Teaching Children with Autism: Strategies for Initiating Positive Interactions and Improving Learning Opportunities / Edition 1

by Robert L. Koegel, Lynn Kern Koegel

Overview

This practical sourcebook equips both parents and professionals with much-needed information regarding autism. Providing a comprehensive approach to behavioral intervention, this user-friendly guide begins with an overview of characteristics and long-term strategies and proceeds through discussions that detail specific techniques for normalizing environments, reducing disruptive behavior, improving language and social skills, and enhancing generalization. Teachers, professionals, and parents working with individuals with autism, as well as professors and students in education and psychology, will turn to this resource for information, guidance, and support.

Product Details

ISBN-13:	9781557661807
Publisher:	Brookes, Paul H. Publishing Company
Publication date:	01/01/1995
Edition description:	New Edition
Pages:	236
Product dimensions:	7.00(w) x 10.00(h) x 0.80(d)
Age Range:	18 Years

About the Author

Lynn Kern Koegel, Ph.D., CCC-SLP, is Clinic Director at the Autism Research Center of the Graduate School of Education at the University of California, Santa Barbara. She has been active in the development of programs to improve communication in children with autism, including the development of first words, development of grammatical structures, and pragmatics. Dr. Lynn Kern Koegel is co-author and co-editor of major textbooks on autism and positive behavioral support and is co-author of the bestselling book Overcoming Autism: Finding the Answers, Strategies, and Hope That Can Transform a Child's Life (Penguin, 2004). In addition to her published books and articles in the area of communication and language development, she has developed and published prodcedures and field manuals in the area of self-management and functional analysis that are used in school districts throughout the United States and have been translated in most major languages used throughout the world. Dr. Lynn Kern Koegel is actively involved in providing support and intervention services in school districts, both locally in California and throughout the United States. She has also been featured in news reports on television stations throughout the United States and acted as a consultant for the internationally broadcast ABC television series Supernanny.

William D. Frea, Ph.D., BCBA, Chief Clinical Officer, Autism Spectrum Therapies, 6001 Bristol Parkway, Suite 200, Culver City, California 90230. Dr. Frea is the co-founder of Autism Spectrum Therapies (http://www.autismtherapies .com), an agency providing comprehensive applied behavior analysis services to individuals with autism. He and his agency specialize in intensive behavioral interventions, positive behavior supports, and social skills across the life span. Autism Spectrum Therapies also works closely with school districts to develop state-of-the-art autism programs.

Robert L. Koegel, Ph.D., is Director of the Autism Research Center, Professor of Educational Psychology and Counseling/Clinical/School Psychology, and Professor of Special Education, Disability, and Risk Studies at the Graduate School of Education at the University of California, Santa Barbara. Dr. Robert L. Koegel is internationally known for his work in the area of autism, specializing in language intervention, family support, and school inclusion. He has published well over 150 articles and papers relating to the treatment of autism. He also has authored five books on the treatment of autism and on positive behavioral support. He has been the recipient of numerous multimillion-dollar research and training grants from the National Institutes of Health, the U.S. Department of Education, and the National Institute of Mental Health. Models of his procedures have been used in public schools and in parent education programs throughout California and the United States, as well as other countries.

Read an Excerpt

Excerpted from chapter 1 of Teaching Children with Autism: Strategies for Initiating Positive Interactions and Improving Learning Opportunities, edited by Robert L. Koegel, Ph.D., & Lynn Kern Koegel, Ph.D.

Copyright © 1995 by Paul H. Brookes Publishing Co. All rights reserved.

Describing the Characteristics of Autism

When the label of Autism was first coined by Leo Kanner in 1943, he was subclassifying a unique group of children who demonstrated relatively common characteristics and who differed from the previous broad classification termed childhood psychosis. In his description of 11 case histories, Kanner noted considerable differences in these children compared to the typical child labeled with childhood psychosis. These differences included 1) the degree of the child's disability, 2) the manifestation of specific features, 3) the family constellation, and 4) the step-by-step development in the course of years. Due to the realization of these differences, the number of individuals now diagnosed as having autism or "autistic-like" features has increased geometrically from those original 11 children to include up to as many as 3 or 4 out of every 2,000 children (G. Dunlap, Robbins, Dollman, & Plienis, 1988; Schreibman, 1988). Although these children share the same diagnosis, their behavioral symptoms vary greatly.

