Tizard Learning Disability Review

Person-centred approaches to supporting children and adults with autism spectrum disorders
Julie Beadle-Brown Rachel Roberts Richard Mills
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Julie Beadle-Brown Rachel Roberts Richard Mills, (2009),"Person-centred approaches to supporting children and adults with
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Carol Povey, (2009),"Commentary on person-centred approaches to supporting children and adults with autism spectrum
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 Feature

Person-centred approaches
to supporting children
and adults with autism
spectrum disorders
Julie Beadle-Brown
Tizard Centre, University of Kent
Rachel Roberts
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Parent
Richard Mills
Director of Research, National Autistic Society

Abstract
The editorial for this issue sets out the context of increasing awareness of the need for better services for children
and adults with autism spectrum disorders, and highlights the importance of policy to maintain awareness and
provide incentives while recognising that more would be needed to ensure that people with autism have a good
quality of life and reach their full potential. There are two sections to this paper. The first is a case study written
from a parent’s perspective and highlighting the need for good joint working and supporting families, as well as
the importance of understanding how autism affects a child and his/her family. The second part considers good
practice in supporting children and adults with autism to increase social inclusion, independence, choice and
autonomy.

Key words
autism; person-centered approaches; SPELL framework

Introduction Peasey kotick penguins, and equal

Changes in Early Years provision such as the
introduction of the Team around the Child (TAC)
were intended to improve the experience of children
and families, in particular during statementing and
transition. The approach is based on having a small
group of people who know the child and the family
and work together with the family to organise
appropriate support for the child. When it works well,
it achieves these aims but sometimes, as with any
person-centred planning process, the experience can
vary over time, as illustrated in the case study below.
partners: a parent perspective
Equal: 1) the same in quantity, quality, size,
degree, rank, level etc; 2) evenly balanced (an
equal contest); 3) having the same rights or status
(human beings are essentially equal); 4) uniform in
application or effect (equal opportunities). (Concise
Oxford English Dictionary)
This case study outlines the experiences we, as a
family, have been through in the last seven years.

18 Tizard Learning Disability Review Volume 14 Issue 3 July 2009 © Pavilion Journals (Brighton) Ltd
 Person-centred approaches to supporting children and adults with autism spectrum disorders
If you were to meet us in the street, you might
perceive us a normal family of four, or more likely
as a family with an unruly ‘attention seeking’ nine
year old ‘who should have outgrown tantrums by
now’. We have a child who is normal but behaves
differently and perceives the world in a very
interesting way. I will call him ‘Thomas’.
At the moment, Thomas is very interested in
words, and their precise definitions. He is both
fascinated and frustrated by the way language
works, the way words can be bent to fit meanings
which don’t always match the given definition, the
conventional usages which often defy his logic. Above
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all, it is the sound of words which often makes no
sense to him. His speech therapist describes his use
and understanding of language as ‘idiosyncratic’.
For instance, he wants to know ‘Why are the penguins
peasey koticks? What does it mean? What is a
peasy kotick?’. I understand the questions but I have
difficulty defining and explaining the answers. These
idiosyncratic black and white birds have long held a
fascination for him, but this is a new set of questions.
This recent ability to question and engage in dialogue
is remarkable in its own right. Differing definitions
and the origin of words often provide the clues to
shape his understanding. As parents, we have dealt
with the many idiosyncrasies that stem from having a
child who doesn’t fit into any single, neat stereotype.
Idiosyncrasy is a useful word to use to describe our
experiences, but it may be helpful to refer to the
dictionary definition.
Idiosyncrasy… 1) a mental constitution, view of
feeling, or mode of behaviour peculiar to a person;
2) anything highly individualized or eccentric; 3) a
mode of expression peculiar to an author…. Greek
idiosugkrasia from idios own + sun together +
krasis mixture. (Concise Oxford English Dictionary)
The idiosyncratic modes of behaviour and expression
that are central to Thomas mean that his formal and
informal support, at school and at home, needs to be
equally idiosyncratic and individualised. In order to
achieve this we have often found ourselves debating,
Tizard Learning Disability Review Volume 14 Issue 3
working with and sometimes challenging the practices
and processes we have come across. Primarily this
has been to access something basic: a full-time
education for Thomas.
