Mainstreaming Children With Autism
By Barbara J. Lecomte, PhD
Autism is a complex educational, communicative and social condition that affects one in four or five children out of 1,000 (Rutter, 1978). Although most children diagnosed with infantile autism initially appear to be developing typically, clinical observations reveal conditions of perseveration, “stereotyped play patterns, abnormal preoccupation, or resistance to change” by the age of 2 1/2 (Swisher, 1994, p. 256).
A small number of children with autism may function in the near-normal range, but most are in the severe to profoundly retarded range. An inability to relate socially and a lack of compliance often contribute to the ineffectiveness of traditional testing methods and lower reported test scores.
For these reasons mainstreaming the autistic child often is not possible without collaboration between the family and the educational staff.
The child’s ability to understand and respond appropriately to the communication demands of everyday life experiences are related to cognitive, linguistic and social-emotional adjustment patterns. While children with autism appear to have educationally depressed intellectual skills, they often have well-developed fine motor skills.
Because of good articulation skills, these children have an echoic verbiage of songs and commercials. The fact that they may repeat an utterance heard in other contexts, such as a teacher saying, “Sit in your seats, class,” reveals an auditory system that appears to be intact.
Although some higher-functioning children may read at or near age or grade level, they often do not comprehend what they read and exhibit prosody and rate disorders. Failure to use appropriate intonation, rate and accent may limit their social success with peers.
Children with autism have an inability to understand figurative language; and higher-level semantic relationships, metaphors and similes compound their verbal confusion in the mainstreamed classroom. Teachers and parents need to be aware and assist them in understanding figurative language and idioms.
The language of basal readers, whole language projects, science experiments and word problems may present challenges to children with autism; and linguistic and grammatical complexity may preclude them from understanding the underlying concepts of science and social studies lessons. Pronoun referents can cause comprehension difficulty at times.
Abstract language becomes difficult for more verbal children, ages 7-10. As their peers understand and readily use jokes, riddles, analogies and discourse, children with autism may become frustrated, confused and angered by their inability to cope with the linguistic demands of their age group.
Because these children have limited expressive skills, behavioral outbursts and physical attacks may occur within a 30-second time span. A child may be copying spelling words, drawing a picture, or writing numbers from rote one minute and throwing objects, biting and swearing the next. Something as simple as the speech-language pathologist using script rather than a manuscript “W” may cause the child to react unfavorably.
Clinicians, teachers and parents should help children with autism express their needs through spoken, gestural or nonverbal communication (Wetherby, 1986). Picture faces can be used by nonverbal children to depict emotions, and more verbal children can compose a sentence to match their mood.
Rephrase directives like “Don’t swear” or “Don’t scream” to requests for a positive change in behavior, such as “Speak quietly” or “Please use a friendly voice.” These requests remind and cue children regarding desirable and expected behaviors. Pairing picture cues with written sentences helps to concretize their experiences.
Similarly, using picture cards and printed sentences for feelings of happiness demonstrates for the nonverbal child that pleasant feelings are relevant to share with others, just as feelings of anger and sadness are.
A 10-year-old repeats the question, “What are you going to do tonight?”; and an 8-year-old echoes and gets stuck on the phrase “not with the cat” from the Dr. Seuss book Green Eggs and Ham. Both of these utterances seem innocent enough, but researchers count them as examples of communicative functions associated with immediate echolalia.
The question functions as interactive turn-taking, while the repeated phrase is non-interactive and has no apparent intent, often occurring in a state of high arousal such as fear or frustration. Whatever its purpose, echolalia is used frequently by verbal autistic children.
Some outbursts may act as stress relievers that help children achieve a calmer neurological state. Clinicians may need to shape these behaviors to be more socially appropriate rather than attempt to extinguish them completely.
To assume that a higher functioning youngster cannot be enrolled in first grade and progress through the third grade may be imposing limits that are unnecessarily stringent for some children.
A classroom teacher and aide, basic skills personnel, speech-language pathologist and social worker can collaborate as a support team and maintain regular contact with the family and behavioral therapist to help some children with autism succeed in learning to read at the first-grade level, do math word problems at the second-grade level, and write a two-paragraph story with assistance based on personal interests.
Learning how to play board games with a classmate and enjoy lunch with classmates have been realized by one little boy whose earliest educational experience was a self-contained special school for autistic children.
Although a mainstreamed educational program may not be appropriate for all children with autism, attending school can be a special experience if it is done with peers in a mainstreamed classroom. This can become a reality for more children if they are given the opportunity.
Clinicians and teachers should be firm and consistent about their expectations and use immediate positive reinforcement. They should provide suitable outlets for frustration and the inability to communicate verbally and pair picture cues with socially appropriate verbal responses.
All of the child’s communication partners should become familiar with suitable communication skills. Relevant word meanings should be given when multiple meanings are possible, and figurative language must be explained.
The support team should ameliorate an anxiety-causing situation or restructure the setting to fit the child’s stress level and provide down time as an outlet for frustration. Some “self-stimming” may reduce tension and anxiety in certain settings.
The source of unfamiliar noises should be shown or explained, as children with autism may be more fearful of sounds due to a lack of understanding symbolic use and may perceive sounds at a louder level than others.
When behavioral problems occur, an observational approach is recommended. What happened? How did the child react? Was deviate behavior inadvertently reinforced instead of desirable behavior? What was the child trying to communicate?
Implement peer-teaching whenever possible. Learning and practicing with peers encourages social interactions.
In addition, correct word usage should be modeled in social settings, so children can practice more socially appropriate verbal utterances.
Above all, be patient and remember that treatment is highly individual–what works for one child may not work for another.
References
Gelman, J. (1996). “Managing behavior in autism,” ADVANCE for Speech-Language Pathologists & Audiologists. Vol. 6, No. 1.
Iskowitz, M. (1997). “Diagnosing autism and PDD in young children,” ADVANCE for Speech-Language Pathologists & Audiologists. Vol. 7, No. 1.
Kuder, S.J. (1997). Teaching Students with Language and Communication Disabilities. Boston: Allyn and Bacon.
Rutter, M. (1978). “Language disorders and infantile autism,” in Autism: A Reappraisal of Concepts and Treatment, M. Rutter & E. Schopler (Eds.). New York: Plenum Press.
Shoemaker, A. (1997). “Preparing children for life: Addressing speech and language issues in autism.” ADVANCE for Speech-Language Pathologists & Audiologists. Vol. 7, No. 1.
Swisher, L. (1994). “Language disorders in children,” in Introduction to Communication Sciences and Disorders, F. Minifie (Ed.). San Diego: Singular Publishing Group, Inc.
Wetherby, A. (1986). “Ontogeny of communicative functions in autism,” Journal of Autism and Developmental Disorders, 16, 295-316.
* About the author: Dr. Barbara Lecomte is associate professor of speech-language pathology at Kean College of New Jersey and has a private practice.
