Introduction
This article describes the meaning of Autism Spectrum Disorders (ASD), the characteristics of ASD, the diagnosis process of ASD, ASD diagnosis instruments, and the strengths and interests of children with ASD. The article also presents supporting and educating techniques, behaviour management strategies and communicating strategies for students with ASD.
Understanding Autism Spectrum Disorders
Before the publication of the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) (APA, 2013), various terms were used to refer to children with complex neurodevelopmental conditions (e.g., ASD, atypical autism, childhood psychosis, childhood schizophrenia, and autism). The term “autism” was defined differently from childhood schizophrenia and other psychoses, such as “pervasive developmental disorders” (PDDs), after the publication of DSM-III. Moreover, DSM-IV included several subtypes of PDD: autism, AS, PDDNOS, Rett syndrome, and disintegrative disorder (APA, 2013). After the DSM-5, the subcategories were eliminated and replaced with the single diagnosis of “ASD” and the DSM-5 revised the diagnostic criteria for children with autism spectrum disorders (APA, 2013). The term ‘ASD’ is used throughout this article – consistent with DSM-5 diagnostic criteria.
Characteristics of students with ASD
Students with autism may experience difficulties in the following areas. Table 1 presents characteristics of students with autism.
Table 1 characteristics of students with autism
| Communication | Social interaction | Restricted and repetitive patterns of behaviour |
● delay in speech and language ● have trouble understanding other people ● hard communicating what they want ● could use body parts or objects to indicate what they want to say ● may have an unusual tone, pitch, or accent ● may not understand non-verbal communication (e.g., facial expressions, body language, and gestures) ● may have difficulty following instructions ● Sometimes may appear not to hear at all | ● may not join in play with other students and may appear disinterested in other people ● may prefer to play or be alone ● may not play as often as same-aged peers ● rarely bring toys and objects to share with other students ● may not respond to other people’s greetings or smiles ● may experience difficulty with social situations and understanding social rules ● may not understand others’ emotions, thoughts, or actions ● difficulty with eye contact | ● A strong preference for routine and order ● get very upset if their routines are interrupted ● may have trouble with transitioning to new environments ● may have a special interest that they enjoy talking about a lot ● may use behaviour including challenging behaviour as a way of communicating ● may appear to be clumsy and have poor motor skills ● may make unusual movements or sounds ● may have poor problem-solving or organisational skills ● hyper or hypo-sensitive to various stimuli (link to sensory) |
(Altogether Autism, 2023; APA, 2013).
Strengths and interests of students with ASD
Students with ASD excel in various learning styles, including acquiring knowledge. Specifically, they may be good at:
- rote learning
- remembering information for extended periods
- detailed and chunk-based learning
- paying close attention to small details
- concentrating on narrow topics of interest
- using visual information meaningfully
- using concrete information, understanding and following rules
- actions and thought logical processes
- follow strict rules
Diagnosis process for students with ASD
There are several theories about the causes of ASD, but none of them have been scientifically proven (Autism New Zealand, 2020; Thapaliya, 2023a, 2023b). Researchers are still investigating varied factors that might contribute to the development of ASD. Some studies suggest that people with ASD may have genetic predispositions, whereas other research signals viral infections, structural and functional brain abnormalities, and dysfunctional immune systems (APA, 2013).
The diagnostic process requires input from multiple professionals (e.g., child psychologists, educational psychologists, pediatricians, clinical psychologists, audiologists, and teachers) and parents (APA, 2013). Professionals also involve an evaluation process. Specifically, the following criteria are commonly used to diagnose ASD:
- assessments of multiple areas of functioning (e.g., intellectual and communication skills, a review of developmental history)
- parental input
- medical tests (a loss of hearing test and eye test before considering a diagnosis of ASD)
- assess multiple areas of functioning
- collect information from a variety of settings
- provide a single coherent view
- provide implications for adaptation and learning
- liaison with schools and other agencies to support the implementation of recommendations
- developmental history
- diagnostic assessment of speech, language and communication
- sensory and motor skills assessments
- medical evaluations
Figure 1 presents the two diagnosis domains of ASD based on DSM-5: communication and repetitive patterns of behaviour (APA, 2013).
(APA, 2013)
Diagnostic instruments
The following diagnostic tools may be used to diagnose autism spectrum disorder.
