The SCERTS Model: A Transactional Approach to Enhancing Communication

LWW/IYC AS213-03 August 11, 2003 8:50 Char Count= 0
Infants and Young Children

Vol. 16, No. 4, pp. 296–316
c 2003 Lippincott Williams & Wilkins, Inc.
The SCERTS Model

A Transactional, Family-Centered
Approach to Enhancing
Communication and Socioemotional
Abilities of Children With Autism
Spectrum Disorder
Barry M. Prizant, PhD; Amy M. Wetherby, PhD;
Emily Rubin, MS; Amy C. Laurent, OTR-L
A range of educational/treatment approaches is currently available for young children with autism
spectrum disorders (ASD). A recent comprehensive review by an expert panel on ASD (National
Research Council, 2001) concluded that a number of approaches have demonstrated positive out-
comes, but nonetheless, not all children benefit equally from any one approach. Efforts to increase
communicative and socioemotional abilities are widely regarded as among the most critical prior-
ities, and growth in these areas is closely related to prognosis and long-term positive outcomes.
However, some widely disseminated approaches are not based on the most contemporary de-
velopmental research on social and communication development in children with and without
disabilities, nor do they draw from current understanding of the learning style of children with
ASD. This article describes the SCERTS Model, which prioritizes Social Communication, Emotional
Regulation, and Transactional Support as the primary developmental dimensions that must be ad-
dressed in a comprehensive program designed to support the development of young children
with ASD and their families. The SCERTS Model has been derived from a theoretical as well as
empirically based foundation and addresses core challenges of children with ASD as they relate to
social communication, emotional regulation, and transactional support. The SCERTS Model also is
consistent with empirically supported interventions and it reflects current and emerging “recom-
mended practices” (National Research Council, 2001). Key words: autistic spectrum disorder,
autism, developmental, early intervention, education, communication, emotional regulation,
family support, social
A UTISM SPECTRUM DISORDER (ASD) or

Pervasive Developmental Disorder (PDD)
(APA, 1994) is a category of developmental
disability characterized by qualitative impair-
ments in social interaction and social related-
ness, difficulties in acquiring and using con-
ventional communication and language abili-
ties, and a restricted range of interests often
co-occurring with an extreme need for con-
From Childhood Communication Services and the
Center for the Study of Human Development, Brown sistency and predictability in daily living rou-
University, Providence, RI (Dr Prizant); the tines. Frequently co-occurring and associated
Department of Communication Disorders, Center for characteristics include problems in sensory
Autism and Related Disorders, Florida State
University, Tallahassee, Fla (Dr Wetherby); the processing (Anzalone & Williamson, 2000;
Communication Crossroads, Monterey, Calif Greenspan & Wieder, 1997), motor planning
(Ms Rubin and Laurent); and the Yale University (Anzalone & Williamson, 2000; Prizant, 1996),
Child Study Center, New Haven, Conn (Ms Rubin).
emotional regulation and arousal modulation
Corresponding author: Barry M. Prizant, PhD, (Cole, Michel, & Teti, 1994; Dawson and
Childhood Communication Services, 2024 Broad St,
Cranston, RI 02905 (e-mail: Barry Prizant@brown. Lewy, 1989; Prizant, Schuler, Wetherby, &
edu). Rydell, 1997), and behavioral organization
296
The SCERTS Model 297
(Ornitz, 1989). The learning profile of chil- tices derived from tenets of learning the-
dren with ASD is typically uneven and inflex- ory and operant conditioning (Lovaas, 1981;
ible, with relative strengths in “object knowl- Maurice, Green, & Luce, 1996) (see Prizant
edge,”rote memory, and visual-spatial process- & Wetherby, 1998, for further discussion
ing, and weaknesses in “social knowledge,”se- of the continuum of educational/treatment
mantic and conceptual memory, and abstract approaches and the debate on efficacy of
problem-solving (Prizant, 1983; Wetherby, intervention).
