Special Education and Autism: What Everyone Needs to Know
Presentation compiled and created by Karen Snead
Director of Education The Arc of Greater Houston www.thearcofgreaterhouston.com
Last revision: October 2010
October 2010 RevisionReproduction: No part of this manual may be reproduced in any form without permission from The Arc of Greater Houston. Any permitted reproduction of the material must include the usual credit line and the copyright notice. Printing history: 1st edition 2006. Copyright © 2009
Thinking about what those with autism bring to the table:
• Tony Attwood said this: "Asperger’s syndrome has probably been an important and valuable characteristic of our species throughout evolution". http://lastcrazyhorn.wordpress.com/quotes-about-autism-and-everything-that-includes/
(retrieval date 10_4_2009)
• "Autism is an extremely variable disorder". Temple Grandin http://www.brainyquote.com/quotes/keywords/autism.html (retrieval date
• "Autism Rocks! (and rolls and spins and flaps and loves and laughs)". Anonymous on http://www.circleofmoms.com/autismaspergerspdd-awareness/favorite-autismquotes-569012 (retrieval date 10_4_2009)
Autism: Brief Description
• "Autism is a complex developmental disability that typically appears during
the first three years of life and is the result of a neurological disorder that affects the normal functioning of the brain, impacting development in the areas of social interaction and communication skills..." http://www.autismsociety.org/site/PageServer?pagename=about_whatis (3)
Family income, lifestyle and educational levels do not affect the chance of autism's occurrence. Autism predominantly interferes with the normal development of the brain in these areas ♦ social interaction (problems understanding social rules, perspectives) ♦ communication skills (odd/poor understanding and use of language) ♦ reasoning to behavior (rigid thoughts, concrete obsessions, sensory irregularities translated into atypical behavior)
Important Factors Relating to Autism
• Autism spectrum disorders (ASDs) occur in individuals of all ethnicities, races and socioeconomic statuses. • The ratio of male to female occurrences is 4:1. (1) • Some estimates for occurrence rates are as high as 1 in 150. ___________________________________________ • Can have co-morbid diagnoses such as depression, mental retardation, anxiety or schizophrenia.
• There are currently no scientifically validated, complete cures for ASDs. • Some treatment methods do have substantial research supporting their effectiveness in decreasing some of the symptoms associated with ASDs.
Autism Typologies and Diagnosis
♦ Autism (Classic Form) ♦ Asperger Disorder ♦ Pervasive Developmental Disorder-Not Otherwise Specified _______________________________________________ ♦(Rett’s Syndrome)-not discussed in this training ♦(Childhood Disintegrative Disorder)-not discussed in this training-basically same as other ASD’s except for age and pattern of onset. Autism is a spectrum disorder (ASD) where an individual can express somewhat differing characteristics of the disorder in differing amounts. However, the underlying core deficits must meet a minimum threshold and accepted diagnostic criteria.
Autism (classic form) http://www.appi.org/book.cfm?id=2024
"Diagnostic Criteria for Autistic Disorder (Diagnostic and Statistical Manual – IV-TR) 299.00 (13) A. A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3) (1) qualitative impairment in social interaction, as manifested by at least two of the following: (a) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction (b) failure to develop peer relationships appropriate to developmental level (c) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest) (d) lack of social or emotional reciprocity (2) qualitative impairments in communication as manifested by at least one of the following: (a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime) (b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others (c) stereotyped and repetitive use of language or idiosyncratic language (d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level (3) restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least two of the following: (a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus (b) apparently inflexible adherence to specific, nonfunctional routines or rituals (c) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements) (d) persistent preoccupation with parts of objects B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play C. The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder". 7 • Verbal IQ is typically less than performance IQ
"Diagnostic Criteria For 299.80 Asperger's Disorder (DSM-IV-TR) (13) A. Qualitative impairment in social interaction, as manifested by at least two of the following: - marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction - failure to develop peer relationships appropriate to developmental level - a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g. by a lack of showing, bringing, or pointing out objects of interest to other people) - lack of social or emotional reciprocity B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following: - encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus - apparently inflexible adherence to specific, nonfunctional routines or rituals - stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements) - persistent preoccupation with parts of objects C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years) E. There is no clinically significant delay in cognitive development or in the development of ageappropriate self-help skills, adaptive behavior (other than social interaction), and curiosity about the environment in childhood F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia" * Verbal IQ not generically impaired and is usually higher than Performance IQ http://www.appi.org/book.cfm?id=2024 (13) 8
Pervasive Developmental Disorder – Not Otherwise Specified (13)
PDD-NOS (DSM IV-TR) 299.80 "This category should be used when there is a severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills or when stereotyped behavior, interests, and activities are present but the criteria are not met for a specific pervasive developmental disorder, schizophrenia, schizotypal personality disorder, or avoidant personality disorder. For example, this category includes "atypical autism" presentations that do not meet the criteria for autistic disorder because of late age at onset, atypical symptomatology, or subthreshold symptomatology, or all of these".
• Recap of Main Characteristics of Autism Spectrum Disorders 1) 2) -------------------------------*3)
What do these areas of weakness mean for education?
We need to understand what the law promises for students with disabilities first. Under the Individuals with Disabilities Education Improvement Act (IDEA) of 2004, students with disabilities should receive A free, appropriate education in the least restrictive environment that results in meaningful progress in order to prepare them for 1) employment, 2) further education and 3) independent living
IDEA also requires ♦curriculum/services based on peer reviewed
research to the extent practicable ♦genuine access and opportunity to participate within the general curriculum with the same high expectations as students without disabilities ♦genuine opportunity to participate in extracurricular activities offered by schools just as peers do ♦evaluation and services that cover the academic, developmental and functional needs of a child
IDEA 2004 General Things to Know (findings related to law)
"Congress found that implementation of IDEA “has been impeded by the failure of schools to apply replicable research on proven methods of teaching and learning.” IDEA 2004 includes numerous references to “scientifically based instructional practices” and “research based interventions. (findings section IDEA) (Therefore) The child’s IEP must include “a statement of the special education and related services and supplementary aids and services, based on peer-reviewed research to the extent practicable to be provided to the child.” (Section 1414(d)(1)(A)(i)(IV))“
www.wrightslaw.com/idea/art/10.tips.steedman.htm#3/ (Retrieval date 6/9/2008) "10 Tips: How to use IDEA 2004 to Improve Your Special Education". Steedman, W. from the website Wrightslaw.Com.
