I am a teacher of students with autism at the high school level. How can I promote independence and community integration for those individuals with autism who require one on one support and supervision?
Answered by
Randy Horowitz, MSEd, SAS
Nassau Suffolk Services for Autism (NSSA)
Credit: Artwork by Marina Azimova, EdM, MSW, BCBA
In 1987, Lovaas published an article that described the outcomes of early intensive behavioral intervention for young children with autism. In this article, Lovaas categorized the children into three separate groups: (1) a recoverable group who became indistinguishable from their age-matched peers and who no longer demonstrated characteristics of autism; (2) an intermediate group who made progress but who still met diagnostic criteria of autism; and (3) a small group for whom early intensive behavioral intervention was ineffective. In 1993, the field of autism education and treatment was blessed with an extraordinary and inspirational story about a family’s triumph over autism. Catherine Maurice’s seminal book, Let Me Hear Your Voice, was another example of “a recoverable group” who, as a result of early intensive behavioral intervention, became indistinguishable from their age-matched peers.
But, what about the other groups? Designing and implementing instruction for individuals with autism who require one to one support and supervision to generalize skills, to learn new skills, and to be meaningfully included into home, school, and community activities, remains a shared responsibility. For educators and caregivers, there is plenty of literature demonstrating that through the use of video modeling (Charlop & Milstein, 1989), pictorial activity schedules (MacDuff, Krantz and McClannahan, 1993), social stories (Gray & Garand, 1993), and work systems (Mesibov, Shea, & Schopler, 2005), individuals with autism can learn to function independently in a variety of settings.
Johnson, Meyer, and Taylor (1996) defined a model of supported inclusion that consisted of sending a student with autism into a regular education classroom accompanied by a support staff (e.g., aide or instructor) who is trained in the principles of applied behavior analysis. The criteria for fading these supports are based on objective data related to skill acquisition and problem behavior. The above-mentioned teaching strategies and this model of supported inclusion have been used for over two decades and have expanded to other domains (e.g., leisure, recreation, vocational).
Increased independence and fading of support staff can potentially lead to risk in the community. Again, for educators and caregivers, there is a myriad of studies demonstrating that through the use of technology, individuals with autism can learn to keep themselves safe. Taylor, Hughes, and Richard (2004) taught teenagers with autism to respond to a vibrating pager when lost by going to the nearest adult and handing over a card requesting assistance. Other researchers taught individuals with autism to use mobile phones to get assistance when lost (Hoch, Taylor, & Rodriguez, 2009). The use of mobile applications (e.g., FaceTime, GPS, Find My Phone) is also a possibility for individuals with autism.
Although educators and caregivers have access to empirically-validated teaching techniques, components of effective support models, and strategies for systematically fading supports and building skills, individuals with autism continue to suffer poor outcomes in transitioning to independent living, especially at work and in social environments (Gerhardt, 2009). Even those who may live independently and are able to get a job, continue to need significant assistance and support. According to a National Autism Indicator Report, one in five young adults on the autism spectrum lived independently, four in ten never worked for pay between high school and their early twenties, and approximately one in four was socially isolated and never interacted with friends (Roux, Shattuck, Rast, Rava, & Anderson, 2015).
Therefore, building vocational, healthy living, and recreational partnerships within the community (e.g., local businesses, running clubs) are critical in promoting independence and integration, and an area that could perhaps shape a brighter future for individuals with autism, their families, and service providers. The notion of “natural supports” is frequently referenced in the context of using co-workers and managers as trainers for individuals with autism (Wehman, 2001). Natural supports include selecting activities based on skill requirements, response effort, interest, and preference.
An example of building such partnerships that may be replicable across locations is joining forces with a volunteer non-profit organization. For example, Meals on Wheels is a volunteer non-profit organization that provides two meals a day for homebound adults, Monday through Friday and holidays. Adult learners and their support staff can transport and deliver hot and cold meals to their neighbors. The goal is for individuals with autism to take on as much of the task as possible towards independence. In the meantime, the following targets can be included in the curriculum:
- Retrieves meals from designated location
- Loads meals into delivery vehicle
- Follows delivery schedule
- Enters locations into mobile app (e.g., Waze, Google Maps)
- Sorts meals by name
- Appropriately exits vehicle
- Delivers designated meal to home
- Greets novel people
- Completes a “To Do” list
Evaluating the efficacy of this partnership may include measures of skill acquisition, levels of problem behavior, percentage of meals delivered (hot and on time), data on how the homebound adults experience individuals with autism, and how Meals on Wheels compares the volunteerism of individuals with autism with the volunteerism of typical people. These targets can be applied to other venues in which “giving back to the community” is emphasized (e.g., clothing drives, shoe drives, and donating produce to local food pantries).
