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The boy wasn’t working. All the other fifth grade students were taking their tests, but he was sitting quietly. It was perhaps fifteen minutes before his teacher noticed him and asked why he wasn’t writing anything. He said, “I don’t have a pencil.” “Well, what happened to your pencil?” his teacher asked. “It’s broken,” was his explanation.

“He had gotten through maybe three test questions and his pencil broke. He didn’t raise his hand, he didn’t ask, he just sat there,” describes Ronda Layman, who was observing this student with Asperger’s syndrome in class. “He didn’t have the social communication and skills to say, ‘I need to sharpen my pencil, it broke. I can’t take my test.’ A lot of times you think it’s defiance. But he had no clue how to handle this situation.”

Layman works with teachers and students across Rockingham County to help meet the needs of students with autism spectrum disorders. Her county has approximately forty students placed in Exceptional Children’s services under the autistic label. Most of these students are in kindergarten through third grade and most are in self-contained, cross-categorical classrooms. Some of these children don’t speak and throw violent tantrums. Others attend regular classes and earn straight A’s. All of them, Layman says, need extra help communicating. “A lot of times people will assume that they know and can comprehend a lot more than they do,” she says. Children with autism and Asperger’s disorder, even those who can speak fluently about subjects that interest them, have difficulty using language to communicate their day-to-day needs. They also tend to adhere rigidly to rules and schedules and have trouble adjusting to unexpected changes, like fire drills or broken pencils.

Educated as a speech therapist, Layman taught a self-contained classroom for autistic children for nine years and worked in early intervention for five years before taking her current position at Rockingham County Schools. Now she observes children with autistic spectrum disorders in their classrooms, assesses their needs, and works with the students and their teachers to meet those needs. “I think it’s real easy to go around and say, ‘You need to this and you need to do that,’ and then walk off and leave them. What I try to do is come back and spend a day or two trying to help the teacher implement a strategy and see how it’s used. That seems to work a lot better,” she says. She also meets with students individually and in groups. Layman doesn’t leave her training at work when she goes home at the end of the day. Her son, who attends a regular fourth grade class, is also autistic.

Helping students speak up

Language is a basic human ability, and most children learn without formal training to clearly communicate their needs and desires. However, many children with autism never learn to speak — or learn much later than average. Imagine not being able to say what you wanted to eat, that you needed to use the bathroom or sharpen your pencil, or that you were angry or sick or frustrated! To allow nonverbal children to communicate, their teachers and parents must give them options other than spoken language: objects, photographs, drawings, sign language, voice output systems. Children with autism spectrum disorders generally find it easier to communicate when they are choosing from a set of limited options or following clear rules.

[Pullout: To allow nonverbal children to communicate, teachers must give them options other than spoken language.]Layman recommends that teachers and parents scaffold communication for children with autism spectrum disorders by reinforcing the relationships of objects and pictures to language. The more similar a symbol is to the concept it represents, the easier it is to associate the two. Usually objects are most straightforward symbols used to establish relationships, then photographs, then drawings, then words. Some children move gradually through all these representational stages before arriving at language. “I have known some kids who never cared about the object stage and went right into pictures,” Layman says. “Look at what they need and go from there.”

For instance, nonverbal children can choose what they want to eat, even if it’s just by grabbing a carton of milk or a banana. To reinforce the idea that those foods are associated with symbols and words, the teacher can label the food with both a picture and a word. Once the child understands that a picture means milk, he can select milk by pointing to the labeled picture instead of reaching for the milk carton. “I try to have placemats at mealtime, once we get to that point,” Layman says. All around the border of a placemat, she glues pictures coupled with words. When students use cafeteria trays, she puts their placemats on their trays and they use these placemats to indicate their food choices.

Some schools have also allowed her to post labeled pictures on the glass barrier that separates students from food in a cafeteria line. “I have always been really big on these students, if at all possible, eating in the cafeteria. I know a lot of self-contained classes don’t. Cafeterias are very noisy and that bothers kids. I have had kids go in with earphones, just to cut down on the noise. But I feel like if you’re ever going to leave your house, you’ve got to have that experience, and it’s our job to prepare them.” Ordering food by pointing at pictures is, Layman points out, a transferable skill. A nonverbal child who can point at pictures in the cafeteria may also be able to order fast food outside school. “They can be a little bit more independent with pictures.”

