THE RANGE OF EDUCATIONAL PROVISION FOR CHILDREN WITH AUTISM

In a recent follow-up study of young adults with autism, Goode and her colleagues explored the types of school most commonly attended.

Although, as children, they had attended a wide range of different schools, the majority had spent most of their school life in specialist autistic schools or units (see Figure 6.1).

Specialist schools for children with autism

In England, the National Autistic Society is directly responsible for 5 schools for children with autism and throughout England and Wales there are 7 additional schools run by local autistic societies, offering approximately 400 places in all (Jones and Newson, 1992). There are also a number of units or classes run by local education authorities, offering a further 600 specialist placements. Thus, in an estimated population of 7,800 children with autism in these countries (Autisme Europe, 1988), approximately 1,000 (12.5 per cent) are in specialist provision. Jones and Newson found that of a total of 105 local education authorities in England and Wales in 1992, only 37 per cent had any specialist provision for children with autism, 52 per cent would fund placements outside the authority, and 10 per cent funded no specialist provision, placing all pupils with autism in schools for children with learning disabilities, or in a few cases in mainstream provision.

In other countries where there is little or no specialist education

Figure 6.1 Principal school placements of individuals followed-up by Goode and colleagues Note: ‘Other’ includes: private, ‘delicate’, home tutor

(for either economic or political reasons), small classes or units are often set up by charitable or parental organisations. The success of the TEACCH classes, which originated in North Carolina (Mesibov, 1992) and which have since been adopted by a number of countries in Europe, also demonstrates how research-based programmes can be adapted for use in schools.

As in any educational setting, the curriculum and quality of teaching offered within specialist schools or units is very variable.

Although there have been attempts to evaluate the most appropriate types of teaching programme and school environment for children with autism (Newson and Jones, 1994), the small sample size of such studies, together with problems in experimental design, means that the conclusions are often contradictory or uncertain. There remains no firm evidence in support of the argument that the majority of children with autism are best educated in special autistic schools.

Indeed, because of the heterogeneity of children with autism, it would be surprising if any one approach or system were to be universally effective. As Rutter pointed out many years ago (Rutter and Bartak, 1973), what is needed is task-oriented, highly structured teaching adapted to meet individual needs.

The unique advantage of autistic schools, however, lies in the specialist knowledge and expertise of the teachers who work there.

Their training, and the experience that comes from being in daily contact with children with autism, places them in a singular position when it comes to dealing with behaviour difficulties, minimising ritualistic and obsessional behaviours, developing social and communication skills, and generally creating an optimal environment to reduce problems and maximise abilities. Support and guidance from colleagues working with the same problems helps to maintain a high standard of teaching and the emphasis on home-school links, which tends to be a particular focus of these schools, also ensures greater consistency in treatment and management. Small class-sizes and a very high teacher-to-pupil ratio are other advantages, rarely available in non-specialist provision. Many such schools also have strong links with other experienced professionals, such as social workers, GPs, paediatricians, psychiatrists and psychologists who are able to offer additional help to deal with other aspects of the child’s or family’s needs.

Many children with autism, even those with severe behavioural disturbances, show rapid improvement when placed in specialist autistic provision. Despite the advantages, however, there are also clear drawbacks to segregated units of this kind. Firstly, the peer

group itself, by its very nature, is unlikely to offer opportunities for the development of social relationships. That is not to suggest, of course, that simply placing a child with autism alongside normal peers will automatically lead to improvements. As discussed later in this chapter, the development of social interactions requires highly skilled input from teachers. Nevertheless, if all the other children in the school also have profound social impairments, even the most expert of teachers will have problems encouraging social interactions. Many parents are also concerned about the effects of placing their child with others who may be even more severely handicapped. Autistic children, like any others, have a propensity for copying undesirable behaviours from their peers, and parents may be understandably anxious about the risk of new problems being acquired in this way.

Perhaps the most important drawback of special units, especially for more able children, however, is the limited educational facilities that they are able to offer. Small schools may have a great advantage when it comes to developing a consistent and individualised approach to teaching but these very factors make it difficult, if not impossible, to offer a wide teaching curriculum. Despite the fact that special schools are expected to incorporate the ‘normal curriculum’ into their teaching as far as possible, the extent to which this can be done is obviously limited. Few autistic schools are able to offer a child with autism the opportunity to take external examinations in maths, physics, computing or similar topics, since they are unlikely to have staff adequately qualified in these areas. The London-based study by Sue Goode and colleagues has shown that very few people with autism, even those of normal intellectual ability, leave school with any formal qualifications (see Figure 6.2).

But, since success in later life is highly dependent on the qualifications obtained in school or college, the inability of autistic schools to provide such opportunities has serious implications for at least a minority of their pupils.

