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Autism Spectrum Disorder Archive 2008

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Ann England, M.A. CCC-SLP-L
Speech-Language Pathologist
Assistant Director Diagnostic Center, Northern California

Ann has 27 years of special education experience and has extensive training and certification in the assessment and teaching of students with an Autism Spectrum Disorder (e.g., TEACCH, PECS, ADOS, etc.) She participates on a multidisciplinary assessment team at the Diagnostic Center to determine if students have an Autism Spectrum Disorder. She also provides the all day training “Teaching Students with an Autism Spectrum Disorder” to school staff throughout northern California. Additionally, she provides onsite consultation and mentoring to school district administrators and teaching teams to assist in the development and implementation of evidence-based public school programs for students with an Autism Spectrum Disorder. Ann has served on several California Department of Education committees related to Autism Spectrum Disorders and most recently was invited to participate on the Task Force on Education and Professional Development of The Legislative Blue Ribbon Commission on Autism.

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  • How to determine if and when a student is ready to give up aide support?

Question:

Do you have any suggestions or guidelines for helping with the weaning process or a way to determine if and when a student is ready to give up aide support?

Lynne


Answer:

Dear Lynne,

Thanks for writing. The answer to your question really goes all the way back to the moment the IEP team decided to assign a one-to-one aide. That is, if an IEP team initially engages in an objective strategic planning process for assigning an aide, then it will be apparent when the aide is no longer needed or needed less.

When you make the decision to assign a one-to-one aide you should always specify exactly how and when the aide is to provide support and you must also always make plans from the very beginning to reduce the student’s need for an adult to provide that assistance. Yes, it’s true that some students with an ASD may need some level of support throughout their lifetime; however, others may only need some support in some situations. Again, the level of aide support should always be based on the student’s individual needs. That’s why it’s called an Individualized Education Program! Too many times I’ve seen the assignment of a full time one-to-one aide made automatically when, in fact, the student really only needed support in those less structured school contexts such as lunchtime and recesses.

There is no doubt that aides are important and necessary members of the educational community. When assigning an aide, keep in mind that the aide is not supposed to take the place of the teacher but to help promote student independence, not dependence. I actually prefer the title “Independence Facilitator” because we want the aide to teach and implement specific strategies that will maximize the student’s ability to become as independent as possible. It is imperative to remember the fundamental principal that students with an ASD require a curriculum that promotes independence and skills needed for adult functioning. The curriculum needs to focus on helping students to work, socialize and manage their own behavior as much as possible. It is especially important that that the aide has a clear understanding of their role in developing student independence.

In the article, “Determining When a Student Requires Paraeducator Support”, Mueller and Murphy describe a process to help IEP teams determine when to assign aides to support students with disabilities. The focus of this decision-making model is to determine the role of the paraeducator in relation to:

  • The specific support needs of the student.
  • How independence can be progressively furthered.
  • What natural supports are to be used to support the student.
  • How social acceptance can be increased.

The instrument is divided into three parts:

  • The Intensive Needs Checklist is designed to assist in developing an overview of the student’s needs in direct relation to the classroom environment.
  • The Student’s Abilities and Assistance Needs Matrix focuses specifically on what the student can or cannot, do and the extent to which s/he needs assistance. The objective is to systematically review the student’s entire day.

Activity

What student can do without assistance

What student cannot do and needs accom-modation to complete

What student cannot do and needs assis-

tance with

Identify areas to promote social acceptance and how peers will be utilized

Identify areas you will target for indepen-dence (should be identified in IEP)

Arrival

 

 

 

 

 

Period 1

 

 

 

 

 

Period 2

 

 

 

 

 

etc.

 

 

 

 

 

 

  • The Plan for Paraeducator Assistance identifies where, when and how the paraeducator will provide support and how the team will encourage independence in the student.

 

Specify Class

Activity

Identify need

for

paraeducator

Indentify areas to increase socialization (utilize natural supports, peers, yard teacher, librarian, etc.)

