Autism and ASD : Reducing and Managing (Behavioural) Symptoms

 

This set of thoughts, summarised from recently published papers, begins with a description of a purpose-built centre for children with ASD and learning difficulties, designed to compensate for characteristic (sensory) problems and to enhance day to day functioning.

On a similar theme, the second section is concerned with the possible use of colour schemes by which to enhance performance among autistic children in providing a link between thinking, feeling, and willing (a sense of self-efficacy).

Reference is then made to the management of hyperlexia, and the use of particular areas of good language competence in developing skills in other areas such as oral interchange and comprehension.

The final section concerns the enhancement of attention to, and understanding of, facial (emotional) expressions via explicit guidance.

 

Building Design

 

Whitehurst (2006) describes a specialist school offering 52 week education and residential care for children diagnosed with ASD and (severe) learning difficulties.

 

The children for whom the school provides are said not only to show the characteristic (triad) impairments of poor communication, interaction, and imaginative play, but also to experience difficulties with spatial awareness and with the input and interpretation of sensory information across the whole range of senses.

 

This author refers to the growing frequency with which mention is made of “autism-friendly” environments in which the learning and social settings are modified to take account of the particular needs demonstrated by this group of children.

She reviews some existing research data which have shown that creating a setting where ease of mobility is ensured is not sufficient, and that thought must be given to the most efficient use of space, resources, and staff when designing accommodation.

(In respect of the staffing “factor”, Whitehurst cites the exploratory work by Plimley [2004] who felt that benefits to the children are linked as much to within-people qualities such as an understanding and experience of the needs associated with autistic spectrum disorders as to physical aspects of the building.) 

Particular reference is made to the need to build social inclusion, such as at mealtimes, and to maximise those conditions which provide for the children’s comfort as well as their health and safety.

 

Turning to the design of the building, Whitehurst quotes Humphreys (2005) who emphasised scale and proportion, along with natural ingredients such as light, air, and selected materials. 

With regard to creating an autism-friendly building, Humphreys based the design upon the following principles …..

·        A sense of calm and order

·        Good levels of light and natural ventilation

·        Reduction of detail

·        Good proportionality

·        Proxemics (the amount of space that children with ASD like to have between themselves and others)

·        Containment (ensuring that the children are secure and safe in the setting)

·        Easily maintained and durable materials

·        Constant ability to maintain observation of the children

·        Good quality acoustics.

 

(It was also seen as necessary and logical to incorporate into the planning the opinions and advice of teaching and care staff with direct knowledge of the needs of children with ASD.)

 

In accordance with the above principles, and in liaison with staff, the designs for the proposed new school and residential accommodation incorporated the following elements :

·        Single storey construction (to maintain safety and ease of movement)

·        Single bedrooms (to show respect for the children’s need for privacy and personal space)

·        Circulation space (providing areas for play and seating with lidded play boxes which could double as bench seating, plus high level cupboards for further storage)

·        A range of communal areas (including lounge, dining room, activity rooms, and sensory centre).  The activity room (which could be used as a quiet space for children and staff to share) to be sited at the end of the circulation space and overlooking the outdoor space to ensure full observability of the children.

·        Outdoor space (including a covered courtyard) to provide a safe outdoor setting where the children can interact independently albeit still under the discrete monitoring of staff; and where material can be stored, and children play, even during poor weather.

·         Curved walls (reducing the existence of harsh corners and providing some cues by which to lead the children from one area to another, compensating for any visuo-spatial weaknesses).

·        High level windows (in addition to standard windows in order to give further light and air but without increasing any risk to the children)

·        Soft and non-flickering lighting

·        Underfloor heating (to ensure comfort but no hazards in the form of hot surfaces, and to avoid the unsightliness of radiators as well as the loss of space).

