"Okay, let's just calm down for a minute and I will try to answer your questions," Susannah spoke soothingly. "This is an alter who hasn't been out before?" Sam asked for clarification. "Yes, I'm sure this is an alter who has never been out before. He may have already been in the system or Todd may have split off a new alter or fragment and no, I don't think he is deaf. I think this alter is male and approximately three to five years old." Susannah explained and then went on. "I'm reasonably sure that this one has no language skills. I am also reasonably sure that this alter is autistic." Most of the staff had already figured that out, but Viki, Sam, Kevin and Téa looked at each other with fear. Susannah could feel their anxiety increase. She was afraid that, of them all, this alter's behaviors would be the hardest ones for them to cope with. Getting into his world and even more, getting him into theirs would not be easy.

*****

Susannah asked everyone to come to her office for the debriefing. Frank returned from his break and joined them. Susannah waited until Todd's family and her staff were settled and began to speak. "First I want to know if any of you have any questions or comments about the restraint? Anyone feel there could have been a better or different way to handle the situation?" "I don't think he would have calmed without sedation. He would not have held still on is own for us to administer it," Eileen spoke up. The others nodded in agreement. "You do all realize that this alter is probably very young and most likely autistic?" They nodded again. "Do any of you have more of an issue using physical restraints on such a young child?" Susannah asked and looked around. "I do," Janet spoke up. "I know it was necessary, yet it still disturbs me. He had no idea why we were doing that to him and he was terrified." Looking at Todd's family, Janet continued. "I hate to make this analogy, but it feels like when I take my cat to the vet. He has no idea why I'm holding him and letting this person hurt him. I don't think I will ever get used to having to do restraints on kids." "Would you prefer not to be involved in any future restraints?" Susannah asked. Janet thought for a minute "No, I understand it is sometimes necessary and at least he's being handled by people who care for him. That isn't always the case in some facilities."

Susannah understood how difficult doing whatever treatment was necessary for the very young alters could be. "I want you all to understand that it is all right if any of you have a problem with any particular aspect of Todd's treatment. I want you to always feel free to discuss it," Susannah made this clear to them. Viki spoke up. "I really want to thank all of you for the care you give my brother. I am happy to see that you do not take things like having to restrain him lightly. We are all very grateful for the level of care Todd is receiving." Some of the staff said thank you and some of them, not trusting their voice, nodded and smiled sadly.

"You were certainly right about seeing him cry out for his mother and beg her forgiveness. Man! That was a killer," Angelo stated, shaking his head at the memory. "It's normal for a child to think that they are the cause of everything that happens around them," Eileen commented. "Yes it is. Especially in a case like this, when the remaining parent tells them it's their fault," Terry added. "A child needs to have a reason for what is happening to them. The only reason Todd had was that he did something to cause his mother to leave him. If he had been a better or braver boy she would not have gone. Then finding her, only to have her send him back to his tormentor, did the most damage," Susannah added.

"Mom said something about another new alter coming out?" Kevin asked. "Yes, his name is Storm and he's nine. I believe he's been dormant in the system for a while." Addressing Todd's family, Susannah stated, "If you can, I would like all of you to hear the tape of the session I had with Storm and Todd. Then I will answer your questions about Storm and the things he and Todd disclosed before you came into the room. I'm sure once you hear the tape you will have many more questions." They all nodded in agreement.

"Susannah," Viki began nervously. "You couldn't get Todd back or reach any of the other alters. Can Todd stay inside this time? Can he be lost to us forever?" Susannah heard the fear in Viki's voice. "I don't think that will happen. I believe Todd and his whole system just need some time to stabilize." Susannah could see her words didn't reassure them. "You're still not saying it is impossible for him to stay inside forever," Sam wanted more reassurance and Susannah could not honestly give it to him. "No, I'm sorry. I wish I could tell you that it's impossible, however, there is always that possibility. I can tell you that it is unlikely and I don't believe that's what happened, but there is always that possibility," Susannah sadly admitted. Viki could see how frightened Tea looked. She turned to her. "Tea, I am afraid for Todd, but I know how Todd has fought to survive all these years. I also know how much my brother loves us and especially loves you. He'll be back. Todd doesn't abandon those he loves. He'll be back." Viki realized that she really believed every word she just said. She believed with every fiber of her being that Todd would come back. She began to relax a little. Sam still remained fearful. He kept it to himself.

Susannah turned to Frank. "Are you okay?" "Yeah, it just got to me a little. I'm gonna have to go ten rounds with the punching bag when my shift ends. Then Frank asked Susannah, "Do you think he'll digest the disclosure?" "I'm not sure. I hope so. Just his remembering is a huge step, unfortunately he was completely overwhelmed. The whole system may have been overwhelmed." "Do you think he just split off this autistic alter?" Terry asked. "There is a very good chance. This has been the most traumatic memory Todd has had. This alter could have been dormant in the system for a while, but I have a feeling that today's memories cased the split to just happen" Sam turned to Susannah. "We knew there was a danger of that happening. So what happens in the future! Todd has so many traumatic things to remember. Does he just keep splitting until there are hundreds of them!" They could all hear the fear and frustration in Sam's voice.

"As Todd begins to trust that we can keep him safe when the memories happen and begins to have confidence in his ability to handle them, meaning that he sees the world will not end if he remembers. He will start to feel stronger. Each time he makes it through, even with the help of another alter, it will help him. Right now not only doesn't Todd want to remember, there may be alters in the system who don't want him to remember, thinking something terrible with happen. The more it is proven to them that something terrible did not happen the less afraid they will be." "Did he react as strongly as he did because I was in the room and heard?" Tea asked. "Tea, I know Todd was upset when he realized that you were still there and heard what his father did to him, but I really believe he needed you to hear. Todd didn't just remember. He allowed himself to remember," Susannah explained and assured.

Kevin stood up and walked toward the window. He banged his fist against the wall. "How's he going to do it? How the Hell is he going to be able to remember all the things that were done to him and not go inside forever? I have to tell you, if it were me I could never do it." Viki walked to where Kevin stood. "Kevin, thank God you will never have to, but if you did you would get through it and so will Todd. If there is one good thing my father seems to have given us all it's the strength to survive no matter what is done to us. Sweetheart, don't sell yourself short. There have been a lot of very awful things in your life that you have survived, your dad dying, having Lee Ann take your son away, my illness, the fire. Please, don't be so hard on yourself." Kevin was surprised. He had not expected him mom to say that to him. Tears formed in his eyes. "My God! I need her praise and acceptance almost as much as Todd does," Kevin thought to himself, embarrassed by the revelation. Kevin hugged Viki and they both went back and took their seats.

"Susannah, are you sure this alter is autistic?" Sam asked. "No, not completely, but he has already displayed many symptoms of it and it is quiet common for there to be autistic and handicapped alters. They usually come out in a situation like this, when the host and the system are completely overwhelmed. It is very similar to the Baby coming out. No one else wants to come out, so this alter was either sent out or created." "Do you think he has any language skills at all?" Angelo asked. "No, I don't, although I can't really be sure yet. I don't know how much of what we say he understands either. I want to discuss his biting Steve. This alter probably has no concept of someone else's pain. He is not at all strong, physically, as those of you who participated in the restraint must realize, but assault precautions need to be in place. He has aggressive tendencies and will most likely continue to bite and lash out in various ways when feeling threatened and possibly when any demands are placed on him. We will try to reduce or hopefully eliminate those behaviors as quickly as possible. In the meantime, if possible, you have to manipulate yourselves environmentally so that you are not in a position to be bitten. I think handling him from behind is safest, for now. We will probably be doing a lot of hands on therapy with this child. If you need to lead him, lead him by his shoulders whenever possible. Try to place your arms or other body parts in a place that he can't reach with his mouth." Susannah turned to Tea, Sam, Viki and Kevin.

"How much do any of you know about autism?" They looked at each other and all admitted that they knew next to nothing. "If this child is autistic he seems to be in the moderate to severe range. Children with autism can be as different from each other as any typical child, but there are some characteristics that many of them have in common. The behaviors you saw this alter present with are some of them. There are different tools we use to diagnose autism. We use the DSM IV. With this, there are six criteria out of three lists that we look for. One of the other more common screening tools we us is CARS, Childhood Autism Rating Scale. Using a 7-point scale, we look for the degree to which the child's behavior deviates from that of a typical child of the same age. I will need to observe and assess this child the next few times he comes out, if he does. I have a feeling he may stay out for a while because of what Todd's memory may have done to the system. Just the fact that this alter was sent out tells me that Todd's system is most likely in total chaos and completely overwhelmed," Susannah surmised.