Identify how independence will be encouraged

Total time needed for paraeducator support

Total anticipat-ed time reduc-tion in paraed-ucator support by annual review

The authors maintain that in completing all three parts of the instrument, the IEP team will have completed a thorough review of what the student actually needs in terms of aide support. Also, the IEP team will have addressed ways to facilitate social acceptance and academic learning by progressively reducing restrictive supports and making sure that the student’s program includes other natural supports, such as peer modeling, thereby enhancing the student’s independence and social acceptance. The authors also state that this method helps the aide gain a clearer understanding of their role in helping a student become as independent as possible.

I encourage you to read the full article and give the process a try with your IEP team.

Thanks for your great question. I’d like to hear back from you!

Ann

Suggested Readings:

Determining When a Student Requires Paraeducator Support by Patricia H. Mueller and Francis V. Murphy, Teaching Exceptional Children, Vol. 33, No. 6, pp 22-27, The Council for Exceptional Children, 2001.

Helping or Hovering? Effects of Instructional Assistant Proximity on Students by Michael F. Giangreco, Susan W. Edelman, Tracy Evans Luiselli, Stephanie Z.C. MacFarland, Exceptional Children, Vol. 64, No. 1, pp. 7-18, The Council for Exceptional Children, 1997.


  • Teaching sign language to a student with ASD.

Question:

I have a student with ASD who is nonverbal. What do you think about teaching him to use sign language to help him communicate?


Answer:

This is a question that I’m asked frequently because teaching communication strategies to nonverbal children with autism is challenging. When an individual is nonverbal it is essential that we provide support by providing individualized evidence-based interventions one of which is augmentative and alternative communication (AAC) strategies to provide a nonvocal option for communication.

Schreibman and Ingersoll state in their chapter in the Handbook of Autism and Pervasive Developmental Disorders that “…sign language is symbolic and requires the ability to imitate; therefore, many nonverbal children [with autism] fail to acquire it. In addition, because the majority of the population is unfamiliar with signs, children using this system are often unable to communicate in the community.” I wholeheartedly agree. Remember, children with ASD demonstrate significant impairments in imitation (e.g., imitation of face and body movements, actions on objects, etc.). Learning how to sign requires the individual with autism to engage in behaviors that are inherently challenging such as being interested in others, focusing their attention on others and imitating others. Schreibman and Ingersoll go on to say that picture or iconic systems have been used to teach functional communication to children with autism who fail to acquire verbal language and these systems (e.g., picture boards, picture exchange) seem to be easier to acquire than sign language. Paul and Sutherland state in their chapter in the aforementioned handbook that “…acquisition of signs is related to fine motor abilities, suggesting that children with low levels of fine motor development are less likely to benefit from this form of AAC.” All of these professionals agree that picture or iconic communication systems are readily recognizable to individuals who have not been trained in these systems, thus increasing the number of people with whom the children can communicate successfully. There is definitely a continued need for research to examine which AAC systems for nonverbal individuals with an ASD are efficacious.

So, to answer your question, teaching sign language to individuals with an ASD is not supported by research. What is recommended is a comprehensive assessment of the nonverbal child with autism to determine which evidence-based AAC system is most effective for increasing communication.

Suggested reading:

Handbook of Autism and Pervasive Developmental Disorders, Volume 1 and 2, Third Edition, 2005, Volkmar, F., Paul, R., Klim, A. and Cohen, D., ISBN: 047-1716-987, Harcourt Assessment, Inc. P.O. Box 599700, San Antonio, TX 78259, www.harcourtassessment.com, (800) 211-8378

“Language Outcomes for Young Children with Autism Spectrum Disorders”, Watson, L., Flippin, M., in The ASHA Leader, Volume 13, Number 7, May 27, 2008, American Speech-Language- Hearing Association, 2200 Research Blvd., Rockville, MD 20850, www.asha.org, 800-498-2071


  • Can you tell me something about use of medications for individuals with ASD?

Question:

I have several students in my classroom that have been diagnosed with ASD. Many of my students are on some kind of medication for their behavior. Can you tell me something about use of medications for individuals with ASD?


