While most first- and second-graders at Medford's Abraham Lincoln Elementary are reading or solving math problems, the pupils in teacher Jennifer McBride's class are reviewing a lesson on how to greet someone.

Sporting two paper bag puppets, "Sally" and "Max," to demonstrate each step, McBride asks, "What are the three things you need to do to greet someone?"

"Say hello!" a boy shouts out.

"You're supposed to smile," chimes in another.

"Look at the person's eyes," adds a third.

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The social courtesies and behavior that most children learn during ordinary interaction early in life are usually a puzzle to students with autism.

Significant growth in the number of students with the neurological disorder spurred the Medford School District to launch Abraham Lincoln's STAR (Strategies for Teaching using Autism Research) program three years ago to help meet their unique needs.

Autism, the fastest-growing disorder among Oregon school children, changes the way teachers give instruction. Social skills often have to be taught before anything else.

The need for specialized instruction span the state and nation, where the perplexing disorder is being diagnosed in record numbers.

On average, about one in 150 U.S. children has autism, according to a study released last month by the U.S. Centers for Disease Control and Prevention.

In Oregon, autism numbers have more than quadrupled in the last 10 years to 6,374 in 2006, from 1,617 in 1996, according to the Oregon Department of Education.

The causes and cures of autism remain a mystery, but the disorder has certain patterns, favoring boys and sometimes manifesting itself in more than one member of a family.

"Historically, autism is the kid who rocks back and forth," said Kelli Schlapfer, a Medford district autism specialist.

In Oregon, the definition has expanded to include any child whose education is hampered by a combination of characteristics: communication, sensory and social impairments and patterns such as a fixation on a particular object. Asperger's syndrome and pervasive development disorders are also counted in the autism category.

Autism, however, can take different forms, and not all children exhibit the same characteristics. For instance, some children with autism don't speak at all, while others are loquacious.

In the STAR program, the goal is to equip pupils who have autism with enough social skills to function in a mainstream classroom.

"Most came to us because they weren't making it in regular education," McBride said.

The students, in grades kindergarten through second, possess some language skills and to the casual observer appear normal.

"They are almost able to reach regular education, but they have holes," said Schlapfer. "If we can fill the holes with enough social and academic skills, they can learn in a regular education setting."

Behaviors such as regarding a person who is speaking generally have to be taught because children with autism don't understand most social courtesies.

Their disorder often doesn't allow them to understand the perspective of others.

"For them, life is about what works," Schlapfer said. "It's not about social perceptions."

STAR lessons involve step-by-step behavioral instruction and visual prompts. A lesson on answering questions during class might include a teacher giving instructions such as, "Raise your hand if you know the answer. If the teacher calls on another student, put your hand down." A handout with pictures exhibiting the desired behavior might follow that.

"Otherwise he might keep his hand up for 20 minutes," McBride said.

The walls of McBride's classroom are sparse. Fluorescent lights are taboo. Children with autism generally cannot tolerate the sensory onslaught of flickering and buzzing from the energy-efficient bulbs, nor the distraction of colorful classroom decorations that delight other children.

Even small changes to the classroom require careful consideration and strategy. Autism drastically increases most children's sensitivity to change.

"If there is major change to the day or the structure of the room, we would pre-teach them and prepare them before the change ever happened," Schlapfer said.

The STAR program's aim to move pupils to a regular classroom is not always achieved.

Depending on test results and goals outlined in their state-mandated independent education plan, some pupils will go to a regular classroom, possibly with the assistance of a special education aide.

Others move to other special programs, including MAPS (Multiple Age Positive Supports), which offers more structure and one-on-one attention, and Focus, which teaches desired behaviors.

Another option is STEPS (Specialized Training in Education Program Service), a life skills program for those with more severe autism or other disabilities.

Parents are often faced with agonizing decisions about where to send their child next, a choice they usually make in tandem with teachers and administrators.

"It's hard because you want to make sure you make the best decision for them at the time and for their future success," said Jim Norris, father of 6-year-old STAR pupil Elena.

Elena can read, spell, count and type and is adept at using a computer. But her limited fine motor skills keep her from fully grasping a pencil, and her cognitive function is limited in responding to situations happening around her.

For instance, Norris said, she will give the same response to the same question given any situation, a condition known as echolalia, involuntarily repeating the speech of another person.

Her teachers have recommended she move to the MAPS program because they fear she will fall behind her STAR classmates in schoolwork, he said.

"To me, it's not that she can't grasp the concepts," Norris said. "It's that she can't hold a pencil."

For a parent, learning that a child has autism is often a slow dawning.

"We thought she was just slow in her developmental milestones," said Linda Hansen, whose daughter, Andrea, is now 16. "We didn't have a problem with that. We were just loving her and enjoying each milestone because they were so hard to get to, so when we reach one it is very exciting."

Andrea made her way in special education programs in public schools in Central Point for a decade. But once she reached her freshman year, the enormity of Crater High and its some 1,500 pupils overwhelmed her.

Her parents and Crater officials mutually decided to pull Andrea out of Crater and provide her with home instruction to reduce her anxiety. A Crater tutor visits her home three times per week, during which time Andrea works on schoolwork at about middle school level.

"She is happier inside her house, but these kids can't ask for help, so you only know something is wrong when they act out," Hansen said.

For Andrea, that often involves a tantrum, Hansen said.

A month ago, Andrea started attending a STEPS program at Crater two days a week.

To prepare her for the change, STEPS staff members sent her a pamphlet with photographs of each employee and student in the program and information about their personality, preferences and habits.

By seeing their faces in advance, Andrea was able to smoothly transition to the program.

"She does have decent academic skills," Hansen said. "It's more the social situations that blow her away."

Some students with autism demonstrate remarkable skills in math, reading, computer literacy and memorization, but putting them to use in a career is another matter. Because of their social limitations and aversion to change, it's rare for adults with autism to keep a job, and they often need lifelong support of some form, Schlapfer said.

"They can learn how to ride a bus, but if a problem comes up, they don't know what to do," she said. "They don't ask for help because they don't know they need it. They are just frustrated."

Reach reporter Paris Achen at 541-776-4459 or pachen@mailtribune.com.