Autism and Its Treatment:  Challenges for the 21st Century

Stanley L. Swartz, Ph.D.
California State University
United States of America

Introduction

Perhaps autism is the most mysterious of all of the developmental disabilities.  We are not sure what causes this condition and we are also not sure what to do about it.  It continues to be what we might call an orphan disability.  No one takes responsibility for it and the resources for research and treatment are inadequate.  We are also beset by individuals that prey on the concerns and anxieties of parents by peddling false promises and miracle cures.  The challenge for the 21st Century will be to change these circumstances and give the attention to this puzzling and devastating disability that it deserves.  Even if autism cannot be cured, there is a great deal more that can be done to understand it and to provide effective treatments.

It is a telling statistic that the incidence of autism has virtually exploded.  These data from California show that unlike other disabilities, such as cerebral palsy, epilepsy and mental retardation, where modest increases are seen consistent with population growth, autism has increased by more than 200% in the decade between 1987 and 1998.  To what might this growth be attributed and what are the challenges to the profession to treat this disorder?

Exhibit 1, Developmental Disorder Increase

The important issues include definition and diagnosis, treatment, inclusion, and family involvement.  Definition and diagnosis because there is still no universal agreement among professionals.  Is autism a single syndrome or are there various conditions better conceptualized by similarities in presenting problems and treatment needs?  Next, treatment of children with autism is both controversial and contentious.  There are those who promise a cure for autism and others who say a cure is not possible.  How can what is possible and what is not be determined?  Because autism is primarily a social and communication disability we need to consider not only how they are treated but where they are treated.  Should children with autism be included in the mainstream of educational services or should they be provided for in special and separate settings?  Does it matter?  And last, how can families be involved in the treatment of children with disabilities generally, and children with autism specifically?  Too often decisions are made and programs designs developed without sufficient consideration to the issues of social validity for the family. 

Definition and Diagnosis

The first issue to consider is the one of definition.  Is the increase in autism attributable to a definition that is unclear or too broad or is there a causal factor that has produced the increase?  We do not have general agreement on definition because some favor attempts to specifically define autism as a single, identifiable syndrome and others are comfortable with the general category of pervasive developmental disorders, where various diagnoses with similar characteristics are subsumed under an umbrella term.

In the United States, the American Society for Autism has developed the definition used frequently.  It should be understood however, that this group is composed of both professionals and parents and that the definition that they have developed is both scientific and political.

Autism is a complex developmental disability that typically appears during the first three years of life. The result of a neurological disorder that affects the funtioning of the brain, autims and its assoicated behaviors have been estimated to occur in as many as 1 in 500 individuals. Autism is four times more prevalent in boys than girls and knows no racial, ethnic, or social boundaries. Family income, life-style, and educational levels do not affect the chance of autism's occurrence.

Autism interferes with the normal development of the brain in the areas of social interaction and communication skills.  Children and adults with autism typically have difficulties in verbal and non-verbal communication, social  interactions, and leisure or play activities.  The disorder makes it hard for them to communicate with others and relate to the outside world.  They may exhibit repeated body movements (hand flapping, rocking), unusual responses to people or attachments to objects and they may resist changes in routines.

Over one half million people in the U.S. today have some form of autism.  Its prevalence rate now places it as the third most common developmental disability - more common than Down syndrome.  Yet most of the public, including many professionals in the medical, educational, and vocational fields, are still unaware of how autism affects people and how to effectively work with individual with autism.  American Society for Autism.

This definition is clear that autism is caused by a neurological disorder and equally clear in rejecting a history that once considered parenting and environmental circumstances as a likely cause of autism.  Difficulties with social interaction and communication are the major features and a wide variety of behavior problems are manifested because of these problems. The definition concludes with the strong statement that not enough is known about autism even though it is a very common disability.

Exhibit 2, Definition of Autism

The Diagnostic and Statistical Manual IV (DSM-IV, American Psychiatric Association, 1994)  states that “the essential features of Autistic Disorder are the presence of markedly abnormal or impaired development in social interaction and communication and a markedly restricted repertoire of activity and interests.”

