Scenario 4
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Chapter9.docxNever before have so many treatment and intervention programs been promoted for use with individuals with autism, and the number of options continues to grow. For example, Green and colleagues (2006) surveyed 552 parents of children with autism worldwide and identified 108 different therapies, medications, treatments, and intervention approaches that parents reported their children had received. The explosion in the number of programs is partly the result of the increased awareness of and interest in autism, desperate attempts by parents to find a cure for the disorder or strategies to alleviate the unique symptoms and partly the result of efforts by entrepreneurs who see ripe opportunities for profit.
Unfortunately, popular press books, television news and daytime talk shows, newspapers and other media outlets, social media, and Internet websites continue to spread the false notion that autism can be cured or, at the very least, the symptoms alleviated to allow an individual with autism to lead a “normal” life. This proliferation of unsubstantiated autism “treatments” is often intuitively appealing; because many are easy to administer, family members often rush to try them. However, numerous of these “treatments” are costly and potentially dangerous in many cases (Travers, Tincani, & Lang, 2014). A more important point is that the vast majority of these treatments have no scientific evidence to support their claims. In their review of approximately 400 autism treatments found through Internet searches, Romanczyk and Gillis (2008) reported that less than 2% have strong research support for their purported outcomes. For their National Standards Project, a team of experts at the National Autism Center (NAC) reviewed 775 studies that evaluated autism interventions; of those, only 11 were identified as likely to be effective for individuals with autism (National Autism Center, 2009, 2015).
Evidence-based practices are important because potential problems develop when ineffective strategies and programs are promoted directly to families and schools before being vetted by the scientific process or after they have failed to show beneficial outcomes during rigorous intervention research. For example, using close physical “hugging” to help the individual develop attachment to another person (Tinbergen & Tinbergen, 1983) is not an evidence-based practice and is quite different from using applied behavior analysis (ABA) strategies, which we know to be effective for targeting behaviors to be decreased (e.g., self-injurious behavior or aggression) or increased (e.g., communication skills, interpersonal skills). Unfortunately, in many instances, parents and educators embrace different ideas and feelings about what constitutes effective educational practices for a student with autism. These disagreements about basic special education services can lead to individualized educational program (IEP) meetings that last for many hours across multiple days and end with one party or the other requesting a due process hearing and not with an agreed-on IEP. Nor is it uncommon for both sides to involve advocates or lawyers to discuss appropriate programming, resulting in the development of programs that favor the side that presents the most compelling legal argument and not necessarily the one with the strongest evidence that best matches the needs of the student involved.
Families and educators of children with autism are no doubt exposed to countless exciting, hopeful stories of strategies and programs that have vastly improved the lives of individuals with autism. Regrettably, many of those stories promote approaches that are backed only by emotional appeals to fears, concerns, and feelings of hopelessness that caregivers and educators share and not by scientific evidence (Offit, 2008; Travers, Ayers, Simpson, & Crutchfield, 2016). Fortunately, since the 1960s, there has been increasing focus on using rigorous and scientific methods for identifying the most effective interventions for individuals with autism (Wong et al., 2013). Education, in general, has also seen a shift toward EBPs for all students, including students with disabilities. Three federal education laws mandate the use of evidence-based practices: The No Child Left Behind Act of 2001 (NCLB, 2006), Individuals with Disabilities Act (IDEA, 2004), and the Every Student Succeeds Act (ESSA, 2015). The U.S. Department of Education provides guidance regarding EBPs, instructing state and local education agencies to use “evidence-based activities, strategies, and interventions” (U.S. Department of Education, 2016, 2).
