Groupwork with Children Aged 3-5 with Autistic Spectrum Disorder

An Integrated Approach

Ayson Eggett, Christina Howe, Liz Ann Davidson

• Publisher: Routledge
• Year: 2018
• Print ISBN:
  9781138050013
• eBook ISBN:
  9781351688123
• Topic: Psychology
• Subtopic: Education General
• Index: Psychology

"Groupwork for Children with Autism Spectrum Disorder: Ages 3-5" is the first of three books promoting a multidisciplinary approach to working with children on the autism spectrum. The author team of speech & language therapists and occupational therapists have used their experience of working together in this way to create a practical resource for professionals working with children with ASD in small groups. The book aims to develop the children's skills in seven key areas of development: Communication & language; Socialisation; Play; Sensory; Motor; Behaviour; and, Emotional. Case studies, working examples, photocopiable checklists, assessment forms and session sheets are provided for group facilitators to: assess individual needs; set individual targets; create personalised programmes; plan & run group sessions; evaluate progress; and, carry out peer reviews. Forty photocopiable activities, differentiated according to the developmental area being targeted as well as the developmental level of the child, are also included. "Groupwork for Children with Autism Spectrum Disorder: Ages 3-5" provides an invaluable resource for speech & language therapists, occupational therapists, physiotherapists, play therapists, family therapists, teachers, support staff and all those working to develop the children's skills in small groups. Parents and carers are actively encouraged to participate in groupwork with their child. 'I enjoyed joining in the group and being part of my child's therapy'.

1 What is Autism Spectrum Disorder?

Communication and language

Socialisation

Play

Sensory issues

Motor skills

Behaviour

Emotional difficulties

Involving parents and carers of children with ASD

Autism was first described by Kanner in 1943 (Aarons & Gittens, 1992). Frith (1991) highlighted the work of Hans Asperger, who described a similar disorder, but with differing levels of impairment. The difficulties he described later became known as Asperger’s Syndrome. Over the years, attention to these disorders has varied, with a recent resurgence of interest in what is now commonly referred to as Autism Spectrum Disorder (ASD). This describes a spectrum of difficulties with shared core deficits that may present in a variety of ways.

Diagnosis and classification of ASD is a complex and detailed process, which will not be described in this book. Clinicians involved in diagnosis will usually use wellrecognised criteria such as DSM IV (American Psychiatric Association, 1994) or ICD-10 (World Health Organisation, 1993). These enable clinicians to map a child’s development and attribute a diagnostic label, where appropriate, according to national and local guidelines.

Whilst a diagnostic label may have some benefits, it does not provide a description of the individual strengths and needs of a child. For professionals working directly with the child, it is important to understand the underlying reasons for differences in the child’s development. This enables more effective educational and therapeutic interventions to be identified.

Wing (1995) describes the difficulties these children experience as a ‘Triad of Impairments’. This model recognises that the behaviour, thinking and learning styles of children with ASD are influenced by fundamental differences in three core areas of development:

• Social communication
• Socialisation
• Social imagination/flexibility of thought

In our experience, in addition to the three main areas of impairment, a large percentage of children with ASD have significant motor and sensory difficulties. We have, therefore, added these to the ‘Triad’ to provide a more comprehensive representation of the difficulties experienced by these children (see Figure 1.1). This adapted model can be used to describe the complex patterns of behaviour presented by children with ASD and to identify the specific needs of the individual.

Whilst diagnosis is based on a pattern of behaviours that are the result of these common core deficits, each child’s presentation is unique. A child’s developmental profile will show areas of relative strength alongside areas of specific need. This diversity has fostered the use of the term ‘spectrum’ to describe this disorder, as no two children are alike.

Differences in these five areas may have a profound affect on a child’s progress across all developmental areas. The child with ASD may differ significantly from his peers in many ways. In our experience, difficulties are often reported within the following aspects of a child’s development.

FIGURE 1.1 ‘Triad of Impairments’. Adapted from Wing L, 1995, Autistic Spectrum Disorders: An Aid to Diagnosis, p5, National Autistic Society, London. Reproduced with permission.

Communication and language

Communication and language should be viewed as two different but related skills.

What is communication?