The DSM-IV established the following diagnostic criteria:

           

The World Health Organization uses a similar but somewhat different criteria (ICD-10 Classification of Mental and Behavioural Disorders, 1992):

There is a translation to Spanish of the Childhood Autism Rating Scale (Spanish, Lopez & Vazquez) developed by colleagues at the Universidad Autonoma de Baja California that can be recommended as a method to collect information from parents and service providers.

Core Features

Both the DSM-IV and ICD-10 diagnostic criteria and an important research review (Matson, 1994) emphasize the areas of abnormal behavior that are considered common to all cases of autism and those that are associated with the disorder by the frequency of their occurrence.  Core features are present in most cases most of the time.

Social skills deficits.  Research findings in this area have included lack of normal attachments to parents, social intent not signaled by smiles or gestures,  poor and avoidant eye contact, poor imitation skills, no peer friendships, no cooperative peer play, and infrequent displays of affection or empathy.

Language deficits.  Studies in language include poor communication is most all cases with some never acquiring any speech.  Also found are less frequent speech, use of speech for social purposes limited, unusual voice quality, and impaired use of nonverbal communication.

Insistence on sameness.  Autistic children are reported to have problems with changes in the environment or routines and show ritualistic behavior patterns.  Stereotypic behaviors such as body rocking and hand flapping are also common.

Responses to sensory stimuli.  Frequent hypersensitivity and occasional hyposensitivity to visual, auditory, and tactile stimuli have been reported in autistics.


Associated Features

Associated features on the other hand are those that occur in some cases some of the time.  In fact, the coexistence of these features complicates the diagnostic process.

Intelligence.  Scores range from superior to profoundly retarded.  Eighty per cent are concurrently diagnosed as retarded, with 60% having IQs of less than 50.

Stimulus overselectivity.  Several studies have found a pattern of selective processing of sensory information which might contribute to insistence on sameness and generalization difficulties.

Self-injurious behavior.  As many as 40% have been reported to exhibit behaviors like biting, head banging, hair pulling, and scratching.

Fears.  An unusual variety and intensity of social and sensory-related fears

Organic disorders. There are a number of organic disorders that occur in individuals with autism at a higher rate than the normal population, including fragile-X syndrome, tuberous scerosis, and neurofibromatosis.  it has also been reported that as many as one-third develop seizures by early adulthood.

Autism is a spectrum disorder which means that the characteristics of autism and the severity of its symptoms occur in a wide variety of combinations from mild to severe.  Two individuals with the same diagnosis of Autistic Disorder might show very different behaviors and have very different skills.

Exhibit 3, Characteristics of Autism

Differential Diagnosis

In addition to the Autistic Disorder, there are four other disorders in the Pervasive Developmental Disorders category and require differential diagnosis.

Asperger’s Disorder - characterized by impairments in social interactions and the presence of restricted interests and activities, with no clinically significant general delay in language, and testing in the range of average to above average intelligence.

Pervasive Developmental Disorder - Not Otherwise Specified - (commonly referred to as atypical autism) a diagnosis of PDD-NOS may be when a child does not meet the criteria for a specific diagnosis, but there is a severe and pervasive impairment in specified behaviors.

Rett’s Disorder - a progressive disorder which, to date, has occurred only in girls.  Period of normal development and then loss of previously acquired skills, loss of purposeful use of the hands replaced with repetitive hand movements beginning at the age of 1-4 years.

Childhood Disintegrative Disorder - characterized by normal development for at least the first 2 years, significant loss of previously acquired skills.

http:www.autism-society.org/whatisautism/autism.html

Exhibit 4, Pervasive Developmental Disorders

Theory of Mind

One other line of inquiry that is interesting and has treatment implications is the theory of mind (Frith, 1989).  This work has developed a psychological theory that individuals with autism have a kind of “mind blindness.”  This metarepresentational deficit results in an inability to infer the content of others’ mental states.  Autistics then appear to operate in a literal way and unable to put events into context.  The problem seems to be understanding that people have mental states different from their own and different from their perception of the real world.  In other words, “if I know it, you know it,” or “if I believe it, you must believe it.” 

