The Groden Center, in Providence, "was the best thing we ever did for both boys," says the mother of two teens with autism.

01:00 AM EDT on Sunday, May 14, 2006

BY FELICE J. FREYER
Journal Medical Writer

"When puberty began, all hell broke loose," says Claudia Swiader.

She's talking about her older son, Adam, who is now 18. Although all parents of adolescents might think they can identify with that comment, Swiader was scarcely exaggerating.

Adam has autism, a neurological condition that affects a person's ability to communicate with others. Diagnosed at age 3, Adam had never learned to speak, but he'd always been "a cuddly teddy bear" -- till just after turning 12.

"He began using his fists against me, our daughter, our dog," Swiader says. At the Northern Rhode Island Collaborative, where Adam went to school, the teachers called her home almost daily to say, "You need to come get Adam because he's uncontrollable and we're afraid."

Swiader looked into Adam's brown eyes, and she saw fear there, too. "He's screaming nonverbally, 'Help me.' "

ADOLESCENCE POSES challenges for every youngster, and everyone reacts differently. Some cope easily; some get into trouble.

The same goes for people with autism, says Cooper Woodard, the clinical psychologist who is director of The Groden Center, the treatment center where Adam Swiader enrolled three years ago.

But autism can make the challenges of adolescence especially daunting. Autism varies in severity, but commonly includes difficulty learning social conventions, connecting with others, absorbing sensory information and adapting to change. Some people with autism also have low intelligence and speak little or not at all.

During adolescence, says Woodard, "they're coping with new emotions, new feelings, physical changes. A lot of times, they're coping with social changes in the home that typically developing peers would experience as well. Parents are getting older; siblings are leaving for college, or jobs.

"The person with autism may want to experience the same independence or increased autonomy they see other people enjoying. They're not able to communicate through words. They begin communicating through behaviors."

At The Groden Center, the staff members consider it their job to figure out what the child who bangs his head or tears off his clothes is trying to say -- and then teach him a better way to deal with it.

The Groden Center is celebrating its 30th year serving children and adults with autism and other developmental disabilities.

It was founded just as federal and state laws began requiring school districts to educate children with special needs. Eleven Rhode Island youngsters with autism were in a program that used aversive techniques, such as electric shock, to control undesirable behavior.

The State of Rhode Island was looking for a better way. It asked June Groden, a psychologist, and her husband, Gerald Groden, who was then with the Rhode Island Hospital Child Development Center, to bid on a contract to provide services to these children.

"They gave us a contract at the end of August [1976]," June Groden recalls. "They said, 'We want you in operation in two weeks.' We did not have a location. We did not have staff."

ALONG WITH TWO colleagues, the Grodens began interviewing prospective staff members. They located a building off Hope Street, in Providence, that had once been the Rhode Island School for the Deaf -- and that remains The Groden Center's headquarters today.

The center has grown to include preschool, day schools, group homes, in-home assistance for families, and vocational training and employment -- services throughout the lifespan for a lifelong affliction.

But those first 11 clients, mostly boys, were all adolescents like Adam Swiader.

Autism was so little known at the time, June Groden recalls, that some people thought she was running a center for "artistic" kids. And in some ways, she was. The Grodens brought to their work a profound respect for the humanity of these people, who engaged in behaviors that many find disgusting, frightening and baffling. And they did something that many thought impossible: they taught these seemingly uncontrollable youngsters how to control themselves.

"I always felt they were regular children," June Groden says. "They have some problems. We have to teach them how to handle their problems, and give them better techniques, so that they can get out and be with other people."

ON A RECENT spring day, Adam Swiader is swinging contentedly on the swing at The Groden Center, where he attends the day school along with his 16-year-old brother, Matt, who also has autism. The two boys live in a Groden Center group home, sharing a room.

While Adam plays outside, inside The Groden Center, Woodard pulls out the graph paper where Adam's teachers indicate how often he exhibits a troublesome "behavior."

This carefully detailed information creates the roadmap to recovery. The staff members make notes of each time a person, say, bites himself or hits a classmate. They make note of what time it happens, how often it happens, what occurs right before -- and what it accomplishes.

If a child throws a book at his teacher, that may be his only way to say he has had enough work; it has the desired effect -- the work stops.

If a child breaks something every day at 2 p.m., it might be because that's when he has to get on the bus, and the transition to the bus makes him anxious. But he might also have a headache or a stomach ache.

For each student, The Groden Center identifies each "behavior" that causes concern -- and tracks it, hour by hour.

Woodard flips through the graph paper on Adam, going back months. It shows page after page of zeroes -- Adam's behavior has been, in a word, perfect. It took more than a year to get him to this point.

Adam speaks little, but he understands more, and he readily agrees to come inside to demonstrate how he learned to change. Stephanie Moreau, a treatment coordinator, sits across from him at a little desk.

"BIG, DEEP breath," she begins. "Make your forehead tight, and rel-a-a-a-x. Make your eyes tight, and relax. Make your nose tight . . . "

One by one, he scrunches his facial features and relaxes them, and then moves through tensing and relaxing his shoulders, chest, back, all the way down to his feet, ending with another "Big, deep breath."

"Let's think about having a good afternoon and playing in the playground," Moreau says.

"My work is almost finished. My hands and voice stay relaxed."

Adam repeats these statements, using sign language and words.

This "progressive relaxation" process is a hallmark of the Groden approach. It has been key to Adam's treatment, and the treatment offered at The Groden Center throughout its 30 years.

The Grodens observed that people with autism suffer a great deal of stress, and deduced that relaxation could be the first step to self-mastery. The Groden Center has found that even the most noncommunicative and mentally impaired people can learn this and other techniques.

The Grodens showed that a child who freaks out in the supermarket because of the noise can be taught to focus on how interesting the place is. "We try to reframe what they're saying to themselves, give them a more positive outlook," June Groden says.

Another feature of the Groden program is "picture rehearsal." Autistic children often respond better to images than to words. So photographs or drawings are made of them enacting a desired behavior.

One picture rehearsal routine for Adam consists of a series of photos depicting Adam walking appropriately with a staff member. The staff member shows the pictures to Adam, one by one, reading aloud the caption on the back of each.

"I'm in the community with staff," reads the caption of the first picture of Adam at a crosswalk.

"I remember to walk relaxed and watch."

"I look to the left and to the right."

"When no cars are moving, I walk relaxed with staff."

After his picture rehearsal, Adam bounds outside to the playground. It's his biggest reward.

CLAUDIA SWIADER is overjoyed with what The Groden Center has done for her sons. Matt's problems had been even more severe. He spent a year at Butler Hospital before joining his brother at Groden. They've also learned job skills. Adam works at a greenhouse and in a factory, and competes in the Special Olympics.

"I love Adam. I love Matty," says their mother. "I enjoy being with them, I enjoy working with them.

"Groden's people invest themselves in your child, completely. . . . They love them, no matter what. It was the best thing we ever did for both boys."

ffreyer@projo.com / (401) 277-7397