Monday, October 16, 2017

What Do School Personnel Know About Autism?

Knowledge of Autism

Autism spectrum disorder (ASD) affects approximately 1 to 2 % of the school-age population. The majority of children with autism are educated within the public school system, most often in general education classes, either full- or part-time. Thus, teachers (regular and special education) and other school personnel must be familiar with current best practices for identifying and treating children with ASD. However, many do not have formal training in educating and intervening with this group of children. To address the increased need for services in school settings, it has been recommended that school personnel participate in trainings to develop the skills and competencies necessary to provide effective services to students with ASD. 

Although a review of the literature suggests that school personnel are receiving some specialized training related to autism, there continues to be a pressing need for more continuing education opportunities and improved preparation. It is vital that school personnel understand this complex neurodevelopmental disorder in order to help students achieve positive outcomes, especially since they share the responsibility of educating the increasing number of children being identified with ASD.
Pilot Study
Although there is a paucity of research focusing on school personnel's perceived and/or factual knowledge of autism, a pilot survey published in the School Psychologist provides us with an exploratory investigation of teacher, counselor, and paraprofessional knowledge of autism. The survey attempted to answer the following questions: (a) To what extent do school personnel (teachers, counselors, and paraprofessionals) perceive that they are competent in their understanding of autism?; (b) What is school personnel's factual knowledge of autism (definition, assessment/diagnosis, and treatments)?; and (c) To what extent do school personnel that work directly with students with autism differ in their perception and factual knowledge of autism in comparison to those who do not work with students with autism?
Participants
Fifty-four school personnel from a southwestern state participated in the pilot survey. Participants were school district employees enrolled in various graduate level majors who were attending a small university (within the college of education) in the Southwestern United States. The sample included 26 general education teachers, 14 special education teachers, 7 school counselors and 7 paraprofessionals. Seventy percent indicated that they worked directly with students diagnosed with autism (instructor, interventionist, care-provider, etc.), while approximately 30 percent indicated that they indirectly served students with autism (consultant, academic planning, multidisciplinary team member, etc.). A majority indicated that they had never participated in autism training(s) and when asked whether they would like to take part in future training(s), most indicated that they did not have a desire to participate.
Participants completed two measures developed by the authors, a Perceptions Survey and a Knowledge Survey. Both measures contained items derived from empirically-supported findings in the research literature. The Perceptions Survey items were designed to assess the respondents' perceived competence of their knowledge and ability to implement research findings. The Knowledge Survey items were designed to assess the respondents' factual knowledge of research findings about autism (definition, assessment/diagnosis, and treatment).
Results
The results of the survey indicated that overall, the perceived competence of general and special education teachers, school counselors, and paraprofessional regarding their knowledge of autism was average. Although school personnel that work directly and indirectly with students both reported having average perceived competence, those providing direct service had a statistically significantly higher level of perceived competence. The results of the Knowledge Survey indicated that school personnel who work directly with students correctly defined the disorder, while those that do not demonstrated moderate knowledge with some errors. However, school personnel's factual knowledge about the assessment/diagnosis and treatment of autism was low, regardless of whether services were delivered directly or indirectly.
    Implications
The findings of this pilot survey raise several important questions about school personnel’s perceived and factual knowledge about autism. A majority of participants indicated they had no prior training and expressed little interest in receiving education related to autism in the future. This is concerning, given that all participants working with students with autism, either directly or indirectly, reported average perceived competence yet demonstrated a low level of factual knowledge. This divergence suggests that teachers, school counselors, and paraprofessionals may overestimate their factual knowledge about autism and as a result, fail to see a need for additional training.
Despite the study’s limitations (e.g., small sample size) and need for further research relating to school personnel’s perceptions and knowledge, the results have significant implications for school-based practice. For example, administrators, supervisors, and support professionals such as school psychologists should exercise caution when assuming that school personnel have an adequate factual understanding and working knowledge of autism. It is also important to recognize that anecdotal reports are insufficient when determing the need for training and that direct assessment of factual knowledge is required. Failure to correctly identify training needs can have a negative effect on screening/assessment and intervention selection, planning, and implementation. The results also raise an important question as to what extent school personnel’s perceived knowledge about autism might limit their willingness to participate in training and contribute to resistance in consultation.
                                                                           Conclusion
There is a critical need for more coordinated efforts among community and school professionals for the training of teachers in evidence-based instruction and behavioral management practices for children with ASD. Because the knowledge base in ASD is changing so rapidly, it is imperative that school personnel remain current with the research and up to date on scientifically supported approaches that have direct application to the educational setting. For example, some intervention and assessment procedures require a specific knowledge base and skills for successful implementation. It is vital that service providers understand best practice procedures across school, community, and home settings. School personnel can help to ensure that students with ASD receive an effective educational program by participating in training programs designed to increase their understanding and factual knowledge about assessment and intervention /treatment approaches.
Key Sources

