What is the best placement for children with autism? 1 WHAT IS THE BEST PLACEMENT FOR CHILDREN WITH AUTISM: INCLUSION, SELF-CONTAINED, OR A SPECIAL SCHOOL? What is the best placement for children with autism: Inclusion, self-contained, or a special school? Kristin Mameli Long Island University What is the best placement for children with autism? 2 Abstract The big debate in education right now is where children with autistic spectrum disorder or ASD should be placed. Some people say that due to the nature of the disorder, children should be placed in a setting that will best accommodate their needs, such as a special school or a self-contained classroom. Others say that socially, children with this disorder should be placed in an inclusion or general education classroom, to learn proper behavior from their peers and be accepted. This paper will help to clarify what autism is, the different placements students with Autism Spectrum Disorder can be taught in and how well they may or may not do in each one. What is the best placement for children with autism? 3 What is the best placement for children with autism: Inclusion, self-contained classroom or a special school? According to studies done by the Center for Disease Control (CDC), autism spectrum disorders are on the rise. Previously, the number of children diagnosed with Autism Spectrum Disorder (ASD) was limited to 4.5 in every 10,000 births. In the past few years, that number has increased to 1 in every 166 births. As of February 8, 2007, the prevalence of autism rose to 1 in 150 live births. This new finding shows that the study and approach to autism is more important than ever, especially when it comes to education. The high amount of children newly diagnosed with the disorder will affect the education system by forcing them to find the best placements for children with this devastating disorder (National Institute of Mental Health 2007). History of Autism Autism is defined as “a developmental disorder that impacts the way a child views the world” (Zelan 1). Eugen Bleuler was the first psychiatrist to coin the term “autism” in 1911. He used the term within the realm of schizophrenia. It meant that the patient had an extreme withdrawal from reality and all social contact that went with life. In 1943, Leo Kanner, conducted a study on 11 children that exhibited characteristics of the autistic type. He used the word “autism” to describe the children because they were not able to keep normal everyday relationships with others. Among the socialization delays (Bregman 2005), he also noted that children with ASD suffered from echolalia (repeating words), perseveration, repetitive behaviors such as hand flapping or rocking, and cognitive delays. In 1944, Hans Asperger fell upon a similar disorder, but one that had better communication ability and overall problem solving ability, but still the same hindering socialization problems that Kanner had experienced. Even though Asperger wrote down his What is the best placement for children with autism? 4 findings, they were not actually followed until the 1970’s. During this time, Autism was still categorized as a psychotic condition, very similar to childhood schizophrenia. When the Diagnostic and Statistical Manual of Mental Disorders (DSM) III was introduced, there was a category for autism, Classical autism, Pervasive Developmental Disorder (PDD) and another for atypical autism. Currently, ASD falls under three different areas: impairment of social interaction, impairment of communication and repetitive behaviors, interests and activities (Bregmen 2005). Characteristics Children who fall on the spectrum exhibit many of the same characteristics. A few of the main characteristics are lack of socialization, lack of communication and the need for sameness. Connor (1999), writes that children who experience this disorder may also be identified through a number of other characteristics. Some of these include an unawareness of the child’s own self, anxiety due to changes in routine, hearing or seeing things, very limited vocabulary and speech abilities, and motor impairments. National Institute of Mental Health, or NIMH, gives an array of common indicators for ASD as well as other indicators. They are 1) by the age of 1, the child is making no attempts to talk, point or gesture, 2) does not speak by 16 months, 3) does not put together words by age of 2, 4) does not respond to his/her name and 5) has difficulty socializing and loses language. Some of the other signs consist of poor eye contact, inappropriate play with toys, repetitive motions and organization of toys, and does not smile. The term ASD encompasses many different disorders with the same characteristics as classical autism. Children may have low functioning autism or high functioning autism. Within this spectrum there are classical autism, Aspergers Syndrome, Pervasive Developmental Disorder- Not Otherwise Specified (PDD-NOS), Rhett’s Syndrome and Childhood Disintegrative Disorder. Even though What is the best placement for children with autism? 