The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defined autism as a Neurodevelopmental Disorder characterized by deficits in social communication and interaction; restricted or repetitive patterns of behavior, interests, or activities; presence of symptoms in early childhood; and impairment in social, occupational, or other important areas of current functioning. Recent researches in the USA show that 1 in 68 children are medically diagnosed with autism. There are more girls diagnosed than boys. Globally, there are more children with autism in urban areas than in rural places. The cause of this disorder is still unknown. However, several studies link autism with maternal stress, family background, and vaccinations.
As a child with autism grows up, support from different professionals is required for him to reach his maximum potential. In school, a special education teacher creates an Individualized Education Plan (IEP) that is based from an assessment to determine his educational needs. A behavior therapist works on the child’s atypical behavior patterns such as fidgeting, turn taking, and tantrums. A speech and language therapist deals with the child’s verbal behavior from the production of desired sounds and phonemes to maintaining casual conversations and understanding social cues. For children who are non-verbal, they are helped to communicate with the use of a Picture Exchange Communication System (PECS) or assistive device such as a talker from an Ipad. An occupational therapist helps the child with the following areas: gross motor skills such as walking, running, jumping; fine motor skills such as holding a pen, using a spoon, fork, and knife; eye-hand coordination; and balance. Collaboration among these professionals together with the general education teacher, teaching assistant, school psychologist, primary caregivers, and parents is crucial and highly significant in the holistic development of the child.
Autism in Thailand
Based on keen observation, medical assessment on children with suspected autism is limited. Ideally, a diagnosis from a developmental pediatrician is necessary for a child to be “labeled” as autistic (or ADHD). Other diagnosis such as hearing and eyesight test is also required to rule out problems with hearing and visual acuity. Denial of the disorder from some parents is also noticed. Students with autism like behaviors are included in mainstream classrooms but with inadequate support. The general education teacher has full responsibility over the educational needs of the student who is believed to have autism.
The Case of Steve
Steve (not his real name) is 10 years old and has been receiving educational support in an international school for students with special needs in Thailand. His mother is Thai and his father is non-Thai. He is nonverbal so he uses his Ipad as a talker. He has a repetitive behavior of playing with CDs and chewing them. Steve does not eat rice, fruits, and vegetables. He does not want the sensation of rice and other unfamiliar food in his mouth. His tantrums include screaming, hitting people, and throwing objects which are manifested every time he is agitated, told no, or his routine has been abruptly changed.
Currently, Steve’s academic subjects are tailored to suit his needs. His numeracy involves counting and sequencing 1 to 10. His literacy includes writing his own name and recognizing objects around him. He is being taught to respond to yes and no questions by using his talker at the same time nodding his head. His occupational therapy is about fine motor skills such as tracing straight and curved lines, coloring, painting, beading, and cutting. He is receiving food training so he can gradually eat healthy foods such as rice, fruits, and vegetables independently.
While Steve’s academic content can be too easy to teach in a regular classroom with regular students, special education demands various strategies to help them cope with daily living. The main objective is for these students to be independent later in life. A method called Discrete Trial Training is utilized wherein a positive behavior target is reinforced and repeated consistently to show mastery. For example, a student needs to learn how to discriminate yellow and red. Constant exposure to each color is done until the student can independently recognize both colors. During the process, every correct response is rewarded with something that is valued by the student such as a verbal praise, toy, or free time. Another strategy called chaining method is used to teach single steps until the whole procedure has been taught. For instance, a child is learning how to brush his teeth. The first step is taught until he can do it independently. The rest of the steps are taught with physical and verbal prompts. The second step is taught until he can do it on his own. The same applies to all steps until the can child can already brush his teeth without assistance. For some autistic students who are deaf-mute, sign language is vital so they can understand and communicate with their teacher.
Educating students with autism is never easy. Teachers and therapists have experienced being hit (in some cases bitten) by children who have exhibited behavior meltdowns. Loads of patience, determination, and passion are the key principles of dealing into special education. It can be a stressful world but rewarding at the same time.
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