Handbook of parent child interaction therapy for children on the autism spectrum cheryl bodiford mcn
Handbook of Parent Child Interaction Therapy for Children on the Autism Spectrum Cheryl Bodiford Mcneil
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Technology and the Treatment of Children with Autism Spectrum Disorder Cardon
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Cheryl B. McNeil
To my wonderful family, amazing doctoral students, brilliant mentors, passionate colleagues, and all of the struggling families referred to me for clinical care, thank you for inspiring me to explore new ways to make an impact in the field of children’s mental health.
Lauren B. Quetsch
This book is dedicated to my husband, Tim, and my children, Layne and Connor, who bring joy and balance to my life. Their support and endless love shine a light on how important family is and how I am so lucky to dedicate my career to help others find that same light in their own families.
Cynthia Anderson
To the many individuals with autism spectrum disorder and their families that I have been lucky to work with and learn from, and to my incredible husband and son who keep me balanced and focused.
Foreword
According to the Diagnostics and Statistical Manual, Fifth Edition (DSM-5; American Psychiatric Association, 2013), autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social interaction and communication, as well as restricted and repetitive behaviors, interests, and activities. Recent estimates indicate that as many as 1 in 59 children in the United States have ASD (Centers for Disease Control, 2018). Many children with ASD present with comorbid behavior problems that many families feel underprepared to address.
In this handbook, we highlight Parent-Child Interaction Therapy (PCIT) as a promising treatment for complementing evidence-based ASD services. In recent years, approximately one dozen published PCIT studies have demonstrated positive outcomes with children on the autism spectrum. Because PCIT is intended to serve as a complementary treatment for other evidencebased approaches, we review those approaches in some depth.
PCIT is an empirically supported parent training program originally designed for young children (2 to 7 years) with disruptive behavior problems. The intervention has been demonstrated to be effective for children presenting with a variety of child mental health concerns including separation anxiety, trauma, ADHD, intellectual disability, and depression. PCIT is unique in that it involves in vivo coaching of parents while they interact with their child, and typically is conducted with the therapist/coach stationed behind a oneway mirror. Parent and child skills are coded and graphed in each session to assess progress toward established mastery criteria; these data are used to guide intervention decisions.
This book compiles the collective knowledge of both PCIT and ASD researchers to present a foundation for the utilization of PCIT for children with ASD. It is the hope of the editors that PCIT will become a standard component of the milieu of services for young children in this population. In PCIT, the first phase of treatment, Child-Directed Interaction, is intended to improve the caregiver-child relationship and increase the social reinforcement value of the parent. The second phase of treatment, ParentDirected Interaction, typically yields large and rapid changes in disruptive behavior, with noticeable improvements in compliance after only a few weeks of receiving this intervention stage. Research demonstrates that a short course of PCIT (~11–22 sessions; M = 19 sessions) for children with ASD leads to significant reductions in behavior problems (as measured using the Eyberg Child Behavior Inventory—Intensity Scale; Eyberg
& Pincus, 1999) from outside normal limits (88th percentile) to within normal limits (34th percentile) and substantial improvements in child compliance (from 41% to 87%) (e.g., Zlomke, Jeter, & Murphy, 2017; N = 17). In this handbook, we argue that PCIT is most effective when provided early in the treatment process, either while waiting for intensive services (e.g., applied behavior analysis) to begin or concurrently with necessary interventions. For higher functioning children with disruptive behavior, PCIT can be conceptualized as a gateway intervention in that it systematically trains parents to quickly modify noncompliance, aggression, and tantrums and thereby improves the effects of other services often required by children on the autism spectrum (e.g., occupational therapy, speech therapy).
The handbook is broken into four sections. The first section of the book, “Conceptual Foundations of Evidence-Based Approaches for Autism Spectrum Disorder,” provides an overview of the evidence-based interventions for children on the autism spectrum, all of which are derived from the science of behavior analysis. This section describes core characteristics of children with autism, the conceptual and scientific foundations of applied behavior analysis, effective models of treatment for youth with autism as well as unsubstantiated treatments for this population that are still present.
The second section of the book, “Evidence-Based Approaches to Treating Core and Associated Deficits of Autism Spectrum Disorder,” reviews the evidence-based approaches to increase skills such as communication and social interaction and reduce problematic behavior such as self-injury or stereotypic behavior that interferes with learning. This is also includes a discussion of strategies for complex and challenging behaviors. The section concludes with specific and feasible recommendations for assessing potential treatments and determining whether a given intervention is both empirically supported and a good match for a particular child.
The third section of the handbook entitled “Parent-Child Interaction Therapy (PCIT) and Autism Spectrum Disorder: Theory and Research” gives an overview of PCIT, the theory behind using PCIT with an ASD population, and preliminary studies using PCIT for children with ASD. A training requirements chapter rounds out this section by detailing the steps needed to become a PCIT therapist or trainer, and the recommended qualifications or additional education needed by PCIT therapists who intend to work with ASD populations. This section elucidates the foundational principles and mechanisms through which PCIT has achieved such powerful effects with disruptive behavior (e.g., Cohen’s d’s of well over 1.0) for children with ASD.
The final section of the book focuses on clinical considerations when using PCIT for children on the autism spectrum. Adaptations for treatment implementation are highlighted as researchers and clinicians work to address the unique needs of these families and children. Considerations are presented for implementing this treatment based on the level of autism severity and comorbid conditions. Using a quick-reference, outline format, the final chapter (McNeil & Quetsch) brings together the most salient clinical takeaway messages from the handbook, providing numerous helpful hints for clinicians working with families of children on the spectrum. Additionally,
the final chapter provides information regarding a novel Social-Directed Interaction phase that can be added to the protocol to address core ASD symptomatology.
This handbook summarizes recommendations for using PCIT with children on the autism spectrum that are based upon a growing body of literature and hundreds of clinical cases. It is our hope that this book will encourage current PCIT providers to expand their referral base to include children on the autism spectrum. We also hope that this handbook sparks interest in the community of providers using traditional treatments with young children on the autism spectrum to learn more about PCIT and consider including the service as part of an empirically supported continuum of care.
Given that caregivers report that their greatest source of parenting stress is the aggression, noncompliance, and tantrums often associated with autism, a short course of PCIT could enhance family wellness with quick, and often dramatic, improvements in disruptive behavior. In this way, PCIT could be an important preventive approach to reduce behavior problems and dysfunctional parent-child interaction patterns that can occur when families have little specialized training in how to parent children on the spectrum. Our vision is to develop a network of providers and researchers with expertise in PCITASD who can provide and evaluate the impact of this treatment as a standard component of a “best practice” continuum of care. Ultimately, we hope to make PCIT readily available as a resource for families with young children on the autism spectrum.
Acknowledgments
This book is the embodiment of a lifelong dedication to young children and families across a number of incredible clinicians and researchers. In turn, this book would not have been possible without their tireless efforts to understand the unique needs of families who are often overlooked or misunderstood. We would like to thank our colleagues for lending their minds to help us build a foundation for clinical understanding while continuing to question our preconceptions about autism spectrum disorder. In turn, our colleagues in the PCIT community have been essential in helping us piece together the puzzle of adapting an evidence-based treatment to address the complex needs of children with ASD.
Specifically, we would like to thank Dr. Sheila Eyberg, the founder of PCIT, for developing this powerful and caring approach to helping families. Thanks also to Dr. Joshua Masse for his willingness to conduct pioneering research in the area of PCIT with ASD while a doctoral student at West Virginia University. To the ABA researchers and clinicians who developed the best practices in this field, we are grateful for your technological discoveries about behavior modification and communication training that are infused in this work. Thanks also to all of our overworked chapter authors who performed under tight deadlines to provide an important service to the profession. And, lastly, this book is dedicated to the loving families who have put their trust into our hands as we explored a new approach to working with young children on the autism spectrum. Please know that we send you a heartfelt “thank you” for informing all that is written in this text.
Part I Conceptual Foundations of Evidence-Based Approaches for Autism Spectrum Disorder
1 What Is Autism Spectrum Disorder? 3
Hannah Rea, Krysta LaMotte, and T. Lindsey Burrell
2 Applied Behavior Analysis: Foundations and Applications 27
Stephanie M. Peterson, Cody Morris, Kathryn M. Kestner, Shawn P. Quigley, Elian Aljadeff-Abergel, and Dana B. Goetz
3 Evidence-Based Models of Treatment
Regina A. Carroll and Tiffany Kodak
4 The Importance of Parent-Child Interactions in Social Communication Development and Considerations for Autism Spectrum Disorders .
