Pacific Child

The Third Story

2012-01-12T15:59:00.000-08:00

In one of my favorite musical satires, Tom Lehrer sings that during “National Brotherhood Week” (yes, there really was such a thing from the forties to the eighties) “to hate all but the right folks is an old established rule.”

The field of psychology has had more than its share of attitude polarization. As a graduate student, the humanistic psychologists were steadfastly at war with the behaviorists, the behaviorists poked fun at the Freudians, the systemic family therapists despised the psychoanalysts, and even the analysts fought deeply among themselves. Yet there were always those who struggled to build bridges, to find common ground. These were often the psychotherapy process researchers, looking for the ingredients common to successful outcomes among the various approaches.

In the field of autism, we have our own polarities: those who believe autism is caused by immunizations versus those who believe the cause is genetic; those who believe we are in the midst of an epidemic versus those who believe we are simply identifying and labeling more children; and those who believe the best treatment is behavioral versus those who believe the solution is psychodynamic or relationship based.

Although I proudly identify myself as a behaviorist, I suspect, like those who have identified the common ingredients of successful psychotherapy outcome, there is common ground to be had among all these apparent differences. In relationship to the question of whether or not the best treatment is either psychodynamic or behavioral, the data are apparently in, at least that’s what the surgeon general says, and that’s what the committees who agree on “best practices” would say. But here’s my personal story:

At my first "real job" out of graduate school, I was assigned two Special Ed classrooms to supervise, and a caseload of about ten children to see in individual, group and family therapy. Two of those children had been diagnosed with autism, and each of them had an interesting treatment pedigree. One of them had been a member of Lovaas' original research study, and had been designated as "cured" by his strictly behavioral methodology. The other child had a book written about the novel treatment approach taken, which turned out to be a very intensive form of psychodynamic play therapy in which the therapist essentially mirrored the child around the clock. The therapist, a woman named Rachel Pinney, also claimed this child was cured.

Both children were remarkably similar. They were highly intelligent, and each had savant qualities. The child treated by Pinney had memorized the entire LA bus system, along with time schedules, and could tell you how to get from anywhere to anywhere, including the best way to transfer. The child treated by Lovaas could build anything out of Legos, intricate jaw dropping structures. According to their parents, both children clearly made remarkable progress, despite the great differences in their treatment methods. Yet, both had many severe behavioral problems which necessitated them being in a special education setting.

Neither child had any friends, both were remarkably self centered, incapable or unwilling to consider another person's feelings, compulsive and prone to severe tantrums if they didn't get what they wanted.

At the time, I had been trained in both behavioral and psychodynamic methods. I primarily used behavioral methods in the classroom and psychodynamic methods in the therapy office. Eventually, I abandoned psychodynamic methods. After years of working "on the floor" with children, I frankly could see very little progress. The lack of progress was frustrating for parents, the children themselves, and for me.

Behavioral methods simply seemed to work better, although at the time they were receiving horrible press. The bad press was in a few cases warranted. There were places that used aversive methods, such as squirting water in children's faces, and even Lovaas himself was known to give an occasional slap or pinch under the table. But mostly, the bad press was unwarranted, and it was clear to me from my first two children with autism that the claim that behavioral intervention turned kids into robots was ridiculous. It was ridiculous because the robotic affect that does sometimes accompany autism was clearly a hallmark of the disease, and not a result of treatment. The child who was lovingly mirrored into psychodynamic health was just if not more robotic in his affect as the child who had been treated by Lovaas.

It has long been said that if you get three experienced clinicians together who approach their work from vastly different theoretical perspectives, and have them all observe the same therapy session, they will all agree on which therapists are most competent, and the extent to which the sessions represent "good therapy". They will, however, each describe the reasons for their determination with their own language, giving vastly different explanations.

The kind of therapy my first two children with autism received couldn't be more dissimilar. Yet both methods did share some common ingredients. Both were extremely intensive, which is to say that each child received over 40 hours a week of therapy. Their therapy was their lives. Both methods were quintessentially individualized. Behavioral protocols were designed specifically to meet the child's needs, and those protocols were changed frequently as the child mastered new skills, responded to some interventions and less to others. Psychodynamically, the child received the therapists' undivided attention, and the therapist did all she could to fulfill the rapidly changing wishes and needs of her client. Both children received attention that was no doubt caring in nature. And there can be no doubt that despite efforts to mirror and lead, it is unlikely that there weren’t subtle prompts occurring that pointed the way to progress.

These ingredients may contribute to the potency of all therapeutic interventions: the intensity of the treatment, the loving and caring attitude with which the interventions are delivered, and an individualized (as opposed to cookie-cutter) approach. One should never underestimate the power of these ingredients.

Perhaps it is natural to polarize. The Talmud states that there are three sides to every story. Those of us who work in any field are typically well-versed in our own story, and hopefully we are fairly well-versed in the stories our competitors tell. It behooves all of us, however, to become versed not just in the two competing stories, but also in the third story. It is through our knowledge of the third path that we are most likely to reach the greatest depth of understanding.

[By the way, you can watch a video of Tom Lehrer singing “National Brotherhood Week” on YouTube at http://youtu.be/CgASBVMyVFI, and Rachel Pinney’s book, titled “Bobby,” is available for under a dollar at Amazon.com.]

Flying

2012-01-01T18:49:00.000-08:00

I have spent most of my adulthood as a child psychologist. (That is probably because I spent most of my childhood as an adult psychologist, but that is another story.) In the last decade I have had the good fortune of indulging in a hobby that I had dreamed about most of my life—flying. The parallels between my vocation and avocation are at times striking.

As a pilot, the most important decision one often makes is whether or not to fly on a particular day: the decision to launch is often called the “go/no-go” decision, and one of the most important predictors of safety. It consists not just of checking the airplane, but also of checking all the circumstances surrounding the airplane, not the least of which is the weather. Airplanes have a way of doing exactly what you tell them to do: the weather doesn’t. What goes on around the airplane is equally as important as what goes on inside.

As a child psychologist and behavior analyst, what goes on around a child can be equally important to the successful outcome as what goes on inside. For those working with children, understanding the family environment is like understanding the weather for the pilot. It can predict the success or failure of your mission.

