Strategies to Support Children with Autism and Other Complex Needs

Resources for teachers, support staff and parents

Christine Macintyre

• Publisher: Routledge
• Year: 2015
• eBook ISBN:
  9781317420316
• Topic: Education
• Subtopic: Education General

Working with young children on the autistic spectrum and supporting them as they learn can be fascinating, challenging, often overwhelmingly difficult, but more than anything else, hugely rewarding.

Strategies to Support Children with Autism and other Complex Needs bridges the gap between explaining what autism is and finding ways to interact through having a balance of play activities interspersed with more formal teaching of skills of everyday living. This highly practical text provides a bank of strategies that are specially designed to be matched to the developmental status of each child. These strategies are endorsed by academics who have monitored the children's responses in communicating, pretending, playing, moving, and singing and describe how the children have responded positively over time.

This book covers a variety of topics such as:

• The importance of play for enhancing learning for children with autism and other complex needs
• Evaluating different ways of developing communication
• Transferring learning from one environment to another to aid memorizing.
• Understanding the impact of sensory hypo and hyperactivity on children's learning.
• Developing a 'Theory of Mind'
• The importance of movement, music and having fun

Observation and assessment schedules are provided, along with clear and helpful evaluation forms which show staff in primary and early years settings how children on the autistic spectrum can be helped to make meaningful and encouraging progress.

This text is an vital read for any practitioners working with children on the autistic spectrum or with complex learning difficulties.

Chapter 1
Come and meet our youngest children at play

First case studies with strategies to foster development

Come and meet some of our youngest children in their first year at school and find how the teaching strategies emerged from observing them closely to compile individual case studies as a basis for planning colourful play and more directed learning activities. The group of professionals who compiled the case studies is called ‘the team’. Some members of the team have different specialisms/responsibilities, e.g. speech and language, physiotherapists and occupational therapists and they work with children throughout the school who need their particular expertise; art and physical education specialists teach all the children each week and smaller groups of classroom specialists, e.g. teachers and nursery nurses work with their own class of children every day. Together they monitor the children’s progress and consider ideas for future development. They plan where play activities and more directed teaching would be appropriate and they provide a whole range of learning experiences, e.g. visiting a local canal and having snack on a barge, or going horse riding so that the children have a rich, varied education. Case studies of the children are shared so that the selection and implementation of strategies can be understood in the context where they took place.

In this opening chapter, you will meet Callum, Jacob, Kieran and Mia. These are four of the five-year-olds in the first class. Each case study gives an early description and a later one so that the children’s reactions to the strategies are explained.

Case study for Callum who appears on the cover of the book

Callum is a gentle five-year-old who is severely affected by autism. This means that, at this time he has very poor communication skills and apart from one or two words, e.g. ‘bubbles on’, quietly but clearly offered in the sensory room, he doesn’t choose to speak to make his needs known. Given this start, however, the team hope he is on the verge of saying more and will encourage this by finding what motivates him and quietly saying key words to accompany his play.

In class and generally around the school, Callum doesn’t appear distressed; he rarely displays emotion. He just prefers wandering around or jumping up and down, two feet together with a bouncing action with (to the team) no apparent purpose. He often lies curled up face down on the floor, hiding his eyes and at times shielding his ears. This can indicate sensory hypersensitivity to both lights and sounds although auditory tests have found his level of hearing normal. He does move closely to the tubes of coloured bubbles in the sensory room and while this might suggest poor vision (which is tested) it could be that the sensations help fulfil his sensory needs. Watching the bubbles gives him a huge amount of pleasure – he is totally engrossed and still – yet he doesn’t make a fuss when it is time to leave. He doesn’t resist taking hands with members of the team, but he doesn’t offer any eye contact either – he looks straight ahead.

In the classroom he seems intrigued by the ceiling. The team wonder whether it is the pattern made by incoming light and why this area should hold his interest. Perhaps he wants to avoid the colourful visual displays that adorn the walls? Or perhaps, as his very experienced nursery nurse, Gemma, described him, ‘he is a child of squares and shadows’. She had observed Callum running his fingers along the edges of the door and choosing hard plastic bricks, not to build but just to feel the hard edges. He also appears entranced by the shadows made by the branches of the tree in the playground and will sway mirroring their action. Is he a visual thinker? Does his learning rely on visual images? It will be intriguing to find if Callum registers whole pictures or begins by absorbing details and builds them into pictures. Grandin (2014) in The Autistic Brain has one chapter called ‘Rethinking in pictures’ where she differentiates between the visual images children see and the perceptions others have. When Callum learns to speak he will be able to explain if he is asked the right questions. Meanwhile the team observe him carefully and gather data to try to explain the way Callum’s thinking is expressed in his actions.

