Educating Students on the Autistic Spectrum

A Practical Guide

Martin Hanbury

• Publisher: SAGE Publications Ltd
• Year: 2011
• Print ISBN: 9780857028945, 9780857028938
• eBook ISBN: 9781446292242
• Edition: 2
• Topic: Education
• Subtopic: Inclusive Education

The aim of this book is to make sure all students on the Autistic Spectrum are given the opportunity to engage in appropriate teaching and learning experiences. It considers the individual with autism, and offers tried and tested approaches that have worked, giving background information on autism and its impact on the learner.

In this new edition, the author has added:

- more information on sensory issues

- an increasingly holistic view of the student with autism

- new ideas for curriculum planning in mainstream settings

- advice on multi-professional working

- guidance on developing positive working relationships with parents and carers

There is a wealth of new electronic material available to download from the SAGE website, including photocopiable materials, PowerPoint presentations and checklists.

A must-have resource for all practitioners working with children and young people on the autistic spectrum, this book will improve your inclusive practice and ensure positive outcomes for these children.

1

Autism: an overview

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This chapter:

• Provides a brief history of autism including discussion of theories causation, diagnostic criteria and changes in prevalence
• Presents current understanding of the condition through the conceptual models of the triad of impairment, mind-blindness, difficulties in executive function, difficulties in central coherence and difficulties with processing sensory information
• Considers the rapidly changing field of autism

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Kanner and Asperger

It is in the seminal work of Leo Kanner (1943) that we first find the word autism applied to an identifiable group of youngsters who shared common characteristics representing a unique and specific condition separate to any other childhood conditions. A year later, Hans Asperger (1944) working in wartime Austria, reported a group of adolescents who, although of average or above average intelligence, shared the same features of social ineptitude, inflexible thought patterns and idiosyncratic use of language. In the immediate aftermath of war, it was Kanner’s work which received wider publicity and engaged the scientific community in further studies of causation and definition.

Kanner’s initial work focused on 11 children, eight boys and three girls, who at the time he was writing were all under the age of 11. Kanner identified in these children many of the features of autism we would recognise today including

• ‘the inability to relate themselves in the ordinary way to people and situations’
• ‘the absence of spontaneous sentence formation’
• ‘insistence on sameness’ (Kanner, 1943: 242–5 passim).

Moreover Kanner recognised that despite the variation among the individual children he was studying, there existed sufficient common characteristics to denote a specific condition. He says

The eleven children (eight boys and three girls) whose histories have been briefly presented, offer, as is to be expected, individual differences in the degree of their disturbance, the manifestation of specific features, the family constellation, and the step-by-step development in the course of years. But even a quick review of the material makes the emergence of a number of essential common characteristics appear inevitable. These characteristics form a unique ‘syndrome,’ not heretofore reported, which seems to be rare enough, yet is probably more frequent than is indicated by the paucity of observed cases. (Kanner 1943: 241–2)

and, in articulating this notion of a singular condition comprised of a range of manifestations, Kanner prefigured the complexity of the condition which was to gradually emerge over the coming decades.

The circumstances of war entailed that Asperger remained unaware of Kanner’s paper and use of the term ‘autism’ when publishing his own work. Asperger used the same label to describe four children aged between 6 and 11, who showed marked difficulties in social integration despite apparently adequate cognitive and verbal skills. Asperger drew a distinction between his patients’ lack of social contact and the withdrawal of children with schizophrenia by highlighting the fact that children with schizophrenia displayed a progressive withdrawal whereas his patients showed this aloofness from the outset. Asperger (1944) stressed that difficulties with social interaction were the defining feature of his conditions but also provided a comprehensive list of symptoms and features, including:

• difficulties in interpreting non-verbal communication such as facial expressions and body movements
• peculiar use of language
• obsessive interests in narrowly defined areas
• clumsiness and poor body awareness
• behavioural problems
• familial and gender patterns.

