Chapter 07 Autism Spectrum Disorder -clean-083023.docx

**Chapter 07** **Autism Spectrum Disorder** **Objectives** **After studying this chapter readers should be able to:** - **Identify the two categories of autism spectrum identification.** - **Understand the importance of each evaluation protocol.** - **Explain how and why language, commun...

**Chapter 07** **Autism Spectrum Disorder** **Objectives** **After studying this chapter readers should be able to:** - **Identify the two categories of autism spectrum identification.** - **Understand the importance of each evaluation protocol.** - **Explain how and why language, communication, social skills, and behavior are important characteristics of students with autism.** - **Recognize how environmental influences can positively or negatively impacts students with autism.** **Chapter 07 Subject Index:** - American Autism Society - Autism Spectrum Disorders - Autism - Individuals with Disabilities Education Act - Autism Spectrum Disorder - Rett's Disorder - The Childhood Autism Rating - Autism Diagnostic Interview-Revised - Autism Diagnostic Observation Schedule - Aggression & Self-Injurious Behavior - Repetitive & Unusual Behavior Patterns - Sameness & Perseverance - Sensory - Generalization - Intellectual Functioning - Applied Behavior Analysis - Social Stories^TM^ - Power Cards - Visual Schedules - Picture Exchange Communication System - Video Modeling *\ * *Introduction* ============== The **American Autism Society** (2003) reported **autism spectrum disorders** (ASD) are the fastest growing developmental disability. Although there are strategies for helping individuals with ASD gain independence and overcome areas of weakness, there is no cure. ASD is a lifelong disorder that requires constant, continuous, and consistent supports. This chapter provides a comprehensive introduction to **autism** which consists of the descriptions of the disorders associated with autism spectrum, causes, characteristics, and includes effective instructional strategies. *IDEA Definition* ================= In 1990, autism was added as a disability category when Congress reauthorized the ***Individuals with Disabilities Education Act*** (IDEA, P.L. 101-476). IDEA defines this disability as: *Disorders* =========== While autism was made a separate category under IDEA in the 1990 reauthorization, autism and similar disorders are typically categorized under the broader term, ASD. Children who receive services under the IDEA category of autism may be diagnosed with one of five related pervasive developmental disorders that make up the ASD. Under DSM-5, the four previous categories were consolidated into a single category of Autism Spectrum Disorder. **Under DSM-5, the terms** Asperger's syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS) have been removed. Under DSM-IV, the onset of autism spectrum disorder was expected to occur prior to age three (DSM-4, 1994). Under DSM-5, according to the CDC, autism spectrum disorder can be detected by 18 months of age but may not be recognized until late adolescence or early adulthood (CDC, 2022). Autism is marked by defining characteristics in two areas: 1) persistent deficits in social communication/interaction and 2) restricted, repetitive patterns of behavior (DSM-5, 2013). These defining characteristics will be discussed in greater detail in the characteristics section of the chapter. The impact of autism on learning and functioning can range from mild to severe. ***Autism Spectrum Disorder**.* Autism is a neurobiological disorder of development. It causes individuals to process information differently. The DSM-5 reduces the diagnosis of autism to just three concerns - impairment of social interaction and communication (now regarded as one combined domain) and restricted repetitive and stereotyped patterns of behavior (APA, 2013, DSM 5, 299.0 (F84.0)). The information-processing differences impact the following areas of communication including 1) deficits in social-emotional reciprocity, 2) deficits in nonverbal communicative behaviors used for social interaction including eye contact and body language, and 3) deficits in developing, maintaining, and understanding relationships with peers and other who are not their caregivers. In addition, repetitive behaviors or responses are also included and students must exhibit at least two of the following: 1. Echolalia, repetitive movements and/or stereotyped speech 2. Rigid adherence to routine(s) or ritualized behaviors 3. Abnormal intense focus on specific interests 4. Increased (hyperactivity) or decreased (hypoactivity) reactivity to sensory input (Children's Hospital of Philadelphia, 2020; DSM-5 299 (F84.0)). Other changes to the diagnosis of autism include identifying and using a severity assessment scale (levels 1-3) based on level of support needed for daily function. Those levels are identified as follows - **Level 1. \"REQUIRING SUPPORT\":** Individuals with this level of severity have difficulty initiating social interactions, may exhibit unusual or unsuccessful responses to social