The focus in these notes is on the idiosyncracies of the learning and social needs among children with autism and the corresponding need for interventions to be based not only upon a general awareness of the triad of core autistic characteristics but also upon their particular manifestation in a given child. The implication is for establishing a relationship by which to gain an understanding of the child’s own perceptions and anxieties and motives.
The value of eliciting and examining the child’s own reports and expressed feelings is underlined if one is to understand the basis for observable behaviours.
The final sections refer to the common problem among children with autism of gaining the overall theme or gist of what they read (with implications for teaching style); and contain a further reference to the question whether there really has been a major increase in the incidence of autism as opposed to a change in the way diagnostic categories have been applied.
The survey by Tutt et al (2006) has examined four commonly practised educational interventions to determine the extent to which they relate to what is known about the psychological nature of autism.
They begin their discussion by noting that what teachers believe or observe about the learning process among normally-developing children, and the interaction of teaching and learning styles, hardly applies to their working with children with autism.
For example, it may not be reasonable to assume an ease or fluency of communication between teacher and child which is required to underpin the acquisition of abilities and knowledge. The child with autism may not understand either the processes involved in true communication or the purpose behind communicative attempts.
Teaching and learning are, for the most part, a matter of social and interactive events, but the child with autism may not appreciate the “what for” and remains focused upon the “what” with the risk that skills acquired remain mechanistic and rigid, and of limited generalisability. Similarly, much teaching may be a function of stimulating and extending the child’s imagination … but this may not be possible with a child who has autistic spectrum difficulties given that a lack of imagination and imaginative play is a basic criterion for the autistic diagnosis.
Accordingly, a number of specific approaches by which to work with children with autism have been developed. However, the authors are concerned lest the autistic characteristics that inhibit the effectiveness of standard teaching and learning processes also deflect attention from the basic purposes or principles of education that should apply to all young learners.
For example, education should be about much more than training individuals for specific tasks in the wider world, and should be geared, rather, towards helping the children to achieve their maximal level in respect of independent and critical thinking.
The corresponding question should involve the precise meaning of “success” when applied to the outcome of some particular approach in contrast to any other.
The first approach considered was the Higashi Approach – Daily Life Therapy.
This is a matter of physical activity involving music and dance, by which to build strength and concentration. The theory holds that vigorous exercise releases endorphins which serve to reduce tension and hyperactivity. Further, the highly-structured routine allows little opportunity for the children to retreat into autistic behaviours or obsessive actions; and the goal is to develop a child’s independence by learning to conform within a group setting rather than through one to one teaching. Self care skills are taught through imitating the teachers actions and those of the other children.
There is a problem in respect of evaluation in that little systematic evidence has been produced although there is some recognition that high levels of physical exercises do help to reduce self stimulation and to improve attention. Self care skills such as toileting and eating have also been said to be more consistently achieved in pupils attending Higashi schools than comparable pupils elsewhere, and self harm or aggressive behaviours do seem to be reduced.
However, there is no evidence that this approach increases understanding or the ability to manage effectively outside the original group setting. It has even been argued that the regime is unreasonably demanding and unresponsive to individual needs and differences … raising the question about the ethical acceptability of seeking a high level of conformity when the basic educational aim is to promote independence.
With regard to underlying psychological theory, the current authors suggest that the emphasis upon specific skills and conformity conflicts with the basic needs of children with autism as illustrated by the work of Hobson (1993) on personal relatedness or Baron-Cohen (1995) on theory of mind. The former highlights the need for assisting and encouraging people with autism to develop relationships, and the latter also focuses upon social relationships and the way in which a failure to appreciate the feelings or perspectives of others will interfere with social interaction.
Similarly, the theoretical view which focuses upon limited executive functioning (an inability to plan or to use existing learning and experience to determine subsequent behaviour) may be at odds with an approach which is about imitating adults and other children rather than about learning to solve problems and to gain independence in that way.
However, it is accepted that autism, when seen as a matter of limited central coherence interfering with central thought processes, may be managed by an approach which focuses upon leading by example and upon imitation as a means of highlighting what is relevant action in any given situation …. but, here again, whether or not the skills acquired would generalise to a different setting remains an issue.
The second approach concerns applied behavioural analysis (Lovaas 1987) which seeks to teach specific skills and to reduce behaviours which appear to inhibit learning.
Specific behaviours are targeted for up to 40 hours per week in an intensive format involving therapists working in partnership with parents and other family members or volunteer helpers.
The concerns include the questionable basis (such as small sample size and inequitable allocation of the sample to experimental and control groups) of the original study which gave rise to the claim that normal functioning could be achieved. Further, while accepting that some gains could be made in social or language areas, it has been noted that long term benefits may not be maintained and that gains tail off when the intensive involvement is reduced. Further, there is no scope for acknowledging the child’s particular needs or personality.
No relationship is established, nor is there any attempt to gain for the children a meaning in events around them or in their own behaviours …. hence the view that this kind of approach has little connection with the four theoretical views of autism described above.
