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Autism spectrum disorder and literacy: Recent findings

Dr Kerry Hempenstall, Senior Industry Fellow, School of Education, RMIT University, Melbourne, Australia.
Each of my articles is available as a PDF at https://tinyurl.com/ybllyw7u


Interest in autism spectrum disorder has led us down numerous paths – and some culs de sac.

Eugen Bleuler in 1908 coined the term autism to describe just one severely withdrawn patient - autós meaning self in the Greek language - implying an inward focus that is reflected in difficulties with social interaction. From the 1940s, Asperger took a particular interest in the higher functioning individuals with autism, while Kanner’s work focussed upon the more severely affected. As to causation, Bruno Bettelheim claimed that maternal “coldness” was the cause of ASD. Intuition, rather than evidence, produced this outrageous proposition, yet, such was the influence of the psychoanalytic interpretations of human behaviour that this view remained influential for many years.

 

Since then, there have been many unproven assertions about its cause, such as mercury poisoning purportedly from MMR [measles, mumps, and rubella] vaccinations asserted by now disgraced anti-vaxxer and physician Andrew Wakefield. Other proposed causes have included television, power lines, nuclear power stations, mobile phone towers, sex position during conception, food allergies, air pollution, and environmental toxins. For a list of 43 mooted environmental causes, see Russell, Kelly, and Golding (2010).

Russell, G., Kelly, S., & Golding, J. (2010). A qualitative analysis of lay beliefs about the aetiology and prevalence of autistic spectrum disorders. Child: Care, Health, and Development, 36(3), 431-436. http://www.brown.uk.com/brownlibrary/russell.pdf

 

Forged by desperation, intuition, or cynical exploitation, non-evidence based treatments have proliferated. For example, the use of hyperbaric chambers, removal of purported heavy metals from the body (chelation), holding therapy, auditory integration therapy, secretin injections, wrapping in cold wet sheets, craniosacral therapy, cannabis, dolphin-assisted therapy, art therapy, music therapy, pet facilitated therapy, camel milk, and various dietary regimes.

“The second part of the text focuses on ‘Historical, Cultural and Psychological Issues.’ ‘History of Fad, Pseudoscientific, and Dubious Treatments in Intellectual Disabilities’, provides a captivating overview of the history of questionable treatments and key components of sound research methodology. Here is where several chapters analyze the most appalling illustrations of bad practice. They include: psychomotor processing, gentle teaching, sensory integration theory, auditory integration therapy, facilitated communication, nonaversive interventions, positive behavioral support, biological or alternative medical interventions, and energy based and paranormal-based therapies. The discussion outlines longstanding factors that can lead to practitioner acceptance without evidence of effective outcomes. ‘The Delusion of Full Inclusion’, is a must read as is ‘Explaining Gullibility of Service Providers Toward Treatment Fads.’ ‘Developmental Disabilities and the Paranormal’ explains why autism attracts dubious therapies. … In part five, ‘Intervention Specific Issues’, the writers offer detailed analysis of several questionable therapies in chapters titled ‘Sensory Integration Therapy’, ‘Auditory Integration Training’, Facilitated Communication’, ‘Positive Behavior Support’, ‘Non-aversive Treatment’, ‘Gentle Teaching’, ‘Pet Me, Sniff Me, Squeeze Me’, ‘Relationship Based Therapies’, ‘Old Horses in New Stables’, ‘The Gluten Free, Casein Free Diet’. … The contributing authors cover separate topics, but agree that interventions utilizing the principles of Applied Behavior Analysis have produced wide-ranging, long-lasting benefits to individuals with autism and ID.” (McKeithan, 2017, p.184)

Mckeithan, G. (2017). Review of: controversial therapies for autism and intellectual disabilities: Fad, fashion, and science in professional practice. International Journal of Developmental Disabilities, 63(3), 184-185.


“The desire for a quick fix or the many interventions that promise cures or rapid results lead parents, professionals, and policy makers toward unproven or ineffective interventions for individuals with autism spectrum disorder (ASD). Symptoms of ASD appear early in life and persist throughout the person’s lifetime. Although we have seen advances in the treatment of ASD, the cause remains widely unknown and this then leaves autism wide open for the development of a large number of interventions (Worley et al., 2014). The unfortunate truth is that these interventions are most often not subject to scientific inquiry and thereby are often used in the absence of any reported efficacy. Parents and children are potentially subjected to harm and, at the very least, a roller coaster ride of emotions as their hopes are raised and dashed again and again. It is of utmost importance that the public is educated about interventions for individuals with ASD and that interventions based in pseudoscience are not left unchecked and allowed to persist. The antidote to pseudoscience is education, critical thinking, and the use of the scientific method. Consumers must be critical of the “newest fad” touted by celebrities, professionals, or advocates of the intervention. At this time, it is well documented that treatments based in ABA [Applied Behavior Analysis] have the most research support and ideally should receive the most attention and promotion in comparison with the pseudoscientific interventions to which we previously referred. The responsibility of our community lies with the promotion of science-based interventions while educating others to have a critical lens toward unproven interventions.” (p.415)

McDonald, M.E., & DiGennaro Reed, F.D. (2018). Distinguishing science and pseudoscience in the assessment and treatment of autism spectrum disorder. In S. Goldstein & S. Ozonoff (Eds.), Assessment of autism spectrum disorder (p. 415–441). Guilford Press.


“The hope for an immediate and dramatic panacea for ASD leads many professionals, parents, and policy makers to unproven interventions. According to Favell (2005), when parents are looking for a treatment for their children, claims of quick, effortless, and easy interventions, although undocumented, can be more attractive, than the scientifically based approaches that don’t make the same claims. Interventions presented as Levels 1 and 2 with validated evidence for effectiveness, can be labor intensive and slow in yielding progress. As long as there is no definitive explanation for the growing number of cases of ASDs, new theories will be put forth and people will claim to have found a cure. The scientific and professional community’s responsibility is clear. In order for parents to be informed consumers and advocates for their child with autism spectrum disorders, the need for valid evidence-based practices has never been more critical.” (p.300)

McDonald, M.E., Pace, D., Blue, E., & Schwartz, D. (2012). Critical issues in causation and treatment of autism: Why fads continue to flourish. Child & Family Behavior Therapy, 34(4), 290-304.


“The “chicness” of an intervention should not be determined by its age or origins but by its effectiveness. Unfortunately, some interventions are considered chic for other reasons, including pretense that they do what they do not. Some interventions are considered chic by their proponents because they claim to allow people with disabilities to do something no one thought they could or to be something no one imagined they are. On closer inspection, the claims made about these interventions are found to be false; proponents falsely claim to make people with disabilities something they manifestly are not, falsely attribute behavior or ability to persons with disabilities, or grossly exaggerate individuals’ abilities. Such sham is characteristic of “faith healing,” particularly of physical or sensory disabilities, but it is most deviously, often shamelessly, practiced in cases of cognitive and emotional/behavioral disabilities. Perhaps the most familiar practice of disability chic related to cognitive function is facilitated communication (FC, now often relabeled “rapid prompting”). Its description and a review of related research are beyond the scope of this article. However, media coverage of FC, plus the fact that a dean of education (Douglas Biklen) at a major institution of higher education (Syracuse University) promoted and continues to promote it has made it an intervention considered chic by some (e.g., see Biklen, 2001; Engber, 2015; Jacobson, Foxx, & Mulick, 2016). The fact is that FC remains a chic intervention in some circles, even though the practice has been thoroughly debunked. It is considered an alternative means of communication on which The Association for Persons with Severe Handicaps (TASH) takes no position (Trader & Edwards, 2016). Promotion or acceptance of FC as a means of communication is a kind of science denial (Specter, 2009), pretense buttressed by individual belief. FC is considered legitimate only by extreme denial of scientific evidence and extreme adherence to an ideology considered superior to science. FC and other practices that some still consider chic are a matter of considerable frustration to those who see applied behavioral analysis as chic because it is grounded in evidence (see Foxx & Mulick, 2016; Jacobson et al., 2016; Travers, Tincani, & Lang, 2014). We see the TASH acquiescence to extremism in this case as equivocation at best, probably more accurately described as science denial.” (p.55)

Kauffman, J.M., & Badar, J. (2018). Extremism and disability chic. Exceptionality, 26(1), 46-61. DOI: 10.1080/09362835.2017.1283632


Often a claim, having been shown to be ineffective, returns in a new guise. For example, the Rapid Prompting Method (RPM) appears to represent a variant of the discredited Facilitated Communication approach.

“This systematic review was deemed empty and revealed no evidence in relation to RPM’s effectiveness meeting our inclusion criteria. The developers of RPM and its proponents have yet to fulfill the crucial burden of proof requirement demanded for novel interventions. Although lack of evidence does not necessarily demonstrate a lack of effect, until future trials have demonstrated safety and effectiveness, and perhaps more importantly, have first clarified the authorship question, we strongly discourage clinicians, educators, and parents of children with ASD from using RPM.” (Schlosser, et al., 2019, p. 8)

Schlosser, R.W., Hemsley, B., Shane, H. Todd, J., Lang, R., Lilienfeld, S.O., Trembath, D.M., Fong, S., & Odom, S. (2019). Rapid prompting method and autism spectrum disorder: Systematic review exposes lack of evidence. Review Journal of Autism and Developmental Disorders, 6, 403-412. https://doi.org/10.1007/s40489-019-00175-w


“FC involves a therapist (or facilitator) supporting the hand of a person with autism while a message is typed on a letter board. FC is widely acknowledged to be a pseudoscientific, unsafe, and unethical treatment for people with autism. RPM is a more recent intervention for people with autism that involves the facilitator holding and moving the letter board while the individual with autism moves their own hand. Those who espouse the perceived benefits of FC and RPM make strikingly similar claims of hidden intelligence and extraordinary communication abilities in people with autism following treatment. Conclusion: Clients, proponents, and practitioners of RPM should demand scientific validation of RPM in order to ensure the safety of people with disabilities that are involved with RPM.” (p. 219)

Tostanoski, A., Lang, R., Raulston, T., Carnett, A., & Davis, T. (2014) Voices from the past: Comparing the rapid prompting method and facilitated communication. Developmental Neurorehabilitation, 17(4), 219-223. DOI: 10.3109/17518423.2012.749952


So, the search for cause(s) continues in the science-based domain, as do the intervention attempts of those with a less-than-scientific persuasion. In the scientific research, the influence of genetics and gene-environment interaction are now major areas of interest.

“The first twin study of autism was conducted in 1977 on 11 identical and ten fraternal twins across Great Britain, where at least one of the twins had autism. Concordance for identical twins was 36%, compared to 0% for the fraternal twins.
While the study was only small in size, it provided the first evidence that autism may be genetic in origin. Since this pioneering study, more than a dozen further twin studies have confirmed this original observation.
The best current estimate is that there is a 50-80% concordance for identical twins and a 5-20% concordance for fraternal twins. This indicates a strong genetic component to the condition. The figure for fraternal twins – 5-20% – also represents the chance of a couple who already have a child with autism having a second child with autism (referred to as the “recurrence risk”).
Once scientists have established that the cause of a disorder is influenced by genes, the next task is to identify the exact genes that might be involved. However, after several decades of intensive research, scientists could find no one genetic mutation that all individuals diagnosed with autism shared.
It was these findings (or lack of findings) that led scientists to stop thinking of autism as one condition with one cause. They started viewing it as many different conditions which all have relatively similar behavioural symptoms.”

Whitehouse, A. (2016). What causes autism? What we know, don’t know and suspect. The Conversation, February 19, 2016. https://theconversation.com/what-causes-autism-what-we-know-dont-know-and-suspect-53977


What is the ASD prevalence in Australia and USA?