advances made by others, and may seem to have decreased interest in social interactions. Additionally, repetitive behaviors may interfere with daily functioning. These individuals may have some difficulty redirecting from their fixed interests. - **Level 2. \"REQUIRING SUBSTANTIAL SUPPORT\":** Individuals with this level of severity exhibit marked delays in verbal and non-verbal communication. Individuals have limited interest or ability to initiate social interactions and have difficulty forming social relationships with others, even with support in place. These individuals' restricted interests and repetitive behaviors are obvious to the casual observer and can interfere with functioning in a variety of contexts. High levels of distress or frustration may occur when interests and/or behaviors are interrupted. - **Level 3. \"REQUIRING VERY SUBSTANTIAL SUPPORT\":** This level of severity causes individuals with ASD severe impairment in daily functioning. These individuals have very limited initiation of social interaction and minimal response to social overtures by others and may be extremely limited in verbal communication abilities. Preoccupations, fixed rituals, and/or repetitive behaviors greatly interfere with daily functioning and make it difficult to cope with change. It is very difficult to redirect this person from fixated interests (Children's Hospital of Philadelphia, 2020, online; DSM-5, 2013). There are also additional assessments for genetic causes of autism (Fragile X Ayndrome, Rett syndrome), language development and level, intellectual disability, and the presence of autism-associated medical conditions such as seizures, anxiety, gastrointestinal disorders, and disrupted sleep (DSM-5, 2013). *Diagnosis & Prevalence of Autism* ================================== Often, it is families who first observe a developmental delay in their child. For example, their child may not be responding to their name, exhibit back and forth gestures (pointing, reaching, or waving), or playing with toys appropriately. Families may then seek professional advice and consultation and complete the Modified Checklist of Autism in Toddlers (M-CHAT). M-CHAT is a list of informative questions that seeks to gain specific information about their child. These answers help to determine if further evaluation by professional would be recommended or needed and serves as a guide for families. Currently, there are no medical tests that diagnose autism. A professional with expertise in autism (e.g., developmental pediatrician, child psychologist, psychiatrist, or neurologist) is often the one who makes the diagnosis of autism using APA's (2017) criteria that focuses on communication skills, social interactions, and stereotyped behaviors. The professional will administer a diagnostic tool for autism that is proven to be both valid and reliable, directly observe the child, and interview the parents to gather a complete history of the child. In addition both families and educators may be asked to complete a rating scale or checklist. It is important to note, when diagnosing autism---because of the broad range of characteristics---no one method of assessment is flawless. Four common assessment tools are described below: ***The Childhood Autism Rating Scale (CARS)***. CARS is one of the most widely used tools for diagnosing autism. It bases the results on parent report, as well as direct observation. The rating scale uses a 1-to-4 Likert Scale to assess 15 items (Schopler et al., 2009). ***Autism Diagnostic Interview-Revised (ADI-R) & Autism Diagnostic Observation Schedule (ADOS)**.* ADI-R and ADOS are used by trained professionals and ideally the results of the ADI-R are supplemented by the ADOS. First, the ADI-R is an interview (typically lasting 2 hours) of a family member or primary caregiver of the child with autism (Lord et al., 1994). Questions are related to the primary characteristics of autism. For the ADOS, a trained professional works with the child using a prescribed set of interactions that are designed to elicit the characteristics of autism (Lord et al., 2000). For additional information about the process of diagnosis and a list of additional tools for screening see https://www.cdc.gov/ncbddd/autism/hcp-screening.html Throughout the world, there has been a notable increase in the number of children diagnosed with autism. The first large-scale epidemiological study of autism was published in 1966, which reported the prevalence was 1 out of 2,500 (Lotter, 1966). Those rates remained comparable to the surveys conducted in the 1970s and 1980s. In studies published in the 1990s, the rate increased dramatically to 12.7 out of 10,000. In 2007, estimates of ASD ranged from 1 out of 1,000 to as high as 1 in 150. The Centers for Disease Control (2012) reported about 1 in 88 and, in 2021 reported about 1 in 44 children as having ASD. ASD is also 4 to 4.5 times more common in boys (1 in 34) than in girls (1 in 145) (Johns Hopkins Bloomberg School of Public Health, 2020). While the reason the disorder occurs more often in males than