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Running header: AUTISM SPECTRUM DISORDER 1

Autism Spectrum Disorder

Franciscan University of Steubenville

Autism Spectrum Disorder


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With the ever-growing population of children with disabilities, schools and intervention

specialists all around the United State have been experimenting with different strategies to help

children with disabilities overcome their obstacles. The obstacles that students with disabilities

may face include cognitive, physical, and emotional difficulties (Gal, Schreur, & Engel-Yeger,

2010). Although students with disabilities face many challenges, today, teachers and schools

have been working diligently to implement successful interventions and teaching strategies for

those with disabilities. Teachers play a very important role in the development and education of

those with disabilities (Toran, Westover, Sazlina, Suziyani, Hanafi, 2016). Both special

education teachers and general education teachers must be able to implement the correct

interventions necessary to ensure that students with disabilities are getting the most out of his/her

education. This includes making sure that the student with disabilities is in the correct placement,

in the least restrictive environment, that his/her behaviors can be identified and managed by

school personnel, and that the student with disabilities is receiving the services necessary for

his/her success. One type of high incidence disability that a teacher can be expected to see in the

classroom is Autism Spectrum Disorder (ASD) (Gage, Lierheimer, Goran, 2012).

Description of Autism Spectrum Disorder

In 2013, the American Psychiatric Association evaluated the Pervasive Developmental

Disorder (PDD) categories. To be labeled with this type of disorder, the behaviors that have been

observed must be severe, pervasive, and these behaviors must be proven to interfere with social

development and communication skills. The umbrella term (PDD) included autistic disorder,

Asperger Syndrome (AS), and PDD Not Otherwise Specified (PDDNOS). These different

disorders have, since then, been combined into one term, ASD (King, Navot, Bernier, & Webb,

2014).
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Research shows that, in the United States, ASD is the fastest growing developmental

disability and about 1 in every 68 children is diagnosed with the disorder (CDC, 2014). The

prevalence of this disorder has increased drastically considering that at one point, ASD was

believed to be rare. The characteristics of ASD can be most commonly seen around the age of

three, with some early signs of ASD that occur around the age of two including inattentiveness to

someone who is speaking, poor eye contact, and little interest in things (Ingles & Elder, 2009).

The effects of ASD on children are manifested in dramatically different ways, therefore, ASD is

known as a spectrum disorder. Two children with ASD could have completely different

behaviors, levels of social and speech skills, among other things (Block, Block, & Halliday,

2006). The main characteristics of ASD include the defective interest in and capacity for proper

social interactions, speech impairments, and having a fixation of certain activities or interests

(APA, 1994).

ASD is an idiopathic disorder and its possible causes have been feverishly debated over

in past years, yet no one cause has been identified. After years of research, several factors of

possible cause have been debated, and most have been abandoned. Unsupported causes that have

been given much attention within society include vaccines and the way in which the child with

ASD was reared. The Immunization Safety Review Committee reviewed many published and

unpublished studies that examined the causation between autism and the measles-mumps-rubella

(MMR) vaccine. The committee concluded that there is no causal relationship between the MMR

vaccine and ASD (CDC, 2004). Child rearing was a very popular possible cause for autism in the

past. The primary focus of treatment involved the parents and children working together and

communicating. This viewpoint has also been rejected by psychologists in recent years (Ingles,

Elder, 2009).
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For the best results for students, ASD needs to be diagnosed as early as possible. The

assessment and diagnosis of ASD is based on the Diagnostic and Statistical Manual of Mental

Disorders (DSM-V) (Foley-Nicpon, Fosenburg, Wurster, & Assouline, 2017). Under the DSM-

V, to be diagnosed with ASD, the individual must show continual difficulties in social

communication and interactions as well as difficulties with behaviors that are repetitive. In

addition, these symptoms must be present in the early developmental period, must be proven to

cause impairment in life, and the disturbances must not be better explained by an intellectual

disability ("DSM-5 Diagnostic Criteria", 2013).

