Running Ahead: Effectiveness in teaching children with autisms in general settings

By Maryse Isma, MSW

Special to CSMS Magazine

In the quest to further the struggle against autism, Maryse Isma, MSW, has analyzed some journal articles which focus in finding the solution for the autism’s problem. She shares her thoughts with our readers.   

Autism, a complex developmental disability, usually occurs during the first three years of life. And according to Carr. D and  Felce. J. (2007), autism is the result of a neurological disorder that affects the normal functioning of the brain. It impacts development in the areas of social interaction and communication skills. Both children and adults with autism typically show difficulties in verbal and non-verbal communication, social interactions, and leisure or play activities. Although it’s been around for a long time, the last two decades prove to be a veritable dilemma for health officials as its numbers are in the rise. There is no known solution to this devastating form of disability. However, professionals working in the field have developed some alternatives to dealing with this developmental disability. Since verbal communication is always a problem with autistic children, it is imperative that solutions are found to help children living with autism live a more meaningful life.

Moving around without being lost

 Jennifer L. Buck, M.Ed. and Special Educator at Charles C. Knowlton School in Ellsworth, Maine reviewed a study that was done by Taylor, B., Hughes, C., Richard, E., Hoch, H., & Coello, A., (2004)  in which the possibility to help autistic teenagers coping with difficulties with moving around in their communities.  To be more precised, the study investigated different strategies to teach individuals with autism how to seek help when lost in community settings. It also evaluates the effectiveness of teaching individuals with autism when it comes to responding to a tactile prompt and seek assistance when separated from a parent or a teacher.

This approach seems very practical and very productive. Rather than isolating children with autism from typical preschool activities and from their peers in order to provide individualized instruction, the researchers of this study stress the emphasis on teaching within the context of developmentally appropriate activities and routines. They draw peers into the instructional situation where possible. This approach requires professional working in the field to use a variety of naturalistic teaching procedures, including mend-model procedures, time delay, incidental teaching, and interrupted routines and behavior chains (for discussions of such procedures, see Noonan & McCormick [1993] and Wolery, Ault, & Doyle, [1992]). These strategies fit particularly well into a preschool setting because they are designed to be embedded in ongoing activities that are interesting to the students. However, the authors do not specify the age group, implicitly suggesting that it would work with children of hire ages than those of preschool. So, I have some reservations with regard to the age group.

 According to Jennifer L. Buck, who reviewed the study, the participants included three students that met the diagnostic criteria for autism, and also had deficits in communication and socialization skills. Each of the participants were given a J Tech vibrating pager and an identification card, which included the student’s name, a statement that he or she was lost, and an emergency contact information. The participants wore the J Tech pager on the rim of their pocket or waist band during all training sessions. These children could not have chosen as participants if they were not teenagers, at least according to their age.

 The more one advances in age, the more crucial his cognitive development becomes. The main purpose of the study was to see if individuals living with autism could truly seek help on their own using their communication skills if they were to be lost in the community. The purpose falls quite in line with the alarmist rise of autistic children in various communities. It is not uncommon while walking through a local store, one would hear small voices calling out “mommy” or “daddy” in search of a parent that may have become momentarily separated from their child.

 Structuring autistic children is the key

The second article abounds on the same idea of trying to help autistic children cope with their daily lives. In finding the solutions to help autistic children live a normal life, it was revealed that teaching with structure and repetitiveness could a make a big difference in achieving success. So, the researchers used fives different locations plus the school site to teach the students before the trial began. Teaching sessions took place at two of the five sites and at school, while the remaining three locations were used as generalization settings. During baseline probes, the student was accompanied by a teacher to each setting. The J Tech pager and identification card were located on the student. An unseen observer watched over the student as the teacher slipped out of view, and collected data on whether the student approached an adult when the teacher disappeared (the pager was not used). Approximately two minutes after the trial began, it was ended when the teacher returning to the student.

