Children with Autistic Spectrum Disorders (ASD) use for communication their secret language; they see this world from their own particular viewpoint and perceive both themselves and those around them differently. They live in mysterious world of direct perception and immediacy and see the world without metaphors. They present ‘mind apart’, but at the same time they are kids.
At first sight it is difficult both for parents and for the specialists to understand this distinction. For that they need to make a journey to ‘foreign land’ and study a new language. Nevertheless accomplishment of this difficult task is a gratifying labour. The prize is invaluable: a child who is able to grow and live normal life independently. Without knowing how to call puzzling behaviour of their children the parents are afraid of uncertainty and face the future in fear.
But real comprehension of this illness and difficulties experienced by the child with ASD clears the way to release from despair which the families suffer, especially at the beginning of the path when they visit the doctors and hear diagnosis sounding like a life sentence (Siegel 1998). Understanding how the child thinks and sense, how he embodies feelings and thoughts in behaviour which sometimes can be bewildering or even destructive will remove many obstacles on the way to full-fledged compensative relations between parents and children as well as to effective cure.
To comprehend the part taken by both the family and the teachers and to define their priorities in the intervention programmes for children with ADS we should evaluate importance of early intervention for gaining positive results in treatment, identify the goals of parents and teachers as well as significance of their coherence, to examine instruments for supporting children on the way to convalescence, and make the conclusions. Early Intervention as a Key Factor to Effective Treatment
The task to give a successful start for primary age children with ASD is a very complicated one as it is connected with a variety of components including pedagogical, medical, psychological and social ones. The nations which managed to resolve it could figure on future earnings – as a result they receive able-bodied and qualified young citizens capable to contribute to further development and flourishing of the country. On this account the community should be interested in the earliest possible diagnosing the cases of children with ASD in order to enable them to be included into the intervention programmes and support them in every way.
It is vital for the autistic child to start as early as possible, until irreversible changes in his brain occurred. Scholars noted that such regress usually is developing too fast (Baron-Cohen & Bolton 1993). The characteristic features of the child with ASD are his self–isolation, adherence to repetitious actions and often to self-injury, low interest in play and delays in language, so early intervention could suppress inadequate behaviour and replace it by correct activities.
Many researches argue it is early intervention enabling children to develop skills in communication and social interaction while lessening unmanageable behaviour (Lovaas 1981; Marfo and Cook 1991; Ershler 1992; Mays & Gillon 1993; Siegel 2003). Jordan in a series of works (1996; 2001; 2002; 2004) argued in favour of early intervention as a method to prevent “secondary ‘handicaps'” which inevitably appear if intervention is lacking, as children with ASD “miss out on all the opportunities to learn and develop through the social and emotional pathways that are the hallmark of intuitive human learning” (2004, p.
1). Quite the contrary, when appropriate explicit and structured teaching is being provided from the very moment of diagnosing ASD, it creates favourable teaching milieu which “do not alter the condition but enable the child to compensate for the difficulties it causes” (2004, p. 3). In this way the child acquires social and communicative skills as well as imagination helping him/her to be prepared to learn in a group (Jordan & Powell 1995).
Moreover being persistently over several years under the supervision of the therapists the child is being diagnosed and corrected in time, any changes either progressive or regressive are revealed in real time which enables the therapists and the parents to undertake appropriate measures and implement adjustments immediately. The crucial aspect here is that diagnosis of ASD is defined for the most part after the age of two years. At this age the brain of the child is very plastic which enables cure givers to attain the highest positive results in modifying the child’s behaviour (Siegel 2003).
During the last two decades the necessity of early intervention is often being substantiated by generally accepted notion that handicapped persons are subjected to negative impact of their disabilities on their further development as a personality when their behavioural and sensory competencies become weaker in the course of time while “optimal transactions with the worlds of objects and persons are founded” upon them. The outcomes of delayed development consecutively strike other capabilities of the child which contributes to his further deprivation of “developmentally appropriate experiences” (Marfo & Cook 1991, p.
11). It is obvious that if the developmental delays are emerging in the primary age when the basis for behavioural development is being loaded undoubtedly early intervention has to be launched as early as possible. That is why the scholars consentaneously ascertain that early intervention for children with ASD “is one of the most effective means of improving long-term social and academic outcomes” while those having got treatment in the course of their preschool years appear to be better trained to meet academic requirements and to keep on developing in cognitive and social aspects (Forest et al.
2004, p. 103). Priorities and Goals for Parents and Teachers in Early Intervention Curriculum for Children with Autism Considering the especial complexity of the task facing the therapists and parents in early intervention curriculum the issue of close interaction between these two sides of educational process takes on special significance.
