Understanding Secondary Students with Autism Spectrum Disorder
The overall focus of this text is on secondary education for adolescents with autism spectrum disorder and the transition from school to independent adult living and employment for these young people. With between 75-85% of students with ASD exiting high school being unprepared for either the next step educationally or for employment (Newman et al., 2011), we have too often failed our students. This text is devoted to supporting secondary school educators to improve these statistics, to create a brighter path of opportunity for students with autism spectrum disorder. Information about identification and characteristics of individuals with ASD will give meaning to information presented in the subsequent chapters.
The first section of the chapter is devoted to definitions and explanations of diagnostic information. An overview of the state of the science of education for adolescents with ASD will follow, highlighting the types of services needed by students with ASD.
Definitions and Clinical Characteristics
Autism is a spectrum disorder, meaning it is highly complex condition with variability along a continuum among individuals holding this diagnostic classification, as well as within individuals at different developmental stages. The clearest and most universal defining characteristic of autism is impairment in social and communicative interaction. Unique learning and behavior characteristics of autism distinguish it from other neurodevelopmental conditions, such as intellectual disability.
The most recent listing of diagnostic criteria for Autism Spectrum Disorder was published in the Diagnostic and Statistical Manual (DSM-5) in 2013. In the U.S., the DSM-5 is considered by healthcare providers to be the standard for diagnosis of mental and behavioral conditions, including autism. The DSM-5 definition has been controversial in the field, as it replaced prior classifications within the prior DSM definitions (DSM IV-R) with new diagnoses. The DSM-5 presents a new perspective on identification of autism spectrum disorder. Factors considered in developing the revised definition included the need for (a) improved criteria for diagnosing autism, (b) more specific and accurate diagnosis, (c) systematic identification of symptoms requiring support services, and (d) clearer assessment of severity level of autism spectrum disorder. We will examine the new definition and will discuss changes in the diagnostic construct of autism over the past several decades.
In the DSM-5, a three-level autism severity scale is presented. By using the DSM-5 scale, clinicians are able to rate a person's autism severity level based on the amount of daily support they require. Level one applies to individuals with ASD, who, due to problems with social interaction and communication, require some degree of support in order to function independently, and whose restrictive and repetitive behaviors may interfere with one or more areas of daily functioning. Level two refers to individuals who, even when provided with substantial support, demonstrate significant social interaction and behavior challenges that impede daily functioning. Level three includes individuals in need of the highest amount of support, exhibiting severe skill deficits in verbal and nonverbal social communication skills, as well as behavior challenges that severely interfere with their functioning (DSM-5, 2013).
Changes from DSM IV-R
The DSM-5 differs from the DSM IV-R in several regards. Specifically, the DSM IV-R had four categories of autism, which have been combined under the umbrella diagnosis of autism spectrum disorder. Previous categories included (a) autistic disorder, (b) Asperger syndrome, (c) childhood disintegrative disorder, and (d) pervasive developmental disorder-not otherwise specified (PDD-NOS). There had been three categories of symptoms, which were (a) social impairment, (b) language/communication impairment, and (c) repetitive/restricted behaviors. These have been condensed into two categories, which are (a) persistent deficits in social communica-tion/interaction and (b) restricted, repetitive patterns of behavior.
Sensory issues have been added and placed within restricted/repetitive behaviors. Sensory issues include hyper or hypo-reactivity to stimuli, such as lights, sounds, or taste.
Creation of a new diagnosis of social communication disorder for disabilities in social communication without repetitive, restricted behaviors has been added.
Understanding High School Students With ASD and Their Experience in School
The core symptoms of ASD are lifelong, and adolescence can be a difficult time for young people with an ASD and their families. Adolescents with ASD often experience difficulties in peer relationships, which are of critical importance in adolescence (Orsmond & Kuo, 2011). Like all adolescents, young people with ASD desire to have friends, and their difficulty in doing so may lead to intense loneliness and depression. Research findings indicate that adolescents with disabilities participate more frequently in dependent, solitary, and family-oriented activities (Brown & Cordon, 1987). Limited engagement in play activities when young can lead to truncated developmental patterns, and participation in age-appropriate activities becomes increasingly restricted in adolescence.
