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Low Incidence, High Results

Washington School District's Low Incidence Program Is Making a Difference for Students With Autism

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Posted: Friday, May 4, 2012 2:00 pm

The school day had barely begun Monday morning at South Point Elementary School in Washington when a student in Ann Heinrich’s “low incidence” classroom for children with intense special needs was lying face down on a soft rug, wood blocks strewn around him.

Heinrich prompted the student to pick up the toys, and he fussed a bit so she helped him. When he got up and walked away, she brought him back to complete the task.

When he suddenly erupted in a tantrum, knocking over several of the student chairs, Heinrich calmly guided him to the corner and then sat with him. If he reached out to strike her or another object she reminded him, “soft touch, soft touch.”

Once he was calm, Heinrich asked him something that people who are unfamiliar with autism may consider a strange question — “Do you need a squeeze?”

But it made all the difference for this student, who has an Autism Spectrum Disorder or ASD.

“It’s proprioceptive input,” Heinrich said, explaining students with autism need that kind of sensory input to help them calm down and be able to focus.

“We may do something like load up a backpack with heavy books and let them walk to class with it to help them keep their hands off the walls,” she added as another example.

After a couple of bear hugs, the student was ready to complete a lesson. First up was math, practicing touch points, and he easily sailed through the lesson.

At the same time in another section of the room, a student was working one-on-one with a paraprofessional. Later several more students who had gone to their traditional classrooms for some lessons returned to the low incidence room for others.

One student completed a spelling test using letters attached to magnets, spelling out his words on a metal cookie sheet. A couple of other students did their spelling tests by writing out the words on paper, but it was just the two of them with a para telling them the words to spell.

Growing Need

The low incidence classroom at South Point is new this school year, but the program is not. It began three years ago during the 2009-’10 school year in the Early Childhood Special Education (ECSE) department, said Dr. Rachel Franssen, director of special education for the Washington School District.

The program was added due to the increasing number of students significantly affected by autism, said Franssen.

Since the ECSE low incidence room was added, it has been full each year with six students enrolled. That isn’t likely to change anytime soon. In fact, the need is only expected to grow.

A 2008 study from the Missouri Autism and Developmental Disabilities Monitoring Project that was funded by the CDC and U.S. Department of Health and Human Services found that one in every 72 children has an autism spectrum disorder with a higher incidence among boys — one in every 46.

According to the CDC, “autism spectrum disorders are a group of developmental disabilities that can cause significant social, communication and behavioral challenges.”

That’s a basic description, but anyone who has ever worked with students who have an ASD will tell you each one is very different in their strengths and needs.

Typically, learning isn’t the issue with students who have an ASD, said Heinrich, noting “most function at or above grade level.” Communication is the issue, teaching them how to give back the information they have learned.

“We do discreet trial training, repetitive lessons over and over . . . so they catch on how to communicate,” said Heinrich.

Although Washington’s low incidence program isn’t exclusively for students with autism, those are currently the students who are being served by it.

Heinrich has eight students with ASD in her “level two” room at the elementary school, all boys ranging in age from 5 to 11. There are three paras, making the student-teacher ratio 2-to-1.

Over in the Early Childhood Special Education program, located across from Washington West Elementary, the “level one” low incidence classroom run by Elizabeth Mades has six students with ASD, four boys and two girls. There are five paras, so here the student-teacher ratio is 1-to-1.

Inside the Classrooms

At first glance, the level one low incidence room looks a lot like a typical preschool, but look closer and you notice some differences.

For starters, lamps are used in place of the overhead fluorescent lights.

“The kiddos say they can hear them humming and see them flickering . . . things most of us don’t see or hear,” said Mades. So she keeps them switched off during class time.

There are room dividers arranged into individual workstations to reduce the visual stimuli and help a student focus better.

Throughout the day the students have scheduled 15-minute sensory sessions to do things like jump on a mini trampoline, swing in a net hanging in the center of the room or tumble on a mat. This isn’t as much a fun activity for them as it is necessary, said Mades, echoing Heinrich’s explanation of the proprioceptive input needs of students with ASD from earlier.