While the therapists involve their professional background and practical experience to gain positive results, family members are the best “teachers, socializing agents, and caregivers for children during their years from birth to age five” who occupy exceptional strategic position and from whom it depends either to reinforce or undo the potential advantages of the early intervention program for the child with ASD (Paget 1992, p. 92). Thus, Moes and Frea proved that behavioural intervention programme having been elaborated in cooperation with parents displayed more successful outcome in child’s performance.
They evaluated two approaches: for the contextualised intervention the curriculum was based on family routines and professional advice in directing execution while for the prescriptive intervention – on a treatment tools which parents were trained to employ. The study demonstrated that the contextualised intervention yielded larger decrease of inappropriate behaviours and amplified correct behaviours (qtd. in Rodger, Braithwaite & Keen 2004, p. 34).
On account of the above the goals for parents and teachers have to be considered in close conjunction of each others. Hence the therapist has to work not merely with the child as a sole object for the intervention programme, but also with the family. Here he has a number of internally connected tasks: to compensate psychological disadaptation of each parent caused by in out-of-contact behaviour of the child; to reconsolidate the family in new traumatic conditions; to assist the family in establishing effective and supportive communication with autistic child.
In other words, the goals of working with the family lie in its psychological and therapeutic countenance ensuring for the child the basic, most significant and potentially curative domestic surroundings. The first stage of such work is beginning with collection of anamnestic data. As in parental perception their child’s behaviour represents a chaotic set of distressing and incomprehensible disorders, it is necessary not only to assist in working out therapeutically expedient insight and perception of child’s status, but also to try to understand what are genuine problems they face in the relations with the child inside the family.
Resolving or at least minimization of these problems often demanding psychotherapeutic work allows moving to the second stage. It is aimed at attainment of the capability by the family members to comprehend and interpret behaviour and feelings of the child without assistance (Paget 1992). It is achievable by means of joint observations over the child and analysis of the situations emerging in everyday life (Ershler 1992). The third stage may be based on individual or group work with parents or combine both approaches.
As regards teaching goals for the child in early intervention programme, Ershler identifies them in the following way: (a) identifying desired behavioural outcomes, (b) identifying and utilizing effective and available reinforcers, (c) determining and hierarchically arranging learning goals that comprise the desired outcome, (d) identifying the skills in the sequence children already possess, (e) determining mastery criteria and, through demonstration and verbal instruction, teaching each step that has not yet been acquired.
(1992, p. 17) These indeed are the goal of the teacher, but it is clear that they could not be attained without active involvement of parents who give the necessary data about the child basing on their everyday observations of the child’s behaviour and their assessment of the child’s skills and capabilities. In this process the teacher is targeting not merely the child but also the interactions between the former and his social surroundings.
At that the intervention programme has to start up internal mechanisms of the child’s organism which consequently are expected to encourage his further progress where sometimes if needed the programme is going on for years. Thus the ultimate goal of early intervention programme for the child with ASD lies in sustaining continuity in evaluation of its performance by parents who are with the child constantly while the therapist could change (Marfo & Cook 1991, p. 12). Another basic goal both for parents and for teachers is teaching autistic child to learn.
Among the steps of developing this crucial ability of the child for his further growth as a personality and a member of human society there is gradual movement to establishing “competencies in fundamental skills such as cause-and-effect reasoning, paying attention, complying with instructions, and imitating”. Any of these skills, for its part, is contributing to obtaining other particular skills (Siegel 2003, p. 316). A very interesting study with regard to the parents’ goals was conducted by Rodger, Braithwaite and Keen.
They described a process by which the teachers involved in the early intervention program for children with ASD worked in collaboration with families to define parental priorities and set up the intervention programme goals. The results are very illustrative and could serve as a clear although simple reflection what two parties engaged in providing treatment conceive to be priorities for their child cure (2004, p. 35). The goals were attributed to five domains: communication, behaviour, social interaction, play, and self-care.
Among these domains the goals belonging to asking for, signalling, gesticulation, soliciting for help, as well as verbal and communication skills were ascribed to communication; the goals belonging to lessening socially inappropriate behaviour such as temper tantrums, blaring as well as those aimed to substitute such behaviour with more adequate one – to behaviour domain; the goals involving any social reciprocity of communication such as conversations with another persons, sharing etc.