A separate but related development further highlights the importance of relying on EBPs for teaching students with disabilities—specifically, autism. IDEA was originally crafted to ensure that students with disabilities receive a free appropriate public education. Over the years, litigation between families of individuals with disabilities and public school districts has attempted to define criteria for an “appropriate” education. The most recent—and high profile—effort to establish that standard occurred in January 2017 with the U.S. Supreme Court decision in Endrew F. v. Douglas County School District RE-1. In that case, Endrew (Drew) was a student with autism and attention-deficit hyperactivity disorder. Drew exhibited behaviors that interfered with his learning and made little progress in elementary school. Alleging that the school had not effectively addressed his behavioral needs, Drew’s parents withdrew him and enrolled him in a private school, where he made significant academic and behavioral progress. The Supreme Court unanimously ruled that an appropriate education means that a child’s educational program must provide more than minimal benefit. Students with disabilities who participate in the general education academic curriculum should be expected to make progress commensurate with their peers. Students whose placement is other than the general education classroom must be offered an educational program that is “appropriately ambitious in light of his circumstances,” and the student should have the opportunity to achieve “challenging objectives” (Endrew F. v. Douglas County School District RE-1, 2017, 3). This decision does not directly address the issue of reliance on evidence-based practices. However, given this expectation that students should make progress toward “challenging objectives,” it seems clear that use of evidence-based practices is essential to help ensure steady and substantial progress, especially for students with the most severe disabilities.
The field of autism in particular has endeavored to quantify EBPs targeted for children and youth with autism through professional policies and major EBP reports. For example, in 1989, the membership of the Association for Behavior Analysis International approved a position statement on the right to effective behavioral treatment. This position statement provides guiding principles that inform assessment and treatment procedures and is intended to protect individuals with autism from harm as a result of inappropriate services (Van Houten et al., 1988).
Did You Know That
· Americans spend billions of dollars each year on unproven medical treatments and products, some of which are actually dangerous (U.S. Federal Trade Commission, November 2011)?
· Between 50 percent and 75 percent of children with autism are receiving some sort of alternative (and unproven) treatment for autism (Singer & Ravi, 2015)?
· Increase in autism prevalence has resulted in a proliferation of fad cures or “treatments” that are often promoted by popular media (Foxx & Mulick, 2016)?
· Problems can arise when stakeholders (parents and educators, teachers and administrators, etc.) disagree on or ignore what constitutes effective strategies and programs?
· Relying on reputable sources of information can help practitioners choose strategies and programs that are most likely to produce desired outcomes?
Further, in an effort to identify the most effective approaches for individuals with autism, the NAC conducted two comprehensive reviews of strategies and programs that target educational and behavioral needs of individuals with autism. Phase 1 of its National Standards Project (2009) focused on interventions for children and adolescents. In the phase 1 report, 11 treatments were classified as established (e.g., clear evidence of efficacy), 22 were classified as emerging (e.g., limited, but promising, evidence of efficacy), and 5 were unestablished (e.g., no acceptable evidence of efficacy, and possibility that the treatment could be harmful) (National Autism Center, 2009). The phase 2 report (National Autism Center, 2015) updated the original review, expanded the target age range to adults, and adopted the term “intervention” in place of “treatment.” Phase 2 results were 14 established interventions, 18 emerging interventions, and 13 unestablished interventions.
Similarly, the National Professional Development Center on ASD (NPDC) reviewed autism intervention research published from 1997 to 2007. Using published guidelines for evaluating research, they identified 175 studies for review. After evaluations, they recognized 24 unique interventions as evidence based. The NPDC released a 2014 update to its original report, evaluating autism intervention research published between 1990 and 2011 (Wong et al., 2013). The review by Wong and colleagues resulted in 27 interventions that met their established criteria for evidence-based practices. Later in this chapter, we summarize the practices identified in both the NAC and the NPDC reports and the number of studies identified in each report that support the interventions listed.
Because it is so important for teachers to use EBPs, we will provide information for recognizing these strategies and programs, discuss sources for identifying EBPs, and list criteria for evaluating strategies and programs. In addition, we will discuss popular, but unsupported, interventions that educators of students with autism may encounter, and we will summarize why those interventions should not be considered EBPs.
9-1 Definition of Evidence-Based Practices
There is no single, accepted definition for what constitutes an evidence-based practice (Reichow, Volkmar, & Cicchetti, 2008). As awareness of the importance of EBPs has grown over the past several decades, many education-related groups, organizations, and agencies have developed various working definitions of EBPs, typically targeted to their population of concern, organization, or agency. For example, a quick Internet search for “evidence-based practices definition’ produces results from the fields of medicine, nursing, mental health, speech and hearing, education, autism, and others. Even a search for evidence-based practices in special education produces results targeted to specific populations (e.g., early childhood, autism) or practices (e.g., assessment, behavior management). However, most definitions of EBPs share common criteria for determining an EBP, including the following.
· Multiple studies have evaluated a particular intervention or combination of interventions to be effective with the target population.
