The Challenges of Autism

Autism is a pervasive developmental disorder (PDD) characterized by deficits in social

interaction and communication, and restricted, repetitive patterns of behaviour, interest and
activity (McGahan, 2001). In several cases, autism is associated with mental retardation.
Individuals with autism may exhibit hyperactivity; short attention span; impulsivity;
aggression; self-injurious behaviours; odd responses to sensory stimuli; eating, sleeping,
motor or mood abnormalities; and difficulty comprehending the environment, thoughts,
emotions and needs of others (McGahan, 2001: 2).
These characteristics usually appear before the age of three, and boys are four times more
likely to develop autism than girls (McGahan, 2001: 8). There is also considerable individual
variation in the type and intensity of symptoms. Although our knowledge of autism disorders
has increased steadily over the past decades, researchers, clinicians and the families of
autistic children still face many challenges.
The complex causes of autism
There is still no definitive answer to the question of what causes autism. Researchers are
exploring a variety of different factors: genetic, medical, neurological and environmental.
Many parents and patient associations are concerned about the highly mediatised coverage
of a possible link between autism and the measles, mumps and rubella (MMR) vaccine.
However, there is no evidence from current studies that support this relationship (Wilson et
al, 2003).
Diagnosis: Improved accuracy but problems with access
Both researchers and clinicians agree that early, accurate diagnosis is
important to ensure early intervention, which in turn enhances the
chances to improve the quality of life, and educational and social
success

of

autistic

individuals

(http://www.cairn-

site.com/en/research2.html). Although the accuracy of diagnostic tests has improved

significantly in the past decade, there are still problems with access to these tests. In the
province of Quebec, for example, the diagnosis of autism requires evaluations by a number
of different professionals (psychiatrists, psychologists, speech therapists and occupational
therapists, etc) working within a healthcare system that is already resource-limited, and in a
variety of institutions and departments, (hospitals, clinics, schools, etc). In short, the
diagnosis requires several complex steps, and parents end up being placed on multiple

waiting lists. This situation not only jeopardises early intervention, but also generates
considerable anxiety and anguish (Poirier and Kozminski, 2008).
Treatment: Needs versus available treatments and services
Many behavioural, educational, drug and alternative therapies have been developed in an
attempt to treat autistic disorders. However, efficacy at generating real and permanent
changes in the core symptoms of autism has not yet been rigorously demonstrated for many
treatments (http://www.cairn-site.com/en/research4.html). Moreover, as the expression of
autistic symptoms varies between individuals, the identification and implementation of an
optimal treatment regime is often a process of trial and error. And access to rapid treatment
is difficult for the same reasons as outlined above for diagnostic
services.

Finally, autism is often accompanied by physical health problems

like eating or sleeping disorders, or motor abnormalities. These may require the intervention
of specialists like endocrinologists or gastroenterologists, some of whom may not be familiar
with PDD or trained to intervene with individuals who exhibit unpredictable behaviour.
Unfortunately, many families are left on their own to cope as best they can with the health
problems of their autistic children (see our interview with Ms. Lahaie from Autisme Montral).
Autistic adults: The forgotten ones
Autism cannot be cured. The goal is to mitigate the symptoms in order to improve quality of
life. While more and more services are becoming available for autistic children and their
families, the reality of adults living with autistic disorders is rarely examined by researchers
or society in general. A British study has shown that the core symptoms of autism persist into
adulthood. The majority of autistic adults still requires assistance in day-to-day activities and
is unable to hold employment or complete schooling (Howlin et al, 2004). The authors
highlight the importance of implementing programs and services focused on the specific
needs of autistic adults. There are still very few such programs in Great Britain and Canada.

This month, Hinnovic presents the perspectives of parents, clinicians and researchers on
autism. These individuals all contribute, in their own unique way, to our understanding of
autism and efforts to improve the quality of life of people living with autism.