– to social interaction; the goals to enhance play skills on the child on his own and with other persons – to play domain; and finally those; self-care goals were any goals relating to everyday habits and natural human needs like eating, dressing, toileting etc. – to self–care (p. 36). The results testify the parents, intentionally or subconsciously, prioritized the goals usually defined by the professional in almost the same order: Communication Social Interaction
To ask before going to the fridge To improve eye contact To increase ability to make needs known To join in more with Mum and siblings To communicate need for toilet To share and take turns with sibling Requesting food and toys To improve tolerance of others Responding to ‘come here’ engaging in play Behaviour Play To express frustration in appropriate ways To play by him/herself for five minutes
To reduce the frequency of unusual To play with nominated friend for behaviour five minutes To sit down for snack time at kindly To play calmly alongside sibling To react calmly when mess/spills made To engage in functional play with a doll To reduce amount of time spent To increase play skills with other self-stimulating children To stay beside parents when walking in open spaces Self-care To tolerate hair-brushing (tolerate parting and bunches)
To sit on toilet for five minutes To tolerate sitting on toilet properly To establish a regular toilet routine. (p. 39) Other scholars identify five basic skill domains at which the early intervention programmes for children with autism should be aimed which are “capability to selectively attend to stimuli, imitation, expressive and receptive language, play, and social interaction” which seem to mean almost the same described above (Anderson et al 2004, p. 46). Home- and School-Based Early Intervention Programmes
Children with ASD do not overgrow their disease, and it means many of them are subjected to continuous intervention programme sometimes in the course of their whole life. In such situation, taking into account that some autistic children have severe forms of ASD, it seems the substantial group of them may be taught exceptionally at home. School premises often could not serve as appropriate for them as there the services usually are delivered for small groups that implies the child has to be able to tolerate presence of other children.
As we know for some children with ASD it is impossible at least at the first stages of their intervention programmes. Hence in some cases home-based programme is rather the sole choice than alternative. Nevertheless this choice cannot be considered as poor one. The home-based intervention proved to be very effective provided that the certain requirements are met. Although Berg et al.
ascertained that “relatively few studies describe the effectiveness of the intervention following the transfer to the home setting”, while researches relied mainly on parents’ reports, hence it is impossible to identify the long-term outcomes of home-based intervention programmes (2002, p. 10), the study conducted by Kaderoglou two years earlier testified something different. She examined implementation of the modified intervention programme based on Portage early intervention curriculum for seven high functioning children with ASD.
The latter were moved to home-based setting after several years of treatment delivered mainly by the therapists. The findings of the study summarized after one year of home-based intervention were very positive: parents proved to be efficient therapists; the greater progress was demonstrated by children in cognitive and language domain in comparison to that during school-based intervention; eye-contact, comprehension and expressive language were improved although to a little extent although the successes of children in this domain were hopeful.
These results enabled the scholar to ascertain that home-based early intervention programmes for children with ASD can advance the quality of the whole family life provided that they should be flexible to facilitate addressing the needs of both each given child and his family (Kaderoglou 2000). The second positive result of home-based early intervention programme is described in the book by Catherine Maurice “Let Me Hear Your Voice: A Family’s Triumph over Autism” (1994).
Two children of the author – girl and boy – were autistic children, and she managed to heal them both entirely with the help of the therapists while the intervention program of Applied Behavioural Analysis which she has been implementing was home-based one from the beginning to the end. The result seemed to be a marvel for a happy mother – both children entered mainstream school. At the same time in cases where the ASD are not so severe, the school-based early intervention programmes are applied in kindergartens and schools.
The positive aspect in such intervention programmes lies in fact that early childhood education surroundings provide the child with inappropriate behaviour many benefits: social interaction, adequate communication, peers to play with, models of adequate behaviour to reproduce, and opportunities to create social relationships. For the early intervention for children under 3 years old usually the programmes are applied which combine treatment at home and in childcare centres. After the age of three the child has the possibility to attend specialized preschool programs on the premises of local schools.
Such mix enables children with autism to adapt to different settings and promotes their socialization (Cushing, Dunlap & Fox 2002). Some scholars emphasize that a rationale for combined for prefer combined service-delivery approach lies in the necessity of active parents’ involvement in the intervention programme. Their argument is that part-time home programme can give important training for parents while the school-based treatment can be used for supervisory examinations, periodic criterion data taking, further planning and adjusting the tasks.
The latter component also provides the opportunities for communicating with peers it is usually realised by means of one-on-one interaction aimed at tutoring or of just playing with each other. The school-based programmes do not mean that the treatment will be always delivered in groups. For instance, for ABA programmes some preschools have classes with separate carrels for one-to-one treatment. In such premises the teacher has the opportunity to observe all the pupils while they feel comfortable being alone in the carrel (Siegel 2003, p. 323).
These studies proved that the early intervention programmes could be implemented at home or in school, or they can include both approaches. The main aspect here is to choose the mode which is the most convenient for the given child with ASD and meets his needs in treatment. Teaching Tools for Support of Autistic Children In fact, there is a wide choice of treatments, therapies, and techniques along with the new nascent methods aimed to help and even heal. But until not long ago no one of those treatments did offer any solid realistic argument changing the opinion that autism is persistent disability (Rogers 1998, p.
