Improving Educational Experiences for Autistic Children and Young People: a Survey of the Experiences and Support Needs of Teachers and Other Education Professionals in Poland



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Improving Educational Experiences for Autistic Children and Young People: a Survey of the Experiences and Support Needs of Teachers and Other Education Professionals in Poland
Marion Hersh

Biomedical Engineering, University of Glasgow, Glasgow G12 8LT, Scotland

marion.hersh@glasgow.ac.uk

Abstract

The results of a survey of 120 teachers and education professionals working with autistic students in Poland are presented. It covers their experiences, use of teaching assistants, training, important and difficult issues, support measures and suggestions for good practice and combines quantitative and qualitative data. The results present the perspective of teachers and education professionals, increase understanding of their experiences and support needs, identify several issues not previously discussed in the literature and provide further evidence of the importance of communication issues, training and teaching assistants. A series of evidence based recommendations obtained from analysis of the results is presented.


Keywords: Autistic students; teachers and education professionals; good practice recommendations; experiences and support needs; Poland

1. Introduction and Literature Review
This paper draws on the results of a survey of 120 teachers, therapists and other professionals working with autistic1 children and young people in an educational context in Poland to increase understanding of their experiences, difficulties, issues of importance and support needs and develop a series of evidence based recommendations for good practice. This is a very important issue for a number of reasons, including the increasing number of autistic children, for instance an average of one in 68 eight year olds in the USA in 2010 (Baio, 2014); teachers' anxiety about their inability to effectively teach both autistic students and the rest of the class (Emam and Farrell, 2009), the lack of and need for appropriate training on working with autistic students (Helps et al., 1999), as well as the likelihood of inappropriate approaches having negative consequences (Marder and deBettencourt, 2015). The increasing use of mainstream approaches e.g. (Avramidis and Norwich, 2002) makes this an issue of relevance to all teachers. There is also serious concern about the future education and employment prospects of autistics, with only an estimated 12-15% of higher functioning individuals in paid employment and only 25 of young autistic adults having any education or training after school (Barnard et al, 2001; Touhig, 2013). There has been limited work in this area, with only a small number of surveys of teachers or other professionals.
A number of success factors have been identified. They include support and training for teachers (Boyer and Lee, 2001; Burack et al, 1997, Rose, 2001), including on the use of several evidence based practices (Alexander et al., 2015), functional communication (Mancil, 2006) and/or speech and language training (Glashan et al., 2004); the head teacher's beliefs about inclusion (Stanovich and Jordan, 1998); and early intervention, individualisation and specialised curricula including attention to the environment, language use and social interaction (Hurth et al., 1999). Further success factors include family involvement including in decision making (Hurth et al., 1999); active participation (Iovanne et al., 2003) and peer involvement (Odom et al., 2003). Parents, teachers and administrators have been found to support intervention programmes involving some combination of (i) individualised programmes, (ii) data collection, (iii) empirically based strategies, (iv) active collaboration, and (v) a focus on long-term outcomes (Callahan et al., 2008).
Teachers are particularly interested in training in social skills, behavioural supports and communication (Burack et al., 1997; Helps et al, 1999; McGregor and Campbell, 2001; Teffs and Whitbread, 2009), but generally have little specific training on autism and high perceived training needs, with special school teachers generally having more training and better support than mainstream teachers. Only a minority of US mainstream teachers feel prepared and a very small minority well-prepared to teach autistic students (Teffs and Whitbread, 2009) and class teachers require about a year to feel they are coping with teaching an autistic child (Glashan et al., 2004). Teachers experience particular difficulties in dealing with the different social and emotional understanding and communication styles of autistic and non-autistic students, autistic students' difficulties in generalising learning across different situations and the need to explain everything in words without the use of facial expressions and body language (Eman and Farrell, 2009). They have been found to consider motivation and communication, followed by the need for patience and 'problematical behaviour' the most demanding issues (Urbanovská et al., 2014).
Full and half-day workshops were the most frequently used training approach in a US survey, followed by practical experience of working with autistic students and self-training (Morrier et al., 2011). However, ongoing technical assistance and access to resources to support training are recommended (Scheuerman et al., 2003). Many effective programmes adapt the environment, instructional materials and teaching interactions and involve full integration with non-disabled children (Hurth et al., 1999).
There is an increasing trend for interventions to be tailored to the particular child (Odom et al., 2003), in line with studies showing the value of individualised goals, strategies and evaluation criteria (Hurth et al., 1999), including in increasing accuracy and the ability to generalise across different learning settings (Hume et al., 2012). The need for consistent strategies, priorities and approaches across parents, teachers and therapists has been identified (Ruble and Dalrymple, 2002). Functional spontaneous communication, social skills, play skills, cognitive development, functional academic skills and pre-emptive strategies to decrease challenging behaviours have been identified as important areas of instruction for young autistic children (Marder and deBettencourt, 2015). The project DATA (Schwartz et al, 2004) includes an inclusive educational programme, collaboration and coordination across services, extended instructional time, technical and social support for families and transition support.
Reviews and meta-analyses of functional communication training and the use of assistive communiction systems with autistic children found that that they improved communication skills and (to a lesser extent) social skills, challenging behaviours and spelling (Ganz et al., 2012; Mancil, 2006). The procedures used in implementing the communication system may be more important than the specific system used (Ganz et al., 2012).
Teachers with a social model perspective have been found to teach more effectively in inclusive classrooms than teachers with a medical model one (Jordan et al., 1997; Stanovich and Jordan, 1998). The school ethos as evidenced by the head teacher's social/medical model orientation and attitudes and beliefs about inclusive classrooms has been found to be the main predictor of effective teaching (Stanovich and Jordan, 1998). Teaching an autistic child was found to increase positive attitudes to integration (Burack et al., 1997; McGregor and Campbell, 2001; Teffs and Whitbread, 2009). Experience of autism has been found to be crucial for supporting autistic children and their teachers, but to have been generally lacking (Glashan et al., 2004). However, teachers generally have positive attitudes towards autistic children with younger and female teachers and teachers who had attended multiple autism workshops having more positive attitudes (Park and Chitiyo, 2011; Robertson et al., 2003). US head teachers have been found to recommend higher levels of inclusion for autistic students who are performing well academically and lower levels for 'socially detached' autistic students, but belief in the inclusion of autistic students in mainstream classes was found to lead to higher levels of inclusive placements, including for 'socially detached' children (Horrocks et al., 2008).
Several studies have shown that teachers and parents prefer to work together e.g. (Freer and Watson, 1999); parents’ knowledge and involvement and preparing families, schools and communities to create supportive environments increase the likelihood of successful placements (Glashan et al., 2004) and contribute to improving educational outcomes for autistic students (Fleury et al., 2014). Parents and families also require considerable emotional support, particularly through frequent largely informal meetings (Glashan et al., 2004).
Engagement in learning has often been defined differently for autistic students in terms of on-task and on-schedule behaviour (Bryan and Gast, 2000; Pelios et al. 2003), rather than specific behaviours, such as attending to the teacher (Greenwood et al., 2002). Visual cues and schedules are increasingly being used with them to increase on-task behaviour and the ability to follow the classroom schedule (Bryan and Gast, 2000). Environmental modifications, such as the modification or reduction of light and sound, removing visual stimuli from the walls and teachers wearing neutral clothing, are being used to influence behaviour (Duker and Rasing, 1989). Traditional learning and teaching strategies based on verbal information are inappropriate for many autistic learners who are unable to process this information (Carnahan et al., 2009). Small scale studies have identified the effectiveness of a combination of visual interactive materials and music, including in group settings and the need for appropriately tailored interventions and age appropriate materials for older students (Carnahan et al., 2009). They have also identified the effectiveness of computers in supporting learning to reading (at pre-school level) (Oakley et al., 2013; Williams et al., 2002); the value of student centred approaches that draw on the autistic child's interests (Oakley et al., 2013); and the use of a sequence of photographic albums for learning fairly complex schedule following skills and generalising them to another setting without prompts (MacDuff et al., 1993).
Most teachers have been found to prefer the use of a teaching assistant who worked closely with the autistic student and often mediated between the teacher and the student (Giancreco et al., 1997; Marks et al., 1999). Many assistants had little or no autism specific training and often little knowledge of the school rules (Burack et al., 1997; Glashan et al., 2004), but many of them had undertaken courses or researched the topic in their own time and shown considerable commitment (Glashan et al., 2004). However, some studies have found that the presence of an assistant can damage the teacher-student relationship and reduce interaction with the teacher (Giancreco et al., 1997; Marks et al., 1999), but this can probably be avoided by the teacher and assistant sharing responsibility for the autistic student, working together to develop a strategy and ensuring that the assistant does not separate the autistic student from the class during activities (Robertson et al., 2003).
A number of social skills training­­ programmes have been developed for autistic children, generally based on analysing tasks, the environment, and situations leading to behaviour considered problematical and identifying the steps required to change it (Simpson and Regan, 1988; Van Hasselt et al., 1979). These programmes should start with the least intrusive (Brown et al., 2001), including environmental modifications, cooperative learning, mixed social group activities (Kamps et al., 1994) and pairing autistic students with socially skilled peer buddies (Terpsta et al, 2002). In addition, activities that encourage isolation, such as students choosing teams, should be avoided (Williams et al, 2005). Peer involvement to support social behaviour has a long history with older studies indicating the effectiveness of this approach and more recent studies looking at the support peers require (Odom et al., 2003). Approaches include peer buddies (Laushey and Heflin, 2000) and inclusive art classes (Schleien et al., 1995). School psychologists have been found to consider training staff and assistants to work with autistic students, followed by direct instruction/pivotal response training interventions, the best social skills interventions for autistic students. They also suggested that highly generalisable approaches all involve non-disabled peers (Day, 2011).

