The Nature Of Asd Education Essay

In this chapter the author explores the nature of ASD. The SENDA (2001) is analysed highlighting key aspects in regards to inclusion of children with ASD into mainstream settings; investigating the advantages and disadvantages of inclusion. Various teaching strategies are examined, highlighting the advantages and disadvantages of each strategy.

Autism

Firstly, it is important to define what is meant by the terms ?Autism? and ?Autistic Spectrum Disorder? (ASD). From the original descriptions of ?Autism? by Kanner?s (1943) and Asperger?s (1944) it is now apparent that the term Autistic Spectrum Disorder(ASD) is an umbrella term used to describe a variety of conditions (Sicile-Kira,2003). ?Autism is the name used for a wide range of developmental conditions on the Autism Spectrum including Asperger syndrome? (Autism Initiatives group, 2009; 1). At the lower-functioning end of the spectrum are those who would have once been described as having ?classic? or ?Kanner?s Autism. At the lower end of the spectrum a child would often fail to develop functional speech (Howlin, 1998) and may exhibit other learning disabilities (Grofer-Klinger & Dawson, 1996). At the higher end of the spectrum are those described as having Asperger syndrome and high-functioning Autism, in general they will develop academically; more often developing good language skills (Wing, 1998).

However, one difficulty that all individuals with ASD share is in making sense of the world around them. Grandin, (1992) Sinclair (1992) cited in Schopler, and Mesibov, (1995) and Williams (1996) suggests individuals with ASD should be viewed as having a different view of the world rather than a deficient world view.

Therefore, rather than trying to change a child to fit into a ?normal? life we need to try to see things from their perspective and provide strategies from them to function and manage everyday situations.

Individuals with ASD particularly experience problems in communication and social development, and often exhibit ritualistic and stereotyped behaviour and resistance to change (Howlin, 1998). The National Autistic Society (NAS) states that Autism is ?a lifelong developmental disability that affects the way a person communicates and relates to people around them.? (NAS, 2010) In 1978, Wing and Gould, identified a triad of impairment in people with ASD. (Sicile-Kira, 2003)

Triad of Impairment

Communication

Interaction Imagination / Rigid thought pattern

(Elks and McLachlan, 2009; 3)

Individuals with ASD often do not develop meaningful language and frequently use echolalic speech. Echolalia is the repetition of other people's words (Potter, and Wittaker, 2001).

They do not engage in conversations, often finding it difficult to understand what is being said, they themselves may be difficult to understand when they are communicating therefore preferring to refrain from any interactions with others.

However, some children with ASD have a high level of speech although they have difficulties using this speech in an appropriate way. They find it difficult to use their speech to facilitate communication with others (Small and Kontente, 2004).

In the most severe cases some individuals exhibit detachment with a lack of interest in other people; however they may enjoy certain types of physical contact and show attachment on a basic level to parents or carers. For those individuals on the higher end of the spectrum ? those with high functioning Autism, the individual may accept social contact, though they do not make unprompted approaches. However, there are some individuals that will approach others spontaneously yet this will often be in an inappropriate and repetitive manner, and paying little or no attention to the responses of the people they approach (Small and Kontente, 2004).

It has been suggested that the difficulty surrounding social impairment is that individuals with ASD do not have the ability to recognise that other people have thoughts and feelings (Sherratt, 2005). This has been described by Harvard Mental Health Board as ?a missing Theory of mind? (Harvard Mental Health Letter, 2001; 3).

Individuals with ASD often exhibit self stimulatory/ reinforcing behaviours this may be because without imagination they find it hard to accept that things can be different, therefore they become frightened of change.

They demonstrate the need for routine and keeping everything the same. As a child with ASD finds it hard to think imaginatively they have problems with play; their play may become repetitive and restrictive, the child often repeats the same sequence over and over again following a set routine (Sherratt, 2005).

Wing (1998) states that all individuals diagnosed as having ASD will display behaviours from the three areas of difficulty; however these behaviours will vary greatly from one individual to another (Wing,1998).

From 1940 to the early 1970?s it was assumed that ASD was a strain of Schizophrenia or psychosis of childhood (Buron and Wolfberg, 2008). However, scientific research has provided evidence of a neurological problem (Bauman and Kemper, 2003). Therefore, ASD is now considered as a neurological developmental disorder with specific areas of the brain not functioning as expected. It is also believed that there is a genetic influence; as it is becoming more common to have siblings affected by the spectrum. In the United Kingdom (UK) it is thought that one in every one hundred people has ASD, however most of these are males. There does not seem to be any apparent reason for this, it may possibly be down to genetics again or maybe something to do with the criteria during diagnoses. Research is still ongoing to find some answers (NAS, 2010).

