cha 9-10

Learning Outcome 10.1 Outline the development of the field of autism spectrum disorder, define this disorder, and identify its prevalence and causes.

The study of autism spectrum disorder is relatively new in the field of special education, as can be seen in the timeline of its development in Figure 10.1. However, the evolution of understanding about this disability has been rapid (Evans, 2013; Matson & Goldin, 2013), and today’s practices for students with autism spectrum disorder are informed by considerable and rapidly expanding research about students’ characteristics and needs.

The timeline shows, 1943: Leo Kanner, a child psychiatrist, coins the term autism (from the Greek word autos, meaning self) to describe 11 children who were withdrawn; he intimated that poor parenting might be the cause of the children’s problems; 1944: Hans Asperger, an Austrian pediatrician unaware of Kanner’s work, uses the term autism to describe patients who are gifted but who are socially isolated; 1949: Kanner attributes autism to “refrigerator mothers” that is, women who are cold and non-nurturing toward their children, thus giving the disorder a strong social stigma; 1950: Bruno Bettelheim popularizes the refrigerator mother idea through multiple publications; 1965: Bernard Rimland founds the Autism Society of America, seen as the beginning of the trend toward awareness and research on this disorder; 1967: Autism Research Institute (ARI) founded, a worldwide network of parents, professionals, and researchers dedicated to understanding ASD; 1980: American Psychiatric Association adds autism to the Diagnostic and Statistical Manual of Mental Disorders (DSM).

The timeline shows, 1990: Autism is added to the Individuals with Disabilities Education Act as a distinct category of disability; 1991: Lorna Wing, through a decade of research, concludes that autism includes a variety of disorders, from those with significant intellectual disabilities and communication problems to those with Asperger syndrome who generally have average or above-average intelligence; 1994: American Psychiatric Association adds Asperger syndrome to the DSM; 2000s: Research focus expands to include study of genetic contribution to autism; 2010s: The multi-year Study to Explore Early Development (SEED) is the largest U.S. study, funded by the CDC, identifying physical and behavioral characteristics, health needs, and risk factors for children ages 2 to 5 with autism and other developmental disabilities; 2013: American Psychiatric Association issues a significant revision in its definition of autism, combining several disorders, for example, Asperger syndrome, pervasive developmental disorder-not otherwise specified into a single new classification called autism spectrum disorder.

A special education teacher reviews daily routines with a student with autism. What are the independent routines and systems that a teacher can implement to help a student with autism stay on task?

In 1943, psychologist Leo Kanner described a group of 11 children whose very unusual behaviors made them qualitatively different from children with other disabilities. According to Kanner (1943), these children’s needs were apparent in early childhood and included the following:

· An inability to relate typically to other people and situations

· Delayed speech and language development, failure to use developed language for communication purposes, and other speech and language abnormalities, such as extreme literalness

· Typical physical growth and development

· An obsessive insistence on environmental sameness

· An extreme fascination and preoccupation with objects

· Stereotypic or repetitive behavior and other forms of self-stimulation

The characteristics of autism as first described by Kanner nearly three quarters of a century ago have been revised, refined, and broadened in recent years. Nonetheless, today’s definitions and conceptualizations of autism continue to reflect many of Kanner’s original observations.

Other developments in the field quickly followed, including the identification by Hans Asperger of a disorder potentially distinct from autism and familiar to many today as Asperger syndrome (Baron-Cohen, 2015; Hartwell et al., 2021). Also common was the belief, held by many professionals, that autism was caused by detached, non-nurturing mothers—sometimes called “refrigerator mothers” (Sterwald & Baker, 2019; Vicedo, 2021). This misconception persisted until the 1980s when published studies of twins demonstrated a genetic basis for autism (Bergbaum & Ogilvie, 2016).

With continued research in the 1980s, the knowledge base about the wide range of disorders called autism quickly grew, as did interest in finding effective treatments (e.g., Wing, 1991). Autism was identified as a separate category of disability in the Individuals with Disabilities Education Act (IDEA) beginning in 1990.

Since that time, interest in, research about, and interventions for autism have exploded. This is partly due to a dramatic increase in the number of individuals diagnosed with this disorder (Durkin, 2019; National Center on Birth Defects and Developmental Disabilities, 2020). Research related to autism now is focused on identifying causes (e.g., Constantino, 2021; Lo-Castro & Curatolo, 2014; Ziats et al., 2021). Other efforts are focused on validating medical treatments (e.g., Bergbaum & Ogilvie, 2016; Márquez-Caraveo et al., 2021 and Rodrigues et al., 2021), identifying psychological therapies (e.g. Ligezka et al. 2021; Salazar et al., 2015; Short & Vital, 2021), and evaluating educational interventions (e.g. Cengher et al. 2021; Rotheram-Fuller, & Hodas, 2015; Sulek et al., 2021). It is likely this work will eventually clarify the nuances of autism and the most effective approaches for working with students with this disorder.

As is true for many other disabilities, the language related to autism requires a brief explanation. The traditional term used for this group of students is autism, and that is the term used in IDEA and many state special education laws. The term autism spectrum disorder(ASD), first used by Wing and Gould (1979), clarifies that this disorder occurs in many forms and cannot be described in any one way; ASD has rapidly become the term of choice among professionals in the field. In fact, as will be discussed later in this chapter, this term was recently adopted by the psychiatric community to replace several other terms formerly used to describe this disability.

According to IDEA, autism is defined as follows:

1. Autism means a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age three, that adversely affects a child’s educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences.

2. Autism does not apply if a child’s educational performance is adversely affected primarily because the child has an emotional disturbance.

3. A child who manifests the characteristics of autism after age three could be diagnosed as having autism if the criteria in paragraph (c)(1)(i) of this section are satisfied. (IDEA 20 U.S.C. § 1401 [2004], 20 C.F.R. § 300.8[c][1][i–iii])

This definition follows the pattern of IDEA, specifying some essential characteristics of students with the disorder, excluding other disabilities, and identifying the necessity of impact on educational performance. However, it does not provide much detail in terms of understanding the diversity of students who might have this disorder.

Because autism spectrum disorder generally is diagnosed by the medical community using criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5) (American Psychiatric Association, 2013), it is important for educators to be aware of this definition as well as the one provided in IDEA. Although the previous version of the DSM included a broad category called pervasive developmental disorder (PDD) and that category included autism disorder, Asperger disorder, and other related conditions, the current manual eliminated the narrow diagnostic labels and adopted the term autism spectrum disorder (ASD) to encompass all of them. The most significant criteria for ASD are significant difficulties in the domains of (a) social interactions or communication and (b) repetitive behavior and fixated or restricted interests.

This recent change in definition was a historic event for the field. The rationale for the change concerned the difficulty of distinguishing in the previous system among the various types of disorders (American Psychiatric Association, 2013). Concerns also have been raised, however. For example, some professionals believe that the new definition limits the number of individuals identified as having this disorder (Maenner et al., 2014; Suckle, 2021), thus depriving them of needed supports and services (e.g., Ferrara et al., 2021). Others fear that the revised classification approach leads to confusion and potentially affects the amount and types of research conducted on ASD (e.g., Jellett & Muggleton, 2021; Parsloe & Babrow, 2016).

Autism was included as a disability category in IDEA in 1990, and it is defined in the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5) as autism spectrum disorder (ASD).

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As the field of ASD evolves, you may hear a variety of perspectives on which students have this disorder, the definitions and language used to describe them, and the priorities in terms of providing special education and other services to such students. To guide your understanding, keep in mind that IDEA’s definitions are the ones generally used in public schools. However, the DSM-5 definition can inform you about the medical community’s perspective of these students. Ultimately, the most important way to make sense of formal definitions is to understand that individuals with ASD are first and foremost real people who lead real lives and experience, like everyone, successes and challenges. In the Professional Edge you can read a brief biography of one well-known individual with ASD, Temple Grandin.

Temple Grandin is one of the most famous individuals with autism. She is the author of several books about autism and has also written an autobiography. Now at Colorado State University, she is a professor of animal sciences who designs livestock facilities. In fact, she is known worldwide for her work related to the humane handling of cattle at meat plants, work designed to reduce animal fear and pain. Nearly half of all cattle handling in the United States is based on equipment that she designed, and she has consulted on this topic with huge corporations such as McDonald’s and Burger King and others worldwide. In 2009, she was named a fellow of the American Society of Agricultural and Biological Engineers.

What makes Dr. Grandin’s accomplishments even more remarkable is her life story. Born in 1947, she did not speak until she was 3 years old. At about that time, she was labeled autistic, and her parents were advised to place her in an institution. However, her mother enrolled her in a highly structured nursery school and also hired a nanny who spent many hours playing games with Dr. Grandin that emphasized taking turns. Dr. Grandin recalls middle school and high school as painful, full of teasing and name-calling. But she persisted, and after graduation, she began her college career in the field of psychology, switching to animal science for her master’s and doctoral degrees.