Education in schools for children with severe learning disabilities The majority of children with autism will, of course, never reach a high level of attainment. Around half of all children with autism have severe to moderate learning problems and because of this many education authorities argue against placement in highly specialised (and expensive) autistic provision, when places are readily available in schools for children with more general learning disabilities.

Figure 6.2

In principle, there might seem to be a number of factors in favour of this argument. Firstly, because there are more schools available for children with learning disabilities, it should be easier to find one relatively close to home, thereby avoiding the need for extensive travelling, or even boarding facilities. Secondly, proximity to the child’s home means that it should be easier to develop the crucial links between parents and teachers. If other pupils live locally, this should also facilitate the development of peer relationships outside school.

Finally, because such schools are larger, the physical amenities are often far better.

Nevertheless, in practice, the very specific pattern of disabilities shown by children with autism poses many problems in mixed settings of this kind. Most children with learning disabilities, especially those in the mild to moderately handicapped range, will show a fairly ‘flat’

profile of abilities. Thus, although delayed in all areas, their social, communication and emotional development will, in general, be on a par with their development in other areas. Teaching can therefore be relatively easily adapted to the child’s overall cognitive level. In the case of autistic children, whose developmental profiles are characteristically uneven, this can prove much more difficult. Thus, certain aspects of motor development may be relatively unimpaired;

there may be moderate delays in other areas of non-verbal development, whilst deficits in verbal, social and emotional development may be very profound. If matched with other learning-disabled children on the basis of their non-verbal skills, pupils with autism will almost certainly be far more handicapped than their peer group in terms of social and communication development. If matched for social or communication skills then they are likely to be far more capable in terms of their motor development. This can give rise to considerable problems for staff having to cope with very delicate or physically disabled children. In addition, if placement is in a special needs unit, then much of the staff’s time is likely to be taken up with activities such as cleaning, feeding or toileting, so that the needs of the physically more able child with autism can easily be neglected.

Additional problems may occur in adolescence, when many children with learning disabilities will have developed good social networks and will be able to work co-operatively, thereby allowing more group teaching to take place. This is rarely the case in autism, where individually based teaching remains an essential requirement.

The child with autism is almost certain to be lacking, too, in the imaginative and imitative skills of other pupils, making play and other joint activities very difficult. This progressive ‘isolation’ can lead to an

upsurge of behaviour problems and staff are unlikely to have the specialist skills needed to deal with these. Specific training related to autism may not be available, and the mutual support and advice about effective strategies that teachers in a school for children with autism can offer each other will also be missing.

Schools for children with mild learning disabilities or emotional and behavioural difficulties

Again, in principle, such provision should be appropriate to meet the needs of more able children with autism whose general intellectual ability falls within the low-average to mildly handicapped range.

Again, however, the very uneven developmental profiles of children with autism can make teaching, and learning, in such settings very difficult. Thus, while the communication and interpersonal skills of children with autism may be much less well developed than those of their peers, their cognitive development, at least in certain areas, may be significantly more advanced, leading to problems for class or group teaching.

Obviously, many pupils in schools of this kind will have behavioural problems but these are often very different in kind, or have very different causes, from the problems shown by autistic children, and hence may demand very different approaches to intervention. Similarly, the general goals of the school may be inappropriate. Thus, an emphasis on the development of independence and self-motivation may prove counter-productive for adolescents with autism who are simply not able to cope without a high level of continuing teacher support and guidance. Their lack of social understanding leaves them highly vulnerable to teasing and verbal or physical abuse, or of being ‘set up’ in some way by more socially aware peers. Moreover, because of their communication problems, pupils with autism are often unable to explain that they are being bullied or teased; they may even misinterpret such behaviours as ‘friendliness’ on the part of their peers. Indeed, it may not be until years later, when they are better able to describe feelings and experiences, that parents become aware of the traumas they have undergone.

Geoffrey had attended a boarding school for children with mild learning difficulties and had never made any complaints to his parents or teachers during his time there. While attending a social group for people with autism, in his mid-thirties, however, he gave graphic accounts of his cruel treatment by other children, and even by some members of staff. On one occasion he had even been caned by his

teacher, after openly admitting that he had let his mother complete his geography project. Another young man, Tony, was excluded from his school for biting one of the teachers but it was not until many years later that he was able to explain that he had done so because of the anxiety and distress caused by continuous bullying from other boys.

Bullying and teasing, of course, are not insurmountable problems, especially if schools are small and well staffed. With due attention to these risks, accompanied by educational programmes that are specifically adapted to meet the cognitive, social and emotional needs of the autistic adolescent, successful placements can be achieved.

However, this depends largely on the skills, care and flexibility of the staff involved, rather than the particular type of school. Certainly, in some cases, schools for children with mild learning disabilities, or for those with emotional and behavioural disturbance, can, and do, offer an effective educational environment; in other instances, such provision may go disastrously wrong.

