The purpose of this essay is to discuss the issues that impact on individuals on the autistic spectrum with regards to assessment, intervention, support and inclusion. Autism Spectrum disorder is a complex developmental disability which affects language and communication, social interaction, and flexibility of thought and behaviour. These areas, known as the 'triad of impairments' (Wing & Gould, 1979), vary significantly between individuals and children and young people with a range of intellectual abilities can be affected. There may also be accompanying sensory issues, for example to touch, smell, noise, taste or visual stimuli. Although there are wide ranging differences, individuals on the spectrum all have some level of difficulty in social interaction, social communication and imagination.
Although the prevalence of ASC is hard to establish, it was recently estimated that it affects approximately 60 in every 10,000 children (Chakrabarti & Fombonne, 2005). The additional support needs of children and young people with ASC varies widely. It is possible for some individuals to achieve very well and with limited additional support can access the full curriculum. Others may require specific interventions and strategies to help them learn and develop. Early identification and assessment of a child's additional support needs in relation to ASD is important so that the planning of educational provision and parental support can be facilitated.
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Assessment is crucial to meeting the needs of any child and for children on the spectrum it is even more important as educational targets should be based on an accurate assessment profile. There is no standard educational assessment or approach as any strategies put in place should consider a child's individual learning style and impact of their autism as well as environmental factors, otherwise the outcome could be inadequate or even detrimental. situation
Individual assessment of children with ASD should be based on careful observation and identification of areas which require further investigation. Discussion with parents is vital, as their perspectives and difficulties at home may differ considerably from that of adults in the education setting. Other professionals may be involved to augment the information gathered as collaboration is necessary for the process to develop. The analysis of this information can then be compiled to form a holistic profile. The staged intervention process to identification, assessment and review, is embedded in sound educational practice. Staff plan strategies based on assessment, apply them and review the results in terms of progress made by the child or young person.
A child in my care, 'John', was noted at approximately 2 years of age to be non-verbal. His play was solitary and repetitive. A stage 1 Support Plan was put in place to encourage him to develop sharing, turn-taking and simple co-operative play. He was encouraged to use early communication skills, such as pointing, gesturing and any attempts at spoken language. Following further concerns regarding his lack of communication skills he was referred to a Speech Therapist and he and his mother attended 'Learning to Talk' programme.
A Stage 2 Support Plan was put in place as John would only allow one adult to share his space, he would move to different areas of the nursery but resisted attempts of interaction from other adults or children in the room and his play remained solitary and restricted to his favourite toys. Using play based intervention similar to the DIR/Floortime Model (ICDL 2000), and using his interest in cars, staff encouraged John to spend a few minutes at free play sharing his toys. Eye contact was established and he pointed in order to draw attention . Advice was sought from Short Term Advice and Response Team (START), due to ongoing concerns with speech and language and social interaction. They advised putting a photo timetable in place to help John manage and predict his day. A Stage 3 Support Plan was set up and 'John' was referred to the Pre-school Assessment Team (PRE SCAT) for input from Educational Psychology and a Preschool Language and Communication Resource. 'John' attended this resource 3 days per week as well as nursery 2 days per week with input from an Educational Psychologist. He was then referred to the Autism team for assessment. His first spoken words appeared at 4 Â½ years. 'John' deferred entry to school for one year. His transition to school was very intensive, visiting regularly to spend time with his class teacher, support staff and to build awareness of his surroundings. 'John' has made significant progress but continues to find changes to his routine difficult to cope with as well as an inability to initiate and sustain interaction with peers. He now attends mainstream school 2 days per week and special school 3 days per week as well as After School Care in my establishment. This outcome would have been unlikely without the support and successful collaboration of staff, other agencies and professionals.
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The current legislative framework of The Education (Additional Support for Learning) (Scotland) Act 2004 requires schools to meet the needs of all children by helping parents, carers and pupils with ASD understand their strengths and challenges and put strategies in place to support their learning. All children have an equal right to access a broad and balanced curriculum with supports adapted to their needs based on continued assessment, intervention and review. Interventions should have a proven track record of success and allow ongoing evaluation in order to support the continued development of the child or young person. In research conducted by Hunt, Soto, Maier, & Doering (2003), a Unified Plans of Support (UPS) team was studied. Children who had a UPS team meeting once a month to assess and re-evaluate existing plans increased in measured test scores.
For a child or young person with ASD, the social curriculum is just as important as the academic curriculum. Assessment should consider social and communication skills e.g. social interaction, language and communication, self awareness, independence, play and imagination and emotional understanding. The assessment process should identify key areas for setting educational and future targets. These targets should not be solely academically based. In order to meet the needs of an individual with ASD, there needs to be a balance between purposeful self help and life skills and academic achievement..
