Autism Spectrum Disorder
How can we identify and support students with autism spectrum disorders?
Autism Spectrum Disorder (ASD) is a neurodevelopmental disability which affects how an individual engages in and responds to social communication and interaction. ASD also involves repetitive behaviors and/or deep, yet restricted interests.[i] ASD diagnoses affect approximately 1 in 68 children. [ii] The condition is about four times more common in boys, and ASD symptoms often present differently in boys and girls.[iii]
ASD is a lifelong condition. Although indicators of ASD may be present within the first year of life, a diagnosis for ASC is considered to be valid, reliable and stable beginning at two year of age. [iv] While there is no cure for ASD, there are therapies and strategies that can build social and communication skills as well as increase daily living skills and quality of life. Because people with ASD behave, interact, and perceive the world in unique ways, they often learn differently than other children. They also require special supports to address challenges related to their ASD diagnosis.
Abilities of Children with ASD
People with ASD have a wide range of intellectual and language capabilities and often have secondary developmental, neurological or psychological disorder.
Some people with ASD lead full independent lives and/or perform well academically, while others are severely disabled and require extensive support to facilitate daily living activities and their learning.[v] As children with ASD age, some skills may improve while others remain impaired.[vi] While 46% have average or above average intelligence, intellectual ability varies widely across the spectrum.[vii] Just as importantly, 95% of children with ASD have another developmental or neurological disorder such as intellectual disability, language disorder, attention deficit hyperactivity disorder (ADHD), mood disorders, obsessive compulsive disorder, anxiety, depression, or psychosis.[viii] Language capacities are very variable across the spectrum, and as much as 30% of the autism spectrum do not develop language. [ix] Children with ASD and intellectual disability tend to have greater deficits in their language comprehension than in their language production. [x] Among individuals without intellectual disability, language comprehension is often compromised or processed through atypical neural networks. [xi,xii] Teachers of students with ASD should be aware that children with ASD may require additional time or supports in language-based tasks. Children with low verbal capacities may benefit from training on alternative picture-based communication systems such as PECS. [xiii]
A different communication style may be needed to reach students with ASD.
Early in their development, most children begin to realize that other people have thoughts, feelings, and perspectives that are different from their own.[xiv] With this concept of theory of mind, they pick up the ability to intuit the mental states of other people based on verbal communication and nonverbal cues like tone of voice and facial expression. Because children with ASD tend to struggle with theory of mind, they often have trouble intuitively understanding what other people are thinking and feeling.[xv] Teachers of students with ASD should be intentional and explicit in their communication, and aware that their attempts to communicate may be received differently than they would be by other children.
Supporting Children with ASD
Targeted therapies can promote skill development in children with ASD.
There are many evidence-based therapies and intervention options for individuals with ASD and their families, including sensory integration interventions, developmental skill-based interventions, or intensive behavioral interventions. [xvi] Applied behavior analysis (ABA) is an intensive behavioral therapy that uses positive reinforcement to teach students with ASD skills and behaviors that can help them function in society and perform better in school.[xvii] For example, ABA rewards certain social behaviors, such as focusing on another person during conversation, that do not develop naturally in children with ASD. Research has found that ABA can improve vocabulary skills, non-verbal IQ, and other cognitive and communication skills. ABA is most effective when it is started early in childhood, continued for a minimum of two years, delivered intensively (as much as 40 hours a week), and includes caregivers in treatment.[xviii] Additionally, individuals with ASD may also benefit from therapies which target common secondary mental health conditions such as anxiety or depression. [xix]
Educational programs should be designed by experts to address the unique learning needs of children with ASD.
Educational programs for children with ASD should be designed in conjunction with trained professionals who can support both the students and educators. Since autism is a spectrum disorder, what works for one student may not work for another student. Research suggests that programs are most effective when both the instruction and learning environment are highly structured, with clear goals, regimented schedules, and thorough planning; however, it is important that each student be considered on an individual basis. Successful programs involve families, and provide both curricular content and learning supports tailored to the needs and challenges of each child.[xx] They also use a functional approach to problem behavior that looks at root causes and uses proven techniques for behavior change. Evidence-based strategies, such as those articulated through the National Professional Development Center on ASD, can be useful guides for designing school-based programs.
