Educational Recommendations for Autism Spectrum Disorders
By Elaine Williams, M.A., Child Development Specialist, Autism and Related Disorders
Autism is a lifelong disability with symptoms typically appearing during the first three years of life. Autism Spectrum Disorders are neurobiologically based and encompass a wide range of disabilities that may affect thought, perception, and attention. Autism Spectrum Disorders (ASD) are also known as Pervasive Developmental Disorders (PDD) and include: Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), Asperger’s Syndrome, Childhood Disintegrative Disorder, Rett’s Syndrome, and Autistic Disorder. The term “autism” can thus be used to refer to this entire group of disorders or to the specific subcategory of Autistic Disorder (also known as classical autism).
Autism can block, delay, or distort signals from any or all of the senses. It is difficult for people with autism to interact with other people through social activities and spoken communication. Pragmatic language skills, including gestures, facial expressions, body language, and other nonverbal communication, may also be impaired. Autism may also be associated with difficulties with learning, imagination, and reasoning.
The major characteristics of Autism Spectrum Disorders are:
- Language delays and/or deficits
- Abnormal ways of relating to people, objects, or events
- Unusual reactions to sounds, sights, taste, touch, or smell
- Uneven developmental abilities, scattered strengths and weaknesses
The mildest forms of Autism Spectrum Disorders often appear similar to language delays and learning disabilities. More severe forms may include repetitive behaviors and aggressive behaviors. It is important to distinguish autism from other disorders since incorrect diagnosis may result in inappropriate and ineffective treatments.
The prevalence of ASDs is currently understood to be 6 per 1,000 for the entire spectrum of autistic disorders, with 2/3 of those being in the high-functioning classifications. The implication for educators of these statistics is that many ASD students have the cognitive ability to be included in regular classrooms. It is critical for educators to understand that the cognitive and language competence of individuals with Asperger Syndrome may mask their significant social and communication difficulties, for which classroom adaptations can enable them to succeed personally as well as academically.
Autism Spectrum Disorders are treatable. Early diagnosis and intervention are vital to the future development of the child. Research indicates that with appropriate treatment, individuals with autism can continue to make progress throughout their lives.
1. Educational Setting: The child with an autism spectrum disorder requires a highly structured program with an emphasis on the systematic presentation of materials, with a small class size and a student:teacher ratio which permits considerable personalized attention. Children with autism learn much better in 1:1 or small group instruction because of their difficulties with attention for adult-directed tasks and with understanding and following instructions, as well as the need for behavioral supervision. It is essential that experiences both in the classroom and at home be structured and systematic, thereby promoting a sense of predictability for the child and enabling him to handle transitions and changes in routines more easily.
Research has clearly shown that intensity of early intervention (approximately 25 hours/week) during the preschool years is important in helping the child with ASD to acquire the social and communication skills she lacks. No single educational technique or method has been shown to be effective with all ASD children; hence, an eclectic approach, combining all of the techniques which are appropriate to the individual child at this particular time in her life, is essential.
Because of the heterogeneous nature of autism spectrum disorders, there will be a need within the school system to provide a variety of educational settings for children with ASD, including individualized attention in special educational classrooms, and partially- or wholly-integrated placements in regular classes (inclusion). Students with Asperger's Syndrome/high functioning autism need to be in a school setting with typical peers where they can learn and practice vital social-communication skills in functional and relevant situations.
2. Functional Skills: Although the student with ASD may be able to learn ordinary rote academic skills (such as identifying colors, shapes, numbers, and letters), special attention must be given to the application of skills such as math and reading to practical tasks like independently buying an ice cream and getting the correct change. A simple "rule of functionality" can guide the decision if a particular task will be useful for the student, asking the question "If he can't complete this task, will someone else have to do it for him?" Activities such as pounding on pegboards, singing rhymes, or memorizing Shakespeare don't pass the test for functionality--no one has to do those things for the student. Although ASD individuals are good at learning facts in a specific situation, it is difficult for them to generalize that information into broader and more useful contexts. It is important to focus on the relevance of information to the individual's functioning in the real world, not wasting time on meaningless drills. The emphasis should be on teaching in context--doing real things in real-life situations.
3. Ideally, we want to help the child with ASD to reach the goals of competence and independence. Because the nature of autism interferes with the learning of pragmatic social and communication skills, the school must include the responsibility for the specific, direct training in functional social skills in the child's Individualized Educational Plan (IEP) in addition to academic goals.
