A u t i s m a n d Ed u c a t i o n

a b,
Kathleen A. Flannery, MEd , Robert Wisner-Carlson, MD *

KEYWORDS
 Autism spectrum disorders  Education  Evidence-based practices  Instruction
 Special education

KEY POINTS
 Special education laws and reform effectuated how individuals with disabilities are
educated in the school setting. The Education for All Handicapped Children Act and the
Individuals with Disabilities Education Act brought about major requirements, such as
individualized education plans, provision of free and appropriate public education, and
educating students with disabilities in a least restrictive environment.
 Research identifies specific evidence-based practices as strategies that, when imple-
mented with fidelity, yield successful outcomes for individuals with autism spectrum dis-
order (ASD) in the school setting. Organizations, such as the National Autism Center and
the National Professional Development Center on Autism Spectrum Disorder, provide in-
formation and resources on effective evidence-based practices for educating children and
youth with ASD.
 Training and preparation for teachers are essential to the education of students with
autism. Knowledge of the characteristics of the disorder, possible comorbid factors,
best practices, and the unique strengths and difficulties of each student is vital to suc-
cessful school outcomes for students with autism.
 The transition from high school to postsecondary years is a difficult time for youth with
autism. Entitlement services drop off. Therefore, transition planning during the high school
years and a strong partnership between the school and family are imperative.

INTRODUCTION

Special education programs did not always exist in the United States. Prior to Su-
preme Court cases, such as Brown v Board of Education (1954) or PARC v Pennsyl-
vania (1971), and the enactment of the Education for All Handicapped Children Act in
1975, it was common for children with disabilities to be excluded from public school
education or receive unequal treatment within the public school system.1 One of the
earliest accounts of an individual being excluded from a public school education dates

a
Sheppard Pratt Health System, 6501 North Charles Street, Towson, MD 21204, USA;
b
Neuropsychiatry Outpatient Program, Adult Developmental Neuropsychiatry Clinic, Adult
Inpatient Intellectual Disability and Autism Unit, Sheppard Pratt Autism Registry, Ethics Com-
mittee, Sheppard Pratt Hospital, 6501 North Charles Street, Baltimore, MD 21285, USA
* Corresponding author.
E-mail address: [email protected]

Child Adolesc Psychiatric Clin N Am - (2020) -–-

https://doi.org/10.1016/j.chc.2019.12.005 childpsych.theclinics.com
1056-4993/20/ª 2020 Elsevier Inc. All rights reserved.
2 Flannery & Wisner-Carlson

to 1893. “In the case of Watson vs. the City of Cambridge, the Massachusetts Su-
preme Court ruled that a child who was ‘weak of mind’ and could not benefit from in-
struction, was troublesome to other children, made ‘unusual noises,’ and was unable
to take ‘ordinary, decent, physical care of himself’ could be expelled from public
school.”2 In 1919, the Wisconsin Supreme Court approved the exclusion of a rising
sixth-grade student who was capable of benefiting from public school education
but displayed distorted facial features, frequently drooled, and had a speech
disorder.3
Students diagnosed with autism spectrum disorders (ASDs) may exhibit the charac-
teristics described previously (ie, “weak of mind,” “troublesome to other children,”
“produce unusual noises,” and “frequent drooling”).2 In Thinking in Pictures: My Life
with Autism,4 Temple Grandin states, “The word ‘autism’ still conveys a fixed and
dreadful meaning to most people—they visualize a child mute, rocking, screaming,
inaccessible, cut off from human contact. And we almost always speak of autistic chil-
dren, never of autistic adults, as if such children never grew up, or were somehow
mysteriously spirited off the planet, out of society.”4
In 2013, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition,5
adopted ASD because it is “broadly considered to be a multi-factorial disorder”6
with a “dyadic definition of core symptoms.” Autism is now better defined as a spec-
trum of disorders that vary in onset, severity of symptoms, and comorbidity.6
Autism is a complex, neurodevelopmental disorder that is characterized by impair-
ments in communication and social interaction combined with repetitive or rigid
behaviors and restricted interests.5 In addition to presenting with these core deficits,
many individuals with ASD also suffer from comorbid disorders, including language
disorders, behavioral problems, attention-deficit/hyperactivity disorder, depression,
anxiety, and other psychiatric conditions.7,8 This wide-ranging inclusion of comorbid
features within a disorder that is described as a spectrum highlights the salient
need for educators to consider each student’s unique strengths and difficulties. There-
fore, educating students diagnosed with ASD can be a complex undertaking that re-
quires special training.