As a pilot, one must always be “ahead of the airplane,” a term that roughly translates to making sure that you have done the planning, practiced scenarios, and know how to operate the machinery so well that the airplane doesn’t lead you where it wants to go, but instead that you are in command of the direction and manner in which the airplane performs. As a behavior analyst, you always want to know where you are going, and it behooves a good behavior analyst to know what the goals are and be facile enough with one’s tools that one can react quickly to any deviation that may arise. While one should always have a plan, as both a pilot and a psychologist, one must be prepared at a moment’s notice to give it up and let it go should the unpredictable complexities of life demand an alternate course of action. But when an alternate course is necessary, both the pilot and the psychologist ought to have the tools and preparation to react swiftly and effectively.

Good pilots need to relax under pressure. It is well known that many accidents occur as a result of a pilot panicking under adversity and making nonsensical decisions. As a psychologist, children will sometimes surprise you by pressing buttons you didn’t even know you had, or raising the stakes with sometimes egregiously self- or other-destructive behavior. Thinking clearly and calmly under those circumstances (and remembering your training) can go a long way to positive outcomes.

And, as is true in nearly endeavor, practicing your skills and keeping current is essential. It is said in flying that experience is the thing you get as a result of not having any. And, of course for psychologists, it is no wonder that what we do is called “practicing”. We only get better by doing what we do over and over again, and constantly learning better and more effective ways of using our tools.

Giving Thanks

2011-11-23T14:09:00.000-08:00

This Thanksgiving, I would like to depart from my typical expression of gratitude to all of you who work with those with autism, and those of you who are parents of children with autism, and thank directly those of you who have an autism spectrum disorder. It has often been said that the best way to judge the level of civilization in a culture is how well they treat those with disabilities (in current parlance, how well we treat those with special needs.) In the mid nineteen-thirties, Adolf Hitler justified his wholesale slaughter of those with disabilities as freeing their tormented souls from their bodies. It was the first step in what eventually became the slaughter of trade unionists, certain Catholics, gypsies, and six million Jews.
Parents of children with autism often describe their eventual awakening to the belief that their children on the spectrum are truly a blessing. They bless their parents’ and siblings’ lives with a deeper understanding of the human condition, and deepen their ability to love. They bring new friends and new meaning to their lives.
Those of us who are blessed to work in this field know well about the souls of those with whom we work, because that is why we do what we do. We know because we feel touched by our children who have "special needs". They touch us with their love, their kindness, their honesty, their humor, and their efforts and strivings. We learn from them daily, how to love, how to appreciate our own blessings, how to take life seriously but not too seriously, how to give and how to let go.
So this Thanksgiving, let’s all pause for a moment, close our eyes and express our appreciation for those on the spectrum, each of whom have touched us in some way or another, each of whom have enrichened us with their precious souls.

PCFA in Mexico

2011-10-30T13:24:00.000-07:00

Recently returned from beautiful Queretaro, Mexico, where I was honored to be the keynote speaker at the second international conference on autism held there. I spoke on "Autism and the Family," highlighting the effects of having a child with autism on the family as a whole, as well as on siblings and marriages. I was also honored to be among three other Pacific Child speakers: Arpi Arabian, Marta Marquez, and Stefanie Finney. All gave very well-received speeches on various aspects of their expertise. If you can read Spanish, you can get more info on the conference, as well as view the amazing poster, at http://caadd.com.mx/.

Pacific Child, Children's Learning and Autism Services North Connect!

2011-08-10T23:09:00.001-07:00

I am proud to announce that Pacific Child has formally joined forces with two great companies, moves that will help us achieve our goal of becoming the preeminent provider of behavior analytic services in the United States.

The first company to join the family is Children’s Learning Connection, based in Orange County, California. The company was started by Melanie Foshee and Kimberly Eissing, two licensed speech and language therapists with expertise in both autism and in bringing scientifically-validated approaches together in a comprehensive and unified way to maximally benefit those in need. Their company provides speech therapy, occupational therapy, physical therapy, and ABA therapy, as well as parent training, infant programs and social skills programs.

We believe that the expertise Kim and Melanie bring to the coordination of services will greatly assist us in developing a broader menu of services throughout Pacific Child.

The second company to join us is Autism Services North (ASN). ASN is headquartered in Pennsylvania, but the company, begun by Paul Eschbach, BCBA, contracts with BCBAs across 24 states. ASN provides superior behavioral care to the TriCare community and has an excellent reputation with parents and referral sources alike. ASN will allow Pacific Child to provide quality care to more children along the spectrum, particularly across the United States where we currently do not have a presence.

This marks an exciting time in the history of Pacific Child. We look forward to creating new, dynamic synergies among our companies.

Minority Bias

2011-08-08T15:15:00.000-07:00

It has been known for some time that minorities, in most walks of life, often do not receive their fair share of services. We know that autism appears in nearly the same proportions throughout all races, nationalities and cultures. But in order to receive the diagnosis, one must be identified by some sort of professional. That is typically a physician.

Several studies have reported that Hispanics have a lower incidence of autism than non-Hispanic Caucasians. Most studies that report these results suggest that this is likely due to the fact that most Hispanics studied have lower income levels, and thus cannot afford the health care required for the diagnosis to be made. This makes sense to me. One study, however, looked at 1184 schools in 254 Texas counties, and counted the number of children in kindergarten through 12th grade in each district who had been diagnosed with autism. In this study, socioeconomic status was in fact controlled for, and the researchers still found fewer Hispanic schoolchildren were diagnosed with autism.

What was fascinating in this study, however, was that that for every 10 percent increase in Hispanic children in a district, the prevalence of autism decreased by 11 percent, while the prevalence of children with intellectual or learning disabilities increased by about 10 percent. Interestingly, the reverse pattern was seen among non-Hispanic Caucasian kids. As their percentage of autism in a district increased by 9 percent, the prevalence of intellectual and learning disabilities fell by about 13 percent.
It appears from these results that Hispanic children may, regardless of their socioeconomic status, be seen as learning disabled, cognitively or intellectually lacking (instead of autistic), while the non-Hispanic children were seen instead as having autism.

Is that surprising?

Congrats to our new BCBA's!

2011-08-03T12:19:00.000-07:00

Just wanting to send congratulations to our newest BCBAs-- Daniella Putnam, Robin Palm, Zsuzsanna Fodor and Danielle Christner. This is a great milestone, and well-deserved!

