Support For Children And Young People With Autistic -PDF Free Download

Support for Children and Young People with Autistic

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Purpose and aim of the guide This report provides a summary of evidence about the effectiveness of approaches for supporting children and young people with autistic spectrum disorder (ASD) whilst in education. The report may be of interest to: parents; teachers, classroom-based support staff, early years workers and further education lecturers; special educational needs coordinators (SENCOs ...



Support for Children and Young People with
Autistic Spectrum Disorder ASD in educational
Parents carers and practitioners supporting children and young people with
Autistic Spectrum Disorder ASD in education settings
This guide provides an overview of the extent to which interventions delivered in
educational settings are effective in realising positive outcomes for children and
young people with ASD It was produced by SQW and the Social Care Institute for
Excellence SCIE The views expressed in this guide are those of the authors and
not necessarily those of the Welsh Government
Action required
This document may be of interest to practitioners and parents carers when
planning provision to support children and young people with ASD
Further information
Enquiries about this document should be directed to
Additional Learning Needs Branch
Support for Learners Division
The Education Directorate
Welsh Government
Cathays Park
e mail additionallearningneedsbranch gov wales
WG Education
Facebook EducationWales
Additional copies
This document can be accessed from the Welsh Government s website at
gov wales aln
Related documents
A Rapid Evidence Assessment of the effectiveness of educational interventions
to support children and young people with Autistic Spectrum disorder Welsh
Government 2018
Mae r ddogfen yma hefyd ar gael yn Gymraeg
This document is also available in Welsh
Crown copyright January 2019 WG37030 Digital ISBN 978 1 78964 727 3
Purpose and aim of the guide 3
Background 4
What is ASD 5
Support for children and young people with ASD approaches and
interventions 6
Types of interventions to support children and young people with ASD 6
Who can put the interventions into practice 7
Outcomes 7
What the research says about the effectiveness of the
interventions 8
Joint attention 8
Play based turn taking interventions 8
Social interventions 9
Peer mediated instruction and intervention PMII 9
Social Skills Training SST 10
Modelling 10
Prompting 11
Reinforcement 12
Pivotal response training PRT 13
Play based interventions 13
Structured play groups SPG 13
Challenging interfering behaviour interventions 14
Behavioural interventions 14
Self management 15
Social narratives 16
Discrete Trial Teaching DTT 17
Exercise 18
Adaptive self help 18
Visual supports 19
Technology aided instruction and intervention TAII 20
Communication interventions 20
Picture Exchange Communication System PECS 21
Video modelling 21
Pre academic academic skills interventions 22
Direct Instruction 22
Comprehensive interventions 22
Cognitive Interventions 25
Cognitive Behavioural Interventions CBI 25
Table 2 Summary of findings 27
Other points to consider when designing and providing support
packages 30
Severity of ASD and effectiveness 30
Age and effectiveness 30
Setting type and effectiveness 30
Intervention length and effectiveness 30
Other considerations 30
What improvements might be expected from using support
packages for children and young people with ASD 32
Outcomes 32
Information sources 33
Contacts 34
Glossary 35
Annex A Bibliography of evidence 37
Purpose and aim of the guide
This report provides a summary of evidence about the effectiveness of
approaches for supporting children and young people with autistic spectrum
disorder ASD whilst in education
The report may be of interest to
teachers classroom based support staff early years workers and further
education lecturers
special educational needs coordinators SENCOs additional learning
needs co ordinators ALNCos
head teachers principals and senior leaders in education settings
local authority education services including specialist services such as
educational psychologists
social workers
health professionals
third sector organisations and
advocacy services dispute resolution services and the Special Educational
Needs Tribunal for Wales
The document focuses on learners aged 0 25 years but some of the findings
may be transferrable to older learners
Practitioners do not have to use the approaches set out in this report The
report does not set out what approaches must or must not be provided for
children and young people with ASD
Practitioners can use this evidence along with their own experience and
knowledge when making decisions about approaches to support children and
young people with ASD The aim of the report is to support practitioners when
planning and delivering timely and effective support for children and young
people with ASD
Not all approaches outlined in the report may be suitable for all children and
young people with ASD Approaches are likely to need to be tailored to each
learner based on their needs and to the specific educational setting
Educators may find it useful to monitor how well their selected support
packages are working for their learners so they know whether they are having
the desired effects or need to be altered
Background
This report is based on a rapid evidence assessment REA of research