·        Warm, easily cleanable, and noise-reducing floor coverings

·        Ceilings with noise-absorbent material to prevent reverberating sound

·        Colour schemes chosen to take account of research evidence that certain colours can be disturbing and other colours reassuring.  Shades of pink and purple are said to be most positive and these have been used on many walls.  Grey, a neutral and non-reflective colour, provoking no extremes of reaction,  has also been widely used.

 

Meanwhile, and in addition to these basic principles, there have been further considerations including …..

·        Bedrooms set out in a zig-zag pattern so that every child can have a view from the window without being overlooked, with all the rooms opening onto the circulation space

·        Each house has 2 bathrooms where the showers do not require a tray such that children can move round more easily (and can access a chair if necessary).  The taps are time-set and switch off automatically so that there is minimal risk of flooding.

·        A sensory room is part of each house and different designs are involved so that some rooms can provide stimulating effects, others can provide calming effects.

·        The staff room/office has high level windows affording a clear view of the circulation space and bedroom wing without intruding on the children’s space (ie  monitoring can be maintained unobtrusively)

·        The dining room maintains the curved wall principle, with a serving hatch to avoid the need for children to enter the kitchen area

·        The living room acts as the main communal area and is designed to minimise right angles, while it has high access to daylight and to views of the courtyard and the wider grounds.

 

Discussion with staff concerning their perceptions of the impact upon the children has highlighted how the children are enabled to have a high degree of freedom and choice.  They can move around at will and interact with other children if they choose, but can also move into their own personal space when they do not wish to be part of a group.  This has been seen as very helpful in avoiding problems with proximity and giving the children the chance to get away from others when they feel the need.

 

Meanwhile, it was noted that the children could communicate their needs and preferences more clearly by their use of the spaces and layout of the building.

Further, issues of privacy did not arise since the children appeared not to feel any need to go into other children’s rooms … but did more frequently invite others to visit and share their space.  There was appreciation for the opportunity to supervise the children discretely so that they could play freely without obvious monitoring.

 

The curved walls were said to facilitate movement, and to reduce any sense of living in an “institution”, and the children appeared to enjoy the opportunity to use the low level windows to observe the various spaces without the need to climb or to jump look through windows.  The circulation space was regarded as beneficial to communication and to sharing activities …. with access to their own rooms as they chose but access, too, to a family atmosphere in the shared space close by.

 

The final comment concerned the general calmness of the atmosphere not only linked to the above features but also to the noise reducing elements, and the careful use of colour.

 

With regard to the staff themselves, the comments emphasised their ability to share and enjoy the calm atmosphere and the ability to supervise the children without encroaching upon their space and allowing them to have wider choice about where to go.  There was less “intensity” in the interactions with the children, and less sense of anxiety over having constantly to follow and observe the children who, in turn, could be more autonomous. 

 

Some specific suggestions for further improvements included …..

·        The need for darker carpet colours to reduce marks, and for paint to be washable

·        Some system for cleaning high surfaces

·        Need to minimise furniture in corners where children could conceal objects

·         (or themselves)

·        Need for softer lighting in lounges and bedrooms (especially for those children who prefer to sleep with the light on)

·        Showers to have key control; press-down taps to be replaced by taps easier to operate; and bathrooms to have more storage space

 

In conclusion, Whitehurst emphasises the point about the children’s having greater autonomy.  They appear to benefit from having the choice (rather than necessity) to interact with others, while also having the opportunity to withdraw into quiet areas or their own rooms as it suits them.  Creating space (and different areas) creates choice with the children playing with others because they choose to do so.

Meanwhile, Whitehurst stresses again that what matters is not just the physical environment, but the interaction of these physical features with human features, namely the knowledge, experience, and understanding of the needs of children with ASD on the part of the staff. 

 

Using Colour

 

The ideas emerging from the work of Pauli (2006) were used in the planning of the colour schemes of the above described residential school for children with ASD and severe learning difficulty.

 

The stimulus for the research came from Steiner (eg 1993) who proposed that human interaction was based upon the linking of thinking, feeling, and willing; and this idea was developed into a perception of autistic symptoms and style as reflecting a failure to integrate these three cognitive-emotional elements.