This simple experiment makes the concept clear.  Where Will Sally Look?  Regular children consider what Sally knows, autistic children consider what they know.

Exhibit 5, Where Will Sally Look?

Causes of Autism

It is now commonly accepted that autism is a biological or neurological difference in the brain.  What causes these differences is not known.  Also, what causes the various forms of autism is unclear and might suggest that there is more than one cause.  Because a familial pattern has been found for autism, a genetic basis is suspected.  There are also continued investigations of some environmental causes such as mercury contained in vaccinations or exposure to other toxic elements whether prenatal or during infancy.

Autism in not a mental illness  or a severe emotional disability and theories about bad parenting or psychological growth and development problems have been rejected.

The lack of evidence about the cause of autism has had a resultant impact on the treatment of autism.  Various theories abound and some acrimony exists among their adherents.

Treatment

Because we don’t know the cause of autism, we can expect a wide range of proposed treatments.  Some of the approaches are based in scientific fact and others seem to be based on wishful thinking.

There is considerable evidence that early intervention is important for maximum growth.  The treatments that are in general use include applied behavior analysis, auditory integration training, dietary interventions, discrete trial teaching, medications, music therapy, occupational therapy, alternative communication systems, sensory integration training, speech/language therapy, and vision therapy.  Not all of these approaches enjoy the full confidence of the profession and some have been accused of exaggerating their success.  Regardless of which method or combination of  methods are used, individuals with autism need highly structured and individualized programs.  They frequently need individual attention and programming that exceeds the traditional school day.  Parent support and training are also considered critical elements in a successful program.

One of the major obstacles to the inclusion of children with disabilities in both school and the community, is behavior that is inappropriate and disruptive.  For children with severe disabilities, behaviors such as tantrums, aggression, or self-injury are challenging beyond what regular education settings are prepared to handle.  Families of children with severe disabilities are also looking for assistance beyond the traditional manipulation of consequences offered by most behavior management programs. 

If we are to accomplish inclusion, it will be necessary not only to identify treatment methods that work, but ones that will be acceptable in the context of inclusive environments.  The three concepts of social validity identified by Wolf (1978) are important considerations in reaching this goal.  These are feasibility - are we able to use the strategy;  desirability – are we willing to use the strategy; and effectiveness – does the strategy make a difference for the individual in increasing inclusion opportunities?  In other words, we need treatment strategies that both parents and teachers are able and willing to use and that make a real difference for the individual and their opportunities to participate in school and in the community. 

Exhibit 6, Social Validity

Research on the efficacy of special education is such that the urgency of placement in regular education is a very real issue for many children with disabilities.  Justification for placement in special education seem unwarranted without some compelling case for its value not only for academic purposes, but as a larger issue of acceptance and even lifestyle (Swartz, 1998).  The case can be made that the only obstacle to the inclusion of most children with disabilities is our preparedness to accommodate their needs, or worse, our willingness.

Promising Practices

Positive Behavior Support

An increasing body of research in the use of positive behavior support (PBS) has demonstrated that these strategies are highly effective for use with the behaviors presented by children with severe disabilities (Carr, Horned & Turnbull, 1999).  In addition, PBS meets the various social validity criteria in most cases and facilitates inclusion of children with disabilities. Unlike traditional behavior management, which views the individual as the sole problem and seeks to “fix” him or her by quickly eliminating the challenging behavior, PBS views such things as settings and lack of skill as parts of the “problem” and works to change those.  As such, PBS is characterized as a long-term approach to reducing the inappropriate behavior by teaching a more appropriate behavior, and providing the contextual supports necessary for successful outcomes (ERIC, 1999).

Effective behavior change must not only reduce inappropriate behaviors it must also teach suitable alternatives.  These changes should not only help the child in the immediate environment, or the short term, they must also be important for their life after school, or the long term.  The key concept of PBS was then determined to be to change a problem behavior, it is first necessary to remediate deficient contexts.  Deficient contexts were found to come in two varieties, those related to behavior repertoires and those related to environmental conditions.   Behavior repertoires means that the individual does not have the necessary behaviors to be successive.  Communication skills, social skills, self-management are all found to be inadequate for the demands of their day-to-day existence, whether in school, home, or community.  Environmental conditions means that the stimuli in any particular environment are not conducive to appropriate behavior for this individual and contributes to the emergence of problem behaviors. 