studies which involved reviewing and appraising existing research and
considering the effectiveness of approaches to support children and young
people aged up to 25 years with ASD Effectiveness includes but is not
limited to achieving positive outcomes for children and young people with
ASD These outcomes include attainment attendance inclusion and social
and emotional development
The assessment summarised the findings of the most reliable research
studies on this topic published between 2013 and 2017 It looked at
approaches which had been studied in any setting where children and young
people receive education such as pre schools schools and further education
institutions
The report does not attempt to summarise all interventions and approaches
available to support children and young people with ASD Rather the report
provides a summary of the evidence identified during the evidence review
The evidence was not comprehensive there were gaps in the evidence base
and in some cases the evidence on effectiveness was inconclusive In
addition not all of the studies identified were robust enough to be included
The report is based on assessment of 16 studies and reviews References of
the studies included in the REA are provided in the Bibliography of evidence
The evidence includes studies from many countries The majority of the
evidence came from the US Canada UK and Europe and included a range
of ages settings and severity of ASD As such not all of the interventions and
approaches detailed in this report would necessarily be applicable to all
children and young people with ASD For more information on the approach
undertaken and the evidence found please visit
https gov wales docs caecd research 2018 180515 assessment
effectiveness educational interventions support children autistic spectrum
disorder en pdf
When the evidence assessment was complete a workshop was held with six
stakeholders including representatives from the National Autistic Society
researchers from Cardiff University and representatives of parents and carers
The workshop provided an opportunity for the participants to consider how the
evidence could be most usefully presented in a report Following the drafting
of the report participants were asked for their feedback which was used to
inform the development of this report
What is ASD
ASD can be defined as
a developmental disorder which affects the way a person communicates with
and relates to other people and the world around them The way in which
people are affected varies from one individual to another and by age and
intellectual functioning ASD Info Wales
ASD is the name for a range of similar conditions including autistic disorder
Asperger syndrome and pervasive developmental disorder not otherwise
specified PDD NOS 1
It is estimated that ASD affects 1 in 100 people 2 In individuals with ASD
signs of the condition usually start before the age of three although the
diagnosis can be made after that age3
It is very common for children and young people with ASD to have sensory
issues alongside impairments in social imagination and a narrow repetitive
pattern of interests and activities These challenges can cause higher than
average levels of stress anxiety and depression
Classrooms are social environments that rely heavily on being able to interact
socialise and communicate with others effectively The challenges that
children and young people with ASD face with regards to communication skills
and socialising can intensify their feelings of stress anxiety and depression
This can in turn lead to a decrease in academic performance 4
ASD can affect children and young people with any level of intellectual ability
from those who are profoundly learning disabled to those with average or
high intelligence Having ASD doesn t necessarily imply learning difficulties
Some children and young people have learning difficulties and require high
levels of support whilst others such as those with Asperger syndrome or
high functioning autism are very academically able Some children may also
have additional specific learning difficulties
The way in which ASD impacts on one individual will be different to the way it
impacts on another individual
Therefore when considering the evidence within this report it is important to
note that whilst an intervention may have proven effective for some children
and young people with ASD it may not necessarily be effective for all children
and young people with ASD
https www autism org uk about what is asd aspx
The NHS Information Centre Community and Mental Health Team Brugha T et al 2012
Estimating the prevalence of autism spectrum conditions in adults extending the 2007 Adult
Psychiatric Morbidity Survey Leeds NHS Information Centre for Health and Social Care
https www nhs uk conditions autism
http theconversation com supporting students with autism in the classroom what teachers
need to know 64814
Support for children and young people with ASD
approaches and interventions
Types of interventions to support children and young people
For this report we have categorised the REA evidence by the focus and type
of intervention We adopted a list of categories suggested by Bond et al
2016 in their systematic review of existing research Bond et al identified
eleven different types of interventions
These categories are not mutually exclusive and a specific intervention may
span two or three categories of focus The categories just provide a way of