As yet there are no medical tests that can be used to diagnose ASD. Instead doctors and psychologists look for the presence of a particular pattern of behaviours. Diagnosis can be a lengthy, complex process that usually starts with continuous observations and monitoring of the child?s behaviour. Diagnosing ASD is believed to be a very difficult process as there are no clear or specific biological markers (Bristol- Power and Spinella, 1999).

Often diagnosis is established by eliminating any other diagnosis, and identifying exhibited behaviours associated with ASD (Shulman, 2001 cited in Gabriels and Hill, 2002). The process will involve many professionals such as the class teacher, health visitor, speech and language therapist and many others.

Various observations of the child will be carried out in different situations and at different times of the day, interviews with professionals and parents will be conducted, together with assessments carried out by the speech and language therapist and a psychological assessment carried out by a psychologist (Lord and Risi, 2000). It is essential that the process of diagnosing a child who is thought to have ASD is conducted with care, as the symptoms presented by individuals can be wide and varied. However, it has been noted that professionals have a greater understanding of ASD therefore; ASD is being diagnosed earlier than ever before (Baron-Cohen et al, 1992). There are a range of assessments and checklists that can be used as a diagnostic tool these include:

Diagnostic and Statistical Manual of Mental Disorders 1V- DSM-1V(American Psychiatric Association, 1994)

Childhood Autism Rating Scale- CARS (Schopler et al, 1988)

Pre-linguistic Autism Diagnostic Observation Schedule- PL-ADOS (Di Lavore et al, 1995)

Checklist for Autism in toddlers ? CHAT (Baron-Cohen et al, 1992)

(Wall, 2006; 144)

Today we live in a society that is very accepting of children who have ASD; with legislation and social policies in place they are given the same opportunities as all children. In 2001 the SENDA was introduced together with the Special Needs Code of Practice.

Special Educational Needs and Disability Act 2001 (SENDA 2001)

The SENDA 2001 was implemented to strengthen the rights of children with disabilities and Special Educational Needs (SEN) to allow them to be educated in mainstream schools alongside their peers. Together with the Code of Practice (2001) emphasis is placed on inclusion of children with SEN into mainstream schools, providing them with the opportunity to access a broad, balanced and relevant education including the National Curriculum (SENDA, 2001). Children with ASD, who would have previously been educated in special schools, now have the right to attend mainstream schools and have an inclusive education. Inclusive education is defined as ?meeting all children?s needs? (Tassoni, 2003; 11) with the emphasis on schools being flexible and adapting to accommodate and meet the needs of all children regardless of their need. According to Mittler (2000) the steer towards inclusion is at the ?heart of both education and social policy' (Mittler 2000; 2).

The SENDA (2001) has had an impact on the amount of children with ASD being educated in mainstream schools along side their peers (Jones, 2004). A study by the NAS in 2002 looked at the attitudes and perceptions of teachers regarding the number of children with autism spectrum disorders in mainstream schools. The study that included seven local educational authorities in England, Wales and Scotland highlighted the fact that one in every 86 children in mainstream had ASD (Barnard et al, 2002). This study is relevant to the author?s research project as it highlights the fact that there is high number of children with ASD accessing mainstream education including primary mainstream education.

In addition to this the NAS have provided statistics to back up their claims from methodological good research.

Inclusion

Inclusion refers to the opportunity for persons with a disability to participate fully in all of the educational, employment, consumer, recreational, community and domestic activities that typify everyday society.

(Florian et al, 1998; 17)

Inclusion is debated in countries across the world; as to whether it is meeting the needs of the children and enabling them to reach their potential. There has been lots of research around the effectiveness of inclusion in the UK and other countries around the world. Often teachers feel ill-equipped to educate children with special needs, especially with recent emphasis on test scores. Research by Avramidis and Norwich (2002) indicates that while teachers? attitudes towards inclusion are by and large positive; the nature and severity of children?s needs highly influence the teachers? perceptions (Avramidis and Norwich, 2002).

