Autism

Spectrum
Disorders
 Autism
Spectrum
Disorders
A HANDBOOK FOR PARENTS
AND PROFESSIONALS
Volume 1: A–O

Edited by
Brenda Smith Myles, Terri Cooper Swanson,
Jeanne Holverstott, and Megan Moore Duncan
Library of Congress Cataloging-in-Publication Data
Autism spectrum disorders : a handbook for parents and professionals /
edited by Brenda Smith Myles, Terri Cooper Swanson, Jeanne Holverstott,
and Megan Moore Duncan
p. cm.
Includes bibliographical references and index.
ISBN-13: 978–0–313–33632–4 (set : alk. paper)
ISBN-13: 978–0–313–34632–3 (v. 1 : alk. paper)
ISBN-13: 978–0–313–34634–7 (v. 2 : alk. paper)
1. Autism in children—Handbooks, manuals, etc.
[DNLM: 1. Autistic Disorder—Handbooks. 2. Child Development
Disorders, Pervasive—Handbooks. WM 34 A939 2007] I. Myles, Brenda
Smith. II. Swanson, Terri Cooper. III. Holverstott, Jeanne. IV. Duncan,
Megan Moore.
RJ506.A9A92377 2007
618.920 85882—dc22 2007030685
British Library Cataloguing in Publication Data is available.
Copyright Ó 2007 by Brenda Smith Myles, Terri Cooper Swanson, Jeanne Holverstott, and
Megan Moore Duncan
All rights reserved. No portion of this book may be
reproduced, by any process or technique, without the
express written consent of the publisher.
Library of Congress Catalog Card Number: 2007030685
ISBN-13: 978–0–313–33632–4 (set)
978–0–313–34632–3 (vol. 1)
978–0–313–34634–7 (vol. 2)
First published in 2007
Praeger Publishers, 88 Post Road West, Westport, CT 06881
An imprint of Greenwood Publishing Group, Inc.
www.praeger.com
Printed in the United States of America

The paper used in this book complies with the

Permanent Paper Standard issued by the National
Information Standards Organization (Z39.48–1984).
10 9 8 7 6 5 4 3 2 1
 Contents

List of Entries vii

Guide to Related Topics xv

The Handbook 1

Appendix A: Newsletters 425

Appendix B: Journals 429

Appendix C: Organizations 437

Appendix D: Personal Perspectives 451

Index 471

About the Editors, Advisory Board, and Contributors 503

 List of Entries

Absurdities Asperger’s Disorder

Accommodation Asperger Syndrome Diagnostic Scale (ASDS)
Activities of Daily Living Asperger Syndrome Screening Questionnaire
Adaptive Behavior (ASSQ)
Adolescent/Adult Sensory Profile Assessment
Adolescent and Adult Psychoeducational Assessment of Basic Language and Learning
Profile Skills (ABLLS)
Adult Supports Assistive Technology
Advocate Assistive Technology Device
Age Appropriate Assistive Technology Service
Ages and Stages Questionnaires: Association Method
Social/Emotional Attention Deficit Hyperactivity Disorders
Allergy (ADHD)
Alternative Assessment Attribution
American Sign Language (ASL) Atypical Behavior
Americans with Disabilities Act (ADA) Audiologist
Amino Acids Auditory Integration Training
Amygdala Augmentative and Alternative
Analysis of Behavioral Function Communication
Analysis of Sensory Behavior Inventory– Autism Behavior Checklist (ABC)
Revised Edition Autism Diagnostic Interview–Revised
Anecdotal Report (ADI-R)
Angelman Syndrome Autism Diagnostic Observation Schedule
Animal Assisted Therapy/Assistance Dog (ADOS)
Placements for Children with Autism Autism Screening Instrument for Educational
Annual Goal Planning–Second Edition
Antecedent Autistic Disorder
Antecedent-Behavior-Consequence (ABC)
Analysis
Antianxiety Medications Baseline
Antibiotics Behavior
Antidepressant Medications Behavioral Assessment of the Dysexecutive
Antipsychotic Medications Syndrome (BADS)
Anxiety Disorders Behavioral Objective
Applied Behavior Analysis (ABA) Behavioral Rehearsal
Apraxia Behavior Analyst Certification Board (BACB)
Art Therapy Behavior Assessment Scale for Children
Asperger, Hans (BASC)
LIST OF ENTRIES

Behavior Health Rehabilitation Services Cognitive Learning Strategies

(BHRS) Cognitive Processes
Behavior Intervention Plan Collaborative Team
Behaviorism Communication and Symbolic Behavior
Behavior Modification Scales (CSBS)
Behavior Principles Communication and Symbolic Behavior
Bettelheim, Bruno Scales Developmental Profiles (CSBS DP)
Bias Communication Board
Biofeedback Co-morbid/Co-occurring
Bleular, Eugen Comprehensive Assessment of Spoken
Board Certified Associate Behavior Analyst Language
(BCABA) Comprehensive Autism Program Planning
Board Certified Behavior Analyst (BCBA) System (CAPS)
Bolles Sensory Integration Concrete Language
Bowel Problems Concurrent Validity
Brushing Confidentiality
Bullying Consent
Consequence
Career Planning Constipation
Cartooning Contingency
Casein-free Contingency Contracting
Catatonia Control Group/Control Condition
CAT Scan Correctional Facility
Central Auditory Processing Disorder Criterion-Referenced Assessment
(CAPD) Curriculum
Central Coherence Curriculum-Based Assessment
Chaining
Checklist for Autism in Toddlers Daily Living Skills
(CHAT) Dance Therapy
Checklist for Occupational Therapy Das-Naglieri Cognitive Assessment System
Chelation (CAS)
Child Behavior Checklist for Ages 11=2 to 5 Data
Childhood Asperger Syndrome Test Deep Pressure Proprioception Touch
(CAST) Technique
Childhood Autism Rating Scale (CARS) Desensitization
Childhood Disintegrative Disorder Detoxification
Children’s Attributional Style Questionnaire Developmental Age
(CASQ) Developmental Delay
Children’s Category Test (CCT) Developmental Disorder
Children’s Depression Inventory (CDI) Developmental Individual-Difference
Chronological Age Relation-Based Intervention (DIR)
Circle of Friends Developmentally Appropriate Practice
Classroom Reading Inventory Developmental Milestones
Clinical Assessment (Educational) Developmental Play Assessment Instrument
Clinical Assessment (Medical) (DPA)
Clinical Evaluation of Language Developmental Quotient
Fundamentals–Preschool Developmental Surveillance
Clinical Opinion Developmental Therapy
Clinical Practice Guidelines Diagnostic and Statistical Manual of Mental
Clinical Significance Disorders–Fourth Edition–Text Revised
Clinical Social Worker (DSM-IV-TR)
Clinical Trial Diet
Clostridium tetani Diet Therapy
Cognitive Behavior Modification Differential Ability Scales
viii
 LIST OF ENTRIES

Differential Diagnosis Face Recognition

Differential Reinforcement Facilitated Communication (FC)
Dimethylglycine (DMG) Facility-Based Employment
Direct Instruction Fading
Direct Observation False-Belief Paradigm
Disability Family Assessment Interview
Discrete Trial Training (Brief Definition) Family Educational Rights and Privacy Act
Discrete Trial Training (Extended (FERPA)
Definition) Fast ForWord
Discrimination Feingold Diet
Discriminative Stimulus Figurative Language
Distributed Practice Fine Motor Skills
Dopamine Fluency
Double Blind Four Steps of Communication
Double Interview Four Steps of Perspective Taking
Due Process Fragile X Syndrome
Durrell Analysis of Reading Difficulty Free and Appropriate Public Education
(DARD) (FAPE)
Dysbiosis Functional Analysis Screening Tool
Dysphasia (FAST)
Functional Behavior Analysis
Early Coping Inventory Functional Behavior Assessment (FBA)
Early Intervention Functional Goals
Echoic/Verbal Behavior Functional Limitations
Echolalia: Immediate, Delayed, Mitigated Functionally Equivalent Alternative Behavior
Ecological Inventory Functional Magnetic Resonance Imaging (fMRI)
Educational Placement Functional Outcomes
Eisenberg, Leon Functional Protest Training
Electroencephalogram Functional Skills
Eligibility Functions of Behavior
Elimination Diet and Food Sensitivities Functions of Communication
Embedded Figures Test (EFT) Fusiform Gyrus
Embedded Skills
Emotional Support General Case Programming
Empiricism Generalization
Encopresis Genetic Factors/Heredity
Engagement Genotype
Enuresis Gentle Teaching (GT)
Environment Giftedness
Environmental Stressors Gilliam Asperger Disorder Scale (GADS)
Epidemiology Gilliam Autism Rating Scale (GARS)
Error Correction Gluten-free
Escape Training Good Grief!
Establishing Operation Graduated Guidance
Evaluating Acquired Skills in Graphic Organizer
Communication–Revised (EASIC-R) Gravitational Insecurity
Evaluation Report Gross Motor Developmental Quotient
Evidence Based Gross Motor Skills
Executive Functions Guided Compliance
Experimental Design
Expressive Language Habit Rehearsal
Extended School Year (ESY) Hair Analysis
Extinction Halstead-Reitan Neuropsychological Test
Eye Gaze Battery (HRPTB)

ix
LIST OF ENTRIES

Hand-over-Hand Assistance (HOH) Kanner, Leo

Hand Regard Krug’s Asperger’s Disorder Index
Head Circumference
Heavy Metals
Hidden Curriculum Lactose Intolerance
High-Functioning Autism Landau-Kleffner Syndrome
Hippocampus Leaky Gut Syndrome
Hippotherapy Learned Helplessness
Homebound/Hospital Bound Program Learning Disorder
Hormone Replacement Learning Styles
Hug Machine Least Restrictive Environment (LRE)
Hyperlexia Leiter International Performance Scale
Hyperresponsiveness Life Skills and Education for Students with
Hyporesponsiveness Autism and Other Pervasive Behavioral
Challenges (LEAP)
Life Skills Support
Idiosyncratic Language Limbic System
I LAUGH Model of Social Cognition Lindamood-Bell
Imagination Local Education Agency
Imitation/Modeling Locomotion
Immunoglobulin Low/Poor Registration
Immunological Tests
Immunotherapy
Impairment Magnetic Resonance Imaging (MRI)
Incidence Mainstreaming
Incidental Teaching Maintenance
Incident Report Maladaptive Behavior
Inclusion Mand
Independent Employment Massed Practice
Indicators of Sensory Processing Disorder Masturbation
Individualized Education Program (IEP) Mean Length of Utterance
Individualized Family Service Plan Mediation
(IFSP) Mental Age
Individualized Health Care Plan (IHCP) Mental Health Counselor
Individualized Transition Plan Mental Retardation
Individual Plan for Employment (IPE) Mercury
Individuals with Disabilities Education Act Metallothionein
(IDEA) Milieu Teaching
Infant/Toddler Sensory Profile Mindblindness
Informal Assessment Modified Checklist for Autism in Toddlers
Integrated Employment (M-CHAT)
Integrated Play Group Model (IPG) Mood Disorders
Intelligence Tests Mood Stabilizing Medications
Internal Review Board (IRB) Motivation Assessment Scale
International Statistical Classification of Motor Imitation
Diseases and Related Health Problems Multidimensional Anxiety Scale for Children
(ICD) (MASC)
Interobserver Agreement/Reliability Multidisciplinary Evaluation (MDE)
Intraverbal Multidisciplinary Team
Irlen Lenses Music Therapy
Mutually Acceptable Written Agreement

Joint Action Routines

Joint Attention Natural Language Paradigm
Journal Neurofeedback

x
 LIST OF ENTRIES

Neuroimaging Picture Exchange Communication System

Neurologist (PECS)
Neurology Pivotal Response Training
Neuromotor Placebo
Neuropsychology Play-Oriented Therapies
Neurotoxic Positive Behavior Support (PBS)
Neurotransmitter Positron Emission Tomography (PET)
Newsletter Postsecondary Education
No Child Left Behind Act 2001 (PL 107-110) Posttraumatic Stress Disorder (PTSD)
No-No Prompt Procedures Power Card Strategy
Nonverbal Learning Disability Pragmatics
Normalization Praxis
Norm-Referenced Assessment Precision Teaching
Notice of Recommended Educational Present Level of Educational Performance
Placement (NOREP) (PLEP)
Nutritional Supplements Presymbolic Thought
Prevalence
Priming
Object Integration Test Probe
Objective Procedural Safeguards
Object Sorting Test Prompt Dependence
Occupational Therapist Prompt Hierarchy
Occupational Therapy Prompting
Operant Conditioning Pronoun Errors
Options (Son-Rise Program) Proprioception
Oral-Motor Skills Prosody
Oral Sensitivity Proto-declarative
Overcorrection Proto-imperative
Overselectivity/Overfocused Attention Prototype Formation
Psychiatrist
Patterning (Doman-Delacato Treatment) Psychobiology
Pedantic Speech Psychoeducational Profile–Third Edition
Peer Reviewed (PEP-3)
Peptide Psychologist
Percentile Psychometrics
Perseveration Psychopharmacology
Perseverative Scripting Psychosocial
Personal Perspectives Punishment
Person First Language
Pervasive Developmental Disorder–Not RDI Program
Otherwise Specified Reactive Attachment Disorder of Infancy
Pervasive Developmental Disorder–Not or Early Childhood
Otherwise Specified Diagnostic Criteria Receptive Language
(Diagnostic Criteria for 299.80, Including Reciprocal Communication/Interaction
Atypical Autism) Red Flags
Pervasive Developmental Disorders (PDD) Rehabilitation Act of 1973
Pervasive Developmental Disorder Screening Reinforcer
Test-II (PDDST-II) Residential Facility
Pesticides Residential Supports
Pharmacology Resource Room
Phenotype Respite Care
Physical Therapist Respondent Conditioning
Physical Therapy Response Cost
Pica Response Latency

xi
LIST OF ENTRIES

Restricted Interest Social Behavior Mapping

Retrospective Video Analysis (RVA) Social Communication
Rett’s Disorder Social Communication Questionnaire (SCQ)
Rett’s Disorder–Diagnostic Criteria for Social Competence
299.80 Rett’s Disorder Social Faux Pas
Rimland, Bernard Social Gaze
Rumination Syndrome Social Play
Social Scripts
Scales of Independent Behavior–Revised Social Skills Defined as Sharing Space
(SIB-R) Effectively with Others
SCERTS Model Social Skills Training
Schedule of Reinforcement Social Stories
Schizophrenia Social Thinking
School Function Assessment Social Validity
Schopler, Eric Somatosensory
Screening Special Day School or Alternative School
Screening Tool for Autism in Two-Year-Olds Speech Delay
(STAT) Speech Language Pathologist
Secretin Speech Therapy
Section 504 of the Rehabilitation Act of 1973 Splinter Skills
Seizure Disorder Spontaneous Play
Selective Mutism Standard Deviation
Self-Advocacy Standardization
Self-Contained Classroom Standardization Sample
Self-Determination Standardized Tests
Self-Help Skills Standard Score
Self-Injurious Behavior Stanford-Binet Intelligence Scales–Fifth
Self-Regulation Edition
Sensation Avoiding Stereotypic Behavior
Sensation Seeking Stimulant Medications
Sensorimotor Stimulus
Sensorimotor Early Childhood Activities Stimulus Control
Sensory History Stimulus Overselectivity
Sensory Integration Storymovies
Sensory Integration and Praxis Test (SIPT) Structured Teaching (TEACCH)
Sensory Integration Dysfunction Student Social Attribution Scale (SSAS)
Sensory Integration Inventory–Revised Supplemental Security Income (SSI)
(SII-R) Supported Employment
Sensory Processing Surthrival
Sensory Processing Dysfunction Symbolic Play
Sensory Profile Symbolic Thought
Sensory Sensitivity Symptom
Sensory Stimuli Syndrome
Sensory Threshold Systematic Desensitization
Serotonin
Setting Events Tact
Shaping Tactile
Short Sensory Profile Tactile Defensiveness
Sibling Support Project Target Behavior
Sibshops Task Analysis
Single-Subject Design Testimonial
Situation-Options-Consequences-Choices- Test of Adolescent and Adult Language–
Strategies-Simulation (SOCCSS) Fourth Edition (TOAL4)
Social Autopsies Test of Language Competence (TLC)

xii
 LIST OF ENTRIES

Test of Language Development–Intermediate, Verbal Behavior

Third Edition (TOLD-I) Vestibular
Test of Language Development–Primary Video Modeling
(TOLD-P) Video Self-Modeling
Test of Pragmatic Language (TOPL) Vineland Adaptive Behavior Scales–Second
Test of Problem Solving–Adolescent Edition (VABS-II)
(TOPS-A) Virtual Environment
Test of Problem Solving–Elementary Viruses
(TOPS-E) Visual-Motor
Theory of Mind Visual Strategies
Tic Disorders Vocational Rehabilitation
Time-out Vocational Rehabilitation Programming
Toe Walking/Equinus Gate Voting
Token Economy
Total Communication
Touch Pressure Wait Training
Touch Therapy Wechsler Individualized Achievement
Tower of Hanoi (TOH) Test–Second Edition (WIAT-2)
Toxicology Wechsler Intelligence Scales for
Trail-Making Test Children–Fourth Edition (WISC-IV)
Transition Planning Welch Method Therapy
Treatment Effectiveness Wilbarger Protocol
Trial Wisconsin Card Sorting Test (WCST)
Tuberous Sclerosis Complex Woodcock-Johnson Psychoeducational
Twenty Questions Task Battery–Revised: Tests of Cognitive
Twin Studies Ability
Work Adjustment Period

Universal Nonverbal Intelligence Test

(UNIT) Yeast-free

Vaccinations (Thimerosal) Zero Reject

Validity Ziggurat Model
van Dijk Approach Zone of Proximal Development (ZPD)

xiii
 Guide to Related Topics

ASD AND ABA TERMINOLOGY Massed Practice

ADVOCACY AND SELF-DISCLOSURE No-No Prompt Procedures
Operant Conditioning
Advocate
Overcorrection
Discrimination
Prompt Hierarchy
Emotional Support
Prompting
Functional Skills
Punishment
Life Skills Support
Respondent Conditioning
Person First Language
Response Cost
Self-Advocacy
Response Latency
Self-Determination
Shaping
Task Analysis
PROFESSIONALS Time-out
Behavior Analyst Certification Board (BACB) Token Economy
Board Certified Associate Behavior Analyst Wait Training
(BCABA)
Board Certified Behavior Analyst (BCBA) TERMINOLOGY
Certified Behavior Analyst Antecedent
Behavior
STRATEGIES Behavioral Objective
Analysis of Behavioral Function Behavior Health Rehabilitation Services
Behavioral Rehearsal (BHR)
Behavior Modification Behaviorism
Chaining Behavior Principles
Contingency Consequence
Contingency Contracting Contingency
Differential Reinforcement Desensitization
Discrete Trial Training (Brief Definition) Discriminative Stimulus
Discrete Trial Training (Extended Definition) Establishing Operation
Error Correction Functionally Equivalent Alternative Behavior
Escape Training Functions of Behavior
Extinction Intraverbal
Fading Learned Helplessness
Functional Protest Training Mand
Graduated Guidance Prompt Dependence
Guided Compliance Reinforcer
Habit Rehearsal Schedule of Reinforcement
Hand-over-Hand Assistance (HOH) Setting Events
GUIDE TO RELATED TOPICS

Stimulus Early Intervention

Stimulus Control Educational Placement
Stimulus Overselectivity Eligibility
Systematic Desensitization General Case Programming
Tact Generalization
Target Behavior Impairment
Trial Inclusion
Intelligence Tests
ASD AND EDUCATION Learning Styles
ADULT ISSUES Local Education Agency
Adult Supports Maladaptive Behavior
Career Planning Multidisciplinary Team
Facility-Based Employment Notice of Recommended Educational
Independent Employment Placement (NOREP)
Integrated Employment Transition Planning
Masturbation
Postsecondary Education SPECIAL EDUCATION LAW
Residential Supports Americans with Disabilities Act (ADA)
Supplemental Security Income (SSI) Due Process
Supported Employment Extended School Year (ESY)
Vocational Rehabilitation Family Educational Rights and Privacy Act
Vocational Rehabilitation Programming (FERPA)
Voting Free and Appropriate Public Education
Work Adjustment Period (FAPE)
Individualized Education Program (IEP)
Individualized Family Service Plan (IFSP)
CONTINUUM OF SERVICES
Individualized Health Care Plan (IHCP)
Correctional Facility
Individualized Transition Plan
Homebound/Hospital Bound Program
Individual Plan for Employment (IPE)
Residential Facility
Individuals with Disabilities Education Act
Resource Room
(IDEA)
Self-Contained Classroom
Least Restrictive Environment (LRE)
Special Day School or Alternative School
Mainstreaming
Mediation
DAILY LIVING Mutually Acceptable Written Agreement
Activities of Daily Living No Child Left Behind Act 2001
Daily Living Skills (PL 107-110)
Environmental Stressors Present Level of Educational Performance
Functional Goals (PLEP)
Functional Limitations Rehabilitation Act of 1973
Functional Outcomes Section 504 of the Rehabilitation Act of
Functional Skills 1973
Self-Help Skills Zero Reject

SCHOOL TERMINOLOGY
Accommodation ASD AND MEDICINE
Adaptive Behavior STRATEGIES
Annual Goal Antianxiety Medications
Behavior Intervention Plan Antidepressant Medications
Bullying Antipsychotic Medications
Cognitive Processes Casein-free
Collaborative Team Chelation
Curriculum Detoxification
Due Process Elimination Diet and Food Sensitivities
xvi
 GUIDE TO RELATED TOPICS

Feingold Diet Pharmacology

Gluten-free Phenotype
Hormone Replacement Placebo
Mood Stabilizing Medications Positron Emission Tomography (PET)
Nutritional Supplements Prevalence
Yeast-free Psychobiology
Psychopharmacology
TERMINOLOGY Psychosocial
Allergy Rumination Syndrome
Amino Acids Secretin
Amygdala Serotonin
Antibiotics Stimulant Medications
Bowel Problems Symptom
CAT Scan Syndrome
Clinical Assessment (Educational) Toxicology
Clinical Assessment (Medical) Treatment Effectiveness
Clinical Opinion Twin Studies
Clinical Practice Guidelines
Clinical Trial ASD AND RELATED DISORDERS
Clostridium tetani Asperger’s Disorder
Co-morbid/Co-occurring Autistic Disorder
Constipation Diagnostic and Statistical Manual of Mental
Differential Diagnosis Disorders–Fourth Edition–Text Revised
Dimethylglycine (DMG) (DSM-IV-TR)
Dopamine High-Functioning Autism
Dysbiosis International Statistical Classification of
Electroencephalogram Diseases and Related Health Problems
Encopresis (ICD)
Enuresis Pervasive Developmental Disorder–Not
Epidemiology Otherwise Specified
Functional Magnetic Resonance Imaging Pervasive Developmental Disorder–Not
(fMRI) Otherwise Specified Diagnostic Criteria
Fusiform Gyrus (Diagnostic Criteria for 299.80, Including
Genotype Atypical Autism)
Hair Analysis Pervasive Developmental Disorders (PDD)
Head Circumference
Heavy Metals
Hippocampus BEHAVIOR
Immunoglobulin Adaptive Behavior
Immunological Tests
Immunotherapy ETIOLOGY
Lactose Intolerance Diet
Leaky Gut Syndrome Environment
Limbic System Genetic Factors/Heredity
Magnetic Resonance Imaging (MRI) Pesticides
Mercury Vaccinations (Thimerosal)
Metallothionein Viruses
Neuroimaging
Neurology RELATED DISORDERS
Neuromotor Angelman Syndrome
Neuropsychology Anxiety Disorders
Neurotoxic Attention Deficit Hyperactivity Disorders
Neurotransmitter (ADHD)
Peptide Catatonia
xvii
GUIDE TO RELATED TOPICS

Central Auditory Processing Disorder Woodcock-Johnson Psychoeducational

(CAPD) Battery–Revised: Tests of Cognitive Ability
Childhood Disintegrative Disorder
Developmental Disorder ASSESSING CO-MORBID CONDITIONS
Fragile X Syndrome Children’s Attributional Style Questionnaire
Giftedness (CASQ)
Landau-Kleffner Syndrome Children’s Depression Inventory (CDI)
Learning Disorder Multidimensional Anxiety Scale for Children
Mental Retardation (MASC)
Mood Disorders Student Social Attribution Scale (SSAS)
Nonverbal Learning Disability
Pica
Posttraumatic Stress Disorder (PTSD) BEHAVIORAL, SOCIAL, LANGUAGE, AND

Reactive Attachment Disorder of Infancy EMOTIONAL ASSESSMENTS

or Early Childhood Assessment of Basic Language and Learning
Rett’s Disorder Skills (ABLLS)
Schizophrenia Behavior Assessment Scale for Children
Seizure Disorder (BASC)
Selective Mutism Child Behavior Checklist for Ages 11=2 to 5
Sensory Integration Dysfunction Clinical Evaluation of Language
Tic Disorders Fundamentals–Preschool
Tuberous Sclerosis Complex Communication and Symbolic Behavior Scales
(CSBS)
Communication and Symbolic Behavior
ASD AND RESEARCH Scales Developmental Profiles (CSBS DP)
Baseline Comprehensive Assessment of Spoken
Bias Language
Clinical Significance Developmental Play Assessment Instrument
Concurrent Validity (DPA)
Confidentiality Early Coping Inventory
Consent Evaluating Acquired Skills in
Control Group/Control Condition Communication–Revised (EASIC-R)
Data Functional Analysis Screening Tool (FAST)
Double Blind Motivation Assessment Scale
Empiricism School Function Assessment
Evidence Based Test of Adolescent and Adult Language–
Experimental Design Fourth Edition (TOAL4)
Incidence Test of Language Development–Intermediate,
Internal Review Board (IRB) Third Edition (TOLD-I)
Interobserver Agreement/Reliability Test of Language Development–Primary
Maintenance (TOLD-P)
Normalization Test of Pragmatic Language (TOPL)
Prevalence Test of Problem Solving–Adolescent
Testimonial (TOPS-A)
Validity Test of Problem Solving–Elementary
(TOPS-E)
Vineland Adaptive Behavior Scales–Second
ASSESSMENTS AND ASD Edition (VABS-II)
ACADEMIC ASSESSMENTS
Classroom Reading Inventory COGNITIVE ASSESSMENTS
Durrell Analysis of Reading Difficulty Absurdities
(DARD) Behavioral Assessment of the Dysexecutive
Wechsler Individualized Achievement Syndrome (BADS)
Test–Second Edition (WIAT-2) Children’s Category Test (CCT)
xviii
 GUIDE TO RELATED TOPICS

Das-Naglieri Cognitive Assessment System SENSORY ASSESSMENTS

(CAS)
Differential Ability Scales
Leiter International Performance Scale
Object Sorting Test
Social Faux Pas
Stanford-Binet Intelligence Scales–Fifth
Edition
Test of Language Competence (TLC)
Trail-Making Test
Twenty Questions Task
Universal Nonverbal Intelligence Test (UNIT)
Wechsler Intelligence Scales for Children–
Fourth Edition (WISC-IV)
DIAGNOSTIC INSTRUMENTS
Asperger Syndrome Diagnostic Scale (ASDS)
Autism Diagnostic Observation Schedule
(ADOS)
Childhood Autism Rating Scale (CARS)
Gilliam Asperger Disorder Scale (GADS)
Gilliam Autism Rating Scale (GARS)
Krug’s Asperger’s Disorder Index
INTERVIEW INSTRUMENTS
Autism Diagnostic Interview–Revised (ADI-R)
Family Assessment Interview
Adolescent/Adult Sensory Profile
Analysis of Sensory Behavior Inventory–
Revised Edition
Checklist for Occupational Therapy
Indicators of Sensory Processing Disorder
Infant/Toddler Sensory Profile
Sensory Integration and Praxis Test (SIPT)
Sensory Integration Inventory–Revised
(SII-R)
Sensory Profile
Short Sensory Profile
SOCIAL COGNITION ASSESSMENTS
Comprehensive Assessment of Spoken
Language
Test of Problem Solving–Adolescent
(TOPS-A)
Test of Problem Solving–Elementary
(TOPS-E)
TESTS IN RESEARCH PARADIGMS
Embedded Figures Test (EFT)
Object Integration Test
Prototype Formation
Tower of Hanoi (TOH)
Wisconsin Card Sorting Test (WCST)

PRE-ACADEMIC AND VOCATIONAL BIOGRAPHIES

ASSESSMENTS Asperger, Hans
Adolescent and Adult Psychoeducational Bettelheim, Bruno
Profile Bleular, Eugen
Psychoeducational Profile–Third Edition Eisenberg, Leon
(PEP-3) Kanner, Leo
Rimland, Bernard
SCREENING INSTRUMENTS Schopler, Eric
Ages and Stages Questionnaires:
Social/Emotional COMMUNICATION
Asperger Syndrome Screening Questionnaire
INTERVENTIONS
(ASSQ)
Communication Board
Autism Behavior Checklist (ABC)
Autism Screening Instrument for Educational
Planning–Second Edition PROFESSIONALS
Checklist for Autism in Toddlers (CHAT) Audiologist
Childhood Asperger Syndrome Test (CAST) Speech Language Pathologist
Modified Checklist for Autism in Toddlers
(M-CHAT) TERMINOLOGY
Pervasive Developmental Disorder Screening Concrete Language
Test-II (PDDST-II) Dysphasia
Red Flags Echoic/Verbal Behavior
Screening Tool for Autism in Two-Year-Olds Echolalia: Immediate, Delayed, Mitigated
(STAT) Expressive Language
Social Communication Questionnaire (SCQ) Figurative Language

xix
GUIDE TO RELATED TOPICS

Fluency Standard Deviation

Functions of Communication Standardization
Joint Attention Standardization Sample
Mean Length of Utterance Standardized Tests
Pedantic Speech Standard Score
Pragmatics
Pronoun Errors MISCELLANEOUS
Prosody
TERMINOLOGY
Proto-declarative
Proto-Imperative Age Appropriate
Receptive Language Association Method
Reciprocal Communication/ Attribution
Interaction Chronological Age
Social Communication Developmental Age
Social Competence Developmental Delay
Social Gaze Developmentally Appropriate Practice
Speech Delay Developmental Milestones
Symbolic Play Developmental Quotient
Developmental Surveillance
Direct Instruction
FUNCTIONAL BEHAVIOR Disability
ASSESSMENTS Distributed Practice
Engagement
Antecedent-Behavior-Consequence (ABC)
Four Steps of Perspective Taking
Analysis
Perseverative Scripting
Functional Behavior Analysis
Respite Care
Functional Behavior Assessment (FBA)
Retrospective Video Analysis (RVA)
Scales of Independent Behavior–Revised
Social Skills Defined as Sharing Space
(SIB-R)
Effectively with Others
Zone of Proximal Development (ZPD)
TERMINOLOGY
Alternative Assessment
Anecdotal Report OCCUPATIONAL THERAPY
Assessment AREAS OF IMPACT
Clinical Assessment (Educational) Atypical Behavior
Clinical Assessment (Medical) Central Coherence
Criterion-Referenced Assessment Executive Functions
Curriculum-Based Assessment Eye Gaze
Direct Observation Face Recognition
Ecological Inventory False-Belief Paradigm
Evaluation Report Hand Regard
Incident Report Hyperlexia
Informal Assessment Idiosyncratic Language
Intelligence Tests Imagination
Mental Age Imitation/Modeling
Multidisciplinary Evaluation (MDE) Mindblindness
Norm-Referenced Assessment Perseveration
Objective Presymbolic Thought
Percentile Restricted Interest
Probe Self-Injurious Behavior
Procedural Safeguards Social Play
Psychometrics Stereotypic Behavior
Screening Symbolic Thought
Single-Subject Design Theory of Mind
Social Validity Toe Walking/Equinus Gate
xx
 GUIDE TO RELATED TOPICS

TERMINOLOGY SENSORY
Gross Motor Developmental Quotient INTERVENTIONS
Locomotion Bolles Sensory Integration
Motor Imitation Hug Machine
Praxis Sensorimotor Early Childhood Activities

PROGRAMS PROFESSIONALS
Occupational Therapist
American Sign Language (ASL)
Physical Therapist
Applied Behavior Analysis (ABA)
Assistive Technology
Assistive Technology Device TERMINOLOGY
Assistive Technology Service Apraxia
Auditory Integration Training Brushing
Augmentative and Alternative Deep Pressure Proprioception Touch
Communication Technique
Cartooning Fine Motor Skills
Circle of Friends Gravitational Insecurity
Cognitive Behavior Modification Gross Motor Skills
Cognitive Learning Strategies Hyperresponsiveness
Comprehensive Autism Program Planning Hyporesponsiveness
System (CAPS) Low/Poor Registration
Developmental Individual-Difference Oral-Motor Skills
Relation-Based Intervention (DIR) Oral Sensitivity
Developmental Therapy Overselectivity/Overfocused Attention
Discrete Trial Training (Brief Definition) Proprioception
Discrete Trial Training (Extended Self-Regulation
Definition) Sensation Avoiding
Facilitated Communication (FC) Sensation Seeking
Fast ForWord Sensorimotor
Gentle Teaching (GT) Sensory History
Incidental Teaching Sensory Processing
Integrated Play Group Model (IPG) Sensory Processing Dysfunction
Life Skills and Education for Students with Sensory Sensitivity
Autism and Other Pervasive Behavioral Sensory Stimuli
Challenges (LEAP) Sensory Threshold
Milieu Teaching Somatosensory
Natural Language Paradigm Tactile
Options (Son-Rise Program) Tactile Defensiveness
Picture Exchange Communication System Touch Pressure
(PECS) Touch Therapy
Pivotal Response Training Vestibular
Play-Oriented Therapies Visual-Motor
Positive Behavior Support (PBS) Wilbarger Protocol
Precision Teaching
SCERTS Model
Sensory Integration STRATEGIES
Sibshops Biofeedback
Social Skills Training Double Interview
Structured Teaching (TEACCH) Embedded Skills
Total Communication Four Steps of Communication
van Dijk Approach Good Grief!
Verbal Behavior Graphic Organizer
Ziggurat Model I LAUGH Model of Social Cognition
xxi
GUIDE TO RELATED TOPICS

Irlen Lenses Video Self-Modeling

Joint Action Routines Virtual Environment
Lindamood-Bell Visual Strategies
Neurofeedback
Patterning (Doman-Delacato Treatment)
Power Card Strategy THERAPIES
Priming Animal Assisted Therapy/Assistance Dog
Situation-Options-Consequences-Choices- Placements for Children with Autism
Strategies-Simulation (SOCCSS) Art Therapy
Social Autopsies Dance Therapy
Social Behavior Mapping Diet Therapy
Social Scripts Hippotherapy
Social Stories Music Therapy
Social Thinking Occupational Therapy
Storymovies Physical Therapy
Surthrival Speech Therapy
Video Modeling Touch Therapy

xxii
 A
ABSURDITIES
Absurdities refer to the verbal and pictorial components of the Stanford-Binet
Intelligence Scales designed to test nonverbal knowledge.
JEANNE HOLVERSTOTT

ACCOMMODATION
Accommodations are changes made to the general education curriculum or instruc-
tional techniques that do not substantially change the requirements of the curriculum
or standards, but assist the student in making adequate progress. The accommodations
are determined by the Individualized Education Program (IEP) team and are docu-
mented on the IEP. Accommodations must be provided in all appropriate environ-
ments and subject areas.
KATHERINE E. COOK

ACTIVITIES OF DAILY LIVING

Activities of daily living refer to the ongoing behaviors that occur on a daily basis.
Such behaviors include eating, cooking, bathing, social interactions (such as leisure
activities, attending school or work, or assisting with chores), and other activities that
one might routinely expect an individual to perform or participate in. For many
school-aged students, the skills to perform daily activities and develop independence
for adult life may be included in the student’s Individualized Education Program
(IEP) as goals and objectives.
ANDREA M. BABKIE

ADAPTIVE BEHAVIOR
Adaptive behavior refers to the manner in which a person copes with the demands
of the environment. It includes responses to biological demands (e.g., hunger), as well
as social demands such as community expectations (e.g., following rules, personal
responsibility), interpersonal requirements (e.g., communication, socialization), and
practical challenges of daily living (e.g., using money, preparing meals, toileting;
Nihira, Leland, & Lambert, 1992).
ADAPTIVE BEHAVIOR

A significant deficit in adaptive behavior is a

key criterion in the diagnosis of mental retarda-
tion (APA, 2000). In adaptive behavior assess-
ment, clinicians commonly use checklists and
questionnaires that yield standardized scores
comparing a person’s level of adaptive function-
ing with age-matched samples (see Vineland
Adaptive Behavior Scales). These instruments
are also used to determine the individual’s rela-
tive adaptive strengths and weaknesses, as well
as to identify ‘‘next step’’ instructional goals.
For example, if it is determined that a child is
using a spoon at mealtime, consideration might
be given to instruction in using a fork.
Level of adaptive functioning is determined by
both the repertoire of adaptive skills an individ-
ual possesses and his or her ability to use those
skills at the appropriate times. For example, in
order to keep their hands clean, individuals must
be able to carry out the multistep skill of hand
washing (e.g., turning on the faucet, applying
soap, and so on), use that skill when necessary
Requesting help is an important adaptive skill. (e.g., before lunch), and complete it appropri-
ately (e.g., without taking ‘‘too much time’’ or
requiring repeated prompting from others in a school or vocational setting).
Independent of overall level of cognitive functioning, persons with autism display
significant deficits in the ability to apply the skills that they possess in adaptive ways.
For example, they may have relatively large vocabularies but use spoken language
almost exclusively to make requests rather than to interact with peers. Similarly, they
may demonstrate a relative strength in reading or arithmetic, but not use the skill to
participate in classroom activities (Carter et al., 1998). Self-care skills, such as dress-
ing and toileting, are often areas of relative strength; however, because of the complex
social and practical requirements of these tasks, specialized instruction is often neces-
sary in these areas as well (VanMeter, Fein, Morris, Waterhouse, & Allen, 1997). Due
to this ‘‘scattered’’ profile, careful adaptive behavior assessment is necessary.
Through systematic instruction, as well as specialized supports (e.g., picture-based
prompts or directions), persons with autism may learn complex adaptive skills and
eventually generalize those skills to relevant settings. For example, communication
and social skills (e.g., problem solving, requesting help) may be taught through speci-
alized curricula implemented with a combination of structured and incidental teach-
ing (e.g., Frost & Bondy, 2002; McGinnis & Goldstein, 1997). Daily living skills,
such as toileting and tooth brushing, may be taught using task analytic procedures that
break activities down into small units of instruction (Baker & Brightman, 1997).
Because the construct of adaptive behavior focuses upon participation in everyday
activities, it is a key consideration in comprehensive curricula designed to promote in-
dependence and quality of life.
2
 ADOLESCENT AND ADULT PSYCHOEDUCATIONAL PROFILE

REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
Baker, B. L., & Brightman, A. J. (1997). Steps to independence: Teaching everyday skills to children
with special needs. Baltimore: Brookes Publishing Co.
Carter, A. S., Volkmar, F. R., Sparrow, S. S., Wang, J., Lord, C., Dawson, G., et al. (1998).
The Vineland Adaptive Behavior Scales: Supplementary norms for individuals with autism.
Journal of Autism and Developmental Disorders, 28, 287–302.
Frost, L., & Bondy, A. (2002). The picture exchange communication system training manual (2nd
ed.). Newark, DE: Pyramid Educational Products, Inc.
McGinnis, E., & Goldstein, A. P. (1997). Skillstreaming the elementary school child (2nd ed.).
Champaign, IL: Research Press.
Nihira, K., Leland, H., & Lambert, N. (1992). AAMR Adaptive Behavior Scale-Residential and
Community: Examiner’s manual. Austin, TX: Pro-Ed.
VanMeter, L., Fein, D., Morris, R., Waterhouse, L., & Allen, D. (1997). Delay versus
deviance in autistic social behavior. Journal of Autism and Developmental Disorders, 27,
557–569.
DANIEL W. MRUZEK

ADHD. See Attention Deficit Hyperactivity Disorders

ADOLESCENT/ADULT SENSORY PROFILE

The Adolescent/Adult Sensory Profile (Brown & Dunn, 2002) was designed to
identify sensory processing patterns in individuals 11 years and older. An individual
can self-evaluate by completing a Self-Questionnaire that addresses how an individual
typically responds to various situations and experiences. It is used to identify patterns
of sensory processing consistent with those described in Dunn’s Model of Sensory
Processing. The items on the profile address the areas of taste/smell, visual, touch,
movement, auditory, and activity level.

REFERENCE
Brown, C., & Dunn, W. (2002). Adolescent/Adult Sensory Profile manual. San Antonio, TX: Har-
court Assessment.
LISA ROBBINS

ADOLESCENT AND ADULT PSYCHOEDUCATIONAL PROFILE

The Adolescent and Adult Psychoeducational Profile (AAPEP; Mesibov, Schopler,
Schaffer, & Landrus, 1989) is an extension of the Psychoeducational Profile-Revised
designed as an assessment instrument for the TEACCH program. The AAPEP is ap-
plicable to the needs and goals of adolescents and adults with autism spectrum disor-
der (ASD), and is used to provide an evaluation of current and potential skills that
are necessary for successful, semi-independent functioning in the home and the com-
munity. It contains a Direct Observation Scale, a Home Scale, and a School/Work
Scale, with each scale divided into six function areas: vocational skills, independent
functioning, leisure skills, vocational behavior, functional communication, and inter-
personal behavior.
3
ADULT SUPPORTS

REFERENCE
Mesibov, G., Schopler, E., Schaffer, B., & Landrus, R. (1989). Adolescent and adult psychoeduca-
tional profile: Individualized assessment and treatment for autistic and developmentally disabled chil-
dren. Austin, TX: Pro-Ed.
JEANNE HOLVERSTOTT

ADULT SUPPORTS
Individuals with autism transitioning into adulthood continue to require habilita-
tion to prepare for community-based day and vocational programs and the possibility
for competitive employment, with or without supports. Individuals must be provided
the opportunity to attain independence through a variety of services to include all
realms of daily living across all environmental settings. Services consist of supports
ranging from counseling, extended care, employment, family, financial, and health.
Counseling supports are provided through face-to-face, individual, group, or family
therapy. Sessions are designed to promote problem-solving skills, to improve commu-
nication, and to address behavioral, emotional, and cognitive concerns. Crisis inter-
vention is available in emergency situations when individuals experience specific and
time-limited problems that threaten to disrupt their home, school, or community
situations.
Extended care supports include recreation, habilitative, and social components. Rec-
reational supports offer leisure and social activities to promote interactions with mem-
bers of the community as well as developing hobbies one can participate in
independently at home or in the community. Day habilitation services provide a non-
residential setting, separate from the individual’s home residence. Transition and adap-
tation skills are addressed according to skill levels and interests and assist in
improving skill acquisition, retention, self-help, socialization, and motor manipulation.
Further development of social skills, communication, safety awareness, and daily living
skills is essential to increasing independence. Social components are integrated
throughout both recreation and day habilitation services.
Employment supports include all aspects of transitioning into the workforce and
continued vocational support. Individualized assistance includes vocational training,
job coaching, travel training, technological aids, job placement, and employment
maintenance. Services may include job training, on- or off-site, to enhance job duty
performance, work behaviors, use of community resources, and transportation to and
from the workplace. More information is available at the local vocational rehabilita-
tion office.
Family supports include licensed residential programs, support groups, in-home ser-
vices, respite care, parent advocacy and training, and service coordination. Services
begin with a referral to a service provider. The service provider will then go through
an intake process to identify needs and link to services after establishing eligibility.
Coordinators then use a person-centered process to develop, implement, and maintain
an Individualized Family Service Plan and to determine the level of support the indi-
vidual and/or family needs. Parent support and education is provided through parent
advocacy and training. In the event an individual becomes unable to be cared for in
the home, residential services may be sought, including supervised group living, semi-
independent group living, and other residential options.
4
 ALLERGY

Financial supports offer guidance and consultation about sources of funding, bene-
fits, and entitlements. More information is available at the local Social Security
Office.
Depending upon the individual’s needs and insurance coverage, health care supports
may consist of medical, dental, and other health-related services. More information
can be obtained by contacting the individual insurance company.
See also self-determination.
STACEY L. BROOKENS

ADVOCATE
An advocate is an individual who speaks, writes, or acts on behalf of another, espe-
cially in a legal context. According to the Americans with Disabilities Act (ADA)
of 1990 (PL 101-336), individuals with disabilities and their families may advocate for
themselves or appoint another to do so.

REFERENCE
Americans with Disabilities Act, 42 U.S.C. §§ 12101-12213 (1990).
JEANNE HOLVERSTOTT

AGE APPROPRIATE
Age appropriate refers to the principles used for students with disabilities when a
decision is required for placement, setting, and environment. Based on chronological
age, not mental age, children with disabilities should be served in the same setting
and environment with their nondisabled peers of the same or similar age.
KAI-CHIEN TIEN

AGES AND STAGES QUESTIONNAIRES: SOCIAL/EMOTIONAL

Ages and Stages Questionnaires: Social/Emotional (ASQ: SE; Squires & Potter,
2004) is a screening system used to evaluate social-emotional development at various
stages (6, 12, 18, 24, 30, 36, 48, and 60 months). Completed in approximately 15
minutes by parents or caregivers at the eight designated intervals, the ASQ: SE
screens the following behavioral areas: self-regulation, compliance, communication,
adaptive functioning, autonomy, affect, and interaction with people.

REFERENCE
Squires, J., & Potter, L. (2004). Ages and stages questionnaires. Baltimore: Brookes Publishing Co.
JEANNE HOLVERSTOTT

ALLERGY
An allergy is an exaggerated reaction to a specific or multiple substances. This reac-
tion is specific to the immune system. Symptoms to specific substances produce no ill
effects or symptoms to the majority of individuals. Allergic reactions occur through
exposure via the skin, respiratory system, or the stomach and intestinal system.
KATHERINE E. COOK
5
ALTERNATIVE ASSESSMENT

ALTERNATIVE ASSESSMENT
Alternative assessment measures are nontraditional approaches to obtaining informa-
tion regarding a student’s strengths and needs. The information gained from these mea-
sures directly relates to current and future curricular content. Examples of alternative
assessments include the portfolio assessment, performance-based assessment, authentic
assessment, curriculum-based assessment, and criterion-referenced assessment.

FURTHER INFORMATION
Overton, T. (2003). Assessing learners with special needs: An applied approach. Upper Saddle
River, NJ: Merrill/Prentice Hall.
THERESA L. EARLES-VOLLRATH

AMERICAN SIGN LANGUAGE (ASL)

American Sign Language (ASL) is a special visual language that has existed for
over 200 years. ASL relies on visual/manual properties and requires visual perception
for decoding and encoding. The production of ASL involves movement in space and
is formed using hands, body, and facial expressions. Individuals are able to communi-
cate the meaning of a concept through a single sign or combination of signs. ASL has
been compared and contrasted to many other languages and is reported as having a
similar structure, however it varies greatly from the English language (which has audi-
tory/spoken properties). A key difference from other languages is the way in which
ASL is acquired. ASL is usually learned through a peer transmission process, rather
than through the passing on of a language from generation to generation within fami-
lies. The most fluent users of ASL are children who have deaf parents and children
who have attended schools for the deaf or residential schools.
RASCHELLE THEOHARRIS

AMERICANS WITH DISABILITIES ACT (ADA)

The most comprehensive legislation that protects the rights of individuals with dis-
abilities is the Americans with Disabilities Act (ADA). This legislation applies to both
public and private sectors, including libraries, state and local governments, restaurants,
hotels, theaters, transportation systems, and stores (Fleischer & Zames, 2001).
Prior to ADA, several laws served as the driving force in the creation of the Ameri-
cans with Disabilities Act. The Civil Rights Act of 1964 prohibited discrimination
based on race, color, sex, religion, and national origin in employment, public accom-
modations, and the provision of state and local government services. A decade later
in 1973, the Federal Rehabilitation Act protected the civil and constitutional rights
of people with disabilities. Section 504 of the Federal Rehabilitation Act of 1973
prohibited against discrimination of people with disabilities involved in a program or
activity receiving federal assistance. Both of these laws guaranteed that people with
disabilities would not be discriminated against in certain areas of their life, such as in
being served at lunch counters, bus stations, and as recipients of federal assistance.
However, these laws did not protect people with disabilities who sought employment
where the company did not receive federal funding or assistance.
The Americans with Disability Act provided this protection by regulating the rights
of people with disabilities in the public and private sectors. ADA provided full
6
 AMYGDALA

citizenship, independent living, and economic self-sufficiency for people with disabil-
ities, assuming equality of opportunity (Turnbull, Turnbull, Shank, & Leal, 1999) as
well as the accommodations needed in public places for people with disabilities to use.

COMPONENTS OF THE AMERICANS WITH DISABILITIES ACT

As stated in Section 3 of the Americans with Disabilities Act, disability is defined
as (a) a physical or mental impairment that substantially limits one or more of
the major life activities of such individual; (b) a record of such an impairment; or
(c) being regarded as having such an impairment (ADA, 1990). In addition, ADA
also applies to those who have an association with an individual known to have a dis-
ability (such as a parent) as well as those who are coerced or subjected to retaliation
for assisting people with disabilities.
ADA is divided into five titles. Title 1, or Employment, addresses business accom-
modations, such as restructuring jobs, altering the layout of workstations, or modifying
equipment. Applying for a job, hiring, pay, and benefits are also covered under Title I.
Title II, or Public Services, includes state and local government, public transportations
systems, and other commuter authorities. The third title, or Public Accommodations,
gives rules and regulations to all new construction and existing facilities to be accessi-
ble to all people with disabilities. This includes hotels, restaurants, grocery stores, and
privately owned transportation systems. Title IV, or Telecommunications, regulates
that all telecommunication companies offering telephone service must have telephone
relay services for individuals with disabilities. The final title, or Miscellaneous, includes
a provision prohibiting coercion or threatening people with disabilities from asserting
their rights under ADA or retaliating against those that speak up for their rights.

REFERENCES
Americans with Disabilities Act, 42 U.S.C. §§ 12101-12213 (1990).
Fleischer, D. Z., & Zames, F. (2001). The disability rights movement: From charity to confrontation
(pp. 88–109). Philadelphia: Temple University Press.
Turnbull, A., Turnbull, R., Shank, M., & Leal, D. (1999) Exceptional lives: Special education in
today’s schools. (2nd ed.) Upper Saddle River, NJ: Prentice Hall.
MELISSA L. TRAUTMAN

AMINO ACIDS
Amino acids are the building blocks of proteins. There are approximately 80 natu-
rally occurring amino acids, of which 20 are necessary for human growth and health.
The body is capable of producing some amino acids in the liver, but others must be
obtained from food. Some food proteins contain all the necessary amino acids and are
therefore considered to be complete proteins such as milk, cheese, eggs, and meat.
Vegetables and grains are considered incomplete proteins.
BRUCE BASSITY

AMYGDALA
A brain structure located deep in the temporal lobes, the amygdala is involved in
perceiving threats and producing a response to such threats. It receives input directly
and quickly from sensory pathways as well as from other areas of the brain that filter
7
ANALYSIS OF BEHAVIORAL FUNCTION

the sensory input and put it into context so an appropriate response can be made.
The amygdala is part of the limbic system.
BRUCE BASSITY

ANALYSIS OF BEHAVIORAL FUNCTION

Analysis of behavioral function is a process of determining the function of a chal-
lenging behavior. This is a data-driven process that often includes direct observation
and the use of formal assessment measures designed to assess behavioral functions.
These tools are used to form a hypothesis regarding the function of the behavior; this
hypothesis is tested with the implementation of strategies designed to replace the
undesirable behavior with appropriate behavior.
JEANNE HOLVERSTOTT

ANALYSIS OF SENSORY BEHAVIOR INVENTORY–REVISED EDITION

The Analysis of Sensory Behavior Inventory–Revised (ASBI-R; Morton & Wolford,
1994) is designed to collect information about an individual’s behaviors as they are
related to sensory stimuli. It assesses six sensory areas and is designed to evaluate both
sensory-seeking and sensory-avoidance behaviors within each modality. The ASBI-R
can be completed by anyone who is familiar with the individual and may be done
individually or by a group. Results may be used to develop effective intervention strat-
egies and accommodations.

REFERENCE
Morton, K. & Wolford, S. (1994). Analysis of Sensory Behavior Inventory–Revised. Arcadia, CA:
Skills with Occupational Therapy.
LISA ROBBINS

ANECDOTAL REPORT
The anecdotal report is a technique used to describe behavior. An observer watches
a person or group of people and writes down what they observe during a specified time
period. This provides rich information about behavior and should also include a
description of the setting, what others say and do, and time notations.

FURTHER INFORMATION
Alberto, P. A., & Troutman, A. C. (2003). Applied behavior analysis for teachers (6th ed). Upper
Saddle River, NJ: Merrill/Prentice Hall.
PAUL G. LACAVA AND RASCHELLE THEOHARRIS

ANGELMAN SYNDROME
Angelman syndrome is a rare (approximately 1 in 25,000 births) genetic disorder
that results in severe neurological problems. It is named after Dr. Harry Angelman,
the pediatrician who discovered the common traits evident in three of his patients.
He first named it ‘‘Happy Puppet’’ syndrome, based on several features characteristic
to the three children. Over the years, the name was changed to the more respectful
‘‘Angelman syndrome.’’
8
 ANGELMAN SYNDROME

Angelman syndrome is caused by one of several problems with gene material on

chromosome 15. One of the most common is a deletion or ‘‘turning off’’ of some
genes from the maternal chromosome 15. There may also be a mutation of this partic-
ular genetic material, or a double portion from the father’s chromosome 15, or an
imprinting defect, and in some cases, there is no apparent cause found on chromo-
some 15.
Common prenatal tests cannot bring these genetics problems to light. It is difficult
to detect Angelman syndrome from birth to about three months of age. As these
babies develop and grow, the identifiable characteristics become apparent. Since this
is a syndrome, and there are varying problems on chromosome 15, not all features will
be present in each child with Angelman syndrome. Some children may be more or
less affected than others.
The most frequently cited characteristics include:

¥ Little or no spoken language, although receptive language may be somewhat better

¥ Unusually affectionate
¥ Very happy affect, including bursts of laughter and giggling
¥ Severe developmental delays (mental retardation)
¥ Disjointed, awkward gait and large muscle movements
¥ Some unusual features, including a distinct mouth, protruding tongue, and somewhat flat-
tened head
¥ Seizures of all kinds
¥ Sleep problems such as insomnia
¥ Impulsive behaviors, extreme hyperactivity
¥ Dual diagnosis of autism
¥ Misdiagnosed as having cerebral palsy, autism, etc.
¥ Obsessions with water

There is no cure or remediation for Angelman syndrome, although use of best prac-
tices in a well-designed and implemented IEP via special education services can ensure
a brighter future than was previously imagined possible. Use of augmentative and al-
ternative communication systems such as the Picture Exchange Communication Sys-
tem, signing, and/or communication devices all can improve quality of life. Use of
behavioral strategies that include applied behavior analysis and positive behavior sup-
ports can be used to teach new skills as well as help the individual learn to control
disruptive behaviors. Making environmental changes that can help with impulsive
behaviors and ensure personal safety can make it easier for the individual with Angel-
man syndrome to enjoy family, school, and community life.
Students with Angelman syndrome can be included in neighborhood schools with
special education supports; some can participate in athletic and leisure activities
shared by the rest of the family. Due to impulse problems that impact sleeping and
safety issues as well as extreme cognitive delays, they most likely will require constant
supervision and not be able to live unassisted.
Parents report some of their greatest challenges as being sleep deprived due to their
child’s insomnia, finding the proper medications for seizures, continual household
chaos caused by the child’s hyperactivity, and teaching toileting skills. Again, getting
good behavioral and medical supports to help with some of the traits of Angelman
syndrome can vastly improve the quality of home life for the entire family.
9
ANIMAL ASSISTED THERAPY/ASSISTANCE DOG PLACEMENTS FOR CHILDREN WITH AUTISM

See also augmentative and alternative communication; Picture Exchange Communi-

cation System.

FURTHER INFORMATION
Angelman Syndrome Foundation; 3015 E. New York Street, Suite A2265; Aurora, IL 60504;
Phone: 1-800-432-6435; Fax: 630-978-7408; E-mail: info@angelman.org.
ANN PILEWSKIE

ANIMAL ASSISTED THERAPY/ASSISTANCE DOG PLACEMENTS FOR

CHILDREN WITH AUTISM
Intelligent selection of a canine partner is of central importance in creating a suc-
cessful assistance dog placement for a child on the autism spectrum. The job descrip-
tion of a dog slated to work with a child with autism should be individually tailored
to meet the unique needs of the child; the training of the dog, as well as the teaching
of the child, should be positive, not corrections based, and should move in tandem
with both the dog’s and the child’s natural development. Educated parental involve-
ment, appropriate temperamental fit, and proper supervision of the child-dog team are
all essential elements in creating an assistance dog placement that is safe as well as
effective.
Creating assistance dog placements for children on the autism spectrum differs from
creating placements between assistance dogs and physically challenged adults. Specific
task training takes a back seat to being certain the assistance dogs selected are safe
and social companions to the children on the autism spectrum that they will serve.
The primary emphasis in selecting an assistance dog must be on achieving a correct
temperamental fit between the child and the puppy, along with having the puppy’s
early socialization dovetail with his or her future role. Without specific exposure to
the profile of a child with autism, a puppy has no clue as to how to interpret autistic
behaviors and therefore may react unpredictably. Children with autism may throw
loud tantrums or fail to grant the body space that we unconsciously and consistently
grant each other. Dogs depend greatly on nonverbal communication, and are apt to
be uncomfortable with a child’s violation of their ‘‘personal space’’ or with a child’s
unusual sounds or movements; but with proper communication and appropriate early
socialization, a puppy can easily learn to interpret a child’s unusual behavior as posi-
tive events that are predictive of reward.
Considerable energy should also go into teaching the child to interact appropriately
with his or her dog. As the quality of the relationship they share matters more than
any other variable, the communication between the puppy and child must be properly
facilitated. The same difficulties with communication that children with autism expe-
rience with people can exist with dogs as well, as dogs take their cues from humans
regarding how relationships are structured. It is important for the caretakers of a child
with autism to understand that their role is to ensure that the relationship between
child and puppy is consistently gentle and mutually enjoyable.
The concept of ‘‘time out’’ with an assistance dog reliably holding a down-stay posi-
tion to provide comfort and support can be a positive way for a child with autism to
regain control over his emotions, as research has shown the mere presence of a trusted
10
 ANIMAL ASSISTED THERAPY/ASSISTANCE DOG PLACEMENTS FOR CHILDREN WITH AUTISM

dog can have a calming effect on a child. Use of the assistance dog can be preventive,
as a dog may be employed as part of a structured activity to reduce stress and avoid
meltdowns. Assistance dogs can be used to help meet other therapeutic goals, such as
those established in occupational or physical therapy, either directly, such as being
brushed or fed by his or her child, or simply by providing motivation. (One little girl
took a break to pet her North Star dog after every 10 repetitions of a particularly gru-
eling exercise.)
Children with autism often have great difficulty in generalizing learned speech to
new situations and people, due to their overly selective attention and tendency to
respond to only a limited number of cues; using an assistance dog as a tool for teaching
pragmatic language at home as well as in the community can be as simple as rehearsing
stock responses to the fairly predictable questions people are likely to ask when they see
a well-trained dog wearing a vest with a patch that reads ‘‘Please Ask to Pet Me.’’ As
children with autism tend to be dependent on verbal cues provided by others, this posi-
tive and predictable social response is a valuable tool to help develop speech within
natural settings in the home as well as the outside community. It should also be noted
that people who may have shied away from the responsibility of starting a conversation
with a child with autism, as well as maintaining it, often relax and rise to the challenge
when a dog is available to help structure the questions and comments.
Occasionally an assistance dog can also provide a safety role for a child with autism,
either by being trained to deliver a warning bark when a child with autism wanders
away or to shadow his or her charge (in which case a global positioning device and
an easy-to-read name tag attached to the dog’s collar may well help a nonverbal child
to be safely returned home). A technique known as blocking is also being developed at
North Star Foundation; this technique can only be employed if a child is small
enough in comparison to the dog to be safely blocked when in flight. National Service
Dogs (NSD) in Canada tethers assistance dogs to some children with autism who are
prone to running off, but this method of keeping a child safe can only be employed if
the child is small enough to be physically stopped by the weight of the assistance dog.
Unfortunately, some children are not good candidates for placements involving a
dog, such as children who are aggressive. Some children with poor impulse control
may still be appropriate candidates for an older, more stable dog with the necessary
guidance and supervision, but in general children who tend to lash out physically are
not good candidates for an assistance dog unless such tendencies are brought under
strict control. For the right child on the autism spectrum, a properly selected and
trained canine companion can be a valuable tool in helping to achieve social, emo-
tional, educational, and safety goals.

FURTHER INFORMATION
Gross, P. D. (2006). The golden bridge: A guide to assistance dogs for children challenged by autism
or other developmental disabilities. West Lafayette, IN: Purdue University Press.
McNicholas, J., & Collis, G. M. (1995). Relationships between young people with autism and
their pets. Paper presented at the 7th International Conference on Human-Animal Interac-
tions, Animals, Health and Quality of Life, September 6–9, 1995, Geneva, Switzerland.
North Star Foundation: www.NorthStarDogs.com E-mail: northstarfoundation@charter.net.
Toeplitz, Z., Matczak, A., Piotrowska, A., & Zygier, A. (1995). Impact of keeping pets at home
upon the social development of children. Paper presented at the 7th International Conference on

11
ANNUAL GOAL

Human-Animal Interactions, Animals, Health and Quality of Life, September 6–9, 1995,
Geneva, Switzerland.
PATTY DOBBS GROSS

ANNUAL GOAL
A required component of the Individualized Education Program, annual goals is a
statement of desired educational attainment for an individual student that is written
based on information from the present level of educational performance. Annual
goals must be written in measurable terms, include the skill or behavior to be
achieved and direction for the behavior. They are written for a 1-year period and must
contain either short term objectives or benchmarks.
KATHERINE E. COOK

ANTECEDENT
The antecedent is the behavior that precedes a given situation or behavior. Since
behavior cannot occur in isolation, what occurs in the environment before the behav-
ior (the antecedent) and after the behavior (the consequence) is often key to address-
ing or changing the behavior. The antecedent may provide insight into the purpose or
function of behavior. For this reason, most functional behavior assessments include
the observation and recording of antecedents, such as on an Antecedent-Behavior-
Consequence (ABC) Analysis.
KATIE BASSITY

ANTECEDENT-BEHAVIOR-CONSEQUENCE (ABC) ANALYSIS

Antecedent-Behavior-Consequence analysis was first described by Bijou, Peterson,
and Ault (1968) as anecdotal observation, a process of analyzing the events that precede
and follow a behavior. The conditions may be modified to change the behavior.

REFERENCE
Bijou, S. W., Peterson, R. F., & Ault, M. H. (1968). A method to integrate descriptive and ex-
perimental field studies at the level of data and empirical concept. Journal of Applied Behavior
Analysis, 1, 175–191.
JEANNE HOLVERSTOTT

ANTIANXIETY MEDICATIONS
Antianxiety medications include various drug classes that are used depending on
the severity of anxiety, length of treatment, and age. Drugs that have a mild sedative
effect and are short acting such as hydroxyzine (Atarax) or diphenhydramine
(Benadryl) are commonly used for short-term relief. Hypnotics like benzodiazepines
(Valium family) are used along with some others for more significant agitation. A
number of the newer selective serotonin reuptake inhibitors (SSRI) and antidepres-
sants also have antianxiety properties and are specifically indicated for treatment of
various kinds of anxiety.
See also antidepressant medications.
BRUCE BASSITY
12
 ANXIETY DISORDERS

ANTIBIOTICS
Antibiotics are medications used to treat infectious disease. This may involve treat-
ment to eliminate microorganisms causing acute infection, or prevention or mainte-
nance of a less acute or chronic infection. Antibiotics may be broad spectrum
(effective against many different microorganisms), or narrow spectrum (specific for just
a few microorganisms). Antibiotics may be used in oral, injectable, intravenous, or
topical form.
BRUCE BASSITY

ANTIDEPRESSANT MEDICATIONS
A variety of medications are prescribed to alleviate the signs and symptoms of
depression and some have additional uses as well. The most prescribed class of these is
known as selective serotonin reuptake inhibitors (SSRI) such as paroxetine (Paxil),
fluoxetine (Prozac), and sertraline (Zoloft). Older antidepressants that are less used
include tricyclics (TCA) and monoamine oxidase inhibitors (MAOI). There are addi-
tional older and newer groups as well. Most antidepressants alter neurotransmitter ac-
tivity, specifically serotonin, norepinephrine and dopamine.
BRUCE BASSITY

ANTIPSYCHOTIC MEDICATIONS
These medications are most commonly used for treating conditions such as schizo-
phrenia, but some of the newer medications have broader uses. There are three cate-
gories: (a) typical, which are the oldest medications and include chlorpromazine
(Thorazine), haloperidol (Haldol), and fluphenazine (Prolixin); (b) atypicals, which
include clozapine (Clozaril), ziprasidone (Geodon), risperidone (Risperdal), quetiapine
(Seroquel), and olanzapine (Zyprexa); and (c) others, which includes aripiprazole
(Abilify). All of these medications can have potentially serious side effects, some of
which can be irreversible. Careful monitoring is required by the healthcare provider.
BRUCE BASSITY

ANXIETY DISORDERS
Anxiety disorders include social phobia, obsessive compulsive disorder, posttrau-
matic stress disorder, and generalized anxiety disorders.
Social phobia (or social anxiety disorder) is characterized by marked and substantial
distress or discomfort in social situations such as meeting new people, appearing for
interviews, and speaking in public. For something to be considered a phobia, the
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; APA, 2000)
states that for individuals under 18 years of age, the fear must persist for at least 6
months and be intense enough to interfere with normal activities. Children may not
complain about their fears, but when placed in the feared situation may express their
anxiety by crying, having tantrums, freezing, or clinging. Adolescents and adults are
more likely to experience a panic attack—several minutes of terror where they feel
they are about to have a heart attack, lose control or ‘‘go crazy’’ (Gelfland, Jensen, &
Drew, 1997, p. 174). A diagnosis of social phobia should not be made in an individual
with an autism spectrum disorder because degrees of anxiety are often present in this
13
ANXIETY DISORDERS

population. However, there may be occasions when the distress and symptoms are so
severe that diagnosis and treatment beyond the autism spectrum disorders are
warranted.
Obsessive compulsive disorder (OCD) is a condition where either obsessions
(abnormal thoughts, impulses or images) or compulsions (repetitive acts that the indi-
vidual feels they must complete) or both are present. DSM-IV-TR (APA, 2000) states
that they must also meet the following: (a) are unrealistic and dysfunctional, (b) are
experienced as unwelcome but irresistible, (c) are experienced as products of one’s
own mind and not external in origin, (d) are ritualistic and stereotyped, (e) are time-
consuming, taking more than 1 hour each day, and disrupting other activities.
Typical obsessive themes by school-age children involve aggression, contamination,
and maintaining order (Clarizio, 1991), and both children and adults are more likely
to engage in rituals at home rather than in public. Obsessions and ritualistic behaviors
are often seen in autism spectrum disorders but do not usually meet the specific crite-
ria for OCD as previously outlined and would not warrant a separate diagnosis of
OCD in the majority of cases.
Posttraumatic stress disorder (PTSD) is an anxiety disorder that develops following
a traumatic experience such as witnessing a severe accident, assault, natural catastro-
phe, life-threatening illness, and sexual or physical abuse. PTSD can develop immedi-
ately following the event, but may appear months or years afterwards. Primary
symptoms in children include agitated and disorganized behavior, re-enacting of the
traumatic event or avoidance of anything associated with it, difficulty sleeping, irrita-
bility, attention problems, exaggerated startle responses, and hypervigilance. Children
may also show physical symptoms such as stomach aches or headaches, regression, loss
of toilet training, or clingy behaviors.
Generalized anxiety disorder (GAD) consists of uncontrollable, excessive anxiety
and worry, occurring consistently for at least 6 months, and pervasive in that it covers
several events or activities. Other characteristics required for the diagnosis include
irritability, restlessness, fatigue, muscle tension, concentration difficulties, or sleep dis-
turbance. According to Beidel, Christ, and Long (1991), the persistent disorder in
childhood usually begins around 10 years of age and often co-occurs with depression.
While many difficulties with anxiety can be seen in children and adults with au-
tism spectrum disorders, the differentiation here is due to the specificity of the anxi-
ety difficulties. Usually, therefore, anxiety disorders are not given as co-morbid
diagnoses to ASD except in circumstances where the impact of the anxiety difficul-
ties has become so pervasive and interfering with normal functioning that additional
diagnosis and anxiety treatment measures are appropriate. Treatments for anxiety dis-
orders include psychotherapy and pharmacological treatments (Gelfland et al., 1997,
pp. 170–192).

REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
Beidel, D. C., Christ, M. G., & Long, P. J. (1991). Somatic complaints in anxious children.
Journal of Abnormal Child Psychology, 19, 659–670.
Clarizio, H. F. (1991). Obsessive-compulsive disorder: The secretive syndrome. Psychology in the
Schools, 28, 106–115.

14
 APPLIED BEHAVIOR ANALYSIS (ABA)

Gelfland, D. M., Jensen, W. R., & Drew, C. J. (1997). Understanding child behaviour disorders
(3rd ed.). Orlando: Harcourt Brace.

FURTHER INFORMATION
Csoti, M. (2003). School phobia, panic attacks and anxiety in children. London: Jessica Kingsley
Publishers.
March, J. S., & Mulle, K. (1998). OCD in children and adults. London: Guilford Press.
FIONA J. SCOTT

APPLIED BEHAVIOR ANALYSIS (ABA)

Applied Behavior Analysis (ABA) employs principles of learning theory to help
people change behaviors and learn new skills (Cooper, Heron, & Heward, 1987).
ABA is perhaps best known as an intervention for persons with autism spectrum disor-
ders (ASD), but it is also used effectively for other populations, including children
and adults with attention deficit hyperactivity disorder, conduct disorder, schizophre-
nia, and developmental delays. In addition, ABA is also used for teaching academic
skills in both general and special education settings, for increasing productivity in the
workplace, and for promoting healthy lifestyles.
As defined originally by Baer, Wolf, and Risley (1968), the term applied means that
ABA focuses on socially relevant outcomes. For example, when ABA interventions
for individuals with ASD were initially developed in the 1960s and 1970s, a primary
goal was to enable these individuals to move out of institutional settings such as state
hospitals (Lovaas, Koegel, Simmons, & Long, 1973), where most lived at that time.
Later ABA interventions centered on increasing opportunities for inclusion in com-
munity settings such as general education classes in public schools (Lovaas, 1987) and
improving relationships with peers and caregivers (Koegel & Koegel, 2005).
The term behavioral in ABA reflects an emphasis on measurable outcomes. Accord-
ing to Baer et al. (1968), any action that can be measured is a behavior. Thus, the
defining features of ASD (problems with reciprocal social interaction, limited social
communication, and intense repetitive behaviors or narrow interests) are all consid-
ered behaviors. In addition, associated features of ASD (characteristics such as delays
in cognitive and self-help skills that are displayed by many but not all individuals with
this diagnosis) are also viewed as behaviors.
Finally, the term analysis as used indicates that decisions about interventions derive
from an examination of data. Thus, ABA investigators conduct studies in which they sys-
tematically start and stop interventions to determine whether they reliably change
behavior. Such research has identified an array of interventions that can help individuals
with ASD. When ABA practitioners implement these interventions for a particular indi-
vidual, they collect objective data to evaluate whether the interventions are working.

ABA INTERVENTION STRATEGIES

ABA studies show that many effective intervention strategies involve operant learn-
ing. Operant learning occurs in all humans and many other organisms. It takes place
when an antecedent event sets the occasion for a behavior, and a consequent event
either increases or decreases the likelihood that the behavior will occur again. An an-
tecedent event is a change within the individual or in the external environment that
occurs just prior to the behavior of interest and that acts as a trigger for the behavior.
15
APPLIED BEHAVIOR ANALYSIS (ABA)

A consequent event is a change that immediately follows the behavior of interest.

Consequent events that increase behavior are called reinforcers; consequent events that
decrease behavior are said to result in extinction. For example, when a student with
ASD sees an instructor (antecedent event), she may make eye contact and say, ‘‘Hi.’’
If the consequence is a smile and praise from the instructor (a reinforcer), the student
is likely to greet the instructor in the future. However, if the instructor walks by with-
out acknowledging the greeting, the student may not greet the instructor on subse-
quent occasions as the behavior was not reinforced.
Two related forms of learning are modeling and rule-governed behavior. In model-
ing, the individual observes the antecedent-behavior-consequence relationship instead
of experiencing it directly. Thus, a person with ASD might learn how to make greet-
ings by observing two people greet each other. In rule-governed behavior, on the other
hand, the individual is told about the antecedent-behavior-consequence relationship.
For example, a person with ASD might learn about greetings by hearing an instructor
explain, ‘‘When you greet others, it’s important to make eye contact and say ‘Hi’ or
‘Hello’ to show you’re interested.’’
To promote operant and related forms of learning, ABA practitioners often use
prompting. Prompting involves systematically providing physical, gestural, or verbal
guidance on performing a behavior in response to a cue. Prompts are gradually reduced
and eventually eliminated as the individual masters the behavior. Other common pro-
cedures include task analysis, which consists of breaking down a complex skill into
smaller steps; then chaining, in which steps are taught separately and subsequently
linked together; and shaping, in which successive approximations of a behavior are
taught. For example, eye contact may be shaped by reinforcing the individual first for
casting fleeting glances in the general direction of the communicative partner, and
then increasingly for better accuracy and sustained lengths of time. The shaping pro-
cess may also be extended to more advanced skills, such as looking back and forth
between another person and an object or activity of mutual interest (a skill called
joint attention), modulating eye contact during conversations, and alternating gaze
among several communication partners.

ABA FOR TEACHING NEW SKILLS

Many ABA strategies have been designed to promote learning in individuals with
ASD of all ages and developmental levels. Some strategies are highly structured. For
example, discrete trial teaching (DTT) simplifies instruction as much as possible by
breaking down learning trials into their component parts and carefully planning how
to implement each (Smith, 2001). The instructor begins each discrete trial with a
brief instruction or cue (referred to as a discriminative stimulus), which may include
a prompt. The person with ASD then gives a response. The instructor immediately
gives a consequence—corrective feedback for an incorrect response or positive rein-
forcement such as praise or access to preferred objects for a correct response. After this
exchange, which typically lasts only seconds, there is a brief pause (intertrial interval)
before the next trial. During DTT, an instructor often minimizes distractions by work-
ing individually with a person with ASD in a setting away from other activity.
Other ABA strategies include incidental teaching, which makes use of a person’s
motivation for preferred items or activities to encourage communication or social
16
 APPLIED BEHAVIOR ANALYSIS (ABA)

initiations (Fenske, Krantz, & McClannahan, 2001). It is usually embedded into natu-
rally occurring activities throughout the day such as work time, play centers, or snack.
During these activities, the instructor generally withholds a preferred item, thereby
creating an opportunity for the person with ASD to use language to request it. For
example, if a child is putting together a favorite puzzle, the instructor may withhold a
puzzle piece so that the child is apt to request it. The instructor may prompt the child
by asking, ‘‘What do you want?’’ or simply waiting expectantly.
Additional ABA strategies involve providing instruction to groups rather than to
one individual (Heflin & Alaimo, 2006), or having an individual work alone by fol-
lowing instructions presented in pictures, written words, or audio-taped recordings
(McClannahan & Krantz, 1998). Having typically developing peers serve as models or
tutors for the individual with autism is another commonly used approach (Strain &
Schwartz, 2001). Across all strategies, the aim is to provide opportunities to learn new
skills and to have positive interactions with instructors. Contemporary ABA programs
blend these various strategies, rather than relying exclusively on any one approach, in
an effort to individualize interventions and optimize outcomes.

ABA FOR CHALLENGING BEHAVIORS

Sometimes a goal of ABA treatment is to decrease or eliminate challenging behav-
iors while teaching more appropriate skills (Horner, Carr, Strain, Todd, & Reed,
2002). Through assessment methods such as interview and direct observation, ABA
practitioners seek to identify the various functions that challenging behaviors serve.
For example, some students are especially likely to display challenging behaviors when
requests are made of them, indicating that the function of the behavior is to escape or
avoid requests. Others exhibit challenging behaviors when they cannot immediately
get something they requested, suggesting that the function is to gain access to pre-
ferred objects or activities.
After identifying a possible function, practitioners can develop individualized inter-
ventions. One aspect of the intervention is to reinforce behaviors that are alternatives
to or incompatible with the challenging behavior. For example, if the challenging
behavior is screaming and the function is getting attention from others, the student
might be reinforced for raising his hand, or for a behavior such as pulling objects off
shelves, the student might be reinforced for putting her hands in her pockets.
Along with reinforcing alternative behaviors, ABA practitioners may withhold rein-
forcement for the challenging behavior. For example, they may praise the student for
raising his hand but not for screaming. Alternatively, they may respond to screaming
by placing the student in time-out, where no reinforcement is available, for a time.
Another intervention is overcorrection, in which the student restores the environ-
ment to a state better than it was before the challenging behavior occurred. For exam-
ple, if a student throws a drink on the floor, she may be directed to clean up the spill
and the surrounding area.
A token economy combines procedures for reinforcing appropriate behavior and
withholding reinforcement for challenging behavior. In this system, a student can earn
tokens for appropriate behavior and cash them in for a reinforcer such as additional
time with a favorite peer. Conversely, he may lose a token for challenging behaviors
such as aggression (a procedure called response cost). All of these strategies for
17
APPLIED BEHAVIOR ANALYSIS (ABA)

reducing challenging behavior are most successful when implemented in conjunction

with instruction and reinforcement for more appropriate behaviors.

MODELS FOR IMPLEMENTING ABA

Some ABA intervention models for persons with ASD are comprehensive, designed
to address all areas of need. Others are directed toward a more circumscribed, specific
set of goals. One comprehensive approach is early intensive behavioral intervention
(EIBI). Applied with children under 5 years old, EIBI typically consists of 20–40 hours
weekly of ABA treatment, much of it involving one-to-one instruction (Handleman
& Harris, 2001). EIBI often occurs in the home or child-care setting, with active par-
ticipation from parents and others in that setting, and may be employed for two to
three years. Studies indicate that EIBI can yield significant gains such as increases in
IQ and other standardized test scores, along with increased access to special education
services (Smith, Groen, & Wynn, 2000). However, additional research is necessary to
confirm these exciting findings.
Comprehensive ABA treatment programs for older children and adults with ASD
take place in specialized classrooms or occupational settings (Handleman & Harris,
2006; Holmes, 1997). Such programs usually mix individual and group instruction
throughout the day. The learner may spend a portion of the day engaged in one-to-
one, individualized instruction to pre-teach or review skills to be addressed later in
the day during group instruction and spend other portions of the day in typical aca-
demic group activities. Research shows that persons with ASD in these programs learn
many new skills. Still, little information is available on long-term outcomes such as
whether graduates of the programs succeed afterward in less specialized settings.
Specific skill models may involve working directly with persons with ASD in a par-
ticular area (e.g., social interaction) or training parents, peers, or personnel in educa-
tional or occupational settings to implement ABA interventions. Training typically
includes instruction on characteristics of ASD, assistance with identifying skills to
teach, guided practice in applying ABA methods, direction on how to collect data on
the effects of intervention, and establishment of a system for communication and col-
laboration between the intervention setting and home. Many studies document that,
with training, parents, peers, and educators can become proficient at implementing
ABA interventions under supervision of a professional ABA practitioner.

CURRENT STATUS AND FUTURE DIRECTIONS

Though not a cure for ASD, ABA is an effective approach to teach many new
skills and alleviate challenging behaviors. As a result, it has become an important
intervention for persons with ASD. Research continues on how to enhance its
effectiveness.

REFERENCES
Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of applied behavior
analysis. Journal of Applied Behavior Analysis, 1, 91–97.
Cooper, J. O., Heron, T. E., & Heward, W. L. (1987). Applied behavior analysis. Columbus, OH:
Merrill/Prentice Hall.
Fenske, E. C., Krantz, P. J., & McClannahan, L. E. (2001). Incidental teaching: A not discrete
trial teaching procedure. In C. Maurice, G. Green, & R. M. Foxx (Eds.), Making a difference:
Behavioral intervention for autism (pp. 75–82). Austin, TX: Pro-Ed.

18
 ART THERAPY

Handleman, J. S., & Harris, S. L. (2006). School-age education programs for children with autism.
Austin, TX: Pro-Ed.
Handleman, J. S., & Harris, S. L. (Eds.). (2001). Preschool programs for children with autism (2nd
ed.). Austin, TX: Pro-Ed.
Heflin, L. J., & Alaimo, D. F. (2006). Students with autism spectrum disorders. Upper Saddle
River, NJ: Merrill/Prentice Hall.
Holmes, D. L. (1997). Autism through the lifespan: The Eden model. Bethesda, MD: Woodbine
House.
Horner, R. H., Carr, E. G., Strain, P. S., Todd, A. W., & Reed, H. K. (2002). Problem behav-
ior interventions for young children with autism: A research synthesis. Journal of Autism and
Developmental Disorders, 32, 423–446.
Koegel, R. L., & Koegel, L. K. (2005). Pivotal response treatments for autism: Communication,
social & academic development. Baltimore: Brookes Publishing Co.
Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning
in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3–9.
Lovaas, O. I., Koegel, R., Simmons, J. Q., & Long, J. S. (1973). Some generalization and
follow-up measures on autistic children in behavior therapy. Journal of Applied Behavior Analy-
sis, 6, 131–166.
McClannahan, L. E., & Krantz, P. J. (1998). Activity schedules for children with autism: Teaching
independent behavior. Bethesda, MD: Woodbine House.
Smith, T. (2001). Discrete trial training in the treatment of autism. Focus on Autism and Related
Disorders, 16, 86–92.
Smith, T., Groen, A., & Wynn, J. W. (2000). Randomized trial of intensive early intervention
for children with pervasive developmental disorder. American Journal on Mental Retardation,
104, 269–285.
Strain, P. S., & Schwartz, I. (2001). ABA and the development of meaningful social relations
for young children with autism. Focus on Autism and Related Disorders, 16, 120–128.
CHRISTINE R. PETERSON AND TRISTRAM SMITH

APRAXIA
Apraxia is the inability to plan, organize, and carry out a physical, motor action.
Individuals with apraxia may have difficulty putting on their shoes, climbing on play
equipment, or skipping.
KELLY M. PRESTIA

ART THERAPY
During the 1940s, psychiatrists became more interested in the artwork of their men-
tally ill patients. About the same time, educators became interested in their students’
work as it showed differences in development (cognitive and emotional). As popular-
ity grew, art therapy began being offered alongside traditional psychoanalytic therapy
programs. It is through the creative process that art therapy has grown to be used in
the assessment and treatment of individuals with various disorders as well as for pro-
moting wellness.
Art therapy is a mental health profession that uses art and the creative process to
improve the lives of the clients who are served. These clients range in ages (from chil-
dren to older adults), and levels of wellness. Art therapy combines the areas of human
development, visual arts, and counseling. It can be utilized with diagnoses such as
depression, anxiety, mental illnesses, addiction, relationship issues, abuse and domestic
violence, disability, loss, and medical illnesses.
19
ASPERGER, HANS

In order to enter into the art therapy profession, completion of a master’s degree in art
therapy or with an emphasis on art therapy is required. The Art Therapy Credentials
Board (ATCB) is the credentialing agency that defines the requirements for certification.
In order to be considered a registered art therapist (ATR or ATR-BC) 1,000 hours of
direct client contact must be accrued after graduation. The national organization for art
therapists is the American Art Therapy Association, Inc. (AATA). This professional or-
ganization defines and regulates the educational, professional, and ethical standards for
art therapists. A separate entity, the Art Therapy Credentials Board (ATCB) awards
registration as an art therapist (ATR) and after passing a written examination confers
the credentialing of a board-certified art therapist (ATR-BC). This credential must be
maintained with continuing education hours (American Art Therapy Association, 2006).
Art therapists work in a variety of settings including hospitals, mental health facili-
ties, residential treatment centers, shelters, schools, correctional facilities, nursing
homes, private practice, and art studios. Art therapists may work independently or as
part of a treatment team. In addition, treatment settings vary from individual sessions
to group placements.

REFERENCE
American Art Therapy Association, Inc. (2006). Retrieved July 24, 2006 from www.arttherapy.
org/about.html.
LYNN DUDEK

ASPERGER, HANS
Hans Asperger (February 18, 1906–October 21, 1980) was an Austrian pediatrician
who published the seminal research on the disorder that is now called Asperger syn-
drome. In his original findings, he noted that four boys from his clinical practice
exhibited distinctive characteristics that he labeled as autistischen psychopathen.
Asperger identified the traits within this disability as: (a) social isolation and awk-
wardness, (b) self-stimulatory responses, (c) insistence on environmental sameness,
(d) normal intellectual development, and (e) normal communication development.
See also Asperger’s disorder.

FURTHER INFORMATION
Frith, U. (1991). Autism and Asperger syndrome. Cambridge: Cambridge University Press.
TERRI COOPER SWANSON

ASPERGER’S DISORDER
Like all autism spectrum disorders, Asperger’s disorder (or Asperger syndrome)
involves difficulties in three major areas: social interaction, communication, and
behavior (Wing & Gould, 1979). While lower-functioning individuals with autism
might show little desire for social interaction and spontaneous communication, those
with Asperger’s disorder are typically quite verbal, and often eager to share informa-
tion. It is the unusual quality of their language, their poor social skills, and their un-
usual habits or behaviors that distinguishes them. Because the symptoms are more
subtle than those of classic autism, most children with Asperger’s disorder are not
diagnosed until elementary school, or even much later (Attwood, 1998).
20
 ASPERGER’S DISORDER

There is a certain amount of debate among experts today about what, exactly, con-
stitutes Asperger’s disorder. The Diagnostic and Statistical Manual of Mental Disor-
ders (DSM-IV-TR; APA, 2000), which publishes the official criteria used by
psychologists and psychiatrists in the United States, uses much of the same language
to describe Asperger’s disorder and Autistic disorder (e.g., at least two symptoms of
‘‘impairment in social interaction’’ and one symptom of restricted, repetitive interests
or behaviors). However, to receive the Asperger’s diagnosis, the individual may not
have mental retardation and may not have had a significant delay in learning to talk.
Given those criteria, many argue that Asperger’s is not, in fact, a separate disorder in
itself, but a form of high functioning autism.
Other experts argue, however, that Asperger’s disorder has more distinct characteris-
tics than those covered in the DSM-IV-TR criteria. Commonly mentioned ones include
poor social skills, special interests, language peculiarities, sensory processing difficulties,
gross and fine motor problems, and difficulties with self-help and organizational skills.

SOCIAL SKILLS
While small children with Asperger’s disorder may initially show little interest in
playing with other children, they are generally described as being very attached to
parents and family members. Older children and adults with Asperger’s generally do
want to establish friendships and relationships—but they lack the knowledge to do so.
Others may view them as quirky, shy, or, in some cases, even frightening. This is due
to the fact that while most people automatically develop an understanding of social
rules and nonverbal communication, people with Asperger’s disorder do not. They
need to be explicitly taught.

LANGUAGE
Children with Asperger’s disorder are often described as sounding like ‘‘little profes-
sors’’ because of their often extraordinary vocabularies and their tendency to lecture.
While their speech may be superficially perfect, they often tend to be overly literal in
their use and interpretation of language. Metaphors and idioms (e.g., ‘‘beating a dead
horse’’) might be baffling. Others’ inexact use of language, such as Mom asking,
‘‘Would you mind getting that?’’ when she really means ‘‘Get that!’’ can cause frustra-
tion and anger. The pragmatics (social aspects) of speech—such as the ability to carry
on back-and-forth conversations—often do not come naturally to people with Asperg-
er’s, and must be explicitly taught. One distinctive language feature of many individu-
als with Asperger’s disorder is their love of perseverative scripting—telling the entire
story line of, say, a cartoon, video game, or movie, over and over again, complete with
exact dialogue and, sometimes, speech inflections and accents.

SPECIAL INTERESTS
Individuals with Asperger’s disorder often have one or more all-encompassing spe-
cial interests. These interests go far beyond those of a normal hobby, and can interfere
with social skills, academics, and work. The amount of information on a particular
topic that an individual with Asperger’s may acquire can be quite staggering. Some-
times the area of interest may be typical for their age group—for example, baseball
scores, video games, or cartoons—but the degree of interest sets the person with
Asperger’s apart. Other interests can be quite unusual, such as vacuum cleaners or
21
ASPERGER’S DISORDER

train schedules. When the person reads or views the same material over and over
again, this is a form of perseveration.
DESIRE FOR SAMENESS
While many people love surprises, individuals with Asperger’s typically crave consis-
tency. ‘‘Sameness’’ seems to provide comfort and security in a world with so many
unwritten rules to decipher. Parents and teachers report that a change in routine—
even a ‘‘fun’’ one like a party or school assembly—can often trigger a ‘‘meltdown’’ in a
child with Asperger’s disorder.
SENSORY AND MOTOR DIFFICULTIES
Many individuals with Asperger’s disorder seem to be overly sensitive to light,
sound, noise, smells, and/or touch. Clothing, especially tags and sock seams, may cause
discomfort for them. Others seem to be less sensitive to sensory input than the average
person, and not even notice, say, a scraped knee that would set another child crying.
Some seek out unusual sensory activities, such as spinning. These are all examples of
difficulties with sensory integration dysfunction (also known as sensory processing dys-
function). Many people with Asperger’s also have difficulties with gross motor skills
(e.g., running, jumping, riding a bicycle) and tend to be clumsy. Some also have diffi-
culty with fine motor skills, such as handwriting.
SELF HELP AND ORGANIZATIONAL SKILLS
Contrary to the DSM-IV-TR (APA, 2000) criteria, clinicians today report that
most individuals with Asperger’s disorder have difficulties in self-help skills and adapt-
ive behavior (Attwood, 2006). These difficulties extend logically from the other diffi-
culties characteristic of individuals with Asperger’s. For example, tying shoes and
getting dressed require fine motor skills; shopping at the supermarket requires an abil-
ity to adapt to change (as groceries are often rearranged, or out of stock) and often
some social interaction at the cash register. Going from class to class in middle school
requires tolerating loud noise, being bumped into, and other students behaving in
unpredictable ways. Many people with Asperger’s disorder also have difficulties with
executive functions (e.g., organizing and planning skills).
Not every person with Asperger’s disorder manifests the same characteristics in
number or degree. Therefore, it is important to keep in mind that Asperger’s disorder
is a spectrum disorder, ranging from relatively mild to quite severe. One person might
be so impaired that he or she is unable to live independently, while another might be
able to hold down a job—even be quite talented and successful at it—but still have
significant difficulties in interpersonal relationships.

REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
Attwood, T. (1998). Asperger’s syndrome: A guide for parents and professionals. London: Jessica
Kingsley Publishers.
Attwood, T. Is there a difference between Asperger’s syndrome and high-functioning autism?
Retrieved August 25, 2006, from http://www.tonyattwood.com.au.
Wing, L. & Gould, J. (1979). Severe impairments of social interaction and associated abnormal-
ities in children: Epidemiology and classification, Journal of Autism and Developmental Disor-
ders, 9, 11–29.

22
 ASPERGER SYNDROME SCREENING QUESTIONNAIRE (ASSQ)

FURTHER INFORMATION
Myles, B. S., & Simpson, R. L. (2002) Asperger syndrome: An overview of characteristics. Focus
on Autism and Other Developmental Disabilities, 17(3), 132–137.
Myles, B. S., Barnhill, G. P., Hagiwara, T., Griswold, D. E., & Simpson, R. L. (2001). A syn-
thesis of studies on the intellectual, academic, social/emotional and sensory characteristics of
children and youth with Asperger syndrome. Education and Training in Mental Retardation and
Developmental Disabilities, 36(3), 304–311.
Powers, M. D. (2002). Asperger syndrome & your child: A parent’s guide. New York: Skylight Press.
LISA BARRETT MANN

ASPERGER SYNDROME DIAGNOSTIC SCALE (ASDS)

The Asperger Syndrome Diagnostic Scale (ASDS; Myles, Bock, & Simpson, 2000)
is a norm-referenced measure that can help determine if a child or adolescent has
Asperger syndrome. It is composed of 50 items, divided into five subscales: language,
social, cognitive, sensory-motor, and maladaptive. Respondents indicate the presence
or absence of certain characteristics in each area, and the resulting standard score
shows the probability that the child or adolescent has s syndrome. Parents and teach-
ers can complete the scale and share the results with their clinician.
The ASDS can be also used with confidence to document behavioral progress as a
consequence of special intervention programs, target goals for change and intervention
of the child’s Individualized Education Program, and measure the characteristics of
Asperger syndrome for research purposes.
See also Asperger’s disorder; norm-referenced assessment.

REFERENCE
Myles, B. S., Bock, S. J., & Simpson, R. L. (2000). Asperger Syndrome Diagnostic Scale. Austin,
TX: Pro-Ed.
SUSANA BERNAD-RIPOLL

ASPERGER SYNDROME SCREENING QUESTIONNAIRE (ASSQ)

The Asperger Syndrome Screening Questionnaire (ASSQ; Ehlers & Gillberg, 1993;
Ehlers, Gillberg, & Wing 1999) was designed to screen for possible cases of Asperger
syndrome or high-functioning autism in children. The ASSQ has cut-off scores for
both parent and teacher ratings of the child’s behavior, and there have been a range
of studies published highlighting the validity of the instrument. For parent ratings, the
true positive rate (those who score as having Asperger syndrome or high-functioning
autism on the instrument and who really do have the condition) is 62 percent with a
false positive rate (those who score as having AS or HFA but who do not have the
condition) of 10 percent. For teacher ratings the true positive rate is 70 percent with
a false positive rate of 9 percent.
See also Asperger’s disorder.

REFERENCES
Ehlers, F., & Gillberg, C. (1993). The epidemiology of Asperger syndrome: A total population
study. Journal of Child Psychology and Psychiatry and Allied Disciplines, 34, 1327–1350.
Ehlers, F., Gillberg, C., & Wing, L. (1999). A screening questionnaire for Asperger syndrome
and other high functioning autism spectrum disorders in school age children. Journal of Au-
tism and Developmental Disorders, 29, 129–142.
FIONA J. SCOTT
23
ASSESSMENT

ASSESSMENT
Assessment is the overall process of gathering information, evaluating students, and
making decisions based on what is learned. Assessment may involve many components
including gathering background information, direct observation, formal and informal
evaluation measures, report writing, team problem solving, interpretation of testing,
decision making, and ongoing monitoring of student progress.

FURTHER INFORMATION
McMillan, J. H. (2004). Educational research: Fundamentals for the consumer (4th ed.). Boston:
Allyn & Bacon.
PAUL G. LACAVA

ASSESSMENT OF BASIC LANGUAGE AND LEARNING SKILLS (ABLLS)

The Assessment of Basic Language and Learning Skills (ABLLS; Partington &
Sundberg, 1998) is an assessment tool, a curriculum, and a skills tracking system that
can be used for students with language delays, autism, cognitive disabilities, and many
other areas as well. The ABLLS is built around skills students use in everyday activ-
ities and by using task analyses for the different indicators. Applied behavior analysis
is the theory around which the ABLLS is centered, incorporating verbal behavior
strategies for teaching skills to students.
The introductory set for the ABLLS contains two books: The ABLLS protocol is
used for each student to score how students perform on the skill sets and The ABLLS
Scoring Instructions and IEP Development Guide. Once completed, the protocol
becomes a curriculum tool individualized for the student.
There are four sections that make up the ABLLS protocol: (a) Basic Learner Skills,
(b) Academic Skills, (c) Self-Help Skills, and (d) Motor Skills. Within each section
skills are identified within 25 domain areas (e.g., visual performance, receptive lan-
guage, motor imitation, play and leisure).
The ABLLS is not designed to provide age norms or to compare students to their
peers. Typically developing students completing kindergarten or first grade should
know the majority of the areas covered. Parents, teachers, psychologists, and other
team members can complete the ABLLS as long as they know the student. The Scor-
ing and Instruction Guide has strategies for teams to use to develop Individualized
Education Programs for students.

REFERENCE
Partington, J., & Sundberg, M. (1998). The assessment of basic learning and language skills. Pleas-
ant Hill, CA: Behavior Analysts, Inc.
BROOKE YOUNG

ASSISTIVE TECHNOLOGY
Several legislative acts or amendments have defined assistive technology (AT),
assistive technology device, and assistive technology service. These include (a) Tech-
nology Related Assistance for Individuals with Disabilities Act of 1988 (PL 100-407)
(Tech Act), (b) Individuals with Disabilities Education Act of 1990, (c) Americans
with Disabilities Act of 1990, (d) Tech Act Amendments of 1994, and (e) Individu-
als with Disabilities Education Act Reauthorization of 1997.
24
 ASSISTIVE TECHNOLOGY

First defined by the Technology Related Assistance for Individuals with Disabilities
Act of 1988 (PL 100-407), AT means ‘‘any item, piece of equipment, or product sys-
tem, whether acquired commercially, off the shelf, modified or customized, that is used
to increase, maintain, or improve functional capabilities of individuals with disabil-
ities.’’ AT can be anything that makes it easier for the student to participate in class,
complete homework, get around, turn things on, and communicate with friends and
more (Assistive Technology Training Online, n.d.). AT should also be a required con-
sideration in vocational training and in the workplace to increase independence. The
Individuals with Disabilities Education Act of 1990 confirmed that AT is to be con-
sidered as part of a related service under special education and began the need for spe-
cific assessments in the area of AT for identification and selection.
The Americans with Disabilities Act of 1990 ensures access to buildings and
employment; ADA ensures that employers could not and cannot discriminate due to
disability, and that a reasonable accommodation must be made to allow for the indi-
vidual to work. In addition ADA ensures that AT devices and services are included
under this legislation to provide that reasonable accommodation.
The Tech Act of 1994 offers further clarification to what AT can do specifically related
to vocational supports, natural environments, and workplace supports. It follows up on
the provisions of ADA and further supports AT considering the advances in technology.
In the Reauthorization of IDEA 1997, AT is seen as a critical tool to provide fur-
ther access to the general education classroom for all students. IDEA 1997 requires
that AT must be considered as an option for all students that receive an IEP.
These acts ensure that AT needs must be identified on an individual basis and con-
sidered along with the child’s other educational needs. Identification of AT needs
must involve family members and a multidisciplinary team. Parents or IEP members
can ask for additional evaluation or an independent evaluation to determine AT
needs. When an evaluation is being conducted, the team should consider the follow-
ing: fine-motor skills, communication, and alternatives to traditional learning
approaches. Lack of availability of equipment or cost alone cannot be used as an
excuse for denying an assistive technology service. If included in the IEP, assistive
technology services and assistive technology devices must be provided at no cost to
the family and, if so indicated, devices must be allowed to go home with the student.
Parents always have the right to appeal if assistive technology services are denied.

REFERENCES
Americans with Disabilities Act, 42 U.S.C. §§ 12101-12213 (1990).
Assistive Technology Training Online. (n.d.). Introduction to AT. Retrieved November 29,
2006, from http://atto.buffalo.edu/registered/ATBasics/Foundation/intro/index.php.
Individuals with Disabilities Education Act Reauthorization of 1997 (Public Law 105-17).
Technology Related Assistance to Individuals with Disabilities Act of 1988 (P.L. 103-218).
Technology Related Assistance to Individuals with Disabilities Amendment Act of 1994 (P.L.
103-218).

FURTHER INFORMATION
Assistive Technology Training Online: http://atto.buffalo.edu.
Edyburn, D., Higgins, K., & Boone, R. (2006). The handbook of special education technology
research and practice. Whitefish Bay, WI: Knowledge by Design, Inc.
TERRI COOPER SWANSON
25
ASSISTIVE TECHNOLOGY DEVICE

ASSISTIVE TECHNOLOGY DEVICE

There are a wide variety of assistive technology
devices ranging from low tech to high tech. Low-
tech devices, which do not involve batteries or any
type of electronics, may include: (a) visual support
strategies—typically low cost, hand made, and easy
to use such as dry erase boards, clipboards, 3-ring
binders, manila file folders, and photos; (b) tools to
aid in writing, such as pencils or pens with a spe-
cial grip; and (c) communication boards—portable
communication boards allow the nonverbal student
the means to be able to express their wants and
needs. Mid tech includes battery-operated devices
or simple electronic devices requiring limited
advancements in technology, such as a tape re-
corder, Language Master, overhead projector, timer,
calculator, or simple voice output device. High-
tech devices are complex technological support
strategies—typically ‘‘high’’ cost equipment. Exam-
ples include video cameras, computers and adaptive
hardware, and complex voice output devices.

FURTHER INFORMATION
Assistive Technology Training Online: http://atto.buffalo.edu.
TERRI COOPER SWANSON

ASSISTIVE TECHNOLOGY SERVICE

Any individual with an Individualized Education
Program can receive assistive technology services.
Assistive technology service means any service that directly assists an individual with a
disability in the selection, acquisition, or use of an assistive technology device. This
may also include the evaluation of the needs of an individual with a disability, includ-
ing a functional evaluation of the individual in the individual’s customary environment;
purchasing, leasing, or otherwise providing for the acquisition of assistive technology
devices by individuals with disabilities; selecting, designing, fitting, customizing, adapt-
ing, applying, maintaining, repairing, or replacing of assistive technology devices; coordi-
nating and using other therapies, interventions, or services with assistive technology
devices, such as those associated with existing education and rehabilitation plans and
programs; training or technical assistance for an individual with disabilities, or, where
appropriate, the family of an individual with disabilities; and training or technical assis-
tance for professionals (including individuals providing education and rehabilitation
services), employers, or other individuals who provide services to, employ, or are other-
wise substantially involved in the major life functions of individuals with disabilities.
FURTHER INFORMATION
Assistive Technology Training Online: http://atto.buffalo.edu.
TERRI COOPER SWANSON
26
 ATTENTION DEFICIT HYPERACTIVITY DISORDERS (ADHD)

ASSOCIATION METHOD
The Association Method is a phonics-based, multisensory, and multilevel curricu-
lum designed to teach oral and written communication to people with severe commu-
nication disorders (Kotler, 2004), including autism spectrum disorders. This method
develops and systematically associates each of the specific skills that must be coordi-
nated for the development of the ability to understand and use oral communication.
Multisensory teaching includes the use of auditory, visual, tactile, and motor-kines-
thetic cues for learning.
Matched to the strengths and needs of each individual child, the curriculum pro-
gresses from sounds to syllables, to words of gradually increasing length, to basic sen-
tences and questions, and then more advanced sentence structures. Ultimately, when
sufficient language skills have been achieved, a transition is made to traditional text-
book formats for instruction.

REFERENCE
Kotler, M. (2004). What is the association method? Retrieved October 17, 2006, from http://
www.apraxia-kids.org/faqs/responsefromJcotler.html.
JAN L. KLEIN

ATTENTION DEFICIT HYPERACTIVITY DISORDERS (ADHD)

Attention deficit hyperactivity disorders (ADHD) are developmental disorders that
include attention deficit/hyperactivity disorder, conduct disorder, and oppositional defi-
ant disorder. There have been some arguments that hyperactivity disorders are part of
the autism spectrum. While attention difficulties are seen in many children with autism
spectrum disorders, this does not indicate that these disorders in their own right are part
of the autism spectrum. In fact, presentation of difficulties in ‘‘pure’’ ADHD, conduct
disorder and oppositional defiant disorder, while overlapping with behaviors seen in au-
tism spectrum disorders (ASD), often have very different underlying motivations and a
different quality to them. Also, such behaviors when seen in children with ASD do not
necessarily require an additional diagnosis. This is dependent on the degree to which
difficulties and behaviors interfere with functioning over and above the ASD. However,
research does indicate the prevalence of such difficulties among children diagnosed with
ASD. Gillberg (2002, p. 48) reports that the majority of children meeting diagnostic
criteria for Asperger syndrome also met criteria for ADHD. In a recent Swedish study,
Tonge, Brereton, Gray, & Stewart (1999) found that children and adolescents with au-
tism spectrum conditions presented with more psychopathology, and were more disrup-
tive, more antisocial, and more anxious than their nonspectrum peers.

CHARACTERISTICS OF ADHDS
Hyperactivity disorders are characterized by substantial restlessness, impulsiveness,
and inattentiveness (Goodman & Scott, 2005). The key issue is in the lack of control
over levels of activity, rather than the activity itself. Behaviors include fiddling with
objects or clothing, getting up and walking about when the child should be seated,
fidgeting or squirming when seated, being easily distractible and having difficulty stay-
ing on task, or a tendency to switch activities frequently. Commonly associated fea-
tures include aggressive, antisocial, or defiant behaviors such that classification with
27
ATTRIBUTION

the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; APA,

2000) can often lead to a dual diagnosis of ADHD and conduct disorder or ADHD
and oppositional defiant disorder in many children (Goodman & Scott, 2005). How-
ever, both hyperactivity disorders and ‘‘pure’’ conduct or oppositional disorders are
characterized by impulsive behaviors, and by wandering in the classroom.
Children with hyperactivity disorders often have difficulties with social relation-
ships. They may be rejected by peers who find the impulsive behaviors and interrup-
tions during class and other activities a nuisance. There may be inappropriate calling
out or rude or cheeky comments to adults and authority figures.
Other associated difficulties in some children with hyperactivity disorders include
specific learning difficulties, soft neurological signs such as general clumsiness, and a
history of developmental delay.
Conduct disorder and oppositional defiant disorder are characterized by antisocial
behavior, failure to control behavior in a socially acceptable way, aggression, and defi-
ance. Criteria for conduct disorder according to the DSM-IV-TR (APA, 2000) is that
the child has shown at least four of the following behaviors for at least 6 months: (a) of-
ten losing temper, (b) often arguing with adults, (c) often defying adult requests or rules,
(d) often deliberately annoying others, (e) often shifting blame to others, (f) often touchy
or easily annoyed, (g) often angry and resentful, and (h) often spiteful or vindictive.
Criteria for oppositional defiant disorder according to the DSM-IV-TR (APA,
2000) is that there has been at least 12 months with at least three of the following
behaviors: (a) often bullying, threatening, or intimidating; (b) often starting fights; (c)
using serious weapons in fights; (d) being physically cruel to people; (e) being physi-
cally cruel to animals; (f) stealing with force; (g) forcing someone into sexual acts; (h)
fire-setting to cause damage; (i) destroying other’s property; (j) breaking into cars or
houses; (k) conning others; (l) stealing without force; (m) often going out at night
without permission; (n) running away from home overnight at least twice; and (o) of-
ten truanting, with truanting beginning before age 13.
REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
Gillberg, C. (2002). A guide to Asperger syndrome. Cambridge: Cambridge University Press.
Goodman, R., & Scott, S. (2005). Child psychiatry (2nd ed.). Oxford: Blackwell Publishing.
Tonge, B. J., Brereton, A. V., Gray, K. M., & Stewart, L. E. (1999). Behavioural and emotional
disturbance in high-functioning autism and Asperger Syndrome. Autism: International Journal
of Research and Practice, 3, 117–130.

FURTHER INFORMATION
Rutter, M. (1998). Antisocial behaviour by young people. Cambridge: Cambridge University Press.
Taylor, E. (1998). Clinical foundations of hyperactivity research. Behavioural Brain Research, 94,
11–24.
FIONA J. SCOTT

ATTRIBUTION
According to Frith (1991), the ability to represent mental states such as thoughts,
feelings, or beliefs is impaired among individuals with autism. Such perspective-taking
deficits are a basis for the quality of social behaviors most frequently observed for this
28
 ATTRIBUTION

population (Meyer & Minshew, 2002; Jolliffe & Baron-Cohen, 1999). It is also inter-
esting to note that when parents are asked about their children’s performance in these
areas, they consistently share significant concerns about their children’s skills. How-
ever, when the children are asked to rate themselves in the same areas, they show no
significant concerns (Barnhill, Hagiwara, Myles, & Simpson, 2000). Further review of
current research shows that individuals with Asperger syndrome have a heightened
awareness for details coupled with deficits in organization of information, increasing
the potential to severely affect problem solving and reasoning skills (Minshew, Gold-
stein and Siegel, 1997). Just from this sampling of research findings, it is not impossi-
ble to see how individuals with autism spectrum disorders (ASD) are challenged daily
in many ways as they attempt to successfully interact in the social world around them.
One area that holds promise for improving social function is that of attribution
retraining.
Attribution patterns can be defined as how individuals under differing circumstances
assume causation of words or deeds. A substantial research effort in the early 1970s
resulted in the Attributional Theory of Achievement Motivation pioneered by Weiner
et al. (1971). Originally tested in the learning disabilities community to determine
factors influencing academic achievement, researchers were looking to explain the link
between the children’s causal ascriptions for achievement outcomes and their behav-
ioral responses to academic success and failure. The results concluded that attributions
are clearly related to motivation and affect performance (Weiner, 1986). Our ability
to manipulate these attributional beliefs about the sources and causes of success and
failure allows us to maintain some control over our own experiences and is directly
related to our self-esteem and successful self-determination (Covington, 1985).
It is reasonable to suggest that if a person does not correctly attribute someone else’s
thoughts, words, or deeds on a regular basis that it may cause frequent misunderstand-
ings during social interactions, and if left untreated could cause that person to become
defensive or develop ‘‘hostile’’ attribution over time in an effort to avoid unpleasant
interactions. These aggressive or hostile attribution patterns can be maladaptive when
considering the potential for future behavior changes (Baumeister, 1989; Weiner,
1986) and lend itself to the development of clinical depression as proposed in the
reformulated Learned Helplessness Theory (Metalsky, Abramson, Seligman, Semmel,
& Peterson, 1982).
So where is the connection between attribution and the world of autism? One study
shows that a third of adolescents with Asperger syndrome have pessimistic, maladap-
tive attribution styles; Barnhill (2001) and Baron-Cohen have spent a considerable
amount of time advancing research that individuals with autism spectrum disorders
are universally affected by deficits in theory of mind, which is our ability as a person
to assume the emotions or activities going on in another person’s head. Baron-Cohen
refers to these activities as mentalizing and on numerous occasions has found that indi-
viduals with ASDs are not able to take on the perspective of others and accurately
determine their thoughts or motivations. It is widely thought that people with autism
do not enjoy what is referred to as the Shared Attention Mechanism. A key component
of our theory of mind, it is the drive we should have toward establishing what is a
shared interest between oneself and another person. It is a way to get on the same
‘‘wave length’’ with each other (Baron-Cohen, 1997, p. 66). Along with the
29
ATTRIBUTION

previously mentioned deficits, if those with autism are not ‘‘hard wired’’ necessarily to
have that ability or interest in establishing a common ground socially with others, it
is easier to imagine that misunderstanding or perceiving social situations could occur
regularly.
To incorporate attribution retraining as the first of many steps to increase social flu-
idity, example diagrams illustrate the following three variables in attribution retraining
as identified by Weiner (1986):

1. Is the issue internal or external in locus? Did it happen because of something about you
or something else?
2. Is the issue stable or unstable? Is it something you think will always happen?
3. Is it controllable or uncontrollable? Can you do anything about it?

Here is a real life example:

You are sitting in a restaurant and there is a screaming baby at the table next to
you! The average individual with Asperger syndrome or PDD-NOS is likely to think
that the screaming is internal to them because it hurts their ears, that it will NEVER
stop and that they have no control over it, essentially coming up with a depressing or
negative assessment of the situation.
The solution using attribution retraining would go something like this:

1. The problem is outside of me. A baby near me is having trouble and crying.
2. The situation really isn’t stable. Sooner or later the baby will have to stop crying.
3. I do have some control over the situation in that I can ask to leave the room, use self-
calming strategies or maybe change the table in order to make it less offensive to me.

As you can see, this assessment is still an uncomfortable situation but much more
positively assessed, leaving room for the possibility of resolution to everyone’s benefit
without notions of purposeful or hurtful behaviors and emotionally charged responses.
It is possible to use this methodology to improve the person’s attribution pattern so
that they are more consistently able to assess their circumstances and then select an
appropriate response. While attribution is not the entire process of social problem
solving, it should be thought of as an integral part of the successful problem solving
experience.

REFERENCES
Barnhill, G. (2001). Social attributions and depression in adolescents with Asperger syndrome.
Focus on Autism and Other Disabilities, 16, 45–53.
Barnhill, G., Hagiwara, T., Myles, B. S., & Simpson, R. L. (2000). Asperger syndrome: A study
of the cognitive profiles of 37 children and adolescents. Focus on Autism and Other Develop-
mental Disabilities, 15, 146–153.
Baron-Cohen, S. (1997). Mindblindness: An essay on autism and theory of mind. Cambridge, MA:
MIT Press.
Baumeister, R. F. (1989). Masochism and the self. Hillsdale, NJ: Lawrence Earlbaum Associates.
Covington, M. V. (1985). Anatomy of failure-induced anxiety: The role of cognitive mediators.
In R. Schwarzer (Ed.), Self-related cognitions in anxiety and motivation. Hillsdale, NJ: Lawrence
Erlbaum Associates.
Frith, U. (1991). Autism and Asperger syndrome. Cambridge: Cambridge University Press.
Jolliffe, T., & Baron-Cohen, S. (1999). The Strange Stories Test: A replication with high-
functioning adults with autism or Asperger syndrome. Journal of Autism and Developmental
Disorders, 29, 395–406.

30
 AUDITORY INTEGRATION TRAINING

Metalsky, G. I., Abramson, L. Y., Seligman, M. E., Semmel, A., & Peterson, C. (1982). Attri-
butional styles and life events in the classroom: Vulnerability and invulnerability to depres-
sive mood reactions. Journal of Personal and Social Psychology, 43, 612–617.
Meyer, J., & Minshew, N. (2002). An update on neurocognitive profiles in Asperger syndrome
and high-functioning autism. Focus on Autism and Other Disabilities, 17, 152–160.
Minshew, N., Goldstein, G., & Siegel, D. J. (1997). Neuropsychological functioning in autism:
Profile of a complex information processing disorder. Journal of the International Neuropsycho-
logical Society, 3, 303–316.
Weiner, B. (1986). Attribution theory of motivation and emotion. New York: Springer-Verlag.
Weiner, B., Frieze, I., Kukla, A., Reed, L., Rest, S., & Rosenbaum, R. M. (1971). Perceiving the
causes of success and failure. New York: General Learning Press.

FURTHER INFORMATION
Ozonoff, S., Rogers, S., & Pennington, B. (1991). Asperger syndrome: Evidence of an empirical
difference from high functioning autism. Journal of Child Psychology and Psychiatry, 32, 1081–
1105.
Szatmari, P. (1991). Asperger’s syndrome: Diagnosis, treatment and outcome. Psychiatric Clinics
of North America, 14, 1, 81–92.
SHERRY MOYER

ATYPICAL BEHAVIOR
Atypical behavior refers to any behavior or combination of behaviors found to be
extreme. Areas of atypical behaviors commonly presented by individuals with autism
spectrum disorders include temperament, attention, attachment, social behavior, play,
vocal and oral behavior, senses and movement, self-stimulation and self-injury, and
neurobehavioral state.
MELANIE D. HARMS

AUDIOLOGIST
The role of an audiologist is to evaluate an individual’s hearing to determine if
there is a hearing loss. Once a hearing loss has been detected, the audiologist will
make recommendations for services needed, which might include speech therapy, as-
sistance from a medical professional, or an amplification device.
KATHERINE E. COOK

AUDITORY INTEGRATION TRAINING

Auditory Integration Training (AIT) is an intervention designed to help those with
auditory processing problems. Consisting of 10 hours of listening to electronically
modified music on headphones, typically done in two half-hour sessions a day over
10–12 days, AIT is intended to decrease auditory sensitivities and slightly improve
overall hearing. It is also thought to positively influence behavior, social interactions,
attention, and communication. It is purported to aid individuals with a variety of dis-
abilities including ADHD, ADD, central auditory processing disorder, autism, and dys-
lexia. It can be used for both children and adults, but it is not recommended to be
given prior to age 5 as the ear is not fully developed until then.
AIT was created by ear, nose, and throat physician Dr. Guy Berard in France in the
1960s, as he dealt with his own loss of hearing. Having studied briefly under
31
AUDITORY INTEGRATION TRAINING

Dr. Alfred Tomatis but unsatisfied with his approach, Dr. Berard’s idea was to develop
a sort of physical therapy for the auditory system. Over 5 years, he built his first AIT
device, then came to produce the AudioKinetron and the Earducator. There are now
other AIT devices on the market as well. Dr. Berard administered AIT to over several
thousand individuals before retiring and reports great success; however, he never car-
ried out any research or took data. He published a book explaining AIT and the
theory behind it titled Hearing Equals Behavior (originally published in French in 1982
as Audition egale comportement, translated and published in English in 1993). However,
it was the book Sound of a Miracle by Annabel Stehli (1991) that brought public
attention to this intervention. Stehli wrote about her daughter, Georgianna, diagnosed
with autism, who was ‘‘cured’’ after receiving AIT from Dr. Berard.
Before intervention is begun, a child is given an audiogram to determine the fre-
quencies to which the child is hypersensitive, represented by auditory peaks in their
performance on the test. Other tests may also be conducted to find the decibel level
to be used as well as other measurements of hearing and auditory sensitivities. Based
on these tests the child then listens to music through headphones, which is electroni-
cally processed in two possible ways (can be used separately or both simultaneously).
One is through modulation, whereby using wide-band filters the AIT device randomly
dampens different frequencies of the music as it plays. The dulling of one frequency
may last from a fraction of a second to a few seconds. Although not always done, the
music may also be modified through narrow-band filters. These filters dampen the fre-
quencies to which the child is hypersensitive. However, this requires accurate audio-
metric measures that may be difficult to attain depending on the functioning level of
the child. If there is any doubt of the accuracy of audiometric tests, it is better to not
use the narrow-band filters rather than risk using the wrong ones. Audiograms are usu-
ally given again in the middle of treatment and finally 3 months after treatment has
finished. The delay in giving the final exam is Berard’s observation that results often
take up to 3 months to appear. Berard also reports that during, and for several weeks
after the intervention, a client’s behavior may worsen.
Although Berard himself never carried out any research regarding the efficacy of
AIT, there have been over 20 studies conducted since the early 1990s. Nonetheless,
there is still a great deal of controversy regarding this technique and its efficacy. Pro-
ponents and skeptics alike, including the American Speech-Hearing-Language Associ-
ation (ASHA) and the American Academy of Audiology, emphasize that AIT is still
in the investigative stages and should only be undertaken if this is clearly understood
by the family or individual seeking therapy. Both sides of the debate find serious flaws
in opposing studies and there is certainly a lack of studies that can stand up to rigor-
ous scientific scrutiny. Frequent critiques arise because of the lack of sufficient num-
bers of participants, control groups, and adequate, objective assessments. Finally, much
skepticism finds its justification in the lack of understanding of how and why AIT is
effective. Some critics assert that explanations given by Berard are contrary to current
accepted science in the field. While there are several proposed explanations for
improvement as a result of AIT, there is no proof for any of them.
It should be noted that the Food and Drug Administration (FDA) has not yet
approved AIT devices for marketing. Therefore, by law no claim can be made as to
the effectiveness and safety of AIT. Practice of AIT requires a special investigative
32
 AUGMENTATIVE AND ALTERNATIVE COMMUNICATION

device exemption (IDE) filed with the FDA, and charges should be nominal and not
result in profit for the professional administering AIT.

REFERENCES
Berard, G. (1993). Hearing equals behavior. New Canaan, CT: Keats Publishing.
Stehli, A. (1991). Sound of a miracle. New York: Doubleday Dell.

FURTHER INFORMATION
American Speech-Language-Hearing Association. (2004). Auditory Integration Training. ASHA
Supplement 24, in press. Retrieved June 27, 2005, from http://www.asha.org/NR/rdonlyres/
A0067509-9F38-458A-A065-1B9312ECF990/0/v1PSAIT.pdf.
Dawson, G., & Watling, R. (2000). Interventions to facilitate auditory, visual, and motor inte-
gration in autism: A review of the evidence. Journal of Autism and Developmental Disorders,
30(5), 415–421.
Edelson, S., Arin, D., Bauman, M., Lukas, S., Rudy, J., Sholar, M., & Rimland, B. (1999). Au-
ditory integration training: A double-blind study of behavioral and electrophysiological effects
in people with autism. Focus on Autism and Other Developmental Disabilities, 14(2), 73–81.
Gravel, J. S. (1994). Auditory integration training: Placing the burden of proof. American Jour-
nal of Speech-Language Pathology: A Journal of Clinical Practice, 3(2), 25–29.
Mudford, O., Cross, B., Breen, S., Cullen, C., Reeves, D., Gould, J., & Douglas, J. (2000). Au-
ditory integration training for children with autism: No behavior benefits detected. American
Journal on Mental Retardation, 105(2), 118–129.
Rimland, B., & Edelson, S. (1994). Is theory better than chicken soup? American Journal of
Speech-Language Pathology, 3(2), 38–40.
Rimland, B., & Edelson, S. (1994). The effects of auditory integration training on autism.
American Journal of Speech-Language Pathology, 3(2), 16–24.
Tharpe, A. M. (1999). Auditory integration training: The magical mystery cure. Language,
Speech & Hearing Services in Schools, 30(4), 378–383.
KATIE BASSITY

AUGMENTATIVE AND ALTERNATIVE COMMUNICATION

Augmentative and alternative communication (AAC) refers to an array of systems
designed to compensate for oral or written communication impairments (American
Speech-Language-Hearing Association [ASHA], 2005). The systems either supplement
the existing communication modality or are the primary form of communication. The
purpose of AAC is to enable individuals to express wants and needs, transfer informa-
tion, support interpersonal closeness, and establish social etiquette (Light, 1988; Light,
Parsons, & Drager, 2002) so that they can ‘‘efficiently and effectively engage in a vari-
ety of interactions and participate in activities of their choice’’ (Beukelman & Mir-
enda, 2005, p. 8). AAC systems include symbols, aids, techniques, and strategies
(ASHA, 2004, 2005).
Individuals with autism spectrum disorders demonstrate an array of communication
difficulties including limited comprehension and use of language and the nonverbal
aspects of interactions. Frequently these difficulties coincide with the emergence of be-
havioral difficulties, frustration, and/or withdrawal. The varied AAC options currently
available allow for individualization in the selection and design of an AAC system for
a child or an adult with autism spectrum disorders (ASD). A system can be developed
to meet the needs of a child who is just beginning to understand cause-and-effect rela-
tionships and the turn-taking aspects of human communication. Systems can also
change over time to address the communicative ability of individuals who are able to
33
AUGMENTATIVE AND ALTERNATIVE COMMUNICATION

express wants and needs as well as construct unique utterances specific to educational,
vocational, or leisure contexts. Therefore, AAC systems for individuals with ASD
address behavioral, language, social, learning, and literacy needs. Interdisciplinary
team assessment and intervention practices guide professionals and families in identi-
fying, developing, and utilizing AAC systems. Teams should monitor progress and
modify the system based on therapeutic evidence in order to address the changing
needs of the individual.
SYMBOLS
Many AAC systems use symbols that represent ideas, events, or objects. The level
of abstraction, or representation, varies across symbols. Symbols can be concrete, or
transparent, clearly representing an idea, event, or object. These types of symbols
include natural gestures and signs, life-size or miniature objects, graphic representa-
tions such as photos, or color pictures, as well as some line drawings and Rebus sym-
bols (Beukelman & Mirenda, 2005). Other symbols are abstract, or opaque, where the
referent or relationship between the symbol and the event is not immediately appa-
rent. These types of symbols include words, some gestures, iconic line drawings, and
Rebus symbols, as well as more abstract and complex iconic systems such as Blisssym-
bols (Silverman, 1995). Some commercially available symbol programs include Board-
maker (Mayer Johnson LLC, 2004) and DynaSyms (Poppin & Company, 2005).
The comprehension and use of symbols is integral and essential to language develop-
ment and thus successful use of an AAC system. Given that people with ASD possess
difficulties with symbolic thought or language (APA, 2000), it is important to consider
the available array of concrete objects and oral, gestural, and graphic symbols so that
representation of ideas within the system best matches the individual’s ability. In the
process of developing and implementing an AAC system, symbol comprehension and
use is taught and enhanced. Consequently, the level of representation can change over
time from concrete objects to iconic symbols or gestures as the individual’s symbolic
thought or language ability grows. Systems can integrate multiple sensory components
where an object or graphic symbol is paired with texture and/or an auditory dimension.
Doing so can support comprehension and learning and result in increased meaningful
use of the system. For example, a young child with minimal language skills may use a
miniature bus affixed to a voice output device that sings ‘‘the Wheels on the Bus’’ when
depressed. The concrete object paired with the verbal cue provides the child with com-
prehension support. Over time and with consistent presentation, the child is more likely
to spontaneously use the device to signal ‘‘time for the bus.’’
AIDS
AAC systems also include a variety of aids or devices referred to as low (unaided),
medium, or high (aided) technology, depending upon the level of computer technol-
ogy involved. Low-technology, electronically unaided systems include natural forms
of communication such as functional gestures, sign language, and facial expressions.
Medium-technology aids consist of physical and graphic symbols in the absence of
electronic technology. Objects or photographs, color or black and white line drawings,
iconic representations, alphabet boards, or words organized on concrete displays such
as poster boards, wallets, flip charts, vests, or within binders are all medium-technology
aids (Beukelman & Mirenda, 2005).
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 AUGMENTATIVE AND ALTERNATIVE COMMUNICATION

Finally, high-technology devices utilize electronic and/or computer technology and

voice output. Speech-generating devices (SGD) produce speech via synthesized (elec-
tronic) or digital (recorded) productions paired with some type of symbol represented
on either a fixed, dynamic, or hybrid visual display. Fixed displays include overlays
where symbols occupy a fixed location. Dynamic display devices use LCD screens that
allow the symbols to be manipulated using various functions on the device. Hybrid
systems incorporate both fixed and dynamic symbol displays. Results of research on
the effect of SGDs on the behavioral, linguistic, and social functioning of children
with ASD have been positive (Beukelman & Mirenda, 2005). Some contemporary
high-technology SGDs include Tech Speak (Liberator Co., 2005), Chat PC (Saltillo,
2005), Macaw (ZYGO Industries, 2005), Dynamo (DynaVox Technologies, 2005),
and ChatBox (Prentke Romich Co., 2005).

TECHNIQUES
The technique used to activate symbols on medium- and high-technology systems
varies across devices. Symbol selection depends upon the individual’s visual, auditory,
and motor skills. Direct selection options include physical pressure, touch, or removal
of symbols; use of eye gaze or index finger to point to the symbol; as well as speech
recognition systems (Beukelman & Mirenda, 2005). Various activation options include
timed activation, release activation, visual or auditory scanning, and enlarged pictures.
Timed and release activation options can be adjusted to assist individuals who tap
repeatedly or those with low muscle tone that results in difficulty depressing symbols
(Beukelman & Mirenda, 2005). Visual scanning uses a light to highlight symbol
options and auditory scanning uses a tone; these systems can also be combined.
Finally, tactile options such as raised grids to separate symbols can support successful
activation of desired symbols.

STRATEGIES
The strategy with which specific symbols are stored affects the timing of the com-
municative act, formulation of ideas, and the rate of communication (Beukelman &
Mirenda, 2005). Strategy refers to the amount of information or number of messages
an SGD can hold, which ranges from a single message (single-hit device) to hundreds
of messages arranged according to topics. Messages can be arranged by levels, or over-
lays, similar to computer files and stored within the device’s electronic system. Com-
plete messages can be stored individually within one symbol. Symbols representing
single- or multiple-word messages may be sequenced together or ‘‘chained’’ in order to
formulate more novel ideas, and some SGDs integrate a spelling keyboard function.
Many devices allow flexibility in moving from single-hit productions of complete
utterances to chaining of ideas and spelling options.

SELECTION OF AAC DEVICE

AAC must address the individual’s changing needs. Light (1989) provides a frame-
work that includes analysis of the individual’s linguistic, operational, social, and strate-
gic competence. Linguistic competence involves identifying the individual’s ability to
understand and use symbol systems. Some AAC experts (Beukelman & Mirenda,
2005; Cress, 2002; Harwood, Warran, & Yoder, 2002; Light et al., 2002) discuss
35
AUGMENTATIVE AND ALTERNATIVE COMMUNICATION

linguistic competence by separating the beginning communicator who does not under-
stand or use symbols and the beginning communicator with emerging symbolic under-
standing from the communicator with more advanced academic needs. Given the
severity and range of language impairments found among individuals with ASD, this
distinction is important.
Individuals who are beginning communicators with minimal symbolic understanding
require support to develop foundational communication skills including cause-effect
and object permanence awareness, imitation, joint attention, and use of a natural ges-
tural system. Successful communication development at this stage requires that the
communicative partner learn facilitative strategies such as optimizing responsiveness,
focusing on what the child is attending to, recognizing and interpreting communica-
tive attempts, creating predictable routines, and modeling language using simplified
utterances, commenting, expansions, and elaborations (Siegle & Cress, 2002). At this
stage, low- and medium-technology AAC is initially beneficial (Beukelman & Mir-
enda, 2005).
As children develop into beginning communicators with emerging symbolic skills,
medium-technology AAC may be beneficial. These children are ready to use object
and graphic symbols to make choices and requests, gain attention, protest or reject,
and self-select symbols (Beukelman & Mirenda, 2005). At this point, social and stra-
tegic competence as defined by Light (1989) emerges and can be therapeutically
addressed. That is, children are ready to learn how to initiate, maintain, develop,
repair, and end conversations using the AAC device. Turn-taking ability and use of
the device to ask questions, comment, answer, and acknowledge emerges along with
communication breakdown coping strategies (Light, 1989). As mentioned earlier,
careful selection of symbols, messages, and aids that support social and strategic com-
petence is critical for individuals with ASD.
Since adaptive social functioning is essential to programming for children with
ASD, consideration of the behaviors a child with ASD uses to protest and gain atten-
tion is important. AAC systems can assist individuals with ASD in developing adapt-
ive protesting behaviors using messages such as ‘‘I want to be alone’’; ‘‘don’t touch
me’’; ‘‘it is too loud in here’’; ‘‘no thanks’’; or ‘‘not yet.’’ Additionally, the inherent
human behavior of gaining attention can be addressed. Indeed, research has shown
that integrating AAC with Functional Communication Training (FCT) is effective in
reducing maladaptive, while increasing adaptive, attention gaining behaviors (Durand,
1993, 1999; Mirenda, 1997).
Operational competence considerations balance the demands of the individual’s de-
velopmental and chronological ages in order to support functional and meaningful
interactions. Systems must be adaptable to account for anticipated growth but be use-
able in the present. Portability and durability of the device are critical considerations
affecting access across communicative contexts. Increased access translates to
increased opportunity for use, which promotes increased skill, and is therefore an
essential programming component. Additionally, the cultural background, age, and
gender of the individual must be considered. For example, the wording of messages
and the voice used to transmit the message on the SGD must match that of the
individual using the system and his/her social network (Beukelman & Mirenda,
2005).
36
 AUGMENTATIVE AND ALTERNATIVE COMMUNICATION

TRANSDISCIPLINARY TEAM
Assessment and intervention requires a transdisciplinary approach. Beukelman and
Mirenda (2005) propose use of the Participation Model, which considers intrinsic and
extrinsic variables influencing AAC use. With this model, individual independence,
personal characteristics, and opportunities of use are cohesively addressed. Individual
independence involves analysis of the level of support and prompts needed for success-
ful utilization of the AAC system. Addressing personal characteristics involves formal
and informal analysis and treatment of the individual’s cognitive, language, social,
hearing, vision, behavioral, motor, and literacy abilities. The team must also consider
and plan for extrinsic strengths and challenges. For example, studies (Angelo, Jones, &
Kokoska, 1995; Angelo, Kokoska, & Jones, 1996) examining parental concerns have
identified that parents of children who use AAC worry about acquiring additional
knowledge of and training in the use, maintenance, and programming of AAC devices
along with the ability to plan for the future and integrate the device across settings.
Community awareness and support, funding, parent and professional training and
accessibility to devices are other concerns expressed by parents (Angelo, Jones, et al.,
1995; Angelo, Kokoska, et al., 1996). Assessment tools such as the Wisconsin Assis-
tive Technology Initiative Assistive Technology Assessment (WATI, 2004) and the
Augmentative Communicative Assessment Profile (Goldman, 2002) allow for analysis
of intrinsic and extrinsic variables when considering high- and low-technology systems
for children.

AAC METHODS FOR INDIVIDUALS WITH ASD

Various AAC methods have been discussed in the literature specifically for use with
individuals with ASD. One method, Facilitated Communication (FC), involves the
use of a second person who manually supports or facilitates the use of the AAC sys-
tem with the person with ASD (Biklen, 1990). Controversy surrounding this method
has focused on the authenticity of the messages produced. Given the research, numer-
ous professional organizations, including ASHA, have issued position statements indi-
cating that FC should be viewed as an experimental method.
Another method used with children with ASD is the Picture Exchange Commu-
nication System (PECS; Frost & Bondy, 2002). This method utilizes prescribed
applied behavioral analysis (ABA), whereby very systematic verbal productions are
paired with the use of tangible symbols. PECS requires use of a supportive third per-
son, or assistant, who prompts the individual to physically remove a symbol and give
it to the communicative partner, or facilitator. Thus, sharing communication with a
partner is emphasized. Over time, the level of prompts and reliance on the assistant
is faded, and use of symbols for a variety of social-communicative purposes is
expanded.
AAC systems, or assistive technology, also support more advanced academic and
communicative needs, specifically access to written communication and literacy sup-
port. For example, assistive technology devices, like label makers, allow the individual
to type out short answers and affix them to worksheets. Word processors are consid-
ered assistive technology when used to compensate for fine-motor difficulties. Touch
screens provide access to computer technology and are an effective tool in
supporting teaching of concepts, literacy development, and computer access. Finally,
37
AUGMENTATIVE AND ALTERNATIVE COMMUNICATION

speech-recognition word processing systems are also available and may prove to be an
effective tool for some individuals with ASD.
AAC systems used to organize time and create predictability include various sched-
ule boards, which are different and separate from systems used for oral communication.
Schedule boards can integrate objects, pictures, or print (Quill, 1989). Some higher
functioning individuals with ASD can benefit from using high technology, computer-
ized scheduling systems such as a Palm Pilots or Blackberries. Schedule systems used
to represent part of or an entire day are referred to as macroschedules. Schedules can
also represent steps needed to complete a particular task, such as hand washing, and
are referred to as microschedules (Quill, 1989).
Varied AAC systems are available to enhance the social, communicative, linguistic,
behavioral, academic, and vocational lives of individuals with ASD. An interdiscipli-
nary team approach is necessary to assist in identifying the AAC system best suited to
meet an individual’s current needs. Initially, an assessment of the individual’s cogni-
tive, motor, language, and social skills is essential to identifying a system that matches
his/her current ability. Additionally, planning must consider strategies that will sup-
port the individual’s further growth as a communicator and learner. AAC systems are
not static and should be modified as the individual grows and gains skills. Successful
and consistent integration of AAC systems across the multiple environments a person
encounters can elicit and support adaptive functioning and consequently learning and
socialization.
REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
American Speech-Language-Hearing Association. (2004). Roles and responsibilities of speech-
language pathologists with respect to augmentative and alternative communication: Techni-
cal report. ASHA Supplement, 24, 1–17.
American Speech-Language-Hearing Association. (2005). Roles and responsibilities of speech-language
pathologist with respect to alternative communication: Position statement. Retrieved June 1, 2006,
from http://www.asha.org.
Angelo, D., Jones, S., & Kokoska, S. (1995). Family perspective on augmentative and alterna-
tive communication: Families of young children. Augmentative and Alternative Communication,
11, 193–201.
Angelo, D., Kokoska, S., & Jones, S. (1996). Family perspective on augmentative and alterna-
tive communication: Families of adolescents and young adult. Augmentative and Alternative
Communication, 12, 13–22.
Beukelman, D. R., & Mirenda, P. (2005). Augmentative and alternative communication: Supporting
children and adults with complex communication needs (3rd ed.). Baltimore: Brookes Publishing Co.
Biklen, D. (1990). Communication unbound: Autism and praxis. Harvard Educational Review,
60, 291–314.
Cress, C. J. (2002). Expanding children’s early augmented behaviors to support symbolic devel-
opment. In J. Reichle, D. R. Beukelman, & J. C. Light (Eds.), Exemplary practice for beginning
communicators: Implications for AAC (pp. 219–272). Baltimore: Brookes Publishing Co.
Durand, V. M. (1993). Functional communication training using assistive devices: Effects on
challenging behavior. Augmentative and Alternative Communication, 9, 168–176.
Durand, V. M. (1999). Functional communication training using assistive devices: Recruiting
natural communities of reinforcement. Journal of Applied Behavior Analysis, 32, 247–267.
DynaVox Technologies. (2005). Dynamo. Pittsburgh, PA: Author.
Frost, L., & Bondy, A. (2002). Picture exchange communication system training manual (2nd ed.).
Newark, DE: Pyramid Education Products.

38
 AUTISM BEHAVIOR CHECKLIST (ABC)

Goldman, H. (2002). Augmentative Communication Assessment Profile. London: Speechmark

Publishing.
Harwood, K., Warren, S., & Yoder, P. (2002). The importance of responsivity in developing
contingent exchanges with beginning communicators. In J. Reichle, D. R. Beukelman, &
J. C. Light (Eds.), Exemplary practice for beginning communicators: Implications for AAC
(pp. 59–96). Baltimore: Brookes Publishing Co.
Liberator Company. (2005). Tech Speak. London: UK: Author.
Light, J. (1988). Interaction involving individuals using augmentative and alternative communi-
cation systems: State of the art and future directions. Augmentative and Alternative Communi-
cation, 4, 66–78.
Light, J. (1989). Toward a definition of communicative competence for individuals using aug-
mentative and alternative communication systems. Augmentative and Alternative Communica-
tion, 5, 137–144.
Light, J. C., Parsons, A. R., & Drager, K. (2002). ‘‘There’s more to life than cookies’’: Develop-
ing interactions for social closeness with beginning communicators who use AAC. In J.
Reichle, D. R., Beukelman, & J. C. Light (Eds.), Exemplary practice for beginning communica-
tors: Implications for AAC (pp. 187–218). Baltimore: Brookes Publishing Co.
Mayer Johnson LLC. (2004). Boardmaker. Solana Beach, CA: Author.
Mirenda, P. (1997). Supporting individuals with challenging behavior through functional com-
munication training and AAD: Research review: Augmentative and Alternative Communication,
13(4), 207–225.
Poppin & Company. (2005). DynaSyms, Unity, ME: Author.
Prentke Romich Company. (2005). ChatBox. Wooster, OH: Author.
Quill, K. (1989). Educating children with autism. Albany, NY: Delmar.
Saltillo. (2005). Chat PC. Millersburg, OH: Author.
Siegle, E. B., & Cress, C. J. (2002). Overview of the emergence of early AAC behaviors: Pro-
gression from communicative to symbolic skills. In J. Reichle, D. R. Beukelman, & J. C.
Light (Eds.), Exemplary practice for beginning communicators: Implications for AAC (pp. 25–57).
Baltimore: Brookes Publishing Co.
Silverman, F. (1995). Communication for the speechless (3rd ed.). Needham Heights, MA: Allyn
& Bacon.
Wisconsin Assistive Technology Initiative. (2004). W.A.T.I. Assistive Technology Assessment.
Retrieved June 1, 2006, from http://www.wati.org.
Zygo Industries. (2005). MacCaw, Portland, OR: Author.
LISA R. AUDET

AUTISM. See Autistic Disorder

AUTISM BEHAVIOR CHECKLIST (ABC)

The Autism Behavior Checklist (ABC; Krug, Arick, & Almond, 1993) is an inde-
pendent autism screening tool of 57 items completed by parents. The assessment relies
on direct observation of the student and historical information provided by parents
and other people knowledgeable about the student. This tool is designed to assist in
the diagnosis of autism rather than provide programming information about treatment.
The ABC is a subtest of the Autism Screening Instrument for Educational Planning
(ASIEP-2).

REFERENCE
King, D. A., Arick, J. R. & Almond, P. J. (1993). Autism screening instrument for educational
planning. Austin, TX: Pro-Ed.
BROOKE YOUNG
39
AUTISM DIAGNOSTIC INTERVIEW–REVISED (ADI-R)

AUTISM DIAGNOSTIC INTERVIEW–REVISED (ADI-R)

The Autism Diagnostic Interview–Revised (ADI-R; Lord, Rutter, & LeCouteur,
1994; Rutter, LeCouteur, & Lord, 2003) is a detailed parental history interview
designed to identify individuals with autism. The interview covers early developmental
history and current and early behavior presentation in each of the triad areas of the
autism spectrum, and includes algorithms that allow the assessor to categorize presen-
tation of autism features as measured against DSM-IV-TR and ICD-10 requirements,
as well as provides extra non-algorithm information to enable appropriate diagnostic
subtypes on the spectrum to be identified, and severity of presentation of symptoms.
The ADI-R has been shown to be good at distinguishing autism from non-autism in
clinical populations, but it does not in itself differentiate between core autism and the
broader autism spectrum presentations. It was designed to be used in conjunction with
the Autism Diagnostic Observation Schedule, with research indicating a positive
result on both instruments is 99 percent accurate for diagnosis of autism. Both instru-
ments require training before use.

REFERENCES
Lord, C., Rutter, M., & LeCouteur, A. (1994). Autism Diagnostic Interview–Revised: A revised
version of a diagnostic interview for caregivers of individuals with possible pervasive develop-
mental disorders. Journal of Autism and Developmental Disorders, 24, 659–685.
Rutter, M., LeCouteur, A., & Lord, C. (2003). ADI-R Autism Diagnostic Interview–Revised. Los
Angeles: Western Psychological Services.
FIONA J. SCOTT

AUTISM DIAGNOSTIC OBSERVATION SCHEDULE (ADOS)

The Autism Diagnostic Observation Schedule (ADOS; Lord et al., 2000; Lord, Rut-
ter, DiLavore, & Risi, 2002) is designed to measure presentation of behavioral
response and communicative attempt as compared to the triad features of autism. It
has four modules depending on the child’s level of communicative functioning, cover-
ing (a) preverbal/single words, (b) phrase speech, (c) fluent speech child, and (d) flu-
ent speech adolescent/adult. It enables the examiner or clinician to record the range
of various presentations of the core triad features of autism spectrum disorders—namely
impairments in social interaction, impairments in communication, and presentation of
repetitive and stereotyped behaviors coupled with poor imagination or symbolic play
skills. Like the Autism Diagnostic Interview–Revised (ADI-R), the ADOS uses algo-
rithms to classify individuals, but unlike the ADI-R it covers both autism and autism
spectrum. The ADOS was designed for use alongside the ADI-R, and combined use
offers 99 percent accuracy in classifying autism. The ADOS requires training prior to
use.

REFERENCES
Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Jr., Leventhal, B. L., DiLavore, P. C., et al.
(2000). Autism Diagnostic Observation Schedule: Generic: A standard measure of social and
communication deficits associated with the spectrum of autism. Journal of Autism & Develop-
mental Disorders, 30(3), 205–223.
Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (2002). The Autism Diagnostic Observation
Schedule: Generic. Los Angeles: Western Psychological Services.
FIONA J. SCOTT
40
 AUTISTIC DISORDER

AUTISM SCREENING INSTRUMENT FOR

EDUCATIONAL PLANNING–SECOND EDITION
Autism Screening Instrument for Educational Planning–Second Edition (ASIEP-2; Krug,
Arick, & Almond, 1996) is an individually administered instrument designed to help
professionals evaluate autistic individuals (18 months of age through adulthood) and
develop appropriate instructional plans in accordance with the Individual with Dis-
abilities Education Act (PL 94–142). It can also be used for differential diagnosis, as
it distinguishes individuals with autism from those with other severe handicaps. The
scale looks at five aspects of behavior, which together provide a clear picture of the
individual’s functional abilities and instructional needs.
The ASIEP is composed of five subtests: Autism Behavior Checklist (sensory, relat-
ing, body concept, language, and social self-help behaviors); a sample of vocal behav-
ior (spontaneous verbal behavior); interaction assessment (social interaction based on
observable behaviors); educational assessment (language performance and communica-
tive abilities through signed or verbal responses); and prognosis of learning rate. Each
subtest employs a different format, and each is individually normed. The entire test
can be administered by a professional with experience with children with autism in
11=2 to 2 hours. It yields percentiles and summary scores for each subtest.

REFERENCE
Krug, D., Arick, J., & Almond, P. (1996). Autism screening instrument for educational planning.
Los Angeles: Western Psychological Services.
JEANNE HOLVERSTOTT

AUTISM SCREENING QUESTIONNAIRE. See Social Communication

Questionnaire

AUTISTIC DISORDER
Autistic disorder, or autism, is currently understood as a developmental disability
that begins before the age of three. Autism’s three main areas of impact are in the
domains of social interaction, communication, and restricted, repetitive, and stereo-
typed interests and behaviors. The psychiatric handbook of mental disorders, the
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR: APA, 2000),
classifies autism as a pervasive developmental disorder (PDD). This PDD term refers
to a group of disabilities with similar core characteristics and a wide range of manifes-
tation and prognosis. The other four diagnostic PDD labels include Asperger syndrome
(AS), Childhood Disintegrative Disorder (also known as Heller’s syndrome), Rett’s
Disorder (also known as Rett syndrome), and Pervasive Developmental Disorder–
Not Otherwise Specified (PDD-NOS, also known as atypical autism).
Autism has been known by several other names over the past decades including:
early infantile autism, childhood autism, Kanner’s autism, and classical autism.
Individuals with autism present on a continuum of expression with cognition across
all IQ levels and possession of individual strengths and needs. Some with autism have
no language, have significant cognitive impairment, and are in need of constant care.
Others have limited language and mild cognitive impairments, but are in need of sig-
nificant support. Still others have average to above-average intelligence and their
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AUTISTIC DISORDER

difficulties are less noticeable. Common strengths in autism include visual/spatial abil-
ities, systemizing skills, proclivity for routine-oriented behaviors, rote learning, and
physical development. Some with autism have splinter skills, or unique talents and
abilities that seem unusual when compared to adaptive or other functioning levels.
For example, an 8-year-old child with autism may not be toilet trained but be able to
do puzzles at amazing speed. Or an adult with autism may be nonverbal but be able to
play a musical instrument with expertise.
Generally, those with autism have challenges with verbal and nonverbal communi-
cation, relating to others, difficulty learning by traditional methods, are resistant to
change, and insist on familiarity. Other concerns include possible co-occurring medi-
cal conditions, sensory processing difficulties, and behavioral deficits and/or excesses.
Approximately one-third of those with autism experience seizures at some point. Some
individuals with autism exhibit odd repetitive behaviors such as hand flapping, finger
twisting, light filtering, body posturing, or complex movements of the body. It has
been inferred that these behaviors are due to a need to respond to sensory input or as
a means to deal with stress, anxiety, or confusion. Others with autism may have self-
injurious or aggressive behaviors. These behaviors are often the result of inappropriate
teaching, lack of positive supports, and the difficulties facing a person who may have
limited communication and/or means to have needs met.
Today, many use the term autism to refer to an autism spectrum disorder (ASD) or
the clustering of three of the most common PDDs (autism, AS, and PDD-NOS). The
distinctions between these labels can be subtle, but generally those with PDD-NOS
meet at least one of the criteria of autism but lack other criteria to qualify for the au-
tism diagnosis. For example, a child with PDD-NOS might have average IQ, good
social skills, but significant and pervasive communication issues. Those with AS have
average to above-average cognition and speech development that is typical, but have
social and behavioral impairments. For example, an adult with AS might have a high
IQ, hold a job in a computer company, be married, but have intense social needs and
anxieties as well as some repetitive and stereotyped behaviors. Autism tends to be the
most challenging of the group, with many having cognitive impairment (IQ less than
70), less or no verbal language ability, and more medical, sensory, and behavioral
needs. For example, a teenager with autism might have cognitive impairment and lim-
ited adaptive skills, no language ability, use limited sign language to communicate,
have epilepsy, and self-injurious behaviors. The previous examples are merely attempts
at detailing the wide range of presentations for similar disabilities. Although each
individual with autism has impairments in the three main areas (social, communica-
tion, and behaviors), each is unique in how the impairments and strengths are
expressed, in personality and in potential. Today, many professionals use the terms
PDD and ASD interchangeably.
Another ongoing debate in the field is whether or not AS is a distinct disability or
just a form of high-functioning autism (HFA). The term HFA has been used to
describe those with autism who are less impaired compared to those with severe cogni-
tive impairment, individuals with autism who have an IQ above 70, or those with av-
erage or even superior IQ. Since AS was added to the Diagnostic and Statistical Manual
of Mental Disorders in 1994 (APA), there has been debate about whether AS and
HFA are the same or different diagnoses.
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 AUTISTIC DISORDER

Although autism has been one of the most studied disabilities of childhood, it
remains one of the most perplexing. What causes autism is still beyond the under-
standing of scientists, although they are much closer today than when autism was first
described in the literature by Leo Kanner in 1943. Autism has been conceptualized in
a number of ways over the past 60 years. From the mid-1940s into the 1960s, autism
was thought to be a psychogenic condition of childhood caused by parents’ inability
to bond with their children, and the negative term ‘‘refrigerator parent’’ (often the
mother was implicated) was used to label the parents of children with autism.
Although Kanner and others first posited that autism was a condition that was present
at birth or developed soon after, professionals missed some telltale signs (such as if
parents could not bond with their child with autism, why did they have other children
who developed without having autism?), and chose rather to blame the parent. From
the 1960s onward, evidence was presented that began to overturn this unfortunate be-
ginning. This evidence came in the form of family and twin studies, brain research,
and other designs that described autism as a biological disorder that had genetic roots.
Even though most today agree that autism is a spectrum of disorders that range from
mild to severe presentations, there is still debate on how autism develops. Some
believe that autism is predetermined genetically and that the impact of the disability
will depend on the number of genes affected in any one individual. Others believe
that autism is caused by environmental factors that combine with affected genes to
cause the disability. Still others believe that autism is caused when various environ-
mental toxins get into a child’s body, and the immune system is unable to process
these materials. What most agree on is that the behavior, learning, and characteristics
of individuals with autism are different from typically developing individuals because
the biology of the brain is different due to genetic and/or environmental influences.
Although biological in nature, there is currently no medical test for autism and it is
diagnosed only after observations of the child and interviews with caregivers.
Autism was once thought an extremely rare condition of childhood. Initial preva-
lence statistics estimated that 4 to 5 out of 10,000 children had autism. Currently, au-
tism is one of the most diagnosed disabilities of childhood with a prevalence rate of
approximately 2 to 6 per 1,000. How and why the prevalence rate is changing are
controversial questions; some blame the environment and others conclude that the
broadening of the autism spectrum accounts for the increase. Today the total autism
population in the United States has been estimated at approximately 1.5 million chil-
dren, youth, and adults (Autism Society of America, 2006). Both historically and cur-
rently autism is much more common in males than females (4 to 1 for autism, as high
as 9 to 1 for AS).
In the middle of the 1900s, psychotherapy and/or removal of the child with autism
from the home were seen as possible treatments. Since that time, applied behavior
analysis (ABA), special education, cognitive behavior modification, visual/environ-
mental supports, structured teaching, positive behavior support, speech-language
therapy, occupational therapy, physical therapy, counseling, and social skills training
have all become avenues to teach individuals with autism. Historically, many individ-
uals with autism were placed in institutions. Since the inclusion and deinstitutionali-
zation movements and passage of national laws, most individuals with autism now live
at home and go to public schools. However, some children are home-schooled or
43
AUTISTIC DISORDER

attend special schools, and many families augment public school education by provid-
ing their children with private services at home.
The future for individuals with autism remains variable depending on education,
supports, availability of services, early intervention, degree of strengths and impair-
ments, and other factors. Although considered a lifelong disability, many with autism
have made significant progress and contributions. For example, Temple Grandin, Pro-
fessor of Animal Sciences at Colorado State University, is one of the most well
known adults with autism in the United States. Grandin has become an expert in
livestock handling and is well known internationally for her expertise in this area as
well as being a speaker and advocate for those with autism.
Since the controversy over the increased diagnosing of autism and related disorders
in the 1990s to today, autism has become better known to the public. Television
shows, magazine articles, newspaper stories, motion pictures, documentaries, and so
forth have all helped to spread awareness about autism and its impact on individuals,
families, educators, other professionals, and communities. For example, many people
have seen or heard of the award-winning motion picture Rain Man, which was pro-
duced in 1988, a portrayal of an adult with autism and his brother as they journeyed
across the country.
One of the biggest and later controversies in autism pertains to the question of
potential cures for this disability. Some believe that those with autism can and should
be cured. This remains highly controversial, and the ethical question of whether or
not autism should be cured has been asked. Others, both those with autism and their
advocates, have spoken out against curing autism. They believe that autism is a cul-
ture and that curing autism would be eradicating these persons and their way of life.
They aren’t arguing against helping and teaching persons with autism, however they
argue that curing autism would take away the uniqueness and future contributions of
those with autism.
In the early twenty-first century, the autism research community was focusing on a
number of areas including, genetics, brain research, treatment and education, possible
environmental contributors, and how autism develops. It is very possible that in the
next 50 years the specific genes responsible for autism will be located and that thera-
pies will be created to address these chromosomal differences both in utero and post-
natally. Furthermore, continued advances in the field of brain studies may also bring
about treatments to change neurology. Environmental factors may also be identified as
contributors to autism with appropriate responses following. Other new or existing
methodologies will be identified as best practice for teaching those with autism. If an
eventual cure for autism is discovered, the ethical question of whether or not autism
should be cured will continue to be debated. Included within this discussion will be
the moral imperative to treat those with this disability with dignity and respect.
See also self-injurious behavior; speech therapy; visual supports.

REFERENCES
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders
(4th ed.). Washington, DC: Author.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
Autism Society of America [ASA]. (2006). What is autism? [Brochure]. Bethesda, MD: Author.

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 AUTISTIC DISORDER

FURTHER INFORMATION
Frith, U. (Ed.). (1989). Autism: Explaining the enigma. Oxford: Blackwell.
Gillberg, C., & Coleman, M. (2000). The biology of the autistic syndromes (3rd ed.). London:
Keith Mac Press.
Grandin, T. (1995). Thinking in pictures and other reports from my life with autism. New York:
Vintage Books.
Herbert, M. R. (2005). Autism: A brain disorder, or a disorder that affects the brain [Electronic
Version]. Clinical Neuropsychiatry, 2, 354–379.
Johnson, M. (producer), & Levinson, B. (director). (1988). Rain Man [Motion Picture]. United
States: United Artists.
Kanner, L. (1943). Autistic disturbances of affective content. The Nervous Child, 2, 217–250.
National Research Council. (2001). Educating children with autism. Committee on Educational
Interventions for Children with Autism. Division of Behavioral and Social Sciences and Edu-
cation. Washington, DC: National Academy Press.
Powers, M. D. (2000). Children with autism (2nd ed.). Rockville, MD: Woodbine House.
Quill, K. A. (2000). Do watch listen say: Social communication intervention for children with autism.
Baltimore: Brookes Publishing Co.
PAUL G. LACAVA

45
 B
BASELINE
‘‘Baseline conditions serve as the background or context for viewing the effects of a
second type of condition’’ (Johnston & Pennypacker, 1993, p. 225). Kennedy (2005)
further explained, ‘‘The starting point for most experimental analyses of behavior is
the establishment of a baseline’’ (p. 35). In other words, baseline refers to the occur-
rence of a response in its freely occurring or natural state. It is the observations of a
dependent variable response prior to the administration of a treatment condition,
which may or may not change this response. It is the measure against the result of the
treatment to see whether the dependent variable changes or not. The recording of a
baseline is very important because the baseline data serves as the standard against
which change elicited by the experimental treatment is assessed.

REFERENCES
Johnston, J. M., & Pennypacker, H. S. (1993). Strategies and tactics of behavioral research (2nd
ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.
Kennedy, C. H. (2005). Single-case designs for educational research. Boston: Pearson Education,
Inc.
KAI-CHIEN TIEN

BEHAVIOR
Behavior is the observable manifestation of internal functioning. This means that
behavior is a form of communication and can be a reaction to either an external or
internal situation. For example, self-stimulatory behavior is widely considered to serve
the function of stimulating the individual’s mind and senses, as well as serving a self-
regulating function. These behaviors would be a response to internal conditions. On
the other hand, if a room is noisy and the child covers his ears, he is reacting to the
external situation. It is important to remember that all behavior, including undesired
or inappropriate behavior, is a form of communication. Any intervention for a tar-
geted behavior will be unsuccessful if it does not address what the individual intended
the behavior to communicate.
KATIE BASSITY
BEHAVIORAL ASSESSMENT OF THE DYSEXECUTIVE SYNDROME (BADS)

BEHAVIORAL ASSESSMENT OF THE

DYSEXECUTIVE SYNDROME (BADS)
The Behavioral Assessment of the Dysexecutive Syndrome Battery (BADS; Wilson,
Alderman, Burgess, Emslie, & Evans, 1996) is designed to assess adolescents and
adults with dysexecutive syndrome (DES). DES includes disorders of planning, organi-
zation, problem solving, and attention, closely resembling what was once called ‘‘fron-
tal lobe syndrome.’’ The BADS includes items that are specifically sensitive to frontal
lobe damage and to those skills involved in problem solving, planning, and organizing
behavior over an extended period of time. It assesses capacities for everyday living
that reflect the real-life demands that occur when people need to solve problems, set
priorities in the face of competing demands, and adapt behavior to changing situa-
tions. The BADS helps determine whether an individual has a general impairment of
executive functioning or a specific kind of executive disorder.

REFERENCE
Wilson, B. A., Alderman, N., Burgess, P. W., Emslie, H., & Evans, J. J. (1996). Behavioural
assessment of the dysexecutive syndrome. Bury St. Edmunds, UK: Thames Valley Test
Company.
JEANNE HOLVERSTOTT

BEHAVIORAL OBJECTIVE
A behavioral objective is a definition of a desired behavior toward which a child is
working. It should be observable and measurable, such that anyone reading it would
be able to clearly identify the behavior being addressed, as well as assess if the objec-
tive has been met. Therefore, a behavioral objective must also include criteria that
define what it means to accomplish or meet the objective. Behavioral objectives
should also be stated in positive terms and should be socially valid, helping an indi-
vidual reach maximum independence and integration.
KATIE BASSITY

BEHAVIORAL REHEARSAL
Behavioral Rehearsal is a method employed for the acquisition of skills, particularly
one related to social competence. To utilize behavioral rehearsal, a desired objective
(behavior) is identified; for example, an individual will appropriately gain and sustain
the attention of peers. Positive manifestations of this skill are then described (visually
with pictures, television clips, etc., and verbally) and demonstrated. For the child with
difficulties asking other students to play, desirable behavioral outcomes might be spe-
cific phrases (‘‘Can I play with you?’’ or ‘‘Do you want to play?’’). After observing
these demonstrations, the individual engages in structured practice of this skill while
coaching and feedback guide performance. Several modalities of behavioral rehearsal
can assist in the acquisition of the skill in this context. Covert rehearsal presents a sit-
uation for the individual to mentally practice, while verbal rehearsal incorporates
verbal processing of the situation. Overt rehearsal involves role-playing or modeling
the skill. The individual should be encouraged to implement this skill in real-world
situations to promote generalization.
JEANNE HOLVERSTOTT
48
 BEHAVIOR HEALTH REHABILITATION SERVICES (BHRS)

BEHAVIOR ANALYSIS. See See Applied Behavior Analysis

BEHAVIOR ANALYST CERTIFICATION BOARD (BACB)

The Behavior Analyst Certification Board (BCBA) is a nonprofit corporation that
sets international standards for certification in behavior analysis. The certification
process is voluntary, which means a practitioner may practice behavior analysis with-
out certification from the BACB. However, the board and its certification process are
intended to promote high quality practitioners in the field of behavior analysis as well
as standards for consumers. The BACB currently offers two levels of certification:
Board Certified Associate Behavior Analyst, and Board Certified Behavior Analyst.

