Before Shmuel Caplan entered the Tishma School & Center for Autism, the red-headed boy hardly spoke, avoided social interaction and soiled his pants regularly at school. Eighteen months later, the 12-year-old spontaneously articulates his wants and needs, can sit down and play a matching board game with his brother and is for the most part continent at school. His progress, says his mother, has been incredible. She believes the tailor-made instruction in this school-based intensive behavioral intervention program will ultimately help her son get on par with other boys his age. "I don't ever want him to leave there - ever, ever, ever..." says Yehudit Caplan, who lives with her family on the outskirts of Jerusalem. "I want him to be there the rest of his life. That's how I feel. He fits in well with this program." According to executive director Moshe Weinstein, Tishma is the only school-based Applied Behavior Analysis (ABA) program of its kind in Israel for kindergarten and school-age children with autism and related disorders. ABA is a scientific discipline whose principles can be used for successful therapeutic intervention for these children. Autism is a developmental disability that inhibits a child's ability to communicate, form relationships with others and respond to his environment in ways considered appropriate. Some common symptoms include repetitive, self-inflictive behavior, loss of eye contact, hyper/hypo activity, attention deficit issues and poor eating and sleeping habits. The causes of autism, however, are unknown. What is known is that the numbers of children diagnosed with autism have dramatically increased. "In the last few years its become something of a worldwide epidemic," says Weinstein. "When I started in 2001, statistics showed that 1 in 500 of children are autistic. Today, there are different figures. [Some sources quote] one in 250 and the New York Times quoted one in 160 but it's recognized worldwide as an epidemic." The ABA program employed by Tishma involves analyzing a child's behavior, and then teaching and reinforcing behaviors considered appropriate so that they can take part in and be accepted into mainstream society, explains Hannah Sykes-Haas, Tishma's early childhood educational coordinator. "All these things that we do and take for granted that regular kids just pick up, they have to learn step by step," Sykes-Haas says. It's "getting the child to advance in the right direction by using the individual approach that each child needs," Weinstein explains. The program works to eliminate certain behaviors associated with autism by creating a tailor-made program for the child, teaching him tasks that are broken down and mastered in simple steps and by using positive reinforcement and praise. The goal is to keep these children out of institutions and to help them function as well as possible in a regular society, he adds. In 2001, The Tishma School and Center for Autism started with just two children with the assistance of a seed grant by the Helen Bader Foundation. The School and Center now have 30 students between the ages of 3 and 15. Another 30 or so students were turned away or placed on a waiting list this year alone because of lack of space. Weinstein says his goal is to accommodate every child whose parents believe should be helped by such a program. Tishma is now in the midst of a campaign to raise $1.5 million to purchase a 6,000 square-meter facility in the Kiryat Yovel area for the school's new home. The new site, if purchased, would initially accommodate 80 students and with additional property to expand, could eventually take in up to 200 children. "It's just a matter of fundraising, and a matter of saying these children deserve it," maintains Weinstein, who previously worked in public education in New York City for 18 years. "They do. They deserve a home of their own." Tishma is also raising funds to start a $210,000 home program for after school and weekends that would include staff, the student's parents and other family members to evaluate and resolve behavioral challenges. Instruction at Tishma takes place as close to a 1:1 student teacher ratio as possible. A class of six, for example, will have a minimum of four teachers and the same ratio applies to kindergarten throughout the day, Weinstein says. Early and intensive interaction has been found to be very important for those with autism. Tishma uses a technique called Discreet Trial Training (DTT) developed by researcher and Applied Behavior Analyst Ivar Lovaas of UCLA. According to Tom Gumpel, chair of the Department of Special Education at Hebrew University and Professor of the Department of Special Education and Disability Policy at Virginia Commonwealth University, this is one of the few empirically supported ways of dealing with children with autism. Studies shows that children trained in DDT are more fully integrated into general education settings at an earlier age and tend to make and keep friends longer than those that don't have this type of early and intensive intervention, Gumpel says. "There are a lot of methods floating around that have very little or no empirical backing, but this is definitely one that has quite a strong empirical backing," he continues. "It's been reinvestigated and replicated many times. It's very data driven, which gives the scientific community a lot of confidence in its results." In addition to DDT, which generally involves learning new skills across a desk, Tishma also utilizes other ABA techniques that offer learning opportunities in a natural environment, such as learning during meal time, during circle time and while shopping at a store. They also teach children how to generalize, or learn a skill that can be applied to different people and in various settings, explains Lisa Lebovic, educational supervisor for the school. This week at Tishma, in a small room of their own, a four-year-old girl in the kindergarten puts two pieces of Lego blocks together for her enthusiastic teacher and is then rewarded by choosing between two toys of her choice. Just weeks before, the little girl was unable to perform the task and would throw the pieces on the ground, Sykes-Haas notes. In another kindergarten room, a girl is asked to identify a carrot by pointing to the right picture card. When the little girl puts her hand on the other image, the teacher takes her hand and placed it over the image of the carrot. "She's still on the 'prompt' level," her teacher explains. Upstairs, two older children are learning to read complex words with the help of their teacher. "Suf-gan-ee-ya!" one boy sounds out slowly to his teacher, as his partner is occupied with cutting out words from a page. In yet another class, several 12 to 14 year old boys with drumsticks in their hands are lightly drumming on their teachers, on the wall, and on other class fixtures as two teachers sing out instructions to the tune of "It's a Small World." Such tasks teach the children to follow instructions, preparing them to work in the outside world in simple jobs, "for living and giving for the community," Lebovic says. Parent Nechama Marguiles says she was initially disappointed that her son, who was previously at a state religious school, needed to be placed in Tishma because "it wasn't a sign of progress." But her son, Simcha Yehuda, who has an autism spectrum disorder called Pervasive Development Disorder, didn't want to do mathematics and would scream and be uncooperative during the class. Now she says that the 11-year-old seems to be in the right place and is being given the attention, love and life training that he needs. Besides math, he is also learning how to handle money and tell time, she adds. "They are trying to teach him a lot of life skills, how to cut a salad, how to polish shoes, how to clean, wipe down a table....Things that a kid who lives on his own, in the future, will have to do to be independent...Things every kid should know." More information about the Tishma School & Center for Autism can be found at www.tishma.org or by calling 02-648-3042.


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