Prizant, & Schuler, 1997). ASD is now under- Over the past 2 decades, there have been in-
stood to be of neurogenic origin and is gener- creased attempts at “cross-fertilization,” with
ally considered to be a lifelong disability that developmental research and “family-centered”
can dramatically impact family members. Ad- and “child-centered” practice influencing the
vances in research on early identification have content and teaching practices of traditional
resulted in earlier diagnosis of ASD (Lord & ABA approaches (Strain et al., 1992), re-
Risi, 2000). As a result, there is a great de- sulting in a clear distinction between con-
mand for current information on education temporary ABA practice and traditional ABA
and treatment for young children. practice. Similarly, developmental approaches
A variety of treatment approaches currently are increasingly infusing tenets of ABA ap-
are available, ranging from educational to clin- proaches to address the need for consistency,
ical to biomedical (eg, psychopharmacolog- intensity, and accountability, which have
ical, nutritional) (National Research Council been strengths of ABA practice (Prizant &
[NRC], 2001). Within the category of edu- Wetherby, 1998). However, in our recent ex-
cational and clinical strategies, efforts to in- perience, current educational/treatment pro-
crease communication and socioemotional grams tend to fall into 1 of 2 categories.
abilities are widely regarded as among the First, some programs continue to adhere to
most critical priorities (NRC, 2001; Wetherby only 1 or 2 approaches, with little integra-
& Prizant, 2000). These difficulties virtually tion of practices from different perspectives.
define ASD, and progress in communication In contrast, other programs use a “patch-
and socioemotional development is closely work quilt” strategy borrowing from different
related to outcome and independent func- practices along the continuum, even when
tioning. However, approaches to enhancing such practices are not easily integrated, re-
these abilities vary greatly, resulting in con- sulting in a fragmented approach to program-
fusion for caregivers and some professionals. ming. For example, a young child may re-
One source of this variability is the extent ceive services in an integrated developmental
to which educational/treatment approaches preschool setting focusing on communica-
are based (1) on current understanding of the tion, play, and peer interaction, but also re-
learning style and the nature of the disability ceive traditional ABA treatment in additional
of ASD, and (2) on the most contemporary home-based therapy focusing on readiness
research on communication and socioemo- skills and “compliance training,”with little co-
tional development in children with and with- ordination between settings. Such fragmenta-
out disabilities. On the one end of the con- tion may cause confusion for children who are
tinuum, approaches that are developmentally exposed simultaneously to highly structured,
based draw heavily from the knowledge base directive approaches based on repetitive
on typical child development (eg, Greenspan teaching drills, as well as more loosely struc-
& Wieder, 1997; Gutstein, 2000; Prizant, tured, child-centered approaches using more
Wetherby, & Rydell, 2000; Rogers & Lewis, natural activities for teaching. It may also
1989; Wetherby et al., 1997). On the other result in considerable confusion for parents
end of the continuum are more traditional and frustration for professionals who come
ABA (applied behavior analysis) approaches, from different, and sometimes diametrically
which are based primarily on teaching prac- opposed, orientations. Thus, there remains
298 INFANTS AND YOUNG CHILDREN/OCTOBER–DECEMBER 2003
a great need for a comprehensive educa- our previous empirical research and clini-
tional/treatment model with the following fea- cal investigation in understanding conven-
tures: (1) the model is based on the most cur- tional and unconventional communication in
rent research in child development and ASD; ASD including communicative functions and
(2) it is flexible enough to incorporate differ- intentions of behavior (Prizant & Duchan,
ent perspectives (ie, developmental and con- 1981; Prizant & Rydell, 1984; Prizant &
temporary ABA); (3) it can be applied in an Wetherby, 1987; Rydell & Prizant, 1985;
individualized manner while addressing the Schuler & Prizant, 1985; Wetherby, 1986;
“core deficits” of ASD; and (4) it is family- Wetherby & Prutting, 1984) and is philosoph-
centered, taking into account critical individ- ically consistent with tenets of recent work
ual differences across families in reference to in positive behavior supports (Fox, Dunlap,
their priorities, and their involvement in criti- & Buschbacher, 2000; Koegel, Koegel, &
cal programmatic decision-making. Dunlap, 1996; Lucyshyn, Dunlap, & Albin,
This article provides an overview of the 2002). The model also is built upon our work
SCERTS Model, a comprehensive, multidisci- addressing the relationships among commu-
plinary approach to enhancing communica- nication, socioemotional development, and
tion and socioemotional abilities of children emotional regulation (Prizant, 1999; Prizant
from early intervention to the early school et al., 1990; Prizant & Meyer, 1993; Prizant
years. The SCERTS Model was developed to & Wetherby, 1990) and is consistent with
directly address the limitations of available the work of Rogers and Lewis (1989) and
approaches noted above. The model priori- Greenspan and Wieder (1998, 2000) ad-
tizes Social Communication, Emotional Regu- dressing socioemotional factors, and DeGangi
lation, and Transactional Support as the pri- (2000) and Tronick (1989) addressing arousal
mary developmental dimensions that must be modulation and emotional regulation.