In fact, variability may best describe the characteristics of individuals with autism. Whereas all of the children seem to have some difficulties with social communication, the expression of these difficulties differs immensely in both type and severity. Recent interest in the issue of heterogeneity has recognized that children with autism most likely have distinctly different etiologies (Courchesne et al., in press; Damasio & Maurer, 1978; Gillberg & Gillberg, 1983; Ritvo, Ritvo, & Brothers, 1982; Rosenberger-Debiesse & Coleman, 1986). Moreover, specific characteristics such as cognitive ability (Fein, Waterhouse, Lucci, & Snyder, 1985), communication and social skills, and behaviors such as activity level and aggression (Eaves, Ho, & Eaves, 1994) vary greatly across children with autism. Furthermore, the impact of the characteristics of the children changes throughout development (Waterhouse, Fein, Nath, & Snyder, 1987). Thus, the label of autism offers limited communication among professionals and may even enhance misperceptions among those who are unfamiliar with the disorder.

As a result of a number of researchers have attempted to define subtypes of autism. Attempts to delineate subtypes have focused on distinctly different patterns of behavior the children demonstrate, such as perceptual performance, verbal skills, memory, motor skills, and asymmetry (Fein et al., 1985), language patterns such as onset of language (Kolvin, 1971), severity and predominance of behavioral characteristics during play (Siegel, Anders, Ciaranello, Bienestock, & Kraemer, 1986), and social characteristics (Borden & Ollendick, 1994; Wing & Gould, 1979).

The characteristics of autism vary greatly across children, and to be diagnosed with autism does not mean a person must display all of them. The following section describes the most common characteristics of autism.

CHARACTERISTICS OF AUTISM

Social Communication

As is discussed in dept in Chapters 2 and 5, the one characteristic exhibited in almost all children with autism is their apparent lack of social-communicative gestures and utterances. Very early on, perhaps beginning in the first few months of life, it is evident that children with autism may not engage in simple social behaviors such as eye gaze, smiles, and response to parents' attempts to prompt vocalizations and play interactions. When vocabulary and language are learned, they are often used instrumentally rather than socially. Such patterns can continue throughout life. Even when language competence is achieved, pragmatic skills such as initiating conversation and responding to the conversation of others (L.K. Koegel, Koegel, Hurley, & Frea, 1992), appropriate turn-taking, prosody, speech detail, perseveration, and attention during conversation, may be lacking (Frea, 1990; R.L. Koegel & Frea, 1992). However, researchers are now addressing these issues, and later chapters in this book discuss effective intervention procedures.

Language

Verbal language does not develop in a small percentage of children with autism. Early figures estimated that 50% of children with autism never develop functional expressive language (Prizant, 1983; Rutter, 1978b); however , now that improved language teaching procedures are available, the outlook is considerably brighter. Currently, if language emerges, it is primarily used for requests and desires (Wetherby & Prutting, 1984) and not typically for the purposes of social interaction or social support (newer procedures, discussed in Chapters 2 and 5, attempt to address this). This is most likely due to the social-communicative difficulties of children with autism. A number of authors have recently discussed core underlying problems of communication as the primary disability in autism and other behavioral problems as secondary. Evidence of this has been documented repeatedly. For example, L.K. Koegel, Koegel, Hurley, and Frea (1992) found that, when children are taught to engage in appropriate communicative behaviors, inappropriate behaviors such as aggression, self-injury, and certain types of self-stimulation decrease without special intervention. Other studies have demonstrated this inverse relationship when functionally equivalent communicative responses are taught. Carr and Durand (1985) demonstrated that disruptive behaviors exhibited as attention or escape mechanisms can be reduced or eliminated when functionally equivalent communicative behaviors, such as "Is this right?" (for the teacher's attention) or "I need help" (for the teacher's assistance with a difficult assignment), are taught.

Self-Stimulation

Self-stimulatory behavior, or stereotypic behavior, refers to repetitive behaviors such as hand flapping, twirling objects in front of the eyes, and body rocking that extends for a prolonged period of time and seems to provide sensory or kinesthetic feedback for a child with autism (Lovaas, Litrownik, & Mann, 1971). Self-stimulatory behaviors may be expressed in a variety of ways. Sometimes they are subtle, such as gazing at lights or making inappropriate facial expressions or grimacing. Others are quite obvious, such as body rocking or loud and repetitive vocalizations. Most self-stimulatory behaviors appear to have little or no obvious social meaning to others and appear to interfere with relationships, learning, and neurological development (L.K. Koegel, Valdez-Menchaca, & Koegel, 1994). In addition, these behaviors have an inverse relationship with many appropriate behaviors, and , when they are suppressed, spontaneous increases with academic responding and play are observed; when certain types of play and learning are increased, certain stereotypic behaviors spontaneously decrease (Kern, Koegel, & Dunlap, 1984; Kern, Koegel, Dyer, Blew, & Fenton, 1982; R.L. Koegel, Firestone, Kramme, & Dunlap, 1974).

