autismo y educación -rita jordan
TRANSCRIPT
Autism & Education
Prof Rita Jordan PhD OBEEmeritus Professor in Autism Studies
University of Birmingham, UK
Conference for the 35th Anniversary of APNABI: December 11, 2014 Bilbao
What’s Special about ASD?
• need to learn explicitly what others acquire intuitively or through social tutoring
– identity of self/ other
– saliency of social signals
– agency and intention
– relevance and priority
– social/cultural meaning
– nature of communication
– emotional consciousness
Co-Morbidities
Wing: “Nature never draws a line without smudging it”
• ASD rarely occurs as sole disorder
• additional developmental disorders & later anxiety disorders
• diagnostic heirarchy rules deny reality:
– language disorder & autism
– ADHD &ASD
– SpLD & ASD
– SLD (LD) & ASD
• expression of disorders affected by comorbid conditions
The ‘ASD’ lens
• diagnosis not a good basis for services – should be needs led
• individual needs determine learning and should determine teaching
• individuality is even more the case in ASD
• yet a lack of mutual empathy means
– teachers have to use non-intuitive routes in teaching those with ASD
– just as those with ASD have to use non intuitive routes in their learning
SEN of ASD
Jordan (2005)
• children with ASD have needs that are:
– common (as children)
– individual (as individuals - assessed needs)
but also
– group (related to ASD)
• and it is only through awareness of group needs that individual needs can be recognised and met
Role of Education
• as entitlement to broad & relevant curriculum
– human right
– adult success
– need to consider reality of access
• as therapy addressing the problems presented by ASD
both aspects are needed but vary in priority with individual needs
Intervention & Education
• educational entitlement
– adaptation and access
– range of provision
– parent support for informed choice
• education as therapy
– eclectic tradition
– no evidence of single approach
– fit with local services
– based on principles and best practice
Learning Style
• visual rather than verbal
• memory
– cued
– rote
• ‘social’ is a dimension of difficulty
• emotions and cognition
– use interests for engagement
• at sensory stage of meaning
– presentation -> reference
• repetition & consolidation
• need explicit strategies for problem solving
Difficulties & Differences
• executive functions– ‘monotropic’ attention– impulse control (difficult to limit)– idiosyncratic perception
• imagination & reality testing• empathy & emotional/ conscious understanding• concept development
– problems abstracting (not to do with ‘abstract’ concepts)
– rigidity of concept & schema boundaries (teach to include exceptions)
Sensory Issues
• evidence that at extremes
• both over- and under-responsive to different senses
• ‘over-responsive’: sensory avoiding; ‘under-responsive’: sensory seeking
• most sensory avoiding
• shield from sensitivities and/or desensitise
• attach meaning to perception - reduce ‘bombardment’ of meaningless stimulation
• aware of variability - use proximal blocks
• give environmental control to individual if possible
• reduce overall stress
• teach to monitor and manage levels of arousal
Perceptual Challenges
• cannot easily understand social meaning so:
– teach for meaning (emphasise goals not parts of
tasks - or get prompt dependence)
– give explicit rules & instructions
• visual ‘rules’ & ‘matching’
– allow time for processing
– check on child’s perspective (squirrel story)
Memory Challenges
• excellent rote memory but poor functional memory:
• processes for teaching or generalisation of skills in
functional environments
• methods to enable memory cues across home/ school
environments e.g. in homework
• teaching a range of memorisation strategies
(stories of cake making)
Communication
• language and communication separate
• often associated language problems
• prognosis
• all aspects:– gesture
– posture
– facial expression
– emotion
– pragmatics
• use of IT - reversal of learning process - ‘reading’ 1st?
