‘Different Colours’
Educational experiences that make a positive difference to learning for children and adults with Autism Spectrum Disorder (ASD)
Tim Powell
Over the past few years there has been a greater awareness and interest in the specific educational and support requirements for children and adults with Autism Spectrum Disorders (ASD). There are now some exciting educational and behavioural tools based on validated research and efficacy that are assisting people to learn important communication and social skills that will help in daily living and that provides a platform for future learning and success. It is important to attempt to understand the nature and characteristics of conditions that are complex, where not one strategy fits all, and where people are faced with many challenges across all dimensions of daily life. In view of this, clinicians and families are faced with the challenge of making informed decisions amidst heated debates over the most effective treatment approaches for children and adults with Autism. This paper provides a perspective on this debate by considering ways to enhance social and communicative abilities through effective teaching, supplementing this proven educational and behavioural support with the use of positive support strategies.
At present there are a number of passionate debates regarding the most effective ways to support the development of people with Autism Spectrum Disorders (ASD). These debates involve all who are aware of the technology to assist people in learning and occur in research environments, in the media, at conferences, in articles and online, and across all disciplines (Prizant & Wetherby, 1998). This adds to the confusion and doubt for professionals, families and care-providers who support and teach individuals with ASD, as to what methods are best and what is the most valid way to support learning. Some of these debates include the effectiveness of some behavioural approaches in changing behaviour and teaching, the use and structure of reinforcement and consequences, and generally the status and understanding of applied behaviour analysis methods.
The best way to conceptualise approaches to enhance social, communication and other abilities for children and adults with ASD, is along a continuum with traditional behavioural approaches at one end (Lovaas, 1977, Lovaas, Varni, Koegel, & Lorsch, 1975), and the developmental social pragmatic approaches at the other end, which include relationship based approaches that are individualised and grounded within a developmental model (Wetherby, 1997, Prizant, Shuler, Wetherby, & Rydell, !997). Contemporary behavioural approaches fall between the extremes of this continuum and incorporate aspects of each (Meyer & Evans, 1993, Warren, 1993). Applied Behaviour Analysis (ABA) moves along this continuum.
Rather than debating the merits or shortfalls of any one method, it is more constructive to focus on the specific elements that are definitive and effective of the different approaches, especially those that fall under the label of ABA, rather than making global statements about the (de)merit of treatment types. This may provide a context for more thoughtful and reflective discussion about what happens in teaching interactions. Ultimately, by focussing on the definitive elements of practice, efforts to determine treatment effectiveness (efficacy) will be more open to individualised and eclectic approaches than to comparisons of philosophy constrained and narrowly defined treatment packages. Progress has been made recently toward this goal (Dawson & Osterling, 1997, Rogers, 1996), but much more work is needed.
The focus of this paper will be to look at Applied Behaviour Analysis and in particular Discrete Trial Teaching, that has been successful in teaching and providing behavioural support to people who fall on the ASD spectrum (LaVigna & Willis, 1997), that falls within the ABA continuum, and by adding and supplementing learning opportunities with Visual Supports strategies, that collectively will support more effective learning experiences. Within the context of validated research, evidence strongly suggests that children and adults with ASD are able to learn social and communication skills effectively and with high degrees of success by combining these approaches (Gray, 1995, Wetherby, 1997, Prizant & Wetherby, 1998).
A glimpse of Autism
Autism was first recognised by Dr Leo Kanner and by Dr Hans Asperger during the 1940’s. Although Aspergers contribution wasn’t recognised until much later (Wing 1991), it is generally recognised that they were the first academics to research Autism and Aspergers Syndrome and other Pervasive Developmental Disorders, writing a series of papers recognising the nature of a number of conditions that are within the ‘Autism Spectrum’.
Autism and Aspergers Syndrome are considered separate conditions that fall within an interrelated continuum (Attwood, 1998). These conditions are complex and challenging and affect the person in all areas of life and throughout life. It is considered a life long condition. Research to date indicates that there is no cure for autism (Accardo, Magnusen, & Capute, 2000). The effects however, may be assisted through early and/or behavioural intervention. Medication in some cases may assist with certain issues (Zimmerman, Bonfardin, & Meyers, 2000). Some procedures and treatments may have an effect, for example special diets and sensory motor integration techniques etc, but this does not guarantee success. For some people things may work, but for others the same methods may have no effect at all. Often, the major beneficial effect however, is usually through intensive behavioural intervention. (Koegel & Koegel, 1995, LaVigna & Willis, 1997).