Going Home

2011-06-01T20:45:00.000-07:00

Of the original psychoanalytic triumvirate of Freud, Adler, and Jung, perhaps the most forgotten was Alfred Adler. Adler was best known for the creation of the term “inferiority complex”, but perhaps his greatest contributions were his founding of the child guidance movement, community mental health centers, and his humanistic approach to psychopathology in general.
Adler died suddenly and unexpectedly, most likely of a heart attack, while on a speaking tour in Scotland. He was cremated there, but oddly, his ashes disappeared, perhaps in the chaotic runup to the Second World War. The ashes were just recently found on a shelf just a few hundred yards from the crematorium in Edinburgh, and are being returned to Vienna to be buried in an honored place in the central cemetery.
I am writing these words in a hotel in New York, not far from the hospital where I was born almost six decades ago. Yesterday a cab driver took me down Park Avenue, to a writer’s bar in Greenwich Village I wanted to see. As you travel south from midtown, you drive through a tunnel carved not out of a mountain, but under a building—the Metropolitan Life building (now the Helmsley building). It is an interesting way to build something, and the road itself takes a sharp carve just after you go through the building.
I have not lived in New York for more than half a century, so the experience seemed new to me. But tonight, as I let the thick air of Manhattan surround me as I walked, I remembered it. As a child I would often perch myself on the ledge behind the back seat that most cars had then. I could stare straight up at the world through the back window. That odd sensation of driving down a central street in Manhattan, entering the mouth of a big building, the sky disappearing, and then quickly entering a curve, like a horizontal roller coaster, just came back to me. I remember the strangeness of it, the slight dizziness, not unlike I felt last night in the taxi.
I am not terribly nostalgic about coming home. Life was not good when I lived here. In fact, it was mostly horrible. But it is a touchstone, something that makes one remember who one is. Of course, it is a silly cliché that we all end up going home eventually; we start as ashes and dust and end as ashes and dust.
But there is still something compelling about going back to that original nest, the comfort and safety of the womb, or at least the illusion of that safety.
I left New York and moved to California in high school. Neil Diamond, who went to my high school in New York and had the same music teacher, wrote “L.A.’s fine but it ain’t home, New York’s home but it ain’t mine no more.” What then, is it?
“Home” becomes a touchstone, that which we touch to remind us that we are still alive. It is an anchor, of sorts, a mooring whenever the seas get rough.
Pacific Child began as a dream of independence from the mental health clinics where I had worked previously. Yet it has been my home for 23 years now. As my connection to the heartbeat of PCFA moves closer and more distant, it is my touchstone, my home, my illusion of safety, yet still just a stopover somewhere between ashes and ashes.

Welcome to our New Clinical Director

2011-04-14T10:45:00.000-07:00

I am thrilled to announce the hiring of our new agency-wide clinical director, Michael Cameron, Ph.D., BCBA-D. Dr. Cameron has been serving in his new post since March 1st, and has already made a great impression on all those with whom he has come in contact. Dr. Cameron's hiring followed an extensive, nationwide search. Prior to joining PCFA, Dr. Cameron was associate professor and founding chair of the Department of Behavior Analysis at Simmons College in Boston. Dr. Cameron brings a breadth of knowledge and experience to PCFA. His fields of expertise include assessing and treating people with autism spectrum disorder, the evaluation of public and private school-based programs for children and adults with ASD, staff traininhg, and direct supervision of evidence-based behavior analytic services. He also has special interests in health and behavioral medicine. He serves on the editorial boards of the Behavior Analyst Today and the Journal of Speech-language Pathology and Applied Behavior Analysis. He has held positions as clinical director, and vice-president of research and development with behavior analysis agencies in Massachusetts, as well as maintaining a private clinical practice. Dr. Cameron chose to join PCFA because he shares our core values: the client always comes first, and our commitment to providing scientifically validated services built on a solid foundation of respect for those we serve. As agency clinical director, Dr. Cameron is responsible for ensuring the quality, viability and expansion of services of PCFA's offices. He also oversees training and the overall clinical direction of the agency. You can reach Dr. Cameron via our toll-free number: 888-805-0759. His direct extension is 204.

Congrats in Order

2011-02-24T19:58:00.000-08:00

Congratulations to our newest BCBAs! Holly Park from our Los Angeles office and Kim Altic from the Redwood Coast office successfully crossed the finish line after completing their marathon requirements toward receiving their board certification. Needless to say, I am so proud of their accomplishments. Both are extraordinarily talented people deeply committed to the work they are doing. We are blessed to have them on our team.

Waiting

2011-01-27T19:42:00.001-08:00

I don’t read much fiction, a fact of which I am not proud, but a few years ago I read a book that haunts me. The book was a best-seller by the Chinese author Ha Jin, called “Waiting,” in which a Chinese physician was caught in an arranged marriage and, because divorce was not legal, spent 18 years of his life waiting to marry a nurse with whom he fell in love.

In these modern times and in this western world, we are used to things happening quickly. It is difficult to wait for anything. We want our fast food, our fast cars, and, well…. And as I recognize the person staring back at me in the mirror less and less, waiting seems even more difficult. Time is a limited commodity, and there is simply less of it left in the bottle to drink.

But time is only experience; it is nothing more. And “waiting” is nothing more than wishing or imagining we were somewhere other than where we are now. So, we suffer from our imagination. We suffer from wishing our hands were doing something else, our eyes were feasting on a different sight.

So let us breathe in patience, and appreciate each moment to the extent our neuroses allow. In the Midwest there is a saying: if wishes were horses, beggars would ride. So, let’s let wishes be horses, and let’s let them ride off into the sunset with empty saddles.

Just a Little Bit Better

2010-12-31T22:08:00.000-08:00

Ten years after Braulio Montalvo succeeded Salvador Minuchin at the reins of the Philadelphia Child Guidance Clinic, an interviewer asked him what the biggest difference was in his impressions of family therapy from the early days. He stated that he learned to expect less, that families didn't change as radically as what was hoped for when family therapy was nascent. Yet, what became clear to me after practicing family therapy for two decades, was that small changes in families were often perceived by family members as big.

As a couples and family therapist, I learned to ask a simple question. What is the smallest change that needs to happen in order for you to know that things are getting better?

When people were able to focus on making small changes, they felt better. Change did not have to be daunting, and they could see their accomplishments and feel good about their success.

As behavior analysts, we know this well. We are taught to shape behavior by breaking down complex behavior chains into their smallest parts, and we teach "successive approximations" until the complex behavior becomes seamless.

Can we apply our own methods to ourselves? What if we told ourselves, "what is the smallest change I can make in order to know things are getting better?" Would we choose not to focus on losing 20 pounds, but instead on 2? Would we choose to finally pick up the musical instrument that sits dormant, and practice for just five minutes a day? Would we choose to write one page of our dissertation or that article we have been intending to tackle, instead of focusing on completing the entire project?