In the soft play room, he appears interested in pictures on the wall and will stand facing them, jumping up and down rather than being involved in free play on the soft apparatus. In class, he has a favourite plastic toy, a torch, and he walks around with this held closely to his ear. It emits a quiet sound interspersed with a soft count of 1, 2, 3, 4, 5. Carol, the occupational therapist, suggests that Callum listening to the soft sound may help him cut out the other noises in the room. If this is so, he has found a useful way to reduce any sensory overload. He will put the toy down though, so although it seems to comfort him, it is not an obsession – he is not fixated on having it, nor does he appear upset if another child has a turn.

At ‘circle time’, a time for joining together to sing the ‘hello’ song, listen to a story or to follow the visual timetable that indicates what activity comes next, he will sit down for brief spells but shows no animation towards any song or story. He follows the classroom routine; he copes with hand washing, teeth cleaning and visiting the toilet; he makes no fuss at all. Although he makes very little eye contact with the staff, he can fix his eyes on items he wants to have. Even then his facial expression doesn’t change.

Fortunately he enjoys his food (many children with autism are very picky eaters) and he will point to his favourite item on the snack table – a banana. He clutches this and moves away. As yet, he is using an adult as a tool rather than someone to share experiences but the fact that he points is encouraging for this can herald communication that in time can stimulate speech. Callum is newly able to find the picture of a banana in his PECS book that contains a number of velcro fastened symbols and the team is working to have him recognise and use the ‘I want’ symbol so that a short sentence can be made.

For a good part of the day he prefers to be isolated and silent. He is not aggressive to other children but on occasion can become so frustrated that he bangs his head on the floor or pulls his hair hard. Very occasionally he will nip a child who comes too close, but this is reducing as he gains confidence in his surroundings. The other children often smile at him and are happy to sit by him, but his lack of response means he is often alone.

Out of doors he fills in time but couldn’t be said to be playing with any purpose or gaining much motor development in terms of strength or control. He avoids the cycles and floor trampoline and he stumbles quite often, suggesting that his sense of balance is underdeveloped. He has some hyper-flexibility in his hips and low muscle tone in his legs, perhaps due to his unwillingness to run around, so outdoor play is very important for him. His fine motor skills, e.g. using the pincer grip are, not yet fully developed either. He will pick up a crayon, clutching it rather than using the pincer grip, but he has no interest in mark making. His hand dominance is still to be established for although he usually carries his toy in his left hand, he uses his right one to feed himself at snack and lunch times. Banana is his favourite, with crackers and hummus second. He prefers savoury finger foods to yoghurt and jelly. It is quite difficult to encourage him to have milk or juice but he will have water.

When he does pick up a toy, he spins it round and round and if thwarted, e.g. by suggestions or demonstrations of other ways to use it, he ignores these and wanders away. He likes to line up the small toys but doesn’t appear to differentiate between bricks and animals – he doesn’t give them personalities.

He is not yet toilet trained. Callum’s parents explain that he is a poor sleeper. This leaves the family exhausted.

What can we do? Two strategies to develop Callum’s skills

Ellie, Callum’s nursery nurse was instrumental in his development. She was anxious to build on Callum’s existing actions so her written aims were just one step ahead of his present level of development. In this way they could be attainable and recorded as progress.

1. She wanted to extend his purposeful pointing skills so that he came to understand communication and realised that adults could help him have things he could not reach alone. She hoped that communication would stimulate bonding and also that Callum would come to appreciate when seeking help was appropriate.
2. She also wished to teach him to crawl using the cross lateral pattern. He already crouched on the floor so Ellie decided to use that as a starter and encourage him to stretch his limbs and balance on his hands and knees in the table position. This would help to strengthen his legs and his pelvic area so that crawling using the cross lateral pattern, with all its intrinsic gains, became possible.