The diagnosis of ASD also heavily relies on studying the individual's behavior. The first

stage of the diagnostic period involves a developmental screening test that is conducted by the

child’s pediatrician. The screening test is simply a questionnaire that parents complete with

questions geared towards activities and behaviors that a typically developing child should

accomplish, but children with ASD may not be able to do so. The second stage of diagnosis

involves a trained multidisciplinary team. The team tests the child’s body movement, openness

to change, their listening skills, verbal abilities, and their social relatedness. Based on these

observations, the group comes up with a diagnosis and shares the diagnosis with the parents

during a meeting in which the parents are to have ample amount of time to ask the professional

team their questions about their child’s newly diagnosed disorder (Strock, 2004).

Communication Skills

Many children with moderate to severe ASD have no, or very little, ability to

communicate through speech. Some examples of behaviors that a nonverbal child with ASD

would rely upon to communicate would be finger pointing, the use of their facial expressions,

and minimal sign language (Xin & Leonard, 2014). Children with ASD who are able to speak,
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usually do so differently than their typically developing peers. Children with ASD are more

likely to speak loudly, to speak with an abnormal tone, to speak in short, one to two-word

sentences, or engage in echolalia (i.e., - the repeating of another’s spoken words). This lack of

communication skills has been shown to lower their social acceptance at times. Lack of social

relatedness is just one of the many challenges in which children with autism face on a daily basis

(Block, Block, & Halliday, 2006).

Strategies to Support Communication: iPads

Many studies have found that the use of augmentative and alternative communication

(AAC) by children with ASD have positively influenced the productivity of language and

communication. AAC devices are used to help individuals communicate without using verbal

speech. These devices are designed to help individuals with disabilities reduce the everyday

frustrations of not being able to verbalize wants and needs. (Light, 1989). Examples of AAC

include symbol boards, tablets, speech-generating device (SGD), and downloadable applications

(Thiemann-Bourque, Mcguff, & Goldstein, 2017). AAC devices also can be grouped into “high-

technology” and “low-technology” categories. The use of high-technology appliances is often

encouraged by professionals and these tools, such as iPads, have been found to increase ASD

attention span and account for a decrease in behavioral issues (Eliçin & Kaya, 2016).

Xin and Leonard et al. (2016) conducted research to determine how effective technology

is when trying to teach children with ASD language and communication skills. Their study

looked at 3 previously diagnosed ASD children aged 10 who had very little language and speech

capabilities. Two of the participants were labeled as nonverbal, and the other participant was

labeled as having less than 2 years old expressive language skills. Each participant was given an

iPad with the application Sonoflex already downloaded. The Sonoflex app speaks phrases in a
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gender and age appropriate voice when icons are clicked. For example, the participant clicks on

the number 4, the iPad speaks: “four.” The study tracks the requests of the teacher, along with

the responses and comments of the participant. During the beginning of the study, the number of

requests made by the teacher and the responses of the participant was lower than they were

towards the end of the study. The convicting conclusion that can be made from the data is that

the number of comments made by the participants increased majorly and that the iPad provides

students with ASD the ability to interact with peers and to communicate with their teachers.

Picture exchange system. Another form of AAC is the picture exchange communication

system (PECS). This low-technology technique had been found to be a key intervention to

enhance children with ASD’s communicative skills as well as their social skills and interaction

with peers. PECS consists of six phases. These phases include how to communicate, distance and

persistence, picture discrimination, sentence structure, responsive requesting, and commenting.

