INTERVIEW WITH JUNE GRODEN,
Dr. June Groden is considered one of the pioneers
in the field of Autism
and developmental disabilities. Her primary areas of interest are
stress and anxiety and procedures to reduce stress. She has focused
on the development of relaxation and imagery based procedures for
a population with Autism and developmental disabilities. Dr. Groden
is the Director of the Groden Center in Providence, Rhode Island.
The Groden Center provides community-based evaluative,
therapeutic, educational and vocational programs for children and
adults who have or are at risk for moderate to severe behavioral/emotional
problems, including Autism. Dr. Stephen M. Edelson interviewed Dr.
June Groden on November 13, 1996.
Could you tell us a little bit about your background?
I have a bachelor's degree in business administration,
a master of education and a master of arts in psychology and a Ph.D.
in psychology. The combination of education and psychology is helpful
in combining both the academic and behavioral programs since behavioral
problems are often affected by the appropriate curriculum or vocational
My interest in stress reduction arose from the
work I had done earlier in self-management and self-control, and
I felt that it was important to look at inner behavior in addition
to overt behavior. I had studied the work of Joseph Cautela, Ph.D.
at Boston College and went to study with him for the specific purpose
of adapting the procedures he developed which he labeled as Covert
Conditioning to use with the population with Autism and developmental
disabilities. We are still working together to continually refine
and expand these procedures. He is the co-author of the Relaxation
Manual and has been part of developing the videos, Breaking the
Barriers: I and II which feature the relaxation and imagery procedures.
Since you are considered an expert in the areas of relaxation
and visual imagery, could you describe your work so our readers
will have a better idea of what is involved and what they might
The relaxation program that we use involves progressive
relaxation developed by Edmund Jacobson. Basically, this program
involves teaching consumers how to discriminate between tense muscles
and relaxed muscles. Children and adults are taught the relaxation
procedure, usually in a one-to-one teaching session lasting for
as long as the participant can maintain attention. This usually
ranges from a few minutes to twenty minutes. The practice session
is a regularly scheduled event built into the person's schedule.
The person learns to tighten and relax the arms, hands, and legs,
and to do deep breathing in a sitting position. The child or adult
is then taught relaxing without tensing. Finally, the person is
taught to tighten and relax all remaining muscle groups of the body.
After the person has mastered the relaxation procedure,
we administer a stress survey which I have developed and which helps
to identify stressful situations. Once these stressful situations
have been pinpointed, the client can then use coping strategies,
such as relaxation or imagery to reduce their stress. The relaxation
program can also be used to develop self-control by the individual
learning to make a relaxation response in place of the typical maladaptive
behavior he or she exhibits during stressful situations.
The imagery programs utilize visual imagery and/or
a procedure we call picture rehearsal. After conducting a functional
analysis of behavior (this is described in our book Understanding
Challenging Behavior), a script is written which utilizes the
information from the analyses. For procedure rehearsal programs,
line drawings or photographs depict the antecedent event, the targeted
behavior and the consequences. For visual imagery alone, just the
script is read without the pictures. Often relaxation is incorporated
into the scene. An example of a scene which targets bedtime behavior
might be: "You are watching TV and mother says, It's time to
go to bed. You take a deep breath and relax and say okay, I will
get into my pajamas. You feel proud you were so cooperative. Now
imagine your mother reading your favorite book before you get in
bed." The mother, therapist or teacher describes the scene
first and then the child or adolescent repeats it either verbally
or by pointing to each picture.
During a recent lecture of yours, you mentioned that imaging a
reward could be as effective as actually receiving the reward. I
thought this was a very interesting concept, and it could be an
extremely important behavioral tool.
There is some evidence to suggest that at times
the effects of observable behavior and imagined behavior can be
similar. Studies by K.D. Brownell, D. H. Barlow and A.E. Kazdin
support this. We have also observed our children and adults smiling
when they imagine a reinforcer or swallowing when they imagine eating
a favorite food. It has a great impact on the use of imagining for
therapy since it is possible to create many different situations,
places and reinforcers without actually being there.
Could you describe a couple of individuals who benefited from
There is a person in our adult program who had
lived in a state hospital where he had a two-on-one staff ratio
around the clock. He was also receiving a very heavy dosage of medication.
When he arrived at our program, he could not even be in a room with
other people. He had to be placed alone because he was extremely
aggressive. We started working with him, one-on-one or two-on-one;
and we started teaching him relaxation as a way to control himself.
At first, he did not want to use relaxation with a staff person,
so we recorded the relaxation procedure on an audiotape. He would
listen to the tape but he would often break the tape. Over time,
he started using the tapes and doing the relaxation procedure. We
then started to identify situations for him in which he was anxious
so he could learn to relax himself using the relaxation procedure.
