Structured Teaching

Structured Teaching

TEACCH Staff, Chapel Hill TEACCH Center

Autistic students respond well to structure.

A teacher must structure the classroom in order to effectively teach autistic students.

These statements or similar ones are often proclaimed by teacher trainers and other

professionals familiar with autism. But many times there is minimal understanding of how to plan

for and use the concept of structure.

The dictionary states one definition of structure as the action of building or constructing--

arranging things in a definite pattern of organization. For example, a gardener desiring a

prosperous garden must use structure in planning and cultivating a garden. Seeds and plants

must be arranged with a definite pattern of organization and using systematic methods to-allow

for individual preferences and needs of plants for shade, sun, water, and closeness to other

plants. Using this structure will amplify a plant's strengths and help to compensate for and

circumvent its weaknesses. The plant will then grow faster and bear more fruit. Teachers, too,

must structure and organize classroom life in order for students to expand their strong areas as

well as grow in their weaker ones.

Before further exploring the use of structure in the classroom, it will be helpful to briefly review

some of the deficits of autism and how they can point to a need for structure when planning for

successful learning experiences.

Receptive language difficulty is characteristic of autism. Many times a student cannot understand

language as well as a teacher believes he can, and so may demonstrate aggressive behaviors or

lack of initiative. He also may lack the necessary language to communicate things appropriately,

and so can not let the teacher know when he is tired, hot, hungry, finished, or bored except by

tantrumming or aggression. He may have a poor sequential memory, and so he can not keep the

order of even familiar events in his mind or is not sure when something different will happen.

Often he feels more comfortable staying with familiar activities and will resist learning new

activities or routines. Many times he is unable to organize or put limits on his own behavior and

does not understand or acknowledge society's rules. This can result in trying to get others'

attention in inappropriate ways or preferring to be alone. Because of his lack of social relatedness

he may be unmotivated to please others or unrewarded by praise, and consequently seems

resistant to learning. Hypersensitivity to sensory input can often lead to disturbing behaviors.

Being easily distracted and lacking skills in perception and organization of time can also lead to

behaviors that get in the way of learning.

Providing structure and organization in the classroom or any other learning environment on a

student's level of understanding can help to alleviate or moderate these problems and the

resultant ineffective learning situations.

This chapter discusses the features of structure that have proven useful in classrooms for

students of all ages with autism. These features are physical organization, scheduling, and

teaching methods. The key to effectively using each of these features is individualization. A

classroom that is physically well-organized and scheduled will not benefit students unless

individual student strengths and needs are considered in the planning phase. A teacher who uses

teaching methods like prompts and reinforcement cannot do so effectively without assessing

individual student interests and learning styles. Further discussion on the use of each of these

features follows in the next sections.

Physical Organization

A teacher must teach autistic students the classroom in order to effectively teach students.

The physical layout of the classroom is an important consideration when planning learning

experiences for autistic students. Even the arrangement of the classroom furniture can help or

hinder a student's independent functioning and his recognition and compliance with rules and

limits. Keep in mind the deficits of autism when planning the physical arrangement of the

classroom so that it will be structured effectively. Many autistic students have organizational

problems, not knowing where to be and how to get there by the most direct route. Because of

receptive language difficulties, they will often not understand directions or rules. Structuring the

environment gives them visual cues to help them understand. Some persons with autism are also

easily and highly distracted by things in the environment. Teachers need to structure the

environment so it is not as distracting.

Before planning the specific physical arrangement of the classroom, the teacher may want to give

some thought to the general classroom environment. Good structure will not be as effective if

there are other problems. Many times a teacher does not get a choice of which classroom is

assigned her in the school. But if there is a choice, features to give attention to include size of the

room, what other classrooms/students are nearby, number of and access to electrical outlets,

location of nearest bathroom, lighting, distracting wall space, and other immobile features.

Some undesirable features can be overlooked or even modified, but there are a few situations

that might necessitate a change in classroom. A classroom with multiple exits (especially one to

the outside) is not desirable for a teacher with a student who is a runner. A classroom for

intermediate students should not be located on the kindergarten hall. This type of situation does

not provide any peer socialization opportunities and definitely places a stigma on the obviously

bigger and older students. A too small classroom or one without adequate storage spaces

creates an uncomfortable atmosphere of always having something in the way or working on top

of each other. This does not provide a relaxed learning atmosphere. A very high priority feature is

the bathroom location. Teachers who are doing toilet training do not want to have to make a long

distance trek each time a student is scheduled for the toilet. Even if students have independent

bathroom skills, valuable classroom time should not be wasted as they walk long journeys to and

from the bathroom, if other arrangements can be made -- Once the teacher has settled on a

particular classroom site, she is ready to begin arranging and structuring the learning and training

areas specific to the focus or content of her classroom. Having specific areas for learning specific

tasks, marking clear boundaries, and making materials easily accessible helps students

independently know where they are supposed to be and where to get their own materials. In this

way teachers do not have to be constantly giving reminders to students and repeating directions.

There is much less verbal confusion in the classroom. Every classroom and every student will not

need the same amount of structure, though. Lower functioning students and those with less

developed self-control will need more structure, more limits, boundaries, and cues than higher

functioning students.

A teacher of younger students would want to structure learning areas for play, individual and

independent work, snack, and developing self-help skills. There might also be a group area and a

specific area for doing prevocational skills. A classroom for older students would have a leisure

area, workshop area, domestic skills area, self help/grooming area, and places for individual

teaching to occur. Many classrooms need to utilize a time-out area as a place for particular

students to get away from distractions and stimulation and regain some self-control. All

classrooms should have somewhere for students to put their personal belongings. This can be

cubbyholes, lockers, or special boxes. The teacher's desk or area should be another established

place in the classroom.

