Q&A with Roger Ideishi on Inclusion

About Dr. Ideishi

Roger I. Ideishi, JD, OT/L, FAOTA, is a professor in the occupational therapy program. His work focuses on creating community access and opportunity for children with diverse sensory and cognitive abilities. He advises community organizations on building meaningful learning experiences for children and their families.

Some of the organizations he has collaborated with include The John F. Kennedy Center for Performing Arts and the Smithsonian Institution in Washington, DC, Minnesota Orchestra in Minneapolis, MN, Pittsburgh Symphony Orchestra & Andy Warhol Museum in Pittsburgh, PA, and Philadelphia Museum of Art, Pennsylvania Ballet & Philadelphia Orchestra.

Q&A

How did you get interested in addressing the needs of children with autism?

So I’m clinically and educationally prepared as an occupational therapist and have been working in a variety of populations across the lifespan fot 35 years. 

I began working with disability and inclusion among school-age children, and recognizing that for many practitioners — while they are doing wonderful jobs in the classroom — the link between home and community was not often there. That came across loud and clear from parents. 

Together with the practitioners I worked with, we began to explore this and tried to make what was happening in the classroom a lot more relevant to home and community life. And that’s how we began the process, about 25 years ago. 

Why is it that the physical environment is so important for students with autism and other disabilities?

I think it’s not only the physical environment, I think it’s also the social environment and the overall context of where learning and experiences occur. There is literature out there that really speaks to learning in context. And learning a skill or practicing a skill in one context may not transfer to other environments. We need to address those variations of how a person organizes information in different contexts and I think it’s really important for practitioners to understand that.

I think the classroom work is absolutely important, but I think practitioners, educators, and therapists need to move in both directions, both inward within the classroom, but outward as well. And I think that sets the student up for greater success in the future. 

I’m wondering very broadly how a student with autism, for example, might process the school environment differently from other students. What does it mean for them as they walk into a school room in terms of physical sensations, predictability, and sensory processing. How is their school experience, their life experience different?

We discovered, that in the classroom school environment we — the teachers and the therapists — can create a supportive, controlled environment so the child can learn and the child is comfortable and feels safe learning. And that’s where we see a lot of growth. 

But when you move outside of the classroom — being in the school playground, or doing a neighborhood walk, or going to the grocery store — those variables are no longer controlled in the same way that we’re able to control them in the classroom. So I think preparing and supporting kids in these unpredictable, variable situations, and making sure they have the flexibility to reorganize and manage sort of the complex set of skills is really important.

And I think oftentimes being in the classroom we forget about that. The controls are inherently built into the classroom and teachers and therapists design the environment that way, because we want to optimize learning as much as we can.

But beyond the classroom, the controls just don’t exist. And I think that’s where we were hearing from parents that while the student might be doing well in the classroom with a particular task, out in the community you can’t control sound, you can’t control crowds. And so it’s a very different way of learning out in the natural environment. That’s a challenge and I think that’s a huge difference between classroom learning and naturalistic environment learning.

If you walked into a typical school or a typical classroom where a teacher was not particularly attuned to these issues, what kinds of barriers or obstacles might you see for students with cognitive or sensory disabilities?

I think for the general education teacher who doesn’t necessarily have special education training or therapeutic training, to a certain degree they’re in an uncontrolled environment when kids have sensory processing disorder or autism and they’re faced with students who are having difficulty in that environment.

One of the things that we really try to establish is a routine, because that idea of predictability is so important. And I know general education teachers try to do that as well. But when you have someone who is hypersensitive to sound or hypersensitive to visual input, it can break the routine that the teacher has created in the classroom.

It’s really important to consider the sensory inputs as you structure the routine, and ask how do you make the sensory environment pretty predictable?

And this is where it becomes challenging because for the person who has sensory processing disorder, the range of response to the classroom environment is very wide. You can go from someone who is what I would call hyposensitive, where they may not actually perceive or taking in a lot of the sensations, and so they’re not responsive.

And it’s not because they’re not responsive in an intellectual way or not responsive in an emotional way; it’s that they’re not perceiving the sensation. So if they’re not perceiving it and taking it in, how do you even know to respond?

