The Sevier County Department of Special
Education’s
Manual for Working with Students with Autism Spectrum Disorders:
An Integrated Approach to
Educating the Autistic Child
June, 2000
AUTISM SPECTRUM DISORDERS
Autism
is a pervasive developmental disorder, which is characterized by impairments in
communication and social interaction, and restricted, repetitive and
stereotypic patterns of behavior, interests, and activities (American
Psychiatric Association (APA), 1994). It is a complex neurological disorder
that affects the functioning of the brain.
Autism
is referred to as a spectrum disorder, which means that the symptoms can be
present in a variety of combinations, and can range from mild to severe.
Multiple abilities can be affected, while others are not (Bristol et al., 1996;
Minshew, Sheeney, and Bauman, 1997).
Some individuals may have a severe intellectual disability, while others have normal levels of intelligence. There may be a range of difficulties in expressive and receptive language and communication. It is estimated that up to 50% of individuals with autism do not develop functional speech. For those who do, speech may have unusual qualities and be limited in terms of communicative functions. There are problems with attention and resistance to change. All individuals with autism have difficulties with social interaction, but the extent and type of difficulty may vary. Some may be very withdrawn, while others may be overly active and approach others in peculiar ways. They may respond differently to sensory stimuli and may exhibit odd behaviors such as hand flapping, spinning, or rocking. They may also demonstrate unusual use of objects and attachments to objects.
Although
individuals with autism share some common features, no two individuals are the
same. In addition, the pattern and extent of difficulties may change with
development. The common characteristics help us to understand general needs
associated with autism, but there is a need to combine this information with
knowledge of the specific interests, abilities, and personality of each
student.
Prevalence
Prevalence
has been commonly cited as 4.5 in every 10,000 births. However, recent
estimates of the prevalence of autism indicate a frequency of 10 in 10,000 (Bristol
et al, 1996; Bryson, Clark & Smith, 1988), and a higher incidence when the
broader spectrum of Pervasive Developmental Disorders is included.
There
is a higher incidence among males. The ratio varies depending on the
definition, but studies reveal a ratio of 3:1 to 4:1 males to females (Bryson,
1997).
Etiology
Considerable research has been, and is being, conducted around the question of what causes autism. Although the cause is not known, there is growing evidence that autism is a genetic condition, and that there may be several different genes involved. (Bristol et al., 1996; Rutter, Bailey, Simonoff, & Pickels, 1997)
DIAGNOSIS
The
diagnosis of autism is made by a physician or clinical psychologist with
expertise in the area of autism. Assessment and diagnosis typically involve a
multidisciplinary team comprised of a pediatrician or psychiatrist, a
psychologist, and a speech and language pathologist (SLP). The psychologist
administers assessments to gather information on developmental level and behavior,
and the SLP assesses speech, language, and communicative behaviors. The medical
assessment is conducted to rule out other possible causes for the symptoms, as
many of the characteristics associated with autism are also present in other
disorders. In addition, a medical and developmental history is taken through
discussion with the parents. This information is combined with the assessments
to provide the overall picture, and to rule out other contributing factors. Parents who are seeking additional
information regarding diagnosis can contact health professionals in their
community.
Autism
is diagnosed by the presence or absence of certain behaviors, characteristic
symptoms, and developmental delays. The criteria for autism and other Pervasive
Developmental Disorders are outlined in the Diagnostic and Statistical Manual
of Mental Disorders (DSM-IV) (American Psychiatric Association, 1994) and the
International Classification of Diseases (ICD-10) (World Health Organization,
1993).
The DSM-IV, which is most commonly used in North America, classifies autism within the category of Pervasive Developmental Disorders (PDD). PDD is an umbrella term for disorders that involve impairments in reciprocal social interaction skills, communication skills, and the presence of stereotyped behaviors, interests, and activities. The onset of the symptoms occurs before the age of three years. The conditions classified as PDD’s are:
Autism
Childhood Disintegrative Disorder (CDD)
Rett’s Disorder
Asperger’s Disorder
Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS)
Autism
has, historically, been the most well defined diagnosis within the category of
PDD. At times, some of these diagnostic terms appear to be used interchangeably
within the literature and by practitioners. The term Autism Spectrum Disorders
is sometimes used to refer to autism and other conditions that are included
within the PDD classification. PDD is sometimes used to refer to all conditions
within the category of PDD, and at other times it has been used to refer to
PDD-NOS.
It
is important to note that all of the disorders within the PDD classification
have some common features and may benefit from the same instructional
strategies, but there are differences in some areas such as the number of
symptoms, age of onset, and developmental pattern. The following diagnostic
criteria for each of the disorders outlines the characteristics.
