A Look Into Supports for Individuals With Autism

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Eddie Boynton
Danielle Puig
Samantha Horne
Victoria Campo








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What is Autism?


Autism is one classification in a larger group known as Autism Spectrum Disorders (ASD). Autism is a bio-neurological developmental disability that is usually identified before the age of 3 (National Autism Association). Autism and the rest of the ASDs, are characterized by varying degrees of severity of social difficulties, communication impairments, and stereotyped behaviors. Individuals with autism also typically experience difficulties with verbal and non-verbal communications and leisure or play activities (National Autism Association). In addition to autism, other disorders that are included under the "umbrella" classification of Autism Spectrum Disorders are Asperger's syndrome and Pervasive Developmental Disorder-Not Otherwise Specified. Below is an illustration of the Autism "umbrella" and the different variations of Autism (Autism Speaks Inc). Autism does not have an effect an individual's life expectancy, and while there is no cure for autism, early identification, interventions, and treatment can greatly improve an individual's symptoms (National Autism Association).

Below is an edited transcript of a telephone interview recorded in February 2010 with Dr. Susan Levy. Dr. Susan Levy is a developmental pediatrician and medical director of the Regional Autism Center at The Children’s Hospital of Philadelphia. She is a member of the American Academy of Pediatrics Autism Subcommittee. Her research interests include early identification and treatment of autism, and complementary and alternative medical treatments of autism.

What is Autism? - Sound Clip

Transcription of Sound Clip
Q: Dr. Levy, what is autism?

A: Dr. Levy: Autism is one of a group of developmental disorders, the category of which is called Autism Spectrum Disorder or what people commonly say are the ASDs. Children who have ASD have problems with social interaction, communication, and restricted or repetitive behaviors. The other diagnoses in this category are Asperger’s Syndrome and Pervasive Developmental Disorder - Not Otherwise Specified, or PDD-NOS. And even though there are three diagnoses in the category, each child, regardless of which diagnosis they have, has different ranges of development and issues, and how many symptoms they have and how severely they’re affected can vary greatly from one child to another (Levy, 2010).

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Statistics


The most recent statistics show that 1 in 110 children born in the United States is born with an ASD.This is a 600 percent increase in prevalence over the past two decades (Autism Speaks Inc, 2011).

Members of all racial, ethnic, and socioeconomic groups are equally represented in the diagnosis statistics. However, boys are three to four times more likely to be diagnosed as having autism than their female counterparts. It is estimated that 1 in 70 boys in the United States are diagnosed with autism.

Diagnosis


There is no medical test that can definitively identify an individual as having autism. Medical professionals with support from physical, speech, and occupational therapists make recommendations based on patterns of observed behaviors. Typically, parents are the first to notice some of the early signs. If their children engage in unusual behavior such as a lack of eye contact, not responding to their names, or fail to meet certain childhood milestones parents should seek professional assistance. There are a number of resources available to parents at their disposable to assist in identifying early indicators of autism. The MCHAT (the Modified Checklist of Autism in Toddlers) is an example of one of these resources; this set of questions assists parents in determining whether further evaluation by a specialist is appropriate.

The diagnostic evaluation that takes place after parents or specialists observe the early signs are conducted by multidisciplinary teams, bringing together pediatricians, psychologists, speech and language pathologists, and occupational therapists. By involving all of these different professionals in the process, their different backgrounds and areas of expertise can be used to try and best understand the student's needs. These professionals observe and evaluate the child's behavior, interview the student and parents, and may administer medical tests to screen for related medical conditions.

While autism is usually identified in young children, adolescents and young adults can also be diagnosed with an autism spectrum disorder. Similar to the process that takes place in identifying young children, behavioral observations and interviews are conducted to determine if the individual meets the criteria set forth by the DSM-IV. The excerpt below is from the DSM-IV and clearly outlines the criteria that must be met in order to warrant a diagnosis of autism.

National Autism Association Diagnostic Criteria
FOR 299.00 AUTISTIC DISORDER
*Source: The American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Washington D.C., American Psychiatric Association, 1994.

