A child with an autistic spectrum disorder does not intuitively understand the social world. Severely affected kids may have little apparent interest in people around them. Someone with mild impairment may be quite motivated socially, but lack the skills to initiate or maintain social exchange or play. Regardless of whether the diagnosis is autism, Asperger's syndrome or pervasive developmental disorder (PDD)-nos, this difference in social development defines the disability.
Educational planning for children with autistic spectrum disorders is often complex and difficult to negotiate. When children have severe impairments, they often end up in specialized classrooms -- and sometimes are mainstreamed too quickly. For children more able to integrate into mainstream settings, an appropriate balance between class time and services to address their special needs can be hard to define. They benefit from, and hopefully enjoy, time with mainstream peers and teachers, but they still are behind developmentally and require services.
The bottom line in educational planning, however, is this: As long as a child continues to show symptoms of an autistic spectrum disorder of any kind, he or she requires continued and targeted special services. Even children with mild social impairments, who are able to get by in mainstream classes and frequently do not act out in any way, require services. To meet a child's long-term potential, we must define and develop a long-term plan that addresses the often subtle social and communication skills that lag behind peers.
As the school year beings, here's an overview of educational planning (in 500 words or less):
1. Behavioral therapy is the core intervention.
For intense impairments, a self-contained classroom with an autism-specific behavioral program is the quickest way to catch a child up. With milder impairment, children still benefit from direct instruction. As long as symptoms of autism persist, children require ongoing behavioral intervention, considering both individual and group interventions, to teach core social skills. Exposure to typically developing children alone doesn't accomplish enough. If they could instinctively learn from peers, they probably wouldn't have autism.
2. Speech language delay is part of the autism diagnosis.
Regardless of how high-functioning children with autism appear, they have language deficits. It's a defined part of the diagnosis. Some have profound delays in expressive skills and comprehension, but for others the delay is more subtle.
Pragmatic language refers to all the unspoken, nonverbal aspects of human communication. Pragmatic language delays are inherently part of having autism, so children require ongoing speech-language therapy. Importantly, pragmatics are impossible to quantify, so we cannot rely on test scores to define needed services. As long as social awkwardness, lack of awareness, or communication concerns persist, skillful language intervention has a role.
3. Daily repetition is needed to learn social skills.
If the absolute most important thing in the world was for your child to become a concert pianist by age 16, she would have to practice multiple hours almost every day to get there.
Similarly, for children with autistic spectrum disorders the development of social and communication skills is the absolute most important thing in the world. Their educational plan, considering what happens both in and out of school, should include daily reinforcement through a variety of services. As children catch up, or for those with very mild impairment, the intensity can be decreased.
4. Monitor the need for related services.
Occupational therapy addresses fine motor, handwriting and sensory concerns when present, all of which are common with autism. Physical therapy addresses primarily gross motor concerns. Psychoeducational testing should look for these types of impairments, with an emphasis on daily living and adaptive life skills.
5. Monitor for other academic difficulties.
Children with autism frequently have symptoms of attention deficit/hyperactivity disorder (ADHD). They also can have learning disabilities. Obsessive, rigid thinking may affect classroom performance. On a more subtle level, pragmatic difficulties impact their ability to understand and interpret reading assignments, social studies, and other work. This means they likely will need ongoing intervention to address a broad range of educational difficulties.
6. Many children with autism need more support during unstructured time than structured time.
The social rules in a classroom are simple: Sit down. Be quiet. Raise your hand when you want to speak. On the playground, in the lunchroom, and during recess social rules are constantly in flux. A recent study suggested half of children with autism become victims of bullies, which is much more likely during unmonitored time. Planning should address this unstructured, often unsupervised time of the day.