Jim Smeal/BEI/Shutterstock

The estimated prevalence of autism spectrum disorder has been gradually increasing over the past decade, due in part to increased focus on early and accurate diagnosis (e.g., Maenner et al., 2020). The Office of Special Education Programs of the U.S. Department of Education (2021) reports the prevalence of autism as 1.0% of allstudents ages 6 to 21 (called the resident population), that is, approximately 655,405 students. However, that estimate is based on school data, which are usually incomplete. The Centers for Disease Control and Prevention (CDC) (2020), through the Autism and Developmental Disabilities Monitoring (ADDM) network, estimates the prevalence as 1 in 54 children. The CDC also notes that boys are four times more likely than girls to have ASD—1 in 34 boys versus 1 in 144 girls—but some researchers have reported a diagnostic gender bias (Loomes et al., 2017).

Prevalence of ASD also may be affected by the DSM-5 definitional change. Some professionals hypothesize that it underrepresents people who truly do have ASD, while others propose it may be inflating the numbers. For example, a study by Maenner et al. (2014) applied the DSM-5 criteria to previous prevalence data and concluded a drop in the rate of diagnosis would occur.

Similar to other disability categories, questions often are raised about whether students from various racial or ethnic backgrounds are more or less likely to be identified as having ASD. The most recent IDEA data suggest that only small differences exist (Office of Special Education Programs, 2021): Students who are American Indian or Alaska Native, Asian, Black or African American, or White have a risk ratio of 1, meaning that they are represented in this disability category exactly in the proportion as they are represented in the population. Native Hawaiians/Other Pacific Islanders have a risk ratio for autism of 1.3 and thus are more likely than expected to be identified; Hispanic students have a risk ratio of 0.9 and are slightly under-identified.

Racial, ethnic, and other differences extend to the domain of treatment as well. When researchers explore whether children diagnosed as autistic receive intensive early interventions, considered critical for achieving positive outcomes, they find that White children and children in high socioeconomic groups are more likely than other children to access such services (e.g., Magaña et al., 2015; Sturm et al., 2021).

Although the term Asperger syndrome is no longer part of the terminology for individuals with ASD, you probably will encounter the replacement phrase students with high-functioning ASD (HFASD).

As with many disabilities, the specific causes of autism spectrum disorder are not completely understood. Professionals generally agree that symptoms of this disability are triggered by genetic differences or other malfunctions in the brain (e.g., Frazier et al., 2014; Maximo et al., 2021), although environmental factors also contribute to the disorder (e.g., Pugsley et al., 2021). Research on the causes of ASD is leading to rapid changes in the field. To learn about how to find the most current information, access the resources summarized in the Professional Edge.

Many topics related to autism spectrum disorder are changing rapidly. More students are being identified with ASD, medical studies are increasing knowledge about the causes of this disability, and research is under way to identify treatments and interventions that would be most beneficial to students. If you are interested in keeping up with research related to autism, here are resources to use:

Researchers currently are focusing on genetic factors related to autism spectrum disorder, speculating that DNA likely is responsible for causing developmental dysfunction in the brains of individuals with this disability. Simple logic based on this hypothesis is that parents with autism spectrum disorder are likely to have a child with ASD. However, such cases are very rare. Extensive genetic research has shown that many genes may contribute to the development of ASD and various specific characteristics of this disorder (Liu et al., 2021; Lo-Castro & Curatolo, 2014), but the degree of exhibited symptoms varies across family structure (e.g., Binder, 2021; Smith et al., 2009). For example, the father of a child identified with an autism spectrum disorder might have subtle characteristics (e.g., relatively intense concentration when working on a favorite project) compared with others or unusual patterns of social interactions, but function in an acceptable manner in his day-to-day life. Some evidence also suggests a high frequency of autism spectrum disorder among siblings when compared to other disabilities (Thompson, 2018; Yoo, 2015), although this is not a universal finding (De la Marche et al., 2012). Viewed collectively, research to date suggests that no single genetic factor is responsible for causing autism spectrum disorder, but instead that multiple genetic factors seem to intricately connect to form a wide range of developmental malfunctions.

If genes are the primary cause of autism spectrum disorder, what symptoms are found in the brain? Recent technology, such as magnetic resonance imaging (MRI), enables researchers to obtain accurate information about the brain, and a number of brain functions that may trigger autistic symptoms have been observed. For example, individuals with autism spectrum disorder have been found to have abnormalities in the cerebellum, the part of the brain that controls motor coordination, balance, and cognition (e.g., Salazar et al., 2015). Similarly, research has examined the frontal and temporal lobes: The frontal lobe manages social and cognitive functions (Klin et al., 2003; Pierce & Courchesne, 2001), whereas the temporal lobe is involved in understanding facial expressions and in social cues and memory (e.g., Dougherty et al., 2016; Rahko et al., 2016). Researchers generally have found that in these and other parts of the brain, individuals with autism spectrum disorder may have fewer cells, higher cell density, or less volume than in typical individuals, and their brain development is likely to be atypical (e.g., Itani & Thanou, 2021; Lainhart, 2015).

Although the early belief that autism spectrum disorder was caused almost exclusively by environmental factors such as maternal neglect has long been proven untrue, most professionals agree that these factors can influence the number and intensity of symptoms (e.g., Balboni et al., 2020; Vijayakumar & Judy, 2016). For example, the quality of care by family members and professionals plays an important role in the development of children with autism spectrum disorder (Ludlow et al., 2012; Mandy & Lai, 2016; Milgramm et al., 2021). A positive, structured environment can significantly improve behavior problems often displayed by these children and youth. In many cases, positive supports, unconditional family love, and similar factors probably have a positive effect on how the symptoms of autism spectrum disorder occur.

One of the most controversial causal issues related to autism spectrum disorder is immunization, especially that given for measles, mumps, and rubella (MMR). However, findings to date have discredited this view (Centers for Disease Control and Prevention, 2020). For example, DeStefano and colleagues (2013) did a thorough review of all available scientific evidence related to eight vaccines typically administered to young children (MMR, varicella for chickenpox, influenza, hepatitis A, hepatitis B, human papillomavirus/HPV, meningococcal, and diphtheria-toxoid/tetanus toxoid/acellular pertussis). The conclusion issued was that vaccines generally are very safe and that serious side effects are very rare. In particular, no causal link was found between the MMR vaccine and ASD. This finding was echoed in a report by the American Academy of Pediatrics (2013), and it also is consistent with a retraction that was issued by the authors of a key study on this topic that had reported a clear link and fueled the debate on the danger of immunizations. That study was determined to be fraudulent.

Despite the absence of evidence of a link between vaccinations and the onset of autism, you probably will meet professionals and parents who continue to believe a relationship exists. For example, in one study, researchers surveyed parents of children who had been diagnosed with autism or other developmental disabilities, asking for their views about vaccines. Parents of children with autism were nearly 12 times more likely than the other parents to believe that toxins in vaccines caused their child’s disability (Mensah-Bonsu et al., 2021). Keep in mind that when children are not vaccinated, there is a higher risk they will become infected with a disease such as measles that can have serious complications (National Center for Immunization and Respiratory Diseases, 2020).

Learning Outcome 10.2 Describe the characteristics of individuals with autism spectrum disorder.

Autism is a complex disorder, and discussing the characteristics of individuals with this disorder cannot provide a full description of a particular student who will have endearing qualities as well as persistent challenges. Beginning at an early age and typically continuing throughout the life span, individuals with autism spectrum disorder generally have difficulty relating appropriately to others. They usually have a wide range of language and communication disorders. Many have an obsessive insistence on environmental sameness and are well known for their unusual and often difficult-to-understand behaviors. For example, students with autism may display stereotypic, repetitive, and self-stimulatory responses (e.g., Houwen et al., 2016; Moulton et al., 2016).

Children and youth with ASD often have irregular patterns of cognitive and educational strengths and deficits, with the majority of individuals with ASD having some level of intellectual disability, although some have average to above-average ability (Gillberg et al., 2016; Srivastava & Schwartz, 2014). Further, most individuals with autism have a comorbid psychiatric disorder, often depression or attention-deficit/hyperactivity disorder (Kerns et al., 2021), and these individuals generally have poorer outcomes than those who do not have comorbid diagnoses.

Although children and youth with autism share some characteristics with students with other disabilities, their unique features set them apart and sometimes create significant challenges for those who serve them. These distinguishing characteristics include overreliance on rote memory, problems with theory of mind, and problem-solving challenges.

Autistic savant refers to a person who has extraordinary skills that others do not have (although not all individuals who are savants have autism). Examples of these skills include mathematical calculations (e.g., figuring the day of the week for any date in history), memory feats (e.g., knowing every entry in a dictionary), and musical ability (e.g., playing any piece of music after hearing it just one time).

Rote memory is the ability to easily remember things without necessarily knowing what they mean. Have you ever memorized a phrase in a different language or a mathematical formula so that you could say it or write it when you needed to—even if you did not understand what it meant? Those are examples of rote memory. Although rote memory usually would be considered an asset, it can be a great liability for students with autism spectrum disorder. Because they often have well-developed rote memory skills, students with this disability can give the impression that they understand certain concepts when in fact they do not (Gabig, 2008; Olin et al., 2020). For example, a student with autism may hear certain words or phrases in conversation and then use them in a rote manner that mimics comprehension. This parroting gives the inaccurate impression that the student has well-developed, higher level comprehension skills.

