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Educating Children with Autism
treatment is carried out in a different context from that in which the targeted behaviors are expected to appear.
However, there are somewhat different examples in other areas of education and medicine in which interventions have broad effects on behavior. One example is the effect of vigorous exercise on general behavior in autism (Kern et al., 1984). In addition, both desensitization (Cook et al., 1993) and targeted exercise in sports medicine and physical therapy often involve working from interventions carried out in one context to generalization to more natural circumstances. Yet, in both of these cases, the shift from therapeutic to real-life contexts is planned explicitly to occur within a relatively brief period of time. At this time, there is no scientific evidence of this kind of link between specifically-targeted therapies and general improvements in autism outside the targeted areas. Until information about such links becomes available, this lack of findings is relevant to goals, because it suggests that educational objectives should be tied to specific, real-life contexts and behaviors with immediate meaning to the child.
Because the range of outcomes for children with autistic spectrum disorders is so broad, the possibility of relatively normal functioning in later childhood and adulthood offers hope to many parents of young children. Although recent literature has conveyed more modest claims, the possibility of permanent “recovery” from autism, in the sense of eventual attainment of language, social and cognitive skills at, or close to, age level, has been raised in association with a number of educational and treatment programs (see Prizant and Rubin, 1999). Natural history studies have revealed that there are a small number of children who have symptoms of autism in early preschool years who do not have these symptoms in any obvious form in later years (Szatmari et al., 1989). Whether these improvements reflect developmental trajectories of very mildly affected children or changes in these trajectories (or more rapid movement along a trajectory) in response to treatment (Lovaas, 1987) is not known.
However, as with other developmental disabilities, the core deficits in autism have generally been found to persist in some degree in most persons with autistic spectrum diagnoses. There is no research base explaining how “recovery” might come about or which behaviors might mediate general change in diagnosis or cognitive level. Although there is evidence that interventions lead to improvements and that some children shift specific diagnoses within the spectrum and change in severity of cognitive delay in the preschool years, there is not a simple, direct relationship between any particular current intervention and “recovery” from autism. Because there is always room for hope, recovery will often be a goal for many children, but in terms of planning services and programs,