While these idiosyncrasies of behaviour, expression
and understanding relate to Thomas, we have
often found ourselves in situations which mirror his
bafflement with language, especially when trying to
understand the terminology used by professionals
to describe and discuss Thomas’s needs. The main
idiosyncrasy stems from having a child with complex
and serious special needs who is also extremely able
in specific areas. Thomas fits into the criteria outlined
in the Special Education Code of Practice (Sencop),
but he fails to match conventional ideas of either a
‘disabled’ child or a ‘normal’ child. A preoccupation
with terminology often sidetracks attention away from
provision, accessibility and equality, which are at the
core of both the DDA and the Sencop. I will clarify
what I mean by professions. My OED gives:
Profession… 1) a vocation or calling esp. one that
involves some branch of advanced learning or
science [the medical profession].
This raises key points about levels of expertise
and competence from which expectations about
professional behaviour might stem. However it
goes on:
2) a body of people engaged in a profession
(Concise Oxford English Dictionary).
Professional bodies have an important role in
supporting their members, in advocacy, regulation
and networks. They ensure that ‘advanced learning’
remains up to date, in line with current research
and within the law. Parents are usually outside
these organisations, not party to the specific use of
language, ‘the jargon’ used within each profession.
As a result, an unfortunate, often unequal, sense
of ‘us’ and ‘them’ can arise between professionals
and parents. The differences can be so profound
as to cause wariness between professional groups
July 2009 © Pavilion Journals (Brighton) Ltd 19
 Person-centred approaches to supporting children and adults with autism spectrum disorders
themselves. As parents, we have often felt that
there is a bizarre competition, in meetings and
correspondence, between the professions in
the use of obscuring jargon. We are constantly
hunting down the meaning of simple words. The
different interpretations of ‘assessment’ by health
professionals, psychology, local education services
and social services is a case in point. Educational
terms such as ‘differentiating the learning outcomes’
and ‘adult mediated learning environments’ have
often left us feeling as though we are trapped in the
Hunting of the Snark.
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The method employed I would gladly explain,
While I have it so clear in my head,
If I had but the time and you had but the brain –
But much remains to be said.
(Lewis Carroll, The Hunting of the Snark. Fit the fifth:
The beaver’s tale, verse 18)
This barrier between people is all the
more frustrating when the Sencop specifies
clarity of language and acknowledgement of
parental viewpoints.
2.7 To make communication effective professionals
should:
† Acknowledge and draw on parental knowledge
and expertise in relation to their child
† Focus on the children’s strengths as well as
areas of additional need
† Recognise the personal and emotional
investment of parents and be aware of their
feelings
† Ensure that parents understand procedures, are
aware of how to access support in preparing
their contributions, and are given documents well
before meetings
† Respect the validity of differing perspectives and
seek constructive ways of reconciling different
viewpoints
20 Tizard Learning Disability Review
† Respect the differing needs parents themselves
may have, such as a disability, or communication
and linguistic barriers
† Recognise the need for flexibility in the timing of
and structure of meetings (Chapter 2, p17).
This outline has been translated into agendas in
which agencies are encouraged to facilitate and
enable parents to become equal partners in decision
making processes, or words to that effect. This is a
curiously indicative phrase, which positions parents
as less than equal. I suggest that the vast majority
of parents will always have a greater, a more than
equal, interest in their children than anyone else.
One of the major frustrations we have faced is in
having our expert knowledge of Thomas ignored or
undermined by those who are, in theory, our ‘equal
partners’. This is not to say that professionals do not
care or are uninterested, but we carry the unequal
majority share of the ‘partnership’. Those of us who
ask too many questions are ‘the awkward squad’ or
‘over-demanding’ or – my favourite – ‘unrealistic’. It
would be refreshing if all those involved followed the
Sencop advice, which reminds professionals:
2:6 Positive attitudes to parents, user-friendly
information and procedures and awareness of
support needs are important. There should be no
presumption about what parents can or cannot
do to support their children’s learning. Stereotypic
views of parents are unhelpful and should be
challenged. All staff should bear in mind the
pressures a parent may be under because of the
child’s needs (Sencop, Chapter 2, p17).
The nature of such partnerships becomes all the
more complex when the concerns of the parents,
siblings, grandparents – indeed, the concerns of
all the extended family and friends (from whom
the most immediate, practical support most often
derives) – are considered.
