Research Paper on Autism
The International Journal of Special Education 2005, Vol 20, No. 1. OVERCOMING CHALLENGES AND IDENTIFYING A CONSENSUS ABOUT AUTISM INTERVENTION PROGRAMMING Carolyn E. Stephens University of Georgia Identifying effective interventions to help children with autism reach their potential has been a source of disagreement among professionals and parents for decades. The complexities of the challenges that face children with autism, and uncertainty about best practices, have delayed progress.
This article identifies seven critical program components that address some of the challenges associated with providing effective and efficient autism intervention programs. The results for children who participate in these programs encourage belief in the ability of children with autism to respond with positive change to appropriately designed and implemented interventions. The number of children with autism entering public school systems has increased dramatically in the last 15 years (National Research Council, 2001; Yeargin-Allsopp, et al. 003). In response, schools are struggling to meet the demands for skilled personnel and effective program structures (Peeters & Gillberg, 1999; Simpson, 1995). Professionals have disagreed about how best to identify components necessary for appropriate programs, how to implement programs that meet a broad range of children’s needs, and how to match efficient and effective services to specific characteristics of individual children (Anderson & Romancqyk, 1999; Brown & Bamberra, 1999; Cohen, 1999; Feinberg & Vacca, 2000; Pfeiffer & Nelson, 1992).
This article presents a brief historical perspective on factors that have complicated implementation of effective interventions on the large scale necessary to meet the needs of school systems in the United States. It also presents seven program components that, based on the literature, may significantly improve results of any comprehensive intervention. These seven program characteristics are supported by many professionals from multiple disciplines involved in studying needs of children with autism.
In this regard, the use of the word professionals includes teachers as well as others, such as speech and language pathologists, psychologists, and program administrators. Changes in autism interventions are clearly moving in a positive direction in which children are demonstrating motivation to learn in programs that can address the developmental deficits that interfere with their learning (Bryan & Gast, 2000; Koegel, Koegel, & McNerney, 2001). Multiple factors Influence Development of Effective Systems of Intervention
The literature identifies at least four factors that have contributed to the difficulty many program administrators face in trying to provide effective and sufficient services for children with autism (Conderman & Katsyannis, 1996; Feinberg & Vacca, 2000). They include the following: (a) Characteristics of autism interfere with learning, (b) Programs maintain low expectations based on historically poor long-term results, (c) Funding resources are limited and intensive programs are costly, and (d) Parents and professionals have had divergent points of view about some fundamental issues.
Characteristics of Autism Interfere with Learning The unique learning characteristics of those diagnosed with autism vary widely from typical learners, and contribute to the complexities of determining a single best treatment (American Psychiatric Association (APA), 1994, Campbell, Schopler, Cueva, & Hallin, 1996). Atypical patterns of attending to stimuli impede children with autism from focusing on critical aspects of tasks (Koegel, Koegel, Frea, & Green-Hopkins, 2003; Smith & Lovaas, 1998). Atypical choices in reinforcement interfere with children’s correct responding to tasks assigned (Heflin & Alberto, 2001).
Social interactions that contribute to early learning experiences of typically developing children are often replaced with preferences for focusing on objects rather than people (Garfield, Peterson, & Perry, 2001; Pierce & Schreibman, 1995). Receptive and expressive languages develop unevenly and usually assume unique patterns, which require adaptations or specific methods of intervention to overcome (Lamers, & Hall, 2003; Koegel, 1995). When learning does occur, unless children reach a level of mastery and self-motivation in using new skills, they often fail to generalize their use in natural settings (Anderson, Taras, & Cannon, 1996).
As a result, specific learning strategies and environments are necessary in order to maintain children’s attention to task and their motivation for school progress. Behavior differences in children with autism are resistant to change and often do not respond to common methods of discipline and reinforcement in schools. When interventions do not address the broad range of behaviors characteristic of children with autism, children remain isolated from their communities, disrupt their families’ lives, and show poor long-term outcomes (Abelson, 1999; Norton & Drew, 1994; Sanders & Morgan, 1997).