Self-Injurious and Aggressive Behavior

Occasionally children with autism display self-injurious and aggressive behaviors. In the past, these behaviors were conceptualized as extremely stigmatizing and potentially harmful and punitive consequences were administered to treat them. However, a shift in the field has focused on the communicative function of these behaviors, and functionally equivalent replacement behaviors are now being taught. Specifically, analysis of the function of disruptive behaviors has been researched, and behaviors such as self-injury, aggression, and other related disruptive behaviors (e.g., tantrums and property destruction) fall into specific patterns of function or reasons the individual displays them. Common functions include attention seeking; avoidance of a perceived unpleasant situation; or escape from an undesirable activity, task, or circumstance. If such functions are assessed and appropriate communicative behaviors are taught, self-injury and aggression can be reduced, eliminated, or prevented.

Demand for Sameness and Preoccupation with Objects

Children with autism often develop excessive preoccupations with particular objects, routines, or the preservation of sameness in the environment. They may have particular objects that they interact with in an idiosyncratic fashion, such as lining up small cars by size or color. Attempts to engage the child with other toys or disrupt the order may result in tantrums or aggression. Preservation of routines is displayed when a child insists on unusual patterns of behavior, such as following a specific route to a familiar location or being served foods in a specific order (e.g., requiring milk to be poured into a bowl before the cereal and spoon are placed in the bowl). Again, the child may become upset if such routines are not followed. Desire for sameness can be observed by their apparent distress when specific aspects of their environments are disrupted or changed. For example, some children become troubled if the furniture is rearranged; others may insist on wearing the same clothes daily. Although this behavior is not well understood and few intervention techniques other than response interruption exist, it is a common characteristic of children with autism.

Epidemiology and Etiology

The incidence of autism, excluding those children diagnosed as "autistic-like" or with other primary diagnoses, has been estimated to be about 1 out of every 2,000 live births and is four to five times more common in males than females (G. Dunlap et al, 1988; Schreibman, 1988). For a period of time after autism was regarded as its own distinct entity, a parental-causation theory was developed and prevailed for several decades. However, following an emphasis on scientifically based methodologies focusing on etiology, this theory was essentially abandoned. In fact, although the burden and demands of having a child with significant disabilities may results in stress on the family, transactional views suggest that the behaviors of a child displays may actually cause the parents to adjust their style of interaction accordingly (cf. Curcio & Paccia; Mahoney, 1988a).

Current research and theory regarding etiology are focusing on organic factors, and it is generally accepted that autism is present at birth or shortly thereafter. It is also becoming evident that the behavioral characteristics of a child needs to display to be diagnosed as having autism may represent a variety of different causes. It is important to note, in this discussion of the possible physiological correlates, that, although studies have reported the following variables to be significant, none has reported any variable to be evident in all of the children or families assessed, which again demonstrates the suggestion that the underlying cause may vary across children. Although there is much research to support the various etiologies, it is not the purpose of this book to discuss them in detail; therefore, each one is discussed briefly here. Some possible causes and signs of autism that have been the focus of research of research include prenatal, perinatal, and neonatal complications, such as bleedings, pre-and post-maturity, severe infection during pregnancy, generalized edema, medication for more than 1 week during pregnancy, reduced Apgar scores (Gillberg & Gillberg, 1983), and congenital rubella (Chess, 1977).

Neurological and neuroanatomical research has found atypical patterns of cerebral lateralization (Dawson, Finley, Phillips, & Lewy), differences in brain stem responses (Gillberg, Rosenhall, & Johansson, 1983), abnormal EEGs (Mesibov & Dawson, 1986), and cerebellar asymmetry in specific areas (Courchesne, Lincoln, Yeung-Courchesne, Elmasian, & Grillon, 1989) in children with autism. Because the functioning of the brain structures is not clearly understood, interpretation of these studies is complex and further studies are needed to elucidate these findings. Neurochemical researchers have noted differences in blood serotonin levels, particularly a tendency toward higher levels (Campbell, Friedman, DeVito, Greenspan, & Collins, 1974), in children with autism. Although results have been varied and some negative side effects have been observed, studies that have administered fenfluramine as a means of reducing blood serotonin levels have sometimes found some positive changes in the behavior of children with autism (Ritvo, Freeman, Geller, & Yuwiler, 1983). Other researchers have hypothesized based on behavioral observations about possible neurochemical factors, such as opioid systems (Sahley & Panksepp, 1987) and beta endomorphins and changes in acetylcholine levels (L. Kern Koegel, Dyer, et al., 1982). Others have discussed possible differences in vitamin metabolism (Rimland, 1994).

Literature addressing chromosomal and genetic patterns has identified a "fragile" site on the X chromosome (fragile x syndrome) in some children with autism; minor physical anomalies (Walker, 1977); and a tendency for relatives of children with autism to have other disabilities, including an increased incidence of autism or related symptoms (Ritvo et al, 1985).

In summary, the physiological data are still inconclusive; however, with the increasing sophistication of medical research and the subclassification of autism based on different behavior topologies, more information on the etiology of autism should be available in the future.