IDEA 2004 General Things to Know
"Legal Rulings on IEPs … general principles, among others, emerge clearly from a review of the hundreds of past IEP rulings from agencies and courts: The availability of services may not be considered in writing the IEP. If a service is needed it must be written on the IEP and if the district does not have it available, it must be provided by another agency. One of the earliest of all the agency rulings mandated that availability of services be disregarded in writing the IEP (Leconte, EHLR 211:146, OSEP, 1979). This principle has been reiterated repeatedly by the Office of Special Education and Rehabilitative Services (OSERS) and the Office of Special Education Programs (OSEP) and virtually ignored by the field. IEPs must be individualized. The same goals, same content areas, same discipline or the same amounts of therapy on many IEPs (e.g., every student who receives speech therapy in a particular building receives 30 minutes daily) reveals a violation of this individualization requirement (Tucson, AZ Unified Sch. Dist. #1, EHLR 352.547 (OCR 1987)). " www.wrightslaw.com/info/iep.success.bateman.htm/ (14)
Autism and Public Policy (continued) Texas Autism Supplement---November 2007 revision of law
TAC Code Chapter 89.1055- Nov 2007 revision (Content of the IEP - Autism Supplement) "(e)
For students eligible under §89.1040(c)(1) of this title (relating to Eligibility Criteria), the strategies described in paragraphs (1)-(11) of this subsection shall be considered, based on peer-reviewed, research-based educational programming practices to the extent practicable and, when needed, addressed in the IEP: (1) extended educational programming (for example: extended day and/or extended school year services that consider the duration of programs/settings based on assessment of behavior, social skills, communication, academics, and selfhelp skills); (2) daily schedules reflecting minimal unstructured time and active engagement in learning activities (for example: lunch, snack, and recess periods that provide flexibility within routines; adapt to individual skill levels; and assist with schedule changes, such as changes involving substitute teachers and pep rallies); (3) in-home and community-based training or viable alternatives that assist the student with acquisition of social/behavioral skills (for example: strategies that facilitate maintenance and generalization of such skills from home to school, school to home, home to community, and school to community)";
Autism and Public Policy (continued) Texas Autism Supplement---November 2007 revision of law
TAC Code Chapter 89.1055- Nov 2007 revision (Content of the IEP - Autism Supplement) "(4) positive behavior support strategies based on relevant information, for example: (A) antecedent manipulation, replacement behaviors, reinforcement strategies, and data-based decisions; and B) a Behavior Intervention Plan developed from a Functional Behavioral Assessment that uses current data related to target behaviors and addresses behavioral programming across home, school, and community-based settings; (5) beginning at any age, consistent with subsections (g) of this section, futures planning for integrated living, work, community, and educational environments that considers skills necessary to function in current and postsecondary environments;" http://framework.esc18.net/SBS_April_2008.pdf
Autism and Public Policy (continued) Texas Autism Supplement---November 2007 revision of law
TAC Code Chapter 89.1055- Nov 2007 revision (Content of the IEP - Autism Supplement)
"(6) parent/family training and support, provided by qualified personnel with experience in Autism Spectrum Disorders (ASD), that, for example: (A) provides a family with skills necessary for a child to succeed in the home/community setting; (B) includes information regarding resources (for example: parent support groups, workshops, videos, conferences, and materials designed to increase parent knowledge of specific teaching/management techniques related to the child's curriculum); and (C) facilitates parental carryover of in-home training (for example: strategies for behavior management and developing structured home environments and/or communication training so that parents are active participants in promoting the continuity of interventions across all settings)";
Autism and Public Policy (continued) Texas Autism Supplement---November 2007 revision of law
TAC Code Chapter 89.1055- Nov 2007 revision (Content of the IEP - Autism Supplement)
"(7) suitable staff-to-student ratio appropriate to identified activities and as needed to achieve social/behavioral progress based on the child's developmental and learning level (acquisition, fluency, maintenance, generalization) that encourages work towards individual independence as determined by, for example: (A) adaptive behavior evaluation results; (B) behavioral accommodation needs across settings; and (C) transitions within the school day; (8) communication interventions, including language forms and functions that enhance effective communication across settings (for example: augmentative, incidental, and naturalistic teaching); (9) social skills supports and strategies based on social skills assessment and curriculum and provided across settings (for example: trained peer facilitators (e.g., circle of friends), video modeling, social stories, and role playing)";
Autism and Public Policy (continued) Texas Autism Supplement---November 2007 revision of law
TAC Code Chapter 89.1055- Nov 2007 revision (Content of the IEP - Autism Supplement)
"(10) professional educator/staff support (for example: training provided to personnel who work with the student to assure the correct implementation of techniques and strategies described in the IEP); and (11) teaching strategies based on peer reviewed, research-based practices for students with ASD (for example: those associated with discrete-trial training, visual supports, applied behavior analysis, structured learning, augmentative communication, or social skills training). (f) If the ARD committee determines that services are not needed in one or more of the areas specified in subsection (e)(1)-(11) of this section, the IEP must include a statement to that effect and the basis upon which the determination was made.
Top Ten Priorities for Special Education
• Know the Texas Administrative Code 89.1040 section e inside and out. This law is a child's road to success. • Know, embrace and utilize/exploit a child's strengths. • Know everything there is to know about a child's reinforcers and know more than the basics of principles of reinforcement. • Know how to approach and teach a child self advocacy skills and self defense skills. Ensure that part of the IEP address these skills every year a child is in school • For parents, create an engaging portfolio of your child that addresses educational needs in terms of academic functioning, interests, motivators, strengths and weaknesses. • Ensure that everyone involved in social skills planning, goal creation and assessment is using published curriculums for all three aspects of this area.
Top Ten Priorities for Special Education
• Know the Student Handbook Code backwards and forwards. • Know what is included in a good Functional Behavior Assessment (FBA) and a good Behavior Intervention Plan. • Make sure that a child is provided with meaningful frequent opportunities to interact with age appropriate peers in extracurricular activities. • Know the full range of possible services offered for students with autism. • Know how to ask for and access information on specific autism related teaching experience, training and professional credentials of all school personnel who work with a child. Know how to request training if needed.