Autism is considered to be an organic disability. This means that it has a neurological base in terms of cause (Attwood 1994, 2001, Zimmerman & Gordon, 2000), and that a person with autism is often unable to have control over the effects of having the condition. It is still unclear as to what the cause may be, but it is believed that there may be an interactive trigger that increases the likelihood of the condition to appear (Attwood, 1998, Happe, 1994). Once thought to be a rare condition, recent research estimates the incidence of autism to be between 1 in 500 and 1 in 1000 births in the general population for Kanners Autism, or Autism where individuals have higher or increased support requirements, and up to 1 in 300 for Aspergers Syndrome, where individuals may be functioning at a higher cognitive level (Matson, 1994, Happe, 1994, Zimmerman & Gordon, 2000). Lorna Wing (1996), discusses the ‘Triad of Impairments’ that identifies significant differences in communication, social skills, creative and imaginative thinking for people with ASD, as well as the underpinning of sensitivities that affects learning and anxiety.
For many children and adults who fall on the autism continuum, there appears to be a number of common issues that impact on the person that can contribute to a difference in the way life is experienced. From a teaching or treatment point of view, it is very important to understand the impact that these have on the person and how they can affect what is happening. Some examples include the following from ‘A GLIMPSE’ of Autism (Powell, 2001): based on the research of Baron-Cohen (1995, 2005), Frith (1989), Grandin (1998), Happe (1994), Quill (1995), Rand (1998), Wing (1996), Accardo (2000), Accardo, Magnusen & Capute, (2000).
1. Attention to Detail
When processing information people generally tend to get the overall picture first such as remembering the theme of a story rather than every detail. People with ASD seem to process information in a different style that focuses on the detail rather than the overall bigger picture. This focus makes many people with autism skilled at certain tasks where there is a need to attend to detail, for example a remembering every detail of a television programme and to the point of repeating scenes. Fascination to small detail that may seem irrelevant or unimportant to others without autism, a small thread on clothing, a blemish on a person adds to the interest.
2. Generalisation
People with ASD often learn skills or behaviours in one situation but have great difficulty generalising these to a different situation. For example, they might learn to comb hair with a black hairbrush, then refuse at brushing hair with a brush of any other colour, might learn to wash plates but not realise that the same process is used for washing glasses, might learn the literal wording of a rule but not understand its underlying purpose and thus have trouble applying it in different situations.
3. Literalness
Many people with autism pick up on the literal meaning of language and focus on the content of what is said rather that what it means. For example statements like “Running on empty”, “Laugh your head off”, “ Mummy has had enough!”, “ and take a running jump”, can be interpreted in different ways. A person with autism may only pick up what is actually said and not what is implied.
4. Inferences
This refers to the difficulty that many people with autism have in determining the hidden meanings in language and behind what is said, or in determining inferences that are made. Communication is full of subtle messages that include the use of body language, verbal statements or requests, how these are interpreted can lead to misunderstanding for a person.
5. Metaphors/Similes
This represents understanding the content of speech and the way that language is used descriptively to illustrate something. This can be very confusing for a person with Autism or Aspergers Syndrome. Metaphors, for example “She is a fish in water”, “the cars were spiders when they travelled along the road”, and Similes, for example, “as warm as the glow of honey”, can be misinterpreted by the person with autism and make understanding difficult in terms of actual meaning.
6. Motivation
Many people with ASD lack motivation in doing activities or applying themselves in any situation that does not hold any interest value. For many the interest lies in the sensory value or stimulation that is obtained from focussing on the interest area. Special interests are important, often to the exclusion of anything else.
7. Motor
Many children and adults with autism have coordination difficulties or where physical movement can be erratic. Sometimes coordination can be affected by the persons intense focus on something else and losing concentration on what needs to happen to be successful, for example focusing on the instruction of “catch the ball”, and dropping the ball because attention has been diverted. For some motor ability can be enhanced with a high level of skill and ability demonstrated. Stereotypical behaviours, for example flicking fingers, may be present as well.
