of autism spectrum disorder. Development
The TEACCH approach to autism
and Psychopathology, 20, 775-803.
Dawson, G., Rogers, S. J., Munson, J., Smith,
M., Winter, J., Greenson, J., . . .Varley, J.
(2010). Randomized, controlled trial of an
intervention for toddlers with autism: The
Early Start Denver Model. Pediatrics,
125(1), e17– e23.
Grandin, T. (2008). The way I see it: A per-
sonal look at autism & asperger’s. Arling-
ton, TX: Future Horizons.
Gray, C. (2010). The new social story™
book: Revised and expanded 10th anniver-
sary edition. Arlington, TX: Future Hori-
zons.
Greenspan, S. I., & Wieder, S. (1998). The
child with special needs: Encouraging in-
tellectual and emotional growth. Reading,
MA: Addison-Wesley.
Greenspan, S. I., & Wieder, S. (1999). A
functional developmental approach to au-
tism spectrum disorders. Journal of the As-
sociation for Persons with Severe Handi-
caps, 24 (3), 147-161.
Kasari, C., Gulsrud, A. C., Wong, C., Kwon,
S., & Locke, J. (2010). Randomized con-
trolled caregiver mediated joint engage-
ment intervention for toddlers with autism.
Journal of Autism and Developmental Dis-
orders, 40, 1045–1056.
Koegel, R. L., & Koegel, L. K. (2006). Piv-
otal response treatments for autism: Com-
munication, Social, & academic develop-
ment. Baltimore: Brookes.
Lovaas, O. I. (2003). Teaching individuals
with developmental delays: Basic interven-
tion techniques. Austin, TX: Pro-Ed.
Lovaas, O. I. (1987). Behavioral treatment
and normal educational and intellectual
functional in young autistic children. Jour-
nal of Consulting and Clinical Psychology,
55 (1), 3-9.
Marcus, L., Schopler, E., & Lord, C. (2001).
TEACCH services for preschool children.
In J. S. Handleman & S. Harris (Eds.).
Preschool education programs for children
with autism, 2nd ed., (215-232). Austin,
TX: Pro-Ed.
Mesibov, G. B., Shea, V., & Schopler, E.
©2011 AFB, All Rights Reserved
(2004).
spectrum disorders. New York: Springer.
Odom, S. L., Collet-Klingenberg, L., Rogers,
S. J., & Hatton, D. D. (2010). Evidence-
based practices in interventions for children
and youth with autism spectrum disorders.
Preventing School Failure, 54 (4), 275-
282.
Ozonoff, S., Losif, A. M., Baguio, F., Cook,
I. C., Hill, M. M., Hutman, T., Rogers S. J.,
Rozga, A., Sangha, S., Sigman, M., Stein-
feld, M. B., & Young, G. S. (2010). A
prospective study of the emergence of early
behavioral signs of autism. Journal of the
Academy of Child and Adolescent Psychi-
atry, 49(3), 256 –266.
Rogers, S. J., & Dawson, G. (2010). Early
Start Denver Model for young children
with autism: Promoting language, learn-
ing, and engagement. New York: Guilford
Press.
VanDerHeyden, A. M., & Burns, M. K.
(2010). Essentials of response to interven-
tion. Hoboken, NJ: Wiley.
Shirley Cohen, Ph.D., professor emeritus, De-
partment of Special Education, 9th Floor West,
Hunter College, City University of New York, 695
Park Avenue, New York, NY 10065; e-mail:
⬍profcohen@aol.com⬎.
Autism Spectrum Disorders
and Visual Impairment Are Here
to Stay: Using an Expanded Core
Curriculum to Implement
a Comprehensive Program
of Instruction
Marilyn H. Gense and D. Jay Gense
I n this article, we provide a conceptual
framework for an expanded core curriculum
for students who have an autism spectrum
disorder (ASD) in addition to visual impair-
ment (ASDVI). Drawing from known
evidence-based practices, as well as existing
models of an expanded core curriculum, the
framework presented in this area addresses
(1) the foundational components of a compre-
hensive educational program; and (2) a cor-
Journal of Visual Impairment & Blindness, June 2011 329
responding expanded core curriculum, that, in
the experiences of the authors, provides a
structure to help ensure the best outcomes for
learners with ASDVI.