And you go from that end all the way to the other end where the person is hypersensitive. Where they’re picking up a lot more sensations and maybe even picking up sensations with more intensity than other students. And so their response to that input can be disorganized and then disruptive to that child’s body. And then they’re responding to this sense of being overwhelmed.

So teachers have to manage those two polar opposites and that’s really pretty challenging to do. So, again, it’s going back to this very repetitive and predictable routine, so that wherever a child is on the spectrum, that predictability happens over and over again.

For children who are hyposensitive, they may over time begin to sensitize because the same inputs are coming at them over and over again. Whereas those children who are hypersensitive, because those same inputs and that same routine is happening over and over again, they can begin to accommodate to those sensations.

So I always try to establish routine very consistently and manage sensory inputs as well, making sure that there’s not extraneous or overly stimulating ambient noise and keeping the lighting and the visual inputs of movement fairly consistent.

It doesn’t mean that everybody sits down all the time. It just means that it’s very consistent throughout the day that everybody is getting up at the same time or moving about in the same space or in the same sort of moment in time. That way, the child can really predict and start to self-organize how they’re going to manage and navigate through that moment. I think that’s usually what my primary partnership with teachers involves — establishing those routines.

Are there ways the teachers can use visual cues to help support kids with ASD?

Visual supports are really, really helpful for children with autism. Auditory support is important, too — you know, providing multi-modal ways of introducing information.

So if you’re just using auditory direction and if a child is hyposensitive (meaning he may not even be perceiving all of the information or taking in all the information), then he’s going to take maybe a little bit more processing time to understand what’s going on.

And the teacher might be feeling the need to rush, thinking “come on, let’s get up, let’s get up, let’s go, let’s move.” There’s a time schedule that the teacher is trying to stick to. But if a child is not taking in all of that information, it’s going to take him longer to process that information.

So visual supports can help. The teacher can use some imagery that really cues the student that now is the time to move or now is the time to transition to something else.

That visual cue almost gives that student more control and more self-determination in how he’s collecting the information to respond to. But I think it’s really important that it’s actually multimodal — it’s visual, auditory, and could be other means as well.

Special educators are really good at this. So I would definitely make sure that the general education teachers are consulting with special educators, occupational therapists, and other related professionals.

Have you seen examples of an inclusive classroom where people are doing this really ingenuously, really well? Are there any specifics that might come to mind?

Oh yeah, yeah. That’s really where my work has been for the last 20 years in helping to create those routines. One of the things that we discovered in creating these routines and these multi-modal inputs within an experience is the discovery of the creative arts process, because the creative arts are multi-modal in nature.

And so we started to incorporate more creative expression, creative art, and creative visualization whenever these transitions were happening. And it just seemed to work much more smoothly because every student was able to enter that moment in his or her own way, as well as at his or her own pace. But if you’re only using one mode of learning or one mode of input, then you’re very likely to lose the attention of students.

Can you give one or two concrete examples of what a resourceful thoughtful teacher could do to signal to kids, for example, that it’s almost time to go to lunch, or about to change from the English block to the math block? 

Sure. Let’s say it’s time to get your books out or it’s time to go to recess or it’s time to go to lunch. You can start with the straight, language-based directive, and then add some creative, multisensory elements. You can use music, you can create a little song or rhyme around it, and add movement.

You’re establishing a routine during transitions, where the class does stretches and creative movement that signals the next transition. So that’s a way of using movement and rhyme and music rather than just the straight auditory directive.

I see teachers using that creative multimodal instruction, and I find students responding to that much, much more. And it actually feels more organized (even though it may sound a little bit disorganized) because everyone’s in tune with what’s happening.

They’re in tune in their own way, but as long as everyone is getting to that end target objective, it actually makes for a more organized and smoother transition. So that’s a really simple tool to use.

Are there other things that schools can do in helping to address or prevent the anxiety that many students feel?

Preparation. Just giving kids information up front to process so they can begin to prepare for what’s going to happen next. And there are a couple different ways that teachers do this. There’s the directive, prescriptive way, which is essentially giving directions.