 

Pauli notes that one school of thought (Hobson 2002) regards the core (emotional) impairment in autism as the lack of “connectedess” with other people, reflected in a failure to develop theory of mind … ie  a failure to recognise that other people have their own perspectives and feelings, or to recognise their significance, together with a problem in understanding one’s own feelings.

 

A further school of thought exemplified by Russell (1996) holds that the fundamental characteristic of autism is a matter of an absence of personal “willing” … a failure to  recognise what can be achieved by one’s own actions, or to develop any sense of personal agency.

 

The argument continued by Pauli is that these two impairments are of equal relevance and that the core nature of autism is revealed when the capacities of thinking/feeling and the sense of personal agency do not act together in a coherent way, so that interactions among them, necessary for appropriate day to day (social) functioning, are somehow blocked.

 

To help the children by engaging their feelings and their will, the children are seen on a 1:1 basis in a specially designated room where the interior colour can be modified by means of dimmer-controlled coloured lights. 

The major approach to the therapy is that of Intensive Interaction where the adult mirrors the child’s actions and behaviours, while seeking to empathise with and reflect the child’s mood, and modifies them in order to build up some relationship and dialogue.

Over time, and as signs of rapport and communication are shown, the adult begins to prompt the child into making certain movements or sounds.  The positive feelings associated with the child’s successful response are seen as a first and major step towards developing the self-efficacy (the “willing” element); and the longer term goal is that of sharing simple stories which have an emotional content and where words can be associated with actions …. thus connecting feeling, thinking and willing. 

 

Changes in ambient colour are used to reinforce the mood and atmosphere during an interaction.  The walls and floor of the room are grey so that they can take up the colour of the lights.

A range of colours are tried in order to gain an idea of the child’s reactions to different colours, and to be able to use the optimal colour to enhance the child’s mood during the interaction. 

It has been commonly observed, for example, that red appears to have an arousing effect and green to have a calming effect, although prolonged exposure to any one strong colour produces discomfort after a period. 

The adult will then use the dimmer controls in responding to the reactions of the child thus further to build up a dialogue.  (This use of colour is described as somewhat analogous to the use of music responses in music therapy.)

 

The case study is given of a child with autism and Down Syndrome with no meaningful speech and whose play could be aggressive. 

Observations of her reactions indicated that movements or the expression of sounds were faster and more lively when exposed to red colours, but gentler and quieter when exposed to blue or green colours.

The natural tendency to rock from side to side was the starting point for the interaction, with the adult taking her hand and rocking with her accompanied by fading up and down the red or blue colours, with the adult imitating the more animated or the more gentle forms of behaviour. 

An exercise named “ In and Out ” was introduced where the child and adult were to come together in the middle of the room when the lights shifted to red, and to move apart when they changed to blue.  The report describes the effort required on the part of the child to grasp the pattern, but the clearly observed pleasure when it was grasped and the spontaneous use of the word “out”.

The therapy continued in respect of introducing different types of shared movements, until an innovation was reported where the child spontaneously began to shake her head while making a kind of buzzing noise.  This was mirrored by the adult, with the child becoming more animated, accompanied all the while by yellow and pink colours.

The next stage was the eliciting of speech sounds accompanied by particular movements and colours, leading gradually to the introduction of words or short sentences to the point where, after  a prolonged intervention, the child had gained the capacity to use a number of words and to provide one-word answers to simple questions.

A tangential benefit was the gradual elimination of rough or over-excitable play and an apparent recognition of boundaries of behaviour, coupled with a happier and more sociable style in the company of other children.

 

The author goes on to offer a second example by which to highlight the value of mirroring a child’s emotional state, and providing a means of expression thus to enable the child to be aware of his feelings and then to channel them into “willing” via some more appropriate action (such as stamping his foot rather than banging his head). 