HYPERACTIVE

"You're not paying attention." "Don't you know where you put your lunch money?" "Stop
fidgeting!" "Don't interrupt."
Can you imagine what it would be like to hear people talk to you this way every single day? If
you can imagine it, or if it sounds just like what you're used to hearing, then you know what
it's like to have ADHD. Those letters stand for a condition called attention deficit hyperactivity
disorder.
Kids who have ADHD are not bad, lazy, or stupid. They have a disorder that means they
might have problems paying attention or sitting still in their seats. They can also act on
impulse this means doing things without thinking about them first. Kids with ADHD may
spend a lot of time in the principal's office. Sometimes they do things that cause them to get
hurt. They might change their friends a lot.
Who Gets ADHD?
About 9% of kids have ADHD. That means out of 100 kids, about 9 may have ADHD. So if
your school has 300 kids, 24 to 30 of them might have ADHD. Kids who have ADHD usually
start having problems in preschool. Boys have ADHD more often than girls. In fact, three
times as many boys have ADHD, but no one knows why.
A kid might have a greater chance of developing ADHD if one of his or her relatives already
has ADHD or another type of behavior problem. But no one is sure why anyone has ADHD,
although scientists and doctors think that it probably has to do with differences in the way
people's brains work. No one gets ADHD on purpose, so it isn't ever anyone's fault. And
ADHD isn't contagious you can't catch it from someone like the flu.
What Are the Signs of ADHD?
ADHD can cause kids to act in different ways, depending on who has it. Most kids with
ADHD have problems concentrating and paying attention. Some kids with ADHD also might
have trouble sitting still in class and waiting for their turn. They might yell out the answers
before other kids have a chance to raise their hands.
Sometimes they can be disorganized, distracted, or forgetful. They might lose things and
have trouble finishing assignments. They may wiggle around in their seats, move around a
lot, talk too much, or interrupt other people's conversations.
It's important to remember that everybody does these things once in a while. It doesn't mean
you have ADHD.

Effects of Hearing Loss on Development

It is well recognized that hearing is critical to speech and language development,
communication, and learning. Children with listening difficulties due to hearing loss or
auditory processing problems continue to be an underidentified and underserved population.
The earlier hearing loss occurs in a child's life, the more serious the effects on the child's
development. Similarly, the earlier the problem is identified and intervention begun, the less
serious the ultimate impact.
There are four major ways in which hearing loss affects children-1.

It causes delay in the development of receptive and expressive communication skills

(speech and language).
2.
The language deficit causes learning problems that result in reduced academic
achievement.
3.
Communication difficulties often lead to social isolation and poor self-concept.
4.
It may have an impact on vocational choices.
Specific Effects
Vocabulary

Vocabulary develops more slowly in children who have hearing loss.

Children with hearing loss learn concrete words like cat, jump, five, and red more
easily than abstract words like before, after, equal to, and jealous. They also have
difficulty with function words like the, an, are, and a.
The gap between the vocabulary of children with normal hearing and those with
hearing loss widens with age. Children with hearing loss do not catch up without
intervention.
Children with hearing loss have difficulty understanding words with multiple
meanings. For example, the word bank can mean the edge of a stream or a place where
we put money.
Sentence Structure

Children with hearing loss comprehend and produce shorter and simpler sentences
than children with normal hearing.
Children with hearing loss often have difficulty understanding and writing complex
sentences, such as those with relative clauses ("The teacher whom I have for math was
sick today.") or passive voice ("The ball was thrown by Mary.")
Children with hearing loss often cannot hear word endings such as -s or -ed. This
leads to misunderstandings and misuse of verb tense, pluralization, nonagreement of
subject and verb, and possessives.
Speaking

Children with hearing loss often cannot hear quiet speech sounds such as "s," "sh,"
"f," "t," and "k" and therefore do not include them in their speech. Thus, speech may be
difficult to understand.
Children with hearing loss may not hear their own voices when they speak. They may
speak too loudly or not loud enough. They may have a speaking pitch that is too high.

They may sound like they are mumbling because of poor stress, poor inflection, or poor
rate of speaking.
Academic Achievement

Children with hearing loss have difficulty with all areas of academic achievement,
especially reading and mathematical concepts.
Children with mild to moderate hearing losses, on average, achieve one to four grade
levels lower than their peers with normal hearing, unless appropriate management occurs.
Children with severe to profound hearing loss usually achieve skills no higher than
the third- or fourth-grade level, unless appropriate educational intervention occurs early.
The gap in academic achievement between children with normal hearing and those
with hearing loss usually widens as they progress through school.
The level of achievement is related to parental involvement and the quantity, quality,
and timing of the support services children receive.
Social Functioning

Children with severe to profound hearing losses often report feeling isolated, without
friends, and unhappy in school, particularly when their socialization with other children
with hearing loss is limited.
These social problems appear to be more frequent in children with a mild or
moderate hearing losses than in those with a severe to profound loss.

