Different approaches to the education of children with autism Autism was first defined by the American child psychiatrist Leo Kanner in 1943, who noted that there was a difference between autism and childhood schizophrenia and described autism as a separate syndrome with two key characteristics: "autistic closedness" and "desire for immutability", along with other behavioral manifestations and isolated abilities.

Autism (Greek autós - self) is an umbrella term for a group of pervasive1 developmental disorders that are characterized by severe deficits in three areas (the so-called triad of impairments) - communication, social interaction and imagination. Disturbances in the field of communication (quantitative and qualitative) can be manifested by: echolalia (repetition of words and sentences), monotonous speech without intonation, lack of imitation, spontaneity in the use of language, incorrect use of pronouns, inability to understand abstract concepts, problems understanding the speech of others and maintaining a meaningful conversation, etc. Impaired development of the imagination, but also the area of activity and interests, manifests itself as follows: stereotyped and repetitive patterns of behavior (clapping hands, turning the body, grimacing, tapping...), abnormal focus on a certain pattern of behavior or routine activity and striving for their immutability, unusual handling of toys - focusing on parts of the object, inability to play with toys or objects imaginatively... Disruption of social interaction can manifest itself: avoiding eye contact, problems understanding facial expressions, inability to establish and develop adequate social contacts with peers, prefer solitude, lack interest in other people, use another person's hand to reach something, show minimal initiative to play together Autism is an umbrella term that includes several clinical units, differing in etiology, prevalence and symptomatology. Sometimes autistic manifestations in behavior are very diverse and represent a whole continuum of strange to disturbed behavior. In the professional literature, the umbrella term - autism spectrum disorder (ASD), autistic syndrome or pervasive developmental disorder (PDD) is mentioned. Up to 80% of the population with ASD has an intellectual disability. A specific subcategory is also the so-called high-functioning autism (VFA, from the English High-functioning Autism - HFA), which has been used since the eighties for a subgroup of children and young people diagnosed with childhood autism with intellect in the normal range. Children with HFA have more pronounced language deficits (difficulties with understanding and using language, more pronounced difficulties in the pragmatics and semantics of speech) and problems in social interactions.

Experts from several fields and scientific disciplines are dealing with the causes. Apparently, there is no single cause, but rather a complex of several factors involved in the development of autism. From the point of view of current medicine, it is a neurodevelopmental disorder, the emergence of which has a fundamental influence on genetics (inheritance) and psychogenic environmental factors. The impact of the immune system and metabolism on the development of this disorder is also considered. Some studies have shown an increased incidence of autism in connection with the use of psychiatric drugs in pregnant women.

Siklenková reports that in 30% of autistic children, an excessive increase in brain size was observed between the first and second year of life (frontal area and amygdala). Consequently, there is no pre-pubertal brain volume increase in autistic people. There is often a reduction in the volume of the corpus callosum, which is the part of the brain responsible for connecting the nerve cells of both brain hemispheres (so-called interhemispheric communication). It is generally proven that in autistic people the connectivity between individual parts of the brain is disturbed, for which it is not possible to integrate more distant areas of the brain with each other to the required extent. This leads to insufficient processing of complex and demanding information or processes, such as speech and social behavior.

The hypermasculine brain theory postulates a link between autistic traits and increased exposure of the fetus to the influence of testosterone. During intrauterine development, it significantly affects the maturation of the brain and contributes to the different abilities and characteristics of both sexes. Men are generally more gifted in logical reasoning, spatial imagination, their brains are more systematic. On the other hand, emotional strengths such as empathy and speech skills dominate in women. Persons with ASD show increased systematization abilities at the expense of empathic abilities (interest in systems, orders, repetitive behavior, resistance to any changes and the need for sameness, social awkwardness, reduced ability to recognize other people's moods and feelings). It is a theory that is based on the older concept of the psychologist Baron-Cohen, that behind the emergence of autism is the so-called Mindblindness Theory. The ability of 'theory of mind' is described as the cognitive component of empathy, as what allows us to put ourselves in someone else's shoes and imagine how they feel and what they think. This theory says that autistic children are simply delayed or limited in the development of 'theory of mind'.

Theory of mind (or awareness of mental states that enable mind reading) is a specific cognitive ability that allows creating a system of judgments and opinions about mental states that cannot be directly observed (what a person thinks about, what he experiences, what he desires, what he is convinced of, what he believes, what he intends). If a person is able to recognize the mental state of a person, he is also able to guess the reasons for his behavior. This ability thus allows us to predict and control behavior and is the basis for the ability to empathize and provide comfort to others. We perceive the consequences of the inability to be aware of mental states especially in children with ASD and can be as follows: misunderstanding of human feelings (incorrect, indifferent reactions in emotionally tense situations); inability to take into account what people know (based on information known only to them); understand other people's intentions (they don't guess that people are joking, lying, wanting to make people happy, wanting to make fun of others, etc.); estimate the interest and needs of other people (they give completely inappropriate gifts, lead boring monologues...); guess what people will think or how they will react (they don't follow social norms, behave tactlessly, make inappropriate comments, etc.).

