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The moment he stepped out of the school bus, Ryan*, an 11-year-old with Autism Spectrum Disorder (ASD), would be off and running — around to the back of the school, all over the schoolyard and eventually into the school where he’d wander the halls before settling into class. A staff member always followed closely — sometimes for up to an hour. School staff had learned that trying to redirect Ryan usually agitated him and, at times, led to angry outbursts. On several occasions he had hurt people. So initially, the staff went with this path of least resistance, but eventually sought help from the school board’s autism team.

“We determined that Ryan really enjoyed the bus ride — so much that he was over-stimulated by it,” explains Andrea Dekker, OCT, a Durham DSB teacher working as the board’s Autism Facilitator. “Running around after getting off the bus had become his entrenched self-calming routine.” After establishing the cause for Ryan’s behaviour, Dekker helped school staff work out a plan for teaching him a more acceptable way to regulate his feelings.

“We developed a fitness circuit for Ryan,” says Dekker. “Jumping on a mini-trampoline, tossing a ball into a basket, playing catch with his EA, and walking the halls removing pictures of hands which served as visual cues for the end of the routine.” Once they had taught Ryan this routine, he was happy to follow it and was generally in class within 15 or 20 minutes.

Then and now

Thirty years ago, schools weren’t often dealing with challenges like this. Most children with ASD did not go to neighbourhood schools. The few who did were in segregated classes.

But now, most Ontario children with autism attend their local school, more often than not in a regular class. And the number of students with ASD has increased dramatically — even in the past 10 years. For example, the Durham DSB, home to around 70,000 students (including Ryan) had about 650 children with ASD in 2007–08. By 2012–13, that number had ballooned to over 1,100. Similarly in 2012, the National Epidemiologic Database for the Study of Autism in Canada reported substantial rises in the prevalence of autism in three parts of Canada including Southeastern Ontario (Kingston, Brockville, Peterborough, and so on), where ASD diagnoses had increased by 142 per cent in boys and 161 per cent in girls from 2003 to 2010. Part of that increase is due to changes in diagnostics and some catch-up diagnosing of children who would have flown under the autism radar in the past. Bottom line: Having a student with ASD in your class is typical for Ontario teachers these days.

As a result teachers have had to increase their knowledge and understanding of this developmental disorder and acquire the skills to help their students with ASD succeed. Accordingly, Ontario school boards have been training teachers, developing resources and putting together autism resource teams to help teachers better understand and serve children with this multi-faceted disorder. However, because no two children with autism are exactly alike, educating students with ASD requires not only knowledge and training but also a keen sense of observation and the ability to adjust to the needs of individual children.

Looking deeper

In Ryan’s case, the key was addressing what experts refer to as the functional reasons behind his behaviour — a concept rooted in Applied Behaviour Analysis (ABA), the approach Ontario’s Ministry of Education requires schools to use when designing special education programs for students with ASD. Put simply, ABA is an approach to changing behaviour (reducing problematic behaviours and increasing helpful ones) based on principles of learning theory. ABA methods can help educators figure out why a child’s behaving in certain ways, and what can be done to systematically shape behaviour in a more positive direction.

“If we want to influence the behaviour of students with ASD we first have to understand what function it serves,” says Elizabeth Starr, OCT, a professor of education at the University of Windsor. “Nine-tenths of the iceberg is below what we see on the surface. If a child with ASD is disruptive, it’s often because the situation is aversive or stressful in some way. It might be that the lights are too bright, the task too difficult or the room is too noisy, for example.”

The sensory overload Starr is referring to is a kind of stress, and research suggests that stress is a significant problem for children with autism at school. A 1992 study found that children with ASD who were integrated into mainstream schools tended to secrete higher levels of cortisol — the stress hormone — than their neurotypical peers. Sensory and social experience are key sources of this stress. Teachers talk about another way it plays out: anxiety over not knowing what is expected and what is going to happen next.

Individual strategies

Frank Emanuele, OCT, a learning support teacher at Parkview PS in Komoka, recalls his steep learning curve when he started working with a boy named Grayson in his Grade 3 class several years ago. “At first we were dealing with a lot of meltdowns and the only strategy we had was to take him out of the classroom,” Emanuele recalls. That solved the immediate problem but it wasn’t helping Grayson learn more acceptable behaviour. Emanuele gradually learned that he got better results by addressing Grayson’s stressors.