addressed in a comprehensive program de- The SCERTS Model also integrates contem-
signed to support the development of chil- porary understanding of the learning style of
dren with ASD. Because the model addresses persons with ASD as addressed in our pre-
core deficits or challenges definitive of ASD, vious work (Prizant, 1982b, 1983; Prizant &
it can be applied flexibly to a range of chil- Wetherby, 1998; Wetherby et al., 1997), and
dren who have varying degrees of disabil- as reflected in the current emphasis on the
ity (ie, mild to severe) in cognitive, commu- use of visual supports in educational program-
nicative, sensory processing, and regulatory ming (Hodgdon, 1995; Quill, 1998). Finally,
capacities. the family-centered philosophy espoused in
The SCERTS Model is derived from over the model draws from the work of Bailey and
2 decades of empirical and clinical work, colleagues (Bailey & Simeonsson, 1988) and
and is consistent with recommended tenets Dunst and colleagues in early intervention
of “evidence-based” practice espoused by re- (Dunst, Trivette, & Deal, 1988), and has been
searchers and clinical scholars in ASD and re- greatly influenced by the Hanen Early Lan-
lated disabilities (NRC, 2001; Prizant & Rubin, guage Centre Model for supporting parents of
1999). More specifically, the developmental, children with language disabilities (Manolson,
social-pragmatic focus of the model has been 1992) and ASD (Sussman, 1999). Our previous
the hallmark of our work for many years work that addresses our interpretation and ap-
(Prizant, 1982a; Prizant et al., 1997; Prizant plication of family-centered research and prac-
& Wetherby, 1985, 1987; Wetherby et al., tice, both within and outside the ASD litera-
1997; Wetherby & Prutting, 1984) and has ture (Prizant & Bailey, 1992; Prizant & Meyer,
been influenced by other developmentally 1993; Prizant, Meyer, & Lobato, 1997, Prizant
based communication intervention models & Wetherby, 1993), is infused in all aspects of
outside of ASD (Bricker, Pretti-Frontczak, & the model.
McComas, 1998; McLean & Snyder-McLean, Thus, the SCERTS Model clearly is consis-
1978). The model reflects and integrates tent with, or has been directly influenced
by, contemporary practices and education/ an overview), provide sample goals for each
treatment approaches noted above. How- component, and conclude by considering the
ever, we believe it offers an important and overriding importance of ecological validity in
novel contribution to currently available ap- programs for young children with ASD.
proaches by establishing clear priorities in the
areas of social communication, emotional reg- SOCIAL COMMUNICATION
ulation, and transactional support, in a man-
ner that addresses the complex interdepen- It is now well documented that positive
dencies among these most crucial areas. In long-term outcomes for children with ASD are
this manner, the model reflects a new concep- strongly correlated with the achievement of
tualization of education/treatment that most communicative competence (Garfin & Lord,
closely addresses the core deficits observed in 1986; Koegel, Koegel, Yoshen, & McNerney,
ASD, and therefore represents an example of 1999, NRC, 2001; Venter, Lord, & Schopler,
what we believe to be the “next generation”of 1992). Additionally, those children who dis-
treatment approaches for ASD. In the follow- play a greater capacity to establish and follow
ing discussion, we will define the core com- the attentional focus of their communicative
ponents of the SCERTS Model (see Table 1 for partners are more likely to initiate bids for
Table 1. SCERTS Model—Summary of education/treatment priority goals
I. Social communication
A. Enhance capacities for joint attention
1. Expression of communicative intent
2. Expand range of communicative functions
3. Enhance social reciprocity (rate of communication, repair, persistence)
4. Enhance communicative gaze, sharing emotional states
B. Enhance capacities for symbol use (symbolic behavior)
1. Movement from unconventional to conventional means of communication
2. Movement from presymbolic to symbolic behavior in communication and play
3. Movement from echolalia to creative language
4. Enhance comprehension of language and other symbolic systems
II. Emotional regulation