4. While it is sometimes necessary and desirable to provide 1:1 instruction for the child with autism, particularly during the preschool years if there are speech and attention difficulties, the child with ASD should be encouraged to work in small groups (1 adult to 2 or 3 students) where she can learn and practice the social and communication skills which will enable interactions with other children and adults in the everyday world. Remember, autism is above all a disorder of social interactions (called "a social learning disability" by Dr. Bryna Siegel), and providing guided experiences in appropriate social responding will be essential throughout the ASD person's life. A combination of individual and small-group teaching is beneficial for most preschool and primary age children with ASD who have limited communication.
Care should be taken to avoid separating the child, either physically or psychologically from social interactions with classmates. If the child has an instructional aide, it is best for that person to facilitate instruction and social interactions in as non-intrusive a way as possible, enabling the child to do the work himself with adequate support, thereby fostering independent functioning over the long term.
5. Because autism is such a complex, heterogeneous disorder, individualized programming is both appropriate and essential for the child with ASD, with frequent reviews to ensure that progress is being made on all Individualized Educational Plan (IEP) goals. If the child is not progressing on each goal and objective, attention should be focused on finding methods which are more adequate to help the child's understanding and acquisition of the skill being taught. Individualized teaching should be demonstrable on a daily basis in the training of specific and functional skills in a variety of areas. The child's IEP should be based on short-term goals and objectives which are mutually agreed upon by her teachers and parents, and which are modified according to her capacity to respond.
6. The child's teachers, aides, and therapists should be trained and experienced in working with children with autism spectrum disorders. Additional staff training through on-site consultations, inservice workshops, and conferences will enable teachers to continue to expand their repertoire of educational techniques for the autism spectrum disorders.
7. Consistency in special education for children with ASD means the use of teaching and behavioral strategies which remain the same across time, environments, and people. Being consistent is an important aspect of structured, systematic teaching, and promotes learning and generalization. Consistency in teaching does not imply rigidity and control, but rather it is based on systematic teaching and dependable environments.
The child with ASD demonstrates his need for consistency by his preference to continue playing the same way with certain toys or materials ("preference for sameness/resistance to change"), which is more comfortable to him than the relative unpredictability of interacting with new persons or places. Consistency will promote learning and generalization to new situations, as well as being the basis for building success and trust for the ASD child.
The child's preference for sameness, insistence on rigid routines, and the tantrums or meltdowns that may result when she is frustrated or overwhelmed, are all evidence for the anxiety which is common to persons with autism. While respecting the child's need for the comfort which her repetitive, self-directed routines bring her, the learning environment should be structured so as to help the child accept changes gradually over time. This process can be greatly facilitated through the use of visual materials (picture schedules, written or computerized planners, sequence strips, daily calendars) to let the child know the order of activities and any variations in the usual sequence of events before and as they occur. The tendency to be rigid about her preferred routines is the child's way of holding things together in the face of a world that is often chaotic and confusing for her.
8. Individuals with autism often have difficulty processing information that comes at them too rapidly, producing overload and shut-down of their ability to understand and respond, including following verbal conversations. It is important to give children and adults with ASD a little extra time (this is known as latency) to process and respond to what has been said or requested.
9. Transitions from one activity to another present considerable difficulty for persons with autism because their sensorimotor world is quite disorganized, based on central nervous system dysfunction. Maintaining "sameness" and/or adherence to their "rules" or standards are ways for them to keep from being overwhelmed by stimuli, and to attain a sense of security that comes from being able to predict what's going to happen next. Sometimes carrying an object from one task to the next is a way of smoothing the transition to another activity or location. Another transition facilitator can be the use of various sensory or movement activities.
10. MAKE IT VISUAL! Because most persons with ASD are much better visual than auditory learners, it is strongly recommended that facilitating transitions as well as general classroom instruction should be accomplished using visual materials which are paired with clear, concrete, concise verbal instructions. For example, one way for a child to comprehend the flow of activities at home and at school is to use a daily calendar in both settings, with a drawing or photo plus the word for each activity. These can be discussed in terms of what he just did, what he's doing now, and what he's going to do next, thereby facilitating his sense of continuity, structure, and security. If there is a change in the usual daily routine (such as seeing his speech therapist in a different setting, or going on a school field trip), a special picture/word card can be given to the child to hold as the day's events unfold, with discussion before, during, and after the event. The use of words along with pictures can be important since some individuals with ASD process and understand written words more easily than the words they hear.