In my experience, there is one question which
new professionals unfailingly ask when they meet
us and which illustrates the differences in status
Volume 14 Issue 3 July 2009 © Pavilion Journals (Brighton) Ltd
 Person-centred approaches to supporting children and adults with autism spectrum disorders
between ‘professional’ and parent: ‘… and what is it
that you do?’. Over time I am finding this question
increasingly hard to answer, as the more rooted
I become in providing for my child’s educational
and other needs, the less located I am in my own
professional field. As a parent, I find the question
patronising and the need for simplistic pigeonholing
depressing. The question becomes all the more
irritating when one has answered it nearly a 100
times. The information is certainly already contained
on page 1 of the file, if only someone would read it.
In two years from the first visit to our GP,
through statutory assessment for a statement of
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special educational needs, until Thomas started
in reception, we were dealt with by an ever-
changing chain of more than 60 professionals. This
number is now over 100. As a result, continuity
has been poor. Only our GP, the paediatrician,
two LEA case officers and a research psychologist
have remained constant. Any concept of ‘equal
partnership’ dissolves when so many people are
involved. We would not have achieved the levels of
support Thomas has had to date without the legal
underpinning of a statement of Special Educational
Need.
The emotionally gruelling ‘statementing’ process
took ‘only’ a year and, although it was highly
stressful, Thomas got the educational support he
requires. However, even with this detailed and
considered document, it has continued to be
extremely difficult to get the recognition of what is
required and that provision put in place.
Following the issue of the statement, the chain
of 63 professionals diminished into a small group.
Throughout playgroup and infant school we had
a core team working in a Team Around the Child.
This team consisted of a dozen or so remarkable
people who did work in genuine partnership. It
included members of staff from the settings and
external experts. (Expert: having special knowledge
or skill in a subject… from Latin expertus, past
participle of experiri: to try.) They prioritised ‘the
needs of the child’ as the starting point to making
provision work. The lead professional believed very
Tizard Learning Disability Review Volume 14 Issue 3
strongly ‘in keeping the conversation live’, a phrase
which essentially means ‘listen and talk to each
other’ and ‘keep it meaningful’. This ethos was a
key element of very successful team working. One
group of professionals who are often closest to
understanding equal partnerships with parents are
the expert teaching assistants who support some
of the most complex and challenging children in the
school system.
However, as time has progressed, the genuine
working partnership has come and gone. As
parents, we find it hard to describe the impact of
the ever-changing procession of professionals. We
have found it exhausting keeping track, over seven
years, of who is involved and what they are doing.
Trying to maintain progress in a shifting tide of
professionals is not easy. Files get lost, or not read,
reports with errors are distributed, and ultimately,
progress is lost. The strategic inability to maintain
continuity can cause great disruption, not only for
parents and professionals but also, more centrally,
for the child. This became evident during Thomas’s
routine move from local infant to local junior school,
which involved changing teaching assistants, special
educational needs co-ordinator and educational
psychologist. Key relationships were lost, and this
proved disastrous. Thomas was terrified and lasted
only four days in that setting. He needed over a
year out, during which time I provided his support
full-time. An exhausting situation, too complex to
detail here.
Thomas is now in a very different, supportive,
inclusive school. Though the current legislative
framework demands that all schools should be
fully inclusive, this is, as many parents know,
exceedingly rare. The move to secondary school is
on the horizon, so we are entering the process all
over again. New assessments, visits and, no doubt,
more ‘equal partners’. We have nearly two years of
‘transitional planning’ to get through before he even
changes school. Thankfully, for now, we have the
support of a fully inclusive school and a new team
of key professionals who have taken the time to
know him.
July 2009 © Pavilion Journals (Brighton) Ltd 21
 Person-centred approaches to supporting children and adults with autism spectrum disorders
In the meantime, while his sister plays Simple
Gifts on her fiddle, I need to explain, idiosyncratically
of course, what a psychosis is, why the makers of
Madagascar might think penguins are psychotic and
why we say it the way we do when it is spelt the
way it is.
Good practice in supporting
children and adults with autism
The case study illustrates some of the issues faced
by children and families through early years, primary
school and times of transition. The emphasis of the
case study is on legislation, co-ordination and the
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importance of partnership with families. It is also
important to consider what support is needed on a
day-to-day basis – support to learn and develop,
support to be socially included and support to
become as autonomous and independent as possible.