A. A total of at least six items** from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):
  1. Qualitative impairment in social interaction, as manifested by at least two of the following:
    • marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction.
    • failure to develop peer relationships appropriate to developmental level
    • a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)
    • lack of social or emotional reciprocity
  2. Qualitative impairments in communication as manifested by at least one of the following:
    • delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
    • in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
    • stereotyped and repetitive use of language or idiosyncratic language
    • lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level
  3. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
    • encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
    • apparently inflexible adherence to specific, nonfunctional routines or rituals
    • stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole body movements)
    • persistent preoccupation with parts of objects
B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.
C. The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder.

Causes of Autism


While there has yet to be one definite cause identified, over the last five years, scientists have identified a number of rare gene changes, or mutations, associated with autism. A small number of these are sufficient to cause autism by themselves. 10-15% of cases have a specific, identifiable genetic cause like Fragile X Syndrome, Tuberous Sclerosis, and Angelman's Syndrome. Most cases of autism, however, appear to be caused by a combination of autism risk genes and environmental factors that early brain development. Researchers have identified several autism susceptibility genes that upon interacting with certain environmental factors have a greater likelihood of causing autism. While there has been a great deal of focus on identifying specific genes affect the development of autism, less research has been done about specific environment factors. However, it is believed that when a mother is exposed to certain environmental factors, her unborn child has a greater likelihood of developing autism. Some of these environmental factors include infectious diseases such as maternal rubella or cytomegalovirus. If the mother were to contract these illnesses during the pregnancy then the child is at higher risk for having autism. Also, exposure to certain chemicals such as thalidomide or valproate have been shown to have an effect (Autism Speaks Inc).

A current belief of some involved in advocating for autism is that certain childhood vaccines have a direct link to the onset of autism. The National Autism Association identifies a link between an additive found in vaccines and the development of autism. Thimerosal, is an inorganic mercury compound that has been added to vaccines since the 1930's as a preservative. Once metabolized, thimerosal becomes ethylmercury and thiosalicylate. Mercury is hazardous to humans, and the supporters of this argument, feel that is should be eliminated entirely from vaccines. They argue that the manufacturers of vaccines have never examined the effects of thimerosal, and there is evidence to support that it is neither "safe nor effective" as a preservative. The National Autism Association explains a relationship between the higher incidence of autism and the increase in the use of thimerosal. Comparisons have been published of the characteristics of mercury poisoning and those associated with autism. Further research needs to be conducted around this topic if a direct relationship is to be established (National Autism Association).

Over the years many theories (some very controversial) have been at the forefront of the debate about what causes autism. One very controversial theory that became widespread in the mid-1900's was the idea of bad parenting causing autism. Dr. Leo Kanner,a psychiatrist was the first to describe autism in 1943 and he is attributed to beginning the idea that bad parenting can cause autism. Cold and unloving mothers, according to Dr. Kanner, were the direct cause for their children's autism. This theory has since been proven incorrect, but not before causing guilt and suffering to the mothers of children with autism (Autism Speaks Inc).



What does being on the spectrum mean?


"If you know one person with autism, you know one person with autism" (Autism Speaks Inc, 2011).

No two individuals with autism are the same even though many on the autism spectrum possess similar abilities. Some common abilities including exceptional abilities in visual skills, music and academic skills. About 40 percent have average to above average intellectual abilities. Others with autism have significant disability and are unable to live independently. About 25 percent of individuals with ASD are nonverbal but can learn to communicate using other means. For these individuals this means the development and delivery of more effective medical and behavioral treatments that can address significant challenges in communication and physical health. For others, it means increasing acceptance, respect and support (Autism Speaks Inc, 2011).

Autism spectrum disorders can affect a person's ability to communicate, have successful social interactions, engage in repetitive behaviors, and can have an impact on their physical health. Many individuals with ASDs experience different severity levels or combinations of the symptoms.
  • Social Symptoms: Individuals with autism may have a difficult time engaging in the "give-and-take" of human interactions. These individual may also prefer to be alone and and be resistant to physical contact such as hugs or cuddling. As they get older they may experience difficultly in trying to "read" or interpret what others are feeling or thinking by their facial expressions, gestures, or tone of voice. Coupled with the challenging task of taking another human's perspective it might be more challenging to understand others' actions for individuals with an ASD (National Institution of Mental Health)

  • Communication Difficulties: While some people with ASDs may remain mute for their entire lives, the majority are able to develop some level of spoken language and are able to learn some way to communicate. The development of speech may be delayed in children with an ASD, and can develop as late as five to nine years old. Once their speech is developed, these individuals may exhibit certain characteristics such as echolalia (repeating words they hear) or the inability to combine words into meaningful sentences. In contrast, some individuals may develop large vocabularies. Even having strong vocabularies, these individuals may still experience difficulty with the back and forth nature of language, not allowing others to contribute to the conversation and often going on long monologues about their favorite subjects. When speaking out loud, their tone of voice, facial expressions, and body language may not reflect the true meaning of their words (Autism Speaks Inc).

