Accessing the Curriculum for Learners with Autism Spectrum Disorders

Using the TEACCH programme to help inclusion

Gary Mesibov, Marie Howley, Signe Naftel

• Publisher: Routledge
• Year: 2015
• ISBN:
  9781317407201
• Edition: 2
• Topic: Pedagogía
• Subtopic: Educación general

This brand new edition of Accessing the Curriculum for Learners with Autistic Spectrum Disorders will provide educators with the principles and practices of Structured Teaching and how to apply these to enable learners to access the curriculum, whatever that curriculum may be.

This unique resource is intended to be essential reading for schools and settings who are keen to implement Structured Teaching as an approach to including learners on the autism spectrum in teaching and learning. With a wide range of helpful advice and support, this book:

• 
  
  

• demonstrates how to make use of the approach to address diverse needs, overcome barriers to learning and achieve successful differentiation;

• 
  
  

• uses case studies and examples that illustrate how the approach is applicable across Early years, Primary, Secondary and vocational curricula;

• 
  
  

• provides the physical structure, schedules, work systems and visual information necessary to illustrate use of these components to promote curriculum access, with an emphasis on understanding and meaning.

This new edition is fully updated to include examples of new technologies and is suitable for use in a range of international educational contexts. It also includes a brand new chapter on blending Structured Teaching.

Chapter 1

Overview of the autism spectrum

Autism spectrum disorders

The word ‘autism’ first appeared in the professional literature when Leo Kanner, a child psychiatrist at Johns Hopkins University in Baltimore, MD, wrote a description of 11 children from his child psychiatric unit in 1943. These children were different from the others in his unit who were diagnosed with Childhood Schizophrenia. The children Kanner wrote about in his original paper had little interest in other people, peculiar language, an insistence on routines, and they displayed unusual body movements and repetitive behaviours.

Kanner’s original description emphasised three areas of difficulty: social isolation, abnormal communication and an insistence on repetitive, narrow routines. These major areas of impairment have continued to be the foundation of the autism diagnosis in the major diagnostic systems used throughout the world.

The definition of autism spectrum disorders has transformed over the years, but the ‘triad of impairments’ (Wing and Gould 1979) has remained central to the diagnosis of autism. The most recent transformation of the definition of ASD occurred in 2013 when the term Pervasive Developmental Disorders (PDD) shifted to the umbrella term Autism Spectrum Disorder (ASD) in the DSM-5 (American Psychiatric Association 2013). Current diagnostic systems, DSM-5 and ICD-10 (WHO 1992), define ASD as differences in social communication and social interaction skills as well as restricted behaviours or interests. Communication differences are not considered a separate diagnostic criterion, as is in previous definitions, but instead, are thought to be intertwined with social impairments. Therefore, communication differences are contextualised within the social communication and social interaction diagnostic criterion. In order to qualify for the ASD diagnosis, a person must demonstrate deficits in the areas of social communication and interaction as well as repetitive behaviours or interests.

ASD is a broad continuum of functioning levels, with similar core characteristics of social communication difficulties and repetitive behaviours/interests. Specific characteristics within the social communication and social interaction criterion include deficits in social-emotional reciprocity, deficits in non-verbal communication, and deficits in social relationships. Specific characteristics in the restricted, repetitive patterns of behaviour/interests include stereotyped motor movements, inflexibility, highly restricted interests, or unusual sensory differences. Not all characteristics are required for a diagnosis, but characteristics are required to be present in the early developmental periods. Additionally, severity level along the continuum must be specified. Severity levels for ASD are categorised as Level 1 ‘Requiring support’, Level 2 ‘Requiring some support’ and Level 3 ‘Requiring very substantial support’ (DSM-5).

Prior to this current definition of ASD, the term Pervasive Developmental Disorders (PDD) was used as the umbrella category of all people showing impairments or peculiarities in these three areas, including more subtle ones. Various diagnoses existed within the PDD category, autism being the best-known and most widely used diagnostic category within the autism spectrum. Autism was defined as differences in three areas: communication, socialisation and repetitive behaviour, which is similar to the current definition, but with communication being a separate category. In addition to autism, several other specific diagnostic classifications were considered distinguishable from classical autism because of their characteristics, including Pervasive Developmental Disorder – Not Otherwise Specified (PPD-NOS), Asperger Syndrome, Rett’s Syndrome, and Childhood Disintegrative Disorder.

