Autism: Reaching for a Brighter Future. Service Guidelines for Individuals With Autism Spectrum Disorder through the Lifespan
Ohio Developmental Disabilities Council, Ohio Center for Autism and Low Incidence, et al. (2011).
Columbus (OH): Ohio Developmental Disabilities Council, 2-143.
This guideline provides recommendations for families and professionals in assessing, treating, and developing educational and community transition programs for people on the autism spectrum from birth to 21. The target audience of this guideline includes families, educators, medical professionals, and other service providers.
Ohio Center for Autism and Low Incidence; Autism Society of Ohio
When evaluating students' eligibility for special education services under the Individuals with Disabilities Education Improvement Act (IDEIA), federal and state guidelines require assessment of hearing (p. 31).
<div>Individuals with feeding issues (e.g., pica, coprophagia or obsessive-compulsive symptoms manifesting as food rituals) should be referred for evaluation. Parents should consult with a professional experienced in working with children on the autism spectrum that have feeding issues.</div>
"Teams should identify how technology may assist the individual not only to effectively communicate but also to progress in the general education curriculum, to access curricular and extracurricular activities, and to make progress on individual [individualized education program] IEP goals and objectives" (p. 52).
"To diagnose [autism spectrum disorder] ASD, a comprehensive multidisciplinary evaluation by professionals experienced with ASD should be done" (p. 15). "Regardless of the tools used, person(s) conducting the assessments/evaluations must have a firm understanding of ASD in order for the results to be valid" (p. 31).
"Regardless of the environment used or the strategies selected, instruction in socialization and social understanding must be provided in a well-planned systematic manner" (p. 57).
<p>The "assessment of social competence should include:</p>
<ul>
<li>the age of the student;</li>
<li>sensory motor processing challenges;</li>
<li>imitation skills;</li>
<li>receptive and expressive language skills;</li>
<li>cognitive abilities;</li>
<li>the student's interests and skills; [and]</li>
<li>the environment where socialization occurs" (p. 56).</li>
</ul>
"Screening of all toddlers for a possible diagnosis of [autism spectrum disorder] ASD at 18 and 24 months of age is currently recommended by the American Academy of Pediatrics.... If the screening reveals developmental concerns, the child should be referred for an in-depth developmental assessment" (p. 14).
<p>Social goals should be developed in consideration of:</p>
<ul>
<li>imitation and joint attention;</li>
<li>personal space needs;</li>
<li>environmental barriers;</li>
<li>others' emotions;</li>
<li>requests for assistance;</li>
<li>sarcasm, slang, joking, teasing;</li>
<li>social interactions;</li>
<li>turn-taking;</li>
<li>body language;</li>
<li>behavior with individuals of the opposite sex;</li>
<li>and workplace behavior (pp. 56-57).</li>
</ul>
"'Children [on the autism spectrum] should receive specialized instruction in settings in which ongoing interactions occur with typically developing children. Individual skills should be targeted to provide optimum benefit from interactions with typically developing children and to provide the foundation for success in natural or inclusive settings" (p. 103).
"Consider supporting receptive communication as well as expressive communication through both nonverbal and verbal methods: visual supports (object boards, pictures, gestures, sign language) and voice output communication devices" (p. 50).
"Social skills may not generalize without specific training; therefore, it is important that social competence be reinforced in all environments (including the workplace), especially for students who are in transition. Specific strategies and supports for social development and related skills must be provided to students" on the autism spectrum (p. 56).
For children under three on the autism spectrum, the focus of intervention should include attending to and engaging with people in the environment, developing both verbal and motor imitation skills, initiating and sustaining interactions, using verbal and nonverbal communication, and playing appropriately (including symbolic play) with toys (p. 27).
To increase the individual's ability to benefit from the educational experience, intervention programs should target attention, imitation, communication, socialization, cognition, purposeful play/recreation, and essential life skills (p. 41).
"It is important to understand the individual's unique communication style/skills, which lead to the development of a successful means for communication. Supporting all forms of communication – verbal, signing/gestural, pictorial, augmentative (and often a combination of more than one) promote learning" (p. 49).
