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11 Instructional Strategies This chapter provides a brief introduction to instructional strategies for young children with autistic spectrum disorders. In Chapter 12 we discuss ten representative comprehensive programs. Many instructional strategies summarized in Chapter 11 are used by most of those programs. TYPES OF INSTRUCTIONAL STRATEGIES Behavioral Strategies Teaching New Behaviors The continuum of behavioral teaching approaches has been carefully described (Anderson and Romanczyk, 1999; Prizant and Wetherby, 1998; Schreibman, 2000). Behavioral strategies take various approaches to the concepts of discrete trials, massed trials, naturalistic behavior, and peer mediation. A discrete trial is defined as a set of acts that includes a stimulus or antecedent, a behavior, and a consequence. Differences in the delivery of a discrete trial (e.g., selecting different settings for the trials) mark differ- ent uses and styles of behavioral teaching. Massed trials (see, e.g., Lovaas et al., 1981) are adult-directed (adult leads, child responds) teaching episodes in which a child responds to a teacher or to environmental instructions (antecedents). Consequences, or reinforcers, are not necessarily related to the childâs activity or action. Each skill being taught is initially repeated several times in succession. 133
134 EDUCATING CHILDREN WITH AUTISM Naturalistic behavioral strategies are forms of discrete-trial teaching in which the childâs own motives or behavior initiate the instruction and lead to a reinforcing event (ânatural reinforcerâ). These approaches are more child-centered than massed trial teaching, in that childrenâs motiva- tions, interests, favored activities, and choices figure strongly in the teach- ing. Two examples of naturalistic strategies are pivotal response training and incidental teaching. Incidental teaching consists of a chain of prespecified child-tutor in- teractions. The interactions involve materials that are highly preferred by the child, prompting and shaping techniques embedded in natural con- texts, and child-initiated (ânaturalâ) interactions. Incidental teaching has been demonstrated, with replication, to be an effective technique for in- creasing language learning in both typical children (Hart and Risley, 1975) and in children with autism (McGee et al., 1983, 1999). In pivotal response training (Koegel et al., 1999), certain behaviors are seen as central to wide areas of functioning. Changing these pivotal behaviors is thought to change other associated behaviors without spe- cifically targeting the associated behaviors. Pivotal response techniques include child choice, reinforcement, and correcting behaviors. Peer-mediated strategies (e.g., Strain and Kohler, 1998) also demon- strate a naturalistic application of behavioral teaching. The typical peers of a child with an autistic spectrum disorder are instructed in a more adult-centered, mass-trial approach, while children with autistic spec- trum disorders are taught by their peers in a more child-centered, natural- istic type of approach. Decreasing or Altering Existing Behaviors These strategies may include aversive approaches, functional analy- sis, differential reinforcement of other behaviors, extinction, antecedent manipulation, and combinations of these strategies (Dunlap et al., 1994. Aversive approaches involve administration of an aversive stimulus, or punisher, which, according to behavioral terminology, is an event to which a person responds by escaping or avoiding the stimulus. When an aversive stimulus is used as a consequence in the antecedent-behavior- consequence chain, the frequency of the behavior decreases over time. Mildly aversive approaches are commonly used with all children (e.g., saying ânoâ), but most strategies aimed at decreasing the frequency of unwanted behaviors currently emphasize the use of positive reinforce- ment strategies, which reward a child for performing more appropriate behaviors in place of the unwanted behaviors. In order to plan an effec- tive intervention, one needs to know what current reinforcing conse- quences (both positive and negative reinforcers) are maintaining the un- wanted behavior. This requires a functional analysis of behavior.