females is unknown, there are a several theories. This difference could be due to the fact (as with other disabilities) males are more biologically susceptible to neurological dysfunction or because professionals are quick to refer and/or diagnose males who display behaviors that are outside the typical range. Experience suggests, for example, girls with autism are better at masking their social confusion than boys and show more positive improvement to programs teaching social skills compared to boys (Koppe & Gilberg, 1992). The prevalence rate is also higher in European and American populations compared to Latinos or African American populations (Madell et al., 2009; Maenner et al., 2016). There are at least two possible reasons for the difference in prevalence across ethnic groups. One reason could be based on the access to better health care, and the other may be the bias to diagnose Latinos or African Americans with low IQs with an intellectual disability verses autism diagnosis. *Determining Causes* ==================== The proposed causes of autism have shifted throughout history and continue to be defined as understanding of the disability evolves with research. When first described in the late 1940s to early 1970s, the cause was primarily due to the lack of love and attention from the child's mother. The emotionally unavailable moms were often referred to as *refrigerator mothers*. Later, scientific-research established the cause of autism was unrelated to parenting (Bauman & Kemper, 2003). Today, autism is considered a neuro-developmental disorder and research on causes tends to be related to brain development and genetics. This section will specifically look at genetics, neurology, and development from pregnancy through early childhood. ***Genetics**.* Research has proven that the genetic component to autism is very strong (Sutcliffe, 2008). Parents who have one child with autism greatly increase the likelihood of having another diagnosed with autism. One study stated the chances are 15% greater that the younger child will also be diagnosed with autism (Sutcliff, 2008; Xueya et al., 2022). While numerous genetic links have been identified, the causal relationship is not fully understood. For example, if one identical twin has autism the other may not. Since identical twins share the same genes, another factor must be the cause (Interactive Autism Network, 2011). The current theory suggests the idea of complex inheritance. This means there are likely to be multiple genetic factors. Research has been consistent in saying a single autism gene does not exist. Multiple genes are involved and the same genes are not impacted in all individuals with autism (Xueya et al., 2022). ***Neurology**.* Research has also shown a clear neurological relationship in children with autism due to the high incidence of seizures and cognitive deficits (Volkmar & Pauls, 2003; DSM-5, 2013). Other research studies that included magnetic resonance imaging (MRI) have shown approximately 10% of children with autism (Gillberg & deSouza, 2002). A longitudinal review of historic MRIs has provided "valuable structural and functional information in understanding the neuropathophysiology of ASD and how the autistic brain changes during childhood, adolescence, and adulthood" (Rafiee et al., 2021, p. 1613). Another study found that 26% of student with autism also had epilepsy (Viscidi et al., 2013) and, according to the National Institute of Neurological Disorders and Stroke (NINDS), one third of children identified with autism and epilepsy have treatment resistant epilepsy (NINDS, 2023). Finally, neuropathological research studies have reported structural abnormalities within the brain that are connected to emotions (Bauman & Kemper, 1994; Rafiee et al., 2021) and to facial recognition (Jure, 2022) may play a role in helping to diagnose autism. In addition, the research suggests that children with autism have brain cells that exhibit the inability to communicate with each other (Glessner et al., 2009; Rafiee et al., 2021). **Genetic Disorders Classified under Autism Spectrum Disorders** ***Rett's Disorder**.* Rett's disorder is primarily found in girls, as it is an X-linked dominate disorder. The disorder does not occur until after the age of two. Normal development is reported during the first 18 months of life. However, as the child ages, development declines, and by age 10 a loss of at least two of the following skills has occurred: language (expressive or receptive), social skills, bladder control, and motor skills. Similar to autism, girls with Rett's disorder, have notable impairments in social interactions and communications. In addition, they have repetitive and stereotypic behaviors, such as hand wringing. There continues to be debate among some medical clinicians as to whether or not Rett's disorder should be included in autism spectrum disorders. **Fragile x Syndrome**. ***Fragile X Syndrome (FSX) happens when a single gene on the X chromosome fails to function or functions incorrectly, affecting a specific protein needed for brain development. Without that protein, the brain does not develop as it should. Both male and female children can be affected by FXS and more boys than girls are affected. FXS is most commonly categorized as an intellectual disability but there is a connection to autism (CDC, 2022). While there may be a delay in learning to speak, most are verbal and have good peer to peer interactions. Most boys affected by FXS and one-third of girls tend to have intellectual disabilities as well as emotional and behavioral issues. Life expectancy is within the normal range and most are active and have good health (FRAXA, 2023).