FURTHER INFORMATION
Board Analyst Certification Board: http://www.bacb.com.
KATIE BASSITY

BEHAVIOR ASSESSMENT SCALE FOR CHILDREN (BASC)

Behavior Assessment Scale for Children (BASC) is an assessment tool designed to
identify emotional disturbances and problem behaviors in children and adolescents
(Manning & Miller, 2001). As such, the BASC is used to make educational evalua-
tions, clinical diagnoses, and intervention plans. BASC encompasses five components:
a Teacher Rating Scale (TRS); a Parent Rating Scale (PRS); a Self-Report Inventory;
a Student Observation System (SOS); and a Structured Developmental History (SDH;
Reynolds & Kamphaus, 1992). This multidimensional assessment is thought to include
many aspects of behavior, not only problem behaviors, but also strengths and adaptive
behaviors.

REFERENCES
Manning, S. C., & Miller, D. C. (2001). Identifying ADHD subtypes using the parent and
teacher rating scales of the behavior assessment scale for children. Journal of Attention Dis-
orders, 5(1), 41–51.
Reynolds, C. R., & Kamphaus, R. W. (1992). Behavior Assessment System for Children–Manual.
Circle Pines, MN: American Guidance Service.
YU-CHI CHOU

BEHAVIOR CONTRACT. See Contingency Contracting

BEHAVIOR HEALTH REHABILITATION SERVICES (BHRS)

Behavioral Health Rehabilitation Services (BHRS), sometimes called wraparound
services, are behavioral services provided in home, school, and community settings
based on the recommendation of a psychiatrist or psychologist. Generally, these ser-
vices are provided through the Office of Medical Assistance Programs and are put in
place for those individuals who require more than outpatient services and otherwise
might need a more restrictive environment. BHRS is composed of three levels of sup-
port: Behavioral Specialist Consultants (BSC), Mobile Therapists (MT), and Thera-
peutic Staff Support (TSS), in addition to the psychologist or psychiatrist.
KATIE BASSITY
49
BEHAVIOR INTERVENTION PLAN

BEHAVIOR INTERVENTION PLAN

A Behavior Intervention Plan (BIP) is a detailed plan that identifies the student’s
maladaptive behavior, the function of behavior, and strategies to teach new socially
appropriate behaviors. A BIP is framework to assist educators in using proactive teach-
ing strategies when confronted with a target behavior.
KATHERINE E. COOK

BEHAVIORISM
Behaviorism is the philosophy regarding the science of behavior and is considered
one aspect of study within the science of behavior. Beginning as a school of thought
within the field of psychology, behaviorism finds its greatest influence from the work
of B. F. Skinner. There are several different kinds of behaviorism, some of which
acknowledge the existence and influence of internal states and processes; others do
not. It is this aspect of behaviorism that has created controversy. This controversy
continues today, particularly as the application of applied behavior analysis in educa-
tion with individuals with autism and other disabilities and disorders has found sub-
stantial research support.

FURTHER INFORMATION
Cooper, J., Heron, T., & Heward, W. (1987). Applied behavior analysis. Upper Saddle River, NJ:
Pearson Education.
KATIE BASSITY

BEHAVIOR MODIFICATION
Behavior modification is the application of operant conditioning principles in
everyday situations. However, behavior modification is a widely used term, particu-
larly by educational practitioners, which generally refers to any interventions that
seek to change behavior. This may include the use of proactive or antecedent inter-
ventions. These interventions focus on occurring prior to a behavior in order to
prevent it.
KATIE BASSITY

BEHAVIOR PRINCIPLES
Behavior principles are the main findings on which behaviorism is based. These
principles express a functional relationship between behavior and something that con-
trols it. For example, reinforcement and punishment are two principles of behavior.
Behavior principles have been shown to be true across thousands of situations and
people, but across other species as well. In other words, these may be considered laws
of behavior. Although there are few behavior principles, each has many forms of
application in practice. A method that puts a principle of behavior into practice is
referred to as a behavior change procedure.

FURTHER INFORMATION
Cooper, J., Heron, T., & Heward, W. (1987). Applied behavior analysis. Upper Saddle River, NJ:
Pearson Education.
KATIE BASSITY
50
 BIOFEEDBACK

BETTELHEIM, BRUNO (AUGUST 28, 1903–MARCH 13, 1990)

Bruno Bettelheim rose to prominence as a psychologist in the United States. Bettel-
heim’s significant theory claimed that unemotional and cold mothering was the essen-
tial cause of childhood autism. This theory, often called the ‘‘refrigerator mother’’
theory and now soundly repudiated by science, caused severe damage to thousands of
families who believed his untested claims. He was convinced that autism had no or-
ganic basis, but that it instead was mainly influenced by the upbringing of mothers
who did not want their children to live, either consciously or unconsciously, which in
turn caused them to restrain contact with them and fail to establish an emotional
connection.
VIRGINIA L. COOK

BIAS
Shadish, Cook, and Campbell (2002) define bias as systematic errors in an estimate
or an inference (p. 505). To be more specific, a bias is a prejudice in a general or spe-
cific sense, usually in the sense of having a predilection to one particular point of view
or ideology. Any mental condition that would prevent an individual from being objec-
tive and impartial is called bias. In statistics, the word bias means that an estimator
has been averaged over- or under-estimated (Cohen, 2001). It is a statistical sampling
or testing error caused by systematically favoring a particular outcome over others. It
has at least two different senses, one referring to something considered very undesir-
able and the other referring to something that is occasionally desirable.

REFERENCES
Cohen, B. H. (2001). Explaining psychological statistics (2nd ed.). Danvers, NY: John Wiley &
Sons, Inc.
Shadish, W. R., Cook, T. D., & Campbell, D. T. (2002). Experimental and quasi-experimental
designs for generalized causal inference. Boston: Houghton Mifflin Company.
KAI-CHIEN TIEN

BIOFEEDBACK
Biofeedback refers to a continuous auditory or visual feedback of changes in bodily
reactions or functions brought about by changes in an individual’s thoughts or emotions.
Some examples of bodily functions could be breath, muscle tension, skin temperature,
and heart rate. By providing information about a bodily state frequently, the individual
can learn to recognize the link between thoughts, physical reactions, and feelings. Bio-
feedback is a form of self-management, and is developed to empower people to feel bet-
ter about themselves. This is done by essentially changing destructive, problematic
behavior and habits or inefficient patterns of coping into positive behaviors.
Biofeedback works when a person is hooked up to electromechanical equipment,
such as a blood pressure monitor. The equipment measures and records physiological
functions and provides the individual with information about them. For example, a
visual display on a computer screen, a tone or both may be used to indicate when
blood pressure is below the predetermined level. Heart rate can also be measured and
individuals can learn the association between the pace of the heartbeat and relaxa-
tion. An individual would be hooked up to a heart rate monitor. The external
51
BLEULAR, EUGEN

electronic monitoring device (EKG) would give the individual an immediate and con-
tinuous readout of the beating heart.
Biofeedback is essentially a step-by-step process for self-control and makes use of
many of the same techniques used by behavior therapists. Biofeedback involves pro-
viding the individual with information about physiological processes of which they are
normally unaware. With the benefit of this additional information they can learn to
bring voluntary control over physiological conditions that otherwise may have been
potentially harmful to their health.
Biofeedback involves developing an increased awareness of body states, learning
voluntary control over these states, and learning to use these new skills in everyday
life. The goal is for the individual to use the new skill to control the bodily state
without the biofeedback instruments. This learning occurs through the biofeedback
training through increased awareness of other physical sensations. The feedback equip-
ment informs the individual when their body is producing too little or too much of
the state it is measuring. This learning increases the individual’s self-control by return-
ing the responsibility for one’s health to the individual and allows the individual to
control their own stress responses.
Biofeedback and relaxation training techniques have had efficacious applications
and success for reducing anxiety, diabetes, tension and migraine headaches, insomnia,
chronic pain, asthma, psoriasis, epilepsy, stroke, hypertension, and cardiac arrhythmia.
For example, an individual with high blood pressure can learn to regulate their
heart rate by being hooked up to a heart rate monitor. An auditory tone or a visual
display can indicate the current rate. The individual can use relaxation techniques to
lower the blood pressure. Once they learn to lower their blood pressure by using the
biofeedback, then they can achieve the same outcome without the equipment. This
can involve increased knowledge and attunement with their bodily sensations of
higher and lower blood pressure during the biofeedback training sessions.
STEPHANIE NICKELSON

BLEULAR, EUGEN
Eugen Bleular (April 30, 1857–February 9, 1940), a Swiss psychiatrist, was ap-
pointed professor of psychiatry at the University of Z€urich in 1898 and director of the
University Psychiatric Hospital from 1898 to 1927. Considered one of the most influ-
ential psychologists of his time, Bleuler is best known today for his introduction of the
terms schizophrenia in 1908 and autism in 1912.
TERRI COOPER SWANSON

BOARD CERTIFIED ASSOCIATE BEHAVIOR ANALYST (BCABA)

The Board Certified Associate Behavior Analyst (BCABA) certification is a combi-
nation of coursework, experience supervised by a Board Certified Behavior Analyst
(BCBA), and a standardized exam. In addition, a BCABA must have a minimum of a
bachelor’s degree. In practice, a BCABA may supervise behavior analytic intervention
and train others in behavioral interventions in areas similar to his or her training.
However, the Behavior Analyst Certification Board (BACB) strongly recommends
that a BCABA practice under a BCBA according to the standards of the Board.
52
 BOWEL PROBLEMS

FURTHER INFORMATION
Behavior Analyst Certification Board: http://www.bacb.com.
KATIE BASSITY

BOARD CERTIFIED BEHAVIOR ANALYST (BCBA)

The Board Certified Behavior Analyst (BCBA) certification is a combination of
coursework, experience supervised by a BCBA, and a standardized exam. This certifi-
cation requires more credit hours and longer experience than the Board Certified
Associate Behavior Analyst (BCABA). Additionally, certification requires a minimum
of a master’s degree. In practice, a BCBA may create and implement behavior analytic
interventions based on current research, train others in behavioral principles and
interventions, and conduct, analyze, and interpret a variety of behavioral assessments
and data.
See also Behavior Analyst Certification Board.

FURTHER INFORMATION
Behavior Analyst Certification Board: http://www.bacb.com.
KATIE BASSITY

BOLLES SENSORY INTEGRATION

Bolles Sensory Integration, also known as Bolles Sensory Learning Method, was
developed by Mary Bolles, an occupational therapist, to re-educate and remediate an
individual’s ability to process and integrate sensory information. This approach stimu-
lates particular sensory systems to learn or relearn the ability to receive, process, and
integrate sensory information. This specialized intervention combines specific visual, au-
ditory, and vestibular stimuli into one sensory experience to facilitate effective sensory
integration. To date, Bolles Sensory Integration is not supported by empirical data.
KELLY M. PRESTIA

BOWEL PROBLEMS
Fecal incontinence and constipation are the common symptoms of bowel problems.
Fecal incontinence occurs when feces are passed involuntarily and inappropriately
(Royal College of Physicians, 1995), which usually causes urgency or passive leakage
(Boyd-Carson, 2003). Constipation, on the other hand, occurs when there is a reduc-
tion in the frequency of passing stools and increased straining in passing stools
(Arnaud, 2003; Storrie, 1997). Approximately 20 percent of children with autism or
pervasive developmental disorders reportedly experience constipation (O’Moore,
1978). Children who experience bowel problems may produce loose stools, move their
bowels three times per week or less, strain to move their bowels, have difficulties pro-
ducing stools, pass gas frequently, and burp or belch frequently (Kerwin, Eicher, &
Gelsinger, 2005).

REFERENCES
Arnaud, M. J. (2003). Mild dehydration: A risk factor of constipation? European Journal of Clini-
cal Nutrition, 57, Supplement 2, S88–S95.
Boyd-Carson, W. (2003). Faecal incontinence in adults. Nursing Standard, 18(8), 45–54.

53
BRUSHING

Kerwin, M., Eicher, P., & Gelsinger, J. (2005). Parental report of eating problems and gastroin-
testinal symptoms in children with pervasive developmental disorders. Children’s Health Care,
34(3), 221–234.
O’Moore, M. (1978). Irish Journal of Psychology, 4, 33–52.
Royal College of Physicians. (1995). Incontinence: Causes, management and provision of services.
London: Royal College of Physicians.
Storrie, J. B. (1997). Biofeedback: A first-line treatment for idiopathic constipation. British Jour-
nal of Nursing, 6, 152–158.
YU-CHI CHOU

BRUSHING
Brushing refers to a general technique of applying gentle but firm, rhythmic pressure
with a stiff brush in an attempt to reorganize an individual’s sensory system to prepare
them for learning. A specific protocol for brushing was developed by Patricia
Wilbarger.
See also Wilbarger Protocol.
KELLY M. PRESTIA

BULLYING
Experts define bullying as repeated negative actions intended to harm or distress a
target and characterized by a power imbalance, which can either be social, psychologi-
cal, or physical in nature. Bullying can take many forms, including physical, verbal,
social, or educational. ‘‘Educational bullying is when adults who perform as members
of the school staff in some function use their power to either intentionally or uninten-
tionally harm students, causing them distress’’ (Heinrichs, 2003, p. 27). Verbal bully-
ing is the most common type of bullying for both boys and girls.
Bullying is pervasive in our schools and communities. Almost one third of students
are involved in moderate to frequent bullying either as a target or aggressor (Nansel
et al., 2001). According to anecdotal reports, nearly all students say they have been
teased and harassed at school (National Association of Attorneys General, 2000). Fur-
thermore, every school day, 160,000 students miss school because they are afraid of
being bullied (Fried & Fried, 1996).

HIGH-RISK STUDENTS
For some students, bullying experiences are severe, chronic, and frequent. Approxi-
mately 10–15 percent of children who are targeted for bullying fall into this high-risk
group. A smaller proportion (5–10 percent) are so seriously targeted that without sig-
nificant support from adults and peers, they will most likely not be able to overcome
the consequences of their experiences and progress positively (Pepler & Craig, 2000).
As a group, children with special needs are more frequent targets of bullying, and
kids who talk, act, or think differently tend to suffer more bullying and exclusion than
does someone with a physical challenge. Children and adults may have more difficulty
understanding differences that cannot be seen such as significant social, behavioral,
emotional, and/or sensory challenges, especially when these same individuals exhibit
cognitive/academic strengths (Kavale & Forness, 1996; Little, 2002). For example,
children with autism spectrum disorders (ASD) often make statements that are
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interpreted as rude because of their social deficits and tendency toward literal interpre-
tations. Because these children may look ‘‘normal’’ physically, peers and adults may
have little tolerance for this characteristic manifestation of their disorder (Heinrichs,
2003).

BULLYING AND CHILDREN/YOUTH WITH AUTISM SPECTRUM DISORDERS (ASD)

There is little research on bullying and children with ASD. Liza Little (2002) sur-
veyed over 400 parents of children diagnosed with Asperger syndrome (AS) and
nonverbal learning disability (NLD), ranging from 4 to 17 years, about bullying.
Ninety-four percent of the parents indicated that their child had been bullied at least
once during the previous year. Compared to studies of the general population, kids
with AS were four times more likely to be bullied. The survey also indicated that chil-
dren with Asperger syndrome and NLD experience a very high level of peer shunning
that increases with age and peaks in high school—a time when peers are becoming
more important in the lives of adolescents. Peer shunning is the act of ignoring or
excluding children and includes such examples as not being invited to parties, sitting
alone at lunch, and being picked last for activities. This study suggests that peer vic-
timization and bullying of all kinds are pervasive among children diagnosed with AS.
Clearly, children and youth with autism spectrum disorders are at considerable risk
for bullying due to the innate characteristics of their disability related to their social,
communication, behavioral, and sensory challenges, which set them apart from their
peers and make it more difficult for them to recognize and respond when targeted by
others. Because of bullying and peer shunning, children with AS may be excluded or
have negative experiences when involved with the activities that commonly make up
the social lives of our children. They are more likely to experience frequent, severe,
and chronic bullying, placing them in the 5–10 percent of high-risk students who will
need a significant amount of support and intervention from adults to progress posi-
tively in their school and community (Heinrichs, 2003).

HOW CHILDREN COPE WITH BULLYING

Recent research on bullying experiences in school that explore the social world of
students indicates that our children do not feel safe (Garbarino & deLara, 2002;
National Association of Attorneys General, 2000; Rigby, 1996). Garbarino and
deLara’s work with teenagers found that the students did not feel safe in school
and that their main coping mechanism is trying to predict the behavior of their peers
and teachers. In other words, when they could predict someone’s behavior based on
past experiences, they felt safer and could determine how to stay out of harm’s
way. This included identifying ‘‘unowned spaces’’ or ‘‘hot spots’’ that should be
avoided—typically less-supervised areas identified by students as being potentially unsafe
(e.g., restrooms, hallways, and locker areas).
Garbarino and deLara (2002) determined that students are ‘‘overfunctioning’’ trying
to stay safe in school while adults seem to be ‘‘underfunctioning.’’ Students are
expending energy on trying to predict behaviors in order to feel safe. This is energy
that detracts from their ability to learn. The authors concluded that adults need to
take more responsibility for providing a safe learning environment so students can
attend to learning.
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BULLYING

IMPLICATIONS FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS

If typical students are spending too much time and energy trying to predict behav-
iors so they can feel safe, we can assume that children with ASD expend even more
time and energy predicting behavior. They are more frequently targeted for bullying
and exclusion, and because of the innate characteristics of their disability will have
more difficulty predicting the behaviors of others. Characteristically, individuals with
ASD have difficulty taking the perspective of others or predicting what others may be
thinking or feeling in social situations (Theory of Mind). This puts them at a great
disadvantage, and as a result they will expend a great deal of time and energy trying
to stay safe with very little success. Consequently, this may increase their already
higher levels of anxiety and may eventually lead them to express negative feelings
about school or even begin to exhibit school refusal (Heinrichs, 2003).

KEY COMPONENTS OF A SUCCESSFUL BULLYING PREVENTION PROGRAM

Successful bullying prevention programs must include a strong emphasis on aware-
ness, understanding, and willingness on the part of all adults to be proactive and do
what is necessary to provide a safe environment for all children. Ultimately, ‘‘we can-
not expect the least empowered person, the targeted child, to bear the burden of
‘beating the bullies’ or to somehow figure out how to change his or her behavior in
order to create a safer school environment’’ (Heinrichs, 2003, p. 15). This is especially
true for high-risk students with ASD ‘‘because compared to their neurotypical peers,
their social-communication disability renders them less skilled at effectively protecting
themselves when bullying occurs’’ (Heinrichs, 2003, p. 15).
Effective bullying prevention needs to involve the entire community of children/
youth and adults and include steps at the school, class, and individual level. Special
attention and modifications must be considered when dealing with students with
exceptionalities so they can be safe and continue to learn. Using special assessment
tools such as the Modified Inventory of Wrongful Activities to accurately identify the
extent of bullying in children with ASD, along with periodic social interviews, can
help provide an accurate picture of their bullying and social experiences (Heinrichs,
2003). Drawing on best practices that will enable children with ASD to have more
success in the social arena is also of great importance.
Critical components of a successful bullying prevention program include: (a) identi-
fying high-risk areas and increasing supervision with trained adults; (b) adults model-
ing appropriate behaviors; (c) promoting social-emotional learning for all students,
involving parents; and (d) most importantly, a long-term commitment to making bul-
lying prevention a priority. Adults are key to bullying prevention and our dedication
to providing a safe environment for children to learn will ultimately make a difference
for children with ASD and for all children.

REFERENCES
Fried, S., & Fried, P. (1996). Bullies and victims: Helping your child survive the schoolyard battlefield.
New York: M. Evans and Company, Inc.
Garbarino, J., & deLara, E. (2002). And words can hurt forever: How to protect adolescents from
bullying, harassment, and emotional violence. New York: The Free Press.
Heinrichs, R. (2003). Perfect targets: Asperger syndrome and bullying: Practical solutions for surviv-
ing the social world. Shawnee Mission, KS: Autism Asperger Publishing Co.

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Kavale, K. A., & Forness, S. R. (1996). Social skills deficits and learning disabilities: A meta-
analysis. Journal of Learning Disabilities, 29, 226–237.
Little, L. (2002). Middle-class mothers’ perceptions of peer and sibling victimization among
children with Asperger’s syndrome and nonverbal learning disorders. Issues in Comprehensive
Pediatric Nursing, 25, 43–57.
Nansel, T., Overpeck, M., Pilla, R., Ruan, W., Simons-Morton, B., & Scheidt, P. (2001). Bully-
ing behaviors among U.S. youth: Prevalence and association with psychosocial adjustment.
Journal of the American Medical Association, 285, 2094–2100.
National Association of Attorneys General. (2000). Bruised inside: What our children say about
youth violence, what causes it, and what we need to do about it. Retrieved July 7, 2004, from
http://www.ct.gov/ag/lib/ag/children/bruised.pdf.
Pepler, D. J., & Craig, W. (2000). Report 60: Making a difference in bullying. Toronto: LaMarsh
Centre for Research on Violence and Conflict Resolution.
Rigby, K. (1996). Bullying in schools: And what to do about it. London: Jessica Kingsley
Publishers.

FURTHER INFORMATION
Gray, C. (2004). Gray’s guide to bullying. Jenison Autism Journal, Spring 2004.
Olweus, D. (1993). Bullying at school: What we know and what we can do. Oxford: Blackwell
Publishers.
REBEKAH HEINRICHS

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 C
CAREER PLANNING
Prior to adulthood, it is essential that caregivers, teachers, and community supports
ensure individuals with autism have the opportunities to acquire the skills necessary
to be successfully employed in a desired profession. The Individuals with Disabilities
Education Act (IDEA, 2004) mandates that each student with a disability will begin
to transition from the classroom to the workforce no later than age 16. However,
when the student reaches adulthood, the Vocational Rehabilitation Act and Ameri-
cans with Disabilities Act mandate only equal access and not the provision of neces-
sary services and supports once access is obtained.
The career planning process is based on individual needs, preferences, interests, and
the individual’s participation in job sampling, family input, comprehensive vocational
assessments, and structured community experience (DeStefano and Wermuth, 1992).
Literature on career/transition planning presents a consensus of best practices. Items
are grouped in relation to (a) transition planning, (b) transition implementation, or
(c) transition evaluation.
Transition planning includes development of long-term goals, short-term objectives,
a plan for posttransition services, case management services, and a timeline for transi-
tion activities. Transition implementation includes vocational, leisure, and residential
options; transportation training; money management; and vocational skills training.
Transition evaluation comprises long-term support and follow-up of specific outcome
evaluations (Stowitschek, 1992).
The most important contribution to transitioning is the parents’ role as an advocate for
their child (Friedlander, 1989). Parental advocacy, support, and input become more critical
as their child enters into adulthood. Given the complexity and long-term needs of these
individuals, comprehensive planning is a necessity and must include the individual,
parents, educational staff, and agency representatives (IDEA, 2004). Considerations for
ongoing support services throughout adulthood must include a structured community expe-
rience, community-referenced behavior management and social skills training (Berkell,
1992), and the incorporation of individual choice (Winking, O’Reilly, & Moon, 1993).
To obtain suitable employment there are several routes that an individual with ASD
can choose. First, attend a two- or four-year college to receive the necessary training for a
professional career. Second, prepare a portfolio for potential employers and seek out
CARTOONING

mentors in the business community that recognize their abilities and potential to enhance
their skill base. Third, contact vocational rehabilitation services to set up a work evalua-
tion for assessment of job skills, job sampling, and job training. Fourth, contact a local
vocational training center to apply for services in a sheltered workshop setting. Most
importantly, all of these options can be incorporated into a student’s Individual Service
Plan and begin working on discovering the best career option when they turn 16.

REFERENCES
Berkell, D. E. (1992). Transition issues for secondary school students with autism and develop-
mental disabilities. In F. R. Rusch, L. DeStefano, J. Chadsey-Rusch, L. A. Phelps, & E. Szy-
manski (Eds.), Transition from school to adult life: Models, linkages, and policy (pp. 460–472).
Sycamore, IL: Sycamore.
DeStefano, L., & Wermuth, T. R. (1992). IDEA (PL 101–476): Defining second generation of
transition services. In F. R. Rusch, L. DeStefano, J. Chadsey-Rusch, L. A. Phelps, & E. Szy-
manski (Eds.), Transition from school to adult life: Models, linkages, and policy (pp. 537–549).
Sycamore, IL: Sycamore.
Friedlander, B. (1989). Becoming an advocate. In M. Powers (Ed.), Children with autism: A
parent’s guide (pp. 231–252). Rockville, MD: Woodbine House.
Individuals with Disabilities Education Improvement Act of 2004. Public Law 108–446. U.S.
Code. 20 2004. [section] 1400 et seq.
Stowitschek, J. J. (1992). Policy and planning in transition programs at the state agency level. In
F. R. Rusch, L. DeStefano, J. Chadsey-Rusch, L. A. Phelps, & E. Szymanski (Eds.), Transition
from school to adult life: Models, linkages, and policy (pp. 519–536). Sycamore, IL: Sycamore.
Winking, D. L., O’Reilly, B., & Moon, M. S. (1993). PREFERENCE: The missing link in the
job match process for individuals without functional communication skills. Journal of Voca-
tional Rehabilitation, 3, 27–42.
STACEY L. BROOKENS

CARTOONING
Cartooning is a visual interactive strategy that can be designed to assist a person in his
understanding a social situation. Talking bubbles, which are drawn from the character’s
mouth, and thinking bubbles, drawn from the character’s head, are used to illustrate verbal
expression, unspoken thoughts, and cues about what is going on. This is done in the same
way as in traditional comics. Cartooning may be used to illustrate the order in which certain
events will happen, to tell a story, to assist in organizing tasks, to clarify what people mean
when they use certain words, or to problem solve a particularly difficult social conflict.
Examples of cartooning include comic strip conversations (Gray, 1994), cognitive picture
rehearsal (Groden & LeVasseur, 1995), and Social Mapping (Curtis & Dunn, 1999).
The social disorder in autism is perhaps the least understood aspect of the autism
disorder (Klin & Volkmar, 1993). Children on the autism spectrum do not appear to
understand why people do what they do, why they think the way they think, or why
they make the decisions they make (Baron-Cohen & Howlin, 1993). Simon Baron-
Cohen refers to this as an inability to ‘‘mind read’’ (Baron-Cohen, 1995). Tony Att-
wood explains this as ‘‘lacking the ability to think about thoughts’’ (Attwood, 1998).
A person who has difficulty in this area of social understanding is likely to find school
and other social settings threatening and difficult to interpret. Why does a teacher
make the decisions she makes? Why does a peer play with you one day on the play-
ground but not the next day? Why do some teachers ignore misbehavior and others
promptly call attention to it? When, if ever, is it okay to swear? Why do people want
60
 CARTOONING

me to say ‘‘hi’’ to them in the hallway? These and other everyday questions surround-
ing social behavior can be directly taught through the use of cartooning.

COMIC STRIP CONVERSATIONS

A way of making social language and social behavior more concrete, cartooning is
best used proactively, or as a teaching tool prior to a situation that typically causes
problems. Cartooning can be used to teach new or alternative behavior. When con-
fronted with a social problem, students with autism often become anxious and frus-
trated. This frustration can heighten when a parent or teacher attempts to correct the
problem, and a face-to-face confrontation can increase the frustration and stress even
more. Using cartooning strategies to explain what went wrong and to offer solutions
can take the ‘‘edge’’ off such otherwise volatile situations. When using cartooning
strategies, it is important to recognize and validate the perspective of the person with
ASD even if you consider that perspective irrational. Perspective taking is a two-way
street, and without mutual understanding and respect, it can be difficult to motivate
the person with ASD.
Behavioral conflicts between individuals with ASD and their parents, teachers, or
peers often occur because of a communication breakdown or a misinterpretation. For
example, the person with ASD may misinterpret a person’s nonverbal social language
(facial expression, tone of voice, etc.) or her reaction to a particular situation. A comic
strip conversation as defined by Gray (1994) can be used to visually review the conflict
situation.
For example, while John was at his fifth-grade environmental retreat, he decided to
take off all of his clothes and run naked through the cabin. The other boys in John’s
cabin were mortified, embarrassed, and confused, so they laughed. John misinterpreted
their laughter to mean that his behavior was funny. He continued to do it even though
his counselor told him that the behavior was inappropriate. A comic strip conversation
was used to clarify for John what had happened. As illustrated in Figure 1, stick figures

Figure 1 Comic Strip Conversations for the Individual’s Perspective

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CARTOONING

Figure 2 Comic Strip Conversations for the Peers’ Perspectives

were drawn to illustrate the situation. The environment was labeled, and the words of
each person were written in their talking bubbles. John was then asked to fill in his
thinking bubble. Now the counselor was able to acknowledge John’s perspective. John
was then asked to guess what might have been in the other campers’ thinking bubbles
when he ran naked (see Figure 2). He was able to fill in the thinking bubbles with his
ideas. Again, this enabled the counselor to acknowledge John’s perspective and give
him more information by filling in other ideas about how others felt about his behav-
ior. This method of processing an incident increased the accuracy of John’s thinking
about what happened and how others were affected.
Gray (1994) expands on the comic strip conversation by suggesting that color be
added to help clarify the intent of someone’s words (see Figure 3). This can be partic-
ularly helpful for the student who has difficulty ‘‘reading’’ nonverbal social cues such
as tone of voice. For example, consider the example of John at camp. If one of the
other boys had said to John that his behavior would make him really popular with the
other boys, the adult working with John may consider the use of color to more clearly
demonstrate the boy’s motivation for saying those words. For example, teasing or sar-
castic words may be defined prior to the conversation as being red. Honest or inno-
cent words may be defined as being blue. When John tells the adult that he said,
‘‘How do you like me now?’’ he reports that he was serious and wanted an honest an-
swer. In this case John’s words should be blue to illustrate their honest motivation.
On the other hand, Edward’s words are red to clearly illustrate for John that he did
not mean what he said literally, that he was being sarcastic.
Many individuals with ASD have difficulties understanding another person’s per-
spective or how another person feels about certain situations. The ability to under-
stand that your actions have an impact on those around you and that others can
contribute to making your experiences pleasurable is at the core of social
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 CARTOONING

Figure 3 How Color Can Clarify the Intent of Words

understanding. If a person with autism does not understand another person’s contribu-
tion to a social interaction, he may be less likely to seek out interactions or recognize
the value of social interactions.

COGNITIVE PICTURE REHEARSAL

Cognitive picture rehearsal (Groden & LeVasseur, 1995) combines cartooning with
repetitive practice to teach self-control. This method involves presenting a behavioral
sequence in the form of cartoons with a written script. The goal is to teach a skill or
response to replace an unwanted behavior. The method also builds in the direct
teaching of relaxation by prompting the use of relaxation strategies when faced with a
stressful situation.
Prior to using this method, it is important to analyze the behavior being addressed
so that you can accurately describe when it typically happens, under what conditions
it typically happens, what happens after the unwanted behavior is exhibited, and how
do those around her react. An example of how this might work would be the situation
with Claire, a 4-year-old with ASD who consistently screams and hits other children
during morning groups (see Figure 4). The teacher has determined that the breakdown
occurs while she is waiting for her turn. The teacher knows that allowing Claire to
hold a preferred toy helps her to relax while waiting.
After drawing a cartoon, the teacher reviews the story with Claire repetitively,
especially immediately prior to group time. This story can be varied over time to
teach new routines within the same group time.

SOCIAL MAPPING
Social Mapping (Curtis & Dunn, 1999) is a strategy used to review social situations,
events, field trips, family reunions, and so on, in a concrete visual way. A social map
clearly illustrates the contributions of all the people involved. Although social maps
63
CARTOONING

Figure 4 How Cognitive Picture Rehearsal Can Teach Skills

are not limited to cartoons, cartooning can be an effective way to present the infor-
mation including the use of stick figures.
The process begins by writing what Gray has called a fear-reducing story (1994).
This is a story made up of descriptive sentences about the upcoming event. The story
might mention who the child will be sitting next to on the bus or car ride, what the
child is hoping or anticipating about the event, and what the teacher, peer or parent
is hoping or looking forward to. This sets the stage for a more relaxing event, while it
highlights some of the ways another person may influence the social outing.
After the event, the person with ASD fills out a worksheet designed to prompt
thoughts about the trip and, ultimately, formulate his or her contribution to the social
map. Each person involved with the trip fills out a worksheet of their own and brings
it to the group meeting or family gathering after the trip. The person organizing the
event should bring a large sheet of paper or poster board, markers, and glue. Each per-
son takes a turn and shares what he or she recalled on the worksheet, using it as a vis-
ual guide. The social map is created using stick figures labeled with each person’s
name and details of each person’s input based on the meeting. Photographs, particu-
larly photos of the person with ASD having fun with a peer or family member, can
add interest to the map. The end product is a visual representation of a social event
that displays pieces of information from everyone’s perspective. The map can be hung
in the classroom or at home to be reviewed and studied over time, not unlike a photo
album of someone’s family vacation.
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 CARTOONING

Figure 5 Social Map Worksheet

An example might be Mrs. Smith taking her third-grade class to the local museum.
Prior to the trip, she writes a brief story about what the children will see at the mu-
seum. She knows her student with ASD is concerned with buses, so she includes the
fact that they will be taking a large bus (and includes the bus company name). She
assigns each student to a travel partner and states this in the story. She writes that
she is very excited about the dinosaur exhibit and about eating lunch at the park. She
asks for input prior to writing the story so that she can include some other perspec-
tives. Mrs. Smith carefully corrects any unrealistic hopes and clarifies any rules that
would be helpful to remember. The story is then sent home with each student to be
shared with parents, read, and reread.
After the museum trip, Mrs. Smith hands out the social map worksheet (Figure 5)
and assists her students in filling it out. She has the partners work together to help
each other by prompting memories.
When the worksheets are completed, Mrs. Smith gathers her class into a group and
creates a social map using the information from the worksheets. She puts thoughts in
the thinking bubbles based on the worksheets and adds pictures to increase under-
standing and motivation (see Figure 6).
Like all good teaching strategies, cartooning is best done proactively. Creating time to
draw and review cartoons throughout the day is beneficial. However, cartoons can also be
drawn in a crisis situation when verbal processing is not productive. By drawing what is
going on using talking bubbles and thinking bubbles, you can eliminate the need to talk
out loud. The vocabulary used in cartooning is less abstract and more direct than language
typically used in social situations. A wonderful example of how this can assist in compre-
hension comes from my friend, Emily. Emily had a tendency to say what was on her mind,
whether it hurt someone’s feelings or not. Cartooning was used to help her understand
that even though she might think these things, the words should stay in her thinking bub-
ble and not get into her talking bubble. Emily announced to her mother that she got it,
that the best way to not hurt others’ feelings was to ‘‘not pop your think bubble!’’
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CASEIN-FREE

Figure 6 Classroom Social Map

REFERENCES
Attwood, T. (1998). The links between social stories, comic strip conversations and the cognitive models
of autism and Asperger syndrome. Retrieved on October 17, 2005, from www.tonyattwood.com.
Baron-Cohen, S. (1995). Mindblindness: An essay on autism and theory of mind. Cambridge, MA:
MIT Press.
Baron-Cohen, S., & Howlin, P. (1993). The theory of mind deficit in autism: Some questions for
teaching and diagnosis. In S. Baron-Cohen, H. Tager-Flushberg, & D. Cohen’s (Eds.), In under-
standing other minds perspectives from autism (pp. 466–480). Oxford: Oxford University Press.
Curtis, M., & Dunn, K. (1999, Spring). Social mapping. The Morning News (pp. 7–8). Jenison,
MI: Jenison Public Schools.
Gray, C. (1994). Comic strip conversations. Arlington, TX: Future Horizons.
Groden, J., & LeVasseur, P. (1995). Cognitive picture rehearsal: A System to teach self-control.
In K. Quill, In teaching children with autism (pp. 287–306). New York: Delmar Publishers.
Klin, A., & Volkmar, F. (1993). Social development in autism: Historical and clinical perspec-
tives. In S. Baron-Cohen, H. Tager-Flushberg, & D. Cohen (Eds.), In understanding other
minds’ perspectives from autism (pp. 40–55). Oxford: Oxford University Press.
KARI DUNN BURON

CASEIN-FREE
Milk contains three major components: lactose (which is milk’s sugar), caseins (which
are mild proteins), and fat. When a person needs a casein-free diet, that person needs to
avoid milk because of the proteins within the milk. Although this seems rather simple,
one needs to become extremely mindful of reading product ingredients. Hidden milk
ingredients include whey, sodium caseinate, sodium lactylate, protein, high protein, and
protein enriched products. Some families of children with ASD have decided to try a
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gluten-free/casein-free diet as they believe the gluten and casein may adversely affect
their child’s neurological processes. Some parents report that removing gluten and casein
from their child’s diet results in increased attention as well as reduced tantrums.

FURTHER INFORMATION
www.gfcfdiet.com: This Web site has resources for parents of children with ASD who wish to
implement a gluten-free/casein-free diet.
MAYA ISRAEL

CATATONIA
Catatonia is a condition marked by changes in muscle tone or activity associated with a
large number of mental and physical illnesses. There are two distinct sets of symptoms that
are characteristic of this condition. In catatonic stupor, the individual experiences a deficit
of motor (movement) activity that can render him/her motionless. Catatonic stupor is
marked by immobility and a behavior known as cerea flexibilitas (waxy flexibility) in which
the individual can be made to assume bizarre (and sometimes painful) postures that they
will maintain for extended periods of time. The individual may become dehydrated and
malnourished because food and liquids are refused. Catatonic excitement, or excessive
movement, is associated with violent behavior directed toward oneself or others. The indi-
vidual is extremely hyperactive, although the activity seems to have no purpose. A variety
of symptoms are associated with catatonia. Among the more common are echopraxia (imi-
tation of the gestures of others) and echolalia (parrot-like repetition of words spoken by
others). Other signs and symptoms include violence directed toward oneself, the assump-
tion of inappropriate posture, selective mutism, negativism, facial grimaces, and animal-
like noises. Recognition of catatonia is made on the basis of specific movement symptoms.
These include odd ways of walking such as walking on tiptoes or ritualistic pacing, and
rarely, hopping and skipping. Repetitive odd movements of the fingers or hands, as well as
imitating the speech or movements of others, also may indicate that catatonia is present.
JEANNE HOLVERSTOTT

CAT SCAN
Computed axial tomography (CAT scan or CT scan) is a radiological study that
essentially takes a rapid series of x-ray pictures from many angles, while the person is
lying flat on a table. The images are then run through a computer, which generates a
series of three dimensional views or ‘‘slices’’ that can show organs and soft tissues as
well as bones. These studies may be done with or without contrast dye to enhance the
image of the specific organs or body systems.
BRUCE BASSITY

CENTRAL AUDITORY PROCESSING DISORDER (CAPD)

Central auditory processing disorder (CAPD) is a dysfunction of the coordination
between the ears and the brain but is not a hearing impairment. There are many pos-
sible causes for CAPD including head trauma, lead poisoning, and frequent and severe
ear infections. Additionally, sometimes the causes of CAPD cannot be determined.
The symptoms of CAPD can vary greatly, but often include the following: (a) sensi-
tivity to loud sounds; (b) difficulty with reading, writing, spelling, or speech and
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language; (c) difficulty comprehending abstract information; (d) difficulty with organi-
zation; and (e) difficulty following conversations.
A child displaying the symptoms of CAPD may be misdiagnosed as ADHD due to
the commonality of symptoms. In addition, CAPD can occur in conjunction with
other disabilities making the diagnosis of CAPD difficult. The only way of obtaining a
diagnosis of CAPD is through an audiologist who performs central auditory processing
tests to determine if there is a problem. Once a child is diagnosed with CAPD, the
child is referred to a speech pathologist.
The main areas of difficulty for children with CAPD are: (a) auditory attention
problems (not remembering directions, materials, and so on); (b) auditory discrimina-
tion problems (difficulty hearing the difference between words that sound similar);
(c) auditory figure-ground problems (difficulty maintaining attention where there is
background noise); and (d) auditory cohesion problems (difficulty drawing conclusions,
understanding math problems, following complex directions).
There are several things teachers and parents can do to help children with CAPD.
Because all children with CAPD have unique strengths and areas of difficulty, there is
no generic list of accommodations that can help all children with CAPD. However,
the following is a list of suggestions that may be helpful.
When required to complete important tasks, reduce background noise as much as
possible. For example, when studying, provide a quiet study area. When taking tests,
provide an area away from loud noises (e.g., not near the cafeteria!).
Help the child recognize that he or she must look at and attend to the person talking.
Ask the child to repeat important directions to make sure they have understood
them completely. Make sure the child understands the directions by asking specifics
required in the assignment.
Develop a system of organization for school materials, schedule of events, and other
areas that are difficult for the child to keep organized.
Maintain a positive attitude and do not blame the child for displaying the previ-
ously mentioned difficulties.
FURTHER INFORMATION
Friel-Patti, S. (1999). Clinical decision-making in the assessment and intervention of central
auditory processing disorders. Language, Speech, and Hearing Services, 30(4), 345–352.
Rosen, S. (2005). A riddle in a mystery inside an enigma: Defining central auditory processing
disorder. American Journal of Audiology, 14(2), 139–142.
MAYA ISRAEL

CENTRAL COHERENCE
Central coherence refers to the tendency to process information in a global way by
integrating and connecting all sources of information to elaborate higher levels of
meanings. Persons who process information in typical ways show a tendency to use
the context to make sense of the events. However, persons within the autism spec-
trum tend to process only parts or details of the information, disregarding the context
or failing to process the information as a whole. The consequences of a poor central
coherence, for example, are the inability to see connections among themes and expe-
riences, generalizing and applying new knowledge to different situations, or inflexibil-
ity in their points of view.
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 CHECKLIST FOR AUTISM IN TODDLERS (CHAT)

FURTHER INFORMATION
Briskman, J., Happe, F., & Frith, U. (2001) Exploring the cognitive phenotype of autism: Weak
central coherence in parents and siblings of children with autism: II. Real life skills and pref-
erences. Journal of Child Psychiatry, 42, 309–316.
Cumine, V., Leach, L., & Stevenson, G. (1998). Asperger Syndrome, a practical guide for teachers.
London: David Fulton Publishers.
Frith, U. (2003). Autism explaining the enigma. Oxford: Blackwell Publishing.
Happ, F. (1999). Autism: Cognitive deficit or cognitive style? Trends in Cognitive Sciences, 3,
216–222.
Jolliffe, T., & Baron-Cohen, S. (2001). A test of central coherence theory: Can adults with
high-functioning autism or Asperger syndrome integrate fragments of an object? Cognitive
Neuropsychiatry, 6, 193–216.
SUSANA BERNAD-RIPOLL

CERTIFIED BEHAVIOR ANALYST. See Board Certified Behavior Analyst

CHAINING
Chaining requires that a task be divided into several smaller steps. The steps are
then taught in order, either reverse or forward. As each step is mastered, a new step is
added onto the ‘‘chain.’’ This is a similar process to task analysis, but steps are always
taught in the context of the whole task. In reverse chaining, the last step is taught
first, and the previous steps are completed by another individual or are prompted.
Once able to complete the last step independently and on a consistent basis, the indi-
vidual is then taught the second-to-last step, and the process continues.
KATIE BASSITY

CHECKLIST FOR AUTISM IN TODDLERS (CHAT)

The Checklist for Autism in Toddlers (CHAT; Baron-Cohen et al., 1996; Baird
et al., 2000) is a screen for autism given at around 18 months of age. The CHAT
is administered by parents or a primary health care worker, and consists of nine short
questions asked of the parent about the child’s behavior, and five short observational
tasks. Research indicated that if a child failed the CHAT it was 97 percent likely that
they had autism spectrum disorders (ASD). However, the CHAT in its original format
missed many cases of Asperger syndrome and subtler ASDs, and research is now
underway to revise the instrument into the Q-CHAT (Quantitative Checklist for Au-
tism in Toddlers). Other adaptations include the M-CHAT (Modified Checklist for
Autism in Toddlers).

REFERENCES
Baird, G., Charman, T., Baron-Cohen, S., Cox, A., Swettenham, J., Wheelwright, S., & Drew,
A. (2000). A screening instrument for autism at 18 months of age: A six year follow up
study. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 694–702.
Baron-Cohen, S., Cox., A., Baird, G., Swettenham, J., Nightingale, N., Morgan, K., Drew, A., &
Charman, T. (1996). Psychological markers in the detection of autism in infancy in a large
population. British Journal of Psychiatry, 168, 158–163.
FIONA J. SCOTT
69
CHECKLIST FOR OCCUPATIONAL THERAPY

CHECKLIST FOR OCCUPATIONAL THERAPY

The Checklist for Occupational Therapy (OTA-Watertown, 1997) is a series of four
checklists—infant, preschool, school-age, and adolescent-adult—providing information
about certain behaviors and whether they are seen frequently or not. The items look at
behaviors that can be related to sensory processing difficulties (movement, sound, sight,
self-regulation, touch), although the categories of behaviors change across the age ranges.
The infant-through-school-age checklists ask whether a behavior occurs frequently or
not, whereas the adolescent-adult checklist can be rated on a 1–5 scale with 1 being
never and 5 being always. The instrument can be completed by teachers, day care pro-
viders, occupational therapists, or physical therapists without specific prior training.

REFERENCE
Occupational Therapy Association [OTA]-Watertown, (1997). Checklist for occupational therapy.
Watertown, MA: OTA-Watertown. Retrieved September 17, 2006, from http://www.otawa-
tertown.com/sensintdys.html.
LISA ROBBINS

CHELATION
Chelation is a highly controversial medical procedure that involves the use of che-
lating agents, which include DMSA (dimercaptosuccinic acid), DMPS (2,3-dimercapto-
1-propanesulfonic acid), and ALA (alpha lipoic acid) to remove heavy metals such as
mercury, iron, arsenic, and lead from the body. Chelation is often administered by
intravenous infusions or by swallowing oral pills.

FURTHER INFORMATION
Autism Research Institute: media@autismresearchinstitute.com.
National Autistic Society: www.nas.org.uk.
KATHERINE E. COOK

CHILD BEHAVIOR CHECKLIST FOR AGES 11=2 TO 5

The Child Behavior Checklist for Ages 11=2 to 5 years is the most widely used general
behavioral scale for assessing children. The Child Behavior Checklist is a test consisting
of 99 items designed to assess a child’s behavior and social competency, as reported by
the parents. It provides descriptions of problems and disabilities as well as what concerns
parents most about their child and the best things about the child. The tool requests that
parents rate their child on a scale of not true, sometimes true, or true on a variety of
social issues. Administration time ranges from 10 to 20 minutes (Hart & Lahey, 1999).

REFERENCE
Hart, E. & Lahey, B. (1999). General child behavior rating scales. In D. Shaffer, C. Lucas, &
J. Richters (Eds.), Diagnostic assessment in child and adolescent psychopathology (pp. 65–87).
New York: Guilford Press.
AMY BIXLER COFFIN

CHILDHOOD ASPERGER SYNDROME TEST (CAST)

The Childhood Asperger Syndrome Test (CAST; Scott, Baron-Cohen, Bolton, &
Brayne, 2002; Williams et al., 2005; Williams et al., 2006) is a 37-item parental report
questionnaire for children ages 4 to 11 years, asking for simple yes/no information as
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 CHILDHOOD AUTISM RATING SCALE (CARS)

to whether the child shows certain social or communicative behaviors that are thought
to be associated with Asperger syndrome or broad autism spectrum disorder (ASD).
Unlike many other screening tests, the CAST has been validated for use with a non-
clinical sample and can therefore be used as a screen for ASD prior to referral into ser-
vices. Research indicates the CAST has a sensitivity of 100 percent (it can detect every
case of ASD), with a specificity of 97 percent (it tends towards being overinclusive, mis-
identifying 3 percent as having possible ASD). Research indicates that those who are
misidentified typically have some other difficulty with language or social skills.

REFERENCES
Scott, F. J., Baron-Cohen, S., Bolton, P., & Brayne, C. (2002). The CAST (Childhood
Asperger Syndrome Test): Preliminary development of a UK screen for mainstream primary
school age children. Autism, 6, 9–31.
Williams, J., Allison, C., Scott, F. J., Stott, C., Bolton, P., Baron-Cohen, S., & Brayne, C.
(2006). The Childhood Asperger Syndrome Test (CAST): Test-retest reliability. Autism, 10,
415–427.
Williams, J., Scott, F. J., Stott, C., Allison, C., Bolton, P., Baron-Cohen, S., & Brayne, C.
(2005). The CAST (Childhood Asperger Syndrome Test): Test accuracy. Autism, 9, 45–68.
FIONA J. SCOTT

CHILDHOOD AUTISM RATING SCALE (CARS)

The Childhood Autism Rating Scale (CARS) is a standardized instrument designed
to assist in the diagnosis of autism. The rating scale can be used with children as
young as 2 years of age. Each of 15 items covers a specific characteristic, ability, or
behavior that includes relationships with people, imitation, affect, use of body, rela-
tion to nonhuman objects, adaptation to environmental change, visual responsiveness,
auditory responsiveness, near-receptor responsiveness, anxiety reaction, verbal commu-
nication, nonverbal communication, activity level, intellectual functioning, and the
clinician’s general impression. These items are rated by the specialist using a 7-point
system based on the degree to which the child’s behavior deviates from that of a typi-
cal child in the same age group. A total score is computed by summing the individual
ratings on each of the 15 items. Children who score above a predefined level are cate-
gorized as having autism. Based on these scores, identified children are further classi-
fied into categories ranging from mild and moderate to severe.
See also standardization.

FURTHER INFORMATION
DiLalla, D., & Rogers, S. J. (1994) Domains of the childhood autism rating scale: Relevance for
diagnosis and treatment. Journal of Autism and Developmental Disorders, 24, 115–128.
Rellini, E., Tortolani, D., Trillo, S., Carbone, S., & Montecchi, F. (2004) Childhood Autism
Rating Scale (CARS) and Autism Behavior Checklist (ABC): Correspondence and conflicts
with DSM-IV criteria in diagnosis of autism. Journal of Autism and Developmental-Disorders,
34, 703–708.
Schopler, E., Reichler, R., DeVellis, R. F., & Daly, K. (1980). Toward objective classification of
childhood autism: Childhood Autism Rating Scale (CARS). Journal of Autism and Develop-
mental Disorders, 10, 91–103.
Schopler, E., Reichler, R. J., & Renner, B. R. (1988). The Childhood Autism Rating Scale
(CARS). Los Angeles: Western Psychological Services.
SUSANA BERNAD-RIPOLL
71
CHILDHOOD DISINTEGRATIVE DISORDER

CHILDHOOD DISINTEGRATIVE DISORDER

Childhood disintegrative disorder (CDD) is a rare disorder with distinctive clinical
features, often has a poor prognosis, and is sometimes associated with encephalopathy.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; APA,
2000) specifies that following at least 2 years of normal development as manifested by
age-appropriate verbal and nonverbal communication, social relationships, and play
and adaptive skills there is a clinically significant loss of skills in at least two of the
following areas: (a) expressive or receptive language, (b) social skills or adaptive
behavior, (c) bowel or bladder control, (d) play, and (e) motor skills. In addition,
there must be abnormalities of functioning in at least two of the following areas:
(a) qualitative impairment in social interaction (e.g., impairment in nonverbal behav-
iors, failure to develop peer relationships, lack of social or emotional reciprocity);
(b) qualitative impairments in communication (e.g., delay or lack of spoken language,
inability to initiate or sustain conversation, stereotyped and repetitive use of language,
lack of varied make-believe play); and (c) restricted, repetitive, and stereotyped patterns
of behavior, interests, and activities, including motor stereotypes and mannerisms.
It is clear from the previous description that there is a substantial degree of overlap
in presentation between CDD and autism spectrum disorders. The distinct difference
is that in autism spectrum disorders a child may not develop appropriate skills,
whereas in CDD there was clearly normal level of skill followed by loss of that previ-
ously acquired skill.
However, Heller (1908), who first reported on the condition, also noted that chil-
dren presented with anxiety and affective symptomatology such as moody, negativistic
behaviors, and other professionals have since emphasized deterioration in self-help
skills (Volkmar, 1992, 1994). These characteristics are not emphasized in the DSM-
IV-TR (2000) description.
The etiology of the condition is not yet clear, although there has been some associ-
ation noted with neurological disorders (Evans-Jones and Rosenbloom, 1978), and
with known medical conditions such as measles encephalitis. Heller (1908) did not
include any known conditions as being associated with CDD, and in terms of a diag-
nosis specific neurological diseases should be ruled out. Those that should be excluded
include tuberous sclerosis complex (Creak, 1963), neurolipidoses (Malamud, 1959),
metachromatic leukodystrophy (Corbett, Harris, Taylor, & Trimble, 1977), and suba-
cute sclerosing panencephalitis (Rivinus, Jamison, & Graham, 1975).
Prognosis of the condition is generally poor. Volkmar (1992) followed up on 76
cases over a period of 1 to 22 years, and reported that a minority showed minimal
improvements while three quarters showed a static course of presentation, with overall
functioning in the moderate to severe range of mental retardation. All the children
required special education and commonly received services in residential facilities.

REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
Corbett, J., Harris, R., Taylor, E., & Trimble, M. (1977). Progressive disintegrative psychosis of
childhood. Journal of Child Psychology and Psychiatry, 18, 211–219.
Creak, E. M. (1963). Childhood psychosis: A review of 100 cases. British Journal of Psychiatry,
109, 84–89.

72
 CHILDREN’S CATEGORY TEST (CCT)

Evans-Jones, L. G. & Rosenbloom, L. (1978). Disintegrative psychosis in childhood. Develop-

mental Medicine and Child Neurology, 20, 462–470.
Heller, T. (1908). Dementia infantalis. Zeitschrift fur die Erforschung und Behandlung des Jugenli-
chen Schwachsinns [Journal for Research and Treatment of Juvenile Feeblemindedness], 2, 141–165.
Malamud, N. (1959). Heller’s disease and childhood schizophrenia. American Journal of Psychia-
try, 116, 215–218.
Rivinus, T. M., Jamison, D. L., & Graham, P. J. (1975). Childhood organic neurological disease
presenting as psychiatric disorder. Archives of Disease in Childhood, 50, 115–119.
Volkmar, F. R. (1992). Childhood disintegrative disorder: Issues for DSM-IV. Journal of Autism
and Developmental Disorders, 22, 625–642.
Volkmar, F. R. (1994). Childhood disintegrative disorder. Child and Adolescent Psychiatric Clinics
of North America, 3, 119–129.
FIONA J. SCOTT

CHILDREN’S ATTRIBUTIONAL STYLE QUESTIONNAIRE (CASQ)

The Children’s Attributional Style Questionnaire (CASQ: Seligman et al., 1984) is
designed to assess attributional style in children ages 8–13. The 48 items are divided
equally between positive (‘‘You get an A on a test’’) and negative events (‘‘You break
a glass’’). Respondents select between two possible causes for the statement, and each
option represents the presence or absence of an attribution dimension (e.g., internal
or external cause). Attributions for each dimension are computed by calculating the
number of internal, stable, or global responses.
FURTHER INFORMATION
Abramson, L. Y., Alloy, L. B., Kaslow, N. J., Peterson, C., Seligman, M. E., & Tanenbaum, R.
L. (1984). Attributional style and depressive symptoms among children. Journal of Abnormal
Psychology, 93(2), 235 –238.
JEANNE HOLVERSTOTT

CHILDREN’S CATEGORY TEST (CCT)

Children’s Category Test (CCT; Boll, 1993) is an individually administered instru-
ment designed to assess nonverbal learning and memory, concept formation, and
problem-solving abilities in children ages 5–16 years. It provides information on the
child’s ability to change problem-solving strategies, to develop alternative solutions,
and to benefit from experience. This constellation of mental processes is highly related
to fluid intelligence, or those abilities that involve problem solving with novel mate-
rial. Because of its nonverbal nature, the child’s reasoning ability can be assessed indepen-
dently of his/her expressive language skill level. Thus, the CCT is less educationally
dependent than verbal reasoning measures. In addition, the CCT directly assesses the
cognitive processes required for successful academic achievement by measuring the
child’s ability to learn, to solve problems, and to develop, test, and modify hypotheses.
The CCT may be used to determine whether a child is able to perform these
learning-based processes despite the existence of learning disorders, verbal or motor
deficits, neurological deficits, or emotional handicaps. Because of its nonverbal,
untimed, and nonmotor format, the CCT can be used to assess a wide range of chil-
dren for whom other, more traditional, psychometric procedures are inappropriate.
REFERENCE
Boll, T. (1993). The Children’s Category Test. San Antonio, TX: PsychCorp.
JEANNE HOLVERSTOTT
73
CHILDREN’S DEPRESSION INVENTORY (CDI)

CHILDREN’S DEPRESSION INVENTORY (CDI)

The Children’s Depression Inventory (CDI; Kovacs, 1992) is a self-report test that
assists in the assessment of the cognitive, affective, and behavioral signs of depression
in children and adolescents 6 to 17 years old. This assessment takes approximately
15 minutes to complete with the respondent selecting the statement that best
describes his or her feelings for the past 2 weeks for 27 different items. The CDI con-
tains six scales commonly associated with depression (Negative Mood, Interpersonal
Difficulties, Negative Self-Esteem, Ineffectiveness, and Anhedonia); and it is designed
for a variety of situations, including schools, child guidance clinics, pediatric practices,
and child psychiatric settings.

REFERENCE
Kovacs, M. (1992). The Children’s Depression Inventory. North Tonawanda, NY: Multi-Health
Systems, Inc.
JEANNE HOLVERSTOTT

CHRONOLOGICAL AGE
Chronological age refers to the number of days or years a child has lived since
birth. To determine an individual’s chronological age, subtract his or her birth date
from a specific date. For example, Jacob was born on June 25, 2005. His chronological
age should be five-and-half years (or 66 months) on December 25, 2010. Chronologi-
cal age is frequently used in psychometrics as a standard against which certain varia-
bles, such as behavior and intelligence, are measured. Chronological age is also
sometimes used to compare an individual with a normative sample of others of the
same chronological age.
KAI-CHIEN TIEN

CIRCLE OF FRIENDS
Circle of Friends or Circle of Support (Falvey, Forest, Pearpoint, & Rosenberg,
1997) is a program for children who have difficulties making friends. The object is to
make sure the child is included in activities and feels a part of a group. A facilitator is
required and could be a parent, counselor, or teacher. A social map is prepared for the
child with the child’s help. This map of circles lists the social contacts of the child.
See Figure 7 for an example of a social map.
In the center of the social map is the child. In the first circle are the people who
are the closest to the child such as family (Intimate). In the second circle are friends
(Friendship). The third circle represents people who may participate in the child’s life
such as doctors, teachers, and counselors (Participation). The fourth circle contains
people who may interact with the child in passing such as policemen, firemen, and
neighbors (Exchange). Often the Friendship circle has few people.
Once it is determined who is in each of the rings a meeting is held for the entire
class. The system is explained to the class by one or two classmates who have volun-
teered to be mapped. This map is drawn on the board. Most classmates will have sev-
eral friends in the Friendship circle.
Then the map is drawn for the child with disabilities. Volunteers are asked to be in
the child’s Friendship circle. These children then act as mentors for the child. These
74
 CLINICAL ASSESSMENT (MEDICAL)

classmates make sure they greet the child, Figure 7 Circle of Friends
walk to class with him, or be friendly or
helpful in other ways. There are weekly
meetings (usually 15–20 minutes) in which
the mentors talk about what the good things
were that happened that week, and then
they discuss behaviors that may have caused
problems and suggest ways to correct them.
The child also participates and tells what
he or she liked and didn’t like for that week.
The goal is a situation in which everyone
learns and friendships develop. This is a pro-
gram that can be written into a child’s Indi-
vidualized Education Program.

REFERENCE
Falvey, M. A., Forest, M., Pearpoint, J. M., &
Rosenberg, R. L. (1997). All my life’s a circle:
Using the tools, circles, maps, and paths. Ontario:
Inclusion Press.
TERRI COOPER SWANSON

CLASSROOM READING INVENTORY

Classroom Reading Inventory (CRI; Sil-
varoli, 2000) was designed to be used by teachers of all experience levels to test read-
ing comprehension, word-recognition abilities, inferential and critical reading skills,
and thinking abilities. The CRI includes a pretest and a posttest.

REFERENCE
Silvaroli, N. J. (2000). Classroom Reading Inventory. Dubuque, IA: Brown and Benchmark Publishers.
JEANNE HOLVERSTOTT

CLINICAL ASSESSMENT (EDUCATIONAL)

Clinical assessments are tests that are administered on an individual basis by a
trained professional or specialist. These measures typically assess general intellectual
ability, specific cognitive abilities, scholastic aptitude, and oral language development.
THERESA L. EARLES-VOLLRATH

CLINICAL ASSESSMENT (MEDICAL)

Clinical assessment refers to assessment of a medical, psychiatric, or psychological
problem by a qualified health professional based on examination/observation, inter-
view, and possibly testing of the individual with the problem (along with family mem-
bers) in order to arrive at a diagnosis. Clinicians draw on prior knowledge, training,
and experience to form a diagnostic impression that may be tentative pending further
testing, observation, or trial treatment. Treatment recommendations or a treatment
plan are given as part of a clinical assessment.
BRUCE BASSITY
75
CLINICAL EVALUATION OF LANGUAGE FUNDAMENTALS–PRESCHOOL

CLINICAL EVALUATION OF LANGUAGE

FUNDAMENTALS–PRESCHOOL
Clinical Evaluation of Language Fundamentals–Preschool (CELF-P; Wiig, Secord, &
Semel, 1992) is an individually administered, norm-referenced test developed to iden-
tify, diagnose, and use in follow-up evaluation of language and communication disor-
ders in preschool children ages 3 to 6. Administering the CELF-P takes approximately
30–45 minutes. A variety of subtests provide in-depth assessment of a child’s language
skills as well as a preliteracy scale and phonological awareness subtest. Additionally, a
pragmatics profile helps to describe the child’s language use at school or at home.
See also norm-referenced assessment.

REFERENCE
Wiig, E. H., Secord, W., & Semel, E. (1992). Clinical Evaluation of Language Fundamen-
tals–Preschool. San Antonio, TX: PsychCorp.
JEANNE HOLVERSTOTT

CLINICAL OPINION
Clinical opinion is established through the evaluation and assessment of an individ-
ual and is often required for eligibility requirements for services. Clinical opinion may
be established by professionals such as medical or health service providers.
TERRI COOPER SWANSON

CLINICAL PRACTICE GUIDELINES

Clinical practice guidelines are a standardized approach to the diagnosis and treat-
ment of a specific diagnostic entity, which is often developed or adopted by health
professional organizations or government agencies. Typically, these guidelines are sup-
ported by outcome-based research. These guidelines are modified over time to reflect
new findings and improvements.
BRUCE BASSITY

CLINICAL SIGNIFICANCE
Many researchers use statistical significance to determine the efficacy of a research
project. Statistical significance relies on the use of statistical tests to determine
whether or not the results meet an accepted criterion level. Clinical significance does
not rely on statistical tests to determine effectiveness; rather; it relies on the true
effects of the intervention on the individual or on any other problem identified as a
relevant priority in the field. Clinical significance refers to a judgment about whether
the intervention made a real and important difference in the lives of the individuals
who participated in the research and/or whether the results will be useful or applicable
to the population in general.
THERESA L. EARLES-VOLLRATH

CLINICAL SOCIAL WORKER

A clinical social worker is a licensed practitioner who helps individuals, families, or
communities improve or restore their competence in social functioning. Social workers
76
 COGNITIVE BEHAVIOR MODIFICATION

must understand the dynamic interaction of social, economic, and cultural institu-
tions. They assist people in managing everyday life stresses in addition to helping
them overcome more traumatic events.
STEVE CHAMBERLAIN

CLINICAL TRIAL
A clinical trial is a research method used to determine the effectiveness and safety
of a new intervention (e.g., drug, device, therapy, or other intervention). A trial typi-
cally involves the use of the new intervention with one group of people, while others
receive placebo treatment with short- and long-term outcomes monitored. Clinical tri-
als usually include four phases. Phase I trials involve a small number of participants
(e.g., 20–80) to assess the safety and side effects of an intervention. Once the initial
safety of the therapy has been confirmed in Phase I trials, Phase II trials are performed
on larger groups (e.g., 100–300) and are designed to assess clinical efficacy of the ther-
apy as well as to continue Phase I assessments in a larger group of volunteers and
patients. Phase III studies are randomized, controlled trials on large patient groups
(1,000–3,000 or more) and are aimed at being the definitive assessment of the efficacy
of the new intervention, especially in comparison with currently available alternatives.
Phase IV trials, which follow Food and Drug Administration approval, involve the
post-launch safety surveillance and ongoing technical support of an intervention.
JEANNE HOLVERSTOTT

CLOSTRIDIUM TETANI
Clostridium tetani is the organism that causes tetanus (Mylonakis, 2006). Tetanus is
extremely fatal in humans. Mortality rates are from 13 to 52 percent. Because the dis-
ease is so fatal, widespread immunizations have taken place in the United States. The
tetanus organism is found in infected manure, dirt, clothing, skin, and in 10 to 25 per-
cent of human gastrointestinal tracts (Mylonakis, 2006).
Most cases of tetanus result from small puncture wounds or cuts, which become
infected with the Clostridium tetani spores. The resulting toxin is what causes the pain-
ful spasms, rigidity of voluntary muscles, the ‘‘lockjaw’’ symptom, and eventual death.

REFERENCE
Mylonakis, E. (July 18, 2006). Tetanus. Retrieved September 22, 2006, from www.emedicine.com.
LYNN DUDEK

COGNITIVE BEHAVIOR MODIFICATION

Cognitive Behavior Modification (CBM) is a technique that allows an individual
with exceptionality to function independently in his or her daily life (Quinn, Swag-
gart, & Myles, 1994). It has been widely used in a variety of settings with individuals
addressing issues of aggression, anxiety, panic disorders, substance abuse, schizophre-
nia, bipolar disorder, borderline personality, depression, limited self-control, poor
social problem solving, and related problems (Kendall, 1993; Larson & Lochman,
2002; Leahy & Beck, 1988; Mayer, Lochman, & Acker, 2005). More recently, this
technique has also been applied successfully with individuals with autism who exhibit
a range of skills (Quinn, Swaggart, & Myles, 1994).
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COGNITIVE BEHAVIOR MODIFICATION

CBM unites cognitive theory with behavior modification (Mahoney, 1974). In

other words, CBM is a combination of cognitive and behavioral learning principles to
shape and encourage desired behaviors. To be more specific, Hughes (2000) defined
that CBM refers to a diverse assemblage of theoretical and applied orientations that
share three underlying assumptions: (a) an individual’s behavior is mediated by cogni-
tive events (i.e., thoughts, images, expectations, and beliefs); (b) a change in media-
ting events results in a change in behavior; and (c) an individual is an active
participant in his or her learning. The third assumption recognizes the reciprocal rela-
tionships among an individual’s thoughts, behavior, and his or her environment and
views the individual as a positive participant of environmental influence.
Mayer, Lochman, and Acker (2005), in a very broad and basic sense, considered
the evolution of CBM as occurring in three stages over several decades. Concurrent
with the work of early behaviorists, in which explicit and observable behaviors were
considered the only acceptable data allowed in research, the early focus was on purely
observable stimulus-response (S-R) phenomena. Later on, consideration of mediation
processes in a stimulus-response model was seen in the work of Hull and Tolman.
Organism-specific variables (O) became important, and the S-R psychology moved
toward S-O-R psychology (Mahoney, 1974). A third stage of development assembled
thinking, perception, motivation, and cognitive mediation processes, drawn from the
research of Bolles, Bower, and Neisser (Kazdin, 1978). Sharpening the historical focus
on these developments, Mayer et al. further argued that CBM can be seen as having
emerged in the late 1950s, 1960s, and 1970s as a result of the following three factors.
First, psychology in the 1970s had ‘‘gone cognitive,’’ with particularly significant
developments in modeling, self-instruction, and problem-solving protocols. Next,
research in self-control had gone beyond traditional behavior therapy approaches to
include a specific cognitive component. Third, the development of the comprehensive
cognitive therapeutic procedures was completed and the cognitive-behavioral therapy,
being recognized as a field, started to obtain its own right.
The strategy of CBM is known by a variety of other names, including self-management,
self-monitoring, self-instruction, and metacognition (Quinn et al., 1994). Those names
also reflect characteristic components of a CBM procedure identified by Lloyd (1980).
CBM is a technique that teaches individuals to monitor their own behavior, pace, or per-
formance, and delivers self-reinforcement at established increments of time. In addition,
the strategy is designed to provide specific steps to facilitate appropriate cognitive process-
ing during the completion of a task. Kneedler and Hallahan (1981; as cited in Wahlberg,
1998) stated, ‘‘CBM is not an external structure to manipulate behavior; rather, it con-
centrates on activating an individual to act as his or her won behavior agents’’ (p. 224).
To be more specific, educationally speaking, in CBM, the teacher or supervisor strives for
the activation of a student’s cognitive processes in a behavior change system to alter his
or her thinking as well as behavior. Thus far, the premise of CBM is that, as a prerequi-
site to behavior change, individuals must develop their ability to notice (a) how they feel,
think and behave and (b) the impact their behavior has on others (Meichenbaum,
1980). The CBM approach emphasizes the modification of thinking as a means of chang-
ing feelings and behavior (Corey, 1991; Harris, 1988; Hughes, 1988).
An early demonstration of CBM was used by Meichenbaum and Goodman (1971)
when they introduced cognitive approaches to behavior modification to a group of
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hyperactive children who demonstrated poor self-control (Wahlberg, 1998). Further-

more, Meichenbaum’s work on self-instruction has contributed a foundational element
to CBM (Craighead, 1982). Meichenbaum (1977) stated: ‘‘The focus of self-instruction
training has been on the child’s conscious self-regulatory ability’’ (p. 103). He proposed
that self-instruction would support the development of the following skills: (a) control-
ling impulsive behavior; (b) attending to important events or cues; (c) focusing on spe-
cific goals; (d) coping with stressors; and (e) managing verbal and nonverbal behavior.
In self-instruction, the individual is taught to regulate his or her behavior through self-
talk. The individual is taught to ask and to answer covertly questions that guide his or
her own performance. The questions are of four types: (a) the nature of the problem
(What is it I have to do?); (b) plans, or self-instruction for solving the task (How
should I do it?); (c) self-monitoring (Am I using my plan?); and (d) self-evaluation
(How did I do?). Educationally, self-instruction is essentially students teaching them-
selves. With the help of teachers or other professionals, students can use ‘‘self-speech’’
to control behaviors. Meichenbaum outlined five steps in his self-instruction model to
teach individuals to use self-speech as part of self-instruction.

Step 1: Demonstrate by Model

As a teacher, speak aloud about the steps you are going through to reach a solution to a
problem or situation. For example, if the task is to make a peanut butter sandwich, talk
through the steps while making the sandwich. ‘‘What do I need to make a peanut butter
sandwich? I need peanut butter, two pieces of bread, and a knife. Okay, now I have to
put some peanut butter on one piece of bread and spread it out with my spread knife
easily and slowly. The next step is to put another piece of bread on top of it. Finished.
I did it!’’

Step 2: Modeling with Overt Adult Guidance

The student will begin to independently approach a problem or situation while saying
the steps aloud. The teacher is there to help the student with what he or she is doing
correctly and incorrectly.

Step 3: Modeling with Overt Self-Guidance

The student now approaches the problem without the teacher. The student is still saying
the steps aloud.

Step 4: Modeling with Faded Self-Guidance

The only difference between this step and the previous step is that the child is now whis-
pering the steps to himself or herself.

Step 5: Modeling with Covert Self-Guidance

At this point, the student can now approach the problem independently. The student is
still thinking about the steps in his or her head (silent self-guidance).

A large amount of research has been done focusing on CBM in working with chil-
dren and young adolescents (Walberg, 1998). CBM techniques have been shown to
be effective ways to help children and young adolescents deal with a variety of func-
tional difficulties (Kazdin, 1991; Wahlberg, 1998). Quinn et al. (1994) reviewed the
literature on CBM for persons with autism from 1989 to 1994 and found that
although the research is limited to a small number of investigations, the results are
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Table 1. CBM Instructional Sequence for Traditional Autism

Steps What to do?

1. Modeling The teacher verbalizes aloud what he or she is doing while demon-
strating the strategy steps of a task.
2. Put-through Following modeling, the teacher puts the student through the proc-
ess, providing prompts if necessary. This procedure is performed on
a daily basis until the student performs the task with minimal
prompting. The teacher collects data and monitors the process
until the student is able to master the task at the pre-established
criteria.
3. Self-recording After following a signal or visual representation of a step, the student
places a chip on a board, places a mark on a self-monitoring sheet,
or otherwise records the occurrence of the target behavior.
4. Self-rewarding After the picture sequence or after the self-monitoring has been com-
pleted, the student self-rewards from a menu of preferred
reinforces.

positive: ‘‘All of the studies reviewed indicated that CBM is an effective strategy for
helping to monitor social and vocational skills while teaching independence’’ (p. 2).
In addition, it is also an effective strategy to promote academic and vocational skill
acquisition by individuals with autism. Quinn et al. further proposed that one solution
to the dilemma of attending difficulties exhibited by children with autism spectrum
disorders (ASD) is to teach them to maintain a record of on-task behavior through
the use of CBM; however, the premise is that children must possess the skills necessary
to complete assigned work. Quinn et al. stated, ‘‘This procedure is most appropriate for
students who have the skills necessary to independently perform a particular task but
are unable to complete it due to attending difficulties’’ (p. 4). In terms of CBM imple-
mentation for individuals with autism, Quinn et al. outlined instructional sequences for
individuals with traditional autism and individuals with high-functioning autism, respec-
tively. The instructional sequences are delineated in Table 1 and Table 2.

Table 2. CBM Instructional Sequence for Traditional Autism

Steps What to do?

1. Self-monitoring The student listens to the audio/ape signal; when he or she hears a
signal, the student self-question, ‘‘Am I paying attention?’’
2. Self-recording The student quickly assesses whether or not she or he was attending.
If the student was attending, he or she circle ‘‘yes’’ on the self-
monitoring sheet. If the student was off task, he or she circles
‘‘no’’ on the self-monitoring sheet.
3. Self-rewarding The student provides a self-reward for on-task behavior by saying,
‘‘Good job.’’ If the student was off task, he or she will silently
prompt himself or herself by saying, ‘‘Get back to work.’’ The stu-
dent resumes work immediately.

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REFERENCES
Corey, F. (1991). Theory and practice of counseling and psychotherapy. Belmont, CA: Brooks/Cole
Publishing Company.
Craighead, W. E. (1982). A brief clinical history of cognitive-behavioral therapy with children.
School Psychology Review, 11, 5–13.
Harris, K. R. (1988) Cognitive-behavior modification: Application with exceptional students. In
E. L. Meyen, G. A. Vergason, & R. J. Whelan (Eds.), Effective instructional strategies for excep-
tional children (pp. 253–268). Denver: Love Publishing Company.
Hughes, J. N. (2000). Cognitive behavior therapy. In C. R. Reynolds & E. Feltcher-Janzen
(Eds.), Encyclopedia of special education: A reference for the education of the handicapped and other
exceptional children and adults (pp. 407–409). New York: J. Wiley & Sons.
Hughes, J. N. (1988). Cognitive behavior therapy with children in schools. New York: Pergamon
Press.
Kazdin, A. E. (1978). History of behavior modification: Experimental foundations of contemporary
research. Baltimore: University Park Press.
Kazdin, A. E. (1991). Effectiveness of psychotherapy with children and adolescents. Journal of
Consulting and Clinical Psychology, 89, 785–798.
Kendall, P. C. (1993). Cognitive-behavioral therapies with youth: Guiding theory, current
status, and emerging developments. Journal of Consulting and Clinical Psychology, 61, 235–
247.
Larson, J., & Lochman, J. E. (2002). Helping schoolchildren cope with anger: A cognitive behavior
intervention. New York: Guilford Press.
Leahy, R. L., & Beck, A. T. (1988). Cognitive therapy of depression and mania. In A. Gorgotas
& R. Cancro (Eds.), Depression and mania (pp. 214–267). New York: Elsevier.
Lloyd, J. W. (1980). Academic instruction and cognitive behavior modification: The need for
attack strategy training. Exceptional Education Quarterly, 1, 53–63.
Mahoney, M. J. (1974). Cognition and behavior modification. Cambridge, MA: Ballinger.
Mayer, M., Lochman, J., & Acker, R. V. (2005). Introduction to the special issue: Cognitive-
behavior interventions with students with EBD. Behavioral Disorders, 30, 197–212.
Meichenbaum, D. (1977). Cognitive-behavioral modification: An integrated approach. New York:
Plenum.
Meichenbaum, D. (1980). Cognitive-behavior modification: A promise yet unfulfilled. Excep-
tional Education Quarterly, 1, 83–88.
Meichenbaum, D., & Godman, J. (1971). Training impulsive children to talk to themselves: A
means of developing self-control. Journal of Abnormal Psychology, 77, 115–126.
Quinn, C., Swaggart, B. L., & Myles, B. S. (1994). Implementing cognitive behavior manage-
ment programs for persons with autism. Focus on Autistic Behavior, 9(4), 1–13.
Wahlberg, T. (1998). Cognitive-behavioral modification for children and young adolescents
with special problems. Advances in Special Education, 11, 223–253.
KAI-CHIEN TIEN

COGNITIVE LEARNING STRATEGIES

Cognitive learning strategies are principles or rules that help students solve prob-
lems or complete learning activities independently (Friend & Bursuck, 2006) by guid-
ing the ways they acquire, store, retrieve, and use information (Alley & Deshler,
1979; Deshler & Lenz, 1989). In short, cognitive learning strategies teach students
how to modify their thinking and problem-solving skills, and how to learn and prob-
lem solve effectively (Alley & Deshler, 1979; Bock, 2000, 2005, 2006; Deshler &
Schumaker, 1993; Salend, 2005).
A cognitive learning strategy consists of a series of specific steps that must be com-
pleted in the order specified. An acronym is often used to help students remember the
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COGNITIVE LEARNING STRATEGIES

strategy steps (Bender, 2004). For instance, in the reading comprehension strategy,
POSSE (Englert & Mariage, 1991), the acronym POSSE represents the strategy steps
as follows:

P Predict ideas.
O Organize the ideas.
S Search for the structure.
S Summarize the main idea.
E Evaluate your understanding.

Thus, when students use POSSE, they first predict the ideas that will be discussed in
the reading passage. They then use a graphic organizer to organize these ideas. Stu-
dents then search for the structure of the reading assignment. After reading the assign-
ment, students summarize the main idea from the reading. Finally, students evaluate
their understanding of the reading assignment.
Research investigating cognitive learning strategies has demonstrated that they
work very well with students who present strategy production deficiencies due either
to developmental immaturity or executive dysfunction (Bender, 2004; Bock, 2000,
2005, 2006; Boudah, Lenz, Bulgren, Schumaker, & Deshler, 2000; Schumaker &
Deshler, 1992). This research also supports use of cognitive learning strategies across
all subject content areas (e.g., reading comprehension, reading fluency, writing,
spelling, mathematics) and many academic activities (e.g., completing multiple-
choice tests, taking notes; Bender, 2004; Ellis, Deshler, Lenz, Schumaker, & Clark,
1991).
Research has identified eight steps teachers should follow when providing learning
strategy instruction (Bender, 2004; Ellis et al., 1991). The strategy instruction steps
are as follows:

Step 1: Pretest and commitment

Step 2: Describe the strategy
Step 3: Model the strategy
Step 4: Verbal strategy rehearsal
Step 5: Controlled practice and feedback
Step 6: Grade-appropriate practice and feedback
Step 7: Posttest and communication to generalize
Step 8: Generalize the strategy

In Step 1, teachers pretest the students to identify students who do not have effec-
tive learning strategies and solicit commitment from these students to participate in
learning strategy instruction. In Step 2, teachers describe the learning strategy. In Step 3,
teachers model use of the strategy. In doing so, teachers also share their thinking behav-
iors. This helps students learn how the learning strategy guides the teachers’ thinking. In
Step 4, teachers guide students in verbally rehearsing the strategy. In this step, students
also begin to memorize the strategy steps and acronym. Teachers then provide practice
and feedback using practice materials developed specifically for Step 5. Once students
demonstrate mastery of strategy use on the controlled practice materials, teachers provide
practice and feedback using grade-appropriate materials. These materials often come
directly from current class assignments (e.g., the daily reading assignment). Once
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students demonstrate mastery of strategy use Figure 8 Story Graphic Organizer

on the grade-appropriate materials, teachers
go on to Step 7, posttest and communication
to generalize. The posttest evaluates students’
strategy recall and application to grade-appro-
priate materials. During this instructional
step, teachers also discuss the need to general-
ize this strategy to all class assignments. The
final instructional step involves helping the
students generalize strategy use to all relevant
content areas. This often involves teaching
classroom teachers the learning strategy and
asking them to remind students to use the
strategy when giving assignment instructions.
Most students with autism spectrum disorders
(ASD) present signs of executive dysfunction
(i.e., problems keeping several tasks going at
the same time and switching between them,
problems making high-level decisions to resolve
conflicting responses, problems overriding auto-
matic behavior, and problems inhibiting inap-
propriate impulsive actions; Ozonoff & Griffith,
2000; Russell, 1997). Executive dysfunction
leads to strategy production dysfunction. Cog-
nitive learning strategy instruction is one way
to teach these students how to use effective
meta-cognitive (or learning) strategies. How-
ever, the unique information processing skills of students with ASD (Bock, 2005, 2006;
Ozonoff & Griffith, 2000; Russell, 1997) require several strategy modifications:

Modification 1: Visual supports

Modification 2: Learning strategy story
Modification 3: Strategy teaching script

Since many students with ASD are visual learners, strategies should include both acro-
nyms and visual icons representing each strategy step (see Figure 8). A graphic organizer
should also be used to clearly delineate each of the strategy steps. Many students with
ASD are not able to understand others’ thoughts and actions. Consequently, watching the
teacher model strategy use may not be beneficial for them. Instead, teachers should create
a learning strategy story that provides a ‘‘thinking model’’ from the student’s perspective
that is derived from the lived experience of the student who will learn the strategy. For
instance, if a student has difficulties participating in the activity period, the learning strat-
egy story should describe activity period and how to use the strategy to participate in ac-
tivity period. Finally, teachers should develop a specific teaching script—a specific set of
questions and responses teachers will use to teach SODA to students with ASD.
The cognitive learning strategy in Table 3 includes a strategy graphic organizer,
strategy story, and strategy teaching script. SODA was used to help a student
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COGNITIVE LEARNING STRATEGIES

Table 3. Making Sense of Activity Period

(Stop, Observe, Deliberate, Act)
Directions: Read the following story silently. When you are finished, raise your hand to let your
teacher know you are ready to discuss the story.
Sometimes when I go to activity period I get into trouble and am sent to the principal’s office.
Ms. Jones, my activity period teacher, tells me that I should stay in the principal’s office until
I am ‘‘. . . willing to get along with the other students.’’ This confuses me because I am always
willing to get along with the other students. During activity period I talk with all the other
students. I talk about NASA, space, and space travel. Sometimes they stop playing their
game and ask me a question about space travel. Sometimes they tell me to leave them alone.
Sometimes they ask me to go away. I leave when they ask me to leave. I go to another stu-
dent and talk about space travel. I think I am getting along with the other students during
activity period, but then Ms. Jones sends me to the principal’s office. When I go back to ac-
tivity period, I’m going to use SODA to help me figure this out.
When I enter my homeroom for activity period, I will Stop. I will then ask myself, ‘‘Where
should I go to observe?’’ (I will sit at my desk to observe.) I will ask myself, ‘‘What is the room
arrangement?’’ (I will notice if there is any change in the room arrangement.) Finally, I will ask
myself, ‘‘What is the routine?’’ (I will look at the board in the front of the room to see what games
or activities Ms. Jones has planned for today.)
I will then Observe. While observing I will ask myself, ‘‘What are Ms. Jones and the other stu-
dents doing?’’ (I will watch Ms. Jones and the other students to see what they are doing. Ms. Jones
may be showing us what games we will play today. The students may be deciding who they want to
play with and what game they want to play. The students may be reading the game directions.) I
will then ask myself, ‘‘What are Ms. Jones and the other students saying?’’ (I will listen to
Ms. Jones and the other students to hear what they are saying. Ms. Jones may be asking who wants
to play ‘‘Clue.’’ The students may be saying what they want to play. The students may be talking
about other things, like the basketball game or their favorite music group.) I will also ask myself,
‘‘What happens when Ms. Jones and the other students say and do these things?’’ (Ms. Jones
may smile and thank the students who form groups and begin playing their game right away. The
students may smile and laugh as they play their games.)
I will then Deliberate about my observations. To help me deliberate, I will ask myself, ‘‘What
would I like to do?’’ (I now realize that we go to activity period to play games. I would like to play a
game with Joe.) I ask myself, ‘‘What would I like to say?’’ (I now realize that we can visit as we
play games. Joe likes to visit about NASA, space, and space travel. I would like to visit with Joe about
NASA, space, and space travel as we play a game.) I will ask myself, ‘‘How will Ms. Jones and
the other students feel when I do and say these things?’’ (They will feel happy.) I will ask myself,
‘‘How will Ms. Jones and the other students act when I do and say these things?’’ (They will let
me join a group and play a game. They will not tell me to leave them alone. I will not be sent to the
principal’s office.) And finally, I will ask myself, ‘‘Why will Ms. Jones and the other students act
this way?’’ (They want to play games and visit during activity period. They want me to do this, too.
That’s why they won’t tell me to go away.)
After I’ve completed my deliberations, I will decide how I will Act during activity period. I can
now see that when I walk around the room talking to the other students about NASA, space, and
space travel during activity period that they cannot play games or visit with each other. This makes
them mad. Then they ask me to go away and leave them alone. Then Ms. Jones sends me to the
principal’s office. If I play a game and visit about things that interest the other students, they will feel
happy and want me to stay and play the game with them. And I won’t be sent to the principal’s
office. When I go to activity period I plan to:
walk up to Joe and ask what game he wants to play today;
tell Joe that I want to play that game too and ask if I can play the game with him;
listen to Joe and his friends talk about cars they like during the game;

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 COGNITIVE LEARNING STRATEGIES

talk about cars I like during the game;

talk about how space travel has led to improvement in these cars over recent decades; and
help Joe put the game away at the end of the period.
Strategy teaching script.
Teacher directions: Complete this teaching script immediately after the student has read the
strategy story. Bring the SODA graphic organizer and a blank sheet of paper to cover it up.
(You will gradually uncover sections of the graphic organizer as directed below.)
Teacher: You just read a story about your participation in activity period. What was the name
of the strategy that you used to help you figure out what to do during activity period?
Student: SODA.
Teacher: That’s right! (If the answer was correct.) Now tell me what the letters S, O, D, and A
represent. [Teacher uncovers the SODA icons on the left side of the SODA graphic
organizer.]
OR
The strategy was called SODA. (If the answer was incorrect.) Now tell me what the letters S,
O, D, and A represent.
Student: S represents ‘‘stop.’’ O represents ‘‘observe.’’ D represents ‘‘deliberate.’’ A represents ‘‘act.’’
Teacher: Exactly! [Teacher uncovers the SODA icons on the left side of the SODA graphic
organizer.]
When you go to homeroom for activity period, you must stop, observe, deliberate, and then act.
While stopped, what three questions must you ask yourself?
Student: Where should I go to observe? What is the room arrangement? What is the routine or
schedule?
Teacher: Right again! [Teacher uncovers the ‘‘stop’’ self-questions on the left side of the SODA
graphic organizer.] When going to activity period, you must stop and ask yourself: Where
should I go to observe? I will sit at my desk to observe. What is the room arrangement? I will
notice if there is any change in the room arrangement. What is the routine or schedule? I will look
at the board in the front of the room to see what games or activities Ms. Jones has planned for
today.
OR
Correct any questions the student missed.
This teaching script follows the same pattern through all four sections of the SODA graphic
organizer.

understand how to participate in activity period, lunch, and cooperative learning during
English class. The teaching story and script were developed for activity period. Addi-
tional stories and teaching scripts were developed for lunch and cooperative learning.
Strategy story.
Teacher directions: Introduce the student to this activity by saying, ‘‘SODA is a
strategy some people use to figure out what to do and say when they are confused.
The following short story shows how you can use SODA to figure out what to do and
say when you go to activity period. Please read the story silently and raise your hand
when you are finished so we can talk about it.’’

REFERENCES
Alley, G., & Deshler, D. (1979). Teaching the learning disabled adolescent: Strategies and methods.
Denver: Love.
Bender, W. (2004). Learning disabilities: Characteristics, identification, and teaching strategies (5th ed.).
Boston: Allyn & Bacon.

85
COGNITIVE PROCESSES

Bock, M. (2000). The impact of social behavioral learning strategy training on the social interaction
skills of eight students with Asperger syndrome. Unpublished manuscript, University of North
Dakota.
Bock, M. (2005). SODA: Learning strategy intervention for a child with Asperger syndrome. Manu-
script submitted for publication.
Bock, M. (2006). SODA strategy instruction: Demystifying social interactions for students with
Asperger syndrome. Manuscript in preparation, University of North Dakota.
Boudah, D., Lenz, B., Bulgren, J., Schumaker, J., & Deshler, D. (2000). Don’t water down!
Enhance content learning through the unit organizer routine. Teaching Exceptional Children,
32(3), 48–57.
Deshler, D., & Lenz, B. (1989). The strategies instructional approach. International Journal of
Disability, Development, and Education, 6(3), 203–244.
Deshler, D., & Schumaker, J. (1993). Strategy mastery by at-risk students: Not a simple matter.
Elementary School Journal, 94, 153–157.
Ellis, E., Deshler, D., Lenz, B., Schumaker, J., & Clark, F. (1991). An instructional model for
teaching learning strategies. Focus on Exceptional Children, 24(1), 1–14.
Englert, C., & Mariage, T. (1991). Making students partners in the comprehension process:
Organizing the reading ‘‘POSSE.’’ Learning Disability Quarterly, 14, 123–138.
Friend, M., & Bursuck, W. (2006). Including students with special needs: A practical guide for class-
room teachers (4th ed.). Boston: Allyn & Bacon.
Ozonoff, S., & Griffith, E. (2000). Neuropsychological function and the external validity of
Asperger’s syndrome. In A. Klin, F. R. Volkmar, & S. S. Sparrow (Eds.), Asperger’s syndrome
(pp. 72–96). New York: Guilford.
Russell, J. (Ed.). (1997). Autism as an executive disorder. Oxford: Oxford University Press.
Salend, S. (2005). Creating inclusive classrooms: Effective and reflective practices for all students
(5th ed.). Upper Saddle River, NJ: Merrill/Prentice Hall.
Schumaker, J., & Deshler, D. (1992). Validation of learning strategy interventions for students
with learning disabilities: Results of a programmatic research effort. In B. Y. L. Wong (Ed.),
Contemporary intervention research in learning disabilities (pp. 22–46). New York: Springer-Verlag.
MARJORIE A. BOCK

COGNITIVE PROCESSES
The ability to think about a task including intellectual abilities, such as memory
and the ability to solve problems and make judgments based on past experiences and
the context of the situation.
KATHERINE E. COOK
COLLABORATIVE TEAM
Collaboration is a necessary practice in special education, where education profes-
sionals work together to assess and educate students with disability. Collaborative
teams can occur through coordination of services, consultation among professionals,
and teaming during service provision.
KATHERINE E. COOK
COMIC STRIP CONVERSATIONS. See Cartooning

COMMUNICATION AND SYMBOLIC BEHAVIOR SCALES (CSBS)

The Communication and Symbolic Behavior Scales (CSBS; Wetherby & Prizant,
2002) is a norm-referenced, standardized instrument used to assess infants, toddlers,
and preschoolers at risk for communication delays and impairments. This assessment is
used during natural play routines and other adult-child interactions. The 22 five-point
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 COMMUNICATION BOARD

rating scales survey children’s language skills as well as their symbolic development,
which are demonstrated by the children’s gestures, facial expressions, and play behav-
iors. The CSBS should be administered by a speech-language pathologist, early inter-
ventionist, psychologist, or other professional trained to assess developmentally young
children. The assessment takes approximately 50–75 minutes to administer with the
parents or caregivers completing a Caregiver Questionnaire, which provides back-
ground information that serves as a baseline against which to evaluate a child’s per-
formance. The early childhood professional then takes a direct sampling of the child’s
communicative behaviors in structured and unstructured play situations in the child’s
natural environment.

REFERENCE
Wetherby, A., & Prizant, B. M. (2002). Communication and Symbolic Behavior Scales. Baltimore:
Brookes Publishing Co.
JEANNE HOLVERSTOTT

COMMUNICATION AND SYMBOLIC BEHAVIOR SCALES

DEVELOPMENTAL PROFILES (CSBS DP)
Communication and Symbolic Behavior Scales Developmental Profiles (CSBS DP;
Wetherby and Prizant, 2002) is a norm-referenced screening and evaluation tool designed
to help determine the communicative competence (use of eye gaze, gestures, sounds,
words, understanding, and play) of children with a functional communication age
between 6 months and 24 months (chronological age from about 6 months to 6 years).
The tool is administered by a certified speech-language pathologist, early interven-
tionist, psychologist, pediatrician, or other professional trained to assess develop-
mentally young children. The CSBS DP may be used as a starting point for
Individualized Family Service Plan (IFSP) planning, as an outcome measure to help
determine the efficacy of intervention, and as a guide to indicate areas that need fur-
ther assessment. The CSBS DP contains three components. The Infant-Toddler
Checklist, for use with children from 6 to 24 months of age, can be used indepen-
dently or with the other components of the CSBS DP. It is the first step in routine
screening to decide if a developmental evaluation is needed. A parent or a primary
caregiver who nurtures the child on a daily basis can complete the Checklist’s 24
multiple-choice questions in approximately 5 to 10 minutes. Clinicians may also
present the questions in an interview format. If the scores resulting from the Check-
list indicate concern, the child is further evaluated with the Caregiver Questionnaire
and a Behavior Sample of the child interacting with the clinician and caregiver is
taken.
REFERENCE
Wetherby, A. M., & Prizant, B. M. (2002). Communication and Symbolic Behavior Scales Develop-
mental Profile. Baltimore: Brookes Publishing Co.
JEANNE HOLVERSTOTT

COMMUNICATION BOARD
A communication board is an assistive technology device and a visual strategy that
promotes expressive communication. Depending upon the individual’s need the
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CO-MORBID/CO-OCCURRING

communication board may use letters, words, commonly needed phrases, line drawings,
or photographs.
A communication board is typically used with individuals with limited verbal ability.
This may mean that the individual does not have the ability to verbalize or may have dif-
ficulty finding the right words when in stressful situations. For the young child a commu-
nication board may be used so that they can make simple requests such as asking for
their favorite toy or letting their teacher know their need to go to the bathroom. For the
adult with Asperger syndrome or high-functioning autism who drives a car, they may
have difficulty expressing themselves if they were to get pulled over by the police. To
assist with their communication they could have a communication board in their car
that included information related to their disability, who they are, and where they live.
Communication boards can be simple to complex and take a variety of forms. They
can be used in any setting, with any aged person and with a variety of abilities. They
are designed to help the individual be successful in getting their wants, needs, and
ideas across.
See also augmentative and alternative communication.
TERRI COOPER SWANSON

CO-MORBID/CO-OCCURRING
Co-morbidity refers to the existence of one (or more) disorders occurring simultane-
ously with a primary disorder.
JEANNE HOLVERSTOTT

COMPREHENSIVE ASSESSMENT OF SPOKEN LANGUAGE

The Comprehensive Assessment of Spoken Language (CASL; Carrow-Woolfolk,
1999) is an individually and orally administered, oral language assessment battery for
ages 3 through 21. The CASL takes approximately 30–45 minutes to administer the
15 tests that measure language processing skills (comprehension, expression, and
retrieval) in four language structure categories: lexical/semantic, syntactic, supralinguis-
tic, and pragmatic. One benefit to the CASL is that the need for reading and writing is
replaced by verbal or nonverbal (pointing) responses. Therefore, the CASL battery is
ideal for measuring delayed language, oral language disorders, dyslexia, and aphasia.

REFERENCE
Carrow-Woolfolk, E. (1999). Comprehensive Assessment of Spoken Language. Circle Pines, MN:
American Guidance Services.
JEANNE HOLVERSTOTT

COMPREHENSIVE AUTISM PROGRAM PLANNING SYSTEM (CAPS)

The Comprehensive Autism Program Planning System (CAPS; Henry & Myles,
2007) is a process approach that is focused on designing and implementing a compre-
hensive intervention program specifically for individuals with autism spectrum disorders.
This process is designed to promote the acquisition of core content, whether it is educa-
tional, vocational, or community based, and facilitate the individualized planning of
interventions to meet the social, communication, sensory, and educational needs of
88
 Figure 9 Comprehensive Autism Planning System (CAPS)
Child/Student:__________________________ Program Manager:_______________________ Date:_____________

Targeted skill
Specially Designed Data collection Communication / Instructional Generalization
Time Activity short-term Sensory Strategies
Instruction forms Social Skills Materials Plan
objective

89
COMPUTED AXIAL TOMOGRAPHY

persons with ASD. A team of individuals, including parents, general and special educa-
tion staff, support services (i.e., speech language pathologists, occupational therapists,
physical therapists), and administration (i.e., local and regional), complete the CAPS
planning matrix for an individual’s ‘‘typical’’ day at school, home, or the workplace.
This process begins with informal information gathering about factors directly related to
the individual’s program success, such as issues related to motivation, communication,
sensory issues, and generalization (see Figure 9). These components inform the comple-
tion of the planning matrix, which can include the following categories: time, activity,
target skill/short-term objective, specially designed instruction (materials need to aid
instruction, i.e., a visual schedule), data collection, instructional materials, social and
communication skills, sensory issues, and generalization. This individualized team plan-
ning approach aims to create consistency across time and setting, share information
with interested parties, and organize an individual’s program with many methodologies
that target the core challenges faced by individuals with autism spectrum disorders.

REFERENCE
Henry, S., & Myles, B. (2007). Comprehensive autism planning system. Shawnee Mission, KS: Au-
tism Asperger Publishing Company.
JEANNE HOLVERSTOTT

COMPUTED AXIAL TOMOGRAPHY. See CAT Scan

COMPUTED TOMOGRAPHY. See CAT Scan

CONCEPT FORMATION TEST FROM HALSTEAD-REITAN BATTERY. See

Halstead-Reitan Neuropsychological Test Battery

CONCRETE LANGUAGE
Concrete language is characterized by using specific and observable terminology to
describe a person, place, or thing. Specific words are chosen and used that make the
communicative message visual, versus abstract language that utilizes vague and general
vocabulary where the listener is responsible for their own interpretation of the message.
KATHERINE E. COOK

CONCURRENT VALIDITY
Concurrent validity refers to a parameter demonstrated when a test correlates posi-
tively with a previously validated measure. The two measures may be for the same
construct, or for different, but presumably related constructs.
JEANNE HOLVERSTOTT

CONFIDENTIALITY
Confidentiality is the act of ensuring that information is accessible only to authorized
individuals. According to the procedural safeguards created by the Individuals with
90
 CONSTIPATION

Disabilities Education Act (IDEA), there is a ‘‘right to confidentiality of personally

identifiable information, including the right of parents to written notice of and written
consent to the exchange of such information’’ [20 U.S.C. § 1439(639)]. In addition to
IDEA, two other major pieces of legislation regulate third-party access to educational
and medical records: the Family Educational Rights and Privacy Act (FERPA, 1975)
and the Health Insurance Portability and Accountability act (HIPPA, 1996).

REFERENCES
Family Educational Rights and Privacy Act (FERPA) 20 U.S.C. § 1232 et seq.
Health Insurance Portability and Accountability Act (HIPPA).
Individuals with Disabilities Education Act (IDEA), 20 U.S.C. § 1401 et seq.
THERESA L. EARLES-VOLLRATH

CONSENT
Consent is the act of giving written permission by an individual who is fully
informed on information relevant to the proposed activity. According to the Individu-
als with Disabilities Education Act (IDEA), written parental consent is required prior
to the following: initial evaluation, placement of students in special education, change
of placement, and release of records (IDEA, 20 U.S.C. § 1414(a) (1) (D)). Consent
must be given voluntarily by parents who have sufficient information and who have
the capacity to give consent. In addition, consent can be revoked at any time while
the activity for which consent was given occurs.

REFERENCE
Individuals with Disabilities Education Act (IDEA), 20 U.S.C. § 1414(a) (1) (D).

FURTHER INFORMATION
Yell, M. L. (2006). The law and special education (2nd ed). Upper Saddle River, NJ: Prentice Hall.
THERESA L. EARLES-VOLLRATH

CONSEQUENCE
A consequence is what happens immediately after a behavior or response. A conse-
quence may be intentional, unintentional, positive, or negative. Regardless, the conse-
quence shapes the behavior that precedes it. For example, a student who disrupts
math class and is consequently sent from the room may be escaping math class. In this
case, the consequence is exactly what the student desires and only serves to
strengthen the behavior, disrupting class. Therefore, it is important to be aware of the
function of behavior before assigning a consequence.
KATIE BASSITY

CONSTIPATION
Constipation is a condition in which the passage of stool decreases in frequency
and/or stools become hard, dry, and difficult to pass. Numerous factors can contribute
including diet, lack of appropriate schedule, psychological problems, intestinal obstruc-
tion, and medications. There is a wide variety on ‘‘normal’’ frequency of bowel move-
ment, ranging from 2–3 times a day to 1–2 times per week.
BRUCE BASSITY
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CONTINGENCY

CONTINGENCY
A contingency is the relationship between a behavior and its associated consequen-
ces. A contingency exists when an event is consistently presented, removed, or with-
held following the occurrence of a specific behavior. Contingencies can occur
naturally (Ferster, 1965), or they can be contrived (e.g., when a piece of food is given
for an appropriate response).

REFERENCE
Ferster, C. B. (1965). Arbitrary and natural reinforcement. Psychological Record, 17, 341–347.
JEANNE HOLVERSTOTT

CONTINGENCY CONTRACTING
A contingency contract is an agreement between two individuals, usually a student
and teacher or other adult. Also known as a behavior contract, it is usually written
out and explicitly names a desired behavior that the student commits to in return for
explicitly named reinforcement that the teacher or other adult will provide when the
desired behavior occurs. A contingency contract is generally put in place to encourage
a positive behavior in place of an existing undesired behavior.
KATIE BASSITY

CONTROL GROUP/CONTROL CONDITION

The control group (also called control condition or comparison group) is used to
compare the different groups in an experimental research study. For example, in an
investigation of a reading intervention, one group of children would receive the inter-
vention that is being studied while the control group would not receive the interven-
tion and would either receive an alternate treatment or no treatment at all. The
purpose of the control group is to increase the strength by which researchers can claim
that the intervention (the independent variable) caused the changes in subject behav-
ior and that other factors were not involved.

FURTHER INFORMATION
Everitt, B. S. (2002). The Cambridge dictionary of statistics (2nd ed.). Cambridge: Cambridge Uni-
versity Press.
Salkind, N. J. (2005). Exploring research (6th ed.). Upper Saddle River, NJ: Prentice Hall.
PAUL G. LACAVA

CORRECTIONAL FACILITY
A court appointed facility for juvenile offenders where education services are pro-
vided for an established time period set by the juvenile court system. Educational ser-
vices are continued if the student had an Individualized Education Program (IEP) at
the time of entrance into the juvenile system.
KATHERINE E. COOK

CRITERION-REFERENCED ASSESSMENT
A criterion-referenced assessment measures a student’s mastery of specific content
or skills. These assessments provide information regarding what a student knows
related to a standard or criteria; in contrast, norm-referenced assessments measure
how much one knows.
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 CURRICULUM-BASED ASSESSMENT

FURTHER INFORMATION
Pierangelo, R., & Giuliani, G. (1998). Special educator’s complete guide to 109 diagnostic tests:
How to select and interpret tests, use results in IEPs, and remediate specific difficulties. West
Nyack, NY: Center for Applied Research in Education.
Taylor, R. L. (2006). Assessment of exceptional students: Educational and psychological procedures
(7th ed.). Needham Heights, MA: Allyn and Bacon.
THERESA L. EARLES-VOLLRATH

CT SCAN. See CAT Scan

CURRICULUM
Curriculum is the subject matter that is to be taught by the teacher and mastered
by the student. Curriculum is usually described in terms of its scope and sequence.
One might examine the curriculum of a special school, for example, to determine
whether it matches the Individualized Education Program of a student who had been
recommended to receive services there.
KATHERINE E. COOK

CURRICULUM-BASED ASSESSMENT
Curriculum-Based Assessment (CBA) is an ongoing, alternative method of assessing
student performance that compares the student’s abilities with the curricular sequence
he will be taught or the content that has been taught. An advantage of this assess-
ment method is that the results relate directly to instructional objectives and
materials.

FURTHER INFORMATION
Scheuermann, B. & Webber, J. (2002). Autism: Teaching does make a difference. Belmont, CA:
Wadsworth/Thomson Learning.
THERESA L. EARLES-VOLLRATH

93
 D
DAILY LIVING SKILLS
Daily living skills are those behaviors that are required for independence in the cur-
rent environment and in adult life. Depending on age and ability level, daily living
skills may include knowledge to: (a) purchase foods and prepare meals, (b) manage
personal finances (counting money, making change, and using banking services inde-
pendently), (c) care for personal and home needs (bathing independently, doing laun-
dry, and cleaning the house), (d) navigate the community using various means of
transportation (knowing where one lives, being able to make short trips, and using
public transportation or driving a car), (e) understand health and safety issues
(knowing who to contact in an emergency), (f) social interaction skills (interpersonal
skills, self confidence, self-advocacy, communicating with others appropriately), and
(g) decision making/problem solving. For many students identified with ASD, these
skills may be included in school learning in order to ensure the individual achieves
the greatest self-reliance and independence in adult life.

FURTHER INFORMATION
Brolin, D. (1997). Life centered career education: A competency based approach (4th ed.). Reston,
VA: Council for Exceptional Children.
ANDREA M. BABKIE

DANCE THERAPY
Dance, or movement therapy, is the therapeutic use of movement and dance as a
method to treat emotional, cognitive, social, and physical disorders (ADTA, 2006).
Dance/movement therapy can be a tool for stress management, the prevention of
physical and mental health problems, easing chronic pain, and enhancing the circula-
tory and respiratory systems. It can also benefit those with diagnoses including learn-
ing disabilities, visual or hearing impairments, or mental handicaps.
This type of therapy promotes improvement by creating bonds between clients,
decreasing muscular tension, trusting personal impulses, and encouraging self-expres-
sion. In addition, this movement is physical and provides the benefits of exercise and
improved health. One of the guiding ideas behind dance therapy is the connection
between the mind and body and how this connection influences a person’s well-being
and mental functioning.
DAS-NAGLIERI COGNITIVE ASSESSMENT SYSTEM (CAS)

The designation of Dance Therapy Registered (DTR) is for individuals who are at
the entry level, have a master’s degree, and completed 700 hours of a supervised clini-
cal internship. The Academy of Dance Therapists Registered (ADTR) is an advanced
designation and is reserved for those individuals who have completed 3,640 hours of
supervised clinical work as well as other supervision requirements by a dance therapist
who has received the Academy of Dance Therapists Registered designation.
Dance/movement therapists can work with clients on an individual basis or in a
group setting in general hospitals, psychiatric hospitals, developmental centers, mental
health centers, schools, and rehabilitation centers. Referrals and/or recommendations
may come from a primary care physician regardless of whether the dance/movement
therapist is an independent provider or part of a treatment team.

REFERENCE
American Dance Therapy Association 2006. (n.d.). Who we are. Retrieved September 20, 2006,
from www.adta.com.
LYNN DUDEK

DAS-NAGLIERI COGNITIVE ASSESSMENT SYSTEM (CAS)

Das-Naglieri Cognitive Assessment System (Naglieri, 1999) is a norm-referenced
measure of intelligence based on the PASS theory of cognitive processing. PASS con-
sists of four cognitive components (planning, attention, simultaneous, and successive
processes) that form a complex and interdependent system. Planning refers to a set of
decisions or strategies an individual adopts and modifies to solve a problem and to
reach a goal. Planning tasks in the CAS require an individual to develop some
approach of solving the task in an efficient and effective manner. Attention implies
that the individual is alert. Alertness can be sustained for a period of time and is
selective. Arousal, or alertness, is a prerequisite for learning and memory. Attention
tasks in the CAS require the individual to selectively attend to one and ignore the
other aspect of a two-dimensional stimulus. Simultaneous processing refers to the per-
son’s facility in relating and integrating discrete pieces of information. Simultaneous
tasks in the CAS require the individual to interrelate the component parts of a partic-
ular item to arrive at the correct answer. The relationship between all the component
parts must be incorporated into some complete pattern or idea. Successive processing
refers to the person’s ability to keep things in a particular order. Successive tasks in
the CAS require the individual to either reproduce a particular sequence of events or
answer some questions that require correct interpretation of the linearity of events.
The CAS is appropriate for use with individuals between the ages of 5 and 18.

REFERENCE
Naglieri, J. (1999). Essentials of CAS Assessment (Essentials of Psychological Assessment Series).
New York: Wiley.
JEANNE HOLVERSTOTT

DATA
Data is a large class of practically important statements collected from each subject
or the variables through measurements or observations. Those statements may com-
prise numbers, words, or images. Data on its own has no meaning. It only takes on
96
 DEVELOPMENTAL AGE

meaning and becomes information when interpreted by some kind of data processing
system. People or computers can find patterns in data to perceive information, and in-
formation can be used to enhance knowledge.
KAI-CHIEN TIEN

DEEP PRESSURE PROPRIOCEPTION TOUCH TECHNIQUE

Deep pressure proprioception touch technique is a method of intervention that pro-
vides sensory information to the joints and larger muscle groups in the body through
firm touch and pressure. This information helps the individual organize his body and
movements into more purposeful, adaptive responses.
KELLY M. PRESTIA

DEMENTIA INFANTALIS. See Childhood Disintegrative Disorder

DESENSITIZATION
Desensitization is a method to reduce or eliminate an individual’s negative reaction
to a substance or stimulus. In pharmacology, desensitization is the loss of responsive-
ness to the continuing or increasing dose of a drug. In psychology, desensitization (or
graduated exposure therapy) is a process for mitigating the harmful effects of phobias
or other disorders. It also occurs when an emotional response is repeatedly evoked in
situations in which the action tendency that is associated with the emotion proves
irrelevant or unnecessary. A common application of desensitization is the pairing of
an aversive stimulus with a reinforcing stimulus with gradual, increased exposure to
what is aversive. For example, an individual who fears snakes would begin by looking
at a snake from afar and gradually working to hold the snake.
JEANNE HOLVERSTOTT

DESIRED BEHAVIOR. See Target Behavior

DETOXIFICATION
Detoxification is a practice that purportedly removes toxins from the body in order to
improve functioning and/or reduce symptoms related to the presence of toxins (heavy
metals, poisons). Detoxification is not currently supported by empirical research.
See also chelation; heavy metals; vaccinations.
JEANNE HOLVERSTOTT

DEVELOPMENTAL AGE
Developmental age is an index of development stated as the age of an individual
and determined by specified standardized measurements such as motor and mental
tests and body measurement. It is a measure of a child’s development or maturation in
different domains expressed in terms of age norm. In other words, developmental age
is the physical, neurological, social, emotional, and intellectual growth changes that
have occurred within a particular child. Those growth changes are unique to the child
and make the child different from every other child. All children mature at slightly
97
DEVELOPMENTAL DELAY

different rates. A child’s developmental age may or may not correspond with his or
her chronological age.
KAI-CHIEN TIEN

DEVELOPMENTAL DELAY
As defined by the Division of Early Childhood (DEC) in 1991, ‘‘developmental
delay is a condition which presents a significant delay in the process of development.
It does not refer to a condition in which a child is slightly or momentarily lagging in
development.’’ Without early or special interventions it is likely that educational per-
formance at school age will be affected. Developmental delay can be diagnosed by the
child’s pediatrician through a series of tests or checklists.

REFERENCE
Division of Early Childhood. (1991). Retrieved October 17, 2006, from http://www.dec-
sped.org/pdf/positionpapers/PositionStatement_DevDelay.pdf.
JAN L. KLEIN

DEVELOPMENTAL DISORDER
Developmental disorder is the term used to describe a diagnostic grouping of condi-
tions seen from childhood and into adulthood. These include speech and language
delay, reading delay, autism spectrum disorders, generalized learning disabilities, enure-
sis, and encopresis. They are a heterogeneous group that are characterized by abnor-
mality or delay in the development of functions and abilities that normally are seen
during childhood development or maturation. Disorders such as autism spectrum disor-
ders (also known diagnostically as pervasive developmental disorders) are considered
primarily as neurodevelopmental disorders with neurological or genetic factors influ-
encing the cause, presentation, and progress of the disorder.
Other disorders that are usually grouped elsewhere are conduct disorder, opposi-
tional-defiant disorder, and hyperactivity (grouped as disruptive behavior disorders),
and anxiety disorders, phobias, depression, obsessive-compulsive disorder, and somati-
zation (grouped as emotional disorders). However, the division between these group-
ings is somewhat spurious and due more to convenience than to any defined
difference between the developmental status of the conditions. Indeed, all of the dis-
orders reported in disruptive behaviors and emotional disorders can be seen in chil-
dren and present during development, so are often also referred to as developmental.
In addition, there are other disorders seen in childhood that do not fit neatly into
the aforementioned groupings: Tourette’s syndrome, anorexia nervosa, early onset
schizophrenia, attachment disorders, and so on. Thus developmental disorders do not
cover the whole range of childhood psychiatric or mental health difficulties that are
seen (Goodman & Scott, 2005, pp. 27–28).
In terms of the pervasive developmental disorders, those developmental disorders
that incorporate autism, these are currently listed in the Diagnostic and Statistical
Manual of Mental Disorders (DSM-IV-TR: APA, 2000) to include the following:
Autistic disorder, Asperger’s disorder, Pervasive Developmental Disorder–Not Oth-
erwise Specified, Rett’s disorder, and Childhood Disintegrative Disorder. The latter
two conditions are different than the former three in that they are thought to be of
98
 DEVELOPMENTAL INDIVIDUAL-DIFFERENCE RELATION-BASED INTERVENTION (DIR)

different origin or etiology to autism disorders, but are included under the general term
of pervasive developmental disorders due to the similarity in features, the desire to differ-
entiate between similar presentations, and the fact that the difficulties seen are pervasive.

REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
Goodman, R., & Scott, S. (2005). Child psychiatry (2nd ed.). Oxford: Blackwell Publishing.
FIONA J. SCOTT

DEVELOPMENTAL INDIVIDUAL-DIFFERENCE
RELATION-BASED INTERVENTION (DIR)
Developed by Stanley Greenspan and Serena Wieder, developmental individual dif-
ference relation-based intervention (DIR) is often referred to as floor time; however,
the floor time component is only part of the approach. DIR is a framework for assess-
ment and intervention for children with challenges related to social relatedness and
communication. The general approach of the DIR model is to assist children in devel-
oping logical understanding of the world around them through a variety of interven-
tions including floor time.

OVERVIEW OF THE DIR MODEL

Greenspan and Wieder believe that teaching children through the DIR model en-
ables them to become independent thinkers. This is done through using emotional
and motivating experiences to help the child master the building blocks of social
skills, language, independence, learning specific concepts, and academics.
DIR focuses on several components as part of the intervention program. These
include: (a) home programming, (b) school programming, (c) specific therapies, (d) bio-
medical interventions, and (e) family support. Additionally, according to Greenspan,
home and school programs should consist of the three following learning experiences: (a)
floor time sessions, (b) semi-structured problem-solving interactions, and (c) sensorimotor
activities. These activities are incorporated in the development of the child’s milestones.
Within the DIR model, autism is considered as a form of developmental delay
(Greenspan & Wieder, 1998, 2003). For example, failure to attain the capabilities of
joint attention (Reed, 2002) and social reciprocity (Conners & Multi-Health Systems
Staff, 1995; Goldstein, Johnson, & Minshew, 2001; Heaton, Chelune, Talley, Kay, &
Curtis, 1993; Korkman, Kirk, & Kemp, 1998; Minshew & Goldstein, 2001) are con-
sistent across autism and pervasive developmental disorders. Other missed milestones
in functional language and early motor capacities, along with planning, sequencing,
and symbolic functioning required for pretend-play also indicate possible autism or a
related condition (Greenspan & Wieder, 2003). Finally, modulation of sensory input
is also highly correlated with autism and other pervasive developmental delays (Kientz &
Dunn, 1997; Stone & Lemanek, 1990).
As with physical development, charting the social, emotional, cognitive, language,
and motor skills according to typical developmental landmarks helps determine and
address the developmental delays associated with pervasive developmental delays such
as autism (Greenspan & Wieder, 2003).
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DEVELOPMENTAL INDIVIDUAL-DIFFERENCE RELATION-BASED INTERVENTION (DIR)

Greenspan and Wieder (1998) identify six developmental milestones children with
autism need to master in order to develop the necessary skills of communication,
thinking, and coping with the world on a cognitive-emotional level. Due to the devel-
opmental nature of the stages, each milestone must be mastered before attempting to
reach the next level.

SIX DEVELOPMENTAL MILESTONES

Milestone 1: Self-Regulation and Interest in the World
Success in this stage means the child is able to use his five outer (sight, touch, taste,
smell, and hearing) and two inner (vestibular and proprioception) senses to gather infor-
mation from the environment while self-regulating the strength and quality of the input
for successful interaction with the environment. For some children, failure to master this
stage demonstrates itself in becoming overwhelmed with sensory input resulting in irrita-
ble behavior or shutting down. Other children, due to lack of perceptible data from the
environment, will take little interest in their environment and seem detached.
Milestone 2: Intimacy
Success in this stage means the child demonstrates interest in interacting in a
warm, joyful, and loving manner with their peers as well as others. Failure to master
this level of development—likely due to sensory processing difficulties—results in the
environment becoming confusing, scary, or painful. Many children who experience
difficulties at this stage prefer the company of older people because adults are more
able to scaffold conversations and other interactions with them.
Milestone 3: Two-Way Communication
The initiation of interaction is considered as opening the circle of communication,
whereas the response to another person’s intent to interact is considered as closing the
circle of communication. Success in this stage presents a child who feels secure in his
interactions with others as a prerequisite for understanding that his communicative intent
affects others’ reactions and that he has an impact on the world. Two-way communica-
tion occurs with single gestures to initiate (open) and to respond to (close) circles of
communication (Greenspan & Wieder, 1998). Failure to master this level of develop-
ment results in a child that can be hard to engage, seems oblivious to the environment,
or perhaps watches from the sidelines appearing that they would like to get involved. Dif-
ficulty in reading nonverbal and pragmatic information impinges on successful two-way
communication, necessitating outside help in facilitating interaction and taking initiative.
Milestone 4: Complex Communication
The child who successfully navigates this level has mastered the basics of two-way
communication and developed a vocabulary for expressing wishes. This child now
conceptualizes behavioral sequences that he or she can use to convey wishes and
intentions as well as reading them in others. Failure to reach and work through this
developmental phase stems from issues of sensory integration leading to difficulties in
motor planning, logical thought, and reading the behavior of others without direct
(often intensive) instruction. As the complexity of two-way communication increases,
the child becomes more overwhelmed and confused, resulting in defensive, irritable,
or isolationist behaviors.
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 DEVELOPMENTAL INDIVIDUAL-DIFFERENCE RELATION-BASED INTERVENTION (DIR)

Milestone 5: Emotional Ideas—‘‘The Ability to Create Ideas’’

The child begins to engage in appropriate representational play at this stage
(Greenspan & Wieder, 1998; Miller & Eller-Miller, 1989; 2000). The child now uses
toy cars for pretend races, travel, accidents, and repairs rather than turning it upside
down to spin the wheels. A baby doll will be fed and told ‘‘night night’’ when it is
time to sleep. The child also begins to narrate these activities, and words now have
meaning rather than being just symbols of objects, events, people, and ideas. The
child can use words to explain thoughts and feelings, and to create stories. Emotional
islands of expression are formed around these activities.
The child who is unable to master this milestone continues to have difficulties with
intimate and two-way communication. While he or she often shows an interest in toys
and can keep calm, however, communication occurs only when motivated. He or she
may use one-word requests for wants and needs but will rarely use items for representa-
tive play or create a story.

Milestone 6: Emotional Thinking

A child who is at stage six is able to connect the islands of emotional expression and
sequence several representative pretend-play events. For example, instead of playing
with the toy cars and doll as explained previously as separate events, the two activities
are now connected. For example, after the doll goes to sleep, mommy and daddy doll
may bring her into the car for a drive to the ice cream store or a friend’s house where
the baby doll may wake up to play with friends or to eat. The child develops a greater
understanding of self, how his or her actions affect another person, and vice versa. For
example, the child can now say, ‘‘I am happy that you gave me cookies and milk,’’ and
can interact on higher levels of emotionality as verbal and spatial skills increase.
The child who is unable to reach this stage remains unable to link the emotional
islands described earlier. The previous emotional milestones seem to have been
achieved at times but often fall apart under stress and result in being unable to close
circles of communication.
According to Greenspan and Wieder (1998), mastering these developmental mile-
stones gives the child a foundation of ‘‘critical basic tools for communicating, think-
ing, and emotional coping’’ (p. 89) and decreases the negative impact the autism
spectrum disorder has for the person’s development. Stress is placed on the child mas-
tering each developmental level before attempting to complete the next level as
opposed to chronological age as a consideration.

REFERENCES
Conners, C. K., & Multi-Health Systems Staff. (1995). Conners continuous performance test.
Toronto: MHS.
Goldstein, G., Johnson, C. R., & Minshew, N. J. (2001). Attentional processes in autism. Jour-
nal of Autism & Developmental Disorders, 31(4):433–440.
Greenspan, S., & Wieder, S. (1998). The child with special needs: Encouraging intellectual and emo-
tional growth. Reading, MA: Addison Wesley.
Greenspan, S., & Wieder, S. (2003). Assessment and early identification. In E. Hollander (Ed.),
Autism spectrum disorders (pp. 57–86). New York: Marcel Dekker, Inc.
Heaton, R. K., Chelune, G. J., Talley, J. L., Kay, G. G., & Curtis, G. (1993). Wisconsin card
sorting test (WCST) manual revised and expanded. Odessa, FL: Psychological Assessment
Resources.

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DEVELOPMENTALLY APPROPRIATE PRACTICE

Kientz, M. A., & Dunn, W. (1997). A comparison of the performance of children with and
without autism on the Sensory Profile. American Journal of Occupational Therapy, 51, 530–
537.
Korkman, A. S., Kirk, U., & Kemp, S. (1998). A developmental neuropsychological assessment.
San Antonio, TX: The Psychological Corporation.
Miller, A., & Eller-Miller, E. (1989). From ritual to repertoire: A cognitive-developmental systems
approach with behavior-disordered children. New York: Wiley-Interscience.
Miller, A., & Eller-Miller, E. (2000 November). The Miller method: A cognitive-developmental
systems approach for children with body organization, social and communication issues. In
S. Greenspan & S. Wieder (Eds.), ICDL clinical practices guidelines: Revising the standards of prac-
tice for infants, toddlers and children with developmental challenges (pp. 489–516). Bethesda, MD:
The Interdisciplinary Council on Developmental and Learning Disorders.
Minshew, N. J., & Goldstein, G. (2001). The pattern of intact and impaired memory functions
in autism. Journal of Child Psychology and Psychiatry, 42, 1095–1101.
Reed, T. (2002). Visual perspective taking as a measure of working memory in participants with
autism. Journal of Developmental and Physical Disabilities, 14(1), 63–76.
Stone, W. L., & Lemanek, K. L. (1990). Parental report of social behaviors in autistic pre-
schoolers. Journal of Autism and Developmental Disorders, 20, 513–522.

FURTHER INFORMATION
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th. ed., text rev.). Washington, DC: Author.
Gutstein, S. (2000). Autism Aspergers: Solving the relationship puzzle: A new developmental program
that opens the door to lifelong social & emotional growth. Arlington, TX: Future Horizons.
Gutstein, S. (2003). Can my baby learn to dance? In L. Willey (Ed.), Asperger syndrome in ado-
lescence: The ups, downs, and inbetweens (pp. 98–128). London: Jessica Kingsley Publishers.
Spence, S. J. & Geschwind, D. H. (2003). Autism screening and neurodevelopmental assess-
ment. In E. Hollander (Ed.), Autism spectrum disorders (pp. 39–56). New York: Marcel Dek-
ker, Inc.
STEPHEN SHORE

DEVELOPMENTALLY APPROPRIATE PRACTICE

Professionals who adhere to developmental models such as those based on Piaget’s
theories often refer to their philosophy as developmentally appropriate practice
(DAP). This practice is based on knowledge about what is typically expected of and
experienced by children of different ages and developmental stages. As Katz (1995)
states, ‘‘what should be learned and how it would best be learned depend on what we
know of the learner’s developmental status and our understanding of the relationships
between early experience and subsequent developments’’ (p. 109). The philosophy and
the guidelines for DAP are described in widely disseminated materials published by
the National Association for the Education of Young Children (NAEYC; Bredekamp,
1987; Bredekamp & Copple, 1997).

REFERENCES
Bredekamp, S. (1987). Developmentally appropriate practice in early childhood programs serving chil-
dren from birth through age 8. Washington, DC: National Association for the Education of
Young Children.
Bredekamp, S., & Copple, C. (1997). Developmentally appropriate practice in early childhood pro-
grams. Washington, DC: National Association for the Education of Young Children.
Katz, L. (1995). Talk with teachers of young children: A collection. Norwood, NJ: Ablex.
KAI-CHIEN TIEN
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 DEVELOPMENTAL SURVEILLANCE

DEVELOPMENTAL MILESTONES
Developmental milestones are a set of functional skills that most children can do at a
certain age range as defined by the American Academy of Pediatrics. These milestones
are used by qualified professionals to check developmental progress. These milestones
can be broken down into the following areas: (a) motor skills; (b) sensory and thinking
skills; and (c) language and social skills. During the first year, the milestones are usually
assessed at 3, 6, and 12 months. Although each milestone has a corresponding age level,
the actual age when a normally developing child reaches that milestone can vary.

REFERENCE
American Academy of Pediatrics. (n.d.). Retrieved October 17, 2006, from http://www.aap.org/
healthtopics/stages.cfm.
JAN L. KLEIN

DEVELOPMENTAL PLAY ASSESSMENT INSTRUMENT (DPA)

The Developmental Play Assessment Instrument (DPA; Lifter, Sulzer-Azaroff,
Anderson, & Cowdery, 1993) is designed as a curriculum-based assessment of chil-
dren’s play activities, providing an evaluation of the quality of a child’s toy play skills
in relation to those of typically developing children.
Play activities have been identified as critical to the development of language, motor
skills, and social interaction in children with developmental disabilities. The DPA identi-
fies a child’s current level of performance in the play curriculum and then determines the
steps necessary for that child to acquire more developmentally challenging play activities.

REFERENCE
Lifter, K. Sulzer-Azaroff, B., Anderson, S., & Cowdery, G. (1993). Teaching play activities to
preschool children with disabilities: The importance of developmental considerations. Journal
of Early Intervention, 17(2), 139–159.
JEANNE HOLVERSTOTT

DEVELOPMENTAL QUOTIENT
Used to express a developmental delay, the adaptive Developmental Quotient (DQ)
is a ratio of the developmental (functional) age to the chronological age and is
expressed as a percentile. The overall developmental score relates to performance in
four domains: motor skills (e.g., balancing, sitting); language use; adaptive behavior
(e.g., alertness, exploration); and personal-social skills (e.g., feeding, dressing). DQ
can be calculated on the basis of standardized developmental tests suitable for young
children, but DQ is also used for estimates of mental age based on the impressions of
professionals (e.g., child psychologists, pediatricians, and teachers) as well as parents
or other family members.
See also standardization tests.
JAN L. KLEIN

DEVELOPMENTAL SURVEILLANCE
Developmental surveillance is a flexible, continuous process whereby knowledgeable
professionals perform skilled observations of children during the provision of health
care. The components of developmental surveillance include: (a) eliciting and
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DEVELOPMENTAL THERAPY

attending to parental concerns, (b) obtaining a relevant developmental history, (c)

making accurate and informative observations of children, and (d) sharing opinions
and concerns with other relevant professionals.
Pediatricians often use age-appropriate developmental checklists to record mile-
stones during preventive care visits as part of developmental surveillance.
JAN L. KLEIN

DEVELOPMENTAL THERAPY
Developmental therapy (DT) is a program designed to enhance social functioning
during interactions between people. Misunderstandings of social situations may lead to
withdrawal, aggression, and lower self-esteem, especially in students with an autism
spectrum disorder. This structured teaching program can be used for students from
birth to age 16, with various disabilities. Developmental therapy matches teaching strat-
egies to a student’s needs, helps create an understanding of uneven or splinter skills,
assists in revising program strategies, and then evaluates the progress.
Developmental therapy consists of five stages; each stage consists of four compo-
nents. The components that DT addresses are: behavior, communication, socialization,
and academics. The stages included in the program are as follows:

¥ Stage 1: Responding to the environment with pleasure

¥ Stage 2: Responding to the environment with success
¥ Stage 3: Successful group participation
¥ Stage 4: Investing in group process, with concern for others
¥ Stage 5: Using individual and group skills in new situations

Students in stage one may be impulsive, display no problem solving skills, have tan-
trums, aggressions, and/or display self-injurious behaviors when problems occur. This
lack of ability to handle problems may be attached to anxiety, stemming from feelings
of abandonment, helplessness, deprivation, and uncertainty.
The four components address several milestones during each stage—behavior, com-
munication, socialization, and academics—used in developmental therapy. Behavioral
milestones in stage one include indicating awareness of sensory stimuli, responding to
stimuli, independently responding to play materials, spontaneously moving from area
to area, and indicating recall of routine without assistance. In the area of communica-
tion, stage one’s main goal is for the students to use words to gain their needs. Mile-
stones in the communication component include producing sounds, attending to the
person speaking, responding to a verbal stimuli with a motor behavior, responding to
verbal cues, using recognizable word approximation or words to describe, label, or
request, and producing recognizable single words or meaning sequencing of words.
These communication milestones prepare a child for work toward the socialization
goal of trusting and communicating with adults. To accomplish this, the student indi-
cates an awareness of others, attends to other’s behaviors, responds to an adult when
his or her name is called, engages in organized and solitary play, interacts with an
adult nonverbally or verbally to have needs met, demonstrates an understanding of a
single verbal request or direction, and conveys a beginning awareness of self. The last
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 DEVELOPMENTAL THERAPY

component’s goal, academics, requires the student to respond to the environment with
intentional body movements and basic mental processes of memory, classification, and
receptive language. Milestones in this area show spontaneous short-term memory for
people and objects, spontaneously imitate simple, familiar actions of adults, show fine-
and large-motor skills associated with an 18-month-old developmental level, and indi-
cate an understanding of names of familiar objects, matching shapes of objects with
corresponding space, identifying own body parts, and sorting two types of similar
objects with slightly different attributes.
The overall goal of stage two, responding to the environment with success, is
accomplished by addressing the concerns of the students. These concerns include
pleasing adults, low confidence or self-esteem, limited awareness of cause and effect,
ineffective responses to adults and peers, impulsive behaviors, and frustration directed
toward adults. The students’ motivation to gain adult approval and seek recognition
allows the adults to address the four components in this stage.
The behavioral milestone for stage two focuses on participating in routines and ac-
tivity with success. Teaching students to play with materials appropriately, wait with-
out physical intervention by an adult, and participate in sitting and movement
activities without intervention helps strengthen skills. During these activities, adults
encourage the students to use words constructively, such as answering questions or
requests with relevant words, indicating comprehension of others, spontaneously using
simple word sequences, spontaneously using words to share information with adults
and other children, and describing simple, tangible characteristics of oneself and
others. Socially, the students in this stage work on initiating imaginative play and
appropriate social movement towards peers and participating in sharing activities
and interactive play with peers. Academically, the student develops self-help skills
and motor coordination comparable to the level of a 5-year-old. The student also
concentrates on language, mental processes of discrimination, sequencing, and numer-
ation, up to the number 10.
While focusing on the skills needed to interact and participate appropriately in
groups, the time Stage 3 students take to progress varies. The concern with looking
good to others motivates students and recognition of fair play and a preoccupation
with law and order makes the introduction of rules a smooth transition. Instructors
teach and evaluate skills such as completing individual tasks independently, under-
standing the rules and reasons that regulate behavior, refraining from unacceptable
behavior when others are losing control, and maintaining acceptable physical and
verbal behavior in a group. The students need to show that they are able to spontane-
ously describe personal experiences and ideas, show positive and negative feelings
appropriately, participate in group discussions, describe attributes of themselves and
others, and recognize the feelings of other students. An improvement in the student’s
communication skills directly affects their socialization goal of finding satisfaction in
group activities. Students share materials, take turns, imitate appropriate behavior of
peers, lead or demonstrate a group activity, and participate in activities suggested by
other students. These beginning level skills of Stage 3 help students develop a friend-
ship with a peer and spontaneously seek out assistance from peers (social milestones
serve as the end goal). Academically, Stage 3 students vary from being able to per-
form at the level of a 6-year-old to reading and writing simple sentences, using
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DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS

addition and subtraction involving time and money, using place value, regrouping,
and multiplication to solve problems.
Real-life experiences and group activities are used with Stage 4 students to address
the goal of investing in group processes and demonstrating concern for others. These
students are concerned with meeting the expectations of others. When presented with
a problem, they accept responsibility for themselves and vacillate between conforming
to the peer group or standing apart. The behavioral milestones in Stage 4 address
skills that enable the student to contribute to the group’s success. Participating in new
activities with control, implementing acceptable alternative behaviors, and accepting
responsibility for their actions and attitudes are the skills taught to achieve the behav-
ioral goal. Both communication and socialization goals target group communication
and participating successfully as a group member. The student learns to express their
feelings appropriately in a group and explain the cause-and-effect relationships
between feelings and behaviors. Listening to group members, expressing awareness of
other’s actions, suggesting group activities, and problem solving all signal the student’s
accomplishment of the socialization milestones in Stage 4. Academics, the last compo-
nent in Stage 4, covers skills needed for successful social group experiences, such as
computing values for money up to 10 dollars, writing to communicate information,
events, and feelings, and reading for pleasure and personal information.
The final stage, Stage 5, teaches skills students need in new situations. These skills
help students respond to life experiences with constructive behaviors, use appropriate
words to establish and enrich relationships, initiate and maintain effective interperso-
nal relationships independently, and utilize academic skills for personal enrichment.
Behavior, communication, academics, and socialization milestones continue to be
taught and addressed in this stage.
Overall, developmental therapy emphasizes structured activities that help students
promote their social-emotional functioning. The activities that are incorporated into
DT help students feel successful and produce social-emotional competence while pro-
moting responsible behavior in students. Developmental therapy serves as a useful
teaching method for students on the autism spectrum.

FURTHER INFORMATION
Wood, M. M. (1996). Developmental therapy–developmental teaching: Fostering social-emotional com-
petence in troubled children and youth (3rd ed.). Austin, TX: Pro-Ed.
MELISSA L. TRAUTMAN

DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS–

FOURTH EDITION–TEXT REVISED (DSM-IV-TR)
The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the
American Psychiatric Association (APA), is a guidebook most commonly used by
mental health professionals in the United States to diagnose mental disorders. The
DSM uses medical concepts and terminology and classifies criteria-based disorders into
distinct categories and subcategories. For example, pervasive developmental disorder
includes autistic disorder, Asperger’s disorder, Rett’s disorder, childhood disintegra-
tive disorder, and pervasive developmental disorder–not otherwise specified.
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 DIET THERAPY

REFERENCE
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
JEANNE HOLVERSTOTT

DIET
Diet has been a focus for many families and professionals who attempt to help those
with autism. Dietary interventions have been used to address several major concerns
for those with autism spectrum disorders (ASD). For example, some individuals with
autism have difficulties breaking down certain proteins such as gluten or casein. The
gluten-free or casein-free diet has been one of the most used for those with ASD; this
diet eliminates wheat, barley, oat, rye, and dairy products. Special diets have been
used to treat infections from fungi such as Candida, a typically found yeast-producing
disease in humans. This diet would reduce or eliminate certain sugars, carbohydrates,
yeasts, and various foods prepared by curing or drying. Other well-known diets include
the ketogenic and Feingold diets. Although there is limited and mixed supportive evi-
dence for special diets, many have used this method, and much more research is
needed in this area for parents and professionals to make important decisions.
See also diet therapy; gluten-free.

FURTHER INFORMATION
Simpson, R. L., de Boer-Ott, S. R., Griswold, D. E., Myles, B. S., Cook, K. T., Otten, K., et al.
(2004). Autism spectrum disorders: Interventions and treatments for children and youth. Thousand
Oaks, CA: Corwin Press.
PAUL G. LACAVA

DIET THERAPY
The use of specific foods and special diets to treat diseases and conditions has
existed for hundreds of years. Sailors used limes or vinegar to treat scurvy (for the
vitamin C), and families treated thrush, an oral yeast overgrowth, with buttermilk.
Today, diet therapy has been used to treat or lessen the effects of certain conditions
from heart disease to autism. While there is no diet or medication that can cure au-
tism, some believe that dietary changes may lessen the effects of autism spectrum
disorder.
Current dietary interventions for the treatment of autism include the use of vita-
mins and minerals, dimethylglycine (DMG) supplements, gluten/casein-free foods,
and secretin therapy. While some of these methods may show improvement in a
child’s behavior and/or language skills, well-controlled, consistent, empirically based
research does not exist in sufficient amounts to warrant widespread use.

VITAMINS AND MINERALS

Through anecdotal reports, families have shared the benefits of using vitamin and
mineral supplements in children on the autism spectrum. The rationale behind using
vitamins and minerals is the idea that these children may have absorption problems
and/or nutritional deficiencies due to dietary difficulties (ASA, 2006). Intestinal disor-
ders can interfere with the proper absorption of some vitamins and minerals. This is
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DIFFERENTIAL ABILITY SCALES

what drives some to believe that children with autism may have deficiencies in vita-
mins A and several B complexes as well as minerals like magnesium.
Before beginning vitamin therapy, a physician and/or health care professional must
examine the child. Throughout vitamin therapy the child’s doctor should monitor
blood levels, behaviors, and reactions as some vitamins may be toxic at certain levels.

DIMETHYLGLYCINE
Dimethylglycine (DMG) is an amino acid that is naturally found in plant and ani-
mal cells (and in foods like brown rice and liver). DMG is produced in the cells and
aids in the metabolism of certain chemicals in the body. Claims have been made that
it aids in the management of autism because it is an oxygenator of brain and body tis-
sues (citation). This compound is also believed to augment immune responses. More
human-based studies are needed to examine the effectiveness of this compound.

GLUTEN/CASEIN-FREE
This diet is the removal of all foods that contain gluten (the protein in wheat) and
casein (the protein in milk). Some children with autism have difficulties breaking
down certain proteins (GFCF Diet, 2006). By eliminating these foods, it is believed
that the by-product of the breakdown of gluten and casein, an opiate-like compound,
will be eliminated and thus improve the functioning of children with autism. As with
any dietary manipulation, the child’s physician must be consulted.

SECRETIN THERAPY
Secretin is a hormone that is found naturally in the body (ASA, n.d.). Over the
past few years, infusions of secretin were believed to decrease the symptoms of autism.
Since that time, research has shown that the use of secretin to treat autism is ineffec-
tive (Sturmey, 2005).

REFERENCES
Autism Society of America (ASA). (n.d.). Biomedical and dietary approaches. Retrieved Sep-
tember 20, 2006, from www.autism-society.org.
GFCF Diet. (2006). Introductory FAQs. Retrieved September 20, 2006, from www.gfcfdiet.com.
Sturmey, P. (2005). Secretin is an ineffective treatment for pervasive developmental disabilities:
A review of 15 double-blind randomized controlled trials. Research in Developmental Disabil-
ities, 26, 87–97.
LYNN DUDEK

DIFFERENTIAL ABILITY SCALES

The Differential Ability Scales (DAS; Elliott, 1990) is an individually administered
battery of cognitive and achievement tests for children and adolescents ages 2 years,
6 months through 17 years, 11 months. Because the DAS covers such a wide age
range, it is divided into three levels: Lower Preschool (ages 2 years, 6 months through
3 years, 5 months), Upper Preschool (ages 3 years, 6 months through 5 years,
11 months), and School-Age (6 years, 0 months through 17 years, 11 months). The
DAS was designed to measure specific, definable abilities and to provide interpretable
profiles of strengths and weaknesses. The DAS also contains three achievement tests,
co-normed with the cognitive battery, which allows direct ability-achievement
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 DIFFERENTIAL REINFORCEMENT

discrepancy analysis. The DAS is considered suitable for use in any setting in which
the cognitive abilities of children and adolescents are to be evaluated, although many
of the DAS subtests are not appropriate for students with severe sensory or motor dis-
abilities. The DAS cognitive battery yields a composite score labeled General Concep-
tual Ability (GCA) that is defined as the general ability of an individual to perform
complex mental processing that involves conceptualization and transformation. The
DAS contains a total of 20 subtests grouped into core cognitive, diagnostic, or
achievement tests. The core cognitive subtests are those used to compute the GCA
and cluster scores, while the diagnostic subtests are those considered important and
useful in the interpretation of an individual’s strengths and weaknesses, but which do
not assess complex mental processing well.
See also normalization.

REFERENCE
Elliott, C. D. (1990). Differential Ability Scales. San Antonio, TX: PsychCorp.
JEANNE HOLVERSTOTT

DIFFERENTIAL DIAGNOSIS
Differential diagnosis is a list of any and all conditions that might be the cause of
the particular signs and symptoms under investigation. By comparing signs and symp-
toms of similar diseases/conditions, the possibilities can be narrowed down and more
specific diagnostic testing or possible treatments can be instituted.
BRUCE BASSITY

DIFFERENTIAL REINFORCEMENT
Differential reinforcement occurs when a target behavior is reinforced while another
behavior is not, or a target behavior is reinforced under certain conditions but not
others, which increases positive behavior and decreases inappropriate behavior
(Alberto & Troutman, 1999). The following are the five types of differential rein-
forcement:

1. Differential reinforcement of other behavior (DRO): reinforcement given when after a

predetermined period of time the target behavior has not occurred (Reynolds, 1961). The
focus is on a behavior never occurring as opposed to one occurring and then being
reinforced.
2. Differential reinforcement of incompatible behavior (DRI) is the reinforcement of a
behavior occurring at a time when it is impossible for the target behavior to occur (Deitz
& Repp, 1983). For example, if a child is reinforced for having hands in his lap when the
behavior of concern is doodling, having his hands in his lap would be an incompatible
behavior to be reinforced. Having hands in your lap and doodling cannot occur at the
same time.
3. Differential reinforcement of alternative behavior (DRA): reinforces an appropriate and
functional alternative to the inappropriate behavior (Alberto & Troutman, 1999). The
two behaviors are not incompatible. For example, a student may be reinforced for using
appropriate words to express emotion instead of using aggressive acts. The appropriate
words and aggression are not incompatible, but the words are an alternative behavior to
the aggression.
4. Differential reinforcement of low rate of behavior (DRL): reinforces target behavior when
it is present at a low rate (Cooper, Heron, & Heward, 1987).

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DIMETHYLGLYCINE (DMG)

5. Differential reinforcement of high rate of behavior (DRH): reinforces target behavior

when it is present at higher rates (Cooper, Heron, & Heward, 1987).

REFERENCES
Alberto, P. A., & Troutman, A. C. (1999). Applied behavior analysis for teachers. Upper Saddle
River, NJ: Merrill, 279–289.
Cooper, J. O., Heron, T. E., & Heward, W. L. (1987). Applied behavior analysis. Upper Saddle
River, NJ: Prentice Hall.
Deitz, D. E., & Repp, A. C. (1983). Reducing behavior through reinforcement. Exceptional Edu-
cation Quarterly, 3, 34–46.
Reynolds, G. S. (1961). Behavioral contrast. Journal of the Experimental Analysis of Behavior, 4,
57–71.
JESSICA KATE PETERS AND TARA MIHOK

DIMETHYLGLYCINE (DMG)
Dimethylglycine (DMG) is a non-protein amino acid found naturally in animal and
plant cells. It is the main component of calcium pangamate, also called pangamic
acid, and best known as vitamin B15. DMG is legally classified as a food, and it is
available in many health food stores without a prescription. The history of DMG
began in 1965 when two Russian investigators, M. G. Blumena and T. L. Belyakova,
published a report showing considerable improvement in the speech of 12 of a group
of 15 mentally handicapped children who had not been able to use speech to commu-
nicate (Rimland, 1990). The children had been treated with a substance variously
known as calcium pangamate. In addition to enriched vocabulary, the children began
to use simple sentences, their general mental state improved, and there was better
concentration and interest in toys and games. An American psychiatrist used DMG
on children with autism produced similar results. Concurrently, B-15 entered the
United States market, with manufacturers claiming to have replicated the Russian for-
mula. The Food and Drug Administration was forced to intervene, outlawing B-15
and permitting the sale of DMG as a food, not as a drug or vitamin. While anecdotal
evidence exists supporting the benefits of DMG for children with autism, there is no
clear empirical research supporting such claims.
See also diet therapy.

REFERENCE
Rimland, B. (1990). Dimethylglycine (DMG), a nontoxic metabolite, and autism. Autism
Research Review International, 4(2), 3.
JEANNE HOLVERSTOTT

DIR/FLOOR TIME. See Developmental Individual-Difference Relation-Based Inter-

vention

DIRECT INSTRUCTION
Direct instruction is used to describe a lesson where the teacher has control. The
steps of a direct instruction include: (a) the teacher giving a lecture, (b) the teacher
guiding the students through a complex problem with the problem broken down into
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 DISCRETE TRIAL TRAINING (EXTENDED DEFINITION)

simple steps, (c) the students are given, one by one, the simple steps to carry out on
their own, and (d) the students are given one or many simple problems to accomplish
on their own.
The primary goal of direct instruction is to increase student achievement through
carefully focused instruction. Clear instruction eliminates misinterpretations and can
greatly improve and accelerate training. It provides a model of instruction that
emphasizes the use of carefully planned lessons designed around a specific knowledge
base and a well-defined set of skills for each subject.
JAN L. KLEIN

DIRECT OBSERVATION
Part of the assessment process, direct observation is a common method of collecting
information by formally observing an individual, several persons, or even a group. In
direct observation, one may observe specific behaviors (such as the number of times a
student raises his hand in class) or overall general behavior.
PAUL G. LACAVA

DISABILITY
A disability refers to restrictions or lack of ability to perform an activity within a
range that is considered typical. A disability can be temporary or permanent and typi-
cally produces difficulties when attempting to function in society. For a person with
autism, disability may refer to impaired development in communication, social inter-
action, and behavior.
JAN L. KLEIN

DISCRETE TRIAL TRAINING (BRIEF DEFINITION)

Discrete trial training is a behavioral method stemming from the field of applied
behavior analysis (ABA) and is commonly used in the field of autism. The teaching
method includes several key steps. First, the teacher gives the student an instruction.
Many times this instruction will be given during direct instruction, but can also be
given during other routines or incidental teaching. The child is then expected to
respond to the teacher who then follows the response by giving corrective feedback
and/or reinforcement for correct or approximated responses. Each sequence of steps is
considered to be one discrete trial. This type of instruction is only one method within
the field of applied behavior analysis (Anderson, Taras, & Cannon, 1996).

REFERENCE
Anderson, S. R., Taras, M., & Cannon, B. O. (1996). Teaching new skills to young children
with autism. In C. Maurice, G. Green, & S. L. Luce (Eds.), Behavioral intervention for young
children with autism (pp. 181–194). Austin, TX: Pro-Ed.
TARA MIHOK

DISCRETE TRIAL TRAINING (EXTENDED DEFINITION)

Discrete trial training (DTT) is a highly structured teaching method that involves
carefully manipulated sequences of antecedents and consequences in order to elicit a
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DISCRETE TRIAL TRAINING (EXTENDED DEFINITION)

target behavior. Therapists primarily use DTT with children with autism or other de-
velopmental disabilities; however, DTT can be used with other children as well. DTT
requires the teacher to break down skills into small and specific instructional steps.
Educators teach each part in isolation until the child masters the skill, and then the
educator adds the next step. The steps are taught through repeated trials. Each trial
has a clear beginning and a clear end, hence the term discrete. At the onset of teach-
ing a new skill, the teacher uses an errorless teaching approach heavily prompting the
student to avoid incorrect responding. The level of prompting decreases the student
being able to respond independently. If the response is incorrect, an error correction
procedure involving prompting will occur. DTT should and typically does occur in a
designated ‘‘work area’’ free of distractions (e.g., a table or space where student and
teacher sit directly across from one another).
The skills that can be taught using DTT include: compliance, attending, language,
imitation, preacademic/academic, motor, self-help, and beginning play and social
skills. The components of a discrete trial include: antecedent/instruction (SD-discrimi-
native stimulus), behavior/response (R), consequence (SR-reinforcing stimulus), and
the intertrial interval (ITI). Again, a prompt (SP-prompting stimulus) will also be
present when teaching a new skill (errorless teaching) or in an error correction proce-
dure. The discrete trial has also been referred to as a three-term contingency for the
three main components: antecedent, behavior, consequence (or ABC).

THE ANTECEDENT/INSTRUCTION (SD–DISCRIMINATIVE STIMULUS)

The antecedent initiates a discrete trial. Most antecedents are verbal in nature and
need to be delivered with an authoritative instructional voice. Initially, antecedents
should be simple (e.g., ‘‘throw away’’) due to language difficulties. Later, when a stu-
dent acquires more language skills, they can become more complex (e.g., ‘‘Throw away
your plate and put your cup in the sink’’). The antecedent may also be nonverbal
(e.g., holding up a card for the student to read and follow directions). It is important
to avoid pairing the child’s name with the antecedent. When this is done, the child
associates his name as part of the sequence of the trial. A child responds to his name
but it should be set apart from other instructions. It is equally important to avoid
repeating an antecedent without providing a consequence. By repeating an anteced-
ent, we actually train a child to wait until he hears an instruction for the third or
fourth time before he responds. If more than one person works with a particular stu-
dent, it is imperative that a consistent format and planned wait time is used. This
consistency must be maintained across all team members, and any changes to either
should be a team decision.

THE RESPONSE/BEHAVIOR (R)

Consistent criteria must be used to determine an appropriate response. Extraneous
behaviors (e.g., self-stimulatory behaviors) should not be present at the time of the
response. The time that lapses between the delivery of the antecedent and the
child’s response should not extend 3–5 seconds. Otherwise, a child learns that a
delayed response is acceptable and provides time for off-task behaviors to occur. A
non-response is considered incorrect and may occur for several reasons. The student
112
 DISCRETE TRIAL TRAINING (EXTENDED DEFINITION)

may not be ready, may not know the correct response, or finds the response aversive.
The predetermined criteria for mastering a step must be met before adding the next
step. Changes in the criteria need to be agreed upon by all team members.

THE CONSEQUENCE (SR–REINFORCING STIMULUS)

The consequence consists of a reward for correct responses to strengthen a desirable
behavior or an informational ‘‘no’’ and the removal of a reward to weaken an undesir-
able behavior. Positive reinforcement occurs when something preferred is delivered to
the child (e.g., edibles). On the other hand, negative reinforcement occurs when
something unpleasant to the child is removed (e.g., ‘‘escape’’). It is imperative that
the consequence immediately follows the response in order for the child to correctly
associate the direction and behavior. Conducting a reinforcement inventory on a regu-
lar basis allows a teacher to determine the most highly preferred reinforcers (primary)
versus less preferred reinforcers (secondary). A reinforcer should always be paired with
social reinforcement in order to train ‘‘praise’’ as a reinforcer in itself. Particular atten-
tion should be paid to not satiate any one reinforcer. Vary the reinforcement pro-
vided, conduct regular reinforcement inventories, and limit the use of the reinforcer
outside of the work session. Provide high levels of reinforcement while introducing
and shaping (accepting closer and closer approximations) a response and then fade
reinforcement to a more intermittent schedule. Using a token economy reinforcement
system (e.g., blocks in a cup or a penny board) teaches delayed gratification. With this
system, more trials can be completed before a reinforcement break is given, maximiz-
ing therapy times.

THE INTERTRIAL INTERVAL (ITI)

The intertrial interval is simply a brief pause between trials. It should be just long
enough to signal the end of one trial (consequence provided) and the beginning of
the next (antecedent given). It must be short enough to avoid eliciting avoidance or
undesirable behaviors. Often times, a teacher utilizes brief time to record data and
reset the teaching items needed for the next trial.

THE PROMPT (SP–PROMPTING STIMULUS)

A team decision determines the sequence of prompting used to teach a specific skill.
In order to avoid prompt dependency, prompt least to most (e.g., model, visual, posi-
tion, verbal, physical). When teaching independent functioning skills, it is important
to prompt physically rather than verbally. Otherwise, children with autism tend to as-
sociate verbal prompts as part of the skill sequence and become dependent on the
verbal cue. Pay particular attention that you are not inadvertently prompting a child
with your body language. Systematic fading of prompts is also necessary to avoid
prompt dependency. For example, fade a physical hand over hand prompt to a prompt
at the wrist, then the elbow, then the shoulder, and then an independent response.
Prompted trials should always be followed by unprompted trials to ensure independent
responses. Once a child has mastered a skill, reduce the reinforcement for prompted
trials (e.g., offer a secondary reinforcer) and provide primary reinforcers for indepen-
dent responses only.
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DISCRIMINATION

PUTTING IT ALL TOGETHER

The order of the discrete trial can thus be represented as:

SD fi R fi SR fi ITI
(SP)
-or-
A fi B fi C fi ITI
Antecedent Behavior Consequence Intertrial Interval

GENERALIZATION
Due to the highly structured nature of DTT, it is imperative that a teacher pro-
grams or plans for generalization of skills. Generalization must occur across individu-
als, materials, environments, and antecedents as language skills increase. When
teaching items are mastered and moved to maintenance-level programs, they are typi-
cally introduced into target generalization programs in one or more of the previous
areas depending on the child and the skill. For example, when a label is mastered
expressively, the original teaching picture can be put in a maintenance program while
the ‘‘label’’ is moved to generalization programs (e.g., materials—different pictures of
the same item) that would eventually include all four areas listed herein.

FURTHER INFORMATION
Leaf, R., & McEachin, J. (1999). A work in progress: Behavior management strategies and a curricu-
lum for intensive behavioral treatment of autism. New York: DRL Books.
Lovaas, O. I. (1981). Teaching developmentally disabled children: The me book. Baltimore: Univer-
sity Park Press.
Lovaas, O. I. (2003). Teaching individuals with developmental delays: Basic intervention techniques.
Austin, TX: Pro-Ed.
Maurice, C., Green, G., Luce, S. C. (1996). Behavioral intervention for young children with autism:
A manual for parents and professionals. Austin, TX: Pro-Ed.
Simpson, R. L., & Myles, B. S. (1998). Educating children and youth with autism: Strategies for
effective practice. Austin, TX: Pro-Ed.
Sundberg, M. L., & Partington, J. W. (1998). Teaching language to children with autism or other
developmental disabilities. Pleasant Hill, CA: Behavior Analyst, Inc.
MICHELE MULLENDORE

DISCRIMINATION
Discrimination is the act of making distinctions between stimuli on the basis of a
particular category (i.e., race, color, shape, gender). Behavior analytic approaches
focus heavily on the development and reinforcement of making correct discrimina-
tions. More generally, discrimination is critical in the development of language (pro-
noun usage) and social competence (social cues).
See also differential reinforcement.
JEANNE HOLVERSTOTT

DISCRIMINATIVE STIMULUS
In the field of applied behavior analysis, the discriminative stimulus is usually
referred to as the SD. The SD is an antecedent trigger that signals that a specific
behavior will be either reinforced or punished based upon past experiences. The SD
114
 DOUBLE BLIND

can be signals such as words, gestures, or sounds that cue the person that reinforce-
ment will occur if the stimulus is followed by correct behavior (Lovaas, 2003). Dis-
crimination between stimuli is often learned by a behavior being reinforced following
one trigger and being punished in the presence of another (Driscoll, 2005). For exam-
ple, in teaching a child to sit down, the phrase ‘‘Sit down’’ can be a discriminative
stimulus to the child, assuming that he or she follows the instruction with the knowl-
edge that reinforcement will follow. For other children, the bell ringing at the end of
the day is the discriminative stimulus for them to leave the classroom to go home
(assuming that leaving school is reinforcing to the child).
See also punishment; reinforcer.

REFERENCES
Driscoll, M. P. (2005). Psychology of learning for instruction (3rd ed.). Boston: Pearson Education, Inc.
Lovaas, O. I. (2003). Teaching individuals with developmental delays: Basic intervention techniques.
Austin, TX: Pro-Ed.
TARA MIHOK AND ANDREA HOPF

DISINTEGRATIVE PSYCHOSIS. See Childhood Disintegrative Disorder

DISTRIBUTED PRACTICE
Distributed practice is a strategy in which the student exerts or distributes effort over
time rather than concentrating effort within a short period. Frequent distributed practice
helps students maintain and develop concepts and skills that were previously introduced
in a sequence and gives the students the time needed to find appropriate and meaningful
ways of integrating information from a variety of sources. Distributed practice does more
than simply increase the amount learned; it frequently shifts the learner’s attention away
from the verbatim details of the material being studied to its deeper conceptual structure.
JAN L. KLEIN

DOPAMINE
Dopamine is a substance that is synthesized by the adrenal glands (located on top
of the kidneys). It has several functions in the body including regulation of circulation
and blood pressure and as a neurotransmitter in the brain. It is an immediate precur-
sor to the formation of norepinephrine.
BRUCE BASSITY

DOUBLE BLIND
Double blind is a type of experimental research design where both the researchers
and the participants do not know who is receiving the treatment. For example, in a
medication investigation, neither the researcher nor the participants know who is
receiving the drug under investigation or who is receiving the placebo. The purpose of
the double-blind study is to increase the strength of claims by researchers that the
intervention (the independent variable) caused the change in behavior for partici-
pants who received the treatment and that other factors were not an issue.
See also experimental design.
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DOUBLE INTERVIEW

FURTHER INFORMATION
Everitt, B. S. (2002). The Cambridge dictionary of statistics (2nd ed.). Cambridge: Cambridge Uni-
versity Press.
Salkind, N. J. (2005). Exploring research (6th ed.). Upper Saddle River, NJ: Prentice Hall.
PAUL G. LACAVA

DOUBLE INTERVIEW
The double interview is an informal assessment technique to explore one’s capacity
to shift perspective and the focus of one’s language from talking about one’s self to
talking about another person. The first task in the double interview is for the assessing
clinician to interview the client by asking specific questions to the client about the
client (e.g., What are your hobbies? Do you have any siblings? What do you like/
dislike about school? etc.). As the client answers, the assessor is to consider not only
the client’s ability to narrate a solid response to provide the assessor with a range of
novel information, but the assessor is also evaluating the student’s nonverbal aspects of
communication (e.g., eye contact, body language, tone of voice, etc.). It is expected
that the client should be near his or her communicative best when talking about him-
or herself. The assessor is careful to only ask questions and to only provide brief
responses to show interest in the client, or to ask follow-up questions to gain access to
more information about the client.
Once the assessor has completed their interview with the client, they exclaim,
‘‘Wow, I just learned a lot about you (They can then state specifics of what they have
learned) by interviewing you. But I realize that you don’t know very much about me,
so I thought it would only be fair if I let you interview me.’’ The interviewer then
reviews with the client that an interview consists of asking questions to the person
who is being interviewed about that person. The assessor can also try and make the
task easier on the client by providing pictures that give some information about the
assessor by showing the client pictures of the assessor’s family, etc. After providing this
extra support, they then say, ‘‘OK, this is a good time to interview me.’’ The assessor
then waits and observes, writing down any response or question that the client pro-
vides. At this point it is very common for the client to have a much more difficult
time generating language. It is often very difficult for the clients to ask any questions,
and they may say, ‘‘I can’t do this!’’ Given that this task requires the client to shift
perspective and focus on the assessor, the client struggles given that this is one aspect
of social thinking that is a great challenge for him or her. It is not uncommon for the
client to start to explain that he or she ‘‘can never do this’’ and they ‘‘never know
what to say to people.’’ Preliminary research, done at the University of Kansas by
Miller (2004) and Zweber (2004) demonstrated that the double interview helps to dif-
ferentiate our clients with social cognitive deficits from their peers at age 8 years old
and beyond.