Education Options

For the possibilities of education and social integration, it is necessary to determine the strengths and weaknesses of the child, the level of his support and rehabilitation services, the level of measures in education and upbringing and peculiarities in behavior, the occurrence of aggressive and threatening behavior for the environment and the child himself.

We include among the effective methods and programs for students with ASD: 1. TEACCH program - English Treatment and education of autistic and related communication handicapped children. The name of this method can be translated as a method of educating children with autism and related communication disorders, but in Slovakia its abbreviation TEACCH is generally used and known. It is currently the most widespread program used in the education and training of people with autism worldwide. It is a comprehensive approach that respects the specific profile of people with autism. When we talk about TEACCH, we talk about structured learning. It has been known in the world since the 1970s. It was created in North Carolina, USA by Professor Eric Schopler. It has been used in Slovakia for almost twenty years and is also legally enshrined in the state educational program for children with autism or other pervasive developmental disorders. The world around us, which is legible and clear to people with a neurotypical way of thinking, is often incomprehensible to people with autism. The TEACCH program tries to adjust the environment of people with ASD so that they know what is expected of them, how long it will take, where and when the given activity will take place, and what will follow about it. In this way, their stress and problematic behavior, which is often caused by the inability to understand their surroundings, is significantly minimized.

The TEACCH program is characterized by the following procedures:

  • adaptation of communication and its visual support,
  • provision of instructions in a suitable form - often also in a visual form,
  • provision of aids for orientation in time and space,
  • training of general patterns of behavior for systematic and routine activities,
  • flexibility support,
  • provision of rules and aids for decision-making,
  • explaining social contexts.

The TEACCH program emphasizes three basic principles: individualization, structuring and visualization.

a. Individual assessment and individual educational approach

Each child with autism is a separate personality that differs from others in a certain way. From the point of view of an individual approach, it is necessary to find out the level of individual developmental areas of the child, choose an adequate type of communication system according to the degree of abstract thinking ability, draw up an individual educational plan and, if necessary, choose appropriate strategies for solving potential problem behavior.

b. Structured environment and learning

Structured learning is considered one of the successful educational programs. Structuring means introducing clear rules, an overview of the sequence of activities and organizing the environment in which a child with ASD moves. This specific approach compensates to some extent for the learning difficulties that autism undoubtedly brings with it. Uncertainty and confusion will be replaced by logic, order, security and safety, which will allow accepting new tasks and demands and better tolerate situations and events that are unpredictable. The structure of the environment helps the child in spatial orientation and answers the question of WHERE. It thus creates a connection between places, activities and behavior and thus offers the child security. Structuring is also essential when organizing and arranging the workplace. The space for teaching should be comfortable and free of distracting stimuli. The system of work from left to right is applied. On the left side, there are boxes with tasks that need to be completed, in the middle there is a space for completing individual assignments, and on the right side, the child puts away the tasks that have already been completed.

c. Visual support

A child with ASD has a very hard time understanding the abstract concept of time, his thinking is concrete, so he cannot organize his work in time. He needs not only to hear the instruction, but to add visual support to it. The inability to foresee events and make connections is mostly compensated by rituals and stereotypical behavior. If we convey information to him in a visual form, we alleviate his deficiencies in communication, memory and abstract abilities. The visualized daily program answers WHEN to the child with autism, helps him orientate in time, differentiates individual activities and leads to greater independence. Types of visual support are, for example (from the simplest to the most complex: the choice depends on the mental level of the child): a specific object (3D dimension), photographs, colored pictures, pictograms, inscriptions, a diary, written schedules... We must make the day of the so-called daily schedule. It usually takes the form of a panel with the child's name and photo. It is placed so that the child has access to it. Its function is to tell the child in a visible form what he should do now, what he will do next, when he will do what he likes. It can be oriented in a horizontal or vertical position, according to the needs of the child. At the end of the plan is placed the so-called wastebasket. When using visualization using a plan, we need to know what level of understanding the child is at the moment, and what higher level he would be able to master. (http://www.aplajc.cz/autismus/vychovne-a-vzdelavaci-pristupy/teacch-program.htm; ČADILOVÁ, V, ŽAMPACHOVÁ, Z. : Strukturované učení. Praha: Portál 2008. ISBN 978807367475)

