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- Findings and Discussion
ALEV GİRLİ 2007, 8 (2)
44
ASPERGER SENDROMLU VE YÜKSEK İŞLEVLİ OTİSTİK ÇOCUKLARIN EĞİTİMDEN YARARLANMA DÜZEYLERİ
ÖZEL EĞİTİM DERGİSİ 45
The Benefit Levels of Children with High Functioning Autism and Asperger Syndrome from an Educational Process Alev Girli *
* Asist. Prof. Dr. Alev Girli, Dokuz Eylül University. Buca Faculty of Education, Department of School Psychology, Izmir. E-posta: alev.girli@deu.edu.tr Autism was first defined by Kanner (1943) and it is a developmental disorder of social interaction and communication which is characterized by repetitive behaviours and limited interest areas (American Psychiatric Association, 2000). Asperger Syndrome (AS) was defined in Germany (1944) by Asperger and individuals with Asperger Syndrome have normal language development but have the same characteristics with autism in showing limited social interaction and repetitive ceremonial behaviours (Ghaziuddin & Mountain-Kimchi, 2004). The most important difference which distinguishes AS from autism is that there is no delay or regression in language and cognitive development (Kırcaali-İftar, 2005 & Korkmaz, 2003). In general, it is thought that there is no clear difference defined yet between high functioning autism and asperger syndrome (Myles, 2004; Meyer and Minshew 2002, cited in Chaing and Lin, 2007). Recent studies show that autism stems from neurological differences which negatively affect perception and comprehension. The papers and books written by people with high functioning autistics or people with asperger syndrome about themselves have enabled us understand autism better (Howlin, Baron-Cohen & Hadwin, 2003) and increasing in information with regard to how they learn resulted in preparation of more effective educational programs for them. One of these programs, TEACCH (Schopler, Mesibov et al, 1966), focuses on differences, needs, skills and interests in terms of comprehension, thinking styles and learning styles of autistic people (Schopler, 1986). The main purpose of TEACCH approach is to equip children with skills which will enable them adapt to the social life when they grow up. The TEACCH approach puts family, in the centre of the education program, as one of the basic factors. In this approach, it is important to design individualized education program which aims to teach skills in a structured learning environment with one-on-one basis. It is also paid great importance to generalize skills into other environments such as inclusion
environments (Kırcaali- İftar, 2005). The main purpose of this study was to investigate how much the research group benefited from the education program they received. This was investigated through a Psycho Educational Profile Revision Form (PEP-R) in 7 sub areas from the developmental domain such as imitation, perception, fine motor, gross motor, hand-eye Ankara Üniversitesi Eğitim Bilimleri Fakültesi Özel Eğitim Dergisi 2007, 8 (2) 45-48
ALEV GİRLİ 2007, 8 (2)
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areas from the behavioural domain such as language, relating and affect, play and interest in materials and giving sensory responses. Another purpose of the study was to determine if there is a difference in terms of the level to which children benefit from the education between the children whose parents attended the “family training” program and the children whose parents did not. Children’s beginning level performances and their final performances were evaluated via PEP-R. Their individualized education programs were prepared by using TEACCH and HANEN approaches.
This is a of 5-year longitudinal study of the educational process of 28 children with high functioning autism and children with Asperger Syndrome
The subjects in the study group were diagnosed by university hospitals according to DSM-IV-TR criteria’s between September 1999 and June 2000 as high functioning autism and Asperger syndrome. The study group consisted of 28 children that 22 of them were high functioning autistic children and 6 of them are children with Asperger Syndrome. 6 Children (21.4 %) were girls and 22 (78.6%) were boys. Their starting age of education ranged between 20 months to 48 months old. 17 volunteered parents were trained and among those 11 mothers’ age mean was 31.96 and 6 fathers’ age mean was 37.50.
Two of the mothers were elementary school graduates, four of them were high school graduates and five of them were university graduates. As for the fathers, two of them were high school graduates and four were university graduates.