Establishing areas in the classroom can begin with the natural setting. For example, work areas

are probably not good to set up near distracting mirrors or windows. if there is no avoiding this,

then blinds or cardboard taped to the window can eliminate some distractions. It is beneficial to

have work areas near shelves or storage cabinets, so work materials are easily accessible. Built-

in cabinets are good for building a work area around because of the easy accessibility to

materials. Blank walls are also good to build a work area around. Students' tables or desks face

the blank walls and some distractions are thus eliminated. It is important that classroom furniture

be the right size for students for age appropriateness and for their ease and comfort in completing

their work. Areas where students spend some independent time, such as play or leisure, are

better off not being located near exits. This can take away a bit of worry about student escapes

from the teacher's mind. Rugs, bookshelves, partitions, tape on the floor, arrangement of tables,

all of these can beused to make clear boundaries. For example, the carpeted area may be the

leisure area. Students are not to be in any other floor area during break time. The workshop area

may be outlined by shelves full of materials and 2-3 long work tables. When a student gets

workshop materials, he then sits in that area to work. A teacher may use a small throw rug in front

of the sink to show students where to stand when they are washing their hands or washing the

dishes.

Materials should also be clearly marked or arranged at a student's level of understanding. Some

materials are for teachers only. Some materials can not be used at play or leisure time. Pictures,

color coding, number symbols, etc., can help students label and obtain or put away materials by

themselves.

As a teacher plans the physical structure of the classroom it is important to remember to consider

individual needs of students. Individualization can be illustrated with examples of three differently

structured work areas within the workshop area in a classroom. On two sides of the workshop

area are shelves full of workshop materials. This defines the workshop area. There is a table and

chairs in the middle of the workshop area for those students who are not bothered by others'

activities or are learning to work with distractions present. Another work table is facing a blank

wall and pieces of tape on the floor show where chairs should be while working. This is for

students who are more easily distracted and tend to wander when not busy working. A third work

area is partitioned on two sides with dividers and faces a blank wall on the third side. The student

who works here is easily distracted by what others are doing and has some behaviors which are

disturbing to others while working. The structure needs for each student have been individually

assessed and planned for. As students learn to function more independently, the physical

structure can be lessened bit by bit.

Following are some questions for teachers to consider when arranging their classroom.



Work areas

 Is there space provided for individual and group work?

 Are work areas located in least distractable settings?

 Are work areas marked so that a student can find his own way?

 Are there consistent work areas for those students who need them?

 Does the teacher have easy visual access to all work areas?

 Are there places for students to put finished work?

 Are work materials in a centralized area and close to work areas?

 Are a student's materials easily accessible and clearly marked for him or her?

 Are play or leisure areas as large as possible? Are they away from exits?

 Are they away from areas and materials that students should not have access to during

free time?

 Are boundaries of the areas clear?

 Can the teacher observe the area from all other areas of the room?

 Are the shelves in the play or leisure area cluttered with toys and games that are broken

or no one ever uses?

Scheduling

A teacher must have a framework in order to effectively teach autistic students.

Two students are involved in a cooking activity in the kitchen area with the teacher assistant.

There is a student latch hooking a rug in the-leisure area. Another student is independently

completing a list-of activities in the workshop area, and a fifth student is doing some individual

number work with the teacher. In the background a timer can be heard clicking off the minutes. It

rings and there seems to be the potential for pandemonium as materials are put away, chairs are

moved, reinforcers are awarded along with praise, a few directions are given, everyone moves to

a new area of the room, and then steady work begins again. How does everyone know where to

go and what to do? How do teachers know who they are responsible for? Why does it all flow so

smoothly? This classroom most assuredly has a purposeful, clear, and consistent schedule--a

framework that outlines who, what, where, and when.

Schedules are a part of the classroom structure needed by autistic students. Many students have

problems with sequential memory and organization of time. Receptive language difficulties can

also make it difficult for students to understand what they should be doing. Besides giving

direction to everyone for certain time periods of the day, a schedule can help a student organize

and predict daily and weekly events. This lessens anxiety about not knowing what will happen

next. Besides knowing what activity will happen during a time period, a schedule can aid students

in transitioning independently between activities. Their schedule lets them know where they

should go next. Also, students with low initiative may be more motivated to complete a difficult or

dreaded task if they see on their schedule that it will be followed by a more enjoyable task or

activity.

There are usually two types of schedules being used simultaneously in classrooms. The first type

is the general overall classroom schedule. The second type is individual student schedules.

The overall classroom schedule outlines the events of the day. It does not specify work activities

for students but does show general work times, break times, etc. Here is an example of a typical

schedule for an intermediate age classroom:

8:30 Student arrival, put belongings away, greetings

8:45 Work session 1

9:30 Work session 2

10:15 Break

10:30 Leisure learning/School friends

11:00 Work session 3

11:45 Prepare for lunch

12:00 Lunch

12:30 Outside/gym

1:00 Clean cafeteria tables and floors

1:45 Work session 4

2:30 Dismissal

This schedule shows when students are working and when they are doing other activities. During

the work times the students and teachers might be involved in a variety of activities from

independent prevocational work, individual training on self-help skills, to jobs around the school.

