El trastorn de l'espectre autista i les aules de comunicació i llenguatgeconeixements dels futurs mestres, efectivitat de la metodologia teacch i anàlisi del perfil sensorial

Resumen

The increase in the prevalence of children diagnosed with ASD in recent years (Christensen et al., 2016), along with the enactment of the inclusion principle in the latest educational laws (LOE, 2006; LOMQE, 2013), means that attention to these children is a true social need for which the teaching staff needs to be prepared. Although traditionally not been contemplated in the diagnostic criteria, several studies have shown that most children with ASD present alterations in the sensory processing of information (eg: Ashburner et al., 2008; Ben-Sasson et al., 2009; Lai et al., 2011; Tomchek et al., 2014), which often hinders their social adaptation (Kuhaneck & Britner, 2013). Research indicates that sensory modalities with the highest degree of alteration are hearing and touch (Di Renzo et al., 2017; Howe & Stagg, 2016; Puts et al., 2014), and children with ASD also tend to have difficulties in integrating higher order functions, such as social participation and praxis (Baranek et al., 2014; Kuhaneck & Britner, 2013; Miguel et al., 2017; Roley et al., 2015). Although sensory processing patterns have universal qualities (Little et al., 2017) that are independent from the developmental context (Brown & Dunn, 2010; Lai et al., 2011), these patterns have also been found to reflect the unique and specific sensory circumstances of each environment, which can provide support for and/or create challenges to children's performance (Dunn, Myles et al., 2002). So far, however, few studies have analyzed the sensory difficulties of children with ASD in different contexts. This comparison is necessary because children with ASD present a very heterogeneous symptomatology that can vary from one environment to another (Brown & Dunn, 2010; Lai et al., 2011; Parham et al., 2007). For this reason, in order to provide empirical evidence in this field, in the first study of this doctoral thesis, the characteristics of sensory processing, social participation, and praxis are compared between a group of 41 children with ASD and a group of 38 children with typical development, in both the school context of the classroom and the family context. In both groups, the age of the participants is between 5 and 8 years, and they have an average non-verbal IQ of around 97. The evaluation instruments used in this study are: the Raven Colored Progressive Matrices Test (Raven, 1996), the Gilliam Scale for Autism Assessment (GARS-2, Gilliam, 2006), the Sensory Processing Measure (SPM, Parham et al., 2007), and a self-made questionnaire on demographic information to obtain relevant information about the parents and the participating teachers. In this study, the ASD group obtained scores indicating higher levels of dysfunction on all the measures evaluated in both settings. The greatest differences were in the variables of social participation and praxis, and the most affected sensory modalities were hearing in the home environment and touch in the school environment. Statistically significant differences were found between the information reported by the parents and the information reported by the teachers only in the case of the ASD group. Specifically, teachers reported greater dysfunction than parents in social participation, touch, and praxis. With the aim of more closely studying the sensory processing of children with ASD, and taking into account the high heterogeneity within the spectrum of autism, the second study analyzes the possible relationship between the characteristics of sensory processing, social participation, and praxis in a sample of children with ASD in relation to various intrinsic characteristics of the children themselves, such as: non-verbal IQ, the severity of the autism symptoms, and the number of ADHD symptoms (inattention and hyperactivity/impulsivity) in both contexts, the family and the school. Previous studies that have analyzed these possible relationships in one context or the other have obtained inconsistent results, possibly due to the great heterogeneity of the evaluation instruments used and the wide age range of the participating samples. In our study, the age range of the 41 participating children with ASD is quite limited, as only children between 5 and 8 years old are included. In addition, as an innovative aspect, not only is the possible relationship between these variables analyzed, but also the extent to which the intrinsic characteristics of the child can be predicted by the characteristics of sensory processing, social participation, and praxis in each of the two contexts evaluated. In this study, the average age of the participants was 6.09 years (SD=1.06), and the non-verbal IQ was 97.88 (SD=20.47). The evaluation instruments used were the same as in study 1, as well as the behavioral assessment scale for ADHD symptoms from the DSM-IV-TR (APA, 2002). In our study, as in previous studies carried out with children with ASD, no type of relationship between non-verbal IQ and sensory processing characteristics was obtained (Ashburner et al., 2008; Rogers et al., 2003), or it was very small (Ausderau et al., 2014). Regarding the severity of the autistic symptomatology, in agreement with other studies (Ausderau et al., 2014; Ben-Sasson et al., 2009; Hilton et al., 2007), we also found a direct relationship, so that the greater the dysfunction in sensory processing, the greater the degree of severity of the disorder. We also found that the different subscales of the SPM predict a significant percentage of the variance of the ASD symptomatology, both in the family context and in the classroom context. The subscale that explains the highest percentage of variance in both contexts is social participation, followed by the total score on the sensory systems. With regard to the relationship between the sensory processing, social participation, and praxis of children with ASD and the ADHD symptoms, some peculiarities were