“In 2018: there were 205,200 Australians with autism, a 25.1% increase from the 164,000 with the condition in 2015. Males were 3.5 times more likely than females to have the condition, with prevalence rates of 1.3% and 0.4% respectively.” (Australian Bureau of Statistics, 2018)

Australian Bureau of Statistics. (2018). Disability, Ageing and Carers, Australia: Summary of Findings, 2018. https://www.abs.gov.au/statistics/health/disability/disability-ageing-and-carers-australia-summary-findings/latest-release


“This study aimed to provide an autism spectrum disorder (ASD) prevalence update from parent and teacher report using the Longitudinal Study of Australian Children (LSAC). The LSAC is a prospective cohort study of Australian children representative of the population with two cohorts: Kinder (birth year 1999/2000) and Birth cohort (birth year 2003/2004). … Parent-reported ASD prevalence in 2016 in 12-year-old children from the Birth cohort of the Longitudinal Study of Australian Children was 4.4%, and higher than the 2.6% in the earlier born Kinder cohort. The Birth cohort had a milder presentation with fewer social, emotional, and behavioral problems than the Kinder cohort. Milder cases of ASD are being diagnosed in Australia resulting in one of the highest reported prevalence rates in the world” (May, Brignell, & Williams, 2020, p. 821)).

May, T., Brignell, A., & Williams, K. (2020). Autism Spectrum Disorder prevalence in children Aged 12–13 years from the Longitudinal Study of Australian Children. Autism Research, 13, 821–827.


“The U.S. Department of Education (USDE, 2014) reported that more than 5.8 million children, or 8.4% of the total student population between the ages of 2 and 6, received services under IDEA Part B in 2012 (IDEA, 2004). Of these students receiving special education services, 40% were classified as having specific learning disabilities, 18% had speech or language impairments, 7% were diagnosed as having autism, and 7% were classified as having intellectual disabilities, with the remaining students falling into the categories of other health impairments, emotional disturbances, and all other disabilities combined (USDE, 2014).”

What’s happening with diagnosis of ASD and assessment issues?


“There have been significant changes in the way Autism has been defined especially in the last decade. The changes encompass criteria over a spectrum rather than individual diagnoses based on clusters of criteria. With these changes, there has been a push for earlier screening and diagnosis to be made to ensure individual impacted by the deficits have ample time and opportunity to receive the services they need. Additionally, with the changes that have come up, screening tools and assessments have also been changed and improved to assist with the increasing demand of early screening. Screeners have been created to help in primary care settings so physicians can gauge the severity of symptoms and refer patients to the appropriate resources. The assessment and diagnostic process for Autism involves a large battery including parental interviews and forms, the ADOS-II, and a multitude of other intellectual assessments to get a full picture of what the individual is experiencing. Once an individual is diagnosed with Autism, the interventionist team, physicians, and clinicians assist the family in finding the appropriate resources and treatment plan.” (p.66)

Chahin, S.S., Apple, R.W., Kuo, K.H., & Dickson, C.A. (2020). Autism spectrum disorder: Psychological and functional assessment, and behavioral treatment approaches. Translational Pediatrics (Neurodevelopmental and Neurobehavioral Disorders in Children), 9(1), S66-S75.


“Clendon et al. (2021) contribute to this forum with a tutorial on how to assess emergent and early literacy skills in children with ASD who have limited verbal communication skills. This group of children with ASD has been described as “the neglected end of the spectrum” (Tager-Flusberg & Kasari, 2013), partly because of the difficulties in valid assessment. The authors present a comprehensive emergent and early literacy assessment battery that was developed and trialed as part of a pilot project specifically for children with ASD who do not use verbal communication, with many of these children demonstrating an intellectual disability. In addition, the authors provide an overview of ASD-specific assessment considerations, summarized in an assessment preparation checklist, to assist clinicians in selecting appropriate assessment tools and providing appropriate supports during the assessment sessions (see also Paynter, 2015). The tutorial clearly highlights the need for a comprehensive, well-planned, individualized, and child-friendly assessment approach involving all members of the educational team.” (p.150)

Westerveld, M.F., & Paynter, J. (2021). Introduction to the forum: Literacy in autism-across the spectrum. Language, Speech and Hearing Services in Schools, 52(1), 149-152.


There is diversity among those with ASD

Dr. Stephen Shore is responsible for the famous quote: “If you’ve met one person with autism, you’ve met one person with autism.”

Dr. Stephen Shore “This quote emphasizes that there is great diversity within the autism spectrum. While the commonalities of people on the autism spectrum include differences in communication, social interaction, sensory receptivity, and highly focused interests, it’s important to understand that the constellation of these characteristics blends together differently for each individual. This is why some on the spectrum are good at mathematics while other may be good in their arts, sports, or writing – just like the rest of humanity. Autism is an extension of the diversity found in the human gene pool.”

Lime Connect. (2020). Leading perspectives on disability: A Q&A with Dr. Stephen Shore, 23/3/2020. https://ibcces.org/blog/2018/03/23/12748/


Adding to this diversity is the wide range of comorbid conditions affecting the ASD community. Apart from sex differences such as a male to female ratio of  4– 5:1, there are reported elevated rates of ADHD, schizophrenia, and epilepsy, gastrointestinal difficulties (including constipation and diarrhea), sleep disorders, autoimmune disorders, Type 1 diabetes, muscular dystrophy, and CNS/cranial anomalies (Supekar, Iyer, & Menon, 2017).

 

Supekar, K., Iyer, T., & Menon, V. (2017). The influence of sex and age on prevalence rates of comorbid conditions in autism. Autism Research, 10(5), 778-789. http://med.stanford.edu/content/dam/sm/scsnl/documents/the-influence-of-sex-and-age-on-prevalence-rates-of-comorbid-conditions-in-autism.pdf


This paper is largely focussed upon the issue of literacy with this population. Do children with ASD have particular problems with reading?

For an interesting series of 10 very recent articles on ASD and reading, see Language, Speech and Hearing Services in Schools: Literacy in Autism—Across the Spectrum (janvier 2021)at  http://www.cra-rhone-alpes.org/spip.php?article12249

 

First it is important to recognise that not all children with ASD will have difficulties with reading acquisition. However, studies suggest that an unnecessarily high proportion do so. They are a heterogenous group, varying across a number of characteristics relevant to reading. Providing only average figures across the various domains, thus, can be misleading.


“Children with Autism Spectrum Disorder (ASD) are at increased risk of failure in acquiring and developing adequate reading skills (e.g., Henderson et al. 2014; Westerveld et al. 2016). Although the majority of children with ASD show difficulties in reading comprehension, studies suggest as many as 50% of children with ASD struggle with reading accuracy, with some children not learning to read at all (Nation et al. 2006; Westerveld et al. 2018).” (p.3060)

Westerveld, M.F., Paynter, J., Brignell, A. et al. (2020). No differences in code-related emergent literacy skills in well-matched 4-year-old children with and without ASD. Journal of Autism and Developmental Disorders, 50, 3060–3065. https://doi.org/10.1007/s10803-020-04407-5


“Autism spectrum disorder (ASD) is an early-onset neurodevelopmental disorder characterized by social communication deficits and restricted, repetitive patterns of behavior or interests (American Psychiatric Association, 2013). … Beyond these core diagnostic characteristics, the clinical presentation of ASD is highly heterogeneous, although delays in oral language development are common and approximately 30% of children go on to develop only minimal verbal communication skills2 (Anderson et al., 2007; Kasari et al., 2013). Limitations in social communication and oral language development as well as other common comorbidities, including challenging behaviors and intellectual disability, have the potential to constrain academic participation and achievement for some children with autism (Jones et al., 2009; Randi et al., 2010). With an estimated 1% of children worldwide diagnosed with ASD and the potential for growing numbers due to underdiagnosis of girls,3 there is a pressing need to identify effective methods for improving educational outcomes for this population (Australian Bureau of Statistics, 2018; Baxter et al., 2015; Christensen et al., 2016; Elsabbagh et al., 2012; Kirkovski et al., 2013). It is well known that reading skills are linked with educational and other life outcomes. Reading can be an area of weakness for some children with autism (Frith & Snowling, 1983; Mawhood et al., 2000; Minshew et al., 1994; Nation et al., 2006). According to the “simple view of reading,” skilled reading requires the development and coordination of two distinct abilities: decoding and listening comprehension (Gough & Tunmer, 1986).” (p. 225-226)

Arciuli, J., & Bailey, B. (2021). The promise of comprehensive early reading instruction for children with autism and recommendations for future directions. Language, Speech and Hearing Services in Schools, 52(1), 225-238.


“Reading is arguably one of the most important skills children learn at school (National Early Literacy Panel, 2008). Although reading is sometimes highlighted as an area of relative strength for children with ASD (e.g., see review of academic skills by Keen, Webster, & Ridley, 2016), many children with ASD, even those with intelligence in the average range, show difficulties acquiring reading skills (Nation, Clarke, Wright, & Williams, 2006). For those who learn to read, up to 60% may show below average performance in reading comprehension (Ricketts, 2011; Ricketts, Jones, Happe, & Charman, ´ 2013). It is, therefore, important to acknowledge the literacy needs of children with ASD along with their social-communication needs. … There is a lack of strong epidemiological data regarding the proportion of children with ASD who experience reading difficulties, with the best current estimates of between 30–60% based on existing data (e.g., Jones et al., 2009; Nation et al., 2006; Ricketts et al., 2013). The estimated high proportion of children with ASD presenting with reading difficulties is not surprising, given that communication impairments affecting oral language and pragmatics are characteristic of ASD, with approximately 25–35% of children with ASD minimally verbal (i.e., little or no verbal communication) at school entry (e.g., Anderson et al., 2007; Rose, Trembath, Keen, & Paynter, 2016). Drawing from the simple view of reading, impairments in oral language clearly put children with ASD at risk of later reading challenges. In addition, rates of intellectual disability (approximately 30%) are elevated in ASD (Centers for Disease Control and Prevention, 2014), and the difficulties children with intellectual disability experience in skills — including reasoning, planning, and problem-solving — are likely to translate to difficulties across educational activities, including learning to read. Although the majority of children with ASD who show reading difficulties experience challenges in reading comprehension skills, with relative strengths in word recognition (Jones et al., 2009; Nation et al., 2006; Ricketts et al., 2013; Troyb et al., 2014), it is important to acknowledge the considerable individual differences in reading ability (Norbury & Nation, 2011).” (p. 205-207)

Paynter, J., Westerveld, M. F., & Trembath, D. (2016). Reading assessment in children with autism spectrum disorder. Journal of Psychologists and Counsellors in Schools, 26(2), 205-217. doi: doi 10.1017/jgc.2016.15


Aren’t students with ASD hyperlexic?

“Much research has focused on children with ASD having “hyperlexia” (i.e., precocious abilities to decode text that are incongruent with, and exceed, their reading comprehension abilities; Frith & Snowling, 1983). This contrasts with research findings that indicate a hyperlexic profile (i.e., strong decoding, poor comprehension) is not the most common (e.g., 25% in Nation et al., 2006) profile observed in children with ASD. These findings highlight the importance of including detailed assessment of word recognition skills in children with ASD rather than assuming this is an easily learnt skill. To illustrate, in our recent study (Westerveld et al., 2018) investigating the word reading abilities of 41 children with ASD who were in their first year of schooling, we found that 56% performed below expectations in reading accuracy on a standardized assessment of reading ability (York Assessment of Reading for Comprehension; Snowling et al., 2012).” (p.167)

Clendon, S., Paynter, J., Walker, S., Bowen, R., & Westerveld, M.F. (2021). Emergent literacy assessment in children with autism spectrum disorder who have limited verbal communication skills: A tutorial. Language, Speech, and Hearing Services in Schools, 52, 165–180.


