Meeting the needs of children with autistic spectrum disorders

Rita Jordan, Glenys Jones

• Publisher: David Fulton Publishers
• Year: 2012
• Print ISBN: 9781138161337
• eBook ISBN: 9781136609268
• Edition: 1
• Topic: Education
• Subtopic: Education General

This text is meant as a companion for students in teacher-training, newly-qualified teachers, or for anyone teaching children with autistic spectrum disorders for the first time in a mainstream setting. Using a case-study approach, the authors: help the teacher to identify the meaning behind pupils' actions and reactions; provide suggested responses via practical exercises and curriculum ideas; and provide signposts to other useful literature and list services and organisations which can further help the pupil. No prior knowledge of autistic spectrum disorders is required.

Chapter 1

Introduction to Autistic Spectrum Disorders

Diagnoses and Labels

The isolation of autism need not be a negative trait … We don’t deserve to be condemned or laughed at, or made to fit into the plastic box of society’s correctness. We shouldn’t spend our entire lives trying to become someone else, someone acceptable … It is unfair to be continuously labelled, analysed, picked to bits, dissected like a specimen, peered at with a large eye through a magnifying glass.

(O’Neill 1998, p. 199)

The quotation above is from a person with an autistic spectrum disorder (ASD) and reflects the growing trend (in common with other people with disabilities) for people with autistic spectrum disorders to assert their right to be different. This sometimes seems at odds with the views of parents and professionals that an early diagnosis is crucial for providing effective services, including education. In fact the views are complementary, not opposed. Teachers (and others in a teaching role whom we will refer to as ‘teachers’ for convenience, regardless of their professional designation) need to recognise the differences if they are to ensure that a pupil is to develop fully and is not to be handicapped by the misunderstandings and misinterpretations of behaviour that will otherwise follow.

A medical diagnosis is not the sole determiner of a special educational need, yet it may be a necessary precursor to providing the support that will prevent a pupil developing such a need. It is not a question of ‘to label’ or ‘not to label’. We all naturally categorise and give labels to people, based on the behaviour we see, and it is a matter of a diagnosis helping us to interpret the behaviour in ways that are helpful, rather than misleading and discriminatory. A pupil may be described as ‘lazy’, ‘rude’, ‘aggressive’ and so on. These ‘labels’ will then partly determine how we react to the behaviour. A diagnostic label, however, alerts us to the fact that there may be other less obvious reasons for the behaviour, which in turn will lead to more appropriate and helpful reactions. Pupils with autistic spectrum disorders are still individuals, of course, and there are reasons why they may in fact be more different from one another than other pupils; knowing that a pupil has such a disorder does not tell you exactly how they will behave or exactly how they should be taught. A young man with Asperger’s syndrome put it very well:

Autism is not a label; it is a signpost. (Exley 1995: personal communication)

We hope that this book will help those working with pupils with autistic spectrum disorders in mainstream settings reach some understanding of that signpost.

‘Autistic spectrum disorder’ is the name given to a family of biologically based disorders which comprise a number of different medically diagnosed conditions. There are two different diagnostic systems which may be used for these diagnoses, which have slightly different criteria and classification but share a common understanding of the features that must be present; one of these is the International Classification of Diseases-10 (ICD-10: World Health Organisation 1992) and the other the Diagnostic and Statistical Manual-IV (DSM-IV: American Psychiatric Association 1994).

The diagnostic categories that fall within these two systems and which we are calling autistic spectrum disorders (after Wing 1996) include:

autism

autistic disorder

atypical autism

Rett’s syndrome

childhood disintegrative disorder

Asperger’s syndrome

pervasive developmental disorder

pervasive developmental disorder, not otherwise specified

semantic pragmatic disorder

Sometimes, people making the diagnosis, especially if it is made in connection with defining a pupil’s special educational needs for a statement or record of needs, will use other less-defined descriptions. For example, a child may be described as having ‘autistic features’, ‘autistic traits’ or even ‘autistic tendencies’. Such terms do not have any validity, as we discuss below, but generally indicate that the person making the diagnosis may be unsure or feel that the full diagnostic criteria for any of the list of disorders given above are not met, yet the child still appears to have ‘autistic’ difficulties.