*** ***Development from Pregnancy through Early Childhood**.* Little research has been conducted on the theories that cause autism during pregnancy and those that have been completed have had relatively small sample sizes. Some thought that viral infections cause autism. However, studies found no supporting evidence linking congenital rubella to autism, a common theory of the 1970s (Fombonne, 2001). Beversdorf (2005) reported a possible cause was a mother contracting the herpes virus during pregnancy and a young child contracting measles encephalitis and herpes encephalitis. Others are testing the effects of vitamin and mineral deficiencies, excessive hormones, and other prenatal agents as a possible cause (Erdogan et al., 2022; Loan et al., 2022; Sauer et al., 2022). Finally, vaccinations have been reported as a cause of autism. In 1998, an English physician, Andrew Wakefield, suggested the Measles-Mumps-Rubella vaccine led to regression in development and autism. This theory gained media attention around the world. However, there have not been any research studies that have established a correlation between immunizations and autism (Honda et al., 2005; Gabis et al., 2022). *Historical Perspective* ======================== A review of fairy tales and medical records suggests there have been individuals with autism throughout history. They were often referred to as *idiots*, *fools*, or possessed by the devil. Rarely, they were thought to be prophets or possessed by angels. It was not until the 1940s autism was recognized as a disability. More than 50 years have passed since a pattern of behavior was described as "early infantile autism" (Levy et al., 2006, p. 55). Since then, research has led to broadening the concept of ASD. In 1943, autism symptoms were first described and the disability was named by Leo Kanner, a child psychologist at John Hopkins Hospital in Baltimore. Kanner's discovery was based on his observation and work with 11 children (8 boys and 3 girls). A key finding from Kanner's work was distinguishing children with schizophrenia from those with autism. The word *autism* originated from the Greek word *autos,* which means self, implying a narrowing of relationships with others. A year later, in 1944, unaware of Kanner's work, Hans Asperger, a pediatrician in Vienna, used a similar term, autistic psychopathology, to describe a group of older children and adolescents (Wing, 1981). While their work was similar and happening at the same time, Asperger's work was virtually unreported in English speaking countries until the work of Lorna Wing in 1981. Wing, a London psychiatrist and parent of a daughter with autism, became highly respected in the field of autism with her books, articles, and conference presentations. In her paper published in 1981, she described 34 cases of children and adults (from ages 5 to 35) whose profile had greater resemblance to the characteristics described by Asperger compared to the descriptions made by Kanner. It was almost 40 years after Asperger's original research that Wing's work described his studies and gained notoriety and sparked interest. It was Wing who suggested naming the syndrome after Hans Asperger which became a new diagnostic category within the autism spectrum. However, the term Asperger's Syndrome was removed from the DSM-5 in 2013. A negative mark in autism history came in 1967 and was the result of the fraudulent work of Bruno Bettelheim which caused detriment to many children with autism and their families. Bettelheim claimed to be a student of Sigmund Freud. With his acclaimed, esteemed credentials, his skills as a writer (wrote the book *The Empty Fortress* in 1967), and his outgoing personality, he was awarded a faculty position at the University of Chicago. Later, he became the director of Orthogenic School (affiliated with the University), an institution that specialized in working with children with autism and their families (Jepson & Johnson, 2007). The treatment Bettelheim used was based on his theory the parents were cold and unfeeling, and their children's autism was a result of their lack of affection. Since his belief was that the parents' disorder caused the child's disorder, both received therapy. He separated the children from their families. While the children were in his residential school, the parents attended therapy sessions to cure their psychopathology (Sicile-Kira, 2004). Bettelheim's basic concepts about the causes of autism and his treatments became accepted and implemented both nationally and internationally (Sicile-Kira, 2004), but by the 1970s his theory on the causes and the treatment had proven ineffective (Jepson & Johnson, 2007). This caused him to resign from his faculty position at the University of Chicago and directorship of the Orthogenic School. Later, it was learned that Bettelheim had lied about his credentials and that he had misdiagnosed and abused a number of children (Jepson & Johnson, 2007). Bettelheim committed suicide in 1984. In 1964 Bernard Rimland, the father of a child with autism, published *Infantile Autism: The Syndrome and Its Implications for Neural Theory of Behavior.