These programs employ somewhat different, and occasionally mixed, models of service delivery. Some programs are primarily home based; that is, most of the child’s treatment, at least initially, is done in the home by one or more service providers. At some point, these children usually will transition to a school setting. This model is the one employed originally by Lovaas and his colleagues at the University of California at Los Angeles (UCLA) but has been used by others as well. Note that many programs include a home component, but the truly home-based programs are fundamentally and primarily based in the home. In contrast, center-based programs provide the majority of their services within a specialized (nonpublic school) setting. These programs include the Douglass Program at Rutgers and the Children’s Unit at Binghamton Universities. Training for parents and family members is provided and is often focused on generalization of skills to the home setting. The goal is eventual integration of children on the autism spectrum into classes in the public school or within the center.
The majority of children with autism are given services within school-based settings. Again, there are many variations, ranging from self-contained classes within a public school to partial or full inclusion in mainstream educational settings. The Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) program is a good model of such a program where services are provided to regular schools throughout the state of North Carolina. There are many variations on these basic themes. The following provides a brief summary of a number of these programs; a web address for additional information is included at the end of each summary.
This parent training program originated in West Virginia before it was moved to Florida in 1987 (see papers by Dunlap & Fox in the reading list). This program is provided in home and community settings with a period of intense involvement and then ongoing follow-up. The program is meant to be added to ongoing daily special education intervention. Goals include helping the family become more knowledgeable about their children’s needs and fostering communication and social skills. The emphasis on family support is an important aspect of this program.
Each of the models we’ve just reviewed has its stronger and weaker points. But one of the most important things about these programs is their commitment to research, in terms of changes made over short and long time frames. Work of this kind has advanced and will continue to advance the field. As the NRC report Educating Children With Autism makes clear, a number of things can be said about the importance of intervention in the lives of children with autism and related conditions. All this being said, what are the limitations of what we know?
Clearly, the research base for each of these treatments is highly variable. In some cases, there has been elegant and rigorous research, although often with a small number of subjects. Most of the work has, probably understandably, focused on very young children. One of the problems is that we don’t have much research that compares different approaches; to put the issue another way, how do we know what approach works best for what child?
There are pros and cons to the various treatment models. Home-based treatments have some advantages for preschool children. The child is already in the environment where learning will take place, and it is more “normative” for services to be provided where children live at this age. But the commitment to a home-based treatment model can be daunting for parents, particularly when, as is now frequent, both work. The expectation that a parent quit his or her job to be able to provide a home-based program is unrealistic except for highly affluent families or those where the family can survive on one parent’s income. The intensity of this work also entails some special burdens on those delivering the services and may have important implications for family life and the marital relationship. However, this approach quickly enables parents to become versed in intervention techniques that can then be applied consistently throughout the child’s day.
Center-based approaches have other pros and cons. One great advantage is bringing together in one place an entire group of people knowledgeable about autism and in regular communication with each other. The family does not need to transport the child to various sites for service. Backup is readily available; for example, if one staff member is sick, another trained staff member can take over. This can be a greater challenge in the public school setting, e.g., when there may be only one school psychologist or speech pathologist. Although parents are very much involved in center-based programs, the intensity of their, involvement is considerably lessened as compared to home based programs. The absence (often, but not always) of typically developing peers is a major drawback. More and more center-based programs now include a mainstream component (e.g., with an integrated classroom). It is also possible to combine approaches, for example, with special classes within schools with opportunities for mainstreaming or, for younger children, an option for a gradual transition into more normative preschool settings with some time at the center-based program and other time in the typical preschool.
School-based programs have the substantial advantage of the potential for considerable exposure to peers and mainstream, normative experiences. All the many resources available in school settings are available, including the possibility of additional services from professionals like the school psychologist or speech pathologist or occupational therapist. That being said, successful integration of students on the autism spectrum into public school settings does require thoughtful planning. Many of the techniques developed in center- and home-based programs for children with autism can be implemented readily in school settings, although maintaining the intensity of some of these interventions and their supervision can be a challenge. Preparation of teaching staff, particularly teaching assistants and paraprofessionals, is critical. A frequent challenge is that it may be easier for the aide to do something for the child rather than facilitating the child’s engagement in the behavior/activity. The routine of a typical classroom day can be used to great advantage, for example, in terms of structuring mainstream exposure time, insuring predictability, and so forth. These routines also have great potential for use in teaching adaptive skills. Challenges for staffing have to do with training levels for teachers and other classroom personnel. Given the complexity of supports required, it is imperative that teachers be particularly well organized. Teachers must be familiar with a range of potential intervention techniques and have a detailed lesson plan that can be readily implemented. Opportunities for more intensive interaction with parents are also often much more limited.