Evidence provided by Brinker and Thorpe (1983) Wang and Birch (1984) Slavin and Madden (1986) and Ferguson and Asch (1989) indicated that inclusion was not always effective and often depended on the experiences and opportunities provided by each individual school. Often children with special needs are segregated within the mainstream setting; therefore failing to build friendships with other peers in their class (Reiter and Levi, 1980). However, research by Bennett and Cass (1989) shows that inclusion allows children with special needs to be more successful academically and socially, and helps their peers gain an understanding and acceptance of diversity (Bennett and Cass, 1989).

Educating children with ASD can be challenging especially in mainstream schools; successful inclusion requires staff to have high levels of skills, knowledge and support (Sherratt, 2005).

While all pupils with ASD have individual needs they tend to share the same characteristics; therefore certain key issues must be addressed for inclusion to be successful (Fletcher, 2003).Wagner (2009) believes that for inclusion to be successful careful, thorough planning is essential (Wagner, 2009). This view is shared by Smith and Brown (2000) who believe that inclusion should involve reorganisation of the curriculum and classroom to meet each individual child?s needs to enable them to reach their potential, believing that an Autism friendly environment can be created in any educational environment (Smith and Brown, 2000). However, this will need careful planning, communication and cooperation between different agencies. They believe that with the right attitude towards the inclusion of ASD children, together with knowledgeable staff and multi agency working then inclusion will be successful.

On the other hand Mesibov and Shea (1996) suggest that inclusion for children with ASD may not provide the same benefits as it would for children with other special needs (Mesibov and Shea, 1996). They claim that, because of their difficulties with communication and following instructions some children with ASD are not receptive to mainstream teaching techniques. This view is shared with Barnard et al (2000) who believe that there are some children with ASD that are best educated by a specialised team (Barnard et al, 2000). Similarly MacBeath et al (2006) argued that inclusion can be seen as the form of abuse, as some children are placed in settings that are inappropriate for them (MacBeath et al, 2006).

Smith and Brown (2000) suggest that for inclusion to be successful parents need to be involved in assessing the child's needs and in planning their child's education programme (Smith and Brown, 2000). Research conducted by Barnard et al in 2000 and Jindal-Snape et al, in 2005 that looked at the perceptions of parents with regards to inclusion; suggest that parents were more satisfied with their child's education when they had been involved in the decision making.

The research also indicated that parents felt happier when there was provision of Autism specific support for their child (Barnard et al, 2000 and Jindal-Snape et al, 2005).

Unfortunately, research is suggesting that there are children with ASD that are included in mainstream schools that are supported by staff that have no knowledge or understanding of ASD, and often do not have any relevant training to facilitate their role.

In 2002, the NAS undertook research looking at the training about ASD received by teaching staff in mainstream schools. The research project titled: Autism in Schools: Crisis or Challenge? Provided statistical evidence that indicated 72% of the teachers surveyed were not happy with the level of training they had received about ASD. It illustrated that only 22% of teachers had received any training on ASD; and provided data that showed 47% of teachers in mainstream schools with ASD pupils in their class, would like to receive more training and advice on ASD (Barnard et al, 2002,). This research included mainstream schools across England, Wales and Scotland that were educating children with ASD in their classes. In addition it investigated the level of training received by the teachers.

However, as Scotland has a different education system to England and Wales when the results were analysed there was substantial differences so Scotland?s results were reported separately (Barnard et al, 2002). Reporting Scotland?s results separately can be seen as a criticism of the research, if the results from Scotland had been reported with England and Wales? results then the findings may have been different.

By adopting a quantitative method of data collection questionnaires were sent out to 1,223 schools and given to teaching staff to complete. The research received a high response rate; 373 completed questionnaires were returned which indicates it is a subject that is of great relevance in mainstream schools.

A recommendation of the report was to train all teachers and TA?s in awareness and understanding of ASD, and that TA?s supporting children with ASD should be required, to complete a minimum level of training delivered to a common regional standard ( Barnard et al, 2002;26). Even though this research focused on teachers in mainstream schools the report is relevant to the author?s research project as the training and support that teachers receive has been analysed and it has highlighted the need for more training and understanding of ASD. On the whole teachers tend to receive more training than TA?s; therefore this suggests that as teachers? knowledge and understanding is limited then TA?s supporting the child will be at a disadvantage. Without the understanding and the knowledge of ASD a teacher will not be able to offer support to the TA.