* The book proposed the causes of autism were related to neurological and genetic factors rather than a result of poor parenting. Rimland is also credited with founding the Autism Research Institute which has contributed significant amounts on autism over the last 40 years (Sincile-Kira, 2004). In 1987, psychologist Ivan Lovass, created a treatment known as applied behavior analysis (ABA). The treatment is discussed in detail in the strategies section below. It should be noted both Rimland and Lovass made a significant mark in the history of autism. Rather than finding a cure, both focused on understanding the disorder and developing treatment and improving the lives of children with autism. *Characteristics* ================= There are no physical characteristics of autism. The defining characteristics of ASD are primarily related to the differences in the child's language, communication, social skills, and behavior (APA, 2000; CDC, 2022). Although impacted in all three areas, no two children who have autism are the same (APA, 2000 and 2022). Therefore, it is important for educators and families to understand the characteristics of autism before thinking about interventions. "Interventions will be ineffective and often make matters worse unless others understand why these children learn and behave the way they do" (Janzen, 2002, p. 17). The remainder of this chapter will clarify how the child's language, communication, social skills, and behavior along with sensory and intellectual functioning are intertwined. *"On the Spectrum" What Does it Mean?* ====================================== Autism was identified as a spectrum disorder. What does that really mean? ASD belongs to an *umbrella* category of two pervasive developmental disorders discussed earlier in the chapter. These disorders share many of the same characteristics, but they differ in severity and impact. Each individual with autism is a unique individual and displays different degrees of the characteristics described below. Many individuals with autism have exceptional abilities in visual, music, mathematics, reading, memorization, or other academic skills. Some---about 50-60%---are also diagnosed with an intellectual disability (Baio et al., 2018). ***Communication & Language**.* Children with autism usually have a number of language impairments. Their language abilities cover a broad range from no-or-limited verbal language to quite complex verbal communication (National Research Council, 2001). Historically, many believed that only half of the children diagnosed with autism would develop the ability to communicate in meaningful ways using speech (Prizant, 1983). Today, with research-based teaching strategies and early intervention, 85-90% of children with autism learn to speak meaningfully (Koegel, 2000). Children with autism have difficulty with communication and language in the following areas: (a) focusing on one topic (e.g., often wanting to talk about their specific interest); (b) using natural gestures to support verbal language; (c) pronoun reversals; (d) echolalia---repeating the language they hear others use (immediately after it is said or delayed---repeating it at a later time); (e) expressive and receptive language (e.g., understanding literal & figurative language). One factor that impacts the communication and language of children with autism is the fact they neither watch people with intent nor do they automatically turn their heads toward sound. For children with autism, the complexities of language must be directly taught because they have difficulty applying meaning to their experiences naturally (Kodak et al., 2017). ***Socialization**.