Information on Five Challenging Disabilities-Autism

Educational and Clinical Classifications: Differences Between Systems

Educators use educational classifications of disabilities that focus on how a disability will affect a child's ability to learn, with the goal of developing an individualized education program (IEP) to address specific learning needs. Mental health practitioners, however, classify disabilities according to clinical criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSMIV- TR) developed by the American Psychiatric Association (APA, 2000) and are more concerned with diagnosis as a means of identification and appropriate treatment planning to resolve mental health issues.

In the remainder of this chapter, we will focus on five of the thirteen categories of exceptionality—autism, emotional disturbance, ID, SLD, and ADHD, which encompass some of the most challenging and complex concerns for parents and teachers. We will provide information about prevalence rates, associated features, and mental health issues for these disorders.

Autism

Autism is a neurological disorder listed in the DSM-IV-TR (American Psychiatric Association, 2000) under the main category of pervasive developmental disorders (PDD).

Defining Criteria   IDEA 2004 recognizes three primary features of autism that result in severe and pervasive difficulties in the majority of daily activities, including learning:

1. Restricted range of social interaction
2. Impaired communication skills
3. Persistent pattern of stereotypical behaviors (for example, rocking, hand flapping), interests, and activities (for example, nonfunctional routines, such as lining up objects or spinning parts of objects)

Prevalence and Cause   Autism is one of five disorders classified under the category of pervasive developmental disorders (PDD) in the DSM-IV-TR (APA, 2000). According to the DSM-IV-TR, autism is a rare disorder with the "median rate" of children with autistic disorder being five cases per 10,000 with rates raging from "2 to 20 cases per 10,000 individuals" (p. 73). The disorder is far more prevalent (four times more common) in males than females. However, results of a survey conducted in 2006 by the Autism and Developmental Disabilities Monitoring (ADDM) Network sponsored by the Centers for Disease Control (CDC, 2009) reported a prevalence rate of 1 percent or one child in 110 for children in the United States as having an autistic spectrum disorder (ASD) based on the eleven sites sampled across the United States.

The majority of children with autism (approximately 75 percent) have some degree of intellectual disability. Others who are referred to as having High Functioning Autism will score above an IQ 70. Significant controversy exists regarding how children develop autism, and no single gene or genetic link has been established.

Associated Characteristics   Children with autism must demonstrate a number of symptoms in each of the four areas described:

Language and communication skills. Language is likely delayed, if present at all, with minimal use of nonverbal communication (for example, pointing, directed eye gaze). If language exists, it is rarely used to initiate or sustain communication with others. Speech patterns are odd (for example, monotone) or demonstrate echolalia (repeating what someone else has said). Children with high-functioning autism (HFA) may "talk at others" on topics of high interest to themselves while ignoring their audience.

Play, imitation, and social interaction. Children with autism often seem to be in a world of their own and do not spontaneously participate in social interaction. Youngsters with autism do not develop age-appropriate play (for example, make-believe) or peer relationships and are often more intent on playing with parts of objects (spinning a wheel on a car) than interacting with others. Instead of forming attachments to people, children with autism may form strong attachments to inanimate objects, such as a plastic spoon or button.

Stereotypical and repetitive behavior patterns. Children with autism are often preoccupied with objects, repetitive movements or activities, or rigid adherence to routines and rituals that have little function in the real world, such as spending considerable time lining up objects (for example, toy cars) in a row. Often, it is difficult to disengage these children from their intense focus on repetitive motor movements such as hand flapping or twirling (called self-stimulation), which prevents them from engaging in their social world.

Children with autism are often highly resistant to any changes in their schedule or routines, regardless of how minor. While some professionals believe that autistic children hold on to the predictable because they are overwhelmed by external stimuli, others believe that these behavior patterns result from children being under-responsive to their environment.

Learning and development. Skill development can be uneven, and some children with autism demonstrate higher-functioning skills in specific areas, exhibiting hyperlexia (reading at an advanced rate) or an unusual ability to perform mathematical calculations. These skills are sometimes referred to as savant skills. Even when children with autism have elevated skill levels, they often lack comprehension; for example, a child might be able to perform calculations but have no number sense.

Autism and Asperger's Disorder   Asperger's disorder shares deficits in two of the three areas noted for autism: impaired social reciprocity and stereotypical and repetitive movements. However, one criterion for Asperger's disorder is that an individual does not have language, cognitive, or adaptive delays. As a result, children with Asperger's disorder often score well above children with autism on IQ tests, and some may have an above-average or superior IQ. Although Asperger's disorder is listed as a separate disorder under pervasive developmental disorders in the DSM-IV-TR, the disorder is not mentioned by IDEA 2004. Because their language skills are not impaired and they function at a higher level, children with Asperger's disorder are often diagnosed at a much older age than those with autism. Because Asperger's disorder shares similar features to autism but at a much higher level of functioning, many clinicians prefer to think of these two disorders as the autistic spectrum disorders (ASD), in order to reflect the idea of a continuum with higher and lower levels of functioning.

Educational Planning   Educational programs for children with autism emphasize early intervention and focus on increasing skills in communication and social, behavioral, and adaptive functioning. Often, it may be necessary to address behavioral issues before an educational plan can be put in place. A functional behavioral assessment (FBA) is often helpful in pinpointing behaviors to be targeted for change. A functional behavioral assessment sometimes uses a chart referred to as an ABC chart (for antecedents, behaviors, and consequences), which shows what triggers the behavior (antecedent) and what the outcome is (consequence). Once problem behaviors are identified, a behavioral intervention plan (BIP) can be developed to help alter behavior patterns and develop more appropriate ways of responding. Examples of an FBA and a BIP are presented in Table 3.1.

Children with autistic features represent a wide range of functioning. Therefore, no single program or educational plan will meet the needs of all children with autism. However, all programs should emphasize the importance of consistently reinforcing common goals in the home and at school. A summary of key intervention strategies and the reasons that these strategies are important is available in Table 3.2.

What the Research Says About Treatment   At a minimum, successful early intervention should include individualized and systematic instruction, intense programming effort, and parent involvement in the educational process. Although controversy exists regarding which is ultimately the best program, two programs have documented research support of their positive impact on learning potential: the UCLA ABA Program developed by Ivar Lovaas and the Treatment and Education of Autistic and related Communication-Handicapped Children (TEACCH) Program, developed in the early 1970s by Eric Schopler at Duke University in North Carolina.

Children in the ABA program had very positive outcomes; almost half of the children were promoted to the second grade and required little or no special education support.

The TEACCH program focuses on intentional communication, with the belief that children will learn to communicate in order to reach their goals. For example, if a child is thirsty and the only way he is going to get a drink is to say "juice," then he will learn to communicate. Instead of teaching language as an academic subject, this program focuses on developing a child's awareness of the practical use of language. The program also includes visual charts and displays to help children better understand abstract concepts such as time and space.