5 there are disorders under the umbrella of autism, they are still of an autistic heritage based on the characteristics that these disorders all share (NIMH 2004). Causes Despite the recent research, scientists have yet to determine the main cause of autism. There are a number of different theories regarding the disorder. One theory (Connor 1999) is that autism is caused during the early stages of ones life where the body is most susceptible to disease. Any kind of sickness such as allergies, measles, or lack of oxygen can stunt or hurt the nervous system, which then may lead to autism. Another theory is (Tsai 2005) that there may be some problem with the frontal lobe of the brain which may cause drooling, clumsiness and a number of other characteristics seen in children with autism. As of late, there has been some research done on genetics and its link to autism. On February 18, 2007, the Autism Genome Project had some what of a breakthrough. They discovered that on chromosome 11, there may be rare variations that give a higher incidence towards ASD (NIMH 2007). Interventions and Therapies Therapy and interventions for children with ASD have improved greatly from earlier years. There are many different types of programs such as TEACCH, PECS, and ABA. These programs, although just a few, all aim to improve the quality of life for students with autism, either through direct instruction, socialization or changing behavior. For each student the method will differ, but the goal for each is all the same: to help these students live life as normally as possible and achieve as much as they can. TEACCH. Treatment and Education of Autistic and Related Communication-Handicapped Children, or TEACCH (Connor 1999), is a program which encourages structure, behavior and cognitive What is the best placement for children with autism? 6 interventions and direct teaching with visual cues. Siegel (1999) explains that this method, based out of the University of North Carolina, is focused mainly around main traits of autism: routine and sameness, visual processing of information and independence. Due to the extraordinary amount of visual cues and pictures, this method can be very beneficial for preverbal children and also for older children who are nonverbal. Although each station of TEACCH is discrete trials and tasks, it rarely, if ever, allows for socialization, which for most children with autism is something they need. PECS. Along with sign language, this system is used to help nonverbal students communicate. Created by Bondy and Frost (Sigafoos 2005), this method is called the Picture Exchange Communication System or PECS due to the physical nature of the act. First students are introduced to pictures for their needs and possibly even their wants. Using the teachings of ABA, they are trained to hand over pictures of their desires and in turn, receive what they want. Some students are able to point to the pictures, which allows for more independence on their part. ABA. During the 1980’s, Dr. Lovaas began using ABA (Applied Behavioral Analysis) to help his patients who had autism (Siegel 1999). This approach is used to teach skills and also reinforce desired behaviors. There are two major parts to ABA: Discrete trial training and applied verbal behavior. An article by Axlerod and Kates-McElrath (2006) aims to explain both parts of the ABA program. During the 1970s, a man by the name of O. Ivar Lovaas created the Young Autism Program. This program is made up of discrete trail training and applied verbal behavior. For the What is the best placement for children with autism? 7 experiment, Lovaas reported behavioral treatment program results for two groups who were diagnosed with autism. The experimental group received treatment in a one to one setting for forty hours per week for two years. The control group participated in ten hours or less, one to one treatment for two years. The results were that nearly half of the experimental group reached normal intellectual functioning by the end of two years (Axlerod & Kates McElrath 2006). Through the use of discrete trials, students are exposed to repetition and limited ability to fail at a task. Discrete trial training breaks tasks down into their smallest parts, which allows students to master each step before moving onto the next. There is also constant reinforcement for tasks attempted and preformed. In order for a student to gain access to the reinforcer of choice, they must be compliant with the commands given. The other part of ABA, Applied Verbal Behavior, has parts of DTT within it but teaches expressive language using manding. Manding is a verbal request by the student which allows them access to what they want when the request is made (Axlerod & Kates McElrath 2006). There are some differences in the instruction of DTT and AVB. Even though both are taught in a 1:1 ratio, the way instruction is given differs. For DTT, there are limited distractions within the environment and there are constant visual cues given to help the student throughout the day. AVB teaching takes place in a normal environment. This natural environment teaching is more based on student interest. The teacher has to be able to balance time in a student’s natural environment with time spent on task. Both services are delivered about 30-40 hours a week. Both of these programs also rely on errorless teaching. This means that the student is hand fed the answers to avoid failure, in hopes that when they attempt it themselves, they will know how to do it. The DTT version deals with sequencing, prompting, fading and visual cues. This allows for the student to either get it right the first time or be able to self correct after a What is the best placement for children with autism? 