by Susan Stokes Autism Consultant
Introduction
The positive outcome of early intervention programming for any child with developmental delays/disabilities has been documented in numerous research articles and publications. However, unlike many other developmental disabilities, children with autism are typically not diagnosed until between the ages of two and three, as there are no medical tests to make a definitive diagnosis of autism at an earlier age. Many medical professionals prefer to take a "wait and see" approach, due to the wide range of "normalcy" in early developing children. Thus early intervention programming can often be delayed for these children, resulting in the "loss" of several critical years of intensive intervention during which significant developments in the brain are occurring. Due to this time factor, once a diagnosis is given, early intervention programming becomes crucial to appropriately address the child's needs in all developmental areas and, most importantly, to develop the child's ability to function independently in all aspects of his life.
Effective interventions for young children with autism are based upon the presence of certain fundamental features. Therefore, a "best practice" approach for providing early childhood services for children with autism should incorporate the fundamental features discussed in this article. Much of this information is also covered in more detail through the statewide training. This link will access information on Autism and the Early Childhood Training: http://www.dpi.state.wi.us/dpi/dlsea/een/auttrain01.html
The fundamental features necessary for a successful early childhood program for children with autism are:
- Curriculum Content
- Highly Supportive Teaching Environments and Generalization Strategies
- Need for Predictability and Routine
- Functional Approach to Problem Behavior
- Transition Planning from Early Childhood program to elementary school
- Family Involvement
Curriculum Content:
The curricular areas to be focused on in an early childhood program should address the core features and characteristics of autism spectrum disorder. The goals and objectives to address each curricular area should be highly individualized for each child's developmental level, as well as his learning strengths and weaknesses (5). Knowledge of typical child development is also crucial in providing a guideline for intervention in the curricular areas. The following curricular areas have been identified as essential to meeting the needs of young children with autism spectrum disorder:
- Attending Skills: A common feature of autism is the child's significant difficulty in interpreting and prioritizing the importance of various external and internal stimuli continually bombarding him (e.g., a fly buzzing around the room; internal perseverative thoughts such as recitation of math facts). As a result, many of these children can exhibit the following:
- Variable attending skills: The child demonstrates attending skills that vary significantly, depending upon his interests. For example he attends well to what is interesting or "makes sense", such as the computer, videos, puzzles, etc., but attends poorly to large group listening activities.
- Difficulty in shifting attention from one stimulus to another: For example if the child is engaged in a visual perceptual task of putting a puzzle together, he may not be able to shift his attention to focus on an auditory directive given by the teacher.
- Difficulty attending in situations where there are multiple stimuli. Because the child with autism has significant difficulty shifting attention, as well as prioritizing stimuli, attending to the "essential information" is challenging. For example, if the child's focused attention is on "sitting appropriately in a small group setting", he may not be able to focus on the information being taught by the teacher.
- Imitation: Imitation is a critical developmental skill for children with autism spectrum disorder to develop, as learning throughout life is based on the foundation of being able to imitate. The ability to imitate impacts learning in all areas, including social skills and communication. Various imitation skills must be specifically and directly taught to the child with autism. These include:
- Imitating fine and gross motor movements;
- Imitating actions on objects;
- Imitating designs with manipulatives;
- Imitating sounds and words;
- Communication (Understanding and Use): Children with autism exhibit significant communication difficulties in both their abilities to comprehend and to express language appropriately. Many children, at the early intervention level, have not learned the "power" of communication - that is, the cause and effect of communication. They have not developed the "intent" to communicate. Some children will try to obtain the desired item themselves and not seek out others for assistance. Children with autism have difficulty understanding that communication is an intentional exchange of information between two or more people. Therefore in order to teach this intent to communicate at this early intervention level, many children with autism must be "tempted" to communicate by using their highly desired objects and actions (1).
- Play Skills with Toys: Children with autism exhibit marked difficulty engaging in appropriate play skills with toys. Play skills with toys can range from the following:
- No interaction: The child shows no interest in touching or holding toys.
- Manipulative/explorative play: The child holds and gazes at toys; mouths, waves, shakes, or bangs toys; stacks blocks or bangs them together; lines up objects.
- Functional play: The child puts teacup to mouth; puts brush to hair; connects train sections and pushes train; arranges pieces of furniture in dollhouse; constructs a building with blocks.
- Symbolic/pretend play: The child pretends to do something or to be someone else with an intent that is representational, including role-playing (e.g., child makes hand move to mouth, signifying drinking from teacup; makes a puppet talk; uses a toy person or doll to represent self; uses block as a car accompanied by engine sounds).
Appropriate play skills with toys and play with peers will need to be specifically and directly taught to children with autism.
- Social Play/Social Relations: A core feature of autism is difficulty understanding, and engaging in, social interactions. At the early intervention level, children with autism typically exhibit significant difficulty engaging in social play with peers. Social play skills with peers can range from the following:
- Isolation: The child appears to be unaware of, or oblivious of others. He may occupy himself by watching anything of momentary interest.
- Orientation: The child has an awareness of the other children, as evidenced by looking at them or at their play materials or activities. However the child does not enter into play.