PDD-NOS referred to those people on the autism spectrum who share many of the characteristics, but might not show the precise number of characteristics required for the autism diagnosis, or they might not have the marked deficits or peculiarities in the social area that are necessary. Many professionals viewed PDD-NOS (Atypical Autism) as a milder form of autism. Another diagnosis that fell within the autism spectrum in the previous conceptualisation was Asperger Syndrome (AS). The definition of AS was similar to autism, but the primary difference was in the area of communication; a person did not have to demonstrate any communication difficulties to qualify for the AS diagnosis. In fact, it was a requirement that their language developed at the normal time, using words by the age of two and simple phrases by age three. For a diagnosis of AS, it was also required that a person have an average or above average IQ.

Finally, two other less common diagnoses were included in earlier conceptualisations of the PDD umbrella. These diagnoses are Rett’s Syndrome and Childhood Disintegrative Disorder. PDD-NOS, AS, Rett’s Syndrome and Childhood Disintegrative Disorder no longer formally exist under the new umbrella of ASD, though Rett’s Syndrome is mentioned as a neuro-genetic disorder. Individuals with a previous diagnosis of AS and PDD-NOS should instead be considered as having ASD. This conceptualisation is considered simpler, as it is one continuum rather than several separate diagnoses.

To summarise, ASD is a continuum of characteristics, with a wide range of severity. While some individuals with ASD are non-verbal, others are highly verbal, but have difficulty using their language for social reasons. The commonality across the spectrum is difficulty with social communication, social interaction, and displaying repetitive, restricted interests or behaviours.

Overlapping disorders

It is a major challenge identifying people with ASDs and determining where they appear on the continuum. It is also difficult to distinguish ASDs from related conditions because there are sometimes significant areas of overlap. Diagnoses with the greatest overlap that are most frequently confused with ASDs are Obsessive-Compulsive Disorder (OCD), Social (pragmatic) Communication Disorder, Attention Deficit Hyperactivity Disorder (ADHD) and Schizoid Personality Disorder.

Obsessive-Compulsive Disorder is identified by repetitive thoughts and/or behaviours. A distinction is usually made between obsessions, which are recurrent and persistent thoughts, and compulsions, which are non-functional repetitive behaviours. Sometimes the distinctions between OCD and ASDs are difficult to distinguish because many people with ASDs have repetitive thoughts or behaviours. Some differences that help professionals make these discriminations are that most people with OCD are secretive about their repetitive ideas or behaviours because they realise that other people would consider them bizarre. Those affected with OCD usually wish that the routines would go away and feel great anxiety when thinking about or performing them. This is very different from people with ASDs, who have little insight into the non-productive nature of their repetitive behaviours or how these behaviours impact on others. Often people with ASD feel calm, engaged, and even joyful when thinking about and performing their rituals, rather than anxious.

It is important for clinicians to understand that the narrow interests associated with ASDs are not the same as obsessive thoughts. The preoccupations that these youngsters think and talk about are much less likely to be the sex, religion or bodily concerns that are more frequently seen in OCD. Developmental histories can also be helpful in making these distinctions. People with OCD usually do not have preschool or early onset of these preoccupations and other developmental difficulties. The earlier onset of these obsessions or compulsions, plus other developmental problems, are much more typical in ASDs.

Social (pragmatic) Communication Disorder (SCD) is a developmental language disorder characterised by problems in the social use of verbal and non-verbal communication (DSM-5, 2013). People who fall within this diagnostic classification show several similarities to ASDs. They have problems with some of the same aspects of interpersonal communication, including difficulties initiating and sustaining conversations, staying on topics, matching their communication style to the context, and understanding subtleties. The primary difference from ASD is that people with social communication disorder do not display repetitive or stereotyped behaviours/interests, as do people with ASD.

