The Autism Society Event and Education Recordings Archive

Introduction Autism specific curriculum versus integrated programs has been an ongoing debate since special instruction for children with autism was identified. This program is designed for children with a diagnosis of ASD; that is, there are no children with other disabilities or typically developing children involved. There are a couple of reasons for employing an autism-only program. One, this program focuses on daily living skills, beginning play skills and functional communication systems. These skills are daily living skills in that they need to be present before a child can interact with peers, typically developing or otherwise. Generally the students who complete this program have come from integrated programs and have been noted as not doing well. The second reason is that because the children are elicited through entrance criteria that specifies limited functional communication skills, limited functional toy play, limited joint attention, etc., having all of the children engaged in the same activity at the same time encourages parallel play skills, structured group games and structured communication activities that all of the children participate in at the same level. This program, however, does not advocate for children to be in autism-only or autism-specific settings for the whole academic year, but rather, to teach basic living skills during a six week summer program to help promote success in a less restrictive environment in the fall. Introduction Generally the students who complete this program have come from integrated programs and have been noted as not doing well. The second reason is that because the children are elicited through entrance criteria that specifies limited functional communication skills, limited functional toy play, limited joint attention, etc., having all of the children engaged in the same activity at the same time encourages parallel play skills, structured group games and structured communication activities that all of the children participate in at the same level. This program, however, does not advocate for children to be in autism-only or autism-specific settings for the whole academic year, but rather, to teach basic living skills during a six week summer program to help promote success in a less restrictive environment in the fall. Teaching and Administrative Staff The program requires a certified special education, early childhood teacher, occupational therapist, speech therapist and three instructional aides to ten children. A ratio of 2:1 children to adults is the least offered; often a much higher rate of adult to child ratio is achieved. The last two years of this program we have accepted one volunteer to help with program set-up, facilitation of activities and record keeping to help alleviate staff attrition. Program Description Curriculum This curriculum is based on functional daily living skills at the preschool level. An important feature is that it utilizes four types of learning that build upon each other to ensure success. Each theme is specifically taught using video instruction or video self modeling, structured pretend play schemas, behavioral practice in a controlled or familiar environment and then generalizing the skill to community settings. For example, for the theme of “Grooming and Hygiene,” the children were shown a two to three minute video of a child with autism having his hair washed by his father. Next, the structured pretend play included a three step schemata of bathing a baby, drying it off and putting it to bed. The third step, structured practice, had the children getting their hair washed and blown dry daily in the familiar school setting. The fourth step was to take the children to a local hair salon and have their hair washed and blown dry by a professional stylist. Themes were selected based on parent reports that reflected on what parents' goals were for their children during daily routines and activities. Themes were also based on teachers' and therapists' feedback concerning area of need in order to be able to participate in classroom activities. Parents most frequently had concerns regarding their child being able to have his hair washed, nails clipped, toileting, being out in the community without tantrumming and responses to change in daily routines. Secondary concerns involved being able form friendships, play with toys in a typical manner and expanding limited interests. Teachers and therapists most commonly had concerns regarding sensory input regulation issues, ability to participate in circle time activities and understanding classroom routines. Secondary concerns for this group were peer play skills and decreasing aggressive or isolating behaviors. For both parents and caregivers, the prevalent underlying concern was the child's lack of a functional communication system. Most often, the children that benefit most from this intensive therapy program are children who are functionally non-verbal and are using behaviors, typical and atypical, to meet their needs and wants. To address these concerns directly, themes chosen regularly each year are Animals (taps into a high interest area for 70% of the children) for two weeks; Grooming and Hygiene (to address daily self-help skills) for three weeks; and McDonald's (to address playing appropriately in a community setting) for one week. Visual Supports This curriculum relies heavily on the prevalence of non-verbal children using their vision and vision comprehension as their primary source of information. To address central processing disorders and to provide the positive behavioral support needed for success, all auditory input in all but eliminated. That is, there is no adult talk unless an adult is giving a direction or giving feedback to an activity. It is a very silent environment that we have found really helps the children focus on what they are expected to do and be successful at it. We have also found that by eliminating any adult talk in the room when a child does begin to talk, it is heard clearly. This strategy is then paired with visual supports in a variety of ways. The auditory stimulus is then