· These studies utilize high-quality research designs that increase assurances that results are, in fact, the result of the intervention provided and not extraneous, intervening variables.
· The interventions studied produce consistent beneficial outcomes.
· The intervention studies have been replicated across participant age groups, settings, and other variables (Agran, Spooner, & Singer, 2017; Spooner, McKissick, & Knight, 2017).
9-2 How to Determine EBPs
Determining what is and is not an EBP clearly can be a complicated undertaking. Thus, we encourage readers to rely on reliable, reputable sources for information and updates on EBPs. Albeit still somewhat difficult, it has never been easier to stay abreast of EBPs in the field of autism. Government agencies, professional organizations, university autism clinics and research centers, and advocacy organizations are usually good sources for information regarding EBPs, and each source may make reports available free of charge (or nominal charge only) on Internet websites. In Table 9.1, we provide a partial list of recommended sources for identifying EBPs to guide educational practices for students with autism. Read the reports with the intent of identifying how EBPs were determined and compare these criteria to the preceding bulleted list. Any report listing EBPs should be able to provide a list or discussion of such criteria. Avoid websites that appear to have a vested interest in a particular intervention and do not provide detailed criteria for determining that a strategy is an EBP.
Table 9.1
Reliable Sources for Identifying EBPs
9-2a Effective Practices as Identified by the NAC and NPDC
As examples of sources for EBP’s and autism, we have described the work undertaken by the NAC and the NPDC to identify effective intervention practices. Basically, each group identified interventions in one or more of two broad categories:
· (a)
comprehensive treatment models (CTMs) consisting of a broad set of practices designed to affect core symptoms of autism (e.g., the Lovaas Institute, the Denver model, Division TEACCH) and
· (b)
Odom and colleagues identified 30 CTMs and evaluated each model across multiple variables. They found that CTMs were strongest in terms of organization and operationalization of their models, which means that they had clearly described implementation procedures and materials. However, CTMs did not fare as well on indicators of efficacy compared to published efficacy studies of focused interventions. In this book, we have emphasized focused interventions (strategies and methods) and described research support for those interventions.
Table 9.2 lists evidence-based practices (those found to be established) identified by the NAC’s National Standards Projects, phase 1 (National Autism Center, 2009) and phase 2 (National Autism Center, 2015), and by the NPDC (Wong et al., 2013), along with the number of studies reviewed for each. Note that the NAC and the NPDC used slightly different approaches to categorize treatments. For example, the NAC grouped behavioral interventions, whereas the NPDC presented specific behavioral strategies separately. Also note that the interventions listed are only those that were classified by the groups as established or evidence based. The NAC’s National Standards Project reports also list emerging treatments that are not included on this table.
Table 9.2
Established Evidence-Based Practices Identified by NAC and NPDC
|
ESTABLISHED INTERVENTIONS (CTMS AND FOCUSED) |
EXAMPLES OF TECHNIQUES INCLUDED IN EACH CATEGORY |
NUMBER OF STUDIES REVIEWED |
||
|
|
|
NAC – NSP 1 |
NAC – NSP 2 |
NPDC |
|
Antecedent-Based Interventions |
Contriving motivational operations Prompting and prompt fading Modification of task demands Errorless learning Time delay |
99 |
|
32 |
|
Behavioral Interventions |
Function-based interventions Chaining Promptin |
|
|
|
9-3 Developing and Evaluating Effective Educational Programs
As part of educational planning for students with autism, IEP teams may have to consider multiple programs or intervention options (Reichow et al., 2008). We propose that teams consider the four essential areas described in the following sections to evaluate those intervention options. The information presented in each area is not meant to be comprehensive but to serve as initial criteria for evaluating interventions with regard to individual student needs. Once the educational program has been agreed on, the final step in IEP development should be to determine how program effectiveness will be evaluated. In the following sections, we explain the four essential areas to consider in choosing interventions and considerations for program evaluation. These essential areas of consideration are encompassed in a list of questions for education planning teams to consider before adopting any strategy or program and are presented in Table 9.3.