"Children with autism have difficulty letting others know what they want or need until they are taught how to communicate through speech, gestures, or other means" (Autism Speaks Inc, 2011).





  • Repetitive Behaviors: Individuals on the spectrum may physically appear to be the same as their nondisabled peers, however, it is often their repetitive movements that distinguish them as "different." Some children and adolescents with autism may repeatedly flap their hands or arms, and may even walk on their toes. In addition to making these repetitive motions, children may not play with their toys in the "typical" ways. For example, instead of playing with cars and trains by moving them around a pretend road or tracks, they may spend hours lining them up and become very upset if they are moved. Individuals with autism typically thrive in consistent environments. They may enjoy maintaining strict routines, and if there is a slight change in this routine it can prove to be very stressful. In addition to routines and repetitive movements, individuals with autism may also experience a strong preoccupation with certain topics. The preoccupation can be about any topic that strikes the individuals' interest, and can be about anything (fans, cars, planes, weather, etc). These interests can be intense in nature and the individuals can usually talk about the topic in detail (Autism Speaks Inc).

"Many children with autism need, and demand, absolute consistency in their environment"(Autism Speaks Inc, 2011),

  • Physical and Medical Implications: There are a number of medical issues that have the potential to also affect those diagnosed with autism. While not all individuals on the spectrum experience these physical and medical issues, there is a higher incidence of these conditions in those with autism. Epilepsy occurs in about 39% of individuals with autism, and is more prevalent in those who also have cognitive deficits. People with autism may experience both "grand mal" and petit mal" seizures. These seizures typically begin in early childhood but can occur anytime but can be treated with an anticonvulsant or seizure medication. 10-15% of individuals with autism may also have a neurogenetic condition such as Fragile X Syndrome, Angelman's Syndrome, or other chromosomal abnormalities. It is important to identify these conditions in order to receive the proper medical treatments for any of the symptoms. Individuals on the spectrum also have a greater chance of having a Sensory Integration Disorder. This means that individuals with this condition may experience unusual responses to sensory stimuli. Their vision, smell, taste, hearing, and touch can all be affected. These reactions are due in part to a difficulty in processing incoming sensory information. This condition can be treated with occupational and/or sensory integration therapy (Autism Speaks Inc).


Academic Supports for Students with Autism


Instructional Methods
  • Structured Teaching
    • Stokes (2011) introduced an instructional method known as Structured Teaching. This is based upon an understanding of the unique features and characteristics connected with the nature of autism. It considers the conditions in which a person should be taught. Structured Teaching is a system of organizing environments, developing appropriate activities, and helping students with autism understand what is expected of them. This method uses visual cues with intentions of helping the student to focus on the relevant information. It also concentrates on creating a supportive environment that promotes appropriate learning. The goal of Structured Teaching is to increase the students independent functioning.
  • Discrete Trial Training
    • According to Dunlap and Fox (1999), Discrete Trial Training has been proven to be a successful instructional method for teaching specific skills in an intensive, efficient manner. Skills should be taught within a highly structure, one-to-one environment. Discrete Trial Training allows teachers to provide clear and concise instruction, additional prompts, and explicit reinforcers for performing the skills successfully. Ideally, skills taught in this method are presented in a least-to-most prompting sequence. This allows skills to be built upon one another. Verbal prompts, visual prompts, as well as physical guidance can be used to teach students different skills.
  • Activity Based Instruction
    • The main component of Activity Based Instruction is to include skills within activities that are beneficial for the students. Dunlap and Fox (1999) believe that instruction must encompass routine and activities that are student focused. These skills should be taught within relevant activities and across different contexts. This is done to increase the probability that the student will generalize the skills to numerous activities and environments.
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    • Dunlap and Fox (1999) argue that students with autism may also be taught in small group settings. It has been proven that nondisabled peers have been successful in providing instructional support for students with autism. Cooperative learning groups also provide a system that includes the students with autism who may be learning skills that are different from their peers.



