Chapter 9 Autism – Flashcards

Autism is a lifelong developmental disability that is best described as a collection of behavioral symptoms. The extent and severity of those symptoms provide a range of diagnoses referred to as autism spectrum disorders.

Autism means a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age 3 that adversely affects a child's educational performance. Other charac-teristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or daily routines, and unusual responses to sensory experiences. The term does not apply if a child's educational performance is adversely affected primarily because the child has an emotional disturbance. A child who manifests the characteristics of " autism" after age 3 could be diagnosed as having " autism" if the criteria in the above paragraph are satisfied.

1. qualitative impairment in social interaction, as manifested by at least two of the following: a. marked impairment in the use of multiple nonverbal behaviors such as eye- to- eye gaze, facial expression, body postures, and gestures to regulate social interaction b. failure to develop peer relationships appropriate to developmental level c. a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people ( e. g., by a lack of showing, bringing, or pointing out objects of interest) d. lack of social or emotional reciprocity 2. qualitative impairments in communication as manifested by at least one of the following: a. delay in, or total lack of, the development of spoken language ( not ac-companied by an attempt to compensate through alternative modes of communication such as gesture or mime) b. in individuals with adequate speech, marked impairment in the abil-ity to initiate or sustain a conversation with others c. stereotyped and repetitive use of language or idiosyncratic language d. lack of varied, spontaneous make- believe play or social imitative play appropriate to developmental level 3. restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following: a. encompassing preoccupation with one or more stereotyped and re-stricted patterns of interest that is abnormal either in intensity or focus b. apparently inflexible adherence to specific, nonfunctional routines or rituals c. stereotyped and repetitive motor mannerisms ( e. g., hand or finger flapping or twisting, or complex whole- body movements) B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: ( 1) social interaction, ( 2) language as used in social communication, or ( 3) symbolic or imaginative play. C. The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder.

pervasive devel-opmental disorders ( PDD) or autism spectrum disorders. These terms refer to a collection of syndromes and conditions ranging from those in which only a few of the characteristics of autism are present or the characteristics are present in a very mild form, to autism itself. Over time, each of these syndromes were given specific names and the characteristics more clearly delineated. The following dis-orders are considered to be part of autism spectrum disorders. You can see how the symptoms of the disorders overlap:

" Classic" or Kanner's Autism— As defined above, children exhibit se-verely disordered verbal and nonverbal language and unusual behavior patterns.

• Asperger's syndrome— This is one of the most common autism spec-trum disorders. Estimates vary, but a Approximately 1 in 500 school- age children are diagnosed with Asperger's syndrome ( Torpa, C. B., 2009). Individuals with Asperger's syndrome may have many of the social and behavioral characteristics of autism but, importantly, without any marked delays in language and cognitive development. They experience difficul-ties in social functioning and relationships, but not in intelligence or lan-guage skills. A child with Asperger's syndrome is likely to be a student who does very well in some academic areas, yet not so well in others. He or she may work well alone and love to use the computer and the Internet, but resist working in cooperative learning groups or on group projects.

Also called " high functioning autism" or " atypical autism." Children experience nonverbal language difficulties but do not meet the criteria for other PDDs such as autism, Asperger's syndrome, or Rett's disorder.

Rett's disorder. A rare genetic neurodegenerative disorder that primarily affects girls, resulting in loss of social skills, language, and motor develop-ment, accompanied by distorted hand movements.

