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WHAT ARE THE FOUNDATIONS OF AUTISM SPECTRUM DISORDERS?

• The five autism spectrum disorders are autistic disorder (autism), Asperger syndrome, Rett syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified. (p. 360)

History

• Leo Kanner brought attention to autism in 1943. Hans Asperger brought attention to Asperger's syndrome in 1944, although his original work was not translated from German to English until 1991. Rett syndrome was initially identified in 1966. The other two disorders were included in the 1994 DSM-IV-TR. (p. 360-61)
• Autism was recognized as a disorder by the American Psychiatric Association (APA) in 1980 and a disability under IDEA in 1990. (p. 361)

Definition

• Autism is characterized by social impairments, communication impairments, and restrictive or repetitive behaviors occurring before the age of three. (p. 361-62)
• Asperger syndrome involves social interaction problems and restrictive, repetitive interests without the communication problems seen in autism. (p. 362-63)
• Rett syndrome is a neurodevelopmental disorder occurring virtually exclusively in girls. (p. 363)
• Childhood disintegrative disorder occurs between ages 2-10 and involves regression in areas such as language, social skills, and bowel and bladder control. (p. 363)
• Pervasive Developmental Disorder not Otherwise Specified is used when a child has autistic features but does not meet the criteria for any of the other four autism spectrum disorders. (p. 363)

Prevalence

• Prevalence estimates vary but have been reported to be between 2 to 6 per 1,000 children. A more recent estimate indicated that 1 in 150 have an autism spectrum disorder. (p. 363)
• Autism is the most prevalent of the autism spectrum disorders with some data suggesting 1 in every 250 children will have autism. (p. 363)
• The prevalence of autism has increased dramatically in recent years possibly due to greater awareness, improved methods of identification, and increased recognition that they can appear across all IQ levels. (p. 363-64)
• Autism, childhood disintegrative disorder, and Asperger syndrome are found more in males, whereas Rett syndrome is found virtually exclusively in girls. (p. 364)

WHAT ARE THE CAUSES AND CHARACTERISTICS OF AUTISM SPECTRUM DISORDERS?

Causes

• Although Rett syndrome is the result of a specific gene mutation, the exact cause of the other disorders is unknown. (p. 365)
• Controversial theories about the cause of autism include poor parenting ("refrigerator mom"), and its triggering from vaccines including the MMR vaccine. (p. 365)
• Autism appears to be due to brain abnormalities caused by genetic factors and possibly triggered by environmental factors including problems during pregnancy and delivery, viral infections, and metabolic imbalances. (p. 365-66)

Characteristics

• Autism spectrum disorders, in general, result in social impairments, although there is no single, common characteristic. (p. 367)
• Individuals with autism display a number of social, communication, and behavioral deficits. These include difficulty with joint attention, the tendency to repeat what is said to them, and the need for a routine. (p. 367-72)
• Up to 10% of individuals with autism have savant syndrome, displaying remarkable talents in areas such as art, music, and math computation. (p. 368-69)
• Approximately 70% of individuals with autism have mental retardation. (p. 370)
• Individuals with autism have weaknesses in verbal areas and strengths in visual areas. (p. 370-72)

HOW ARE AUTISM SPECTRUM DISORDERS IDENTIFIED?

• Screening and diagnosis should be a multidisciplinary effort. A medical, intellectual, and communication evaluation are all usually involved. (p. 372)
• Parents are usually the first to notice a problem. (p. 372)
• An individual's developmental history is important in diagnosing autism. (p. 372)
• Screening checklists and specific rating scales are available to help diagnosis. (p. 372-73)

WHAT AND HOW DO I TEACH STUDENTS WITH AUTISM SPECTRUM DISORDERS?