Table 9.3
Guidelines for Discussing Intervention Options
|
1. To guide consideration of the appropriateness of an intervention option for supporting a student’s IEP goals, the team may ask: 1. Have meaningful goals been written for the student? 2. Do the goals promote independence and self-determination? 3. Do the outcomes promoted by the option match the goals written for the student? 4. Is the student similar to other individuals who have benefited from the program? 2. To guide consideration of the appropriateness of an intervention option based on the presence of potential risk, the team may ask: 1. Are there any immediate or eventual health or behavioral risks for the student? 2. Are there immediate risks for family members or school personnel? 3. Will the option negatively impact the quality of life for the student, family, or school personnel? 4. If the option fails, will the financial, time, and energy resources have been justified? |
9-3a Intervention Outcomes
The IEP team should consider whether the outcomes promised by the intervention match the student’s IEP goals. This simply means that each child’s individual needs as addressed in IEP goals must drive decision making about interventions. If the IEP team determines that the purported outcomes of the intervention match the student’s IEP goals, the team should next consider the likelihood that implementation of the program with a particular student will likely result in those outcomes. This can be done by comparing descriptions of students who have benefited from the program to characteristics of the student for whom the program is being considered. Students who do not fit these descriptions may not demonstrate the same outcomes.
In some cases, there may be little to no intervention research involving participants with characteristics and goals similar to that of your student. For example, there is little research on improving reading comprehension for high school students with autism that are English Language Learners (ELLs). In such cases, the best course may be to select from options that have been effective in improving reading comprehension for high school ELLs without autism and then adapting those strategies to be more suitable for your student (e.g., embedding the child’s perseverative interests into the reading) (e.g., El Zein, Solis, Lang, & Kim, 2016). As with all educational programs, ongoing data collection and progress monitoring should be conducted, and revisions to the program should be made based on that process.
9-3b Potential Intervention Risk
After the IEP team has ensured that the student’s goals and likely intervention outcomes are aligned and appropriate, the team should consider the potential for any negative outcomes; that is, the team should consider whether or not there are any inherent risks in the intervention. The team needs to consider potential risk not only for the student but also for family members and school personnel. Risk may be related to physical health, behavior, or quality of life. Using one approach to the exclusion of other options might diminish the quality of life for a student and his family (Donnelly, 1996).
9-3c Evidence
One of the most contentious issues that the IEP team should address is the availability of proof to substantiate the effectiveness of a treatment or intervention option. As mentioned previously, school systems are held accountable for their decisions and are required to use empirical evidence to make (and defend) their choices (Simpson & Myles, 1995).
In this chapter, we have discussed resources and criteria for identifying EBPs. Unfortunately, families may desperately seek improvements in their children’s learning and relief for themselves (Lehr & Lehr, 1997) and therefore may be willing to try even unsubstantiated approaches (Boynton, 2012). This willingness can result in hope being replaced by despair and personal and financial resources being drained (Christopher & Christopher, 1989; Todd, 2012). Educators should listen carefully to parents’ goals for their child and frustrations with previous educational programs, and they should use that information to choose EBPs that are most compatible with the student’s educational needs and the parents’ wishes while still adhering to a standard of evidence (Fox & Mulick, 2016).
Currently, most proof supports the use of a structured educational program that has been individually tailored to the student’s developmental abilities, educational and behavioral needs, and long-term goals. The program should use systematic, ABA-based instructional practices and should be provided in an intensive manner with specific programming for generalization. Parents should be involved in educational planning, which should emphasize social and communication training (Maurice, Green, & Foxx, 2001). The strategies described in this book meet these criteria.
9-3d Considering Alternatives
Finally, a team considering intervention options should discuss how the selection of particular options might affect the use of other approaches. Some program options require the exclusion of others. For example, imagine a situation in which a family insisted that a child’s teachers use only facilitated communication, not an EBP, for communication purposes. No other form of communication was allowed. In this case, the intervention being insisted on—facilitated communication—is likely the most notorious of dangerous and ineffective interventions, and the risk clearly out weights the possibility of any benefit (Boynton, 2012; Todd, 2012; Tostanoski, Lang, Raulston, Carnett, & Davis, 2014). Further, this type of exclusionary practice is not only unnatural (e.g., most individuals, even children with autism, use multiple forms of communication) but also has potential for negative outcomes for the student if the exclusive practice does not produce desired outcomes. As discussed previously, such a situation may present a potentially unacceptable form of risk.