Contrary to the first article, the researchers of this study clearly states the age group. According to the authors, children below 3^rd grade level cannot participate in the study. However, results could be used to better prepare young children living with autism. The students were not given the opportunity to try their new acquired skills in the community at large until it was determined that they could be left to try it out in a more explicitly way. When it was revealed that they were ready, two locations from the community were used. By then, the investigators were quite convinced that the participants were able to retrieve and give their identification card to a familiar adult. One or two teaching trials were conducted during each outing. Community teaching sessions involved all of the same procedural safeguards that were in place during baseline data collection, with the exception that the teacher activated the pager when the student became separated from him or her. The participant had 30 seconds to produce their identification card, if the student was unable to do so, a least to most prompting hierarchy was implemented.

The authors of the study use a two-pronged strategy by first teaching autistic students some urgently need survival skills and then, trying to develop the cognitive abilities by using computer technology to teach children with autism. A two-fold strategy would achieve a lot for autistic children. However, it seems overwhelming to try to throw too much to children with neurological problems.

Teach and Provide Opportunities for Independence

The entire effort being put forward by professionals working in this field is unique, everyone is working under one common denominator, which is teaching to provide opportunities for independence. While interdependence is appropriate and normal in human relationships, we also expect children to learn increasingly independent behavior as they get older. Independence during classroom routines continues to be a major expectation for students beginning kindergarten (Hairs, Fowler, Schwartz, Kottwitz, & Rosenkoetter, 1987), which is why so many opportunities are being provided for, and actively teach, independent behavior.

Sarah Land, who reviewed the study, stresses the importance of using notebook activities to teach “structure” to children living with autism. While on one should doubt the positive outcome of the study as clearly explained in the Ms. Land’s review, again one group within this autistic community is missing: the non-verbal group which makes a significant number among children living with autism.

However, one must agree on the efficacy of the method used here. The authors compare notebook activity schedules to “to do lists” because they often serve as functional cues for skills that normally require prompting from staff. Notebook activity schedules can also promote independent task initiation and completion, while reducing undesired behavior during transitions (Schmit, Alper, Raschke, & Ryndak, 2000). Furthermore, notebook schedules can be used to teach new skills via schedule- following. MacDuff, Krantz, and McClannahan (1999) found students could follow both trained and novel orders of schedules. The students also generalized to other activities that they were familiar with, but that had not been included in the original trained schedule.

 In addition to the support the study received from the academic community, there is a large body of support for the benefits of notebook activity schedules. Parents who used the notebook schedules at home increased engagement and social initiation, and decreased disruptive behaviors (Krantz, MacDuff, and McClannahan, 1993).

Using computer-based intervention program

 The third article also focuses on the same aspect of using technology to develop the cognitive ability of children living with autism. Reviewed by Melissa Ortega, M.A, the study lays the emphasis on using computer-based intervention programs to teach communication skills to students living with autism.

 The premise by which the authors embarked on the project lies on the fact that highlighted the difficulties children with autism have with the understanding of concepts, communicative interactions, and representational thought. These deficits are said to be linked to the theory of mind (ToM) (Baron-Cohen, 1988; Tager-Flusberg, 1997) which is the ability to use predictive skills to understand relationships between external states of affairs and internal states of mind. Furthermore, ToM is associated with understanding, organizing, using language appropriately in a functionally communicative manner.

 Children with autism can have impairments in these areas in various degrees of severity, and can be expressed through immediate echolalic speech (repetition of words heard immediately or later after being heard) and irrelevant speech. Hertzroni and Tannous, who were the investigators of this study, sought to increase the opportunities to interact in an environment that modeled language in appropriate settings to enhance communication and ideally advance the development of language (Mesibov, Schopler, & Hearsey, 1994). Again, this study, just the two previous one, does not seek to accommodate nonverbal children and it does not specify the age group.

The verbal behavior approach to early and intensive behavioral intervention for autism

 The fourth article has a different approach and it is the only one that focuses on early intervention to deal with the verbal behavior from children living with autism. Reviewed by Suzannah Ferraioli, B.A, and conducted by Carr and Firth, this study highlights several similarities between the Lovaas and VB models.

 Firstly, they each stress the importance of environmental control through their utilization of contrived instructional settings, with ready access to salient tangible items and activities to be delivered contingently upon correct responding. Secondly, both approaches teach behavior based upon the expressive/speaker and receptive/listener relationships. Lastly, the Lovaas and VB models deliver instruction and consequences in a discrete-trial instruction format. However, the VB model uses DTI concurrently with Natural Environment Training (NET) while the Lovaas approach uses only DTI.