EDUCATIONAL PROGRAMS

The Autism Society of America (ASA) defines quality of life as “basic human rights that
allow people to interact with one another and the world in their own terms.”9 One
example of a quality-of-life indicator cited on the ASA Web site is academic success
that is defined as “the opportunity to participate in school to one’s fullest capability
and learn in an environment that enables success.”9
Some students with autism may access educational services and treatment in a
general education setting whereas other may require special education services in a
more restrictive setting. This is dependent on the level of supports a student needs
to access curriculum. In 2014, data from the Centers for Disease Control and Preven-
tion indicated that approximately 22% of 8-year-old children having a clinical ASD
diagnosis also have an intellectual disability.10 These data suggest that 78% may
be academically capable. Based on this, Barnard-Brak and Reschly state, “academ-
ically capable students with no behavioral health needs and limited externalizing
behavior concerns may not require services or an educational diagnosis to do well
in school.”11 In 2015, the US Department of Education (DOE) estimated that approx-
imately 40% of students with ASD were participating in the general education setting
for at least 80% of the school day.12 Kim and colleagues13 concluded that children
with ASD, including those with average or above-average IQ and achievement scores
 Autism and Education 3

were more likely to move from general education or inclusion classrooms to full-time
special education classrooms from ages 9 years to 18 years compared with those with
non-ASD diagnoses.
Throughout the United States, there are a multitude of education programs available
to individuals diagnosed with ASD. These programs include the general education
setting, special education services within the general education setting, special edu-
cation services within a separate special education setting, and intensive in-home
teaching. All programs vary in implementation and outcomes and have advantages
and disadvantages depending on the needs of the student. To identify an educational
environment that can effectively teach a child with autism, Sundberg and Partington,14
recommend that, “When considering options it is important to remember that there are
several outcomes desired for any educational program. The most important outcome
is that the child acquires skills that are both immediately useful to him and allow him to
learn additional skills without highly trained staff and individualized instruction. Ideally,
the child should acquire skills that enable him to learn from what he sees and hears
every day, while interacting with a variety of individuals (eg, aunts, uncles, neighbors,
peers). In order to meet these goals it is essential to identify an educational environ-
ment that can effectively teach the child.”14

RESEARCH ON EVIDENCE-BASED PRACTICES

In 2001 The National Research Council (NRC) published a book entitled, Educating
Children with Autism toward its mission “to improve government decision making
and public policy, increase public education and understanding, and promote the
acquisition and dissemination of knowledge in matters involving science, engineering,
technology, and health.”15 The NRC book provides a summary of recommendations
for children with autism from birth to age 8 years, across 7 areas, 2 of which are goals
for educational services and characteristics of effective interventions:16
 Goals for educational services
 Objective: observable, measureable behavior and skills
 Characteristics of effective interventions
 Educational services; immediate, adapted, intensive, individually located
 Sufficient individualized attention
 Ongoing measurement of educational objectives
 Specialized instruction with typically developing children
 Six kinds of interventions should have priority
The identified 6 kinds of interventions that should have priority include functional,
spontaneous communication; social instruction; teaching play skills; cognitive devel-
opment; problem behavior; and functional academic skills. Furthermore, the NRC
recommends that the content of curriculum for children with ASDs should be based
on sound research17 and that educational services should be a minimum of 25 hours
per week, 12 months a year.16
In 2015, the National Autism Center (NAC) identified 14 evidence-based practices
(EBPs) for children and youth with ASD in its National Standards Project, a project
that sought to provide educators and others with the most current information on
effective treatment of individuals with ASD.18 The NAC mission is to “provide leader-
ship and comprehensive evidence-based resources to families, practitioners, and pol-
icymakers, to programs and organizations, and to the national community.”18 The 14
treatments are behavioral interventions, cognitive behavioral interventions package,
comprehensive behavioral treatment of young children, language training
4 Flannery & Wisner-Carlson

(production), modeling, naturalistic teaching strategies, parent training package, peer

training package, pivotal response treatment, schedules, scripting, self-management,
social skills package, and story-based intervention.18
From 2007 to 2014, the Office of Special Education Programs in the DOE funded the
National Professional Development Center on Autism Spectrum Disorder (NPDC).19
The goal was to advance the use of EBPs for individuals with ASD from birth to
22 years of age.19 In 2015, the NPDC identified 27 EBPs as effective interventions
when implemented with fidelity (Table 1). The EBPs identified by both the NAC and
NPDC overlap and most fit in to the 6 priority intervention areas outlined in the NRC
recommendations.
It is important for educators to understand the limitations of relying solely on
EBPs,38,39 including that what is meant by evidence-based may vary and that inter-
ventions not labeled as evidence-based might still be effective. Lubas and colleagues8
point out that just because a strategy is evidence based does not mean it is effective
for every student with ASD. Also, the implementation of EBPs may not take into ac-
count the individuality of students with ASD because the focus of EBPs is centered
on research. Lubas and colleagues8 believe the current “skewed focus” of research
in EBPs does not account for teacher expertise or student characteristics, 2 additional
critical facets of educational programming for students with ASD.