Parents of children with ASD benefit from social support as well as interventions that improve their children’s well being.
Raising a child with ASD has been linked to elevated levels of stress among parents of both younger and older children.[xxi] One study found that mothers of children with ASD had higher levels of stress than mothers of children with other kinds of developmental disabilities.[xxii] Informal social support from family, friends, and other families with children with ASD is associated with reduced parental stress, increased optimism and psychological well being, and lower levels of depression.[xxiii] Outcomes for parents and children are interconnected: when parents experience less stress they can offer more support for their children, and, conversely, when children with ASD have improved functioning, this can reduce parental stress. For example, sleep difficulties are common in children with ASD and can negatively affect their daytime behavior. Sleep interventions that improved the sleep patterns and daytime behavior of children with ASD were also found to improve family functioning and reduce parental stress. [xxiv]
Explore Autism Spectrum Disorder on the Visualization.
[i] The association between the social and communication elements of autism, and repetitive/restrictive behaviours and…[Review] Kuenssberg R, Mckenzie K, Jones J in RES DEV DISABIL (2011)
[ii] Centers for Disease Control and Prevention (2015). Autism Spectrum Disorder (ASD). Accessed March 27, 2019 from http://www.cdc.gov/ncbddd/autism/data.html.
[iii] Centers for Disease Control and Prevention (2015). Autism Spectrum Disorder (ASD). Accessed March 27, 2019 from http://www.cdc.gov/ncbddd/autism/data.html.
Review of gender differences in core symptomatology in autism spectrum disorders [Review] Rivet TT, Matson JL in RES AUTISM SPECT DIS (2011).
[iv] Early Identification of Autism Early Characteristics, Onset of Symptoms, and Diagnostic Stability [Review] Webb SJ, Jones EJH in INFANT YOUNG CHILD (2009)
[v] Standardizing ADOS Scores for a Measure of Severity in Autism Spectrum Disorders[Article] Gotham K, Pickles A, Lord C in J AUTISM DEV DISORD (2009)
[vi] Do Autistic Symptoms Persist Across Time? Evidence of Substantial Change in Symptomatology Over a 3-year Period in…[Article] Pellicano E in AJIDD-AM J INTELLECT (2012)
Autism after adolescence: Population-based 13- to 22-year follow-up study of 120 individuals with autism diagnosed in… [Article] Billstedt E, Gillberg C, Gillberg C in J AUTISM DEV DISORD (2005)
[vii] Centers for Disease Control and Prevention (2015). Autism Spectrum Disorder (ASD). Accessed March 27, 2019 from http://www.cdc.gov/ncbddd/autism/data.html.
[viii]Levy, Susan E., et al. “Autism spectrum disorder and co-occurring developmental, psychiatric, and medical conditions among children in multiple populations of the United States.” Journal of Developmental & Behavioral Pediatrics 31.4 (2010): 267-275.
Leyfer, O. T., Folstein, S. E., Bacalman, S., Davis, N. O., Dinh, E., Morgan, J., … & Lainhart, J. E. (2006). Comorbid psychiatric disorders in children with autism: Interview development and rates of disorders. Journal of autism and developmental disorders, 36(7), 849-861.
Matson, J. L., & Nebel-Schwalm, M. S. (2007). Comorbid psychopathology with autism spectrum disorder in children: An overview. Research in developmental disabilities, 28(4), 341-352.
[ix]Tager‐Flusberg, H., & Kasari, C. (2013).Minimally verbal school‐aged children with autism spectrum disorder: The neglected end of the spectrum. Autism Research, 6(6), 468-478.
[x]Maljaars, J., Noens, I., Scholte, E., & van Berckelaer-Onnes, I. (2012). Language in low-functioning children with autistic disorder: Differences between receptive and expressive skills and concurrent predictors of language. Journal of Autism and Developmental Disorders, 42(10), 2181-2191.
[xi]Eigsti, I. M., Stevens, M. C., Schultz, R. T., Barton, M., Kelley, E., Naigles, L., … & Fein, D. A. (2016). Language comprehension and brain function in individuals with an optimal outcome from autism. NeuroImage: Clinical, 10, 182-191.
