In line with a tradition we are slowly building, the newsletter for this week will discuss another interesting subject, highly controversial for the 21st century parenting: autism. It is controversial because, as of now, we know there is no one cause of autism. The recent research has been suggesting that autism develops from a combination of both genetic and non-genetic (environmental) influences (Autism Speaks Inc., 2017). The way these influences interweave determines the degree of the risk a child will develop autism.
But what is autism? According to the latest DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition, 2013) autism or autism spectrum disorder (ASD) refers to a range of conditions that show lack of balance in both of these 2 categories:
– deficits in social communication and in social interaction
– restricted, repetitive patterns of behaviour, interests or activities.
Hitherto, the research has indicated that no two autism cases look alike, therefore different combinations of the influence categories exist. Every child with this diagnosis has distinctive abilities, symptoms and challenges. Autism or Autism Spectrum Disorder (ASD) refers to a wide range of variations of these categories leading to a specific level of disability.
Most obvious signs of autism spectrum disorder appear between 2 and 3 years of age, though it can be identified as early as 18 months of age, and symptoms change with development. If any autism-like signs are observed, the child should be examined by a medical professional or by a clinical psychologist for a thorough evaluation; but just because a child displays such signs, it doesn’t necessarily mean that he or she has autism spectrum disorder.
With the latest DSM-5 identification, ASD includes several diagnostic labels previously known as Asperger’s syndrome and Pervasive Disorder Not Otherwise Specified (PDD-NOS). Under the same diagnosis of ASD, one could identify severity levels based on the support given, from level 1 (requiring support), to level 2 (requiring substantial support) and level 3 (requiring very substantial support). Therefore, a new diagnosis may include the name of the disorder and a level.
Children diagnosed with ASD Level 1 show deficits in social communication, difficulty in initiating or decreased interest in social interactions and atypical responses. These individuals may engage in exchanges of information but not necessarily conversations. Regarding behaviours, the inflexibility may cause some interference with operating in different situations making them dependent on some help. With some individualised help and some differentiated instruction, these children can be easily integrated in typical classrooms leading towards average or high achievements.
Children diagnosed with ASD Level 2 indicate clear deficits in verbal and nonverbal communication (sometimes odd), exhibit limited interactions and have limited to narrow special interests. Their behaviours are more inflexible, having a hard time with transitions and changes and display frequent restricted/repetitive behaviours that interfere with some daily activities. The children with such diagnosis can be included in typical classrooms with a full-time or a part-time schedule, accompanied by a paraprofessional and individualised work, and may be involved with some specialised therapies.
Children diagnosed with ASD Level 3 show severe deficits in verbal and nonverbal social communication skills, limited initiation of social interactions and minimal response to social cues. These individuals have an extremely hard time coping with change, and display abundant restricted/repetitive behaviours that interfere with daily activities. Most of the times, children with this diagnosis will be attending special education classrooms and will benefit from specialised therapies.
Quite often, ASD may be associated with other known medical conditions or genetic conditions or other neurodevelopmental or behavioural disorders, from language delays to intellectual disabilities, and at the same time, it may be associated with savant skills involving mathematical calculations, calendars, artistic and musical abilities. With the help of early intervention and of specific therapeutic approaches, children diagnosed with ASD may overcome some deficits and could end up leading an independent life. These therapies address sensory problems, emotional difficulties and uneven cognitive abilities.
Addressing problem behaviours in such cases may be crucial for further inclusion of a child in typical environments. Considering the verbal social abilities, children are usually taught in a repetitive manner until they create their own routines and meet incremental goals. After a functional behaviour assessment has been done, an ABA (Applied Behavioural Analysis) therapist identifies and teaches the child appropriate social behaviours, language skills, socializing skills and academics. Other methods include creating a routine/a structure for the day, set meaningful consequences, TEACCH method, DIR model, and the Early Start Denver Model. Methods that include both developmental and behavioural approaches have proven to be most successful as they focus on encouraging interpersonal skills, develop spontaneous imitation of object use and focus on play.
Classrooms that provide inclusion to children with such diagnoses have to be built with the following principles in mind, principles that could benefit typical students as well:
– provide sensory processing regulating experiences
– provide a structured environment with clear expectations, rewards and consequences
– provide consistency in approach
– provide clear communication so everyone can express his or her wants and needs.
Nowadays, there is a large amount of confusion surrounding the appropriateness of inclusion. In Romania, much of this confusion is based on misunderstanding of the diagnosis and erroneous interpretations of general definitions of concepts used in education and educational law. The concept of inclusion is based on understanding that students do not fall into simple teachable categories (with or without disabilities), that students should be taught in supportive classrooms (least restrictive environments), and that students should have the possibility to interact across abilities (Pratt, 1997).
The future of general education is definitely changing and along with implementing differentiation, educators understand that all children can benefit from an inclusive approach: typical children learn how different they all are, an open-minded attitude for the future, and children with disabilities benefit from exposure to typical life.