Newsletter
Volume 30 | 2007 | Number 3
Issues, Trends, and Scientifically-Based Practices for Learners with Asperger Disorder
By Dr. Richard L. Simpson, University of Kansas
Individuals diagnosed with Asperger Disorder (AS) are characterized by social peculiarities, social deficits and an odd communication style. Their cognitive and language abilities are generally within the average to above-average range.
Recognition of AS is credited to a Viennese medical student, Hans Asperger, in 1944. Related to foreign language conversion and World War Two, Asperger’s work was largely unknown in the United States and most other countries until the 1980’s. In 1994 AS was added to the Diagnostic and Statistical Manual of Mental Disorders classification subgroup of Pervasive Developmental Disorders. It has subsequently become one of the most frequently diagnosed forms of ASD.
Effective Practice and Learners with Asperger Disorder
Numerous challenges confront professionals and families who teach and manage children and youth diagnosed with AS. Among the most significant of these issues involves identifying and using effective interventions and treatments. This task is being made more difficult because of a significant lack of agreement and a paucity of empirically supported effective practices for learners with AS. That there are few practical and well-designed guidelines that professionals and families can use to make methodology-related decisions has also made this a problematic process. Some of the most efficacious and frequently used tools for children diagnosed with autism, such as discrete trial training, are frequently not well suited for learners with AS, thus further complicating methodology selection.
In spite of debate over the precise meaning and fundamental elements that comprise effective practices for students with AS, there is nevertheless widespread recognition of the need for a variety of objectively and scientifically validated methods for these students. Effective practices are generally agreed to refer to methods and strategies that have been shown to be objectively utilitarian based on scientifically valid empirical research. A salient caveat connected to effective practices is that these methods will confer significant benefit only when properly tailored to fit individual student needs and applied consistently and systematically with fidelity by well trained and knowledgeable personnel.
There is virtually universal agreement that identifying and using effective practices with learners with ASD and AS is essential. Putting in place professional development and training mechanisms that will ensure that there are personnel who are able to correctly use methods that are judged to be effective is an additional effective practice consideration. Accordingly, there are two principal general actions associated with identifying effective practices for children and youth diagnosed with AS. The first involves identifying fundamental features associated with effective programming; evaluating existing methods that are purported to be suitable for use with children and youth with AS; and training professionals to correctly apply and evaluate these practices. The second involves creating mechanisms for evaluating future methods, strategies and methodologies for learners with AS; and training professionals to use these objective evaluation criteria and mechanisms in their work. That is, since the field is so dynamic related to new methods continually being introduced, evaluating the relative utility of existing methods is only a partial answer to the ASD effective practice issue. Accordingly, objective and scientifically valid evaluation strategies that can be used by practitioners and others are needed to facilitate assessments of new methods and the suitability and effectiveness of these practices with individual students. Of course, applied behavior analysis is the ideal means for carrying out this process.
In spite of the novelty of AS and the debate over what methods are most effective for these students, there are clearly interventions and strategies that appear to have significant promise. These strategies and practices require additional validation, however. Discussed below are several of these perceived-to-be promising methods.
Visually Oriented Environmental Supports
Visually oriented environmental supports appear to have significant promise for learners with AS. These antecedent-focused tools present abstract concepts such as time in a concrete and manageable form and thus provide organization those students with AS need to understand and predict activities and events, anticipate change and comprehend expectations. Visual supports provide learners information about daily activities and events by illustrating tasks that will occur at specific times and sequences. Visual schedules have been used to increase on-task behavior and facilitate students’ abilities to independently make transitions from one activity to another (MacDuff, Krantz, & McClannahan, 1993).
Varied forms of visual supports have been successfully used with learners with AS In addition to daily and weekly schedules, (a) task organizers have been used to provide a task analysis of the steps required to complete specific activities; (b) choice making menu’s have been used to structure decision making; (c) turn taking cards have concretely shown students the social skill of alternating turns at an activity; (d) consequence maps illustrate for students the consequences associated with various responses; and (e) pictures and icons have been used to reflect environmental change and facilitate transitions associated with breaks in routine.