DSM-IV
Criteria for Autistic Disorder
Rett’s
Disorder
Childhood
Disintegrative Disorder
Asperger’s Disorder
Pervasive
Development Disorder - Not Otherwise Specified
DSM-IV Criteria for Autistic
Disorder (299.00)
A.
A
total of at least six items from (1), (2), and (3), with at least two from (1),
and one from (2) and (3):
(1)
Qualitative impairment in social interaction, as manifested by at least two of
the following:
1
(a) Marked impairment in the use of multiple
nonverbal behaviors such as eye-to-eye
gaze, facial expression, body postures, and gestures to regulate social
interaction
(b)
Failure to develop peer relationships appropriate to developmental level
(c)
Markedly impaired expression of pleasure in other people’s happiness.
(2)
Qualitative impairments in communication as manifested by at least one of the
following:
(a)
Delay in, or total lack of, the development of spoken language (not accompanied
by an attempt to compensate through alternative modes of communication such as
gestures or mime)
(b)
In individuals with adequate speech, marked impairment in the ability to
initiate or sustain a conversation with others
(c)
Stereotyped and repetitive use of language or idiosyncratic language
(d)
Lack of varied spontaneous make-believe play or social imitative play
appropriate to
developmental
level.
(3)
Restricted repetitive and stereotyped patterns of behavior, interests, and
activities, as manifested by as least one of the following:
(a)
Encompassing preoccupation with one or more stereotyped and restricted patterns
of interest that is abnormal either in intensity or focus
(b)
Apparently compulsive adherence to specific nonfunctional routines or rituals
(c)
Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or
twisting, or complex whole-body movements)
(d)
Persistent preoccupation with parts of objects.
B.
Delays
or abnormal functioning in at least one of the following areas, with onset
prior to age threeYears:
(1)
social interaction,
(2)
language as used in social communication, or
(3)
symbolic or imaginative play.
C.
Not
better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder.
Reprinted,
with permission, from the Diagnostic and Statistical Manual of Mental
Disorders, 4th Edition, (1994). Washington, DC: American Psychiatric
Association, pp. 70-71.
Rett’s Disorder
Rett’s
Disroder, also referred to as Rett syndrome, is a condition that is found only
in females. Physical and mental development are essentially normal for the
first 6 to 8 months of life. This is followed by a slowing or cessation in
achieving developmental milestones. By 15 months of age, about half of the
children with Rett syndrome demonstrate serious developmental delays. By age
three, there is generally a rapid deterioration of behavior evidenced by loss
of speech and excessive levels of hand patting, waving, and involuntary hand
movements (Van Acker, 1997).
DSM-IV
Diagnostic criteria for 299.80 Rett’s Disorder
A.
All
of the following:
(1)
apparently normal prenatal and perinatal development
(2)
apparently normal psychomotor development through the first 5 months after
birth
(3)
normal head circumference at birth.
B.
Onset
of all of the following after the period of normal development:
(1)
deceleration of head growth between ages five and 48 months
(2)
loss of previously acquired purposeful hand skills between ages five and 30
months with the subsequent development of stereotyped hand movements (e.g.,
hand-wringing or hand washing)
(3)
loss of social engagement early in the course (although often social
interaction develops later)
(4)
appearance of poorly coordinated gait or trunk movements
(5)
severely impaired expressive and receptive language development with severe
psychomotor retardation
Reprinted,
with permission, from the Diagnostic and Statistical Manual of Mental
Disorders, 4th Edition, (1994). Washington, DC: American Psychiatric
Association, pp. 72-73.
Childhood Disintegrative
Disorder
For individuals with CDD, there may be several years of reasonably normal development, which is followed by a loss of previously acquired skills. In approximately 75% of cases, the child’s behavior and development deteriorate to a much lower level of functioning. The deterioration stops, but there are minimal developmental gains past this point in the progression of the disorder. In addition, there is the development of various autistic-like features (Volkmar, Klin, Marans, & Cohen, 1997).
DSM-IV
Diagnostic criteria for 299.10 Childhood Disintegrative Disorder
A.
Apparently
normal development for at least the first two years after birth as manifested
by the presence of age-appropriate verbal and nonverbal communication, social
relationships, play, and adaptive behavior.
B.
Clinically
significant loss of previously acquired skills (before age 10 years) in at
least two of the following areas:
(1)
expressive or receptive language
(2) social skills or adaptive behavior
(3)
bowel or bladder control
(4)
play
(5)
motor skills
C.
Abnormalities
of functioning in at least two of the following areas:
(1)
qualitative impairment in social interaction (e.g., impairment in nonverbal
behaviors, failure to develop peer relationships, lack of social or emotional
reciprocity)
(2)
qualitative impairments in communication (e.g., delay or lack of spoken
language, inability to initiate or sustain a conversation, stereotyped and
repetitive use of language, lack of varied make-believe play)
(3)
restricted, repetitive, and stereotyped patterns of behavior, interests, and
activities, including motor stereotypes and mannerisms.
