Low-Functioning Autism

Working with Students (with Low-Functioning Autism)

These are some tips (principles) for working with students who are on the low-functioning end of the Autism spectrum. I pretty much had to learn this stuff by trial and error, since most of the readily available information on teaching students with Autism is geared towards the higher-functioning end of the spectrum. These are some basic principles that I had to arrive at on my own, so I can confirm that they are effective, but just the other day, I came across an article "Teaching Students Who Are Low-Functioning: Who Are They and What Should We Teach?" on Indiana University's Resource Center for Autism.

I've taken the liberty of adapting this material to the particulars of my own situation--working with Bob* (for instance, there's more info in the original about "behaviors", but Bob doesn't really have a lot of issues around behavior.:


1. Take lots of time to introduce and teach each new skill. Learning a new skill will take a lot of time and practice. Depending on the difficultly of the skill it may take anywhere from a few days to several weeks for the student to learn the skill and apply it consistently. Even when a skill seems mastered, the student will need to review and practice previously learned skills from time to time to ensure retention (use it or lose it).

When I'm introducing a new DT Lesson or a functional skill with Bob, I usually treat the first several sessions as "introductory" in nature. Depending on how abstract or difficult the task is, the introductory period may be a few days or a whole week. One thing I do is keep the initial introductions short. In DT, the new lesson usually comes after a review of a familiar topic (so that Bob has already had a "warm up").

Another key difference is that I use reinforcers more for "effort" at this time, not necessarily accuracy of response. When starting something new and difficult, motivation is more important than accuracy (you'll get there sooner or later). Once it becomes clear that Bob is starting to "get it", then I switch to using reinforcers for accuracy only.


2. Do not remove "supports" (particularly visual or environmental supports) when a task is mastered by the student. The student may always need certain supports to be successful at a given task. This is especially true if the support compensates for a student's motor or communication difficulties.

One of the hardest parts of working with Bob in the beginning was that I had no idea what his skill levels were, and what supports had been used in the past. Once his files turned up and I had his assessment information, I had a better idea of what he had done in the past, and what supports were being used before I arrived. Based on that information, I quickly realized for example that he would benefit from more visual supports (to facilitate transitions), and have been able to design and implement additional supports that have really helped him function more independently (fading much of the physical prompting).

3. Do not require the student to work on a single task for prolonged periods of time (a simple rule of thumb is 20-30 minutes max for the same task/sequence). It is wise to plan for small breaks throughout the day to give the student a chance to recharge between difficult tasks. Be prepared to shift activities when the student seems to be losing interest or focus (end a session while the student is still successful), and be sure to provide both easy and difficult tasks so that the student will experience both challenges and success during the sessions. A typical day should include significantly more opportunities to perform familiar tasks which promote security and positive/successful experiences, than to engage in new and challenging tasks all of the time.

I'm lucky that I work with a student who is surprisingly good at staying focused. Bob has an amazing ability to stay focused on instructional sequences for a non-verbal student with severe autism! This is good for me because we can really get a lot done during instructional episodes. But even he has his limits. Most days, I can count on anywhere between 20-30 minutes for DT. With pre-vocational skills, it varies, but sometimes he'll stay on task and focused for very long periods, on other days, 15 minutes is about the limit before he starts getting distractible.

Keep in mind that Bob is a high school student--younger children, I've noticed, do better with 5-10 minute instructional episodes, and need more frequent breaks. (I would never dream of asking a 6-year old kid in a CB classroom to do DT for 20 minutes!) For some students, just sitting still in a chair for a minute or so is an instructional goal. You have to start where your student IS. Once you have the sense for how long they can stay focused, you can gradually increase your instructional times. During instruction, it's a good idea to keep things focused on success--learning should be "fun" after all, and because it's so important, it's better to have lots of highly-successful but short session, than one long frustrating one. After all, you will be doing this EVERY DAY. If one day is a bit "off", you can always try again later.

4. Provide the student with clear information about the beginning and ending times of an activity sequence (this can be verbal/visual or both), and about the expectations and requirements of the task. To promote initiative/independence, avoid taking apart and/or redoing a task that the student perceives as "finished" (even the results are not perfect by your standards--this reduces student motivation). If additional practice is needed, intersperse it throughout the day rather than requiring sequential trial repetitions. (This is a good idea anyway, as it reduces fatigue.)

This is a very task-specific principle, and the way you apply it will look different for every student/every task. A lot of the information/cueing will be environmental in nature--that is events that occur naturally will determine what the student's response is (When X happens, you do Y).

Since I am working with a student who happens to have good receptive verbal skills, I "talk" my way through the things we are working on, using very consistent language.

