Early intervention and inclusion open doors for children with autism.
By Cindy Long
Halfway though the morning lesson, 7-year-old Danny starts screeching, pressing his hands tightly over his ears and rocking violently forward and back in his chair. Some students seem unaware of Danny's outburst, but it's sensory overload for others, who get distracted or simply shut down. They're in a special education classroom for children with autism at Henry B. Milnes School in Fair Lawn, New Jersey, but despite their developmental and behavioral challenges, many of them, including Danny, will eventually be "mainstreamed," spending part or even most of the school day in general education classrooms.
It's estimated that one in 150 children in the United States have autism. There's no cure, but with early diagnosis and the hard work of dedicated educators, many of these children will grow up to live independently, and even make extraordinary contributions to society. A big factor for their future success, say the experts, is being educated in regular classes, where they can learn to interact with their peers and to control or modify their behaviors.
But transitions are difficult for children with autism, and sometimes inclusion is tough on teachers, too. No matter how great their desire to help, some teachers see a student like Dan and fear they won't be able to handle teaching an autistic child alongside the rest of their students. That "fear factor" is a big roadblock for general education teachers, says Julie Moore, a middle school teacher in Kitsap, Washington, and member of NEA's IDEA Resource Cadre.
Moore spent much of the last two decades teaching in special ed classrooms. When the inclusion movement took hold, she saw nervous and unprepared general education teachers in need of support. That's when she began leading a six-hour autism workshop for Washington state teachers based on The Puzzle of Autism, a resource guide created by NEA and the Autism Society of America.
"The best advice is to keep a sense of humor and don't be afraid to try new things," says Moore. "And, of course, the paraprofessionals are always there to assist you. Once a child is mainstreamed, we don't cut the supports."
She says successful inclusion programs prepare everyone for the transition—not only the autistic child, but also the educators. And the process begins long before the child flies from the special education nest.
Nancy Potter is a paraprofessional who has worked with an autistic 9-year-old named Kristen since she was in first grade. Kristen trusts her completely (although she went through a phase when she couldn't tolerate Potter wearing brown). Like most paraprofessionals who work with students with disabilities, Potter sits beside Kristen in class, ready to assist her, quiet her, or remove her from the class when her behavior becomes a distraction.
Kristen has long blonde hair, a sharp sense of humor, and a strong aversion to geese or pelicans, though she no longer screams when entering a McDonald's. She speaks louder than most people, in a husky monotone, but she has a ready smile and now looks people in the eye without hesitation. She spends most of each day in the general education class with the other fourth-graders at the Milnes School.
"I was a little nervous about it at first," admits Kristen's teacher, Carol Granoff. "I thought there'd be a lot of screaming, but it's more like fretting. And if she has a problem, she simply returns to the special education classroom. But she's just amazing, and she grasps so much. She gets 100s on most of her tests, and she has such a memory."
To prepare for Kristen's arrival, Granoff talked to the special education teachers and paraprofessionals who had worked with her over the years, as well as her third-grade teacher, who offered a lot of practical advice.
Granoff learned that she should give Kristen more time to complete assignments, and allow her to work on projects more independently and creatively. While the rest of the class discussed healthy breakfast options in a health education unit, for example, Kristen colored a food pyramid worksheet.
Like many children with autism, Kristen excels in specific subjects (spelling is her favorite) and has unusual cognitive abilities. Granoff regularly assigns spelling words to the class and then reads them aloud the next day, using a particular pattern to reorder the words before asking the students to spell them. She soon found that Kristen could decipher the pattern. "She'd have the next word spelled before I even said it," says Granoff.
Other classroom activities challenge Kristen. When Granoff dims the lights and shows a video, Kristen gets agitated and needs to leave the room. "But whenever there's a problem, Nancy's there to support her and ease her back into the lesson, or to take her out of the room," Granoff says.
Back in the special education classroom down the hall, a paraprofessional works to bring Dan back into the lesson. To quiet his screeching, she asks him to push a button on his "Hip Talk," a small device resembling a fanny pack with icons of faces expressing different emotions, like sad, angry, and scared. Dan pushes a button and a recorded voice says, "I'm angry."
"He's angry because he wants to draw," explains special education teacher Jennifer Gruber. "A lot of problem behaviors we see in kids with autism result from their inability to express themselves. Hip Talk allows Dan to tell us what he's feeling."
Dan's screams have quieted, but he continues rocking with his hands over his ears. As he rocks, the paraprofessional gently kneads his arms. "These children often like tactile stimulation. I have one student who likes to have his head squeezed," says Gruber.
There are other common traits that are helpful for general education teachers to understand, says Marguerite Colston of the Autism Society of America.
