7-10 page paper on Quality of Life, Special Needs Class

Running Head: CRITICAL LITERATURE REVIEW 1

Critical Literature Review

SE 600: Oakland University

CRITICAL LITERATURE REVIEW 2

Autism is a very complex disorder in which severity is based on a continuum. Autism

Spectrum Disorder (ASD) is characterized by social impairments, communication difficulties,

differences in sensory structure, and restricted, repetitive, and stereotyped patterns of behavior.

An individual with ASD may also display differences in motor skills and cognition (Cihak,

Smith, Cornett, & Coleman, 2012). Since ASD can vary depending on its’ severity, it is always

important to evaluate each person and identify individual strengths and weaknesses. It has been

found that many people with ASD often have considerable deficits in their ability to function

independently and typically have poor adult outcomes (Caothers, & Taylor, 2004). Their limited

life outcomes are generally due to overall low levels of adaptive functioning. Adaptive

functioning is referred to as the effectiveness with which an individual can perform daily

activities and meet everyday environmental demands required for personal and social sufficiency

(Hudepohl, Robins, King, & Henrich, 2013). Struggling to acquire adaptive behavior skills is

likely to have a substantial impact on a person’s quality of life, specifically in the area of

personal development (Clark, Magill-Evans, & Koning, 2014). Given this deficit often

individuals with ASD possess, it is important that educators teach interventions or strategies to

improve the adaptive functioning of students with ASD in the hope to advance their overall

personal development.

Quality of life is known as a multidimensional structure that is always changing in

regards to how someone feels within Robert L. Schalock’s eight specified domains. These

domains include (1) material well-being, (2) personal development, (3) interpersonal well being,

(4) emotional well being, (5) physical well being, (6) social inclusion, (7) self determination, and

(8) rights (Schalock, 2000). The focus of this review will be on the area of personal development

as it relates to an individual with ASD’s quality of life. Personal development consists of

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improving awareness and identity, developing talents and interests, the realization of dreams and

aspirations, and building the necessary skills to be independent (Skills You Need, 2014).

Personal development consists of three indicators; an individual’s educational status, personal

skills, and adaptive behavior (Buntinx, & Schalock, 2010). In order for an individual to gain

complete independence he must develop personally within all three indicators, but especially

within the area of adaptive behavior. Sub-domains that are essential in the development of

adaptive behavior include daily living skills (personal, domestic, community), communication

skills (receptive, expressive, written), socialization skills (interpersonal relationships, play,

leisure, coping skills), and motor skills (gross, fine) (Fenton, D’ardia, Valente, Vecchio, Fabrizi,

& Bernabei, 2003). Caothers, & Taylor (2004) note that if taught adaptive skills throughout life

children with autism are more likely to have better adult outcomes that allow them to live more

independently and successfully as adults.

In order to appreciate the importance of adaptive behavior as it relates to an individual

with autism’s personal development and their overall quality of life, research must be reviewed

and evaluated. Four research studies that describe and appraise adaptive behavior skills have

been assessed; (1) Adaptive function in preschoolers in relation to developmental delay and

diagnosis of autism spectrum disorders: Insights from a clinical sample by Susan L. Milne, Jenny

L. McDonald, and Elizabeth J. Comino, (2) Understanding the gap between cognitive abilities

and daily living skills in adolescents with autism spectrum disorders with average intelligence by

Amie W. Duncan and Somer L. Bishop, (3) Vineland adaptive behavior profiles in children with

autism and moderate to severe developmental delay by Gemma Fenton, Caterina D’ardia,

Donatella Valente, Ilaria Del Vecchio, Anna Fabrizi, and Paola Bernabei, and (4) The role of

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emotion perception in adaptive functioning of people with autism spectrum disorders by

Margaret B. Hudephol, Diana L. Robins, Tricia Z. King, and Christopher C. Henrich.

In all of the studies, participants were either preschoolers or adolescents. In the article by

Milne, McDonald, and Comino (2012) they evaluated 152 preschoolers; 79 of them had a

diagnosis of autism and 73 did not have a diagnosis of autism. The article by Fenton, D’ardia,

Valente, Vecchio, Fabrizi, and Bernabei also evaluated preschoolers and their study consisted of

23 preschoolers with autism that also had a moderate to severe developmental delay and 27

children that did not have autism but still had a moderate to severe developmental delay. The last

two articles consisted of children who are considered adolescents. In the article by Duncan and

Bishop they evaluated 417 children with autism who had average intelligence, and in the article

by Hudephol, Robins, King, and Henrich they compared 18 adolescents with autism to 22

children who were typically developing. Overall, the age range within the four studies varies

from preschool to adolescent age.

