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Creating Inclusive Environments for children with Autism

11

Creating Inclusive Environments

for Children with Autism

Dagmara Woronko and Isabel Killoran

York University

Canada

1. Introduction

Although the prevalence rate of Autism Spectrum Disorders (ASD) varies, recent figures

suggest that close to 1% of children (Autism Society Canada, 2009; CDC, 2006) are identified

with ASD. With inclusive philosophies paving the way for education in mainstream

classrooms, attention must be given to equitable opportunities and practices for this

growing population in our school systems (Killoran & Adams, 2006; Sapon-Shevin, 2003;

United Nations, 2006). The research on inclusion and children with ASD is fairly limited;

however, it has shown that in some regions at least, these students are excluded from school

at a “significantly higher rate than students with other [special education needs]”

(Humphrey & Lewis, 2008, p. 132). Children with ASD are “considered more difficult to

include effectively than those with other SEN” (Humphrey & Lewis, 2008, p. 133). While

there is much diversity with respect to strengths, abilities, functional levels and challenges

among children with ASD, a core set of universal concerns exist. Some of these include

sensory responsiveness, communication, and socialization. This chapter will focus on

creating a sensory responsive environment, developing effective verbal and/or non-verbal

communication, and fostering genuine relationships.

Using the three main principles of Universal Design for Learning (UDL) as an overarching

assumption, this chapter will explore how educators can provide effective opportunities

for multiple means of representation, expression, and engagement to address common

areas of need (CAST, 2011; Hehir, 2009). By following these principles, an educator is able

to create a community that welcomes all while addressing students’ specific needs. Many

educators have been overwhelmed with the past practice of individualization in isolation,

a task that left many students alone and disconnected from their peers. The current

practices of differentiation and universal design for learning enable educators to plan for

their students in such a way that all are integral, contributing, valued members of the

learning community.

This chapter provides a synthesis of current research on evidence-based classroom

interventions and accommodations for learners with ASD in inclusive settings, at all age

levels, with respect to sensory environments, assisted communication, and facilitation of

social relationships. Emphasis is placed on accommodations that meet UDL requirements. A

comprehensive search of the Education Resources Information Center (ERIC) database was

conducted using keywords for, and related to, autism, universal design for learning and

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Autism Spectrum Disorders – From Genes to Environment

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sensory, communication, and social skills interventions. Empirical research was reviewed,

as well as qualitative studies and narratives. Manual searches of the reference lists were

conducted to identify additional sources.

2. Creating a sensory responsive environment

Children with ASD often display atypical sensory processing. “Sensory processing” refers to

the relationship between neurological thresholds and self-regulatory strategies for adaptive

behaviour (Hocchauser & Engel-Yeger, 2010). From a clinical perspective, sensory underresponsiveness

and/or over-responsiveness can lead to behaviours, which either generate or

avoid sensory stimulation in an effort to help the child with ASD cope with environmental

stimuli (Iarocci & McDonald, 2006). In order for inclusive education practices to be effective

for children with ASD, a deeper awareness of sensory processing needs must be acquired by

educators, and classroom environmental accommodations implemented.

Sensory integration dysfunction, or “sensory perceptual issue”, is defined as a disruption

in the process of organizing sensational information gathered from the seven senses:

smell, taste, touch, sight, sound, vestibular (movement), and proprioceptive (muscle and

joint receptors) senses (Ayres, 1979; Bogdashina, 2003; Howe, Brittain, & McCathren, 2004;

Myles, Cook, Miller, Rinner, & Robbins, 2000; Yack, Aquilla, & Sutton, 2002). Sensory

integration difficulties have been reported in 42 to 88% of children with ASD (Baranek,

2002, p. 398). These difficulties can influence a child’s gross and fine motor development,

balance, coordination, visual perception and self-help skills, thus having a potential

impact on the ability to engage in social activities and develop feelings of success and

mastery in the classroom (Baranek, Boyd, Poe, David & Watson, 2007; Howe, et al., 2004).

The Ziggurat model, an intervention program for learners with ASD, stipulates that a

student’s sensory needs must be met before effective and engaged learning can take place

(Murray, Hudson Baker, Murray-Slutsky, & Paris, 2009; Myles, Grossman, Aspy, Henry &

Bixler Coffin, 2007).

