1 What Is ASD and How Do the Core Areas of Impairment Affect Students in a Traditional School Setting?
Autism Spectrum Disorder
Autism Spectrum Disorder (ASD) is a neurobiological impairment that impacts a child's development. The disability can be present from birth, with some of the symptoms being recognized by twelve months of age. These earliest symptoms include limited eye contact or failure to look at the eyes and faces of others, limited response to their name and to the social gestures of others, and impaired imitation of both sound and actions. Other children with ASD appear to have a typical pattern of early development with a fairly sudden onset of symptoms and a loss of skills, including loss of words, eye contact, and play skills. This regressive subtype often becomes symptomatic between eighteen to twenty-four months of age.
The average age of diagnosis for Autistic Disorder is three years of age, but often individuals with fewer autistic symptoms, such as those with Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), or those with Asperger's Syndrome (AS), considered the highest functioning on the Autism Spectrum, are diagnosed much later. The average age of diagnosis for Asperger's Syndrome is eight to twelve years of age and is very often a second or third diagnostic label given to a child with the disability. Disorders such as Attention Deficit Disorder (ADD), Obsessive Compulsive Disorder (OCD), or other Behavioral Disorders, including Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD), are often assigned first, typically by professionals who lack an understanding of ASD.
Autism is referred to as a "spectrum disorder" because of the wide variability of functioning seen in individuals with the disability. The core areas that are impaired in ASD are communication and socialization skills. An additional area that is affected is restrictive and repetitive patterns of behavior. People with ASD may engage in self-stimulating behaviors such as spinning or rocking or repetitious routines such as lining things up or insisting that things be done in a very specific order. Children with Asperger's Syndrome (AS) are often highly verbal, but tend to use unusual language and may perseverate on one specific topic or have an intense area of interest. Children with classic Autistic Disorder have a delay in the development of spoken language and often use echolalic or repetitive speech or they may remain nonverbal, having no way to communicate basic needs and desires except through their behavior.
It is generally accepted that children with ASD face varying levels of challenges processing sensory information. The literature reports that people with ASD process sensory experiences differently from people who do not have ASD. It is estimated that around two-thirds of children with ASD also have significant sensory processing issues that impact their ability to function in one or more life-skill domains. Many with ASD experience a high sensitivity to touch, sound, light, or movement that results in behavioral refusal and avoidance of a variety of situations and activities. Most children develop a set of protective responses, including covering their ears, actively moving away from or avoiding people, or avoiding highly stimulating settings. Some develop coping skills to get through "overstimulating" activities, but may eventually act out or become exhausted by their efforts. This exhaustion looks like complete shutdown, where the individual will not respond even to activities they know how to perform.
Impacts in Traditional School Settings
Traditional school settings are usually highly active and interactive environments. People with ASD face many challenges tolerating and coping with the sensory stimulation. They are also challenged with recognizing, interpreting, and responding to social situations; understanding all the facets of the academic task demands; and processing a great deal of verbal communication. For students with ASD, traditional school settings may feel like being in rush-hour traffic in a strange city, on a rainy day with the dog barking in the backseat. While this is possible, it is also exhausting!
People with ASD have high verbal skills and average to above-average intelligence as measured on standardized IQ tests. They tend to have relative strengths in many academic areas, including decoding (many are hyperlexic or self-taught readers), math calculation (some becoming brilliant mathematicians, engineers, or physicists), and other academic areas that require memorization or implementation of rules and procedures. These same individuals have extreme impairments in using and understanding nonverbal communication, in recognizing and responding to their emotions or the emotions of others, and in taking other people's perspectives and responding in socially appropriate ways. They may also be highly rigid in their thinking and behavior and respond inappropriately to a change in routine or a new expectation.