D.
The
disturbance is not better accounted for by another specific Pervasive
Developmental Disorder or by Schizophrenia.
Reprinted,
with permission, from the Diagnostic and Statistical Manual of Mental
Disorders, 4th Edition, (1994). Washington, DC: American Psychiatric
Association, pp. 74-75.
Asperger’s Disorder
Asperger
syndrome has many features common to autism. The distinguishing criteria are
that there are no clinically significant delays in early language development,
and no clinically significant delays in cognitive development or in the
development of age-appropriate self-help skills, adaptive behaviour, and
curiosity about the environment in childhood. The DSM-IV uses the term
Asperger’s Disorder. In this document we use the term Asperger syndrome, which
is consistent with the literature in the area.
DSM-IV Diagnostic criteria
for 299.80 Asperger’s Disorder
A.
Qualitative
impairment in social interaction, as manifested by at least two of the
following:
(1)
marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye
gaze, facial expression, body postures, and gestures to regulate social
interaction
(2)
failure to develop peer relationships appropriate to developmental level
(3)
a lack of spontaneous seeking to share enjoyment, interest, or achievements
with other people (e.g., by a lack of showing, bringing, or pointing out
objects of interest to other people)
(4)
lack of social or emotional reciprocity.
B.
Restricted
repetitive and stereotyped patterns of behavior, interests, and activities, as
manifested by at least one of the following:
(1)
encompassing preoccupation with one or more stereotyped and restricted patterns
of interest that is abnormal either in intensity or focus
(2) apparently inflexible adherence to specific, nonfunctional routines or rituals
(3)
stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or
twisting, or complex whole-body movements)
(4)
persistent preoccupation with parts of objects.
C.
The
disturbance causes clinically significant impairment in social, occupation, or
other important areas of functioning.
D.
There
is no clinically significant general delay in language (e.g., single words used
by age two years, communicative phrases used by age three years).
E.
There
is no clinically significant delay in cognitive development or in the
development of age-appropriate self-help skills, adaptive behavior (other than
in social interaction), and curiosity about the environment in childhood.
F.
Criteria
are not met for another specific Pervasive Developmental Disorders or
Schizophrenia.
Reprinted, with permission, from the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, (1994). Washington, DC: American Psychiatric Association, p. 77.
Pervasive Developmental
Disorder Not Otherwise Specified (Including Atypical Autism)
This
diagnosis is used when an individual demonstrates impairments in the
development of reciprocal social interaction or verbal and nonverbal
communication, or when the repetitive and stereotyped behaviors are present,
but the criteria are not met for Autistic Disorder, Asperger’s Disorder, Rett’s
Disorder, or other specific conditions (DSM-IV, 1994).
Educating The Student With Asperger
Syndrome
Persons
with Asperger syndrome (AS) share some of the same characteristics as
individuals with autism, and there is debate on whether AS is an independent
diagnostic category or another dimension at the higher end of the autistic
continuum (Szatmari,1995). Although Asperger syndrome shares some
characteristics with higher-functioning autism, there are some unique features,
and a different developmental progression and prognosis (Myles & Simpson,
1998) for individuals with AS.
According
to DSM-IV (1994) criteria, the child must meet the criteria for social
impairment, repetitive activities and age of onset, but have normal cognitive
and language development. AS involves fewer symptoms than autism.
1.
Asperger syndrome is characterized by a qualitative impairment in social interaction. Individuals with AS may be keen to relate to others, but do not have the skills, and may approach others in peculiar ways (Klin & Volkmar, 1997). They frequently lack understanding of social customs and may appear socially awkward, have difficulty with empathy, and misinterpret social cues. Individuals with AS are poor incidental social learners and need explicit instruction in social skills.
2.
Although children with AS usually speak fluently by five years of age, they often have problems with pragmatics (the use of language in social contexts), semantics (not being able to recognize multiple meanings) and prosody (the pitch, stress, and rhythm of speech) (Attwood, 1998). Students with AS may have an advanced vocabulary and frequently talk incessantly about a favorite subject. The topic may be somewhat narrowly defined and the individual may have difficulty switching to another topic. They may have difficulties with the rules of conversation. Students with AS may interrupt or talk over the speech of others, may make irrelevant comments and have difficulty initiating and terminating conversations. Speech may be characterized by a lack of variation in pitch, stress and rhythm and, as the student reaches adolescence, speech may become pedantic (overly formal). Social communication problems can include standing too close, staring, abnormal body posture and failure to understand gestures and facial expressions.
3.