Further evidence from a report from the University of Birmingham's Autism Centre for Education and Research (2008) backs up the findings of the NAS (2002) research. This report indicated that too many teachers and support staff did not have an understanding of the needs of children with ASD and struggled to teach them effectively (Jones, et al, 2008).

Similarly, the Cambridge Report (2006) ?The cost of inclusion? another report relevant to the author?s research project, as it investigated the views of teachers and TA?s that included Primary mainstream schools. Found that TA?s receive very little training to fulfil their role when working with children with special needs, with 75% of participants dissatisfied with the extent of their training. One TA stated ?In every other work place you get training before you go on the shop floor but in schools it doesn?t work like that. It is hands on with no training? (MacBeath et al, 2006; 37).

It also highlighted the fact that a high proportion of school staff had little knowledge of ASD often leaving them feeling helpless and deskilled. Many TA?s were said to adopt a mothering role as a result of not having any relevant training, which often led to dependency on the adult (MacBeath et al, 2006). What was evident from the report was that teachers and TA?s often relied on parents? expertise and knowledge to help them understand the child?s needs.

The report also highlighted that TA?s were often not included in discussions with outside agencies that came into school to offer advice and support for the child they were supporting (MacBeath et al, 2006). As the TA?s are the ones that would be implementing any programme that the child is following, it is imperative that TA?s are released to liaise with other professionals.

However, it was also evident from the report that accessing specialist help was very difficult as there seemed to be a growing demand for the service (MacBeath et al, 2006).

Conversely, criticism of this research is that the inclusion criterion for the research was for schools that were committed to implementing inclusion, rather than those where inclusion is not a priority. Therefore the report may not be presenting a broad balanced view of the issues of training and support.

When supporting a child with ASD in a mainstream school it is imperative that TA?s have an understanding on how they learn.

Autistic learning is of a disconnected kind and therefore children with autism need to be shown what connections are; as well as what the specific connections are within a particular learning experience with which they are engaged.

(Powell, 2000; 9)

Children with ASD are mainly visual learners. Visual learners are those that prefer to learn by seeing, preferring information to be presented to them in a visual way, incorporating pictures and symbols (Pritchard, 2005). In mainstream education it is important to meet the learning style of the child with ASD, in order to help them meet their potential. Effectual teaching of children with ASD require teachers and TA?s to adopt a variety of teaching styles and implement teaching strategies that suit the individual (Galton, 1989 and Joyce et al, 1997).

Within schools today a variety of teaching strategies can be adapted to meet the needs of the child with ASD. For these teaching strategies to be implemented effectively; appropriate training is essential.

According to Jordan (2001) finding an appropriate teaching method for children with ASD remains a challenge for staff in mainstream schools (Jordan, 2001). The author has focussed the research project on the widely used teaching strategies with children with ASD.

Applied Behaviour Analysis (ABA)

An ABA programme incorporates different teaching methods including prompting, shaping and rewarding that can be used in all areas of a child?s education. The approach can be employed to teach self help skills, speech and language, communication, academic skills and appropriate behaviour. It is based on the theory that all learned behaviours have an antecedent and a consequence, motivating the desired behaviour will therefore lead to the child repeating this behaviour (Sicile-Kira, 2003).

According to Sicile-Kira (2003) ABA has proved to be the most effective way to teach children with ASD (Sicile-Kira, 2003; 83). This view is shared by Jager (2009) he believes ABA is a proven effective teaching programme that teaches communication, self help skills, socialization and academics to people on the autistic spectrum (Jager, 2009).

In 1996, over five hundred studies on ABA were reviewed, the findings of this review indicated that ABA provides positive outcomes in relation to educating and enhancing life skills of children with ASD (Matson et al, 1996).

ABA is based on the work of B.F Skinner (1904 ? 1990) a psychologist who studied behaviour and the process of learning. Skinner studied the behaviour of animals under strictly monitored surroundings; then analyzed the findings. However, some people believe that research undertaken on animals is not appropriate to use on humans.

ABA has taken the findings from the studies undertaken by Skinner (1937) and applied them to humans; in particular the theory of operant conditioning (Pound, 2005).

Operant conditioning is a process of behaviour modification in which a person is encouraged to behave in a desired manner through reinforcement; the person will come to relate the feeling of having the reinforcement with the behaviour. It is believed that reinforced behaviours will continue, while those that are not reinforced will steadily fade. ?Operant conditioning is the underlying principle of the behaviour modification technique used in ABA? (Kearney, 2008; 36).