Under those circumstances, the students often don’t have a lot of choice. They have to follow the directions that are being provided to them. And that’s why using the group creative multi-modal way really allows students a lot more control and determination of how they’re experiencing that.

But then there’s another way of doing it that I would describe as very descriptive, where you’re just describing what the scenario is going to be, and what the expectations are going to be.

When you’re “priming” the students, and giving them enough time to process that information, that facilitates the students’ own problem solving. How am I going to navigate this situation that was just described to me? How am I going to do that? How am I going to organize my behavior and my thoughts in accomplishing this goal, or what’s going to happen in the next scenario?

Sometimes the more prescriptive way is useful, but when you want to start transferring more control and decision making to the student, I would recommend using a more descriptive way of priming or preparing students. You still have to support and facilitate them in doing that problem solving so that they’re doing that self-organization and figuring out how they’re going to manage that situation.

We sometimes describe this priming as creating social narratives, scripting, and social stories. And there are particular ways that people may do social narratives or scripting social scripts.

The essential idea behind it is really priming and preparing and “pre-inputting” information, with the idea that the student is going to start to self-organize rather than always being directed by someone else.

That sounds really smart, and really effective. Can you share a concrete example of how that would work?

Here’s an example. In order to transition to lunch, the teacher can describe the whole scenario: when the clock strikes 12, it’s going to be time to transition to lunch; we’re going to put our books away, and we’re going to go wash our hands.

And you’re just going to describe what’s going to happen and the objectives or the expectations of that scenario. And then you’re going to share this scenario with the students. And some students may take it up very quickly; other students may need a lot more support and coaching in how they’re going to do that.

So, you present that story, or that narrative. You begin to say, “Johnny, how are you going to prepare for lunch or, how much time do you need to put your books away?” You’ll start posing those coaching questions rather than the directive, “Johnny, put your books away now.”

And so Johnny starts to navigate in his own mind how this is all going to happen and starts to organize himself. Other kids, by providing that information, will start to self-organize and have a plan of what they’re going to do. So the whole idea is getting each child to do their own planning.

So just provide that scenario, provide those descriptions, and then support the students through that process. If they don’t need the coaching anymore and start to self-organize on their own, that’s great. If they do need ongoing support and coaching, again, do it in a way that transfers the responsibility to the student for planning and organizing his actions.

Interviewer: It’s a way of delivering the message without stigmatizing or shaming or blaming the child who might struggle with this. You’re sort of making an announcement for everybody, then asking some individuals questions. It just feels like a much different way of communicating.

Yes, absolutely. Instead of pointing out the students who may have a little bit more difficulty with the pre-planning, it’s having everybody do what is already naturally happening in most of the kids’ minds anyway. So it is a very natural, much more inclusive way to present information.

How can teachers and parents work together constructively to where it’s creating a welcoming environment at school?

What I say might sound a little bit disparaging, because I know there are really wonderful educators and therapists out there.

But I think parents often feel that teachers and therapists are not listening to them. I really had to teach myself to do a lot more listening — listening to parents and listening to students. And not always presuming that because I was trained a certain way, that I had the answer.

So I just think listening is just really, really key. And not listening as an act, but listening because you really want their input and their insights. And you even want their coaching on how you can be a better educator or a better therapist.

Interviewer: … Because parents have done a lot of trial and error by the time their child shows up in your classroom.

Exactly. And you know, I think therapists and educators, we need to do it more. And I’m guilty of it, too because I have to get through my day and I have so many things I have to accomplish in that day, so I know how it feels. But I think it really does make a huge difference when you are truly, truly listening to the parent.

Can you think of examples of fairly simply changes that schools or other institutions have made that have generated really positive results? What are some things we might be able to do to make the whole school more welcoming?

I think we recognize that many students with disabilities are not included in the general flow of school activities — whether it’s a special event or a school assembly or recess or lunchtime, all of these non-academic moments in the school day or after school.

I think it’s important that we carry over all those same strategies for perspectives and values within these non-academic situations.