In applying PBS, the research review completed by Carr and his colleagues found two categories of intervention: stimulus-based and reinforcement-based (Carr, et al., 1999).  When environments are deficient it is when there are too few stimuli to support positive behavior and that changes in this environment are necessary as part of the effort to help children with disabilities exhibit more appropriate behavior.  On the other hand, from a reinforcement perspective, the existence of positive behaviors competes with or makes negative behaviors unnecessary because the positive behaviors provide an alternative for accessing the available reinforcement.  In sum, PBS tries to change the environment so that the conditions for appropriate behavior and its reinforcement are available and to teach appropriate behaviors as a substitute for accessing reinforcement in the environment.

Positive behavior support appears to be best suited for long-term change and is proactive to the extent that it attempts to teach behaviors and impact the environment that surrounds these behaviors.  This is contrasted to aversive or punitive approaches that seem best suited to a crisis management mode.  From the perspective of the family, and in keeping with the principles of social validity, PBS would seem to be the appropriate choice because of its good fit with a family environment.   Parents are able to work with their children using techniques that are effective and at the same time part of a normal pattern of interaction.   From the perspective of the school, PBS is a good match because of its suitability for use in inclusive settings and because it is primarily a teaching method.   Positive behavior support is procedure more likely to encourage the inclusion of children with disabilities in regular classrooms.

Exhibit 7, Characteristics of Positive Behavior Support

Redirective Therapy

Redirective Therapy was developed as part of a training program in a university clinic for parents and families of children with pervasive developmental disabilities (Swartz,  1994).  Parents had reported that though some techniques currently available appeared to be effective, they were too harsh and too unusual as a pattern of parent-child interaction.  They felt that the treatment became an aversive to both parent and child because of its intensity and that its suitability for the community or an inclusive school setting was an issue.  The criteria used in the development of Redirective Therapy (RT) was that it must allow for a positive interaction between parents and their children and that it must be suitable for use in all settings.  Using research in nonpunitive techniques (Donnellan, et al., 1998) the strategy focused on a simple pattern of redirection with teaching an appropriate behavior as the end goal.  Similar in this regard to the strategy identified as differential reinforcement of alternative behavior (DRA), Redirective Therapy diverged by electing to use only social rewards.  It was felt that since one of the primary goals for most children in the program was increased socialization, the use of social rewards would be the first important step in teaching social skills. 

Therapists using RT were taught to interrupt the undesired behavior and redirect the child to an appropriate behavior.  They were instructed to do this interruption in the least intrusive way possible (for example, a word or a gesture would be a preferable interruption to a physical cue).  Social reinforcement (praise or touch, or both) would immediate follow the interruption and redirection.  In this way, the concern about limited availability of reinforcement in the use of differential reinforcement of other behaviors (DRO) could be resolved.  This pattern was repeated until the child stayed on the new task and exhibited an appropriate behavior.  Parents reported that their good feeling about this strategy was that they could use it at home and on any trips into the community.  In another words, it met both the social validity criteria of feasible (I can use it) and desirable (I will use it). 

Exhibit 8, Redirective Therapy

Early Literacy Learning

Another promising practice is an intense literacy learning project developed in the United States and Mexico for all children including those having difficulties and children with disabilities (Swartz, Shook, & Klein, 2001). This work teaches children to read and write using research based teaching methods. The model also focuses on professional development and a particular organization of service provision.  The amount of time focused on literacy is increased to a full school day and content areas are taught using literacy strategies.  In addition, teachers, both regular and special, align their strategies.  This means that the teachers use the same teaching methods, the same classroom routines, and similar materials.  This alignment has the benefit of reducing confusion and allowing children to build on their own knowledge from year to year.  Children with special needs benefit from this alignment because they receive individualized and specialized instruction but using the same methods and procedures as those the regular classroom.  This supports their learning and makes for a smoother transition from special to regular education settings.  It also supports inclusion.  Special education does not necessarily mean different teaching methods, it should mean teaching that is more strategic because of the opportunity to individualize made possible by one-to-one or small group instruction.