However, Ormrod (1999) suggests that there are people who dislike the idea of operant conditioning, as they believe that reinforcement is bribery, and that it promotes dependence on concrete external rewards. Furthermore, attempting to change problem behaviour through positive reinforcement does not alter the underlying cause of the behaviour (Ormrod, 1999).

Despite the evidence to support the effectiveness of ABA there are many critics of the approach. Many believe that it changes a child, removing their autistic traits by repressing their personalities and making them passive and compliant. They believe that children turn into robots, which are capable only of mimicking what they have been taught (McEachin, 1998).

One of the most famous researchers in teaching children with ASD is Ole Ivar Lovaas, (1927 -2010) a clinical psychologist of the University of California at Los Angeles. His model of ABA therapy is based on forty years of research. It involves one to one teaching of children with ASD by adult therapists.

The approach uses a discrete trial reinforcement method; the children are taught skills by breaking them down to their smallest component, using constant reinforcement and repetition. A process some disapprove of as they see it like training a dog.

At the same time, antisocial behaviour such as hand-flapping or rocking back and forth is discouraged. Initially, Lovaas discouraged antisocial behaviour by using smacking or shouting, this was highly criticised (Weiss and Harris, 2001). Therefore, changes were made to the approach, the general principal now is that good or desired behaviour is positively rewarded with negative behaviour being ignored (Weiss and Harris, 2001).

After seventeen years of testing and research a study of Lovaas' work was published in 1987. Lovaas found 47% of the nineteen ASD children studied who had received thirty to forty hours of eight-hour-a-day intensive therapy achieved "normal functioning"(Lovaas,1987). Children who participated in the program for two years made average IQ gains of thirty points, and were able to attend mainstream schools in place of special schools.

Criticism of the study comes from both internal and external validity. Margiati and Howlin (2001) suggest that different IQ tests were used at baseline and at the follow up, after therapy; which would have impacted on the reliability of the measurement (Margiati and Howlin, 2001). In addition to this the selection process in Lovaas? 1987 study was not a random selection, therefore open for criticism; did Lovaas deliberately choose children who were suitable to respond positively to his approach of behaviour modification? Lovaas (1987) does not appear to include any children with ASD who at the start of the study were in the "severe" range, who had IQs of less than thirty seven. At the start of the study the children were all verbal with an average IQ of around sixty three and in the "moderate" range.

Also the average for those children who achieved normal functioning was (just) in the normal--"high functioning"--range. (IQ sixty nine) Reed, (2004) believes in relation to the threats of external validity of Lovaas? (1987) study that the reliance of IQ as a total measure may be questioned; particularly that IQ is not necessarily the main difficulty for children with ASD (Reed, 2004).

Loovas? (1987) work has been replicated in a number of studies including: Anderson et al (1987), Smith et al (1997), Smith et al (2000), Bibby et al (2001), and Eikeseth et al (2002). All of these studies came to the same conclusion as Loovas (1987) (PEAT, 2011).

TEACCH

The TEACCH programme is designed to support children with ASD by providing visual information, structure and predictability (Cumine et al, 2000). It was developed to match the different ways individuals with ASD understand, think and learn (Mesibrove and Howley, 2003). Soan (2009) suggests that using the TEACCH approach is working with the strengths of a child with ASD; it incorporates their like of routine and structure and draws on their preferred learning style (Soan 2009; 145). Founded in 1972 at the University of North Carolina (Lord and Schopler, 1994) TEACCH is now thought to be one of the most widely used approaches with ASD in the UK (Schopler and Mesibov, 1995).

TEACCH is a social- pragmatic intervention that uses elements of a behavioural method of intervention such as ABA. Conversely, some practitioners believe that successful programs should only incorporate one teaching method TEACCH or ABA but not both (Webber and Scheuermann, 2008). On the other hand, it is suggested that teachers use structured teaching strategies and ABA based methods as the root for effectual programming (Myles et al, 2007).

The main priority of the TEACCH programme is a structured teaching approach. Schopler et al, (1971) indicated that children with ASD learn better in a structured learning environment (Schopler et al, 1971). A structured classroom with visual boundaries, daily schedules, work stations, and visual materials, is deemed to be effective in helping the child build on their skills and independence (Cumine et al, 2000). Structured teaching will help a child with ASD to become involved with individual, paired or group activities, therefore assisting them in accessing the curriculum (Mesibrov and Howley, 2003).