Strategies

1. Ellie explained how she developed Callum’s skills. She began by using his liking for banana! First of all, Ellie realised that Callum had to see the banana before he wanted it – he did not appear to think, ‘I feel like having a piece of banana’ and then search for it. The sight stimulated the desire. She explained her thinking behind her action plan,
   I built on his liking for bananas by placing them where he could see them but just out of his reach. He had then to realise that I could help him so I showed him how this could happen. The next move was that I stayed back so that he had to come for me and point to the banana. I said the word ‘banana’ quietly as he looked for help. I also demonstrated that he could fetch the ‘I want’ picture from his PECS book and show that to anyone in the room. Having a piece of banana was his reward. Very quickly Callum came to realise that I was willing to help him and appeared pleased when he achieved his goal. I tried to hold eye contact but he was only focusing on the banana at this time.
   Ellie hoped this ‘shared enterprise’ would build up trust and communication.
2. As Callum did not look around for objects that were not immediately visible, Ellie placed the banana on a shelf but slightly to the side so that Callum would have to select a PECS symbol then begin to search. Gradually as Callum followed this new routine she increased the distance so that Callum would come to recognise that objects out of sight could still be there.
3. Ellie then tried to interest Callum in peek-a-boo games to encourage communication through turn taking, but also to give him practice in realising that people or objects could still be present even if they were covered or out of sight. This was to develop object permanence, however Callum appeared baffled by this and lost interest quickly.

What did Callum learn?

Intellectual/social skills

Callum has quite quickly grasped the idea that Ellie will help him. After three weeks, he is more confident in using his PECS symbols to contact Ellie to get pieces of banana. He recognises that the two dimensional picture symbolises the actual fruit.

He is searching for and recognising words in his PECS book, e.g. crackers, toast. Ellie hopes that this is a sign that he will soon ask for other things.

He is willing to contact other adults for support.

Motor skills

He is using the pincer grip to detach and manipulate the PECS symbol. This should help inhibit his palmar reflex and so make his finger and hand movements more precise.

Forward plan

1. Try to extend this shared initiative idea by having him point to a glass of water and then use two symbols, the first for ‘I want,’ the second for ‘a drink’.
2. Put his toy on the shelf just out of reach so that he has to search and come for help. This would show he was able to transfer his learning to encompass different items.

This plan followed the advice given by Barrett et al. (2004) who wrote, ‘Look for opportunities to organise the environment so that a child can experience success in achieving a goal with help from an adult, i.e. try to develop “shared initiatives”’.

Social skills

Two weeks later, Callum used the ‘I want’ symbol to get support from two adults although they were not able to discover what it was he wanted. Perhaps he just wanted attention? The fact that he approached them showed he was recognising that he could cooperate with a chosen adult. He was initiating contact. This was a real step forward and another encouraging instance of transfer of learning for he had realised that ‘help’ did not always mean bananas!

Emotional skills

The team hoped that he had gained confidence, as he was more willing to approach adults to make his wishes known. His overtures also resulted in successes e.g. knowing he could request what he wanted. The team hoped that ‘being in charge’ through making choices would boost his self-esteem and give him a measure of independence.

Theoretical link: ‘Milieu teaching’

Garfinkle and Schwartz (2002) call this kind of interaction, ‘Milieu teaching’, i.e. taking advantage of teachable moments by setting up the environment so that these moments were likely to re-occur. They explain that this approach has been used successfully even with preschool children with autism. In addition, ‘verbal modelling’, i.e. ‘the teacher making comments or asking questions that have come from observing the child’s play and teaching specific skills can be embraced within this strategy’ (Boutot et al. 2005). This was important as the team aimed to stimulate Callum’s play skills.

Strategy 2: Developing crawling using the cross lateral pattern

This was a different kind of intervention because although Callum curled up tightly, face down on the floor, he had shown no interest in crawling or moving in any direction. Perhaps he was hiding or cutting out noise? Whatever the reason, he resisted any encouragement from his teacher, Laura, to move. So this actio...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Acknowledgements
• Preamble
• General strategies
• Introduction: setting the scene
• 1 Come and meet our youngest children at play: first case studies with strategies to foster development
• 2 The importance of play for enhancing learning for children with autism and other complex needs
• 3 Theoretical underpinnings for the first selection of strategies
• 4 Come and meet our older children at play: more case studies with strategies to foster development
• 5 Theoretical underpinnings for the second selection of strategies
• 6 A positive reflection on observation and assessment
• Final strategies
• Appendix 1: Differences in speech and communication across the autistic spectrum
• Appendix 2: Visual timetables
• Appendix 3: An introduction to autistic spectrum disorders
• Bibliography
• Index