* When children are diagnosed with autism, families often think back to when their child was a baby or toddler and report they did not respond normally to being touched, cuddled, or picked-up. Some children with autism respond similarly to family members, teachers, and strangers rather than discriminating between the different relationships. Atypical social development is a key characteristic of autism. The APA (2013) has established two criteria for diagnosing atypical social development in children with autism: lack of (a) persistent deficits in social communications and social interactions across multiple contexts and (b) restricted, repetitive patterns of behavior, interests, or activities. Many children with autism have difficulty knowing the emotional state of others, expressing emotions, and forming relationships. Because children with autism have not fully developed awareness of their own beliefs, perspectives, and intentions, nor do they see how theirs' are different from others, they have difficulty in understanding the emotions and desires of others and their ability to show empathy (Baron-Cohen & Wheelwright, 2004). Children with autism often show deficits in joint attention which is a social skill that in typically developing children begins to emerge during infancy. Those early observational skills lead to following gestures and making eye contact or attending to something that is moving. When two individuals use gestures and eye gaze during conversation, it allows them to share their environment in the same frame of reference which is an important factor in language and social skill development. Lack of joint attention is one reason children with autism have difficulty learning from what is happening in the environment naturally. ***Behavior**.* There are several areas of behavior to address concerning children with autism. These areas of behavior are characteristic of the disability. For *all* children, behaviors are messages. However, for children with limited language and difficulty expressing their needs and wants, the messages behaviors send are extremely important for others to be observe and understand. In this section aggression and behavior, repetitive and unusual behavior patterns, and *sameness* and *perseverance* will be defined. ***Aggression & Self-Injurious Behavior*.** Aggression and self-injurious behavior are similar in that they cause harm. Aggressive behaviors are directed towards others and are problematic in all environments. Some children have self-injurious behaviors, such as head banging, biting, or scratching. These behaviors can continue into adulthood (Hyman & Towbin, 2007). Children with self-injurious behaviors run the risk of permanently causing harm. ***Repetitive & Unusual Behavior Patterns***. Repetitive and unusual behavior patterns are characteristic of children with autism. Repetitive behavior includes repeated movement or verbalizations. As discussed above, children may exhibit sterotypy which is a pattern of repetitive behaviors such as rocking their bodies when sitting, flapping or wringing their hands, humming, and sustained attention to objects such as clicking pens. A child may spend significant amounts of time engaged in these distracting behaviors that make it difficult to learn and participate in other activities. In addition, these behaviors are a social stigma which inhibits others from interacting with the child in a typical way and prevents the child from being included in school and community activities (Loftin et al., 2007; Callahan et al., 2023). ***Sameness & Perseverance***. Strict adherence to routines and insistence on sameness provide predictability, structure, and security for children with autism (Carruthers et al., 2020). When there is an interruption in normal routine (vacation or snow day), the child can become very stressed or anxious. In addition, they may have a need for items to be put in the same place all the time and get upset if items are moved. Insignificant changes in routine or placement can be significant causing *meltdowns* for some. ***Sensory**.* Sensory sensitivity (hypersensitive or hyposensitive) is an area of autism that is least known. Between 70%-to-80% of individuals with autism have difficulty or exhibit unusual reactions to sensory stimulations (Harrison & Hare, 2004; Timms et al., 2022). Individuals may be hypersensitive or hyposensitive to sensory input from the environment. Hypersensitive means the child is overresponsive. They are not able to stand certain sounds or can hear sounds others are unable to hear (e.g., *butterfly wings*). They may dislike touch or the texture of certain items. Because of taste, texture, or smell individuals may refuse to eat certain foods. The hyposensitive child is under responsive and appears oblivious to sensory stimuli that would typically gain a reaction (Timms et al., 2022). To an observer the child may seem deaf or blind. In fact, several diagnoses begin with hearing evaluations because a hearing loss is suspected. Some children with autism do not seem to feel pain. Finally, it is not uncommon for a child with autism to show a combination of both hypersensitive and hyposensitive responses to sensory stimuli. A child, for example, maybe hypersensitive to sound and not like loud noises such as a fire alarm, but hyposensitive to touch and not notice a cut after falling down. ***Generalization.