Communication involves the exchange of information between two people; one person who sends the message and another person who receives and responds to it.

Communication may take place whether or not there is a conscious effort to do so. For example, a mother may interpret her baby’s crying as a request for food and respond by feeding the child. A large proportion of our communication is non-verbal (such as facial expression, posture, gestures). Often, these behaviours are not a conscious or direct attempt to communicate, but are interpreted and responded to by another person as if they are.

What is language?

Language can be defined as the formal coding system that we use to convey messages. For most of us, this formal coding system is speech.

Phases of communication development

For the 3-5 age range, we have found it helpful to assess children by identifying phases of development. These phases may overlap and children may appear to be inconsistent in their use of skills, depending on the context in which they are communicating.

Non-intentional communication

In this phase, communication is reliant on an adult’s interpretation of the child’s behaviours. Behaviours may include facial expression, body movements, touching or manipulating objects/people, crying or vocalising.

Intentional communication

As adults respond to the child’s behaviours, he gradually realises that his behaviours have an effect on others and these become more deliberate. They are consciously used to gain another person’s attention and to make basic needs and preferences known. For example, reaching for a desired object may result in an adult giving this to the child and, as a result, the movement will be used more intentionally (perhaps becoming a more refined pointing gesture) as the child realises that it has the desired effect.

Formal communication

Gradually, the child’s understanding of language develops (ie, recognition that specific gestures, sounds or symbols represent a specific meaning). A formal communication system emerges which may include speech, signs, symbols (photos, pictures or line drawings) and/or written words. The choice of a formal communication system will depend on the individual child’s abilities and learning style.

This communication development section has been based on Coupe O’Kane J & Goldbart J, 1998, Communication Before Speech, 2nd edn, pp59-66. Originally published by David Fulton Publishers Ltd, London. Used with permission.

Communication skills in children with ASD

A child with ASD will show differences in the development of both communication and language skills.

Some communication behaviours may not develop or the child may present with a ‘patchy’ profile (ie, he may use skills in one context but does not generalise them into other similar situations). For example, a child may label his pet ‘dog’ but fail to recognise that the word can also be used to describe a friend’s dog or a dog in a book. His labelling skills are context-dependent and have failed to fully generalise.

Most commonly, a child with ASD may not see the need or wish to communicate. As a result, many young children we see are at a non-intentional phase of development or intentional communication is just emerging. Without a formal means of communicating, the child has no way to express himself and this frequently leads to frustration.

Some children may acquire the rudimentary skills to establish a formal communication system, but differences in language development are evident. Echolalia (repeating the last thing heard) rather than using language creatively and spontaneously is often a feature of language development. Idiosyncratic use of language is also common, where children will use certain words or phrases in a way that is inexplicable to another person. For example, one child with a taste for Chinese food talked about ‘snow crisps’, which was his unique way of asking for prawn crackers!

The emphasis within groupwork should be to establish intentional communication initially; then a more formal language system can be introduced. This could be using speech, signs or symbols depending on the individual needs of the child.

CASE STUDIES

ALEX is 4 years old and at a non-intentional phase of development. His favourite activity is ‘Hot dog!’ (Activity 4). During the activity, he laughs, Vocalises and wriggles, which is interpreted as showing enjoyment. The group facilitators encouraged more intentional communication by waiting and responding to non-intentional movements before repeating the activity. As he developed an understanding of cause and effect, his movements became more deliberate and were used as intentional requests for ‘more’.

LUCY is 3½ years old and at an intentional phase of development. At snack time, she will make brief eye contact and reach towards her preferred snack (eg, when offered a choice between apple or banana). The group facilitators encouraged the development of a formal communication system by introducing a Picture Exchange Communication System (Frost & Bondy, 19943. She was encouraged to initiate interaction and make requests by exchanging a picture in return for her choice of snack. Initially, she required physical prompts to do this, but gradually worked towards making independent requests using pictures. This enabled adults to respond to her more consistently.

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Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• List of activities
• Acknowledgements
• Introduction
• 1 What is Autism Spectrum Disorder?
• 2 Working in a team
• 3 Assessment
• 4 Planning a group
• 5 Running a group
• 6 Keeping records
• 7 Activities
• Appendices
• Recommended reading
• References