CURRICULUM

A challenge faced by both general and special educators is aligning educational pro-
grams for students with ASD to curriculum standards. This is the case particularly
when the standards are as rigorous as the Common Core State Standards (CCSS),
which have been adopted by 41 states as well as the District of Columbia during the
past 9 years.40 The CCSS provide information for what students should know/be able
to learn by the end of each grade so, by the time they graduate high school, they
have the skills to succeed in college, a career, or an alternative educational setting.40
Students with ASD characteristically demonstrate weak executive function, diffi-
culty interpreting nonverbal cues, difficulty with perspective taking, and problems
seeing the big picture.41 Because of this, an educator working with students on the
spectrum should understand how their particular set of strengths, challenges, and def-
icits can affect their ability to interact with curriculum. For example, a student may
have a prolific vocabulary but have trouble comprehending simple instructions or
may have strengths in decoding but difficulty with reading comprehension.41
Furthermore, students with ASD may struggle with standards that require cognitive
flexibility, analytical thinking, and/or increased processing speed.41,42 In addition to
understanding these curricular challenges it is important for teachers to be aware
that many students with ASD “do not ask questions or seek help from others.”41
Therefore, it is crucial for educators to adapt the curriculum, modify instructional ma-
terials, and have a working knowledge of EBPs.38,39,43,44
Research conducted by Hudson and colleagues45 showed promise for 2 evidence-
based, instructional practices that can be used during math instruction. These
involved the use of graphic organizers and manipulatives with a simultaneous prompt-
ing procedure. In a study conducted by Knight and colleagues,46 task analysis,
another identified, EBP, whether scripted or unscripted, was found to be successful
for acquisition of science content. Constable and colleagues41 recommended that ed-
ucators use EBPs, such as prompting, visual supports, social narratives and comic
strip conversations, naturalistic interventions, and peer-mediated instruction, to sup-
port and improve learning in English language arts.
 Autism and Education 5

Table 1
Twenty-seven evidence-based practices identified by the National Professional Development
Center on Autism Spectrum Disorder

Intervention Definition/Description
Antecedent-based A behavior change strategy that manipulates contingency-
intervention independent antecedent stimuli (motivating operations)20
Cognitive behavioral Teaches learners to examine their own thoughts and emotions,
intervention recognize when negative thoughts and emotions are escalating in
intensity, and then use strategies to change their thinking and
behavior.21
Differential A procedure for decreasing problem behavior in which reinforcement
reinforcement is contingent on the absence of the problem behavior during or at
specific times20
Discrete trial training An approach in which the instructor delivers 1 or multiple
discriminative stimuli and, contingent on the appropriateness of
the participant response, provides reinforcement or implements
individualized prompting strategies22
Exercise Can be used to improve the physical fitness of learners with ASD. In
addition, exercise can be used to increase desired behaviors (time
on task, correct responding) and decrease inappropriate behaviors
(aggression, self-injury).23
Extinction The discontinuation of a reinforcement of a previously reinforced
behavior (ie, response no longer produces reinforcement); the
primary effect is a decrease in the frequency of the behavior until it
reaches a prereinforced level or ultimately ceases to occur.20
Functional behavior A systematic method of assessment for obtaining information about
assessment the purposes (functions) a problem behavior serves for a person;
results are used to guide the design of an intervention for
decreasing the problem behavior and increasing appropriate
behavior20
Functional An antecedent intervention in which an appropriate communicative
communication behavior is taught as a replacement behavior for problem behavior
training usually evoked by an establishing operation; involves differential
reinforcement of alternative behavior20
Modeling Demonstrating the desired behavior24
Naturalistic Incorporating instruction for individuals with disabilities into less
interventions structured activities24
Parent-implemented Practitioners collaborating with, training, and coaching parents to
interventions implement EBPs with their children throughout daily routines and
activitie.25
Peer-mediated Systematically teaching peers without disabilities ways of engaging
instruction and learners with ASD in positive and meaningful social interactions26
intervention
Picture exchange An alternative/augmentative communication system that was
communication developed to teach functional communication to children with
system limited speech. The approach is unique in that it teaches children to
initiate communicative interactions within a social framework.27
Pivotal response A naturalistic intervention that focuses on motivation, responsivity to
training multiple cues, self-management, and social initiations28,29
Prompting Additional stimuli that increase the probability that a discriminative
stimulus will occasion the desired response24

(continued on next page)