M. Alice Shillingsburg and Brittany Juban
5 Measuring the Effects of Medication for Individuals with Autism
Jennifer Zarcone, Annette Griffith, and Chrystal Jansz Rieken
6 Unsubstantiated Interventions for Autism Spectrum Disorder 87
Yannick A. Schenk, Ryan J. Martin, Whitney L. Kleinert, Shawn P. Quigley, and Serra R. Langone
Part II Evidence-Based Approaches to Treating Core and Associated Deficits of Autism Spectrum Disorder
7 Behavioral Approaches to Language Training for Individuals with Autism Spectrum Disorder 109
Jason C. Vladescu, Samantha L. Breeman, Kathleen E. Marano, Jacqueline N. Carrow, Alexandra M. Campanaro, and April N. Kisamore
8 Behavior Analytic Perspectives on Teaching Complex Social Behavior to Children with Autism Spectrum Disorder .
April N. Kisamore, Lauren K. Schnell, Lauren A. Goodwyn, Jacqueline N. Carrow, Catherine Taylor-Santa, and Jason C. Vladescu
129
9 Assessment and Treatment of Stereotypical Behavior Displayed by Children with Autism Spectrum Disorders . . . . . 147
Jennifer L. Cook, John T. Rapp, and Kristen M. Brogan
10 Functional Analysis and Challenging Behavior 169
Kathryn M. Kestner and Claire C. St. Peter
11 Function-Based Interventions for Problem Behavior: Treatment Decisions and Feasibility Considerations 189
Sarah A. Weddle and Abbey B. Carreau
Part III Parent–Child Interaction Therapy (PCIT) and Autism Spectrum Disorder: Theory and Research
12 Mapping PCIT onto the Landscape of Parent Training Programs for Youth with Autism Spectrum Disorder . . . . . . . . 219
Karen Bearss
13 A Clinical Description of Parent-Child Interaction Therapy 237
Paul Shawler and Beverly Funderburk
14 PCIT: Summary of 40 Years of Research 251
Laurel A. Brabson, Carrie B. Jackson, Brittany K. Liebsack, and Amy D. Herschell
15 Theoretical Basis for Parent-Child Interaction Therapy with Autism Spectrum Disorder 277
Desireé N. Williford, Corey C. Lieneman, Cassandra R. Drain, and Cheryl B. McNeil
16 Parent-Child Interaction Therapy with Children on the Autism Spectrum: A Narrative Review . .
Christopher K. Owen, Jocelyn Stokes, Ria Travers, Mary M. Ruckle, and Corey Lieneman
297
17 Child-Adult Relationship Enhancement for Children with Autism Spectrum Disorders: CARE Connections . . . . . . . 321
Robin H. Gurwitch, Melanie M. Nelson, and John Paul Abner
18 Core Training Competencies for PCIT and ASD . . . . .
Christina M. Warner-Metzger
339
19 Autism Spectrum Disorder and Family Functioning: A Therapist’s Perspective
Susannah G. Poe and Christopher K. Owen
20 Sleep Concerns in Children with Autism Spectrum Disorder 363
Jenna Wallace, Jodi Lindsey, Victoria Lancaster, and Meg Stone-Heaberlin
21 Autism Spectrum Disorder and Attachment: Is an Attachment Perspective Relevant in Early Interventions with Children on the Autism Spectrum? 373
Sara Cibralic, Christopher K. Owen, and Jane Kohlhoff
22 Helping Parents Generalize PCIT Skills to Manage ASD-Related Behaviors: Handouts and Clinical Applications 399
Catherine A. Burrows, Meaghan V. Parladé, Dainelys Garcia, and Jason F. Jent
23 PCIT and Language Facilitation for Children with Autism Spectrum Disorders
Brenda L. Beverly and Kimberly Zlomke
24 Summary of Lessons Learned from Two Studies: An Open Clinical Trial and a Randomized Controlled Trial of PCIT and Young Children with Autism Spectrum Disorders
Ashley Tempel Scudder, Cassandra Brenner Wong, Marissa Mendoza-Burcham, and Benjamin Handen
25 Melding of Two Worlds: Lessons Learned about PCIT and Autism Spectrum Disorders
Joshua J. Masse and Christina M. Warner-Metzger
26 Clinical Application of Parent-Child Interaction Therapy to Promote Play and Vocalizations in Young Children with Autism Spectrum Disorder: A Case Study and Recommendations
M. Alice Shillingsburg, Bethany Hansen, and Sarah Frampton
27 Reflections on the First Efficacy Study of Parent-Child Interaction Therapy with Children Diagnosed with Autism Spectrum Disorder
Susan G. Timmer, Brandi Hawk, Megan E. Tudor, and Marjorie Solomon
28
Lessons Learned from the Application of Parent-Child Interaction Therapy with Children with Autism Spectrum Disorder 517
Heather Agazzi, Kimberly Knap, Sim Yin Tan, and Kathleen Armstrong
29 PCIT for Children with Severe Behavior Problems and Autism Spectrum Disorder 531
30
Korrie Allen, John W. Harrington, and Cathy Cooke
Internet-Delivered Parent-Child Interaction Therapy (I-PCIT) for Children with Autism Spectrum Disorder: Rationale, Considerations, and Lessons Learned .
Natalie Hong, Leah K. Feinberg, Dainelys Garcia,
Jonathan S. Comer, and Daniel M. Bagner
31 What PCIT Clinicians Need to Know About ASD Assessment
Stacy S. Forcino and Cy B. Nadler
. 545
559
32 Child-Directed Interaction Treatment for Children on the Autism Spectrum 575
John Paul Abner, Leah N. Clionsky, and Nicole Ginn Dreiling
33 Parent-Directed Interaction: Considerations When Working with Young Children with Autism Spectrum Disorders
Ashley Tempel Scudder, Stephanie Wagner, and Paul Shawler
589
34 Parent-Child Interaction Therapy with a Child on the Autism Spectrum: A Case Study 609
Nancy M. Wallace and Holly Glick Sly
35 A Case Study of Parent-Child Interaction Therapy with Adaptations for the Treatment of Autism Spectrum Disorder in Early Childhood 619
Heather Agazzi, Sim Yin Tan, Kimberly Knap, and Kathleen Armstrong
36 PCIT and Autism: A Case Study
Amelia M. Rowley and Joshua J. Masse
37 Parent-Child Interaction Therapy (PCIT): Autism Case Study #4
Dorothy Scattone, Dustin E. Sarver, and Amanda D. Cox
38 Parent-Child Interaction Therapy-Toddler (PCIT-T): Case Overview for a Child on the Autism Spectrum with a Comorbid Developmental Disability
Victoria E. Montes-Vu and Emma Girard
633
651
665
39 Parent-Child Interaction Therapy for a Child with Autism Spectrum Disorder: A Case Study Examining Effects on ASD Symptoms, Social Engagement, Pretend Play, and Disruptive Behavior
Corey C. Lieneman, Mary M. Ruckle, and Cheryl B. McNeil
40 Putting It Together: Takeaway Points for Clinicians Conducting PCIT with Autism Spectrum Disorder .
Cheryl B. McNeil and Lauren B. Quetsch
Contributors
John Paul Abner Milligan College, Johnson City, TN, USA
Heather Agazzi University of South Florida Morsani College of Medicine, Tampa, FL, USA
Elian Aljadeff-Abergel Kinneret Academic College, Kinneret, Israel
Korrie Allen Innovative Psychological Solutions, Fairfax, VA, USA
Kathleen Armstrong University of South Florida Morsani College of Medicine, Tampa, FL, USA
Daniel M. Bagner Department of Psychology, Center for Children and Families, Florida International University, Miami, FL, USA
Karen Bearss Department of Psychiatry and Behavioral Sciences, Seattle Children’s Autism Center, University of Washington, Seattle, WA, USA
Brenda L. Beverly University of South Alabama, Mobile, AL, USA
Laurel A. Brabson West Virginia University, Morgantown, WV, USA
Samantha L. Breeman Caldwell University, Caldwell, NJ, USA
Kristen M. Brogan Auburn University, Auburn, AL, USA
T. Lindsey Burrell Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Emory University School of Medicine, Atlanta, GA, USA
Catherine A. Burrows Duke University, Durham, NC, USA University of Miami, Coral Gables, FL, USA
Alexandra M. Campanaro Caldwell University, Caldwell, NJ, USA
Abbey B. Carreau May Institute, Randolph, MA, USA
Regina A. Carroll University of Nebraska Medical Center’s Munroe-Meyer Institute, Omaha, NE, USA
Jacqueline N. Carrow Caldwell University, Caldwell, NJ, USA
Sara Cibralic University of New South Wales, Sydney, NSW, Australia
Leah N. Clionsky Thriving Child Center PLLC, Sugarland, TX, USA
Jonathan S. Comer Department of Psychology, Center for Children and Families, Florida International University, Miami, FL, USA
Jennifer L. Cook University of South Florida, Tampa, FL, USA
Cathy Cooke Clinical Associates of Tidewater, Newport News, VA, USA
Amanda D. Cox Department of Pediatrics, Center for Advancement of Youth, University of Mississippi Medical Center, Jackson, MS, USA
Cassandra R. Drain West Virginia University, Morgantown, WV, USA
Nicole Ginn Dreiling University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Leah K. Feinberg Department of Psychology, Center for Children and Families, Florida International University, Miami, FL, USA
Stacy S. Forcino Department of Psychology, California State University, San Bernardino, CA, USA
Sarah Frampton May Institute, Inc., Randolph, MA, USA
Beverly Funderburk University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
Dainelys Garcia University of Miami, Coral Gables, FL, USA
Department of Psychology, Center for Children and Families, Florida International University, Miami, FL, USA
Emma Girard School of Medicine, University of California Riverside, Riverside, CA, USA
Holly Glick Sly FMRS Health Systems, Inc., Beckley, WV, USA
Dana B. Goetz Western Michigan University, Kalamazoo, MI, USA
Lauren A. Goodwyn Caldwell University, Caldwell, NJ, USA
Annette Griffith The Chicago School of Professional Psychology, Chicago, IL, USA
Robin H. Gurwitch Duke University Medical Center, Durham, NC, USA
Benjamin Handen University of Pittsburgh, Pittsburgh, PA, USA
Bethany Hansen Munroe Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA
John W. Harrington Children’s Hospital of The King’s Daughters, Norfolk, VA, USA
Eastern Virginia Medical School, Norfolk, VA, USA
Brandi Hawk Department of Pediatrics, CAARE Diagnostic and Treatment Center, UC Davis Health, Sacramento, CA, USA
Amy D. Herschell West Virginia University, Morgantown, WV, USA
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Natalie Hong Department of Psychology, Center for Children and Families, Florida International University, Miami, FL, USA
Carrie B. Jackson West Virginia University, Morgantown, WV, USA
Jason F. Jent University of Miami, Coral Gables, FL, USA
Brittany Juban May Institute, Randolph, MA, USA
Kathryn M. Kestner West Virginia University, Morgantown, WV, USA
April N. Kisamore Hunter College, New York, NY, USA
Whitney L. Kleinert May Institute, Randolph, MA, USA