Learning Areas Affected by Autism and Educational Interventions
Diagnoses and Impact on Education Areas
• Knowing all of the core deficits typically found in individuals with autism helps with educational planning. The DSM-IV TR diagnostic criteria outline 6 main areas that can significantly affect school and life outcomes in all areas. • These areas include ▲Cognition ▲Social Skills/Social Cognition/Social Language ▲Communication (many aspects of language) ▲Sensory and Motor Skills ▲Adaptive Behaviors (life/daily living skills) ▲Problematic Behavior Requiring Intervention
In order to learn we need adequate:
• joint attention skills (thinking) • imitation skills (behavior) • Normative/normal interest and motivation leads to effective communication social interaction Result -- Successful Human LEARNING
• Odd thinking patterns/interests (repetitive/obsessive thoughts, odd detail fixation-- one note interests--trains, problems with abstract thought processes-can’t see big view • Lack of theory of mind (weakness to non-ability to take the perspective of others) • Lack of joint attention (seems like ADD but op. pattern) • Lack of discrimination (figuring out what is pragmatically important in the environment) • Lack of generalizing of learning • Odd cognitive thinking/awareness in relation to sensory exp • Difficulties of organizing and planning- executive functioning, sequencing • Frequent inability to effectively use and understand certain symbols • Difficulty with socially complex imaginative thinking • Literal and fixed rule bound thoughts/expectations
• May be more interested in visual information/thinking (especially exaggerated in high functioning classic autism) • May show much higher spatial reasoning skills (puzzles, rotating objects in space-especially in classic high functioning autism) • Computer/machine use interest may be very high • May have odd splinter “savant/brilliant” detailed skills (less that 1% of total autism population) ALL OF THESE PERMEATE MOST LEVELS OF EXPERIENCE TO SOME DEGREE - THE MORE SEVERE THE AUTISM SPECTRUM DISORDER, THE MORE THESE INFLUENCE DAILY LIFE -- READINESS TO LEARN* ►You have to effectively motivate students with ASDs in order for them
to be able to learn to move beyond/outside of these characteristics. ► The more high functioning the student, the more they may be aware of their deficits/failures.
Relative Cognitive Strengths: -For those w/o ID, often very good auditory short term & long term rote memory (but not typical working memory) -High funct. autism, often good spatial skills and applied math -w/Asperger’s often have excellent, intact basic language skills -Detail oriented -For many, functioning good basic readers (phonological awareness) -For many, exceptional spelling ability -Exceptionally high motivation to focus on areas of interests -High tolerance for repetitive tasks of interest
Successful Intervention for Cognitive Difficulties- the “Biggies”
• • • • • • • • • Daily schedules reflecting minimal unstructured time Environmental regularity control (centers, fewest sensory distracters possible, picture explanations of what to do/next) Practice w/change. One-on-one to small group instruction to paraprofessional use depending on severity of ASD symptoms Highly rigorous behavior manipulation and intervention with frequent, successful use of reinforcement based on individualized, unique characteristics of the child Rote, frequent practice for generalization of learning across environments Visual and high tech/computer curriculum/skills practice Proven, effective research based behavior and learning interventions for cognitive difficulties Fidelity of interventions/practices across environments monitored regularly Significant modifications and accommodations that are consistent as needed across environments
Cognition Intervention Strategies
• Use odd interests/obsessions as motivating reinforcers • Follow regular, fixed activities and schedule to the greatest extent possible (have visual board of day/activity schedules, room labels for specific activity areas and checklists for what has already occurred. Use Reinforcer Token Boards • Introduce new activities and environments in incremental steps. Show complete outlines of how things are supposed to occur in a visual, concrete set of symbols • Test knowledge skills across many and varying environments • Explicitly explain why social/language/abstract actions occur and repeatedly do so across environments. Explain covert reinforcement properties, etc. --why people do what they do.
Cognition and IEPS
▲Perhaps more than in any other area, the need for the selection of meaningful accommodations and modifications will be needed - across subject areas. ▲Because academic areas will be dependent on cognitive ability, accommodations and modifications for specific academic area requirements will also need to be clearly considered and specified. ▲IEP goals should be created to deal with the following concerns in all academic settings -frequent self-monitoring of task purpose and organization -understanding the big picture vs. detail of assignments -thinking about thinking -understanding future activities/behavior expectations ▲Assignment books/electronic organizers/parent teacher assignment logs may be key to success--requirements must be written in IEP.
Language is the ability to communicate (impart/receive = transmit info.) and includes; receptive language (understanding what is said/read/gestured) expressive language (speaking/writing/gesturing or other body language ability) pragmatic/social language (ability to understand the underlying intended meaning of language) ------------------------------------------------------------------------------
Typical ASD deficits may include: concreteness/literalness, pronoun reversal, flat or odd intonation, repetition of words and phrases, big problems with metaphors, difficulty beginning, sustaining and ending “typical” conversation (chitchat), difficulty reading nonverbal language, puzzlement over jokes, problems with emotional conversation/vocabulary, obsessive speech on narrow range of topics, insensitivity to other’s communicative response (verbal or nonverbal), no, little and or odd pretend play/language, inability to understand social language (verbal, body and gestures)
Children with autism have extreme difficulty with the pragmatics of language [the everyday use of language by agents or communities of interpretation in particular circumstances and contexts]. (1) -Language is often domain specific. -Meaning is derived from contextual cues (facial cues, tone of voice, gestures, sarcasm) (Generalization issues) Typically, if children with autism have average IQs they may understand the concrete meaning of concrete language. And they can often memorize specific rule and definition examples. However, generalized understanding of the rules governing nonliteral language use is very difficult. A dog is an animal with four legs. (Understood) It’s raining cats and dogs. (Not Understood)
Three main intervention areas: Functional communication- to replace challenging behaviors Increases in initiation of verbal and nonverbal communication Increases in core communication skills Some Educational Interventions: Augmentative communication devices/methods (including signing) Social Stories (Carol Gray) Role-playing curriculum and activities Direct teaching of receptive and expressive language Abstract language explanation and practice Emotional expression training Pragmatic language training Total Communication (speech plus sign language - child signing ability is correlated with motor skills-apraxia-problems w/movement) PECS- Picture Exchange Communication System- exchange of picture symbols for communication (behavioral program) speech tends to develop with use of 30 -100 symbols or more. Highly correlated with IQ Facilitated communication-different from typical AC systems- continued support from others. Be very careful in agreeing to this intervention -not much research support for this system. Negative review from ASHA. Voice output device-digitized speech output/picture, word and or letter display (2) 33
Findings on Signing and Children with Autism (9)
[“ 1. There is no evidence that use of AC systems as collaterals
to language instruction results in delays of acquisition of speech. 2. There is evidence that sign language enhances the use of speech for some children. 3. There is no evidence to suggest that sign language interferes with the development of speech. 4. Children with good verbal imitation skills demonstrate better speech production than those with poor verbal imitation skills, with or without AC. 5. Children with poor verbal imitation skills are the best candidates for an AC system, such as sign language, because they are likely to make poor progress in speech acquisition without AC.”] (9)
Practical IEP Implications for Language Needs
1. Facilitated Communication methods, as the results in some research studies indicate, may be frequently misused. (9) (1) 2. Make sure language goals include clear, pragmatic language skills (find a curriculum if possible) 3. Encourage Total Communication as the method for implementing language instruction until the child acquires adequate speech/language skills. 4. Move beyond PECs into attempts of vocal speech requirements of child if he/she adequately uses 30 or more symbols and appears to have adequate vocal, physical structures for speech including good vocal imitation skills.
