They Deserve Good Teaching, Too

Jay is tapping a plastic dinosaur’s tail constantly against a table; Eddie is moaning, periodically flapping his hands, and pacing the floor before class begins; Shawn was sitting quietly, but then suddenly he slams his body against a metal cabinet until an aide comes to help him calm down. This is Room 9 at a Northern California school especially designed for students with severe autism.

Each classroom has one certified special education teacher and multiple instructional assistants (IAs) who work with two students each on lessons from their Individualized Education Programs (IEPs). Working as an IA in Room 9, I was constantly amazed and inspired by my colleagues’ passion and dedication toward these students. I was troubled, though, by the school’s almost complete reliance on behavior plans instead of curriculum and pedagogy. Good teaching practices were forgotten as students’ interests and voices went unheard. How, I wondered, could I apply social justice teaching to this situation? What would it look like to help these students give voice to their ideas and feelings?

From College to the Real World

This was my first job out of college. I had already worked with higher functioning students with autism as part of my undergraduate degree program and was excited to work with youth on a different part of the spectrum. However, once I started training to become an IA, I became conflicted. Motivating students through external rewards was examined very critically in my degree program, yet the program used by the school, Applied Behavior Analysis (ABA), is predicated on extrinsic motivation.

Developed by a behavioral scientist in the 1980s, ABA uses rewards and repetition to teach students with severe autism. In academia, there is a lot of controversy surrounding ABA. Many educators and psychologists think that behaviorism is an outdated branch in psychology and that it is equivalent to training animals—giving a token or starburst to a student for getting a right answer is analogous to giving a dog a biscuit for sitting. However, almost all school programs for students with severe autism are based on ABA. Alternative programs are difficult to find and parents may not know of their existence. As someone fairly new to special education, I was torn between two different realities, but wanted to experience ABA for myself to formulate my own opinions about extrinsic motivation.

Behaviors, Behaviors, Behaviors

“The whole goal is to teach our clients independence so that they can have the best quality of life,” the training director said during my IA training. However, during the two-week training, we novice IAs were taught one teaching method: Repeat a scripted lesson until the student has completed it with 80 percent accuracy. The purpose of the training was not how to best teach students with severe autism, but to understand students’ “behaviors” and how to appropriately react to them.

Our students do sometimes become violent, throwing objects, kicking/hitting staff or other students, and hurting themselves. Many IAs have scars on their arms (myself now included) from students biting or scratching. I saw my colleagues in room 9 intentionally put themselves in harm’s way by taking the kicks and punches from students in order to protect others. Students do not choose to act like this; their actions are side effects of the disorder. We were taught not to take students’ aggression personally.

But I felt that there was a missing piece to the puzzle. Why is so much attention in the training focused on reacting to students’ potentially harmful actions rather than preventing them? Where does this leave room to improve teaching practices?

In the Classroom

After my training, I started work as an IA in Room 9. The students’ ages ranged from 14 to 21. IAs rotated stations every two weeks to work with a new pair of students. My first students were Jess and Eddie, who weren’t usually aggressive.

I decided to work first with Eddie, a nonverbal 16-year-old student who used an iPad to communicate. One of his lessons required him to tell the difference between “on top” and “under.” Applying what I learned from training, I began the scripted lesson plan:

“Hi Eddie! We’re going to do a lesson. What would you like to work for today?”

Eddie picked icons on his iPad to respond: “I want a walk.”

“Great, Eddie, you’ll earn a walk once we complete this lesson. OK, show me on top,” I said as I handed him a block, which was to be placed on top of a toy bridge.

Eddie began placing it under the bridge. I gestured to him with my finger to place it on top. “That’s on top,” I stated.

Now we had to repeat the instruction until he got it right. “OK, Eddie, put it on top.”

Eddie grabbed the block and began placing it under the bridge until I gestured for him to place it on top. “That’s on top,” I said again. We repeated this process until Eddie placed the block on top of the bridge without my gestures.

This is Discrete Trial Training, the teaching method used in ABA. There are at most 10 trials for a lesson but, because Eddie misplaced the block three times, we would stop the lesson once he answered the question correctly because he needed at least 80 percent to move on.