found, depending on the context. In the family environment, although in almost all cases the relationships were marginally significant, a significant relationship was obtained with both inattention and hyperactivity/impulsivity. In this context, all the SPM variables contributed significantly to the explained variance in both the inattention and hyperactivity/impulsivity scores, with a greater weight in the case of inattention. In the classroom, a much lower weight was obtained for the SPM variables that explain the ADHD symptoms than in the home. The analyses performed with hearing and touch showed that hearing is the only variable that explains a percentage of the marginally significant variance in the inattention score in the classroom context. In this case, although this result is only marginally significant, it also agrees with the results obtained by Ashburner et al. (2008), a study that shows that lack of attention is particularly associated with difficulties at the auditory processing level. Although alterations in the sensory processing of information are very common in people with ASD, they are not exclusive to this disorder (Coman et al., 2016). They are also present in people with other types of diagnoses, such as attention deficit disorder with or without hyperactivity (ADHD) (e.g.: Cheung & Siu, 2009; Dalpatadu et al., 2017; Ghanizadeh, 2011). In order to elucidate specific sensory patterns for each disorder, the third study focuses on analyzing this aspect in depth. Thus, as in the first study, the characteristics of sensory processing, social participation, and praxis are compared, at home and at school, but in this case with 4 groups: a group of children with ASD (n=21), a group of children with ADHD (n=21), a group of children with a comorbid diagnosis ASD+ADHD (n=21), and a group of children with typical development (n=27). The age of the participants in the four groups is between 5 and 8 years old, with an average age of 6.32 (SD=1.11), and they have an average non-verbal IQ of 98.72 (SD=16.84). The evaluation instruments used were the same as in study 2. When analyzing the sensory processing of the different groups, the three groups of children with neurodevelopmental disorders obtained high levels of dysfunction on most of the PMS subscales in both the family and school contexts. When comparing these three groups, differences were obtained depending on the context. In the family context, the comorbid group was the most affected. This group obtained a level of dysfunction similar to the ADHD group on the body awareness and balance and movement subscales (Jung et al., 2014; Shum & Pang, 2009). Regarding the external sensory modalities, high percentages of visual dysfunction were obtained in the two ADHD groups, and hearing dysfunction in the two ASD groups. As far as social participation is concerned, the comorbid group presented a higher degree of dysfunction than the ADHD group, but no greater difficulties were found in the social functioning of children with a comorbid diagnosis compared to those with ASD alone. The comorbid condition, therefore, does not seem to have an additive effect on social difficulties, compared to the ASD condition, in the family context. In the classroom context, the pure ASD group and the comorbid group were the most affected, with no differences between them. In terms of sensory modalities, tactile processing was the most affected in the three groups with neurodevelopmental disorders. In this context, both the comorbid group and the group with ASD obtained higher percentages of dysfunction on auditory processing and difficulties in social participation, compared to the group with ADHD. The comorbid condition, in this case, had an additive effect with respect to ADHD, but not with respect to ASD. The difficulties in social participation attributed to the ASD condition were greater according to the teachers compared to the parents. When analyzing the possible differences between contexts, neither the ADHD group nor the comorbid group obtained differences between informants. Differences between the information reported by the parents and the teachers were only obtained in the case of the ASD group, and it was the teachers who indicated a greater degree of dysfunction, specifically in social participation, planning and ideas, and touch. A possible explanation for this result could be related to the hyperselectivity or detail-focused processing style that people with ASD usually present (Foster et al., 2016). All these sensory peculiarities condition the way children perceive the world, a very important aspect to take into account from the point of view of intervention. For this reason, besides considering the increase in the ASD diagnosis and the necessary social inclusion, the Generalitat Valenciana Education, Research, Culture and Sport Counsel began to create Communication and Language classrooms (CiL classrooms) in the 2004-2005 academic year. They are specific special education units included within some ordinary public schools. In these classrooms, the TEACCH methodology is used, a methodology that focuses on understanding "the culture of autism", intervening less based on the shortcomings these children present and more based on their potential (Mesibov & Shea, 2010). Several review studies on the effectiveness of the TEACCH methodology, carried out with people of different ages and in different socio-educational settings, also find positive results and high satisfaction with the treatment expressed by the families (Eikeseth, 2009; Ospina et al., 2008). Specifically, the literature reports a reduction in stereotyped behaviors and communication and social interaction difficulties (NasoudiGharehBolagh et al., 2013). However, all the review studies carried out so far have pointed out the focus on the child’s development, but without considering the possible effects of the use of the methodology on educators. With the aim of providing evidence in this field, and taking into account the limited number of studies and, especially, reviews that support the