“Reading can be an area of weakness for some children with autism (Frith & Snowling, 1983; Mawhood et al., 2000; Minshew et al., 1994; Nation et al., 2006). According to the “simple view of reading,” skilled reading requires the development and coordination of two distinct abilities: decoding and listening comprehension (Gough & Tunmer, 1986). This model captures the well-accepted fact that reading ability is underpinned by multiple componential skills. Many early studies of reading and autism focused on hyperlexia or precocious reading, where decoding skills seemed more advanced relative to comprehension skills or broader intellectual functioning (Burd & Kerbeshian, 1985; Calhoon, 2001; Grigorenko et al., 2003; Huemer & Mann, 2010; Lanter & Watson, 2008; Newman et al., 2007). However, more recent studies have pointed out the discrepancies in definitions of hyperlexia and the great variability seen in both the decoding and comprehension skills of children with autism (Arciuli et al., 2013; Norbury & Nation, 2011; Tong et al., 2019). As such, the topic of hyperlexia is less of a focus in the autism literature than it once was.” (p. 226)

Arciuli, J., & Bailey, B. (2021). The promise of comprehensive early reading instruction for children with autism and recommendations for future directions. Language, Speech and Hearing Services in Schools, 52(1), 225-238.


“Right posterior inferior temporal sulcus in hyperlexic reading. This extra-striate region has been implicated in visual form recognition (Tanaka, 1997), and our normative developmental study revealed that children developmentally disengage this area over the course of reading acquisition (Turkeltaub et al., 2003). Young children probably recruit these right extrastriate regions for early phases of reading, during which they use visual patterns or visual context to recognize words (e.g., a small word with a tail is “dog,” a word in a red hexagonal sign is “stop”) (Ehri, 1999; Frith, 1985; Hoien and Lundberg, 1988). Then, these areas are likely disengaged as children rely more on letter-to-sound correspondences and less on visual configural analysis to identify words. … the fMRI data do not support a memory-based mechanism for reading. (p.1)

Turkeltaub, P.E., D. L. Flowers, A. Verbalis, M. Miranda, L.Gareau & Eden, G.F. (2004). The neural basis of hyperlexic reading: An fMRI case study. Neuron, 41, 1-20.


Some have argued that children with ASD are visual learners, and any difficulties are best addressed by teaching them through some form of visually-based instruction.

“Many educators have found that children with one of the autism spectrum disorders may struggle with verbal instruction, or the decoding of a written text, but seem to thrive with instruction that incorporates anything visual, particularly visuals that correspond seamlessly with the text with which they are engaging” (Reading Eggs, nd).

Reading Eggs (n.d.). Retrieved from http://readingeggs.com.au/articles/2012/08/15/reading-and-autism/


“Because children with ASD have a greater propensity to learn through visual means than auditory-based teaching techniques, visually based strategies such as video modeling hold promise in positively impacting the learning of children with ASD.” (Ganz, Earles-Vollrath, & Cook, 2011, p. 17)

Ganz, J.B., Earles-Vollrath, T.L., & Cook, K.E. (2011). Video modelling: A visually based intervention for children with Autism Spectrum Disorder. Teaching Exceptional Children, 43(6), 8-19.


So, do the low progress children with ASD require a special form of reading instruction, such as one that eschews initial phonics in favour of strategies that shift the emphasis to the visual? Adopting this perspective may lead to a strong emphasis on whole word reading in beginning reading instruction to the detriment of ensuring a strong base of phonological skills. Would that be beneficial?

 

Some research has failed to find such a visual predilection among students with ASD.

“Children with autism spectrum disorder (ASD) are often described as visual learners. We tested this assumption in an experiment in which 25 children with ASD, 19 children with global developmental delay (GDD), and 17 typically developing (TD) children were presented a series of videos via an eye tracker in which an actor instructed them to manipulate objects in speech-only and speech + pictures conditions. We found no group differences in visual attention to the stimuli. The GDD and TD groups performed better when pictures were available, whereas the ASD group did not. Performance of children with ASD and GDD was positively correlated with visual attention and receptive language. We found no evidence of a prominent visual learning style in the ASD group. (Trembath, Vivanti, Iacono, et al., p. 3276)

Trembath, D., Vivanti, G., Iacono, T. et al. (2015). Accurate or assumed: Visual learning in children with ASD. J Autism Dev Disorders, 45, 3276–3287. https://doi.org/10.1007/s10803-015-2488-4


“The present study examined the learning curves in children with ASD, ADHD, VCFS and controls across repeated trials using the visual and word selective reminding tasks of the TOMAL. The main novel finding is that contrary to expectations, the ASD group demonstrated a relative weakness in visual learning compared to neurotypicals and children with ADHD, and this does not appear to be accounted for by differences in general visuo-spatial abilities as children with ASD demonstrated similar nonverbal intellectual skills as the neurotypical and ADHD sample.” (Erdodi, Lajiness-O’Neill, & Schmitt, 2013, p.886)

Erdodi, L.A., Lajiness-O’Neill, R., & Schmitt, T.A. (2013). Learning curve analyses in neurodevelopmental disorders: Are children with autism spectrum disorder truly visual learners? Journal of Autism and Developmental Disorders, 43, 880–890. doi: 10.1007/s10803-012-1630-9.


However, even if it were true that students with ASD were more visually-driven, it doesn’t necessarily follow that instruction should thus focus on whole word reading and picturing strategies. It can also be interpreted that the phonological domain requires more intensive, evidence-based instruction for skilled reading to occur, just as it is usually the case with struggling neurotypical readers.

As a general principle, effective reading programs tend to be shown to be effective for all children rather than only for specific groups (Goyen, 1992; O'Neill & Dunlap, 1984). Perhaps this is because the task itself is a more productive curriculum focus than are differences in learner characteristics. So, attention to the methods shown to reflect current knowledge about reading development and instruction appears to be the most apt direction.

 

Goyen, J. (1992). Diagnosis of reading problems: Is there a case? Educational Psychology, 12, 225-237.

 

O'Neill, R., & Dunlap, G. (1984, Spring). DI principles in teaching autistic children. Direct Instruction News, 3(3), 21.

 

“More recent research has focused on confirming that similar skill sets contribute to successful reading in children with and without autism (e.g., Dynia et al., 2017; Jacobs & Richdale, 2013; McIntyre et al., 2017; Nash & Arciuli, 2016; Ricketts et al., 2013). However, at least some of the reading difficulties experienced by children with autism can be attributed to more distal factors, including the nature of children’s literacy experiences and the type and quality of reading instruction…. Similarities in the skills underlying reading for children with and without autism have prompted researchers to investigate whether children with autism can benefit from the same kind of evidence-based reading instruction that is helpful for any beginning, at-risk, or low-progress reader.” (p.226)

Arciuli, J., & Bailey, B. (2021). The promise of comprehensive early reading instruction for children with autism and recommendations for future directions. Language, Speech and Hearing Services in Schools, 52(1), 225-238.


“The present paper firstly confirmed prior research [8,9,22] by showing a great heterogeneity (from floor to ceiling levels) in literacy skills in this sample of 12-year olds with ASD without ID. Importantly, though, there were significantly increased rates of poor reading comprehension and reading fluency in our study cohort compared with population norms. The crosssectional results obtained in the study also support the notion that different language/cognitive skills are uniquely predictive of different literacy subskills. These findings are important as they detail the language/cognitive background factors associated with each of the important literacy skills analyzed in the study. Interestingly, when it comes to the relative importance of the language/cognitive skills in predicting literacy scores, the pattern of results is likely to be familiar to many general reading researchers (i.e. outside the context of autism) (c.f., 3,7]. Thus, literacy seemed to be supported by many of the same underlying subskills in children with ASD as in non-ASD children. As pointed out by Bailey and Arciuli [14], potentially important issues are at stake in this context, because if there are similar concurrent predictors of literacy and literacy problems in children with ASD, then there are greater reasons to assume that standard models of (remedial) literacy instruction might be helpful also for children with ASD. From clinical and educational perspectives, this also highlights the importance of assessing literacy skills in students with ASD so that pedagogic interventions can be provided for those in need of it – instead of assuming that any literacy problems are secondary or “just part of the autism.” Besides support for general phonological models of spelling and word reading accuracy [4,7], we observed a clear and distinct association between RAN and reading fluency, also in keeping with a large general literature on children’s literacy development [23]. Besides phonological awareness, also semantic processing, indexed by listening comprehension capacities, made a unique contribution in predicting word reading accuracy and spelling, which align well with predictions from the lexical quality hypothesis [5]. Finally, for reading comprehension, we found it to be statistically predicted mainly by listening comprehension. Also this finding is in line with a widely accepted general model of reading comprehension, namely the simple view of reading [24], which predicts that reading comprehension capacities in individuals with adequate word reading skills (accuracy and fluency) will closely mirror listening comprehension.” (p.3, 4)

Johnels, J.A., Fernell, E., Kjellmer, L., Gillberg, C., & Norrelgen, F. (2021). Language/cognitive predictors of literacy skills in 12-year-old children on the autism spectrum. Logopedics Phoniatrics Vocology, DOI: 10.1080/14015439.2021.1884897


There is also support for this position arising from some of the neuroscience findings, such as from Dehaene (2009, 2020).

“It simply is not true that there are hundreds of ways to learn to read […] when it comes to reading we all have roughly the same brain that imposes the same constraints and the same learning sequence” (p. 218) - “… all children regardless of their socioeconomic backgrounds benefit from explicit and early teaching of the correspondences between letters and speech sounds. This is a well-established fact, corroborated by a great many classroom experiments. Furthermore, it is coherent with our present understanding of how the reader’s brain works” (Dehaene, 2009, p. 326).

Dehaene, S. (2009). Reading in the brain: The science and evolution of a human invention. New York: Viking/Penguin.


“Rescind the idea that all children are different. The idea that each of us has a distinct learning style is a myth. Brain imaging shows that we all rely on very similar brain circuits and learning rules. The brain circuits for reading and mathematics are the same in each of us, give or take a few millimetres-even in blind children. We all face similar hurdles in learning, and the same teaching methods can surmount them. Individual differences, when they exist, lie more in children’s extant knowledge, motivation, and the rate at which they learn. Let’s carefully determine each child’s current level in order to select the most relevant problems-but above all, let’s ensure that all children acquire the fundamentals of language, literacy, and mathematics that everyone needs” (Dehaene, 2020, p.240-241)

Dehaene, S. (2020). Why brains learn better than any machine . . . for now. Penguin Publishing Group.


Having pointed to the general instructional direction, what modifications may be specific to this diverse cohort remains an important focus for research?

“Generally speaking, instruction should be individualized in line with profiles of weaknesses, strengths, and interests in children with autism in order to be optimally effective (e.g., Trembath & Vivanti, 2014). In the case of reading instruction, for instance, foundational phonemic awareness and phonics skills should be targeted as a matter of priority for children with autism who have very limited decoding skills, although opportunities to develop reading comprehension, vocabulary, and fluency skills should also be made available to each individual at some point and tailored (e.g., questions in reading comprehension activities could be tailored to match children’s oral language abilities). (p.231)

Arciuli, J., & Bailey, B. (2021). The promise of comprehensive early reading instruction for children with autism and recommendations for future directions. Language, Speech and Hearing Services in Schools, 52(1), 225-238.


 Apart from the phonological domain, another potential area of need for intervention is reading comprehension.