Social & Emotional Development
– skills difficult without understanding
– need some rules with a wide currency e.g. need
communicative partner
– value of Legotherapy / SHEDs for adults - social skills in
context
– other 'rules' may be socially disabling e.g. look when being
addressed
• will not know purpose
• not able to time gaze appropriately
• danger of giving wrong signals
Teaching for Purpose
• different approach needed to suit
– individual characteristics
• sociability
• language
• cognitive level
• sensory issues
• age
– goal
– practitioner comfort/ ability/ knowledge
– Gunilla Gerland (2013) (Secrets to Success for professionals in the Autism Field: JKP}
Individual factors: Sociability
• Sociability NOT the same as social skills or understanding
• Wing’s classification– withdrawn/ solitary -> passive/ responds -> ‘active but odd’
-> eccentric & sensitive
• varies with conditions & with teaching
• level suggests optimum form of approach– withdrawn - 1:1 directive & desensitisation
– passive - interest & structured play experience
– active but odd - social rules & experience (context)
– eccentric - social skills in context e.g. buddy
Behaviour & ASD
• behaviour itself not the basis of ASD
– only a guide to underlying brain functioning/ psychology (Frith, 1989; Peeters, 1997)
– no behaviours unique to ASD
– poor basis for diagnosis - should be clinical judgment based on developmental history
– DSM-V likely to exacerbate problems with ‘social & communication’ category for PDD-NOS not meeting ASD criteria
Is ‘Normal’ a Sensible Goal?
• ‘acting’ typically may still be at a cost
– more stress
– breakdowns in unfamiliar/ unsupported situations
• ‘recovery’ is liable to mean withdrawal of support or
even understanding
• cases of successful individuals with ASD at school
failing to cope with ‘ordinary’ life
– even suicide
Goals of Education
• to become as good as one can be
• not necessarily ‘less autistic’ in terms of behaviouralone
• But:
– free from the fear & stress of not understanding
– with skills and support to lead a full & worthwhile life
– with capacity for enjoyment
– with resilience to cope when life is difficult or disappointing
Role of the Teacher/ Supporter
• not to create artificial ‘autism friendly’ environments, at least, not long-term
• to teach explicitly all the knowledge, skills and understanding that the rest of us just ‘pick up’ in ways that are both meaningful and accessible to the individual
• most of this will not be ‘set’ lessons but a sensitivity to what needs to be taught in daily contexts
• focusing on deficit, we get it wrong
Understanding is key
• there is no intuitive or instinctual responses across the autism/ non-autism divide
• both parties have to use cognitive routes to understand the other
• such routes are difficult and inefficient
• but they are essential if we are to live happily together
Principles that should underlie effective
educational practice:
• need for education to adapt to the learning style of individuals with autism
• need to help individuals to adapt their learning style -better able to understand and operate independently in the non-adapted environment
Problems with Educational
Language
• model of conversation
– contributions, topic maintenance
• assumption of joint attention
– holding up, eye/finger pointing
• sarcasm & metaphor
• literal understanding
– jokes, idioms, pragmatic context,
• model of questions
– display, probe
Teaching to Cope
• pre-empt:
– stress - prosthetics & exercise
– anger - alternative
– frustration - communication
– panic - posture / drill
• train for ‘escape’
• teach relaxation
• teach social understanding
– Social Stories/ video life/ soaps
Research Evidence on Interventions
• no single approach
• evidence for:
– structure
– broad modern behavioural methods
– training in social interaction & communication techniques
• in all studies some do well and some do not
• in all studies children tend to learn only what they are explicitly taught
Important Distinction (Mesibov 2009)
• Evidence Supported
Treatment (EST)
– most common use
– starts with treatment &
asks if it works for a
particular (narrow)
group
• Evidence Based
Practice (EBP)
– what we should do
– starts with person and
asks how we can
achieve the best
outcome
Importance of Process
• sensitivity & flexibility of implementation at