SPECIAL EDUCATIONAL NEEDS OF THE CHILD WITH AN ASD
There are some excellent resources (many listed at the end of this chapter) describing school- and center-based programs developed to address the special needs of children on the autism spectrum. Educating Children With Autism summarizes areas of both agreement and divergence across the 10 comprehensive programs it surveyed. Probably most important is that there was consensus from all the programs that early intervention can make a major difference for many children, although not all children improve to the same degree. There was also agreement on the importance of several things about intervention programs:
• Intervention needs to be planned and intensive.
• Specific curricula should be used.
• Intervention programs must be interdisciplinary with good integration of services.
• Teachers and other service providers need experience, training, and ongoing support.
• Family involvement is critical to help the child generalize skills.
• Child engagement is essential—the child has to be actively involved.
• Functional behavior management procedures should be used to foster behaviors that facilitate learning.
• Attention must be paid to transition planning.
In the report, programs that appeared to work for younger children were year-round and “averaged” about 25 hours/week. (Note the quotation marks around “average” since, in fact, there were tremendous variations in how programs were organized and it was difficult to come up with a single number that captures this variation.)
There was also much consensus on the kinds of things that need to be worked on. These include social skills, communication skills, play (for younger children and leisure time for older children), behavioral issues and obstacles to learning, organizational and “learning-to-learn” skills (the ability to sit, pay attention to a task, and engage with the teacher or activity in learning), and to generalization and the translation of knowledge into real-world settings (adaptive skills).
Physical Space
The setting of the intervention was also felt to be important, given the difficulties children on the autism spectrum have in regulating their attention—particularly in more complex environments. This would usually imply a need for a balanced approach with “pull-outs” and opportunities for more intensive work mixed with classroom and small group work. It also implies that attention needs to be paid to the classroom environment, which can help or hinder the child’s ability to attend. Having continuity and a consistent approach is also important. Having the team work together in a flexible and collaborative way is helpful in implementing the program and monitoring the IEP goals.
THE CLASSROOM ENVIRONMENT FOR THE CHILD WITH AN ASD
Goals: The physical environment should enhance and not distract engagement and attention for children with ASDs.
Organization of the Room
• Place materials/furniture to help organize the child (natural boundaries).
• Look out for obvious distractions; place desks so the child looks at the teacher (not outside).
• Don’t have computer displays running where the child can see them.
• Have an area in the room with few distractions where the child can “retreat” if he or she needs to.
Respect Visual Learning Style and Difficulties with Generalization/Organization
• Masking tape can be used to mark out specific areas, e.g, where the child sits in the classroom.
• Visual schedules/supports should be used; these can transition into other organizational supports for older children (preteaching, organizational software).
Attend to the Social Environment
• Think about entrance/exit issues; for example, children’s cubbies should be away from the door.
• Consider proximity issues, for example, desk spacing, activity areas.
Applied Behavior Analysis(ABA)/Behavioral Treatments
Programs differ in the ways they manage behavioral issues and problems and in their approaches to teaching skills. A range of approaches can be used, but many methods derive from the ABA literature. This literature has been remarkably productive over the past decades in helping us understand effective ways to teach children with autism, particularly children who lack learning-to-learn skills and need real help in being able to profit from the school environment. These methods also apply to older and more cognitively able children. They can include a combination of several different strategies, including discrete trial training, pivotal response training, and use of functional routines. Discrete trial methods can be used for very basic skills. This procedure results in having a clear sequence where concepts are broken down into tasks that can be targeted. In the discrete trial, a cue is given to the child, who then responds and receives a reward or consequence of some kind before the procedure is repeated. Careful data are kept, and there is a larger vision of what is to be accomplished; that is, basic things like sitting in the chair are targeted first, and then as activities become more complex they are pulled together to help the child achieve higher skill levels. Pivotal response training focuses very much on the environment, broadly defined, and ways in which the reinforcement can be a natural consequence; this has the great advantage of making it easier to carry the procedure throughout the day and simplifies the task of generalization. It also meshes nicely with an approach that looks at functional routines. The functional routines approach focuses on a sequence of predictable events such as snack or circle time or going to lunch. These routines can then be used as the basis for various teaching activities, e.g., use of words, social skills, concepts, and so forth. Because typical children also are engaged in such activities, this method can seem to be very natural. Methods that use these behavioral techniques must, of course, develop a clear vision of expectations for the child. A few models have been developed that try to use child preference more actively; we discuss these in greater detail later in this chapter.