First, the individual learns to use a single picture to exchange for an item that is desired. Once

mastered, the individual, still using a single picture, learns to generalize the skill by using it in

different settings, with different people, and across distances. Then, individuals learn to select

from two different pictures to indicate what they want. The next phase is when individuals learn

how to create simple sentences (e.g. “I want”, “Let’s go to”). Next, individuals learn how to use

the cards to answer questions such as “What would you like to eat?”. The final phase is when

individuals can make comments in their everyday life following simple questions (e.g. “I see…a

bug”, “I hear…a train”). After mastering the system, students with disabilities can communicate

more effectively with their teachers and their peers. This system provides students with the

opportunity to communicate similarly to how their peers without disabilities communicate

(Bondy & Frost, 2014). PECS has been found to have a positive effect on the way in which
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children play, decrease socially unacceptable behaviors and increase the probability that a

nonverbal child with ASD engage in verbal speech. Another encouraging fact is that there is a

positive correlation between the number of people who are being taught this system and the

retention rate of this system. It has been found that the majority of people who are taught to use

this system, will learn how to use this system effectively and to their benefit (Greenberg,

Tomaino, & Charlop, 2012).

Thiemann-Bourque et al. (2016) investigated how effective the PECS is in terms of social

communication among peers. The participants without disabilities were trained and shown how

to effectively bring about communication from their peers with ASD in accordance with the

phases in the PECS. Through the PECS training, the participants without disabilities learned how

to communicate with their peers with disabilities. This study assessed the effectiveness of PECS

and its ability to provide quality communication between students with disabilities and students

without disabilities. In the study, effectiveness was measured by how often the PECS system was

used, how relevant the tool was to the interaction, and the results of the interaction in terms of

satisfaction. The study concluded that the use of PECS can be helpful to children with ASD not

only when trying to communicate with peers, but also when trying to implement social skills.

After the nondisabled peers were trained, they could effectively and independently receive the

pictures and exchange objects with their classmates with ASD. This study sheds light on the

importance of PECS training for children without disabilities in order for children with ASD’s

communication and peer interaction skills to be optimized in the classroom.

Social Skills

Children with ASD tend to experience difficulty properly using their communication

skills in social environments. This deficiency can affect the way the student creates and
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maintains friendships among same-age peers, as well as the way they engage in effective social

interaction with adults. Not being able to engage socially is especially difficult because social

interactions are a large part of everyday life. Smiles, jokes, and signs of sadness are just a few

examples of the wide variety of social cues that an individual without disabilities can pick up on

and either smile back, laugh at the joke, or try to console the sadness away. For an individual

with ASD, these types of everyday, seemingly small interactions, do not come naturally.

Compared to their typically developing peers, children with ASD are less likely to initiate social

interactions and to respond when others initiate a social interaction (Radley, O’Handley,

Battaglia, Lum, Dadakhodjaeva, Ford, McHugh, 2017). Unlike typically developing children,

children with ASD need to observe and be taught proper social interaction. Social skills training

has been found to be very effective as an intervention strategy for children with ASD who are

struggling with social skills (Murphy, Radley, & Helbig, 2018).

Strategies for Social Skills

Social skills training. Social skills training (SST) aims to increase the number of

reciprocal friendships and to increase the quality of friendships for students with ASD. It also

aids in more extensive and effective social skills (Ke, Whalon, Yun, 2018). These types of

training sessions are most beneficial in a group setting to ensure that children with ASD engage

in social interactions with a range of students. Another positive of group settings is to give the

child the opportunity to put their skills into action through practice. This strategy is effective

because it gives children the opportunity to practice their social skills in settings in real, practical

situations (Deckers, Muris, Roelofs, & Arntz, 2016).

Deckers, Muris, Roelofs, & Artnz et al. (2016) took children with ASD and had them

grouped for their SST training. The study was designed to determine whether group social skills
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training was effective in increasing social skills. Each group consisted of a trained psychologist,

who was the leader of the group, a co-therapist, and four children with ASD. Each child and

parent were given a workbook that included themes and guidelines for each session. The sessions

included lessons on basic social skills. Social skills such as initiating a conversation, using

manners, resolving conflict in friends, and how to help others were taught. Within the highly

structured sections, children were given the opportunity to review the social skills they had

learned from the previous session and to practice the new social skills from that current session.