8 negative response. For AVB there are trials that follow an error. If the child is told to clap hands and the child stomps his feet, there is a hand over hand guiding and then the child is asked the command again (Axlerod & Kates McElrath 2006). When students with autism are ready to go into the school system, there are many different options to choose from. Parents will sometimes start their child in an early intervention class before kindergarten. Students are tested, written up an IEP based on their need and then parents and teachers as a team will decide placement. This is not always an agreeable situation. Both parties have choices to make about placement such as, where will the student learn best, what is the least restrictive environment for the student and where will they succeed the most. Should it be in an inclusion classroom, a self contained classroom or a special school? Inclusion Inclusion is defined as making a pact to each child, to teach them to their maximum potential, in a classroom that is the least restrictive for them. The debate about inclusion has been going on for many years now. It is one that may never be solved due to the different needs of each student and the ideals of teachers and parents. The theory of inclusion is, according to Harmon and Jones (2005), “...when special education students are included in regular classrooms, they have greater achievement, better self concepts, and more appropriate social skills than those special education students who are placed together in one classroom”(187). This theory, even though seen at work, may not be for every student. History of Inclusion During the 1800’s, students with disabilities were in special schools, far away from the typical populations of students. These atypical students, suffering from physical, mental or emotional disabilities, received little to no education. It was believed that they could not be What is the best placement for children with autism? 9 taught. For the past two decades, the inclusive movement has been the topic of debate for placement of children with autism (Harmon and Jones 2005). In 1975, the Education for all Handicapped Act was created. It stated that there was to be “free and appropriate public education for all students with disabilities in the least restrictive environment possible” (Grainer-Sirota, Kremer-Sadlik, Ochs & Solomon 400 2001). This act gave the push for students with disabilities to have the same rights as their typical peers. In 1997, the act was renamed as Individuals with Disabilities Education Act and it gave children, especially with autism, the right to be taught with their peers in a general education setting. The success for children with autism is based on the fact that they might learn the appropriate behavior from their peers, but they will need intervention to support, not only socialization, but academics also. Inclusion Today Inclusion today is viewed in a variety of different ways, depending on where one is located. In the United States, many people view inclusion as a different method of teaching students with disabilities. Ainscow (2007) states, in his article, that the idea of inclusion is different internationally. Within other countries, people see inclusion as a means to get rid of social exclusion. It is a theory of welcoming all different kinds of learners working together towards a common goal. In order to reach this goal though, there has to be collaboration between schools, parents, student and the community to want to include students with ASD in their classroom. In order to accomplish this, a model was set up to help teachers educate children with ASD (Ainscow 2007). The Autism Spectrum Disorder Inclusion Collaboration Model What is the best placement for children with autism? 10 In the article by Boer-Ott, Simpson and Smith-Myles (2003), they discuss how including students with autism may be a challenge for some educators. Some educators find themselves less than capable of teaching and serving the needs of children on the spectrum. To support teachers, a model called The Autism Spectrum Disorder Inclusion Collaboration Model, was created. The main ideas of this model are that students with ASD benefit from being with their typical peers. Support staff will be present to help the teacher and the student with their needs. The general education teacher will take on the responsibility of being the main teacher, but collaborate with special area teachers to help the student succeed (117). There are five major parts to this model and no one part can work alone. The first part is called Environmental and Curricular Modifications, General Education Classroom Support and Instructional Methods. This kind of support is very important for students on the spectrum because they have such diverse needs. Some students may need smaller class sizes, while others may need their class work simplified. Teachers also need the ability to plan more thoroughly for their classes so that they can handle any difficulties that may arise (Boer-Ott, Simpson and Smith-Myles 2003). The second part is called Attitudinal and Social Support. This deals with keeping the teachers attitudes about inclusion and ASD positive. If the teacher does not have faith that the child with ASD will succeed in their classroom, then the likely hood that the student will fail is high. Positive attitudes by the school administrators, teachers, students and even parents are necessary for the success of children with ASD. As for social support, this model allows for certain training methods to be applied. Students with ASD require direct instruction of all skills to learn. They may also need to be prompted to begin working, respond to a question or accomplish other daily tasks. Typical peers within the classroom may be trained in how to What is the best placement for children with autism? 