The social world is confusing to children with autism, and they don't pick up on cues that come naturally to others. They can't generalize, and don't realize that accepted behavior they've learned in one setting is appropriate for all settings: for example, table manners learned at home should also be practiced at school. They have selective attention and sometimes focus on one detail, such as the color of a car rather than the car itself. Later, they might not be able to identify another car if it's not the same color. They often engage in self-stimulatory activities, like rocking or hand flapping, to ease anxiety. Repetition and consistency are comforting—even slight changes to routines are distressing.
Still, autism is a heterogeneous disorder and, as Colston often says, "If you've met one child with autism, you've met one child with autism"—which is why effective interventions and therapies vary from child to child.
The research is consistent on this point: the earlier that special education staff begin helping children with autism manage their differences, the better. In the Fair Lawn Public School District, children enter the autism program, called "Stepping Stones," at age three. Not all students from the program will be included in general education classes, but the goal is to prepare them for the possibility.
Domenica Bassora is a Stepping Stones teacher at Edison Preschool in Fair Lawn. She leads a team of paraprofessionals who work one-on-one with six preschoolers with autism. The curriculum in Bassora's classroom is based on Applied Behavioral Analysis (ABA), which provides a very structured interaction with the child, a defined set of goals, and a careful recording of progress. (For a description of other therapies, including Floor Time, see sidebar to right.)
At first, they work on basic attending skills, such as making eye contact and staying seated in a chair. Physical therapists teach the students to walk up and down stairs or to roll a ball. Occupational therapists help them with their motor skills, like holding a toothbrush or a crayon. Some children are even potty trained at school.
Speech-language pathologists work on improving communication skills, whether through a picture-symbol, sign language, or verbal system. If the student remains nonverbal, some learn to express themselves with assistive technology, which is expensive but can open up the world for a child with autism.
Paraprofessionals work on imitation skills, asking students to follow their lead as they clap their hands or put their hands on their head. The students are taught to wave or say hello and goodbye, to wait, to take turns, and to share.
In Bassora's classroom, the children sit in their own partitioned "cubbies," allowing them to feel cocooned and secure. On one wall of the cubbie is a pictorial schedule of activities so they always know what comes next, which eases transitions.
When they graduate to the next step in the Stepping Stones program, the children work in twos in an open classroom environment where the beginning of each carefully scheduled activity is signaled by a bell. The students move from one work station to another where they develop more academic skills, always with the goal of inclusion.
"The general education teachers tell us what the students will need to do, and we work on those skills," says special education teacher Alison Pahlck. "We work on the components of letters by drawing lines and circles, and they learn to identify letters and numbers." In the fine motor skills center, they work to desensitize children to different substances like glue and finger paint. "This also helps build the muscle tone in their hands, which can be weak in children with autism," says Pahlck.
For some, like Nick, a ninth-grader at Central Kitsap Middle School in Kitsap, Washington, maintaining fine motor skills will be an ongoing struggle. Nick, 15, has a lot of trouble writing, and his hands begin to shake with fatigue after several minutes of typing on his Alpha Smart, a small, portable word processor.
Although he is able to spend most of the school day in general education classes, Nick also has ongoing academic challenges. Steve Coleman, a paraprofessional who works with middle school children with autism at Central Kitsap, says he finds ways to make academic work more palatable by engaging Nick in his particular areas of interest.
Like many of his classmates, Nick likes to watch the Discovery Channel and Animal Planet and is a big fan of video games. Unlike his classmates, he also likes to hide out in the library and is often overdressed in school, even on the hottest days, with his coat buttoned to the top and, until recently, a hood tied tightly over his head.
Nick and five other autistic students bookend their days in the special education classroom. In first period they work on social and behavioral skills; during last period, they debrief and work on study skills. They can also visit or stay in the special education classroom at any time during the day if they need a break.
As part of the inclusion process at Central Kitsap, students with autism can also serve as teaching assistants (TAs) for general education teachers. It's a volunteer position, performed after regular class work is completed. Nick is a TA for Julie Moore, of NEA's IDEA Resource Cadre, who is now a general education teacher at Nick's school.
He makes photocopies, three-hole punches papers, and completes clerical tasks. "I like the work. It makes me feel good," says Nick.
One of his proudest achievements was making a hallway bulletin board display of student work, including "Why High School Matters" bumper stickers created by his classmates. "Creativity doesn't come easily to Nick," says Moore. "This was a big deal for him."
So was being named Student of the Month in December. The best part, says Nick, was seeing his picture hang right alongside the other Students of the Month.
Most of the children in Nick's school treat him and the other autistic students with respect, or, at worst, with indifference, says Coleman. Just as they find Nick to be different, he finds them equally bewildering. Which is why Coleman says inclusion leads to one of education's most important lessons: "It's an opportunity to teach tolerance to all of the children."
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Kristen, 9, spends most of the day in a general education classroom.
Learn more about autism at the Autism Internet Module project , including characteristics, diagnosis, interventions and supports, transition, and employment. Currently AIM has three modules available with 32 in progress.