After a few years of normal develop-ment, children regress progressively in all areas, including language, social development, and motor development

Another difficulty in attempting to diagnose autism is the fact that it coexists with a number of other conditions, such as fragile- X syndrome, an inherited disor-der caused by chromosomal abnormalities. Unlike autism, fragile- X syndrome is diagnosed through genetic testing. Affected children exhibit many of the same behaviors as children with autism, such as communication delays, stereotypic movements, perseveration, and hyperarousal. In fact, according to the National Fragile- X Foundation, about one- third of all children with fragile- X syndrome are clinically diagnosed with autism and approximately 20 percent of children with fragile- X also are diagnosed with PDD- NOS Between 2 and 6 percent of individuals diagnosed with autism have autism caused by the fragile- X gene mutation

Estimates of the prevalence of autism fluctuate and often include the entire spec-trum of autism disorders. In general, it is estimated that between 1 in 80 and 1 in 240 ( average estimate of 1 in 110 children) are diagnosed each year with autism or a related disorder

Autism was first defined in the mid- 1940s by Leo Kanner ( 1943), who identified a cluster of behavioral characteristics that are essentially the same as those used today to diagnose children with autism. Kanner speculated about a range of possible causes, but it was Bettleheim ( 1967) who felt strongly that autism was a psychiatric response to an unsupportive and deprived environ-ment. Naturally, the person responsible for the young child's environment was the mother, and it was she who was held responsible for the autistic state of her young child. How? It was assumed at the time that the child's withdrawal from social contact, abnormal focus on objects rather than people, and delayed lan-guage development reflected a lack of appropriate socialization and loving be-haviors from the mother. In fact, the term refrigerator mother was used to describe the mothers of young children with autism— cold, unfeeling, icy. So, if you were a mother forty or fifty years ago and had a young child with autism, not only did you have the great challenge of trying to teach your toddler how to talk and play and smile, you also had to shoulder the burden of responsibility for supposedly causing these learning problems.

Although there is still much speculation in the field, today our hypotheses about the causes of autism focus on physiological differences. The search for physio-logical causes for autism began in the 1960s and has received increasing support in the past few decades. Most scien-tists agree that the collection of symptoms constituting autism spectrum disor-ders are neurodevelopmental disorders originating before birth. In other words, it is likely that autism is caused by differences in the neurological system— beginning very early in the embryonic development of the child. Children with autism have specific differences in brain development, specifically in the brain stem ( see Figure 9.1). Many also have specific genetic abnormalities. Although many genes appear to be associated with autism, no clear causal relationship between a specific genetic abnormality and the occurrence of autism has yet been established.

Certainly, one of the puzzling factors about the onset of autism is that in close to 30 percent of children diagnosed, the defining characteristics don't appear until the child is a toddler, at which point some of the children begin to regress markedly in communication and social abilities. This phenomenon is referred to as autistic regression Although this characteristic may be attributed to genes that are active only during specific times of a child's development, it has fostered increased, yet unsubstantiated, speculation about direct environ-mental influences, such as childhood vaccines or prenatal exposure to diseases such as rubella. On the other hand, the most recent research presents twin studies that suggest, although genetics is still considered a factor in autism, it may be less of a factor than we originally thought. In a large, recent twin study— known as the California twin study— Hallmayer et al. ( 2011) found that although identical twins had a 60 to 70 percent chance of one having autism if the other one did, frater-nal twins had a 20 to 30 percent chance of this occurring. Although these results certainly illustrate the genetic component, the fraternal twin dual diagnosis rate was higher than expected, and the identical twin dual diagnosis rate was lower than expected.

Children with autism can be found at all levels of intellectual ability. As we stated earlier, although the data are changing, it appears that close to 50 percent of people diagnosed with autism are also diagnosed with intellectual disabilities. Individuals with autism, even those without significant intellectual disabilities, display unusual, uneven learning patterns, often consisting of relative strength in one or two areas of learning. Although a very small number of children with autism are truly gifted in one area, many do have learning strengths that are sur-prising in light of the child's overall level of functioning. A child with autism may demonstrate ability in auditory memory, organiza-tion, or telling time and yet have extreme difficulty in other learning skills, such as reading or writing.