The National Autism Plan for Children (NAS, 2003) encourages multi-disciplinary assessment and proposes that family contribution including the child's developmental history and environment and observations from other settings are included. Multi-agency involvement in the assessment process is recommended by the Scottish Intercollegiate Guidelines Network, as it may 'identify different aspects of ASD and aid accurate diagnosis.'(Assessment, diagnosis and clinical interventions for children and young people with autism spectrum disorders, SIGN 2007).
Although diagnosis of an ASD is ultimately the responsibility of health professionals it is not made in isolation and information should be obtained from a wider multi-agency team including parents/carers, speech and language therapists, teachers and educational psychologists. The Psychological Service can contribute to the 'Getting it Right for Every Child' initiative, which focuses on the needs of the child and aims to streamline processes in order to deliver appropriate services thereby helping the child or young person fulfil their full potential. Other appropriate agencies e.g. health and social work services offer advice on and assist in particular and future interventions and strategies. (Educational Psychology Assessment in Scotland, 2005). Input from a Speech & Language therapist is usually necessary in order to support children and young people with difficulties in communication skills as well as issues involving eating and drinking. An occupational therapist can assist with co-ordination and movement difficulties and self-help skill such as washing, dressing and toileting.
Willing participation (Henneman E.A., Lee J.L. & Cohen J.I. 1995) and a high level of motivation (Molyneux 2001) are central to effective interprofessional collaboration. This involves developing, planning, monitoring and evaluating mutually agreed targets and combining the knowledge and expertise of professionals (Cook G., Gerrish K. & Clarke C. 2001) to assist joint decision making based on shared professional opinions (Russell and Hymans 1999, Stapleton 1998). Unless individual practitioners are aware of the role, performance and professional boundaries of others they may not be able to make an effective contribution to any planned strategies. (Bliss J., Cowley S. & While A. 2000).
Following assessment, an individualised educational programme (IEP) should be developed. Most children will need specific targets and the assessment process will have identified areas of difficulty for the pupil. These can then be prioritised and tackled by setting realistic, specific targets. The IEP should be reviewed regularly and progress against previous targets monitored. There are some children whose additional support needs include one or more complex factors which are likely to continue for more than one year. If they require significant support to be provided by an education authority and one or more appropriate agencies, a Co-ordinated Support Plan (CSP) which is a legal document, is compiled. The CSP focuses on supporting the child to benefit from set educational objectives and assists in the co-ordination of services such as education, health and social work. It should be monitored and reviewed regularly, at least every 12 months. In future, the Scottish Government wants each child to have just one plan covering all their support needs, provided by health, education and social work , in line with 'Getting it Right for Every Child' (GIRFEC ).
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The physical environment can be difficult to cope with for children with ASD mainly due to sensory difficulties and problems with central coherence. ( Happé, F., & Frith, U. 2006). It is important for children with a communication impairment to ensure that realistic adjustments are made to limit as many obstacles to learning as possible, 'for almost any other special need, the classroom only becomes disabling when a demand to perform a given task is made. For the child with autism, disability begins at the door.' Hanbury (2007). The environment should be as tidy and free of clutter as possible to reduce the level of anxiety and confusion. Structure and consistancy can reduce stress and in some cases challenging behaviour. "Difficult or challenging behaviour is not a part of an autistic spectrum disorder, but it is a common reaction of pupils with these disorders, faced with a confusing world and with limited abilities to communicate their frustrations or control other people." (Jordan & Jones 1998).
Individual class or group charts may be required as most children on the autistic spectrum respond well to visual timetables. A planned programme taking account of the needs of the child's sensory and processing difficulties should be undertaken as stressful situations can create challenging behaviour (Waterhouse 2000). Speech and language programmes that have been correctly prepared can help improve a child's comprehension and increase their vocabulary which in turn will enhance their social communication skills and correct problems with intonation or articulation (Howlin 1998).
The Individuals with Disabilities Act (IDEA), proposes that children with ASD should be educated in as open and inclusive an environment as possible. Although this legislation is necessary and does protect a child's rights to the best education possible, it can create difficulties for teachers.
Classroom sizes have been reduced and employment of teachers has been cut. Inclusion laws require teachers to educate children at many different developmental stages. Children with ASD require a variety of teaching strategies in order to meet their individual needs. According to Cumine, Leach & Stevenson (1998), many teachers feel they have not received training to instruct children with these kinds of learning disabilities. Strosnider, Lyon, & Gartland (1997) state that teachers feel under pressure in carrying out educational plans due to lack of time to collaborate with other professionals and the shortage of special education teachers. Major gaps in training have been recognised at every level and across all sectors and services. It was estimated that half (54%) of teachers who work in this field have little (34%) or no (20%) ASD training. Obstacles cited are release of staff, lack of suitable training and funding (Scottish Government Publication 2009).