Rote memory may be a disadvantage for students with autism spectrum disorder in another way, too. Adults often assume that having strong rote memory skills means that students can remember, at any time, pieces of information or events. But this is not true for many individuals with autism spectrum disorder. Although chunks of information are stored in memory, students with this exceptionality may have trouble retrieving them. Often, a question worded in a specific manner must be used to prompt retrieval from memory. For example, Devon, a 12-year-old boy with autism, has memorized all of the menu items at a fast-food restaurant. However, unless the server asks, “May I take your order?” Devon cannot recall what he wants to order and may repeat all the items on the menu. The server’s words need to be precise in order for Devon to access the information he has memorized.

One of the core cognitive deficits of autism spectrum disorder concerns theory of mind. This relatively new explanation of autism is based on the belief that people with this disorder do not truly understand that others have their own thoughts and points of view and that people with autism face challenges in understanding others’ beliefs and emotions (Hutchins et al., 2016; Lecheler et al., 2021). Difficulties with theory of mind can be seen when individuals with autism spectrum disorder have difficulty explaining their own behaviors, recognizing that others may not know answers to their questions, predicting others’ emotions or behaviors, comprehending others’ perspectives, understanding how behavior affects others’ thoughts and feelings, participating in conversations, and distinguishing fact from fiction (Gupta, 2015; Miller, 2012; Myles & Southwick, 2005). Academic tasks may also be affected: For example, students with autism may struggle to understand inferences in the literature they read, and they may not understand what is meant by an author’s point of view.

Although theory of mind has been explored in studying the development of all children (e.g., An & Kochanska, 2021), professionals are finding that deficits in this domain often distinguish individuals with autism spectrum disorder from individuals with other disabilities. For example, Robert, a high school sophomore with ASD, could not understand why he was in trouble for loudly announcing that his history teacher had bad breath. In his mind, he was only telling the truth and could not comprehend the impact of his words on his teacher or classmates.

Many students with ASD have access to only one problem-solving strategy for a particular situation and use it consistently, regardless of whether it is successful and even if the situation changes. Difficulty retrieving information or strategies may make problem solving even more challenging (Alderson-Day, 2011). For example, when Alex could not find his toothbrush, he discontinued brushing his teeth. It did not occur to him to ask his mother to purchase a new toothbrush or to help him to find the old one. Although learners with autism spectrum disorder may be able to recite several problem-solving strategies and verbally report that they can be generalized, often they are not able to recall any of these strategies when needed. That is, Paula, who was introduced at the beginning of the chapter, has learned that if she is not sure how to find her classroom, she can ask another student or an adult, or look to see if she is near the office and ask someone there. When she suddenly becomes disoriented, though, she cannot remember what to do and begins screaming and thus still needs to be accompanied from class to class.

Problem solving becomes even more difficult if abstract concepts or interpersonal interactions are involved (Radley et al., 2021). The problem-solving deficits of some students, especially those with average or above average intellectual ability, may not be recognized easily, thus making the situation even more complex. Their pedantic style, advanced vocabulary, and grammatically perfect responses often mask their skill levels. For these reasons, by the time they realize that a problem exists, they often are so confused or angry that their reactions are inappropriate, sometimes involving tantrums or withdrawal.

Students identify types of sentences (declarative, exclamatory, and interrogative) as a whole group and also complete their agendas for the day. Consider the classroom management that occurs as the teacher helps students understand expectations and describes the next activity on the schedule. How are such procedures beneficial for students with autism?

The social and emotional challenges that students with autism spectrum disorder encounter are directly related to their other exceptionalities. In particular, language disorders, unconventional language use, and immaturity often characterize these students (e.g., Ellis, 2016).

Many students with autism spectrum disorder have extraordinary difficulties related to language (DiStefano et al., 2016; Georgiou et al., 2021), and these differences sometimes can be identified as early as their first birthday (Lazenby et al., 2016; Veness et al., 2012). This, in turn, has a significant negative impact on their abilities to interact successfully with others. For example, they may experience delays in developing language. In addition, they may fail to use language to communicate, or they may lack the desire to interact with others.

Several examples of language disorders can clarify how important this area is for students with autism spectrum disorder. Students may have problems with proxemics—that is, knowing the socially acceptable distance to maintain between people during conversation. These students may stand closer to or farther away from another person than is customary. They also may stare intensely at another person while interacting, making that person very uncomfortable. In contrast, some students may fail to make any eye contact at all, looking to the side or up or down during conversation. This makes it difficult for the other person to judge whether the student is engaged in the topic being discussed. In addition, students may fail to understand or respond to others’ gestures or facial expressions during communication. As a result, they may not notice that the other person is bored or that the person wants to ask a question.

Students at the higher end of the autism spectrum often have unusual traits in their language skills (e.g., Lane et al., 2016; Wing, 1981).

Many students with ASD cannot comprehend language related to abstract ideas such as democracy and justice. They also may struggle with understanding and correctly using figures of speech such as metaphors, idioms, parables, and allegories and grasping the meaning and intent of rhetorical questions. For example, when Rick was told, “Put your best foot forward,” he looked down and asked in all seriousness which foot was his best.

When you think of an individual whom you consider mature, what characteristics come to mind? Maturity is often assessed by actions in social situations. To be socially adept, people must be able to perceive and understand social cues such as frowns, smiles, boredom, and other expressions of emotion. They must be able to think clearly about their own behaviors and the behaviors of others. Some students with ASD may have good structural language skills, such as clear pronunciation and correct syntax, but otherwise poor communication abilities. For example, some students may repeat the same phrase over and over, talk with exaggerated inflections or in a monotone and droning style, discuss at length a single topic that is of little interest to others, or experience difficulty in sustaining a conversation unless it focuses exclusively on a particular topic. These communication problems are not surprising, given that effective communication requires that individuals have mutually shared topics to communicate about and are willing to listen as well as to talk.

No single set of characteristics can describe students with autism; they have unique combinations of strengths and needs.

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One characteristic that is somewhat unique to individuals with autism spectrum disorder concerns problems with communicative intent. That is, these students often do not communicate in order to obtain the attention of others, and they may not communicate for social purposes (Di Rezze et al., 2016; Meadan et al., 2012). How might this characteristic apply to Christopher, whom you met at the beginning of the chapter? Approximately 50% of individuals with autism are nonverbal; that is, they have few or no verbal language skills.

Those who do have verbal skills often engage in echolalia, repeating words and phrases that have been uttered by someone else with little or no understanding of their conventional meanings. Students also may have problems with pronoun reversals, using you for I and vice versa. They also may lack voice tone or inflection. Individuals with autism may have prosody problems—use of a monotone or sing-song tone of voice, regardless of the intended message (Loveall et al., 2021). Because of the many language disorders and communication challenges experienced by students with autism, they often make statements that do not make sense or give inappropriate responses to others’ questions. They also experience frustration when their communication does not accomplish its purpose. As a result, these students often seem extraordinarily naïve or immature.

A special educator works with a student individually to use a visual aid to identify numbers to communicate, which is part of his preparation in order to one day receive a technology-based communication device. What are some of the skills students with autism must have in order to work with a communication device? How can this be included as a goal in an individual education program?

A final domain to consider in characterizing students with autism spectrum disorder is behavior. Some of the challenges these students may have include self-stimulatory behaviors, difficulty with generalizations, and sensory responses.

Self-stimulatory behaviors, sometimes informally referred to as stimming, may involve rocking, hand flapping, and any other repetitive, stereotyped behavior patterns that appear to have no apparent function (Centers for Disease Control and Prevention, 2020; Rodgers et al., 2012), although they sometimes are associated with stress and can be perceived as adaptive (Kapp et al., 2019). These behaviors, common for students with autism, tend to stigmatize them, interfering not only with social acceptance and integration but also with learning (McCormick et al., 2015). Other similar behavioral challenges, such as self-injurious behaviors (e.g., self-biting, head banging), also can be serious issues; however, such behaviors are relatively uncommon.

When a student’s behavior is uncontrolled and continued to an exceptional degree, it is referred to as perseveration, and this is one of the most common ASD characteristics. Perseveration may relate to an object, as when a student is obsessively interested in a toy; an action, as when a student rocks for an extended period of time; or a verbal pattern, as when a student asks the same question many times. Professionals working with students with ASD often implement structured behavioral programs to reduce these behaviors (e.g. Fiske et al., 2015; Migan-Gandonou Horr & Michael, 2021).

Neurodiversity is the concept that autism, as well as other disabilities, are normal variations of functioning of the human mind, not pathological conditions or deficits. The neurodiversity movement calls for appropriate supports and inclusiveness for all individuals and may refer to those without ASD or other disabilities as neurotypicals.