Another example that ties together effective education and treatment with successful community integration is the careful selection of lifelong, age-appropriate health and fitness skills. Exercise has the benefit of decreasing problem behavior and increasing health and fitness, and most importantly for individuals with autism, the social implications of participating in activities with typically developing peers (Sowa & Meulenbroek 2012). Studies have shown that physical activity can lead to positive social outcomes (Pan & Frey, 2006; Strauss, 2001). These outcomes are extremely valuable for individuals with autism, their families, and communities.
Selecting activities (e.g., running, swimming, cycling) and developing repertoires based on competence and shared interest among individuals with autism and their educators and caregivers, are essential for promoting independence and community integration. Some examples of skills to focus on that are generalizable across activities include:
- Increasing duration of time on-task during the activity
- Staying with an adult
- Dressing appropriately for the weather/activity
- Requesting assistance
- Responding to changes in the environment
Evaluating activities based on shared interest may include rates of problem behavior during the activity, frequency of requests for the activity, duration of time spent with educators and caregivers, and how families rate their overall quality of life as a result of shared engagement in an activity.
In Silent Running, a story of triumph, passion, and perseverance, Robyn Schneider (2015) eloquently illustrates how skill building, effective supports, developing community partnerships, and selecting activities based on shared interest, can promote independence and community integration for individuals with autism. Schneider’s model can be used as a jumping off point for those who support individuals with autism.
References
Charlop, M. H., & Milstein, J. P. (1989). Teaching autistic children conversational speech using video modeling. Journal of Applied Behavior Analysis, 22(3), 275–285.
Gerhardt, P. F. (2009). The current state of services for adults with autism. Arlington, VA: Organization for Autism Research.
Gray, C. A., & Garand, J. D. (1993). Social stories: Improving responses of students with autism with accurate social information. Focus on Autism and Other Developmental Disabilities, 8, 1–10.
Hewitt, A. S., Stancliffe, R. J., Johnson, A. C., Hall-Lande, J., Moseley, C., Taub, S., …, & Bershadsky, J. (2012). Characteristics of adults with autism spectrum disorder who use adult developmental disability services: Results from 25 US states. Research in Autism Spectrum Disorders, 6, 741-751.
Hoch, H., Taylor, B. A., & Rodriguez, A. (2009). Teaching teenagers with autism to answer cell phones and seek assistance when lost. Behavior Analysis in Practice, 2(1), 14–20.
Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55(1), 3-9.
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.
Maurice, C. (1993). Let Me Hear Your Voice. New York, NY: Alfred A. Knopf, Inc.
Mesibov, G., Shea, V., & Schopler, E. (2005). The TEACCH approach to autism spectrum disorders. New York, NY: Plenum Press.
Pan, C. Y. & Frey, G. C. (2006). Physical activity patterns in youth with autism spectrum disorders. Journal of Autism and Developmental Disorders, 36(5), 597-606.
Roux, A. M., Shattuck, P. T., Rast, J. E., Rava, J. A., & Anderson, K. A. (2015). National autism indicator report: Transition into young adulthood. Philadelphia, PA: Life Course Outcomes Research Program, A.J. Drexel Autism Institute, Drexel University.
Schneider, R. (2015). Silent running: Our family’s journey to the finish line with autism. Chicago, IL: Triumph Books LLC.
Sowa, M., & Meulenbroek, R. (2012). Effects of physical exercise on autism spectrum disorders: Meta-analysis. Research in Autism Spectrum Disorders, 6(1), 46-57.
Taylor, B. A., Hughes, C. E., Richard, E., Hoch, H., & Coello, A. R. (2004). Teaching teenagers with autism to seek assistance when lost. Journal of Applied Behavior Analysis, 37, 79–82.
Wehman, P. (2001). Life beyond the classroom: Transition strategies for young people with disabilities, 3rd Edition. Baltimore, MD: P.H. Brookes Publishers.
Wolf, M. (1978). Social validity: The case for subjective measurement or how applied behavior analysis is finding its heart. Journal of Applied Behavior Analysis, 11, 203-214.
Citation for this article:
Horowitz, R. (2019). Clinical Corner: Promoting success of individuals with autism in the community. Science in Autism Treatment, 16(3).
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