grouping similar types of interventions and approaches together
Within each category there are numerous different approaches In the table
below we provide examples of interventions covering eight of the eleven
categories identified by Bond The REA we conducted did not provide high
quality evidence of effectiveness for the other three categories
Table 1 Examples of interventions explored within this document
categorised by focus
Intervention focus Type of Intervention
Joint attention Play based turn taking intervention
Social interventions Peer mediated instruction and intervention
Social Skills Training
Reinforcement
Pivotal response learning
Play based interventions Structured play groups
Challenging interfering Behavioural interventions
behaviour Self management
Naturalistic interventions
Antecedent based interventions
Differential reinforcement of alternative
incompatible or other behaviour
Social narratives
Discrete trial teaching
Parent implemented intervention behaviours
Adaptive self help Visual support
Technology aided instruction and interventions
Communication Milieu social environment teaching
interventions Incidental teaching
Picture exchange communication system
Video modelling
Language training
Task analysis
Intervention focus Type of Intervention
Pre academic Direct instruction
academic skills Comprehensive interventions
Multi sensory interventions
Cognitive Cognitive behavioural interventions
Explanation about the interventions listed in the table above is provided in
Who can put the interventions into practice
The evidence indicates that a wide range of people can effectively put
these interventions into practice The implementers in the majority of the
interventions reviewed were teachers and other educators such as teaching
assistants Other implementers were children and young people without ASD
parents and carers and children and young people with ASD Implementers
may require training in the specific techniques of the interventions to deliver
them effectively
The interventions reviewed were designed to improve children and young
people s skills and behaviours In most cases the interventions focused on
either developing social skills communication skills or the reduction of
challenging or disruptive behaviour or academic attainment for example
abilities in reading and maths A few of the interventions focused on
improving school readiness the wellbeing of children and young people
vocational skills and improving their play and interaction with peers
The extent to which the outcomes were achieved varied across the different
interventions this is explored in the next section
What the research says about the effectiveness of the
interventions
In this section we summarise the findings from the REA We review each
approach and intervention in turn exploring the extent to which they were
found to be effective in supporting the learning and development of children
and young people with ASD
For each intervention we provide a short description of the activities that
proved effective and examples of the types of settings and children and
young people with which they were effective Some interventions may be
applicable across different settings and aspects of a child or young person s
life although the studies reviewed often provide examples of implementation
in just one setting
Joint attention
Play based turn taking interventions
Joint attention interventions aim to develop children and young people s joint
attention and or joint engagement Joint attention is the process in which a
child learns to recognise the direction of an adult s gaze orient their own gaze
to follow it and then look in the same direction Joint engagement is the
process in which a child learns to interact with the same object or event as
another person These interventions usually involve 1 1 delivery of play
based turn taking activities by a teacher or parent
Joint attention interventions were found to be effective for pre school
aged children Improvements were noted in both joint attention and joint
engagement
The interventions were effective in a range of education settings
including a mainstream pre school setting and an independent school for
children with ASD
Interventions were often delivered by a teacher or parent for short daily
sessions over 8 12 weeks with external supervision External supervision for
example from trained counsellors from Child and Adolescent Mental Health
Services CAMHS provided qualified and experienced professional support
to help deliver the intervention effectively
In practice the interventions included a 1 1 approach delivered by support
staff focused on teaching the child ren to respond to joint attention
approaches e g another person smiling and nodding and to teach joint
attention skills in tasks based on turn taking5
Isaksen J and Holth P 2009 An operant approach to teaching joint attention skills to
children with autism in Behavioral Interventions 236 215 236 cited in Bond et al 2016
Social interventions
Social interventions as described by Bond et al 2016 and defined by Wong
et al 2013 are those focused on developing the skills needed to interact
with others
Some specific examples are explored below
Peer mediated instruction and intervention PMII
Children and young people without ASD interact with and or help children and
young people with ASD to acquire new behaviours communication skills and
social skills by increasing social and learning opportunities within natural
environments6 Teachers or service providers systematically teach children