*** Many children with ASD experience difficulty generalizing knowledge and skills from one environment to another (Theoharis & Fitzpatrick, 2014). While children with ASD may be able to memorize facts, there continues to be a disconnect, because they cannot apply the information they have learned to different individuals or in different settings. Families and teachers often express this as a concern and this is a reason a strong partnership between school, home, and community is so important. Strong partnerships enhance generalization abilities and the effectiveness of an intervention (Theoharis & Fitzpatrick, 2014; Timms et al., 2022). By ensuring the ability of strategies to be implemented in different contexts with different individuals and in different environments, helps to support the child's ability to generalize strategies, skills, and concepts (Buron & Wolfberg, 2008). ***Intellectual Functioning**.* ASD spans across a full range of intellectual abilities. However, epidemiological surveys show that as few as 35% (CDC, 2022) and as high as 70%-to-80% of those with autism meet the criteria for intellectual disabilities (Coolican, Bryson, & Zwaigenbaum, 2008) and half of those individuals who have an IQ score available are in the severe to profound range of intellectual disabilities. Some professionals differentiate those individuals with intellectual disabilities from those without using the terms low-functioning and high-functioning autism. Two other somewhat common intellectual functioning characteristics are splinter skills and savant syndrome (Meilleur et al., 2015). Between 10%-to-15% of children with autism exhibit splinter skills (CEC, 2022). Splinter skills are when a child demonstrates relatively superior performance that would be unexpected based on their abilities in other areas. Professionals estimate about 10% (no exact numbers are available) of individuals with autism have savant syndrome. Savant syndrome is when an individual has extraordinary ability in a specific area such as mathematical calculations, dates in history, or musical skills while functioning at an intellectual disability in all other areas (Heaton & Wallace, 2004). As noted above, some individuals with autism meet the criteria for intellectual disabilities, some cognitive processing problem seem to be specific to autism. Children with autism have difficulty coding and categorizing information (Scheuermann & Webber, 2002). Temple Grandin (2006), a professor of animal science at Colorado State University and an individual with ASD, coined the term *thinking in pictures* to describe a way of thinking for many individuals with autism. It is the difference in visual and spatial abilities compared to language and conceptual abilities. *Using Effective Instructional Strategies* ========================================== The practice of using unfounded interventions and strategies in the field of special education has always been a pervasive problem (Jacobson, Foxx, & Mulick, 2005; Paynter et al., 2022). In the history section, it was mentioned the tragedies unproven interventions could have on families and children with autism. Due to the broad range of challenges children with autism face and families longing for anything that might help (Maurice & Taylor, 2005), this diagnosis has opened the door to numerous exaggerated claims, fads, and cures. The Interactive Autism Network (2011) found that families were using 381 treatments for autism and some were using multiple concurrently (an average of 5). Many of these claims such as hormone injections, eating radical diets, listening to soothing sounds, brushing skin, and spending time in a room with colorful lights are unsupported by little or no evidence or research (Schribman, 2005). Families and educators of children with autism are extremely easy targets for these claims which offer fast and vast improvements or cures. Therefore, it is important for educators to be aware they are equally at risk to falling prey. Schools that use interventions and strategies that are not research-based run the risk of depleting financial resources, promoting families' unrealistic expectations, and slowing the child's progress (Zane et al., 2008; Paynter et al., 2022). Children with ASD have difficulty processing, understanding, and organizing information (Theoharis & Fitzpatrick, 2014; Mercado et al., 2020). Research has suggested interventions that work best for students with ASD are those that target specific areas of need, such as social skills, language acquisition, nonverbal communication, and behavior management. Focusing on these areas can greatly improve achievement and independence (National Research Council, 2001). Williams and Minshew (2010) reported that children with autism spectrum disorder need to develop explicit connections between visual and auditory information. By providing information in these formats, children are able to draw upon a permanent reference. Systematic organization with explicit connections between visual auditory information provides support for teaching and learning new tasks including skills that are social or behavioral. ABA, Social Stories^TM^, Power Cards, Visual Schedules, Picture Exchange Communication System (PECS), and Video Modeling are research based strategies that are visually based, aid in communication, and promote independence. ***Applied Behavior Analysis**.