2. Methodology
A survey was carried out of teachers and education professionals working with autistic students to investigate their experiences, training and support requirements and suggestions for good practice. The first section of the two-part questionnaire covered personal information for statistical correlation purposes, including gender, profession, main place of work, years of experience and the main subjects taught and/or the main areas of professional expertise. The second section collected quantitative and qualitative data. Closed questions covered (i) working with autistic students, (ii) working with nonverbal autistic students, (iii) the presence of an additional teacher in their classes (in the case of teachers) and (iv) participation in training. Follow-up open questions asked for details, specifically (i) the number of autistic students they worked with, (ii) communication methods used with nonverbal autistic students; (iii) the role of additional teacher(s); and (iv) details of training, including who paid and when it took place. Two rating scale questions asked for a numerical evaluation of the importance of various factors and suggestions for support. Four open questions asked what in work with autistic students they considered (i) the most important; (ii) the most difficult; and (iii) good practice; and for (iv) additional comments and suggestions.
A Polish version has been produced and other language versions are being considered to allow comparison of experiences and (good) practice in different countries. The questionnaire was distributed at workshops in Poland on communication with autistic children and young people presented by the author and also distributed electronically through schools by the author's Polish colleagues. The results of a companion questionnaire for parents will be discussed in a subsequent paper. In line with ethical procedures, completion of the questionnaire was voluntary, all the responses were submitted anonymously and the submitted responses were confidential to the author.
A contingency table X2 test with five degrees of freedom with software developed by Kirkman (1996) was used to test for statistical significance. Where the presence of zeros across a row prevented the use of a test with five degrees of freedom, four or three degrees, as appropriate were used. Analysis of the qualitative data was carried out without translation and only the chosen quotes were translated (by the author).