The Option Approach (SonRise) is an interactive approach involving three elements … to accept and approve what the child does – to offer experiences to tempt him or her out of the autistic aloneness – and to teach skills by breaking targets into small and manageable steps.
The defining element here is that, in the beginning, the adult seeks to enter the child’s world, copying his actions, as opposed to encouraging the child to copy what the adult is doing. The idea is that the child will gain confidence by being allowed to take the lead and by selecting activities such that there is a predictability of events.
Again, there is little systematic evidence for the effectiveness of this approach, but the current authors describe their own findings to the effect that teachers typically feel strongly that there are clear limits to how far this kind of approach is practicable or helpful in a school setting …. even if it is accepted that there is some logic in seeking to build on the child’s interests and chosen activities. It has been argued that to build on these interests, even at an obsessional level, may be better than challenging them or seeking to change or end them.
One strength of the approach is the attempt to establish a relationship with another person as a foundation for learning and development … and this fits to the principles behind the social and relational contents of the Hobson and Baron-Cohen perspectives, or to the need for developing a sense of central coherence by means, for example, of adapting the environment to limit distractions and to provide a predictable setting and routine.
Again, however, there is the question of how far any gains will be demonstrated outside this very specific setting or away from the familiar adult(s).
TEACCH is basically a behavioural approach but with flexibility to allow for incidental learning, and with an emphasis upon communication and independence.
Spoken instructions are reinforced by visual materials such as photographs or symbols or signing, and the child has an individual work setting where there is a clear and visual timetable describing the activities to be pursued in order. The classroom is demarcated into given work areas, all designed to develop a sense of routine and predictability.
Group working is encouraged through regular opportunities for the children to share a play or work activity.
Surveys have indicated parental satisfaction with the approach but there is no evidence about the effectiveness compared to the effectiveness of alternative approaches.
It has a logic in that, for example, the idea of work stations and timetables and demarcated work zones will compensate for the problems with central coherence and seek to provide a structure by which to gain the whole picture of the working day and the elements thereof. Executive functioning is also encompassed via the grading of tasks and an avoidance of anxiety and impulsive reactions through maximising predictability of events.
The outcomes do seem positive and TEACCH has become a widely used approach, falthough the current authors feel a need for caution about the behaviourist basis and the corresponding possibility that behaviours learnt in one very specific setting may not generalise to a different setting.
The authors then refer to “eclectic” approaches which seek to bring together a range of components because of the difficulty in determining which particular element of any existing approach is the effective one for any given child. The NAS approach – SPELL – for example, combines a predictable structure, positive expectations and self esteem building, empathy and an individual programme to match the observed needs, low arousal by means of a distraction free and non-confrontaional style, and links with parents.
Reference is made to the survey by Jordan et al (1998) which examined the main approaches to autism and concluded that there is no strong evidence that any one approach is better than any other, although positive elements include early intervention direct teaching of basic skills, and the involvement of the parents.
The current authors could infer that this highlights the logic of an eclectic approach, but might equally suggest that, because there is no evidence for the particular benefits of one approach, it does not follow that a mixture of different methods will be more effective.
However, they conclude that an individual programme does provide the opportunity to take account of the various needs of the child with autism – such as the desirable emphasis upon empathy, communication, and relationship building; the modification of the environment to ensure predictability and security; a visual emphasis; a focus upon what is relevant thus to compensate for central coherence weaknesses; and a structure and set of activities to match the child’s competence level by which to build executive functioning.
This conclusion is based upon the recognition that all children have uniquely individual needs with their own way of responding to the environment; and, while there will be some common themes among children with autism, there will also be significant differences.
Programmes should, therefore, take account of the (accepted) psychological perceptions of the nature of autism and of the particular profile of needs and strengths and preferences of the individual child.
The concept of idiosyncracy of needs and styles and behaviours is also highlighted in the work of Barrett (2006) who described the usefulness for teachers and other professionals of gaining some direct insight into the reported experiences and feelings of young people with autism as a means of understanding observable events and putting them into a context. A greater awareness of this kind was also thought likely to be relevant in the establishment of a relationship between the school professionals and the young people with autism.
The starting point for the work in eliciting biographical data from the young people themselves was the growing realisation that autism is a wide-ranging condition and that a child with autism may be as different from another child also diagnosed with autism as from a non-autistic peer. In determining the elements of any intervention programme, it is the relationship with the individual, an understanding of his/her perceptions and beliefs and anxieties, which forms the important basis.
As well as access to the range of theories and data which provide explanations of the aetiology and nature of autism, it is necessary to have access to the ways in which the autism is reflected in individual behaviours which, in turn, reflect those individual thoughts.
For example, if fears are common among a sample of young people with autism, it is appropriate to specify the source of the fear and to seek to understand what it is about a given experience or perception which is arousing.
Barrett contrasts the “formal” diagnostic criteria within DSM-IV with more vivid and individual descriptions of day to day life with autism as set out in existing and published autobiographical accounts.
These latter commonly include references to a failure to understand events, to read signals and clues by which to predict what is going to happen, or to enable others to recognise their own wishes or anxieties … hence a growing sense of pressure which could be reflected in attempts to withdraw from the confusing and threatening world of social interaction.