Social Skills Teaching
Social skills are usually taught using a balance of methods. These vary somewhat with the age of the child. For younger children, peer-mediated approaches are frequently used, while for adults, direct instruction is most frequent, and for school-aged children, what might be called “hybrid” methods are often used, for example, a social skills group where there is an adult leader (or leaders) with a peer group; this group might include other children with ASD as well as typically developing peers. Various combinations of these approaches are also possible, of course; for example, a speech pathologist might work with a child in a small group, like a “lunch bunch” and individually. Play skills should typically be explicit targets of intervention in younger children. There are many ways to teach play skills, including specific ABA-type instruction with development of scripts and functional play routines. Modeling by peers can also be helpful. Social skills intervention is always an important aspect of the plan for children on the autism spectrum. Chapter 6 reviews social skills interventions in greater detail.
Language/Communication Interventions
Language and communication skills are also an essential aspect of intervention, given that we know that the language levels and the capacity to speak are better signs for long-term outcome. We believe that with early intervention, the number of children with more prototypical autism who manage to be able to speak by age 5 is around 75%; this is a marked increase from a decade or two ago when the number was more like 50%. As we discuss in Chapter 6 and subsequent chapters, there are many different approaches to intervention in this area. It is important to keep in mind that even for children who don’t speak, a focus on communication is essential, and for such children augmentative approaches can be used.
More verbal students on the autism spectrum present some interesting challenges for the system. Occasionally, the communication needs of more able children with Asperger’s are minimized or ignored. We have heard statements like “He has such a great vocabulary, he doesn’t need to see the speech pathologist,” but this is said of a child who can’t carry on a conversation except about his topic of interest. This is, of course, just the reason he needs to see the speech pathologist. Language and communication skills should be targeted at multiple levels, depending on the child’s needs, for example, both expressive and receptive language as well as social language should be targeted.
AUGMENTATIVE COMMUNICATION STRATEGIES
• Provide “workarounds” for communication for students with limited or no spoken words.
• These workarounds can take various forms:
• Picture exchange
• Manual sign language
• Computerized communication systems
• Typically, emphasize the stronger visual learning style of children with autism.
• Use of these augmentative strategies does not prevent children from learning to talk—it should increase their ability to talk if they are capable of it.
Organizational Issues, Learning to Learn, and Adaptive Skills
One of the obstacles for learning arises from the tendency of children with autism to be overly focused on details and not see the “big picture.” This likely is very much related to the social difficulties and difficulties with dealing with change. These difficulties result in problems in developing joint attention and other early emerging social skills, which “set the stage” for the child in terms of learning what to and what not to focus on. This leads to problems in what psychologists call executive functions (the ability to get the big picture and multitask) and requires specific intervention for children at all ages and cognitive levels. For younger children, this can take the form of visual aids, for example, the classroom schedule on a bulletin board in picture format. As children become more cognitively able, these can be supplemented by other supports, for example, written lists/schedules, organizers, computer software, and so forth. Another problem that arises from difficulties with organization and a tendency to hyperfocus is a failure to appreciate that the skills learned in one context can be applied in another. This activity is called generalization. It becomes truly critical if children are to achieve independent living skills. Accordingly, it is important that schools and families work together to be sure that there is carry-over of activities into home and other settings. Organizational aids can also help, as children need to do homework or help with simple household activities like shopping. Providing a structure, in advance, can prevent many problems from happening. It is important for parents and teachers not to teach skills in isolation. Generalization should be encouraged at every opportunity, as this will facilitate the acquisition of skills necessary for ultimate adult independence and self-sufficiency. We talk about daily living and other skills in the next chapter.