I am a sixties (that's 1960's, not 1860's) musical fanatic. I can't help but think of Peter Noone singing the chorus of one of Herman's Hermits great songs: Now ain't that just a little bit better?

Happy Kaizen New Year!

2010-12-30T09:55:00.000-08:00

Those of you who have recently been meandering around the hallowed halls of Pacific Child and Family Associates have heard me muttering the word "kaizen" repeatedly under my breath. This is my new mantra. I have been trying to implement this American-born and Japanese-bred management style at Pacific Child, in true kaizen style, little by little over the last couple of months. Things are going great here, and I do believe this approach is a very cozy bedfellow for those of us who call ourselves behavior analysts. It is a method that encourages personal initiative. It is interactive and flexible, creating cycles of creative progress which ultimately lead onward and upward.

So, in the next few blogs, I intend to clue you in on the principles of kaizen and how they apply to what we do.

There are several facets of the kaizen approach, some big ones and some not so big ones. One key element is the focus on making small, measurable change, as opposed to large, radical shifts. Sounds like ABA, yes? We take our baseline, assess the problem, make a plan, measure the outcome, and memorialize the results if they are positive. It is the classic A-B design.

But in this entry, I want to focus on another piece of kaizen philosophy. That is the piece having to do with the importance of taking care of oneself. It is about working hard at what we do, but not so hard that we allow ourselves to get burned out.
In this holiday season let’s pause and consider how self-care gives us more energy to care for others as well. Self care doesn’t mean self-indulgence, or being self-centered. And it’s much more than finally taking that long, slow bath or treating yourself to a massage. Nurturing oneself can also mean embracing the kaizen principle of ‘personal discipline’ as a daily practice. That type of self-care helps us reduce from our lives those things which waste time, energy, space and resources. We find we have more time and more energy.
It’s not about expecting more from oneself than is reasonable. Rather, recognizing that the kaizen elements of effort and quality and can be applied to our own lives as well as our work. Underlying it all is the willingness to change.

Research has shown that the majority of New Year’s resolutions are broken very quickly. The one-shot, sudden approach, no matter how well-intentioned, can fail us. I’m going to look toward 2011 as the beginning of a fresh personal philosophy, inspired by the kaizen method of sustained change which is aimed at gradual improvement in a humane, people-oriented way. I hope to take better care of myself and in so doing take better care of our employees and our clients. Happy New Year.

Rising Stars

2010-11-23T14:44:00.001-08:00

Just some words of congratulations on some of Pacific Child's rising stars. Marta Marquez and Hilary Zeller are our newest BCBAs! Congratulations on leaping the final hurdle. Also, I want to congratulate LaDonna Haltom, one of our senior therapists in the Southern California office, for being promoted to a supervisor position. Also, I want to welcome aboard two new supervisors. A warm welcome goes to Laura Simpson, our newest supervisor in the East Bay office, and Andria Hernandez, our newest supervisor in the Inland Empire office. We welcome your commitment and passion and your dedication to providing the highest quality ABA services to our clients. Congratulations to you all, and welcome aboard.

"Go East!"

2010-09-19T12:40:00.000-07:00

“Go West, Young Man, Go West!” were the famous words written by Horace Greeley in support of Manifest Destiny. For Pacific Child, this is a difficult calling, because we have been born and bred in the west. So for Pacific Child, our most recent calling is to “Go East!”
I am thrilled to announce that Pacific Child is opening its first office in the Midwest, which to us in California is really the East. Deb Ewen Miller, who has shepherded our Eureka, California office so brilliantly in the last several years, will be running our first office in Duluth, Minnesota. We hope to serve the entire Minnesota area out of this office.
As we embark on our Easterly expansion, I want to thank Deb Miller for her extraordinary work among the redwoods of Northern California. We are truly blessed to have her continue her work with PCFA, and brave the bitter winters, in Minnesota.

Lifelong Learning

2010-09-17T10:23:00.001-07:00

There was a phrase I heard constantly throughout my childhood. In the Bronx accent I usually heard it, it sounded like this: “You live and you loyn.” Translation: You live and you learn. It was most often uttered as a way of comforting someone when something happened that wasn’t quite right, kind of like, well, you won’t make that mistake again and it will be alright.

But, as is typical with phrases that hang around for a lifetime, there was a lot more to it than that. Do we, in fact, “live and learn”?

In “The Once and Future King,” T.H. White writes (through the character of Merlyn):

The best thing for being sad… is to learn something. That is the only thing that never fails. You may grow old and trembling in your anatomies, you may lie awake at night listening to the disorder of your veins,… you may see the world around you devastated by evil lunatics, or know your honor trampled in the sewers of baser minds. There is only one thing for it then—to learn. Learn why the world wags and what wags it. That is the only thing which the mind can never exhaust, never alienate, never be tortured by, never fear or distrust, and never dream of regretting. Learning is the thing for you.

For many of us, the product of our education system in the U.S. is to see learning as a chore. It is something we have to do to go from here to there, like an uncomfortable bus ride over pot-holed streets. But in Merlyn’s comforting words learning takes a different form. It is a kind of therapy, a comfort and a solace. It is to some degree a place away from the hectic world of business and rumor, but it is also a powerful tool with which to engage life. Perhaps most importantly it is an antidote to “fear and distrust.” Learning, the pursuit of the truth, guided by a moral compass, leads to compassionate understanding and is a powerful weapon against those “evil lunatics” who, in reality, fail to understand or see the deeper truths.

