Tips to provide Structure to a Young Person with ASD

Structure is important for neurotypical individuals and has a even greater importance to young persons with ASD, because it helps them to ease the stress related with changes by allowing them to predict events or to organize their day and mind (repetitive, restrictive behaviours).

To use structure we should use clear aids, which can be visual, body-kinaesthetic, tactile or auditory. Some examples of aids used are: timetables, schedules, diaries, memory post-its, etc.

In the next paragraphs, we will enumerate a list of good practices for educators:

The imagery used needs to be adequate to the student. For example: if the student is comfortable with symbols we shouldn't use photographs. If the educator is unsure about the imagery to use he should try different approaches until he achieves the objective, through trial and error.

We should make a correct use of timetables. They should be put in a vertical manner and thorough the development of time the activities/steps done should be put away in a finish box or erased from board. If showing in detail a structured activity, in the timetable, its components should be put horizontally. Also, if the understanding of the students requires it, we could use “now and then” boards instead.

One strategy we could use if the educators need to change the timetable for any reason is introducing a change card. To use a change cards we can follow the following steps: 1) introduce the concept of change with the change card; 2) wait 20 min; 3) use a personal interest, of the pupil, to introduce change: “Today the change is playing a videogame”; 4) next time, can be on another day, wait 40 min; 5) use another personal interest, something not so fun but pleasant, to introduce change: “Today the change is reading”; 6) the pupil should accept the change, but if he complains ignore it and provide the change as soon as possible; 7) repeat the strategy different times with different events/activities to prepare the pupil to real changes, until the student accepts the change card.

To respect the structure there are practices that the educators should avoid. We should not violate the structure, if we are unsure of the planning for the day we should keep the timetable vague. Also, we should avoid a disorganised environment or having no pre-planning.

I hope you find these tips handy.

Social Communication Impairments in Fluently Verbal Individuals

It is not because an individual with ASD is fluently verbal that he/she doesn't face language and communication challenges, since language is a social phenomenon (Self, 2013).

Individuals with ASD who have a good vocabulary could face difficulties due to a literal understanding or due to a concrete way of thinking and inflexibility of thought, which might be expressed by their difficulties in understanding figures of speech and idioms or understanding that certain words have alternative meanings.

Regarding social language, a person with ASD may experience difficulties when making inferences; when answering to WH questions (who, when, where, what...); when writing or reading complex sentence structures; and when connecting ideas from a conversation or text (Vicker, 2009).

Regarding social communication, individuals with ASD may experience difficulties understanding others' perspectives or points of view; when experiencing sensory overload; when talking aloud with self in public; initiating, maintaining or terminating a conversation; understanding others' roles and/or to adjust topic and/or speech according to situation; understanding that he/she needs to be clear to be understood; monitoring own comprehension to be able to seek clarification if needed; and making predictions (Vicker, 2009).

A person with ASD may not understand that other people have their own ideas and motivations, and that their personal interests may not be interesting to their peers. An obsession with personal interests may prevent him/her to participate in reciprocal interactions (Selfe, 2013; Vicker, 2009).

Some comprehension problems may be masked by the use of sophisticated language, when a person with ASD tries to promote an inflated self-image (Selfe, 2013; Vicker, 2009).

Sensory issues may lead to communication problems as well. A person with ASD may experience difficulties to listen if highly stimulated, or a person with ASD can lie to achieve sensory relief – e.g. be left alone (Selfe, 2013; Vicker, 2009).

To enhance communication specific resources should be prepared and used, in order to address specific needs of individual students. Those resources should always provide options and variety.

For example, we can use visual aids to facilitate the communication: visual cards with particular words and symbols; boards to help express emotions or feelings (“feelings' meter”, “emotions' chart”) which help working out semantic difficulties. Or, other example, we can teach expected behaviours in diverse social contexts through rehearsals: playing games in a group context to teach social communication skills through mimic and exemplar attitudes.

Islet of Ability

The concept of islet of ability is commonly used to refer to an extraordinary skill of a person with neurological impairments. Some individuals diagnosed with ASD may present particularly exceptional or savant skills in specific areas. The percentage of savant individuals among the total of population with ASD is 10% (Waterhouse, 2013).