• Effective programs are based on the unique needs and abilities of each individual student and the needs of the family. (p. 374)

Instructional Content

• For some students, the general education curriculum, with some modifications, will be appropriate; for others, major adaptations may be needed. (p. 374)
• Most programs will include goals in functional communication, social skills, cognitive functioning, and/or possible behavior supports. (p. 374-75)
• Early intervention plays an extremely important role in future success. The earlier the intervention, the more successful the outcome will be. (p. 375)
• Early intervention programs include the Young Autism Project (YAP); Learning Experiences, an Alternative Program for Preschoolers and their Parents (LEAP); and, Project DATA (Developmentally Appropriate Treatment for Autism). (p. 375-76)
• The need for teaching more conventional communication exists, although students with autism have a wide range of communication abilities. (p. 377)
• Social skills should be delivered throughout the day in various settings. One important area of social skills that is too often neglected is the hidden curriculum. (p. 377-78)
• Most students will need instruction in some areas of academic and cognitive skill development. (p. 378)
• The importance of parents playing a central role in their children's intervention has been strongly acknowledged. (p. 379)
• The range of expectations in transition planning is wide, from success in college to pursuing and keeping a job to independent living skills. Self-determination skills are essential for all. (p. 379)

Instructional Procedures

• Effective practices are those that are scientifically validated and match the needs of the individual, the setting, and the family. (p. 379)
• Effective practices include direct instruction, TEACCH, and several applied behavioral analysis programs. Also promising are Social Stories . (p. 380-83)
• Direct instruction can be used to teach communication, social skills, and cognitive skills. (p. 380)
• TEACCH develops a program around a student's skills and interests by creating an autism-friendly environment. (p. 380)
• Applied behavior analysis ( ABA ) techniques are the most widely scientifically validated procedures to bring about behavior change. (p. 380-82)
• One of the most utilized highly structured approaches is the discrete trial method of teaching. (p. 381)
• Emphasis on communicative intent led to the development of other more naturalistic behavioral approaches such as pivotal response teaching and incidental teaching. (p. 382)
• The use of Social Stories to explain social concepts and situations and introduce changes and novel events is a promising intervention. (p. 382-83)
• Many unsupported treatments are available for unsuspecting, well-meaning families and need to be avoided. (p. 383-84)

WHAT ARE OTHER INSTRUCTIONAL CONSIDERATIONS FOR TEACHING STUDENTS WITH AUTISM SPECTRUM DISORDERS?

Instructional Environment

• Structure and routine are key to a positive environment. (p. 385)
• Learning in natural environments is likely to be the most effective intervention for young children. (p. 385)
• Elementary and secondary classroom environments and time need to be planned with as much structure and routine as possible. (p. 386)
• Visual schedules, charts, or cue cards capitalize on the strengths of most students. (p. 386-87)
• A child's placement in a classroom should take into account noise sensitivity. A home base where the student can go to escape stress and regain control may be useful. (p. 387)
• Physical arrangement of the classroom may be influenced by the use of positive behavior support. (p. 387)
• Carefully structured group instruction provides an excellent environment to promote generalization and maintenance of skills taught individually. (p. 387)
• Peer buddies may take many roles in the student's academic and social life in school. Well-trained peer tutors can be effective. (p. 387)

Instructional Technology

• Instructional technology is most often used to support communication. (p. 387)
• The computer can be a very attractive and powerful tool. (p. 388-89)
• Augmentative and alternative communication technology can be very useful and can be high tech or low tech. (p. 390)
• The most widely used communication system is the Picture Exchange Communication System (PECS). (p. 390)
• Voice Output Communication Aids (VOCAs) can be used effectively by some students. (p. 390)

WHAT ARE SOME CONSIDERATIONS FOR THE GENERAL EDUCATOR?

• Inclusion takes very careful planning and collaboration among the general education teacher, special education teacher, specialists, and the family. (p. 391)
• One model that offers guidelines and support is the Autism Spectrum Disorder Inclusion Collaboration Model. (p. 391)
• There are many specific strategies that may be useful for a successful inclusion classroom. (p. 392-93)