"He seemed to be in his own world," Sam remarked. "Quite often children with autism live in their own world. It is not by choice. They are isolated in their world. As for Todd, all the feelings he felt during the trauma he remembered today came back to him, the terror and fear, the extreme helplessness and humiliation. He couldn't handle them. If this child is autistic, he was probably created just for the purpose of keeping the world out. We are going to have to get into his world and try to reduce the stereotypic behaviors and increase behaviors like paying attention, using language, even if it's nonverbal like pointing, play skills and eventually eye contact. Most likely this little boy does not know how to play with toys appropriately," Susannah explained.

"Isn't autism neurological disorder?" Viki asked. "Yes, it interferes with normal development of the brain in areas that control verbal and nonverbal communication, social interaction, sensory and motor development. It is also four times more common in boys than girls. That is one of the reasons I believe that this child is probably male." "Do you think Todd has developed some kind of neurological disorder, in addition to the epilepsy or is this caused by the epilepsy?" Tea asked Susannah, clearly confused. "No, epilepsy doesn't cause autism. However, about thirty-five percent of all children with autism develop epilepsy, especially as they get older. There may be some neurological deficits in the brain when this alter takes over the body that causes this or it may be the need for an alter who is in a world of his own. Like the Baby, it is possible that this alter has never experienced abuse. That is why I feel that he may have just been split off."

"Is this a form of psychosis?" Sam asked. "No, autism is considered a Pervasive Developmental Disorder. The symptoms and characteristic behaviors present themselves in a wide variety of combinations and in any degree of severity. This alter may not present with all the behaviors, but as I said, he has already displayed some of them." "Was the odd way he looked at the window shade and at the candy one of the symptoms?" Viki asked. "Yes, some children with autism use their peripheral vision almost exclusively. I'm sure you also noticed his lack of eye contact." "He stared at the ceiling when Susannah spoke to him," Viki informed Kevin, who had not been in Susannah's office with them. "Was hitting himself and poking himself in the eye some of those behaviors?" Sam asked Susannah. "Yes, self-injurious behaviors and self-mutilation are a big problem with some children with autism. They sometimes use them out of frustration or fear. He may use them to avoid demands or to reduce stress. Some children self-injure or mutilate if they are in pain or uncomfortable in some way or sometimes just to gain attention. Very often in autism the senses are over or under stimulated and everyday things in the environment become extremely uncomfortable or even painful to the child."

Tea started to remember some of his other odd behaviors. "Was that why he sniffed and licked the objects on your desk and the toys and even your sleeve?" "Yes, he was looking for sensory input. He may also suffer from an over stimulation of some senses and find normal odors, tastes, sounds and images very disturbing," Susannah replied. "Was his playing with the window shade in your office a symptom too?" Sam asked, sounding curious and discouraged at the same time. "Yes, it was a repetitive, possibly a ritualistic behavior. Also, his inability to change direction and stop playing with it and the tanturming that followed are also stereotypic behaviors. He was completely resistant to any intrusion in his play.

Kevin's mind was racing and at the same time he was numb. He felt sick whenever he thought of what Todd had to remember. He could not fathom what it must feel like to remember that your own father forced sexual abuse on you. Kevin desperately wanted to learn how to help this little alter who had come out when Todd could not face his memories.

"Susannah, if there is a neurological component to this, isn't there some treatment or medication you can give this little boy?" "Kevin's right, there must be some kind of medication for autism?" Tea added to what Kevin had to say. "There is no specific cure for autism, and no one drug. Scientists are looking for abnormalities in the brain structures that make up the limbic system. Inside the limbic system an area called the amygdala is known to help regulate aspects of social and emotional behavior. One study of high-functioning children with autism found that the amygdala was indeed impaired but that another area of the brain, the hippocampus, was not. In another study, scientists followed the development of monkeys whose amygdala was disrupted at birth. Like children with autism, as the monkeys grew, they became increasingly withdrawn and avoided social contact. Differences in neurotransmitters, the chemical messengers of the nervous system, are also being explored. For example, high levels of the neurotransmitter serotonin have been found in a number of people with autism. Since neurotransmitters are responsible for passing nerve impulses in the brain and nervous system, it is possible that they are involved in the distortion of sensations that accompanies autism. One of the drugs that they have been trying with children with autism is Zoloft and some of the other SSRIs. As it can with Brina's ritualistic behaviors, Zoloft may also help the ritualistic behaviors of this child. They are basically obsessive compulsive behaviors like Brina's, if the child has them" "You're planing to start Todd on that anyway, so that's good. I mean that may help this child too," Viki commented, hopefully.

Susannah did not want to sound discouraging, nevertheless, she knew that there hasn't been that much success with this. "I hope so, but to date there has been no conclusive study done with this. What I would like to try with this child, if he is autistic, is called Applied Behavior Analysis. ABA is the only method with a study complete with a control group. It has been met with a lot of success. It is based primarily on B.F. Skinner's principles of operant conditioning and on behavior modification. Doctor Ivar Lovaas did the pioneering research with ABA." "What do you mean by behavior modification, like Pavlov and his dogs?" Sam asked, not liking the sound of this. "No, I know it sounds like that but there are many differences. I would like to explain the program I have in mind for this alter in detail. For right now, the basic idea is to reduce the undesirable behaviors and reinforce the desirable ones, to discriminate between different stimuli and to give him functional communication." Susannah knew this was going to be difficult for them to accept.

"There are some things you need to understand. If this child is autistic, there is a chance he is also mentally retarded to some degree. His IQ may only be in the mid-forty to mid-fifty range and there is a good chance it is under seventy." "No way Susannah!" Kevin spoke up, harshly. "Todd is a genius. I don't believe that any of them can be . . ." Kevin couldn't even say the words. Kevin was still in denial over the chance that Timmy may be suffering from a deficit in his intellect. He hated what was happening to all of them.

"Kevin, I'm sorry, I know it is difficult to understand. I'm not saying this definitely the case. This alter may not have a low IQ at all. I just want to prepare you for the possibility." Kevin shook his head, but kept quiet. He knew Susannah had to be wrong about that. He was more determined than ever to help this child.

"I don't understand, if this alter needs to be in his own world why not just let him be?" Tea wondered out loud. "Because it will be impossible to do treatment with him this way. Like the others he will eventually have to become a part of Todd. Just the way we have to help the others work through their particular issues and in a sense to grow up, we have to do the same for this child. Even the Baby will eventually have to be helped to mature, but we are looking far into the future. For now we need to help this child for himself. It is what is best for him. The behaviors you saw may be just the tip of the iceberg. If he has the full spectrum of stereotypic behaviors we will certainly have our work cut out for us."

"Susannah, I want to help. I want to work with this little boy in whatever way I can," Kevin volunteered. "I'm glad you feel that way. He will need all of us working with him. I think it may also be necessary to bring in a therapist who works with children with autism. I did some work with children with autism when I was in Switzerland. A colleague of mine had a child with autism and ran a program at the hospital where I worked. The work is intensive and he may need more than this treatment team to work with him. For starters, he needs to be assessed for some things, like what skills and abilities he already has, his developmental level, the severity of his autistic symptoms and his tolerance for intervention. Then, the first thing he needs to learn is how to learn. Many children with autism do not learn things the way typical children do. Most are visual learners. Some are auditory learners and some learn tactilely. We are going to have to find out which way this alter learns best. In essence we will have to retrain his brain. We also need to find out what precedes his behaviors, especially what precedes tantruming. As a first step I would like to do what's called a reinforcer assessment and a functional analysis. Usually the parents would draw up a list of what stereotypic behaviors they want decreased and what behaviors they would like to see increased. They would also have a pretty good idea of what is reinforcing to the child. What foods, toy's, games, video's, activities, things like that, the child likes to engage in. In this case, that is not possible because you are not familiar with this child. Functional analysis is used to determine the function of particular inappropriate behaviors. Then behavioral strategies are devised to reduce maladaptive behavior by using differential reinforcement of appropriate behavior and aversives to try to decrease inappropriate behaviors . . ."