and young people without ASD strategies for engaging their peers with ASD in
positive and extended social interactions in both teacher directed and
learner initiated activities
PMII was found to be an effective intervention for developing social
interaction amongst children and young people with ASD aged between
5 and 14 years old Improvements were noted in social skills and in
social interaction
Outcomes for children receiving peer mediated interventions included
increased peer interaction improvements in social skills and the
potential for increased social inclusion
The evidence of the effectiveness of PMII to improve comprehension
and employment skills is mixed and therefore inconclusive
One study implemented socialisation opportunities by offering lunchtime clubs
additional to those already on offer with activities relating to each
participant s interests Participation was voluntary for both the children with
and without ASD Undergraduate university students acted as social
facilitators and introduced a daily lunchtime club including a movie trivia
and card game club but then took a step back once the activity began 7 to
encourage peer to peer engagement
The studies suggest that delivering peer mediated interventions and group
activities in everyday settings can prove effective The evidence suggests that
there is no difference in effectiveness when the intervention is delivered by
Learning opportunities in natural environments refers to teaching interventions in the real
world rather than teaching interventions in a structured setting such as therapy
Koegel R L Fredeen R Kim S Danial J Rubinstein D and Koegel L 2012 Using
perseverative interests to improve interactions between adolescents with autism and their
typical peers in school settings in Journal of Positive Behavior Interventions 14 3 133 141
cited in Bond et al 2016
trained peers children and young people without ASD compared with
untrained peers8
Social Skills Training SST
SST involves group or individual instruction designed to teach learners with
ASD ways to appropriately interact with others This can include instruction on
basic concepts role playing and providing feedback to help learners with
ASD to acquire and practice communication play or social skills to promote
more positive interactions
SST was found to be effective amongst children and young people with ASD
aged between 2 and 17 years old There is a gap in the evidence regarding
the use of different SST techniques across different age groups
Improvements were noted in the frequency length and quality of social
interaction between children and young people with ASD and their peers
without ASD
There is moderate evidence that SST is an effective intervention to improve
social interaction However across the studies the number of participants
varied substantially and much of the evidence is based on small numbers of
participants This means the current evidence base regarding SST isn t as
strong as that for some other interventions
The interventions mainly involved starting and sustaining social interactions
during free play for example suggesting games initiating a conversation or
paying compliments use of social scripts for example cue cards or comic
strips and or prompts to teach social initiation
One example is the Stay Play Talk programme 9 In this intervention
selected pupils without ASD or all classmates learn strategies to start and
maintain interaction with their peers with additional learning needs
The interventions were delivered by a range of people including classroom
teachers specialist teachers and researchers Activities were delivered in
mainstream and specialist education settings during or after the school day
Modelling involves a desired behaviour or action being demonstrated to the
child or young person with ASD to encourage imitation or mirroring of the
behaviour This in turn can then lead to the child or young person displaying
that behaviour without the need for further modelling
In a number of interventions training was provided to children young people without ASD in
responding to interaction initiations and social advances from participants with ASD
Goldstein et al 1997 Interaction Among Pre schoolers with and Without Disabilities
Effects of Across the Day Peer Intervention Journal of Speech Language and Hearing
Research 40 1 33 48 and Batchelor Taylor 2005 Social inclusion next step user
friendly strategies to promote social interaction and peer acceptance of children with
disabilities Australian Journal of Early Childhood 30 4 10 18 Cited in Garrote et al 2017
It is important to note that individuals with ASD may find imitation difficult and
may need to be taught this foundation skill specifically
Modelling may be considered to be a teaching strategy rather than an
intervention and is often combined with other strategies such as prompting
and reinforcement
Modelling was used in interventions to promote reading comprehension
and employment skills Modelling was found to have strong effects on
promoting employment skills such as interacting with others and
completing clerical tasks amongst young people with ASD when used
alongside prompting and reinforcement approaches
However there is no conclusive evidence regarding the effectiveness of
modelling used on its own
Teachers assistants may use modelling to improve the reading
comprehension skills of learners through explaining the different meanings
