todd's legal guardian?" Blair repeated.
"I need to think about it some more," Sam responded.
"Sam, what's to think about? You love Todd with all your heart. Who would be better watch out for him."
"Blair, I need to think about this. Now leav . . ." Sam stopped talking when they heard a piercing, high-pitched scream coming from Adam.
Blair and Sam rushed back to Susannah's office. Sam nearly tripped over the buffing machine a worker from housekeeping was using to polish the hallway floor. Adam was in the throes of another full-fledged tantrum. He was on the floor kicking and screaming. His face was already red and tearstained. He was cupping his ears, but not really hurting himself. Viki, Susannah, Kevin, Téa and the staff stood off to the side. Sam started to go to him.
Viki took his arm. "Sam don't! Susannah is sure he will stop in a couple of minutes if we don't attend to his tantrum." It was killing Viki not to rush to him and take him in her arms. She was determined to do what was best for Adam.
Sam looked into Viki's eyes. He saw she honestly believed what she said. He knew there was no point in arguing with her. Blair was right. Viki had complete faith in Susannah's judgment and nothing was going to change that.
"Why is he so upset this time? What did you do to him!" Blair directed her question more in Téa and Kevin's direction than in Susannah and Viki's.
"Nothing was done to him, Blair. He was brought to the table the same way he had been. He'd been crying for each of the trials, but not loudly and he was not tantruming. He suddenly started screaming and crying and hitting his ears. He dropped to the floor and started kicking and flailing his arms." Téa described what happened for them.
"You must have done something to hurt or upset him. Maybe he wanted to watch some more of the movie?" Blair accused.
She couldn’t stand seeing him suffer this way. She too wanted to rush to him. She didn't. She was afraid they would ask her to leave.
"I'm sure his tantrum is serving a function. That function might be avoidance of the task we were asking him to do and we don’t want to reinforce that by attending to this tantrum. We . . ." Susannah stopped talking. The worker from housekeeping was now up to the section of floor that was right in front of Susannah's office. For the first time she could hear the hum of the machine.
Susannah ran to her outer office. The noise got louder. She opened her office door. "Excuse me. EXCUSE ME!" Susannah shouted to be heard over the buffing machine. "Please turn that machine off!"
"What? Doc I'm sorry, were you saying something?" The worker turned to her.
"Eddie, you can't use that machine on this unit anymore. I'll call housekeeping and tell them. We have an alter who is extremely sensitive to sound. I think he's finding the noise from the machine very disturbing."
Eddie was horrified. "Doc I'm sorry. No one told me. It's my day to do the floors. I had no idea."
Susannah noticed that Adam's screaming and crying had already lowered. "Eddie, that's all right. You had no way of knowing. I didn't realize it until you got close enough for me to hear you. He must have been able to hear it even when you were down the hall."
"Doc, does this go for any noisy machinery?"
"Yes, I'll let them know that nothing like that is to be used here until further notice." Susannah thought of something else. "I'm also going to tell them that I don't want anything with a strong chemical odor being used on the unit. They will have to find some alternatives to clean with. This child may be very sensitive to odors as well."
Eddie shook his head. "Poor little fella. Don't you worry, Doc. I'll make sure to let everyone know to be careful with what we use around here."
"Thank you Eddie. I appreciate it," Susannah told him and headed back into her office.
Adam was lying on his side. His arms and legs were still. He had stopped screaming and his crying had lowered. He was sucking his thumb. Don had already verbally praised him for his “good quiet.” He had been offered an M&M and then some juice, but he refused it. Susannah approached Todd's family first and explained why Adam had suddenly started to tantrum.
"So he wasn't trying to avoid your damn task. He was in pain. His ears were hurting. Damn it Susannah!" Sam was so angry he couldn't see straight. The only thing that kept him from shouting was his fear of upsetting Adam.
"I know this is very difficult to understand and even more so to carry out, but even under these circumstances we still should not address a tantrum. We need to give him a better way to let us know when something is hurting or bothering him," Susannah tried to get Sam to understand.
It tortured Viki to know that Adam had been in pain and that's why he was screaming and crying, still she understood Susannah's point. So did Kevin.
Téa was having some trouble with it. She was left pale and shaken by the knowledge that this child was being ignored while in pain. "How do you even begin to get him to communicate his pain to us instead of reacting the way he did?" Téa asked.
"He is not ready to learn to communicate yet. We begin by getting him to understand that this behavior will not help to remove any uncomfortable stimuli. Then he will be more open to finding a better way."
"So you just leave him in agony until he makes this so-called connection you keep talking about," Blair sputtered out angrily.
"No, it is our job to find the function for his tantrums. In a case like this we remove what is upsetting him. I will make sure that no machinery or cleaning solutions with strong odors are used here."
Adam had now stopped crying. He grabbed his blanket and sat up. Susannah quickly headed for Kevin. "Give him verbal praise and sing him that song he likes."
Kevin rested on his knees in front to Adam. "Great quiet, Adam. I love the quiet." Kevin began to sing the theme from the Yogi Bear cartoon. He was so intent on rewarding Adam and being given the chance to make this child happy that he didn't even feel any embarrassment singing the silly little song to Adam in front of everyone.
Immediately they could tell Adam still loved hearing the song. "Ehhhh," Adam cooed, almost as if her were tying to sing along.
A little smile formed on Adam's lips. A big smile formed on Kevin's. Téa and Viki were also smiling as they watched Adam enjoy the song. Sam did not smile. He stood to the side. He could not believe they ignored Adam when he was in pain. Blair quietly walked to where Sam was and stood next to him. "We have to get him out of here," she whispered, barely moving her lips. Sam said nothing. He just nodded, more to himself than to Blair.
Adam sat on his knees, his rear resting against his heels. "Okay, Kevin stop singing to him now," Susannah instructed.
Adam looked confused for a moment, as if he couldn't figure out why the song had stopped.
"I think he's wondering if Kevin has a power button he can turn on," Téa joked. She had been so relieved to see Adam having a good time. All in the adults in the room, except Blair and Sam saw the humor in Téa's statement.
Adam began to rub his blanket against his right cheek with his right hand and wiggle his fingers near his eyes with his left. He still sat back on his heels. Purely out of instinct, Kevin took Adam's hands and pulled Adam towards him as Kevin pulled his own body back, in a seesaw effect. Adam pulled back. Kevin allowed himself to be pulled toward Adam. Adam immediately realized this could be fun. They went back and forth several times. Adam smiled and giggled. Kevin didn't realize it, but what he had just done was Differential Reinforcement of Incompatible Behavior. Adam could not engage in his self-stimulatory behavior and play "seesaw" with Kevin at the same time. The play itself, a preferred activity, was the reinforcer. "Great playing, Adam!" Kevin verbally reinforced.