"Susannah, what do you mean by aversives? You're not planning on having him punished in some way?" Viki was horrified by the thought. "No, not physically, ever! Aversives would be something like requiring him to do a boring task, or giving him a time-out, or withholding a favorite toy, or turning off the TV, perhaps a firm word. Even if he doesn't understand the words, he will begin to associate the tone with the inappropriate behavior, although, many of these children do understand even if they have no language skills to use. Screaming and crying may be one of the ways he communicates, especially if these behaviors increase around others. Once we have an idea of what function a particular inappropriate behavior serves and what reinforcers work best with this child the real work begins. We use differential reinforcement to reward the child's appropriate behavior and responses."

Tea needed some clarity on this. "What do you mean by 'differential reinforcements?'" She asked. "Every single time you see this child engaging in the correct behavior, in or out of a therapy session, you reinforce that behavior with verbal or social praise and at the beginning, a tangible or edible reinforcer or a preferred action like playing a game. We have to discover what motivates this little boy. We also reward by the quality of the child's response. If the child does something really big, something that was especially difficult or really puts extra work into something we would make a really big deal over it with our praise and we would probably double or triple the reinforcer or use a more powerful one. We also use DRO, Differential Reinforcement of Other Behavior. That would be to reinforce a substitute appropriate behavior for an inappropriate one. We will give him substitutes for some of his stereotypic behavior, which is what we call the autistic behaviors. For instance, if his licking of things persist, we may use Oral Motor Therapy. It will give him something appropriate to satisfy his need for oral input, something like a lollipop or even things like a sports bottle with a thick straw, or aquarium tubing to chew on. Sometimes this can also help if he has any tendency to bite himself, although it is not always helpful with that."

"Do some of these children do that?" Tea asked nervously. "Yes, self-injurious biting is common. There is also DRI, Differential Reinforcement of Incompatible Behavior," Susannah replied and continued. We try to engage him in something that makes engaging in a stereotypic behavior difficult. We need to do a reinforcer assessment to tell us what will work with him. A reinforcer is something that increases the probability of a behavior. The usefulness of a reinforcer is how the child responds to it. How much it motivates him to do the work. If he's not interested in it then it is not a reinforcer to this child. We already know he likes chocolate."

"At least this one likes to eat," Kevin commented in a joking tone. "You think this is funny!" Sam spat out. "No . . . I . . . Sam, I'm sorry, I was just trying to lighten the mood," Kevin was worried about Sam. He seemed to be jumping down everyone's throats these days. Viki took Kevin's hand and squeezed it. She looked at Sam. She could see he was already sorry for his outburst. "I'm sorry, Kev. I know you meant it that way." Sam apologized, hating the way he was feeling lately. Sam and Viki were both still having problems with the therapy Susannah was describing for this child.

"I noticed you praised him and made a really big deal of his walking to you. Is that part of his therapy?" Kevin inquired. He was already intrigued in the methods that would be used to help this little boy. "Yes, that was a reinforcer. He probably did not understand the praise yet, still, the tone of voice you use is just as important as the words. The primary reinforcer at this point is the candy. That he pleased me by running up to me most likely meant nothing to him. He most likely has no concept of my needs or desires. Have any of you ever heard of Theory of Mind?" Susannah inquired, directing her question to Todd's family.

"I've heard of it. I'm not sure what it really refers too though," Viki responded. The others shook their heads no. "What it means is that this little boy may have no concept that others have thoughts and feelings. He may not understand that there is a viewpoint other than his own. He is not out to please anyone. We are very lucky that he likes chocolate. It will make an excellent reinforcer, for now. The amount I gave him was too much, unfortunately, it was all I had. I'm going to lay in a supply of other edible reinforcers, things like M&M's and Skittles and other small treats and give them to him one at a time. There may be some other things he likes, cookies, that would be crumpled into tiny pieces and handed out one small piece at a time, maybe jelly beans or juice. We will also see if he likes any tangible reinforcers like toys or maybe, once he's calmed down and gotten used to us, social interaction, like hugs, singing or preferred activities like games, Usually the parents are able to let the therapist know what the child likes. However, in this case we will have to start from scratch. At first he'll be presented with several choices of reinforcers and we'll see what, if anything, he chooses on his own."

"What if he doesn't like any of the things you offer him?" Tea asked. "We'll try other things. He may like blowing soap bubbles, or clapping. He may like cartoons or some videos. Some children like things like string, spin tops, lights, certain textures or sounds or even being tickled. Sometimes the reward is the removal of any type of demand or instruction and being allowed to engage in stereotypic behaviors during his play time."

"Susannah, do you think this alter will eat without problems?" Sam asked. "I hope so, though often children with autism are very limited in their diets. He may only like a very narrow range of foods and then only when they are prepared in a very specific way. Some children only like foods of certain texture or color. He may only want to wear certain clothes or walk in a certain routine. Routine and sameness is very important to many of these children. It can be extremely upsetting to them when there is even the slightest variation in their routine." Susannah knew they could not even comprehend how difficult the world might be for this child.

"Doctor Hanen, did you see the movie Rainman? Is that what this alter will be like?" Tea spoke up. "The character Dustin Hoffman played in Rainman was very high functioning. An autistic savant, actually. That is pretty rare. I don't believe this child is high functioning. That movie is a good example though, in some respects. Do you remember the way the character of Raymond only wanted to buy his underwear at K-Mart?" They all nodded. "That was because he had no concept that there are other places that the same underwear could be bought. He also felt secure in his pattern. When his brother broke that pattern he felt completely out of control. It was the same with his need to have his bed positioned the way it had been in his room and the same breakfast lined up exactly the same way he was used to. This child may already have his way of doing things. Once we start trying to change his patterns he may feel out of control and he may tantrum."

Susannah could see they all became frightened at the thought of this child tantruming, frightened for him not themselves. "The major problem of doing this kind of program with an alter is the time we will have to work with him, will be greatly insufficient. Usually, for the first couple of years, children with autism are worked with one-to-one from a minimum of thirty to forty hours a week. At first learning involves the use of discrete trials to break the learning down into small steps. It is referred to as Discrete Trial Training. A high priority is to make learning fun for the child. Most likely we will not have anywhere near the time that is usually required. We will have to try our best to work with him as intensely as possible when he is out. The program usually involves the whole family. The family is trained to use the same techniques we use and to work with the child using incidental or naturalistic teaching. We want to maximize every learning opportunity. That means to take any natural opportunity in the child's day to use anything that interests or engages his attention and use it as an opportunity to reinforce appropriate behavior and skills that were learned. For instance, if you catch him using eye contact or playing with a toy appropriately or pointing to something he wants, you reinforce that with praise and a reinforcer. Eye contact may be very difficult for this child. If you catch him making good eye contact with you that would require a huge reinforcer. You would make a very big deal of it and give him more of a reinforcer or a better reinforcer than you usually would. If he were to speak, especially a whole sentence and make eye contact, you would practically throw a party," Susannah explained only half kidding.

"Do we call it to his attention when he doesn't do a skill correctly?" Kevin asked. "It depends, if it is a new skill then no, you would always model and prompt a new skill the first time, possibly the first few times. If he doesn't get it after two tries you would prompt him. When a skill is first being learned it is usually necessary to use a full physical prompt. Then, you use the least invasive prompts first, like a gesture or a tap on the elbow. If that doesn't help you would prompt him hand-over-hand. Once he knows a skill, if he seems to be having trouble with it or he doesn't comply or forgets how to do the skill you can use what is called the no-no-prompt. Instead of using the animated tone you use for praise, you would use a dull monotone and simply say something like, 'nope,' or 'no' or 'nope, try again.' You say it quickly and non-judgmentally and always in a dull tone. The animated tone is reinforcing to the child. So in contrast, this tone is dull and lackluster. Again, remember, you allow him only two unsuccessful attempts. We prompt on the third because we want to make sure he succeeds and gets his reinforcer."