Using schedules is appropriate to the visual learning styles of children with ASD, and provides predictability and clarity (Soan, 2009). Schedules inform the child about what is going to happen, therefore reducing anxiety. Similarly, a work system is used to organise individual activities and inform children what work they are required to do, how much work they are expected to do, when it will be finished and what they should do next (Soan,2009). Equally each individual work task must be structured and visually organized to help with understanding, clarity and motivation and thus reduce anxiety (Mesibov and Howley, 2003). In addition to structure, the founders of TEACCH believe that by focusing on the child?s interest will help increase their motivation and understanding of what they are doing (Schopler et al, 1971).

An important aspect of TEACCH is developing communication skills. A number of ways of communicating are recognized and taught depending on each individual, this may include using objects of reference, photographs and pictures, symbols and words (Mignano, 2008).

TEACCH is not without its critics; some feel that the approach is too structured. Breakey (2006) suggests that the structured teaching offered by TEACCH acts as a prompt for the child with ASD (Breakey, 2006). Another criticism of the programme is that children with ASD may become too distracted by the charts and schedules used within the approach (Quinn, 2005).

A study by Schopler et al in 1982 assessed the effect of the approach with 647 children that had either completed a TEACCH programme or were at the time following a TEACCH programme (Schopler et al, 1982). Questionnaires that were completed by the children?s parents, led the researchers to conclude that the individuals that followed the TEACCH approach both at school and home, made the most progress.

However, a criticism of this study was that there was no control group, the researchers were not blind to the study and the data was determined by the feedback provided by parents (Schopler et al, 1982). A report by the National Foundation for Educational Research (NFER) in 2003 ?Review of the research literature on educational interventions for pupils with Autistic Spectrum Disorders? indicates that evidence is very weak on the effectiveness of TEACCH; as studies do not take into account any variables, such as other interventions that may have been used alongside TEACCH (Fletcher-Campbell, 2003).

PECS

PECS a pictorial augmentative communication system developed by Bondy and Frost (1994) allows individuals to acquire functional communication skills (Bondy and Frost, 1994). Research indicates that augmentative communication develops a child?s communication and aids the development of speech (Greenspan and Lewis, 2002).

Developed within the Delaware Autistic Program in the USA; PECS is an approach that incorporates ABA perspectives; just like ABA the teaching of PECS incorporates a variety of teaching strategies such as prompting, shaping and fading techniques (Bondy and Frost, 1994). Through positive reinforcement of a desired object the aim is to encourage children to initiate communication by using the exchange of symbols. Children are taught to give a picture or a symbol of a desired item to a communicative partner in exchange of the item (Wall, 2006).

However, PECS differs from other communication programmes as it teaches a child to request an item first rather than label it (Bondy and Frost, 2001). Bondy and Frost (2001) believe that teaching a child to request an item first is more effective, as they are immediately rewarded with a concrete reinforcer therefore more likely to repeat the process again (Bondy and Frost, 2001).

PECS is extensively used with children with ASD as the system is easy to implement for both the child and the communicative partner. Another positive effect of using the PECS approach is that there is a decrease in unwanted behaviours (Ganz and Simpson, 2004 and Bondy and Frost, 2001). Children with ASD find it frustrating and often exhibit unwanted behaviours when they are unable to communicate in an effective manner (Jordan, 2001).

However, according to Charlop - Christy et al (2002) there are no well controlled empirical investigations conducted into the effectiveness of PECS. On the other hand there are reports that suggest that the PECS method leads to increased functional communication in a relatively short period of time often with the development of speech in children with ASD (Charlop - Christy et al, 2002).

A longitudinal study on children with ASD who were five years old and younger by Bondy and Frost (1994) indicated that over half of the 66 children taking part in the study were able to use speech without the PECS within a year of starting the programme (Bondy and Frost, 1994). This has also been highlighted in other studies undertaken by Magiati and Howlin, (2003) Schwartz, et al, (1998) and Webb, (2000). While these studies provide subjective support for the effectiveness of PECS, the quality of evidence is limited due to lack of experimental control.

Further research by Schlosser and Wendt (2008) and Preston and Carter (2009) that examined the efficacy of PECS in ten children arrived at similar conclusions, that PECS is effective in providing a system of communication for children with little or no speech. However, both studies suggested that the data is not as clear about speech outcomes when using PECS system of communication (Schlosser and Wendt, 2008 and Preston and Carter, 2009).

