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Educating Children with Autism Committee on Educational Interventions for Children with Autism Division of Behavioral and Social Sciences and Education National Research Council 2001 Summary by Carol Burmeister - Desert Mountain SELPA and Andrea Walker - Orange County Department of Education
The most important consideration in devising educational programs have to do with recognition of the ASD as a whole, with the concomitant implications for social, communicative, and behavioral development and learning.
Recommends that children with any ASD, regardless of severity or function, be eligible for special education services
Ten + years ago, autism was typically not diagnosed until children were of public school age
Early identification critical, even as young as age two
Recommends appropriate screening and multidisciplinary assessment with follow-up diagnostics within 1 -2 years after initial evaluation.
Why a much higher incidence?: more complete diagnoses , broader definition of autistic spectrum disorders
Parents need to have access to balanced information about ASD and the range of appropriate services.
Parents need to have the opportunity to learn techniques for teaching children new skills and reducing behavioral problems. Parents can learn to successfully apply skills to changing their child’s behaviors.
Parents’ concerns and perspectives should actively help shape educational planning.
There is a need for early entry into intervention programs
Active engagement in intensive instructional programming 25 hours a week, 12 months a year
Use of planned teaching opportunities that are developmentally appropriate
Sufficient amounts of adult attention to meet individualized goals (1:1 and small group)
Recommends the services begin as soon as a child is suspected of having an ASD. Planned activities in a variety of settings with ongoing interactions with typically developing peers.
Focus on the core deficits of ASD…..
Priorities of Focus: - functional academic skills and spontaneous communication - social instruction delivered throughout the day in various settings - teaching of play skills, focusing on play with peers - intervention strategies that address problem behaviors with an emphasis on positive, proactive approaches - instruction aimed at goals for cognitive development, carried out in the context in which the skills are expected to be used, with generalization and maintenance in natural contexts as important as acquisition of new skills
IDEA contains the necessary provisions yet the implementation involves many disciplines and agencies. Confuses lines of responsibility...
Recommends the coordination across services and funding at federal and state levels. Creation of a federal joint agency task-force on ASD. State monitoring of coordination among service delivery systems. Establish minimum standards for personnel.
Education at home, at school and in community settings remains the primary treatment for children with ASD
Many techniques and comprehensive programs have clear effects on important aspects of learning
Links between interventions and improvements are dependent on characteristics of the children and aspects of the treatment that are not yet fully understood
Recommends the use of longitudinal and other interventions studies that assess the relative effectiveness of the various treatment models, precise measurements of outcomes, educational skills, family variables, child factors and responsiveness to interventions, etc…
- Families need specialized knowledge and skills AND scientifically based information
- Need support for the family stresses
- Empowering parents to take a key role in effective treatment = great benefit to child
- Need initial training and ongoing support
- Need to learn techniques to support generalization and maintenance of skills
- Need adaptive skills and behavioral support training
- Learn to be a ‘good advocate’ (effective collaborator) Vs ‘adversarial’ with the ‘team’
- Adopt a ‘family-centered’ approach
- Be sensitive to cultural issues
Key Points continued C. Goals for Educational Services -Must address independence and social responsibility as well as language, cognitive, social, and adaptive goals that are not part of standard curricula - Issues of standards-based educational reform - Objectives must be based on specific behaviors targeted for planned interventions - Educational objectives should be tied to specific, real- life contexts and behaviors with immediate meaning to the child
Issue of “recovery” “ Whether these improvements reflect developmental trajectories of very mildly affected children or changes in these trajectories in response to treatment (Lovaas, 1987) is NOT known.” “… the core deficits in autism have generally been found to persist in some degree in most persons with ASD. There is no research base explaining how “recovery” might come about or which behaviors might mediate general change in diagnosis or cognitive levels.” “ Although there is evidence that interventions lead to improvement and that some children shift specific diagnoses within the spectrum and change in severity of cognitive delays in the preschool years, there is not a simple, direct relationship between any particular current intervention and “recovery” from autism.”