5. Remember language skills acquisition will be directly related to motivation. Children with ASDs often have little intrinsic motivation to acquire many of these skills (this lack of motivation is not so common for those with Asperger’s Syndrome)- an intense behavioral intervention methodology such as ABA may have to implemented first in some cases to make meaningful progress in language or any other areas-later discussion) 6. The tendency for literalness/concrete language use needs to be addressed with specific IEP goals for improvement. 7. Language skills overlap with social skills and cognitive, thinking skills and need to be addressed together across educational environments. 8. Test of Pragmatic Language (TOPL)- seems to test superficial rules-caveat - many w/high functioning Autism and Asperger’s Disorder score well (9). 9. CASL -Comprehensive Assessment of Spoken Language 10. Good task to have a student with adequate language to interview an unknown adult about his/her family. This requires an ability to formulate questions, listen, perspective take, inhibit monologues, etc (9). 11. Accommodations and modifications to curriculum, homework, testing etc., will have to be well defined and serve a child’s unique language needs.
Social Skills/Social Cognition
Social skills/social thinking are one of the 3 core deficit areas in children with ASDs. (1) social skills, (2) communication and (3) unusual thinking, behavior and interests Social skills will overlap with intelligence (verbal IQ) and language skills to some degree. Social problems are almost never fully cured but with the right services and curriculum they can be potentially lessened.
Lack of Theory of Mind (9)
Uta Frith's lack of theory of mind may help in understanding why these children often have little empathy, understanding of another's (the other’s) perspective and few social skills.
A consequence of this problem is that explaining other’s motivations and rationale for appropriate and inappropriate social interaction may or may not be a totally effective strategy when used as an intervention strategy.
Social functioning and ASDs
▪ impairments in relationships with peers ▪ impairments in the use and understanding of nonverbal communication behaviors (pragmatics) ▪ impairments in verbal, social communication ▪ impairments in the use of imitation, and symbolic or dramatic play • Motivation may be the most important factor for success. This may be why ABA (Applied Behavior Analysis)---when used as specified by most researchers in autism--, as a treatment method ,has been associated with tremendous improvement in a significant number of cases. • Those with Asperger’s may often have more intrinsic motivation to succeed socially.
Social Deficits-Joint Attention (9)
Poor joint attention, just as in language, is assumed to cause many of the social deficits in individuals with ASD’s. In most children, the ability to bring objects, hand them to others for interaction, follow eye gaze, make eye contact (referential looking) develops by around age 1 yr. Even with intensive training the ability may be shown infrequently in ASD children. The degree of this ability seems to be somewhat related to IQ and early intervention. Children with ASDs do not seem to understand body space. Those that do approach others may touch them inappropriately, talk obsessively about personal interests and have few to no “reciprocal interaction” skills
All of these social weaknesses can result in children who very quickly become defined as “behavior problems” if they persist in social interaction and “aloof, mechanical robots” if they don’t interact. Educationally it will be very important to allow them to interact (and fail at first as long as the behavior doesn’t harm others). Then teach appropriate social skills to the extent possible. Also clearly explain to others students the aspects of the disability that cause the unusual interaction behavior. 4241
Social Skill/Social Cognition (9)
Because social cognition includes the ability to read and understand emotions in others and to some extent in oneself, direct goals for learning emotional vocabulary and appropriate emotional expression will need to be addressed with goals and curriculum. Remember these kids have typical emotions but at times can’t interpret or express them in understandable and or appropriate manner. Meaningful assessment of social skills is crucial for children with ASDs -Vineland Adaptive Behavior Scales -Social Skills Scales attached to Social Curriculums -Environmental Observation -Walker Mc Connell Scale of School Competence and School Adjustment -Good task to have a student with good verbal language to interview an unknown adult about his/her family. Requires ability to formulate questions, listen, perspective take, inhibit monologues, etc. (Show 3 photos if can’t do it spontaneously) (Link social assessment to developmental functioning) 4342
Examples of Social Skills Curricula
Walker Social Skills Curriculum: The Access Program Autism and PDD Adolescent Social Skills Lessons Skillstreaming Program (Adolescents) Navigating the Social World: A Curriculum for Individuals w/Asperger’s Disorder and High Functioning Autism Jeanette Mc Affee Social Stories/Comic Strip Conversations- Carol Gray Social Autopsies-Richard Lavoie Social Skills Training for Children w/Asperger Syndrome and Social Communication Problems-Jed E. Baker The Transporters (www.thetransporters.com ) Face Say (www.facesay.com ) Teach Town http://web.teachtown.com/ Lets Face It program http://web.uvic.ca/~letsface/letsfaceit/ Ten IPAD revolutionary IPAD applications http://www.gadgetsdna.com/10-revolutionary-ipad-apps-to43 help-autistic-children/5522/ 44
Sensory Motor Skills (9)
In many with ASDs sensorimotor difficulties are some of the first signs families notice alerting them to the fact that something may be different with their child. Differences according to some researchers include: Stereotypical behaviors (ex. hand flapping) Under and overreactions to auditory/visual stimuli-especially in early years Unusual posture Unstable Visual Attention Over/undersensitivity to tactile stimuli Atypical sensory modulation Slower rates of habituation Researchers agree that certain motor areas are sometimes impaired: Motor imitation-body imitation predictive of later language skills Balance Coordination Hypotonia Speech articulation Apraxia- Motor planning Adolescents seem to catch up on many basic motor skills but may still have difficulty w/skilled motor tasks 44 BIG ISSUES for team sports interest, etc,. 45
Sensory Motor Skills (9)
Common Therapies: Sensory Integration Therapy -brain processing of sensory information key to higher functioning (adaptation to controlled sensory experiences worked on) Auditory Integration Therapy -music massages middle ear hairs, reduces hypersensitivity, improves auditory processing, earphones and music used, some frequencies filtered out (Berard method common in US) *little known/accepted, valid empirical success info Vision Therapy - (colored filters, oculomotor exercises, Irlen lenses) *no well controlled empirical studies to my knowledge Occupational Therapy – fine motor training Physical Therapy – gross motor training
Adaptive Behaviors (9)
Adaptive behaviors refer to all those general life skills needed to function on a day by day basis out in the real world. This area of functioning is very broad and many of the goals may extremely obvious from an educator’s perspective. You need to pay particular attention to the IDEA regulations regarding related services to defend a position that community integration, community navigation, use of social and leisure time, etc., can all count as valid educational needs that require individualized attention. There are several curriculums that deal with life skills such as “FACES”. Caveat- careful to match curriculums with a child’s developmental and academic levels. For a child with high functioning autism, many of these curriculums will be too simple. In these cases, unique, individually created goals will have to be created.