Answer:

What a great question! Yes, it is true that medication(s) may be prescribed for individuals with an ASD. This is a decision that warrants careful consideration. Always remember that there is no single best treatment for all children with ASD and that medication is only one of several treatment options.

The National Institute of Mental Health (NIMH) and professionals agree that an effective treatment program will build on the child's interests, offer a structured program with a predictable schedule, teach tasks as a series of simple steps, actively engage the child's attention in highly structured activities, use visual supports and provide teaching of and regular reinforcement of pro-social behavior. Implementation of these and other best practices for a child with an ASD often helps to reduce behaviors that may interfere with learning and functioning socially. However, there may be a time in the treatment planning that the team makes a determination to add medication as a treatment option.

I have asked John Digges, MD, PhD, MPH, FAAP, our Behavioral Pediatrician, to consult with me. Here is what he had to say:

Currently, there are no medications which have been shown to be efficacious in addressing the core difficulties with social relationships which are fundamental to the ASDs. Nevertheless, medications have been used to treat various symptoms in individuals diagnosed with an ASD. Few of these medicines have been well researched, particularly in children. The aim of treating with medications is to alleviate specific symptoms and is not to sedate children in an effort to inhibit their acting out behavior. For example, the non-pharmacologic therapeutic modalities which have shown efficacy with affected children are more likely to be effective if the child is not engaging in aggressive and potentially injurious behaviors directed towards the therapist.

There are several symptoms that are prevalent in many individuals with an ASD which have been successfully treated with medications. These include anxiety, depression and behaviors such as aggression or tantrums.

Two broad classifications of medications have been used to treat these symptoms: anti-psychotics and anti-depressants. Haldol is an example of a classic anti-psychotic medication which has been used to treat children with an autism spectrum disorder. These medications may have significant side effects, and they have been replaced more recently by a better tolerated class of medications referred to as atypical antipsychotics. One example, Risperdal, has recently been granted FDA approval for use in children with an autism spectrum disorder who have significant tendencies towards displaying aggression and acting out.

Prozac and Zoloft are examples of a type of anti-depressant medication referred to as a selective serotonin reuptake inhibitor (SSRI for short). These medicines are reasonably well tolerated and have demonstrated efficacy with respect to decreasing anxiety, depressive symptoms, and features of obsessive compulsive disorder in children with an autism spectrum disorder.

When considering any psychotropic medication, it is always desirable to consult a physician, such as a child psychiatrist or behavioral pediatrician, who is knowledgeable about the autism spectrum disorders and their treatment. A child should always be monitored closely while taking a medication.

To learn more about medications and treatment options for individuals with an ASD visit the National Institute of Mental Health website for Autism Spectrum Disorders (Pervasive Developmental Disorders):http://www.nimh.nih.gov/health/publications/autism/complete-publication.shtml


  • What should we do about a autistic student who makes noises while working?

Question:

I have a student with autism in my third grade general education classroom. Everything is going really well except he makes noises while he’s doing his work. It’s pretty disruptive to the other students and me, too! What should we do?


Answer:

Making noises in class is actually a very common concern. As with all challenging behaviors we must dedicate some thought to determine the purpose of the behavior. Is the function of the behavior (i.e. making noises) to ‘get something’ or to ‘protest, reject, escape or avoid’? Let’s begin with the hypothesis that the purpose of this behavior is to ‘get something.’ To get what? Well, let’s explore some of the possibilities

  • The student may be making noises to ‘get attention.’ It may have been that from the very first time the student made noises while engaged in class work an adult came over and said, “Shh!” and then maybe even helped the student with the work. Guess what may have happened? Yep, from that moment on, making noises was reinforced as a way to gain an adult’s attention! So, if this hypothesis is correct then you’re going to replace the challenging behavior of making noises for the purpose of getting attention with a more socially acceptable means of gaining another’s attention. 