REFERENCES
Miller, A. C. (2004). Double interview task: Assessing the social communication of children with
Asperger syndrome. Unpublished Masters Thesis. University of Kansas.
Zweber, K. J. (2004). Double interview: Assessing the social communication of adolescents with
Asperger syndrome. Unpublished Masters Thesis. University of Kansas.

116
 DYSBIOSIS

FURTHER INFORMATION
Winner, M. (2002). Thinking about you thinking about me. San Jose, CA: Michelle Garcia
Winner.
MICHELLE GARCIA WINNER AND JAMIE RIVETTS

DSM-IV. See Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition–Text

Revised

DUE PROCESS
Due process is a procedure guaranteed by federal law for families and school profes-
sionals for resolving disputes regarding special education services that cannot be
resolved through mediation.

FURTHER INFORMATION
U.S. Department of Education. (2004). Procedural safeguards: Due process hearings. www.ed.gov/
policy/speced/guid/idea/tb-safeguards-3.pdf.
KATHERINE E. COOK

DURRELL ANALYSIS OF READING DIFFICULTY (DARD)

The Durrell Analysis of Reading Difficulty (DARD; Durrell & Catterson, 1980) is
an individually administered assessment for children ages pre-kindergarten and older
designed to assess the reading abilities in the following skill areas: oral and silent read-
ing, listening comprehension, word recognition and analysis, listening vocabulary,
sounds in isolation, spelling and phonic spelling, visual memory of words, identifica-
tion of sounds in words, prereading phonics abilities, syntax matching, identifying let-
ter names in spoken words, phoneme awareness, letter names and letter writing, and
copying.

REFERENCE
Durrell, D. D., & Catterson, J. H. (1980). Durrell Analysis of Reading Difficulty. San Antonio,
TX: PsychCorp.
JEANNE HOLVERSTOTT

DYSBIOSIS
Symbiosis is the medical term for the balance between a person’s intestinal tract
and good bacteria. Good bacteria within the intestinal tract is responsible for detoxifi-
cation, production of vitamins, and protection from unfriendly organisms. Dysbiosis is
the opposite of symbiosis and is the medical term for an imbalance in the gastrointes-
tinal tract. There are three main causes of dysbiosis: parasites, fungus overgrowth, and
poor diet. Characteristics can be acute (diarrhea, nausea, abdominal pain, cramps) or
chronic (loose stool, constipation, bloating, gas, food cravings, allergies, fibromyalgia,
rheumatoid arthritis, and chronic fatigue syndrome).
KATHERINE E. COOK
117
DYSPHASIA

DYSPHASIA
Dysphasia is a speech disorder characterized by impairments in expressive speech,
writing, and impairments in comprehension of spoken and written language. Although
individuals with dysphasia typically do not have impaired intellect, they are often
viewed as mentally impaired. Aphasia is a severe form of dysphasia. This disorder
arises from damage to the left side of the brain, which is responsible for speech and
language.
KATHERINE E. COOK

118
 E
EARLY COPING INVENTORY
The Early Coping Inventory (ECI; Zeitlin, Williamson, & Szczepanski, 1988) is an
observation instrument used for assessing the coping-related behavior of children who
function developmentally from 4 to 36 months. The 48 items in this inventory are di-
vided into three categories. Sensorimotor organization behaviors are those skills used to
regulate psychophysiological functions as well as to integrate sensory and motor process.
Reactive behaviors are actions used to respond to the demands of physical and social
environments. Self-initiated behaviors are autonomously generated, self-directed actions
used to meet personal needs and to interact with objects and people. Professionals as
well as nonprofessionals who are knowledgeable in infant development may administer
and score the inventory. If observers are not familiar with the child, they should observe
the child at least three times in different situations. Analysis of a child’s scores on this
instrument provides information about level of coping, style, and specific strengths and
weaknesses. The findings can then be used to create educational and therapeutic inter-
ventions. In addition, the ECI can be used to involve parents in its use as a means of
increasing knowledge of the child and communication with staff. The ECI can also be
used to support staff development and training to increase observation skills, expand
their domain of concern, facilitate teamwork, and measure child progress.

REFERENCE
Zeitlin, S., Williamson, G. G., & Szczepanski, M. (1988). Early coping inventory. Bensenville,
IL: Scholastic Testing Service, Inc.
JEANNE HOLVERSTOTT

EARLY INTERVENTION
Early intervention is the purposeful application of resources with the aim of
developing or improving interactions between an individual and the environment
(Hooper & Umansky, 2004). It applies to children from birth to school age that are
discovered to be at risk, have disabilities, or other special needs that may affect their
development. Early intervention may be center-based, home-based, hospital-based, or
a combination.
See also homebound/hospital bound program.
ECHOIC/VERBAL BEHAVIOR

REFERENCE
Hooper, S. R., & Umansky, W. (2004). Young children with special needs. Upper Saddle River,
NJ: Pearson Education, Inc.
KAI-CHIEN TIEN

ECHOIC/VERBAL BEHAVIOR
Echoic behavior is when a child uses verbal imitation. For example, in verbal
behavior the child would use echoic behavior to request a desired item. The echoic
behavior would be repeated and eventually the child would learn that the word has
the specific function of getting his or her need met.
TERRI COOPER SWANSON

ECHOLALIA: IMMEDIATE, DELAYED, MITIGATED

Echolalia is the repeated use of words or phrases used by others. There are three dif-
ferent forms of echolalia: immediate, delayed, and mitigated. Immediate echolalia
refers to words or phrases that are repeated immediately or very soon after the model
of the utterances was first heard. Delayed echolalia refers to the echo of words or
phrases after a lapse of time. Some children repeat one or numerous phrases from
video clips; this is a form of delayed echolalia. The third form of echolalia is referred
to as mitigated where the speaker clearly is repeating a phrase, but it is not an exact
repetition. Historically echolalia was viewed to be noncommunicative. However, in
recent years practitioners have realized that echolalia often serves a communicative
function for the individual. For example, after hearing his mother one evening at din-
ner repeatedly ask with a tone of frustration if William wanted ketchup on his fish
sticks (fisherboys), William starting using the phrase, ‘‘Do you want ketchup on your
fisherboys?’’ to indicate that he was frustrated. Until William was taught a more
appropriate and understood phrase he used, ‘‘Do you want ketchup on you fisherboys?’’
in any setting and situation where he felt anxious or frustrated.
KATHERINE E. COOK

ECOLOGICAL INVENTORY
This highly individualized assessment analyzes all aspects (i.e., leisure, domestic,
school, community, vocational) of the learner’s current and future environments. The
student’s abilities are then compared to the assessed demands of each of the target
environments and a list of skills is identified for use as instructional priorities.

FURTHER INFORMATION
Brown, L., Branston, M. B., Hamre-Nietupski, S., Pumpian, I., Certo, N., & Gruenewald, L.
(1979). A strategy for developing chronological-age-appropriate and functional curricular
content for severely handicapped adolescents and young adults. Journal of Special Education,
13, 81–90.
Snell, M. E., & Brown, F. (2006). Instruction of students with severe disabilities (8th ed.). Upper
Saddle River, NJ: Prentice Hall.
Westling, D. L., & Fox, L. (2004). Teaching students with severe disabilities (3rd ed.). Upper Sad-
dle River, NJ: Prentice Hall.
THERESA L. EARLES-VOLLRATH
120
 ELIGIBILITY

EDUCATIONAL PLACEMENT
There are different types of educational placement for children with autism.
Depending on the child’s need, his Individualized Education Program may be carried
out in general education, in special education, at home, in an institution, or in other
settings. In all cases, the parents have the right to be a member of the group that
decides the educational placement of the child.
See also homebound/hospital bound program.
KAI-CHIEN TIEN

EISENBERG, LEON
Leon Eisenberg received his medical degree from the University of Pennsylvania
(1946) and took his internship at the Mount Sinai Hospital in New York City. He
took a fellowship in child psychiatry at the Johns Hopkins Hospital in Baltimore,
Maryland, under the direction of Professor Leo Kanner (1954). Eisenberg worked
closely with Kanner during this fellowship, and they became colleagues, publishing
research together on autism. In 1967, he moved to Harvard as chief of psychiatry
where he became chair of the Department of Social Medicine and Health Policy in
1980. In 1993, Dr. Eisenberg reached emeritus status at Harvard Medical School and
continues to work full time. Eisenberg has published more than 250 articles in refereed
journals, 130 book chapters, and 9 edited books.

FURTHER INFORMATION
Harvard Medical School Department of Social Medicine. (n.d.). Faculty: Leon Eisenberg.
Retrieved on November 24, 2006 from www.hms.harvard.edu/dsm/WorkFiles/html/people/
faculty/LeonEisenberg.html.
Kanner L., & Eisenberg, L. (1956). Early infantile autism. American Journal of Orthopsychiatry,
26, 55–65.
TERRI COOPER SWANSON

ELECTROENCEPHALOGRAM
An electroencephalogram (EEG) measures the electric activity in the brain. The
electrical brain activity is measured by placing electrodes onto the scalp of the
patient.

FURTHER INFORMATION
Tuchman, R. F., & Rapin, I. (1997). Regression in pervasive developmental disorders: Seizures
and epileptiform electroencephalogram correlates. Pediatrics, 99(4), 560–567.
TERRI COOPER SWANSON

ELIGIBILITY
Eligibility is the process where the Individualized Education Program (IEP) team eval-
uates formal and informal assessment results to determine if a student qualifies for spe-
cial education services. If a student meets eligibility, an IEP is written and implemented.
KATHERINE E. COOK
121
ELIMINATION DIET AND FOOD SENSITIVITIES

ELIMINATION DIET AND FOOD SENSITIVITIES

This medically supervised diet is used to identify food sensitivities and allergies.
While food intake levels are maintained, the variety of foods consumed is
restricted to the least reactive foods (those foods that cause the least digestive
problems for the majority of people) such as rice and potatoes. Additional foods
are gradually and systematically added according to the plan specified by the
health care provider. The patient or caregiver keeps a daily food diary noting the
foods eaten and any responses. After time, the physician may suggest a challenge,
which is a medically supervised reintroduction of a suspected problem food to
determine whether or not a food sensitivity exists. The duration of the diet varies
by the sensitivity of the patient and by the success or lack of success detecting
which food or foods are the causes of the patient’s sensitivities. Elimination diet
should not be confused with the Gluten-free/Casein-free Elimination Diet or the
Candida Elimination Diet.

FURTHER INFORMATION
Hurt Jones, Marjorie (2001). The allergy self-help cookbook: Over 325 natural foods recipes, free of
all common food allergens: Wheat-free, milk-free, egg-free, corn-free, sugar-free, yeast-free. New
York: Rodale Books.
Le Breton, M., & Kessick, R. (2001). Diet and intervention in autism: Implementing a gluten free
and casein free diet: A guide for parents. London: Jessica Kingsley Publishers.
Tidwell, J. (2006). Food allergies/intolerances. Retrieved August 18, 2006, from About health
and fitness Web site: http://allergies.about.com/cs/foods/a/blfood.htm.
MYRNA J. ROCK

EMBEDDED FIGURES TEST (EFT)

An embedded figures test presents an individual with a simple (target) shape in iso-
lation and then asks this person to find this same shape in a larger, more complex
configuration. Research (Witkin, Dyk, Faterson, Goodenough, & Karp, 1962; Baron-
Cohen & Hammer, 1997) has illustrated that males are significantly faster than
females at locating the embedded figure.

REFERENCES
Baron-Cohen, S., & Hammer, J. (1997). Parents of children with Asperger syndrome: What is
the cognitive phenotype? Journal of Cognitive Neuroscience, 9, 548–554.
Witkin, H. A., Dyk, R. B., Faterson, H. F., Goodenough, D. G., & Karp, S. A. (1962). Personal-
ity through perception. New York: Harper & Row.
JEANNE HOLVERSTOTT

EMBEDDED SKILLS
Embedded skills are present within naturally occurring activities and allow for
opportunities to practice learning objectives. As such, they allow for new skills to be
practiced in the presence of already learned or ongoing skills. For example, to practice
letter recognition, a child would be allowed to select only movie titles with a particu-
lar letter present.
JEANNE HOLVERSTOTT
122
 ENURESIS

EMOTIONAL SUPPORT
Emotional support is assistance obtained through relationships, either professional
or familial. Psychologists, social workers, counselors, and medical doctors are mental
health professionals often enlisted by individuals to provide therapeutic support.
Friendships and partnerships with family, friends, and caregivers can also serve as a
source of emotional support.
JEANNE HOLVERSTOTT

EMPIRICAL EVIDENCE. See Empiricism

EMPIRICISM
Empiricism is a Western concept that espouses knowledge can be derived through
careful observation and cataloging of phenomena and extrapolating laws or principles
from these observations. Empiricism’s origins in the West in its most developed form
are in the philosophy of Aristotle, whose theories on intellectual inquiry first intro-
duced the process of experiment or a controlled, replicable experience. The process of
replication enables others to build a knowledge base by testing for the truths of the
laws and theories. The resultant knowledge areas are then grouped to further designate
experimental sciences, such as physics and medicine. Empirical evidence of the
observed behaviors of individuals with autism further expands the understanding and
knowledge of the disorder.
See also experimental design.
MELANIE D. HARMS

ENCOPRESIS
Encopresis is the involuntary passage of stool taking place over at least 6 months in
duration and in an individual over the age of 4 years. This is often a result of chronic
constipation or retaining of stools.
BRUCE BASSITY

ENGAGEMENT
Engagement is the amount of time that children spend involved with the environ-
ment (adults, peers, or materials) in a way that is appropriate given their age, abilities,
and surroundings.
See also age appropriate; chronological age; mental age.
JAN L. KLEIN

ENURESIS
Enuresis is the involuntary discharge of urine after the age when voluntary bladder
control is usually established, typically around 5 years of age. Nocturnal (night time)
enuresis is the most common form in children, present in approximately 10 percent of
5-year-olds and 1 percent of 15-year-olds. Enuresis may be due to bladder control
never being established or a regression in bladder control.
BRUCE BASSITY
123
ENVIRONMENT

ENVIRONMENT
Does the natural environment (water, air, earth) contain toxins that may contribute
to autism? Moreover, do other man-made substances in the environment contain
materials that may contribute to autism? These questions have been some of the most
controversial within the field of autism into the mid-2000s. The role of the environ-
ment in the cause of autism has been a question addressed for many decades.
Recently, the role of the environment has been questioned as a potential source for
the huge increases in the prevalence of autism.
Historically, autism was considered an emotional disorder caused by ineffective par-
enting. That is, the social environment was deficient between child and parent and
thus autism was the outcome. This was proven wrong after decades of research and au-
tism became known as a neurobiological/developmental disorder.
Although the conceptualization of autism has changed over time, the question of
what may contribute to the etiology of this disability still remains. Some believe that
autism is caused by genetics alone. Others believe that their child became autistic when
exposed to some environmental toxin. In the 2000s, it is common to believe that a
combination of a genetic predisposition to autism as well as some environmental insult
causes autism. The severity of the disability would therefore depend on the number of
genes affected in the individual as well as the type of environmental insult that occurs.
Some environmental toxins that have been questioned in the development of au-
tism include heavy metals such as mercury, chemicals, pesticides, pre- and postnatal
viruses, flame retardant materials, and food additives. There have been reports of indi-
vidual cases of autism spectrum disorders (ASD) being associated with various prenatal
infections and environmental toxins. This includes maternal use of alcohol and co-
caine, as well as infection by cytomegalovirus.
In the 1990s and into the 2000s, the claim that the MMR vaccination and mercury
were possible culprits causally connected to autism became a critical research concern.
Some believed that the huge increase in autism over the previous years was causally
related to either the MMR vaccination in young children or in the mercury that was
part of the preservative thimerosal that was in many childhood vaccines. It was
claimed that children who had weak immune systems, or those who were already pre-
disposed to having autism, were placed at risk with the ongoing accumulation of mer-
cury in these vaccinations. It was claimed that their systems could no longer process
and expel the mercury poisoning and thus autism developed.
As of 2007, this remains highly controversial. However, the preponderance of the
evidence from government and other medical/scientific studies suggests that neither
the MMR vaccination nor the use of mercury/thimerosal were causally connected to
the increase in autism. Much research is still needed in this critically important area,
and it is not yet known if there is a connection between autism and vaccinations or
mercury for some subsets of particularly vulnerable individual children. At this point,
however, conclusive evidence has not been presented to confirm which environmental
factors contribute to autism.
FURTHER INFORMATION
Centers for Disease Control and Prevention. (2004). FAQs about MMR vaccine and autism.
Retrieved March 30, 2005, from http://www.cdc.gov/nip/vacsafe/concerns/autism/autism-
mmr.htm.

124
 ERROR CORRECTION

Kennedy, R. (February 2005). Deadly immunity [Electronic version]. Rolling Stone, Retrieved
August 18, 2005, from http://www.rollingstone.com/politics/story/_/id/7395411?rnd=11243888
56090&has-player=true&version=6.0.11.847.
Kirby, D. (2005). Evidence of harm: Mercury in vaccines and the autism epidemic: A medical contro-
versy. New York: St. Martin’s Press.
National Broadcasting Company. (Executive Producer). (February 23, 2005). The Today Show
[Television Broadcast]. New York: National Broadcasting Company.
Rutter, M. (2005). Etiology of autism: Findings and questions. Journal of Intellectual Disability
Research, 49, 231–238.
PAUL G. LACAVA

ENVIRONMENTAL STRESSORS
Environmental stressors refer to a variety of internal and external events that could
interfere with an individual being successful in the immediate future, and as such,
need to be monitored and acted on as quickly as possible. Such stressors may include:
(a) prejudice toward someone who is perceived as ‘‘different’’ and the effect that might
have on the person, such as negative self-concept, anxiety, and expectation of failure;
(b) restricted social and vocational opportunities; (c) inadequate social supports;
(d) life changes such as a new teacher, a new job, living arrangements, family losses,
and other life changes; (e) the inability to process sensory information and ‘‘make
sense’’ of the world; and (f) victimization, including social and sexual abuse. These
stressors need to be considered seriously when working with individuals with ASD as
lack of immediate action to reduce or assist the individual’s handling of these stressors
can have a long-term impact on the person’s ability to develop life skills and develop
the skills necessary to manage their world.
ANDREA M. BABKIE

EPIDEMIOLOGY
Epidemiology is the study of outbreaks of disease. Scientific analysis is used by epi-
demiologists to understand how diseases start, how they are spread, and how they can
be prevented. There are several possible causes of autism including: (a) genetics,
(b) vaccinations, (c) environment, and (d) diet. At this time there are no research
supported cures or solutions to prevent autism spectrum disorders.
See also environment.
TERRI COOPER SWANSON

ERROR CORRECTION
Error correction is the process or procedure followed when a student gives an incor-
rect response. Methods of error correction include, but are not limited to, overcorrec-
tion, time-out, and a no-no-prompt procedure. Because some students with autism
spectrum disorders are highly sensitive to error correction, there is often an attempt to
use ‘‘neutral’’ forms of error correction such as offering no verbal reaction to a stu-
dent’s incorrect response and instead intentionally looking away from the student for
a few seconds.
See also applied behavior analysis.
KATIE BASSITY
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ESCAPE TRAINING

ESCAPE TRAINING
Escape training is similar to negative reinforcement. When a student does not enjoy
an activity or situation, he may be allowed to escape it after completing a certain por-
tion of the work or activity. In this way, the student learns that some work must be
completed, but that once the work is completed, he will be allowed to move to a
more enjoyable activity.
KATIE BASSITY

ESTABLISHING OPERATION
An establishing operation, as described by Michael (1982) is ‘‘any change in the
environment which alters the effectiveness of some object or event as reinforcement
and simultaneously alters the momentary frequency of the behavior that has been fol-
lowed by that reinforcement’’ (pp. 150–151). Establishing operations may either
increase the effectiveness of the reinforcer (due to deprivation) or decrease the effec-
tiveness of the reinforcer (due to satiation; Alberto & Troutman, 1999). These envi-
ronmental, social, or physiological events affect the motivation of an individual and
thus affect the behavior that is influenced by the reinforcers (Michael, 1993). Because
a person’s desire for food is greater when he or she is hungry, behavior that is rein-
forced by food may be strengthened before a meal. On the contrary, edible reinforce-
ment may be less effective after a meal, weakening a behavior linked to that
reinforcement. Establishing operations have also been referred to as setting events or
motivating operations (Laraway, Snycerski, Michael, & Poling, 2003).

REFERENCES
Alberto, P. A., & Troutman, A. C. (1999). Applied behavior analysis for teachers (p. 230). Upper
Saddle River, NJ: Merrill.
Laraway, S., Snycerski, S., Michael, J., & Poling, A. (2003). Motivating operations and terms
to describe them: Some further refinements. Journal of Applied Behavior Analysis, 36, 407–414.
Michael, J. (1982). Discriminating between discriminative and motivational functions of stim-
uli. Journal of the Experimental Analysis of Behavior, 37(1), 149–155.
Michael, J. (1993). Establishing operations. The Behavior Analyst, 16, 191–206.

FURTHER INFORMATION
Michael, J. (2000). Implications and refinements of the establishing operation concept. Journal
of Applied Behavior Analysis, 33, 401–410.
TARA MIHOK AND JESSICA KATE PETERS

EVALUATING ACQUIRED SKILLS IN

COMMUNICATION–REVISED (EASIC-R)
Evaluating Acquired Skills in Communication–Revised (EASIC-R; Riley, 1991) is
an inventory that was developed to measure spoken language, both receptive and ex-
pressive, of children with autism ages 3 months to 8 years. The EASIC-R has also
been used successfully with individuals who have developmental language delays. The
tool assesses semantics, syntax, morphology, and pragmatics communication skills at
five levels: Pre-Language, Receptive 1, Expressive 1, Receptive 2, and Expressive 2.
Results can be displayed on the Skills Profile to show changes that have occurred from
one testing session to another. In addition, results can be portrayed on the
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 EXECUTIVE FUNCTIONS

Developmental Age Chart. The child’s communication skills are arranged in easy to
difficult order along with the age ranges at which children normally acquire each of
the described skills. Administration time ranges from 15 to 30 minutes.

REFERENCE
Riley, A. M. (1991). Evaluating Acquired Skills in Communication–Revised. San Antonio, TX:
Harcourt Assessment.
AMY BIXLER COFFIN

EVALUATION REPORT
An evaluation report provides a detailed, written summary of the information
gained through the assessment process. There are no standardized formats for evalua-
tion reports, however most reports contain many of the following sections: identifying
data, reason for referral, background history, observations, tests administered, test
results, test-by-test analysis, conclusions, and a summary table.
See also standardization.

FURTHER INFORMATION
Overton, T. (2003). Assessing learners with special needs: An applied approach. Upper Saddle
River, NJ: Merrill/Prentice Hall.
THERESA L. EARLES-VOLLRATH

EVIDENCE BASED
The term evidence based was first used in the field of medicine (Cutspec, 2004) and
has since been used to describe a variety of professions. The evidence-based
approaches have advantages and disadvantages, but the variety of these approaches
provides an implication that the term evidence based is not enough in itself to describe
what a given profession provides. In the field of education, there is the potential for
an evidence-based approach combined with knowledge and practice in an attempt to
move from individualistic approaches and designing original research as the founda-
tion on which to assess best practices for educators.

REFERENCE
Cutspec, P. A. (2004). Origins of evidence-based approaches to best practice: Evidence-based
medicine. In P. A. Cutspec & A. L. Watson (Eds.), Interlock: Identifying, synthesizing, validat-
ing, and disseminating evidence-based practices. Draft version two (Ch. 2). Asheville, NC: Ore-
lena Hawks Puckett Institute.
KAI-CHIEN TIEN

EXECUTIVE FUNCTIONS
Executive functions are higher-order cognitive skills and include inhibitory control,
planning, organization, self-regulation, and problem solving. The development of exec-
utive functions parallels the neurodevelopment of the prefrontal regions of the brain,
which are largely responsible for the neural networks that direct attention, perceptions
of time and order, emotion, and response as well as the retention and utilization of
memory. Deficits in the area of executive functions are evidenced by noncompliance,
limited or neglect for the consequences of past actions, exaggerated or nonexistent
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EXPERIMENTAL DESIGN

emotional expression, difficulty with concepts such as time and money, and other diffi-
culties related to social situations and organization.
MELANIE D. HARMS

EXPERIMENTAL DESIGN
Experimental design is a blueprint of a procedure that enables the researcher to test
his hypothesis by reaching valid conclusions about relationships between independent
and dependent variables. It refers to the conceptual framework within which the
experiment is conducted.
JEANNE HOLVERSTOTT

EXPRESSIVE LANGUAGE
Expressive language is the use of language to express a thought, idea, or feeling. Typi-
cally expressive language is thought to indicate spoken language, but it also includes
thoughts, ideas, or feelings that are expressed through written communication.
KATHERINE E. COOK

EXTENDED SCHOOL YEAR (ESY)

Extended School Year (ESY) refers to the special education and related services
beyond the normal school year that are provided to a child with a disability. ESY may
include the provision of summer schooling or other summer programming, the contin-
ued provision of services during vacation periods, or any other number of options.
According to the Individuals with Disabilities Education Act (IDEA), every student
with a disability must be considered for ESY services as part of the development of
their Individualized Education Program (IEP; IDEA, 2004).
Eligibility for ESY is based on a variety of factors that are considered during
the meetings to develop and review a student’s IEP. The most appropriate method
for determining eligibility for ESY is direct, ongoing assessment of IEP objectives as
they relate to the regression and recoupment a child experiences (Browder, 1987;
Browder & Lentz, 1985). Typically, to determine ESY eligibility, a team asks itself
how much a student would suffer a regression in skills if his or her educational services
were interrupted for a period of time and how much time would be required for the
student to then regain the lost skills. Other factors that the child’s team may look at
include severity of the disability, degree of regression and necessary recoupment time,
the ability of the parents to provide services at home, the student’s vocational needs,
the ability of the student to interact with nondisabled peers, and whether the student
is at a crucial or ‘‘breakthrough’’ moment in his or her learning.
Examples of children with disabilities for whom ESY is especially important might
include children who: (a) lose skills or behaviors relevant to their IEP goals and
objectives while school is out, (b) have difficulty catching up, (c) have not yet fully
learned and generalized an important skill or behavior and need help learning and
practicing that skill in the formal educational setting, (d) have a disability that makes
them vulnerable to interruptions in the educational program and who are at risk of
withdrawing from the learning process, or (e) have a degenerative condition and need
ESY to prevent or delay loss of skills or behaviors.
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 EYE GAZE

ESY can be provided in a variety of ways depending on the needs of the individual
child. A school may provide all-day schooling during the summer months, other vaca-
tion periods, or only the related services that are necessary to avoid serious regression
during vacation periods. Services may be provided in a traditional classroom setting,
at the student’s home, at recreational centers such as summer camps or community
centers, or at any other location that is deemed appropriate to the needs of the stu-
dent. Finally, services can also be provided one on one or in a group setting.

REFERENCES
Browder, D. (1987). Assessment of individuals with severe handicaps: An applied behavioral approach
to life skills assessment. Baltimore: Brookes Publishing Co.
Browder, D., & Lentz, F. E. (1985). Extended school year services: From litigation to assessment
and evaluation. School Psychology Review, 14, 188–195. EJ317622.
Individuals with Disabilities Education Improvement Act, 2004, Public Law 108-446. Retrieved
November 27, 2004, from http://www.ed.gov/policy/speced/guid/idea/idea2004.html.
JAN L. KLEIN

EXTINCTION
Extinction occurs when a behavior that has a history of being reinforced with posi-
tive or negative reinforcement stops being followed by reinforcement. Once extinction
begins, the likelihood is that there will be an increase in the rate of the behavior and
possibly an increase in the intensity of the behavior; a decrease in the rate of the
behavior should then follow. Spontaneous recovery, or the occasional display of the
behavior after a period of the behavior’s absence, may occur (Cooper, Heron, &
Heward, 1987). Extinction can also be a termination of sensory reinforcement, specifi-
cally, such as the reinforcement gained by some when they eat non-edible items or
smell items not intended to be smelled.
See also reinforcer.

REFERENCE
Cooper, Heron, & Heward (1987). Applied behavior analysis. Upper Saddle River, NJ: Prentice
Hall.
TARA MIHOK

EYE GAZE
Eye gaze is the act of directing one’s eyes toward a designated stimulus. This may
be observed as an individual facing one way and his eyes glancing in another, provid-
ing the individual with the opportunity to process visual and auditory information at
a pace appropriate to the individual. Because it is not uncommon for individuals on
the autism spectrum to describe eye contact as painful, eye gaze serves as a replace-
ment for eye contact. If an individual with autism demonstrates the ability to answer
questions and perform actions that involve eye contact, they may be compensating
with the use of eye gaze.
MELANIE D. HARMS

129
 F
FACE RECOGNITION
Face recognition is a neural process that takes part in the ventral temporal cortex
otherwise termed as the fusiform face area (FFA). Objects are processed in the internal
gyri and based on its features, such as size, texture, color, and more. The perception of
the face is processed part in features (eyes, nose, mouth, etc.) and part as a whole
(one object) rather than individual features. Researchers (Boucher & Lewis, 1992;
Braverman, Fein, Lucci, & Waterhouse, 1989; Hauck, Fein, Maltby, Waterhouse,&
Geinstein 1998; Kline, Sparrow, de Bildt, Cicchetti, Cohen, & Volkmar, 1999; Ozon-
off, Pennington, & Rogers, 1990) identify that individuals with autism and Asperger
syndrome tend to activate a feature-based strategy when presented with face recogni-
tion tasks, meaning they identify a face by a feature rather than its whole presenta-
tion. The fact that individuals with autism are presenting primarily feature-based
strategies to process faces lends to a deficit in processing individuals’ facial affect rela-
tive to emotional response. The inability to read the face as a whole causes individuals
with autism to miss social cues and must be considered when teaching social skills.

REFERENCES
Boucher, J., & Lewis, V. (1992). Unfamiliar face recognition in relatively able autistic children.
Journal of Child Psychology and Psychiatry, 33, 843–459.
Braverman, M., Fein, D., Lucci, D., & Waterhouse, L. (1989). Affect comprehension in chil-
dren with pervasive developmental disorders. Journal of Autism and Developmental Disorders,
19, 301–316.
Hauck, M., Fein, D., Maltby, N., Waterhouse, L., & Geinstein, C. (1998). Memory for faces in
children with autism. Child Neuropsychology, 4, 187–198.
Kline, A., Sparrow, S. S., de Bildt, A., Cicchetti, D. V., Cohen, D. J., & Volkmar, F. R.
(1999). A normed study of face recognition in autism and related disorders. Journal of Autism
and Developmental Disorders, 29, 499–508.
Ozonoff, S., Pennington, B. F., & Rogers, S. J. (1990). Are there emotion perception deficits in
young autistic children? Journal of Child Psychology and Psychiatry, 31, 343–361.
MELANIE D. HARMS

FACILITATED COMMUNICATION (FC)

Facilitated communication (FC) refers to a form of augmentative and alternative
communication (AAC) that involves providing physical as well as instructional and
FACILITATED COMMUNICATION (FC)

emotional support to aid individuals with autism and other developmental disabilities
to communicate by pointing. The method was first described by Crossley and McDo-
nald (1980) as a method that could be used with people with cerebral palsy. Crossley
subsequently began to use facilitated communication with individuals with autism in
the 1980s (Biklen, 1990; Blackman, 1999).
Candidates for FC are said to include individuals who have limited or no speech or
whose speech is highly disordered (e.g., echolalic) and who have unreliable pointing
skills (Crossley, 1994). Crossley refers to the method as facilitated communication
training (FCT), emphasizing the importance of developing the ability to ultimately
communicate without physical support. Accounts of the same methodology are
reported in the literature from Japan (Wakabayashi, 1973), Sweden, and the United
States (Oppenheim, 1974; Schawlow and Schawlow, 1985). The recent literature pro-
vides descriptions of individuals who have achieved independent typing (Mukhopad-
hyay, 2000; Rubin et al., 2001) after first receiving physical support for their initial
pointing. The Academy Award-nominated film, written by an FC user, Rubin, illus-
trates physically independent typing (Wurzburg, 2004). Other individuals who first
learned to type with facilitation have learned to speak the words they are typing
before and as they type (Biklen, 2005; Broderick and Kasa-Hendrickson, 2001; Broder-
ick and Kasa-Hendrickson, in review).
For people with severe speech impairments, alternative forms of communication
may include use of gestures or body language, manual sign language, writing, or com-
munication aids (e.g. headpointers, eye gaze technology on computing devices, yes/no
communication boards, computers). Facilitated communication is an augmentative sys-
tem for individuals whose disability affects motor performance, including effective, in-
dependent use of the hands. The method involves a communication partner
(facilitator) who may aid the person in achieving useful hand function. Initially, this
may mean helping the person to isolate the index finger and/or to slow the person’s
pointing down by providing backward pressure under the wrist or forearm. Over time,
the goal is to fade the physical support. Crossley writes,

The facilitator uses his or her hand(s) to support or inhibit the aid user. The immediate
aim is to allow the aid user to make choices and to communicate in a way that had been
previously impossible. Practice, using a communication aid such as a picture board,
speech synthesizer, or keyboard in a functional manner, is encouraged to increase the
user’s physical skills and self-confidence and reduce dependency. As the student’s skills
and confidence increase the amount of facilitation is reduced. (Crossley, 1994, p. 3)

The facilitated communication method involves a variety of supports, including

verbal encouragement, monitoring the person’s eye contact with the target, sequenc-
ing of activities, practice sessions as well as other strategies (see Biklen, 1993, pp. 20–
23).
The theoretical explanation for facilitation is that individuals with developmental
disabilities, including autism, often have not only motor difficulties but also develop-
mental dyspraxia. Dyspraxia is a neurological condition characterized by difficulty in
reliably producing voluntary actions. That is, the person may be able to do something,
for example, say a particular word or fetch a toy, but may not be able to do it on com-
mand. The person may be able to carry out an action automatically or spontaneously,
132
 FACILITATED COMMUNICATION (FC)

but not intentionally. Early descriptions of dyspraxia appear in the professional prac-
tice literature (e.g., Oppenheim, 1974) as well as in the neurological literature
(Maurer and Damasio, 1982). The broader topic of motor disturbance and autism has
been summarized by Leary and Hill (1996). Borthwick and Crossley (1999) suggest
that difficulties with physical performance, including communication, be decoupled
from assessments of intellectual capacity.
Facilitated communication has been called a controversial technique because, as
most practitioners and researchers agree, it has been shown that a facilitator’s physical
touch of the typist’s hand or arm may influence the person’s pointing, thus affecting
the message. A number of studies document the problem of influence and/or difficul-
ties in verifying authorship in facilitated communication (Bebko, Perry, & Bryson,
1996; Bomba, O’Donnell, Markowitz, & Holmes, 1996; Cabay, 1994; Crews et al.,
1995; Eberlin, McConnachie, Ibel, & Volpe, 1993; Klewe, 1993; Montee, Milten-
berger, & Wittrock, 1995; Moore, Donovan, Hudson, Dykstra, & Lawrence, 1993;
Regal, Rooney, & Wandas, 1994; Shane & Kearns, 1994; Smith & Belcher, 1993;
Szempruch & Jacobson, 1993; Wheeler, Jacobson, Paglieri, & Schwartz, 1993). The
study by Wheeler and his colleagues is often cited as the classic case where researchers
were able to demonstrate that some facilitators unknowingly influence facilitated
typing and also that some FC users had difficulty in demonstrating their thinking com-
petence and communication skills when tested through an apparently simple message-
passing experiment.
Subsequent research on message-passing reveals contradictory evidence, however;
that is, several studies have demonstrated that under controlled conditions, over mul-
tiple sessions of testing, many individuals were able to demonstrate uninfluenced
authorship (Cardinal, Hanson, & Wakeham, 1996; Sheehan & Matuozzi, 1996; Weiss,
Wagner, & Bauman, 1996). Similarly and more recently, other studies, using a range
of test situations as well as linguistic analysis and documentation of physical, inde-
pendent-of-facilitator typing offer evidence demonstrating authorship (Broderick &
Kasa-Hendrickson, 2001; Calculator & Singer, 1992; Emerson, Grayson, & Griffiths,
2001; Janzen-Wilde, Duchan & Higginbotham, 1995; Niemi & K€arn€a-Lin, 2002;
Rubin et al., 2001; and Zanobini & Scopesi, 2001).
In light of the controversy surrounding FC, researchers and practitioners alike have
wanted to establish means by which to confirm the FC user’s authorship. The most
obvious protection against influence is physically independent typing and/or speaking
before and while typing. Beukelman and Mirenda (1998) write, ‘‘in regard to a small
group of people around the world who began communicating through FC (facilitated
communication) and are now able to type either independently or with minimal,
hand-on-shoulder support . . . there can be no doubt that, for them, (facilitated com-
munication) ‘worked,’ in that it opened the door to communication for the first
time. . . . For them, the controversy has ended’’ (p. 327). Several individuals have
reached the point where they can type without physical support (Blackman, 1999;
Rubin et al., 2001). At the same time, there is an emerging literature relating typing
to speech (Biklen & Burke, 2006; Broderick & Kasa-Hendrickson, 2001; Broderick &
Kasa-Hendrickson, in review). Four documentary films feature people who have
learned to communicate without physical support (Kasa-Hendrickson, Broderick, and
Biklen, 2002; Mabrey, 2003; Terrill, 2000; Wurzburg, 2004).
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FACILITATED COMMUNICATION (FC)

Given that progress toward and achievement of physically independent typing and/or
development of functional and dialogical speech can take several years or may not
appear at all, standards have been developed to guide practitioners in the use of facilita-
tion. For example, in an article written for school personnel, Duchan and her colleagues
suggested a series of steps for using any controversial methods of communication,
including facilitated communication (Duchan, Calculator, Sonnenmeier, Diehl, & Cum-
ley, 2001). Among the procedures they identify is informed consent.

REFERENCES
Bebko, J., Perry, A., & Bryson, S. (1996). Multiple method validation study of facilitated com-
munication: Individual differences and subgroup results. Journal of Autism and Developmental
Disabilities, 26, 43–58.
Beukelman, D., & Mirenda, P. (1998). Augmentative and alternative communication: Management
of severe communication disorders in children and adults. Baltimore: Brookes Publishing Co.
Biklen, D. (1990). Communication unbound: Autism and praxis. Harvard Educational Review.
60, 291–314.
Biklen, D. (1993). Communication unbound: How facilitated communication is challenging traditional
views of autism and ability/disability. New York: Teachers College Press.
Biklen, D. (2005). Autism and the myth of the person alone. New York: NYU Press.
Biklen, D., & Burke, J. (2006). Presuming competence. Equity and Excellence in Education, 39,
1–10.
Blackman, L. (1999) Lucy’s story: Autism & other adventures. Redcliffe, Queensland, Australia:
Book in Hand.
Bomba, C., O’Donnell, L., Markowitz, C., & Holmes, D. (1996). Evaluating the impact of
facilitated communication on the communicative competence of fourteen students with au-
tism. Journal of Autism and Developmental Disorders, 26, 43–58.
Borthwick, C., & Crossley, R. (1999). Language and Retardation. Psychology, 10(38). Retrieved
July 13, 2004, from http://psycprints.ecs.soton.ac.uk/archive/00000673/.
Broderick, A., & Kasa-Hendrickson, C. (2001). ‘‘Say just one word at first’’: The emergence of
reliable speech in a student labelled with autism. Journal of the Association for Persons with
Severe Handicaps, 26, 13–24.
Broderick, A., & Kasa-Hendrickson, C. (in review). I am so much more real than retarded:
Deconstructing assumptions about speech and its relationship to competency. Equity and
Excellence in Education.
Cabay, M. (1994). A controlled evaluation of facilitated communication with four autistic chil-
dren. Journal of Autism and Developmental Disorders, 24, 517–527.
Calculator, S., & Singer, K. (1992). Preliminary validation of facilitated communication. Topics
in Language Disorders, 12, ix.
Cardinal D. N., Hanson, D., & Wakeham, J. (1996). An investigation of authorship in facili-
tated communication. Mental Retardation, 34, 231–242.
Crews, W., Sanders, E., Hensley, L., Johnson, Y., Bonaventura, S., & Rhodes, R. (1995). An
evaluation of facilitated communication in a group of nonverbal individuals with mental
retardation. Journal of Autism and Developmental Disorders, 25, 205–213.
Crossley, R. (1994). Facilitated communication training. New York: Teachers College Press.
Crossley, R., & McDonald, A. (1980). Annie’s coming out. New York: Penguin Books.
Duchan, J., Calculator, S., Sonnenmeier, R., Diehl, S., & Cumley, G. (2001) A framework for
managing controversial practices. Language Speech and Hearing Services in Schools, 32, 133–
141.
Eberlin, M., McConnachie, G., Ibel, S., & Volpe, L. (1993). ‘‘Facilitated communication’’: A fail-
ure to replicate the phenomenon. Journal of Autism and Developmental Disorders, 23, 507–529.
Emerson, A., Grayson, A., & Griffiths, A. (2001). Can’t or won’t? Evidence relating to author-
ship in facilitated communication. International Journal of Language and Communication Disor-
ders, 36 Suppl., 98–103.

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Janzen-Wilde, M., Duchan, J., & Higginbotham, D. (1995). Successful use of facilitated commu-
nication with an oral child. Journal of Speech and Hearing Research, 38, 658–676.
Kasa-Hendrickson, C., Broderick, A., & Biklen, D. (Producers). (2002). Inside the edge. (Documen-
tary Film). Syracuse, NY: Syracuse University.
Klewe, L. (1993). An empirical evaluation of spelling boards as a means of communication for
the multihandicapped. Journal of Autism and Developmental Disorders, 23, 559–566.
Leary, M. R., & Hill, D. A. (1996). Moving on: Autism and movement disturbance. Mental
Retardation, 34(1), 39–53.
Mabrey, V. (Producer/Director). (2003). Breaking the silence. [Documentary]. U.S., 60 Minutes II.
New York: CBS News, CBS Broadcasting, Inc.
Maurer, R., & Damasio, A. R. (1982). Childhood autism from the point of view of behavioral
neurology. Journal of Autism and Developmental Disorders, 12(2), 195–205.
Montee, B., Miltenberger, R., & Wittrock, D. (1995). An experimental analysis of facilitated
communication. Journal of Applied Behaviour Analysis, 28, 189–200.
Moore, S, Donovan, B., Hudson, A., Dykstra, J., & Lawrence, J. (1993). Brief report; Evaluation
of eight case studies of facilitated communication. Journal of Autism and Developmental Disor-
ders, 23, 541–552.
Mukhopadhyay, T. R. (2000). Beyond the silence: My life, the world and autism. London: National
Autistic Society.
Niemi, J., & K€arn€a-Lin, E. (2002). Grammar and lexicon in facilitated communication: A lin-
guistic authorship analysis of a Finnish case. Mental Retardation 40, 347–357.
Oppenheim, R. (1974). Effective teaching methods for autistic children. Springfield, IL: Charles
Thomas.
Regal, R., Rooney, J., & Wandas, T. (1994). Facilitated communication: An experimental eval-
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pendence, participation, and the meaning of intellectual ability. Disability & Society, 16, 415–429.
Schawlow, A. T., & Schawlow A. L. (1985). The endless search for help. In M. R. Brady & P.
Gunther (Eds.), Integrating moderately and severely handicapped learners: Strategies that work (pp.
5–15). Springfield, IL: Charles Thomas.
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Sheehan, C., & Matuozzi, R. (1996). Investigation of the validity of facilitated communication
through the disclosure of unknown information. Mental Retardation, 34, 94–107.
Smith, M., & Belcher, R. (1993). Brief report: facilitated communication with adults with
autism. Journal of Autism and Developmental Disorders, 23, 175.
Szempruch, J., & Jacobson, J. (1993). Evaluating facilitated communications of people with
developmental disabilities. Research in Developmental Disabilities, 14, 253–264.
Terrill, C. (Producer/Director). (2000). Inside story: Tito’s story. [Documentary]. England: BBC.
Wakabayashi, S. (1973). A case of infantile autism who became able to communicate by writ-
ing. Psychiatria et Neurologia Japonica, 75, 339–357.
Weiss, M., Wagner, S., & Bauman, M. (1996). A validated case study of facilitated communica-
tion. Mental Retardation, 34, 220–230.
Wheeler, D., Jacobson, J., Paglieri, R., & Schwartz, A. (1993). An experimental assessment of
facilitated communication. Mental Retardation, 31, 49–60.
Wurzburg, G. (Producer/Director) (2004). Autism is a world [Documentary Film]. Atlanta: CNN.
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logia Clinica dello Sviluppo, 5, 395–421.
DOUGLAS BIKLEN

FACILITY-BASED EMPLOYMENT
Facility-based employment is a good choice for individuals who have more severely
challenged job skills or who require intensive levels of supervision to complete the
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FADING

required tasks of their job. This type of employment is often found at vocational reha-
bilitation agencies or private nonprofit community organizations whose services
include supported employment arrangements. Because employment is not competi-
tively based for participants in the program, the benefits of such an environment
would be successful socialization, active participation in work activities, and intensive
support for all types of skill deficits. Eligibility assessments include IQ, work readiness,
and general functioning level. Availability of these programs may be limited because
of funding and low attrition rates unless the program operates for specific periods of
time or sessions in order to accommodate a larger volume of participants. Since many
of these programs have been operating in some cases for decades, they should be
investigated carefully before committing to participation at any facility. Be sure to
look for a program that is comprehensive and nurturing with a skilled staff that insists
on a positive environment.
SHERRY MOYER

FADING
In order to increase generalization to a natural setting, fading of unnatural anteced-
ent stimuli should take place. Fading is used as a part of a technique called transfer of
stimulus control. The teacher presents the unnatural antecedent stimulus (or teaching
stimulus) paired with the natural stimulus to replace the teaching stimulus with the
stimulus in the natural environment. The teaching stimulus should be gradually faded,
allowing the natural stimulus to control the person’s behavior. The stimulus may be
faded physically, spatially, audibly, and visually (Cooper, Heron, & Heward, 1987).
For example, a teacher could use fading when teaching a student that when the bell
rings, they are to leave the classroom. At first, the teacher may need to physically
prompt the student to move when the bell rings. This physical prompt, in the absence
of the bell ringing, is the student’s stimulus for his behavior of getting up and moving
out of the classroom. In the presence of the bell, the full physical prompt with two
hands can be faded to a light pull on the arm and then to a touch on the arm. The
end is that the student responds to the natural stimulus of the bell without any physi-
cal prompting.
See also antecedent; stimuli.

REFERENCE
Cooper, J. O., Heron, T. E., & Heward, W. L. (1987). Applied behavior analysis. Upper Saddle
River, NJ: Prentice Hall.
TARA MIHOK

FALSE-BELIEF PARADIGM
The False-Belief Paradigm is a task designed to assess theory of mind (ToM) devel-
opment. Theory of mind describes an area of research that focuses on a child’s ability
to understand mental concepts such as belief, desire, the difference between appear-
ance and reality, and the existence of other minds. The classic false-belief paradigm
presents a child with two dolls, two boxes (one red and one green), and a marble, all
of which are in a single miniature scene. One doll puts the marble in the green box,
so that it is hidden, and then departs. While the first doll is gone, the second doll
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removes the marble from the green box and puts it in the red box. The first doll then
returns, and the child is asked: ‘‘Where will the first doll look for the marble?’’ Chil-
dren younger than four typically reply that the doll will look in the red box, the
actual location of the marble. They are unable to understand that the doll might have
a false belief, one that does not correspond to reality. After the age of four, children
begin to give the correct response: the doll will look in the green box, where it had
last seen the marble. Individuals with autism of all ages have difficulty with the false-
belief paradigm due to difficulties with understanding and reading the emotions and
thoughts of others.
JEANNE HOLVERSTOTT

FAMILY ASSESSMENT INTERVIEW

The family assessment interview is part of the family assessment process (FAP)
designed to match families with the appropriate services for their children and
empower the families based on their individual strengths. Upon referral, a family
assessment specialist meets with the members of the family for an initial interview
and to conduct the necessary assessments. During this meeting, the specialist conducts
a family assessment interview in order to facilitate an exchange of feelings and experi-
ences, examine family challenges from multiple perspectives, and enhance communi-
cation between caretakers and youths. Depending on the needs of the family (i.e.,
mediation, crisis management), the specialist will compile this information and refer
the family to the appropriate service provider (i.e., community-based service, mental
health evaluation, mediation, designated assessment service, or other applicable
service).
JEANNE HOLVERSTOTT

FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT (FERPA)

The Family Educational Rights and Privacy Act, also known as FERPA, is a federal
law created in 1974 to protect students’ educational records. The Individuals with
Disabilities Education Act (IDEA, 1997) and the Section 504 of the Rehabilitation
Act of 1973 also address these areas (FERPA, 1974). The law applies to all educa-
tional institutions that receive funding from the United States Department of Educa-
tion, including public schools, colleges, and universities, as well as many private
schools that also receive some form of funding. Institutions may have their funding
removed if they fail to follow FERPA regulations (FERPA, 1974).
FERPA was created for three specific reasons. First, schools were denying parent
requests to access records while government agencies and prospective employers were
allowed to see the records. Second, information contained in school records was not
always factual, education-based, or objective. Third, access to student records varied
greatly from state to state and was based on common law practices, case law, and local
policies (Copenhaver, 2002).
FERPA designates the requirements for keeping educational records. Personal iden-
tifiable records must be kept confidential. All schools or educational entities are
required by FERPA to follow the same basic guidelines. Districts must adopt a written
policy designating the rules for obtaining and keeping educational records and
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following procedures that meet FERPA standards. Permanent files should be main-
tained on all students (Copenhaver, 2002). Students with special education services
should have three separate files, one file for student information such as immunizations
and discipline referrals, one for Individualized Education Programs (IEP) and other
special educations forms, and a file for the special education teacher that holds student
information. Schools must keep a logbook of who accesses the files. Only school per-
sonnel whose titles are given access by the district’s educational records policy may
see the records. These may include administrators, therapists, teachers, medical staff,
social workers, school law enforcement, a parent serving official school duty, and
board members (FERPA, 1974).
FERPA gives parents the right to review their child’s education records. Education
records relate directly to a student, contain personal information, and may include in-
formation recorded in a variety of formats including handwritten, tape, film, or print
(Copenhaver, 2002). When requested, a school district must disclose the types of
records they keep (FERPA, 1974). The institution must make the documents available
within 45 days of receiving the request or within the school district’s set limits. How-
ever, schools are not required to provide copies. Noncustodial parents may have access
to the files unless that right has been removed due to state order, court order, or other
legally binding document (FERPA, 1974). When the student is 18 or attends college,
these rights transfer to them. At this point of transfer, students are referred to as ‘‘eli-
gible students’’ (Holbum, 2003).
Parents or eligible students can request that a school amend records they believe to
be incorrect (Holbum, 2003). If the school district does not amend the records,
parents or eligible students may request a hearing. If the hearing is unsuccessful,
parents or eligible students may place a statement explaining their views of the situa-
tion into the permanent education records. The statement from parents or eligible stu-
dents must be included with the records it pertains to at each disclosure or time the
file is viewed.
Parents or eligible students who believe that an institution is not correctly applying
FERPA have the right to file a complaint with The U.S. Department of Education.
Complaints should be directed to the Family Policy Compliance Office of the Depart-
ment of Education.
Schools may release information regarding students when they are given written
consent by the parent or eligible student. Exceptions are release within the public
school system, release of directory information as outlined by their district policy, or
in emergency or health-related situations. Parents and students must be notified each
year of their rights pertaining to education records under FERPA. Parents should be
provided information on what will be disclosed in directory information and have the
opportunity to choose not to participate on a yearly basis. The law does not specify
how the parents will be notified. Personal notes made by staff members and main-
tained by that person and not shared with others are exempt from parental disclosure.
These personal journals are not required to be shared with parents or eligible students
under FERPA requirements. These records do not include health and treatment infor-
mation for persons age 18 and over that are maintained by health care professionals
(Copenhaver, 2002). Also, records cannot be released to Medicaid for benefit claims
without parental consent (Ahern, 2002).
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There are specific requirements that must be fulfilled before disclosing information
that is not available under the exceptions of the law such as ‘‘directory’’ information.
A parent or a student who has become eligible must provide a written and signed con-
sent form before personal information can be released. The form must state what
documents are to be disclosed, why the documents are being disclosed, and who spe-
cifically the documents are being disclosed to. The institution will provide a copy of
the information disclosed if the eligible student or parent requests it (FERPA, 1974).
The goal of The Family Education Rights and Privacy Act (1974) is to protect the
confidentiality of students and families while providing information as appropriate.
Interpretation of law may affect how school districts in various areas approach the
law. This may in turn reflect how much information is released. Often districts are
overcautious in their release of information (Center for Mental Health in Schools,
2002). Even with the variance of interpretation between education institutions, the
outcome is still realized; education records are protected and privacy is maintained.
REFERENCES
Ahern, E. (2002). Medicaid: Parent consent issues. Quick turn around (QTA). Alexandria, VA:
National Association of State Directors of Special Education.
Center for Mental Health in Schools. (2002). Confidentiality: A center quick training aid. Univer-
sity of California–Los Angeles (UCLA).
Copenhaver, J. (2002). Primer for Maintaining Accurate Special Education Records and Meeting
Confidentiality Requirements when Serving Children with Disabilities—Family Educational Rights
and Privacy Act (FERPA). Utah State University.
The Family Educational Rights and Privacy Act of 1974 (FERPA). Public Law No. 93-380 (20
U.S.C. § 1232g; 34 CFR Part 99).
Holbum, T. (2003). College student records: Legal issues, privacy, and security concerns. (ERIC
Document Reproduction Service ED 480467).
Individuals with Disabilities Education Act Reauthorization of 1997. Public Law No. 105–17 (1997).

FURTHER INFORMATION
Brookshire, R., & Klotz, J. (2002). Selected Teachers’ Perceptions of Special Education Laws. Paper
presented at the annual conference of the Mid-South Educational Research Association.
Chattanooga, Tennessee.
Doyle, S. L. (2002). FERPA: What exactly is an educational record? (ERIC Document Reproduc-
tion Service ED 473342).
O’Donnell, M. L. (2003). FERPA: Only a piece of the privacy puzzle. Student Rights Journal of
College and University Law, 29(3) 679–717.
VALERIE JANKE REXIN

FAST FORWORD
Fast ForWord is an intervention for children with language, memory and processing
problems. The intervention involves speech sound discrimination exercises, a two-tone
sequencing exercise and receptive language exercises. Novel to their intervention was
the application of neuroscience research on brain plasticity and auditory processing
problems stemming from over 20 years of neuroscience research.
The exercises were designed to build the cognitive skills essential for learning lan-
guage and learning to read: memory, attention, processing, and sequencing. Although
many of the tasks they introduced were similar to those used conventionally by speech
and language pathologists to treat language and processing disorders, the Tallal/
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Merzenich intervention was different because the speech stimuli in the exercises were
acoustically enhanced to conform to the perceptual needs of children with auditory
processing problems. Further, children were asked to practice the exercises 2 hours a
day, 5 days a week, for 4 to 6 weeks. This intense training protocol stemmed from
research by Merzenich et al. (1996) showing that four characteristics of training maxi-
mize brain reorganization: (a) frequency of stimuli presentation, (b) adaptability, (c)
simultaneous stimulation of several cognitive domains, and (d) timely motivation.
After the initial field trial of the intervention with almost 500 children, the inter-
vention was named Fast ForWord. Today there are nine Fast ForWord products, all
based on the same neuroscience research. The original intervention is now called Fast
ForWord Language. The additional Fast ForWord products are designed around the
same neuroscience principles to build the same cognitive skills of memory, attention,
processing, and sequencing, but in the context of reading.
The results of the national field trial instituted to test the efficacy of the new inter-
vention revealed that the average language gain nationwide was almost two standard
deviations (representing a year and one-half growth in language skills) in most cases,
achieved after 4 weeks of training. Among the children who participated in the
national field trial were many who had diagnoses of autism spectrum disorders (ASD).
Although many of the children with ASD had more severe language and processing
issues than the average Fast ForWord participant, they made almost the same gains
overall as the children for whom the intervention had been designed—namely, those
with specific language impairment (Tallal et al., 1997).

WHAT IS A NEUROSCIENCE-BASED PERSPECTIVE AND HOW DOES IT HELP

IN INTERVENTION WITH AUTISM SPECTRUM DISORDERS?
Researchers have speculated for years that ASD must have something to do with
brain processing differences. However, despite many studies of the brains of individuals
with ASD, there has been little consensus as to the ways in which the brain might be
organized differently in these individuals. Bauman and Kemper (1994) studied brain
cells of persons with autism who have died of natural causes, noting that while there
are abnormalities in the brain cells in some of the older parts of the brain that regu-
late movement and emotion, brain cells important for thought and language (cells in
the outer brain parts, the cortex) appeared normal. Herbert and her associates worked
to confirm the hypothesis that children on the autism spectrum may have intact corti-
cal brain cells important for thought, language, and reasoning, but those cells may be
organized differently, specifically in the way they communicate with each may pose a
problem. Brain cells in the cortex have connecting fibers that are ‘‘wrapped’’ with an
insulating sheet called myelin. Myelin is important because it allows brain cells to
‘‘talk’’ to each other using very efficient connections. According to Herbert, Ziegler,
Makris, et al. (2004) and Herbert, Ziegler, Deutsch, et al. (2004), myelin begins to
insulate brain cell connections at very specific times during the development of the
brain. These researchers have found that in children with developmental language dis-
orders and children with Asperger syndrome, the neuron pathways may get ‘‘wrapped’’
too soon or in unusual ways. This may cause the brain to become ‘‘hardwired’’ while
the brain is still immature and not well organized. Herbert hypothesizes that this could
interfere with the child’s ability to process language and learn other higher cognitive
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tasks easily. Her research using MRI scans suggests that the brains of children with
Asperger syndrome and developmental language disorders have the same number of
cortical brain cells as those of children who do not exhibit autism spectrum disorders,
but the connections between the brain cells are less efficiently organized.
Although research by Herbert, Ziegler, Makris, et al. (2004) and Herbert, Ziegler,
Deutsch, et al. (2004) needs to be verified by other studies before firm conclusions
may be drawn, it appears that if children with ASD demonstrate immature or ineffi-
cient connections, those are malleable in the human brain. Neuroscientists have dem-
onstrated that intensive interventions can reroute brain connections, even in adults.
The ability to Fast ForWord Language to normalize brain organization has been inves-
tigated in two studies (Temple et al., 2000; Temple et al., 2003). This research with
children and adults with dyslexia, using MRI to create images of the brain working
before and after Fast ForWord Language intervention, revealed neurological wiring
changes in children and adults with dyslexia and associated auditory processing prob-
lems. Further, these investigations demonstrated that brain function could be normal-
ized in 4 to 6 weeks.

HOW DO FAST FORWORD PRODUCTS DIFFER FROM OTHER INTERVENTIONS FOR

CHILDREN ON THE AUTISM SPECTRUM?
Because they were developed specifically for improving receptive language, memory,
attention, processing, and sequencing the Fast ForWord products can augment other
interventions for ASD that address behavioral and interaction patterns by filling in
the auditory, language, and cognitive gaps that these children may experience. In a
retrospective study of 100 children with ASD who used Fast ForWord Language,
Melzer and Poglitsch (1999) reported that many therapists successfully implemented
Fast ForWord Language in conjunction with sensori-integration modifications as part
of an Applied Behavior Analysis (ABA) or naturalistic intervention programs. The
authors noted that although there was substantial variability in the quantity and qual-
ity of gains realized as a result of Fast ForWord Language intervention, almost all of
the children who complied with the intervention schedule showed enhanced atten-
tional, receptive language, and expressive formulation skills. Children on the autism
spectrum may require a significantly longer training period than children with other
language or reading disorders, but the gains are significant.

REFERENCES
Bauman, M. L., & Kemper, T. L. (1994). The neurobiology of autism. Baltimore: Johns Hopkins
University Press.
Herbert, M. R., Ziegler, D. A., Makris, N., Filipek, P. A., Kemper, T. L., Normandin, J. J.,
et al. (2004). Localization of white matter volume increase in autism and developmental lan-
guage disorder. Annals of Neurology, 55, 530–540.
Herbert, M. R., Ziegler, D. A., Deutsch, C. K., O’Brien, L. M., Kennedy, D. N., Filipek, P. A.,
et al. (2004). Brain asymmetries in autism and developmental language disorder: A nested
whole-brain analysis. Brain Advance Access, November 24, 2004.
Melzer, M., & Poglitsch, G. (1999). Use of Fast ForWord with children who have autism spectrum
disorders. Paper presented at the annual convention of the American Speech-Language Hear-
ing Association, San Antonio, TX.
Merzenich, M. M., Jenkins, W. M., Johnston, P., Schreiner, C. E., Miller, S. L., & Tallal, P.
(1996). Temporal processing deficits of language-learning impaired children ameliorated by
training. Science, 271, 77–80.

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Tallal, P., Saunders, G., Miller, S., Jenkins, W., Protopapas, A., & Merzenich, M. M. (1997).
Rapid training-driven improvement in autistic and other PDD children. Society for Neuro-
science, 23, 490–491.
Temple, E., Poldrack, R. A., Protopapas, A., Nagarajan, S., Salz, T., Tallal, P., et al.
(2000). Disruption of the neural response to rapid acoustic stimuli in dyslexia: Evidence
from functional MRI. Proceedings of the National Academy of Sciences, 97(25), 13907–
13912.
Temple, E., Deutsch, G., Poldrack, R., Miller, S., Tallal, P., & Merzenich, M. (2003). Neural
deficits in children with dyslexia ameliorated by behavioral remediation: Evidence from func-
tional MRI. Proceedings of the National Academy of Sciences, 100(5), 2860–2865.
MARTHA S. BURNS AND PAULA TALLAL

FEINGOLD DIET
The Feingold diet was developed in 1973 by Benjamin Feingold, MD, a pediatric
allergist, who proposed that salicylates, artificial colors, and artificial flavors caused
hyperactivity in children. To treat or prevent this condition, Feingold suggested a diet
that was free of such chemicals. Feingold also advised individuals to avoid certain
over-the-counter and prescription drugs and to limit the purchases of mouthwash,
toothpaste, cough drops, perfume, and various other nonfood products. There is no
empirical evidence to support the efficacy of the Feingold diet.
JEANNE HOLVERSTOTT

FIGURATIVE LANGUAGE
Figurative language or speech contains specific words that are intended by the
speaker to create interesting images. Figurative language provides a new way of looking
at or understanding a message by making comparisons of different items to demon-
strate the unique similarities. Figurative language is used to enhance the communica-
tive meaning or message of the speaker.
KATHERINE E. COOK

FINE MOTOR SKILLS

Fine motor skills describe a movement that requires the use and coordination of the
smaller muscles of the body. Examples of fine motor skills include writing, cutting
with scissors, or buttoning a shirt.
KELLY M. PRESTIA

FLOOR TIME. See Developmental Individual-Difference Relation-Based Intervention

FLUENCY
Fluency is the normal rhythm and timing of words and phrases including variations
in speed and pauses. A fluency disorder is defined as an interruption in the flow of
spoken language by atypical rate, rhythm, and repetitions. Stuttering is the most com-
mon fluency disorder characterized by repetitions of consonant or vowel sounds as the
speaker tries to express a thought, idea, or feeling.
KATHERINE E. COOK
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 FOUR STEPS OF COMMUNICATION

FOOD INTOLERANCE/SENSITIVITIES. See See Elimination Diet and Food

Sensitivities

FOUR STEPS OF COMMUNICATION

Communication, verbal or nonverbal, is an ever-present complex process when
relating to others. To help we realize how to begin the process of evaluating and treat-
ing persons who have difficulty sharing space with others/communicating effectively.
The four steps of communication were developed by Winner (2002) to help under-
stand how the communicative process unfolds. It is in this same order that we begin
to address teaching social thinking skills to persons with near-normal to way-above-
normal intelligence who also have social cognitive deficits. Most students with social
cognitive deficits need to work on all four of these steps, meaning that we have to do
far more with them than simply practice teaching them to participate in a conversa-
tion while sitting at a table.

Step 1: Thinking about Others and What They Are Thinking about Us
We THINK about who we are near or who we want to talk to or play with. We are
aware people have little thoughts about all the people around them, and that we have
those same types of thoughts. We even monitor our own behavior based on what we
think other people might be thinking of us!
We consider what we know about the other person and what they like to do in order
to keep the other person feeling like we are aware of them or thinking about them.
Step 2: Establishing a Physical Presence
When we desire to communicate or ‘‘hang out’’ with someone, while thinking about
them, we have to establish a physical presence to show that person that we would like to
talk to the person or just be with them. Our physical presence can include standing close
enough to the person (often about an arm’s length away), having our shoulders turned
towards them, and keeping our body relaxed to move easily to include other people or to
move away from a person as needed. Our physical presence usually communicates intent,
which helps to kick off communication. For example, if you are thinking about me, and
you want to hang out with me but you are standing about four feet away and looking
around but wishing I would come to you, you have failed to establish a physical presence
for me. I would not be able to ‘‘read your intention’’ to communicate with me.
Step 3: ‘‘Thinking with Your Eyes’’
As we are thinking about the person we desire to communicate with and we establish
physical presence, our intention to communicate is only explicitly clear once we have
established eye-contact with the other person. This is the third step, since it is possible
to engage in the previous two steps without using eye-contact, but communication or
sharing space effectively is usually not functional without using our eyes, not only to
show someone we are interested in talking, but to also watch the physical movements
and facial expression of the others to determine their intentions, feelings, and needs, as
well.
Step 4: Using Language to Relate to Others
While language is undisputedly central to all language-based communication, it is of-
ten not effective or functional if the first three steps are not in place. For example, if a
student comes up to you to tell you all the details about the Titanic, and he or she talks
endlessly without considering what you are thinking about and without establishing eye-
contact, it may be interesting to listen to (if you are an adult), but this is not truly com-
munication; it should better be described as ‘‘downloading’’ information. Language use in
communication requires that language users constantly consider the thoughts, feelings,
prior knowledge, experiences, intentions, and needs of the communicative partner. Each

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partner has to work to regulate their language to meet the needs of the listener while also
conveying the message that helps them to add their own thoughts to the interaction.
Effective language-based communication requires students to ask questions to others
about other people, produce supportive responses, add their own thoughts by connecting
their experiences or thoughts to what other people are saying, and so forth.

REFERENCE
Winner, M. (2002). Thinking about you thinking about me. San Jose, CA: Michelle Garcia
Winner.

FURTHER INFORMATION
Winner, M. (2005). Worksheets! For teaching social thinking and related skills. San Jose, CA:
Michelle Garcia Winner.
MICHELLE GARCIA WINNER AND JAMIE RIVETTS

FOUR STEPS OF PERSPECTIVE TAKING

Perspective taking should occur each time we share space with one or more people;
it is as important when we are not talking to people as when we are engaged in an
active discussion/conversation. One definition of perspective taking is the ability to
read other people’s thoughts, emotions, motives, intentions, belief systems, prior
knowledge and experiences, and personality to gain insight into the communicative
intent of the person conveying the message. Perspective taking is critical for people to
work effectively together in groups; it is at this time that all people have to regulate
their communication around their own needs as well as the needs of others.
The four steps of perspective taking were developed by Winner for us to better
understand how a ‘‘thought’’ about another person quickly turns into behavioral regu-
lation (2002). We can use the following four steps of perspective taking not only for
us adults to better assess where a child may be struggling, but also as a teaching tool
for older students with Asperger syndrome and like diagnoses, to help them under-
stand more concretely the abstract process of perspective taking.

Step 1: I think about you and you have a thought about me, when we are just sharing
space (e.g., when sharing an elevator) or when we are talking or planning to talk.
Step 2: I try to determine why you are near me. What is your motive/intention for being
near me or thinking about me? Are we just in the same place at the same time by coinci-
dence, or do you plan to harm or trick me?
Step 3: Since I realize you are having a thought about me, I wonder what you are think-
ing about me.
Step 4: As I try and figure out what you are thinking about me, I monitor and possibly reg-
ulate my behavior to keep you thinking about me the way I want you to think about me.

For example: When I am on an elevator by myself, I will often look in the mirror,
fix my clothing, makeup, etc. As soon as you get on the elevator, I realize you are
having a thought about me so I stop looking in the mirror and I face the door (Steps
1, 3, and 4); I also may keep an eye on you to make sure you are just trying to get to
another floor on the elevator and not trying to steal my wallet (Step 2).

REFERENCE
Winner, M. (2002). Thinking about you thinking about me. San Jose, CA: Michelle Garcia
Winner.
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FURTHER INFORMATION
Winner, M. (2005). Think social! A social thinking curriculum for school aged students. San Jose,
CA: Michelle Garcia Winner.
MICHELLE GARCIA WINNER AND JAMIE RIVETTS

FRAGILE X SYNDROME
Fragile X syndrome (fragile X) is the most common inherited form of mental retar-
dation. A single mutated gene, which is found on the X chromosome and passed down
from one generation to the next, causes fragile X. The body’s building blocks are made
up of proteins that perform specific jobs needed for the body’s chemical functions and
for the structure of organs and tissues. Fragile X occurs because a specific gene, the
FMR1 gene, is not able to make usable amounts of a specific protein. The amount of
fragile X mental retardation protein (FMRP) determines how mild or severe the symp-
toms of fragile X are in a body. The less FMRP levels in the body, the more severe
the symptoms.
The gene that causes fragile X was discovered in 1991 by scientists at the National
Institute of Child Health and Human Development (NICHD). International research-
ers continue to study fragile X and are working to find medical and preventative treat-
ments as well as effective therapeutic strategies for the syndrome.
The range of physical signs and symptoms varies. Often infants and children with
fragile X have no discernable features from other children until they reach puberty.
Some young children may have very soft skin, a broad forehead, or a bit larger head
circumference than their typical counterparts. At puberty, however, more discernable
features often develop. These might include a longer face or jaw, and large ears. Often
individuals with fragile X do not grow as tall as might be expected based on the
height of others in their family. Many males develop what is called macro-orchidism,
or enlarged testicles, which does not affect sexual development and is not caused by a
hormonal imbalance.
Other symptoms that might occur in fragile X are caused by loose or weak connective
tissues. This can be manifested by loose or flexible joints, flat feet, and the ability to
extend thumb, knee, and elbow joints further than what is considered normal. Sometimes
weak connective tissues can cause a heart murmur or mitral valve prolapse. Older indi-
viduals with fragile X syndrome may develop hand tremors or have difficulty walking.
Females with fragile X are affected differently than males. Since females have two
X chromosomes, they will have only one FMRP1 gene that is mutated and another
that is normal. Cells randomly choose which gene on a chromosome will be used to
make proteins, so if the gene that makes normal amounts of the FMRP is active, then
the female, even with a full mutation, will be able to make some of the needed pro-
tein. Therefore, symptoms in females with fragile X are less severe and occur less often
than symptoms in males.
One significant effect of a permutation form of the fragile X gene in females is
called premature ovarian failure (POF). It is found in 16 to 19 percent of females with
the permutation gene. Women with POF stop ovarian function very early, often
before their forties, and sometimes as early as their twenties (the average age for men-
opause in normal females is 51). The possibility of early menopause can be a signifi-
cant issue for women considering pregnancy, so early knowledge of the gene is a must.
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FREE AND APPROPRIATE PUBLIC EDUCATION (FAPE)

Anxiety, social fears, and sensory issues are characteristic of individuals with fragile
X. They may have difficulty in social situations or meeting new people, and therefore
avoid situations that might make them nervous, anxious, or uncomfortable. They may
be oversensitive to sounds, lights, temperatures, textures, or movement. Transitions or
a change in routine can sometimes be difficult. Often the individual’s reaction to
overstimulation, anxiety, or sensory input can be so heightened that his behavior can
potentially escalate to aggression or self-injurious behavior. The anxiety level in males
with fragile X appears to last longer than in their typical peers.
There is a strong association of fragile X and autism. Children with fragile X exhibit
many of the same characteristics as those with autism, but do not necessarily meet the
full criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSW-IV-
TR; APA, 2000) definition. In recent years, researchers have found that a significant
subgroup of children with fragile X also have autism. Bailey found that 25 percent of
boys with fragile X met the criteria of autism using the Childhood Autism Rating
Scale (Bailey, Hatton, Skinner, & Mesibov, 2001), and that they characteristically
appeared very similar to children with autism without fragile X. Rogers, Wehner, and
Hagerman (2001) found 15 to 33 percent of the children they evaluated with fragile
X syndrome met the criteria for autism. Further research is needed to determine the
causal genetic factors of fragile X to autism. At this time, fragile X is the most com-
mon genetically known cause of autism.

REFERENCES
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th
ed., text rev.). Washington, DC: Author.
Bailey, D. B., Hatton, D. D., Skinner, M., & Mesibov, G. (2001). Autistic behavior, FMR1 pro-
tein, and developmental trajectories in young males with fragile X syndrome. Journal of Au-
tism and Developmental Disorders, 31(2), 165–174.
National Institute of Child Health & Human Development. (2006). What are the signs and
symptoms of Fragile X syndrome? Retrieved November 16, 2006, from www.nichd.nih.gov/
publicatios/pubs/fragileX/sub8.htm.
Rogers, S. J., Wehner, E. A., & Hagerman, R. (2001). The behavioral phenotype in fragile X:
Symptoms of autism in very young children with fragile X syndrome, idiopathic autism, and
other developmental disorders. Journal of Developmental & Behavioral Pediatrics, 22(6), 409–417.

FURTHER INFORMATION
Bailey, D. B., Jr., Hatton, D. D., Mesibov, G., Ament, N., & Skinner, M. (2000). Early devel-
opment, temperament and functional impairment in autism and fragile X syndrome. Journal
of Autism and Developmental Disorders, 30(1), 49–59.
The National Fragile X Foundation. (February 3, 2006). How do the behaviors seen in persons with
Fragile X relate to those seen in autism? Retrieved August 11, 2006, from www.fragilex.org/html/
autism.htm.
ANN PILEWSKIE

FREE AND APPROPRIATE PUBLIC EDUCATION (FAPE)

As part of the Individuals with Disabilities Education Act, Part B, every school
district must provide a free and appropriate public education (FAPE) for children with
disabilities. By definition, all special education and related services should be provided
to the student with a disability at no cost to his or her parents. In general, all students
of school age are provided a free and appropriate public education.
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 FREE AND APPROPRIATE PUBLIC EDUCATION (FAPE)

The Individuals with Disabilities Education Act defines FAPE as special education
and related services that (a) have been provided at public expense without charge to
the parents; (b) meet the standards of the state educational agency; (c) include an
appropriate preschool, elementary, or secondary school education in the state
involved; and (d) are provided in conformity with the student’s individualized educa-
tion program (20 U.S.C.A. § 1401(8)) [2004]. IDEA defines FAPE but does not set
any requirements or standards, which has troubled many school districts and parents.
The definition of what is appropriate education has led many families to the federal
court to decide what is appropriate for their student’s education.
FAPE is best defined as an individualized program designed to meet the child’s
unique needs and from which the child receives educational benefit. The definition of
FAPE first came under scrutiny with Board of Education of the Hendrick Hudson School
District v. Rowley (1982). This case reached the U.S. Supreme Court, with the court
developing a two-part test to determine if a school district provided a free and appro-
priate public education. The first part of the test verified that the procedural require-
ments of IDEA were followed during the development of the IEP. The second part
determined if the IEP developed adhered to all of the law’s procedural requirements
and was reasonably calculated to enable the student to receive educational benefits.
The Supreme Court decided that the school district did adhere to both parts of the
test and that an appropriate education did not mean providing the student with a dis-
ability the best education possible (Fielder, 2000).
Many court cases followed Rowley regarding autism spectrum disorders and specific
instructional approaches or methodologies. The courts have consistently declared that
as long as an appropriate educational program is provided, the choice of approach or
methodology is within the school’s discretion. That being said, if the student’s parents
can prove that the school’s methodology is not producing educational benefits, then
some courts have ordered school districts to use a specific methodology. This excep-
tion only applied to cases where the methodology requested showed educational
results and the school’s methodology did not.
Placements of students with disabilities have also been questioned when discussing
FAPE. According to IDEA, school districts must follow specific requirements in deter-
mining placement. These requirements are as follows:

¥ The placement must be based on the student’s Individualized Education Program (IEP)
and be designed as the most appropriate setting where the required special education
and related services can be delivered (IDEA Regulations, 34 C.F.R. Sec. 300.
552(a)(2)).

The educational placement must be determined at least annually (IDEA Regula-

tions, 34 C.F.R. Sec 300. 552(a)(1)).

¥ The placement must comply with the least restrictive environment requirement (IDEA
Regulations, 34 C.F.R. Sec. 300. 553(a)(4)).

Any placement of a student with a disability must be made by the IEP team after
the IEP is written. Disagreements regarding placement in an IEP by parents may go to
mediation or due process if the school and parents cannot come to an agreement.
147
FUNCTIONAL ANALYSIS SCREENING TOOL (FAST)

REFERENCES
Board of Education of the Hendrick Hudson School District v. Rowley, 458 U.S. 176 (1982).
Fiedler, C. R. (2000). Making a difference: Advocacy competencies for special education professionals.
Boston: Allyn and Bacon.
Individuals with Disabilities Education Act, 20 U.S.C.A. § 1401(8) (2002).
U.S. Department of Education. (1992). IDEA Part B Regulations, 34 C.F.R. Sections 300. 500–
662.
MELISSA L. TRAUTMAN

FUNCTIONAL ANALYSIS SCREENING TOOL (FAST)

The Functional Analysis Screening Tool (FAST; Iwata & DeLeon, 1996) is a
behavior rating scale used to identify factors that may influence the occurrence of
behavior problems. Designed to be a component of a comprehensive functional analy-
sis, the FAST’s 18 items are yes-no questions completed by a parent, therapist,
teacher, or residential staff member. The ‘‘yes’’ items correspond with ‘‘likely main-
taining variables,’’ which include social reinforcement (attention/preferred items),
social reinforcement (escape), automatic reinforcement (sensory stimulation), and
automatic reinforcement (pain attenuation).

REFERENCE
Iwata, B. & DeLeon, I. G (1996). The functional analysis screening tool. Gainesville, FL: The
Florida Center on Self-Injury.
JEANNE HOLVERSTOTT

FUNCTIONAL BEHAVIOR ANALYSIS

Functional behavior analysis is a technique for analyzing relationships between behav-
ior and the environment (Pierce & Cheney, 2004). Functional behavior analysis
involves manipulating antecedents (before) and consequences (after) in a highly con-
trolled environment to determine their controlling functions (Mace, Lalli, & Lalli,
1991; Gresham, Watson, & Skinner, 2001; Pierce & Cheney, 2004). Before conducting
functional behavior analysis, information needs to be gathered through observation or
interview, and hypotheses should be generated. The purpose of conducting functional
analysis is to (a) define problem behaviors, (b) find stimuli that extinguish problem
behaviors, and (c) identify functions of problem behaviors (Foster-Johnson & Dunlap,
1993; Horner & Carr, 1997; O’Neill, Homer, Albin, Sprague, Storey, et al., 1997).
Functional behavior analysis is not generally used in school settings, and it is re-
served for the most severe behaviors under the most controlled conditions since it
requires intensive time and controlled conditions (Bowen, Jenson, & Clark, 2004).

REFERENCES
Bowen, J. M., Jenson, W. R., & Clark, E. (2004). School-based interventions for students with
behavior problems. New York: Springer.
Foster-Johnson, L., & Dunlap, G. (1993). Using functional assessment to develop effective indi-
vidualized intervention for challenging behaviors. Teaching Exceptional Children, 25, 44–50.
Gresham, F. M., Watson, T. S., & Skinner, C. H. (2001). Functional behavioral assessment:
Principles, procedures, and future directions. School Psychology Review, 30, 156–172.
Horner, R. H., & Carr, E. G. (1997). Behavioral support for students with severe disabilities:
Functional assessment and comprehensive intervention. Journal of Special Education, 31, 84–
104.

148
 FUNCTIONAL GOALS

Mace, F. C., Lalli, J. S., & Lalli, E. P. (1991). Functional analysis and treatment of aberrant
behavior. Research in Developmental Disabilities, 12, 155–180.
O’Neill, R. E., Homer, R. H., Albin, R. W., Sprague, J. R., Storey, K., & Newton, J. S. (1997).
Functional assessment and program development for problem behavior: A practical handbook. Bel-
mont, CA: Wadsworth.
Pierce, W. D., & Cheney, C. D. (2004). Behavior analysis and learning (3rd ed.). Mahwah, NJ:
Lawrence Erlbaum Associates.
HYE RAN PARK

FUNCTIONAL BEHAVIOR ASSESSMENT (FBA)

Functional behavior assessment is based on research in applied behavior analysis. It
provides a method of examining relationships between and generating hypotheses
about the antecedents and consequences that trigger or maintain behaviors (Dunlap
et al., 1993; Ervin et al., 2000; Iwata, Vollmer, & Zarcone, 1990). The purpose of
conducting an FBA is to determine (a) discriminative stimuli or antecedents that
elicit problem behavior, and (b) the reinforcing consequences that maintain the prob-
lem behavior (Erickson, Stage, & Nelson, 2006).
The FBA consists of two stages. The first stage consists of teacher interviews, direct
observation/descriptive assessment, and hypothesis development. The second stage
includes functional analysis to test the conditions that are hypothesized to be maintain-
ing the students’ disruptive behaviors, and potential interventions based on the condi-
tions that maintain appropriate behavior (Ervin et al., 2000; Kamps et al., 1995).

REFERENCES
Dunlap, G., Kern, L., dePerczel, M., Clarke, S., Wilson, D., Childs, K. E., & White, R. L.
(1993). Functional analysis of classroom variables for students with emotional and behavioral
disorders. Behavioral Disorders, 18, 275–291.
Erickson, M. J., Stage, S. A., & Nelson, J. R. (2006). Naturalistic study of the behavior of stu-
dents with EBD referred for functional behavior assessment. Journal of Emotional and Behav-
ioral Disorders, 14, 31–40.
Ervin, R. A., Kern, L., Clarke, S., DuPaul, G. J., Dunlap, G., & Friman, P. C. (2000). Evaluat-
ing assessment based intervention strategies for students with ADHD and comorbid disorders
within natural classroom context. Behavioral Disorder, 25, 344–358.
Iwata, B. A., Vollmer, T. R., & Zarcone, J. R. (1990). The experimental (functional) analysis
of behavior disorders: Methodology, applications, and limitations. In A. C. Repp & N. N.
Singh (Eds.), Perspectives on the use of nonaversive and aversive interventions for persons with
developmental disabilities (pp. 301–330). Sycamore, IL: Sycamore Publishing Company.
Kamps, D., Ellis, C., Mancina, C., Wyble, J., Greene, L., & Harvey, D. (1995). Case studies
using functional analysis for young children with behavioral risks. Education and Treatment of
Children, 18, 243–260.
HYE RAN PARK

FUNCTIONAL GOALS
Functional goals are based on the ultimate desired, postschool outcome for an indi-
vidual. According to Cronin and Patton (1993), functional goals should be based on
‘‘events or activities typically encountered by most adults in everyday life.’’ Essentially,
the idea is to determine the most important goals for an individual to achieve opti-
mum adult independence based on his or her needs and skills, as well as the needs of
the family and major life demands. Functional goals can include those in self-help
149
FUNCTIONAL LIMITATIONS

and daily living skills, as well as functional academics and social skills. These goals
are broken down into basic steps that are taught as functional skills.

REFERENCE
Cronin, M. E., & Patton, J. R. (1993). Life skills instruction for all students with special needs. Aus-
tin, TX: Pro-Ed.

FURTHER INFORMATION
Wehman, P, & Kregel, J. (2004). Functional curriculum for elementary, middle, and secondary age
students with special needs (2nd ed.). Austin, TX: Pro-Ed.
ANDREA M. BABKIE

FUNCTIONAL LIMITATIONS
Functional limitations refer to restrictions an individual may have in terms of devel-
opment of skills or cognitive abilities and the restrictions placed on him or her in
terms of opportunities to achieve. These limitations may include having difficultly
mastering, maintaining, and generalizing skills taught, including those in the aca-
demic, self-help, daily living, and social skills areas. Limitations also include behav-
ioral issues an individual may exhibit that interfere with successful integration into
the school or community setting.
From the perspective of restrictions placed on an individual, these may include non-
acceptance of differences, job or community requirements beyond an individual’s
skills, and the need to develop an understanding of how to work with the individual.
Additionally, the term functional limitations may be used to refer to the lack of
opportunities provided by the school and postschool settings to develop functional
skills, especially if the focus is academically based rather than a functionally based
curriculum.
ANDREA M. BABKIE

FUNCTIONALLY EQUIVALENT ALTERNATIVE BEHAVIOR

Functionally equivalent alternative behavior refers to the replacement of an unde-
sired behavior with a new, generally more acceptable or more effective alternative
behavior. This new behavior fulfills the same function as the behavior being replaced.
When considering what to teach as an alternative behavior, it is important to con-
sider what is socially appropriate, not only by parents, teachers, and other adults, but
also among peers and in community settings.
KATIE BASSITY

FUNCTIONAL MAGNETIC RESONANCE IMAGING (FMRI)

Functional magnetic resonance imaging (fMRI) is a neuroimaging technique used to
measure activity in structures of the brain. fMRI is different from a typical MRI scan in
that the fMRI is taken while the patient is involved with some mental exercise or activ-
ity, thus showing which parts of the brain are being activated and used for various
actions. This is crucial to understanding what areas of the brain may be different or
damaged in individuals with autism and could potentially help with treatment. One area
of intense fMRI study in autism has been the study of the fusiform gyrus.
150
 FUNCTIONAL SKILLS

FURTHER INFORMATION
Bremner, J. D. (2005). Brain imaging handbook. New York: W. W. Norton & Co.
PAUL G. LACAVA

FUNCTIONAL OUTCOMES
Functional outcomes refer to an individual achieving optimum independence in the
post-school environment, based on the individual’s development and on the provision
of an appropriate curriculum. Functional outcomes may be focused on academic goals,
and functional goals and skills that allow for successful integration into the adult
community (whether it be socially, occupationally, and/or residentially), or a combina-
tion of both. The goal for all students with ASD is to be a participating and involved
member of the community while school-aged and as an adult.
ANDREA M. BABKIE

FUNCTIONAL PROTEST TRAINING

Functional protest training involves teaching an appropriate, functional form of pro-
test to replace nonfunctional or undesired forms of protest. For example, if a student
screams when she experiences an unpleasant auditory experience, a more appropriate
form of protest would be for the student to cover her ears (for a nonverbal student) or
say ‘‘That hurts my ears’’ (for a verbal student).
KATIE BASSITY

FUNCTIONAL SKILLS
Functional skills are those skills necessary to progress successfully in school and life
and can include daily living and self-help skills as well as the academic and social
skills. The focus is to select and teach skills that the individual will use in immediate
and future environments, and to present or teach them in such a way that the skill
will be used routinely, allowing for maintenance and generalization. The decision on
what is a functional skill can be thought of as a process used by teachers to answer
questions such as ‘‘How, when, and where will my students use this knowledge now
and in the future?’’ (Weaver, Landers, & Adams, 1991). Depending on the age and
developmental level of the individual, as well as family desires, functional academic
skills may address: (a) reading for information (basic reading such as a recipe, a news-
paper article, a job application, a course, or a transportation schedule); (b) mathemati-
cal skills to allow personal independence (basic math skills, using a calculator,
comparing prices, making purchases); (c) science skills (such as reading a medication
chart); (d) social studies (registering to vote and voting, determining the appropriate
bus route in the community); and (e) social skills (communication, cooperation, prob-
lem-solving, self-initiation) among others (Cronin and Patton, 1993).
See also adaptive behavior; age appropriate; developmental age.

REFERENCES
Cronin, M. E., & Patton, J. R. (1993). Life skills instruction for all students with special needs. Aus-
tin, TX: Pro-Ed.
Weaver, R., Landers, M. F., & Adams, S. (1991). Making curriculum functional: Special educa-
tion and beyond. Intervention in School and Clinic, 25, 284–287.
ANDREA M. BABKIE
151
FUNCTIONS OF BEHAVIOR

FUNCTIONS OF BEHAVIOR
In the field of behavior analysis, it is believed that challenging behavior serves four
functions: escape/avoidance, attention, sensory, and tangible. Escape/avoidance refers
to behavior that is intended to allow the child to avoid a person or escape doing a
task. Behavior that seeks attention includes that which receives positive and negative
attention. Sensory and tangible functions are straightforward in that they seek some
type of sensory input and something tangible, respectively.
These functions may not be apparent to a caregiver in the midst of a challenging-
behavior situation. In addition, a single behavior may serve more than one function.
For example, through one behavior an individual may seek both to avoid an unpleas-
ant task and to gain a preferred item (escape/avoidance and tangible). The function of
a behavior can also evolve, beginning as an escape and evolving into attention seek-
ing as the individual finds the resulting attention rewarding. It is important to note
that behaviors can actually be strengthened if a consequence is put in place that does
not address the correct function of a behavior. For instance, if a child originally exhib-
its a behavior to escape a nonpreferred activity and receives reinforcement of the
behavior in the form of attention, the escape behavior is more likely to happen again
because the consequence, attention, is even more reinforcing than escaping the
activity.
KATIE BASSITY

FUNCTIONS OF COMMUNICATION
Functions of communication are the purposes for which one communicates. These
functions include requesting (i.e., ‘‘I want a ball’’), joint attention (shifting another’s
attention to an object, act, or topic), attracting attention (i.e., ‘‘Watch this!’’), com-
menting (i.e., ‘‘I like your new shoes’’), and protesting (i.e., ‘‘I don’t want to eat
that’’). Children with autism demonstrate a restricted pattern of communicative func-
tions, often protesting and requesting at higher frequencies than the other communi-
cative functions (Wetherby & Prizant, 1999).

REFERENCE
Wetherby, A., & Prizant, B. (1999). Enhancing language and communication development
in autism: Assessment and intervention guidelines. In D. B. Zager (Ed.), Autism: Identifica-
tion, education, and treatment (2nd ed., pp. 141–174). Mahwah, NJ: Lawrence Earlbaum
Associates.
JEANNE HOLVERSTOTT

FUSIFORM GYRUS
The fusiform gyrus (FG) is located in the temporal lobe of the cerebrum of the
human brain. Imaging studies have indicated that the FG is activated when processing
faces but that there is lower FG activation for those with autism. Further evidence has
highlighted that the FG is involved with the processing and perception of objects or
areas of expertise (such as categories, special interests, and so on). One vital area of
research being explored is how the FG operates within the network of other brain
regions and how this might be different and how it may affect social cognition for
those with autism.
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 FUSIFORM GYRUS

FURTHER INFORMATION
Gauthier, I., Tarr, M. J., Anderson, A. W., Skudlarski, P., & Gore, J. C. (1999). Activation of
the middle fusiform ‘‘face area’’ increases with expertise in recognizing novel objects [Elec-
tronic version]. Nature Neuroscience, 2, 568–573.
Haxby, J. V., Hoffman, E. A., & Gobbini, M. I. (2002). Human neural systems for face recogni-
tion and social communication [Electronic version]. Biological Psychiatry, 51, 59–67.
Herbert, M. R. (2004). Neuroimaging in disorders of social and emotional functioning: What is
the question [Electronic version]? Journal of Child Neurology, 19, 772–784.
Insell, T. R., & Fernald, R. D. (2004). How the brain processes social information: Searching
for the social brain [Electronic version]. Annual Review of Neuroscience, 27, 697–722.
Pierce, K., M€uller, R. A., Ambrose, J., Allen, G., & Courchesne, E. (2001). Face processing
occurs outside the fusiform ‘‘face area’’ in autism: Evidence from functional MRI. Brain, 124,
2059–2073
Puce, A., Allison, T., Gore, J. C., & McCarthy, G. (1995). Face-sensitive regions in human
extrastriate cortex studied by functional MRI [Electronic version]. Journal of Neurophysiology,
74, 1192–1199.
Sasson, N. J. (2006). The development of face processing in autism. Journal of Autism and Devel-
opmental Disorders, 36, 381–394.
Schultz, R. T., Grelotti, D. J., Klin, A., Kleinman, J., Van der Gaag, C., Marois, R., et al.
(2003). The role of the fusiform face area in social cognition: Implications for the pathobiol-
ogy of autism [Electronic version]. Philosophical Transactions of the Royal Society, 358, 415–27.
PAUL G. LACAVA

153
 G
GENERAL CASE PROGRAMMING
General case programming is a generalization strategy where multiple examples of a
concept or behavior, and systematically varying aspects of the training or intervention,
are utilized to increase the success of skill generalization to novel situations.
KATHERINE E. COOK

GENERALIZATION
Generalization occurs when a behavior can withstand many environments (settings
and people) over time, and that one behavior can affect behavior change in other
associated areas (Baer, Wolf, & Risley, 1968). For example, a child has generalized
learning the color blue when he or she can point to any blue object in an environ-
ment at any time and label that object as blue.

REFERENCE
Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of applied behavior
analysis. Journal of Applied Behavior Analysis, 1(1), 1–7.
TARA MIHOK

GENETIC FACTORS/HEREDITY
The myth of autism being caused by inappropriate parenting or parental bonding
with the infant has been shattered by scientific research over the last four decades.
Although parenting abilities don’t cause autism, research supports a genetic compo-
nent to this disability. As with many other areas, the field of autism has been the ben-
eficiary of genetic research over the last few decades. It has become clear that autism
is a disability that is predisposed in some individuals. This genetic susceptibility has
been shown in studies that have suggested that as many as 5 to 20 different genes
may be associated with autism. One of the most significant findings has been the
results of twin and family studies. These results have revealed that there is a much
higher rate of autism between identical twins, that a family member of someone with
autism has a higher probability of having an autism spectrum disorder than the typical
GENOTYPE

population, and that some disorders can be linked to genetic conditions such as fragile
X syndrome.
See also twin studies.

FURTHER INFORMATION
Pericak-Vance, M. A. (2003). Discovering the genetics of autism. USA Today, 131, 56–57.
PAUL G. LACAVA

GENOTYPE
Genotype refers to the internally coded, inheritable information carried by all liv-
ing organisms. This stored information is used as a blueprint or set of instructions for
building and maintaining a living creature. These instructions are found within
almost all cells (the internal part), they are written in a coded language (the genetic
code), they are copied at the time of cell division or reproduction, and they are
passed from one generation to the next (inheritable). These instructions are inti-
mately involved with all aspects of the life of a cell or an organism. They control
everything from the formation of protein macromolecules, to the regulation of metab-
olism and synthesis. On-going research studies are being conducted to identify the au-
tism genotype.
JEANNE HOLVERSTOTT

GENTLE TEACHING (GT)

Gentle teaching (GT) was originally defined as a nonaversive approach to dealing
with challenging behaviors (McGee, Menolascino, Hobbs, & Menousek, 1987). It is a
broad term based on a philosophical approach that emphasizes mutual bonding
between caregivers and persons with behavior difficulties. As such, it is considered an
alternative to any kind of aversive intervention used by parents and professionals.
The term gentle teaching was first introduced by McGee in 1985 (Jones, McCaughey,
Connell, & Clwyd Health Authority, 1991; McGee, 1985a, b). McGee (1985b) suc-
cessfully applied gentle teaching to more than 650 persons, ranging from those with
severe to profound mental retardation and persistent self-injurious behaviors (Menola-
sino & McGee, 1983) to persons with mild to moderate mental retardation and a
range of mental illnesses such as depression and schizophrenia (Menolascino &
McGee, 1983) over a 5-year period. The results showed a decrease in maladaptive
behaviors.
More recently, McGee and Menolascino (1991) redefined GT as a psychology of
interdependence between caregivers and persons with behavioral difficulties. This rela-
tionship requires mutual change, starting with the need for caregivers to analyze and
increase their value-centered interactions and decrease dominative ones.
To differentiate GT from behaviorism, McGee (1990) explained its basic assump-
tions as follows: (a) frequent and unconditional value giving is central to the interac-
tional exchange; (b) everyone has an inherent longing for affection and warmth; (c)
dominating actions, such as the use of restraint and punishment, need to be decreased
and replaced with value-centered behaviors; and (d) change in both the caregiver and
the person exhibiting maladaptive behaviors is critical.
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 GENTLE TEACHING (GT)

According to McGee (1992), GT is distinct from applied behavior analysis in its

unconditional valuing, its focus on mutual change, its analysis and measurement of
dyadic variables, and its underlying assumptions. However, past behavioral research
contributed to GT using various applied behavioral analysis techniques and the use of
the following supportive techniques for enhancing relationships and decreasing chal-
lenging behaviors were recommended: (a) errorless teaching strategies, (b) task analy-
sis, (c) environmental management, (d) precise and conservative prompting, (e)
identification of precursors to target behavior, (f) reduction of verbal instructions or
verbal and physical demands, (g) choice making, (h) fading assistance, and (i) integra-
tion of other caregivers and peers into the relationships (McGee et al., 1987).
Since McGee (1985a) published his first study on the effects of GT, several
researchers have reported positive outcomes of this approach (Jones et al., 1991; Jor-
dan, Singh, & Repp, 1989; Kelley & Stone, 1989; Paisey, Whitney, & Moore, 1989;
Polirstok, Dana, Buono, Mongelli, & Trubia, 2003). However, several studies have
reported negative effects. Some suggested that GT, while not harmful, was not effec-
tive (Cullen & Mappin, 1998). Others noted that GT might have potential risks for
people who show aggression, including self-injurious behavior (Barrera & Teodoro,
1990; Emerson, 1990).
In addition, the original concept of GT has been criticized because the strategies
used were not different from those of applied behavior analysis, and no clear definition
of GT has been provided to examine the effectiveness of GT. Moreover, its research
methodology was limited to conclude that GT is effective. For example McGee
(1985b) did not control extraneous variables and did not have a baseline to be com-
pared. Since the original reports of GT did not include quantification of behavior
change or criteria for how to determine successful results, more information is needed
to support an objective review of this approach (Mudford, 1995; Simpson et al.,
2005).
Primarily, gentle teaching is a philosophical approach used with individuals with
disabilities as an alternative to aversive intervention. To date, few empirical studies
have reported evidence-based research on gentle teaching.
See also empirical evidence.

REFERENCES
Barrera, F. J., & Teodoro, G. M. (1990). Flash bonding or cold fusion? A case analysis of gentle
teaching. In A. C. Repp & N. N. Singh (Eds.), Current perspectives on the use of aversive and
non-aversive interventions with developmentally disabled persons (pp. 199–214). Sycamore, IL:
Sycamore.
Cullen, C., & Mappin, R. (1998). An examination of the effects of gentle teaching on people
with complex learning disabilities and challenging behavior. British Journal of Clinical Psychol-
ogy, 37, 199–211.
Emerson, E. (1990). Some challenges presented by severe self-injurious behaviour. Mental Hand-
icap, 18, 92–98.
Jones, R., McCaughey, R., Connell, E., & Clwyd Health Authority (1991). The philosophy and
practice of gentle teaching: Implication for mental handicap services. The Irish Journal of Psy-
chology, 12, 1–16.
Jordan, J., Singh, N., & Repp, A. (1989). An evaluation of gentle teaching and visual screening
in the reduction of stereotypy. Journal of Applied Behavior Analysis, 22, 9–22.
Kelley, B., & Stone, J. (1989). Gentle teaching in the classroom. Entourage, 4, 15–19.

157
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McGee, J. J. (1985a). Gentle teaching. Mental Handicap in New Zealand, 9(3), 13–24.
McGee, J. J. (1985b). Examples of the use of gentle teaching. Mental Handicap in New Zealand,
9(4), 11–20.
McGee, J. J. (1990). Gentle teaching: The basic tenet. Metal Handicap Nursing, 86, 68–72.
McGee, J. J. (1992). Gentle teaching’s assumptions and paradigm. Journal of Applied Behavior
Analysis, 25, 869–872.
McGee, J. J., & Menolascino, F. J. (1991). Beyond gentle teaching: A non-aversive approach to
helping those in need. New York: Plenum Press.
McGee, J. J., Menolascino, F. J., Hobbs, D. C., & Menousek, P. E. (1987). Gentle Teaching: A
non-aversive approach to helping persons with mental retardation. New York: Human Sciences
Press.
Menolascino, F. J., & McGee, J. J. (1983). Persons with severe mental retardation and behav-
ioral challenges: From disconnectedness to human engagement. Journal of Psychiatric Treat-
ment and Evaluation, 5, 187–193.
Mudford, O. C. (1995). Review of the gentle teaching data. American Journal of Mental Retarda-
tion, 99, 345–355.
Paisey, T. J., Whitney, R. B., & Moore, J. (1989). Person-treatment interactions across nonaver-
sive response-deceleration procedures for self-injury: A case study of effects and side effects.
Behavioral Residential Treatment, 4, 69–88.
Polirstock. S. R., Dana, L., Buono, S., Mongelli, V., & Trubia, G. (2003). Improving functional
communication skills in adolescents and young adults with severe autism using gentle teach-
ing and positive approaches. Topics in Language Disorders, 23, 146–153.
Simpson, R. L., Boer-Ott, S. R., Griswold, D. E., Myles, B. S., Byrd, S. E., Ganz, J. B., Cook,
K. T., Otten, K. L., Ben-Arieh, J., Kline, S. A., & Adams, L. G. (2005). Autism spectrum dis-
orders: Interventions and treatments for children and youth. Thousand Oaks, CA: Corwin Press.

FURTHER INFORMATION
Gentle teaching: http://www.gentleteaching.nl.
Gentle teaching international: http://www.gentleteaching.com.
HYO JUNG LEE

GIFTEDNESS
Extreme giftedness, or savant skills, is rare and typically seen in individuals with
some degree of mental handicap, hence the original (now unused) term of idiot sav-
ants, although the presence of mental handicap is not guaranteed. Around 2 to 3 per-
cent of the general population have a mental handicap, but only around 0.06 percent
of those individuals are estimated to have the exceptionally high level of ability in a
certain area that goes beyond what the average individual can achieve (Hermelin,
2001). Savant skills are found more frequently in individuals with autism than in any
other population, however there would still only be 1 or 2 individuals in every 200
with autism who have such abilities.
Areas of savant skill typically include the following: numbers and math, calendrical
calculations, drawing and art, date memory, and musical ability. Hermelin (2001) also
reports poetry skills and skills with foreign languages.
Individuals with number and math savant skills are capable of doing complex and
vast mathematical calculations in their heads. Those who are calendrical calculators
can tell you exactly what day a certain date will fall on any time for the past or
future. Savants with drawing skills are capable of artwork such as producing phenome-
nal, accurate, and proportioned pictures with perspective from a very early age. A
well-known autistic artist with this ability is Stephen Wiltshire. Oliver Sachs (1995)
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 GILLIAM ASPERGER DISORDER SCALE (GADS)

wrote an excellent essay on Wiltshire’s talent and artistic ability in contrast to his au-
tism. Savants with date memory can tell you exactly what was happening, what peo-
ple were wearing, or give you the exact date for an event when asked, no matter how
insignificant that event may seem to others. Those with musical savant skills often
have perfect pitch and can hear every note accurately. They are able to perform such
feats as sitting in front of a piano, having never learned to play, and reproducing com-
plex pieces of classical music. Frith (2003) cites the case of Nigel, a man unable to
look after himself who is nevertheless a sought-after classical pianist capable of playing
any piece after having heard it only once. Those with skills in poetry or in foreign
languages show an aptitude beyond their general abilities and beyond those of others
around them. Smith and Tsimpli (1995), for example, discuss the case of Christopher,
a multilingual savant who has learned to speak dozens of languages fluently.
There is some uncertainty about how savants possess the skills they do while at the
same time often having learning disabilities. Nettlebeck (1999) suggests that general
theories of intelligence cannot account for the phenomena. Many researchers suggest
that it may be something to do with the tendency in autism to focus on details, on
piece-meal processing, building up connecting units of information or details rather
than focusing on the bigger picture (Frith, 2003; Mottron & Belleville, 1993; Heaton,
Pring, & Hermelin, 1998), and some have attempted to design computer programs
that can mimic the savant skills, for example of calendrical calculation (Norris,
1990). Whatever the theories, savant skills and giftedness is one area that highlights
the strengths and amazing capabilities of those who are seen otherwise to be low func-
tioning and disabled.

REFERENCES
Frith, U. (2003). Autism: Explaining the enigma (2nd ed.). Oxford: Blackwell Publishing.
Heaton, P., Pring, L., & Hermelin, B. (1998). Autism and pitch processing: A precursor for sa-
vant musical ability. Music Perception, 15, 291–305.
Hermelin, B. (2001). Bright splinters of the mind: A personal story of research with autistic savants.
London: Jessica Kingsley Publishing.
Mottron, L., & Belleville, S. (1993). A study of perceptual analysis in a high level autistic sub-
ject with exceptional graphic abilities. Brain and Cognition, 23, 279–309.
Nettlebeck, T. (1999). Savant skills–rhyme without reason. In M. Anderson (Ed.), The develop-
ment of intelligence (pp. 247–273). Hove: Psychology Press.
Norris, D. (1990). How to build a connectionist idiot (savant). Cognition, 35, 277–291.
Sacks, O. (1995). An anthropologist on Mars. London: Picador.
Smith, N., & Tsimpli, I. M. (1995). The mind of a savant: Language learning and modularity.
Oxford: Blackwell Publishing.
FIONA J. SCOTT

GILLIAM ASPERGER DISORDER SCALE (GADS)

The Gilliam Asperger Disorder Scale (GADS; Gilliam, 2001) is an instrument used
for the assessment of individuals ages 3 through 22. This tool can be used by anyone
who has direct contact with the individual such as teachers, parents, and other team
members. The scale consists of sections including: Restricted Pattern of Behavior,
Cognitive Patterns, Pragmatic Skills, Early Development, and Key Questions. The
GADS can be used to identify individuals with Asperger syndrome, assess people
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GILLIAM AUTISM RATING SCALE (GARS)

referred for behavior challenges, document progress in the area of behavior problems,
and target goals for Individualized Education Programs.
See also cognitive processes; pragmatics.

REFERENCE
Gilliam, J. (2001). Gilliam Asperger disorder scale. Austin, TX: Pro-Ed.
BROOKE YOUNG

GILLIAM AUTISM RATING SCALE (GARS)

The Gilliam Autism Rating Scale (GARS) is a standardized, norm-referenced, be-
havioral checklist used to identify and measure changes in programming for individu-
als with autism ages 3 to 22. The checklist is divided into three subscales: stereotyped
behaviors, communication, and social interaction. Items on the GARS are measurable
by objective frequency of behavior; therefore, direct observation is necessary. Parents
and/or professionals at school or home can complete these scales in 5 to 10 minutes.
See also norm-referenced assessment; standardization.

FURTHER INFORMATION
Gilliam, J. E. (1995). Gilliam autism rating scale examiner’s manual. Austin, TX: Pro-Ed.
MELANIE D. HARMS

GLUTEN-FREE
Gluten is a wheat protein found in wheat, rye, and barley. A gluten-free diet
excludes any food or drink that either contains gluten or could have potentially been
contaminated by gluten; it is thought that most sources of oats are contaminated with
gluten as well. Gluten is found in common foods such as breads, pastas, cookies, cereals,
and luncheon meats. It can also be hidden in other foods with ambiguous ingredients
such as natural flavoring, artificial flavorings, and caramel color. In these cases, calling
the food manufacturer usually clears up questions regarding gluten in the products.
Some families of children with autism spectrum disorder have decided to try a gluten-
free/casein-free diet believing that gluten and casein may adversely affect their child’s
neurological processes. Some parents report that removing gluten and casein from their
child’s diet results in increased attention as well as reduced tantrums and aggression.
See also diet; diet therapy.

FURTHER INFORMATION
Celiac Disease and Gluten-free Diet Support Center, www.celiac.com.
Gluten Intolerance Group of North American, www.gluten.net.
MAYA ISRAEL

GOOD GRIEF!
Children with autism spectrum disorders (ASD) face myriad challenges as they en-
counter life’s disappointments. Loss is at the center of many struggles. Sometimes, the
loss experienced by a child with ASD is perceived similarly to that of a typical child,
but frequently the child with ASD demonstrates responses that are similar in content
but different in intensity. For example, their responses, though conventional in topic
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or format, may be characterized by an increased or decreased amount of emotion, end-

less repetition, and/or seemingly timeless duration. On other occasions, children with
ASD may respond in ways that are genuinely unique!
Parents and professionals need guidelines to help them provide individuals with
ASD the support they need to learn from life’s unanticipated setbacks, whether it is
the loss of a favorite toy (considered a day-to-day loss) or the loss of a loved one
(death & dying). Over time, this translates into an effort to teach children with ASD
to tie their experiences together and use the information gained when presented with
future obstacles.
To help individuals with ASD turn life’s losses into learning opportunities (i.e.,
‘‘good grief’’), parents and professionals may find the following guidelines helpful
(Gray, 2003):

1. Abandon Assumptions: ‘‘Start from social scratch’’ by replacing our confidence in being
able to interpret the behavior of persons with ASD with respect for their differences. This
involves considering an event alongside what we know about how that child perceives
the social world.
2. Advance Notice: Gather information before it is needed. In this matter of loss, this refers
to the process of gathering background information and using activities (i.e., Social Sto-
ries or similar methods) to share what we’ve learned—that is, to provide the benefit of
‘‘knowing what to do’’ ahead of time.
3. Accommodations and Analogies: Teach children with ASD abstract concepts with the use
of individually tailored vocabulary and examples. For children who interpret words liter-
ally, discussions about loss run the risk of frequent expressive and receptive misunder-
standing. Carefully choosing vocabulary or using analogies may bridge the gap between a
concept and comprehension.
4. Affirm Feelings: Use affirmation to acknowledge the validity and importance of the child’s
feelings without necessarily knowing what she is thinking or feeling. Affirmation says, ‘‘I
know you and I are currently in very different emotional places, and that’s okay. I am on
your team and we are in this together.’’ In instances where the source of distress is diffi-
cult to identify or the events leading up to it are hard to trace with any certainty, affirma-
tion plays a large and helpful role.
5. Associations: Teach appropriate associations. Children with ASD often associate loss with
negative emotion or mistakenly make a connection between two simultaneous but unre-
lated cues. The goal of Good Grief! is to encourage identification between accurate links
of past, present, and future experiences. Use strategies that gradually, step-by-step, lead to
cumulative learning and positive feelings of accomplishment.

Collectively these guidelines help children ‘‘move through’’ and learn from uncom-
fortable and/or unanticipated setbacks. In this way, losses become opportunities to
gain practical skills to navigate life’s unexpected twists and turns.

REFERENCE
Gray, C. (2003). Gray’s guide to loss, learning, and children with ASD. Jenison Autism
Journal, 15(3).
CAROL GRAY AND WHITNEY MITCHELL KRUSNIAK

GRADUATED GUIDANCE
Graduated guidance is the incremental adjustment of full physical prompts to assure
student success in a particular task. Graduated guidance is most frequently used for
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GRAPHIC ORGANIZER

tasks that are more complex or have multiple steps. However, it is not a preset system of
fading and relies heavily on the instructor’s judgment of student need. Prompts within
graduated guidance range from: (a) full hand-over-hand, (b) light touch, and (c) shadow-
ing. Graduated guidance can include both increasing and decreasing prompts with the
focus always on providing the level of support needed for a particular task at a particular
moment.
KATIE BASSITY

GRAPHIC ORGANIZER
Graphic organizers or content maps are visual strategies that display information in
a concrete and organized manner (see Figure 10). They take abstract information and
organize the concepts into simpler concepts, highlight important information, and dis-
play relationships. Graphic organizers can be
Figure 10 Venn Diagram Supporting Common used to structure writing projects, help in
Interests
problem solving, decision making, studying,
planning, and brainstorming. Graphic organ-
izers can be used prior to reading as an
advanced organizer, during reading to assist
with connecting key concepts, and after read-
ing to measure understanding.
According to Myles and Southwick, graphic
organizers often enhance the learning of stu-
dents with autism spectrum disorders because:

1. They are visual; this modality is often a strength for students.

2. They are static; they remain consistent and constant.
3. They allow for processing time; the student can reflect on the material at his own pace.
4. They are concrete and are more easily understood than a verbal-only presentation.
(p. 120, 2005)

See also cognitive learning strategies.

REFERENCE
Myles, B. S., & Southwick, J. (2005). Asperger syndrome and difficult moments: Practical solutions
for tantrums, rage, and meltdowns. Shawnee Mission, KS: Autism Asperger Publishing
Company.

FURTHER INFORMATION
Bromley, K., Irwin-DeVitis, L., & Modio, M. (1995). Graphic organizers: Visual strategies for
active learning. New York: Scholastic.
Wiig, E. H., & Wilson, C. C. (2001). Map it out: Visual tools for thinking, organizing, and commu-
nicating. Eau Claire, WI: Thinking Publications.
TERRI COOPER SWANSON

GRAVITATIONAL INSECURITY
Gravitational insecurity refers to difficulty maintaining balance and coordination of
movements along variable surfaces and inclines, such as stairs, a gravel walkway, or

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 GUIDED COMPLIANCE

icy sidewalk. Oftentimes, gravitational insecurity is a result of an inadequately func-

tioning vestibular and/or proprioceptive sensory system.
See also proprioception; sensory processing; sensory processing dysfunction.
KELLY M. PRESTIA

GROSS MOTOR DEVELOPMENTAL QUOTIENT

Gross motor development quotient is a score that refers to the results of standar-
dized tests that measure the use of the large muscle groups and gross motor skills.
See also standardization.
KELLY M. PRESTIA

GROSS MOTOR SKILLS

Gross motor skills is a term used to describe any activity that requires the use and
coordination of the larger muscle groups of the body, such as the legs, arms, or trunk.
Examples of gross motor skills include skipping, throwing a ball, or running.
KELLY M. PRESTIA

GUIDED COMPLIANCE
Guided compliance is the use of physical guidance through a task to cause a student
to comply with directions. Although similar to hand-over-hand assistance, guided
compliance is technically not a prompt; it acts as a consequence for noncompliance.
Guided compliance occurs after the student is given the opportunity to comply with
direction but does not comply and/or attempts to escape. The caregiver then places
her hands over the student’s hands, feet, or under the student’s arms (to aid in stand-
ing, moving, etc.) and physically guides the student through the task. Some research
suggests that the use of guided compliance is particularly effective when noncompli-
ance is accompanied by escape behaviors.
See also graduated guidance; prompting.
KATIE BASSITY

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 H
HABIT REHEARSAL
Habit rehearsal is the repetition of desired behaviors in order to build the behaviors
to fluency. Such rehearsals are performed in as functional or as realistic settings as pos-
sible so the desired behaviors can be easily performed in natural situations. Habit re-
hearsal is often used for training appropriate behaviors in stressful situations, such as
relaxation techniques.
KATIE BASSITY

HAIR ANALYSIS
Hair analysis measures the mineral content in hair. These types of analyses have
been employed to test for the presence of heavy metals, such as mercury, in epidemi-
ological efforts with regard to autism. According to the American Medical Associa-
tion, hair analysis may not be used in the determination of medical therapies (n.d.).
See also epidemiology.

REFERENCE
American Medical Association (n.d.). H-175.955 Hair analysis—a potential for medical abuse.
Retrieved on December 8, 2006, from www.ama-assn.org/apps/pf_new/pf_online?f_n=brows-
e&doc=policyfiles/HnE/H-175.995.HTM.

FURTHER INFORMATION
Kirby, D. (2005). Evidence of harm: Mercury in vaccines and the autism epidemic: A medical contro-
versy. New York: St. Martin’s Press.
Marhon, S. (2002). Natural medicine guide to autism. Charlottesville, VA: Hampton Roads Pub-
lishing Co.
MYRNA J. ROCK

HALSTEAD-REITAN NEUROPSYCHOLOGICAL TEST BATTERY (HRPTB)

The Halstead-Reitan Neuropsychological Test Battery (HRPTB; Reitan & Wolfson,
1993) is a set of eight tests used to evaluate brain and nervous system functioning in
individuals ages 15 years and older, typically for individuals with suspected brain dam-
age, by testing concept formation and abstract reasoning. Children’s versions are the
Halstead Neuropsychological Test Battery for Older Children (ages 9 to 14) and the Reitan
HAND-OVER-HAND ASSISTANCE (HOH)

Indiana Neuropsychological Test Battery (ages 5 to 8). The Halstead-Reitan evaluates a

wide range of nervous system and brain functions, including: visual, auditory, and tac-
tual input; verbal communication; spatial and sequential perception; the ability to an-
alyze information, form mental concepts, and make judgments; motor output; and
attention, concentration, and memory. The battery also provides useful information
regarding the cause of damage (e.g., closed head injury, alcohol abuse, Alzheimer’s dis-
order, stroke), which part of the brain was damaged, whether the damage occurred
during childhood development, and whether the damage is getting worse, staying the
same, or improving. Information regarding the severity of impairment and areas of per-
sonal strengths can be used to develop plans for rehabilitation or care.

REFERENCE
Reitan, R. M., & Wolfson, D. (1993). The Halstead-Reitan neuropsychological test battery: Theory
and clinical interpretation (2nd ed.). South Tucson, AZ: Neuropsychology Press.
JEANNE HOLVERSTOTT

HAND-OVER-HAND ASSISTANCE (HOH)

Hand-over-hand (HOH) assistance is the practice of an adult (or peer) placing his
or her hands over a student’s hands and physically moving the student through a
given process or task. HOH also applies to physically moving other parts of a student’s
body through a task. Also referred to as hand-over-hand prompting, it is the most
invasive form of prompting and is generally considered best to use only when other
prompts are ineffective or impractical, and should be faded as quickly as possible. Used
appropriately, HOH can be an effective tool; however, there is concern that overuse
of HOH assistance results in prompt dependence. In addition, some students may
resist HOH assistance as a result of desired independence or control, or because of an
aversion to touch. However, in some situations it may be the only way to provide as-
sistance and may be preferred over high rates of verbal prompting.
See also graduated guidance; guided compliance; prompting.
KATIE BASSITY

HAND REGARD
Hand regard is a behavior that is repetitive or sensory generating in nature and con-
sists of an individual looking at his fingers and/or hands. The fingers and hands can be
still or moving. This behavior is common in typically developing children around four
months of age but may persist for years for those with autism.

FURTHER INFORMATION
Accardo, P. J., Whitman, B. Y., Laszewski, C., Haake, C. A., & Morrow, J. D. (1996). Diction-
ary of developmental disabilities terminology. Baltimore: Brookes Publishing Co.
Oxbridge Solutions, Ltd. (2003). Hand regard. Retrieved May 18, 2006, from http://www.gpnote
book.co.uk/homepage.cfm.
PAUL G. LACAVA

HEAD CIRCUMFERENCE
Head circumference is the measured distance of the widest part of the human skull.
Typical development is measured in centimeters, and there are norms for sex and age.
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 HIDDEN CURRICULUM

Research from the 1990s into the 2000s has highlighted that some youngsters with au-
tism have atypical head circumference due to differences in brain volume. Increased
head circumference measured at birth and between 6 and 14 months was a finding in
one study for 59 percent of subjects with autism spectrum disorders (Courchesne, Carper,
& Akshoomoff, 2003). This head growth was significantly higher than typically develop-
ing youngsters from a reference group. This and other findings suggest that increased
head growth in infancy may be either a possible symptom or a risk marker for autism.

REFERENCE
Courchesne, E., Carper, R., & Akshoomoff, N. (2003). Evidence of brain overgrowth in the first
year of life of autism. Journal of the American Medical Association, 290, 337–344.

FURTHER INFORMATION
Courchesne, E. (2004). Brain development in autism: Early overgrowth followed by premature
arrest of growth. Mental Retardation and Developmental Disabilities Research Reviews, 10, 106–
111.
Lainhart, J. E. (2003). Increased rate of head growth during infancy in autism. Journal of the
American Medical Association, 290, 393–394.
PAUL G. LACAVA

HEAVY METALS
Heavy metals refer to any of a number of higher atomic weight elements, which
normally present as metallic substances at room temperatures. Living organisms require
trace amounts of some heavy metals, including cobalt, copper, manganese, molybde-
num, vanadium, strontium, and zinc, but excessive levels tend to accumulate, a proc-
ess that continues as organisms age (Harte, Holdren, Schneider, & Shirley, 1991).
Other heavy metals such as mercury, lead, and cadmium have no known vital or ben-
eficial effect on organisms, and their accumulation over time in the bodies of mam-
mals can exhibit toxic effects (Harte et al., 1991). Proponents of the relationship
between heavy metals and autism spectrum disorders point to the toxicity to the cen-
tral nervous system and multiple sources of exposure, including environmental (food,
water, dust) and medical (mercury preservatives in vaccinations). Chelation is the pre-
dominant treatment for heavy metal toxicity. Chelation involves the use of chelation
agents to bind to the metal and increase excretion.
See also vaccinations (thimerosal).

REFERENCE
Harte, J., Holdren, C., Schneider, R., & Shirley, C. (1991). Toxics a to z: A guide to everyday
pollution hazards. Sacramento, CA: University of California Press.
JEANNE HOLVERSTOTT

HELLER’S SYNDROME. See Childhood Disintegrative Disorder

HIDDEN CURRICULUM
The hidden curriculum is the set of rules that everyone in the school knows, but no
one has been directly taught (Bieber, 1994). Children with autism spectrum disorders
do not pick up on hidden curriculum items—they must be directly taught. Knowing
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HIGH-FUNCTIONING AUTISM

the hidden curriculum is essential as it helps the student be successful in understand-

ing: (a) teacher expectations, (b) a person’s body language, (c) if a person is really
their friend, and (d) how to interact or respond in social situations. It is essential to
incorporate the teaching of the hidden curriculum into any social skills curriculum as
well as teach them on a daily and on-going basis.

REFERENCE
Bieber, J. (Producer). (1994). Learning disabilities and social skills—Richard Lavoie: Last one picked
. . . first one picked on. Washington, DC: Public Broadcasting Service.

FURTHER INFORMATION
Myles, B. S., Trautman, M. L., & Schelvanm, R. L. (2004). The hidden curriculum: Practical solu-
tions for understanding unstated rules in social situations. Shawnee Mission, KS: Autism Asperger
Publishing Company.
TERRI COOPER SWANSON

HIGH-FUNCTIONING AUTISM
Although used frequently by professionals and parents, the term high-functioning
autism is not a true diagnosis in the Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV-TR; APA, 2000). In previous generations, the term was some-
times used to refer to a person with classic autism who had vocal abilities. Today,
high-functioning autism tends to be used as a short-hand term for autistic disorder with-
out mental retardation (an IQ above 70). It is estimated that at least 25 to 33 percent
of individuals diagnosed with autism today fall in the high-functioning category.
In order to be diagnosed with autistic disorder, an individual must have shown
delays or abnormalities in social interaction, symbolic or imaginative play, or social
use of language before age 3. In addition, the individual currently must show at least
two symptoms of ‘‘qualitative impairment in social interaction,’’ one symptom of
‘‘qualitative impairments in communication,’’ and one symptom of ‘‘restricted repeti-
tive and stereotyped patterns of behavior, interests, and activities’’ (APA, 2000).
There is significant disagreement today as to whether high-functioning autism and
Asperger syndrome are two distinct syndromes. The only difference in the DSM-IV-
TR criteria for autistic disorder and Asperger syndrome is that Asperger’s requires ‘‘no
clinically significant general delay in language (e.g., single words used by age 2 years,
communicative phrases used by age 3 years),’’ and ‘‘no clinically significant delay in
cognitive development or in the development of age-appropriate self-help skills, adapt-
ive behavior (other than in social interaction), and curiosity above the environment
in childhood’’ (APA, 2000). However, clinicians today report that people with
Asperger syndrome typically do have significant difficulties with self-help skills and
adaptive behavior (Attwood, 2006).
Some research suggests that the symptoms of high-functioning autism and Asperger’s
look different at an early age but are quite similar by adolescence or early adulthood.
Generally, a child with high-functioning autism is diagnosed earlier and tends to show
more severe and ‘‘classic’’ symptoms of autism. Overall, the average age for a diagnosis of
autism is 3, while children with Asperger syndrome are generally diagnosed at age 7 or 8.
Children with high-functioning autism or Asperger syndrome both tend to have dif-
ficulties in several common areas. Nonverbal communication (facial expressions and
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 HIGH-FUNCTIONING AUTISM

body language) can be difficult for many to decipher. They often will interpret figura-
tive speech (such as ‘‘go jump in a lake’’ or ‘‘drop dead’’) too literally. Most have trou-
ble understanding the ‘‘hidden curriculum’’ (unwritten social rules, such as how far
you should stand from someone, or when it’s okay to interrupt). Desire for ‘‘sameness’’
(having difficulty with change and transitions, and deriving comfort from routines) is
also common.
Often, children with high-functioning autism are described as ‘‘aloof,’’ having little
interest in interacting with other people, while children with Asperger syndrome seek
out interaction, but do so in an odd or inappropriate manner.
Both groups have ‘‘restricted, repetitive’’ behaviors or interests, but children with
high-functioning autism tend to perform more repetitive movements, especially odd
hand movements, such as finger flicking or hand flapping, and are more likely to be
interested in the parts of an object or in manipulating an object. These tend to be sol-
itary interests. Children with Asperger syndrome are more likely to spend their time
researching and accumulating vast amounts of information about a particular subject
and often seek to share their information with other children or adults.
Children with high-functioning autism and Asperger syndrome both tend to have
language difficulties, though qualitatively different ones, especially at a young age. Chil-
dren with high-functioning autism may have significant speech delays or at least lag
somewhat in general areas of speech such as vocabulary. They may engage in echolalia
(repeating whatever is said to them). Overall, they tend to have better nonverbal abil-
ities than verbal abilities. Conversely, many children with Asperger syndrome have
extremely advanced vocabularies, particularly in their areas of special interest (hence
the nickname ‘‘little professors’’). Rather than repeating a word or phrase over and over,
they tend more to repeat long monologues and ask repetitive questions. In fact, their
superficially perfect language may play a role in delaying their diagnosis.
Medically, children with high-functioning autism and Asperger syndrome may have
some differences. Children with high-functioning autism are more likely to suffer seiz-
ures than children with Asperger syndrome (although far less likely than children with
autism and mental retardation). Children with Asperger syndrome, on the other hand,
are more likely to have co-morbid diagnoses such as depression, ADHD, obsessive-
compulsive disorder, or Tourette’s disorder. Children with Asperger syndrome are also
more likely to have motor difficulties or sensory integration dysfunction.
Because the DSM-IV-TR diagnostic criteria are so similar, different clinicians might
give the same high-functioning child different diagnoses. For example, a clinician who
believes in following the diagnostic criteria to the letter might be inclined to diagnose a
4-year-old child with autistic disorder because the child failed to speak any words until
age 3. Another might diagnose Asperger syndrome based on the same child’s obsessive
interest in astronomy. A third might diagnose PDD-NOS, because he doesn’t want to
‘‘label’’ the child before age 5. And yet another might diagnose autism because she
knows that label will get the child more intervention services in the local school system.
Even among people diagnosed with Asperger syndrome or high-functioning autism
there is tremendous variability. Their symptoms vary, their strengths vary, their behav-
iors vary, and their likes and dislikes vary. Ultimately, whether the diagnosis is high-
functioning autism or Asperger syndrome, the most important thing is to look at each
individual’s strengths and weakness and to obtain appropriate intervention.
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HIPPOCAMPUS

REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
Attwood, T. Is there a difference between Asperger’s syndrome and high-functioning autism?
Retrieved August 25, 2006, from http://www.tonyattwood.com.au.

FURTHER INFORMATION
Eisenmajer, R., Prior, M., Leekam, S., Wing, L., Gould, J., Welham, M., et al. (1996). Compari-
son of clinical symptoms in autism and Asperger’s disorder. Journal of the American Academy
of Child and Adolescent Psychiatry, 35, 1523–1531.
Freeman, B. J., Cronin, P., & Candela, P. (2002). Asperger syndrome or autistic disorder? The
diagnostic dilemma. Focus on Autism and Other Developmental Disabilities, 17, 145–151.
Ozonoff, S., Dawson, G., & McPartland, J. (2002). A parent’s guide to Asperger syndrome and
high-functioning autism. New York: Guilford Press.
Powers, M. D. (2000). Children with autism: A parents’ guide. Bethesda, MD: Woodbine House.
Sciutto, M. J., & Cantwell, C. Factors influencing the differential diagnosis of Asperger’s disorder
and high-functioning autism. Journal of Developmental and Physical Disabilities, 17, 345–359.
Tryon, P. A., Mayes, S. D., Rhodes, R. L., & Waldo, M. (2006). Can Asperger’s disorder be dif-
ferentiated from autism using DSM-IV criteria? Focus on Autism and Other Developmental Dis-
abilities, 21, 2–6.
Wing, L. (2001). The autistic spectrum. Berkeley, CA: Ulysses Press.
LISA BARRETT MANN

HIPPOCAMPUS
Part of the limbic system, the hippocampus is involved in the formation of memo-
ries of experienced events and spatial orientation, or place memory and recognition. It
is located deep in the temporal lobes above the amygdala.
BRUCE BASSITY

HIPPOTHERAPY
Hippotherapy (Greek word hippos for horse) is a treatment that uses the movement
of the horse to improve physical mobility and cognitive functions for people with
varying disabilities. It takes the client out of the clinical setting and places them in a
natural environment to work on therapy goals. Physical therapists, occupational
therapists, and speech language pathologists who provide this treatment have special-
ized training in using the movement of the horse as a therapy tool. The hippotherapy
team includes the horse, rider, sidewalkers, and instructor.
Treatment strategies promote motor planning, mobility strength, and stimulation of
the central nervous system. Hippotherapy is considered an effective therapy method
because a horse’s gait mimics the human gait and a horse takes the same number of steps
per minute as a human (American Hippotherapy Association, 2005). The horse’s muscle
groups move forward, backward, up, down, and from side to side. The body responds to
the horse’s movement by trying to maintain balance, and therefore the rider develops
muscle tone, stretch, and strength to the same muscle groups that are used in sitting,
reaching, and walking. The rider’s senses are stimulated by the warmth, smell, sight, and
feel of the horse. In addition, riders connect emotionally with the horse, which makes
treatment fun, and professionals report an increase in attention span and memory skills.
Hippotherapy is used to treat a variety of diagnoses that include autism, cerebral
palsy, multiple sclerosis, developmental delay, traumatic brain and spinal cord injury,
170
 HOMEBOUND/HOSPITAL BOUND PROGRAM

Down syndrome, stroke, attention deficit disorders, learning or language disabilities,

and visual or hearing impairments. People of all ages can benefit from hippotherapy;
however, clients may be excluded if they weigh more that 300 lbs or more than 20
percent of the horse’s weight. In addition, a client might be excluded from the treat-
ment if they have brittle-bone osteoporosis, acute arthritis, curvature of the spine
greater than 30 degrees, degenerative hip joints, or are on anticoagulant medications
for heart conditions. Safety measures include sidewalkers that are ready to steady
riders and help with exercises, equestrian helmets, and quick release stirrups that
unhook if a rider falls. A fleece or foam pad with gripping handles strapped around
the horse’s belly is used instead of a saddle.
Typically, insurance does not cover hippotherapy. Sessions may last up to 1 hour,
once or twice per week, and the cost may range from $50 to $120 per session. Critics
believe there is not enough research to show that the benefits are different than exist-
ing forms of physical therapy. Research designs are difficult due to variables such as
different kinds of horses and instructors; however, Dr. Daniel Bluestone from the Uni-
versity of California, San Francisco compared MRI scans of children over time and
found that the repetitive movement of riding helps rework networks within the cere-
bellum and the motor system in the cerebrum (American Equestrian Association,
2005).
Hippotherapy should not be confused with Therapeutic Riding. The goals of hippo-
therapy are directed at improving balance, coordination, posture, fine motor control,
articulation, and increasing cognitive skills. Therapeutic riding teaches the rider how
to control the horse and stable management.

FURTHER INFORMATION
American Equestrian Alliance. (n.d.) What is hippotherapy? Retrieved June 1, 2005, from http://
www.americanequestrian.com/hippotherapy.htm.
American Hippotherapy Association. (n.d.) Retrieved May 31, 2005, from www.americanhippo
therapyassociation.org.
CP Resource Center. Introduction to hippotherapy by Barbara Heine, PT. Reprinted from
NARHA Strides, April 1997 (Vol. 3, No. 2). From http://www.twinenterprises.com.
Infinitec.org. Hippotherapy. http://www.infinitec.org.
The Right Step therapy Services. Hippotherapy or therapeutic riding, http://www.rightstep
therapy.com.
Rolandelli, P. S., & Dunst, C. J. (2003). Influences of hippotherapy on the motor and social-
emotional behavior of young children with disabilities. Bridges, http://www.evidencebased
practices.org/bridges.
CYNTHIA K. VAN HORN AND KARLA DENNIS

HOLDING THERAPY. See Welch Method Therapy

HOMEBOUND/HOSPITAL BOUND PROGRAM

Students receive special education and related services in a hospital or homebound
program when unable to attend neighborhood school for medical, behavioral, or other
reasons. Less than 1 percent of all students receiving special education services receive
homebound or hospital bound services. Students with multiple disabilities represent
the largest category of disabilities being educated in homebound or hospital bound
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HORMONE REPLACEMENT

programs. Educational services provided in these environments can range from a few
days to months depending of the needs of the students.
KATHERINE E. COOK

HORMONE REPLACEMENT
Hormone Replacement Therapy (HRT) replaces naturally occurring hormones that
are deficient in the body but are needed for normal functioning and health. Common
examples are thyroid hormone for underactive thyroid, insulin for diabetes, and estro-
gen for women who have had a hysterectomy.
BRUCE BASSITY

HOSPITAL BOUND PROGRAM. See Homebound/Hospital Bound Program

HUG MACHINE
Hug machine, also known as the ‘‘Squeeze Machine’’ or the ‘‘Hug Box,’’ is a device
developed by Temple Grandin, an individual with autism, which provides deep pres-
sure and proprioceptive input at the control of the individual. The individual lies or
squats in the center of the padded, V-shaped machine as air is pumped through cylin-
ders that push padded sideboards together to ‘‘squeeze’’ the individual.
See also proprioception.
KELLY M. PRESTIA

HYPERLEXIA
Children with hyperlexia are able to read words precociously and demonstrate an
intense fascination with letters or numbers at their chronological age. However, they
have significant difficulty in understanding verbal language, deficits in social skills,
and difficulty in socializing and interacting with people.
JOUNG MIN KIM

HYPERRESPONSIVENESS
Hyperresponsiveness is an overactive or intense response to typical sensory information.
What may go unnoticed by others may be overly intense to an individual with a hyper-
responsive sensory system. Examples of hyperresponsiveness may include covering the ears
and screaming at the sound of a ringing telephone, or avoiding holding another’s hand.
KELLY M. PRESTIA

HYPORESPONSIVENESS
Hyporesponsiveness is an underactive or slower reactive response to typical sensory
information. Individuals with hyporesponsive sensory systems may require more
intense, longer, or multiple sensory stimuli to get a response. Examples of hyporespon-
siveness may include not looking or responding when their name is called or when
tapped on the shoulder.
KELLY M. PRESTIA
172
 I
IDIOSYNCRATIC LANGUAGE
Idiosyncratic language is frequently characterized as dialogue borrowed from a spe-
cific video, repetitive questions used with alternative meanings, or social scripts par-
roted in new and different contexts. Idiosyncratic language is often used to reassure
the communicator.
KATHERINE E. COOK

I LAUGH MODEL OF SOCIAL COGNITION

The I LAUGH model of social cognition was developed by Winner to demonstrate
how we can take an abstract concept such as social thinking and break it down into
much more salient, observable parts (Winner, 2000). The I LAUGH model is an ac-
ronym to demonstrate six different skills that form the basis through which we com-
municate effectively with others, verbally and nonverbally (social pragmatic skills).
Not coincidentally, these same skills help us engage in life skills such as personal
problem solving, working as part of a group, playing, and curriculum-based skills that
require social thinking such as reading comprehension, written expression, and organi-
zational skills. Each aspect of the model has been shown through research to be rele-
vant to address in treatment for students with social cognitive deficits.
The I LAUGH model provides parents and educators with a more specific lens
through which to evaluate and understand the strengths and weaknesses of persons
with social-cognitive deficits. Given that the area of social cognition is difficult to
assess through formalized measures, an informal assessment that explores each of these
areas of functioning can be quite revealing of a student’s relative social strengths
versus socially based weaknesses.
The I LAUGH model has also become a framework for understanding how better
to assess students with possible social-cognitive deficits (the autism spectrum, nonver-
bal learning disability, ADHD, etc.). Using formal and informal tasks we can begin to
understand how a child does with relationship to initiating functional communication,
listening actively, abstract and inferential thinking, understanding others’ perspectives,
getting the big picture and humor.
The I LAUGH model is briefly reviewed here.
I LAUGH MODEL OF SOCIAL COGNITION

I=Initiation of language. Initiation of language is the ability to use one’s language

skills to seek assistance or information. A student’s ability to talk about his own topics
of interest can be in sharp contrast to how that student communicates when he needs
assistance.
L=Listening with eyes and brain. Most persons with social-cognitive deficits have
difficulty with auditory comprehension. Listening, however, requires more than just
taking in the auditory information; it also requires the person to integrate information
he sees with what he hears to understand the deeper concept of the message, or to
make a smart guess about what is being said when you cannot clearly hear it.
A=Abstract and inferential language/communication. Communicative comprehension
also depends on one’s ability to recognize that most language/communication is not
intended for literal interpretation. To interpret adequately, one must be able to be
flexible enough to make smart guesses about the intended meaning of the message; at
times one must pursue the analysis of language/communication to seek the intended
meaning. Abstract and inferential meaning is often carried subtly through verbal and
nonverbal means of communication. This skill begins to develop around kindergarten
and continues through our school years as the messages we are to interpret, both
socially and academically, become more abstract. Interpretation depends in part on
one’s ability to ‘‘make a guess’’; it also depends on one’s ability to take perspective of
another.
U=Understanding perspective. This is the ability to understand the emotions,
thoughts, beliefs, experiences, motives, and intentions of yourself as well as others.
We generally acquire this skill across early development, intuitively. Most students
have acquired a solid foundation in this ability between the ages of 4 and 6 years old.
The ability to take perspective is key to participation in any type of group (social or
academic) as well as interpreting information that requires understanding of other
people’s minds such as reading comprehension, history, social studies, etc. Weakness
in perspective taking is a significant part of the diagnosis of social cognitive deficits.
G=Gestalt processing/getting the big picture. Information is conveyed through con-
cepts and not just facts. When talking in a conversation, the participants intuitively
should determine the underlying concept being discussed. When reading, the reader
has to follow the overall meaning (concept) rather than just collect a series of facts.
Conceptual processing is another key component to understanding social and aca-
demic information. Furthermore, difficulty with organizational strategies is born from
problems with conceptual processing.
H=Humor and human relatedness. Most of the clients I work with actually have a
very good sense of humor, but they feel anxious since they miss many of the subtle
cues that help them to understand how to participate successfully with others. It is im-
portant for educators/parents to work compassionately and with humor to help mini-
mize the anxiety the children are experiencing. At the same time, many of our clients
use humor inappropriately; direct lessons about this topic should be taught often.

FURTHER INFORMATION
Fullerton, A., Stratton, J., Coyne, P., & Gray, S. (1996). Higher functioning adolescents and young
adults with autism. Austin, TX: Pro-Ed.
Howlin, P., Baron-Cohen, S., & Hadwin, J. (1999). Teaching children with autism to mind read: A
practical guide. New York: Wiley and Sons.

174
 IMITATION/MODELING

Kunce, L., & Mesibov, G. (1998). Educational approaches to high-functioning autism and
Asperger syndrome. In E. Schopler, G. Mesibov, & L. Kunce (Eds.), Asperger syndrome or
high-functioning autism? (pp. 227–263). New York: Plenum Press.
Myles, B. S., & Adreon, D. (2001). Asperger syndrome and adolescence: Practical solutions for
school success. Shawnee Mission, KS: Autism Asperger Publishing Company.
Winner, M. (2000). Inside out: What makes the person with social cognitive deficits tick? San Jose,
CA: Michelle Garcia Winner.
Winner, M. (2002). Thinking about you thinking about me. San Jose, CA: Michelle Garcia
Winner.
MICHELLE GARCIA WINNER AND JAMIE RIVETTS

IMAGINATION
Delays or differences in the development of imagination are characteristic of autism
spectrum disorders (APA, 2000). Difficulties in the area of imagination first manifest
in a lack of pretend play appropriate to a child’s developmental level. Restricted,
repetitive, and stereotyped patterns of behavior, interests, and activities are further
associated with problems in imagination. Imagination is the process of producing ideas
or mental images in the mind of that which is not present or has not been experi-
enced. Further, imagination involves recombining experiences to solve problems in a
flexible, creative, and resourceful fashion (for reviews, see Jarrold, 2003; Leslie, 1987;
Wolfberg, 1999, 2003).

REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
Jarrold, C. (2003). A review of research into pretend play in autism. Autism: The International
Journal of Research and Practice, 7(4), 379–390.
Leslie, A. M. (1987). Pretense and representation: The origins of ‘‘theory of mind.’’ Psychological
Review, 94, 412–426.
Wolfberg, P. J. (1999). Play and imagination in children with autism. New York: Teachers College
Press, Columbia University.
Wolfberg, P. J. (2003). Peer play and the autism spectrum: The art of guiding children’s socialization
and imagination. Shawnee Mission, KS: Autism Asperger Publishing Company.
PAMELA WOLFBERG

IMITATION/MODELING
From infancy, typical development includes imitation of caregivers. As those with
autism spectrum disorders often have challenges with verbal and motor imitation
skills, teaching these building blocks is critical. An imitation or modeling program
may be developmental, behavioral, or mixed in its approach, but the programming
usually includes the child’s motivation and targeted objectives.

FURTHER INFORMATION
Dapretto, M., Davies, M. S., Pfeifer, J. H., Scott, A. A., Sigman, M., Bookheimer, et al. (2005).
Understanding emotions in others: Mirror neuron dysfunction in children with autism spec-
trum disorders [Electronic version]. Nature Neuroscience, 9, 28–30.
Ingersoll, B., & Schreiberman, L. (2006). Teaching reciprocal imitation skills to young children
with autism using a naturalistic behavioral approach: Effects on language, pretend play, and
joint attention. Journal of Autism and Developmental Disorders, 36, 487–505.

175
IMMUNOGLOBULIN

Quill, K. A. (2000). Do watch listen say: Social and communication intervention for children with au-
tism. Baltimore: Brookes Publishing Co.
Rogers, S. (1999). An examination of the imitation deficit in autism. In J. Nadel & G. Butter-
worth (Eds.), Imitation in infancy (pp. 254–279). Cambridge: Cambridge University Press.
PAUL G. LACAVA

IMMUNOGLOBULIN
Immunoglobulin is a protein produced by plasma cells that plays an essential role in
defending the body from foreign substances, like bacteria.
JEANNE HOLVERSTOTT

IMMUNOLOGICAL TESTS
Immunological tests may be skin tests in which the skin is scratched and a serum of
some allergen like animal dander is applied. A raised wheal or local reaction indicates
an allergy. There are many other forms of immunological tests that check for antibod-
ies or antigens indicating the presence or absence of a particular disease. ABO blood
typing is a common example. Blood testing for many diseases, from rheumatoid arthri-
tis to infectious mononucleosis to HIV, are also immunological tests.
BRUCE BASSITY

IMMUNOTHERAPY
Immunotherapy commonly refers to a type of treatment for environmental allergies
where the body is desensitized to allergens by giving gradually larger doses of the aller-
gen by injection over a period of many months to several years. It also refers to vari-
ous drug treatments to stimulate or suppress the immune system. Immune stimulating
drugs such as interferon and interleukin are used to treat cancers, and immune sup-
pressive substances are used to treat autoimmune diseases such as rheumatoid arthritis
and prevent rejection of transplanted organs.
See also allergy.
BRUCE BASSITY

IMPAIRMENT
Impairment refers to the reduced function or loss of any body part (i.e., hearing loss
translates to a hearing impairment).
KATHERINE E. COOK

INCIDENCE
Related to prevalence, incidence is the number of new cases of a specific condition,
disease, etc. over a period of time. Incidence levels are typically calculated for 1-year
periods and are often presented as a percentage of a population (e.g., 4 percent of all
school-aged children). For example, researchers could calculate all the new cases of
autism in a population over a 1-year period. As with prevalence, the incidence of au-
tism is also controversial, and much research is needed to clear up issues regarding
both how many persons have autism and how many new cases of autism are occurring
each year.
176
 INCIDENTAL TEACHING

FURTHER INFORMATION
Fombonne, E. (2003). Epidemiological surveys of autism and other pervasive developmental dis-
orders: An update. Journal of Autism and Developmental Disorders, 33, 365–382.
Rutter, M. (2005). Incidence of autism spectrum disorders: Changes over time and their mean-
ing. Acta Paediatrica, 94, 2–15.
PAUL G. LACAVA

INCIDENTAL TEACHING
Incidental teaching was designed to teach new skills within ongoing, typical activ-
ities utilizing children’s interests to increase motivation for learning (McGee, Daly, &
Jacobs, 1994). Table 4 shows the essential steps in implementing incidental teaching
as well as an example of how each step may be implemented.

Table 4. Essential Steps in Incidental Teaching

Steps Example
The teacher or parent chooses an Labeling the letters of the alphabet.
educational objective.
The adult arranges the environment to Eli enjoys puzzles. His teacher, Miss May,
encourage the student motivation and to finds a puzzle with the letters of the
attract interest in the materials related to alphabet. During center time, while Eli is
teaching the objective. working on puzzles, Miss May puts the
puzzle on the table with the letters in a
clear container that Eli is unable to open.
The child shows interest in the materials Eli points to the box and says, ‘‘letters.’’
through verbalization or gesture, thus
initiating the teaching session.
The adult encourages an elaboration on the Miss May opens the box and holds up the
initiation. Ways to encourage elaborated letter R, asking, ‘‘What letter do you
responses include: want?’’
Ask a question (e.g., ‘‘What color car do
you want?’’ or, ‘‘Where is the car?’’)
Make a gesture, sound, or word (e.g., point
to the blue car)
Model the desired response
(e.g., ‘‘blue car’’)
Child’s response
If the child responds correctly to the prompt, Eli says, ‘‘Letter R,’’ so Miss May says,
the adult provides specific praise and ‘‘That’s right! It’s the letter R!’’ and allows
gives the child brief access to the materials. him to put the letter in the puzzle.
If the child does not respond or responds Eli repeats, ‘‘Letter,’’ so Miss May says,
incorrectly, the adult provides up to three ‘‘Letter R.’’ Eli repeats, ‘‘Letter R,’’ so Miss
more prompts. Once the child responds May says, ‘‘Right, that’s R!’’ and allows
correctly, he or she receives praise and him to put the letter in the puzzle.
access to the materials.
The adult ‘‘takes a turn’’ with the materials Miss May closes the box again and waits for
and the steps begin again. Eli to say, ‘‘Letter,’’ or point to the box.
The incidental teaching session should end
with success, be brief, and end once the
child loses interest.
Source: McGee, Morrier, & Daly, 1999.

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INCIDENTAL TEACHING

Incidental teaching is an efficient and positive strategy in several ways. It is likely

that integrating instruction of new skills into typical, on-going activities promotes
generalization of skills (McGee et al., 1999). Moreover, social skills, which are defi-
cient in individuals with ASD, are integral to incidental teaching sessions. That is,
interaction is required during the course of incidental teaching instruction. Addition-
ally, incidental teaching is based in student motivation and initiation, thus encourag-
ing student participation and decreasing the need for secondary reinforcement (e.g.,
rewards). Families are also able to integrate incidental teaching into typical daily rou-
tines by finding ways to encourage their children to elaborate during everyday activ-
ities (e.g., dinner time, outside play, bed time).

SUPPORT FOR INCIDENTAL TEACHING IN THE PROFESSIONAL LITERATURE AND RESEARCH

Incidental teaching has been demonstrated to be an effective method of teaching
sociocommunicative skills and to promote generalization of those skills. This strategy
has been used with typically developing children (Hart & Risley, 1980) and individu-
als with autism spectrum disorders (ASD; McGee, Krantz, & McClannahan, 1986).
Incidental teaching has been found to be more effective than clinical, teacher-directed
teaching methods in decreasing dependency on prompts and cues and as or more
effective then such methods in teaching new skills, such as prepositions (McGee,
Krantz, & McClannahan, 1985), adjectives (Miranda-Linne & Melin, 1992), and
spontaneous speech (Charlop-Christy & Carpenter, 2000). Peers have been trained to
implement incidental teaching with individuals with ASD, resulting in increased
speech and social interactions (Farmer-Dougan, 1994). Additionally, incidental teach-
ing has been used with children with ASD to teach academic skills such as reading
(McGee et al., 1986).

ASSESSMENT OF SKILLS DURING INCIDENTAL TEACHING

Evaluation should take place during teaching sessions, within other settings, with a
variety of communicative partners, and with a variety of instructional materials to
ensure that generalization takes place. Data should be collected frequently to make
certain that the child is making progress. If the data do not show improvement,
another strategy should be considered or the method of delivery should be assessed to
judge if changes are necessary.
When assessing a child’s skills, probe data should be used (McGee et al., 1985).
Probe data collection may take place before a teaching session begins and in the set-
ting in which prior teaching has taken place. The order of presentation of the materi-
als should be random, so the adult can be sure that the child has not simply learned a
pattern of responding. The child may receive reinforcement (e.g., praise, edibles), but
it should not be connected to the correctness of his or her responses (e.g., provide
praise for following directions). When collecting probe data, unlike in the middle of a
teaching session during which the adult would wait for the child to initiate the session
by showing interest in an item with a gesture or verbalization, the adult would initiate
the data collection session by asking the child elaboration questions (e.g., ‘‘where is
the juice?’’ might be asked to check for use of prepositions). Correct responses occur
when the child uses a correct elaboration spontaneously or within approximately
5 seconds of the adult’s question (McGee et al., 1985). Errors are those exchanges in
178
 INCIDENT REPORT

Table 5. Data Collection Sheet: Sample

Desired Did student If not, what

response respond prompt(s)
Question (elaboration) without was (were)
Date Environment Materials asked from student prompting? required?
09/23 Snack time Cookies ‘‘What shape is ‘‘Square’’ No Verbal: ‘‘say
this cookie?’’ ‘square’’’
09/24 Snack time Cookies ‘‘What shape is ‘‘Square’’ No Verbal: ‘‘say
this cookie?’’ ‘square’’’
09/25 Snack time Cookies ‘‘What shape is ‘‘Square’’ Yes
this cookie?’’
Student: Beth
Educational objective: Beth will use the attribute of shape to make detailed requests.

which the child does not respond or responds more than approximately 5 seconds after
the adult’s question, or the child responds incorrectly (e.g., asks for a circle cookie
when the cookies are squares). In the case of an error during data collection, the adult
would not prompt a correct response and the child would not receive the item. There-
fore, it is important to keep the data collection sessions short to prevent frustration.
A sample of a completed data collection sheet is provided in Table 5.

REFERENCES
Charlop-Christy, M. H., & Carpenter, M. H. (2000). Modified incidental teaching sessions: A
procedure for parents to increase spontaneous speech in their children with autism. Journal of
Positive Behavior Interventions, 2(2), 98–112.
Farmer-Dougan, V. (1994). Increasing requesting by adults with developmental disabilities using
incidental teaching with peers. Journal of Applied Behavior Analysis, 27(3), 533–544.
Hart, B. M., & Risley, T. R. (1980). In vivo language intervention: Unanticipated general
effects. Journal of Applied Behavior Analysis, 13(3), 407–432.
McGee, G. G., Daly, T., & Jacobs, H. A. (1994). The Walden Preschool. In S. L. Harris &
J. S. Handleman (Eds.) Preschool education programs for children with autism (pp. 127–162).
Austin, TX: Pro-Ed.
McGee, G. G., Krantz, P. J., & McClannahan, L. E. (1985). The facilitative effects of inciden-
tal teaching on preposition use by autistic children. Journal of Applied Behavior Analysis,
18(1), 17–31.
McGee, G. G., Krantz, P. J., & McClannahan, L. E. (1986). An extension of incidental teach-
ing procedures to reading instruction for autistic children. Journal of Applied Behavior Analysis,
19(2), 147–157.
McGee, G. G., Morrier, M. J., & Daly, T. (1999). An incidental teaching approach to early
intervention for toddlers with autism. Journal of the Association for the Persons with Severe
Handicaps, 24(3), 133–146.
Miranda-Linne, F., & Melin, L. (1992). Acquisition, generalization, and spontaneous use of
color adjectives: A comparison of incidental teaching and traditional discrete-trial procedures
for children with autism. Research in Developmental Disabilities, 13(3), 191–210.
JENNIFER B. GANZ

INCIDENT REPORT
An incident report is a written summary that documents behavior incidents, espe-
cially situations in which someone is hurt. An incident report usually contains a
179
INCLUSION

description of the behavior, the antecedent, individuals involved, when and where the
behavior occurred, action taken by staff, and injuries, if applicable.
THERESA L. EARLES-VOLLRATH

INCLUSION
New Zealand scholar Keith Ballard defines inclusion as:

Inclusive education means education that is non-discriminatory in terms of disability, cul-

ture, gender or other aspects of students or staff that are assigned significance by a society.
It involves all students in a community, with no exceptions and irrespective of their in-
tellectual, physical, sensory or other difference, having equal rights to access the cultur-
ally valued curriculum of their society as full time valued members of age-appropriate
mainstream classrooms. (Ballard, 1999, p. 1)

According to Meijer and his colleagues (Pijl & Meijer, 1997), inclusion is to use
different instructional strategies to teach all kinds of students under the same educa-
tion system. Mittler (2000), on the other hand, believes that inclusion is to see every
individual as a whole and put every child together to let them learn, work, and play
together. Smith and his colleagues (Smith, Polloway, Patton, & Dowdy, 1998) claim
that inclusion is to put students in a regular classroom from the very beginning of
their school lives, and provide individualized service as necessary. In short, the inclu-
sion concept highlights that everyone is equal and should stand on the same position
at the starting point with the others even though they have different abilities and
backgrounds.

REFERENCES
Ballard, K. (1999). International voice: An introduction. In K. Ballard (Ed.), Inclusive education:
International voice on disability and justice. London: Taylor & Francis.
Mittler, P. (2000). Working towards inclusive education: Social context. London: David Fulton.
Pijl, S. J., & Meijer, C. J. W. (1997). Factors in inclusion: A framework. In S. Pijl, C. J. W.
Meijer, & S. Hegarty (Eds.) Inclusive education: A global agenda (pp. 8–13). London and New
York: Routledge.
Smith, T. E., Polloway, E. A., Patton, J. R., & Dowdy, C. A. (1998). Teaching students with spe-
cial needs in inclusive settings. Boston: Allyn & Bacon.
KAI-CHIEN TIEN

INDEPENDENT EMPLOYMENT
For those who are quite capable of self-directed activities, independent employment
may prove to be a desirable option. Individuals with autism spectrum disorders (ASDs)
who consider this idea must realize that even though they may not require notable
accommodations at work, they may have to put effort into improving skills that help
them maintain a job in a competitive situation such as taking directions, working in
group situations, or knowing what individual tasks are most important to successful
completion of their job. It is also advisable to choose when and where to disclose in-
formation about yourself or diagnosis in order to advocate for minor accommodations
that could be the difference for successful independent employment or the need for a
more supervised employment option.
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Self-employment is another form of independent employment option where people

capitalize on their strengths by selling their knowledge or skills to customers who need
the services. Like any other self-employed person, those who choose this option must
be very good at time and money management, because the availability of either one
may vary with the workload. Scheduling, estimating required resources, managing
cash-flow, marketing yourself, and bookkeeping are all necessary functions that do not
necessarily require being completed independently to make them occur. With careful
assessment and reflection of personal interests, passions, and abilities, independent or
self-employment could be the key to a career or just plain paying the bills.

FURTHER INFORMATION
Shore, S., & Rastelli, L. (2006). Understanding autism for dummies. Indianapolis, IN: Wiley Pub-
lishing, Inc.
SHERRY MOYER

INDICATORS OF SENSORY PROCESSING DISORDER

In the Indicators of Sensory Processing Disorder (Abrash, 1996), respondents
are requested to place a mark beside observed behaviors across several sensory and
regulatory areas including tactile, proprioception, vision, auditory, gustatory (taste),
olfactory (smell), vestibular/kinesthetic, chemical regulation, arousal and attending
and social consciousness. Following completion of this checklist, a determination
can be made by an occupational therapist or related professional as to whether or not
to pursue further observation and/or assessment. Information gleaned from the
checklist can also serve as a catalyst for discussion between the therapist and
teacher as a way of arriving at basic interventions that can be implemented in the
classroom.

REFERENCE
Abrash, A. (1996). Clinical Connection, 9(3), 15–17.
LISA ROBBINS

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

Every student in a public school system that receives special education and/or
related services must have an Individualized Education Program (IEP) as regulated by
federal law. An IEP for a student must be individualized to the student’s strengths and
needs.
The IEP is developed by a team, which consists of the student (when appropriate
according to age and ability to participate), parents or guardians, teachers, school
administrators, related service providers, school psychologist, and other support per-
sonnel. Other members of the IEP team can include the school counselor, therapists
outside of the school environment, and any other person directly involved with the
student. Collaboration among the individuals on an IEP team directly relates to creat-
ing an effective plan for the student to succeed.
Each IEP is mandated to have certain components by the Individuals with Disabil-
ities Education Act (IDEA, 2004). This law outlines the components that each IEP
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must have, even though school districts and states may use different forms (Drasgow,
Yell, & Robinson, 2001). The components in an IEP are as follows:

¥ Current performance or present levels of performance: The present levels of performance

must describe how the student is performing in school. Evaluation results from achieve-
ment testing, observations, and testing from related services providers are recorded in this
section. Another required part of the present level of performance is the statement of how
the student’s disability affects his or her involvement and progress in the general education
classroom.
¥ Annual goals: Each goal is specifically written to be accomplished by the student in one
year. Goals are broken down into objectives or benchmarks that lead to the annual goal.
Goals may cover academic subjects, social or behavior needs, speech needs, gross motor or
occupational needs, and any other need that is required for the student to succeed in
school. Goals must be written so they can be objectively measured.
¥ Special education and related services: Each IEP must reflect supplementary aids and services
as well as modifications and accommodations (e.g., eating lunch in a quiet room) that the stu-
dent receives. Also listed are the special education and related services received by the child.
¥ Participation with peers without disabilities: This component of the IEP states the extent
(if any) to which the student will not participate with peers without disabilities.
¥ Assessment: Each IEP must outline the modifications, if any, that are needed for state and
district-wide tests. If the testing is not appropriate for the student, an explanation must be
provided and an alternative testing must be provided.
¥ Service plan: Every related service and special education service must record the duration
(daily or weekly) and setting of services.
¥ Transition service needs and services to be provided: Upon a child’s turning 14 years old,
the IEP must explain the courses he or she needs to take to transition from school to the
working environment.
¥ Age of majority: One year before the student reaches the age of majority, usually age 18,
the rights of the student must be explained to the student. These rights are usually trans-
ferred from the parents to the student at that time.
¥ Measuring progress: Each IEP must show how the student’s progress will be measured and
how the parents will be informed of this progress.