No two children are alike, and this is especially true for children with ASD. Because there is

much variation with respect to sensory responsiveness, educators need to acquaint

themselves with their students’ specific sensory needs before the school year commences,

thus giving them time to make any necessary accommodations to the classroom

environment (Killoran, 2005). Often children with ASD will require a sensory diet delivered

during the school day (Baranak 2002; Yack, et al., 2002). Below is a synthesis of evidencebased

environmental accommodations for a variety of sensory integration responses and

behaviours. Each student with ASD will present with his or her own unique set of

responses, behaviours and needs.

Hochhauser and Engel-Yeger (2010) have found an association between smell overresponsiveness

and a reduced amount of participation in certain classroom activities in

children with ASD. Common classroom activities such as crafts, colouring, drawing and

snack/lunch periods can be particularly distressing for children with odour overresponsiveness

(Hochhauser & Engel-Yeger, 2010). Making classrooms scent-free

environments and purchasing odourless craft supplies can help not only those with ASD,

but also any children with odour sensitivities in the classroom (Case-Smith & Arbesman,

2008). Encouraging children to bring in snacks and lunches that are not response-inducing

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will eliminate the need for removal of students with ASD from the classroom during these

particularly socially engaging periods in the school day.

Children with ASD who have an over-responsive tactile sense may exhibit negative

emotional reactions to specific consistencies of solids and fluids, and/or to intentional or

accidental touch. Tactile over-responders will engage in sensory avoiding behaviours, aimed

at people, situations, tasks and activities that are anxiety inducing (Killoran, 2004; Myles et

al., 2000; Murray, et al, 2009). These learners may need preferential seating within the

classroom to give them distance from others who may contribute to touch that may be

distressing (Murray, et al., 2009). When lining up for recess or other activities, educators

should assign these students to the back or front of the line, thereby minimizing

opportunities for unwelcome touch (Howe, et al., 2004; Killoran, 2004). The UDL guidelines

call for multiple tools for expression, communication, composition and construction in the

inclusive classroom (CAST, 2011). For learners with tactile over-responsiveness, educators

should consider the use of tools rather than hands for craft and other messy classroom

activities (Howe, et al., 2004). These tools can be used by all students in the inclusive

classroom, not only those with ASD.

Children with ASD who are tactile under-responders must have their needs accommodated

within the inclusive classroom environment as well. These children require consistent tactile

stimulation throughout their school day. They respond well to the use of weighted or

vibrating pencils and the use of sandpaper placed under written work (Myles et al, 2000;

Murray, et al, 2009; Yack et al, 2002). Providing an under-responsive tactile learner with a

fidget toy to hold can reduce potentially disruptive sensory seeking behaviour, such as

touching peers at inappropriate times (Friedlander, 2008; Howe, et al, 2004). Placing a ricefilled

or inflated cushion on their chair can provide needed tactile stimulation as well

(Friedlander, 2008). These classroom accommodations respond to the UDL’s requirement for

the provision of tools for self-regulation and optimize access to tools and assistive

technologies for students with ASD in inclusive classroom settings (CAST, 2011).

Learners with ASD who are sight and sound over-responders may be distracted by

classroom stimuli such as fluorescent lights that buzz or flash, an overabundance of colours

in the classroom, noise from fans or air conditioners, the clinking of dishes in the cafeteria

down the hall, or a line tapping against a metal flagpole outside (Friedlander, 2008; Howlin,

2005). Environmental accommodations in the classroom are needed to calm their nervous

systems by eliminating extraneous noise and visual distraction (Case-Smith & Arbesman,

2008; Murray, et al., 2009).

Hochhauser and Engel-Yeger (2010) found that children with ASD who have high visual

and auditory sensitivity work best one-to-one rather than in groups, as the opportunity for

visual and auditory distraction is minimized. The UDL guidelines highlight the need for

educators to provide options for self-regulation that facilitate personal coping skills and

strategies (CAST, 2011). One such strategy is the use of Auditory Integration Training (AIT).