Kimberly Knap University of South Florida Morsani College of Medicine, Tampa, FL, USA
Tiffany Kodak Marquette University, Milwaukee, WI, USA
Jane Kohlhoff University of New South Wales, Sydney, NSW, Australia
Krysta LaMotte Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Victoria Lancaster Department of Pediatrics, Section of Neurology, WVU School of Medicine, Morgantown, WV, USA
Serra R. Langone May Institute, Randolph, MA, USA
Brittany K. Liebsack West Virginia University, Morgantown, WV, USA
Corey C. Lieneman West Virginia University, Morgantown, WV, USA
Jodi Lindsey Department of Pediatrics, Section of Neurology, WVU School of Medicine, Morgantown, WV, USA
Kathleen E. Marano Caldwell University, Caldwell, NJ, USA
Ryan J. Martin May Institute, Randolph, MA, USA
Joshua J. Masse University of Massachusetts Dartmouth, North Dartmouth, MA, USA
The Boston Child Study Center, Boston, MA, USA
Cheryl B. McNeil Department of Psychology, West Virginia University, Morgantown, WV, USA
Marissa Mendoza-Burcham Penn State University—Beaver, Monaca, PA, USA
Victoria E. Montes-Vu School of Medicine, University of California Riverside, Riverside, CA, USA
Cody Morris Western Michigan University, Kalamazoo, MI, USA
Cy B. Nadler Division of Developmental and Behavioral Sciences, Children’s Mercy Kansas City, Kansas City, KS, USA
Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
Melanie M. Nelson University of Florida College of Medicine, Gainesville, FL, USA
Christopher K. Owen University of Pittsburgh Medical Center, Pittsburgh, PA, USA
West Virginia University, Morgantown, WV, USA
Meaghan V. Parladé University of Miami, Coral Gables, FL, USA
Stephanie M. Peterson Western Michigan University, Kalamazoo, MI, USA
Susannah G. Poe Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV, USA
Lauren B. Quetsch Department of Psychology, West Virginia University, Morgantown, WV, USA
Shawn P. Quigley Melmark, Berwyn, PA, USA
John T. Rapp Auburn University, Auburn, AL, USA
Hannah Rea University of Georgia, Athens, GA, USA
Chrystal Jansz Rieken The Chicago School of Professional Psychology, Chicago, IL, USA
Amelia M. Rowley Boston Child Study Center, Boston, MA, USA
Mary M. Ruckle West Virginia University, Morgantown, WV, USA
Dustin E. Sarver Department of Pediatrics, Center for Advancement of Youth, University of Mississippi Medical Center, Jackson, MS, USA
Dorothy Scattone Department of Pediatrics, Center for Advancement of Youth, University of Mississippi Medical Center, Jackson, MS, USA
Yannick A. Schenk May Institute, Randolph, MA, USA
Lauren K. Schnell Hunter College, New York, NY, USA
Ashley Tempel Scudder Chatham University, Pittsburgh, PA, USA
Paul Shawler University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
M. Alice Shillingsburg May Institute, Randolph, MA, USA
Marjorie Solomon Department of Psychiatry and Behavioral Sciences, MIND Institute, Imaging Research Center, UC Davis Health, Sacramento, CA, USA
Claire C. St. Peter West Virginia University, Morgantown, WV, USA
Jocelyn Stokes West Virginia University School of Medicine—Eastern Division, Martinsburg, WV, USA
Meg Stone-Heaberlin Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Sim Yin Tan University of South Florida Morsani College of Medicine, Tampa, FL, USA
Catherine Taylor-Santa Caldwell University, Caldwell, NJ, USA
Susan G. Timmer Department of Pediatrics, CAARE Diagnostic and Treatment Center, UC Davis Health, Sacramento, CA, USA
Ria Travers Georgia Pediatric Psychology, Atlanta, GA, USA
Megan E. Tudor Department of Pediatrics, MIND Institute, UC Davis Health, Sacramento, CA, USA
Jason C. Vladescu Caldwell University, Caldwell, NJ, USA
Stephanie Wagner Child Study Center, Hassenfeld Children’s Hospital at NYU Langone, New York, NY, USA
Jenna Wallace Department of Pediatrics, Section of Neurology, WVU School of Medicine, Morgantown, WV, USA
Department of Behavioral Medicine, WVU School of Medicine, Morgantown, WV, USA
Nancy M. Wallace Johns Hopkins School of Medicine, The Kennedy Krieger Institute, Baltimore, MD, USA
Christina M. Warner-Metzger DePaul University Family and Community Services, Chicago, IL, USA
Sarah A. Weddle May Institute, Randolph, MA, USA
Desireé N. Williford West Virginia University, Morgantown, WV, USA
Cassandra Brenner Wong University of Pittsburgh, Pittsburgh, PA, USA
Jennifer Zarcone May Institute, Randolph, MA, USA
Kimberly Zlomke University of South Alabama, Mobile, AL, USA
About the Editors
Cheryl, Bodiford, McNeil, Ph.D. is a Professor of Psychology in the Clinical Child program at West Virginia University. Her clinical and research interests are focused on program development and evaluation, specifically with regard to adapting treatments and managing disruptive behaviors of young children in both the home and school settings. Dr. McNeil has coauthored several books (e.g., Parent-Child Interaction Therapy, Second Edition, Short-Term Play Therapy for Disruptive Children, Parent-Child Interaction Therapy with Toddlers: Improving Attachment and Emotion Regulation), a continuing education package (Working with Oppositional Defiant Disorder in Children), a classroom management program (The Tough Class Discipline Kit), and a Psychotherapy DVD for the American Psychological Association (Parent-Child Interaction Therapy). She has a line of research studies examining the efficacy of Parent-Child Interaction Therapy and Teacher-Child Interaction Training across a variety of settings and populations, including more than 100 research articles and chapters related to the importance of intervening early with young children displaying disruptive behaviors. Dr. McNeil is a master trainer for PCIT International and has disseminated PCIT to agencies and therapists in many states and countries, including Norway, New Zealand, Australia, Taiwan, Hong Kong, and South Korea.
Lauren Borduin Quetsch, M.S. will complete her doctoral degree in the Clinical Child Psychology program at West Virginia University in 2019 under the mentorship of Dr. Cheryl B. McNeil. Mrs. Quetsch’s research interests include the dissemination and implementation of evidence-based treatments (EBTs) in community settings as well as the adaptation of EBTs for young children with severe behavioral problems. As a research associate at West Virginia University, Mrs. Quetsch already has more than 20 publications and plans to continue in a research-focused faculty position after graduating from West Virginia University and completing her internship.
Cynthia M. Anderson, Ph.D., B.C.B.A.-D. is the Senior Vice President of Applied Behavior Analysis for the May Institute. She holds a joint appointment as the Director of the May Institute’s National Autism Center. Dr. Anderson provides consultation and support to clinical staff supporting individuals exhibiting challenging behavior such as self-injury, aggression, and property destruction. In addition, she also promotes research in and
dissemination of evidence-based practices through the National Autism Center. Dr. Anderson received her Ph.D. in Clinical-Child Psychology from West Virginia University. She is a licensed psychologist and a Board Certified Behavior Analyst at the doctoral level. Dr. Anderson currently serves as the Applied Representative on the Executive Council of the Association for Behavioral Analysis International and is the Representative at Large for Division 25 of the American Psychological Association. She has provided editorial support to numerous journals including serving as Associate Editor for School Psychology Review and Journal of Behavioral Education, and on the editorial boards of the Journal of Applied Behavior Analysis, The Behavior Analyst, and other journals.
Part I
Conceptual Foundations of EvidenceBased Approaches for Autism Spectrum Disorder
What Is Autism Spectrum Disorder?
Hannah Rea, Krysta LaMotte, and T. Lindsey Burrell
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder with socialcommunication deficits and restricted and/or repetitive behaviors and/or interests. The diagnostic criteria of the disorder have evolved over the years with new research on the features, associated symptoms, prevalence, and etiology of the disorder. This chapter offers an overview of the presentation, development, history, prevalence, and impact of ASD on the child and family. Research on the etiology of ASD, including potential risk factors and dispelled myths, is summarized.
H. Rea
University of Georgia, Athens, GA, USA
K. LaMotte
Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA
T. L. Burrell (*)
Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Emory University School of Medicine, Atlanta, GA, USA
e-mail: Lindsey.Burrell@choa.org
1.1 The Diagnosis and Presentation of Autism Spectrum Disorder
Autism spectrum disorder (ASD) is a neurodevelopmental disorder associated with deficiencies or excesses in two domains: social-communication and restricted, repetitive behaviors and interests (American Psychiatric Association [APA], 2013). Social-communicative skills and restricted and repetitive behaviors and interests vary across individuals with and without a diagnosis of ASD. These distinct domains can be atypical or normative depending on where an individual falls within the spectrum of the behavior. Behaviors of individuals with ASD and normative samples are etiologically and qualitatively related; however, individuals who do not meet the criteria for ASD may not demonstrate abnormalities in those domains, may exhibit abnormalities in a single domain, or may display minimal difficulties in both domains (Constantino & Todd, 2003). Individuals with ASD must exhibit impairment in social-communication and restricted, repetitive behavior and interest, but they are heterogeneous in presentation and severity of impairment. The purpose of this chapter is to describe the history and presentation of ASD by introducing the diagnostic criteria, common presentation and development of the disorder and comorbidities in children, and risk factors that contribute to the disorder.