WRITING THE IEP AND IMPLEMENTING THE IEP

When writing the IEP, there are several factors to consider. These needs are as fol-
lows: (a) behavior that interferes with the student’s learning or the learning of others,
(b) a limited proficiency in English, (c) special communication needs, (d) students who
are blind or visually impaired, (e) students who are deaf or hearing impaired, and (f)
assistive technology needs for the student. To address these factors, strategies and sup-
ports must be put into place. When writing the IEP, the team must also include the stu-
dent’s strengths, needs, and the parent’s ideas for enhancing their child’s education.
After the IEP is written, a copy must be provided to the parents, and the parents
must give written permission before any special education or related services are pro-
vided to their child. It is also beneficial that each member of the IEP team and any
other adults that interact with the student on a daily basis have a copy of the IEP.
When implementing the IEP, it is helpful to assign a case manager, or someone
who is willing to coordinate all special education services and be a contact for the
family. Establishing communication between home and school is also beneficial, to aid
in problem solving and generalization. Regular progress reports must also be filled out
and sent home to report the progress on the student’s goals and objectives.
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REVISING THE IEP

According to IDEA, the IEP must be reviewed at least once a year. The parents or
school may request for the IEP to be reviewed more often than once a year. Each goal
must be reviewed to see if the goal has been attained or how much progress has been
made toward the goal. New goals must be written if the old goals have been met.
In some cases, the parents of the student with an IEP do not agree with what the
school recommends as services. In this case, if the parents and school cannot come to
terms with an appropriate plan, mediation or due process can occur.

REFERENCES
Drasgow, E., Yell, M. L., & Robinson, T. R. (2001). Developing legally correct and education-
ally appropriate IEPs. Remedial and Special Education, 22, 359–373.
Individuals with Disabilities Education Improvement Act of 2004. Public Law No. 109-446, § 20
U.S.C. (2004).
MELISSA L. TRAUTMAN

INDIVIDUALIZED FAMILY SERVICE PLAN (IFSP)

The Individualized Family Service Plan (IFSP) is a roadmap that a family and child
use while receiving service when the child is ages birth to 3 years old. Along with a
service coordinator, the family and professional personnel will develop a plan that will
outline the services and locations for the child’s early intervention.
Information recorded on the IFSP is child specific and requires a separate page for
each child in the family. The IFSP is always developed with the family as an equal
member of the team. There is only one IFSP plan per family with additional pages
added per child. The following IFSP sections will be completed for each child in the
family and filed in sequential order to reflect the family’s plan:

Cover
The cover page must be completed in the presence of the parent. It is the part of the
document where the family creates a vision for their family. Each time the service coordi-
nator reviews the plan with the family, they will reexamine the vision statement as well.
The vision statement is a fluid document and can be long- or short-term in nature. The
parent(s) has the right to change the vision statement without an ‘‘official’’ IFSP review.
The vision statement addresses the parents’ hopes for the child as well as what they want
their child to learn, know, and accomplish.
Parents will also receive information regarding parents’ rights and procedural safeguards.
This section of the document will also identify demographics and timelines. It is here that
dates of reviews of the IFSP will be recorded as well as information regarding name, birth-
days, household size, ethnicity, race, parents, address, communication method used, date of
referral, initial IFSP date, school district, and preparation for initial transition date.

Health and Medical Information

This section of the document gathers medical information about the child from the par-
ent. Consents could also be obtained in order to collect pertinent medical information
from medical professionals.

Evaluations, Assessment for Program Planning, Screening

This section is to determine the child’s eligibility for Part C services of the Individuals
with Disabilities Education Act (IDEA, 2004). Children who are eligible for Part C

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services shall receive ongoing assessment in areas of delay for the purpose of gathering
additional information to identify strengths and needs as well as appropriate services to
meet those needs. Children who are eligible for Part C services due to a diagnosed medi-
cal condition shall have an initial and ongoing assessment in all developmental areas for
the purpose of program planning.

Family Resources, Priorities, and Concerns

Here is where the family will record their concerns and immediate priorities. After com-
pleting this assessment, the family will have outlined resources, priorities, and concerns
related to their family and child’s development.

Everyday Routines, Activities, and Places

Collection of this information is beneficial for two reasons. First, information regarding
the family’s interests, routines, and activities are known, Second, these activities can be
used as outcome measures on the IFSP. This information assists the service coordinator
with helping the child participate in the family activities, culture, and community.

Outcome/Goal
Individual outcomes/goals related to the child and family’s needs are defined here. This is
not a request for service or items. This is what the parent(s) wants their child or their
family to be able to accomplish and what the family needs in order to support their
child’s development in the next four months.

Developmental Evaluation/Assessment
Evaluations from other professionals (medical professionals, speech pathologists, physical
therapists, etc.) can be added in this section.

Summary
This section summarizes the fee for service information for the parent, the outcomes,
location of service, length of service, and the payment arrangements.

Justification
This is completed only if a service(s) that addresses an outcome/goal on the IFSP cannot
be provided in the child and family’s everyday routines, activities, and places (natural
environments).

Transition Outcome/Goal
The team uses this section to assess the child’s current developmental level as they pre-
pare to transition from the early intervention setting into another program.

Transition Documentation Checklist

Documentation of the steps that are to be taken to make certain a smooth transition
between early intervention and other services exists are kept here. This documentation is
to promote a partnership between all agencies involved with the family.

IFSP Signatures and Consents

This section documents that the parent/guardian has participated in the IFSP develop-
ment and that they agree with the plan. A section for obtaining consents from the

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parents is available. It also outlines the other members of the team and who needs to
receive a copy of the report.

Appendices
Several appendices exist to provide information such as a glossary of terms and an early
track data dictionary.

The format that a specific document takes may vary from state to state. The impor-
tant thing to remember is that the IFSP places the focus on helping the child progress
not only along developmental lines, but as a member of the family as well. At each level
of the plan, the family’s vision, needs, and desires are taken into account. The goal is to
create a strong partnership with the family and all individuals serving the child.

REFERENCE
Individuals with Disabilities Education Improvement Act of 2004. Public Law No. 109-446, § 20
U.S.C. (2004).
LYNN DUDEK

INDIVIDUALIZED HEALTH CARE PLAN (IHCP)

An Individualized Health Care Plan (IHCP) is a document that outlines the diag-
noses, services, and outcomes for a medically involved child while at school. Any
child with a severe health care need that requires frequent nursing intervention ser-
vices while at school should have an IHCP. An important part of the IHCP is the
Emergency Care Plan. The Emergency Care Plan is required when a chronic condition
has the potential to result in a medical emergency.
Because school nurses may be assigned to several buildings or have a large number
of students, nurses must follow specific guidelines to prioritize students for an IHCP.
The National Association of School Nurses (November 2003) has recommended that
‘‘the prioritization of students and their needs is essential and begins by identifying
students whose health needs affect their daily functioning, that is, students who:

¥ Are medically fragile with multiple needs.

¥ Require lengthy health care or multiple health care contacts with the nurse or unlicensed
assistive personnel during the school day.
¥ Have health needs that are addressed on a daily basis.
¥ Have health needs addressed as part of their IEP or 504 plan.’’

The school nurse is the leader of the school health team. As the leader, the nurse
will assess the student’s health status, collect additional information regarding health
and safety, and develop a health care plan for the school. The plan will assure school
staff and parents that the child is receiving the proper care.
The IHCP helps ensure that:

¥ communication between the school nurse and staff, students, and parents is accurate and
up-to-date;
¥ safer processes for delegation are in place;
¥ the health plan can be incorporated into a 504 or IEP if necessary;

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¥ proper safeguards are in place (i.e. Emergency Care Plan); and

¥ advancement of professional school nurses’ practice can take place.

It is also the position of the National Association of School Nurses that the school
nurse is the one who should be responsible for writing of the IHCP in collaboration
with the student, family, and health care providers. In addition, the school nurse is
the one responsible for seeing that the IHCP is implemented and includes periodic
evaluation for evidence of desired student outcomes.

REFERENCE
National Association of School Nurses (November 2003). Individualized Health Care Plans (Posi-
tion Statement). Silver Spring, MD: Author.
LYNN DUDEK

INDIVIDUALIZED TRANSITION PLAN

An Individualized Transition Plan (ITP) is an extension of a student’s Individual
Education Plan that looks beyond high school and plans for adulthood. The goal of
the ITP is to facilitate a student’s movement from school to the world of adult work,
living, and community participation. The ITP takes into consideration the hopes and
dreams of the student and outlines the steps that one would need to take to achieve
them. According to the Individuals with Disabilities Education Act (IDEA 2004),
the ITP must be in place by the age of 16. This is required practice; however, on a
more practical level, some professionals recommend that students with autism spec-
trum disorders start the transition process by the age of 14, if not earlier (Swanson &
Smith, in press; Holtz, Owings, & Ziegert, 2006; Schelvan, Swanson, & Smith, 2005;
Myles & Adreon, 2001).
According to Holtz et al. (2006), each student’s plan will be individualized to meet
their postschool needs and may include information such as: (a) assessment of the
child’s needs, interests, and abilities; (b) a statement of preferences for education,
employment, and adult living; (c) steps to be taken to support achievement of these
goals; (d) specific methods and resources to meet these goals, including accommoda-
tions, services, and/or skills that are related to the transition goals; (e) instruction on
academic, vocational, and living skills; (f) identification of community experiences
and skills related to future goals; (g) exploration of service organizations or agencies
to provide services and support; and (h) methods for evaluating success of transition
activities.
To facilitate this process, each individual student will work with their ITP team to
determine and design the best course of action to help the student learn or maintain
the skills necessary to pursue post-high school endeavors. The ITP team must include
the student, parents, or guardians, teachers, and representatives from local agencies
(i.e., Vocational Rehabilitation). According to IDEA 2004, the ITP must include
‘‘appropriate measurable postsecondary goals based upon age appropriate transition
assessments related to training, education, employment, and, where appropriate, inde-
pendent living skills’’ and ‘‘the transition services (including courses of study) needed
to assist the child in reaching those goals.’’
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REFERENCES
Holtz, K. D., Owings, N. M., & Ziegert, A. K. (2006). Life journey through autism: A transition
guide. Alexandria, VA: Organization for Autism Research.
Individuals with Disabilities Education Improvement Act of 2004. Public Law No. 109-446, § 20
U.S.C. (2004).
Myles, B. S., & Adreon, D. (2001). Asperger syndrome and adolescence: Practical solutions for
school success. Shawnee Mission, KS: Autism Asperger Publishing Company.
Schelvan, R. L., Swanson, T. C., & Smith, S. M. (2005). Making each year successful: Issues in
transition. In B. S. Myles (Ed.), Children and youth with Asperger syndrome: Strategies for success
in inclusive settings. Thousand Oaks, CA: Corwin Press.
Swanson, T. C., & Smith, S. M. (in press). Transition planning for individuals with autism
spectrum disorders: Building bridges to the future. In R. Simpson & B. Myles (Eds.), Educating
children and youth with autism. Austin, TX: Pro-Ed.
TERRI COOPER SWANSON

INDIVIDUAL PLAN FOR EMPLOYMENT (IPE)

An Individual Plan for Employment (IPE) is similar to an Individualized Education
Plan (IEP), but the focus is vocational. An IPE is facilitated through Vocational
Rehabilitation services (VR), while an IEP is regulated by the school district. VR
helps persons with varying degrees of disabilities find appropriate employment and
assists them in obtaining independent skills. VR is funded by federal and state monies.
Services are based on the individual’s needs and limited to a short period of time.
Services may be renewed or changed as necessary (deFur, 2002). VR services generally
begin after high school, but they may start earlier depending on the needs of the indi-
vidual (McDonald, Parker, & Goldberg, 2000).
Before an IPE is created, the individual must be determined eligible for services. To
be determined eligible, an individual must have a disability that makes it difficult to
find work or maintain a job. The individual must also need services provided by VR
to prepare for a job, procure a job, or keep a job that fits his personal needs and abil-
ities. Eligibility is based on job-related skills in a setting that is individualized and
integrated as appropriate for the individual. Areas assessed may include: mobility, in-
dependence, independent living skills, social skills, ability to communicate, work tol-
erance, and work-related skills (McDonald et al., 2000).
The IPE is a plan outlining goals, objectives, and services required by an individual
to meet a goal. It is a formal planning process in which goals and objectives, services
and the time frame of services, and how the success of the IPE will be monitored are
written into a plan (Consumer’s Guide to Maine’s Vocational Rehabilitation Pro-
grams, n.d.). A team of people creates the IPE and includes the individual or the indi-
vidual’s representative and the vocational rehabilitation counselor. Other members
may include a vocational evaluator, a casework technician, and another VR counselor
(possibly a supervisor of the VR counselor who handles the case), and a parent of the
individual if that person requires a guardian (Hayward & Schmidt-Davis, 2003).
The Vocational Rehabilitation Act 1973 and its amendments mandate that individ-
uals with disabilities must be actively involved in their own programs while making
informed decisions about their goals and vocational services. The IPE must be devel-
oped jointly and agreed upon by the consumer and the vocational rehabilitation coun-
selor. If the individual is unable to be actively involved, the parents, guardian, family
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member, or other person may make the decision. In such cases where the consumer
refuses to sign or disagrees with the IPE, there is no plan. The matter should be dis-
cussed and documented, and attempts should be made to settle the concerns and rede-
velop the plan for employment. If the matter cannot be resolved, the consumer has a
right to appeal through the Client Assistance Program (CAP). If resolution is not pos-
sible, the consumer’s case will be closed. Each year the consumer or the representative
must review the IPE. The employment plan may be reviewed more often as necessary.
Changes to the IPE will not take effect until the consumer agrees to the changes and
signs the document (New York State Office of Child and Family Services, n.d.).
Each IPE has the same set of requirements. The IPE must contain long-term goals
for rehabilitation that describe the employment to be gained. The intermediate objec-
tives should relate directly to successful completion of the long-term goal. It will also
include the timeline for reaching the employment goal and the criteria to evaluate
the objectives and the procedure for evaluation. Specific rehabilitation services to be
provided must be included, as well as the services providers. The IPE will list the
responsibilities of the state agency and those of the consumer. It will also address the
conditions set forth for the services. The IPE includes a statement in the consumer’s
wording that describes how they were given information about alternatives such as
goals, objectives, services, and service providers. A statement of the consumer’s rights
and responsibilities is laid out in the IPE (UT RCEP Online, n.d.). Finally, the IPE
includes information about the local Client Assistance Program, assessment of the
consumer’s future need for postemployment services, and a listing of benefits that may
help pay for the cost of services. Information regarding the need for assistive technol-
ogy, on-the-job services, and personal assistance may be included if relevant to the
individual consumer (New York State Department of Education, 1999).
If an individual receiving services under an approved IPE chooses a different voca-
tional goal, the existing IPE will end. The consumer has 30 days to develop a new IPE.
If it is not completed in 30 days, all services except those necessary to develop a new
IPE will be dropped. Consumers will be notified by letter confirming the IPE is not in
effect. The letter will also include the necessary steps to creating a new IPE. If the con-
sumer appeals the end of the IPE, services will continue until a determination is made
regarding the IPE (New York State Office of Children and Family Services, n.d.).
The goal of the Individual Plan for Employment is to help a consumer find success
in employment that meets their personal needs and abilities. In creating a long-term
goal it is helpful to consider the following items: employment availability, occupa-
tional requirements, medical concerns, and information regarding the consumer’s pre-
vious jobs, interests, and strengths. The goal selection should be based on an
assessment of vocational rehabilitation needs with the goal of finding placement in an
integrated employment setting. Intermediate objectives are in actuality short-term
goals, which build toward completion of the long-term goal. It is often helpful to
assess the needs of a consumer in the areas of education, vocation, independent living
skills, technology, and medical or social areas when creating long-term goals and in-
termediate objectives (New York State Office of Children and Family Services, n.d.).
With the goal of preparing for employment, finding employment, or maintaining a
job, the individual consumer and the VR counselor together create Individual Plans
for Employment in a collaborative effort.
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REFERENCES
Consumer’s Guide to Maine’s Vocational Rehabilitation Programs. Section V. (n.d.). Individual
plan for Employment. Retrieved June 17, 2005, from http://www.caresinc.org/docs/vrguide/
005.htm.
deFur, S. H. (2002). Transition Planning. A team effort. National Information Center for Chil-
dren and Youth with Disabilities. Washington, DC.
Hayward, B. J., & Schmidt-Davis, H. (2003). Longitudinal study of the vocational rehabilitation
services program. Final report 2: VR services and outcomes. Durham: NC: Research Triangle
Institute.
McDonald, S., Parker, R., & Goldberg, P. (2000). The road to work. An introduction to vocational
rehab. A booklet for youth and adults with disabilities, family members and advocates (2nd ed.).
Minneapolis, MN: Pacer Center, Inc.
New York State Department of Education. Vocational and Educational Services for Individuals
with Disabilities. (1999). Individual plan for Employment policy. Retrieved June 15, 2005, from
http://www.vesid.nysed.gov/policies/206.htm.
New York State Office of Children and Family Services. (n.d.) Individual plan for Employment.
Retrieved June 16, 2005, from http://www.ocfs.state.ny.us/main/cbvh/vocrehab_manual/
06_IPE.htm.
UT RCEP Online. The University of Tennessee, Regional Rehabilitation Continuing Education
Program. (n.d.) Opportunity to make informed choice. Retrieved June 19, 2005, from http://
web.utk.edu/rrcep4ut/informed/home.html.
VALERIE JANKE REXIN

INDIVIDUALS WITH DISABILITIES EDUCATION ACT (IDEA)

The Individuals with Disabilities Act (IDEA) became a federal law in 1975 and is
currently the primary law governing special education in schools. IDEA ensures the
right of individuals with disabilities to have free and appropriate education, as well as
requiring schools and school staff to continually monitor and evaluate the individual’s
progress. The student’s abilities, needs, and progress are monitored and measured by
developing an Individual Education Plan (IEP). In 1997, IDEA was reauthorized, and
amendments were added to further protect and benefit the education of individuals
with disabilities. Some of the most significant amendments included requiring the con-
sideration of assistive technology, educating the student in the least restrictive envi-
ronment, and behavioral assessment and intervention. Assistive technology refers to
any device that may increase, maintain, or improve the capabilities of a student with a
disability. Examples of assistive technology can be as simple as using a pencil grip for a
proper pencil grasp, or may be as high tech as using specific word-prediction software on
a computer to promote written language. Under IDEA, the student also has the right to
be educated with his peers in the least restrictive environment. The reauthorization of
IDEA requires that the school specifically state the extent to which the student will
and will not participate with nondisabled peers in academic, nonacademic, and extra-
curricular settings. The amendments to IDEA also promote the use of positive behav-
ioral supports to prevent and intervene upon inappropriate behaviors. It requires the use
of a functional behavioral assessment to determine what the interfering behaviors are
and their cause. It also requires that the school define the interfering behaviors and pro-
vide positive, supportive interventions to prevent or change inappropriate behaviors.
IDEA was reauthorized again in 2004 in an attempt to make educators more ac-
countable for their impact on the education and functioning of students with disabil-
ities. Under the new amendments, students with disabilities are required to take state
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assessments at their level of functioning. This can mean that students with disabilities
take the same assessment as nondisabled peers, take a modified assessment, or take an
alternate assessment. A modified assessment is essentially the same assessment the
nondisabled peers take, however, the student with a disability is allowed accommoda-
tions that meet his needs, such as allowing extra time, typing rather than handwriting
answers, or having questions read aloud to him. An alternate assessment generally
looks very different from the state-issued assessment, and encompasses more basic,
functional academic and life skills.
IDEA exists to protect individuals with disabilities from being excluded in the edu-
cational setting. Prior to the implementation of this federal law, individuals with dis-
abilities often did not attend school, or were placed in isolated, special education
programs without access to the general education curriculum or their nondisabled
peers. IDEA continues to be reevaluated by legislators, educators, and individuals with
disabilities in an attempt to provide better protection for individuals with disabilities
and their families, as well as better guidelines for educators in providing optimal ser-
vices and learning environment.

REFERENCE
Individuals with Disabilities Education Improvement Act of 2004. Public Law No. 109-446, § 20
U.S.C. (2004).
KELLY M. PRESTIA

INFANT/TODDLER SENSORY PROFILE

The Infant/Toddler Sensory Profile (Dunn, 2002) is designed for children ages 7 to
36 months to be completed by a caregiver or someone else who has daily contact with
the child. Reporters are asked to respond to the frequency with which they observe
the occurrence of various responses to the basic sensory systems, ranging from almost
always to almost never. The responses are scored in an attempt to identify certain pat-
terns of behavior. If areas of sensory processing difficulties are identified, the team
working with the child can work to address the relationship between sensory process-
ing and a child’s performance.

REFERENCE
Dunn, W. (2002). Infant/toddler sensory profile. San Antonio, TX: Harcourt Assessment.
LISA ROBBINS

INFORMAL ASSESSMENT
Informal assessment measures are nonstandardized approaches for monitoring and
evaluating student progress and obtaining information regarding an individual’s
strengths and needs. There are a variety of informal assessment measures, including
curriculum-based assessments, curriculum-based measurement, criterion-referenced
assessments, checklists, work samples, permanent products, observations, questionnaires,
and many teacher-made tests.

FURTHER INFORMATION
Overton, T. (2003). Assessing learners with special needs: An applied approach (4th ed.). Upper
Saddle River, NJ: Merrill/Prentice Hall.
THERESA L. EARLES-VOLLRATH
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INTEGRATED EMPLOYMENT
As implied by its name, the term integrated employment is used to describe the type
of employment available for individuals who are capable of working in a community
setting. People with disabilities can engage the services of an employment agency,
vocational rehabilitation agency, or private job coaches to help match their interests
and skills to appropriate employers in the community. To be successful in an inte-
grated employment setting, the individual will need to be able to work with minimal
supervision, stay focused on each task required for their job, and perhaps most impor-
tantly, know when and how to ask for help. For individuals with autism spectrum dis-
orders, this might be best achieved by utilizing their strengths or areas of special
interest to help encourage a successful experience. Just a few ideas might include:
guides at museums, computer repair, ticket takers at local sporting events, or dog sit-
ters. Jobs can vary with the skill level and interest of the individual; the possibilities
are endless as long as the person functions with reasonable level of independence and
more ordinary types of supervision while at work.
SHERRY MOYER

INTEGRATED PLAY GROUP MODEL (IPG)

The Integrated Play Groups (IPG) model was originally developed by Wolfberg
(1999, 2003) to address the unique challenges children on the autism spectrum encoun-
ter in peer relations and play. Defining features of autism spectrum disorders (ASD)
include a ‘‘lack of varied and imaginative or imitative play’’ and a ‘‘failure to develop
peer relationships appropriate to developmental level’’ (Charman & Baird, 2002,
p. 289). These difficulties are closely connected to characteristic impairments in the
development of reciprocal social interaction, communication, and imagination (APA,
2000). Guided by current theory, research, and evidence-based practices, the IPG model
reflects a blending of approaches to foster development in each of these areas.
The IPG model is designed to support children of diverse ages and abilities on the
autism spectrum (novice players) in mutually enjoyed play experiences with typical
peers and siblings (expert players). These children regularly play together in small
groups under the direction of a qualified facilitator (play guide). Through a carefully
constructed system of support, play sessions are tailored to the unique interests and de-
velopmental capacities of individual children. A major effort is directed to maximizing
children’s developmental potential by capitalizing on each child’s intrinsic motivation
to socialize and play. Equal emphasis is placed on teaching the typical peers to be
empathetic, responsive, and accepting of children who present differing ways of com-
municating, relating, and playing. Further, novice and expert players are expected to
mediate their own play activities with minimal or no adult guidance.

PROGRAM AND ENVIRONMENTAL DESIGN

The IPG model was originally developed for children from preschool through ele-
mentary school age (approximately 3 to 11 years of age); however, adaptations and
extensions of the model are in progress to support both younger and older children.
Each IPG is customized for an individual child as a part of his or her educational or
therapy program.
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Play guides receive training and supervision to set up and carry out IPGs. They
include practitioners, parents, and other care providers experienced in working with
children with ASD.
Play groups include three to five children with a higher ratio of typically developing
peers and/or siblings (expert players) to children with special needs (novice players).
Expert players are recruited from places where children ordinarily have contact with
peers (e.g., school, family friends, neighbors, community). Playmates ideally have some
familiarity and attraction to one another and the potential for developing long-lasting
friendships. Groups may vary with respect to children’s gender, ages, developmental
status, and play interaction styles.
The same group of children meets over an extended period of time (6 months or
longer), two or more times per week for approximately 30 minutes to an hour. Times
may vary depending upon the age and development of the children as well as the con-
text of the intervention (i.e., school-based vs. therapy).
IPG programs take place in natural play environments within school, home, com-
munity, or therapy settings. These are primarily integrated settings where, given the
opportunity, children would naturally play. Play areas are created to be safe, familiar,
predictable, and highly motivating, allowing children to comfortably explore and
socialize. They are designed with consideration of multiple factors such as size, density,
organization, and thematic arrangements of the play area. Play materials include a
wide range of sensory motor, exploratory, constructive, and socio-dramatic props with
high potential for interactive and imaginative play. In addition, they vary in degree of
structure and complexity to accommodate children’s diverse interests, learning styles,
and developmental levels.
Play sessions are structured by establishing routines and rituals that foster familiar-
ity, predictability, and a cohesive group identity. Personalized visual calendars and
schedules help children anticipate the days and times of meetings. Basic rules for fair
and courteous behavior and appropriate care of materials are presented at the onset of
play groups. Group membership is established by creating a ‘‘club name’’ and associ-
ated rituals. Play sessions begin and end with an opening and closing ritual (e.g.,
greeting, song, and brief discussion of plans and strategies).

ASSESSMENT
The IPG model includes a comprehensive assessment component that provides a
basis for setting appropriate goals, designing effective intervention strategies, and eval-
uating children’s progress. This includes an observation framework and corresponding
assessment tools that focus on documenting children’s social play styles, cognitive/
symbolic and social dimensions of play, communication functions and means, play
preferences, and diversity of play.
For example, within the symbolic dimension of play, manipulation, functional, and
symbolic/pretend play represent acts that are directed towards objects or signify spe-
cific events. Within the social dimension of play, isolation, orientation/onlooker, prox-
imity/parallel, common focus, and common goals represent the child’s distance to and
involvement with one or more peers.
How children communicate within the context of peer play activities is also exam-
ined. The functions of communication (e.g., requests for objects, peer interaction and
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affection, protests, declarations, and comments) may be measured through a variety of

verbal and nonverbal means (including facial expressions, eye gaze, proximity, manipulat-
ing a peer’s hand, face, or body, showing or giving objects, gaze shift, gestures, intonation,
vocalization, nonfocused or focused echolalia, and one-word or complex speech/sign).
Documenting play preferences offers a means to identify and match children’s play
interests. Play preferences include a child’s attraction to toys or props, mode of inter-
acting with toys or props, choice of play themes, and attraction to particular play-
mates. Identifying the number and range of play interests provides a basis for
measuring diversity of play.

INTERVENTION
The IPG intervention, guided participation, was inspired by the work of Vygotsky
(1966, 1978). Guided participation is described as the process through which children
develop while actively participating in culturally valued activity (in this case, play)
with the guidance, support, and challenge of companions who vary in skill and status
(Rogoff, 1990). The intervention involves methodically supporting novice and expert
players to initiate and incorporate desired activity into socially coordinated play while
challenging novice players to practice new and increasingly complex forms of play.
Play guides apply the following key set of practices.

Monitoring Play Initiations

This practice focuses on uncovering novice players’ meaningful attempts to socialize
and play by recognizing, interpreting, and responding to their initiations. Play initia-
tions may take both conventional and unconventional forms, and include acts
directed to oneself, peers, and materials. Even acts that reflect unusual fascinations or
obscure forms of communication are interpreted as purposeful, adaptive, and meaning-
ful attempts to participate in play. These provide a foundation on which to build and
extend each novice player’s existing play repertoire, as well as for novice and expert
players to establish a mutual focus and coordinate play activities.

Scaffolding Play
This practice involves building upon the child’s initiations by systematically adjusting
assistance to match or slightly exceed the level at which the child is independently able
to engage in play with peers (i.e., within the child’s ‘‘zone of proximal development’’;
Vygotsky, 1978). The idea is to avoid being so lax that the play falls apart, or so intru-
sive that it ruins the moment. The key is to find that ever-so-delicate balance for the
play to unfold in genuine ways. At times, the play guide sets the stage for play by
directing the event and modeling behavior. This involves arranging props, assigning
roles, and scripting parts. As the children catch on to the activity, the adult gradually
withdraws from the group and redirects the children to one another while extending
their play. This includes posing leading questions, commenting on activities, offering
suggestions, and giving subtle reminders using verbal and visual cues. Ultimately, the
adult moves to and remains on the periphery of the group as a ‘‘secure base.’’
Social-Communication Guidance
This practice involves supporting both novice and expert players in using verbal
and nonverbal social-communication cues to elicit each other’s attention and sustain
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joint engagement in play activities. For example, experts learn how to interpret and
respond to subtle or obscure forms of communication in a meaningful way so that
novices may be included. Novices learn how to interpret and respond to the complex
ways in which expert players communicate, as well as how to communicate in more
conventional ways so that they may be more easily understood. Strategies focus on
‘‘what to do’’ and ‘‘what to say’’ to invite peers to play (including reluctant peers),
join peers in play, enter peer groups, and maintain and expand interactions in play.
Play guides coach the children using custom-made visual supports such as cue cards
and posters.

Play Guidance
This practice encompasses a progression of strategies that support novice players in
peer play experiences that are slightly beyond the child’s capacity while fully
immersed in the play experience. Play guidance strategies start at the level of the
child and move along a continuum of development. Play guides must be well versed
in a range of techniques to foster orientation, imitation-mirroring, parallel play, joint
focus, joint action, role-enactment, and role-playing. Novices may participate in com-
plex and sophisticated play scripts organized by expert players at their own level of
ability, even if participation is minimal. They may carry out play activities and roles
that they may not yet fully comprehend. For example, a child inclined to line up
objects may incorporate this scheme into a larger play theme of pretending to be a
store clerk who is responsible for arranging groceries on a shelf. The idea is to stimu-
late novices to explore and diversify existing play routines through repeated exposure
to the experiences of peers.

EFFICACY OF THE IPG MODEL

The IPG model has been adopted by numerous schools and programs at the local,
national, and international level, and has gained recognition as best practices for chil-
dren with ASD (see California Department of Education, 1997; Iovannone, Dunlop,
Huber, & Kincaid, 2003). This research-based model specifically incorporates elements
that have been shown to be effective in enhancing social interaction, communication,
play, and imagination in children with ASD. Further, the goals and methods are con-
sistent with the recommendations of the National Research Council (2001), which
has ranked the teaching of play skills with peers among the six types of interventions
that should have priority in the design and delivery of effective educational programs
for children with ASD.
To evaluate the efficacy of the IPG model, a series of experimental and exploratory
studies have been conducted over the years (for a recent overview, see Wolfberg &
Schuler, in press). This research has focused on documenting outcomes for novice and
expert players, as well as perceptions of play guides and families (Gonsier-Gerdin,
1993; Lantz, Nelson, & Loftin, 2004; Mikaelian, 2003; O’Connor, 1999; Wolfberg,
1988; 1994; 1999; Wolfberg & Schuler, 1992; 1993; Yang, Wolfberg, Wu, & Hwu,
2003; Zercher, Hunt, Schuler, & Webster, 2001). More recently, several studies exam-
ined the efficacy of combining the IPG model with sensory integration therapy (Anti-
polo & Dichoso, 2003; Mahnken, Baiardo, Naess, Pechter, & Richardson, 2004;
Schaefer & Atwood, 2003).
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Although it is not feasible to determine which components of the intervention were

most pertinent to the observed changes (since the IPG model is a comprehensive
intervention), the cumulative findings suggest that the intervention as a whole con-
tributed to generalized and socially valued gains. The system of support involving
explicit guidance and peer mediation contributed to the children’s social and symbolic
development. Guided participation in intrinsically motivating play activity with more
competent peers provided novice players the opportunity to refine their imitation
skills and practice more advanced forms of social communication and play. Finally,
the IPG model stimulated reciprocal friendships between children with ASD and typi-
cal peers through active engagement in mutually enjoyed play experiences.

REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
Antipolo, L., & Dichoso, D. (2003). The effects of integrated play groups with sensory integration
on the play and social skills of children with sensory integrative dysfunction. Unpublished master’s
thesis, San Jose State University, San Jose, CA.
California Department of Education. (1997). Best practices for designing and delivering effective pro-
grams for individuals with autistic spectrum disorders. Produced by RiSE, Resources in Special
Education, Sacramento, CA.
Charman, T., & Baird, G. (2002) Practitioner review: Diagnosis of autistic spectrum disorder in
2 and 3 year old children. Journal of Child Psychology & Psychiatry, 43, 289–305.
Charman, T., & Baron-Cohen, S. (1997). Brief report: Prompted pretend play in autism. Journal
of Autism and Developmental Disorders, 27, 325–32.
Gonsier-Gerdin, J. (1993). Elementary school children’s perspectives on peers with disabilities in the
context of integrated play groups. Unpublished position paper, University of California–
Berkeley.
Iovannone, R., Dunlop, G., Huber, H., & Kincaid, D. (2003). Effective educational practices
for students with ASD. Focus on Autism and Other Developmental Disabilities, 18(3), 150–165.
Lantz, J. F., Nelson, J. M., & Loftin, R. L. (2004). Guiding children with autism in play:
Applying the integrated play group model in school settings. Exceptional Children, 37(2),
8–14.
Mahnken, H., Baiardo, C., Naess, M., Pechter, R., & Richardson, P. (2004). Integrated play
groups and sensory integration for a child diagnosed with ASD: A case study. Poster presented at
the American Occupational Therapy Association Annual Conference, Minneapolis, MI.
Mikaelian, B. (2003). Increasing language through sibling and peer support play. Unpublished mas-
ter’s thesis, San Francisco State University, CA.
National Research Council. (2001). Educating children with autism. Committee on Educational
Interventions for Children with Autism, Division of Behavioral and Social Sciences and Edu-
cation. Washington, DC: National Academy Press.
O’Connor, T. (1999). Teacher perspectives of facilitated play in integrated play groups. Unpublished
master’s thesis, San Francisco State University, CA.
Rogoff, B. (1990). Apprenticeship in thinking. New York: Oxford University Press.
Schaefer, S., & Atwood, A. (2003). The effects of sensory integration therapy paired with integrated
play groups on the social and play behaviors of children with autistic spectrum disorder. Unpublished
master’s thesis, San Jose State University, San Jose, CA.
Vygotsky, L. S. (1966). Play and its role in the mental development of the child (translation
from 1933). Soviet Psychology, 12, 6–18.
Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes (transla-
tion from 1932). Cambridge, MA: Harvard University Press.
Wolfberg, P. J. (1988). Integrated play groups for children with autism and related disorders. Unpub-
lished master’s field study, San Francisco State University, CA.

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Wolfberg, P. J. (1994). Case illustrations of emerging social relations and symbolic activity in children
with autism through supported peer play. Doctoral dissertation, University of California at
Berkeley with San Francisco State University. Dissertation Abstracts International,
#9505068.
Wolfberg, P. J. (1999). Play and imagination in children with autism. New York: Teachers College
Press, Columbia University.
Wolfberg, P. J. (2003). Peer play and the autism spectrum: The art of guiding children’s socialization
and imagination. Shawnee, KS: Autism Asperger Publishing Company.
Wolfberg, P. J., & Schuler, A. L. (1992). Integrated play groups project: Final evaluation report
(Contract # HO86D90016). Washington, DC: Department of Education, OSERS.
Wolfberg, P. J., & Schuler, A. L. (1993). Integrated play groups: A model for promoting the
social and cognitive dimensions of play in children with autism. Journal of Autism and Devel-
opmental Disorders, 23(3), 467–489.
Wolfberg, P. J., & Schuler, A. L. (in press). Promoting social reciprocity and symbolic represen-
tation in children with ASD. In T. Charman & W. Stone (Eds.), Early social communication
in autism spectrum disorders. New York: Guildford Publications.
Yang, T., Wolfberg, P. J., Wu, S., & Hwu, P. (2003). Supporting children on the autism spec-
trum in peer play at home and school: Piloting the integrated play groups model in Taiwan.
Autism: The International Journal of Research and Practice, 7(4), 437–453.
Zercher, C., Hunt, P., Schuler, A. L., & Webster, J. (2001). Increasing joint attention, play and
language through peer supported play. Autism: The International Journal of Research and Prac-
tice, 5, 374–398.
PAMELA WOLFBERG

INTELLIGENCE TESTS
Intelligence tests assess samples of behavior to measure one’s aptitude and intelli-
gence. The result of these assessments is an Intelligence Quotient (IQ) score. Intelli-
gence tests can be given in group or individual formats. Individually administered
intelligence tests are primarily used in special education for identification, eligibility,
and educational placement decisions.

FURTHER INFORMATION
Salvia, J., & Ysseldyke, J. E. (2007). Assessment: In special and inclusive education (10th ed.). Bos-
ton: Houghton Mifflin Company.
Taylor, R. L. (2006). Assessment of exceptional students: Educational and psychological procedures
(7th ed.). Needham Heights, MA: Allyn and Bacon.
THERESA L. EARLES-VOLLRATH

INTERNAL REVIEW BOARD (IRB)

An Internal Review Board (IRB), also known as the Human Subjects Review Com-
mittee, is a group of individuals who are charged with the protection of human sub-
jects used in research at universities and other institutions. An IRB reviews proposed
research projects to ensure that the protocol outlined in the study complies with speci-
fied regulations and with other ethical and professional standards for use of human
subjects in research. The committee also evaluates proposed projects to ensure that
potential research subjects will be protected from harm and that they will be treated
respectfully and fairly.
THERESA L. EARLES-VOLLRATH
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INTERNATIONAL STATISTICAL CLASSIFICATION OF DISEASES AND

RELATED HEALTH PROBLEMS (ICD)
International Statistical Classification of Diseases and Related Health Problems
(ICD), published by the World Health Organization (WHO), is a guidebook com-
monly used by mental health professionals to diagnose mental disorders outside of the
United States. Like the Diagnostic and Statistical Manual of Mental Disorders
(APA, 2000), the ICD uses medical concepts and terminology, classifies disorders
based on criteria into distinct categories and subcategories, and is revised periodically.
The ICD is currently in its tenth edition.

REFERENCE
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
JEANNE HOLVERSTOTT

INTEROBSERVER AGREEMENT/RELIABILITY
Interobserver agreement or interobserver reliability refers to having two or more
observers record the same data, on the same student(s), at the same time, but inde-
pendent of each other. The data of all observers are then compared, and a reliability
coefficient or a percent of agreement is calculated. While there is set standard for ac-
ceptable interobserver reliability, the accepted standard among some behavior analysts
is a coefficient of approximately 90 (Alberto & Troutman, 1995). The higher the reli-
ability coefficient or percent of agreement, the more accurate and reliable the data.

REFERENCE
Alberto, P. A., & Troutman, A. C. (1995). Applied behavior analysis for teachers (4th ed). Upper
Saddle River, NJ: Prentice Hall.
THERESA L. EARLES-VOLLRATH

INTRAVERBAL
As first described by B. F. Skinner (1957), an intraverbal is the verbal response to a
verbal stimulus that has no direct verbal relation to the stimulus. For example, when
someone asks another, ‘‘What is your favorite food?’’ the person responding would say,
‘‘lasagna.’’ The response is correct and is reinforced within the verbal exchange
between two people, but the response does not directly relate word for word to the
verbal stimulus. A directly related response to the question would be, ‘‘My favorite
food is lasagna’’ (Lerman, Parten, Addison, Vorndran, & Volkert et al., 2005).

REFERENCES
Lerman, D. C., Parten, M., Addison, L. R., Vorndran, C. M., Volkert, V. M., & Kodak, T.
(2005). A methodology for assessing the functions of emerging speech in children with devel-
opmental disabilities. Journal of Applied Behavior Analysis, 38(3), 303–316.
Skinner, B. F. (1957). Verbal behavior. New York: Appleton-Century-Crofts.
TARA MIHOK

IRLEN LENSES
Irlen lenses are color-tinted lenses used to reduce vision difficulties. In 1980, Olive
Meares was one of the first people to note the signs and symptoms of visual distress in
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school-age children. Helen Irlen, the name most commonly identified with colored
lenses, presented findings in 1983 that her students had less visual distortions while
reading if they used a transparent colored overlay (Wilkins, 2003).
There are a variety of terms that are used in conjunction with the light-sensitivity
disorder in which one needs colored overlays or colored lenses to manage perceptual
distortions. Helen Irlen originally coined the phrase scoptic sensitivity syndrome (SSS)
(1991), however the Irlen Institute now uses the phrase Irlen syndrome (Irlen syn-
drome/Scoptic syndrome, 1991). Others prefer the term Meares-Irlen syndrome to
include Olive Meares, who was one of the first proponents of using color to reduce
vision difficulties (Wilkins, 2003).
Irlen syndrome is not a vision problem but rather a difficulty with the visual percep-
tual system. It occurs in some individuals with learning or reading disorders, autism,
and other developmental disorders. Individuals with SSS experience visual stress,
which leads to distortions while reading or viewing the world around them. Difficulties
may be expressed through problems with light brightness or types of lighting, move-
ment of letters or words on the page, difficulty with high contrast situations, and diffi-
culty reading groups of letters (Edleson, n.d.).
There are specific symptoms related to SSS/Irlen syndrome. Some people may expe-
rience difficulty reading for long periods of time. Others find their reading to be ineffi-
cient. Some readers are unable to skim or speed read. Strain and fatigue is often
reported after reading. Phrases read aloud may sound hesitant or choppy. The reader
may have poor comprehension skills and difficulty retaining information. A slow read-
ing rate and high error rates may also be noted in readers (Irlen syndrome/Scoptic syn-
drome, 1991).
Deficiencies in visual skills may lead to poor academic performance. The National
Institute of Health estimates that 10 million American children have difficulty read-
ing. Eighty percent of student learning in the classroom depends on the ability of the
visual system to process correctly (Stone, 2003). Basic school vision screenings only
test for a few learning-related visual skills such as distance, 20/20 eyesight, using the
eyes together, and muscle balance. Although states require vision screenings, most
leave it to the school district to determine how the testing will be initiated. Typically,
school districts do not test for other visual skill concerns. Most people are not aware
of the connection between poor academics and visual skill deficiencies. Although the
number of children with reading disabilities that are helped by Irlen lenses varies
according to different researchers, it is possible that 460,000 to 4.6 million children
could be helped by the use of color overlays or tinted lenses (Stone, 2003).
Irlen lenses are created to meet the needs of the wearer through a specific testing
method. While these lenses are often used for persons with light sensitivities, dis-
orders, and reading disabilities, individuals with autism and other developmental
disorders have also worn them with success.

REFERENCES
Edleson, S. M. (n.d.). Scotopic sensitivity syndrome and the Irlen lens system. Retrieved June 13,
2005, from http://www.autism.org/irlen.html.
Irlen, H. (1991). Reading by the colors. Garden City Park, NY: Avery Publishing Group Inc.
Irlen syndrome/Scoptic syndrome. (1991). Retrieved June 12, 2005, from http://www.irlen.com/
sss_main.htm.

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Stone, R. (2003). The light barrier. New York: St. Martin’s Press.
Wilkins, A. (2003). Reading through colour. London: John Wiley & Sons.

FURTHER INFORMATION
Ludlow, A. K., Wilkins, A. J., & Heaton, P. (2006). The effect of coloured overlays on reading
ability in children with autism. Journal of Autism and Developmental Disorders. 36, 507–516.
Thomson, W. D., & Wilkins, A. J. (2006). Memory for the color of non-monochromatic lights.
Color Research and Application, 32, 11–15.
VALERIE JANKE REXIN

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JOINT ACTION ROUTINES
Joint Action Routines (JAR) is an intervention strategy used to scaffold language
development for individuals with autism spectrum disorders (ASD). This instructional
strategy is known also by names such as Activity Based Strategy (Bricker, 1998), and Soci-
odramatic Script Training (Goldstein, Wickstrom, Hoyson, Jamieson, & Odom, 1988).
The term JAR was coined by Snyder-McLean, Solomonson, McLean, & Sack (1984) who
developed this methodology in their work with students with various disabilities, includ-
ing mental retardation, various language delays, and/or other health impairments.
JAR is a routinized series of activities and communication-based interactions
between an individual and one or more communicative partners. Those interactions
are purposeful and are performed repeatedly and in a certain logical order that the
individual has learned. JAR treatment includes features such as a unifying theme,
joint focus between one or more communicative partners, a certain number of roles
(e.g., chef, waitress, customer), a logical, predetermined sequence of activities, turn-
taking, repetition, and variation. These elements make JAR an intervention strategy
uniquely appropriate to meet the needs of students with language and communication
delays in general, and those diagnosed with autism spectrum disorders (ASD), in par-
ticular (Goldstein et al., 1988; Prizant, Wetherby, & Rydell, 2000). Professionals also
consider JAR a particularly suitable treatment option for individuals with ASD
because it borrows elements from both the behavioristic and the naturalistic perspec-
tives, such as reliance on careful planning and enhancement of environmental struc-
tures designed to ensure a child’s successful participation in a routine. The features of
JAR that reflect a behavioristic approach include the use of repetitions and, depending
on the student’s developmental age, routines could also be teacher directed. JAR’s
characteristics associated with a naturalistic approach include limiting reinforcers only
to those that are intrinsic to a routine, focusing on student-initiated activities in rou-
tines, and structuring meaningful contexts for the instruction of new communicative
skills. Other strategies employed during the implementation of routines include sabo-
tage, oversight, silly situations and time delay. Sabotage refers to a situation such as
when a caregiver offers a child M&M’s in a closed container, causing the child to ask
for help to open it. An oversight can happen when a child is offered a bowl of soup
with no spoon. A silly situation occurs when a parent gives a child a fork to eat soup.
JOINT ACTION ROUTINES

Time delay is a technique in which a teacher gradually lengthens the time between a
stimulus and a prompt to allow the student more time to provide the expected verbal
response. Throughout this time, the teacher keeps eye contact with his student, look-
ing at him expectantly. These procedures are designed to prevent boredom and to cre-
ate a need to communicate in a child’s natural environment.
Snyder-McLean et al. (1984) identified four major categories of routines: routines
related to daily living skills, routines that involve preparation of a product, those that
focus on a specific theme, and those that involve social games. Routines related to daily
living skills entail instruction designed to promote communication skills related to adapt-
ive behavior competency around topics such as bath time, getting out of bed, shopping,
eating in a restaurant, using public transportation, and so forth. Routines that involve
preparation of a product focus on instruction of language skills that involve activities such
as snack preparation, creating an art project, and prevocational readiness (i.e., product
assembly). JARs that focus on a theme foster language development around topics of in-
terest to the students and include leisure activities (e.g., picnic, ball game, amusement
park activities), or familiar stories. Social cooperative games provide a perfect venue for
teaching turn-taking skills, and thus are especially helpful in making concrete for chil-
dren with ASD the concepts that are inherent in communication, such as the ‘‘back
and forth,’’ waiting for a turn, responding based on a partner’s reaction, and so forth.
These activities might be of the nature of sharing a game on a computer, playing cards
and other table top games, putting a puzzle together, and much more.
These routines have been developed for implementation across all age groups and
levels of disability: toddlers or young children with developmental age of or below 24
months, preschool- and elementary-age students, and middle- to high school-age stu-
dents. For infants or young children with a mental age below 24 months, roles may be
limited to only adult and child, and might not be exchangeable between them. In
addition, the adult might be the sole initiator of routines, which might also have to
be simplified in their task complexity and communication requirements.
The following are basic guidelines for successfully using JAR with students with
ASD:

1. Choose target behaviors that match a student’s current level of performance and which
are in line with the IEP objectives. Careful consideration should also be given to students’
age and their familiarity with and interest in the JAR topic.
2. Establish procedures for data collection to measure students’ progress.
3. Design the Joint Action Routines while considering—
¥ the topic,
¥ time and place of implementation,
¥ the roles,
¥ the props needed,
¥ the order of activities, and
¥ the teaching method (i.e., should the routine be taught in a backward chaining fashion,
starting with the last task in the chain, or rather, should the first two to three steps be
taught first, and so forth).
4. Prepare relevant props.
5. Prepare materials needed.
6. Based on the complexity of a JAR, establish a signal to indicate the beginning and ending
of a routine.
7. Introduce the routine.

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The following provides an example of a JAR designed to teach preschoolers with

autism to follow one-step instructions, such as ‘‘get tissue,’’ ‘‘throw away,’’ and, ‘‘give
me five.’’

Objective: To teach students to follow one-step instructions.

Data Collection: Data will be collected weekly on a student’s correct response. A ( ) will
indicate a prompted response, and a (+) will indicate a correct independent response.
Time and Place: Five repetitions during mealtime (one time a day).
The Roles: Adult and child.
Props: No props needed.
Order of Activities:
¥ Drink or food is ‘‘accidentally’’ spilled.
¥ Teacher exclaims, ‘‘Oh, no!’’ points to the spill and says, ‘‘Get tissue.’’
¥ Student gets up and takes a tissue.
¥ After child wipes spill, he/she is then told to ‘‘throw (the tissue) away.’’
¥ Student throws tissue into a waste can.
¥ Teacher says, ‘‘Give me five!’’
¥ Student ‘‘gives five.’’

JAR serves as a strategy for promoting communication skills in individuals with au-
tism spectrum disorders by providing learners with a context for communication, cre-
ating a need for mutual focus and attention between and among communicative
partners, encouraging students to tune into a communicative partner’s perspectives,
and creating a controlled environment that supports the growth and development of
communication skills.

REFERENCES
Bricker, D. (with Pretti-Frontczak, K., & McComas, N.). (1998). An activity based approach to
early intervention (2nd ed.). Baltimore: Brookes Publishing Co.
Goldstein, H., Wickstrom, S., Hoyson, M., Jamieson, B., & Odom, S. L. (1988). Effects of soci-
odramatic script training on social and communicative interaction. Education and Treatment
of Children, 11, 97–117.
Prizant, B. M., Wetherby, A. M., & Rydell, P. J. (2000). Communication intervention issues for
children with autism spectrum disorders. In S. F. Warren & J. Reichle (Series Eds.) & A. M.
Wetherby & B. M. Prizant (Vol. Eds.), Communication and language intervention series: Vol. 9.
Autism spectrum disorders: A transactional developmental perspective (pp. 193–224). Baltimore:
Brookes Publishing Co.
Snyder-McLean, L. K., Solomonson, B., McLean, J. E., & Sack, S. (1984). Structuring joint
action routines: A strategy for facilitating communication and language development in the
classroom. Seminars in Speech and Language, 5, 213–228.
JOSEPHA BEN-ARIEH

JOINT ATTENTION
Joint Attention involves the shifting of attention from one object of desire back to
another object or person. This is a developmental milestone that is typically first seen
in young children as they point out objects or direct adults to look at the same object
that has gained their interest. Many times infants will point to an object prior to their
ability to label all aspects of the object. The use of joint attention coordinates mutual
interest to a desired person, place, or thing among two or more communicative

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JOURNAL

partners. For example, an infant might point to an airplane in the sky, and the adult
holding the child then often labels the item, ‘‘You see a big plane.’’
KATHERINE E. COOK

JOURNAL
Journals are scholarly compilations of research-based articles in a peer-reviewed
format. For a list of journals related to autism spectrum disorders see Appendix C.
TERRI COOPER SWANSON

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 K
KANNER, LEO
Leo Kanner (1894–1981) substantially influenced the field of child and adolescent
psychiatry by providing the first description of infantile autism (Neumarker, 2003). He
is recognized as the first person to formally describe and coin the term autism more
than a half century ago (Kanner, 1943). Kanner published a description of this profile
based on his case studies in a paper identifying autistic children in 1943 (Kanner,
1943, p. 227), which has become the most quoted work in the literature on autism
(AMA-Autism History, n.d.).

REFERENCES
AMA-Autism History (n.d.). Retrieved July 31, 2006, from http://www.ama.org.br/
autismhistory.htm.
Kanner, L. (1943). Autistic Disturbances of Affective Contact. The Nervous Child, 2, 217–250.
Neumarker, K. (2003). Leo Kanner—his years in Berlin, 1906–1924: The roots of autistic disor-
der. History of Psychiatry, 14, 205–218.
Sanua, V. (1990). Leo Kanner (1894–1981): The man and the scientist. Child Psychiatry and
Human Development, 21(fall), 3–23.

FURTHER INFORMATION
Kanner, L. (1946). Irrelevant and metaphorical language in early infantile autism. American
Journal of Psychiatry, 103, 242–246.
CAROL L. PITCHLYN

KRUG’S ASPERGER’S DISORDER INDEX

Krug’s Asperger’s Disorder Index (KADI) is an assessment tool used to identify
individuals with Asperger’s disorder. The KADI enables professionals to correctly differ-
entiate individuals with Asperger’s disorder from individuals with other forms of high-
functioning autism. It can be used as a prescreening scale to immediately determine
individuals who do not have Asperger’s disorder. The Krug’s Asperger’s Disorder Index
can be administered on individuals ranging from 6 years of age to 22. Information
KRUG’S ASPERGER’S DISORDER INDEX

associated with the KADI can be used to help assess a student’s educational needs.
Administration time ranges from 15 to 20 minutes (Pierangelo & Guiliani, 2006).

REFERENCE
Pierangelo, R., & Guiliani, C. A. (2006). Assessment in special education: A practical approach.
Boston: Allyn & Bacon.
AMY BIXLER COFFIN

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 L
LACTOSE INTOLERANCE
Lactose intolerance is a gastrointestinal condition in which individuals are intoler-
ant to milk and some dairy products. It may be present from birth or acquired later in
life and varies in severity. It is a deficiency of lactase, an enzyme required to absorb
lactose (a form of sugar found in milk) from the intestines. Treatment varies from
avoidance of dairy products to use of digestive enzyme tablets.
BRUCE BASSITY

LANDAU-KLEFFNER SYNDROME
Landau-Kleffner syndrome (otherwise known as acquired epileptic aphasia) is a rare
disorder involving the loss of language skills after a period of normal development, first
described by Landau and Kleffner in 1957. The onset of loss usually occurs between the
ages of 3 and 9 years, and is often associated with clear-cut seizures. The loss of lan-
guage skills is usually gradual, occurring over the course of months, although there are
cases where the loss is more rapid. First noted loss is in receptive language skills, with
the child becoming increasingly unresponsive to spoken language. Hearing tests however
are normal. The loss of receptive skills is followed by loss of expressive abilities. Three
different types of presentation are reported: (a) acute loss of language, sometimes in
association with encephalopathic illness and/or seizures, with usually good recovery; (b)
long, slow deterioration of language, which may be unresponsive to antiepileptic drugs,
and moderate or poor recovery; and (c) variable onset during which there may be sev-
eral episodes of language fluctuation, which, if responsive to antiepileptic drugs, may
lead to a good recovery (Lees & Neville, 1996).
Types of language difficulty in addition to verbal agnosia (inability to comprehend
language) include word-finding difficulties, problems with written language, a range of
neologisms and paraphasias, and deficit in prosody.
Children with Landau-Kleffner do not usually present with autism spectrum disorder
(ASD), although ASD might be considered in some cases due to the similarity of
some of the receptive and expressive language difficulties coupled with levels of frus-
tration, behavior difficulties, and sometimes hyperactivity in these children. The dif-
ferentiating criteria include the fact that this is an aphasia with EEG abnormalities
LEAKY GUT SYNDROME

typically underlying the loss of skills, and with deficits focusing on language. There
are not usually impairments in social interaction of an autistic type, but as noted frus-
trations, and possibly also underlying neurological deficits, may lead to some social dif-
ficulties or behavior problems (e.g., Mantovani, 2000). Tests of general mental ability
or cognitive functioning can also help to clarify the selective loss of language skills
seen in Landau-Kleffner syndrome versus general loss of cognitive skills in other more
progressive childhood dementias (Goodman & Scott, 2005, p. 203).
In terms of outcome, Bishop (1985) reviewed the literature and reported that the
younger the age of onset the poorer the prognosis for the child. A long-term follow-up
by Ripley and Lea (1984) demonstrated that while low language levels were the usual
outcome, most of the group had found employment and were living independently as
adults. Speech and language therapy programs, antiepileptic medications, and some-
times surgery are considered as possible treatment options (Vance, 1991; Lees &
Neville, 1996; Cole et al., 1988).

REFERENCES
Bishop, D. (1985). Age of onset and outcome in acquired aphasia with convulsive disorder
(Landau-Kleffner syndrome). Developmental Medicine and Child Neurology, 27, 705–707.
Cole, A. J., Andermann, F., Taylor, L., Olivier, A., Rasmussen, T., Robitaille, Y., et al. (1988).
The Landau-Kleffner syndrome of acquired epileptic aphasia: Unusual clinical outcome, surgi-
cal experience and absence of encephalitis. Neurology, 38, 31–37.
Goodman, R., & Scott, S. (2005). Child psychiatry (2nd ed.). Oxford: Blackwell Publishing.
Landau, W. M., & Kleffner, F. (1957). Syndrome of acquired aphasia and convulsive disorder in
children. Neurology, 7, 523–530.
Lees, J. A., & Neville, B. G. R., (1996). Fit for neurosurgery? RCSLT Bulletin (November
1996), 535, 10–11.
Mantovani, J. F. (2000). Autistic regression and Landau-Kleffner syndrome: Progress or confu-
sion? Developmental Medicine and Child Neurology, 42, 349–353.
Ripley, K., & Lea, J. (1984). Moorhouse school: A follow up study of receptive aphasic ex-pupils.
Hurst Green, Oxted, Surrey: Moorhouse School.
Vance, M. (1991). Educational and therapeutic approaches used with a child presenting with
acquired aphasia with convulsive disorder (Landau-Kleffner syndrome). Child Learning Teach-
ing and Therapy, 7, 41–60.
FIONA J. SCOTT

LEAKY GUT SYNDROME

Leaky gut syndrome, also referred to as intestinal permeability, is a medial condition
affecting the lining of the intestines. In leaky gut syndrome openings develop between
the cells of the intestine that allow in bacteria, toxins, and food. Common symptoms
of leaky gut syndrome include chronic muscle or joint pain, blurred thinking, indiges-
tion, gas, mood swings, nervousness, skin rashes, recurrent bladder or yeast infections,
constipation, and anxiety.
KATHERINE E. COOK

LEARNED HELPLESSNESS
Learned helplessness was introduced in 1965 by Martin Seligman as the result of a
series of experiments with dogs (Seligman, Maier, & Geer, 1968). Based on Pavlov’s
classical conditioning experiments, a bell was paired with an unpleasant stimulus,
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rather than food. It was expected the dog would move in order to avoid the unpleas-
ant stimulus, however it did not move. The result was an understanding that individu-
als may reach a frame of mind in which they do not attempt independence or exert
effort toward a task. The individual comes to feel that effort would be pointless as it
always ends in failure, or that they are incapable of doing something on their own.
The overall mindset is that of powerlessness. Learned helplessness is relevant to people
with depression and disabilities, and to people coming from at-risk backgrounds.

REFERENCE
Seligman, M. E., Maier, S. F., & Geer, J. N. (1968). Alleviation of learned helplessness in the
dog. Journal of Abnormal Psychology. 73, 256–262.
KATIE BASSITY

LEARNING DISORDER
Learning disorder is a term that can be used in a variety of ways for a variety of con-
ditions or disabilities. Children and adults with learning disorders tend to have chal-
lenges with academic subjects, but may in fact have normal levels of overall
intelligence. The term, therefore, is rather broad and nonspecific, and can be inter-
preted in a variety of ways. Learning disorder is defined legally as:

Those children who have a disorder in one or more of the basic psychological processes
involved in understanding or in using language, spoken or written, which disorder may
manifest itself in an imperfect ability to listen, think, speak, write, spell or do math cal-
culations. The term includes such conditions as perceptual handicaps, brain injury, mini-
mal brain dysfunction, dyslexia, and developmental aphasia. (IDEA, 1975)

In contrast to Public Law 94-142, which includes only individuals with normal
intelligence (IQ of 70 or higher), the Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV-TR; APA, 2000) allows for individuals with IQs below 70 and
with uneven cognitive profiles, but excludes those whose learning problems are due to
known neurological disorders. These differences demonstrate further how opaque usage
of the term can be.
Currently, learning disorders in the DSM-IV-TR (APA, 2000) are reported to
include reading disorder (dyslexia), spelling disorder, mathematics disorder (dyscal-
culia), disorder of written expression (dysgraphia), social-emotional learning disorder,
and more recently, nonverbal learning disorder.
Reading disorders, or specific reading difficulties, are perhaps the most common of
the aforementioned learning disorders, affecting 3 to 10 percent of children, with
research indicating they are up to three times more common in males. Reading disor-
ders are commonly associated with spelling difficulties (Goodman & Scott, 2005).
Many learning disorders overlap with other conditions such as autism spectrum dis-
orders (ASD). Research suggests there may be an overrepresentation of dyscalculia in
individuals with Asperger syndrome; dyslexia is also commonly seen in individuals
with Asperger syndrome, although there is some debate as to whether this is above
what may be seen in the general population (Gillberg, 2002). Individuals with ASD
are often also reported to have poor handwriting skills, although this may reflect
motor difficulties rather than a specific disorder such as dysgraphia (Beversdorf et al.,
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LEARNING STYLES

2001). Nonverbal learning disorder is often confused with Asperger syndrome, and
many researchers argue there is little difference between the two, with individuals
with nonverbal learning disorder often also meeting criteria for Asperger syndrome or
pervasive developmental disorder-not otherwise specified (PDD-NOS) (Dinklage,
2001). These overlaps can often add to the confusion in interpretation and applica-
tion of the term learning disorder.

REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
Beversdorf, D. Q., Anderson, J. M., Manning, S. E., Anderson, S. L., Nordgren, R. E., Felopulos,
G. J., et al. (2001). Brief Report: Macrographia in high-functioning adults with autism spec-
trum disorder. Journal of Autism and Developmental Disorders, 31, 97–100.
Dinklage, D. (2001). Asperger’s disorder and nonverbal learning disabilities: How are these two
disorders related to each other? Retrieved July 20, 2006, from www.nldontheweb.org/
Dinklage_1.htm.
Gillberg, C. (2002). A guide to Asperger syndrome. Cambridge: Cambridge University Press.
Goodman, R., & Scott, S. (2005). Child psychiatry (2nd ed.). Oxford: Blackwell.
Individuals with Disabilities Education Act, Public Law No. 94-142 (1975).
FIONA J. SCOTT

LEARNING STYLES
A learning style refers to an individual’s primary learning mode, which identifies
instructional techniques most likely to enhance their learning. Learning styles most
commonly recognized in the classroom include visual learners (learn best when infor-
mation is presented in a visual format), auditory learners (learn best when information
is presented in an auditory format), and kinesthetic/tactile learners (learn best when
hands-on and movement experiences are incorporated in the lesson).
KATHERINE E. COOK

LEAST RESTRICTIVE ENVIRONMENT (LRE)

Children with autism spectrum disorders (ASD) represent a heterogeneous group
requiring individualized and highly unique programs. Some approaches have been
found to be more beneficial than others. According to Dunlap (1999), a critical key
to success is to match specific practices, supports, and services with each student’s
unique profile and the individual family’s characteristics. That is, ‘‘Educational person-
nel are required, through the Individuals with Disabilities Education Act (IDEA)
Amendments of 1997, to provide a continuum of individualized supports, services, and
placements to students, ranging from inclusion in general education with varying lev-
els of supports to extremely specific services and instruction in specialized settings’’
(Iovannone, Dunlap, Huber, & Kincaid, 2003, p. 153).
Planning and placement teams (IEP teams) should consider general education class-
room placement as the first option for children with disabilities. Other placement con-
siderations should occur only when supplementary aids and services implemented in
the general education setting have not yielded educational benefit for the student.
Many children with autism are successfully included in general education classrooms
and are learning with typical peers (Wagner, 1998). In particular, peers are often able
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 LEAST RESTRICTIVE ENVIRONMENT (LRE)

to successfully model typical behavior in addition to assist with generalization of skills

taught.
The IDEA (H.R. 1350 § 612 (a) (5)(A) of IDEA ‘04) requires school personnel to
consider the least restrictive environment (LRE) for children with disabilities. This
means that students, to the maximum extent appropriate, be educated with their non-
disabled peers. Special classes, separate schooling, or other removal of children with
disabilities from the general education environment occur only when the nature and
severity of the disability are such that education in general education classes with the
use of supplementary aids and services cannot be achieved satisfactorily.
However, for some students, the general education classroom is the least restrictive
environment, while for others it may not afford an appropriate education. Thus, LRE
is not always the general education classroom. Considerations for determining the
least restrictive environment for an individual child, based on his or her unique char-
acteristics, learning style, and needs, should include:

1. determining appropriate supports, accommodations and modifications to support the

child’s access to the general education curriculum;
2. collaborating with families to establish shared preferences for goals, methods, and place-
ment settings (Iovannone et al., 2003);
3. embedding the child’s special interests and preferences in the program methods (Hurth
et al., 1999, cited in Iovannone et al., 2003); and
4. clearly identifying the child’s strengths and weaknesses (student profile) to determine in-
tensity of instructional level. (National Research Council, 2001, cited in Iovannone
et al., 2003)

In brief, placement decisions should not be based on the student’s disability, but on
where the child’s needs may be appropriately addressed. That is, having a diagnosis of
autism should not automatically place the student in the school’s or district’s ‘‘autism
class or program.’’ No one program, support, or service is likely to meet the needs of
all children identified with autism. Schools should provide flexible placement and sup-
port options to meet students’ individual goals (Dunlap & Fox, 2002).
It is important to note that inclusion, mainstreaming, and LRE are not synony-
mous. Mainstreaming, a practice that originated in the 1970s, refers to students spend-
ing portions of their school day with typical peers. This is generally based on students
having achieved the expected behavior and/or academic goals necessary to participate.
Inclusion refers to a belief system that drives educational practice and is not merely
an issue of a student’s educational placement (McGregor & Vogelsberg, 1998). More
recent thinking advocates an inclusive philosophy that entails the student having a
sense of belonging to the education community versus inclusion being a place or a
program (i.e., the inclusion room).

The bottom line throughout the mainstreaming movement has been that the student will
adapt and be ready to participate in the general education classroom, and that the gen-
eral education classroom will not change. In contrast to this perspective, the current
inclusion movement assumes that major changes will occur in the general education
classroom, ensuring that students with disabilities will ‘‘fit into’’ these classes. Thus, gen-
eral education classroom curriculum, instructional practices, organization, and so forth are
changed to better meet the needs of the students, rather than expecting students to adapt
to the classroom. (McLeskey & Waldron, 2000, p. 14)

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LEAST RESTRICTIVE ENVIRONMENT (LRE)

Successful inclusion in general education settings for children with autism requires
careful planning and implementation of program components to address students’ social
and academics needs (Kamps, Barbetta, Leonard, & Delquardi, 1994). Responsible in-
clusive practice refers to ensuring and maximizing student success in general education
classrooms by providing teachers support to meet students’ needs. Such support may
involve training, materials, and time to collaborate with colleagues. Responsible inclu-
sive practice calls for educators and parents to reflect on the following questions:

What are the educational benefits to the student in the general education classroom, with
supplementary aids and services, compared with the educational benefits of a special edu-
cation classroom? [or other placement options along the continuum]
What will be the nonacademic or personal benefits to the student in interactions with
nondisabled peers?
What will be the effect on the teacher and other students in the general education
classroom?
How will the team define and measure the success of inclusion?
(National Research Council, 2001, p. 179)

Responsible inclusive practice does not mean providing one-to-one instruction in the
back of a general education classroom without meaningful interaction with nondisabled
peers. This is often referred to as a class-within-a-class. Instead, students need opportuni-
ties for interaction with nondisabled peers through both informal and planned activities.
Children with autism should receive instruction and support to maximize successful
interaction with nondisabled peers (New York State Education Department, Office of
Vocational and Educational Services for Individuals with Disabilities, 2001).

REFERENCES
Dunlap, G. (1999). Consensus, engagement, and family involvement for young children with
autism. The Journal of the Association for Persons with Severe Handicaps, 24, 222–225.
Dunlap, G., & Fox, L. (2002). The challenge of autism from a large systems perspective. Unpub-
lished manuscript, University of South Florida, Tampa.
Individuals with Disabilities Education Act, Public Law No. 101–476 (1990).
Individuals with Disabilities Education Act, Public Law No. 108–446 (2004).
Iovannone, R., Dunlap, G. Huber, H., & Kincaid, D. (2003). Effective educational practices for
students with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities,
18, 3, 150–165.
Kamps, D., Barbetta, P., Leonard, B., & Delquadri, J. (1994). Classwide peer tutoring: An inte-
gration strategy to improve reading skills and promote interactions among students with au-
tism and regular education peers. Journal of Applied Behavior Analysis, 27, 49–60.
McGregor, G., & Vogelsberg, T. R. (1998). Inclusive schooling practices: Pedagogical and research
foundations. Baltimore: Brookes Publishing Co.
McLeskey, J., & Waldron, N. L. (2000). Inclusive schools in action: Making differences ordinary.
Alexandria, VA: Association for Supervision and Curriculum Development.
National Research Council. (2001). Educating children with autism. Committee on Educational
Interventions for Children with Autism. C. Lord & J. P. McGee (Eds.), Division of Behav-
ioral and Social Sciences and Education. Washington, DC: National Academy Press.
New York State Education Department, Office of Vocational and Educational Services for Indi-
viduals with Disabilities. (2001). Autism program quality indicators. Albany, NY: Author.
Wagner, S. (1998). Inclusive programming for elementary students with autism. Arlington, TX:
Future Horizons.
DAVID R. CORMIER
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 LIFE SKILLS AND EDUCATION FOR STUDENTS WITH AUTISM

LEITER INTERNATIONAL PERFORMANCE SCALE

The Leiter International Performance Scale is a cognitive assessment tool designed
to measure an individual’s nonverbal intelligence. The original Leiter scale was devel-
oped by Russell in 1929; the latest version is the Leiter-Revised published in 1997
(Roid & Miller).
The Leiter-R includes two batteries, the visualization and reasoning battery (VR)
and the attention and memory battery (AM), each consisting of 10 subtests. The sub-
tests in the VR battery are as follows: figure ground, design analogies, form comple-
tion, matching, sequential order, repeated patterns, picture context, classification,
paper folding, and figure rotation. Subtests in the AM battery include associated pairs,
immediate recognition, forward memory, attention sustained, reverse memory, visual
coding, spatial memory, delayed pairs, delayed recognition, and attention divided.

REFERENCE
Roid, G. H., & Miller, L. J. (1997). Leiter International Performance Scale–Revised. Wood Dale,
IL: Stoelting.
HYO JUNG LEE

LIFE SKILLS AND EDUCATION FOR STUDENTS WITH AUTISM AND

OTHER PERVASIVE BEHAVIORAL CHALLENGES (LEAP)
LEAP stands for Lifeskills and Education for Students with Autism and other Perva-
sive Behavioral Challenges. Administered by the Kennedy Krieger Institute in Balti-
more, Maryland (Kennedy Krieger Institute, 2005), this 12-month, intensive early
intervention special education program is designed to serve students 5–21 years old
who are diagnosed with autism or related disorders.
The LEAP program, developed in 1984 by Hoyson, Jamieson, and Strain, combines
several learning theories with a primary focus on social development. With an empha-
sis on building routines that facilitate learning, the LEAP program incorporates a prac-
tical life skills curriculum, into students’ individualized education programs (IEP),
including such strategies as applied behavior analysis (ABA), TEACCH (Treatment
and Education of Autistic and Related Communications Handicapped Children), dis-
crete trial, incidental learning, errorless teaching, augmentative and alternative com-
munication, picture exchange communication systems, sensory diets, and vocational
training along with other established approaches. Instead of adhering to a fixed curric-
ulum, teachers collect data on the IEP objectives and use data to make modifications
to the teaching plans, as necessary. The main goal is to develop a treatment that fits
the individual variables in each student’s life. With enough data, programs can be
altered to provide the most efficient use of resources and time and be altered as the
students’ needs change during treatment. Lessons taught at school are also practiced at
home with the help of family members. This not only reinforces the lessons but allows
students to see how the information applies to their everyday lives. This realization
helps them to learn social skills that will help them throughout life.

LEAP RELATING TO AUTISM

The underlying focus of the LEAP program is achieved through an inclusive class-
room-based program that runs 3 hours daily, year round. Developmentally appropriate
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LIFE SKILLS AND EDUCATION FOR STUDENTS WITH AUTISM

practice and applied behavioral analysis techniques are employed, and typically devel-
oping peers are used in modeling and encouraging appropriate behavior. A major goal
is to increase students’ independence and help them develop functional communica-
tion, daily living, and vocational skills. The methods used to attain this goal are one-
on-one and group instruction carried out in a highly structured environment. The
structure is necessary to maximize efforts and to provide cohesiveness not only to the
subject matter but also to the teaching methods used. Consistency and repetition are
the keys to providing an environment that is conducive to learning.
Social interaction is fostered throughout the day in the classroom and on the play-
ground. Nondisabled peers play a major role here by teaching students social skills
and getting them to interact with others. Nondisabled students receive special training
so they can help achieve a constant open environment for the students to practice
initiating and responding to social conditions. It is this constant reinforcement that
allows the child with autism to learn to fully participate in social interaction.

LEARNING OPPORTUNITIES IN SCHOOL

For younger children, LEAP’s primary teaching method involves the discrete trial
approach. With some children, errorless prompting is used.
Students spend much of their day engaged in drills, learning things like colors,
numbers, animals, and parts of the body. The rest of the day includes music and art
therapy, and theme group activities, with therapist-led group learning about a specific
topic like cooking. Since children with autism prefer to work by themselves, the goal
of a group activity is to teach them social skills so they are able to sit next to peers at
a group table and wait for their turn to participate.

LEARNING OPPORTUNITIES OUTSIDE THE CLASSROOM

As the children progress, teachers use the same approach in natural environments.
Thus, older students practice tasks in the real world. They go to stores and look for a
certain item, go to the cash register, pay for it, and then get back into the van to
return to school, thus learning how to accomplish tasks necessary for everyday life.
See also augmentative and alternative communication; discrete trial training; voca-
tional rehabilitation.

REFERENCES
Hoyson, M., Jamieson, B., & Strain, P. (1984). Individualized group instruction of normally
developing and autistic-like children: The LEAP curriculum model. Journal of the Division for
Early Childhood, 8, 157–172.
Kennedy Krieger Institute. (2005). LEAP program (Lifeskills and Education for Students with
Autism and other Pervasive Behavioral Challenges). Retrieved August 22, 2006, from http://
www.kennedykrieger.org/kki_school.jsp?pid=1422&bl=1.

FURTHER INFORMATION
Dawson, G., & Osterling, J. (1997). Early intervention in autism. In M. J. Guralnick (Ed.), The
effectiveness of early intervention (pp. 307–326). Baltimore: Brookes Publishing Co.
Educating Children with Autism. (2001). Front matter executive summary (pp. 168–169).
Retrieved August 22, 2006, from http://newton.nap.edu/books/0309072697/html/168.html.
Erba, H. W. (2000). Early intervention programs for children with autism: Conceptual frame-
works for implementation. American Journal of Orthopsychiatry, 70(1), 82–94.

214
 LINDAMOOD-BELL

The PDA Center at the University of Colorado at Denver (1998). (The Professional Develop-
ment in Autism Center). Retrieved August 22, 2006, from http://depts.washington.edu/
pdacent/sites/ucd.html.
Psychosocial Paediatrics Committee. Canadian Paediatric Society (CPS). (2004). Early inter-
vention for children with autism. Pediatrics & Child Health, 9(4), 267–270. Retrieved August
22, 2006, from http://www.cps.ca/english/statements/PP/pp04-02.htm#Committee#Committee.
Schopler, E., Reichler, R. J., DeVellis, R. F., & Daly, K. (1988). The Childhood Autism Rating
Scale (CARS). Los Angeles: Western Psychological Services.
Shaw, G. (2005). Autism in the classroom: What works. Neurology Now, 1(3), 32–33. Retrieved
August 22, 2006), from http://www.neurologynow.com.
Strain, P. S. (1987). Comprehensive evaluation of young autistic children. Topics in Early Chil-
dren Special Education, 7, 97–110.
Strain, P. S., & Hoyson, M. (2000). On the need for longitudinal, intensive social skill inter-
vention: LEAP follow-up outcomes for children with autism as a case-in-point. Topics in Early
Children Special Education, 20, 116–122.
JOUNG MIN KIM

LIFE SKILLS SUPPORT

Life skills support refers to an educational or vocational support program or setting
targeting the psychosocial and interpersonal skills that assist individuals in the process
of making informed decisions, communicating effectively, and developing coping and
self-management skills. Life skills supports often provide instruction in personal
hygiene, functional academics, culinary skills, and social competence in order to help
individuals lead a healthy and productive life.
JEANNE HOLVERSTOTT

LIMBIC SYSTEM
The limbic system is a set of brain structures (the list varies with the source con-
sulted), which includes the amygdala, hippocampus, hypothalamus, and several other
nearby structures. The limbic system is mainly involved in emotions and formation of
memories. It also influences the autonomic nervous system (involuntary body func-
tions) and endocrine system (hormone secretion).
BRUCE BASSITY

LINDAMOOD-BELL
The Lindamood-Bell learning process was cofounded by Pat Lindamood and Nanci
Bell. It is headquartered in San Luis Obispo, California and has 39 learning centers in
the United States and one in London.
Lindamood-Bell conducts diagnostic evaluations on students, designs lessons, sched-
ules instruction, and sets up learning environments (Lindamood & Bell, 2005). Based
on the students’ needs, they use an interactive, balanced approach entailing Socratic
questioning and clinical teaching, and provide follow-up services to continue process-
ing and development in everyday life.
Lindamood-Bell School Services provides workshops for teachers, onsite consulting,
and professional support in the areas of sensory cognitive programs, professional devel-
opment, learning environments, leadership, and accountability.
215
LOCAL EDUCATION AGENCY

REFERENCE
Lindamood, P., & Bell, N. (2005). Lindamood-Bell learning process. Online Resource: http://
www.lblp.com.
JOUNG MIN KIM

LOCAL EDUCATION AGENCY

A Local Education Agency (LEA) ensures that school personnel are trained and
qualified to provide educational services for students with special needs at the local
public school district level.
KATHERINE E. COOK

LOCOMOTION
Locomotion refers to the ability to walk or move in a forward motion.
KELLY M. PRESTIA

LOSS AND LEARNING THEORY. See Good Grief!

LOW/POOR REGISTRATION
Low registration is a neurological characteristic of individuals who have a high sen-
sory threshold, or tolerance, that must be met for typical stimuli to produce a
response. Individuals with low registration often appear lethargic and inattentive and
may require intense sensory stimulation to gain their attention or engage them in
activities.
See also sensory stimuli.
KELLY M. PRESTIA

216
 M
MAGNETIC RESONANCE IMAGING (MRI)
Magnetic resonance imaging (MRI) is a technology used to create detailed images
of the insides of humans or other organisms. MRI use is extremely expensive but is
generally a noninvasive procedure with few known side effects. An MRI can take 2-D
images or 3-D models, and the outcome is of high quality. In the field of autism, MRI
has been used extensively over the last decade to make images of the brain. This
includes pictures of the brain to chart seizure damage, brain structure and anatomy,
brain volume, amount of gray and white matter, and other structures.

FURTHER INFORMATION
Bremner, J. D. (2005). Brain imaging handbook. New York: W. W. Norton & Co.
Radiological Society of North America, Inc. (2006). MR Imaging (MRI Body. Retrieved June 5,
2006, from http://www.radiologyinfo.org/content/mr_of_the_body.htm.
PAUL G. LACAVA

MAINSTREAMING
Mainstreaming is a term that is used when considering placement of a student with
an autism spectrum disorder (ASD) in a general education classroom (Zionts, 1997).
It has been used interchangeably with the term inclusion; however, mainstreaming
and inclusion are two different approaches to serving students with disabilities. Usu-
ally, when an IEP team considers mainstreaming, it is assumed that the student is able
to show progress with the nondisabled peers in the regular educational setting. These
students have the appropriate skills to progress using the same curriculum, usually with
some adaptations or modifications.
The term mainstreaming was used in the late 1970s and early 1980s after the Indi-
viduals with Disabilities Education Act (IDEA) was passed into law. During this
time, mainstreaming was implemented by including students with disabilities in nona-
cademic portions of the curriculum, such as music, art, and physical education, while
continuing academic instruction in self-contained classrooms, limiting the time with
nondisabled peers.
Educators and parents did not approve of the act of mainstreaming, creating the
Regular Education Initiative (REI). REI had three major goals, which included sharing
MAINTENANCE

responsibility of students with special needs, including students with special needs into
regular education classrooms full time, and increasing the achievement of students
with mild disabilities (Fuchs & Fuchs, 1994). This debate between special educators
and general education leaders resulted in a new term, inclusion. Inclusion became the
model for serving students with disabilities in school settings.
Now, mainstreaming is considered as placing a student with a disability in a class-
room with the expectation that the student is able to keep pace or make progress in
the general education classroom. Mainstreaming has definite benefits. The student
with an ASD would benefit from being around appropriate social and behavioral role
models. It is important to evaluate if being mainstreamed in the regular education
classroom is the least restrictive environment (LRE) for the student. If a student with
ASD is mainstreamed in the regular education classroom, it is important for the regu-
lar classroom teacher and special education teacher to consult regularly on how to
help create the most successful environment possible. Mainstreaming does not have to
be the entire school day; the IEP can be selective and choose times that the student
is able to participate and show progress the same as other nondisabled peers. This may
be during different academic times of the day, physical education, music, or any other
time of the day.

REFERENCES
Fuchs, D., & Fuchs, L. S. (1994). Inclusive school movement and the radicalization of special
education reform. Exceptional Children, 60(4), 294–305.
Zionts, Paul. (Ed.). (1997). Inclusion strategies for students with learning and behavioral problems:
Perspectives, experiences, and best practices. Austin, TX: Pro-Ed.
MELISSA L. TRAUTMAN

MAINTENANCE
Maintenance, also known as generalization across time, refers to an individual’s
ability to use a skill at an acceptable rate for a specific amount of time following the
termination of part or all of a systematic instructional procedure or intervention. For a
skill to be maintained, it should be durable and resistant to extinction. For example, if
a student learned to write numbers 1–10, staff should intermittently perform mainte-
nance checks to assess the skill and to ensure that the student can perform the skill at
the same proficiency.

FURTHER INFORMATION
Alberto, P. A., & Troutman, A. C. (2006). Applied behavior analysis for teachers (7th ed). Upper
Saddle River, NJ: Prentice Hall.
Cooper, J. O., Heron, T. E., & Heward, W. L. (1987). Applied behavior analysis. Upper Saddle
River, NJ: Prentice Hall.
Heflin, J. L., & Alaimo, D. F. (2007). Students with autism spectrum disorders: Effective instruc-
tional practices. Upper Saddle River, NJ: Prentice Hall.
Scheuermann, B., & Webber, J. (2002). Autism: Teaching does make a difference. Belmont, CA:
Wadsworth/Thomson Learning.
Westling, D. L., & Fox, L. (2004). Teaching students with severe disabilities (3rd ed.). Upper Sad-
dle River, NJ: Prentice Hall.
THERESA L. EARLES-VOLLRATH
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 MASTURBATION

MALADAPTIVE BEHAVIOR
Maladaptive behavior refers to undesirable, deviant, or negative behaviors displayed
over a period of time to meet a want or need in place of a more socially appropriate
behavior.
KATHERINE E. COOK

MAND
A mand is a request. The term mand was created and introduced by B. F. Skinner
in his 1957 book, Verbal Behavior. In it Skinner defines a mand as something that
names its reinforcer and is brought about by deprivation or aversion. For example,
when a child wants juice he says ‘‘juice’’ and is given juice. ‘‘Juice’’ is a mand. As long
as manding is reinforced, the response is giving the child what he asks for; manding
tends to increase over time, therefore increasing language. As may be anticipated,
manding is typically the first step in the development of functional language.

REFERENCE
Skinner, B. F. 1957. Verbal behavior. New York: Appleton-Century-Crofts.
KATIE BASSITY

MASSED PRACTICE
Also referred to as mass trials in some forms of discrete trial programming, massed
practice is repeated trials of one task or skill. In massed practice, a student is required
to demonstrate a particular skill for many consecutive repetitions. Massed practice is
generally one of the first steps in learning a new task or skill within more structured
forms of applied behavior analysis, such as discrete trial training instruction.
KATIE BASSITY

MASTURBATION
Like their neurotypical counterparts, most people with autism spectrum disorders
(ASD) develop an interest in intimacy, relationships, and sexuality (Lawson, 2005;
Shore, 2003). One natural means for satisfying some of this interest could be mastur-
bation or exploration of our own bodies for sexual gratification (Realmuto & Ruble,
1999). Masturbation is reported in several studies to be a common occurrence among
children, adolescents, and adults with ASDs (Koller, 2000; Haracopos & Pederson,
1999; Realmuto & Ruble, 1999; and Reichle & Palmer, 1997).
While there is little written material specifically addressing the subject of sexuality
issues and ASDs, most experts agree that teaching necessary information in a proactive
and factual manner is the most responsible route for parents, caregivers, or professionals
to assume (Shore & Rastelli, 2006). Blum and Blum (1981) cited in Hinsburger (1995)
suggest the following learning objectives when teaching the topic of masturbation:

¥ Masturbation is NORMAL and HEALTHY. Myths about the effects of masturbation can
be very destructive (Grandma’s story about going blind is nonsense!). Feelings of shame,
guilt, immorality, and fear can interfere with masturbation in such a way that leads to
obsessions, anxiety, and inappropriate public behaviors.
¥ There are appropriate times and places to engage in masturbation. Discussion about private
versus public behavior becomes very important at this point because public masturbation

219
MEAN LENGTH OF UTTERANCE

is illegal in most places and one of the most frequently noted inappropriate behaviors in
the autistic population (Helleman and Deboutte, 2002). Since nonverbal communication,
perspective taking, and sensory deficits are all well-documented challenges for individuals
with ASD, comprehensive educational programming should include very clear and open
discussion of ways to help compensate for these challenges that lead to successful social or
sexual experiences.
¥ Learning what kind of stimulation leads to pleasure goes back to the sensual nature of sex-
ual stimulation. Because many individuals with autism have sensory processing deficits,
programming should include awareness of the physiological nature of sensory issues and
compensatory strategies for whatever tactile sensitivities may exist.

With some effort, parents and professionals can find books and curricula that will
help them initiate and support appropriate education regarding sexuality issues for
individuals with ASD, just like they would for any other person. It is not unreasonable
to suggest that the person providing the instruction should allow themselves the op-
portunity to examine their own social bias and values prior to taking on such a
responsibility in order to avoid the potential for inadvertent subjective or judgmental
messages during instruction. There is no denying that sexuality along with drug or
alcohol abuse and many other culturally defined issues can make for very awkward
conversations that promote myths and misinformation. As with any other population,
a genuine understanding of the issues that influence social success can provide caregiv-
ers and professionals with some of the best tools for supporting healthy development.

REFERENCES
Haracopos, D., & Pederson, L. (1999). The Danish report. Kettering: Autism Independent UK.
Helleman, H., & Deboutte, D. (2002). Autism spectrum disorders and sexuality. Paper presented
at the Melbourne World Autism Congress.
Hinsburger, D. (1995). Hand made love: A guide for teaching male masturbation through understand-
ing and video. New Market: Diverse City Press.
Koller, R. (2000). Sexuality and adolescents with autism. Sexuality and Disability, 18(2), 125–
135.
Lawson, W. (2005). Sex, sexuality and the autism spectrum. London: Jessica Kingsley Publishers.
Realmuto, G. M., & Ruble, L. A. (1999). Sexual behaviors in autism: Problems of definition
and management. Journal of Autism and Other Developmental Disabilities, 29(2), 121–127.
Reichle, N. C., & Palmer, A. (1997). Sexual behavior in adults with autism. Journal of Autism
and Other Developmental Disabilities, 27(2) 113–125.
Shore, S. (2003). Beyond the wall: Personal perspectives with autism and Asperger syndrome. Shaw-
nee Mission, KS: Autism Asperger Publishing Company.
Shore, S., & Rastelli, L. (2006). Understanding autism for dummies. Indianapolis, IN: Wiley Pub-
lishing, Inc.

FURTHER INFORMATION
Henault, I. (2006). Asperger’s syndrome and sexuality. London: Jessica Kingsley Publishers.
Kempton, W. (1993). Socialization and sexuality: A comprehensive guide. Santa Barbara, CA:
James Stanfield Company.
Diverse City Press at www.diverse-city.com.
SHERRY MOYER

MEAN LENGTH OF UTTERANCE

Mean Length of Utterance (MLU) is one tool used to calculate the linguistic activ-
ity or proficiency of young children’s spoken language. To calculate the mean length
220
 MENTAL RETARDATION

of utterance of a child, you add up the total number of words spoken by the child and
divided by the number of morphemes within the spoken words. A morpheme is defined
as the smallest unit of meaning within a word. For example, ‘‘I see plane’’ would have
a MLU of (3).
KATHERINE E. COOK

MEDIATION
Mediation is a process that helps resolve disputes between two parties. According to
the Individuals with Disabilities Education Act (2004), all school districts are
required to make special education mediation available to parents of children with dis-
abilities. Special education mediation is designed to be a cooperative discussion where
both parties can reach an agreement. A mediator is used to facilitate this process;
once an agreement is met, the written agreement is binding.

REFERENCE
Individuals with Disabilities Education Improvement Act of 2004. Public Law No. 109-446, § 20
U.S.C. et seq.

FURTHER INFORMATION
Vocational and Education Services for Individuals with Disabilities. (n.d.). Special education
mediation. Retrieved December 13, 2006, from www.vesid.nysed.gov/specialed/mediation.htm.
TERRI COOPER SWANSON

MENTAL AGE
Mental age (MA) is the level of intellectual development as measured by intelli-
gence tests. MA is expressed as the age at which that level of development is typically
attained. For example, when a child is described as having a MA of 12, he is able to
solve the same test problems as average 12-year-old children.
THERESA L. EARLES-VOLLRATH

MENTAL HEALTH COUNSELOR

A mental health counselor is a licensed counselor that helps individuals, couples,
and families discuss their problems for the purpose of resolving interpersonal and
intrapersonal conflicts. Mental health counselors often counsel parents and siblings of
autistic children and typically work closely with other professionals such as psycholo-
gists and psychiatrists.
STEVE CHAMBERLAIN

MENTAL RETARDATION
Mental retardation is a broad term used to describe someone who has limits in their
cognitive or thinking skills as well as difficulties with adaptive skills such as communi-
cation, self-help, social skills, and academics. This disability originates before the age
of 18 (American Association on Mental Retardation, 2002). In order to receive a di-
agnosis of mental retardation, an individual must score significantly below average on
an intelligence test, as well as exhibit limited functioning in the previously listed
221
MERCURY

areas. The average score on an intelligence test (IQ test) is 100. People scoring below
a 70 are said to have mental retardation.
The Individuals with Disabilities Education Act of 2004 (IDEA) defines mental retar-
dation as ‘‘significantly subaverage general intellectual functioning, existing concurrently
with deficits in adaptive behavior and manifested during the developmental period, that
adversely affects a child’s educational performance’’ (Federal Register, 1999).
Individuals with mental retardation develop and learn but at a much slower rate
than typically developing peers. The degree to which mental retardation affects a per-
son ranges from profound, severe, or moderate, to mild.
Mental retardation is the most common developmental disorder. The Centers for
Disease Control and Prevention (CDC) found in 1993 that 1.5 million children and
adults in the United States had mental retardation (Mental Retardation, 2005). The
highest rate of mental retardation was found in West Virginia, while the lowest rate
was found in Alaska.
The causes of mental retardation are extremely varied. The condition can be caused
by disease, injury, or neurological abnormality. Some of the most common causes are
Down syndrome, fetal alcohol syndrome (FAS), and fragile X syndrome. Diseases
such as cytomegalovirus and measles may also cause mental illness. In addition, lead
exposure and lack of prenatal care may lead to mental retardation. Additional causes
may involve asphyxia, head injury, stroke, metabolic conditions (phenylketonuria), or
hydrocephalus.
Most diseases or events that cause mental retardation cannot be prevented. However,
some, such as fetal alcohol syndrome, can be prevented if no alcohol is ingested while a
mother is pregnant. Additionally, prompt treatment for jaundice can prevent a specific
type of brain damage that can occur if the bilirubin is allowed to reach too high of a
level. Metabolic conditions may be able to be identified after birth through blood tests.
Once identified, these babies are treated with medications and/or special diets.
Several organizations exist to support families and individuals with mental retarda-
tion. Some of the bigger ones are The Arc of the United States, The American Asso-
ciation on Mental Retardation, and the Division on Developmental Disabilities.
See also adaptive behavior.

REFERENCES
American Association on Mental Retardation. (2002). Mental retardation: Definition, classifica-
tion, and systems of supports (10th ed.). Washington, DC: Author.
Federal Register Department of Education Assistance to States for the Education of Children
with Disabilities and the Early Intervention Program for Infants and Toddlers with Disabil-
ities; Final Regulations. 34 CFR Parts 300 and 303. Vol. 64, No. 48. Friday, March 12, 1999.
Mental Retardation (October 29, 2005). Developmental Disabilities. Retrieved October 30,
2006, from http://www.cdc.gov/ncbddd/dd/mr3.htm.
LYNN DUDEK

MERCURY
Mercury is an element that has been historically used in a number of ways including in
chemical production, thermometers, dental fillings, and electronics. Mercury and its
many forms can become very toxic to humans and other animals. Research has lead to
the phasing out of mercury thermometers as well as increased emphasis on environmental
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 MILIEU TEACHING

safety. From the 1990s to the publication of this volume, increased research was con-
ducted to explore the effects of ethyl mercury contained in the vaccine preservative thi-
merosal for a possible connection to an increase in the prevalence of autism. At this
writing, although no conclusive evidence has been revealed that shows causality between
thimerosal and increased autism rates, the controversy has not been settled.
See also vaccinations (thimerosal).

FURTHER INFORMATION
Centers for Disease Control and Prevention. (2004). FAQs about MMR vaccine and autism.
Retrieved March 30, 2005, from http://www.cdc.gov/nip/vacsafe/ concerns/autism/autism-mmr.
htm.
Kirby, D. (2005). Evidence of harm: Mercury in vaccines and the autism epidemic: A medical contro-
versy. New York: St. Martin’s Press.
National Broadcasting Company. (Executive Producer). (February 23, 2005). The Today Show
[Television Broadcast]. New York: National Broadcasting Company.
PAUL G. LACAVA

METALLOTHIONEIN
Metallothioneins (MTs) are proteins that participate in the uptake, transport, and
regulation of zinc in a biological system. By binding and releasing zinc, metallothio-
neins regulate its level within the body. Metallothionein also carries zinc ions (as sig-
nals) from one part of the cell to another. When zinc enters a cell, it can be picked
up by thionein (becoming metallothionein) and carried to another part of the cell
where it is released to another organelle or protein. This system is particularly impor-
tant in the brain, where zinc signaling is prominent both between and within nerve
cells. In a 2001 presentation to the American Psychiatric Association, Dr. William J.
Walsh of the Pfeiffer Treatment Center suggested a potential link between metallo-
thionein disorders and autism. He concluded that ‘‘Many classic symptoms of autism
may be explained by a MT defect in infancy including [gastrointestinal] tract prob-
lems, heightened sensitivity to toxic metals, and abnormal behaviors. These data sug-
gest that an inborn error of MT functioning may be a fundamental cause of autism’’
(Walsh and Tarpey, 2001).

REFERENCE
Walsh, W. J., & Tarpey, J. (May 2001). Disordered metal metabolism in a large autism population.
Presented at the American Psychiatric Association annual meeting, New Orleans.
JEANNE HOLVERSTOTT

MILIEU TEACHING
Milieu teaching is a naturalistic approach to teaching language in a child’s environ-
ment (Goldstein, 2002). Many studies have shown that milieu teaching is the effective
way to teach language, especially for children with autism spectrum disorders (Gold-
stein, 2002; Hancock & Kaiser, 2002; Koegel, Koegel, & Surratt, 1992; Koegel, O’Dell,
& Dunlap, 1988). According to Paul and Sutherland (2005), milieu teaching includes
the following components: (a) teaching and training occur in the child’s everyday envi-
ronment rather than in a ‘‘therapy room’’; (b) activities take place as part of the daily
routine rather than only at ‘‘therapy time’’; (c) preferred toys and activities are included
223
MILIEU TEACHING

in the environment so that participation in activities is self-reinforcing; (d) adults en-

courage spontaneous communication by refraining from prompting and using ‘‘expect-
ant waiting’’ such as facial expression or eye gaze; (e) the child initiates the teaching
situation by gesturing or indicating interest in a desired object or activity; (f) teachers
provide prompts and cues for expanding the child’s initiation; and (g) expanded child
responses are rewarded with access to a desired object or activity.
Incidental teaching is one of the most common types of milieu teaching. Teachers
can plan expected learning for children based on their interests or desires. For
instance, if the child always wants to have a specific toy in the playroom, the teacher
can place the toy in sight but out of reach in the playroom. The teacher then waits
for the child to initiate his need to have the toy. The teacher may gaze at the child
or use facial expressions to prompt the child’s initiation to get the toy. If the child
does not initiate, the teacher may ask the child what he or she wants. If the child pro-
duces the target initiation, the teacher meets the child’s need. By carefully arranging
the environment, teachers can promote child engagement with activities and commu-
nication (Ostrosky & Kaiser, 1991). Teachers and parents can use ‘‘teachable
moments’’ in the daily routine as well as in planned situations.
The mand model also uses natural situations based on the child’s desire. For example,
when the teacher observes the child’s interest, the teacher utters a request such as
‘‘What is this?’’ or ‘‘Do you want this?’’ If the child shows the target response, the
teacher gives him the preferred object and allows him to play with it for a certain time.
Time delay or prompt-free approaches are also examples of milieu teaching methods
(Goldstein, 2002; Paul & Sutherland, 2005). Using time delay, adults wait for a cer-
tain length of time for the child to respond appropriately. With a prompt-free
approach, if the child reaches or touches the provided pictures or objects without
being prompted, she gets the target object.
Even though milieu teaching is generally used to teach requesting, because of the
high motivation inherent in requesting desired items that presumably function as rein-
forcers (Goldstein, 2002), it can also be a helpful way to maintain and generalize new
behaviors in the child’s natural environment.

REFERENCES
Goldstein, H. (2002). Communication intervention for children with autism: A review of treat-
ment efficacy. Journal of Autism and Developmental Disorders, 32, 373–396.
Hancock, T., & Kaiser, A. P. (2002). The effects of trainer-implemented enhanced milieu
teaching on the social communication of children with autism. Topics in Early Childhood Spe-
cial Education, 22, 39–54.
Koegel, R. L., Koegel, L. K., & Surratt, A. (1992). Language intervention and disruptive behav-
ior in preschool children with autism. Journal of Autism and Developmental Disorders, 22, 141–
153.
Koegel, R. L., O’Dell, M. C., & Dunlap, G. (1988). Producing speech use in nonverbal autistic
children by reinforcing attempts. Journal of Autism and Developmental Disorders, 18, 525–538.
Ostrosky, M. M., & Kaiser, A. P. (1991). Preschool classroom environments that promote com-
munication. Teaching Exceptional Children, 23, 6–10.
Paul, R., & Sutherland, D. (2005). Enhancing early language in children with autism spectrum
disorders. In F. R. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and
pervasive developmental disorders (pp. 946–976). Hoboken, NJ: John Wiley & Sons, Inc.
HYO JUNG LEE
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 MOOD DISORDERS

MINDBLINDNESS
Mindblindness refers to an inability to read or be aware of others’ minds. Baron-
Cohen developed the term in order to describe a major characteristic of autism
(1990). Understanding others’ minds is one of the key factors in social interaction
because most people use nonverbal information such as gestures, facial expression, or
voice tone to understand social situations. Mindblindness is a common characteristic
of individuals with autism spectrum disorders.

REFERENCE
Baron-Cohen, S. (1990). Autism: A specific cognitive disorder of ‘‘mind-blindness.’’ International
Review of Psychiatry, 2, 79–88.
HYO JUNG LEE

MODIFIED CHECKLIST FOR AUTISM IN TODDLERS (M-CHAT)

The M-CHAT (Robins, Fein, Barton, & Green, 2001) is an American modified
version of the original UK CHAT. The M-CHAT is a 23-item parent-report checklist
(yes/no responses) designed to screen children ages 16 to 30 months old for possible
autism. Research identified six critical items, and children failing any three total items
or any two of the six critical items are recommended to undergo further investigation.
Sensitivity of the M-CHAT is reported to be good, based on children being diagnosed
after age 2 years with autism who had failed the M-CHAT screen. Researchers suggest
that rescreening after the initial M-CHAT with a second M-CHAT can help rule out
those who have developed skills after the original screen.

REFERENCE
Robins, D. L., Fein, D., Barton, M. L., & Green, J. A. (2001). The Modified Checklist for Au-
tism in Toddlers: An initial study investigating the early detection of autism and pervasive
developmental disorders. Journal of Autism and Developmental Disorders, 31, 131–144.
FIONA J. SCOTT

MOOD DISORDERS
Every year 44 million people are afflicted with mental illness (United States Depart-
ment of Health and Human Services–Substance Abuse and Mental Health Adminis-
tration [USDHH-SAMHA], 2006). Mood disorders are common mental illnesses, and
according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-
TR; APA, 2000), they are divided into four categories: (a) depressive disorders,
(b) bipolar disorders, (c) mood disorders due to a general medical condition, and
(d) substance-induced mood disorders (APA, 2000). Depressive disorders and bipolar
disorders are the most common types of mood disorders (USDHH-SAMHA, 2006).
According to the APA (2000), there are three types of depressive disorders:
(a) major depressive disorder, (b) dysthymic disorder, and (c) depressive disorder not
otherwise specified. The four types of bipolar disorders include: (a) bipolar I disorder,
(b) bipolar II disorder, (c) cyclothymic disorder, and (d) bipolar disorder not otherwise
specified (APA, 2000). Mood disorders due to a general medical condition are charac-
terized challenges with depression due to physiological difficulties due to a general
medical condition. Substance-induced mood disorders are characterized by drug abuse
or exposure to a toxin.
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MOOD STABILIZING MEDICATIONS

Mood disorders can be treated, and individuals affected by them can lead productive
lives. Types of treatment may include medication and psychotherapies. Treatment
may be short- or long-term depending upon the type of mood disorder and the length
of time it has occurred.
For additional information on the specific diagnostic features of mood disorders, see
the Diagnostic and Statistical Manual of Mental Disorders (APA, 2000).

REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
United States Department of Health and Human Services–Substance Abuse and Mental Health
Administration. (2006). Mood disorders. Retrieved December 1, 2006, from http://mental-
health.samhsa.gov/publications/allpubs/ken98-0049/default.asp.
TERRI COOPER SWANSON

MOOD STABILIZING MEDICATIONS

Mood stabilizing medications are used to control extreme behaviors, mood swings,
depression, and mania, which cause disruption in functioning. Various types of medi-
cations are used such as antidepressants, some antipsychotics, and anticonvulsants
such as valproic acid (Depakote), carbamazepine (Tegretol), and lithium.
See also antidepressant medications; antipsychotic medications.
BRUCE BASSITY

MOTIVATION ASSESSMENT SCALE

The Motivation Assessment Scale (MAS; Durand & Crimmins, 1988) is an indirect
assessment designed to assess the function of a challenging behavior. Family members,
teachers, case managers, or others with knowledge of the challenging behavior answer
the 16 questions on the MAS by assessing frequency from 0 (never) to 6 (always) and
are directly correlated to one of four behavioral functions: self-stimulation, escape/
avoidance, attention, and tangible. The MAS should be used with other tools to
determine the function of and a replacement behavior(s) for a challenging behavior.

REFERENCE
Durand, V. M., & Crimmins, D. B. (1988). Identifying the variables maintaining self-injurious
behavior. Journal of Autism and Developmental Disorders, 18, 99–117.
JEANNE HOLVERSTOTT

MOTOR IMITATION
Motor imitation is the ability to replicate a motor movement or group of move-
ments from a model or demonstration.
KELLY M. PRESTIA

MULTIDIMENSIONAL ANXIETY SCALE FOR CHILDREN (MASC)

The Multidimensional Anxiety Scale for Children (MASC; Pierangelo & Giuliani,
2006) is a diagnostic tool, which assesses the key features of anxiety problems in chil-
dren and adolescents, ages 8 to 19. It consists of 39 items disseminated across four
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 MUSIC THERAPY

basic scales: Physical Symptoms, Harm Avoidance, Social Anxiety, and Separation/
Panic. Subscales include Somatic Symptoms and Tense Symptoms, Perfectionism and
Anxious Coping, and Humiliation Fears and Performance Fears. The MASC is com-
monly used in schools, outpatient clinics, residential treatment centers, juvenile
detention centers, child protective services, and private practices.

REFERENCE
Pierangelo, R., & Giuliani, G. (2006). The special educator’s comprehensive guide to 301 diagnostic
tests. New York: Wiley.
AMY BIXLER COFFIN

MULTIDISCIPLINARY EVALUATION (MDE)

A multidisciplinary evaluation (MDE) is a comprehensive evaluation conducted by
a multidisciplinary team (MDT) consisting of professionals from various disciplines
such as special education, speech-language pathology, occupational therapy, physical
therapy, and school health services. The purpose of the MDE is to determine eligibil-
ity for special education, establish current levels of performance, and assist in develop-
ing appropriate programming.
See also speech-language pathologist.
THERESA L. EARLES-VOLLRATH

MULTIDISCIPLINARY TEAM
When providing services to students with disabilities, professionals from different
disciplines (i.e., occupational therapy, speech therapy, special education, general edu-
cation) that generally work independently of each other work together during assess-
ment, program planning, and implementation.
KATHERINE E. COOK

MUSIC THERAPY
The American Music Therapy Association (AMTA) defines music therapy as ‘‘the
clinical and evidence-based use of music interventions to accomplish individualized
goals within a therapeutic relationship by a credentialed professional who has com-
pleted an approved music therapy program’’ (2006). Music therapy may take place in
a variety of settings including homes, community programs, or schools, and is consid-
ered a related service under the Individuals with Disabilities Education Act (2004).
The nonthreatening environment afforded by the music therapy session often enables
individuals and often results in improved outcomes. Academic skills can be addressed
through structured music drills for math facts, letter identification, and more. Reading com-
prehension can be addressed over time with musically assisted attention development and
the expansion necessary for making inferences in reading, writing, and day-to-day living.
When designing interventions, music therapists consult with other professionals to
determine and construct a treatment plan that will serve the individual’s needs in a
proactive manner. For example, is a school setting they will be part of the child’s
Individualized Education Program (IEP) team, and that team will determine and con-
struct the treatment plan together.
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MUSIC THERAPY

When working with individuals with autism, a music therapist may do some of the
following activities.
Communication
When working to increase and build communication, a music therapist may use familiar songs
or repetitive melodies with original lyrics. Utilizing intermittent breaks in the lyrics while
keeping the rhythm steady provides opportunities for the individual to predict and often pro-
duce a response. The music therapist extends these activities to expand vocabulary for use in
receptive and expressive language, as well as developing language use in a social context.

Socialization
When working to develop, increase, and/or improve socialization, a music therapist may
utilize rhythm to provide structure and melody to organize information by setting Social
Stories or social scripts to music. The music may be original or familiar depending on the
individual’s needs. The music therapist may construct peer groups to practice socialization
in a true social context while using instrument play. Structured and unstructured instru-
ment play allows the music therapist to embed opportunities for turn taking, verbal and
nonverbal communication of needs and wants, attention, awareness of others and self, as
well as an opportunity to be successful.

Behaviors
When working to address specific behaviors, the music therapist will begin by working
with the individual’s team to identify the function of the behavior. In the event that the
function is communication, necessary vocabulary and concepts can be taught through the
use of repetitive melodies and lyrics paired with visuals if necessary and rehearsal and
reinforcement across contexts. An example of this might be a student’s inability to under-
stand the concept of ‘‘wait’’ or ‘‘don’t interrupt.’’ The music therapist can compose a sim-
ple and repetitive song paired with actions that aid the individual to learn the basic
behaviors of ‘‘waiting’’ that function across settings such as keeping hands in lap and/or
lips together with the voice turned off. In this example we also introduce the concept of
time over space. Music exists naturally over time and space and serves as an excellent
medium for experiencing and teaching such an abstract concept as ‘‘wait.’’
Other behaviors are the function of situational problem solving. Musically adapted Social
Stories and social scripts are one way to address preparing individuals for transitions, changes
in schedule, asking for help, and asking a peer to play. Playing instruments that require two
or more pieces to produce a sound are also used to rehearse problem solving skills.

Sensory Needs
Sensory needs can also be addressed through music therapy. Music therapists may provide
a variety of interventions suited to the individual that may range from psychoacoustical
therapies (special training required) to scheduled music listening times.

The music therapist is held to national Standards of Practice (AMTA, 2006) for
assessment, treatment planning, documentation, evaluation, and termination. No stand-
ardized music therapy assessment currently exists for individuals with autism. Models of
treatment and documentation vary based on the professional training of the music thera-
pist, the setting the music therapist is working in, and the individual needs of the client.

REFERENCES
American Music Therapy Association (2006). Autism spectrum disorders: Music therapy research
and evidence based practice support. Retrieved November 20, 2006, from www.musictherapy.
org/factsheets/MT%20Autism%202006.pdf.
Individuals with Disabilities Education Improvement Act of 2004. Public Law No. 109-446, § 20
U.S.C. (2004).

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 MUTUALLY ACCEPTABLE WRITTEN AGREEMENT

FURTHER INFORMATION
American Music Therapy Association: www.musictherapy.org.
Kaplan, R. S., & Steele, A. L. (2005). An analysis of music therapy program goals and outcomes
for clients with diagnoses on the autism spectrum. Journal of Music Therapy, 42(1), 2–19.
Kielinen, M., Linna, S. L., & Moilanen, I. (2002). Some aspects of treatment and habilitation
of children and adolescents with autistic disorder in Northern-Finland. International Journal of
Circumpolar Health, 61(Suppl. 2), 69–79.
Thaut, M. H. (2005). Rhythm, music, and the brain: Scientific foundations and clinical applications.
New York: Taylor and Francis Group, LLC.
Whipple, J. (2004). Music in intervention for children and adolescents with autism: A meta-
analysis. Journal of Music Therapy, 41(2), 90–106.
MELANIE D. HARMS

MUTUALLY ACCEPTABLE WRITTEN AGREEMENT

A mutually acceptable written agreement is a binding document that is the result
of mediation.

FURTHER INFORMATION
Vocational and Education Services for Individuals with Disabilities. (n.d.). Special education
mediation. Retrieved December 13, 2006, from www.vesid.nysed.gov/specialed/mediation.htm.
TERRI COOPER SWANSON

229
 N
NATURAL LANGUAGE PARADIGM
The natural language paradigm (NLP) is an intervention procedure that approxi-
mates the manner in which typically developing children acquire language (Koegel,
O’Dell, & Koegel, 1987). NLP is built upon arranging the environment to increase a
child’s opportunities to use language. Children are encouraged to initiate the interac-
tion as stimulus items are chosen by the child, varied every few trials, age appropriate,
and found in the child’s natural environment. Both teacher and child play with the
stimulus item (the item is functional within the interaction). A loose-shaping contin-
gency is used to reinforce attempts to respond verbally, except for self-stimulation
(Koegel, Koegel, & Parks, 1995). NLP represented a shift from pull-out procedures
using drill procedures and imitation to more naturalistic procedures for language inter-
vention. Pivotal response training has emerged from NLP (Koegel & Koegel, 2006).

REFERENCES
Koegel, R. L., & Koegel, L. K. (2006). Pivotal response treatments for autism. Baltimore: Brookes
Publishing Co.
Koegel, R. L., Koegel, L. K., & Parks, D. R. (1995). ‘‘Teach the individual’’ model of generaliza-
tion: Autonomy through self-management. In R. L. Koegel & L. K. Koegel (Eds.), Teaching
children with autism: Strategies for initiating positive interactions and improving learning opportunities
(pp. 67–77). Baltimore: Brookes Publishing Co.
Koegel, R. L., O’Dell, M. C., & Koegel, L. K. (1987). A natural language paradigm for teaching
nonverbal autistic children. Journal of Autism and Developmental Disorders, 17, 187–199.
JEANNE HOLVERSTOTT

NEUROFEEDBACK
Neurofeedback, also referred to as EEG biofeedback, is a form of biofeedback. It
uses the principles of biofeedback to create a learning opportunity through operant
conditioning. Like traditional biofeedback, neurofeedback increases awareness of a
bodily state and increases control over that state. In the case of neurofeedback, the
individual learns to impact his or her states of arousal through operant conditioning
through feedback of brainwave activity.
Operant conditioning waits for a behavior to occur and then consequates the
behavior. The purpose of the training is to increase awareness and allow the brain to
NEUROFEEDBACK

practice shifting states of arousal. Arousal is the state of awareness from internally
focused to our own thoughts and feelings to external focus within the environment.
When we are very internally focused we emit brain waves that are large in amplitude
and slow in frequency. The lower brain waves are called delta waves. During sleep the
majority of the brain is emitting delta waves. Delta waves range from 0.5 to 3 cycles
per second (cps). At a resting or daydreaming state, the majority of the brain is emit-
ting brainwaves with the frequency range of 8 to 11 cps, and these are called alpha
waves. The sensorimotor rhythm (SMR) is a state of calm that is often associated with
external awareness yet quietly alert. And finally, the so-called thinker waves or beta
are characterized as focused, analytic, often externally oriented and intense thinking,
and are measured at 16 to 20 cps.
The function states of arousal are to tune ourselves into internal and external
demands within our environment. A healthy nervous system will effortlessly shift from
internal states such as sleep (0.05–3 cps) to meet task demands of a learning task
within a classroom; for example, they could range from 8 to 20 cps. An example of
alpha wave activity is when you have been driving for some time and look up and re-
alize you have been daydreaming and do not remember passing through some traffic.
The theory is that some neurological-based disorders are impacted arousal states that
are predominant or do not meet the internal or external environmental task demand.
Through this ‘‘brain workout’’ the individual learns to better attend to the internal
and external environment. The benefits of the training are largely individual and can
impact several neurological symptoms. The hypothesized reason that there are such
varied results is the nature of the brain functioning.
The materials necessary for neurofeedback are an EEG and a specially designed
computer program. A typical session includes the following steps. First, the individual
is clinically assessed and a training program is established. A trained, certified clinical
professional will design an individual training program depending on their neurologi-
cal profile. The individual will have electrodes placed on their scalp with a sticky
paste. Then the individual will watch a video game. This game is actually a visual
and auditory feedback system of their own brainwave activity. When they bring their
brain waves within a set cycle per second, then they are reinforced and the game pro-
gresses. In many of the games, when they produce brainwave activity outside the set
parameters the game stops or does not progress. Through this game the individual’s
brain undergoes a ‘‘mental workout.’’ This requirement to shift their focus from either
more internal to external or vice versa is the exercise. This, in turn, produces a brain
that adapts to the environmental task demands.
FURTHER INFORMATION
Bitsika, V., & Sharpley, C. (2000). Development and testing of the effects of supports on the
well-being of parents of children with autism—II: Specific stress management techniques.
Journal of Applied Health Behaviour, 2(1), 8–15.
EEG Spectrum International. (2001). Retrieved June 1, 2005, from http://www.
eegspectrum.com.
Evans, J. R., & Abarbanel, A. (1999). Introduction to quantitative EEG and neurofeedback. San
Diego: Academic Press.
Jarusiewicz, B. (2002). Efficacy of neurofeedback for children in the autistic spectrum: A pilot
study. Journal of Neurotherapy, 6(4), 39–49.
Robbins, J. (2000). A symphony in the brain. New York: Atlantic Monthly Press.

232
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Schwarts, M., & Androasik, F. (2003). Biofeedback: A practitioner’s guide. New York: Guilford
Press.
Sichel, A. G., Fehmel, L. G., & Goldstein, D. M. (1995). Positive outcome with neurofeedback
treatment in a case of mild autism. Journal of Neurotherapy, 1(1), 60–64.
STEPHANIE NICKELSON

NEUROIMAGING
Neuroimaging is the use of MRI, PET, SPECT, and CAT scans to evaluate and
monitor development and/or alterations in brain anatomy and function. This is an
expanding and experimental area with much current research into developmental and
degenerative disorders. More is being learned about structural differences in the brains
of persons with what had previously been considered ‘‘behavioral’’ disorders.
BRUCE BASSITY

NEUROLOGIST
A neurologist is a medical doctor who treats patients with neurological disorders,
which are disorders that affect the central, peripheral, and autonomic nervous systems.
Such disorders include epilepsy, cerebral palsy, migraine headaches, tic disorders, sleep
disorders, multiple sclerosis, traumatic brain injuries, and spinal cord disorders.
STEVE CHAMBERLAIN

NEUROLOGY
Neurology is the branch of medicine that deals with disorders of the nervous sys-
tem. Neurologists are specialized physicians trained to diagnose and treat these disor-
ders, and are mostly trained to work with adults. Pediatric neurology is a subspecialty
of pediatric medicine.
BRUCE BASSITY

NEUROMOTOR
Neuromotor is a term relating to the connection between nerves and muscles, gen-
erally an impulse transmitted from the nervous system to the musculoskeletal system.
BRUCE BASSITY

NEUROPSYCHOLOGY
A combination of neurology and psychology, this discipline seeks to understand the
relationship between the structure and function of the brain on psychological proc-
esses and behavior. As in neurology, these specialists may work in research, clinical di-
agnosis and treatment, or teaching.
BRUCE BASSITY

NEUROTOXIC
Neurotoxic is a term referring to toxicity or harm against the nervous system. Many
chemicals that were previously thought harmless, such as lead (in paint, plumbing),
are now known to cause damage to the brain and nervous system.
BRUCE BASSITY
233
NEUROTRANSMITTER

NEUROTRANSMITTER
A neurotransmitter is a substance (such as acetylcholine, dopamine, serotonin, nor-
epinephrine) that is released from the axon terminal (outgoing end) of a neuron or
nerve cell, travels across the gap to the receptor end of anther nerve cell to either in-
hibit or excite that next cell. Dysfunction of brain neurotransmitters, which are some-
times referred to as chemical messengers, can be related to various psychiatric and
cognitive disorders.
BRUCE BASSITY

NEWSLETTER
Newsletters discuss general information related to autism spectrum disorders in a
user-friendly format. Newsletters provide information relevant to a specific geographic
region. For a list of newsletters, please see Appendix A.
JEANNE HOLVERSTOTT

NO CHILD LEFT BEHIND ACT 2001 (PL 107-110)

President George W. Bush proposed a framework based on bipartisan education
reform that became the No Child Left Behind (NCLB) Act of 2001. The NCLB Act
aims to increase accountability; give more choices to parents and students; offer
greater flexibility for states, school districts, and schools; make reading a priority; and
offer other program changes that best suit state and school needs.

REFERENCE
U.S. Department of Education. (n.d.). No Child Left Behind. Retrieved November 30, 2006,
from www.ed.gov/nclb/landing.jhtml.
MELANIE D. HARMS

NO-NO PROMPT PROCEDURES

A no-no prompt procedure is a form of error correction. The procedure is as follows.
A directive or discriminative stimulus (Sd) is given. If the student responds incorrectly,
the instructor says, ‘‘No.’’ The same directive is given a second time. If the student
responds incorrectly, the instructor again simply responds, ‘‘No.’’ The third trial is then
prompted, meaning immediately after giving the directive the instructor prompts the
student so that he responds correctly. This form of error correction is used after an ini-
tial teaching period during which other forms of prompting may and should be used.
Once a designated level of acquisition is achieved, the instructor may then shift to a
no-no-prompt schedule of prompting whenever the task is presented in the future.
KATIE BASSITY

NONVERBAL LEARNING DISABILITY

A nonverbal learning disability (NLD) is a neurological syndrome that includes
both specific strengths and precise deficits. Strengths include: (a) early speech and vo-
cabulary development; (b) exceptional rote memory skills; (c) attention to detail;
(d) early reading skills; (e) excellent spelling skills; (f) strong auditory retention; and
(g) articulate verbal skills. Deficits include: (a) motor delays such as poor coordination,
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 NORMALIZATION

balance, and handwriting skills; (b) visual-spatial-organizational weaknesses; (c) social

difficulties such as nonverbal communication, transitions, social judgments; and
(d) sensory issues such as disorders or dysfunctions in any of the sensory modes.
Specific causes of nonverbal learning disorders are not known. A genetic or familial
link has yet to be identified as has been in language-based learning disorders (i.e., dys-
lexia). Brain scans of individuals with NLD have revealed mild abnormalities of the
right cerebral hemisphere. Developmental histories revealed several children suffering
from NLD have had one of the following: (a) moderate to severe head injury,
(b) repeated radiation treatments on or near their heads for an extended amount of
time, (c) congenital absence of a corpus callosum, (d) hydrocephalus, or (e) brain tissue
removed from the right hemisphere (Thompson, 1996).
At this time, nonverbal learning disability has not been recognized by the Ameri-
can Psychiatric Association. Diagnosis is made using a neurological profile that has
been defined in the literature. Johnson and Myklebust (1967) were the first to describe
a definition of nonverbal learning disorder in which children have specific difficulties
with social awareness. Rourke (1995) further defined nonverbal learning disorders as
having primary, secondary, and tertiary deficits that result in socioemotional or adap-
tational deficits.
Children with Asperger syndrome and nonverbal learning disability may present
similarly in several areas of strength and deficit. The children with nonverbal learning
disorders appear to not exhibit the restricted interests or special skills that would meet
the criteria for a diagnosis of Asperger syndrome.
REFERENCES
Johnson, D., & Myklebust, H. (1967). Learning disabilities: Educational principles and practices.
New York: Grune & Stratton.
Rourke, B. (Ed.). (1995). Syndrome of nonverbal learning disabilities: Neurodevelopmental manifesta-
tions. New York: The Guilford Press.
Thompson, S. (1996). Nonverbal learning disorders. NLDline. Retrieved October 30, 2006, from
http://www.nldline.com/.
LYNN DUDEK

NORMALIZATION
The concept of normalization was first introduced by Nirjie in the 1960s and popular-
ized by Wolfensberger in the 1970s. Normalization involves the acceptance of individu-
als with disabilities, offering them the same living and learning experiences as those
available to individuals without disabilities. According to Wolfensberger (1972), the
concept of normalization does not refer to making individuals ‘‘normal,’’ or to making
them behave in a certain manner, or forcing them to conform to societal norms. Rather,
normalization aims to ensure that individuals with disabilities have the opportunities to
live a normal rhythm of life. Inclusion is based on the concept of normalization.

REFERENCES
Nirje, B. (1969). The normalization principle and its human management implications. In R.
Kugel & W. Wolfensberger (Eds.), Changing patterns in residential services for the mentally re-
tarded (pp. 179–195). Washington, DC: President’s Committee on Mental Retardation.
Wolfensberger, W. (1972). Normalization: The principle of normalization in human services. To-
ronto: National Institute on Mental Retardation.

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NORM-REFERENCED ASSESSMENT

FURTHER INFORMATION
Westling, D. L., & Fox, L. (2004). Teaching students with severe disabilities (3rd ed.). Upper Sad-
dle River, NJ: Prentice Hall.
THERESA L. EARLES-VOLLRATH

NORM-REFERENCED ASSESSMENT
A norm-referenced assessment compares an individual student’s performance to per-
sons of the same age and/or grade level (norming group). This assessment measures
how much one knows in comparison to others. The comparison can occur at the class-
room, local, or national level.
FURTHER INFORMATION
Salvia, J., & Ysseldyke, J. E. (2007). Assessment: In special and inclusive education (10th ed.). Bos-
ton: Houghton Mifflin Company.
Taylor, R. L. (2006). Assessment of exceptional students: Educational and psychological procedures
(7th ed.). Needham Heights, MA: Allyn and Bacon.
THERESA L. EARLES-VOLLRATH

NOTICE OF RECOMMENDED EDUCATIONAL PLACEMENT (NOREP)

Notice of Recommended Educational Placement is a procedural notice provided to all
Individualized Education Program (IEP) members that identifies the multiple place-
ments considered and the chosen educational placement. The notice of recommended
educational placement must provide a written statement why placement was chosen and
why alternative educational placements were not appropriate for the individual student.
KATHERINE E. COOK

NUTRITIONAL SUPPLEMENTS
Nutritional supplements are intended to supply nutrients that are missing or not
consumed in sufficient quantity in a person’s diet. Varied amounts of research have
been done on supplements for persons with autism spectrum disorders. The largest,
most promising body of evidence comes from studies focusing on B vitamins, espe-
cially B6, given in combination with magnesium. For other nutrients, the data are not
robust. Appropriate dosing presents a key problem with regard to the empirical study
of supplements. Nutritional supplementation should be undertaken only with the assis-
tance and supervision of a physician with a strong background in autism, nutritional
analysis, and nutritional treatments. Nutritional supplements as treatment options for
autism include, but are not limited to, vitamin A (retinol) and beta carotene, vita-
mins B1 (thiamin), B2 (riboflavin), B3 (niacin), B5 (pantothentic acid), B6 (pyri-
doxine), and folic acid, vitamin C (ascorbic acid or sodium ascorbate), vitamin E
(alpha tocopherol), coenzyme Q10 (antioxidant), magnesium, selenium, and zinc
(minerals), and dimethylglycine (DMG).

FURTHER INFORMATION
Hamilton, L. M. (2000). Facing autism. Colorado Springs, CO: Waterbook Press.
Marhon, S. (2002). Natural medicine guide to autism. Charlottesville, VA: Hampton Roads Pub-
lishing Co.
Shaw, W. (2002). Biological treatments for autism and PDD. Lenexa, KS: Sunflower Publishing.
MYRNA J. ROCK
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 O
OBJECT INTEGRATION TEST
An object integration test involves sets of line drawings depicting objects and peo-
ple intended to be either visually integrated to make the most coherent scene or com-
pared for similarities. Individuals with autism exhibit impairments in their ability to
integrate objects, not in their ability to look for similarities. This test provides support
for Frith’s (1989) central coherence hypothesis. Central coherence has been defined as
the natural built-in propensity to process incoming stimuli globally and in context,
pulling information together to acquire higher-level meaning.

REFERENCE
Frith, U. (1989). Autism: Explaining the enigma. Oxford, UK: Blackwell.
JEANNE HOLVERSTOTT

OBJECTIVE
An objective is a stated and desired outcome of intervention based on a derived set
of educational goals and individual needs. Objectives are written in observable and
measurable terms to ensure consistency among staff and to provide for precise evalua-
tion of progress.
THERESA L. EARLES-VOLLRATH

OBJECT SORTING TEST

An object sorting test is a test of cognitive functioning designed to assess abilities
at category development. As the name implies, the test consists of sorting objects by
specified categories.
JEANNE HOLVERSTOTT

OCCUPATIONAL THERAPIST
An occupational therapist (OT) is a health professional with a bachelor’s or mas-
ter’s degree from an accredited university who has passed the national occupational
therapy certification exam. The word occupation in occupational therapy refers to the
activities, roles, and goal-oriented behaviors of individuals from birth to old age in
OCCUPATIONAL THERAPY

their daily lives. An OT may work in a school, hospital, skilled nursing facility, com-
munity mental health center, or other related organizations in which individuals require
the assistance of a skilled professional to remediate, adapt, or prevent a disability from
interfering in their daily lives. An OT may complete a task analysis of the activity or
situation in which the child with an autism spectrum disorder is having difficulty to
determine a step-by-step intervention to improve a skill, such as using a fork. For exam-
ple, an OT may use clay for finger and hand strengthening, finger painting on a win-
dow for eye-hand coordination, and tossing and catching weighted beanbags for body
awareness, all of which are necessary components of using a fork appropriately.
KELLY M. PRESTIA

OCCUPATIONAL THERAPY
Occupational therapy (OT) is a health profession that provides purposeful activities
and interventions to individuals of all ages who need to regain the skills necessary to
participate fully in their life roles. For individuals with autism spectrum disorders
(ASD), those life roles may include going to school, playing, socializing with peers,
being an active member of their family and community, engaging in sports and other
extra-curricular activities, and taking care of their own personal needs.
OT services for a child with ASD may take place in a hospital or private practice,
in the child’s own home, in the community, or in the school. In a hospital, commu-
nity, or in-home setting, occupational therapy services may not be provided without a
written order from the child’s physician. In a school setting, occupational therapy is
provided as a related service to other special education services, and may not be pro-
vided as the only service for the child. Occupational therapists have a background in
neurology, child development, psychology, and sensory processing. OT services can be
provided in two ways: (a) as a direct service, or (b) as a consultation service. When pro-
viding direct service, the OT works directly with the child with ASD to remediate,
improve, or maintain a specific skill. Prior to working with the child, the OT analyzes
the skill to be worked on, as well as the student’s strengths and needs, to develop a
step-by-step program for that particular skill development. For example, for a student
who is unable to button his own shirt, the OT must first determine why he is unable to
perform this skill. It may be due to poor strength, hand-eye coordination, or vision. The
OT may use formal, standardized testing, and/or informal screenings and observations to
determine the cause of the child’s difficulty. An OT assessment may include an evalua-
tion of a child’s fine and gross motor skills, daily-living skills, sensory processing, or vis-
ual perception. Based upon the analysis, interventions are individually tailored to
address the skill deficit.
Consultation OT service is appropriate when the child is able to maintain learned
skills and apply them to everyday situations. The purpose of consultation is to monitor
the child’s performance on a regular basis to determine if changes (e.g., in daily rou-
tine, the environment) need to be made to continue his success or improve his overall
independence. Consultation involves observation, planning, and contact with the
child, his family, and any staff that may work with the child on a regular basis to
determine if adjustments in his program must be made. For example, a child with
ASD might receive OT consultation services to monitor his computer and
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 OPTIONS (SON-RISE PROGRAM)

keyboarding skills in the classroom as an alternative to handwriting his work. The OT

may check in weekly with the student, parents, and teacher to ensure that he is com-
pleting necessary work, is independent in using the computer, and is able to stay on
task. Modifications may be necessary to address specific problems. For instance, if the
student is distracted and not able to stay on task while on the computer, the OT may
provide headphones and a study carrel to minimize distractions.
Occupational therapy can provide valuable services and resources to students and
their families to help the individual with ASD perform at his or her optimal level. By
understanding the student’s strengths and needs, making necessary modifications, or
directly intervening to gain or improve a skill, an OT can help the individual with
ASD experience success in a variety of situations and environments.

FURTHER INFORMATION
Christiansen, C., & Baum, C. (1991). Occupational therapy: Overcoming human performance defi-
cits. Thorofare, NJ: SLACK Inc.
KELLY M. PRESTIA

OPERANT CONDITIONING
Operant conditioning is a behavioral paradigm that states that the consequences of
a behavior affect the future occurrences of that behavior. Operant conditioning relies
upon a behavioral framework that includes an antecedent stimulus that precedes a
behavior, a behavior, and a consequence contingent upon the behavior. The probabil-
ity of a behavior occurring again is increased if it is reinforced or rewarded. The
behavior is less likely to occur again if the consequence is unpleasant or aversive.
When the rate of the behavior is changed due to the consequences, then the behavior
is considered to be an operant (Cooper, Heron, & Heward, 1987). The principles of
operant conditioning have been used to increase or decrease existing behaviors or
teach new behaviors through the manipulation of consequences.

REFERENCE
Cooper, J. O., Heron, T. E., & Heward, W. L. (1987). Applied behavior analysis. Upper Saddle
River, NJ: Prentice Hall.
ANDREA HOPF AND TARA MIHOK

OPTIONS (SON-RISE PROGRAM)

The Son-Rise Program, developed by Barry Neil Kaufman and Samahria Lyle Kaufman
for their son Raun, is a specific and comprehensive program based on joining in a child’s
behavior to discover his or her own motivation (Autism Treatment Center of America,
n.d.a). Raun Kaufman was diagnosed as being severely autistic. Instead of institutionaliz-
ing their son, the Kaufmans created a treatment program that used the home environ-
ment as the place to nurture the growth of their son in a caring and respectful way.
The Kaufmans believe that autism is a relational and interactive neurological
disorder. When a child displays self-regulatory or so-called ‘‘stimming’’ behaviors, or
ritualistic or perseverative behaviors, the Son-Rise Program intervenes in enthusiastic,
play-based interventions to build rapport and connect with the child. The idea is that
by participating in the child’s activity or behaviors rather than teaching through drills
or repetition, eye contact and other socialization skills will increase.
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OPTIONS (SON-RISE PROGRAM)

Although the Kaufmans have worked with many skilled and caring professionals,
they believe that parents hold the key as the most powerful and committed teachers
to develop a specific program to meet the unique needs of their own children. Their
program involves empowering parents with tools to create the attitudinal changes
needed to teach a child with autistic spectrum and other developmental disorders.
The Son-Rise Program is based at the Option Institute in Sheffield, Massachusetts.
The staff at the Option Institute must complete ‘‘a rigorous and comprehensive educa-
tional curriculum . . ., which includes extensive work with children of varying ages
and diagnoses, classroom education, group instruction, comprehensive ideological and
attitudinal training, and continual observation and feedback by experienced Son-Rise
Program Teachers’’ (Autism Treatment Center of America, n.d.b).
The staff at the Option Institute has worked many years with hundreds of families.
Staff members come from a multitude of disciplines and experiences, and hold degrees
in special education, psychology, sociology, and physical therapy, among others. The
Autism Treatment Center of America at the Option Institute is the only learning and
treatment center that offers professional training for the Son-Rise Program. At the
Option Institute, all child facilitators and teachers are certified by the Son-Rise Pro-
gram professional certification programs.
The Son-Rise Program is designed to be a one-on-one, home-based program that
helps in the development of socialization, communication, self-help, and other learn-
ing skills. The Son-Rise Program is based on the following principles:

1. Joining in a child’s repetitive and ritualistic behaviors supplies the key to unlocking the
mystery of these behaviors and facilitates eye contact, social development, and the inclu-
sion of others in play.
2. Utilizing a child’s own motivation advances learning and builds the foundation for educa-
tion and skill acquisition.
3. Teaching through interactive play results in effective and meaningful socialization and
communication.
4. Using energy, excitement, and enthusiasm engages the child and inspires a continuous
love of learning and interaction.
5. Employing a nonjudgmental and optimistic attitude maximizes the child’s enjoyment,
attention, and desire throughout their Son-Rise Program.
6. Placing the parent as the child’s most important and lasting resource provides a consistent
and compelling focus for training, education, and inspiration.
7. Creating a safe, distraction-free work/play area facilitates the optimal environment for
learning and growth. (Autism Training Center of America, n.d.c)

The Son-Rise Program can be used in conjunction with other therapies, treatments,
and interventions such as diet and vitamin therapies, sensory integration, and biologi-
cal interventions.

REFERENCES
Autism Treatment Center of America. (n.d.a). History of the Son-Rise Program? Retrieved No-
vember 13, 2006, from http://www.autismtreatmentcenter.org/contents/about_son-rise/
history_of_the_son-rise_program.php.
Autism Treatment Center of America. (n.d.b). Frequently Asked Questions About the Son-Rise
Program. Retrieved November 13, 2006, from http://www.autismtreatmentcenter.org/contents/
about_son-rise/faq.php.

240
 OVERSELECTIVITY/OVERFOCUSED ATTENTION

Autism Treatment Center of America. (n.d.c). ‘‘What Is the Son-Rise Program?’’ Retrieved No-
vember 13, 2006, from www.autismtreatmentcenter.org/contents/about_son-rise/what_is_the_
son-rise_program.php.

FURTHER INFORMATION
The Option Institute: www.option.org.
ANN PILEWSKIE

ORAL-MOTOR SKILLS
Oral-motor skills refer to any activity that requires the use and coordination of the
muscles in and around the mouth and tongue. Examples of oral-motor skills are chew-
ing, licking, and puckering the lips.
KELLY M. PRESTIA

ORAL SENSITIVITY
Oral sensitivity is an observable response to an overactive gustatory (taste) system.
Observable responses of oral sensitivity are the dislike of or refusal to brush one’s teeth
or eat certain textures or temperatures of foods.
KELLY M. PRESTIA

OVERCORRECTION
Overcorrection is a form of punishment that requires the individual to engage in a
repetitive behavior intended to decrease the reoccurrence of an undesired behavior.
There are two types of overcorrection techniques: restitution and positive practice.
Restitution requires the individual to not only correct what he did wrong, but to do
something else in addition. A commonly used example is an individual who creates a
mess while throwing a tantrum. In restitution, that individual is required to clean up
the mess he made, as well as any mess that already existed in the room before the tan-
trum. Positive practice involves the student repeatedly engaging in the alternate, posi-
tive behavior—the desired behavior in the given situation. For example, for the
student who runs to get in line first, having him repeatedly walk to the line and walk
back to his seat is positive practice. In addition, negative practice is sometimes associ-
ated with overcorrection, although in fact it is the opposite of overcorrection. Nega-
tive practice requires the student to engage in the negative behavior numerous times,
under the teacher’s or adult’s control. There are ethical and practical concerns regard-
ing the use of negative practice.
KATIE BASSITY

OVERSELECTIVITY/OVERFOCUSED ATTENTION
Overselectivity/overfocused attention, also referred to as tunnel vision, describes
when an individual intently focuses upon an object, person, or activity, disregarding
all other stimuli or environmental cues. Overselectivity may result from an individu-
al’s difficulty screening out or discriminating irrelevant stimuli to determine what is
most important. For example, an individual with an autism spectrum disorder may fix-
ate on the blinking light on a computer across the room.
KELLY M. PRESTIA
241
 Autism
Spectrum
Disorders
 Autism
Spectrum
Disorders
A HANDBOOK FOR PARENTS
AND PROFESSIONALS
Volume 2: P–Z

Edited by
Brenda Smith Myles, Terri Cooper Swanson,
Jeanne Holverstott, and Megan Moore Duncan
Library of Congress Cataloging-in-Publication Data
Autism spectrum disorders : a handbook for parents and professionals /
edited by Brenda Smith Myles, Terri Cooper Swanson, Jeanne Holverstott,
and Megan Moore Duncan
p. cm.
Includes bibliographical references and index.
ISBN-13: 978–0–313–33632–4 (set : alk. paper)
ISBN-13: 978–0–313–34632–3 (v. 1 : alk. paper)
ISBN-13: 978–0–313–34634–7 (v. 2 : alk. paper)
1. Autism in children—Handbooks, manuals, etc.
[DNLM: 1. Autistic Disorder—Handbooks. 2. Child Development
Disorders, Pervasive—Handbooks. WM 34 A939 2007] I. Myles, Brenda
Smith. II. Swanson, Terri Cooper. III. Holverstott, Jeanne. IV. Duncan,
Megan Moore.
RJ506.A9A92377 2007
618.920 85882—dc22 2007030685
British Library Cataloguing in Publication Data is available.
Copyright Ó 2007 by Brenda Smith Myles, Terri Cooper Swanson, Jeanne Holverstott, and
Megan Moore Duncan
All rights reserved. No portion of this book may be
reproduced, by any process or technique, without the
express written consent of the publisher.
Library of Congress Catalog Card Number: 2007030685
ISBN-13: 978–0–313–33632–4 (set)
978–0–313–34632–3 (vol. 1)
978–0–313–34634–7 (vol. 2)
First published in 2007
Praeger Publishers, 88 Post Road West, Westport, CT 06881
An imprint of Greenwood Publishing Group, Inc.
www.praeger.com
Printed in the United States of America

The paper used in this book complies with the

Permanent Paper Standard issued by the National
Information Standards Organization (Z39.48–1984).
10 9 8 7 6 5 4 3 2 1
 Contents

List of Entries vii

Guide to Related Topics xv

The Handbook 1

Appendix A: Newsletters 425

Appendix B: Journals 429

Appendix C: Organizations 437

Appendix D: Personal Perspectives 451

Index 471

About the Editors, Advisory Board, and Contributors 503

 P
PATTERNING (DOMAN-DELACATO TREATMENT)
The Doman-Delacato patterning treatment is an intervention involving exercises
aimed at forming or correcting neurological organization that has been damaged or
never developed. Created by Doman and Delacato (The Institutes for the Achieve-
ment of Human Potential [IAHP], n.d.) in the 1960s, and carried out by the IAHP,
this intervention is based on the belief that the development of a child mirrors that
of human evolution (crawling, creeping, crude walking, and mature walking). IAHP
believes that most disabilities are false labels, each representing only different symp-
toms of brain damage. Therefore all children with disabilities, from those in persistent
vegetative states to those with mild learning disabilities, are referred to as brain-
injured children (diagnoses then consist of where the brain injury is and to what
extent). This therapy is thought to aid all children, regardless of their brain injury,
with the goal that children ‘‘achieve intellectual, physical and social excellence’’
(IAHP Goals).
The first step is to determine the stage of development where injury took place or
normal development ceased. A child is then taken through the steps or movements
that a typically developing child would go through in that stage. The aim is to train
the brain to go through the typical developmental process, believing that this will
then lead to a return to normal development. IAHP states that once injury occurs, de-
velopment at higher levels cannot occur; each level must be mastered before a child
can move on to the next level. If a child is able, he or she performs the exercises
alone. If the child is not able to perform the exercises, three adults cause the body to
move through the exercises in a fluid manner. Patterning is an intensive therapy, used
in conjunction with intensive programs covering reading, math, social skills, fitness,
health, and so on.
Although several studies were carried out in the late 1960s–1970s, there was no evi-
dence that patterning held any benefit above that of normal care. Despite these find-
ings, as well as the rejection by science of this child development model and the
ability to change development and structure of the brain through repetitive move-
ments, this intervention continues to be practiced and claimed as a cure. Many organ-
izations have issued statements of concern about patterning, including the American
PDD-NOS

Academy of Pediatrics (AAP), American Academy of Neurology, and the United

Cerebral Palsy Association. In its statement the AAP says,

Treatment programs that offer patterning remain unfounded . . . In most cases, improve-
ment observed in patients undergoing this method of treatment can be accounted for based
on growth and development, the intensive practice of certain isolated skills, or the nonspe-
cific effects of intensive stimulation . . . On the basis of past and current analyses, studies,
and reports, the AAP concludes that patterning treatment continues to offer no special
merit, that the claims of its advocates remain unproved, and that the demands and expec-
tations placed on families are so great that in some cases their financial resources may be
depleted substantially and parental and sibling relationships could be stressed. (1999)

REFERENCES
American Academy of Pediatrics. (1999). The treatment of neurologically impaired children
using patterning. Pediatrics, 104(5), 1149–1151.
The Institutes for the Achievement of Human Potential. (n.d.). Retrieved June 28, 2006, from
www.iahp.org.

FURTHER INFORMATION
Novella, S. (1996). Psychomotor patterning. The Connecticut Skeptic, 1(4), 6. Retrieved June 28,
2005, from http://www.theness.com/articles/patterning-cs0104.html.
KATIE BASSITY

PDD-NOS. See Pervasive Developmental Disorder–Not Otherwise Specified

PEDANTIC SPEECH
Pedantic speech is often characterized by expressive language that is overly formal,
excessive in technical details, has an adult quality with sophisticated grammar, and is
often precise in intonation.
See also Asperger’s disorder.
KATHERINE E. COOK

PEER REVIEWED
Peer reviewed (or refereed) refers to a process of subjecting work or ideas to experts
in the field for review and critique. This process is designed to ensure that authors
adhere to the standards of their field.
JEANNE HOLVERSTOTT

PEPTIDE
Peptides aid in digestion. Digestive peptides assist the body in the breakdown of
gluten, casein, and protein. Many individuals with autism have lower levels of amino
acids in their body, which results in the buildup of opioid peptides that may mimic
the effects of morphine. When there is a buildup of opioid peptides, one may observe
that the individual may appear drunk or may have a more difficult time with behav-
ioral self-control.
See also casein-free; gluten-free.
TERRI COOPER SWANSON
244
 PERSON FIRST LANGUAGE

PERCENTILE
Percentile is a value on a ranking scale from 1 (low) to 99 (high) and a median of
50 that specifies the percent of the distribution that falls equal to or below the norm.
A percentile rank illustrates the percentage of a norm group obtaining the same score
or scores lower than the test-taker’s score.
A percentile score is often confused with percentages. It does not refer to the num-
ber of questions marked correctly. The 85th percentile, for example, indicates the
score below which 85 percent of the scores fall in a particular distribution of scores.
RASCHELLE THEOHARRIS

PERSEVERATION
Perseveration, manifested in speech, play, or other motoric actions, is characteristic
of individuals with autism. Perseverative speech is the repetition of the same words or
phrases, either spontaneously spoken or echoed (echolalia), which may or may not be
functional in its purpose. Perseverative play is the repetition of the same motor or
other behavioral activities used in play, such as the lining up of animals over and
over, the exact same placement of an object in a container over and over, or repeat-
ing the script from a cartoon or movie included in any dramatic play.
See also echolalia: immediate, delayed, mitigated.

FURTHER INFORMATION
Quill, K. A. (2000). Do-watch-listen-say: Social and communication intervention for children with au-
tism. Baltimore: Brookes Publishing Co.
ANN PILEWSKIE

PERSEVERATIVE SCRIPTING
Perseverative scripting is a term used to describe the habit of repeatedly retelling an
entire story line from a movie, television show, video game, etc. A common behavior
among individuals with Asperger syndrome, this retelling can be very exact and
detailed, complete with dialogue, speech inflections, and accents. In children, it might
involve the repeated acting out of the story line, possibly with toys.
See also echolalia: immediate, delayed, mitigated.

FURTHER INFORMATION
Osborne, L. (June 18, 2000). The little professor syndrome. The New York Times Magazine.
Retrieved September 3, 2006, from www.nytimes.com/library/magazine/home/20000618mag-
asperger.html.
LISA BARRETT MANN

PERSONAL PERSPECTIVES
Personal perspectives are an individual’s narration about their own experiences. For
more on personal perspectives related to autism spectrum disorders, see Appendix D.
TERRI COOPER SWANSON

PERSON FIRST LANGUAGE

Person first language puts the person before his or her disability or supports (i.e.,
child with autism, not autistic child) in an effort to separate the person from the
245
PERVASIVE DEVELOPMENTAL DISORDER–NOT OTHERWISE SPECIFIED

condition and retain his or her dignity. Some individuals on the autism spectrum dis-
like person first language, preferring autistic person to person with autism, because the
diagnosis is critical to their self-concept.
JEANNE HOLVERSTOTT

PERVASIVE DEVELOPMENTAL DISORDER–NOT

OTHERWISE SPECIFIED
Pervasive Developmental Disorder–Not Otherwise Specified (PDD-NOS) is one of
five disorders classified as pervasive developmental disorders. The other disorders
include autistic disorder, Asperger’s disorder, Rett’s disorder, and childhood disinte-
grative disorder. An individual with a PDD-NOS diagnosis does not meet the diagnos-
tic criteria for pervasive developmental disorders, yet clearly shows unusual development
in the areas of communication, social interaction, and interests/attention.
PDD-NOS is a neurological disorder, and symptoms can range from mild to severe.
Individuals with a PDD-NOS diagnosis have more intact social skills than individuals
diagnosed with other pervasive developmental disorders. Sometimes this diagnosis is
given to very young children with limited communication skills who also show char-
acteristics of autism. As the child’s communication skills increase, other symptoms of
autism may become apparent (Chakrabarti & Fombonne, 2001). Some infants with
PDD-NOS tend to avoid eye contact and demonstrate little interest in human voice.
They do not usually put up their arms to be picked up in the way that typical children
do. They may seem indifferent to affection and seldom show facial responsiveness. As
a result, parents often think the child is deaf. In children with fewer delays, lack of
social responsiveness may not be obvious until well into the second or third year of
life (Tsai, 1998).
Children with PDD-NOS may continue to show lack of eye contact, but may enjoy
physical contact. They do not develop typical attachment behavior, possibly indicat-
ing a failure to bond. Generally, they do not follow the parents around the house, do
not show normal separation or stranger anxiety, may approach a stranger almost as
readily as they do their parents, and may show a lack of interest in being with or play-
ing with other children. They may even actively avoid other children (Tsai, 1998).
These children may develop a greater awareness or attachment to parents and other
familiar adults. However, social difficulties continue with group games and forming
relationships; albeit, some children with less-severe PDD-NOS may become involved
in other children’s games. As they grow older they may become affectionate and
friendly with their parents or siblings. The social relationships may still be difficult to
understand (Tsai, 1998).
Chakrabarti and Fombonne (2001) state that no two individuals diagnosed with
PDD-NOS are exactly alike. However, many individuals with PDD-NOS have some
characteristics in common including: deficits in social behavior; uneven skill develop-
ment (strengths in some areas and significant delays in others); poorly developed
speech and language comprehension and skills; difficulty with changes in environ-
ment; deficits in nonverbal communication; uncommon responses to taste, sight,
sound, smell, and touch; repetitive or ritualistic behaviors (i.e., opening and closing
doors repeatedly or switching a light on and off); and unusual likes and dislikes.
246
 PERVASIVE DEVELOPMENTAL DISORDERS (PDD)

Current estimates are that 3–4 per 1,000 individuals may have PDD-NOS, often
occurring with some degree of cognitive impairment. Individuals with PDD-NOS are
found in all races, ethnicities, and social status (Chakrabarti & Fombonne, 2001).

REFERENCES
Chakrabarti, S., & Fombonne, E. (2001). Pervasive developmental disorders in preschool chil-
dren. Journal of the American Medical Association, 285(24), 3093.
Tsai, L. Y. (1998). Pervasive developmental disorders. A briefing paper written for the publication
of the National Dissemination Center for Children with Disabilities.
VIRGINIA L. COOK

PERVASIVE DEVELOPMENTAL DISORDER–NOT OTHERWISE

SPECIFIED DIAGNOSTIC CRITERIA (DIAGNOSTIC CRITERIA
FOR 299.80, INCLUDING ATYPICAL AUTISM)
The essential features of PDD-NOS are: severe and pervasive impairment in the de-
velopment of reciprocal social interaction or verbal and nonverbal communication
skills; stereotyped behaviors, interests, and activities; and the criteria for autistic disor-
der are not met because of late age onset, and atypical and/or subthreshold symptoma-
tology are present.
This category should be used when there is a severe and pervasive impairment in
the development of reciprocal social interaction or verbal and nonverbal communica-
tion skills, or when stereotyped behavior, interests, and activities are present, but the
criteria are not met for a specific pervasive developmental disorder, schizophrenia,
schizotypical personality disorder, or avoidant personality disorder. For example, this
category includes atypical autism—presentations that do not meet the criteria for autis-
tic disorder because of late age of onset, atypical symptomatology, or subthreshold
symptomatology, or all of these.

FURTHER INFORMATION
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
JEANNE HOLVERSTOTT

PERVASIVE DEVELOPMENTAL DISORDERS (PDD)

A pervasive developmental disorder (PDD) is a general term for a group of specific
disorders characterized by pervasive (affecting multiple environments and domains)
and significant impairments in the development of social interaction, imaginative ac-
tivity, and verbal and nonverbal communication skills, as well as a limited number of
interests and activities that tend to be repetitive (Tsai, 1998).
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; APA,
2000), identifies the following pervasive developmental disorders: autistic disorder,
Rett’s disorder (also known as Rett syndrome), childhood disintegrative disorder
(CDD), Asperger’s disorder, and pervasive developmental disorder–not otherwise
specified (PDD-NOS). PDD is often misused as a reference to PDD-NOS. PDD-NOS
refers to individuals demonstrating levels of impairment that do not meet the criteria
for disorders within the PDD spectrum.
247
PERVASIVE DEVELOPMENTAL DISORDER SCREENING TEST-II (PDDST-II)

REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
Tsai, L. Y. (1998). Pervasive developmental disorders. A briefing paper written for the National
Dissemination Center for Children with Disabilities.
VIRGINIA L. COOK

PERVASIVE DEVELOPMENTAL DISORDER SCREENING TEST-II

(PDDST-II)
The Pervasive Developmental Disorder Screening Test-II (PDDST-II; Siegel, 2004)
is a questionnaire to be completed by parents for children between the ages of 18
months and 3 years. The questionnaire contains symptoms from the three diagnostic
categories of communication, repetitive movements, and social interaction.

REFERENCE
Siegel, B. (2004). Pervasive Developmental Disorder Screening Test II. San Antonio, TX: Harcourt
Assessment.
BROOKE YOUNG

PESTICIDES
Pesticides are substances (often chemical or biological in nature) used to control or
kill various insects, plants, animals, fungi, or bacteria that can bother and harm
humans. Over the past decade the role of pesticides has been questioned as a possible
causative agent for autism. Some researchers claim that pesticides such as maneb can
cause neurological damage. However, the research on pesticides and autism remains
very limited and increased scientific studies are needed.
FURTHER INFORMATION
Barlow, B. K., Lee, D. W., Cory-Slechta, D. A., & Opanashuk, L. A. (2005). Modulation of
antioxidant defense systems by the environmental pesticide maneb in dopaminergic cells.
Neurotoxicology, 26, 63–75.
PAUL G. LACAVA

PHARMACOLOGY
Pharmacology is the systematic investigation of how chemicals interact with living
organisms. When chemicals have medicinal effects, they are considered pharmaceuti-
cals. At this time, there are no pharmaceuticals to cure or suppress autism, however
there are pharmaceuticals that assist with controlling compulsion (SSRI), anxiety
(SSRI), inattention (Dexadrine), aggression (towards self [SSRI], towards others [Clo-
nidine]), sleep disturbance (Clonidine, Klonpin), and seizures (Tegretol).
See also anxiety disorders; mood disorders.
TERRI COOPER SWANSON

PHENOTYPE
According to the National Human Genome Research Project (n.d.), phenotype is
the ‘‘observable traits or characteristics of an organism, for example hair color, weight,
or the presence or absence of a disease.’’ In autism spectrum disorders, phenotypes
could include social, cognition, language, and communication.
248
 PHYSICAL THERAPY

REFERENCE
National Human Genome Research Project. (n.d.). Talking glossary. Retrieved November 30,
2006, from www.genome.gov/glossary.cfm?key=phenotype.
TERRI COOPER SWANSON

PHYSICAL THERAPIST
A physical therapist (PT) is a medical professional with a minimum of a master’s
degree in physical therapy from an accredited university, who has passed a national
certification exam. A PT specializes in remediation, prevention, or slowing the regres-
sion of physical conditions that may result from physical injury, chronic disease, or
other causes. The PT provides services to people of all ages, including mobility train-
ing, range of motion, strengthening, balance, coordination, and modalities.
Two different professional designations exist in the physical therapy community. A
physical therapist has graduated from a master’s degree program in physical therapy
and has received a license to practice in the state of their choice (if required). A li-
censed physical therapist (PT) will evaluate and treat individuals with specific motor
impairments. A physical therapist assistant (PTA) must complete the education pro-
gram at an approved university and be supervised by a licensed physical therapist. A
PTA may carry out interventions after the physical therapist has evaluated the patient
and created the treatment plan. The PTA may neither evaluate nor make modifica-
tions in the treatment plan and must work under the supervision of a PT.
Physical therapists work in a variety of settings including private practices, hospi-
tals, nursing homes, schools and development centers, and universities. Those physical
therapists that work with children who have yet to develop a certain skill are referred
to as developmental therapists. Physical therapists that help individuals regain skills or
strength after an injury or illness are sometimes referred to as rehabilitation therapists.
Other specialties in physical therapy include pediatrics, orthopedics, sports medicine,
and rehabilitation.

FURTHER INFORMATION
American Physical Therapy Association: www.apta.org.
LYNN DUDEK AND KELLY M. PRESTIA

PHYSICAL THERAPY
Physical therapy (PT) is the treatment delivered by a licensed practitioner (physical
therapist or physical therapist assistant) to treat the physical aspects of illnesses or
injuries. Therapy may involve the use of exercises and specific activities to maintain
and restore function and strength as well as condition muscles.
When an individual has sustained an injury, has surgery, or has movement difficul-
ties because of a disability, illness, or disease, their physician may recommend physical
therapy. Physical therapy is an effective treatment for people of any age. A physical
therapist uses many different methods of exercises and modalities to improve function-
ing and decrease pain. These include stretching, strength training, therapeutic exer-
cise, play activities, aquatic therapy (water), electrical stimulation, transcutaneous
electrical nerve stimulation (TENS), interferential current (IFC), iontophoresis,
ultrasound, phonophoresis, hot or cold therapy, and massage. Other treatment
249
PICA

interventions include gait training, balance activities, range of motion, joint mobiliza-
tion, and wound care.

FURTHER INFORMATION
American Physical Therapy Association: www.apta.org.
LYNN DUDEK

PICA
Pica is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-
IV-TR; APA, 2000; 307.52 Pica) as an eating disorder. It is not pathological in all
situations, as it has a lengthy history that has been well documented among most cul-
tures since ancient times. Therefore, it must meet four guidelines as outlined in the
DSM-IV-TR:
Persist for at least one month duration.
Developmentally inappropriate behavior.
Not associated with cultural practices.
If pica persists with individuals who have a concurrent developmental disorder, treatment
may need to be targeted just for the pica behavior.

By definition, pica (pronounced pike-a) is the eating of nonnutritive items, such as

dried paint, candles, wax, soap, rust, burnt matchsticks, feces, needles, light bulbs, dirt,
used coffee grounds, and so on. Because babies frequently mouth, taste, lick, and chew
nonedible items, this behavior becomes a problem when exhibited for at least 1 month
after the age of 18 months, although some say after age 3 years.
Historical evidence links the practice of pica as a medicinal treatment of stomach
ailments and by pregnant women who may be nutritionally deficient due to the preg-
nancy. It has been hypothesized that the compulsion is caused by the body’s natural
instinct to supplement missing nutrients not taken in by food alone. However, pica
also has been used ritualistically, even magically, to promote healing, fertility, and
other curatives. It has also been used during times of famine as a way to ‘‘bulk up’’
available food, such as clay baked with bread, or cooked into potatoes. Even today,
Haitian women make mud pies of clay and water, baking them in the sun and selling
them as a way to ‘‘put something in the belly.’’
Pica has elements of being a compulsive behavior and therefore needs prompt
attention when displayed by children or adults with developmental disorders such as
autism, mental retardation, or mental health disorders such as schizophrenia.
While the human body can be marvelously resilient, there are many assaults that it
cannot withstand, such as the ingestion of lead-based paint, which can cause a multi-
tude of health and behavior disorders, and substances such as animal feces that can
cause serious intestinal diseases, or items that can pierce the intestinal walls or cause
bowel obstructions. Another danger is that once this behavior begins, it may become
a compulsion that the individual may not be able to quit.
Further, in some instances, people resort to pica because they do have certain min-
eral deficiencies, such as iron. For these people, treatment with a change in diet to
meet these nutritional requirements may be enough to change the behavior.
If pica exists as part of an obsessive-compulsive disorder, multiple steps will likely
be needed to change this behavior, including behavioral intervention, nutritional
250
 PICTURE EXCHANGE COMMUNICATION SYSTEM (PECS)

monitoring or instruction, and even environmental controls. When pica is first diag-
nosed during early childhood, chances for successful treatment are higher than when
it first occurs later on.

