Local Authorities should provide or arrange access to a range of provision (from early years to post-16) for children on the autism spectrum and ensure a coordinated and coherent approach. It is good practice for a local authority to have a policy on provision for children on the autism spectrum that includes the provision of home-based programmes. Parents and professionals should be made aware of the different approaches used in teaching children on the autism spectrum, including approaches used in the home.
Increasing numbers of parents of children on the autism spectrum are now following home-based programmes adapted specifically for the needs of children on the autism spectrum. For some this is done in preparation for entry into mainstream school. For others, elective home education provides an alternative to the provision offered by the local authority which parents may feel to be unsuitable for the needs of their child.
Some parents feel mainstream educational provision for children on the autism spectrum can be inadequate or inappropriate. An increasing number of parents dissatisfied with the education system are looking elsewhere for an approach that will suit their children's needs and have chosen to home educate their children.
For some children on the autism spectrum, the enforced socialisation created by the school environment is problematic. Many children encounter bullying in mainstream school because of their condition, which puts them under great stress - some refusing to go to school as a result. In the worst cases children can become school phobic.
Elective Home-Education: Guidance
Elective home education is the term used by the Department for Children, Schools and
Families (DCSF) to describe parents’ decisions to provide education for their children at
home instead of sending them to school. This is different to home tuition provided by a local authority or education provided by a local authority other than at a school which may include autism spectrum specific home-based provision.
The DCSF has produced guidance on Elective Home Education. The local authority’s primary interest should lie in the suitability of parents’ education provision and not their reason for doing so.
The DCSF recommends that each local authority provides written information about
elective home education that is clear, accurate and sets out the legal position, roles and
responsibilities of both the local authority and parents. Local authorities should recognise that there are many approaches to educational provision, not just a “school at home” model. What is suitable for one child may not be for another, but all children should be involved in a learning process.
There a number of reasons a parent may choose to electively home educate they include:
- distance or access to a local school
- religious or cultural beliefs
- philosophical or ideological views
- dissatisfaction with the system
- as a short term intervention for a particular reason
- a child’s unwillingness or inability to go to school
- special educational needs
- parents’ desire for a closer relationship with their children
The responsibility for a child’s education rests with their parents. In England, education is compulsory, but school is not. Parents have a right to educate their children at home. Section 7 of the Education Act 1996 provides that:
“The parent of every child of compulsory school age shall cause him to receive efficient
full-time education suitable –
(a) to his age, ability and aptitude, and
(b) to any special educational needs he may have,
either by regular attendance at school or otherwise.”
Parents do not have to follow the national curriculum nor be a qualified teacher to home educate. Formal testing is not required and the child does not have to sit any key stage tests
Parents’ right to educate their child at home applies equally where a child has SEN. This
right is irrespective of whether the child has a statement of special educational needs or not.
Where a child has a statement and is home educated, it remains the local authority’s duty to ensure that the child’s needs are met. It is the authority’s duty to arrange the provision specified in the statement, unless the child’s parent has made suitable provision, for as long as a statement is maintained and to review the statement annually.
In some cases a combination of provision by parents and the local authority may best meet the child’s needs. Local authorities should consider, for example, providing access to additional resources or treatments where appropriate. The child's statement should specify the home-based support the local authority will fund and any other support such as speech and language therapy the local authority will arrange. Local Authorities should ensure that where professional input (for example, speech and language therapy) is required, it complements the approach of the home-based provision.
Local authorities may also wish to explore scope for linking home-based provision with available social activities and perhaps linking parents who have chosen similar approaches. Where a local authority provides resources and funding for home-based provision it should ensure police checks and references are taken up on all volunteer, freelance or privately-employed practitioners working on home-based programmes. Local authorities should also ensure a gradual and well-planned transition from any home-based to school provision.
The DCSF recommends that each local authority should have a named senior officer with responsibility for elective home education policy and procedures. This officer should be familiar with home education law, policies and practices. It would be beneficial if this officer is familiar with SEN home-based programmes and provision for children on the autism spectrum.
There is a wide range of programmes on offer, but few are backed by conclusive scientific research. Better evidence is available to support the effectiveness of programmes with an emphasis on early development of cognitive, social, play and communication skills. Research Autism, a charity dedicated to research into autism interventions, states that while core features of autism have been shown to be resistant to intervention by whatever means, “It has been shown that individualised and persistent structured help, focusing on autism features and communication, is helpful and can greatly improve adaptive behaviour, academic potential and reduce the disabling effects of the condition.”