Sensory-Motor Issues
Sensory and motor issues can sometimes be a source of great difficulty for children on the autism spectrum. It is important that, as part of the IEP, the occupational and/or physical therapist be involved to develop procedures specific to the individual child. For some children, help with gross and particularly fine motor activities may be needed. The child with Asperger’s may, for example, have particular problems with cursive handwriting, and it may be possible to justify alternatives (e.g., a laptop) if these difficulties can be documented. Both the speech pathologist and occupational therapist can be helpful around eating/ feeding issues.
Use of the child’s natural motivations and of more developmental approaches has been somewhat less common than ABA-based approaches, but these approaches have been effectively used. With these approaches, as indeed with typically developing children, the idea is that learning is easiest when it follows the natural inclinations/leads of the child. This approach also often assumes that, in general, normal developmental progressions are followed—that is, that you can make reasonable predictions of what a sequence of skills learning will be. As with other approaches, and perhaps even more with this one, it is important to (1) pay attention to the child’s learning environment and (2) be sure that the child is producing enough leads to follow. We have seen children enrolled in such programs fail to progress if they are not producing enough in the way of cues/leads for the teacher to follow.
AREAS OF VULNERABILITY AND POTENTIAL RESPONSES
Behavioral Management Issues
Programs vary in the ways they manage behavioral issues and problems and in their approaches to teaching skills. As mentioned earlier, ABA methods have been very helpful in giving us more effective ways to teach children with autism. These methods work both in encouraging the kinds of behaviors and skills that parents and teachers want to develop and in dealing with problem behaviors that can arise. These methods also work for older and more able children. They can include one or several different strategies, including discrete trial training, pivotal response training, and use of functional routines. Methods that use these behavioral techniques must, of course, develop a clear vision of expectations for the child, i.e., what behaviors are to be developed and encouraged and what behaviors are to be decreased and/or discouraged. A few models have been developed that try to use child preference more actively; we discuss these in greater detail in Chapter 14.
MAINSTREAMING
Under the law, it is presumed that children with autism and related conditions should be mainstreamed as much as possible. With the growing sophistication of support methods for both affected children and typically developing peers, it is increasingly possible to support children with ASDs in more typical, mainstream settings. If the process of identification and intervention starts early, it is frequently possible to have children fully included by the time they reach first grade, and even those not fully included are more able to relate to their typical peers and to achieve at least partial inclusion.
Various terms are used for mainstream settings, these include full inclusion and integration. Various possible models are available; for example, a special education integrated class might include some children who were typically developing. Usually, mainstream classes are structured around a traditional classroom model, while an integrated class also includes work individualized for specific students. A wide range of models are available including ones where both a regular classroom teacher and special ed teacher work together in the same inclusive class.
When considering inclusion of the child with an ASD in mainstream settings, parents and the school must take into account the needs of the child, the context of inclusion, the need for adult supervision, the expectations of peers, and so forth. Attention to activities used in the class, the structure and routine of the interaction, and the physical environment all contribute to successful social interaction. The teacher often needs support to learn techniques for inclusion and managing problem behaviors. Support staff such as teacher assistants and paraprofessionals may also benefit from training, with one of the goals being to help support the child in the environment through an emphasis on peer-mediated, rather than adult, intervention.
One of the great advantages of mainstream/integrated classes is the potential for fostering social skills. Most of the work that has taken place to date has centered on preschool children, although some work on older children has appeared as well. That being said, it is clear that simply putting the child with an ASD in the classroom is not, by itself, sufficient. Rather, the teacher and peers must be appropriately prepared if peers are to be helpful and effective models. An entire body of work has now emerged on strategies and procedures for teaching social skills in these contexts using typical peers and free play and other situations. Adult supervision is typically used to help initiate interaction and monitor ongoing activities. Peers can be very effective agents of change—if given the special license to do so. For older children, more complex and sophisticated strategies are needed. Even here, benefits can be shown from peer interaction and self-monitoring. The experience can be a valuable one for peers as well as for the child with ASD. As might be expected, younger peers need more support and monitoring than older ones.