“To gain a broader understanding of the reading capabilities of children representative of the autism spectrum, Nation et al. (2006) examined the reading skills of 41 children with ASD ages 6–15 including 16 identified with autism, 13 with pervasive developmental disorder not otherwise specified (PDD-NOS), and 12 with Asperger syndrome. Inclusion criteria included “measurable language skills” even if language skills were limited. Children were assessed on measures of single word recognition in isolation, pseudoword or nonword recognition, text reading accuracy, and text comprehension; on average, they demonstrated good word reading ability and poor comprehension. Their vocabulary and oral language comprehension scores were highly correlated with their scores on the reading comprehension measure (i.e., .72 and .67 respectively). However, the authors noted large individual differences in performance with some children scoring far above average, and others unable to complete the task. This level of variance demonstrates the heterogeneity in reading ability across the autism spectrum, and suggests using caution when interpreting mean scores for this population of students (Nation et al.). Another study specifically examined the degree to which students with ASD could master phonics rules. Calhoon (2001) studied the word recognition skills of ten children with autism who obtained varied IQ scores ranging from 60 to 100, and were able to identify sight words on a second grade level at the onset of the study. The author assessed each child’s understanding of word parts, grapheme-phonemes, onsets and rime, and recognition of high frequency words. Results indicated that the children had developed phonics skills and that they attended to word parts that provide cues such as rimes. The author suggested phonics instruction that encompasses word families, word parts, and structural analysis (e.g., prefixes and suffixes) may prove beneficial for students with autism. Two further studies have shown that children with Asperger syndrome who developed grade level decoding skills could comprehend material containing factual information, but had trouble making inferences (Griswold, Barnhill, Myles, Hagiwara, & Simpson, 2002; Myles et al., 2002).” (p.1-2)

“Because of the unstable reading profile associated with ASD (Nation et al., 2006), some learners will have difficulty developing both word reading and comprehension skills. Therefore, it is important that reading instruction emphasize both code- and meaning focused skills. Although limited in number and variable in quality, the reviewed studies indicate that children with ASD can benefit from instruction in the five areas of reading recommended by the NRP as well as NRP advocated strategies. In combination these studies yield support for comprehensive reading instruction to include the five areas of reading with a focus on reading/language comprehension in the early grades. Children with ASD may benefit from phonics instruction consistent with the NRP and offered through general education curriculum. For example, the NRP suggested teaching students how to identify sounds in words (i.e., phonemic awareness), map those sounds to each corresponding letter (i.e., phonics), and blend those sounds together to form words (NICHD, 2000). This approach is used in many comprehensive commercial reading programs (e.g., Reading Mastery, Open Court), and is similar to the nonverbal reading approach utilized in the Coleman et al. study (2005). Such approaches are direct and should be taught systematically by introducing all primary sound-letter relationships in a logical and sequential manner (e.g., teaching individual consonant and vowel letter sound relationships prior to blends and digraphs; Ehri, 2004).” (p.10-11)

Whalon, K.W., Al Otaiba, S., & Delano, M.E. (2009). Evidence-based reading instruction for individuals with Autism Spectrum Disorders. Focus on Autism and Other Developmental Disabilities, 24(1), 3–16.


“We conducted a search for scientific articles published from 2000 to 2019 using the keyword “autis*” in combination with the terms “reading comprehension” and “intervention” or “instruction” in Psyc Info and Scopus databases. After applying inclusion and exclusion criteria, a total of 25 studies were selected. The content analysis of these studies shows that when specific interventions are carried out, students with ASD are able to take advantage of the instruction they receive and compensate for difficulties. Understanding inferences and the main idea of the text are the most common reading comprehension topics, and direct instruction is the most widely-used intervention method in the reviewed studies. … In addition, reading comprehension is conditioned by pragmatic characteristics and language comprehension, such as understanding metaphors, jokes, and ironies, making inferences, understanding idioms, or understanding meanings whose interpretation depends on the context. These issues are challenging for students with ASD, even for those with preserved linguistic and cognitive abilities, as in Asperger Syndrome (AS) (level 1 ASD, according to the DSM-5 criteria) [10]. Due to the great heterogeneity in the presentation of the clinical forms of autism, the possible comorbid difficulties, or the age of onset of the first signs and their evolution [11,12], the reading comprehension difficulties can vary in their severity and intensity in students with ASD [13]. Some possible explanations for these difficulties in reading comprehension are the classic theoretical explanations for ASD [14]. For instance, the theory of weak central coherence [15] states that people with ASD have difficulties integrating elements they perceive in isolation into a whole, an essential skill for construction meaning in reading comprehension; the theory of executive dysfunction [16] explains some of the characteristics of ASD based on difficulties in processes such as inhibition, working memory, or planning, key processes in reading comprehension; also, the theory of mind [17] explains some of the difficulties people with ASD have in attributing intentions or mental states in others, a key skill for understanding narrative texts. … The results show that a large number of studies used direct instruction, some of them as the only technique [27, 30–33, 40, 41] and others as a part of the intervention [26]. Direct instruction consists of a teaching approach based on breaking down tasks into sequences of more concrete steps with the aim that students acquire the different skills worked in sequence. It is an approach that emphasizes the structuring of the teaching processes through scripts that guide the teaching process. The results of this review confirm that, according to previous reviews [14,20], this is a positive methodology for teaching school content to children with ASD, considering that these children need individualized attention, and that this systematic methodology is particularly well adapted to the order and structuring needs of students with ASD.” (p.1, 8)

Tárraga-Mínguez, R., Gómez-Marí, I., & Sanz-Cervera, P. (2021). Interventions for improving reading comprehension in children with ASD: A systematic review. Behavioral Sciences, 11(3), xx https://doi.org/10.3390/bs11010003


“Prior research indicates that reading comprehension skills in individuals with ASD align with oral language skills, as well as ASD symptomatology and social communication impairments (McIntyre et al., 2017; Ricketts et al., 2013; Solari et al., 2019). Higher-order cognitive and linguistic comprehension skills such as narrative production and inferencing are linked to proficient reading comprehension and have been shown to be challenging for many individuals with ASD (Norbury & Bishop, 2002; Tirado & Saldana, 2016). In this sample of chil- ~ dren and adolescents with ASD without ID, narrative and inference skills displayed differential patterns of growth. Narrative retelling skills followed a linear trajectory of improvement and standardized means increased from performance in the below average range at TP1 to the average range at TP3, which is an encouraging finding. This growth was not observed for inference skills for which standardized means were more than one standard deviation below average at TP1 and declined further by TP3. Lexical-semantic knowledge explained significant heterogeneity in initial narrative and inference skills, while ASD symptomatology explained additional variance in initial narrative skills and age contributed to variance in initial inference skills. Finally, reading comprehension skills at TP3 were below average and were significantly related to TP1 narrative and inference skills in this sample. Each of these findings is discussed in more detail below. … These findings suggest that narrative and inference skills, in addition to lexical-semantic knowledge, are important to target beginning in elementary grades to improve reading comprehension outcomes for children and adolescents with ASD without ID.” (p.10, 2)

McIntyre, N.S., Grimm, R.P., Solari, E.J., Zajic, M.C., & Mundy, P.C. (2020). Growth in narrative retelling and inference abilities and relations with reading comprehension in children and adolescents with autism spectrum disorder. Autism Dev. Lang. Impair, 5, doi: 10.1177/2396941520968028


“Students with ASD can learn to read, but their disability may provide distinctive challenges for comprehending text. For example, theory of mind, which is the ability to understand or take the perspective of others (Baron-Cohen, Leslie, & Frith, 1985), and weak central coherence, the ability to understand the context or see the bigger picture (Hill & Frith, 2003), have been used to explain the difficulties that students with ASD have with comprehension (Carnahan, Williamson, & Christman, 2011; McIntyre et al., 2017; Ricketts, Jones, Happé, & Charman, 2013). Some students with ASD may lack theory of mind, which can affect their ability to understand characters’ perspectives, emotions, and actions when reading a text (Carnahan, Williamson, & Haydon, 2009). Similarly, having weak central coherence may negatively affect understanding of literary elements such as plot because it requires knowledge of the all the characters and events in the text, as well as the ability to make connections across multiple pieces of information. Specifically, in reading comprehension, students with ASD may be focused on insignificant or irrelevant details of the narrative rather than the global picture (Carnahan et al., 2011).” (p.2)

Chang, Y-C., Menzies, H.M., & Osipova, A. (2021). Reading comprehension instruction for students with autism spectrum disorder. The Reading Teacher, 0(0), 1–10


“Studies conducted between 1980 and 2012 with K-12 students identified with autism spectrum disorders (ASD). Nine single-subject design studies, one quasi-experimental study, and two single-group design studies met the criteria for inclusion. Findings from the studies indicate that modifying instructional interventions associated with improved comprehension for students with reading difficulties may improve reading comprehension in students with ASD. Four studies implemented strategy instruction that included (a) question generation; (b) graphic organizers; and (c) making predictions. Two studies utilized anaphoric cueing instruction, three implemented explicit instruction, and three examined student grouping practices. Among the reviewed studies, the majority (n = 9) measured reading comprehension through researcher-developed probes, and two studies reported results from standardized measures.” (p.1303)

El Zein, F., Solis, M., Vaughn, S., & McCulley, L. (2014). Reading comprehension interventions for students with autism spectrum disorders: A synthesis of research. Journal of Autism and Developmental Disorders, 44(6), 1303-1322. doi: 10.1007/s10803-013-1989-2


“The validity of using standardised assessments with children with ASD is commonly queried in school contexts; however, standardised assessments can be administered validly with children with ASD (Reisinger, Steiman, Ferencz, & Sattler, 2014). Understanding the symptoms, common challenges and comorbidities associated with ASD can assist professionals in choosing appropriate assessment tools, as well as in preparing for, and conducting, an assessment in a manner that gives the best opportunity for a valid assessment. A typical assessment would include interviews with parents/caregivers, teachers, and the child (as appropriate to developmental level), observation, standardised assessment, and referral for medical/genetic/audiological examinations as indicated by observations or interview information (Reisinger et al., 2014).” (p.106)

Paynter, J. (2015). Assessment of school-aged children with autism spectrum disorder. Journal of Psychologists and Counsellors in Schools, 25(1), 104–115.


Can other educational domains areas be negatively affected?

“In a referred sample of 741 children, LD in written expression was found in 62% with ADHD and 60% with autism (Mayes & Calhoun, 2006a). Relatedly, most children with ADHD and most children with autism have dysgraphia or impaired handwriting legibility.” (p.69)

Mayes, S.D., Waschbusch, D.A., Calhoun S.L., & Mattison, R.E. (2020). Correlates of academic overachievement, nondiscrepant achievement, and learning disability in ADHD, Autism, and general population samples. Exceptionality, 28(1), 60-75. DOI: 10.1080/09362835.2020.1727324


“Meta-analysis (Finnegan & Accardo, 2018) of writing skills found handwriting of individuals with ASD is larger than the handwriting of typically developing peers. Individuals with ASD also scored lower on measures of legibility and spelling. Compared to TD peers, individuals with ASD wrote at a slower rate and wrote less. Content scores assessed on rubrics were significantly lower.” (p.74)

Finnegan, E.G. (2019). Literacy instruction for students with autism spectrum disorder in inclusive settings. DADD Online Journal, Journal of the Division on Autism and Developmental Disabilities, Council for Exceptional Children, 6(1), 72-88.


In summary, it is important to assess the emergent and early literacy skills of children with ASD - don't assume. At this stage there is no reason to believe that instructional methods that work well for children with language disorders (e.g., systematic explicit intensive approaches to phonics / phonological awareness, etc.) should not work for children with ASD. Although this answer focuses mainly on early print-related literacy skills, for children with ASD who do learn to decode, reading comprehension may still be compromised - some interesting new research is emerging and reported on in systematic reviews:

 

Direct Instruction has proved useful in a number of studies, as has a focus on comprehension strategy instruction.

