Puzzling Through
New Ways to Teach Children with Autism
 By Deirdre Wilson
Sixty or more years ago, if you had a child with autism, you’d likely be told to put him in a mental health institution and move on with your life.
Children with the most severe autism symptoms – obsessively spinning in circles, unable to verbalize clearly, throwing tantrums and shrieking at small changes in their daily routines – baffled physicians and researchers alike.
“There was no treatment,” says Susan Wilczynski, Ph.D., executive director of the Randolph-based National Autism Center, which provides resources and best practices for treating people with the disorder. “There was just isolation, and that unfortunately continued for a long period of time.”
Today, there are many treatment options. There are also many more children with an Autism Spectrum Disorder (ASD) – one in every 110 children nationwide, with nearly 10,000 eligible for special education services in Massachusetts alone. ASD encompasses three main conditions – autistic disorder, Asperger syndrome and Pervasive Developmental Disorder – and all of these cause serious social, behavioral and communication problems in kids and adults.
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Fast Facts
- One in every 110 American children has an Autism Spectrum Disorder (ASD).
- Signs of autism are typically evident by ages 2 or 3.
- Boys are four times more likely than girls to have an ASD.
- 9,976 Massachusetts students were eligible for special education services for autism in 2009 – up nearly 13 percent from the previous year.
- Children with autism make up 5.9 percent of the more than 166,000 Massachusetts students receiving special education services.
Sources: national Centers for Disease Control and Massachusetts Department of Education |
In the 1950s and ’60s, schools dedicated to teaching kids with an ASD finally began cropping up in different parts of the country – some founded by parents who were frustrated by the lack of services for their children with autism. Today, nearly two dozen schools serve children with ASD across Massachusetts, with dedicated teachers, therapists and others working to help these children cope with their disorder, function in the world and, above all, learn.
It’s a tall order – one that doesn’t yield immediate results, often involves repeated trial and error, and can be discouraging for teachers and parents alike. But with autism on the rise and no cure in sight – the number of kids with an ASD who need special education services in Massachusetts jumped nearly 13 percent between 2008 and 2009, according to state education data – the demand for schools and services to meet these children’s needs will continue to grow.
Whether you’re the parent of a child with an ASD or simply curious about how these children can be taught, you’ll be amazed by how far special education teachers have come. Here’s a look at some of the treatment methods being used here in Massachusetts.
Change the Environment,
Change the Behavior
Most schools teaching children with autism base their techniques on a method that has been shown to work – Applied Behavioral Analysis (ABA). The idea behind ABA is to figure out how to change the environment around a child with autism so that she can express herself more successfully. It works better than simply telling the child what to do.
“For example, I might offer you a choice of what to do instead of telling you what to do,” says Wilczynski of the NAC, which was created and is based on the same Randolph campus as the May Institute, a large, respected provider of educational, rehabilitative and behavioral services to people with ASD and other developmental disabilities.
“It also involves changing the environment based on what choices you make,” Wilczynski says. “Say that I love ice cream and you have a similar passion for ice cream. If you like ice cream and I want you to be able to say ice cream, I want to make sure that when you do say it, what you will get is ice cream! Ideally, we try to build a direct relationship between desirable outcomes and the environment the child is in.”
Last September, the NAC published a “National Standards Report,” which identifies 11 “best practices” – teaching and treatment methods known to be the most consistently effective for students with an ASD. Most of them come primarily or exclusively from the field of ABA, Wilczynski says.
The report, which took three and a half years to complete, involved 80 reviewers from all over the world evaluating 775 studies of treatment methods, including some conducted as early as the 1950s. Forty experts developed a process to determine which methods were most effective and 40 others wrote up the results.
“Our goal is to say what is good science,” Wilczynski says. “The only way to know that is if there have been more than one study that consistently shows a treatment method is working.”
One, called Naturalistic Teaching Strategies, involves creating an environment in which kids are motivated to act or communicate a specific want or need. “Say a child’s favorite toy is put up on a shelf,” Wilczynski says. “Now I have the opportunity to teach the child to say ‘up’ or to ask for the toy itself – ‘car.’ For kids who have far more advanced language, I might be working on getting them to say, ‘Will you give me the car please?’ It’s all about creating an environment where kids are motivated to take action and creating a situation where they can be successful.”
The May Institute operates three schools for students with ASD in Massachusetts, including the May Center for Child Development in Randolph, and one in California.
At the Randolph school, which serves about 150 students ages 2.9 to 22, teachers use another proven method called “modeling” – basically a way to prompt a student to enhance his learning. “It’s basically imitating a task,” May teacher Stephanie Child, Ph.D., says. “The teacher gives instructions and imitates the steps necessary to complete that instruction.” Providing that prompting when, say, getting a child to build a tower with blocks, helps the child learn more easily and eases his potential frustration at not knowing what is expected.
These methods sound simple – and obvious.
“The strategies that we’re talking about, frankly, can be effective with any of us,” Wilczynski says. “The difference is that a lot of times we have to be more structured for individuals with an Autism Spectrum Disorder. There are some skills that are very complicated, and those require someone to invest a tremendous amount of energy finding out where the breakdown is, teaching the skills in very concrete ways and making sure they’re being taught in a variety of real-life settings.”
