You are on page 1of 16

Effective Educational Practices

for Students with Autism


Spectrum Disorders

Rose Iovannone, Glen Dunlap, Heather Huber,


and Don Kincaid

Students with autism spectrum disorders (ASD) present unique challenges to educators creased prevalence of ASD, growth in
trying to plan effective instructional programs. Although an impressive body of re- litigation concerning appropriate inter-
search identifying effective practices has emerged, there have been minimal attempts ventions, a massive amount of literature
to integrate the findings into a curricular foundation to be adopted by school districts. regarding treatments, and a lack of guid-
This article provides a description of 6 core elements that have empirical support and ance in determining which treatments
should be included in any sound, comprehensive instructional program for students
are appropriate for individual children.
with ASD. These core elements are (a) individualized supports and services for students
Recent epidemiological studies have
and families, (b) systematic instruction, (c) comprehensible/structured learning environ-
ments, (d) specialized curriculum content, (e) functional approach to problem behavior, reported that the prevalence of ASD has
and (f ) family involvement. This article provides illustrations of the core elements in the increased from 4 to 5 cases per 10,000
form of specific instructional practices that have been demonstrated to be effective individuals in the 1960s (Lotter, 1966)
with students with ASD. to 5 to 31 cases per 10,000 individuals in
the 1990s (Nordin & Gillberg, 1996;
Webb, Lobo, Hervas, Scourfield, &
Fraser, 1997). Specific geographic re-

I
t has been more than half a century agnosed before 3 years of age and per- gions have been the focus of prevalence
since Kanner (1943) first described sisting through adulthood, with no iden- investigations. The Centers for Disease
autism after observing a group of 11 tified etiology or cure. The deficits dis- Control and Prevention (CDC) recently
children displaying deficits in communi- played by individuals having ASD affect reported that in Brick Township, New
cation skills and interpersonal relation- the most vital aspects of quality of life, in- Jersey, 40 out of 10,000 children ages
ships. Today, despite the efforts of nu- cluding interacting with other people, 3 to 10 years have autism (CDC, 2000).
merous researchers, autism remains a communicating ideas and feelings, and The California Department of Develop-
unique and perplexing disability. The Di- understanding what others feel or think mental Services reported that the num-
agnostic and Statistical Manual of Men- (National Research Council, 2001). ber of individuals receiving services for
tal DisordersFourth Edition (DSM-IV; Although the last decade has seen an autism increased by 273% from 1987 to
American Psychiatric Association, 1994) expansion in our knowledge of effec- 1998 (CDC, 2001). A recent population-
defines autism as a pervasive develop- tive instructional practices for students based study of trends in autism preva-
mental disorder marked by social and with ASD, controversy exists among re- lence of successive cohorts of children
communication impairments along with searchers, program developers, educa- born between 1987 and 1994 in Califor-
a restricted repertoire of activities and in- tors, parents, attorneys, advocates, and nia reported a prevalence rate of 11.0 per
terests. Autism, however, is not a single the media regarding the appropriateness 10,000 (Croen, Grether, Hoogstrate, &
condition; rather, it is a spectrum disor- of specific strategies (e.g., Gresham, Selvin, 2002). Relatedly, state educa-
der that results in individuals presenting Beebe-Frankenberger, & MacMillan, tional departments have reported a rise in
with a wide range of abilities and disabil- 1999; Heflin & Simpson, 1998b; Hurth, the numbers of students with ASD de-
ities (Heflin & Simpson, 1998a). Fur- Shaw, Izeman, Whaley, & Rogers, 1999). manding autism-specific services (Hurth
thermore, autism spectrum disorder Multiple factors have contributed to the et al., 1999; National Research Council,
(ASD) is a lifelong disorder, usually di- current contentiousness, including an in- 2001), with some states (e.g., California,
FOCUS ON AUTISM AND OTHER DEVELOPMENTAL DISABILITIES
VOLUME 18, NUMBER 3, FALL 2003
PAGES 150165
VOLUME 18, NUMBER 3, FALL 2003
151

Florida, Illinois) reporting an epidemic there has not been an integration of the tional strategies that have been empiri-
growth (Feinberg & Vacca, 2000). Vari- existing research to facilitate decision- cally documented as being successful for
ability in reported prevalence rates has making policies at the state, district, or individuals with ASD will be presented
been explained by differences in criteria campus levels (National Research Coun- within the discussion of core compo-
used to define autism cases, strategies to cil, 2001). A confounding factor is the nents. As it is impossible within a single
obtain data, or population demographic inconsistency of service delivery and in- article to comprehensively review all
characteristics (Croen et al., 2002). A tervention practices across states, school studies of interventions for students with
rate of 7.5 cases of autism per 10,000 in- systems, and individual schools within ASD, we are presenting a selective review
dividuals has been suggested as a sum- the systems. A large part of the confusion of recent studies (between 1992 and
mary figure representing the results of exists because the research on interven- 2002) whose research questions at-
multiple studies conducted since 1987 tions conducted thus far has failed to tempted to address one or more of the
(Fombonne, 1999). identify one practice that is equally ap- essential core components.
Related to the increase in the number propriate or effective for all children with
of students with ASD in the school sys- ASD (Pelios & Lurd, 2001; Prizant &
tems, there has been a significant increase Rubin, 1999). Furthermore, researchers Review of Recent Reports
in the number of contested Individual- have not identified one approach that is
ized Education Programs (IEPs; Heflin better than all other approaches; rather, Several authors and expert groups have
& Simpson, 1998b; Hurth et al., 1999). there is documented support for a range provided comprehensive reviews for the
Districts report IEP meetings that last of practices (Prizant & Rubin, 1999; purpose of identifying effective practices
multiple days, often ending up in due Rogers, 1999). Although intervention for individuals with ASD. Table 1 pro-
process, with parents questioning the studies present improvement in specific vides a comparison of the essential com-
methodology used in the school settings students, there does not yet appear to be ponents identified in the separate re-
or requesting a specific treatment (Heflin a clear, definitive relation between par- ports.
& Simpson, 1998b; Hurth et al., 1999; ticular strategies and a childs progress Powers (1992) provided one of the
Yell & Drasgow, 2000). Between the (National Research Council, 2001). In first sets of core components of effective
years of 1993 and 1998, there were 45 addition, there is no evidentiary support instructional practices for students with
published due process hearings and court to indicate that interventions focusing on autism. He based his review on examin-
cases related to parents of children with one aspect of autism (e.g., sensory def- ing practices of various early intervention
ASD challenging school methodology icits) result in concurrent improvements programs, and he concluded that there
(Yell & Drasgow, 2000). Baird (1999) in other areas of deficit (e.g., social inter- were no data available to conclude that
stated that the area of contested method- action; Rogers, 1999). one program was effective for all. How-
ology for students with ASD is the fastest Fortunately, recent reports have iden- ever, he did identify a set of best practices
growing area of litigation in special edu- tified essential components of effective that should be included in programs for
cation. programs for individuals with ASD. Al- students with autism. These identified
The literature regarding interventions though the primary focus of the recent components included structured treat-
and programs for ASD has exploded in reviews has been on effective practices for ment using principles of applied behavior
the last 10 to 20 years (Heflin & Simp- early intervention programs (age range analysis (ABA); parent involvement in
son, 1998a). The literature, however, is a 08 years), they originated from re- the school, community, and home; early
mix of science, anecdotal reports, and spected scholars and groups within the intervention; intensive treatment; pro-
unproven theories (Olley, 1999, p. 595), field of autism and their existence helps gramming for generalization; specified
with many reports being made public guide educators in making sound deci- curricula emphasizing social and com-
through various media, such as maga- sions regarding the use of educational munication skills; and integration with
zines (e.g., Time, Newsweek), television practices for students of all age ranges. typical peers when possible.
programs (e.g., Dateline, 20/20), and a The purpose of this article is to present a Dawson and Osterling (1997) re-
huge variety of Internet sites (Dunlap & set of effective core components that viewed the literature on practices of na-
Fox, 2002; Feinberg & Vacca, 2000). should be considered and included in any tionally known, well-established, and
Presented with an array of treatment op- educational program for students of all well-respected models of early interven-
tions, parents and professionals are left ages with ASD. First, a review of the re- tion programs and identified several key
with minimal guidelines to determine cent reports on the shared components elements that were common to all pro-
which approaches are fringe therapy of effective programs for students with grams reviewed. These elements in-
and which are empirically supported and ASD will be presented. Second, the core cluded specific curriculum content focus-
efficacious (Dunlap, 1999; Olley, 1999). components essential for sound educa- ing on core deficits of autism; highly
Although there has been a substantial tional program practices for students supportive and structured teaching envi-
body of sound research on educational with ASD of all ages will be suggested. In ronment; predictability and routine;
interventions for children with ASD, addition, examples of specific instruc- functional approach to problem behav-
FOCUS ON AUTISM AND OTHER DEVELOPMENTAL DISABILITIES
152