The
student with AS is of average to above average intelligence and may appear
quite capable. Many are
relatively
proficient in knowledge of facts, and may have extensive factual information
about a subject that they are absorbed with. However, they demonstrate relative
weaknesses in comprehension and abstract thought, as well as in social
cognition. Consequently, they do experience some academic problems,
particularly with reading comprehension, problem solving, organizational
skills, concept development, and making inferences and judgements. In addition, they often
have difficulty with cognitive flexibility. That is their thinking tends to be
rigid. They often have difficulty
adapting to change or failure and do not readily learn from their mistakes
(Attwood, 1998).
4.
It
is estimated that 50%-90% of people with AS have problems with motor
coordination (Attwood, 1998). The affected areas may include locomotion, ball
skills, balance, manual dexterity, handwriting, rapid movements, lax joints,
rhythm and imitation of movements.
5.
Individuals with AS share common characteristics with autism in terms of responses to sensory stimuli. They may be hypersensitive to some stimuli and may engage in unusual behaviors to obtain a specific sensory stimulation.
6.
Individuals
with AS may also be inattentive and easily distracted and many receive a
diagnosis of ADHD at one point in their lives (Myles & Simpson, 1998).
7.
Anxiety
is also a characteristic associated with AS. It may be difficult for the
student to understand and adapt to the social demands of school. Appropriate
instruction and support can help to alleviate some of the stress.
Many
of the strategies for teaching students with autism are applicable for students
with AS. The professional literature often does not differentiate between
high-functioning autism and Asperger syndrome when outlining recommended
practices. However, it is important to
give consideration to the unique learning characteristics, to provide support
when needed, and to build on the student’s many strengths.
The following identifies the specific learning diffculty and suggests a number of possible classroom strategies: Adapted from Attwood (1998), Donnelly & Levy (1995), Grandin (1998), Moreno & O’Neal (1997), Myles & Simpson (1998), Williams, (1995).
Learning
Difficulty
Classroom
Strategies
tendency
to make irrelevant comments
tendency
to interrupt
tendency
to talk on one topic and to talk over the
speech
of others
difficulty
understanding complex language, following directions, and understanding intent
of words with multiple meanings
Comic
Strip Conversations (Gray, 1994) can be applied to a range of problems with
conversation skills
teach
appropriate opening comments
teach
student to seek assistance when confused
small
group instruction for conversational skills
teach
rules and cues regarding turn-taking in conversation and when to reply,
interrupt or change the topic
use
audio taped and videotaped conversations
explain
metaphors and words with double meanings
encourage
the student to ask for an instruction to be
repeated,
simplified or written down if he does not understand
pause
between instructions and check for understanding
limit
oral questions to a number the student can manage
watch videos to identify nonverbal expressions and their meanings
Insistence
on sameness
wherever
possible prepare the student for potential change
use
pictures, schedules and social stories to indicate impending changes
Impairment in social interaction
difficulty
understanding the rules of social interaction
may
be naïve
interprets
literally what is said
difficulty
reading the emotions of others
lacks
tact
problems
with social distance
difficulty
understanding "unwritten rules" and when
they
do learn them, may apply them rigidly
provide
clear expectations and rules for behavior
explicitly
teach rules of social conduct
teach
the student how to interact through social stories,
modeling
and role-playing
educate
peers about how to respond to the student’s
disability
in social interaction
use
other children as cues to indicate what to do
encourage
cooperative games
may
need to provide supervision and support for the
student
at breaks and recess
use
a buddy system to assist the student during
non-structured
times
teach
the student how to start, maintain and end play
teach
flexibility, cooperation and sharing
teach
the students how to monitor their own behaviour
structured
social skills groups can provide opportunity
for
direct instruction on specific skills and to practice
actual
events
may
need to develop relaxation techniques and have a
quiet
place to go to relax
Restricted range of interests
Limit extended discussions and questions
set
firm expectations for the classroom, but also provide opportunities for the
student to pursue his own interests
incorporate
and expand on interest in activities and assignments
often
off task
distractible
may
be disorganized
difficulty
sustaining attention
frequent
teacher feedback and redirection
break
down assignments
timed
work sessions
reduced
homework assignments
seating
at the front
use
nonverbal cues to get attention
Poor organizational skills
use
schedules and calendars
maintain
lists of assignments
help
the student to use "to do" lists and checklists
pictures
on containers and locker
picture
cues in lockers
Poor motor coordination
involve
in fitness activities
may
prefer fitness activities to competitive sports
take
slower writing speed into account when giving
assignments
(length often needs to be reduced)
provide
extra time for tests
consider
the use of a computer for written assignments,
as
some students may be more skilled at using a
keyboard than writing
Academic
difficulties
usually
average to above average intelligence
good
recall of factual information
areas
of difficulty include poor problem solving,
comprehension
problems and difficulty with abstract concepts