REFERENCE
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
ANN PILEWSKIE

PICTURE EXCHANGE COMMUNICATION SYSTEM (PECS)

The Picture Exchange Communication System (PECS) is a functional, expressive
communication system designed for children and adults who do not use speech as
their primary means of communication (Frost & Bondy, 2002). PECS is a low-tech al-
ternative or augmentative communication system. It can be implemented as a primary
communication system or to enhance current speech skills. PECS can be rapidly
acquired because the only prerequisite is being able to identify powerful reinforcers.
Users are not required to establish and maintain eye contact, discriminate among pic-
tures, be a certain age, or have a predetermined level of cognitive ability prior to be-
ginning PECS. Research has shown that the use of PECS as an alternative or
augmentative communication system enhances the development of speech rather than
inhibiting it (see Mirenda, 2003, for review of the relationship between augmentative/
alternative systems, including PECS, and speech development.) In addition, when
given an effective communication system, most people’s inappropriate behaviors
greatly decrease (Charlop-Christy, Carpenter, Le, LeBlanc, & Kelley, 2002).
Bondy and Frost began developing PECS in 1985, and it is based on the Pyramid
Approach to Education in Autism (Bondy & Sulzer-Azaroff, 2002). The Pyramid
Approach to Education encompasses the principles of broad-spectrum applied behavior
analysis and stresses the importance of functional activities, powerful reinforcement
systems, functional communication, and behavior management plans. PECS uses a va-
riety of lesson formats, teaching strategies, error correction procedures, and plans for
generalization of skills from the start.
Prior to beginning PECS, an extensive reinforcer assessment must be conducted to
determine what the student prefers. This assessment is ongoing and should result in a
hierarchy of most preferred to least preferred items.
The PECS protocol is comprised of six phases. Individuals begin PECS with Phase I
and move forward in a linear fashion. The early phases parallel typical language devel-
opment by first teaching students to communicate in a nonvocal manner, just as typi-
cal infants and toddlers do before they use speech. Very young children are able to
initiate communication by doing something that gains someone’s attention (e.g., look-
ing at an object and then the person), acting in some manner that influences the
communicative partner (e.g., gesture), and then receiving some type of reinforcement
(social or direct) via that person. Therefore, Phase I teaches what to do with the pic-
ture rather than trying to teach the meaning of the picture. In later phases, picture
discrimination is taught, which is comparable to the first spoken words of typical stu-
dents. PECS is then expanded to include the use of simple sentences, adjectives, pro-
nouns, prepositions, verbs, and other parts of speech. Students are also taught to
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answer simple questions and comment via PECS. Each phase systematically builds
upon skills acquired in earlier phases.

PHASE I: HOW TO COMMUNICATE

The goal in Phase I is to teach the student ‘‘how’’ to communicate by socially
approaching a listener to initiate communication by giving a picture in exchange for a
desired reinforcer. The student is provided with only one picture at a time, as picture
discrimination is not required at this time. This phase involves two trainers: a commu-
nicative partner and a physical prompter. The communicative partner’s role is to entice
with a desired item, wait for the student to initiate (usually a reach for the item), and
deliver the reinforcer immediately once the picture is placed into the trainer’s hand.
The role of the physical prompter is to wait for initiation and then physically prompt
the exchange of the picture. Over time, the physical prompter fades prompts to mini-
mize prompt dependency. Phase I is taught across settings, using various reinforcers and
different trainers to increase generalization. The student has mastered Phase I when,
upon seeing a desired item, he independently exchanges the picture.

PHASE II: DISTANCE AND PERSISTENCE

The goal in Phase II is to teach the student to generalize the use of PECS to more
communicative partners in many settings while also increasing the distance traveled
to both communicative partners and to the communication book. In this phase, one
picture at a time is displayed on the front of a communication book; no picture dis-
crimination is required. Two trainers will speed acquisition of this phase. The teaching
strategy of shaping is the primary teaching strategy used. A physical prompter is
‘‘standing by’’ in case the student needs a gestural prompt to facilitate traveling.

PHASE III: PICTURE DISCRIMINATION

The goal in Phase III is to teach the student to discriminate among many pictures
that are included in a communication book. Phase IIIA begins by teaching the stu-
dent to discriminate between a preferred picture and a nonpreferred/contextually irrel-
evant picture. This is known as simple discrimination. If the preferred picture is
exchanged, the outcome is immediately reinforcing. If the nonpreferred picture is
exchanged, an error correction procedure is initiated to improve discrimination. The
student should be able to discriminate between two pictures at least 80 percent of the
time. If the student is having difficulty with picture discrimination, a variety of alter-
native discrimination strategies can be implemented by manipulating the size, color,
dimension, or image of the icon.
Phase IIIB requires the student to discriminate between two preferred pictures. This
is known as conditional discrimination. The communicative partner conducts corre-
spondence checks to be sure that the student is making the correct correspondence
between the picture that is exchanged and the item that is chosen. If the student
makes an incorrect correspondence, the trainer uses an error correction procedure to
teach about the picture of the desired item. Discrimination among three, four, and five
pictures is also taught. At the end of this phase, the student will be able to find her
communication book, flip through the pages of reinforcer pictures, find a desired pic-
ture, and then travel to a communicative partner to deliver the message.
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PHASE IV: SENTENCE STRUCTURE

The goal in Phase IV is to teach the student to make a request using a simple sen-
tence. The sentence starter ‘‘I want’’ is introduced and paired with a picture of a rein-
forcer to construct a two-picture sentence on a separate sentence strip to make a
request. This sequential lesson is taught using backward chaining, that is, teaching the
last step in the chain first and then the second to the last step and so on. Once the
student is able to independently construct a two-picture sentence, he is taught to tap
the pictures as the communicative partner reads the sentence. To facilitate speech
without demanding it, a pause is inserted when reading the sentence to the student,
and the student is differentially reinforced for speaking. If the student does not speak,
the exchange is honored and the reinforcer is delivered. At this point in the training,
many preschool students begin to vocalize (Frost & Bondy, 1998; Ganz & Simpson,
2004).

Attributes
Once Phase IV is mastered, the teaching of attributes starts. The student’s current
reinforcers are assessed to determine which attributes might be taught. For example, if
the student likes markers, the trainer can develop a color lesson. Other attributes to
be taught include size, shape, and quantity or specific aspects of things such as body
parts, animals, and toys. By learning additional vocabulary, the student gains more
opportunities to deliver a clear message. It is impossible to have a picture for every
item. By teaching attributes, the student will be able to describe a desired item, such
as ‘‘I want brown, square cracker,’’ to indicate the desire for a graham cracker even
when that specific picture is not available.

PHASE V: RESPONDING TO A REQUESTING QUESTION (WHAT DO YOU WANT?)

The goal of Phase V is to teach the student to respond to the simple question,
‘‘What do you want?’’ This is the first time in the protocol that the student is taught
to respond to the trainer’s communication. A time-delay prompt strategy is used to
teach this lesson. It is imperative that trainers not ask questions all day, because this
could undermine spontaneous requesting.

PHASE VI: COMMENTING

The goal in Phase VI is to teach the student to comment in response to questions
such as, ‘‘What do you see?’’ or ‘‘What do you hear?’’ and eventually to make sponta-
neous comments about events in the environment. This function of language is often
difficult for students on the autism spectrum because the student does not receive a
tangible reinforcer, as when making a request such as, ‘‘I want book.’’ Instead, the
reinforcer for commenting is social.
Phase VI is taught using the same time-delay prompt strategy as in Phase V. The
trainer asks the student a commenting question such as ‘‘What do you see?’’ and the
student answers the question by constructing a sentence using the ‘‘I see’’ sentence
starter and a picture of the corresponding item. Students are also taught to discrimi-
nate among many sentence starters as these will serve as the means for the listener to
know if the student is making a request or a comment.
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RESEARCH ON PECS
Bondy and Frost (1994) first reported outcome data regarding a large proportion of
preschool children with autism who learned PECS and subsequently displayed speech.
A preliminary controlled group study from England (Magiati & Howlin, 2003) demon-
strated successful implementation of PECS in a variety of classroom settings. Single-
subject studies also have demonstrated not only acquisition of PECS, but significant
improvement in speech acquisition, social orientation, and reductions in behavior
management problems (Charlop-Christy et al., 2002; Ganz & Simpson, 2004; Kravits,
Kamps, & Kemmerer, 2002). Research continues in an effort to ensure quality imple-
mentation as well as to improve teaching strategies.

SUMMARY
The Picture Exchange Communication System can be a valuable tool for both
parents and educators. It is a relatively easy augmentative and alternative communica-
tion system to teach, and an effective approach to use with individuals who are not
yet speaking or who speak without spontaneity. PECS is a good place to start inter-
vention because there are virtually no prerequisite skills required for its use. Many stu-
dents have gone beyond PECS to use speech as their primary modality for
communication; others have transitioned to a higher-tech voice output device. It is
important to help students communicate effectively with people in their surroundings.
Having an effective communication system that everyone can understand is a neces-
sary component in reaching this goal.

REFERENCES
Bondy, A., & Frost, L. (1994). The Picture Exchange Communication System. Focus on Autistic
Behavior, 9, 1–19.
Bondy, A., & Sulzer-Azaroff, B. (2002). The pyramid approach to education in autism. Newark,
DE: Pyramid Educational Products.
Charlop-Christy, M. H., Carpenter, M., Le, L., LeBlanc, L., & Kelley, K. (2002). Using the Pic-
ture Exchange Communication System (PECS) with children with autism: Assessment of
PECS acquisition, speech, social-communicative behavior, and problem behaviors. Journal of
Applied Behavior Analysis, 35, 213–231.
Frost, L. A., & Bondy, A. S. (1998). The Picture Exchange Communication System. Seminars
in Speech and Language, 19, 373–389.
Frost, L., & Bondy, A. (2002). The Picture Exchange Communication System training manual (2nd
ed.). Newark, DE: Pyramid Educational Products.
Ganz, J., & Simpson, R. (2004). Effects on communicative requesting and speech development
of the Picture Exchange Communication System in children with characteristics of autism.
Journal of Autism and Developmental Disabilities, 34, 395–409.
Kravits, T. R., Kamps, D. M., & Kemmerer, K. (2002). Brief report: Increasing communication
skills for an elementary-aged student with autism using the Picture Exchange Communication
System. Journal of Autism and Developmental Disorders, 32, 225–230.
Magiati, I., & Howlin, P. (2003). A pilot evaluation study of the Picture Exchange Communi-
cation System (PECS) for children with autistic spectrum disorders. The International Journal
of Autism, 7, 297–320.
Mirenda, P. (2003). Toward functional augmentative and alternative communication for stu-
dents with autism: Manual signs, graphic symbols, and voice output communication aids.
Language, Speech, and Hearing Services in Schools, 34, 203–216.
JO-ANNE B. MATTEO
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PIVOTAL RESPONSE TRAINING

Children with autism spectrum disorders (ASD) display characteristics of impaired
social interactions, restricted repetitive patterns of behavior, and difficulties in verbal
and/or nonverbal communication (APA, 2000). Pivotal response training (PRT) is a
naturalistic intervention that has been implemented to promote appropriate social
interactions and communicative skills in children with ASD (Humphries, 2003). As
opposed to traditional behavioral interventions, PRT places great emphasis on the
child’s environment using natural prompts. In addition, the procedures of this inter-
vention are child- and family-centered (Humphries, 2003).
In the 1990s, researchers at the University of California, Santa Barbara, identified
four pivotal areas of child functioning, including: (a) responding to multiple cues and
stimuli, (b) improving motivation, (c) increasing self-management capacity, and (d)
increasing self-initiations (Koegel & Koegel, 1995). The purpose of PRT is to provide
children with ASD with adequate social and communicative skills that would lead
them to function independently in natural environments.
PRT is suitable for individuals with ASD across a range of ages; however, it focuses
primarily on early intervention. The cognitive ability of candidates for PRT ranges
from mild cognitive challenges to average intelligence (Simpson et al., 2004), and
minimal receptive and expressive language is required (Simpson et al., 2004). To be
successful, children have to show interest in objects and be able to demonstrate imita-
tion skills (Humphries, 2003). Since PRT occurs in the most inclusive settings, the
best implementers of PRT are those who work with the children on a regular basis,
such as general and special education teachers, therapists, and other professionals. Fur-
ther, family members should be part of the intervention (Simpson et al., 2004).

RESPONDING TO MULTIPLE STIMULI

The first pivotal area is responding to multiple cues and stimuli. Children with
ASD have a habit of responding to very limited and irrelevant cues in their environ-
ments, called stimulus overselectivity (Lovaas, Schreibman, Koegel, & Rehm, 1971).
One example of such stimulus overselectivity may be that a child with ASD only
notices tiny telephone numbers on a small commercial sign in a background of a pic-
ture. In the light of this characteristic, two approaches to the intervention in this piv-
otal area are suggested. The first approach is within-stimulus prompting (Schreibman,
1975), whereby an important feature of a stimulus item is greatly exaggerated to show
the relevance between the object and its components. After this differentiation has
been made, the exaggerated feature is faded away gradually (Dunlap, Koegel, & Burke,
1981; Rosenblatt, Bloom, & Koegel, 1995). For example, to teach a child to distin-
guish pennies from quarters, the size of coins could be exaggerated. After the child
has learned the differences, the original sizes of the pennies and quarters are
reintroduced.
The second approach is to directly teach the child to respond to multiple cues and
components by arranging activities and environments (Koegel & Schreibman, 1977;
Schreibman, 1988; Schreibman, Stahmer, & Pierce, 1996). There are many concur-
rent cues and stimuli in everyday life, and being able to respond to them is necessary
for successful social interactions. Thus, teachers and parents can focus on a few stimuli
at a time and arrange for these selected stimuli to stand out against other stimuli in
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PIVOTAL RESPONSE TRAINING

the environment. An example would be to ask the child to sort toys into colored bas-
kets. If the child is asked to put the toy car into the red basket while there are other
baskets of different colors, the child has to respond to those colors and make a correct
differentiation. Therefore, the first pivotal area focuses on teaching children with
ASD to be responsive to multiple cues in an effort to teach them to generalize the
skill to various settings, such as home, school, and community, and to facilitate
learning.

MOTIVATION
The second pivotal area is improving child motivation. Improving motivation is
associated with increasing responsiveness to environmental stimuli, decreasing
response latency, and changing emotions (Koegel, Koegel, & Carter, 1999). Lack of
motivation is one of the characteristics of children with ASD that interferes with
everyday learning and social interactions. In the light of this, the second pivotal area
encompasses several procedures for improving child motivation. First, the child should
be allowed to choose materials, topics, and toys during interactions. When learning
communicative skills, for instance, if the child is allowed to select her favorite toys as
stimulus or reinforcement items, chances are that she will have a sense of engagement
in learning activities. Besides increasing motivation, studies have indicated a decrease
in challenging behaviors (Sigafoos, 1998). In addition, the use of natural and direct
reinforcers benefits target behaviors and other functional activities (Koegel et al.,
1999). The third way to improve child motivation is to intersperse previously learned
tasks with newly acquired tasks (Dunlap, 1984; Dunlap & Koegel, 1980; Koegel &
Koegel, 1986; Koegel & Johnson, 1989). Thus, the child maintains the level of com-
petence and at the same time gains new skills based upon what he has learned. Thus,
a strong possibility of completing tasks results in high motivation and increased
responses. The other important motivational technique is to reinforce any clear and
goal-directed attempts made by the child (Koegel & Johnson, 1989; Koegel & Mentis,
1985; Koegel, O’Dell, & Dunlap, 1988). That is, the child is more motivated to
attend tasks if he receives encouragement when making any attempts to respond.

SELF-MANAGEMENT
The third pivotal area is increasing self-management capacity. Having self-management
skills helps children with ASD to: (a) be more independent from their intervention
providers, (b) minimize the services of practitioners, and (c) reduce the supervision of
the implementers. Using this approach, the intervention providers teach the child
daily-living tasks and activities within the child’s natural environments and encourage
the child to be actively involved in the intervention.
Several general procedures are suggested to the use of self-management intervention
(Koegel, Koegel, & Surratt, 1992). First, the intervention provider and the child iden-
tify a target behavior they are going to work on. For example, it could be a socially
valid behavior that needs to be taught or an inappropriate behavior that needs to be
reduced. The second step is to identify reinforcers. In order to improve self-management,
it is better to use self-recruit reinforcement instead of external rewards. The third step
is to select a self-monitoring device. Fourth, the intervention provider can teach the
child how to monitor the occurrence or absence of the target behavior using the
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selected self-monitoring device. The final step is to see whether the child can generalize
the self-management procedures to real-life situations. An example of incorporating
these procedures is using self-management strategies to modulate the feelings. The inter-
vention provider can start by assisting the child in identifying the behavior the child
demonstrates when feeling angry. Worksheets or visual reminders, such as feeling ther-
mometers, could be used as self-monitoring device. Then the child is taught how to use
the monitoring device independently. For reinforcements the child can earn extra time
doing his favorite activity to calm down. The goal of these intervention procedures is to
enable children with ASD to internalize the self-monitoring device and foster behav-
ioral management responsibility and use self-administered rewards.

SELF-INITIATION
The fourth pivotal area focuses on increasing self-initiations. A lack of spontaneous
language expression is a major characteristic of children with ASD. Koegel and her col-
leagues (1988) found that children with ASD could learn to generalize the skill of
initiating simple questions. Several self-initiations include why-questions; assistance-
seeking questions and information-seeking questions are also important (Houghton, Bro-
nicki, & Guess, 1987; Koegel et al., 1999; Shukla, Surratt, Horner, & Albin, 1995).
To increase self-initiation, the intervention provider can start by having the child
engage in his preferred activity and then create a teaching situation where these self-
initiating questions occur. At first, the child is prompted and reinforced to ask ques-
tions. Gradually, the prompts are faded after the child is able to generalize these skills
across settings. Teaching children with ASD how to initiate questions not only
increases their language expressions but also improves their social communicative
competence.
There are no documented risks of implementing PRT interventions (Simpson et al.,
2004), and since most materials come from the child’s natural environments, it is not
costly. Further, PRT incorporates teaching sessions into the child’s daily activities
and, therefore, reduces the need for intensive intervention hours. However, the inter-
vention provider should be careful about arranging teaching and learning environ-
ments, especially when introducing multiple components and stimuli into the
intervention process. Thus, the instruction should be clear and uninterrupted.
Some areas that children with ASD have difficulties with are not included in PRT,
such as sensory processing and motor planning (Simpson et al., 2004). In general,
PRT focuses on teaching children to be responsive to the many learning opportunities
and social interactions that occur in natural environments, as well as increasing moti-
vation and improving self-initiation. The ultimate goal of PRT intervention is to help
children generalize the behaviors they have learned in these four pivotal areas to
other natural environments.

REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
Dunlap, G. (1984). The influence of task variation and maintenance tasks on the learning and
affect of autistic children. Journal of Experimental Child Psychology, 37, 41–64.
Dunlap, G., & Koegel, R. L. (1980). Motivating autistic children through stimulus variation.
Journal of Applied Behavior Analysis, 13, 619–627.

257
PIVOTAL RESPONSE TRAINING

Dunlap, G., Koegel, R. L., & Burke, J. C. (1981). Educational implications of stimulus overse-
lectivity in autistic children. Exceptional Education Quarterly, 20, 37–49.
Houghton, J., Bronicki, G. B., & Guess, D. (1987). Opportunities to express preferences and
make choices among students with severe disabilities in classroom settings. Journal of the Asso-
ciation for Persons with Severe Handicaps, 12, 18–27.
Humphries, T. (2003). Effectiveness of pivotal response training as a behavioral intervention for
young children with autism spectrum disorders. Bridges, 2(4), 1–10.
Koegel, L. K., & Koegel, R. L. (1986). The effects of interspersed maintenance tasks on aca-
demic performance and motivation in a severe childhood stroke victim. Journal of Applied
Behavior Analysis, 19, 425–430.
Koegel, L. K., & Koegel, R. L. (1995). Motivating communication in children with autism. In
E. Schopler & G. B. Mesibov (Eds.), Learning and cognition in autism (pp. 73–87). New York:
Plenum.
Koegel, R. L., & Johnson, J. (1989). Motivating language use in autistic children. In G. Dawson
(Ed.), Autism: Nature, diagnosis, and treatment (pp. 310–325). New York: Guilford.
Koegel, R. L., Koegel, L. K., & Carter, C. M. (1999). Pivotal teaching interactions for children
with autism. School Psychology Review, 28(4), 576–594.
Koegel, R. L., Koegel, L. K., & Surratt, A. (1992). Language intervention and disruptive behav-
ior in children with autism. Journal of Autism and Developmental Disorders, 22, 141–152.
Koegel, R. L., & Mentis, M. (1985). Motivation in childhood autism: Can they or won’t they?
Journal of Child Psychology and Psychiatry, 26, 185–191.
Koegel, R. L., O’Dell, M. C., & Dunlap, G. (1988). Producing speech use in nonverbal autistic
children by reinforcing attempts. Journal of Autism and Developmental Disorders, 18, 525–538.
Koegel, R. L., & Schreibman, L. (1977). Teaching autistic children to respond to simultaneous
multiple cues. Journal of Experimental Child Psychology, 24(2), 299–311.
Lovaas, O. L., Schreibman, L., Koegel, R., & Rehm, R. (1971). Selective responding by autistic
children to multiple sensory input. Journal of Abnormal Psychology, 77(3), 211–222.
Rosenblatt, J., Bloom, P., & Koegel, R. L. (1995). Overselective responding: Description, impli-
cations, and intervention. In R. L. Koegel & L. K. Koegel (Eds.), Teaching children with au-
tism: Strategies for initiating positive interactions and improving learning opportunities (pp. 33–42).
Baltimore: Brookes Publishing Co.
Schreibman, L. (1975). Effects of within-stimulus and extrastimulus prompting on discrimina-
tion learning in autistic children. Journal of Applied Behavior Analysis, 8, 91–112.
Schreibman, L. (1988). Autism. Newbury Park, CA: Sage.
Schreibman, L., Stahmer, A., & Pierce, K. (1996). Alternative applications of pivotal response
training: Teaching symbolic play and social interaction skills. In L. K. Koegel, R. L. Koegel,
& G. Dunlap (Eds.), Positive behavioral support: Including people with difficult behavior in the
community (pp. 353–371). Baltimore: Brookes Publishing Co.
Shukla, S., Surratt, A. V., Horner, R. H., & Albin, R. W. (1995). Examining the relationship
between self-initiations of an individual with disabilities and directive behavior of staff per-
sons in a residential setting. Behavioral Interventions, 10, 101–110.
Sigafoos, J. (1998). Choice making and personal selection strategies. In J. K. Luiselli & M. J.
Cameron (Eds.), Antecedent control: Innovative approaches to behavioral support (pp. 187–221).
Baltimore: Brookes Publishing Co.
Simpson, R. L., Adams, L. G., Ben-Arieh, J., Byrd, S. E., Cook, K. T., de Boer-Ott, et al.
(2004). Autism spectrum disorders: Interventions and treatments for children and youth. Thousand
Oaks, CA: Corwin Press.

FURTHER INFORMATION
Koegel, L. K., Camarata, S. M., Valdez-Menchaca, M. C., & Koegel, R. L. (1998). Setting gen-
eralization of question-asking by children with autism. American Journal on Mental Retardation,
102, 346–357.
Koegel, L. K., Koegel, R. L., & Dunlap, G. (Eds.). (1996). Positive behavioral support: Including
people with difficult behavior in the community. Baltimore: Brookes Publishing Co.

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Koegel, L. K., Koegel, R. L., Hurley, C., & Frea, W. D. (1992). Improving social skills and dis-
ruptive behavior in children with autism though self-management. Journal of Applied Behavior
Analysis, 25(2), 341–353.
YU-CHI CHOU

PLACEBO
A placebo is a pill that contains no active ingredients and is given to individuals in
control groups in medication research studies. Although the placebo is made to look
like an actual drug intended to help patients, it is used to help discover if the real
drug provides better benefits than the placebo. The placebo effect is when a subject’s
behavior improves or gets better because they think they are taking a real drug.
PAUL G. LACAVA

PLAY-ORIENTED THERAPIES
Play-oriented therapies and interventions are among the wide range of educational
and treatment options available for children with autism spectrum disorders (ASD;
Boucher & Wolfberg, 2003). These approaches greatly vary with respect to theoretical
orientations, as well as the goals, methods, and contexts in which they are applied.
While many utilize play as a vehicle to achieve goals that are not play-specific (e.g.,
social skills, positive behavior, communication, and language), others are explicitly
designed to support children in learning how to play. Those interventions with the
goal of promoting play often target specific aspects of play behavior focusing on cogni-
tive and/or social domains. With regard to methods, play-oriented approaches vary in
degree of structure, the kinds of materials used, whether they are situated in a clinic
versus natural play setting, whether they involve play with an adult versus with other
children, and the age and ability ranges of peers. Theoretical orientations also run the
gamut of psychodynamic, developmental, and behavioral with offshoots and combina-
tions of each. The following gives an overview of an assortment of play-oriented
therapies and interventions that are geared to children with ASD.

TRADITIONAL PLAY THERAPY

Traditional forms of play therapy are rooted in the psychoanalytic tradition (Freud,
1946), which prevailed in the early treatment of children with ASD, who were classi-
fied among children with a wide range of psychological problems (Axline, 1947; Klein,
1955). In general, play therapy focuses on resolving emotional and behavioral prob-
lems by establishing communication between therapist and child utilizing a variety of
play activities—such as puppets, a dollhouse, sand, or clay. The idea is that play
allows the child to express emotions that would otherwise be too difficult to verbalize
or discuss with another person. An underlying premise of the psychoanalytic approach
is that the child’s problems reflect unresolved internal conflicts that arise from past
experience, all of which may be represented in play. In its original application to chil-
dren with ASD, play therapy focused on drawing the child out of his or her ‘‘autistic-
state’’ by working through inner struggles that were interpreted as stemming from a
dysfunctional mother-child relationship (Mahler, 1952). As theories of autism shifted
from psychogenic to organic explanations for the disorder, traditional psychoanalytic
play therapy was no longer considered a treatment of choice. While contemporary
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versions of psychodynamic play therapy are now widely practiced with children who
have diverse emotional issues, little research exists to determine its explicit benefits to
children with ASD (Mittledorf, Hendricks, & Landreth, 2001). Nevertheless, play
therapy may offer benefits to higher-functioning children who are experiencing emo-
tional difficulties coupled with or as a by-product of ASD.

ADULT-DIRECTED APPROACHES
Many play-oriented interventions for children with ASD are adult-directed, based
on the principles of applied behavior analysis (for a review, see Stahmer, Ingersoll, &
Carter, 2003). These interventions focus on the use of systematic reinforcement to
increase target play behaviors. One such approach that is commonly practiced today is
discrete trial training (DTT) as associated with the work of Lovaas (1987) and col-
leagues (Leaf & McEachin, 1999; Maurice, Green, & Luce, 1996). In DTT, target play
behaviors are broken down into a discrete set of subskills, which are taught through a
series of repeated teaching trials. The environment is highly structured and controlled
by the adult who relies on prompting, shaping, and reinforcement to elicit the target
response. Pivotal response training (PRT) uses an adult-directed approach to promote
play that capitalizes on the child’s motivation (Stahmer, 1995; Thorp, Stahmer, &
Schreibman, 1995). PRT involves presenting the child with choices of preferred play
activities, modeling the desired action, reinforcing the child for reasonable attempts at
correct responding, and directly prompting the child to give the correct response
(Koegel, Koegel, Harrower, & Carter, 1999).
Also based on the principles of applied behavior analysis are in vivo modeling
(Tryon & Keane, 1986) and video modeling techniques (Schwandt et al., 2002; Tay-
lor, Levin, & Jasper, 1999) to promote play in children with ASD. In each approach,
the child is systematically reinforced for imitating an adult or peer who models or per-
forms a predictable sequence of desired play behaviors (live or on video).
Self-monitoring techniques are also being used to support children with ASD in inde-
pendent play (Stahmer & Schreibman, 1992) and social play with peers (Shearer, Kohler,
Buchan, & McCullough, 1996). This involves training the child to monitor and deliver
self-reinforcement for appropriate behavior as adult support is systematically withdrawn.

CHILD-CENTERED APPROACHES
Many play-oriented therapies and interventions for children with ASD involve
child-centered approaches that primarily operate within a developmental framework.
In general, the adult follows the child’s lead to stimulate, expand, and scaffold play
along a continuum that mirrors typical development. Van Berckelaer-Onnes (2003)
designed a play intervention that supports children in developing early forms of
manipulative, relational, and functional play with objects. This intervention is carried
out by an adult who offers and models toy play that is matched to the child’s interest
and developmental level. Beyer and Gammeltoft (1999) devised a more comprehen-
sive intervention whereby an adult supports the child in following a series of play
sequences that are patterned after typical development, as well as adapted to the
child’s developmental level. Each play sequence is carefully planned with respect to
selecting motivating themes and materials and setting up the visual organization and
structure of the play at the table where activities take place.
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‘‘Floor time’’ is part of developmental individual-difference relation-based interven-

tion that supports children with ASD in reciprocal forms of play (Wieder & Green-
span, 2003). In floor time sessions, the adult follows the child’s lead utilizing gestures,
words, and affect to establish joint attention and increasingly complex social-
communicative exchanges. Sherrat (2002) developed a systematic classroom-based
approach that similarly involves elements of structure, affect, and repetition to stimu-
late symbolic play in children with ASD. The SCERTS model (Social Communica-
tion, Emotional Regulation and Transactional Support) also incorporates a variety of
child-centered practices that support children with ASD in social and symbolic forms
of play (Prizant, Wetherby, Rubin, Rydell, & Laurent, 2003).

PEER-MEDIATED APPROACHES
Play-oriented interventions for children with ASD also include a variety of peer-
mediated approaches. Odom and Strain (1984) were among the first to document peer-
mediated interventions based on behavioral methods. Accordingly, typical peers are
trained through modeling, prompting, and reinforcement to increase the play initiations
and responses of the child with ASD. Extensions of this approach include a dual focus
on providing explicit instruction to both the typical peers and the children with ASD
applying ABA procedures (Haring & Lovinger, 1989; Oke & Schreibman, 1990). Simi-
lar methods have also been used for sociodramatic script training (Goldstein & Cisar,
1992). This procedure involves modeling, prompting, and reinforcing triads (consisting
of one child with autism and two typically developing peers) to act out specific actions
and dialogue in play scenarios that are scripted in advance for the children.
A number of peer-mediated approaches for children with ASD incorporate a variety
of child-centered practices that are consistent with a developmental orientation. Doc-
umentation of early efforts shares a common focus on promoting spontaneous recipro-
cal play between small groups of children with ASD and typical peers in natural
contexts (Bednersh & Peck, 1986; Casner & Marks, 1984; Lord & Hopkins, 1986).
There is also an emphasis on facilitating social, communicative, and play exchanges
with minimal adult intrusion (Meyer et al., 1987). Further, attention is focused on en-
gineering the play environment by arranging the physical space and providing intrinsi-
cally motivating activities that are highly conducive to interactive as opposed to
isolated play (Beckman and Kohl, 1984).
These early influences have carried over into current models of supported peer play.
The Denver model (Rogers, Hall, Osaki, Reaven, & Herbison, 2000) applies child-
centered practices to engage children with ASD in ‘‘sensory social exchanges’’ that
revolve around toy preferences and social initiations with typical peers. This approach
teaches children to initiate, imitate, and engage each other in social games and rou-
tines. The integrated play group model is a comprehensive intervention that uses
guided participation to support children with ASD and typical peers in mutually
engaging play experiences (Wolfberg, 1999; 2003). Routines, rituals, and visual sup-
ports are incorporated into play sessions that revolve around highly motivating social
play activities. The adult facilitates by monitoring play initiations, scaffolding, and
guiding social communication and play geared to each child’s unique interests, ability,
and experience. Extensions of this approach include combining integrated play groups
with sensory integration therapy to enhance play (Fuge and Berry, 2004).
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The selection of play-oriented therapies and interventions described herein includes

a wide range of promising practices for children with ASD. It should be noted that
this selection is by no means comprehensive, as there are undoubtedly other notewor-
thy play therapy and intervention models not mentioned here. It is also of interest to
point out that despite apparent conceptual and methodological differences among
these different approaches, there are actually some common threads that may be help-
ful for guiding parents and professionals in their efforts to support their children in
play. First, there is a growing appreciation for the importance of including play in the
lives of children with ASD. This is consistent with the recommendations of the
National Research Council (2001) who ranked the teaching of play skills with peers
among the six types of interventions that should have priority in the design and deliv-
ery of effective educational programs for children with ASD. Further, there is a gen-
eral consensus that play interventions need to be adapted to each child’s unique
interests, developmental levels, and learning style (see for example, Kok, Kong, &
Bernard-Opitz, 2002; Quill, 2000). Another common focus is on identifying and
responding to what is intrinsically motivating for the child. There is also a growing
trend toward more naturalistic approaches, which includes providing opportunities and
support for children with ASD and typical peers to play together as play partners.
Finally, there is a greater openness to blending best practices to ensure that every child
with ASD is given the opportunity and means to reach his or her full potential for
play.

REFERENCES
Axline, V. (1947). Play therapy. New York: Ballantine Books.
Beckman, P. J., & Kohl, F. L. (1984). The effects of social and isolate toys on the interactions
and play of integrated and nonintegrated groups of preschoolers. Education and Training of the
Mentally Retarded, 19, 169–175.
Bednersh, F., & Peck, C. A. (1986). Assessing social environments: Effects of peer characteris-
tics on the social behavior of children with severe handicaps. Child Study Journal, 16(4), 315–
329.
Beyer, J., & Gammeltoft, L. (1999). Autism and play. London: Jessica Kingsley Publishers.
Boucher, J., & Wolfberg, P. J. (Eds.). (2003). Special issue on play. Autism: The International
Journal of Research and Practice, 7(4), 339–346.
Casner, M. W., & Marks, S. F. (1984). Playing with autistic children. Paper presented at the an-
nual convention of the Council for Exceptional Children, Washington, DC.
Freud, A. (1946). The psychoanalytic treatment of children. London: Imago (originally published
1926).
Fuge, G., & Berry, R. (2004). Pathways to play! Combining sensory integration and integrated play
groups. Shawnee Mission, KS: Autism Asperger Publishing Company.
Goldstein, H., & Cisar, C. L. (1992). Promoting interaction during sociodramatic play: Teach-
ing scripts to typical preschoolers and classmates with disabilities. Journal of Applied Behavior
Analysis, 25, 265–280.
Haring, T. G., & Lovinger, L. (1989). Promoting social interaction through teaching general-
ized play initiation responses to preschool children with autism. Journal of the Association for
Persons with Severe Handicaps, 14(1), 58–67.
Klein, M. (1955). The psychoanalytic play technique. American Journal of Orthopsychiatry, 25,
223–237.
Koegel, L. K., Koegel, R. L., Harrower, J. K., & Carter, C. M. (1999). Pivotal response interven-
tion I: Overview of approach. Journal of the Association for Persons with Severe Handicaps, 24,
174–185.

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Kok, A. J., Kong, T. Y., & Bernard-Opitz, V. (2002). A comparison of the effects of structured
play and facilitated play approaches on preschoolers with autism: A case study. Autism: The
International Journal of Research and Practice, 6, 181–196.
Leaf, R., & McEachin, J. (1999). A work in progress: Behavior management strategies and a curricu-
lum for intensive behavioral treatment of autism. New York: DRL.
Lord, C., & Hopkins, M. J. (1986). The social behavior of autistic children with younger and
same-age nonhandicapped peers. Journal of Autism and Developmental Disorders, 16(3), 249–
262.
Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning
in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3–9.
Mahler, M. (1952). On child psychosis in schizophrenia: Autistic and symbiotic infantile psy-
chosis. In R. S. Eissler, A. Freud, H. Hartmann, & K. Kris (Eds.), Psychoanalytic study of the
child (pp. 265–305). New York: International University Press.
Maurice, C., Green, G., & Luce, S .C. (1996). Behavioral intervention for young children with au-
tism: A manual for parents and professionals. Austin, TX: Pro-Ed.
Meyer, L. H., Fox, A., Schermer, A., Ketelsen, D., Montan, N., Maley, K., et al. (1987). The
effects of teacher intrusion on social play interactions between children with autism and their
nonhandicapped peers. Journal of Autism and Developmental Disorders, 17(3), 315–332.
Mittledorf, W., Hendricks, S., & Landreth, G. L. (2001). Play therapy with autistic children. In
G. L. Landreth (Ed.), Innovations in play therapy (pp. 257–270). New York: Routledge.
National Research Council. (2001). Educating children with autism. Washington, DC: National
Academy Press.
Odom, S., & Strain, P. (1984). Peer-mediated approaches to promoting children’s social interac-
tion: A review. American Journal of Orthopsychiatry, 54(4), 544–557.
Oke, N. J., & Schreibman, L. (1990). Training social initiations to a high-functioning autistic
child: Assessment of collateral behavior change and generalization in a case study. Journal of
Autism and Developmental Disorders, 20, 479–497.
Prizant, B., Wetherby, A., Rubin, E., Rydell, P., & Laurent, A. (2003). The SCERTS Model: A
family-centered, transactional approach to enhancing communication and socioemotional
abilities of young children with ASD. Infants and Young Children, 16(4), 296–316.
Quill, K. (2000). Do-watch-listen-say: Social and communication intervention for children with au-
tism. Baltimore: Brookes Publishing Co.
Rogers, S. J., Hall, T., Osaki, D., Reaven, J., & Herbison, J. (2000). The Denver model: A com-
prehensive, integrated educational approach to young children with autism and their families.
In J. S. Handleman & S. L. Harris (Eds.), Preschool education programs for children with autism
(2nd ed., pp. 95–133). Austin, TX: Pro-Ed.
Schwandt, W. L., Pieropan, K., Glesne, H., Lundahl, A., Foley, D., & Larsson, E. V. (2002).
Using video modeling to teach generalized toy play. Paper presented at the annual meeting of the
Association for Behavior Analysis, Toronto, Canada.
Shearer, D. D., Kohler, F. W., Buchan, K. A., & McCullough, K. M. (1996). Promoting inde-
pendent interactions between preschoolers with autism and their nondisabled peers: An anal-
ysis of self-monitoring. Early Education and Development, 7, 205–220.
Sherrat, D. (2002). Developing pretend play in children with autism: A case study. Autism: The
International Journal of Research and Practice, 6(2), 169–179.
Stahmer, A. C. (1995). Teaching symbolic play to children with autism using pivotal response
training. Journal of Autism and Developmental Disorders, 25, 123–141.
Stahmer, A. C., Ingersoll, B., & Carter, C. (2003). Behavioral approaches to promoting play.
Autism: The International Journal of Research and Practice, 7(4), 401–413.
Stahmer, A. C., & Schreibman, L. (1992). Teaching children with autism appropriate play in
unsupervised environments: Using a self-management treatment package. Journal of Applied
Behavior Analysis, 25, 447–459.
Taylor, B. A., Levin, L., & Jasper, S. (1999). Increasing play-related statements in children with
autism toward siblings: Effects of video modeling. Journal of Developmental and Physical Disabil-
ities, 11, 253–264.

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Thorp, D. M., Stahmer, A. C., & Schreibman, L. (1995). Teaching sociodramatic play to chil-
dren with autism using pivotal response training. Journal of Autism and Developmental Disor-
ders, 25, 265–282.
Tryon, A. S., & Keane, S. P. (1986). Promoting imitative play through generalized observatio-
nal learning in autistic-like children. Journal of Abnormal Child Psychology, 14, 537–549.
Van Berckelaer-Onnes, I. A. (2003). Promoting early play. Autism: The International Journal of
Research and Practice, 7(4), 415–423.
Wieder, S., & Greenspan, S. I. (2003). Climbing the symbolic ladder in the DIR model through
floor time/interactive play. Autism: The International Journal of Research and Practice, 7(4),
425–435.
Wolfberg, P. J. (1999). Play and imagination in children with autism. New York: Teachers College
Press, Columbia University.
Wolfberg, P. J. (2003). Peer play and the autism spectrum: The art of guiding children’s socialization
and imagination. Shawnee Mission, KS: Autism Asperger Publishing Company.

FURTHER INFORMATION
Autism Institute on Peer Relations and Play: www.autisminstitute.com.
PAMELA WOLFBERG

POSITIVE BEHAVIOR SUPPORT (PBS)

Positive behavior support (PBS) is an empirically validated process for addressing
problem behaviors and enhancing the lives of people with autism spectrum disorders
(ASD). PBS is based on scientific principles, including applied behavioral analysis
and humanistic theory. However, it is broader in that it is not a specific strategy, but
a foundation for building effective interventions based on an understanding of the per-
son’s behavior and preferred lifestyle. PBS takes a functional approach to behavior
and is considered an effective practice for students with ASD by several respected
groups, including the National Research Council (2001), and others (Hurth, Shaw,
Izeman, Whaley, & Rogers, 1999; Iovannone, Dunlap, Huber, & Kincaid, 2003).

CHARACTERISTICS
Although PBS is an individualized approach, it is made up of a set of components:

1. the gathering and use of functional behavior assessment information to develop hypothe-
ses about the purposes of behaviors;
2. the development of a multicomponent support plan based on the assessment data that
includes:
(a) strategies to prevent behavior from occurring,
(b) strategies to teach the person a replacement skill for effectively interacting within
various settings, or an appropriate communicative replacement behavior that will get
the person the same outcome as did the problem behavior, and
(c) strategies that change the way others respond to problem behavior so that it is no
longer reinforced and to desired behaviors so that they are repeated.
3. the design of an evaluation and monitoring plan that documents the effectiveness of the
interventions and provides data for making decisions about next steps.

Additional components characterize effective PBS. First, PBS works best when a
collaborative team approach is used throughout the process of assessment and inter-
vention. At a minimum, the teams should include the family members/caregivers,
teachers, school staff, agency staff, and the student when appropriate. Each team
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member contributes his or her expertise and perspective of the person with autism
spectrum disorder (ASD) and assists in developing a socially valid support plan.
Second, PBS is an ongoing process that addresses both long-term and short-term
goals. Although problem behavior is usually the reason why the PBS process is initi-
ated, enhancing the quality of life for the person with ASD is a crucial goal of the
support plan. Specifically, inclusion in typical environments in both the school and
the community is an objective underlying the entire process. The PBS process, there-
fore, continues even when the problem behavior is extinguished and new appropriate
behaviors consistently occur.

EXAMPLES OF USE
Generally, PBS consists of five steps: (a) establishing goals of intervention; (b) gath-
ering information; (c) developing a hypothesis; (d) building a support plan; and
(e) designing an evaluation, monitoring, and follow-up plan (Hieneman et al., 1999).

Establishing Goals of Intervention

Identifying the appropriate short- and long-term goals is typically done by a support
team. Team members must have a vested interest in the person with ASD and be
committed to achieving the long- and short-term goals established.
The team develops goals based on the preferences, desires, abilities, and unique
characteristics of the person with ASD. Goals should include reducing problem behav-
iors, increasing pro-social and academic skills, and improving the quality of the per-
son’s life, including increased inclusion in school, social, and community activities
(Carr et al., 2002). Person-centered planning is one method that can help the team es-
tablish goals (Kincaid, 1996). A person-centered plan provides a foundation for under-
standing the person’s vision for his or her life, the conditions that currently exist, and
the resources that need to be accessed to help the person fulfill their vision. Outcomes
of person-centered plans not only include long- and short-term goals, but also action
steps for each team member to pursue throughout the process. Figures 11 and 12 pres-
ent graphic examples of person-centered planning activities revolving around a vision
and goals for Hannah, a 5-year-old girl with ASD who has limited verbal language.

Gathering Information
Functional behavior assessment information may be gathered through indirect mea-
sures such as interviews, questionnaires, and rating scales, or through direct observatio-
nal measures in various environments. The assessment is used to help the team
understand the circumstances surrounding the problem behavior and provide insight
into possible purposes, or functions, for engaging in the behavior. Examples of envi-
ronmental circumstances may include demands, transitions, removal of a preferred
object or activity, or the presence of a specific peer or adult. Most behavior serves two
main purposes: (a) escaping or avoiding, or (b) obtaining (e.g., attention, tangible
object, etc.). The assessment also explores the responses from others that follow the
problem behavior. Typical responses following problem behavior include reprimands,
redirects, removal of items, time-out, etc. The information gathered is reviewed by the
team to identify patterns of circumstances (where, when, what, with whom) related to
the behavior.
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POSITIVE BEHAVIOR SUPPORT (PBS)

Figure 11 Sample Dream Frame from Hannah’s Person-Centered Plan

Developing a Hypothesis
Hypotheses or summary statements are made based on the data gathered. At a mini-
mum, hypothesis statements should address the context or circumstances related to
the behavior, the description of the behavior, and the function served by the behavior
(O’Neill et al., 1997).
An example of a hypothesis statement for Hannah is as follows: When presented with
a demand/request/instruction by an adult, particularly when the demand takes Hannah away
from a preferred activity, Hannah screams loudly to avoid and protest the demand and to
keep access to her preferred activity. The context most often related to Hannah’s behav-
ior is being presented with demands, particularly when they take her away from activ-
ities she likes. The behavior Hannah engages in under the conditions of demands is
screaming with marked intensity (loudly). Finally, the purpose that is surmised from
the data is that Hannah screams during demand conditions to escape the demand and
continue to keep doing her favored activity and express her feelings about the situa-
tion. In other words, Hannah is communicating in the most effective and efficient
way that is currently in her repertoire.
Building a Support Plan
The hypothesis statement is important because it provides the foundation upon
which interventions are built. Hypotheses are vital, particularly with people with
ASD and deficient verbal skills, in that they provide a viewpoint of what the person
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 POSITIVE BEHAVIOR SUPPORT (PBS)

Figure 12 Sample Goal Frame from Hannah’s Person-Centered Plan

is trying to say with the behavior. By modifying the events under which behavior pre-
dictably occurs, the behavior can be prevented and made irrelevant (i.e., no longer
necessary). Further, by teaching an appropriate, socially valid way to obtain the same
outcome with the same or better effectiveness and efficiency, the problem behavior
becomes inefficient and ineffective (O’Neill et al., 1997).
Examples of interventions designed to prevent problem behavior include choices, cur-
ricular modifications, transition cues, and environmental and visual supports. Interven-
tions that teach new skills can either be strategies that provide the person a functional
communicative replacement behavior (e.g., teach the person to ask for a break rather
than screaming to avoid something) and/or an alternative skill (e.g., self-management,
problem-solving strategies). Since the new behavior must be as efficient or better than
the problem behavior in getting a desired outcome, it is important to select a behavior
that is already in the person’s repertoire. For example, if the person is nonverbal and
the strategy is to teach her to ask for a break, the communicative method must be easy
to use and one that others can respond to efficiently. Finally, the support plan should
include different ways for adults and others to respond to the person’s new replacement
behaviors and old problem behaviors. The responding interventions should include a
way to (a) reinforce the replacement or alternative behavior so that it is used instead of
the problem behavior and (b) no longer reinforces the problem behavior.
An example of a PBS plan for Hannah that includes the three minimum compo-
nents of interventions (i.e., prevent, teach new skills, respond in new ways to behav-
ior) is shown in Figure 13. Because Hannah has minimal verbal language, the team
selected one word and sign, wait, both already in her repertoire, to replace her
267
 Figure 13 Positive Behavior Support Plan for Hannah

268
 POSITIVE BEHAVIOR SUPPORT (PBS)

Figure 14 Evaluation Plan for Evaluating Change to Hannah’s Problem Behavior

screaming behavior. The team also selected several prevention strategies to make the
demand to transition less aversive to Hannah. Finally, the team carefully agreed upon
how they were going to respond when Hannah used her new behavior and how they
would respond if she engaged in her problem behavior.
The additional strategies in the fourth column in Hannah’s support plan relate to
some of the goals that were developed during the person-centered plan. The intent of
269
270
Figure 15 Hannah’s Evaluation Plan
 POSITIVE BEHAVIOR SUPPORT (PBS)

the strategies is to improve Hannah’s quality of life by expanding her social relation-
ships and community activities.
Once a support plan is developed, it is important for the team to make an action
plan that outlines how the interventions will be implemented. The action plan
should include the steps to be taken, training to be delivered, and resources to be
accessed.

Monitoring and Evaluation

Once the support plan is implemented, the team gathers information to evaluate
the effectiveness of the supports and to make decisions for future activities (Dunlap &
Hieneman, 2005). Information to be collected should include ways to evaluate behav-
ior changes, including the person’s use of replacement or alternative behaviors.
Finally, an evaluation plan should be developed to assess quality-of-life changes for
the individual (e.g., having more friends, being included in more community events).
Several data methods may be used to measure change in behavior, ranging from fre-
quency recording to perceptual ratings. The important thing to consider when choos-
ing a data method is whether the person collecting the data can use the method with
minimal intrusiveness to the daily routine. A sample evaluation plan to assess whether
Hannah’s screaming behavior changes is shown in Figures 14 and 15.
The team chose this method because the teacher felt that something as simple as
circling a number once a day would make it more likely that she would do so consis-
tently than taking interval or frequency data. Once Hannah’s screaming behavior
decreased, the team developed another evaluation method that would provide infor-
mation on Hannah’s use of her new behavior as well as the occurrence of problem
behavior. This form measures the teacher’s perception of the occurrence of Hannah’s
problem behavior and replacement behavior.
See also empiricism.

REFERENCES
Carr, E. G., Dunlap, G., Horner, R. H., Koegel, R. L., Turnbull, A. P., Sailor, W., et al. (2002).
Positive behavior support: Evolution of an applied science. Journal of Positive Behavior Inter-
ventions, 4(1), 4–16.
Dunlap, G., & Hieneman, M. (2005). Positive behavior support. In G. Sugai & R. Horner
(Eds.), Encyclopedia of behavior modification and cognitive behavior therapy (Vol. 3): Educational
applications (pp. 1421–1428). Thousand Oaks, CA: Sage Publications.
Hieneman, M., Nolan, M., Presley, J., DeTuro, L., Gayler, W., & Dunlap, G. (1999). Facilita-
tor’s guide, positive behavioral support. Tallahassee: Florida Department of Education, Bureau of
Instructional Support and Community Services.
Hurth, J., Shaw, E., Izeman, S. G., Whaley, K., & Rogers, S. J. (1999). Areas of agreement
about effective practices among programs serving young children with autism spectrum disor-
ders. Infants and Young Children, 12(2), 17–26.
Iovannone, R., Dunlap, G., Huber, H., & Kincaid, D. (2003). Effective educational practices
for students with autism spectrum disorders. Focus on Autism and Other Developmental Disabil-
ities, 18(3), 150–165.
Kincaid, D. (1996). Person-centered planning. In L. K. Koegel, R. L. Koegel, & G. Dunlap
(Eds.), Positive behavioral support: Including people with difficult behavior in the community
(pp. 439–465). Baltimore: Brookes Publishing Co.
National Research Council. (2001). Educating children with autism. Washington, DC: National
Academy Press.

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O’Neill, R. E., Horner, R. H., Albin, R. W., Sprague, J. R., Storey, K., & Newton, J. S. (1997).
Functional assessment and program development for problem behavior: A practical handbook (2nd
ed.). Pacific Grove, CA: Brooks Cole Publishing Company.

FURTHER INFORMATION
Carr, E. G., Horner, R. H., Turnbull, A. P., Marquis, J., Magito-McLaughlin, D., McAtee, M.
L., et al. (1999). Positive behavior support for people with developmental disabilities: A research
synthesis. Washington, DC: American Association on Mental Retardation.
Koegel, L. K., Koegel, R. L., & Dunlap, G. (Eds.). (1996). Positive behavioral support: Including
people with difficult behavior in the community. Baltimore: Brookes Publishing Co.
ROSE IOVANNONE

POSITRON EMISSION TOMOGRAPHY (PET)

Positron Emission Tomography (PET) is an imaging technique that utilizes tiny
amounts of injected, radio-labeled compounds. The photon emissions are then
recorded like x-rays in a CAT scan. The accumulation of these compounds in certain
areas of the body may show glucose use, blood flow, oxygen, or dopamine transport
depending on the type of compound injected.
BRUCE BASSITY

POSTSECONDARY EDUCATION
Postsecondary education occurs after graduation from high school. Postsecondary
education can be provided in a variety of settings: continuing education, vocational
technical school training, community college education, technical college education,
and traditional four-year university training. Placement in one of these settings is
determined based on eligibility and meeting the policy requirements of the institution
to which the individual applies.
Individuals with disabilities who have applied to and been accepted by an institu-
tion may be eligible for reasonable accommodations in the educational setting. The
individual will need to seek out the support services office to determine eligibility and
the type of reasonable accommodations for which the student may be eligible. It is im-
portant for individuals with disabilities and their parents to understand that the
accommodations and modifications received in high school will not automatically
transfer to reasonable accommodations in the postsecondary setting. Therefore, the
student needs to self-disclose his or her disability if the student wants assistance in the
educational setting. The student will also need to be reassessed to determine what
accommodations for the disability will be reasonable in the postsecondary setting.
See also Americans with Disabilities Act; Section 504 of the Rehabilitation Act of
1973; self-advocacy; self-determination.
BETH CLAVENNA-DEANE

POSTTRAUMATIC STRESS DISORDER (PTSD)

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-
IV-TR; APA, 2000), posttraumatic stress disorder typically develops following expo-
sure to an extreme traumatic event that involved actual or threatened death or serious
injury or a threat to the physical integrity of self or others. The reaction is extreme
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fear, helplessness, or horror; in children it may be expressed by disorganized or agitated

behavior.

SYMPTOMS
The Traumatic Event Is Reexperienced
The person has repeated painful memories, dreams, or flashbacks in which the event
seems to be recurring. Sometimes the patient experiences bodily reactions to stimuli
or situations that resemble the traumatic event. Children may engage in repetitive
play in which they reflect the themes or elements of the trauma.

Constant Avoidance of Stimuli Related with the Trauma and Emotional Numbing
Efforts to avoid feelings, thoughts, activities, places, or people associated with the
trauma are constant with an inability to recall important aspects of the event. Some
patients demonstrate a detachment from others; others express lack of interest or par-
ticipation in activities that they previously enjoyed and a feeling of no future.

Persistent Symptoms of Increased Arousal That Were Not Present before the
Trauma
The person can experience persistent symptoms of anxiety, difficulty falling asleep
or staying asleep, and nightmares. Some persons report difficulty concentrating and
being in a constant state of vigilance. Also irritability and outburst of anger and exag-
gerated startle response can occur.

DURATION AND COURSE OF THE SYMPTOMS

This disorder causes clinically significant distress or impairment in social, occupa-
tional, and other important areas of functioning. Symptoms are classified as acute, if
the length is less than 3 months, chronic, if the symptoms last 3 months or longer, and
with delayed onset, if at least 6 months have passed between the traumatic event and
the onset of symptoms.
Posttraumatic stress disorder can occur at any age and symptoms usually begin
within the first 3 months after the traumatic event. The disorder can develop in any
person without predisposing conditions, especially if the stressor was particularly
extreme; however, there is evidence of a heritable susceptibility to the transmission of
the disorder.

REFERENCE
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.

FURTHER INFORMATION
Breslau, N., Chilcoat, H. D., Kessler, R. C., Peterson, E. L., & Lucia, V. C. (1999). Vulnerabil-
ity to assaultive violence: Further specification of the sex difference in post-traumatic stress
disorder. Psychological Medicine, 29, 813–821.
Davison, J. R. T., Book, S. W., Colket, J. T., Tupler, L. A., Roth, S., David, D., et al. (1997).
Assessment of a new self-rating scale for post-traumatic stress disorder. Psychological Medicine,
27, 153–160.
Yule, W. (1999). Posttraumatic stress disorder. Archives of Disease in Childhood, 80, 107–109.
SUSANA BERNAD-RIPOLL
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POWER CARD STRATEGY

POWER CARD STRATEGY

Power Cards, created by Gagnon (2001), are a visual aid that uses the child’s inter-
ests in teaching appropriate social interactions, routines, behavior expectations, and
the meaning of language. Using a hero or special interest serves several purposes: easy
to ‘‘buy into’’ idea, capitalizes on the relationship between the hero and the child, and
has generalization built into the strategy. Moreover, Power Cards are a quick, portable,
low cost, and nonthreatening motivator for children. To develop a Power Card, the
teacher or parent writes a short scenario in first person (from the child’s point of
view) on a single sheet or booklet form, describing how the hero or special interests
solves a problem.
In the first paragraph of this scenario, the hero attempts a solution to the problem
and experiences success. The second paragraph encourages the student to try the new
behavior, which is broken down in three to five steps. The Power Card is about the
size of a business card, bookmark, or trading card, includes a small picture or special
interest, and summarizes the problem-solving steps. This card is carried with the stu-
dent to aid in generalization. For an example of a Power Card see Figure 16.
To use the Power Card in a school setting, follow these steps: identify the problem
behavior and special interest, conduct a functional assessment, collect baseline data,
write and introduce scenario/Power Card, take data, evaluate, modify if needed, and
fade scenario/Power Card and let student help with the decision to continue use. The
same steps can be taken when used at home.
When used appropriately, Power Cards address sensory needs to help students realize
when sensory input is needed, not to help tolerate sensory needs. To use a Power
Card, a child must understand spoken language at a sentence or paragraph level, must
exhibit behaviors frequently, and must have a well-developed interest. The Power
Card is not a punishment, so the presenter should have a good relationship with the
student.
See also visual strategies.

Figure 16 Power Card Example: Barbie and Her Markers

Barbie and Her Markers

When Barbie finishes her school assignments, she loves to draw and color with markers. She
has learned that it is important to take care of her markers so that they will last a long time.
When she is getting ready to draw, Barbie puts the marker cap on the opposite end of the
marker so she won’t lose it. She is always careful to draw only on the paper so her desk and
body stay clean. When she is finished with a marker, she carefully puts the cap back on. Barbie
wants every girl and boy to take good care of their markers. She has learned that it is important to have
markers with caps so her favorite colors won’t dry up.
Barbie wants you to remember these three things:
Put the cap on the end of your markers before you draw.
Be careful to only draw on the paper.
Put the cap back on the marker when you are finished.
Try your best to remember these three things so you can draw just like Barbie!

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 PRESENT LEVEL OF EDUCATIONAL PERFORMANCE (PLEP)

REFERENCE
Gagnon, E. (2001). Power Cards: Using special interests to motivate children and youth with Asperger
syndrome and autism. Shawnee Mission, KS: Autism Asperger Publishing Company.

FURTHER INFORMATION
Gagnon, E., Keeling, K., Myles, B. S., & Simpson, R. L. (2003). Using the Power Card strategy
to teach sportsmanship skills to a child with autism. Focus on Autism and Other Developmental
Disabilities, 18(2), 105–107.
JEANNE HOLVERSTOTT

PRAGMATICS
Pragmatics involves the ability to use practical components of language to enhance
the communicative message. Components of pragmatics are similar to the rules of
nonverbal language, including the use of eye contact between communicative part-
ners, the distance between speaker and listener, and gestures to enhance meaning and
turn-taking and topic selection within a conversation. Pragmatics is often based on
one’s cultural experiences or background.
KATHERINE E. COOK

PRAXIS
Praxis is the ability to plan, organize, and carry out a physical, motor action.
See also sensory integration.
KELLY M. PRESTIA

PRECISION TEACHING
Precision teaching, an ‘‘instructional decision-making method’’ (Cooper, Heron, &
Heward, 1987) under the realm of applied behavior analysis principles, is founded in
several theories. First, those who use precision teaching believe that the best way to
assure learning has occurred is to measure a difference in the rate of learning
responses. Second, they believe that ‘‘learning most often occurs through proportional
changes in behavior’’ (Cooper et al., 1987). Finally, future learning has a positive cor-
relation with past performance gains or losses.

REFERENCE
Cooper, J. O., Heron, T. E., & Heward, W. L. (1987). Applied behavior analysis. Upper Saddle
River, NJ: Prentice Hall.

FURTHER INFORMATION
Athabasca University Online Precision Teaching Training Module, http://psych.athabascau.ca/
html/387/OpenModules/Lindsley.
The Standard Celeration Society: www.celeration.org.
TARA MIHOK

PRESENT LEVEL OF EDUCATIONAL PERFORMANCE (PLEP)

The present level of educational performance (PLEP), also referred to as the present
level, is an integral part of an Individualized Education Program (IEP) that shares
current information about the student’s functioning. The present level is the corner
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PRESENT LEVEL OF EDUCATIONAL PERFORMANCE (PLEP)

stone to which all areas of the IEP should connect by summarizing the basic informa-
tion related to a student’s needs in one place. All goals and short-term objectives writ-
ten later in the IEP process must relate directly to a need in the present level
(Nebraska Department of Education Special Populations Office, n.d.). The PLEP cov-
ers all areas of development such as academics, daily living skills, social issues, behav-
ior concerns, sensory needs, communication concerns, mobility issues, and vocational
training. It also includes strengths, weaknesses, and learning styles of the individual
(Rebhorn, 2002).
There are a variety of ways that an IEP team can gain information regarding the
PLEP of a student. These include evaluation information (in district and independ-
ently done), information shared by parents, regular education teacher reports, grades,
examples of student work, special education teacher observations, information from
therapists’ data collection, and, as appropriate, the information shared directly by the
student (Massanari, 2002). The more information available, the more useful the pres-
ent level will be to the IEP team. All information used must be current.
There are specific items that should be included in a present level. Information
regarding the impact of the child’s disability and how it pertains to progress within
the general education setting is an absolute necessity when it comes to planning an
appropriate IEP. This also pertains to how the preschool-aged child is involved in pre-
school activities and how their participation is affected by their disability (Rebhorn,
2002). When addressing how the child’s disability affects their participation in the
general education curriculum, it is necessary to understand the requirements of the
grade-level classroom. This would include what the student’s typical peers are required
to learn and in what ways they are required to do so. The concerns related to the
individual needs can be compared to the expectation of general education curriculum
(Massanari, 2002).
A student’s strengths should be directly addressed in the PLEP. These strengths can
include academic skills, social skills, communication skills, or any other area the child
shows as a strength (Rebhorn, 2002) or a relative strength. Strong abilities are impor-
tant because they give the team a baseline of what a child can do well (LD Online,
n.d.). These aptitudes are the foundations of instructional programming for individu-
als. By building on strengths through the creation of goals and objects based on abil-
ities, success can be gained.
Parental concerns should be placed directly within the present level (3rd Cycle
Special Education Special Education Self-Assessment [SEMSA] Training, 2004).
These concerns may relate to home, school, or long-term issues. Concerns may relate
to academics, social skills, or behavior issues that are individual to their child. If
appropriate, later items within the IEP may address these concerns through a goal,
objective, or behavior intervention plan if necessary.
The PLEP should contain information related to the most recent evaluations. This
would include initial testing as well as 3-year reevaluation information. Specific test
names and scores may be noted if appropriate. Information for an independent evalua-
tion may also be included (Rebhorn, 2002). However, it is not necessary to list every
test and score given. Often a statement of the child meeting the criteria for a specific
diagnosis is included.

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Changes in the student’s functioning since the last IEP should be included in the
present level of educational performance. This may include: met IEP goals and objec-
tives, a change in placement, a change in school or living arrangement, or a change
in health. Any change that affects the child and is relevant to education may be
included.
State and district-wide assessments should be addressed within the present level. This
includes what assessments will be taken and modifications that will be used if necessary.
A statement of exemption from certain tests may also be included. Scores received on
state and district testing should be summarized and explained clearly in relation to the
strengths and weaknesses of the student (3rd Cycle SEMSA Training, 2004).
If a student is of an age to receive transition services, the present level should also
contain information about employment and independent living issues and other final
outcomes. Specific considerations should include academic and occupational skills the
student will require, social and communication skills for success in a social setting,
and personal management skills for independent living (LD Online, n.d.).
Within the present level, there are items that should not be included. These
include statements of when, where, or how services will be provided. This information
cannot be determined until goals are set (LD Online, n.d.). These items will be
acknowledged after the IEP goals and objectives are written in a later part of the IEP.
The PLEP is an integral part of the IEP. It is the basis for goals and short-term
objectives, modifications, behavior intervention plans, related services, and finally
placement. It is imperative that the PLEP be measurable, include baseline data,
include strengths and concerns, and include both academic and nonacademic informa-
tion (WI Family Assistance Center for Education, Training, and Support, n.d.). The
present level should be written in such a way that it would explain the needs of an
individual child even to someone that did not know the child personally.

REFERENCES
LD Online. (1999). IEP: The process. Retrieved December 7, 2006, from www.ldonline.org/
article/6277.
Massanari, C. B. (2002). Connecting the IEP to the general curriculum: A talking paper. Des
Moines, IA: Mountain Plains Regional Resource Center.
Nebraska Department of Education Special Populations Office. (n.d.). Present level of educational
performance (PLEP). Retrieved June 6, 2005, from www.nde.state.ne.us/SPED/iepproj/develop/
pre.html.
Rebhorn, T. (2002). Developing your child’s IEP: A parent’s guide. Washington, DC: National In-
formation Center for Children and Youth with Disabilities.
Tennessee State Department of Education, Nashville. Division of Special Education. (2001).
Individualized Education Program (IEP). Nashville: Author.
3rd Cycle Special Education Special Education Self-Assessment (SEMSA) Training. (2004).
Special Education Compliance MoDESE. Retrieved June 8, 2005, from http://dese.mo.gov/
divspeced/Compliance/MSIP_Monitoring/3rdCycleSpecEd_FY06_files/slide0028.htm.
WI Family Assistance Center for Education, Training, and Support. (n.d.). The IEP process &
product. Retrieved June 9, 2005, from www.wifacets.org/learning/IEPProc&Prod.ppt.

FURTHER INFORMATION
Gibb, G. S., & Dyches, T. T. (2000). Guide to writing quality individualized education programs:
What’s best for students with disabilities? Needham Heights, MA: Allyn & Bacon.

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PRESYMBOLIC THOUGHT

Tillmann, J. D., & Ford, L. (2001). Analysis of transition services of individualized education pro-
grams for high school students with special needs. Eric Document Reproduction Service ED
456608.
Trainor, A. A., Patton, J. R., & Clark, G. M. (2006). Case studies in assessment for transition
planning. Austin, TX: Pro-Ed.
VALERIE JANKE REXIN

PRESYMBOLIC THOUGHT
Presymbolic thought is the developmental and emotional stage, generally present
between 8 and 24 months, that precedes symbolic thought. Presymbolic thought is
manifested through gestures, such as pointing; vocalizations, such as ‘‘ma-ma’’ and
‘‘wa-wa’’; reciprocity, the back and forth behavior communicated between an infant
and caregiver; and affect signaling, such as smiling, frowning, or crying. Presymbolic
thought is the formation of the sense of ‘‘self.’’ A toddler’s ability to see cause and
effect, discover patterns, and learn to discriminate are all part of presymbolic thought
processes.

FURTHER INFORMATION
Greenspan, S., & Shanker, S. (2004). The first idea, how symbols, language, and intelligence
evolved from our primate ancestors to modern humans. Cambridge, MA: Da Capo Press.
Quill, K. A. (2000). Do-watch-listen-say: Social and communication intervention for children with au-
tism. Baltimore: Brookes Publishing Co.
ANN PILEWSKIE

PREVALENCE
Prevalence is the rate of occurrence of a condition, disease, or characteristic
within a specified population group. To obtain prevalence, one takes all the persons
in a group, country, etc. and counts the number of persons with a specific condition
at that time. The prevalence for autism has been and continues to be controversial.
From the 1960s to the 1980s, the prevalence rate for autism was considered to be 4
or 5 per 10,000. In the 1990s, the rate rose to 10 per 10,000. Current prevalence
rates for autism spectrum disorders are between 1 in 500 (20/10,000) and 1 in 166
children (60/10,000; Centers for Disease Control and Prevention, 2006; Chakra-
barti & Fombonne, 2005; Fombonne, 2003; Department of Health and Human
Services, n.d.).

REFERENCES
Centers for Disease Control and Prevention. (2006, May 4). Fact sheet: CDC autism research.
Retrieved May 16, 2006, from http://www.cdc.gov/od/oc/media/ transcripts/AutismResearch
FactSheet.pdf.
Chakrabarti, S., & Fombonne, E. (2005). Pervasive developmental disorders in preschool chil-
dren: Confirmation of high prevalence. American Journal of Psychiatry, 162, 1133–1141.
Department of Health and Human Services, Centers for Disease Control and Prevention. (n.d.)
How common are Autism Spectrum Disorders (ASD)? Retrieved May 17, 2006, from http://
www.cdc.gov/ncbddd/autism/asd_common.htm.
Fombonne, E. (2003). The prevalence of autism. The Journal of the American Medical Association,
289, 87–89. Retrieved May 16, 2006, from www.jama.com.
PAUL G. LACAVA
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 PRIMING

PRIMING
Priming is a strategy that helps prepare children for an upcoming activity or
event with which they normally have difficulty. This intervention can be used
with children with exceptionalities who engage in avoidance behaviors when
materials or tasks are presented, require extensive exploration time before they can
participate with a material, need help with social interactions, or have trouble
transitioning in their environment (Wilde, Koegel, & Koegel, 1992). It can occur
at home or in the classroom and is most effective if it is built into the child’s rou-
tine. The actual priming session is short and concise and typically involves using
the actual materials that will be used in the lesson or activity. Priming can occur
the day before the activity, the morning of, or right before the activity (Zanolli,
Daggett, & Adams, 1996). It can be performed by anyone that works with the
child at home or at school. The purpose of priming is to introduce predictability
into the information or activity, thereby reducing frustration and anxiety. It is not
meant to teach the material, but only to familiarize the child with the material or
the event in a nonthreatening and exploratory manner, increasing the probability
of success.
The first step in priming is to determine who is going to prime and what activities
are going to be involved. It is important that everyone working with the child (home
and school) be involved in this process. This can be done at an Individualized Educa-
tion Program meeting or conference. A classroom teacher, resource room teacher, par-
aprofessional, parent, or even a peer may prime the student.
Once the teacher, support staff, and parents have decided who will prime, it is
important for open communication to exist between the teacher and family as to
upcoming situations that may require priming. The following items must be
addressed:

1. Who will prepare the priming materials?

2. Where and when can the primer access the priming materials?
3. How will the primer notify the teacher that the priming has occurred?
4. How will it be determined that priming is an effective strategy?
5. How will the problems be addressed?
6. How will documentation of priming session results be shared?

After communication and collaboration strategies have been implemented, the

actual priming session can take place. Develop a routine by choosing a specific time
and place to hold the priming sessions. Familiarize (not teach!) the student with the
new material. During the priming session, be patient and encouraging and always
reward the student for all attempts to participate in the session. Remember, this is
supposed to be a positive experience! Students have more motivation to complete
tasks if they feel they have some control over their environment. If possible, allow the
student to be involved in deciding where the priming session will be held and what
reinforcements will be used.

EXAMPLE OF PRIMING
Bryan is having difficulty paying attention during circle time in kindergarten. He
often disrupts other children particularly when the teacher is reading their daily story.
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PROBE

During a parent conference, Bryan’s teacher and mother decided to use priming tech-
niques at home to reduce his off-task behavior while in circle time.
Bryan’s teacher gave his mother the book they were going to read the next day in
circle time. Bryan’s mother read the book to Bryan as part of his bedtime routine that
evening. She asked him general questions along the way, but did not interrupt the
story. By doing this, Bryan became familiar with the pictures and the text in a com-
fortable setting.
Because Bryan had heard the story the night before and knew what to expect from
the story, he was able to focus on the book during circle time the following day. By
familiarizing him with the book, Bryan attended to the story without disrupting the
teacher or his peers.
This example can be used at all grade levels for upcoming events and academic
subjects.
Communication between the teacher and the priming implementer continues after
the priming session. After each session the priming implementer should notify the
teacher of the results of the priming activity. Documentation as to whether the pri-
ming session had an impact on the student’s behavior is necessary to determine if the
intervention is effective.
See also accommodation.

REFERENCES
Wilde, L. D., Koegel, L. K., & Koegel, R. L. (1992). Increasing success in school through priming:
A training manual. Santa Barbara: University of California.
Zanolli, K., Daggett, J., & Adams, R. (1996). Teaching preschool age autistic children to make
spontaneous initiations to peers using priming. Journal of Autism and Developmental Disorders,
26(4), 407–422.

FURTHER INFORMATION
Bainbridge, N., & Myles, B. S. (1999). The use of priming to introduce toilet training to a child
with autism. Focus on Autism and Other Developmental Disabilities, 14(2), 106–109.
Koegel, L. K., Koegel, R. L., Frea, W., & Hopkins, I. G. (2003). Priming as a method of coordi-
nating educational services for students with autism. Language, Speech, and Hearing Services in
Schools, 34(3), 28–35.
Moore, S. T. (2002). Asperger syndrome and the elementary school experience: Practical solutions for
academic and social difficulties. Shawnee Mission, KS: Autism Asperger Publishing Company.
Roy, D., & Mukherjee, N. (2005). Towards situated speech understanding: Visual context pri-
ming of language models. Computer Speech and Language, 19(2), 227–248.
Schreibman, L., Whalen, C., & Stahmer, A. (2000). The use of video priming to reduce disrup-
tive transition behavior in children with autism. Journal of Positive Behavior Interventions,
2(1), 3–11.
CYNTHIA K. VAN HORN AND KARLA DENNIS

PROBE
Probes are assessments of small samples of behavior or skills under natural condi-
tions, without teacher assistance or reinforcement. A probe evaluates how well a child
learned a target skill. Some educators probe a student’s performance on a skill prior to
each instructional sitting. The results are then used to guide instruction.
See also assessment; reinforcer; single-subject design.
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 PROMPT HIERARCHY

FURTHER INFORMATION
Salvia, J., & Ysseldyke, J. E. (2007). Assessment: In special and inclusive education (10th ed.). Bos-
ton: Houghton Mifflin Company.
Scheuermann, B., & Webber, J. (2002). Autism: Teaching does make a difference. Belmont, CA:
Wadsworth/Thomson Learning.
Westling, D. L., & Fox, L. (2004). Teaching students with severe disabilities (3rd ed.). Upper Sad-
dle River, NJ: Prentice Hall.
THERESA L. EARLES-VOLLRATH

PROCEDURAL SAFEGUARDS
Procedural safeguards are the protections that federal law, the Individuals with Dis-
abilities Education Improvement Act of 2004 (IDEA), affords to all students and their
caregivers as they navigate the educational system. Some of the procedural safeguards
include the right to inspect records, receive prior written notice before meetings, partici-
pate in meetings, register complaints, and obtain an outside independent evaluation.

REFERENCE
Individuals with Disabilities Education Improvement Act of 2004. Public Law No. 109-446,
§ 20 U.S.C. (2004).

FURTHER INFORMATION
Wright, P. W. D. (2004). The individuals with disabilities education improvement act of 2004: Over-
view, explanation, and comparison, IDEA 2004 v. IDEA 97. Retrieved May 26, 2006, from
http://www.wrightslaw.com.
PAUL G. LACAVA

PROMPT DEPENDENCE
Prompt dependence is an individual’s reliance on prompts rather than attempting
independence. This most often occurs when prompts have been overused (highly inva-
sive prompts being used when less invasive ones are appropriate) or not faded quickly
enough as the individual becomes capable of independent success. For example, when
learning writing, a student may hold a pencil but not attempt to write, instead waiting
for an adult to do the writing through prompts. Allowing a student to remain depen-
dent on prompts in several areas of functioning can also lead to learned helplessness.
Over time, the student may begin to believe he or she is not capable of completing a
task independently.
See also graduated guidance; guided compliance; prompt hierarchy; prompting.
KATIE BASSITY

PROMPT HIERARCHY
A prompt hierarchy is a series of supports provided to help a learner perform new
skills and behaviors. The prompts are arranged by the level of support they provide.
From least to most supportive, these prompts generally include natural environmental
stimuli, gesturing, verbal prompting, modeling, and physical assistance. A decreasing
prompt technique initially provides a prompt that ensures a correct response and sys-
tematically fades the prompt down the hierarchy until the learner achieves indepen-
dence. For example, in teaching a child to touch his head when instructed, the
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PROMPTING

teacher will first give the instruction, ‘‘Touch your head,’’ paired with moving the
child’s hand to touch his head. Then the teacher will repeat the instruction while
touching his elbow and moving the hand up to his head. Following this, the teacher
will repeat the instruction while modeling the correct response or pointing to the
child’s head. Finally, after some repetition and this prompt fading, the child should be
able to touch his head when given the verbal instruction.
In contrast, an increasing prompt technique allows the learner to first attempt the
behavior and increases the level of prompt as needed until the learner successfully per-
forms the behavior. In least-to-most prompting, the child is given the chance to
increase his or her spontaneous responses for skills already mastered. If the child does
not respond spontaneously, then the teacher would prompt from the least intrusive
prompt to the most intrusive prompt to reach a correct response from the child
(Anderson, Taras, & Cannon, 1996).
See also graduated guidance; guided compliance; prompt dependence; prompting.

REFERENCES
Anderson, S. R., Taras, M., & Cannon, B. O. (1996). Teaching new skills to young children
with autism. In C. Maurice, G. Green, & S. L. Luce (Eds.), Behavioral intervention for young
children with autism (pp.181–194). Austin, TX: Pro-Ed.
TARA MIHOK AND ANDREA HOPF

PROMPTING
Prompting is any physical, verbal, or gestural assistance given to an individual to
aid in the completion of or successful response to a given task. Prompts are generally
used in the initial teaching stages of a new task or behavior. Within each type of
prompting (physical, verbal, or gestural) there are several different levels of prompts.
For example, physical prompts range from highly intrusive (such as hand-over-hand
assistance) to least intrusive (such as placing a correct response closer to the student
or a light touch to the body part needed for a successful response). It is preferable to
use the least intrusive prompt necessary for the individual to succeed. For example,
the intrusive hand-over-hand prompt would only be used if the individual could not
succeed supported by a less invasive prompt. In addition, it is important to fade
prompts as quickly as possible to allow the student to complete as much of the task
independently as possible. It is important to use the form of prompting, which can
most easily be faded, while ensuring the student’s success. As always, it is also impor-
tant to maintain consistency, particularly across individuals working on the same
skills.
See also graduated guidance; guided compliance; no-no prompt procedure; prompt
dependence.
KATIE BASSITY

PRONOUN ERRORS
A common speech characteristic for individuals with autism is pronoun error or
pronoun reversal. This is when an individual substitutes various pronouns such as say-
ing ‘‘You’’ when ‘‘I’’ should be used. An early myth of autism was that pronoun diffi-
culties were the child’s misunderstanding of their own identity. Research has clearly
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 PROTO-DECLARATIVE

shown that this is not the case, as pronoun errors are common in typical child devel-
opment. However, most children develop more sophisticated language over time while
those with autism may not. Children with autism may exhibit pronoun errors due to
their echolalic use of language. That is, if they hear someone say, ‘‘Do you want ice
cream?’’ they may repeat back ‘‘you want ice cream.’’ Pronoun errors may also be due
to confusion over when to use the correct tenses.
See also echolalia: immediate, delayed, mitigated.

FURTHER INFORMATION
Frith, U. (1989). Autism: Explaining the enigma. Oxford, UK: Blackwell Publishers.
PAUL G. LACAVA

PROPRIOCEPTION
Muscle, joint, and tendon movements activate the receptors of the proprioceptive
system, making carrying multiple objects down a packed hallway possible by providing
information about the location and movement of a body part. For some individuals
with autism spectrum disorder, these movements are not automatic, resulting in poor
posture, incoordination, and chronic fatigue accompanying physical activity.
See also sensory integration; vestibular.
KELLY M. PRESTIA

PROSODY
Prosody is an overall term used to describe the rhythm, intonation, and stress during
speech production—that is, the importance of how something is said as opposed to
the content of the speech. Both are essential to understanding and communicating
language, emotion, intent, and so on. Some of the difficulties facing those with autism
spectrum disorders (ASD) include producing understandable tone of voice, pitch,
voice volume, pauses between syllables and words, speech rate, and so forth. Although
not a characteristic of all, many with ASD have prosodic challenges that may or may
not be changed over time. This communication challenge with both expressing and
understanding prosody may contribute to social and relationship difficulties.

FURTHER INFORMATION
Gerken, L., & McGregor, K. (1998). An overview of prosody and its role in normal and disor-
dered child language. American Journal of Speech-Language Pathology, 7, 38–48.
Prosody and Autism Spectrum Disorders. (n.d.). Retrieved July 21, 2006, from http://www.
qmuc.ac.uk/ssrc/prosodyinASD/.
Shriberg, L. D., Paul, R., McSweeny, J. L., Klin, A., Cohen, D. J., & Volkmar, F. R. (2001).
Speech and prosody characteristics of adolescents and adults with high-functioning autism
and Asperger syndrome. Journal of Speech, Language, and Hearing Research, 44, 1097–1115.
PAUL G. LACAVA

PROTO-DECLARATIVE
Proto-declarative pointing is when a baby or toddler uses their index finger/hand to
point to an object to indicate that they have an interest in something and that they
want another person to share in their attention. The key to this joint attention
behavior is that the baby/toddler is indicating communicative intent with another
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PROTO-IMPERATIVE

person. Proto-declarative pointing is a behavior that typically developing youngsters

begin to use around 14 months of age and is often delayed or absent in toddlers with
autism. The absence of three behaviors (proto-declarative pointing, gaze response, and
pretend-play) in toddlers at 18 months of age is often highly predictive of a future au-
tism diagnosis.
See also autistic disorder; theory of mind.

FURTHER INFORMATION
Baird, G., Charman, T., Baron-Cohen, S., Cox, A., Swettenham, J., Wheelwright, S., et al.
(2000). A screening instrument for autism at 18 months of age: A 6-year follow-up study.
Journal of the American Academy of Child and Adolescent Psychiatry, 39, 694–702.
Baron-Cohen, S. (1995). Mindblindness: An essay on autism and theory of mind. Cambridge, MA:
MIT Press.
Frith, U. (1989). Autism: Explaining the enigma. Oxford, UK: Blackwell Publishers.
Gerrans, P. (1998). The norms of cognitive development. Mind and Language, 13, 56–75.
PAUL G. LACAVA

PROTO-IMPERATIVE
Proto-imperative pointing is when an infant attempts to obtain something by using
their index finger/hand to point to an object while verbalizing and alternating looking
at their parent/caregiver. This behavior often begins around 1 year of age in typically
developing youngsters. The child points to an object that they want and then looks to
another person to indicate that they want it. The child is indicating what they want
by verbalizing, pointing, and alternating looking at the adult. This behavior is devel-
opmentally part of joint attention behaviors, and toddlers with autism typically use
this behavior but sometimes without eye contact or by pushing/taking the adult to the
object they want.

FURTHER INFORMATION
American Academy of Pediatrics, Committee on Children with Disabilities. (2001). Technical
report: The pediatrician’s role in the diagnosis and management of autistic spectrum disorder
in children [Electronic version]. Pediatrics, 107.
Baird, G., Charman, T., Baron-Cohen, S., Cox, A., Swettenham, J., Wheelwright, S., et al.
(2000). A screening instrument for autism at 18 months of age: A 6-year follow-up study.
Journal of the American Academy of Child and Adolescent Psychiatry, 39, 694–702.
Gerrans, P. (1998). The norms of cognitive development. Mind and Language, 13, 56–75.
PAUL G. LACAVA

PROTOTYPE FORMATION
Prototype formation involves the integration of information and the generalization
of previously learned concepts to new situations. To assess prototype formation, uti-
lize learning tasks that can be solved using a rule-based approach and a second set
of tasks in which rules did not govern category membership (prototype tasks). Indi-
viduals with autism spectrum disorders have difficulty categorizing new information
by forming prototypes and, instead, tend to rely on a rule-based approach to
learning.
JEANNE HOLVERSTOTT
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PSYCHIATRIST
A psychiatrist is a medical doctor who specializes in the diagnosis, treatment, and
prevention of mental and emotional disorders. Psychiatrists can diagnose individuals
with an autism spectrum disorder and can prescribe medication.
STEVE CHAMBERLAIN

PSYCHOACTIVE MEDICATIONS. See Antipsychotic Medications

PSYCHOBIOLOGY
Psychobiology refers to the scientific study of the biological bases of behavior and
mental states. Psychobiology and neuroscience both study the central nervous system,
using techniques such as functional magnetic resonance imaging (fMRI), making it
difficult to establish if the two are branches or one in the same study. As such, the
terms are often used interchangeably. Psychobiology has been criticized because of its
reductionist approach to the development of a disorder, which reduces human behav-
ior to genetics; this position is contrasted by researchers who adopt a functionalist
approach, which seeks to use psychological concepts to explain disorders of the mind.
See also genetic factors/heredity.
JEANNE HOLVERSTOTT

PSYCHOEDUCATIONAL PROFILE–THIRD EDITION (PEP-3)

The Psychoeducational Profile–Third Edition (PEP-3; Schopler, Lansing, Reichler, &
Marcus, 2005) is an evaluation that addresses the unique strengths and needs for those
with autism and other related disabilities. The PEP-3 can be used to diagnose, chart
developmental levels, and develop programming goals. The PEP-3 has a standardized,
norm-referenced section that is administered to children and an informal report that
is completed by the parent/caregiver. Some key features of the PEP-3 are its flexibility
in administration and ability to be used with students who have severe cognitive and
language impairments. The PEP-3 is appropriate for children ages 2 through 71=2 or for
those who are older but functioning at lower levels.
See also norm-referenced assessment; standardization.

REFERENCES
Schopler, E., Lansing, M. D., Reichler, R. J., & Marcus, L. M. (2005). PEP-3: Psychoeducational
Profile (3rd ed.): TEACCH Individualized Psychoeducational Assessment for Children with Autism
Spectrum Disorders. Austin, TX: Pro-Ed.
PAUL G. LACAVA

PSYCHOLOGIST
A psychologist is a scientist who studies psychology, the study of human behavior
and mental processes. Psychologists provide mental health care services, such as indi-
vidual and family counseling, and contribute to the research base on human behavior/
mental processing. Psychologists can diagnose autism and are major contributors to
the autism research base.
STEVE CHAMBERLAIN
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PSYCHOMETRICS

PSYCHOMETRICS
Psychometrics is the field of study concerned with the design, administration, and
interpretation of tests that measure the psychological characteristics (i.e., knowledge,
skills, abilities, and personality traits) of an individual.
THERESA L. EARLES-VOLLRATH

PSYCHOPHARMACOLOGY
Psychopharmacology broadly refers to the branch of science that studies the effect
of drugs on brain chemistry and human behavior. It is also a term used to describe
treatment with medications for those with emotional, psychiatric, or mental disorders.
Psychopharmacology has been used for over 50 years to treat those with autism spec-
trum disorders (ASD). However, prescriptions for those with ASD have increased over
the last decades. It has been estimated that 50 percent of those with an ASD are tak-
ing at least one prescription medication to help with the various symptoms. To date,
little research has concluded the effectiveness of many psychotropic medications for
use with children.

FURTHER INFORMATION
Aman, M. G., Lam, K. S., & Collier-Crespin, A. (2003). Prevalence and patterns of use of psy-
choactive medicines among individuals with autism in the Autism Society of Ohio. Journal of
Autism and Developmental Disorders, 33, 527–534.
Tsai, L. (2000). Children with autism spectrum disorder: Medicine today and in the new mil-
lennium. Focus on Autism and Other Developmental Disabilities, 15, 138–145.
Tsai, L. (2002). Taking the mystery out of medications in autism/Asperger syndromes: A guide for
parents and non-medical professionals. Arlington, TX: Future Horizons.
PAUL G. LACAVA

PSYCHOSOCIAL
Psychosocial refers to psychological development pertaining to relationships with
others and the adjustments necessary to navigate social situations. Psychosocial treat-
ments involve a licensed psychiatrist, psychologist, social worker, or counselor, with
the therapist and psychiatrist sometimes working together as the psychiatrist prescribes
medications and the therapist monitors the individual’s progress.
JEANNE HOLVERSTOTT

PUNISHMENT
Punishment is an aversive stimulus contingent on a behavior that decreases the
likelihood that the behavior will occur in the future (Azrin & Holz, 1966). Positive
punishment consists of applying an aversive stimulus. Examples of positive punishment
include giving a child detention for talking in class or spanking a child for violent
behavior. Negative punishment consists of removing a positive reinforcer. Examples
of negative punishment include grounding a teenager for breaking curfew or taking
away a video game system for poor grades. Response cost is a form of negative punish-
ment (Alberto & Troutman, 1999). Contrary to popular use of the term, punishment
does not have to be aversive to the person to whom it is being applied. The

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consequence is punishing simply because the frequency of the behavior will be less-
ened in the future (Cooper, Heron, & Heward, 1996).
See also applied behavior analysis.

REFERENCES
Alberto, P. A., & Troutman, A. C. (1999). Applied behavior analysis for teachers. Upper Saddle
River, NJ: Merrill.
Azrin, N. H., & Holz, W. C. (1966). Punishment. In W. K. Honig (Ed.), Operant behavior:
Areas of research and application (pp. 380–447). New York: Appleton-Century-Crofts.
Cooper, J. O., Heron, T. E., & Heward, W. L. (1987). Applied behavior analysis. Upper Saddle
River, NJ: Prentice Hall.
TARA MIHOK AND JESSICA KATE PETERS

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RDI PROGRAM
The RDI Program educates and guides parents and teachers of children with autism
spectrum disorders (ASD) and others who interact and work with the child. It is a
‘‘mission oriented’’ program. This means that it is not wedded to any specific tech-
niques. The mission of the RDI Program is to develop the most effective methods,
whatever they might be, to remediate those specific deficits that impede people on the
autism spectrum from productive employment, independent living, marriage, and inti-
mate social relationships. Current treatment and intervention services do not address
the abilities that ASD people need to attain a good quality of life. RDI strives to de-
velop ‘‘real-world’’ dynamic abilities that will translate into future success.
Remediation is a gradual, systematic process of correcting a deficit, to the point
where it no longer constitutes an obstacle to reaching one’s potential. Remediation is
a developmental process. It involves addressing early areas that, due to the neurologi-
cal disorder, were never mastered. We search for the period in development where the
child ‘‘hit a wall’’ and was not able to progress further. We go back and build compe-
tence from that point.
Ongoing program evolution is critical if we are to help increasing numbers of indi-
viduals on the autism spectrum to attain a quality of life. The latest findings from de-
velopmental psychology and autism research are carefully ‘‘engineered’’ to provide
clinical methods that improve effectiveness. Continual program evaluation critically
determines which program components are effective and highlights areas of necessary
modification.
RDI empowers families and those who are primarily involved in caring for and edu-
cating the child. The bulk of resources are invested in preparing parents and teachers
to act as participant guides, creating daily opportunities for the child to respond in
more flexible, thoughtful ways to novel, challenging, and increasingly unpredictable
settings and problems. Both fathers and mothers are essential participants in the treat-
ment process.
Preliminary research indicates that the RDI Program is a powerful, effective means
for increasing children’s capacity and motivation for experience sharing, as well as
their flexibility and adaptation. Parents engaged in RDI overwhelmingly report signifi-
cant improvement in the quality of life of the ASD child, their own quality of life, as
RDI PROGRAM

well as the lives of their nonaffected children (Gutstein, 2005; Gutstein, in press; Gut-
stein, Burgess, & Montfort, in press; Gutstein, Gutstein, & Baird, 2006). While family
is central to the RDI model, treatment success also depends upon the commitment of
school staff and other professionals to implement essential principles of remediation.
Real-world competence emerges from children participating as active, but junior
partners—‘‘apprentices,’’ who are carefully guided by parents and other adults. Guides
have access to a comprehensive system of over 1,200 developmentally staged objec-
tives, which they use to carefully provide increasingly complex problems and chal-
lenges. Guides help the child capture and stockpile critical memories that build an
experiential repository of success in gradually more complex environments. Parents are
taught to rethink their daily lifestyle, structuring activities throughout the day to pro-
vide safe, but challenging opportunities for discovery.

WHAT IS THE RDI PROGRAM?

¥ Systematic, long-term remediation of specific deficits that define autism spectrum disorders
and limit the quality of life of people on the autism spectrum
¥ Preparing parents and teachers to act as participant guides. Restoring the critical early
guided-participation relationship damaged by ASD
¥ Creating numerous daily opportunities for the child to respond in more flexible, thoughtful
ways
¥ Helping children capture and stockpile critical memories that build a repository of compe-
tence, in gradually more complex environments

Education and coaching is implemented through the following methods:

¥ Small-group, intensive parent education

¥ Customized, balanced remediation planning, emphasizing a biopsychosocial model
¥ Careful selection and evaluation of developmentally based objectives. Each objective has
clear criteria for cognitive mastery
¥ Individualized consultation sessions with parents
¥ Regular video-taped review of samples of parent-child performance in the home
¥ School staff training and consultation

SELECTING THE FOCUS OF REMEDIATION

Over 200 research studies have, over the past 15 years, attempted to determine
what deficit areas are unique and universal to individuals on the autism spectrum. In
performing a comprehensive analysis of these studies we came to some important
conclusions:

1. Autism spectrum disorders cannot be defined by ‘‘discrete’’ skills, such as speech, social
skills, academic skills, or behavioral compliance (Hobson, 2002; Klin, Jones, Schultz, &
Volkmar, 2003; Mayes & Calhoun, 2001; McGovern & Sigman, 2005). Rather, they
appear to be related to ‘‘continuous process’’ abilities (Fogel, 1993).
2. Standard forms of measuring intelligence do not predict the severity of the autism itself
(Howlin, 2003; Howlin & Goode, 2000).
3. Research results overwhelmingly support the idea that ASDs involve a wide range of neu-
rological vulnerabilities that lead to more homogeneous deficits in certain types of com-
plex information processing, which then lead to difficulties in all aspects of life (Belmonte
et al., 2004; Just, Cherkassky, Keller, & Minshew, 2004; Minshew, Johnson, & Luna,
2001; Minshew, Williams, & Goldstein, 2004; Minshew, Goldstein, & Siegel, 1997).

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The deficits universally found in ASD appear to belong to what is termed Dynamic
Intelligence (Day & Cordon, 1993; Grigorenko & Sternberg, 1998; Sternberg, Forsythe,
Hedlund, & Horvath, 2000). The ability to maintain employment, friendship, mar-
riage, and most aspects of daily life are dependent on dynamic abilities. The dynamic
elements of settings provide us with opportunities for growth, discovery, integration,
and collaboration. We go to hear someone lecture not because we want them to
repeat what they have written in a book, but to hear something new. When we have
a conversation, we certainly do not ask to, once again talk about what we spoke about
last week. We choose friends and mates who will encourage us to develop and grow.
We spend much of our lives choosing to enter situations of greater dynamic potential.
You are probably more familiar with static intelligence, such as the abilities measured
in IQ tests. Think of static intelligence as measuring what you know, while dynamic
intelligence measures what you can do with what you know in the real world. The fol-
lowing chart outlines some critical distinctions between dynamic and static forms of
intelligence:

Dynamic
Continuous processing
Regulating and adapting
Flexible problem-solving
Dynamic analysis
Episodic memory
Experience sharing
Self-evaluation and self-regulation
Simultaneous
Flexible and contextual content use
Static
Discrete processing
Performing
Absolute problem-solving
Static analysis
Rote-procedural memory
Instrumental communication
Behavioral compliance
Sequential
Content accumulation

Almost all human communication and interaction occurs in dynamic encounters.

The term dynamic implies the continual introduction of new information as well as
the ongoing transformation of current information based upon changed contexts and
relationships (Gaussen, 2001; Granic & Hollenstein, 2003; Lewis, 2000).
The dynamic elements of settings provide us with opportunities for growth, discov-
ery, integration, and collaboration. Dynamic encounters provide an enormous payoff,
but require a good deal of effort and different types of abilities than static environ-
ments. Because dynamic environments require continual evaluation and adaptation,
they are referred to as regulatory. In more static settings, success accrues from accumu-
lating enough right answers and correct solutions and applying them in association with
specific setting cues. In other words, if I pick the right response, formula, or solution
and apply it in the way I was taught, I will be successful. In contrast, the application
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of any single response or formula is a guarantee of failure in dynamic settings. Instead

of absolute thinking, they require relative or regulatory functioning.
Regulation involves making continual adjustments to maintain optimal states of
functioning in dynamic, constantly evolving systems. Regulation requires ongoing mon-
itoring of the system and detection of important changes. It also requires the ability to
rapidly distinguish important (central) from unimportant (peripheral) changes in the
system and to rapidly adapt actions to maintain functioning given system changes.
By the end of their second year, typical infants have gone a long way towards learn-
ing to manage the difficulties inherent in dynamic systems. The 12-month-old actually
prefers dynamic encounters because he feels competent in managing the tension in-
herent in such challenges and has already learned that the ‘‘edge’’ of his competence
is the most rewarding place to be (Sroufe, 1996). Children with ASDs leave the path-
way of dynamic learning somewhere in the first two years of life and are thus deprived
of further opportunities for dynamic learning.
Domains of Dynamic Intelligence
In order to develop a systematic progression of objectives, from rudimentary to
highly sophisticated cognitive abilities, we have separated the elements of dynamic
intelligence into five ‘‘processes.’’
Creative-Flexible Thinking
Creative thinking involves altering problem solutions and ways of perceiving a
problem, based on ongoing monitoring of current effectiveness. Flexible problem-solving
involves finding ‘‘work arounds’’ when running into unexpected problems, or lacking
the typical resources to solve problems. This is a critical problem for people with ASD
(Berger, Aerts, van Spaendonck, & Cools, 2003; Channon, Charman, Heap, Crawford,
& Rios, 2001; Craig & Baron-Cohen, 1999; Emerich, Creaghead, Grether, Murray, &
Grasha, 2003; Jarrold, 2003).

¥ Think of how often in a typical way problems arise that require flexibility?
¥ Consider how rare it is for you to feel completely certain about your decisions?
¥ Are the proper tools and resources always available when you need them? How do you
manage?

Dynamic Analysis
Environments present many potential ways we can organize, relate, and prioritize in-
formation. Dynamic analysis is the act of evaluating the adaptational significance of
our environment on a moment-to-moment basis. It entails actively searching for oppor-
tunities for growth and goal attainment. We integrate the realities of environmental
demands, constraints and resources, with personal interests. Dynamic analysis is only
possible when we learn that there are multiple ways we can organize meaning from any
particular event or setting. Research has confirmed problems in dynamic analysis as a
core aspect of ASDs (Burack, 1994; Dawson et al., 2004; Goldstein, Johnson, & Min-
shew, 2001; Hoeksma, Kemner, Verbaten, & Van Engeland, 2004; Hughes & Russell,
1993; Landry & Bryson, 2004; Lopez & Leekam, 2003; Mann & Walker, 2003).
¥ How many times in a day do you employ ‘‘good enough’’ thinking?
¥ How do you know when a change is central or peripheral?
¥ How well would you function if you did not analyze contextual information?

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Episodic Memory
Episodic memory involves more than just remembering details of a past episode. It
entails extracting something that is personally important, different, changed, or that
stands out and has personal meaning to us. Without episodic memories, you do not
have access to your personal past in a manner that allows you to project into the
future. You do not develop the ability to anticipate and think in a hypothetical sense
about what might happen in your future. You do not learn to dream, create goals,
plans, and really tie the past in with the future. Over 20 research studies confirm that
episodic memory deficits appear to be universal in ASD (Bowler, Gardiner, & Grice,
2000; Bowler, Gardiner, & Berthollier, 2004; Millward, Powell, Mewwer, & Jordan,
2000; Shalom, 2003).

¥ What would your life would be like if you could not mentally prepare yourself for potential
future events?
¥ How would you motivate yourself to reach goals if you could not ‘‘preview’’ the feeling of
success prior to reaching it?
¥ How successful would you be if you were unable to learn from your own mistakes?

Experience Sharing
Human communication differs from all other species in that it offers the opportu-
nity to share our subjective experiences of the world. The essence of all human com-
munication entails sharing and integrating experiences, combining something from
you with something from me with the hope that something unique and unexpected
emerges. As we become proficient communicators we learn that we can fluidly share
our internal and external experiences as well as linking our past, present, and future.
Experience sharing requires ongoing ‘‘continuous process’’ monitoring and evaluation
of mutual comprehension and interest. Researchers have noted a lack of experience-
sharing communication in individuals on the spectrum, regardless of their cognitive or
language abilities. In fact, the single best predictor of future language for young chil-
dren on the autism spectrum is the degree to which they develop the earliest manifes-
tations of experience sharing (Baron-Cohen, Baldwin, & Crowson, 1997; Berger,
2006; Bono, Daley, & Sigman, 2004; Camaioni, Perucchini, Muratori, Parrini, &
Cesari, 2003; Downs & Smith, 2004; Geller, 1998; Gutstein, 2000; Gutstein & Whit-
ney, 2002; Hobson, 1989; Hobson & Lee, 1998; Keen, 2003).

¥ What is the role of language in communication? Can you communicate without words?
What happens to adults who have a stroke and lose their language? Are ‘‘non-verbal’’
ASD children really only ‘‘non-verbal’’ or are they also ‘‘non-communicative’’?
¥ Imagine a conversation that did not include the desire to create bridges between minds.
What is there to talk about?

Self Awareness
Self awareness involves developing a coherent sense of self; a ‘‘me’’ that we perceive
as unique and coherent, even as it continues to grow and develop. The self becomes
the primary organizing principle for appraisal and evaluation. The lack of a self in au-
tism proves devastating in terms of the problem-solving capability of individuals; as
they are unable to develop memories of themselves as problem-solving agents, they
are therefore unable to build up stores of remembered skills in such a way that they
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can reflect on them strategically. We develop our sense of self through contrast
and comparison with others. ASD individuals appear to have striking deficits in self-
development (Dawson & McKissick, 1984; Gomez & Baird, 2005; Hill & Russell,
2002; Klein, Chan, & Loftus, 1999; Lee, Hobson, & Chiat, 1994; Nair, 2004; Powell &
Jordan, 1993; Russell & Hill, 2001; Toichi, Kamio, Okada, Sakihama, Youngstrom,
et al., 2002).

THE INTERSUBJECTIVE RELATIONSHIP

The Intersubjective Relationship (IR) is perceived by developmental psychologists
as the essential lab for learning to function in dynamic systems—environments in
which new information is continually introduced and where success requires ongoing
monitoring of the meaning of information in a contextual manner (Tomasello, 1999;
Trevarthen & Aitken, 2001). For information, ideas, and mental skills to move from
the social-interactive plane to the internal-thinking plane, the adult and child must
strive for a common approach to the situation. In the IR each participant in the dia-
logue strives to grasp the subjective perspective of the other, an effort that results in a
‘‘meeting of minds’’ in which the partner’s thoughts make contact, connect, and coin-
cide. In a sense, through participating in the IR, children are able to temporarily
‘‘appropriate’’ their parents’ mental processes—their ways of analyzing, evaluating, and
reacting to the changes in their world.
ASD children’s early failure to develop intersubjectivity is the most documented
deficit in the autism research (Bacon, Fein, Morris, Waterhouse, & Allen, 1998; Char-
man et al., 1997; Dawson, Hill, Spencer, Galpert, & Watson, 1990; Gipps, 2004;
Mundy, 1995; Mundy, Kasari, & Sigman, 1992; Mundy & Sigman, 1989; Robertson,
Tanguay, L’Ecuyer, Sims, & Waltrip, 1999; Trevarthen, Aitken, Papoudi, & Robarts,
1996). It has also been found by researchers to be the deficit that is most persistent
and resistant to change over time (Sigman, 1998; Sigman & McGovern, 2005). A pri-
mary focus for RDI consultants is helping parents and their children restore the criti-
cal IR that is inherently damaged by ASD. Our hope is that through reengaging the
IR, the child, through parental guidance, can begin to develop on the pathway of
dynamic learning opportunities and can internalize the complex mental processes that
are essential to attaining a quality of life.

PARENTS LEARN TO BE COMPETENT GUIDES

Guided participation, a term associated with psychologist Barbara Rogoff, describes
the way that adults teach children to become competent in real-world thinking and
problem solving (Rogoff, 1990, 1991, 1993). When we study societies and cultures all
over the world, it is very clear that the way in which children learn to function in
dynamic systems is not through direct instruction. You have never taken a course in
any of the areas of dynamic intelligence. Rather we learn through acting as an inex-
perienced apprentice with an adult guide who gradually introduces us to more and
more complexity in the world. Our guides also gradually require us to become more of
a partner in maintaining the regularity of the system.
The underlying ‘‘engine’’ of guided participation is intersubjectivity: a sharing of
focus and purpose between children and their more skilled partners (Harding, Weiss-
mann, Kromelow, & Stilson, 1997; Hodapp, Goldfield, & Boyatzis, 1984; Kaye, 1982;
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Tronick & Gianino, 1986). By participating in thousands of carefully constructed

encounters involving shared understanding and problem solving, children appropriate
an increasingly advanced understanding of and skill in managing the intellectual prob-
lems of their community. The aim of The RDI Program is to restore the guided partic-
ipation relationship that is universally lost due to the ASD child’s neurological
vulnerabilities.
Support and challenge have to be in balance for parent-child interactions to be
optimal for the child’s development. Parents are taught to combine support with set-
ting of challenging action goals to assist the child to achieve beyond his or her cur-
rent level of mastery. Parents learn to focus their support on those aspects of tasks
that are just beyond the level of mastery currently attained by their children (one-
step-ahead strategy). Such a strategy is optimal for maintaining a functional balance
between challenging a child’s developmental potential and balancing for its
weaknesses.
As children gain in mastery, parents learn to transfer greater responsibility for
problem-solving and regulatory monitoring to the child. The parent objective is not just
to maximize the number of their child’s successes by balancing for their weaknesses, but,
additionally, to sustain a level of challenge that they deem to be most promoting their
children’s development of competence.
In summary, adults learn to encourage and advise their child to attain the level of
performance just beyond their current mastery and avoid providing superfluous assis-
tance or clues so as not to be overfacilitative to the child’s performance. They con-
front the child with additional cognitive demands for attaining a new level of
performance when lesser challenges have been mastered, and they gradually transfer
the responsibility for problem-solving, regulating, evaluating, and managing progres-
sively more complex real-world problems and settings.

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STEVE GUTSTEIN

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REACTIVE ATTACHMENT DISORDER OF

INFANCY OR EARLY CHILDHOOD
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; APA,
2000) defines two types of reactive attachment disorder: disinhibited type and inhib-
ited type. In the former (disinhibited), the child lacks selectivity in the people from
whom comfort is sought, shows clinging behavior in infancy, or indiscriminately
friendly behavior in early or middle childhood coupled with attention seeking and
poorly modulated social interactions. In the latter (inhibited), the child may respond
to caregivers with a mixture of approach, avoidance, and resistance to comfort. They
lack emotional responsiveness and may act aggressively in response to distress—either
their own or another person’s.
It is clear from these descriptions that there could be some difficulty in distin-
guishing reactive attachment disorders from autism spectrum disorders as the
behaviors described may be evident in both. Research has indicated that the only
way to clearly distinguish between the two in terms of the social difficulties is that
reactive attachment disorders tend to respond more positively to interventions and
therapy leading to the child no longer showing the behaviors (e.g., when placed
in stable and positive foster care the child becomes more reciprocal and shows
rapid emergence of social responsiveness), or that there has been a clear history of
neglect or abuse in early childhood in those who develop reactive attachment
disorder.
According to the DSM-IV-TR (APA, 2000), the following criteria are relevant for
diagnosis of reactive attachment disorder: (a) severity—there is no attachment in any
meaningful sense and no enduring relationship with caregivers; (b) pervasiveness—
attachment difficulties must be seen across several different contexts and with several
different caregivers; (c) distress or disability—the disorder causes the child persistent
social disability or persistent distress; (d) onset before age five years; (e) not
autistic—the lack of other autism impairments such as repetitive or ritualistic behav-
iors or communication difficulties indicates that the child does not have an autism
spectrum disorder that could explain the impaired social relationships; (f) mental age
greater than 10–12 months; and (g) pathogenic care—an early abnormal care giving
environment either due to several changes of primary caregiver or due to neglect of
the child’s emotional or physical needs.
Reactive attachment disorders are rare, and are differentiated from insecure attach-
ments. Around 40 percent of children may be classified as insecurely attached
(Goodman & Scott, 2005, p. 123), but in insecure attachment this can relate to only
one caregiver with the child being appropriately and securely attached to other care-
givers. The condition is therefore not pervasive. Insecure attachment also does not
necessarily lead to difficulties with social responsiveness and relatedness, whereas this
is a core characteristic of reactive attachment disorder.

REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
Goodman, R., & Scott, S. (2005). Child psychiatry (2nd ed.). Oxford: Blackwell Publishing.

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FURTHER INFORMATION
O’Connor, T. G. (2002). Attachment disorder of infancy and childhood. In M. Rutter & E.
Taylor (Eds.), Child and adolescent psychiatry (4th ed., pp. 776–792). Oxford: Blackwell
Science.
Zeanah, C. H. (1996). Beyond insecurity: A reconceptualisation of attachment disorders of
infancy. Journal of Consulting and Clinical Psychology, 64, 42–52.
FIONA J. SCOTT

RECEPTIVE LANGUAGE
Receptive language is the ability to understand and process spoken and written lan-
guage (listening and reading). Processing auditory information is difficult for some
individuals with autism. It is important to remember that frequently information,
directions, rules, corrections, and procedures are presented verbally. Consider incorpo-
rating pictures, icons, gestures and sign language.
See also American Sign Language; visual strategies.
RASCHELLE THEOHARRIS

RECIPROCAL COMMUNICATION/INTERACTION
Reciprocal communication refers to a specific component of interaction involving
appropriate communication based on the understanding of the conversational partner’s
message. Reciprocal communication tends to extend conversations as an individual’s
comment (i.e., ‘‘I am tired’’) is met by comments and questions (i.e., ‘‘Did you not get
enough sleep last night?’’). Challenges with reciprocity, often referred to as ‘‘give and
take,’’ are hallmarks of autism spectrum disorders (ASD). Comments that would serve
as a starting point for reciprocal communication may fail to receive a response from
individuals with ASD; consequently, communication with or between individuals with
ASD can seem disjointed or one-sided. Individuals with ASD are often explicitly
taught to engage in reciprocal communication.
See also American Sign Language; augmentative and alternative communication;
Picture Exchange Communication System; social skills; visual strategies.
JEANNE HOLVERSTOTT

RED FLAGS
A red flag is an alert or warning intended to draw attention to a problem or poten-
tial problem. Certain behaviors can be red flags that alert parents and professionals to
a child’s potential needs and/or delays. There are numerous red flags that differentiate
those with autism spectrum disorder (ASD) from children with other developmental
disabilities and from typically developing youngsters. These red flags include: (a) lack
of appropriate eye gaze; (b) coordination of eye gaze; (c) facial expression, gestures,
and sounds; (d) lack of warm expression to others with gaze; (e) unusual vocal pros-
ody; (f) repetitive movements of the body, hands, etc.; (g) not responding to name;
and (h) absence of showing interest, sharing interest, or enjoyment (Wetherby &
Woods, 2002). The Centers for Disease Control and Prevention started a new cam-
paign in 2005 that highlighted the need for parents of infants and toddlers to know
the warning signs of autism.
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REFERENCES
Centers for Disease Control and Prevention. (2005). Learn the signs: Act early [Brochure].
National Center on Birth Defects and Developmental Disabilities. Atlanta, GA:
Author.
Wetherby, A. M., & Woods, J. (2002). Systematic observation of red flags for autism spectrum dis-
orders in young children (SORF). Unpublished manual. Florida State University, Tallahassee,
FL.

FURTHER INFORMATION
Osterling, J. A., Dawson, G., & Munson, J. A. (2002). Early recognition of 1-year-old infants
with autism spectrum disorder versus mental retardation. Development and Psychopathology, 14,
239–251.
Wetherby, A. M., Woods, J., Allen, L., Cleary, J., Dickinson, H., & Lord, C. (2004). Early indi-
cators of autism spectrum disorders in the second year of life. Journal of Autism and Develop-
mental Disorders, 34, 473–493.
PAUL G. LACAVA

REHABILITATION ACT OF 1973

The Rehabilitation Act of 1973 guarantees certain rights to individuals with disabil-
ities. Most notably, Section 504 is internationally recognized as the foundational civil-
rights legislation for persons with disabilities, paving the way for further legislation for
individuals with disabilities.
See also Section 504 of the Rehabilitation Act of 1973.

REFERENCE
Pub. Law No. 93-112, 87 Stat. 394 (September 26, 1973), codified at 29 U.S.C. § 701 et seq.
TERRI COOPER SWANSON

REINFORCER
Reinforcement is a procedure that increases the likelihood of a behavior occurring
again. A reinforcer is what is used to bring about that increase in behavior. Rein-
forcers can also be divided into primary and secondary types. Primary reinforcers are
those things that are biologically necessary: food, water, and sex. All other reinforcers
are secondary; however, there is some debate as to whether sensory reinforcers serve
as primary or secondary reinforcers. Secondary reinforcers may be a tangible item, such
as specific foods, toys, and movies, or social interaction.
See also sensory integration; sensory processing.
KATIE BASSITY

RESIDENTIAL FACILITY
Students receive special education and related services in a facility where the stu-
dents receive care and services 24 hours a day. Residential facilities can be public or
privately owned. Students with visual impairments and hearing impairments represent
the largest percentage of students receiving educational services in residential
facilities.
KATHERINE E. COOK
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RESIDENTIAL SUPPORTS
As children grow into adults, families are faced with the complexities of how to
best meet their child’s needs and provide support for an appropriate living arrange-
ment. Given the complexity and heterogeneity of autism spectrum disorders (ASD),
no single residential treatment approach is appropriate for everyone. Individuals with
autism need to be assessed on their strengths and needs when planning for continuity
of services. The initiative for most residential supports currently available came from
parents and teachers concerned about the future of their children and students as they
transitioned into adulthood.
During the 1970s and 1980s, a number of autism-specific, community-based, resi-
dential programs were developed across the United States. In an effort to promote
maximum integration into the community, most programs consisted of group homes
in urban or suburban settings, with up to six clients in each (LaVigna, 1983; Wall,
1990). Some residential programs preferred smaller ratios of four per home, or garden
apartments and town homes with two or three residents (CSAAC, 1995).
Community-based programs often focus on sharing common goals of residents (Sloan
& Schopler, 1977), optimizing development though independence and competence in
various areas (Lettick, 1983), and facilitating individual independence (LaVigna,
1983).
During the last two decades, larger residential group settings have proven beneficial
as well. Larger facilities are able to provide increased opportunities for social interac-
tions and allow for an increase of staff members to provide a variety of background
skills including more flexible supervision of residents. Larger settings also provide nat-
ural subgroups for social and work participation around common interests and skills
(Kay, 1990).
Many community-based models include self-contained programs offering vocational
and residential components, where residents interact with nondisabled neighbors in
the community. Some sites offer educational and behavioral programming with a
range of school, work, and agricultural environments, as well as individualized life
skills instruction. The general model of these programs focuses on residents and staff
working together to contribute to all aspects of the community. On-site activities
emphasize visual, fine-motor and gross-motor skills in order to maximize each individ-
ual’s possibilities for success.
When considering residential support programs, it is important for the family and
the individual with ASD to consider the following. First, what are the facility’s mis-
sion and goals and do they match or meet your family’s needs? Every facility is going
to have their own unique philosophy and it is important that it matches your family’s.
Second, visit the residential site to determine if the program is the right fit. Taking a
tour of the facility will help to learn what features the facility has to offer, will allow
formal and informal conversations with staff, which will provide first-hand information
as to how individuals are treated and cared for. Third, does the facility offer the type
or level of support that is appropriate for your child? For individuals with ASD, hav-
ing the appropriate environment, staff training, and understanding of the characteris-
tics of each individual is extremely important. Finally, ask to talk with other families
whose children live or work at the facility. This is a great way to find out about the
quality of the facility and services that they provide.
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REFERENCES
Community Services for Autistic Adults and Children (CSAAC). (1995). Adult residential pro-
gram, adult vocational program [Brochure]. Rockville, MD: Author.
Kay, B. R. (1990). Bittersweet Farms. Journal of Autism and Developmental Disorders, 20, 309–
322.
LaVigna, G. W. (1983). The Jay Nolen Center: A community-based program. In E. Schopler &
G. B. Mesibov (Eds.), Autism in adolescents and adults (pp. 381–410). New York: Plenum
Press.
Lettick, A. L. (1983). Benhaven. In E. Schopler & G. B. Mesibov (Eds.), Autism in adolescents
and adults (pp. 355–379). New York: Plenum Press.
Sloan, J. L., & Schopler, E. (1977). Some thoughts about developing programs for autistic ado-
lescents. Journal of Pediatric Psychology, 2, 187–190.
Wall, A. J. (1990). Group homes in North Carolina for children and adults with autism. Journal
of Autism and Other Developmental Disorders, 20, 353–366.
STACEY L. BROOKENS

RESOURCE ROOM
During a student’s Individualized Education Program (IEP) meeting, the team
determines the most appropriate placement for the student in the least restrictive
environment (LRE). The resource room is one possible environment in which the stu-
dent could spend part of the school day. The resource room can offer students extra
instruction or support in deficit areas (such as homework help, organization, and test
or homework modification). The amount of time a student spends in the resource
room is determined by the IEP team according to the student’s individual needs.
RASCHELLE THEOARRIS

RESPITE CARE
The autism spectrum includes children and adults with a variable range of complex
issues. What is common to all families whose children have an autism spectrum disor-
der (ASD) is a comprehensive need for a myriad of services and supports. Near the
top of the list for many families is the need for a break from the constant demands of
parenting. This is often referred to as a need for respite.

DEFINITION OF RESPITE
The concept of respite first appeared in the late 1960s based on the belief that a
child with special needs would be served best at home. Most often, respite is thought
of as temporary, short-term care for an individual with special needs. According to
United Cerebral Palsy (n.d.), ‘‘Respite . . . is a service in which temporary care is pro-
vided to children or adults with disabilities, or chronic or terminal illnesses, and to
children at risk of abuse and neglect.’’ For purposes of discussion, the definition of res-
pite will be broadened to include providing both temporary and ongoing support for
children or adults with ASD within the context of their own home.

SAMPLE JOB RESPONSIBILITIES

The job responsibilities of a respite provider span a wide range of duties, dependent
on the particular needs of the individual with ASD being supported. Duties change over
time dependent on the developmental needs of a particular child or adult with ASD.
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Following are examples of duties with a younger child with ASD: (a) personal care
and/or teaching of personal hygiene (bathing, face and hand washing, tooth brushing,
dressing, (b) dispensing of medication, (c) food preparation, (d) implementing inter-
vention strategies (e.g., Developmental Individual-Difference Relation-Based Interven-
tion, Applied Behavior Analysis, Relationship Development Intervention, etc.),
(e) transportation to therapy appointments, (f) engaging in prescribed activities between
therapy sessions (e.g., speech, physical, occupational, vision therapy, etc.), (g) prepara-
tion of visual calendars and schedules, (h) regular communication with early interven-
tion or school personnel, and (i) facilitating social interaction with peers.
For an older school-aged child with ASD, although many of the just-mentioned
duties are applicable, new responsibilities emerge as a child matures. Examples include:
(a) facilitating self-care, (b) overseeing preparation for the school day (e.g., selecting
clothes, preparing lunch, gathering necessary school materials together, etc.), (c) facil-
itating completion of daily homework, and (d) attendance at Individualized Education
Program (IEP) meetings.
As a child with ASD approaches their high school years, the focus of respite respon-
sibilities shifts in the direction of supporting transition to adult life and greater inde-
pendence. Examples include: (a) community skills (e.g., bus training, shopping,
banking, etc.), (b) food preparation (table setting, kitchen clean-up, grocery lists, etc.),
(c) use of public transportation, (d) seeking needed information and resources (e.g., via
Internet, phone book, etc.), and (e) aid in developing social and recreational outlets.

JOB DESCRIPTIONS
A useful job description should include a statement that describes the philosophy
underlying how a provider is expected to treat that person. For example, if supporting
the person to learn self-advocacy is a high-priority goal, one would expect the worker to
solicit input from the child or young adult whenever possible, and to show respect for
whatever is communicated. Key job responsibilities and expectations need to be spelled
out so that an applicant has a clear idea of what the job entails (Lieberman, 2005).

QUALITIES TO SEEK IN A PROVIDER

Prior to hiring an in-home respite worker, one must do some advance preparation.
This entails thinking through specific duties that will be required. It also requires
identifying desired personality qualities in a provider that will allow for a better match
with the culture of the child or young adult’s home. For example, a spontaneous,
right-brain type of person will not fit easily into a household that operates best with
solid structure and routine. (For a more detailed explanation, see Lieberman. A
Stranger Among Us, 2005, Ch. 2.)

DETERMINING BOTTOM-LINE ISSUES FOR HIRING

When hiring a respite provider, each family must decide what the essential bottom-
line issues are in order to rule out inappropriate applicants. Following is a sample list
of bottom-line issues that might be used for screening:

¥ Comfort relating to people with ASD or other neurological differences

¥ Use of a reliable car, good driving record, and current driver’s license
¥ Nonsmoker

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¥ Current schedule fits with desired hours and days

¥ Able to make one-year commitment
¥ Pay requirements within family’s ability to pay. (Lieberman, 2005, p. 64)

SPECIFIC AREAS TO EXPLORE IN A FACE-TO-FACE INTERVIEW

It is helpful to find somebody who has been exposed to people with ASD or other
kinds of disabilities. Beyond that, there are other important areas to explore in-depth
in a face-to-face interview.

Self-Care and Emotional Stability

Working with a child or young adult with ASD requires, at the very least, calmness,
a great deal of patience, and personal maturity. One way to assess whether a candidate
possesses these qualities is to ask questions that explore self-care and emotional stabil-
ity. ‘‘The ideal candidate should ‘have a life’ outside of work . . . you don’t want some-
one who is looking to meet the bulk of her emotional needs in your household . . .
You are looking for answers that demonstrate the ability to maintain control when
confronted with a child’s challenging behaviors’’ (Lieberman, 2005, pp. 80–81).
A good candidate should have a regular and healthy routine for managing stress,
whether a regular fitness activity, a recreational sport, yoga or dance, prayer, or medi-
tation practice. People who practice healthy stress management in their own lives are
better equipped to handle difficult behaviors exhibited by children or young adults
under stress.

Relationship to Drugs and Alcohol

It is definitely pertinent to explore an applicant’s relationship with drugs or alcohol.
Most people who are in active recovery from drugs and/or alcohol are likely to be
forthcoming in sharing the amount of time in recovery. A good rule of thumb is for
someone to be in active recovery from addiction for at least 1 year before considering
that person as a viable candidate. On the other hand, don’t automatically rule out
someone with a history of addiction. Those who overcome this challenge in their lives
can exhibit strength of character that serves them well in supporting a child or young
adult with ASD.
A word of caution: If an applicant with a history of addiction claims to no longer
use a certain drug but still has an occasional drink, be prepared to question that per-
son in greater detail. Addicts in recovery must stay away from all drugs if they truly
intend to live a clean and sober lifestyle.

Comfort with Expressing Emotion

Be cautious of someone who claims never to get angry. Nobody can avoid some
degree of internal agitation just from living in today’s fast-paced society. Those feel-
ings must be expressed periodically to avoid unpredictable ‘‘explosions.’’ Working with
a child or young adult with behavioral challenges can tax a provider’s emotions. It
would therefore be important to assess how comfortable that applicant is with experi-
encing a full range of emotions in a healthy way.

Ability to Set Limits

A quality provider must be comfortable with setting limits. Someone who says ‘‘yes’’
to doing things she is not comfortable doing is at risk for burning out or building up
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resentment. It works best when that person has bottom lines about what she will or
won’t do. Setting limits is also important in providing support to a child or young
adult with ASD. Behaviors may arise that require a calm, but firm response that helps
that child or young adult to learn appropriate boundaries. Examples of behaviors
might include such things as invading someone’s private space, grabbing something
out of another person’s hand, monopolizing a conversation without noticing a lack of
interest on the part of the listener, etc.

Attitudes Toward Discipline

How a candidate was disciplined as a child would have a direct effect on how he
handles challenging situations with the child or young adults he is supporting. If
someone has been physically abused, it is essential that a candidate can demonstrate
emotional work that has been done to counteract the negative effects of being abused.
Explore the candidate’s ideas about what discipline is and how it should be
implemented.
Discipline is teaching desired behavior, that is, helping a child or young adult to
understand what is expected. It is distinctly different from punishment, which is
defined as reacting, based on what that person has done wrong. It often takes the form
of venting anger in response to challenging behavior. Punishment does not teach
desired behavior. In short, look for candidates who clearly understand the difference
between discipline and punishment.
Closely aligned with investigating attitudes toward discipline is how an applicant
interprets the challenging behaviors exhibited by children and young adults with
ASD. One way this can be accomplished is to pose a challenging situation and ask
that person how she would handle it. How an applicant answers is a good indicator
of whether she grasps the neurological basis of behavior in this population. Avoid
candidates who automatically assign negative intent to difficult behaviors. This kind
of attitude is rarely helpful when supporting people with ASD, and in fact, can be
harmful.

Positive Behavioral Support

Positive behavioral support is a more appropriate response to challenging behaviors.
This involves seeking to understand what a child or young adult may be trying to say
through their behavior. Howard and Pitonyak (2005), in an article entitled ‘‘All
Behavior Is Meaningful,’’ say:

Difficult behaviors result from unmet needs . . . Supporting a person with difficult behav-
iors requires us to get to know the person as a human being influenced by a complex per-
sonal history. While it is tempting to look for a quick fix, which usually means attacking
the person’s behavior to make it go away, intervening in a person’s life without under-
standing something about the life he or she is living is disrespectful and counterproduc-
tive. (p. 3)

Listen for indications that the candidate is able to avoid taking challenging behav-
ior personally and screen out candidates who seem concerned with enforcing compli-
ance. The best applicant will demonstrate an understanding of the many factors to
take into consideration when trying to positively address difficult behavior, including
the person’s health, the sensory environment, changes in circumstances, and so forth.
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Utilizing respite providers in the home is often overlooked as an option. Hiring a

provider is a complex and time-consuming process fraught with uncertainty. But with
careful preparation, a clear job description, upholding bottom lines, and a thoughtful
in-depth interview, a quality provider can enhance the life of a child or young adult
with ASD, while providing much needed respite to family members.

REFERENCES
Howard, E., & Pitonyak, D. (2005). All behavior is meaningful—magic can happen! ASP Cares
(June), 3.
Lieberman, L. (2005). A stranger among us: Hiring in-home support for child with autism spectrum
disorder or other neurological differences. Shawnee Mission, KS: Autism Asperger Publishing
Company.
United Cerebral Palsy. (n.d.). What is respite care? Retrieved December 14, 2006, from www.
ucp.org/ucp_channeldoc.cfm/1/11/51/51-51/2106.
LISA ACKERSON LIEBERMAN

RESPONDENT CONDITIONING
Respondent conditioning, also referred to as classical conditioning, is a type of learn-
ing within the behavioral school of thought. It is the process of pairing a neutral stimu-
lus, something that inspires no response from the individual, with something that
instigates an automatic reaction from the individual, an unconditioned stimulus. This
pairing takes place until the neutral stimulus causes the same reaction as the uncondi-
tioned stimulus, without the presence of the unconditioned stimulus. The formerly neu-
tral stimulus is then referred to as a conditioned stimulus. This process was originally
referred to as classical conditioning by Ivan Pavlov, in his famous study with dogs.
See also antecedent-behavior-consequence analysis; applied behavior analysis; behav-
ior modification.
KATIE BASSITY

RESPONSE COST
Response cost falls into the category of punishment. In a response-cost system, a
person is denied a certain piece of or the whole reinforcement for each behavior they
perform that is deemed inappropriate. As in the definition of punishment, a procedure
is not a response cost if after the reinforcement is taken away, the behavior does not
decrease (Cooper, Heron, & Heward, 1987; Azrin & Holz, 1966). Response cost has
been successful in token-based treatment programs in a variety of settings, including
clinics, homes, hospitals, and schools (Kazdin, 1972). Because response cost utilizes
the removal of positive reinforcement, positive reinforcement must be available and
the reinforcers must be effective (Alberto & Troutman, 1999). Additionally, rein-
forcers must have the ability to be withdrawn (which is why edible reinforcers do not
typically work). Fines for speeding and loss of tokens for talking out of turn are exam-
ples of response-cost procedures.
See also applied behavior analysis; token economy.

REFERENCES
Alberto, P. A., & Troutman, A. C. (1999). Applied behavior analysis for teachers. Upper Saddle
River, NJ: Merrill.

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Azrin, N. H., & Holz, W. C. (1966). Punishment. In W. A. Honig (Ed.), Operant behavior:
Areas of research and application. New York: Appleton-Century-Crofts.
Cooper, J. O., Heron, T. E., & Heward, W. L. (1987). Applied behavior analysis. Upper Saddle
River, NJ: Prentice-Hall.
Kazdin, A. E. (1972). Response cost: The removal of conditioned reinforcers for therapeutic
change. Behavior Therapy, 3, 533–546.
TARA MIHOK AND JESSICA KATE PETERS

RESPONSE LATENCY
Response latency is the amount of time between a given command and the stu-
dent’s response. This measure may be used for a variety of purposes, including as a
check for mastery and/or fluency. For example, a teacher asks a student to name an
animal and immediately begins to count silently. If the student responds when the
teacher reaches the count of five, the response latency for this situation would be
5 seconds.
KATIE BASSITY

RESTRICTED INTEREST
These topical interests can become all consuming to the exclusion of others. Often,
individuals on the autism spectrum will only talk or read about their interest, not par-
ticipate in it. Restricted interests is one of the characteristics that defines Asperger’s
disorder as ‘‘restricted patterns of interest that is abnormal in intensity or focus’’
(APA, 2000). A survey by Online Asperger Syndrome Information and Support
(OASIS) found the top five specialized interest topics to be: peer-appropriate fads or
interests; video or computer games; works of art, movies, fictional books, or television
programs; and computers (Bashe & Kirby, 2001, p. 39). Sometimes, the restricted
interests lean toward the strange or odd. These have included interest in: bleach bot-
tles, alarms and alarm systems, lawn mowers, organs and organ music, road signs,
maps, clocks, time, directions (north, south, east, west), telephone books, game shows,
and insects (Bashe & Kirby, 2001, p. 40).

REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
Bashe, P. R., & Kirby, B. L. (2001). The OASIS guide to Asperger syndrome, advice, support,
insights and inspiration. New York: Crown Publishers.
ANN PILEWSKIE

RETROSPECTIVE VIDEO ANALYSIS (RVA)

Retrospective video analysis (RVA) uses home videos for documentation of a
child’s development. RVA has been used as an option for assessing very early
periods in development. RVA can help identify behaviors that distinguish
between autism and other developmental disabilities in children as young as
8 months of age.
JAN L. KLEIN
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 RETT’S DISORDER

RETT’S DISORDER
Rett’s disorder is currently included within Diagnostic and Statistical Manual of
Mental Disorders (DSM-IV-TR; APA, 2000) classifications of mental disorders and
listed as a pervasive developmental disorder. However there is some controversy
around whether it should be classified instead as a neurological disorder (e.g., Tsai,
1992). Rett’s disorder is characterized according to DSM-IV-TR (APA, 2000) as fol-
lows: There must be the presence of normal prenatal and perinatal development, nor-
mal psychomotor development through the first 5 months after birth, and normal
head circumference at birth. Then, after a period of normal development there should
be onset of all of the following: (a) deceleration of head growth between ages 5 and
48 months, (b) loss of previously acquired purposeful hand skills between ages 5 and
50 months with the subsequent development of stereotyped hand movements (e.g.,
hand wringing or hand washing), (c) loss of social engagement early in the course
(although social interaction often develops later), (d) appearance of poorly coordi-
nated gait or trunk movements, and (e) severely impaired expressive and receptive
language development with severe psychomotor retardation.
Other criteria not required for diagnosis but commonly observed include breathing
dysfunctions including hyperventilation or apnea, electroencephalogram (EEG) abnor-
malities including slowing of normal electrical patterns, appearance of epileptiform
patterns, and reduction in REM sleep, seizures, muscle rigidity or spasticity, scoliosis,
teeth grinding, and small feet (Schilling, 1997).
Diagnosis of Rett’s disorder is usually made between 6 and 24 months of age, and is
believed to be present primarily in girls, with few confirmed male cases recorded (Hag-
berg, 1985), although the possibility remains of undiagnosed male cases. Recent
research has indicated the possibility of a gene for Rett’s disorder, MECP2 (Amir
et al., 1999), with one reported male with the gene mutation who only survived to
1 year of age (Meloni et al., 2000). It is possible that the fatality of the gene mutation
in males is what accounts for no known male cases of Rett’s disorder. Although there
is now a known genetic mutation, diagnosis is still predominantly based on the pres-
ence or absence of behavioral and clinical criteria.
Rett’s disorder is a rare condition thought to occur in about 1 in every 10,000–
15,000 live births (Glasson, Thomson, Fyfe, Leonard, Bower, et al., 1998; Deb, 1998).
Following a relatively short period of normal development, there is a sudden regression
with irreversible effects leading to a severe developmental disorder affecting cognitive,
motor, communication, and social functioning (Perry, Sarlo-McGarvey, & Factor,
1992). Many of the early characteristics present similarly to autism, and Witt-Engerstrom
and Gillberg (1987) report that around 78 percent of girls with Rett’s disorder have been
previously misdiagnosed as having infantile autism. In fact, the inclusion of Rett’s dis-
order in the pervasive developmental disorders in DSM-IV-TR (2000) was in part to
try and reduce the number of incorrect autism diagnoses (Volkmar & Lord, 1998).
Van Acker (1997) argues that there are certain characteristics that distinguish
between Rett’s disorder and autism in young girls, and that assessing motor develop-
ment could be an important means for making accurate differential diagnosis. Specifi-
cally, in Rett’s disorder both communication and motor skills regress simultaneously,
whereas in autism regression, if it occurs, tends to be in communication alone. Van
Acker (1997) goes on to suggest that assessment in other areas should include:
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(a) respiratory patterns, (b) ability and speed of movements, (c) purposeful hand
movements, (d) degree and type of stereotypical movements, (e) ability to acquire
new skills, (f) physical development, and (g) overall developmental milestones. How-
ever, he also contends that due to the developmental nature of the disorder any diag-
nosis of Rett’s disorder should be tentative until between ages 3 and 5 years.

REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
Amir, R. E., Van der Veyver, I. B., Wan, M., Tran, C. Q., Franke, U., & Zoghbi, H. Y. (1999).
Rett syndrome is caused by mutations in X-linked MECP2, encoding methyl-CpG binding
protein 2. Nature Genetics, 32, 185–188.
Deb, S. (1998). Self injurious behaviour as part of the genetic syndromes. British Journal of Psy-
chiatry, 172, 385–388.
Glasson, E. J., Thomson, M. R., Fyfe, S., Leonard, S., Bower, C., Rousham, E., et al. (1998). Di-
agnosis of Rett syndrome: Can a radiograph help? Developmental Medicine and Child Neurology,
40, 737–742.
Hagberg, B. (1985). Rett’s syndrome: Prevalence and impact on progressive severe mental retar-
dation in girls. Acta Pediatrica Scandanavica, 74, 405–408.
Meloni, I., Bruttini, M., Longon, I., Mari, F., Rizzolio, F., D’Adamo, P., et al. (2000). A muta-
tion in the Rett syndrome gene, MECP2, causes X-linked mental retardation and progressive
spasticity in males. American Journal of Human Genetics, 67, 982–985.
Perry, A., Sarlo-McGarvey, N., & Factor, D.C. (1992). Stress and family functioning in parents
of girls with Rett syndrome. Journal of Autism and Developmental Disorders, 22, 235–248.
Schilling, D. (1997). Our Rett syndrome page. Retrieved August 17, 2005, from http://pages.
prodigy.com/DebbieSchilling.
Tsai, L. Y. (1992). Is Rett syndrome a subtype of pervasive developmental disorders? Journal of
Autism and Developmental Disorders, 22, 551–561.
Van Acker, R. (1997). Rett syndrome: A pervasive developmental disorder. In D. J. Cohen &
F. R. Volkmar (Eds.), Handbook of autism and pervasive developmental disorders (2nd ed.)
(pp. 60–93). New York: Wiley & Sons.
Volkmar, F. R., & Lord, C. (1998). Diagnosis and definition of autism and other pervasive de-
velopmental disorders (pp. 1–31). In F. R. Volkmar (Ed.), Autism and pervasive developmental
disorders. Cambridge: Cambridge University Press.
Witt-Engerstrom, I., & Gillberg, C. (1987). Rett syndrome in Sweden. Journal of Autism and De-
velopmental Disorders, 17, 149–150.
FIONA J. SCOTT

RETT’S DISORDER–DIAGNOSTIC CRITERIA FOR

299.80 RETT’S DISORDER
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR;
APA, 2000), the diagnostic criteria for Rett’s disorder include all of the following: (a)
apparent normal prenatal and perinatal development, (b) apparent normal psychomo-
tor development through the first 5 months after birth, and (c) normal head circum-
ference at birth. Additional criteria include all of the following with onset following
the period of normal development: (a) deceleration of head growth between ages 5
months and 48 months, (b) loss of previously acquired purposeful hand skills between
ages 5 months and 30 months with the subsequent development of stereotyped hand
movements (e.g., hand-wringing or hand washing), (c) loss of social engagement early
in the course (although often social interaction develops later), (d) appearance of
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 RUMINATION SYNDROME

poorly coordinated gait or trunk movements, and (e) severely impaired expressive and
receptive language development with severe psychomotor retardation.

REFERENCE
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
JEANNE HOLVERSTOTT

RIMLAND, BERNARD
Bernard Rimland (1928–2006) received his PhD in experimental psychology and
research design from Pennsylvania State University in 1953. A few years later, his son
Mark was born. It was Mark, who was diagnosed with early infantile autism, who
sparked his father’s interest in better understanding the rare disorder. Much of
Dr. Rimland’s work has been controversial. Specifically, Dr. Rimland was one of the
first professionals in the field to speak out against the ‘‘refrigerator mother’’ theory. In
the 1990s, he was one of the first to call attention to the rise in autism and the use of
vaccinations containing thimerosol. Dr. Rimland founded the Autism Society of
America in 1965 and the Autism Research Institute in 1967, where he carried out his
work until his death.
TERRI COOPER SWANSON

RUMINATION SYNDROME
Rumination is the chewing of food. In rumination syndrome, a person chews and
swallows food and then regurgitates it back to the mouth to chew and swallow again.
Rumination may be voluntary or involuntary. In infants, rumination may begin at the
age of 3–6 months and usually resolves on its own. In adults, the disorder may accom-
pany physical and/or psychological disorders.
Contrary to thought, the regurgitated material does not taste bitter or sour. Severe
health consequences can develop if the disorder is not treated. These include bad
breath, tooth enamel damage, dehydration, weight loss, pneumonia, and even death.
LYNN DUDEK

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 S
SCALES OF INDEPENDENT BEHAVIOR–REVISED (SIB-R)
The Scales of Independent Behavior–Revised (SIB-R; Bruininks, Woodcock,
Weatherman, & Hill, 1996) is a standardized measure of adaptive behavior across
7 skill clusters (e.g., Personal Living Skills) and 22 subscales (e.g., eating and meal
preparation) and includes a measure of the impact of problematic behavior on adaptive
functioning. Adaptive behavior generally refers to those skills or skill sets associated
with personal, vocational, and social self-sufficiency in real-life situations (Klin, Saul-
nier, Tsatsanis, & Volkmar, 2005). The SIB-R was normed on 2,100 individuals across
15 states with these norms extending beyond adolescence (from 3 months to 80+ years
of age). The SIB-R is generally regarded as a valid and reliable assessment of adaptive
functioning and, when properly administered, can be very useful in individual evalua-
tion, Individual Education Plan development, and functional transition planning.
See also individualized transition plan; standardization; transition planning.

REFERENCES
Bruininks, R. H., Woodcock, R. W., Weatherman, R. F., & Hill, B. K. (1996). The scales of in-
dependent behavior–revised. Chicago: Riverside Publishing Company.
Klin, A., Saulnier, C., Tsatsanis, K., & Volkmar, F. (2005). Clinical evaluation in autism spec-
trum disorders: Psychological assessment within a transdisciplinary framework. In F. R. Volk-
mar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental
disorders (3rd ed., pp. 772–798). New York: Wiley & Sons.
PETER GERHARDT

SCERTS MODEL
The Social Communication, Emotional Regulation, and Transactional Support or
the SCERTS Model is a comprehensive educational approach and multidisciplinary
framework designed to enhance the core challenges, communication, and social-
emotional abilities faced by children with autism spectrum disorders (ASD) and
related disabilities (Prizant, Wetherby, Rubin, & Laurent, 2003). The SCERTS Model
was collaborated and developed by a group of interdisciplinary professionals. This
model was derived from a theoretical- as well as a research-based foundation on
communication and social-emotional development in children with ASD. It was
developed to address the critical need identified by professionals and parents for a
SCERTS MODEL

comprehensive multidisciplinary team model for children with ASD (Prizant, Wetherby,
Rubin, Laurent, & Rydell, 2006). In addition, the model was designed to have broad
application in educational settings, clinical settings, and in everyday activities at home
and in the community (Prizant, Wetherby, Rubin, Laurent, & Rydell, 2002). Thus far,
the model is not a treatment approach or methodology; instead, it is a framework that
provides guidelines for implementing a comprehensive therapeutic and educational plan.
Furthermore, although the model was designed for children with ASD, many other chil-
dren with challenges in social communication and emotional regulation would poten-
tially benefit from the SCERTS Model (The SCERTS Model, 2006).

CORE VALUES OF THE SCERTS MODEL

The SCERTS Model is grounded in explicitly stated core values and principles that
guide educational and treatment efforts (Prizant et al., 2006). Following are the state-
ments of core values and guiding principles (The SCERTS Model, 2006, p. 18):

1. The development of spontaneous, functional communication abilities and emotional regu-

latory capacities are of the highest priority in educational and treatment efforts.
2. Principles and research on child development frame assessment and educational efforts.
Goals and activities are developmentally appropriate and functional, relative to a child’s
adaptive abilities and the necessary skills for maximizing enjoyment, success, and inde-
pendence in daily experiences.
3. All domains of a child’s development (e.g., communicative, social-emotional, cognitive,
and motor) are interrelated and interdependent. Assessment and educational efforts must
address these relationships.
4. All behavior is viewed as purposeful. Functions of behavior may include communication,
emotional regulation, and engagement in adaptive skills. For children who display uncon-
ventional or problem behaviors, there is an emphasis on determining the function of the
behavior and supporting the development of more appropriate ways to accomplish those
functions.
5. A child’s unique learning profile of strengths and weaknesses plays a critical role in deter-
mining appropriate accommodations for facilitating competence in the domains of social-
communication and emotional regulation.
6. Natural routines across home, school, and community environments provide the educa-
tional and treatment contexts for learning, and for the development of positive relation-
ships. Progress is measured in reference to increasing competence and active participation
in daily experiences and routines.
7. It is the primary responsibility of professionals to establish positive relationships with chil-
dren and with family members. All children and family members are treated with dignity
and respect.
8. Family members are considered experts about their child. Assessment and educational
efforts are viewed as collaborative processes with family members, and principles of family-
centered practice are advocated to build consensus with the family and enhance the
collaborative process.

ESSENTIAL CHARACTERISTICS OF THE SCERTS MODEL

There are three essential characteristics underlying the SCERTS Model identified
by the model collaborators (Prizant et al., 2006). First, the model is systematic and
semistructured but also flexible. In contrast to either adult-directed instructions or
facilitative approaches, the model attempts to find the balance and work in the middle

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Table 6. An Overview of Ultimate Goals of the SCERTS Model

Social Communication Emotional Regulation Transactional Support

Enhance capacities for Enhance capacities for Educational and learning
joint attention self-regulation support
Enhance capacities for Enhance capacities for Interpersonal supports
symbolic behavior mutual regulation Family support
Enhance capacity to Support among
recover from professionals
dysregulation

ground. Second, instead of solely focusing on training skills, the model addresses
underlying capacities as well as supports the development of functional skills. The pri-
mary goals in the model are to develop educational, self-help and independent living
skills. Last, the model is flexible enough to incorporate practices from a variety of
approaches and teaching strategies, such as augmentative communication, relaxation
techniques, and sensory supports. However, it should be noted that only those that
support social communication and emotional regulation, and that are philosophically
consistent with the core values and guiding principles of the model are considered
compatible with practice in the model (Prizant et al., 2006).

CORE COMPONENTS OF THE SCERTS MODEL

The acronym SCERTS refers to Social Communication (SC), Emotional Regulation
(ER), and Transactional Support (TS). These are the core components of the
SCERTS Model as well as the primary developmental dimensions that Prizant and his
colleagues (2002) believe should be prioritized in a program designed to support the
development of children with ASD and their families (see Table 6).

SOCIAL COMMUNICATION (SC)

The Social Communication (SC) component of the SCERTS Model addresses the
over-riding goals of helping a child to be a confident, increasingly proficient, success-
ful, and active communicator and participant in social activities (Prizant et al., 2006).
In addressing this goal, the model collaborators believed that children must acquire
capacities in two major areas of functioning: joint attention and symbolic behavior
(Prizant et al., 2006). They further identified those two areas as foundations of social
communication based on the following two reasons. First, children become more capa-
ble in sharing attention and emotion as well as expressing intentions in reciprocal
interactions when their capacities of joint attention increase. Second, children de-
velop more sophisticated and abstract means to communicate and play with others
when their capacities of symbolic behavior increase. The ultimate goal targeted in the
SC component of the SCERTS Model is to support a child in developing his or her
foundational capacities in joint attention and symbolic behavior that support commu-
nicative and social competence and emotional well-being. It is believed that with
these capacities, children are more likely to find satisfaction and even great joy in
being with, relating to, and learning from others (Prizant et al., 2006).

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SCERTS MODEL

EMOTIONAL REGULATION (ER)

The Emotional Regulation (ER) component of the SCERTS Model focuses on sup-
porting a child’s ability to regulate emotional arousal (Prizant et al., 2006). The model
collaborators believed that emotional regulatory capacities enable a child (a) to seek
assistance and/or respond to others’ attempts to provide support for emotional regula-
tion (referred to as mutual regulation), (b) to independently remain organized (referred
to as self-regulation), and (c) to recover from states of emotional meltdown (referred to
as recovery from dysregulation). Furthermore, they believed the child will be optimally
available for learning once he or she has those emotional regulatory capacities and
skills. Therefore, the ultimate goal of the ER component of the SCERTS Model is to
support a child in adapting to and coping with the daily challenges he or she will face
in maintaining optimal states of arousal most conducive to learning, relating to others,
and experiencing positive emotions (Prizant et al., 2006).

TRANSACTIONAL SUPPORT (TS)

Transactional Support (TS) is the third and concluding core component of the
SCERTS Model. Transactional support includes: (a) interpersonal supports, (b) learn-
ing and educational supports, (c) support to families, and (d) support among professio-
nals and other service providers. Furthermore, the model collaborators emphasized
that transactional support needs to be infused across different activities and social
partners since meaningful learning occurs only within the social context of everyday
activities (Prizant et al., 2006). Thus far, the ultimate goals of the TS component of
the SCERTS Model are: (a) to develop and provide the necessary learning and educa-
tional supports for a child, (b) to coordinate efforts among all partners in using inter-
personal supports most conducive to social communication and emotional regulation,
(c) to provide learning experiences with other children leading to the development of
meaningful peer relationships, and (d) to support families with educational resources,
direct strategies, and emotional support (Prizant et al., 2006).

THE MEANFUL ACTIVITIES (MA) & PURPOSAL ACTIVITIES (PA) APPROACH

In light of designing individualized learning activities and modification of everyday
activities to be both motivating and functional for a child, the SCERTS Model
applies the Meanful Activities (MA) & Purposal Activities (PA) approach, which
refers to the use of meaningful activities and purposeful activities (Prizant et al.,
2006).

TYPES OF ACTIVITIES
In the MA & PA approach, three types of activities are included: (a) goal-directed
activities, (b) cooperative turn-taking games, and (c) theme-oriented activities (Pri-
zant et al., 2006).
Goal-Directed Activities
Goal-directed activities are the activities that have a sequence of steps with a clear
and easily perceived end goal, such as making a sandwich, doing puzzles, and so on.
They typically follow a logical sequence to conclusion. The primary function of engag-
ing in such activities is to reach the end goal.
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Cooperative Turn-Taking Games

The primary goal of cooperative turn-taking games is in the success of social reci-
procity, turn-taking, and mutual enjoyment derived from such shared activities. Such
activities do not necessarily have clear end goals in the same sense as goal-directed
activities. Rather, the success is measured by qualities like shared emotional experi-
ence, cooperation, and social reciprocity.
Theme-Oriented Activities
Theme-oriented activities are organized around and may have multiple embedded
components. Those components may be related to functional skills in daily routine
such as going to school or visiting a doctor that involve sequences of smaller events
that are organized in a logical manner. Such activities may be most appropriate for
children at the more advanced language level.

GUIDELINES FOR IMPLEMENTING ACTIVITIES

In the training manual of the SCERTS Model (pp. 18–19), the model collaborators
provided guidelines for (a) implementing activities within natural settings and routines
according to the MA & PA approach, (b) individualizing educational programming to
meet the unique needs of each child with ASD, and (c) providing the transactional
supports necessary to best support a child with ASD while implementing the program.
They are as follows:

1. Identify developmentally appropriate goals and outcomes.

2. Identify at least three activities that are meaningful, purposeful, and motivational.
3. Infuse goals across at least three activities across settings.
4. Identify/select optimal levels of social complexity in activities based on the child’s learn-
ing need and strengths.
5. Within Steps 2–4, identify the sequential skills that are embedded into each activity.
6. Identify appropriate transactional supports for social communication and emotional
regulation.
7. One-to-one or small-group planned activity routines may be provided as opportunities for
increased practice or rehearsal of skills that require more instructional opportunities.

In summary, the MA & PA approach of the SCERTS Model is defined by the fol-
lowing six criteria made by the model collaborators. First of all, activities should make
sense relative to a child’s daily life activities and routines. That is, activities that occur
across settings or that can readily be scheduled to occur are designed and/or modified to
support the learning of functional skills. Second, activities should be selected on the ba-
sis of a child’s interests, motivations, and strengths. If an activity is not inherently moti-
vating, efforts should be made to infuse the activity with supports, topics, information,
or qualities that support the child’s learning and emotional regulation. Third, activities
should be designed and/or transactional supports should be used to provide a child with
a clear sense of the goal of the activity, the logical sequence of the activity, the steps
within the activity, and clear indicators of when the activity is completed. Fourth,
activities should provide a child with multiple and frequent opportunities for initiating
communication, making choices, repairing breakdowns, and responding to the commu-
nication of partners. Fifth, activities should have an understandable structure for social
participation and turn-ranking. Last but not least, whenever possible, activities should
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involve the participation of children who provide good language and social models as
well as to support the development of positive relationships.
See also augmentative and alternative communication; play-oriented therapies;
social skills training; symbolic thought.
REFERENCES
Prizant, B. M., Wetherby, A. M., Rubin, E., & Laurent, A. C. (2003). The SCERTS Model: A
transactional, family-centered approach to enhancing communication and socioemotional
abilities of children with autism spectrum disorder. Infants and Young Children, 16, 296–316.
Prizant, B. M., Wetherby, A. M., Rubin, E., Laurent, A. C., & Rydell, P. J. (2002). The
SCERTS Model: Enhancing communication and socioemotional abilities of children with
autism spectrum disorder. Jenison Autism Journal, 14, 2–19.
Prizant, B. M., Wetherby, A. M., Rubin, E., Laurent, A. C., & Rydell, P. J. (2006). The
SCERTS Model: A comprehensive educational approach for children with autism spectrum disorders.
Baltimore: Brookes Publishing Co.
The SCERTS Model (2006). Introduction to the SCERTS Model. Retrieved December 10,
2006, from http://www.scerts.com/frequently_asked_questions.htm.
KAI-CHIEN TIEN

SCHEDULE OF REINFORCEMENT
Many different schedules of reinforcement may be applied to a person’s behavior.
Schedules of reinforcement are rules used to provide reinforcement for a target behavior
(Skinner, 1953). Continuous schedules of reinforcement provide reinforcement for each
instance of the behavior. Interval schedules of reinforcement require a minimum
amount of time that must pass between reinforced responses (Ferster & Skinner, 1957).
Interval schedules may have a consistent time period (fixed interval schedule) or a
variable time period between reinforcers (variable interval schedule). Ratio schedules
require a specific number of responses before a reinforced response (Ferster & Skinner,
1957). The number of responses may be fixed from one reinforcer to the next (fixed
ratio schedule) or it may vary between reinforcers (variable ratio schedule). In extinc-
tion, reinforcement of a response is stopped, leading to a decline in the response (Zeiler,
1977). Finally, an intermittent schedule of reinforcement means that reinforcement fol-
lows at any rate that is lower than a continuous rate (Cooper, Heron, & Heward,
1996). Different schedules of reinforcement lead to different patterns of response.
REFERENCES
Cooper, J. O., Heron, T. E., & Heward, W. L. (1987). Applied behavior analysis. Upper Saddle
River, NJ: Prentice Hall.
Ferster, C. B., & Skinner, B. F. (1957). Schedules of reinforcement. New York: Appleton-Cen-
tury-Crofts.
Skinner, B. F. (1953). Science and human behavior. New York: Macmillan.
Zeiler, M. (1977). Schedules of reinforcement: The controlling variables. In W. K. Honig & J.
E. R. Staddon (Eds.), Handbook of operant behavior. Englewood Cliffs, NJ: Prentice Hall.
JESSICA KATE PETERS AND TARA MIHOK

SCHIZOPHRENIA
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-
IV-TR; APA, 2000), schizophrenia is a mental disorder that lasts for at least 6 months
and includes at least 1 month of active symptoms.
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 SCHIZOPHRENIA

SYMPTOMS
Active symptoms include:

¥ Delusions, which are disturbances of thinking involving misinterpretation of perceptions or

experiences. Their content include a variety of topics, such as persecutory (e.g., the person
believes that he or she is being spied on or followed), religious, referential (e.g., the person
believes that passages from books, song lyrics, or certain gestures or comments from people
are specifically directed to him or her), or somatic or grandiose (e.g., the person believes
that he possess a special ability, beauty, or is an important person).
¥ Hallucinations, which are sensory perceptions but without the external stimulus that trig-
gers them. They can be auditory, which are the most frequent, (e.g., hearing voices exter-
nal to themselves), visual (e.g., seeing people, lights, animals that others can’t see),
olfactory, gustatory, and tactile.
¥ Disorganized speech, whereby the person switches from one topic to another, gives answers
that are only minimally or not at all related to the question. In some cases the speech is
so unorganized that it is nearly incomprehensible.
¥ Disorganized or catatonic motor behavior, which can be manifested in many ways, from
decreased reactions to the environment to unpredictable agitation. Difficulties involve
doing daily activities such as maintaining proper hygiene or dressing in unusual ways.
¥ Negative symptoms, which include poor eye contact, reduced body language, and an unex-
pressive face. Also, speech is brief and laconic, and the person is unable to initiate and
persist in goal-directed activities.

SUBTYPES OF SCHIZOPHRENIA
There are five subtypes of schizophrenia:

¥ Paranoid. Characterized by frequent preoccupation with one or more delusions or frequent

auditory hallucinations.
¥ Disorganized. Characterized by disorganized speech and behavior and inappropriate or flat
affect.
¥ Catatonic. Characterized by motoric immobility, trance or excessive motor activity, extreme
negativism, mutism or echolalia, and stereotyped movements.
¥ Undifferentiated. This type of schizophrenia presents the core symptoms but does not meet
the criteria for paranoid, disorganized, or catatonic types.
¥ Residual. Refers to instances when there has been at least one episode of schizophrenia but
the actual clinical picture is without the core symptoms. Characterized by the presence of
flat affect, poor speech, and attenuated symptoms of odd beliefs or unusual perceptual
experiences.

This disorder involves dysfunction in one or more major areas of functioning such
as interpersonal relations, work, education, or self-care. The dysfunction is clearly
below the level that the person had achieved before the onset of the disorder.

ONSET AND COURSE

The onset of schizophrenia typically occurs between the late teens and mid-30s; it
is rare prior to adolescence. The age of onset for men is between 18 and 25 years and
for women is between 25 and the mid-30s. The outbreak may be sudden; however,
the majority of individuals manifest some early signs that develop slowly and gradually
such as deterioration in hygiene, outbursts of anger, loss of interest in work or school,
or social detachment. First-degree biological relatives of individuals with schizophrenia
are 10 times more at risk for developing schizophrenia than the general population.
319
SCHOOL FUNCTION ASSESSMENT

The course and outcome of schizophrenia are variable. Some patients will exhibit
remissions, whereas others chronically show the symptoms. Complete remission is
uncommon.

PREVALENCE
Schizophrenia has been identified all around the world, and prevalence among
adults is often reported to be 0.5–1.5 percent. Annual incidences range from 0.5 to
5.0 per 10,000.

REFERENCE
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.

FURTHER INFORMATION
American Academy of Child and Adolescent Psychiatry. (1997). Practice parameters for the
assessment and treatment of children and adolescents with schizophrenia. Journal of the Amer-
ican Academy of Child and Adolescent Psychiatry, 36, 177–193.
Mueser, K. T., & McGurk, S. R. (2004). Schizophrenia. The Lancet, 363, 2063–2072.
National Alliance for the Mentally Ill (NAMI): www.nami.org.
National Alliance for Research on Schizophrenia and Depression: www.narsad.org.
National Institute of Mental Health: www.nimh.nih.gov.
SUSANA BERNAD-RIPOLL

SCHOOL FUNCTION ASSESSMENT

The School Function Assessment (SFA; Costerl, Deeney, Haltiwanger, & Haley,
1998) looks at functional tasks throughout a school day (kindergarten through grade
6) and the level of supported participation needed by the student. This questionnaire
can be utilized to assist with collaborative program planning by school teams. The
SFA is a tool that examines how much support is needed by the student so they can
participate to the fullest extent possible and includes the adaptations will be needed
to ensure that participation can happen.
REFERENCE
Costerl, W., Deeney, T., Haltiwanger, J., & Haley, S. (1998). School function assessment. Austin,
TX: Pro-Ed.
BROOKE YOUNG

SCHOPLER, ERIC
Eric Schopler (1927–2006) received his PhD from the University of Chicago in
Clinical Psychology and then joined the faculty at the University of North Carolina
at Chapel Hill (UNC). It was at UNC in 1966 that Dr. Schopler furthered his disser-
tation research into what is now known as the TEACCH program (Treatment and
Education of Autistic and Related Communication-Handicapped Children). Dr.
Schopler wrote over 400 books and articles and received numerous awards for his
work. The TEACCH program is recognized throughout the world. Dr. Schopler car-
ried out his work at Division TEACCH until his death.
See also structured teaching.
TERRI COOPER SWANSON
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 SECRETIN

SCREENING
According to Ireton (1992), ‘‘the term screening technically refers to the process of
selecting out for further study those high-risk individuals whose apparent problems
might require special attention or intervention’’ (p. 487). Hooper and Umansky
(2004) also stated that screening is a procedure used to identify infants and pre-
schoolers who may be in need of a more comprehensive evaluation. To be more spe-
cific, screening is a quick process to identify young children who may be at risk for a
disability or developmental problem or who may need further assessments for diagno-
sis. Screening is usually conducted through tests, checklists, or observations. In the
process of screening, the professionals often depend on parents or others who know
the child well to provide information on the child (e.g., sleeping patterns, eating
behaviors, and so on).
See also Autism Screening Questionnaire; Checklist for Autism in Toddlers; Child
Behavior Checklist for Ages 11=2–5; Childhood Autism Rating Scale; Modified Check-
list for Autism in Toddlers.

REFERENCES
Hooper, S. R., & Umansky, W. (2004). Young children with special needs. Upper Saddle River,
NJ: Pearson Education.
Ireton, H. (1992). Child development inventories. Minneapolis, MN: Behavior Science Systems.
KAI-CHIEN TIEN

SCREENING TOOL FOR AUTISM IN TWO-YEAR-OLDS (STAT)

The Screening Tool for Autism in Two-Year-Olds (STAT; Stone & Ousley, 1997)
uses 12 interactive questions to assess an array of domains including play, communica-
tion, and imitation. The purpose of the STAT is to assist in the early identification
and intervention of children with autism. To complete administration of the STAT,
evaluators need a 20–30 minute semistructured play situation. The STAT is currently
only given out at training workshops, as Vanderbilt University continues to study the
validity of the administration.
See also screening.