I felt like I was torturing Eddie. Not only did I bribe him with a walk to do this lesson, he was losing his dignity because he obviously did not understand the concept on top. When our IA rotation came full circle, I was assigned to work with Eddie again. I discovered that this lesson was no longer being taught because he had struggled with it unsuccessfully for two months. I was furious. I knew Eddie could have learned this concept had he been provided with better teaching—with an approach that tied this new idea to something he cared about or already understood.

All of the students’ lessons are scripted in their binders. The IAs read the scripts verbatim. The idea is that the more concise and predictable lessons are, the more students will learn and the less likely that they will become confused, frustrated, or upset, which could lead to aggression. Teaching students living skills (e.g., brushing teeth, folding laundry) and academic content is supposed to empower them to become independent.

But are students truly becoming independent when they depend on external rewards for motivation? Extrinsic motivation is not just problematic for students with learning disabilities, it is problematic for everyone. A meta-analysis conducted by researchers led by Edward Deci of the University of Rochester indicates that external rewards often lead to poorer performance on activities and cognitive tasks. Participants focus more on the reward than the task itself. In other words, external rewards can hinder the potential for people to become internally invested in learning. For my students with autism, this translates to undermining their ability to become independent.

For example, 18-year-old Trish jumped out of her seat and stole Eddie’s iPad, throwing it at a nearby IA, after being denied candy. Was Trish angry because she wanted candy? Or was she angry because of the static teaching practices and external reward system, which are not age appropriate for teenagers? We’ll never know, because Trish has not been taught or provided with the opportunity to explain to us why she was upset.

Our students had very little voice in our classroom. The only choices they made for themselves were deciding what reward they wanted to earn and what lesson they wanted to do first. This is not the least bit empowering for students approaching adulthood. The nonverbal students had iPads and icons to communicate with, but they were programmed only for academic lessons. We did not spend time with our students teaching them how to express their emotions or confusions.

When students’ emotions were understood and staff communicated with them honestly, fewer aggressions occurred. Talking about the obsessive-compulsive disorder of a student who was upset by his printed schedule, one IA said: “Well, you know, he’s a 21-year-old guy. Sometimes he wants things his way, just like any other 21-year-old.” Because the IA empathized rather than managing the behavior, the student’s schedule was fixed and the situation did not escalate.

However, when the root cause of students’ emotions and frustrations were not obvious, demands were placed on students who were not given opportunities to express themselves. This led to more dangerous behavior. For example, when Shawn was repetitively hitting himself in the face, an IA told him, “Quit hitting yourself.” Although this IA cares deeply for these students, how is this helping Shawn learn to respect himself? It only resulted in Shawn hitting himself more often without us understanding why.

Is There Another Way?

I wondered if there were other alternatives for teaching students with severe autism. Searching the internet, I was disappointed by the results. Nearly all the schools in my region followed the ABA framework. Alternative programs were uncommon and costly.

After some investigating, I found that Relationship Development Intervention (RDI) is the main alternative to ABA. RDI was developed in the 1990s by clinical psychologists Rachelle Sheely and Steven Gutstein. It focuses on strengthening the exact areas that people with autism struggle with most: social skills and interactions with others. The philosophy of RDI is that people with autism can participate in emotional relationships as long as they are exposed to them gradually. According to Sheely and Gutstein, this results in neurocognitive changes because the brain is malleable; it can adapt and learn when given challenges, regardless of disability. Rather than having people with autism repeatedly practice scripted social interactions and responses, in RDI their interests are built into games and activities that involve another person. This establishes bonds that support more social interactions and possibilities to learn.

Unfortunately, there have not been many studies to evaluate the effectiveness of RDI. Gutstein led one five-year study in which 16 children who participated in RDI showed significant improvements on two commonly used diagnostic tests for autism in terms of their ability to socially interact and communicate, be flexible with changes, and function independently at school. Although the study had important limitations—there was no control group and no children with severe cognitive difficulties—it did find that “not only did the children demonstrate dramatic gains in functioning, but those gains remained stable.” Learning about RDI gave me the confidence to try teaching my students differently.