3. Results and Discussion
3.1 Quantitative Data
121 responses were received, 115 at workshops and other events and six electronically. One questionnaire was discarded as it was not from a teacher or other education professional, giving 120 useful responses. As shown in tables 1-3 participants represented the whole sector with regards to location, profession and experience, though the greatest numbers were primary and preschool teachers. The majority of women (table 1) is in line with the gender distribution in the sector and other surveys e.g. (McGregor and Campbell, 2001). The majority of school-based respondents worked in special schools, with only 15.8% in mainstream schools (table 2). This indicates that, at least at pre- and primary school level, the majority of autistic children in Poland were in special schools. This adds to the picture of the extent of inclusion and integration worldwide and is out of line countries such as Scotland and USA e.g. (McGregor and Campbell, 2001; Teffs and Whitbread, 2009).


Profession (118)2

Gender (120)

Teacher

Therapist

Teacher + therapist

Psychologist

Speech therapist

Teacher + other

Other

Female

Male

43

23

15

13

11

6

7

110

10

36.4%

19.5%

12.7%

11.0%

9.3%

5.1%

5.9%

91.7%

8.3%

Table 1 Profession and gender


Place of work (118)

Type of school (76)

Preschool

Primary school

Other school(s)

Clinic

Therapy centre

Other

Main

Stream


Integrated

Special

Mainstream +integrated

25

39

15

14

15

10

12

15

44

5

21.2%

33.1%

12.7%

11.9%

12.7%

8.5%

15.8%

19.%7

57.9%

6.6%

Table 2 Place of work
The overwhelming majority of respondents were currently working with autistic students, with a small number having done so in the previous, but not the current year (table 3). Respondents most commonly worked with 2-5 autistic children and young people (40%), with about a fifth working with each of 6-10 and 11-20 autistic children (table 4). Just over half those who replied had a teaching assistant and nearly 40% did not have one, with small numbers having one sometimes or rarely (table 4). This seems lower than in the literature e.g. (Burack et al., 1997) and may be due to the economic situation in Poland compared to other countries. In about a third of 22 replies the assistant supported only autistic children, whereas about two thirds supported both autistic and other disabled children. In the overwhelming majority of 19 replies the assistant supported a small group of 2-5 students. In nearly 60% of 31 replies the assistant was present at all classes, in about a sixth of cases only at academic lessons and in nearly 10% for about half the teaching time). The circumstances in which additional teachers or assistants were provided does not seem to have been considered previously in the literature.


Years of experience (115)

Work with AS3 (120)

Work with NV (119)

Training (119)

< 2

3-5

6-10

11-20

21+

Yes

No

ST

Yes

No

Yes

No

14

24

20

34

23

104

6

10

89

30

108

11

12.2%

20.9%

17.4%

29.6%

20.0%

86.7%

5.0%

8.3%

74.8%

25.2%

90.8%

9.2%

Table 3 Experience working with autistic children and young people



Number of autistic people worked with (105)




Teaching assistant (72)

1

2-5

6-10

11-20

21-40

60+




Yes

Sometimes

Rarely

No

7

42

23

19

12

2




40

3

1

28

6.7%

40%

21.9%

18.1%

11.4%

1.9%




55.6%

4.2%

1.4%

38.9%

Table 4 The number of autistic people worked with and the use of a teaching assistant
Three quarters of the respondents had worked with non-verbal autistic children (table 3). They used a wide range of different communication methods, with many respondents using several different ones (table 5). The most popular approaches were graphical, in line with the literature on the effectiveness of interactive visual learning materials and cues with autistic students (Bryan and Gast, 2000, Carnahan et al., 2009). They involved both the pictorial communication systems PECS and PCS, and drawings, photos and pictograms. Other popular approaches were gestures, Makaton and speech. Only three respondents used a national sign language. The types of communication systems used by teachers with non-verbal students seem to have received minimal discussion previously. Most of the communication systems used by respondents are most suitable for expressing basic needs and cannot easily be used for more complex communication. This is probably appropriate for the pre- and primary school age children the majority of respondents were working with, but could be restrictive later.


Pictograms

Makaton

PCS

PECS

Gestures

Drawings

Photos

AAC

Verbal

20

20

35

12

29

9

6

6

11

25.6%

25.6%

44.9%

15.4%

37.2%

11.5%

7.7%

7.7%

14.1%

Table 5 Communication methods with non-verbal autistic children and young people


Just over 90%, had engaged in some sort of training on autism. However, half of them had paid for it themselves, with the employer only paying all costs in an eighth of cases and only paying either a part or all costs in just over a fifth of cases (table 6a). Only a small fraction had attended training fully or partially in work time. The overwhelming majority had attended training outside work, and 10% had had to take leave in order to do this (table 6b). The much higher percentage of respondents who had attended training as compared to the literature e.g. (Boyer and Lee, 2001) may be due to participants being more highly motivated than average and therefore willing to pay for their own training and attend in their own time. However, in view of the recognised importance of training (Boyer and Lee, 2001), access to it should not be dependent on paying oneself and attending outside work. Too few respondents provided information on the topics covered and the length of training attended to comment on this in detail.


