Victoria Shea

Full inclusion and students with autism.

The concept of “full inclusion” is that students with special needs can and should be educated in the same settings as their normally developing peers with appropriate support services, rather than being placed in special education classrooms or schools. According to advocates the benefits of full inclusion are increased expectations by teachers, behavioral modeling of normally developing peers, more learning, and greater selfesteem. Although the notion of full inclusion has appeal, especially for parents concerned about their childrens rights, there is very little empirical evidence for this approach, especially as it relates to children with autism. This manuscript addresses the literature on full inclusion and its applicability for students with autism. Although the goals and values underlying full inclusion are laudable, neither the research literature nor thoughtful analysis of the nature of autism supports elimination of smaller, highly structured learning environments for some students with autism.

The TEACCH Program in the Era of Evidence-Based Practice

Abstract‘Evidence-based practice’ as initially defined in medicine and adult psychotherapy had limited applicability to autism interventions, but recent elaborations of the concept by the American Psychological Association (Am Psychol 61: 271–285, 2006) and Kazdin (Am Psychol 63(1):146–159, 2008) have increased its relevance to our field. This article discusses the TEACCH program (of which the first author is director) as an example of an evidence-based practice in light of recent formulations of that concept.

Evidence-Based Practices and Autism

Interventions for autism are increasing being held to standards such as ‘evidence-based practice’ in psychology and ‘scientifically-based research’ in education. When these concepts emerged in the context of adult psychotherapy and regular education, they caused considerable controversy. Application of the concepts to autism treatments and special education has raised additional concerns. An analysis of the benefits and limitations of current approaches to empiricism in autism interventions is presented, and suggestions for future research are made.

State-dependent learning in children receiving methylphenidate

Methylphenidate state-dependent learning was investigated using a paired-associate learning task of 16 pairs of pictures. Subjects were 15 children for whom methylphenidate was currently being prescribed. Each child was seen for two learning sessions and two testing sessions. Learning took place under placebo and under the childs regular dosage of methylphenidate. During retention testing all combinations of learning drug-state and testing drug-state were observed for each child. Data were analyzed using contrast variables which took into account the repeated-measures nature of the design. The results indicated that there was a trend in the direction of state-dependence in the whole sample. Significant symmetrical state-dependent effects were obtained in those subjects whose original learning was facilitated by methylphenidate.

Interpreting Results to Parents of Preschool Children

The interpretive session in which parents are told the results of their child’s developmental testing is the culmination of a complex process of testing, interviewing, analysis of findings, formulation of a diagnostic impression, and generation of recommendations. The session can be a therapeutic turning point for parents, as they are helped to understand their child’s needs and plan for his or her future treatment and well-being. Or the session can be a brief, confusing, emotionally devastating lecture about the child’s deficits, defects, and labels. The difference derives largely from the professional’s commitment to the importance of the interpretive session, and skill in presenting findings in a way that is most helpful to families. The purpose of this chapter is to outline a general approach to interpreting the results of a diagnostic evaluation for mental retardation, autism, and other developmental disabilities (Shea, 1984), and to discuss issues that apply specifically to families of preschool children.

Explaining Mental Retardation and Autism to Parents

To be told that his or her child has a serious disability is one of the most painful experiences in a parent’s life. Numerous articles by parents eloquently describe the feelings of despair, anger, shock, or fear that the news of the child’s diagnosis precipitated (Massie and Massie, 1976; Murray and Murray, 1975; Shigley, 1980; Turnbull and Turnbull, 1978; Wolfensberger and Kurtz, 1969). Some of the distress that learning their child has a serious disability causes parents is unavoidable. Parents must grieve the loss of the hoped-for normal child, and the normal grief process is often lengthy and painful. Some pain is unnecessary, however; this is the pain caused by thoughtless or unskilled professionals. Unfortunately, many parents have described experiences of being told abruptly, coldly, or superficially about their child’s disabilities and future potential.

The Theoretical Context of Structured Teaching

Structured Teaching, TEACCH’s intervention approach for people with autism spectrum disorders (ASD), shares principles and techniques with other psychoeducational interventions for this population. For example, during TEACCH’s earlier days in the 1970’s when behaviorism was the predominant educational intervention approach for students with developmental handicaps, most of the TEACCH intervention efforts emphasized reward and punishment contingencies. This approach is similar to many programs based on Applied Behavior Analysis (ABA) today. Structured Teaching continues to share with ABA a highly structured learning environment that facilitates development in people with ASD. Unlike many ABA approaches, however, TEACCH does not create structure by relying on repeated trials that begin with a prompt and are followed by material reinforcements, because of concerns that doing so would likely lead to strong attachment to this routine (sometimes called “prompt dependence”) and would compound already severe problems with generalization. Instead, structure is provided by the physical environment, organizational strategies, and the presentation of materials, which is also similar to the Montessori approach with typically-developing children. Materials are organized systematically in visual ways that are meaningful to individuals with ASD and are also tailored to individuals’ strengths and interests.

Providing Diagnostic Information to Parents

When parents understand their child’s developmental problems and special needs, they can obtain services, they can connect with other parents for support and mutual assistance, and they can form coalitions to advocate for more and better services and for research into treatment and prevention. However, initially learning about their child’s significant developmental problems is very distressing for most parents. First hearing the words “autism” and “mental retardation” is one of their worst nightmares come true, with fear, pain, grief, disbelief, rage, and heartache flooding them as the professional talks. Although professionals in psychology, education, medicine, etc. chose their careers in order to help people, not to cause them distress, the very nature of telling parents that their child has a developmental disability involves inflicting extraordinary pain. So the process of explaining developmental test results to parents can be difficult for professionals as well as for parents (Abrams & Goodman, 1998; Lipton & Svarstad, 1977; Nissenbaum, Tollefson, & Reese, 2002).

The Origins and History of the TEACCH Program

The TEACCH Program as it exists at the time of this publication has served thousands of individuals and families involved with the challenges and problems of the autism spectrum It now employs hundreds of staff with multi-disciplinary training. The program’s mission, priorities, services, and practices are the product of the thoughtful, dedicated work and contributions of many faculty and staff. This chapter is intended to trace the motivating factors shaping the development and history of the program.

Core Values of the TEACCH Program

Several years ago at our University of North Carolina-Chapel Hill University Day observance, the keynote speaker, Dr. Robert Allen, described a Stanford University Business School study designed to identify shared elements of excellent and visionary companies. The authors of this study had assumed that the important variables would be factors such as exceptional leadership, strategic planning, mission statements, profit margins, or some combination of these. Instead, they found that what distinguished excellent companies was a shared core ideology: a set of values and sense of purpose beyond just making money. Moreover, those values were clearly articulated and well-understood among the workers of the companies. The core values were not the same from company to company, although they did have some important factors in common, but they all resulted in progressive growth and excellence.