(Excerpt from Book to be Published)
Let me tell you about the day we first used the MSE with our very first consumer. Our room was completed on a Thursday in June 1992. The next morning we brought in a consumer twenty-two years old with profound intellectual disabilities and a diagnosis of Autism Spectrum. He had no communication skills, had no social skills and made no eye contact with anyone. He had stereotypic autistic behaviors of flapping his hands and staring at them. He could also get aggressive and hit people. He was brought into the room and we slowly started to turn down the regular lights as we turned on equipment. Since I did not want to overwhelm anyone, not all equipment was turned on at once and not everything in the room was utilized. I considered this an assessment period to see what equipment someone would like, or hopefully, interact with. So, one-piece equipment was turned on at a time and I would wait for a response. (See the Equipment Protocol for sequence of equipment operation) His reaction was to stand in the middle of the room and appear not to notice or look at anything or anyone. We spent thirty minutes in the room and then I proceeded to take him back to his activity room. I was very disappointed there was no reaction.
I went home. Over the weekend I wondered about my expectations. I did not see anything happen: he did not relax or touch or look at anything. I concluded I must have done something wrong.
Monday morning I was sitting in my office and I heard a big commotion down the hall. There were noises and banging and a loudspeaker announcement for “code red”. This meant the Behavior Staff Team needed to respond ASAP to a consumer out of control. I got up to look down the hall: it was the consumer who had been in the MSE on Friday and he was kicking down the door. I ran with the keys in my hand shouting at the staff, “Don’t do anything, he is telling us something.” I got there, opened the door and he ran in. I proceeded to start to turn on the room. He went to the middle of the room and began to pace in figure eights, making larger and larger passes at a piece of equipment lying on the floor. It was a two inch diameter tube eight feet long with lights flickering on and off in a rhythmical pattern. He returned to the middle of the room and his behavior returned to what it looked like on Friday.
After thirty minutes he was escorted back to his room, there were no further incidents during the day. I began to think about what I had just observed. I realized first, he knew where the MSE was located and negotiated getting there on his own. (Our room was at a quiet end of the building opposite from the areas he was accustomed to being in). Second, he knew where he wanted to be; a sign of deliberate action and independence. Third, he had remembered (possible learning had taken place) since Friday. Fourth, his noises and kicking represented a form of communication; “I want this”. Fifth, while in the room he seemed to demonstrate a preference for a piece of equipment (getting closer and closer to the light tube), but I was not a hundred percent sure. I surmised that by his returning to the MSE, he must have found some pleasure or at least he had not had a negative reaction to the experience on Friday. I began to plan what I was going to try the next day.
Tuesday, I prepared the room by moving the light tube to the other side of the room. Everything else was left as it was. He came in and again stood in the center of the room, I noticed he was facing the same direction as the previous days. The light tube was now behind him on the floor. Again he began to slowly pace figure eights on the floor turning towards the light tube getting within inches of this piece of equipment. He, however, never looked directly at the light tube or attempted to touch it. The session ended after thirty minutes.
Wednesday, again I prepared the room differently. This time I moved the light tube back to its original position and hooked a Powerlink and large on/off switch onto the tube. (A Powerlink is a device that allows you to interface a piece of equipment with a switch, and customize the duration of how long a piece of equipment will stay operating and how the switch will function. It is used to shape or modify behavior. [More on this specific equipment later.]) I set the Powerlink to keep the light tube operating for five minutes. After that someone, me or I had hoped him, would have to activate the switch to make the light tube come back on. I thought if he liked the tube he would want it on. I brought him in and started the room as usual. He exhibited the same response. After five minutes the light tube turned off. I was nowhere near it and he was nowhere near it. I waited to see what would happen. He continued to make the figure eights, no apparent change. I had planned to go over, pick up the switch and demonstrate/model the behavior that touching the switch would make the light tube turn on. Instead to my surprise, he came over to me, looked me in the eye, took my hand and led me over to the light tube. I turned it on immediately. I left it on for the rest of the session. I again thought about the process that just took place, and realized he had used eye contact, took my hand and invited me into his world. There had been spontaneous social and direct contact with me. At this point, I felt that the Multi-Sensory Environment, which could be adapted and controlled, was going to be the key to changing challenging behavior. I couldn’t wait until the next day to try it again.
I prepared the room again. This time I set the Powerlink to operate the light tube to stay on for three minutes when the switch was activated and then turn off again. I brought him in and turned the room on in the usual sequence. But this time when it was time to turn on the light tube, I went over and activated the switch. He went over to the light tube and stood directly by it.
It turned off after the preset three minutes and I waited. He looked at the tube and then at me, once again making eye contact from across the room. I went over and demonstrated activating the switch, and turned on the tube for another duration of three minutes. He stood by the tube. After the three minutes it turned off again. This time, he picked up the switch and held it. I waited to see what he would do: he did not activate the switch, but looked at me again. I went over and took his hand and physically helped him activate the switch, to turn on the light tube. He smiled and looked at me and I smiled back. I thought I had died and gone to heaven! We connected!
I wanted to analyze the MSE and the process to be able to concretely repeat it. I began a list, which included the following:
- The MSE was in the relaxation mode.
- The music and the sequence of turning on equipment was the same each day.
- I identified a piece of sensory equipment he appeared to like.
- I was consistent with my behavior.
- I made no demands of him.
- I gave him personal space and choice.
- I was using behavioral techniques, and principles of conditioning and learning theory to decrease challenging behavior.
I had so many more questions than I had answers. Why did this room seem to work? He had excellent teachers who tried to adapt activities and manipulate his environment for learning. Why had that not worked? I thought about the room and knew it was unique and novel. Was that it? I also did not observe any overt signs of relaxation taking place with him. I realized I needed to know more about the concept and science of relaxation. I began to understand that the MSE would not be for everyone: the equipment / environment could be overwhelming for some people. I understood that when working with people that could not communicate and tell you their likes or dislikes, it would be necessary to proceed cautiously. It could be a powerful tool. It is an environment that when used properly by a trained technician could be utilized for treatment, learning or socialization.
During this initial period I used the room strictly in a manner one would think: for relaxation; a soft, quiet, gentle space. The tone of music, lighting effects and intensity of the room were subtle and slow in nature producing a calming atmosphere. I used the environment to establish a motivating setting to reduce stress and build a trusting relationship. (Later, I would learn that slow was not always calming but, more on that next time.)
My journey began…
Note: This young man continued to make progress in social interaction and self-determination.