BACKGROUND
In the last several years, the field of special
education has brought considerable focus to
the identification of evidence-based practices
that teams can use to design and implement
quality educational programs for students.
These efforts serve to ensure that teachers are
able to implement the highest quality instruc-
tional strategies for their students and can pair
such strategies with the “craft” of teaching to
best address each learner’s individualized
needs. Concurrently, leaders in the disability-
specific fields of education for children who
are visually impaired (that is, those who are
blind or have low vision) and for children
with ASDs have brought focus to a concep-
tual framework for curriculum through which
evidenced-based and other practices can be im-
plemented to best address individual students’
learning needs. In the field of visual impair-
ment, this focus led to the development and
implementation of an expanded core curricu-
lum—a curriculum of instruction provided in
conjunction with the standard core curriculum
that is designed to meet the unique learning
needs of children who are visually impaired.
Most teachers of students with visual impair-
ments, orientation and mobility (O&M) spe-
cialists, other service providers, and parents
have embraced the expanded core curriculum
for students with visual impairments.
In the field of autism, two recent efforts
relative to curriculum development that rely
on evidence-based practices are important to
note. First, Educating Children with Autism
(Lord & McGee, 2001) identified the major
components of a curriculum for learners with
ASDs. In 2009, the National Standards (Na-
tional Autism Center) report identified inter-
ventions based on research that produce the
best results for individuals with ASDs. In
330 Journal of Visual Impairment & Blindness, June 2011
addition, the National Professional Develop-
ment Center on Autism Spectrum Disorders, a
multiuniversity center funded to identify and
promote the use of evidence-based practice
for children and adolescents with ASDs,
works collaboratively with state departments
of education or Part C agencies (that is, state
agencies that administer the early intervention
aspect of the Individuals with Disabilities Ed-
ucation Act) and the University Center for
Excellence in Developmental Disabilities to
provide professional development to teachers
and others serving students with ASDs. With
these efforts, there now exists a solid base of
evidence and access to training to assist
teachers and other services providers to im-
plement a quality program of instruction for
learners with ASDs.
However, when addressing the needs of
learners with ASDVI, relatively little research-
based evidence exists. Best practice and curric-
ulum design for these students, then, must re-
flect empirical knowledge of what is known
about ASDs and visual impairment, and must be
informed by the experiences of teachers and
others working with both populations. Educa-
tors who understand the strengths of each set of
learners need to match those strengths with in-
terventions that have been identified to demon-
strate positive outcomes.
A COMPREHENSIVE PROGRAM FOR LEARNERS
WITH ASDVI
Using a simple analogy of the basic structural
framing of a house (see Figure 1), a compre-
hensive program of instruction for learners
with ASDVI must include components that
serve as the foundation, the walls and sup-
portive interior, and over-arching roof. As
with a house, the structural integrity of a
comprehensive program for learners with
ASDVI cannot exist without reflection of all
components, and none of the components can
function independently. An interdependence
exists among the foundation, the walls, and
the roof. Without such interdependence, the
©2011 AFB, All Rights Reserved

Figure 1. A comprehensive program of
instruction for learners with ASDVI.
instructional program cannot appropriately
serve the function for which it was designed.
This model is useful when considering critical
elements of a comprehensive program.
The assessment of the learner serves as the
foundation, the first component of the model.
The assessment has to be accurate and reli-
able, and it must serve to clearly identify the
strengths and needs of the student. Everything
else the educational team does is based on
information and data gathered through assess-
ment. The success of the foundational assess-
ment is based on the team’s ability to develop
an accurate “picture of the learner,” and the
extent to which the assessment provides ac-
curate information and data that show the
team how the learner interacts with the envi-
ronment and with the expectations of the en-
vironment at any given time.
