Tyquelle Washington is a wiry 8-year-old with an infectious smile, boundless energy - but not a single friend. During board games, he interrupts his cousins and won't take turns. At school, he rarely listens to other children's interests, choosing instead to chatter about his own.
Like many autistic children, Tyquelle doesn't seem to know how to interact with people or form relationships. But he's learning skills that often come naturally to others through an experimental therapy in an unconventional setting - during trips to the National Aquarium in Baltimore.
The 16-week program designed by therapists at Baltimore's Kennedy Krieger Institute's Center for Autism and Related Disorders uses the entertaining backdrop of the aquarium to engage high-functioning autistic children and lay the foundations of essential social behaviors.
As the youngsters hold lizards and gaze at sea urchins, two psychologists provide intensive behavior therapy that teaches children how to read visual cues, understand emotions and take an interest in others. The therapists work with a group of children ages 6 through 8 and another ages 10 through 12, stages that are considered critical for building social interaction. While many autism treatments emphasize one-on-one contact, this one brings together groups of four children to create, clinicians hope, bonds that last.
"For children with high-functioning autism, social skills deficits can present barriers to participating in school and community life as they get older," said Dr. Rebecca Landa, director of the autism center. "Addressing these challenges in a structured way can offer school-age children with high-functioning autism the potential to have more of the same experiences as their typically developing peers, from having a friend to going on a field trip."
The very nature of autism is perplexing. One in 150 children nationwide is affected by a range of related disabilities known as autism spectrum disorders, which vary widely and are different in every child. Doctors are not sure what causes autism, there is no cure and the field is crowded with new research theories and therapies.
Kennedy Krieger has found that constant repetition and prompting are key to therapies that help autistic children understand how to relate to others.
Tyquelle's program is called BUDS, for Building Up Development of Socialization. The staff works with the children once a week, alternating between classroom therapy and trips to the aquarium. Using a colorful flow chart, the kids learn to describe their emotions and recognize the consequences of their behavior. They are taught how to make eye contact, when to approach a playmate and even how to e-mail them. Before going to the aquarium, they get homework outlining exactly what they should expect during the visit.
Parents are invited to watch the classroom therapies through a one-way mirror and are encouraged to join the aquarium trips. At the aquarium, they dole out positive reinforcement with points when their child follows directions, communicates his needs or offers to help someone. The more points, the bigger the prize at the end of the visit.
A few weeks ago, Tyquelle and his grandmother Lettuce Clark joined the group for their first visit to the aquarium for a 1 1/2 -hour scavenger hunt.
The boys are all full of adrenaline as they approach the aquarium entrance, rushing to the exhibits and leaving their families, two teachers and three aquarium educators trailing behind.
The youngsters move from tank to tank, searching for animal life listed in their homework. The goal is not only to check off as many bullfrogs and electric eels as they can find, but also to share the encounter with others.
Through much of the visit, therapists Elizabeth Stripling and Brian Freedman prompt the boys: "Show your friends!" and "What do you see?" But a couple of times, Tyquelle initiates discussions on his own.
"Come look, it's a flounder!" Tyquelle squeals to the others. "It's down there - it's concealed in the sand. He looks like he's looking at you."
Cameron Langkam, 8, comes rushing over and is immediately mesmerized by the tank. But he doesn't respond to Tyquelle, and after a moment runs to the next exhibit. He's still chattering about the sturgeon from three tanks ago, which he calls the "seduction fish," to the amusement of the adults.
Stripling and Freedman offer Tyquelle an emphatic round of "good job!" for trying to engage Cameron.
For much of the visit, the boys have a blast, weaving through the meandering exhibits, giggling and peppering the aquarium staff and even passers-by with questions.
Still, there are moments of intense frustration. Cameron's mechanical pencil becomes dull and he plops down on the floor, shouts that it's broken and refuses to continue the assignment. Freedman squats to his level, and calmly instructs him to ask for help. Cameron does. And the pencil incident is over as quickly as it started.
Near the end of the visit, Tyquelle pouts, shouts to no one in particular "I'm starving," and declares he wants to go home that instant. He did not have an after-school snack today, explains Clark, with the knowing look of a caregiver who understands this craving for routine. A peanut butter and jelly sandwich is the first thing Tyquelle asks for after school, but on this day, she and her grandson were running late.
Clark tries to refocus Tyquelle on the work. "We're almost done," she says steadily, grabbing hold of his assignment. "OK, what's next?"
She says later that when she first became his guardian, she was often impatient. "But one day I said to myself, 'Why are you doing this?' I had to go into my inner self and remind myself that I needed to have a lot of patience." Parents and guardians of autistic children often worry that taking their child into the community will result in an embarrassing meltdown, said Stripling. The program tries to instill confidence that they can enjoy an outing like any other family.
Still, after a while, the children become exhausted.
"What we are asking these kids to do is really tough," said Freedman, clinical director for autism at Kennedy Krieger. "We are asking them to focus and use these social interaction skills that, while intuitive for most individuals, are not for these kids. We are working on muscles that need a lot of work to grow. And afterward, their social muscles are sore."
Cameron's mother, Victoria Langkam, said her son nonetheless looks forward to the program. He is a triplet and his two brothers are also autistic. One is nonverbal. While the trio is close, Langkam says they are not playmates in the typical sense.
At home, Tyquelle doesn't talk about Cameron or the other boys in the program, but once he arrives at the classroom or the aquarium and gets a glimpse of the others, he becomes excited, Clark said.
It's a far cry from Tyquelle's behavior when Clark, 66, gained custody of him four years ago. Clark, a retired examiner at the Social Security Administration, volunteered to become his guardian after worrying that her son and his girlfriend weren't giving him enough attention.
Back then, Tyquelle couldn't talk and would scream or cry at the slightest touch. Child care centers refused to take him. But one provider suggested that he could have autism and recommended Kennedy Krieger to Clark.
Since his diagnosis, Tyquelle has participated in a host of speech and behavior therapies. Clark reinforces the work at home with a behavior chart, rewarding Tyquelle with a blue, silver or gold star. A blue star means he receives a dollar, $2 for a silver and $3 for gold.
Today, he's a third-grader at the Chatsworth School in Reisterstown for children with disabilities. Clark was beaming when she shared the results of Tyquelle's latest report card - all A's and B's and glowing comments about his progress.
"I am proud he has come so far," Clark said. "His teachers are always saying how bright he is. I just try to make him independent. I want him to do as much for himself as he can."
Freedman and Stripling are still evaluating the success of the BUDS program. So far, they have used parent questionnaires to gauge the children's progress and most have reported improvements. Freedman said they hope to tweak the program, fine-tune how they measure progress and develop it into a model that could be used by others.
Clark thinks Tyquelle is beginning to learn the concept of friendship. She says that before he joined BUDS, a therapist asked him if he had any friends. "No," he replied flatly.
When the therapist followed up by asking did he want friends, he burst into a wide grin and said, "Yes!"