8. Problem Solving
For many people with autism, the way that problems are solved is often unusual. For some their problem solving abilities are exceptional and many people are in positions where their problem solving talents are recognised, for example in design, accountancy, engineering etc. What is observed is the non-lineal way that solutions are often obtained. Regardless of cognitive level, people appear to have greater difficulty with symbolic or abstract language or concepts, than with the interpretation of straightforward facts and descriptions. Lack of concept of meaning, excessive focus on details with limited ability often to prioritise the relevance of details, thinking processes that are more concrete, difficulty with combining or integrating ideas, and differences with organisation and sequencing are common features.
9. Sensitivities
People with autism often may show unusual responses to sensory experiences, particularly sound, touch, taste, smell or pain. There may be an under or over reaction to stimuli, or the anticipation or experience of a situation may produce anxiety or panic.
10. Empathy (Theory of Mind)
Normally developing children are able, from about the age of four years, to understand that people have feelings and desires and beliefs ‘inside their heads’, and that other people do not automatically know what feelings and desires the child is experiencing. Research has demonstrated that people with ASD are poor ‘mind readers’, finding it difficult to understand that another person may feel, want, know or believe differently from themselves. ‘Mind blindness’ can explain some of their difficulties with communication and some inappropriate behaviours.
Applied behaviour analysis and discrete trial teaching
It is important to understand that Applied Behaviour Analysis is a framework and not any one specific programme (Wetherby, 1997). This is important to consider when one analyses behavioural programmes for people with autism and regularly there are encounters with situations where children or adults are “doing ABA”. Typically these people are actually involved in or running intensive behavioural programmes based on discrete trials, for example Lovaas or Precision Teaching type programmes. It is important to note that they are developed and constructed as ABA based interventions with particular philosophical or treatment approaches, and are quite specific in their objectives, but are not the whole of ABA itself. This may seem a semantic argument, but one should remember that ABA is a set of principles and guidelines upon which educational processes (or any number of applications) are based (Prizant &Wetherby, 1998).
LaVigna and Willis (1997, 2005) outline a number of essential elements of an ABA based programme:
* The programme must be applied. The behaviours that one chooses to focus upon should have some social significance and importance and functionality.
* The programme has a behavioural focus, the environment and physical events should be detailed with precision.
* The approach must be objective and analytical. There should be clear and convincing evidence through carefully collected data that identifies that intervention is responsible for change in behaviour.
* Techniques must be able to be described well enough to allow for duplication and replication.
* The programme must be conceptually systematic. There should be relevance to established and accepted principles, for example operant conditioning and positive programming.
* It must be effective and should seek to change the targeted behaviour in a positive way, not causing pain or intrusive distress.
* There should be a focus on generalisability. A change in behaviour should be seen in a wide variety of environments, or should spread to a wide variety of related or similar behaviours.
Discrete Trial Teaching has been defined as a strategy to teach new skills to children and adults and is one of “several methods that increase the likelihood that a person will give a desired response so that it can be reinforced…” (Anderson et al., 1996, p.187). A trial is considered to be a single teaching unit that begins with the presentation of a stimulus (teacher instruction), the person’s response, the consequence, and a pause between trial and interval, before the person in the teaching role presents the next stimulus.
Instructions are usually given once with the persons response evaluated as correct/incorrect, or no response. At this point depending on the programme philosophy, this is followed by a consequence that is based on the correctness of the response relative to a predetermined criterion. Usually, correct responses are reinforced with praise or primary reinforcers (e.g. verbal “well done”, physical contact like a handshake, or in some cases tangible like food or a token). LaVigna & Willis (1997), and Meyer & Evans (1986, 1993), highlight the importance of the use of positive experiences to enhance and reinforce desired behaviours and most importantly that no aversive or punitive consequences should be used.
According to this philosophy, incorrect responses are either shaped, redirected or diverted towards the desired outcome. If success is not forthcoming then the target behaviour may be broken down into smaller steps, restated or adjusted so that there is always some successful outcome. LaVigna and Willis (1997), note that “participating in the interaction and teaching session is success in itself and warrants positive feedback” (p.182). In many programmes incorrect responses are reinforced with verbal feedback, such as “no” or “wrong”, and physically guiding the person to a correct response, which is referred to as a correction trial (Anderson et al, 1996). In some approaches the incorrect response is redirected or shaped, with physical or verbal guidance, with no direct reference to what was done incorrectly (LaVigna & Willis, 1997). The purpose is to delineate each teaching opportunity.