Although few options specifically exclude the use of other programs, some can become exclusionary because of the amount of time required for implementation. For example, to decide to require many hours (e.g., 40 hours per week) of any approach means there is little time available for anything else. This becomes particularly critical when the 40 hours must be provided in an isolated setting, denying the student access to peer interactions and eliminating the opportunity to benefit from other strategy or program options. Any treatment, with specific or coincidental exclusions of other options, must be carefully considered.
9-3e Program Evaluation
If an intervention supports a student’s IEP goals, presents manageable risk, has objective empirical evidence of effectiveness, and may be used in conjunction with other interventions, then the team may recommend its implementation as a part of the student’s IEP. Before implementing the option, the team should decide how to measure the effectiveness of the strategy or program, usually with student progress data, although other types of program evaluation may also be used (e.g., parent or student satisfaction or both). Direct observation of target behaviors is recommended as the preferred objective evaluation method for monitoring student progress. Chapters 2 and 5 describe the process of selecting appropriate progress monitoring techniques for evaluation purposes.
Another component of program evaluation may include data collection to show how well the specific strategy or program is being implemented; this is known as fidelity of implementation (see Chapter 5). For example, discrete trial training (DTT) is implemented in a systematic fashion that adheres to specific criteria. The person providing DTT should be observed to ensure that she or he is using the technique accurately. This is particularly important when paraprofessionals are given the responsibility of implementing significant portions of a child’s education plan in general education settings (Rispoli, Neely, Lang, & Ganz, 2011). Fidelity of implementation can be monitored using simple checklists that provide a task analysis of the procedure being observed and some sort of rating system to evaluate each step (e.g., implemented correctly, partially correct, or incorrectly). It can also include a teacher self-evaluation such as the one provided in Chapter 5.
In addition to considering how to evaluate strategies or programs, the IEP team should determine who will be responsible for program evaluations. Several members of the team may be given responsibility for portions of program evaluation, or consideration may be given to asking individuals who are not on the team (outside evaluators) to conduct evaluations. Persons qualified to evaluate interventions must have knowledge of the student and the program components and should follow a fidelity checklist for consistency across evaluators and across evaluation times.
Once the team has determined how to evaluate an intervention and has decided who will be responsible for conducting evaluations, the members should discuss how often to evaluate. Infrequent evaluations hinder the ability of the team to make timely modifications, whereas too frequent evaluations may unnecessarily drain time and other resources. The team should delineate clear outcome criteria before program implementation and use lack of progress toward those criteria to decide when to discontinue the strategy or program (Nickel, 1996). In addition, the team may agree that the strategy or program will be discontinued if only minimal progress is made within a 2-month period or immediately if the student or family suffers negative side effects. Further, a strategy or program might be abandoned if improvements are temporary and disappear within a short period of time. Implementation of an educational strategy or program should not become an end unto itself but rather a means to achieve desirable outcomes for a student (Hanft & Feinberg, 1997).
Because autism constitutes a lifelong disability, individual needs will change over time. The team must be sensitive to those changes and modify strategies and programs accordingly using agreed-on guidelines to facilitate ongoing discussions. The next section delineates reasons why programs may fail to benefit students. To enhance the likelihood that students will make progress toward IEP goals, teams should discuss strategies to circumvent these possible programming weaknesses.
9-4 Why Education Programs for Students with Autism Can Fail
In cases of disagreement, judges are increasingly being asked to make programming decisions based on the most compelling legal arguments for a particular program. These decisions often adhere to the letter of the law (lack of adherence is called a “procedural violation”) and not evidence of an appropriate program. For example, it is not uncommon for a hearing officer or judge to tell the school district that it must provide whatever programming a parent requests because the district failed to give adequate notice of a meeting. It is less common but still possible for a hearing officer or judge to find that programming provided by the school district might be adequate and find against the parents because the parents never placed the student in the district’s program. Analysis of hearing decisions and litigation outcomes reveals five issues that influenced due process decisions. These issues can affect arguments presented by parents as well as school districts. To construct a carefully crafted program, advocates must guard against the following mistakes.
9-4a Lack of a Clearly Articulated Program
Since the signing of PL 94-142 in 1975 (the original Education for All Handicapped Children Act, now the IDEA), decisions about how a student will be instructed have been generally left to the discretion of the schools (Boomer & Garrison-Harrell, 1995; Yell, 2011). The decisions of how best to facilitate goal attainment are primarily decisions regarding instructional methodology. Unfortunately, methodology controversies have been and continue to be the basis of many disagreements among IEP team members when determining an appropriate education for students with autism.