effectiveness of this intervention (Wong et al., 2015), the fourth study in this doctoral thesis includes an updated review on the effectiveness of the TEACCH methodology. In this review study, we consider the effect of this intervention on the development of the child with ASD, in addition to the effect of this intervention on the level of stress of the parents and teachers of these children. In line with the results obtained in previous research, regardless of the country and context of the intervention, all the works included in study 4 on reviewing the effectiveness of the TEACCH methodology obtained improvements in the developmental skills and a reduction in the autistic symptomatology and maladaptive behaviors after the implementation of an intervention based on the TEACCH methodology (Eikeseth, 2009; Ospina et al., 2008). The reviewed studies show that the use of the TEACCH methodology not only improves the developmental areas of children, but it also reduces the stress levels of parents and teachers and improves the well-being of the adults themselves (Turner-Brown et al., 2016). These results demonstrate the need for pre-service teachers to know not only what the disorder and characteristic symptomatology consist of, but also intervention methodologies such as the TEACCH. Taking into account the principle of educational inclusion in the current legislation (LOMQE, 2013), initial teacher training for special education specialists and all ordinary classroom teachers should be one of the key aspects in offering a quality education where the needs of all students are considered. With the aim of analyzing the quality of the university education that is currently provided at the University of Valencia, the fifth study included in this doctoral thesis examines the degree of knowledge and number of misconceptions and gaps about ASD presented by first-year students and fourth-year students in the bachelors’ degree in teaching. In the last training course, an analysis by specialties is also carried out, in order to discover possible differences in the quality of the training. A total of 435 first-year students and 431 fourth-year students from the University of Valencia participated. Of the 435 first-year students, 162 were enrolled in early childhood education, and 273 were enrolled in primary education. As for the fourth-year students, of the 431 participants, 229 were enrolled in early childhood education, and 202 were enrolled in the primary education degree. Of these 202, 38 attended the special education specialty, 37 attended the speech pathologist specialization, and 127 were enrolled in other specialties, such as: music, English, information and communication technologies, science and mathematics. An adaptation of the Autism Knowledge Questionnaire (AKQ) was used to determine the level of the participants’ knowledge about ASD. The results obtained in our study, in line with several previous studies, corroborated that the training of pre-service teachers about the needs of children with ASD is insufficient (Al-Sharbati et al., 2015; Barned et al., 2011; Haimour & Obaid, 2013; Segall & Campbell, 2012). When comparing pre-service teachers’ knowledge in the first and last years of their degree, the fourth-year students obtained a higher level of knowledge and fewer gaps than the first-year students. Despite the increase in knowledge, fourth-year pre-service teachers also had more misconceptions than first-year pre-service teachers. When comparing the knowledge of special education and speech and language pathology pre-service teachers to the knowledge of the early childhood education and primary education pre-service teachers in their last year of training, the specialists obtained a higher level of knowledge and fewer gaps. These results coincide with previous studies with in-service teachers showing that special education teachers have more knowledge and training than general education teachers (Haimour & Obaid, 2013; Segall & Campbell, 2012). It was surprising, however, that the early childhood education pre-service teachers obtained more correct answers and fewer gaps than the primary education pre-service teachers because both groups had received the same training in ASD at the university. As expected, special education pre-service teachers also obtained fewer misconceptions than early childhood education pre-service teachers, with these differences being significant. It was also surprising that special education pre-service teachers obtained significantly fewer misconceptions than the speech and language pathology pre-service teachers because both had received the same amount of training during the degree. Although special education pre-service teachers and speech and language pathology pre-service teachers present more knowledge about ASD, the results obtained are not positive for the inclusive education framework in which the current educational system is legally immersed. This situation where the specialists are the most knowledgeable perpetuates a dual model in which special education teachers have a high level of knowledge about special educational needs, whereas generalist teachers, who are responsible for carrying out effective inclusion in ordinary classrooms, show more deficiencies in how to intervene with these students. Considering the results obtained, in the future curricula of the teaching degree, more credits should be included in the subject of special education. This training, in addition, should not only address the theoretical presentation of knowledge, but it should also emphasize the importance of: 1) detection; 2) carrying out curricular adaptations; 3) more training in intervention strategies supported by the latest research that favor the inclusion of children with ASD with their peers; 4) greater awareness of the importance of the attitudes that teachers themselves transmit to children; and, 5) carrying out cooperative work between the school, the family, the specialists, and other community services, with the aim of making the social inclusion principle truly effective.