In many respects Asperger’s original work had little influence on the field of autism until the 1970s. Then, as notions about autism evolved to incorporate a broader spectrum (Gillberg 1985; Wing and Gould 1979), so the group associated with Asperger began to be included in the debate. Because of the distinctions between the two original groups studied, it became usual to describe people of lower cognitive ability as classically autistic, or as experiencing Kanner’s autism, whereas more able individuals were seen as experiencing Asperger’s Syndrome.

It is important to note at this point that the relationship between autism and Asperger’s syndrome remains a controversial arena for discussion (Cohen and Volkmar 1997). The basic standpoints are:

• Kanner’s autism and Asperger’s Syndrome are part of a spectrum of associated conditions known as autistic spectrum conditions. People with Asperger’s Syndrome represent a high-functioning group within the spectrum.
• Asperger’s Syndrome is distinct from other conditions. High-functioning autism is not the same as Asperger’s Syndrome; there are qualitative differences in the condition.

Studies which have attempted to identify criteria which discriminate between autism and Asperger’s Syndrome have yielded mixed results. We must recognise that understanding of autism is still at a very early stage in its evolution and consensus over the precise demarcation of groups will remain problematic for some time to come. As educators, our primary concern does not lie with diagnostic distinctions but rather with the features of the condition(s) which adversely affect a student’s ability to learn; our focus must remain here.

Causation

Early ideas of causation were obscure and confusing. It must be remembered that Kanner was a psychiatrist operating in the climate of psychoanalytic thinking which had come to dominate in the 1940s. Consequently, thinking around the cause of autism began to form around theories of parenting and in particular the role of the mother in nurturing the child. Fortunately, by the mid-1960s the work of Rimland (1964) and others demonstrated that autism had a biological basis and should be regarded in the same way as any other condition.

Today, the question of causation remains complex with research focused in three key areas, namely:

• psychology
• neurology
• genetics.

Each of these fields may be characterised as follows:

• Psychology – related to an individual’s cognition, perception and understanding. Research has focused on language, memory, spatial awareness, sensory perception, social awareness, empathic awareness.
• Neurology – related to the dysfunction of particular structures of the brain and the neuro-chemicals which transmit information within the brain. The commonality of symptoms across the spectrum has led researchers to investigate a unique underlying neurobiology.
• Genetics – related to the inherent characteristics which make up an individual. The Autism Genome Project (AGP) has successfully identified a number of genetic locations associated with autism. Recent research from AGP indicates that scientists are moving towards an understanding of how each of these genetic factors interlink with one another.

While investigations in each of these key areas is essential for furthering our understanding of autism, the differing perspectives held by researchers in each discrete field can lead to confusion. Furthermore, definitions of the term ‘cause’ may vary significantly among researchers just as the phenomena being studied may be wide ranging. Consequently, there are a variety of different, sometimes conflicting, theories of causation.

For our purposes as educators, it is necessary to take a pragmatic view on this issue. Based on what we know, it is reasonable to see autism as a behaviourally defined developmental condition resulting from neurological characteristics caused by genetic factors.

If we ask ‘what causes autism?’ our answers lie along a complex chain of events defined by several levels of causation. A geneticist answering the question may refer to the locus of genetic events; a neurologist will reference brain pathologies determined by those events; and a psychologist will point to the developmental issues impacting on an individual as a consequence of their neurological make-up. Our understanding, as educators, is best informed by taking account of this complexity and attempting to integrate each level of causation in order to produce a picture of the whole child.

A further point to consider is that at each level there may be a number of possible causes. Therefore, there may be a number of genetic factors, a variety of possible brain pathologies and a range of developmental impairments which lead to the spectrum of behaviour we term autism. Indeed, the fact that there are perhaps many permutations of causation may well account for the breadth of the spectrum and the ‘fascinating peculiarities’ (Kanner 1943) of each unique individual with autism.