TABLE 1
Comparison of Commonality Studies
Study/ Powers Dawson & Osterling Hurth et al. National Research Council
component (1992) (1997) (1999) (2001)

Supportive and structured learning


environments X X X
Family involvement X X X X
Early intervention X X X
Specialized curricula focusing on
communication and social interaction X X X X
Integration with typical peers X
Predictability and routine X
Functional approach to problem
behaviors X X
Planned transitions between
preschool and kindergarten/
first grade X
Individualization of supports and
services X X
Systematic, carefully planned
instruction X X
Intensity of engagement X X
Deveopmentally appropriate
practices X

iors; planned transitions between pre- Most recently, the National Research social instruction, cognitive development,
school and kindergarten/first grade; and Council (2001) formed a committee of play skills, and proactive approaches to
family involvement. renowned experts to examine research behavior challenges.
The National Early Childhood Tech- related to autism and present an orga- In reviewing the four reports, we dis-
nical Assistance System (NECTAS), nized and synthesized format of the mul- covered the following two noteworthy
funded through a cooperative agreement titude of scientific findings and un- issues:
with the Office of Special Education Pro- knowns in the field of early education of
grams (OSEP) and the U.S. Department children with autism. They specifically 1. The effective characteristics
of Education, examined seven effective reviewed practices and programs de- identified focused on broad practices
programs for young children with ASD signed for children 8 years of age and rather than specific treatments or
and synthesized the information by de- younger and presented a framework for strategies.
scribing the areas of agreement across the evaluation of programs and practices. 2. There are definitive areas of
programs (Hurth et al., 1999). Six areas Similar to the previous summary reports, agreement, or commonalities,
of agreement were identified as common a consensus of the characteristics of ef- among the reports.
to all programs reviewed: earliest possible fective interventions used in programs
start to intervention; individualization of for children with ASD was determined.
services for children and families; system- These characteristics were early entry Integration of Core
atic, carefully planned teaching; special- into intervention programs, active en- Components From
ized curriculum; intensity of engage- gagement in intensive instructional pro- Published Reports
ment; and family involvement. Three gramming, use of planned teaching op-
additional elements were presented as portunities, sufficient amount of adult The major reviews discussed in the pre-
common to some, but not all, programs: attention to meet individualized goals, vious section have focused on essential
structured environment, developmen- and active family involvement. Accompa- features of early intervention programs.
tally appropriate practices, and interven- nying the characteristics were the follow- To date, there has not been a similar con-
tion in settings with typical children or in ing priority areas for instructional focus: certed effort by authors to identify core
natural environments. functional spontaneous communication, components shared by effective educa-
VOLUME 18, NUMBER 3, FALL 2003
153

tional programs for older students (i.e., tive educational program for students ports, services, and placements to stu-
elementary through secondary) with with ASD: dents, ranging from inclusion in general
ASD, though there have been earlier at- education with varying levels of supports
tempts to identify guidelines for educa- 1. individualized supports and services to extremely specific services and in-
tional efforts (Dunlap & Robbins, 1991; for students and families, struction in specialized settings. The de-
Olley & Rosenthal, 1985). More re- 2. systematic instruction, termination of the appropriate levels of
cently, Heflin and Simpson (1998a) pro- 3. comprehensible and/or structured supports and services to be provided to
vided a critique of several established environments, each student with ASD is the foundation
programs (e.g., Project TEACCH, 4. specialized curriculum content, of the IEP. Within this framework,
UCLA Young Autism Project) and strat- 5. a functional approach to problem choices regarding curriculum emphasis
egies (e.g., social stories, visual sched- behaviors, and will be made. For some students with
ules). In a follow-up article, the authors 6. family involvement. ASD, the general education curriculum
offered guidelines for school districts with minimal or moderate modifications
to use when choosing specific interven- Embedded within our discussion of core and adaptations will be appropriate,
tions for students with ASD (Heflin & components, we will review a number of whereas others may need major adapta-
Simpson, 1998b). Gresham, Beebe- studies that used a range of strategies tions (e.g., a more functional academic
Frankenberger, and MacMillan (1999), with students of all ages having ASD and approach). Therefore, no one program,
using Dawson and Osterlings (1997) that documented effectiveness in provid- support, or service (e.g., self-contained
common elements as an evaluative guide, ing one or more of the core components, class for autism) is likely to meet the
conducted a comparative review of sev- with the understanding that specific needs of the population as a whole. In-
eral comprehensive treatment programs strategies can concurrently address more stead, schools should provide flexible
for children with autism (e.g., Project than one component. Table 2 provides a placement and support options to meet
TEACCH, UCLA Young Autism Proj- list of a representative sample of studies each students individualized goals (Dun-
ect, Learning Experiences . . . An Alter- using specific strategies. Criteria used to lap & Fox, 2002).
native Program [LEAP]). Gresham et al. determine inclusion of a study in Table 2 Although there is not one distinct ap-
suggested that these elements were ap- were (a) including individuals with proach that is effective for all students
propriate for all school systems and autism who were at least 5 years of age, with ASD, some approaches benefit indi-
should be provided in educational pro- (b) having been published within the last vidual children and families more than
grams for all children with autism. 10 years (19922002), and (c) the inter- others. A critical key to success is for
Although the majority of the previous vention having been demonstrated to be school personnel to find ways to match
reviews focused on programs targeting effective. specific practices, supports, and services
young children (8 years of age and with each students unique profile and
younger), we believe that the areas iden- the individual familys characteristics
tified are consistent with effective prac- (Dunlap, 1999). Individualized supports
Individualized Supports
tices for children of any age with ASD. and services include the following:
and Services
Although less information is available re-
garding the application of these practices 1. considering family preferences when
with school-age children, there is no rea- There is consensus among well-respected determining the goals to be taught
son to believe that these broad core com- scholars in the field of autism that there and the methods by which instruc-
ponents would not apply to an older is no empirical basis for recommending tion will be delivered,
child. Of course, implementation of any one approach or endorsing a single pro- 2. incorporating the childs preferences
component may vary in its form or level gram as being superior for all individuals and special interests into the instruc-
of intensity depending on the individual with ASD (Dunlap & Fox, 2002; Heflin tional program (Hurth et al., 1999),
students needs and characteristics, in- & Simpson, 1998a). Students with ASD and
cluding age. With that in mind, we will are heterogeneous in their presentation 3. focusing on the childs strengths and
attempt to identify and describe those of behaviors and in their unique prefer- weaknesses to determine the most
core components that are agreed upon ences, interests, and learning styles re- appropriate intensity and level of
by most of the summary reports and ap- quiring individualized instructional sup- instruction to meet the childs indi-
pear to be appropriate for all instruc- port needs (Dunlap & Fox, 2002; vidual goals (National Research
tional age levels. Using Table 1 as our Dunlap & Robbins, 1991). Educational Council, 2001).
guide for synthesizing the core elements personnel are required, through the In-
identified by each summary report, we dividuals with Disabilities Education Act Procedures used should take on the char-
have recognized six essential themes or (IDEA) Amendments of 1997, to pro- acteristic of being custom designed for
components to be included in an effec- vide a continuum of individualized sup- each child, allowing for individual ad-
154

TABLE 2
Overview of Studies Using Interventions Implementing Core Components with Children with Autism
Core component Study Na Age Target behavior Intervention

Individualized supports Baker, Koegel, & 3 57 Increase social engage- Functional use of chil-
and services Koegel (1999) ment with peers drens unique obses-
sive behaviors as play
themes

Bryan & Gast (2000) 4 79 Increase engagement in Picture activity sched-


tasks and schedules ules and graduated
guidance

Gena & Kymissis 3 5 Develop individualized Individualized assess-


(2001) plans to increase en- ments of levels of
gagement and behaviors and
support inclusion in targeted instruction
general education for specific needs
kindergarten

Heckaman, Alber, 4 69 Decreasing rates of dis- Task interspersal


Hooper, & ruptive behavior and (difficult/easy); least-
Heward (1998) increasing engage- to-most prompting;
ment in instruction progressive time
delay

L. K. Koegel, Cama- 1 5 Self-initiation of Motivational procedures


rata, Valdez- question-asking and (incorporation of pre-
Menchaca, & generalization ferred items, natural
Koegel (1998) reinforcers)

MacDuff, Krantz, & 4 914 Increase engagement Photographic activity


McClannahan and on-schedule be- schedules and gradu-
(1993) haviors ated guidance

Systematic instruction Callahan & 1 8 Increase on-task behav- Self-management


Rademacher iors and school per-
(1999) formance

Eikeseth, Smith, 25 47 Increase discrete behav- Intensive discrete trial


Jahr, & Eldevik iors (language, social training compared to
(2002) behaviors, motor eclectic treatment
skills, etc.) based on Dawson &
Osterlings compo-
nents

Mancina, Tankersley, 1 12 Reduction of inappropri- Self-management


Kamps, Kravits, & ate vocalizations and
Parrett (2000) increasing engage-
ment and indepen-
dence