The visual schedule technique can also be applied on an impromptu basis to just 3 or 4 classroom activities occurring in a short period of time by making simple, informal sketches of the sequence of activities and having a space for the child to check off each activity as it's completed before going on to the next. It's a good idea to intersperse favored tasks with those which are more difficult for the child, and to end with something she really enjoys.
1. Communication that is truly functional should be the top priority for instruction of children with ASD. Limitations in both receptive and expressive language interfere with their understanding and performance of a wide variety of learning activities. It is strongly recommended that pictorial-based systems, such as the Picture Exchange Communication System (PECS) or the Prizant/Weatherby Transactional Exchanges, be utilized. These systems have been used successfully with many ASD persons who were previously nonverbal, also often resulting in a decrease in behavior management concerns. Pictorial-based systems use pictures in exchange for items or activities which the child strongly wants, thereby teaching the idea of the transactional nature of true communication, whether by verbal speech or by using just the pictures alone.
2. For children with autism who may have below-average cognitive functioning, and little or no expressive language, the most urgent priority is to provide them with a means to communicate their wants and needs. Their behaviors--sometimes aggressive or anxious--are indeed their means of communication. Furthermore, children with ASD typically have significant deficits in auditory processing, which makes it difficulty for them to understand verbal instructions. One function of echolalia (repeating what has been said, either immediately or after a delay) is for the child to have more time to process and respond to what was just asked or said. Allowing a little latency to give the child extra time to understand and respond may enable her to demonstrate her competence in a task.
3. Although students with Asperger Syndrome may have a large vocabulary and little difficulty in expressing themselves, they usually have significant problems with pragmatic language--the unspoken, between-the-lines aspects of communication which include gestures, facial expressions, body language, and appropriate of language in specific situations. Children with Asperger's typically need IEP goals and objectives which can include: waiting one's turn and introducing a new topic appropriately; holding the floor for an appropriate length of time; noticing when a listener is bored or confused and how to adapt what one is saying accordingly; giving effective directions to a listener; using tact and socially-sensitive comments and observations. Asperger's children and adults may also need help in learning to initiate speech with both adults and peers, such as asking for help; commenting on activities; engaging in truly communicative and socially interactive speech.
1. Since individuals with ASD, including those with Asperger Syndrome, are essentially "socially learning disabled," children with autism need to learn how to initiate and carry out appropriate and complex play interactions with peers, which is more than just parallel play, involving truly sharing in cooperative activities. For persons with Asperger's, the greatest impediment to successful career and life adaptation as adults is the lack of appropriate interpersonal skills. Since they lack the intuitive social instincts to respond appropriately in social situations, these skills must be trained very specifically from an early age throughout all school years and in varying real-life contexts so that they generalize into useful overall abilities which facilitate competence and independence as an adult.
2. Furthermore, it is difficult for persons with ASD to learn social skills just by observing a model, so that how to behave appropriately and what other options might be available must be specifically taught and rehearsed across a wide variety of everyday situations. Just telling the child not to do something is inadequate--they must be taught a number of behavioral options which are appropriate in that situation. That is, we must deliberately teach what they need to know and do in social interactions. Carol Gray's "Social Stories" can be very helpful in this regard (see www.thegraycenter.org).
MOTIVATION AND BEHAVIOR PROBLEMS
1. The ASD child's interest and cooperation in activities which can promote his learning are likely to be best motivated by utilizing his own special interests or routines (whatever is truly important to him at the time, such as aliens and outer space themes, dinosaurs, trains, mermaids, jumping, playing with strings, favorite music, water play) as a means to teach and provide practice in new concepts. In addition, giving the student frequent short "rest breaks" in which he can engage in his own self-directed play or stereotypic behaviors, and/or providing frequent sensory-input breaks with sensory diet activities, should be beneficial in rewarding the child's cooperation for and continuation of other educational tasks.
2. It is important to make use of the child's own particular reinforcers (which may be unusual!) in order to catch her attention for activities and to motivate her to participate on her own. These reinforcers should be given initially for behaviors which the child can already do well, then gradually increase the complexity and variety of what she is asked to do for them.