A major challenge facing educators and others who work with students with autism spectrum disorder relates to students’ difficulty in transferring information to new settings, individuals, and conditions. As a result, a student who is able to perform a written task in one classroom cannot be assumed to be able to perform the same task correctly in another classroom. To address generalization, professionals must spend considerable time developing strategies for enabling students to use information and skills flexibly. These strategies may include practicing skills in community and general education classroom settings, receiving support from peers, and learning to self-monitor (Smith et al., 2016).

Students with autism spectrum disorder experience a myriad of sensory processing issues (McCormick et al., 2015; Neufeld et al., 2021). That is, they have difficulty with the (a) tactile, (b) vestibular, (c) proprioception, (d) visual, (e) auditory, (f) gustatory, and (g) olfactory senses. Figure 10.2provides an overview of each of the sensory systems, including its location and function.

SOURCE: Myles, B. S., Cook, K. T., Miller, N. E., Rinner, L., & Robbins, L. A. (2001). Asperger syndrome and sensory issues: Practical solutions for making sense of the world (p. 5). Autism Asperger Publishing. Reprinted with permission from Autism Asperger Publishing Co.

The figure also provides examples of how students with autism may experience difficulties related to the senses. For example, you may know a person with autism who can hear sounds that are not discernible to those without autism or who finds the feeling of a tag inside a shirt very painful. Because the visual area tends to be a strength for students with autism spectrum disorder, visual supports often are used to assist in learning (Bateman & Wilson, 2021; Kaldy et al., 2016).

Sensory difficulties affect all areas of learning (e.g., McPartland et al., 2015). Many students with autism spectrum disorder receive occupational therapy to address these issues and to receive the maximum benefit from instruction. All professionals who work with students with ASD should be aware of the impact of sensory issues on behavior and achievement (e.g., Mays et al., 2011).

As an educator, understanding the characteristics of students with autism is the foundation for designing and implementing effective instruction. But just as important is recognizing that these students’ qualities can contribute to their success. For example, their ability to be highly focused on a single topic or project can lead to having a wealth of knowledge or ideas for innovations. Their strong sense of logic can enable them to make decisions based on reasoning rather than emotion. Their attention to detail can lead them to be astute observers in science and other subject areas. As is true for all students, including those with disabilities, what matters most is facilitating students’ learning by responding to their characteristics and needs in order to maximize their potential.

Learning Outcome 10.3 Explain how autism spectrum disorder is identified.

The definition of autism in IDEA is very general, and so it is common for this disorder to be diagnosed using the more detailed criteria in DSM-5(American Psychiatric Association, 2013) and including the child’s developmental history and observed behaviors. Even so, identifying these students is rather complex because the symptoms occur in so many different ways and in so many degrees of intensity (e.g., Matson et al., 2012). As for all students, a team, including the parents, must participate in the assessment and eligibility determination similar to those outlined in chapters you have already read. Importantly, even though a physician may have diagnosed this disorder, professionals must apply the IDEA requirements in their decision-making.

Deciding whether a student has the characteristics of an autism spectrum disorder involves both formal and informal assessment. Psychologists and psychiatrists may use standardized instruments that are designed just for this purpose. One example is the Autism Diagnostic Interview–Revised (ADI–R) (Le Couteur et al., 2003). However, teachers and other professionals also may be asked to complete rating scales designed to screen students for the disability. Three examples of these rating scales are the Modified Checklist for Autism in Toddlers-Revised (M-CHAT) (Robins et al., 2009), the Gilliam Autism Rating Scale, Third edition (GARS-3) (Gilliam, 2013), and the Asperger Syndrome Diagnostic Scale (ASDS) (Myles et al., 2000).

One additional evaluation informs professionals about whether a student has an autism spectrum disorder: sensory assessment. Usually administered by a trained professional, an instrument such as the Sensory Profile-2 (Dunn, 2014) can be used to pinpoint specific sensory problems such as the ones about which you have already read.

Part of the assessment for autism spectrum disorder is similar to the assessments completed for students who may have other disabilities. That is, an individual intelligence test is administered, as are both formal and informal assessments of academic achievement using standardized achievement tests and curriculum-based measures. Language assessment often is part of this process because, as already noted, most students with autism spectrum disorder have language-related delays or problems. In addition, students’ adaptive behaviors are measured, including, as appropriate, tasks related to self-help (e.g., dressing, brushing teeth) and functioning in the community (e.g., ordering in a fast-food restaurant, riding a bus).

Because autism spectrum disorder is considered a developmental disability, comprehensive assessment also must explore developmental characteristics. Using an instrument such as the Psychoeducational Profile (3rd ed.) (PEP-3) (Schopler et al., 2005), a professional can ask parents about their child’s fine- and gross-motor skill development, language development, and related areas. For older students, questions may be asked concerning vocational skills, independent functioning, leisure activities, functional communication, and interpersonal behavior.

Students with autism spectrum disorder often have behavior challenges. These behaviors usually are assessed by asking parents, teachers, and others who interact with the student to complete a behavior checklist, a procedure you learned about in Chapter 7 regarding students with emotional disabilities.

In addition, a functional behavior analysis also may be helpful for determining the relationships between behavior and the environment for students with autism. As you may recall, the functional behavior analysis usually involves investigating antecedent events and their consequences based on a previously developed hypothesis about what is causing a behavior. Through this process, environmental, social, and communicative factors that might trigger problem behaviors are revealed and interventions can then be planned (Leader & Mannion, 2016). Think about how this type of assessment would be useful in understanding the challenges faced by a student like Paula, introduced in the opening of the chapter, both for initial assessment as well as intervention planning. Examples of data collection tools that might be used for both this type of functional behavior assessment and monitoring of the effectiveness of interventions are presented in Instruction in Action.

ASD is diagnosed and monitored based on constellations of behaviors, and so having a wide array of data collection tools is critical for school professionals. The information gathered is also central to designing effective interventions to address student needs. In addition to data collection options presented in other chapters, here are two websites that specifically address data collection for students with ASD as well as examples of recording forms.

· Compliance: Does the student do as requested? With or without prompting? How many prompts?

· Independence: Which steps of the skills being taught is the student able to complete without adult guidance?

· Imitation: If given a direction, does the student comply with it? How much support is needed for the student to complete the direction (e.g., physical prompting, verbal prompting)?

· Work behaviors: Does the student get out the assigned work? Begin it? Persist? Complete it?

After assessment data are gathered, the team of educators, medical professionals, parents, and related services personnel address the IDEA questions that guide special education decision making:

· Does a disability exist?

· Does it have a negative impact on educational performance?

· Is the student eligible for special education services?

· Will the student benefit from those services?

Two points should be stressed related to the determination of eligibility in the disability category of ASD. First, as for all students with disabilities, the most important part of the identification process is not what label is assigned but what services are provided to meet the student’s needs. Continuous data collection, monitoring, and analysis through assessments and flexible interventions are essential to effectively educate such a student. Second, receiving a diagnosis of autism, especially if that decision occurs after a child has entered school, is particularly stressful for parents. Stories from parents often use expressions like “devastating,” “numb,” “run over by a truck,” and “alone.” Of course, others would add “relieved” and “affirmed” at having a label for their child’s disorder. As you have learned, nearly all parents of children with disabilities experience a range of emotions upon learning of their child’s disability. For parents of children with ASD, the stress can be compounded by the sometimes sensationalized media coverage of this topic, the attention given to it by celebrities, and the sometimes very complex process of identifying and obtaining the appropriate services. Educators should be aware of the potential impact of this disability diagnosis and be prepared to offer the strong support that some parents are likely to need.

A mother's interview: Beth's mother reflects on her characteristics and diagnosis. What tools are helpful to gather data and provide appropriate interventions to educate students if a formal diagnosis is delayed?

Learning Outcome 10.4 Discuss how students with autism spectrum disorder receive their education.

Because children and youth with autism spectrum disorder differ greatly in their skill levels, their educational options vary as well. Generally, however, early and intensive education provides the best outcome.

The National Research Council (2001) studied educational programs that provide early intervention services to young children with autism, and programs today still often have these characteristics (e.g., Frey et al., 2015; Rollins et al., 2016). The study found many instructional approaches and many variations regarding the setting in which the program was offered. For example, one program used the home as the instructional setting, and one used a school-only model. The programs shared the following features:

· Intervention prior to age 3

· Twenty to 45 hours of intervention per week

· Active family involvement

· Highly trained staff providing services to children with autism and their families

· Ongoing assessment of children’s progress

· A systematically implemented curriculum

· A highly supportive teaching and learning environment

· A focus on communication goals and other developmental areas

· Plans to help students apply skills they learn in a variety of settings and to maintain their skills over time

· Individualized interventions for each student

· Plans to assist the young child and family transition from early childhood services to school-age programs

Since that report, researchers have continued to investigate these and other interventions for young children with autism spectrum disorder (e.g., Bejarano-Martín et al. 2021; Pasco & Tohill, 2015). Emphasis usually is on providing highly intensive interventions in a variety of settings with a high degree of family involvement so as to optimize student social and learning outcomes later in life (e.g., Coleman et al., 2021).

Paraprofessionals often play a key role in supporting students with autism in both general education and special education settings, working under the direction of a special education teacher or other specialist to respond to student behavior, practice newly learned skills, and gather data about student progress (e.g., Walker et al., 2021).

