 DRAFT
Autism has
been the subject of controversy for many years for various
reasons. The first
controversy had to with a theory that was soon proven wrong that
cold mothers with no attachment to their children made them
autistic. Although
this theory wasn’t around long, it negatively impacted
families already dealing with a difficult situation and
influenced the thinking of many people.
The next controversy had to do with Applied Behavior
Analysis and that instructors used subversives (hit the
child’s leg) when the child did not respond with the correct
answer. Now there
is the mercury controversy.
Many parents believe their children are suffering from
mercury poisoning from government-required vaccinations.
Many natural alternatives (vitamins and herbs) are also
controversial in traditional doctor and drug company’s
opinions. Also, it
is debated between parents and the government whether the number
of children who have autism has truly skyrocketed or if doctors
are now doing a better job at diagnosing the disorder.
Another highly disputed area is whether the children are
“cured” or if they are “unidentifiable from their
peers.”
Define
Autism
“There are
difficulties in defining autism as a syndrome, because of other
developmental problems that often accompany it” (Jordan &
Powell, 1996). Autism
is a neurological disorder where developmental problems can be
seen soon after birth and many other children do not have
problems until about 18 months of age, which is late-onset
autism. According
to the Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV)
by the American Psychiatric Association (1994), in order to be
diagnosed with autism he or she must exhibit or have exhibited a
specified number of problems in social interaction, in
communication and in imaginative play, as well as unusual
behaviors and restricted interests and activities by age 3.
Since autism has so many different aspects it is
sometimes hard to get a proper diagnosis and receive early
intervention. It affects more boys than girls.
Professionals are now calling it autism spectrum disorder
with several specific disorders within it such as Asperger’s
Disorder, Pervasive Development Disorder (PDD), Pervasive
Development Disorder Not Otherwise Specified (PDD-NOS), Rett’s
Disorder, and Childhood Disintegrative Disorder to name the most
popular.
Most parents
are given little hope once they receive a diagnosis and many are
happy just to receive a diagnosis.
Parents are told that their child has a lifelong
disability. They
are not told that there are ways to improve their child’s
quality of life or perhaps cure
them. If parents were armed with at least some positive information
they would spend what it takes to help their child. Unfortunately, they do not receive this information and may
go into denial or depression as a result.
This further delays their child from receiving early
intensive intervention.
What
are the costs: Individualized
multidisciplinary education is expensive.
Multidisciplinary teams can include:
an autism consultant, a special education teacher, speech
therapist, physical therapist, occupational therapist,
psychologist, social worker, student advocate, attorneys,
parents, and a school administrator.
While most of these people will work with more than one
child, it is labor intensive if done correct.
The teams spends time individually and collaboratively
conducting initial and then periodic evaluations, team meetings,
continually updating goals and objectives, working with the
student or students as well as highly trained personnel to work
with each child individually and prepare new materials. Most programs do not have adequate autism consultant time
which should lead the team, design the curriculum, train the
team as well as paraprofessionals and suggest changes in
methods. This may require direct teaching time and observation.
The better the consultant and teachers know the child the
better the services will be.
Define
Behavior Teaching: Various
Models
Behavior
teaching also goes by many names and there are different
versions. A good
program will use various characteristics of these programs that
are individually suited to the child.
They must find the strengths of the child.
Behavioral
therapy is my favorite therapy so far because it can be used for
a wide variety of behaviors and skills. Behavioral Therapy
is an autism teaching strategy to correct a child's behavior
(rather it's throwing a tantrum, getting eye contact or teaching
social skills) and includes these techniques:
Discrete
trials include mass and expanded trials.
- breakdown of tasks into small units
- systematic use of reinforcement
(food, praise or toy)
- verbally simple using clear and
straightforward language
Receptive
language (understanding of language)
Expressive
language (spoken use of language)
Action
on object command ("Put the toy on the chair.")
Errorless
teaching with most-to-least prompting.
Prompting:
positional, physical, gestural, verbal, and visual.
Assists
with focus and student being able to sit still.
ABA
therapy is sometimes also called “discreet trial training”
or the Lovaas Method. Pioneered by Dr. O. Ivaar Lovaas,
professor emeritus at the University of California at Los
Angeles, it is an early intervention program for children as
young as 2 or 3 years old. ABA therapy refers to a wide variety
of techniques that use rewards to develop new skills or reduce
unwanted behaviors, like aggression or self-injury. Skills, such
as learning to make eye contact, are developed one at a time.
ABA is a highly structured, adult-led program (the adult directs
the activity while the child follows along) intended to prepare
a child to enter kindergarten by age 5 or 6. It involves
intensive one-on-one instruction between the child and a
therapist or parent. The therapy takes place in the home or
school for as many as 20 to 40 hours per week.
ABA
is backed by the strongest scientific support of any autism
treatment, mostly based on Lovaas’s original 1987 study in
which he cited a 47 percent recovery rate. However, no other
study has replicated Lovaas’s results. ABA is recognized for
its effectiveness in helping children learn language and
cognitive skills, but critics charge that the rigid structure
does not build social skills and that children tend to become
more robotic in their responses and less spontaneous in adapting
to real-world situations.
