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By Lisa Ruble, PhD, & Trish Gallagher, MEd, University of Louisville Health Sciences Center

Autism Spectrum Disorders refer to a complex group of related disordersmarked by impaired communication and socialization and by a limited (and oftenunusual) range of interests. Although sometimes not diagnosed until school age,

Autism Spectrum Disorders develop early in life and are life-long conditions withimplications for education, social development, and community adjustment.

Autism became an eligibility category for special education services in 1991.Since that time an enormous amount of research has been conducted regardingidentification and effective interventions for children with Autism Spectrum

Disorders. The good news is that information learned over the years has resultedin a broader definition of autism and many strategies for parents and educators touse in supporting the development of these children, starting in early childhood.

However, distinguishing misinformation from accurate information can bea daunting task. It is critical that parents and educators understand this complexdisorder. Teachers and parents working together will help children achievepositive outcomes.

Basic Facts

Diagnosis. Autism Spectrum Disorders are diagnoses based on behaviors

and not on medical tests. In order to accurately diagnose Autism SpectrumDisorders, the child should have a comprehensive evaluation by professionalswho can address development of language, behavioral, social, and cognitiveskills in young children. Atypical development must be identified insocialization and communication, and the child must display narrow interests orrepetitive behaviors.

Autism Spectrum Disorders affect children differently, and two children canmeet different combinations of the diagnostic criteria. Autism, the typicalAutism Spectrum Disorder, often occurs with other disorders such as cognitiveimpairment, fragile X syndrome, Down syndrome, and tuberous sclerosis.

The cause of Autism Spectrum Disorders is unknown and most likely resultsfrom many factors, such as a combination of heredity, environment, and brainfunctioning. Autism Spectrum Disorders are notthe result of parenting style but,rather, are the results of changes in brain development that may occur beforebirth or shortly thereafter.

Characteristics. Autistic Disorder, Aspergers Disorder, and PervasiveDevelopmental Disorder Not Otherwise Specified (PDD-NOS) are consideredAutism Spectrum Disorders. The degree to which different characteristics affecta child depends on the level of severity of impairments:

Children with autism have problems in three core areas: socialization,communication, and restricted patterns of behaviors and interests.

Autism Spectrum Disorders:

Primer for Parents and Educators

S P E C I A L N E E D S

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Children with Aspergers have problems in two areas: socialization andrestricted patterns of interests.

Children with PDD-NOShave problems in socialization and one of the twoother areas: communication or restricted patterns of behaviors and interests.

General characteristics of children with Autism Spectrum Disorders include:

Cognitive: Uneven development of cognitive skills; relative strength inprocessing visual versus verbal information.

Social skills: Difficulty understanding social rules such as taking turns andsharing; problems understanding and reading the emotions of others;difficulty taking the perspective of other people; problems initiating andmaintaining interactions and conversations with other people.

Communication:Trouble responding to verbal information presented at a fastpace; trouble understanding multiple-step commands; inconsistentunderstanding of verbal information; a need for verbal information to berepeated, especially information that is new.

Organization/self-direction: Difficulty screening out distractions; difficulty

completing activities independently and initiating work activities; problemsorganizing free time and stopping one activity and moving on to the next;difficulty being flexible, shifting attention to a new focus; problems doingmore than one thing at a time.

Prevalence.Autism is not rare and affects as many as 1 out of 500 children.When considered with the related disorders (Aspergers Disorder and PDD-NOS), as many as 1 out of 160 children are affected. Autism is a lifelongdisability with no known cure. Although a small number may make significantimprovements, relative weaknesses in social and communication skills remain.

Intervention approaches. Children with Autism Spectrum Disordersrespond to specialized interventions. The use of environmental supports and

adaptations are necessary for effective intervention. The main treatments forautism are educational and behavioral approaches. Other treatment approachessuch as medication and alternative methods may be used in combination withthese approaches. Parents and teachers can be effective in promoting theirchilds social and communication skills. Therapies or programs that include aparent training component are better than those that do not.

Education: First Line of Intervention

Collaboration. Because the first line of intervention for children with AutismSpectrum Disorders is educational and behavioral, developing collaborative and

positive family-school partnerships is essential. Early diagnosis is important becauseit will help parents in gaining an understanding of their child and their childsspecific needs early in his or her development. Parents who are empowered withknowledge will be the best advocates for their child. By working collaboratively andsharing information with each other and with other school and communityprofessionals, parents and teachers can develop strong educational programs forchildren with Autism Spectrum Disorders. Close communication (such as a dailylog) between teachers and parents will ensure consistency across the childsprogram and facilitate school and parent relationships.

