But I don’t do autism

by Christina Borders, Ph.D.

Teachers of the Deaf are well-equipped for addressing the language, communication and literacy needs of students who are deaf/hard of hearing (D/HH). With the increase of autism spectrum disorders (ASD) in the D/HH population (now at a rate of 1 in 591), teachers are seeking out clear direction, especially when they consider new and challenging behaviors in the classroom. I often get frantic phone calls or emails from teachers stating, “but I wasn’t trained for this!” In order to offer some guidance to those who have not had experience or training in ASD or are unsure how to modify directly for students with both D/HH and ASD, I would like to suggest some starting points.

While the field of deaf education has been around for well over 100 years, the research in specific effective practices for students who are D/HH is limited. Contrarily, the field of ASD has 50 years rich in research that guide educational practices. For a listing and resources related to evidence-based practices in the field of ASD, visit http://autismpdc.fpg.unc.edu/evidence-based-practices.

Functions of Behavior

Understanding the “why” behind a behavior is paramount to understanding how to intervene and make change. Behavior is always communication. A teacher’s job is to identify what is being communicated or “the why.” There are four researched functions (the “whys”) of behavior (I use the acronym SEAT to remember them). Below is a table of these functions with a non-exhaustive list of possible observable behaviors. What is important to understand is that the majority of behaviors occur in order to gain or avoid one of these four things.

Function of Behavior Potential Observable Behaviors
Sensory Gain – spinning, hand-flapping, humming, toe-walking, smelling items, chewing

Avoid – covering eyes or ears, taking off clothing or shoes, eloping, physical outburst or tantrum

Escape Eloping, physical outburst, taking off hearing aids or implant, refusal
Attention Gain – tantrum, touching others, vocal outbursts

Avoid – eloping, covering eyes or avoiding contact, tantrum

Tangible Gain – grabbing item, tantrum

Avoid – throwing, tantrum, eloping

The process to identify the function (or multiple functions) a behavior is serving is known as Functional Behavior Assessment (FBA).  For step-by-step directions conducting an FBA, visit http://afirm.fpg.unc.edu/node/783.

Reinforcement

After you have identified the function of the behavior you would like to change, it is important to identify a flexible list of reinforcement items you can use to encourage (and increase) behaviors that are favorable and discourage (and decrease) negative behaviors. The consistent and immediate use of feedback is necessary to change behavior. In fact, behavioral theory states that a behavior cannot continue to occur if it is not reinforced2. Therefore, if you want a child to raise their hand and ask for a break rather than running out of the room, you must plan to reinforce the child as soon as they start to raise their hand. Effective intervention starts with selecting an appropriate behavior to replace the unwanted behavior.  Then reinforce the behavior you want to increase. The alternate behavior you select (in this case, raising hand) must be as easy and quickly reinforced as the negative behavior you would like to change (in this case, running out of the room).  For more information on how to differentially reinforce desired behaviors, visit http://afirm.fpg.unc.edu/differential-reinforcement.

Structure and Visual Supports

Students with ASD thrive when structure is embedded within their day. It allows for a clear understanding of expectations without the need for language processing. A great example is a clearly set-up classroom. If the room is clearly divided visually, the students will know what is expected in each area of the room. For example, the corner with the books and soft chairs is used for reading time. Additional visual supports, such as schedules, visual timers, independent work systems/stations and environmental labels can also increase predictability and consistency within the classroom environment. For additional information on how to incorporate visual supports in the classroom, visit http://afirm.fpg.unc.edu/visual-supports.

While there are many directions teachers can go to begin setting up their classrooms to increase success for D/HH students with ASD, there are some essential first steps. Additional information is available from the website and resources section listed below.

References

  1. Szymanski, C. A., Brice, P. J., Lam, K. H., & Hotto, S. A. (2012). Deaf children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42, 2027-2037. doi:dx.doi.org/10.1007/s10803-012-1252-9
  2. Skinner, B. F. (1938). The Behavior of organisms: An experimental analysis. New York: Appleton-Century.

Websites/Resources

http://autismpdc.fpg.unc.edu/evidence-based-practices

http://afirm.fpg.unc.edu/node/783

http://afirm.fpg.unc.edu/differential-reinforcement

http://afirm.fpg.unc.edu/visual-supports

Borders, C., Bock, S. J., & Probst, K. (2017). A review of educational practices for deaf/hard of hearing students with comorbid autism. Deafness & Education International. doi:10.1080/14643154.2016.1255416

Bruce, S., & Borders, C. (2015). Communication and language in learners who are deaf with additional disabilities: Theories, research, and practice. American Annals of the Deaf, 160(4), 368-384.  doi:10.1353/aad.2015.0035

Borders, C. & Bock, S. J. (2014, September 18).  Core Strategies for Supporting Children with Deafness and Autism Spectrum Disorders:  Part 1 [Webinar].  In Advanced Bionics Webinar Series.  Retrieved from www.advancedbionics.com.