6 Flannery & Wisner-Carlson

Table 1
(continued )
Intervention Definition/Description
Reinforcement Occurs when a stimulus change immediately follows a response and
increases the future frequency of that type of behavior in similar
conditions20
Response A procedure in which the therapist physically intervenes as soon as
interruption/ the learner begins to emit a problem behavior to prevent
redirection completion of the targeted behavior20
Scripting A visual or auditory cue that supports learners to initiate or sustain
communication with others30
Self-management The personal application of behavior change tactics that produces a
desired change in behavior20
Social narratives Describing social situations for learners by providing relevant cues,
explanation of the feelings and thoughts of others, and
descriptions of appropriate behavior expectations26
Social skills A therapeutic approach used to improve interpersonal relations31
training
Structured Small group activities with a defined area, activity, theme, and roles
play groups with typically developing peers and an adult scaffolding as needed
to support the learner with ASD’s performance32
Task analysis Breaking a complex skill or series of behaviors into smaller, teachable
units; also refers to the results of this process20
Technology-aided Refers to instruction or intervention in which technology is the
instruction and central feature supporting the acquisition of a goal for the
intervention learner33
Time delay A fading format used when prompting. Rather than presenting the
prompt immediately, the teacher waits, thus allowing the student
to respond before prompting.24
Video modeling Involves a child watching a video of an adult, peer, or him/herself
performing a target behavior and in turn displaying the
behavior34,35
Visual supports Can be in the form of objects, pictures, line drawings, or words36 that
are used to prompt and remind students to organize work and
materials and/or engage in appropriate behavior or activities37

Data from The National Professional Development Center on Autism Spectrum Disorder. 2019.
Available at https://autismpdc.fpg.unc.edu/evidence-based-practices. Accessed July 16, 2019.

Denning and Moody’s42 research suggests that students with ASD matriculated in
the general education setting may benefit from support provided through the princi-
ples of Universal Design for Learning (UDL). The core features of UDL include multiple
means of representation, action and expression, and engagement.47 Denning and
Moody42 outlined several strategies that, when implemented within a UDL framework
in an inclusive setting, yielded successful instructional outcomes for students with
ASD. Some of the strategies included in their work are use of schedules, video
modeling, interest-based lessons, visual supports, explicit instructions, modeling,
and guided practice.42

AUTISM IN THE CLASSROOM

Children and youth with autism respond well to structure and thrive in classroom envi-
ronments that are highly predictable.36,48 Additionally, they may lack motivation, have
 Autism and Education 7

difficulty engaging and filtering unnecessary information, habe trouble successfully

completing work, demonstrate cognitive rigidity, and struggle with executive func-
tioning.42 TEACCH, formerly referred to as Treatment and Education of Autistic and
Communication related handicapped CHildren, was cofounded in 1972 by Eric Schopler
and colleagues, a pioneer in the field of autism education.49 TEACCH is an evidence-
based service that conducts research, trains professionals and families, and provides
programming for individuals with ASD of all ages and abilities.49,50 TEACCH has become
a model for programs across the country and around the world. TEACCH emphasizes
the importance of structured teaching by using schedules, visual structure, physical or-
ganization, and work systems.50 The elements of structured teaching are intended to
give the student a set of clear and consistent expectations in an orderly and predictable
environment. Structured teaching also consists of highly individualized programming
with the end goal of increasing an individual’s independent functioning.49,50
Research indicates that individuals with ASD have strengths in visual processing51
and are stronger visual learners than their typically developing peers,49 making the use
of visual supports vital to success in the classroom. One type of visual support that
should be available to all students with autism is schedules. Sarahan and Copas state,
“visual schedules and predictable routines help take the chaos out of the learning envi-
ronment.”52 Furthermore, they assist with understanding and retaining verbal and
sequenced information.48,52 Schedules are visual cues to organizing tasks in temporal
order (Figs. 1 and 2). When developing a schedule, teachers should consider each
individual student’s learning characteristics so the schedule is individualized and
meaningful to the student. Therefore, considerations, such as form, cue to initiate
use, location and portability, length, and method to manage, all must be taken in to
account for each student. An effective schedule focuses on the development of inde-
pendent skills (Fig. 3).36,48 It organizes time, helps a student shift attention, and pro-
motes tolerance and flexibility when the environment is less predictable.36
In addition to visual schedules, visual structure in the classroom is also vitally
important. Young people with autism may experience confusion and/or distress
when they are expected to process and follow verbal directions.49 Research53 indi-
cates that children with ASD may present with a range of language delays in both
expressive and receptive language and that young children with ASD have core def-
icits in joint attention and shared affect. Curiel and Sainato further assert that these
delays could include “very limited speech, lack of response to social interactions,
and deficits in understanding gestures.”54 The use of visual structure in the class-
room can provide students with a strategy for approaching tasks differently and
help draw attention to relevant information.36,48 Visual structure involves the use
of space and materials in a manner that helps limit the focus of attention (Figs. 4
and 5). Another is the use of visual presentations of information (Figs. 6 and 7).
The use of written or picture instructions (Fig. 8), models, or cutout jigs provides stu-
dents with a systematic strategy for work completion. Visual instructions help putt-
ing separate parts of the task together in the correct sequence (Figs. 9 and 10). The
use of visual clarity emphasizes where to look (Fig. 11). Examples include high-
lighting information, indicating sequence, clarifying placement, and displaying clear
indication of how/when a task is finished.
Another key component of structured teaching is physical organization.49 This in-
volves the arrangement of materials and the physical space. It is important for a class-
room to have clearly defined areas so students can understand where they are
supposed to be and what is expected of them in each area of the classroom. Careful
considerations to the physical space can help control distractions and focus a stu-
dent’s attention. For example, furniture or partitions can be used to define boundaries
8 Flannery & Wisner-Carlson