Susannah gave them a few moments to digest her instructions. "So do we actually do the task for him if he can't seem to do it himself?" Tea wanted to make sure she understood. "You don't do the task for him once you've modeled it. If necessary you take his hands and manipulate them to do the task. That is a hand-over-hand prompt. If you are showing him how to, say, place like shapes like a bowl in bowl together and he doesn't get it or doesn't cooperate, you take his hand and physically have him place the bowl in the bowl. You would then praise and reward as if he did it himself, at the beginning. Later on a prompted response would not be reinforced. Also a less invasive prompt would be reinforced more than a fully prompted one. This is part of differential reinforcement. The important thing is to let him know he succeeded. The aim is to make him successful. You have to remember that most likely everything will be new to this child. If he has been in the system and has ever been out before or has somehow observed life, it would be helpful, if not we are starting from scratch. Even if he has been out before, he cannot be expected to know how to pay attention or to sit in the chair. He has to be taught that first. That is called shaping."

"I like the idea of him feeling successful, even if he needs to be helped," Viki stated. Sam remained silent. "What if he starts to hurt himself again. What do we do?" Tea sounded worried when she asked this. "At first, if his behavior is self-injurious then you would want to take his hands down. You hold them down for a few seconds. During this time you would not give him eye contact or speak to him. You do not want to attend to this behavior or reinforce it in any way. Then, you praise him for keeping them down, even if we are the ones holding them down. If he continues you would hold his hands down again and firmly say, 'no hitting' or 'no biting' or whatever self-injurious behavior he was engaging in. We may also try to redirect him to another behavior or one that is incompatible with his self-injurious behavior. Unfortunately, with some children all of this intensifies the behavior. Sometimes, if the child is not in real danger of harm it is best to ignore the behavior."

Sam couldn't believe she just said that. "So you suggest we just allow him to hit and bite himself until what . . . until he knocks himself unconscious, pokes his eyes out or chews his hand off?" Sam asked bitterly. "No, as I said, if he begins to do real damage to himself we intervene, with anything from holding his hands down to a physical restraint if necessary. I really don't think physical restraint will often be necessary in the future. This child has little strength and we should be able to contain him by simply holding his hands down. He may begin to understand 'no hitting' and stop when we say that. We just don't want him to become dependent on our saying hands down or no hitting. Repeating that often can sometimes increase self-injurious behavior or make him dependent on our verbal prompt. Sam, it will take some time before all of this starts sinking in for him and for all of you." Susannah did not want to give Sam or any of them false expectations of the program or make them feel that they should already understand everything she told them about ABA.

Sam looked disbelieving. "You expect to teach a child who is running around like a frightened little animal and has no idea what we are saying to him to sit calmly in a chair and learn lessons! Are you kidding!" "Sam I know it seems hopeless, but it's not. Everything is broken down into the most basic steps. If at first we can get him to approach the chair, that is reinforced, then we may get him to sit for two seconds. That is a success and is reinforced." "What if he resists your attempts to teach him?" Viki asked. She did not want to see this little boy punished, even if that punishment was just withholding a favorite toy.

"Viki, I can tell you right now that in all probability this child will scream and cry during the first few sessions. Having demands placed on him will be new to him. If we can get him to do an appropriate behavior or skill even while still crying, he will be shown that he has succeeded and be rewarded. If he's crying and still goes near that chair he will be allowed to go play. The message being, 'I've asked you or prompted you to do something, you did it and now I'm letting you go.' Very often the child quickly figures out that this isn't so terrible, because we are not addressing the crying at all. That is very important. It is sometimes necessary for the parents to remove themselves from the child during a session if they can't ignore the crying. If the parent interferes it reinforces the crying because it gives the child the message that if I cry mom or dad will come and I won't have to do the work."

Susannah could tell that Viki and Sam were not at all happy to hear that. She understood that the concept of ABA could seem frightening to parents who wanted nothing more than to see their child happy and at peace. They did not like the idea of demands being placed on a child they considered extremely fragile. "I want to make sure you all understand nothing will be asked of this child that he is not capable of. For the most part his sessions will be fun for him, once he gets used to us. At the beginning he would be worked with for about two minutes and then allowed to go play or do what he wants for two minutes." "For how long, about twenty minutes or so?" Tea wondered out loud. "Depending on the child the sessions usually run for about two hours each, and there are three of them for a total of six hours a day, however . . ."

Before Susannah got a chance to say another word they all protested. "Six hours! You are not putting that little boy through this for six hours a day!" Sam was adamant. "Susannah, I can't agree to that. Six hours! He's just a baby," Viki stated, very disturbed by the very idea of it. "Doctor Hanen, I have to agree, that seems very excessive," Tea spoke up. "I'm with them on this one, Susannah. You can't really be serious about putting his little guy through six hours of lessons a day," Kevin agreed with the others.

"Please, let me finish. Because of this child's fragility and because he is an alter who will never need some of the skills that are usually taught, he would be worked with for just two or three hours a day. At the beginning less than that, maybe just and hour to ninety minutes, and that would be broken up into very short periods of instruction and play. There would be as much playtime as instruction time. There would also be rest and eating time. He would also be allowed to be physically active. He would be given time to run or jump or whatever activity he enjoys. Even the demands placed on him would be made to seem like fun," Susannah hoped this would help them to understand.

"I don't understand, why place demands on him at all? Why are you Hell bent on torturing this one. You don't place such demands on the other children," Sam declared. He did not want this done to this child.

"Sam, Viki, I understand your concerns and hopefully I can allay your fears when we go over this program in greater detail. For now, I promise you, he will not be harmed. He will be lost in his own world forever without some kind of therapy. He will not be able to communicate or take pleasure in most things life has to offer. The world will stay frightening and confusing to him. He will not be able to participate in therapy and will cause problems if we are ever to get Todd integrated. He will not be able to align with the system. I know that ABA has a high success rate. That is why I chose it but if you are not comfortable with it, than I will honor your wishes. There are other therapies, however the reports of their success are anecdotal. None are scientifically proven or have the success rate of ABA."

"Mom, Sam, I can't tell you what to do with this alter, but if you want my opinion I don't think it is fair to deny him this chance. It's not fair to him and not to Todd." "Kevin, it's not your kid she's planing on torturing. How the Hell do you know what it feels like to watch someone do that to your child!" Sam could see by the disapproving look in Viki's eyes that he had said the wrong thing.

"I don't really know. I don't know what, if anything, anyone is doing to my son," Kevin sadly admitted and continued. "I do know if I had any say in it and he was autistic I would do whatever it took to help him to have as normal a life as possible. Even if it meant doing things he may not like at the beginning. Sam, everything that has been done to Todd since the day he came into this hospital has been things he hates. It has all been against his will. If Todd could he'd be out of here so fast it would make our heads spin. Would you let him do that? You know if he were out that door he would have no life. He'd either kill himself or starve to death or die from not having needed medical care. You and mom allow things to be done to him that he considers torture because you love him and want to help him. Why would you do any less for this little boy?"

Viki and Sam looked at each other. Kevin's words had gotten to Viki. She knew he was right. Still, she was afraid and unsure. Sam wasn't buying this. He wanted no part of this program. "Tea, what do you think?" Viki asked, desperately. Tea thought for a minute before she answered. "You know I don't want to see Todd or any of them forced to do things that upset them, only look at how this child is now. That's no way to live if there is some way to help him."

Tea stood up and knelt in front of where Sam and Viki sat. "Do you both remember Helen Keller's story, 'The Miracle Worker?'" Sam and Viki nodded. "Helen Keller was also a child lost in her own world and not able to communicate. For different reasons, yes, still, a lost child nonetheless. Her parents also had trouble with the program Annie Sullivan put her on. It seemed like she was torturing the child. What she was doing was being strong enough to do what she had to give this little girl a life. I think that is what Susannah and Kevin are suggesting. I also don't think anything Susannah has said about ABA will harm this little boy in any way. Yes, he may not be too happy having demands placed on him in the beginning. It just sounds to me that there are a lot of fun things within the structure of this program. I want you both to know that if you go ahead with it, I would love to help out and work with this alter. I would take whatever time is necessary and be here."

Viki cupped Tea's cheek in her palm. She started to say something, her voice broke. Tea took Viki's hand. "It's all right. Viki, you don't have to say it. You also don't have to thank me. I love Todd. I love him so much that it hurts. I want to help him. I want to help him with all my heart. It is as much for me as for him that I want to help. I know I gave up any legal say in Todd's treatment way back, and yet, if I had that say now I would want to help this alter in any way possible."