"Transition assessment information should note social and communication concerns and the types of supports and interventions that may be effective. Interventions and supports should be included in plans for the future (including behavior support plans)" (p. 79).
"When considering the assistive technology needs of a student, the [individualized education program] IEP team should consider a continuum of assistive technology solutions, ranging from low tech to high tech.... Teams should also address the types of assistive technology services that are required, ... [which] include, but are not limited to, evaluation, device acquisition, device maintenance and repair, training for the student and his/her family and educators as needed, and technical assistance" (p. 53).
<p>Target treatment areas for socialization include:</p>
<ul>
<li>"intentional and systematic introduction to social situations with the ability to initiate and respond;</li>
<li>turn-taking – includes verbal, nonverbal, and activity related action;</li>
<li>adult-child, child-child, and adult-adult interactions;</li>
<li>sharing;</li>
<li>ability to give help and accept help;</li>
<li>choice-making; [and]</li>
<li>understanding other person’s emotions and perspectives" (pp. 32-33).</li>
</ul>
<p>Strategies to promote the development of an effective communication system include:</p>
<ul>
<li>promoting meaningful imitation;</li>
<li>establishing focus on the speaker and joint attention;</li>
<li>teaching turn-taking;</li>
<li>determining communicative intent of verbal and nonverbal messages;</li>
<li>identifying and promoting communication opportunities in daily activities;</li>
<li>recognizing and responding to communicative attempts including the use of descriptive feedback;</li>
<li>arranging the environment to promote communication; and</li>
<li>providing adequate time for the student to initiate communication or respond (p. 50).</li>
</ul>
Target treatment areas for communication skills include the use and comprehension of nonverbal communication (e.g., gestures, gaze and facial postures), primary vocabulary and simple sentence structures, grammatical-parts of speech, and combined/multiple communicative means. Other areas of focus include the use of spontaneous language and language use for a variety of reasons (i.e., request, protest, comment, repair) (p. 32).
"Evaluation should also be provided by a speech-language pathologist with expertise in assessing children with [on the autism spectrum] .... This should be done even in a child with ... [typically developing] speech, in part to examine social and pragmatic skills" (p. 15).
<p>A number of strategies to teach socialization and social understanding are available and include:</p>
<ul>
<li>"rehearsal – scripting, modeling, and practice;</li>
<li>role play;</li>
<li>social curriculum;</li>
<li>social skills manuals;</li>
<li>visual supports;</li>
<li>peer models; [and]</li>
<li>structured peer supports" (p. 57).</li>
</ul>
"Assessments … must take into consideration the unique learning style and preference of the person [on the autism spectrum] …. Results of assessments/evaluations in the above areas may be obtained from standardized, norm-referenced tests, criterion-referenced assessments, curriculum-based assessments, and structured interviews. Norm-referenced tests may have limited usefulness in designing interventions to address individual academic achievement and functional performance, however" (p. 31).
"Social skill training and instruction may be necessary for a student [on the autism spectrum] ... and should occur in environments that closely resemble the future situations in which these skills will need to be used" (p. 79).
<p>When supporting the individual on the autism spectrum in integrated activities designed to foster successful social-communicative interactions, consider the following guidelines:</p>
<ul>
<li>Assess comfort level with integration (p. 58).</li>
<li>Integration should progress in a meaningful manner "(e.g., individual to segregated classroom to small group to large group instruction)" (p. 58).</li>
<li>"Remember to consider the level of demand that integration with typical peers may place on the individual when planning for additional teaching/learning demands. Learning to tolerate the proximity and actions of others may take a great deal of learning capacity and reduce the individual's ability to focus on other tasks until he/she is comfortable" (p. 58).</li>
<li>"Continue to emphasize the acquisition of skills that will allow the individual to benefit from integration experiences" (p. 58).</li>
<li>Help peers to recognize, respond, and maintain social-communicative interactions (both verbal and nonverbal) with individuals on the autism spectrum (p. 58).</li>
<li>Include social learning opportunities (e.g., such as dealing with rejection, responding to bullying) and environmental supports (e.g., cue cards) (p. 58).</li>
</ul>