You might be thinking that many of these intervention approaches are not unique to just students with autism. Which of the items on the preceding list would apply to high-quality services for all young children with disabilities?

According to current statistics, approximately 42% of students with autism spectrum disorder are educated primarily in a setting away from the general education classroom (Office of Special Education Programs, 2020). Figure 10.3 illustrates the range of settings in which these students are served.

SOURCE: National Center for Education Statistics. (2020, February). Percentage distribution of students 6 to 21 years old served under Individuals with Disabilities Education Act (IDEA), Part B, by educational environment and type of disability: Selected years, fall 1989 through fall 2018 [Table 204.60]. U.S. Department of Education, Institute of Education Sciences. https://nces.ed.gov/programs/digest/d19/tables/dt19_204.60.asp

The pie chart shows General education (GE greater than 80 percent): 40.0 percent, Resource (GE 40 to 79 percent): 18.5 percent, Separate setting (GE less than 40 percent): 33.2 percent, Separate school: 6.8 percent, Residential setting: 0.3 percent, Parent placement in a private school: 1.0 percent Correctional facility: 0.0 percent, home slash hospital: 0.8 percent.

It should be noted that these placement data vary considerably by state. For example, 21.9% of students with ASD in New Jersey are primarily in general education settings, while in Nebraska, the comparable number is greater than 64.8% (U.S. Department of Education, 2020). New Mexico (0.18%) and Oklahoma (0.24%) serve very few students with ASD in residential settings or separate schools, but nationally the number is 7%.

Although no single approach is always correct when deciding how students with disabilities should receive an education, a trend is emerging to support students with autism spectrum disorder in the general education setting more often than was common in the past (Bateman & Wilson, 2021; Kleinert et al., 2015; Mesibov et al., 2016; Sainato et al., 2015). For students to succeed in general education environments, however, some challenges must be addressed, including these (Majoko, 2016):

· Social isolation, often self-imposed

· Repetitive behavior and obsessions with specific objects or topics

· Focus on a narrow range of topics and inability to recognize that others may not share those interests

· Difficulty in transitioning from one activity to another in a timely manner

· Inability to recognize the feelings of classmates

These challenges should not lead to the conclusion that inclusive practices are not possible for students with ASD. One example of a model to guide professional thinking is the autism inclusion collaboration model.

The autism inclusion collaboration model is designed to support general educators in their work with students with autism through collaboration with special educators and ancillary staff. The model and other similar approaches have the following four components (Simpson et al., 2003):

· Environmental and curricular adjustments and general education classroom support. For children and youth with autism, a variety of adjustments and supports are particularly important because of these students’ unique needs. The supports may include availability of appropriately trained support personnel, reduced class size, access to collaborative problem-solving relationships, adequate teacher planning time, professional development, and availability of paraprofessionals.

· Attitudinal and social support. Administrators, general and special education teachers, students with ASD, and their peers without disabilities must all understand and support each other in the educational system. Success depends on many types of collaboration.

· Coordinated team commitment. This component includes opportunities for planning and carrying out programs across all environments. It also recognizes that education professionals need support to ensure that students’ needs are met in all environments. For example, if a student needs a visual schedule (explained later in this chapter), a special educator might be responsible for making that schedule available either on small cards or a tablet device that can be carried from the classroom to the lunchroom to the gym.

· Home–school collaboration. For successful inclusion, educators and parents must work together in a strong partnership to ensure that a comprehensive program is implemented for the student with autism spectrum disorder and that the skills the student learns at school are generalized at home and in the community.

Adequate supports—for students with ASD; the general education teachers who become their primary teachers; and the special educators, related service providers, paraprofessionals, and others who may provide services for the students—are essential, but when educated in general education classrooms, these students can learn from their peers and readily access the general curriculum.

A mother's interview: Beth's mother reflects on how Beth's new program and IEP are more effective and how the teachers have improved Beth's quality of life by not limiting what they teach her based on her IEP. In what ways can teachers set appropriate academic expectations for students with autism and also support behavior goals?

Adolescents and young adults with ASD often have difficulty learning skills that their nondisabled peers have learned with little or no formal instruction (Matson et al., 2012; Munsell & Coster, 2021). For example, students with autism may not know how to approach another student to have a conversation or otherwise interact. Similarly, think of how often and for how many purposes you use social media. A recent study examined the types of social media adolescents with ASD accessed (Iglesias et al., 2019). The researchers found that these students had fewer opportunities than typical students to use social media, were more recently acquainted with it, and were more limited in how they used it. They were most likely to look at others’ information on social media rather than communicate with friends and others.

Challenges often continue into adulthood (e.g., Howlin & Taylor, 2015). If youth with ASD plan to attend college, they need to be able to proficiently advocate for themselves and communicate effectively (Barnhill, 2016; Suzuki et al., 2021; Zukerman et al., 2021). If they plan to find employment, they must learn the skills that will make them marketable (e.g., Seaman & Cannella-Malone, 2016). Thus, careful planning for the transition to adulthood is necessary for these students, and this planning should occur across all domains. Depending on students’ abilities and needs, areas of importance may include the following:

· Self-help skills such as eating, dressing, personal hygiene, and grooming

· Play, leisure, and recreation skills

· Social skills

· Sexuality

· Home management skills such as bill paying, grocery shopping, and cleaning

· Vocational skills

· Skills for participating in postsecondary education, including living independently

· Skills for making personal decisions (i.e., self-determination) and accessing community opportunities

Stewart (2001) calls these topics community membership skills and emphasizes that they should be taught long before the student’s formal transition steps begin at age 16. One model of life span issues for community membership is included in Figure 10.4. Which of these skills seem especially important for Christopher, Paula, and Casey, whom you met at the beginning of the chapter?

SOURCE: Adapted from Stewart, R. (2001). Essential components of community living: A life span approach. Indiana Resource Center for Autism Reporter, 5(1), 18–27. Reprinted by permission.

Learning Outcome 10.5 Outline recommended educational practices for students with autism spectrum disorder.

For many years, little research on effective interventions for students with ASD was available. Now that is changing (e.g., Doehring, 2021; Höher Camargo et al., 2016; Odom & Wong, 2015). Generally, recommended practices include early intervention, intensive instruction, carefully planned but brief instructional periods, parent involvement, and sufficient one-to-one or small-group instruction to meet students’ goals. All of these practices are designed to address the social, behavior, and sensory challenges of these students, and many of the practices benefit other students with disabilities as well. Similarly, many of the academic interventions introduced for students with learning disabilities, emotional disabilities, intellectual disability, and communication disorders can enhance learning for students with autism spectrum disorder.

The following sections highlight a sample of available interventions, but keep in mind that there are many others.

Environmental supports are changes in a student’s surroundings that are considered key to effective instructional programming. Some of the most common environmental supports include visual supports, a home base, and assistive technology.

Students with autism spectrum disorder generally benefit from visually presented information. One example for younger students involves labeling items (e.g., desk, door, table) in the general or special education classroom in order to help expand these students’ vocabularies. Another example is a visual schedule, which presents a list of activities using a combination of icons, photographs, words, or clock faces to help students anticipate upcoming events and activities, develop an understanding of time, and predict change.

Task cards are similar. They help many students with ASD recall academic content, routines, or social skills. Typically presented on business-card-size paper or an electronic device, the task card lists the steps the student must follow in a series of directive statements, expressed in concise language. For adolescents, task cards can provide an overview of the routines and teacher expectations to each class. For younger children, a task card may outline four conversation starters that can be used with peers during lunch. Examples of visual schedules and task cards that special education teachers or general education teachers might use are included in the Instruction in Action.

Students with ASD often benefit by having tasks, schedules, and activities clearly explained to them ahead of time. Using words, pictures, or a combination of both, professionals can prepare students for the school day, help them know what happens next, clarify expectations, and foster independence. Two examples of visual supports are given here. Try making a simple visual support for one of the students described at the beginning of the chapter or another student with whom you are familiar.

SOURCE: Moore, S. T. (2002). Asperger syndrome and the elementary school experience: Practical solutions for academic and social difficulties. Autism Asperger Publishing. Reprinted by permission of Autism Asperger Publishing Co.

The travel card is yet another type of visual support for students with autism spectrum disorder in middle or high school settings (Carpenter, 2001). This type of card provides an efficient and effective means for dealing with the complex scheduling and shortage of time for personalized communication that characterize secondary schools. As you read about travel cards in the Instruction in Action, think about how they would be helpful to parents, teachers, and students.

As students move from elementary school to middle school and then high school, ensuring clear communication becomes more difficult. More teachers work with the students, the schools are larger, and maintaining close communication with parents can become more challenging. A travel card (e.g., Texas Statewide Leadership for Autism Training, 2019) is designed to support middle and high school students with ASD by

· increasing appropriate student behavior across environments;

· facilitating collaboration among teachers;

· increasing awareness among teachers of the academic, behavior, and social goals on which the student is working; and

· improving home–school communication.