They all stayed quiet for a few minutes, taking Kevin and Tea's words to heart. Kevin broke the silence. "So, if he does what we ask of him, let's say he looks at us. We tell him we like that he looked at us and give him a reward?" Kevin felt the more Sam and his mom new about ABA the less frightening it would seem. "At the beginning it is important to be behavior specific with verbal praise. Later on you might just say, 'I like seeing your eyes.' You also don't want to say the same things all the time and end up sounding like a robot to this child, yet you want him to understand what he is being praised for. You might also say, 'that was great looking at me' or simply 'good looking.' Also, you also need to let him know what is expected of him. If it's playtime, tell him. He needs to know exactly what is expected of him. You keep it very simple. If it were naptime, you would not say 'you really need to take a nap,' or 'you're tired and need to lie down.' You say, 'nap time,' that's it. Don't use complicated sentences. There is much more to it and we would cover that in a more formal training session. The work we do in each session needs to be incorporated into every aspect of most of his waking hours." "Susannah, I meant what I said. I want to work with him. I will do whatever training is necessary," Kevin assured her. "So will I," Tea promised.

Susannah was happy to hear this. "That's great! Thank you both." Susannah did not miss the fact that Sam and Viki did not yet offer to be trained to work with this child. She knew if what she already said disturbed them the next point she was getting to would be the most difficult one for them to cope with, not only for Todd's family, but for the staff as well. She needed to get it out in the open if they were to make an informed decision. "I understand this may not be easy for you, however, in the future, when this alter tantrums, unless it is so bad that he is in danger of doing real physical harm to himself or to someone else, I want him to be ignored." "Ignored!" Sam and Viki both said, loudly, at the same time. "Susannah, you can't be serious," Sam stated. "We can't just let him scream and cry and jump around or worse," Viki exclaimed, horrified by the thought of it. "Doctor Hanen, you mean not to make a big deal out of it, and yet still comfort him, don't you?" Tea asked. She was sure that Sam and Viki had misunderstood.

"No, I mean ignore. I want absolutely no attention paid to him while he is tantruming. He is not to be spoken to or given anything or touched. There is to be no reaction. Please understand, we are ignoring the tantrum, not the child. Any de-escalation will be reinforced. The very second he stops or his crying lowers he would be rewarded with verbal praise, like 'good calming down' or 'I like you being quiet.' You don't say I like that you're not crying anymore. You don't mention the particular disruptive behaviors. With some children it is better not to label the positive behaviors either. It might be best to say something like, 'you're nice to be with.' Only at the beginning would he receive an edible or tangible reinforcer for quieting down after a tantrum. Eventually the reinforcers for that would become less and less powerful, and finally faded and only verbal praise would be used. Even at that, the he would not receive the most powerful reinforcers for de-escalating. The more powerful reinforcers would be saved for times when he completes a task that was asked of him. Once he calms, even a little, if the tantrum turns to just crying, we would immediately reward him. If it's during a session we would have him immediately complete a task so he could be reinforced." Susannah looked around the room. She knew her staff understood. They might not feel completely comfortable with it, however, they understood. Todd's family only saw cruelty in ignoring this child in the throes of a tantrum and then withholding the reinforcer he wanted until he worked for it.

"I realize your first instinct will be to rush to him and comfort him and give him whatever he wants. Yet again, by doing that you will be sending him the message that this is acceptable behavior, an acceptable way to handle stress and frustration and a way to get your attention or to get something he wants or a way to avoid doing a task. If he didn't make the connection that this is a way to get a rise out of all of you, you will be giving it to him if you react to this kind of behavior. Please understand, before it escalates to a full meltdown tantrum we will try to redirect the inappropriate or disruptive behavior. If he is hitting himself we may take his hands and place them on a pot he can hit, or give him some other way to satisfy that need. If he not paying attention and running around we will place him in the chair and put his hands on the task we want him to work on and then reward him. I want you to keep in mind that when we first attempt to alter these behaviors we can expect their rate and intensity to increase. These behaviors are functional for him and we are trying to take them away. If he gets a huge reaction out of you for inappropriate or disruptive behavior that will reinforce it. It will reinforce the functionality of these behaviors. The upside of him becoming upset when we try to change these behaviors is that it shows he is aware of change, he is able to be persistent and he is being interactive with us."

Even Tea was having a problem with this aspect of the therapy. "If he becomes upset we just let him scream and cry endlessly? She asked, unbelievingly. "No," Susannah repeated. "The very second he shows any sign of calming down, even a little, if his crying goes from high to low, you would use DRL which is Differential Reinforcement of Lower Rates of behavior. We want to decrease the incidence of disruptive behaviors by reinforcing desirable behaviors and the absence of these disruptive and inappropriate behaviors. These reductive procedures are designed to not only help eliminate disruptive and inappropriate behaviors, they also help to establish or increase the frequency of appropriate alternative behaviors. Equally important is discovering the function each behavior serves and then giving him an appropriate alternative behavior. If we don't supply him with that he will just replace one maladaptive behavior with another. For instance, he might replace hitting himself in the face with head banging or biting himself.

"Okay, so it is all right to reinforce him once he starts to quiet down, even a little?" Tea wanted to be very sure on this. "Yes, you might say 'good calming down' and immediately have him do a task so he is successful and gets reinforced. If it is not during his session time you might try to engage him in appropriate play. Even if he is still crying while he does it, if he complies you reinforce. If he handles the toy appropriately you can say something like, 'oooh, I like your hands,' or 'you're sitting nicely with me.'"

Tea was becoming more invested in this now. "Will you be teaching us exactly what the right thing to say is?" "There are no exact phrases. As long as you keep it simple, keep your tone cheerful and animated you'll be all right. What we want to make sure to do is to reinforce the positive behaviors instead of attending to the negative behaviors. It is better to prompt a desired behavior than to attend to a negative one. If he doesn't look at the reinforcers it is all right to hold them in is line of vision. If he isn't using eye contact you may want to hold the reinforcer near your eyes, which may cause him to look at you. Once he does, he gets big praise and an edible or tangible reinforcer, or is allowed to engage in social interaction or do a preferred activity. You want to create a situation that will cause the child to succeed, then reinforce that. Our aim is to always make this child succeed." Susannah appreciated how complicated and confusing ABA could be at the beginning.

Kevin spoke up, "Susannah, you mentioned that he might play with toys inappropriately. Do we teach him the appropriate way?" Yes, we model it for him. He will most likely learn best through imitation. Imitation is a very important tool. He has no concept of appropriate in most areas. Please keep in mind that all of this happens over time. There will be no pressure placed on this child to learn beyond his own pace of learning. Our goals, at first, are very basic. We want to teach him to attend, reduce self-stimulatory and aggressive behaviors, build compliance, teach imitation and give functional communication. We work on his receptive language to help facilitate that. That may not be speech, at first. If we can teach him to point or sign, that would be considered communication."

"Can autism be cured with this kind of therapy?" Tea asked. "No, not cured, nevertheless, the undesirable behaviors can be reduced and often eliminated. The child can learn to function. He can learn to engage with us and become a part of our world, even if it's to a limited degree. This doesn't apply to this little boy, but very often the child begins to function so well that they are able to attend regular classes and do quite well in them."

"Susannah, I can agree to some aspects of this treatment, nonetheless, I have very big problems with some of it," Viki stated nervously. "What parts are you having the most problems with?" Susannah asked, already knowing what Viki was going to say. "I don't like the idea of doing things to him that will cause him to become upset to the point of a tantrum and then ignoring it when it happens. I also don't like the thought of any kind of aversives." "Viki, I understand your concerns and I will respect your decision if you don't want aversives used, again, as I explained, he will never be harmed, and it is an important tool in reducing inappropriate behavior.

Sam wanted no part of this treatment plan. "What are you going to have us do next? Hit him on the nose with a rolled up newspaper if he misbehaves?" Viki understood it would be nothing like what Sam had just sarcastically alluded to, however she was still appalled by some of what Susannah had in mind. "I don't think I can agree to using any form of aversives or ignoring him if he tantrums, Susannah. It is just to cruel. Why would you treat this child that way when the other children are treated so lovingly and patiently?" Tea also had a problem with the vision she had of this child being treated like a dog in a lab experiment. "Wouldn't it be better to give him his own way just until he gets used to us? He seems like such a little boy," Tea observed. "I think we ought to do it," Kevin stated firmly. They all turned to him.