Specific Curriculums Created for Autism Characteristics and Needs
Specific Curriculums/Methods that are Commonly Used for Autism Intervention ♦ABA/Lovaas ♦ TEACCH ♦ FloorTime
Applied Behavior Analysis: Lovaas
• Applied Behavior Analysis: Intensive Behavior Program: designed to be one-onone. It uses action-immediate reinforcement modeling (many repeated trials) "Lovaas recommended that ABA programmes should begin as early as possible, preferably before children reach five years of age. This allows them to be taught basic social, educational and daily life skills, and can reduce stereotypical and disruptive behaviours before they become established. However, it is still worth implementing the programme after this age: adults with autism have used ABA programmes too". http://www.nas.org.uk/nas/jsp/polopoly.jsp?d=1071&a=15100 (14 b) "The programme team are the people who actually work ….with children with autism, implementing the programme which has been designed for them. They will usually work on a one-to-one basis with the child for six to eight hours per day, five to seven days a week. Teaching sessions usually last two to three hours with breaks in between. All skills are taught using what is called discrete trial teaching. This involves breaking down the items to be taught into small tasks. These tasks are taught in a very structured way, accompanied by lots of praise and reinforcement: For example: Instruction -------- Response ------------ Reinforcement (if correct response) (eg clap hands) (child claps hands) (child is given preferred item)"
http://www.nas.org.uk/nas/jsp/polopoly.jsp?d=1071&a=15100 (14 b)
http://www.health.state.ny.us/community/infants_children/early_intervention/autism/ch4_pt 2.htm retrieval date 6/6/2008 (15)
"Intensive Behavioral and Educational Intervention Programs The three basic elements of intensive behavioral and educational intervention programs include: • systematic use of behavioral teaching techniques and intervention procedures • intensive direct instruction by the therapist, usually on a one-to-one basis • extensive parent training and support so that parents can provide additional hours of intervention Frequency, intensity, and duration of intervention • It is recommended that intensive behavioral programs include as a minimum approximately 20 hours per week of individualized behavioral intervention using applied behavioral analysis techniques (not including time spent by parents). [A]" Other ABA References
Dawson G, Osterling J. Early intervention in autism. Guralnick MJ (ed). The Effectiveness of Early Intervention. Baltimore, MD: Paul H. Brookes Publishing Co,1997, 307-326. Guralnick MJ. Effectiveness of early intervention for vulnerable children: A developmental perspective. American Journal of Mental Retardation 1998; 102: 319-45. Matson JL, Benavidez CA, Compton LS , Paclawskyj T, Baglio C. Behavioral treatment of autistic persons: A review of research from 1980 to the present. Research in Developmental Disabilities 1996; 17: 433-465.
WHY DISCUSS APPLIED BEHAVIOR ANALYSIS FIRST? This method, if applied appropriately, addresses the precursors required for learning. The only method with evidence for learning to learn effectiveness. • The method directly addresses motivation • Required In order to learn/communicate a) joint attention b) imitation skills c) motivation • In order to be certified there are stringent training requirements
TEACCH Method (16)
" TEACCH is a North Carolina program administered through the University of North Carolina at Chapel Hill, but because of its training activities and publications the TEACCH approach is widely known nationally and internationally. Founded in the early 1970s by the late Eric Schopler, Ph.D., TEACCH developed the concept of the “Culture of Autism” as a way of thinking about the characteristic patterns of thinking and behavior seen in individuals with this diagnosis. "The long-term goals of the TEACCH approach are both skill development and fulfillment of fundamental human needs such as dignity, engagement in productive and personally meaningful activities, and feelings of security, self-efficacy, and selfconfidence. To accomplish these goals, TEACCH developed the intervention approach called “Structured Teaching.” http://www.teacch.com/whatis.html
“TEACCH uses structured teaching to train children in the areas of social skills, living skills, vocational skills, leisure skills and communication skills. The four major components to structured teaching are physical organization, task organization, visual schedules and work systems” [A Literature Review of the Treatment and Education for Autistic and Related Handicapped Children (TEACCH) Program, Timothy Peerenboom, The Graduate School of School Psychology, University of Wisconsin-Stout, August 2003]
TEACCH Research Report
Current and past published research on autistic children and their families. Conducted by Division TEACCH Faculty and Staff http://www.teacch.com/Attachments/resrepo.pdf
Useful Aspects of TEACCH
• Stations for learning • Visual Schedules + Schedules reflecting minimal unstructured time • Focuses on functional living skills • Assessment of child using a specific Psycho Educational Profile developed by creators of method • TEACCH has a certification procedure for practitioners • http://teacch.com/
Case of ABA vs. TEACCH in Court
• The record presents a convincing demonstration that the TEACCH method was not appropriate for instructing RT, considering the level of RT's basic learning skills (imitation and joint attention skills), and his degree of stimming. Likewise, the record makes a convincing case that the methodology was not appropriate to teach RT the more complex language, pre-writing, and academic skills needed to transition towards education in the natural environment”. (19) "Notwithstanding the rather convincing record criticisms of the TEACCH method in general, the Court does not make any findings of fact as to the appropriateness in general of the TEACCH method because, to the extent that the TEACCH method is at issue here, the issue is whether that the method, as used at Twin Hickory pursuant to the November 2002 IEP, was appropriate to educate RT.“(19)
"As the most widely researched treatment approach,"Siegel, supra, 23 (SB-3), Lovaas therapy, named after its pioneer O. Ivar Lovaas, has spawned several methods, including Applied Behavorial Analysis, Discrete Trial Training, and Intensive Behavorial Intervention, of teaching autistic children the basic building blocks that are required for learning in the natural enviorment. Siegel lists the goal of Lovaas- based methods as "teach[ing] [the] child how to learn focusing on developing skills in attending, iimitation, receptive/expressive language, preacademics, and self-help“ (19) 'Testimony by the experts at the administrative hearing, as well as the publications submitted as evidence demonstrates that ABA therapy entails lengthy and intensive one-on-one instruction by a trained teacher with the autistic student. Goals are highly defined and broken down into small discrete components.“(19) "The teacher gives an instruction to the student, who responds either compliantly, non-compliantly, or with delay, and the teacher either responds immediately to correct the non-compliant response, praises and rewards an immediate compliant response, or delays the response in the case of the student's delay. Repetitive practice aims to teach the student the skill". (19) "Instructors maintain detailed data, recording each response by the student as it is made. Once several discrete skills are mastered separately, the tasks are intermingled to develop so-called "discrimination"skills. ABA is time intensive". (19) "All the witnesses knowledgeable in ABA therapy testified that, at least, six hours of ABA therapy year round would be required for a student like RT to reach normal grade level.“ (19)
Case Findings (19)
• "[B]y a prepondance of the evidence that the November 4, 2002 IEP was not reasonably calculated to provide RT with the requisite benefit. See Rowley, 458 U.S. at 207. The evidence demonstrated clearly that in the fall of 2002 RT engaged in a high frequency of self- stimulatory behaviors that interfered with his ability to learn, lacked all but the most basic attending skills, did not possess joint attention or imitation skills. Absent these skills, and until the stimming was brought under control, RT could not make any more than de minimis educational progress. The preponderance of the evidence also demonstrated that for RT to learn these skills and to stop stimming, RT required a rigorous, intensive education program of between 20 and 40 hours of instruction per week. The fifteen hours of instruction provided by the November IEP was insufficent. Moreover, the preponderance of the evidence demonstrated that to learn attending skills, reduce the stimming, and learn imitation skills, RT required a highly structured, highly focused education methodology such as ABA therapy in which RT would receive intensive one-on-one instruction. The TEACCH program at Twin Hickory was not designed to, and did not, and could not provide RT with this type of instruction. And in the fall of 2002, the School Board understood that fact".