“It helps them relax . . . calms them down, but mostly it gets them engaged to be ready to learn,” she explained.

At times, Mades pairs the sensory movements with a language activity because together they reinforce the learning better than when used alone.

Just as in the level two low incidence room, here students receive one-on-one instruction with repetition of tasks/skills, discreet trial training, floor time play and more.

“They will have one-on-one instruction with goals broken into smaller steps that progress to bigger goals,” said Mades, who offered this example.

“If I were teaching a student to wash his hands, I would backward chain it — start with letting him do the last step on his own, throwing away the paper towel.

“We use errorless training, with my hands on theirs to do the steps, gradually fading off assistance.”

In the level two low incidence room at South Point, the room looks very similar. There are nylon covers over the fluorescent lights to filter the harsh light, room dividers to create individual workstations, visual schedules, a blue foam mat covering the entire floor . . .

The white board in the room is often used to project images the students find calming — snow falling or an aquarium scene. Just like the level one room, there is a swing bolted to a metal beam in the ceiling here. It can hold up to 500 pounds.

“We may put them on it if their engine is running low, if they’re lethargic because the movement brings their energy up,” said Heinrich. “Or we can swing them slowly if we need to calm them down.

“We have a net or a log swing (attachment). We can sit on the log and sing songs with them . . . we use what we can to get back from them any information.”

In both classrooms there are students who stay in the low incidence room for most or all of the day, but there are others who attend classes integrating with their typical developing peers. In the level two room there are a couple of students who only come to the low incidence room to check in in the morning and periodically throughout the day.

“It’s really individualized,” said Heinrich.

As students progress and become more independent, they are able to move in and out of the low incidence room, which opens space for other students to move in.

Seeing Progress

To people who aren’t familiar with children who have autism or other intense special needs these types of activities may seem strange or indulgent, but Mades has seen the difference they make for students and their families, and ultimately for the school district and the entire community.

“We had one student who wouldn’t talk, he would ‘script,’ just saying familiar phrases.

“I would say, ‘What did you bring today?’ and he would say something like, ‘I need to go to the bathroom.’ There was no communication.”

That was when the child was about 4 years old. He’s now 5 and is able to have a more typical conversation.

“Our two big areas here are language and social skills,” said Mades.

There is focus on peer interaction, such as asking friends to play, and self-help skills, learning to be more independent.

“We have one student who is paired with another and a para for a 2-to -1 ratio. He’s using the bathroom, washing his hands, taking care of his personal materials . . . before he had assistance with all of that,” said Mades.

“Without this program, he would have had minimal progress. He wouldn’t have become as independent. He wouldn’t be as developed with his language skills, which all means he would have needed more one-on-one instruction in the older grades.”

Mades, who worked in a traditional early childhood special education classroom for several years before helping develop the low incidence program, recalls seeing students in that half-day program who weren’t progressing.

“Even with small group instruction, they weren’t engaged. They needed one-on-one instruction to stay attentive,” said Mades.

Working with Maria Brady-Smith, Washington’s psychological examiner, Mades researched and observed programs at other districts, including United Services in St. Peters and Rockwood, to help in shaping Washington’s program.

Mades, who writes and modifies the program, said she’s excited about what it means for her students.

“It’s been a process, but it’s worth it because I see the progress they’re making,” she said.

Heinrich agrees.

“The students’ goals are embedded in their schedules and I go back every couple of weeks to see if it’s still working.

“With these kids, it’s a lot of change because one day something may work, but the next day it won’t. They experience a satiation.”

Heinrich, who last year worked with several of the students now in the level two low incidence room in a cross categorical room, meaning there were students who had learning disabilities, emotional disturbances and other health impairments, along with ASD students, said the environment of the low incidence room has helped them progress more than they would have without it.

“It meets more of their necessities,” she said.

IPad Increases Learning

One tool that has been found to increase learning for student with ASD is the iPad and many apps, like DynaVox, that will talk for the students.

“Right now the kids bring me a card with a picture of something they want on it and they learn, ‘When I bring this to her, I get . . . ’

“With the app, it gives them all the same choices, they click the one they want, and it says what it is, ‘Cheerios.’ The hope is that it will help them learn to say the word. It’s just a way to promote communication skills.”