Physical Methods
Physical Structure refers to the way the student's physical environment is set up and organized. It is one component from Stokes' (2011) Structured Teaching model.
  • Stokes (2011) argues that attention to physical structure is essential for numerous reasons. The level of self-control demonstrated by the student determines the amount of physical structure needed for each student. As independent functioning levels increase, the physical structure can be decreased.
    • Physical structure provides environmental organization for students with autisms.
    • Clear physical and visual boundaries help the person to understand where each begin and end.
    • The physical structure minimizes visual and auditory distractions.
  • Physical structure consists of a number of components:
    • Location: Physical structure should be taken into account in any environment in which the student interacts.
    • Layout: Each area should be clearly, visually defined. This can be done with furniture or boundary markers. Large spaces can be difficult for students with autism to understand. By arranging furniture to clearly define areas, it will decrease the child’s chance to wander. These cues will help students better understand their environment, while increasing their ability to become more independent.
    • Minimize Visual and Auditory Distractions. Stokes (2011) believes this can be done by:
      • Painting the entire environment a neutral color
      • Limiting the amount of visual stimuli
      • Placing sheets or curtains to cover shelves and other visually distracting equipment
      • Storing unnecessary materials in another area
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        Examples of student work stations
      • Using natural light to reduce the use of distrustful fluorescent lights
      • Controlling the amount of light through the use of blinds, curtains, etc.
      • Using individual work areas away from others in order to reduce environmental visual distractions
      • Making careful considerations regarding where the student with autism will sit in the regular education classroom
      • Using carpeting, lowered ceilings, headphones, etc. to minimize auditory distractions
    • Establish appropriate instructional, independent, recreation, and leisure areas in each environment. These should be clearly defined for the student. It should offer a safe atmosphere where the child can develop independently
  • According to Stokes (2011) a physically structured environment must be extremely organized. Students can be taught organization through the use of pictures, color-coding, numbers, symbols, etc.


Visual MethodsOne highly used visual method is visual schedules. This method tells the student with autism what activities will occur and in what sequence.Visual schedules are another component from Stokes' (2011) Structured Teaching model.
  • Stokes (2011) argues that visual schedules are important for students with autism because they:
    • Help address the child’s difficulty with sequential memory and organization of time.
    • Assist the student with language comprehension problems to understand what is expected of them.
    • Lessen the anxiety level.
    • Clarify what activities happen within a specific time period
    • Alert the student to any change that might occur.
    • Assist the student in transitioning independently between activities and environments
    • Can be used across contexts
    • Can be incorporated into various social interactions
    • Can increase the student’s motivation to complete activities

  • The visual schedule method must be directly taught and consistently used. This increases the student’s ability for independent functioning across different contexts.
  • When developing visual schedules some considerations should be made:
    • They should be arranged from “top-to-bottom” or “left-to-right”
    • A method should be determined for the student to manipulate the schedule to indicate that an activity is finished.
    • A minimum of two scheduled items should be taught at a time.
      • This is so the student can understand that events and activities happen in a sequential manner
    • The schedules can be designed using a variety of formatsDifferent visual representations (real objects, photographs, drawings, etc.) can be used depending on the individual’s preference.
      • It is important to choose a format that is most appropriate for the individual student
    • The number of activities should be monitored to avoid anxiety and information overload.

  • Although many general education classrooms already implement visual schedules for the whole class, it is important to provide the student with autism an individual visual schedule. This will give the student extra support, as well as important information that can be readily understood.

