Introduction

I chose to complete these four modules (8 credits) because I have recently been assigned a case of a student who has been diagnosed with ASD. It will be the first time that I have worked with a student, whānau and teacher from the perspective of an RTLB, and as I work collaboratively to support this student transition to a new school, I thought this would be a relevant and authentic context for learning. Refer to Neurodiversity & Autism for a summary of my prior knowledge about autism, from previous modules and teaching experience. Already having a good theoretical understanding of autism and its relevant issues (inclusion, equity and cultural responsiveness), my goal in choosing these modules is a more practical understanding of evidence based practice to support teachers and learners in the classroom, and the opportunity to be involved in the implementation of applicable practices. These practices will of course be directly applicable to all students.

Initial stance

The main issue relevant to AS (and other neurodiverse) students within the New Zealand education system is inclusion. There are three core principles of inclusion: to be in mainstream classrooms with one's peers, to be active and involved participants in classroom activities, and the removal of barriers that hinder these goals (MacArthur, 2009).

My stance at the outset of these modules is that there is a wide range of neurodiversity in society and this is reflected in our classrooms. In terms of inclusion, it doesn't matter what label is applied (in this case AS), the answers are the same. An education system that is inclusive, culturally responsive, and child centred: universal design for learning. This philosophy has been the basis of my teaching practice for many years and while these modules may reinforce these values, my learning will be in the specific measures that can be implemented in the classroom to achieve these goals for students with AS, while also benefiting all learners.

The American Psychiatric Association (2013) (DSM-5) list 'social interaction and communication, restricted and repetitive behaviours or interests, restricted, fixated interests, and hyper or hyporeactivity to sensory input' as the main challenges experienced by autistic children. The latter is perhaps the least well known and may take the form of sensitivity to specific sounds or textures and excessive smelling or touching of objects (Green et al., 2016). This presents challenges to educators in providing an inclusive learning environment where these challenges are minimised. Undertaking a Sensory Profile was one of our first steps to find out [name redacted's] individual needs when he enrolled at his new school.

Timi sensory profile

The CAPs goals for this term focus on reducing [Name redacted's] anxiety about being at school and having him happily settled into the classroom environment. [Name redacted] has both hyper and hypo sensitivities, both of which can lead to increased levels of anxiety and consequently to an increased likelihood of challenging behaviours (South & Rodgers, 2017). As levels of anxiety increase, there is an increase in hormone levels (cortisol and adrenaline) which effectively results in what is commonly known as 'red brain'. The individual no longer has access to the higher executive functioning of the cortex and responses are thus limited to active 'fight or flight' or passive 'freeze or hide' behaviours. While adrenaline dissipates quickly, cortisol can remain in the system for long periods of time increasing the likelihood that in this heightened state, a 'red brain' response will be triggered (Green and Ben-Sasson, 2010). Reducing anxiety by addressing sensory stressors and teaching students how to manage their emotions are the two main strategies recommended.

Global strategies that have been adopted for all students in this classroom include organising walls to be less busy and clearly organised,  reducing bright lights, organising and clearly labelling resources, managing classroom noise levels, providing a calming space. Because [Name redacted] is both sensory seeking (hyporeactive) (makes noises for noise sake, touches certain objects repeatedly) as well as hyperreactive to sensory stimuli, individualised strategies are discussed later.

A class situation where [name redacted's] hyperreactivity to sensory inputs occurs is during clean-up time prior to transition to the next activity. This is a time where the children in [Name redacted's] Y3/4 class are moving freely around the classroom. Most of the students are on task and busy cleaning up. Because it is an unstructured time, student behaviour is less predictable. There is a lot more 'hustle and bustle' as students try and clean up quickly. Noise levels typically rise during this time. [Name redacted] initially continued with his activity but after a short time he covered his ears and began to scream. No amount of teacher interaction (consoling, redirection) stopped the behaviour. [Name redacted] is sensitive to loud noises and, as previously discussed, the anxiety caused by this hypersensitivity can mean that challenging behaviour such as this is more likely to occur (Bachevalier and Loveland 2006).