There are several educational theories associated with ASD. Dr. Bryna Siegel's (1996) idea of 'reinforcement', is that the teacher takes the time to determine a child's main interest. She can then request and reinforce the required behaviour using the object of interest as an incentive. Another teaching technique is 'applied behaviour analysis' and 'discrete trial training' (ABA/DTT). Siegel (2003) describes ABA/DTT as "a science that studies how principles of behavioural conditioning can be applied to learning.' Siegel suggests that learning can be broken down into small steps, which can be built on each other, and this ultimately will lead to the overall concept. ABA/DTT is highly recommended for children with autism. Shore's (2002) research explains the difficulties ASD children have with sensory perception and how they can be helped by using ABA/DTT. It is challenging for a child with ASD to make sense of the different experiences occurring throughout the school day and by applying ABA/DTT this allows the child to focus on smaller quantities of information giving them the opportunity to complete an assignment rather than becoming overwhelmed.
The relationship between curriculum and social education can also cause confusion. If a child is placed in a group for project work it is possible he would be so overcome by the social aspect that he would find it extremely difficult to focus on the curriculum aspect. Strosnider, R., Lyon, C., & Gartland, D. ,(1997) recognize this overlap as academic, physical and interpersonal skills are all areas of difficulty for the ASD child. Strosnider, et al., (1997) compiled The Academic, Physical and Interpersonal Inclusion Plan (API Inclusion Plan). This plan helps teachers to use brainstorming strategies for each of these areas and is particularly useful if there is no availability of a special needs teacher to collaborate with. Kluth (2003) suggests that the learning environment is itself a strategy. In constructing the best environment Kluth (2003) suggests an aspect that needs to be considered is that of sounds. He uses the familiar example of nails on a chalk board sending a chill down the spine Kluth (2003) states that to a child with ASD every day sounds can have a similar effect. Kluth (2003) promotes the importance of a teacher assessing noise levels and putting strategies in place to exclude excessive noise such as allowing the child to listen to soft music with headsets during class times or using earplugs.
Children should be prepared ahead if there are to be changes in their routines, to avoid excessive anxiety. Ozonoff, et al., (2002), elaborate on the suggestion of visual signs for the ASD child. Their research claims that visual instructions and schedules help the child to feel more secure and less stressed so the mind can direct its attention to learning. All of these stress factors must be taken into consideration when assessing which strategies and interventions would be beneficial to the child or young person with ASD. According to Williams (2001), reducing stress and worry, ensuring the environment is predictable and minimizing transitions is crucial to delivering an effective education for the child with ASD.
Having considered the environment, other strategies require to be put into place. An approach to education widely used is the Treatment and Education of Autistic and related Communication-handicapped Children program. It is referred to as TEACCH. Ozonoff, Dawson, & McPartland (2002) describe this method as a way to build upon the ASD child's memory strengths as many children have the ability to remember large quantities of information on subjects they are interested in. Cumine et al., (1998) indicate that TEACCH has 4 main elements. These include modifying the physical environment, setting visual schedules for the daily activities, verbal explanation of the expectations of type and length of work and verbal and visual presentation of instructions. Strategies used are designed to address the difficulties faced by children with ASD, and be adapted to their needs. TEACCH methodology is embedded in behaviour therapy on the basis that there are underlying reasons, such as lack of understanding of what is expected of the child or what will happen to them next or sensory under or overstimulation, for their challenging behaviour. By addressing these communication difficulties, the child will be able to express his needs and feelings by other means. In line with Dr Bryna Siegel (1996) Shevitz, Weinfeld, Jeweler, & Barnes-Robinson (2003) suggest a program that achieves the concept of maximizing children's strengths as well as increasing self esteem by using their preoccupation with a favourite item or topic of interest.
Social behaviours are necessary for achieving good educational standards as well as successful playground interaction. Myles and Simpson (2001) have entitled this aspect of education "The Hidden Curriculum". This includes the basic 'how to's' of living, which are not apparent to children with ASD. Knowing what is appropriate or inappropriate conversation may be foreign to an ASD child.
Teachers should be prepared to educate themselves on effective strategies in order to support children with ASD in collaboration with other professionals, support staff and the wider community and agree on appropriate interventions.. Inclusive classrooms give children the opportunity to have their intellectual ability challenged and fostered and it should be the responsibility of all teachers to do whatever is necessary to help these children to achieve success. "Inclusion is more than a set of strategies or practices, it is an educational orientation that embraces differences and values the uniqueness that each learner brings to the classroom." (Kluth, 2003. p. 23-24).
In conclusion, the increasing focus on early identification and effective intervention is a continual challenge but every child needs to be assessed, have a plan established addressing areas of weakness, and most importantly have a teacher who believes in him and has the desire to learn, implement new strategies and work effectively in collaboration with other professionals and agencies for successful inclusion. This in turn will hopefully give the child with ASD the outcome he needs and deserves.
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