A. Enhance capacities for self-regulation—Ability to independently use sensory motor and/or
cognitive/linguistic strategies to regulate emotional arousal, and support attention and
engagement
B. Enhance capacities for mutual regulation—Ability to seek support from others or respond
to partners’ efforts to regulation of emotional arousal in the context of social transaction
through sensory motor and/or cognitive/linguistic strategies
C. Enhance capacity to recover from dysregulation—Ability to recover from extreme states of
dysregulation either independently or with support from partners
III. Transactional support
A. Educational and learning supports—Use of visuals and other organizational supports;
environmental modification; curriculum modification
B. Interpersonal supports—Calibrate partner language and interactive style, and
developmental support to enable child to attend, communicate, engage, and play at more
sophisticated levels. Design opportunities for learning with and developing relationships
with peers
C. Family support—Emotional and educational support provided to parents to enhance their
confidence and abilities in supporting their child’s development
D. Support among professionals—Provide opportunities for enhancing educational and
therapeutic skills, and for emotional support to cope with work-related challenges
communication, use more contingent lan- contact or gaze to deliberately affect (ie, com-
guage and acquire conversational skills, use municate with) another person. A child’s abil-
more sophisticated gestures and symbolic lan- ity to monitor the social environment through
guage, recognize and repair communicative social referencing (ie, shifting gaze) and to
breakdowns, and respond to contextual and share affect typically precedes the develop-
interpersonal cues (Carpenter & Tomasello, mental milestone of intentional communica-
2000; Wetherby, Prizant, & Hutchinson, tion, which is then followed by an expanded
1998). The “SC” component of the SCERTS ability to express intentions across commu-
Model directly addresses the core challenges nicative partners and for a range of commu-
in social communication faced by children nicative functions or purposes. Prior to the
with ASD. Although there is great heterogene- development of language, a child’s capacity
ity in children with ASD, research over the for joint attention also underlies the ability to
past 2 decades has identified core challenges communicate not only for need-based instru-
that fall into 2 major areas: (1) the capacity mental purposes (eg, requesting or protesting
for joint attention, which underlies a child’s by using push away or giving gestures), but
ability to coordinate and share attention, also for more social purposes (eg, comment-
share emotions, express intentions, and ing in order to share observations and experi-
engage in reciprocal social interactions, and ences by using showing or pointing gestures).
(2) the capacity for symbol use, which As a child makes the transition to language,
underlies a child’s understanding of meaning the capacity for joint attention facilitates the
expressed through conventional gestures, development of a more sophisticated and ex-
words, and more advanced linguistic forms, plicit system of communication. There is a
and the ability to engage in appropriate rapid expansion of vocabulary and linguistic
use of objects leading to imaginative play concepts, and emergence of more sophisti-
(Wetherby, Prizant, & Schuler, 2000). The cated sentence structures for the purposes of
educational/treatment goals within the social- sharing intentions and emotions (Wetherby
communication dimension of the SCERTS et al., 2000). At more advanced stages of lan-
Model have been derived to enhance these guage acquisition, the emergence of more
core capacities. sophisticated joint attention capacities sup-
ports communication about past and future
Capacity for joint attention events and enables children to consider what
A child’s ability to consider the attentional is novel, interesting, and important to their lis-
focus of another and to draw another’s at- tener based on their listener’s attentional fo-
tention toward objects and events of mu- cus, interests, and knowledge of prior events
tual interest is a foundation for the develop- (Carpenter & Tomasello, 2000).