Fig. 1. This is a classroom schedule using photos, picture symbols, and words so that non-
readers and readers know which activity occurs during each interval of the school day.
(Courtesy of The Forbush School at Hunt Valley, Part of the Sheppard Pratt Health System,
Towson, MD.)

and create smaller areas in a larger classroom (Fig. 12). Book shelves can be used to
create a barrier between a leisure and instructional space. In addition to the physical
layout and organization, environmental sensory stimuli should be considered. Stu-
dents with autism display sensory sensitivities to environmental stimuli that affect their
attention and engagement in classroom learning activities.54 Sarahan and Copas52
point out that careful consideration of lighting, sensory stimulation, classroom and
play arrangements, and group structure is necessary. Kinneal and colleagues55
concluded that there can be a positive effect on students’ attention in the classroom
when classroom walls are constructed with material that absorbs sound. Students
who are sensitive to fluorescent lighting in the classroom may be less disturbed or
distracted when magnetic, fabric panels are hung over the lights (Fig. 13). The panels
help filter the light and reduce the flickering and glare typically produced by fluores-
cent lighting that can be bothersome and upsetting to some individuals with ASD.
 Autism and Education 9

Fig. 2. This is an individual schedule for a student who is able to read. It identifies what is
happening and when during the school day. It is on a clipboard so that it can be either sta-
tionary or portable. (Courtesy of The Forbush School at Hunt Valley, Part of the Sheppard
Pratt Health System, Towson, MD.)

The final component of structured teaching is work systems. Work systems provide
students with a systematic way to approach assignments.56 The space is organized
visually so that students can independently practice previously acquired skills. An
effective work system answers 4 questions: What work? How much work? When
am I finished? and What is next?49,57 Furthermore, work systems are designed to
enable generalization of skills to other environments. Teachers are advised to consider
form, organization, and sequence; how progress is tracked by the student; and how
the transition after task completion is indicated when creating work systems for their
students. Fig. 14 shows a color-coded work system. This work system was designed
for 5 different students to complete 4 different tasks each. During work time, each stu-
dent is provided with a corresponding visual schedule that indicates the color and 4
tasks they are assigned to complete. In their study, Park and Kim56 found that the
work systems could contribute to reducing disruptive behaviors and promoting inde-
pendent, sustained engagement for participants. When Hume and colleagues57 used
work systems as an intervention for first-grade students, less adult assistance was
needed and students achieved more accurate object/photo classification and sight
word recognition.
When incorporating any element of structured teaching, TEACCH recommends that
educators integrate students’ strengths and interests. Denning and Moody42 suggest
that teachers spend time learning each student’s special interests and use them for
classroom activities and readings in an effort to enhance and maintain engagement
in classroom assignments. Mancil and Pearl58 believe that “Embedding restricted
10 Flannery & Wisner-Carlson

Fig. 3. This schedule is for a student who is learning to complete multiple steps to a task
with greater independence. As students complete each step, they move the picture symbol
to the finished side. The use of a visual schedule allows a teacher to provide less intrusive
prompting as a student as moves through the tasks. The break picture at the end is the rein-
forcer for work completion. (Courtesy of The Forbush School at Hunt Valley, Part of the
Sheppard Pratt Health System, Towson, MD.)