The data regarding the 28 children was collected from the database of the special education center which they attended. In this study while evaluating the children, Psycho-Educational Scale- Revised (PEP-R) was used (Schopler, Reichler, Bashford, Lansing & Marcus, 1990). PEP-R is made up of 174 items, of which 131 are used to determine the developmental level of the child in a total of seven domains, and such as, fine motor, gross motor, hand-eye integration, cognitive and verbal skills, and 43 to determine the level of autistic behaviours in four domains such as language, interest in games and materials, affectivity and sensory reactions. Skills in the developmental domains are evaluated as passed, failed, emerging and those in the autistic behaviours as severe, mild or appropriate. All of these assessment criteria can be found in the test booklet. PEP-R, which enables developmental and behavioural assessment of the child, is a useful assessment and programme planning tool for measuring acquired, unacquired and emerging skills. This particular aspect of the scale paves the way for working out an Individual Education Programme (IEP) making use of the child’s emerging skills. The reliability analysis of PEP-R was carried out by Schopler et al. (1990) in two different methods. A considerably high correlation of .92 was determined among sections. Differences among different measurements applied in the second method were not found to be significant F(6,24)= 5.30 p> .01). In reliability studies, a significant relationship was found in the reliability of the developmental domain among values obtained in various implementations, such as r=0.85 with Merril Palmer, r=0.84 with Vineland Social Maturity Scale, r=0.77 with Bailey, r=0.71 with Peabody, Picture Vocabulary Test r=0.71, WISC-R and WPPSI r=0.47, Leiter International Performance Scale r=0.24 (p<.0001). Dimensions of the behavioural domain with respect to content validity have been prepared according to CARS (Childhood Autism Rating Scale) (r=0.70), which proved to be a valid and reliable scale over the years. High validity values for both behavioural and developmental dimensions have been obtained in many studies conducted in countries using CARS (Steerman, 1997; Muris et al., 1997; Van Berckelaer-Onnes & Van Dujin, 1993; Kating-Lam & Rao, 1993; Kikas & Haidkind, 2003). In Turkey, the internal consistency of Turkish version of PEP-R was carried out by using data ASPERGER SENDROMLU VE YÜKSEK İŞLEVLİ OTİSTİK ÇOCUKLARIN EĞİTİMDEN YARARLANMA DÜZEYLERİ
ÖZEL EĞİTİM DERGİSİ 47 collected from 178 children’s (aged between 18 months to 12 years). Cronbach Alpha is .88-.97. The content validity measures were done comparing the developmental scale of PEP-with Ankara Development Scanning Inventory (AGTE)
and the results are (r=0.81) for total developmental points, r=0.55-0.88 among the categories. Also when calculated with Ritvo-Freeman Scale (RFRLS), the values are r=0.68 for total behavioural points and r= 0.27-0.68 p< .01 and p<.05 for the categories. The results showed that PEP-R can be used as a reliable and valid instrument in Turkey (Girli, Atasoy & Mutlu, 2003).
Procedure The first year that the children started education, a six-day long, a total of 48 hour “teacher training” program was conducted by researcher with 6 psychologists who will train children at the beginning of the five-year study. The “teachers training” program consisted of TEACCH, HANEN programs and the use of PEP-R. 17 volunteered parents had a “parent training” program for 16 sessions about 40 hours. At first, 8 sessions the “informational counseling” was conducted as the first stage of the parent training and as the second stage “teaching skills” program was conducted for 8 sessions more. 11 parents didn’t attend the parents training program.
Below are the statistical PEP-R results for the developmental and behaviouristic areas given separately regarding to the differences between pre- test and post-test results of children’s five year longitudinal educational process as well as the findings about whether there is a difference between children whose parents attended the family education program and whose parents did not.