ment of language, social-conversational skills, The core challenge in the capacity for joint
and social relationships. Moreover, these early attention impacts 4 critical developmental ca-
capacities are strongly related to the ability pacities in the social-communicative profile of
to interpret and share emotional states and children with ASD, resulting in a number of
intentions, and to consider another’s prior significant developmental challenges and lim-
experiences and perspective in relation to itations:
events or conversational topics (Carpenter & 1. Limitations in coordinating attention
Tomasello, 2000; NRC, 2001). and affect result in difficulties in (a) ori-
At prelinguistic stages of language acquisi- enting and attending to a social partner;
tion, joint attentional capacities are manifest (b) shifting gaze between people and
in the ability to orient to a social partner, to objects in order to monitor another’s at-
coordinate and shift attention between peo- tentional focus and intentions; (c) shar-
ple and objects, to share and interpret affect ing emotional states with another per-
or emotional states, and ultimately, to use ges- son; (d) following and drawing another
tures and vocalizations paired with physical person’s attention toward objects or
events for the purpose of sharing experi- which children “construct” knowledge and
ences; and (e) participating in reciprocal shared meanings based on interactions with
interactions over multiple turns in social people and experiences in their environment
exchange. (Bates, 1979; Bloom, 1993; Lifter & Bloom,
2. Limitations in sharing intent (Prizant 1998). Children typically progress through 3
& Wetherby, 1987) result in difficulties major transitions en route to developing more
in (a) directing signals to others to ex- sophisticated symbolic language skills to ef-
press intentions, (b) gaining another’s fectively communicate shared meaning with
attention when initiating either gestu- communicative partners. First, at the prelin-
ral, vocal, or linguistic communication, guistic stage of language acquisition, a child
(c) communicating intentionally at a rate typically makes a transition to intentional
necessary to maintain reciprocal inter- communication, a developmental shift to-
action, and (d) persisting and repairing ward the systematic use of conventional
communicative breakdowns when they gestures (eg, giving, waving, showing, and
occur. pointing) and/or vocalizations to deliberately
3. A restricted range of communicative affect another person; second, at the emerg-
functions resulting in a reduced fre- ing language stage, a child makes the transi-
quency of communication for more so- tion to early symbolic communication, a shift
cial purposes (Wetherby, 1986) such as toward the acquisition of single word vocabu-
for social interaction or calling atten- lary (eg, first words, signs, or picture symbols)
tion to oneself, or for joint attention marked by the acquisition of vocabulary that
such as commenting on and sharing serves a variety of communicative functions;
experiences, and expressing emotions; and third, a child at more advanced language
and stages makes the transition to linguistic com-
4. Difficulties inferring another’s perspec- munication (eg, the construction of multi-
tive or emotional state—resulting in word combinations, grammar, and discourse).
(a) problems in monitoring the appro- Parallel development during the transition to
priateness of verbal and nonverbal dis- symbolic and linguistic communication is ev-
course; (b) selecting appropriate topics; ident in a child’s use of objects, initially for
(c) providing sufficient background in- conventional, functional purposes, then in
formation; and (d) reading and respond- symbolic play, and later in sociodramatic, co-
ing appropriately to others’ emotional operative play. Capacities in joint attention
expressions. contribute to and interact with the develop-
These difficulties may be manifest differ- ment of more conventional and sophisticated
ently across children, thus creating a pic- linguistic knowledge, as observed in the abil-
ture of great heterogeneity in the ASD pop- ity to modify linguistic structure and style in
ulation. However, they reflect each child’s order to clarify intent for one’s listener (NRC,
struggle to establish and maintain shared at- 2001; Wetherby et al., 2000). In addition to
tention, and to interpret and express inten- serving important communicative functions,
tions at the prelinguistic, emerging language, language also comes to serve as an increas-
and advanced language stages (Carpenter & ingly important tool in problem-solving, plan-
Tomasello, 2000; Wetherby et al., 2000). ning and regulating behavior, and in regulat-
ing arousal and emotional state (Prizant et al.,
Capacity for symbol use 2000) (see next section on Emotional Regula-
In the SCERTS Model, the basis for under- tion for further discussion).