Even if not all the individuals with ASD are savant, Grandin (2011, p. 17) affirms that “all minds on the autism spectrum are detail-oriented, but how they specialize varies”. Also, the author emphasises that each individual with ASD has an area of strength, that we can relate to the islet of ability, and an area of deficit; describing three types of specialized thinking styles that individuals with ASD have dominantly: a) visual thinking – thinking in pictures; b) logic thinking – thinking in patterns; c) verbal thinking – thinking in words.

Following the same line of though, Happé (1999) emphasises the concept of weak Central Coherence Theory that refers to autism as a cognitive style biased towards local, rather than global, information processing; however this theory is controversial and there are studies that indicates that it needs more academic sustainability.

Autism: Triad vs. Dyad

The Triad of Autism

The triad of impairments is in the base of the diagnosis of Autism, according to the DSM IV (APA, 1994). It consists in impairments in three specific areas: social interactions; social language and communication skills; and restricted, repetitive and stereotyped patterns of behaviour.

In the area of social interactions the impairments could be expressed via the contact with others and relationships. Some examples that an autistic child could demonstrate in this area are: deficits in the use of several non-verbal behaviours; inability to develop relationships according to their developmental level; inability to seek to share, spontaneously, enjoyment, interests and/or achievements with others; and lack of social and/or emotional reciprocity, empathy (APA, 1994)

The social language and communication skills impairments are related with the difficulty that autistic individuals have to initiate or maintain a conversation, or to use language as a information tool. For example, an autistic individual may demonstrate: lack of verbal and non-verbal skills – inability to understand questions, directions or expressions; inability to initiate or sustain a conversation; use of stereotyped, repetitive and/or idiosyncratic and metaphorical language – sometimes only perceptible for those who are familiar with individual; lack of imagination skills that could be detected through make-believe play and/or social imitative play; use of an abnormal pitch, intonation, rate, rhythm, and/or stress of speech (when the speech is developed); immature use of grammatical structures (APA, 1994).

The restricted, repetitive and stereotyped patterns of behaviour impairments are related to the short flexibility of though, to the difficulty of accepting changes and to the obsession regarding some topics, behaviours or activities. According to DSM IV (APA, 1994), this area of impairments could be observed through: abnormal intensity or focus in stereotyped and restricted patterns of behaviour; use of stereotyped and repetitive motor mannerisms; adherence to non-functional and specific routines; restricted range of interests; insistence on sameness; inability to cope with changes (APA, 1994).

Dyad of Autism

Nowadays the triad of impairments concept is falling into disuse and it is being substituted by the concept of dyad of impairments, and it used to diagnose the ASD condition that became broader. The differences are few, although I consider them important to be clarified.

The dyad of impairments manifests in two wide areas: social communication and social interaction in multiple contexts; and restricted and repetitive patterns of behaviour, interests or activities (APA, 2013; Selfe, 2013).

The area of social communication and social interaction encompass impairments in: the understanding and use of language; the verbal and/or non-verbal communication; and the interaction with others and development of relationships. For example, an autistic individual may show: lack of social and/or emotional reciprocity, empathy; difficulties to initiate or maintain a conversation and/or answer to social overtures; reduced ability to seek to share, spontaneously, interests, emotions and/or affection with others; inability to use and/or understand several non-verbal behaviours; lack of ability to develop, sustain and/or understand relationships; difficulties to adjust behaviour according to various social contexts; imaginative play skills impairments; lack of interest in peers (APA, 2013; Selfe, 2013).

On the other side, the area of restricted and repetitive behaviours, interests or activities encompass: the flexibility of behaviour, the acceptance of changes, organisational and planning skills, restricted and repetitive behaviours, interests or activities, behaviours; sensory issues conveyed in behaviours and/or needs. For example: use of stereotyped and repetitive motor mannerisms (flapping hands), use of objects (aligning objects) and/ or speech (echolalia, idiosyncratic phrases); insistence on sameness; adherence to non-functional and specific routines; inability to cope with changes; hyper or hypo reactivity to sensorial stimulus and/or abnormal interest to environmental sensorial features (APA, 2013, Selfe, 2013).