interests into activities as motivators can help children with ASD stay engaged during
academic activities.”58 The work area shown in Fig. 15 was designed specifically for a
student who engages in out-of-seat behavior in an attempt to hide from teachers. The
sheet tied around the legs of the desk provides the student with an opportunity to
“hide” while remaining in location. This small modification to the work area increased
motivation to stay in the work area and be more consistently available for instruction.
Lanou and colleagues state, “Educators can embrace students’ unique humor, idio-
syncratic interests, and seemingly ‘nonfunctional’ behaviors to motivate them in
meeting challenging social and academic expectations while also increasing their
confidence and independence.”51
One case study, described in Lanou, Hough, and Powell’s research as the
“Iceberg Cue,” capitalized on Jimmy’s interest in the RMS Titanic to develop his
awareness of personal space. Teachers and peers would use the phrase “iceberg
right ahead” when Jimmy would begin to encroach on someone’s personal space.
This intervention resulted in a significant decrease in Jimmy entering his peers’ per-
sonal space.51 Mancil and Pearl58 shared that by tapping into students’ interests,
teachers at the elementary, middle, and high school levels experienced an increase
in sustained engagement in academic instruction and marked improvements in
reading, history, science, and math for their students with ASD. Preece and How-
ley59 discovered that understanding the individuality of each student with ASD and
appealing to each student’s interests is key to helping students with high rates of
absenteeism reengage in formal education.
When incorporating students’ interests into academic instruction, factors to be
considered include the appropriateness of the interest as it relates to the academic
outcome, whether and how the restricted interest may interfere with peer
 Autism and Education 11

Fig. 4. This is a student’s work system. The bins on the left are labeled with picture symbols
and there is a corresponding set of index cards with identical picture symbols on top of the
shelf. During work, the student is provided with a set of index cards indicating which work
she needs to be complete. The bins on the right are labeled with yellow numbers 1 to 4.
There is a corresponding visual schedule located above the bins that the student uses to
move through her work. Through color coding and matching numbers, the student is
able to complete all the required tasks during work with independence. (Courtesy of The
Forbush School at Hunt Valley, Part of the Sheppard Pratt Health System, Towson, MD.)

relationships, and the age appropriateness of the interest.58 Atwood60 (2007) suggests
that a child’s or youth’s restrictive interests may serve
 To overcome anxiety
 To provide pleasure
 To provide relaxation
 To ensure greater predictability and certainty in life
 To help understand the physical world
 To create an alternative world
 To create a sense of identity
 To occupy time, facilitate conversation, and indicate intellectual ability60
12 Flannery & Wisner-Carlson

Fig. 5. The cups and bins on this student’s desk are used to organize and store materials. The
cups store pencils, which this student likes to collect. The plastic bin holds the “money” the
student earns as a reward for expected behavior. The hourglass timer is used as needed so
the student is able to see how much time she has for breaks. (Courtesy of The Forbush
School at Hunt Valley, Part of the Sheppard Pratt Health System, Towson, MD.)

Fig. 6. This is a visual presentation of the rules students are expected to follow while in class.
(Courtesy of The Forbush School at Hunt Valley, Part of the Sheppard Pratt Health System,
Towson, MD.)
 Autism and Education 13

Fig. 7. This visual aid is used by students and/or staff. Students are able to indicate their
readiness for learning and staff are able to ask students if they are ready to work or if
they need a break. (Courtesy of The Forbush School at Hunt Valley, Part of the Sheppard
Pratt Health System, Towson, MD.)

Fig. 8. This shopping list uses both words and pictures so that both readers and nonreaders
can refer to it while shopping. As they find each item at the store, they can put a check or
mark the box to indicate completion of the task. (Courtesy of The Forbush School at Hunt
Valley, Part of the Sheppard Pratt Health System, Towson, MD.)
14 Flannery & Wisner-Carlson

Fig. 9. This is a set of written instructions for a student to follow to complete a school-based
job. As the student completes each step, a checkmark is placed in the box. (Courtesy of The
Forbush School at Hunt Valley, Part of the Sheppard Pratt Health System, Towson, MD.)

When restricted interested cannot be part of instruction, research58 suggests that

teachers consider following the Premack principle and using the individual’s restricted
interest as a reinforcer.
There are advantages and disadvantages to implementing components of TEACCH
in the classroom and its effects may vary across domains. TEACCH provides a range
of approaches rather than there being a universal curriculum that every student should
try to fit into.61 Results from a study conducted by Boyd and colleagues62 yielded an
interesting finding: children who received lower baseline Mullen scale scores made
greater gains than their higher scoring peers when enrolled in TEACCH classrooms.
The Mullen Scales of Early Learning are an assessment tool that provides a quick, reli-
able measure of motor development and cognitive ability for infants through age
68 months. This may suggest “that some of the environmental and behavioral sup-
ports used in TEACCH are more beneficial to children with greater cognitive impair-
ments.”62 Furthermore, a study conducted by Park and Kim56 suggests that
TEACCH-structured teaching improved independent engagement and reduced
disruptive behavior in 3 young adults with severe autism. Virues-Ortega and col-
leagues63 conducted a meta-anfalysis and determined that TEACCH methods yielded
greater gains in the areas of social and maladaptive behaviors versus communication,
 Autism and Education 15

Fig. 10. This is a set of written instructions for a student to follow to complete a school-
based job. As the student completes each step, a checkmark is placed in the box. (Courtesy
of The Forbush School at Hunt Valley, Part of the Sheppard Pratt Health System, Towson,
MD.)

motor, perceptual, or adaptive skills. These varying outcomes help to highlight how
critical it is for educators to individualize instruction for students with ASD.