Morse & Schuster 3 6 (two) & 9 (one) Increase acquisition, Combination of in vivo
(2000) generalization, and training, constant
maintenance of gro- time delay, and picto-
cery shopping skills rial storyboard simula-
tion

Comprehensible Dettmer, Simpson, 2 5&7 Facilitating transitions Visual schedules, sub-


(structured) Myles, & Ganz between activities schedules, finished
environment (2000) boxes, and timers

(table continues)
155

(Table 2 continued)

Core component Study Na Age Target behavior Intervention

Pierce & Schreib- 3 69 Increase acquisition of Pictorial


man (1994) daily living skills self-management
system

Schreibman, 3 36 Decrease disruptive be- Video priming


Whalen, & Stah- havior during
mer (2000) transitions

Specialized curriculum: Buffington, Krantz, 4 46 Acquisition, generaliza- Modeling, prompting,


Communication McClannahan, & tion, and maintenance reinforcement
Poulson (1998) of functional commu-
nicative gestures in
combination with
verbal language

Dyches (1998) 4 1012 Effects of switch training Least-to-most prompts


on functional
communication

Jahr (2001) 5 37 Transfer and mainte- Multiple exemplar


nance of wh- discrete trial
questionanswering
skills

Sarokoff, Taylor, & 2 89 Increase conversational Script-fading with em-


Poulson (2001) exchanges bedded textual cue as
stimulus

Scherer et al. (2001) 5 411 Increase responses to Video-modeling (others


conversation and self )
questions

Schwartz, Garfinkle, Study 1: 16 36 Study 1: Rate of acquisi- PECS


& Bauer (1998) Study 2: 11 tion of PECS
Study 2: Increase in
functional communi-
cation

Thiemann & Gold- 5 611 Acquisition and general- Social stories, pictorial
stein (2001) ization of social com- cues, written social
munication skills phrases

Specialized curriculum: Kamps, Leonard, 3 7 Increase social initia- Peer mediation and
Social skills Vernon, Dugan, & tions, responses, and monitoring
Delquadri (1992) exchanges

Kamps et al. (2002) 5 39 Increase social participa- Peer mediation


tion with peers

Laushey & Heflin 2 5 Increase social interac- Peer mediation (peer tu-
(2000) tion skills tors)

Morrison, Kamps, 4 1113 Improve social initiations Peer mediation and


Garcia, & Parker and social interactions monitoring (peer and
(2001) self)

Norris & Dattilo 1 8 Increase social behaviors Social story


(1999)

(table continues)
156

(Table 2 continued)

Core component Study Na Age Target behavior Intervention

Pierce & Schreib- 2 78 Increase social behaviors Peer mediation (pivotal


man (1997) response training)

Stahmer & Schreib- 3 712 Increase appropriate Self-management


man (1992) play with toy skills package

Zercher, Hunt, 2 6 Increase joint attention, Peer-supported


Schuler, & Web- play, and language integrated play
ster (2001) groups

Functional approach to Chandler, Dahlquist, 12 36 Decrease challenging School team-based func-


problem behavior Repp, & Feltz behaviors and in- tional behavior as-
(1999) crease appropriate sessment
behaviors

Durand (1999) 2 911 Decrease challenging Functional behavior as-


behaviors and in- sessment and func-
crease communicative tional communication
behaviors training

Graff, Lineman, 1 6 Decrease challenging Functional analysis,


Libby, & Ahearn behavior differential reinforce-
(1999) ment and consequen-
tial strategies

Hagopian, Wilson, & 6 6 Decrease challenging Functional analysis, func-


Wilder (2001) behavior and increase tional communication
communicative behav- training
iors

Kuttler, Myles, & 1 12 Reduction in challenging Functional behavior as-


Carlson (1998) behavior sessment and social
stories

Mueller, Wilczynski, 1 8 Reduction in challenging Functional analysis and


& Moore (2001) behavior antecedent manipula-
tions

ONeill & 2 6 & 15 Decrease challenging Functional communica-


Sweetland-Baker behavior and increase tion training
(2001) appropriate behavior

Patel, Carr, Kim, 1 10 Decrease challenging Functional behavior as-


Robles, & behavior sessment, DR0
Eastridge (2000)

Family involvement Frea & Hepburn 2 4 Decrease challenging Parent training of func-
(1999) behavior and increase tional behavior as-
appropriate behavior sessment

Koegel, Bimbela, & 17 M=6 Effects of different par- Parent training: Pivotal
Schreibman ent training interven- response training
(1996) tions on parent inter- compared with dis-
action styles crete trial training

Lorimer, Simpson, 1 5 Prevention of challeng- Social stories as an-


Myles, & Ganz ing behavior tecedent intervention
(2002) in home setting

Note. PECS = Picture Exchange Communication System (Frost & Bondy, 1994). DR0 = differential reinforcement of zero rates of responding.
aNumber of children in study 5 years or older with an autism spectrum disorder.
VOLUME 18, NUMBER 3, FALL 2003
157

justments within the package that meet can include one-to-one discrete trials as tional activities for four elementary stu-
each childs unique skills and needs well as more naturalistic instructional tech- dents with autism (Heckaman, Alber,
(Hurth et al., 1999; National Research niques. Hooper, & Heward, 1998).
Council, 2001). Pivotal response training (PRT), a nat- The other representative studies in
A key aspect of individualization for uralistic teaching approach, has received Table 2 used various strategies based on
students with ASD involves approaches increasing attention as a method to pro- individualized characteristics of the tar-
for supporting high rates of engagement. mote motivation and engagement (L. K. get child to increase engagement. Incor-
Engagement, the amount of time that Koegel, Harrower, & Koegel, 1999; porating a childs idiosyncratic interests
the student is attending to and actively R. L. Koegel, Koegel, & Carter, 1999; into instructional activities has proven to
interacting in his or her social and nonso- Pierce & Schreibman, 1997). PRT ap- be an effective method to enhance en-
cial environments (Dunlap, 1999; Hurth proaches include following the childs gagement in activities. Baker, Koegel,
et al., 1999), has been cited as one of the lead, using preferred items or activities, and Koegel (1999) incorporated a childs
best predictors of positive student out- teaching within natural contexts, and us- perseverative interests in maps into so-
comes (Logan, Bakeman, & Keefe, ing natural reinforcers rather than artifi- cially appropriate games to increase the
1997; Rogers, 1999). When a child is en- cial or arbitrary reinforcers. Whereas in- childs willingness to socially interact
gaged, connections and interactions are cidental teaching and other naturalistic with others in the environment during
occurring. Conversely, when the child is procedures focus on teaching specific tar- social study activities. MacDuff, Krantz,
not engaged, he or she is not available for get behaviors (McGee, Krantz, & Mc- and McClannahan (1993) and Bryan and
learning (Hurth et al., 1999). Difficulty Clannahan, 1985), PRT focuses on the Gast (2000) used picture activity sched-
in motivating students with ASD to en- acquisition of behaviors that are crucial ules designed for individual students and
gage with or respond to their environ- to wide areas of functioning so that a prompting strategies to increase on-task
ment, a key diagnostic marker, has been change in the pivotal behavior will result and on-schedule behaviors. The develop-
well documented in the literature (Dun- in the acquisition of a variety of other be- ment of specific educational plans based
lap & Robbins, 1991; R. L. Koegel & haviors (R. L. Koegel et al., 1999). Mo- on the unique learning characteristics of
Mentis, 1985; Olley & Reeve, 1997; tivation, self-initiation, and responding students with autism resulted in their in-
Simpson & Myles, 1998). Students with to multiple cues are examples of pivotal creased engagement in an inclusive
ASD have difficulty attending to and in- behaviors. Providing choices, varying kindergarten setting (Gena & Kymissis,
teracting during events occurring in their tasks, interspersing tasks, reinforcing all 2001).
settings and thus lose out on crucial attempts (even if incorrect), and using In summary, considering a childs
learning opportunities (Dunlap, 1999). natural reinforcers are methods used unique preferences, needs, and learning
Engagement of students with ASD will within PRT to increase students respon- characteristics, along with the familys
be unlikely unless there is some deliber- siveness to social and environmental preferences, is a component that has
ate design, such as carefully planning stimuli and thus increase their engage- demonstrated effectiveness through nu-
changes to the physical environment, sys- ment and motivation (R. L. Koegel & merous investigations. Optimal progress
tematically using materials and/or activ- Egel, 1979; R L. Koegel et al., 1999). of a student with ASD is dependent on
ities, incorporating preferred materials and Several studies in Table 2 used PRT the extent to which assessments of the
activities, and capitalizing on a students strategies to increase active engagement childs abilities and the selection of inter-
spontaneous interests and initiations of children with autism. The use of pre- ventions are individualized.
(Hurth et al., 1999). The calculated ferred objects and natural reinforcers to
methods selected to ensure the engage- increase the motivation of three children
ment of individual students should be to (a) self-initiate questions to others and Systematic Instruction
guided by the students unique prefer- (b) generalize the use of spontaneous
ences and characteristics. Engaged time questions about novel objects to other The second component that scholars
can be provided at different levels of in- people and within new environments was have agreed is critical is providing sys-
tensity and in a wide variety of settings investigated by L. K. Koegel, Camarata, tematic instruction. Systematic instruc-
using a range of strategies based on stu- Valdez-Menchaca, and Koegel (1998). tion involves carefully planning for in-
dents individual needs and characteris- Other PRT strategies to increase motiva- struction by identifying valid educational
tics. For example, engagement can occur tion in children with autism include vary- goals, carefully outlining instructional
in various settings, including (a) one-to- ing the presentation of tasks and inter- procedures for teaching, implementing
one instruction with an adult, (b) inde- spersing maintenance tasks so that the instructional procedures, evaluating
pendent work time with specific planned children with autism experience success the effectiveness of the teaching proce-
activities and materials, (c) group instruc- in the activity. The strategy of interspers- dures, and adjusting instruction based on
tion spent with a peer tutor or an adult, ing easy and difficult tasks was used to data (Hurth et al., 1999; Westling &
and (d) general instruction that occurs decrease problem behaviors and increase Fox, 2000). Having systematic, mean-
throughout a students day. Strategies participation in and responses to instruc- ingful data collection for making instruc-
FOCUS ON AUTISM AND OTHER DEVELOPMENTAL DISABILITIES
158