Strategies for increasing interaction in a mainstream setting are varied. These include social scripts, for example, in teaching fantasy play (an area of great difficulty for many children on the autism spectrum). Teaching both response to social overtures and initiation is important. It is critical that the child with an ASD be able to both initiate and respond appropriately; the latter is much easier, of course. Videotapes can be used as effective adjuncts to the teacher; for example, the child can review the tape, observe when things go wrong, discuss alternative responses, and so forth. Video feedback can be highly effective, given the visual learning style in autism.
Researchers have developed various models of inclusion. For less cognitively able children, the emphasis may be on skills relevant to community involvement. This may be reflected in initial classes with an emphasis on one-on-one teaching with an eventual move to small group and more inclusive classes, eventually with typically developing peers. Transitions to mainstream settings should be carefully planned and supervised. Unfortunately, school districts often attempt to mainstream children into what are, seemingly, the easiest settings to manage: gym, recess, and cafeteria. Unfortunately given the lack of structure and reduced levels of adult supervision for children on the autism spectrum, these are usually the absolute worst situations to begin mainstreaming.
The goal is to have a successful mainstream experience. To this end, a well-worked-out transition plan with a gradual increase in exposure of the child to the mainstream setting is valuable, with careful, thoughtful adjustment based on response of the child. For preschool children, situations readily used for mainstream activities include story time and free play as well as snack or lunchtime. With appropriate support, recess can also be used. For older children, music and art and similar activities can be positive times. For the more cognitively able child, some mainstream academic classes may be appropriate (and easier than less structured activities). The greater complexity of middle schools and high schools presents significant challenges, although even here mainstreaming can be successful. Issues do arise for lower functioning students, where the balance of benefit (of exposure to normal peers) versus trade-off (need for more vocationally focused, transitional activities) can be an issue. For example, in one case with which we are familiar, a very cognitively disabled teenager who was not yet showering independently enrolled in a traditional American history class; in this case, whatever benefit came from being exposed to a discussion of the U.S. Constitution was probably greatly outweighed by a lack of attention to basic self-care skills.
INTERVENTIONS TO SUPPORT INCLUSION
Peer-based interventions (e.g., peer modeling, buddy systems)
Teach play skills
Participation in social skills groups
Provide visual activity schedule for classroom
Teaching social scripts (and then fade scripts over time)
Teaching self-management skills (initiation, staying on task, social routines)
Support inclusion (encouraging peer response, teacher responds to child through peer, environment supports peer interaction)
Management of problem behaviors
Adapted, with permission, from Handleman, J. S., Harris, S. L., & Martins, M. P. (2005). Helping children with autism enter the mainstream. In F. R. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders (3rd ed., pp. 1038, Table 40.1). Hoboken, NJ: Wiley.
STUDENTS WITH ASPERGER’S
There are somewhat different challenges for more cognitively able students, particularly those with Asperger’s. Often, the problem here is a lack of awareness, or minimization, of the child’s level of social disability. Put another way, the very good language (but not communication) skills of the child overshadow an awareness of the child’s vulnerability. Typically, this is reflected in comments like “He is too bright to be in special ed” or “She is too verbal to be on the spectrum.” This is a bit like saying, “He’s too bright to have pneumonia” or “She is too verbal to have polio.”
The communication goals for the child with Asperger’s may have a somewhat different focus than those of the child with autism. For Asperger’s, these usually will include work on social communication (pragmatics). Issues such as carrying on a conversation with a beginning, middle, and end are important, as are issues of topic sharing, reciprocity, humor and irony, expectations for turn taking, and building on what the other person just said. Teaching self-monitoring and self-correction is important; even very rigid phrases like “Am I talking too much?” or “Would you like to talk now?” can elicit helpful feedback. Video and audio feedback can be valuable ways to learn self-monitoring and gauge progress. Work on prosody and voice volume can be helpful in this way as well. Most of us have hundreds, if not thousands, of different voices we use for different people and/or different settings. For individuals with ASDs who are verbal and who tend to be monotonic and loud, having three voices is very helpful (soft, medium, and loud) as long as the individual knows which one goes where (soft for church, medium for class, loud for playground).