standing and addressing the symbolic deficits Challenges in the capacity for symbol use
in children with ASD is derived from the liter- impact 3 critical developmental capacities in
ature on typical developmental processes in the social-communicative profile of children
language acquisition and play development. with ASD, resulting in a number of significant
Language learning is an active process in limitations:
1. Limitations in the use of conven- ties. An essential component of the SCERTS

tional hand gestures (eg, showing, wav- Model is to profile a child’s strengths and
ing, and pointing) and other nonver- weaknesses in abilities related to the capac-
bal conventional communicative means ity for joint attention, by documenting abili-
(eg, head nods and headshakes) result- ties to express a range of intentions, to engage
ing in a reliance on primarily concrete, in reciprocal interactions and shared activi-
presymbolic motor-based gestures (eg, ties with adults and peers, and to use social-
manipulating a caregiver’s hand, leading affective signals such as gaze shifting for so-
another toward a desired item, and re- cial referencing and affect sharing. Abilities
enacting desired actions). Additionally, related to the capacity for symbol use are
the use of socially undesirable commu- assessed by documenting presymbolic (e.g,
nicative means or challenging behaviors types of gestures), quasi-symbolic (eg, picture
for communication (eg, screaming, ag- or other nonspeech systems), and symbolic
gression, tantrums), often observed in means (eg, spoken and signed language) to
children with ASD, may be a direct con- communicate, as well as types and complexity
sequence of these limitations, as they are of play. Specific goals and a plan for support-
used in lieu of more conventional ges- ing social communicative and symbolic ca-
tures for protesting or establishing social pacities across contexts are then formulated.
control; Thus, in the SCERTS Model, a developmental
2. Unconventional vocal development, sequence of social-pragmatic competencies
which may be marked by a paucity is addressed within a variety of settings and
of vocal communication or the use of across natural environments. Table 2 provides
difficult to read, unconventional sounds; sample educational/treatment goals in social
3. Unconventional verbal behavior such communication as children progress through
as the use of immediate or delayed forms prelinguistic, emerging language, and more
of echolalia, perseverative speech, or in- advanced language stages.
cessant questioning (Rydell & Prizant, In the majority of cases, modifications and
1995; Schuler & Prizant, 1985; and adaptations in environments and activities
4. Limitations in functional object use are often necessary to support optimal learn-
and symbolic play, as marked by ing (to be discussed in the upcoming sec-
difficulties using objects appropriately, tion on Transactional Supports). However, we
which may be due in part to limita- agree with Strain, McGee, and Kohler (2001)
tions in motor planning and in imitat- that most children with ASD are capable of
ing the nonverbal behaviors of others, as learning in natural activities and inclusive
well as limitations in the underlying sym- environments as long as the environmental
bolic capacity to represent social events, and interpersonal contexts are modified to
to “role-play,” and to elaborate on play match the unique learning style and social-
schemes (Wolfberg, 1999). communicative needs of the child. There is lit-
tle, if any, empirical evidence supporting the
Addressing core social-communication “myths” for segregating young children with
challenges ASD from natural activities and interactions
A child initially develops communicative (eg, children with ASD can only learn in 1:1 in-
competence through experiences with differ- struction, more natural activities and environ-
ent partners in the social environment over ments are too overly stimulating). However,
time and across contexts (Sameroff & Fiese, there is much empirical support for the effi-
1990). Newly acquired capacities are prac- cacy of educating young children with ASD
ticed as a child learns to share his or her with typical peers in well-designed natural
intentions and emotional states with others activities with appropriate transactional sup-
within natural contexts and recurring activi- ports (Strain et al., 2001).
Table 2. SCERTS Model: Sample social communication goals∗
Goals for joint attention Goals for symbol use

Prelinguistic level
• Establish anticipatory behaviors (eg, • Establish a consistent means for expressing intent (eg,
orienting to social stimuli, social referencing, conventional gestures, signs, picture communication)
following another’s gaze and gestures) • Replace earlier developing or unacceptable
• Establish shared affect (eg, smiling and communicative means with socially acceptable forms
looking) • Develop a child’s ability to use multiple gestural and
• Establish early intentional behaviors (eg, vocal means (eg, a give gesture, a contact and distal
coordinating gestures/vocalizations with point, a push away, a head nod, a head shake, and
physical contact or gaze) adding vocalizations to nonvocal means)
• Increase frequency or rate of communicative • Develop the use of nonverbal strategies for the purpose
bids of sharing and calling attention to oneself (eg, a wave
• Expand range of communicative functions gesture, a show gesture, and declarative pointing)
beyond instrumental functions (eg, • Establish functional use of familiar objects and early