Cognitive-Based Intervention Methods
Cognitive-based intervention methods involve use of self-management strategies that teach students to actively monitor and control their own behaviors, as opposed to relying on parent or teacher prompts or external interventions. Self-management strategies also assist students in generalizing what they learn in various natural settings. Related to the need that learners with AS have for practical and transportable strategies and supports that facilitate generalization and skill maintenance within general education classrooms and other natural settings, there is obvious value in teaching these students to self-monitor and self-assess, self-record, self-evaluate and self-reinforce.
Self-management programs typically involve some combination of two or more of the following strategies: self-monitoring (e.g., self-recording), self-evaluation (e.g., decision-making), and self reinforcement for goal attainment. Thus, the process involves individuals learning to differentiate the occurrence of a target response; reliably self-record the target response in accordance with some specified standard; evaluate their behavior relative to the standard; and subsequently deliver contingently self-selected rewards and reinforcement.
A number of researchers have reported positive outcomes associated with using cognitively-based self-management methods with children and youth with ASD, including related to transitioning and engaging in desired social activities (Lee, Simpson & Shogren, 2007). Clearly, in spite of time and training requirements and with full awareness that not every student diagnosed with AS will be responsive to this method, self-management strategies appear to have a number of strengths and appear to have the elements of a promising method.
Social Stories
Social stories are designed to provide learners salient cues and acceptable responses for particular social situations. In spite of relatively limited empirical support, social stories and related social supports are widely used with children and youth diagnosed with AS.
Gray and Garand (1993) recommended that social stories include (a) descriptive sentences (i.e., designed to provide information about the subject setting and background information); (b) directive sentences (i.e., descriptions of appropriate behavioral response for particular situations); (c) perspective sentences (i.e., identification of possible feelings and reactions of others); and (d) control sentences (i.e., descriptions of related actions and responses using nonhuman subjects). For example, a control statement might read: “A cat scratches to get a family’s attention; when Rhonda is at school she quietly raises her hand to get the attention of her teacher.” Social stories for young children and those lacking literacy skills may incorporate pictures or icons. Research in support of social stories has not consistently followed Gray et al.'s protocol and there is little evidence that their formula-based recommendations are required.
Students with ASD and AS have been successfully responded to social story interventions for an assortment of behavior problems, self-help skill instruction, academic problems and social skill acquisition (Bledsoe, Myles & Simpson, 2003). This tool is relatively easy to implement, can be used with a range of students and behavioral targets and is easily taught to parents and professionals. Additional efficacy research is clearly needed on this popular intervention, however.
Concluding Thoughts
There is little chance that there is a single best-suited and universally effective method for all students with AS. Nevertheless there are effective and promising methods that should form the foundation of programs for these students, and these methods and strategies will likely lead to the best outcomes. Presently there are limited confirmed scientifically supported practices for students with AS. Accordingly, it is essential that the field continue to make progress in identifying and using those methods that have the greatest potential for achieving desired outcomes; training personnel to use these methods with fidelity; and evaluating future methods that claim to be suitable for use with children and youth with AS.
References
Bledsoe, R., Myles, B., & Simpson, R. (2003). Use of social story intervention to improve mealtime skills of an adolescent with Asperger Syndrome. Autism, 7(3), 289-295.
Gray, C., & Garand, J. (1993). Social stories: Improving responses of students with autism with accurate social information. Focus on Autistic Behavior, 8(1), 1-10.
Lee, S., Simpson, R., & Shogren, K. (2006, in press). Effects and implications of self-management for students with autism: A meta-analysis. Focus on Autism and Other Developmental Disabilities, 21(4).
MacDuff, G. S., Krantz, P. J., & McClannahan, L. E. (1993). Teaching children with autism to use photographic activity schedules: Maintenance and generalization of complex response chains. Journal of Applied Behavior Analysis, 26(1), 89-97.