Reading and Students with Speech or Language Impairments

Students with speech or language impairments face unique challenges when reading. Yet
with targeted interventions and accommodations in reading instruction and assessment,
students with these disabilities can become proficient readers. Understanding the
characteristics of students with speech or language impairments that may affect reading is
an important step toward developing effective instruction and appropriate assessments.
This paper is intended to begin a discussion of the issues surrounding reading and students
with speech or language impairments; it is not intended to be a comprehensive research
review. This paper provides: (1) an overview of the characteristics of students with speech or
language impairments, (2) a description of common approaches to reading instruction, and
(3) assessment approaches and issues that surround the assessment of reading for
students with speech or language impairments.
The paper is one of several brief papers developed to contribute to the process of
conducting research and developing accessible reading assessments for students with
disabilities. Creating accessible reading assessments based on accepted definitions of
reading and proficiencies of reading requires knowledge of the issues specific to each
disability and how they affect reading and the assessment of reading. The information in
these papers was obtained through a broad review of literature and Web sites of national
agencies and organizations, along with feedback and input from professionals in the
disability areas. Each paper is intended as a first step to facilitate discussions that include
individuals who do not know the disability, in this case speech or language impairments, and
those who may know the disability but have not considered the interaction of the disability
with reading or the assessment of reading through statewide testing.
Students with Speech or Language Impairments
Approximately one million students 6-21 years of age in the United States received special
education services for speech or language disabilities in the 2000-2001 school year,
comprising nearly 20% of all students with disabilities in U.S. schools (U.S. Department of
Education, 2002). These children have a number of receptive and expressive impairments,
including, but not limited to, inability to understand or use language, stuttering, impaired
articulation, or voice impairments. Hearing loss, neurological disorders, brain injury, mental
retardation, drug abuse, physical impairments such as cleft lip or palate, and vocal abuse or
misuse are all factors that can contribute to the severity of the speech or language
impairment.
It has been estimated that 83,982 K-12 English language learners (ELLs) received special
education services for speech or language impairments in 2001-2002. Thus, approximately
23.5% of school-age ELLs with disabilities were identified with speech or language
impairments (Zehler, Fleischman, Hopstock, Pendzick, & Stephenson, 2003). Typically, to
qualify for these services, ELLs must demonstrate difficulties with communication that are
not related to the second language acquisition process and show that those difficulties are
present in both the first and second language. The challenge of learning English and having
a speech or language impairment adds another level of complexity to learning to read and
demonstrating reading achievement (Muller & Markowitz, 2004).

There is evidence of a relationship between language impairments and reading disabilities,