Children with autism also may be very rigid in their demands for environ-mental sameness and dependent on exact routines during the day

Children with autism are usually described as average in appearance, if not as un-usually attractive children. Most young children with autism look like any other typically developing young child. There are some physical characteristics that can be associated with autism spectrum disorder, including a number of features as-sociated with the symmetry of the face ( mouth, eyes, general facial asymmetry) and shape of the head ( brachycephaly, prominent lower jaw) ( Ozgen et al., 2011). These characteristics are truly minor, are not present in all children, and are dif-ficult to observe unless one knows to look for them. Researchers also hypothesize that some physical characteristics could present

Many individuals with autism appear to be highly sensitive or reactive to cer-tain sensory stimulation. In particular, many children with ASD have differences from typically developing children in the way they process information from all five senses ( hear, see, smell, taste, touch), as well as the proprioceptive ( reflex) or vestibular ( balance) systems ( Baker, Lane, Angley, & Young, 2007). This means that some individuals will appear highly sensitive and react strongly to loud noises, for example, or perhaps be unable to stand wearing a rough fabric— reactions can vary widely depending on each individual child. Research related to audi-tory responses suggests that although students with ASD scored similarly to typi-cally developing children on auditory tests— in other words, there appear to be no physiological differences— they exhibited more reactive behaviors in response to sounds ( Stiegler & Davis, 2010; Tharpe et al., 2006). It has often been hypoth-esized that oversensitivity to external stimuli is responsible for some of the un-usual behaviors individuals with ASD may demonstrate ( e. g., hands over ears, hand- flapping, toe- walking). Research continues to explore these relationships.

Individuals with autism typically demonstrate patterns of social behavior that re-flect social withdrawal and avoidance of others. These patterns can include failure to make eye contact and to attend to others in the room, even if the other indi-viduals are attempting to play with or talk to the child. The individual with autism simply may not react or may actively avoid other people's efforts at social inter-action or communication. In fact, a characteristic description given by parents is that the child with autism appears to look through or past them ( Maurice, 1993; Park, 1998). Historically, young children with autism were often misdiagnosed as being deaf, because their inattention was so marked that parents assumed they couldn't hear the noises around them, including their own names.

Many children with autism focus their attentions on objects instead of other people. They seem to disregard the desire for joint attention— the mutual shar-ing of experiences, activities, or even objects with friends, teachers, or parents

Difficulties and delays with language and communication are the hallmarks of children with autism. As we've just mentioned, many toddlers with ASD don't engage in or initiate joint attention— seeing a dog outside, pointing to it, and urg-ing mom to look at it too. Joint attention emerges about the same time as lan-guage and specific deficits in joint attention are related to delays in receptive and expressive language development

If individuals with autism acquire oral speech, their speech patterns may take unusual forms. One common example is echolalia, the repetition of speech sounds. For example, if you asked a child, " What is your name?" the child would respond, " What is your name?" The child also may repeat certain words over and over— the jingle from a television advertisement or a sentence he or she has overheard. Although echolalic speech may seem to be nonfunctional— that is, not used for a specific purpose such as asking a question— it often does represent an attempt at direct communication.

As you can probably see, many individuals with autism have a difficult time with reciprocal language— the use of language to give and receive information. Reciprocal speech combines the social or pragmatic aspects of communication, such as eye contact and turn taking, with the mechanical requirements of commu-nication. It also involves skills in both receptive language, that is, understanding and interpreting information, and expressive language.

We still have much to learn about the receptive communication skills of indi-viduals with autism. As we mentioned earlier, individuals with autism often do not respond to language directed toward them. Sigafoos ( 2000) conducted research that reinforced our knowledge base on the relationship of poor communication skills to inappropriate behavior. Interestingly, he found stronger correlations between inap-propriate behavior and receptive communication than between inappropriate be-havior and expressive language. In other words, children with autism may be even more frustrated by their inability

Individuals with autism may display a unique range of characteristic, sometimes disturbing, behaviors. Some are typical of the types of behaviors you might see in any child, but they occur at greater rates and intensities and at unexpected times.

An unusual behavioral tendency demonstrated by some individuals with autism is the performance of repetitive patterns of behavior such as rocking, twirling objects, clapping hands, and flapping a hand in front of one's face. These repetitive, nonharmful behaviors are often referred to as stereotypic behaviors, or self- stimulating behaviors. Some people with autism display a number of stereotypic behaviors and perform them frequently, if not constantly. Others may engage in one or two behaviors, such as rocking, during periods of inactivity.