A Great Loss

2010-08-09T20:02:00.001-07:00

O. Ivar Lovaas died just over a week ago at a hospital in Lancaster. He was 83 years old. I did not know him personally, although I spoke with him on a couple of occasions and attended a lecture of his at Cal-ABA on self-stimulatory behavior. To say that Lovaas was an icon is an understatement. Although he was not the originator of the methods that eventually became so associated with him that for many years they were called “Lovaas therapy,” his contributions as a researcher and tireless promoter were huge.
In reality, the methods he used to treat children with autism and others were developed by his mentors at the University of Washington—Don Baer, Todd Risley, Montrose Wolf, and others—methods that eventually came to be called applied behavior analysis. Lovaas was a graduate student at the University of Washington who had been trained in classical psychoanalytic methods, and although he became perhaps the most well-known advocate for behavioral methods for children with autism, he never swayed completely from his psychoanalytic roots. In fact he was probably the only behavioral researcher who gave Rorschach tests to his subjects.
Lovaas was a controversial figure, revered by many and reviled by many others. In his early work, he occasionally used aversive procedures, which he defended adamantly although he eventually abandoned them in favor of non-aversive procedures. He claimed for some time that the only way to achieve the formidable results he achieved was to be trained only by him or those authorized by him, thereby giving a proprietary flair to his methods. In true scientific fashion, many academicians looked askance at anything proprietary, capitalism and science being the awkward bedfellows they can sometimes be.
Those who knew him and were close to him have told me that he was often sweet and charming, but definitely genuine. You knew where you stood with him. In my view, his responses to those who criticized him occasionally lacked sensitivity; he did joke at times that his Norwegian farmer roots led him to say things simply and directly. There can be no doubt that without his contributions, many thousands of children would not have received the help they needed.
In the last few years, he had been diagnosed with Alzheimer’s, and he did not lecture or appear in large public forums. He eventually died of an infection following hip surgery. He was a giant and we will miss him. Most importantly, those of us in the field of helping children with autism owe him a deep debt of gratitude.

Great Perseverance

2010-05-02T19:14:00.000-07:00

If we are facing in the right direction, all we have to do is keep on walking. - Buddhist Saying

In my first full-time job as a psychologist, I was lucky enough to have two children diagnosed with autism in my caseload. One of them had participated in Lovaas’ 1987 landmark study, and the other was the subject of a book about a play therapy technique. Both of these children improved dramatically, so much so that the medical director and child psychiatrist at the agency said to me that he thought these children were misdiagnosed. The reason? “They couldn’t have had autism because they got better.”
Prior to the ABA “revolution”, professionals dismissed children with autism as incapable of learning, of “mentally retarded,” because those simple things other children could learn to do quickly, either through simple imitation or quick demonstration, children with autism could not. But those of us who work in this profession know that this is not the case; that skills which may take a “typical” child one or two trials to learn, may take the child with autism one or two thousand trials. Yet they do learn.
The difference between a child with autism growing up to be an adult with autism and a child with autism who may grow up nearly indistinguishable from his or her peers can be boiled down practically to one thing: perseverance. It is the great perseverance of those around them who have the patience to work hour after hour on teaching simple skills. It is the perseverance of the parents who themselves intervene and struggle, minute-by-minute, with the required caretaking and emotional stamina. And ultimately, it is the perseverance of the child him or herself, who works diligently hour after hour, through much frustration in order to “rewire” a neurological system that is wreaking havoc with his or her development.
The “magic” that is ABA is, of course, no magic at all. Those of us who ply that trade have often wondered why it took so long for ABA pioneers to “discover” that simply taking skills and breaking them up into their component parts and training through repetition, prompting and reinforcement could allow our children to break free of the bonds of silence and withdrawal.
Perhaps it is the loneliness of non-functioning in the mainstream world that spurs the perseverance of the child. Or perhaps it is the love and devotion of parents and caregivers, who themselves persevere. But this determination to keep going, to keep trying which method works for which individual and to repeat and repeat until there is progress, turns into a reciprocal experience. We persevere so the child perseveres. When the child perseveres it inspires us to do likewise.
Each child with autism presents a unique set of challenges. But one thing that is shared among most is the sense that change occurs ever so slowly. It is easy to give up in the face of the pain. It is a similar challenge each of us faces when confronted with our own devastations, such as the loss of a loved one, our own diagnosis of a life-threatening illness, or a traumatic life upheaval. At times, the devastation can be so great that we feel as though we are losing our breath.
There are many clichés about what comes next. But the bottom line is that we must take one breath at a time, walk one step at a time, face the right direction and keep moving. We must not lose our great faith, we must hold on to our great doubt as our partner, and above all, we must persevere.

Great Doubt

2010-04-26T17:05:00.000-07:00

My last blog entry mentioned the three tenets of a “successful” Buddhist practice: great faith, great doubt and great perseverance of effort. I wrote about great faith, and how it applies to the everyday lives of those working with children with autism. Both faith and perseverance are relatively self-evident ingredients. Great doubt is perhaps the least self-evident and yet equally important.
In the Buddhist tradition doubt is required in order to challenge and eventually overcome the tendency to “understand” something superficially. So many concepts can be grasped at so many different levels, and the more superficial our understanding the less likely we are to succeed.
In autism, parents are exceptionally vulnerable to the unproven, snake oil treatments that are marketed their way endlessly. Whether it is the promise of secretin infusions, chelating heavy metals, megavitamin treatments, or the more subtle hopes of sensory integration, play therapy, or other unproven methods, parents are lured to do things for their children that range from the directly harmful to the indirectly dangerous misappropriation of valuable time, money and energy that could be spent on things that actually do help. In these situations, it is great doubt that steers parents towards making the right decisions.
As therapists and supervisors, we too can be lured in by so-called treatment advances that have little or no research evidence, but that can tempt us to divert our valuable time and energy from proven, effective methods. Great doubt is the gift of skepticism that leads us to greater prudence in choosing our treatment methodologies and skillfully adapting them to the needs of the individual child.
Great doubt as our companion makes professionals better students. It leads us to always question authority, to refuse to take someone’s word that one action is better than another, to refrain from sycophantism, and to let intellectual honesty and scientific rigor underpin our efforts to help.
Some see faith as the absence of doubt and doubt as the absence of faith. In the Buddhist tradition the two co-exist; they do not negate each other but can occupy the same space. Sensei Sevan Ross, director of the Chicago Zen Center has described faith and doubt as “two ends of a spiritual walking stick.” We grip the ‘faith’ end and poke ahead with the ‘doubt’ end. It is our determination (Great Perseverence, which I will discuss in my next blog entry) that allows us to pick up the stick and to continue on our journey.
It is the acknowledgement of doubt that makes faith in Buddhism mean something different than faith as religion. It is more a ‘practice’ than a religion or ideology. Likewise, dealing with autism should be a practice that we engage in on a day to day basis, not a religion where we become sure that we have found a certain method that becomes the one right path. We need faith to deal with our fear. But healthy doubt can accompany faith. In our mindful daily practice, we as professionals should work together with parents and children in such a way that neither rote approaches nor the belief in the certainty of our methods should limit us.

Great Faith

2010-04-07T12:07:00.000-07:00

I am and have always have been fear-based. Among the long list of my weaknesses, this is perhaps at the top. I lose sleep as a result of fear, it drives my anxiety, and it is the sweetest nectar for the demons that get between me and that elusive state of inner calm. It is my constant, unrelenting companion, and it gnaws at my soul.