In all of the studies the measures used to gather information were very similar. The

Vineland Adaptive Behavior Scale or the Adaptive Behavior Assessment System- Second

Edition (ASAS-II) was used to determine the participants adaptive functioning. All of the

findings from the studies suggest that overall adaptive functioning is low for individuals with

autism despite the participants’ age or IQ. Milne, McDonald, and Comino (2012) found that

preschoolers’ overall adaptive functioning was very closely correlated to their developmental

ability. In addition, they found that the poor performance of children with autism on both

developmental and adaptive functions reflected their lower developmental level overall. More

specifically, preschoolers who have autism showed poorer performance on practical and social

domains related to adaptive functioning. These specific results contradict the research of Fenton,

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D’ardia, Valente, Vecchio, Fabrizi, and Bernabei (2003). Although the authors support the

notion that children with autism have lower adaptive behavior when compared to typically

developing children, they found their group of preschoolers with autism to only have slightly

lower adaptive behavior skills in each of the domains. They found no large differences within the

adaptive behavior domains. Fenton, D’ardia, Valente, Vecchio, Fabrizi, and Bernabei found that

their scores of adaptive behavior were very homogeneous compared to previous research in this

area. Their results revealed that communication was the lowest area while daily living and

socialization were similar. This does not support previous findings from other authors of low

socialization scores, intermediate communication scores, and higher daily living scores. In

addition, the authors’ evaluated preschoolers with autism who also had low IQ or moderate to

severe developmental delays. The authors’ research supports the notion that for children in the

low IQ group, there is no significant correlation between autistic characteristics and adaptive

behavior. Lastly, the authors’ research pointed out that children with or without autism and

moderate to severe developmental delays cannot easily be distinguished through the use of

adaptive behavior scales. These two studies on preschoolers with autism confirms that children

with autism have lower adaptive behavior and there is a need teach adaptive skills early in order

for them to become independent as adults.

In the other two studies, all of the participants were in the adolescent age group. The

authors found that individuals with higher functioning autism had lower daily living skills and

overall adaptive functioning despite their IQ. In the article by Duncan and Bishop (2013) their

results indicated more than half of the participants who had autism with average intelligence had

daily living skills that were significantly below what would be expected based on their full scale

IQ. In addition, the article by Hudephol, Robins, King, and Henrich (2013) found similar results

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in their study, citing people with high functioning ASD, on average, had more impaired adaptive

functioning than typically developing peers. These authors emphasized that cognitive

functioning does not sufficiently predict how people with ASD meet day-to-day life demands.

Their study also looked at the role of emotional perception in the adaptive functioning of people

with autism. The authors found that emotion perception acted as a significant mediator for

socialization, but not for communication or daily living skills. This supports the understanding

that in people with ASD lower socialization abilities is, in part, the result of emotional perception

difficulties. Overall, adolescence is a very moldable time for children with autism. They are

continuing to grow and change and in order for them to have positive adult outcomes they need

to be continuously taught adaptive skills.

The area of personal development, specifically adaptive behavior, can be promoted for

individuals with autism in many ways. First, direct instruction that teaches emotional awareness,

the understanding of others, and how it all is important in day-to-day activities and real-life

situations can help promote adaptive behavior but also inter-personal well-being as well. In

addition, interventions that simultaneously consider individual, family, and environmental

factors, as well as techniques that lead to skill acquisition in individuals with ASD will likely be

the most successful in increasing daily living skills because the skills can be taught with a focus

on the strengths and weaknesses of the family and generalized across environments (Duncan, &

Bishop, 2013). Another way to promote adaptive behavior as it relates to personal development

is the implementation of occupational therapy to target daily living skills directly (Milne,

McDonald, & Comino, 2012). In addition, teaching skills in natural environments is always the

most preferred when working on adaptive skills. However, when the natural environment is not

accessible video modeling can be used. This approach includes videotaping another student

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performing the desired task so that the videotape can be shown repeatedly to the student

attempting to acquire the new skill. For example, videotaped modeling has been used to teach

children with autism to make purchases in community grocery stores, and the skill was later

generalized to unfamiliar stores (Caothers, & Taylor, 2004). Another strategy to teach adaptive

skills is photographic or pictorial activity schedules. In this technique, a series of pictures depicts

the stages of a task in order to help the student perform the task independently (task analysis).

