For many children with autistic spectrum disorders (ASD) in mainstream education, the transition from elementary to secondary education at the age of 11 years or so can be particularly stressful, clinical experience shows. No previous study has systematically evaluated the impact on the child, their family and the school of that period of transition. Nor do we know what potential individual and systemic influences determine the success of the transition.
Objectives:
Our objective was to identify a nationally representative sample of families with a child who had a confirmed ASD diagnosis. We aimed to recruit children before they made the transition to secondary education, and to undertake comprehensive assessments of individual, family and school variables that could influence the success of the transition. Our aim was then to re-evaluate those variables 6 months after the transition, in order to identify the most discriminating predictors of outcome.
Methods:
28 schools participated in the investigation. Measures were obtained of autistic and comorbid conditions (3Di, ADOS), cognitive abilities (WISC), language skills (CELF) and functional impairment (Vineland) from parental reports and individual child assessment. Family stress was measured by questionnaire (PSI). School teacher’s evaluation of the child was obtained from Autism Scenarios. School support was assessed by the My Class Inventory, both in elementary and secondary school.
Results:
At the time of the evaluation before transition 90% of children with ASD had significantly discrepant cognitive profiles, with a greater range of cognitive skills than are found in >97% of the general population. Impairments were in executive abilities (e.g. poor working memory or processing speed – 80% affected), or in verbal or non-verbal intelligence.
On measures of emotional and behavioural adjustment, over 50% had clinically significant anxiety, with a similar proportion having clinically significant depressive symptoms. 65% had severely compromised self-esteem and 28% showed disruptive behaviour.
Parenting stress was exceptionally high, over 60% of families suffered from levels of stress in the severe, clinically significant range.
Six months after transition, parenting stress remained high with 73% in the severe, clinically significant range. Self-reported child difficulties in: anxiety, depression, self-concept, disruptive behaviour or anger did not significantly change. Teacher ratings of significant peer problems identified 37% before transition and 40% afterwards, but impairment in prosocial behaviour had deteriorated from 33% before transition to 50% afterwards.
Conclusions:
The period of transition from elementary to secondary school is stressful for most children with ASD, whether or not they have support in terms of assistance for special educational needs. Families suffer tremendous stress at this time, which has not ameliorated 6 months afterwards. Independent ratings by teachers indicate there has been deterioration in some aspects of behavioural adjustment in most cases. Children with ASD rate themselves as distressed and depressed by the experience. Support structures are urgently needed to ameliorate this worrying situation, which can lead to school drop-out if not managed effectively.