Many of the same challenges and strategies for inclusion we have discussed previously (see the text box on page 137) apply to the student with Asperger’s. There are a couple of potentially important differences. Two of these things make life a bit easier for teachers: (1) Often, there is a strong motivation on the part of the student to “fit in,” and (2) better verbal abilities make it easier to teach explicit (verbal) strategies and rules for self-regulation and mastery of classroom routine. However, the one-sided social approaches may be off-putting to the typically developing students, so careful support and work with peers is important. Bullying (which we discuss in greater detail in Chapter 8) can start to be a problem, particularly as children become a bit older.
For students with Asperger’s, another contributing factor to lack of recognition of the child’s difficulties is the relatively frequent variability of the child’s behavior across settings; for example, the child may seem engaged and enthusiastic in class, but the same child may literally be lost on the playground or the lunchroom. Often, behavior problems develop when the social difficulties are not attended to. These behavior problems can then lead to highly inappropriate labels; these vary from state to state, but terms like BD (behavior disturbed), ED (emotionally disturbed), or SEM (social-emotionally maladjusted) are used, and then the child is placed in a classroom with truly conduct-disordered children—usually boys—and all hell usually breaks loose very quickly. We’re aware of one case where a very bright but quite socially limited first grader was put in a BD class for having talked back to his teacher (reminding her repeatedly that circle time was running late). He was in this BD class for no more than 5 minutes when a truly behavior-disturbed boy (who was very socially sophisticated) told him to “go pull the handle of that bright red box on the wall—a lot of stuff will happen,” and indeed it did. This kind of placement leads to the worst possible mismatch. The support of the communication specialist is often very helpful in dealing with communication issues that contribute to behavior problems. Behavior management procedures can be effective but should be informed by the child’s patterns of strengths and weaknesses and attempt, as much as possible, to help the child engage in self-monitoring /self-management.
ADDRESSING AREAS OF VULNERABILITY FOR CHILDREN WITH ASPERGER’S
• Be explicit, explicit, explicit:
• Put things/rules into words.
• Teach social rules.
• Assume nothing.
• Make things verbal:
• Use video examples to explain ongoing stories and personal reactions.
• Teach narrative and observation skills (child as “detective” or “reporter”—a person who asks all the Wh questions: who?, what?, where?, when?, and why?).
• Teach emotions and the language of emotions:
• Self-awareness of feelings, problem situations.
• Teach about the experience of anxiety, depression, reactions to novelty.
• Teach explicit coping strategies:
• Include verbal self-talk and verbal coping.
• Increase self-monitoring capacities and invitations for feedback (“Am I talking too much? ”).
• Teach alternative solutions when child is aware of starting to have problems—for example, a pass to visit an adult at school (his or her “safe address”) and then rapid return to the class.
Behavioral strategies for management of problem behaviors in more able individuals should be informed by an understanding of the child’s disability. What can seem like very inappropriate behaviors may be much better understood from the child’s point of view. An excessive tendency to follow the rules can lead to trouble; for example, the child may be quite insistent on a routine partly because she or he has learned to use it as a lifeline. The special interests often seen in students with Asperger’s and sometimes with other students on the autism spectrum can present some challenges for the student and teacher alike. Whenever possible and when appropriate it may be helpful to use the students’ natural interests/motivations in a positive way. Sometimes the task is helping the student learn to contain an interest, for example, to have something to talk to other students about apart from rocks or dinosaurs; in these cases, giving the child the opportunity (for very discrete periods) to pursue his or her interest may be used as an incentive for other work. We talk more about behavioral strategies and other approaches in Chapters 8, 9, and 14.
Family Support
Support of the parents and siblings is essential for many reasons. First and foremost, the family remains with the child when school staff do not. Also, unlike school staff, they don’t come and go over time. They have particular advantages when it comes to work on generalization of skills and helping the child on the spectrum make connections between academic and real-world knowledge. As we discuss later on in this book (Chapter 19), support for siblings and parents is important.