Social skills, in particular, are difficult to teach to children with an ASD, whether it’s classic autistic disorder or the higher-functioning Asperger syndrome. “Some people think that if you have kids attend an hour of social skills training, that will transfer to the workplace, the playground, wherever,” Wilczynski says. “That’s not often the case.”
Breaking New Ground
Children with an ASD can be at very different learning and functioning levels; some, at higher levels, do fine in a public school setting, while others need the more intense and focused treatment a specialized private school offers.
The League School of Boston in East Walpole serves just over 90 students with five different programs, or “strands,” to address children’s differing abilities. One strand provides a vigilant environment designed to keep students with more severe autism safe. At the other end, another strand helps children who are high functioning and high achievers, often those with Asperger syndrome.
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Signs of ASD
Signs of an Autism Spectrum Disorder begin to show up by the time ages 2 or 3, and the earlier a child begins receiving treatment, the better the chances of success. The National Centers for Disease Control and the Mayo Clinic list several signs to watch for in a young child:
- doesn’t respond to his name by 12 months of age;
- has delayed speech and language skills;
- avoids eye contact;
- has trouble understanding others’ feelings or difficulty expressing her own;
- repeats words and phrases over and over;
- is obsessed with specific objects (such as the wheels of a toy truck, or a ceiling fan);
- repeatedly flaps hands, rocks or spins his body;
- becomes very upset with minor changes in routine;
- resists cuddling or holding and seems to want to play alone.
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“You can’t take one approach and use it with everyone,” says League School Interim Director Margaret Reed, a longtime special education teacher. “For the most behaviorally challenged young people, we have a number of behavior therapists. They go in, they observe, they try to get at the function of the behavior. Our theory is that all behavior has a function. Some kids may tantrum. That student’s whole perception of what is going on around him may be very different from yours or mine. The base for everyone who works is here is trying to figure out how a student is perceiving what you’re asking him to do.”
For high-functioning students, the focus, along with more intense academics, is on social skills, Reed says. “Being able to communicate properly and interact properly. These students seem so smart and so verbal. They also seem almost willful sometimes. So people wonder, ‘Why, if you’re so smart in one area, are you not able to talk to people like everyone else does?’”
The League School is in the process of implementing a new treatment method for ASD called the SCERTS® program. Developed by world-renowned ASD expert and researcher Barry Prizant, Ph.D., of Rhode Island, and three other colleagues, SCERTS (Social Communication, Emotional Regulation and Transactional Support) is based on 25 years of ASD research, including another national study of effective treatment methods that came out about five years ago. The method combines several treatment strategies that can be used by both educators and parents.
“In more classical ABA,” Reed says, “grownups are trying to impose on a young person a perception of what the child ought to be doing.” The SCERTS method involves identifying a student’s strengths, building on those and then creating a strategy to improve that student’s weaknesses, she says.
The idea is to always try to move from concrete ways of communicating to the verbal to the more abstract, Reed says. “Instead of pointing to an object, or handing a child something or using pictures of that object, you move to something more typical, like words.”
The SCERTS method isn’t one of the 11 best practices in the NAC’s “National Standards Report,” primarily because it’s still relatively new. But League School educators and therapists are excited about the method, particularly because it also closely involves parents. Through SCERTS, teachers and other staff can train parents in techniques to use at home for the most difficult struggles they may be having with their child – toileting or hygiene, for example, Reed says.
This gives parents more confidence in their own abilities, Reed says, adding that “parents are very powerful in this whole process because, unless a student is living at the school, he or she lives at home. If it works here; it has to work at home, too.”
The League School is the first private school in Massachusetts to adopt the SCERTS program. Once staff members are fully trained and the school works out how to best assess the program’s effectiveness, it will be fully up and running next year, Reed says.
Choosing the Best Program for Your Child
The League School and the May Center for Child Development are just two of the programs committed to helping kids with an ASD in Massachusetts. There are many to choose from. And as research continues, more treatment options will emerge. How do you find the best program for your child right now?
“Visit the school; get a tour and watch what the students are like. Watch how the teachers react to and interact with the students,” says Wilczynski. “I would also want to know that the teachers respected the students and connected with them.”
Ask when and how treatments and teaching methods are assessed, she says, since regularly checking the effectiveness of a method is vital to keeping on track.
As the number of children with an ASD continues to rise, so does the understanding of these disorders and the drive to start treating kids with signs of autism as early as possible, Reed says. “Pediatricians are better at recognizing it. There are early intervention services they can refer parents to.” And parents have a better understanding as well.
Today, instead of referring to children with an ASD as being serious disturbed or mentally ill, she says, “we understand that kids develop in very different ways and that having a disability is sometimes just a more extreme form of how we all are.”
Deirdre Wilson is senior editor of the Boston Parents Paper.
Resources
• League School of Greater Boston – www.leagueschool.com – This East Walpole school teaches students with ASD and has adopted the SCERTS® program (see www.scerts.com).
•May Institute – www.mayinstitute.org – The May Institute offers educational and behavioral services for people with ASD and other developmental disabilities. The Institute operates four schools for students with ASD – three in Massachusetts, including the May Center for Child Development in Randolph, and one in California.
• National Autism Center – www.nationalautismcenter.org – Learn more about this organization’s report on the 11 “best practices” for treating kids with an ASD.
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