We also identified situations that were antecedent
to some of his tantrums. We did a thorough functional analysis of
his behavior, and we were able to determine precursors to situations
in which he would become aggressive. We then developed several imagery
scenes which we put on index cards. It is the procedure I just described
called picture rehearsal. We used the cards to rehearse more appropriate
behavior. We were also able to get him involved in a vocational
training program and an academic program. In about six months he
reduced his aggressive behaviors, and we then transferred him to
the adult vocational program. Now, seven years later, he is in a
group home where he has a separate apartment. He has a job and uses
public transportation independently. Although he is doing very well,
he still has a few episodes where he may break items, usually his
own; but his aggression has not been towards other people or himself.
He has changed dramatically and people who knew him at the institution
and meet him now cannot believe the difference. This case is more
fully described in the Covert Conditioning Casebook (Cautela &
Kearney, 1993). Reprints are available from me.
In another case, we worked with a three-year old
boy who was diagnosed as having Autism. He did not interact with
other children, and he had very little language at that time. We
started working with him in a regular nursery school. I was the
consultant on this case, and he had a teacher aide who worked with
him one-on-one in addition to the other teaching staff. The main
part of the program was teaching him the relaxation procedure and
using picture rehearsal. We also taught his parents the relaxation
procedure, and they were able to use this procedure with him at
home. After a short time, every time he became anxious, the staff
member cued him and he was able to relax immediately. We also identified
situations which caused him to become anxious and incorporated these
events into the picture rehearsal program.
The picture rehearsal scenes identified events
that made him uncomfortable and illustrated how to behave and act
more appropriately. We worked with him from preschool through kindergarten
and first grade. When he got into first grade, the teacher thought
the relaxation procedure was very helpful and requested it be taught
to the entire class. When he continued into the second grade, that
class also performed the relaxation procedure everyday. Eventually,
he started developing his own imagery scenes; and by the third grade,
he was doing so well that we began reducing the amount of time he
spent with his aide. By fifth grade he did not need special services
any more. He is now in a regular high school, and he is the junior
class president. This is a real success story, and I do not think
anybody would be able to pick him out as having Autism.
Let me describe another case. We had a person
in our program who was very disruptive. She would yell out in class,
and she would throw things and get very upset. When she came into
our program, we started using imagery to reduce her disruptive behavior.
She would rehearse scenes on how to wait and how to act more appropriately.
She also practiced relaxation. Within one year, we were able to
reduce her aggression and her tantrums. In the second year, we started
working on additional appropriate social behavior, such as learning
how to interact with other people and how to be more assertive in
her responses instead of screaming or yelling. Within a short time,
she was able to handle these situations in a more appropriate manner.
We then started teaching her how to go into stores and learn what
to say to strangers so that her mother could feel safe when taking
her into the community. Overall, she did very nicely; and now she
is back in a public school.
Often people cannot imagine how a relaxation or an imagery program
can be used to teach individuals who are very low functioning. What
are your experiences with these issues?
It is assumed that because of their cognitive
deficits, this population is not able to benefit from procedures
that are used frequently with a non-handicapped population. This
misconception is particularly the case concerning the use of relaxation
and imagery-based procedures. People with severe intellectual disability
are able to learn the relaxation response, and we have been very
successful for over 20 years in teaching relaxation and using picture
rehearsal with these individuals. We had one boy, who comes to mind,
who spoke with just a few words and could point to a few pictures.
It took many years to teach him independent living skills, such
as shoe tying and dressing, but he was able to participate in the
relaxation program. If you cue him to relax, he knows exactly what
to do. The training took about five or six years, until he was able
to do the breathing correctly and to relax all parts of his body.
Could one assume that the best candidates for your program are
those who suffer from anxiety and stress?
I feel that everybody, to some extent, has stress
or anxiety in their life. It is the way that we cope with the stress
and anxiety that makes the difference. We focus on teaching coping
strategies that are beneficial and increase the well-being of the
individuals we serve.
Since autistic individuals typically have communication problems,
I would assume that they are more likely to experience stress in
their life than those individuals with good communication skills.
Yes. In the literature, stress is often associated
with not being able to assert oneself and not being able to say
what one wants. This, of course, applies particularly to people
Can you describe the relaxation procedure in more detail?
