Autism and Developmental Disabilities: Current Practices and Issues: Volume 18

This book examines current practices and issues related to assessing, instructing and lifelong planning for individuals with autism and developmental disabilities. Due to the inclusive philosophy of educating, training and treating individuals with autism and developmental disabilities, society is being challenged in a variety of ways to deal effectively with the growing number of children and adults with autism and developmental disabilities. Educators, mental health professionals, clinicians and parents are constantly searching for information on best practices and research-based findings related to: identification, characteristics, diagnosis; special, general, early and postsecondary education; and quality of life concerns. In this book, the authors provide information on best practices and research-based knowledge that should be helpful. For example, there are chapters on assessment which examine the emerging field of infant mental health, testing protocols, barriers to diagnosing diverse students and recent developments in the diagnosing and assessment of autism spectrum disorders such as genetic testing, home movies and robots. Also, there are a number of chapters on instructional aspects that delineate curriculum innovations, procedures to implement social skills, the use of assistive technology and planning for postsecondary education. Lastly, there are chapters on lifelong planning that provide readers with unique content on self-determination, the challenges of meeting social competence, sibling aspects and employment and retirement considerations. Finally, there is a case study and a chapter on the reflections of an individual with Autism Spectrum Disorders (ASD) that provide the reader with insightful commentary on the thinking and emotional experiences of persons with ASD.

The core deficits associated with ASD pose significant obstacles to achieving social competence; indeed, the deficits, in many cases, define social incompetence. The diagnostic criteria for autism include qualitative impairment in social interactions and verbal and non-verbal communication, including delay in the acquisition of expressive language (American Psychiatric Association (APA), 2000). A pattern of narrow, restricted interests and stereotyped behavior are also requirements of the diagnosis. The diagnostic criteria for Asperger's Disorder also include impaired social interaction and restricted interests without delay in language acquisition and with average to above average intelligence (APA, 2000). In sum, ASD is defined by significant impairment in social functioning that is qualitatively distinctive from both typical social functioning and from social functioning deficits associated with other diagnoses.

It is imperative to understand the salient characteristics of autism before selecting and embarking on curricular experiences. One cannot engage in any innovative programming for students he/she does not understand. The American Psychiatric Association (2000) indicates that children with autism exhibit three, namely, (a) impairment in reciprocal skill interaction, (b) impairment in verbal and communication, and (c) restrictive, repetitive, and stereotyped patterns of behavior, interests, and activities. These characteristics have direct impact on curriculum innovation and instructional strategies for teachers, parents, and community (see Brock, Nishida, Chiong, Grimm, & Rimm-Kaufman, 2008; Crooke, Hendrix, & Rachman, 2008; Palmer, Didden, & Arts, 2008). The three characteristics should be viewed as a framework that educators and families might employ when communicating about services and planning curricular experiences (Park, 1996). Because on the impact these characteristics have on learning, they are highlighted in the following subsections.

A social skill is similar to a skill found in a workplace that involves social interaction. The hallmark of a social skill is the smooth progression toward a goal. As with other workplace skills, social skills have both cognitive and behavioral components (Attwood, 2003). According to Webster's New World Dictionary (1986), a social skill is a “developmental tool used to interact and communicate with others to assist status in the social structure and other motivations” (p. 23). This means that social rules and social relations are created, communicated, and changed in verbal and nonverbal ways creating social complexity useful in identifying outsiders. The process of learning these skills is called socialization (Barry & Burlew, 2004). Specific examples of social skills may include initiating, responding, and keeping interactions going; greeting others and conversing on a variety of topics; giving and accepting compliments; taking turns and sharing; asking for help and helping others; and including others in activities (Wahlberg, Rotatori, Deisinger, & Burkhardt, 2003). Simply put, social skills are the behaviors we use to work and socialize with other people. As Walker, Todis, Holmes, and Horton (1988) pointed out, social skills are defined as social responses and skills that (a) allow one to initiate and maintain positive relationships with others, (b) contribute to peer acceptance and to a successful classroom adjustment, and (c) allow one to cope effectively and adaptively with the social environment.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, American Psychiatric Association (APA), 2000), autistic spectrum disorders (ASD) are a collection of chronic conditions that include Autistic Disorder, Rett's Disorder, Childhood Disintegrative Disorder, Aspeger's Disorder, and Pervasive Developmental Disorder Not Otherwise Specified. Typically, ASD are often identified during infancy or the toddler years. Most individuals with ASD have some degree of mental retardation. According to Deisinger (2001), genetic factors, abnormalities in brain structure and biochemistry, and complications during pregnancy have been implicated as possible causes of these disorders. Generally, students with ASD have difficulties with daily activities such as language, self-care, mobility, and independent functioning. The focus of this chapter examines the many features that must be considered before diagnosing and classifying individuals with ASD.

