Autism & Education

Prof Rita Jordan PhD OBEEmeritus Professor in Autism Studies

University of Birmingham, UK

Conference for the 35th Anniversary of APNABI: December 11, 2014 Bilbao

What’s Special about ASD?

• need to learn explicitly what others acquire intuitively or through social tutoring

– identity of self/ other

– saliency of social signals

– agency and intention

– relevance and priority

– social/cultural meaning

– nature of communication

– emotional consciousness

Co-Morbidities

Wing: “Nature never draws a line without smudging it”

• ASD rarely occurs as sole disorder

• additional developmental disorders & later anxiety disorders

• diagnostic heirarchy rules deny reality:

– language disorder & autism

– ADHD &ASD

– SpLD & ASD

– SLD (LD) & ASD

• expression of disorders affected by comorbid conditions

The ‘ASD’ lens

• diagnosis not a good basis for services – should be needs led

• individual needs determine learning and should determine teaching

• individuality is even more the case in ASD

• yet a lack of mutual empathy means

– teachers have to use non-intuitive routes in teaching those with ASD

– just as those with ASD have to use non intuitive routes in their learning

SEN of ASD

Jordan (2005)

• children with ASD have needs that are:

– common (as children)

– individual (as individuals - assessed needs)

but also

– group (related to ASD)

• and it is only through awareness of group needs that individual needs can be recognised and met

Role of Education

• as entitlement to broad & relevant curriculum

– human right

– adult success

– need to consider reality of access

• as therapy addressing the problems presented by ASD

both aspects are needed but vary in priority with individual needs

Intervention & Education

• educational entitlement

– adaptation and access

– range of provision

– parent support for informed choice

• education as therapy

– eclectic tradition

– no evidence of single approach

– fit with local services

– based on principles and best practice

Learning Style

• visual rather than verbal

• memory

– cued

– rote

• ‘social’ is a dimension of difficulty

• emotions and cognition

– use interests for engagement

• at sensory stage of meaning

– presentation -> reference

• repetition & consolidation

• need explicit strategies for problem solving

Difficulties & Differences

• executive functions– ‘monotropic’ attention– impulse control (difficult to limit)– idiosyncratic perception

• imagination & reality testing• empathy & emotional/ conscious understanding• concept development

– problems abstracting (not to do with ‘abstract’ concepts)

– rigidity of concept & schema boundaries (teach to include exceptions)

Sensory Issues

• evidence that at extremes

• both over- and under-responsive to different senses

• ‘over-responsive’: sensory avoiding; ‘under-responsive’: sensory seeking

• most sensory avoiding

• shield from sensitivities and/or desensitise

• attach meaning to perception - reduce ‘bombardment’ of meaningless stimulation

• aware of variability - use proximal blocks

• give environmental control to individual if possible

• reduce overall stress

• teach to monitor and manage levels of arousal

Perceptual Challenges

• cannot easily understand social meaning so:

– teach for meaning (emphasise goals not parts of

tasks - or get prompt dependence)

– give explicit rules & instructions

• visual ‘rules’ & ‘matching’

– allow time for processing

– check on child’s perspective (squirrel story)

Memory Challenges

• excellent rote memory but poor functional memory:

• processes for teaching or generalisation of skills in

functional environments

• methods to enable memory cues across home/ school

environments e.g. in homework

• teaching a range of memorisation strategies

(stories of cake making)

Communication

• language and communication separate

• often associated language problems

• prognosis

• all aspects:– gesture

– posture

– facial expression

– emotion

– pragmatics

• use of IT - reversal of learning process - ‘reading’ 1st?