showing that a majority of native English speaking students who do not develop proficient
reading skills in English had an early history of spoken-language deficits (Catts, Fey,
Tomblin, & Zhang, 2002). Although the connection between language impairments and
reading difficulties is not causal or inevitable, students with a history of language
impairments are at risk for failure in reading achievement more than students without
language impairments.
Instruction for Students with Speech or Language Impairments
Children with speech or language impairments may experience a range of challenges in the
school setting due to their disability. Examples of these challenges that have been identified
by the American Speech-Language-Hearing Association (ASHA) include misunderstanding
social cues, showing poor judgment, having difficulty understanding and expressing
language, and having difficulty with tests. These challenges may be especially apparent in
noisy, complex classroom environments (ASHA, 2005a,b). ASHA cited research indicating
that children who are not fluent readers by the fourth grade are likely to struggle with reading
into adulthood. Students who received intervention before age five had increased
opportunity for overcoming speech or language impairments, with the potential to prevent
academic issues later in life (ASHA, 2005).
Children with speech and language deficits can have reading problems that fall into two
categories. First, they may have difficulty with decoding, or the ability to identify printed
words through letter-sound correspondences. Research has shown that children with speech
and language impairments tend to show poor phonological awareness and other higher level
phonological skills (Gillon, 2000; 2002) and these skills are known to be related to the
successful acquisition of literacy (Adams, 1997). For these difficulties, direct instruction and
practice in phonological segmentation, sound counting, and letter-sound associations have
been shown to improve decoding skills (e.g., Ball & Blachman, 1991; Snow, Burns, & Griffin,
1998). Second, children with speech and language impairments may have difficulty with
reading comprehension because of their lack of facility with comprehending complex
discourse (Bishop, 1997; Westby, 2005). In this sense, the comprehension difficulties are
secondary to their weak grasp of higher level language in any modality, spoken or written.
Intervention efforts to improve comprehension of spoken language would be expected to
generalize to comprehension of written language, as well (Westby, 2005).
Many techniques can facilitate reading success in the classroom for students with speech or
language disabilities. These techniques are generally effective for all students. Teachers can
improve the learning environment for children with speech or language impairments by
manipulating their approaches in a variety of ways, including seating students away from
auditory or visual distractions; monitoring sources of background noise (e.g. air vents,
playgrounds, hallways, street traffic); establishing a consistent class time structure and
routine; maintaining the students focus and attention; ensuring a child is paying attention
before giving directions; speaking slowly and clearly; using sequential words such as first,
next, and finally; and using visual cues and supports to aid comprehension. In addition,
Ehren (2002) suggested that for students with speech or language impairments, the speech
language pathologist might work with students on vocabulary instruction to, in turn, facilitate
reading comprehension; it has also been suggested that word learning strategies might be

implemented to facilitate reading fluency and understanding of meaning in context

(McGregor, 2005), or the scaffolding of language to support listening and expression in the
context of literacy events.
Assessment of Students with Speech or Language Impairments
Students with speech or language impairments may struggle on tests because their
language impairments hamper their ability to understand directions or the wording of specific
test items, even when administrators read them aloud. They may also have increased test
anxiety due to a history of struggling with academic tasks and the added pressure of high
stakes assessments, whether the stakes are for the system or the student.
To minimize the effects of the disability on test performance, states, districts, and schools
typically allow students to use accommodations during testing. Accommodations for students
with speech or language impairments may include having material read aloud; having the
assessment broken down into smaller parts; additional time; use of a text book or dictionary;
an assistive augmentative communication device; or a variety of other accommodations.
In states 2003 accommodation policies, 48 states permitted tests to be read aloud, but only
3 allowed the read-aloud accommodation without any restrictions (Clapper, Morse, Lazarus,
Thompson, & Thurlow, 2005). In 14 states, having a test read aloud to a student could
disqualify the student from receiving a valid score. Thirty-one states allowed directions to be
repeated, re-read, or clarified although there were scoring consequences in some states
when this was done. Testing environment accommodations, including noise buffers and
amplification equipment, were considered by a majority of states to be non-controversial
accommodations. Few states have accommodation policies for ELLs with disabilities, and
we know little about the accommodations typically used by ELLs with speech or language
impairments.
Measuring reading proficiency is not straightforward, even for typical students. Despite the
work of several expert panels and national reading initiatives, there is still disagreement on
what constitutes reading proficiency. For students with speech or language impairments
who may have difficulty with sound/symbol connection, auditory processes, and language
comprehension what reading proficiency means, how to help students achieve it, and how
educators measure it is even less clear.
For instance, researchers are undecided about the extent to which reading fluency predicts
overall reading ability for these students. Despite considerable evidence that rapid naming
(Catts, 1993) and letter identification (Catts et al., 2002) in kindergarten are excellent
predictors of reading achievement in first and second grade for students in general, we do
not know whether this holds true when children have speech or language impairments. And
does this matter when it comes to state and district assessments? Are there aspects of these
assessments that create a need for fluency skills? Do certain characteristics of students with
speech or language impairments create one set of issues, and other characteristics create
another?

