Joy Falahee thought she knew how to play with her 2-year-old, Alexa.
There she was holding a plastic microphone, pretending to talk to Alexa. There she was offering a tiny zebra for Alexa to put in a brown plastic boat.
But when she looked back later at video of her and Alexa playing, Joy realized it was all wrong. Alexa barely looked at her. Alexa wanted nothing to do with her.
Alexa has autism. Joy, 32, received her daughter's diagnosis four months ago. Research says that by age 5, children's brains are mostly formed. Alexa's doctor told Joy and her husband, Tom, that they have only a few years to draw Alexa out.
She and Tom, a manager at CVS, have spent $70,000 to get her help. Occupational therapy. Physical therapy. Even horse therapy.
But recently they found another way to help Alexa, one that will require hours on a blanket with Alexa and a tub of toys.
• • •
Joy suspected autism early on. Alexa was 18 months old when she stopped saying ma-ma and da-da. She started screaming whenever they left the house. She refused to be touched.
Joy, a former opera singer and voice coach, sought out specialists and seminars. She realized that the symptoms of autism described Alexa. Children with autism sometimes don't talk or interact. They don't like to be touched or held. They have trouble understanding other people's feelings. They need lots of one-on-one therapy — up to 25 hours a week.
Joy and Tom, 34, enrolled Alexa in free federally funded child development services and took her to every therapy they could find. They moved from Tampa Palms to St. Petersburg to be closer to doctors and therapists at All Children's Hospital.
The traditional therapies were designed to help Alexa learn to talk, build upper-body strength, allow her parents to brush her teeth. They were built on positive reinforcement: If Alexa did what she was told, she got a reward.
But Joy knew one of Alexa's biggest challenges would be her ability to socialize. Her daughter never looked at people. She always played alone.
Was there a way to make her daughter at least give her a hug?
• • •
One day in March, Suzanne Tredo, an early interventionist with a background in autism, arrived at Joy's home in St. Petersburg.
Suzanne went up to Alexa, who was fitting animal-shaped pieces into slots in a wooden board. She picked up a piece and offered it to Alexa.
Alexa got up and walked away.
Later Suzanne tried again. Alexa ignored her. But then, for less than a second, Alexa's little blue eyes caught Suzanne's.
"You need to build a relationship with your daughter," she said. "To do that, you must get her to look you in the eye."
Joy thought about her interactions with Alexa, how fleeting they were. Unless she needed something, Alexa didn't care if Joy was there or not. Not one bit.
In the spring, Suzanne traveled to Ann Arbor, Mich., for a unique training in autism therapy. Traditional therapies for autism are based on getting children to change their behavior with positive reinforcement.
The P.L.A.Y. Project, or Play and Language for Autistic Youngsters, is one of several methods being extensively studied. It is child-directed and encourages parents to bring out their autistic children through play.
Thousands of children around the country have received P.L.A.Y. Project therapy in the past decade, according to Dr. Rick Solomon, the pediatrician and behavioral specialist who founded the project. He is overseeing a study funded by the National Institute of Mental Health.
Joy and Tom were determined to make sure Alexa started kindergarten with everyone else. For $4,500, they hired Suzanne to meet with them 10 times during the course of a year. At each appointment, she'd take video of them playing with their child and analyze it. Many of the videos would go to specialists at the P.L.A.Y. Project, who would review Suzanne's findings and provide more suggestions.
Suzanne told the Falahees they could essentially eliminate most of Alexa's other therapies.
Joy and Tom liked the idea of helping Alexa on their own. The $4,500 seemed cheaper than the $70,000 they'd spent in just half a year.
A week after Suzanne got back from the training, she sat down next to Alexa on the floor on a blanket.
Alexa was putting a doll to bed on a tiny chaise longue. She picked it up, hugged it, put it back to bed. Picked it up, hugged it, put it back to bed. Over and over. Such repeat behaviors are characteristic of autistic children.
Suzanne picked up Alexa's doll and mimicked Alexa. She hugged it and pretended to put it to sleep on the ground. Then she petted it and said, "Night, night." Over and over. Just like Alexa.
Alexa looked at Suzanne. She picked her doll up and handed it to Suzanne to hug.
Suzanne smiled. She couldn't believe she'd reached Alexa so easily.• • •
Joy came to count on Suzanne. Suzanne had gotten her daughter to make eye contact with her. Sometimes Alexa even sat down and watched TV with them now.
But they still had a long way to go.
One day recently, Tom and Joy sat down to review video from a previous meeting. Suzanne explained that she'd noticed Alexa liked to sort her dolls. They seemed to give her peace.
But before Suzanne could continue, Alexa threw back her head and howled. She became inconsolable.
Suzanne pulled out a videocamera and turned it on. Time for the first lesson.
"Wanna play?" Joy asked her daughter in a sing-song voice.
Alexa stomped her feet, opened her mouth, screamed.
"I know you're angry," Joy said. "What do you want to do?"
Joy tried not to be frustrated. This was how Alexa was. One little thing like bringing her milk when she wanted juice would create bedlam for hours.
She tried singing.
"Row, row, row your boat . . ."
"Scream with her," said Suzanne. "Then bring your tone down to help her."
Joy couldn't bring herself to scream. She hugged Alexa tight, rocking her back and forth.
She picked up a plastic doll, Boots. Alexa shook her head. She picked up a Dora doll. Alexa howled.
Tom offered Alexa two stuffed dogs.
"This one or this one?" he asked.
Alexa, her face wet with tears, chose a German shepherd over dachshund.
Tom hauled her over his shoulder, hung her by her feet upside down, while she clutched the stuffed dog. Suddenly she was smiling and giggling.
Suzanne told Joy and Tom that understanding what calmed Alexa would help them understand her. She liked sorting dolls. She liked rough play.
"You need to touch what she's touching and use more sounds in play," Suzanne said. "You want her to reach out to you."
Suddenly Alexa was running into their living room, climbing on the couch, tossing pillows.
"Don't you tear up my couch," Joy said smiling at her.
"Pick her up," said Suzanne.
Joy threw Alexa over her shoulder and lowered her. Up and down. Joy flopped on the couch, pretending to be tired. Alexa climbed up on her. Joy tickled her. She played peekaboo with a pillow.
"Keep engaging her," Suzanne encouraged. "You're doing great. Don't take away the eye contact."
Joy raised and lowered the pillow, smiling and making eye contact. Then she stuck out her tongue. "Where's my tongue?"
Just like that, it was over. Alexa pulled away. She wailed and ran off.
Suzanne explained that Joy had changed the play, upping it from just simple "sensory motor play" to a different type of play, one that was above Alexa's understanding. She rewound her videocamera, showed Joy the moment she lost Alexa.
"Lightbulbs are going off right now," Joy said.
Moments later, though, Alexa ran up to her Mom. She put her arms around her hips.
"Oh," Joy said softly. "A hug."
She threw her arms around her little girl.
Times researcher Carolyn Edds contributed to this report. Leonora LaPeter Anton can be reached at firstname.lastname@example.org or (727) 893-8640.