Pivotal Response Training or PRT is an approach based on the ABA method but is
considered to be more naturalistic, meaning that instruction
takes place in a relaxed environment and the teaching is
child-centered, or guided by the child’s interests,
motivations and favorite activities. Researchers believe that
“pivotal behaviors” affect a range of responses in children
with autism. Because these behaviors influence a diverse area of
functions, positive changes can have a ripple effect on other
behaviors. In PRT therapy, instructions and rewards are more
varied than with traditional ABA. PRT is offered through clinics
and school programs.
Floortime was developed by
Drs. Stanley Greenspan and Serena Wieder. It is an
alternative behavorial approach focused on helping children
build fundamental skills needed for communication and
relationships. It is primarily a home-based technique that
enlists professional helpers to work alongside parents and their
children. The adults get down on the floor with the child and
follow the child’s natural interests.
Some
critics say there is not enough scientific research supporting
the effectiveness of DIR Floortime and that children with more
severe autism may not be well-served by such a child-centered
program. However, the Floortime Foundation claims that in a
review of 200 children diagnosed with autistic spectrum
disorders who were treated intensively with DIR Floortime for up
to six years, more than 50 percent have "become warm,
engaged and loving."
Treatment and Education of Autistic and Related Communication Handicapped
Children (TEACCH)
is an approach developed in 1964 at the University of North
Carolina at Chapel Hill. The classroom-based program evolved
from the theory that children with autism have strong visual
skills and respond well to visual cues and symbols. Instead of
using rewards for behavior modification, TEACCH emphasizes
picture systems to develop organizational skills and help
children better understand what is expected of them. TEACCH is
based on brain research that suggests people with autism have
more difficulty switching their attention from one task to
another. The approach focuses on helping children transition
more smoothly from one activity to the next.
Parent
Involvement
Why
early in Childhood
Benefits:
Children
such as Catherine Maurice’s, who wrote Let
Me Hear Your Voice, have become indistinguishable to even
an expert. She
recovered two of her children from autism several years ago and
has worked hard to let other families know there is a possible
cure. Her children
require no additional support in school. She set-up her own program in their home.
She was smart enough to say that she knew she could help
her children. It
was expensive, but compared to the alternative of having two
children to support for the rest of their life was the
alternative.
A
functioning human being in society perhaps without any
government support in childhood and/or adulthood.
More direct
teaching time with an experienced expert...
Not only does it assist the teachers, but also the
children. The
current statistic is 1 in 166 children are in the autism
spectrum.
An autism
consultant assists the teachers by:
- Having
specialized training in a field with a lot of unknowns and
diversity of challenges
- Keeping
up with literature
- Training
teachers
- Acting
as a support person (cheerleader)
- Someone
to go to for problem solving
- Understanding
that many of these children do have bright futures!
These factors
will in turn assist with special education teacher attrition.
We are very lucky to have such great teachers and should
try to keep them.
As you can
tell, this is an extremely important subject to me.
I heard a parent last week talk about how many of the
public school programs had the placebo effect on autistic
children (as well as parents!).
That statement brought tears to my eyes.
That is exactly what happened to Allen in the Early
Childhood Program! I
was led to believe that the preschool was the only option for
him. Allen was in
preschool for over a year and was slipping away from us right
before our eyes. After
I requested (which I should NOT have had to do!!!) ABA-type
services, he gained eye contact and his personality!
The changes were positive, finally!
He is far from recovered, but the significant changes in
him are apparent today. The School District has and will save enormous amounts of
money on services for him due to this early intervention. There is documented evidence that intensive work with a child
early can RECOVER a child from autism.
Just think, he may not have needed any special services
now and in the future if he had he received the intensive
intervention much earlier when he should have.
We lost an entire year!
Sadly, most
parents didn’t know that we had an Autism Consultant or what a
valuable resource it is. I
feel guilty not letting them know about this resource because I
was afraid it would take away the little bit of valuable time
that Allen was receiving. I
should not have to feel that way.
I know that having an Autism Consultant is expensive, but
the payoff not only for the schools, teachers and families is
enormous!!!! I can
tell when Tracy has “consulted” with him.
He is more talkative, happy, plays with his toys.
It helps him in numerous ways.
It is an effective treatment.
I have seen it before my own eyes!
The Service
Center needs to hire additional experienced people to do quality
work with these children. Again,
the payoff can’t even be described.
One thing
that experts and parents agree on is that behavioral therapy
produces results that have been documented.
The problem with the use of it has many facets as well.
There are various types of behavior programs available.
Quality programs are expensive to run.
The behavior program must be individualized for each
child and normally consists of a multidisciplinary team.
Also there are few people who know how to properly set-up
programs for students. None
of this can happen until the child has been properly diagnosed.
The bottom
line is that the government must require those who are
diagnosing children to give them adequate information and
perhaps even more importantly referral to the school so that
proper arrangements can be made to start
intensive intervention immediately.
Autism
Education and Materials!
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