INSTRUCTIONAL STRATEGIES 135 A functional analysis of a behavior is an assessment procedure that yields an understanding of how the unwanted behavior functions for a childâwhat needs the child is addressing through the use of the behavior (what reinforcements are maintaining it). This evaluation involves inter- views and observations to develop a hypothesis about the functions of the behavior and then controlled manipulations to test the hypotheses. De- tailed procedures for performing a functional assessment of behavior are available to practitioners (OâNeill et al., 1990). The approach generally referred to as differential reinforcement of other behaviors, or differential reinforcement of incompatible behaviors, involves replacing the unwanted behavior with a more desirable behav- ior, built on the same reinforcing consequence that is currently support- ing the unwanted behavior. This approach requires that the replacement behavior is just as powerful (quick, easy, efficient, and successful at gain- ing the reinforcement) as the unwanted behavior. For young children, the replacement behavior is very often a conventional social-communicative behavior (âfunctional communicationâ). Extinction involves the removal of the consequence from an anteced- ent-behavior-consequence chain. It is often used in combination with a differential reinforcement approaches, so that the unwanted behavior is no longer followed by the reinforcing consequence (extinction), while the new, adaptive behavior, is followed by the reinforcing consequence. This results in an increase in the frequency of the adaptive behavior. In antecedent manipulation approaches, instead of manipulating the behavior-consequence part of the chain, the focus is on the antecedent- behavior links. In some functional analyses, a very specific antecedent can be identified, and this antecedent can be manipulated in such a way that the behavior is not performed (and therefore not reinforced). For example, if an analysis reveals that a child hits in response to an adult saying âDonât ___â, the adult may change the antecedent instruction to âWould you please___â. Use of prompts is a common way of performing antecedent manipulations. Behavioral instruction of young children with autistic spectrum dis- orders often involves use of multiple interventions in an environment. One example might be the use of clearly marked visual cues (antecedent interventions) along with communication training to make requests and refusals (intervention by differential reinforcement of incompatible be- haviors) (Watson et al., 1989). Developmental Strategies for Building New Skills In a developmental approach, the skills of a child with an autistic spectrum disorder are compared with the skills of a developmental se- quence seen in typical children. Patterns of typical development for each
136 EDUCATING CHILDREN WITH AUTISM skill area are established by the many early childhood assessment tools. The skills that a child demonstrates (âpassesâ on the assessment tools) indicate the childâs current developmental level. As part of goal develop- ment for a child, failed or partially accomplished items then become the targets of teaching. A developmental approach to teaching generally refers to a child- centered approach (child leads, adult follows) that uses materials and tasks that fit a childâs developmental level in a particular area. Materials are provided to the child, and the childâs behavior with the materials is scaffolded by the teacher along the lines of the targeted developmental skill. Childrenâs behaviors and initiative with materials guide the adult, who may use modeling or demonstration, prompting, or hand-over-hand instruction. Childrenâs preferences guide the selection of materials; adults provide support and encourage, but do not require, that materials are used and activities are carried out in the desired way. Rather than adult- supplied consequences for certain behaviors, internal, naturally occurring reinforcers are assumed to provide the motivation for learning. An ex- ample of an internal reinforcer is a sense of mastery and efficacy in func- tioning (e.g., pleasure in completing a puzzle). Augmentative and Alternative Strategies Augmentative and alternative strategies use assistive devices that provide a symbolic communication system other than speech (as de- scribed in Chapter 5). Examples are the use of visual systems like the Picture Exchange System, visual schedules, computerized communica- tion systems, and manual language in place of verbal language. Although there are sometimes concerns voiced by parents and teachers that using an augmentative or alternative strategy may prevent a child with an au- tistic spectrum disorder from developing more conventional skills in that area (e.g. using manual signs might slow the acquisition of speech), there is no empirical evidence that demonstrates a negative result from using alternative strategies. Rather, there is some evidence that alternative strat- egies may assist development in some areas (Bondy and Frost, 1994). Current practices in education of young children with autistic spec- trum disorders generally support the tailored use of alternative and aug- mentative communication strategies, where appropriate, to facilitate par- ticipation in the educational environment by some children with autistic spectrum disorders. While some educational approaches gain maximal participation with carefully structured teaching and without much use of alternative or augmentative systems (e.g., the Walden preschool pro- gram), other approaches emphasize the use of strategies such as sched- ules or picture systems, along with many other methods to assist children with autism (e.g., the TEACCH program [Treatment and Education of
INSTRUCTIONAL STRATEGIES 137 Autistic and Related Communication Handicapped Children]). In part, these results may be affected by how children are selected for the pro- grams. There is no available empirical evidence that compares the gains made with and without such systems, but the best-documented ap- proaches are uniform in their emphasis on maximizing child participa- tion in educational experiences. INDIVIDUAL VERSUS GROUP INSTRUCTION Because young children with autistic spectrum disorders lack social and communicative skills necessary for attending to an adult and learn- ing from distal instruction, it is generally assumed that initial skill devel- opment will be accomplished from individual instruction. Providing chil- dren with autistic spectrum disorders the language, social, and attentional behaviors needed to learn from an adult in a group situation is, in fact, a goal of early intervention for young children with autistic spectrum disor- ders. Delivery of individual instruction episodes can take place in a variety of settings, including situations in which only a child and teacher are present (model of initial instruction at