REFERENCE
Stone, W. L., & Ousley, O. Y. (1997). STAT Manual Screening Tool for Autism in Two-Year-
Olds. Unpublished manuscript, Vanderbilt University, Nashville, TN.
BROOKE YOUNG

SECRETIN
Secretin is a peptide hormone that is found in the small intestine, brain, liver, and
pancreas. Secretin is a controversial treatment for autism. At this printing, the U.S.
Food and Drug Administration does not approve the use of secretin as a treatment for
autism as there have been no clinical trials conducted. In 2004, Sturmey conducted a
double-blind review of 15 articles related to the use of secretin to treat autism. The
review found that none of the research articles reported that secretin showed signifi-
cant effects, nor was it effective.
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SECTION 504 OF THE REHABILITATION ACT OF 1973

REFERENCE
Sturmey, P. (2005). Secretin is an ineffective treatment for pervasive developmental disabilities:
A review of 15 double-blind randomized controlled trials. Research in Developmental Disabil-
ities, 26, 87–97.
TERRI COOPER SWANSON

SECTION 504 OF THE REHABILITATION ACT OF 1973

The Rehabilitation Act of 1973 contains a variety of provisions focused on rights,
advocacy, and protections for individuals with disabilities (U.S. Department of Health
and Human Services, n.d.). Specifically, Section 504 of the Rehabilitation Act of
1973 is, in a sense, civil rights legislation for persons with disabilities by prohibiting
discrimination on the basis of disabling conditions by programs and activities receiving
or benefiting from federal financial assistance (deBettencourt, 2002; Smith, 2001,
2002).
According to the U.S. Department of Education (as cited by the U.S.
Department of Health and Human Services, 2006), under Section 504 of the Rehabil-
itation Act, a recipient of federal financial assistance may not, on the basis of
disability:

¥ Deny qualified individuals the opportunity to participate in or benefit from federally

funded programs, services, or other benefits.
¥ Deny access to programs, services, benefits, or opportunities to participate as a result of
physical barriers.
¥ Deny employment opportunities, including hiring, promotion, training, and fringe benefits,
for which they are otherwise entitled or qualified.

Unlike the Individuals with Disabilities Education Act (IDEA), Section 504 pro-
tects individuals, birth through adulthood. Whereas IDEA is federally funded, school
districts receive money based upon compliance with the law. Since Section 504 is a
civil rights statute, the federal government does not provide additional funding for stu-
dents identified under Section 504 (deBettencourt, 2002).

DEFINING TERMS
Section 504 protects otherwise qualified individuals from discrimination based on
their disability. This means that a person with a disability must be qualified to do
something before the presence of the disability can be a factor in discrimination. For
example, an individual with attention deficit hyperactivity disorder (ADHD) tries
out for a baseball team and does not have the skills to throw, catch, hit the ball, or
run the bases and, therefore, is not picked for the team. Discrimination under Section
504 in this case would not be an issue because the individual is not otherwise qualified
to be on the team (Smith, 2001, 2002).
Section 504 states:

No otherwise qualified individual with a disability . . . shall solely by reason of her or his
disability be excluded from the participation in, be denied the benefits of, or be subjected
to discrimination under any program or activity receiving Federal financial assistance. (29
U.S.C.A. § 794)

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 SECTION 504 OF THE REHABILITATION ACT OF 1973

To be eligible for services under Section 504, then, a person must satisfy this defini-
tion for disability. A person is considered to have a disability if he or she (Rehabilita-
tion Act, § 706[8]):

¥ has a physical or mental impairment that substantially limits one or more of such person’s
major life activities,
¥ has a record of such an impairment, or
¥ is regarded as having such an impairment.

The Rehabilitation Act of 1973 defines a physical or mental impairment as: (a) any
physiological disorder or condition, cosmetic disfigurement, or anatomical loss affect-
ing one or more of the following body systems: neurological, musculoskeletal, special
sense organs, respiratory, speech organs, cardiovascular, reproductive, digestive, genito-
urinary, hemic and lymphatic, skin, and endocrine; or (b) any mental or psychological
disorder such as emotional or mental illness (Smith, 2002, p. 260). The burden of pro-
viding proof of this disability falls on the individual (Madaus & Shaw, 2004).
Major life activities include a wide variety of daily activities such as caring for one-
self, performing manual tasks, walking, stooping, seeing, hearing, speaking, eating,
breathing, learning, and working. Basically, any function that is performed routinely
by individuals is considered a major life activity. (Smith, 2002)

QUALIFYING FOR SERVICES

To qualify for services under Section 504, a student must be identified through eval-
uation procedures that gather information from a variety of sources. A team of knowl-
edgeable personnel is charged with the task of determining whether a disability
substantially limits a major life activity. This is a very subjective process. According to
Smith (2001), ‘‘substantially limits’’ may be defined as:

¥ unable to perform a major life activity that the average person in the general population
can perform, or
¥ significantly restricted as to the condition, manner, or duration for which an individual
can perform a particular major life activity as compared to the condition, manner, or dura-
tion for which the average person in the general population can perform that same major
life activity. (p. 337)

Smith (2001, 2002) recommends that when teams are defining limits they make
comparisons to the average child or person. Specifically, decisions should be based
upon: the nature and severity of the disability, the duration of the disability, and any
long-term impact of the disability. As with the requirements of IDEA, parent notifica-
tion is required, but contrary to IDEA, for the 504 determination, assessment decisions
do not require written parental consent. However, good professional practice would
suggest that parental consent be obtained.
Section 504 requires ‘‘periodic’’ reevaluation, and a reevaluation is required before a
‘‘significant’’ change in placement takes place. Unlike IDEA, there is no provision that
allows for independent evaluation at the school district’s expense (deBettencourt, 2002).
It is important to note that children who qualify for protection and services under
IDEA also qualify for protection under Section 504. Thus, they are entitled to all the
rights and privileges of this act as well (Turnbull, Brennan, & Stowe, 2002).
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SERVICES
Under Section 504, an ‘‘appropriate’’ education means an education that is compa-
rable to that provided to students without disabilities (deBettencourt, 2002). Blazer
(1999) outlines a structured, collaborative approach to program planning that
includes parents, the student, and school personnel. Although a written document is
not mandated, it is recommended. The Individualized Education Program (IEP)
form may be used, but many schools use a different form for the Section 504 plan.
There are no specific requirements for parent participation, nor is a time period
specified for review of the 504 plan, but best practice suggests reviewing the docu-
ment annually.
For many school-aged children, the major life activity affected by their disability is
learning. Accommodations are one way that schools provide services for individuals
that qualify for a 504 plan. The vast majority of accommodations will occur in the
general education setting.
Section 504 is not limited to individuals within the school. For purposes of employ-
ment, qualified individuals with disabilities are persons who, with reasonable accommo-
dation, can perform the essential functions of the job for which they have applied or
have been hired to perform (Smith, 2002). ‘‘Reasonable accommodation’’ means that
employers must take reasonable steps to accommodate the disability unless it would
cause them undue hardship. Again, it is important to keep in mind that a person must
be otherwise qualified for the job in order for the employer to be required to make
reasonable accommodations.
In summary, Section 504 is the civil rights legislation that protects persons, birth
through death, who qualify for services under IDEA. In addition, it protects all other
individuals who meet the definition for having a disability outlined within the Reha-
bilitation Act of 1973.

REFERENCES
Blazer, B. (1999). Developing 504 classroom accommodation plans: A collaborative, systematic,
parent-student-teacher approach. Teaching Exceptional Children, 32(2), 28–33.
deBettencourt, L. U. (2002). Understanding the differences between IDEA and Section 504.
Teaching Exceptional Children, 34(3), 16–23.
Madaus, J. W., & Shaw, S. F. (2004). Section 504: Differences in the regulations for secondary
and postsecondary education. Intervention in School and Clinic, 40(2), 81–87.
Rehabilitation Act of 1973, 29 U.S.C. § 701 et seq.
Smith, T. E. C. (2001). Section 504, the ADA, and public schools: What educators need to
know. Remedial and Special Education, 22(6), 335–343.
Smith, T. E. C. (2002). Section 504: What teachers need to know. Intervention in School and
Clinic, 37(5), 259–266.
Turnbull, H. R., III, Brennan, L. W., & Stowe, M. J. (2002). A brief overview of special
education law with focus on autism. Journal of Autism and Developmental Disorders, 32(5),
479–493.
United States Department of Education, Office of Special Education and Rehabilitative Ser-
vices. (2004). The rehabilitation act. Retrieved September 15, 2006, from http://www.ed.gov/
policy/speced/reg/narrative.html.
United States Department of Health and Human Services, Office of Civil Rights, (n.d.). Your
rights under Section 504 of the rehabilitation act. Retrieved September 15, 2006, from http://
www.hhs.gov/ocr/504.html.
SHEILA M. SMITH
324
 SEIZURE DISORDER

SEIZURE DISORDER
Seizure disorder (or epilepsy) is a neurological disorder in which abnormal electrical
signals occur in the brain. There are different kinds of seizure disorders, and people
are affected differently by them. Some people experience seizures frequently and others
experience them quite infrequently.

COMMON TERMINOLOGY
Aura
Many people experience a ‘‘warning feeling’’ right before a seizure occurs. These
warning feelings may include a change in body temperature, a strange taste or smell,
or a particular sound.

Febrile Seizures
These seizures result from a child experiencing a rapidly increasing fever. Although
they look like tonic-clonic seizures, these are not epileptic seizures.

Partial Seizures
In these seizures, the excessive electrical signals occur in only one part of the brain
and are many times unnoticeable. In fact, the child may look like he or she is simply
daydreaming for a few seconds. These seizures used to be referred to as petit mal
seizures.

Status Seizures
These seizures occur so rapidly that the child does not regain consciousness between
seizures. If this occurs, it is considered a medical emergency.

Tonic-Clonic Seizures
In these seizures, a child undergoes two phases. In the tonic phase, the child loses
consciousness and becomes rigid. In the clonic phase, the child’s extremities jerk. Af-
ter the seizure, the child slowly begins to regain consciousness.

SEIZURE DISORDER AND AUTISM

There are many causes for a person to develop seizures, although, in some cases,
there are no known causes for the seizures. Some known causes include head injury,
meningitis, brain tumors, stroke, poisoning, or birth defects that affect the brain.
Additionally, several studies have reported that individuals with autism are at a
greater risk for developing a seizure disorder. These studies have found that seizure dis-
orders are more common in individuals with autism who have a lower IQ.

FURTHER INFORMATION
Jurasek, G. (2001). Options in seizure management: The vagus nerve stimulator—experiences
to date. Part 1: An introduction to seizure disorders and existing therapies. The Exceptional
Parent, 31(8), 107–112.
Tuchman, R. (2003). Brain waves, seizures, and the child with autism. The Exceptional Parent,
33(3), 104–107.
MAYA ISRAEL
325
SELECTIVE MUTISM

SELECTIVE MUTISM
Selective mutism is a childhood disorder, characterized by the persistent failure to
speak in at least one social environment. It usually occurs before a child is 5 years old
and in most cases the child will speak to their parents and/or select others. The Diag-
nostic and Statistical Manual of Mental Disorders (DSM-IV-TR; APA, 2000,
pp. 125–127) defines selective mutism as:

¥ Consistent failure to speak in specific social situations (in which there is an expectation
for speaking, e.g., at school) despite speaking in other situations.
¥ The disturbance interferes with educational or occupational achievement or with social
communication.
¥ The duration of the disturbance is at least one month (not limited to the first month of
school).
¥ The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken lan-
guage required in the social situation.
¥ The disturbance is not better accounted for by a communication disorder (e.g., stuttering)
and does not occur exclusively during the course of a pervasive developmental disorder,
schizophrenia, or other psychotic disorder.

Features and severity of selective mutism vary from child to child. Individual chil-
dren with the disorder sometimes display excessive shyness, fear, anxiety, and embar-
rassment. They usually do not display other speech or language problems, although
there can be associated articulation or phonological difficulty or receptive or expres-
sive language disorder, but these are not implicit in the mutism disorder.
Children with selective mutism often will respond by head nodding or gestures.
They may ‘‘wait out’’ a person trying to guess what the child wants or needs to com-
municate. Children with selective mutism have a real fear of speaking and often will
stand motionless when requested to speak.
Many children from bilingual families, or who have lived in a foreign country, make
up a proportion of children who are selectively mute. There is no correlation or asso-
ciation between children who are selectively mute and those who are on the autism
spectrum. The differences are distinct in that children who are selectively mute have
the ability to speak and process language normally, whereas children with autistic dis-
orders do not process language in the same way as typically developing children, and
they display atypical social interactions and repetitive behaviors.
Due to the rarity of selective mutism, few professionals are familiar with the disor-
der, and sometimes misinterpret the child’s behavior as ‘‘just shy,’’ oppositional, or
defiant. Often selective mutism is misdiagnosed, and therefore children with the disor-
der do not receive appropriate treatment. The child with suspected selective mutism
should be evaluated by a knowledgeable psychologist and a speech language patholo-
gist should conduct a thorough language evaluation. The evaluation process should
include a comprehensive interview with the parent and observations in different set-
tings where the child is expected to speak, such as the home and school.
There are several approaches to treatment for selective mutism. Behavioral
approaches include the use of positive reinforcement and desensitization techniques.
Slowly introducing the child to social environments in nonthreatening ways can help
reduce the child’s anxiety of speaking. Play or interaction with one other child in the
classroom setting when no one else is there, can be slowly extended into two children,
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 SELF-DETERMINATION

and then a small group when the child with selective mutism becomes more comforta-
ble and begins to speak. The child should be positively reinforced when he or she is
comfortable receiving praise or encouragement.
Psychological approaches to treatment, such as play therapy and psychotherapy, can
be used effectively when the child does not feel threatened to speak and can help a
child lessen his or her anxiety. Cognitive behavior therapy is used to redirect fears
and highlight the child’s positive characteristics.
Certain medications such as selective serotonin reuptake inhibitors that help reduce
anxiety and/or depression have been found to be effective for treating selective
mutism, especially when paired with behavioral treatments. Other treatment
approaches include self-esteem boosters, frequent socialization, school involvement,
and family involvement and acceptance.

REFERENCE
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.

FURTHER INFORMATION
Anstendig, K. (1998). Selective mutism: A review of the treatment literature by modality from
1980–1996. Psychotherapy, 35, 381–391.
Anstendig, K. D. (1999). Is selective mutism an anxiety disorder? Journal of Anxiety Disorders,
13, 417–434.
Bergman, R. L., Piacentini, J., & McCracken, J. T. (2002). Prevalence and description of selec-
tive mutism in a school-based sample. Journal of the American Academy of Child and Adolescent
Psychiatry, 41, 938–946.
Dow, S. P., Sonies, B. C., Scheib, D., Moss, S. E., & Leonard, H. L. (1995). Practical guidelines
for the assessment and treatment of selective mutism. Journal of the American Academy of
Child and Adolescent Psychiatry, 34(7), 836–846.
ANN PILEWSKIE

SELF-ADVOCACY
Self-advocacy is the practice of knowing of and controlling one’s own rights,
responsibilities, and resources without undue influence from others.
See also advocate; self-determination.
JEANNE HOLVERSTOTT

SELF-CONTAINED CLASSROOM
A self-contained classroom is an educational setting outside of the general educa-
tion classroom where students with disabilities receive educational and related services
for the majority of their school day. Students with mental retardation represent the
largest disability category represented in self-contained classrooms.
KATHERINE E. COOK

SELF-DETERMINATION
Promoting self-determination has become an increasingly important topic in disabil-
ity advocacy and supports. This is, in large measure, because people with disabilities
have identified enhanced self-determination as being important to and because
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SELF-DETERMINATION

research has shown that adolescents and young adults who are more self-determined
achieve more positive adult outcomes and a more positive quality of life.
The meaning of the term has its roots in the philosophical doctrine of determinism.
Determinism refers to the idea or proposition that all events, including human behav-
ior and thought, are caused by events that occurred before the event. Self-determined
behavior refers to human behavior that is caused (e.g., determined) by the person as
opposed to being caused by someone or something else.
People who are self-determined, then, make or cause things to happen in their own
lives. They act volitionally (based on their own will, preferences, choices, and inter-
ests) instead of being coerced or forced to act in certain ways by others or by
circumstances.
Just as important, self-determined behavior is intentional and goal oriented. That is,
self-determined people intentionally and purposefully act to achieve goals in their
lives. Particularly with regard to individuals with more significant intellectual impair-
ments, it is important to note that what constitutes ‘‘self-determined’’ behavior is not
independently performing all the steps in achieving a goal, but that it is the person
who is causing this to happen.
During the twentieth century, the self-determination construct began to be used
with reference to the right or rights of people to self-governance. The right to self-
determination, as applied to citizens of a country or to members of a minority group
such as people with disabilities, implies that individuals have the right to a voice in
decisions that impact their lives—to have a say in governing themselves. Again, how-
ever, even in this group context, self-determination implies that it is the people them-
selves (self-) who have the right to cause things to happen to and for them—the
essence of governing.
People with disabilities express the desire both to have greater opportunities to
become more self-determined as individuals and to the right to self-determination as a
group.

SELF-DETERMINATION IN DISABILITY ADVOCACY AND SUPPORTS

Efforts to promote self-determination in disability advocacy and services have taken
several forms. Among the first such initiatives were programmatic efforts to provide
instruction and opportunities to promote the self-determination of transition-age
youth with disabilities. Research with adolescents with disabilities has shown that stu-
dents who leave high school more self-determined achieve more positive adult out-
comes, including better employment, community inclusion, and independent living
outcomes. Educational efforts focus on teaching students the skills and knowledge they
will need to act in a self-determined manner. Curricular areas include teaching deci-
sion making, problem solving, goal setting, self-advocacy, and self-management skills.
In addition, providing opportunities for students to express preferences and make
choices has also been recognized as important. Thus, a frequent practice involves
instructional efforts and supports to enable students to play a meaningful role in their
own transition planning meeting, including, in some circumstances, having the stu-
dent be the chairperson for the meeting.
A second application of the self-determination construct to disability advocacy and
supports has involved initiatives that enable people with disabilities (and, when
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 SELF-DETERMINATION

necessary or appropriate, their family members) to make decisions about how money
and other resources that are intended to provide supports are allocated and used. His-
torically, funding for services was given to agencies that created these supports. How-
ever, many people with disabilities found that available services did not fit their needs
well. As an alternative, model programs began to be developed in which the funding
went to the person with the disability and/or his or her family, who then made deci-
sions about what services to purchase. These models often involved person-centered
planning, individualized budgeting, and the use of service brokers, who act on behalf
of the person with the disability or his or her family to identify what options exist to
provide the types of supports identified by the person and his or her family.
What is central to both of these initiatives and similar efforts is that they enable
people with disabilities to act in a self-determined manner—that is, to act volitionally,
without coercion, and to make or cause things to happen in their lives.
Writing in 2000, Jean Paul Bovee, a man with autism, stated that ‘‘people with au-
tism should be treated with the same dignity, respect, and equality as people without
autism’’ (pp. 250–251). Recognizing the importance of promoting self-determination is
an important way to ensure that people are treated with dignity and respect and to
enable people to attain true equality.

REFERENCE
Bovee, J. P. (2000). A right to our own life, our own way. Focus on Autism and Other Develop-
mental Disabilities, 15(4), 250–252.

FURTHER INFORMATION
Algozzine, B., Browder, D., Karvonen, M., Test, D. W., & Wood, W. M. (2001). Effects of
intervention to promote self-determination for individuals with disabilities. Review of Educa-
tional Research, 71, 219–277.
Field, S., Martin, J., Miller, R., Ward, M., & Wehmeyer, M. (1998). A practical guide to teaching
self-determination. Reston, VA: Council for Exceptional Children.
Palmer, S., & Wehmeyer, M. L. (2003). Promoting self-determination in early elementary
school: Teaching self-regulated problem-solving and goal setting skills. Remedial and Special
Education, 24, 115–126.
Sowers, J., & Powers, L. (1995). Enhancing the participation and independence of students with
severe physical and multiple disabilities in performing community activities. Mental Retarda-
tion, 33, 209–220.
Test, D. W., Karvonen, M., Wood, W. M., Browder, D., & Algozzine, B. (2000). Choosing
a self-determination curriculum: Plan for the future. Teaching Exceptional Children, 33(2),
48–54.
Wehmeyer, M. L. (1998). Self-determination and individuals with significant disabilities: Exam-
ining meanings and misinterpretations. Journal of the Association for Persons with Severe Handi-
caps, 23, 5–16.
Wehmeyer, M. L. (1999). A functional model of self-determination: Describing develop-
ment and implementing instruction. Focus on Autism and Other Developmental Disabilities,
14, 53–61.
Wehmeyer, M. L., Abery, B., Mithaug, D. E., & Stancliffe, R. J. (2003). Theory in self-determination:
Foundations for educational practice. Springfield, IL: Charles C Thomas, Publisher.
Wehmeyer, M. L., Agran, M., & Hughes, C. (1998). Teaching self-determination to students with
disabilities: Basic skills for successful transition. Baltimore: Brookes Publishing Co.
Wehmeyer, M. L., & Palmer, S. B. (2003). Adult outcomes for students with cognitive disabil-
ities three years after high school: The impact of self-determination. Education and Training in
Developmental Disabilities, 38, 131–144.

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SELF-HELP SKILLS

Wehmeyer, M. L., Palmer, S. B., Agran, M., Mithaug, D. E., & Martin, J. (2000). Teaching stu-
dents to become causal agents in their lives: The self-determining learning model of instruc-
tion. Exceptional Children, 66, 439–453.
Wehmeyer, M. L., & Schwartz, M. (1997). Self-determination and positive adult outcomes: A
follow-up study of youth with mental retardation or learning disabilities. Exceptional Children,
63, 245–255.
MICHAEL L. WEHMEYER

SELF-HELP SKILLS
Self-help skills generally focus on necessary skills for an individual to perform inde-
pendently the routine activities of daily living. At the most basic level, these include
dressing oneself, demonstrating knowledge of personal hygiene (bathing, brushing
teeth, grooming), feeding oneself, and caring for one’s possessions. At a more advanced
level, these skills can include knowing how and who to ask for assistance, exercising
judgment in terms of interacting with others and decision making, using money to
make purchases, traveling in the community independently, maintaining a job, living
successfully in semi-independent or independent circumstances, socializing appropri-
ately with peers and coworkers, and other necessary skills expected for independence.
See also adaptive behavior; self-advocacy.
ANDREA M. BABKIE

SELF-INJURIOUS BEHAVIOR
Self-injurious behavior (SIB) is any self-inflicted physical behavior that causes
bruises, open wounds, tissue damage, redness, bleeding, and welts. These behaviors are
most commonly inflicted by biting the hand, wrist, or arm, head-banging, and scratch-
ing or rubbing the skin. Sometimes seen in individuals with autism or severe develop-
mental disabilities, self-injurious behavior may have many reasons for its manifestation.
These include possible biochemical problems (release of beta-endorphins from the
injury); seizure activity; masking of pain from competing infections, headaches, or gas-
trointestinal problems; sensory stimulation to increase arousal levels; frustration due to
communication difficulties; and social attention. A thorough functional behavioral/
medical analysis is needed to determine causes and interventions for self-injurious
behavior.
See also functional behavior assessment; seizures; sensory integration.

FURTHER INFORMATION
Durand, V. M., & Crimmins, D. B. (1988). Identifying the variables maintaining self-injurious
behavior. Journal of Autism and Developmental Disorders, 18, 99–117.
Dyer, K., & Larsson, E. V. (1997). Developing functional communication skills: Alternatives to
severe behavior problems. In N. Singh (Ed.), Prevention and treatment of severe problems: Mod-
els and methods in developmental disabilities (pp. 121–148). Pacific Grove, CA: Brooks Cole
Publishing Company.
Edelson, S. M. (1984). Implications of sensory stimulation in self-destructive behavior. American
Journal of Mental Deficiency, 89, 140–145.
Edelson, S. M., Taubman, M. T., & Lovaas, O. I. (1983). Some social contexts to self-destructive
behavior. Journal of Abnormal Child Psychology, 11, 299–312.
ANN PILEWSKIE

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SELF-REGULATION
Self-regulation is the ability of an individual to recognize her own sensory needs
and adjust her actions and behaviors as needed to meet the demands of the activity or
situation in which she is engaged.
KELLY M. PRESTIA

SENSATION AVOIDING
Sensation avoiding is a neurological characteristic of individuals who have a low
sensory threshold, or tolerance, for sensory stimuli in which they withdraw or avoid
certain environments or activities that are overwhelming or unpleasant for them. For
example, an individual with a low threshold for tactile stimulation may refuse to wear
loose or scratchy clothing.
KELLY M. PRESTIA

SENSATION SEEKING
Sensation seeking is a neurological characteristic of individuals who have a high
threshold, or tolerance, for sensory stimuli. Sensory seekers are constantly looking for
sensory stimuli in their environment in an attempt to fulfill their sensory need. The
child who runs his hand along the wall as he walks down the hall may be seeking sen-
sory input from the changes in textures on the wall.
KELLY M. PRESTIA

SENSORIMOTOR
Sensorimotor refers to the connection between movement and sensation. The brain
receives sensory information via one or more of the sensory systems, the nervous sys-
tem processes that information, and the body turns that information into a meaning-
ful, appropriate motor response.
KELLY M. PRESTIA

SENSORIMOTOR EARLY CHILDHOOD ACTIVITIES

Young children with poor sensory processing abilities, especially those with autism
spectrum disorder (ASD), benefit from specific sensorimotor input in order to modu-
late their nervous systems so that they can participate in activities of daily living.
Such activities are most beneficial in early childhood, the period of time when their
sensory systems are at the most crucial neurological development. There are many
ways to introduce these sensory-rich experiences to children with sensory processing
disorder (SPD), for example including sensory strategies incorporated into a child’s
daily routine along with sensorimotor activities can help a child maintain a ‘‘just
right’’ alertness for participation and focusing.
Early childhood sensorimotor activities involve integration on multiple levels. The
activities are integrated within the context of a child’s educational curriculum, an
integrative team of therapists and teachers work together, and the activities them-
selves integrate each child’s nervous system in an organized manner. These activities
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are based on four principles: (a) they are created around the sensory integration
(Ayers, 1979), so that sequenced activities follow sensorimotor development for each
lesson plan; (b) they are theme based, as activities are developed around thematic
educational curriculum, and literature based, as a storybook is included in every lesson
plan, allowing children to develop early emergent literacy skills; (c) they use a trans-
disciplinary approach to treatment in which an integrated team crosses the discipli-
nary lines collaborating and modeling for one another utilizing best practice for
services; and (d) the children engage in the sensorimotor activities within classroom
settings for inclusion with peer models.
There can be many different themes included with these early childhood sensori-
motor activities, anything from apples to zoo. As outlined by Brack (2004), the
structure of the early childhood sensorimotor activities always follows a prescribed
sequence:

1. A warm-up activity cues children that group time is ready to begin and introduces them
to the theme.
2. A movement activity involving the vestibular system helps to alert the nervous system
for engagement.
3. A ‘‘heavy work’’ activity involving the proprioceptive system helps to modulate the nerv-
ous system allowing the children to focus.
4. A balance activity is a higher level of sensory integration and balance skills are necessary
for large motor skills development.
5. An eye-hand coordination activity helps children develop skills necessary for school read-
iness, such as handwriting, coloring, and cutting.
6. A cool-down activity helps children attain a ‘‘just right’’ alertness level so that they are
prepared to focus on the fine-motor activity.
7. A fine-motor activity completes the routine as the children engage in functional activ-
ities. The children work on refined fine-motor coordination skills so that they can hold a
pencil, use crayons and scissors, and manipulate fasteners such as buttons and zippers.

Transitions can be difficult for children with SPD and especially children who are
on the autism spectrum. Therefore a transition sequence is included in every lesson
plan. This involves the children giving themselves a hug, pushing on their heads,
(proprioceptive input), blowing a feather (for deep diaphragmatic breathing for sen-
sory modulation), ‘‘kissing their brains’’ for self-affirmation, finally saying, ‘‘You’re so
smart, you’re ready to start!’’
While the children are engaged in the sensorimotor activities, they are developing
essential school readiness skills for cognitive development, language skills for commu-
nication, social skills for cooperative and imaginative play, and emotional develop-
ment to give courage and hope for children with sensory processing difficulties.
See also imagination; proprioception; sensory processing; sensory processing dysfunc-
tion; social skills training; vestibular.

REFERENCES
Ayres, A. J. (1979). Sensory integration and the child. Los Angeles: Western Psychological
Services.
Brack, J. C. (2004). Learn to move, move to learn: Sensorimotor early childhood activity themes.
Shawnee Mission, KS: Autism Asperger Publishing Company.
JENNY CLARK BRACK
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 SENSORY INTEGRATION

SENSORY HISTORY
Sensory history is documented information from a primary caregiver regarding an
individual’s sensory preferences and patterns of behavior. This information is impor-
tant in developing appropriate interventions and setting up the individual’s environ-
ment for optimal performance.
KELLY M. PRESTIA

SENSORY INTEGRATION
Sensory integration is often used interchangeably to describe three different, but
related, areas. The term sensory integration can describe a theory, a neurological proc-
ess, and a form of therapy. First, sensory integration is often used to describe a
theory developed in the 1970s by Dr. A. Jean Ayres, an occupational therapist who
researched sensory functioning in individuals with learning disabilities. Ayres pro-
posed that maladaptive, inappropriate behaviors result from a dysfunction in the
nervous system between the sensory receptors: the brain and the motor responses
(Ayres, 1979). Sensory integration is a model that describes, as well as anticipates,
behavior from a neurological perspective. Ayres also described sensory information as
‘‘food for the brain’’ (Ayres, 1979). Similar to the way our bodies process food for
nourishment and physical activity, our brains must process sensory information for
optimal physical, cognitive, and neurological development. Fisher and Murray (1991)
describe five assumptions of sensory integration as a theory. First, the central nervous
system is ‘‘plastic’’—that is, its structure and processes can be modified or changed.
Second, sensory integration within the nervous system occurs in a developmental
sequence. This means that behaviors can change as the nervous system matures.
Third, the brain functions as a whole but the individual sensory systems are organ-
ized in a hierarchy. The brain is composed of low and high areas. The lower areas
are where the sensory information is received and organized. The higher areas are
where more complex, cognitive functioning takes place, such as language, learning,
and complex behavior. The emergence of the higher levels is dependent upon the
ability of the lower levels to receive, organize, and integrate information properly.
Fourth, eliciting adaptive behaviors facilitates a nervous system that functions in an
organized, integrated manner. Conversely, an accurately and appropriately function-
ing sensory and nervous system is reflected through adaptive responses. Sensory inte-
gration theory believes that the development of behaviors is circular, in that each
behavior gives feedback to the nervous system, which in turn, promotes further mat-
uration of the nervous system. Finally, there is an inner drive within people to de-
velop integration between their sensory systems and nervous system through
sensorimotor activities. Simply ‘‘being’’ or ‘‘seeing’’ is not enough for people. Individ-
uals have a strong desire to explore and learn about their environment and its con-
tents for themselves.
Sensory integration also describes the neurological process between the sensory
receptors, the brain, and the muscles and nerves that produce behaviors and responses.
It is the ability of the brain to receive input from various receptors in the body,
organize and prioritize that input, and produce an appropriate behavior or response,
known as an adaptive behavior or adaptive response. The sensory receptors have two
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main functions. First, sensory receptors respond to a sensation to alert or arouse the
brain to generate awareness. This is important for detecting harmful situations. Sec-
ond, the receptors respond to gather information about the environment to create a
sort of ‘‘map’’ of the body and the environment. These ‘‘maps’’ help the brain to
organize a response and take appropriate action. It also helps us to differentiate
objects in the environment, and know where our bodies end and where the world
begins. In typical sensory integration, these two functions of the sensory receptors
work together and balance one another so that we may be alerted to harmful situa-
tions, as well as learn from our environment. When an imbalance of these two sys-
tems occurs, a dysfunction of sensory integration occurs. Typical sensory integration is
important for the development of self-control, self-esteem, motor skills, and higher-
level cognitive functions (Kranowitz, 2003). When sensory integration within the
body is disrupted or dysfunctional, atypical or inappropriate behaviors and responses
can be seen.
Third, sensory integration can also refer to a specific therapeutic intervention, often
provided by an occupational therapist. Sensory integration therapy is a direct inter-
vention, which provides controlled sensory input, often combined with physical activ-
ity, to produce an adaptive response. Interventions that combine increasing challenges
with activities in which the individual is already successful often have the most suc-
cessful results for changing behaviors. The behaviors and responses of the individual
receiving sensory integration therapy must be carefully monitored by the intervening
therapist to determine if the sensory input is appropriate in intensity and length, and
is meaningful to the individual. If sensory stimulation is too intense or not meaningful
for the individual, then no change in response or an adverse change in responses may
occur. The overall goal of sensory integration therapy is to rewire the nervous system
to process and organize sensory information more efficiently and effectively to produce
adaptive responses. Before an intervention begins, the intervening therapist may use
specific assessment tools to gather important information about how the individual is
functioning. For example, The Sensory Profile (Dunn, 1999) or The Sensory Integration
and Praxis Test (Ayres, 1989) are tools used by professionals to gather information
regarding the individual’s ability to process sensory information, and how they respond
to typical sensory stimuli. Specialized certifications and training programs in sensory
integration therapy are available for professionals.
See also maladaptive behavior; self-injurious behavior.

REFERENCES
Ayres, A. J. (1979). Sensory integration and the child. Los Angeles: Western Psychological
Services.
Ayres, A. J. (1989). The sensory integration and praxis test. Los Angeles: Western Psychological
Services.
Dunn, W. (1999). The sensory profile. San Antonio, TX: Harcourt Assessment.
Fisher, A. G., & Murray, E. A. (1991). Introduction to sensory integration theory. In A. G.
Fisher, E. A. Murray, & A. C. Bundy (Eds.), Sensory Integration Theory and Practice (pp. 3,
15–17). Philadelphia: F. A. Davis Company.
Kranowitz, C. S. (2003). The out of sync child has fun. New York: Berkley Publishing
Group.
KELLY M. PRESTIA
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 SENSORY INTEGRATION DYSFUNCTION

SENSORY INTEGRATION AND PRAXIS TEST (SIPT)

The Sensory Integration and Praxis Test (SIPT; Ayres, 1989) is a standardized bat-
tery consisting of 17 subtests designed to identify patterns of function and dysfunction
in sensory integration and motor planning (praxis). Administration of this assessment
is time-consuming (2–3 hours) and scoring is tedious (computer scoring programs can
help cut down on scoring time). It is appropriate for use with children ages 4 through
8 years, 11 months of age. Competent administration and interpretation of this assess-
ment require specific training and certification provided by Sensory Integration Inter-
national or Western Psychological Services.

REFERENCE
Ayres, J. (1989). The Sensory Integration and Praxis Test. Los Angeles: Western Psychological
Services.
LISA ROBBINS

SENSORY INTEGRATION DYSFUNCTION

Individuals on the autism spectrum are often called lazy, overactive, stubborn, or
even accident prone. These descriptions often misrepresent individuals when it comes
to the child with an autism spectrum disorder (ASD). Many individuals with ASD
have difficulty regulating their sensory systems. This is known as sensory integration
dysfunction (SID).
A. Jean Ayres (1973) wrote Sensory Integration and Learning Disorders. It was in this
first book that she described the first six sensory modalities: (a) the vestibular system,
(b) the tactile system, (c) proprioception, (d) the auditory system, (e) olfaction, and
(f) vision. Today professionals in the area of sensory systems have added the gustatory
system to the sensory systems to make the total seven. These seven sensory systems
work together to interpret the sensory input coming in from the environment, chang-
ing the input into information that the body can use. For further descriptions of each
sensory system and where they are found, see Table 7.
SID is the inability of the sensory system to interpret input from the environ-
ment in a manner that is usable. Individuals with SID do not effectively utilize sen-
sory information coming through the sensory systems in a manner that is
functional. As a result, individuals with SID appear to be clumsy, unoriented, or
lazy (Miller & Lane, 2000). In response, an individual may avoid confusing or
distressing sensations or seek out more of the sensation to find out more about it
(Biel & Peske, 2005).
A variety of sensory assessments are available to provide the necessary information
for professionals, such as occupational therapists, to provide the correct form of sen-
sory integration therapy. Commonly used assessments include: (a) the Sensory Profile
(Dunn, 1999), (b) the Short Sensory Profile (McIntosh, Miller, Schyu, & Dunn,
1999), and (c) Sensory Integration and Praxis Test (SIPT; Ayres, 1989). Administra-
tion and interpretation of these assessments are typically the first steps in determining
the type(s) of sensory integration therapy necessary for an individual. These interven-
tions aid the sensory systems of individuals with SID to organize themselves, thus
allowing the child to function appropriately.
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Table 7. Location and Functions of the Sensory Systems

System Location Function

Tactile (touch) Skin—density of cell distribu- Provides information about the envi-
tion varies throughout the ronment and object qualities (touch,
body. Areas of greatest den- pressure, texture, hard, soft, sharp,
sity include mouth, hands, dull, heat, cold, pain).
and genitals.
Vestibular (balance) Inner ear—stimulated by head Provides information about where our
movements and input from body is in space, and whether or not
other senses, especially we or our surroundings are moving.
visual. Tells about speed and direction of
movement.
Proprioception Muscles and joints—activated Provides information about where a cer-
(body awareness) by muscle contractions and tain body part is and how it is
movement. moving.
Visual (sight) Retina of the eye—stimulated Provides information about objects and
by light. persons. Helps us define boundaries
as we move through time and space.
Auditory (hearing) Inner ear—stimulated by air/ Provides information about sounds in
sound waves. the environment (loud, soft, high,
low, near far).
Gustatory (taste) Chemical receptors in the Provides information about different
tongue—closely entwined types of taste (sweet, sour, bitter,
with the olfactory (smell) salty, spicy).
system.
Olfactory (smell) Chemical receptors in the nasal Provides information about different
structure—closely associated types of smell (musty, acrid, putrid,
with the gustatory system. flowery, pungent).
Source: From Asperger Syndrome and Sensory Issues: Practical Solutions for Making Sense of the World (p. 5), by B. S.
Myles, K. T. Cook, N. E. Miller, L. Rinner, & L. A. Robbins, 2000, Shawnee Mission, KS: AAPC.

REFERENCES
Ayres, A. J. (1973). Sensory integration and learning disorders. Los Angeles: Western Psychological
Services.
Ayres, A. J. (1989). Sensory integration and praxis test. Los Angeles: Western Psychological Services.
Biel, L., & Peske, N. (2005). Raising a sensory smart child. New York: Penguin Books.
Dunn, W. (1999). The Sensory Profile: A contextual measure of children’s responses to sensory expe-
riences in daily life. San Antonio, TX: The Psychological Corporation.
McIntosh, D. N., Miller, L. J., Schyu, V., & Dunn, W. (1999). Short sensory profile. San Anto-
nio, TX: The Psychological Corporation.
Miller, L. J., & Lane, S. J. (2000). Toward a consensus in terminology in sensory integration
theory and practice: Part 1: Taxonomy of neurophysiological processes. Sensory Integration
Special Interest Section Quarterly, 23(1), 1–4.
Myles, B. S., Cook, K. T., Miller, N., Rinner, L., & Robbins, L. (2000). Asperger syndrome and
sensory issues: Practical solutions for making sense of the world. Shawnee Mission, KS: Autism
Asperger Publishing Company.

FURTHER INFORMATION
Brack, J. C. (2004). Learn to move; move to learn: Sensorimotor early childhood themes. Shawnee
Mission, KS: Autism Asperger Publishing Company.

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 SENSORY PROFILE

Brack, J. C. (2005). Sensory processing disorder: Simulations and solutions for parents, teachers and
therapists. Shawnee Mission, KS: Autism Asperger Publishing Company.
Emmons, P. G., & Anderson, L. M. (2005). Understanding sensory dysfunction: learning, develop-
ment and sensory dysfunction in autism spectrum disorders, ADHD, learning disabilities and bipolar
disorder. London: Jessica Kingsley.
Kranowitz, C. (1998). The out of sync child: Recognizing and coping with sensory integration dysfunc-
tion. New York: Skylight Press.
Williams, M. W., & Shellenberger, S. (1996). How does your engine run? A leader’s guide to the
Alert Program for Self-Regulation. Albuquerque, NM: Therapy Works.
Yack, E., Aquilla, P., & Sutton, S. (2003). Building bridges through sensory integration (2nd ed.).
Las Vegas: Sensory Resources.
JENNIE LONG

SENSORY INTEGRATION INVENTORY–REVISED (SII-R)

The Sensory Integration Inventory–Revised (SII-R; Reisman & Hanschu, 1992) is a
screening tool can be used in two ways: (a) it can be completed by therapists, staff, or
teachers familiar with a child in approximately 30 minutes; or (b) it can be used by
an occupational therapist as a semistructured interview for parents, teachers, caregiv-
ers, and others. Respondents mark whether or not a described behavioral response is
typical, not typical, or unsure if the behavior is typical or not. Items are organized into
four sections: tactile, vestibular, proprioceptive, and general reactions. Items are con-
sidered to reflect possible patterns of sensory processing difficulties.
See also proprioception.

REFERENCE
Reisman, J., & Hanschu, B. (1992). Sensory integration inventory–revised. Farmington, MA: Ther-
apro, Inc.
LISA ROBBINS

SENSORY PROCESSING
Sensory processing is the process of receiving sensory information from the environ-
ment through one or more of the senses and transmitting that information to the brain.
See also sensory integration; sensory integration disorder; sensory processing
dysfunction.
KELLY M. PRESTIA

SENSORY PROCESSING DYSFUNCTION

Sensory processing dysfunction is the inability to accurately perceive sensory infor-
mation from the environment through one or more of the sensory systems.
See also sensorimotor early childhood activities; sensory integration disorder.
KELLY M. PRESTIA

SENSORY PROFILE
The Sensory Profile (Dunn, 1999) is a norm-referenced questionnaire completed by
someone who is very familiar with the child. The items on the profile describe child-
ren’s behavioral responses to different sensory experiences, and their ability to modu-
late/adjust their reactions efficiently. It provides a description of emotional and
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behavioral responses associated with sensory processing difficulties. The Sensory Profile
can be given in an interview format or to the respondent for independent completion.
The person completing the profile reads each description and determines how often
the child engages in a certain behavior (always, frequently, occasionally, seldom, or
never). Scoring and interpretation takes approximately 20 to 30 minutes.
See also norm-referenced assessment; sensory integration disorder.

REFERENCE
Dunn, W. (1999). Sensory profile. San Antonio, TX: Harcourt Assessment.
LISA ROBBINS

SENSORY SENSITIVITY
Sensory sensitivity is a neurological characteristic of individuals who have a low
threshold, or tolerance, for sensory stimuli. Accordingly, these individuals are easily
overwhelmed or disorganized by sensory information. Individuals with sensory sensitiv-
ity may be easily distracted or hyperactive, as they attend to all new stimuli in their
environment.
KELLY M. PRESTIA

SENSORY STIMULI
Sensory stimuli is a general term that refers to any occurrence within an environ-
ment that evokes a response.
KELLY M. PRESTIA

SENSORY THRESHOLD
Sensory threshold refers to the amount of a stimulus needed to evoke a response
from an individual. Thresholds are neurological points within the nervous system at
which an action may result when enough of a stimulus is provided.
KELLY M. PRESTIA

SEROTONIN
Serotonin is a chemical that serves as a neurotransmitter in the brain but also is
found in other parts of the body with other functions. It is found in gastrointestinal
mucosa, platelets (for blood clotting), and mast cells (related to allergies and
inflammation).
BRUCE BASSITY

SETTING EVENTS
A setting event is something happening in the environment that controls or influ-
ences behavior. This control usually takes the form of temporarily changing the way
an individual responds to an interaction that follows the setting event. For example, a
student is being bullied on the bus ride home. This is a setting event for the interac-
tions that he will have at home that evening, and possibly even into the next day.

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The setting events for a behavior may not always happen immediately before the
behavior; there may be a delayed impact.
See also applied behavior analysis.

FURTHER INFORMATION
Cooper, J. O., Heron, T. E., & Heward, W. L. (1987). Applied behavior analysis. Upper Saddle
River, NJ: Pearson Education.
KATIE BASSITY

SHAPING
Shaping is a behavioral strategy used to teach an individual a new behavior. Shap-
ing a new behavior involves providing reinforcement for successive approximations of
the target behavior. Reinforcement is provided each time a behavior is exhibited that
approximates the target behavior. Once that particular behavior is firmly established
in the individual’s repertoire of behaviors, then reinforcement is reserved only for a
new behavior that more closely approximates the target behavior. This process is con-
tinued to help guide the individual towards the acquisition of a goal behavior in a
step-by-step manner.
See also applied behavior analysis.

FURTHER INFORMATION
Anderson, S. R., Taras, M., & Cannon, B. O. (1996). Teaching new skills to young children
with autism. In C. Maurice, G. Green, & S. L. Luce (Eds.), Behavioral intervention for young
children with autism (pp. 181–194). Austin, TX: Pro-Ed.
ANDREA HOPF AND TARA MIHOK

SHORT SENSORY PROFILE

The Short Sensory Profile (Dunn, 2001) is a 38-item abbreviated form of the Sensory
Profile (1999) and is appropriate for children ages 3 to 17. It can be used as a screen-
ing tool to determine whether or not more in-depth assessment is needed in the area
of sensory processing. It can be completed in about 10 minutes by someone who
knows the child, and scored and interpreted in 10 to 20 minutes by someone with
knowledge in the area of sensory integration.

REFERENCES
Dunn, W. (1999). Sensory profile. San Antonio, TX: Harcourt Assessment.
Dunn, W. (2001). Short sensory profile. San Antonio, TX: Harcourt Assessment.
LISA ROBBINS

SIBLING SUPPORT PROJECT

Sibling Support Project is a national program devoted to providing information and
creating peer support programs for siblings of individuals with disabilities, illnesses,
and mental health issues. This project provides workshops, listservs, children’s books,
publications, and Web sites to assist siblings of all ages gain a better understanding of
their brother or sister and cope with the unique issues surrounding having a sibling

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with a disability. Additionally, the Sibling Support Project has developed curricula to
assist agencies or schools in developing Sibshops.

FURTHER INFORMATION
6512 23rd Ave NW, #213
Seattle, WA 98117
Phone: 206.297.6368
Fax: 509.752.6789
Web site: www.thearc.org/siblingsupport/.
KATHERINE E. COOK

SIBSHOPS
In families that include children with disabilities, siblings of exceptional children
are often lost in the shuffle. Siblings should be included in planning for meeting the
needs of families with children with disabilities. Often siblings may assume roles not
required in the typical family such as taking on care-giving roles similar to a parent.
Research shows that meeting the needs of typical siblings is critical in the big family
picture (Winter, n.d.).
Donald Meyer, the director of The Sibling Support Project, created Sibshops in
1994 as a way to support typical siblings and help them deal with their personal situa-
tions involving their families in a healthy manner. Typical siblings deal with a variety
of concerns that need to be addressed in an appropriate manner. These include isola-
tion, feeling guilt about or resentment toward their sibling and/or family, being a care-
giver to their sibling, feeling pressured to perform well in school, and other activities
and future concerns regarding their sibling (Harakas, 2005a). Sibling concerns should
be addressed as part of the whole family’s health and well-being.
Often Sibshops are described as parties or celebrations for these brothers and sisters
who bring so much to their exceptional families. They were created specifically for
child siblings of individuals with health and developmental needs but have been
modified successfully for similar concerns. Currently the Sibshop model is used in 160
specific gatherings including 10 countries worldwide. These countries include: Argen-
tina, Canada, Croatia, England, Guatemala, Iceland, Japan, Mexico, New Zealand,
and the United States (Harakas, 2005b).
The Sibshop model has five specific goals for each session. First, Sibshops will provide
typical siblings the opportunity to meet with other brothers and sisters in a fun and rec-
reational event. Second, the activity will allow opportunities to share common joys and
difficulties with other typical siblings. Third, siblings will have an opportunity to see
how other siblings handle similar situations they have encountered in their own lives.
Fourth, siblings will have a chance to learn more about the needs of their exceptional
sibling. Finally, Sibshops will gain information about the needs and concerns experi-
enced by typical siblings of individuals with disabilities, which will, in turn, be shared
with parents and professionals in the hopes of better meeting the needs of the whole fam-
ily (Meyer & Vadasy, 2000). By having these goals, Sibshops are easily run by organiza-
tions that have received the proper training and keep these goals in mind with planning.
Sibshops were originally created for children ages 8 to 13, but with a little modifica-
tion they can meet the needs of older and younger siblings. They have been adapted

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to meet the needs of specific populations as well. Sibshops are recreational in theme,
with fun games and activities, as well as time for discussions. They are designed to be
unique and appeal to a wide variety of children. Sibshops can be held on a weekly,
monthly, or yearly schedule (Meyer & Vadasy, 2000). Sometimes they are offered in
conjunction with conferences for parents.
Sibshops run from 2 to 6 hours and include a variety of activities and discussions
that are similar during each meeting. Sibshops generally start with a ‘‘trickle-in activ-
ity’’ that allows latecomers to arrive and time for participants to transition into the
activities. This is followed with an introductory activity. The rest of the time is filled
with fun recreational games, crafts, peer discussion groups, informational activities,
and guest speakers (Meyer & Vadasy, 2000).
One favorite activity that is a standard for Sibshops is ‘‘Dear Aunt Blabby.’’ During
this activity, Aunt Blabby, a fictional advice columnist, requires expert help in
answering letters written by typical siblings with an exceptional brother or sister. Aunt
Blabby does not have a sibling with a disability and requires expert help in answering
her letters. Participants are asked to read a letter to Aunt Blabby and then answer it
using their own expertise and experiences. This is an easy activity to involve siblings,
as they are often interested in sharing their own ideas and experiences (Meyer &
Vadasy, 2000).
Successful Sibshops require forethought and preparation. Depending on the
expected attendance there should be at least two facilitators. In general, it is best to
have an adult sibling as a facilitator to share their perspectives. Other appropriate
facilitators are often service providers and could include teachers, nurses, doctors,
therapists, social workers, and psychologists. Parents of exceptional children may vol-
unteer their services but should not facilitate a Sibshop in which their child partici-
pates (Meyer & Vadasy, 2000).
Sibshops are not a therapy, although a therapeutic effect may be seen in some par-
ticipants. They offer similar support that an adult group would offer to parents in a
parent support group (Harakas, 2005b). They focus on the idea that most families are
functioning acceptably with concerns and issues and offer a safe place to share and
learn. Facilitators of Sibshops may refer siblings for further interventions if concerns
are noted (Meyer & Vadasy, 2000). One study showed that there was no significant
increase in self-esteem in siblings (D’Arcy, Flynn, McCarthy, O’Connor, & Tierney
2005). However, most reported they liked the activities and thought they had learned
from the event. Parents also reported positively regarding the program and felt their
typical children received benefits from attending.
Sibshops are a valuable tool for families with exceptional and typical siblings. They
offer a fun, safe environment for typical siblings to share their experiences and learn
from other typical siblings as they engage in activities. While Sibshops are not consid-
ered therapy, they offer a supportive place for siblings to interact with other typical
peers with similar families. Sibshops are similar to a support group setting for adults,
just geared to meet the needs of children.

REFERENCES
D’Arcy, F., Flynn, J., McCarthy, Y., O’Connor, C., & Tierney, E. (2005). Sibshops: An evalua-
tion of an interagency model. Journal of Intellectual Disabilities, 9(1), 43–57.

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SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY

Harakas, M. (2005a, January 2). The invisible ones. South Florida Sun-Sentinel. Retrieved
December 10, 2006, from http://www.sun-sentinel.com/features/lifestyle/sfl-lisiblingsjan02,0,
4197092.story?coll=sfla-features-headlines.
Harakas, M. (2005b, January 2). Sibshops is about fun, friendship. South Florida Sun-Sentinel.
Retrieved June 10, 2005, from www.sun-sentinel.com/features/lifestyle/sfl-lisiblings-sidejan02,
0,6947269.story?coll=sfla-features-headlines.
Meyer, D. J., & Vadasy, P. F. (2000). Sibshops: Workshops for siblings of children with special needs.
Baltimore: Brooks Publishing Co.
Winter, J. (n.d.) Sibshops. Retrieved June 10, 2005, from www.enabledonline.com/BackIssues/
Jan-Feb2002/text/kids1.html.

FURTHER INFORMATION
Meyer, D. J. (Ed.). (2005). The sibling slam book: What it is really like to have a brother or sister
with special needs. Bethesda, MD: Woodbine House.
The Sibling Support Project: www.siblingsupport.org.
VALERIE JANKE REXIN

SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY. See Positron

Emission Tomography

SINGLE-SUBJECT DESIGN
Single-subject design is often considered the design of choice when measuring be-
havioral change or when performing behavioral modification. Rather than comparing
groups of subjects, this design relies on the comparison of treatment effects on a single
participant or on a small group of individuals.
See also behavior modification.
JAN L. KLEIN

SITUATION-OPTIONS-CONSEQUENCES-CHOICES-STRATEGIES-
SIMULATION (SOCCSS)
SOCCSS, the Situation-Options-Consequences-Choices-Strategies-Simulation strat-
egy, was developed by Jan Roosa (Myles & Adreon, 2001) to help students with social
disabilities process social situations and develop problem-solving skills by putting
social and behavioral issues in a sequential form. SOCCSS is commonly used after
a social situation to help students process and interpret the situation and their
choices. This strategy may also be used to preteach social skills or social situations
that the students may encounter. This may be done in a small group or a one-on-one
situation.
The steps in the SOCCSS strategy are as follows:

1. Situation: Following a social problem, students report to a teacher the who, what, when,
where, and why of the conflict. Who was involved in the situation? What actually hap-
pened? When did it happen? Where did the problem occur? Why did it happen? As the
students become familiar with the SOCCSS strategy, the goal is for them to independ-
ently report these variables without prompting.
2. Options: The students and adult brainstorm behavioral options that the student could
have chosen. The adult should accept all answers and record them on the SOCCSS form.

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At the beginning of the process, adults may need to encourage the students to brainstorm
multiple options that they could have chosen.
3. Consequences: For each behavioral option generated, a consequence is listed. To do so,
the adult asks the student, ‘‘So what would happen if you. . .’’ and names the first option
from the list. As the adult goes down the list of created options, some of the options may
have one or more consequences. Students may have difficulty generating consequences;
thus role-playing at this stage may be beneficial.
4. Choices: Options and consequences are prioritized using 1 through 5 or a yes/no response.
Once prioritized, the student should be prompted to pick the choice that she thinks
(a) she will be able to carry out, and (b) the one that most likely gets her what she wants.
5. Strategies: Next, the student develops a plan to carry out the choice that she made if the
situation occurs again. It is crucial for the student to develop the plan so she feels like
she has ownership over the plan.
6. Simulation: Practice is the last stage in the SOCCSS strategy. Simulation can occur by
visually imagining, talking with another person about the plan, writing down the plan, or
role-playing. Regardless of the method selected, the student ends up evaluating his
impressions of the simulation.

SOCCSS allows students to learn cause and effect, that choices exist in all situa-
tions, and that, through choice making, they can impact the result of the situation.

REFERENCE
Myles, B. S., & Adreon, D. (2001). Asperger syndrome and adolescence: Practical solutions for
school success. Shawnee Mission, KS: Autism Asperger Publishing Company.
MELISSA L. TRAUTMAN

SOCIAL ARTICLES. See Social Stories

SOCIAL AUTOPSIES
Developed by Richard LaVoie (cited in Bieber, 1994), social autopsies are designed
to help students with autism spectrum disorders (ASD) understand social situations
and mistakes made during those situations. A social skills autopsy is guided by an adult
who asks a series of questions to identify the error and possible solutions. These ques-
tions and their answers can be documented in a worksheet, filled out either by the stu-
dent or the teacher. This visual format capitalizes on the favored mode of processing
for many students with ASDs, and serves as a record to reference in future situations.
For an example of what a social autopsy worksheet may look like, see Figure 17.
The autopsy begins with an adult asking, ‘‘What happened?’’ to the student. This
prompt allows the student to start the process of ‘‘dissecting’’ the social situation. As
the student describes the social situation, the adult asks clarifying questions designed
to help the student identify the error, determine who was harmed by the error, decide
how to correct the error, and finally develop a plan so that the error does not happen
again.
Social autopsies help students learn the cause-and-effect relationship between a
social behavior and its consequences. Adults in all of the students’ environments
should be knowledgeable on how to complete a social autopsy to help foster general-
ization and skill acquisition.
See also social skills training; theory of mind.
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SOCIAL BEHAVIOR MAPPING

Figure 17 Worksheet for Social Autopsies

Source: Myles, B. S., & Adreon, D. A. (2001). Asperger syndrome and adolescence: Practical solutions for school
success (p. 109). Shawnee Mission, KS: Autism Asperger Publishing Company.

REFERENCES
Bieber, J. (1994). Learning disabilities and social skills with Richard LaVoie: Last one picked . . . first
one picked on. Washington, DC: Public Broadcasting Service.
Myles, B. S., & Adreon, D. A. (2001). Asperger syndrome and adolescence: Practical solutions for
school success. Shawnee Mission, KS: Autism Asperger Publishing Company.
MELISSA L. TRAUTMAN

SOCIAL BEHAVIOR MAPPING

Social behavior mapping is a practical strategy that helps us explore how our own
behavior causes people to have emotional reactions that impact how others react to
us (the consequences, positive or negative), which then impacts how we feel about
ourselves. The map is a cognitive behavioral strategy to help students explore how all
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 SOCIAL BEHAVIOR MAPPING

behavior, when produced in the presence of others, impacts others as well as one’s
self. Another important feature of the social behavior map is that it explores the
notion that behavioral expectations vary by environment, or context within a specific
environment. (For example: at dinnertime, or while working in the classroom, eating
in the cafeteria, etc.) Within each environment or context there is a set or sets of
‘‘hidden curriculum’’ (hidden rules) that we are expected to follow and adjust our
behavior to in order to keep those around us calm and responding to us in a neutral
or positive (versus negative) way.
The social behavior maps (SBM) are usually printed on two sides of one piece of
paper: on one side of the paper are the ‘‘expected behaviors’’ and on the other side
are the ‘‘unexpected behaviors.’’ See Tables 8 and 9 for examples of expected
and unexpected social behavior maps. To use the map well, those working with a stu-
dent need to catch the child in the ‘‘act of doing what is expected,’’ and then dem-
onstrate the resulting behavioral chain by circling the words or concepts that best
represent the student’s expected behavior, how it makes someone feel, the natural
consequences the communicative partner produced in response to the behavior, and
then how the student feels about himself on the ‘‘expected side of the SBM.’’ Draw
lines to connect one circle to the next; this provides a graphic organizer of social be-
havioral responses. On less frequent occasions, the maps can be turned over to the
‘‘unexpected side’’ and the unexpected behavior, related emotional responses, and re-
sultant consequences should also be circled with lines drawn to connect the circles
and demonstrate the overall effect a behavior has on the interaction pattern with

Table 8. Social Behavior Mapping: Expected Behaviors

How You Feel about the

*Expected Behaviors Feelings of Other People Consequences Consequences
1. Listen with body and 1. Happy 1. People talk to you with 1. Happy
eyes a calm faces and voice
2. Use a 2 ft. voice 2. Proud 2. The teacher may praise 2. Proud of myself
you
3. Use friendly words 3. Pleased that you are 3. You may earn rewards 3. Confident that I can be
learning as part of the for working as part of a good student
group the group
4. Talk about what the 4. Calm 4. Other students want to 4. You stay calm
group is talking about include you in their
work and or play
5. Don’t let words bump 5. Group members feel
into others good because they can
learn too
6. Follow directions
7. Do the work, even if it
is boring or you think
you already know how
to do it
*Behaviors/feeling/consequences are listed in categories in arbitrary order. There is not a 1:1 correlation between the informa-
tion listed in each column. For example: whatever behavior is listed first does not have to match to the first emotional
reaction or the first consequence, etc.

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SOCIAL BEHAVIOR MAPPING

Table 9. Social Behavior Mapping: Unexpected Behaviors

How You Feel about

*Unexpected Behaviors Feelings of Other People Consequences the Consequences
1. Distracted as body and eyes 1. Unhappy 1. People talk to you with 1. Mad
are not focused on the an unhappy faces and
teacher voice
2. Use a loud voice 2. Frustrated 2. The teacher may nag 2. Sad
you to do what is
expected
3. Use unfriendly words 3. Worried you are not 3. You may lose privileges 3. Stressed out
working as part of the
group
4. NOT talking about what the 4. Stressed 4. Other students may not
group is talking about want to work or play
with you
5. Words bump into others 5. Group members feel
frustrated because you
are not working with
the group
6. Do NOT follow directions
7. Avoid doing the classwork
*Behaviors/feeling/consequences are listed in categories in arbitrary order. There is not a 1:1 correlation between the informa-
tion listed in each column. For example: whatever behavior is listed first does not have to match to the first emotional
reaction or the first consequence, etc.

others. This side should be used far less frequently since our job as parents and educa-
tors is to illuminate when our students are doing what is expected (typically this set
of behaviors is ignored by others) and then contrast that cycle of behavior and emo-
tional responses with what happens when the unexpected does occur. Students always
do more expected than unexpected behaviors; we have to learn to positively acknowl-
edge this! An example of information gleaned from social behavior maps is demon-
strated below. SBMs can be written for any situation and individualized to what a
child needs to focus on.
See also cognitive learning strategies; social cognition; social skills training.

FURTHER INFORMATION
Attwood, T. (2006). The complete guide to Asperger syndrome. London: Jessica Kingsley
Publishers.
Buron, K. D., & Curtis, M. (2003). The incredible 5-point scale. Shawnee Mission, KS: Autism
Asperger Publishing Company.
Gray, C. (1994). Comic strip conversations. Arlington, TX: Future Horizons.
Winner, M. (2000). Inside out: What makes the person with social cognitive deficits tick? San Jose,
CA: Michelle Garcia Winner.
Winner, M. (2002). Thinking about you thinking about me. San Jose, CA: Michelle Garcia
Winner.
Winner, M. (2003). Social thinking across the home and school day (DVD). Grand Rapids,
MI: The Gray Center Publishers.

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 SOCIAL COMMUNICATION QUESTIONNAIRE (SCQ)

Winner, M. (2005). Think social! A social thinking curriculum for school aged students. San Jose,
CA: Michelle Garcia Winner.
Winner, M. (2005). Worksheets! For teaching social thinking and related skills. San Jose, CA:
Michelle Garcia Winner.
MICHELLE GARCIA WINNER AND JAMIE RIVETTS

SOCIAL COGNITION. See Social Thinking

SOCIAL COMMUNICATION
Generally, social communication refers to a field of study that primarily explores
the ways information can be perceived. It could also be used to assess severity of
symptoms in individuals with autism spectrum disorder. It refers to the communication
of cognitive and emotional information through facial expression, gestures, and pros-
ody, and through implicit understanding of pragmatics. Moreover, it implies knowl-
edge of the social rules of human communication and the implicit ability to deduce
the thoughts and motives of others, a phenomenon that has been called theory of
mind (Baron-Cohen, 1995).

REFERENCE
Baron-Cohen, S. (1995). Mind blindness. Cambridge, MA: MIT Press.

FURTHER INFORMATION
Tanguay, P., Robertson, J., & Derrick, A. (1998). A dimensional classification of autism spec-
trum disorder by social communication domains. Journal of the American Academy of Child and
Adolescent Psychiatry, 37, 271–277.
JOUNG MIN KIM

SOCIAL COMMUNICATION QUESTIONNAIRE (SCQ)

The Social Communication Questionnaire (SCQ), formerly published as the Au-
tism Screening Questionnaire, is a parent report questionnaire designed by Berument,
Rutter, Lord, Pickles, & Bailey (1999) to screen for autism spectrum disorder in clini-
cal populations. The SCQ is based on DSM-IV-TR criteria for autism, and closely
follows the Autism Diagnostic Interview–Revised (ADI-R; Lord, Rutter, & LeCou-
teur, 1994) algorithm for autism. There are two versions of the SCQ: one for chil-
dren younger than age 6, and one for individuals 6 years and older. The SCQ is
designed to differentiate children with pervasive developmental disorders from those
who do not have pervasive developmental disorders in a clinic-based sample (i.e.,
those who are already referred to medical services with possible developmental disor-
der). The SCQ does not differentiate between subgroups on the autism spectrum.
The authors point out that the questionnaire is not recommended for use at a popu-
lation level (Bailey, 2001).

REFERENCES
Bailey, A. (2001). The social communication questionnaire. Presentation at NIASA working group
meeting on screening and surveillance for autism spectrum disorders for pre-school and
school-age children. London: National Autistic Society.

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SOCIAL COMPETENCE

Berument, S. K., Rutter, M., Lord, C., Pickles, A., & Bailey, A. (1999). Autism screening ques-
tionnaire: Diagnostic validity. British Journal of Psychiatry, 174, 444–451.
Lord, C., Rutter, M., & LeCouteur, A. (1994). Autism diagnostic interview–revised: A revised
version of a diagnostic interview for careers of individuals with possible pervasive develop-
mental disorders. Journal of Autism and Developmental Disorders, 24, 659–685.
FIONA J. SCOTT

SOCIAL COMPETENCE
Social competence indicates the abilities to establish meaningful, emotional-based
relationships; to work collaboratively with classmates, coworkers, or other teammates;
and to participate in various social settings, including schools, workplaces, or
communities (Gutstein & Whitney, 2002). Three essential elements of social com-
petence include secure attachment, instrumental social learning, and experience-
sharing relationships (Bruner, 1983; Emde, 1989; Fogel, 1993; Gottman, 1983).
Attachment refers to the bond and secure relationship between children and caregiv-
ers; instrumental social learning helps individuals understand the relationships between
specific social behaviors and the desired consequences; experience-sharing relationships
are the fundamental principles of establishing friendships. Children with autism
spectrum disorders demonstrate limited social competence, such as lacking eye contact,
facial expression, social play, joint attention, reciprocal communication/interaction,
and so on.
See also social skills training.

REFERENCES
Bruner, J. S. (1983). Child’s talk. Oxford, UK: Oxford University Press.
Emde, R. N. (1989). The infant’s relationship experience: Developmental and affective patterns.
In A. Sameroff & R. Emde (Eds.), Relationship disturbances in early childhood: A developmental
approach (pp. 33–51). New York: Basic Books.
Fogel, A. (1993). Developing through relationships. Chicago: The University of Chicago Press.
Gottman, J. M. (1983). How children become friends. Monographs of the Society for Research in
Child Development, 48(3), 1–82.
Gutstein, S. E., & Whitney, T. (2002). Asperger syndrome and the development of social com-
petence. Focus on Autism and Other Developmental Disabilities, 17(3), 161–171.
YU-CHI CHOU

SOCIAL FAUX PAS

The ability to detect a social faux pas is an ‘‘advanced’’ theory of mind ability. Typ-
ically the ability to detect social faux pas develops around age 8 (Baron-Cohen,
O’Riordan, Stone, Jones, & Plaisted, 1999). Individuals with an autism spectrum dis-
order have challenges with theory of mind; that is, they have difficulty with perspec-
tive taking. In a test to detect advanced theory of mind, Happe (1994) uses sarcasm,
bluff, irony, and the double bluff to assess a person’s ability to detect a social faux pas.
See also false-belief paradigm; theory of mind.

REFERENCES
Baron-Cohen, S., O’Riordan, M., Stone, V., Jones, R., & Plaisted, K. (1999). A new test of
social sensitivity: Detection of faux pas in normal children and children and Asperger syn-
drome. Journal of Autism and Developmental Disorders, 29, 407–418.

348
 SOCIAL SCRIPTS

Happe, F. (1994). An advanced test of theory of mind: Understanding of story characters’

thoughts and feelings by able autistic, mentally handicapped, and normal children and adults.
Journal of Autism and Developmental Disorders, 24, 129–154.
TERRI COOPER SWANSON

SOCIAL GAZE
Social gaze is the movement of one’s eyes for a communicative purpose. This move-
ment can involve ‘‘eye-to-eye’’ contact, for the purposes of reading body language and
facial expression, or ‘‘eye-to-object’’ contact, also referred to as joint attention. Joint
attention involves making eye contact with a person and then shifting the focus of
the eyes to a third party (object or person). Abnormalities in social gaze are among
the earliest pronounced symptoms of autism, with 1-year-old infants with autism tend-
ing to make less eye-to-face contact than typically developing infants.
JEANNE HOLVERSTOTT

SOCIAL PLAY
Children with autism spectrum disorders present distinct problems in developing
social play with both adults and other children (APA, 2000). Social play reflects the
ability to coordinate mutually enjoyed activities with another person. Building on
early capacities for joint attention (e.g., following another’s gaze to share the experi-
ence of observing an object or event), imitation, and emotional responsiveness, social
play increases in frequency, duration, and complexity with growing exposure to peers.
Examples of social play include: onlooker (e.g., watching peers at play), parallel play
(e.g., playing independently beside peers), common focus (e.g., reciprocal play with
one or more peers), and common goal (e.g., cooperative play with one or more peers;
for reviews, see Jordan, 2003; Wolfberg, 1999, 2003).
See also integrated play groups; play-oriented therapies; social skills training.

REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manual for mental disorders
(4th ed., text rev.). Washington, DC: Author.
Jordan, R. (2003). Social play and autistic spectrum disorders. Autism: The International Journal
of Research and Practice, 7(4) 347–360.
Wolfberg, P. J. (1999). Play and imagination in children with autism. New York: Teachers College
Press, Columbia University.
Wolfberg, P. J. (2003) Peer play and the autism spectrum: The art of guiding children’s socialization
and imagination. Shawnee Mission, KS: Autism Asperger Publishing Company.
PAMELA WOLFBERG

SOCIAL SCRIPTS
A social script is an intervention used with children with autism spectrum disorders
(ASD) to improve their social and communication skills (Simpson, Myles, & Ganz, in
press). Such scripts are designed to give children with ASD the words or phrases they
should use in a variety of contexts. This intervention is appropriate for children with
autism as an intervention that accommodates for memory and social skills deficits
common in autism. Social scripts have been used to improve imitation (Pierce &
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SOCIAL SCRIPTS

Schreibman, 1995) and social (Johnston, Nelson, Evans, & Palazolo, 2003; Krantz &
McClannahan, 1998) and communication (Krantz & McClannahan, 1993; Sarokoff,
Taylor, & Poulson, 2001) skills in individuals with ASD. Social scripts have also
resulted in reduced problem behaviors (Sasso, Melloy, & Kavale, 1990).

STEPS IN IMPLEMENTING SOCIAL SCRIPTS

Ganz, Cook, and Earles-Vollrath (in press) recommend the following steps when
implementing social scripts. First, a sociocommunicative skill or skills should be cho-
sen (e.g., asking questions for information), as well as settings and scenarios in which
the skills should be demonstrated. These should be skills and scenarios that cause the
individual with ASD difficulty. Then, a script or scripts should be written including
specific phrases the student should learn. Drawings may be included or used in place
of the written words if the student is unable to read or unable to read fluently. Prior
to implementing the script in the difficult setting, the script or scripts should be
taught to the student until he or she can read it aloud fluently and without prompts.
At this time, the script may need to be adjusted for ease of reading. Next, the script
or scripts should be implemented during the difficult activity or setting. The script
may be given to the student to check off or an adult (e.g., teacher, parent) may hold
phrases up periodically to be read aloud. Finally, the script should be faded (e.g.,
remove portions of the script from the end to the beginning).

EXAMPLE OF A SOCIAL SCRIPT

The following is an example of a social script intervention with Sarah, a 10-year-
old fifth-grader with high-functioning autism. Sarah infrequently used spontaneous
social speech and preferred to draw alone. Her teacher decided to implement social
scripts to increase her social initiations. Specifically, they decided to work on increas-
ing positive comments and offers to share during art class, which took place once a
week. Sarah’s teacher wrote a script including a variety of phrases she could use during
art, such as, ‘‘I like your drawing of a ____,’’ and, ‘‘Do you want the purple paint?’’
These phrases were put on note cards on a ring for Sarah to carry with her. Because
Sarah could read, the script did not include pictures. Sarah’s teacher then spent three
15-minute sessions practicing the script with her until she was able to read the phrases
independently, fluently, and with affect. Then, the script was given to Sarah to use
during art class. The first few classes during which the script was used, her teacher
reminded her beforehand and periodically pointed to the cards to remind Sarah to
read them aloud. Finally, once Sarah used the scripts independently in art class, they
were faded by cutting the note cards starting at the end of the sentence, and gradually
removing more of each sentence until no words were visible. At that point the script
was removed and a new skill and scenario was targeted.
See also social skills training; visual strategies.

REFERENCES
Ganz, J. B., Cook, K. E., & Earles-Vollrath, T. L. (in press). How to write and implement social
script interventions with learners with autism spectrum disorders. Austin, TX: Pro-Ed.
Johnston, S., Nelson, C., Evans, J., & Palazolo, K. (2003). The use of visual supports in teach-
ing young children with autism spectrum disorder to initiate interactions. Augmentative and
Alternative Communication, 19(2), 86–103.

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 SOCIAL SKILLS TRAINING

Krantz, P., & McClannahan, L. (1993). Teaching children with autism to initiate to peers:
Effects of a script-fading procedure. Journal of Applied Behavior Analysis, 26(1), 121–132.
Krantz, P., & McClannahan, L. (1998). Social interaction skills for children with autism: A
script-fading procedure for beginning readers. Journal of Applied Behavior Analysis, 31(2), 191–
202.
Pierce, K., & Schreibman, L. (1995). Increasing complex social behaviors in children with au-
tism: Effects of peer-implemented pivotal response training. Journal of Applied Behavior Analy-
sis, 28(3), 285–295.
Sarokoff, R. A., Taylor, B. A., & Poulson, C. L. (2001). Teaching children with autism to
engage in conversational exchanges: Script fading with embedded textual stimuli. Journal of
Applied Behavior Analysis, 34(1), 81–84.
Sasso, G. M., Melloy, K. J., & Kavale, K. (1990). Generalization, maintenance, and behavioral
co-variation associated with social skills training through structured learning. Behavioral Disor-
ders, 16(1), 9–22.
Simpson, R. L., Myles, B. S., & Ganz, J. B. (in press). Efficacious interventions and treatments
for learners with autism spectrum disorders. In R. L. Simpson & B. S. Myles (Eds.),
Educating children and youth with autism: Strategies for effective practice (2nd ed.). Austin, TX:
Pro-Ed.
JENNIFER B. GANZ

SOCIAL SKILLS DEFINED AS SHARING SPACE

EFFECTIVELY WITH OTHERS
While we use our social skills to share, play with others, interact in discussion and
conversation, it is important to realize that we even use our social skills at all the
times that we are just sharing space with others. When we enter into a space shared
by another person(s), all people(s) should be having a little thought about those
around them. The thoughts usually stay ‘‘small’’ and ‘‘routine’’ if people are sharing
space effectively and not making people have ‘‘weird thoughts.’’ However, if when
sharing space we produce an unexpected social behavior, people can become less com-
fortable with the person who is doing the ‘‘unexpected’’ social behavior even if no
one is speaking to each other in that environment. To consider this more fully, think
about how aware each person is of the other when just sharing space on an elevator.
If one does it well, then this is one example of using ‘‘good social skills.’’

FURTHER INFORMATION
Winner, M. (2002). Thinking about you thinking about me. San Jose, CA: Michelle Garcia
Winner.
Winner, M. (2005). Think social! A social thinking curriculum for school aged students. San Jose,
CA: Michelle Garcia Winner.
MICHELLE GARCIA WINNER AND JAMIE RIVETTS

SOCIAL SKILLS TRAINING

Social skills training refers to instruction or support designed to improve or facili-
tate the acquisition and/or performance of social skills. Social skills are critical to suc-
cessful social, emotional, and cognitive development. Social skills have been defined
as ‘‘socially acceptable learned behaviors that enable a person to interact with others
in ways that elicit positive responses and assist in avoiding negative responses’’ (Elliot,
Racine, & Busse, 1995, p. 1009). Effective social skills allow us to elicit positive
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reactions and evaluations from peers as we perform socially approved behaviors

(Ladd & Mize, 1983).
Impairment in social functioning is a central feature of autism spectrum disorder
(ASD) and is well documented in the literature (Attwood, 1998; Rogers, 2000). Typi-
cal social skill deficits include difficulties with reciprocity, initiating interactions,
maintaining eye contact, sharing enjoyment, empathy, and inferring the interests of
others. The cause of these skill deficits varies, ranging from inherent neurological
impairment (e.g., limbic system dysfunction) to lack of opportunity to acquire skills
(e.g., social withdrawal). Regardless of origin, social skill deficits make it difficult for
the individual to develop, and keep, meaningful and fulfilling personal relationships.
Although social skill deficits are a central feature of ASD, few children receive
adequate social skills programming (Hume, Bellini, & Pratt, 2005). This is a troubling
reality, especially considering that the presence of social impairment may portend the
development of detrimental outcomes, such as social failure and peer rejection, possi-
bly leading to anxiety, depression, substance abuse, and other forms of psychopathol-
ogy (Bellini, 2004; La Greca & Lopez, 1998; Tantam, 2000). Most important, social
skill deficits impede the ability to establish meaningful social relationships, which of-
ten leads to withdrawal and a life of social isolation. Social skills training should be
an integral part of a child’s overall programming.
Social skills are primarily acquired through learning that involves observation,
modeling, coaching, social problem solving, behavior rehearsal, feedback, and reinforce-
ment-based strategies (Gresham & Elliot, 1990). Two underlying assumptions of all
social skills training programs are that individuals can be taught to behave differently,
and that they will elicit more positive reactions and evaluations from peers as they
acquire and perform more socially approved behaviors (Ladd & Mize, 1983). Gresham
and Elliot discuss five factors that contribute to social skills deficits: (a) lack of knowl-
edge, (b) lack of practice or feedback, (c) lack of cues or opportunities, (d) lack of
reinforcement, and (e) the presence of interfering problem behaviors. Social skills
training programs should identify which factors are contributing to the social skill defi-
cits of the target child and attempt to ameliorate these deficits through programming.

SOCIAL SKILLS ASSESSMENT

The first step in any social skill training program should consist of a thorough eval-
uation of the child’s current level of social functioning, including both strengths and
weaknesses. The purpose of such assessment is to answer one very basic, yet compli-
cated, question: What is precluding the child from establishing and maintaining social
relationships? For most children, the answer takes the form of specific social skill defi-
cits. For others, the answer takes the form of cruel and rejecting peers. And for yet
other children, the answer is both.
The assessment should involve a combination of observation (both naturalistic and
structured), interview (e.g., parents, teachers, playground supervisors), and standar-
dized measures (e.g., behavioral checklists, social skills measures). The skills that are
identified during the social skills assessment will be the direct target of the interven-
tion. For more information on social skill checklists specifically designed for children
with ASD, see Do-Watch-Listen-Say by Quill (2000), or Building Social Relationships by
Bellini (2006).
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SOCIAL SKILLS TRAINING STRATEGIES

When teaching social skills to children with ASD, it is important to use a large
repertoire of strategies. It is also important to teach social skills across a variety of set-
tings, including home, community, classroom, resource room, playground, and thera-
peutic clinic, and with multiple persons. Thus, the success of a social skills program is
dependent upon the cooperation and contribution of both parents (and other family
members and caregivers) and professionals (teachers, counselors, speech language
pathologists, social workers, occupational and physical therapists, psychologists,
physicians, case managers, or many others).
A number of important questions must be considered when selecting social skill
strategies. For instance, does the strategy target the skill deficits identified in the social
assessment? Does the strategy enhance performance? Does the strategy promote skill
acquisition? Is there research to support its use? If not, what is the plan to evaluate its
effectiveness with the child? Is it developmentally appropriate for the child?
In his review of the research, McConnell (2002) concluded that indirect strategies
such as arranging the environment to include structured, preferred activities and
opportunities for interactions with more socially competent peers can help promote
social interactions for young children with ASD. However, these strategies are rarely
sufficient in themselves and should be part of comprehensive intervention plans that
include more targeted, direct interventions.
One example of direct intervention is to specifically teach and reinforce social
skills. The use of teacher prompts has also been shown to be an effective way to
increase social initiations and duration of interactions in young children (Odom &
Strain, 1986). Another well-studied strategy (McConnell, 2002), peer-mediated inter-
ventions, involves the use of trained peers to prompt the social interactions of young
children with ASD. Furthermore, the use of multiple peer mentors has been found to
increase the generalization of these skills to other settings or persons. Various social
intervention programs have been designed to facilitate both adult-child and child-
child interactions in children with ASD, including pivotal response training, visual
cuing, peer-mediated instruction, video modeling, peer mentoring, social scripting,
and Social Stories (Rogers, 2000). Social skills interventions should focus on positive
behaviors and use methods that can be easily incorporated into the classroom
curriculum.
Social skills training strategies can typically be separated into one of two categories:
(a) strategies that teach new skills (skill acquisition) and (b) strategies that enhance
the performance of existing skills (performance enhancement). Examples of skill ac-
quisition strategies include social stories, video modeling, social problem solving,
teaching social rules, and social scripting. Performance enhancement strategies include
reinforcement strategies, environmental modifications, peer-mediated interventions,
and social priming. Social skills training can focus on early social-communicative
skills, play skills, initiations and responses, and other prosocial skills.

RESEARCH ON SOCIAL SKILLS TRAINING

Research has shown that traditional social skills training programs are only minimally
effective in teaching social skills to children and adolescents (Gresham, Sugai, &
Horner, 2001; Quinn, Kavale, Mathur, Rutherford, & Forness, 1999). Quinn et al.
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(1999) found that social skills programs that targeted specific social skills (turn taking,
social initiations, etc.) were more effective than programs that focused on more global
social functioning for larger groups of students, such as ‘‘friendship’’ skills, cooperation,
and so on. The researchers concluded that effective social skill programs must be
adapted to fit the needs of the child. Too often the opposite logic is used. We force
children to ‘‘fit’’ into the social skill strategy or strategies that we have selected for
them. After reviewing numerous studies on social skills training, Gresham et al.
(2001) recommended that social skills training be implemented more frequently and
more intensely than what is typically the case. They concluded that ‘‘thirty hours of
instruction, spread over 10–12 weeks is not enough’’ (p. 341) and that the social skill
instructional strategies should match the type skill deficits. Matching instructional
strategies to the type of skill deficit exhibited by the child is a key component of suc-
cessful social skills programs.

PLAN FOR GENERALIZATION

A critical aspect of all social skills programs is a plan for generalization, or transfer
of skills. Generalization refers to performance of skills across settings, persons, situa-
tions, and time. The ultimate goal of social skills training is to teach the child to
interact successfully with peers in natural environments. From a behavioral perspec-
tive, the inability to generalize a skill or behavior is a result of too much stimulus con-
trol. That is, the child only performs the skill or behavior in the presence of a specific
stimulus (person, prompt, directives, etc.). For instance, the child may respond to the
social initiations of other children, but only if his mother is there to prompt him. If
mom is not available, he does not respond. Therefore, the skill has not been general-
ized. Several strategies may be used to facilitate generalization of social skills, including
(a) reinforcing the performance of social skills in the natural environment, (b) training
with multiple persons and in multiple settings, (c) ensuring the presence and delivery
of natural reinforcers for the performance of social skills, (d) practicing the skill in
the natural environment, (e) fading prompts as quickly as feasible, (f) providing multi-
ple exemplars for social rules and concepts, and (g) teaching self-monitoring strategies.

SOCIAL ACCOMMODATION VERSUS SOCIAL ASSIMILATION

Prior to selecting intervention strategies, it is important to consider the concepts of
social accommodation and social assimilation. Accommodation, as it relates to social
skills instruction, refers to the act of modifying the physical or social environment to
promote positive social interactions. Examples include training peer mentors to interact
with the child throughout the school day, conducting autism awareness training or sen-
sitivity training for classmates, and signing the child up for various group activities,
such as Little League, Boy or Girl Scouts, and so on. Whereas accommodation addresses
changes in the environment, assimilation focuses on changes in the child. Specifically, it
refers to instruction that facilitates skill development that allows the child to be more
successful in social interactions. By their nature, social accommodations enhance social
performance, and social assimilation involves promoting skill acquisition.
The key to a successful social skills training program is to address both accommoda-
tion and assimilation. For example, providing ample opportunity for the child to inter-
act with others without providing him/her with the skills necessary to be successful in
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those interactions may lead to failure and frustration. Similarly, providing skill instruc-
tion (assimilation) without modifying the environment to be more accepting of the
child with ASD also sets the child up for failure. This happens the moment an eager
child with ASD tries out a newly learned skill on a group of nonaccepting peers.
Thus, the key is to teach skills and modify the environment.
See also social scripts.

REFERENCES
Attwood, T. (1998). Asperger’s syndrome: A guide for parents and professionals. Philadelphia: Jes-
sica Kingsley Publishers.
Bellini, S. (2004). Social skill deficits and anxiety in high-functioning adolescents with autism
spectrum disorders. Focus on Autism and Other Developmental Disabilities, 19(2), 78–86.
Bellini, S. (2006). Building social relationships: A systematic approach to teaching social interaction
skills to children and adolescents with autism spectrum disorders and other social difficulties. Shaw-
nee Mission, KS: Autism Asperger Publishing Company.
Elliott, S. N., Racine, C. N., & Busse, R. T. (1995). Best practices in preschool social skills
training. In A. Thomas & J. Grimes (Eds.), Best practices in school psychology (3rd ed., pp.
1009–1020). Washington, DC: NASP.
Gresham, F. M., & Elliot, S. N. (1990). Social skills rating system–manual. Circle Pines, MN:
American Guidance Service.
Gresham, F. M., Sugai, G., & Horner, R. H. (2001). Interpreting outcomes of social skills train-
ing for students with high-incidence disabilities. Teaching Exceptional Children, 67, 331–344.
Hume, K., Bellini, S., & Pratt, C. (2005). The usage and perceived outcomes of early interven-
tion and early childhood programs for young children with autism spectrum disorder. Topics
in Early Childhood Special Education, 25(4), 195–207.
Ladd, G. W., & Mize, J. (1983). A cognitive-social learning model of social skill training. Psy-
chological Review, 90, 127–157.
La Greca, A. M., & Lopez, N. (1998). Social anxiety among adolescents: Linkages with peer
relations and friendships. Journal of Clinical Child Psychology, 26, 83–94.
McConnell, S. R. (2002). Interventions to facilitate social interaction for young children with
autism: Review of available research and recommendations for educational intervention and
future research. Journal of Autism and Developmental Disorders, 32, 351–372.
Odom, S. L., & Strain, P. S. (1986). A comparison of peer-initiation and teacher-antecedent
interventions for promoting reciprocal social interaction of autistic preschoolers. Journal of
Applied Behavior Analysis, 19, 59–71.
Quill, K. (2000). Do-watch-listen-say: Social and communication intervention for children with au-
tism. Baltimore: Brookes Publishing Co.
Quinn, M. M., Kavale, K. A., Mathur, S. R., Rutherford Jr., R. B., & Forness, S. R. (1999). A
meta-analysis of social skills interventions for students with emotional and behavioral disor-
ders. Journal of Emotional and Behavioral Disorders, 7, 54–64.
Rogers, S. (2000). Interventions that facilitate socialization in children with autism. Journal of
Autism and Developmental Disorders, 30, 399–409.
Tantam, D. (2000). Psychological disorder in adolescents and adults with Asperger syndrome.
Autism, 4, 47–62.
SCOTT BELLINI, ANDREA HOPF, AND JESSICA KATE PETERS

SOCIAL STORIES
A Social Story describes a situation, skill, or concept in terms of relevant social
cues, perspectives, and common responses in a specifically defined style and format.
Social Stories were originally developed to share social information with children with
autism spectrum disorders (ASD) that most people take for granted, with each Story
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patiently describing the details of an often unspoken social code. For example, a
Social Story may outline the general routine of a birthday party, explain the thoughts,
statements, and actions of children at the party, or the rationale behind expectations
for the behavior of those attending the party.
Social Articles (Gray, 1999) are similar to Social Stories, but tailored for review
and use by adolescents and young adults. Thus, Social Articles use (a) the third-
person perspective instead of first-person, (b) advanced vocabulary, and (c) in many
cases columns like a newspaper article, to share information. For many children and
adults with ASD, Social Stories and Social Articles have resulted in improved
responses to situations or understanding of concepts that were previously problematic
for them. Most are written by parents and professionals, and people with ASD of all
ages are their most frequent audience.
First described by Gray & Garand in 1993, Social Stories have been updated and
expanded upon in subsequent articles and book chapters (Gray, 1995, 1998a, 1998b,
2000a; 2000b; Gray & White, 2000) The continually expanding use and popularity of
the approach created a need for an updated, detailed delineation of what is—and is
not—a Social Story. Thus, many stories were being developed for students with ASD,
and referred to by their authors as Social Stories, though relatively few adhered to the
defining criteria. Concern for students’ social and emotional safety when exposed to
unauthorized use of the approach, and concern for its overall quality and effectiveness,
resulted in an expansion and reorganization of the 10 defining characteristics, referred
to as Social Stories 10.0 (Gray, 2004). Currently, Social Stories 10.0 clearly distin-
guishes Social Stories from fiction and traditional nonfiction, task analyses, social
scripts, or other visual strategies.
First gaining credibility in practice, numerous studies have been conducted on
Social Stories, the majority of them reporting positive results. New studies are contin-
ually being launched to improve understanding of the approach and answer questions
that emerge with continued practice. Though the original guidelines and the new
defining criteria are based on the learning characteristics of people with ASD, experi-
ence indicates that Social Stories may also be helpful for individuals with other
impairments, as well as for those who are developing normally.

REFERENCES
Gray, C. (1995). Teaching children with autism to ‘‘read’’ social situations. In K. A. Quill
(Ed.), Teaching children with autism: Strategies to enhance communication and socialization (pp.
219–241). New York: Delmar Publishers.
Gray, C. (1998a). Social Stories and comic strip conversations. In E. Schopler, G. Mesibov, & L.
Kunce (Eds.), Asperger Syndrome or high-functioning autism? (pp. 167–198). New York: Plenum
Press.
Gray, C. (1998b). The advanced social story workbook. The Morning News, 10(2), 1–24.
Gray, C. (1999). Gray’s guide to compliments. The Morning News, 11(1), 1–20.
Gray, C. (2000a). Writing social stories with Carol Gray [Video]. Arlington, TX: Future Horizons.
Gray, C. (2000b). Writing social stories with Carol Gray: Workbook to accompany video. Arlington,
TX: Future Horizons.
Gray, C. (2004). Social Stories 10.0: The new defining criteria and guidelines. The Jenison Au-
tism Journal, 16(1), 2–21.

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Gray, C. A., & Garand, J. (1993). Social Stories: Improving responses of individuals with au-
tism with accurate social information. Focus on Autistic Behavior, 8, 1–10.
Gray, C. A., & White, A. L. (2000). My social stories book. London: Jessica Kingsley Publishers.

FURTHER INFORMATION
The Gray Center: www.TheGrayCenter.org.
CAROL GRAY

SOCIAL THINKING
Social thinking is a user-friendly term for social cognition. Social cognition is one
of many different forms of intelligence that each of us has to a greater or lesser extent
that helps to define how we interpret, relate, and respond to the people and informa-
tion around us (written, spoken, media, etc.). In relation to others, there are multiple
and complex factors that combine synergistically to create communicative compe-
tence. Factors related to social thinking involve reading people’s gestures, body lan-
guage, tone of voice, facial expressions, breathing patterns, and intended language
meaning in an environmental context to glean the overall communicative intention
of the message. Social thinking is active in every situation where two people share
(even outside of language-based communication); and it is actively present in the
classroom environment. There is no single moment in a classroom when social think-
ing does not need to be actively considered.
An example of teaching by ‘‘social thinking methods’’ includes teaching ‘‘eye-
contact’’ to students who lack this skill. If we are teaching a child eye contact by
teaching him or her to use the ‘‘social skill,’’ then we simply remind the child to ‘‘look
at me.’’ If we are teaching the child the concept of eye contact through ‘‘social think-
ing methods,’’ then we help the child to learn that eye-gaze direction helps the
‘‘listener’’ to understand what others might be thinking about based on where they are
looking. The student (i.e., ‘‘listener’’) is then taught to ‘‘think with his or her eyes’’ to
consider what others might be looking at or thinking about. The listener can then be
cued to think with his or her eyes to better understand why he or she should look to
the face of another person.

FURTHER INFORMATION
Winner, M. (2002). Thinking about you thinking about me. San Jose, CA: Author.
Winner, M. (2005). Think social! A social thinking curriculum for school aged students. San Jose,
CA: Michelle Garcia Winner.
Winner, M. (2005). Worksheets! For teaching social thinking and related skills. San Jose, CA:
Michelle Garcia Winner.
Social Thinking: www.socialthinking.com.
MICHELLE GARCIA WINNER AND JAMIE RIVETTS

SOCIAL VALIDITY
Social validity is the perceived worth of research and its results.
JAN L. KLEIN

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SOMATOSENSORY

SOMATOSENSORY
Somatosensory refers to the sensory receptors on the skin’s surface, which help to
determine where the body ends and where the world begins. The somatosensory sys-
tem is also referred to as the tactile system.
KELLY M. PRESTIA

SPECIAL DAY SCHOOL OR ALTERNATIVE SCHOOL

Special day school/alternative school programs are settings where students receive
educational and related services for more than 50 percent of their school day. Multiple
disabilities represent the disability category most often represented within special day
school or alternative school programs.
KATHERINE E. COOK

SPECT. See Positron Emission Tomography

SPEECH DELAY
Speech delay refers to a delay in the development or use of the mechanisms that
produce speech. Speech, which is distinct from language, refers to the actual process
of making sounds, using such organs and structures as the lungs, vocal cords, mouth,
tongue, teeth, etc. Because language and speech are two independent developmental
stages, delays may present independently.
JEANNE HOLVERSTOTT

SPEECH LANGUAGE PATHOLOGIST

Speech language pathologists (SLP) are trained professionals who work in hospitals,
private clinics, and the school system diagnosing speech/language disorders, preparing
for, and providing direct services. Speech language pathologists are trained to diagnose
and provide services for students with speech impairments including: fluency disorders,
articulation and phonological disorders, and voice disorders. Language disorders
focused on by speech language pathologists include aphasia and language delays. These
services can be provided in individual, small, or large group settings. Additionally,
many SLPs focus on pragmatics and social skill instruction within individual, small,
and group settings.
In order to practice as a speech pathologist, a minimum of a master’s degree, pas-
sage of a national exam, a minimum of 400 (325 at the graduate level) supervised
clinical hours, and the completion of a clinical fellowship year must be completed
(American Speech-Language-Hearing Association, n.d.). The American Speech-
Language Hearing Association (ASHA) is the organization that awards the Certificate
of Clinical Competence (CCC) upon successful completion of these requirements.
The addition of a state license to practice may be required depending on that specific
state.
See also fluency; social skills training.

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 SPEECH THERAPY

REFERENCE
American Speech-Language-Hearing Association. (n.d.). Academic, Clinical, and Exam Standards
for the Certificate of Clinical Competence (CCC). Retrieved September 22, 2006, from
www.asha.org.
KATHERINE E. COOK AND LYNN DUDEK

SPEECH THERAPY
Speech therapy, also known as speech pathology or speech-language pathology, is
the diagnosis and treatment of communication and swallowing disorders. Speech
pathologists (or speech therapists) diagnose, treat, and prevent communication disor-
ders. In addition to diagnosing and treating disorders, speech pathologists are respon-
sible for programs that stress the prevention of certain disorders—such as a vocal
hygiene program to avoid the development of poor vocal behaviors (yelling, vocal
abuse).
Communication encompasses many areas. Language skills refer to syntax (grammar),
semantics (vocabulary), and pragmatics (language use and social skills). Speech skills
mean articulation (pronunciation), voice (hoarseness, resonance), and fluency (stut-
tering). Swallowing ability refers to the intake, manipulation (chewing), movement,
and swallowing of liquids and solids.
The need for services from a speech pathologist may be for a variety of reasons
including:

¥ Developmental delays (not developing speech and language)

¥ Articulation errors
¥ Motor planning disorders (dyspraxia, apraxia)
¥ Accident or injury
¥ Stroke
¥ Traumatic brain injury
¥ Cancer
¥ Autism spectrum disorders
¥ Cerebral palsy
¥ Congenital disorders
¥ Birth injuries
¥ Trauma (car accident)
¥ Feeding/swallowing disorders

A speech pathologist may use many different methods to develop or redevelop the
skills necessary for effective communication and swallowing. These may include:

¥ Play-oriented therapy
¥ Articulation practice
¥ Oral-motor therapy
¥ Articulation ‘‘drills’’
¥ Reading readiness
¥ Memory activities
¥ Augmentative and alternative communication devices
¥ Sign language
¥ Picture Exchange Communication System (PECS)
¥ Homework

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Speech pathologists work in a variety of settings including private practice, nursing

homes, schools, rehabilitation centers, hospitals, and universities. Along with diagnos-
ing and treating communication disorders, speech pathologists are responsible for diag-
nosing and treating disorders associated with feeding and swallowing.
Speech pathologists may see patients/clients in a variety of settings including indi-
vidual and/or group treatment. In a school setting, group therapy is utilized to take
advantage of peer modeling and generalization. In other settings, such as a hospital or
clinic, they may utilize individual treatment. One of the growing areas of treatment
for speech pathologists is in the area of pragmatics/social language and social skills
training. As children with autism spectrum disorders grow on caseloads, so too do the
number of social skills groups.
It is important to remember that the child, the family, and the speech pathologist
are all partners in the therapy process. It is vitally important that the family be
involved in creating goals and the speech pathologist helps the family learn how to
practice at home. Only going to therapy once or twice a week will not be of benefit
unless home programs are instituted as well.

FURTHER INFORMATION
Social Thinking: www.socialthinking.com.
LYNN DUDEK

SPLINTER SKILLS
Splinter skills (also called islets of ability or islands of precocity) are abilities in one
or several areas that a person is quite talented in relative to their overall cognitive
ability. For example, an individual may be cognitively impaired, yet have a photo-
graphic memory or be able to play a song on a musical instrument perfectly after only
hearing it once.

FURTHER INFORMATION
Frith, U. (1989). Autism: Explaining the enigma. Cambridge, MA: Blackwell Publishers.
Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2, 217–250.
Scheuermann, B., & Webber, J. (2002). Autism: Teaching does make a difference. Belmont, CA:
Wadsworth Group.
PAUL G. LACAVA

SPONTANEOUS PLAY
A lack of spontaneous play appropriate to developmental level is a defining feature
of autism spectrum disorders (APA, 2000). Spontaneous play reflects the child’s active
engagement in intrinsically motivating activity that is self-generated and freely cho-
sen. Spontaneous play manifests in both symbolic and social forms, which transform
in form, function, and degree of complexity as children develop (Boucher & Wolfberg,
2003; Libby, Powell, Messer, & Jordan, 1998; Wolfberg, 1999, 2003).
Spontaneous forms of play within the symbolic dimension may include: sensory ex-
ploration of objects (e.g., spinning the wheels of a toy car), functional play with
objects (e.g., rolling a toy car on a surface or placing a cup on a saucer), and pretend-
ing to do or be someone else (e.g., holding a tea party with dolls). Spontaneous forms
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of play within the social dimension may include: onlooker (e.g., watching peers at
play), parallel play (e.g., playing independently beside peers), common focus (e.g., re-
ciprocal play with one or more peers), and common goal (e.g., cooperative play with
one or more peers; Wolfberg, 2003).
See also integrated play groups; play-oriented therapies.

REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
Boucher, J., & Wolfberg, P. J. (2003). Editorial: Special issue on play. Autism: The International
Journal of Research and Practice, 7(4), 339–346.
Libby, S., Powell, S., Messer, D., & Jordan, R. (1998). Spontaneous play in children with au-
tism: A reappraisal. Journal of Autism and Developmental Disorders 28, 487–497.
Wolfberg, P. J. (1999). Play and imagination in children with autism. New York: Teachers College
Press, Columbia University.
Wolfberg, P. J. (2003). Peer play and the autism spectrum: The art of guiding children’s socialization
and imagination. Shawnee Mission, KS: Autism Asperger Publishing Company.
PAMELA WOLFBERG

STANDARD DEVIATION
In statistics, standard deviation (SD) is a measure of variability. The SD is the aver-
age distance that each score, in a distribution of scores, deviates from the average of
all scores (also known as the mean). The SD tells how far scores vary and how they
disperse around the average score.

FURTHER INFORMATION
Kotz, S., & Johnson, N. L. (Eds.). (1988). Encyclopedia of statistical sciences, Vol. 8. New York:
John Wiley & Sons.
Salkind, N. J. (2005). Exploring research (6th ed.). Upper Saddle River, NJ: Prentice Hall.
PAUL G. LACAVA

STANDARDIZATION
Standardization is the process of applying a consistent set of procedures for design-
ing, administering, and scoring an assessment in order to ensure that all students are
assessed under the same conditions and are not affected by different conditions. Stand-
ardization also ensures that optimal results are obtained.

FURTHER INFORMATION
Wrightslaw (n.d.). Glossary of assessment terms. Retrieved August 8, 2006, from http://
www.wrightslaw.com/links/glossary.assessment.htm.
THERESA L. EARLES-VOLLRATH

STANDARDIZATION SAMPLE
A standardization sample is a large group of test takers who represent the popula-
tion for which the test is intended and to which comparisons can be made. Knowledge
of the standardization sample, also referred to as the norm group, is important when
using standardized or norm-referenced assessment measures.
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STANDARDIZED TESTS

FURTHER INFORMATION
Pierangelo, R., & Giuliani, G. (1998). Special educators’ complete guide to 109 diagnostic tests:
How to select and interpret tests, use results in IEPs, and remediate specific difficulties. West
Nyack, NY: Center for Applied Research in Education.
Salvia, J., & Ysseldyke, J. E. (2007). Assessment: In special and inclusive education (10th ed.). Bos-
ton: Houghton Mifflin Company.
THERESA L. EARLES-VOLLRATH

STANDARDIZED TESTS
Standardized tests are a form of measurement that has been normed against a spe-
cific population. These assessment measures are uniformly developed, administered,
and scored according to very specific procedures. A variety of standardized scores are
calculated for comparison against the performance of the norm group.
See also norm-referenced assessment.

FURTHER INFORMATION
Pierangelo, R., & Giuliani, G. (1998). Special educators’ complete guide to 109 diagnostic tests:
How to select and interpret tests, use results in IEPs, and remediate specific difficulties. West
Nyack, NY: Center for Applied Research in Education.
THERESA L. EARLES-VOLLRATH

STANDARD SCORE
Standard scores are raw test scores that have been converted to a scale with equal
means and standard deviations. These scores allow ‘‘raw scores’’ on different assess-
ments to be compared, allowing one to determine where a student’s score falls in com-
parison to his/her overall ability, to another person, or to a group.

FURTHER INFORMATION
Salvia, J., & Ysseldyke, J. E. (2007). Assessment: In special and inclusive education (10th ed.). Bos-
ton: Houghton Mifflin Company.
Taylor, R. L. (2006). Assessment of exceptional students: Educational and psychological procedures
(7th ed.). Needham Heights, MA: Allyn and Bacon.
THERESA L. EARLES-VOLLRATH

STANFORD-BINET INTELLIGENCE SCALES–FIFTH EDITION

The Stanford-Binet Intelligence Scales–Fifth Edition (SB5; Roid, 2005) is individu-
ally administered to individuals ranging in ages from 2 to 90+ as an assessment of
intelligence and cognitive abilities. The SB5 allows assessors to compare nonverbal
and verbal performance, which is beneficial when evaluating for a learning disability.
SB5 aids in determining special needs and assists with identifying and describing indi-
viduals who qualify as learning disabled, gifted and talented, mentally retarded,
ADHD, speech and language delayed, traumatic brain injured, and/or autistic.

REFERENCE
Roid, G. H. (2005). Stanford-Binet Intelligence Scales–Fifth Edition. Rolling Meadows, IL: River-
side Publishing Company.
AMY BIXLER COFFIN

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STEREOTYPIC BEHAVIOR
Stereotypic behaviors may include hand waving, rocking, playing with hands, fid-
dling with fingers, twirling objects, head banging, self-biting, or hitting various parts
of one’s own body (APA, 2000). In addition, individuals may use an object in per-
forming these behaviors.

REFERENCE
American Psychiatric Association. (2000). Diagnostic and statistical manual for mental disorders
(4th ed., text rev.). Washington, DC: Author.
HYO JUNG LEE

STIMULANT MEDICATIONS
Stimulant medications are a very commonly used psychotropic medication. Ritalin,
Adderall, and Concerta are examples of this class of drugs. Stimulants work by trigger-
ing the level of activity in the central nervous system. Stimulants are often prescribed
to persons with autism spectrum disorders (ASD) to help improve attention, decrease
hyperactivity, restlessness, and impulsivity, and for other behavioral concerns. Some
common side effects include reduction in appetite and mild insomnia. Many stimu-
lants are produced in regular and sustained-release forms. Individuals with ASD may
benefit from stimulants, but research has shown that those without autism who take
stimulants respond at a higher rate.

FURTHER INFORMATION
Aman, M. G., Lam, K. S., & Collier-Crespin, A. (2003). Prevalence and patterns of use of psy-
choactive medicines among individuals with autism in the Autism Society of Ohio. Journal of
Autism and Developmental Disorders, 33, 527–534.
Quintana, H., Birmaher, B., Stedge, D., Lennon, S., Freed, J., Bridge, J., et al. (1995). Use of
methylphenidate in the treatment of children with autistic disorder. Journal of Autism & De-
velopmental Disorders, 25, 283–294.
Tsai, L. (2000). Children with autism spectrum disorder: Medicine today and in the new mil-
lennium. Focus on Autism and Other Developmental Disabilities, 15, 138–145.
Tsai, L. (2002). Taking the mystery out of medications in autism/Asperger syndromes: A guide for
parents and non-medical professionals. Arlington, TX: Future Horizons.
Werry, J. S. (2001). Pharmacological treatments of autism, attention deficit hyperactivity disor-
der, oppositional defiant disorder, and depression in children and youth: Commentary. Journal
of Clinical Child Psychology, 30, 110–113.
PAUL G. LACAVA

STIMULUS
Stimulus refers to a specific element in the environment that influences behavior.
It is normally used to refer to something that is being changed or administered in
order to impact behavior, or to find what its impact is on the behavior of an indi-
vidual. Stimuli can be internal or external, although the focus within applied behav-
ior analysis is the study and manipulation of external stimuli. However, some
interventions for individuals with autism spectrum disorders also attempt to teach
recognition of internal stimuli and self-control or self-regulation, in light of such
stimuli.

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STIMULUS CONTROL

FURTHER INFORMATION
Cooper, J. O, Heron, T. E, & Heward, W. L. (1987). Applied behavior analysis. Upper Saddle
River, NJ: Pearson Education.
KATIE BASSITY

STIMULUS CONTROL
A behavior is said to be under stimulus control when that behavior is more
probable to occur after a particular stimulus than under other normal circumstances
(Halle & Holt, 1991). The reason for this control is that the stimulus that produces
higher rates of behavior also is followed by higher rates of reinforcement (Cooper,
Heron, & Heward, 1996). Once it has been associated with the behavior, the stimu-
lus or cue may then induce the response (Alberto & Troutman, 1999). For example,
a child knows how to walk out of the classroom, but it would be under stimulus con-
trol if the child does this automatically during a fire drill. Likewise, if a parent or
teacher often gives in to tantrums, it is likely that a child will throw more tantrums
in his or her presence in the future.

REFERENCES
Alberto, P. A., & Troutman, A. C. (1999). Applied behavior analysis for teachers (p. 20). Upper
Saddle River, NJ: Merrill.
Cooper, J. O., Heron, T. E., & Heward, W. L. (1987). Applied behavior analysis. Upper Saddle
River, NJ: Prentice Hall.
Halle, J. W., & Holt, B. (1991). Assessing stimulus control in natural settings: An analysis of
stimuli that acquire control during training. Journal of Applied Behavior Analysis, 24, 579–589.
JESSICA KATE PETERS AND TARA MIHOK

STIMULUS OVERSELECTIVITY
Stimulus overselectivity, also called restricted stimulus control, is attention being
given to a limited number of stimuli, or features of a stimulus, in a given situation.
For example, an individual may identify any red fruit as an apple and not recognize a
green apple as an apple. This is because they have learned to identify an apple based
on one feature, ignoring the other components that make an apple an apple. This can
also apply to only attending to one piece of visual information being presented or
attending only to visual information when it is accompanied by oral directions.
See also stimulus control.
KATIE BASSITY

STORYMOVIES
A Storymovie (Gray & Shelley, 2006) is a Social Story (Gray & Garand, 1993)
illustrated with a short (2–6 minutes), professionally developed movie shot on loca-
tion, which merges descriptions of social concepts and skills with footage of live situa-
tions. Although developed specifically for individuals with autism spectrum disorders
(ASD) to help them understand the interactions and situations that surround them,
Storymovies may be useful with other audiences as well. In all Storymovies, a black-
and-white freeze frame—that frequently stills an important social cue—appears with
an announcer reading superimposed text. This is the Story that describes what is
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 STRUCTURED TEACHING (TEACCH)

occurring and why. When the announcer finishes reading the segment, the action
continues.
Storymovies require no specialized training to implement and are equally user-
friendly in the hands of parents or professionals. In a school or clinical setting, Story-
movies may complement a current social curriculum or initiative, and may be used to
achieve existing classroom or individual objectives. At home, parents may use Story-
movies more informally to illustrate topics that arise in daily conversations or to help
them explain important social concepts and skills.
Storymovies utilize features that are impossible with other forms of illustration, such
as instant replay, slow motion, and relaxing background music. Carefully placed where
needed, instant replay and slow motion provide an immediate second opportunity to
look for social cues that may occur too fast or elude identification altogether. Back-
ground music is optional; a simple click on the DVD menu turns the music on or off.
Many of the Storymovies within a chapter use the same movie for illustration. There
are two important reasons for this. Working from the same movie introduces new
details on a familiar backdrop and focuses attention on the Story to emphasize related
ideas within a chapter. To demonstrate the important ties between concepts, ideas
covered in one chapter are mentioned and applied in subsequent chapters and DVDs,
with new movies as a backdrop. This promotes the generalization of concepts to new
contexts, and encourages the retrieval of previous experience and/or information rele-
vant to the current topic.
Each Storymovie DVD addresses a specific theme. Storymovies are grouped into
chapters that build one or more basic concepts related to that theme. Topics are listed
from simpler to more advanced and are designed to be used in sequence. Any Story-
movie may also be used in isolation, making it possible to skip a review of topics that
are already understood.

REFERENCES
Gray, C. A., & Garand, J. (1993). Social Stories: Improving responses of individuals with au-
tism with accurate social information. Focus on Autistic Behavior, 8, 1–10.
Gray, C.A., & Shelley, M. (2006). [DVD]. Social concepts and skills at school. Columbia, SC:
Specialminds Foundation.

FURTHER INFORMATION
The Gray Center: www.TheGrayCenter.org.
The Special Minds Foundation: www.specialminds.org.
CAROL GRAY AND MARK SHELLEY

STRUCTURED TEACHING (TEACCH)

Structured Teaching is a primary component of the Treatment and Education of
Autistic and related Communication-Handicapped Children (TEACCH) program’s
approach to working with individuals with autism spectrum disorders (ASD).
TEACCH is a statewide program that offers support to individuals with ASD and
their families in North Carolina. In addition, TEACCH is able to offer support to
families and children with ASD around the country and throughout the world through
a set of intervention strategies, referred to as Structured Teaching, that are used in
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STRUCTURED TEACHING (TEACCH)

classrooms, at home, and in community-based services to increase the independence

and competence of individuals with ASD (Mesibov, Shea, & Shopler, 2005).
An underlying principle of Structured Teaching is to match educational practices
and daily interventions to the specific way in which people with ASD think and learn
(Mesibov & Howley, 2003, chap. 2). Specifically, individuals with ASD display neuro-
logical differences that can result in receptive and expressive language difficulties,
problems with attending to relevant detail and switching attention, poor organiza-
tional skills, distractibility when faced with sensory stimulation, and difficulty with
abstract thinking and perspective-taking. In addition, individuals with ASD tend to
be visual, rather than auditory learners (Mesibov et al., 2005).
Incorporating the distinct learning pattern and thought processes of individuals with
ASD, the elements of Structured Teaching include physical organization, the use of
schedules, the use of work systems, and the use of visual structure and information.

PHYSICAL ORGANIZATION
The physical layout of classrooms, homes, and job settings plays an important role
in providing visual information that adds meaning to the environment for individuals
with ASD (Mesibov & Howley, 2003, chap. 4). That is, the way the furniture, materi-
als, and general surroundings are organized can help clarify expectations and activities
and reduce distracting visual and auditory stimulation. Providing individuals with
ASD with a neat and orderly environment can increase independence and alleviate
anxiety often caused by ambiguity.
The degree of physical organization necessary in an environment varies, depending
on the needs of the individual with ASD. For younger children or children with more
severe needs, more physical structure may be required. This may be created through the
strategic placement of furniture to provide natural boundaries and define specific areas
within the classroom (Mesibov & Howley, 2003, chap. 2). For example, a teacher can
arrange separate and distinctive areas for group work, independent work, play, one-to-
one teaching, and snack by arranging the furniture in a clear manner (Mesibov & How-
ley, 2003, chap. 4). These boundaries convey to children with ASD what is expected of
them within these particular areas, which can lead to greater independence. Another
way to provide clear physical organization is visual cues. That is, different areas of the
classroom can be clearly labeled, materials can be color-coded in a meaningful way, and
visual prompts can be used to let a student know where to sit (Mesibov et al., 2005).
Students with ASD who are included in a general education classroom may require
a lesser degree of physical organization. For example, it is often helpful to create a
quiet, nonstimulating area within the classroom where the student can go when feel-
ing stressed or frustrated. In addition, for these students, the independent work area
should be located in the least stimulating part of the classroom to eliminate distrac-
tions, perhaps assigning them to the same seat each day. Finally, a clear place in
which to put finished work is helpful for almost all individuals with ASD, as it pro-
vides closure on a task and prepares them for the next step.

SCHEDULES
Schedules are visual cues that tell us what to expect during the day and in what
order (Mesibov & Howley, 2003, chap. 5). Schedules are particularly helpful for
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 STRUCTURED TEACHING (TEACCH)

individuals with ASD, as they reduce a reliance on language. Visual schedules can
also remain accessible, eliminating the need to rely on memory for sequential informa-
tion. Finally, schedules aid in transitions, which are often the most difficult times of
the day for individuals with ASD.

Types of Schedules
Visual schedules take many forms depending on the level of functioning of the
intended user (Mesibov et al., 2005). For more capable individuals, the schedule may
be written to match their reading level. For nonreaders, schedules should be in the
form of pictures or icons, depending on what makes the most sense to the particular
individual. For example, a picture of a paintbrush could symbolize art, a picture of a
parent could indicate it is time to go home, or an icon of a table could represent inde-
pendent work. Icon and picture schedules can be paired with a simple word or phrase
for those with emerging reading skills for additional clarity. Finally, object schedules,
which provide a one-step indication of what is next, may be used for individuals who
require a high degree of concrete structure. Objects must be clear and meaningful, such
as using a plate to symbolize lunchtime or a part of a task to symbolize work sessions.
The length of the schedule should also be determined based on individual needs.
Whereas object schedules typically only present one item at a time, picture and writ-
ten schedules can provide a sequence of activities in whatever length is most appropri-
ate. Some individuals are most successful with just a few activities on their schedule,
while others benefit from seeing a half day or full day of activities on their schedule.
The ways in which schedules are manipulated also vary depending on the individ-
ual. For example, some schedules require students to remove a picture card to carry
with them and match to a corresponding picture card in an area, whereas others sim-
ply require the user to cross off or place check marks over completed activities
(Mesibov & Howley, 2003, chap. 5). This manner of checking a schedule should be
established as a routine to increase independent functioning.
It is helpful to not only provide individualized schedules for particular students, but
also to provide a general classroom schedule, giving students the most information
possible (Mesibov et al., 2005). General classroom schedules should remain similar
from week to week, while the individual schedule provides an opportunity to vary
activities. Such variation prevents students from becoming too accustomed to a partic-
ular routine, which might be difficult to break.

WORK SYSTEMS
Whereas physical organization and schedules tell an individual where to go and
what to expect during the day, work systems explain how to approach particular activ-
ities (Mesibov & Howley, 2003, chap. 6). Thus, work systems offer the structure indi-
viduals with ASD need to understand what is expected of them when completing a
task, remain focused on the task, and work independently. Specifically, work systems
convey which tasks students are supposed to complete, how many tasks must be com-
pleted, how much progress they have made as they are working, and finally, what hap-
pens after they have completed the work.
Like physical organization and schedules, work systems are tailored to the level of
understanding of the individual with ASD. A work system for the most capable
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STRUCTURED TEACHING (TEACCH)

students might be a written checklist embedded within a schedule (Mesibov & How-
ley, 2003, chap. 6). The schedule typically tells the individual to go to a particular
area, where he will utilize a separate work system to complete the work or tasks within
that area. For example, a student with high-functioning autism might benefit from a
work system consisting of a written list of tasks, along with materials that correspond
with each task. By using this list to cross off items as they are finished, the student
has a clear sense of making progress and then finishing (Mesibov et al., 2005). The
work system should include information at the end regarding what to do next; this
may be as simple as a message reading, ‘‘Check Schedule.’’
For individuals with ASD who have limited language, work systems can use pic-
tures, icons, objects, or colors to convey what is expected. For example, a nonreader
might use a work system consisting of separate picture cards attached to a Velcro strip.
These pictures cards correspond to a matching picture on a bin that contains the task.
The number of bins containing tasks indicates how much work the student must com-
plete. When no more cards remain, the student knows that she has completed the
work session. The last card on the Velcro strip should indicate what the student
should do next.
Such work systems can be used in one-to-one teaching areas until the tasks have
been mastered. The work system can then be transferred to an independent work area.
Work systems are not only useful in the classroom, but can be helpful in completing
everyday activities, such as brushing teeth, preparing a sandwich, establishing a rou-
tine for riding the bus, or shopping in the community (Mesibov et al., 2005).

VISUAL STRUCTURE AND INFORMATION

As mentioned before, individuals with ASD display visual strengths. Visual informa-
tion provides clarity and meaning, which increases understanding, success, and inde-
pendence. In contrast, tasks that rely solely on language-based information tend to be
confusing for a person with ASD. Three components of visual structure will be dis-
cussed in this section: visual clarity, visual organization, and visual instructions.
Visual Clarity
Visually clarifying important information for individuals with ASD can accommo-
date for their difficulty in recognizing relevant information. Rather than including an
excessive number of materials, which can cause confusion regarding what needs to be
done, work areas can be clarified by presenting tasks with a limited amount of materi-
als (Mesibov et al., 2005). Further, information within tasks can be clarified by high-
lighting important instructions or putting a tab on an important reference page within
a textbook (Mesibov & Howley, 2003, chap. 2). Similarly, a more basic sorting task
could include two distinctly different colors that are to be sorted, such as red and
green, to highlight the purpose of the task (Mesibov et al., 2005).
Visual Organization
Individuals with ASD often prefer neat and orderly environments and are easily dis-
tracted by extraneous materials or disorganized work areas. Furthermore, they often
lack the ability to organize materials themselves. Visual organization refers to the dis-
tribution and stabilization of materials, which provides an orderly environment and
clarifies what is expected (Mesibov & Howley, 2003, chap. 2). For example, in a
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sorting task involving several materials, individuals with ASD have a greater under-
standing of the task if the materials are distributed in containers rather than spread
out across the table. Thus, a task consisting of separating red from blue fish could be
presented with a container holding all the materials to be sorted, an additional empty
container labeled ‘‘Red Fish,’’ and another empty container labeled ‘‘Blue Fish.’’ This
level of organization provides the meaning and clarity needed for an individual with
ASD to understand the task and complete it independently.

Visual Instructions
Finally, visual instructions are essential in providing meaning for most individuals
with ASD (Mesibov & Howley, 2003, chap. 2). Individuals with ASD often benefit
from a jig, or visual representation, of where materials belong or how a task is to be
completed. For example, a jig can provide a visual depiction of how to set a table.
Visual instructions not only utilize the strong visual perceptual skills of individuals
with ASD, but also support the development of flexibility. That is, visual instructions
allow individuals with ASD to learn the routine of relying on instructions, rather than
learning a rigid routine of how to perform a particular task, which will not generalize
to other tasks and can be hard to break.
Overall, Structured Teaching incorporates the strengths of individuals with ASD,
such as their visual perception skills, while accommodating for weaknesses, such as
poor organization and receptive language, difficulty determining relevant information,
and problems with transitions. Not only is Structured Teaching useful for teaching
academic or functional daily living skills, it can be helpful in teaching communica-
tion, social, and leisure activities. Used across many different settings such as the
school, home, and community, these intervention strategies provide the organization
and structure needed for individuals with ASD to understand their environments and
our expectations more fully, and to function more independently and successfully.

REFERENCES
Mesibov, G., & Howley, M. (2003). Accessing the curriculum for pupils with autistic spectrum disor-
ders. London: David Fulton Publishers.
Mesibov, G. B., Shea, V., & Shopler, E. (2005). The TEACCH approach to autism spectrum dis-
orders. New York: Kluwer Academic/Plenum Publishers.
SIGNE M. BOUCHER AND GARY B. MESIBOV

STUDENT SOCIAL ATTRIBUTION SCALE (SSAS)

The Student Social Attribution Scale (SSAS; Bell & McCallum, 1995) measures a
student’s awareness of the reason(s) behind school-related success and failure. The
questionnaire includes 30 written scenarios that illustrate examples of school success
and failure that are followed by four possible causes including ability, chance, effort,
and task difficulty. The participant is required to identify how often these causes apply
to him or her. The most current version of the SSAS is made up of 16 subscales. A
shorter 12-scenario version is also available.

REFERENCE
Bell, S. M., & McCallum, R. S. (1995). Development of a scale measuring student attributions and
its relationship to self-concept and social functioning. School Psychology Review, 24, 271–286.

369
SUPPLEMENTAL SECURITY INCOME (SSI)

FURTHER INFORMATION
Barnhill, G. (2001). Social attributions and depression in adolescents with Asperger syndrome.
Intervention in School and Clinic, 16(1), 46–53.
AMY BIXLER COFFIN

SUPPLEMENTAL SECURITY INCOME (SSI)

One program that individuals with autism spectrum disorders may access is Supple-
mental Security Income (SSI), which is a program of the federal government designed
to provide enough personal income each month to subsidize basic needs of food, cloth-
ing, and shelter. Generally speaking, eligibility is reserved for the aged and disabled
who have little or no income and less than $2,000.00 in assets. SSI is a means-tested
program, which means that there are income guidelines that include the parents if the
child is under age 18. The means-test is also a consideration when estate planning
because if the disabled individual receives a sizeable inheritance, it is possible that
would jeopardize their eligibility for further SSI payments. It is also possible to work
while receiving SSI benefits, and your local Social Security Office should be able to
guide you as to the amount of employment income you may have so that you do not
accidentally forfeit your program eligibility. IQ and previous employment are also taken
into consideration when determining eligibility; however, once you are deemed eligible
for SSI it is also possible that you will qualify for food stamps, Medicaid or Medicare.
Even though SSI is a federal program, there are specific rules for income or benefit caps
that vary from state to state. The best way to get started with the application process is
to use the Web site provided by the Social Security Administration, which is http://
www.socialsecurity.gov/pubs/11000.html or the toll-free phone line at 1-800-772-1213.
SHERRY MOYER

SUPPORTED EMPLOYMENT
The Division of Vocational Rehabilitation (VR) provides supported employment as
a support for individuals with the most severe disabilities who are eligible for competi-
tive employment with ongoing, continual job coach support. VR usually contracts this
service with an agency that provides adult services for individuals with cognitive or
emotional disabilities. This service allows individuals with cognitive disabilities, signif-
icant developmental delays, and severe emotional disturbances to attain and maintain
community-based employment. The adult service agency provides ongoing job coach
support to assist with the needs an individual may have that may prevent him or her
from maintaining competitive employment independently or with minimal support.
An example of a need for supported employment is an individual who is blind and
has been diagnosed with autism. This individual completes daily tasks in order at
work; however, he needs frequent reminders to move from one task to another or to
continue a task and needs assistance with transitions from one place to another.
Supported employment provides an opportunity for individuals with more severe
disabilities to receive employment in the community with their adult peers. It is a
benefit for the individual as well as the community.
See also individualized transition plan; vocational rehabilitation.
BETH CLAVENNA-DEANE
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 SURTHRIVAL

SURTHRIVAL
For many years, parents and professionals have witnessed sharp contrasts in the edu-
cational experiences of many students with autism spectrum disorders (ASD). Parents
may report that their child thrives during first grade, only to struggle for social and
emotional survival in second grade. Similarly, a teacher may have a wonderful year
working with her first student with Asperger syndrome, only to watch sadly as he is
repeatedly ‘‘in trouble’’ with his teacher the following year.
Attempts to explain these sharp contrasts, this thrive versus struggle to survive phe-
nomenon, often center around the personality or attitude of the teacher and/or others
on the student’s educational team. However, attitude can explain only part of the dif-
ference. A student’s social and emotional success does not rest solely in mastery of the
goals and objectives in his or her educational plan. Instead, it is the result of effort
and learning by a student and all of those working on his behalf. Surthrival is the shared
social goal in ASD—a positive social process that yields benefits for all.
Created by merging the terms survive and thrive, Surthrival derives its meaning from
both words (see Figure 18). Students have a responsibility to learn the concepts and
skills to help them socially and emotionally survive, and those who surround them
have an equal responsibility to learn the attitudes and practices that create contexts
where students can thrive. Based on a belief that the social impairment in ASD is a
shared challenge, Surthrival seeks to discover social solutions rather than invent prede-
termined, prescribed outcomes. For this reason, Surthrival often results in outcomes
that take everyone pleasantly by surprise!
Formally defined in Figure 18, Surthrival is supported by a paradigm, social curiosity,
and five practices. Social curiosity has strong roots in respect for other perspectives
and social styles, and is fueled by the possibilities of a third social option that is not
typical, and not ASD, but collaboration between the two. The five practices are repre-
sented by occupations used as metaphors to represent important skill sets. These
include: (a) an Investigative Reporter, who seeks to understand the roots of unique
responses; (b) a Personal Trainer, who has a great sense of humor and extends a ‘‘come
as you are’’ welcome; (c) a Travel Agent, who provides support by structuring experi-
ence; (d) an Air Traffic Controller, who can foresee problem situations and ‘‘coach
pilots’’ through challenging situations; and (e) a Choir Director, who leads ‘‘individual
voices: learning to work effectively as a group. Sharing a strong foundation in social
curiosity, these five practices are interdependent and work together to create opportu-
nities for Surthrival.

Figure 18 Definition of Surthrival

Surthrival /s r thr
v’ l (noun). 1) the shared goal and solution to ‘‘the social impairment in
e e
autism spectrum disorders (ASD),’’ often with unanticipated benefits for all, 2) the social, emo-
tional, and intellectual growth of a child, adolescent, or adult with an ASD in an environment
governed by a philosophy and defined set of practices (possibly within an environment not oth-
erwise conducive to such learning), 3) a state of inherent social health and balance between
two or more parties with often distinct perceptions, perspectives, and responses to social con-
texts and communication. To surthrive (verb).

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SYMBOLIC PLAY

Returning to the reality of the ‘‘survive’’ versus ‘‘thrive’’ phenomenon of students

with ASD described earlier, can the paradigm and practices of Surthrival be taught
and learned? Or does it require inborn traits, delegating opportunities for students with
ASD to thrive in learning environments to a random hit or miss luck of the draw?
These authors believe that ‘‘if Surthrival can be identified, it can be measured. If Sur-
thrival can be measured, it can be taught. If Surthrival can be taught, it can be
learned’’ (Gray & Krusniak, 2006, p. 31).

REFERENCE
Gray, C., & Krusniak, W. M. (2006, Summer). Evidence of Surthrival. Autism Spectrum Quar-
terly, 30–32.

FURTHER INFORMATION
The Gray Center: www.TheGrayCenter.org.
CAROL GRAY AND WHITNEY MITCHELL KRUSNIAK

SYMBOLIC PLAY
Children with ASD show delays or differences in the development of symbolic play
(a.k.a. pretend, make-believe, imaginary play; APA, 2000). Symbolic play reflects the
child’s capacity to intentionally disengage from reality and act as if he is doing some-
thing or being someone else in a manner that is representational. This includes object
substitutions, attribution of absent or false properties, and representing imaginary
objects or events as present (Baron-Cohen, 1987; Leslie, 1987; Wolfberg, 1999, 2003).
See also integrated play groups; play-oriented therapies.

REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
Baron-Cohen, S. (1987). Autism and symbolic play. British Journal of Developmental Psychology,
5(2), 139–148.
Leslie, A. M. (1987). Pretense and representation: The origins of ‘‘theory of mind.’’ Psychological
Review, 94, 412–426.
Wolfberg, P. J. (1999). Play and imagination in children with autism. New York: Teachers College
Press, Columbia University.
Wolfberg, P. J. (2003). Peer play and the autism spectrum: The art of guiding children’s socialization
and imagination. Shawnee Mission, KS: Autism Asperger Publishing Company.

FURTHER INFORMATION
Autism Institute on Peer Relations and Play: www.autisminstitute.com.
PAMELA WOLFBERG

SYMBOLIC THOUGHT
Symbolic thought is the developmental stage when a child begins to use formal sym-
bols such as words and pictures to create meanings and communicate ideas. This is typ-
ically manifested in spoken words. This stage develops between 18 and 30 months of
age. A child will progress through several levels of symbolic thought: words and actions
used together; action words used instead of the corresponding behavior; words used to
convey feelings such as, ‘‘I’m happy’’; words used to convey bodily states, ‘‘my stomach
aches’’; words used to communicate global feelings as, ‘‘I’m OK’’; and words used to
372
 SYSTEMATIC DESENSITIZATION

convey more specific feelings, such as, ‘‘I feel angry’’ (Greenspan & Shanker, 2004).
Children also begin to use symbolic thought in play by using toys, props, and other
people to direct their actions. Later, children will communicate symbolic thought by
pretending in play using object substitution, role taking, and role-play. (Quill, 2000).
REFERENCES
Greenspan, S., & Shanker, S. (2004). The first idea, how symbols, language, and intelligence
evolved from our primate ancestors to modern humans. Cambridge, MA: Da Capo Press.
Quill, K. A. (2000). Do-watch-listen-say: Social and communication intervention for children with au-
tism. Baltimore: Brookes Publishing Co.
ANN PILEWSKIE

SYMPTOM
A symptom is a change in health, such as having a raised temperature, being in
pain, or being nauseous. When referring to an illness, a symptom is used in aiding in
diagnosis. When discussing symptoms, one may talk about general symptoms or spe-
cific symptoms related to body systems or diseases.
TERRI COOPER SWANSON

SYNDROME
The term syndrome refers to a disorder or abnormality that is diagnosed based upon
a group of signs and symptoms that tend to occur together. When certain signs and
symptoms co-occur frequently, it is suspected that they may have the same underlying
cause, may run in certain families, may follow the same course, or may respond to the
same treatments. All autism spectrum disorders are, in fact, syndromes, because they
are diagnosed based on combinations of difficulties in social interaction, communica-
tion, and repetitive behaviors (APA, 2000).
REFERENCE
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
LISA BARRETT MANN

SYSTEMATIC DESENSITIZATION
Systematic desensitization was first used by Wolpe in 1958. This technique is usu-
ally applied to situations in which people are experiencing anxiety and/or phobias.
The person is asked by the therapist to rank a group of scenarios from least or most
anxiety or fear producing. Then while the person is experiencing that situation or
imagining it, he or she learns to replace their anxious feelings with feelings of relaxa-
tion. Once the least fearful situation becomes no longer anxiety producing, the person
can move to more anxiety-producing situations (Cooper, Heron, & Heward, 1987).
See also anxiety disorders.
REFERENCES
Cooper, J. O., Heron, T. E., & Heward, W. L. (1987). Applied behavior analysis. Upper Saddle
River, NJ: Prentice Hall.
Wolpe, J. (1958). Psychotherapy by reciprocal inhibition. Stanford: Stanford University Press.
TARA MIHOK
373
 T
TACT
The term tact originated with writings on verbal behavior within the field of
applied behavior analysis. A tact is the labeling of an item. An example would be a
parent holding up a shoe and the child labeling the shoe. No requesting is involved
in the tacting of an item; it is simply labeling an item in the environment (Lerman,
Parten, Addison, et al., 2005).

REFERENCE
Lerman, D. C., Parten, M., Addison, L. R., Vorndran, C. M., Volkert, V. M., & Kodak, T.
(2005). A methodology for assessing the functions of emerging speech in children with devel-
opmental disabilities. Journal of Applied Behavior Analysis, 38(3), 303–316.
TARA MIHOK

TACTILE
Located in the skin cells, the tactile system provides information about objects in
the environment. Individuals with autism spectrum disorders often exhibit touch sensi-
tivity. At its extreme, tactile hypersensitivity, or defensiveness, involves physical dis-
comfort when coming into contact with someone or something that others might not
register. Standing in line, shopping for clothing, bathing, eating, and using a glue stick
all present potentially stressful situations for tactilely defensive individuals. In con-
trast, individuals who are hyposensitive fail to respond to the touch of others, yet of-
ten use touch to explore the environment for the tactile input they crave.
See also sensory integration; sensory integration disorder.
KELLY M. PRESTIA

TACTILE DEFENSIVENESS
Tactile defensiveness is a behavior or coping mechanism exhibited by individuals
who may be sensitive to certain tactile sensory stimuli. Observable behaviors of tactile
defensiveness may include pulling away from the touch of others or wearing tagless
undershirts.
KELLY M. PRESTIA
TARGET BEHAVIOR

TARGET BEHAVIOR
A desired or target behavior is a single, clearly defined, observable behavior. The
behavior is defined to allow observations, data recording, and/or teaching of the specific
behavior. A target behavior may be a negative or undesired behavior or a positive
behavior being taught. For example, in discrete trial training, the specific skill or
response being taught within a program is called the target behavior. It is of utmost im-
portance that the desired or target behavior be clearly defined so that anyone reading
its description would know exactly what is being addressed. This definition is referred to
as an operational definition. Having a good operational definition provides clarity for
staff and students alike and ensures accurate data and consistent instruction.
KATIE BASSITY

TASK ANALYSIS
A task analysis is a breakdown of the individual steps involved in a complex behav-
ior. For example, for hand washing, the task analysis would identify each step: turn on
water, get hands wet, get soap, rub hands, rinse hands, turn off water, dry hands. The
degree to which a behavior is broken down depends upon the individual and the task.
Once a task analysis is performed, chaining is often used to teach the behavior.
See also applied behavior analysis.
KATIE BASSITY

TESTIMONIAL
Testimonial is a written or verbal statement often given by an individual or group
of individuals in support of a particular truth, fact, or claim. This anecdotal evidence
is typically used to persuade others to support their belief.
See also anecdotal report.
THERESA L. EARLES-VOLLRATH

TEST OF ADOLESCENT AND ADULT LANGUAGE–

FOURTH EDITION (TOAL4)
The Test of Adolescent and Adult Language–Fourth Edition (TOAL4; Hammill,
Brown, Larsen, & Wiederholt, 2007) measures expressive and receptive language skills
from individuals ages 12 to 24. This norm-referenced assessment yields scores in the
following areas: listening, speaking, reading, writing, spoken language, written lan-
guage, vocabulary, grammar, receptive language, and expressive language.

REFERENCE
Hammill, D. D., Brown, V. L., Larsen, S. C., & Wiederholt, J. L. (2007). Test of adolescent and
adult language–fourth edition. Austin, TX: Pro-Ed.
JEANNE HOLVERSTOTT

TEST OF LANGUAGE COMPETENCE (TLC)

The Test of Language Competence (TLC; Wiig & Secord, 1989) determines stu-
dent language strategies, assists in developing remediation plans, and aids in the devel-
opment of Individual Education Plan goals and objectives. Subtests of this assessment
include Ambiguous Sentences, Listening Comprehension: Making Inferences, Oral
376
 TEST OF PRAGMATIC LANGUAGE (TOPL)

Expression: Recreating Speech Acts, Figurative Language, and a supplemental memory

subtest. Two levels of the TLC can be administered to children ages 5–9 and 10–18.

REFERENCE
Wiig, E. H., & Secord, W. (1989). Test of language competence. New York: Harcourt Publishing.
JEANNE HOLVERSTOTT

TEST OF LANGUAGE DEVELOPMENT–INTERMEDIATE, THIRD

EDITION (TOLD-I)
The Test of Language Development–Intermediate, Third Edition (TOLD-I; Ham-
mill & Newcomer, 1997) consists of five subtests that measure components of spoken
language. Students ages 8–0 through 12–11 are given tasks in combining sentences,
understanding word relationships, constructing sentences with appropriate word order,
knowing abstract relationships, recognizing grammatical sentences, and correcting ri-
diculous or absurd sentences.

REFERENCE
Hammill, D. D., & Newcomer, P. L. (1997). Test of language development–intermediate, third edi-
tion. Austin, TX: Pro-Ed.
JEANNE HOLVERSTOTT

TEST OF LANGUAGE DEVELOPMENT–PRIMARY (TOLD-P)

The Test of Language Development–Primary (TOLD-P; Hammill & Newcomer,
1996) consists of nine subtests that measure components of spoken language. Picture
Vocabulary, Relational Vocabulary, and Oral Vocabulary assess the understanding and
meaningful use of spoken words. Grammatic Understanding, Sentence Imitation, and
Grammatic Completion subtests assess differing aspects of grammar. Word Articulation,
Phonemic Analysis, and Word Discrimination are supplemental subtests that measure
the ability to say words correctly and to distinguish between words that sound similar.

REFERENCE
Hammill, D. D., & Newcomer, P. L. (1996). Test of language development–primary. Minneapolis,
MN: Pearson Assessments.
JEANNE HOLVERSTOTT

TEST OF PRAGMATIC LANGUAGE (TOPL)

The Test of Pragmatic Language (TOPL; Phelps-Teraski & Phelps-Gunn, 1992) is
an individually administered test designed to assess an individual’s ability to use prag-
matic language. The test includes 44 items, each of which establishes a social context.
After a verbal stimulus prompt from the examiner, who also displays a picture, the
student responds to the dilemma. TOPL test items provide information within six core
subcomponents of pragmatic language: physical setting, audience, topic, purpose
(speech acts), visual-gestural cues, and abstraction.

REFERENCE
Phelps-Terasaki, D., & Phelps-Gunn, T. (1992). Test of pragmatic language. Austin, TX: Pro-Ed.
JEANNE HOLVERSTOTT
377
TEST OF PROBLEM SOLVING–ADOLESCENT (TOPS-A)

TEST OF PROBLEM SOLVING–ADOLESCENT (TOPS-A)

The Test of Problem Solving–Adolescent (TOPS-A; Bowers, Huisingh, Barret,
Orman, & LoGiudice 2007) assesses problem solving, critical thinking skills, and ex-
pressive language skills of adolescents ages 12–18. The 13 problem-solving items are
composed of passages and open-ended questions designed to assess skills in clarifying,
evaluating, fair-mindedness, analyzing, thinking independently, and affect.
REFERENCE
Bowers, L., Huisingh, R., Barret, M., Orman, J., & LoGiudice, C. (2007). Test of problem
solving–adolescent. East Moline, IL: LinguiSystems, Inc.
JEANNE HOLVERSTOTT

TEST OF PROBLEM SOLVING–ELEMENTARY (TOPS-E)

The Test of Problem Solving–Elementary (TOPS-E; Bowers, Huisingh, & LoGiu-
dice, 2005) assesses the ability of children ages 6 to 11 years to organize thoughts and
express thoughts clearly. Performance is assessed in problem solving, determining solu-
tions, drawing inferences, empathizing, predicting outcomes, using contextual cues,
and vocabulary comprehension.
REFERENCE
Bowers, L., Huisingh, R., & LoGiudice, C. (2005). Test of problem solving 3–elementary. East
Moline, IL: LinguiSystems, Inc.
JEANNE HOLVERSTOTT

THEORY OF MIND
Theory of mind refers to the ability to understand and impute to people mental
states such as feelings, beliefs, or intentions that are different from our own (Baron-
Cohen, Leslie, & Frith, 1985; Cumine, Leach, & Stevenson, 1998; and Klin, Volkmar, &
Sparrow, 2000). There are two levels of theory of mind. First order comprises the abil-
ity to predict a mental state of someone else (e.g., I think that Katy thinks), the sec-
ond order involves the ability to predict one person’s mental state about another
person’s mental state (e.g., Katy thinks that Mark thinks). The theory of mind
hypothesis related to autism proposes that persons with autism have difficulty or are
unable to perceive the desires, intentions, or beliefs of others. The significance of this
deficit is the inability of a person to develop and understand social relationships and
answer appropriately to the social demands of his or her environment.
See also social skills training; social thinking.
REFERENCES
Baron-Cohen, S., Leslie, A. M., & Frith, U. (1985). Does the autistic child have a theory of
mind? Cognition, 21, 37–46.
Cumine, V., Leach, L., & Stevenson, G. (1998). Asperger syndrome, a practical guide for teachers.
London: David Fulton Publishers.
Klin, A., Volkmar, F. R., & Sparrow, S. S. (2000). (Eds.). Asperger syndrome. New York: Guil-
ford Press.

FURTHER INFORMATION
Baron-Cohen, S. (1997). Mindblindness: An essay on autism and theory of mind. Cambridge, MA:
The MIT Press.

378
 TIC DISORDERS

Baron-Cohen, S. (2004). Mind READING The interactive guide to emotions [DVD edition]. Lon-
don: Jessica Kingsley Publishers.
Charman, T., Baron-Cohen, S., Swettenham, J., Baird, G., Cox, A., & Drew, A. (2000). Test-
ing joint attention, imitation, and play as infancy precursors to language and theory of mind.
Cognitive Development, 4, 481–498.
Howlin, P., Baron-Cohen, S., & Hadwin, J. (1998). Teaching children with autism to mind-read: A
practical guide for teachers and parents. New York: John Wiley.
McAfee, J. (2002). Navigating the social world: A curriculum for individuals with Asperger’s syn-
drome, high functioning autism, and related disorders. Arlington, TX: Future Horizons.
SUSANA BERNAD-RIPOLL

TIC DISORDERS
A tic is a brief, nonrhythmic, recurrent, and rapid movement caused by a problem
in the brain with neurons that use dopamine. Tics can involve the skeletal muscles,
which produce motor tics, or the smooth muscles, which produce vocal tics. Tics can
be simple, involving only one muscle group, or complex, involving multiple groups.
Common motor tics include simple ones such as eye blinking, head turning, or jaw
movements, as well as complex ones such as hand gestures, jumping, or twirling.
Vocal tics most commonly involve simple ones like clearing the throat or snorting.
Complex vocal tics are rarer and can include saying words or phrases, including curse
words. These words, like many tics, are unrelated to the situation and are potentially
very embarrassing. Kurlan, McDermott, Deeley, Como, Brower, et al. (2001) found
that around 20 percent of typical grade school children exhibited at least one tic.
Most of these children and their families did not attach significance to their tics, and
therefore they did not reach medical attention.
When tics interfere with a person’s ability to function, a tic disorder may be diag-
nosed and treatment considered. The Diagnostic and Statistical Manual of Mental
Disorders–Fourth Edition–Text Revision (DSM-IV-TR; APA, 2000) identifies four
basic tic disorders: chronic motor or vocal tic disorder, transient tic disorder, tic disor-
der NOS, and Tourette’s disorder. Individuals with a chronic motor tic disorder pres-
ent only motor tics and no vocalizations. Chronic vocal tic disorder is similar except
that the individual exhibits vocal tics with no motor involvement. Transient tic disor-
der patients have motor and/or vocal tics not for more than one year for at least four
weeks. To be diagnosed with tic disorder NOS, the duration or frequency does not
match the stipulations of the other conditions. Additionally, tic disorders must start
before age 18 and cannot be secondary to substance abuse or another known medical
condition. Tourette’s disorder, sometimes referred to as Tourette’s syndrome or TS,
combines vocal and motor tics, though both do not have to be consistently present.
The DSM-IV-TR (APA, 2000) states that in both chronic tic disorders and Tour-
ette’s, tics must be present for at least one year with no tic-free periods longer than
3 months. With Tourette’s disorder, the intensity of tics fluctuates across time, with
new ones starting and old ones subsiding, only to re-emerge later. Tics usually worsen
with stress or excitement, such as during the school year.
The treatment of tics involves the use of dopamine antagonist medications such as
pimozide or haloperidol. Newer medications such as risperidone and aripiprazole are
also being used, but are not yet FDA-indicated treatments.
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TIME-OUT

REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
Kurlan, R., McDermott, M. P., Deeley, C., Como, P. G., Brower, C., Eapen, S., et al. (2001).
Prevalence of tics in schoolchildren and association with placement in special education.
Neurology, 57, 1383–1388.

FURTHER INFORMATION
Adams, R. D., Victor, M., & Ropper, A. H. (1985). Principles of neurology (3rd ed.). New York:
McGraw-Hill.
JAMES R. BATTERSON

TIME-OUT
Time-out is a form of punishment intended to decrease the likelihood of a behavior
reoccurring. Time-out simply removes the individual from reinforcement, whether that
is attention, computers, playtime, or another situation or activity. There are two types
of time-out: seclusionary and nonseclusionary. Seclusionary time-out removes the indi-
vidual from the setting where the reinforcement is offered; nonseclusionary keeps the
individual in the setting while still denying her access to reinforcement. It is impor-
tant to remember that time-out is only effective and should only be used if it
decreases the likelihood of the undesired behavior occurring again. In addition, time-
out must remove the individual from all forms of reinforcement. For these reasons,
time-out is not effective for all behaviors, all situations, or all children.
See also reinforcer.
KATIE BASSITY

TOE WALKING/EQUINUS GAIT

Toe walking, also called equinus gait for its similarity to the way a horse walks, is
normal for typically developing youngsters up to age 3. For those with autism spectrum
disorders or other disabilities, toe walking may be seen well into childhood. Toe walk-
ing can be caused by a number of factors including habit, immature nervous system,
visual problems, and various neuromuscular disorders.

FURTHER INFORMATION
Edelson, S. M. (2005). Toe walking. Retrieved June 5, 2006, from http://www.autism.org/
toewalk.html.
Schwentker, E. P. (2004). Toe walking. Retrieved June 5, 2006, from http://www.emedicine.
com/orthoped/topic451.htm.
PAUL G. LACAVA

TOKEN ECONOMY
Token economy is an individualized reinforcement system that uses a conditioned
stimulus, or token, such as a coin, a poker chip, or even a mark on a paper, to repre-
sent progress towards the receipt of a predetermined reinforcer for a certain predeter-
mined behavior. The tokens are earned for performing appropriate behavior and are
then traded for reinforcement, which are tangible goods or privileges desired by the
individual (Alberto & Troutman, 1999). Token economies can take many forms. The
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 TOUCH THERAPY

tokens can be traded one token for one reinforcer, or can be traded at a higher rate of
multiple tokens for one reinforcer. Token economies are beneficial for several reasons.
They assist in the delay of reinforcement over time and between different places or set-
tings and decrease the satiation of reinforcement (Cooper, Heron, & Heward, 1987).
See also applied behavior analysis.

REFERENCES
Alberto, P. A., & Troutman, A. C. (1999). Applied behavior analysis for teachers (pp. 235–247).
Upper Saddle River, NJ: Merrill.
Cooper, J. O., Heron, T. E., & Heward, W. L. (1987). Applied behavior analysis. Upper Saddle
River, NJ: Prentice Hall.
JESSICA KATE PETERS AND TARA MIHOK

TOTAL COMMUNICATION
Total communication is an educational philosophy for children who are deaf or
hearing impaired. This philosophy promotes the use of all modes of communication
that are most effective for the child in any given moment. This allows the child to
use all available modes of communication such as speech, lip-reading, sign language,
writing, visual supports, or a combination of these. This philosophy was meant to find
a middle ground between advocates for oral language only and advocates for sign lan-
guage only as methods of communication.
The term total communication was first coined by Roy Holcomb in 1967 in Califor-
nia and developed by David Denton at the Maryland School for the Deaf. By the mid
1970s, most of the schools for children who were deaf incorporated such philosophy
in their instructional curriculums.

FURTHER INFORMATION
Baker, R., & Knight, P. A. (1998). Total communication: Current policy and practice. In S.
Gregory, P. Knight, W. McCracken, S. Powers, & L. Watson (Eds.), Issues in deaf education
(pp. 77–78). London: David Fulton, Publisher.
Evans, L. (1982). Total communication: Structure and strategy. Washington, DC: Gallaudet Uni-
versity Press
Gibbs, E., & Springer, A. (1994). Early use of total communication: An introductory guide for
parents. Baltimore: Brookes Publishing Co.
SUSANA BERNAD-RIPOLL

TOUCH PRESSURE
Touch pressure is also known as proprioception, which involves firm but gentle
touch to strategic parts of the body as an intervention to calm and reorganize the
body and nervous system.
KELLY M. PRESTIA

TOUCH THERAPY
Touch therapy is an intervention that attempts to desensitize an individual who
may be overly sensitive to touch by slowly increasing the amount and types of touch
that the individual will tolerate.
KELLY M. PRESTIA
381
TOWER OF HANOI (TOH)

TOWER OF HANOI (TOH)

The Tower of Hanoi (TOH; Lawrence Hall of Science, n.d.) is a mathematical puz-
zle invented by the French mathematician Edouard Lucas in 1883. TOH consists of a
tower of eight disks, initially stacked in increasing size on one of three pegs. The
objective is to transfer the entire tower to one of the other pegs, moving only one disk
at a time and never a larger one onto a smaller.

REFERENCE
Lawrence Hall of Science (n.d.). Tower of Hanoi facts. Retrieved December 10, 2006, from
http://www.lawrencehallofscience.org/Java/Tower/index.html.
JEANNE HOLVERSTOTT

TOXICOLOGY
Toxicology refers to the study of the symptoms, treatments, and detection of the
adverse effects of chemicals on living organisms, typically referred to as poisoning.
The chief criterion regarding the toxicity of a chemical is the dose or the amount of
exposure to the substance.
JEANNE HOLVERSTOTT

TRAIL-MAKING TEST
The Trail-Making Test (TMT; Reitan, 1958) requires participants to draw a single,
continuous line (a trail) through randomly located items on a sheet of paper. In
TMT’s Form A, the trail is drawn through numbers to be connected in numerical
order from 1 to 25. In Form B, the trail is through spatially intermingled numbers and
letters, alternating between the two kinds of items, 1, A, 2, B, and so forth. The total
time to complete each form is measured and performance is summarized by scoring
each test separately, computing the difference between the two total times, or by their
ratio. TMT is used to assess executive functioning; specifically, differential perform-
ance on the two forms has been linked to the ability to perform complex executive
functions, such as planning of actions and switching between activities (Kuhlman,
Little, and Sekuler, in press).

REFERENCES
Kuhlman, A., Little, D., & Sekuler, R. (in press). An interactive test of serial behavior: Age
and practice alter executive function. Journal of Clinical and Experimental Neuropsychology.
Reitan, R. M. (1958). Trail making test: Manual for administration, scoring and interpretation. Indi-
anapolis, IN: Indiana University Medical Center.
JEANNE HOLVERSTOTT

TRANSITION PLANNING
The Individuals with Disabilities Education Act (IDEA; 2004) provides for func-
tional transition planning beginning no later than age 16 years and designed to sup-
port the movement of the individual learner from school-age services and supports (to
the greatest extent possible) to the postschool world of adult independent living.
IDEA defines transition planning as a coordinated set of activities that focus on
improving the academic and functional achievement of the student and facilitate
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 TRANSITION PLANNING

Figure 19 Initial Employment Experience Goal

Student: Mark Doe Age: 14 years

Transition to Employment Goal: To obtain an employment experience in a field/location

where:
There are clear completion criteria
He will be able to listen to his music on a Walkman
He will be able to consistently get to the location, and
He will work directly with one primary supervisor.
Short-term (3 Month) Objectives & Person Responsible:
Investigate employment opportunities meeting these criteria—School Staff
Assess specific instructional opportunities in terms of production (the work he will do), social
(the interaction environment of the workplace), navigation (e.g., ability to independently
access the Men’s Room) and safety demands (potential hazards such a complex
machinery)— Transition Specialist
Develop instructional programs to meet noted skill demands in new environment—Transition
Specialist
Develop brief coworker training protocol focusing on the strengths of Mark Doe and what he
may need to support effective communication—Transition Specialist and Newly Identified
Employer
Obtain bus pass for ride to work—Mark and His Parents
Obtain state issued photo identification and age-appropriate wallet—Mark and His Parents
Purchase work specific clothes (if necessary)—Mark and His Parents
Schedule next meeting—All Concerned

movement from school to postschool activities. Additionally, IDEA requires that the
transition services be based on the student’s strengths, as well as their preferences and
interests, and that the transition process is driven by a ‘‘results-oriented’’ philosophy
of instruction and program development.
In practice, there is general agreement as to the overall importance of comprehen-
sive transition planning. Comprehensive, in this case, can best be understood as
including input from all relevant sources (e.g., the individual and family, school per-
sonnel, interested community members, representatives from postsecondary agencies/
services, potential employers, etc.) with goals developed across all relevant domains
(e.g., academics, behavior support, communication and social skills, community inde-
pendence, safety, navigation, employability) and across all relevant environments
(e.g., home, community, work, recreation). The central question to be addressed across
all areas of comprehensive transition planning is, quite simply, ‘‘To what is the learner
with ASD transitioning and what skills, competencies, services or supports will they
need once they get there?’’ Failure to adequately answer this question results in a proc-
ess best described by Lewis Carroll (1832–1898) when he wrote, ‘‘If you don’t know
where you are going, any road will take you there.’’ In other words, in the absence of
good planning quite a bit of time and effort will be exhausted with few, if any, dis-
cernable outcomes. A sample results-oriented goal for the development of a first
employment experience may look something like this:
383
TRANSITION PLANNING

THE ROLE OF THE FAMILY

There is little disagreement as to the critical role the family plays in effective tran-
sition planning. Beyond their personal knowledge of, and relationship with, their son
or daughter, many parents with learners with autism spectrum disorders (ASD) are
well versed in the current state of ASD research, services, and supports through their
attendance at conferences, reading of journal articles, access of relevant texts, and
extensive networking. Any reduction in parent involvement, either through the
implementation of policies or procedures that restrict parental involvement or familial
fear of ‘‘rocking the boat’’ denies the transition team access to both valuable informa-
tion and, in many cases, an educated colleague.
Perhaps the most important role, among many, that parents and family members
can play in the transition process is their continuing role as an advocate for their
child. Despite a bevy of new stressors that may appear during the transition years
(e.g., an unfamiliarity with the adult system of services and supports; the potential
inability of this system to meet the needs of their, now, nearly adult child; the stress
associated with life-cycle transitions in general and, uncertainty regarding the future),
the need for parents to forcefully advocate on behalf of their son or daughter does not
diminish with age. For all aspects of comprehensive transition planning to be effec-
tively implemented, the critical role that parent advocacy plays cannot be overstated.
Transition planning, in summary, is a complex, complicated, dynamic, and highly
individualized (or person-centered) process. Based on an almost backwards process,
good transition planning begins not where the student is, but rather where the student
wants to be as the initial, school-based process winds to a close. Individual goals and
objectives are developed accordingly. It is important to note that good transition plan-
ning actually continues across a person’s postschool life with new goals and objectives
developed on a regular basis to provide the skills necessary to meet such challenges as
moving into a new apartment, starting a new job, graduating from college, or meeting
new people. Comprehensive transition planning, it seems, does not terminate as a
function of one’s high school graduation but instead, is only temporarily suspended at
times as a function of one’s attaining a preferred, active, and included quality of life.
See also Individualized Transition Plan; postsecondary education; vocational
rehabilitation.

REFERENCE
Individuals with Disabilities Education Improvement Act of 2004. Public Law No. 109-446, § 20
U.S.C. (2004).

FURTHER INFORMATION
Bannerman, D. J., Sheldon, J. B., Sherman, J. A., & Harchik, A. E. (1990). Balancing the right
to habilitation with the right to personal liberties: The rights of people with developmental
disabilities to eat too many doughnuts and take a nap. Journal of Applied Behavior Analysis,
23, 79–89.
Ford, A., Schnorr, R., Meyer, L., Davern, L., Black, J., & Dempsey, P. (Eds.). (1989). The Syra-
cuse community-referenced curriculum guide for students with moderate to severe disabilities. Balti-
more: Brookes Publishing Co.
Gerhardt, P. F., & Holmes, D. L. (2005). Employment: Options and issues for adolescents and
adults with autism. In F. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism
and pervasive developmental disorders (3rd ed., pp. 1087–1101). New York: Wiley.

384
 TUBEROUS SCLEROSIS COMPLEX

Gerhardt, P. F. (2003). Transition support for learners with Asperger syndrome: Toward success-
ful adulthood, In T. Gullota & R. Ducharne (Eds.), Aspergers syndrome (pp. 159–174). New
York: Klewer/Plenum.
Griffiths, D. M., Richards, D., Fedoroff, P., & Watson, S. L. (Eds.) (2002). Ethical dilemmas: Sex-
uality and developmental disabilities. Kingston, NY: NADD Press.
Howlin, P., Goode, S., Hutton, S., & Rutter, M. (2004). Adult outcome for children with au-
tism. Journal of Child Psychology and Psychiatry, 45, 212–229.
Jefferson, G. L., & Putnam, G. L. (2002, May). Understanding transition services: A parent’s
guide to legal standards and effective practices. Exceptional Parent Magazine, 70–77.
Koller, R., (2000). Sexuality and adolescents with autism. Sexuality and Disability, 18, 125–135.
Steere, D. E., Rose, E., & Cavaiuolo, D. (2006). Growing up: Transition to adult life for students
with disabilities. Boston: Allyn & Bacon.
Wehman, P. (2002). Individual transition plans: The teacher’s curriculum for helping youth with spe-
cial needs (2nd ed.). Austin, TX: Pro-Ed.
Wehman, P. (2006). Life beyond the classroom: Transition strategies for young people with disabil-
ities. Baltimore: Brookes Publishing Co.
PETER GERHARDT

TREATMENT EFFECTIVENESS
Treatment effectiveness refers to the ability of a particular treatment (e.g., pharma-
cological, psychosocial) to remediate the symptoms of a psychological disorder.
Because anecdotal reports from providers and clients typically provide flawed data,
treatment effectiveness is typically assessed through empirical research.
See also empirical evidence.
JEANNE HOLVERSTOTT

TRIAL
A trial is the individual, distinct unit of behaviorally based instruction. It is com-
prised of four parts: the discriminative stimulus (SD), the response (R), the reinforcing
stimulus (SR), and the intertrial interval. In addition, a prompt may be added, in which
case it would immediately follow the SD and precede the response. The SD is the com-
mand or demand, and it may be verbal, such as ‘‘touch head,’’ nonverbal, or a combina-
tion of the two. The R is the student’s response to the given command, and the SR is
the instructor’s response to the student’s response. While it is desired that the SR is a
conscious reinforcement provided by the instructor, dependent on the student’s
response, some form of SR occurs regardless of the teacher’s intent because it is virtually
impossible to not react to the student’s response. An intertrial interval follows each SD-
R-SR sequence to separate it from the next SD-R-SR sequence; this is what makes the
trial an individual unit of instruction. There are a wide variety of prompts which can be
used within a trial, and instructors should be fully conscious of themselves while carry-
ing out a trial to be sure prompts are only given when and how they are intended.
See also discrete trial training; prompting.
KATIE BASSITY

TUBEROUS SCLEROSIS COMPLEX

Tuberous sclerosis complex is a genetic disorder in which multiple tumors appear in
the skin, brain, heart, and kidneys of affected children. Infants born with this disease
may have facial skin lesions (called angiofibromas), tumors of the central nervous
385
TWENTY QUESTIONS TASK

system (called astrocytomas), and other lesions, producing mental retardation and
seizures.
JEANNE HOLVERSTOTT

TWENTY QUESTIONS TASK

The Twenty Questions Task (Denny & Denny, 1973) is a test of abstract thinking
and problem solving involving two participants. One participant selects a topic, typi-
cally a person, place, object, or idea. The other participant can ask up to 20 yes-or-no
questions in order to discover the other participant’s topic. Success typically results
from employing efficient strategies and effective communication.