Given the sometimes intense needs for immediate support, it is critical for parents and teachers to not lose sight of the big picture. While all the behavioral techniques of ABA represent powerful tools, it is essential that schools and families have a longer term vision for the child and that the teacher, in particular, be prepared to implement an appropriate curriculum with realistic, objective, and measurable goals. Methods derived from pivotal response training and functional routines also offer powerful approaches to address fundamental problems in learning and facilitate generalization.
As we describe in greater detail in subsequent chapters, specific areas for instruction will, understandably, differ depending on the child’s age and levels of functioning. For preschool children, appropriate tasks involve receptive and expressive language, social engagement (particularly joint attention, which becomes critical for profiting from a classroom environment), basic learning-to-learn skills (staying in the chair, attending to materials at hand), play skills, and preacademic abilities. The latter include use of areas of strengths, for instance, in nonverbal problem solving or visual spatial skills, to help the child learn to read words that can serve as prompts for specific behaviors. For the school-aged child, more traditional academic skills become more important. In addition to the continued need for supporting social and communicative development, there may be a growing awareness of the child’s areas of vulnerability, and problems with anxiety may loom larger. Sensory processing problems may also become more prominent (see Chapter 16). Problem behaviors (see Chapter 14) may also loom larger in importance. New strategies for teaching social skills may be needed, for example, social skills groups and direct instruction. The seemingly simple task of negotiating a more complex middle school may represent its own problems, with endless potential for the student to be sidetracked by others or the tremendous social demands of moving about in hallways filled with children (one of many possible solutions is to have the child move just before the bell rings and to give practice when the school is empty, along with visual supports, if needed). Organizational issues also loom larger (see Chapter 6) as academic demands increase. Using areas of strength to address areas of weakness and respecting different potential approaches to problem solving is important. For individuals with more “classical” autism, the visual learning style should be used in a positive way to facilitate coping and organization; for the student with Asperger’s, an emphasis on verbal scripts and strategies may be equally as important.
High school (see Chapter 9) presents its own special challenges. For students who are unable to participate in part or fully in regular educational settings in high school, there is tremendous potential for social isolation. Fortunately, often by this age, behavior problems start to diminish and, whenever possible, the child’s motivation for success can be a valuable ally. As in middle school, having an advocate within the school is highly valuable. This person can help the diverse range of teachers and staff the child has to deal with to understand the nature of autism and advocate for appropriate accommodations. At this time, thinking about next steps and transitions to work or college or other activities should begin (see Chapter 9).
SUMMARY
In this chapter, we have surveyed current best practices in educating children with autism as exemplified by a range of model programs, each of which has at least some empirical research support. The issue, for the individual child, of exactly what approach is most suitable remains a challenging one. As we have noted, significant gaps in research exist, and although we can rightly point to many accomplishments, much remains to be done. In particular, the issue of helping develop a program designed for the child rather than trying to force a child into a program remains a common source of difficulty. Unfortunately, there is a lack of good studies that replicate findings in other locations and in which different interventions or models of intervention could readily be compared. As noted, even with very intensive service, many children continue to have significant learning challenges. For the present, the choice of program should be based, as much as is possible, on the individual needs of the child and family, while keeping in mind that things needed at one point in the child’s life may not be needed later on.
■ READING LIST
Arick, J. R., Krug, D. A., Loos, L., & Falco, R. (2005). School-based programs. In F. R. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders (3rd ed., pp. 1003-1028). Hoboken, NJ: Wiley.
Dunlap, G., & Fox, L. (1996). Early intervention and serious problem behaviors: A comprehensive approach. In L. K. Koegel, R. L. Koegel, and G. Dunlap (Eds.), Positive behavioral support: Including people with difficult behavior in the community (pp. 31-50). Baltimore: Brookes.
Dunlap, G., & Fox, L. (1999). A demonstration of behavioral support for young children with autism. Journal of Positive Behavioral Interventions, 2, 77-87.
Dunlap, G., & Fox, L. (1999). Supporting families of young children with autism. Infants and Young Children, 12, 48-54.
Greenspan, S. I. (2006). Engaging autism: Helping children relate, communicate and think with the DIR floortime approach. New York: Da Capo Lifelong Books.
Greenspan, S. I., & Wieder, S. (2009). Engaging autism: Using the floortime approach to help children relate, communicate, and think. Cambridge, MA: Da Capo Lifelong Books.
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