“Children with autism spectrum disorder (ASD) often have comorbid learning difficulties in reading comprehension, an essential skill in accessing any area of the curriculum. The aim of this systematic review is to analyze the effectiveness of reading comprehension interventions in students with ASD. … After applying inclusion and exclusion criteria, a total of 25 studies were selected. The content analysis of these studies shows that when specific interventions are carried out, students with ASD are able to take advantage of the instruction they receive and compensate for difficulties. Understanding inferences and the main idea of the text are the most common reading comprehension topics, and direct instruction is the most widely-used intervention method in the reviewed studies. … The results show that a large number of studies used direct instruction, some of them as the only technique [27, 30–33, 40, 41] and others as a part of the intervention [26]. Direct instruction consists of a teaching approach based on breaking down tasks into sequences of more concrete steps with the aim that students acquire the different skills worked in sequence. It is an approach that emphasizes the structuring of the teaching processes through scripts that guide the teaching process. The results of this review confirm that, according to previous reviews [14,20], this is a positive methodology for teaching school content to children with ASD, considering that these children need individualized attention, and that this systematic methodology is particularly well adapted to the order and structuring needs of students with ASD.” (p.1, 8)

Tárraga-Mínguez, R., Gómez-Marí, I., & Sanz-Cervera, P. (2021). Interventions for improving reading comprehension in children with ASD: A systematic review. Behavioral Sciences, 11(3). https://doi.org/10.3390/ bs11010003


“As the number of students with Autism Spectrum Disorder (ASD) being prepared for statewide assessment rises, there is increased demand for effective instructional strategies to improve reading comprehension scores in these students. The authors synthesized the findings of 15 studies, which included 88 school-aged students identified with ASD. The studies were conducted between 1989 and 2015. Findings indicate that Direct Instruction (DI) and graphic organizers have positive effects, while cooperative learning, anaphoric cueing, and question generation show promise. Electronic supported text shows little to no effect on reading comprehension measures in students with ASD.” (p.187)

Finnegan, E., & Mazin, A. L. (2016). Strategies for increasing reading comprehension skills in students with autism spectrum disorder: A review of the literature. Education and Treatment of Children, 39(2), 187-219. doi: 10.1353/etc.2016.0007


“This research demonstrates that DI is a promising practice for students with ASD. … there appears to be a gap in the extant literature on using DI to teach language skills to high school students with ASD in a group format. … The purpose of this study was to determine the effectiveness of DI, and specifically the SRA Reading Mastery Signature Edition language program, in teaching high school students with ASD in a small group setting to answer ‘‘who,’’ ‘‘where,’’ and ‘‘what’’ questions. An additional purpose of this study was to determine whether any effects demonstrated during the intervention would maintain after instruction was removed. The results indicated that the DI curriculum, as modified, was effective in teaching all participants to answer ‘‘who’’ and ‘‘what’’ questions to mastery. In addition, the data revealed that the participants maintained these improvements at both the 2- and 4-week post-intervention follow-up assessments.” (p. 2969, 2976)

Cadette, J.N., Wilson C.L., Brady, M.P., Dukes, C., & Bennett, K.D. (2016). The effectiveness of Direct Instruction in teaching students with autism spectrum disorder to answer "wh-" questions. Journal of Autism and Developmental Disorders, 46(9), 2968-78.


“Several studies have been done showing the effectiveness of Direct Instruction on improving the reading comprehension skills of students with ASD (Bethune & Wood, 2013; Flores & Ganz, 2007, 2009; Ganz & Flores, 2009). Direct Instruction requires frequent, immediate corrective feedback from the teacher so can only be taught in small groups or in one-to-one settings.” (p.81)

Finnegan, E.G. (2019). Literacy instruction for students with autism spectrum disorder in inclusive settings. DADD Online Journal, 6(1), 72-88.


“DI curriculum has been used to teach language skills for young children who needed communication interventions. Researchers have shown DI improved language skills for children with developmental delays (DD) and autism spectrum disorders (ASD). Benner et al. (2002) investigated the difference between the DI program Language for Learning (LL; Engelmann & Osborn, 1999) and a traditional kindergarten curriculum. Students who received LL performed significantly better than comparison students in receptive language. Woldron-Soler, Martella, Marchand-Martella, and Tso (2002) implemented LL within an integrated preschool setting. Children with DD who received 15 weeks of instruction using LL demonstrated greater gains in receptive and expressive language skills than children who did not participate in the program. In addition, students who received LL showed increased gains in social skills. Other LL research with young children investigated variations in implementation of the program. For example, Tincani et al. (2005) compared the effects of slow-paced and fast paced teaching on the response opportunities, participation, accuracy, and off-task behavior of 4 pre-kindergarten students who were at-risk for school failure. Between the fast-paced and slow-paced instructional methods, there were significant differences between groups. The fast-paced group demonstrated four more responses per min. The fast-paced group provided three more correct responses and exhibited less off-task behavior than the slow-paced group. The groups did not differ in the percentage of academic responses. …

The current study extends the literature (e.g., Benner et al., 2002; Woldron-Soler et al., 2002; Flores et al., 2013) regarding DI for students with DD and ASD by investigating the effects of implementation of a Language for Learning program within an inclusive rural classroom setting in a manner that balanced the wide variety of diverse student characteristics, instructional learning styles, and achievement levels of students in the classroom. The researchers administered instruction in rotating stations as a way to individualize instruction based on unique student strengths and weaknesses. All students in the classroom received academic instruction, but the researchers also pulled students to receive intensive instruction based on learning needs. Students who required more intensive language interventions received DI. All students in this study made progress across all behaviors and also maintained progress after instruction ended. Teachers who provide instruction for students with significant language needs can implement instruction using DI procedures and focusing on language behaviors. Language behaviors involve teaching students to make action statements, make identity statements, answer “yes” and “no” questions, make descriptions using prepositions, make descriptions using opposites, and apply prepositions and opposites in discussion prompted by teacher questions. Interventions can occur during station teaching as a way to differentiate instruction.” (p. 3, 7)

Flores, M.M., Schweck, K.B.; Hinton, V. (2016). Teaching language skills to preschool students with developmental delays and autism spectrum disorder using Language for Learning. Rural Special Education Quarterly, 35(1), 3-12. DOI: 10.1177/875687051603500102


“Although several studies have documented strengths in word recognition for some students with autism spectrum disorder (ASD; for example, Newman et al., 2007), most investigators have concluded that a disproportionate number of students with ASD do not meet grade-level expectations in word recognition or comprehension (Asberg, Dahlgren, & Sandberg, 2008; Brown, Oram-Cardy, & Johnson, 2013; Estes, Rivera, Bryan, Cali, & Dawson, 2011; Huemer & Mann, 2010; Nation, Clarke, Wright, & Williams, 2006; Norbury & Nation, 2011; Ricketts, Jones, Happé, & Charman, 2013). …Findings of concern included frequency of use of paraprofessionals to provide primary instruction, teachers’ relatively low self-efficacy for teaching reading to students with ASD, and provision of less than the recommended instructional time for K-3 reading. … A second condition relates to instructional time and intensity. Beginning readers should be engaged in instruction for a sufficient amount of time to support progress. A common recommendation for K-3 programs is a dedicated instructional block of 90 to 120 min for all students (Allington, 2009; Foorman & Connor, 2010). In addition, students who are reading below grade level should receive more intensive instruction than other students (Allington, 2009, 2013; Griffiths & Stuart, 2013; Vaughn, Denton, & Fletcher, 2010). Instructional intensity may be enhanced by increasing instructional time and reducing group size (e.g., Mellard, McKnight, & Jordan, 2010; Vaughn et al., 2010).” (p. 337-8) … “On the positive side, teachers indicated that the vast majority of students with ASD participated in daily reading instruction and received more comprehensive instruction on the essential components of reading than the sight-word approach that has been used in the past. Of concern, though, were the findings that almost one third of students received primary instruction from a paraprofessional, a sizable percentage of teachers lacked confidence in their preparation and effectiveness in teaching reading to students with ASD, and a majority of students received less than the recommended instructional time for K-3 reading.” (p.343)

Spector, J.E., & Cavanaugh, B.J. (2015). The conditions of beginning reading instruction for students with autism spectrum disorder. Remedial and Special Education, 36(6), 337–346.


“Published instructional programs that incorporate explicit and systematic procedures in a scripted manner allow consistent implementation across instructors of varying skill levels. Scripted programs control instructional delivery, increasing fidelity of implementation (Cooke et al. 2011). According to Watkins and Slocum (2004), scripts accomplish two goals: 1. To assure that students access instruction that is extremely well designed from the analysis of the content to the specific wording of explanations, and 2. To relieve teachers of the responsibility for designing, field-testing, and refining instruction in every subject that they teach. (p. 42) Importantly, Cooke et al. (2011) compared scripted to nonscripted explicit instruction and found increased rates of on-task instructional opportunities during scripted instruction. Additionally, students indicated they enjoyed answering together (i.e., in unison) and instructors shared positive outcomes including greater student attention, consistent routine, and reduced likelihood of leaving out crucial concepts.” (p.56)

Plavnick, J., Marchand-Martella, N., Martella, R., Thompson, J., & Wood, A. L. (2015). A review of explicit and systematic scripted instructional programs for students with autism spectrum disorder. Review Journal of Autism and Developmental Disorders, 2, 55-66. doi:10.1007/s40489-014-0036-3.


“The Reading Mastery curriculum in particular has a powerful evidence base for its effectiveness with disadvantaged children, English Language Learners, and children with disabilities (Engelmann 1997; Gersten et al.1987; Kamps and Greenwood 2005; Kamps et al. 2008), but limited studies specifically targeting children with ASD. … Findings support the use of explicit and Direct Instruction curricula for high risk children who are struggling academically (Kame’enui and Simmons 2001; Kamps et al. 2008); and more specifically children with ASD at risk for learning problems (El Zein et al. 2014; Flores and Ganz 2009; Ganz and Flores 2009; Plavnick et al. 2014, 2016). Findings also support the use of the Reading Mastery curriculum to teach children with ASD basic phonemic awareness, decoding skills and word reading (Plavnick et al. 2016; Spector and Cavanaugh 2015).”

Kamps, D, Heitzman-Powell, L, Schwartz, I., Mason, R., Swinburne Romine, R., & Fleming, K. (2016). Effects of Reading Mastery as a small group intervention for young children with ASD. Journal of Developmental Physical Disabilities, 28, 703-722. DOI 10.1007/s10882-016-9503-3


“The results of this study also confirm the findings of previous research which has indicated that DI is an effective methodology for diverse groups of students, including those from low socioeconomic backgrounds (Goldman, 2000; Torgesen, Alexander, Wagner, Rashotte, Voeller, & Conway, 2001), students at-risk for academic failure (Carlson & Francis, 2002; Foorman, Francis, Fletcher, & Schatschneider, 1998; Frederick, Keel, & Neel, 2002; Grossen, 2004; Shippen, Houchins, Steventon, & Sartor, 2005), students with learning disabilities (Swanson, 1998; Torgesen et al.), and students with cognitive deficits (Bradford, Shippen, Alberto, Houchins, & Flores, 2006; Flores, Shippen, Alberto & Crowe, 2004; Gersten & Maggs, 1982).” (p.94) … Considering the success of the participants in this study as well as the overwhelming evidence of the efficacy of DI programs for a variety of individuals as well as emerging evidence for those with autism, it is worthwhile to explore and explain factors that most likely contributed to the efficacy of this program for individuals in this study. Programs developed from behavioral theory are perhaps the most effective for those with autism. For example, applied behavior analysis is generally regarded as the treatment of choice for individuals with autism since Lovaas’ seminal study in 1987. Since this time, significant research and litigation have been devoted to this type of therapy. DI is a specific set of academic curricula that is rooted in behavioral theory and has similarities to that of ABA. Research has supported that specific components which contribute to the efficacy of these programs is that they both focus on measurable behaviors and provide carefully designed instruction (Knight et al., 2013) which includes predictable instructional formats (Hume et al., 2012) with high rates of responding (Lamella & Tincani, 2012) and immediate feedback (Ranick, et al., 2013).” (p.95-96)

Head, C. (2016). The effects of Direct Instruction on reading comprehension for individuals with autism or intellectual disability. A dissertation submitted to the Graduate Faculty of Auburn University in partial fulfilment of the requirements for the Degree of Doctor of Philosophy Auburn, Alabama August 6, 2016. Retrieved from https://etd.auburn.edu/bitstream/handle/10415/5272/FINAL_DISS.pdf?sequence=2&isAllowed=y