2. ABA (Applied Behavior Analysis)

It is based on the theory that autism is a neurologically conditioned syndrome that manifests itself in the child's behavior. Thus, ABA works with an individual's behavior by teaching and reinforcing desirable behaviors. It is therefore a strategy that is based on CBT (cognitive-behavioral therapy) and helps to reduce inappropriate (aggressive) behavior of individuals with ASD by replacing it with more socially acceptable behavior. At the same time, this method builds skills in autistic children that help better adaptability, self-care, communication and overall social interaction (Dictionary spec.pg.-Valenta). The basic concept is therefore to change behavior through reinforcers, and the basic question when applying ABA is: How to eliminate elements of behavior that we do not want and support desirable elements of behavior? (Kaufman) We can best understand a child's behavior if we assess in detail the set of circumstances before and after the observed behavior. After evaluating the circumstances, we can begin to change the behavior and teach the child to behave in a different way. For example, if we want to find out why a child dropped a toy, we need to know what preceded it. Maybe the toy doesn't work the way the child would like, maybe the child was called by a different name, maybe the toy is a ball for the child. To understand why a child repeatedly throws toys, we need to know what repeatedly happens after the child behaves in a certain way. Maybe a person in the room comes out when the child throws a toy, maybe mom fixes the toy...all these events reinforce the child's toy throwing.

The basic knowledge and principles of the ABA method were laid down by B.F. Skinner and other researchers dealing with behavioral disorders. Ivar Lovaas was one of the first to apply these principles to children with autism in order to scientifically substantiate their effectiveness. In the 1960s, Lovaas began working intensively (30-40 hours a week) with autistic, mostly cognitively impaired and non-speaking children at the Neuropsychiatric Institute of the University of California, Los Angeles, and was able to prove that thanks to intensive behavioral therapy, they learned speech and made great progress in the cognitive field. In 1987, he published the impact of early intervention therapy on 19 preschool children. In all research participants he described a dramatic improvement in the increase in intellect. Most of the children who completed the program were integrated into mainstream schools and achieved a "normal level of functioning".

ABA is based on learning through gradual steps, when the instructor (parent, teacher, therapist, etc.) offers the child Sd (discrimination stimulus), i.e. instruction and waits for the child's reaction. There are a variety of different discriminative stimuli: verbal; visually (signs or pictures that symbolize an instruction or an element in the environment, for example a puzzle that the child should play with), gestures (e.g. we show the direction where the child should look or at the object that the child should take) or facial expressions. If the child reacts correctly, the teacher reinforces the desired reaction with praise or a reward for a job well done. If the child reacts incorrectly, the instructor immediately guides him to react correctly. Guidance is conducted in such a way that the child learns the correct reaction to the given instruction. Types of positive reinforcement include: food and drink; verbally such as "good job", "you are a unit", "excellent"; materially, such as a favorite toy, doll, toy car; social such as stroking, patting, song...Negative reinforcement consists in removing an unpleasant stimulus immediately after the desired behavior. Negative reinforcement results in an increase in the intensity of this behavior. For example, an alarm clock with a very unpleasant sound will increase the likelihood that the child will get up, because the desired behavior (getting out of bed) is reinforced by the need to turn off the unpleasant alarm.

There is no doubt that behavioral techniques are successful to some extent and play a central role in intervention. It is possible to use them effectively to improve deficits, to mitigate and reduce problematic behavior that pervasive developmental disorders bring. However, they cannot be seen as a means that can cure autism. Rigidity of the approach, excessive intensity of individual work and little emphasis on ordinary children's activities that bring joy to the child are often a source of criticism from professional workers (Thorová, 2006).

3. DIR ® / Floortime ™ Model (Stanley I. Greenspan) (Developmental, Individual-difference, Relationship-based model).

The authors are psychologist S. Wieder and professor of psychiatry and pediatrics S. I. Greenspan, and it is mainly used in the USA. The goal is to achieve healthy development and not work only on external manifestations and behavior. The program can be incorporated at home or at school or is part of other approaches. Floortime is one of the basic strategies of the model. The task of the parent or teacher is to follow the child and play with him any game that he is interested in and at the same time develops his social, emotional and intellectual skills.

Part D (developmental) of this model describes each step in building certain abilities of the child. It specifically means helping a child with autism to teach him to form relationships with others, to answer questions appropriately, to understand and use social and emotional gestures, to know how to take care of himself, to stay calm in situations, etc.

Part I (Individual-difference) of the model describes the unique and biological ways in which the child receives, understands and responds to feelings and sensations, such as sound or touch, and also how he plans and categorizes his thoughts and activities. For example, some children react very sensitively to touch and sound, some are hypoactive when reacting to given stimuli, and others seek them out.

The R (Relationship-based) part of the model describes the creation of relationships with others (with teachers, parents, guardians), which is adapted to the individual characteristics and differences of the child, which allows him to progress in acquiring and mastering these basic skills.