Our job, therefore, is twofold: ( 1) determine the purpose or function of the behavior, and ( 2) identify and teach an appropriate, alternative behavior that will serve the same function. To accomplish these goals, we conduct functional behavioral assessments that include observations of the student performing the behavior in home, school, or play settings

Several times throughout this chapter, we refer to issues and challenges faced by families of individuals with autism. It is difficult to talk about autism without including parents in the discussion. Parents have been substantial contributors to the knowledge base in the field, both as ethnographers and as sources of objec-tive evidence on the effectiveness of various interventions. Unfortunately, most parents are forced into the roles of treatment evaluator, teacher, and, in some cases, intervention designer. Because of the dearth of practical information about living with children with autism, difficulty getting an early diagnosis, inconsis-tency in treatment recommendations, and lack of early intervention programs, parents took the reins and brought the needs of children with autism into focus. This effort by parents is still under way, but now many parents and professionals are working together, and parent advocacy has resulted in a renewed demand for objective, empirical proof of an intervention's effectiveness as well as increased interventions for very young children.

tops the list of concerns for many parents. Because early diagnosis is so critical, a number of screening tests have been developed that can be given in the home, doctor's office, or day care settings and can depend largely on parent input. The National Institute of Mental Health ( NIMH) ( 2011) recommends that screening instruments routinely should be part of well- child check- ups.

Once a diagnosis is obtained, parents are faced with a growing body of litera-ture and testimonials about literally dozens of interventions, all of which should begin when the child is about 2 years old. So, sifting through the research and try-ing to find the intervention and desired service provider in the community as soon as possible become the next priorities. Of course, families with limited resources or those living in rural areas may experience even more difficulty finding appro-priate services. It is no wonder that parent support groups and organizations such as the Autism Society provide valuable guidance and assistance as parents try to make their way through the intervention maze. Research suggests that social net-works provide needed support to families of children with ASD— many of whom get much of their information about autism from other parents ( Meadan, Halle, & Ebata, 2010). Visit the website of the Autism Society of America to learn more about advocacy, resources, research, and general information related to autism and autism spectrum disorders. Once an intervention is chosen, the role of the parents and other family members will only increase. Almost all recommended interventions for young children with autism include intensive teaching, often within the child's home, and usually involving round- the- clock instruction, measuring, and evaluating by parents. So, by the time a child with autism is 3 or 4, his or her family will have de-voted at least two to three years of nonstop searching, investigating, and teaching. Because of the intimate role parents play in service delivery, great care is taken to understand and incorporate their needs and educational concerns in areas such as communication priorities ( Stephenson & Dowrick, 2000). Obviously, finding and evaluating appropriate and effective interventions for their children is the priority for many parents of children with ASD, but often it is day- to- day life that causes stressors for families. Some young children with ASD have severe acting out episodes, some will engage in stereotypic behaviors, or some kids will suddenly engage in spurts of running and jumping that can make public interaction challenging, or make parents think twice about bringing kids to church or taking the family on a long car ride to the beach. If your child doesn't want to engage in social interactions and won't or can't communicate with other children, what happens at birthday parties, T- ball games, sleepovers, or play dates? Do you go and try to encourage some interaction even when your child fights it?

As you might expect, students with autism may receive special education ser-vices at all levels of the service delivery continuum, depending on each student's individual strengths and needs. Many young children receive services at home, or attend a preschool program. As with all children with disabilities, decisions about educational settings for children with autism will be based on short- term and long-range educational goals for the child, and on his or her ability to perform in gen-eral education settings. You may find a child with autism and moderate intellectual disabilities served in a self- contained class or in a high- school vocational training program. Or, you may find a child with autism receiving academic instruction in the general education class, with accommodations for language and in- class instruc-tion in social skills. You may notice there is no section in this chapter on academic characteristics or instruction. That is because students with ASD have a very wide range of abilities in academic areas, so it is impossible to characterize them in one way. There also has been little research on best teaching practice specific to chil-dren with autism.