least as important as particular intervention
• rigid interpretation of manuals leads to poor
outcomes
• lack of understanding of ASD de-skills staff
and prevents effective individualisation
Curriculum for ASD
• entitlement to culturally valued skills, knowledge & understanding
• therapeutic needs from ASD difficulties
• additional explicit content for otherwise ‘intuitive’ knowledge
• long-term need for a ‘curriculum for life’
Goal is Q of Life not getting through
the lesson
• try not to give definite answers or models when there are exceptions
• be authentic & praise effort, not success
• don’t introduce unnecessary levels of learning e.g. fake materials when the real is available
• appreciate the value of contact time
– don’t use it for work that could be done independently
– always think what is the student learning rather than what am I teaching
– use structure to make choices (and non-choices) clear
Build on Strengths
• relationships - use them
– getting consistency across staff
– motivating the children to learn
– work with CAL
• detailed planning
– plan to pre-empt difficulties rather than ‘mopping up’
• opportunities to apply learning - plan for some ‘out of the box’ lessons that use the environmental facilities available
– make lessons fit into life rather than be apart from it
Understanding behaviour: Functional
Analysis
• Settings
– ‘last straw’ not always ‘trigger’
– whole child (inc. skills) & whole school approach
– parent collaboration
• Behaviour
– accurate
– frequency
– duration
– intensity
• Results
Teaching Consequences
• less able - single track
• more able -
– railway - no turns
– 2 clear termini with no
connections
– choice point
emphasised
Moment of choice
Problem Taught alternative
Basic Guide to Anxiety Reduction
• relaxation
– general - sensory/ meditation/ yoga/ deep pressure
– specific - fold arms, close eyes, chant or hum
• exercise
– aerobic/ contingent & non-contingent
• diet
– GI index low / low stimulants/ sugar & additives
• talking with others
– drawing? music
Examples of Good Practice
• CBT e.g.Attwood (anxiety/ anger/ toolbox); Greig &
McKay (homunculi programme)
• CBT for adults (Hare)
• Moran - PCP - ‘ideal self’
• structured support for families (Preece & Almond)
• self-help support groups
Tensions in Education for ASD
• entitlement vs. specialism– access or meeting SEN?
• optimum for learning vs. optimum for social integration– specialised or peer engagement
• ‘readiness’ for inclusion vs. learning without experience– how to achieve ‘readiness’ without experience?
Processes for Inclusion
• support
– trained - ASD
– enabling - Observe/ Wait/ Listen
• staged
– special -> reverse ->integrated
• resource base
– better than ‘unit’ or ‘class’
• ‘free time’
– use of buddies / circles of friends
‘Unprepared’ Integration
• evidence that it is not successful
– from research
– from autobiographies of those with ASD
– from parents seeking tribunals
– Council of Europe study
• results in
– increased segregation
– even institutionalisation
Later: Ecological Curriculum
• assess individual
• assess current and future environments & occupations
• gaps in skills, appreciation, knowledge and experience form curriculum goals
• teach in functional ways
• practise in functional contexts
Train for sensory ‘panic’
• need for trained
response for ‘panic’
situations &
buddy or visual cue
to remind.
• note use of prime
numbers!
Use of LSA
• care from a distance
• checking not creating
‘learned helplessness’
• available to others
Teaching adaptations
• visual instructions
• lists for meaning
• allow time for
interests
• work then play
Managing Democracy
• no tact or
sensitivity
• no intentional
rudeness
• give alternative
• mark for future
teaching
Fostering ‘Realistic Optimism’
• use ‘ecological curriculum’ approach to life and social skills
– accurate appraisal of self
– see plan for future coping
• help them notice good things that happen
• teach ‘mindfulness’ & avoid
– too much worry over future
– too much anger & distress over past
Teaching is hard
• teaching students with ASD is hard
– intellectually hard to try to ‘work out’ what would
otherwise be intuitive
– pragmatically hard to ‘act against the grain’ and do
things not to suit ourselves but someone else - and
keep it up
– practically hard to monitor the students and oneself
continuously - exhausting, in fact