 One must say that this point highlights a primary difference between the two models, their approach to language training. NET facilitates generalization through a focus on teaching in naturalistic settings as well as under contrived conditions, and by capitalizing on current motivating operations. This contrasts to the systematic, analog environment evoked under the Lovaas model, although generalization may be integrated into instructional programming. In addition, the VB model teaches language using a hierarchy of functions (e.g., mand, tact, intraverbal), and through function-specific motivating variables. Conversely, the Lovaas approach teaches language in discrete steps, without specific regard for the functionally relevant antecedents and consequences.

I completely agree with the way the authors present their findings. As a matter of intellectual probity, they recognize the relativity of their findings and they recommend further studies. However, they recognize the VB approach as a viable model that deserves further empirical analysis. A systematic progression from case studies to multiple comparisons, and finally to experimental evaluations may provide evidence to justify the widespread implementation of the VB model in a clinical setting.

Effects of training, prompting, and self-monitoring on staff behavior in a classroom for students with disabilities

 The last article stresses the need of using class rules to teach children with autism how to apply good behavior in academic and social settings. While the typical classroom rules and reprimands may be appropriate for some students, they may not suit the needs of a student with a disability. Uncontrolled and unpredictable behavior exhibited by a student with a disability can interfere not only with the student’s ability to learn but may also affect the teacher’s ability to teach the student. Therefore, effective staff training and feedback sessions are warranted to train school staff to manage student and classroom behavior.

  In conclusion, targeting skills for instruction can be useful to children’s lives. This means targeting skills a given child needs in non-training situations and those that are typically enjoyed by children of the same chronological age. Such useful skills will be practiced across many persons and in many situations over time, which is so important for promoting generalization and maintenance. Further, when skills are useful, they often achieve a naturally reinforcing outcome, reducing the need for artificial reinforcers in new situations or across time. Using instructional prompts judiciously and fading them rapidly. Using the least directive and intrusive prompt will ensure successful skill performance and then fade that prompt as quickly as possible without disrupting performance. It is important to reduce the probability that children (who may demonstrate stimulus overselectivity) become hooked on adult assistance and direction.

References

Bailey, J. S., & Burch, M. R. (2002). Research methods in applied behavior analysis. Thousand Oaks, CA: Sage

Carr, J. E. & Firth, A. M., (2005). The verbal behavior approach to early and intensive

behavioral intervention for autism: A call for additional empirical support. Journal of Early Intensive Behavioral Intervention, 2(1), 18-27.

Hertzroni, O.E. & Tannous, J., (2004). Effects of a computer-based intervention program on the communicative functions of children with autism. Journal of Autism and Developmental Disorders, 34(2), 95-113.

Seligson-Petscher E., Bailey J., (2006). Effects of training, prompting, and self-monitoring on staff behavior in a classroom for students with disabilities. Journal of Applied Behavioral Analysis, 39, 215-226.

Shabani, D. B., Katz, R. C., Wilder, D. A., Beaucham, K., Taylor, C. R., & Fisher, K. J. (2002).?Increasing social initiations in children with autism: Effects of a tactile prompt. Journal of Applied Behavior Analysis, 35, 79-83.

Stromer, R., Kimball, J.W., Kinney, E.M., Taylor, B.A., (2006) Activity Schedules, Computer Technology, and Teaching Children with Autism Spectrum Disorders. Focus on Autism & Other Developmental Disabilities 2(1), 14-24

Taylor, B., Hughes, C., Richard, E., Hoch, H., & Coello, A., (2004). Teaching teenagers with autism to seek assistance when lost. Journal of Applied Behavior Analysis, 37, 79-82.

Taylor, B. A., Hughes, C. E., Richard, E., Hoch, H., & Coello, A. R. (2004). Teaching teenagers with autism to seek assistance when lost. Journal of Applied Behavior Analysis, 37, 79-82.

Taylor, B. A. & Levin, L. (1998). Teaching a student with autism to make verbal initiations: Effects of a tactile prompt. Journal of Applied Behavior Analysis, 31, 651-654.

Note: Maryse Isma is the executive director for Community Enrichment and Empowerment Enterprise, Inc. She wrote this piece exclusively for CSMS Magazine.