    I’d recommend that you teach the student to raise his hand when he wants the teacher’s attention just like the other students in the class. How? Use visuals. Explore placing a visual behavior rule card on his desk that has a picture symbol of a student raising his hand. Make sure to have the word ‘help’ printed on it, too. Each time the student makes a noise, point to the behavior rule card and say, “Raise your hand” and then acknowledge the student. Eventually fade your verbal prompt and pointing to the card. Always reinforce the student for performing the desired prosocial behavior (e.g., “Thanks for raising your hand. What do you need?”) Don’t forget to collect data to see if this strategy results in a decrease in making noises.

help

Help

  • The student could possibly be making noises as a way to ‘get regulated.’ That is, the student may be feeling stressed (‘dysregulated’) while doing his class work; making noises may be a way he soothes himself. If this hypothesis is correct, then you should review the class work being assigned to the student. Evaluate the work by asking yourself these questions and then make appropriate adjustments:
    • Is the work too hard?
    • Did I give him too much work?
    • Is the work boring/uninteresting?
    • Does he know how much work he is to complete?
    • Is there enough time to complete the work?
    • Are appropriate accommodations provided?
  • The student may be making noises to simply ‘get sensory stimulation.’ He likes making noises!!! If this hypothesis is true, then you might implement strategies to delay making noises and include it on his mini-task schedule as a reward. For example, you would first show him the visual behavior rule card:

shhhhh

Shhh! Quiet!

Then you would show him his mini task schedule that might look like this:

  • Do math problems 1-5.
  • Put math worksheet into finished basket.
  • Go outside to recess and make noises or play.
  • Return to class and check schedule.

You might also consider using an ‘If / Then’ card. For example,

If I do my work Then I can make noises in my break area for 5 minutes

I’ve had success in developing a social story to address this issue. Teaching a student when and where he can make noises is an important life-long skill that will help him become more socially successful in many contexts such as school, community and the workplace. Social stories are a way of teaching social and life skills to students with an ASD. According to Carol Gray, the developer of Social Stories, “ A Social Story describes a situation, skill, or concept in terms of relevant social cues, perspectives, and common responses in a specifically defined style and format. Although the goal of a Story should never be to change the individual’s behavior, that individual’s improved understanding of events and expectations may lead to more effective responses.” Examples of a social story title for your student might be, “When and Where I Can Make Noises.” To learn more about how to write a social story visit www.thegraycenter.org The Gray Center for Social Learning and Understanding, the “Official Home of Carol Gray and Social Stories.”

Finally, don’t forget to take data so you’ll know if your strategy is effective at reducing the noisemaking.

Thanks for your great question and best of luck as you explore the most effective intervention strategy for your individual student.


  • My student with autism has difficulty making transitions from one activity to another.

Question:

My student with autism has difficulty making transitions from one activity to another. He even has difficulty when he is going to go do something he really likes to do! He also has difficulty when the there are changes in the schedule for the school day. Do you have any suggestions?


Answer:

Resistance to change and difficulty with transitions for individuals with autism has been well documented. We know that structure is very helpful in easing the stress some students may feel during transitions. The TEACCH program (www.teacch.com) states, “To effectively teach autistic students a teacher must provide structure, i.e., set up the classroom so that students understand where to be, what to do, and how to do it, all as independently as possible.”

We also know that the probability of having the exact same class schedule each and everyday is highly unlikely!!! Assemblies, shortened school day, rainy day schedules, and field trips are just a few examples of how a school day changes from one day to the next.

Linda Hodgdon of www.usevisualstrategies.com says there are four common causes for transition troubles: 

1.Leaving a favored activity 
Students can enjoy favorite toys or activities or people so much that they absolutely don’t want to stop.

2. Moving to anything that is disliked 
If you hate the dentist, you aren’t going to go there with enthusiasm. Keep in mind that students may dislike activities or locations that you think are wonderful. Perhaps you think of gym as a fun place to go. In contrast, your student may be terrified by the lights or sounds or wide open space.

3. Going to an unknown destination or activity 
Do you ever take kids with you without telling them where you are going? Or perhaps you told them but they didn’t hear. Or maybe they don’t remember. So their brains are thinking, “Where are you taking me? What is happening? It’s new. I don’t understand. I don’t like it here.”