Although individuals with ASD may have excellent vocabulary skills, they also tend to interpret language literally. This often results in problems interpreting what other people mean in their everyday speech. For example, the teacher might say, "Everyone take your seat." The student with ASD might respond with "Take it where?" This is not noncompliance or sarcasm. The student with ASD interprets the instruction in the literal sense and may make a mistake in his attempt to follow the teacher's direction. Teachers who do not understand the nature of this disability might misinterpret the student's behavior and assume that the student is being willful, oppositional, or comical. The more frequently these "miscommunications" occur, the more anxious the student may become. He may spend a great deal of time during the school day attempting to interpret the teacher's instructions or the comments and slang words or phrases used by peers.
Academic areas that require mental flexibility, problem solving, prediction, and perspective taking are a struggle for individuals with ASD. Many do very well in school until the curriculum shifts at around third grade. Up until that point, the focus of learning is on facts and procedures, which are a relative strength for these learners. At around third grade, students are expected to engage in more complex learning, which includes making predictions, making inferences, and solving complex problems. Once this shift occurs, many students with ASD begin to fall behind or become increasingly frustrated with school and homework.
Challenges in Middle School and High School
Another shift that is very challenging for those with ASD occurs in the late elementary grades and middle school. Teachers begin to expect students to maintain the organization of their own work space, materials, and assignments.
In the early grades, teachers provide a high level of organizational structure and support. This is accomplished through classroom design, such as having learning centers where materials are all prepared in advance and ready for students to use when they arrive at the center. Teachers also provide a highly predictable and structured schedule that includes regular routines each day, homework packets that are broken up over the week, regular standing tests, and activity times. The teachers will lead their students through complex assignments like book reports by breaking them into manageable chunks, providing explicit step-by-step procedures, and listing student expectations. These strategies provide students with ASD the physical, temporal, and cerebral organizational structure that they need to succeed. Given that students with ASD lack the hardwired organizational skills, also called executive functioning capabilities, to manage their own physical and cerebral organization, the highly structured environment, predictable schedule, and orderly presentation of assignments are critical for students with ASD.
In contrast, when students reach the later elementary grades and middle-school years, the teacher's expectation is that the student has the ability to manage his own physical space and assignments. The teacher assumes that the student has developed the skills to organize his desk, locker, backpack, and his own assignments such as homework, reading, research, reports, and test preparation without additional teacher direction. Teachers also expect the student to manage his own time by using downtime for studying, organizing himself, and preparing for upcoming events or assignments. School can quickly become overwhelming for a student with ASD or for any student who does not have highly developed organizational skills or the executive functioning capabilities to manage these organizational processes. Executive functioning will be discussed in greater detail in Chapter Four, Question 13.
Impacts of Fine and Gross Motor Challenges
Many students with ASD struggle with motor coordination, including the gross motor skills that are required for sports and P.E., as well as the fine motor skills that are required for handwriting. The expectation that students in traditional education programs will participate in group sports puts social and performance pressures on those with ASD who struggle with social skills and motor coordination. Physical education classes and recess can be very stressful times for students with ASD. These are also time periods where students with ASD can be victimized or teased relentlessly for their lack of physical prowess or for their quirky behaviors.
The fine motor demands of writing that are expected in traditional schools and the rigid nature of the schedule, where a great deal of written output is expected within a short period of time, are also a high source of stress and oftentimes failure. When provided with an alternative form of output, such as keyboarding or dictation, students with ASD can perform quite well. These accommodations may be challenging to access or implement in a traditional school setting. Even if they are available, many with ASD do not want the stigma of using the necessary accommodations in the traditional school settings because these accommodations set them apart from their peers and make them feel "different."
Adolescents with ASD are at high risk for depression and anxiety. Many of these students are bright enough to recognize they are different, and it becomes hard to focus on their strengths when all they may see in a traditional school setting are their social, academic, or physical weaknesses. While on the surface, individuals with ASD may simply appear quirky, they are fully affected by the core deficits of Autism and the effects on learning and behavior. Because of high verbal skills and academic strengths in certain areas, teachers often have unrealistic academic and social expectations for some ASD students. The student may be able to do certain aspects of an assignment, but may struggle with others. He may be able to explain how to do something, but cannot execute the plan without ongoing prompting and support. He may want to have friends and work in a group, but lack the social skills and understanding to do this successfully. These types of academic and social frustrations often result in acting out or shutting down in traditional school programs.