According to current estimates, the prevalence of autism spectrum disorders (ASDs) ranges from 1 in 500 children to 1 in 150 children (Centers for Disease Control and Prevention/CDC, 2007; Desmon, 2007). In the past such disorders usually were not identified until a child was school-aged, but these disorders are now more likely to be diagnosed in affected individuals during the preschool years (McConachie, Le Couteur, & Honey, 2005; Rutter, 2006). For example, Mandell, Novak, and Zubritsky (2005) surveyed over 900 caregivers of children with ASDs and learned that on an average, children with autistic disorder were diagnosed at 3.1 years of age. These researchers also reported that children who exhibited such characteristics as severe language impairment, toe walking, hand flapping, and sustained unusual play behaviors were diagnosed earlier than children without these features.

Estimates of the prevalence of AS in children throughout the entire population of the United States are highly limited and greatly variable. Ozonoff, Dawson, and McPartland (2002) stated that estimates of AS range from 0.2 to 0.5% (or 2–5 individuals in 1,000), while Volkmar and Klin (2000) cited studies reporting rates of 36 in 1,000 to approximately 1 in 10,000. The Diagnostic and Statistical Manual of the American Psychiatric Association (2000), fourth edition (DSM-IV-TR), states that “definitive data about the prevalence of Asperger Syndrome does not exist.”

The heritability of ASDs reportedly exceeds 90% (Halgin & Whitbourne, 2007; Rutter, 2005), indicating that genetic endowment strongly influences the etiology of these disorders (Halgin & Whitbourne, 2007). Research to date has suggested chromosomes 2, 7, and 15 as possible sites for genetic abnormalities associated with ASDs (Filipek et al., 1999; Halgin & Whitbourne, 2007; Muhle, Trentacoste, & Rapin, 2004; Yonan et al., 2003). However, the genetics of autism is complex and is not yet fully known (Chuthapisith, Ruangdaraganon, Sombuntham, & Roongpraiwan, 2007; Goldberg et al., 2005; Muhle et al., 2004; Ozonoff, South, & Provencal, 2005; Rutter, 2005; Szatmari, Zwaigenbaum, & Bryson, 2004).

Mr. Markley's personal reflections mirror the characteristics and social experiences of students with ASD that have been delineated in previous chapters of this book. Similar to high functioning students with ASD, his diagnosis came later and even though he became eligible for special education services, the breath of the services were insufficient to address his social skills needs. Fortunately, Mr. Markley had superior intellectual capabilities that allowed him to channel his interests into academics that he enjoyed. This adjustment strategy worked most of the time but as Mr. Markley emphasized, he still was challenged by his ASD characteristics which lead at times to discomfort and distress.