- Diagnostic and Statistical Manual of Mental Disorders (DSM)- 5
- Asperger Syndrome Diagnostic Interview (ASDI)
- Asperger Syndrome Screening Questionnaire (ASSQ)
- Australian Scale for Asperger syndrome (ASAS)
- Autism Behaviour Checklist (ABC)
- Autism Diagnostic Observation Schedule (ADOS) and ADOS-G
- Autism Screening Questionnaire (ASQ)
- Autistic Diagnostic Interview (ADI, and also ADI-R)
- Childhood Asperger Syndrome Test (CAST)
- Childhood Autism Rating Scale (CARS)
- Child Communication Checklist (CCC)
- Checklist for Autism in Toddlers (CHAT)
- Diagnostic Interview for Social Communication Disorders (DISCO)
- Gilliam Autism Rating Scale (GARS)
- Parent Interview for Autism (PIR)
- Pervasive Developmental Disorders – mental retardation (PDD-MR)
- Social Response Scale (SRS)
- Treatment and Education of Autistic and related Communications Handicapped Children (TEACCH) checklist
- Wing Autistic Disorder Interview Checklist (WADIC)
Teaching and learning strategies for students with ASD
Researchers recommend a wide range of teaching approaches, methods, and techniques to teach students with autism, such as structured teaching programmes, social stories, visual cues, sensory corners in the classroom, and using assistive technology to deliver course content in the classroom (Autism New Zealand, 2020; Bevan-Brown & Dharan, 2016; Thapaliya, 2023). The following section describes key teaching strategies for students with ASD.
Rules of 5 (Fewer than 5 words, wait 5 seconds)
In this strategy, teachers have to present the information in sentences that only have five words. Teachers can give students five seconds to comprehend each statement so they can focus on and understand what you said. For example,
- Stay in your seat
- Hand on pencils only
- Use friendly words
- Raise your hand to speak
- Focus on your task
Use the student’s name first
Saying the student’s name first gets the students’ attention and allows them to work out that the teacher is speaking to them. For instance, teachers can frequently remind them to do the task. Tom, time for math.
Giving positive direction
Teachers need to give positive direction while instructing students with autism in the classroom because students with autism may have trouble when they hear the word ‘no’. For example, ‘Please use a tissue, instead of saying ‘Stop picking your nose!’.
First-then strategies
A first-then strategy may provide the students with a visual means of introducing a new task in a way that they can understand. This technique helps to establish a routine and controlled environment for students with autism. Specifically, teachers can use a first-then strategy to increase independence, provide predictable environments/activities, clarify expectations while providing sequencing of events, support transitions (activity to activity or between locations), reduce verbal information (prompts) provided to a child and increase motivation for completing an adult-directed task/activity (MoE, 2023). For example, first reading a passage, then having a break time.
Give warnings before an activity finish
It is recommended to give students prior warnings before ending a favourite activity to prevent anger. Three warnings, accompanied by visual cues, are the usual practice (Autism New Zealand, 2020; MoE, 2023). For example,
- Hunter, you have ten minutes left to complete your math task.
- Hunter, you have five minutes left to complete your math task.
- Hunter, math time is finished.
Use assistive technology
Using assistive technology (e.g., computers, iPads), can help reduce learning barriers in the classroom while teaching students with autism spectrum disorders (Autism New Zealand, 2020; MoE, 2023; Thapaliya, 2023a). Using computers can be a useful tool for teaching literacy and language skills (e.g., listening, speaking, reading, and writing) and numeracy skills. Jacklin and Farr (2005) reported the benefit of using computers with students with autism spectrum disorders in the classroom because they provide a “visual impact on what they are learning” (p. 208). While completing academic tasks, students with autism spectrum disorders may gain a sense of predictability, confidence, and self-control (Murray, 2015).
Learner profile
A learner profile includes everything about students’ learning needs, strengths, and individual needs in the classroom. In other words, the learner profile can assist schoolteachers, school psychologists, and school staff in understanding the perspectives of ākonga (student) and their whānau/parent), forging relationships with them, and tailoring instruction to fit the needs of individual students (MoE, 2023). Specifically, a learner profile can provide information about students (e.g., how to communicate with students, likes, and dislikes) (Thapaliya, 2023b).
Provide visual support
Visual support refers to a shared set of tools that are employed for a variety of tasks and are more permanent than words. Visual support consists of objects that are used to visually enhance a person’s understanding of the information, physical environment, social situation, and abstract concepts (Rutherford, et al., 2020).
Visual support may assist expressive communication by serving as a substitute for words, signs, gestures, and physical acts. Visual support can support people in meeting their developmental stage by offering a variety of skills (e.g., skill acquisition, motivation to learn, and utilizing their new learning). Similarly, visual support can offer students with ASD the structure, routine, and sequence they need to participate in everyday tasks (Thapaliya, 2023b).
. For instance,
Social story support
Researchers claim that social skills are the most effective way to manage students with ASD behavioural issues if they are taught within the natural environment (Fleury et al., 2014; Murray, 2015; Ostmeyer & Scarpa, 2012). Social skills can provide an opportunity for imitative skills and observation skills for students with autism spectrum disorders, as well as help them get support from their peers and tutors.
There are three types of story support (Autism New Zealand, 2020) to improve students with ASD behaviour:
- Story for self-esteem provides a positive story of student’s behaviour and learning. Also, it was applied to enhance students’ self-esteem and confidence.
- Story for information offers practical information (e.g., how to brush teeth), calming strategies to reduce their anxiety, and a new classroom timetable.
- Story for understanding is used to explain misunderstood communication and enhance students’ comprehension of course content.
