Language Delay and Disorders 13Case Study 1-3: Autism in a Residential Treatment Fa cil i ty
Hannah Beth knew that most people simply did not understand how an autistic child dra-
matically alters family life. The birth of any child has a strong effect on the family’s relationships,
routines, and finances, but the special needs of a child with autism can turn a house hold upside-
down. Hannah Beth and her husband, Steven, met the challenges of autism head on, and Mikey’s
Moonshadow Ranch is the result. The ranch has taken 20 years to create, but it now provides eight
autistic adults, six men, and two women an exemplary residential treatment fa cil i ty.
At first, Michael, or “Mikey,” as every one called him, appeared normal and acted like most
infants. However, there were early signs that Mikey’s development was aty pi cal. The first sign was
the lack of bonding. Mikey was aloof and distant. He was tactile defensive, not seeking or appear-
ing to enjoy physical intimacy. He tended to treat his parents as objects, showing little interest in
them and even less affection. Another early sign of autism was self- stimulation. Mikey used several
forms, but especially putting his spread- out fin gers close to his eyes and rapidly moving them up
and down, creating a strobe effect. This is his favorite “stimming” be hav ior, and he frequently uses
it when anxious or distressed.
Mikey’s Moonshadow Ranch is set on 10 acres of rolling hills. A small creek runs through the
center of the ranch, and several weeping willow and oak trees border it. The ranch is fenced with
wire and steel t- posts, and the corrals are made of wooden panels carefully painted by the “ranch-
ers.” There is an old red barn with a hay loft and several outbuildings. In the center of the ranch
are the bunk house, main home, mess hall, and swimming pool.
There are no typical days at Mikey’s Moonshadow Ranch, but they usually start early in the
morning when one of the ranchers disrupts the quiet of the bunk house. The aide who sleeps in the
bunk house awakens the rest of the male ranchers in time for breakfast. (The two women sleep in the
main house with Hannah Beth, Steven, and another aide.) Most of the men can dress themselves if
their clothes have been laid out the night before. They then go to the mess hall for breakfast, although
some wander and need coaxing and direction. Mikey is usually first at the table and has the biggest
appetite. The two aides help the ranchers with the meal and try to keep spilled liquid and food to a
minimum. This morning the orange juice is more tart than usual, causing Mikey to say repeatedly,
“Dentist,” perhaps referring to the taste of the juice in his mouth or, as often happens, apparently
referring to nothing at all. He also begins “strobing” and making facial grimaces.
After breakfast, the ranchers sit in the living room awaiting direction from Steven, the fore-
man, and assignments of morning chores. One of them tries to turn on the tele vi sion, but it has
been disconnected. The blaring talk, canned laughter, loud commercials, and rap music on tele vi-
sion are prohibited during the day. The excessive stimulation, particularly in the morning, triggers
chaotic be hav ior among the ranchers and can disrupt the relative calm and order of the ranch
throughout the day.
Today, Mikey is to complete his usual chores of feeding hay to the two horses and filling the
water trough. He and an aide walk to the barn, and Mikey automatically pulls a hay bale from the
stack. It falls to the concrete f loor, with dust billowing, causing Mikey to sneeze. The sneeze sets
off several self- stimulating be hav iors, including rocking, repeatedly turning his head from left to
right, and saying, “Dentist, dentist, dentist.” The aide gently redirects Mikey to the stack of hay
and points to another bale.
Mikey is not allowed to use sharp instruments unsupervised, and the aide gives him a brown
pocket knife. Over the past few weeks, Mikey has learned to open it and safely cut the twine that is
compressing the hay bale. Then he carefully closes the knife and says, “Dentist.” Mikey enjoys this
part of his chores and often needs coaxing to return the pocket knife to the aide.
One in ter est ing aspect of Mikey’s language is his tendency to confuse pronouns. This is appar-
ent when the horses are fed and it is time to fill the water trough. Mikey turns to the aide and says,