Cathy White places a piece of paper in front of Jonas Knutson. She tells him they are going to have a lesson on emotions. White points to the two lists on the sheet of paper while she explains the differences between positive and negative emotions. She asks him which facial expression would fit each emotion. She then asks Knutson if he would rather be positive or negative.
As the 20-year-old with curly brown hair tentatively pauses, he says, "I want to be positive." White then explains that everyone gets negative sometimes and it's OK.
Knutson is one of the 1 percent of children in the U.S. born with autism, a complex developmental disability that affects a person's ability to communicate and interact with others at varying degrees.
Autism appears to be increasing because of the psychological testing that is available to detect it, said Ramona Puget, who earned a bachelor of arts in psychology and is the president of the Kern Autism Society, a local chapter in the national organization of the Autism Society.
Early intervention of autism is crucial, she said.
"The sooner you are able to get them diagnosed and get them the help they need, the better," she said.
The exercise Knutson is engaging in is a part of a program called Building Connections, one of several at Speech Therapy Associates that are designed to provide high-quality, individualized therapy for preschool-age children up to young adults with autism or special needs. The organization is one place in Lodi that offers programs for autistic children to learn life skills and to communicate effectively in society.
Who autism affects, and its symptoms
It is estimated that one in 110 births, or one percent of the population of children in the U.S. from the ages 3 to 17, will have an autism spectrum disorder, according to research by the Centers for Disease Control and Prevention as cited by the Autism Society.
There is no known single cause for autism, but it is accepted that it's caused by abnormalities in brain structure or function, according to the research. It is a neurological disorder that is present at birth, but symptoms may not appear until much later. At 12 to 15 months of age, parents may start to notice that something is not quite right, she said.
During the early stages of development, a potentially autistic child may show signs such as lack of developing language, lack of eye contact and repetitive behaviors that may seem a little odd, said Puget. Some children may develop some language skills, but lose them later.
"It isn't until you start noticing deficits in language and eye contact where you will start to see some areas of concern for development," she said.
Robin Knutson, Jonas Knutson's mother, said she and her husband first noticed Jonas' use of language was a little odd. He was also echolalic, where he imitated what others said but had no originality in his own language. He had behaviors that were self-stimulating, such as staring at objects or lining them up.
On the other hand, Jonas had other abilities most children his age hadn't yet developed. He could identify shapes such as a triangle and an octagon at age 2. He also demonstrated perfect pitch.
"We would go visit my parents, and before we rang the door bell he would hum it at the same pitch," she said. "He could carry a tune. I remember he used to sing 'Shenendoah.'"
Some autistic children may lack spontaneity or "make believe" play because they don't understand it, said Puget. Many will have sensory issues and may also develop habits such as repetitive hand motions or walking on their toes all the time. They may have a persistent preoccupation with objects, such as carrying around lug nuts like prized possessions or collecting and hoarding rocks.
Autistic children are also inflexible when it comes to routines. They can be very ritualistic, such has having to turn on a light every time they come into the house.
"If it goes out of that structure, it really upsets them," she said.
Diagnosed at age 4 with high-functioning autism, or Asperger's, Owen McGuire's symptoms were not as prevalent as some of the other kids', said his mother, Sheila McGuire.
A special education teacher at Lodi Unified School District, Sheila knew what kind of symptoms to look for. In social situations, he had trouble figuring out what to say. He also had trouble handling changes in his routine, where a typical 3- or 4-year-old would just go with it, she said.
"For Owen, the biggest red flag was his social skills. We would have to prompt him to say hello or goodbye. He wouldn't do it on his own," said Sheila.
At first, he was receiving speech therapy for articulation at age 3. Sheila and her husband thought he would grow out of it but as time went on, he suddenly seemed to get a little worse.
Academically, he's really bright, which is typical with high-functioning autism, said Sheila. He attends kindergarten in a regular classroom setting, but he is reading at a second-grade level and can do third-grade math. A lot of people say he's very smart, but that's part of it, she said.
Children who can do well academically are known as "little professors" said Puget.
"They may not be able to fit in and may come off as an extremely shy child, but (they) are very good academically," she said.
Diagnosis and treatment
Owen places a chip on the board of the game "Sequence for Kids." He has matched three characters in a row with his cards on the board. He only needs one more to win the game. He finishes his turn by drawing another card.
"Kangaroo!" he says.
The other two players then take their turns.
"Whose turn is it?" asks Sharon Palmer.
The 5-year-old boy with dark hair smiles and points to himself.
"Good, you're using your non-verbal skills," she says to him.