The second component of the comprehen-
sive program (the walls) is composed of eight
steps of a quality program of instruction. It is
important that each of these steps is informed
by and built upon information from the pre-
ceding step. This model, adapted from the
“Intervention Ziggurat” (Aspy & Grossman,
2007), includes the following steps:
1. address sensory and biological needs;
2. provide appropriate reinforcement;
©2011 AFB, All Rights Reserved
3. provide opportunities to communicate and
functional communication systems;
4. provide concrete (tactile, auditory, visual)
supports to assist with participation and
understanding;
5. address task demands;
6. provide systematic, planful instruction;
7. use data to drive decisions; and
8. provide an appropriate level of instruction.
Each step within the development and imple-
mentation of this program of instruction
needs to reflect each preceding step (that is,
the first step must be addressed prior to the
completion of step 2). If a team or teacher
does not understand and subsequently address
the sensory needs of an individual with AS-
DVI, does not consider what type of rein-
forcement is appropriate or how to deliver it,
and then moves directly to instruction, it is
likely the instruction will not be successful.
At the very least, the instruction will take
longer, or worse, will likely not make sense to
the student, depending on the level of sensory
need or sensory interference he or she expe-
riences.
The third component of the comprehensive
program for learners with ASDVI (the roof)
addresses activities and opportunities to sup-
port the generalization of acquired skills.
Generalization refers to the ability of an in-
dividual to demonstrate the use of an acquired
skill across settings and situations. A signifi-
cant critical learning characteristic of individ-
uals with ASDs and ASDVI is difficulty with
generalization. When working with learners
with ASDVI, a generalization plan must be
developed and implemented. For example,
due to the nature of ASDVI, a learner may
need to be taught how to raise a hand to ask
for help rather than shouting out. This is
taught by pairing the instruction “raise your
hand when you need help,” with a concrete
support (braille, for this learner, that says
“raise your hand when you need help”). How-
ever, unless that same learner is given the
Journal of Visual Impairment & Blindness, June 2011 331
opportunity to learn to ask for help in a vari-
ety of settings and situations, and is provided
support and reinforcement once the initial
skill is acquired, the learner will likely have
difficulty using the skill functionally. Plan-
ning for and providing ample opportunities
for generalization is a critical component of
any program for learners with ASDVI (Gense
& Gense, 2005).
Together, the assessment information, the
comprehensive program of instruction, and a
focus on generalization of skills, will be uti-
lized to implement instructional strategies de-
signed to address each learner’s individual-
ized needs. Many resources from the field of
autism are available to assist teachers and
service providers trained in the field of blind-
ness. The National Professional Development
Center on Autism Spectrum Disorders
(2010), for example, provides quality infor-
mation, including evidence-based practice
briefs and corresponding autism Internet
modules, developed for the most currently
identified evidence-based practices.
AN EXPANDED CORE CURRICULUM
FOR STUDENTS WITH ASDVI
Concurrent with the development of this com-
prehensive program is the need to know what
to teach. As with all learners, implementation
of the general core curriculum is important
for learners with ASDVI. However, as is true
for students who are visually impaired, in
addition to the standard core curriculum, an
expanded core curriculum specifically de-
signed for students with ASDVI is needed.
The ASDVI expanded core curriculum we
propose reflects both the ASD and visual im-
pairment curricula, but requires modifications
and adjustments to ensure a uniquely de-
signed expanded core curriculum that ad-
dresses the learning characteristics of students
with ASDVI. This curriculum includes:
• skills of engagement: “learning to learn”
skills, including attending, waiting, re-
332 Journal of Visual Impairment & Blindness, June 2011
sponding to instructions, learning from
prompts, persistence, staying on task, ob-
servational learning, asking questions, and
asking for assistance
• communication skills: expressive, recep-
tive, and nonverbal skills, including the use
of functional communication systems
• play and social skills: these skills include
those used in recreation and leisure activi-
ties
• adaptive skills
• organizational skills
• O&M or purposeful-movement skills: these
include sensory and motor skills
• career and life education
• self-advocacy skills
Table 1 provides an example of functional
applications in each of the expanded core
curriculum areas for a student named Rafa, a
second grader who is totally blind with severe
autism. He has limited verbal communication
skills, and is currently served in a specialized
classroom in his neighborhood school. His
primary learning mode is auditory, but he also
uses tactile learning methods.