Since 1964 the National Autistic Society have been
supporting families and professionals working with
those with autism. After years of experience, and
building on a sound evidence base of research and
practice including feedback from people with ASD
themselves, they developed a framework which forms
the basis of their training on autism and their provision
of services for people with autism. It is called the
SPELL framework (Mills, 2008) and uses cognitive
learning theory to instil five key pillars of good
practice through the simple mnemonic SPELL:
† Structure
† Positive approaches and expectations
† Empathy
† Low arousal
† Links
This section will consider each of these pillars in turn,
outlining definition, implementation and challenges
for each element. Overall, the framework fits very
neatly on the person-centred support agenda; it
recognises the individuality of all people with autism
and highlights the importance of planning for and
supporting people on that basis. The framework
aims to reduce the disabling effects of autism and,
in particular, the anxiety experienced by so many
22 Tizard Learning Disability Review Volume 14 Issue 3
children and adults with ASD. It is not an approach
as such, but rather a foundation on which to build
other interventions focusing on communication,
participation, education and behaviour.
Structure
There is a great deal of evidence to confirm the value
of structure in programmes for autism (Bartak &
Rutter, 1968; Schopler et al, 1971; Rutler & Schopler,
1978; Schopler & Olley, 1980; Rutler & Schopler,
1992; Schopler et al, 1995). Structure is a major
element of other intervention approaches such as
TEACCH (Treatment and Education of Autistic and
related Communication Handicapped Children).
It involves the use of supports such as visual
timetables, environmental management and other
non-verbal communication aids, to make the world
more comprehensible and predictable and thus
reduce anxiety. It is generally recognised that almost
all people with autism are substantially stronger
in processing visual information and in organising
their lives if information is presented in logical and
concrete ways. Even the most able individuals, with
good language, are helped in their ability to respond
independently by use of signs, symbols, photographs,
drawings or having tasks presented to them in
predictable format.
We all use a selection of methods to provide
structure in our own lives – diaries, calendars, work
plans and schedules, to name but a few. Individuals
with autism need more attention to structure because
they may have particular difficulty in organising
information instinctively, and may find it especially
hard to understand the mental states and intentions of
other people. This leads directly to problems, not only
in understanding spoken language but also with the
unwritten rules implied by gesture, facial expression
and intonation of voice. Words may be taken literally,
or an apparently good vocabulary may mask receptive
deficits. The use of structure removes ambiguity
and helps to reduce reliance on prompts and verbal
instruction, thereby promoting independence and
autonomy. Something as simple as a picture on a
kitchen cupboard or drawer reduces the need for a
July 2009 © Pavilion Journals (Brighton) Ltd
 Person-centred approaches to supporting children and adults with autism spectrum disorders
carer to prompt an individual where to go for a plate
or a spoon. Presenting choices visually to people
also promotes their ability to understand the choices
being presented. This can also apply to more able
individuals, whose ability to function in work is greatly
enhanced by knowing how much work has to be
done, the sequence of the work and when the work
has been completed.
Structure is not the same as rigid routine. It does
not mean that the person has to do the same thing
every day, nor does it mean that they cannot try new
things or that everyone has to do the same thing.
Indeed, the NAS training materials suggest that it
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is important to build change into people’s routines
in order to encourage flexibility – but in a carefully
managed way to avoid anxiety. One issue sometimes
met in services is that, despite professional guidance
to use visual structure and communication systems,
staff teams decide that having pictures on the kitchen
cupboards is not ‘normal’ and so they remove them.
However, it is important to remember that, for
someone with autism, removing those timetables or
symbols could be as disabling as taking the wheelchair
from someone who cannot walk.
Positive approaches and expectations
At a time when person-centred approaches
and respecting people’s choices are seen as very
important, it is good to revisit what they mean in
practice. Mansell et al (2005) reminds us that to
have real choice we have to have more than one
option, and experience of the options and of having
our choices respected, with support to achieve
success. Teaching choice making is an essential tool
in enhancing communication, preventing distress and
reducing challenging behaviour. Teaching a person
how to request a preferred activity or to indicate
when they wish something to stop is central to the
approach.
Positive approaches and expectations do not mean
allowing people to sit and do nothing or to engage in
self-stimulatory behaviour all the time because they
seem to be ‘choosing’ to do so, but supporting people
to try new things safely, so they can make choices,
Tizard Learning Disability Review Volume 14 Issue 3
learn and grow in independence. In essence, positive
approaches are concerned with engaging people in
meaningful activities and relationships using a helpful
style of interaction embedded in positive attitudes and
a knowledge of the individual, using approaches such
as person-centred active support, total communication
and positive behaviour support (Mansell et al, 2008;
Beadle-Brown, 2006; Mansell et al, 2005).