C. B. McNeil et al. (eds.), Handbook of Parent-Child Interaction Therapy for Children on the Autism Spectrum, https://doi.org/10.1007/978-3-030-03213-5_1
1.1.1 Diagnostic Criteria
The diagnostic criteria for ASD that are most commonly used by clinicians in the United States are derived from the American Psychiatric Association’s Diagnostic Statistical Manual, Fifth Edition (DSM-5 2013). The DSM-5 states that ASD impairments in the domain of socialcommunication include failure to initiate and/or reciprocate emotional and social exchanges, abnormalities in nonverbal communication behavior and understanding, and/or difficulties forming and sustaining relationships. The DSM-5 criteria for restricted interests and repetitive behavior include the presentation of at least two or more of the following: stereotyped or repetitive movements or speech (e.g., flapping arms back and forth or repeating the same sentence/ phrase), rigidity in routine, abnormalities in domain or intensity of interests, and/or abnormalities in reactivity to sensory input (APA, 2013). Despite these specific diagnostic criteria, consistency in presentation across and within individuals and reliability of diagnosis are fairly low (Falkmer, Anderson, Falkmer, & Horlin, 2013) depending on developmental period, severity of impairment, and genetic, medical, and psychosocial comorbidities, which are described below. See Table 1.1 for diagnostic criteria and examples.
1.1.1.1 Social-Communication Deficits
Social-communication deficits or excesses are often the first sign of ASD, and can appear within the first year of a child’s life (Guthrie, Swineford, Nottke, & Wetherby, 2013; Richler et al., 2006; Sacrey et al., 2015). Early social-communication difficulties may include abnormalities in the use of nonverbal expressive and receptive communication, such as gestures and imitation of facial expressions. Before children can speak, most neurotypical children try to communicate with caregivers by pointing or reaching for things. When neurotypical infants see an object of interest, they may engage in joint attention by looking to the object, then the caregiver, and then back at the object, as if to direct their caregiver’s attention to the item of interest (Baron-Cohen, Leslie,
& Frith, 1985). When their caregiver points or looks at something, the infant likely follows the direction of the point. Similarly, when the caregiver smiles, the infant likely reciprocates the behavior and smiles back.
For children with ASD, however, many of those social and communicative behaviors are atypical or absent. Many children with ASD do not engage their parents in acts of joint attention, and may not attempt to gain a caregiver’s attention (Charman, 2003; Macari et al., 2012), for example, by pointing or gesturing (Macari et al., 2012). Additionally, some children with ASD lack imitation skills (see review in Jones, Gliga, Bedford, Charman, & Johnson, 2014). For example, if a parent shakes a rattle or puts blocks together, a child with ASD may not imitate those behaviors. Other atypical behaviors include avoiding looking at faces, glancing at a face quickly, or focusing on parts of the face that do not communicate emotions (Jones et al., 2014). Because infants learn language, communication, and social behaviors through joint attention and imitation (e.g., Charman, 2003), infants and young children with deficits in these areas may miss valuable learning opportunities, which may contribute to more significant and more pronounced impairments at a later age (Dawson, 2008).
As children grow, neurotypical children begin to display interest in and then seek out peers to play with. Some children with ASD seem to avoid social play opportunities, whereas others may desire relationships but do not know how to initiate or maintain them. Such a child may hover on the outskirts of a peer group, but not ever integrate into the group, even when invited to do so. Some children with ASD spend more time in solitary play, even when peers are present (Zager, Cihak, & Stone-MacDonald, 2017), while other children with ASD may attempt to play with peers but do not exhibit the foundational social skills necessary to engage in reciprocal play behavior. For example, a child with ASD may not be skilled in sharing or turn-taking or may not pick up on verbal and nonverbal cues that guide interaction and indicate how a game should be played. A child with ASD may not understand the
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DSM-5 diagnostic criteria and examples
Table 1.1
Examples
• Looks down when someone says, “Hi”
• Responds to a peer’s description of weekend activities with an off-topic monologue
• Avoids eye contact
• Facial expressions and/or tone of voice seem flat or robotic
• Plays alone instead of with others
• Avoids physical touch
• Flaps hands repeatedly
• Organizes toys instead of playing with them
• Throws a tantrum when a stop is added on the typical drive home
• Insists on looking in every window he or she passes by
• Talks almost exclusively about a collection of old video game consoles
• Stares at the wheel of a toy car, instead of the whole car
• Cries when in a place with bright lights or loud noises
• Does not show a reaction to a sudden loud noise, like an alarm or clap of thunder
Diagnostic criteria
Failure to initiate and/or reciprocate emotional and social exchanges
Abnormal nonverbal communication behavior and understanding
Difficulties forming and sustaining relationships
Stereotyped or repetitive movements or speech
Domain
Social-communication Deficits
Restricted, repetitive interests, behaviors, and activities (at least two)
Rigidity in routine
Abnormalities in domain or intensity of interests
Abnormalities in reactivity to sensory input
concept of a “do-over” and may become frustrated at the perception that another child is not following the rules. This unawareness or failure to comply with social norms can lead to peer rejection (Schroeder, Cappadocia, Bebko, Pepler, & Weiss, 2014).
Another key skill that most children with ASD lack is often labeled theory of mind (BaronCohen et al., 1985). Theory of mind is the ability to perceive or understand other people’s perspectives (Wellman, Cross, & Watson, 2001). Children with ASD are typically more concrete and often misinterpret others’ behaviors and miss important social cues. For example, children with ASD may not realize that it is inappropriate to enter into a conversation with a group of individuals who are talking to one another in a heated or an animated manner or may make a factual statement about another person that may be hurtful without considering the other person’s feelings. Children with ASD may also struggle to understand facial expressions and the cause of others’ emotions. For example, a child with ASD may, along with peers, learn that another child in the class was seriously injured. Most peers may cry or otherwise express distress yet the child with ASD may appear unaffected and may even question the behavior of peers, “Why are they crying?” (Bauminger, 2002). Many also struggle to identify, cope with, and appropriately express their own emotional states. For example, some children with ASD may not identify their feeling as “angry” despite yelling, hitting, and clenching their fists (Mazefsky, Borue, Day, & Minshew, 2014).
Additionally, many children with ASD struggle during play due to deficits in imitation, understanding of symbolism (i.e., use of objects, actions, or ideas to represent other objects, actions, or ideas; Prizant, Wetherby, Rubin, & Laurent, 2003), imagination, and social understanding (Bauminger, Shulman, & Agam, 2003). Most preschoolers engage in imaginative and symbolic play, such as pretending to make dinner in a toy kitchen and using the toy stove to “cook.”
However, a child with ASD who has limited imitation or creative play may not know how to join the play. When children with ASD avoid, learn to
avoid, or are rejected from play and social experiences, they miss important modeling and learning opportunities, which may exacerbate their deficits (Dawson, 2008). Children with ASD’s social difficulties are further compounded by excessive repetitive and restricted behaviors, interests, and activities, which may also impact their social engagement and opportunities.
1.1.1.2 Repetitive and Restricted Behaviors, Interests, and Activities
Repetitive and restrictive behaviors often become most apparent when a child begins to play with toys independently and develop language. There is some research reporting repetitive and restrictive behaviors in children with ASD by the second year of life (e.g., Wetherby et al., 2004), while other studies report that those behaviors only become atypical later in childhood (e.g., Werner & Dawson, 2005). The presentation, assessment, and treatment of repetitive and restricted behaviors, interests, and activities will be covered in greater depth in Chap. 9, so they are only briefly reviewed here.
Some repetitive and restricted behaviors change as children develop, as interests and skills change. For example, a young child may repeatedly line up blocks or other toys instead of building or playing with them, and then, in later years, begin to insist that his or her clothes be hung in a particular manner and that other precise organizational patterns are followed (Watt, Wetherby, Barber, & Morgan, 2008). Stereotyped behaviors can also appear in the use of language, such as repeating one word or phrase (echolalia) or only repeating information on one topic that is of interest to them, which may also make the individual seem “rigid” (APA, 2000).
Children with ASD can also exhibit rigidity in their adherence to routines, social flexibility, and understanding of rules. For example, some children with ASD have trouble adapting to unexpected changes to schedules. Some may become upset when other children want to invent new games or alter the rules in games because they do not understand that some rules can be flexible (Hobson, Lee, & Hobson, 2008). Children with
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ASD may also display rigid and atypical interests such as in the mechanics of toys, rather than the function (Ozonoff et al., 2008). For example, while neurotypical children might roll a toy car on the floor and make car noises such as the noise of a horn, a child with ASD might be more likely to play with a toy car by staring at the spinning wheels, repeatedly opening and shutting the hood, or lining up all the toy cars in a row. Children with ASD may have very restricted interests, such as exclusive focus on batting averages in major league baseball, or in types and functions of different vacuum cleaners. Some children become focused on very specific environmental stimuli, such as a moving ceiling fan or reflections in car windows. Vocal children with ASD may focus most or all conversation on their restricted interests and fail to pick up on signals that their conversational partner has lost interest in the topic.