As you can see by looking at the accompanying figure, the travel card lists four or five of a student’s target behaviors across the top and the classes the student attends along the left side. Classes include reading, science, social studies, and others. At the end of each period, the teacher indicates whether the student performed the desired behaviors by marking a 1 (yes), 0 (no), or NA (not applicable) on the card. At the end of the day, the positive notations are tallied and graphed. Points are accumulated toward a menu of rewards that have been negotiated by the student and the professionals responsible for the travel card.

SOURCE: Travel card from Myles, B. S., & Adreon, D. (2001). Asperger syndrome and adolescence: Practical solutions for school success. Autism Asperger Publishing. Reprinted by permission of Autism Asperger Publishing Co.

Educators use many additional informal visual supports. For example, if a student is working in a small group and is supposed to complete three math problems before receiving the reward of working on the computer, the teacher may sketch on a sheet of paper or a small whiteboard three simple pictures of a pencil. Each time the student successfully completes a problem, the teacher crosses off one of the drawn pencils. This lets the student know how much more work is required and does so in a way that does not require lengthy verbal explanations.

Home base is a place students can go to when they are beginning to feel anxious or upset and need to calm themselves (Autism Speaks, 2018; Myles & Southwick, 2005). For example, students with autism spectrum disorder can go to a home base to (a) plan or review the day’s events, (b) escape the stress of the classroom, (c) prevent a “meltdown,” or (d) regain control if a tantrum, rage, or meltdown has occurred. A resource classroom or counselor’s office may be used as the home base. When a student feels the need to leave the classroom, whether general education or special education, she can take assignments to the home base and work in that less stressful environment.

This photo shows an example of an actual visual schedule for a student with autism spectrum disorder. Think about how it helps them understand what will happen throughout the school day.

Gail Shotlander/Moment Open/Getty Images

School personnel sometimes schedule the school day of students with autism spectrum disorder so that they begin at the home base and have frequent stops there throughout the day. This creates a consistent student–teacher relationship and specifies a place to go when the need arises. It also can help students participate in general education by providing them with breaks from the social stress and stimulation of the classroom.

You have learned about the importance of assistive technology for many students with disabilities, and you probably can surmise that students with autism spectrum disorder access technology, too. These students may use items that other students with disabilities use, such as adapted eating utensils, talking calculators, pencil grips, voice output devices, audible word-scanning devices, and text-to-speech software.

Yet another effective use of technology for students with autism is video-based intervention (VBI) (Rayner, 2015). For example, Axe & Evans (2012) showed adults with various facial expressions (e.g., bored, in pain). Other adult models then demonstrated appropriate responses. Children with autism in this research project learned the facial expressions and how to respond to them, correctly identifying and responding across different people and settings. Others have implemented VBI approaches to teach social skills (e.g., MacFarland & Fisher, 2021; MacPherson et al., 2015), self-help skills (e.g., Domire & Wolfe, 2014), and a variety of academic skills (e.g., Edwards et al., 2020; Morlock et al., 2015). You can read more about this innovative assistive technology in the Technology Notes.

Through video modeling, professionals can take advantage of the strong visual learning preferences of many students with autism spectrum disorder and at the same time provide very concrete and specific skill instruction. This readily available technology is being used to teach skills such as these (Edwards et al., 2020; Helbig et al., 2021; Mason et al., 2016; Wynkoop, 2016):

· Appropriate classroom behavior (and reduction of inappropriate behavior)

· Verbal skills

· On-task and other learning behaviors

· Academic skills

· Peer interactions

· Job-related skills

Several approaches to video modeling have been developed, usually based on who is selected to demonstrate on a video recording the skill being taught. These are the most common options (Cardon, 2016; Wynkoop, 2016):

· Adult models, usually someone familiar to the student such as a parent or teacher

· Peer model, usually someone of the same age and gender as the student, or perhaps a classmate or sibling

· Self, when the student is “caught on camera” appropriately demonstrating the skill being taught and is then shown that video in order to increase use of the skill

· Point-of-view, in which the image shown is what would be seen if the participant were actually engaged in the behavior. For example, a camera might be held over the shoulder of a peer putting the heading on a paper, which would show the student with autism what he would see when completing the task

· Mixed model, using more than one of the above approaches

Students often view such videos on a computer, but they also can be placed on smartphones or tablets so that students can view them as they move from place to place. Teachers usually combine this learning experience with other techniques, including behavior plans that provide reinforcement.

The effectiveness of video modeling is well established, but as technology continues to evolve, new variations on this powerful instructional technique are likely to emerge. How might video modeling be implemented with Christopher, Paula, and Casey, introduced at the beginning of the chapter?

Many instructional strategies have been demonstrated to be effective with students with autism spectrum disorder (e.g., Asaro-Saddler, 2016). Three illustrative examples are priming, discrete trial intervention, and prompting.

Priming occurs when a parent, paraprofessional, teacher, or trusted peer previews with a student actual materials that will be used in a lesson or activity the day, the evening, the morning, or, occasionally, moments before that lesson or activity occurs. This is done as a means of reducing stress and anxiety by increasing student familiarity with the materials (Gengoux, 2015; Wiskow et al., 2018). Priming is most effective when it is built into the student’s routine. It should occur in a relaxed environment and be facilitated by a primer who is both patient and encouraging. Finally, priming sessions should be short, providing a brief overview of the day’s tasks in just a few minutes.

Unlike most of the practices outlined so far that might easily be implemented by general education teachers, special education teachers, or others working with students with autism spectrum disorder, discrete trial interventions (DTI) (sometimes called discrete trial teaching or, in its most formal form, discrete trial training) is a group of approaches that require a significant time commitment and specialized training (Cardinal et al., 2017; Plaisance et al., 2016). This intervention is often implemented for preschool children, with trained parents and others possibly participating. This practice follows a basic pattern in which the teacher gives a prompt (i.e., cue) to which the student attends, a command for the student to perform, and finally a reward to the student for the desired behavior (Fazzio & Martin, 2019; Lovaas, 1987).

For example, the student could be given a prompt such as “Look at me” or a nonverbal cue such as pointing to the teacher’s eyes. Once this command is given, the teacher waits for the student to focus attention as directed. In some instances, the teacher may need to guide the child physically through the desired behavior, such as lifting the child’s chin so her eyes focus on the teacher when the command “Look at me” is given. In addition, the teacher may decide to reward behavior similar to or leading toward the desired behavior, a technique referred to as shaping the behavior. For example, when the command “Look at me” is given, a reward would be given if the student lifted her head briefly, even if she did not maintain eye contact. Of course, the goal is for students to be able to use the skills they learn in the discrete trial training across settings and situations.

A promising variation of discrete trial intervention has been reported by Radley, Dart, Furlow, and Ness (2015). They taught typical elementary students the principles of DTI, and those students worked with peers with ASD in learning academic skills. The students were able to learn and effectively use the DTI protocol, thus opening the possibility of implementing this intervention with older students and in a school environment.

Despite widespread implementation with students with autism, some concerns have been voiced about DTI. One issue relates to the amount of repetition involved and the stress this may cause students, a criticism that advocates say does not occur when this technique is properly applied. Another concern centers on whether behavior change resulting from DTI generalizes to other situations; the criticism is that the procedures followed are so structured that students are unlikely to respond similarly with other adults or in other settings. A third issue arises when DTI or similar approaches are used to shape students’ behavior to be like that of typical peers. Focusing on getting students to make eye contact and stop self-stimulatory behavior, for example, is understandably perceived as attempts to make them appear “normal” rather than teaching useful skills.

As you just learned, a prompt is a cue designed to get a student to perform a specific behavior, and it is effective in promoting student achievement. Prompts frequently are used by professionals working with students with ASD, and prompts vary based on their intrusiveness. For example, a physical prompt is very intrusive, with the teacher physically engaging the student (e.g., moving the student’s hand to the pencil or turning the student’s head toward the task). Somewhat less intrusive are gestures, such as pointing or signing, guiding the student where to look or move. Verbal questions or statements are even less intrusive prompts, involving no physical assistance at all. Finally, a written prompt, such as a cue card or keyword taped to the student’s desk, is the least intrusive prompt. Prompts help students to learn without repeatedly making mistakes.

Prompts are helpful when teaching students with ASD a wide variety of skills, and in some instances they are employed for errorless learning.That is, the teacher will give a command to the student but then immediately, before the student can respond, prompt the student to give the correct response. The goal is to ensure the student always responds correctly, avoiding the problem of learning any task incorrectly. As the teacher observes that the student can carry out the task correctly, prompts are gradually removed.

Think about the value in using prompts as part of teaching students with ASD. How might you use them if you were working with students like Christopher, Paula, or Casey, the students introduced at the beginning of the chapter?

Perhaps the most important area of intervention for students with autism spectrum disorder is social skills (Kent et al., 2021; Radley et al., 2021). Social skills interventions generally are positive behavior supports designed to enhance opportunities for social interaction, reduce problem behaviors, and build new competencies that have a positive impact on quality of life (Bondy & Weiss, 2013; Leaf et al., 2012). Specific issues that can be addressed include understanding the thoughts and feelings of others, following social rules, and learning self-monitoring.