APPLIED BEHAVIOR ANALYSIS

Applied behavior analysis (ABA) is one of the most empirically validated forms of treat-
ment of educating individuals with ASD.64 ABA is an EBP that distinguishes itself from
experimental analysis of behavior “by its focus on solving socially important problems
in socially important settings.”65 ABA is widely used to educate children and youth
with ASD because of its emphasis on social impact and its reliance on making
data-based decisions. Cooper and colleagues define ABA as “the scientific approach
for discovering environmental variables that reliably influence socially significant
behavior and for developing a technology of behavior change that takes practical
advantage of those discoveries.”20(p3)
The application of ABA interventions for children and youth with autism dates back
to the 1960s. Within the field of autism, Dr Ole Ivar Løvaas was a strong and early pro-
ponent of the use of discrete trial training, an approach in which the instructor delivers
16 Flannery & Wisner-Carlson

Fig. 11. Visuals are used at this recycling station to indicate examples of items that are recy-
clable and to clarify placement of items that are recycled. (Courtesy of The Forbush School at
Hunt Valley, Part of the Sheppard Pratt Health System, Towson, MD.)

1 or multiple discriminative stimuli and, contingent on the appropriateness of the par-

ticipant’s response, provides reinforcement or implements individualized prompting
strategies.22 Ivar Lovaas and his colleagues were able to demonstrate that, with an
effective intervention, children with ASD could make social and intellectual gains.64
Many of the NPDC-identified EBPs18 are “foundational applied behavior analysis
techniques,”66 These include antecedent-based intervention, differential reinforce-
ment, extinction, functional communication training, pivotal response training,
prompting, reinforcement, task analysis (Fig. 16), and time delay.20,35,46,65
The gap between research and practice can be a limitation to the use of ABA in
school settings.65 Some interventions rooted in ABA can be difficult to implement in
a classroom setting whereas others can be simpler for teachers to implement (eg,
pivotal response training).29 An added limitation may be the lack of teacher prepared-
ness and training in the principles of ABA. Often, ABA programs are developed and
overseen by a Board Certified Behavior Analyst (BCBA). BCBAs receive extensive
and systematized education, training, and supervision as they pursue their license.67
 Autism and Education 17

Fig. 12. Partitions are used to create a student’s work space in a large classroom. (Courtesy
of The Forbush School at Hunt Valley, Part of the Sheppard Pratt Health System, Towson,
MD.)

The training a BCBA receives is not commensurate with that of a teacher, particularly
as it relates to programming for students with ASD. Despite these limitations, there still
is a significant amount of evidence to support that procedures based on the principles
of ABA are representative of effective EBPs for individuals on the spectrum.65,67

BEHAVIOR CHANGE IN THE CLASSROOM

Both general and special educators may experience a wide range of behaviors from
the ASD students in their classrooms. Some students with autism may engage in se-
vere, dangerous, and challenging behaviors that can be disruptive to the classroom
and contribute to academic failure.68 Research suggests that 10% to 15% of
individuals with an intellectual disability exhibit challenging behaviors, including
aggression, self-injurious behavior, and destructive behavior.69,70 Other students

Fig. 13. Magnetic, fabric light covers are used to decrease sensitivity to fluorescent lights in
a classroom. (Courtesy of The Forbush School at Hunt Valley, Part of the Sheppard Pratt
Health System, Towson, MD.)
18 Flannery & Wisner-Carlson

Fig. 14. This is a color-coded work system. This work system is designed for 5 different stu-
dents to complete 4 different tasks each by using visual schedules that correspond to the
numbers and color-coding on the bins. (Courtesy of The Forbush School at Hunt Valley,
Part of the Sheppard Pratt Health System, Towson, MD.)

may engage in behaviors, such as repetitive movements or scripting, that do not pose
a safety risk but are disruptive. Schopler and colleagues71 contend that students tend
to make steady academic progress when their idiosyncratic behaviors are accepted
by their teachers and, therefore, teachers should focus only on those behaviors that
interfere with learning. For example, when a behavior like finger tapping is ignored
and accepted by teachers, a student with ASD may flourish academically.71
It is thus important for educators to be prepared for their students with autism to
exhibit disruptive and challenging behaviors. When teachers are not prepared, these
behaviors pose risks for students of academic failure, poor social supports, restrictive