Traditional psychological wisdom holds that the antidote to fear is courage. Courage is holding the fear as your guidepost while you take action toward resolving the thing that is feared. While courage is certainly the most direct medicine, it is often difficult for me to find it on the shelf. There is another antidote that I have been trying to ingest that some suggest might work just as well. That antidote is faith.

In the Zen Buddhist tradition it is often held that there are three elements needed to make spiritual progress: great faith, great doubt and great perseverance. In the world of autism treatment, we face the deep need for all of these. We need faith to overcome the fears that surround us: the fear that our children won’t learn to speak or have friends, that our interventions won’t work, that we won’t be as good as we can be, that we won’t be able to get that report done on time, that our supervisors or the parents with whom we work won’t like us, that the economy will threaten our jobs, and on and on.

Many religious folks will tell you that the problem with the word “faith” is that it is a noun. As such, it is something you either have or don’t have; it is something you can somehow possess. This is problematic because faith is really something you do, not something you have. (Arguably it should be a verb; harden the “th” sound as in “tithe” and pronounce it as though it were spelled “fathe.”) One does not “have faith” but instead one actively “fathes”. To fathe is to actively believe that one can do or accomplish or have or be or overcome the thing that is feared. Whatever obstacles fear engenders “faithing” can overcome.

Faith often teases truth to the point where those who are strongly wedded to truth and its kissing cousin reality become dismissive. When I feel most troubled, I cannot bring myself to believe things that I wished were true but that I have no evidence to believe are in fact true. I can, however, make “soft plans” coupled with the belief that somehow, either operating within or outside of the box, I can get to the other side of whatever I fear.

Parents of children with autism “fathe” their way into seeing their children as gifts, celebrating each small victory of learning along the way. PCFA staff “fathe” their way into finishing their reports, confronting their supervisors, trying new interventions, facing crowded freeways, and instilling confidence in their supervisees.

Faith, I believe, must become as natural as the breath. If absent, it requires intention to revive it, but it should become our constant companion in order to combat the fears that plague us. So when the fear rises up within us, we “breathe” the belief that we can do the thing that is feared, and this faith transforms the energy used by fear to the energy required to take action.

It is always this brief suspension of “realistic” thinking that allows us to take the leap to become just a little more than we are. It allows us to have the courage to love better, to confront those who hurt us, to receive love and the other gifts those in our lives try to give us, and to see the world as filled with potential and awe. Faith is a true antidote to fear; it can still the demons inside us and guide us toward a sense of peace.

The Art of Science

2010-03-13T10:35:00.000-08:00

In younger days, whenever a group of pretentious young adults got together for a gathering, it wasn’t long before someone brought up the question: “What is art?” The idea was to try to say something intelligent without sounding too silly, nearly always an impossible task. Eventually someone would say something about art similar to what Supreme Court Justice Potter Stewart said about pornography: that he couldn’t quite explain it, but “I know it when I see it.”
I have taught now for several years at UCLA School of Medicine. Initially the course I tutored was in the first year of medical school, and occasionally I would ask the students whether they thought medicine was a science or an art. Typically in the first year nearly all the students said it was a science. In the second year, however, the students were split more evenly down the middle. I have often wondered where the numbers would be by the fourth year. Real life, I suppose, can transform that which appears at first to follow the linear rules of scientific inquiry into the more mystical realm of art.
It has been said that good art awakens something in us, and becomes the abode of that which we might call “spirit.” Defining “spirit” of course is another party topic, one more likely to be heard these days than the question of defining art. For the moment, let us agree that spirit refers to some sort of essential life-force. It is that force that animates us, drives us to feel alive.
Behavior analysts are trained to believe that a defining characteristic of their profession is that it is a science. It follows logical rules, and decisions are based on data, not intuition or guesswork. The former of course are the domain of science, where the latter tends to reside in the realm of spirit. But I would suggest the opposite: watch a behaviorist at work. The truly good ones are artists. Their work awakens something inside of us, makes us feel alive. Their interactions are like impromptu dances, reacting gracefully and seamlessly to the client’s behavior. The behavior analyst as artist spontaneously creates something beyond the logic of science as she taps into her repertoire and responds with a deep awareness of the child’s needs, wishes, intentions and the environment within which the child interacts. As it is with most art, these results take years of study, years of “science”, years of clumsy, “bad art” to build on.
As the whole is always more than the sum of its parts, the behavior analyst creates something beyond the mere piecing together of the data. She uses those tools as a painter might learn how to mix colors, or which paints or brushes creates a desired effect. But the end result is the creation of something larger than the technical methods could do on their own. A child’s spontaneous smile, a laugh at just the right moment, the uttering of the first meaningful words, the twinkling in a child’s eyes as he discovers something new is an awakening of the child’s spirit. It is an awakening that comes often as the partial result of the creative efforts of the behavior analyst, the artistry and dedication, the creative and yes, even intuitive, dance between the spirit of the behavior analyst and the spirit of the client.

Invisible Rubrics

2010-02-03T08:18:00.000-08:00

I have always loved my work, and have said that if ever the negatives outweigh the positives then it is time to reconsider my work life. At a recent supervisor meeting, I asked our supervisors for suggestions on how to make their lives at Pacific Child less burdensome. I wanted to know what they loved about their jobs and what they wanted to see different. Of course it was nice to hear about the positives, but I was concerned that people weren’t feeling safe to talk about the negatives. One supervisor used a phrase that I loved. She stated that she was afraid of the “invisible rubric,” and what I believe she meant was that she didn’t know exactly how she was being evaluated, and therefore carried around a lot of anxiety that what she was doing wasn’t what we, her supervisors, were evaluating her on.
It is always the unknown that frightens us the most, the monster hiding in the closet. And perhaps that is the greatest source of pain that the parents of our children with autism feel as well. The word “autism” originally meant “self-focused,” and focusing on oneself also meant shutting out the rest of the world. But if we truly believed there was no one hiding beneath the cloak of silent withdrawal we wouldn’t care much. It is that view, that there is someone hiding in the closet of our child’s mind that is so taunting. Who is this child? What is he thinking? What does he want? And what does he think of us?
In a strikingly parallel way, it is our children with autism who we believe lack the ability to determine (or even care) how others think of them (“theory of mind”). Our supervisors and staff work diligently to plant and nurture within our children the seeds of knowing and caring how others think about them, yet our supervisors themselves struggle to know what it is that they are being evaluated on, what it is that their supervisors think about them.
We are all evaluated by others, especially by those with whom we are close, continually. “Unconditional positive regard” was the watchword of the sixties, and it was as mythical as unicorns. So we struggle to know what it is that others expect of us so that we can choose freely whether or not we wish to jump through those hoops. But it is those invisible hoops that are the toughest, especially when the hoops are on fire.
So it behooves us all to make the invisible rubrics visible. But that is also a two-way street. When in doubt, ask those for whom we care what they want and expect from us, and let’s not be shy about making the deal go in both directions. Even those doing the supervision wonder and worry about how their supervisees are viewing them. Let us strive toward making our expectations clear, and let’s talk about it often and openly.