Teachers are trained to use a gradual decline of teacher support and a gradual increase in student independence based on demonstrated student capability.  This reduction of teacher support is based on observations of individual child growth in understanding the process of literacy.  The child's use of a variety of problem-solving strategies is supported through good teacher decision-making about ways to assit each child toward the goal of independence.  The elements of the instructional framework are designed to help each child and the whole class move together toward that goal.  The framework is designed to structure classrooms that use literacy acitivites throughout the day of every school day.  Other curricular areas are delivered using literacy activities as the method of instruction. 

Early Literacy Learning Framework of Instruction

Phonological Skills

            Builds a foundation of phonemic awareness for explicit skills learning

            Teaches systematic phonics with writing, spelling and reading

            Supports development of accurate spelling

Oral Language Development

            Assists students in language acquisition

            Develops and increases vocabulary

            Promotes the use of accurate language structure

            Provides a basis for reading comprehension

Reading Aloud

            Introduces good children1s literature in a variety of genre

            Increases repertoire of language and its use

Shared Reading

            Promotes the development of early reading strategies

            Encourages cooperative learning and child-to-child support

            Stresses phonemic awareness and phonological skills

Guided Reading

            Allows observation of strategic reading in selected novel texts

            Provides direct instruction of problem-solving strategies

            Allows for classroom intervention of reading difficulties

Independent Reading

            Allows children to practice strategies being learned

            Develops fluency using familiar texts

            Encourages successful problem solving

Interactive Writing

            Provides an opportunity to jointly plan and construct text

            Develops letter-sound correspondence and spelling

            Teaches phonics and the writing process

Independent Writing

            Encourages writing for different purposes and different audiences

            Fosters creativity and an ability to compose

            Allows opportunity to practice or attempt new learning

The Redlands School, An American Mexican Project, has been developed as a demonstration of this literacy learning model and uses a dual immersion, English and Spanish instructional design.  Children with disabilities are integrated with their normal peers throughout the day. 

Exhibit 9, Major Components of Early Literacy Learning

Inclusion

There wouldn’t need to be a discussion about inclusion if there hadn’t been exclusion.  Individuals with disabilities have been treated differently and excluded from our society and our communities in many ways.  What is the case for many disabilities is even more so for autism because of their social and communication deficits.

In the United States we have a long history of excluding groups, sometimes we think for their good, and other times clearly for our own good.  In the early history of the U.S. you could only vote if you were a land owner and if you were a male.  Mostly boys went to school, our doctors and lawyers were all male, blacks had their own places to live and went to separate schools, and children who didn’t speak English often had no school at all to attend.  If you had a disability or special needs there were no public services and certainly no public school.  Most of this has changed.  We now have mostly an integrated society, except for children with disabilities.  This group continues to be segregated and isolated.  We continue to exclude them from the mainstream of our society.  They are special and so we provide them with a special school or a special classroom.  What was learned from past exclusion will also be learned from the exclusion of those with disabilities.  It serves no useful purpose and it is wrong.

There are numerous problems with how we provide services to children with disabilities that question our use of separate programs.  Issues to consider include:

1.  The evaluation systems used for children with disabilities produce results hardly better than the flip of a coin.  We continue to identify children as handicapped using tests and procedures in which professional examiners have no confidence and these various tests are unable to predict educational need, the only legitimate purpose that this kind of testing could have. 

2.  Growth in certain categories of handicapping condition has clearly become more a function of political pressure and professional fad than the characteristics and needs of students.  Some disability categories like learning disability has grown almost 100% per decade. And the growth in autism has been attributed by some to the result of service availability for this category as compared to other disabilities.

3.  Inclusion affects only about 5% of the mild to moderate category and even fewer children in the severe category.  This might be acceptable if there were good student outcomes for special programs provided in exclusionary settings.  Unfortunately, this is not the case.