In addition to stereotyped behavior and restricted interests, many children with ASD have abnormal reactions to sensory stimuli that are considered repetitive and restricted behaviors (APA, 2013). Some children with ASD are hypersensitive to sensory experiences, such as reacting negatively to loud noises, bright lights, strong tastes, or physical touch. In contrast, some children with ASD are hyposensitive to sensory stimuli. This is referred to as sensory under responsivity and often manifests as failure to exhibit discomfort or to communicate pain (Hazen, Stornelli, O’Rourke, Koesterer, & McDougle, 2014). For example, a child with ASD may show no reaction when he or she bangs his or her head on the table yet demonstrate clear indicators of pain when he or she trips and falls. Some children with ASD don’t react to even extreme temperatures, such as seeming not to be cold even when the temperature is quite low. Other children may not react to loud and sudden noises, even when the noise was so extreme that everyone around exhibits a startle response. As with other domains, the response to environmental stimuli is variable among children with the same diagnosis.
The range in presentation of DSM-5 criteria alone demonstrates the heterogeneity within the
disorder. Deficits in both core domains can affect movement, speech, interests, and reactions, and children with ASD can present with any combination of types or presentations of abnormalities. Further contributing to differences in presentations is a variety of deficits that are commonly associated with ASD diagnoses.
1.1.2 Associated Deficits and Abnormalities
While not part of the diagnostic criteria, children with ASD often exhibit a range of cognitive, linguistic, and adaptive living deficits, as well (Ousley & Cermak, 2014). Deficits in these other domains are not currently included as core deficits in the diagnosis of ASD because it is unclear if they are caused by comorbid disorders, if they overlap with other disorders because the disorders are related, or if they are more central deficits of ASD (Mazefsky et al., 2014). These commonly co-occurring impairments are noteworthy as they affect presentation and treatment.
1.1.2.1 Cognitive Impairments
Both global cognitive functioning and specific cognitive abnormalities are common in children with ASD but there is no singular cognitive profile (Joseph, Tager-Flusberg, & Lord, 2002). Global cognitive ability can range from intellectual impairment to above-average intelligence, as will be discussed more in the section on comorbidities. But, even children with ASD with aboveaverage intelligence often exhibit some specific cognitive deficit. Common cognitive abnormalities in this population include deficits in executive functioning, a bias towards details instead of the larger picture, the ability to process large amounts of information, cognitive flexibility, and learning and processing speed (DeMyer, Hingtgen, & Jackson, 1981; Minshew & Williams, 2007). Deficits in executive functioning will be reviewed more in the section on comorbidities because they often result in a diagnosis of attention-deficit hyperactivity impulsivity (ADHD) disorder, but the deficits may include problems with working memory and the ability to
inhibit impulses, organize, plan, and execute strategies (Ozonoff & Stayer, 2001). All of these problems can make it difficult for children with ASD to organize large amounts of information together or to break large amounts of information down into manageable parts.
Relatedly, a bias towards focusing on details may make it hard for the child to take a broad perspective or to learn and process large amounts of information (Happé & Frith, 2006). Some children with ASD exhibit superior processing of details, such as the ability to detect modifications to melodies in music (Mottron, Peretz, & Ménard, 2000) or faster performance on spatial tasks, like map learning, because they have a preference for processing details (Caron, Mottron, Rainville, & Chouinard, 2004). The preference for details can be a strength that helps the child excel in fields that value details, like mathematics, engineering, or music. The processing bias can also detract from the child’s perception of the larger picture, in some instances. It remains unclear if these children with ASD have true deficits in global processing, or if their global processing is just negatively impacted by the focus on details sometimes, but bias towards details should be considered as it can affect the child’s social, emotional, and cognitive behaviors (Happé & Frith, 2006). The focus on details is not present in all children with ASD and given the heterogeneity in cognitive ability within and between children with ASD in all cognitive domains it is important to assess each individual’s relative strengths and weaknesses to ascertain where they may excel and where they may need additional support.
1.1.2.2 Linguistic Deficits
Many children with ASD also need support and early intervention due to linguistic deficits beyond social-communication abnormalities (Kim, Paul, Tager-Flushberg, & Lord, 2014). A majority of children with ASD develop expressive and receptive language (Norrelgen et al., 2014), but they do so later and at a slower rate than neurotypical children do (Kim et al., 2014). Some children with ASD have relatively normal language development but make grammatical
errors or exhibit abnormalities in prosody (speech rhythm, stress, and intonation; Charman, Drew, Baird, & Baird, 2003; Eigsti, de Marchena, Schuh, & Kelley, 2011). Finally, some children with ASD do not develop spoken communication or phrase speech at all (Kim et al., 2014; Norrelgen et al., 2014).
For children with ASD who do develop spoken communication, they may exhibit deficits in expressive language, receptive language, or both. Early signs of deficits and delays in receptive language include failure to respond to the sound of one’s name (Nadig et al., 2007) or a mother’s voice in infancy (Klin, 1991), and lack of understanding of instructions at an older age. Expressive language delays include a delayed average age of first word production; the average is 38 months for children with lower functioning ASD, compared to an average age of 8–14 months for neurotypical children (Howlin, 2003). Additionally, some toddlers and children with ASD produce noises that are inappropriate in content, volume, or clarity and some exhibit echolalia, or repetition of others’ words, phrases, and/or intonation (Kim et al., 2014).
Other linguistic errors and oddities can be seen in children with ASD and language delays or normal language development (Kim et al., 2014). Some children make speech and grammatical errors, such as incorrect articulation of consonants (Shriberg et al., 2001), misuse of personal pronouns (e.g., “she wants water” instead of “I want water”), or make errors in other syntactical rules (Kim et al., 2014). These deficits may be related to cognitive ability, too, however (Eigsti et al., 2011). Some children also exhibit prosody oddities, like flat affect or tone (Diehl & Paul, 2013; Lord & Paul, 1997), misplaced stress, slowed phrasing (Shriberg et al., 2001), and/or inappropriate volume and alternation between volumes (Shriberg, Paul, Black, & Van Santen, 2011). These speech oddities can also affect comprehension, as children with ASD may have trouble understanding others’ intonations, prosody marks of questions, or emotion, or they may struggle to integrate knowledge and context with verbal stimuli (Diehl & Paul, 2013; Kim et al.,
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2014). Again, there is heterogeneity in the domain of deficits and many of these deficits only apply to subsets of children with ASD.
As noted above, and contributing to heterogeneity in presentation, a subset of children with ASD do not develop spoken communication. Some children never develop spoken communication while others may have initially talked, and then ceased to do so. Cases of “regression,” or lost skills, are commonly reported in the media, but, because studies are largely based on retrospective reports, more research is needed to examine the validity of these reports (Thurm, Powell, Neul, Wagner, & Zwaigenbaum, 2017). Importantly, many children who do not use spoken communication may be taught to communicate using sign language, pictures, or other methods of augmentative communication (Paul, 2009). For more information on teaching communication, see Chaps. 7 and 8.
1.1.2.3 Adaptive Functioning Deficits
In addition to the deficits that may disrupt social engagement, children with ASD may have motor delays and may be less likely to independently engage in daily living skills. The impairments in communication and social skills previously described likely contribute to adaptive skill deficits. Neurotypical children usually exhibit adaptive living skills that are aligned with their verbal or intellectual ability, but children with ASD may not (Klin et al., 2007). Children with ASD’s adaptive functioning skills are often significantly below their measured cognitive ability (Kanne et al., 2011). The discrepancy between IQ and adaptive functioning is especially pronounced among individuals with high-functioning ASD, who often do not show improvements in adaptive living skills that are comparable to same-aged peers (Klin et al., 2007). These adaptive functioning deficits may manifest as an inability to independently dress, develop appropriate sleep hygiene, become toilet trained, or complete chores. Motor deficits often include difficulties with gross motor skills, like running or jumping, and fine motor abilities, like holding a pencil or tying shoes (Volkmar, 2013). Adaptive skills affect the everyday functioning of children with
ASD across contexts including home, school, and the community.
In sum, children with ASD exhibit a wide array of difficulties in the two core domains that distinguish the diagnosis from others, but they also may demonstrate deficits in other areas, including cognition, language, emotion, and adaptive functioning. No two children with ASD have the same strengths, weaknesses, or presentations because even if they technically meet similar diagnostic criteria, the presentation and severity vary drastically. As our understanding of the presenting problems and the relation between deficits change, so too do the diagnostic criteria and diagnostic considerations. Many of the DSM-5 diagnostic criteria relate to the original case studies on ASD, but much of our understanding has and continues to change.
1.2 History
The current diagnostic criteria for ASD represent a historical development from the first case studies. ASD was first described in case studies by two independent researchers, Leo Kanner and Hans Asperger. In 1943, Austrian-American psychiatrist Leo Kanner met a 5-year-old child who took no interest in people around him, liked to spin around in circles, and threw tantrums when his typical schedule was interrupted (Kanner, 1943; Morrier, Hess, & Heflin, 2008). This case inspired Kanner to conduct 11 case studies, which he compiled into his groundbreaking paper, Autistic Disturbances of Affective Contact (1943). Kanner’s paper was the first to differentiate “infantile autism” from “childhood schizophrenia,” arguing this disorder was not “a departure from an initially present relationship” (p. 242). Rather, it was an “extreme autistic aloneness” (p. 242) in which the child does not respond to anything in the outside world. Kanner stated that the fundamental marker of autism was the “children’s inability to relate themselves in the ordinary way to people and situations from the beginning of life” (Kanner, 1943 p. 242).