Supporters of Discrete Trial Teaching indicate that it is but one strategy for teaching new skills (Lovaas, 1995, Anderson et al, 1996, LaVigna & Willis, 1997). Lovaas states that it should only be used for short term periods at the beginning of the programme, however, the most frequently cited and recommended literature published on Discrete Trial Teaching (Maurice, Green, & Luce, 1996, Prizant & Wetherby, 1998), focus on Discrete Trial programmes as the overall predominant strategy for teaching people with Autism/Pervasive Developmental Disorders, with a range of cognitive abilities. The role of the person in the teaching role is to initiate teaching interactions, maintain instructional control (Anderson et al, 1996, La Vigna & Willis, 1997, Meyer & Evans, 1986), and reliably follow programmes of instruction that are well designed beforehand. This allows an opportunity for the person in the teaching role to be trained and skilled in the use of Discrete Trial Teaching strategies and focus on shaping incorrect responses positively.
The primary elements of Discrete Trial Teaching include (Prizant & Wetherby, 1998, p.11):
1. The teaching structure is highly prescribed, including the choice of the stimuli presented, the responses targeted, and the consequences proved. This includes the physical teaching situation.
2. There is a focus on teaching discrete and objectively defined behaviours.
3. The learning context involves 1:1, person/teacher ratio, with the teacher determining the activity and focus of attention (curriculum)
4. Predetermined criteria are provided for correctness of response evaluated as correct/not correct. Off task responses, even if communicative or relevant to some aspect of the training context may be ignored, redirected or shaped).
Discrete Trial Teaching research (Prizant, 1982, Prizant & Wetherby,1989 & 1998), cites a number of contributions that these approaches have made to the successful teaching , learning and support for people with ASD. There is a focus on intensive instruction, a provision of strategies for breaking down teaching goals and activities, demonstration of the value of utilising highly structured routines in teaching sessions that are successful for people with Autism and Aspergers Syndrome, a focus on attentional skills and interest, is systematic, and has a clear prescription for teaching. An important feature is the transitional and reciprocal nature of social interaction and communication is seen as the essence of enhancing social and communication abilities (Prizant & Wetherby, 1998).
Discrete Trial Teaching approaches have pioneered the use of task analysis for breaking down activities into small steps, however a concern experienced is that there is potential for fragmented teaching interactions and activities that lose their meaningfulness. Training attentional skills is also a basic tenet of the approach, however this can be detrimental to focus solely on teacher control of a persons attention rather that facilitating a shared attentional capacity by considering and following the persons attentional focus and interests. Another concern is having a clear prescription for teaching may be comforting and necessary for some professionals and parents, and may provide a starting place for some people with ASD, however there are risks in following prescriptions (i.e. teaching programmes and formulas) too rigidly, ignoring opportunities for building student-initiated, spontaneous interaction, communication and play.
Related to this, from the authors clinical/ teaching experience as well as from current literature, there are other points that need to be considered when participating or designing a Discrete Trial programme (Elliot, Hall & Soper 1991, Prizant, 1982, Fay & Schuler, 1980, Wetherby, Prizant and Schuler, 1997):
* To be careful not to have a narrow focus on speech and grammatical structure in lieu of multi-modal communication that serves a range of communicative functions.
* To note that treatment and teaching activities may be characterised by a fragmented, unrealistic structure, without logical sequence of events that relate to the persons everyday experiences and interactions.
* The person in the teaching role has primary control of how learning is to proceed, with the person in the learning situation placed in the respondent role, which may result in passivity. Internal control involving initiation and spontaneity are not goals until later in the programme.
* Learners may become extremely prompt dependent or cue dependent due to inflexible teaching interactions.
* There needs to be inclusion of peers or opportunities to learn from and interact with others with skill capability to reinforce and enhance motivation, offering modelling and demonstration of the learning goal.
Another critical point to note is that Discrete Trial Teaching approaches attempt to teach clearly defined skills, however such approaches may not address or may de-emphasise the core deficits observed in ASD. These include problems in shared and joint attention, spontaneous and initiated preverbal and verbal communication, emotional expression and relatedness, and imaginative play.
Using visual support techniques to supplement learning
The use of visual methods to supplement teaching has probably been one of the greatest advances in the success of teaching strategies and learning support for children and adults with Autism Spectrum Disorder (Quill, 1995, Grandin, 1995, Attwood, 1998). When combined with Discrete Trial Teaching, can impact positively on learning.