"You want this baby being treated like that! You want him to scream and cry and think none of us give a damn about him! You want him to be reward for good behavior and punished for bad like an animal in the circus!" Sam stated furiously. "Honey," Viki looked at Kevin, "I really think there has to be a better way than this." Viki tried to stay calm. She knew Sam was always on the edge these days. "Mom, I'm sure if there was a better way Susannah would be suggesting it. I can't tell you and Sam what to do, I just think you'll be cheating both Todd and this child out of the best chance they have if you don't allow this." Kevin was adamant.

"No, you're damn right you can't tell us what to do. Maybe you'd better look at your own life and your own problems and desires and stay the Hell out of this, Kevin!" "SAM!" Viki shouted. She understood Sam was frightened for this child and for Todd and blamed himself for Todd's condition, however she was not about to allow him to treat Kevin that way. "Sam, I think you're being unfair to Kevin. He just wants what's best for Todd and this little boy," Viki tried to stay calm. She knew Sam couldn't take much more right now.

"Maybe you should ask Kevin why he's so eager to spend so much time here with this child," Sam blurted out. "WHAT THE HELL IS THAT SUPPOSED TO MEAN!" Kevin shouted out angrily. "All right, let's all calm down and not turn this into a shouting match." Susannah knew what Sam meant and did not want them to get into this right now. Sam was sorry the minute those words had left his mouth. He turned to look at Viki. He saw tears and anger in her eyes. Sam hated the way he was feeling. He was filled with rage. Rage at Peter, rage at Barbara, at life, and most of all at himself. He knew that none of this would be happening if he had done more to help Todd when he was growing up. Every time Sam thought of the small bruised face of the eleven year old Todd he had met that first day, every time he remembered those huge eyes looking up at him, already filled with pain, he felt guilt so unrelenting that he wanted to put his fist through a wall. He wanted to be able to take Todd and run with him. He wanted to take Todd to where the pain couldn't find him and give him the kind of comfort Goodone was able to provide. Sam knew how illogical his thinking was, and that frightened him. Yet, that was what he wanted to do most. "ENOUGH!" He thought. Sam had always been the one who wanted Todd to go into therapy. He's always believed the only way for Todd to heal was to face his demons. Now, along with his "famous" instinct, that had not detected how severely abused Todd was, Sam doubted these beliefs. "Maybe Blair is right? Maybe all of this is just making Todd sicker?" Sam thought.

"Sam I don't know what your problem is, but I was just giving my opinion. If you have some kind of problem with me why don't you just spit it out." Kevin knew in his heart that he wanted what was best for Todd and this child. "Sam!" Kevin called out loudly when he realized Sam was not even listening. He was lost in his own thoughts. "Sam, Kevin is talking to you." Viki spoke gently. She knew that Sam was losing it. Sam looked at her. He realized he had to get himself together. He took a deep breath. "I'm sorry." Sam then turned to Kevin. "Kevin, look, just forget what I said. You're entitled to your opinion. I just don't think we should rush into anything. This child has been here for all of a couple of hours. Why not just let him be for a while before we rush him into this program."

Viki looked at Tea, who had been quiet through Sam and Kevin's outburst. Tea knew this wasn't like Sam. She was worried about him. She also wondered what he meant about Kevin. She remembered conversations she and Kevin had and wondered if any of that was what Sam was alluding them. Tea hated seeing what was happening to everyone. "Doctor Hanen," Tea spoke up. "Does this program have to be started immediately, as soon as this child wakes up, if he's still the one who is out?" "No, of course not. As I said, the first step is evaluation. The first few sessions would be pretty much allowing him to act as he pleases with just some intervention. All I would like to do now is have your permission to do the functional analysis and the reinforcer assessment and start him in the right direction if you should decide to go ahead with the ABA program. That would pretty much just require observation."

Viki looked at Kevin and then Tea. They both shrugged, and nodded yes. Viki turned to Sam. They looked deeply into each other's eyes for a second. Both of them seeing the pain and fear each other felt. Sam took Viki's hand and also nodded yes.

"All right, Susannah, do the functional analysis and reinforcer assessment," Viki agreed, "but I'm still not sure if I want this child to go through the whole program," she added. "That's fine. There is no rush. Also, I don't want any of you to lose sight as to why this child came out. Todd made some incredible progress today. He was finally able to remember and disclose some of the sexual abuse and he was able to explore his feelings about his mother and remember what his father did to her that night. Also very important was that he made the connection from what he witnessed as a child to his actions as an adult." "Do you mean because he realized that his throwing me out in the snow was what his father did to his mother?" Tea asked. "Yes, he not only saw the similarity in his action but allowed some of the memories he had about feeling forced to surface," Susannah replied. Tea looked ashamed. "I never meant to hurt him. I just wanted that closeness for us." "Tea, you did nothing wrong that night. You had no way of knowing what had happened to Todd," Viki stated.

Susannah looked at all of them. "I understand you each have some guilt issues where Todd is concerned. I can't tell you not to feel what you feel. What I can tell you is that guilt will in no way help Todd or yourselves. You can't change the past. You can hopefully change the future. I also think it's time you all started addressing your own needs more. You need to take some time away from here for yourselves. Sam, Viki, I don't think either of you have been away from Todd for more than an hour since his first seizure." Susannah turned to Tea and Kevin,"And you've both practically been living here as well. I think it would be a very good idea if you all went about your business for a few hours. This alter should not be awake for at least three or four hours." "I guess we can go to the lounge for a while and . . ." "Viki, that's not exactly what I had in mind," Susannah interrupted. "Why don't you go to the Banner or just go home for a while. Sam, Tea, Kevin, why don't you each just go live your life for the next few hours. Allow yourselves to recharge and then come back when this child should be waking up."

They all exchanged looks. "Mom, I do think it would be a good idea if you checked out the new presses. They were not running as smoothly as we had hoped," Kevin suggested. Tea walked over to Sam. "I could use some input on some of Todd's holdings and on one case I'm working on. Maybe we can stop by the diner and say hello to Carlotta afterward. I'll bet she'll have some cookies we can bring back for our newest little one." Both Viki and Sam realized that Kevin and Tea were making "busy work" for them, however, both agreed to leave for a while. Sam really did want to leave the hospital. He constantly felt ready to explode and hated feeling that way. He hoped this would help.

"You'll call us immediately if there are any changes or problems?" Viki asked, wanting to be assured once again. "Yes, of course, I promise. Please try not to worry. What happened with Todd today is a good thing in many ways. Even this alter coming out may be a positive. There is just one more thing I want to discuss before you all go. It is usually not a good idea to give a name to an alter who has none. It can be counterproductive to encourage an alter to have a decreased sense of connectedness and an increased sense of autonomy. However, in this case we don't know if this alter has a name because he can't tell us. As you know, I tried to contact the adult caretakers to at least give us some information about this child if they didn't want to come out themselves and there was no response from any of them. I believe this alter was sent out to give the system a rest and a chance to stabilize. If we can't get any information on this little boy, I think before we start any work with him we are going to have to give him a name. He needs to be addressed by something. If we only use terms of endearment with him he will become confused. So, perhaps while you're all away you can think of a name for this child."

Susannah looked at her staff. She appreciated the fact that they had given Todd's family a chance to do most of the talking and bring some of their concerns to the front. Addressing them, she asked. "Does anyone have any questions or comments?" "Yeah, I think I'd better bring a snack to Steve. You know how long the ER can take for non-emergency's," Dave remarked smiling. "I think that would be a great idea, and then take a long break for yourself. I think this would be a good time for all of us to take a break," Susannah declared and stood up. She faced Todd's family. "I have all your cell numbers, so please don't worry. Why don't I see you all back here in about three or four hours. I think he should be waking up by then." Susannah headed for her office. She planned on calling some colleagues she knew who worked primarily with children with autism. Susannah wanted to make sure she was up on the latest changes and treatments. She also wanted to call Bill and find out if he'd like to have dinner with her. As much as it made her anxious to admit it, she needed Bill's calming influence in her life.