One year after Kanner’s publication, Hans Asperger independently wrote about a
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them. Once in a while the young calf would run back, hop around the man, then return to his mother. When the calf would catch up with his mother he would say: “Mother, let us go slow. Father is tired.” The Buffalo cow would say: “No, my son, you must not run to that man; he put us into the fire.” In the night, the man saw a tipi near a river. He went to it. The calf came out and said, “Father, my mother said you were to lie down outside.” The young man lay down outside and went to sleep. When he awoke the next morning the tipi was gone. So he got up and followed the Buffalo. Every time the cow came to a stream of water she would rush in and lay a covering of dust over it, so that the water was hidden. The dust layer would be about two inches deep, so that the man could walk over it. The calf came to the man and said, “Father, do you want to drink?” The man said, “I am dying, for my throat is dry.” The calf told the man that he would stick his foot through the crust of dust, so that he could drink when he came to the little hole; that when he was through he must cover up the hole. The man found the hole and drank. He also washed his face and head. He first thought: “What a little hole. Can I get enough to drink?” But he was soon filled, and thought it wonderful that a little hole like that should hold so much water. The man felt refreshed and ran on after the Buffalo. In the night the man again saw the tipi, and he knew that it was the Buffalo tipi. He went to it, and the calf came out, and said, “Father, my mother says you are to come into the tipi and lie down by the entrance.” So the man went into the tipi and lay down by the entrance. When he woke up, the tipi was gone. He went on west and saw the Buffalo cow going with the calf. The calf went back and met the man, and said, “My father, are you hungry?” The man said, “Yes, I am starving.” The calf said: “Watch me. I will drop something and you are to pick it up and eat it. When you have eaten enough put it away and eat it when you are hungry.” The calf ran, and all at once he stopped. His tail went up and he dropped a chip. The man picked up the chip when he came to it, and to his surprise it was pemmican. It was not a very large piece. It seemed to have more fat in it than meat. As the man took a bite he thought the piece was too small to satisfy his hunger, but as he ate, it seemed to grow larger. It was made from a whole buffalo. That evening the man went into the tipi. He was told by the boy
Buffalo that his mother had said his father was to sit by her So the man walked up where the woman sat and sat down by her. In the night they slept together. The boy was very happy. Next morning the boy got up and played with his father. When the woman got up she shook her robe and wrapped herself in it, and there she stood, a Buffalo. The tipi disappeared. The boy was a Buffalo calf. The three now walked on, and the woman spoke to the man, and said, “On yonder hill sits this boy’s grandfather, who is waiting for us.”
When they arrived at the hill he saw the Buffalo bull sitting upon the hill. When the Buffalo bull saw them coming he stood up, stretched, and said: “So you people have come at last. I have been waiting here for you.” The man then took two eagle feathers and tied them upon the horns of the Buffalo bull. He shook his head and jumped around to see the feathers wave. “Go,” said the Buffalo bull. “This is what we want. You will see two bulls sitting on yonder hill. Give them presents and they will be glad to get them.” So they went on, and when they got to the hill they saw the two bulls. The young man went up to the bulls and put his feathers upon their shaggy heads. They also ran and jumped about, shaking their heads. “Go,” they said. “On yonder hill sit three bulls who are waiting for you. Make them glad by giving them presents.” So they went on again. They came to the hill and the three bulls sat there. The young man put feathers upon their shaggy heads. They also jumped around and were thankful. “Go,” they said. “On yonder hill sit four Buffalo bulls, who are chiefs of the Buffalo camp.” The young man took his feathers and put them upon the heads of the Buffalo The Buffalo jumped around and shook their shaggy heads, each looking at the other’s feathers, until they finally locked horns.
The man, the Buffalo cow, and the boy were told to go and enter the village of the Buffalo. They went and entered and drove off Buffalo, but as the man did not have enough feathers to go around, the Buffalo became mad. Some said, “We can not kill him, for he has not enough.” But others said, “We must kill him, for he burned our messenger.” Some said, “We can not kill him, for the messenger did wrong by turning to an old woman and sticking onto the young man.” The Buffalo were angry. They told the woman to tell the man to sit
upon the hill until it was decided what should be done with him. The young man went upon the hill, took from his buffalo belt a flint stone knife and stuck it in the ground. As he did so he called upon the gods in the ground to form stone around where he sat. The young man seemed to know what was coming.
The calf soon came and told the man that the Buffalo intended to kill him, for the people had burned his mother. The calf told him that there were Buffalo who took his part, but as they were few in number they could do nothing; that the woman had done wrong by turning into an old woman and causing him trouble, but this story was of no avail, for the Buffalo were determined to kill the young man. The man took his seat upon the hill as he was requested. The calf said: “Father, I am to run a race with three other calves. I have a friend here who says that he will help me.” The man looked at Yellow-Calf standing by his son. He knew Yellow-Calf was a wonderful calf, that was liked and loved by all of the Buffalo. So the man knew that the calf was safe. The calves went far away, and ran. The two calves beat the others. The Buffalo were furious, hooking the ground here and there. Again the Buffalo gathered in council and it was decided that the man should hunt his wife. There were four other Buffalo cows placed with the boy’s mother, who looked like them all. The boy placed a burr upon his mother’s head, so that his father would know her. The man passing the Buffalo knew the woman cow and picked her out.
The Buffalo bulls decided to kill the man by rushing upon him where he sat and stamping him to death. If not, then they were to hook him. The boy went to his father and told him what was to happen. He took a downy feather and placed it in his father’s hair The Buffalo came and stamped about the man, around whose head waved the downy feather. Four times the Buffalo rushed upon the man, but when they scattered he was always found sitting upon the hill. The Buffalo became furious. They ran to hook him, but every time the Buffalo hooked the ground their horns were knocked off. The ground around the boy had spread and formed flint rocks, for the boy had stuck his flint stone into the ground and formed flint rock.
Four times the Buffalo attacked the man, but they could not reach him. At last they gave up, and returned to their places in the herd.
The Buffalo now again sat in council. They decided to send the man, Buffalo cow, and calf to the Indian village for presents, such as eagle feathers, and native tobacco. The Buffalo said to the man: “Your people are hungry. You must go home and we will follow you. When the presents have been brought to us, then we will send to your people a bunch of buffalo so that they may kill and have meat to eat.” The man was glad, and started on his homeward journey; but a Buffalo bull got in his way. It had also been decided to turn the man into a Buffalo, and the bull was the one to turn him into a Buffalo. The bull attacked the man, but the man stood his ground and met the Buffalo, so that the man was run over by the Buffalo. The next thing he knew he was locking horns with the other Buffalo and to his surprise he found that he was now a Buffalo.
After the man had become a Buffalo he and his wife and the son started for their country, the main herd of Buffalo following. After several nights’ travel the man told the Buffalo that he and his wife and child would start for their country at once. The Buffalo were glad. The three, as Buffalo, started on ahead, the rest following slowly. They traveled very fast, until at last they came in sight of the village. The Buffalo rested in a hollow and the next morning turned themselves into human beings and walked on into the village. The man found his lodge. People flocked into the lodge to see them, for they were fine-looking beings. Their robes were all new. The man told the people to keep their distance, for they (the people) smelled very badly. The man told of his errand and the people began to come in with eagle feathers and native tobacco. The man took all the things, and with his wife and son went out. People watched them, and as the three went over a hill they became Buffalo again. The three ran until the Buffalo came up, and the man gave many presents. Those who received presents were willing to go with the first bunch to be slaughtered by the people. So the three ran back to the village, and got there in the night. A big fire was made in the Buffalo man’s lodge, chiefs were sent for, and the man told them to be ready to go out the next morning; that the people would find a
bunch of Buffalo on the other side of the hills. The people went out and found the Buffalo. They surrounded them and killed all of them. Again the young man told them to go out and kill Buffalo. Four times they killed. The whole drove came to the village.
The leader of the Buffalo now sat upon a high hill, with a Buffalo skull in front of him. The Buffalo man was sent for, and the Buffalo leader said: “I am satisfied. The people are happy. This day I give you sticks to play with. The two sticks are people. The ring is a kind of people—the Buffalo. When you play, the sticks which you ring are the enemy, whom you conquer. The ring is the Buffalo. The people will become very jealous of their hunting-ground. You will be at war with other people in the country.” These sticks were placed in the priests’ lodge, so that when a bundle ceremony was given the sticks were placed before the people. The sticks were people. Two sets of people who became jealous of the Buffalo then fought. The ones who caught the ring were conquerors. The man went home and lived a long life. The Buffalo calf started the Buffalo ceremony among the people.
FOOTNOTES:
[30] Told by Hawk.
30. THE ORIGIN OF THE WOLF DANCE.[31]
When the Arikara lived on the Missouri River, there was a handsome young man in the village, whose father was a chief. The young man had never been on the war-path. He never played with other young men, but stayed around close to his lodge. Many young girls in the village went to him to be married to him, but he would not have them. There was one place that he went and that was upon a high hill, west of the village. He had a certain way of going to that hill.
Now, there were seven beautiful girls in the tribe, each of whom had tried to marry the young man and had been refused. The seven girls got together and planned to put the young man into a hole, which was about ten feet in depth, and larger at the bottom. They spread some weeds over the hole, and when the time came for the young man to come that way they hid. The young man came, stepped over the hole and fell in.
For some time he stood yelling for help. At last the seven girls went to the hole and they told him that he must give his clothing to them. He took his things off, and the girls each took a little basket, dropped it down, and received in it a piece of clothing. Then each girl dropped her basket, and asked the young man to spit in it, promising that if he did what they asked they would take him out. As each basket received the spittle the girl would pull it out and lick the spittle. After each girl had got the boy’s spittle and licked it, they said, “You must give us your loin-cloth.” This he gave to them. They tore it in seven pieces, so that each had one piece. Iamque puer nudus erat.