Borders, C. & Bock, S. J. (2014, October 23).  Core Strategies for Supporting Children with Deafness and Autism Spectrum Disorders:  Part 2 [Webinar].  In Advanced Bionics Webinar Series.  Retrieved from www.advancedbionics.com

Bock, S. J., & Borders, C. (2013, December 11).  The impact of deafness on the use of EBPs for students with ASD: Part 1 [Webinar].  In TASN Autism and Tertiary Behavior Supports: Evidence-Based Practices Webinar Series. Retrieved from http://www.kansasasd.com/webinararchive.php

Borders, C., & Bock, S. J. (2013, December 18).  The impact of deafness on the use of EBPs for students with ASD:  Part 2 [Webinar].  In TASN Autism and Tertiary Behavior Supports: Evidence-Based Practices Webinar Series.  Retrieved from http://www.kansasasd.com/webinararchive.php

E-Learning Academy Modules – http://www.isrc.us/isrc-elearning-academy

Dr. Christy Borders is a leader in addressing the needs of students who are deaf/hard of hearing (D/HH) with additional disabilities, particularly autism spectrum disorders (ASD). She has spent considerable time identifying gaps in literature and potential interventions for use with this population of students. Christy’s research stems from personal classroom and clinical experiences that involved this particular population. She has extensive academic and clinical experience and training in serving students who D/HH and those with ASD. Her undergraduate and graduate degrees both focused on education of D/HH students. In addition, Christy has over 10 years of clinical, classroom, and administrative experience working with individuals with disabilities. She furthered her academic and research skills and experiences through doctoral studies in the area of special education in order to attain additional strategies for D/HH students who have comorbid disabilities. Dr. Borders’ research has focused on the interventions teachers of the deaf utilize with this population and differences in educational services with the presence of an additional disability.

4 replies
  1. Sydne
    Sydne says:

    Dr. Borders,

    Thank you for your insightful post about Autism in students who are also Deaf/Hard of Hearing. I was not aware of the increased prevalence of ASD in this population of students, but as ASD prevalence is increasing overall, I am not surprised it has increased in students who are D/HH. Your post leaves me curious as to the overlap of strategies between ASD and D/HH. You say teachers often feel unprepared to have a student with ASD in their classroom, however many of their communication needs may be the same. Do you think there is any specific training for these teachers to make them feel more at ease having a student on the spectrum in their class? As a current graduate student studying the education of students with multiple and severe disabilities, I am aware of the concepts you spoke about and have used them with my students in the past. I agree that selecting an intervention for a student is dependent on the function of that student’s behavior and would like to add another important component of reinforcement: choice. Having the ability to choose their reinforcement or having a preferred activity or toy as reinforcement is much more likely to have a positive effect on a child’s behavior. Thank you again for bringing these strategies to light for those unfamiliar with working with students with ASD.

    Reply
  2. Ali Fine
    Ali Fine says:

    Hello!

    I very much enjoyed reading your post. I am a current masters student at Teachers College, Columbia studying Severe and Multiple Disabilities and Applied Behavioral Analysis. I appreciate you bringing up how important behavior is and the why behind a child is performing a certain behavior. As part of my ABA coursework I learn a lot about functions of behavior and reinforcement. I intern at a school that implements ABA strategies and they rely heavily on reinforcement but eventually phase the children into social reinforcement. I have come across many teachers who do not believe in the use of reinforcement while research has shown how crucial and how imperative it can be in the development and progress of children. In addition, I did not know that there is an increase in prevalence rate among deaf and hard of hearing children and autism. From learning about that, I want to dive into some more research regarding this as I find it so fascinating. Do you think that teachers who are well trained to work with children with autism are also well trained to work with children who are deaf and hard of hearing?

    Thank you for your insightful post

    Reply
  3. Lia
    Lia says:

    Hi Dr. Borders,
    I thoroughly enjoyed reading your post regarding service of students who are diagnosed with autism spectrum disorders as well as deafness/hearing impairments. I am currently a graduate student studying severe and multiple disabilities special education with a focus on autism and intellectual disability. I was not aware of the increased prevalence of autism among students who are D/HH, and it was very fascinating to read about the intersection of these two disabilities. I am familiar with and have utilized the strategies that you mentioned, including the use of reinforcement to promote positive behavior and decrease undesirable conduct, clear and predictable scheduling and routines, and visual supports. I also appreciated your point that the implementation of effective interventions relies, in part, on the function of students’ behavior. You mentioned that many educators who typically serve students who are D/HH feel unprepared to teach students who also have diagnoses of autism. Because both populations of students require intensive support in the areas of language of communication, I wonder if the pedagogical methods are similar. How do you think teachers of D/HH students could be better prepared to teach students with autism? Is professional development sufficient, or should teacher-training programs require instruction and exposure to students with autism?

    Thanks so much for your ideas!

    Reply
  4. Ryan
    Ryan says:

    I found the “Function of Behavior” chart in this post particularly helpful. It is crucial to understand the function of the behavior before deciding how to respond to it. I also liked the idea of structural and visual support in the classroom. Since Deaf and HOH students are typically strong visual learners, having the classroom separated into different areas can provide visual cues on the expectations of what is to be done in each area. These suggestions are great for a new teacher who is not yet familiar with working with students with ASD. Thank you!

    Reply

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