- Parallel/proximity play: The child plays independently beside, rather than engaging with, the other children. There is simultaneous use of the same play space or materials as peers.
- Common focus: The child engages in activities directly involving one or more peers, including: informal turn-taking; giving and receiving assistance and directives; and active sharing of materials. There is a common focus or attention on the play.
Typically developing peer models are essential to facilitate developmentally appropriate social behavior for children with autism.
Highly Supportive Teaching Environments and Generalization Strategies:
The previously noted curricular areas must be taught in an environment which takes into consideration the unique features and characteristics associated with autism spectrum disorder. The specific skills per curricular area should be taught in a highly supportive and structured teaching environment, and then systematically generalized to more functional, natural environments (1). Features of the environments which should be addressed include the following:
- Physical Environment: Due to difficulties in appropriately processing and modulating all in-coming sensory stimulation, the physically structured environment should provide environmental organization for children with autism. (See next article for additional information.)
Furniture arrangement: Environmental organization includes clear physical and visual boundaries, which (a) help the child to understand where each area begins and ends, and (b) minimize visual and auditory distractions (2). Each area of the classroom (or other environment) should be clearly, visually defined through the arrangement of furniture (e.g., bookcases, room dividers, office panels, shelving units, file cabinets, tables, rugs, etc.).
Children with autism generally do not automatically segment their environments like typically developing children. Large, wide-open areas can be extremely challenging for children with autism. They do not understand what is to occur in each area, where each area begins and ends, and how to get to a specific area by the most direct route. Strategically placing furniture to clearly, visually-define specific areas will decrease the child's tendency to randomly wander/run from area to area.
Visual distractions can be minimized by painting the entire environment (walls, ceilings, bulletin boards, etc.) a muted color (e.g., off-white) as well as markedly limiting the amount of visual "clutter" which is typically present in most classrooms in the form of art projects, seasonal decorations and classroom materials. Reduction of Visual Clutter can be accompanied by using sheets/curtains to cover classroom materials (including equipment such as a computer or TV/VCR), or by removing unnecessary equipment/materials from the classroom or to an area not in the student's view. Certain fluorescent lighting can be visually distracting to some children with autism. Natural lighting via windows can provide an easy solution to this visual distraction. Through the use of blinds, curtains, or shades, the amount of light coming into the environment can easily be controlled, thus creating a warm and calm environment.
Auditory distractions: The lowering of auditory distractions in a physically structured environment can be achieved through the use of carpeting, lowered ceilings, acoustical tiles, P.A. system turned off or covered with foam to mute the sound, and headphones for appropriate equipment, such as the computer or tape players.
Auditory distractions: The lowering of auditory distractions in a physically structured environment can be achieved through the use of carpeting, lowered ceilings, acoustical tiles, P.A. system turned off or covered with foam to mute the sound, and headphones for appropriate equipment, such as the computer or tape players.
A physically structured environment will create an easily understood, predictable and thus calming environment for the child with autism. As a result the child's attention to the most relevant information for learning will be maximized.
(See the article "Structured Teaching: Strategies for Supporting Students with Autism" for more information on a physically structured environment.)
- Visual Support Strategies: Visual support strategies refer to the presentation of information in a visually structured manner. These strategies are effective in helping children with autism understand what is expected of them and how to function appropriately. These strategies support the children's strongest processing area - visual. The visual cues help the child to focus on the relevant and key information. Visual support strategies help children with autism learn better and more effectively. These strategies also minimize stress and anxiety by helping children grasp their environment. Visual support strategies in an early intervention program can include the following:
Schedules directions (e.g., self help skills - tooth brushing; hygiene; washing hands)
- forewarning/foreshadowing
- independent work activities
- teaching rules/alternative behaviors
- increasing language comprehension skills
- expressive communication skills
- making choices
- turn-taking
- waiting
- attending
- academic/readiness areas
"Obect Schedule" "Activity Schedules"
(See the other articles "Structured Teaching: Strategies for Supporting Students with Autism" and "Assistive Technology for Students with Autism" for more information on visual support strategies.)
- Trained Staff: A well trained staff in understanding the unique features and characteristics associated with autism is an essential feature in providing a highly supportive teaching environment. The Wisconsin Statewide Autism Training Project is accessible year round and covers multiple areas. Information on the training is found at the Wisconsin Department of Public Instruction website: http://www.dpi.state.wi.us/dpi/dlsea/een/cspd_trg.html. In addition, CESA #6 provides numerous trainings relating to autism spectrum disorders. CESA #6 web site: http://www.cesa6.k12.wi.us . The Autism Society of Wisconsin also provides information of training opportunities. See http://www.asw4autism.org
Additional training in specific strategies is also suggested (e.g., Structured Teaching Practices, Picture Exchange Communication System - PECS, Sensory Integration Strategies, Music/rhythm integration strategies, discrete trial, Greenspan's Floortime web site: http://www.stanleygreenspan.com , etc.).
If you reprint or use this article, or parts of it, please include the following citation:"Written by Susan Stokes under a contract with CESA 7 and funded by a discretionary grant from the Wisconsin Department of Public Instruction. "
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