* ABA has proven to be effective direct instruction that is highly structured and focuses on teaching functional skills with continuous monitoring of progress. ABA uses a positive reinforcement behavior approach to teach skills systematically. Children are provided with repeated opportunities to practice what they have learned and generalize the skills across environments and with other individuals. ABA has a tremendous amount of evidence (more than any other treatment for children with autism) stating its effectiveness for individuals with disabilities including those with autism (Simpson et al., 2005). ***Social Stories^TM^**.* Carol Gray developed Social Stories^TM^ which has proven to be an effective tool with children with autism (Simpson et al., 2005). Social Stories^TM^ encourage appropriate behaviors and social skills. They are short simple stories (typically 5-to-10 sentences), that use a specific formula including descriptive, perspective, directive, affirmative, and partial sentences (Gray, 2000). Through text and pictures, Social Stories^TM^ describe a social situation (e.g., greetings, turn-taking, or waiting) and provide instruction on positive and appropriate social behaviors (Gray & Garland, 1993). Presenting social stories before a specific event can reduce anxiety, improve behavior, and increase awareness of others. ***Power Cards.*** Power cards provide a visual support that incorporates the child's special interest into a lesson on a social skill, routine, or hidden curriculum that the child needs additional support. Power cards present a scenario on one piece of paper. This short scenario is told from the perspective of the child's hero---or special interest. It describes how the hero would solve the problem. A small card, is then developed, the power card, recaps with the child could do in a similar situation. The small card includes short manageable steps that are easy for the child to remember and follow---the small card that includes the hero's picture serves as a visual reminder. ***Visual Schedules**.* Research has shown Visual Schedules are an effective tool for children with autism (Goodman & Williams, 2007; Springgs et al., 2007). Difficulty with transitions can greatly impede a child's ability to independently complete tasks across environments (Scheuermann & Webber, 2002). Visual Schedules assist children in transitioning independently from one activity to another and provide them with structure and predictability (Byan & Gast, 2000). Additionally they can be used in a variety of ways to meet the needs of individual students or groups of students. Using real objects, photographs, drawings, or words, they illustrate a sequence of events or the steps to complete an activity. By providing a visual of the day or the task to be completed, it enables children to predict what will happen next, reduces anxiety, and promotes peaceful transitions. ***Picture Exchange Communication System**.* PECS is away for children to communicate their needs and wants using pictures and does not require spoken language. It promotes self-initiated communication (Malandraki & Okalidou, 2007). While PECS was originally developed to use with young children, it has been proven effective for varying ages and developmental levels through adulthood (Malandraki & Oklidou, 2007). PECS provides away to teach the individual how to interact with another person, exchanging the picture of the desired item for the actual item. This process teaches the child how to initiate spontaneous communication in different environments and allows them to participate in cause-effect conversation (Malandraki & Okalidou, 2007). ***Video Modeling.*** Students with autism have difficulty initiating, maintaining and generalizing skills across environments. Video modeling provides students with a visual that shows the context and steps required for a desired behavior or task (Bellini et al., 2007). The children are shown a video of an ideal scenario of a situation or behavior, and then are prompted to imitate the model. Video models have been used to teach academic, social, communication, and behavior skills (Hitchcock et al., 2004). Research indicates video modeling maybe an effective tool for children with autism, since television is an engaging medium that does not require social interaction for learning (Daneshvar et al., 2003). Daneshvar and colleagues' research also suggested that video modeling may also result in faster generalization of skills. Video models offer a way to provide multiple ways of representing information with concrete real-life examples and support resulting in increased independence. *Summary & Conclusion* ====================== Autism is a complex disorder that impacts an individual's life in three areas: communication, socialization, and behavior. While autism is a life-long condition with no cure, a review of history illustrates the prognosis for individuals is much better today than in the past. Having an understanding of the causes, characteristics (knowing each child with autism is unique), and using research-based interventions and strategies promotes success, independence, and relationships.