Kevin and Viki stayed at the paper for a couple of hours. Neither of their mind's was really on business. Viki was surprised when she heard one of the editors talking to Clint. She didn't realize that he had been calling every now and then to find out how things were and to offer any long distance assistance he could. Viki asked to speak to him. At first they both felt a little awkward, but soon fell back into their old patterns. There was no love lost in Clint's feelings for Todd. Still, he understood how much Viki loved her brother. He did have some sympathy for Todd, knowing what child abuse can do to a person and Bo had told him that Todd had really gotten a raw deal in life. "Is Jessie there?" Viki asked. "No, our little Jessie has herself a new beau. He lives on the next ranch and he's studying marketing at Jessie's college." Viki felt both sadness and happiness. She was happy that Jessie was getting on with her life and sad because she had lost touch with her daughter's life. "I can tell from the tone in your voice that you approve of this boy." Viki smiled to herself knowing that Clint was not shy about voicing his disapproval where Jessica's boyfriends were concerned.

"He's a good kid, and he treats Jessie like a queen. Not that even that is good enough for our girl," Clint chuckled. Viki laughed. "I guess there's no chance that Jessie will be wanting to come home for a while during spring break?" "Viki, I'm sorry. I know you miss Jessie, but she's really happy here. She's doing great in school and she loves riding and walking in the desert. She also loves the new BMW I bought her." "Are you spoiling our little girl rotten?" Viki asked. Clint heard the humor in her voice. "You bet I am, every chance I get," Clint answered in the same vein. Then in a serious tone, Clint said, "Jessie does think about you and her Uncle Todd you know." "I know. She e-mails me and lets me know she cares when we talk on the phone. She's offered to visit, but I don't want her in the middle of all this and I haven't been away from our little girl so long that I couldn't tell from her voice that she is happy with you in Arizona." "Did you know that Pa and Renee came out for a few days a couple of weeks ago?" Clint asked. "No, I haven't been in touch with Asa since Todd's been sick. I've seen Renee a few times when Sam and I had dinner at the hotel, but Asa wasn't around. It's really just as well given his feelings about Todd." Clint understood. He knew that like Nora, discovering that Todd was indeed very ill had not changed Asa's feeling about Todd.

"So you and Rappaport are pretty serious?" Clint asked, trying to keep his voice casual. Viki knew Clint well enough to hear that he hoped the answer was no. She also still cared enough about him to not want to hurt him. "Sam is a very important part of my life, but right now all we can think about is Todd. He's very ill Clint. I don't know if anyone told you. He's developed epilepsy. He had status epilepticus seizures which are the most serious and can be fatal." "Yes I do know. Kevin filled me in. Viki I'm sorry. I really am. Todd may not be my favorite person in the world, but I don't wish any of this on that boy." Viki could hear that Clint was being genuine. "Thank you. I know that. Will you do something for me?" Viki asked. "When have I ever been able to say no to you any more than to Jessie," Clint smiled to himself as he said that. He knew, to this day, there was nothing he wouldn't do for Viki. That hadn't changed. "Will you give our little girl a big hug and kiss from her mom and tell her how much I love her?" "You got it, as soon as she comes through the door." "Clint," Viki spoke softly. "It was nice talking to you again. Take care of yourself." "It was grea . . . er, nice talking to you again too. Promise you'll let me know if there is anything I can do to help you." Viki was touched. No matter what transpired between them or how much time went by she knew Clint would always be there for her and his family. "I will," Viki promised. She and Clint said goodbye and hung up.

Tea and Sam sat in one of the back booths at the diner. Sam had been trying to keep his mind off of Todd's problems and concentrate on Todd's business. Sam was very impressed with Tea's business savvy. She was making money for Todd. She was also making sure that all the charities Todd cared about were being taken care of. There really was nothing more he could add to what Tea had done. He began to feel that everyone could take better care of Todd than he could, however he also felt relief in the knowledge that Todd's financial affairs were not on his shoulders. Sam noticed that he was having trouble concentrating these days.

Seeing that Tea and Sam only had coffee and had barely touched the pie they had ordered, Carlotta came to their table and asked, "Is everything all right. Is Todd worse?" "No, not in the way you mean. Actually he was able to remember something very painful today. Doctor Hanen considers it progress, but another alter came out. This one may only be three years old and he's probably autistic," Tea filled Carlotta in. "Autistic!" "Carlotta shook her head. "Do you remember Mrs. Torez?" Carlotta asked. Tea nodded. "She has a grandchild with autism, a little boy. He's five now and doing very well. He can speak a little, and he may be able to start going to a regular first grade next year. He's been on some kind of special program since he was two and a half." "Applied Behavior Analysis?" Tea asked. "Yes! I do think that is the name of it. Mrs. Torez brings him in here sometime and I once asked her about the way she talks to him and she mentioned that name. That was the program he was on."

Tea and Sam exchanged looks. "You say this program has really helped this little boy?" Sam asked. "Very much. When he was very young no one could even take him out of the house. He would scream and cry and try to run all over the place. He would hurt himself and other children. Other times he would want to sit in a corner for hours and do nothing but wiggle his fingers and rock himself. He acted like no one existed. It broke his parents and grandmother's heart." "And now?" Sam inquired, hopefully. "Oh, now he is almost like every other little boy. He hugs and kisses his family. He smiles. He is able to ask for some things. He plays with toys instead of just holding them. He can write his name. You'd never believe it's the same little boy. Maybe sometime you can meet him. His grandmother always brings him around when she's baby-sitting him."

Tea felt so encouraged by what Carlotta had just told her. "I would love that! Sam?" Sam was not as happy over this as Tea. He reasoned that the situation was totally different. This little boy was not part of someone who was a damaged child who had been tortured all of his life. He was not an alter who only came out now and then. He doubted that the program would be successful for this child, even if it was for others. "I'm not sure. This child doesn't have Todd's problems." Tea did not want Sam's pessimism to discourage her. She also felt so sad that he could not allow himself to hope anymore.

"Sam, that's all right. I will let Tea know if little Alano is going to be here with his grandmother. I know she won't mind showing him off to you. She is very proud of him," Carlotta suggested. Then as Tea had hoped, Carlotta offered her some treats for this new alter and some boxes of freshly baked pastries for the adults and the hospital staff. Tea gratefully accepted.

"Do you think there is any chance you can get away for dinner tonight?" Bill asked Susannah after she filled him in on the latest news about Todd. Bill was beginning to learn enough about Todd's therapy to realize that what happened today was more good than bad. He knew that while she was worried, Susannah also had reason to be happy. "I'm glad you said late dinner. There is a chance for that. I want to stick around and wait for our latest little fellow to wake up and spend some time with him. If it is he who wakes up," Susannah informed Bill. "Just give me an hour's notice and I will whip you up a feast that will leave you weak in the knees and singing my praises," Bill promised. "You don't have to cook for me for that to happen." Susannah was surprised and embarrassed by her own words. They were out of her mouth before she had a chance to think about them. "As a smile covered Bill's face, he said, "Well, Doctor Hanen, I believe I can see you blushing through the phone." Susannah's felt her face flush even more than it already had. "Don't go getting full of yourself, Commissioner. I've had a long day and my defenses are down," Susannah kidded. "Remind me to thank Todd for that when he is able to understand." Susannah could hear both humor and sincerity in Bill's voice. Susannah promised to call Bill and let him know one way or the other if she could make dinner. She smiled to herself as she hung up the phone.

Viki and Kevin were the first to arrive back at the hospital. Susannah was still in her office. They immediately headed for Todd's room. Viki went in by herself, not sure who she would find. Don and Angelo were near Todd's bedside, playing cards. Connie's shift had started and she was writing some notes when Viki came in. "How's he been?" Viki asked nervously. "He's doing great. I just did vitals on him and everything is fine. He had a feeding about half an hour ago." "Do you know what happened during Todd's session earlier and that this is another alter. One who is probably autistic?" Viki asked Connie. "Yes, I saw it in the progress notes and Frank filled me in before his shift ended. I hope you are feeling encouraged by today's session. Todd did very well. He took a huge step today. Please don't be frightened by this alter coming out. It is not unusual for there to be an autistic alter." "I know. Susannah explained that to us. Still, this child is so fragile and so very young. He's really just a baby. Probably younger than Timmy." "I know," Connie gently acknowledged, "but you have to remember that for whatever reason, he serves an important purpose in Todd's system. Right now Todd's system needs him to be out. He is helping. He may be like the steam that escapes to keep Todd's inner system from exploding."

