Autism spectrum disorder
The Diagnostic and Statistical Manual, Fifth Edition lists autism under autism spectrum disorder. Diagnosis is based on deficits in two domains: social communication and restrictive interests and repetitive behaviors. Diagnosis also takes into account the severity of symptoms displayed. The Individuals with Disabilities Education Act definition is relatively broad (see Autism, IDEA).
The Centers for Disease Control and Prevention recently revised its autism spectrum disorder prevalence estimate of one child per 110 children to one child per 88 children. Males are three to four times more frequently identified than females. Siblings of children with autism spectrum disorders are much more likely to be diagnosed than their peers without such siblings. The number of military-connected children with autism spectrum disorders is not publicly documented. The 2011 Individuals with Disabilities Education Act federal child count reported 455,339 children with autism spectrum disorders ages 2 through 3: more than double the number reported in 2005. Autism spectrum disorder is now the fourth most populous disability category.
The National Professional Development Center on Autism Spectrum Disorders, the National Autism Center and the Center for Medicare and Medicaid Services have developed lists of evidence-based practices for autism spectrum disorders (see Evidence-Based Practices Comparison Chart). Applied behavior analysis is the most extensively researched intervention. Applied behavior analysis' effectiveness for deficits such as speech/language delays and generalization of skills has been questioned. Proponents counter that applied behavior analysis is effective when properly planned and implemented. Teacher training requirements for autism spectrum disorders continue to be reviewed. Delaware, for example, now requires teachers assisting children with autism spectrum disorders to have an autism spectrum disorder endorsement.
Limited data on post-school outcomes for children with autism spectrum disorders is available, but it appears that relatively few individuals with autism spectrum disorders live independently or sustain full-time employment. Similarly, few attend and even fewer complete post-secondary education programs. As with all disabilities, effective secondary transition planning is critical.
The Diagnostic and Statistical Manual, Fifth Edition does not categorically define emotional/behavioral disorder, but does define associated conditions (such as anxiety disorder, depression and bipolar disorders). The Individuals with Disabilities Education Act's definition (see Emotional Disturbance, IDEA) focuses on five domains and does not require a clinical diagnosis. The phrases "long period of time" and "to a marked degree" are subjective but frequently defined as occurring for at least six months and across multiple settings (such as school, home and community).
The 2011 Individuals with Disabilities Education Act federal child count reported 373,152 children ages 3 through 21 identified with emotional/behavioral disorder, a decrease of 22 percent since 2005. Some researchers believe this is statistically low and that emotional/behavioral disorder is under-identified. Males are more frequently referred and identified than females. Children from under-represented populations and families with low socioeconomic status are more likely to be identified than their white peers.
Students with emotional/behavioral disorder experience few positive educational outcomes. While their reading and math skills are frequently closer to grade level than peers with other disabilities, they frequently earn lower grades (14 percent earned mostly Ds and Fs compared to 8 percent for other disabilities). A significant number experience learning disabilities resulting in a cycle of both academic and emotional deficits contributing to overall school failure. Students with emotional/behavioral disorder demonstrate a high dropout rate (55 percent) and few (20 percent) pursued post-secondary education. Only 30 percent were employed within three years of leaving school, much lower than the rate for students with learning disabilities. Students with emotional/behavioral disorder are more likely to become involved with the legal system.
Both individual and school-wide interventions, such as positive behavior support, are often used to assist students with behavioral concerns. Assistive technology tools ranging from low to high tech (checksheets to video game consoles) are often used as instructional tools or rewards/reinforcers.
The American Association on Intellectual and Developmental Disabilities defines intellectual disability as "...characterized by significant limitations both in intellectual functioning and in adaptive behavior, which covers many everyday social and practical skills. This disability originates before the age of 18." This is similar to the Individuals with Disabilities Education Act definition (see Intellectual Disability, IDEA). Adaptive behavior domains include communication, self-care and social skills. Until Rosa's Law was enacted in 2010, the term "mental retardation" was used in the Individuals With Disabilities Education Act and by some states. The change to intellectual disability represents, for many, a paradigm shift that emphasizes the fit between a student's capacities and the demands placed on them, as well as the supports the student requires for self-determination.
The Individuals with Disabilities Education Act 2011 federal child count reported 434,572 children ages 3 through 21 identified with intellectual disabilities, a decrease of 22 percent since 2005. Males are more frequently identified than females and children from under-represented populations and from families with low socioeconomic status are more likely to be identified than their white peers.
Students identified with intellectual disabilities demonstrate limited educational achievement. Only a small percentage enrolls in post-secondary education programs. Employment is low, with only 31 percent employed three years after leaving high school. Wages were generally low suggesting that this population may be underemployed. Relatively low rates of community participation and independent living were also reported.
Educational programs for students with intellectual disabilities have historically emphasized functional skill development and were often provided in segregated special education settings. While many believe functional skills are important, data increasingly suggests that students with intellectual disabilities demonstrate improved academic achievement when provided quality instruction using general education curricular materials in the general education classroom. Similarly, data suggests that students with intellectual disabilities can be successful in post-secondary education settings. The U.S. Department of Education's Office of Post-Secondary Education has established the Transition Programs for Students with Intellectual Disabilities to promote enrollment.
Evidence-based practices for students with intellectual disabilities include applied behavior analysis, instructional matching, functional communication and self-management strategies. Universal design for learning principles and incorporating assistive technology (computer-based learning, tablets and video game consoles) are also being promoted. Effective secondary transition planning is critical.
Both the No Child Left Behind legislation and Individuals with Disabilities Education Act encourage the use of evidence-based practices but do not define them. Researchers have attempted to develop evidence-based practice criteria, but conducting special education research is difficult due to:
- Number of Individuals with Disabilities Education Act disability categories
- Wide range of prevalence rates among disability categories
- Variability of student needs
- Variability of educational settings
Another challenge is creating guidelines for determining whether the research supporting a practice is sufficient. The Council for Exceptional Children and the What Works Clearinghouse have created widely-cited guidelines and lists of evidence-based practices.
Use of evidence-based practices
The extent to which evidence-based practices are being used in classrooms is unclear. One factor is whether evidence-based practices information and resources are readily available to teachers. Another is whether evidence-based practices materials (such as manuals and forms) are designed to allow teachers to implement evidence-based practices easily given their time constraints. To increase usage, many suggest evidence-based practice content must be further embedded into pre-service/in-service teacher preparation programs. Organizations such as the What Works Clearinghouse and the National Professional Development Center on Autism Spectrum Disorders have developed evidence-based practice training modules and supports to encourage usage.
Teachers often use some components of interventions to create a student's individualized education program. Critics suggest this eclectic approach results in no intervention being implemented as designed, which reduces its effectiveness. They further question whether school personnel have received sufficient training to implement multiple practices. Proponents suggest this approach allows school staff to create programs to meet each student's individual needs.
The National Secondary Transition Technical Assistance Center rates secondary transition practices as being evidence-based, research-based, promising and unestablished in order of rigor. They have also organized evidence-based practices according to the skill level being emphasized such as functional life skills or community participation, many of which are functional and very specific (such as purchasing skills).