Semantic pragmatic disorder was often used before the diagnosis of Asperger’s syndrome became common and it will still be used by some professionals, mainly speech and language therapists. It indicates that a child has good structural language skills but has some difficulties with meaning and with understanding how language is used in social contexts. Everyone with an ASD who has speech will have semantic and pragmatic difficulties; the question is whether there are individuals who just have those difficulties and do not have the social and flexibility difficulties that make up the underlying triad of impairments that characterise an ASD. Most research suggests that children with semantic pragmatic disorders do have these additional characteristics, albeit in a mild and subtle form. From a practical standpoint, it is usually helpful to treat them as if they had an ASD in any case.

A large proportion of pupils with autistic spectrum disorders have additional learning difficulties, some severe. Those with Asperger’s syndrome or ‘high functioning autism’ will not have general learning difficulties and may in fact be very intellectually able or even gifted in certain areas, but even so this group may still have additional specific difficulties such as dyslexia. Nor is there anything in autism that protects a child from having additional sensory or physical difficulties. Older children and young adults may also develop mental illnesses (just as other people do) and may have specific reasons for depressive illnesses, related to their growing awareness of their difference from others and the lack of peer support that usually aids the difficult transition from childhood to adulthood. Teachers of that age group will need to be aware of this additional vulnerability and the need for extra support at this time.

The difficulties in learning that are a direct result of the autistic spectrum disorder are better characterised as ‘differences’, since they only become difficulties if they are not accommodated. Within the constraints of mainstream settings, this can be difficult at times, although not impossible. This book aims to help staff understand the perspective of a pupil with an autistic spectrum disorder and to encourage schools to accommodate their differences. Flexibility is required when a pupil is experiencing problems in understanding what is required or in following the usual conventions within school. On a good day, those challenges are stimulating and teaching pupils with autistic spectrum disorders can be fulfilling and fun. On a bad day, the teacher may feel it is all too difficult, that he or she is making too many mistakes and that the pupil would be better off in a specialist situation. Occasionally that is true, but there are no magic solutions, even for those who have gained specific expertise in working with such pupils. A commitment to the pupil and a recognition of his or her right to as inclusive an education as possible, is an important step in meeting their needs. All teachers should recognise that everyone makes mistakes when working with children with autistic spectrum disorders, because they require ways of reacting that do not always fit what seems natural or how we would react to others; the only secret is to recognise those mistakes and learn from them.

The Basis of Autistic Spectrum Disorders

The shared characteristics of all autistic spectrum disorders have come to be known as the ‘triad of impairments’ (Wing 1988) although, as explained in the preceding paragraph, they might be better characterised as developmental differences rather than impairments. Each diagnosis includes criteria related to these three areas of development. Note that they represent developmental areas, rather than specific behaviours. There are no behaviours that are of themselves characteristic of autism (that is why it is misleading to speak of ‘autistic features/traits’ and nonsensical to speak of ‘autistic tendencies’) and it is necessary to have ‘impairments’ in all three areas before a diagnosis can be made. Autistic spectrum disorders are more easily characterised by aspects of development that are missing or abnormally delayed, but the way the pupil’s behaviour reflects these developmental difficulties will vary from one individual to another. These individual differences reflect the interrelation with other difficulties or strengths, the child’s personality, his or her experiences, and the particular setting being considered. There will not only be differences between individuals but also over time within the same individual.

Social interaction: This is the most obvious and characteristic area of difference, but even so there will be great individual variation. Some pupils may show the classical features of being very socially withdrawn and isolated, relating neither to adults nor peers. Others may be very dependent on familiar adults, especially parents, and may join in passively with familiar children such as siblings, but have difficulty initiating social contact with others and making friends. Even more common in mainstream settings will be those pupils who appear very sociable, in that they seek contact and may try to dominate contact with both adults and peers, yet cannot manage to get that interaction right and appear socially awkward and naive. It is not just that friendship behaviour is absent or disturbed, however, but that they do not understand social signals and find it difficult to learn through the social interactions that are characteristic of most kinds of learning situations in schools.

Communication: Although language difficulties are commonly associated with autistic spectrum disorders, most of the pupils who are in mainstream settings will not have obvious difficulties with spoken language. Autistic spectrum disorders are the only cases, however, where structural aspects of language (its grammar and articulation) may develop without an underlying understanding of communication. Regardless of language ability, pupils with autistic spectrum disorders will have problems using language to communicate or understanding how others do so. They tend to interpret language literally and never go beyond that to take into account what the speaker was likely to have meant.

All but the most obvious facial expressions and communicative gestures are either not attended to or are seen as puzzling distractions. Intonation can be heard (as witnessed by those children who echo exactly what they have heard, maintaining the original intonation pattern) but the pupil usually cannot understand the meaning that the intonation pattern conveys. Generally, even in those pupils who are dominating interactions with long monologues, there are difficulties in engaging in conversations and in processing verbal information (especially when utterances are long or spoken rapidly); their own level of language use is a poor indicator of the language level they can process and understand.