added back in when the skill is introduced in community settings. Visual supports, in this curriculum, include environmental, visual matching schedules, choice boards, storyboards, social stories, first/then strips as well as a visual functional communication system such as P.E.C.S. (Picture Exchange Communication System, Bondy and Frost). The goal of these systems is to teach a child a specific skill. For example, learning to “read” a visual schedule is a skill taught with an eye to future implementation in his developmental preschool classroom. Having a functional communication system that others easily understand such as P.E.C.S., is a primary focus that is continuously carried out in various environments, with various people, across various activities. Most importantly, the visual communication supports are used in a variety of activities to help the child better understand his environment and to elicit an increase in participation in offered activities. Play Skills Play skills are addressed through water play, structured activities and group games. The activities are structured to teach turn-taking, waiting and peer interaction. The children are never allowed to be isolated from the group and are paired on all activities. For example, a child riding a trike will have another child riding on the back step; a child sliding down a slide will have a “train” of at least one other child to go down with. Group games are used as transition signals as well as age-appropriate game skills. For example, at the end of outside play, ring-around-the-rosy is taught as a game in which children learn to hold hands, come when called, listen to the song and fall down at the end of the song. Later, this becomes their transition to putting on their back packs and getting on the “rope.” This builds independence, in our view, as children with autism learn these new routines as a sequenced “chunk” of information and learn to perform the whole chunk as one activity. Other examples of activities that are age-appropriate and very popular, once learned are musical chairs and “Don't Break the Ice!” (Hasbro). Pretend play skills continue to be a huge struggle for children with autism. Pretend play schemas are introduced based on the theme and generally mimic real life experiences. For example, washing the baby doll's hair or using Play-doh McDonald's and giving a “chicken nugget” to a friend. Community Outings We strongly believe in directly teaching each new skill in the community. Although some generalization happens more spontaneously, this program focuses on teaching specific daily living skills in highly-supported environments and then directly teaching the children to generalize that skill to a new environment. The new environments are naturally occurring with new people, less structure and certainly more uncertainty about ongoing events. Here, we are teaching not only the new skill in a different environment, we are teaching the coping mechanisms and strategies in a new environment. For example, if a child has learned to get his hair washed and blown-dry at the more structured school environment by counting to ten or saying the alphabet and then having the activity stop, and successfully had that prompt faded to independence (when your hair is completely dry, you're finished) he may use these same coping skills to participate in the new environment and they are honored. Parental and Family Involvement A large part of the success of this program depends on the families of our children. We have incorporated three meetings in the six-week time period. The first meeting is a parent orientation meeting. This meeting focuses on helping parents and caregivers meet other parents with children of similar abilities, understand the curriculum and its philosophy and goals and to help parents identify their own goals and outcomes for their child. We begin to build a supportive community of parents because their children will be going through the public school system together. A parent of a child who has gone through the program is present to answer any parent questions they may have and to present their experience as a parent. The second meeting generally involves a parent educational component. The last two years have been successful in obtaining the Southwest Autism Network parent advocate to come and talk about advocacy issues. We have also done “make and take” meetings instead of a speaker or had someone from Parents Reaching Out explain their purpose and organization. The secondary important part of this meeting is to watch videos of the childrens' progress. Each child has been video taped at least once a day in an activity (circle time, pretend play, motor time, etc.). These video clips are then formatted into a “movie” with the focus being on watching similar activities up until the third week. This gives parents one, a chance to see what the program looks like and two, a jumping off point to having some of the strategies used at home. The third meeting is generally a wrap-up time to discuss progress, future placement changes, etc. Parents are contacted at least two of the four days of the week via written communication notebooks that travel with the child from school to home and back. Parents are encouraged to call or email at anytime for help, problem-solving, bringing new strategies into the home or to watch video progress of their child with a staff member. Parent satisfaction surveys have provided a 95% satisfaction (average) on a likert-type scale of strongly agree, Agree, Disagree and Strongly Disagree. These were aswered on four components: overall parent perception of the quality of the program; parents' specific questions being answered promptly and professionally; was the curriculum and strategies used explained in a way the parent could understand; and parents' perception of increase in communication skills. Areas were allowed for the parent to respond to three things that went well for them and anything they would like to change about the program. Future Research Implications Future research is indicated in the area of efficacy and possible long term outcomes.

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