Often
strong in word recognition and may learn to read very early, but difficulty
with comprehension
May
do well at mathematical computations, but have difficulty with problem solving
don’t assume that the student has understood simply because he/she can re-state
the information
be
as concrete as possible in presenting new concepts and abstract material
use
activity-based learning where possible
use
graphic organizers such as semantic maps
break
down tasks into smaller steps or present it another way
provide
direct instruction as well as modeling
show
examples of what is required
use
outlines to help student take notes and organize and categorize information
avoid
verbal overload
capitalize
on strengths, e.g., memory
do not assume that they have understood what they have read – check for comprehension, supplement instruction and use visual supports
Emotional
vulnerability
may
have difficulties coping with the social and emotional demands of school
easily
stressed due to inflexibility
often
have low self-esteem
may
have difficulty tolerating making mistakes
may
be prone to depression
may
have rage reactions and temper outbursts
provide
positive praise and tell the student what she/he does right or well
teach
the student to ask for help
teach
techniques for coping with difficult situations and for dealing with stress
use
rehearsal strategies
provide
experiences in which the person can make choices
help
the student to understand his/her behaviors and reactions of others
educate
other students
use
peer supports such as buddy systems and peer support network
most
common sensitivities involve sound and touch, but may also include taste, light
intensity, colors and aromas
types
of noises that may be perceived as extremely intense are:
sudden,
unexpected noises such as a telephone ringing,
fire
alarm
high-pitched
continuous noise
confusing,
complex or multiple sounds such as in shopping centers
be
aware that normal levels of auditory and visual input can be perceived by the
student as too much or too little
keep
the level of stimulation within the student’s ability to cope
it
may be necessary to avoid some sounds
having
the student listen to music can camouflage certain sounds
minimize
background noise
use
of ear plugs if very extreme
teach and model relaxation strategies and diversions to reduce anxiety
MANAGING CHALLENGING
BEHAVIOUR
Children
with autism may present with some unusual and challenging behaviors, and do not
always respond to the usual methods of discipline. It is frequently necessary
to develop a systematic plan for changing behaviors. It is important that any
behavior intervention plan is based on an understanding of the characteristics
of autism, as well as knowledge of the strengths and needs of the individual
student.
A
behavior plan can be developed through a collaborative problem-solving process
involving the significant people in the student’s life, including the
parent(s)/guardian, classroom teacher, and special educator. It may also
include other involved persons such as the principal, a consultant, speech
language pathologist, and psychologist. The major components of the process
(adapted from Dalrymple & Porco, 1993) to develop a behavior plan are:
Identification
of the Problem Behavior
Identification
of the Function and Contributing Factors
Identification
of an Alternative Behavior
Strategies for Changing Behavior
Environmental
Adaptations
Positive
Program Strategies
Reactive
Strategies
Development
of the Behavior Intervention Plan
Evaluation
of the Intervention Plan
Identification of the Problem Behavior
Identify
and describe the behavior in observable terms, including where and when it
occurs, what usually happens before the behavior, and the typical reactions of
other people. It is important to
determine whether the behavior actually does pose a problem. Some key
considerations are:
Is
the behavior potentially harmful to the student or others?
Does it interfere with the student’s learning or the
learning of others?
Does it result in negative reactions and/or avoidance by
peers and adults?
The student may display more than one challenging behavior. It may not be reasonable to expect to change all behaviors, and priorities for intervention will need to be established.
The
function or purpose of a behavior is not always obvious. It is frequently
necessary to collect information about the student, behavior, environment, and
consequences to determine what purpose the behavior serves and what factors are
maintaining the behavior.
A
comprehensive behavior plan should include a thorough assessment of the
behavior and the context in which it occurs, to determine the underlying
contributing factors. Assessment should
also include gathering significant information about the student, such as likes
and dislikes, fears and frustrations, communication skills, strengths and
needs, how the student interacts socially, and the typical responses to
sensory
stimuli. Problem behaviors may be a
result of other characteristics associated with autism, such as attending
difficulties, problems with interpreting verbal information, limited verbal
expression, impairment in social skills, and different responses to sensory
stimulation. For example, what appears to be a lack of cooperation may be the
result of not understanding expectations or not knowing what is going to
happen. Functional Analysis of Behavior
is the process of identifying the function(s) that a specific behavior serves
for the individual, and is based on the premise that all behavior serves some
purpose.
The purpose may be to (1) gain attention, (2)
gain a tangible consequence, (3) escape from an unpleasant situation, (4) gain
a sensory consequence, (5) self-regulate, (6) make a comment or declaration,
(7) release tension, or (8) it may be habitual (Donnellan, Mirenda, Mesaros,
& Fassbender, 1984; Durand & Crimmins, 1988).