Types of Problems a Visually Impaired Child Would Have

By Chelsea Day, eHow Contributor
Coordination
o

According to Family Connect, physical balance and coordination can be a

challenge for visually impaired children, as they can't always see the objects around them-they rely instead on sound and familiarity with their environment. Family can help by always
putting toys away in a designated area. Avoid rearranging furniture as well. Other things that
family and friends can do to aid with coordination is to walk with the child through unfamiliar
areas and install ramps as opposed to stairs when possible.
Engaging with the World and Developing Interests

According to Growing Strong, visually impaired babies and children may not
naturally develop an interest in objects or activities like other children, since they can't
interact with their environment the same way. Blind children rely entirely on sound and
feeling. Since visually impaired children can't see everything around them, they don't know
to investigate things further and ask questions. Encourage your child to move about their
environment and to ask questions when she can't understand something, and prompt
discussion with your child about different subjects. Also, engage her with objects of varying
textures and weights, as well as items that make unique sounds.
Emotional Stress

American Foundation for the Blind says that even in cases where the
impairment comes on gradually or they've had a visual impairment since birth, visually
impaired children will feel stress in new or unfamiliar situations, particularly when they feel
isolated from peers. Starting at a new school or entering a new class can be particularly
stressful. Visually impaired children also may occasionally feel sad or frustrated. Friends and
family can help by listening to the child's concerns and encouraging the child to share his
feelings. Teachers can help by fostering understanding and open discussion about visual
impairment within the class, while also keeping expectations of the visually impaired children
high.

Learning Challenges
o

According to the National Federation of the Blind, there are a few learning
problems that visually impaired children may experience in any learning setting, and
particularly in a traditional classroom. If educators use a board to draw out graphs, charts, or
other examples, visually impaired children can't always see it or benefit from it. The same
concept applies to physical exercises and group activities, which are very visual. Educators
can help teach visually impaired children by including specific verbal explanations and
tangible objects that children can touch and feel.
Organization

Because they can't always see what objects are around them or specifics in
terms of what papers are labeled, visually impaired children may have difficulty with
organization, including homework management. The National Federation of the Blind
recommends developing a storage system with bins, folders, and braille labels to help the
child organize his or her schoolwork. For children who have some sight, the American
Foundation for the Blinds also recommends labeling things in colors that the child can
identify. Children who are color blind may also benefit from large icons to label each subject.

Teaching Students with Special Needs

It is inevitable that you will have the opportunity (and pleasure) of working with special
students in your classroom. You may need to make accommodations for some and
modifications for others. Providing for the needs of special education students will certainly
be one of your greatest challenges as a professional educator. Consider these tips and
strategies.
Jabberwocky
When working with special needs students, two terms you are sure to encounter are
accommodation and modification. An accommodation is a device, material, or support
process that will enable a student to accomplish a task more efficiently. Modification refers to
changes to the instructional outcomes; a change or decrease in the course content or
outcome.
Students with Learning Disabilities
Learning disabled students are those who demonstrate a significant discrepancy, which is
not the result of some other handicap, between academic achievement and intellectual
abilities in one or more of the areas of oral expression, listening comprehension, written
expression, basic reading skills, reading comprehension, mathematical calculation,
mathematics reasoning, or spelling.

Following is a list of some of the common indicators of learning disabled students. These
traits are usually not isolated ones; rather, they appear in varying degrees and amounts in
most learning disabled students. A learning disabled student

Has poor auditory memoryboth short term and long term.

Has a low tolerance level and a high frustration level.

Has a weak or poor self-esteem.

Is easily distractible.

Finds it difficult, if not impossible, to stay on task for extended periods of time.

Is spontaneous in expression; often cannot control emotions.

Is easily confused.

Is verbally demanding.

Has some difficulty in working with others in small or large group settings.

Has difficulty in following complicated directions or remembering directions for

extended periods of time.

Has coordination problems with both large and small muscle groups.

Has inflexibility of thought; is difficult to persuade otherwise.

Has poor handwriting skills.

Has a poor concept of time.

Teaching learning disabled youngsters will present you with some unique and distinctive
challenges. Not only will these students demand more of your time and patience; so, too, will
they require specialized instructional strategies in a structured environment that supports
and enhances their learning potential. It is important to remember that learning disabled
students are not students who are incapacitated or unable to learn; rather, they need
differentiated instruction tailored to their distinctive learning abilities. Use these appropriate
strategies with learning disabled students:

Provide oral instruction for students with reading disabilities. Present tests and
reading materials in an oral format so the assessment is not unduly influenced by
lack of reading ability.