DIR/FloorTime Model • “Central to the DIR®/Floortime™ Model is the role of the child’s natural emotions and interests which has been shown to be essential for learning interactions that enable the different parts of the mind and brain to work together and to build successively higher levels of social, emotional, and intellectual capacities. Floortime™ is a specific technique to both follow the child’s natural emotional interests (lead) and at the same time challenge the child towards greater and greater mastery of the social, emotional and intellectual capacities. With young children these playful interactions may occur on the “floor”, but go on to include conversations and interactions in other places”.
http://www.icdl.com/dirFloortime/overview/index.shtml (retrieval 10/2/10)
DIR/Floortime “Follow child’s lead (emotional and action) and push beyond current skill level”
Here are three types of developmentally appropriate interactions and practices that need to be part of the child's daily routine at school: 1. Floortime™, spontaneous interactions during which the teacher, teacher assistant, caregiver, or another peer follows the child's lead and helps him or her elaborate 2. Semistructured, problem-solving interactions, during which specific learning objectives are worked on through the creation of dynamic challenges that the child wants to solve. 3. Motor, sensory, perceptual-motor, and visualspatial physical activities to strengthen important processing foundations.
• Circle of communication 1) open circle of communication by following child’s lead (imitative behavior) 2) help the child close the circles of communication by creating a challenge (addition to imitative behavior requiring change in child behavior) 3) Shared social problem solving (create many circles of communication in a row) 4) continuous flow of communication http://www.icdl.com/distance/webRadio/docume nts/9-16-2004.pdf (retrieval 10/2/10)
References for other Therapies
http://www.nas.org.uk/nas/jsp/polopoly.jsp?d=1350&a=3348 (20) • • • "Brown S. Autism and music therapy - is change possible, and why music? Journal of British Music Therapy 1994; 8: 15-25. Delmolino L, Romanczyk RG. Facilitated communication: A critical review. The Behavior Therapist 1995; 18: 270-300. Greenspan SI, Wieder S. Developmental patterns and outcomes in infants and children with disorders in relating and communicating: A chart review of 200 cases of children with autistic spectrum diagnoses. Journal of Developmental and Learning Disorders 1997; 1: 87-141. Kezuka E. The role of touch in facilitated communication. Journal of Autism and Developmental Disorders 1998; 27: 571-593. King LJ. A sensory-integrative approach to the education of the autistic child. Occupational Therapy in Health Care 1987; 4: 77-85. Nickel RE. Controversial therapies for young children with developmental disabilities. Infants and Young Children 1996; 8(4): 29-40. Wimpory D, Chadwick P, Nash S. Brief report: Musical interaction therapy for children with autism: An evaluative case study with two-year follow-up. Journal of Autism and Developmental Disorders 1995; 25: 541-552. Articles Cited as Evidence Bettison S. The long-term effects of auditory training on children with autism. Journal of Autism and Developmental Disorders 1996; 26: 361-374. Field T, Lasko D, Mundy P, Henteleff T, Kabat S, Talpins S, Dowling M. Brief report: Autistic children's attentiveness and responsivity improve after touch 60 therapy. Journal of Autism and Developmental Disorders 1997; 27: 333-338".
• • • • • • •
Behavior Problems and Autism
People are always looking for the single magic bullet that will totally change everything. There is no single magic bullet. Temple Grandin
http://www.brainyquote.com/quotes/authors/t/temple_grandin.htm l (retrieval date 10/2/10)
Problem Behavior (Socially unacceptable behaviors) Many students with ASDs experience behavior problems that are related to their disability in school settings. • Parents and school professional must know the Student Conduct Code and if a child can follow it. If not, they must know which parts a child cannot follow based on disability characteristics. • For those Conduct Code, required behaviors that the child can’t follow, parents must not agree to the written part of the IEP that states that the child can understand and follow the Student Code of Conduct. • For behavior codes that a child cannot obey, a Functional Behavior Assessment and Behavior Intervention Plan need to be considered. • Parents and professionals must understand the federal rules for behavior and discipline procedures under IDEA 2004. They also need to understand state rules.
High functioning students with Autism often can memorize rules to perfection and can even “explain” them. This ability does not mean they can follow them. Because of lack of generalization skills and the inability to adequately take the perspectives of others, they may often impulsively disobey rules without purposeful intent, even though they can explain the rule and why it should be obeyed. Parents must keep detailed logs/notes of behavior incidents. Behavior logs and e-mails are a good way to communicate. IEPs can contain log reqs. Schools should report (in writing) descriptions of any significant incidents. A copy of incident reports should be provided to the parents. These notices should be distributed as soon after the fact as possible.