The
process for collecting the information for a functional analysis involves
identifying:
Antecedents
(what happened just before the behavior, where did the behavior occur, and with
whom)
Behavior
description
Consequence (what happened after, and as a result of, the behavior)
When
describing the students behavior:
include
the frequency, intensity and duration of the behavior be specific; for example,
hollering and screaming can vary in intensity and duration, and may or may not
be a priority; clearly identify the
situation where the behavior does and does not occur.
Information
can be acquired through observation and data collection. Parents, teachers and
others involved with the student on a regular basis can provide
information. The information is
analyzed to identify patterns, possible reinforcers and anything that may be
triggering the behavior. In some situations, a questionnaire such as the
Motivation Assessment Scale (Durand & Crimmins, 1988) can assist in
determining possible functions of behaviors.
Functional analysis of behavior serves as the
foundation for developing the behavior plan. Once the possible purpose of a
behavior is determined or hypothesized, it is possible to identify an
alternate, more appropriate behavior that can serve the same function.
The focus of the behavior intervention is on
instruction rather than discipline. The goal is to increase the student’s
alternate appropriate means of achieving the same purpose. The success of the
plan is more dependent on the instructional and proactive components, and less
influenced by the reactive strategies. The following may assist in
identification of alternate behaviors:
· The alternate behavior might
also be a more appropriate means of seeking sensory stimulation, or an
appropriate method for reducing anxiety (i.e, relaxation exercises, visual
imagery, going to a quiet place).
· In most situations, teaching of the alternate behavior will need to be combined with other positive program strategies.
1.
Environmental
Adaptations
Problem
behaviors can often be reduced or eliminated by making changes in the
environment. The assessment and analysis of the behavior may indicate that it
occurs within specific areas, or during specific times such as transitions.
Sometimes the likelihood of the behavior occurring can be minimized by making
environmental accommodations. This does not mean that the entire classroom has
to be changed for one student, but there are adjustments that can be made
depending on the student’s individual needs.
Possible
environmental adaptations:
2.
Positive
Program Strategies
Provision
of a program that emphasizes the development of communication and positive
behaviors in a predictable and rewarding environment can help to reduce the
frequency and severity of problem behaviors.
Components
of a positive program include:
Teach
communication skills. The appropriate form and content will vary depending on
the abilities of the student. Consideration of the use of augmentative systems
is done in collaboration with the parents and a speech language pathologist.
Teach
social skills. Remember that children with autism have difficulty reading
social cues and will not simply "pick up" social skills from watching
others. When a child displays an inappropriate behavior, we can’t assume that
they have the appropriate skill in their repertoire, or that they know when to
use it. Social skills need to be taught for each situation.
Use social stories to teach behavior for situations, which pose a problem. Social stories can also be used to prepare the student for new situations and activities.
Provide
clear expectations for behavior. Post rules and use appropriate visual aids to
help the student to understand what is expected.
Provide
a clear schedule. Go through the schedule with the student, and involve him/her
in referring to the schedule. Use the schedule to prepare the student for
transitions between activities and to prepare for any changes that may occur.
Teach
the student to make choices and provide opportunities for choice within the
schedule.
Provide instruction at a level appropriate to the student, and use visual aids to clarify instructions and teach new concepts and skills.
Observe
the student for signs of increasing anxiety and the environmental factors that
may be associated with increased anxiety. For example, if social play increases
stress, it may be helpful to provide the opportunity for isolated play. This
does not mean that the program should forego the goal of increasing interactive
play with peers. However, the amount of time spent with others may need to be
restricted if the student is very anxious. Over time, contact with other
students can be increased, within the context of a program which teaches social
skills and provides support within interactive situations.
Provide opportunities for relaxation throughout the day. This may be for brief 5-10 minute periods, and can be accomplished in a variety of ways, such as going to a special calm place in the school, listening to music with headphones, playing with a favorite object, sitting quietly and looking out the window, or engaging in a repetitive behavior. It is important to note that what is calming for one child may increase anxiety for another. Teach the student to say "I need a break". Relaxation training can be provided by teaching the student specific routines and behaviors to relax.
Provide
opportunities for rehearsal and desensitization to new places, people or
things. Remember that change is difficult. However, adapting and coping with
change is a necessary life skill. Introduce new situations slowly so that the
student has an opportunity to become familiar with the setting, people and
expectations. Remember to reinforce
appropriate behavior, and to use reinforcements that are meaningful to the individual
student.
One
type of behavior that is frequently of concern to parents and teachers is the
repetitive stereotyped behavior. These behaviors cannot be totally eliminated,
but they may be reduced and, in some situations, replaced with more suitable
alternatives. The response to the specific behaviors will depend, in part, on
the function that it serves for the individual child. For example, Grandin
(1995) describes how repetitive rocking and spinning helped shut out the world
when noise became too overwhelming.