Building on Strengths and Interests

I began using some of the theories of RDI when working with my students by focusing on their interests and incorporating them into our lessons. Jay, a nonverbal and enthusiastic student who loved puzzles, had difficulty with a lesson that required him to differentiate between the corner, side, and middle of objects. Instead of following the scripted lesson, I used Jay’s puzzle and asked him to place corner pieces in their designated spots. After he completed this with no difficulty, I gave Jay the same instruction but used the original materials of the lesson. Jay correctly identified the corner of the paper because it was now relatable to his puzzle. We continued this process for middle and side, which Jay learned easily when we compared it to his puzzle. I did not have to bribe Jay with a reward to complete the lesson. He simply learned because he could relate the new idea to something he was interested in.

Roland was entirely unmotivated to complete his lesson categorizing index cards into numbers and letters. He loved stacking blocks, so I taped the index cards to his blocks. I handed him a block with a letter on it and asked him to stack that block with other letter blocks. Not only did he become engaged in the lesson, he rapidly got better at differentiating specific letters and numbers.

My new approach wasn’t a panacea. When students did not understand my initial explanation, I found myself repeating a variation of my previous explanation—so much for staying away from repetitiveness. Sometimes repetition actually helped, but it was most effective when it built upon student interests and when students had opportunities to practice new concepts with relatable activities they enjoyed.

Listening for Student Voice

Now that our lessons were going better, I was ready to tackle the most difficult part of being an IA: teaching students to express themselves even though they had a disorder that makes social interactions and communication painful. When students showed signs of frustration or annoyance—such as pushing materials off desks or refusing to do something—staff would say something like: “You look frustrated, let’s have a break.” That’s what we were trained to do. But that response assumed we knew how the student felt. Unsurprisingly, remarks like this often led to student aggression. I wanted, instead, to teach my students to express their feelings so that they could more effectively communicate with us and ultimately have more control of their lives.

I printed out emotion icons and, during periods of inactivity, I had my students identify them: “Show me happy” or “Where is angry?” As the icons became more familiar, I had students practice expressing their feelings during everyday activities. My students had no difficulty identifying their emotions; they just needed help expressing it to staff members.

Some students adapted well to using the emotion icons when upset, but other students wanted nothing to do with them. I asked Shawn, after he threw his binder across the room, what he was feeling. He grabbed the emotion icons and threw them as well. I said: “What do you feel? Tell me so I can help.”

He began hitting himself.

“Shawn, use your voice. You feel—”

Once he calmed down, he picked up the emotion icons and formulated his sentence: “I feel frustrated.”

“What can I do to help?” I asked.

He formulated another sentence: “I want hand pressure.”

I congratulated Shawn for expressing his feelings, and told him that I understood and could help.

When students express what they feel and staff ask what can be done to help, students are learning they have more control of their lives when they use their voice. Their voices are empowering them to move into the world of effective communication—quite a victory for individuals with severe autism. Although students still struggle to independently express themselves without being prompted, they are slowly learning to use their voices in class rather than hurting themselves or others.

Lessons Learned

Once my students understood that their feelings and voices mattered, many of their aggressive responses stopped. Once our lesson plans incorporated my students’ interests, outbursts of frustration decreased. In essence, once my students were exposed to good teaching practices, they flourished and were empowered by their own voices and interests. All teachers—no matter what population we are working with—need to build on students’ strengths, connect new ideas to students’ background knowledge, and create curriculum based on students’ interests and needs.

People with severe autism are not objects to be fixed. Like all of us, they have particular strengths and weaknesses—strengths to build on and weaknesses that can be improved when their education is meaningful and emancipatory. Like all students, they deserve good teaching.

References

Deci, Edward, R. Koestner, and M. R. Ryan. 1999. “A Meta-Analytic Review of Experiments Examining the Effects of Extrinsic Rewards on Intrinsic Motivation.” Psychological Bulletin. 125(6), 627-668.

Gutstein, Steven, F. A. Burgess, and K. Montfort. 2007. Relationship Development Intervention Program.” Autism. 11(5), 397-411.