Autism spectrum disorder (ASD) or Autism, is a neurodevelopmental disorder characterized by impaired social interaction, verbal and non-verbal communication, and restricted and repetitive behavior. Parents usually notice signs in the first two years of their child’s life. These signs often develop gradually, though, some children with autism reach their developmental milestones at a normal pace and then regress. The diagnostic criteria require that symptoms become apparent in early childhood, typically before age three. All autism disorders were merged under one umbrella diagnosis of ASD. Previously, they were recognized as distinct sub-types, including Autistic Disorder, Childhood Disintegrative Disorder, Pervasive Developmental Disorder- Not Otherwise Specified (PDD-NOS) and Asperger’s Syndrome. Autism appears to have its roots in very early brain development. However, the most obvious signs of autism and symptoms of autism tend to emerge between 2 and 3 years of age. ASD can be associated with intellectual disability, difficulties in motor coordination and attention and physical health issues such as sleep and gastrointestinal disturbances.
Two theoretical frameworks outlined for early childhood intervention include Applied Behavioral Analysis (ABA) and Developmental Social Pragmatic Models (DSP). One interventional strategy utilizes a parent training model, which teaches parents how to implement various ABA and DSP techniques, allowing parents to disseminate interventions themselves. Various DSP programs have been developed to explicitly deliver intervention systems through at-home parent implementation.
Educational interventions can be effective to varying degrees in most children. Intensive ABA treatment has demonstrated effectiveness in enhancing global functioning in preschool children and is well-established for improving intellectual performance of young children. Similarly, teacher implemented intervention that utilizes an ABA combined with a developmental social pragmatic approach has been found to be a well-established treatment in improving social-communication skills in young children.
Research shows people with autism can function independently at jobs that are suited to their strengths and abilities, as long as the specific tasks involved in the job are taught to mastery criterion. To match students abilities with vocational opportunities, their training can vary from those who have intellectual impairment and they can be vocationally trained in repetitive task and with picture flashcards. Their options of vocational training can be:
1. Wiring work
2. Data Entry
4. Dish washing
5. Food Preparation(Making Milkshakes, Sandwiches, etc.)
6. Sorting Laundry
7. Putting a sticker or sorting items
A lot of options for vocational training can be given to promote social rehabilitation, children with severe symptoms only require sheltered workshops, but under supervision they can do well. Some persons with ASD excel in visual skills, music, math and art.
Sensory processing disorder (SPD) is quite common among children with ASD. Children with evidence of sensory processing dysfunction, such as those with ASD, often have difficulty regulating responses to sensations and specific stimuli and may use self-stimulation to compensate for limited sensory input or to avoid over stimulation. Self-stimulatory behaviors, defined as repetitive movements that serve no perceptible purpose in the environment can have considerable social, personal, and educational implications and often limit the ability to participate in normal life routines. Behaviors such as stereotype motor movements, aimless running, aggression, and self-injurious behaviors have been correlated with these sensory processing abnormalities. Each behavior interferes with a child’s ability to engage in or learn from therapeutic activities.
Sensory integration (SI) theory was originally developed by A. Jean Ayres to focus on the neurological processing of sensory information. SI theory is based on the understanding that interferences in neurological processing and integration of sensory information disrupt the construction of purposeful behaviors. The treatment is designed to provide controlled sensory experiences so that an adaptive motor response is elicited. Interventions based on the classic SI theory use planned, controlled sensory input in accordance with the needs of the child and are characterized by an emphasis on sensory stimulation and active participation of the patient and involve patient-directed activities.
If locally you do not have access to Sensory Integration therapists, it is important for parents to develop these setups at home as well, which generally requires:
1. a swing
2. a ball pool
3. a slides
4. a rocking chair
5. a ball
6. a trampoline
Swimming and running are the best sports to fulfil sensory needs of kids with autism. Hence, this summer, parents should gear up for these activities and train their kids to participate in these activities which would help them to adjust well with society, eventually.
Education of Children with autism
1. Use Task Analysis – very specific, tasks in sequential order.
2. Always keep your language simple and concrete. Get your point across in as few words as possible. Typically, it’s far more effective to say “Pens down, close your journal and line up to go outside” than “It looks so nice outside. Let’s do our science lesson now. As soon as you’ve finished your writing, close your books and line up at the door. We’re going to study plants outdoors today”.
3. Teach specific social rules/skills, such as turn-taking and social distance.
4. Give fewer choices. If a child is asked to pick a color, say red, only give him two to three choices to pick from. The more choices, the more confused an autistic child will become.
5. If you ask a question or give an instruction and are greeted with a blank stare, reword your sentence. Asking a student what you just said helps clarify that you’ve been understood.
6. Avoid using sarcasm. If a student accidentally knocks all your papers on the floor and you say “Great!” you will be taken literally and this action might be repeated on a regular basis.
7. Avoid using idioms. “Put your thinking caps on”, “Open your ears” and “Zipper your lips” will leave a student completely mystified and wondering how to do that.
8. Give very clear choices and try not to leave choices open ended. You’re bound to get a better result by asking “Do you want to read or draw?”, than by asking “What do you want to do now?”
9. Repeat instructions and checking understanding. Using short sentences to ensure clarity of instructions.
10. Providing a very clear structure and a set daily routine including time for play.
11. Teaching what “finished” means and helping the student to identify when something has finished and something different has started. Take a photo of what you want the finished product to look like and show the student. If you want the room cleaned up, take a picture of how you want it to look some time when it is clean. The students can use this for a reference.
12. Providing warning of any impending change of routine, or switch of activity.
13. Addressing the child individually at all times (for example, the CHILD may not realize that an instruction given to the whole class also includes him/her. Calling the child’s name and saying “I need you to listen to this as this is something for you to do” can sometimes work; other times the child will need to be addressed individually).
14. Using various means of presentation – visual, physical guidance, peer modelling, etc.
15. Recognizing that some change in manner or behavior may reflect anxiety (which may be triggered by a [minor] change to routine).
16. Not taking apparently rude or aggressive behavior personally; and recognizing that the target for the child’s anger may be unrelated to the source of that anger.
17. Avoid overstimulation. Minimizing/ removal of distracters, or providing access to an individual work area or booth, when a task involving concentration is set. Colorful wall displays can be distracting for some children with autism, others may find noise very difficult to cope with.
18. Seeking to link work to the child’s particular interests.
19. Exploring word-processing, and computer-based learning for literacy.
20. Protecting the pupil from teasing at free times, and providing peers with some awareness of his/her particular needs.
21. Allowing the pupil to avoid certain activities (such as sports and games) which s/he may not understand or like; and supporting the pupil in open-ended and group tasks.
22. Allowing some access to obsessive behavior as a reward for positive efforts.
23. Use of ABA (Applied Behavior Analysis) is essential for children with Autism.
– Miss Aditi Shardul
Project Head Vihang
Special Educator and Counsellor
P.G.Diploma in Special Education (Multiple Disabilities: Physical and Neurological)
M.S in Psychotherapy and Counselling