What woman doesn’t like being told that she’s wearing great shoes? Marie is no exception. In more than 40 years, however, it’s a compliment that rarely came her way—until she met Jaime Rische.

Marie is an adult whose life has been defined by severe developmental disabilities. Rische is a 2008 graduate of The Chicago School’s Applied Behavior Analysis (ABA) program who, as a student therapist, brought about significant and unexpected change in her client.

As an ABA intern, Jaime Rische successfully brought down communication barricades that had long stood between Marie and the rest of the world.

Admiring Marie’s shoes, her sparkly sunglasses, and her purplypink room décor contributed to Rische’s success. So did the unwavering interest, patience, and understanding that she showed her client, whom she treated as much like a friend as a patient. But it was her training as a behavior analyst, and her ability to put the lessons learned in class to practical and effective use that was the key to what Marie’s residential care staff term a “breakthrough.”

“We’re talking about people with significant limitations and, for Marie, Jaime was a difference maker,” Anthony DiVittorio, executive director of Blue Cap, the Blue Island agency that has cared for Marie for decades, says. “But the success goes beyond Marie. Our staff was so impressed with what Jaime was able to accomplish with the techniques she used that they have asked to be trained themselves so that they can use the same methods with other people they care for.”

The technique DiVittorio cites is the Picture Exchange Communication System (PECS), an intervention designed by a behavior analyst to help nonverbal clients communicate through the use of picture cards. Using PECS, Rische was able to teach Marie to make her needs and feelings known—a radical change from the behavior that had long been characteristic for her.

“Before I started working with her, Marie was without functional communication and intensely aggressive toward her surroundings and toward herself,” Rische says. “Human contact was a big problem; touching her could result in furniture being thrown or she would destroy the part of her skin that was touched.” She adds that when she initially reviewed Marie’s records, she found that frequent incidents of self injury had a been a pattern as far back as the ‘80s.

“It was the only way she knew to get attention,” Rische says.

Mental health experts say that mental retardation (MR) and selfinjury often go hand in hand, a correlation that is also noted in The Diagnostic and Statistical Manual of Mental Disorders. Evidence suggests that the behavior is particularly prevalent among nonverbal patients and is often a result of not having learned to identify or express difficult feelings in a healthy way.

For individuals like Marie— who spent her childhood in an institution—the lack of early intervention or experiences with positive interactions contributed to the solitary path her life would take. After completing a functional behavioral analysis, Rische was able to determine that the selfinjurious behaviors Marie used to get attention were, essentially, learned behaviors—behaviors that might have developed differently in another environment.

Today, infants identified with cognitive impairments receive immediate and intensive services designed to develop the individual’s potential to its fullest and to teach, among other things, the social skills that can help the person function as normally as possible. It is that level of early intervention that Marie missed out on, Rische says. But the sense of what might have been didn’t stop her from designing the program that would, as DiVittorio says, become a “difference maker in Marie’s life.”

That difference began with a relationship.

“I realized what Marie needed was a girlfriend; it was the kind of attention she had never had,” Rische says. She began by showing Marie that it could be fun to have a friend to sit with, to share a cup of coffee with, to be silly with. She complimented her clothes, brought her fun hats to wear, and danced to Beach Boys music with her. In a few weeks, Marie began seeking Rische out. Then, once PECS was introduced, Marie’s progress exploded. Armed with a book of picture cards held in place by Velcro, Marie learned to ask for coffee, to specify cream or sugar, and—for the first time in her life—to make verbal sounds such as “c-c-c” for “coffee.”

Our staff was so impressed with what Jaime was able to accomplish with the techniques she used that they have asked to be trained themselves so that they can use the same methods with other people they care for.

Developed a decade ago as a way of helping children with autism learn to communicate, PECS is widely used with children and adults with an array of communicative, cognitive, and physical disabilities. It has proven particularly valuable— a claim backed up by extensive research—in encouraging nonverbal patients to initiate conversation and to express their desires and feelings. Marie’s book, which Rische compiled based on PECS protocols, includes pictures that represent many of the things that are part of her everyday life: banana, Reese’s Pieces candy, chair, shoes, car, hug. It has been instrumental in bridging the communication gap between her and the staff who care for her.

The story of Rische’s success with Marie has not been met with surprise by faculty at The Chicago School. Breakthroughs of this type are what the field of applied behavior analysis is all about. Sometimes considered painstakingly laborious by those who are looking for quick fixes for complex behavior issues, the data—which meticulously tracks responses to minute changes in environmental stimuli—offers indisputable evidence of what works and what doesn’t work.

Marie is what Rische refers to as “a shining example” of the effectiveness that behavior analysis can have on those with other developmental disabilities. Born with severe cognitive impairments, she was institutionalized in early infancy, and remained in that setting until the deinstitutionalization movement of the late 1970s. At her current home, Blue Cap, she lives in a Community-Integrated Living Arrangement (CILA) group home, and attends an adult day services program that includes classes in daily living skills. She also works part time on an assembly line, sorting flashlight components and building supplies.

Rische and Marie reunited during a visit.

It was in the Blue Cap adult classroom, during her Chicago School internship, that Rische first encountered Marie. After observing her low frustration threshold, aggressive outbursts, and repeated self-injurious behavior, Rische proposed using her recently acquired ABA skills to work with Marie in a oneon- one setting.

DiVittorio, who had just assumed the executive directorship at the agency, was quick to take her up on it. A graduate of the University of Nevada-Reno ABA program, he understood what Rische wanted to do and believed she could bring about a positive change in Marie’s behavior.

“Before I came, many of the services provided here were basically day care,” he said. “Our board had expressed an interest in going in a more clinical direction. Jaime was one of those pockets of quality that we already had available to us—she had done great work in our adult classroom—so this was an opportunity to let her really make a difference.”

During the time Marie and Rische spent together—almost every day for close to a year—the accomplishments mounted. Marie abandoned her horror of being touched, came to love gaudy costume jewelry used to reinforce not harming herself, and learned to use her PECS book to order a hamburger and french fries at McDonald’s. Most importantly, she delighted in the friend she had in Rische—a relationship that, sadly, couldn’t last forever.

Rische graduated in May and, armed with a new master’s degree, moved to California. Blue Cap staff recount the parting, which they say tugged at a fair share of heartstrings. But the breakthrough had been made and, although DiVittorio acknowledges ups and downs in the wake of Rische’s departure, Marie now has a way to communicate. She and her PECS book are never far apart.

“The difference has been remarkable,” DiVittorio observes. “Behavior analysts are known for the data they collect but in this case, if I want data, all I need to do is look at Marie’s arms.”

The lingering scars that he references were still apparent when Rische returned from California recently for a visit with her old friend. But they are no longer the angry wounds that speak of freshly inflicted rage and frustration. Faded and healed, they are reminders that change can happen.