the University of California at Los Angeles program) and situations in which a child is in a typical group setting with a fairly large number of peers, but adults or peers join the child to deliver a discrete trial within the group situation. The various empirically supported models vary widely in the amount of time children are alone in a space with a teacher, compared with the amount of time they are in a group of peers, but these programs are quite similar in the use of individual teaching episodes to establish basic language, social, and cognitive skills. Appropriate responding in a group situation is a specific part of the curriculum in empirically supported models. Carefully planned and implemented instruction is used to teach children to participate indepen- dently in typical classroom routines like hanging up a coat, sitting in a circle with a small group, moving from one center to another, getting materials, using them appropriately, putting them away, and lining up for outdoor time. Instruction in these group routines is usually delivered like other areas of instruction for children with autistic spectrum disor- ders: the initial teaching is provided with maximal individual instruction and support, and then adult instruction and prompting are gradually faded as the child learns to carry out the routine independently. Task analysis is often used to identify the specific skills involved in classroom routines and to develop teaching strategies. Visual strategies, like the use of picture schedules and picture com- munication systems, visually structured independent work schedules, visual organization and cueing of the environment (names on chairs, coat
138 EDUCATING CHILDREN WITH AUTISM hooks, and cubbies), are also used by many programs of both behavioral and developmental orientation to support children with autistic spectrum disorders in group situations. Group instruction provides an important environment for maintenance, generalization, and normalization of skills that may have first been taught individually. THE USE OF PEERS AS INSTRUCTORS Studies have demonstrated that interactions established between chil- dren with autism and adults do not easily generalize to peer partners. However, typical peers have been shown to be effective intervention agents for young children with autism. In these approaches, the peers are taught particular strategies for eliciting social, play, and communicative responses from a young child with autism. Most of these procedures have also been demonstrated to be effective when used in an inclusive setting, in which most of the children present are typically developing (Goldstein et al., 1992; Strain et al., 1977, 1979; Oke and Schreibman, 1990; McGee et al., 1992; Odom and Strain, 1986). However, it is important to note that, though these approaches are intended to be used in inclusive settings, they require planning and implementation by well-trained staff, as they would in any setting. Variables found to be important in maintenance and generalization include characteristics of the peers, methods of prompting and reinforc- ing peers, fading reinforcers, ages of children, and characteristics of the setting, as well as the use of multiple peer trainers (Brady et al., 1987; Sainato et al., 1992). Self-monitoring systems for the peers have also been used successfully (Strain et al., 1994). These interventions have been found to be most powerful when delivered in inclusive preschools, but they have also been used successfully by parents and siblings in homes (Strain and Danko, 1995; Strain et al., 1994; parent training is discussed in detail in Chapter 3). These highly effective peer-mediation approaches are com- plex to deliver, requiring socially skilled typical peers and precise adult control in training peers, managing and fading reinforcement, and moni- toring ongoing child interaction data. However, the approach is manualized and well described in many publications (Danko et al., 1998). THE ROLES OF SELECTED DISCIPLINES Provision of evaluation and treatment by occupational, physical, and speech and language therapists is mandated by the Individuals with Dis- abilities Education Act when speech and language and motor deficits are impeding a childâs educational progress. The knowledge held by speech and language therapists and motor therapists is crucial for evaluating the needs of young children with autistic spectrum disorders and developing
INSTRUCTIONAL STRATEGIES 139 goals and objectives, as well as assessing progress. These therapists can have an important role in identifying appropriate goals and teaching tech- niques in their area of expertise. They can teach classroom staff and parents to use those techniques and to identify learning opportunities for the child in the classroom, community, and home. Speech/language and motor therapists are also carefully trained in specific treatment techniques in their individual areas. The current role of psychologists and behavior specialists as interven- tionists in the education of young children with autistic spectrum disor- ders most often involves assessment, consultation, and development of intervention strategies. Psychologists and behavior specialists are often involved in providing functional analyses of problem behaviors; design- ing behavioral interventions; providing cognitive, adaptive, and social assessments; guiding the educational curriculum in these areas; and con- sulting with the rest of the educational team about educational strategies and interventions. Psychologists, social workers, and speech language therapists are sometimes involved in carrying out social skills groups, generally for older school age children. Psychologists and behavior spe- cialists are often involved in parent training and support as well. Whatever the discipline involved, justification for individual therapy as part of an educational program should be based on the use of particu- lar intervention strategies in which the therapist is skilled. The research literature suggests that the greatest effects of any direct treatment for young children with autistic spectrum disorders lie in the generalization of learning achieved through working with classroom personnel and par- ents. There is little reason to believe that individual therapies carried out infrequently (e.g., once or twice a week) have a unique long-term value for young children, unless the techniques are taught to and used regularly by the child and the people who are with him or her in natural contexts. The value of one-on-one therapy lies in generalization, which must be planned and directly addressed. On the other hand, the assumption in all of the model programs is that skill development begins in individual instruction that may occur in the classroom or in individual treatment. Adequate amounts of individual instruction, whether by a teacher or parent or therapist, are crucial to early learning.