A similar response occurred when [Name redacted] couldn't find a much loved toy. This incident happened when [Name redacted] was reminded that it was time to stop his current activity. This coincided with packing-up time prior to lunch. In this case, the heightened noise and activity levels and possibly the teacher prompt could be described as 'setting events', increasing [Name redacted's] anxiety levels thereby reducing his ability to manage his responses (White et al. 2014). The setting events thus may have contributed to an increased likelihood of the behaviour occurring (Boyd et al. 2008). Losing the toy was the antecedent in this case, and the consequence was that the teacher responded immediately by stopping the class and asking them to search for the toy. Once found, the behaviour ceased immediately. Because the children were sitting on the mat by this time, it is difficult to know whether reduction in noise and activity levels was also a consequence. By considering behaviour as a means of communicating needs, enables teachers to respond positively by trying to minimise setting events and antecedents and to teach alternate strategies that provide the same function. In this case, finding his toy. 

Because it can be difficult to clearly identify antecedents (there may be more than one) or gauge the function of a behaviour (there may be more than one), Functional Behaviour Assessment (FBA) is often used. It requires several observations of a behaviour in a range of different settings in order to accurately understand what the child is trying to communicate (Dunlap and Kern 2018). There are several challenges in completing an ABC chart. [Name redacted] has high levels of anxiety and many hypersensitivities. In the context of a busy classroom of 25 small children, it is difficult for a teacher to have noticed what happened immediately antecedent to the behaviour unless released specifically to undertake observations. This is often impracticable given that multiple observations are required and the behaviour may or may not occur. As previously stated, there may be more than one contributing factor and possible consequences are frequently difficult to determine. The  Motivational Assessment Scale (MAS) is a useful tool to help with this analysis. A specialist teacher is often able to undertake observations to support the teacher. Regardless of who is completing the FBA/MAS, this can be a time heavy undertaking. The teachers, whānau and I are working collaboratively to complete the FBA, MAS and sensory profile to inform development of a hypothesis.

The Behaviour Support plan includes both proactive and reactive strategies, informed by a school and class sensory audit (TEACCH) and [Name redacted's] strengths (Horner et. al.,1999). I found sharing the TEACHH and the Sensory Audit (Autism Education Trust) with [Name redacted's] teachers prior to CAPs hui, was really useful. It helped to focus his teachers' on environmental triggers and initiated conversations about what could be changed so that everyone was keyed in to using proactive strategies from the outset. There will always be occasions when a teacher's response will be reactive. It is important to make sure that the reaction is positive, de-escalates a situation and is student led. The Safety Plan (below) outlines the reactive strategies the school is trialing when a situation occurs that requires management rather than prevention. Note that these 'living' documents are a work in progress, as our first team hui was held at end of Term 3. These shared documents will be updated as we all get to know [Name redacted] better. They will be formally discussed and reviewed at each CAPs/IEP hui.

The School has already identified that understanding emotions is important for many students, including students who have heightened anxiety due to trauma, grief, autism and other causes. They have been proactive in introducing Zones of Regulation across the whole school as a tool to teach students how to recognise different states of emotion in themselves and in others, and learn strategies to manage these emotions. Circle time has also been introduced as a way of explicitly teaching Zones of Regulation and to help students learn to talk about how they're feeling in a safe environment. Thomas the Tank Engine is one of [Name redacted's] favourite characters. This lends itself to teaching emotions and facial recognition as well as strategies to manage emotions. For this reason, I have tried to find ways of using Thomas to reinforce Zones of Regulation. Employing high interest subjects is a useful teaching strategy that  makes use of his visual processing skills and excellent memory. My next step is to trial how digital social stories could also be used as a self-calming tool.

Having shared these ideas with [Name redacted's] teachers, one of them created their own book to help reduce his anxiety about coming to school.