“Grayson would get distressed when he didn’t understand what was going on or what was expected of him,” says Emanuele. “He’d get loud, start to cry, bang his hands on his desk.” So Emanuele found ways to help him understand what was happening in the classroom. At the beginning of each day, he would review with Grayson what was going to happen that day, particularly if there was a change in routine. “If he knew what was coming he could handle it.” Emanuele also helped Grayson manage his anxiety with calming techniques like deep breathing or wearing a weight vest.

Dekker agrees that it’s important to teach students how they are affected by ASD and strategies they can use to cope and calm themselves. “When I return to the classroom next year I plan to work with all of my students on self-awareness around stress and anxiety — how they are feeling emotionally and also how different parts of their body are feeling,” she says. “I will also teach self-calming strategies like deep breathing or physical activity. With students with ASD or other special needs I’ll be watching for little opportunities to do extra one-on-one work practising self-calming techniques and talking about when to use them.”

Helpful tools

Communication is another major source of anxiety and stress for children with ASD, particularly those who are non-verbal. “It is very important for a child with ASD to have functional ways to communicate,” Starr says. “When children are unable to communicate you’re much more likely to see meltdowns.”

Starr is a proponent of the Picture Exchange Communication System (PECS), a copyrighted picture-based system of alternative communication developed in 1985. PECS can be used to teach non-verbal children with ASD to make simple requests using pictures. Eventually, children can learn to construct simple sentences with pictures. (PECS now offers an iPad app, an additional teaching aid for helping students who have trouble learning picture discrimination. A demo video is available on the company website.)

“In as little as 10 minutes, I have seen non-verbal children begin to grasp the idea that they have to give the card to a person to get a toy or snack they want,” says Starr. “That teaches the child that communication involves getting an idea across to another person, which is very important.” While some people have worried that dependence on picture-based communication may inhibit the speech development, Starr says that research has shown that PECS can help develop speech.

Another tool that Dekker recommends for teachers working with students with ASD is structured teaching, as defined by the Treatment and Education of Autistic and related Communication Handicapped Children (TEACCH) Autism Program, developed at the University of North Carolina.

The five aspects of structured teaching are as follows.

Obviously there is much more to structured teaching than can be explained here. The Durham DSB has been providing three-day sessions for teachers on structured teaching for the past 10 years. “It wasn’t until I became an autism facilitator that I really began to understand the value of structured teaching,” Dekker says. While this approach does require some upfront work, it’s actually less work in the long run — fewer meltdowns, less time explaining and re-explaining things, and less stress for both students, teachers and parents, Dekker says.

Ongoing learning

Regardless of the tools a teacher may use, teaching students with ASD involves an ongoing learning process, as Tanya Giroux, OCT, can attest. Giroux, who teaches Grade 1 at École élémentaire catholique Saint-Joseph in Sturgeon Falls, sometimes uses student work to illustrate Level 1, 2, 3 and 4 examples of a completed assignment. Earlier this year, one assignment required children to write a short letter, with the date, salutation and understandable two-sentence message positioned properly. “I had photocopied letters written by previous students to use as visual examples of Level 1, 2, 3 and 4,” she explains. “When the students had completed their letters they were supposed to compare their own work with the four examples and then make corrections or alterations based on this self-evaluation.”

That worked well except with one little boy with ASD. “He wasn’t getting the format right because he had focused completely on trying to make his printing exactly like the printing in the student example,” says Giroux. “I never would have anticipated that the little imperfections in the students’ writing would be so distracting.” After Giroux made new exemplars in her own handwriting, the boy was able to do the assignment just fine. “It’s an example of how flexible and observant you have to be with students with ASD.”

*not his real name

What about high school?

We tend to hear a lot about young children with autism, but what happens when they reach high school? One initial challenge is the transition from elementary to secondary school. That’s why Renee Zarebski, OCT, starts the process in March or April of Grade 8. Zarebski, a program resource consultant with the St. Clair Catholic DSB, has been working on school transitions with her colleague Denise Emery, OCT, High Needs Autism Lead with the Lambton Kent DSB, as part of the co-terminus boards’ collaborative services model. Here’s how it works.