Positive approaches are also about playing to
strengths, about having high enough expectations for
people not to become bored and therefore to resort
to self-stimulatory or self-injurious behaviour, but not
such high expectations that we fill people with anxiety
and lack of confidence. They are also about working
with people to recognise and develop their strengths
to achieve their maximum potential, and about valuing
their contribution, whatever that might be.
Finally, positive approaches are about how we
portray people with autism to others – the language
we use, the imagery we use, the places we provide
for them to live, the way we present them to new
people, the activities we offer them (age-appropriate
and real), and the way we support them to be a
valued member of their community.
Empathy
In order to support children and adults with autism,
it is necessary to understand what it is like to have
an autism spectrum disorder, or more accurately to
understand how having autism affects an individual’s
life. Empathy is about respecting people’s right to
be a bit different from you or me and working to
understand how they communicate, experience the
world around them or feel in a given situation. It is
about finding ways to help them function as well as
possible in what may seem to them an alien world.
Empathy is about understanding the different ways
in which people with autism experience the world.
We have already spoken about the need for structure,
but we should try to understand that for many
individuals the world is a confusing, often nightmarish,
place where they are bombarded with information
that makes absolutely no sense to them. They may
have a particularly concrete or literal view of events
July 2009 © Pavilion Journals (Brighton) Ltd 23
 Person-centred approaches to supporting children and adults with autism spectrum disorders
and language that leads them to logical but socially
incorrect or inappropriate conclusions. This can lead
to a great deal of distress or teasing and bullying.
Empathy is not about acknowledging the
difficulties someone faces and then allowing them
to avoid any difficult situation, but supporting them
through those difficulties using rehearsal of potentially
difficult scenarios, positive approaches, expectations
and structure. It is not about finding one ‘autism-
friendly approach’ for all people with ASD, but the
right approach to support each individual.
Low arousal
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This element of the framework applies to both the
environment and our interactions with an individual. It
is important to improve focus and concentration, but
it is also important in reducing anxiety and managing
‘challenging behaviour’. Environmental manipulation is
an important part of LaVigna’s framework of positive
behaviour support (Lavigna & Willis, 1995).
We are increasingly aware that the sensory profile
of individuals with autism often differs markedly from
that of the general population and that they may be
either over- or under-sensitive across the full range
of sensory domains (Kern et al, 2006). They may
be sensitive to light, sound, heat, smell and touch.
They may have problems in integrating the sensory
domains into a coherent whole. Their so-called
challenging behaviours may be a reaction to these
problems, and an attempt to regulate and achieve
equilibrium. It is here that attention to interaction and
environment is crucial
We should not confuse low arousal with no
arousal. Such approaches need to be person-centred;
what brings about a state of high arousal for one
person might not be experienced in the same way
by another. Here empathy is important; being aware
of how the environment affects each individual
should dictate how best to arrange their environment.
In interactions it is important to use a quiet, non-
confrontational approach with individuals with autism.
Giving people the opportunity to experience new
and potentially anxiety-provoking events or activities
in very small chunks, with control over the course of
24 Tizard Learning Disability Review Volume 14 Issue 3
the activity, will help them to be able to engage in
activities and interactions in the future (Marvin, 1998;
Carr & Collins, 1992; Mansell et al, 2005).
This element of the framework is often said
to be the most difficult to implement, especially
in mainstream environments where most people
do not have ASD. In some environments, such as
mainstream UK schools, the principle of low arousal
goes against the Government’s recommendation that
children should be stimulated as much as possible.
Asking teachers to tone down art work or science
displays in classrooms, for example, or use alternative
ways of displaying children’s work sometimes is
met with resistance. Although the National Autistic
Society argues that the SPELL framework can be
implemented in most situations and that most, if not
all, children would benefit from a calm and organised
environment, research evidence to support this view
is lacking.
Links
The links element is focused primarily on supporting
integration in mainstream society through consistency
and continuity of approach. This is achieved by
partnership with families, schools, public agencies and
so on, and it is here, often at times of transition, that
things may go particularly badly. Those supporting
people directly should not feel on their own or
unsupported. They must be able to refer to others
for advice, assessment, intervention and support –
particularly important where children and adults have
challenging behaviour. While the SPELL framework,
including use of person-centred approaches, goes a
long way to producing the conditions that will reduce
challenging behaviour, it will not replace the need for
guidance and support from informed professionals.