Behaviors frequently include self-injury, aggression, property destruction, odd vocalizations, sleep disturbances, or stereotypical self-stimulation. Preoccupations with aimless and repetitive behaviors add to children’s isolation from meaningful social interactions with teachers and peers that are essential for emotional development and cognitive growth (Koegel, Koegel, Harrower, & Carter, 1999).. PG 35-36 Seven Critical Program Components are Described in the Autism Literature
The literature identifies significant challenges facing intervention decision makers as they develop new programs and strengthen old ones. The literature also serves as a source for empirically supported critical program components that strengthen interventions (Campbell, 2003; Dunlap, 1999; National Research Council, 2001; Pfeiffer & Nelson, 1992; Rogers, 1998). The critical components address communication, social, and behavioral areas of functioning that form the triad of diagnosing criteria for autism (APA, 1994). The program components target a wide range of deficit areas in order o enable children with autism to act more independently, have real choices in natural contexts, and appropriately communicate socially and academically. The seven critical program components that represent a consensus among professionals are identified as: 1. Autism interventions that are supported by empirical evidence should begin as early as possible. 2. Parents should be teachers and decision makers in collaborative teams with professionals with autism expertise. 3. Families and professionals should individualize communication strategies using a broad range of scaffolding approaches. . Professionals should individualize instructional strategies to enable children to demonstrate regular cognitive growth. 5. Programs should provide multiple opportunities for social engagement supported by scaffolding from adults and peers. 6. Adults should teach children pivotal behaviors, including behaviors for initiating, maintaining, and generalizing skills across natural settings and motivate children to function capably in all settings. 7. Children should be given multiple opportunities to learn the social-cognitive skills related to theory of mind concepts about other people’s thinking.
A diversity of theoretical approaches, empirical methods of investigation, and professional disciplines support the seven program components that form a consensus among many professionals studying autism intervention. The program components discussed below are not sufficient to change inadequate, unsuccessful programs that have weak theoretical underpinnings into successful ones. However, children with autism in programs without these seven components, are not likely to reach high levels of meaningful, life enhancing functioning. Early and Evidence-based Intervention
Evidence is strong and undisputed in support of the first program component. Autism interventions that are supported by empirical evidence should begin as soon as toddlers and preschoolers can be identified (Klinger & Renner, 2000; New York State Department of Health, 1999; Osterling, Dawson, & Munson, 2002; Rogers, 1998, Simpson, 2001; Wolery, 2000; Woods & Wetherby, 2003). With the help of reliable screening and diagnostic instruments for young children with autism developed in recent years, children can begin intervention at younger ages than was possible in the ast (Lord, Risi, Lambrecht, Cook, Leventhal, DiLavore et al. , 2000; Stone, Coonrod, and Ousley, 2000). Courchesne, Karns, David et al. , (2001) provide evidence that children with autism may be born with brain sizes within a normal range at birth but deviate from average patterns of growth in the first few years of their lives. Empirical evidence from programs representing varied intervention approaches, supports the long-term positive effects for children with autism when interventions begin as soon as children at risk are identified (Greenspan & Wieder, 1997; 1999; Lovaas, 1987).