• FBAs/BIPs must be requested within an ARD context. • Also, at ARDs, when considering the problem areas for a child’s understanding and behavior in relation to the Student Conduct Code, distribute and discuss information and research on the behavior and the disability. EVIDENCE is needed that shows____ type of behavior or lack of understanding is related to the disability. • Texas Positive Behavior Support Initiative - Web Link (Positive Intervention Req. by law in Texas, Each Campus must have trained core group) http://bsisd.esc18.net/SpecialEd/SESS/sped/DOCS/TBSI/M odule1/Module1Handouts/HO6QATrainingM1.pdf http://www.txbehaviorsupport.org/training/html/index.html • Restraint, Seclusion and Time Out Law (Texas Link). Whenever restraint is used, staff using it must be trained In TPBSI http://framework.esc18.net/Documents/23_Restraint_and_ti meout.htm
Problem Behaviors continued (6)
The TAC code spoken of earlier for the 11 topics that must be considered if a child has autism TAC Code Chapter 89.1055 (Content of the IEP - rev. Nov. 2007)
"4) positive behavior support strategies based on relevant information, for example: (A) antecedent manipulation, replacement behaviors, reinforcement strategies, and data-based decisions; and B) a Behavior Intervention Plan developed from a Functional Behavioral Assessment that uses current data related to target behaviors and addresses behavioral programming across home, school, and community-based settings; "
[This information clearly announces a red flag for autism being connected with behavior problems] http://framework.esc18.net/SBS_April_2008.pdf
IDEA 2004 Law on Discipline Procedures reg. 300.530 Removal for up to 10 Days (5) • "(b) AUTHORITY - School personnel under this subsection may remove a child with a disability who violates a code of student conduct from their current placement to an appropriate interim alternative educational setting, another setting, or suspension, for not more than 10 school days (in a given academic year). (to the extent such alternatives are applied to children without disabilities). ANY FURTHER DISPLINARY ACTION requires consideration of whether a behavior was a) related to a disability b) related to failure to implement IEP\ If no to both a and b school can discipline like a student without a disability. If yes to either a or b --IDEA discipline procedures 66 required 87
Functional Behavior Assessments What Makes a Good One?
• • • Functional Behavior Assessment must be a team effort that evaluates behaviors across environments and time frames. Evaluators will probably need formal training in behavior assessment. Teachers who conduct assessments need to be formally trained to do so. Parents in ARD meetings may ask for qualifications and training experience of those conducting the assessments. Teachers, aides and others who work with your child may be overwhelmed by the FBA process without formalized training that addresses the rigor and skills needed for data collection, observation and analysis techniques. Parents have the right under IDEA, to request training for teachers and staff who will be conducting FBAs if needed. There are a series of simple questions that can be asked of planned assessors to determine if minimal qualifications are met.
What makes a Good BIP?
• • • Reinforcement is one of the most critical aspects of the BIP Baseline data collected during the FBA provides information about the frequency with which the problem behavior occurred and was reinforced. The student must be reinforced much more often for the replacement behavior than for the problem behavior. At minimum the replacement behavior must be reinforced twice as much as the problem behavior. Example: Ann disrupts math class typically twice in an hour-- this means at minimum she should be reinforced 4 times during that hour for appropriate behavior. Reinforcement may need to be almost continuous (non-contingent) in the initial period if the old behavior occurred frequently. All specific reinforcements, reinforcement frequencies and fading procedures/frequencies should be specified in the plan.
• • •
Transition Planning for Students with Autism [Slides 101 -110]
Reg. 300.43: Transition Planning according to IDEA 2004 (5)
• How IDEA 2004 Defines Transition
• "(A) TRANSITION SERVICES - The term `transition services' means a coordinated set of activities for a child with a disability that(1) is designed to be within a results-oriented process, that is focused on improving the academic and functional achievement of the child with a disability to facilitate the child's movement from school to postschool activities, including post-secondary education, vocational education, integrated employment (including supported employment), continuing and adult education, adult services, independent living, or community participation; (2) is based on the individual child’s needs taking into account the child's strengths, preferences, and interests; and
includes instruction, related services, community experiences, the development of employment and other post-school adult living objectives, and, if appropriate, acquisition of daily living skills and provision of a functional vocational evaluation.
Further, the purpose of IDEA 2004 is: Section 1400 (d) (1)(A) To ensure that all children with disabilities have available to them a free appropriate public education that emphasizes special education and related services designed to meet their unique needs and prepare them for further education (new for the first time ever in IDEA 2004), employment and independent living: (5)
What are the post-school activities?
• post-secondary education –college & or vocational education • integrated employment (including supported employment) • continuing and adult education, • adult services (financial, medical, social, etc) • independent living and community participation (including social and leisure activities) • Alternatives to guardianship (durable power of attorney, etc) or guardianship in most extreme cases IEP goals, services and activities as well as progress monitoring in relation to all of the above areas (5)
Transition and Autism Specific Concerns
• Transition may need to be started much earlier than age 16 depending on a child’s needs. The law states- at age 16 unless the committee agrees to an earlier start time (5). • Adequate social, academic and functional living skills are the most important prerequisite requirements for employment, independent living and further education. • Self Advocacy 1) identifying/explaining one’s disability 2) requesting needed supports because of disability 3) understanding where to go for help if supports are not implemented (start at young age, incorporate bullying info.) • Links/connection to others with Autism Spectrum disorders (Facebook/web, social &support groups) -MHMRA Coffee House http://www.mhmraharris.org/mrsd/thecoffeehouse.htm -ASPIE Group of Houston http://www.aspieinfo.com/
Putting It All Together
Now that we know everything there is to know about autism, learning areas affected, special education law, and therapies, the question becomes what’s the bottom line? -A child may need very specific, individualized services. IDEA clearly states that IEP placement and services must be tailored to a child’s unique needs. -IDEA does not promise a child the best education possible but does promise that the education will result in reasonable progress. -At ARDs, positions and service requests must be supported through objective research, objective progress measurement, expert recommendations and, at times, law (case law and legislative content).
Putting It All Together Continued
-Parents have a right to request data that shows school services, curriculums being offered have peer reviewed research that supports use (general and school/district level, proof of success data may be requested). -Parents have a right to ask about credentials and training of people working with a child. This is true for any public, federal employees and this information is rightfully obtained under the Public Information Act. Texas Government Code, Chapter 552, gives you the right to access government records;
http://tlo2.tlc.state.tx.us/statutes/docs/GV/content/htm/gv.005.00.000552.00.htm (retrival date 6/9/2008)
Focus day in and day out, as much as you can on improving language –particularly pragmatic language- and socialization skills. Emotional/social intelligence is key to functioning in the world at large.