Training (119)

Payment for training (76)

Yes

No

Self

Employer

Part self (or free) part employer

Other

Part self part finance or free

108

11

36

17

9

4

6

90.8%

9.2%

50.0%

23.6%

12.5%

5.6%

8.3%

Table 6a Training




Weekend

After work

Took holiday

Unspecified outside work

Work time

Work + non-work time

Holiday + outside work

Other

22

13

8

26

3

3

3

1

27.8%

16.5%

10.1%

32.9%

3.8%

3.8%

3.8%

1.3%

Table 6b: When training takes place (79)

All the suggested issues were considered to be important by respondents (table 7). Communication with non-verbal people received the highest score on importance, followed by aggression, self harm and lack of social interaction. These issues have all been highlighted in the literature e.g. (Brown et al., 2001; Glashan et al, 2004; Horner et al., 1991; Lovaas, 1987; Mancil, 2006), though there do not seem to have been any analogous surveys previously. As might be expected with a large number of respondents, the medium and larger, but not the smaller, differences were generally found to be statistically significant at the 0.05 and sometimes the 0.01 or 0.001 levels.







Comm NV

Comm VB

Agress

Ion


Self harm

Parents'

Prej


Parents' expect

Adapt program

Lack time

Lack soc int

Score

4.2

3.7

4.0

4.0

2.9

3.9

3.5

3.5

4.0

No.

101

100

104

102

99

104

94

88

101

Table 7 The importance of particular issues and problems


All the proposed solutions were considered very useful with scores of between 4.3 and 4.7 out of 5 (table 8). The highest score was for an assistant or additional teacher for each autistic student, followed closely by regular training and the lowest for information and workshops for non-disabled students. The importance given to assistants and training parallels teachers' expressed preferences for a teaching assistant (Giancreco et al, 1997; Marks et al., 1999) high perceived training needs and desire for training (Burack et al., 1997; Helps et al, 1999; McGregor and Campbell, 2001; Teffs and Whitbread, 2009). However, the scores for the different solutions were fairly closely grouped and therefore only the highest differences were found to be statistically significant at the 0.05 level. Small differences in the importance and usefulness ratings of teachers and therapists were obtained, but were not statistically significant.





Assistant for all

Regular training

Meeting other teachers

Meeting autistic adults

Training for students

Training for parents

Score

4.7

4.6

4.4

4.4

4.3

4.4

No.

108

107

109

106

108

106

Table 8 The usefulness of proposed solutions



3.2 Qualitative Data
The overwhelming majority of participants responded to the open questions on important issues and difficulties and just over half provided good practice and further comments and suggestions. Communication, working with the parents of autistic children, and understanding autistic students and their needs were considered both important and difficult by significant numbers of respondents (tables 9 and 10). Communication was considered important by over half the participants, with 13.5% concerned specifically about autistic children learning to communicate, and difficult by over a quarter. It was the subject of suggestions for good practice by nearly a fifth. This is in line with survey data showing communication to be one of the most demanding issues for participants (Urbanovská et al., 2014). Many participants focused on finding an effective form of communication, with comments including 'to find a method of communication that is accepted by the autistic person'; 'developing points of communication, so the autistic person feels less frustrated' and 'communication in different ways to get to the student'. Communication difficulties included communication with non-verbal people, developing appropriate communication systems and understanding needs. Specific comments included 'reaching them in the case of serious autism'; 'expanding the types of communication suitable for autistic people and adapted to the way they think', 'the child's inability to communicate his/her needs and wants ... instead of answering the question the child repeats it or gives all possible answers' and 'lack of communication about their feelings'.


Communication

Learning to communicate

Making contact

Social abilities

Independence and self-care

Relationships

Work with parents

59

15

19

18

13

11

8

53.2%

13.5%

17.1%

16.2%

11.7%

9.9%

7.2%

Table 9 Issues considered the most important (111)





Commun

Ication


Making contact

Agres

Sion


Self

Harm


Difficult behaviour

Understand needs

Understand

behaviour



Work

with parents



Lack

Time and resources



Concentraton and motivation

31

10

24

15

27

9

9

14

7

7

28.7%

9.3%

22.2%

13.9%

25%

8.3%

8.3%

13.0%

6.5%

6.5%

Table 10 The greatest difficulties (108)