tional decisions has been identified as a adaptive skills. Morse and Schuster (2000) doing. If the observer is unclear about
major factor in schools winning due pro- used a combination of in vivo training in- what is happening for each student, it
cess cases related to disagreement about cluding constant time delay and visual stands to reason that the students may
methodologies (Yell & Drasgow, 2000). icons to teach students to shop for gro- also be uncertain (Olley & Reeve, 1997).
Individuals with ASD have demonstrated ceries. Callahan and Rademacher (1999) A comprehensible classroom for students
significant progress in attainment of used self-management procedures to in- with ASD is one that is arranged in such
competencies when programs use in- crease the independent academic behav- a way as to elicit, facilitate, enhance, or
structional approaches that are both ior of a high-functioning second-grade support the acquisition of specific skills
comprehensive and systematic (Heflin & student with autism in a general educa- such as language acquisition, appropriate
Alberto, 2001; Simpson, 2001). System- tion setting. When self-management pro- behavior, social interactions, and tar-
atic instruction also provides a structured cedures were implemented, there were geted academic goals (Earles, Carlson, &
teaching plan for generalization and significant increases in on-task behavior, Bock, 1998; Hurth et al., 1999). A com-
maintenance of learned skills. Another as well as increases in independent aca- prehensible environment allows a stu-
critical feature of systematic instruction is demic and behavior functioning. An ad- dent with ASD (and others) to (a) pre-
planning for high levels of engagement. ditional study using self-management dict what is currently happening within
Strategies using applied behavior anal- procedures resulted in the reduction of the learning process and what will hap-
ysis (ABA) have been documented to be inappropriate vocalizations and increases pen next, (b) anticipate requirements of
effective in systematically teaching target in the on-task behavior of a 12-year-old specific settings, and (c) learn and gener-
behaviors. It is important for educators girl with autism and moderate mental re- alize a variety of skills (Earles et al., 1998;
and families to keep in mind that ABA tardation (Mancina, Tankersley, Kamps, Gresham et al., 1999; Volmer, 1997).
is not a specific program, procedure, or Kravits, & Parrett, 2000). Thus, self- Examples of strategies that assist in struc-
technique; it involves methods and prin- management procedures can be used turing the environment include visual
ciples that are applied in diverse ways with children with diverse functioning cues or supports that
(Dunlap, 1999, p. 224). Within these levels.
various formats, specific instructional In summary, systematic, well-planned 1. organize the instructional setting
procedures (e.g., prompt delivery, shap- instruction is an essential component of (Heflin & Alberto, 2001);
ing, fading) are provided at a level and all classrooms including students with 2. provide a schedule of activities
intensity that fits the context and the ASD. By carefully targeting meaningful (Rogers, 1999; Simpson & Myles,
unique characteristics of the student skills to be taught, planning specifically 1998);
(Harrower & Dunlap, 2001). Strategies when and how to provide instruction 3. carefully plan and provide choice-
based on ABA principles include intense based on the unique characteristics of the making opportunities (Dalrymple,
structured approaches (e.g., discrete trial specified student, determining data- 1995);
training), naturalistic approaches (e.g., collection methods to gauge student 4. provide behavioral support (Earles
incidental teaching, pivotal response progress and instructional effectiveness, et al., 1998);
training), and self-management proce- and using data to make sound instruc- 5. define specific areas of the classroom
dures. See Table 2 for a list of studies that tional decisions, educational personnel and school settings (Heflin &
use strategies based on ABA principles to should have effective and defensible pro- Alberto, 2001; Volmer, 1997);
improve the rate of acquisition of novel grams. 6. provide temporal relations, (Earles
skills and to maintain and generalize et al., 1998; Heflin & Alberto,
learned skills. 2001); and
The representative studies (listed Comprehensible/Structured 7. facilitate transitions, flexibility, and
under systematic instruction) in Table 2 Learning Environments change (Simpson & Myles, 1998).
use a variety of methods based on ABA
principles (e.g., discrete trial training, in Although students with ASD often need Although environmental supports ap-
viro training, self-management) to in- classrooms that are structured, the term pear to have widespread use, research ex-
crease acquisition, maintenance, and structure is not consistently defined amining the effects of using specific
generalization of skills in children with (Olley & Reeve, 1997). A program is strategies is sparse. The studies presented
ASD. An evaluation of the effect of 1 year considered structured when the curricu- in Table 2 focus on using temporal sup-
of school-based intensive discrete trial lum (activities, schedule, environment) is ports, such as visual schedules, to orga-
training procedures on a group of chil- clear (i.e., comprehensible) to both the nize sequences of time for students and
dren with autism was conducted by Eike- students and the educational personnel. using spatial supports, such as priming,
seth, Smith, Jahr, and Eldevik (2002). A good test of determining whether an to provide and preview specific informa-
Results indicated that the children made environment is comprehensible is to ob- tion regarding the organization of a new
gains on standardized measures of func- serve the students for 10 minutes and environment and activities that will occur
tioning assessing cognition, language, and identify what each one is supposed to be in the setting. Dettmer, Simpson, Myles,
VOLUME 18, NUMBER 3, FALL 2003
159