“Parents or guardians meet in the spring with secondary and elementary teachers, resource teachers, principal and a consultant (myself) to discuss any supports or strategies the student may require,” says Zarebski. This generates information that goes into a profile, which helps Grade 9 teachers gain a sense of the students’ strengths and weaknesses, calming behaviours and, generally, what the child needs to be comfortable in class and learn. High school transition planning can also include visits to the secondary school before the year’s end, having secondary staff come to the elementary school to observe staff working with the student, and even setting up trial school bus runs. “We also plan each student’s schedule carefully,” says Zarebski. “We try to select courses that the student will be most engaged in for the first semester.” Some students may take three regular courses and then a general learning strategies course, which is a small group of students with special learning needs working with a resource teacher on organizational strategies, study habits or completing homework and assignments.

One approach the Simcoe County DSB took to help secondary teachers understand and meet the needs of students with ASD was to set up a professional collaboration site at one of its high schools. “For the past three years, Barrie North Collegiate was a professional collaboration site for inclusion in autism,” says Hailey McLean, OCT, teacher/consultant working with the board’s Complex Needs Team. Teachers from other high schools could get release time to go and spend a day at Barrie North. “They would observe students for half the day and for the rest of the day I would work with them to develop an action plan for taking what they learned back to their own classroom,” says McLean. Simcoe County DSB secondary teachers are also encouraged to use the Modified Comprehensive Autism Planning System (M-CAPS), a tool that helps educators create a comprehensive plan and schedule for students with ASD. “M-CAPS embeds the modifications, supports, structure, transition plans and skills to be taught as outlined in the student’s IEP,” says McLean. “Essentially, it’s the IEP in action. Teachers have told me they find M-CAPS helps them set up the classroom environment in ways that helps students with ASD be comfortable and successful.”

Learning to be social

Chris Magowan, OCT, is rolling a ball back and forth with Bradley,* a seven-year-old student with Asperger’s Disorder. It’s not just any ball — this one is covered with stickers of crystals — and they’re not just doing it for fun. Bradley had been hitting one of the other kids a few minutes ago.

But rather than try to restrain him or take him out of the room, Magowan is trying to help the boy calm down by engaging him in a physical activity. He chose a sticker-covered ball because he knows Bradley is very interested in amethysts; he knows everything about them.

Magowan is using a principle borrowed from an autism therapy called the Developmental, Individual Difference, Relationship-based (DIR) Model. His school, Oakwood Academy, a small Mississauga private school where about 80 per cent of the students have ASD, is trying to embed some DIR concepts into its program.

Rather than trying to break social skills down into chunks and teach each chunk step by step, DIR tries to build children’s ability and motivation to participate in and actually enjoy social interaction. It does this by reducing the sensory and social stressors and distractions that make it tough for children with ASD to interact. The children are then provided with two one-hour play therapy sessions where their parents learn to reduce stressors and read their child’s cues. This is combined with 20 hours per week of parent-child activities (known as Floortime), where parents gradually build their child’s ability to socialize.

Unlike other behaviour therapies, DIR uses no external rewards like candies, stickers or praise. The only rewards are the intrinsic ones that the rest of us get from social interaction: sharing happiness and excitement, getting comfort or sympathy or simply enjoying idle banter with some friends, according to linguist Devin Casenhiser, who directed a major study of an adapted version of DIR at York University.

“The goal is for children to make eye contact for the same reasons other people do — because it’s a way of understanding and connecting with the other person,” says Casenhiser, who is now an assistant professor of audiology and speech pathology at the University of Tennessee.

The York study found that, among other things, one year of treatment produced sizable improvements in children’s ability to engage in, enjoy and initiate joint attention with their parents — now recognized as one of the key social deficits of autism. When babies and toddlers can’t get interested in what Mom or Dad are interested in, they miss out on a ton of important brain-building social experiences, including those that promote language development. This, theorists believe, contributes to the development of autism symptoms.

The challenge for Oakwood teachers is that DIR does not translate easily to a larger group setting such as a school. Oakwood teacher, Chris Magowan says it’s more about trying to embed the principles of DIR in the teachers’ approach to relating to students. “We try to get into the child’s world, to really understand what is driving their behaviour,” he says.

“A lot of it is about using the child’s interests and passions to go into his world and draw him out into our shared experience.”

*not his real name

Resources

For more information about TEACCH methods, Dekker recommends visiting teacch.com, and the books How Do I Teach This Kid to Read? by Kimberly Henry and Tasks Galore, by Laurie Eckenrode, Pat Fennell and Kathy Hearsey.

For information about the Picture Exchange Communication System go to pecs-canada.com.

Summer Training: The Geneva Centre for Autism offers a summer training course for teachers in Toronto, Ottawa, London and Barrie. For information: autism.net/training/summer-training-institute.html.