3. Regarding tantrums and other undesirable behaviors, it is recommended that the child's parents and teachers study the situations in which the behaviors occur, then change the antecedents and/or consequences as necessary. It is important to try to anticipate times or situations which are most likely to provoke outbursts and head them off preventatively, although take care not to facilitate things so much that he does not learn how to adapt to changes and other daily-life situations. Instead of just pointing out what a child should not do, it is essential to teach the desirable alternative behaviors which help the child get what he wants in a socially acceptable way. Offering the child frequent, short breaks and/or using systematic rewards for his compliance (such as play with Legos, if that's a favorite activity) are additional means for reinforcement of his cooperative efforts.
4. The use of medications in conjunction with appropriate behavior management techniques is often the best way to help with attentional and behavioral problems. Consultation regarding medical management should be discussed with a physician who is experienced in treating children with autism spectrum disorders. Medications may also be essential in managing the anxiety disorders which frequently accompany autism at all points along the spectrum and throughout life.
SENSORY MOTOR PROCESSING
1. Children with ASD usually have difficulty with receiving and responding to sensory stimuli, and in the integration of input from the five senses. For this reason, it is important to obtain an assessment by an occupational or physical therapist with experience in autism and who is trained in Sensory Integration techniques to determine if the child has difficulty in these areas, and to receive appropriate therapy which should be carried out in treatment settings and in everyday situations (home and classroom). Suggestions by the SI therapist for individualized sensory diet activities should be incorporated frequently into the child's day, in all life settings, in order to maintain her level of comfort and cooperation. As mentioned above, having opportunities for regular, predictable sensory input may help the child during transitions or other adjustments (such as their "off days" which are so common in ASD children, as they are with students who have attention deficit disorder or learning disabilities).
2. The use of intensive sensorimotor therapy activities for very significantly impaired persons with autism who fail to relate or have little interest in their environment, and who do not communicate verbally, is strongly recommended. This emphasis on almost continuous SI activities will be the basis for the child to eventually organize his world, and to be able to respond to other activities which can promote his communication and learning. Serious behavioral problems are also usually responsive to adequate sensory input.
3. Teachers and parents should be aware that children with ASDs frequently have particular difficulty with motor planning (praxis) and specifically with handwriting skills, even though their fine and gross motor functioning may otherwise be adequate. If such is the case, the use of a computer to do schoolwork, both in the classroom and at home, should be viewed as a necessary prosthetic device, such as eyeglasses are for visually impaired persons. The program "Handwriting Without Tears" has been very successful in assisting with the improvement of handwriting skills in ASD individuals (see website: www.hwtears.com).
4. Remember that teaching "skills" (whether occupational/physical therapy or speech) only in therapy sessions is inadequate--these techniques and supports must be integrated into their everyday lives. Persons with autism spectrum disorders frequently describe their difficulty with sensory hypersensitivities and/or dysfunctions throughout their lives, indicating that this problem is an almost-universal aspect of the overall disability.
Most students with autism, regardless at which point they may fall along the continuum of intellectual and communication abilities, have difficulty with attention and the executive functions of self-monitored organizational skills. Direct, explicit training in strategies for self-regulation and other executive function capabilities are advised, particularly for students with Asperger syndrome. Such teaching can help the child to learn: flexibility of thoughts and actions, planning and organizational strategies, using feedback from mistakes, and shifting away from ineffective problem-solving strategies. Additional executive functions include: goal selection and self-monitoring on progress toward a goal; organized search for new solutions; impulse control; inhibition of irrelevant responses; the organization, ordering, and categorization of information; and help in attentional skills (initiating, sustaining, inhibiting, and shifting attention). Further advice regarding executive function disorders and strategies can be obtained from a neuropsychologist experienced in working with ASD individuals.
THE FOCUS FOR TEACHING CHILDREN WITH AUTISM SPECTRUM DISORDERS SHOULD BE ON FUNCTIONAL LEARNING AND COMMUNCIATION, WHICH IS TAUGHT IN CONTEXT, IS MEANINGFUL TO EVERYDAY LIFE, IS TAUGHT VISUALLY, WITH THE GOAL OF MAKING WHAT THE CHILD LEARNS USEFUL BECAUSE ALL THE PIECES FIT TOGTHER IN A WAY THAT IS COMPREHENSIBLE FOR HIM.