4. Son-Rise

It is a home education program for children and adults with autism. It is based on the fact that love and deep respect for a person is the most important factor influencing a child's motivation to learn. It was created by parents Barry Neil Kaufman and Samahria Lyte Kaufman in the US when their son Raun was diagnosed with severe autism at 18 months old (in 1974). The parents did not want to put up with it, so they found their own way. They developed their own home program, which is currently used by therapists in many countries around the world. Thanks to the Son-rise program, the mute and withdrawn boy, who was measured with an IQ of 30, became a university student in the field of biomedical ethics after a certain time. The Kaufmans founded a center where they help other families. The center has been operating for over 30 years. The basic tenets of the program are as follows:

  • Connection.

It is one of the most basic. It helps to find the key to the child's world and promotes eye contact. Different rituals and different activities are used within this principle. For example: spinning, swaying, staring into space, repeating the same word, running around, putting things in the same rows, talking about the same thing for a long time, etc. It is about actively participating in the child's rituals and activities, however bizarre they may be. The child must gain confidence and establish relationships with those who influence him, and only then will he be willing to continue working on himself. In the school environment, the process of socialization is forgotten and an autistic child is immediately required to perform. A child who does not feel trust in people is not willing to cooperate with them.- Using the child's motivation. The motivation of a child with autism is different and often has very special reasons for his behavior that we may not know. In this phase of the program, instead of supporting robotic repetition of activities, we try to develop a love of learning in the child. So we use his motivation if we want to teach him something.- Teaching using an interactive game. Whatever we want to teach a child, we only teach him when he is not closed in his own world. In the Son-rise program, we teach children fundamentally at a time when they want to be taught. What the child learns from his own conviction and at the time when he wants to learn, it is of great importance to him. However, if a child wants to shut himself up in solitude, there is no point in tearing him out of his world and his play.- Energy, enthusiasm and enthusiasm. Often it doesn't even matter what we present to the child, but how we present it. If the child is bored and annoyed, it goes without saying that he will not want to have anything to do with the teacher. However, if we can make the child genuinely enthusiastic about the activity, we have a much better chance that he will perceive us.- Optimistic approach without prejudices. None of us is able to determine in advance what a person can or cannot do and what their potential is. It is much more pleasant for a child when a person works with him who believes in him, does not judge him and does not feel sorry for him. With such a person, it is easier for the child to show what is really in him.- Parent as the most valuable resource for a child. There is no one closer and more loving to a child than a parent. No one knows a child better, no one has developed a better intuition, no one is a better expert on their child. Parents also have the greatest motivation to help the child. Their feelings, love and patience are irreplaceable for a child. The role of the therapist is to support parental self-confidence and provide professional advice.- Creating a safe and undisturbed room for playing and working. Children with autism can find it very difficult to concentrate. Therefore, it is necessary to create such an environment for them in which they can concentrate on something undisturbed. The Son-rise playroom has as few distracting stimuli as possible, so the child focuses on the parent (therapist) more than on things around him.

5. Intensive interaction

is a special educational method of teaching the pre-verbal basics of communication for children or adults with severe mental disabilities or autism who are still in the early stages of communication development. It is associated with the name of its 'discoverer' - Dr. Dave Hewett, who has been working across the UK for almost 20 years as an independent consultant and trainer for staff in institutions which focus on helping people with severe intellectual disabilities and/or autism. Intensive interaction is now a recognized method for teaching communication and is widespread throughout the UK. Dave Hewett is currently the director of the newly formed Institute for Intensive Interaction. This method is highly practical. The only tool used in this approach is a receptive person who plays the role of a partner in this mutual interaction. Intensive interaction seeks to gradually develop a pleasant and relaxed series of interactions between the interaction partner and the person learning to communicate using this method.

Intensive Interaction focuses on some central areas where people with autism fall behind, such as:

  • ability to socialize - understand other people,
  • participate in an interaction with another person,
  • enjoy the presence of other people and desire to be with them,
  • learn communication skills and routines,
  • learn to understand non-verbal expressions with emotional content; use and understand.

Modern ICT technologies, using specialized autistic software or hardware, have an irreplaceable place in the current education of children and pupils with autism. Among the programs and tools used, we include: Bee-bot, the Newrom program, the LenTalk application, Look At Me, Teaching flashcards, TapToTalk, ABCD and others.

Author: PhDr. Petra Jedličková, PhD.

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1 The term pervasive (pervasive developmental disorders) means all-pervading, affecting many abilities and areas of life. According to Némethová (2004), this term means that mental abnormalities enter all areas of thinking and are a pervasive feature of the child's behavior in all situations. It reflects the permanence of manifestations, the impairment of many psychological functions (in contrast to specific developmental disorders) and the occurrence of symptoms that are qualitatively different from normal development.