This is the element of the framework with which
the case study presented above is largely concerned.
The framework maintains the importance of links
with all those involved in the lives of the child or
adult with autism, and with professionals who could
support the child and the family. One would be
excused for thinking that this should be the easiest
element to implement; it does not require autism-
July 2009 © Pavilion Journals (Brighton) Ltd
 Person-centred approaches to supporting children and adults with autism spectrum disorders
specific skills, but some understanding and
empathy with the child and his or her family.
However, there is substantial anecdotal evidence
that many parents have to spend much of the life
of their child fighting to receive appropriate support
and struggling to manage the involvement of a
multitude of professionals who may not agree
with each other. There are too many challenges for
parents to elaborate on here, but issues such as the
lack of early intervention, the ‘postcode lottery’ in
the UK and lack of knowledge of autism in health
and public service personnel make the job of
parents even more difficult.
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What is needed to implement
good practice more widely?
Awareness and training
Although this framework for good practice is
becoming more widespread, it is still not commonly
in place in schools and services apart from those
provided or accredited by the NAS. The tendency for
local authorities and services to develop their own
‘bespoke’ training can result in a lack of consistency
of knowledge and approaches. It has been
recognised by government that, despite the work of
the NAS, awareness of autism is still limited in public
services such as social services, health services,
the police and mainstream education. However, as
illustrated in places such as Jersey, it is possible
to overcome this and to train people in a range of
services in the SPELL framework, with beneficial
effects.
Carers and professionals in all fields that
support people with autism in any way need a
good understanding of autism and of good practice.
Training that offers a clear and consistent approach
is essential.
As noted in the case of Thomas, described
above, despite a legal right to inclusive education,
the reality at present is that this rarely happens
for children with ASD. However, when it is done
well, the benefits can be tremendous. Apart from
the beneficial effects on the child, there are other
important benefits in awareness, knowledge and
Tizard Learning Disability Review Volume 14 Issue 3
acceptance of autism as a different but perfectly
valid way of being. At one local mainstream primary
school where there are a number of children with
ASD, the children show an amazing acceptance and
integration of the children with ASD, while they
have worked out how and when to approach or
not approach these children and when to give them
space. They also clearly value the ASD children
and help these children feel part of the class,
supporting and recognising their achievements. In
order to help people with autism to be accepted as
valued members of our community, it is essential to
enable them to access the same environments and
opportunities as their peers – but little and often –
so that you increase tolerance on both sides.
Legislation and policy
Legislation and policy that have integration, choice
and fulfilling potential at their core would provide
incentives for these good practices to take root. In
particular, legislation and policy can be important
in ensuring consistency across locations. However,
any general disability, education, health or social
care legislation needs to mention autism specifically
and set out any special provision clearly, since it
is an area (acknowledged by the DH, 2006) that
crosses traditional boundaries of health, social care,
education and so on. All legislation should apply to
people with autism, but the way in which it should
be done is often open to interpretation or, in some
cases, misinterpretation. Without this specificity,
people with autism will continue to fall through the
gaps of provision and struggle to access mainstream
or even general disability services. One example is
facilitating access for people with autism under the
Disability Discrimination Act, where an understanding
receptionist and a private (low arousal) interview
room are needed to facilitate access to social
services departments or banks, rather than a ramp
or automatic doors.
Research
The SPELL framework is based on substantial
practical experience and research into what works
July 2009 © Pavilion Journals (Brighton) Ltd 25
 Person-centred approaches to supporting children and adults with autism spectrum disorders
for children and adults with autism, and has received
a positive evaluation in the only published critique
(Tutt et al, 2006). Each of the elements of the
framework has a strong evidence base, but the effect
of the implementation of the framework as a whole
has not been evaluated. Research on elements such
as active support has included people with autism
but has not explored specifically the effect on people
with autism. In order to support implementation of
the SPELL framework in mainstream settings as well
as autism-specific settings, research in both special
and mainstream settings is necessary, in particular
to show that such a framework does not harm the
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development or quality of life of the other people
without ASD but rather that it is a useful framework
for supporting learning, development and quality of
life in any setting to which children or adults with
autism are to have access.
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