Good practice suggestions generally covered the use of communication systems for non-verbal students, in line with the literature on the use of communication systems to improve communication and other skills e.g. (Ganz et al., 2012). In many cases a particular communication system, such as PECS, PEC or pictograms, was mentioned without further comments. However, one respondent suggested 'classes with the support of non-verbal communication methods such as Makaton and PCS symbols'. Many of the comments show awareness of the child's perspective, empathy with their possible feelings, respect and recognition of the importance of the communication system being appropriate to the particular child. Despite considerable discussion of communication with autistic students in the literature, there do not seem to been previous reports of teachers' and other (educational) professionals' views.
Important areas related to working with parents included 'positive relationships with the parents, taking into account the family situation' and difficulties included problems in working together for instance 'lack of collaboration with the family'; 'lack of interest in working together between pre-school and home'; 'it seems as though they do not understand how to help their child, ... do not want to work together with teachers to help him obtain success at school and in life'. Unrealistic expectations were a further source of difficulty, for instance 'parents who do not accept disability, are counting on a miracle, a total cure'. However, positive comments about the parents' role included 'contact with the parents greatly helped my work' and 'ongoing collaboration with the parents and individuals working with the children has really good results in both teaching and the child's functioning in the family environment and with classmates'. While the literature has discussed the importance of and preferences for parent-teacher collaboration e.g. (Ruble and Dalrymple, 2002; Freer and Watson, 1999); this paper gives a much more detailed picture of teachers' and other education professionals' experiences and attitudes to working with parents and illustrates both their positive experiences and the difficulties.
Suggestions for good practice included the need for more information and support for parents, with the two sometimes linked. For instance, 'I would like parents to have more support - support groups ... an assistant for the family, ... who would enable the mother even just for a few hours in the week to have time for herself, information ... for fathers who try and repress the problem and run away from it' and 'workshops for the parents of children with autism ... the parents learn ... they can also meet up, relax, exchange information, the children's problems, spend time outside the home (with people who understand them)'. The need for regular contact between parents and teachers was also stressed e.g. 'regular meetings of the team of teachers and parents' and 'regular conversations with the parents of autistic and nonautistic children about their expectations and the common use of the preschool where I work'. Thus, this proposal combines social support, information exchange and support for inclusion or, at least, integration.
Participants also emphasised with their autistic students, avoided blaming them and stressed the importance of understanding them, for instance 'knowing their needs', 'knowing the reasons for difficult behaviours, particularly self-harm and aggression' and 'understanding what autism is and that unusual behaviour is not intentional from the point of view of the child and emotions can be measured in various ways and needs indicated or not'. Proposals for improving understanding of autistic students included 'good contact with a lot of people with autism' and 'practice is important'. Behaviour, both specific behaviours and a lack of understanding of the reasons for them was a significant cause of difficulties, in line with the literature e.g. (Urbanovská et al., 2014). Particular difficulties related to behaviours included 'self harm’, 'biting', 'scratching', 'the child's aggression to ... peers, books, teachers ...', 'difficult behaviour which is dangerous for their safety or health e.g. a 15 year old boy who climbs bare foot onto everything in the gym and becomes aggressive when he is forbidden to do this', 'unforeseen behaviour from individuals who are bigger than me (teenage boys)' and 'the rigidity of their behaviour, the teacher must be in the class when they come in or they shout and rage ... they want to play with the same toys in every class'.
Behaviour was also considered a source of information about needs, for instance 'to observe the child's behaviour in order to read from it what the child needs at a particular moment'. Teachers also recognised that ‘difficult’ behaviour was often a response to external circumstances e.g. 'understanding the sources or stimulation which causes [aggression and self harm]' and 'the student who is aware of his/her "otherness", but does not accept it. S/he does not want help, ... but at the same time gets angry when things don't work'. This led to responses of managing the environment, for instance ‘removing or reducing sensory stimulation which causes difficult situations' and 'foreseeing situations in which the student will be oversensitive'. Teachers recognised that some of the difficulties they experienced in understanding the behaviour of autistic children were a consequence of their lack of knowledge and understanding of autism, for instance 'I sometimes understand their untypical behaviour and understand them (and the causes)' and 'my very limited knowledge of autism'. They also expressed difficulties in understanding needs and desires, including 'recognising the needs of the child' and 'not knowing their preferences'. While there has been discussion of managing behaviour e.g. (Hart, 2012) and modifying the environment e.g. (Duker and Rasing, 1989), the comments presented here give a more detailed picture. They show the genuinely difficult situations experienced by teachers, their willingness, despite the demands on them, to try to understand and look for solutions and the fact that, despite the possible temptation to do so, they resist blaming the child.
Other important issues raised by significant numbers of participants included autistic students' relationships and social abilities, in line with concerns in the literature about encouraging social interaction and developing social abilities (Brown et al., 2001; Stichter et al., 2007), the teacher or other professional making contact with them, independence and self-care, and important personal qualities and behaviours for teachers and other professionals. Suggestions for developing social skills, including 'helping autistic people understand the system of social obligations', 'developing social skills', 'help with social functioning' and 'preparation for managing in a social group (to the extent of their possibilities)'. On the negative side 'the inability to follow group rules and norms' was considered a difficulty. Good practice in this area included peer group involvement. For instance, 'we introduced a buddy system into classes with autistic students. The neurotypical students looked after the autistic children, in classes they invited them to take part in group work, they spent the breaks with them. ... the neurotypical students themselves understood the sense and the need for such a system'. Other approaches were based on educating the non-disabled children and inclusive approaches to teaching social skills, including 'teaching the children how to understand the child with autism ... what his or her behaviour means, how to play with that colleague etc' and 'lessons in small groups (2-3 children) for autistic and non-disabled children about social abilities and communication'. This last proposal indicates the potential for autistic and non-disabled students learning from each other and developing social strategies and interactions that work for both groups and draw on their strengths.
While not quite expected to be a combination of saint and superperson, a number of characteristics and attitudes were considered important for teachers and other professionals. These included 'sensitivity to the needs of autistic people, patience with various difficulties and limitations, joyfulness, creativity, the ability to observe', 'respect for autistic people' 'empathy' and 'mutual acceptance, understanding of the other person, tolerance for certain behaviours', 'openness and lack of prejudice', and 'a certain distance, humour'. Suggestions for good practice included 'belief in the child's abilities' and 'accepting [autistic people] as they are ... asking for initiatives from them'. This implies challenging autistic students (to an appropriate degree) and recognising their potential for achievement.