Connie said nothing about Susannah's proposed treatment. She saw in the notes that Todd's family was, for the most part, not yet ready to decide if this was the way to go. She didn't want to influence Viki one way or the other.

Viki walked to the bedside. The little alter was still sleeping soundly. The bed had been raised and he had been turned on his back for his feeding and medication. Shortly afterward he turned back on his side. Now, he was once again curled up and sucking his thumb. Viki was fairly sure it was still the same child because his sleep seemed more peaceful than any of the other's, except for the Baby. Viki kissed his cheek. "I'll be right outside," she whispered to Angelo and Dave. Viki noticed that even though they were keeping themselves occupied, they were always at the ready. Every few seconds one or the other would look up from the hand they were holding and check on Todd. Viki was very appreciative of the care that they were giving her brother.

"He's sound asleep. I think it's still the autistic alter who's out. Oh Kevin, he looks so sweet and innocent. I hope Susannah is right about this one never having been abused." "Me too mom. Have you thought about a name for him?" Viki smiled. "Yes, but I would like to wait until Sam and Tea get here and tell you all at once. I especially want Sam's reaction. I don't want him to feel left out of any decision making where Todd is concerned."

Kevin saw this as a good opportunity to bring up the way Sam has been acting. "Mom, I'm a little worried about Sam. He's really not acting like himself. Is he okay?" "Oh sweetheart, I don't know. You are right. He has not been himself lately. It seems that everything is setting him off. I hope you don't take what he said to heart. Sam has been lashing out a lot." "It's all right. I did get upset, but then I realized that Sam is on the edge with everyone," Kevin admitted. "He feels so guilty, Kevin. He blames himself for not rescuing Todd when he was a child." Guilt was an emotion Kevin could certainly relate to. Yet Kevin did wonder how Sam, who worked with kids and had his own, could have missed what had to be so many signs of abuse.

"I guess it's like Susannah said, we can't change Todd's past for him. Let's hope she's right about being able to change his future." Not wanting to discuss feelings of guilt anymore, Kevin changed the subject. "I'll bet dad was really happy to have a chance to talk to you. He's always asking how you're doing and he even asks about Todd. He knows how much you love your brother, mom." Viki smiled as she thought about her conversation with Clint. "I know your dad still cares about his family. Unlike Asa, your dad and Uncle Bo are able to see beyond Todd's actions. I was a little surprised to hear that Jessie had a new boyfriend. I'm happy that she is not upset about Christian going to art school in New York without her. Did you know about Jessie's new love interest?" Viki did not sound angry or like she felt anything was being kept from her. She sounded pleased that her child was happy.

"I didn't know it was serious. I still don't. I think she would have said something. Mom, you've had a lot on your mind. I'm sorry. I wasn't keeping anything from you." "Sweetheart, that okay. I know that I've been preoccupied with Todd. I'm happy that your sister was able to talk to you. I just hope Jessie realizes how much I love her." "She does mom. She loves Todd. She knows how much you love him and understands why he is your special child. I do know she misses you though," Kevin added.

Before they had a chance to say anymore they saw Tea and Sam waiting to be let in with their arms loaded with pastry boxes. "From Carlotta," Tea announced, as she placed the boxes on the counter of the nurses station. "Oh my, Carlotta didn't have to do that. I'll call her later and thank her," Viki promised. "Has he woken up?" Sam asked. "No, he's seems to be a sound sleeper. Even in a drugged sleep most to the others don't sleep peacefully. This one seems to." Viki informed them.

Sam headed for the lounge near Todd's room and sat down wearily. Sam was feeling so tired these days. Tea told Viki and Kevin what Carlotta told them about the little boy with autism whom she knew. Kevin seemed very encouraged. Like Sam, Viki had reservations. She also reasoned that this was not a typical child with autism. Viki was about to bring up naming this little boy when they saw Susannah walk towards them. Viki held off until Susannah had a chance to sit down. "I'll be right with you," Susannah called out and headed for Todd's chart. She then went in to personally check on him.

Once satisfied that he was doing well Susannah joined the rest of them. "I see that he's a good sleeper. That isn't always the case with children with autism. Of course he's been heavily sedated. We have to see how he does on his own or with just a standard dose of sleep meds." "Then you do think that is still the same alter?" Viki asked. "Yes, as I said earlier, I have a feeling he's going to be with us for a while. Todd's system needs to stabilize. In case I can't reach Todd or any other alter and find out this child's name, if he has one, have you given any thought to a name?" Susannah inquired of them.

Viki looked at Sam. "Do you have a name you would like to give this child?" Sam shook his head. His thoughts had been too jumbled to think about it. Viki turned to Tea. "Tea, as Todd's wife if you like you can give him a name." Tea felt it should be Viki's decision. "No, whatever you think is all right with me." "Kevin, any suggestions?" Viki didn't want him to feel left out. "No mom, same here. Whatever you decide will be fine with me."

Viki had been giving it a lot of thought and she knew what she wanted this child called if he had no name of his own. She hoped that, like Susannah as surmised, this child was a clean slate. She hoped that, like the Baby, he was Todd before he had been handed over to the Mannings.

"Since we believe there is a possibility that this child has never known abuse I would like to start him out with the name Todd started with before all his suffering began. I would like to name him Adam." Tears welled up in Tea's eyes and spilled down her cheek. Kevin was too choked up to speak. Sam swallowed hard his eyes also welled up, but the tears did not spill. He took Viki's hand. "I think Adam is the perfect name. Adam is the child Todd could have been if the Mannings had not gotten a hold of him."

Viki held on to Sam's hand tightly. She was so relieved that he was happy with the name. "You realize it is in no way a tribute to my father. I know he gave Todd that name. That is not why I chose it. I chose it because it belonged to whom my brother would have been if my father had not forced Irene to give him up. It is a tribute to Todd, not Father." Viki wanted to make sure that was very clear.

"I know," Sam replied, his voice barely above a whisper. How he wished he could give Todd more than the name he was born with. He wished he could give Todd back the life he was born with, the life that was nearly destroyed.

"Mom, Adam is a great name. I remember seeing pictures of Uncle Adam in some of those very old photo albums. I think Todd has his eyes." "Yes, sweetheart, you're right!" Viki nodded. Viki was sorry she had not thought of looking for pictures of her uncle. Now that she thought back she realized that even in the old black and white pictures you could see that Todd did look something like Uncle Adam.

Viki shook her head and a tear slid down her cheek. "You're wondering how Grandpa Victor could have given away a son that looked like a brother he loved so much, how he was able to look into those eyes and hand him over to a monster?" Kevin looked into his mother's eyes as he stated that. Kevin also wondered how different was he than his grandfather. For all he knew someone could be abusing his son at this very moment. He kept those thoughts to himself.

"Yes, that is exactly what I am wondering. It's useless, Kevin. We'll never know why father did what he did." As Viki said that feelings of guilt she couldn't understand washed over her. She knew it wasn't because she was the one who got to be raised by the great Victor Lord. No, she would not have wished that on Todd. All she knew was that every time she gave her father forcing Irene to give Todd up any serious thought unrelenting feelings of guilt bombarded her.

"I think Adam is a fine name for that little boy," Tea spoke up. "Doctor Hanen, what do you think?" Tea asked. Susannah smiled at Viki. "Yes, I think Adam is an excellent name for him." "If we're sure that he is a he," Viki stated, smiling.

Don came out into the lounge area. He asked them to step into Todd's room for a minute. The little alter had turned over on his stomach, still sleeping peacefully and soundly and still sucking his thumb. "Do you think the Baby came out?" Viki immediately asked.

Susannah approached the bed. She closely observed this child for a few moments. "No, I think it is the alter we just met and I think this is a pretty good indication that he was not abused, at least not sodomized or forced to lay on his stomach to be beaten and burned."

"Maybe this one hasn't known torture?" Tea remarked, hopefully. "Yes, maybe he is really Adam. The child my brother was meant to be," Viki's voice was sad and wistful.

Tea asked everyone to come out and have some of the treats Carlotta had sent over. She knew Don and Angelo had to stay at Todd's bedside so she brought them some and some coffee.

Viki noticed that Sam just picked at his. She was very worried about him. She was about to call him to aside to talk to him when Angelo stuck his head out the door. "I think he's starting to wake up." They headed for Todd's room, to find out if it was Adam or someone else waking up.

TO BE CONTINUED