4.  There is very little evidence that the services provided to children with disabilities is very effective.  Few graduate from school, few have jobs, few live independently, and few have social lives outside of their immediate families.  It appears that, in some cases, it would have been better to do nothing.  In most cases, the outcomes of special education are not even measured.

Exhibit 10, Why Inclusion?

The premise of special education is that there are two kinds of learners, normal and abnormal, and that they need two separate systems of education, needs to be challenged and changed.  This dichotomy is false.  Learners are found on a continuum and can be served in integrated settings.  There are no services provided in special education that cannot be provided in a regular school.

What is needed is a single, unitary, integrated system of education for all children.  There should be no tracks, no special classes, or segregated schools.  When children participate in their learning together, when no one is excluded, everyone will the better for it. The stigma of separation, the emotional impact of being considered so different as to be excluded or set aside, is sufficiently harmful, sufficiently devastating to the self esteem and feelings of self-worth of a child as to negate whatever benefits might be expected to accrue from the services provided.

Family Involvement

There are a number of issues that are key to ensuring successful family involvement in the education of children with disabilities.  It might be said that there are three levels of parental involvement.  The first is presence.  It means they attend meetings but have no real involvement in the program of their child.  The next level is participation.  Parents do what they are asked and support and participate in the program.  The highest level, and the one that is needed for truly effective program, is parent partnership.  Not just in name, but partners in reality.  This recognition by professionals that effective programs are dependent on informed and involved parents is critical.  Parents need to realize that their involvement is vital and not just gesture of show of support.

Exhibit 11, Levels of Parental Involvement

A survey was completed to determine what parents of autistic children considered their greatest needs. The survey covered three major areas of need.  When asked what service needs they had for their children they listed seven major areas in the following rank order: respite, speech therapy, recreation/social, dental, psychological, medical, and legal.  For the development of a program for their child they listed needs such as assistance with the development of a program plan, procedures to evaluate the program their child was receiving, the support of an advocate, independent evaluation, and support to challenge the actions of their service provider.  They were also asked what behavior problems they were having in the home. These were rank ordered: communication, socialization, compliance, tantrums, eating, routine refusal, and sleeping.  And their personal needs were reported as participation in a support group, parenting training, individual counseling, and marital counseling.  This survey was interesting because the results were not a match to the expectations of the professional staff.  Most programs were developed without asking about parent need.  To have parents as partners, their needs will be an important consideration.

Exhibit 12 and 13, Parent Surveys

Conclusion

From these various issues what can be considered the primary challenges to those committed to the education and treatment of children with disabilities?

1.  Definition and diagnosis need to be improved.  Effective service relies on understanding the disability, its characteristics, and the education and treatment needs.

2.  Research into prevention and cure should be established as high priorities.  

3.  Effective treatments are needed but they need to be respectful of the rights of the individual.  Only services that meet the social validity criteria should be considered.

3.  Children with disabilities should be included in our schools and in our communities.  There is no justification for current exclusionary practices.  Inclusion is the right thing to do.

4.  Parents as partners is the key to effective parental involvement.  Program success is directly related the the level of parental involvement.


Exhibit 14, Challenges

And last, more international collaboration and exchange is needed.   Professionals all benefit as they learn from one another.

Let me be the first to suggest that this first symposium not be the last.  Let us begin our planning for the second meeting and please be invited to consider either the United States as a location for the event.

Primer Simposium Internacional de Atencion a Personas Autistas y Personas con Sindrome Down
Facultad de Psicologia
Universidad de la Habana
Ciudad de la Habana, Cuba
13 al 16 de Noviembre 2001


References

American Society for Autism.  What is Autism?  2000.

Carr, E.G., Horner, R.H., & Turnbull, A.P. (1999).  Positive behavior support for people with developmental disabilities.  Washington, DC: American Association on Mental Retardation.

Donnellan, A., LaVigna, G., Negri-Shoultz, N., & Fassbender, L. (1988).  Progress without punishment. New York: Teacher’s College Press.