[xii]Noterdaeme, M., Wriedt, E., & Höhne, C. (2010). Asperger’s syndrome and high-functioning autism: Language, motor and cognitive profiles. European child & adolescent psychiatry, 19(6), 475-481.
[xiii]Sulzer-Azaroff, B., Hoffman, A. O., Horton, C. B., Bondy, A., & Frost, L. (2009). The Picture Exchange Communication System (PECS) What Do the Data Say?. Focus on Autism and Other Developmental Disabilities, 24(2), 89-103.
[xiv] Intuition and autism: a possible role for Von Economo neurons [Review] Allman JM, Watson KK, Tetreault NA, Hakeem AY in TRENDS COGN SCI (2005)
[xv] Baron-Cohen, S., Leslie, A. M., & Frith, U. (1985). Does the autistic child have a “theory of mind”?. Cognition, 21(1), 37-46.
Theory of Mind in Adults with HFA and Asperger Syndrome [Article] Spek AA, Scholte EM, Van Berckelaer-Onnes IA in J AUTISM DEV DISORD (2010)
Baron‐Cohen, S., Jolliffe, T., Mortimore, C., & Robertson, M. (1997). Another advanced test of theory of mind: Evidence from very high functioning adults with autism or Asperger syndrome. Journal of Child Psychology and Psychiatry, 38(7), 813-822
[xvi] Case-Smith, J., & Arbesman, M. (2008). Evidence-based review of interventions for autism used in or of relevance to occupational therapy. The American Journal of Occupational Therapy, 62(4), 416.
[xvii] Matson, J. L., Turygin, N. C., Beighley, J., Rieske, R., Tureck, K., & Matson, M. L. (2012). Applied behavior analysis in Autism Spectrum Disorders: Recent developments, strengths, and pitfalls. Research in Autism Spectrum Disorders, 6(1), 144-150.
[xviii]Peters-Scheffer, N., Didden, R., Korzilius, H., & Sturmey, P. (2011). A meta-analytic study on the effectiveness of comprehensive ABA-based early intervention programs for children with autism spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 60-69.
[xix] Hollocks, M. J., Lerh, J. W., Magiati, I., Meiser-Stedman, R., & Brugha, T. S. (2019). Anxiety and depression in adults with autism spectrum disorder: a systematic review and meta-analysis. Psychological medicine, 49(4), 559-572.
A comparison of intensive behavior analytic and eclectic treatments for young children with autism [Article; Proceedings Paper] Howard JS, Sparkman CR, Cohen HG, Green G, Stanislaw H in RES DEV DISABIL (2005)
Parent inclusion in early intensive behavior interventions for young children with ASD: A synthesis of meta-analyses…[Review] Strauss K, Mancini F, Fava L in RES DEV DISABIL (2013)
[xx] Lovannone, R., Dunlap, G., Huber, H., & Kincaid, D. (2003). Effective educational practices for students with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 18(3), 150-165.
[xxi] Davis, N. O., & Carter, A. S. (2008). Davis, N. O., & Carter, A. S. (2008). Parenting stress in mothers and fathers of toddlers with autism spectrum disorders: Associations with child characteristics.Journal of autism and developmental disorders, 38(7): 1278-1291.
[xxii] Estes, A., Munson, J., Dawson, G., Koehler, E., Zhou, X. H., & Abbott, R. (2009). Parenting stress and psychological functioning among mothers of preschool children with autism and developmental delay. Autism, 13(4): 375-387.
[xxiii] Ekas, N. V., Lickenbrock, D. M., & Whitman, T. L. (2010). Optimism, social support, and well-being in mothers of children with autism spectrum disorder.Journal of autism and developmental disorders, 40(10): 1274-1284.
[xxiv] Malow, B. A., Adkins, K. W., Reynolds, A., Weiss, S. K., Loh, A., Fawkes, D., Katz, T., Goldman, S.E., Madduri, N., Hundley, R., & Clemons, T. (2014). Parent-based sleep education for children with autism spectrum disorders. Journal of autism and developmental disorders, 44(1): 216-228.