and Ganz (2000) used both visual sched- ley, 1999). Curriculum content and the ticularly for those children who do not
ules of daily activities and subschedules instructional methods to teach it should acquire functional speech or have diffi-
(e.g., task analysis of sequential steps of be based on an individualized assessment culty comprehending language (National
broad activities) to facilitate transitions of students and should consider the fam- Research Council, 2001). There is lim-
between activities by reducing latency ilys preference for targeting goals (Olley, ited research, however, providing clear
time for two boys with autism. The au- 1999). In addition, educators should guidelines for matching characteristics of
thors concluded that the visual supports consider the functionality of the skills children and elements of AAC and/or
significantly reduced the latency time of targeted within the curriculum. Focus AT that may produce effective outcomes.
transitioning for both boys, and concur- should be on those skills that (a) are most The studies reviewed in Table 2 explored
rent increases were observed in commu- likely to be useful in the students life to picture communication systems and vo-
nication and independent behaviors. control his or her environment, (b) will cal output communication devices (e.g.,
Video priming is a practice that pre- increase the students independence and switches, Cheap Talk).
views information or activities that usu- quality of life, and (c) will increase the Schwartz, Garfinkle, and Bauer (1998)
ally trigger problem behaviors with the students competent performance (Dun- used the Picture Exchange Communica-
child before he or she actually becomes lap & Robbins, 1991). A good test of the tion System (PECS; Frost & Bondy,
involved in the activity (Harrower & functionality of a skill is to ask whether 1994) to evaluate young childrens rate
Dunlap, 2001). Priming allows the child the result of not learning a specific be- of using the system and to examine the
to predict what will happen during the havior will require another person to per- systems ability to facilitate acquisition of
upcoming activity. Schreibman, Whalen, form the task for the student. For exam- increased functional communication. All
and Stahmer (2002) used a video prim- ple, a goal for all students with ASD children participating in the study
ing intervention to reduce disruptive should be to communicate effectively, learned to use PECS within 3 to 28
transition behavior in three children with even if the form or structure of com- months (M = 14 months). Furthermore,
autism. They noted that the reduction of munication is nontraditional (i.e., non- increases in functional communication
problem behaviors generalized to un- verbal; Olley & Rosenthal, 1985). If a for the purposes of commenting and re-
trained transitions and were maintained student does not learn a method of com- sponding were found across all settings.
after the study ended. munication, another person will always A combination of visual cues, including
Comprehensible learning environ- need to be present to assist the student pictures and texts, was used to teach so-
ments provide students with ASD with a with communication efforts. cial communication skills (Thiemann &
way to make sense of what is happening Table 2 lists several studies focusing on Goldstein, 2001). Scherer et al. (2001)
in their environment, enhance instruc- acquisition of either language abilities used the medium of video recordings of
tion of their targeted skills, and build or social interaction skills. A review of peers and target students as a visual sys-
their competencies (e.g., independence, the studies focusing on improving lan- tem to increase responses to questions.
communication). Depending on the guage abilities included using strategies Dyches (1998) explored training upper
unique characteristics of individual stu- based on ABA principles and using elementary school-age students with
dents, environmental supports can range augmentative/assistive technology strat- autism to use a switch that triggered
from minimal (e.g., written schedule in egies (e.g., picture communication sys- recorded requests and statements (e.g.,
student planner, review of homework at tems, switches, and voice output devices). I want a drink, Im thirsty) to in-
the end of the day) to substantial (e.g., Discrete trials were the intervention of crease spontaneous communication in-
labels, boundaries defined, subsched- choice for Buffington, Krantz, McClan- teractions within a natural context. A
ules). nahan, and Poulson (1998), who taught concurrent increase in one students use
four children with autism to use gestures of verbalizations also resulted. Schepis,
with oral communication. Jahr (2001) Reid, Behrmann, and Sutton (1998)
Specific Curriculum Content used multiple exemplars in discrete trials taught four preschool children with au-
to train five children diagnosed with tism to use voice output communication
The core deficits in individuals with ASD autism to answer wh-questions and to aids (VOCAs) with line-drawing graph-
are in the areas of communication and generalize across novel questions and ics to make requests and social com-
social interaction. Children with autism novel people. Sarokoff, Taylor, and Poul- ments.
display difficulties in the development of son (2001) used fading procedures with The studies that addressed social inter-
social reciprocity and communication embedded textual cues to increase the action vary in the specific method used.
skills. Specialized curriculum should in- number of students conversational ex- Techniques included using naturalistic
clude systematic instruction in social en- changes. teaching procedures (i.e., incidental teach-
gagement skills, including initiating and Augmentative communication (AAC) ing, pivotal response training), social sto-
responding to social bids, appropriate and assistive technology (AT) have been ries, visual supports, self-management
recreational or leisure skills, and language identified as viable emerging compo- packages, and peer supports. Many of the
comprehension and communication (Ol- nents of an instructional program, par- articles in Table 2 use some form of peer-
FOCUS ON AUTISM AND OTHER DEVELOPMENTAL DISABILITIES
160

mediated strategy involving recruiting gaged in the activity. Although widely lum content that targets communication
and training peers to increase appropriate used, most of the effectiveness of Social and social interaction skills. A crucial
social interactions of students with ASD. Stories has been anecdotal and informal guideline for determining specific cur-
It is interesting to note that studies using in nature. Norris and Dattilo (1999) riculum content is to prioritize teaching
peer-mediated practices are becoming in- used a social story intervention to de- skills within the domains of communi-
creasingly sophisticated, with some stud- crease the inappropriate social behaviors cation and social interaction that the
ies including the training of typical peers of an 8-year-old girl with autism during student will use outside of the school en-
to use instructional methods such as piv- lunchtime. Inappropriate behaviors started vironment and in adult life. Communi-
otal response training (Pierce & Schreib- to decrease on the 5th day of the inter- cation and social skills are the behaviors
man, 1997), incidental teaching (McGee, vention. No significant increase in ap- that provide us with the greatest quality
Almeida, Sulzer-Azaroff, & Feldman, propriate social interactions, however, of life, leading to more control over our
1992), monitoring strategies (Kamps, was noted. The authors concluded that environment. It is essential that an edu-
Leonard, Vernon, Dugan, & Delquadri, using Social Stories with another inter- cational program provide all students
1992; Morrison, Kamps, Garcia, & vention might be more effective than with ASD with the necessary level of ser-
Parker, 2001), and peer tutoring (Kamps using Social Stories as the sole strategy. vices and supports to attain competent
et al., 2002; Laushey & Heflin, 2000). In The Integrated Play Group Model skills in these areas.
Pierce and Schreibmans (1997) study, (Wolfberg, 1995) was used as the pri-
eight typical peers were taught PRT mary intervention for twin boys with
strategies to increase the social interac- autism (Zercher, Hunt, Schuler, & Web- A Functional Approach to
tion skills of two elementary children ster, 2001). The Integrated Play Group Problem Behavior
with autism. The investigators also noted Model uses peer mediation techniques
that both boys generalized their im- and is characterized by the following fea- Problem behaviors of students with au-
proved social interaction behaviors to tures: tism present unique challenges and stres-
untrained peers. McGee et al. (1992) sors to schools and parents. Recent re-
1. natural environments,
taught peer tutors incidental teaching search evidence has suggested that in
2. inclusive settings,
techniques to increase peer interactions. order for educational interventions ad-
3. inviting play spaces and selection of
Even after adult coaching of the typical dressing problem behaviors to be suc-
play materials based on individual
peers was systematically faded, mainte- cessful, positive and proactive behaviors
characteristics and interactive
nance of increased social interactions re- must be considered and developed (Na-
potential,
mained. Kamps et al. (1992) formed and tional Research Council, 2001). That is,
4. play groups consisting of three
trained peers in social skills groups to the childs problem behavior is not
typical peers for every one or two
increase initiations, responses, and ex- merely decreased or eliminated; rather,
peers with disabilities,
changes of students with autism. Typical interventions should focus on replacing
5. guided participation, and
peers were also taught to self-monitor the problem behavior with an appropri-
6. full participation in play (Wolfberg &
their social performance. Morrison et al. ate alternative or replacement behavior
Schuler, 1993).
(2001) studied the effects of combining that results in the same or similar conse-
self-monitoring with peer-mediated strat- Zercher et al. found that the boys with quence.
egies to improve the social interactions of autism had significant increases in play Until the mid-1980s, the primary ap-
four upper elementary students (ages behaviors, along with increases in verbal proach for ameliorating problem behav-
1113 years) with autism. The combina- utterances. iors was using operant behavior modifi-
tion intervention proved effective for in- While peer-mediated strategies have cation procedures that focused on the
creasing requesting, commenting, and proven to be effective, Stahmer and effects of contingencies for increasing de-
sharing behaviors during free-play time. Schreibman (1992) explored the use of a sired behaviors and decreasing undesired
Kamps et al. (2002) and Laushey and self-management package to help stu- behaviors (Carr et al., 2002). Interven-
Heflin (2000) trained peer tutors to in- dents monitor and supervise their own tions emphasized the use of conse-
crease the social participation of students appropriate play skills. The students used quences and were directed toward elimi-
with autism in cooperative learning alarm wristwatches as their cue to evalu- nating the behaviors of concern by
groups. ate whether they had used appropriate reinforcing the absence of the target be-
Social Stories is an intervention devel- play skills during the interval. All children havior, reinforcing other or alternative
oped by Carol Gray (1995) to facilitate exhibited appropriate play skills using behaviors (e.g., differential reinforce-
interpretation of social situations by indi- their self-management systems. Further- ment), or applying punishment (e.g.,
viduals with autism. Social Stories is, in more, the skills generalized to novel set- overcorrection, time-out) after problem
essence, a priming strategy. It previews tings. behaviors occurred.
potentially difficult situations for a stu- In summary, it would benefit educa- In the mid-1980s, researchers began
dent prior to the student becoming en- tional personnel to emphasize curricu- to appreciate the perspective that prob-
VOLUME 18, NUMBER 3, FALL 2003
161