Such home-based interventions can be costly, both financially and in the huge investment of time that many programmes require of parents. Most of these programmes require intensive intervention from trained therapists, and costs can be as high as £25,000 a year depending on the hours, the location of instruction and the qualifications and number of therapists used. Some local authorities however, do fund part or all of certain types of home-based support such as Early Intensive Behavioural Intervention (EIBI, sometimes also referred to as ABA or Lovaas). The National Autistic Society (NAS) estimates that around 100 local authorities in England and Wales are currently funding EIBI programmes.
There are also issues to consider regarding the training and supervision of those working in the home with the child, and with regards to how the home-based provision fits with the work of other agencies and with transition to school if that is wished.
The following programmes are home-based interventions that aim to modify the behaviour of children on the autism spectrum.
Early Intensive Behaviour Intervention
Early Intensive Behavioural Intervention was originally developed in the 1960s by psychologist Dr Ivor Lovaas, also known as Applied Behavioural Analysis (ABA), this is a highly structured and intense form of therapy which aims to teach linguistic, cognitive, social and self-help skills by breaking them down into small tasks. Discrete Trial Training (DTT) is the main strategy used within this programme whereby the trainer instructs the child using a series of learning opportunities or ‘trials’. Praise and rewards are used to reinforce good behaviour.
The programme recommends 40 hours a week of intensive therapy for at least two years. A consultant designs a programme for each child, and a team of at least three therapists is employed to work with the child, usually on a one to one basis. Because of the need to train and supervise such a team, costs can be high.
These programmes have been well evaluated, and while claims that they result in recovery from autism cannot be substantiated, there is good evidence that EIBI results in important improvements for many children on the autism spectrum.
The NAS has produced a briefing paper on this type of intervention. TreeHouse which uses the approach in its school has a briefing paper which sets out the key elements of the approach. Research Autism also reviews EIBI in detail.
Milieu training (Research Autism)
Milieu training describes a form of teaching which makes use of the child’s interest in the things around him, the ‘milieu’ to provide learning opportunities. A review of this intervention can be found on the Research Autism website.
Pivotal response training (PRT)
A type of training which focuses on key pivotal aspects of a child’s development. These are motivation, self-management, self-initiation, and the ability to respond to multiple environmental cues. A review of this intervention can be found on the Research Autism website.
Relationship based programmes
These programmes aim to engender a sense of relatedness, encouraging affection, attachment and bonding.
Also known as Options, the Son-Rise programme is a home-based programme based on the premise that the best way to help a child with autism is to follow the child’s lead, so that the adult joins the child in his behaviour rather than trying to superimpose his own ideas on the child. The aim is to build trust so that the child feels accepted and loved rather than judged by his behaviour. As the relationship grows, so the adult can use the child’s own motivation to teach him new skills based around his own interests.
The programme uses parents and volunteers to work with the child, usually in a special playroom, for between 20 and 40 hours a week. Parents must receive training from the Autism Treatment Center of America before starting the course. The considerable input required from parents to run the programme may have a significant impact on the family as a whole. Moreover, it can be difficult to recruit and retain sufficient properly vetted volunteers to run the programme.
Research Autism reports considerable positive anecdotal evidence from people who have used the Son-Rise programme. However, there is no scientific evidence to demonstrate benefits, largely because the Option Institute has never allowed or carried out any formal research on the effectiveness of the programme.
The NAS offers a useful information sheet on this programme and Research Autism reviews it in full.
The DIR method aims to help children on the autism spectrum to master the building blocks of relating, communicating and thinking by employing a series of interactive ‘Floortime’ exercises in which the carer follows the child’s lead and plays at whatever has captured his interests, but in a way that encourages a two-person interaction. This intensive method requires considerable commitment from the parents and other carers. The Research Autism website offers a fuller review.
This highly controversial therapy consists of forced holding of a child by a therapist or parent until that child stops resisting or until a fixed period has passed. The child is required to ‘surrender’ and look into the carer’s eyes before the hold is released. In its review of this technique, Research Autism reports “There is no sound evidence for effectiveness and there are significant concerns about the use of forced physical contact with individuals who may find this profoundly distressing.”
This approach works with parents, training them to detect and respond appropriately to the individual child’s attempts to communicate, no matter how unusual. Communication strategies can then be devised based on what works for that individual child.
Programmes using this approach include:
- The ‘More Than Words’ programme, run by the Hanen Centre in Ontario, Canada.
- The Responsive Teaching programme, run by Responsive Teaching International Outreach.
- The ‘Child Talk’ programme, currently being evaluated by the University of Manchester.