Deinde puellæ dixerunt si sibi glandem penis ostenderet eique limum aspergeret, se eum sublaturas. Hoc puer abnuit. Tum dixerunt puellæ, “Si vis nos omnes in matrimonium ducere polliceri, te tollere volumus.” Puer pollicitus est. But all the girls spoke out, and said: “You have always been mean; you have had a dislike for us; we will leave you in this hole and let you die; we are not going to take you out.” So the girls went away and the boy commenced to cry.
Soon after the girls had gone away a gray Wolf looked down upon the boy, and said, “I am sorry for you, and I will help you.” The Wolf went away, and while he was gone a Bear came to the hole. The Wolf came back and a dispute arose over the ownership of the boy. The Bear claimed that the boy belonged to him; but the Wolf said, “He is mine.” The Bear said: “He is mine, too. I shall eat him up.” So the Bear and the Wolf began to quarrel to see who should have the boy. The Wolf whispered to the boy, and said: “I shall dig with this Bear, and you must dig on this side; for if he digs through first he will eat you; but if I dig through first and reach you before he does I shall save you, and you shall be my son.” So it was agreed between the Bear and the Wolf that they each should dig through the earth, and whosoever should first dig through to where the boy was should claim him.
The Bear and the Wolf began to dig. Where the Wolf and the boy were digging there was nothing but sand, while on the side where the Bear was digging it was hard dirt, mixed with stones and gravel; so the Wolf was the first to dig through. When the Bear came through, he found out that the Wolf had already dug through. The Bear stood up, and said, “You have beaten me, but this young man shall be my son, and I shall help him whenever he calls upon me.”
The Wolf took the boy among the Wolves. The boy soon ceased to care to walk, and began to crawl upon his hands and knees, and to eat raw meat, just as the Wolves did. He came to act like a Wolf. The skin upon his haunches was now so thick that he could slide on them.
In the village, the boy’s father mourned for him for many years. But in a chase for buffalo somebody saw a drove of Wolves with this
human being among them. He told other people about it. After the hunt was over, all the men in the camp went out where they had killed the buffalo and there they found the Wolves, and this human being among them. They ran their horses after the Wolves, but this human being ran so fast that he beat all the Wolves and escaped; but they knew that it was the young man. For a whole year they planned to catch the human Wolf, but he was so swift that they could not catch him.
Now, there was a man in the tribe who had medicines for catching the human Wolf and for taking the Wolf feeling out of him. This man agreed to try to catch the human Wolf. So the man went and selected a place in a hilly country. There was a steep bank on the west side, another on the south side, and another on the east side, and there was an opening at the north side. Having selected this place, the man told the people to make their village about three miles east from there. He ordered the women to go to this place, and dig a deep hole on the south side of the banks, so that the Wolves could not climb out. The women also cut long poles and set them on the top of the banks, so that, in case the Wolf did crawl up, these poles would be in his way. At the opening, long poles were set up, so that there was left only a little opening. They also strung a lot of willows, which was to be a doorway to close up the entrance. The man now ordered a certain number of young men to go and kill buffalo. These young men went out, and they killed the buffalo, brought the meat, and placed it inside of this enclosure. The Wolves followed them up, and then the men on horseback circled the Wolves and ran them into this trap, the human Wolf among them. There were four strong men who put on rawhide leggings, and caps with holes in them, so that they could see, and these four men were put into the trap. They ran after the Wolf man. Every time the Wolves ran around by the doorway the door was removed, and the Wolves went out. At last they had the man Wolf by himself. The entrance was stopped. The four men finally succeeded in catching the Wolf man. Then they tied him and took him out. He tried to bite them, but the rawhide was so dry that he could not hurt them. While the four men were catching him the medicine-man had built a sweat-lodge. The hot stones were taken into the lodge quickly and the man was taken in there and tied.
The man poured water upon the hot stones, and sweated the Wolf man. The medicine-man kept pouring water on the stones, until the Wolf man begged for some water. Then the medicine-man gave him some medicine that he had prepared, and the Wolf man began to vomit. The Wolf man vomited hairs of Wolves, white clay, also froth and raw meat. All this time the people were rubbing wild sage upon his body, especially upon his knees. The Wolf man became exhausted and finally said, “I feel better now.” The medicine-man continued to give him medicine until the Wolf man could vomit no more. They then untied him and took him into his lodge, and he finally recovered.
The Wolf man stayed in bed all night and the next day. Then, in the night, he sent for his father. He told his father that he wanted him to build a tipi, and that towards evening he wanted him to go through the village and invite the bravest men in the tribe to come to his, the father’s, tipi—not to the tipi he had built for the boy.
Now, the seven girls who had put the boy into the hole were invited. They were told to dress up in their fine clothes, and as he had promised to marry them he wanted them to come to his tipi that they had put up for him. These girls came to the tipi, and the young man gave them seats. The young man left the lodge, and told his father to place the brave men around the lodge; that he was going out, and as soon as he should come back the guards were to leave their stations. The boy went to the north, and cried, “Father, my father, come and help me!” The Wolves came up, and said: “We will help you. What is it you want?” The boy said: “The girls who were the cause of my being with the Wolves are in my tipi. I want you to devour them.” The Wolves promised that they would. Then the boy went to the west, among the cedars, and there he cried: “Father Bear, make haste. I have something for you to eat.” The Bear came, and said, “My son, what is it?” The boy said: “The girls who put me into the hole are now in my tipi. I want you to go with your friends and devour them.” The Bear said: “We will do this gladly; we will come.” The boy went back to the village, and stood a little distance from his tipi. Soon the Wolves came on his left, and the Bears came from behind. He led them up to his tipi. He told the Wolves to stand
on the north side, and the Bears to stand on the west and south side. After this was done, the young man went into the tipi, and said: “Girls, you put me into a hole, and you left me there to die. The Wolves took me out, and I was with the Wolves for some time. Those same Wolves are now to eat you up.” The girls begged for mercy, but there was no mercy shown them. Each girl tried to crawl out from where she was sitting, but the Wolves ate them.
At the same time the old man, the boy’s father, went through the village, telling the people that the seven girls were being devoured by wild animals, because they had dug the hole and placed his son there to die. The old man told the story of the taking off of the young man’s clothing, and of the girls’ promise to take the boy out of the hole if he would do certain things which he had refused to do, and of their leaving the boy in the hole to die.
When the people heard the story they were angry at the girls, so that the relatives of the girls did not offer to save them, as the girls had done wrong.
The next day the people broke camp and went away from the place. This young man became a great warrior and a brave, and finally became a chief. He married and started a dance among the Arikara that is known as the “Wolf dance.” This was a young man’s dance, but the people do not dance it any more.
FOOTNOTES:
[31] Told by Snowbird.
31. THE MEDICINE DANCE OF THE
BEAVER,
TURTLE, AND WITCHWOMAN.[32]
In olden times the animals met in a lodge to have sleight-of-hand performances. All the medicine-animals and all the birds who had magic power went to this lodge. The animals decided that only the leading animals should perform—the Beaver, the soft-shell Turtle, and the old Witch-Woman.
First, the crowd arose where sat the Medicine-Beaver. The Beaver arose and began to sing, telling his followers to sing. Then the Beaver went to the first post, which was supporting the lodge at the southeast, and began to gnaw it. The post was gnawed until only a small piece of it remained. The Beavers still sang. The Beaver then went to the next post and gnawed away at the base. He gnawed until just a little was left. The Beavers still sang and the Beaver went to the next post and gnawed until he had nearly gnawed through.
The people began to get scared. The animals also became scared, so they called upon the errand man to ask the Beaver not to gnaw the post through, for the lodge was about to fall. The errand man arose and begged the Medicine-Beaver to stop. The Beaver stopped, and then ran around the lodge, repaired all the posts again, and said: “This was only sleight-of-hand. It is not real.” The animals and lookers-on rejoiced to see the trick, for now the lodge stood solid as usual.
Now came the Turtle, who was mad because the Beaver fooled the people. So he called for his followers, and they gathered around him and sang:
“Let me stand where my fathers stood. Let a flood pour forth from my throat! I am doing something wonderful. Let all people look!”
So the people looked. The Turtle took his knife and stuck it close to his left collar-bone. Water began to pour forth from the cut, until there was water all over the lodge. Then the people began to get scared. The errand man was requested to beg the Turtle to stop pouring forth water in the lodge. The errand man begged the Turtle and the Turtle inhaled and drew all the water back into himself. The people all took their places again. Stawi, a Witch-Woman, came, and said:
“Gun given me by old medicine-men. Gun given me by old medicine-men. Gun given me by old medicine-men.”
The old woman had a buffalo robe over her shoulders, and she held in her hands a mysterious-looking thing dotted with spots of white clay and painted in black. At the top of it were red feathers. The object was a gun, a thing to kill with, to shoot medicine. Now, at this time, the old woman wanted to show the power of this mysterious object. She ran around the lodge and then placed the object upon the ground. She ran to it. She wrestled with it. She covered it with her robe. Now she lifted it. She ran around, and all at once she began to groan—as if in pain. At last she called for help, for she was in misery. The people went to her, and there they found the old woman in travail. She was cared for, and she gave birth to a child, who was to become a great medicine-man among the people and a leader in the medicine dance. The medicine-animals rejoiced and sang their songs again with joy.