Although there is a great variety of available interventions for individuals with autism, the proponents of virtually all of them agree on one thing: the earlier the better. Early interventions for young children with ASD can be grouped into two types of evidence- based practices discussed by Boyd, Odom, Humphreys, and Sam ( 2010). The first type is called focused interventions— these are specific instruc-tional strategies or interventions and include behavioral and naturalistic inter-ventions. We look at several of these in the following sections. The other type of interventions, comprehensive treatment models, consist of theoretically based, mul-tifaceted programs. The comprehensive treatment models can include focused interventions, but the efficacy of the program is evaluated based on the entire model, which may include parent, family, and community components.

1. Functional, spontaneous communication should be the primary focus of early education. 2. Social instruction should be delivered throughout the day in various settings, using specific activities and interventions planned to meet age- appropriate, individualized social goals. 3. The teaching of play skills should focus on play with peers, and additional instruction in appropriate use of toys and other materials. 4. Instruction aimed at goals for cognitive development should also be carried out in the context in which the skills are expected to be used, with generalization and maintenance in natural contexts as important as the acquisition of new skills.Intervention strategies that address problem behaviors should incorporate information about the contexts in which the behaviors occur; positive, proac-tive approaches; and the range of techniques that have empirical support. 6. Functional academic skills should be taught when appropriate to the skills and needs of a child.

These six components ( Iovannone et al., 2003, p. 153) are: • Individualized supports and services for students and families: include looking at parent and child preferences to establish goals for instruction • Systematic instruction: carefully plan, deliver, and evaluate instruction and student outcomes • Comprehensible and/ or structured environments: include organizing and defining the classroom setting, using schedules, behavioral supports, and opportunities for choice • Specialized curriculum content: teach functional skills based on individual assessment and emphasizing social, behavioral, and communication skills • A functional approach to problem behavior: use Functional Behavior As-sessment to identify the relationship between the environment and prob-lem behavior, to develop positive interventions, and to teach appropriate and alternative behaviors

applied behavior analysis is not a spe-cific intervention, but rather the application of scientific principles to the study of behavior. The application of ABA to intervention strategies focuses on clearly defining behavior within the context of the environment and then arranging theenvironment and providing consequences for increasing or decreasing specific behaviors. First you determine the role or function that the student's behavior plays in his or her environment, and then you identify alternative behaviors that can serve the same function. New behaviors are taught through reinforcement-based opportunities for response. In other words, a specific skill, such as hand raising, could be taught to replace hand flapping, if teacher attention were the stu-dent's goal. The reason for the behavior is determined through a functional behav-ior analysis. The student would receive instruction in how and when to raise his hand. The teacher would carefully attend to the student whenever the appropriate behavior was performed— reinforcing the student's appropriate action. The occur-rence of the original behavior ( hand flapping) and the new, substitute behavior ( hand raising) would be recorded and observed over time to determine if the re-inforcement supplied by the teacher and others in the environment was resultingin increases in the desired, new behavior. Complex or multistep behaviors, such as some vocational tasks, may be taught in segments and then linked together. Other skills, such as getting dressed, are presented as a whole, with the student gradually increasing participation. Students with autism may require many instructional trials ( discrete trials) and explicit training across environments.

This project uses interventions based on strategies developed by Ivar Lovaas over thirty years ago. The project developers present data that sup-port significant change in children's cognition, language, and behavior The project is based on the principles of applied behavior analy-sis; however, some professionals question the curriculum context ( what skills are taught and where they are taught) and criticize the quality and validity of the program's experimental research ( Gresham & MacMillan, 1997). The Lovaas method, or discrete trial training, as this intervention is com-monly called, requires intensive training of teachers or parents and begins when the child is 2 to 3 years of age. The trained interventionist provides intensive, dis-crete trial training with the child on a one- to- one basis in the child's home. A dis-crete trial is one episode in a set of repetitive instructional sessions, designed to teach a specific skill. Training is recommended for up to forty hours per week for a minimum of three years.