 

Pauli concludes that, through the use of mirrored and then shared actions, accompanied by the directing or modifying effects of colours, it has been possible to achieve a more fulfilled state for the children; and she expresses the hope that this will encourage other therapists/teachers to work, via the channelling of feelings and developing a sense of self efficacy (an awareness of having some degree of control over events), towards establishing a meaningful relationship with children with autism.

 

Hyperlexia and ASD        

 

The article by Craig and Telfer (2006) describes a child (“J”), diagnosed with pervasive developmental disorder (ASD), whose superior early reading and writing skills were used to support growth in (oral) language skills. 

Like a child with “classical” autism, J presented marked impairments in social interaction and in communication, while behaviour was stereotypical. 

 

The symptoms presented by J have been more apparent at some periods of his life than at others. 

At age 5 years, social interaction was characterised by very limited eye contact, and an absence of gestures or use of facial expression to demonstrate feelings.  There was no shared attention or shared interest in activities or objects, and mannerisms, such as hand flapping, were common.

Communication was delayed and echolalic.

Later, and as schooling became more salient, J was described as showing very limited social interaction, so that only rare attempts were made to initiate activities or conversation, and he was dependent upon adults to create opportunities to participate in group activities. 

The “mechanics” of communication were present but there was no pragmatic skill, so that J was unable to take turns verbally, could not maintain or elaborate topics, and could not read the perspectives or feelings of other people. 

 

The parents had become concerned about linguistic and social development by the time J was 3 years old, and he was placed in a pre-school class for children with special needs (which took up 12 hours per week), while also provided with a home-based behavioural programme occupying between 15 and 20 hours per week, based upon the ABA principles of Lovaas,  3 to 5 hours per week of private speech and language therapy, and 1 hour of music therapy.

The ABA worked towards eliciting speech and directing attention to the speaker, and, while speech and attention did increase, the language remained formulaic and stereotyped and had poor intonation. 

At age 5+, J was referred by the parents to the authors (based at the Michigan University Centre for the Development of Language and Literacy) with a view to improving his functional use of language.

 

The investigation confirmed J’s advanced recognition and production of letters and words.  This pattern was seen as a form of hyperlexia in that these recognition skills were in advance of what would be predicted from mental age, and also in advance of comprehension.  J was seen to be reading in the sense of being able to decode the print, but not in the sense of being able to extract the meaning and content of the text.  Sounds and letters were linked in order that words could be recognised, but there was no meaningful reading of consecutive words or phrases/sentences. 

 

Day to day observations confirmed this situation in that J could read road signs but had no awareness of what they meant … ie there was the ability to decode in the absences of functional expressive language … and his favourite toy at this time was a doodle board on which he spent his time writing upper and lower case letters.

He also wrote whole words memorised from a phonics videotape which he watched every day, while also demonstrating an ability to remember complex visual sequences and to solve visual puzzles.  There continued to be a discrepancy between his (average) measured ability and his superior skills with regard to processing and coding visual symbols.

 

At age 7+, decoding skills remained high and reading rate was good average.  However, these scores continued to contrast sharply with scores on measures of comprehension where performance remained at a low average level.

Strengths were also maintained in writing, with a capacity to write letters, pseudo words and real words from an early age.  There continued to be a strong interest in writing which had showed an appropriate developmental progression from drawing single shapes to producing actual words and, eventually, whole strings of words.

 

The long term goals for J were for the improvement of the structure and pragmatics of his language, notably an increase in the length and complexity and frequency of responses to questions, plus appropriate eye contact and turn-taking.

 

A basic principle of the programme established for J was the potential use of the interest in, and capacity for, print in developing other forms of communication.  The goal was to capitalise upon the affinity with letters and figures to enhance comprehension and communication.

 

J showed a capacity for focused attention (when working on lines and shapes) and this encouraged the belief that he would be a good candidate for the use of print as a means of re-orienting and motivating him towards wider communicative skills (plus a greater willingness to use the skills).