and use of words and then modelling their correct use
Effective modelling requires time and planning and modelling can be
challenging when utilised in an inclusive setting an educational setting with
children and young people of a range of learning abilities including those with
and without ALN This is because teachers are required to manage a
classroom with several students in a less structured environment than that
offered in clinics and special education classrooms
Prompting is the verbal gestural or physical assistance given to learners to
assist them in acquiring or engaging in a targeted behaviour or skill Prompts
are generally given by an adult or peer either before or as a learner attempts
to use a skill or demonstrate a particular behaviour
As with modelling prompting may be considered to be a teaching strategy
rather than an intervention
The evidence suggests that incorporating the use of prompting into
interaction with children and young people with ASD can help to enhance
the effectiveness of other interventions
Evidence suggests that prompting and positive reinforcements can be
effective with or without modelling of the desired behaviour or skill
However the evidence is based on a small number of studies
Interventions using prompting as a delivery approach included
social story short descriptions of a particular situation event or activity
which include specific information about what to expect in that situation and
visual scripts written and pictorial examples of phrases or sentences
which children with ASD can use to cue themselves regarding appropriate
topics of conversation or other verbal interactions
peer training training children and young people without ASD to interact
with and or help children and young people with ASD
Prompting can be used effectively to promote reading comprehension
amongst children and young people with ASD One evidenced example of
prompting involved vocabulary or text reading sessions in which an assistant
read a word then asked students to re read it The assistant then gave a brief
definition of the word and an example sentence including the word following
which a student repeated the definition and formulated a new sentence with
the word this routine was repeated for eight words 10
Reinforcement
Reinforcement involves an event activity or other circumstance occurring
after a learner engages in a desired behaviour which is intended to
encourage the learner to repeat that behaviour in the future For example
children and young people with ASD being able to choose or participate in an
activity they enjoy because they complete a task that is required of them such
as homework to encourage them to do their homework in future
Reinforcement can also be in the form of praise to encourage desired
behaviour and may be considered a teaching strategy rather than an
intervention There is however inconclusive and limited evidence as to its
The evidence suggests that reinforcement can effectively be used
alongside other interventions for supporting children and young people
The evidence suggests that planned reinforcement where activities and
actions are planned in advance can be more effective than unplanned
reinforcement
However the evidence is limited and based on a small number of
Prompting and reinforcement are often used simultaneously Interventions
which involve positive reinforcement e g praise tangibles and or edibles
Cited in Roux et al 2015
peer imitation observing and replicating a peer s behaviour
buddy skills strategies to encourage interactions and support friendships
between children with ASD and their peers without ASD
Pivotal response training PRT
Pivotal response training uses a child or young person s interests as
motivators to engage them in learning opportunities It focuses on four key
areas of child development motivation responding to multiple cues self
management and self initiation to guide the intervention
PRT was found to be effective in supporting social interaction and joint
attention but progress was not maintained for some children post
intervention
The evidence is inconclusive with regards to the effect of PRT on
improving eye contact
There was a lack of examples of how PRT was used in practice within the
evidence base The majority of the evidence regarding PRT was based on it
being implemented in children and young people s homes or at school
Play based interventions
Play based interventions as described by Bond et al 2016 and defined by
Wong et al 2013 are those which use toys or leisure materials to support
Structured play groups SPG
Structured play groups are small group activities designed to help develop
play and social engagement skills They involve carefully defined activities
which encourage peer interaction and build social and communication skills
for example developing skills such as sharing and taking turns
The structured play groups normally include peers who can act as role
models and activities or themes which encourage interactive play supported
with instructional techniques for example explaining or demonstrating
sometimes involving the use of models objects pictures equipment etc by
teachers and other adults in the form of scaffolding learning breaking up
learning into smaller pieces and providing support for that learning
The evidence suggests that SPG is an effective intervention for improving
the social skills of children aged 3 to 13 years old
However the evidence base is small


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