“Rigorous studies included in the current review indicate that comprehensive NRP instruction is effective in improving reading outcomes when administered to relatively diverse groups of children with ASD. … We conducted a systematic review of the literature on reading instruction for children with ASD, following the recommendations of the National Reading Panel (NICHD, 2000). Our study provides an updated review for the years 2009–2017 along with an analysis of effect sizes and research quality using the Evaluative Method for Determining Evidence-Based Practices in Autism (Reichow et al. 2008). The 19 studies that met our inclusion criteria reported gains in phonics, reading accuracy, reading fluency, and/or reading comprehension skills. … One high-quality study investigated multi-component NRP [National Reading Panel] instruction as applied to a relatively large, diverse sample (Kamps et al. 2016). … Literacy instruction was delivered using a commercially available program [Reading Mastery] designed to target phonemic awareness, phonics, reading fluency, and reading comprehension skills. Over an extended period of 2 years, children who received instruction targeting these skills exhibited statistically significant, large gains in reading accuracy as compared to children in a control group. … Comprehensive literacy instruction encompassing all of the NRP Big Five was the focus of one adequate-quality study (Bailey et al. 2017). Similar to Kamps et al. (2016), participants in this study were required to meet relatively broad inclusion criteria: 5 to 12 years of age, confirmed diagnosis of ASD, no hearing or vision impairments, measurable language abilities, and ability to sustain attention to task for 15 min. Results showed that participants who received comprehensive NRP instruction achieved statistically significant gains in word and passage reading accuracy and comprehension relative to children in a control group, with each of these gains associated with a large effect size.4 This suggests that fully implemented (comprehensive) NRP instruction may be effective in promoting reading accuracy and reading comprehension skills for school-aged children with ASD. … Only comprehensive instruction incorporating a focus on all of the NRP Big Five was effective in improving both reading accuracy and comprehension skills in a diverse sample of children with ASD. Based on these adequate and high quality studies, we recommend that professionals consider using comprehensive NRP instruction incorporating phonemic awareness, phonics, vocabulary, reading fluency, and reading comprehension strategies when working with children with ASD.” (p.18, 19)

Bailey, B., & Arciuli, J. (2020). Reading instruction for children with autism spectrum disorders: A systematic review and quality analysis. Review Journal of Autism and Developmental Disorders, 7, 127–150. https://doi.org/10.1007/s40489-019-00185-8


“This study further demonstrates that students with ASD and DD can benefit from group instruction. One-on-one instruction in the form of discrete trial teaching represents the largest body of intervention research for this population (National Research Council, 2001). However, students in the current study successfully participated in DI which required sustained attention, frequent responding, and choral responses in a group format. This is significant since group instruction may provide for greater efficiency in meeting students’ needs in diverse classrooms. In addition, providing instruction to students with ASD and DD in a group format may also better prepare them for participation in group situations within general education classrooms” (p.46-7).

Flores, M. M., Nelson, C., Hinton, V., Franklin, T. M., Strozier, S. D., Terry, L., & Franklin, S. (2013). Teaching reading comprehension and language skills to students with autism spectrum disorders and developmental disabilities using Direct Instruction. Education and Training in Autism and Developmental Disabilities, 48(1), 41-48.


“Research shows that evidence-based practices have significant benefits for individuals with ASD [16]; and such practices are required by law [10]. However, there are many factors that influence the use of EBPs in schools, including the varying abilities and symptoms of individuals with ASD, limited ASD-specific training for teachers in public schools, and the large number of available treatment options, paired with limited large-scale reports on the effectiveness of such interventions. (p.2) … The five most highly reported academic practices were structured teaching (68%), direct instruction (61%), applied behavior analysis (59%), naturalistic teaching (51%) and TEACCH (50%)”. (p.6)

Ferreri, S.J., Witmer, S.E., & Shivers, C.M. (2016). Autism spectrum disorders and evidence based practices: A statewide exploration of public school programming. Austin Journal of Autism & Related Disabilities, 2(2), 1018. https://austinpublishinggroup.com/autism/fulltext/autism-v2-id1018.php


“Little research has been conducted reporting the effects of DI on language development. … This literature, though sparse, suggests DI is a promising practice, particularly for students who do not easily learn language skills incidentally, such as those with ASD. Direct Instruction, as noted above, is particularly suited for use with individuals with ASD who lack a considerable amount of common language concepts and who require intensive, explicit instruction to learn such skills. DI interventions have resulted in improvements in reading skills in children with such deficits. Specifically, DI has positively affected reading decoding (Fredrick et al. 2002; Shippen et al. 2005) and reading comprehension (Carlson and Francis 2002; Flores and Ganz 2007). DI has improved reading skills in children from elementary (Carlson and Francis 2002; Humphries et al. 2005) to middle school (Grossen 2004; Shippen et al. 2005). Additionally, DI has been used successfully with children with a variety of abilities, including autism (Flores and Ganz 2007), epilepsy (Humphries et al. 2005), learning disabilities and cognitive impairments (Carlson and Francis 2002), those with limited English proficiency (Carlson and Francis 2002), and students at risk (Carlson and Francis 2002; Grossen 2004).” (p.76) … The purpose of this study was to extend the research on the use of DI to the remediation of oral language skills in elementary children with ASD. … The students’ increases in expressive language skills are consistent with previous research regarding students with developmental delays (Waldron-Soler et al. 2002) and students with epilepsy and academic deficits (Humphries et al. 2005). However, this study extends the line of research in include students with ASD. Furthermore, the students in the current study maintained their performance after instruction ceased.” (p. 81)

Ganz, J.B., & Flores, M.M. (2009). The effectiveness of Direct Instruction for teaching language to children with autism spectrum disorders: identifying materials. Journal of Autism and Developmental Disorders, 39, 75–83.


“The current investigation builds upon prior research by evaluating the effectiveness of the complete DI Language for Learning curriculum for teaching language skills to children diagnosed with ASD during a one-to-one teaching arrangement.” (p.45) … Both statistical analyses and visual inspection of the data provides evidence that the Language for Learning curriculum is associated with an increase in responding to language. … Analysis of each group suggests that an increase in each participant’s language skills occurred following the implementation of the DI intervention. For each group, the percentage of correct responses immediately post-intervention was significantly higher than pre-intervention.” (p. 51-52)

Shillingsburg, M.A., Bowen, C.N., Peterman, R.K., & Gayman, M.D. (2015). Effectiveness of the Direct Instruction Language for Learning curriculum among children diagnosed with Autism Spectrum Disorder. Focus on Autism and Other Developmental Disabilities, 30(1), 44–56.


What’s happening about reading and non-verbal students with ASD?

“Although, generally there is a lack of research relating to the nonverbal ASD population, it is not known whether this cohort are very likely to fall into the ‘low functioning’ category of ASD . However, ‘low functioning’ is a common term for those children on the ASD spectrum who are identified as having poor language and cognitive abilities (O’Connor and Klein, 2004b). In the UK, children with ASD who fit into this broad category of ‘low functioning’ are likely to be educated in settings which form part of schools providing additional learning needs (ALN) education (Reed and Osbourne, 2014). Picture Exchange Communication Systems (Frost & Bondy 2002) along with other forms of alternative augmentative education are commonly used in ALN settings to support the communication skills of nonverbal and minimally verbal students. The results of the current study therefore have implications for such settings, as they would imply that there could be children who are able to read and comprehend to at least a single word level, who are being supported by the use of picture and/or symbol-based systems for the purposes of communication. Therefore limiting, rather than exploiting the potential for more advanced forms of communication to develop. … Further implications of the study are also clear in that not every child or young person with ASD who is nonverbal will lack the ability to recognise printed and/or understand their meaning. This means that many nonverbal children who are on the autism spectrum may have the beginnings of a reading skill which is currently undetected. Verbalisation is a common element of reading tests being used in ALN settings (Arnold & Reed, 2016b), by removing this element, the digital format of assessment used in this study promotes a form of assessment that not only measures the reading ages of nonverbal children, but also allows for comparison with their verbal cohorts. What schools choose to measure can be a reflection of what they choose to value. Assessment data forms part of school self-evaluation which informs the plans for school improvement. The school improvement plan will set out how resources are allocated, and which interventions are employed. Therefore, nonverbal ASD students who are not represented in the data, will also be prone to exclusion from more advanced forms of reading instruction and communication intervention. This is a crucial matter for the field of special education, as unless reasonable adjustments are made, nonverbal children and young people with ASD will continue to be excluded from interventions which could improve their chances of being successful readers and communicators in future. In which case they are likely to remain, as Tager-Flusberg (2013b) argue ‘the neglected end of the spectrum’.” (p. 17-19)

Arnold, S., & Reed, P. (2020. Measuring-the-comprehension-abilities-of-children-who-are-both-verbal-and-nonverbal. Pre-Print Jan 2020. https://www.researchgate.net/profile/Sharon-Arnold/publication/340129061_Measuring_the_comprehension_abilities_of_children_who_are_both_verbal_and_nonverbal_with_ASD_Extending_the_analysis_of_a_novel_digital_test_format/links/5e7a2269a6fdcc5499566616/Measuring-the-comprehension-abilities-of-children-who-are-both-verbal-and-nonverbal-with-ASD-Extending-the-analysis-of-a-novel-digital-test-format.pdf


“Keefe and Copeland (2011) argued that the belief that some individuals cannot acquire literacy skills can then lead to individuals being denied opportunities to acquire these skills. Mirenda (2003) also highlighted this issue and argued that students with ASD who have cognitive impairments may be excluded from literacy instruction due to mistaken beliefs that they do not have the capacity for acquiring literacy skills, yet show skills that are directly related to literacy learning such as interest in books, print awareness, and recognition of sight words. Mirenda advocated abandoning a “readiness” model and the assumption that spoken language was needed to benefit from instruction, and instead suggested a need for the use of multiple strategies formulated at the child’s level of literacy development, underpinned by assessment of the child’s strengths and needs. Several studies have demonstrated that children who have limited verbal communication skills can, and do, develop language and literacy skills when they are provided with high-quality literacy learning opportunities (e.g., Afacan et al., 2018; Allor et al., 2010; Erickson et al., 1997). These findings are consistent with the view that every child sits somewhere on a literacy learning continuum (Erickson, 2000), and that no child is “too anything” to learn to read and write (Yoder, 2001, p. 5). To better understand each child’s strengths and challenges in literacy-related skills, indepth assessment is required to help guide individualized literacy instruction.” (p.167)

Clendon, S., Paynter, J., Walker, S., Bowen, R., & Westerveld, M.F. (2021). Emergent literacy assessment in children with autism spectrum disorder who have limited verbal communication skills: A tutorial. Language, Speech, and Hearing Services in Schools, 52, 165–180.


Some other areas of research emphasise choosing interventions with:

  • evidence of effectiveness,
  • that address student self-management strategies, and
  • maths interventions

“Identifying effective interventions to use with children who have ASD can be challenging for educators and parents alike, especially when various fads and “quick-fix” solutions may receive as much if not more press than evidence-based approaches. The current emphasis on implementing evidence based interventions leads educators and parents to seek out programs supported by data from empirical research. Although there is a growing body of quality research available on effective interventions for children with ASD, it is still fairly limited, especially given the increasing prevalence rates and wide range of educational, verbal, and social skill deficits associated with this disability.” (p.101)

Ryan, J.B., Hughes, E., Katsiyannis, A., McDaniel, M., & Sprinkle, C. (2014). Research-based educational practices for students with autism spectrum disorders. Teaching Exceptional Children, 47(2), 94–102.


“A recent review conducted by Root et al. (2017) concluded that CAI was an evidence-based practice for teaching academic content to students with autism spectrum disorders (ASD). Although the majority of the included studies addressed 130 literacy instruction (e.g., sight words reading, comprehension) to students with ASD, only a few specifically assessed using CAI to teach phonics and decoding (e.g., Travers et al., 2011; Whalen et al., 2010). Travers et al. (2011) compared teacher-led instruction on alphabet skills to an author-developed CAI program. The CAI program utilized discrete trial teaching and errorless learning in 10 minute lessons. Both interventions were effective in improving preschoolers’ alphabet skills. Whalen et al. (2010) used TeachTown: Basics (TeachTown Inc., 2016) with PreK-1st grade students with ASD for three months. TeachTown: Basics utilizes Applied Behavior Analysis principles to teach a wide range of early learning skills. Students in the intervention group showed improved skills in language and basic academic skills (including reading) compared to the control group, who received business-as-usual instruction.” (p. 130-131)

Snyder, S.M. (2020). An investigation of computer assisted reading instruction to teach phonics skills to young students with developmental disabilities. DADD Online Journal, Journal of the Division on Autism and Developmental Disabilities, Council for Exceptional Children, 7(1), 130-143.