AIT is based on the concept that electronically filtered music provided through earphones

may be helpful in remediating auditory hypersensitivities (Baranek, 2002; Case-Smith &

Arbesman, 2008; Dawson & Watling, 2000). Auditory Integration Therapy was developed in

1993 by Berard and Tomasis. It involves listening to electronically modified music which has

had the peak frequencies to which an individual with ASD is hypersensitive, dampened

(Baranek, 2002; Dawson & Watling, 2000). Children typically listen to 2 half-hour daily

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Autism Spectrum Disorders – From Genes to Environment

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sessions for a total of 10 hours (Dawson & Watling, 2002). Recorded music is individualized

according to specific needs, and can be kept in the classroom for use when sensory overresponsive

behaviours are peaking.

Additional sound dampening accommodations such as tennis balls on chair legs, floor

carpeting and vent covers may be helpful in decreasing background noises in the

classroom as well (Myles et al., 2000; Murray et al., 2009; Yack et al., 2002). Visual

schedules can help over-responders to focus their attention to the task at hand (Case-

Smith & Arbesman, 2008; Humphrey, 2008). These environmental accommodations can be

useful in minimizing sound and visual distractions for all learners in the inclusive

classroom, not just those with ASD.

The vestibular system is located in the inner ear. Accurate processing of vestibular

information allows individuals to successfully regulate posture, balance, and eye movement

(Howe et al., 2004; Yack et al., 2002). Children with ASD who are over-responders to

vestibular input are fearful, cautious or avoidant of movement; those who are underresponders

seek excessive vestibular input (Howe, et al, 2004; Myles et al., 2000; Yack et al.,

2002). Hocchauser and Engel-Yeger (2010) found that children who are over-responsive to

vestibular input tend to be clumsy, have motor difficulties, low muscle tone and low levels

of energy. Consequently, they may be reluctant or unable to participate in physical

education classes (Hocchauser & Engel-Yeger, 2010). Howe, et al.,(2004) caution against

forcing these children into participating in physical activities. Instead, they suggest offering

the student opportunities for self-directed movement. Additionally, it is important to

provide over-responsive vestibular learners with secure seating in the classroom, given their

difficulties with balance. In place of traditional seating, educators should consider providing

these students with alternative forms of seating such as bean bag chairs that mould to the

student’s body (Howe, et al., 2004).

Children with ASD who are under-responsive to vestibular input require regular

opportunities for physical exercise and stimulation (Baranek, 2002; Yack et al., 2002). Daily

routines and classroom accommodations may include sensory-motor breaks or movement

breaks to improve attention spans, social skills and work performance (Howlin, 2005;

Murray, et al., 2009). These can be built in to the daily physical activity that all children

should be getting. The use of therapy balls in the classroom on which students can bounce

to stimulate the vestibular system is another strategy that other children in the inclusive

classroom may benefit from (Howlin, 2005; Wong Bonggat & Hall, 2010).

Finally, attention must be paid to the proprioceptive system of children with ASD. The

proprioceptive system is located in the muscles and joints, and notifies the brain with

respect to body position (Howe, et al.,2004; Killoran, 2004; Yack et al., 2002). The brain uses

this information to move in a coordinated manner and to plan movements for a new task

(Howe, et al., 2004). Children with proprioceptive difficulties can appear clumsy when

completing tasks; they may bump into their surroundings in an effort to collect needed

input for the body with respect to position (Howe, et al., 2004; Yack et al., 2002). Murray, et

al., (2009) point out the need for strong sensory input that provides meaningful sensory

feedback. Songs with gestures, high-energy rhythmic activities, jumping on a trampoline,

stretching activities, or other activities to wake up the sensory systems should be integrated

into the learners’ day (Murray, et al., 2009). These activities will not only benefit the students

with ASD in the classroom, but all children learning in the inclusive classroom.

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All of the accommodations discussed above satisfy CAST’s (2011) guidelines for UDL. The

accommodations mentioned above support inclusive learning environments, as they do not

necessitate the removal of children with ASD from general education classrooms. These

accommodations can benefit many learners in the classroom, as they are designed for

universal use and multifaceted situations. They provide the sensory responsive

environment necessary for children with ASD to learn in an engaging and inclusive

classroom. Coupled with effective communication programs, strategies and

accommodations, the foundation for fostering genuine relationships is laid.