As the details of the expanded core curric-
ulum for students with ASDVI are developed
and addressed, several additional but overar-
ching skill sets must be reflected in all
areas of such an expanded core curriculum,
including
• the application of assistive technology and
visual efficiency skills and
• the determination of each learner’s appro-
priate symbolic level of representation for
communication. (that is, use of concrete
objects, braille, large print, print, auditory,
sign, or some combination)
Successfully addressing the needs of students
with ASDVI must reflect a well-designed, com-
prehensive program of instruction, as well as an
expanded core curriculum. The evidence-based
practices identified by the autism field will be
©2011 AFB, All Rights Reserved
Table 1
Examples of functional applications of the expanded core curriculum to a student with autism
Expanded core curriulum areas
Skills of engagement
Communication skills
Play and social skills (including recreation and
leisure)
Adaptive skills
Organization skills
Orientation and mobility/purposeful movement
skills (include sensory and motor skills)
Career and life education skills
Self-advocacy skills
critical and need to be applied for students with
ASDVI. Service providers and parents must be-
come prepared to work collaboratively to im-
plement these strategies, drawing from best and
current knowledge from the fields of visual im-
pairment and autism.
REFERENCES
Aspy, R., & Grossman, B. (2007). The Zig-
gurat Model: A framework for designing
comprehensive interventions for individu-
als with high-functioning autism and
Asperger syndrome. Shawnee Misson, KS:
Autism Asperger Publishing Company.
Gense, M. H., & Gense, D. J. (2005). Autism
spectrum disorders and visual impair-
ments: Meeting students’ learning needs.
New York, NY: AFB Press.
©2011 AFB, All Rights Reserved
Examples of functional applications
Rafa is learning to complete a sequence of:
1. Making a choice of a reinforcement.
2. Obtaining necessary material.
3. Completing a work task.
4. Returning his materials.
5. Receiving reinforcement.
Rafa uses object cues, paired with audio
recordings and braille, to follow a daily
schedule.
Rafa is learning appropriate turn-taking skills
when engaged in a group activity with his
peers.
Rafa uses a braille and auditory list giving
him the sequence of a routine for getting
ready to go outside for recess (e.g., go to
the closet, get your coat and mittens, get
your cane, wait by the door)
Rafa works with a daily schedule and a
finished box, using braille, auditory, and
object symbols.
Rafa is learning to navigate in the classroom
by using a concrete reference point (his
schedule box), and uses this reference to
orient himself to find his materials and
return to his desk.
Rafa is learning to deliver the classroom’s
daily attendance sheets by traveling from
the classroom to the office, handing the
records of attendance to the secretary.
Rafa is learning to use an auditory
communication device to request staff
attention appropriately in a variety of
situations.
Lord, C., & McGee, J. (Eds). (2001). Educat-
ing children with autism. Washington, DC:
National Academy Press.
National Professional Development Center on
Autism Spectrum Disorders. (2010).