When working with individuals with Autism using
progressive relaxation, I suggest starting with gross motor areas
because it is easier for them to learn to tense and relax these
muscle groups rather then starting at the head and working down
the body. First, we tighten and we relax each arm individually,
and then the same for each leg individually. Because many people
with Autism exhibit stereotypic
behavior, I have them concentrate on tightening and relaxing
each hand because we want them to know what if feels like to have
their hands relaxed. Then, when they are engaging in stereotypic
behaviors, we can say "relax your hand," and they understand
what that means. After the arms, legs and hands, we start deep breathing
exercises. We teach them to inhale and exhale. Also, I teach them
to associate a meaningful calming word, such as peace or a religious
word or the word "relax" as they exhale. The word then
becomes associated with a relaxed feeling.
Changing the topic slightly, and this is a question I often ask
during my interviews, 'when you come across a family with a newly
diagnosed child, what recommendations do you give them?'
I usually tell them to get involved in a program.
If the child is young, they should be in an early intervention program.
If they are older, the family should find a consultant with expertise
in the field of Autism to go into the classroom and set up a program
that is appropriate for the child and act as an interpreter to the
teacher and staff. I also feel that parents should receive counseling
and education on how to handle a child or adult with Autism, what
to look for, what kinds of problems might occur, and what they should
do about them.
We emphasize parent teaching at our program, so
that parents learn how to handle some of the problems when their
children are young. We also inform them of resources available to
them, and we tell them about the kinds of assessments they should
have for their children. This is all very individualized because
there is such a wide variation of problems since Autism is a spectrum
disorder. We try then to determine what is appropriate for that
What do you think about teaching a child in a home situation?
I feel that it is very good for parents to learn
what to do and to work with their children at home and for the children
to have home services. I also think that children should be part
of a school program. These children should have the opportunity
to be with other children, to be with their peers and to learn to
have social relationships. For very young children, Lovaas
has found it effective to do intensive applied
behavioral analysis for 40 hours per week at home. We provide
this type of home program but also supplement the discrete trial
format with self-control procedures using relaxation and imagery.
We introduce academics at an early age, using direct instruction,
incidental teaching and communication training. We also have these
services provided in preschools and classrooms with typical peers.
You mentioned that you developed a stress survey. Can you describe
this survey in more detail?
Yes. We felt that there was a need for a good
assessment tool to measure stress with people with special needs.
I first used an open-ended questionnaire and asked a number of people
within our system and other staff, parents, and persons with Autism
to tell us what they felt were significant stressors for people
with Autism. We then placed these responses into a number of categories.
By a statistical analysis, called principal component analysis,
we divided the stressors into categories. This questionnaire also
provides us with a stress profile, and this information helps us
to develop imagery scenes and other programs to reduce stress. People
can obtain a copy of the stress survey by writing to our Center.
Could you tell us a little bit about your Center?
We have a very large continuum of services that
are flexible and personalized. They were developed in response to
the needs in our area. We first started with a 6-day extended hour
school-based program. Since some parents could no longer keep the
children in their own homes, or some parents were not able to care
for their children because of other issues, we started residential
programs which include apartments, group homes, as well as what
we call 'professional family living arrangements' (PFLA).
Basically, we want young children to be part of
a family, so we train foster families and call them 'professional
families.' We give them the extra training on how to handle children
with special needs, and place some children with these families
for a period of time. Sometimes the children need only a short period
of time and then they return to their natural families while others
remain at their PFLA for extended periods. We also have home-based
services for early intervention, in which we send therapists and
supervisors to work up to 40 hours in homes; and we also set up
programs for children in their own home schools.
Using an applied behavioral analysis approach,
they receive intensive services but they are still part of a regular
classroom. We also serve individuals with special needs through
adulthood. We have vocational programs, and all of our vocational
services are located in the natural community, such as hospitals,
food banks, etc. Our supported employment program has job coaches
or natural supports. In addition, we have parent programs, offer
consultation services to schools and to other programs. We provide
training workshops to disseminate our procedures.
Do you offer workshops at your Center?
We do workshops outside of our Center like the
one you attended in Portland. However, we are thinking about establishing
a training center at our institute where people can come for a week
or two to receive training. We have had many requests from people
who want this type of training and are interested in our relaxation
and imagery procedures and our assessment procedures, which include
the functional analysis of behavior. Our Center has several manuals
and videotapes for people to learn more about these procedures.
The address of the Groden Center is: 86 Mount
Hope Avenue, Providence, Rhode Island 02906 USA; and their telephone
numbers are: (401) 274-6310 and (401) 421-3280 (fax).
Further reading: Brain
chemistry and Autism
Copyright The purpose of this copyright is to
protect your right to make free copies of this paper for your friends
and colleagues, to prevent publishers from using it for commercial
advantage, and to prevent ill-meaning people from altering the meaning
of the document by changing or removing a few paragraphs.
Reproduction kindly allowed by www.autism.org
Visit their site for more useful resources.
Click here for the full
range of Asperger's and Autism fact sheets at www.autism-help.org