Melinda Macht-Greenberg, PhD
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On the Need for Dual Disability Programs and Services in Schools: Serving Students with ASD and LBLD
In my private practice, I work with dozens of students who are diagnosed with both Autism Spectrum Disorder and Language-based Learning Disabilities, including dyslexia. Although this combination of attributes is very common, not enough attention is given to developing optimal ways to meet the needs of students with dual disabilities and diagnoses. Furthermore, there are few public school programs that I am aware of which specifically address this combined disability sub-type.
Instead of addressing the specific and unique needs of students with dual diagnoses, public schools tend to place students in programs geared to students who either have ASD or LBLD, but not the combination of both.
As one can imagine, providing services designed for one subgroup means that a large component of a student's needs go relatively, or perhaps minimally, addressed. The end result is often that students do not make effective progress in either disability area.
Take, for example, the story of an 8th grade middle school girl, whom I’ll refer to as Susie. When I first met Susie, she was placed in an in-district classroom geared to students with language-based learning disabilities. She was also diagnosed with Autism and the only service she received to address this disability was a weekly lunch bunch group which was provided to meet benchmarks under a Social/emotional goal on her IEP.
Two problems were inherent in this limited program design. First, there was insufficient attention given to her communication, behavioral, social, and emotional presentation related to Autism as most of her IEP was written for someone who primarily has a specific learning disability. Thus, she had a speech and language goal with benchmarks related to written language and reading comprehension. The SLP was not working on pragmatic language or social skills. So, we had a middle school girl who was placed in an LBLD class with peers of average cognitive and social abilities who were dyslexic. But they were not her friends and Susie could not form social relationships with the members of her class. The end result being that this middle schooler was extremely socially isolated and could not connect effectively with others, leading her to become increasingly depressed and anxious.
Second, Susie was not making meaningful progress with regard to her learning disabilities. Upon observation of the student in her middle school program, it was evident that Susie was unable to fully make use of the LBLD teaching strategies to which she was exposed throughout the day. Primarily, she could not engage in the multitude of interactive learning and practice opportunities inherent in the LBLD classes because she is also Autistic. Imagine being a 14 year old girl with Autism and teachers are constantly trying to get you to practice and build academic skills by working cooperatively in small groups or with partners. Teachers frequently ask students to turn to a peer and share ideas or gather research on a topic by working in small groups. These social interactions were beyond this student's capacity and Susie would not talk with peers or partners and would ask teachers if she could work alone. Because the program was not designed to teach and reinforce social group learning skills, Susie was isolated and did not have the opportunity to practice skills. Not surprisingly, Susie did not make effective progress in either her literacy or her social skills.
By contrast, we have the story of a 6th grade middle school boy, I’ll refer to him as Dave. Dave is dually diagnosed with Autism Spectrum Disorder and a language-based learning disability in areas of reading, written language, and math. Year after year, Dave struggled socially and academically. He fell further behind his peers in both areas, he failed to make effective progress at school,and he became increasingly anxious at home and school. These difficulties were apparent despite a multi-year placement in a district program designed for students with LBLD.
Once placed in an appropriate private program geared for students with dual disabilities and diagnoses, Dave immediately began making progress both socially and academically. The primary difference between a program geared for students with dual diagnoses and program for students with singular disabilities is that the skill building for both disabilities is integrated into one program throughout the day. So, a written language lesson is taught while social skills for group learning are explicitly taught and practiced. Rather than assuming students have the social skills to work with others, those skills are taught along with breaking down the writing process and teaching academic skills in a step-by-step manner.
Further, by providing an educational program with peers who have the same dual diagnoses, these students form true friendships with each other as they are learning academic and social skills at the same level and at the same pace with others.
The results are remarkable. Not only do students with dual disabilities make progress in both areas simultaneously, but there is also a significant reduction in secondary symptoms of anxiety and depression. Students report that they are happier and much more self-confident in 100% of cases once they were finally placed in appropriate programs for students with dual diagnoses.
Given the notable progress students with dual disabilities achieve once in appropriate, fully integrated programs that meet all of their needs, it is time for the public schools to develop similar programs within districts. Teaching staff must be highly trained in working with dual disabled students, as being trained in one area does not suffice. One must be trained and supervised in teaching students with both ASD and LBLD. Smaller towns should make every effort to join with other towns and share resources to meet the needs of their dual disabled students in nearby communities.
Without appropriate programs for students who have dual disabilities and diagnoses, students will continue to suffer and will not make effective progress in either diagnostic realm. However, with an appropriate program, highly trained staff, and the opportunity to be educated with peers who have similar profiles, these students will be able to make progress in all skill areas as they grow toward leading meaningful, independent lives.