“Most intervention research with school-age children with ASD has rightly examined the effectiveness of strategies aimed at improving social communication (Chang and Locke 2016; Watkins et al. 2015) and play (Kossyvaki and Papoudi 2016). However, a growing emphasis on ensuring access to the general education curriculum and improving post-school outcomes related to employment, higher education, and independent living necessitates both the use of effective intervention in schools to improve functional academic skills for this population and further research in this area (Wehman et al. 2014). … Four different areas of skills were targeted in literacy: (a) emergent literacy (i.e., letter identification), (b) phonics and fluency (i.e., word recognition, fluency), (c) reading comprehension (i.e., inferential skills), and (d) writing (i.e., composition, spelling). … The mean score across all the studies was high (M Tau-U = 0.78), but ranged from weak to very high with scores between 0.15 and 1.00. Regarding practices with some evidence, all interventions proved to have high to very high effectiveness. These interventions were self-regulated strategy development (Tau-U = 0.90), TouchMath (Tau-U = 0.87), direct instruction (Tau-U = 0.83), and test-taking instruction (Tau-U = 0.83). … ” (p. 311, 319, 320)

Alresheed, F., Machalicek, W., Sanford, A., & Bano, C. (2018). Academic and related skills interventions for autism: A 20-year systematic review of single-case research. Review Journal of Autism and Developmental Disorders, 5(4), 31-326.


“The MTSS model offers a flexible structure for teachers, IEP teams, and schools for delivering high quality instruction, research based practices, and effective support. The academic supports described above can be used in combination with behavioral supports (Leach, 2018). Many of the supports described will be beneficial to students who do not have ASD, which facilitates flexible grouping arrangements that are often necessary in GE classrooms. Teachers can group students according to need rather than disability category.” (p.82)

Finnegan, E.G. (2019). Literacy instruction for students with autism spectrum disorder in inclusive settings. DADD Online Journal, Journal of the Division on Autism and Developmental Disabilities, Council for Exceptional Children, 6(1), 72-88.


“Literacy skills in ASD are an important topic worthy of further attention. At present there are significant gaps in the literature describing the acquisition, development, and effective interventions for reading in children with ASD. We know that many children with ASD will encounter difficulties with literacy, and areas of strength (e.g., decoding), need (e.g., oral language impairment), or assumed “learning styles” can lead to unhelpful assumptions. As a result, speech pathology intervention may neglect to incorporate literacy goals tailored to meet an individual child’s learning profile. Until we have further evidence, we must draw upon the evidence-based practice frameworks by using the best available evidence combined with clinical reasoning and judgement (Hoffmann, Bennett, & Del Mar, 2013). The best available evidence at present includes an extensive literature base on typical development and language impaired populations (e.g., Catts, Herrera, Nielsen, & Bridges, 2015). This knowledge can be interpreted in conjunction with ASD knowledge and assessment of the individual child to formulate appropriate interventions that include literacy related goals and activities (see Lanter & Watson, 2008, for further recommendations).” (p.82)

Westerveld, M. F., Paynter, J., & Trembath, D. (2016). Reading instruction for children with ASD: Getting the story straight. Journal of Clinical Practice in Speech-Language Pathology, 18, 80-83.


“Many of the evidence-practices in special education have their beginnings in applied behavior analysis. For example, one prominent application of ABA in schools is Response to Intervention (RtI), which is a widely used, decision-making framework for preventing and addressing a variety of academic and behavioral challenges (Tilly, 2008). RtI shares key elements of ABA including direct measurement of behavior, interventions designed to produce significant improvements, and ongoing progress monitoring to assess acquisition, maintenance, and generalization of target skills (Fuchs & Fuchs, 2006). Other examples of techniques in use that are ABA rooted include examination of data to make individualized changes in intervention, functional behavioral assessment, and direct instruction methods. Therefore, it is logical and appropriate to seeks ways to formally embed ABA-based approaches into existing programming to benefit students and their teachers. Other examples of techniques in use that are ABA-rooted and have good classroom application include peer-mediated instruction, visual schedules, and priming.” (p.110)

Barnett, J.H., Zucker, S.H., & More, C. (2020). Applied behavior analysis in today’s schools: an imperative for serving students with autism spectrum disorder. DADD Online Journal, Journal of the Division on Autism and Developmental Disabilities, Council for Exceptional Children, 7(1), 108-117.


“The application of self-management procedures to academic behaviors has been identified as a gap in the published literature (Lee et al., 2007); however, since then, seven studies have been published targeting academic behaviors, such as a student’s ability to stay on task or improve the quality or volume of academic work. Findings of this review have indicated that self-management was highly effective for academic behaviors.” (p. 39)

Carr, M.E., Moore, D.W., & Anderson, A. (2014). Self-management interventions on students with Autism: A meta-analysis of single-subject research. Exceptional Children, 81(1), 28–44.


“In this study, we conducted a multilevel meta-analysis to determine whether the self-regulated strategy development (SRSD) approach to teaching writing to students with autism spectrum disorder (ASD) improves significantly the number of words written and overall quality of writing, whether the effects of SRSD were consistent or variable across studies, and whether the moderator of age could explain the potential variability in the number of words written and overall quality of writing. Results indicated that SRSD had large, statistically significant and meaningful effects on the number of words written and overall quality of writing.” (p.1)

Asaro-Saddler, K., Moeyaert, M., Xu, X., & Yerden, X. (2020). Multilevel meta-analysis of the effectiveness of self-regulated strategy development in writing for children with ASD. Exceptionality, 1-17. DOI: 10.1080/09362835.2020.1850457


“The purpose of the current meta-analysis was to investigate the effectiveness of self-regulated strategy development (SRSD) reading interventions for students with disabilities in school settings. We used the Council for Exceptional Children’s Standards for Evidence-Based Practices in Special Education (CEC-EBP) to evaluate experimental investigations that targeted reading comprehension using an SRSD reading intervention and included students with disabilities. Summary outcome measures presented in the analysis include the between-case standardized mean difference, percentage of non-overlapping data, and visual analysis. Although the results indicated SRSD to be generally effective, the small number of studies and the fact that only 2 studies met all of the CEC-EBP quality indicators prevent the strategy from presently being considered evidence based.” (p.1)

Sanders, S., Losinski, M., Ennis, R.P., White, W., Teagarden, J., & Lane, J. (2019). A meta-analysis of self-regulated strategy development reading interventions to improve the reading comprehension of students with disabilities. Reading & Writing Quarterly, 35(4), 339-353. DOI: 10.1080/10573569.2018.1545616


“Regardless of its limitations, research regarding mathematics instruction for students with ASD does provide some guidance for practitioners. Explicit instruction consisting of prompts and supplemented with positive consequences remains the standard for addressing the needs of students with disabilities (Browder et al., 2008). Instruction enhanced with video modeling, computer equipment, and peer tutoring—though promising—is relatively absent from the literature. Practitioners may refrain from using techniques that strain resources in favor of simpler, validated forms of instruction. The few studies involving word problems suggest that students with ASD are amenable to instruction in these areas.” (p. 458)

King, S.A., Lemons, C.J., & Davidson, K.A. (2016). Math interventions for students with Autism Spectrum Disorder: A best-evidence synthesis. Exceptional Children, 82(4), 443–462.


How important is early identification and intervention?

“Growing evidence suggests ASD has its origins in prenatal life -- most likely during the first or second trimester of pregnancy -- and children begin to display symptoms of the condition by their first birthdays, such as failing to respond to their names or positively interact with others.
Early diagnosis of ASD means earlier intervention and improved therapeutic benefit. "The sooner you can address issues of ASD, the better the outcome for the child," said the study's first author, Karen Pierce, PhD. … Multiple studies, including research conducted by Pierce, have found that simple parent checklists performed at the child's first birthday can identify symptoms of ASD. And yet the mean age of ASD diagnoses in the United States, write the researchers, is "often years later, generally between ages three and four. … Synaptic density or connections between neurons in the prefrontal and temporal cortex, brain regions centrally involved in higher order social behavior, doubles between birth and one to two years in age," said Pierce. "It's conceivable that outcomes for children with autism could be improved if treatment occurred during this period of rapid brain growth, rather than after, which is more commonly the case." … The overall diagnostic stability for ASD was 0.84, higher than for any other diagnostic group. Only 2 percent of toddlers initially considered to have ASD transitioned to later diagnoses of typical development.”

University of California - San Diego. (2019, April 29). Autism diagnoses prove highly stable as early as 14 months: Finding suggests earlier, effective identification can result in earlier, more effective treatment. ScienceDaily. www.sciencedaily.com/releases/2019/04/190429111803.htm

Pierce, K., Gazestani, V.H., Bacon, E., et al. (2020). Evaluation of the diagnostic stability of the early autism spectrum disorder phenotype in the general population starting at 12 months. JAMA Pediatrics, 2019 DOI: 10.1001/jamapediatrics.2019.0624


“In infants that later showed higher ASD symptoms, researchers saw decreased connectivity between frontal regions. The infants also showed increased connections across temporo-parietal areas in the right hemisphere, which are associated with social information processing.
"These findings improve our understanding of the neural differences that precede autism and show which brain regions reveal the earliest signs of disruption," Dr. Dickinson said. The findings bolster the idea that disrupted brain connectivity is a root cause of ASD, not a consequence.
The authors suggest that the low cost, wide availability and low risk of EEG make it a good screening tool to identify babies at higher risk of developing ASD or those with "borderline" symptoms, so that they get early intervention. "Mapping patterns of activity associated with autism could ultimately help identify infants who show early signs of neural risk."

Elsevier. (2020, August 11). Early neural activity associated with autism: EEG measurements in infants predicted ASD symptoms in toddlers. ScienceDaily. www.sciencedaily.com/releases/2020/08/200811120144.htm


Dickinson, A., Daniel, M., Marin, A., Gaonkar, B., Dapretto, M., McDonald, N.M., & Jeste, S. (2020). Multivariate neural connectivity patterns in early infancy predict later autism symptoms. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, S2451-9022(20), 30140-3. DOI: 10.1016/j.bpsc.2020.06.003

“Early and effective intervention: Clinicians should respond appropriately to family or clinical concerns and results of screening to avoid delays in diagnosis and treatment. Intervention for the communicative, adaptive, and behavioral deficits associated with ASD should take place as soon as the need becomes evident. Intervention is most effective if it is early, intense, and involves the family. Research has demonstrated that interventions using principles of behavioral intervention are associated with skill acquisition and improved outcome. There is evidence that training parents to support developmental skill building is helpful. Primary care providers should help families learn to interpret evidence about interventions so they can make informed decisions about their child’s care. Many interventions, including many nutritional interventions, do not have evidence to support their use at this time. Families should be referred to community support resources and be included in the shared decision-making process.” (p.2)

Hyman, S.L., Levy, S.E., Myers, S.M., AAP Council on Children with Disabilities, Section on Developmental and Behavioral Pediatrics. (2020). Executive Summary: Identification, evaluation, and management of children with Autism Spectrum Disorder. Pediatrics, 145(1), e20193448


“Research investigating the emergent literacy skills of children on the spectrum during the preschool period has shown particular challenges in meaning-related skills (e.g. vocabulary and story retelling and comprehension) and relative strengths in print-related skills, including alphabet knowledge (Davidson and Ellis Weismer, 2014; Fleury and Hugh, 2018; Lanter et al., 2012; Westerveld and Roberts, 2017; Westerveld et al., 2017). While these uneven emergent literacy profiles may be related to children’s language abilities and/or cognitive skills (Westerveld et al., 2020b), emerging longitudinal research has confirmed the importance of these precursor literacy skills to future reading performance (Davidson and Ellis Weismer, 2014; Dynia et al., 2017; Westerveld et al., 2018), reinforcing the importance of early intervention.” (p. 2)

Westerveld, M. F., Wicks, R., & Paynter, J. (2021). Investigating the effectiveness of parent-implemented shared book reading intervention for preschoolers with ASD. Child Language Teaching and Therapy, 0265659021995522.