Some reasons for this success includes:
* People with autism often demonstrate relative strengths in concrete thinking, rote memory, understanding of visual-spatial relationships, and difficulties in abstract thinking, social cognition, communication and attention (Quill, 1995). The use of pictographic and written cues can often aid in helping the student to learn, communicate and develop self-control.
* One of the advantages of using visual aids is that they can be examined for as long as needed to process the information. In contrast, oral information is transient. Once it is said, the message is no longer available. This may pose problems for people who have difficulties processing language, and who require additional time (Attwood, 1997). In addition, it may be difficult for the child with autism to attend to the relevant information and to block out the background noises. The use of visual supports enables the individual to focus on the message.
The type of visual aids and symbols vary in complexity. Objects are the most concrete forms. Pictures and photographs are the next level of representation. Graphic symbols are somewhat more complex and consist of pictographs and written language. Graphic symbols have been widely used and proven to be successful for children with autism. There are software packages available, which provide quick access, and the opportunity to create customised symbols.
A good example of this is the Boardmaker@Program (Mayer-Johnson 1987-2006) and COMPIC communication system. Also the resources developed over the past few years by Hogdon (1991, 2004) and Larkey (2006) have re-energised and enhanced learning utilising visual supports.
* Visual supports can be used in a variety of ways in the educational setting. It should be remembered that these visuals should be modified for children and adults to include more than just words by providing pictures, photographs and drawings. Quill (1995), Hogdon (2004) and Larkey 2006) provide a range of good examples of different types of supports. Some of these include:
* Visual aids for organisation, such as daily schedules, mini-schedules, activity checklists, calendars, choice boards. Aids for giving directions, such as classroom rules, file cards with directions for specific tasks and activities, pictographs and written instructions for learning new information are also useful.
* Strategies for organising the environment, such as labelling objects and containers with both words and pictures, signs, lists, charts, and messages.
* Aids for social development such as posting rules and routines, and teaching social skills through the use of Social Stories (Gray, 1993). A social story is a description of a social situation, which includes the social cues and appropriate responses, and is written for a specific situation for the individual child. A way to personalise a teachable moment, especially in social situations, and then be able to return to that experience for further teaching.
* Aids to assist in managing challenging behaviours and developing self-control. This may include rules, as well as pictographs, which provide a cue for expected behaviour, rules, limits and boundaries.
* An important point is to consider when planning an activity or giving an instruction is "How can this information be presented in a simple visual format?" The selection of visual aids is guided by an understanding of the child and his/her abilities and responses.
Provide structured, predictable environments.
The environment should be structured in the sense that it provides consistency and clarity, people with ASD know where things belong, they know what is expected of them in a specific situation, and can anticipate what comes next. The rules, routines, customs and events within the environment are consistent. All those working with the child should have clear and consistent strategies already planned for dealing with the person. If possible these strategies should be replicated in the home environment to ensure consistency across environments.
Provide customised, visual daily schedules.
Vary tasks to prevent boredom, although it should be acknowledged that many people with ASD enjoy repetition, order and routine and variation can cause distress. Alternate activities to reduce anxiety can prevent some inappropriate behaviour to emerge. For example, alternate familiar, successful experiences with less preferred activities. It may be helpful to alternate large group activities with opportunities for calming activities in a quiet environment.
Incorporate physical activity and exercise
This should be done at regular points throughout the day is helpful. Encourage outdoor experiences, music and movement and physical exercise.
Always provide positive praise and reinforcement while learning (Meyer & Evans, 1993, LaVigna & Willis, 1997)
As explained in the context of Discrete Trial Teaching, provide information about what the person does right or well. Be specific and clear about the praise being given and keep it simple. Reinforcement must be available but consider that child with autism may not be motivated by common reinforcers. He/she might prefer some time spent alone (or sanctuary), time to talk to a favourite person, an exercise routine such as going for a walk, time to enjoy a favourite object or getting to perform a favourite routine. Items that provide specific sensory stimulation appear to work for some. It is important to know what is reinforcing for each person and that this is an individual choice.
Consider sensory factors in instruction and environment
Some of the factors to consider that relate to sensitivity to note include:
* Visual – Are there distracters such as light, movement, reflection, or background patterns? Consider the eye level of the person, the position of the teacher in relation to the child and distracters that may interfere with attention. Also to consider is the time required to shift attention.