Another diagnostic category that overlaps with ASD is Attention Deficit Hyperactivity Disorder (ADHD). ADHD is used to describe people who have difficulty paying attention and controlling their behaviour and activity levels. People in this group can often resemble people with ASD because they appear not to listen when addressed, they have difficulty following verbal directions, problems with concentration, a reluctance to engage in certain tasks, problems with impulse control, and excessive talking.

Even though there are many similarities between ADHD and ASD, the underlying reasons for the difficulties are usually different. For children with ADHD, there appears to be a neurological problem limiting their focused attention that can have implications for social and communication difficulties. It is not that these children can’t understand language or social nuances, it is rather that they have difficulty focusing and maintaining their attention in appropriate ways at appropriate times. For people with ASD, their problem is not necessarily limited attention but rather a different way of focusing their attention. It has been suggested that their focus is more narrow and intense and that they also have difficulty shifting their attention. Social and communication difficulties for people with ASD are usually the reasons why they have problems communicating and also with understanding and responding to directions. It is these social and communication problems that make interaction difficult, in addition to their attentional differences, rather than simply their attentional problems.

A final condition that is sometimes confused with ASD is Schizoid Personality Disorder. This disorder is characterised by a ‘pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings’ (DSM-5, American Psychiatric Association 2013: 652). Problems with social skills and friendship, aloofness, an apparent insensitivity to others and a narrow single-mindedness are characteristics that this group shares with people with ASD. The differences, however, are that people with Schizoid Personality Disorder have less severe problems with interpersonal relationships, and they manifest themselves later in the school years or in early adulthood, rather than in the preschool and early school years, as is seen with ASD. Communication problems among individuals with Schizoid Personality are also more limited. These individuals show a capacity for imagination and fantasy, and they do not have the narrow special interests of people with ASD. There also seems to be a genetic link between Schizoid Personality Disorder and other psychiatric conditions.

In spite of these differences, Wolff (1998) argues that Schizoid Personality Disorder might be part of the autism spectrum. She argues that many of the effective intervention approaches used with higher functioning people with ASD can also be used effectively with this group, even though they are slightly more socially skilled, independent, and have a better long-term prognosis.

Summary

In summary, those who receive a diagnosis of ASD have many important similarities to one another, especially in the areas of social interaction, social communication, perseveration and conceptualisation. These common characteristics have important implications for educational programmes and provision and will be the major focus of this book. Learners with overlapping, but different, diagnoses will share enough common characteristics that they will probably benefit from some of the educational strategies described in the chapters that follow.

Chapter 2

Structured Teaching as a foundation for educational programmes

Division TEACCH

Division TEACCH (Treatment and Education of Autistic and related Communication handicapped Children) is North Carolina’s statewide programme serving people with ASD and their families. The programme was initially funded by the Federal Government in 1966. At that point, ASD was viewed as an emotional disorder and parents were seen as the main cause. Terms like ‘refrigerator mother’ were commonly used to describe these parents and convey how cold, aloof and sometimes rejecting behaviours might cause ASD in their children.

Eric Schopler, co-founder and the first director of Division TEACCH, was among the pioneers in establishing ASD as a developmental disorder and demonstrating that parents did not cause ASD and could be effective teachers of their children. This was the focus of the initial Federal grant to Schopler that was the precursor to Division TEACCH in 1966. The Federal grant was enormously successful and had an immediate positive impact on the parents who participated and their children. For this reason, the state of North Carolina adopted Division TEACCH statewide and initiated state funding in its founding legislation in 1972.

Over the past five decades, Division TEACCH has helped to reconceptualise theories about ASD and has created a successful and widely used intervention approach. TEACCH has also implemented a comprehensive service delivery system that has impacted on the lives of people with ASD and their families in North Carolina, the United States, and throughout the world. The programme’s major priorities include:

• enabling individuals with ASD to function meaningfully, productively and as independently as possible in their communities;

• to offer exemplary services to individuals with ASD and their families and those who work with them and support them; and

• as a member of the University of North Carolina community, to generate knowledge, to integrate theory with clinical practice and to disseminate information about theory and practice internationally.