Fig. 15. The sheet tied around the legs of this student’s desk allows her to “hide” when she
is feeling overwhelmed. “Hiding” is a replacement behavior she is offered to do instead of
leaving her seat or eloping from the classroom. (Courtesy of The Forbush School at Hunt Val-
ley, Part of the Sheppard Pratt Health System, Towson, MD.)
 Autism and Education 19

Fig. 16. Prompt hierarchy: B, backward chaining; F, forward chaining; FP, full physical
prompt; GP, gestural prompt: I, independent; MP, model prompt; PP, partial physical prompt;
TT, total task chaining. (Courtesy of The Forbush School at Hunt Valley, Part of the Sheppard
Pratt Health System, Towson, MD.)

behavioral techniques, medications possibly with significant side effects, and/or

disproportionate rates of suspension.68 Preparing teachers with the tools and skills
required to effectively teach students with autism can be particularly challenging
because students with ASD are a heterogeneous group.72 Woolfson73 indicates that
teachers often convey feelings of anxiety regarding teacher preparedness. Teacher
training needs to focus on EBPs to meet the academic, social, and language needs
of students with autism. Denning and Moody state, “Today’s classrooms are increas-
ingly diverse and teachers need to proactively set-up the environment and instruc-
tional methods in ways that support all learners.”42 Therefore, it is imperative for all
educators to be equipped to teach students with autism, including having an under-
standing of the components of a classroom that make it more conducive to students
with autism. Effective teacher preparation programs should be ever evolving so that
teachers stay motivated. Busby and colleagues state,

If teachers have superior training, preparation and experiences, and are provided
the tools to facilitate success, they will begin to feel more confident in their abilities
to teach children with autism and other disabilities. Teachers will feel empowered
and the challenges that they face will become less daunting.74

POSTSECONDARY

Many individuals with ASD struggle with change.75,76 According to Marsh and col-
leagues77 starting school is a major event that can be particularly challenging for indi-
viduals with ASD. For youth with autism who are transitioning to their postsecondary
years, this transition can be exacerbated by several other factors. There is research to
support that the life beyond high school can be bleak.76 According to Shattuck and
colleagues,78 35% of young adults (ages 19–23) with autism have not had a job or
received postgraduate education after leaving high school and they were most as
risk for being fully detached from all postsecondary opportunities.
When students exit school with a high school diploma or alternative certificate, they
are no longer entitled to the same educational services and funding they were entitled
to under the Individuals with Disabilities Education Act (IDEA) during their kindergarten
20 Flannery & Wisner-Carlson

through 12th-grade years. This results in challenges for families as the responsibility to
continue to provide support to their child during this transition lies with them.76 Addi-
tionally, according to Lounds and colleagues,79 this transition period can cause
increased anxiety for mothers of children with ASD, and research76 has concluded
that when there is more negativity than positivity in the family home, this had an impact
on the occurrence of problem behaviors for youth with ASD. For individuals with ASD,
as they continue to mature and navigate this postsecondary transition, they continue
to face challenges similar to those they faced when they were enrolled in school. Just
because the calendar changed does not mean a student changed or that the supports
they were provided the day or month before are no longer needed.
Research by White and colleagues80 emphasizes the importance of planning for a
transition from high school to postsecondary opportunities. In 1997, IDEA was reau-
thorized and mandated that individualized education plans include transition planning
to begin at age 14 and include a transition services component at age 16.81–83 There-
fore, it is the responsibility of school professionals to help ensure that students who
have a disability and receive special education services be part of transition planning
that begins early in their high school years. In order for this transition to be optimal, all
aspects of the transition plan should be participant driven to the greatest extent
possible.84 Flexibility and individualization in incorporating students’ strengths and in-
terests is vital to meeting their unique needs.83
Research on postsecondary outcomes indicates that adaptive functioning, IQ, and
psychiatric comorbidity are significant predictors of postsecondary success for indi-
viduals with ASD.85 Furthermore, a study conducted by Zukerman and colleagues
found that “lower adaptive functioning was associated with the severity of social anx-
iety and obsessive compulsive symptoms in ASD participants.”85 These findings
stress the importance of continued access to instruction in independent living skills
and social emotional behavior beyond the high school.

SUMMARY

The passage of laws pertaining to individuals with disabilities has opened the door for
greater opportunity for children and youth diagnosed with ASDs to receive the special-
ized and individualized educational services that yield successful outcomes. It is
evident that there is still no 1 best practice for educating individuals with autism due
to the spectrum and variety of symptoms experienced by those with ASD and the
need for highly individualized programming. Although there is a wide breadth of
research on educating children and youth with autism, more is necessary for educa-
tors and the pubic to gain a greater understanding of the wide range of outcomes that
exist. There is particular need for additional studies beyond school-aged children
because educating a person with ASD does not stop at high school graduation; it is
a lifelong pursuit.

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