3. Developing effective communication

Children with ASD can live relatively secluded lives with little social interaction outside of

school hours (Hochhauser & Engel-Yeger, 2010). Social isolation stems in part from

qualitative impairments in reciprocal social interaction and communication, and a tendency

for restricted, repetitive, and stereotyped patterns of behavior, interest, or activity (Walker &

Berthelsen, 2008). Communication challenges are most pronounced in children with ASD

who are non-verbal; however echolalia, expressive language delay, receptive language

difficulties and literal interpretations of idioms and colloquial language contribute to

communication difficulties even among high-functioning, verbal children with ASD. The

ability to communicate effectively, be it through the medium of spoken language, sign

language, PECS, or computer assisted communication, is the foundation upon which

meaningful social relationships are built. This section will examine the communicative

challenges of children with ASD, and the role of the classroom teacher in creating an

inclusive classroom environment in which various forms of communication are valued and

explored. Effective communication programs, strategies and accommodations will be

discussed, with an emphasis on their contribution to opportunity for social and academic

success in the general education classroom.

The ability to communicate effectively contributes to meaningful, reciprocal and

satisfying social relationships. Children with ASD who are nonverbal require effective

communication programs, strategies and accommodations within the inclusive classroom

in order to have an equitable opportunity for social engagement with peers and educators

(Freeman, Perry, & Bebko, 2002). Through the use of gestures, vocalizations and/or

augmentative and adaptive communication systems, children with ASD are able to

interact meaningfully and reciprocally with their peers and their classroom environment

(Mastrangelo & Killoran, 2007). A universally designed classroom is one in which

multiple modes of communication and expression are explored, encouraged and given

value (CAST, 2011).

Children with ASD who are nonverbal can use a number of strategies and assistive

technologies in order to communicate more effectively with the world around them. One

such assistive strategy is the use of the Picture Exchange Communication System (PECS).

PECS teaches spontaneous communicative skills within a social context through the use of

pictures or symbols (Howlin, 2004; Magiati & Howlin, 2003). In a universally designed

inclusive classroom, these pictures or symbols can be used throughout the room as an

assistive technology for use with all learners, not only specifically those with ASD. Teaching

all children in the classroom how to communicate using the PECS binders of peers with

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ASD can help to facilitate reciprocal communication (Simpson, 2005). Educators who have

incorporated the use of PECS in their inclusive classrooms report positive outcomes not only

for children with ASD, but for the entire classroom population. They cite increased

independence and confidence, improvement in the use of words for learners with ASD,

reduced tantrums and frustrations over the inability to communicate, and improved

teaching practices (Case-Smith & Arbesman, 2008; Magiati & Howlin, 2003). Mirenda (2003)

notes increased reciprocal communication exchanges and social interactions with peers as

additional benefits to symbolically augmented communication.

Training in Sign Language (SL) can result in quicker and more complete learning of

vocabulary among children with ASD than does speech training (Goldstein, 2002; Mirenda,

2003; Yoder & Layton, 1988). The presentation of speech training programs is particularly

ineffective among those children with ASD who have poor verbal imitation skills (Yoder &

Layton, 1988). Incorporating SL gestures into the inclusive classroom setting serves to

benefit all learners (Bonvillian, Nelson & Rhyne, 1981; Tincani, 2004). Teaching typically

developing children SL has become commonplace in mainstream society, as a means to pair

spoken language with gestures. Typically developing school-aged children often learn

second languages through the pairing of speech and SL gestures (Iverson & Goldin-

Meadow, 2005; McCafferty, 2002). This use of SL can thus be expanded within the inclusive

classroom setting to teach both learners with ASD and those without how to reciprocally

communicate with one another. This satisfies CAST’s (2011) UDL guidelines for provision of

multiple options for perception and comprehension, use of multiple types of media for

communication, and fostering a sense of collaboration and community.

The use of speech generating devices (SGD) with children with ASD is an emerging field.