The other main sources of difficulties were a lack of time and resources and a lack of concentration and motivation by autistic students, as line with other studies e.g. (Helps et al., 1999; Rose, 2001; Urbanovská et al., 2014). Resource related problems included 'lack of support from the authorities'; 'the impossibility of employing additional specialists ... the impossibility of employing help for the teacher, due to the lack of financial resources ... (despite the need)'; 'stress due to the limited organisational possibilities'; and 'the lack of textbooks for the programme (I have to prepare everything myself)'. In addition, the limited available resources were not always used effectively, for instance 'subsidies do not accompany students to school. They are often wasted on trifles and paperwork'. Lack of resources may have also contributed to inappropriate education systems, for instance 'the school system is not adapted to [autistic students'] needs'. A related issue was problems due to bureaucracy and unnecessary demands - 'school has so many demands and obligations, that teachers lose pupils amidst the entrenched practices, bureaucracy and frustrations'.
Comments on lack of motivation included 'I do not know what to propose a child who does not want to do anything in class (just sits at the table)' and 'motivating someone with Asperger's syndrome to work on himself. He is totally passive, does not expect anything of himself and others, just spends time on his favourite thing - computer games'. Good practice solutions included an ‘individual motivational system'. An area of difficulty which does not seem to have been discussed in the literature was initiating the process of interaction with autistic students. Specific problems included 'making the first contact and building trust with an autistic child' and 'the start is the most difficult: on the one hand I want to get to know the child, on the other I'm afraid my lack of knowledge will cause the child stress and frustration'. The importance of 'forming a relationship with the child, without this no therapy will work’ and 'at the start create a friendly atmosphere of play and work' were recognised. Further good practice suggestions are given in table 10. While previous surveys asking for best practice suggestions seem to be lacking, these ideas are consistent with the literature on, for instance, emotional support for parents (Glashan et al., 2004); and the needs for individualised programmes (Callahan et al., 2008) and environmental modifications (Ruble and Dalrymple, 2002).
Specific comments on the teaching environment included the importance of 'an appropriately prepared place of work', 'quiet', 'ensur(ing) quiet and calm in the group', and 'adapting the environment as far as possible to the child's needs'. Creating an appropriate environment was also experienced as a difficulty with teachers concerned that they were not always able to create a suitable environment. Thus, due to 'different sensory perceptions sometimes despite trying hard I cannot create an environment which is comfortable for them'. Lack of resources also made it more difficult to create suitable environments, for instance 'money to adapt the room fully to work with the child. It's frustrating when I see that the child has potential, but the conditions are unfavourable (and there is no money to change this). While the value of adjusting the environment to reduce sensory overstimulation has been considered e.g. (Ruble and Dalrymple, 2002), difficulties due to lack of resources do not seem to have been discussed.
Good practice suggestions for integration included 'total integration as it's lacking', 'continuing integration of autistic children from preschool to school'. They frequently focused on inclusive social events, such as 'common socials and outings for students with and without autism, between-class social events for children with different degrees of disability, integrating social events for students from our school and the mainstream school'. Other suggestions related to giving autistic students a role and responsibilities, such as 'including the student in the life of the class, asking what s/he thinks about particular initiatives, entrusting him with certain responsibilities ... selecting the student as team captain (in sport), engagement in class plays etc'. The suggestion for making autistic students team captain is particularly interesting, as team selection by students has been suggested as a type of activity to be avoided, as it leads to exclusion (Williams et al., 2005). With appropriate support and resource, the approach of giving autistic students appropriate roles and responsibilities has the potential to counter stereotypes and improve social skills by allowing the autistic student to develop their strengths. While the need to 'prepare non-disabled students for “otherness”, including for contact with non-verbal autistic students' was noted, one teacher considered that 'the students who are in classes with autistic students are tolerant, friendly, caring to them'. A related important issue was the need for autistic children to feel safe and comfortable. In particular, this included 'respect (for classmates)', 'the widest possible understanding of [autistic people] by society to avoid them being objects', 'ensuring acceptance and a feeling of safety for the child' and 'feeling good in lessons'.
Good practice related to additional teachers or assistants included 'employing an assistant just for the autistic children'. An assistant was considered necessary for non-academic as well as academic classes, as 'the fact that students do not need to sit on a bench during gymnastics classes does not mean that an autistic student does not suddenly lose control in front of the other students'. In some areas bureaucratic rules prevented the employment of assistants. 'In my preschool the mothers employed [an assistant], (using a loophole in the rules). ... in other schools an autistic person would not have this possibility.' In some cases assistants were not employed even when resources were available. 'Every school receives a large subsidy for children with autism, but when they cause problems, instead of employing an assistant, they are pushed out of school'.
Further good practice suggestions related to teaching approaches, included the basic principles of 'consistent behaviour', 'clear rules', 'collaboration with the family', 'engaging every individual and specialist involved in working with the child', 'finding the child's strengths', 'a means of motivating the student', 'adjusting approaches to the needs of the individual child' and 'stability'. Some of the more creative suggestions for good practice included the use of psychodrama to 'practice empathy and remove aggression to other students'. The importance of adequate preparation for transition, including starting or changing school, was recognised. Suggestions included 'holding workshops on the child's problems with techniques for communication' and 'clear observations about the student before they come to pre-school'.
The only suggestion or comment raised by a significant proportion of respondents (21.3%) was the need for more and better training, in line with a general lack of training on autism and the need for it (Helps et al., 1999). Several participants wanted fully financed training, with 'a need for specific training courses teaching approaches for work with students with Asperger's syndrome or autism, coping with aggression and self-harm'; 'greater accessibility (including financially) of professional training for specialists, above all for workshops'; and 'a professional course on how to work with autistic people. Such courses are very expensive'. However, one teacher complained that 'it is very difficult in our school to motivate teachers to participate in training and workshops about autism'. This may have been explained by the need to pay for training themselves and attend outside work. Teachers and others working outside the larger towns and cities experienced particular difficulties in 'access to schooling in smaller towns and villages ... where it is impossible to find qualified specialists'.