Flexible thinking and behaviour: Sometimes ‘imagination’ difficulties are referred to in this area, but that can be misleading. Pupils with autism in mainstream settings do have difficulty in creating something entirely from their imagination but that does not mean that they cannot be good and even exceptional artists in the visual, musical or even language arts. They also do not join with others in the typical shared pretend play situations of early childhood but they may show an ability to ‘imagine’ within their own narrow play routines; it is with sharing in the imagination of others and creating joint play scenarios that they have most difficulty. More important for their daily learning experiences, they have difficulty abstracting central meaning (especially social or cultural meaning) from their experiences, generalising learning to new situations, problem solving outside of cued rote responses and broadening interests to other than a few narrow (often obsessional) ones that dominate their thinking and behaviour.

Range of Provision

Whether or not a mainstream teacher will encounter pupils with any of the autistic spectrum disorders depends almost as much on government and local educational policy as it does on the features of the actual disorders. It also depends on the agerange and context. Thus, it is still often policy in many areas to include children in mainstream settings at the pre-school level, almost as a form of assessment, and only later send some to specialist (autism specific) or special schools or units. Mainstream schools in rural areas may need to include a wider range of pupils than areas where there are sufficient children to form units or resource bases. It is not possible to say that one form of provision is the best for all pupils with autistic spectrum disorders; child and school characteristics as well as parental wishes will help determine the best setting for each individual (Jordan and Powell 1995a).

Table 1.1 gives some of the pros and cons that are associated with mainstream placement, although these can only be broad generalisations, given the enormous variation within the mainstream sector. It should also be remembered that the ‘ideal’ placement for a particular pupil may change over time. It is our view that children with autism would benefit most from early specialist education within which the child can develop the skills needed to learn in less specialised settings at a later date ( Jordan and Powell 1995b, Jordan and Jones 1996).

Table 1.1: Pros and cons of mainstream placeement for children with autistic spectrum disorders

Pros	Cons
Access to ‘better’ models of social and linguistic behaviour. Easier access to full curriculum resources including the National Curriculum. Specialist subject teaching to develop child’s interests and strengths. Peers available as a resource for ‘buddies’ and teaching aides. Higher expectations to develop knowledge and skills and improve life chances. Broader opportunities for curriculum development, qualifications and career choice. Locational opportunity for social integration within a community and for family involvement. Opportunities to spread awareness and tolerance of ASD in society. A better context for developing understanding of, and conformity to, the cultural values and rules of society.	Many staff and pupils to be understood and adjusted to. Curriculum may not be designed to meet the special needs of the pupil. Less likelihood of staff having knowledge of autistic spectrum disorders. Poorer staff:pupil ratio to identify and meet needs and develop skills, except when extra adult support is allocated. Less realistic expectations and less availability of curriculum methods that reduce stress and enable learning. Fewer opportunities to learn in functional contexts and to address difficulties that interfere with life chances. Poorer understanding of isolating effects of the disorder and fewer resources to support families. Fewer opportunities for staff to share problems/experiences/successes with others and gain support. Assumptions of ‘normality’ as a framework offer less understanding and tolerance of difference.

With increasing emphasis on inclusion, and growing awareness of autistic spectrum disorders among all professionals, this does not necessarily mean that that specialised teaching needs to take place in segregated specialist settings and certainly it should become rare for a child with an autistic spectrum disorder to spend all of their educational life in segregated settings. There may be early segregation to teach initial skills but even then, mainstream teachers should become increasingly involved in staged integration experiences for these pupils. Later on, at adolescence or early adulthood, there may again be a need for some students to move to specialist settings for residential provision to teach independence skills and to aid the difficult transition to adult life. The movement across specialist and mainstream settings should be more a matter of planned progression rather than exclusion; the direction of the process should generally be from the specialist towards the less specialist rather than the reverse.

Case Studies

The following are examples...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• Foreword
• Chapter 1: Introduction to autistic spectrum disorders
• Chapter 2: Language and communication – problems and strategies
• Chapter 3: Developing social relationships
• Chapter 4: Helping the children become more flexible
• Chapter 5: Managing and preventing challenging behaviour
• Chapter 6: Working with parents and carers
• Chapter 7: Working collaboratively – whole-school practice
• Chapter 8: Management of teacher stress
• Conclusion
• References, further reading and useful addresses
• Index