As reported by Orsmond and Kuo (2011 ), too many adolescents with ASD spend their free time alone or interacting with adults, such as parents and paid professionals, rather than with peers. They spend relatively more time engaged in solitary activities and less time doing social activities than peers without disabilities. Adolescents without disabilities spend a large amount of time socializing, and most of this time is spent talking to their friends (Larson & Seepersad, 2003), while adolescents with ASD spent most of their time alone or with adults.
The learning and behavior profile of students with ASD is complex. Young people with ASD may have uneven skill development and a jagged skills profile, which can result in difficulty with assessment and for instructional planning. Auditory processing tends to be slower than that of their same-age peers. Thus, for educators, it may be helpful to present instructional material and schedules visually, which we'll talk more about in subsequent chapters. In addition, students with ASD may have a tendency to overly focus on particular details, missing important concepts and the "big picture." Executive functioning (i.e., organization skills and self-regulation) is often impaired, resulting in difficulty planning and carrying out activities (Rosenthal et al., 2013). Strategies to address these issues are discussed in subsequent chapters.
Even students with superior intellectual ability may need supports to mediate the effects of their core autism symptoms, as well as co-occurring significant psychopathology, often seen in older students with ASD. Autism does not exempt young people on the spectrum from the range of psychiatric conditions that may affect all people. Commonly co-occurring conditions include anxiety, obsessive compulsive disorder, depression, attention deficits, and seizure disorders. According to Steinbrenner and Nowell (2019), approximately 60% of adolescents with ASD between the ages of 15-17 have at least two mental health conditions in addition to autism. Over one-half have an attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD) and 51% have been diagnosed as having an anxiety disorder, with 24% experiencing depression. Thirty percent of young people with ASD also have intellectual disability, 37% have a behavior disorder, and 13% have a seizure disorder.
High school students on the autism spectrum exhibit varying levels of language skills, social skills, and autism symptomatology. Too often, their language and social skills fall below expected levels in high school, and they continue to exhibit challenges requiring speech-language intervention. Socially, students with ASD may demonstrate difficulty in recognizing and understanding their own feelings, as well as those of others (referred to as Theory of Mind), and may have difficulty comprehending idioms, abstract concepts, and humor. Although the diagnostic criteria for ASD does not include academic difficulties, impairments in social communication, narrow interests, sensory issues, and stereotypies do interfere with learning and academic achievement (Fleury et al., 2014). Thus, students with ASD often require special education services to enable them to be successful in secondary school.
The following statistics obtained from the findings of the National Longitudinal Transition Study-2 (NLTS2) (NCSER 2012-3000) sponsored by the U.S. Department of Education (Newman et al., 2011) provide further insight into the needs of high school students with ASD. To begin understanding the needs and types of supports and services required, it's important to note that in secondary school, nine out of ten students with autism receive some form of instructional accommodation and/or modification. Accommodations may include additional time to complete assignments or tests (52%); about half receive alternative tests. Twenty-five percent have tests read to them. Thirty-eight percent are given shorter or different assignments than their classmates. Approximately two out of five (41 %) have the pace of their instruction adjusted, and 22% of students with ASD receive direct support with learning strategies and study skills.
Assistive technology is utilized by 57% of students with ASD. More than one-quarter (28%) are permitted use of a calculator or computer when other students are not permitted to use one. Approximately one out of four (23%) use computer software specifically designed for students with disabilities, and 16% use an augmentative communication device.
In addition to the accommodations and supports provided in their classroom, 70% of secondary students with autism receive some type of ancillary related service. Communication services, psychological or mental health counseling or services, and social work services each are provided to 22% of secondary students with autism. Speech-language pathology service is the most frequently received therapeutic/support service, with two-thirds receiving this assistance. In addition, 24% receive occupational therapy, 14% receive health services, and six percent receive physical therapy. More than half participate in adaptive physical education. Behavior intervention is provided to 35% of students with autism. Most secondary school students with autism attend public schools (97%). Overall, more than four out of five (84%) attend regular schools that serve a wide variety of students, and about 12% attend special schools that serve only students with disabilities. The other four percent attend alternative, hospital, or home schools.
More than nine out of ten secondary students with autism (92%) take at least one academic subject in a given semester. Most take language arts (89%) and mathematics (90%); somewhat fewer take social studies (69%) or science (67%). A foreign language is taken less often than other kinds of academic courses, with 12% of secondary students with autism enrolled in a foreign language course. Vocational education plays an important role in the secondary education of students with autism; more than three-quarters (77%) take vocational education coursework.