This strategy has been successfully used to teach cooking skills, clerical and laundry tasks, and

computer use (Caothers, & Taylor, 2004). In addition, an instructional technique that has been

successfully used in schools involves the participation of peers. The goal of this strategy is to use

peers without disabilities as models in teaching functional community-based skills to students

with disabilities (Caothers, & Taylor, 2004). Lastly, there are a number of organizations in our

area that can be utilized to promote the lives of individuals with autism in the area of personal

development. One agency includes the Autism Play Place in Sterling Heights. This facility holds

classes that focus on life skill development. They have over 20 specialized and comprehensive

lesson plans, including time management, money skills, music and movement therapy, safety,

hygiene, and courtesy and manners. In addition, they feature employment opportunities focused

on individual strengths and talents with well-defined goals in a sheltered and secure capacity.

The positions include greenscaping, retail, food service, greeters, stock assistants, maintenance,

program attendants, and light office duties. Another great organization that supports adaptive

behavior is known as the Friendship Circle. Friendship Circle of Michigan created Weinberg

Village. Here is where lessons for life fill the gap between classroom learning and real world

experiences by teaching life skills and giving the opportunity to confidently assume

responsibility and independence in the outside world. Lastly, the Arc of Michigan in Lansing as

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well as online is a wealth of information and assistance for families with special needs. This

resource can be used to help find occupational therapy services in our area, employment,

education, and information about adaptive skills for individuals with special needs. Overall, there

is a great deal of information, a number of resources, and many helping hands that can be used to

promote an individual with autism’s personal development.

Autism is a very complex disorder in which severity is based on a continuum. One of the

quality of life domains affected by this complex disorder is personal development. After

examining four research studies related to personal development and adaptive behavior, it has

been found that many people with ASD often have considerable deficits in their ability to

function independently. In addition, they also typically have poor adult outcomes due to overall

low levels of adaptive functioning. Although a low level of adaptive functioning is not a key

characteristic of autism it is greatly impacted by it and strategies should be taught to improve

skills within this area. There are many techniques, approaches, organizations, and agencies in our

state to help promote individuals with autism in the area of adaptive behavior. Finally, as

educators it is our job to enable individuals with autism to live as independently and successfully

as possible.

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References

Buntinx, W.H.E., & Schalock, R. L. (2010). Models of disability, quality of life, and

individualized supports: Implications for professional practice in intellectual disability.

Journal of Policy and Practice in Intellectual Disabilities, 7, 283- 294.

Carothers, D.E., & Taylor, R. L. (2004). How teachers and parents can work together to teach

daily living skills to children with autism. Focus on Autism and Other Developmental

Disabilities, 19, 102-104.

Cihak, D.F., Smith, C. C., Cornett, A., & Coleman, M. (2012). The use of video modeling with

the picture exchange communication system to increase independent communicative

initiations in preschoolers with autism and developmental delays. Focus on Autism and

Other Developmental Disabilities, 27, 3-11.

Clark, B.G., Magill-Evans, J.E., & Koning, C.J. (2014) Youth with autism spectrum

disorders: Self- and proxy- reported quality of life and adaptive functioning. Focus on

Autism and Other Developmental Disabilities, 19, 1-8.

Duncan, A. W., & Bishop, S.L. (2013). Understanding the gap between cognitive abilities and

daily living skills in adolescents with autism spectrum disorders with average

intelligence. Autism, 25, 1-9.

Fenton, G., D’ardia C., Valente, D., Vecchio, I.,D., Fabrizi, A., & Bernabei, P. (2003). Vineland

adaptive behavior profiles in children with autism and moderate to severe developmental

delay. Autism, 7, 269-286.

Hudepohl, M.B., Robins, D.L., King, T.Z., & Henrich, C.C. (2013). The role of emotion

perception in adaptive functioning of people with autism spectrum disorders. Autism, 11,

1-6.

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Milne, S.L., McDonald, J.L., & Comino, E. J. (2012). Adaptive function in preschoolers in

relation to developmental delay and diagnosis of autism spectrum disorders: Insights

from a clinical sample. Autism, 12, 743-753.

Schalock, R. L. (2000). Three decades of quality of life. Focus on Autism and Other

Developmental Disabilities, 15, 116-127.

Skills You Need. (2014). Skills You Need. Retrieved from:

http://www.skillsyouneed.com/ps/personal-development.html.