To allow students to indicate that they need to go to the bathroom, Layman starts with an empty toilet paper roll, labels with it with a photo of the school bathroom or a picture of a toilet, and wraps it in plastic wrap. First the student can be handed the toilet paper roll when he is being taken to the bathroom. Later he can learn to carry the roll to the teacher to indicate that he needs to go. When the student progresses past the object stage, Layman takes the picture off the toilet paper roll and affixes it to a popsicle stick. “It helps them visualize — this is where you want me to go, or this is where I’m going,” she says. “If they don’t have verbal language, they know to run and get their stick and show it to you, so you know they need to go to the bathroom.”

As children accumulate a vocabulary of symbols, their teachers or parents can assemble communication books the children can carry around. Layman gathers many of the pictures a child commonly uses to communicate, punches holes in the corner, and threads them onto a ring or carabiner that can be clipped onto the child’s belt loop or backpack. “I try for each activity to make sure that everybody has available a visual for what they’re going to do,” she says, and it’s easier for children to carry their own individualized pictures than for the teacher to look through all of hers at every activity.

Even on field trips, Layman encourages teachers to take pictures for communication. After a field trip, children can use the pictures to construct a story about what they did and saw. Many people with autism have trouble organizing their thoughts to write a story and can work more easily when the exercise is multiple choice instead of free form. Using appropriate images, the teacher can provide the beginnings of sentences (At the aquarium, we saw…) and ask students to choose endings (starfish, sharks, turtles). Children who can read can choose from a list of written words. For many children, handwriting is an additional barrier to the mental exercise of writing a story or paper. Layman recommends that children who have messy handwriting and find writing frustrating be permitted to type class work and homework on a computer when one is available.

To create her labels and visuals, Layman uses Boardmaker software, which includes over 3000 symbols, and the Boardmaker supplement Picture This, which has another 2700 realistic pictures. These are produced by Mayer-Johnson and are available in Macintosh and Windows versions. Layman tries to avoid using black on white because the well-known autistic author and speaker, Dr. Temple Grandin, has reported that people with autism perceive high contrast as painful. Layman also takes digital pictures of objects and people at her schools. She often begins using these realistic images and then gradually moves the student on to Boardmaker images. Other children understand Boardmaker pictures the first time Layman introduces them.

Students with autism may also use voice output systems that convert their chosen pictures or typed words to automated spoken language. One voice output system, produced by Ablenet and called a BIGmack, is a large single button for which a single message can be recorded. When the child hits the button, the message plays. After observing one student, Layman concluded that he was throwing temper tantrums when he was frustrated by his schoolwork and wanted the teacher’s attention. Layman and the teacher set up a BIGmack for him that played “I need help,” and Layman spent three or four mornings in the class watching the student get frustrated, taking his hand, and helping him hit the BIGmack. Once he got the hang of it, he’d push the button for help just so he got finish his work faster. “But,” Layman says, “that evens itself out after the novelty wears off.” She hopes to install more of these devices. “Even for kids who have a little language, it seems asking for help is a really hard thing for them.”

Language development of children with autism, like that of all children, is also aided immensely by adults talking, narrating everyday events, and identifying everyday objects and concepts. If the child has been signing at home, spoken language and signing can be used together in addition to written language and symbols. Children may have signs they’ve developed at home that can be shaped into more standard American Sign Language.

Layman cautions that teachers shouldn’t give up on children’s language development, and shouldn’t let the initial report they receive on a student limit their expectations. “I’ve had students that started out with pictures who would end up talking as late as eight years old. We even had one boy who was in middle school before he ever said a word to us.”

Managing meltdowns

When children throw tantrums, “they’re communicating something to you. This is not just, ‘I’m going to scream because it’s Thursday.’” Communication strategies can make classroom management easier. Layman tries, for instance, to teach children symbols and words for sick, mad, I need help, and I need a break. “A lot times,” she says, “if they can hand you a card saying that they’re mad, then they don’t need to scream at you or throw themselves on the floor.”

[Pullout:When children throw tantrums, they’re communicating something. This is not just, ‘I’m going to scream because it’s Thursday.’] Layman also explains that the behavior of a child with autism, disruptive though it may be, is rarely purposefully malicious. When teachers tell her, “He hates me,” she counters, “No, he’s trying to tell you something.” People with autism have a particular inability to see another person’s point of view, to understand that other people have their own knowledge, problems, opinions, and motivations. If the teacher comes into the classroom one morning and says, “I have a really bad headache, I need you to be good today,” a student with autism may not understand that logic.