Social & Emotional Development

– skills difficult without understanding

– need some rules with a wide currency e.g. need

communicative partner

– value of Legotherapy / SHEDs for adults - social skills in

context

– other 'rules' may be socially disabling e.g. look when being

addressed

• will not know purpose

• not able to time gaze appropriately

• danger of giving wrong signals

Teaching for Purpose

• different approach needed to suit

– individual characteristics

• sociability

• language

• cognitive level

• sensory issues

• age

– goal

– practitioner comfort/ ability/ knowledge

– Gunilla Gerland (2013) (Secrets to Success for professionals in the Autism Field: JKP}

Individual factors: Sociability

• Sociability NOT the same as social skills or understanding

• Wing’s classification– withdrawn/ solitary -> passive/ responds -> ‘active but odd’

-> eccentric & sensitive

• varies with conditions & with teaching

• level suggests optimum form of approach– withdrawn - 1:1 directive & desensitisation

– passive - interest & structured play experience

– active but odd - social rules & experience (context)

– eccentric - social skills in context e.g. buddy

Behaviour & ASD

• behaviour itself not the basis of ASD

– only a guide to underlying brain functioning/ psychology (Frith, 1989; Peeters, 1997)

– no behaviours unique to ASD

– poor basis for diagnosis - should be clinical judgment based on developmental history

– DSM-V likely to exacerbate problems with ‘social & communication’ category for PDD-NOS not meeting ASD criteria

Is ‘Normal’ a Sensible Goal?

• ‘acting’ typically may still be at a cost

– more stress

– breakdowns in unfamiliar/ unsupported situations

• ‘recovery’ is liable to mean withdrawal of support or

even understanding

• cases of successful individuals with ASD at school

failing to cope with ‘ordinary’ life

– even suicide

Goals of Education

• to become as good as one can be

• not necessarily ‘less autistic’ in terms of behaviouralone

• But:

– free from the fear & stress of not understanding

– with skills and support to lead a full & worthwhile life

– with capacity for enjoyment

– with resilience to cope when life is difficult or disappointing

Role of the Teacher/ Supporter

• not to create artificial ‘autism friendly’ environments, at least, not long-term

• to teach explicitly all the knowledge, skills and understanding that the rest of us just ‘pick up’ in ways that are both meaningful and accessible to the individual

• most of this will not be ‘set’ lessons but a sensitivity to what needs to be taught in daily contexts

• focusing on deficit, we get it wrong

Understanding is key

• there is no intuitive or instinctual responses across the autism/ non-autism divide

• both parties have to use cognitive routes to understand the other

• such routes are difficult and inefficient

• but they are essential if we are to live happily together

Principles that should underlie effective

educational practice:

• need for education to adapt to the learning style of individuals with autism

• need to help individuals to adapt their learning style -better able to understand and operate independently in the non-adapted environment

Problems with Educational

Language

• model of conversation

– contributions, topic maintenance

• assumption of joint attention

– holding up, eye/finger pointing

• sarcasm & metaphor

• literal understanding

– jokes, idioms, pragmatic context,

• model of questions

– display, probe

Teaching to Cope

• pre-empt:

– stress - prosthetics & exercise

– anger - alternative

– frustration - communication

– panic - posture / drill

• train for ‘escape’

• teach relaxation

• teach social understanding

– Social Stories/ video life/ soaps

Research Evidence on Interventions

• no single approach

• evidence for:

– structure

– broad modern behavioural methods

– training in social interaction & communication techniques

• in all studies some do well and some do not

• in all studies children tend to learn only what they are explicitly taught

Important Distinction (Mesibov 2009)

• Evidence Supported

Treatment (EST)

– most common use

– starts with treatment &

asks if it works for a

particular (narrow)

group

• Evidence Based

Practice (EBP)

– what we should do

– starts with person and

asks how we can

achieve the best

outcome

Importance of Process

• sensitivity & flexibility of implementation at

least as important as particular intervention

• rigid interpretation of manuals leads to poor

outcomes

• lack of understanding of ASD de-skills staff

and prevents effective individualisation

Curriculum for ASD

• entitlement to culturally valued skills, knowledge & understanding

• therapeutic needs from ASD difficulties

• additional explicit content for otherwise ‘intuitive’ knowledge

• long-term need for a ‘curriculum for life’