Evidence-based practice briefs. Chapel
Hill, NC: Author. Retrieved from http://
autismpdc.fpg.unc.edu/content/briefs
National Standards Autism Center. (2009). The
national standards project—Addressing the
need for evidence based practice guidelines
for autism spectrum disorders. Randolph,
MA: National Autism Center. Retrieved
from www.nationalautismcenter.org/pdf/
NAC%20Standards%20Report.pdf
Marilyn H. Gense, M.A., retired, private consul-
tant and chair, Oregon Commission on Autism
Journal of Visual Impairment & Blindness, June 2011 333
Spectrum Disorder; mailing address: 675 Valley-
wood Drive SE, Salem, OR 97306; e-mail:
⬍mnjg@comcast.net⬎. D. Jay Gense, Ed.S., di-
rector, National Consortium on Deaf-Blindness,
Teaching Research Institute, Western Oregon Uni-
versity; mailing address: NCDB, Western Oregon
University, 345 N, Monmouth, OR 97361; e-mail:
⬍gensej@wou.edu⬎.
Optic Nerve Hypoplasia and
Autism: Common Features
of Spectrum Diseases
Cassandra Fink and Mark Borchert
A utism is a developmental disorder charac-
terized by impaired social interaction, prob-
lems in verbal and nonverbal communication,
and stereotyped or repetitive activities and
interests. Rather than a single condition, au-
tism is today generally regarded as consisting
of a spectrum of pervasive developmental dis-
orders that together are known as autism
spectrum disorders (ASDs).
Optic nerve hypoplasia (ONH) is a congenital
condition characterized by underdeveloped op-
tic nerves and neurological impairment involv-
ing endocrine dysfunction and developmental
delay, with or without brain malformations that
are visible by way of neuroimaging tools. In-
creasing in prevalence, ONH is now the leading
single ocular cause of blindness in children in
the developed world, affecting 10.9 per 100,000
births (Patel, McNally, Harrison, Lloyd, &
Clayton, 2006; Hatton, Schwietz, Boyer, & Ry-
chwalski, 2007).
Clinical observations and recent reports in-
dicate a high frequency of ASDs in children
with ONH (Ek, Fernell, & Jacobson, 2005;
Parr, Dale, Shaffer, & Salt, 2010). In children
with ONH, there are additional characteristics
of ASD beyond those attributable to visual
impairment alone, such as echolalia and ste-
reotypic motor movements. We argue that
ONH, like ASDs, should be considered a
spectrum disorder to account for the range of
severity in outcomes and symptoms associ-
ated with this condition. In addition, we be-
lieve the similarities in the two conditions
334 Journal of Visual Impairment & Blindness, June 2011
illustrate the possibility of a shared neurode-
velopmental origin. Comparing the similari-
ties in these conditions may lead to a greater
understanding of the risk factors contributing
to either condition, as well as potential clini-
cal outcomes, as the relationship is further
explored.
ASD AND BLINDNESS
It is not surprising that ASDs are prevalent in
children with ONH when one considers that
published data indicate ASDs are overrepre-
sented in the visually impaired population,
with prevalence estimates as high as 1 case of
autism in every 4 visually impaired persons
(Brown, Hobson, Lee, & Stevenson, 1997),
compared to 1 out of 110 in the general pop-
ulation (Rice, 2009). The behaviors and char-
acteristics of children with vision impairment
that resemble those of children with ASDs,
including echolalia, pronoun reversal, stereo-
typic motor movements, and delays in devel-
oping pretend play, are often attributed to the
vision impairment itself (Andrews & Wyver,
2005). These behaviors may be termed
“blindisms,” since they are explainable in the
context of vision impairment. (For example,
rocking or spinning may provide needed ves-
tibular stimulation in a child with limited mo-
bility due to lack of vision; language devel-
opment and social interactions may be
impaired in congenitally blind children due to
their lack of concrete experiences and visual
models.) The similarity of these “blindisms”
to “autistic-like” behaviors, coupled with the
absence of autism diagnostic measures de-
signed for use with people who are blind or
visually impaired, complicates the diagnosis
of ASDs in children who are visually im-
paired.” Thus, the debate concerning whether
“true” autism is prevalent in children who are
visually impaired remains unresolved.
ASDS AND ONH
Most reports of ASDs in children with vision
impairment (ASDVI) are limited to children
©2011 AFB, All Rights Reserved