The most prominent of the environmental intervention ap-proaches is Project TEACCH ( the Treatment and Education of Autistic and Re-lated Communication Handicapped Children program) ( Mesibov, 1994). The TEACCH program began as a statewide service delivery system in North Caro-lina over thirty years ago, and it has spread across the United States and Europe. The intervention emphasizes encouraging and maintaining existing behaviors and structured teaching of developmentally appropriate new skills, often using one- on- one instruction, and focusing on the individual interests and needs of the student become more independent. A fundamental component of the TEACCH program is the close working re-lationship between the professionals in the program and parents and families ( Scott, Clark, & Brady, 2000). The program focuses on early intervention but contin-ues throughout adulthood, providing safe and interactive learning environments for individuals with autism. Intervention research supports the effectiveness of TEACCH programs in producing satisfaction in increasing independence, and in reducing problem behaviors among the families and children and adults with autism

Although social skills training may be a compo-nent of many other types of instructional approaches, including applied behav-ior analysis and TEACCH, there is a current emphasis on training social skills as a distinct intervention. The emphasis of peer- focused social skills interven-tion involves creating an environment that simultaneously teaches and reinforces appropriate social behavior. Many of the social skills interventions for children with autism that include peers frequently incorporate peers in an instructional role. Usually the interventions include typically developing peers, but in some cases, peers with mild intellectual disabilities have participated in interventions.

These programs focus on incorporating the personal needs and circumstances of the individual child into the instructional program. The goal of these interventions may be simply to achieve more effective communication, to improve social interactions— including student- initiated interactions, or ver-bal guidance of appropriate alternative behaviors. When communication is at stake— it is critical that we carefully look at what is most " usable" by the child and by teachers, friends, classmates, and, of course, family

Picture Exchange Communi-cation System ( PECS) is a communication system based on teaching nonverbal children to use pictorial symbols to request information.formalized the PECS system and developed the training manual. The children gradually learn to combine the pictures to make picture sentences— eventually using language to accompany and, possibly, to replace the picture symbols. The PECS program uses a wide variety of pictures and an assortment of different pic-ture boards on which to create phrases and sentences. The picture boards are based on the concept of a traditional communication board; in this case, however, the emphasis is on student selection of the pictures and symbols used and the constant changing of these symbols to reflect immediate student needs. For students to use this tech-nique, it must be an effective and efficient means of communication for the in-dividual child; therefore, immediate responses by teachers, parents, and peers

A Voice Output Communication Aid ( VOCA) is an electrical device that assists people who are unable to use natural speech to express their needs and exchange information

Whereas the PECS system, and those like it, focus on symbols or pictures to foster language and social interaction, social stories are based primarily on verbal and written language. Gray ( 2003) created and defined so-cial stories over a decade ago as a means of addressing the language and social needs of verbal children with autism spectrum disorders.

In essence, a social story is a brief sequence of sentences designed to provide a self- instruction plan for the student. The social story uses four types of sentences, including descrip-tive sentences, perspective sentences, affirmative sentences, and directive sen-tences, to talk a child through specific situations, scenarios, or tasks. Each story is created by parents or teachers to reflect a specific challenge for the individual child. Sometimes, stories are designed to help a student engage in appropriate alternative behavior in problem situations; to prepare the child for a new expe-rience, such as going to a new playground; or to help a child make decisions or remain calm. The complexity of the sentences, the length of the stories, and the vocabulary used will depend on the child. Winterman and Sapona ( 2002) found that the social story concept could be used by a nonverbal child with autism by utilizing picture communication symbols instead of sentences and creating picture stories. Examples of social stories on a variety of topics are readily available to teach-ers and parents. Research is still continuing in the area of social stories— there is evidence of the effectiveness of social stories in teaching appropriate behavior, but more research needs to be done that conforms to the gold standard for deter-mining evidence- based practices