Pacing Yourself

2009-09-26T23:45:00.000-07:00

Marathon runners know how to pace themselves. They know that if they went all out from the outset of the race they would run out of steam well before the race was done. It is a lesson we all must learn. We must learn how to slow down in order to get the job done well, and to prevent ourselves from burning out along the way.

Slowing down also allows us to see the scenery around us, to take in the beauty and majesty of this magical world in which we live. It allows us to see the sparkle in our children’s eyes, and to catch the nuances that we are likely to miss as we race through our everyday lives.

Those of us who have done this job for a while get a thrill from seeing our children learn to do things and be things that they could not do or be before. We celebrate our children’s accomplishments, and truly take joy in the small roles we have played in their progress. Yet there are times when coming to work does not feel so thrilling or joyful. We begin to forget the reasons we do what we do, we pick up the pace and rush to meet obligations.

When we rush to get through our days we begin to breathe shallowly, and as we breathe shallowly we begin to think shallowly. We do our jobs poorly and sloppily. We live in the future and the past, and each individual moment disappears before we can live in it and feel its power.

Ironically, we rarely get more done by moving faster, or if we do the quality of our work suffers. Remember that we can do better work by recalling the things about our work that brought us here to begin with; the joy of seeing children lead richer lives and making a difference in the world. Remember that we rarely accomplish anything by repeatedly blasting ourselves for past mistakes, and that our past is merely a catalogue of present moments; if we want to create a past that will serve us well the only way to do so is to live meaningfully in the present. Slow down and focus on what is in front of you. Breathe deeply and involve yourself passionately in your work, and reward yourself meaningfully when your work is well done. Maintain your high standards, but refuse to let perfectionism take hold. Be both honest and fair to yourselves. And remain grateful for the gifts you have been given.

PCFA Speaks

2009-04-27T09:51:00.000-07:00

April is now receding into the past. As Autism Awareness Month, it is perhaps one of the busiest months of the year. I have just returned from Queretaro, Mexico, where PCFA alum Teresa Tassinari hosted an extraordinary conference called “Primer Encountro Internacional de Autismo y Desordenes del Desarrollo”, which I'm pretty sure means “First International Conference on Autism and Developmental Disorders”. Teresa was kind enough to invite me to deliver the keynote address, which I titled “Myths, Magic and Reality in the Treatment of Autism.” Also on the program were PCFA supervisors Stefanie Finney and Marta Marquez. Stefanie presented on “Implementation of ABA Programs in California: Methods of Intervention and Results” and Marta presented on “What is Autism and What are its Behaviors?” (Not sure if I translated Marta's title correctly from Spanish.) All of our presentations were very well received by the eager audience, composed of parents, students and professionals.
Earlier in the month I presented at the first autism conference in Armenia, providing a basic overview of the history, theory and techniques of Applied Behavior Analysis, and PCFA supervisor Arpi Arabian also presented on “Theory of Mind and Autism.” Arpi's presentation went extremely well.
In Mexico, one of the presenters in the two-day conference was a past PCFA therapist who went on to work for a school district. It was interesting to hear how many other past therapists were also working for school districts, and to play the “where are they now?” game with a group comprised of both current and past PCFA staff members. It is really interesting to think of how PCFA functioned as the training ground for so many professionals over the years, and how widespread their influence has become.

Cal-ABA week

2009-03-08T21:32:00.000-07:00

So if you are not familiar with Cal-ABA, it is not a western U.S. version of a Swedish pop music group. It is the organization to which many behavior analysts in California belong, and it holds an annual convention which has become quite a big deal. The convention alternates each year between Northern and Southern California, and this year it is being held in Burlingame, a suburb just south of San Francisco. The conference begins on Thursday, March 12, and ends on Sunday the 15th.
PCFA will have quite a presence at the conference this year. We are sending nearly 30 supervisors and senior therapists. Our very own Cara Entz and Sally Torrens will be presenting this year, so if you are going to be there make sure to show up and give them some support. We will also have a booth in the exhibit hall or lobby, where I will be mostly hanging out. So please come visit me to chat. Looking forward to seeing you in the Bay Area!

Prozac Nation

2009-02-27T17:30:00.000-08:00

Fluoxetine (Prozac) is a selective serotonin reuptake inhibitor, which is a rather fancy way of saying that it works by making more of the neurotransmitter serotonin available in the synapses (the spaces between neurons) in the brain. Given that serotonin levels have been linked to much of what spiritually ails we humans (and mice of course), and that parents of children with autism and all of us in the field are so desperate to find avenues of improving our childrens' lives, it is no wonder that studies are being conducted to investigate the effectiveness of using SSRI's such as Prozac for children with autism.

A study currently being conducted by a specialty pharmaceutical company called Neuropharm Group, which manufactures a new form of fluoxetine, has so far yielded disappointing results. This study investigated the effects of this new form of Paxil on the repetitive behaviors of children with autism. In this double blind study, results have demonstrated that both Paxil and placebo reduced the repetitive behavior of children with autism, and that the differences between the two were not significant.

There are two interesting aspects of this study to me. First, the study was sponsored by the same company that manufactures the medicine, and their conclusions were that it was no more effective than placebo. This conclusion will result in tremendous financial losses for this company, yet they had the integrity to publicize these negative results. While one certainly can't conclude that all drug companies have integrity, it is clear that at least one does. Second, it is always interesting to me to think about the power of a placebo. Simply the belief that an intervention will work will often "cause" the intervention to work. The general effectiveness of placebos begs the classic mind/body question. Does it make any sense at all to assume that the mind is somehow different from the body?

Classic studies done in the 1970's revealed that the neurochemistry of actors who pretended to be depressed or schizophrenic yielded the same metabolites in their urine as patients hospitalized for those conditions for many years. So if we do separate our thoughts from our chemistry, then we must always ask the chicken and egg question. And if our thoughts change our chemistry, and our chemistry changes our thoughts, how should one intervene?