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Example of Visual Schedules


Behavioral Supports for Students with Autism


Applied Behavior Analysis (ABA)
ABA is a treatment for ASD that looks to encourage positive and correct behaviors while simultaneously discouraging the negative behaviors associated with Autism. ABA involves systematically manipulating the environment and subsequently observing and recording changes in behavior (Miller, 2009). It is implemented across both academic and social settings within school.
Benefits:
  • This type of intervention is becoming a highly recommended treatment for children on the autism spectrum.
  • ABA is recognized as an essential and scientifically valid method of educating and managing children with autism spectrum disorder. Research has shown children with ASD can be expected to make significant progress when they are exposed to ABA (Simpson, 2001).
  • This intervention teaches children behaviors that help them communicate and function in day-to-day life.
  • ABA allows student to learn in a safe and natural environment. Children with ASD are found to respond well to this.
  • A common characteristic of ASD is resistance to change. ABA is a highly useful and flexible method that can be applied in a variety of ways and setting for students with autism spectrum disorders (Simpson, 2001). Since it can be applied across settings, students can adapt to the instruction and not be distressed throughout the day. ABA can also be introduced and put into practice at the child’s home environment.
  • ABA has a “team approach” method which allows a greater amount of support for the student. The team is made up of professionals such as occupational therapists, social workers, teachers, and parents. The team individualizes the intervention based on the child’s specific needs.

Critiques:
  • Some feel ABA is too rigid and strict. This may cause stress for children, resulting in more negative behaviors.
  • The repetition of drills and constant reward system is believed to make children dependent on cues and rewards. Some believe it creates robotic, prompt-dependent, and emotionless children (Rudy, 2009).
  • ABA can be a costly method. Most children require 40 hours or more a week of this type of therapy. Training teachers and paraprofessionals can be expensive and many school districts cannot afford the training. Therefore, schools cannot implement an ABA system.





Positive Behavior Support (PBS)
  • PBS is a proactive, constructive educational approach for resolving behavioral problems.
  • This is currently the preferred approach because it is based on extensive research.
  • The PBS approach is supported by the discipline regulations of the Individuals with Disabilities Education Act (IDEA).
  • PBS also keeps students’ best interests at the forefront and makes sure to treat students with dignity and provide them access to as many educational opportunities as possible.
  • PBS uses a functional behavioral assessment (FBA) along with the individualized behavior support plan. The plan includes procedures for teaching alternatives to the behavior problems, and alterations to the environmental and instructional circumstances most associated with the problems. Alterations include: changes to the curriculum, instructional techniques, and social settings.
  • The FBA process gathers information about the purple or "function" of the behavior and the circumstances associated with its occurrences and/or non-occurrences.
  • The results of the FBA aid the individualized behavior support plan.
  • Overall, the PBS intervention helps prevent problems from occurring and teaches skills that will allow them to interact with the environment in a more effective and desirable way.
(Dunlap & Fox, 1999)

Social Skills Stories
  • Social Stories are a great tool to teach social skills to children with ASD. These stories provide the student with accurate
    information about situations they may find confusing or difficult.
  • The situation is thoroughly described and focuses on a few key points: the important social cues, the events and reactions the student might expect to occur in the situation, the actions and reactions that might be expected of him/her, and why.
  • The goal of a Social Story is to help the child understand the situation and make him/her feel more comfortable when in a situation similar to the one in the story. It should also recommend the appropriate responses for the situation being described.
  • Social Stories are most effective when everyone who works with the child is familiar with the story and can refer to it when appropriate. A consistent schedule for reviewing the story can also help make the story more effective. As the student becomes more successful with the situation discussed in the story, the story can be faded out of his/her instruction.
Benefits:
  • Social Stories provide perspective on the thoughts, emotions, and behaviors of others. This helps the student predict the actions of others.
  • Social Stories introduce situations in a structured and consistent way.
  • They provide the social information through pictures and text opposed to speech and observation, which is an area of weakness for children with ASD.
  • Social Stories provide a way for students to practice often.



First hand perspectives
When working with students it is always useful to get their input and opinions about their learning. Students know what methods work best for them, as well as what they need in order to be successful. Teachers should initiate conversations with their students around this idea. Kluth (2004) presented suggestions made by students with autism in regards to their learning environments in his article titled Autism, Autobiography, and Adaptations. Some suggestions included in the article were:

  • Classroom set up
    • Consider lighting
    • Beware of sounds
    • Offer safe spaces
  • Communication
    • Help students interpret language
    • Do not focus on eye contact
    • Be aware of and modify volume, quality, and tone of voice
  • Instruction and teaching strategies
    • Bring interests into the instruction
    • Use visuals
    • Incorporate projects and independent work
    • Use a range of assessments

What It's Like To Live With Autism





Pay particular attention to the first six minutes, he gives an excellent description of what it's like to live with autism.

Parent Perspective of Having a Child With Autism



















What does this mean for teachers?