These are reflected on individual student schedules. This general schedule may also serve as the

weekly schedule, except on those days when field trips, special events, or community training are

scheduled.

The general classroom schedule is usually posted somewhere in the classroom for all to be able

to see and use. Often it is reviewed upon student arrival or during a morning group session. The

format for this schedule may be written, as in the example. But not all students will be able to

comprehend a written schedule. The same schedule as in the example can also be done with

pictures or drawings representing the activities. For example, a picture of a desk or table can be

used instead of the words "work session." Picture schedules can be arranged from top to bottom

or from left to right on large poster board.

Using this general schedule, teachers can daily or weekly divide the responsibilities for teaching

students. A clipboard with the schedule attached to it for each teacher is easy to handle and

glance at. Considerations when dividing teaching responsibilities include which students work

well in small groups, which students have independent work skills, what activities will involve a

teacher out of the room with students, and which students have hard to manage behaviors. Both

teachers (and other volunteers using the schedule) must feel they know what and who their

instructional responsibilities are.

To help students understand what to do during the activities listed on the general schedule,

individual student schedules are used. These can take a variety of forms but must be individually

oriented, i.e., age appropriate, balanced with difficult and successful activities, based on student

level of comprehension, and based on student endurance level (how often reinforcement or

change in activity is needed).

Individual schedule types can vary from ones that are teacher directed and administered to those

that students make up and follow themselves. The important aspect is that they are

individualized, i.e., understood by the students they are developed for. Some examples are

described below:

 As the teacher and a student finish an activity and its subsequent reinforcer, the teacher

shows the student an item from the next activity. The student either moves to the

appropriate area taking the item with him, or he uses the item as an example to get other

materials needed and brings them to his work table.

 On a student's desk is a strip of poster board with different color circles paper clipped to it

in a vertical row. The student has learned to take the topmost circle and match it to the

same color circle taped to a box on the work area shelves. He takes the box back to his

desk, completes the task in the box (with or without teacher help, depending on the task),

and puts the box back on the shelf when finished. He continues this until all the color

circles have been done.

 Tacked to the bulletin board beside a student's-work area are rows of 4-5 Polaroid

pictures for each work session. The student starts with the topmost picture and gets

materials needed, completes the activity and puts his materials away. He continues

following this schedule through all the pictures for a work session. The last picture in

each row is of a game or toy that the student likes. When he reaches that picture, he can

play with the toy until the bell rings for the next work session to begin. Taped to a

student's desk is a piece of paper divided into 3 rows of 3 squares each. Each square

has a drawing or a list of numbers in it. Each square corresponds to a time block of the

general classroom schedule. The student follows the schedule from left to right. The first

block lists numbers of the tasks he is to do independently in the workshop area. At the

signal which ends the first work period, he follows directions in the second box which

shows a drawing of a table and chair representing individual work with a teacher. The

third block has a drawing of the break area. The student continues following the schedule

throughout the day. This student receives money upon successfully completing or

attempting all the activities listed or drawn in each block. He spends his money at snack

and at the end of the day for edibles or inexpensive treats like stick-ons.

 After arriving, a student puts away his personal belongings and picks up his clipboard

which is hanging on the wall. On the clipboard is a time schedule which includes all his

activities for the day, each followed by a small box for a checkmark. The teacher and

student wrote the schedule together at the end of the previous day. He sees what his

8:30 activity is and does it to completion. He then calls the teacher to check his work and

receives a checkmark in the box on his schedule. His next task is scheduled at 8:50. If

there is time remaining he may spend it quietly in the leisure area. He proceeds through

the day by referring to his schedule and the clock. He does not receive checkmarks if he

does not finish a task in the allotted time or with appropriate behavior. Receiving a certain

number of checkmarks results in a star on a chart at the end of the day. Four stars during

the week leads to his choice of free time activity instead of work on Friday afternoon.

All of these examples show individualization. For students who do not read or cannot understand

pictures, then colors or objects are used to help them move through daily activities. Some

schedules have 2 or 3 activities to be done within a time period while others have only one before

a break or reinforcement occurs. Each individual schedule also reflects a student's preference for

activities-alternating enjoyable with less enjoyable.

Utilizing clear and consistent schedules facilitates a smooth running classroom and grants more

time for real teaching and learning instead of constant reorganizing and planning during student

time. As students learn to comprehend and follow schedules, they develop good independent

functioning skills and direction following skills, both of which are very important skills to have for

successful functioning in future placements, e.g., vocationally and residentially. Following are

some questions teachers need to consider when planning classroom and individual student

schedules.

 Is the schedule clearly outlined so that teachers know all daily responsibilities?

 Is there a balance of individual, independent, group, and leisure activities incorporated

daily?

 Do individual student schedules consider student needs for break times, reinforcement,

unpreferred

 activities followed by preferred activities?

 Does the schedule help a student with transitions -- where to go and what to do?

 Does the schedule help a student know where and when to begin and end a task?

 How are transitions and changes in activity signaled? timer rings? teacher direction?

student monitors clock?

 Is the schedule represented in a form that is easily comprehended by the student?

Teaching Method

A teacher must systematize and organize teaching methods in order to effectively teach

autistic students.