Because Bob* has some fine motor skills deficits, I've had to determine what are realistic standards for "finished tasks", and how much "help" to offer. In general, I use the "close enough" principle, where consistency of effort is more important than absolute perfection. For instance, one of Bob's school jobs is to stack milk cartons on a tray in the cafeteria. Is he able to line them up correctly in neat orderly rows on the trays without assistance? Not at the present time. So instead of insisting on that, the current expectation is that the milk cartons make it onto the tray and in an upright position. Occasionally he'll make attempts to correct their position himself, so I would imagine that one day that will be something he'll be able to do himself. Do we need to get there by tomorrow? Not really, but I will certainly praise him every time he tries to do so. (Only once I take them out of sight to put them away in cold storage, do I turn them around so they all face the same direction...)

And speaking of standards, I've noticed that if a student is NOT being successful at something you KNOW they know they are able to do, there's often something going on at that moment that is interfering with their ability to perform the task (a distraction or physical discomfort). Often in this case, instead of insisting that the student "push on through" or "stay with it until they get it right", it's better to come back to the task later--even if it's just ten minutes later. Or if the problem is consistent, consider moving the instructional sequence to another time of day (the source of distraction could be related to the timing of meals or the effect of certain medications).

5. Embed communication into all aspects of the school day, and teach communication skills in their natural contexts whenever possible.

This is especially important for non-verbal students who rely on AAC systems to communicate. In order to encourage vocabulary development, you need to have "real things to talk about". Naturally this effort will begin in a clinical or classroom setting, but it should expand as soon as possible into other environments. In order to encourage the student to use their AAC system, they need communication partners and real topics. The most logical place to encourage both vocabulary development and desire to communicate is often right out there in the real world.

Practice communicating outside of the classroom when possible, and involve others (the family, the student's peers, other school personnel, people outside of school) whenever possible. The benefit is that you'll have a wider range of real communication topics, and give the student the idea that communication is not just something they do with their teacher at school!

6. Take time to teach essential skills in places and at times when skills are needed. For example, take time to teach students to put their coats on when it is time to go outside. Avoid the tendency to do essential life tasks for students while rushing to "get things done". While there are many time-based-expectations in the school setting, most are somewhat flexible and the student should be encouraged to accomplish tasks and transitions independently at his or her own pace. If time is of the essence, plan to begin transitions as early as needed, for the student to do them independently. Generally, avoid doing anything for the student what he/she can do for him/herself.

When you're working with students on the lower end of functioning, life skills or functional skills make up the bulk of the student's IEP goals and curriculum. They ARE important. Rather than view them as afterthoughts, these kinds of tasks should be viewed as the student's daily "performance-based assessments".

For these kinds of skills, mastery is critical, and accuracy is far more important than speed and efficiency. For example, would Bob get from point A to point B faster if I set the pace, held his hand, and guided him the whole way? Sure he would, but that's not in either of our bests interests. So even if it takes twice as long, I always insist that he walk on his own, at his own pace, and if he gets stuck, I wait to see if he'll get going again on his own before I do *any* prompting. The idea is to ALWAYS give the student the opportunity to do things on their own to encourage maximum independence (and reduce reliance on others).

For some tasks, the student may always need some assistance, but the level of assistance offered should be tailored to the student's strengths (and future potential to do the task independently). Maybe at this point in time, the student needs you to "start" the task, but they can finish it (or vice versa). This may eventually lead into the student gradually taking on more and more responsibility for completion of the task sequence, so you have to be on the lookout for those subtle signs of readiness.

The take home message, ultimately, is that the vast majority of students with Low-Functioning Autism should be viewed by educators as capable learners (who will make progress over time), so long as each student's individual characteristics (motivation and readiness) are taken into consideration during instructional episodes.

What progress looks like will vary considerably from student to student, but in my experience the teacher's attitude has a great deal of impact on how much progress a student will make. While there are many factors outside of teacher control, teachers DO have control over how they view and work with low-functioning students. Perception is everything here, and the teacher's attitude tends to be a self-fulfilling prophecy: if a student is viewed as incapable and helpless, then the student's outcomes will almost certainly reflect this. If the teacher encourages and models initiative, persistence, patience, and above all believes that the student is a capable learner who will make progress over time (at his or her own pace), one can expect to see those outcomes.

When in doubt, err on the side of believing in the student's abilities (it certainly won't hurt them any).

(adapted from: Pratt, C. & Stuart, R. (1997). Teaching students who are low functioning: Who are they and what should we teach. The Reporter, 2(3), 6-9.)