Relationship Development Intervention
Relationship Development Intervention (RDI) focuses on the problems children on the autism spectrum have forming true social and emotional relationships with others. Having evaluated a child’s relationship skills, a consultant sets objectives for the child and equips the parents with techniques to achieve these objectives. The parents then introduce their child to emotional relationships in a gradual and systematic way. The Research Autism website offers further information.
Skills based interventions
These interventions aim to develop particular skills in a child on the autism spectrum.
Social Stories were developed by Carol Gray to assist children on the autism spectrum develop greater social understanding. They provide explanations around situations that may be challenging for a child on the autism spectrum. Social stories can be written on paper, audio recorded or filmed. They are usually written in the first person and in the present tense, focusing on an issue of importance to an individual, and looking at social cues, things that might happen and why, and what the individual may choose to do about it. There is good evidence that Social Stories can be effective in reducing unwanted behaviour in children on the autism spectrum and in helping in social interaction. The NAS has a useful information sheet on social stories.
Picture Exchange Communications System (PECS)
This widely used intervention was developed specifically for children on the autism spectrum. A child is taught to exchange a picture card for something he wants such as a toy or food. The picture reinforces the word spoken by the adult, who gives the child the thing they want. PECS is effective in establishing the basics of communication as the child is highly motivated to request a wanted item, and the system uses visual skills.
This approach is relatively straightforward, compared to some interventions, and does not use expensive equipment. However, properly trained individuals should be used to implement PECS to ensure its correct use.
The NAS offers an information sheet on PECS, and a further review of the system can be found on the Research Autism website.
Functional Communication takes as its premise the idea that people on the autism spectrum use challenging behaviours such as self-harm or throwing tantrums as a form of communication, and aims to teach them how to substitute other forms of communication to get the same message across. Each problem behaviour is assessed to identify its function or “message”, and the child is then taught how to communicate that message in a more acceptable form.
Research Autism has further information on this approach.
Facilitated Communication (FC)
This intervention is a form of Augmentative Alternative Communication (AAC), and involves a communication partner or facilitator, physically supporting the individual so that he can point to pictures, symbols, letters or words, thus communicating.
It is particularly controversial for children on the autism spectrum as it assumes that a movement disorder is at the root of the difficulties faced by people with autism, rather than social or communication disorders.
Research Autism reports a significant body of evidence to show that FC is ineffective for people on the autism spectrum. The NAS also produces an information sheet describing this method and concerns associated with it.
Theory of Mind
Theory of Mind training programmes are designed to teach individuals on the autism spectrum how to recognise mental states (thoughts, beliefs, desires, intentions, and emotions) in oneself or others, and to be able to make sense of and predict actions. See Research Autism’s review for further information.
It is recommended that where local authorities fund home based programmes they also think about how to track the effectiveness of the intervention they are funding. In this way evidence can be built up to show whether or not programmes are cost effectiveness in terms of the positive impact they have on a child’s learning and development.
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Get help from...
Elective Home Education: Guidelines for Local Authorities (DCSF) 2007
Teachernet provides a useful guide to good practice in home-based provision, particularly for those interested in a later transition to school.
Research Autism offers a comprehensive review of many forms of intervention for children on the autism spectrum.
Useful report from the Journal of the Royal Society of Medicine http://www.researchautism.net/pages/interventions/introduction
Howlin, P. (2000). Autism and intellectual disability: diagnostic and treatment issues. Journal of the Royal Society of Medicine 93(7), pp. 351-355.
Useful review of autism interventions available:
Researching interventions in ASD and priorities for research – Surveying the membership of the NAS. Richard Mills and Lorna Wing 2005
Approaches to autism: an easy to use guide to many and varied approaches to autism. London: The National Autistic Society, 5th ed. 2003. 1899280561
A comprehensive guide to some of the many different approaches that are used in the education and care of children and adults with autism.
Available from the NAS Publications Department
Applied Behavioural Analysis (ABA) information sheet from the NAS
NAS Son-Rise information sheet
NAS information sheet on social stories
NAS information sheet on PECS
NAS information sheet on facilitated communication
Remington, B., Hastings, R. P., Kovshoff, K. et al. A field effectiveness study of early intensive behavioural intervention: outcomes for children with autism and their parents after two years. American Journal on Mental Retardation.
TreeHouse briefing paper on Applied Behavioural Analysis
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ABA Resources Limited
The Hanen Centre, Ontario
NAS EarlyBird Programme
PEACH (Parents for the Early Intervention of Autism in Children) is a charity set up by parents to promote early behavioural intervention for children on the autism spectrum.
Picture Exchange Communications System
Responsive Teaching International Outreach
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