Behavior problems are common in toddlers and preschoolers. Richman, Stevenson, and Graham (1975) identified difficulties with eating, sleeping, toileting, temper, fears, peer relations, and activity as typical in this young population. While all young children should be expected to experience behavior problems as part of their normal development, an ongoing challenge in the field has been to determine when these “normal” developmental problems rise to the level of being considered “clinical” behavior problems (Keenan & Wakschlag, 2000). For example, when does a two-year-old child's tantrum behavior, a three-year-old's urinary accidents, and a four-year-old's defiance become clinically significant? To answer these questions, clinicians must examine the frequency, intensity, and durability of these difficulties, their potential to cause injury to the child or others, the extent to which they interfere with the child development, and the degree to which they disrupt the lives of their siblings, caregivers, peers, teachers, and others.

If students with developmental disabilities are to develop self-determination skills, instruction in targeted competencies must, of necessity, begin in the public schools. Wehmeyer, Field, Doren, Jones, and Mason (2004) have noted that “promoting access to the general education curriculum provides the chance to more fully infuse efforts to promote self-determination and student involvement actually provides a means to promote the participation of students with disabilities in the general curriculum” (p. 417). Teachers working with students with disabilities thus can (a) facilitate progress in the general education curriculum by teaching standards-based skills and knowledge associated with elements of self-determination (that are typically reflected in state and local standards); and (b) teaching specific self-determination skills, including self-regulation, self-management, goal setting, decision-making, and problem-solving (see Wehmeyer et al., 2004).

The transition from school to work or to post-secondary training is a critical period for all students (Gilmore, Bose, & Hart, 2001; Zaft, Hart, & Zimbrich, 2004). Thus, a challenge for educators is to develop educational programs and services that embrace the characteristics that is prevalent in highly successful adults with and without disabilities. For years, adolescents and adults with development disabilities did not receive much attention from general or special educators. Fortunately, special educators now are reorganizing the complex needs of these older individuals and are making progress in designing interventions to meet their diverse needs. However, they alone cannot ensure the success of these students in secondary and post-secondary situations (see Hart, Mele-McCarthy, Pasternack, Zimbrich, & Parker, 2004). Legislators and policymakers must consider the special needs of this population in reforming secondary education; and general and special educators must share the responsibility of preparing them for graduation and post-secondary planning (see Bailey, Hughes, & Karp, 2004). In addition, community services must join forces with educators and employers to provide individuals with developmental disabilities with a continuum of services throughout their life span. Many students with developmental disabilities find themselves unprepared at college entry in a number of areas including inadequate knowledge of subject content, underachieving in academic skills, poor organizational skills (e.g., time management and study skills), poor test taking skills, lack of assertiveness, and low self-esteem (Dalke & Schmitt, 1987; Mull, Sitlington, & Alper, 2001; Stodden & Whelley, 2004).

People with developmental disabilities have persistent levels of low employment and employment rates among the working-aged disabled are declining (see Bound & Waidmann, 2002). For example, the average employment rate of those graduating with a four-year degree is just under 90% while employment rates for those graduates with a disability hover around 50% (The Center for an Accessible Society, n.d.). Subsequently, people with disabilities often have a difficult time becoming economically self-sufficient (see National Council on Disability, 2000; Sowers, McLean, & Owens, 2002). The Americans with Disability Act (ADA) is one notable attempt to help provide those with a disability to employment access. While the ADA has been a champion of the cause, people with developmental disabilities still face a host of employment-related barriers (e.g., biases associated with the disability) (see DiLeo, 2007; Luecking & Mooney, 2002). Furthermore, while most people have concerns over retirement (e.g., social isolation) those concerns are exacerbated for people with developmental disabilities (see Hodges & Luken, 2006).

Simpson (2005) reported that although children with DD and autism can benefit from the use of AT, the potential for use of this medium by this population remains largely unexplored. According to Simpson, AT may be an effective intervention to address student needs in: (a) communication, (b) matching, (c) spelling, (d) problem solving, (e) alertness, (f) motivation and behavior, (g) task completion, and (h) self-help. In addition, AT may be effective with students with DD and autism because these students love playing with a computer due to the predictability of its activities (see Thorp, 2007). Furthermore, computers provide stimulating visual images that children with DD and autism crave.