11 interact with peers on the spectrum. Peer tutoring also falls under social support for children with ASD (Boer-Ott, Simpson and Smith-Myles 2003). The third part is called Coordinated Team Commitment. This section is here because often the special educator assumes responsibility for the special education student. Within the idea of inclusion, the general education teacher assumes main responsibility for the success of the student with ASD. This model allows for both the general education teacher and the special education teacher to get together and talk about how to meet the needs of their students. There is a shared responsibility between the two teachers. The general education teacher must accept the responsibility of teaching a child with autism, but has every right to be included in the decision making process for that student and full support from the special education teacher (Boer-Ott, Simpson and Smith-Myles 2003). Recurrent Evaluation of Inclusion Procedures is part four. In order for a program to succeed, assessment must be a part of that. This section in the model deals mainly with how the child is progressing within a general education environment. On students IEPs, certain goals must be met. An IEP team is continually evaluating if those goals are being met within the current setting and changing the goals accordingly. The team constantly checks if the there are appropriate services being provided, if the placement is benefiting the student, and if there is evidence of student participation. This team observes and uses a checklist to keep track of what is being met and what is not. Then they are able to target both the strengths and weaknesses of the child and the program, and discover a way to make both improve. The last part is HomeSchool collaboration. Not only does IDEA provide students for the least restrictive environment, but they also require the participation of parents in educational planning, decision making and implementation (Boer-Ott, Simpson and Smith-Myles 2003). What is the best placement for children with autism? 12 Pros and Cons of Inclusion Today there is a large division of opinion on whether inclusion is good or bad. Not only is this based on if the child can survive the academics, but also the social integration that goes with inclusion. In 2005, Boutot and Bryant conducted a study about the social integration of students with autism in an inclusive classroom. They found that the children who had high functioning autism and were included in general education classrooms were chosen for games, birthday parties and a number of other social gatherings just as much as their peers (pp 14). Mack (2007) had written an article that highlighted how wonderful inclusion could be. A mother of a student who had disabilities was worried that her son would not be able to live up to the standards of a normal fifth grade classroom. After a few months, the mother was thrilled because not only was her son learning but he was with typical children. Within the inclusive setting, children with IEPs receive all the same services they would in a self contained setting. In New Hanover County, schools are proposing a pilot program where more and more students, including students with autism, are to be placed in inclusive settings. A special education teacher within the district stated that “inclusion in regular classrooms has boosted self-esteem, improved behavior and garnered acceptance of special needs students” (Mack 2007). This is true for some students, but for others being in an inclusive setting may be their downfall. Durand (2005) states that one of the main things to change when thinking about inclusion is the expectations of the students on the spectrum. If they are to succeed, then the presupposed ideas of a general education teacher must change. It has been noted that many teachers are very hesitant to agree to inclusive practices under their supervision. There have been attitude studies conducted that show that general education teachers have not yet learned What is the best placement for children with autism? 13 how to empathize with students on the spectrum. This can be devastating for students placed in that kind of environment. Avramidis, Bayliss and Burden (2001) noted that many teachers were against inclusion due to either their lack of knowledge about the disorder or about the disruptions that went on in the classroom due to pull outs and behaviors. There are some important factors that teachers and parents should keep in mind when deciding on an inclusive placement. First, the child with little to no behaviors will succeed more in a general education setting. Any type of challenging behavior such as hitting, biting, and any other inappropriate behavior may make the experience one of distaste for the students in the class and the child with autism. Next, both teachers and students should be informed of the included child’s abilities and made aware of how to make the transitions easier for the child with autism. Last and most importantly, services will be needed to help the student with autism through their included setting, both academically and socially. If all these are kept in mind and followed, the student that is included should be able to blend in with his or her classmates and have a very successful time in school (Blacher & Kaladjian 2005, pp. 83). Special Schools During 1896, there was a major Supreme Court ruling that stated separate but equal. This meant that students with disabilities were equal as people, but had to be taught or taken care of in their own setting, not that of a public school. Within this time, a eugenic scientist by the name of Francis Dalton was studying the hereditary lines within races of people. A follower of Dalton, Madison Grant said that populations coming into the country should be controlled because “those judged unfit would be unfit forever” (D’Haem 2004). History of Special Schools What is the best placement for children with autism? 