4. Recommendations
The following recommendations have come out of the results of the survey and consideration of the literature:
I Supporting, and teaching autistic students

  1. An individual teaching assistant or support teacher for each autistic student, who shares responsibility and works with the teacher to develop a strategy to ensure effective support for the student(s) and avoid becoming a gatekeeper between them and the teacher or their peers.

  2. The use of small group teaching and individual planning for autistic students, including individual motivation systems, with support for the transition between smaller and larger groups.

  3. An appropriate balance between therapy and education, so that autistic students have access to useful therapy, but not at the expense of their education or an excessive workload or very long day.

  4. A positive, but realistic attitude to each autistic student’s potential and recognition that autistic and neurotypical students have both strengths and weaknesses. The use of pedagogical approaches with an appropriate degree of challenge tailored to the student, which make appropriate demands, draw on strengths and minimise the effects of weaknesses.

  5. The importance of developing autistic students’ academic, social and other abilities and skills and the potential for using their special interests, if any, to do this.


II Provision of a safe environment for autistic students

    1. The organisation of all teaching to minimise sensory disturbances or overstimulation e.g. good sound insulation between classrooms, quieter in-class end of lesson indicators to replace school bells, calm décor, blinds on windows giving the option of shutting out excessive light, the use of scent free cleaning products, encouraging staff not to use scented products or wear jewellery, sequins etc, sufficiently large classrooms, if necessary allowing autistic students to leave before the other students to avoid crowds in corridors.

    2. Actively working to create a climate where all students feel safe and there is mutual respect between students and teachers and between autistic and non-autistic students. This will require teaching about the social model of disability and about autistic (and other disabled) people in an age appropriate way.

    3. Systematic and consistent approaches to teaching and class organisation amd clear rules across all settings.

    4. Advance information in a clear, easy to understand format about classes, timetables, changes and other relevant issues. All information needs to be communicated explicitly.

    5. Visits to schools by autistic adults who can act as role models for autistic students.


III Resources and inclusion

    1. Adequately funded schools and sufficient resources of all types to fully support quality teaching for both disabled and non-disabled students. In particular, this would allow for additional teachers, smaller classes, higher staff student ratios, quiet rooms to which autistic students can withdraw for shorter or longer periods and a wide range of teaching materials.

    2. Measures to promote inclusion, including inclusive social events, opportunities for autistic students to take on particular roles and responsibilities, small classes, very small groups and/or one to one tuition for autistic students, and mechanisms to ensure that autistic students are not excluded from group activities or chosen last.

    3. The active involvement of non-disabled students in inclusion, for instance through buddy systems, while taking care to avoid overloading them with responsibility.

    4. Well managed transitions for autistic students, including between schools, classes and at the start and end of their school career. This should include the provision of information about the student to e.g. the new school, the provision of advance information in an appropriate format to the student and opportunities for them to visit the new school in advance and meet the teachers, and meetings between teachers from the two schools.


IV Training and information for teachers, therapists and other professionals

    1. Regular training for teachers and other professionals working with autistic students which takes place in working time and which is appropriately financed so they do not need to pay themselves.

    2. Significant input from autistic adults and the parents of autistic children to all training.

    3. Training content which includes (i) understanding autism from the perspective of autistic people; (ii) the social model of disability (iii) communication with both verbal and non-verbal autistic people, including communication systems for non-verbal learners; (iv) responding to autistic students whose behaviour professionals find challenging.

    4. Regular meetings for teachers and other professionals working with autistic students to exchange experiences and information and learn about good practice and strategies. Autistic adults should be invited.

    5. A(n) (on-line) forum for advice and support, for instance in dealing with difficult situations, teachers, therapists, parents and others.

    6. A repository of resources to support teachers and other professionals working with autistic students both in their own training and for use in classes.


V Information and support for parents and non-disabled students

    1. Information for the parents of autistic and non-autistic students e.g. information days and workshops, including on effective communication with verbal and non-verbal autistic people.

    2. Age-appropriate information for non-disabled students to encourage them to understand, accept, respect and interact with their autistic classmates.

    3. Significant input from autistic adults to training for both parents and non-disabled students.

    4. Support and resources to facilitate the greater involvement of the parents of autistic students e.g. one to one meetings and discussion groups involving several parents and teachers.

    5. Assistance in organising support and self-help groups for the parents of autistic children, possibly in combination with support/self-help groups.



