Joshua* used to start his school days bouncing off the walls. The 16-year-old, who attends the LEAP Program (Lifeskills and Education for Students with Autism and other Pervasive Developmental Disorders) at Baltimore's Kennedy-Krieger Institute, rides a bus for more than an hour to participate in the highly regarded day program. The long trip made Joshua so agitated that most of the first half of his day was spent calming him down.
He would be completely hyper and wound up, which could evolve into aggressive behavior, says Linda Brandenburg, M.S.Ed, director of the LEAP Program.
No more. Today, when Joshua arrives at school, he heads straight for the multisensory environment room, a new high-tech facility that uses equipment providing various combinations of music, light, vibrations, tactile sensations and aromatherapy to help children with autism spectrum disorders focus. Also known as a Snoezelen room (the name comes from the Dutch words for sniff and doze, and the rooms originated in the Netherlands in the 1970s), the multisensory environment provides a full range of relaxing sensory stimulation.
Since Joshua needs to calm down and focus, he sits in a special massage chair whose vibrations coincide with a musical beat. Meanwhile, a projection wheel on the wall rotates through abstract images that he can focus on. Within ten minutes, he is much calmer, says Brandenburg. He can make eye contact and sit at a desk, and he starts the day off much better.
The Snoezelen room is just one aspect of LEAP's multifaceted approach to educating children with autism, which balances multiple learning methods in the belief that no single approach works for all children. The combination of therapies is eclectic, but not haphazard. All of the interventions were created with one goal in mind - providing structure.
Having a clear physical structure to the classrooms and an organizational structure to the day's schedule allows these kids to learn to go through the day independently, says Brandenburg. All day long, students follow mini-routines, such as the arrival routine: getting off the bus, going into the building, getting to their locker, opening it, putting their lunch in, closing it, going to their first room of the day.
For younger children, LEAP's primary teaching method involves what's called the discrete trial approach, with steps such as the discriminative stimulus, prompt, response and consequence. For example, a teacher may place a penny and a nickel on the table and ask a child to point to the nickel - the stimulus. If the child starts on the wrong path, the teacher prompts him.
With some children, we use what's called 'errorless prompting' - correcting them before they point to the penny, so that they always get the right answer and feel successful, says Brandenburg. With others, we may prompt simply by saying 'no,' and they make a mistake once or twice before prompting ahead of time. After a successful response comes the consequence: positive reinforcement that can include high fives, M&Ms or tickets for computer time. They spend much of their day engaged in such drills, learning things like colors, numbers, animals and parts of the body.
The rest of the day includes music and art therapy, and theme group activities, in which therapists lead a group learning about a specific topic like cooking. Kids with autism prefer to be left alone and work by themselves, so the inherent goal in a group activity is to teach them social skills. Can they sit next to peers at a group table and wait for their turn to participate? says Brandenburg.
As the children progress, teachers use the same approach to move from classroom lessons into a natural environment. It starts within the school building - for example, at aquatics therapy. When a student finishes in the pool, the instructor works with her on a task analysis of changing back into her street clothes. We break any task down into simple steps and teach it one step at a time - routines for handwashing, toothbrushing and other daily activities, says Brandenburg.
Older students travel to places like McDonald's or Target to practice tasks in the real world. Since many do not read, they're given picture schedules of what they will do: look for a certain item, go to the cash register, pay for it, then get back into the van to return to school.
Though Kennedy-Krieger incorporates innovative approaches like the Snoezelen room, the school resists jumping on bandwagons. There's always an 'approach of the month' springing up, but we've found that the tried-and-true methods work. Setting a clear visual and physical structure, establishing routines and combining that with applied behavioral therapy - we have consistently found that this approach gets results.
Autism Society of America
The Autism Society of American has a search engine that provides links to day programs, along with a description of their teaching philosophy and approach. Visit www.autism-society.org and click on Resources.
Association for Science in Autism Treatment
MAAP Services for Autism, Asperger's, and PDD
National Dissemination Center for Children with Disabilities
U.S. Dept. of Education, Office of Special Education Programs
Fax: (202) 884-8441
National Institute of Child Health and Human Development (NICHD)
Tel: (301) 496-5133
National Institute on Deafness and Other Communication Disorders Information Clearinghouse
TTD/TTY: (800) 241-1055
*Not his real name [Context Link]