“Early intensive behavioral interventions as the mainstay for treatment has been shown to help young children with ASD gain skills and improve long-term outcomes (30). The gold standard treatment is Applied Behavior Analysis (30).” (p.72)

Chahin, S.S., Apple, R.W., Kuo, K.H., & Dickson, C.A. (2020). Autism spectrum disorder: Psychological and functional assessment, and behavioral treatment approaches. Translational Pediatrics (Neurodevelopmental and Neurobehavioral Disorders in Children), 9(1), S66-S75.


“The results of this review would seem to suggest that teaching staff might be able to learn how to effectively deliver early intervention, with a reasonable degree of fidelity, to young children with ASD in inclusive preschool environments. Further, the delivery of early intervention in these settings may improve outcomes for the participating children. However, many of the reviewed studies had minimally acceptable levels of quality based on the Goldstein et al. (2014) rating framework. Given the need for high-quality studies to guide evidence-based practice, the results of this review point to the need for additional and higher-quality studies. At the present time, any statements regarding the effectiveness of the early interventions included in this review must be viewed as tentative. Although these results suggest that a range of early intervention programs can be effective when implemented in inclusive preschool settings, further research is needed to establish the generality of the findings of this review. Specifically, there is a need for more high-quality studies that evaluate the long-term effectiveness of interventions and the long-term maintenance of both child and teacher outcomes.” (p.19)

Tupou, J., van der Meer, L., Waddington, H., & Sigafoos, J. (2019). Preschool interventions for children with autism spectrum disorder: A review of effectiveness studies. Review Journal of Autism and Developmental Disorders. Online First. https://doi.org/10.1007/s40489-019-00170-1


How well prepared are teachers to employ evidence-based literacy instruction with this cohort?

“Misconceptions about the brain and its relation to education are widespread. This can lead to the implementation of ineffective methods and the waste of precious resources. To examine the extent of belief in neuromyths, a survey about the brain in education was conducted. Respondents (n = 169) came from special education (n = 83) and general education (n = 78), and included preservice teachers (n = 34), in-service teachers (n = 63), higher education faculty (n = 39), and educational leaders (n = 33). The survey contained 15 Myths and 18 Facts, and overall, participants were able to correctly identify approximately 66% of all the Facts. On the other hand, on average, respondents responded correctly for only one third of the Myths. The most commonly misidentified Myths were related to motor coordination exercises to improve literacy skills, the right brain-left brain myth, and learning styles.” (p.16)

van Dijk, W., & Lane, H.B. (2020). The brain and the US education system: Perpetuation of neuromyths. Exceptionality, 28(1), 16-29. DOI: 10.1080/09362835.2018.1480954


“Less than half (38%) of Australian teachers feel prepared to teach students with special needs when they finish their formal training. This is despite 74% having trained to teach in mixed-ability settings as part of their studies. The latest Teaching and Learning International Survey (TALIS) shows teachers across the OECD felt professional development opportunities were particularly inadequate for teaching students with special needs. … According to the TALIS report, nearly 30% of teachers in Australia work in classes where at least 10% of students have special needs. The report adds to a body of research suggesting teachers feel unprepared to teach students with special needs in mixed-ability classrooms. … Depending on the data source, between 8% and 20% of school-age children have identified disabilities or special educational needs.”

Jarvis, J. (2019). Most Australian teachers feel unprepared to teach students with special needs. The Conversation, June 26. Retrieved from https://theconversation.com/most-australian-teachers-feel-unprepared-to-teach-students-with-special-needs-119227


“ … Washburn, Binks-Cantrell, Joshi, Martin-Chang, and Arrow (2016) found preservice teachers from Canada, England, New Zealand and the USA lacked knowledge of the component skills required for effective reading instruction. … [In Australia] it would appear that fewer than half of the coordinators for whom information was available had specific qualifications, publications, research interests or expertise related to early reading instruction. A similar observation was made in a NSW Government report investigating the quality of initial teacher education (BOSTES, 2014). This finding is of concern because the percentage of faculty members with advanced degrees has been identified as one of the contributing factors to the quality of teacher preparation programs (Feuer et al., 2013; Ingvarson et al., 2014) and, in much the same way that classroom teacher quality affects student achievement, it can be argued that teacher educator quality will affect teacher performance. In addition, the work of Joshi et al. (2009) and Washburn, Joshi, and Hougen (2012) showed that teacher educators themselves may have poor linguistic knowledge and this may be reflected in lack of knowledge of the pre-service teachers they work with. The apparent lack of expertise in early reading of some unit co-ordinators may thus be a contributor to poorer quality teacher education.” (p. 3, 13)

Meeks, L., & Stephenson, J. (2020). Australian preservice teachers and early reading instruction. Australian Journal of Learning Difficulties, 25, 65–82. DOI: 10.1080/19404158.2020.1743730


“Importantly, teachers and clinicians do not always employ research-based reading instruction methods when working with children with autism (Accardo & Finnegan, 2019). This may be due, in part, to a tendency for children with autism to be underestimated in terms of their ability to learn how to read and ties in with pseudoscientific theories about the underlying causes and effective treatment of reading difficulties (Griffiths et al., 2016; Mirenda, 2003; Wheldall & Beaman, 2000).” (p.226)

Arciuli, J., & Bailey, B. (2021). The promise of comprehensive early reading instruction for children with autism and recommendations for future directions. Language, Speech and Hearing Services in Schools, 52(1), 225-238.


“EBPs [Evidence-Based Practices ] are only effective if, and when implemented. Although teachers in this and other studies report high-frequency use of some EBPs, they report limited familiarity with and use of others (Brock et al., 2019; McNeill, 2020). Because students with ASD are not making adequate progress in their social communication development (Brock et al., 2019), focusing attention on how to support ECSE [Early Childhood Special Education ] teachers' implementation of key EBPs that are infrequently used but require minimal resources, may reduce the implementation gap. ECSE teachers must have multiple "tools" in their toolbox (Kasari & Smith, 2013), yet this study suggests that ECSE teachers' toolboxes are dependent on individual factors above and beyond the evidence-base of any given practice. Just as teachers should consider student and contextual fit of interventions, professional development providers and implementation researchers should explore tailoring their implementation supports to individual teachers based on their beliefs (Cook, 2020; Fishman et al., 2018). By doing so, teachers will be motivated to use effective interventions for young children with ASD to cultivate the skills that help them access the opportunities and activities they deserve (Goldstein et al., 1992).” (p.153-154)

Hugh, M.L. (2020). Exploring determinants of early childhood special educators' practice selections for young children with autism spectrum disorder. A dissertation submitted to the Faculty of the University of Minnesota in partial fulfilment of the requirements for the degree of Doctor of Philosophy. https://conservancy.umn.edu/bitstream/handle/11299/216385/Hugh_umn_0130E_21470.pdf?sequence=1&isAllowed=y


“The U.S. Department of Education (USDE, 2014) reported that more than 5.8 million children, or 8.4% of the total student population between the ages of 2 and 6, received services under IDEA Part B in 2012 (IDEA, 2004). Of these students receiving special education services, 40% were classified as having specific learning disabilities, 18% had speech or language impairments, 7% were diagnosed as having autism, and 7% were classified as having intellectual disabilities, with the remaining students falling into the categories of other health impairments, emotional disturbances, and all other disabilities combined (USDE, 2014). Despite the fact that federal legislation has required the use of teaching strategies that are evidence based (IDEA, 2004; Morrier, Hess, & Heflin, 2011), service delivery professionals do not consistently apply evidence-based strategies with students receiving special education services (Hess, Morrier, Heflin, & Ivey, 2008; Schreck & Mazur, 2008). While evidence-based practice has been an integral part of medicine since the beginning of the 20th century (Bernard, 1957), reliance on scientific evidence for selecting appropriate educational interventions has not kept pace with other health-related services (Vyse, 2005). For a variety of cultural, fiduciary, logistical, and educational reasons, there is a gap between the IDEA requirements to use empirically based teaching strategies and their actual implementation by educators and service delivery professionals (Fixsen & Blasé, 1993; Neef, 1995; Odom, Bratlinger, Gersten, Horner, Thompson, & Harris, 2005; Page, Iwata, & Reid, 1982; Shreck & Mazur, 2008).”

Zane, T., Weiss, M.J., Blanco, S., & Otte, L. (2015). Fads in special education. In Richard M. Foxx and James A. Mulick (Eds). Controversial therapies for autism and intellectual disabilities: Fad, fashion, and science in professional practice (2nd. ed). Ch 8, New York, Routledge.


Parent views on school support

“Many children on the autism spectrum struggle in their reading development. This study investigated parents’ views of challenges and facilitators to literacy learning at home and at school in children on the autism spectrum who were in their first year of schooling. Thematic analysis of semi-structured interviews with 37 parents revealed parents’ in-depth knowledge of their child’s strengths and interests, which they utilised to engage their child in literacy learning activities at home. Parents raised concerns about the support their children were receiving at school, with many describing challenges with teacher understanding of autism spectrum disorders, limited adaptation of the curriculum to suit the child’s learning needs and poor communication between school and home. The study challenges schools and educators to review and refine current practices to ensure individualised, learner-focused and inclusive pedagogies and practices to better support children on the autism spectrum.” (p.1)

O’Leary, K., Fluckiger, B., Paynter, J. & Westerveld, M. (2019). Parent perceptions of literacy learning of their young children on the autism spectrum in their first year of schooling. Australian Journal of Education, Early Online. doi: 10.1177/0004944119860639


So, what changes might we see in the future?

Earlier diagnosis made available through novel means?

“In infants that later showed higher ASD symptoms, researchers saw decreased connectivity between frontal regions. The infants also showed increased connections across temporo-parietal areas in the right hemisphere, which are associated with social information processing.
"These findings improve our understanding of the neural differences that precede autism and show which brain regions reveal the earliest signs of disruption," Dr. Dickinson said. The findings bolster the idea that disrupted brain connectivity is a root cause of ASD, not a consequence.
The authors suggest that the low cost, wide availability and low risk of EEG make it a good screening tool to identify babies at higher risk of developing ASD or those with "borderline" symptoms, so that they get early intervention. "Mapping patterns of activity associated with autism could ultimately help identify infants who show early signs of neural risk."

Elsevier. (2020, August 11). Early neural activity associated with autism: EEG measurements in infants predicted ASD symptoms in toddlers. ScienceDaily. www.sciencedaily.com/releases/2020/08/200811120144.htm

Dickinson, A., Daniel, M., Marin, A., Gaonkar, B., Dapretto, M., McDonald, N.M., & Jeste, S. (2020). Multivariate neural connectivity patterns in early infancy predict later autism symptoms. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, S2451-9022(20), 30140-3. DOI: 10.1016/j.bpsc.2020.06.003


Leading to earlier intervention - as noted by Pierce et al. (2020)?

"The map and magnifier approach showcases a generalizable way of using multiple data modalities for subtyping autism and it holds the potential for many other genetically complex diseases to inform targeted clinical trials," said Luo.
Using the tool, the research team also identified a strong association of parental dyslipidemia with autism spectrum disorder in their children. They further saw altered blood lipid profiles in infants later diagnosed with autism spectrum disorder. These findings have led the team to pursue subsequent studies, including clinical trials that aim to promote early screening and early intervention of autism.
"Today, autism is diagnosed based only on symptoms, and the reality is when a physician identifies it, it's often when early and critical brain developmental windows have passed without appropriate intervention," said Luo. "This discovery could shift that paradigm."

Northwestern University. (2020, August 11). AI-enhanced precision medicine identifies novel autism subtype: Tool lays groundwork for autism early diagnosis and intervention. ScienceDaily. Retrieved September 20, 2020 from www.sciencedaily.com/releases/2020/08/200811153921.htm

Luo, Y., Eran, A., Palmer, N., Avillach, P., Levy-Moonshine, A., Szolovits, P., & Kohane, I.S. (2020). A multidimensional precision medicine approach identifies an autism subtype characterized by dyslipidemia. Nature Medicine, 26(9), 1375-1379.


A closer link between research and practice to ensure children with ASD make the best possible start to their lives?

One can hope!

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