5. Conclusions
The paper has presented the results of a survey of 120 teachers, therapists and other education professionals working with autistic students in Poland. It goes beyond the fairly limited body of information and reports of the small number of surveys of teachers and other professionals working with autistic students in a number of ways. In particular, the paper presents a series of evidence based recommendations for working with autistic students obtained from of analysis of the suggestions for best practice submitted by respondents, other survey responses and the literature. The recommendations cover the areas of (i) supporting and teaching autistic students; (ii) providing a safe environment; (iii) resources and inclusion; (iv) training and information for teachers, therapists and other professionals; and (v) information and support for parents and non-disabled students.
Many of the issues raised are in line with the literature, but the work goes beyond the literature in providing additional details, covering a much wider range of issues and raising some issues that do not seem to have previously been discussed. In addition, the survey covers a wide range of education professionals in addition to teachers, including psychologists, therapists, and teachers with additional roles as therapists; and a wider range of employment locations, including different types of schools, clinics and therapy centres, than previous surveys.
Nearly 90% of participants had worked with autistic children and young people. This is in line with the literature, particularly taking into account the high proportion of special school compared to mainstream teachers. The distribution of teachers indicates that the majority of autistic children and young people in Poland are still taught in special schools. 90% of the participants had had some autism specific training, but only 4% of them were able to attend this fully in work time and half needed to pay themselves, with their employers funding the costs in only just under a quarter of cases. The higher participation in training compared to the literature may be due to the nature of the sample leading to an increased willingness to fund their own training and attend in their own time, in line with teaching assistants in Scotland engaging in training in their own time (Glashan et al., 2004) and possible indications that Polish teachers and therapists participate in training to a greater extend than those elsewhere (Urbanovská et al., 2014 ).
The areas considered of greatest importance by respondents were communication with non-verbal people, lack of social interaction and aggression and self harm, followed by communication with verbal people, the expectations of the parents of autistic children, lack of time and adapting the programme to the whole class. Communication was also the issue raised most frequently by participants as both important and a cause of difficulties. While this is in line with the literature, the survey results go further by presenting the perspective of teachers and education professionals and show them trying to understand the child's viewpoint, empathising with what they might be feeling and recognising the importance of the communication system being appropriate to the particular child. Other issues which were considered both important and difficult were working with the parents of autistic children, making contact with autistic children, understanding their needs and adapting environments to meet their sensory and other needs. Other important issues raised by the participants included social abilities, independence and self care and relationships and difficulties included both difficult behaviours and understanding them. The focus in the literature has been on managing 'difficult' behaviours e.g. (Marder and deBettencourt, 2015) rather than also understanding them. The need for emphasising with and understanding the specific perspective of each autistic student is one of the conclusions of this study which does not seem to have received attention in the literature. Other issues raised by participants which do not seem to have been discussed in the literature included the types of communication system used with non-verbal students, the circumstances in which additional teaching assistants were used and their roles and difficulties in initiating interaction with autistic students. In addition, several of the qualities and characteristics considered necessary for teachers and others working with autistic students do not seem to have been mentioned previously.
All the proposed solutions were considered to be exceedingly useful, with a teaching assistant for each autistic student and regular training in first place, followed closely by meeting other teachers, meeting autistic adults and information/workshops for non-disabled students and parents. The very high ratings given to all these items may also indicate the lack of solutions and the demand for them from teachers and education professionals. The basic principles for teaching approaches arising from respondents' comments are consistent behaviour, stability, clear rules, working with the family and all the specialists involved with the child, adjusting approaches to the needs of the individual child and finding their strengths. Creative approaches not found in the literature included the use of psychodrama to practice empathy and reduce aggression. In summary, the results give a picture of concerned and dedicated teachers and therapists who are trying to understand their autistic students, but often frustrated by lack of resources and their own lack of knowledge.
Further research is required in a number of areas, including the following:
Learning

  1. The different ways in which autistic people learn and how best technology and other approaches can be used to support them.

  2. The appropriate balance between education and therapy to give autistic learners the additional support and skills they require without adversely affecting their education or overloading them.


Communication

  1. The communication difficulties experienced by teachers and others working with autistic students.

  2. Best practice on the use of communication technologies and other communication approaches and the factors related to the autistic student, environment, teacher and material being studied that affect this.


Teachers

  1. Approaches and best practice on training teachers and education professionals on autism and communication with verbal and non-verbal autistic students in different countries, including what is taught, who pays and whether the training takes place in work time.

  2. Best practice in different countries on the provision of teaching assistants/additional teachings and the factors that affect their availability and use.

  3. The needs of teachers and education professionals working with autistic students in rural areas for training, resources and other support and how best these can be met.


Inclusion

  1. The impact of giving autistic students roles and responsibilities on their social and academic skills and social interaction, and the support and other factors required for success.

  2. Best practice on peer involvement in inclusion, the development of social and academic skills, and the support and other factors necessary for success.

  3. The percentage of autistic students included in mainstream settings in different countries, the factors that affect inclusion and the impacts of inclusion on learning outcomes.



References


Directory: assistive
assistive -> Patsy Rodenburg. The Actor Speaks: Voice and The Performer. Copyright 1997
assistive -> Patsy Rodenburg. The Actor Speaks: Voice and The Performer. Copyright 1997
assistive -> Common at terminology Coordinating Movements / Manipulating Objects
assistive -> Assistive technology & learning disabilities
assistive -> Shasta County Office of Education Local Plan Area Special Education Assistive Technology Guidelines
assistive -> Assistive Technology Devices for Writing and Spelling
assistive -> Guy’s and St Thomas’ Assistive Communication Service
assistive -> Sarah Holmes rerc on Telerehabilitation
assistive -> Assistive Technology Solutions for Visually Impaired Students
assistive -> Commonwealth of Pennsylvania’s Telecommunication Device Distribution Program revised Jan. 31, 2017


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