 

To begin with, it became clear that J coped better with comprehension questions (or what, where, who, and why  questions) when the focus was upon a book rather than on the content of his play.  Further, it was noted that, in small group sessions, J could use cue cards to assist his responding to questions.  His reading of printed cards was a means of building oral language comprehension. 

 

The therapist, accordingly, presented all new language material both visually, through printed words and symbols on cards, and orally, pairing them with spoken models.

For example, when teaching J to respond to what, where, who, and why questions, the therapist presented each question printed on a card, saying it aloud to J.  The card was then removed, and was replaced by another card showing the word plus a picture of the appropriate object or person, while speaking the response word.

As J learned to respond to these types of question, the visual cards were gradually faded, until they could be removed completely. 

 

This kind of approach was also used to increase interaction and appropriate turn-taking.  For example, when working with a group, the therapist wrote the names of the other children on cards, and encouraged J to read the name of the child in question when she called upon another child to respond.  This had the successful outcome of helping J to recognise when it was his turn and when it was another child’s turn to respond.

 

Meanwhile, in the school setting, the teachers were encouraged to use diaries across all the subject areas, with the children required to make weekly entries which would be shared with the teachers.  J responded well to the system of writing a reply to a teacher’s written question or prompt, producing thoughtful and creative answers in this form which he could not have produced orally. 

The written responses demonstrated a clear understanding of the question and what was expected of his answer.

 

The programme continued by using priming (ie practice on materials and contexts that match the impending task) to help J to work towards the goals set.

Visual priming was used to help him prepare for the language demands of the classroom by coaching him in the necessary vocabulary via printed words or visual cues.  Priming was also used to help with social interaction and transitions. 

 

The first system of priming involved collaboration among staff and parents to ensure consistency, with communication among staff about the impending staff and the priming material.  The use of the material was followed by rapid feedback. 

In J’s case, this involved the targeting of language concepts and vocabulary for priming before their use in the classroom.  Parents were supplied with lesson notes and outlines or fact sheets a week in advance of the lesson in question so that they could work on pre-teaching of the salient concepts and words.

 

In History, for example, a visual time line of dates and events was created at home with J gradually adding new information to it as he completed some reading assignment.  This timeline was gradually converted into a Venn diagram to show how events were linked or had an impact upon subsequent events, while providing continuous visual priming for understanding the necessary vocabulary; and the parents encouraged J to prepare for lessons by reading, whether to himself or aloud, the written notes which would cover the subject matter.

 

In addition, during the early school years, J was taught to recognise facial expressions by means of cue cards depicting characteristic facial signs accompanied by words descriptive of the emotion conveyed by the picture.  Over time, the pictures were faded with J able to recognise facial expressions to at least some extent.

Further, transitions between activities or classes, which commonly give rise to some anxiety or stress, were the subject for priming via J’s preference for reading prompts in the form of printed cue cards (written word plus picture) which enabled him to remind himself of the activity coming next.  In therapy sessions, too, the therapist used cards to set out the activities for the whole session, organised in sequence, and drew attention to them at regular intervals.

 

The authors summarised their approach by restating how J’s superior decoding skills were used to “scaffold” language comprehension and his writing skills to “scaffold” language expression.

Visual priming helped prepare for transitions across clinic and school sessions, and was also used by his home tutor and therapist to prepare for the language demands of impending lesions. 

 

The longer term outcome (J is now 12 years old) shows that J continues to receive therapeutic and educational support, and continues to need help in respect of the structure and pragmatics of his language.  Abstract concepts are challenging for him as well as the complexity of the day to day interchanges among (older) students.

He attends a weekly session with similar other children to work on the social-linguistic skill by which to make and maintain friendships  … including meeting and greeting, turn taking, shared problem solving, negotiating, and conflict resolution … all via verbal means. 

 

Current levels of social and scholastic functioning are better than originally predicted, and, while still showing a tendency to avoid oral language interactions and some difficulties in fitting in to the classes, J is working at the expected level for his age.