..... Our deepest regrets and prayers are with our Southern California scheduler Linda for her recent loss. Also, we wish Chrisa Sadd a speedy recovery, and a very happy birthday to Elizabeth Fraines.

The Little Things

2009-02-23T22:17:00.000-08:00

What is it that we miss most about someone when they're gone? It may or may not be the things we love most about them when they are with us. The things we miss the most are not always the most obvious. They are not always the large things. They are not necessarily the great achievements, the number of books published, the amount of money someone makes, the fancy car they drive. What we miss most are the small things. Sometimes they are the awkward moments, the moments of spontaneity, a tear shed at an unexpected moment, the thoughtful gift, the kind word at just the right time, the odd laugh, the warm and secure embrace in a moment of fear.

In Ben Affleck and Matt Damon's film Good Will Hunting, there is a moment when Will's therapist Sam McGuire talks to Will about McGuire's wife who died of cancer: "My wife used to fart when she was nervous. She had all sorts of wonderful idiosyncracies. She used to fart in her sleep. One night it was so loud, it woke the dog up. She woke up and asked, "Is that you?" I didn't have the heart to tell her. Those are things I miss the most, wonderful things, the little idiosycracies that only I know about. That's what made her my wife."

It is, of course, these little things that make us all who we are. It is those little things we miss the most when we lose something or someone precious to us.

Those of us who devote our life's work to children with deep needs share much in common. One of these is a passion for helping. But we all help in different ways. Let us struggle to celebrate the small differences we discover in each other, the small accomplishments our children make. It is these small accomplishments we will remember in the years ahead. It is the small differences we make in children's lives that our children's parents will remember us for. It is the small acts of devotion and kindness that we will cherish in each other.

We Have a Budget

2009-02-22T09:24:00.000-08:00

So the legislature finally got around to approving a budget. As it stands, the 3% cut to Regional Center services has been approved, so that is very likely going to happen. It will mean a 3% reduction in the payment RC's give us across the board. That is the bad news. The good news is that further reductions in Regional Center budgets that were proposed did not occur. Regional Centers will apparently also have to absorb about 100 million dollars in cuts in July, but this is much less than the proposed 300 million dollars. There is no way at this point to know how if at all this may affect our services. The 3% cut will call for some belt-tightening, but overall will not have a significant impact on our ability to provide services.
Also on the positive side, the president's stimulus package seems to liberate some money for special education programs within school districts, so this might help us to provide more services for children through our relationships with the over 30 school districts we contract with in California.

Some supervisors taking UNT coursework have needed the out of print chapter from B.F. Skinner's About Behaviorism called "The Question of Control." It is posted on the secret supervisors' section of our website in the "information" section in pdf format for those of you who need it or for any supervisor who might want to read it.

Happy birthday to Osong Kim and Gloria Medina.

Parent Survey

2009-02-17T23:56:00.000-08:00

Just wanted to let you know that (in the event that any of our parents ask you about it) our annual parent survey will be sent via email to all of our parents within the next few days. We always try to get the best return we can on these, so if anyone mentions it to you please urge them to complete the survey. It is online, and takes only about five minutes to complete. The data are collected anonymously, in order to encourage parents to speak freely about the services they are receiving from us. As always, I will do the best I can to collate the data and get the results out to all of you as soon as I can. Realistically, this can take a month or more to put together, but I will work hard to get these results out as soon as I can.
And yes, soon after that the staff survey will be sent out to all of our staff, so that you will have the opportunity of freely commenting on various aspects of your work at PCFA.

Troubled Times Ahead

2009-02-12T03:34:00.000-08:00

I am hoping that I can soon pair this blog entry with another one that is headed "Troubled Times Behind." I have been accused (mostly by myself) of being a "terminal optimist," a condition that undoubtedly suits one well for the kind of work we are doing here at PCFA. But for a moment, let's indulge in that delicious state of pessimism and doubt that the world around us, and journalists in particular, are currently so fond of.
Any day now we are expecting a new budget to arrive from Sacramento. (By the way, what do Sacramento and Corpus Christi have in common? Yeah, you got it, they both mean "body of Christ".) Everyone who is anyone, and even a bunch of nobodies, is fully expecting an immediate cut of 3% off of Regional Center budgets. Some RC's are telling us that this cut will be taken "off the top" of any payments made to agencies such as ours. If this comes about, we can certainly live with it, but there are threats that this is "only the beginning." All sorts of dastardly plans are being thrown up against the wall, and no one yet knows what is going to stick.
Protests, marches, and all those wonderful things that sometimes do make a difference are being planned. But in the darkest corners many believe that they are going to fall onto deaf ears; everyone is out there protesting, but as the economy falls to pieces and more and more people are out of work up and down the state there is little sympathy to be garnered.
So we wait, maybe days, maybe weeks, to find out what is going to happen. This company is strong, certainly relative to the others out there. We are one of the largest ABA agencies, with a healthy line of credit, that will give us the flexibility we need in order to retool if there is any retooling that needs to be done. But we are also one of the best out there, so our services are likely to be called upon by those in need even if other agencies should not be able to weather the storm.
As clouds gather overhead, join with me in keeping a watchful eye for silver linings. They are there to be found. And should the rain come, let's use our creativity, cleverness, and passion for this work to forge ahead.

El Paso, Texas and the Military

2009-02-11T22:50:00.000-08:00

A warm welcome is due to our new clients and staff in our latest office in El Paso, Texas. We now have physical locations (offices) in three states: California, New Mexico, and Texas, and we are hoping to add several more before the year's end. Currently, our clients in El Paso are affiliated with Fort Bliss, one of the largest military bases in the U.S. We are providing services there through a contract with Tri-West (Tri-Care), through a program the government has set aside for assisting children of military families. We welcome our new staff to our family, and look forward to seeing some of you at our annual retreat.

We are also providing services to military families through several of our other regional offices.

New to Blogosphere

2009-02-10T13:47:00.000-08:00

I am thrilled to enter the blogosphere with this, my first installment of what I hope to be many. My intention in entering this world is to keep you abreast of developments here at PCFA, in the world of autism treatment in general, and to allow you the opportunity of commenting and participating. Please send me suggestions on what you might like to see me discuss here, ask any questions you might have, or let me know how this space might best be used by you. I hope to keep you in the loop with frequent entries, but let's see how it all develops.
Welcome aboard!