REFERENCE
Denny, D. R., & Denny, N. W. (1973). The use of classification for problem-solving: A com-
parison of middle and old age. Developmental Psychology, 9, 275–278.
JEANNE HOLVERSTOTT

TWIN STUDIES
Autism research studies involving twins as subjects have been conducted since the
1970s. These twin studies have provided some of the most conclusive evidence for the
genetic contribution to autism. Scientists calculate the chances of disabilities such as
autism within twin pairs by studying identical twins (who share one embryo and have
identical DNA) and fraternal twins (who have separate embryos and share only 50
percent of DNA). Twin studies have shown that autism and other autism spectrum
disabilities, as well as other developmental problems, are much more likely in both
identical twins as compared to a set of fraternal twins, non-twin siblings, or the typical
population.

FURTHER INFORMATION
Le Couteur, A., Bailey, A., Goode, S., Pickles, A., Robertson, S., Gottesman, I., et al. (1996).
A broader phenotype of autism: The clinical spectrum in twins. Journal of Child Psychology
and Psychiatry, 37, 785–801
Pericak-Vance, M. A. (2003). Discovering the genetics of autism. USA Today, 131, 56–57.
Rutter, M. (2005). Aetiology of autism: Findings and questions. Journal of Intellectual Disability
Research, 49, 231–238.
The Tech Museum of Innovation. (March 31, 2006). Ask a geneticist. Retrieved July 25, 2006,
from http://www.thetech.org/genetics/ask.php?id=168.
PAUL G. LACAVA

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 U
UNIVERSAL NONVERBAL INTELLIGENCE TEST (UNIT)
The Universal Nonverbal Intelligence Test (UNIT; Bracken & McCullum, 1998) is
designed to provide a thorough assessment of general intelligence for students
from ages 5 through 17 years of age who may be at a disadvantage with traditional
language-based intelligence tests. Students who may benefit from the UNIT are indi-
viduals previously identified with or thought to be diagnosed from many diverse areas
such as different cultural backgrounds, intellectually gifted, limited English proficiency,
deaf or hearing impaired, mental retardation, speech and language difficulties, autism,
serious emotional disturbance or psychiatric disorders, and/or learning disabilities.
The UNIT is administered primarily through nonverbal gestures, and students
respond via symbolic representations and gestures. The UNIT must be given by a psy-
chologist trained and licensed in intelligence testing.

REFERENCE
Bracken, B. A., & McCullum, R. S. (1998). The universal nonverbal intelligence test. Chicago:
Riverside Publishing.
BROOKE YOUNG
 V
VACCINATIONS (THIMEROSAL)
Vaccinations containing the preservative thimerosol are a controversial issue related
to one of the possible causes of autism. Despite the fact that the Centers for Disease
Control and Prevention and the American Academy of Pediatrics issued the state-
ment, ‘‘the available scientific evidence has not shown thimerosol-containing vaccines
to be harmful’’ (World Net Daily, 2004), the U.S. Food and Drug Administration in
1999 decided to no longer use thimerosol in vaccinations. Today several national
organizations continue to raise funds to search for the causes of autism, with vaccina-
tions containing thimerosol being one the leading causes.

REFERENCES
World Net Daily (2004, April 3). Feds won’t warn people about vaccine. Retrieved December 13,
2006, from http://wnd.com/news/article.asp?ARTICLE_ID=37874.
U.S. Food and Drug Administration. (n.d.). Thimerosol in vaccines frequently asked questions.
Retrieved December 13, 2006, from www.fda.gov/cber/vaccine/thimfaq.htm.

FURTHER INFORMATION
Autism Research Institute: www.autismwebsite.com.
Autism Speaks: www.autismspeaks.org.
Centers for Disease Control (n.d.). National immunization program. Retrieved December 13,
2006, from www.cdc.gov/nip/vacsafe/concerns/thimerosal/faqs-thimerosal.htm.
TERRI COOPER SWANSON

VALIDITY
Validity refers to a study measuring information based on its design and the absence
of logical errors in drawing conclusions from the data. Many different types of validity
exist, all concerning the threats and biases that would undermine the meaningfulness
of research.
See also concurrent validity.
JEANNE HOLVERSTOTT
VAN DIJK APPROACH

VAN DIJK APPROACH

The van Dijk approach is an integrated model of assessment and educational curric-
ulum tailored for individuals who are deaf-blind and who may have intellectual dis-
ability and/or physical disability. The approach is based on the understanding that
combined loss of vision and hearing affects communication, socialization, conceptuali-
zation, and movement (MacFarland, 1995).

ASSESSMENT MODEL
In 1960, Dr. Jan van Dijk and his colleagues in the Netherlands developed a series
of assessment strategies that focused on the process of how children who are deaf-blind
learn rather than focusing on individual, discrete skills (Nelson, 2002). Such processes
include: (a) preferred learning channels; (b) ability to maintain and modulate state;
(c) ability to learn, remember, and anticipate routines; (d) ability to accommodate
new experiences with existing schemes; (e) problem-solving approach; (f) ability to
develop social attachments and interaction with others; and (g) communication
modes.
The basis of this type of assessment is the establishment of a secure relationship
between the child and the evaluator. To this end, the child is given time to explore
and become comfortable in the new environment. Parents, or persons with whom the
child feels secure, do not leave until a safe relationship is developed with the
evaluator.
The evaluator is responsible for adjusting his emotional level and communication
to the child and the child’s interests and abilities. In fact, it is the child’s interests
and abilities that determine what materials are used and the direction of the assess-
ment. The child initiates the conversation, and the assessor reproduces what the child
is doing, adding new information as turn-taking routines are built. Communication
signals are elicited by stopping the pleasurable routine and waiting for the child to
sign that she wants to continue (Nelson, 2002). During these interactions, the child is
able to demonstrate her ability to learn, and the evaluator is able to identify methods
and educational objectives for teaching the child.
It is important to note that this process is tailored to each child; therefore, there
are no standard materials or instructions. However, van Dijk and Nelson have devel-
oped an interactive CD with multiple videos of strategies for assessments (see
references).

CURRICULUM MODEL
The van Dijk curriculum uses a holistic approach implemented through the stu-
dent’s daily program. This curriculum model seeks to develop four child outcome char-
acteristics: (a) initial attachment and security; (b) concepts of near senses (touch,
smell, and taste) and distance senses (hearing and vision) in relation to the world;
(c) ability to structure the world; and (d) natural communication systems.
The four outcomes are organized in 14 instructional strategies. These instructional
strategies are teacher-applied methods (McFarland, 1995).
This curricular approach addresses several major principles such as sensory depriva-
tion, integration of sensory information, concept formation, attachment and security,
progressive distancing from concrete to more symbolic concepts, organizing and
390
 VERBAL BEHAVIOR

structuring the world, anticipatory learning, natural symbol development, pragmatic

communication, and symbolic language (McFarland, 1995).
According to van Dijk’s educational theory, there is an interrelationship between
the neurological state of the student with dual sensory loss, vision and hearing, and
the external influences of the student’s environment. Depending on how this interre-
lation is presented and encouraged, the student will develop a rich and meaningful
world of interaction or a limited and self-absorbed one (McFarland, 1995).
In this model, the teacher plays a fundamental role in guaranteeing that all compo-
nents are correctly executed through the student’s educational program and integrated
simultaneously in his or her daily activities (McFarland, 1995).

REFERENCES
McFarland, S. (1995). Teaching strategies of the van Dijk curricular approach. Journal of Visual
Impairments and Blindness, 89, 222–228.
Nelson, C. (2002). The van Dijk approach to child guided assessment. Retrieved April 10, 2006,
from http://www.tsbvi.edu/Outreach/seehear/winter02/vnadijk.htm.

FURTHER INFORMATION
van Dijk, J., & Nelson C. (2002). Child-guided strategies for assessing children who are deaf
blind or have multiple disabilities [CD Rom]. Available at http://www.tsbvi.edu/Outreach/
seehear/winter02/vnadijk.htm and http://www.aapnootmuis.com/.
SUSANA BERNAD-RIPOLL

VERBAL BEHAVIOR
Applied behavior analysis (ABA) and verbal behavior (also known as AVB-applied
verbal behavior) are based on the works of B. F. Skinner. In his book, Verbal Behavior
(1957), Skinner’s theories regarding language classify speech and other forms of com-
munication as behaviors. Skinner’s study of the ecology of behaviors (1953) aided in
the development of the field of behavior modification and the principles of ABA. For
example, reinforcement, motivation, discrete trial instruction, and shaping are all
components of ABA directly applied in AVB. With regard to verbal behavior, the
verbal operant is the ‘‘behavior’’ serving as the object of study. The operants of verbal
behavior include: mand, echoic, tact, receptive function feature class (RFFC), and
intraverbal. Each verbal operant is taught separately and used for language assessment.

THE MAND
Typically used as the first type of language taught, a mand is simply a request for
something (the reinforcer) that an individual is motivated to request. The level of
motivation serves as the establishing operation (EO) demonstrating how effective a
reinforcer is at a particular time or place. An effective EO increases the probability
that a particular behavior will occur, thus creating more opportunities to reinforce the
behavior.
According to Skinner (1957), observation of the child, an interview of the child,
parents, and past teachers, and the administration of reinforcement inventories are
necessary to discover what a child finds motivating. It is preferable to select items or
activities that can be used more than once such as a toy that lights up and/or plays
music. Skinner further suggests (1957) that the innately high level of motivation in
391
VERBAL BEHAVIOR

the natural environment should be harnessed as much as possible. Moreover, a student

should never be prompted to mand for items that are not preferred as this decreases
motivation quickly. Another ‘‘motivation killer’’ is to offer some of the reinforcing
items for ‘‘free’’ sometimes. The use of errorless teaching procedures, while limiting
aversives and punishment, keeps the training enjoyable. Considerations should be
made with regard to consistency across teachers and environments and with regard to
mastery criteria and the accessibility of reinforcers. Skinner also suggests that general-
ization be a consideration from the initial stages of manding (1957) by varying the
pace of instruction, materials, people, and environment whenever possible.

THE ECHOIC
The echoic is verbal behavior that is controlled by another’s verbal behavior, more
commonly known as verbal imitation. Students with a limited verbal repertoire (e.g.,
babbling) and some indication of motor imitation can benefit from the use of pairing
sign language with manding to develop vocalizations. In doing so, the focus should
not be on the sign but on shaping the vocalizations (Sundberg & Partington, 1998),
which is accomplished through differential reinforcing for closer and closer approxima-
tions of the vocalization (differential reinforcement). In this way, signing can be used
as a ‘‘bridge’’ to arrive at the correct vocalization (Sundberg & Partington, 1998). At
this stage, imitation (e.g., teacher says, ‘‘Do this,’’ and claps and the student claps),
receptive language (e.g., student is able to follow a verbal direction) and matching to
sample (e.g., can match items that vary only by color or size in a field of eight) should
be taught as soon as possible with the echoic.

THE TACT
The tact is verbal behavior as a result of a nonverbal stimulus, commonly referred to
as labeling (e.g., the teacher holds up a cup and the child states, ‘‘cup’’). Before teach-
ing the tact, a student should have some words/signs that he can imitate, and he should
have some independent mands (Sundberg & Partington, 1998). Trials of other acquired
skills should be interspersed with tact trials (e.g., echoic, receptive, matching, imita-
tion). At this stage it is important that the student be able to respond to these ‘‘mixed’’
trials effectively and that the mand, tact, and receptive operants are strong and general-
ized before moving on to the next stage. When this basic repertoire has been achieved,
it is time to consider the receptive function, feature, class, and intraverbal operants.

THE RECEPTIVE FUNCTION FEATURE CLASS (RFFC)

Receptive means the ability to respond to the instructions or requests of others.
The response depends upon the verbal behavior of someone else; for example, if the
teacher says ‘‘clap,’’ the student claps. The receptive feature, function, class process
teaches students to distinguish items by how they look (e.g., ‘‘give me the one that is
orange’’), how they are used (e.g., ‘‘give me the one that you drive’’), or by the class
of items a particular object belongs to (‘‘give me the one that is a food’’).

THE INTRAVERBAL
An intraverbal is a verbal response to a verbal behavior without the presence of
nonverbal stimuli (Skinner, 1957). For example, one might answer ‘‘dog’’ when asked,
392
 VESTIBULAR

‘‘What is your favorite pet?’’ A more basic example requires a child to fill in the words
to familiar songs. The response is not an echoic, rather an ‘‘answer.’’ The goal is to
teach a student to respond in a conversational manner. It can be difficult for a student
to distinguish how to respond to the many different word combinations that people
use to say the same thing (e.g., ‘‘Where do you live?’’ vs. ‘‘What’s your address?’’).
Intraverbals are introduced at the same time as RFFC and when a student has at
least 50 mands and tacts (Sundberg & Partington, 1998). Instruction typically begins
with simple fill-in-the-blank responses using songs and nursery rhymes and moves to
teaching a student to give his name, address, phone number, and the names of ani-
mals. Intraverbals pose the most difficult verbal behavior to teach, and many direct
teaching trials are needed to master the intraverbal operant.
Skinner’s analysis of verbal behavior provides a framework for assessment and lan-
guage training (Sundberg & Partington, 1998). Therefore, each of the verbal operants
should be considered as part of language assessment in addition to the physical proper-
ties of a student’s response form (e.g., syntax, pitch, intonation). Verbal behavior
breaks down language into these separate verbal operants in the same way that we
break down any new skill or behavior we want to teach into the individual steps of
that skill. In doing so, we are provided with a more informative language assessment
and a more clearly defined ‘‘roadmap’’ of how to teach language to our students with
developmental delays.
See also discrete trial training; echoic/verbal behavior.

REFERENCES
Skinner, B. F. (1953). Science and human behavior. New York: Free Press.
Skinner, B. F. (1957). Verbal behavior. New York: Appleton-Century-Crofts.
Sundberg, M. L., & Partington, J. W. (1998). Teaching language to children with autism or other
developmental disabilities. Pleasant Hill, CA: Behavior Analyst, Inc.

FURTHER INFORMATION
Lovaas, O. I. (1981). Teaching developmentally disabled children: The me book. Baltimore: Univer-
sity Park Press.
Lovaas, O. I. (2003). Teaching individuals with developmental delays: Basic intervention techniques.
Austin, TX: Pro-Ed.
Maurice, C., Green, G., & Luce, S. C. (1996). Behavioral intervention for young children with au-
tism: A manual for parents and professionals. Austin, TX: Pro-Ed.
MICHELE MULLENDORE

VESTIBULAR
Responsible for balance and movement, the vestibular system resides in the inner
ear and is stimulated by movements and changes in head position. Individuals with
vestibular hypersensitivity have low tolerance for activities involving movement and
exhibit difficulties with changing speeds and directions. They may experience nausea
and/or headaches from spinning and have difficulty sitting still. Hyposensitivity is
observed in the individual who seeks out vestibular input by rocking or swinging; this
individual might also be clumsy and have difficulty ‘‘switching gears.’’
See also hyperresponsiveness; hyporesponsiveness; proprioception; sensory.
KELLY M. PRESTIA
393
VIDEO MODELING

VIDEO MODELING
Video modeling is a technique that involves demonstration of desired behaviors,
outcomes, and attitudes through active, visual representation. When using a video-
modeling intervention, an individual typically watches a video demonstration and
then imitates the behavior of the model. Video modeling can be used with peers,
adults, or self as a model.
The concept of modeling as an intervention technique was first introduced by
Albert Bandura in the early 1960s. Bandura demonstrated that children were more
aggressive towards a toy after an age-matched model demonstrated aggressive behavior
towards the same toy (Bandura & Huston, 1961). Bandura later demonstrated that
watching an individual receive reinforcement for a particular behavior (i.e., vicarious
reinforcement) would later increase the rates of the behavior in the individual observ-
ing the model.
Over the past two decades, modeling has been further explored and implemented
using video technology. Thus, video modeling has been used across multiple disci-
plines and populations to teach a wide variety of skills, including motor behaviors,
increased athletic performance, and even to decrease anxiety (Dowrick, 1999). Fur-
ther, it has been effectively used to teach children with autism spectrum disorders
(ASD), social skills (Nikopoulos & Keenan, 2004), conversation skills (Charlop &
Milestein, 1989), self-help skills (Pierce & Schreibman, 1994), and purchasing skills
(Alcantara, 1994).
As theorized by Bandura, attention is a necessary component of modeling. That
is, a person cannot imitate the behavior of a model if he does not attend to the
model’s behavior. Individuals with ASD tend to exhibit overselective attention or
attend to irrelevant details of the environment. The use of video modeling allows
interventionists to remove irrelevant elements of the modeled skill or behavior
through video editing. The removal of irrelevant stimuli, in turn, allows the individ-
ual with ASD to better focus on essential aspects of the targeted skill or behavior.
In addition, individuals with ASD often exhibit anxiety and distress related to social
interactions, which may significantly impact their ability to attend to a learning task.
Video modeling can be implemented with minimal human interaction, thereby
reducing much of the distress and anxiety related to social interactions. Charlop-
Christy and Daneshvar (2003) noted that the children with ASD in their study
demonstrated increased motivation to watch the model in the video-modeling proce-
dure compared to the live-modeling procedure. Finally, the effectiveness of video
modeling might be a result of preference for visual learning. This notion is supported
by Sherer, Pierce, Paredes, Kisacky, Ingersoll et al. (2001), who noted that video
modeling was most effective for the children in their study who demonstrated prior
preference for visual learning, such as video viewing and the use of visual support
strategies.
Many skills learned via video modeling have been found to generalize across set-
tings and conditions (Dowrick, 1999), and the positive gains made during the video-
modeling intervention are maintained for months following the conclusion of the
intervention. Classroom teachers, professionals, and parents may find video modeling
a promising technique when working with children with autism.
See also social skills training.
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 VIDEO SELF-MODELING

REFERENCES
Alcantara, P. R. (1994). Effects of videotape instructional package on purchasing skills of chil-
dren with autism. Exceptional Children, 61(1), 40–55.
Bandura, A., & Huston, A. (1961). Transmission of aggression through imitation of aggressive
models. Journal of Abnormal and Social Psychology, 63, 575–582.
Charlop, M. H., & Milestein, J. P. (1989). Teaching autistic children conversational speech
using video modeling. Journal of Applied Behavior Analysis, 22, 275–285.
Charlop-Christy, M. H., & Daneshvar, S. (2003). Using video modeling to teach perspective
taking to children with autism. Journal of Positive Behavior Interventions, 5(1), 12–21.
Dowrick, P. W. (1999). A review of self-modeling and related interventions. Applied & Prevent-
ative Psychology, 8, 23–39.
Nikopoulos, C. K., & Keenan, M. (2004). Effects of video modeling on social initiations by
children with autism. Journal of Applied Behavior Analysis, 37, 93–96.
Pierce, K., & Shreibman, L. (1994). Teaching daily living skills to children with autism in
unsupervised settings through pictorial self-management. Journal of Applied Behavior Analysis,
27, 471–481.
Schrer, M., Pierce, K. L., Paredes, S., Kisacky, K. L., Ingersoll, B., & Schreibman, L. (2001).
Enhancing conversation skills in children with autism via video technology. Behavior Modifi-
cation, 25, 140–159.
SCOTT BELLINI AND JENNIFER M. AKULLIAN

VIDEO SELF-MODELING
Video self-modeling (VSM) is a modeling strategy that allows individuals to learn
targeted behaviors by watching videos of themselves successfully performing the
behaviors.
For children with autism spectrum disorders (ASD), VSM integrates a powerful
learning medium (visually cued instruction) with an effective evidence-based inter-
vention modality (modeling). VSM capitalizes on the well-documented success of vis-
ually cued instruction in this population by presenting a visual representation of the
target skill or behavior (e.g., showing a video of the child initiating or responding dur-
ing social interactions).
The use of VSM has been effective in treating children with a variety of disorders,
including selective mutism, autism, attention deficit hyperactivity disorder (ADHD),
social anxiety, aggressive/disruptive behavior, and motor problems (Buggey, 1999;
Dowrick, 1999). Further, an emerging body of research has demonstrated great promise
for the use of VSM as a therapeutic intervention for individuals with ASD (Buggey,
Toombs, Gardener, & Cervetti, 1999; Schrer, Pierce, Paredes, Kisacky, Ingersoll, et al.
2001; Wert & Neisworth, 2003).
According to Dowrick (1999), VSM interventions typically fall within two catego-
ries, positive self-review (PSR) and video feed-forward.
PSR refers to individuals viewing themselves successfully engaging in a behavior or
activity that is currently in their behavioral repertoire. PSR is best used with low-
frequency behaviors or behaviors that were once mastered, but are no longer. In this
case, the individual is videotaped while engaging in the low-frequency behavior and
then shown a video of the behavior.
PSR is a relatively simple strategy to use from a technological standpoint. However,
for very low-frequency behaviors, it requires extensive amounts of raw video footage
to capture even a small amount of the target behavior.
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VINELAND ADAPTIVE BEHAVIOR SCALES–SECOND EDITION (VABS-II)

Video feed-forward, another category of VSM interventions, may be used when an

individual already possesses a component of the target skill in her behavioral reper-
toire, or is performing the skill at a low level of mastery or autonomy. While feed-
forward requires additional editing capabilities, as compared to PSR, it typically
requires a smaller quantity of raw video footage. ‘‘Hidden supports’’ are an important
component of video feed-forward interventions. For instance, the child could be vid-
eotaped interacting with peers while an adult provides assistance through cueing and
prompting. The adult prompt could then be edited out (hidden) so that when the
child views the video segment, she sees herself as independent and successful.
Motivation to watch oneself on a video may be enhanced by the portrayal of pre-
dominantly positive behaviors. According to Buggey (1999), showing predominantly
positive behaviors to children is beneficial because of the confidence they develop
from observing their own success. Watching primarily positive and/or successful
behaviors of oneself, as opposed to negative and/or unsuccessful behaviors, is also
thought to increase attention and motivation to attend to the modeled behaviors. In
addition, Buggey states that VSM is preferable to peer and adult modeling because
peers or adults do not possess the exact characteristics of the target child. That is, the
target individual is more likely to relate to the model because she is the model.
Finally, anecdotal evidence and clinical experience suggest that watching videos is a
highly desired activity for many children with and without ASD, leading to increased
motivation and attention to task.

REFERENCES
Buggey, T. (1999). Videotaped self-modeling: Allowing children to be their own models. Teach-
ing Exceptional Children, 4, 27–31.
Buggey, T., Toombs, K., Gardener, P., & Cervetti, M. (1999). Training responding behaviors in
students with autism: Using videotaped self-modeling. Journal of Positive Behavior and Interven-
tion, 1(4), 205–214.
Dowrick, P.W. (1999). A review of self modeling and related interventions. Applied & Preventa-
tive Psychology, 8, 23–39.
Schrer, M., Pierce, K. L., Paredes, S., Kisacky, K. L., Ingersoll, B., & Schreibman, L. (2001).
Enhancing conversation skills in children with autism via video technology. Behavior Modifi-
cation, 25, 140–159.
Wert, B. Y., & Neisworth, J. T. (2003). Effects of video self-modeling on spontaneous request-
ing in children with autism. Journal of Positive Behavior Interventions, 5(1), 30–34.
SCOTT BELLINI AND JENNIFER M. AKULLIAN

VINELAND ADAPTIVE BEHAVIOR SCALES–SECOND

EDITION (VABS-II)
The Vineland Adaptive Behavior Scales–Second Edition (VABS-II; Sparrow, Cic-
chetti, and Balla, 2005) is used to assess children with autism spectrum disorders in
the areas of communication, socialization, motor skills, daily living skills, and malad-
aptive behavior skills. The VABS-II is available in three forms: interview edition, sur-
vey, and expanded forms. The assessment requires between 20 and 60 minutes for
parents, caretakers, and teachers to fill out and provide information to the psycholo-
gist or social worker. The layout of the assessment allows for comprehensive data col-
lection across settings and individuals. VABS-II has been proven to be an effective
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tool in diagnosing Asperger syndrome, autism, developmental delays, mental retarda-

tion, and speech and language impairments.

REFERENCE
Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland Adaptive Behavior Scales, Sec-
ond Edition. Circle Pines, MN: America Guidance Service.
TYI-SANNA JONES

VIRTUAL ENVIRONMENT
The virtual environment is one form of computer-based learning that has advan-
tages for people with autism in that computer-based programs are logical, predictable,
impersonal, and limit distractions and anxiety while permitting the user to repeat a
lesson as many times as necessary to learn the material or skill taught. Virtual envi-
ronments are three-dimensional simulations of an environment created by a computer
program. The environment may be imaginary or designed to represent a specific loca-
tion. Research to date has shown that users with autism spectrum disorders (ASD)
generally enjoy working with virtual environments and learn to use programs as or
more quickly than peers without autism.
Virtual environments can take the form of virtual reality or immersion environments
in which the user wears headgear and other equipment that displays the visual compo-
nent directly in front of the user’s eyes and translates the user’s movements into move-
ments on the visual display. Another form of virtual environment is represented on a
computer monitor, much like a typical computer game. The equipment used to
immerse a user in a virtual reality is expensive, heavy, and cumbersome, and some users
report nausea, headaches, and dizziness. The virtual environments displayed on a desk-
top computer monitor have no such side effects and are far less expensive, utilizing
existing computers and accessory equipment, such as a mouse, keyboard, and joystick.
The ability to use standard computer equipment also increases the possibility that the
user with autism can use a program at home as well as at school or a training site.
Within the virtual environment, the user ‘‘occupies’’ an avatar, a figure representing
the user, and generally ‘‘sees’’ the environment through the viewpoint of the avatar,
although the user may also be provided with a view of the activity from above. Inter-
action with the environment takes place through the avatar being controlled by the
accessory equipment.
Users with autism have reported that their experiences with virtual environments
are interesting and fun, and they tend to learn to use the equipment and interact with
the environment fairly quickly. There are two types of virtual environments. Those
designed for one user at a time are called single-user virtual environments (SVEs) and
allow the user to interact with the environment and to have limited, preprogrammed
interactions with another. Programs designed for multiple users are called collaborative
virtual environments (CVEs).
SVEs have been designed to allow users to practice daily activities around home,
work, transportation, and cafe settings, and other settings can be developed to allow
for a highly varied and flexible training program. Programs introducing new skills can
be highly structured with limited choices to allow rehearsal of the new skill in realistic
but safe settings. As only the user is involved with the lesson, the user can practice
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each skill and scenario at a comfortable speed and as frequently as necessary to master
the skill. As the person progresses in mastery of the skill, the programs can introduce
more choices and some randomness in placement of objects and simulated people and
variations in prompts to encourage flexibility. Once a skill is learned in one setting
(for instance, asking if a seat is available in a cafe), it can be practiced in other set-
tings, such as a theater, bus, or social event. Since only one person uses the SVE at a
time, the user can learn the skills and visit the same scenario many times without the
difficulty and unpredictability of interacting with other people, and without anxiety or
fear about any consequences for making an error. The session can be recorded and
reviewed by the user and a teacher in order to discuss the user’s performance and any
problems that the user may have. To increase social interaction and generalization, a
teacher, coach, or peer may sit beside the user during some sessions, particularly after
the user has become somewhat familiar with the skill being taught.
A CVE involves more than one user in a shared environment where users can
interact, work together, and communicate through their avatars. Interaction through
avatars, rather than face to face, provides a sense of anonymity and reduces the stress
and sense of risk that can occur during direct interaction with another person, but still
provides the flexibility and reality of interacting with people rather than strictly with
a preprogrammed computer. By reducing the level of threat in communication, and by
bringing people who may be widely dispersed together, CVEs function as an assistive
technology to improve communication and reduce isolation and the sense of social
exclusion for people with autism. Virtual meetings and networks of people with autism
can facilitate communication between people with and without autism, since commu-
nication through CVEs is slower than face-to-face conversation and can provide peo-
ple with autism extra time to respond to the avatar of a communication partner.
Since avatars can be programmed to show facial expressions, users may have an oppor-
tunity to consider and convey their own emotions as well as be aware of the expres-
sions of other avatars.
CVEs can also be used for group lessons for dispersed students with autism and can
provide a setting for more advanced and flexible social skills instruction than is possi-
ble in a SVE where the user can ‘‘interact’’ with characters only in the ways that are
built into the program. Users of a CVE can also work together in role-playing scenar-
ios to practice social skills, and can discuss problems that arise with each other or
with a teacher, as CVEs can also be recorded to allow a user to review the session and
consider alternative ways of handling problems that arise.
Although the use of SVEs and CVEs for the teaching of skills is promising, they are
not appropriate for all users, nor do they offer a complete training program by them-
selves. Studies to date have involved only persons with autism spectrum disorders who
do not have mental retardation. A minority of users in studies have shown difficulty
staying on task in virtual environments, and another minority have had difficulty
understanding that virtual environments are representational of real-life settings and
activities. Thus when an individual with autism is first introduced to the use of virtual
environments, a teacher should observe to make sure that the student is able to follow
instructions and stay on task, and should talk with the user and make sure that the
user is able to understand that the virtual environment represents reality and that
other avatars represent people.
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Another problem with using virtual environments to teach skills is that no study to
date has provided evidence that users of virtual environments and computer-based
learning are able to generalize the learned skills to different environments at signifi-
cant levels. However, existing studies have been of very short duration and have had
few participants. Even in those studies, however, individuals who have used the pro-
grams more have shown a greater ability to generalize than participants who used the
programs for shorter periods of time. Thus it is possible that studies that involve lon-
ger periods of use may provide empirical evidence of generalization by users. Finally, it
should be noted that the use of virtual environments is only one part of any learning
package, especially for social skills. Although SVEs and CVEs can help the user de-
velop appropriate skills and a sense of self-confidence that may make real-life experi-
ences less stressful and more productive, the use of SVEs and CVEs should be
combined with group work, discussion, and experience in real-world settings to
improve mastery and generalization.
See also assistive technology; social skills training.

FURTHER INFORMATION
Cobb, S., Beardon, L., Eastgate, R., Glover, T., Kerr, S., Neale, H., et al. (2002). Applied vir-
tual environments to support learning of social interaction skills in users with Asperger’s syn-
drome. Digital Creativity, 13(1), 11–22.
Golan, O., & Baron-Cohen, S. (2006). Systemizing empathy: Teaching adults with Asperger
syndrome and high functioning autism to recognize complex emotions using interactive mul-
timedia. Developmental and Psychopathology, 18, 591–617.
Moore, D., Cheng, Y., McGrath, P., & Powell, N. J. (2005). Collaborative virtual environment
technology for people with autism. Focus on Autism and Other Developmental Disabilities, 20,
231–243.
Moore, D., McGrath, P., & Thorpe, J. (2000). Computer-aided learning for people with
autism—a framework for research and development. Innovations in Education and Training
International, 37(3), 218–228.
Parsons, S., & Mitchell, R. (2002). The potential of virtual reality in social skills training for
people with autistic spectrum disorders. Journal of Intellectual Disability Research, 46, 430–443.
Parsons, S., Mitchell, P., & Leonard, A. (2004). The use and understanding of virtual environ-
ments by adolescents with autistic spectrum disorders. Journal of Autism and Developmental
Disorders, 34(4), 449–466.
Parsons, S., Mitchell, P., & Leonard, A. (2005). Do adolescents with autistic spectrum disorders
adhere to social conventions in virtual environments? The National Autistic Society, 9(1), 95–
117.
Rajendran, G., & Mitchell, P. (2000). Computer mediated interaction in Asperger’s syndrome:
The bubble dialogue program. Computers and Education, 35, 189–207.
Silver, M., & Oakes, P. (2001). Evaluation of a new computer intervention to teach people
with autism or Asperger syndrome to recognize and predict emotions in others. The National
Autistic Society, 5(3), 299–316.
HYUN-JEONG CHO

VIRUSES
A virus is a submicroscopic infectious organism that reproduces itself in biological
entities (such as human cells) and may cause damage or disease. It has been claimed
that, like other diseases, autism can be caused by slow-moving viruses that affect brain
development. The cytomegalovirus is one virus that has been connected to autism
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spectrum disorders. Maternal rubella is another virus that has been studied for connec-
tions to autism. Rubella was once a very common disease, but since inoculation efforts
has been almost unheard of in the United States. Although rubella has been much
less of a concern due to mass vaccinations, in light of the controversy over the possi-
ble connections between autism and vaccinations, and with the possibility of some
people forgoing inoculations of childhood, the rubella virus cannot be forgotten as a
possible culprit.

FURTHER INFORMATION
Merriam-Webster. (2005). Virus. Retrieved June 30, 2006, from http://www2.merriam-webster.
com/cgi-bin/mwmednlm?book=Medical&va=virus.
Rutter, M. (2005). Aetiology of autism: Findings and questions. Journal of Intellectual Disability
Research, 49, 231–238.
PAUL G. LACAVA

VISUAL-MOTOR
Visual-motor describes any activity that requires the use and coordination of vision
and movement simultaneously. Examples of visual-motor skills include drawing, com-
pleting a puzzle, or painting.
KELLY M. PRESTIA

VISUAL STRATEGIES
Visual strategies refer to ways of using visual stimuli such as photos, drawings, and
so on, to enhance the communication process. A primary purpose for using visual
strategies is to support understanding. Visual strategies provide information in a form
that many students can understand more easily than auditory information. Other
terms used include visual supports, visual tools, visual cues, or visually mediated
communication.
Most students with autism spectrum disorders (ASD) and many others with commu-
nication or behavior challenges demonstrate strength in visual learning compared to
their auditory abilities. That means they understand what they see better than what
they hear. Yet we tend to communicate with them primarily by talking (Hodgdon,
1995). Temple Grandin, a well-known speaker and author with autism, describes her
unique visual learning style in her book Thinking in Pictures (1995).
Using visual strategies to support communication capitalizes on a person’s ability to
gain information from the sense of sight. Photographs, line drawings, computer clip
art, pictures from catalogs or magazines, food labels, signs, logos, objects, and written
language can be used as visual tools to support communication. Video is another vis-
ual medium that is proving effective.
Visual supports can include the following:

Body Language
Facial expressions, body movement, pointing, eye contact.

Cues in the Natural Environment

Furniture arrangement, signs in the environment (in/out, men/women), menus, directions
on a vending machine.

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Commonly Used Tools for Organizing and Gaining Information

Calendar, day planner, TV guide, shopping list, cooking instructions.

Specially Designed Tools for Giving Information

To develop schedules, provide choices, give information, give directions, establish rules,
teach skills, develop self-regulation, and more.

One goal when using visual strategies is to teach students to identify, understand,
and respond appropriately to the visual cues and information that already exist in the
environment. Another goal is to identify their specific communication needs and chal-
lenges as a basis for creating visual tools that give the specific information they need
to understand.
Visual tools are easy to use. We can become more effective communicators if we
use simple language and support our communication by showing the student some-
thing visual to help him understand what we are saying. Sometimes visual tools are
hung on the wall or refrigerator or placed in communication books so the student can
easily access them when he needs them.

REASONS TO USE VISUAL STRATEGIES

Visual strategies assist students in processing language, organizing their thinking,
remembering information, and many other skills necessary to participate and commu-
nicate effectively. The following are some of the possibilities.
Visual tools can provide structure to help create an environment that is more pre-
dictable and understandable as well as present information. They can be used at home
or school or transported to other environments. For example:

¥ Schedules are the most common visual tools. They help students know what is happening
during the day and anticipate transitions from one activity to another.
¥ Visual timers create a visual way for students to understand the passage of time and to assist
with transition.
¥ Task organizers or step-by-step directions guide students through a series of steps to accom-
plish a task.
¥ Choice boards display the options available to choose from.
¥ Classroom or home rules help students remember what to do or state options to unaccept-
able behavior.

A powerful purpose for visual strategies is to give students information. It is common

to give students information verbally and to assume they understand. Anxiety or
behavior problems can emerge when students really don’t understand, or they don’t
remember what to do or how to handle a situation. For example:

¥ People locators help students understand where significant people are, when they will leave,
or when they will return.
¥ Transition and travel helpers can prepare students for predictable activities and routines or
for excursions that are not part of the normal routine.
¥ Behavior helpers guide students to prepare for activities and anticipate what will happen
and what will be expected of them.

Video as a teaching medium is a comparatively new visual tool. It is becoming use-

ful for teaching appropriate social and communication behavior. The value of video is
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that it captures the movement of the social world. It has been used successfully for
teaching a variety of skills including imaginative play, correct behavior, and perspec-
tive taking (Hodgdon, in press).

WHY STUDENTS BENEFIT FROM VISUAL STRATEGIES

Communication is one of the core deficits in ASD. Communication is complex and
there are many reasons why students may have difficulty. For example, research sug-
gests these students experience difficulty shifting and reestablishing attention (Cour-
schene, 1991). Children with autism tend to have particular difficulty attending to
auditory input and may prefer visual input (Anzalone & Williamson, 2000). Green-
span and Wieder (1998) found that 97 percent of their sample of children with autism
showed significant receptive language deficits.
Many of the difficulties these students encounter as they attempt to follow life rou-
tines, handle change and transition, demonstrate appropriate behavior, or participate
in social opportunities are directly related to their communication challenges. Speech
is transient. Consider that an auditory message may disappear before a student has
focused his attention enough to receive it. These children do not easily understand
what is happening around them, what is changing, or what the rules are. The result
can be frustration, anxiety, tantrums, and more.
In contrast, most of these students demonstrate a preference for visual information.
Visual supports are helpful because the visual message stays long enough for the stu-
dent to establish attention and receive information.
Using visual strategies to support understanding can significantly affect a student’s
ability to communicate more successfully, develop appropriate social skills, regulate
behavior in various environments, and participate more independently. The challenge
is to determine how using visual supports will meet each student’s individual needs.

COMMON QUESTIONS
Traditionally, communication boards and other augmentative communication sup-
ports have been used to help nonverbal students or those with limited verbal ability
express themselves better. The current use of visual strategies for supporting under-
standing has shifted that focus. It is appropriate to use visual tools to aid understand-
ing for both nonverbal and verbal students.
Visual strategies are not just for young children. They are appropriate for students
of all ages. Most of us use a calendar or a day planner and other visual supports to
help organize our own lives. Students with ASD can benefit from the same tools; how-
ever, they generally need more visual supports. Visual strategies are tools for life that
can be modified and adapted to meet students’ changing needs as they grow into
adulthood. Visual strategies provide the support students need to participate more
appropriately and independently in their life activities.

CASE STUDY
Problem
Stacy’s Mom was taking her to the doctor for a check-up. Stacy began to cry and
bite her wrist. She kept yelling, ‘‘No shot!’’ Her behavior escalated, making it difficult
for Mom to try to get her into the car.
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Cause
Even though Mom told Stacy she was not going to get a shot this time, Stacy was
nervous because she remembered her last trip to the doctor. She remembered getting
a shot that hurt. Stacy needs a lot of information because she has a memory of fear
and pain. She doesn’t have the communication skills to discuss the situation
adequately, so she is expressing her fear with her behavior.

Solution
Giving Stacy information in a form that she understands will help her anticipate
the event and demonstrate more appropriate behavior. One or more of the following
options should help the situation: (a) tell her verbally and visually where she is going;
(b) give her visual information about the sequence of events; (c) give her information
in a visual form about what will happen and what will not happen; and (d) create a
visual tool that will prompt something to say or do when she goes to the doctor’s
office.

Result
Mom developed some visual tools to communicate the information Stacy needed.
When Stacy had more information, she had a successful doctor visit (Hodgdon,
1999).

REFERENCES
Anzalone, M. E., & Williamson, G. G. (2000). Sensory processing and motor performance in
autism spectrum disorders. In A. Wetherby & B. Prizant (Eds.), Autism spectrum disorders: A
transactional developmental perspective (pp. 145–146). Baltimore: Brookes Publishing Co.
Courschene, E. (1991). A new model of brain and behavior development in infantile autism.
Autism Society of America Conference Proceedings. Indianapolis, IN.
Grandin, T. (1995). Thinking in pictures: And other reports from my life with autism. New York:
Doubleday.
Greenspan, S., & Wieder, S. (1998). The child with special needs: Encouraging intellectual and emo-
tional growth. Reading, MA: Addison-Wesley.
Hodgdon, L. (1995). Visual strategies for improving communication. Troy, MI: QuirkRoberts
Publishing.
Hodgdon, L. (1999). Solving behavior problems in autism. Troy, MI: QuirkRoberts Publishing.
Hodgdon, L. (in press). How to teach social skills with visual strategies. Troy, MI: QuirkRoberts
Publishing.

FURTHER INFORMATION
Hodgdon, L. (1995). Solving social-behavioral problems through the use of visually supported
communication. In K. A. Quill (Ed.), Teaching children with autism: Strategies to enhance com-
munication and socialization (pp. 265–286). New York: Delmar Publishers Inc.
Hodgdon, L. (2005). 25 reasons to use visual strategies. Another view with Linda Hodgdon: Effective
solutions for autism, Asperger’s syndrome and more, 1(4). Retrieved April 23, 2005, from http://
www.lindahodgdon.com/newsletters.html.
Quill, K. A. (1995). Visually cued instruction for children with autism and pervasive develop-
mental disorders. Focus on Autistic Behavior, 10(3), 10–20.
LINDA HODGDON

VISUAL SUPPORTS. See Visual Strategies

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VOCATIONAL REHABILITATION

VOCATIONAL REHABILITATION
The Division of Vocational Rehabilitation Services (VR) is a federally funded
agency that provides job training for adult individuals with disabilities. A vocational
rehabilitation counselor is assigned when the individual applies for services. Therefore,
the individual with the disability needs to seek out the services from VR; VR will not
seek out the individual. The counselor will assess the needs of the individual to deter-
mine whether the individual is eligible for services. Eligibility is determined based on
the level of disability the individual has and the amount of work the individual is ca-
pable of doing.
Service funding availability changes depending on the amount of money the federal
government provides. When funding is low, VR goes on ‘‘Order of Selection,’’ which
only allows monies for individuals with moderate to severe disabilities who were
assessed as able to work in the community with some support. An example of a person
with a moderate to severe disability that VR would still consider employable in the
community is an individual with bipolar disorder who is taking medication but still
needs assistance with social interactions, anger management, and controlling negative
thoughts and actions. This individual would be eligible for job placement services and
job coach support on the job to maintain employment and develop appropriate job
social skills.
Students who are 18 months prior to graduation from high school can apply with
VR services to begin the assessment process and paperwork. Upon graduation, if the
individual qualifies, the VR counselor will assist the individual in finding and main-
taining competitive, paid employment in the community. Short-term job coaching as-
sistance is provided depending on the need of the individual and the demands of the
job. Job coaching ceases after a determined amount of time (usually 90 days), at
which time the individual will need to maintain performance on the job with natural
supports from employees within the job. If the individual wants to change employ-
ment, is promoted within his or her current job, or has job tasks change within the
job, the VR counselor can reopen the case and provide job training services again for
the benefit of promotion and job retention.
See also Individualized Transition Plan; transition planning.
BETH CLAVENNA-DEANE

VOCATIONAL REHABILITATION PROGRAMMING

Each state has a vocational rehabilitation (VR) agency that is designed to help peo-
ple with disabilities enter the workforce, learn a new skill or trade, or return to the
workforce after an extended absence. High school students with disabilities can
receive transition services that are designed to make the move from the school envi-
ronment into the community as a young adult more successful. Students are taught
work readiness skills such as teamwork, communication, how to dress, the importance
of timeliness and basic office skills such as copying, collating, and filing. These ser-
vices can be provided in a variety of settings to maximize the student’s developmental
potential. For those who are able, VR services can include enrollment in a local col-
lege or trade school and community job placements where skills can be learned or
advanced. Job coaches or VR counselors often follow the individual into the
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 VOTING

community for a period of time to provide appropriate levels of supervision or support

to both the individual and the employer. To increase access to other federal programs,
VR agencies are also able to help people apply for Supplemental Security Income
(SSI), subsidized housing, and health care programs, among many things. As with SSI
and most other federal programs, the actual services available at VR agencies do vary
from state to state, so it is best to contact your state agency directly to get information
about what is in your area. The Social Security Administration maintains the follow-
ing Web site with direct links to each state agency to facilitate access to services:
http://www.ssa.gov/work/ServiceProviders/rehabproviders.html.
See also Individualized Transition Plan; postsecondary education; transition planning.
SHERRY MOYER

VOTING
One context in which disability is defined is in federal and state laws, which address
the electoral participation of individuals with disabilities. Federal laws pertaining to
individuals with disabilities and their voting rights include the National Voter Regis-
tration Act of 1993 (NVRA), and; the Americans with Disabilities Act (ADA,
1990), which provides that no qualified individual with a disability may be excluded
from participation in, or denied the benefits of the services, programs, or activities, or
subjected to discrimination by public entities, such as state and local government.
Specially, the NVRA requires that all state-funded agencies offer voter registration.
State-funded facilities may include public schools, facilities providing disability ser-
vices, and voter registration agencies. The ADA ensures that polling sites provide rea-
sonable accommodations, technical assistance materials, and assistance with
registering to vote and casting a ballot. In contrast to these federal laws, state laws
specifying the qualifications of the electorate typically disenfranchise some individuals
with disabilities. A majority of states disenfranchise on the basis of ‘‘mental incompe-
tence,’’ or ‘‘mental incapacity,’’ to characterize who will not be allowed to vote.
Federal law acknowledges the physical and communication barriers that affect elec-
toral participation, but fails to appreciate implications of state policies that exclude
people based on perceived incompetence of cognitive and emotional impairments.
The issue of physical accessibility has required states to ensure voters with cognitive
and emotional disabilities have access to the electoral process and not be subject to
accessibility barriers (ADA, 1990). In 1982, before the ADA was passed, the Ameri-
can Bar Association proposed that competency testing be objective, and suggested a
competent voter be defined as any person able to provide the information, orally, in
writing, through an interpreter, or interpretive device that is reasonably required of all
persons seeking to register to vote, to be considered a qualified voter, and shall be reg-
istered to vote and allowed to cast a ballot in any election held (Schriner, Ochs, &
Shields, 2000).
In October 2002 President George W. Bush signed into law the Help America Vote
Act (HAVA), Public Law 107-252. HAVA was designed to modernize election equip-
ment, facilitate easy use of equipment, maintain confidentiality and independence,
and increase accessibility for persons with disabilities. HAVA was further intended to
provide ‘‘talking’’ voting machines, large print or braille, interpretation for the
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VOTING

hearing-impaired, a more simplified process to make it understandable for the intellec-

tually impaired, and to protect the privacy rights of such voters.
Many resources lend to simplification of the electoral process. Because many indi-
viduals use written communication rather than face-to-face interactions, a large num-
ber of resources are available online. The use of computers and the Internet has made
it possible for many individuals to present their perspective when they lack adequate
communication and socialization skills.
For individuals who want to participate in the democratic process, they must be reg-
istered to vote prior to an election and have appropriate identification. For further in-
formation, contact the local election office or go to www.declareyourself.org/
index.php.

REFERENCES
Americans with Disabilities Act, 42 U.S.C. §§ 12101-12213 (1990).
Help America Vote Act. (2002). Public Law 107-252. U.S. Code. 42, 2002. [section] 15301 et
seq.
National Voter Registration Act (1993). Public Law 103-131. U.S. Code 42, 1993. Sec. 2 et
seq.
Schriner, K., Ochs, L., & Shields, T. (2000). Democratic dilemmas: Notes on the ADA and
voting rights of people with disabilities. Berkeley Journal of Employment and Labor Law, 21(1),
437–472.

FURTHER INFORMATION
Declare yourself. (n.d.). Retrieved November 9, 2006 from www.declareyourself.org/index.php.
U.S. Department of Justice (2005). A guide to disability rights laws. Retrieved November 9, 2006,
from www.usdoj.gov/crt/ada/cguide.htm.
STACEY L. BROOKENS

406
 W
WAIT TRAINING
Wait training is teaching a child to wait using structured, incremental training ses-
sions. Waiting is taught through short trials or sessions in which something desirable
to the child is placed in front of her with the command to wait. Prompting as needed,
the student is given the item after waiting a set period of time. Normally a baseline is
recorded, and this type of program begins at or slightly above the baseline. To begin,
the wait interval could be as short as 1–2 seconds. Wait training is most often done
in the early stages of intervention.
KATIE BASSITY

WEAK CENTRAL COHERENCE. See Central Coherence

WECHSLER INDIVIDUALIZED ACHIEVEMENT TEST–

SECOND EDITION (WIAT-2)
The Wechsler Individualized Achievement Test–Second Edition (WIAT-2; Wechs-
ler, 2001) is a very common assessment tool used in schools to measure the academic
achievement of students. The WIAT-2 consists of nine subtests: word reading, pseudo-
word decoding, reading comprehension, spelling, written expression, numerical opera-
tions, math reasoning, listening comprehension, and oral expression. The WIAT-2 is
a measurement tool for individuals ranging in age from 4 to 85 years and can be used
to assess both low- and high-functioning individuals. It is useful for assessing achieve-
ment skills, determining educational placement, as well as developing curriculum.
Administration time ranges from 30 to 75 minutes.

REFERENCE
Wechsler, D. (2001). Wechsler individualized achievement test (2nd ed.). San Antonio, TX: Psy-
chological Corporation.
AMY BIXLER COFFIN
WECHSLER INTELLIGENCE SCALES FOR CHILDREN–FOURTH EDITION (WISC-IV)

WECHSLER INTELLIGENCE SCALES FOR CHILDREN–

FOURTH EDITION (WISC-IV)
The Wechsler Intelligence Scales for Children–Fourth Edition (WISC-IV; Wechs-
ler, 2003) is a cognitive assessment generally given by a psychologist to determine
cognitive ability of school-aged children. This test provides a full-scale IQ score
obtained from subtests in two subscales: verbal and performance scales. The two scales
allow the examiner to assess a child in tasks that require verbal and nonverbal activ-
ities to evaluate performance and knowledge in: (a) memory; (b) factual information;
(c) language; (d) attention; (e) concentration; (f) abstract, spatial, and visual problem
solving; (g) fine motor and visual coordination; and (h) processing speed. This assess-
ment tool is widely used and known to be helpful in diagnostic, placement, and plan-
ning for children with an array of exceptionalities.

REFERENCE
Wechsler, D. (2003). Wechsler intelligence scales for children–fourth edition. San Antonio, TX: Har-
court Assessment, Inc.
TYI-SANNA JONES

WELCH METHOD THERAPY

THE TREATABLE BASIS OF AUTISM
Clinical observations in the 30-year psychiatric practice of Martha G. Welch, MD,
form the framework for her innovative treatment and research efforts. It is widely
agreed that autism spectrum disorders (ASD) stem from genetic/environmental insults
that are not yet identified. Whatever the cause, we are now focused on intervening in
the subsequent events that stem from the insults. Further, we theorize that such insults
share a common physiological effect: interruption and/or arrest of key developmental
programs. Over time, if uncompensated, the cascade leads to adverse conditioning of
stress adaptation networks, in which case the infant will present with various interre-
lated psychological, neurological, and immunological pathology, including autism. Our
clinical experience has shown that it is possible, regardless of etiology, for the family
to successfully treat autism and related developmental disorders by reinstating compo-
nents of intense parent-child interaction. Our experimental research and laboratory
findings support the idea that it will be possible at some point in the future to treat
autism and related developmental disorders by intervening in stress mechanisms of the
child with administration of exogenous brain/gut peptide combinations.
In Dr. Welch’s practice, two seemingly disparate groups of patients, autistic children
and maternally deprived orphans, shared two symptom complexes: (a) behavioral
symptoms, such as lack of direct eye contact, indiscriminate approaches toward strang-
ers, inability to respond to normal maternal nurturing; and (b) gastrointestinal (GI)
symptoms, such as gut motility abnormalities, discomfort, diarrhea, and odd and re-
stricted food preferences. Dr. Welch developed an intervention that engages intense
parent-child interactions as a means of positively conditioning stress adaptation
responses. This intervention has led to concurrent amelioration of both behavioral
and gut symptoms. In many cases following intensive intervention, direct eye contact
between mother and child ensued, the child was able to benefit from normal nurtur-
ing, adverse behaviors were dramatically reduced, and GI symptoms abated. Because
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mothers often described feeling as though they had just given birth after the therapy,
Welch theorized that the bonding peptide oxytocin had been released. She attributed
the striking post-treatment changes observed in the child’s behavioral and gut health
to the simultaneous release of natural endogenous peptides, including brain/gut pep-
tides secretin as well as oxytocin. These collective clinical observations led to a theory
that brain and gut disorders in autism and behavioral disorders of low-nurture orphans
share a common dysregulation of underlying stress mechanisms.

RESEARCH BACKGROUND
The Welch Laboratory of Childhood Regulatory Disorders and the Ruggiero Labora-
tory of Behavioral Neuroanatomy at Columbia University are engaged in efforts to
translate this clinical experience into an experimental design of new treatments for
autism. The work supports a new paradigm for the treatment of mental illness, based
on a theory that emotions and emotional behavior stem from dysregulations of a uni-
fied stress-adaptation brain-gut network. Peptide mechanisms critical in the condition-
ing of the infant adaptive behavioral patterns are abnormal in developmental
disorders such as autism. Neuropeptides such as secretin and oxytocin are being tested
in animal models to determine their role in compensating for the effects of stress on
the brain and gut. This idea originated from Welch’s clinical experience treating
genetic/congenital ASD, late-onset ASD, and children with other developmental dis-
orders, all of whom shared GI symptoms (see Figure 20).
Medical examination of children with autism reveals inflammation in the brain
(Vargas, Nascimbene, Krishnan, Zimmerman, & Pardo, 2005) and gut, as well as
abnormalities of neurotransmitters, brain/gut peptides, and cytokines (Ashwood,
Anthony, Torrente, & Wakefield, 2004). The high incidence of seizure disorders and
familial autoimmunity suggests that autism is a visceral disorder. Pathological visceral

Figure 20 Differentiating the Welch Method

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WELCH METHOD THERAPY

activity patterns transmit via the vagus nerves and neurohumorally to visceral/
emotional brain regions abnormal in autistic children. We theorize that the viscera
may be a site of pathology causing secondary developmental delays of brain regions
abnormal in autism spectrum disorders. Deserving of clinical study is the functional
integrity of the GI tract in family members of children with autism.
During critical periods of development, visceral diseases generating pathological
stress-related activity lead to impairments of perceptual, emotional, and social devel-
opment, all of which are observed in children with autism. The research literature
provides ample evidence that these children exhibit classic stress-induced inflamma-
tory symptoms in gut and brain areas that are acted upon by neuropeptides. Peptides
are important in determining stress-response patterns. Their actions are the molecular
basis of optimal mother-infant interactions, and they are naturally secreted on physio-
logical demand in response to stress. As such, they are critical in regulating stress and
maintaining homeostasis. It follows that therapies intervening in the peptide mecha-
nisms activated by mother-infant interaction will be most effective in treating devel-
opmental disorders such as autism.
The role of secretin and oxytocin in the treatment of autism is emerging (see Figure
21).
Patients with autism demonstrate symptoms and sites of pathology that respond in
experimental animal models to secretin and oxytocin administration. For example, a
recent clinical study concluded that secretin ameliorated symptoms of autism in a sub-
group of children with GI abnormalities (Kern, Espinoza, & Trivedi, 2004). Another
clinical study showed that behavioral symptoms in autism have responded to oxytocin
peptide treatment (Hollander et al., 2003). In addition, a growing body of research is
providing important information about the role of secretin and oxytocin in both the
gut and the brain. In an example of environmental insult, our preliminary studies of
induced colitis in a rat model demonstrated that systemic combined treatment with

Figure 21 The Role of Secretin and Oxytocin

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 WELCH METHOD THERAPY

secretin and oxytocin reduced peripheral inflam- Figure 22 Secretin and Oxytocin Research
mation and its neurological manifestations in
the brain (Welch et al., 2003b).
In studies designed to determine behavioral
regulatory actions, secretin and oxytocin were
found to activate the visceral thalamic and
hypothalamic stress axes (Welch et al., 2003a).
Secretin and oxytocin were synthesized by
hypothalamic and gut and vascular cells in
response to homeostatic challenges, such as vis-
ceral stress or metabolic stressor (Welch et al.,
2003a). Visceral inflammation activated vis-
ceral/emotional brain regions known to be
abnormal in autism, thus, providing important
evidence of a connection between visceral
inflammation and brain disturbance (Welch
et al., 2005). In another experiment that further
demonstrated a connection between brain/gut
disturbance and peptides, we showed that secre-
tin, like oxytocin, activated many of the same
visceral/emotional brain regions that are dysre-
gulated in chronic disorders such as autism. In a
third experiment we clarified the structural basis
for the mechanisms of individual action of
secretin and oxytocin (see Figure 22). That is, we found that secretin as well as oxyto-
cin are synthesized in the hypothalamus and may act on structures involved in the
pathophysiology of autism (Welch & Ruggiero, in press).
In the future, the long-term benefit of peptide therapy may be demonstrated by the
reversal of the actions of stress transmitters and stress peptides as well as the alteration
of receptor numbers or combinations abnormal in chronic mental and visceral meta-
bolic disorders. Clinical trials will be necessary to assess the efficacy of systemic
administration of combined secretin/oxytocin or other combinations of peptides in
resolving visceral inflammation, autism, and autism with GI symptoms. We also seek a
marker expressed by brain and gut that can identify a precursor stage of autism, pro-
viding a means of early diagnosis and early intervention, which would in turn halt the
progression of the brain changes that are stress induced.

ABNORMAL STRESS ADAPTATION IN AUTISM

The development of the infant’s stress adaptation response patterns is largely de-
pendent on caregiver-infant interactions. This interaction up-regulates neuropeptides
and activates key genetic developmental programs. Key developmental genetic pro-
grams are altered or silenced when the mother-infant interaction is rendered ineffec-
tive (Caldji, Diorio, Anisman, & Meaney, 2004). The infant is thus unable to
respond to the parental care on which his physiological state depends. Unable to
receive stress modulation, the infant reacts with adverse behavioral symptoms: inabil-
ity to nurse, inability to maintain direct eye contact, abnormal face recognition with
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WELCH METHOD THERAPY

Figure 23 Positive Stress-Response Condition- failure to respond to normal cues, inability to

ing Cycle learn or attend to important environmental
stimuli, inability to habituate to background
stimuli, stereotypes, and bizarre fixations on
objects or actions. If left untreated—if normal
responsiveness is not restored—some of the
child’s critical developmental programs may
remain inactivated or silenced. In this event,
the stress effects on the brain and viscera con-
tinue on a downward course that gets progres-
sively worse and eventually ends in a range of
psychological, neurological, behavioral, and
immunological pathology, including autism spec-
trum disorders.
Professionals and parents may never know what
caused the child’s abnormal response patterns, or
in the case of late-onset autism, what precisely
caused the regression in behavior. Causes may
include any number of environmental stressors,
possibly vaccinations, with or without periods of physical illness in a child genetically
predisposed to autoimmunity. In our experience, the cause of the abnormality is less im-
portant than the fact that the abnormal stress responses can be reversed (see Figure 23).
If reversal of stress cascades is accomplished early enough in the child’s develop-
ment—in the case of autism before age 4 or 5, or in the case of other autism spectrum
disorders before age 10 or 11—the negative cascade of stress responses may be reduced
greatly or completely reversed.

TREATMENT PROGRAM
The earlier the family starts to address the brain and behavioral problems by
reinstating important components of parent-child interaction, the sooner typical
development will resume (see Figure 24).
Figure 24 Effects of Family Therapy We believe that very early reversal of
adverse stress response patterns can reverse
the on-going cascade of brain damage. If the
family is performing the therapy effectively af-
ter training, they should achieve results in the
child’s ability to handle stress almost immedi-
ately, such as at the end of a successful 2-day
treatment program. Even the most resistant
child responds to the therapy. Such relatively
rapid results may be supported by recent
research at McGill University in Canada,
where it has been discovered that genetic pro-
grams are activated in an animal model by
intense mother-infant interaction (Weaver
et al., 2004). It takes just 96 hours for this
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 WELCH METHOD THERAPY

activation of genetic stress management programs to occur. It is important to note

that these genes are conserved throughout mammalian development, and humans and
animals express similar genetic stress adaptation programs. We theorize that intense
parent-child therapy releases peptides and helps the family to activate those silenced
genetic programs.
In summary, the etiology and pathophysiology of autism are little understood. How-
ever, inasmuch as autism involves adverse stress response patterns, interventions that
target mechanisms of stress adaptation offer a promising approach. Systemic adminis-
tration of antistress peptides may be an effective preventive measure. Our research
efforts continue to seek support for therapeutic administration of neuropeptide combi-
nations. Outcomes of such experiments could accelerate the development of novel
naturalistic pharmacological treatments that do not have the side effects of current
drugs. Until then, Welch Method therapy allows the parents to intervene naturally in
the stress adaptation conditioning of autistic spectrum disorder children, thereby acti-
vating, as we theorize, important antistress gene programs and halting the harmful cas-
cade that results from unmitigated stress.
See also environment; genetics.

REFERENCES
Ashwood, P., Anthony, A., Torrente, F., & Wakefield, A. J. (2004). Spontaneous mucosal lym-
phocyte cytokine profiles in children with autism and gastrointestinal symptoms: Mucosal
immune activation and reduced counter regulatory interleukin-10. Journal of Clinical Immunol-
ogy, 24, 664–673.
Caldji, C., Diorio, J., Anisman, H., & Meaney, M. J. (2004). Maternal behavior regulates ben-
zodiazepine/GABAA receptor subunit expression in brain regions associated with fear in
BALB/c and C57BL/6 mice. Neuropsychopharmacology, 29, 1344–1352.
Hollander, E., Novotny, S., Hanratty, M., Yaffe, R., DeCaria, C. M., Aronowitz, B. R., et al.
(2003). Oxytocin infusion reduces repetitive behaviors in adults with autistic and Asperger’s
disorders. Neuropsychopharmacology, 28, 193–198.
Kern, J. K., Espinoza, E., & Trivedi, M. H. (2004). The effectiveness of secretin in the manage-
ment of autism. Expert Opinions on Pharmacotherapy, 5, 379–387.
Uvnas-Moberg, K. (1989). The gastrointestinal tract in growth and reproduction. Science Amer-
ica, 261, 78–83.
Vargas, D. L., Nascimbene, C., Krishnan, C., Zimmerman, A. W., & Pardo, C. A. (2005). Neu-
roglial activation and neuroinflammation in the brain of patients with autism. Annual Neurol-
ogy, 57, 67–81.
Weaver, I. C., Cervoni, N., Champagne, F. A., D’Alessio, A. C., Sharma, S., Seckl, J. R., et al.
(2004). Epigenetic programming by maternal behavior, National Neuroscience, 7, 847–854.
Welch, M. G., & Ruggiero, D. A. (in press). GABA in autism and related disorders: Predicted
therapeutic role of secretin and oxytocin in autism: Implications for treatment of mental ill-
ness. International review of neurobiology. Burlington, MA: Elsevier.
Welch, M. G., Keune, J. D., Welch-Horan, T. B., Anwar, M., Anwar, N., & Ruggiero, D. A.
(2003a). Secretin activates visceral brain regions in rats including areas abnormal in autism.
Cellular and Molecular Neurobiology, 23, 817–837.
Welch, M. G., Welch-Horan, T. B., Keune, J. D., Anwar, N., Anwar, M., Ludwig, R. J., et al.
(2003b). Neurohormonal resolution of genetic and acquired IBD and secondary brain activa-
tion in areas abnormal in autism. (Prog. # 318.5 2003 Abstracts). Washington, DC: Society
for Neuroscience Abstracts.
Welch, M. G., Welch-Horan, T. B., Anwar, M., Keune, J. D., Anwar, N., Ludwig, R. J., et al.
(2004). Secretin: hypothalamic distribution and hypothesized neuroregulatory role in autism.
Cellular Molecular Neurobiology, 24, 219–241.

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WILBARGER PROTOCOL

Welch, M. G., Welch-Horan, T. B., Anwar, M., Anwar, N., Ludwig, R. J., & Ruggiero, D. A.
(2005). Brain effects of chronic IBD in areas abnormal in autism and treatment by single
neuropeptides secretin and oxytocin. Journal of Molecular Neuroscience, 25, 259–274.
MARTHA G. WELCH AND DAVID A. RUGGIERIOWILBARGER PROTOCOL
Designed by Patricia Wilbarger, the Wilbarger Protocol is a specific brushing tech-
nique to reduce tactile defensiveness by providing deep pressure to the skin on the
arms, back, and legs using a surgical brush.
KELLY M. PRESTIA

WISCONSIN CARD SORTING TEST (WCST)

The Wisconsin Card Sorting Test (WCST; Grant & Berg, 2003) is a neuropsycho-
logical test of ‘‘set-shifting.’’ The WCST is used to assess perseveration, abstract rea-
soning, and the capacity to modify problem-solving strategies when needed. It has
been considered a measure of executive function because of its reported sensitivity to
frontal lobe dysfunction. The assessment includes 128 response cards and 4 stimulus
cards. The subject taking the test is asked to sort the response cards onto the stimulus
cards based upon sorting rules. The WCST has been widely used with individuals ages
6.5–89 years. Administration time ranges from 20 to 30 minutes.

REFERENCE
Grant, D. A., & Berg, E. A. (2003). Computerized Wisconsin card sorting test version 4. Lutz, FL:
Psychological Assessment Resources, Inc.
AMY BIXLER COFFIN

WOODCOCK-JOHNSON PSYCHOEDUCATIONAL BATTERY–REVISED:

TESTS OF COGNITIVE ABILITY
The Woodcock-Johnson Psychoeducational Battery–Revised: Tests of Cognitive
Ability (WJPB-R; Mather & Jaffe, 2003) is both an individual cognitive and achieve-
ment test. There are two batteries of tests, the Standard Battery and the Extended
Battery. Both versions include 11 subtests incorporating reading, math, and writing/
spelling concepts. The WJPB-R is a useful measure for the assessment of school per-
formance across a variety of academic areas and ages. The tool assesses cognitive
achievement as well as scholastic interests. The WJPB-R can be administered on indi-
viduals ranging in ages 3 through 80.

REFERENCE
Mather, N., & Jaffe, L. (2003). Woodcock Johnson III–reports. Indianapolis, IN: Wiley.
AMY BIXLER COFFIN

WORK ADJUSTMENT PERIOD

The work adjustment period is offered through most vocational rehabilitation agen-
cies to allow for opportunities to train people who have either never entered the
workforce or have few work readiness skills. Training provided during a work adjust-
ment may include interviewing skills, resume writing, staying on-task, hygiene, time
management, assessing vocational interests or skills, and potential job matches. For
the person with an autism spectrum disorder, the very notion of how to plan a future

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 WORK ADJUSTMENT PERIOD

can be quite overwhelming simply because of a lack of exposure to community or

employment experiences. Many of the skills we take for granted, like organizing our
priorities and successfully planning to carry them out, are a great challenge, requiring
direct instruction and support to be completed successfully. The work adjustment pe-
riod is a safe test period for people to test out their skills, gain self-confidence, and dis-
cover what social expectations are associated with the work environment.

FURTHER INFORMATION
Nuehring, M., & Sitlington, P. (2003). Transition as a vehicle: Moving from high school to an
adult vocational service provider. Journal of Disability Policy Studies, 14(1), 23–36.
SHERRY MOYER

415
 Y
YEAST-FREE
Yeast–free refers to a diet that controls yeast intake and strives to starve the yeast
organism of sugars and simple carbohydrates. Complex carbohydrates (whole grains)
and foods with low sugar content typically replace these foods. It is argued that the
chemical compounds produced by yeast are toxic to the nervous system. In relation to
their ability to remediate the symptoms of autism, yeast-free diets are not substanti-
ated by empirical data.
See also empirical evidence.
JEANNE HOLVERSTOTT
 Z
ZERO REJECT
Zero Reject refers to one of the founding principles of the Individuals with Disabil-
ities Education Act of 1975 (PL 94-142; formerly Education of All Handicapped Chil-
dren Act), which states that all children with a disability should be provided full
educational opportunities and are eligible for free and appropriate education. Zero
Reject ensures that no child with a disability as qualified under the Individuals with
Disabilities Education Act should be fully, physically, or functionally excluded from
educational opportunities because of disability or a need for special education and
related services. In practice, the application of Zero Reject has included the creation
of appropriate education programs as well as the transport of students to schools pro-
viding appropriate education programs.

REFERENCE
Education of All Handicapped Children Act of 1975, 20 U.S.C. Sec. 1400(d).
JEANNE HOLVERSTOTT

ZIGGURAT MODEL
The Ziggurat Model (Aspy & Grossman, 2006) is a system for designing compre-
hensive interventions for individuals of all ages with autism spectrum disorders
(ASD). The model is based on the premise that there are critical factors that must be
addressed in all intervention plans for individuals on the spectrum—the five levels of
the Ziggurat. An additional premise is that most social, emotional, and other behav-
ioral difficulties experienced by individuals with ASDs stem from the autism itself. In
other words, these difficulties are symptoms of the underlying disorder; therefore, in
order to be effective, interventions must target underlying factors rather than simply
alleviate surface symptoms. The Ziggurat Model incorporates assessment tools used to
identify those aspects of autism that manifest as social, emotional, and other behav-
ioral concerns. Underlying elements then become targets for intervention. A third
premise of the model is that comprehensive intervention plans include preventative
strategies, strategies for teaching new skills, and effective reinforcement—the three
elements of a functional behavioral assessment (antecedent, behavior, and
consequence).
ZIGGURAT MODEL

INTERVENTION ZIGGURAT
The Intervention Ziggurat is the centerpiece of the Ziggurat Model (see Figure 25).
It contains five levels in a hierarchal structure. Each level is based on fundamental
needs of individuals with ASDs. The levels are interdependent, each contributing to
the effectiveness of other levels.
The base or foundation of the Ziggurat represents what is, in one sense, the basis of
all behavior—biology. Consideration of biological factors is especially important in
the case of autism—a disorder with strong genetic and neurological underpinnings.
Unmet sensory and biological needs will result in changes in behavior—highlighting
the importance of including strategies to address these needs.
The second level of the Ziggurat represents another fundamental need—Reinforce-
ment. Reinforcement is defined as ‘‘a situation or event that follows a particular
behavior, resulting in an increased likelihood that a behavior will recur in the future’’
(Bregman & Gerdtz, 1997, p. 611). The ultimate goal of comprehensive interventions
is to help individuals develop skills that will increase their success. This cannot occur
without reinforcement.
Individuals on the spectrum require instruction and reinforcement for skills that are
generally assumed to have been mastered by same-age peers. This mistaken assumption
often results in punishment for failure to display a skill that has actually never been
acquired. In order to counter this tendency, the Ziggurat Model includes the reinforce-
ment level to facilitate skill acquisition and maintenance.

Figure 25 The Five Levels of the Intervention Ziggurat

Source: Adapted from The Ziggurat Model: A Framework for Designing Comprehensive Interventions for Individu-
als with High-Functioning Autism and Asperger’s Syndrome, by R. Aspy & B. G. Grossman. Copyright 2006.
Shawnee Mission, KS: Autism Asperger Publishing Company. Reprinted with permission.

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 ZIGGURAT MODEL

The third level of the Ziggurat, Structure and Visual Supports, is a response to the
communication deficits and strong need for routine and order often displayed by indi-
viduals with ASDs. Structure is the systematic organization of the environment that
increases predictability. The term visual supports refers to a range of techniques that
incorporates visual media. Visual supports draw upon a strength of individuals with au-
tism spectrum disorders—the processing of visual information. Structure and visual
supports are interrelated concepts. Visual supports are a frequent means of providing
increased structure. Further, both increase the ability of individuals on the spectrum
to predict and understand the world. Visual reminders (e.g., visual schedules and
checklists) or visual instruction techniques (e.g., cartooning and video modeling),
called visual supports, are often provided to address these concerns. Visual supports
and structure often result in the prevention of problem behaviors, making these strat-
egies critical to an effective intervention plan.
Individuals with ASDs are asked to function in a world designed for neurotypicals.
Even seemingly simple situations present multilayered demands (e.g., social, communi-
cation, cognitive, sensory, social, motor, etc) that can be overwhelming and result in
behavioral concerns for those with ASDs. Task difficulty is the focus of the fourth
level of the Ziggurat. The goal is to make certain that the balance of supports offered
and independence expected are appropriate for the task presented.
In general, Task Demand interventions involve identifying prerequisite and compo-
nent skill deficits and reducing the demands of a task. If skills are lacking or supports
are not provided, the demand will be too difficult and expectations cannot be met.
The Ziggurat Model incorporates Vygotsky’s concept of the zone of proximal develop-
ment (ZPD), describing the ideal conditions for skill development, as a guide for
determining the level of task demand (1978, as cited in Miller, 1993). Expectations
must be reasonable; that is, an individual must be capable of succeeding either inde-
pendently or with assistance.
The first four levels of the Ziggurat set the stage for acquisition of skills. Skills to
Teach is the final level of the model. The focus of this level is the teaching of skills
across a range of areas—motor, sensory, emotional, social, communication, cognitive,
etc. Those with ASDs often require direct instruction in skills and concepts that typi-
cally developing individuals acquire effortlessly—this is referred to as the seemingly
obvious or ‘‘hidden’’ curriculum (Myles, Trautman, & Schelvan, 2004). As skills
increase, less intensive interventions will be required on the lower levels of the Zig-
gurat because it is the learning of new skills that makes a permanent difference for
the person on the spectrum. Table 10 lists examples of strategies on each level of the
Intervention Ziggurat.

UNDERLYING CHARACTERISTICS
The social and behavioral challenges presented by individuals with ASDs most of-
ten are manifestations of autism itself. Addressing behaviors without ascertaining and
attending to what underlies them is a common intervention mistake. This surface or
‘‘band-aid’’ approach often fails to establish long-term gains because it ignores the true
need—underlying hidden deficits.
Underlying needs and characteristics related to autism must be addressed (the third
premise of the Ziggurat Model). To that end, the Ziggurat Model includes two
421
 Table 10. Examples of Interventions on Each Level of the Intervention Ziggurat

Level Examples of Interventions

Sensory Differences and Biological Needs ¥ Sensory diets
¥ Pharmacotherapy
¥ Breaks
¥ Headphones
¥ Physical activities
¥ Allowing for personal space
¥ Relaxation strategies
Reinforcement ¥ Reinforcer menu
¥ Token systems
¥ First-then charts
¥ Self-selection of activity
Structure and Visual Supports ¥ Cartooning
¥ Social Stories (Gray, 1998)
¥ Power Cards
¥ Social Autopsies
¥ Calendars (paper or electronic)
¥ Lists
¥ T-chart
¥ Video
¥ Visual map
¥ Scheduled work systems
¥ Preparation in advance of changes
¥ Visual timers
¥ Checklists
¥ Individualized work stations
¥ Picture schedules
¥ Portable transition pictures
Task Demands ¥ Copies of lecture notes
¥ Laptop computer for note taking
¥ Extra time for written work
¥ Personal Digital Assistant (PDA)
¥ Organizational skills support
¥ Coping cards
¥ Circle of Friends
¥ Narration
¥ High interest activities to encourage social
interaction
¥ Peer buddies
¥ Highlighted text
¥ Monitoring teacher
¥ Safe place
¥ Breaks
¥ Preparation in advance of changes
¥ Minimizing transitions
¥ Scheduled work system
¥ PECS
¥ Modeling social/communication skills
¥ Tactile teaching aides

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 ZIGGURAT MODEL

¥ Individualized work station

¥ Verbal prompts
¥ Repeated exposure to activities
¥ Adult-directed play routines
Skills to Teach ¥ Social Stories (Gray, 1998)
¥ Adult-directed play routines
¥ Modeling social/communication skills
¥ Scheduled work system to teach skills for
independence
¥ Video modeling

assessment tools—the Underlying Characteristics Checklist (UCC) and the ABC-

Iceberg (ABC-I)—designed to identify these underlying factors. The UCC is a descrip-
tive assessment instrument that can be completed by multiple respondents and provides
a ‘‘snapshot’’ of how autism is expressed for an individual in the following areas: social,
restricted patterns of behavior, interests, and activities, communication, sensory differ-
ences, cognitive differences, motor, and emotional vulnerability. The ABC-I incorporates
a traditional functional behavioral assessment and helps to illustrate patterns of behav-
ior (i.e., ABCs–antecedent, behavior, and consequence). By including underlying fac-
tors, the ABC-I goes beyond the functional behavioral assessment. The user identifies
items endorsed on the UCC that are related to the behaviors analyzed in the
functional behavior assessment portion of the ABC-I. The process of completing the
ABC-I (functional assessment and identification of related underlying factors) highlights
the link between the behavior and the underlying autism. The identified antecedent,
behavior, and consequences provide three points of intervention. The purpose of
behavior interventions is to teach new skills. Antecedent interventions alter the events
that ‘‘trigger’’ behavior difficulties and thus are preventative, while consequence inter-
ventions alter the events that follow behavior. The Ziggurat Model emphasizes positive
consequences in order to reinforce appropriate behaviors and skill development.

INTERVENTION DESIGN PROCESS

The Ziggurat Model is not a collection of intervention strategies. It is a framework
for intervention design. The Ziggurat Worksheet is a tool to assist in this process. Use
of the worksheet assures that the three required elements for comprehensive interven-
tion are included. These are: (1) five levels of the Intervention Ziggurat; (2) underly-
ing characteristics, and; (3) three points of intervention A-B-C. The authors of the
model emphasize the importance of incorporating evidenced-based strategies. Further,
the model provides for ongoing monitoring of progress.
The Ziggurat Model presents two paths for intervention: general and specific. Gen-
eral interventions address more global needs based on the UCC, while specific inter-
ventions address identified behaviors of concern based on the ABC-I and UCC.
Following the assessment process, actual intervention strategies are selected with the
aid of the Ziggurat Worksheet in order to create a comprehensive plan.
While the Ziggurat Model can be used by an individual, its components lend them-
selves to collaboration among multiple caregivers. The assessment tools are designed
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ZONE OF PROXIMAL DEVELOPMENT (ZPD)

to incorporate the perspectives of multiple team members while assuring that they
work from the same reference point—the individual’s underlying characteristics of au-
tism. The Ziggurat Worksheet also promotes collaboration by helping parents and pro-
fessionals to understand their part in the larger intervention picture. Because of this
capacity to promote collaboration, the Ziggurat Model is an ideal consultation tool for
those serving individuals with ASDs. Through the use of the Ziggurat Model, the
whole truly is greater than the sum of its parts.
See also genetic factors/heredity.

REFERENCES
Aspy, R., & Grossman, B. G. (2006). The Ziggurat Model: A framework for designing comprehen-
sive interventions for individuals with high-functioning autism and Asperger syndrome. Shawnee
Mission, KS: Autism Asperger Publishing Company.
Bregman, J. D., & Gerdtz, J. (1997). Behavioral interventions. In D. J. Cohen & F. R. Volkmar
(Eds.), Handbook of autism and pervasive developmental disorders (2nd ed., pp. 606–630). New
York: John Wiley and Sons.
Gray, C. A. (1998). Social stories and comic strip conversations with students with Asperger
syndrome and high functioning autism. In E. Schopler, G. B. Mesibov, & L. J. Kunce (Eds.),
Asperger syndrome or high functioning autism (pp. 167–198). New York: Plenum Press.
Miller, P. (1993). Theories of developmental psychology (3rd ed.). New York: W. H. Freeman and
Company.
Myles, B. S., Trautman, M. L., & Schelvan, R. L. (2004). The hidden curriculum: Practical solu-
tions for understanding unstated rules in social situations. Shawnee Mission, KS: Autism Asperger
Publishing Company.
RUTH ASPY AND BARRY G. GROSSMAN

ZONE OF PROXIMAL DEVELOPMENT (ZPD)

A student’s zone of proximal development, or ZPD, is the student’s range of ability
with and without assistance from a teacher or capable peer. On one end of the range
is the student’s ability level without assistance. On the other end of the range is the
student’s ability level with assistance. The ZPD bridges that gap between what is
known and what can be known. This theory requires the teacher and student to col-
laborate so that the student can create his own meaning from the information
presented.
JAN L. KLEIN

424
 APPENDIX A: Newsletters
Compiled by Lynn Dudek

AANE NEWSLETTER (ASPERGER’S ASSOCIATION OF NEW ENGLAND)

AANE members receive a semiannual newsletter that contains valuable articles for those with
Asperger syndrome, as well as important news and events.
182 Main Street
Watertown, MA 02472
Phone: 617.393.3824
Fax: 617.393.3827
E-mail: info@aane.org
Web site: www.aane.org

AHA E-LIST (ASPERGER SYNDROME AND

HIGH FUNCTIONING ASSOCIATION E-LIST)
Asperger Syndrome and High Functioning Association subscribers receive articles of interest,
relevant research abstracts and updates about our group.
Web site: www.ahaNY.org

THE ANDI NEWS (AUTISM NETWORK FOR DIETARY INTERVENTION)

The ANDI News is a quarterly publication that covers the dietary aspects of autism. The ANDI
Web site offers links to resources and frequently asked questions. E-mailed inquiries may take up to
several weeks to receive a response.
Web site: www.AutismNDI.com

ASCEND NEWS
ASCEND Group Inc., the Asperger Syndrome Alliance for Greater Philadelphia, is a nonprofit
organization founded in 2001. It was launched by parents of children with Asperger syndrome
(AS) as a means to create a community of people who are concerned about the many ways that
AS and other autism spectrum disorders affect children and adults and their families in the home,
at school, and in every area of their lives. The ASCEND News is a twice-yearly newsletter from
ASCEND Group, Inc.
ASCEND Group, Inc.
P.O. Box 531
Ardmore, PA 19003-0531
APPENDIX A

Phone: 610.449.6776
Fax: 610.853.6137
E-mail: membership@ascendgroup.org
Web site: www.ascendgroup.org

THE ASPEN NEWSLETTER

ASPEN (Asperger Syndrome Education Network, Inc.) is a source of education, support, and
advocacy for families and individuals whose lives are affected by autism spectrum disorders. The
ASPEN Newsletter is included as a benefit of membership in ASPEN.
The ASPEN Newsletter
Asperger Syndrome Education Network, Inc.
Aspen Newsletter
9 Aspen Circle
Edison, NJ 08820
Phone: 732.321.0880
Web site: www.aspennj.org

ATC NEWSLETTER
Periodically published by the Autism Training Center of Marshall University, ATC Newsletter
is a pdf format newsletter concerning the activities in and around the Autism Training Center at
Marshall.
Virginia Autism Training Center at Marshall University
College of Education
One John Marshall Drive
Huntington, WV 25755-2430
Phone: 800.344.5115
Web site: www.marshall.edu/coe/atc/newsletter.html

AUTISM ADVOCATE MAGAZINE

The Autism Advocate Magazine, distributed by the Autism Society of America, is a collection of
the latest autism news, chapter highlights, first-person accounts of families living with and growing
with autism, and tips from parents and professionals. It is distributed to Autism Society of America
members five times a year.
Autism Society of America
7910 Woodmont Avenue, Suite 300
Bethesda, MD 20814-3067
Phone: 800.3AUTISM
Web site: www.autism-society.org

AUTISM ASPERGER PUBLISHING COMPANY (AAPC) NEWSLETTER

The AAPC Newsletter is a free online publication that covers a variety of topics including emo-
tions, diet, school, and relationships. The AAPC Newsletter provides a community of support for
parents, professionals, and people on the spectrum.
Autism Asperger Publishing Company
P.O. Box 23173
Shawnee Mission, KS 66283
Phone: 877.277.8254
Fax: 913.681.9473
Web site: www.asperger.net

426
 APPENDIX A

AUTISM-ASPERGER’S DIGEST
This bimonthly magazine features original articles and materials related to autism spectrum dis-
orders. The magazine is written specifically for parents, teachers, and related service providers.
Web site: www.autismdigest.com

AUTISM RESEARCH REVIEW INTERNATIONAL NEWSLETTER

Autism Research Review International Newsletter is published quarterly through the Autism
Research Institute (ARI). The ARI Web site and newsletter are clearinghouses for biomedical
and educational research on autism.
Autism Research Institute
4182 Adams Avenue
San Diego, CA 92119
Fax: 612.563.6840
Web site: www.autism.com/ari

AUTISM SPECTRUM QUARTERLY

Autism Spectrum Quarterly (ASQ) provides information for individuals on the autism spectrum
as well as their families. Articles are written by individuals on the autism spectrum as well as lead-
ing professionals in the field.
Autism Spectrum Quarterly
c/o Starfish Specialty Press LLC
P.O. Box 799
Higganum, CT 06441-0799
Phone: 877.STARFISH, ext. 3
Fax: 860.345.4471
Web site: www.ASQuarterly.com

DAN! PROTOCOL (DEFEAT AUTISM NOW!)

The DAN! Protocol outlines guidelines for biological treatments of autism. It is published
through the Autism Research Institute.
Web site: www.autism.com/ari/dan/dan.htm

FASTIMES (FLORIDA ASPERGER SYNDROME TIMES)

FASTimes is published by the University of Miami Center for Autism & Related Disabilities.
The newsletter contains tips, articles, resources, and practical intervention strategies for parents
and educators of children with Asperger syndrome.
FASTimes
5665 Ponce de Leon Boulevard
Coral Gables, FL 33124
Phone: 305.284.6556
Web site: www.umcard.org

F.E.A.T. DAILY AUTISM NEWSLETTER

(FAMILIES FOR EARLY AUTISM TREATMENT)
This newsletter is sent daily via e-mail. It includes updates on research, interventions, publicity,
and other news in the autism world.
Web site: www.feat.org

427
APPENDIX A

THE MAAP
The MAAP is the quarterly publication for the families of MAAP Services (More Able Autis-
tic Persons). Each issue includes: a letter from the editor, letters from parents and individuals with
ASD, and an FYI section.
MAAP Services, Inc.
P.O. Box 524
Crown Point, IN 46307
Phone: 219.662.1311
Fax: 219.662.0638
Web site: www.maapservices.org

THE NEW ENGLAND CENTER FOR CHILDREN RESEARCH

NEWSLETTER
The New England Center for Children (NECC) publishes the Research Newsletter, through
which we hope to let families, practitioners, researchers, and others in the NECC community
know about some of the research being conducted here.
The New England Center for Children
33 Turnpike Road
Southborough, MA 01772-2108
Phone: 508.481.1015
Fax: 508.485.3421
Web site: www.necc.org

THE OARACLE
The OARacle is a monthly e-newsletter from The Organization for Autism Research (OAR).
Topics include articles on strategies and interventions, empirical research, personal perspectives,
and updates on OAR’s yearly conference.
Organization for Autism Research
2000 North 14th Street, Suite 480
Arlington, VA 22201
Phone: 703.243.9710
Web site: www.researchautism.org

THE OPEN DOOR NEWSLETTER

The Open Door is the official newsletter of The New England Center for Children. Published
twice a year, The Open Door provides profiles of students, parents, staff, donors, and board mem-
bers, along with news and announcements from all around NECC.
The New England Center for Children
33 Turnpike Road
Southborough, MA 01772-2108
Phone: 508.481.1015
Fax: 508.485.3421
Web site: www.necc.org

USAA NEWSLETTER (U.S. AUTISM AND ASPERGER

ASSOCIATION, INC. NEWSLETTER)
The USAA Newsletter is an e-newsletter that addresses a range of topics on autism and Asperger
syndrome.
Web site: www.usautism.org

428
 APPENDIX B: Journals
Compiled by Lynn Dudek
and Terri Cooper Swanson

AMERICAN JOURNAL OF HUMAN GENETICS

The American Journal of Human Genetics explores topics such as behavioral genetics, biochemi-
cal genetics, clinical genetics, cytogenetics, dysmorphology, gene therapy, genetic counseling,
genetic epidemiology, genomics, immunogenetics, molecular genetics, neurogenetics, and popula-
tion genetics.
American Journal of Human Genetics
1427 East 60th Street
Chicago, IL 60637
Phone: 877.705.1878
Fax: 877.705.1879
E-mail: subscriptions@press.uchicago.edu
Web site: www.journals.uchicago.edu/AJHG

AMERICAN JOURNAL OF OCCUPATIONAL THERAPY

The American Journal of Occupational Therapy is a peer-reviewed journal related to research and
professional development in occupational therapy.
AOTA Subscriptions—AJOT
P.O. Box 31220
Bethesda, MD 20824-1220
Phone: 301.652.2682, ext. 2769
Web site: www.aota.org

AMERICAN JOURNAL OF SPEECH LANGUAGE PATHOLOGY

The American Journal of Speech Language Pathology pertains to all aspects of clinical practice in
speech-language pathology. Articles address screening, assessment, and treatment techniques, and
professional issues.
ASHA
10801 Rockville Pike
Rockville, MD 20852
Phone: 888.498.6699
Fax: 301.897.7355
E-mail: subscribe@asha.org
Web site: www.asha.org
APPENDIX B

ARCHIVES OF GENERAL PSYCHIATRY

The Archives of General Psychiatry publishes original, state-of-the-art studies and commentaries
of general interest to clinicians, scholars, and research scientists in psychiatry, mental health, be-
havioral science, and allied fields.
Subscriber Services Center
American Medical Association
P.O. Box 10946
Chicago, IL 60610-0946
Phone: 800.262.2350
E-mail: ama-subs@ama-assn.org
Web site: http://archpsych.ama.assn.org

ASSESSMENT FOR EFFECTIVE INTERVENTION

(FORMERLY DIAGNOSTIQUE)
Assessment for Effective Intervention is the official diagnostic journal for the Council for Excep-
tional Children. This peer-reviewed journal publishes empirical research that is applicable to diag-
nosticians, special educators, psychologists, and others related to psychoeducational assessment.
The Council for Exceptional Children
1110 North Glebe Road, Suite 300
Department K03082
Arlington, VA 22201-5704
Phone: 888.232.7733
Fax: 703.264.9494
Web site: www.ideapractices.org/bk/catalog2/divjourn.html

AUTISM: THE INTERNATIONAL JOURNAL

OF RESEARCH AND PRACTICE
Autism is an international journal for research of direct practical relevance to improving the
quality of life for individuals with autism or autism-related disorders.
The National Autistic Society
393 City Road,
London, EC1V 1NG, United Kingdom
Phone: +44.0.20.7833.2299
Fax: +44.0.20.7833.9666
E-mail: nas@nas.org.uk
Web site: www.sagepub.co.uk

BRAIN (THE JOURNAL OF NEUROLOGY)

Brain provides researchers and clinicians with original contributions in the field of neurology.
Leading studies in neurological science are balanced with practical clinical articles.
Brain
Journals Subscription Department
Great Clarendon Street
Oxford OX2 6DP, United Kingdom
Phone: +44.0.1865.353907
Fax: +44.0.1865.353485
E-mail: jnls.cust.serv@oupjournals.org
Web site: http://brain.oxfordjournals.org

430
 APPENDIX B

BRITISH JOURNAL OF DEVELOPMENTAL PSYCHOLOGY

British Journal of Developmental Psychology publishes full-length empirical, conceptual, review,
and discussion papers, as well as brief reports on all aspects of developmental psychology, includ-
ing: motor, perceptual, cognitive, social, and emotional development in infancy; social, emotional,
personality, cognitive, and sociocognitive development in childhood, adolescence, and adulthood;
atypical development, including developmental disorders and learning difficulties/disabilities; fac-
tors that impact upon psychological development; theories of psychological development.
The British Psychological Society
St Andrews House
48 Princess Road East
Leicester, LE1 7DR, United Kingdom
Phone: +44.0.116.254.9568
Fax: +44.0.116.247.0787
E-mail: enquiry@pbs.org.uk
Web site: www.bps.org.uk

CAREER DEVELOPMENT OF EXCEPTIONAL INDIVIDUALS

Career Development of Exceptional Individuals is the official journal for the Council for Excep-
tional Children Division on Career Development and Transition. This peer-reviewed journal is
published twice a year on issues related to transition and career development.
The Council for Exceptional Children
1110 North Glebe Road, Suite 300
Department K03082
Arlington, VA 22201-5704
Phone: 888.232.7733
Fax: 703.264.9494
Web site: www.dcdt.org and www.ideapractices.org/bk/catalog2/divjourn.html

EDUCATION AND TRAINING IN DEVELOPMENTAL DISABILITIES

Education and Training in Developmental Disabilities is a peer-reviewed journal published by the
Council of Exceptional Children Division on Developmental Disabilities. The journal is published
quarterly.
The Council for Exceptional Children
1110 North Glebe Road, Suite 300
Department K03082
Arlington, VA 22201-5704
Phone: 888.232.7733
Fax: 703.264.9494
Web site: www.ideapractices.org/bk/catalog2/divjourn.html

FOCUS ON AUTISM AND OTHER DEVELOPMENTAL DISABILITIES

Focus on Autism and Other Developmental Disabilities is published by Council for Exceptional
Children Division on Developmental Disabilities. Focus covers a variety of issues related to au-
tism and developmental disabilities in education, psychology, therapies, and other related areas.
Phone: 800.897.3203
Fax: 800.397.7633
Web site: www.proedinc.com
431
APPENDIX B

INTERVENTION IN SCHOOL AND CLINIC

Intervention in School and Clinic provides user-friendly information for teachers and related prac-
titioners. Topics include information related to children with learning disabilities and behavior
disorders.
Phone: 800.897.3203
Fax: 800.397.7633
Web site: www.proedinc.com

JOURNAL OF APPLIED BEHAVIORAL ANALYSIS

Journal of Applied Behavioral Analysis is a peer-reviewed journal that publishes empirical research
related to the field of applied behavioral analysis.
Kathy Hill, Business Manager
Department of Applied Behavioral Sciences
1000 Sunnyside Avenue
Lawrence, KS 66045-2133
Phone: 785.841.4425
Fax: 785.841.0846
E-mail: behavior@ku.edu
Web site: http://seab.envmed.rochester.edu/jaba

JOURNAL OF AUTISM AND DEVELOPMENTAL

DISORDERS
Journal of Autism and Developmental Disorders is a peer-reviewed journal that specializes in severe
childhood psychopathologies, including autism and childhood schizophrenia. The journal features
experimental research on biochemical, neurological, and genetic aspects of particular disorders,
case studies, and advances in the diagnosis and classification of disorders.
Springer
233 Spring Street
New York, NY 10013
Phone: 800.SPRINGER
E-mail: springerlink-ny@springer.com
Web site: www.springer.com

JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY

AND ALLIED DISCIPLINES
The Journal of Child Psychology and Psychiatry is an international journal covering both child and
adolescent psychology and psychiatry. Articles published include experimental and developmental
studies.
Blackwell Publishing Inc.
Commerce Place
350 Main Street
Malden, MA 02148
Phone: 781.388.8200
Fax: 781.388.8210
Web site: www.blackwellprofessional.com

432
 APPENDIX B

JOURNAL OF NEUROPSYCHIATRY & CLINICAL NEUROSCIENCES

The Journal of Neuropsychiatry and Clinical Neurosciences presents original research and clinical
reports related to the assessment and treatment of neuropsychiatric disorders.
Journal of Neuropsychiatry and Clinical Neurosciences
1000 Wilson Boulevard, Suite 1825
Arlington, VA 22209-3901
Phone: 800.368.5777
E-mail: appi@psych.org
Web site: http://neuro.psychiatryonline.org

JOURNAL OF POSITIVE BEHAVIOR INTERVENTIONS

Journal of Positive Behavior Interventions is a peer-reviewed journal that publishes information on
empirical research and programs and is a forum on controversial issues and published materials.
Phone: 800.897.3203
Fax: 800.397.7633
Web site: www.proedinc.com

JOURNAL OF SPEECH HEARING LANGUAGE RESEARCH

The Journal of Speech, Language, and Hearing Research pertains broadly to studies of the pro-
cesses and disorders of hearing, language, and speech and to the diagnosis and treatment of such
disorders.
ASHA
10801 Rockville Pike
Rockville, MD 20852
Phone: 888.498.6699
Fax: 301. 897.7355
E-mail: subscribe@asha.org
Web site: www.asha.org

JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION

The Journal of the American Medical Association is an international peer-reviewed general medi-
cal journal published 48 times per year. JAMA is the most widely circulated medical journal in the
world.
Subscriber Services Center
American Medical Association
P.O. Box 10946
Chicago, IL 60610-0946
Phone: 800.262.2350
E-mail: ama-subs@ama-assn.org
Web site: http://jama.ama-assn.org

JOURNAL OF THE INTERNATIONAL

NEUROPSYCHOLOGICAL SOCIETY
Journal of the International Neuropsychological Society publishes peer-reviewed articles covering all
areas of neuropsychology with either an experimental or clinical focus.

433
APPENDIX B

Cambridge University Press

100 Brook Hill Drive
West Nyack, NY 10994-2133
Phone: 800.872.7423
Fax: 845.353.4141
E-mail: subscriptions_newyork@cambridge.org
Web site: www.cambridge.org/journals

NEUROLOGY
Neurology is directed to physicians concerned with diseases and conditions of the nervous sys-
tem. The journal’s purpose is to advance the field by presenting new basic and clinical research
with emphasis on knowledge that will influence the way neurology is practiced.
Lippincott Williams & Wilkins
Customer Service Department
16522 Hunters Green Parkway
Hagerstown, MD 21740
Phone: 866.489.0443
Fax: 301.223.2398
E-mail: customerservice@lww.com
Web site: www.neurology.org

NEUROSCIENCE & BIOBEHAVIORAL REVIEWS

This journal publishes original and significant review articles dealing with all aspects of neuroscience,
where the relationship to the study of psychological processes and behavior is clearly established.
Customer Service Department
6277 Sea Harbor Drive
Orlando, FL 32887-4800
Phone: 877.839.7126
Fax: 407.363.1354
E-mail: usjcs@elsevier.com
Web site: www.elsevier.com

NEW ENGLAND JOURNAL OF MEDICINE

The New England Journal of Medicine is a weekly general medical journal that publishes new
medical research findings, review articles, and editorial opinions on a wide variety of topics of im-
portance to biomedical science and clinical practice.
Customer Services
860 Winter Street
Waltham, MA 02451-1413
Phone: 800.843.6356
Fax: 781.893.0413
E-mail: nejmcust@mms.org
Web site: www.nejm.org

PEDIATRICS
Pediatrics is a peer-reviewed journal of the American Academy of Pediatrics. The journal’s vision
since 1948 continues to be ‘‘intended to encompass the needs of the whole child in his physiologic,
mental, emotional, and social structure.’’

434
 APPENDIX B

American Academy of Pediatrics

141 Northwest Point Boulevard
Elk Grove Village, IL 60007-1098
Phone: 866.843.2271
Fax: 847.228.1281
E-mail: journals@aap.org
Web site: http://pediatrics.aappublications.org

PSYCHOLOGICAL MEDICINE
Psychological Medicine is an international journal in the fields of psychiatry, related aspects of psy-
chology, and basic sciences. Each issue features original articles reporting key research being under-
taken worldwide.
Cambridge University Press
100 Brook Hill Drive
West Nyack, NY 10994-2133
Phone: 800.872.7423
Fax: 845.353.4141
E-mail: subscriptions_newyork@cambridge.org
Web site: www.cambridge.org/journals

435
 APPENDIX C: Organizations

AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY

The American Academy of Child and Adolescent Psychiatry is a national professional medi-
cal association dedicated to treating and improving the quality of life for children, adolescents,
and families affected by mental, behavioral, or developmental disorders. The AACAP is com-
posed of over 7,400 child and adolescent psychiatrists and other physicians. These physicians
actively research, evaluate, diagnose, and treat individuals with such psychiatric disorders.
The American Academy of Child and Adolescent Psychiatry
3615 Wisconsin Avenue, NW
Washington, DC 20016-3007
Phone: 202.966.7300
Fax: 202.966.2891
Web site: www.aacp.org
AMY BIXLER COFFIN

AMERICAN HYPERLEXIA ASSOCIATION

American Hyperlexia Association (AHA) is a nonprofit organization represented by children
with hyperlexia, parents, educators, and professionals devoted to identifying and promoting
effective interventions for hyperlexia. Members of AHA receive quarterly newsletters, notice of
conferences, and a directory of membership to encourage networking.
195 W. Spangler Road, Suite B
Elmhurst, IL 60126
Phone: 630.415.2212
Fax: 630.530.5909
Web site: www.hyperlexia.org
KATHERINE E. COOK

AMERICAN MEDICAL ASSOCIATION

The American Medical Association (AMA) is the professional association that organizes and
serves the needs of medical doctors, defines a code of ethics, and determines the standards of prac-
tice. This organization creates policy on the management and treatment of health care issues,
ethics, and internal governance. Detailed information is available on the AMA’s Web site.
515 N. State Street
Chicago, IL 60610
APPENDIX C

Phone: 800.621.8335
Web site: www.ama-assn.org
LYNN DUDEK

AMERICAN MUSIC THERAPY ASSOCIATION

The American Music Therapy Association (AMTA) is the professional association that
organizes and serves the needs of Certified Music Therapists. The organization was founded in
1998, and it sets the educational and clinical standards necessary to be certified as a music
therapist.
American Music Therapy Association, Inc.
8455 Colesville Road, Suite 1000
Silver Spring, MD 20910
Phone: 301.589.3300
Fax: 301.589.5175
Web site: www.musictherapy.org
LYNN DUDEK

AMERICAN OCCUPATIONAL THERAPY ASSOCIATION

The American Occupational Therapy Association (AOTA) is the professional association
that organizes and attends to the needs of occupational therapists, occupational therapy assis-
tants, and students studying to become occupational therapists.
The AOTA, through the Accreditation Council for Occupational Therapy Education
(ACOTE), has developed standards for the profession of occupational therapy. Included in the
standards of AOTA are accountability, respect, and service excellence.
4720 Montgomery Lane
P.O. Box 31220
Bethesda, MD 20824-1220
Phone: 301.652.2682
Fax: 301.652.7711
Web site: www.aota.org
LYNN DUDEK

AMERICAN PHYSICAL THERAPY ASSOCIATION

The American Physical Therapy Association (APTA) is the professional association that
organizes and serves the needs of physical therapists, physical therapy assistants, and students
studying to become physical therapists. APTA defines and administers the rules and terms of
membership for its members, as well as serves as a resource for continuing education, informa-
tion, and research.
American Physical Therapy Association
1111 N. Fairfax Street
Alexandria, VA 22314-1488
Phone: 703.684.APTA (2782)
Fax: 703.684.7343
Web site: www.apta.org
LYNN DUDEK

AMERICAN PSYCHIATRIC ASSOCIATION

The American Psychiatric Association includes over 35,000 U.S. and international member
physicians working together to make certain that all persons with mental disorders, including mental

438
 APPENDIX C

retardation and substance-related disorders, are provided with benevolent care and accessible quality
psychiatric diagnosis and effective treatment. The basic eligibility requirement of being a member is
to have completed a residency program in psychiatry. Applicants for membership must hold a valid
medical license, with the exception of those in residency or medical school, and must provide a ref-
erence from an already existing APA member (American Psychiatric Association, 2006).
American Psychiatric Association
1000 Wilson Boulevard, Suite 1825
Arlington, VA 22209-3901
Phone: 703.907.7300
Web site: www.psych.org
AMY BIXLER COFFIN

AMERICAN PSYCHOLOGICAL ASSOCIATION

The American Psychological Association (APA) is the largest association of psychologists. The
APA seeks to advance the profession of psychology through education, establishment, and main-
tenance of high standards, research, and encouragement of psychology across all its branches.
American Psychological Association
750 First Street, NE
Washington, DC 20002-4242
Phone: 800.374.2721
Web site: www.apa.org
MEGAN MOORE DUNCAN

AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION

The American Speech-Language Hearing Association (ASHA) is the professional association
that organizes and serves the needs of speech language pathologists and audiologists, as well as
those students studying to become speech pathologists and audiologists. ASHA defines and
administers the rules and requirements for certification for its members, as well as serves as a
resource for continuing education, clinical information, and research.
10801 Rockville Pike
Rockville, MD 20852
Phone: 800.638.8255
Fax: 240.333.4705
Web site: www.asha.org
LYNN DUDEK

THE ARC OF THE UNITED STATES

The Arc of the United States is a national organization represented by people with mental
retardation and their families. The Arc advocates at the local, state, and federal levels and is
dedicated to advancing supports and services, and providing resources, educational assistance,
and technical support.
The Arc of the United States
1010 Wayne Avenue, Suite 650
Silver Spring, MD 20910
Phone: 301.565.3842
Fax: 301.565.5342
E-mail: info@thearc.org
Web site: www.thearc.org
KATHERINE E. COOK
439
APPENDIX C

ASSOCIATION FOR BEHAVIOR ANALYSIS

The Association for Behavior Analysis is a nonprofit professional membership organization
with the goal of developing, improving, and supporting the growth and vivacity of behavior
analysis through research, education, and practice. The organization is dedicated to promoting
the experimental, theoretical, and applied analysis of behavior. Memberships include both indi-
vidual and organization memberships.
1219 South Park Street
Kalamazoo MI 49001
Phone: 269.492.9310
Fax: 269.492.9316
Web site: www.abainternational.org
AMY BIXLER COFFIN

ASSOCIATION FOR BEHAVIORAL AND COGNITIVE THERAPIES

The Association for Behavioral and Cognitive Therapies (formerly known as Association for
Advancement of Behavior Therapy) is a nonprofit professional, interdisciplinary organization
consisting of over 4,500 mental health professionals and students who use and/or are interested
in empirically based behavior therapy or cognitive behavior therapy. Members of the organiza-
tion yearn to understand human behavior, develop interventions to improve the human condi-
tion, and promote the appropriate utilization of these interventions.
Association for Behavioral and Cognitive Therapies
305 7th Avenue, 16th Fl.
New York, NY 10001
Phone: 212.647.1890
Fax: 212.647.1865
Web site: www.aabt.org
AMY BIXLER COFFIN

ASSOCIATION FOR SCIENCE IN AUTISM TREATMENT

The Association for Science in Autism Treatment (ASAT) strives to distribute accurate and
scientifically based information about autism. ASAT distributes a free newsletter, Science in Au-
tism Treatment, and hosts Science in Autism Treatment conferences geared towards improving
access to effective, science-based interventions for all individuals with autism.
Association for Science in Autism Treatment
389 Main Street, Suite 202
Malden, MA 02148
Phone: 781.397.8943
Fax: 781.397.8887
Web site: www.asatonline.org
KATHERINE E. COOK

ASSOCIATION OF UNIVERSITY CENTERS ON DISABILITY

Association of University Centers on Disability (AUCD; formerly American Association of
University Affiliated Programs) is a nonprofit organization striving to advance the lives of indi-
viduals with developmental disabilities and their families by promoting and supporting the
national network of university centers on disabilities, as they conduct research, advance policy,
and develop educational interventions.
Association of University Centers on Disabilities
1010 Wayne Avenue, Suite 920

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Silver Spring, MD 20910

Phone: 301.588.8252
Fax: 301.588.2842
Web site: www.aucd.org
KATHERINE E. COOK

AUTISM INTERNATIONAL NETWORK

Autism Network International (ANI) is an organization run by individuals with autism that
provides a medium for autistic persons to share information and problem-solve. ANI provides
an advocacy voice for individuals with autism seeking equal opportunities and rights. Addition-
ally, ANI provides social opportunities for individuals with autism through Autreat, a 3-day
retreat and conference specifically designed for individuals with autism.
Autism Network International
P.O. Box 35448
Syracuse, NY 13235-5448
Web site: www.ani.autistics.org
KATHERINE E. COOK

AUTISM RESEARCH INSTITUTE

Autism Research Institute (ARI) is a nonprofit organization, committed to conducting
research and providing parents and professionals with identified results related to the cause, pre-
vention, diagnosis, and treatment of autism spectrum disorders. ARI publishes a quarterly news-
letter, The Autism Research Review International, which provides up-to-date information and is
available by subscription.
4182 Adams Avenue
San Diego, CA 92116
Fax: 619.563.6840
Web site: www.AutismResearchInstitute.com
KATHERINE E. COOK

AUTISM SOCIETY OF AMERICA

The Autism Society of America (ASA) advocates and supports lifelong accessibility opportu-
nities for individuals with autism spectrum disorders. ASA is one of the leading advocacy groups
for individuals with autism spectrum disorders at the local, state, and federal level. ASA pro-
vides valuable resources to parents, educators, and professionals, including an on-line resource
directory, free e-newsletter, current news and media events, and an annual conference. Most
states within the United States have local ASA chapters. In addition, ASA founded the ASA
foundation to support quality research in the area of autism spectrum disorders.
Autism Society of America
7910 Woodmont Avenue, Suite 300
Bethesda, MD 20814-3067
Phone: 800.328.8476
Web site: www.autism-society.org
KATHERINE E. COOK

AUTISM SPEAKS
Autism Speaks is dedicated to conducting research on the causes, prevention, treatments,
and the cure for autism. Bob and Suzanne Wright, whose grandson is diagnosed with autism,
founded Autism Speaks in 2005 in an effort to find a cure. Their mission is to raise awareness

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and the funds to quicken the pace of research. Most recently Autism Speaks joined forces with
the National Alliance for Autism Research.
2 Park Avenue
11th Floor
New York, NY 10016
Phone: 212.252.8584
Fax: 212.252.8676
Web site: www.autismspeaks.org
TERRI COOPER SWANSON

CENTER FOR THE STUDY OF AUTISM

Center for the Study of Autism (CSA) provides up-to-date information regarding autism
spectrum disorders to parents, educators, and professionals. Additionally, CSA in collaboration
with the Autism Research Institute conducts on-going research looking at the efficacy of various
therapeutic interventions utilized with individuals with autism spectrum disorders.
Center for the Study of Autism
P.O. Box 4538
Salem, OR 97302
Web site: www.autism.org
KATHERINE E. COOK

CENTERS FOR DISEASE CONTROL AND PREVENTION

Founded in 1946, the Centers for Disease Control and Prevention (CDC) is one of the 13
major operating components of the Department of Health and Human Services, which is the
principal agency in the United States government for protecting the health and safety of all
Americans and for providing essential human services, especially for those people who are least
able to help themselves.
1600 Clifton Road
Atlanta, GA 30333
Phone: 800.311.3435
Web site: www.cdc.gov
PATRICIA R. SCHISSEL

CHILDREN’S DEFENSE FUND

Children’s Defense Fund (CDF) is a private, nonprofit organization that advocates, lobbies,
and educates in the need for preventative care for America’s poor, minority, and disabled chil-
dren. Programs include Head Start and Healthy Start. CDF provides a calendar of upcoming
events impacting America’s children.
25 E Street, NW
Washington, D.C. 20001
Phone: 202.628.8787
Web site: www.childrensdefense.org
KATHERINE E. COOK

CLOSING THE GAP

Founded in 1983 by Budd and Dolores Hagen, parents of a child who is deaf, Closing the
Gap, Inc. is an organization that focuses on computer technology for individuals with special
needs. The organization produces a bimonthly newspaper highlighting hardware and software

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products appropriate for people with special needs. Closing the Gap, Inc. also hosts an annual
international conference, which is held each fall in Minneapolis, Minnesota. The conference
allows participants to explore the many ways that technology can be used to improve the lives
of persons with disabilities.
526 Main Street
P.O. Box 68
Henderson, MN 56044
Phone: 507.248.3294
Fax: 507.248.3810
Web site: www.closingthegap.com
AMY BIXLER COFFIN

COLLABORATIVE PROGRAMS FOR EXCELLENCE IN AUTISM

In 1997, the National Institute for Child Health and Development (NICHD), in collabora-
tion with the National Institute on Deafness and Other Communication Disorders (NIDCD),
started a 5-year, $45 million international Network on the Neurobiology and Genetics of Au-
tism. The Network included 10 Collaborative Programs of Excellence in Autism (CPEAs)
designed to conduct research about the possible causes of autism, targeting genetic, immunologi-
cal, and environmental factors. In 2002, the NICHD and NIDCD renewed funding for the
CPEA Network, agreeing to provide $60 million over a period of 5 years. The CPEAs link 129
scientists from 23 universities in the United States, Canada, Britain, and five other countries,
and more than 2,000 families of people with autism. As a result of the CPEAs, researchers now
have data on the genetics and outward characteristics of the largest group of well-diagnosed per-
sons with autism in the world.
6100 Executive Boulevard, Room 4B09F, MSC 7510
Bethesda, MD 20892-7101
Phone: 800.370.2943
Fax: 301.496.3791
Web site: www.nichd.nih.gov/autism/research/cpea.cfm
KATHERINE E. COOK AND PATRICIA R. SCHISSEL

COUNCIL FOR EXCEPTIONAL CHILDREN

The Council for Exceptional Children (CEC) is a professional organization that focuses
on improving the education of children who are gifted or have disabilities. The CEC advo-
cates for these children, provides professional development, and publishes journals and
newsletters.
1110 North Glebe Road
Suite 300
Arlington, VA 22201
Phone: 888.915.5000
Fax: 703.264.9494
Web site: www.cec.sped.org
LYNN DUDEK

CURE AUTISM NOW

Cure Autism Now (CAN) is an organization of parents, medical professionals and research-
ers devoted to lobbying and raising money for autism research, education, and support. The

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principle research goals of CAN are to fund programs seeking to identify the cause(s) of au-
tism so that prevention and treatment options may be implemented.
5455 Wilshire Boulevard, Suite 715
Los Angeles, CA 90036-4234
Phone: 888.8.AUTISM
Fax: 323.549.0500
Web site: www.cureautismnow.org
KATHERINE E. COOK

FAMILY FOR EARLY TREATMENT OF AUTISM

Family for Early Autism Treatment (FEAT) is a nonprofit organization composed of parents
and professionals who are devoted to providing education, advocacy, and support regarding au-
tism spectrum disorders, pervasive developmental disorder, and Asperger syndrome to families,
educators, and professionals. FEAT organizations are located throughout the United States.
Families for Early Autism Treatment
P.O. Box 255722
Sacramento, CA 95865-5722
Web site: www.feat.org
KATHERINE E. COOK

INSTITUTE OF EDUCATION SERVICES

The Institute of Education Services (IES) is part of the U.S. Department of Education. IES is
responsible for finding evidence to support the foundations of education policy and practice.
U.S. Department of Education
400 Maryland Avenue, SW
Washington, DC 20202
Phone: 200.872.5327
Fax: 202.401.0689
Web site: www.ed.gov/ies
TERRI COOPER SWANSON

INTERAGENCY AUTISM COORDINATING COMMITTEE

The Interagency Autism Coordinating Committee (IACC) was mandated by The Children’s
Health Act of 2000 to facilitate the exchange of information on autism research and activities.
The IACC meets biannually at the National Institute for Health (NIH). The committee is
chaired by the director of the National Institute of Mental Health (NIMH) and is composed of
directors or lead administrators from all the agencies of the National Institute of Health (NIH)
plus public members from agencies and universities (i.e., Autism Society of America, Cure Au-
tism Now, a university professor whose child has autism).
National Institute of Mental Health
Public Information and Communications Branch
6001 Executive Boulevard, Room 8184, MSC 9663
Bethesda, MD 20892-9663
Phone: 866.615.6464
Fax: 301.443.4279
Web site: www.nimh.nih.gov/autismiacc/index.cfm
PATRICIA R. SCHISSEL
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 APPENDIX C

INTERNATIONAL RETT SYNDROME ASSOCIATION

The International Rett Syndrome Association (IRSA) provides individuals with accurate in-
formation and resources on Rett syndrome including books, materials, conferences, a web page,
and a quarterly newsletter. IRSA has funded over $2.33 million dollars for the sole purpose of
research related to Rett syndrome. In addition, IRSA provides a toll-free help line, RettNet,
which provides personal answers to individual questions.
9121 Piscataway Road
Clinton, MD 20735
Phone: 800.818.RETT
Fax: 301.856.3336
Web site: www.rettsyndrome.org
KATHERINE E. COOK

LEARNING DISABILITY ASSOCIATION OF AMERICA

The Learning Disability Association of America (LDA) provides support to individuals with
learning disabilities while providing timely, accurate, and objective information, solutions, and
resources for specific learning disabilities, including a calendar of events and an online bookstore. In
addition, LDA specifically provides information regarding learning disabilities under the categories
of parents, teachers, and professionals and for adults.
4156 Library Road
Pittsburgh, PA 15234-1349
Phone: 412.341.1515
Fax: 412.344.0224
Web site: www.ldaamerica.org
KATHERINE E. COOK

LOVAAS INSTITUTE FOR EARLY INTERVENTION

The Lovaas Institute for Early Intervention (LIFE) is a nationwide research-based educational
program that provides an individualized comprehensive curriculum aimed at enhancing lan-
guage, communication, social, preacademic, and independent living skills of young children
with autism spectrum disorders. This program is designed to work with all students regardless of
their functioning level.
11500 West Olympic Boulevard, Suite 460
Los Angeles, CA 90064
Phone: 310.914.5433
Fax: 310.914.5463
Web site: www.lovaas.com
KATHERINE E. COOK

MAAP SERVICES FOR AUTISM AND ASPERGER SYNDROME

MAAP (More Abled Autistic Persons) Services for Autism and Asperger Syndrome is a nonprofit
organization that provides information and advice to families of individuals with autism spectrum dis-
orders via printed materials, phone calls, e-mails, and conferences. Additionally, MAAP distributes a
quarterly newsletter that provides parents and professionals opportunities for timely and accurate infor-
mation as well as a means for networking.
P.O. Box 524
Crown Point, IN 46307

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APPENDIX C

Phone: 219.662.1311
Fax: 219.662.0638
Web site: www.maapservices.org
KATHERINE E. COOK

NATIONAL ALLIANCE FOR AUTISM RESEARCH

National Alliance for Autism Research (NAAR) is a nonprofit organization dedicated to
finding the causes, prevention, and effective treatments for autism spectrum disorders. NAAR
promotes and funds research and science-based approaches through grants, pilot studies, fellow-
ships, and collaborative research efforts with the objective being finding a cure for autism spec-
trum disorders.
99 Wall Street, Research Park
Princeton, NJ 08540
Phone: 888.777.NAAR
Fax: 609.430.9163
Web site: www.naar.org
KATHERINE E. COOK

NATIONAL HUMAN GENOME RESEARCH INSTITUTE

In 1989, Congress established an organization called The National Human Genome Research
Institute (NCHGR), which was the United States’ contribution to the International Human
Genome Project (HGP). In 1990 the HGP began to map the human genome. The Human Ge-
nome Project was the international, collaborative research program whose goal was the com-
plete mapping and understanding of all the genes of human beings; this map is called the
‘‘genome.’’
In 1993, NCHGR expanded its role on the National Institute of Health (NIH) campus by
establishing the Division of Intramural Research (DIR) to apply genome technologies to the
study of specific diseases. In 1996, the Center for Inherited Disease Research (CIDR) was also
established (cofunded by eight NIH institutes and centers) to study the genetic components of
complex disorders.
In 1997, the United States Department of Health and Human Services (DHHS) renamed
this organization, NCHGR, as the National Human Genome Research Institute (NHGRI), offi-
cially elevating it to the status of a research institute—1 of 27 institutes and centers that make
up the NIH.
Now, with the human genome sequence complete since April 2003, scientists around the
world have access to a database that greatly facilitates and accelerates the pace of biomedical
research.
Communication and Public Liaison Branch
National Human Genome Research Institute
National Institutes of Health
Building 31, Room 4B09
31 Center Drive, MSC 2152
9000 Rockville Pike
Bethesda, MD 20892-2152
Phone: 301.402.0911
Fax: 301.402.2218
Web site: www.genome.gov
PATRICIA R. SCHISSEL
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 APPENDIX C

NATIONAL INFORMATION CENTER FOR CHILDREN AND

YOUTH WITH DISABILITIES
The National Dissemination Center for Children with Disabilities (NICHCY) is a national
information center that provides individuals with information, resources, and issues related to
specific disabilities. Specific information provided by NICHCY includes disabilities in infants,
toddlers, children, and youth, IDEA, No Child Left Behind, resources for every state, disability
and professional organizations, and parent materials.
P.O. Box 1492
Washington, DC 20013
Phone: 800.695.0285
Fax: 202.884.8441
Web site: www.nichcy.org
KATHERINE E. COOK

NATIONAL INSTITUTE OF CHILD HEALTH AND

HUMAN DEVELOPMENT
NICHD research on fertility, pregnancy, growth, development, and medical rehabilitation
strives to ensure that every child is born healthy and wanted and grows up free from disease
and disability. Established in 1962, the NICHD, part of the National Institutes of Health
(NIH) within the U.S. Department of Health and Human Services, is one of several institutes
doing research into various aspects of autism, including its causes, prevalence, and treatments.
P.O. Box 3006
Rockville, MD 20847
Phone: 800.370.2943
Fax: 301.984.1473
Web site: www.nichd.nih.gov/autism
PATRICIA R. SCHISSEL

NATIONAL ORGANIZATION FOR RARE DISORDERS

The National Organization for Rare Disorders (NORD) is a consortium of health organiza-
tions (not a government agency) responsible for education, promotion of research, and informa-
tion regarding rare diseases. NORD is dedicated to the identification, treatment, and cure of
those rare disorders.
The definition of a rare disorder is one that affects fewer than 200,000 individuals in the
Unites States (e.g., Huntington’s disease, neurofibromatosis, and cri du chat syndrome).
55 Kenosia Avenue
P.O. Box 1968
Danbury, CT 06813-1968
Phone: 203.744.0100
Fax: 203.798.2291
Web site: www.rarediseases.org
LYNN DUDEK

OFFICE OF SPECIAL EDUCATION AND REHABILITATION SERVICES

The Office of Special Education and Rehabilitation Services (OSERS) is the agency of the
U.S. federal government responsible for the administration of the No Child Left Behind Act
(NCLB) and supports local districts in the outcomes for children with disabilities. OSERS

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provides support in three main areas: special education, vocational rehabilitation, and
research. The OSERS Web site contains links to resources, research, and other government
programs.
U.S. Department of Education
400 Maryland Avenue, SW
Washington, DC 20202
Phone: 800.872.5327
Fax: 202.401.0689
Web site: www.ed.gov/about/offices/list/osers/index.html
TERRI COOPER SWANSON

OFFICE OF SPECIAL EDUCATION PROGRAMS

The Office of Special Education Programs (OSEP) is the agency of the U.S. federal govern-
ment responsible for the administration of the Individuals with Disabilities Act (IDEA) and
supports local districts in the improvement of results for children with disabilities. The OSEP
Web site contains links to state organizations as well.
U.S. Department of Education
400 Maryland Avenue, SW
Washington, DC 20202
Phone: 800.USA.LEARN
Fax: 202.401.0689
Web site: www.ed.gov/about/offices/list/osers/osep/index.html?src=mr
MEGAN MOORE DUNCAN

ORGANIZATION FOR AUTISM RESEARCH

Organization for Autism Research (OAR) is a parent-led organization that focuses on applied
research. OAR’s mission is to apply research to the challenges of autism spectrum disorders by
funding applied pilot studies, commissioning directed studies, and communicating autism
research in a family and community friendly manner.
2111 Wilson Boulevard, Suite 600
Arlington, VA 22201
Phone: 703.351.5031
Web site: www.researchautism.org
KATHERINE E. COOK

PACER CENTER, INC.

PACER Center, Inc. provides support and resources for individuals with disabilities and their
families. PACER is based on the model of parents helping parents and is able to provide one-
on-one help, a newsletter, a catalog of publications, and PACER programs that address specific
needs and resources disabilities.
8161 Normandale Boulevard
Minneapolis, MN 55437
Phone: 952.838.9000
Fax: 952.838.0199
Web site: www.pacer.org
KATHERINE E. COOK
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 APPENDIX C

STUDIES TO ADVANCE AUTISM RESEARCH AND

TREATMENT NETWORK
Congress passed the Children’s Health Act of 2000, legislation that mandated many activ-
ities, among them the establishment of a new autism research network. In response, the five
Institutes of the National Institute of Health Autism Coordinating Committee (NIMH,
NICHD, NINDS, NIDCD, & NIEHS) have implemented the Studies to Advance Autism
Research and Treatment (STAART) network program.
The STAART Network includes eight centers located at Boston University, Kennedy Krieger
Institute (Baltimore), Mt. Sinai Medical School (New York City), University of California at Los
Angeles, University of North Carolina at Chapel Hill, University of Rochester, University of
Washington, and Yale University. Research currently being conducted at the eight sites includes
early characteristics of autism, diet, and behavior in young children with autism, citalopram for
children with autism and repetitive behavior, and relationship training for children with autism
and their peers.
National Institute of Mental Health (NIMH)
Office of Communications
6001 Executive Boulevard, Room 8184, MSC 9663
Bethesda, MD 20892-9663
Phone: 866.615.6464
Web site: www.autismresearchnetwork.org/AN
KATHERINE E. COOK AND PATRICIA R. SCHISSEL

TASH
TASH (formerly The Association for Persons with Severe Handicaps) is an international
association of people with disabilities, family members, advocates, and professionals who believe
in the inclusion of individuals with disabilities. TASH provides numerous printed and online
materials and resources that are timely and accurate, including a monthly newsletter and an an-
nual conference.
29 W. Susquehanna Avenue, Suite 210
Baltimore, MD 21204
Phone: 410.828.8274
Fax: 410.828.6706
Web site: www.tash.org
KATHERINE E. COOK

UNITED STATES DEPARTMENT OF EDUCATION

The U.S. Department of Education was created in 1980 with a mission of creating access to
education for all individuals and to promote excellence in education. The U.S. Department of
Education Web site provides links to related government and state agencies.
U.S. Department of Education
400 Maryland Avenue, SW
Washington, DC 20202
Phone: 800.872.5327
Fax: 800.437.0833
Web site: www.ed.gov
TERRI COOPER SWANSON
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APPENDIX C

UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES,

NATIONAL INSTITUTE OF HEALTH
Founded in 1887, the National Institutes of Health is one of the world’s foremost medical
research centers, and the federal focal point for medical research in the United States. The
NIH, comprising 27 separate institutes and centers, is one of eight health agencies of the Public
Health Service, which, in turn, is part of the U.S. Department of Health and Human Services.
9000 Rockville Pike
Bethesda, MD 20892
Phone: 866.615.6464
Web site: www.nih.gov
PATRICIA R. SCHISSEL

UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES,

NATIONAL INSTITUTE OF MENTAL HEALTH
The NIMH was founded in 1949 and is dedicated to understanding, treating, and preventing
mental illnesses through basic research on the brain and behavior, and through clinical, epide-
miological, and services research.
6001 Executive Boulevard, Room 8184, MSC 9663
Bethesda, MD 20892-9663
Phone: 866.615.6464
Web site: www.nimh.nih.gov
PATRICIA R. SCHISSEL

UNITED STATES FOOD AND DRUG ADMINISTRATION

This agency is under the auspices of the Department of Health and Human Services and in-
formation on a myriad of products, consumer’s rights, and policies can be accessed on their site.
5600 Fishers Lane
Rockville, MD 20857-0001
Phone: 888.463.6332
Web site: www.fda.gov
PATRICIA R. SCHISSEL

WRIGHTSLAW
Wrightslaw is an excellent online resource for finding information related to special educa-
tion law, education law, and advocacy for children with disabilities. This Web site is designed
for parents, educators, advocates, and attorneys and provides access to articles, cases, and other
free resources on topics related to the Individuals with Disabilities Education Act, special edu-
cation, law, advocacy, and training and seminars.
Web site: www.wrightslaw.com
TERRI COOPER SWANSON

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 APPENDIX D: Personal Perspectives

The Cement Mixer (Father)
Finding Friendship and Support (Mother)
Individual Education Plan Ideas (Mother)
Interview with Cameron Blackwell
(Adolescent)
Interview with Craig and Jaime Blackwell
(Siblings)
Interview with Jen Blackwell (Mother)
Life, Newly Realized, on the Spectrum (Adult)
Perceptions of an Older Sibling
Reflections on Teaching Children on the
Autism Spectrum (Teacher)
Succeeding in College (Adult)
Which Is It? Distinguishing Typical Develop-
ment from Disability-Driven Behaviors
(Mother)

THE CEMENT MIXER (FATHER)

As a dad, when your child is diagnosed with autism, you go through many different thoughts
and emotions. Most are heavy and deep, much like cement in a mixer. One by one they come
to the surface as your mind evaluates what is ahead for you, your child, and your family. Slowly
the cement hardens into resolve as you chart your course of action.
In our family, it was no different. My wife and I have four kids, with our oldest dealing with
Asperger syndrome and our youngest son diagnosed with autism almost 7 years ago at the age of
18 months. We have a boy and a girl in-between who are not on the spectrum.
By the time our youngest was several months old, we could see that he was not hitting the
same developmental milestones that our others had. My wife started quickly in getting thera-
pists (physical, occupational, and speech) in to evaluate and help out. The therapists were very
careful NOT to diagnose, but they were AMAZING at helping Jordan develop where he had
not been able to before.
By the time Jordan was 18 months old, I was looking forward to getting a complete diagnosis
as a means to get him the help he needed and to ‘‘put a name’’ on what was ‘‘holding him
back.’’ I kept asking my wife, ‘‘Why can’t we just put a name to this?’’ I thought it was going to
be easy and that the neurologist was going to smile and say, ‘‘Folks, your son has autism (or
PDD or Asperger syndrome).’’ And that would be that. The cement mixer was already churning
and I just wanted solid answers.
Enter the neurologist. After examining Jordan and talking with us, he told us that he thought
Jordan had autism. He looked at me and said, ‘‘That’s what you wanted, right, a diagnosis?’’ He
then proceeded to let us know what the probabilities were for everything that could go wrong
(or right) for Jordan over the course of his life. ‘‘He has such and such percent chance of not
talking . . . or being mentally retarded . . . or not being able to live independently . . . or . . .’’ It
all kind of droned together and I ceased listening and became numb. The cement mixer
churned a little faster that day as I found myself coming to grips with the new reality of things.
Knowing that your son is not meeting some developmental milestones and hearing that he
might not talk or ever be independent were far apart in my mind and they came crashing
APPENDIX D

together with surprising force that day. As the cement mixer inside of me churned, there were
several repeating thoughts that floated to the top.
I was concerned for the life plans that my wife and I had made. We married and started a
family quickly with the thought that we would have a few more ‘‘golden years’’ where we could
enjoy grandkids and do missionary work in Korea (where we met). This was immediately fol-
lowed by guilt for being so selfish as to think about ‘‘us,’’ but I couldn’t help it. This was alter-
ing our life plan and the trepidation that I felt about it was real.
The feelings churned some more . . .
Both Jen and I grew up with a strong sense of faith in our lives. Part of that was accepting
that God had a plan for each of us and that we were all given obstacles as part of our life’s jour-
ney. My mind was at peace when I thought of my own experience. My brother and I were born
10 weeks premature and the doctors had told my parents similar things to what I had heard. I
turned out just fine after overcoming a few obstacles, so why not Jordan?
Our faith as a couple led us to look less for a cure and more towards being in the ‘‘obstacle
removal business.’’ We discussed it on the way home from the neurologist. We decided that we
were going to help Jordan fulfill what God had in store for him and we were going to subordi-
nate our desires for what we wanted him to be. This was a very ‘‘freeing’’ experience for me.
‘‘Maybe God has enough basketball players on the earth and maybe he needs another scien-
tist . . .’’ I told myself little affirmations like this to keep things on track and keep my confi-
dence level up.
More churning . . .
How do I help? My thoughts turned to all of those ‘‘Super-Dads’’ out there. The ones who
leap tall buildings in a single bound, cure their kids of whatever ails them, raise awareness, start
a foundation, and name the wing of the local hospital after their son. I certainly did not fit that
mold although I am certainly glad that some people do. Being an activist wasn’t the right way
for me personally. Some days I wished I was one of them, but I just wasn’t.
My wife was naturally suited to be a great advocate for Jordan. She has a degree in teaching
and was known and well liked in our school district. She had a knack for finding the right peo-
ple, knowing when it was a good fit with our son and establishing rapport with them to get the
needed help. I am not the type to patiently work with people in an Individualized Education
Plan meeting or take the time to go to the myriad of conferences and support groups available.
If my role was not the activist or the advocate, then was it OK to be ‘‘just’’ a supportive dad?
Would I be helping enough with that? Maybe I could be the source of ‘‘normal’’ in our family.
Maybe the right role for me to play was just to be dad . . .
All kids like to have fun, to play games, and to be inside their comfort zone at times. Autism
doesn’t change that. It just makes them have different (and sometimes smaller) comfort zones.
We needed money to pay therapists to work with Jordan. My middle kids needed to feel that
they were not being overlooked. I decided that my role was to supply that comfort zone to each
of our kids on their level, to help facilitate therapists and to provide general support where
needed.
More churning . . .
What is it going to be like for Jordan? Since I didn’t view Jordan’s autism as something that
needed to be cured, but rather an obstacle that he needed help with, what did he need? How
could I give him enough confidence?
Jen and I took a lot of time to research on the Internet many possible therapies and strat-
egies for dealing with autism. That seemed to be the only way for me to calm my fears. And
yes, they were fears.
How am I going to deal with this with extended family? Everyone seemed to have their own
opinion about autism and what we should do. Having a diagnosis only seemed to fuel the

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firestorm of opinions being thrown our way and the opinions were very seldom based on facts.
Almost always, they came from hearsay or projected fear. More often than not, everyone
REALLY wanted to help, but was unsure HOW.
Why does he have autism? Genetically whose ‘‘fault’’ is it? The questions and opinions were
unending.
From my point of view as a dad, I wanted to scream at ALL of them. I just wanted to fix
things . . . That’s what guys are supposed to do, right?
What came out of all the churning was a feeling of resolve. It was a unity between my wife
and me as to how to proceed. We decided that we were going to enlist the help of the best peo-
ple we could find to help Jordan and that we were going to pray for guidance as to who these
people were.
I was not going to be an activist for Jordan, but rather I’d be a father and husband who was
supportive of Jordan and helpful to Jen in being his advocate. I was going to be the ‘‘Director
of Normalcy’’ for our home and try to keep it a safe comfort zone for everyone. I am above all
else, a dad.
ERIC BLACKWELL

FINDING FRIENDSHIP AND SUPPORT (MOTHER)

It seems strange to say my first reaction was relief, but quite honestly it was. The doctor’s
question was, ‘‘Have you ever heard of Asperger syndrome?’’ At that moment all of our worry-
ing, wondering, and questions were, temporarily at least, answered. Our son had a disorder with
a name, and if there was a name, then there must be answers too as to what to do to help him.
More questions came later, and eventually the grief hit too, followed by many more struggles.
But for a single moment, we had peace. It wasn’t our fault; there was something ‘‘wrong’’ with
our child.
Looking back with knowledgeable eyes, we can see so clearly the answers to the questions
we’d asked for years. Why does our baby scream and pull at the feet of his footed pajamas des-
perate to take them off? Why does our preschooler insist on lining up all of his toys in rows,
but never play with them? Why doesn’t he respond when we speak to him? Why won’t he eat
anything but three or four foods? Why does he have meltdowns and tantrums seemingly out of
the blue? The answer was in all accounts, Asperger syndrome.
And so our journey began. There were other revelations, some very painful. I visited the Web
site the doctor suggested only to be shocked to learn Asperger syndrome also meant, gasp, autism.
The first day I was in shock, especially after reading the word, autism. I called my close
friend, Sue, who said, ‘‘That’s what Amy’s son has just been diagnosed with.’’ I knew Amy, she
attended our church, and we often gave each other sympathetic looks as we passed each other
in the hall. She was usually chasing her busy running child, while I was soothing my crying
one. I called Amy hesitantly. I said, ‘‘My son has Asperger syndrome.’’ Her son was diagnosed
four months previously, and she was light years ahead of me. She began reeling off information,
resources, and people to call. I knew so little (nothing at all in fact) that I couldn’t respond to
her, much less even have the least bit of an idea what to ask. Later she recounted, ‘‘I still
remember how shocked you were.’’ For 10 days I did nothing. I had taken the assessment test
online for my son; I knew he had Asperger syndrome, and that’s all I needed to do as far as I
was concerned. Amy called to check on me. Dragging myself out of the thick volume of Chi-
nese history I’d buried myself in, the fifth I’d read that week, I picked up the phone annoyed to
be interrupted. I can’t remember what Amy said, but I didn’t want to talk with her. She wanted
me to take some kind of action, I just wanted to read. Not think. Not cry. Not take action.
Read about Chinese history. In other words, bask in denial.

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At last the day came for our follow-up visit with the doctor. He said, ‘‘Did you take the
test? Do you think it’s a match?’’ I tried to show it to him, he waved it off, not necessary for
him to see it. Suddenly I felt panic. Hopefully, plaintively I inquired, ‘‘What do we do now?’’ I
still remember his face. He hesitated. He had no idea. I walked out, with sudden resolve. I
would find out what to do. I would call Amy.
It was a torturous wait until a decent hour of the morning to call her. I’d been up most of
the night checking the clock impatiently. I’d written out the various interventions listed online:
diet, therapies, books to read, Web sites to go to. I was ready. The moment the clock hit 8:00
a.m. I picked up the phone. Amy had a list of her own, doctors’ and therapists’ names, therapy
centers, and a list of phone numbers. While my previous coping mechanism had been with-
drawal, hers had been not to leave her bedroom in the weeks following her son’s diagnosis, and
she had ferreted out quite a list of resources and interventions. Excitedly, I began dialing. Five
hours of calling later, I laid my head down on the dining room table and cried for the first time.
I sobbed inconsolably. Our insurance didn’t cover any of these places, there were none in our
area that they covered, no one could refer me elsewhere, and no one had any other solutions. I
felt so completely helpless and hopeless. I did not know what to do. So I called Amy, and she
walked me through it.
Amy had a pile of ideas, but what she had most was a clear understanding of how I felt, and
she offered me support. That was the beginning of one of the closest relationships I have ever
had (along with Sue, who made up the triad of ‘‘girls’’). It was only the beginning. Amy and I
had something in common besides the fact that our boys both had Asperger syndrome. Once
we’d decided our course of action, we were both powerhouses. We each had our strengths to
bring to the table. Although she read quite a number of books, I was the quick reader. The first
time I realized I could go to a Web site, click on a book, give my credit card number and a
package would show up at my doorstep two days later, I had found my niche. While I devoured
every single Asperger syndrome book in print at the time (not exaggerating), Amy utilized her
own gift. She was the conference-goer. She was the networking queen, soaking up information
like a sponge and then carrying it back like an ant with breadcrumbs for me who waited salivat-
ing. She knew every presenter, every significant person in the autism community, testified for
the state legislator, started a support group, and trained to be an advocate. I stayed home and
read. Our boys became friends, too. I’ll never forget the day we ‘‘introduced them.’’ They’d been
in Sunday school together for nearly 7 years, but as Amy said to Dylan, ‘‘This is Tom,’’ they
beamed, put out their hands and said, ‘‘Nice to meet you!’’ I’m sure the joy on Amy’s face at
that moment only matched mine.
We spoke daily; the only break in the routine was when she went to a conference, in which
case she’d call me on the way there and on the way home. We had good days and bad days. I
remember one day I heard my call waiting, I clicked over and it was Amy sounding as though
she’d been crying, ‘‘I’ll call you right back!’’ I hurriedly told her, I was on hold with the insur-
ance company. I called her back in awhile crying, too. Our children’s evaluations had both
simultaneously been rejected for payment by the insurance company. We both wailed, ‘‘It’s not
fair!’’ Together we problem solved and devised strategies. Sometimes the strategies involved
multiple phone calls, letters, and even complaints to the state insurance commissioner. Other
times the strategies failed miserably and then we’d get on the phone to lament. We’d occasion-
ally get impatient with each other, ‘‘Well, just submit it AGAIN!’’ That is true friendship,
when you can say, ‘‘Shut up and just do it. I know you don’t feel like doing it AGAIN, but you
have to!’’
Amy’s second son was diagnosed, then my second. ‘‘We’ve got to stop hanging out’’ she said
giggling, ‘‘it must be contagious!’’ We laughed hard and often, and quite inappropriately. We
vented, we commiserated, we cried. Our friendship evolved to the point where we knew each

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other so well that we knew exactly what each other was going to say at almost any given
moment, but our friendship was so close that we still let the other continue anyway.
Daily calling has waxed and waned as our lives changed, as my third child was diagnosed,
she made the difficult decision as to whether she should have another baby and then welcomed
a beautiful girl into their family. Our roles have shifted in the last couple of years. The home-
body and the social butterfly have exchanged roles for various reasons. Amy stays home, while I
trek around to conferences, both of us content with where we are. We laugh about this too.
‘‘Been there, done that!’’ We say to each other. If something significant happens, good or bad,
it is still Amy I want to call. Recently she told me one of her favorite memories was of me call-
ing her from the ladies room at the ASA conference a couple of years ago whispering furiously,
‘‘Aim! Brenda Myles just asked me to write a book!’’ She laughed, she had loaned me my first
book by Dr. Myles, not to mention the fact that she’d been nagging me herself for years to
write. ‘‘See! I told you so!’’ she said smugly. Time has passed, but never the love we have for
each other; the years of friendship we have built are enduring. Whenever I start to get senti-
mental and coo sappily how thankful I am for our friendship, and say, ‘‘What would I have ever
done without you?!’’ Aim will retort, ‘‘Oh shut up! You would have figured it out!’’ Maybe,
maybe not, but I’m glad I’ll never know.
KRISTI SAKAI

INDIVIDUAL EDUCATION PLAN IDEAS (MOTHER)

Many parents nervously face the ever dreaded eligibility and IEP meetings. If this is you, then
you know why emotions run high. Nothing like just being a lowly parent surrounded by
‘‘experts’’ and teachers (which cause you to have elementary school flashbacks of being sent to
the principal’s office) followed by being told everything that is ‘‘wrong’’ with your child as you
cringe painfully. While staff may have the best of intentions, they are often perplexed by the
intensity of emotions we carry into these meetings. But no wonder! This is YOUR child they
are talking about. This is his future, his life, your family. A seemingly small comment about
your child eating lunch alone doesn’t just mean, ‘‘My son is lonely.’’ Our minds immediately
jump to, ‘‘My son might never have friends, never date or get married, he is going to be alone
forever. What is going to happen to him after I’m gone?’’ This is not an irrational thought. Liv-
ing as lonely adults is the reality for many people who have autism spectrum disorder (ASD),
and as parents we’re well aware of this fact. We have a long-term, vested interest in our child,
and we are poised and ready to fight to our last breath on his behalf. And, boy howdy, staff bet-
ter know it, too! No wonder we so easily garner a reputation as a ‘‘difficult parent.’’ While I
generally like to think I’m a reasonable person, I’ve done what my friend referred to as having
‘‘left a trail of bodies’’ behind me when it’s merited. Do I enjoy conflict? No. Is it sometimes
necessary? Yes. But is it ALWAYS necessary? Absolutely not. So what do we do? If you are pre-
pared, confident in your knowledge and abilities, and feel supported, you are better able to han-
dle conflict or avoid it altogether.
Know your child and the characteristics of ASD and how they apply to him. Is he extremely
reactive to noise? Crowds? Smells? Create a list and take it with you, include the strategies you
have found effective. These can be adapted for school use. For example, if you allow your son
to wear headphones in crowded places, perhaps he can do the same on the noisy bus. Providing
staff with concrete solutions shows them you know your child and they are more likely to
respectfully consider your input.
Provide documentation. Had a private evaluation done that backs up what you’re saying
about your child’s strengths and areas that need attention? Take it with you. Don’t assume, as I
have mistakenly done at times, that something is SO OBVIOUS about your child that there is

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no question he is eligible for services. The written work with the signature of a qualified profes-
sional speaks more effectively than we ever can. In the case of eligibility this is especially cru-
cial. Concrete evidence snuffs out many a conflict before it even sparks.
Prepare goals. Have a list of long-term goals you have for your child and the short-term steps
necessary to achieve them. For example, if your child is currently unable to be in the general
ed classroom, but your long-term goal is that he will be able to, a short-term goal might be that
he be able to participate in occasional classroom activities. The meeting is a wonderful way to
elicit ideas and brainstorm with staff about their own ideas to meet those goals. Be open to
their suggestions, you might be surprised at how once they understand the plan how willing
they are to try new accommodations.
Trust that you do know your child. Staff may be seeing a different child, that is, he may be
exhibiting different behaviors you don’t see at home. Knowing your child as you do, the fact
that he is having difficulties at school is an important indicator. If he is displaying what you
would consider unusual behavior for him, then obviously he is stressed and needs supports in
place.
Believe the staff when they relate an incident, have empathy for those involved and resist the
urge to immediately jump on them about how poorly they may have handled the situation.
Instead, use this information to look for the hidden triggers that set him off, and a logical
jumping-off point for creating supports. ‘‘My son has NEVER hit anyone at home. I’m shocked.
Let’s talk about what happened BEFORE that, and see if we can figure out what set him off.’’
Remember that not everyone understands the characteristics of ASD and how they impact
behavior. If staff feel you are listening to them they are more likely to consider what you have
to say and implement change.
Support yourself in meetings by bringing an advocate. Having support means we won’t feel
ganged up on and are less likely to be defensive. Plus, everyone has different skill sets; perhaps
yours isn’t to remain cool under pressure (And who can when it comes to our kids? Certainly
not me!). An advocate can balance you out with complementary skills, reframe a question, and
bring up points you may not have considered. He or she can also be the quiet type who takes
notes, or simply kicks you under the table if you start to get side-tracked. Great choice: someone
who knows your child and how to help him. These can include such folks as his private occupa-
tional or speech therapist or counselor. Better choice: someone who knows both your child and
your family well. Try bringing someone who is in a related field who also happens to be a close
friend, and barring that, a friend of the family who can lend moral support. Always refer to this
person as ‘‘my advocate.’’ Also good: a professional who doesn’t know your child but who under-
stands the needs of kids on the spectrum. Last choice is a professional who doesn’t know much,
but who has a string of important letters after his name who is there to back you. But make sure
you’re on the same page ahead of time, you don’t want to be blindsided by your own advocate.
Emotional? Yes, I’d rather not burst into tears during a meeting, but it’s painful to be
reminded in black-and-white documents what difficulties my child struggles with and on occa-
sion it can be all too much. Sometimes there are tears, and embarrassing as I find that to be, I
give myself that allowance because I’M THE MOM. This is my child and I’m doing my very
best, but it’s not enough. I need the school’s support to help him grow into a productive adult.
At times anger is what comes out instead of tears, but it all stems from the same place: our fears
for our child, our frustrations that we aren’t getting the help that we so desperately need. But
instead of simply expressing our emotion without explanation or resorting to personal attacks (a
big no-no), be clear and go back to the original issues at hand: focusing on the child’s specific
needs and how to meet them. And remember, if emotions are running high, it’s all right to
excuse yourself to calm down, or even to reschedule. If there is ONE staff member who is con-
sistently disruptive, remember that the other team members may not be happy about the

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conflict either. Depending on who it is, you may be able to have that person removed from the
invite list for the next meeting.
Pick you battles. It’s a rare pigs flying kind of meeting for you to get everything you are ask-
ing for, but if it happens, thank your lucky stars. In most cases, however, you’re going to have
to decide what you’re not willing to compromise on. Your child is best served by saving your
fights for the significant issues; for example, I’d fight tooth and nail for appropriate placement.
But bide your time on smaller issues that can be resolved over time if you build a close working
relationship with the staff.
You are The Parent and simply human. But it’s important to remember that although the
staff is made up of professionals, underneath their credentials they are simply human beings,
too, with their own fears, concerns, shortcomings, and desires. It takes a great deal of work and
patience to build an effective IEP team, to get along, to balance give and take, but all relation-
ships take effort, and most are well worth it. And when it comes to your child, no amount of
effort is wasted.
KRISTI SAKAI

INTERVIEW WITH CAMERON BLACKWELL (ADOLESCENT)

Background. Cameron is a freshman in high school, working towards an honors diploma. He
was diagnosed with Asperger syndrome while in second grade. He has been very involved in his
school and church, as well as attending autism-related conferences. His special passion is band.
He marched with the high school band as an eighth grader and hopes someday to be a band
director himself.
Q: What does it feel like to have Asperger syndrome?
Cameron: That’s an interesting question. You know you’re different from other people. You
have different needs and other people are different from you. You realize that we’re all individu-
als, that we’re all different. Not everyone knows that I have Asperger’s.
Q: Why don’t they know?
Cameron: Several reasons: I’m very independent. I do a lot of things for myself. Some people I
have told just because they’re really close to me. It’s just a sad fact about myself, something I
need help with.
Q: Do you feel like other people see the world differently than you do?
Cameron: Yeah, I do. What I view about Asperger’s and autism, I view it as a different perspec-
tive, a different way of thinking. I view it as a different perspective. People with Asperger’s and
autism, they are smart, we are just different from other people.
Q: Describe your sensory world: what in the environment bothers you, for example, particular
lights, sounds, touch, tastes, movements?
Cameron: Yeah, I have gotten better. When I was eight, I was diagnosed with Asperger’s syn-
drome and I had a lot of sound sensitivities, but not light sensitivities, not other senses. Mainly
sound. Now I am in band. I used to have sound therapy where I listened to classical music. Lis-
tening therapy was used about a year or two. Sound is better. In middle school I joined in the
band, and learned to play a brass instrument. I’m a French horn player right now. I’ve become
less sensitive to loud sensitivity. I’m trying to become more tolerant of the flute, but that’s not
sound sensitivity. (Q: Any movement or balance problems?) I used to. I went to a gym and
worked on balance beams. I learned a lot. I’m also in marching band. It takes a lot of stamina
and balance to do that. I’m really progressing and I’m doing well and my balance is better
because of that.

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Q: What in the environment do you especially like?

Cameron: I like—I honestly don’t know. I’m usually not aware of stuff like that.
Q: Do you have behavioral difficulties sometimes?
Cameron: No, I never do anything like that. I’ve never been in any disciplinary problems. I’ve
always tried to follow the rules.
Q: How do you deal with your feelings or emotions?
Cameron: The way I deal with them is every day I try to jog for about an hour or so, so I’m
away from everyone. I use that time to jog and think. That’s the way I deal with my emotions.
Q: What do you want your teachers to know about you?
Cameron: I want them to know that I’m hard working, that I do my best no matter what, that I
do have trouble with organization and handwriting. I have some difficulties, but that is just a part
of me. I will work hard and do my best to have a good year.
Q: What do you want your peers to know about you?
Cameron: I want them to know that I’m good person, that I try hard, I like them a lot, I want
to be around them, that I do have difficulties in my life, that I’ve overcome a lot. I have situa-
tions that I have to deal with, that I’m claustrophobic, but they are understanding of that.
Q: Describe your school experience. What do you do well?
Cameron: Academically, I do really well. I’m an A/B student. I take all honors courses and I do
band for extracurricular activity, and I have a lot of friends from band and in my classes.
Q: What do you need help with?
Cameron: Organization and handwriting. I need people to be understanding. I get a little sensi-
tive to sound. That happens very rarely. (Q: Do you have someone to help with organization?)
I have an OT who I see every two or three weeks. My teachers understand when I am
disorganized—they call a meeting if they see I’m carrying around a mess.
Q: What do you need to do to advocate for yourself?
Cameron: I’m learning to do more of it. I do not like it but I’m learning to like it. I have to go
to more meetings now. I went to my IEP meeting last year. (Q: What was IEP meeting like?) It
was OK. My mom always brings treats so I just ate. It was OK. We talked about what I needed
to do last year. I was transitioning to high school so there was lot of talk about that.
Q: What type of recreational or community activities do you participate in?
Cameron: I used to be in Boy Scouts, not anymore. I go to a couple of meetings cause they’re
at church. I do participate in church activities, service activities, academic activities, band. My
life is pretty busy with that. Not a whole lot else I can do.
Q: What do you want to do after you graduate from high school?
Cameron: First of all I may join a professional drum corps after high school. I may join one of
those for a year. In my church I am expected to serve a mission for two years somewhere else
in the world, so I’ll do that then I’ll go to college, hopefully on a band and some academic
scholarships. I want to major in music and music education and be a band director after
college.
Q: Any thoughts on dating?
Cameron: (laughs) Yeah. I’m gonna—I have to wait ’til I’m sixteen to date. I’ll probably date
people within my religion most of the time. I’ll probably marry a girl after my mission.
Q: Any other thoughts?
Cameron: People with Asperger’s and autism have potential but that can only be reached if the
people around them realize it, then they will act on it to realize their potential. A lot of people

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don’t realize the potential. We do have obstacles in our life; we just need help getting over
them.
ANN PILEWSKIE

INTERVIEW WITH CRAIG AND JAIME BLACKWELL (SIBLINGS)

Background. Craig is 12 years old and in his first year of middle school. He loves cooking,
fishing, golf, and anything to do with dragons. He is in beginning band and enjoys attending
his brother’s marching band competitions. Craig has his own cooking Web site for kids. Jamie,
10 years old, is the lone sister among all the brothers. She is in her last year of elementary
school and enjoying being ‘‘top dog’’ for the year. She loves to sing and not only has she sung
with groups at church, she has performed songs in sign language for both school and church.
She loves to spend time with her friends and family. Craig and Jamie are siblings to Jordan and
Cameron. Both of whom have autism spectrum disorders.
Q: What do you most like about Cameron?
Craig: I really look up to him. It kind of started not that long ago. He’s been in there [band]
much longer than I have so I do a lot of learning from him. He helps me learn my instrument
a little better.
Jamie: That I get to see him in band. It’s fun just watching him out there.
Q: Is there anything you dislike about him?
Craig: One or two times he’ll try to get mad or upset. He likes his personal space. He likes to
be alone a lot.
Jamie: Since he’s older, since he has Asperger’s, when you’re around him he gets mad if you
whistle too much or something like that.
Q: What about Jordan?
Craig: It’s nice to be around Jordan because he’s very good at memorizing things. It’s cool to
have someone who can play video games at your level. He sometime doesn’t listen very well.
Sometimes he doesn’t pay a lot of attention.
Jamie: That he stands up for what he wants and stuff. When he speaks his mind freely most of
the time he doesn’t know what he’s saying.
Q: Do you ever feel left out, or that your parents spend too much time dealing with your broth-
er’s problems?
Craig: No not really. It’s not as bad as other families have it. Sometimes yeah, I do, not very
often, but sometimes.
Jamie: Yeah, sometimes when my mom has to deal with Jordan. She’s talking to him and she
doesn’t know other things that he’s doing, and I notice him and she doesn’t really want to deal
with them [the other things] right then.
ANN PILEWSKIE

INTERVIEW WITH JEN BLACKWELL (MOTHER)

Background. Jen grew up in the Northeast until her family settled in southern Indiana where
she attended high school and college. She earned her degree in secondary education from Indiana
University Southeast and later taught boys with severe emotional disabilities in a group home.
Jen met her husband, Eric, while serving as a missionary in Seoul, Korea and they were married
in 1989. Currently, Jen works in an inclusive preschool run by the local school district. Favorite
pastimes include photography, sports, coaching her kids’ teams, and hanging out with her family.