Unlike many typical learners, students with autism spectrum disorder generally must be directly taught the social skills they need to be successful. One example of an intervention for this purpose is the power card strategy, a visually based technique that uses a student’s special interests to facilitate understanding of social situations, routines, and the meaning of language (Daubert et al., 2015; Olçay et al., 2020). This intervention, although supported with only limited research (e.g., Leaf et al., 2020), contains two components: a script and a power card. A teacher, therapist, or parent develops a brief script, written at the child’s comprehension level, detailing the problem situation or target behavior. It includes a description of the behavior and describes how the child’s special interest has addressed that social challenge. The power card, which is the size of a business card or trading card, contains a picture of the special interest and a summary of the solution. The power card can be carried; attached to the inside of a book, notebook, or locker; or placed on the corner of a child’s desk. The Positive Behavior Supports provides an example of this technique.

Professionals sometimes use the special interests of students with autism to help them learn appropriate ways to behave in particular situations. For example, the following story was written for Cheyenne, a student who was fascinated with Elvis Presley. Then it was summarized, incorporating an appropriate picture, onto a power card that Cheyenne could keep on her desk or carry in her backpack.

Elvis Presley loves being the king of rock and roll, but sometimes it is difficult for him to be nice to everyone. At the end of a long day in the recording studio or after a concert, he is often tired, and it is difficult for him to be nice to fans and friends. Elvis has learned, however, that it is important to smile at people he meets and say nice things to everyone, even when he is tired. He has learned that if he can’t say something nice, it is better to just smile and say nothing at all. He stops and thinks about comments he makes before he says anything.

Just like Elvis, it is important for young people to think before they talk. It would make Elvis proud when you remember to do the following:

1. Think before you say anything. Say it in your head first before saying it out loud.

2. If you can’t think of anything nice to say, don’t say anything.

3. You do not have to say every thought out loud that you think.

When kids who love Elvis remember these three things, Elvis says, “Thank you, thank you very much!”

A social story is an individualized text or story that describes a specific social situation from the student’s perspective. The description may include where and why the situation occurs, how others feel or react, or what prompts their feelings and reactions (O’Handley et al., 2015; Rhodes, 2014). Social stories may be written documents, or they can be paired with pictures, audio recordings, or videos. They may be created by any professional or the parent, often with student input. Casey, the student you met at the beginning of the chapter, was provided with a social story to help him understand his peers’ meaning in calling him a dog. Social stories are mentioned here because they are widely used to teach students with ASD, but it is important to note that recent reviews call into question the strength of the evidence base for them (Leaf et al., 2015; Milne et al., 2020).

Students with ASD sometimes do not understand social situations or do not have skills to resolve a social problem. The SOCCSS intervention (Roosa, 1995) is a teacher-directed strategy that helps students understand cause and effect and realize that they can influence the outcomes of many situations with the decisions they make. The letters in the SOCCS acronym stand for these steps (Myles et al., 2013):

· Situation: The first step is to have the student identify (or help the student identify) the who, what, where, and when components of the event that occurred.

· Options: Next, the student brainstorms, with help as needed, options for responding to the situation. All student responses are recorded, whether they seem appropriate or not.

· Consequences: For each option listed, the student identifies at least one consequence. This sometimes is the most difficult part of the process.

· Choices: The student rates the option as positive or negative, based on the consequences of each.

· Strategies: After choosing an option, the teacher assists the student to form a plan for using that option the next time the situation arises.

· Simulation: This step is designed to provide practice for the student, who could draw the strategy being implemented, role play it, or imagine using it.

SOCCSS can be used with an individual student or as a group activity, depending on the situation and students’ needs. Although this strategy is designed to be interpretive, it also can be used as an instructional strategy. That is, teachers can identify problems students are likely to encounter and address them using SOCCSS so that students have a plan prior to a situation occurring. A sample SOCCSS intervention that describes a problem being encountered by Danielle is included in the Positive Behavior Supports. How would you help this student to complete the worksheet?

A form such as the one below is helpful for recording information as you implement the SOCCSS strategy with students with ASD. With your classmates, complete this form, and discuss the reasons for your responses.

· Who: Danielle and classmates Susan, Evie, Jessica

· What: Danielle wants to be friends with Susan, Evie, and Jessica. When they speak to her, she does not speak in return.

· When: Before school, during lunch, after school

· Where: On the school bus, school hallways, lunchroom

· Why: Danielle thinks the comments made by her classmates are just words; because they are not about anything Danielle considers important, it does not seem necessary to respond

Learning Outcome 10.6 Summarize the perspectives and concerns of parents and families of students with autism spectrum disorder.

Parents of children with autism spectrum disorder usually are the first to recognize that their youngsters are responding differently to the world than are children who are neurotypical. Some parents have reported that as an infant, their child was perfectly content to lie quietly in the crib staring at toys. The infant appeared to be a “good baby.” One mother was convinced that her toddler was gifted because before the age of 2, he recognized all of the letters of the alphabet and could read several sight words. However, the child seldom initiated interactions with those in his environment.

Many parents of children with autism spectrum disorder begin to suspect that something is different in their child’s development sometime around the child’s first birthday. For example, the child may become attached to an object such as a stuffed animal and have an uncontrollable tantrum when the object is not in sight, or the child may show no interest in play, preferring to watch videos for hours on end. Although pediatricians are more aware than ever before of the possibility of ASD in young children and know that diagnosis is possible at 18 to 24 months of age, they may at first assure worried parents that there is little to be concerned about (Kalb et al., 2021; Johnson et al., 2016). For parents, though, nagging doubts usually persist.

In a meta-synthesis of the limited number of qualitative studies of fathers’ experiences with their children with autism, one important finding was that fathers deeply valued their children and celebrated the opportunities for learning about diversity that were part of parenting a child with such unique needs (Lashewicz et al., 2019).

Following diagnosis, parents may become frustrated because even though they have a name for their child’s unique differences, they have little idea what to do about them. Many families of children with autism have found that early intervention, often with an intensive one-to-one home program, enables their children to make progress in the areas of behavior, communication, socialization, and self-help. This type of program, although beneficial to many children with ASD, may require a time commitment of up to 30 or 40 hours each week and can be emotionally and financially taxing for families.

Parents of children with autism spectrum disorder may find themselves required to play demanding roles in the lives of their children (e.g., Kurzrok et al., 2021; Levinson et al., 2021; Stoner & Stoner, 2016). In order to provide appropriate education, parents need to be familiar with the latest research on autism, understand special education law, and know how to be effective advocates for their children (e.g., Longtin & Principe, 2016).

Many parents have learned how to collaborate effectively with the professionals who provide services to their children and are valuable members of the school’s educational team. These parents understand the value of knowing the characteristics of autism and effective educational practices. Parents of children with this disorder also need skills related to resolving differences within a constructive atmosphere and providing support for the professionals who work with their children (e.g., Rubenstein et al., 2015).

Like parents of children with other disabilities, parents of children with autism spectrum disorder often feel concern about their children’s welfare in the years ahead, their children’s ability to function independently at some point, and the community’s acceptance of their children. Mothers of children with autism also report more stress in their lives than do mothers of children with other disabilities (Ekas & Whitman, 2011).

Parents of children with ASD benefit from the availability of both formal and informal social support, but such support must be individualized to meet the needs of each family. Potential sources of assistance include teachers, IEP team members, pediatricians and other health professionals, and other families of children with autism. Families often find that attending a local assistance group provides much needed information and assistance (Papageorgiou & Kalyva, 2010).

A review of qualitative research by Ooi and colleagues (2016) affirmed the complexity of parenting a child with autism. In examining 50 articles that tapped the perspectives of nearly 1,700 parents, the authors found that a diagnosis of autism strongly affected the following:

· Parents, including their emotional response to the diagnosis, challenges in raising a child with this disability, and the effect on their own careers, health, and leisure activities; however, some parents also reported joy and love for their children

· The rest of the family, including both supportive and nonsupportive reactions from extended family members and a strengthening or weakening of the parents’ marriage

· Social interactions, including the benefits of being able to access support groups but the frequent social stigma when out in public

· Health and education services, including the benefits of specialized care for their children, the value of working with skilled and caring professionals, and the frustration of inconsistent care and therapies viewed as not providing benefit

In another study (Myers et al. 2009), parents discussed their experiences. Those who were positive made comments such as this:

Our son is our light and our joy. He has taught us to enjoy the little things . . . a pretty day, a beautiful flower . . . and he has taught us to let the bad things go . . . those days that just need to end. We are closer as a family, and we find as many ways as we can to live in the moment and be happy. Our life goals have changed since he was born, but they’re really great goals.

On the other hand, parents who have a negative perspective offered this type of observation:

Although I love my son, his struggle with autism has affected our entire family. My parents are supportive, but my husband’s parents . . . not so much. I think they’re a little afraid. I worry when we are out in public that he will have a meltdown. It embarrasses our other children, and sometimes we just pick him up and head for home; we retreat behind our closed doors. Sometimes I don’t know if I will have the stamina to help him all the way through life.