McEachin et al. (1993) described the lasting effects for almost 50 % of the children in their intensive intervention group who began treatment when they were preschoolers. McGee, Morrier, and Daly (1999) describe the necessity of providing adequate programs for young children with autism when they can benefit most in preschool inclusion. Identifying children early and beginning intervention programs during critical first years is a major step in improving results for children with autism. PG 38-39) Pivotal Behaviors A number of behaviors that are typically difficult for children with autism to master are pivotal to intervention success (Koegel et al. 1999; Koegel, Koegel, Shoshan, & McNerney, 1999). The sixth critical program component addresses pivotal skills deficits, with emphasis on improving children’s motivation, initiation, maintenance, and generalization of new skills in all natural settings (Burack, Charman, Yirmiya, & Zelazo, 2001; Greenspan & Wieder, 1999; Koegel et al. 001; Rogers, 1998; Strain & Schwartz, 2001; Symon 2001; Wolery, 2000). Koegel et al. (1999) trained adults who regularly interacted with six young children with autism to teach children a series of self-initiation skills designed to promote interactions in their daily lives. The results indicated that three of the six children in the study had good pragmatics on postintervention measures while three had poor pragmatic use of language. The three children with good outcomes had ignificantly higher levels of self-initiations at intake than the children with poor outcomes. Researchers concluded that self-initiations may represent a pivotal skill that should be taught to children with autism who do not initiate social interactions when they enter intervention programs. Milieu intervention strategies are commonly used to teach pivotal skills to children with autism who have difficulty generalizing learning to novel settings. In milieu interventions, children learn in the context of the daily settings where skills are needed.
Yoder and colleagues conducted a number of studies to measure effects of prelinquistic milieu teaching on communication of young children with developmental delays (Yoder, Kaiser, Goldstein et al. , 1995; Yoder & Warren, 1998). In the recent study by Yoder and Warren (2002), 39 children less than 24 months old with developmental delays of unknown etiologies were randomly assigned with their primary caregivers to two comparison groups. Children who participated with parents trained in prelinguistic milieu teaching increased the frequency of initiating comments, requesting, and lexical density.
Preschool programs specifically designed for inclusion of children with autism provide further evidence for effectiveness of milieu intervention strategies. In the Walden Toddler Program, children are provided with multiple repetitions of learning trials by careful structuring of daily activities and objects to teach children to respond appropriately to naturally occurring stimuli (McGee et al. , 1999). For children with autism, learning pivotal skills during naturally occurring interactions, helps children gain mastery and better generalize learning to natural settings. Theory of Mind
The final critical program component for autism intervention is that children with autism should participate in social interactions that help them learn social-cognitive skills related to concepts about others’ minds (Burack et al. 2001; Greenspan, 2001; Klinger & Renner, 2000). The theory of mind hypothesis identifies a failure in children with autism to understand that other persons do not share the same relationship to, or thoughts about, objects and events in their environment (Garfield, et al. 2001). This deficit, in theory, significantly influences children’s social and cognitive functioning.
There is sufficient empirical evidence in the literature to include theory of mind as an important program goal, especially for older children with autism (Frith & Happe, 1999; Skuse, 2003; Tager-Flusberg, 1992; Tomasello, 1995). Some studies provide evidence that children with autism may understand precursor behaviors that may facilitate learning the more complex aspects of theory of mind thinking. Carpenter, Pennington, and Rogers (2001) tested the responses of preschoolers with autism to others’ unfulfilled intentions.
The authors found that children with autism were not significantly different from a control group of children in understanding of others’ intentions. They concluded that deficits in understanding intentions might not be as severe as deficits in completing traditional theory of mind tests for children with autism. Nadel, Croue, Mattlinger, Canet, Hudelot, LeCuyer, and Martini (2002) conducted a study to measure whether low functioning children with autism would form social expectancies for an adult interacting with them during still face paradigm conditions.
The authors found that children moved closer to the adult and touched the adult more frequently after the conditions in which the adult first remained still before repeatedly imitating the child. The authors interpreted children’s increases in social behaviors as evidence that children could integrate previous social experiences with a current situation to form a social expectancy for an interactive partner. Charlop-Christy and Daneshvar (2003) showed three boys with autism video models for perspective-taking tasks.
The children with autism improved understanding about another person’s mental states after watching the videotape on perspective taking. In these studies, children with autism showed potential for understanding some aspects about others’ thinking. Researchers interpreted children’s behaviors as distinguishing others’ thoughts from their own. To fully understand the theory of mind concepts, however, children with autism are likely to need specific adult scaffolding and multiple opportunities before they gain the higher levels of social-cognitive functioning. (PG 41-43) http://www. internationalsped. com/documents/stephens%20(3)1. doc