Makaton

Makaton is an alternative and augmentative communication system developed by Margaret Walker, Kathy Johnson and Tony Comforth in the early 1970?s (Grove and Walker, 1990). The communication system has regularly been used with children with ASD and is now thought to be one of the most widely used augmentative communication systems in the UK (Grove and Walker, 1990). Makaton provides a method of communication for individuals that have language delay or for those who have not developed any verbal communication (Schlosser and Wendt, 2008).

Makaton uses key words, signs and gestures together with speech to support the communication of individuals with communication difficulties to facilitate receptive or expressive communication (Goldstein, 2002).

Research suggests that children with ASD who have no speech are able to learn and use signs, as this is working with the strengths of their preferred visual learning style (Kiernan et al, 1982). Reid (1984) believes that signs are easier to learn than spoken words (Reid, 1984).This is backed up from research by Lynn and Padfield in 2001 who found that 100 children with ASD were able to learn how to sign (Lynn and Padfield, 2001).

Research indicates that using gestures and signs together encourages and stimulates speech development. Research undertaken by Bricker (1972); van Biervliet (1977); Penner and Williams (1982) suggests that using signs and words together leads to the acquisition of spoken words (Grove, 1980). This is backed up by evidence from von Tetzchner (1984) whose research illustrated that a child with limited speech improved his language skills and acquired several spoken words after learning to sign (Von Tetzchner, 1984). The research indicated and there was a clear connection between the signed and the spoken words. Von Tetzchner (1984) suggested that the signs helped to differentiate speech sounds for the child (Von Tetzchner, 1984). However, this view is not shared by Kiernan (1983) whose research on children with ASD highlighted that only those with some potential for speech developed spoken language (Kiernan, 1983).

Children who have communication difficulties may become frustrated or withdrawn (The Makaton Charity, 2011); often exhibiting unwanted negative behaviours, such as kicking and screaming to facilitate communication. Using Makaton often decreases this behaviour and helps the child to communicate in an acceptable manner.

However, a negative of using Makaton is that children with ASD often have poor fine motor skills and poor imitation skills therefore they may struggle with the process of using signs, consequently causing frustration (Goldstein, 2002; Seal and Bonvillian, 1997 and Ticani, 2004).

It is essential that careful consideration is given to the child?s ability to produce clear signs before implementing the teaching of Makaton to individuals. In addition to this, children may develop their own way of producing a sign which can be confusing to others, again causing frustration for the child (Hodgdon, 1995).

Another point is that Makaton is not always used consistently between different establishments or often between different staff in the school setting (Hodgdon, 1995). This again will cause frustration for the child who cannot be understood.

However, on the plus side Makaton does not need to be used as a stand alone strategy; it has the advantage of being able to be integrated into other programmes such as ABA and TEACCH.

The literature review has shown that the children with ASD have many difficulties however the main difficulties are with communication, interaction and imagination; which is referred to as the Triad of Impairments. The severity of these difficulties varies from child to child, depending on which part of the spectrum they fall into.

As discussed in the literature review with the implementation of the SENDA (2001) many children with ASD are now included in mainstream education settings, there seems to be mixed views about whether this is the best place for a child with ASD to be educated. Some believe that with the right training, reorganisation of the curriculum and classroom a child with ASD can be successfully educated alongside their peers. Whereas, there are some who believe that mainstream education is not the best place for a child with ASD; they believe that special schools with specialised staff is more beneficial.

There are many different teaching strategies that can be used with children with ASD; however, it is important to find the one that best suits the child as it is not a case of one size fits all. The literature review discussed four of these methods and examined the positive and negatives of each method.

What is evident from the research is that a child with ASD benefits from structure and routine and prefers teaching methods that incorporate this. Another point that came from the literature review is that children with ASD benefit from having visual aids that meet their learning style, this helps to prevent them from getting frustrated and exhibiting negative behaviours.

Conversely, for inclusion and implementation of the teaching methods to be successful, research suggests that training and support is essential for the staff working with a child with ASD. Unfortunately, there seems to be a lack of training and support for both teachers and TA?s in mainstream. Research undertaken in 2002 and 2006 acknowledged that teachers and TA?s did not have an understanding of the needs of ASD children and struggled to teach them effectively.

Even though the 2002 research recommended that all staff working with children with ASD received training; this does not appear to have been put into practice as this was highlighted again in the 2006 and 2008 research.

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