A mother's interview: Beth's mother reflects on the family and community support she has received. What can teachers do to ensure families have access to assistance in the community?

Siblings often play important yet demanding roles in the lives of their brothers or sisters with autism spectrum disorder (e.g., Coffman et al., 2021). For example, they may positively influence the development of their siblings’ social and communication skills (Ben-Itzchak et al., 2016; Lynam & Smith, 2021). In some families, they may be required to take on additional responsibilities in the home and serve as care providers in the absence of a parent. Despite having demands placed on them, siblings’ knowledge of the disability may be limited. They should have access to resources appropriate to their developmental levels and be as well educated as their parents in the area of autism (Ferraioli et al., 2012). Many nondiagnosed siblings feel that they frequently are ignored in day-to-day family life. They may exhibit more difficulties in emotional, behavioral, and social adjustments and with peer interactions (McHale et al., 2016), although many establish strong, positive relationships with their sibling with ASD. It is vital that parents help siblings pursue their own interests and spend time with them away from the sibling with autism.

Learning Outcome 10.7 Identify issues and trends affecting the field of autism spectrum disorder, including assessment, diagnosis, and prevalence; the evidence base for interventions; and limited availability of adequate professional preparation programs.

The field of autism spectrum disorder is still relatively young, yet it is faced with several significant issues. Among them are those related to more accurate information on assessment, diagnosis, and prevalence; the need for additional research to identify effective interventions; and the need for teachers prepared specifically to effectively educate these students.

Consensus exists among professionals that early diagnosis of autism is critical so that appropriate interventions can be started while they have the greatest likelihood of improving a child’s functioning. However, many challenges exist. For example, because of normal variations in many dimensions of child development, autism cannot be reliably diagnosed prior to 12 months of age (Zwaigenbaum et al., 2015). Further, many parents of very young children who eventually are diagnosed as having autism spectrum disorder still may initially be told that nothing is amiss.

Another factor often mentioned in the early identification of children with ASD is socioeconomic status. That is, children in families with higher incomes usually are identified as having ASD at younger ages than those in families who live in poverty (e.g., Daniels & Mandell, 2014; Mazurek et al., 2014). Children in the latter families are placed at a tremendous disadvantage in terms of accessing the services that would benefit them (e.g., early childhood programs available only if a diagnosis of autism has been made).

Yet another issue related to diagnosis is the need for a comprehensive research agenda leading to a greater understanding of the neurological, behavioral, and developmental characteristics of autism spectrum disorder. This, in turn, might help professionals identify key indicators of autism much earlier in a child’s life. For example, although genes clearly play a role in the development of autism (Elamin & AL-Ayadhi, 2015), more than 100 genetic contributors have been identified, and their relative importance is not clear (Liu et al., 2021; Zwaigenbaum et al., 2015). The changes in the DSM-5 are a reflection of the uncertainty that still exists regarding the identification of individuals with autism. Remember that one reason for combining several disorders into a single category was to focus on the behavioral similarities among individuals with ASD while avoiding controversy about which individuals meet the criteria for the previously delineated specific forms of the disorder.

A directly related matter is prevalence. Is it true that 1 in 54 children have this disorder? Or is the number reported as part of IDEA—1% of all school-age children—more accurate? Do these significant variations in prevalence estimates for autism spectrum disorder matter? Yes. Resources often are allocated to study a disorder and to provide innovative treatments based on its prevalence, and so more accurate prevalence estimates of autism, especially those published by federal agencies such as the National Institutes of Health, might lead to more resource allocation.

Just as for other disability areas, concern exists in the field of ASD to find effective and research-based approaches for teaching students (Koegel et al., 2012). However, students with ASD are so unique that making global statements about effective practices can be risky (Lubas et al., 2016). Thus, professionals often have to rely on a combination of their knowledge of their students’ strengths and needs and an array of evidence-based interventions, making careful selections and often adjusting the intervention to better suit the student. The potential problem with this approach is negatively affecting intervention effectiveness because of changes made to it.

Another issue related to interventions occurs when some professionals who work with individuals with ASD advocate for particular approaches with good intentions grounded in personal experience rather than in research. Two examples in this chapter—power cards and social stories—illustrate this challenge. In fact, too many debates about the effectiveness of interventions for students with autism spectrum disorder in the recent past relied more on emotion than on data. Some of the interventions that have been recommended for which researchers have not been able to independently replicate the claims of those advocating the treatments include the following (Howlin, 2011; Schectman, 2007): auditory integration training, facilitated communication, use of vitamin B6 and magnesium, dietary interventions (e.g., eliminating gluten and casein), chelation therapy (a detoxification procedure designed to address the concern that mercury poisoning is the cause of autism), and hyperbaric oxygen therapy (breathing extra oxygen in a pressurized chamber). A web search would yield many sites related to these unproven approaches.

To address treatments such as these, studies that compare their impact on students need to be undertaken, and the results shared with practitioners and parents. In the meantime, you may find that parents insist on the effectiveness of particular treatments or interventions, and you should be prepared to seek out accurate information about them, taking care to use trustworthy sources. You also may need to consider the complex ethical issues that may be raised: You should not advocate such treatments, and although you can discuss your concerns with parents, you may not be able to convince them of your views.

Before autism was included as a separate disability category in IDEA in 1990, students with this disorder often received services from professionals prepared to work with students with severe and multiple disabilities or intellectual disabilities. After 1990, the number of students identified with ASD grew quickly, and the availability of teachers has not kept pace with this growth (Lambert, 2020), a situation echoed in reports from many state departments of education. For example, teachers have to become familiar with multiple and rapidly changing theories and approaches, and they have to be able to apply these across students and settings. They also need to clearly understand highly technical behavioral techniques, they have to know how to select and use appropriate assistive technology, and they must have considerable knowledge of language acquisition and use and understand how to foster language development in their students. In addition, they have to be adept at creating needed adaptations in the environment, gathering data, and working collaboratively with parents, paraprofessionals, and colleagues.

Another teacher preparation need concerns professionals already working in schools. As more students with ASD spend increasing amounts of time in the general education setting, special educators need the skills to support students there directly and indirectly, and general educators need to welcome these students and understand principles and practices for effectively teaching these students (e.g., Chung et al., 2015; Iadarola et al., 2015; Johnson et al., 2021). Clearly, the need for school personnel to be appropriately prepared for the inevitable increase of students identified through IDEA as having this disability is considerable and likely will grow for the next several years.

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Figure 10.2

Understanding Sensory Systems and Autism

Students with autism may experience difficulties with each of the seven sensory systems, described below, with examples given of the types of problems that may occur.

System

Location

Function

Example of Sensory Problems

Tactile (touch)

Skin—density of cell distribution varies throughout the body. Areas of greatest density include mouth, hands, and genitals.

Provides information about the environment and object qualities (e.g., touch, pressure, texture, hard, soft, sharp, dull, heat, cold, pain).

Feel of fabric texture on skin may be painful; student may not feel heat or cold and so is more at risk for injuries.

Vestibular (balance)

Inner ear—stimulated by head movements and input from other senses, especially vision.

Provides information about where our body is in space and whether we or our surroundings are moving. Tells about speed and direction of movement.

Student may lose balance more easily than classmates or experience difficulty in some games or activities (e.g., jumping rope, playing basketball).

Proprioception (body awareness)

Muscles and joints—activated by muscle contractions and movement.

Provides information about where a certain body part is and how it is moving.

Student may seem clumsy, bumping into desks in narrow aisles or knocking crayons off a table.

Visual (sight)

Retina of the eye—stimulated by light.

Provides information about objects and persons. Helps us define boundaries as we move through time and space.

Student may be very sensitive to bright lights such as those found in classrooms.

Auditory (hearing)

Inner ear—stimulated by air or sound waves.

Provides information about sounds in the environment (loud, soft, high, low, near, far).

Certain sounds (e.g., fire alarm) may be too loud for the student; student may focus on sounds others do not attend to (e.g., electrical hum from classroom equipment).

Gustatory (taste)

Chemical receptors in the tongue—closely associated with the olfactory (smell) system.

Provides information about different types of taste (e.g., sweet, sour, bitter, salty, spicy).

Student may refuse to eat anything except certain preferred foods.

Olfactory (smell)

Chemical receptors in the nasal structure—closely associated with the gustatory system.

Provides information about different types of smell (e.g., musty, acrid, putrid, flowery, pungent).

Student may have a strong reaction to certain scents (e.g., perfume, materials used in a science experiment).

SOURCE: Myles, B. S., Cook, K. T., Miller, N. E., Rinner, L., & Robbins, L. A. (2001). Asperger syndrome and sensory issues: Practical solutions for making sense of the world (p. 5). Autism Asperger Publishing. Reprinted with permission from Autism Asperger Publishing Co.

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A mother's interview: Beth's mother reflects on how Beth's new program and IEP are more effective and how the teachers have improved Beth's quality of life by not limiting what they teach her based on her IEP. In what ways can teachers set appropriate academic expectations for students with autism and also support behavior goals?

I have recorded the video at so many lengths , but I'm getting it large, so I screenshot the scripts. It will be attached