FOOTNOTES:
[32] Told by White-Bear
32. THE VILLAGE-BOY AND THE WOLF POWER.[33]
In olden times there was a village, and in this village was a man who had five children—four girls and a boy In the dances, the girls would go out and take part, although the boy never went on the warpath, and never left the village. For this reason the people called the boy “Village-Boy.”
After a time the people began to make fun of the girls for dancing when their brother had never gone out on the war-path nor taken part in the battle, fought near the village. The girls were sorry. The boy saw that the girls were being made fun of for dancing when he had not gone on the war-path. The young man told his father that he was going up on a high mound where there was a graveyard. The father was glad of this. The boy put black soot upon his face, and he stuck some grass arrows in his hair He went up into the graveyard, and there he stood, mourning.
While he was there, a big white timber Wolf came to him and asked him what he was crying about. The boy told him that he was a poor boy; that he had never been on the war-path, nor taken a scalp; that he had four sisters who danced in the scalp-dance and were ridiculed for dancing when their brother had never been on the warpath. The Wolf told the boy not to cry, for he would take care of him. The Wolf then told the boy that he would look after him; that he should go into the village; and that the first time there was a warparty he should join it and start out with it; that he, the Wolf, would find him and lead him to the enemy’s camp.
One day it was noised through the camp that the people were going on the war-path. Village-Boy then told his friend that if after they had been gone for three days the scouts should kill any Buffalo, he should get some of the knee-caps of the Buffalo and keep them for him, as he would follow close after them.
The war-party started out, and after they had been gone three days Village-Boy told his father that he was going to start out to overtake the war-party. He also told his sisters to make him some moccasins. So the young man started out on the journey; but before this happened the Wolf had been coming to visit the young man, and had taught the young man the secret powers of the Wolf. So the young man started out, and when he had come to a ravine he rolled himself upon the ground, and when he got up he was a Wolf.
The Wolf followed the trail of the warriors. Some time in the night he came to their camp. He did not go right into the camp, but stayed behind, and some time in the night he barked like a Wolf. His friend said, “There is my friend, Village-Boy.” He took up the burned bones and took them to him. When he got there it was the Village-Boy. He threw the bones at the boy The boy gnawed at the bones, just like a Wolf. When Village-Boy got through eating, he told his friend to go back to the camp where the others were and to watch out, for the next day he should see him, and that then he should tell the people that it was Village-Boy. The boy went to the camp, while Village-Boy went on ahead.
The next day Village-Boy was seen coming. Village-Boy’s friend told the other warriors that he was Village-Boy. So he ran up to Village-Boy. Village-Boy then told his friend that the enemy’s camp was a short distance away. The warriors then stopped and sang some songs for Village-Boy. Village-Boy departed. The next day they saw him again, driving many ponies. He brought them to the people. Then he led the warriors into camp. The war-party then attacked the enemy’s village. Village-Boy was in the lead. He killed one enemy and took his scalp. He left, and hid out while the battle was going on. After a time the warriors came back where the horses were, and Village-Boy came there. He gave the scalp to the leader of the war-
party, also all the ponies, telling him that he was going ahead of them.
Village-Boy now returned to his home. Not a word was spoken by him, nor was anything said by him about the battle. He just lay upon his bed.
A few days afterward the war-party returned home and near the village had a sham battle. The people went out to meet them. It was announced by the leader of the war-party that Village-Boy had done all the killing, and capturing of the ponies. Village-Boy’s father thought that the warriors were making fun of his son because he had come back several days before without anything. But when the warriors came into the village and showed the scalp that Village-Boy had taken and given to the leader, and also when the ponies he had captured were brought to the village, then all the old men believed. Village-Boy’s father scolded him because he had said nothing. Scalp dances were made throughout the village. The young man’s sisters now danced the scalp-dance without fear of ridicule. Whenever the young man went out to dance the women surrounded him. He married and became one of the great men of the village.
One day he took several warriors and went east. He came to a village that was known as the “Village-of-the-Dumb-People.” He left the war-party behind and went into the village by himself. He killed their medicine-man, cut his throat, and carried the head away. As he carried the head away it kept mumbling. The people became excited when they found out that their prophet was dead. They began to talk in a peculiar language. These warriors were followed by the DumbPeople, who did not catch up with them.
The head of the medicine-man was placed in the village. When the head dried it turned into a kind of wood. The people used this head for medicinal purposes. When they wanted to give it to a patient they scraped a portion from the head and gave it to the person for certain sicknesses. It cured many people. The same head is still among our people, only it is about the size of a hen’s egg now.
FOOTNOTES:
[33] Told by Yellow-Bear.
33. THE RABBIT-BOY.[34]
In olden times there was a village upon the Missouri River. In this village the young men were all the time going on the war-path, and there were many dances going on. There was a young man who took no part in their dances, nor in their war-parties. The people made fun of him, but he did not care. Each morning he would sleep until after the sun was high. When he ate he would climb up and sit upon the top of the lodge; but the girls did not seem to care for him. His father scolded him, and wanted to know what was the matter with him. So the young man said, “I have never been anywhere, and I have never felt like going anywhere, but to-day I feel like going upon the graveyard hill, to stand and mourn, and to see if the gods will help me.” The old man took out his white clay. He put it upon the boy, and told him to go up to the graveyard. He said that he hoped the gods would help him. The boy went up on the hill and stood by the graveyard. In the afternoon it stormed. The boy huddled himself against a grave mound. The boy’s father came up and tried to coax him to come down, but the boy was determined to stay there. The old man and the old woman took a piece of buffalo hide and stretched it over the boy, and there he remained during the storm, which lasted several days.
As soon as it cleared up there was a noise overhead that sounded like big wind. The boy did not know what it was, but he could hear whistling coming down from above, then it would come up again. While he was there wondering what it was, there came a JackRabbit. It crawled under his robe. Then an Eagle swooped down and sat by the boy, and it said, “My son, I have run that animal down, and
I want you to give it to me, so that I can eat it.” The Rabbit said: “My son, do not give me up! Do not listen to the Eagle! Just now he has the best of me. If you save me I will give you powers that I possess.” The Eagle said: “Give him to me; I want to eat him! If you give him to me I will give you as many scalps (stretching out his right wing) as there are feathers in this wing.” But the young man would not turn the Rabbit loose, for the Rabbit begged him, and said, “I will make you a great warrior.” Then the Eagle said: “Turn that thing loose, so I can eat it, and when I am satisfied, I will give you powers that I possess. I will give you as many scalps as I have feathers on both wings.” But the Rabbit begged hard, and said: “No, do not turn me loose; he will do nothing of the kind. He will take me and eat me and tell you nothing of his power.” The Eagle spread out its wings, and said: “Now see. So many scalps will I give you.” Then the Eagle spread out its tail, and said: “As many feathers as are in my tail—as many of the enemy you shall strike, counting coup. Now give me that which you have there and let me eat it.” The boy said, “No, the Rabbit came to me, and I will take care of him.” The Eagle flew up and away.
The Rabbit now crawled out of the boy’s robe and sat down by him. After a while he said: “My son, I am thankful to you for saving my life. I will make you a great warrior. I will give you a war-club. I will give you a rabbit-skin to wear about your neck. I will give you paint, which you shall put upon your body, and with this club you will kill many enemies.” So the Rabbit gave the rabbit-skin, the war-club, and the medicine paints to the boy
The boy went down into the village in the night, hung his club and rabbit-skin over the head of his bed, lay down, and went to sleep. The next morning, when the father woke up, he saw these things hanging up. He awakened his wife and told her to see the things that the son had brought back with him. They were both glad to see that the boy had returned.
At this time there was a war-party starting out. The young man told his sisters to make him several pairs of moccasins, for he was going to follow up the warriors. The warriors had been gone for four days when the boy started to follow them. He overtook them on the same
day He selected himself as a scout to go on ahead and see what he could find in the enemy’s country. The young man found the enemy’s camp. He came back and told the warriors what he had found. He then sat down among the warriors. The leader took from his bundle a flint knife and stuck it in the ground in front of where the warriors were sitting. The leading warrior also took a spear and stuck it in the ground. He also stuck in the ground an arrow. “Now,” said he, “warriors, whosoever is going to do hard fighting will please rise and choose the weapon he wishes to fight with.” The young man, who was now known as the “Rabbit-Boy,” arose and took the flint knife. He waited to see if somebody else would take the other weapons. None of them did, so the boy took up the spear and arrow.
Among the warriors was a young man who was very poor. RabbitBoy took a liking for him and gave him the spear. He told the young man to follow him wherever he should go. Rabbit-Boy then rose, and said: “Leader and warriors! I shall go on ahead. I shall bring all the ponies belonging to the enemy. I shall hide them in a hollow.” The leader said, “It is well.” So the young man went and brought all the ponies from the village and hid them in a hollow. The young man came and told the leader that the ponies were safe.
The next thing was to attack the enemy in their camp. Rabbit-Boy took his white clay, put it all over his body, put some rabbit-skins around his ankles, also upon his wrists, and then he put a whole skin around his neck, and the two feathers he put on his head to represent rabbit’s ears. The only weapon that he had was the warclub that had been given to him by the Rabbit. Rabbit-Boy planned the attack. The warriors all crawled up to the village just before daylight, and as the sun was coming up in the east an old man came out of the village. He went around yelling for the people to wake and go after their ponies. As he passed in front of where the Rabbit-Boy was, Rabbit-Boy ran and struck the old man on the head and killed him. Then Rabbit-Boy went through the village. As he came to the center of the village he was just about to go by a big tipi, when out came a pretty young girl, who carried a hide-scraper and a robe. The girl saw the young man very plainly. She stopped and watched him. She wished that she might in some way assist him to get away. The