Visual supports of one type or another have provided a wealth of instructional strategies for many types of skills for individuals with ASD. Teachers often use visual schedules— pictures ( photographs, drawings, icons) as reminders of the daily schedule or how to set the table, or what needs to be done to clean the reading corner the visual medium becomes an important tool for instruction. Because we have such access to technology today, there are so many other options for making visual supports active and interactive. Visual activity schedules can be placed on a computer and incorporate Power- Point, audio, video clips, and even interactive components Students can actually watch someone ( or themselves) use the washing machine while they are washing their clothes, instead of just looking at picture prompts. Video- modeling is rapidly becoming a widespread instructional

1. Video prompting: If a student is learning a new and complex task, they can be shown one step of the task, complete it, look at another step, com-plete it, etc. 2. Video- modeling: A video is created of a peer doing the target activity or behavior. The video is shown to the student, who then is asked to per-form the behavior. Students can watch the video repeatedly for practice. 3. Video self- modeling: The student who is learn-ing the behavior models the target behavior and the watches the video and is asked to perform the behavior ( Oglivie, 2011). If, for example, you were teaching the student to walk from the school to the bus along the walkway without re-peatedly running into the driveway, you would verbally prompt the child or redirect as necessary until you reached the bus, while you or someone else is shooting the video. You would edit out the

a number of interventions have focused on biochemistry, includ-ing diet- based interventions, vitamin- based therapies, and others. Most of these interventions lack supporting empirical data. The most recent of the proposed biochemical interventions involves the use of the gastrointestinal hormone se-cretin to reduce the symptoms of autism.

Pharmacological interventions, on the other hand, are widely considered to be an important part of treatment protocols for many individuals with autism. Although not a primary educational intervention, drug treatment is often used to address some of the concomitant symptoms of autism, such as hyperactivity, de-pression, seizure disorders, agitation, aggression, and self- stimulatory behaviors

Adults with autism have the same opportunities for independent performance at work and in residential settings as individuals with other disabilities. Because of the wide range of abilities of children identified with ASD, many individuals will attend high school, graduate, and go on to college or employment. Others may perform various types of work through competitive employment or supported work programs. Of course, the particular social and behavioral characteristics of autism may present great challenges preparing for postschool environments, even for indi-viduals without intellectual disabilities. In spite of the abilities of many students with ASD, almost half ( 43.57 percent) of adolescents with ASD had not graduated after eight years in high school ( Shifter, 2011). Skills such as language use and appropriate social interaction may be targets for instruction throughout the life-time of an individual. Instructional approaches such as applied behavior analysis and TEACCH are used through adulthood. Many adults with autism live with the family; others live semi- independently in group homes or apartments; and some adults live in more restrictive settings. Often, individuals with autism who live independently benefit from support services, even if it is only an occasional visit from a relative or care provider. Adults with ASD may seek out support groups. Jantz ( 2011) reports that adults with ASD may feel lonely, and seek out support groups as a source of social interaction, as well as a place to get information, ad-vice, and structure. In the First Person box, a mother describes Jessy, her adult daughter with autism. Adolescents and young adults with autism spectrum disorders, particularly those with Asperger's syndrome, like many other students with or without dis-abilities, are entering postsecondary education. Some students with ASD are en-tering alternative postsecondary programs, such as those described in Chapter 6, while others are simply going to college. Because many of the students with ASD who enter college will require support, a number of universities have established programs just for that purpose. For example, Wenzel and Rowley ( 2010) describe a year- long course they provide for college students with ASD ( although others

individuals with autism and autism spectrum disorders display a great range of abilities, and learning and behavioral differences. Outcomes of educational programs for adolescents and adults will also vary greatly. Interviews with individuals who are clearly high- functioning adults with autism suggest that they have very strong opinions about what fac-tors were important in facilitating their success, and that they would like to be considered experts and be asked to share their perceptions with the professional community