14 Due to the push of hereditary lines of races, President Churchill was willing to do something to preserve humanity. By 1912, laws were passed in at least eight states that called for the sterilization of the insane and mentally retarded. Schools, like the Vineland Training School for Feeble-Minded Girls and Boys in New Jersey, were created to teach and take care of children who were mentally impaired. Many parents, during the 1920’s, placed their children in homes or schools like the one above because that was the recommendation of their physician. The doctors would tell the parents that the children would be better cared in an institution, when in reality, the parents would be just as competent or even more so for the benefit of their child. This was proven when Jeanne D’Haem (2004) conducted a study to find children who were living in institutions and see if they would benefit from being in a regular school setting. When she arrived at Fernald State Hospital she was told that some children did not even wear clothes because there was not enough for everyone. Some patients would just be wrapped up in a sheet. Also, many of the children there did not get the education they deserved. Even though this was just one place out of hundreds, imagine how horrible it must have been back in the 1920s for some of these schools that were just getting off the ground. Since then, placements for children, especially with autism, have improved tremendously. Residential Placements For some students, residential placements are the best interventions to meet students’ specific needs. These placements can be seen as a last resort or a place to go when all else has failed, when in reality, these are places that work to help the student succeed. Nowadays, residential placements have updated facilities and trained personnel to meet the needs of the students they see each day (Battles & Bryant 2006). What is the best placement for children with autism? 15 In the article by Battles and Bryant (2006), they documented information about the King’s Daughters School Center for Autism in Columbia, Tennessee. This center was created to improve communication and living skills in children with autism. Within this placement there are five different classrooms that promote different types of skills: Communication, academics, life skills, hard play and sensory integration. The teachers in each room use the TEACCH method, which was discussed earlier, as a way to focus on learning and behavior management. Communication is one of the hardest areas to breach for children with autism. The KDC created a communication room to teach nonverbal students a way, through either sign language or pictures, to converse. The students are also taught to use technology as a way to facilitate communication as well as learning. Jody Miller, director at KDS, stated that, “Once we have a solid communication system in place, we can work with students on learning daily living skills and academics” (2006 21). Once students have the ability to communicate their needs and wants, they are then brought to different classes where they can learn life and academic skills. The life skills area consists of practicing laundering, cooking and taking care of their needs. The academics focus mainly on sorting and assembling, something that students will have achievement in, especially when they go for jobs. Pros and Cons of Special Schools Not all special schools are residential placements. Some may be an all day school that students with disabilities go to because they fail to learn or function in a regular setting. Another placement is an education center that fosters growth in students that may not have been happening in public schools. Within a special school or placement, students are taken care of by highly trained personnel in the areas of the child’s needs. In KDC, students who are residents do get exposure to their peers. They are taken from the autism center to the main campus where What is the best placement for children with autism? 