The game is part of an exercise in the Circle of Friends group at Speech Therapy and Associates, which helps teach them turn-taking skills and keeps them aware of what is going on around them, said Palmer, a licensed speech-language pathologist. Usually, they play a simple game or take turns rolling a ball back and forth.
"They are there to work on social skills. We work on eye contact and making sure they are looking at the person who they are talking to, but not staring at them," she said.
After the "Sequence" game is over, Palmer says, "Now we are going to play the 'How do you feel?' game." She makes a face and asks McGuire what emotion she is showing. After he answers, sad, she asks him why he gave that answer.
"Because your eyes are facing down," he says.
She then asks him when he would feel sad. His answer: when it's raining and he can't play outside.
Children who have social skills deficits have a really hard time reading non-verbal communication, including facial expressions, said Palmer. A lot of times, their own facial expression will have a "flat affect," which means no emotion is shown on their face.
"We're working on teaching them not only to identify with other people, but to be able to express that themselves," she said.
Most children are diagnosed with autism at age 2 or 3, said Puget. If a parent suspects their child has the disease, the first step is to talk to the child's pediatrician.
Once autism is detected, an extensive interview is conducted with the parents to gather information such as speech and language development, as well as newborn-infant history and prenatal history. Then, several assessment tests, including living skills, motor skills, socialization and intellectual functioning, are administered.
These assessments are given every three years to see if the child has gained or lost skills, said Puget.
"They will want to see if they have the same skills in the following three years. They want to make sure they assess it properly," she said.
Then, it is important to get the child into an early educational prevention program to help redevelop language skills and handle the basics such as reciting their ABCs, said Puget. Generally, this is a special education program or speech therapy, though some people have also tried music therapy and occupational therapy. Most importantly, it is the early educational introduction.
"You want to start with the basics. You want to make sure the child is able to get that general information," said Puget.
Sometimes it takes a blend of different things to make it work for the child, but the choice on which treatment option is really very individual for every family, she added.
"It's trial and error, whatever works for your son or daughter. If it can make life a little simpler, that's the best plan," she said.
Since Owen has been attending the program, Sheila says he has become a different child. Behaviorally, he has learned the difference between big problems and little problems, as well as how to work through them.
In the past, he would just walk away when children initiated conversations with him. Now he is carrying on conversations with kids his own age, she said. He also learned how to pick up on non-verbal cues, such as when someone is finished talking. He then knows it's time to stop talking.
"His social skills have improved dramatically and his communication skills are better," she said.
After Jonas was diagnosed at age 3, he was placed into the Central Valley Autism Project, a program that involves 40 hours a week of one-on-one intensive behavior training. He began attending the Circle of Friends program at Speech Therapy and Associates, where he attended once a week to participate in activities with other children.
White, who is the speech language pathologist who works with Knutson and others like him, said her goal is to help them be successful communicators and to be successful in school and in social groups.
"My personal goal for these guys is to help them be as successful as they can be in society and to be able to contribute," she said.
The future for autistic children
In August, Jonas returned to the program after taking a few summers off. He plans to go to college next year, and is back to learn how to handle those additional responsibilities of being on his own, said White.
A person with an impairment in social skills will always have it, said White.
"A client may learn all the concepts necessary for that time and then may need to come back later on because of new social concepts they are encountering," she said.
Jonas wakes early in the day to do his job as a newspaper carrier for the Lodi News-Sentinel.
"I put down newspapers on people's porches," he says proudly, with a big smile.
After completing his route, he goes home to get some more sleep before going to school. He spends his afternoons working out on the machines at Twin Arbor Athletic Club. He enjoys swimming in his pool, playing the guitar and trombone, and singing in an adult choir.
As Jonas sits at the small table opposite White, the two talk about what it means to be pessimistic versus optimistic.
White asks him how he feels about people and if he thinks everyone is friendly. At first he answers yes, but he then changes his answer to no.
White said one of the hardest things for Knutson is "perspective-taking," or understanding that others may have a thought that is different than his. He may not realize when someone is being mean or trying to bully him, she said.
"He's super-optimistic, so it's hard for him to handle situations that may be upsetting for him," she said.
Next year, Jonas plans to attend Taft College, a community college in the town of Taft. It has a transition to independent living program that will teach him how to live independently and teaches skills such as how to manage a checkbook, cook and clean.
"I feel like he's doing great. He's got a lot more to learn but I think he has great potential," said Robin Knutson.
Jonas says the Building Communications program has helped him build his confidence in following rules at school and doing his work. He's hoping to learn to be a preschool teacher's aide.
"I've always liked little children, and they like me. And I'm good with little ones," he said.