It was found out that there is a significant difference between the participants’ developmental mean between the pre-test and post-test results (F (7, 19)=30.79 p<.001 η 2 =.92). In addition, the common variable (the start of education time) has a meaningful effect on developmental points (F (7,19)=2.49 p<.05 η 2 =.48). The one-way ANCOVA results with regard to the meaningfulness of the difference between pre-test post-test mean in developmental area as follows; the total developmental points F(1,25)=164,18 p<.001 η 2 =0.87, imitation F(1,25)=93.97 p<.001 η 2 =0.79, perception F(1,25)=75.74 p<.001η 2 =0.75,
fine motor F(1,25)=90.37 p<.001 η 2 =0.78, gross motor
2 =0.69, hand-eye integration F(1,25)=116.90 p<.001 η 2 =0.82, cognitive F (1,25)=116.90 p<.001 η 2 =0.82, verbal F(1,25)= 262.11 p<.001 η 2 =0.91. As shown from the results there is a significant increment in skills in all development areas. Whether there is found to be a significant difference between children whose parents attended the “family training” program and children whose parents did not, in terms of how much they benefited from the education was examined. The imitation (t (26) = 2.58 p< .01) and gross motor skills (t (26) = 2.30 p< .02) of children whose parent attended the “family training” program developed meaningfully more than those whose parents did not have. Findings for the Behavioural Area The relationship between the education program, the independent variable, and the behavioural area, the dependent variable, was determined by one-way ANOVA design. It was found out that the mean of pre-test post-test of the participants differ statistically F(4, 22) =24.33 p<.001 η 2 =0.81 and effect size is high. The common variable (the start of education time), was found to have a meaningful effect on behavioural points F (4, 22)=1.41 p<.05 η 2 =0.20). The results also showed that there is
significant decrement in typical autistic behaviours in 4 behavioural areas namely relating and affect F(1,26)=76.64 p<.001 η 2 =0.75, play and interest in materials F(1,26)=29.14 p<.001 η 2 =0.53, sensory responses F(1,26)= 17.99 p<.001 η 2 =0.41 and language F(1,26)= 128.08 p<.001 η 2 =0.83. Whether children’s parents attending to
parent training program did not have a effect on the way the children benefited from the education in behavioral area; relating and affect (F(1,26)=1.15 THE BENEFIT LEVELS OF CHILDREN WITH HIGH FUNCTIONING AUSTISM AND ASPERGER SYNDROME FROM AN EDUCATION PROCESS ALEV GİRLİ 2007, 8 (2)
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(F(1,26)=0.115 p>.73, sensory responses (F(1,26)=0.71 p>.40), language (F(1,26)=3.37 p>.07) The studies conducted by of Mutlu (1998); Girli (2004); Atasoy & Varır (2005); Girli & Atasoy (2006); Lord et al. (1989), Ozonoff & Cathcart (1998), Venter et al. (1992), which show that TEACCH program works well for autistic children to increase their developmental skills. In addition, the result shows that children whose parents attended the “parent training” program developed meaningfully more than the children whose parents did not attend and this is also an indicator of the functionality of TEACCH approach (Schopler, Reichler et al 1990) which accepts families as a basic factor for education. A meaningful decrement in typical autistic behaviours of all children was determined. This result matches with Panerai et al’s (1997) study results that employed TEACCH approach to decrease the negative behaviours and to increase communication skills of autistic children, children with learning disability and children who can hurt themselves. When it is time to start school, the 26 of the children started elementary schools to inclusion education and two of them attended special education schools. 2 children with Asperger Syndrome quit the special education process and 2 children who have more autistic characteristics carried on their educational life in special education school.
Whether children’s parents attended the parent training program or not did not affect how many the children benefited from the education in behavioural area. One possible reason of these can be that how to fix problematic behaviours was not taught enough in the “parent training” program. Another reason can be that the parents cannot act in a stable way and be patient enough to cope with the autistic behaviours of their children. Under the light of the results, there is a need for conducting more comprehensive and contrastive studies including TEACCH programme and its scale PEP-R, used during autistic children’s early childhood era. In addition to that, this study is thought to have contributed the evaluation of autistic children and the development of materials and education programs in Turkey which are necessary.
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