Sensory regulation
Sensory overload sensitivity is a component of the autism spectrum diagnosis. This does not imply that all autistic students will be sensitive to sensory stimuli (APA, 2013). Students with ASD may have sensitivities to sights, sounds, smells, tastes, touch, and balance. They can experience both hyper- and hyposensitivity (under-reactivity) to a variety of stimuli. Most people combine the two in some way.
Acoustics, lighting, noise-cancellation headphones, low-arousal workspace, and scheduling regular breaks are some suggested strategies to prevent sensory overload for students with autism (Autism New Zealand, 2022). If teachers provide frequent breakout time throughout the day and calming and self-managing activities for students with autism, these activities will help students with autism cope with the classroom environment (e.g., prevent overload anxiety issues). For instance,
- Give students frequent break
- Check in- and check-out times
- Curate a reading corner and breakout space with toys and sensory cushions
Lego therapy
LEGO-based therapy may help to develop social skills in children with autism spectrum disorder (Autism New Zealand, 2020; MoE, 2023; Thapaliya, 2023). Initially, Lego- therapy was designed to help children with ASD, but now it has been used to help kids with various social and communicative issues. In Lego-based therapy, there will be three people:
Engineer: reads the visual instructions and designs
Supplier: finds the pieces as directed by the engineer
Builder: builds the pieces
Lego-based therapy may help to:
- promote social interaction
- develop turn-taking skills and share with others
- collaborate with others for problem-solving
- develop language and motor skills
- increase motivation and self-esteem
- improve participation and engagement skills
- feel calm and relaxed
Universal Design for Learning
Universal support approach refers to the Universal Design for Learning (UDL). The UDL has three principles and guidelines that assist in enhancing learning, including for students with ASD. According to students’ interests and learner variability, teachers can select certain guidelines to apply in their teaching and learning activities (Rao & Torres, 2016). The UDL framework has three principles: i) multiple means of engagement; ii) multiple means of representation; and iii) multiple means of action and expression (CAST, 2018)
The multiple means of engagement principle offer choices for developing likes, purposes, and self-regulation among students. The multiple means of representation principle is structured to assist learning through recognition networks and provide multiple ways of representing the curriculum. The multiple means of action and expression connect to strategic networks in the brain, and they play a key role in language learning and skill development (CAST, 2018).
Behaviour managing strategies
Students with ASD might display problematic, challenging, and aggressive behaviour (e.g., difficulty in listening to their teachers and following instructions, self-harm, difficulty following classroom rules, and repetitive disruptive behaviour). Instructional and behavioural support from behavioural therapists, educational psychologists, and clinical psychologists is put in place to assist students with spectrum disorders (Fleury et al., 2014). The use of technological interventions such as iPads is an effective intervention for decreasing challenging behaviours in the classroom. The following section describes Applied Behaviour Analysis (ABA), Functional Behavioural Analysis (FBA), and Cognitive Behaviour Therapy (CBT) to manage behaviour of students with autism spectrum disorders.
Communication managing strategies
Augmentative and Alternative Communication (AAC)
Augmentative Alternative and Communication (ACC) refers to a range of tools and techniques that assist people with complex communication needs. Students with cerebral palsy, autism spectrum disorders, developmental disabilities, childhood apraxia of speech, language delays, and other medical conditions that result in speech loss can benefit from the use of augmentative and alternative communication (ACC) (Mitchell & Sutherland, 2020).
In other words, the term ‘augmentative’ refers to resources that support and improve the existing communication abilities of a student. For instance, a student with ASD may use an iPad with communication software that produces a synthetic voice in response to a selected image. ‘Alternative’ describes communication systems that are designed to substitute for learners’ lost language and speech or are unlikely to develop in the future. For example, communicating effectively with students who have severe ASD can be challenging, especially in social situations, classrooms, and in their future endeavours where speech is a necessity. However, a high-tech system with speech output could be a temporary solution to serve as their primary means of communication.
There are three types of ACC solutions: No-tech, low-tech, and high-tech.
- No-tech AAC is widely known for utilizing voluntary motor movements (e.g., sign language and facial expression analysis) to convey non-verbal messages.
- Low-tech AAC utilizes simple resources such as books and whiteboards with large lexicons of words and images to support communication. For example, Pictogram Ideogram Communication (PIC), Rebus Signs, Picture Communication Symbols (PCS) and Picture Exchange Communication System (PECS) are some examples of low-tech ACC. In preschools and schools, PECS is very popular. PECS is a functional communication system that is used as a communication tool for students with speech and language difficulties. PECS teaches students to select cards with line drawings, symbols, or photos of desired items or activities and then give them to another person (e.g., communicative partner, peer, teacher, or parent) to receive the object or task.
- High-tech AAC involves the use of electronic devices (e.g., iPads, laptops, computer applications and mobile phones) and speech generating devices (e.g., Proloquo2go) to achieve an AAC goal. Similarly, students with a range of difficulties (e.g., people with visual impairment) and neurological conditions may benefit from software programmes such as text- to- speech output options.
Conclusion
This article explored the meaning of autism, characteristics of students with ASD, and the diagnosis process for ASD. It presented supporting and teaching strategies. managing challenging behaviour and communication strategies for students with ASD.