16 they are able to get the social integration they need, along with being able to use all the different types of facilities there. They are also taken into the towns where they buy groceries, go to the movies and participate in everyday life (Battles & Bryant 2006). There are many cons when associated to residential and special school placement. One is that all children with autism are in one room with no positive role models to help change their behavior. There could also be a difference of opinion on where children should be placed. All special area teachers have different ideas on the levels that a child is at or can attain and that affects the ideas of others. Another con is that the separation of typical and atypical children can lead to teasing and censure when they finally meet. If students are not taught to be tolerant from the very beginning, their views can damage others peoples self esteem (D’Haem 2004). Self Contained Classrooms A placement of self contained means that the child is removed from the general education setting and brought into a smaller, more structured setting that is taught by a special education teacher. There is a multitude of different academic levels within a self contained classroom, as well as a plethora of different behaviors that need management. Students who have high needs such as autism, emotional disorder, behavioral disorder or even learning disabilities may be found in this kind of setting (Mauro 2007). The self contained classroom calls for much of the academic learning to be done with atypical peers in a highly structured setting. The children are usually mainstreamed for specials and lunch with their typical peers. The learning that goes on in a self contained classroom is highly differentiated. Here, teachers are able to devote time to creating a classroom full of auditory and sensory stimulation, as well as areas for down time and time outs. There are times during the day that students come together as a group to be taught a lesson, while at other times What is the best placement for children with autism? 17 they may be working at centers that are designed specifically for their learning needs (The Paideia School 2007). Pros and Cons Some advantages of a self contained classroom are that one teacher is with students throughout the day and is able to control the content being given to the students. This means that the teacher understands the difficulties each student has, the best way that those students learn, how far the teacher can push the students, and what kind of interests they have that can make the lessons relate to their lives. There is also a great deal of communication between teacher, school and parent. Within the self contained classroom, teachers are able to have an integration of all subjects as they desire. Depending on the students needs, the teacher can choose to work on phonics rather then another subject, but somehow tie in the subject so students have a greater degree of success later on. Some disadvantages of self contained classrooms are that the students are only with their typical peers for maybe fifteen to twenty percent of the day. Children can be mainstreamed, or selectively placed in regular classes, based on their ability in that subject (WEAC 2007, pp 1). All students that are in self contained have strengths in certain areas and are expected to earn the right to be in a general education class with their peers. Behaviors can hurt a students chance to be moved into the general education or even an inclusive setting. Sometimes lessons may even be lost due to behavior management that may go on in the classroom daily. Unfortunately, some of the students need the structure that only a self contained classroom can provide (The Paideia School 2007). Outlook for the Future There will always be debate circling placement of students with ASD. This is mainly because some parents and teachers have seen great change in students based on placement and What is the best placement for children with autism? 18 others have not. Word of mouth really affects attitudes and outcomes of children with ASD. One of the greatest challenges that the school districts may face are making all their classroom curricula more flexible and creating a more structured environment. As discussed above, teacher attitudes create a setting of either success or failure. Some teachers, especially general education teachers without knowledge of working with children with ASD, may be hesitant to accept a child into their classroom without proper training (WEAC 2007, pp9). The placements above all have good and bad surrounding them for children with ASD. Inclusion may be great for a child with high functioning autism in the way of academics, but may be hindering due to the social skill deficits the child may have. Students in an inclusion classroom may not be as accepting towards students who are different from them, especially if typical peers were never exposed to their atypical peers. Residential placements provide students with a highly structured environment where they are accepted for who they are. A downfall, as with a self contained classroom, is students do not have typical peers to model behavior for them. They are also cut off from their peers, which may lead to exclusion and a lowering of self esteem due to censure and being made fun of (Battles & Bryant 2006). The argument that autism poses within an educational setting will be different for every child. Some children with autism are capable of handling general education classes with assistance, while others still need the structured environment of a self contained classroom or a residential placement. Whatever the debate may be, the outcome should benefit the child. Parents, teachers and specialists may see different sides to a student. These sides should all be factored in when deciding on a placement. The law states that students have the right to the least restrictive environment possible, but it has to benefit the student and the others within that placement. 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