4. Anything that feels like an unexpected surprise 
A lot of people don’t like surprises. They need to “get ready” for something to happen. Otherwise, there is too much information to take in all at the same time. Shutting down may be the only way to cope. Consider that you may not think something is unexpected, but that is how it feels to the student. S/he may not pick up on the same environmental cues and conversation that everyone else does.

Obviously all transitions are not the same so you’re going to have to take some time to figure out what’s going on at each transition time in order to select the best intervention strategy.

Here are some strategies I often recommend to help students with an ASD cope with transitions:

    • Develop a daily visual schedule for the entire classroom (in certain grade levels.) Display the schedule in the front of the classroom and make sure that the teacher refers to it throughout the day and especially between activities when transitions occur. 
    • Develop and provide the student with an individual schedule that depicts each activity of their day. Individually design the schedule based on the student’s ability so that the schedule is meaningful and understandable. For example, some students may require an object schedule while other students would be better able to understand a pictorial schedule (e.g., photo or picture symbol.) And those students who are able to read would have a written schedule. For sure, make certain that the individual schedule is available to the student at all times, portable and referred to at each transition using simple language. 

    • Make sure the student is aware and understands that an activity has a clear beginning and an end. Sometimes you can add the beginning and ending time on the schedule to help the student see a beginning and end to the task. We often recommend that a student puts the object schedule item in a finished area, the picture symbol in a designated ‘finished pocket’ or the student crosses off each written activity as it is completed. This helps the student understand that the activity is finished and it’s time to transition.

    • Always review the schedule with the student and always indicate when there is change in the schedule. We have found that when a student with an ASD is informed of a change in the schedule ahead of time s/he is often better able to cope. Some teachers use a highlighter to indicate a change in the schedule or affix a ‘change arrow’ next to the activity that is different. And, again, it is critical to review the change in the schedule with the student way in advance so the student has time to adjust.

    • Provide choice making opportunities whenever possible. We know that being involved in decision-making can help ease transitions for some students. So rather than just giving a verbal directive, refer the student to their schedule and say, “It’s time for recess. Do you want to play soccer or basketball today?” 

    • Use a clock, watch or timer to help the student with an ASD understand time periods and when changes will occur. Time is invisible so we like to use a TimeTimer, because it is a visual display of time passing (www.timetimer.com). The TimeTimer comes in various sizes including a wristwatch model with and without sound.

    • Create a social story to help the student cope with change/transitions. Social stories are a way of teaching social and life skills to students with an ASD. Examples of a social story topic might be, “Tomorrow is Picture Day” or “We’re going on a Field Trip.” To learn more about social stories visitwww.thegraycenter.org The Gray Center for Social Learning and Understanding, the “Official Home of Carol Gray and Social Stories.” 

    • Providing a transition object associated with certain transitions can also be very helpful to prepare the student for the next activity. Examples of ‘transition objects’ include: ball to take out for recess, paintbrush to take to art class, book to take to the library, backpack to go to the bus, etc.

Here are some additional resources that may be helpful:

“Visual Supports”, CARD (Center for Autism and Related Disabilities), University of Florida, Gainesville: http://card.ufl.edu/visual.htm

“Visual Supports for Children with Autism”, Michigan Department of Education:
http://www.nhcs.net/sped/Autism/HFA%20Website/VisualSupports%20outside%20resource.ppt.

“Structured Teaching”, Division TEACCH”, University North Carolina:http://www.teacch.com/structureteach.html


  • Can the school limit a student's school day to three hours?

Question:

The school is trying to limit a student’s school day to three hours a day. The student is very upset (high functioning but does get agitated.) Can the school limit the hours? I don’t think so but I was trying to find a law or something in IDEA to support my belief.

Joan from NM


Answer:

Dear Joan from NM,

I am so glad you brought up the topic of the shortened school day. Too often I have run across IEP teams, parents and district staff who have made the decision to shorten a student’s school day in response to the frustrations of educating a student with behavioral challenges.