Azad, G., & Mandell, D. S. (2016). Concerns of parents and teachers of children with autism in elementary school. Autism : The International Journal of Research and Practice20(4), 435–441. doi:10.1177/1362361315588199

Baker, Laura Nichole, Perceived Levels of Confidence and Knowledge of Autism Between Paraprofessionals in Kentucky Schools and Parents of Children with Autism (2012). Online Theses and Dissertations. 106. https://encompass.eku.edu/etd/106

Evidence-Based Practice and Autism in the Schools an educator’s guide to providing appropriate interventions to students with autism spectrum disorder 2nd Edition National Autism Center | Randolph, Massachusetts (2015). https://www.unl.edu/asdnetwork/docs/NACEdManual_2ndEd_FINAL.pdf

Kabot, S., & Reeve, C. (2014). Curriculum and program structure. In L. A. Wilkinson (Ed.). Autism spectrum disorder in children and adolescents: Evidence-based assessment and intervention in schools. Washington, DC: American Psychological Association.

Klein, T. (2012). Consumer corner: Autism for public school administrators: What you need to know. Science in Autism Treatment, 9(1), 6-8.

Life Journey Through Autism: An Educator’s Guide to Autism. Organization for Autism Research (OAR). Arlington, VA 22201 
https://researchautism.org/education/teachers-corner/

Wagner, S. (2014). Continuum of services and individual plan process. In L. A. Wilkinson (Ed.). Autism spectrum disorder in children and adolescents: Evidence-based assessment and intervention in schools. Washington, DC: American Psychological Association.

Wilkinson, L. A. (Ed.) (2014). Autism spectrum disorder in children and adolescents: Evidence-based assessment and intervention in schools. Washington, DC: American Psychological Association.

Wilkinson, L. A. (2017). A best practice guide to assessment and intervention for autism spectrum disorder in schools (2nd Edition.). London and Philadelphia: Jessica Kingsley Publishers.

Williams, K., Schroeder, J. L., Carvalho, C., & Cervantes, A. (2011). School personnel knowledge of autism: A pilot survey. The School Psychologist, 65, 7-9.

Lee A. Wilkinson, PhD, is a licensed and nationally certified school psychologist and a certified cognitive-behavioral therapist. He is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBTHe is also editor of a text in the APA School Psychology Book Series,  Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).
© Lee A. Wilkinson, PhD

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Lee A. Wilkinson, PhD, is a licensed and nationally certified school psychologist, and certified cognitive behavioral therapist. He provides consultation services and best practice guidance to school systems, agencies, advocacy groups, and professionals on a wide variety of topics related to children and youth with autism. He is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBTHe is also editor of a text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition ).

Saturday, October 7, 2017

What is Pragmatic Language?

What is Pragmatic Language?