SGDs are an assistive technology that can help children with ASD who are non-verbal or

language emergent, communicate with peers and educators in the classroom. Despite the

small number of studies conducted with respect to SGD’s success as an accommodation in

the inclusive classroom, researchers are finding that the use of SGDs with some children

with ASD can lead to verbal imitation of SGD output and a desire to use more

communicative tools/devices in general (Blischak, Lombardino & Dyson, 2003; Franco et at.,

2009; Thunberg, Ahlsen, & Dahlgren Sandberg, 2007). Implementation of SGD use in the

inclusive classroom provides children with ASD an option with respect to expression and

communication, and optimizes access to assistive tools and technologies, all of which are

part of the UDL guidelines (CAST, 2011).

Assisted communication for non-verbal children with ASD is a necessary component of the

inclusive classroom. Inclusive classrooms promote social interactions between children with

ASD and their typically developing peers, leading to improved educational outcomes and

greater learning and social competencies (Mastrangelo & Killoran, 2007). Opportunities for

increased and successful social interactions are strongly correlated with the achievement of

communicative competence (Prizant, Wetherby, Rubin, & Laurant, 2003). Research

indicates that limited communication skills are strongly associated with peer rejection for

children with ASD in inclusive classroom settings (Fujiki & Brinton, 1996; Humphrey, 2008;

Walker & Berthelsen, 2008). A universally designed classroom is one which provides

options for language, optimizes access to assistive technologies and fosters collaboration

and community (CAST 2011). A universally designed classroom is the setting necessary for

the creation of meaningful and genuine friendships for children with ASD.

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4. Fostering genuine relationships

Children with ASD often face challenges socializing in general education classroom settings

and have trouble interacting with others (Embregts & van Nieuwenhuijzen, 2009; Fujiki &

Brinton, 1996; Humphrey, 2008). Inclusive school settings should set the development of

social competence as one of their primary goals (Walker & Berthelsen, 2008). The World

Health Organization defines participation in meaningful social activities and relationships

as a vital part of human development and life experience, through which children acquire

skills and competencies, and find purpose and meaning in life (Hochhauser & Engel-Yeger,

2010). Research indicates that increasingly, children with developmental disabilities are

being socially isolated, bullied and excluded in general education classroom settings

(Humphrey, 2008; Wang & Parrila, 2008).

Children with ASD require individual and appropriate support to engage in positive play

experiences and social interactions with their peers (Mastrangelo & Killoran, 2007; Walker &

Berthelsen, 2008). The degree to which they are supported in acquiring peer-related social

skills is a consequence of their classroom teacher, who has a significant role in creating a

learning community within which all children are valued (Mastrangelo & Killoran, 2007;

Walker & Berthelsen, 2008). UDL guidelines specifically outline the need for creating

classroom environments which foster community and collaboration (CAST, 2011). These

inclusive classroom settings make the development of genuine friendships a possibility for

children with ASD.

Too often, peer helpers are mistaken as “friends” for children with ASD in inclusive

classroom settings. Group seating plans and group work activities often perpetuate the idea

that typically developing peers who help students with disabilities, or merely sit next to

them, are akin to “friends.” Peer-mediated strategies have long been used by educators to

increase the rate of social interaction by reinforcing and prompting a typically developing

peer to initiate interactions or shape the social responding of a student with disabilities

(Haring & Breen, 1992; DiSalvo & Oswald, 2002; McConnell, 2002). However, genuine

friendships are those that translate into the after-school settings of home and community

activities; peer-mediated strategies do not always see this translation materialize. As such,

children with ASD remain socially isolated despite having a network of peer support in the

classroom setting. A strategy that is effective at building up more intimate relationships at

all age levels is Circle of Friends, or Circle of Support (Falvey, Forest, Pearpoint, &

Rosenberg, 2000; Forest, Pearpoint, & O’Brien, 2000).

One opportunity often available to educators who have children with disabilities in their

classes is the chance to work with an educational assistant (teacher aide, paraprofessional,

support worker). Research has shown, however, that this resource is often misused and

the results on socialization, particularly, are detrimental to the students (Giangreco,

Edelman, Luiselli, & MacFarland, 1997; Malmgren, & Causton-Theoharis, 2006). With very

little in-service, an educational assistant is able to make a significant difference to peer

interactions and socialization (Causton-Theoharis & Malmgren, 2005). Among the

strategies/accommodations that an educational assistant can provide for a student with

ASD in the classroom are:</