Behavioral Diagnostics

As discussed earlier, the behavioral characteristics of children labeled as having autism vary greatly; therefore, an ongoing assessment that is accurate and reliable regarding the type, amount, environments, and functions of behaviors is essential to develop effective intervention plans.

Description of Behaviors

Researchers and practitioners have long discussed the importance of defining behaviors in an objective, behavioral, and observable manner (Schreibman, 1994) that can be reliably understood and recognized by others. For example, a description of a child as "aggressive" is of little benefit. In contrast, a description such as "pinches adults on the inside of the forearm between the wrist and elbow" provides a clear picture of the aggression the child exhibits.

Degree or Amount of Each Behavior

The strength or degree to which each behavior occurs can be described in terms of amount. This can be accomplished by determining the frequency or duration of the behavior. For example, does pinching occur an average of 10 times a day or once a week? Other behaviors such as self stimulatory behavior or tantrums may be measured by duration (e.g., length of tantrum) and/or latency (e.g., number of seconds that elapsed between presentation of a task and the child leaving the work table) (Schreibman, 1994).

Environments in Which the Target Behavior Occurs

Behaviors cannot be considered in isolation; they must be viewed as a part of the environment in which they occur. To begin with, to help understand and predict behavior, the environment in which they occur must be analyzed. Specifically, the environment is which a behavior occurs (antecedents) and the actions that usually follow the behavior in that environment (consequences) must be assessed (Baker, Brightman, Heifetz, & Murphy, 1976). This is referred to simply as the A-B-C model — antecedents — behavior — consequences. All comprehensive behavioral diagnostics should include a component that focuses on these complex patterns of behavior so that a proactive approach to intervention can be taken. For example, consider the child described earlier who demonstrated pinching. If antecedents were described as "pinching typically occurs within the three seconds following presentation of an academic task," and the consequences were described as "child is taken to the principal's office and parent is called to take child home," we would certainly have a specific idea as to the circumstances surrounding the disruptive behavior.

Perceived Function

Many of the behaviors a child displays are actually being used as a form of communication; disruptive behavior, in particular, can be a very efficient and effective means of communication. Following the evaluation of the antecedents , behavior, and consequences, an attempt to determine the perceived function of a behavior is important for the development of functionally equivalent behaviors.

Many behaviors can be observed to be maintained by specific functions (this is discussed in detail in Chapter 12). Some of the most common functions or reasons a behavior is exhibited, as discussed by O'Neill, Horner, Albin, Storey, and Sprague (1990), include 1) to obtain attention or a desired item; 2) to escape or avoid a particular demand, request, activity, or person; 3) to avoid specific setting events, such as a difficult task, a transition, or being interrupted from a particular activity; or 4) self stimulation (described earlier). Consider the A-B-C pattern just described. When an academic task is presented, the child demonstrates aggression and is subsequently taken away from the task. A hypothesis could be made that the likely function of this behavior is avoidance of the academic task. The child's attempt to avoid the task (i.e., the disruptive behavior) is most certainly being rewarded and maintained by the consequence. Understanding the function of a particular behavior can assist with developing and implementing socially appropriate communicative behaviors that meet the same needs as the disruptive behavior.

Table of Contents

1. Emerging Interventions for Children with Autism: Longitudinal and Lifestyle Implications
   Robert L. Koegel, Lynn Kern Koegel, William D. Frea, and Annette E. Smith
2. Communication and Language Intervention
   Lynn Kern Koegel
3. Overselective Responding: Description, Implications, and Intervention
   Jennifer Rosenblatt, Patricia Bloom, and Robert L. Koegel
4. Spontaneous Language Use
   Don Hawkins
5. Social-Communicative Skills in Higher-Functioning Children with Autism
   William D. Frea
6. "Teach the Individual" Model of Generalization: Autonomy Through Self-Management
   Robert L. Koegel, Lynn Kern Koegel, and Deborah Rumore Parks
7. Parent Education and Parenting Stress
   Douglas Moes
8. Social Support for Families
   Ann Leslie Albanese, Stephanie K. San Miguel, and Robert L. Koegel
9. Friendships Between Children with and without Developmental Disabilities
   Christine M. Hurley-Geffner
10. Integrated School Placements for Children with Disabilities
    Diane Hammon Kellegrew
11. Parent–Professional Collaboration and the Efficacy of the IEP Process
    Michelle Wood
12. A Parent–Professional Consultation Model for Functional Analysis
    Kimberly B. Mullen and William D. Frea

Editorial Reviews

Twelve contributions discuss the behavioral characteristics of autism, intervention methods, and key topics such as spontaneous language, overselectivity, social communication, and self-management. The goals of intervention are examined in detail and presented along with concrete ways to support families, focus on long-term gains and short- term problem solving, develop curricula, and promote independence. Annotation c. Book News, Inc., Portland, OR (booknews.com)

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