* Auditory - Are there fans, fluorescent lighting, loud speakers, several people talking at once, air conditioners, bells, dogs barking, or scraping? What is the general sound level, and the predicability and repetitiveness of sounds?
* Tactile – are there textures which seem to be aversive and the person appears defensive? Are temperatures appropriate? Does the person demonstrate a need to explore through touch and yet avoid being touched? What is the level of ability/defensiveness in the use of objects?
* Vestibular – This is the sense of movement. Consider the person’s need to move and exercise. What are the individual’s reactions to movement?
* Taste – Consider the preferences, dislikes, textures and temperatures of foods. Again be aware of subtle considerations.
Note tasks and activities which create frustration
Examine the environment for items, sounds and activities that may result in sensory overload for the individual. Make available those sensory experiences that may be calming for the child and adapt tasks and materials to promote successful participation. When feasible, decrease environmental distracters that interfere with learning or confuse, disorient or upset the person.
Have a relaxation area or Sanctuary
As described by Attwood (1994), at times, it may be necessary to have a calm, quiet, designated area where the person can go to calm or relax.
Provide opportunities for meaningful contact with other people who have appropriate social behaviour
Involve the person in shared learning arrangements. Some examples include pairing with peers and utilising peer-tutoring situations when possible.
Teaching Communication
The aim of facilitating the development of communication is to focus on natural language interventions that teach functional language skills within the social context where they will be used (Koegel, Koegel, 1995). The home and educational environments provide a wealth of opportunities to develop functional communication within social contexts to promote generalisation, or assist with the ability to use skills in other situations different from the one that the skill was taught in. However, opportunity alone will not address the communication needs of the person with autism. The identification of specific skills for instruction and strategies for developing the targeted skills are needed.
General strategies and suggestions that may assist with developing communication skills:
1. Focus on developing interaction and communication in the environments in which the person actually communicates. This makes it functional and useable.
2. It is necessary to provide structured teaching to develop social and communicative skills. This can be done through the provision of structured opportunities, which incorporate the person’s interests. This includes the use of modelling, physical prompts, visual cues and reinforcement used to facilitate attention, imitation, communication and interaction. These need to be considered in all environments the person is spending time in.
3. Talk at a sentence level, using vocabulary that is appropriate to the person’s comprehension capability (if known). Be careful when considering this.
4. For people with more severe communication needs, choose familiar, specific, and concrete words, and repeat as necessary.
5. Teach the person to wait and to listen. The use of visual supports may aid in obtaining and maintaining attention
6. Talk more slowly and pause between words to allow time for the person to process the information. The pace of speech is dependent on the ability of the individual person.
When working with people who are higher functioning, it is easy to assume that the person understands information, particularly if they are able to repeat it. However, even though there may be good recall, the understanding may not be there. It is important to avoid long strings of information, to use visual supports to aid comprehension and to check for understanding.
For people with limited expression, accept restricted verbal and nonverbal behaviour as communicative. Set up communication opportunities to encourage expression. This can include:
* situations to encourage requests, such as, asking for food, toy or help
* situations to encourage negation such as, refusing a food, object or activity; protesting when asked to do something, or indicating when the child wants to stop.
* situations to encourage commenting, such as verbally labelling pictures in books, or objects from a box, greetings or play activities.
Some people demonstrate echolalia, (the literal repetition of words or phrases). Echolalia can be used as a teaching tool. The echolalic speech can be shaped through the use of rules and using the echolalic skill to model more appropriate language. (Attwood, 1994, 2005).
Some people may benefit from the use of an augmentative communication system. An augmentative communication system is any approach that supports, enhances or adds to the way a person tells you something (Gray, 1995).
There are a variety of augmentative systems including gestures, pictures, symbols, and/or technological devices. When to begin with such a system is variable between individuals but informal systems can be started as soon as the person shows an interest in communication.
Virtually all individuals with autism have difficulty with pragmatics and the interpretation and use of language in social situations. Even those people who have a good vocabulary and appear to have a command of the language may have a restricted understanding of social and conversational interactions. The social use of language is an important area for instruction for people with autism.