Diagnosis

In 1980 the American Psychiatric Association published the third edition of their Diagnostic and Statistical Manual of Mental Conditions, known generally as DSM III, which considered infantile autism as a subgroup of associated conditions termed ‘pervasive developmental disorder’. Following a series of revisions to include the more subtle features of autism, a system for diagnosis was published in DSM IV (1994). This framework forms the basis for diagnosis currently used by many paediatricians.

The other system of classification used by many clinicians is the World Health Organization’s ‘International Statistical Classification of Diseases and Related Health Problems’, or ICD. The edition known as ICD 10 (1993) was the first edition that did not consider autism as a form of psychoses, marking an important point of arrival for the field of autism. ICD 10 (1993) classifies autism as one of several pervasive development conditions ensuring that the basis for diagnosis agreed upon by each of the major systems used by clinicians is developmental.

However, despite the adoption of these systems, the issue of diagnosis remains extremely problematic. This is because autism is defined by what we can see, that is, an individual’s behaviour. There is no clear ‘marker’ which can be clinically obtained and therefore diagnosis reflects the opinion of the diagnostician following observation and interviews with care givers. While for many children, the nature of their condition lends itself easily to diagnosis, there are many children for whom the picture is not clear. This might be for several reasons, including:

1. the manifestation of those features cited as diagnostic criteria in DSM IV and ICD 10 is inconsistent, appearing in certain contexts and apparently not in others
2. the child’s condition is complicated by other difficulties such as profound and multiple disabilities, severe learning difficulties, mental health problems or generally poor health
3. the child’s developmental history is not fully known, therefore diagnostic tools reliant on developmental checklists are compromised
4. the symptoms of autism may change with age and developmental progress – nevertheless, autism remains a lifelong condition.

In cases such as these the child may remain without a diagnosis for long periods of time. The effect of this can be significantly damaging, with youngsters not able to access appropriate care and education and parents remaining in a diagnostic limbo. However, we must recognise the difficulties faced by diagnosticians, given the broad-ranging spectrum embraced by the condition and the complexity of the individuals within that spectrum.

Prevalence

Recent studies have suggested that early estimates of the prevalence of autism were conservative. Research during the 1990s and into the present century shows significant annual rises in the prevalence of autism with as many as 60 people per 10,000 reported by some researchers (Wing and Potter 2002). The reason for this marked increase is as yet unproven, but may be accounted for by the following factors:

• changes in diagnostic criteria
• the evolution of a concept of a wide spectrum of autistic conditions
• increased awareness and therefore identification of the condition
• possible environmental causes.

Whichever factor, or combination of factors, is in operation, the fact remains that we are finding increasing numbers of children with autism in our schools, an issue which must be urgently addressed. Scott et al. (2002) reported prevalence of 60 per 10,000 of the school population for 5–11-year-olds, while Baird et al. (2006) proposed a figure of 116 per 10,000 of the child population. The National Autistic Society presents the figure of 1 per cent of the general population and cautions that this may well be a conservative estimate.

Finally, a marked gender bias is consistently reported in studies of prevalence with figures varying from a ratio of 4 males to every 1 female to 8 males to every 1 female. The strong genetic basis for autism bears out these notable gender differences.

Models of autism

Since Kanner’s seminal work, there have been a number of models proposed which have sought to explain the prevalent features and characteristics of autism. Each of these models has arisen from a particular paradigm for understanding human psychology and reflects the theoretical background they have emerged from. Consequently, in exploring these models of autism it is important...

Table of contents

• Cover Page
• Title Page
• Copyright
• Contents
• Acknowledgements
• About the author
• Downloadable materials
• List of figures
• Introduction
• 1 Autism: an overview
• 2 The impact of autism on learning
• 3 Sharing positive attitudes towards students with autism
• 4 Addressing behavioural issues in autism
• 5 Understanding the effect of the condition
• 6 Effective and established strategies
• 7 Developing the curriculum for individuals with autism
• Epilogue
• Appendix: INSET materials
• References
• Index