Synonyms
Natural language; social communication; social discourse; social language; social skills
Definition
Pragmatics is broadly defined as the ability to understand and use language in social-communicative contexts.
Description
Pragmatics is the area of communication function that involves the use of language in social contexts (knowing what to say, how to say it, when to say it, and where to say it).  It is the ability of natural language speakers to communicate more than that which is explicitly stated and to understand another speaker's intended meaning. Pragmatics includes both the verbal and nonverbal aspects of communication and may be thought of as a conversational code of conduct or a set of rules for communication. We learn this system of rules naturally and implicitly. If one has good pragmatic skills, they are able to communicate an appropriate message effectively in a real world social situation. Pragmatics involve the following social linguistic skills: (a) using language for different purposes (e.g., greeting and requesting); (b) changing language according to the needs of a listener or situation (e.g., talking differently to a peer than to an adult and speaking differently in a classroom than on a playground); (c) understanding non-literal language (e.g., metaphor, irony, figurative language, sarcasm); and (d) following rules for conversations (e.g., taking turns and staying on topic). The pragmatic aspect of language also includes appropriate eye contact, intonation, and the body movements and gestures that accompany communication.
Relevance to Autism
Children must be fluent and capable in the areas of pragmatic language in order to interact and participate successfully in school. When typical children engage in reciprocal conversation they are aware of the knowledge, interests and intentions of the other person, as well as the social rules which determine pragmatic competence. In contrast, children with poor pragmatic skills have significant problems using language socially in ways that are appropriate or characteristic of children their age. Many children with developmental disabilities have difficulties learning the complex rules of social interaction. For example, pragmatic language challenges are a prominent communication problem in children with autism spectrum disorder (ASD). Because social communication deficits are among the core features of autism, an evaluation of pragmatic competence is always a vital part of the assessment process. However, few standardized tests can effectively evaluate and quantify the complexity of pragmatic language. Valid norms for pragmatic development and objective criteria for performance are also limited. Indeed, formal testing may not identify the presence of a social pragmatic problem, thereby preventing the child from receiving the appropriate support. Assessment of pragmatic social skills requires more than a traditional standardized testing approach. Less formal naturalistic assessments are necessary, including observations of children’s pragmatic competency in everyday contexts. Given that pragmatic language is a critical part of everyday communication and social interaction, it is imperative that interventions for children with autism spectrum disorder focus on social (pragmatic) communication skills skills. 
Key References

Prizant, B. M., Wetherby, A. M., Rubin, E., Laurent, A. C., & Rydell, P. J. (2006). The SCERTS model: A comprehensive educational approach for children with autism spectrum disorders. Baltimore, MD: Paul Brookes Publishing Company.

Twachtman-Cullen, D., & Twachtman-Bassett, J. (2014). Language and social communication. In L. A. Wilkinson (Ed.), Autism spectrum disorder in children and adolescents:  Evidence-based assessment and intervention in schools (pp. 101-124). Washington, DC: American Psychological Association.
Winner, M. G. (2005). Think social! A social thinking curriculum for school-age students. San Jose, CA: Think Social Publishing.
Wilkinson, L. A. (2011). Pragmatics in Encyclopedia of Child Behavior and Development, Part 16, 1138-1139, DOI: 10.1007/978-0-387-79061-9_2209

Monday, October 2, 2017

Group Cognitive Behavioral Therapy (CBT) for Autistic Adults


The increase in the prevalence of autism spectrum conditions among children and adolescents and the correspondingly large number of youth transitioning into adulthood has created an urgent need to address the mental health needs, isolation, and poor quality of life faced by many adults on the autism spectrum. Unfortunately, there are few validated treatment options are available for adults with autism spectrum disorder (ASD). Much of the published literature is clinical or anecdotal, or purely based on theory. There is unquestionably a need for the development of treatment options for adults with ASD. At present, alternative treatment options to psycho-therapeutical interventions are social training programs and other group activities. Group settings enable social interaction and sharing experiences with others, thereby reducing social isolation. 