Special education. Public schools must provide services for all children withdisabilities beginning in early childhood (age 3 or earlier as defined by state

regulations). The school districts special education team will provide

The National MentalHealth & Education

Center for Children &

Families

As one of many NASPpublic service programs,he Center fosters best

practices in education andmental health by pro-iding information on

opics affecting todaysouth, families, andchools. The Centers goals to improve outcomesor children and youth by

helping parents, teachers,and other related pro-essionals work more

effectively together topromote healthy learningand development. TheCenter offers free or lowost resources, programs,

and services that promote

effective strategies, greaterollaboration, andmproved outcomes on a

wide range of psycho-ogical, social/emotional,

and academic issues.Resources can be down-oaded or ordered fromhe Center website or

ordered directly fromhe Center.

For materials or further

nformation contact theCenter by phone at301) 657-0270; by e-mail

[email protected];or on the web atw w w.naspcenter.org.

Special Needs

Basic FactsContinued from page 1


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Special Need

evaluations to identify disabilities and then provideany services necessary for children with disabilitiesto benefit from the school program. For youngchildren, these services might include speech andother therapies and preschool programs toencourage socialization and the development ofreadiness skills. By elementary school, students with

autism often receive more specialized services.As for all children with disabilities, Individual

Education Programs (IEPs) for students with autismshould be comprehensive and include environ-mental supports and related services (see below).Previous teachers, parents, and other providers willgive the best information on strategies that havebeen effective. Utilizing environmental supports,information from previous teachers, and relatedservices (speech and language therapy, occupa-tional therapy, psychological services) will facilitateconsistency in the childs program, and colla-boration between regular education and specialeducation personnel.

The local schools special education team is thebest source for more information about evaluationsand services for children with or who are suspectedto have autism and related disorders.

Effective program components. In 2001, theNational Research Council convened a group ofresearchers who were to summarize the com-ponents of effective interventions for children withautism. Become familiar with this report. (The

report is available on the Internet; see Resources.)The National Research Council recommendationsfor children 8 years and younger include:

Immediate enrollment into interventionprograms after the diagnosis.

Active participation in intensive programmingfor a minimum of 25 hours a week, equivalentto a full school day for 5 days a week, with full-year programming based on childs age anddevelopmental level.

Planned and repeated teaching opportunities

in various settings, with sufficient attentionfrom adults and based on the childs develop-ment and individual needs.

At least one adult for two young children withautism.

Provision of family activities and parent training. Ongoing assessment and evaluation to measure

progress and make adjustments.

N A T I O N A L A S S O C I A T I O N O F S C H O O L P S Y C H O L O G I S T

Effective Intervention Strategies

Different teaching approaches have been founeffective for children with autism, and ncomparative research has been conducted thdemonstrates one approach is better than anothe

The selection of a specific approach should be baseon goals that come from a comprehensiassessment. Parents and teachers need to be awathat not all children respond the same way to thsame treatment, and children have individulearning styles, strengths, and challenges.

The selection of an intervention strategy shoube based on an individualized assessment of needsclear description of goals, a selection of strategibased on the goal, and ongoing monitoring progress. For a given student it may be appropriato apply different teaching methods for differe

skills, independently or simultaneously (discretrial, incidental teaching, and structured teaching

APPLIED BE HAVIOR ANA LYSISRecently a great deal of attention has been give

to applied behavioral analysis. Applied behavioranalysis involves utilizing systematic instructionmethods to change behavior in measurable waywith the intent of increasing acceptable behaviodecreasing problematic behaviors, and teaching neskills. Parents and professionals use the term applibehavioral analysisin different ways. It may be used describe highly structured, adult-directed strategiesuch as Lovaas training or discrete trial traininOther systematic strategies include incidentteaching, structured teaching, pivotal respontraining, functional communication training, anthe picture exchange communication syste(PECS). A good resource for information abovarious forms of applied behavioral analysis can bfound in the National Research Councils summar

INTERVENTIONS FOR COMMUNICATION, SOCIALIZATION, AND

SELF-DIRECTIONSpecific attention to social and communicatio

goals is necessary in designing an educationprogram. Limited communication skills creafrustration in children with autism and interfere winearly all areas of development. As functional meaof communication develop, other skill areas will baffected. For example, communication skills hechildren make and maintain friendships. Providinplanned activities with typically developing pee


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NATIONAL ASSOCIATION OF SCHOOL PSYCHOLOGISTS

Special Needs 4

Social: Provide direct social skillsinstruction, peer-mediated instruction,and teacher-mediated instruction.

Communication: Provide temporal,spatial, and procedural supports toenhance learning and new skilldevelopment; allow time for

processing information, slow downpace of information; give instructionsone at a time, backup directions withvisual supports; provide supports onconsistent basis.