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Q: What was it about Cameron that made you seek professional assistance and diagnosis?
Jen: Way back when he was little we knew there was something. We had no idea what it was.
We knew he had to have ideas given to him a certain way. If he didn’t have things a certain
way he didn’t get it. He had language delays at age 3. He started with a speech pathologist in
the school district who was awesome! She quickly figured out he had more than articulation
problems. He had pragmatic problems. She was very good. About 5 years later she sent me an
article in USA Today about Asperger syndrome. She had worked with Cameron from ages 3 to 5.
We found that he was 70 percent unintelligible at age 3. We went to [local] Children’s Hospital
in Fresno and they sent us to the speech therapist. He [Cameron] went for speech and hearing in
1994. The school district gave the diagnosis. Indiana, at that time did not qualify Asperger’s, only
autism. But, the special education director knew Cameron had Asperger’s so she wrote an IEP for
him before the school year was ended.
Q: What went through your head when you received the diagnosis of Asperger’s for Cameron?
Jen: Huge relief. We were also in the process of getting a diagnosis of autism for our other son,
Jordan. We knew with a label that we could get help then.
Q: Talk about Cameron’s school experience. How did/does the IEP process work for you?
Jen: The first few IEPs I made sure I had somebody with me. Other therapists for our son Jordan
came with me to our IEP meetings for Cameron—probably the first 2 or 3 years. I talk to his
coordinator a lot. We’re on a first name basis. We don’t want to sit there for 3 or 4 hours. I
catch teachers in the hall or other places and discuss and have conversations with them, then
bring it all (conversations) to the same place [IEP meeting]. I would make sure I had my lists
going ahead of time. I always bring cookies and make compliments to people how they have
helped. I give very specific and complimentary details to school personnel and also send them
in a letter to the superintendent. After the compliments I can say, ‘‘But now we have this going
on with him and how do we help now?’’ For example, the principal would ask, ‘‘He has all A’s
and B’s, why do we need to serve him?’’ If he has sensory needs why would you take those sup-
ports away?
Q: Have schools been receptive to working with Cameron’s (and others’) unique needs?
Jen: For the most part we’ve had a pretty good reception. We’d ask for only one thing every
year: ‘‘Can we please know who would be his teacher before school started?’’ The answer was
always, ‘‘No.’’ Even the special education department wanted him [Cameron] to know. The OT
took him in before school started one year to meet the teacher. Middle school was a little
harder to pull out of classes for services. Band really met his sensory needs. We used Samonas
Therapeutic Listening for a couple of years at home. Saw a huge difference in him. We’re not
interested in intrusive interventions.
Q: What supports were already in place and what did you have to ‘‘teach’’ the schools? How do
you have to advocate for Cameron?
Jen: School has been receptive but the school knows we have a lot of knowledge. We sit with
school people and exchange knowledge. We go to conferences and trainings together. We eat
and laugh together, and even though sometimes things are horrible, we get along. It’s about
teamwork. Getting in a contest with them once doesn’t promote teamwork. So far so good. I
had an OT who also had a son with Asperger’s syndrome so she was able to help the school
regarding sensory issues and teaching the assistants, teachers, and principal. They did get it at
the end.
Q: Describe your proudest or happiest moments with Cameron.
Jen: Easy one—there’s two: The little boy who was absolutely miserable at school in second
grade, he had no friends, isolated himself from other kids, paced the playground at recess, in

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fifth grade was selected by his peers as the ‘‘Road Runner,’’ the name for their school mascot.
The ‘‘Road Runner’’ is an award given to the best all-around good friend to everyone, a good
person and good friend, the best representative of the school and class. His class gave the award
to him. The second one is marching with the high school band. He was invited as an eighth
grader. He had to march to this complex huge drill. This year’s show could take them to state
finals at the RCA Dome. Everyone who knows him knows how incredible this is! I can’t watch
him without being in tears. He was voted band member of the year last year.
Q: How do you meet the needs of all members of your family?
Jen: Craig [12-year-old son] is gifted, and Jamie [ten-year-old daughter], she is neurotypical. Like
anybody with four kids you take them individually, one at a time. Eric and I try to spend one-
on-one time with each of them—Eric mostly with the two in the middle and I do the kids on
both ends [of the sibling order]. We try to include everyone with all activities and for all to sup-
port each other. Craig will go to ‘‘sib shop’’ workshop. We try to do special things just for each
of them—try to take their passions. Cameron is in band; Craig is into cooking and wants to be
a chef. Jordan is into golf and Jamie is trying to find herself—she likes to sing and is artistic.
We try to build them up on their own. We try to find balance not over one day, but over time.
Q: Is your family different from the ‘‘idealized’’ American family? Why and how or why not?
Jen: We laugh at what’s ‘‘normal’’ anyway. We are as typical of a family as any other family
with four kids. We go to church. The autism thing is our challenge. We deal with it. Other
families have other challenges. That’s how we look at it.
Q: Describe a special family memory.
Jen: We went to Florida for spring break. My uncle lives down there and likes to play golf. We
drove for 16 hours in a car—it was a blast! Each kid had their own electronic device on the
trip. This was the first time in years we got to spend time with family—just really neat.
Q: Do you have tips or suggestions to share regarding family life raising a child or children with
ASD, for example, going to restaurants, shopping, vacations, or leisure activities?
Jen: Do it! It’s hard. I was on a parent panel recently and I was asked to introduce my family
first. After I talked about my family, the person next to me said, ‘‘We have it really hard.’’
Everybody’s family is hard. We had the expectations that we would just do it. We usually go to
buffets rather than sit down restaurants. Jordan can’t wait that long to be served. They [the
kids] sort of rise to the occasion. You can’t stop your whole life or you’d be miserable. They can
be your life but you have to have a life, too.
Q: How do you take care of yourself?
Jen: You have to do something for yourself. I go to conferences that are uplifting like MAAP. I
enjoy listening to things that are uplifting. I like photography. I will shoot pictures at the games
the kids play at. I sometimes will just close my door. I can go to the grocery store by myself.
Most of all I have good friends.
ANN PILEWSKIE

LIFE, NEWLY REALIZED, ON THE SPECTRUM (ADULT)

Bleeping horns. The sound of someone eating an apple. A ticking clock. Hurried conversa-
tions. All around us, in every day, we are subjected to a barrage of sensory messages that most
of us ignore without even thinking about them. Every day, most of us interact with the world
around us without giving much thought to how we are doing it; it just comes naturally. This is
not, however, the case for the person on the autism spectrum. Asperger syndrome is a form of
autism that was not officially recognized and put into the DSM-V until 1994 (APA). There has

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been a huge lack of public awareness and knowledge of this disorder, although it has gotten
more attention in recent years. As a result of this knowledge gap, many kids, teenagers, and
adults are walking around every day carrying feelings of extreme isolation and difference from
those that surround them but never quite knowing why.
I have been one of these people. I am 21; a college senior at Goucher College in Baltimore.
I have a 3.7 GPA in my college and always did well in school, but all my life I have lived with
the knowledge that something was ‘‘different’’ about me, something I couldn’t quite figure out. I
kept to myself as a kid. I entertained myself and lived in worlds I created for myself. I was
happy enough until about the seventh grade, when an unsettling realization hit me. I realized
for the first time that I had no friends. I had never had any desire for them before, but I wanted
them now.
I observed other people pairing up and doing things together. I noticed them talking and
laughing and walking to class together. I suddenly felt lonely. For the first time in my life, I
wanted friends. But I had no idea how to get them. I had always regarded people as targets to
avoid, inscrutable objects that could be potentially dangerous to me. Now I felt a desire to
relate to them. It seemed, though, that I did not speak the same native language as them. I had
no idea what to do with them.
I was the target of quite a bit of bullying and harassment my eighth grade year. I shrank away
from people much more after this. Still, I wanted friends. In high school I got my first taste of
this. My junior year and senior year, I was befriended by a few girls from my classes. For the first
time in my life, I experienced what it was like to ‘‘hang out’’ with people, to go to their houses
or just have conversations with them. Despite these burgeoning friendships, though, I still felt
troubled. I wanted to know why it was so hard to make friends with my peers. I wanted to know
why I still felt so isolated, like there was a thick wall between me and other people. I had a
pretty good life: I had things I was interested in, people to talk to when I wanted, a family that
loved me, all the things I could really want. But I became more and more desperate to find out
the answers to the question of my differences that had always plagued me.
I wanted to know why I didn’t dress the same as others my age, always placing comfort high
above fashion. I wanted to know why I didn’t have any of the same interests as my peers and
why ‘‘friends’’ seemed to be like the seventh class in my senior year schedule. All very intangi-
ble things, and I was reassured over the years by therapists, guidance counselors, and family that
there was nothing different about me, that I was just like everyone else. That I was maybe a lit-
tle anxious around my peers but that I’d find friends. All I had to do was meet people with sim-
ilar interests. I knew this wasn’t true. I knew that I was different in some essential way, some
way that I had absolutely no words for but that I felt in the deepest recesses of my heart. I knew
it in the way that I felt so cut off from people—the feeling that no matter how many interests I
shared with a person, we somehow had two completely different ways of communicating and
would never be able to connect on the level that I needed. People tried their hardest but
nobody had any answers for me, so I learned to cope. I shut out the outside world as much as
possible and learned to take pleasure in my own world, in things that I found enjoyable.
The schism between the way I experienced and related to the world and the way that all of
my peers experienced and related to the world kept growing and growing, and I felt more and
more torn. I wanted desperately to be a part of the world around me, but found it so difficult,
so cumbersome. It took so much energy. It was so much easier to retreat into my world. Yet, I
knew this would lead nowhere I wanted to go; the isolation was becoming unbearable.
And then, at age 21, I learned of Asperger’s syndrome, and for the first time in my life could
fit my behaviors and way of experiencing the world into an already established pattern. I fit
somewhere. There was a perfectly logical explanation for my difficulties. Now, instead of spend-
ing all my energies trying to shut out a world that did not understand me, I could find a

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segment of the world that did. I could start to forgive myself for all the transgressions I had so
painfully made over the years without knowing why. I could find other people who ‘‘spoke
Aspie.’’
Thinking back over my life up until now, I am amazed by the sheer amount of effort those
with AS must make just to get through each day, by the amount of coping techniques we must
intuitively come up with and practice. We are bombarded every day with so much overwhelm-
ing sensory information. Our clothes are too tight, making eye contact can literally hurt, the
sounds of everyday conversation, of a clock ticking or someone tapping a pencil against the
desk can drive us out of our minds. Certain smells can overwhelm us, the lights are too dim or
too bright, we just don’t feel comfortable in our bodies. It’s very hard for us to actually relax,
because there always seems to be a threat lurking somewhere.
Every interaction we have is like solving a 500-piece puzzle before the time is up. When we
see a person we would like to interact with, first we must decide if we have enough energy to
go through with the interaction. Whereas a large segment of the population gets energy from
interaction with others, for us it can be sometimes dangerously overwhelming and depleting. It
is like a forbidden fruit that we would like to enjoy but must weigh the consequences. Then we
have to figure out, often in just a few seconds, what we’re going to say and how we’re going to
say it and try to double check it before we say it to make sure, to the best of our knowledge,
that it might be something that could flow reasonably into the conversation. We have to call
up old scripts and decide which is most appropriate for the situation. And on top of all that, we
have to make it sound as natural as we can.
If you were a native English speaker with some background in the French language, and you
spent a month in France, you would find yourself trying to translate your thoughts in English to
French before you spoke them. This is very similar to what happens when an AS person must
talk: they have to translate their Aspie way of thinking to a more neurotypical format. This can
be a difficult task if you don’t know the language well; slip-ups are bound to happen. It ends up
being a very time-consuming and exhausting process to continuously go through.
When I was growing up, I constantly felt like I was speaking a different language from every-
one around me. I would have such a hard time conveying what seemed to be the simplest of
things, and felt like I was constantly being misunderstood. What a relief it is later, then, to find
in so much of the literature on Asperger syndrome those same very words: ‘‘People with
Asperger syndrome speak a different kind of language than their peers.’’ This is, of course, due
to the fact that we do not understand nonverbal language. We do not pick up on those small
signals, those nuances in the way you say words that are supposedly meant to carry so much
meaning. We won’t see the reassuring look in your face because we can’t read your face. We
only hear the words. When we talk, we might over-explain something due to the fact that so
much of what people take for granted as being understood, we have no way of knowing is
understood; we are awkward and clumsy because we are trying to put words to emotions and
feelings that most people are able to communicate nonverbally.
We are creatures of habit and have a great need for structure and routine; disruptions in our
routine can wreak havoc on us. There are so many things that can make us feel off balance and
it can be very difficult to recover from this. I think the hardest thing for me as a person with
AS is the feeling of always being on the edge. The feeling that yes, I’m coping now, but at any
minute I could loose my hold and become completely overwhelmed by the world around me.
This is terrifying in so many ways and something I deal with so much every day. I try to struc-
ture my days and my routines in such a way that I feel as calm and stable as possible, and I am
always making sure I am engaged in some activity or another so that I give myself as little
chance as possible to succumb to the terror of the unknown—but it creeps up on you during
every down time that you have, and you fight it as best as you can, promising rosier visions of

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the future, promising that there will come a time when you aren’t so scared. You learn to focus
on the one or two things that made you happy in any given day and fixate on them, hold on to
them for as long as possible, using them as your reason to keep fighting.
There are many little things we do to cope with all of the pressures we feel. I personally carry
lavender lotion around with me everywhere; I find the scent and feel of it calms me down when
I’m approaching an overload quicker than just about anything. The feeling of water against my
skin is also a stimulus that is very calming to me. Recently I’ve figured out that water fountains
tend to have much colder water than some public sinks, so I’ve taken paper towels and put
them under the spray of the water fountain to make them as cold and reviving as possible.
There are so many little things like that that we notice that no one else would, so many things
that we must intuit to do to help ourselves function in this world.
So many people are apt to pass off people with AS or any of a number of other disorders as
somehow less intelligent or someone not worth getting to know. If they’re clumsy socially, they
must be clumsy mentally, right? But the fact of the matter is we have to be quite intelligent to
figure out a way to deal with the foreign world in which we live. At any given moment, we are
planning out everything that will happen the rest of the day so that we are not taken by sur-
prise by anything. We are thinking ahead to try to figure out if a proposed activity will be safe
for us and not contain too much sensory overload; we are figuring out how much downtime we
need to program in to anything we schedule ourselves to do.
I explain all of this just to give the average person an idea of what it is like to live on the
autistic spectrum, and especially an idea of what it is like to live there without knowing about
AS. While it is a struggle, it is not an impossible one. There are benefits that go along with it,
too: the ability to remember large amounts of information related to your interests, which could
be helpful for those who manage to get a job in a field of interest to them; the ability to focus
single-mindedly on a task to get it done; and a great deal of honesty, loyalty, and perseverance.
AS employees are much more likely to stick to the rules and do exactly what you have told
them to. People with AS won’t tell you one thing one day and change their mind the next;
they are unfailingly honest. They’ll tell you what they mean; you won’t have to play guessing
games with them.
It is only by learning about each other’s struggles and challenges and really trying to under-
stand them that we can build a world that is safe for everyone to live in. A world where its
inhabitants don’t have to live in fear of being different, but can instead embrace it—a world
where we can truly grow and improve because we are taking advantage of everyone’s strengths,
not just the strengths of a selective few. That is the kind of world that I want to live in. It’s
the kind of world that we all want to live in.

REFERENCE
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
KATE GOLDFIELD

PERCEPTIONS OF AN OLDER SIBLING

When I was a little girl, my biggest wish was to have a baby brother or sister. Actually I pre-
ferred a sister, but at age 8, after years of begging and praying every night, I would have taken
either.
I remember the big day when my dad came to pick me up from school. Heather had arrived
and I was given the honor of choosing her middle name. At the hospital, I helped dress
Heather in her first outfit. It would be the beginning of many firsts we did together. Heather
took her first steps to me. I taught her how to climb up on the couch much to my mother’s

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chagrin. I was Heather’s teacher and she was my wish come true. Being 8 years apart removed a
lot of the normal sibling drama.
My mother says that she knew Heather was special, soon after she joined our lives. As a
baby, I was very demanding while Heather was content most of the time. She was a very good
baby and rarely cried even after undergoing surgery to correct her eye problems. Although I was
young enough not to remember the steps leading up to Heather’s developmental testing, I
clearly remember the psychiatrist trying to explain to me that Heather had autism. I remember
disagreeing with him in my strongest 10-year-old voice and personally vowing that it would not
be so.
So began Heather’s early interventions, both research based and ‘‘experimental.’’ Heather
started high-risk preschool at the nearby university hospital. At home, I started my own inter-
ventions. We had a thin camouflage blanket that had a slick texture on both sides. Heather
loved to be wrapped up tight like a caterpillar in a cocoon. I consistently got in trouble for
‘‘tying Heather up.’’ Heather loved it. Today we know deep pressure can be very calming for
persons with ASD. My mother thought it was sibling war.
It was Heather that led me to choosing my career in the field of autism. It is my relationship
with her and my experience of growing up in our family that gave me a yearning to reach out
to children with autism and their families. After college, I completed my master’s degree with
an emphasis in autism and behavior disorders. I’ve taught 10 years now in the public school set-
ting. I enjoy the opportunity to work with these amazing children and their families.
Heather is in her twenties now. Navigating the world of vocational rehab has proven diffi-
cult. Although she attends several different day programs, none of these have been individual-
ized to meet her specific needs for gaining independence and caring for her health. Heather
continues to live at home. And yes, she has limitations according to the ‘‘real world’’ but what
does the world know?
During a recent visit with Heather, I realized how many amazing abilities she possesses.
Although Heather often appears to tune out in a social setting, she is quick to notice and stop
her 3-year-old nephew when he steps outside the safety ring of adults. She would actually go
after Jonah, pick him up, and return him back to an area that she considered safe. Often I
wouldn’t realize Jonah had wandered away, until she came lugging him back with a proud look
on her face, while he squealed with excitement. So much for a mother’s watchful eye.
One of Heather’s other amazing talents is her creativity with yarn. She can crochet anything
she can imagine, without a pattern. She has created amazing doll costumes, tutus and even doll-
house curtains armed with only a crochet hook and yarn. She has crocheted newborn hats and
sewn blankets that were donated to a children’s hospital in memory of her nephew, Noah, who
passed away before the age of two. Heather struggles with processing information yet she can
follow a long string of verbalized crochet directions without any delay. Being the first born, my
mother spent hours trying to teach me various handwork. I was an unwilling and difficult stu-
dent and lacked the patience to participate for very long. Heather was a different story. So
when it is all said and done, I think perhaps, I am the one with limitations in this crafty
family.
VALERIE JANKE REXIN

REFLECTIONS ON TEACHING CHILDREN ON THE

AUTISM SPECTRUM (TEACHER)
As a teacher working in a small, private school, my experience with children who have been
diagnosed with an ASD has been somewhat limited. I suspect that I have taught a number of
children who may not have been diagnosed or whose parents did not share information because

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they were afraid of the ramifications of such labeling for their child. I also suspect that I have
taught others who had received an early diagnosis and proper intervention, and were doing so
well that the parents did not feel it necessary to share that information. Though I understand
the dilemma of wanting to protect children from the stigma and misunderstanding that may
come with such a diagnosis, it has been my experience that children who are diagnosed as early
as possible, where effective therapies have been on-going, and where there is good communica-
tion between school and home, have experienced greater school success.
As I reflect on my experience with students on the spectrum, two children come immedi-
ately to mind. In both cases, the parents were well-educated and very caring people who
wanted the best for their children. The children had ‘‘social problems’’ or were described by
previous teachers as being ‘‘socially immature.’’ Both families had sought help from their public
school districts. Both were told that their children had ADD but did not meet the qualifica-
tions for special education, and, dissatisfied with this response, both families received outside
evaluations and counseling for their children. Both families turned to private education, hoping
that the smaller class sizes and challenging curriculum would be the answer to their child’s
problems. Neither child was properly diagnosed until major events at school precipitated an
adequate evaluation that targeted the problems encountered by these two children. Though
these children were very bright, in the end, both children ended up leaving the private school
setting and were eventually diagnosed with Asperger syndrome, one at age 13 and the other at
age 11. The most striking thing about this to me was that in one case in particular, the signs
seemed very obvious. I had very little training or experience with ASD and yet suspected
Asperger syndrome within two days of having this child in my class. It seems terribly tragic
that a proper diagnosis and appropriate therapy had not begun years before when the chances
for school success would have been significantly increased. Without such therapy, these two
children were ill-equipped to deal with the social demands of the classroom. The impact on
the other children, even with some of the valuable lessons learned, was still less than satisfac-
tory. They were certainly no more equipped to deal with the conflicts and constant disruptions
than I was. And I felt helpless to provide what I most wanted for both children: an environ-
ment in which they could thrive and succeed. With only suspicions and symptoms to go on, it
was very difficult to know how to do much more than muddle through from one problem to
the next.
Another student I taught was diagnosed by the first grade with a central processing disorder.
I had this student in my fifth/sixth grade multiage class. His parents were very open about his
needs and in constant communication with me about his progress. This consistent communica-
tion gave the therapist who was working with him the information she needed in order to tar-
get specific behaviors and problem areas. The family offered her as a resource for me, and we
met several times to discuss strategies that she had found to be effective with the student over
the many years she had worked with him. Through this process, the child gained much confi-
dence and the skills he needed to succeed in an academically demanding learning environment.
He had a solid group of friends who were very supportive of his learning differences, and though
they were not aware of a label, they did know that their friend processed information differently
than they did. Because his parents were open about this, and he was very aware of both his
weaknesses and strengths, we were able together to educate his peers about how people think,
learn, and communicate in different ways. Given honest information and some helpful tools for
conflict resolution, the kids were able to take this in stride, and the child had several close
friendships and was generally well liked by his classmates. A supportive family, on-going ther-
apy, and a positive school environment made it possible for him to thrive socially and
academically.
LYNDA M. MOORE

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SUCCEEDING IN COLLEGE (ADULT)

College can be a very daunting prospect for anyone, but if you have an autism spectrum dis-
order, it can be downright terrifying. Living on campus? Interacting with other people? Being
away from home? It can sound like a nightmare. But if you know a few things before you start,
it can become a very manageable prospect, that anyone can do, even an individual on the
autism spectrum. I would like to share with you what I believe the most important tips are to
succeeding in college for individuals with an autism spectrum disorder.
Most importantly, make connections with whoever you can. These will become your lifeline.
Try to befriend your professors; they are often much easier to interact with than your peers. Try
to choose a college small enough where you will be able to have a relationship with your profes-
sors. Stay after class and talk to them about the assignment or a particular idea you had about
one of the topics from class. Comment about the weather. Ask their opinion of school-wide
issues. Any kind of repeated small talk leads to a feeling of connection, and a genuine friend-
ship. When you need to talk about more serious issues or need help with something, you will
have natural allies. These connections will keep you from feeling too lonely, and give you a
sense of connection to and belonging within the college. You will most likely find doing this
with professors much easier than with your peers.
The second most important thing is to accept that you are different. Don’t waste all your
time comparing yourself to others. Know that you may appear different, talk different, walk dif-
ferent, and have different interests. It’s not worth beating yourself up over. You’ve known this
for a long time; it’s old news. If you choose the right college, the student body won’t care that
you’re different. Look for smaller, quirky colleges with a more welcoming student body. At my
college, I was quite self-conscious my first few years, but eventually grew into myself and didn’t
care that I appeared different. Instead, I reveled in it. This gave me more confidence when
interacting with my peers and helped me to make friends.
Take classes in what you are truly interested in, not what other people tell you to. Boredom
is the most surefire way to fail academically. Follow your passions. Make the material your own.
When you are assigned a project or a paper, think to yourself, ‘‘What do I want to say about
the world, or myself? What do I want to find out about the world or myself? How can I express
this in this paper in a meaningful way?’’ Find something that engages you and you will excel
academically and really get something out of the process in the meantime. At my college, I
really enjoyed when we got to do portfolios in my psychology classes. We were allowed to
express our learning of the material in any way we wished: through essays, song lyrics, paintings,
research papers, or whatever we liked. I was able to really explore myself and the world around
me while doing these portfolios.
Work around sensory concerns. College can be a sensory nightmare, but only if you let it. If
noise is a problem while you are taking tests, ask to take tests in a separate room or the learning
center. If you have a problem with perfumes, have the teacher ask the class not to wear any. If
you tend to get overwhelmed while being out and about on a busy college campus, get a Walk-
man or iPod to listen to while you walk around. This will soothe you and give you something
to concentrate on. Figure out the way you relax best and work time into your schedule to do it.
Find a nice, quiet place on campus where you can retreat when you need to. For me, that was
the basement of my school library. I personally had trouble going to sleep at night when I could
hear any noise at all coming from any of the other dorm rooms. So I scheduled late classes and
made a point to stay up until two or three in the morning when I was sure everyone else had
gone to sleep. Unorthodox, yes, but it worked throughout the time I was at my college.
Find something you enjoy, and do it regularly. Make you sure you leave time to relax. Don’t
stress out if you don’t have anyone to do it with. There is no law stating you can’t go out to
dinner by yourself or to a movie alone. Sometimes, it is even more enjoyable that way. Take

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yourself out on the town. I used smoothies as rewards for difficult tasks, and regularly went into
town by myself. I wandered around and forgot about school for a while.
Organization is important. Knowing yourself and your patterns, and having a routine, is key
to succeeding. What time of day do you work best? Morning or night? Before dinner or after?
Do you work best under the pressure of deadlines, or do you need to break tasks into smaller,
more manageable chunks? Do you need an area with no distractions to work in, or does some
amount of activity stimulate your thinking process? These are all important things to know
about yourself. Have a schedule of when you will do all your work, and stick to it. Invest in
binders and keep work neatly labeled where you can find it. Try to work around the same time
every day.
Finally, and this is very important, ask for help if you need it. Most colleges have learning
centers where you can get extra tutoring or other accommodations. Don’t be afraid to be a pest
when asking teachers to clarify assignments—it’s better than getting a bad grade. Utilize e-mail
to ask questions of professors if talking to face-to-face is too difficult. Make sure you have a
source of support. The counseling center in your school can be very useful to help you deal with
the myriad stresses of a college career. Make sure you have someone to talk to, whether that
person is a friend, a professor, family member, or whomever.
If you follow all of those tips, I think that you will find you really enjoy your college experi-
ence. Your college years are particularly notable because not only are you learning a ton of stuff
academically, but you are also growing so much as a person. You’re learning how to live on your
own, how to interact with others, how to discipline yourself and stay motivated. You’re learning
about things you are interested in, and new ways to express yourself. You’re building an identity
for yourself. I wish you all the luck as you travel down this important path!
KATE GOLDFIELD

WHICH IS IT? DISTINGUISHING TYPICAL DEVELOPMENT FROM

DISABILITY-DRIVEN BEHAVIORS (MOTHER)
Our son, who has Asperger syndrome, will turn 18 in November. For what seemed like a sea
of endless days and one thing after another, I am astonished at how quickly the years have
passed. I can remember from the earliest days when he was a little more than 2 years old and
having major meltdowns, or insisting the toy trains stay strategically across the living room
floor, to the constant state of chaos and disorganization that we have now, the question has
always been, ‘‘Just what can I blame on the Asperger syndrome and what is garden variety kid
stuff?’’
I take great comfort in knowing that I am not alone in the world with my own obsessive ten-
dencies toward this issue, because I also work with many families whose children are in the
same boat and we all ask the same thing. Since many of those children are younger, I often
appear to be the one who has the most combat time, if you will. The answer is simple: ask a
behaviorist and it is all environmental and learned; ask a pediatrician and it is developmental
and most certainly will be grown out of at some point; and then ask your spouse or the babysit-
ter and it is just plain WRONG. Along the way, I have catalogued most everything by one of
these disciplines and come up with some general guidelines to decipher the mixed messages fly-
ing about and give each faction its due in part.
Whose problem is it? Now this is certainly grounded in most parenting classes, but since our
kids have great difficulty assessing the cause and effect of social situations, it is often a situation
where we as parents or teachers or innocent bystanders find ourselves targeted for blame in a
pinch. So, if I can decide reasonably whether I am impatiently asking for compliance when an
extra minute wouldn’t hurt, or is my child allowing his fondness for video games to interfere

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with the rest of the world, I will be in a much better position to respond without making any-
thing more unpleasant than it already is.
Is it a ‘‘hardware’’ problem? I have become a firm believer in understanding the neurological
underpinnings to the best of my ability, so there are a few basic principles I allow for in my
deliberations. We know that our kids just don’t understand or attribute other people’s motiva-
tions for their words or actions well; forming abstract concepts or the ‘‘big pictures’’ is quite
tough sometimes and knowing that most kids on the autism spectrum have sensory processing
deficits regulating their responses or being overly aware of their physical surroundings, I know
that they are prone to overreacting but can be taught strategies to become more socially appro-
priate. So the moral of that story is this: Educate yourself thoroughly about what’s going on in
their heads.
Don’t forget that everyone is human. Inappropriate behavior is never a good thing, but respect-
ful, POSITIVE approaches are much more effective at correcting the problem and, most impor-
tantly, preserving a better relationship with your kids.
SHERRY MOYER

469
 Index
Page numbers in bold indicate main entries.
AANE Newsletter, 425
AAPC Newsletter, 426
AAPEP. See Adolescent and Adult
Psychoeducational Profile
ABA. See Applied behavior analysis
ABC. See Autism Behavior Checklist
ABC Analysis. See Antecedent–Behavior–
Consequence (ABC) Analysis
ABC-Iceberg, 423
Ability level, 95, 424
ABLLS. See Assessment of Basic Language
and Learning Skills
Abstract concepts: I LAUGH model, 173–74;
symbols, 34; teaching, 161
Abstract information organization, 162
Abstract language, 91, 174; cartooning, 65
Abstract reasoning test, 165–66
Abstract thinking test, 386
Absurdities, 1
Academic achievement, 407; test, 29, 73
Academics, 212; developmental therapy,
104–6; visual skills, 198
Academic skill, 15, 151, 227, 276
Academy of Dance Therapists Registered, 96
Accommodation, 1; assistive technology, 25;
auditory processing, 68; educational
placement, 211; independent
employment, 180–81; Individualized
Education Program, 182, 190; loss and
setback guideline, 161; reasonable,
272, 324; SCERTS model value, 314;
school assessments, 189–90; Section
504, 324; social, 354–55; teaching
methods, 161; transition planning,
188; visual clarity, 368; voting
machines, 405–6
Achievement, 29, 111
Achievement test, 73, 108–9, 182, 407, 414
Acquired epileptic aphasia, 207–8
Activities of daily living, 1
Activity, 67, 91, 193; escape, 126, 152; joint
routine, 201–3; participation, 105;
planning, 89; preferred, 257, 265–68;
priming, 279–80; SCERTS model,
316–18; self-regulation, 331; sensory
motor, 331–32; Sibshops, 340–41;
social scripts, 350; spontaneous play,
360; substantial limits, 323; task
analysis, 283; visual schedule, 367
Activity Based Strategy, 201
Activity period strategy, 83–86
ADA. See Americans with Disabilities Act
Adaptive behavior, 1–2, 36, 42, 409;
Asperger’s disorder, 22, 168;
development, 72, 103; independent
behavior scales, 313; mental
retardation, 221–22; routines, 202;
scales, 313, 396–97; SCERTS model,
314; sensory integration, 333–34
Adaptive social functioning, 36
Adderall, 363
ADHD. See Attention Deficit Hyperactivity
Disorders
ADI-R. See Autism Diagnostic Interview–
Revised
Adolescent: anxiety disorder, 13–14; Asperger
Syndrome Diagnostic Scale, 23;
Cognitive Behavior Modification,
79–80; differential ability scales,
108–9; dysexecutive syndrome, 48;
language test, 376; problem solving
test, 378; psychoeducational profile, 3;
self-determination, 328
Adolescent/Adult Sensory Profile, 3
Adolescent and Adult Psychoeducational
Profile (AAPEP), 3
INDEX
ADOS. See Autism Diagnostic Observation
Schedule
Adrenal gland, 115
Adult, 105; anxiety disorder, 13–14;
assessment, 3; bullying, 54, 56;
dysexecutive syndrome, 48; language
test, 376; residential support, 302; self-
determination, 328; supports, 4–5
Adult-directed approaches, 260
Adult service agency, 370
Adult supports, 4–5
Advance notice, 161
Advocate, 5, 44; family, 384; parents, 59;
personal perspective, 452, 455–57; self,
180, 327–29; transition planning, 384
Age: appropriate, 5; chronological, 74;
developmental, 97–98, 103; majority,
182; mental, 221
Age group, 202
Ages and Stages Questionnaires: Social/
Emotional (ASQ: S/E), 5
AHA E-List (newsletter), 425
AIT. See Auditory Integration Training
Alcohol abuse, 305
Alertness, 96, 331, 332
Allergy, 5, 122, 176
Alternative assessment, 6
Alternative behavior, 61, 150
Alternative school, 358
American Academy of Child and Adolescent
Psychiatry, 437
American Academy of Neurology, 244
American Academy of Pediatrics, 103, 244,
389, 434–35
American Art Therapy Association, Inc., 20
American Association on Mental Retardation,
222
American Bar Association, 405
American Hyperlexia Association, 437
American Journal of Human Genetics (journal),
429
American Journal of Occupational Therapy
(journal), 429
American Journal of Speech Language Pathology
(journal), 429
American Medical Association, 165, 430, 433,
437–38
American Music Therapy Association, 227,
438
American Occupational Therapy Association,
438
American Physical Therapy Association, 438
American Psychiatric Association, 106, 235
American Psychological Association, 438–39
472
American Sign Language (ASL), 6
American Speech-Language-Hearing
Association, 358, 429, 439
Americans with Disabilities Act (ADA), 5,
6–7, 25, 59, 405
Amino acids, 7, 110
Amygdala, 7–8
Analysis of behavioral function, 8
Analysis of Sensory Behavior Inventory–
Revised Edition (ASBI-R), 8
The ANDI News (newsletter), 425
Anecdotal report, 8; Antecedent-Behavior-
Consequence Analysis, 12;
testimonial, 376; treatment
effectiveness, 385
Angelman syndrome, 8–9
Animal assisted therapy, 10
Animal models, 412–13
Annual goal, 12
Antecedent, 12, 112; behavior intervention,
423; fading, 136; functional behavior,
148–49; stimulus, 114–15
Antecedent–Behavior–Consequence (ABC)
Analysis, 12
Antianxiety medication, 12
Antibiotics, 13
Antidepressant medications, 13
Antipsychotic medications, 13
Anxiety: children, 226–27; desensitization,
373; disorders, 13–14; generalized, 14;
humor, 174; medication, 12
Anxiety disorders, 13–14
Aphasia, 118, 207–8
Applied behavior analysis (ABA), 15–19;
behaviorism, 50; discrete trial training,
111; Fast ForWord Language, 141;
gentle teaching, 157; life skills
curricula, 214; play-oriented therapy,
260; pyramid approach to, 251;
stimulus, 363; tact, 375; verbal
behavior, 391–93
Apprentice, 290, 294
Appropriate education, 146–47, 211
Appropriate practice, 102
Approval, 105
Apraxia, 19
Archives of General Psychiatry (journal), 430
The Arc of the United States, 439
Arousal, 273, 316; cognitive assessment, 96;
neurofeedback, 231–32
Art therapy, 19–20
Art Therapy Credentials Board (ATCB), 20
ASBI-R. See Analysis of Sensory Behavior
Inventory–Revised Edition

ASCEND News (newsletter), 425
ASDS. See Asperger Syndrome Diagnostic
Scale
ASIEP-2. See Autism Screening Instrument for
Educational Planning–Second Edition
ASL. See American Sign Language
The Aspen Newsletter, 426
Asperger, Hans, 20
Asperger’s Association of New England,
425
Asperger’s disorder, 20–23, 246, 247;
restricted interest, 308
Asperger’s syndrome (AS), 20, 42; assessment,
23, 69, 70–71, 159–60, 205–6;
Attention Deficit Hyperactivity
Disorders, 27; brain cell development,
140–41; bullying, 55; high-functioning
autism, 168–69; learning disorders,
209–10; nonverbal learning disability,
235; perseverative scripting, 245;
personal perspective, 453–55, 457–59,
461–64, 466
Asperger Syndrome Alliance for Greater
Philadelphia, 425
Asperger Syndrome and High Functioning
Association E-List (newsletter), 426
Asperger Syndrome Diagnostic Scale (ASDS),
23
Asperger Syndrome Education Network, Inc.,
425
Asperger Syndrome Screening Questionnaire
(ASSQ), 23
ASQ: S/E. See Ages and Stages
Questionnaires: Social/Emotional
Assessment, 17, 24, 76; adaptive behavior, 2;
alternative, 6; augmentative
communication, 37; behavior function,
8; clinical, 74–75; criterion-referenced,
93; curriculum-based, 94; direct
observation, 111; double interview,
116; education accommodation,
189–90; evaluation report, 127; family
interview, 137; incidental teaching,
178–79; Individualized Education Plan,
182; Individualized Family Services
Plan, 184; informal, 190; information
gathering, 265; integrated play group
model, 192–93; norm-referenced, 160,
236; probes, 280; sensory integration,
334, 335; situation attribution, 30;
social skills, 352; standardization, 361;
standardized tests, 362; state and
district, 277; van Dijk approach,
390–91. See also Screening
INDEX
Assessment for Effective Intervention (journal),
430
Assessment of Basic Language and Learning
Skills (ABLLS), 24
Assimilation, 354–55
Assistance dogs, 10–11
Assistance scaffolding, 193
Assistive technology, 24–25; augmentative
and alternative communication, 37;
collaborative virtual environments,
398; device, 26, 32–36; Individ-
ualized Education Program, 182;
service, 26; student legal rights,
189–90
Assistive technology device, 26
Assistive technology service, 26
Association for Advancement of Behavior
Therapy, 440
Association for Behavioral and Cognitive
Therapies, 440
Association for Behavior Analysis, 440
The Association for Persons with Severe
Handicaps, 449
Association for Science in Autism Treatment,
440
Association loss and setback guideline, 161
Association method, 27
Association of University Centers on
Disability, 440
ASSQ. See Asperger Syndrome Screening
Questionnaire
AT. See Assistive technology
ATC Newsletter, 426
Attachment, 246; reactive, 299; social
competence, 348; van Dijk approach,
390
Attention: information reception, 402;
modeling component, 394;
overselective/overfocused, 241;
shifting, 203
Attention Deficit Hyperactivity Disorders
(ADHD), 27–28, 322
Attitudinal change, 240
Attribute, picture exchange communication,
253
Attribution, 28–31; scale of social, 369;
style, 73
Atypical autism, 247
Atypical behavior, 31
Audiologist, 31
Auditory Integration Training, 31–33
Auditory learners, 210
Auditory processing, 67–68, 300
Auditory system, 336
473
INDEX
Augmentative and alternative
communication, 33–39, 131–34,
251–54; visual strategy, 402
Aura, 325
Authorship, 133
Autism, 205; career planning, 59; childhood
rating scale, 71; Fragile X syndrome,
146; genetic factors, 155–56;
neuroscience-based perception, 140–
41; phenotype, 248; prevalence, 278;
savant skills, 158–59; screening tool
for two-year-olds, 321; seizure disorder,
325; social disorder, 60–61; strengths,
42; stress in late onset, 412; visceral
disorder, 409–13. See also Autistic
disorder; Cause of autism
Autism: The International Journal of Research
and Practice (journal), 430
Autism Advocate Magazine (newsletter), 426
Autism Asperger Publishing Co., 426
Autism-Asperger’s Digest (newsletter), 427
Autism Behavior Checklist (ABC), 39, 41
Autism Diagnostic Interview–Revised
(ADI-R), 40, 347
Autism Diagnostic Observation Schedule
(ADOS), 40
Autism International Network, 441
Autism Network for Dietary Intervention, 425
Autism Research Institute (ARI), 311, 426,
441
Autism Research Review International Newsletter
(newsletter), 427
Autism Screening Instrument for Educational
Planning–Second Edition (ASIEP-2), 41
Autism Screening Questionnaire. See Social
communication
Autism Society of America (ASA), 311, 426,
441
Autism Speaks, 441–42
Autism Spectrum Quarterly (newsletter), 427
Autism Treatment Center of America, 240
Autistic children, 205
Autistic disorder, 41–45, 42, 98, 168–69,
246–47; Asperger’s disorder, 20–22;
atypical, 247; bullying, 54–55;
Childhood Disintegrative Disorder, 72;
Comprehensive Autism Program
Planning System, 89–90;
developmental delay, 99; diet, 107;
environment, 124; hyperactivity
spectrum, 27–28; joint action routines,
201; life skills curricula, 213–14; loss
and grief, 160–61; mindblindness, 225;
nutritional deficiency, 107–8;
474
nutritional supplements, 236; personal
perspective, 465–66; physiological
effect on treatment, 408; RDI program
mission, 289–95; reactive attachment
disorder, 299; red flags, 300; selective
mutism, 326; sexuality, 219–20; social
skills training, 352; spontaneous play,
360; syndrome, 373; visual learning
strategies, 83–84; without mental
retardation, 168–69. See also
Asperger’s syndrome; Childhood
disintegrative disorder; Pervasive
developmental disorders; Rett’s
disorder
Autopsies, 343–44
Avatars, 397
Aversion to touch, 166
Aversive intervention, 156–57
Awareness, 334; body, 336; causes, 369;
environment response, 104–5;
neurofeedback, 231–32; self, 293–94;
social, 235, 351
Ayres, A. Jean, 333, 335
Balance, 162–63, 336
Ballard, Keith, 180
Bandura, Albert, 394
BASC. See Behavior Assessment Scale for
Children
Baseline, 47
Beginning communicator, 36
Behavior, 42, 47, 50, 92, 95, 345–46, 402–3;
adaptive, 1–2, 313, 333–34, 396–97;
alternative, 61, 150; analysis, 8, 12,
376; antecedent, 12, 148–49, 423;
assessment, 24, 40, 48, 49, 70, 123,
148, 149, 189–90, 265–66, 423;
atypical, 31; challenging, 17–18, 152,
256, 306–7; cognitive approach,
77–80; communication and symbolic,
87–88; contract, 92–93; coping-
related, 119; developmental therapy,
104–6; discipline, 306; disorders, 98;
establishing operation, 126; extinction,
129; function, 8, 92, 152;
generalization, 114, 136, 155, 178,
218, 257, 284, 353, 354, 365, 395,
398; gentle teaching, 156–57; guided
compliance, 163; high-functioning
autism vs. Asperger syndrome, 169;
history, 333; incident report, 179–80;
interfering with school, 189–90;
intervention, 50, 423; maladaptive, 50,
156–57, 219, 333; mapping of social,

344–46; modeling, 16, 175, 193, 218,
332, 360, 394–96; music therapy, 228;
obsession, 14; operant conditioning,
50, 231–32, 239; personal perspective,
468–69; pica, 250–51; play-oriented
therapy, 259; private vs. public,
219–20; progress, 23; protodelcaration,
283–84; protoimperation, 284;
psychobiology, 285; punishment,
286–87, 306; red flag, 300; rehearsal,
48, 165; repetitive, 63, 165, 241, 299,
300; ritualistic, 14, 192, 239–40, 261,
299; SCERTS model value, 314;
schizophrenia, 319; self-determined,
328; self-injurious, 330; sensory, 8,
333–34; sensory profile, 337–38;
sequence, 63, 100; services, 49; setting
events, 338–39; stereotypic, 363;
strategy, 339, 342–43; support, 264–71,
306–7; target, 109–10, 376; triggers,
149; visual tools, 401. See also Applied
behavior analysis; Functional behavior
analysis; Prompting; Reinforcement;
Reinforcer; Stimulus
Behavioral approach, 114, 201, 261, 326–27
Behavioral Assessment of the Dysexecutive
Syndrome (BADS), 48
Behavioral framework, 239
Behavioral function analysis, 8, 114–15, 148
Behavioral objective, 48
Behavioral rehearsal, 48
Behavior analyst, 52–53
Behavior Analyst Certification Board
(BACB), 49, 52
Behavior Assessment Scale for Children
(BASC), 49
Behavior Health Rehabilitation Services
(BHRS), 49
Behavior Intervention Plan, 50
Behaviorism, 50, 156–57
Behavior modification, 50, 342; cognitive,
77–80; verbal behavior, 391–93
Behavior principles, 50
Behavior therapist, 52
Belief, 29, 136–37
Bell, Nanci, 215
Belyakova, T. L., 110
Benchmark, 12
Berard, Guy, 31–32
Best practices, 127, 194–95
Bettelheim, Bruno, 51
BHRS. See Behavior Health Rehabilitation
Services
Bias, 51
INDEX
Big picture, 173
Bilingual families, 326
Biofeedback, 51–52, 231–32
Biological needs, 420
BIP. See Behavior Intervention Plan
Bipolar disorder, 225
Blackwell, Cameron, 457–59
Blackwell, Craig, 459
Blackwell, Eric, 451–53
Blackwell, Jamie, 459
Blackwell, Jen, 459–61
Bladder control, 123
Bleular, Eugen, 52
Blood tests, 176
Bluestone, Daniel, 171
Blumena, M. G., 110
Board Certified Associate Behavior Analyst
(BCABA), 52–53
Board Certified Behavior Analyst (BCBA), 53
Board of Education of the Hendrick Hudson
School District v. Rowley, 147
Body: awareness, 336; environment map, 334;
language, 400
Bolles, Mary, 53
Bolles Sensory Integration, 53
Bovee, Jean Paul, 329
Bowel problems, 53–54
Brain, 331; activity, 121, 150; amygdala, 7–8;
cells, 140; central auditory processing
disorder, 67–68; developmental
process, 234; dopamine, 115; executive
function, 127; fusiform gyrus, 152;
Halstead-Reitan Neuropsychological
Test Battery, 165–66; head
circumference, 167; imaging, 150, 217,
233; limbic system, 215;
metallothionein, 223;
neurotransmitter, 234; reorganization
training, 140–41; seizure disorder, 325;
sensory integration, 333–34; tic
disorders, 379; visceral disturbance,
410–11; waves, 231–32
Brain damage, 222, 234, 411; assessment, 48,
165–66
Brain/gut peptide combinations, 408–13
Brain (journal), 430
British Journal of Developmental Psychology
(journal), 431
The British Psychological Society, 431
Brushing, 54, 414
Bullying, 54–58
Calcium pengamate, 110
Capacities, SCERTS model, 315
475
INDEX
CAPD. See Central auditory processing
disorder
Career Development of Exceptional Individuals
(journal), 431
Career planning, 59–60
Caregiver: gentle teaching, 156–57; infant
interactions, 411
CARS. See Childhood Autism Rating Scale
Cartooning, 60–66
CAS. See Das-Naglieri Cognitive Assessment
System
Casein-free (diet), 66–67, 107, 108, 160
Case manager, 182
CASL. See Comprehensive Assessment of
Spoken Language
CASQ. See Children’s Attributional Style
Questionnaire
CAST. See Childhood Asperger Syndrome
Test
Catatonia, 67
CAT scan, 67
Cause-and-effect relationship: attribution, 29,
369; developmental therapy stage, 106;
social situation, 343
Cause of autism: environment, 124;
epidemiology, 125; fragile X syndrome,
146; genetics, 43; mercury, 222–23;
mothering, 51, 311; pesticides, 248;
thimerosal, 389; viruses, 399–400;
visceral pathology, 410; zinc
metabolism, 223
Causes of mental retardation, 222
CBA. See Curriculum-based assessment
CBM. See Cognitive Behavior Modification
CCT. See Children’s Category Test
CDC. See Centers for Disease Control and
Prevention
CDD. See Childhood disintegrative disorder
CDI. See Children’s Depression Inventory
CEC. See Council for Exceptional Children
CELF-P. See Clinical Evaluation of Language
Fundamentals–Preschool
Center for Autism & Related Disabilities, 427
Center for Inherited Disease Research
(CIDR), 446
Center for the Study of Autism (CSA), 442
Centers for Disease Control and Prevention
(CDC), 222, 300, 389, 442
Central auditory processing disorder (CAPD),
67–68
Central coherence, 68–69, 237
Certification: art therapist, 20; audiologist,
439; behavior analysis, 49; behavior
analysts, 52–53; facilitator, 240;
476
occupational therapist, 237; physical
therapist, 249; sensory integration,
334–35; speech language pathologist,
358, 439
Chaining, 69; applied behavior analysis, 16;
picture exchange communication, 253;
task analysis, 376
Challenging behavior, 17–18; function, 152;
motivation, 256; respite care worker,
306–7
CHAT. See Checklist for Autism in Toddlers
Checklist for Autism in Toddlers (CHAT), 69
Checklist for Occupational Therapy, 70
Checklist work systems, 368
Chelation, 70, 167
Chemical messengers, 234
Chewing, 311
Child Behavior Checklist for Ages 11=2 to 5,
70
Child-centered approaches, 260
Child development, 243–44; delay, 98;
milestones, 99–101, 103; pronoun
errors, 283; retrospective video
analysis, 308; SCERTS model, 313–18
Childhood Asperger Syndrome Test (CAST),
70–71
Childhood Autism Rating Scale (CARS), 71
Childhood disintegrative disorder, 72–73, 99,
246, 247
Childhood disorders, 98
Children: anxiety, 13–14, 226–27; apprentice,
290; appropriate education, 146–47;
assessment, 49, 70–71, 73, 74, 365–68,
378, 408; bowel problems, 53; brain
development, 140–41; central auditory
processing disorder, 68; Cognitive
Behavior Modification, 79–80;
developmental age, 97–98;
developmental quotient, 103; dynamic
learning, 292; engagement, 123;
Fragile X syndrome, 145; guided
participation, 294; hand regard, 166;
intersubjective deficit, 294; Landau-
Kleffner syndrome, 207–8; loss and
grief, 160–61; maternally deprived,
408–9; mother, 51, 259, 289, 311;
motivation, 256; nocturnal enuresis,
123; perceptual needs, 140;
performance concerns, 29; pervasive
developmental disorder, 246;
posttraumatic stress disorder, 273;
sensory motor activities, 331–32; social
contacts, 74–75; social play, 349; wait
training, 407

Children’s Attributional Style Questionnaire
(CASQ), 73
Children’s Category Test (CCT), 73
Children’s Defense Fund (CDF), 442
Children’s Depression Inventory (CDI), 74
Children’s Health Act of 2000, 444, 449
Choice boards, 401
Choice simulation, 342–43
Chromosome 15, 9
Chronological age, 74
Circle of Friends, 74–75
Civil rights, 6–7; Rehabilitation Act of 1973,
301; Section 504 protection, 322
Civil Rights Act of 1964, 6
Clarity, visual, 368
Classmates, 74
Classroom: activities, 2; assistive technology,
25; inclusion, 180; layout, 366; least
restrictive environment, 210–11; life
skill teaching, 214; mainstreaming,
217–18; personal perspective, 466;
self-contained, 327; visual tools, 401.
See also General education classroom
Classroom Reading Inventory (CRI), 75
Class-within-a-class, 212
Client Assistance Program, 187
Clinical assessment: educational, 75; medical,
75
Clinical Evaluation of Language
Fundamentals–Preschool, 76
Clinical method engineering, 289
Clinical opinion, 76
Clinical practice guidelines, 76
Clinical significance, 76
Clinical social worker, 76–77
Clinical trial, 77
Closing the Gap, 442–43
Clostridium tetani, 77
Coaching, 290
Code, 356
Cognitive ability: Das-Naglieri assessment
system, 96; differential ability scales,
108–9; functional limitations, 150;
Leiter International Performance
Scale, 213; splinter skills, 360;
Stanford-Binet intelligence scales, 362;
voting, 405; Wechsler Intelligence
Scales for Children, 408; Woodcock-
Johnson Psychoeducational Battery, 414
Cognitive Behavior Modification, 77–81
Cognitive behavior therapy, 327
Cognitive deficits, 143
Cognitive functioning, 333–34
Cognitive impairment, 42
INDEX
Cognitive learning strategies, 81–86
Cognitive picture rehearsal, 63
Cognitive processes, 86
Cognitive skills: executive function, 127–28;
mental retardation, 221–22
Coherence, 68, 237
Collaboration: priming strategy, 279; student-
teacher, 424; Ziggurat Model, 424
Collaborative Programs for Excellence in
Autism, 443
Collaborative team, 86
Collaborative virtual environments (CVEs),
397–98
Collaborator, 314–16
College, 404; personal perspective, 467–68
Comic strip conversations. See Cartooning
Communication, 42, 47, 143–44, 152, 267,
300; acquired skill evaluation, 126–27;
alternative and augmentative, 9;
Asperger’s disorder, 21; augmentative
and alternative, 33–38; board, 88;
book, 252; cartooning, 61;
collaborative virtual environments,
398; comprehension, 174;
developmental milestone, 100;
developmental therapy, 104–6;
diagnostic, 40; dog-child relationship,
10; dynamic intelligence, 291;
echolalia, 120; experience sharing,
293; facilitated, 131–34; integrated
play group model, 192–93; intent
protodeclaration, 283; music therapy,
228; partner, 252; picture exchange
system, 251–54; play initiation
monitoring, 193; preschool disorders,
76; priming, 279; prosody, 283;
regression, 309–10; SCERTS model,
314; social, 347; social thinking, 357;
Son-Rise Program, 240; speech
therapy, 359; support device selection,
36; symbolic, 36, 87–88, 278, 372–73;
teaching, 365–68; total, 381; twenty
questions, 386; van Dijk approach,
390; visual strategies, 400, 402
Communication and Symbolic Behavior
Scales (CSBS), 86–87
Communication and Symbolic Behavior Scales
Developmental Profiles (CSBS DP), 87
Communication-based interaction, 201
Communication board, 87–88
Communication skill: joint action routines, 203;
pervasive developmental disorder not
otherwise specified, 247; pivotal response
training, 255; social scripts, 349–50
477
INDEX
Community-based employment, 191, 370, 404
Community-based residential programs, 302
Community experience, 59
Community setting, 15
Co-morbid/co-occurring, 88, 169
Comparison group, 93
Competence, 290; communicative, 88;
dynamic intelligence, 292; language
test, 376–77; parents, 294–95; social,
106, 348, 357; voting, 405
Comprehension: communicative, 174;
symbols, 34–35
Comprehensive Assessment of Spoken
Language, 88
Comprehensive Autism Program Planning
System (CAPS), 88–90
Compulsive behavior, 250–51
Computer-based learning, 397–99
Conceptual processing, 174
Concerta, 363
Concrete language, 90
Concurrent validity, 90
Conditioning: learned helplessness, 208–9;
operant, 50, 231–32, 239; respondent, 307
Conduct disorder, 27–28, 28
Confidence. See Self-confidence
Confidentiality, 90–91
Conflict, 61
Confusion, visual and verbal, 368
Connective tissues, 145
Consent, 91; family services plan, 183, 185;
individual employment plan, 186–87;
special education, 182
Consequence, 91; behavioral, 148, 152,
345–46; discrete trial, 16, 113; guided
compliance, 163; social situation
strategies, 342–43
Constipation, 53, 91, 123
Consultation, 238–39
Consumer of services, 186–87
Content maps, 162
Contingency, 92
Contingency contracting, 92
Control condition, 92
Control group/control condition, 92
Conversation, 61–63
Coordination of movement, 162–63
Coping: bullying, 55–56; developmental
milestone, 100, 101; environmental
stressors, 125; inventory of early, 119;
personal perspective, 463
Correction, 125; discrete trials, 112; no-no
prompt, 234; overcorrection, 17, 241;
picture discrimination, 252
478
Correctional facility, 92
Cost, 187, 307; assistive technology devices,
26; hippotherapy, 171; independent
evaluation, 323
Council for Exceptional Children (CEC), 430,
431, 443
Counseling support, 4
Counselor, 186–87, 221, 404
Creative thinking, 292
CRI. See Classroom Reading Inventory
Crisis intervention, 4
Criterion-referenced assessment, 92–93
CSBS. See Communication and Symbolic
Behavior Scales
Cue, 255; stimulus control, 364; Storymovie,
364–65; visual, 366, 395, 400
Culture of autism, 44
Cure, 43
Cure Autism Now (CAN), 443
Curriculum, 93; Assessment of Basic
Language and Learning Skills, 24;
association method, 27; developmental
play assessment, 103; early childhood
sensorimotor, 331–32; hidden, 167–68;
life skills, 213; self-determination, 328;
Storymovie, 365; van Dijk approach,
390–91
Curriculum-based assessment, 93
CVEs. See Collaborative virtual environments
Cytomegalovirus, 399
Daily living, 397–98; activities, 1; early
childhood, 331; Individualized Family
Services Plan, 184; milieu teaching,
223–24; self-determination, 329;
Storymovie, 365
Daily living skills, 2, 95, 202; developmental
therapy stage, 106; functional, 151;
self-help, 330
Dairy products, 207
Dance therapist, 96
Dance therapy, 95–96
DAN! Protocol (newsletter), 427
DARD. See Durrell Analysis of Reading
Difficulty
DAS. See Differential Ability Scales
Das-Naglieri Cognitive Assessment System
(CAS), 96
Data, 96–97; applied behavior analysis, 15;
baseline, 47; collection, 202, 271;
incidental teaching assessment,
178–79
Daydreaming, 232
Day habilitation services, 4

Deaf-blind individuals, 390–91
Deaf individuals, 381
Decision-making method, precision teaching,
275
Decisions, task high level, 83
Deep pressure proprioception touch technique,
97
Defeat Autism Now! (DAN!), 427
Defensiveness, 375
Deficiency strategy production, 82
Deficit: adaptive behavior, 2, 222; Asperger’s
syndrome, 28–29; cognitive, 143;
communication, 402, 421; executive
function, 127–28; face recognition,
131; motor activity, 67; nonverbal
learning, 234–35; perspective taking,
28–29; pervasive development
disorder, 246–47; prosody, 207–8; RDI
program, 291–95; sensory, 220; skill,
136, 238; social, 55, 349, 352–54, 378;
social-cognitive, 173
Deliberate, SODA strategy, 83–86
Delusions, 319
Dementia infantalis. See Childhood
disintegrative disorder
Denton, David, 381
Department of Education, 137, 138, 322, 444,
447–48, 449
Department of Health and Human Services,
450
Dependent variable response, 47
Depression, 29, 74, 209, 225
DES. See Dysexecutive Syndrome
Desensitization, 97, 176, 373, 381
Design: experimental, 128; integrated play
group, 191–92; intervention,
423–24
Desired behavior: habit rehearsal, 165; target
behavior, 109–10, 376
Determinism, 328
Detoxification, 97, 117; chelation, 70, 167
Development: Rett’s disorder, 309; visceral
diseases, 410
Developmental age, 97–98
Developmental delay, 98
Developmental dimensions, SCERTS model,
315
Developmental disability, 41
Developmental disorder, 98–99; Attention
Deficit Hyperactivity Disorders, 27–28;
language, 140–41
Developmental framework, play-oriented
therapy, 260–61
Developmental history, 40
INDEX
Developmental Individual-Difference
Relation-Based Intervention (DIR),
99–102
Developmentally appropriate practice, 102
Developmental milestones, 100–101, 103
Developmental Play Assessment Instrument
(DPA), 103
Developmental process patterning, 243
Developmental profiles, Communication and
Symbolic Behavior Scales, 87–88
Developmental progress, 289
Developmental quotient, 103, 163
Developmental sequence, sensory integration,
333–34
Developmental stage, symbolic thought, 372
Developmental surveillance, 103–4
Developmental therapy, 104–6
Development model, appropriate practice, 102
Device: assistive technology, 26; augmentative
and alternative communication,
34–35; selection of, 35–36
Diagnosis: adaptive behavior, 2; Asperger’s
disorder, 20–21; Attention Deficit
Hyperactivity Disorder, 28; autistic
disorder without mental retardation,
168–69; brain injury, 243; childhood
autism, 71; conduct disorder, 28;
developmental disorders, 98;
differential, 109; generalized anxiety
disorder, 14; International Statistical
Classification of Diseases, 197;
interview, 40; mental disorders, 106;
mental retardation, 221–22; nonverbal
learning disability, 235; observation
schedule, 40; oppositional defiant
disorder, 28; pervasive developmental
disorder not otherwise specified,
246–47; Psychoeducational Profile-
Third Edition, 285; reactive
attachment disorder, 299; Rett’s
disorder, 309, 310–11; screening, 321;
selective mutism, 326; social phobia,
13; symptom, 373; tic disorders, 379
Diagnostic and Statistical Manual of Mental
Disorders–Fourth Edition–Text Revised
(DSM-IV-TR), 13, 21, 28, 41, 72, 98,
106–7, 160–69, 209, 225, 247, 250,
272, 299, 309, 310, 326, 379
Diagnostique (journal), 430
Diet, 107; casein-free, 66; dysbiosis, 117;
Fiengold, 142; food sensitivities, 122;
gluten-free, 67, 160; lactose
intolerance, 207; nutritional
supplements, 236
479
INDEX
Diet therapy, 107–8
Differential Ability Scales, 108–9
Differential diagnosis, 109
Differential reinforcement, 109–10
Digestive peptides, 244
Dimension: developmental, 315; social, 192,
361; symbolic, 192, 360
Dimethylglycine (DMG), 108, 110
DIR. See Developmental Individual-Difference
Relation-Based Intervention
Direct instruction, 110–11
Directions, 68
Directive no-no prompt procedures, 234
Direct observation, 111; Autism Behavior
Checklist, 39; behavioral function
analysis, 8
Direct services, 238
Disability, 111; assistive technology, 25; brain
damage, 243; definition, 7, 322;
normalization, 235; supported
employment, 370
Discipline, 306
Discrete trial teaching (DTT), 16
Discrete trial training: brief definition, 111;
extended definition, 111–14; massed
practice, 219; play-oriented therapy,
260; target behavior, 376
Discretion, appropriate education, 147
Discrimination, 114; Americans with
Disabilities Act, 6–7; Section 504
protection, 322
Discriminative stimulus, 112, 114–15; no-no
prompt procedures, 234; trial, 385
Disintegrative psychosis. See Childhood
disintegrative disorder
Disorder: dysphasia, 118; groupings, 98; mood,
225–26; tic, 379
Distributed practice, 115
Division of Developmental Disabilities, 222
Division of Early Childhood Education
(DEC), 98
Division of Vocational Rehabilitation (VR),
370, 404
DMG. See Dimethylglycine
Dog placement, 10
Domains: assessment, 24, 321; autistic disorder
impact, 41; brain reorganization, 140;
developmental, 97, 103, 247, 314;
dynamic intelligence, 292–94; goal
setting, 383; social, 259
Doman-Delacato treatment, 243–44
Dopamine, 115, 379
Double blind, 115–16
Double interview, 116–17
480
DPA. See Developmental Play Assessment
Instrument
DQ. See Developmental quotient
Drug abuse, 305
Drugs. See Medication
DSM-IV-TR. See Diagnostic and Statistical
Manual of Mental Disorders–Fourth
Edition–Text Revised
DT. See Developmental therapy
DTT. See Discrete trial teaching
Due process, 117
Dunn’s Model of Sensory Processing, 3
Durrell Analysis of Reading Difficulty
(DARD), 117
Dynamic intelligence, 291–94
Dysbiosis, 117
Dyscalculia, 209
Dysexecutive Syndrome (DES), 48
Dysfunction: sensory integration, 335–36;
sensory processing, 337
Dysgraphia, 209
Dyslexia, 209
Dysphasia, 118
Dyspraxia, 132–33
Ear, 67–68, 393
Early childhood: assessment, 87–88, 119;
developmental delay, 98; reactive
attachment disorder, 299; sensory
motor activities, 331–32
Early Coping Inventory, 119
Early intensive behavioral intervention
(EIBI), 18
Early intervention, 119–20
EASIC-R. See Evaluating Acquired Skills in
Communication–Revised
Echoic/verbal behavior, 120, 392
Echolalia, 67, 120, 245, 283
ECI. See Early Coping Inventory
Ecological inventory, 120
Education, 96; appropriate, 146–47, 324;
curriculum accommodation, 1;
evidence based approach, 127;
inclusiveness, 180; laws, 450;
opportunities, 419; postsecondary, 272;
pyramid approach, 251; RDI program,
290; records, 137–39; reform, 234;
speech language pathologist, 358;
structure teaching, 365–68. See also
School; Special education
Educational approach, SCERTS model,
313–18
Educational assessment, 75
Educational bulling, 54

Educational performance: annual goal, 12;
present level, 275–77
Educational placement, 121, 147–48, 236,
324; least restrictive environment,
210–12; mainstreaming, 217–18
Educational practices, daily interventions, 366
Educational services, correctional facility, 93
Education and Training in Developmental
Disabilities (journal), 431
Education of All Handicapped Children Act,
419
Educators, 217–18
EEG. See Electroencephalogram
EEG biofeedback. See Neurofeedback
Effectiveness: establishing operation, 126; RDI
methods development, 289–95;
treatment, 385
Efficacy, 76–77
EFT. See Embedded Figures Test
EIBI. See Early intensive behavioral
intervention
Eisenberg, Leon, 121
Electoral participation, 405
Electroencephalogram, 121, 232
Eligibility, 121; extended school year, 128;
Individualized Education Plan, 121;
Individualized Family Service Plan,
184; special education, 227;
Supplemental Security Income, 370;
vocational rehabilitation, 186–87, 323,
404
Elimination diet and food sensitivities, 122
Embedded Figures Test (EFT), 122
Embedded skills, 122
Emergency Care Plan, 185
Emotion: care giver stability, 305; limbic
system, 215; play-oriented therapy,
259; regulation, 314, 316; respite care
worker, 305; response desensitization,
97
Emotional development, 5
Emotional disability, 405
Emotional disorders, 98, 124; assessment, 49
Emotional ideas, 101
Emotional support, 123
Emotional thinking, 101
Empiricism, 123
Employment: Americans with Disabilities Act,
7; career planning, 59–60; facility-
based, 135–36; independent, 180–81;
individual plan, 186–87; integrated,
191; present level of educational
performance, 277; reasonable
accommodation, 324; respite care,
INDEX
303–7; supported, 370; transition
planning, 383; vocational
rehabilitation, 404
Employment agency, 191
Employment services, consumer rights, 186–87
Employment supports, transition to
adulthood, 4
Empowerment, RDI program, 289
Encopresis, 123
Engagement, 123
Enuresis, 123
Environment, 124–25; adaptive behavior,
1–2; Cognitive Behavior Modification,
78; dual sensory loss, 390–91; dynamic
intelligence, 291–92; ecological
inventory, 120; establishing operation,
126; generalization, 155; integrated
play group, 192; map, 334; motivation,
392; physical organization, 366;
pivotal response training, 255;
response, 104–5; sensory processing,
337; setting events, 338–39; social
behavior mapping, 345; Son-Rise
Program, 240; stimulus, 363; virtual,
397–99
Environmental changes, 9
Environmental factors, 43
Environmental stressors, 125
Environmental task demands, neurofeedback,
232
Epidemiology, 125
Epilepsy, 207–8, 325
Episodic memory, 293–94
Equinus gait, 380
Error correction, 125; no-no prompt
procedures, 234; overcorrection, 17,
241; picture discrimination, 252
Errorless teaching, 112, 392
Escape behavior, 163
Escape training, 126
Establishing operation, 126, 391
ESY. See Extended School Year
Ethics, 44, 196
Evaluating Acquired Skills in
Communication–Revised (EASIC-R),
126–27
Evaluation: multidisciplinary, 227; positive
behavior support, 271; problem
behavior, 269; report, 127; screening,
321; Section 504 qualification, 323;
strategy, 82–83
Evaluation report, 127
Evaluator, 390
Event sequence, 402–3
481
INDEX
Event setting, 338–39
Evidence, 123, 243–44, 376
Evidence based, 127, 423
Excitement, 67
Executive dysfunction, 83
Executive functions, 127–28; Asperger’s
disorder, 22; test, 48, 382, 414
Exercise patterning, 243
Expectation: independence, 366; social
behavior mapping, 345; work systems,
367–68
Expected behavior, 345–46
Experience sharing, 293
Experience-sharing relationship, social
competence, 348
Experimental analysis, 47
Experimental design, 93, 115, 128
Expertise, fusiform gyrus, 152
Expert players, 192
Expressive abilities, loss, 207
Expressive language, 128
Extended care support, 4
Extended School Year (ESY), 128–29
External demands, 232
Extinction, 129
Eye-contact, 129, 246, 408; social thinking,
143, 357
Eye gaze, 129, 300, 349
Face recognition, 131
Facial expression, 300
Facilitated communication (FC), 37, 131–35
Facilitator, 132, 133, 341
Facility-based employment, 135–36
Fading, 113, 136
False-Belief Paradigm, 136–37
Families for Early Autism Treatment (FEAT),
427
Family: bilingual, 326; empowerment, 289;
incidental teaching, 178;
Individualized Family Service Plan,
183–85; Option Institute, 240;
personal perspective, 452–53, 464–65;
residential support need, 302;
SCERTS model value, 314; services
individualized plan, 183–85; speech
therapy, 360; support meetings, 340–
41; supports, 4; transition planning,
384; vision statement, 183
Family assessment interview, 137
Family Education Rights and Privacy Act
(FERPA), 137–39
Family for Early Treatment of Autism
(FEAT), 444
482
Family Policy Compliance Office, Department
of Education, 138
FAST. See Functional Analysis Screening
Tool
Fast ForWord, 139–42
FASTimes (newsletter), 427
Father, 289; personal perspective, 451–53
Faux pas. See Social faux pas
FBA. See Functional behavior assessment
Fear, 13, 326, 373
FEAT. See Families for Early Autism
Treatment
F.E.A.T. Daily Autism Newsletter, 427
Feature-based strategy, 131
Febrile seizures, 325
Federal funding, 6, 137, 322
Federal programs, 405
Feedback: equipment, 51–52; neurological,
231–32; sensory integration, 333
Feeling, 161, 373
Feingold, Benjamin, 142
Feingold diet, 107, 142
Females, 43, 122, 319
Fetal alcohol syndrome, 222
Figurative language, 142
Figurative speech, 169
Figure, embedded, 122
Films, 133
Financial assistance, 322
Financial supports, 5
Fine motor skills, 142
Flexibility, 292
Flight, 11
Floor time, 99; Developmental Individual-
Difference Relation-Based
Intervention, 142; play oriented
therapy, 261
Florida Asperger Syndrome Times (FASTimes)
(newsletter), 427
Fluency, 142, 308
fMRI. See Functional magnetic resonance
imaging (fMRI)
Focus on Autism and Other Developmental
Disabilities (journal), 431
Food, 107–8; amino acids, 7; gluten, 160;
rumination syndrome, 311. See also Diet
Food and Drug Administration (FDA), 32,
110, 389, 450
Food sensitivities, 122
Four steps of communication, 143–44
Four steps of perspective taking, 144–45
Fragile X syndrome, 145–46
Free and appropriate public education
(FAPE), 146–48

Friends, 74
Friendships, 21; personal perspective, 453–55
Frontal lobe syndrome, 48
Frustration, 21, 61, 207–8
Functional Analysis Screening Tool (FAST),
148
Functional behavior analysis, 148–49
Functional behavior assessment (FBA), 149,
189, 265, 423
Functional communication training (FCT),
36
Functional goals, 149–50
Functional limitations, 150
Functionally equivalent alternative behavior,
150
Functional magnetic resonance imaging
(fMRI), 150–51
Functional outcomes, 151
Functional protest training, 151
Functional skills, 151
Functions of behavior, 152
Functions of communication, 152
Funding, 5; facilities-based employment, 136;
federal, 6, 137, 322; rehabilitation,
322, 404; self-determination, 329
Fusiform face area (FFA), 131
Fusiform gyrus, 152–53
GAD. See Generalized anxiety disorder
GADS. See Gilliam Asperger Disorder Scale
Gait, 170, 380
Games, 232, 397
GARS. See Gilliam Autism Rating Scale
Gastrointestinal tract symptoms, autistic and
maternally deprived, 408–9
Gaze, 129, 300, 349
GCA. See General Conceptual Ability
General case programming, 155
General Conceptual Ability (GCA), 108–9
General education classroom: least restrictive
environment placement, 210–12;
mainstreaming, 217–18; organization,
366; participation, 276; Section 504
services, 324
Generalization, 155; demonstration, 365;
discrete trial training, 114; fading, 136;
group therapy, 360; incidental
teaching, 178; maintenance, 218; peer
mentoring, 353; prototype formation,
284; question initiation, 257; social
skill programs, 354; strategy, 155;
video modeling, 394; virtual
environments, 398
Generalized anxiety disorder (GAD), 14
INDEX
Genetic disorder: Angelman syndrome, 8–9;
Fragile X syndrome, 145–46; Rett’s
disorder, 309; tuberous sclerosis
complex, 385–86
Genetic factors/heredity, 155–56
Genetics: causes of autism, 124, 155; mother-
infant interaction, 412–13; twin
studies, 386
Genotype, 156
Gentle teaching (GT), 156–58
Gestalt processing, 174
Giftedness, 158–59
Gilliam Asperger Disorder Scale (GADS),
159–60
Gilliam Autism Rating Scale (GARS), 160
Girls, 309
Gluten-free (diet), 67, 107, 108, 160
Goal: annual, 12; extended school year, 128;
functional, 149–50, 151; Individualized
Education Program, 182;
Individualized Family Services Plan,
184; Individualized Transition Plan,
188–89; Individual Plan for
Employment, 187; instruction, 111;
intervention, 265; SCERTS model,
315; social, 371–72; survive and
thrive, 371–72; therapeutic, 11;
transition, 383–84; vocational, 187
Goal-directed activities, 316–17
Goldfield, Kate, 461–64, 467–68
Good grief, 160–61
Graduated guidance, 161–62
Grandin, Temple, 44, 172, 400
Graphic organizer, 162
Gravitational insecurity, 162–63
Greenspan, Stanley, 99
Grief, 160
Gross motor developmental quotient, 163
Gross motor skills, 163
Group: age, 202; homes, 302; instruction,
17; play, 191–95; socialization,
105–6; support, 339–41; therapy,
360
Guidance, social-communication, 193–94
Guided compliance, 163; physical guidance,
163
Guides: parent competence, 294–95; RDI
program, 290
Gustatory system, 336
Gut, 208
Habit rehearsal, 165
Hair analysis, 165
Hallucinations, schizophrenia, 319
483
INDEX
Halstead-Reitan Neuropsychological Test Battery
(HRPTB), 165–66
Hand-over-hand assistance (HOH), 166
Hand regard, 166
‘‘Happy puppet’’ syndrome. See Angelman
syndrome
Head circumference, 166–67
Head position, 393
Health information, 183
Health services, Individualized Health Care
Plan, 185–86
Hearing, 31
Hearing impaired individuals, total
communication, 381
Heart rate, 51
Heavy metals, 70, 167; autism, 124
Heller’s syndrome. See Childhood
disintegrative disorder
Help American Vote Act, 405–6
Helplessness, 208–9; prompt dependence, 281
Heredity, 155–56; genetic factors, 155–56
Hidden curriculum, 167–68, 169
Hidden supports, video feed-forward, 396
High-functioning autism, 42, 168–70;
Asperger’s disorder, 21, 23
High-risk individuals, 321
High school, 55–56, 404–5
Hippocampus, 170
Hippotherapy, 170–71
Hiring, respite care workers, 304–5
Holcomb, Roy, 381
Holding therapy. See Welch Method Therapy
Home, 43–44
Home-based programs, Son-Rise Program, 240
Homebound/hospital bound program, 171–72
Home care, 303–7
Hormone, 108
Hormone replacement, 172
Horses, 170
Hospital bound program, 171–72
Housing, 405; residential supports, 302
HRPTB. See Halstead-Reitan Neuropsychological
Test Battery (HRPTB)
Hug machine, 172. See also Proprioception
Human Subjects Review Committee, 196
Humor, 174
Hyperactive children: Angelman syndrome, 9;
Cognitive Behavior Modification, 79;
diet, 142
Hyperactivity, 67, 142
Hyperactivity disorders, 27–28
Hyperlexia, 172
Hyperresponsiveness, 172
Hypersensitivity, 375, 393
484
Hypnotics, 12
Hyporesponsiveness, 172
Hypothesis, positive behavior support,
266–67
ICD. See International Statistical
Classification of Diseases and Related
Health Problems
IDEA. See Individuals with Disabilities
Education Act
Ideas, 101
Ideology, 51
Idiosyncratic language, 173
IEP. See Individualized Education Program
IFSP. See Individualized Family Service Plan
IHCP. See Individualized Health Care Plan
I LAUGH model of social cognition, 173–75
Images, 142
Imagination, 175
Imaging, 67, 150, 217, 272
Imitation/modeling, 175–76; echoic, 392;
echoic behavior, 120; motor, 226
Immersion environment, 397
Immune system, 176; allergy, 5; autism, 124
Immunoglobulin, 176
Immunological tests, 176
Immunotherapy, 176
Impairment, 176
Implementation steps, incidental teaching,
177–79
Incidence, 176–77; mental retardation, 222;
Rett’s disorder, 309
Incidental teaching, 16–17, 177–79, 224
Incident report, 179–80
Inclusion, 180; least restrictive environment,
211–12; mainstreaming, 217–18
Income, Supplemental Security, 370
Independence: assistive technology, 25;
Cognitive Behavior Modification,
77–80; daily living, 1; daily living
skills, 95; expectations, 366;
functional goals, 149–50; functional
outcomes, 151; learned helplessness,
209; life skills curricula, 214;
prompting, 281; residential supports,
302; teaching, 80
Independent behavior, scales, 313
Independent employment, 180–81
Independent evaluation, Section 504, 323
Independent functioning skills, 113
Independent living: present level of
educational performance, 277; self-
determination, 328–29; transition
planning, 382–84

Independent thinking, developmental
individual-difference relation-based
intervention, 99
Indicators of Sensory Processing Disorder, 181
Individuality, 180
Individualization, SCERTS model, 317–18
Individualized Education Program (IEP),
181–83, 189–90; accommodation, 1;
annual goal, 12; Assessment of Basic
Language and Learning Skills, 24;
assistive technology, 25, 26; circle of
friends, 75; correctional facility, 93;
eligibility, 121; extended school year,
128; general education classroom,
210–11; language competence,
376–77; life skills, 213; mainstreaming,
217–18; music therapy, 227; personal
perspective, 452, 455–57; placement,
121, 147, 236, 324; present level of
educational performance, 275–77;
resource room, 303; transition plan,
188
Individualized Family Service Plan (IFSP), 4,
88, 183–85
Individualized Health Care Plan (IHCP),
185–86
Individualized interventions, applied behavior
analysis, 17
Individualized planning, 89
Individualized program, free appropriate
education, 147
Individualized Transition Plan (ITP), 186–87
Individual Plan for Employment (IPE),
187–89
Individuals with Disabilities Education Act
(IDEA), 41, 59, 91, 128, 137, 146–47,
181–82, 184, 188, 189–90, 209, 210,
217, 221, 222, 227, 322, 323, 382–84,
419, 448
Infant, 284; development early coping
inventory, 119; dynamic encounters,
292; head circumference, 167; joint
attention, 203–4; pervasive
developmental disorder, 246; proto-
declaration, 283–84; reactive
attachment disorder, 299; sensory
profile, 190; stress adaptation response,
410–12
Infantile autism, 205
Infant/Toddler Sensory Profile, 190
Inference, 51
Inferential language, 174
Inflammatory symptoms, stress-induced, 410
Informal assessment, 190
INDEX
Information: assessment, 24; case study,
402–3; consent to the exchange of, 91;
data, 97; double interview, 116;
gathering, 265–66; intersubjective
relationship, 294; mindblindness, 225;
present level of educational
performance, 276; prototype
formation, 284; school records
disclosure, 137–39; sensory processing,
337; social stories, 355–56; tactile,
375; visual structure, 368–69; visual
support, 401
Information processing: central coherence, 68;
cognitive learning strategy, 83
Initiation, monitoring play, 193
Initiation of questions, generalized skill, 257
Injury, 330; incident report, 179–80
Inner ear, 393
Insecure attachments, 299
Institute of Education Services (IES), 444
The Institutes for the Achievement of Human
Potential (IAHP), 243
Institutions, 43
Instruction: Applied Behavioral Analysis, 18;
direct, 110–11; learning strategies,
82–84; social skill, 398; systematic, 2;
trial, 385; van Dijk curricula, 390–91;
visual clarity, 369
Instructional goal, next step, 2
Instructional sequence, Cognitive Behavior
Modification, 80
Instructional steps, 112
Instructional techniques: accommodations, 1;
learning styles, 210; visual, 421
Instrumental social learning, social
competence, 348
Insurance coverage, 5, 171
Integrated employment, 191
Integrated Play Group Model (IPG), 191–96
Intellectual development, 221
Intelligence: Das-Naglieri assessment system,
96; dynamic and static, 291–92;
learning disorder, 209; Stanford-Binet
scales, 362; universal nonverbal test
of, 387
Intelligence Quotient (IQ), 196
Intelligence tests, 196, 408; mental age, 221
Intensity, loss and grief, 160–61
Intent, communicative protodeclaration, 283
Interaction: developmental milestones, 100;
reciprocal communication, 300
Interagency Autism Coordinating Committee
(IACC), 444
Interdependence, gentle teaching, 156–57
485
INDEX
Interest, restricted, 308
Interest in the world: autism red flag, 300;
developmental milestones, 100
Interests, Asperger’s disorder special, 21–22
Internal conditions, behavior, 47
Internal demands, 232
Internal interval, 113
Internal Review Board (IRB), 196
International Human Genome Project 446
International Rett Syndrome Association
(IRSA), 445
International Statistical Classification of
Diseases and Related Health Problems
(ICD), 197
Interobserver agreement/reliability, 197
Interpretation, 174; communication, 194
Intersubjective relationship (IR), 294
Intervention: auditory integration training,
31–33; clinical significance, 76; design
process, 423–24; developmental delay,
98; Doman-Delacato Treatment,
243–44; early, 119; early intensive
behavioral, 18; Fast ForWord, 139–41;
framework, 99; goals of, 265;
individualized planning, 89–90;
integrated play group, 193; music
therapy, 227; neuroscience based,
140–41; peptide treatment, 408–9;
picture exchange communication, 254;
pivotal response training, 255; priming
strategy, 279–80; RDI program
development, 289; self-management,
256–57; sensory integration, 334;
stimulus, 363; video modeling, 394;
video self-modeling, 395
Intervention in School and Clinic (journal), 432
Intervention plans, social skills training, 353
Interventions: behavior modification, 50;
dietary, 107; occupational therapy,
238–39; play-oriented therapies,
259–62; problem behavior prevention,
267; Ziggurat Model, 419–24
Intervention strategies: accommodation and
assimilation, 354–55; applied behavior
analysis, 15–16
Intervention strategy, joint action routines,
201–3
Intervention Ziggurat, 420–21
Interview: diagnostic, 40; double, 116; family
assessment, 137; respite care workers,
305
Intestinal tract, leaky gut syndrome, 208
Intestinal tract dysbiosis, 117
Intimacy, developmental milestones, 100
486
Intraverbal, 197, 392–93
Investigational device, auditory integration
training, 32–33
IPE. See Individual Plan for Employment
IQ, 41–42, 196; scores, 408
IR. See Intersubjective relationship
Irlen lenses, 197–99
ITP. See Individualized Transition Plan
JAR. See Joint action routines
Jaundice, 222
Jig, 369
Job coach, 370
Job placement services, 404
Jobs, 180–81, 191; respite care worker, 303–4
Joint action routines, 201–3
Joint attention, 203–4, 283, 349
Journal, 204
Journal of Applied Behavioral Analysis, 432
Journal of Autism and Developmental Disorders,
431
Journal of Child Psychology and Psychiatry and
Allied Disciplines, 432
Journal of Neuropsychiatry and Clinical
Neurosciences, 433
Journal of Positive Behavior Interventions, 433
Journal of Speech Hearing Language Research,
433
Journal of the American Medical Association,
433
Journal of the International Neuropsychological
Society, 433–34
Juvenile offenders, 93
KADI. See Krug’s Asperger’s Disorder Index
Kanner, Leo, 43, 121, 205
Kaufman, Barry Neil, 239–40
Kaufman, Samahria Lyle, 239–40
Ketogeic diet, 107
Kinesthetic/tactile learners, 210
Knowledge, empiricism, 123
Krug’s Asperger’s Disorder Index, 205–6
Labeling, 375
Lactose intolerance, 207
Landau-Kleffner syndrome, 207–8
Language, 41, 253; abstract inferential, 174;
American sign, 6; Asperger’s disorder,
20–21; assessment, 76, 89; body, 400;
cartooning, 65–66; competence test,
376–77; concrete, 91; development
test, 377; double interview assessment,
116; echolalia, 67, 120, 245, 283;
expressive, 128; figurative, 142; fluency

disorder, 142; high-functioning autism,
169; idiosyncratic, 173; invitation,
174; milieu teaching, 223–24; personal
perspective, 463; person first, 245–46;
pragmatics test, 377; receptive, 300;
receptive deficits, 402; social thinking
skills, 143–44; total communication,
381; utterance mean length, 220–21;
verbal behavior, 391–93
Language acquisition: American Sign
Language, 6; evaluation, 126–27;
natural language paradigm, 231
Language development: experience sharing,
293; Picture Exchange
Communication System, 251–52
Language disorders, 358
Language intervention paradigm, 231
Language skills, 359
Language training, 393
Latency of response, 308
LaVoie, Richard, 343
Law: due process, 117; Rehabilitation Act of
1973, 301; special education, 189–90;
voter registration, 405–6
Laws of behavior, 50
LEA. See Local education agency
Leaky gut syndrome, 208
LEAP. See Life Skills and Education for
Students with Autism and Other
Pervasive Behavioral Challenges
Learned helplessness, 208–9
Learning: apprentice experience, 294–95;
biofeedback, 52; daily living skills, 95;
embedded skills, 122; forms f, 1616;
massed practice, 219; social skills, 352;
visual, 400
Learning ability, van Dijk assessment, 390
Learning activities, independent completion,
81–86
Learning disabilities: savant skills, 159;
sensory integration, 333
Learning disability, nonverbal, 234–35
Learning Disability Association of America
(LDA), 445
Learning disorder, 209–10
Learning environment, safety, 55–56
Learning language, Fast ForWord, 139–41
Learning methods, Bolles Sensory Integration,
53
Learning opportunities, life skill teaching, 214
Learning pattern, structured teaching, 366
Learning responses, precision teaching, 275
Learning strategies, graphic organizers, 162
Learning strategy, instruction, steps, 82–84
INDEX
Learning styles, 210
Learning theories, life skills education, 213
Learning theory, applied behavior analysis, 15
Least restrictive environment, 189;
mainstreaming, 218; resource room,
303
Least restrictive environment (LRE), 210–12
Legislation, assistive technology, 24–25
Leiter International Performance Scale, 213
Life activities, visual strategy, 402
Life roles, occupational therapy, 238
Life skills: environmental stressors, 125;
residential supports, 302; support, 215.
See also Daily living
Life Skills and Education for Students with
Autism and Other Pervasive
Behavioral Challenges (LEAP),
213–15
Life skills support, 215
Light-sensitivity disorder, 198
Likely maintaining variables, 148
Limbic system, 215
Limitations, 150
Limit setting, respite care worker, 305–6
Linamood, Pat, 215
Lindamood-Bell, 215–16
Linguistic activity, utterance mean length,
220–21
Linguistic competence, augmentative and
alternative communication, 35–36
Listener, 357
Listening, invitation, 174
Local education agency, 216
Locators, visual tools, 401
Locomotion, 216
Loss, 160–61
Lovaas Institute for Early Intervention (LIFE),
445
Low/poor registration, 216
LRE. See Least restrictive environment
Lucas, Edourard, 382
The MAAP (newsletter), 428
MAAP Services for Autism and Asperger
Syndrome, 445–46
Magnetic resonance imaging, functional, 150
Magnetic resonance imaging (MRI), 150, 217
Mainstreaming, 217–18; least restrictive
environment, 211
Maintenance, 218
Major life activity, 323–24
Maladaptive attribution, 29
Maladaptive behavior, 219, 333; gentle
teaching, 156–57; intervention plan, 50
487
INDEX
Males, 43, 122, 145, 309
Mand, 219, 224, 391–92
Maneb, 248
MAOI. See Monoamine oxidase inhibitors
Map, body and environment, 334
Mapping, social behavior, 344–46
Marshall University, 426
MAS. See Motivation Assessment Scale
MASC. See Multidimensional Anxiety Scale
for Children
Massed practice, 219
Masturbation, 219–20
Maternally deprived orphans, 408
Mathematics, Tower of Hanoi, 382
Mathematics disorder, 209
Maturation, developmental age, 97–98
M-CHAT. See Modified Checklist for Autism
in Toddlers (M-CHAT)
MDS. See Multidisciplinary evaluation
Meaningful activities and purposeful activities
approach, 316–18
Mean length of utterance, 220–21
Meares, Olive, 197–98
Measles-mumps-rubella vaccine, 124
Measurable outcomes, applied behavior
analysis, 15
Measurement: biofeedback, 51; data, 96;
Individualized Education Program,
182
Mediation, 117, 221; written agreement, 229
Medical condition, mood disorders, 225
Medical emergency, 185
Medical information, 183
Medication, 12–13; mood stabilization, 226;
psychopharmacology, 286; selective
mutism, 327; stimulant, 363; tic
disorders, 379
Medication research studies, 259
Memory, 213; episodic, 293–94; hippocampus,
170; limbic system, 215
Men, schizophrenia, 319
Menopause, 145
Mental age, 221
Mental disorders, diagnosis, 106
Mental handicap, giftedness, 158
Mental health counselor, 221
Mental illness: mood disorders, 225–26; stress
adaptation network, 409
Mental impairment, 323
Mental retardation, 145, 221–22; adaptive
behavior, 2; Childhood Disintegrative
Disorder, 72
Mental state: attribution, 28–29;
dimethylgycine, 110; psychobiology,
488
285; theory of mind, 29–30, 50,
146–47, 348, 378
Mentors, classmates, 74–75
Mercury, 222–23
Metacognition. See Cognitive Behavior
Modification
Metallothionein, 223
Metals, heavy, 165, 167
Meyer, Donald, 340
Milestone, developmental, 99–106
Milieu teaching, 223–24
Mind: psychobiology, 285; theory, 29–30, 56,
146–47, 347, 348, 378
Mindblindness, 225
Mind read, inability to, 60
Mineral supplements, 107–8
MLU. See Mean length of utterance
MMR vaccine, 124
Mobility limitations, physical therapy,
249–50
Model, applied behavior analysis
implementation, 18
Modeling, 16, 175; play guides, 193; video
self, 395
Modified Checklist for Autism in Toddlers
(M-CHAT), 225
Modified Inventory of Wrongful Activities,
56
Monitoring: play initiation, 193; positive
behavior support, 271; self, 260
Monoamine oxidase inhibitors (MAOI), 13
Mood disorders, 225–26
Mood stabilizing medications, 226
Moore, Lynda M., 466
More Able Autistic Persons (MAAP), 428
Morpheme, 221
Mother: child relationship, 259; infant stress
adaptation, 410–13; personal
perspective, 453–57, 459–61, 468–69;
RDI program, 289; refrigerator theory,
51, 311
Motivation: achievement attribution, 29;
behavior modification, 391–92;
cartooning, 62; establishing operation,
126; incidental teaching, 16–17; of
others, 29; pivotal response training,
256; play groups, 191; success, 105;
video modeling, 394; video self-
modeling, 396
Motivation Assessment Scale, 226
Motor action, apraxia, 19
Motor imitation, 226
Motor planning, 335
Motor response, 331

Motor skills: Asperger’s disorder, 22;
dyspraxia, 132; gross, 163; regression,
309–10
Motor tics, 379
Movement: catatonia, 67; coordination of,
162–63; dance therapy, 95–96;
proprioception, 283; repetitive, 169,
243, 300
Moyer, Sherry, 468–69
MRI. See Magnetic resonance imaging
Multidimensional Anxiety Scale for Children
(MASC), 226–27
Multidisciplinary evaluation (MDE), 227
Multidisciplinary framework, 313–18
Multidisciplinary team, 227, 314
Multisensory association method, 27
Multistep skills, 2
Multitasking, 83
Muscle catatonia, 67
Musical savant skills, 159
Music therapist, 228–29
Music therapy, 227–29
Mutually acceptable written agreement,
229
Mutual regulation, 316
Myelin, 140
National Alliance for Autism Research
(NAAR), 446
National Association for the Education of
Young Children, 102
National Association of School Nurses,
185–86
The National Autistic Society, 430
National Human Genome Research Institute,
446
National Human Genome Research Project,
248
National Information Center for Children and
Youth with Disabilities (NICHCY),
447
National Institute for Child Health and
Development (NICHD), 443
National Institute of Child Health and
Human Development (NICHD), 447
National Institute of Health Autism
Coordinating Committee, 449
National Institute of Mental Health (NIMH),
444, 449, 450
National Institute on Deafness and Other
Communication Disorders (NIDCD),
443
National Institutes of Health, 198, 444, 446,
447, 449, 450
INDEX
National Organization for Rare Disorders
(NORD), 447
National Research Council, 194, 262
National Service Dogs (NSD), 11
National Voter Registration Act of 1993, 405
Naturalistic approach, 201
Natural language paradigm, 231
Needs: assistive technology, 25; underlying,
423
Negative practice, 241
Negative reinforcement, escape training,
126
Nervous system: Halstead-Reitan
Neuropsychological Test Battery,
165–66; rewiring, 334; sensory
integration, 333–34; stimulants, 363
Network on the Neurobiology and Genetics
of Autism, 443
Neurofeedback, 231–33
Neuroimaging, 150, 233
Neurological condition: dual sensory loss,
390–91; dyspraxia, 132; sensory
sensitivity, 338
Neurological damage, pesticides, 248
Neurological disorder, 98; Childhood
Disintegrative Disorder, 72; pervasive
developmental disorder not otherwise
specified, 246
Neurological syndromes, nonverbal learning
disability, 234–35
Neurologic organization, 243–44
Neurologist, 233
Neurology, 233
Neurology (journal), 434
Neuromotor, 233
Neuropsychology, 233
Neuroscience-based perspective, interventions,
140–41
Neuroscience & Biobehavioral Reviews (journal),
434
Neurotoxic, 233
Neurotransmitter, 115, 234; serotonin, 338
New England Center for Children (NECC),
428
The New England Center for Children Research
Newsletter, 428
New England Journal of Medicine (journal), 434
Newsletter, 234
NLP. See Natural language paradigm
No Child Left Behind Act 2001
(PL 107-110), 234, 447
Nocturnal enuresis, 123
Noise, background, 68
No-no prompt procedures, 234
489
INDEX
Nonreaders: visual schedule, 367; work
systems, 368
Nontraditional approaches, 6
Nonverbal communication, 33; dog, 10; high-
functioning autism, 168–69
Nonverbal information, mindblindness, 225
Nonverbal intelligence: Leiter International
Performance Scale, 213; universal test,
387
Nonverbal knowledge, absurdities, 1
Nonverbal language, pragmatics, 275
Nonverbal learning disability, 55, 210,
234–35
Nonverbal mental process, Children’s
Category Test, 73
Nonverbal social cues, cartooning, 62
Nonverbal stimulus: intraverbal, 392–93; tact,
392
Nonverbal students, visual strategy, 402
NOREP. See Notice of Recommended
Educational Placement
Norm, 245
Normalization, 235–36
Norm-referenced assessment, 236; Gilliam
Autism Rating Scale, 160
North Carolina, structure teaching, 365–68
North Star Foundation, 11
Notice of Recommended Educational
Placement (NOREP), 236
Novice players, 193
NSD. See National Service Dogs
Nurse, 185–86
Nutritional deficiencies, 107–8
Nutritional supplements, 236
The OARacle (newsletter), 428
Object integration test, 237
Objective, 12, 48, 237
Object sorting test, 237
Obscure communication, 194
Observation, 83–86; data, 96; diagnostic, 40;
direct, 111; early coping, 119
Observer reliability, 197
Obsessive-compulsive disorder (OCD), 14;
pica, 250–51
Occupation, definition, 237–38
Occupational therapist (OT), 237–38
Occupational therapy, 238–39; checklist,
70
OCD. See Obsessive-compulsive disorder
Office of Medical Assistance Programs, 49
Office of Special Education and
Rehabilitation Services (OSERS),
447–48
490
Office of Special Education Programs (OSEP),
448
Olfactory system, 336
Online Asperger’s Syndrome Information and
Support, 308
On-task behavior, 80
The Open Door Newsletter, 428
Operant: conditioning, 50, 231–32, 239;
learning, 15–16; verbal behavior, 391,
393
Operational competence, augmentative and
alternative communication devices, 36
Operational definition, 376
Opinion, clinical, 76
Opioid peptides, 244
Oppositional defiant disorder, 27–28
Options (Son-Rise Program), 239–41
Option strategy, 342–43
Oral-motor skills, 241
Oral sensitivity, 241
Organization: abstract information, 162;
Asperger’s disorder, 22; attribution
information, 29; learning strategy,
82–83; personal perspective, 467–68;
school material, 68; structured
teaching, 366; visual, 368
The Organization for Autism Research
(OAR), 428, 448
Other minds, 225
Otherwise qualified, 322
Outcome, 237; applied behavior analysis, 15;
attribution pattern, 29; clinical
practice, 76; curriculum model, 390;
documentation, 194; functional, 151;
measure, 88, 184; planning, 265;
survive and thrive, 371; van Dijk
curricula, 390–91
Ovarian failure, 145
Overcorrection, 17, 241
Overfocused attention, 241
Overselectivity/overfocused attention, 241;
stimulus, 364; video modeling, 394
Oversight, 201
Oxytocin, 409, 410–11
PACER Center, Inc., 448
Pangamic acid, 110
Parent, 9, 43; career transition planning, 59;
collaboration, 424; consent, 91–92,
182; early coping inventory, 119;
family vision statement, 183; gentle
teaching, 156–57; guide competency,
294–95; Individualized Family Services
Plan, 185; mediation, 221; personal

perspective, 466; RDI program,
289–90, 289–95; rights, 121, 137–39,
183; Section 504 qualification, 323;
Sibshops, 341; Son-Rise Program, 240;
Supplemental Security Income, 370;
transition planning, 384; van Dijk
approach, 390
Parental care, 411–12
Parental concern: child performance, 29;
developmental surveillance, 104;
present level of educational
performance, 276
Parental history, 40
Parent-child interaction, 295, 411–13
Parenting, 51, 124, 155; respite care, 303–7
Partial seizures, 325
Participation: guided, 294; Individualized
Education Program, 182; perspective,
174
Participation model, 37
PASS theory, 96
Pathology, Welch Method Therapy, 409–11
Patterning (Doman-Delacato treatment),
243–44
PBS. See Positive behavior support
PDD. See Pervasive developmental disorders
PECS. See Picture Exchange Communication
System
Pedantic speech, 244
Pediatrician, developmental surveillance, 104
Pediatrics (journal), 434–35
Peer, 189; developmental therapy, 105–6;
friendship circle, 74; groups, 191, 228;
incidental teaching, 178; inclusion,
212; Individualized Education
Program, 182; life skill curricula,
213–14; mentoring, 353–54; modeling,
332, 360; personal perspective, 467–
68; shunning, 55; social skills, 352
Peer-mediated approaches, 261
Peer reviewed, 244
PEP-3. See Psychoeducational Profile–Third
Edition
Peptide, 244, 321, 408–15
Percentile, 245
Perception, 131
Performance level: Individualized Education
Program, 182; responsibility, 295
Permission, 91–92, 182
Perseveration, 245
Perseverative scripting, 21, 245
Persistence, picture exchange communication,
252
Personality, respite care providers, 304–7
INDEX
Personal perspectives, 245
Personal space, 351
Person-centered planning, 265–71, 266
Person first language, 245–46
Perspective, 116, 174, 201; intersubjective
relationship, 294; other people, 62,
203; personal, 245; theory of mind,
29–30, 56, 378
Perspective-taking, 144, 174, 220; deficits,
28–29
Pervasive Developmental Disorder–Not
Otherwise Specified, 246–47
Pervasive Developmental Disorder–Not
Otherwise Specified Diagnostic
Criteria, 247
Pervasive developmental disorders (PDD), 41, 98,
247–48; bowel problems, 53; nonverbal
learning disorder, 210; not otherwise
specified (PPD-NOS), 42, 246–47; Rett’s,
309; Screening Test-II, 248; social
communication screening, 347
Pervasive Developmental Disorder Screening
Test II, 248
Pesticides, 248
PET. See Positron Emission Tomography
Petit mal seizures, 325
Pharmaceuticals, 248
Pharmacology, 97, 248
Phenotype, 248–49
Phonics association method, 27
Physical activity, 283, 333–34
Physical guidance, 163
Physical impairment, 323
Physical organization, 366
Physical presence, 143
Physical therapist, 249
Physical therapy, 249–50; hippotherapy, 170
Physician, 233, 236
Pica, 250–51
Picture discrimination, 252
Picture Exchange Communication System
(PECS), 37, 251–54
Pilewskie, Anne, 457–61
Pivotal response training, 255–59; play-
oriented therapy, 260
Placebo, 115, 259
Placement: assistance dog, 10; educational,
121, 147–48, 236, 324; job services,
404; least restrictive environment,
210–12; mainstreaming, 217–18
Planning: cognitive assessment, 96;
comprehensive program system, 89–90;
work adjustment period, 414–15;
Ziggurat Model, 419–24
491
INDEX
Play, 105, 245, 349, 360–61; developmental
assessment, 103; developmental
milestones, 101; group, 191–95, 261;
guidance, 194; guides, 192;
imagination, 175; materials, 192;
scaffolding, 193; selective mutism
treatment, 326–27; symbolic, 372
Playmates, 192
Play-oriented therapies, 259–64
PLEP. See Present level of educational
performance
Pointing, 283, 284
Poor registration, 216
Population, 176, 361
Positive behavior support (PBS), 264–72
Positive practice, 241
Positive reaction, 352
Positive reinforcement, 113
Positive self-review (PRS), 395
Positron Emission Tomography (PET), 272
POSSE strategy, 82–83
Postemployment services, 187
Postschool activities, 383
Postsecondary education, 272
Postsecondary transition, 188–89
Posttraumatic stress disorder (PTSD), 14,
272–73
Power Card strategy, 274–75
Powerlessness, 209
Practice, 241, 397–98; appropriate, 102;
disturbed, 115; massed, 219; repetitive,
63
Practitioners, board certification, 49
Pragmatics, 275, 347; test of language, 377
Pragmatic skills, I LAUGH model,
173–74
Praxis, 275; sensory integration, 335
Precision teaching, 275
Predictability strategy, 279
Prediction strategy, 82–83
Predisposition, 124
Preference documentation, 193
Preferred reinforcer, 113
Prenatal infection, 124
Prenatal tests, 9
Preparation of products, 202
Preschool children, 254
Preschool language evaluation, 76
Prescreening scales, 205
Present level of educational performance
(PLEP), 275–78
Preservation, 22, 245
Pressure, 381
Presymbolic thought, 278
492
Prevalence, 176, 278; schizophrenia, 320
Prevalence rate, 43
Prevention programs bullying, 56
Priming, 279–80
Privacy rights, 137–39
Probe, 280–81
Problem behavior, information gathering,
265–71
Problem-solving, 292; adolescent test,
378; assessment, 414; cognitive
learning strategies, 81–86;
developmental therapy stage, 106;
elementary test, 378; self-
awareness, 293–94
Procedural safeguards, 281
Professional: dance therapist, 96;
development, 215; gentle teaching,
156–57; mental health counselor, 221;
multidisciplinary team, 227; music
therapist, 228–29; SCERTS model
value, 314; speech language
pathologist, 358; standards, 196. See
also Certification
Prognosis, 41, 72, 208
Program planning, 89–90; Individualized
Education Program, 181–83;
Individualized Family Service Plan,
183–85; Individualized Health Care
Plan, 185–86; Individualized
Transition Plan, 188–89; Individual
Plan for Employment, 186–87
Progress assessment, 24
Progress reports, 182
Prompt, 161–62, 252, 353; behavior
generalization, 354; dependence, 166,
281; discrete trial training, 112–14;
fading, 136; hierarchy, 281–82; no-no
schedule, 234; trial, 385; visual, 366.
See also Stimulus
Prompt dependence, 281
Prompt-free approach, 224
Prompt hierarchy, 281–82
Prompting, 282; applied behavior analysis, 16;
hand-over-hand assistance, 166;
within-stimulus, 255
Pronoun errors, 282–83
Proprioception, 97, 172, 283, 336, 381
Prosody, 283, 300
Proteins, 108, 223
Protest, 151, 152
Protocols, Assessment of Basic Language and
Learning Skills, 24
Proto-declarative, 283–84
Proto-imperative, 284

Prototype formation, 284
Proximal development, 421, 424
PRS. See Positive self-review
Psychiatrist, 49, 52, 285
Psychoanalytic approach, 259–60
Psychoanalytic therapy, 19
Psychobiology, 285
Psychoeducational Profile–Third Edition
(PEP-3), 285
Psychological approaches, selective mutism,
327
Psychological Medicine (journal), 435
Psychologist, 285; behavior health
rehabilitation services, 49
Psychology: behaviorism, 50; cognitive
behavior, 78; neuropsychology, 233
Psychometrics, 286
Psychopharmacology, 286
Psychosocial, 286
PTSD. See Posttraumatic stress disorder
Public accommodations, 7
Public schools, 43–44
Public services, 7
Punishment, 286–87; discipline, 306;
overcorrection, 241; response cost,
307; skill mastery, 420–21; time-out,
380
Purposeful activities, 238–39
Puzzle, 382
Pyramid Approach to Education in Autism,
251
Quality of life, 265, 271, 289, 328
Questions, 193, 319, 343; answering, 105;
assessment, 368; double interview,
116; interaction, 300; learning
strategy, 83–86; picture exchange
communication, 253; response, 11,
177–79, 197, 253; self-initiated, 257;
self-instruction, 79–80
Rank, percentile, 245
Raw scores, 362
RDI Program, 289–98
Reaction, desensitization, 97
Reactive attachment disorder of infancy or
early childhood, 299–300
Reactive behavior, coping inventory, 119
Reading, 106, 198; assessment, 75–76;
comprehension, 82, 227; difficulty,
117; disabilities, 198; disorders, 209
Reasonable accommodation, 272, 324
Receptive function, feature, class process
(RFFC), 392
INDEX
Receptive language, 300
Receptive skill loss, 207–8
Reciprocal communication/interaction,
300
Recreational supports, transition to
adulthood, 4
Red flags, 300–301
Refrigerator mother theory, 43, 51, 311
Registration, sensory stimulation, 216
Regression: Rett’s disorder, 309; skill, 128
Regular Education Initiative (REI), 217–18
Regulation: dynamic environment, 291–92;
self-, 331
Rehabilitation Act of 1973, 6–7, 137, 301;
Section 504, 322–24
Rehabilitation therapists, 249
Rehearsal, 48; cognitive picture, 63; habit,
165; speech, 11. See also Practice
REI. See Regular Education Initiative
Reinforcement, 420; applied behavior analysis,
17; behavior extinction, 129;
differential, 109–10; escape training,
126; establishing operation, 126;
mand, 219, 224, 391–92; milieu
teaching, 224; modeling behavior, 394;
schedule, 318; shaping, 339; stimulus
control, 364; time-out, 380; token
economy, 380–81
Reinforcement, schedule, 318
Reinforcement inventories, motivation, 391
Reinforcer, 301; applied behavior analysis, 16;
behavior generalization, 354;
inventory, 113; motivation, 256;
Picture Exchange Communication
System, 251; punishment, 286;
response cost, 307; token economy,
380–81
Reinforcing stimulus, discrete trial training,
113
Relatedness, 174
Relationship, intersubjective, 294
Relationships, social skills assessment, 352
Relaxation, systematic desensitization, 373
Relaxation training, 52
Reliability, interobserver, 197
Remediation, 289; RDI program, 290
Reminders, 421
Repetition, 63, 201, 299, 300, 373
Repetitive behavior, 41, 42, 72, 165, 241
Report: anecdotal, 8, 385; evaluation, 127;
incident, 179–80; progress, 182
Representation: attribution, 28–29; symbol
comprehension, 34–35
Requesting, 152
493
INDEX
Research, 44; auditory integration training,
32–33; control group condition, 93;
deficit remediation, 290–94; double
blind design, 115; Eisenberg, Leon,
121; empiricism, 123; epidemiology,
125; experimental design, 128; human
subjects, 196; incidental teaching, 178;
integrated play group model, 194–95;
milieu teaching, 223–24; social skill
training, 353–54; treatment
effectiveness, 385; twin studies, 386;
validity, 389
Research method, clinical trial, 77
Residential facility, 301
Residential programs, 4
Residential supports, 302–3
Resource room, 303
Respite care, 303–7
Respondent conditioning, 307
Responding interventions, 267–68
Response: autism red flag, 300; discrete trial
training, 112–13; environmental and
development, 104–5; intraverbal, 197;
receptive verbal behavior, 392;
training in pivotal, 255–57; trial, 385
Response cost, 17, 307–8; punishment, 286
Response latency, 308
Responses: reinforcement schedule, 318;
sensory threshold, 338; setting events,
338–39; social behavior mapping, 345
Responsibility: developmental therapy stage,
106; performance level, 295
Responsiveness, motivation, 256
Restitution, overcorrection, 241
Restricted interest, 308
Restrictions, functional limitations, 150
Retrospective video analysis (RVA), 308
Rett’s disorder, 98, 246, 247, 309–10
Rett’s disorder–diagnostic criteria, 310–11
Revocation of consent, 92
Rewiring, nervous system, 334
Rexin, Valerie Janke, 464–65
RFFC. See Receptive function, feature, class
process
Rights: parents, 121, 137–39, 183; student,
189–90; vocational rehabilitation
consumers, 186–87
Rimland, Bernard, 311
Ritalin, 363
Ritual behavior, 67, 239–40, 299; Obsessive
Compulsive Disorder, 14; play group,
192, 261
Role model, 218
Roosa, Jan, 342
494
Routine, 36, 42, 86, 169; adaptive behavior,
202; Asperger’s disorder, 22; daily,
178, 184; developmental therapy,
104–5; joint action, 201–3; life skills,
213; milieu teaching, 223–24; personal
perspective, 463; play group, 192, 261;
priming, 279–80; SCERTS model,
314; van Dijk approach, 390; visual
strategies, 402
Rowley. See Board of Education of the Hendrick
Hudson School District v. Rowley
Rubella, 399
Rudeness, 55
Ruggiero Laboratory of Behavioral
Neuroanatomy, 409
Rule-governed behavior, 16
Rumination syndrome, 311
Running off, 11
RVA. See Retrospective video analysis
Sabotage, 201
Safety: assistance dogs, 11; bullying, 55–56;
hippotherapy, 171; Individualized
Health Care Plan, 185–86; social
stories approach, 356
Sakai, Kristi, 453–57
Sameness, Asperger’s disorder, 22
Savant skills, 158
SB5. See Stanford-Binet Intelligence Scales–
Fifth Edition
Scaffolding, 193
Scaffold language development, 201
Scale: adaptive behavior, 396–97; adolescent
and adult psychoeducational profile, 3;
anxiety multidimensional scale,
226–27; Asperger disorder, 23, 159–60,
205; behavior rating, 148; child
anxiety, 226–27; child behavior, 49;
childhood autism, 71; cognitive
performance, 213; communication and
symbolic behavior, 87–88; differential
ability, 108–9; independent behavior,
313; intelligence, 1, 362, 408;
motivation, 226; student social
attribution, 369
Scales of Independent Behavior–Revised
(SIB-R), 313
SCERTS Model, 261, 313–18
Schedule, 367, 401
Schedule of reinforcement, 318
Schizophrenia, 13, 318–20
School, 216; daily living skills, 95; family
rights, 137–39; functional behavior
analysis, 148; funding, 322; least

restrictive environment, 210–11; life
skill teaching, 214; Lindamood-Bell
services, 215; No Child Left Behind
Act, 234; performance assessment,
414; personal perspective, 455–57,
457–59, 459–61; readiness skills, 332;
safety and bullying, 55–56; special and
alternative, 358; special education law,
189–90; success attribution, 369;
vision screenings, 198
School districts, 216, 277, 323
School Function Assessment, 320
School nurse, 185–86
School record, 137–39
School staff, 54
School system, 181–83
Schopler, Eric, 320
Science in Autism Treatment (newsletter), 440
Scoptic sensitivity syndrome (SSS), 198
Score: developmental, 103; General
Conceptual Ability, 108–9;
Intelligence Quotient, 196; percentile,
245; standard, 362; standard deviation,
361
SCQ. See Social Communication
Questionnaire
Screening, 225, 248, 321
Screening tool: Autism Behavior Checklist,
39; Autism Screening Instrument for
Educational Planning, 41; Sensory
Integration Inventory, 337; Short
Sensory Profile, 339; Social
Communication Questionnaire, 347
Screening Tool for Autism in Two-Year-Olds
(STAT), 321
Script: perseverative, 245; play, 193–94;
social, 349–50; teaching, 83–84
Search for structure, POSSE strategy, 82–83
Seclusionary time-out, 380
Secretin, 108, 321–22, 409, 410–11
Section 504 of the Rehabilitation Act of
1973, 137, 301, 322–24
Sedatives, 12
Seeking assistance: developmental therapy
stage, 106; SCERTS model, 316
Seizure disorder, 42, 207–8, 325
Selective mutism, 326–27
Selective serotonin reuptake inhibitors
(SSRI), 12, 13
Self, 293–94
Self-advocacy, 327; personal perspective,
458
Self-awareness, 293–94
Self-care, 2; respite care workers, 305
INDEX
Self-confidence, 396, 399; daily living, 295;
developmental therapy, 105;
facilitation, 132; testing, 415
Self-contained classroom, 327;
mainstreaming, 217–18
Self-contained programs, residential supports,
302
Self-control: behavior therapy, 78; repetition
practice, 63
Self-determination, 327–30
Self-directed activities, independent
employment, 180–81
Self-employment, 180–81
Self-evaluation, 3
Self-help skills, 330; Asperger’s disorder, 22;
Childhood Disintegrative Disorder, 72;
functional, 151
Self-initiated behavior, coping inventory, 119
Self-initiation, pivotal response training, 257
Self-injurious behavior, 330
Self-instruction. See Cognitive Behavior
Modification
Self-management: biofeedback, 51–52; pivotal
response training, 256–57. See also
Cognitive Behavior Modification
Self-monitoring, 260. See also Cognitive
Behavior Modification
Self-regulation, 331; developmental
milestones, 100; SCERTS model, 316;
Son-Rise Program, 239–40
Self-reliance, daily living skills, 95
Self-speech, 79
Self-stimulatory behavior, 47, 219–20
Seligmann, Martin, 208
Sensation avoiding, 331
Sensation seeking, 331
Sense receptors, somatosensory, 358
Sensitivity: elimination diet, 122; error
correction, 125; Modified Checklist for
Autism in Toddlers, 225; sensory, 338;
vestibular system, 393
Sensitivity training, 354
Sensorimotor, 331
Sensorimotor early childhood activities,
331–32
Sensorimotor organization, coping inventory,
119
Sensorimotor rhythm (SMR), 232
Sensory behavior, analysis inventory, 8
Sensory history, 333
Sensory information: Bolles Learning Method,
53; deep pressure touch technique, 97;
hyperresponsiveness, 172;
hyporesponsiveness, 172
495
INDEX
Sensory integration, 333–34; developmental
milestones, 100; dysfunction, 335–36;
early childhood activities, 332; play-
oriented therapy, 261
Sensory Integration and Praxis Test (SIPT),
335
Sensory integration dysfunction, 335–37. See
also Sensory processing disorder
Sensory Integration International, 335
Sensory Integration Inventory–Revised
(SII-R), 337
Sensory loss, van Dijk approach, 390–91
Sensory needs, 420; music therapy, 228–29;
power cards, 274
Sensory processing, 3, 337; dysfunction, 337;
infant/toddler profile, 190
Sensory processing disorder, 22; early
childhood, 331–32; indicators, 181
Sensory processing dysfunction, 337
Sensory profile, 337–38
Sensory Profile, short, 339
Sensory reinforcement, extinction, 129
Sensory sensitivity, 338
Sensory stimulation, registration, 216
Sensory stimuli, 338
Sensory system, 54, 335–36
Sensory threshold, 338
Sentence structure, 253
Serotonin, 338
Service plan, Individualized Education
Program, 182
Services: assistive technology, 26; due process,
117; Individualized Education
Program, 181–83; Individualized
Family Service Plan, 183–85;
Individualized Health Care Plan,
185–86; Individualized Transition
Plan, 188–89; Individual Plan for
Employment, 186–87; least restrictive
environment, 210–11; occupational
therapy, 238–39; postemployment,
187; qualifying for, 323; residential
support, 302; Section 504, 324; self-
determination, 329; speech
pathologist, 359–60; transition
planning, 382–84; transition to
adulthood, 4. See also Special
education; Vocational rehabilitation
Setbacks, learning from, 161
Setting events, 338–39
Settings, occupational therapy, 238
Sex education, 219–20
SFA. See School Function Assessment
Shape, 122
496
Shaping, 339; applied behavior analysis, 16
Shared attention mechanism, 29
Sharing: experience, 293; social competence,
348; space, 351
Sharing activities, developmental therapy
stage, 105
Short Sensory Profile, 339
Shunning, 55
Siblings, 459; personal perspective, 464–65
Sibling Support Project, 339–40
SIB-R. See Scales of Independent Behavior–
Revised
Sibshops, 340–42
Sight, 336
Signing, 392
Sign language, 381
SII-R. See Sensory Integration Inventory–
Revised
Silly situation, 201
Simulation: social situation strategies, 342–43;
virtual environment, 397–99
Simultaneous processing, cognitive assessment,
96
Single-subject design, 342
Single-user virtual environments (SVEs),
397–98
SIPT. See Sensory Integration and Praxis Test
Situation-Options-Consequences-Choices-
Strategies-Simulation (SOCCSS),
342–43
Skill: acquisition, 48, 353; adaptive behavior,
2; assessment, 3, 24, 126–27, 178–79,
313; daily living, 95; deficit, 354;
development, 420–21; embedded, 122;
functional goal, 149–50;
generalization, 114, 155; Individualized
Transition Plan, 188–89; instruction,
112, 421; learning motivation, 256;
loss, 72; maintenance, 218; on-task
behavior, 80; play, 191–95; practice,
219, 397–98; prompt, 113; prompting,
281–82; regression, 128; school
readiness, 332; self-help, 330; social
curiosity, 371; social scripts, 350;
social thinking, 143–44; splinter, 360;
structured teaching, 369; target
behavior, 376; teaching new, 16–17;
transition to adulthood, 4; van Dijk
approach, 390; video modeling, 394;
visual deficiencies, 198
Skin, 176, 358
Skinner, B. F., 50, 197, 219, 391–93
Sleep, 9, 232
SLP. See Speech language pathologist

Smell, 336
Social accommodation, 354–55
Social Articles, 356
Social assimilation, 354–55
Social autopsies, 343–44
Social awareness, 235, 351
Social behavior mapping, 344–47
Social cognition: double interview assessment,
116; I LAUGH model, 173–74
Social communication, 347; integrated play
group, 193–94; SCERTS model, 314,
315; selective mutism, 326
Social Communication, Emotional
Regulation, and Transactional
Support. See SCERTS Model
Social Communication Questionnaire (SCQ),
347–48
Social competence, 348; behavioral rehearsal,
48
Social contacts, circle of friends, 74
Social context: perspective taking, 144;
pragmatic language test, 377;
transactional supports, 316
Social cooperative games, 202
Social cue, Storymovie, 364–65
Social curiosity, survive and thrive, 371
Social deficits, 55
Social development: life skills education, 213;
Son-Rise Program, 240
Social difficulties, pervasive developmental
disorder not otherwise specified, 246
Social dimension: integrated play group
model, 192; spontaneous play, 361
Social disabilities, situation strategy
simulation, 342–43
Social-emotional development, 5
Social exchanges, sensory, 261
Social faux pas, 348–49
Social gaze, 129, 300, 349
Social goal, survive and thrive, 371–72
Social interaction, 41; classroom inclusion,
212; integrated play groups, 191–95;
life skills curricula, 214; pervasive
developmental disorder not otherwise
specified, 247; pivotal response
training, 255; residential supports, 302
Social interactions: perspective, 29–30; power
card strategy, 274; priming strategy,
279
Socialization: developmental therapy, 104–6;
music therapy, 228; play initiation
monitoring, 193
Socializing, hyperlexia, 172
Social learning, competence, 348
INDEX
Social map, circle of friends, 74
Social mapping, cartooning, 63–65
Social movement, 105
Social outing, mapping, 64
Social phobia, 13–14
Social play, 349
Social relationships, Attention Deficit
Hyperactivity Disorder, 28
Social scripts, 349–51; idiosyncratic language,
173
Social Security Administration, 370, 405
Social situation: attribution, 30, 369;
autopsies, 343–44; cartooning, 60–66;
mapping, 63–65; misunderstanding,
104; prediction and school bully,
55–56; psychosocial treatments, 2868;
strategies, 342–43
Social skills, 2; Asperger’s disorder, 21;
classroom, 214; hidden curriculum,
168; incidental teaching, 178; virtual
environments, 398
Social skills defined as sharing space
effectively with others, 351
Social skills training, 351–55
Social Stories, 355–57; music therapy, 228;
Storymovie, 364–65
Social thinking, 143, 357, 378
Social understanding, cartooning, 61–62
Social validity, 357
Social worker, 76–77
Sociodramatic script training, 201, 261
SOCCSS. See Situation-Options-
Consequences-Choices-Strategies-
Simulation
SODA strategy, 83–84
Somatosensory, 358
Son-Rise Program, 239–40
Sorting, test, 237
Space, sharing, 351
SPD. See Sensory processing disorder
Special day school or alternative school, 358
Special education: Angelman syndrome, 9;
collaborative team, 87; extended
school year, 128–29; homebound/
hospital bound program, 171–72;
Individualized Education Program,
181–83; law, 189–90, 450; mediation,
221; multidisciplinary evaluation, 227;
parental consent, 91–92, 182; public
free, 146–47; residential facility, 301
Special interests, Asperger’s disorder, 21–22
Specialized interests, 308
Special needs, early intervention, 119
SPECT. See Positron Emission Tomography
497
INDEX
Spectrum disorder, 22; Angelman syndrome,
9; autism, 43
Speech, 133; deaf individuals, 381; delay, 358;
dysphasia, 118; echolalia, 120; Landau-
Kleffner syndrome, 207; pedantic, 244;
perseverative, 245; picture exchange
communication, 254; pragmatics, 21;
pronoun errors, 282–83; prosody, 283;
rehearsal, 11; schizophrenia, 319;
selective mutism, 326–27; social
scripts, 350
Speech delay, 358
Speech-generating devices (SGD), 35
Speech language pathologist, 358–59
Speech pathologist, 359–60
Speech sound, Fast ForWord, 139–41
Speech therapy, 31, 359–60
Splinter skills, 360
Spoken language: comprehensive assessment,
89; development test, 377; evaluation,
126–27; skill loss, 207–8; utterance
mean length, 220–21
Spoken words, symbolic thought, 372–73
Spontaneous play, 360–61
Squeeze machine. See Hug machine
SSAS. See Student Social Attribution Scale
SSI. See Supplemental Security Income
SSRI. See Selective serotonin reuptake
inhibitors
SSS. See Scoptic sensitivity syndrome
Standard deviation, 361
Standardization, 361
Standardization sample, 361–62
Standardized tests, 362
Standard score, 362
Stanford-Binet Intelligence Scales–Fifth
Edition (SB5), 1, 362
STAT. See Screening Tool for Autism in
Two-Year-Olds
State assessments, 277
State government, 404–5
State voter restrictions, 405
Static intelligence, 291–92
Statistical significance, 76
Statistics, 361
Status seizures, 325
Stehli, Annabel, 32
Stereotypic behavior, 363
Stimming behavior, 239–40
Stimulant medications, 363
Stimulus, 363; behavior generalization, 354;
control, 364; desensitization, 97;
discriminative, 112, 114–15; eye gaze,
129, 300, 349; fading, 136; intraverbal
498
response, 197; learned helplessness,
208–9; low/poor registration, 216;
nonverbal, 392–93; overselectivity,
364, 394; overselectivity/overfucosed
attention, 241; pragmatic language
test, 377; prompting, 113; punishment,
286–87; reinforcing, 113; respondent
conditioning, 307; responding to
multiple, 255–56; sensory, 338; token
economy, 380–81
Stimulus control, 364
Stimulus overselectivity, 255, 364
Stimulus-response model, Cognitive Behavior
Modification, 78
Stool, 123
Stop, SODA strategy, 83–86
Story, fear-reducing, 64
Storymovies, 364–65
Strategy: augmentative and alternative
communication, 35; cognitive
learning, 81–86; incidental teaching,
178; play guidance, 194; power card,
274; shaping behavior, 339; social
skills training, 353; van Dijk approach,
390–91; visual, 400–403
Strategy production, 82–84
Stress adaptation, autism spectrum disorder,
408–13
Stressful situations, habit rehearsal, 165
Stress management, respite care workers, 305
Stressor, environmental, 125
Structure: supports, 421; teaching and visual,
368–69; visual tools, 401
Structured Teaching (TEACCH), 104,
365–69
Struggle, 371–72
Student: bullying, 54–56; challenging
behavior, 17; direct instruction,
110–11; disturbed practice, 115; high
school, 404–5; homebound/hospital
bound program, 171–72; Individualized
Education Program, 181–83;
Individualized Health Care Plan,
185–86; Individualized Transition
Plan, 188–89; legal protection,
189–90; mainstreaming, 217–18;
Notice of Recommended Educational
Placement, 236; personal perspective,
465–66; residential facility, 301;
response trial, 385; schedules, 366–67;
school records disclosure, 136–37;
strengths, 276; survive and thrive,
371–72; transition planning, 382–84;
visual strategies, 402

Student Social Attribution Scale (SSAS),
369–70
Studies to Advance Autism Research and
Treatment Network (STAART
Network), 449
Stupor, 67
Substance, desensitization, 97
Substance abuse, autism, 124
Substantial limits, 323
Success: developmental therapy, 106;
environmental response, 105;
environmental stressors, 125; personal
perspective, 467–68
Successive processing, cognitive assessment, 96
Summarize main idea, POSSE strategy, 82–83
Summer school, 128–29
Supervision, integrated employment, 191
Supplemental Security Income (SSI), 370,
405
Supplementary services, least restrictive
environment, 210–11
Support: circle of, 74; emotional, 123; life
skills, 215; mental retardation, 222;
novice players, 193–94; personal
perspective, 453–55; school function
assessment, 320; siblings, 339–41
Supported employment, 370
Support groups: parents, 341; sibling support
project, 339–41
Supports: facilitated communication, 132–33;
residential, 302; SCERTS model, 316;
self-determination, 327–29; structure
and visual, 421; transition planning,
382–84; visual, 400–401
Supreme Court of U.S., 147
Surthrival, 371–72
Surveillance, developmental, 103–4
SVEs. See Single-user virtual environments
Swallowing disorders, speech therapy, 359
Symbolic development, behavior, 87–88
Symbolic dimension: integrated play group
model, 192; spontaneous play, 360
Symbolic play, 372
Symbolic skills, 36
Symbolic thought, 278, 372–73
Symbols, 34–35
Symptom, 300, 373; central auditory
processing disorder, 67–68; high-
functioning autism and Asperger
syndrome, 169; posttraumatic stress
disorder, 273; schizophrenia, 319;
scoptic sensitivity syndrome, 198;
toxicology, 382; treatment
effectiveness, 385
INDEX
Syndrome, 373
Systematic desensitization, 373
Tact, 375, 392
Tactile, 375
Tactile defensiveness, 375; Wilbarger
Protocol, 414
Tactile system, 336, 375
Target behavior, 318, 376; intervention
framework, 50; motivation, 256;
shaping, 339
TASH (association), 449
Task: chaining, 69; completion, 367–68;
decisions, 83; demand, 421; learning
motivation, 256; organizers, 401;
school, 320; visual instruction, 369
Task analysis, 16, 69, 376
Taste, 241, 336
TEACCH program. See Structured
Teaching;Treatment and Education of
Autistic and Related Communication
Handicapped Children
Teacher: classroom inclusion, 212; direct
instruction, 110–11; learning strategy
instruction steps, 82–84; personal
perspective, 465–66; RDI program,
289–95
Teaching: abstract concepts, 161;
curriculum, 93–94; discrete trial
training, 111; errorless, 112, 392;
hidden curriculum, 168, 421;
incidental, 177–79; independence,
80; masturbation, 219–20; milieu
method, 223–24; pivotal response
training, 257; play skills, 194–95;
session data collection, 178–79;
skills, 16–17, 421; social skills, 353–
54; video use, 401–2
Team: collaborative, 87; evaluation
procedures, 323; Individualized
Education Program, 181, 210–11;
Individualized Family Services Plan,
185; individualized planning, 89;
Individual Plan for Employment,
186–87; multidisciplinary, 227, 314;
school health, 185; transdisciplinary,
37, 332; transition planning, 384
Tech Act of 1994, 25
Technology. See Assistive technology
Technology Related Assistance for
Individuals with Disabilities Act of
1988, 25
Telecommunication, Americans with
Disabilities Act, 7
499
INDEX
Test: intelligence, 196; object integration,
237; object sorting, 237; scores, 18;
standardized, 362
Testimonial, 376
Test of Adolescent and Adult Language–
Fourth Edition (TOAL4), 376
Test of Language Competence (TLC),
376–77
Test of Language Development–Intermediate,
Third Edition (TOLD-I), 377
Test of Language Development–Primary
(TOLD-P), 377
Test of Pragmatic Language (TOPL), 377
Test of Problem Solving–Adolescent
(TOPS-A), 378
Test of Problem Solving–Elementary
(TOPS-E), 378
Tetanus, 77
Theme-oriented activities, 202; SCERTS
model, 317
Theory of mind, 29–30, 56, 378–79; false
belief paradigm, 136–37; social
communication, 347; social faux pas, 348
Therapeutic goal, assistance dogs, 11
Therapeutic intervention, sensory integration,
334
Therapeutic riding, 171
Therapists, 96
Thimerosal, 124, 223, 311, 389
Thinking: developmental individual-difference
relation-based intervention, 99;
developmental milestones, 101; mental
retardation, 221–22; social, 357;
strategy story, 83
Thought: presymbolic, 278; structured
teaching, 366; symbolic, 372–73
Threat perception, 7–8
Thrive, 371–72
Tic disorders, 379–80
Time, 123, 202, 224
Time-out, 10–11, 380
Timers, 401
TLC. See Test of Language Competence
TMT. See Trail-Making Test
TOAL4. See Test of Adolescent and Adult
Language–Fourth Edition
Toddler: modified checklist for autism, 225;
proto-declaration, 283–84; sensory
profile, 190
Toe walking/equinus gait, 380
TOH. See Tower of Hanoi
Token economy, 113, 380–81; applied
behavior analysis, 17–18; response
cost, 307
500
TOLD. See Test of Language Development–
Intermediate, Third Edition;Test of
Language Development–Primary
Tonic-clonic seizures, 325
TOPL. See Test of Pragmatic Language
TOPS. See Test of Problem Solving–
Adolescent;Test of Problem Solving–
Elementary
Total communication, 381
Touch, 336
Touch pressure, 97, 381
Touch therapy, 381
Tourette’s disorder, 379
Tower of Hanoi (TOH), 382
Toxicology, 382
Toxins, 97, 124, 167, 222–23
Trade schools, 404
Trail-Making Test, 382
Training: applied behavioral analysis, 18;
attribution, 30; brain development,
243; discrete trial, 111–14; escape,
126; functional protest, 151; music
therapist, 228–29; neurofeedback,
232; picture exchange
communication, 252–54; pivotal
response, 255–57; play guides, 192;
Sensory Integration and Praxis Test,
335; sensory integration therapy, 334;
social skills, 351–55; speech language
pathologist, 358; virtual
environments, 397–98; work
adjustment period, 414–15
Transactional support, 316
Transdisciplinary team, 37, 332
Transfer of skills, 354
Transition: adulthood, 4–5; developmental
therapy stage, 105; Individualized
Family Services Plan, 184;
individualized plan, 188–89; personal
perspective, 458; planning, 328–29,
382–84; postsecondary, 188–89;
priming strategy, 279; sensory
processing disorders, 332; visual tools,
401; workforce, 59–60
Transition planning, 382–85
Transition services: Individualized Education
Program, 182; present level of
educational performance, 277;
vocational rehabilitation, 404
Traumatic experience, stress following, 14
Treatment, 43–44; baseline, 47; effectiveness,
385; mood disorders, 226; RDI
program development, 289; selective
mutism, 326–27

Treatment and Education of Autistic and
Related Communication Handicapped
Children (TEACCH), 365–68
Treatment effectiveness, 385
Trial, 385; clinical, 77; discrete, 16, 112–14;
mass, 219; prompt, 385; response, 385
Tricyclics, 13
Trigger, 423
Tuberous sclerosis complex, 385–86
Tumors, 385–86
Turn-taking, 36; SCERTS model, 316; van
Dijk approach, 390
Twenty Questions Task, 386
Twin studies, 386
Two-year-olds, screening tool, 321
Typing, 133–34
Underlying Characteristics Checklist (UCC),
423
Understanding, 174; social situations, 60–61
Unexpected behavior, 346
UNIT. See Universal Nonverbal Intelligence
Test
United Cerebral Palsy Association, 244
Universal Nonverbal Intelligence Test
(UNIT), 387
Unspoken code, social stories, 356
U.S. Autism and Asperger Association, Inc.,
428
USAA Newsletter, 428
Utterance mean length, 220–21
VABS-II. See Vineland Adaptive Behavior
Scales–Second Edition
Vaccinations, 223, 311, 389, 399; autism, 124
Vaccinations (thimerosal), 389
Validity, 389; concurrent, 91; social, 357
Van Dijk approach, 390–91
Variables, 47
Verbal behavior, 391–93; echoic, 120, 392;
intraverbal response, 197; mand, 219,
224; rehearsal, 48; tact, 375
Vestibular, 336, 393
Vicarious reinforcement, 394
Video analysis, retrospective, 308
Video feed-forward, 396
Video modeling, 394–95; play-oriented
therapy, 260
Video self-modeling, 395–96
Vineland Adaptive Behavior Scales–Second
Edition (VABS-II), 396–97
Virginia Autism Training Center, 426
Virtual environment, 397–99
Viruses, 399–400
INDEX
Visceral disorders, 409–10
Vision perceptual system, 197–98; embedded
figures test, 122
Vision screenings, 198
Vision statement of family, 183
Visual cue, 366
Visual information organization, 366
Visual learners, 83
Visual learning, 210, 394
Visual-motor, 400
Visual reasoning, 213
Visual representation instruction, 369
Visual schedules, 367
Visual strategies, 400–403
Visual structure in teaching, 368–69
Visual supports, 421
Vitamin B15, 110
Vitamins, 107–8, 236
Vocabulary, 21, 228, 253
Vocal behavior, 41
Vocalization, 392
Vocal tics, 379
Vocational assessment, 59
Vocational goal, 187
Vocational programs, 4
Vocational rehabilitation, 60, 404; individual
plan, 186–87; programming, 404–5;
work adjustment period, 414–15
Vocational Rehabilitation Act of 1973, 59,
186–87
Vocational rehabilitation agencies, 136, 404–5
Vocational rehabilitation counselor, 186–87
Vocational rehabilitation programming,
404–5
Vocational training, assistive technology, 25
Voting, 405–6
Waiting, music therapy, 228
Wait training, 407
Walking, 216; toe, 380
Walsh, William J., 223
WCST. See Wisconsin Card Sorting Test
Weak central coherence. See Central
coherence
Wechsler Individualized Achievement
Test–Second Edition (WIAT-2), 407
Wechsler Intelligence Scales for Children–
Fourth Edition (WISC-IV), 408
Welch, Martha G., 408
Welch Method Therapy, 408–14
Western Psychological Services, 335
WIAT-2. See Wechsler Individualized
Achievement Test–Second Edition
Wieder, Serena, 99
501
INDEX

Wilbarger Protocol, 414 Workforce transition, 4, 59–60, 188–89

Wiltshire, Stephen, 158–59 World Health Organization, 197
WISC-IV. See Wechsler Intelligence Scales Wrightslaw (organization), 450
for Children–Fourth Edition Writing, 106, 162, 209
Wisconsin Card Sorting Test (WCST), 414 Written agreement, 229
WJPB-R. See Woodcock-Johnson Written permission, 91–92, 182
Psychoeducational Battery–Revised
Women, 319 X chromosome, 145
Woodcock-Johnson Psychoeducational X-ray pictures, 67
Battery–Revised: Tests of Cognitive
Ability (WJPB-R), 414 Yeast-free (diet), 417
Words, 120 Youth, self-determination, 328–29
Work, 4, 191; adjustment period, 414–15;
assistive technology, 25; career Zero Reject, 419
planning, 59; readiness skills, 404; Ziggurat Model, 419–24
system teaching, 367–68 Zinc, 223
Work adjustment period, 414–15 Zone of proximal development (ZPD), 421, 424

502
 About the Editors, Advisory Board,
and Contributors

EDITORS
Brenda Smith Myles, PhD, is the chief of programs and development of the Ohio
Center for Autism and Low Incidence, and an associate professor in the Department
of Special Education at the University of Kansas, where she codirects a graduate pro-
gram in Asperger syndrome and autism. The recipient of the 2004 Autism Society of
America’s Outstanding Professional Award and the 2006 Princeton Fellowship Award,
she has written numerous articles and books on Asperger syndrome and autism includ-
ing Asperger Syndrome and Difficult Moments: Practical Solutions for Tantrums, Rage, and
Meltdowns (with Southwick) and Asperger Syndrome and Adolescence: Practical Solutions
for School Success (with Adreon), the winner of the Autism Society of America’s Out-
standing Literary Work. Brenda has made over 500 presentations all over the world
and written more than 150 articles and books on autism and Asperger syndrome. She
is on the executive boards of several organizations, including the Organization for
Autism Research and Maap Services, Inc. In addition, she was recently acknowledged
as the second most productive applied researcher in autism spectrum disorders in the
world from 1997 to 2004.
Terri Cooper Swanson, MS Ed, MT-BC, has worked nationally and internationally
with individuals with Asperger syndrome and autism, including working with adults
with disabilities at Opportunity Village in Clear Lake, Iowa, and serving as a consul-
tant for home, school, and community-based programs. Currently, Terri is a doctoral
student at the University of Kansas in the Special Education Autism/Asperger Syn-
drome Program where she was a Project Coordinator for the Asperger Syndrome
Research Study. She has authored several research articles and book chapters, and has
presented and consulted internationally on autism spectrum disorders.
Jeanne Holverstott, MS Ed, is the autism spectrum specialist at Responsive Centers
for Psychology and Learning in Overland Park, Kansas, where she provides clinically
based therapy, school consultation and advocacy, and diagnostic services. Prior to tak-
ing this position, she earned her master’s degree in special education from the Univer-
sity of Kansas, specializing in the autism and Asperger syndrome program. Jeanne has
worked for 6 years with children on the autism spectrum in a variety of settings and
capacities, including as a clinician, paraeducator, discrete trial therapist, consultant,
ABOUT THE EDITORS, ADVISORY BOARD, AND CONTRIBUTORS

tutor, and camp counselor. Additionally, Jeanne has taught several courses and auth-
ored a number of articles about children with autism and Asperger syndrome.
Megan Moore Duncan, BS, is a full-time wife and mother; she is also a freelance
project coordinator, writer, and speaker. In addition to volunteer work in three
schools and her church, Megan’s passion is to see people (especially her children)
reach their full potential.

ADVISORY BOARD
Simon Baron-Cohen, PhD, is a professor of developmental psychopathology at the
University of Cambridge and a fellow of Trinity College, Cambridge. He is Director
of the Autism Research Centre at the University of Cambridge, in the United King-
dom. Baron-Cohen has authored several books, including Mindblindness and The Essen-
tial Difference: Men, Women, and the Extreme Male Brain, and the DVD-ROM, Mind
Reading: An Interactive Guide to Emotions.
Pat Schissel, LMSW, is the president of the Asperger Syndrome and High Func-
tioning Autism Association (AHA), a parent and professional organization in New
York providing groups, information, and conferences to families and professional
affected by autism spectrum disorders. She is also an adjunct professor at Delphi Uni-
versity and the parent of an adult with Asperger syndrome.
Stephen Shore, PhD, diagnosed with ‘‘strong autistic tendencies,’’ nonverbal until
age 4, and recommended for institutionalization, Stephen completed a doctorate at
Boston University focusing on helping people with autism develop their capacities to
the fullest extent possible. Stephen is an internationally known author, consultant,
and presenter.
Pamela Wolfberg, PhD, is a professor and director of the autism spectrum graduate
program at San Francisco State University. Her research and practice center on efforts
to develop inclusive peer play programs for children on the autism spectrum. She has
authored numerous books, chapters, and articles and actively presents worldwide.

CONTRIBUTORS
Jennifer M. Akullian, MS, is a research assistant for the Indiana Resource Center
for Autism at Indiana University, where she is a doctoral student the School of
Psychology.
Ruth Aspy, PhD, is a licensed psychologist who specializes in assessment and inter-
vention for individuals with autism spectrum disorders. She is coauthor of The Ziggurat
Model. Dr. Aspy speaks nationally on this and other topics.
Lisa R. Audet, PhD, CCC-SLP, is assistant professor of speech-language pathology
at Kent State University where she developed the Pervasive Developmental Disorders
certificate. For over 20 years she has worked extensively with individuals who possess
severe communication disorders. Her research focuses on communication development
for individuals with autism.
Andrea M. Babkie, EdD, is currently working as an educational consultant while
editing and writing. She has served on the executive committees of several interna-
tional organizations, including the Council for Learning Disabilities and the presiden-
tial chain of the Division on Developmental Disabilities of the Council for
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 ABOUT THE EDITORS, ADVISORY BOARD, AND CONTRIBUTORS

Exceptional Children. Dr. Babkie has authored a number of professional articles and
has presented nationally on a variety of topics in the field of special education.
Bruce Bassity, RPA-C, practices primary care medicine in rural northern New
York State.
Katie Bassity, MS, recently completed the autism/Asperger syndrome program at
the University of Kansas. She currently works as an autism consultant at the Ohio
Center for Autism and Low Incidence (OCALI).
James R. Batterson, MD, is a child psychiatrist at Children’s Mercy Hospitals and
Clinics in Kansas City, Missouri, and runs a Tourette syndrome clinic, as well as
working with patients with autism spectrum disorders. He has been the principal
investigator for several medication trials with children and adolescents with these
disorders.
Scott Bellini, PhD, is the assistant director of the Indiana Resource Center for Au-
tism, and is a faculty member with the Indiana University school psychology program.
His research and clinical interests include social-emotional functioning for children
with autism spectrum disorders, including anxiety disorders, social skills programming,
and video self-modeling.
Josepha Ben-Arieh, PhD, is a consultant for students with autism spectrum disor-
ders (ASD) and Asperger syndrome. Dr. Ben-Arieh coauthored the book Autism Spec-
trum Disorders: Interventions and Treatments for Children and Youth and is the author of
How to Use Joint Action Routines. She has presented nationally and internationally on
ASD and Asperger syndrome.
Susana Bernad-Ripoll, MS, is a special education practicum supervisor at the Uni-
versity of Kansas, where she is a doctoral student in the autism/Asperger syndrome
program.
Douglas Biklen, PhD, is Dean of the School of Education at Syracuse University.
He is also Professor of Cultural Foundations of Education and Teaching and Leader-
ship, faculty in Disability Studies and Director of the Facilitated Communication
Institute at Syracuse University.
Amy Bixler Coffin, MS, is the education autism administrator for the Ohio Center
for Autism and Low Incidence (OCALI) where she coordinates and provides profes-
sional development in the area of autism spectrum disorders for Ohio schools and
families.
Cameron Blackwell is a 15-year-old freshman in high school, working towards an
honors diploma. He was diagnosed with Asperger syndrome while in second grade. He
has been very involved in his school and church, as well as attending autism-related
conferences. His special passion is band. He marched with the high school band as an
eighth grader and hopes to someday be a band director himself.
Craig Blackwell is 12 years old and in his first year of middle school. He loves
cooking, fishing, gold, and anything to do with dragons. He is beginning band and
enjoys attending his brother’s marching band competitions.
Eric Blackwell is a husband and father of four children (two of whom are on the
autism spectrum). He is the director of technology for a large real estate brokerage
and owner of Netvantedge, an Internet company that teaches and implements search
engine and e-commerce strategies for business and organization. He regularly teaches
and presents on e-commerce and Internet-related subjects.
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ABOUT THE EDITORS, ADVISORY BOARD, AND CONTRIBUTORS

Jen Blackwell received her degree in education and taught students with severe
emotional disabilities in a group home. Four children and two autism spectrum diag-
noses later, she has returned to work in a special-needs setting, in an inclusive pre-
school. She and her children have served as guest speakers to education classes
dealing with issues related to autism spectrum disorders.
Jaime Blackwell, 10 years old, is the lone daughter among all brothers. She is in
her last year of elementary school and is enjoying being ‘‘Top Dog’’ for the school
year. She loves to sing, and not only has she sung with groups at church, she has per-
formed songs in sign language for both school and church. She loves to spend time
with her friends and family.
Marjorie A. Bock, EdD, is an associate professor of special education at the Associ-
ated Colleges of Central Kansas where she teaches special education courses. She
developed and directed the Global Rural Autism/Asperger Information Network
(GRAAIN) at the University of North Dakota. She has authored several articles and
presented nationally and internationally on autism spectrum disorders.
Signe M. Boucher, BA, is a doctoral student in the school psychology program at
the University of North Carolina (UNC). She has worked in both clinical and
research capacities for Division TEACCH for several years and is currently completing
her internship at UNC with a focus on developmental disabilities.
Jenny Clark Brack, OTR/L, is a pediatric occupational therapist with over 14 years’
experience in school settings. Currently she works both as a staff occupational therapist
within a rural special education cooperative and as a special consultant to schools in
several states. Jenny has presented nationally and has been published in several occupa-
tional therapy periodicals. She is the author of Learn to Move, Move to Learn!
Stacey L. Brookens, MS, is the director for Autism Services, Central Pennsylvania,
at NHS Human Services, where she supervises the Stepping Stones Programs, the
NHS Autism School in Altoona, Pennsylvania, and the Behavioral Health Rehabilita-
tive Services for individuals diagnosed with an autism spectrum disorder.
Martha S. Burns, PhD, CCC-SLP, serves on the faculty of Northwestern Univer-
sity and the professional staff at Evanston-Northwestern Hospital, both in Evanston,
Illinois. She is also Director of the Clinical Specialist Market at Scientific Learning
Corporation. Dr. Burns has published widely on neuropathologies of speech and lan-
guage in children and adults.
Kari Dunn Buron, MS, is retired from K–12 education and currently coordinating
the ASD Certificate program for educators at Hamline University in St. Paul, Minne-
sota. She is the coauthor of The Incredible 5 Point Scale and the author of When My
Worries Get Too Big and A 5 Is Against the Law!
Steve Chamberlain, PhD, is an associate professor of special education at the Uni-
versity of Texas at Brownville. His research interests include different ways culture
influences teacher/student and teacher/parent interactions in schools, and culturally
responsive assessment and instruction for students with disabilities.
Hyun-Jeong Cho, MS, is a second-year doctoral student in special education at the
University of Kansas. Her emphasis is in self-determination and functional education.
She is a graduate research assistant for Dr. Michael L. Wehmeyer.
Yu-Chi Chou, MS Ed, is a doctoral student at the University of Kansas in the au-
tism and Asperger syndrome program.
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 ABOUT THE EDITORS, ADVISORY BOARD, AND CONTRIBUTORS

Beth Clavenna-Deane, MS, is a graduate research assistant with the Transition Co-
alition at the University of Kansas. She is currently a doctoral student in the transi-
tion program. She has 13 years’ experience in the special education arena as a special
educator and transition coordinator for students with autism and Asperger syndrome.
Katherine E. Cook, PhD, is a visiting assistant professor at the University of Kan-
sas in the Department of Special Education. Her areas of specialization include autism
spectrum disorders, early childhood special education, and alternative assessment.
Cook has published several articles, book chapters, and books related to autism spec-
trum disorders and has presented nationally.
Virginia L. Cook, is a doctoral candidate in special education at the University of
Kansas. She works with researchers at Juniper Gardens Children’s Project in Kansas
City, Kansas.
David R. Cormier, MS Ed, is an educational consultant for Connecticut’s State
Education Resource Center where he coordinates the state’s Focus on Autism profes-
sional development and resource initiative. He provides training and technical assis-
tance to education professionals and families on topics including positive behavior
supports, responsible inclusive practices, and differentiated instruction.
Karla Dennis, MA, CCC-SLP, is a speech pathologist for the Blue Valley School
District in Overland Park, Kansas. She works with middle school students with a vari-
ety of disabilities, including autism spectrum disorders. Karla also has a master’s degree
in special education with an emphasis in autism and Asperger syndrome from the
University of Kansas.
Lynn Dudek, MS, CCC-SLP, MBA, is a speech pathology coordinator at the Ohio
Center for Autism and Low Incidence. She has supervised speech language patholo-
gists and specialized in the treatment of individuals with autism spectrum disorders for
12 years, while also presenting on topics such as communication deficits in autism. Of
particular interest to her is professional collaboration and social skills.
Theresa L. Earles-Vollrath, PhD, is an assistant professor at the University of Cen-
tral Missouri. Dr. Vollrath previously worked as a teacher for children with autism, as
a director of an autism resource center, and as an autism specialist for a public school
district. She has also coauthored several books, book chapters, and articles on autism.
Jennifer B. Ganz, PhD, has been working in special education for 12 years as a
general and special education teacher, an educational consultant, university instructor,
and researcher. Ganz has authored several articles, book chapters, and books, and has
presented on strategies to address social and communication skills for individuals with
autism spectrum disorders.
Peter Gerhardt, EdD, is the president of the Organization of Autism Research, a
nonprofit organization, the mission of which is to fund applied research and dissemi-
nate relevant findings in support of learners with autism spectrum disorders and their
families. Dr. Gerhardt received his doctorate from the Rutgers University Graduate
School of Education.
Kate Goldfield is a 22-year-old psychology major from Standish, Maine, who
attended Goucher College in Baltimore. She has written several articles related to au-
tism spectrum issues, and has been published in the Baltimore Sun and Hartford Cou-
rant. She has presented at autism conferences and has been involved with Asperger
syndrome groups in Maine, Baltimore, and Washington, DC.
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ABOUT THE EDITORS, ADVISORY BOARD, AND CONTRIBUTORS

Carol Gray is an educational consultant and president of The Gray Center for
Social Learning and Understanding in Kentwood, Michigan, a nonprofit organization
serving people with autism spectrum disorders (ASD) and those who work on their
behalf. Carol developed the Social Storyapproach in 1991, and is the author of several
articles, chapters, and resources. She is a recipient of the Barbara Lipinski Award for
her international contribution to the education and welfare of people with ASD.
Patty Dobbs Gross serves as Executive Director of North Star Foundation, a non-
profit organization dedicated to partnering assistance dogs with children to help them
reach their social, emotional, and educational goals. She is the author of The Golden
Bridge: A Guide to Assistance Dogs for Children Challenged by Autism or Other Develop-
mental Disabilities.
Barry G. Grossman, PhD, is a licensed psychologist who specializes in assessment
and intervention for individuals with autism. He provides assessment and consulta-
tion services in the public schools as well as staff development in the area of autism
spectrum disorders. Dr. Grossman coauthored The Ziggurat Model and speaks
nationally.
Steve Gutstein, PhD, the founder of RDI, holds a doctorate in clinical psychology
and is the director of the Connections Center and board president of the Foundation
for Autism Research and Remediation (FARR). Dr. Gutstein and his partner and wife
of 25 years, Dr. Rachelle Sheely, have published five books and numerous article
related to RDI. They travel internationally conducting workshops, training, and
programs.
Melanie D. Harms, MME, NMT, MT-BC, is a doctoral student and graduate
research assistant in the autism/Asperger syndrome program at the University of Kan-
sas. Melanie provides music therapy services for Gardner Public Schools and serves as
the Midwest representative on the American Music Therapy Association Standards of
Clinical Practice.
Rebekah Heinrichs, MSN, MS Ed, works as an educational specialist in autism
spectrum disorders and bullying prevention. She is a trained community facilitator
with the Adults and Children Together (ACT) Against Violence Program and is the
author of Perfect Targets: Asperger Syndrome and Bullying. Rebekah presents nationally
on autism spectrum disorders and bullying prevention.
Linda Hodgdon, MED, CCC-SLP, has pioneered the development of visual strat-
egies for supporting students with autism spectrum disorders and related communica-
tion challenges. Author of the best-seller, Visual Strategies for Improving
Communication, Linda is a popular national and international presenter who is well-
known for her practical approach to dealing with communication challenges.
Andrea Hopf, MS, is a doctoral student in the school psychology program at Indi-
ana University. As a graduate assistant at the Indiana Resource Center for Autism,
she collaborated on research regarding social skills assessment and intervention for
children with autism spectrum disorders.
Rose Iovannone, PhD, is the director of a federally funded behavior research cen-
ter, the Prevent-Teach-Reinforce Project, at the University of South Florida. She also
serves as coprincipal investigator in the Professional Development in Autism Project.
She has authored several articles and book chapters and has presented nationally on
autism spectrum disorders.
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 ABOUT THE EDITORS, ADVISORY BOARD, AND CONTRIBUTORS

Maya Israel, MS Ed, is a project coordinator on Project POISE (Providing Out-

reach Instruction for Special Educators), a special education personnel preparation
grant at the University of Kansas. She is a doctoral student in the area of high inci-
dence disabilities.
Tyi-Sanna Jones, MS, is a doctoral student at the University of Nevada, Las Vegas
(UNLV). She teaches in the special education department at UNLV. Her research
and interest areas include autism/Asperger syndrome, gifted education, and multicul-
tural education. She has presented at national professional conferences.
Joung Min Kim, MS, is a doctoral student at the University of Kansas in the au-
tism/Asperger syndrome program. She is also a graduate research assistant for the Posi-
tive Behavior Supports Project at the Juniper Gardens Children’s Project.
Jan L. Klein, MS Ed, is a doctoral candidate in special education with a minor in
multicultural education at the University of Kansas. She has presented statewide and
nationally on culturally responsive teaching and minority parent participation in the
special education process.
Whitney Mitchell Krusniak, MEd, is an educational consultant for students with
autism spectrum disorders for the Ottawa Area Intermediate School District in Hol-
land, Michigan. She is a member of Team Social Stories and has coauthored a series
of articles for the Autism Spectrum Quarterly.
Paul G. LaCava, PhD, earned his degree from the Department of Special Educa-
tion at the University of Kansas. He has worked as a special education teacher, inclu-
sion facilitator, and consultant. His research interests include autism spectrum
disorders, historical perspectives of disability and autism, technology, and interven-
tions for social/emotional skills.
Hyo Jung Lee, MA, is a doctoral student at the University of Kansas where she
worked as a project coordinator for the Asperger Syndrome Research Study, which is
led by Dr. Brenda Myles. Currently, she is working at Ohio Center for Autism and
Low Incidence as a research assistant.
Lisa Ackerson Lieberman, MSW, LCSW, is a psychotherapist with over 30 years’
experience. A national speaker, she skillfully addresses issues related to living with a
disability in the family. She has published numerous articles and a book, A Stranger
Among Us, which is a comprehensive guide to hiring one-to-one providers for people
with disabilities.
Jennie Long, MS Ed, is a doctoral student at the University of Kansas with an em-
phasis in autism and Asperger syndrome.
Lisa Barrett Mann, BA, is a former health care reporter and editor. She is currently
a graduate student at the University of Kansas, studying autism and Asperger
syndrome.
Jo-Anne B. Matteo, MS, CCC-SLP, is a consultant with Pyramid Educational
Consultants, Inc. Prior to working at Pyramid, she was a speech-language pathologist
and special education administrator in the Connecticut public schools for 21 years.
She travels extensively doing presentations and consultation on PECS and the Pyra-
mid Approach to Education.
Gary B. Mesibov, is a professor of psychology in the Departments of Psychiatry and
Psychology at the University of North Carolina and Director of Division TEACCH,
North Carolina’s statewide program serving people with autism spectrum disorders and
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ABOUT THE EDITORS, ADVISORY BOARD, AND CONTRIBUTORS

their families. Mesibov has authored numerous articles, chapters, and books on autism
and related conditions emphasizing educational approaches and thinking and learning
problems. He is also the editor of the Journal of Autism and Developmental Disorders.
Tara Mihok is a doctoral student in special education, emphasizing in autism and
behavior disorders, at the University of Kansas. She has worked as an occupational
therapist for four years for the Washington, DC Public Schools and a private school
in Northern Virginia. Her background also includes in-depth training in the use of
applied behavior analysis in the treatment of autism.
Lynda M. Moore is an elementary school teacher in a multi-age fifth- and sixth-
grade class in Portland, Oregon, where she has taught for the past 12 years. Prior to
working as a classroom teacher, Lynda worked for 3 years as part of a multidisciplinary
team at Oregon Health Sciences University’s Children Day Treatment Center.
Sherry Moyer is a regional consultant for NHS Human Services of Pennsylvania
and the director of the Asperger Syndrome Coalition of the U.S. Moyer has contrib-
uted chapters to several books and speaks internationally. She is also the mother of a
young adult with Asperger syndrome.
Daniel W. Mruzek, PhD, is an assistant professor at the University of Rochester
Medical Center. He serves as Psychology Discipline Coordinator in the Leadership
Education in Neurodevelopmental and Related Disabilities (LEND) program and as
an investigator in the Multisite Young Autism Project, a study on early, intensive be-
havioral intervention for children with autism. He has authored several peer-reviewed
articles and book chapters on autism and other developmental disabilities.
Michele Mullendore, MS Ed, is the mother of a child with autism. In addition, she
is a special education teacher in the Blue Valley School District in Overland Park,
Kansas. Michele joined Blue Valley several years ago where she assisted in opening
the first Applied Behavior Analysis–based program for children with autism and devel-
opmental disabilities.
Stephanie Nickelson, Ed S, is a school psychologist, and Practicum Field Supervisor
at the University of Kansas, where she is a doctoral student studying special education
policy. She has previously participated in research and participated locally and nation-
ally on neurofeedback.
Hye Ran Park, MS, is a doctoral student at the University of Kansas, where she is
specializing in autism and Asperger syndrome.
Jessica Kate Peters, BS, is in the school psychology doctoral program at Indiana
University, where she is focusing on children with autism and children who speak
English as a second language. She is also a graduate research associate for the Early
Childhood Center at the Indiana Institute on Disability and Community.
Christine R. Peterson, PhD, is an assistant professor of pediatrics and team leader
for the autism faculty at Strong Center for Developmental Disabilities at the Univer-
sity of Rochester. She provides consultation and training, and conducts research on
autism and developmental disabilities, with an emphasis on social communication and
transition issues for higher-functioning students with autism and Asperger syndrome.
Ann Pilewskie is Director of Autism Services for the Ohio Center for Autism and
Low Incidence.
Carol L. Pitchlyn, MS, is a support teacher for the Kansas City Kansas Public
Schools. She earned her master’s degree from the University of Kansas in autism/
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 ABOUT THE EDITORS, ADVISORY BOARD, AND CONTRIBUTORS

Asperger syndrome studies and is currently a KU doctoral student in special education.

She is a parent of an adult son with autism. She has presented nationally on families
and children with disabilities.
Kelly M. Prestia, MS Ed, OTR, is a school-based occupational therapist in Colo-
rado. She has worked with students with autism and related disorders in school sys-
tems for 7 years. She has authored several articles and book chapters on autism
spectrum disorders.
Valerie Janke Rexin, MS Ed, is the autism spectrum disorder (ASD) consultant for
the North Kansas City School District where she previously taught in a self-contained
class for students with ASD for 10 years. She has a younger sister with autism, which
sparked her initial interest in the area of autism.
Jamie Rivetts, MS Ed, is a clinician and consultant at Michelle Garcia Winner’s
Center for Social Thinking, Inc., in San Jose, California, where she leads therapy
groups for children in kindergarten through high school. Jaime also consults with local
school districts in the San Francisco Bay area in regard to incorporating social think-
ing across the student’s school day.
Lisa Robbins, MS Ed, is full-time faculty at Missouri Western State University
where she teaches early childhood and special education courses. She is also an autism
consultant and provides training and consultation services to parents and school dis-
tricts nationally and internationally. She is a doctoral student at the University of
Kansas.
Myrna J. Rock, BS, has worked with clients with special needs in a variety of set-
tings. She freelances in writing curriculums and other items.
David A. Ruggierio, PhD, is a thought-leader in the BrainBut Initiative at Colum-
bia University in New York City, where he is exploring the biological basis of nuture
and developing new treatments for developmental disorders including autism. He is
considered a world expert on visceral brain networks and the visceral thalamic/
prefrontal cortical stress axis involved in stress-related developmental disorders.
Kristi Sakai is the mother of Tom, Kito, and Kaede, and wife to Nubuo, all of
whom have Asperger syndrome. She is the author of Finding Our Way: Practical Solu-
tions for Creating a Supportive Home and Community for the Asperger Syndrome Family.
Fiona J. Scott, PhD, is a chartered psychologist specializing in autism spectrum dis-
orders (ASD) based at the Autism Research Centre, University of Cambridge, and
also offers independent consultation and professional training. Dr. Scott has 14 years’
experience in researching assessing children and adults with ASD and is widely pub-
lished in the field.
Mark Shelley is president of The Special Minds Foundation and Special Minds Pro-
ductions. Mark is committed to developing visual-based technology tools that address
everyday issues faced by families living with a diagnosis of autism spectrum disorder.
Sheila M. Smith, MS Ed, is a doctoral student at the University of Kansas. She has
spent over 20 years as a special educator, administrator, and staff developer in New
York, Georgia, Virginia, Kansas, and Ohio. She presents at local, state, national, and
international conferences, and has published articles and chapters on autism spectrum
disorders.
Tristram Smith, PhD, is an assistant professor of pediatrics at the University of
Rochester Medical Center (URMC). He serves as the research director for the
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ABOUT THE EDITORS, ADVISORY BOARD, AND CONTRIBUTORS

Multisite Young Autism Project, which is a federally funded study on early, intensive
behavioral intervention based on the UCLA/Lovaas model for children with autism.
He is also an investigator in a study at the Center for Studies to Advance Autism
Research and Treatment at the University of Rochester. He has authored or coau-
thored a number of the most widely cited studies on treatment outcomes for individu-
als with autism spectrum disorders.
Paula Tallal, PhD, is the cofounder and codirector of the Center for Molecular and
Behavioral Neuroscience at Rutgers University. She has authored over 200 scientific
publications and three books. She is the cofounder of Scientific Learning Corporation,
the company that developed the Fast ForWord family of language and reading inter-
vention programs.
Raschelle Theoharris, MS, is a doctoral student at the University of Kansas in the
deaf education program.
Kai-Chien Tien, MS Ed, is a doctoral student in the autism/Asperger syndrome
program at the University of Kansas. She completed a secondary education licensure
program offered by the Teacher Training Center at the National Taiwan University
of Arts and received an MS degree in special education from the University of
Kansas.
Melissa L. Trautman, MS Ed, teaches students with Asperger syndrome in the Blue
Valley School District located in Overland Park, Kansas. She is a coauthor of The
Hidden Curriculum: Practical Solutions for Understanding Unstated Rules in Social
Situations.
Cynthia K. Van Horn, MS Ed, is the LIFT teacher (Learning Through Intensive
Functional Teaching) at Lakewood Middle School in Overland Park, Kansas. She has
authored several book and video reviews and contributed to a number of book chap-
ters. Cynthia has presented nationally on autism spectrum disorders.
Martha G. Welch, MD, is the codirector of the BrainGut Initiative at Columbia
University in New York, where she is exploring the biological basis of nurture and
developing new treatments for developmental disorders including autism. In addition
to authoring research articles, book chapters, and books, she has presented nationally
and internationally on autism spectrum disorders.
Michael L. Wehmeyer, PhD, is Professor of Special Education and Director, Kansas
University of Center of Developmental Disabilities. He has authored 200 articles or
chapters and 20 books on disability issues, including self-determination, universal
design for learning, and technology and cognitive disabilities. He is editor-in-chief of
Remedial and Special Education.
Michelle Garcia Winner, MA, CCC-SLP, specializes in helping students with
social cognitive deficits. She runs a clinic, has authored numerous books, and speaks
internationally. Michelle’s goal is to help educators and parents appreciate how social
thinking and social skills are an integral part of a student’s academic as well as social
experience.
Brooke Young, MS, is the project coordinator at the Professional Development in
Autism Center, where she is a doctoral student in the autism program at the Univer-
sity of Kansas. Brooke has been working in the field for 15 years as a special education
teacher and autism consultant.

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