As soon as we move outside of the traditional classroom and the desk and the chair and go into the school assembly or recess or lunchtime, I think these things need to be carried over. And that really is a whole-school agenda because then the people in the cafeteria need to understand how to communicate and engage with people with disabilities. It means the bus drivers, the office staff, and the entire school have to have some skill and capacity to engage with diversity. I think that’s really important.

I don’t know that it’s always happening. I know the practitioners I work with and the educators I work with are definitely are trying to do that. 

And teachers have so many tasks throughout the school day, sometimes I think it’s hard to be vigilant with things like that. And so I think the student with a disability often, in these non-academic moments, isn’t fully supported.

These same strategies that I had referred to earlier need to be carried over into non-academic moments during the school day. And then also work on — and this is where I’ve heard from parents and where a lot of my work fits — moving those experiences into the home and into the community and really supporting children in their experiences outside of the school walls.

We know that a huge part of every child’s day is how they’re interacting with their peers. Are there some principles the teachers can follow? Do you try to model or encourage accepting warm, empathetic behavior from non-disabled students?

I think one of the first things is to respect everybody’s point of view. And that includes the student who has a disability or a student who may have sensory processing disorder or just views the world differently. We all view the world in our own idiosyncratic, individualistic ways.

But don’t put a right or wrong label on it and don’t convey that to the student. What’s really important is to be much more receptive to other points of view of the world.

So the student with a disability may view the situation differently, or the person with sensory processing disorder oftentimes perceives the situation very differently. And not to discount it or minimize it, but to really engage with that, as the teacher might engage with other students. “Oh, how did that make you feel?”

Other students and other teachers will see that modeling from that teacher. I just think that’s really key. In your busy day sometimes it’s very difficult to stop, think, reflect, and then act.

How have your ideas evolved over time, about creating welcome environments in school? Are there things that you do differently compared with 10 years ago?

Well, yeah. I’ve had to teach myself to listen a lot more genuinely. You know, as simple as that sounds, it’s actually pretty difficult as a practitioner. Really genuinely listen. I’ve had to teach myself how to do that because it is difficult to do.

So that’s definitely one thing that we all need to reflect on a lot more as being direct service providers for a lot of these students. You know, I think one thing that has really helped me to shape the work that I do is to follow the parents’ and the students’ lead.

You know, I bring a set of information and expertise to the table, but it’s not necessarily the best information for that situation. But when I follow the parents’ and the students’ lead and then I bring my information to the table and then we begin to engage in this dialogue of problem solving, I find that there’s a lot more investment with all parties and all stakeholders in that process.

They begin to process the things that you’re bringing, but then they’re processing it within their context and then sharing their thoughts around how they think it’s going to work. Then it’s truly a collaborative problem solving process. And you actually get to a good outcome more quickly and I think it has a much more lasting impact.

I would even say that’s not just with the parents and the student. I would even say it’s with the multiple professionals that are on the team, whether it’s the educator, the therapist, the speech therapist or occupational therapist, the principal. I think even doing it inter-professionally is really, really important as well.

Do you see signs of changes of attitudes in schools and society towards people with ASD? Are we getting better?

There’s definitely more awareness and knowledge of ASD. As far as how society interacts with autistic people, I think there are still a lot of preconceived ideas. And there’s still a lot of hesitancy from non-autistic or neuro-typical individuals. So I think we still have a lot of work to do.

What makes this work rewarding for you?

It’s rewarding because I see the faces of the students and the parents. And when they feel that they are fulfilling their lives and I see it on their face or they express it directly to me — that’s what keeps me moving forward.

A lot of my work is collaborating with organizations in the community and helping them do some of those attitudinal and value shifts around disability and ASD in particular, as well as some of the very specific skill and capacity-building within their environment.

So when I see organizations or institutions beginning to fundamentally shift the way that they do business, the way that they communicate, the way that they shape their new initiatives where they are really considering the disabled population in their decision making, that’s another thing that keeps me moving in my work.

And so much of it is just kind of common sense and taking the time to think about it. We’re not talking about radically expensive changes or radical changes in behavior; it’s just being more conscious.