 

The main challenge perceived by his therapists is enabling other people to recognise the marked contrast between what J actually knows and understands and what he demonstrates by his day to day performance and contributions.  He remains at a disadvantage in a system which depends upon strong language skills to demonstrate academic competence …. as illustrated by his observable knowledge of geometric concepts when given specific questions in contrast to a failure to score in a test of similar knowledge when the questions were in the form of oral problems (and J could not determine the actual geometric question embedded within the verbage.)

 

The authors concluded by highlighting the importance of acting upon a child’s strengths as much as upon the observed weaknesses.  There may be a tendency to work towards improving the perceived areas where difficulties are noted, but their case study is cited as demonstrating the benefits of using a child’s strengths in one domain to support language growth in a different domain.

 

Enhancing Attention to Facial Emotional Expression               

 

Following on to some extent from the above thoughts about enhancing interaction and  communication, one notes the work of Begeer et al (2006) whose study concerned the means of enhancing attention to emotional cues on the part of children with autism. 

 

These authors begin their paper by stressing the importance of being able to read other people’s emotional expressions for social interaction.  The ability to recognise and interpret emotional signals helps to explain and to anticipate what other people do. 

Processing the information conveyed by facial expression is thought to be one of the earliest means of enhancing interaction, with data available to demonstrate that even very young infants spontaneously attend, and differentially react, to emotional signals from other people. 

Having learned that facial expressions provide indicators of a person’s feelings, the child’s next step will involve the development of more general theory of mind capacities. Conversely, if a child does not spontaneously attend to the emotional expressions of other people, information about that person’s needs and perspectives will be lost, and this will inhibit the understanding or predicting of his or her subsequent actions.

It is held (see, for example, Harris 1989) that the beginnings of theory of mind emerge between the ages of 2 and 3 years when children can show pretend play and imagine moods and psychological states.

 

With regard to children with autism and ASD, deficits in the capacity to perceive emotional signals have been thought, at least partially, to underlie the characteristic social disabilities. 

 

A review of evidence completed by Begeer et al has it that high functioning children with autism are generally competent when it comes to recognising “basic” emotions such as happiness, sadness, fear, and anger. However, there is less competence when it is a matter of recognising more subtle or complex emotions such as pride, embarrassment, surprise, or jealousy.

Further, there is evidence (see, for example, Grossman et al 2000) that when children with autism but average measured ability are compared with mental age controls, attention deficits in the target group become observable as the complexity of the tasks increases … such as when the children can observe only the eye region of the facial expression, or when a facial expression is paired with mismatching emotional words. 

 

An early study (Jennings 1974) involved asking participants with (low-functioning) autism to categorise photographs of human faces which differed on two features, emotional (facial expression) and non-emotional (wearing or not wearing hats).

The children with autism sorted the faces more frequently than the control children according to the non-emotional feature.

 

However, evidence from this study and from follow-up studies (such as that of Weeks and Hobson 1987) demonstrated that children with autism could sort the faces on the basis of emotional features if explicitly asked to do so.

In other words, the ability to perceive emotional expressions may well be intact even among low functioning children with autism, but their use of this skill is not commonly observed.

 

In respect of why such children use this skill less frequently than normally-developing peers, one hypothesis holds that the children do not attend to emotional cues in the artificial setting of some psychological task but that the skill may come into play when the information in question could have some direct value and relevance for the children. 

This hypothesis gains some support from studies which have found that some external trigger can spark a latent capacity in children with ASD, such as when they were prompted by specific instructions, or when their active participation was subject to reinforcement, or when their personal interest was increased.

 

The study by Begeer et al explored this hypothesis among a sample of high functioning children with autism (IQ 80 or above), a sample with pervasive developmental disorder, and a sample of normally-developing controls on a task involving attention to emotional signals in a neutral setting (where the emotions of the portrayed others have no direct implications for the children) and in a second setting where the emotional information could have some direct relevance.