Organization/self-direction. Provideassertion, temporal, spatial, andprocedural supports (schedule, taskanalysis) to help remind the student ofthe task and steps; intersperse lessdesired activities with more desiredactivities; reduce distractions; clarifyhow much work must be completeduntil the child is finished and thepicture of reward/break for finishing;provide visuals to convey choices andpassage of time; use visual schedule toindicate changes in activities orroutines; allow processing time; backup verbalizations with visual aids.

INTERVENTIONS FOR ENGAGEMENTActive engagement is another key

ingredient in effective intervention forchildren with autism. The National ResearchCouncil defines engagement as sustainedattention to an activity or person (NationalResearch Council, 2001, p. 160). Becausechildren with Autism Spectrum Disorders tendto display limited or idiosyncratic interactionswith objects and people, it is important thatparents and teachers adapt activities andmaterials to encourage more appropriateinvolvement. This might include directlyteaching how to use toys and objects,

introducing appropriate activities to replaceinappropriate behaviors, developing visualcues (such as hand signals or pictures) toreduce verbal and physical prompting, andfinding ways to make tasks more meaningfuland motivating.

helps children with autism improve social andcommunicative skills and should be a keycomponent of the Individualized EducationProgram (IEP). Other recommendedcomponents of an IEP include supports fororganization or self-directed skills.

What follows are some examples of social,

communication, and self-direction goals:

Jason will develop a means of initiatingthree requests a day across people andenvironments, using pictures, signs,vocalizations, or verbalizations.

Sarah will respond to her name by ceasingher activity and turning toward thespeaker 50% of the time.

Tony will utilize the PECS/AugmentativeCommunication System to initiate requests20 times during his day.

Maria will play in proximity (3 feet) to twopeers for up to 5 minutes.

Joey will independently complete one taskuntil it is finished using visual cues and awork-reward routine.

ENVIRONMENTAL SUPPORTSEnvironmental supports are the teaching

strategies, modifications, and adaptations usedto help each child be successful. Based onDalrymple (1995), these include:

Temporal:Organize sequences of time andanswers the question: When do thingshappen?

Spatial:Provide specific information aboutthe organization of the environment andanswers the question: Where do thingshappen?

Procedural: Clarify the relationship of thesteps of an activity and between objectsand people and answers the question:What is to happen?

Assertion:Help with initiation and exertionof control.

What follows provides descriptions ofenviron-mental supports that are associatedwith observed characteristics.

Cognitive:Provide procedural supportsto enhance understanding and problemsolving.

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NATIONAL ASSOCIATION OF SCHOOL PSYCHOLOGISTS

5 Special Needs

seem overwhelming, and learning how to sortout the well-tested options from fads is oftennecessary. Resources such as specialists inautism and parent support groups are oftenavailable at a district, state, or regional level. Byworking together and accessing theseresources, parents and teachers can effectively

promote optimal learning and adjustment forchildren with Autism Spectrum Disorders.

Resources

Attwood, T. (1998). Aspergers Syndrome: A guidefor parents and professionals. London: JessicaKingsley. ISBN: 1853025771.

Bondy, A. S. & Frost, L. A. (1992). The PictureExchange Communication System: A parent/staff handout. Newark, DE: Pyramid Edu-

cational Consultants. Available:www.pyramidproducts.com

Dalrymple, N. (1995). Environmental supportsto develop flexibility and independence. InK. Quill (Ed.), Teaching children with autism(pp. 243264). New York: Singular. ISBN:0827362692.

Hodgdon, L. A. (1999). Solving behavior problemsin autism: Improving communication withvisual strategies. Troy, MI: QuirkRoberts.Available: www.futurehorizons-autism.com

Hodgdon, L. A. (1995). Visual strategies forimproving communication: Practical supportsfor school and home. Troy, MI: QuirkRoberts.Available: www.futurehorizons-autism.com

National Research Council. (2001). Educatingchildren with autism. Washington, DC:National Academy Press. Available:www.nap.edu/books/0309072697/html/R1.html

Office of Special Education and RehabilitativeServices (2000). A guide to the IndividualizedEducation Program. Washington, DC: U.S.Department of Education. Available:

www.ed.gov/parents/needs/speced/iepguide/index.html?exp=0

Quill, K. (Ed.). Teaching children with autism.New York: Singular. ISBN: 0827362692.

Ruble, L. A., & Dalrymple, N. J. (2002).COMPASS: A parent-teacher collaborativemodel for students with autism. Focus onAutism and Other Developmental Disabilities,17, 7683.