Goal is Q of Life not getting through

the lesson

• try not to give definite answers or models when there are exceptions

• be authentic & praise effort, not success

• don’t introduce unnecessary levels of learning e.g. fake materials when the real is available

• appreciate the value of contact time

– don’t use it for work that could be done independently

– always think what is the student learning rather than what am I teaching

– use structure to make choices (and non-choices) clear

Build on Strengths

• relationships - use them

– getting consistency across staff

– motivating the children to learn

– work with CAL

• detailed planning

– plan to pre-empt difficulties rather than ‘mopping up’

• opportunities to apply learning - plan for some ‘out of the box’ lessons that use the environmental facilities available

– make lessons fit into life rather than be apart from it

Understanding behaviour: Functional

Analysis

• Settings

– ‘last straw’ not always ‘trigger’

– whole child (inc. skills) & whole school approach

– parent collaboration

• Behaviour

– accurate

– frequency

– duration

– intensity

• Results

Teaching Consequences

• less able - single track

• more able -

– railway - no turns

– 2 clear termini with no

connections

– choice point

emphasised

Moment of choice

Problem Taught alternative

Basic Guide to Anxiety Reduction

• relaxation

– general - sensory/ meditation/ yoga/ deep pressure

– specific - fold arms, close eyes, chant or hum

• exercise

– aerobic/ contingent & non-contingent

• diet

– GI index low / low stimulants/ sugar & additives

• talking with others

– drawing? music

Examples of Good Practice

• CBT e.g.Attwood (anxiety/ anger/ toolbox); Greig &

McKay (homunculi programme)

• CBT for adults (Hare)

• Moran - PCP - ‘ideal self’

• structured support for families (Preece & Almond)

• self-help support groups

Tensions in Education for ASD

• entitlement vs. specialism– access or meeting SEN?

• optimum for learning vs. optimum for social integration– specialised or peer engagement

• ‘readiness’ for inclusion vs. learning without experience– how to achieve ‘readiness’ without experience?

Processes for Inclusion

• support

– trained - ASD

– enabling - Observe/ Wait/ Listen

• staged

– special -> reverse ->integrated

• resource base

– better than ‘unit’ or ‘class’

• ‘free time’

– use of buddies / circles of friends

‘Unprepared’ Integration

• evidence that it is not successful

– from research

– from autobiographies of those with ASD

– from parents seeking tribunals

– Council of Europe study

• results in

– increased segregation

– even institutionalisation

Later: Ecological Curriculum

• assess individual

• assess current and future environments & occupations

• gaps in skills, appreciation, knowledge and experience form curriculum goals

• teach in functional ways

• practise in functional contexts

Train for sensory ‘panic’

• need for trained

response for ‘panic’

situations &

buddy or visual cue

to remind.

• note use of prime

numbers!

Use of LSA

• care from a distance

• checking not creating

‘learned helplessness’

• available to others

Teaching adaptations

• visual instructions

• lists for meaning

• allow time for

interests

• work then play

Managing Democracy

• no tact or

sensitivity

• no intentional

rudeness

• give alternative

• mark for future

teaching

Fostering ‘Realistic Optimism’

• use ‘ecological curriculum’ approach to life and social skills

– accurate appraisal of self

– see plan for future coping

• help them notice good things that happen

• teach ‘mindfulness’ & avoid

– too much worry over future

– too much anger & distress over past

Teaching is hard

• teaching students with ASD is hard

– intellectually hard to try to ‘work out’ what would

otherwise be intuitive

– pragmatically hard to ‘act against the grain’ and do

things not to suit ourselves but someone else - and

keep it up

– practically hard to monitor the students and oneself

continuously - exhausting, in fact

'Normalist' assumptions

• exclude the particular needs of individuals

• deny the right to be different

Treating people equally means treating them

differently, according to need