Putting It All Together
-Use a child’s often rather peculiar, fixated interests to motivate and to present instruction when possible. -Training for professionals who work with a child in school settings may need training about autism. Parents have the right to ask for training for these individuals when needed. Teachers may also request training. -Know the Texas Autism Supplement Code (TAC code 89.1055) inside and out – this is the scaffolding for appropriate Autism services.
I cannot emphasize enough the importance of a good teacher. Temple Grandin http://www.brainyquote.com/quotes/authors/t/temple_grandin.html
• Larry Arnold has this to say in regards to his own autism:
“I didn’t get where I am today by not being autistic.”
http://lastcrazyhorn.wordpr ess.com/quotes-aboutautism-and-everythingthat-includes/ (retrieval date 10/2/2010) Also see http://www.larryarnold.net/
Autism Background and Diagnostic Overview
Good overview websites: 1) http://www.nimh.nih.gov/health/publications/autism/completepublication.shtml 2) http://www.cdc.gov/ncbddd/autism/ 3) http://en.wikipedia.org/wiki/Autism 4)http://www.dmoz.org/Health/Mental_Health/Disorders/Neurodevelopmen tal/Autism_Spectrum 5) http://www.autism-society.org/site/PageServer 6) http://www.feat.org/
(links check date 10/27/08) http://www.abcnews.go.com/Health/ColdandFluNews/story?id=6089162 &page=1 (addresses autism myths) (link check date 10/27/08)
1. Volkmar, Fred & Lord, Catherine, Diagnosis and Definition of Autism and Other Pervasive Developmental Disorders in Autism and Pervasive Developmental Disorders, ed. Fred Volkmar, Cambridge University Press, 1998, New York, NY. (Slides 4,5,29) 2. Prior, Margot & Ozonoff, Sally, Psychological Factors in Autism in Autism and Pervasive Developmental Disorders, ed. Fred Volkmar, Cambridge University Press, 1998, New York, NY. (Slides 33,40,45,46 ) 3. From Autism Society of America website "What are Autism Spectrum Disorders?" Retrieval date 6-11-2008 http://www.autismsociety.org/site/PageServer?pagename=about_whatis 4. Wrightslaw website download (10/30/07 www.wrightslaw.com/info/iep.success.bateman.htm/ ) 5. Wright, Pete & Wright, Pam, Wrightslaw: Special Education Law, 2nd Edition Harbour House Law Press, Hartfield, VA., 2006, 2007
6. http://framework.esc18.net/SBS_April_2008.pdf Texas Education
Agency website. Retrieval date 6/9/2008. Last revision of "Special Education Rules and Regulations" [Side by Side]. April 2008.
7. Relationship Development Intervention website: "Dynamic Intelligence" retrieval date October 30, 2007 http://www.rdiconnect.com/RDI/DynamicIntelligence.asp 8. Grandin, Temple. Thinking in Pictures and Other Reports from My Life with Autism. Vintage Books division of Random House , Inc., 1995 9 Committee on Educational Interventions for Children with AutismDivision of Behavioral and Social Sciences and Education-National Research Council, Educating Children with Autism, National Academy Press, 2001, Washington, DC (Slides 26,30,31,34,38,39,45 10. Wallace, Claudia. Is the Autism Epidemic a Myth?, Time Magazine Vol._Ed._, Jan 12, 2007. 11. Kirst-Colston, Margurite, ASA Applauds President Bush's Signing of Combating Autism Act, Tuesday, December 19, 2006 www.autismsociety.org/site/News2?JServSessionIdr012=3zbexwl9l2.app20a&page =NewsArticle&id=9201&news_iv_ctrl=-1
12. Pragmatics, Author: Wikipedia contributors, Publisher: Wikipedia, The Free Encyclopedia. 16 January 2007 http://en.wikipedia.org/w/index.php?title=Pragmatics&oldid=101068131 (slides 30,31) 13. Diagnostic and Statistical Manual of Mental Disorders [DSM-IV-TR] American Psychiatric Association, American Psychiatric Publishing Inc. 2000 http://www.appi.org/book.cfm?id=2024 14. TEA: Texas Continuous Improvement Process and OSEP Continuous Monitoring Process, May 2003 PowerPoint presentation , slide # 11 http://www.tea.state.tx.us/special.ed/tcip/ppt/report.ppt#36 14 b. From the National Autistic Society web site, "Applied Behavior Analysis". Retrieval date 6-6-08. http://www.nas.org.uk/nas/jsp/polopoly.jsp?d=1071&a=15100 15. Clinical Practice Guideline: Report of the Recommendations: Autism/Pervasive Developmental Disorders - Assessment and Intervention for Young Children (Age 0-3 Years). Department of Health. New York State. Retrieval date 6/6/2008 http://www.health.state.ny.us/community/infants_children/early_intervention/autis m/ch4_pt2.htm
16. from TEACCH web site "What is TEACCH?" retrieval date 6/6/08 http://www.teacch.com/whatis.html A Literature Review of the Treatment and Education for Autistic and Related Handicapped Children (TEACCH) Program, Timothy Peerenboom, The Graduate School of School Psychology, University of Wisconsin-Stout, August 2003. Retrieval date 6/6/2008. www.uwstout.edu/lib/thesis/2003/2003peerenboomt.pdf. 17. from website page "Dave Writes to Ask TEACCH vs. Lovaas" of Wrightslaw.Com. Retrieval date 6/6/08 http://www.wrightslaw.com/advoc/ltrs/debate_teacch_lovaas.htm 18. from website page of Autism Canada Foundation, "TEACCH treatment overview". Retrieval date 6/6/08 http://www.autismcanada.org/teacch.htm 19. from website page of Wrightslaw.com website page, “School Board of Henrico County VA vs. RT et. al. E.D. VA, 2006) http://www.wrightslaw.com/law/caselaw/06/henrico.va.rt.htm . Retrieval date 6/3/09) 20. from the website information sheet of the National Autistic Society UK "Auditory Integration Training (AIT)". Retrieval date 6/6/08 http://www.autism.org.uk/nas/jsp/polopoly.jsp?d=1389&a=3233 21. from the website information sheet of the National Autistic Society UK "Music Therapy". Retrieval date 6/6/08 http://www.autism.org.uk/nas/jsp/polopoly.jsp?d=1350&a=3348 83
22. From website of the University of California San Diego Autism Research Program, "Pivotal Response Training". Retrieval Date 6/9/08. http://psy3.ucsd.edu/~autism/prttraining.html