Positive Expectations

The educators should always try to make the most for their students to achieve their full potential. Instead of lowering the expectations towards a students we, as educators, should redirect the focus of their learning to another objective more adequate to their availability. In other words, if a child is not coping according to our expectations we should change our course of action maintaining positive expectations at all times.

We might have to modify, or redirect, our expectations if a student is not coping with a certain objective in order to keep him motivated with learning or to reassure them and increase their self-esteem. For example, if a child is not coping with an academic subject we should direct the focus of his learning in the adjacent issue, that might be sensorial or behavioural; later, if the new objective was accomplished, we can re-direct the child to achieve the initial objective or create a new one.

This topic leads us to an interesting debate between two different systems – ABA and Son-Rise – used to educate children with ASD. Selfe (2013) leaves the question: should educational programmes address inherent weaknesses in order to improve child's life in general or should educational programmes address evident strengths to develop self-confidence and achieve greater incidental learning? The experience leads us to believe that is the delicate balance between the two ideas that creates the best approach.

ASD: Social Communication Impairments

One thing that can impact on how people with ASD present themselves is their deficit in social communication. ASD comprises challenges of part-taking in society and that can be seen by the special way each individual has to present himself.

Human beings are a social species, even though individuals with ASD show a failure of typical responses to everyday social events during the process of socialisation (Selfe, 2013). If the individual with ASD has no support, the deficits in social communication cause perceptible impairments.

For example, Individuals with ASD may show: difficulties initiating social interactions; decreased interest in social interactions; reduced or abnormal response to overtures from others; issues in verbal and non-verbal social communication such as understanding social cues, facial expressions or gestures; or difficulties to cope with eye-gaze or joint attention experiences.

Autism vs. Asperger Syndrome

ASD is a wide diagnostic term, which encompass disorders previously referred as: Autistic Disorder, Kanner's Autism or Classic Autism, Early Infantile Autism or Childhood Autism, Atypical Autism, Asperger Syndrome, High-functioning Autism, Rett Syndrome, Childhood Disintegrative Disorder and Pervasive Developmental Disorder-Not Otherwise Specified, (APA, 1994; APA, 2013; Autism Speaks, 2012). 

ASD is the current psychiatric term used nowadays, the concept of spectrum implies all the diversity of characteristics that te condition embraces (APA, 2013).

If we are comparing the terms of Autistic Disorder and Asperger Syndrome, used before the DSM-5, we can affirm that, according to Autism Speaks (2012), in the Autistic Disorder the symptoms, related with communication, language and repetitive and restrictive behaviours, are obvious; while in a child with Asperger Syndrome that might not be the clear at a first instance: “In AS, the child doesn't show a significant delay in language development.” 

The individuals with Asperger Syndrome tend to have a superior IQ than that of individuals with Austistic Disorder. Although, both conditions are characterised by issues related to social interaction and communication and sensory perception.

In terms of levels of severity, Asperger Syndrome is more likely to be considered to lay on level 1 or 2 of required support, while Autistic Disorder is more likely to be considered on level 2 or 3.

Autism as a Spectrum Condition

As a light spectrum, an image which results from the diffusion of various rays, autism is a condition which results from a specific set of characteristics that changes according to each individual.

Autism Spectrum Disorder [ASD] is not a single condition and it has not a single cause, on the contrary, it is considered a number of different neurodevelopmental disorders, with similar behaviour features. Those features are related to persistent impairment in the social communication and interaction, and to restricted and repetitive patterns of behaviour (Self, 2013; AutismSpeaks, 2012), known as the dyad of impairments..

To be clear, the ASD diagnosis depends on meeting the criteria set out in DSM V (APA, 2013): a) persistent deficits in social communication and social interaction in multiple contexts; b) restricted and repetitive patterns of behavior, interests or activities; c) Symptoms must be present in the early period of development (even if they are not fully noticed at the time); d) The symptoms cause clinically significant impairment in social, occupational, professional or other important areas of the individual in the present.

Autistic individuals may vary widely not only in presenting symptoms, but also in their cognitive ability, their pragmatic ability, their severity level, presenting co-morbidity conditions, and underlying genetic and neurological status. The distinction made between levels of severity is made according to the level of support needed by each individual: 1) requiring support; 2) requiring substantial support; 3) requiring very substantial support (APA, 2013; Selfe, 2013; Autism Speaks, 2012).