Another way structure is used to help students function successfully is in the setting up of

teaching tasks. Again, receptive language difficulties hinder autistic students' understanding

of what is expected of them. Directions for tasks and the use of prompts and reinforcers

should be organized and systematic in order to build success experiences for students. This

makes learning situations more predictable (and therefore easier) for students and helps to

overcome distractibility, resistance to change, and lack of motivation. Giving a student

directions for tasks can be done verbally and nonverbally. In either case, the directions

should be given at a student's level of understanding. For verbal directions this means using

the minimum amount of language needed. For example, do not say, "I want you to finish

putting all these nuts and bolts together, and then, when you finish, you can go over to the

play area and choose a toy to play with." This statement gets your point across just as well,

"First finish nuts and bolts, then play. 11 Verbal directions should also be accompanied with

gestures to help students understand. In the example above the teacher could point to all the

nuts and bolts and then to the play area while giving the directions. A most important aspect

of giving directions is having the student's attention before the directions are given. This does

not necessarily mean eye contact has to be established. Some students may signal attention

by body orientation, a verbal response, or-by stopping other activities. When giving

directions, a teacher needs to make sure expectations and consequences are clear and

organized for the student. If a student does not know where materials are, how to start a task,

or what to do when he is finished, then he is not likely to perform a task up to teacher

standards.

Besides using gestures, as mentioned above, directions can also be given nonverbally with

contextual and visual cues, like systematically presenting and positioning materials and using

jigs and written instructions.

Uniformly setting up a student's work from left to right gives him an organized and systematic

base for completing tasks more independently, without as many verbal teacher directions.

Providing only the materials a student will need for specific tasks will be less confusing to

him. Placing materials in the setting where they will be used can also help a student follow

directions and complete tasks more successfully. For example, having glass cleaner, sink

cleanser, toilet bowl cleaner, and sponges sitting in a bathroom that is to be cleaned are cues

as to what tasks should be done and what materials to use.

Jigs and written instructions also help a student get and stay organized while working.

Teachers can use samples or pictures of finished products to show students what needs to

be done. Pictures and written instructions (similar to a recipe) can be used to help students

complete a sequential task in the right order. A teacher must be careful, though, not to give a

student visual cues that are too distracting. Some students may not be able to comprehend

complex picture jigs or may not have learned how to work from left to right yet. These skills

should be assessed and training planned on an individualized basis, just as any other skill is

taught.

When teaching students new tasks, teachers use prompts to help students be successful in

what they are learning and doing. There are different types of prompts used to assist

students or give them reminders. A physical prompt is used when the teacher guides the

student's hands in pulling up his pants after using the bathroom. A verbal prompt is used

when the teacher tells a student to put a napkin on his lunch tray. A visual prompt can include

a variety of forms, e.g., the jigs and written directions mentioned in the preceding paragraphs,

a color card which a student matches to a work box to get his own work, PEANUT BUTTER

written in extra large, bold letters on the jar to bring the student's interest to that jar. A prompt

can also be gestural, for example, instead of telling the student to get a napkin, the teacher

points to the napkin holder or to the empty space on the student's lunch tray. Modeling or

demonstrating how something is done can also be a prompt. Prompts can also be situational,

such as "Hi", which is a prompt to greet someone.

To effectively use prompts, a teacher must be systematic in their presentation. That is, the

prompt must be clear,.consistent, and directed toward the student before he responds

incorrectly. For example, a teacher is teaching Chuck how to wash dishes. The step she has

chosen to work on first is adding the correct amount of detergent to the water as it is running

into the sink. After a week Chuck has not shown much improvement in learning this. A lesson

usually goes like this. Chuck picks up the detergent bottle and begins squirting it into the

water. He squirts out way too much detergent. The teacher notices this and says, "No", which

is a prompt to greet Chuck. That is too much. Only use a little detergent." This is an

ineffective attempt at using a prompt.

To effectively prompt Chuck to learn the correct amount of detergent to use, the teacher

could start with a verbal prompt. When Chuck picks up the detergent bottle, she says, "Only a

little bit of detergent." Then she helps Chuck squeeze the bottle into a measuring item (for

example, a lid from a soda pop bottle) and shows him how to swish the measured detergent

into the water to make suds. This continues for 3 days. Eventually the teacher does not have

to use the verbal or physical prompts and Chuck measures the correct - amount of detergent

on his own using the soda pop bottle lid. A variety of prompts were used to make it clear to

Chuck how much detergent to use, and the prompts were all presented before he had a

chance to use an incorrect amount of detergent.

Teachers also need to be aware of giving prompts and cues to students when they do not

mean to. This is where teacher and student positioning in the learning situation is very

important. Many times correct responses can be relayed to students by the slightest

movement of the head or eyes of the teacher toward the correct response. Some students

will not continue working without glancing at the teacher after each step for confirmation and

reassurance of their performance. In these situations the teacher may want to station herself

beside or behind the student instead of in front of him or her. In this way, fewer unintended

prompts and cues will be passed on.

Most people are motivated to work because of a combination of praise from others, intrinsic

satisfaction, and compensation by paycheck. Autistic students often are not automatically

motivated by these things. Teachers need to find out what things are motivating for students

and then teach students how a contingency system works for them. For example, a teacher

discovers that a student is very interested in feeling and using sandpaper. Work times are

arranged so that he knows that when he finishes doing his work, he can use the sandpaper in

the workshop area. Hopefully, this situation helps a student to build a motivation to work.

Reinforcement can include a variety of items or activities. Many students are motivated by

food or toys that they really like. Others may be motivated by a preferred activity. Some

students may be able to earn money or tokens throughout the day and save them to trade in

for a reinforcer at a later time. All students should receive praise and social reinforcers, even

when receiving a more tangible reinforcer. There are some students for whom praise from an

adult or authority figure may be motivating enough to keep them busy working and learning.