lem behaviors occurred for a purpose and The secondary goal is to make problem skills and a high quality of life. Due to the
that this purpose often involved a com- behavior ineffective, inefficient, and ir- ubiquitous nature of autism and its effect
municative intent. This perspective led to relevant (Carr et al., 1999; L. K. Koegel on the individuals functioning in school,
using functional analysis and functional et al., 1996). home, and the community, schools should
assessment to understand why a childs Although contingency management include parents as active partners in de-
problem behaviors occurred, and this un- approaches are still valid and powerful veloping their childs educational plan
derstanding led to incorporating inter- procedures (with reinforcement tech- (Dunlap & Fox, 2002). Children with
ventions that focused on the establish- niques being a central element of PBS), ASD have shown deficits in their ability
ment of socially valid behaviors that the broader process of PBS has become to generalize behaviors learned in one
could serve the same purpose as the tar- the standard approach to behavior man- setting or with one person or one exem-
geted problem behavior (Carr, 1977; agement and support (Carr et al., 2002). plar to others. A collaborative partner-
Iwata, Dorsey, Slifer, Bauman, & Rich- A great deal of research over the past 15 ship with the family can contribute to the
man, 1982). The concept of functional years has provided compelling evidence effectiveness of interventions and pro-
equivalence was the foundation of new regarding the effectiveness of PBS for ad- gramming, particularly when the strate-
strategies such as functional communica- dressing the problem behaviors of stu- gies are used in multiple environments.
tion training, an instructional strategy dents with ASD (Carr et al., 1999; Furthermore, schools have been man-
that applies the concept of functional Horner et al., 1990; L. K. Koegel et al., dated by IDEA to include parents in the
equivalence to identify communicative re- 1996; National Research Council, IEP process, even more so since the 1997
placement behaviors that solicit the same 2001). reauthorization that strengthened the
reinforcement or function that the previ- Several studies reviewed in Table 2 role of parents in the educational process
ous problem behavior achieved (Carr & used some variation of FBA and func- (Yell & Shriner, 1997). Even with this
Durand, 1985; Carr et al., 1994). tional analysis to identify the purposes of IDEA mandate, however, many school
Positive behavior support (PBS) evolved the childs problem behavior prior to de- districts have lost hearings involving chil-
from the roots of applied behavior analy- signing an intervention including func- dren with autism because they failed to
sis as a new scientific approach that has tional communication training and other obtain parent participation (Yell & Dras-
changed the way problem behavior is PBS strategies (e.g., Chandler, Dahl- gow, 2000). A challenge for educational
viewed, assessed, and addressed. PBS uses quist, Repp, & Feltz, 1999; Durand, personnel is determining how best to in-
functional assessment (also referred to as 1999; Graff, Lineman, Libby, & Ahearn, clude families in the IEP process, given
functional behavioral assessment) to build 1999; Hagopian, Wilson, & Wilder, that each family presents unique circum-
individualized support plans that are de- 2001; Kuttler, Myles, & Carlson, 1998; stances in relation to their time, energy,
rived from an understanding of the pur- Mueller, Wilczynski, & Moore, 2001; and goals.
pose and environmental determinants of ONeill & Sweetland-Baker, 2001; Patel, The studies highlighting family in-
a specified problem behavior. Functional Carr, Kim, Robles, & Eastridge, 2000). volvement in Table 2 include teaching
behavior assessment (FBA) is a process Educators should be using a process such parents to implement the strategies and
for identifying variables that reliably pre- as PBS that will help them understand using family characteristics and context
dict and maintain problem behaviors the purposes of problem behavior and to develop appropriate levels of support.
(Horner & Carr, 1997), using data gath- identify contextual factors that may be Frea and Hepburn (1999) taught two
ered through indirect measures (e.g., triggering behavioral episodes. Interven- families, each having a 4-year-old child
interviews) and direct measures (e.g., tions (e.g., support plans) should be with autism, the functional assessment
observations of antecedents, behaviors, comprehensive and focus on performing process. R. L. Koegel, Bimbela, and
and consequences). Prominent purposes antecedent manipulations and teaching Schreibman (1996) compared two dif-
of problem behaviors are escaping/ replacement behaviors, as opposed to ferent parent-training approaches and
avoiding tasks, people, events, objects, or solely eliminating the problem behavior. their effect on families global style of in-
sensory input and/or obtaining specific teractions during the unstructured home
tasks, people, events, objects, or sensory activities of 17 families lives. Lorimer,
input. Behavior support plans typically Family Involvement Simpson, Myles, and Ganz (2002) used
include multiple positive interventions a social story as an antecedent interven-
that prevent problem behavior from oc- Family members are the most stable, in- tion to prevent problem behaviors in the
curring, provide appropriate replacement fluential, and valuable people in the home setting.
behaviors, and change the way others re- childs environment (Dunlap, 1999). Families are essential partners in edu-
spond to problem and appropriate be- Parents are usually the first to recognize cational planning and delivery of sup-
haviors. The primary goal of PBS is to delays and problems in their childrens ports and services. Education practices
enhance the individuals quality of life by development. They actively seek diag- and strategies have a better chance of
expanding his or her existing behaviors noses and interventions that will allow being effective if they are implemented
and adjusting the learning environment. their children to acquire independent across all settings, including the home
FOCUS ON AUTISM AND OTHER DEVELOPMENTAL DISABILITIES
162

and community. Therefore, considera- with particular children. Finally, if an in- autism. Journal of Autism and Develop-
tion of family participation should in- tervention is found to be ineffective, it is mental Disorders, 28, 535545.
clude determining the optimal level of the responsibility of the school and the Callahan, K., & Rademacher, J. A. (1999).
participation based on family characteris- family to adjust and modify the interven- Using self-management strategies to in-
crease the on-task behavior of a student
tics, stressors affecting the family, and the tion or select a new technique that has
with autism. Journal of Positive Behavior In-
needs of the individual child. been empirically supported.
terventions, 1, 117122.
Carr, E. G. (1977). The motivation of self-
ABOUT THE AUTHORS injurious behavior: A review of some hy-
Summary potheses. Psychological Bulletin, 84, 800
Rose Iovannone, PhD, is an assistant professor 816.
Children with ASD present special chal- at the Louis de la Parte Florida Mental Health Carr, E. G., Dunlap, G., Horner, R. H.,
lenges in the educational system. Impor- Institute at the University of South Florida and Koegel, R. L., Turnbull, A. P., Sailor, W.,
assistant director of the Center for Autism and et al. (2002). Positive behavior support:
tant responsibilities are placed on schools,
Related Disabilities. Glen Dunlap, PhD, is a Evolution of an applied science. Journal of
teachers, related school professionals,
professor and director of the Division of Applied Positive Behavior Interventions, 4, 416, 20.
and parents to determine the unique char- Research and Educational Support in the De- Carr, E. G., & Durand, V. M. (1985). Re-
acteristics of each child and match the ap- partment of Child and Family Studies at the ducing behavior problems through func-
propriate educational interventions and Louis de la Parte Florida Mental Health In- tional communication training. Journal of
practices that will allow the child to make stitute at the University of South Florida. Applied Behavior Analysis, 18, 111126.
progress. In this article, we attempted to Heather Huber is a graduate student in the Carr, E. G., Horner, R. H., Turnball, A. P.,
identify core components that any edu- Applied Behavior Analysis program at the Marquis, J., Magito-Mclaughlin, D.,
cational system must provide in order to Louis de la Parte Florida Mental Health In- McAtee, M. L., et al. (1999). Positive be-
ensure a sound educational program for stitute at the University of South Florida. Don havior support for people with developmental
children with ASD. We also identified Kincaid, EdD, is an associate professor at the disabilities: A research synthesis. Washing-
Louis de la Parte Florida Mental Health In- ton, DC: American Association on Mental
several methods used in published stud-
stitute at the University of South Florida Retardation.
ies that attempted to provide one or
and director of the Center for Autism and Re- Carr, E. G., Levin, L., McConnachie, G.,
more of the core components. It is evi- lated Disabilities. Address: Rose Iovannone, Carlson, J. I., Kemp, D. C., & Smith, C. E.
dent in the literature that no one practice DARESMHC 2113, FMHIUniversity of (1994). Communication-based interven-
can be used to the exclusion of others. South Florida, 13301 N. Bruce B. Downs Blvd., tion for problem behavior: A users guide
As a field, we need to continue to Tampa, FL 33612; e-mail: iovannone@fmhi. for producing positive change. Baltimore:
conduct research that examines the ef- usf.edu Brookes.
fectiveness of approaches for specific chil- Centers for Disease Control and Prevention.
dren. We need to further explore emerg- (2000). Prevalence of autism in Brick Town-
REFERENCES
ing strategies, such as the use of assistive ship, New Jersey, 1998: Community Report.
technology and augmentative communi- American Psychiatric Association. (1994). Atlanta, GA: Author.
cation. We need to conduct more re- Diagnostic and statistical manual of mental Centers for Disease Control and Prevention.
search in use of naturalistic strategies, disorders (4th ed.). Washington, DC: Au- (2001). Vaccine fact sheets. Retrieved March
thor. 2002, from: http://www.cdc.gov/od/
such as incidental teaching and pivotal
Baird, M. M. (1999). Legal issues in autism. nvp/fs_tableVII_doc2.htm
response training. We also need data to
Proceedings of the 20th National Institute on Chandler, L. K., Dahlquist, C. M., Repp,
guide us in choosing specific interven- A. C., & Feltz, C. (1999). The effects of
Legal Issues of Educating Individuals with
tions for specific children. For example, Disabilities. Alexendria, VA: LRP Publica- team-based functional assessment on the
does incidental teaching work best with tions, Conference Division. behavior of students in classroom settings.
children who have reached a specific Baker, M. J., Koegel, R. L., & Koegel, L. K. Exceptional Children, 66, 101122.
functional level? Should augmentative (1999). Increasing the social behavior of Croen, L. A., Grether, J. K., Hoogstrate, J.,
communication or assistive technology young children with autism using their ob- & Selvin, S. (2002). The changing preva-
be provided to all children with autism or sessive behaviors. The Journal of the Associ- lence of autism in California. Journal of
only to children who have not acquired ation for Persons with Severe Handicaps, 23, Autism and Developmental Disorders, 32,
functional speech with other strategies? 300308. 207215.
Bryan, L. C., & Gast, D. L. (2000). Teaching Dalrymple, N. J. (1995). Environmental sup-
Finally, we need to conduct more studies
on-task and on-schedule behaviors to high- ports to develop flexibility and indepen-
of students with ASD in middle and high
functioning children with autism via picture dence. In K. Quill (Ed.), Teaching children
school settings. with autism (pp. 243264). New York:
activity schedules. Journal of Autism and
Educators and parents should incor- Developmental Disorders, 30, 553567. Delmar.
porate a variety of strategies that are best Buffington, D. M., Krantz, P. J., McClanna- Dawson, G., & Osterling, J. (1997). Early in-
suited for the childs unique characteris- han, L. E., & Poulson, C. L. (1998). Pro- tervention in autism. In M. Guralnick
tics, and they should consistently evalu- cedures for teaching appropriate gestural (Ed.), The effectiveness of early intervention
ate the effectiveness of specific strategies communication skills to children with (pp. 307326). Baltimore: Brookes.
VOLUME 18, NUMBER 3, FALL 2003
163

