Developing An Intervention to Improve Flexibility in High-Functioning Children with ASD: What Do Parents, Teachers, and Children Say They Need?

Background:

Inflexibility is a commonly observed associated feature of high-functioning autism spectrum disorders (HF-ASDs). Although social functioning is the central area of impairment for children with HF-ASDs, it is likely that inflexibility contributes to these social difficulties and impacts them in other areas of functioning as well. Interventions aimed at improving flexibility are limited and not commonly implemented in home and school settings. We are developing an intervention to improve flexibility in students with HF-ASDs, and as a first step in developing this intervention, we wanted to incorporate stakeholder input into the appropriate targets and methods for the project.

Objectives:

We sought to determine the areas of functioning that inflexibility affects in these children’s lives, as well as the extent of this impact. Additionally, we sought to learn from parents, teachers and youths with ASD what they have found helpful in improving flexibility, in order to help us determine what factors are critical to developing an intervention targeted at improving their flexibility.

Methods:

We conducted focus groups with four groups of participants: Parents of children and adolescents with ASDs (11 participants), public school special education teachers and staff members (6 participants), special education teachers and staff members in an Asperger’s program at a private school (12 participants), and school aged students within the previously mentioned program (17 participants). Questionnaires rating the role of flexibility in various areas of a child’s functioning and the participants’ experiences with resources that seek to improve flexibility in this population were collected from all participants.

Results:

In speaking with these groups and analyzing the collected data, we discovered several common themes regarding flexibility, and learned that inflexibility negatively impacts the social, emotional, behavioral, and academic functioning of children. When asked how it feels when he has to be flexible, one student stated: “Like I’m a lobster slowly being submerged into boiling water and I’m about to explode.” All participants acknowledged that teaching flexibility skills was crucial, but the groups reported needing a structure for teaching the skills and an active reward system to make the work achievable. Based on questionnaire results, 55% of these teachers rated flexibility as impacting their students socially very often, and 39% of teachers rated flexibility as impacting the students academically very often. Seventy-seven percent of all adult participants rated having flexibility techniques in the classroom as essential, and 73% of these participants rated such techniques as likely being useful in other settings as well. Fifty percent of teachers rated themselves as being very likely to use a flexibility manual in their classrooms if available. Children rated various techniques in terms of their helpfulness, and suggested other options that they thought might help them be flexible.

Conclusions:

Results of questionnaires indicate that inflexibility negatively impacts children with HF-ASDs in multiple areas of functioning. Our findings that a majority of parents and teachers believe that inflexibility impairs social and academic functions in HF-ASD, and that they need specific guidance and resources to intervene in this area, has implications for future intervention research.