There are also some students who will find satisfaction in completing work and do not need

other kinds of reinforcement. To utilize reinforcement as an effective teaching tool, a teacher

must be systematic in her use of it. The type and frequency of reinforcement for individual

students should be planned prior to activities. (Some students may need constant and

frequent reinforcement while others can handle more intermittent reinforcement.) The type of

reinforcer must be appropriate and natural to the activity the student is doing and to the level

of student understanding. (For example, if a student does not understand how a token

system works, then this will not be an effective reinforcer. If making requests is the behavior

being reinforced, then do not reinforce a request for juice with an m&m. The appropriate

consequence or reinforcer is to get juice.) The teacher needs to make sure the reinforcing

consequence immediately follows the behavior or skill being learned or increased so that the

relationship between the two is clear to the student. A teacher should be able to determine if

a reinforcer is effective by assessing student interest and acquisition or gains in the skill or

behavior being reinforced.

Following are some questions that teachers should consider when planning how to effectively

structure their teaching methods.

"Giving direction"

 Does the teacher have the student's attention before directions are given?

 Is the verbal language used specific to a students level of understanding and are

gestures paired with

 verbal instructions to help a student understand when he is having difficulty

comprehending?

 Is the student given enough information to be able to complete a task as independently

as possible?

 Does the setting and organization of materials help convey directions to a student?

 Are materials presented in an organized manner?

 Are there too many materials presented at a given time?

 Is a student given as much help as he needs to complete a task successfully?

 Are appropriate prompts chosen specific to a student's learning style and level?

 Are prompts presented before a student responds incorrectly?

 Has the teaching setting been structured so that a student does not receive unintended

prompts?

 Is the student given clear feedback regarding correct and incorrect responses or

behaviors?

 Are consequences and reinforcers for behaviors made clear to the student?

 Do they immediately follow the desired behavior?

 Is reinforcement given frequently enough?

 Are reinforcers based on a student's level of understanding and motivation?

Summary

To effectively teach autistic students a teacher must provide structure, i.e., set up the classroom

so that students understand where to be, what to do, and how to do it, all as independently as

possible.



Applying Structured Teaching Principles to Toilet Training

Many children with autism are difficult to toilet train. Parents and teachers have tried many

approaches to teaching the children to use the toilet independently. Not all children respond to

the same teaching techniques. A method that is helpful in one child's situation may not be useful

in another case. TEACCH consultants are often asked for suggestions for successful toilet

training. This article is the compilation of several experienced teachers' and consultants'

suggestions about this area of programming.

In thinking about setting up a program to help a child learn to toilet independently, the first

TEACCH recommendation would be to try to look at the problem from the perspective of the

student with autism. Another TEACCH recommendation would be to build in many elements of

visual structure to help the child understand exactly what is expected. Look at each element of

Structured Teaching to decide how visual supports can be added to build positive routines, clarify

expectations, and reduce confrontational situations.

The child's perspective

Even in typically-developing children, toilet training is often a difficult skill to master. While the

child may have good awareness and control of his body, there are other factors… social factors…

that determine how easily toileting skills are learned. Small children do not feel an intrinsic desire

to become toilet trained. Rather, they acquire this skill in order to please their parents and to gain

the social status of " big boy" or "big girl". This social motivation is a critical factor in determining

"readiness" for toilet training.

How might the characteristics of autism contribute to a child's difficulty in learning to

independently use the toilet?

1. The child's difficulty with understanding and enjoying reciprocal social relationships would

certainly interfere with this process. While other 2- or 3-year-olds might be proud of their "big boy

pants" and might be happy to please their parents, this type of motivation is rare in a child with

autism.

2. Given the characteristic difficulties in understanding language or imitating models, a child with

autism may not understand what is being expected of him in the toilet.

3. A child with autism typically has significant difficulty organizing and sequencing information and

with attending to relevant information consistently. Therefore following all the steps required in

toileting and staying focused on what the task is all about are big challenges.

4. Further, the child's difficulty in accepting changes in his routines also makes toileting a difficult

skill to master. From the child's point of view, where is the pressing need to change the familiar

routine of wearing and changing a diaper? After 3, or 4, or 6 years of going in the diaper, this

routine is very strongly established.

5. A child with autism may also have difficulty integrating sensory information and establishing the

relationship between body sensations and everyday functional activities. Therefore he may not

know how to "read" the body cues that tell him he needs to use the toilet. He may also be overly

involved in the sensory stimulation of the "product"-- smearing feces is not uncommon in young

children with autism. The child may also be overwhelmed by the sensory environment of the

toilet, with loud flushing noises, echoes, rushing water, and a chair with a big hole in it right over

this water! A further consideration is that the removal of clothing for toileting may trigger

exaggerated responses to the change in temperature and the tactile feeling of clothes on versus

clothes off.

Elements of structured teaching

Structured Teaching is the term given to a set of teaching/support tools designed by Division

TEACCH for people with autism. These tools are responsive to the characteristics of autism using

their strong learning modalities (visual and motor skills and enjoyment of routine) to build bridges

over some of the gaps in learning caused by their characteristic deficits. Structured Teaching not

only increases the learning of new skills but also serves to increase independence and self-

esteem, reducing behavior problems that result from confusion, anxiety, and over-stimulation.

Structured Teaching combines the use of individualized assessment, establishment of proactive

and adaptive routines, and the systematic use of visual supports to support learning.