ERIC Research connections in special education (Winter, 1999). Positive behavior support.  ERIC Clearinghouse on Disabilities and Gifted Education.

Frith, U. (1989).  A psychological theory of autism.

Los Angeles Times. April 16, 1999.  Development Disorders Increase.

Matson, J.  (1994). Autism. Pacific Grove, CA: Brooks/Cole.

Swartz, S.L. (1994). Redirective therapy: Guidelines for use in school and home. San Bernardino, CA: California State University.

Swartz, S.L. (1998). Inclusion of children with disabilities in regular school programs.  In Z. Jacobo & M. Villa, Sujeto, educacion especial e integracion, Mexico: Universidad Nacional Autonoma de Mexico.

Swartz, S., Shook, R., Klein, A., & Hagg, C. (2001).  Ensenanza inicial de la lectura y la escritura.  Mexico City: Editorial Trillas.

Swartz, S., Shook, A., & Shook, R. (2001).  Foundation for California Early Literacy Learning, Technical Report.  Redlands, CA.

Swartz, S., Klein, A., & Shook, R.  (2001)  Interactive writing and interactive editing.  Carlsbad: CA:  Dominie Press.

Wolf, M.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.


Biography

Stanley L. Swartz, Ph.D. is Professor of Special Education at California State University, San Bernardino.  He is the Director of the Autism Research Group and the Foundation for California Early Literacy Learning.  He is also a visiting professor at the Universidad de la Habana, Universidad Nacional Autonoma de Mexico, and the Universidad Autonoma de Baja California and a Lecturer at the University of California.  Dr. Swartz has contributed to more than twenty books and written more than 100 papers and articles.  He has also written more than 30 children’s books that are published in both English and Spanish.  He is the President of the Redlands School in Mexico City, an English and Spanish bilingual elementary school.

Email:              stanley_swartz@eee.org

Web page:       http://stanswartz.com

Telephone:       909.880.5601

Fax:                 909.862.4045

Translation web page:  http://world.altavista.com/tr


Definition of Autism

     neurological disorder

     no parenting or environmental correlates

     impaired social interaction

     communication difficulties

     repetitive or stereotyped behavior


Characteristics of Autism

Core Features

     social skill deficits

     language deficits

     insistence on sameness

     responses to sensory stimuli

Associated Features

     intelligence

     stimulus overselectivity

     self-injurious behavior

     fears

     organic disorders

Spectrum Disorder


Pervasive Developmental Disorders

     Autistic Disorder

     Asperger’s Disorder

     Pervasive Developmental Disorder

     - Not Otherwise Specified

     Rett’s Disorder

     Childhood Disintegrative Disorder


Where Will Sally Look?

To test children’s awareness of others perspectives, researchers present a scenario in which Sallyh places a marble in a container, a second child moves it, and Sally later returns to look for it.

 

Most Children easily surmise that she'll expect to find it in the container where she left it. Autistic children assume that since they know the marble's in the box, that's where Sally will look.

Social Validity

     Feasibility

          Would you be able to use?

     Desirability

          Would you be willing to use

     Effectiveness

          Reduce problem behavior to an

          acceptable level

          Make a difference in lifestyle?


 

Redirective Therapy

Intervention Cycle

 



Major Components of Early Literacy Learning

       Increase emphasis on reading and writing in the curriculum

       Focus on the professional development of teachers

       Support school reform and school restructuring

       Use a balanced reading and writing program supported by scientific research

       Align teaching methods within and across the grade levels

       Support English language learners

       Facilitate inclusion of special needs students

       Use a capacity-building model

       Measure success by student achievement gains


Why Inclusion?

     evaluation

     category growth

     exclusion

     outcomes


Levels of Parental

    Involvement

     presence

     participation

     partnership


Parent Survey

     Service needs

          respite

          speech therapy

          recreation/social

          dental

          psychological

          medical

          legal


    Personal needs

                 support group    

          training

          individual counseling

          marital counseling


Challenges

     definition and diagnosis

     prevention and cure

     education and treatment

     inclusion

     parental involvement