A clearly defined program consists of carefully conceived and well-described elements designed to address specific educational goals, with the understanding that these elements have been used successfully with other children with similar characteristics. We encourage IEP team members not to describe their programs or program components as “pilot” or “new,” which communicates that a tested model is not yet available. Should a disagreement arise in these situations, due process decisions are likely to favor the party who has proposed programs and practices with documented benefits (Delaware Co. IU #25 v. Martin K., 1993). Documented benefits are positive outcomes that are attributable to the program being provided. In pilot programs, the benefit is yet to be demonstrated.
Program intensity also influences outcomes. Programs may be found inadequate if they are not implemented with appropriate intensity (Delaware Co. IU #25 v. Martin K., 1993). However, there is no magic number of hours of programming. The intensity of the programming provided must be balanced against the needs of the student. For example, a 40-hour-a-week program provided across school and home may be inappropriate or even impossible for some families. For example, Osborne and colleagues (2008) found that high levels of family and parenting stress may reduce the effectiveness of early teaching interventions for children with autism who require too many hours of intervention services. To create a clearly defined program, the team should specify appropriate intensity that will likely enable the student to make progress toward IEP goals without detracting from the child and family’s quality of life (Cohen, 1998).
Finally, a clearly defined program will emphasize meaningful outcomes for the student. The program developed by the IEP team should support student progress toward all goals. A program with an exclusive emphasis on teaching reading, for example, will fail to promote progress toward attainment of other and maybe more functional skills (e.g., communication, toileting, play). A program with a singular emphasis on socialization may ignore other priority needs (e.g., vocational training), perhaps resulting in inappropriate programming (Mark Hartmann v. Loudoun County Board of Education, 1997). A well-defined program is one that links methodologies to student progress toward meaningful outcomes. Lack of a well-defined program may be insufficient to support goal attainment and may be indefensible if due process is requested.
9-4b Choosing Popular Rather than Appropriate Options
A program for a student with autism runs a risk of failing if the IEP team incorporates options that are popular at the time rather than those that have been demonstrated to have beneficial outcomes as defined by the criteria described in the previous sections. Nowhere is this more apparent than in the area of placement decisions. Although IDEA 2004 specifies that a full continuum of placement options be available and that placement decisions be individualized, the presumption of the least restrictive environment requires IEP teams to consider not only the student’s educational needs but also the settings closest to general education where those needs can be effectively met. Thus, it is incumbent on IEP teams to make placement decisions based on individual needs rather than on popular philosophy (e.g., full inclusion) or even the availability of resources (e.g., the special education teacher is only available in the afternoon).
Implementing a popular option such as full-time placement in general education without considering the student’s unique needs may lead to program failure. The same is true of implementing the latest “cures” presented in the media. To avoid program failure, IEP teams should evaluate options based not on their popularity but on their merits as revealed through careful analysis using the guidelines recommended in the preceding section. Implementing educational strategies and programs with demonstrated benefit, rather than popular acceptance, can best guarantee success.
9-4b Choosing Popular Rather than Appropriate Options
A program for a student with autism runs a risk of failing if the IEP team incorporates options that are popular at the time rather than those that have been demonstrated to have beneficial outcomes as defined by the criteria described in the previous sections. Nowhere is this more apparent than in the area of placement decisions. Although IDEA 2004 specifies that a full continuum of placement options be available and that placement decisions be individualized, the presumption of the least restrictive environment requires IEP teams to consider not only the student’s educational needs but also the settings closest to general education where those needs can be effectively met. Thus, it is incumbent on IEP teams to make placement decisions based on individual needs rather than on popular philosophy (e.g., full inclusion) or even the availability of resources (e.g., the special education teacher is only available in the afternoon).
Implementing a popular option such as full-time placement in general education without considering the student’s unique needs may lead to program failure. The same is true of implementing the latest “cures” presented in the media. To avoid program failure, IEP teams should evaluate options based not on their popularity but on their merits as revealed through careful analysis using the guidelines recommended in the preceding section. Implementing educational strategies and programs with demonstrated benefit, rather than popular acceptance, can best guarantee success.