MEDICATIONPrescription medications are considered

to be adjunctive therapy because thesemedications do not address the core symptomsof autism but may address behaviors that

interfere with learning. Problems likeoveractivity, aggression, repetitive orcompulsive behaviors, self-injury, anxiety ordepression, inattention, and sleep problemsmay be effectively addressed with medication.

It is important that parents and schoolpersonnel work with healthcare providers whounderstand autism and provide feedback tohelp monitor side-effects. Medication is notappropriate for all children with autism, and, insome cases, concern about side-effects mightoutweigh anticipated benefits.

BEHAVIOR MANAGEMENTMany parents and teachers experience

frustration in trying to understand andrespond to the behavior of a child with autism.They find that discipline strategies that workfor other children do not work for this child.Time-out, punishment, and taking awaypreferred items do not appear to have thesame impact. It may be necessary to consultwith a specialist in autism and behavior when

confronted with challenging behaviors.The specialist can work with parents inidentifying the underlying causes of behavior,skills that the child needs to learn to replace theproblem behavior, strategies to assist the child indeveloping the skills, and ways to respond whenproblem behavior occurs.

This process is called a FunctionalBehavior Analysis (FBA), and school behaviorspecialists (school psychologist, behavioranalyst, special education teacher) can assist inproviding this assessment. If a child is

experiencing problem behaviors that interferewith learning, it is necessary for the child tohave an FBA and apositive behavior support planas part of the IEP.

Summary

Parents and teachers today have manyresources available to address the needs ofchildren who have Autism SpectrumDisorders. At times, so much information may

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S i l N d

N A T I O N A L A S S O C I A T I O N O F S C H O O L P S Y C H O L O G I S T S

Schreibman, L. (2000). Intensive behavioral/psychoeducational treatments for autism:Research needs and future directions.Journal ofAutism and Developmental Disorders, 30, 373378.

Treatment and Education of Autistic and Related

Communication Handicapped Children(TEACCH) (1996). Visually structured tasks:Independent activities for students with autism andother visual learners. Chapel Hill, NC: Universityof North Carolina, Division TEACCH.Available: www.autismsociety-nc.org

WEBSITESAutism Resourceswww.autism-resources.comAutism Society of Americawww.autism-society.orgTEACCHwww.autismsociety-nc.org

Lisa Ruble, PhD, is Assistant Professor of Pediatrics andis Director, Systematic Treatment of Autism and RelatedDisorders (STAR), at the University of Louisville HealthSciences Center, Department of Pediatrics, WeisskopfChild Evaluation Center, in Louisville, KY. TrishGallagher, MEd, is Educational Specialist for STAR atthe University of Louisville Health Sciences Center,Department of Pediatrics, Weisskopf Child EvaluationCenter.

2004 National Association of School

Psychologists, 4340 East West Highway, Suite 402,Bethesda, MD 20814(301) 657-0270.

The National Association of School

Psychologists (NASP) offers a wide variety

of free or low cost online resources to

parents, teachers, and others working with

children and youth through the NASPwebsite www.nasponline.organd the

NASP Center for Children & Families website

www.naspcenter.org. Or use the direct links below to

access information that can help you improve outcomes for

the children and youth in your care.

About School PsychologyDownloadable brochures,

FAQs, and facts about training, practice, and career choices

for the profession.

www.nasponline.org/about_nasp/spsych.html

Crisis ResourcesHandouts, fact sheets, and links

regarding crisis prevention/intervention, coping with

trauma, suicide prevention, and school safety.www.nasponline.org/crisisresources

Culturally Competent PracticeMaterials and resources

promoting culturally competent assessment and

intervention, minority recruitment, and issues related to

cultural diversity and tolerance.

www.nasponline.org/culturalcompetence

En EspaolParent handouts and materials translated into

Spanish. www.naspcenter.org/espanol/

IDEA InformationInformation, resources, and advocacy

tools regarding IDEA policy and practical implementation.

www.nasponline.org/advocacy/IDEAinformation.html

Information for EducatorsHandouts, articles, and other

resources on a variety of topics.

www.naspcenter.org/teachers/teachers.html

Information for ParentsHandouts and other resources a

variety of topics.

www.naspcenter.org/parents/parents.html

Links to State AssociationsEasy access to state

association websites.

www.nasponline.org/information/links_state_orgs.html

NASP Books & Publications StoreReview tables of

contents and chapters of NASP bestsellers.

www.nasponline.org/bestsellers

Order online. www.nasponline.org/store

Position PapersOfficial NASP policy positions on

key issues.

www.nasponline.org/information/position_paper.html

Success in School/Skills for LifeParent handouts that

can be posted on your schools website.

www.naspcenter.org/resourcekit

ResourcesContinued from page 5

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