 Beginning step: Assessment

When hoping to toilet train a child with autism, one of the first things we must do is define a

realistic goal, realizing that independent toileting may be many, many steps down the road. Each

of the steps toward independent toileting is a goal itself. It is necessary to observe and assess the

child's understanding of the toileting process in order to choose the correct starting point.

We should begin with establishing a positive and meaningful routine around toileting and

collecting data about the child's readiness for schedule training or for independent toileting.

A simple chart can be used to collect the data needed about the child's readiness. On a routine

basis, the child is taken to the bathroom for a "quick check" every 30 minutes and data is

recorded on each occasion. A sample of one format for collecting this basic information is shown

below.



Elimination Record

Child's Name: ________________________________________________

Date Begun: ________________________________________________

Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

Time Pants Toilet Pants Toilet Pants Toilet Pants Toilet Pants Toilet Pants Toilet Pants Toilet

7:00

8:00

9:00

10:00

11:00

Pants column -- In the column marked PANTS you will record every hour either:

D :if he is dry U :if he has urinated in pants BM:if he had a bowel movement U / BM:if

he had both

Of course, you don't have to wait an entire hour. Anytime you think he is wet, check him, write in

the time on the chart, and record the results.

Over a period of 1 or 2 weeks, patterns of data begin to emerge.

 Is the child dry for significant periods of time?

 Is there some regularity in his wetting/soiling?

 Does he show any indication that he is aware of being wet or soiled?

 Does he pause while wetting or soiling?

A child for whom the answers to all of these questions is "no" is probably not ready for a goal of

independent toileting, although a goal of establishing a positive bathroom routine may still be very

appropriate.

During the charting phase, we should also be assessing other aspects of the process of toilet

training. As the data is being collected,

 Is the child beginning to pick up on the routine involved?

 How are the child's dressing skills?

 Does he show any particular fears or interests related to the bathroom (reaction to

flushing, water, toilet paper roll, or other bathroom fixtures)?

 What is his attention span?

At the end of this assessment period, we will have the data needed to establish an appropriate

goal to be working toward.

A task analysis of the steps of toileting can give a picture of all the skills needed. Assessing the

child's current skills on each step of a task analysis will help us to choose a realistic goal and

remind us not to try to work on several new skills at once. Task analyses can be global or very

specific. Each step of a task analysis can be further detailed to determine teaching steps.

Examples of a global task analysis and a more detailed analysis of one step are illustrated below.

TASK ANALYSIS FURTHER TASK ANALYSIS

1. Enter the bathroom (Does not do fasteners)

2. Pull clothes down

a. Allows Adult to pull

b. Pull from calves

c. Pull from knees

d. Pull from thighs

e. Pull from hips

f. Pull from waist

3. Sit on toilet

4. Get toilet tissue

5. Wipe with tissue

6. Stand up

7. Throw tissue in toilet

8. Pull clothes up

9. Flush toilet

 Physical Structure

One of the principles of Structured Teaching involves structuring the physical environment for

success. Our goal is to create a meaningful context for an activity to take place. We accomplish

this through the creation of clear boundaries and the reduction of distractions.

When beginning the toilet training of a child with autism, we want to help the child learn that this

set of behaviors (elimination) is associated with a particular place (the toilet). Moving all

diapering, cleaning, and toileting-related dressing to this setting helps the child realize the

purpose of this room. Another way to say this is that we are trying to "isolate the concept" of

where toileting-related behaviors take place. Some families assign a half-bath in their homes to

toilet-training, since the full bathroom has many objects that are associated with other activities

and may be very distracting or confusing (bathtubs and showers, bathing toys, toothbrushes,

makeup, laundry hampers, scales, etc.)

A second goal for creating clear physical structure to assist in toilet training is to create an

environment that is secure and not over-stimulating. The child will be calmer and more

responsive with good physical support for his body. Think about adding foot support, side rails,

opening reducers, or other physical supports. Think also about the plumbing noises and echoes

of many bathrooms. Many children appreciate soft music playing or the addition of sound-

absorbent materials.

 Establish a Visually Supported Routine

After establishing an appropriate goal for the child, it is important that we teach using visual

supports for each step toward this goal. We must create a visual system to let the child know the

step or sequence of steps to completing the goal.

At the most basic level, a transition object may be used to let the child know that the toilet routine

is beginning. An object that is associated with toileting may be given to the child to serve as the

transition object that takes the child to the correct location. Or, this object may be placed in a zip-

lock bag that is glued shut. Or, this object may be glued to a card. In any case, it serves to initiate

the bathroom routine, helping the child know what is to occur and where. At a more abstract level,

a photograph or drawing of the toilet or the printed word on a card may given to the child or

placed on his schedule to accomplish this goal.

Once the transition to the toilet area has been made, it is important to continue to visually support

each step of the toileting routine. We need to let the child know each step he is to accomplish,

when the sequence will be finished, and what will happen when the sequence is finished. Again,

using an object sequence, a picture sequence, or a written list are all ways to communicate this

information to the child. It is important that the child sees the information, manipulates the system

so that he recognizes it's connection to his behavior, and has a clear way to recognize when each

step -- and the entire process -- is finished.

Examples of visual systems a variety of children follow:









Finished Pocket









________ Pull down pants







_________ Pull down underwear







_________ Sit on toilet







_________ Use toilet paper







_________ Pull up underwear

_________ Pull up pants







_________ Flush toilet









_________ Go play



The inclusion of a concrete, visual "what happens when I'm finished" piece of information is an

important part of this system. For some children this may be looked at as a motivator or even a

reward. For many children with autism, it is equally or more important as a clear indication of

closure. Task completion is a powerful motivator for most people with autism.