"Rocking made me feel calm. It was like taking an addictive drug. The more I did it, the more I wanted to do it. My mother and my teachers would stop me so I would get back in touch with the rest of the world. I also loved to spin, and I seldom got dizzy. When I stopped spinning, I enjoyed the sensation of watching the room spin" (p.45).
If the behavior is used to calm down, it may be appropriate to teach other methods of relaxation. For some students, it may be appropriate to find another source of stimulation that may satisfy the sensory need. The following are general suggestions for consideration in reducing/replacing repetitive behaviors:
Teach
an alternative behavior.
Provide
a variety of sensory experiences during the day.
When
the behavior is happening, try to divert the person’s attention to another
activity.
Negotiate
when and where the repetitive actions are acceptable. Controlled access may
reduce thedesperation to engage in the activity, and should be scheduled rather
that being contingent upon good behavior.
Gradually
reduce the amount of time allotted for the behavior.
Increase
the amount of time between scheduled times for repetitive behaviors.
Use
the level of repetitive behavior to assess the person’s level of stress.
Allow
the person to engage in the behaviors in an emergency situation to calm
him/herself down.
Instruction
may need to focus on anger management and self-control.
Social stories may be used to teach students self-control within specific situations.
Cognitive Picture Rehearsal (Groden & leVasseur, 1995) is another visually based approach used to teach self -control. This strategy uses visual supports in an individualized program. Pictures and scripts for a sequence of behaviors are presented, and the student has the opportunity for repeated practice of the behavior, with immediate reinforcement. The general process is to:
identify the target behavior
identify the antecedents and
provide the student with an appropriate way to cope
identify reinforcers that follow the appropriate behavior.
The
student is provided with individual instruction and, when he/she is familiar
with the sequence, the sequence is done prior to the stressful situation, and
then within the situation.
Use strategies to promote independence and self-management. Self-management procedures developed by Koegel et al. (1992) are outlined in the section Guidelines and Strategies for Social Skills Training.
3.
Positive programming strategies which focus on increasing student competence and making the necessary accommodations to the physical setting, materials and instruction will be the most successful in facilitating long-term behavioral change. However, it is sometimes necessary to design a plan for the immediate reaction to a behavior in order to maintain safety. It is essential that everyone involved with the student is prepared to react to specific behaviors in a consistent way. In general, there are three major types of reactive techniques: ignoring the behavior, redirection, and removal from reinforcements.
Ignoring the behavior – this may be appropriate for minor attention-seeking behaviors. However, it is often difficult to implement in a classroom setting. It is important to make sure that the student is not being reinforced by other sources, such as peers.
Redirection is a vital component of any
behavior intervention plan. If a behavior is unacceptable, the student needs to
know what is expected instead, and this needs to be communicated clearly. Assistance
and support may be required. The use of a visual aid, such as a pictograph, is
often helpful.
Redirection
is used in combination with positive programming strategies. The student will
need to be taught the alternate behavior, and provided with opportunities to
practice and rehearse.
Removal from the reinforcements may involve removal from the situation. If a student is very anxious or upset, it may be necessary to leave the situation to calm down before any redirection or teaching of alternate behaviors can occur. This can be combined with positive programming strategies such as teaching the student to recognize when they are becoming anxious, and teaching them to remove themselves from the situation before they lose control of their behavior.
In addition, it is helpful to keep the individual with familiar people, places or objects at a time of crises, rather than trying to introduce change that would increase the level of anxiety.
It may be appropriate to allow the individual to engage in a repetitive, stereotyped behavior in a very stressful situation. It may be a coping mechanism. Although the goal may be to teach other, more appropriate means of dealing with stress, this may be an appropriate reactive strategy that is more suitable than aggression.
Once the team has identified the problem behaviors and contributing factors, the alternate behaviors and the strategies for instruction and management, the specific interventions and approaches should be specified in the student’s IEP.
Written
plans clearly outline the environmental adaptations, positive program
strategies and all reactive strategies, so that all people involved with the
student can maintain a consistent approach. This is particularly important in
maintaining consistency between home and school and environments throughout the
school.
In
addition, time lines need to be established, and a process should be in place
to evaluate the effectiveness of the plan.
Factors
to consider in evaluating the effectiveness of the interventions identified in
the student’s personal behavior intervention plan:
Is
the intervention being implemented consistently?
Does
it need to continue for a longer period of time?
Do
minor adjustments need to be made?
Is
the behavior being maintained through other factors that were not accounted
for?
Do the reinforcements need to be modified?
Are alternate strategies needed?
Developing
the Individualized Education Program
Instructional
Approaches and Classroom Management
Strategies
for Communication Development
Strategies for Social Skills Training
Children
with autism present with differences in learning style, impairments in
communication and social skill development, and the presence of challenging
behaviors. However, there is considerable individual variability in how these
characteristics are manifested. There is no specific curriculum to teach
students with autism. Effective programs are individualized and based on the
unique needs and abilities of each student. The student’s personal program plan
will include a combination of objectives from the regular curriculum as well as
objectives that are unique to the individual.