The Rule of Five strategy has been a useful tool when communicating with [Name redacted].  It has been included in the CAPs plan and Safety Plan. Teachers and staff members are practicing using this strategy with several students. For [Name redacted], using his name to gain attention, ensuring eye contact and using the Rule of Five has increased his response and instruction compliance where previously he might have ignored the instruction or walked away. Giving forewarning that an activity is about to finish, has also proven effective and has been included in his Behaviour Support Plan. The 'first and then' strategy has also been included in CAPs plan. While this strategy of using a preferred activity to positively reinforce completion of a non-preferred activity has been shown to be effective (Premack,1959), the teachers' have shown some reluctance to begin to use it. While they have made a 'first and then' activity board and made cards so that [Name redacted] can choose the preferred 'then' activity, they have yet to put it into practice. I believe that there are a number of reasons for this, that will impact not just implementation of this strategy but also the consistency of implementation of other strategies: it is a very stressful and busy time of the year and this is a very busy and diverse classroom.

Visual supports have already been introduced in the classroom. It has been shown that providing visual supports not only aid communication but also provide structure (Saggers and Ashburner 2019) for some students, for example, visual timetables (Arthur-Kelly et al. 2009). [Name redacted's] timetable is simple and is removable so that he is able to check what is coming next, has some choice about what his day will be like and by removing each activity as it happens, he can gain an understanding of the passage of time (Myles, 2005). Keeping the visuals age and skill level appropriate and high interest are important for all students and so the teachers' have used a range of different styles to meet the needs of all students. They have included Coreboard symbols consistently to support another student in the classroom and to normalise Coreboard use. Macdonald et al. (2018) suggest that work systems support students organisation and independence and the 'this and then' chart is a very simple version of this. It was helpful to have more sophisticated versions modelled in the video (name) to add to my kete for future reference.  

The School has a designated LEGO room, which I have used with other students to meet specific communication goals and to teach a range of social skills such as turn taking, initiating conversation, compromising. It can also be used effectively for language development by pairing a particular child with others who are strong in verbal communication so that they may be exposed to rich language and vocabulary. By reflecting on experienced emotions during the session, it can be used to develop emotional literacy and reinforce Zones of Regulation or other programmes supporting self-regulation such as Mana Potential. The reflection at the end of each session is a really important aspect, and can be like a mini circle time. I like the flexibility of LEGO, not only as a multi-purpose resource but also its ability to be used across multiple levels by making the task demands, questioning and reflection more challenging. This will be a useful resource in the future, to develop [Name redacted's] social and communication skills in a structured group setting using learning through play.

Social skills has been identified by The American Psychiatric Association (DSM-5) as a common characteristic of autism. I shared videos demonstrating different levels of interpersonal engagement with staff members and colleagues alongside the Interpersonal Engagement Scale (Autism New Zealand) which has sparked a lot of discussion about how to facilitate these interactions. It was suggested that 'Pattern, memory and variation' strategy for example, could be used with a wider range of students who have difficulty managing their responses in some situations. A play based intervention like this, where a variation or an interruption to the game is unexpectedly introduced, may increase student resilience to change or the unexpected. One of the challenges is finding the right activity and planning the variation and memory. The 'changing chairs' video illustrated how sophisticated the game is in developing interpersonal engagement. There has been a great deal of thought and planning developing this game - the close eye contact and body language being a cue to move, the memory cue reinforcing the pattern of changing chairs, how and when to introduce the variation of turning the chair and adding in the interruption of blocking the child. Choosing a game appropriate to the age/skill and interest of the child. The person clearly knew the child very well and was highly skilled at communicating the variation wordlessly. This reinforced to me and the others watching the video, that to do this well would require careful planning, predicting and being ready for the child's response to the change, and lots of practice (including overcoming self consciousness). I was happy to see [Name redacted] engaged in "joyous play" with a peer earlier this week, the first time I have seen him smile or laugh. Observing what a student is already doing is a good place to begin (Raab, Dunst, & Hamby, 2013).

The effectiveness of this (and other like activities) can then be evaluated using the Interpersonal Engagement Scale, observing the child at natural play and rating the quality of their social interactions.

References