Research

A study published in the peer reviewed journal Autism assessed the effectiveness of two group interventions for adults with ASD: cognitive behavioral therapy (CBT) and recreational activity.
 A total of 68 adults with ASD participated in the study and were stratified by gender and blindly randomized to one of the two treatment conditions. Both interventions comprised 36 weekly 3-hour sessions led by two therapists in groups of 6–8 participants. The CBT group intervention was adapted to suit adults with ASD and consisted of five elements: (a) structure, (b) group setting, (c) psycho-education (e.g. lectures and discussions on ASD and psychiatric symptoms, including learning to identify and reappraise maladaptive thoughts), (d) social training (e.g. skill building such as practicing phone calls and asking for help) and (e) cognitive behavioral techniques (e.g. setting goals, role-playing, exposure exercises and conducting behavior analysis). A manual describing the 36 individual sessions was created prior to starting the treatment. Each session followed a strict agenda: (a) introduction and presentation of the agenda of the day, (b) review of homework assignments from the previous session, (c) psycho-educative lecture and discussions on the session topic, (d) coffee break with buns or sandwiches and social interaction, (e) relaxation or mindfulness exercise, (f) discussions and exercises on the session topic, (g) distribution of homework and (h) evaluation and end of session.
The purpose of the recreational activity intervention was to facilitate social interaction and to break social isolation. The therapists did not provide any deliberate techniques, such as psycho-education, social training, or CBT. Rather, this intervention relied on structure and group setting only. During the first session, participants were asked to write down group activities they would like to engage in. The therapists created a list of the suggested activities, such as visiting museums, playing board games, cooking, restaurant visits, boating, cinema, and taking walks. Each week, participants voted for the next session’s activity.
The researchers hypothesized that both interventions would lead to improvement in primary measures of quality of life, sense of coherence, and self-esteem, as well as in the exploratory analysis of the secondary measures of psychiatric symptoms. A greater effect in the CBT intervention compared to recreational activity was also expected, due to participants in the CBT intervention receiving a wider range of psychotherapeutic techniques. Several self-report questionnaire measures were administered to the adults before and after the interventions: Quality of Life Inventory (health, relationships, employment, and living conditions), Sense of Coherence (manageability and meaningfulness in life), Rosenberg Self Esteem Scale and an exploratory analysis on measures of psychiatric health (e.g., anxiety and depression). A long-term follow-up was conducted which ranged from 8 to 57 months after treatment termination.
Results

Participants in both treatment conditions reported an increased quality of life at post-treatment, with no significant difference between the group CBT and group recreational activity interventions. Comorbid psychiatric symptoms, sense of coherence, and self-esteem were not affected by either intervention. CBT resulted in less attrition (drop out) than recreational activity. Participants who received CBT also rated themselves as more improved at post-treatment. At follow-up, CBT participants reported better well-being, greater understanding of their own difficulties and improved ability to express needs, compared to participants in the recreational activity intervention. This may reflect the recreation activity intervention’s focus on the intervention elements of structure and group setting, while the CBT intervention also included the elements of psycho-education, social training and CBT techniques. As a result, participants in CBT may have developed greater understanding of their own difficulties and improved ability to express needs and receive support because the objective of psycho-education and social training is to enhance these capabilities. The difference in well-being scores at follow-up may also represent greater insight gained from CBT rather than recreational activity.
Implications

Both interventions appear to be promising treatment options for adults with ASD, as they appeared to improve the participants’ quality of life. The similar efficacy of the interventions may be due to the common elements of structure and group setting. The group setting of both interventions enabled social interaction and sharing experiences. This may have promoted participants’ self-acceptance by allowing them to gain insight into both the impairments and the strengths that characterize ASD, and to recognize that others share similar challenges. CBT may be additionally beneficial in terms of increasing specific skills, greater understanding and insight, and minimizing dropout. Future studies on treatment of comorbid psychiatric symptoms in ASD should include larger samples to differentiate between adults with specific psychiatric problems in order to more effectively assess treatment effects.
Hesselmark, E., Plenty, S., & Bejerot, S. (2014). Group cognitive behavioural therapy and group recreational activity for adults with autism spectrum disorders: A preliminary randomized controlled trial. Autism, 18(6) 672–683. doi: 10.1177/1362361313493681

Lee A. Wilkinson, PhD, NCSP is a licensed and nationally certified school psychologist, and certified cognitive-behavioral therapist. He is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBTHe is also editor of a best-selling text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition)

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