Dettmer, S., Simpson R. L., Myles, B. S., & garten settings. Journal of Developmental prehensive intervention. The Journal of Spe-
Ganz, J. B. (2000). Focus on Autism and and Physical Disabilities, 13, 1126. cial Education, 31, 84104.
Other Developmental Disabilities, 15, 163 Graff, R. B., Lineman, G. T., Libby, M. E., & Horner, R. H., Dunlap, G., Koegel, R. L.,
169. Ahearn, W. H. (1999). Functional analysis Carr, E. G., Sailor, W., Anderson, J., et al.
Dunlap, G. (1999). Consensus, engagement, and treatment of screaming in a young girl (1990). Toward a technology of nonaver-
and family involvement for young children with severe disabilities. Behavioral Inter- sive behavioral support. Journal of the As-
with autism. The Journal of the Association ventions, 14, 233239. sociation for Persons with Severe Handicaps,
for Persons with Severe Handicaps, 24, 222 Gray, C. (1995). Teaching children with 15, 125132.
225. autism to read social situations. In K. A. Hurth, J., Shaw, E., Izeman, S. G., Whaley,
Dunlap, G., & Fox, L. (2002). The challenge Quill (Ed.), Teaching children with autism: K., & Rogers, S. J. (1999). Areas of agree-
of autism from a large systems perspective. Strategies to enhance socialization and com- ment about effective practices among pro-
Unpublished manuscript, University of munication (pp. 219241). Albany, NY: grams serving young children with autism
South Florida, Tampa. Delmar. spectrum disorders. Infants and Young
Dunlap, G., & Robbins, F. R. (1991). Cur- Gresham, F. M., Beebe-Frankenberger, Children, 12(2), 1726.
rent perspectives in service delivery for M. E., & MacMillan, D. L. (1999). A se- Individuals with Disabilities Education Act
young children with autism. Comprehensive lective review of treatments for children Amendments of 1997, 20 U.S.C. 1401
Mental Health Care, 1, 177194. with autism: Description and methodolog- (26).
Durand, V. M. (1999). Functional communi- ical considerations. School Psychology Review, Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bau-
cation training using assistive devices: Re- 28, 559575. man, K. E., & Richman, G. S. (1982). To-
cruiting natural communities of reinforce- ward a functional analysis of self-injury.
Hagopian, L. P., Wilson, D. M., & Wilder,
ment. Journal of Applied Behavior Analysis, Analysis and Intervention in Developmental
D. A. (2001). Assessment and treatment of
32, 247267. Disabilities, 2(1), 320.
problem behavior maintained by escape
Dyches, T. T. (1998). Effects of switch train- Jahr, E. (2001). Teaching children with
from attention and access to tangible items.
ing on the communication of children with autism to answer novel wh-questions by
Journal of Applied Behavior Analysis, 34,
autism and severe disabilities. Focus on utilizing a multiple exemplar strategy. Re-
229232.
Autism and Other Developmental Disabili- search in Developmental Disabilities, 22,
Harrower, J. K., & Dunlap, G. (2001). In-
ties, 13, 151162. 407423.
cluding children with autism in general ed-
Earles, T. L., Carlson, J. K., & Bock, S. J. Kamps, D. M., Leonard, B. R., Vernon, S.,
ucation classrooms: A review of effective
(1998). Instructional strategies to facilitate Dugan, E. P., & Delquadri, J. C. (1992).
strategies. Behavior Modification, 25, 762
successful learning outcomes for students Teaching social skills to students with
784.
with autism. In R. L. Simpson & B. S. autism to increase peer interactions in an in-
Heckaman, K. A., Alber, S., Hooper, S., &
Myles (Eds.), Educating children and youth tegrated first-grade classroom. Journal of
Heward, W. L. (1998). A comparison of
with autism: Strategies for effective practice Applied Behavior Analyis, 25, 281288.
least-to-most prompts and progressive time
(pp. 55111). Austin: PRO-ED. Kamps, D., Royer, J., Dugan, E., Kravits, T.,
delay on the disruptive behavior of students
Eikeseth, S., Smith, T., Jahr, E., & Eldevik, S. Gonzalez-Lopez, A., Garcia, J., et al.
with autism. Journal of Behavioral Educa-
(2002). Intensive behavioral treatment at (2002). Peer training to facilitate social in-
tion, 8, 171201.
school for 4- to 7-year-old children with teractions for elementary students with
autism: A 1-year comparison controlled Heflin, L. J., & Alberto, P. A. (2001). Estab- autism and their peers. Exceptional Chil-
study. Behavior Modification, 26(1), 4968. lishing a behavioral context for learning for dren, 68, 173187.
Feinberg, E., & Vacca, J. (2000). The drama students with autism. Focus on Autism and Kanner, L. (1943). Autistic disturbances of
and trauma of creating policies on autism: Other Developmental Disabilities, 16, 93 affective contact. Nervous Child, 2, 217
Critical issues to consider in the new mil- 101. 250.
lennium. Focus on Autism and Other Devel- Heflin, L. J., & Simpson, R. L. (1998a). In- Koegel, L. K., Camarata, S. M., Valdez-
opmental Disabilities, 15, 130137. terventions for children and youth with Menchaca, M., & Koegel, R. L. (1998).
Fombonne, E. (1999). The epidemiology of autism: Prudent choices in a world of exag- Setting generalization of question-asking
autism: A review. Psychological Medicine, 29, gerated claims and empty promises. Part 1: by children with autism. American Journal
769786. Intervention and treatment option review. on Mental Retardation, 102, 346357.
Frea, W. D., & Hepburn, S. L. (1999). Teach- Focus on Autism and Other Developmental Koegel, L. K., Harrower, J., & Koegel,
ing parents of children with autism to per- Disabilities, 13, 194211. R. L. (1999). Support for children with
form functional assessments to plan inter- Heflin, L. J., & Simpson, R. L. (1998b). In- developmental disabilities participating in
ventions for extremely disruptive behaviors. terventions for children and youth with full-inclusion classrooms through self-
Journal of Positive Behavior Interventions, 1, autism: Prudent choices in a world of exag- management. Journal of Positive Behavior
112116, 122. gerated claims and empty promises. Part II: Interventions, 1, 2634.
Frost, L., & Bondy, A. (1994). The Picture Legal/policy analysis and recommenda- Koegel, L. K., Koegel, R. L., & Dunlap, G.
Exchange Communication System training tions for selecting interventions and treat- (1996). Positive behavioral support. Balti-
manual. Cherry Hill, NJ: PECS. ments. Focus on Autism and Other Develop- more: Brookes.
Gena, A., & Kymissis, E. (2001). Assessing mental Disabilities, 13, 212220. Koegel, R. L., Bimbela, A., & Schreibman, L.
and setting goals for the attending and Horner, R. H., & Carr, E. G. (1997). Behav- (1996). Collateral effects of parent training
communicative behavior of three pre- ioral support for students with severe dis- on family interactions. Journal of Autism
schoolers with autism in inclusive kinder- abilities: Functional assessment and com- and Developmental Disorders, 26, 347359.
FOCUS ON AUTISM AND OTHER DEVELOPMENTAL DISABILITIES
164