Before I provide you my summary answer to your question I want to refer you to one of my sources, PENT, so you and your IEP Team can learn more about shortened days. PENT stands for Positive Environments, Network of Trainers and is a California Positive Behavior Initiative designed to provide information and resources throughout California for educators striving to achieve high educational outcomes through the use of evidence-based proactive positive strategies.

Available at the PENT website [http://www.pent.ca.gov/law.htm] are two valuable documents about shortened days both authored by Diana Browning Wright:

  • “Shortened Day: Appropriate and Inappropriate Uses Concepts Guidelines and Examples”
  • “Shortened Day - Use Guidelines to Administer For Students with Problem Behavior”

Now, let me first answer your specific core question, “Can the school limit the hours?” Basically, as Diana Browning Wright states, “Shortened days will rarely constitute free appropriate public education (FAPE) in the least restrictive environment (LRE) and leaves districts exposed to liability. They [shortened days] should rarely be used unless the purpose is clearly stated, truly requires this option and is for a brief period of time with a clearly written start and end date. Remind staff of other options when a full day is not viable and alternative placement is not required to achieve FAPE.” Diana Browning Wright provides the following examples of shortened school days that may allow progress in general curriculum and mastery of individualized education program goals and objectives. However, she states that evaluation of whether these are the least restrictive solutions and whether they result in appropriate education for a specific student would still need to be made.

  • Earning physical education high school credits for activities off campus such as weightlifting in a local gym, home exercise program, or attendance at a community night class. Changing staff, providing a peer buddy, or other aids and supports should be ruled out before this option is considered.
  • Volunteering or paid work experience placement off campus. This option supports IEP goals in Transition.
  • Assisting staff on campus related to IEP goals and objectives in social skills development, work experience or mastering a skill. Again, IEP goals are being addressed through the activities. Remember to consider the LRE issue before selecting this option. Can these goals be met with supplementary aids and supports in regular programs?
  • Attending day treatment afternoon programs at another site in which IEP goals and objectives in the social-emotional area are taught. This placement was determined to constitute a FAPE component for the student and does not result in less than full time educational programming.
  • Attending classes on a regular campus, followed by classes in other settings where high school units are being earned at the same rate. Before choosing home teaching or enrollment at another site, always account for LRE considerations and make certain the IEP team is in agreement.

The practice of shortening a student’s school day requires careful consideration and scrutiny to determine if FAPE in the LRE is abridged by a shortened day and whether progress in general curriculum toward mastery of IEP goals and objectives can be made. Something else at issue is whether ‘adequate yearly progress’ as described in the No Child Left Behind Act (NCLB) can be achieved.

Clearly you are an advocate for your student, and I think the intent of your question is also about what else could the teaching team be doing to educate the student. You mentioned that the student “does get agitated.” Well, although all individuals with an Autistic Spectrum Disorder (ASD) are unique individuals, we do know that social impairments go with the diagnosis and are lifelong. In this case it sounds like the student may also be presenting with some anxiety.

I recommend that the IEP team meet to evaluate the behaviors you described. A resource for writing behavior plans (in CA they are called Behavior Support Plans or BSPs) can be found at the PENT website: http://www.pent.ca.gov/behplan.htm . In California, most IEP teams would develop a behavior plan to support the student when s/he becomes agitated. In addition to teaching the student better ways to cope when agitated, the team develops ways of modifying the environment to reduce the situations that make the student agitated (reduce, not eliminate of course, because life cannot always be modified!) and to create more supportive environments for the student when agitated.

It seems to me that IEP teams often, not always, resort to a shortened school day because they are not fully knowledgeable of evidence-based practices for individuals with an ASD. There are education and intervention approaches that may reduce some of the challenges associated with this diagnosis. We know that it is essential to develop educational programming that is individually designed and includes goals in the areas of communication, social interaction skills and behavior. We know that structure and providing appropriate visual supports are just two important teaching strategies that assist students with an ASD. The IEP team needs to work together and become informed and educated in how to teach students with an ASD to ensure optimal outcome expectations for the student.

Thanks for your question and good luck in sharing this information with your IEP team.