For generalization purposes, the children were given work to do at home. Participants were to

practice previously learned social skills in their home setting and to reflect on these skills. The

study found that after teaching these social skills, the participants were much more likely to use

these social skills in their daily lives. Although the study was found to be effective for this group

of children, there is still more research that needs to be done. We must keep in mind that even

seemingly small social interactions of children with ASD can have significant ramifications on

that child’s ability to go through his/her daily life.

Superheroes social skills. The Superheroes Social Skills program is a mixture of some

of the most effective social skill intervention strategies. The Superheroes Social Skill program

focuses on behavioral training, social stories, video modeling, self-monitoring, and role-play

scenarios. An example of what the video model (DVD) would consist of is a group of

superheroes presents a target skill, why that skill is important for the child to learn and gives

examples of how that target skill could be achieved. One of the most important features of the

Superheroes Social Skills program is how it is aimed towards generalization. It has been found

that children with ASD have difficulty generalizing the skills they have learned into different

environmental settings (Radley, O’Handley, Battaglia, Lum, Dadakhodjaeva, Ford, McHugh,


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2017). The Superheroes Social Skills program incorporates many different environments and

stimuli into the training model to help with generalization. The generalization includes training

in different settings such as different classrooms with peers, different school settings, along with

at home training with parents as well (Leaf, Leaf, Milne, Taubman, Oppenheim-Leaf, Torres,

Yoder, 2017).

Murphy et al. (2018) studied the Superheroes Social Skills program by evaluating four

participants in middle school with identified ASD and teacher-reported difficulties in peer

interactions. During the periods of intervention, the students were given a Superhero Social

Skills DVD segment to watch. Then the researchers would give incorrect examples of social

skills and ask the participant to identify the issue. The participants then engaged in role play with

other participants. Following the role-play, the participants were shown a review video of the

skills that were just discussed and practiced. As a way to generalize the training, parents, and

guardians of the participants were the probes in some of the tasks. Research on the effectiveness

of the Superheroes Social Skills program is extensive when discussing elementary-aged children.

This study’s results, as determined by the growth in participants social skills, indicate that this

program is also beneficial to children in middle school who have ASD. The results showed an

increase in social skill accuracy, correct use of body language when engaged in social

interactions, and an increase in expression of wants and needs.

Conclusion:

While research is still being gathered about autism and the effects that children may face

daily, teachers need to be aware of some hardships that children with ASD must live through.

Teachers of students with autism need to be aware that autism does not affect each child in the

same way (Nagar, Gupta, 2017). A teacher may implement a certain intervention that may be
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beneficial to one student with autism and may generalize the intervention and think that this

intervention must be beneficial to all children with autism. Children with ASD, especially those

who are nonverbal, have a difficult time expressing themselves (Shih, Patterson, Kasari, 2016).

Teachers need to make sure that they have a strong relationship with their students with ASD in

order to understand and know what they want and what they need. Being able to understand a

child’s needs, whether they have a disability or not, is a key factor in being an effective teacher.

Children with ASD are less likely to accurately process social cues (Shih, Patterson, Kasari,

2016). This becomes an issue when they do not understand the proper way to navigate through

their school day. A child with ASD may yell out answers during class instead of raising their

hand, be quick to judge a peer who gets a question wrong and may not be able to use their social

skills to create friendships with his/her peers (Ke, Whalon, Yun, 2018). It is important that as

teachers we support children with ASD through the entire day, in the least restrictive

environment, giving them opportunities to calm down (e.g., a sensory room) if needed. The

supports for children with ASD need to be constantly available.

While the effects and causes of ASD will continue to be debated for years to come,

researchers will also continue to conduct studies regarding the effectiveness of already

implemented strategies and interventions and some researchers will create new, and even more

effective methods of intervention. While the prevalence of this disorder is projected to grow, so

will the possible interventions and supports that can be implemented in homes and classrooms.

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