There are other apps that are more like games that the students enjoy so much they work as great motivators, said Heinrich.

“I can get one student to do anything if I let him do the Bubble Pop app,” she said, noting it looks and sounds just like bubble wrap.

“It’s great for reinforcement — ‘If you get all of your work done, you can play the app you like.’

“It’s also a great way to do a visual schedule. As the kids get older, using a paper sheet isn’t cool, but they would carry an iPod.”

In a monthly meeting Heinrich has with the parents of her students, the group was talking about ways to increase public awareness of autism and also find a way to provide an iPad for the classroom, when one of the parents, Mark Lohan, vice president of the Franklin County Community Tennis Association (FCCTA), suggested using a foam ball tennis tournament that he organizes every year.

The tournament has always been a fundraiser with money being donated to something related to autism, his wife, Beth Lohan, said.

“Now we will gear it toward this classroom,” she remarked.

All of the parents were supportive and so was the FCCTA.

The tournament was held one weekend in March in the gym at Washington West Elementary to reduce overhead expenses. Foam balls are used because they bounce slower than a regular tennis ball would in indoor play.

“And with foam balls, people who are not great tennis players can still get some great shots,” Beth commented.

Heinrich solicited area restaurants to donate gift certificates that were used as prizes, and one of the paras solicited other donations.

There were several categories, including juniors, mixed doubles, men, women, recreational, open . . .

The turnout was strong and the tournament raised over $1,400 which will be used to purchase an iPad, a variety of apps and other equipment or materials for the level two low incidence room.

‘I Was So Happy’

Beth Lohan said she and her husband are more than happy to give to a program that is making such a difference for their son, who is now in second grade.

“I can honestly say if it wasn’t for this classroom, (our son) would not be in school. I would have to homeschool him,” she said.

Beth said when she heard the district was adding the level two low incidence room for this school year, she cried.

“I was so happy,” she remarked.

“Our son is a runner. When his anxiety level gets to a certain point, he will run. He used to drop to the floor and scream, but he discovered that wasn’t stopping his anxiety, so now he will run, just leave, and head straight for water.”

The chainlink fence surrounding the school isn’t any protection for him.

“He can climb it so fast,” Beth said.

“So to provide a room for him and a teacher who is his safe person is wonderful.”

Her son has no concept of stranger danger. He will leave with anyone. And, as dangerous as it sounds that he will head straight for water when he’s anxious, consider that he also likes spinning tires and is drawn to them. Telling him how dangerous that can be doesn’t make any difference.

“It’s like telling someone not to blink. He can’t stop it,” said Beth.

Now the low incidence room is a place for him to go when he feels that anxiety. He begins his morning there because he can’t tolerate the noise of the gym or a classroom, said Beth. And when he has any sensory needs throughout the day, he goes to the low incidence room.

Beth is pleased that the Washington School District has recognized the needs of students like her son, and she praises Heinrich and the paras in her room.

“She understands that every behavior has a reason and it’s about finding the cause,” said Beth, noting that the monthly parent meetings held on Friday nights in the classroom are so helpful and encouraging.

“She puts photos of our kids up on the white board like a slide show, so we can see what they were doing in the classroom the previous month. And we all love it.

“To see your child being sweet to another child . . . it’s really wonderful,” said Beth.

But these monthly meetings are not the only time Heinrich makes herself available to parents.

“She will speak with me every day,” said Beth. “She has a good, friendly open door policy.

“If it wasn’t for her and the team she has assembled, I don’t know where (our son) would end up . . . the drop out rate for children with ASD is astronomical.”

The teachers say, even as difficult as the work can be some days, they are happy to be working with these students.

“I see a need for these kiddos to have someone to advocate for them so they can have the same opportunities as others,” said Mades. “They needed a voice.”

Heinrich feels the same way.

“They definitely enrich my life,” she said, describing how one student listened to the Snoopy theme song once and then he could play it, never having had a piano lesson. “They are all so cool!”

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