Sevier
County’s Department of Special Education suggests that an Individualized
Education Program (IEP) be developed through collaboration by a team of people
directly involved with the student, including the parents, classroom teacher,
special educator, speech language pathologist, autism consultants, educational
psychologist and the student, where appropriate.
The
written plan is intended to guide the day-to-day work of the educators and to
provide information on the types of adaptations and strategies that will be
used to accommodate the student. The program components are:
Personal
and educational data, including assessment information
Identification
of the student’s strengths and needs
Long-term goals and short-term objectives. This typically includes goals and objectives related to the regular curricular areas and within the main developmental domains.
For the student with autism/PDD, the key curricular areas are:
The
IEP is not intended to provide the daily plan of instruction for the student.
Rather, it provides an outline of the curricular goals for that individual
student, the adaptations, and effective strategies. It is reasonable to expect
that the program may need to be modified throughout the year, as the student
and teachers become more familiar, and as changes take place.
When developing a student’s IEP, it is important to make adaptations in instruction and classroom management to address the needs of the child. Communication and social skills are key areas of the child’s development and must be addressed in the plan. The following information is to assist the team in developing an IEP for a student with autism.
The
following strategies and guidelines were adapted from Gillingham (1995),
Grandin (1995), Gray (1993c), Gray & Garand (1993), Indiana Resource Center
for Autism (1997), Hogdon (1997), Koegel & Koegel (1995), Olley &
Reeve(1997), and Quill (1995a, 1995b).
1.
Use
visual methods of teaching (adapted from Quill, 1995a & Hogdon, 1995a)
Children
with autism often demonstrate relative strengths in concrete thinking, rote
memory, and understanding of visual/spatial relationships, and difficulties in
abstract thinking, social cognition, communication, and attention (Quill,
1995a). The use of pictographic and written cues can often aid in helping the
student to learn, communicate, and develop self-control. One of the advantages of using visual aids
is that they can be examined for as long as needed to process the information.
In contrast, oral information is transient. Once it is said, the message is no
longer available. This may pose
problems for students who have difficulties processing language, and who
require additional time (Hogdon, 1995a). In addition, it may be difficult for
the student with autism to attend to the relevant information and to block out
the background noises. The use of visual supports enables the individual to
focus on the message.
The type of visual aids and symbols vary in complexity. Objects are the most concrete form. Pictures and photographs are the next level of representation. Graphic symbols are somewhat more complex and consist of pictographs and written language. However, graphic symbols have been widely used, and have been successful with children with autism. There are software packages available, which provide quick access and the opportunity to create customized symbols. For example the Boardmaker@Program(Mayer-johnson 1987-1997) and PICTOCOM SE (Maharaj, 1996).
Visual
supports can be used in a variety of ways in the classroom. Hogdon (1995) and Quill (1995a, 1995b)
provide examples of different types of supports:
Visual aids for
organization, such as daily schedules, mini-schedules, activity checklists,
calendars, choice boards,
aids
for giving directions, such as classroom rules, file cards with directions for
specific tasks and activities, pictographs and written instructions for
learning new information,
strategies for organizing the environment, such as labeling objects and containers, signs, lists, charts, and messages.
Aids for social development
such as posting rules and routines, and teaching social skills through the use
of Social Stories (Gray, 1993a, 1993c). A social story is a description of a
social situation which includes the social cues and appropriate responses, and
is written for a specific situation for the individual student. (For further information, refer to the section Guidelines and
Strategies for Social Skills Training.)
Aids to assist in managing challenging behaviors and developing self-control. This may include rules, as well as pictographs, which provide a cue for expected behavior. The key question to ask when planning an activity or giving an instruction is "How can this information be presented in a simple visual format?"
The
selection of visual aids is guided by an understanding of the child and his/her
abilities and responses. Many examples of visual supports are provided in the
book Visual Strategies for Improving
Communication (Hogdon, 1995).
2.
Provide a structured, predictable classroom environment. This is not to be confused with an authoritarian approach. The environment should be structured in the sense that it provides consistency and clarity, students know where things belong, they know what is expected of them in a specific situation, and can anticipate what comes next.
3.
Provide a customized visual daily schedule. Vary tasks to prevent boredom, and alternate activities to reduce anxiety and possibly prevent some inappropriate behaviors. For example, alternate familiar, successful experiences with less preferred activities. It may be helpful to alternate large group activities with opportunities for calming activities in a quiet environment. In addition, the incorporation of physical activity and exercise at points throughout the day is helpful.
4.
Know the individual, and maintain a list of strengths and interests.