Koegel, R. L., & Egel, A. L. (1979). Moti- Morrison, L., Kamps, D., Garcia, J., & Parker, tion, and early intensive behavioral inter-
vating autistic children. Journal of Abnor- D. (2001). Peer mediation and monitoring vention for autism. Behavior Modification,
mal Psychology, 88, 418426. strategies to improve initiations and social 25, 678697.
Koegel, R. L., Koegel, L. K., & Carter, C. M. skills for students with autism. Journal of Pierce, K. L., & Schreibman, L. (1994).
(1999). Pivotal teaching interactions for Positive Behavior Interventions, 3, 237250. Teaching daily living skills to children with
children with autism. School Psychology Re- Morse, T. E., & Schuster, J. W. (2000). autism in unsupervised settings through
view, 28, 576594. Teaching elementary students with moder- pictorial self-management. Journal of Ap-
Koegel, R. L., & Mentis, M. (1985). Motiva- ate intellectual disabilities: How to shop for plied Behavior Analysis, 27, 411481.
tion in childhood autism: Can they or groceries. Exceptional Children, 66, 273 Pierce, K. L., & Schreibman, L. (1997). Mul-
wont they? The Journal of Child Psychology 288. tiple peer use of pivotal response training to
and Psychiatry and Allied Disciplines, 26, Mueller, M. M., Wilczynski, S. M., & Moore, increase social behaviors of classmates with
185191. J. W. (2001). Antecedent manipulations in autism: Results from trained and untrained
Kuttler, S., Myles, B. S., & Carlson, J. K. a tangible condition: Effects on stimulus peers. Journal of Applied Behavior Analysis,
(1998). The use of social stories to reduce preference on aggression. Journal of Ap- 30, 157160.
precursors to tantrum behavior in a student plied Behavior Analysis, 34, 237240. Powers, M. D. (1992). Early intervention for
with autism. Focus on Autism and Other De- National Research Council. (2001). Educat- children with autism. In D. E. Berkell
velopmental Disabilities, 13, 176182. ing children with autism. Committee on (Ed.), Autism: Identification, education
Laushey, K. M., & Heflin, L. J. (2000). En- Educational Interventions for Children and treatment (225252). Hillsdale, NJ:
hancing social skills of kindergarten chil- with Autism. Division of Behavioral and So- Erlbaum.
dren with autism through the training of cial Sciences and Autism. Washington, DC:
Prizant, B., & Rubin, E. (1999). Contempo-
multiple peers as tutors. Journal of Autism National Academy Press.
rary issues in interventions for autism spec-
and Developmental Disorders, 30, 183193. Nordin, V., & Gillberg, C. (1996). Autism
trum disorders: A commentary. The Jour-
spectrum disorders in children with physi-
Logan, K. R., Bakeman, R., & Keefe, E. G. nal of the Association for Persons with Severe
cal or mental disability or both. 1: Clinical
(1997). Effects of instructional variables of Handicaps, 24, 199208.
and epidemiological aspects. Developmen-
engaged behavior of students with disabili- Rogers, S. J. (1999). Intervention for young
tal Medicine and Child Neurology, 38, 297
ties in general education classrooms. Excep- children with autism: From research to
313.
tional Children, 63, 481497. practice. Infants and Young Children,
Norris, C., & Dattilo, J. (1999). Evaluating
Lorimer, P. A., Simpson, R. L., Myles, R. L., 12(2), 116.
effects of a social story intervention on a
& Ganz, J. B. (2002). The use of social sto- Sarokoff, R. A., Taylor, B. A., & Poulson,
young girl with autism. Focus on Autism
ries as a preventative behavioral interven- C. L. (2001). Teaching children with
and Other Developmental Disabilities, 14,
tion in a home setting with a child with autism to engage in conversational ex-
180186.
autism. Journal of Positive Behavior Inter- changes: Script fading with embedded tex-
Olley, J. G. (1999). Curriculum for students
ventions, 4, 5360. tual stimuli. Journal of Applied Behavior
with autism. School Psychology Review, 28,
Lotter, V. (1996). Epidemiology of autistic Analysis, 34, 8184.
595606.
conditions in young children. 1: Preva- Olley, J. G., & Reeve, C. E. (1997). Issues of Schepis, M. M., Reid, D. H., Behrmann,
lence. Social Psychiatry 1, 124137. curriculum and classroom structure. In M. M., & Sutton, K. A. (1998). Increasing
MacDuff, G. S., Krantz, P. J., & McClanna- D. J. Cohen & F. R. Volkmar (Eds.), communicative interactions of young chil-
han, L. E. (1993). Teaching children with Handbook of autism and pervasive develop- dren with autism using a voice output com-
autism to use photographic activity sched- mental disorders (2nd ed., pp. 484508). munication aid and naturalistic teaching.
ules: Maintenance and generalization of New York: Wiley. Journal of Applied Behavior Analysis, 31,
complex response chains. Journal of Ap- Olley, J. G., & Rosenthal, S. L. (1985). Cur- 561578.
plied Behavior Analysis, 26, 8997. rent issues in school services for students Scherer, M., Pierce, K. L., Paredes, S., Ki-
Mancina, C., Tankersley, M., Kamps, D., with autism. School Psychology Review, 14, sacky, K. L., Ingersoll, B., & Schreibman,
Kravits, T., & Parrett, J. (2000). Brief re- 166170. L. (2001). Enhancing conversation skills in
port: Reduction of inappropriate vocaliza- ONeill, R. E., & Sweetland-Baker, M. children with autism via video technology:
tions for a child with autism using a self- (2001). Brief report: An assessment of stim- Which is better, self or other as a
management treatment program. Journal ulus generalization and contingency effects model? Behavior Modification, 25(1), 140
of Autism and Developmental Disorders, 30, in functional communication training with 158.
599606. two students with autism. Journal of Au- Schreibman, L., Whalen, C., & Stahmer, A.
McGee, G. G., Almeida, M. C., Sulzer- tism and Developmental Disorders, 31, 235 C. (2000). The use of video priming to re-
Azaroff, B., & Feldman, R. S. (1992). Pro- 240. duce disruptive transition behavior in chil-
moting reciprocal interactions via peer inci- Patel, M. R., Carr, J. E., Kim, C., Robles, A., dren with autism. Journal of Positive Be-
dental teaching. Journal of Applied & Eastridge, D. (2000). Functional analy- havior Interventions, 2, 311.
Behavior Analysis, 25, 117126. sis of aberrant behavior maintained by Schwartz, I. S., Garfinkle, A. N., & Bauer, J.
McGee, G. G., Krantz, P. J., & McClannahan, automatic reinforcement: Assessments of (1998). The Picture Exchange Communi-
L. E. (1985). The facilitative effects of inci- specific sensory reinforcers. Research in De- cation System: Communicative outcomes
dental teaching on preposition use by autis- velopmental Disabilities, 21, 393407. for young children with disabilities. Topics
tic children. Journal of Applied Behavior Pelios, L. V., & Lurd, S. K. (2001). A selec- in Early Childhood Special Education, 18,
Analysis, 18, 1731. tive review of issues on classification, causa- 144159.
VOLUME 18, NUMBER 3, FALL 2003
165

Simpson, R. L. (2001). ABA and students feedback: Effects on social communication peers: Description of a model and related
with autism spectrum disorders: Issues and of children with autism. Journal of Applied research. International Play Journal, 3(1),
considerations for effective practice. Focus Behavior Analysis, 34, 425446. 3851.
on Autism and Other Developmental Dis- Volmer, L. (1997). Best practices in working Wolfberg, P. J., & Schuler, A. L. (1993). Fos-
abilities, 16, 6871. with students with autism. In A. Thomas & tering peer interaction, imaginative play, &
Simpson, R. L., & Myles, B. S. (1998). Un- J. Grimes (Eds.), Best practices in school psy- spontaneous language in children with
derstanding and responding to the needs of chology (pp. 10311038). Washington, DC: autism. Child Language Teaching and
students with autism. In R. L. Simpson & The National Association of School Psy- Therapy, 15(1), 4152.
B. S. Myles (Eds.), Educating children and chologists. Yell, M. L., & Drasgow, E. (2000). Litigating
youth with autism: Strategies for effective Webb, E. V. J., Lobo, S., Hervas, A., Scour- a free appropriate public education: The
practice (pp. 123). Austin: PRO-ED. field, J., & Fraser, W. I. (1997). The chang- Lovaas hearings and cases. The Journal of
Stahmer, A. C., & Schreibman, L. (1992). ing prevalence of autistic disorder in a Special Education, 33, 205214.
Teaching children with autism appropriate Welsh health district. Developmental Medi- Yell, M. L., & Shriner, J. G. (1997). Inclusive
play in unsupervised environments using a cine and Child Neurology, 39, 150152. education: Legal and policy implications.
self-management treatment package. Jour- Westling, D. L., & Fox, L. (2000). Teaching Preventing School Failure, 40, 101108.
nal of Applied Behavior Analysis, 25, 447 students with severe disabilities (2nd ed.). Zercher, C., Hunt, P., Schuler, A., & Webster,
459. Englewood Cliffs, NJ: Prentice Hall. J. (2001). Increasing joint attention, play
Thiemann, K. S., & Goldstein, H. (2001). Wolfberg, P. J. (1995). Supporting children and language through peer supported play.
Social stories, written text cues, and video with autism in play groups with typical Autism, 5, 374398.