The criteria may be helpful in defining autism, but it may be the latter which are more relevant in seeking to work with a given child or young person. Behaviours which seem non-compliant, or apparently inexplicable bursts of distress or anger, may become more predictable if one were able to perceive events through the eyes of the individuals in question (who may not understand the social rules, or cannot cope with changes in routine or task demands, etc.)
Barrett presented teachers and teaching assistants with examples of autobiographical material expressed by young people with autism, including the high levels of sensory sensitivity, or the failure to recognise what is expected and a corresponding need for clear and fair rules by which to increase the predictability of events, the rapid development of anxiety and insecurity, and the motive for escaping into one’s own safe and reassuring world.
Reference was made to a very able student who, nevertheless, admitted to feelings of significant anxiety in social situations where he relied upon keeping quiet and watching others in order to determine how he should act.
The goal of such material was to offer insights into the basis of some behaviours, including the way in which signs of distress or withdrawal may reflect a social learning deficit, or a failure to learn from experience which would be taken for granted among non-autistic children and young people.
Similarly, it was seen as important for staff to acknowledge a typical social “style” of the young people who tend to express an opinion openly and honestly, or to ask direct and apparently tactless questions, to the point where it could be seen as offensive … all of which reinforces the need to get to know the person and his/her expression of autistic style as a major step towards building a working relationship.
Barrett’s conclusion reinforces the point about highlighting the differences among individuals all legitimately described as autistic, and clarifying the nuances and complexities behind the formal diagnostic label.
In any event, using the direct contributions of the “clients” themselves does accord with the principles of consultation with its emphasis upon agreed plans based on a sharing of observations and experiences among all concerned.
(nb see also “ Asperger syndrome and the self reports of comprehensive school students ” November 1999; “ Autism - current issues 28 ” July 2003; “ Autism – current issues 36 ” January 2005; “ Autism – current issues 37 ” February 2005)
Still with the linking theme of individual differences within autism and between autistic and non-autistic individuals, one notes the research of Diehl et al (2006) whose initial survey of data suggested that there were few quantitative differences between children with high functioning autism and control children in respect of the length or complexity of efforts to produce a piece of writing based upon seeking to recall a story.
Their own study compared a sample of children with high functioning ASD and controls matched for age, gender, language level, and cognitive ability, in a task involving story recall and the coherence of the work.
No differences were observed in story length or grammatical level, and the two groups were largely similar in gaining the overall nature of the story and noting significant events.
The ADD group were significantly poorer in that their stories were less coherent and less organised, and did not successfully use the overall story gist as a framework for their own writing.
The implication could be described as needing to take nothing for granted, even among more able children, in respect of organisation of thoughts and written recording, and for more direct teaching and increased practice of those skills which may develop more readily among peers.
Finally, and with regard to diagnostic classification and differentiation, Shattuck (2006) has argued that the perceived increase in the incidence of autism would appear to be supported by the increased rate in establishing special educational programmes for children with autism. However, he goes on to express the view that this is not an accurate reflection of actual events within the overall population.
He examined the rising rate of autistic diagnoses in the context of the rates of diagnosis of other conditions, and found that the autistic rate rise could appear dramatic in at least some regions; but, during the same ten year period ending in September 2003, the prevalence of learning disability or mental retardation fell.
The increase in autism prevalence was matched with declines in these two other prevalences.
It is his view that the figures do not reflect a real increase in autism but a different style of diagnosis and classification among largely similar numbers of children year by year. There will appear to be a major growth in autism given that autism only recently became available as a separate category in the USA.
One might suggest that he implication is to be cautious about overall labels, or about the use of single and primary categories of need when children commonly reflect a range of needs which could be classified under more than one heading. The further implication is to plan action in accordance with the observed and idiosyncratic pattern of strengths and weaknesses, and within the context of the family expectations and circumstances.
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Baron-Cohen S. 1995 Mindblindness : an essay on autism and theory of mind. Cambridge : MIT Press
Barrett M. 2006 “ Like dynamite going off in my ears ” : using autobiographical accounts of autism with teaching professionals.” Educational Psychology in Practice 22(2) 95-110
Diehl J., Bennetto L., and Young E. 2006 Story recall and narrative coherence of high functioning children with autistic spectrum disorder. Journal of Abnormal Child Psychology 34(1) 83-98
Hobson R. 1993 Autism and the Development of Mind. London : Erlbaum
Jordan R., Jones G., and Murray D. 1998 Educational Interventions for Children with Autism. DfEE : Research Report RR77. Norwich : HMSO
Lovaas O. 1987 Behavioural treatment and normal intellectual and educational functioning in autistic children. Journal of Consulting and Clinical Psychology 55 3-9
Shattuck P. 2006 (University of Wisconsin) Autism Prevalence. Reports of an interview with Reuters Health (April 13th. 2006). Original article published in Pediatrics 117 1028-1036
Tutt R., Powell S., and Thornton M. 2006 Educational approaches in autism : what we know about what we do. Educational Psychology in Practice 22(1) 69-81
© Mike Connor 2006.
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