 Trouble-shooting specific problems

Once a visually supported transition and sequencing system has been established, we continue

to use a problem-solving approach to troubleshooting details. Whenever the child has a problem

with any step of the process, we think about (1) what his perspective might be and (2) how we

can simplify and/or clarify through visual structure. Examples follow:

Resists sitting on the toilet

 allow to sit without removing clothes

 allow to sit with toilet covered (cardboard under the seat, gradually cutting larger hole, or

towel under the seat, gradually removed)

 use potty seat on the floor rather than up high

 if strategies are helpful for sitting in other places, use in this setting also (timers, screens,

picture cues, etc.)

 take turns sitting, or use doll for model

 sit together

 add physical support

 help him understand how long to sit (sing potty song, length of 1 song on tape player, set

timer 1 minute, etc.)

 as he gradually begins to tolerate sitting, provide with entertainment

Afraid of flushing

 don't flush until there is something to flush

 start flush with child away from toilet, perhaps standing at the door

(might mark the spot with a carpetsquare and gradually get closer to the toilet)

 give advance warning of flush, setting up flushing cue system, such as "ready, set, go"

 allow him to flush

Overly interested in flushing

 physically cover toilet handle to remove from sight

 give something else to hold and manipulate

 use visual sequence to show when to flush (after replacing clothing, for example)

 when time to flush, give child a sticker that matches to a sticker on toilet handle

Playing in water

 give him a toy with a water feature as distraction, such as a tornado tube, glitter tube, etc.

 use a padded lap desk while seated

 cover the seat until ready to use

 put a visual cue of where to stand

Playing with toilet paper

 remove it if a big problem, use Kleenex instead

 roll out amount ahead of time

 give visual cue for how much, such as putting a clothespin on where to tear, or making a

tape line on the wall for where to stop

Resists being cleaned

 try different materials (wet wipes, cloth, sponge)

 consider temperature of above material

 take turns with doll

Bad aim

 supply a "target" in the water, such as a Cheerio

 larger target as toilet insert (contact papered or laminated cardboard with target drawn on

it), gradually moved down

 add food coloring in the water to draw attention

Retaining when diaper is removed

 cut out bottom of diapers gradually, while allowing child to wear altered diaper to sit on

the toilet

 use doll to provide visual model

 increase fluids and fiber in diet

 may need to enlist doctor if serious bowel withholding, may give stool softener

These ideas are not intended to be an inclusive list of steps to take to teach a child to use the

toilet. They are, however, illustrative of the problem-solving approach needed and the effort to

provide visual cues to increase understanding, cooperation, and motivation.

 Communication System

Another important step in teaching independent toileting is to plan for a way for the child to initiate

the toilet sequence. At first trips to the bathroom may be initiated by an adult directing the child to

a transition object or schedule. However, eventually the child will need a way to independently

communicate his need to go. Even though he may begin to spontaneously go into a familiar and

available bathroom, he needs to learn a concrete way to communicate this need so that he will be

able to request when a toilet is not immediately available.

As always, the first step in designing a goal is assessment. Is the child currently signaling in any

way that he needs to go to the bathroom, or is he totally reliant on an adult initiating the

sequence? If there are behavioral signals that you as an adult observer can "read", these signals

can show you the "teachable moments" when you can help the child learn to use a systematic

communication tool. Is he able to use objects, pictures, or words to communicate in other

settings?

Many children first learn to use expressively the same tool that the adult has used to teach him

about going to the toilet. For example, if Mom has been giving him an empty "baby-wipe" box to

mean it is time to transition into the bathroom to be changed, the child might begin to use this

same box to let Mom know he needs to be changed. Or, if a photograph of the toilet has been

used on the child's schedule to tell him when it is time to sit on the toilet, the same photograph

will make a meaningful expressive communication tool.

A child who is sometimes able to verbally say "bathroom" may not always able to pull this word

up at the appropriate time. When he is tired, in a new place, with a new person, with too many

people, catching a cold, upset for any reason -- his higher-level verbal skills may fail him. A child

who shows this inconsistency will also be helped by a visual support that (1) helps cue the word

he is looking for and (2) serves as a back-up system when he cannot use verbal language.



"GROUP" IDEAS FOR PRESCHOOL AND PRIMARY CLASSROOMS INCLUDING

STUDENTS WITH AUTISM: STRUCTURING FOR SUCCESS

I."THE LAYERED GROUP":

As in mathematics, remember to start with "lowest common denominator." GROUP TIME can

begin with a circle that includes the entire class. Gradually include more language oriented

activities as the activities progress. In this way, you will add "layers" so GROUP TIME will actually

consist of one, two, or even three discreet groups.

Students should only be expected to stay in the group for the activities that are meaningful to

them and appropriate for their developmental and language level. Start with the most concrete

activities such as songs with visual cues and related objects that the students can hold, shake, or

otherwise manipulate. For example, after a favorite song, direct the child who can only

successfully participate in group for a short period of time, to her next activity. It could be an

independent work session or perhaps time in the free play area.

The next level of activities for the remaining students could include calendar, weather, etc. Other

students could be directed to their next activities as interest wanes, while the remaining children

participate in more abstract or language-focused activities. The "last layer" of the group will

therefore be made up of children who will find meaning and success in the activities that require

more advanced language skills. An example of the teacher's plan for a "layered group" might look

like this:

1. FIRST LAYER: Lively songs with music, routine actions, counting, etc.

Children are given concrete objects to hold. Before a child becomes confused, bored, or

disruptive, send him to the next activity on his individual schedule while the group continues. Do

this at the end of his favorite song or one that he can sit with and enjoy. The idea is to have him

leave when he is still successful---not after he has gotten upset.