The three samples of children (all boys, mean age 9+) were presented with photographs of people which differed according to facial expressions (positive or negative), and according to the presence or absence of non-emotional features

(glasses or moustaches).

In the neutral condition, the children were simply asked to select pairs of photographs that were most similar. 

In the “primed” condition, the children were asked to pair the photographs on the basis of their expectations of the future actions towards them of the people portrayed. 

 

The results showed that the high functioning children with autism tended to pay less attention than controls to the facial emotional expressions of the people in the photographs. They more often selected photographs that matched on non-emotional features like the wearing of glasses or the presence of a moustache. 

No differences were observed between the group with autism and the group with PDD.

 

However, these findings applied only to the neutral condition.

When the children were asked to sort the photographs according to the likely behaviour of the people in the photographs, this difference between the target groups and the control group was no longer observed.  The children equally often sorted the photographs according to the emotional features when specifically asked to sort them on the basis of anticipated actions.

In other words, the children with autism appear able to pair a positive or negative expression with a positive or negative social consequence when asked to make a socially-relevant decision.  Unlike typically-developing children whose attention to emotional features applied to both conditions, the children with autism need some prompting, some situational relevance, to take account of the emotional information. 

 

The authors considered it unlikely that group differences could be attributed to intellectual differences between the target and control groups given the lack of correlation between attention to emotion and measured ability (despite the wide range of ability scores).

Rather, it seems that the autistic children do not have, or do not utilise, the apparently intuitive understanding of emotions available to typically-developing children.  They might tend routinely to ignore facial expressions where such information has no relevance for them ….. (no “ instrumental purpose ” one might say ??).

 

However, Begeer et al also accept the possibility that, even when attention to emotions is triggered among children with autism, their style of processing emotional information could be differentiable from that of non-autistic peers in lacking a holistic or intuitive element reflective of weak central coherence.  Facial expressions provide one item of information to be registered, with others, in a piecemeal fashion.  

 

In any event, the authors concluded that attention to emotions is a less spontaneous event among children with autism than among typically-developing children.  The children are not lacking in a capacity to note emotional cues, but they require help in determining when and where to look for them.

 

                                     *          *          *          *          *          *

M.J.Connor                                                                                              January 2007

 

 

REFERENCES

 

Begeer S., Rieffe C., Terwogt M., and Stockmann L.  2006   Attention to facial emotion expressions in children with autism.  Autism  10(1)  37-51  

 

Craig H. and Telfer A.  2006   Hyperlexia and autistic spectrum disorder.   Topics in Language Disorder  25(4)  364-374

 

Grossman J., Klin A., Carter A., and Volkmar F.  2000   Verbal bias in recognition of facial emotions in children with Asperger Syndrome.   Journal of Child Psychology and Psychiatry  41  369-379

 

Harris P.  1989   Children and Emotion.  Oxford : Blackwell

 

Hobson R.  2002   The Cradle of Thought.  London : Macmillan.

 

Humphreys S.  2005   Autism and Architecture.  Available on-line from the website … www.autismlondon.org.uk

 

Jennings W.  1974   A study of the preference for affective cues in children with autism.   Dissertation Abstracts International  34  4045-4056

 

Pauli D.  2006   Contact through colour.   Special Children  (June/July)  30-33  

 

Plimley L.  2004   Analysis of a student task to create an autism-friendly living environment.   Good Autism Practice  5(2)  35-41

 

Russell J.  1996   Agency : Its Role in Mental Development.   Hove : Erlbaum

 

Steiner R.  1993   Curative Education.  Bristol : Steiner Press

 

Weeks S. and Hobson R.  1987   The salience of facial expression for children with autism.   Journal of Child Psychology and Psychiatry  28  137-152

 

Whitehurst T.  2006   The impact of building design on children with autistic spectrum disorders.   Good Autism Practice  7(1)  31-38