Carol Gray (1994) has developed the Comic Strip Conversation strategy for teaching conversation skills through the use of simple drawings. These drawings illustrate what people say and do, and emphasise what they may be thinking. A set of eight symbols is used to represent basic conversational skills such as listening, interrupting, loud and quiet words, talk and thoughts. Colours may also be incorporated to represent the emotional context.
Teaching Social Skills
One of the defining characteristics of autism spectrum disorder and other pervasive developmental disorders, is the impairment in social interactions and social skills. When addressing social skill development, it is essential that the person have the opportunity to participate and interact in a variety of natural environments where appropriate models, natural cues and stimuli, and functional reinforcers are available. Placement within integrated environments that provides access to peer models and social opportunities is also important.
In general, people with autism require focussed teaching (Discrete Trial Teaching) to develop social skills and understanding of social situations. Some good examples include:
1. Social Stories
This is one of the most helpful methods for teaching social skills through the use of pictures to supplement and support learning. This strategy was first developed by Carol Gray in 1994 and developed over the years.
A social story is a description of a social situation, which includes the social cues and appropriate responses, and is written for a specific situation for the individual person. The story can be used for a variety of purposes, including facilitating the inclusion of the person in regular situations, to introduce changes and new routines, to explain reasons for the behaviour of others, to teach situation-specific social skills, and to assist in teaching new skills.
The process begins with the identification of needs through observation and assessment. Once a difficult situation is identified, the teacher observes the situation and attempts to consider the perspective from the child’s point of view in terms of what will be seen, heard, and felt. A story is then written at an appropriate comprehension level for the person and includes descriptive, directive, and perspective statements. The descriptive sentences provide information on the setting, activity and people involved. It is important to note that the directive statements are positive statements of the desired response for a given situation and the perspective statements provide a description ofthe possible reactions of others.
The use of social stories, as well as other visual supports, is viewed now as an integral part of comprehensive social skills development for a person with autism. They can be incorporated in teaching complex social behaviours and survival skills that are needed in everyday situations. Developing an understanding of the basic rules associated with a given situation will help the person to adapt to the social context, may prevent increased anxiety and, reduce the reliance on inappropriate coping behaviours.
2. Cognitive Picture Rehearsal (Groden & LeVasseur, 1995).
This method involves presenting a sequence of behaviours in the form of pictures or pictographs with an accompanying script. The person is guided through repeated practice of the sequence of behaviours.
Optimally, the end result of developing specific social skills is to enable the child or adult to interact with others in a variety of settings and to facilitate the development of social opportunities and relationships. Children who demonstrate basic social skills may still have difficulty establishing connections with other people and in maintaining interactions with peers.
Finally, the goal for all is to increase independent participation in a variety of environments. One method that has been used to increase independence is teaching self-management procedures (Koegel & Koegel, 1995). Self-management involves teaching the person to monitor their own behaviour and to obtain reinforcement for engaging in the behaviour appropriately.
There are many other strategies and methods available and programmes that have been developed to teach people with communication and social difficulties. The previous methods described provide a sample of examples of positive programming and design that are available for professionals, parents and care-providers
Summary
As a final note, it is important to understand some of the features that can affect the success of any well-motivated intervention or teaching and learning situation for a child or adult with Autism or Aspergers Syndrome.
There are some features that frequently intrude on a person’s ability to achieve success that relates to the condition and what may present. For example:
1. Having autism creates a world that is at times very confusing and chaotic. Many different situations create stress, some are known but many are not, for example auditory sensitivity, tactile sensitivity, visual sensitivity, to name a few. The degree to which these issues may contribute to difficulties are probably more severe than first presumed. Without this understanding more problems could occur.
2. To assist a person at critical times is essential, and developing consistency of approach a fundamental factor. In reality, developing any degree of consistency is very difficult to achieve.
3. Many different situations create stress and this contributes to anxiety. Don’t assume anything. Depending on the level of anxiety a child or adult experiences, the success of certain strategies is effected. For example, if a child is at a high level of anxiety then some teaching methods can be intrusive and could make things significantly worse.
Assisting children and adults by utilising Discrete Trial Teaching and the use of Visual Support Strategies to supplement learning and teaching has made a significant difference to many people’ lives. There are no quick fix methods that can change the way things are for some, and we attempt to be sensitive, or to try to understand what it is like, or try to change the world so life is not so difficult. As we all know, we can make a positive difference that can form a platform for success. We also know that this will take persistence, time, energy and hard work.
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