2. FOLLOWING LAYERS: More songs, Calendar, Weather, etc. Continue activities, perhaps

more songs and then language-based activities. Continue using visual cues--pictures, objects,

etc--to enhance understanding, participation, and interest. Using the same principle as above,

allow children to move to an independent work session, free play area, or other activity, as

appropriate for them. Have each child leave the group while he is still successful!

3.LAST LAYER: This layer consists of more advanced conversational type activities, or other

activities that fit the students who would benefit from participation and would find them

meaningful.

TEN TIPS FOR HELPING STUDENTS WITH AUTISM BE "STRUCTURED FOR SUCCESS" AT

GROUP TIME:

1. Teach a student with autism the routine of coming to group by having him ring the bell and

"call" everyone for GROUP TIME, or...

2. Hand him an object that is related to a lively song that he enjoys (toy bus for "Wheels on the

Bus" song). This object can be used as his TRANSITION OBJECT for group, as well as an object

to hold and manipulate during the first song. If the student has trouble waiting, start his favorite

song (tape or record) immediately after he sits down.

3. Include lively repetitive songs that the student knows and likes. Have him hold objects that

pertain to each song being sung. Follow the same routine with the same beginning songs each

day so the child learns what to expect and can begin to relax, anticipate, and enjoy the group.

4. Display the words to the song on a chart. Many young children with autism are interested in

letters and the written word--and can read already.

5. USE VISUAL CUES! As each song is presented, it should be paired with objects, pictures,

word cards, and/or the written verses. Your song library will consist of a box or folder

containing the record, tape, or CD, along with its visual cues to hand out.

6. When a particular song or songs are completed, this is the end of the first layer of GROUP

TIME. Send the child to his independent work area to complete favorite activities that have been

structured into independent tasks, or let him have a break in the free play area. Keep both the

group time and leaving the group time, a positive experience. Let the child leave the group

BEFORE he becomes frustrated or upset. A short group time is better, to begin with. At the

same time, don't just let the child leave anytime he wants to wander around the room. Give him a

definite activity to do that is an important part of his daily schedule. This is an ideal time for

"independent work."

7. Group activities will continue, this time at a higher language level, appropriate for the students

still there. The group can have as many "layers" as needed. The assistant(s) will monitor the

students who have left to work at their independent work area, in the free play area, or at

"structured play time."

8. If other students with autism remain for the extended group, be sure to continue to use visual

cues. Use objects, pictures, and/or the written word.

9. Show the sequence for the group's activities, in the form of a concrete list. For example,

represent each song or activity with visual cues (objects, pictures, or words) attached to a Velcro

strip on a long, sturdy piece of poster board. You will pull off each cue during the group, as the

activities progress, in the same way your students follow their schedules or work systems. Make

sure that the last cue represents what will come next, when GROUP TIME is finished. A

classroom management tip is to have your students go to the free play area after the group is

finished. Once all the children are there, you and your assistants can make sure everything is

ready before having your students check their schedules to continue the day.

10. Have fun! Choose songs and activities that you enjoy, too!

II. "PARALLEL ACTIVITY" GROUPS:

These groups include activities typically seen in "centers" except that they are set up with a

higher level of structure for the student with autism. The activities should be structured to promote

greater independence and success for the student with autism, while at the same time allowing

for parallel play activities in a social setting.

Some examples are:

1. Puzzle group - Several puzzles are placed on a group table. Puzzles are presented as they

would be in an independent work session. Puzzle pieces are placed in a container with the

puzzle form board. A "finished basket" is placed at the end of the table. The group is completed

when all puzzles are in the "finished basket." Several children can work around this table at the

same time.

2. Duplo group - Several small baskets or shoe boxes of Duplo activities are placed on the

table. Each basket contains one or more picture jigs (patterns to follow) with the corresponding

Duplo pieces. Create a variety of jigs to make many different models. The children in the "Duplo

group" choose a box, follow the jig, and place the finished model in the "finished basket" which is

placed at the end of the table. If you want to work on more "creative skills" with older or higher

skilled students, you can teach them to invent and draw their own jigs for other students to follow.

3. Pegboard group - Several pegboards with different patterns are placed in their own

containers. The same idea as in the above groups.

4. Other groups include: Lotto card group, Tinker Toy group, etc.

III. "SHARED ACTIVITY" GROUPS:

These groups are similar to the common activity groups as described above, except that they

require a higher level of social abilities. Instead of the children working on similar, but separate,

activities, this group requires that two (or more) children work on the same activity. They don't

need to take turns, but they will complete the same puzzle or pegboard, at the same time. The

materials should be large enough to accommodate more than one child, like a large puzzle, or a

large pegboard. When introducing a child with autism to this type of shared activity, it is very

important that the child can already complete the activity by herself. The added element of

working with another person is really teaching the child a totally new skill. For many young

children with autism, this type of group is difficult. Start with small steps.

IV. YOUR IDEAS:

If they are at the appropriate developmental level, many group ideas can be adapted for the

student with autism. Remember the basic principles of Structured Teaching, and remember to

make it VISUAL. Look through the eyes of the student with autism and structure the activity so he

will clearly understand what is expected of him. Make sure you include a way to for the student to

know when he is finished, and what he is to do next.