- Various theoretical frameworks -developmental or behavioral approach
- play skills
- interventions will be based on approaches
- goals for specific social behaviors as they relate to interactions with adults ( prelinguistic = e.g., joint attention, turn taking, imitation, responding to gaze, initiation with adults or later skills needed in classroom contexts = e.g., responding to directions, independence, participation in activities, expression of needs, requesting assistance) and with peers (prelinguistic = e.g., joint attention, requesting, commenting, nonverbal responses)
Goals and objectives in this area need to go hand in hand
There is a need to address at least functional aspects of motor difficulties, particularly as they affect social, adaptive and academic functioning.
Key Points continued E. Adaptive Behaviors - most interventions are geared to teaching individuals with MR self help skills (toilet training, dressing, eating, grooming, etc.) - sleep and eating disorders are frequently reported - safety and danger issues maybe impaired -goals need to focus on age-appropriate independence in various settings - focus on generalization of skills - results are encouraging regarding teaching a range of adaptive behaviors to young children with ASD
Key Points continued F. Problem Behaviors - use of functional behavioral assessment and positive behavioral supports - is the problem from the child’s or adults’ perspective? - the intensity, frequency, duration and/or persistence of the behavior often distinguishes them from peers - neurobiology impact (SI) - reactive Vs proactive interventions - assimilation Vs. accommodations - various approaches - use of medications - implementation of behavior plans
Key Points continued G. Instructional Strategies - there is a range of strategies and approaches - one to one Vs. group instruction -use of visual supports - use of peers as ‘instructors’ Research suggests the greatest effects of any direct treatment lie in the generalization of learning …there is little reason to believe that individual therapies carried out infrequently have a unique long-term value….unless taught to and used regularly by the child and the people who are with him or her in natural context….
Key Points continued H. Comprehensive Programs - the national challenge is to close the gap between the quality of model programs and the reality of most publicly funded early educational programs - reviewed 10 model programs common elements = specific curriculum content, highly supportive teaching environments and planned generalization strategies, predictable routines, use of a functional approach to behavior problems, carefully planned transitions, active family involvement, highly trained staff, adequate resources, supervision of services - early intervention - intervention intensity - cannot be simply measured in terms of hours of enrollment but in terms of “active engagement”
Key Points of Section III A. Public Policy and Legal Issues written social policies should answer major ?s who shall receive the resources/services? (eligibility) who shall deliver the services? (provider) what is the nature of the services? (scope) what are the conditions under which the services will be delivered? (environments and procedures) - IDEA - related services - FAPE - ‘appropriate’ Vs ‘best’ - treatment cost
Key Points of Section III B. Personnel Preparations - diversity in the approaches to personnel preparations - staff must be familiar with theory and research including methods of ABA, naturalistic learning, incidental teaching, assistive technology, socialization, communication, inclusion, adaptation of environments, assessment and the effective use of data collection systems - direct service providers with support teams - recruitment issues - supervision, mentoring, consultation issues - paraeducators/paraprofessionals There are various models for the preparation with different levels of experiences provided...
Key Points of Section III C. Methodological Issues in Research - primary goal is to determine the types of practices that are the most effective for which type of student’s needs. - since not a homogeneous group creates substantial problems when trying use standard research methods - Types of literature - descriptive and attempts to explain the neurological, developmental, behavioral characteristics of ASD or addresses issues related to diagnosis and prevalence and/or examines the effects of comprehensive treatment programs (immediate and long-term outcomes) - funding issues - federal institutes Vs. parent-initiated, nonprofit - remarkably little integration across literature - methodology concerns -selection of participants in studies, internal and external validity, single-subject design, family characteristics, fidelity of treatment, sample number, follow-ups, etc…
to ensure implementation of what is already known so that every child benefits from this knowledge and to work from existing research to identify more effective educational interventions for all children with ASD
Active engagement in intensive instructional programming for a minimum of the equivalent of a full school day, 5 days (at least 25 hrs./wk.) with full year programming varied according to the child’s chronological age and developmental level (systematically planned and developmentally appropriate educational activities)
Children’s outcomes are variable and often difficult to measure
There does not appear to be a clear, direct relationship between any particular intervention and “recovery” from ASD
Results continued: - There is a need for support -Federal and State levels in policy development, financial support and research. - The establishment of regional resource and training centers to provide training and technical assistance. - Professional and advocacy groups should work collaboratively on behalf of students and their families. - Establishment of minimum standards for personnel in education is needed. - Require minimum standards in design and description of intervention projects - Treatment studies should recognize the common components of comprehensive programs and delineate the “active ingredient”