Students with Cognitive Delays and Severe Autism
It is estimated that 75 percent of individuals with Autistic Disorder also have some degree of cognitive impairment. While there are no outward physical symptoms of ASD, individuals who function at the middle or lower end of the spectrum are often easier to recognize than those with high-functioning forms of ASD. Their unusual speech (echolalia) or inability to use words to communicate and higher levels of repetitive motor behaviors (self-stimulating behaviors) make the disability more visible and recognizable to others. Teachers and peers may be more tolerant of behaviors or have more realistic academic and social expectations of a child with moderate forms of ASD in traditional educational settings. An issue faced by these students is the tendency of teachers and aides to overprompt or provide such high levels of support that the student never learns how to do things independently.
Time spent in a general education classroom may be overstimulating to a student with more severe ASD, which may result in higher rates of sensory regulating or self-stimulatory behaviors and missed instructional opportunities. It is also very challenging to address the functional, behavioral, and communication needs of a more-involved student in a traditional inclusive classroom setting. As a result, students with more severe ASD may be educated in special day classrooms (SDC). While this more controlled setting may facilitate academic, functional skills, and communication growth and promote better behavioral regulation, it may also result in missed opportunities for social development. Even when these students are in proximity to typically developing peers, such as during recess, social teaching opportunities are difficult to capture in traditional school programs.
Recess on a traditional school campus is a noisy and active time. The vast space of the traditional playground and the lack of structure make it challenging to be able to teach or facilitate social interactions. Students with ASD may also have great difficulty in generalizing the skills learned at school to other settings such as home and the community.
Sensory differences, social avoidance, and lack of appropriate play or leisure skills often result in unconventional behavioral patterns. Severe behavior may make teachers fearful of working with a student, and may lead peers to steer away from interactions. Individuals with ASD require higher levels of support, more specialized teaching strategies, and frequent reinforcement for engaging in appropriate behavior. When unable to communicate or understand the expectations of others, problematic behaviors such as aggression, throwing tantrums, bolting, or screaming may develop. Individually designed positive behavior support plans (BSP) that include teaching prosocial and adaptive responses are essential for success. These highly individualized teaching plans must be implemented consistently in order to be most effective. This can be challenging in traditional educational settings, as the student may encounter many teachers or specialists throughout the day, each with his or her own unique way of working with the student. Consistent implementation of teaching and behavior support plans requires a great deal of communication and planning time amongst team members, which is often difficult to achieve in traditional school programs.
Physical Signs of Stress
A study by Richdale and Prior (1992) found that people with ASD have a tendency toward cortisol hypersecretion (a hormone associated with stress) during their school hours. In their study, these researchers found that the same subjects had relatively normal levels of cortisol secretion during nonschool hours. This provides evidence that traditional school settings elicit a stress response in people with ASD. These findings are further clarified by Corbett and her colleagues (2006), who found that people with ASD had increased cortisol reactions compared to neurotypical controls when presented with any novel or threatening event. Due to the level of stimulation and the unpredictable nature of a typical school environment, we can ascertain that the nature of traditional school settings is very stressful to children with ASD. This stress impacts them physically as well as behaviorally as they attempt to cope.
Necessity to Provide a Continuum of Options for Students with ASD
While it is not impossible for a student with ASD to access a high-quality and appropriate educational program in a traditional school setting, this scenario does present many challenges. The needs and challenges of the individual child, as well as the structure, training, and readiness of the school staff, must all be considered. With all the right supports and training in place, many with ASD can thrive in traditional public education. However, it must also be recognized that the traditional school setting may not meet the needs of all students and families.
Excerpted from Homeschooling the Child with Autism by Patricia Schetter Kandis Lighthall Copyright © 2009 by Patricia Schetter and Kandis Lighthall. Excerpted by permission.
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