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Many children with autism have made remarkable breakthroughs with the right combination of therapies and interventions. Most parents would welcome a cure for their child, or a therapy that would alleviate all of the symptoms and challenges that make life difficult for them. Just as your child’s challenges can’t be summed up in one word, they can’t be remedied with one therapy. Each challenge must be addressed with an appropriate therapy. No single therapy works for every child. What works for one child may not work for another. What works for one child for a period of time may stop working. Some therapies are supported by research showing their efficacy, while others are not. The skill, experience, and style of the therapist are critical to the effectiveness of the intervention (Autism Speaks Inc, 2011).

As the number of individuals being diagnosed with autism grows, there is a greater possibility that there will be students who need these various interventions in each classroom. Teachers need to be aware of the different types of interventions that are available for them to use with their students. Teachers also need to be aware that the best results will not be obtained by using only one intervention, a combination of behavior and academic interventions will benefit the majority of students.

Teachers and therapists should research all of the benefits and risks associated with each intervention option before making any choices. There are many intricacies and specifics involved in the implementation of each intervention and unless research is conducted prior to conducting it, a teacher may not carry out the intervention correctly. In order to yield the best results interventions should be conduced with fidelity and consistency.

Before implementing any interventions, teachers and therapists need to really understand their student’s needs. As many educators know, each student is unique and their strengths and needs are different than their peers. Professionals should tailor the intervention programs’ frequency, duration, and intensity to meet the children’s needs.

Teachers should always set high standards for their students. Research has shown that with the right interventions students can make tremendous gains. While autism is not curable, the intensity and severity of their symptoms can be drastically improved.


"Inspirational story of j-mac overcoming autism"













Future Areas of Research


Gluten Free, Casein Free Diet (GFCF)
There is continuous research on dietary and nutritional interventions that some feel may help ASD symptoms. However, so far only anecdotal evidence supports the effectiveness of this type of intervention. Gluten is a protein found in barley, rye, wheat, and some oats. Casein is a protein found in dairy products. The theory states these types of proteins are absorbed differently by people who have ASD. After participating in this diet improvements have been seen in sleep activity and habitual behaviors (Autism Speaks Inc).

Causes of Autism
Since there is no definitive cause, research needs to be continued to investigate what could be causing children to have ASD and what can prevent it from occurring.
Potential causes:
  • Genetics
  • Agents that cause birth defects
  • Child immunizations
  • Prenatal virus infection
  • Environmental agents
  • Lack of Vitamin D
  • And many more…

Immune System's Role

Researchers have been looking into the function and regulation of the immune system, in the brain and body, in people who have ASD. Some evidence has been collected over the past 30 years suggesting inflammation of the central nervous system is common among people with ASD. There is also evidence that shows the immune system may influence behaviors associated with autism (Autism Speaks Inc).


Resources

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References

(2009). Autism spectrum disorders. (2009). [Web Photo]. Retrieved from http://www.burrellautismcenter.com/resources/whatisautism.aspx

National Autism Association. National Autism Association, n.d. Web. 3 Dec. 2011.

Autism Speaks Inc. (2011). What is autism spectrum disorder. Retrieved from http://www.autismspeaks.org/

Levy, S. (2010, February). [Audio Tape Recording]. Sound advice. National center for medical home implementation, Retrieved from http://www.aap.org/audio/autism/Levy-Transcript.pdf

Manning-Courtney, P. (2010, March). [Audio Tape Recording]. Sound advice. National center for medical home implementation, Retrieved from http://www.aap.org/audio/autism/manning-transcript.pdf

Stokes, S. (2011). Structured Teaching: Strategies for Supporting Students with Autism? . In Special Education Services. Retrieved November 26, 2011, from http://www.specialed.us/autism/structure/str10.htm

Kluth, P. (2004, April). Autism, Autobiography, and Adaptations. Teaching Exceptional children, 42-47.

Wallin, J. M. (2004). Social Stories. In Polyxo.com. Retrieved December 4, 2011, from http://www.polyxo.com/socialstories/introduction.html

Dunlap, G., & Fox, L. (1999, October). Teaching Students with Autism . In Council for Exceptional Children. Retrieved December 4, 2011, from http://www.cec.sped.org/AM/Template.cfm?Section=Home&CONTENTID=4185&CAT=none&TEMPLATE=/CM/ContentDisplay.cfm