Is Autism a “Public Health Crisis?”. Part 1
Singular attention to ASD risks creating a barrier to services as it places a bubble around persons with ASD that may disconnect them from existing and directly applicable knowledge and resources. A second concern about presupposing persons with ASD to be broadly different from others with developmental and behavioral disabilities is the strong potential of stereotyping need, behavior, and individual characteristics while duplicating existing services and resources. The Commission’s report states that a “broad array of community services available to the public and the traditional models of service available to persons with disabilities (to include through the educational system) are not designed to specifically meet the needs of those with ASD” (California Blue Ribbon Commission Report on Autism, 2007, p. 13) without explaining how this conclusion was reached.
The reality is that there are few, if any, instructional or behavioral strategies unique to children with ASD as compared to other children with and without developmental or learning challenges. Good teaching is more guided by the individual needs and learning styles of the child in combination with features of the setting and the training of the educator than the diagnostic category (Anderson & Algozzine, 2007; Sadler & Sugai, 2009; Sugai, 2000; Wehmeyer et al., 2002). Even though children with ASD may require more explicit attention to social and expressive skill development than many of their peers, for instance, how that is taught is not typically different for children with ASD than those without (Derby et al., 1997; Earles et al., 1998).
At the same time, social and expressive deficits and related behavioral needs are hardly unique to children with ASD or accountable to a unique ‘internal’ process in persons with ASD. Studies have consistently shown that children with chronic expressive deficits are more likely than the general population to use disruptive and aggressive behaviors for communicative purposes. These same studies have demonstrated that effective intervention for communicative deficits can reduce disruptive behaviors across children with very different developmental diagnoses ranging from conduct disorders to autism (Carr & Durand, 1985; Derby et al., 1997; Gilmour et al., 2004; Horner & Day, 1991). In fact, one study (Gilmour et al., 2004) reported that a significant number of children with conduct disorders had pragmatic language impairments and other behavioral features that were similar in nature and degree to those of children with autism.
The ‘communication hypothesis’ described by Carr and Durand (1985) over twenty years ago continues to be a strong inference for the relevance of purpose, function and context over diagnostic category as the foundation for the challenging behavior often seen in children with ASD. As a result, and an example, Functional Communication Training continues to be a commonly used intervention and instructional model for children with ASD as well as for those across the range of developmental disabilities and special needs (Derby, et al., 1997; Winborn et al., 2002).
This reality may counteract the overriding belief widely referenced in the Commission’s report that presupposes a link between the behavior of children with ASD with a medical illness process like that of a cold or flu. Instead, much of the behavior evidenced by persons with ASD may be better viewed as contextually driven and functionally relevant.