Division TEACCH serves people with ASD of all ages and levels of functioning. Starting with diagnostic evaluations that typically occur between the ages of two and four, families first learn about ASD from TEACCH staff, who work out of seven clinical centres geographically distributed throughout the state of North Carolina. Each clinic serves families of people with ASD between the ages of one and 70 in their local regions. About 80 per cent of the initial visits are for children under the age of five.

Division TEACCH integrates a community-based service system into a vibrant university, which encourages the accomplishment of programme goals at a high level of excellence. TEACCH offers the best of what universities are capable of for the benefit of the citizens of the state of North Carolina, including unique opportunities for training, service development and research. The base at the University of North Carolina also allows families easy access to the latest developments in the field and is a wonderful resource for recruiting qualified professionals who often become leaders in the field.

The active involvement of the TEACCH programme in community-based activities also adds to the university’s lustre and credibility. By requiring a university faculty to be actively involved in solving day-to-day needs, there is assurance that the programme will not become an ivory tower. Confronting the compelling needs of families and clients with ASD assures that the university-based programme will be working on important and relevant issues.

As part of the state system, Division TEACCH is well positioned to coordinate and collaborate with a variety of state agencies. Transitions from early intervention to school programmes are smoother because TEACCH is available to work closely with each agency and the families. A consistent intervention strategy also facilitates transitions from one programme to the next. Division TEACCH tries to maintain strong collaborative relationships with major state agencies and also the parent advocacy group and service provider, the Autism Society of North Carolina.

Although the statewide system is an important reason for TEACCH’s many accomplishments, the programme is not just a coordinating and facilitating agency. Through the experiences of the programme over the past 48 years and with the help of its university base, Division TEACCH has evolved its own treatment strategy and approach to working with clients with ASD and their families. This approach, called Structured Teaching, assures continuity and consistency throughout all of the statewide services for people with ASD and their families.

The strategies and administrative structures from Division TEACCH have been implemented throughout the United States and all over the world. Practitioners and administrators have been using these ideas in each of the 50 American states. Many states have set up TEACCH Structured Teaching educational programmes and there are also numerous clinics and other services following these models. Internationally, these techniques are practised throughout Europe, Asia, Australia and South America and have had a major impact in the UK.

Structured Teaching

The concept of Structured Teaching grew out of Division TEACCH’s early recognition of ASD as a developmental disorder (Mesibov et al. 2005). When TEACCH was established in the mid 1960s, most professionals viewed ASD as an emotional disorder, caused by parent ambivalence, rejection and inconsistent responses to their children. Eric Schopler, the co-founder of Division TEACCH, was one of the pioneers to recognise ASD as a developmental disorder involving neurological differences from the ways in which typically developing children processed the environment. Structured Teaching evolved as a way of matching educational practices to the different ways that people with ASD understand, think and learn. Structured Teaching is designed to address the major neurological differences in ASD.

Receptive language difficulties are other important characteristics of ASD that Structured Teaching addresses. Many learners with ASD cannot understand language as well as we perhaps think they can, based on their other skills and responses. They also have difficulty initiating responses to our verbal requests. Receptive language difficulties can result in a limited understanding of what appear to be relatively simple requests.

Expressive communication can also be difficult. Language often falls behind other skills for people with ASD so their responses or ability to express simple requests can be limited. Expressive communication requires a degree of initiation, organisation and comprehension that is sometimes beyond what these otherwise skilled youngsters with ASD can produce. This often results in frustration on everyone’s part because they cannot express many of their needs in ways that allow others to meet those needs.

Attention and memory can also be different in people with ASD. Although their ability to recall specific details ov...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of figures
• List of tables
• Preface
• Acknowledgements
• 1 Overview of the autism spectrum
• 2 Structured Teaching as a foundation for educational programmes
• 3 Challenges to curriculum access for learners with autism spectrum disorders
• 4 Physical structure: making sense out of the classroom
• 5 Visual schedules: what’s going on?
• 6 Work systems: getting organised
• 7 Visual information: adding meaning
• 8 Tying it all together
• 9 Increasing curriculum access by blending Structured Teaching with other strategies
• Bibliography
• Index