Provide learning disabled students with frequent progress checks. Let them know
how well they are progressing toward an individual or class goal.

Give immediate feedback to learning disabled students. They need to see quickly the
relationship between what was taught and what was learned.

Make activities concise and short, whenever possible. Long, drawn-out projects are
particularly frustrating for a learning disabled child.

Learning disabled youngsters have difficulty learning abstract terms and concepts.
Whenever possible, provide them with concrete objects and eventsitems they can
touch, hear, smell, etc.

Learning disabled students need and should get lots of specific praise. Instead of just
saying, You did well, or I like your work, be sure you provide specific praising
comments that link the activity directly with the recognition; for example, I was
particularly pleased by the way in which you organized the rock collection for Karin
and Miranda.

When necessary, plan to repeat instructions or offer information in both written and
verbal formats. Again, it is vitally necessary that learning disabled children utilize as
many of their sensory modalities as possible.

Encourage cooperative learning activities (seeTeaching with Cooperative Learning)

when possible.Invite students of varying abilities to work together on a specific
project or toward a common goal. Create an atmosphere in which a true community
of learners is facilitated and enhanced.

may exhibit hyperactivity, short

attention span, impulsivity,
aggression, self-injurious
behaviours, odd responses to
sensory stimuli, eating, sleeping,
motor or mood abnormalities

autism is often accompanied by

physical health problems like
eating or sleeping disorders, or
motor abnormalities

AUTISM

difficulty comprehending the

environment, thoughts,
emotions and needs of others

They have a disorder that

means they might have
problems paying attention or
sitting still in their seats.

They can also act on impulse

which means doing things
without thinking about them
first.

HYPERACTIVE

They can be disorganized, distracted, or forgetful.

They might lose things and have trouble finishing
assignments. They may wiggle around in their
seats, move around a lot, talk too much, or
interrupt other people's conversations.

delay in the
development of
receptive and
expressive
communication
skills

The language
deficit causes
learning problems
that result in
reduced academic
achievement.

Communication
difficulties often
lead to social
isolation and poor
self-concept.

cannot hear quiet speech

sounds such as "s," "sh,"
"f," "t," and "k" and
therefore do not include
them in their speech. Thus,
speech may be difficult to
understand.

HEARING
IMPAIRED

feeling isolated,
without friends,
and unhappy in
school,
particularly when
their socialization
with other
children with
hearing loss is
limited.

difficulty with all areas of

academic achievement,
especially reading and
mathematical concepts

Children with hearing loss

often cannot hear word
endings such as -s or -ed.
This leads to
misunderstandings and
misuse of verb tense,
pluralization, nonagreement
of subject and verb, and
possessives.

The gap between the

vocabulary of children with
normal hearing and those with
hearing loss widens with age.
Children with hearing loss do
not catch up without
intervention.

misunderstanding social
cues, showing poor
judgment, having difficulty
understanding and
expressing language, and
having difficulty with tests.

difficulty with
reading
comprehension
because of their
lack of facility with
comprehending
complex discourse

difficulty with decoding, or the

ability to identify printed
words through letter-sound
correspondences.

SPEECH IMPAIRED

Struggle on tests because their language

impairments hamper their ability to understand
directions or the wording of specific test items, even
when administrators read them aloud. They may also
have increased test anxiety due to a history of
struggling with academic tasks and the added
pressure of high stakes assessments, whether the
stakes are for the system or the student.

difficulty with
sound or symbol
connection,
auditory
processes, and
language
comprehension

they can't always see the

objects around them and
they rely instead on
sound and familiarity
with their environment.

feel stress in new or

unfamiliar situations,
particularly when
they feel isolated
from peers.

difficulty with organization,

including homework
management.

VISUALLY
HANDICAPPED

visually impaired babies and children

may not naturally develop an interest in
objects or activities like other children,
since they can't interact with their
environment the same way. Blind
children rely entirely on sound and
feeling

few learning problems

that visually impaired
children may experience
in any learning setting,
and particularly in a
traditional classroom. If
educators use a board to
draw out graphs, charts,
or other examples,
visually impaired children
can't always see it or
benefit from it.