169). At present several studies demonstrated that behavioural approach to treatment – early intensive behavioural intervention using the methods of Applied Behavioural Analysis (ABA) – could yield the real positive results for the children with ASD: successful inclusion in a mainstream school for many and quite normal functioning for some of them. In actual fact, there is a number of evidence the methods of ABA, which is also called behavioural intervention or management of behaviour, may produce general and durable improvements of essential skills for the most children with ASD.
ABA uses the methods based on the scientific principles of behaviour to create socially useful skills and decrease those causing problems for a child development (Rogers 1998, p. 172). From this standpoint ASD are the syndromes of behavioural deficits and surpluses having neurological basis which nevertheless may change under influence of special thoroughly designed constructive interactions with the environment. The studies show that young children with ASD are not ready to study in typical surroundings, but many of them are able to learn the suitable instructions (Ingersoll & Stahmer 2004).
Analytical behavioural intervention for children with ASD is based on teaching by discrete measurable cycles systematically. Any skill being displayed by the child does not – from relatively simple reactions, for instance to look at the others, to complicated actions such as spontaneous communication and social interrelation – is divided into small steps. The instructor one-to-one teaches the child to every step by means of special reinforcements or commands. Sometimes the promptings are added (gestures, movements) to attract his/her attention.
Correct reaction should be followed by the certain consequence which was determined to be effective for consolidation of certain skill. The priority target is to afford pleasure for the child, the second one – to teach to discern different stimuli: own name from other words, colours, forms, letters, figures etc. , as well as to distinguish correct behaviour from improper one. Disharmonious reactions (fits of anger, stereotyping, self–injury etc. ) require the system analysis to define what events act as intensifiers for such reactions.
The attempts to teach are repeated many times, initially in rapid consistency until the child reacts without any promptings from the instructor. The child’s actions are recorded and accessed on special objective positions and criteria to monitor his/her achievements which enables both the instructor and parents to regulate learning if the expected outcomes are absent. The time periods and phases are determined precisely for each child and each skill. In this sense behavioural intervention is highly individualized (Lovaas 1981).
While this instrument is being implemented mainly for home-based intervention another programme – TEACCH (Treatment and Education of Autistic and Related Communication-Handicapped Children) – is school-based one. It has originated from the work at project TEACCH at the University of North Carolina in Chapel Hill initiated and implemented by Dr. Eric Schopler (1994). This instrument is based “on exploiting the relative strengths and preferences of individuals with autism by creating learning, working, and living environments that might be called ‘autism-friendly'”.
The aim of TEACCH is to establish learning and living surroundings synchronous to the nature of autistic person. This programme is arranged in the way to derive benefits from weaknesses of the child with ASD. For instance they learn words which are arranged visually or live very routine-based school days intentionally organized in a way to attract them who like repetitive actions and rigid routine (Siegel 2003, p. 353). It differs from ABA method although being based on the same behavioural approach.
The essence of TEACCH is to promote the child’s self-directed behaviour and to provide opportunity for child self-initiative. The main features of the TEACCH instrument is that interactions between the teacher and the child bear a resemblance to those in a classroom for ordinary children, the intensity of the learning experience comes from the inclusion of tasks specifically tailored for the child, the scope of tasks increasing in the course of time the duration of periods for independent work, and the peculiarity of each task, structured in a way that makes clear when the task is finished (Siegel 2003, p.
357). Indeed, there are other tools in early intervention for children with ASD, but two considered are generally accepted to be the most successful ones. Conclusions By the moment there is no cure for Autistic Spectrum Disorders; those who suffer from them are not able to outgrow the disease without special intensive treatment. But if the patient and courageous efforts by parents and professional knowledge and skills of the therapist are united the synergetic effect emerges, and the child with ASD obtains a hope and tools to full recovery.
In this view the necessity to teach highly professional and morally prepared therapists able to perform their complicated tasks in early intervention programmes effectively. Knowledge obtained in the university encourages the students who tomorrow will stand on the forefront of the struggle with autism to improve their basic attainments through practice and persistent training. On the other hand our professional knowledge changes our outlook; it promotes our inclinations to learn more, as our future profession – a SEN supervisor – gives us no right to study anyhow.
We should meet high standards applied to our profession due to our basic tasks – to advise, to control, to consult and make all the efforts to support children with special educational needs. Knowledge attained under research having been made for preparing this paper is of importance for improving our professional awareness about the priorities of parents of the child with ASD and the teachers of early intervention programmes. It contributed to our comprehension of effective tools for enabling them to support autistic children; hence it has led to broadening of our professional knowledgebase.
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