Once a tantrum starts, Layman says teachers have to let it run its course. The child may need to be moved out of the classroom, or if that’s not possible, the class may need to be moved into the hall. One teacher Layman knows who has a self-contained classroom has set up a corner with mats and pillows where children can go hit something until they calm down. “We try very hard not to restrain any kid,” she says, but teachers of self-contained classrooms are trained in restraint in case it’s necessary. On rare occasions parents are called to come get their children. “We try so hard to get the communication skills in place so that we don’t have quite as much of that,” Layman says, “and it usually works.”

Tantrums are not purely the province of nonverbal children or those in self-contained settings. Intelligent, high functioning students with autism spectrum disorders are also subject to meltdowns. “When they get into that rage, you’re not going to get them out of it until it’s passed,” Layman says. “I don’t care how many times they read the rules or how well they know the rules. That’s a hard thing, because they come across as so smart and you think they can control that. But they really can’t.” If teachers can learn to recognize the agitation that precedes a meltdown, they may be able to prevent it by saying, “I think you need a break,” and sending the student on an errand to the office or library or otherwise giving him an out before he breaks down.

Older children in regular classrooms may be able to simply turn over a card on their desks to indicate that they need a break. Other children may just need the reminder of a scenario card they carry that says If I am mad…I ask to leave the room. Once reminded of that rule, they can verbally ask the teacher for permission to leave. Layman says the occasional rest helps students to behave. “If they need that break, nine out of ten times they’re going to go take their break and come back and everything’s okay. They could use the card for avoidance, but they’re still responsible for what you’re presenting in class. They know that, and they don’t want to be behind.”

Creating consistency with a routine

Students with autism spectrum disorders tend to have difficulty making transitions and coping with unexpected situations. Layman recommends that teachers post a clear, inclusive schedule for each student with autism or Asperger’s syndrome in pictures or words or both. By middle school, she says, students who can read usually want their schedules written in words without pictures.

Layman’s son has written schedules and rules for behavior posted at school and at home. “He’s a sweetie,” she says, “but he used to be a holy terror, screaming, throwing things. At the age of three he picked up a 25-inch color TV and hurled it across the room because he was mad. And what we had to do was structure his day from beginning to end. We organized his day with pictures. We labeled everything in the house.” It is a lot of work to set this up, she acknowledges, but once the system is in place it’s easy to maintain, and it makes the children much more comfortable.

[Pullout:Students are more willing to sit through subjects or activities they don’t like if they can see that something they prefer is coming up next.] “A lot of regular classroom teachers say, ‘We do the same routine every day. They know it — they don’t need visuals.’ But they do. It helps them stay on track.” Students are more willing to sit through subjects or activities they don’t like if they can see that something they prefer is coming up next, and many students with autism spectrum disorders, including those in regular education, have trouble keeping schedules in their heads. They tend to be disorganized and distractible. “Watch how much easier your day is if you’ve got a set routine,” Layman says, “if you’re always consistent and they’ve got their schedules posted.” Of course, not every school day is the same. There are class picture days, field trips, health screenings, and least predictably, fire drills. When the teacher knows it’s going to be an unusual day, Layman recommends marking it on the children’s schedules. “I give teachers a little flag to stick on their desks. It means schedule change, something’s going to be different today.” She asks teachers to put the flag on the normal daily schedule at the time for which the unusual activity is planned. “That just tends to help.” When she was teaching, she says, she kept pictures of fire hydrants on popsicle sticks in pockets on the back of the classroom door, and during fire drills she taught the children to take the fire drill popsicle sticks before walking out the door.

Layman also works with parents and teachers in designing situation cards to define rules of behavior and help students deal with unexpected contingencies. Students with autism spectrum disorders, even those who do well in school, often lack the flexibility and pragmatic language skills to respond to unanticipated situations. They tend to feel more comfortable following clear rules. Situation cards present a scenario and a few rules or choices: When I get to school in the morning, I open my book bag, take my homework out, put away my book bag. If the cafeteria doesn’t have what I want, I can choose something else, or I can not eat. If I really need to go to the bathroom, I tell the teacher. “A lot of times they won’t raise their hand and let you know they have to go to the bathroom,” Layman says. Or let the teacher know if they don’t feel well or if a pencil breaks. “It’s endless,” she acknowledges.

When Layman returned to classroom teaching after several years working in early intervention, she got a class that had been through a rapid succession of four or five teachers. The assistant said to her, “I have worked with so many teachers, I really don’t want to work with anybody else. I want out.” Layman remembers saying “Please, just give me the year. They need somebody consistent.” The two of them set about establishing routines, providing visuals, and teaching how to use communication tools. And it worked as Layman says, “We took a classroom — that before couldn’t even leave for music — to Asheboro to the zoo.”