Schools and units for children with language disorders

Because of their widespread communication difficulties it might be expected that placements in a ‘language unit’ might prove very suitable for at least some children with autism. However, specialist language provision for adolescents is extremely limited and the few schools or units that do exist are often unwilling to accept pupils with a diagnosis of autism, because of their additional difficulties, and in particular their lack of motivation to communicate. Whereas most children with specific language disorders show normal social reciprocity, imagination and make-believe play, and have only mild impairments in their use of gesture and other non-verbal skills (Bishop, 1994), children with autism frequently show severe delays and abnormalities in all these areas, even if their expressive language skills appear relatively intact. Thus, again, the skills required for teaching in a language unit may be very different from those needed for teaching children with autism. In addition, few school-leavers in language units obtain formal qualifications (Haynes and Naidoo, 1991), so that the intellectually able student with autism is unlikely to gain any academic advantages in such provision. Indeed, there is some evidence that pupils with autism may achieve more highly in an autistic school than in a placement for children with language impairments (Mawhood, 1995a).

Special autistic units attached to mainstream or other schools An alternative to segregated schooling is the development of small units, specifically designed to meet the needs of children with autism, but on the same site as a larger school. This may be a mainstream school or a school for children with other forms of learning disability.

The advantage of such units is that children can take advantage of the facilities offered by the parent school whilst continuing to have access to the individual support and specialist knowledge of the staff in the autistic unit. However, there is no hard evidence for the effectiveness or otherwise of units of this type. Clearly they do work well for some children but integration within the parent school is often less extensive in practice than in principle. There is also a tendency for teachers in the small unit to feel isolated from, and indeed sometimes even rejected, from the main body of the school.

Children with autism in mainstream schools

For the majority of high-functioning children with autism, their chances of living a full and independent life will be dependent on whether they are able to obtain academic qualifications at school, which will, in turn, allow them to progress to further education and eventually a job. With few exceptions, the only way in which this can be achieved will be by attending ‘mainstream’ school.

The push towards integration, particularly for children with fairly mild problems, has had a significant impact on education at the infant and junior levels and many primary schools have children with a variety of different disabilities on roll. Research evidence suggests that children with milder or less obvious disabilities tend to be more readily accepted by their peers (Howlin, 1994a) so that children whose autism is relatively mild are likely to be more easily assimilated.

There have also been a number of studies indicating that input from normal peers can have very beneficial impact on the play and social interactions of young children with autism (Lord, 1984; Wolfberg and Schuler, 1993; Quill, 1995a). However, such interactions need to be carefully structured and reinforced by teaching staff; the type of play equipment used and the general structure of the classroom are also important, otherwise the enthusiasm of the normal children tends to be short-lived.

There are far fewer studies of integration involving older, secondary school children but such evidence as is available suggests that the risk of rejection rises with age. Discrimination by peers and

teachers alike tends to increase for a number of reasons. Firstly, because of increasing pressures to perform well in academic ‘league tables’ or similar forms of assessment, schools have become more reluctant to accept pupils who are unlikely to do well. If a pupil has disruptive behaviours these, too, of course, can have a negative impact on the work of other children.

Secondly, in adolescence, the need to conform to group norms and to be accepted by peers becomes of paramount importance. Those who do not fit in are increasingly likely to be excluded. Recalling her adolescence Donna Williams writes: ‘At school the other children had begun to pick on me. I’d become fairly insensitive to being called mad but I was now being called stupid and…this still hurt… My history at this last school was the same as at the others. I was a failure’

(Williams, 1992).

Thirdly, the structure of secondary school is very different from that in primary school, and poses far more problems for pupils with autism. In primary school, children often remain with the same peer group for six years or more. Lessons are conducted in the same classroom, with the same teacher for almost every subject, and many children remain with the same teacher for two years or longer. Schools tend to be relatively small in size, so that teachers become familiar with all the children and their parents. Staff will usually learn to tolerate ‘unusual’ behaviours (such as making loud comments in assembly or correcting the teacher in the classroom) once they understand that this is not done out of malice or rudeness but because of a lack of social understanding. Classmates, too, often become used to, and accept the child’s ‘odd ways’. Indeed, these may prove a welcome distraction from the normal boredom of lessons. In such environments it is also usually possible (although by no means always easy) to keep a watch on bullying or teasing and for staff to agree on consistent approaches to education and management.

In contrast, secondary schools are large, sometimes on split sites;

although there may be some familiar children from primary school most will be unknown; lessons, classrooms and teachers change at hourly intervals; most teachers will never get to know the children well, or understand the problems associated with an unusual and specific disability, such as autism. Thus collaboration between teachers in establishing an appropriate educational programme for a

although there may be some familiar children from primary school most will be unknown; lessons, classrooms and teachers change at hourly intervals; most teachers will never get to know the children well, or understand the problems associated with an unusual and specific disability, such as autism. Thus collaboration between teachers in establishing an appropriate educational programme for a