Jean Dunaway sat across from 4-year-old Jason Gillis at the white plastic table set up in his family's living room. She used a purple marker to draw lines on a white sheet of paper.
"Line down," Dunaway said several times as she guided Jason's hand down the page. Then they drew circles on another sheet.
Jason picked up another marker and popped off the cap - a big step in this autistic child's short life. He initially refused to hold markers and only started to color shortly before Christmas. Dunaway hopes she can help Jason graduate from holding markers to using forks and spoons. His mother, Lauri Gillis, still has to spoon-feed him.
Dunaway, a community-based technician for the Anne Arundel County public schools, visits Jason at home in Odenton three times a week. Gillis said she has made a huge difference in Jason's development and has helped his younger sister, Sara, who has shown signs of autism.
"I think it is imperative that we got them early services," Gillis said.
As experts debate whether young children are being labeled too early as autistic, state and county officials are trying to simply meet the need to get them ready for kindergarten.
"The diagnosis isn't as important as addressing the needs," said Barbara Flook, a special-education teacher in Anne Arundel County's community-based program.
People with autism, a neurological disorder that affects the development of the brain, have trouble with reasoning, communication and social interaction. The Autism Society of America notes that early diagnosis can be complicated because the symptoms for autism are similar to other problems, such as hearing loss. Sometimes those problems need to be ruled out first. In other cases, they might coexist with autism.
Further disagreements arise about which treatment option is best, but research indicates that early intervention does help autistic children function better, according to the society.
In 1993, when the state recognized autism as a specific disability category, 260 students were identified as autistic, according to the state Web site. In 2006, Maryland public schools provided services to 5,764 autistic students, ages 3 to 21.
The state Department of Education has recently begun focusing on expanding services. It used a private grant to launch the AutismConnectMD Web site in November. On Jan. 31, state officials opened Sheppard Pratt's Forbush School in Hunt Valley, in Baltimore County, which will serve about 70 autistic students ages 5 to 21.
Like many counties, Anne Arundel relies on a variety of different approaches to early intervention, said Ed Feinberg, coordinator of Infant, Toddler and Preschool Special Education with the county school system. His program helps parents with children as young as 18 months with its Infant and Toddler program. At age 3, children move on to the Early Child Intervention classes. Sometimes children with autism are placed in traditional preschools, and county workers train teachers how to include the children, Feinberg said.
The county serves 100 children from the age of 18 months to 3 years with confirmed diagnoses of autism, Feinberg said. The county also serves 45 autistic children ages 3 to 5 and an additional 200 children who are suspected of having autism. Feinberg said the county tries not to push for a formal diagnosis of autism until age 5 because many parents are not convinced their children are autistic or dislike the label.
"They're hopeful with good intervention, maybe [their child] won't have autism," he said.
Anne Arundel County schools have offered home visits for the past 10 years as part of their Early Childhood Intervention classes. Although the visits are for all special-needs children, autistic children make up the majority of cases, Dunaway said.
Gillis first began to notice that Jason had developmental problems when he was between 12 and 15 months old. He began missing milestones.
"He crawled late, rolled late, walked late," Gillis said.
Jason did not make eye contact or respond when his name was called. He shunned signs of affection. Doctors diagnosed Jason as autistic just before his second birthday.
Jason graduated from the Infant and Toddler Program when he was 3 and now takes Early Childhood Intervention classes five days a week. He also is enrolled in speech and language therapy.
Although Jason has become much more affectionate, talking still poses a challenge. Dunaway uses games and play activities to coax words. She and Gillis swing him from side to side in a towel, a game Jason loves. But first he must ask to swing either by saying "swing" or by signing "more" with his hands. At first, it would take as long as 10 minutes for Jason to give the signal to swing. On Wednesday, he tried to sign the word immediately after they stopped.
Gillis said the activities teach her how to reach her son. She hopes that he will be able to attend traditional kindergarten classes in a year. If he doesn't, that is OK too.
"There's progress - period," she said. "That's all I can ask for."