9-4d One-Size-Fits-All Mentality
Programs may also fail when they apply identical services to all students with autism. By creating a uniform and inflexible “autism program,” a school district is suggesting that all students with autism will need the same type of services. In designing a single program to meet the needs of a heterogeneous group of students, school districts may be opening themselves up to allegations of taking a “cookie cutter approach” (Board of Education of the Ann Arbor Public Schools, 1996; Independent School District No. 318, 1996), a position that is indefensible in due process proceedings. In other words, intervention should be individualized; although autism programs can certainly be put in place that serve groups of children, those programs must be designed in such a way that individualization is possible and encouraged.
Often the one-size-fits-all mentality is evident in the number of hours that programming is offered to students. For example, some districts offer young children a half-day program and older children a full-day program. These standard options may be inappropriate for students with autism. A young child with autism may benefit from a full-day program, whereas an older student may benefit from a half-day program in academics and a half-day program in community-based instruction. Furthermore, the length of the standard school year may not meet the needs of individual students. Students with autism may need a longer school year and even need services during long holiday breaks. For other students with autism, breaks from school programming may not inhibit progress toward IEP goals and may offer important opportunities for other types of educational experiences (e.g., family trips). Thus, all programming must incorporate aspects that can be tailored to meet individual students’ needs.
9-4e Lack of Documentation
Programs may fail when school personnel are unable to demonstrate a relationship between program components and student outcomes. To support a program’s effectiveness, data must be collected demonstrating that the implemented program, not other factors, resulted in progress toward IEP goals. Typically, school personnel conduct pretesting and posttesting of special education students at the beginning and end of the school year in an effort to demonstrate such a relationship. However, it is difficult to conclusively correlate strategies and program components to developmental or skill gains when evaluations occur 9 months apart. Fortunately, ABA relies heavily on frequently collected data for decision-making purposes. Teachers who use ABA-based instruction such as DTT and who rely on ABA data-collection techniques are well prepared to document student progress and successes with direct, objective data. Failure to incorporate ongoing data collection and analysis may result in program failure.
In summary, the likelihood that a program will be successful depends on carefully defined meaningful outcomes, efficacious methodologies that promote the outcomes, and appropriate program intensity. Educational methodologies should be chosen based on their effectiveness as demonstrated in research, not by their popularity as might be evidenced in movies, magazine articles, and celebrity diatribes. Remember, too, that the use of one-on-one teaching assistants can result in increased dependency. Alternate strategies should be considered so that students progress toward independence and self-management. Schools should avoid creating an “autism program” that might deny students’ unique needs. Instead, programming must be individually tailored for each student in terms of length of school day, length of school year, and individual learning characteristics. Finally, frequent and ongoing data collection must be used to support claims that the chosen strategies and programs are responsible for promoting the attainment of IEP goals.
9-4e Lack of Documentation
Programs may fail when school personnel are unable to demonstrate a relationship between program components and student outcomes. To support a program’s effectiveness, data must be collected demonstrating that the implemented program, not other factors, resulted in progress toward IEP goals. Typically, school personnel conduct pretesting and posttesting of special education students at the beginning and end of the school year in an effort to demonstrate such a relationship. However, it is difficult to conclusively correlate strategies and program components to developmental or skill gains when evaluations occur 9 months apart. Fortunately, ABA relies heavily on frequently collected data for decision-making purposes. Teachers who use ABA-based instruction such as DTT and who rely on ABA data-collection techniques are well prepared to document student progress and successes with direct, objective data. Failure to incorporate ongoing data collection and analysis may result in program failure.
In summary, the likelihood that a program will be successful depends on carefully defined meaningful outcomes, efficacious methodologies that promote the outcomes, and appropriate program intensity. Educational methodologies should be chosen based on their effectiveness as demonstrated in research, not by their popularity as might be evidenced in movies, magazine articles, and celebrity diatribes. Remember, too, that the use of one-on-one teaching assistants can result in increased dependency. Alternate strategies should be considered so that students progress toward independence and self-management. Schools should avoid creating an “autism program” that might deny students’ unique needs. Instead, programming must be individually tailored for each student in terms of length of school day, length of school year, and individual learning characteristics. Finally, frequent and ongoing data collection must be used to support claims that the chosen strategies and programs are responsible for promoting the attainment of IEP goals.