nonverbal attempts to greet, show, and/or play schemes directed toward self
request social routines) • Develop the use of more formal augmentative/
• Develop strategies to persist and repair alternative systems to communicate intentions
communicative breakdowns
• Develop ability to communicate intent across
familiar persons, environments, and activities
Emerging language level
• Expand ability to communicate intent across • Acquire core vocabulary to serve a range of
more varied persons, environments, and communicative functions (eg, requesting, protesting,
activities greeting, commenting, and expressing emotional
• Expand ability to coordinate attention and states)
affect through shifting gaze and shared affect • Expand vocabulary to express more varied semantic
• Develop ability to secure attention to one’s relations
self prior to expressing intentions (eg, a • Expand ability to combine words/signs/pictures to
verbal calling function) express a fuller range of semantic relationships (eg, 2-
• Expand range of communicative functions to and 3-word combinations)
include more social purposes (eg, greetings, • Generalize unconventional verbal forms (immediate or
requesting social games or routines, showing delayed echolalia) to express a variety of functions
off, commenting, and requesting • Facilitate segmentation of echolalic forms with rule
information) induction allowing for greater creativity in language
• Increase reciprocity (ie, turntaking and production, and movement to more conventional
contingent use of language) to establish early forms
conversational abilities • Expand representational play themes that involve basic
role-play in familiar and unfamiliar settings
Advanced language level
• Increase ability to communicate about past • Acquire higher level linguistic forms that express
and future events differences in meaning (eg, tense markers, pronouns,
• Facilitate awareness of another’s intentions, etc)
preferences, and experiences • Support the acquisition of verbal conventions for
• Develop ability to modify topic selections initiating, exchanging turns, and terminating
based on a listener’s attentional focus, interactions
preferences, and emotional state • Increase ability to use and interpret nonverbal behavior
• Increase ability to interpret and use language to support language use and social interaction (eg,
flexibly depending upon the social context body posture and orientation, communicative gaze,
and the nonverbal cues of one’s facial expressions, gestures, and intonation)
communicative partner (eg, drawing • Acquire ability to use language as a tool for emotional
inferences, multiple meaning words, regulation
figurative language, and sarcasm) a. develop vocabulary to express emotions and share
experiences with others
b. use language to prepare for changes in routine
c. discuss potentially problematic emotionally
dysregulating situations
d. use language to request assistance and comfort
∗ Actual goals will vary depending on child’s needs and family priorities.
In the SCERTS Model, all who interact with regulation may be referred to as respondent
a child with ASD on a regular basis (eg, mutual regulation. For example, a child’s fa-
parents, other caregivers, siblings, peers, ed- cial expression or bodily tension may signal
ucators, and therapists) are viewed as poten- fear or anxiety, to which a caregiver responds
tial developmental facilitators and may bene- with verbal or nonverbal comfort. With the
fit from guidance and support in enhancing development of greater social awareness and
specific competencies in joint attention and communicative abilities, children begin to use
symbol use. However, a child’s ability and initiated mutual regulation strategies. That is,
“availability” for social engagement and com- they are able to intentionally communicate
munication, and learning in general, is greatly their needs (eg, for assistance, comfort) to
determined by the capacity for maintaining their caregivers through verbal and/or non-
well-regulated emotional and arousal states. verbal means. For example, to request com-
We now turn to this second critical compo- fort, a preverbal child may purposefully reach
nent, the “ER” of the SCERTS Model. out to be held, and a verbal child may request
comfort by saying “I’m scared.”
EMOTIONAL REGULATION Emotional regulation and arousal

Through the process of emotional regu-
Emotional regulation defined lation children strive to maintain an opti-
Emotional regulation is a core process un- mal state of arousal that matches the social
derlying attention and social engagement, and and physical demands of their environments
is believed to be essential for optimal socioe- and that allows them to respond adaptively
motional and communication development, (DeGangi, 2000). Arousal has been defined as
and the development of relationships for chil- a continuum of physiological states or biobe-
dren with and without disabilities (Prizant & havioral states ranging from sleep to wakeful
Meyer, 1993). Cicchetti, Ganiban, and Barnett (Lester, Freier, & LeGasse, 1995). Modulation
(1991) defined emotional regulation as “the abilities (ie, the efficient and appropriate tran-
intra and extra organismic factors by which sition along the continuum of arousal states)
emotional arousal is redirected, controlled, enable children to transition along this contin-
modulated, and modified to enable an indi- uum in accordance with internal and external
vidual to function adaptively” (p. 15). Tronick factors. Factors influencing the ability to tran-
(1989) distinguished between emotional self- sition along the continuum include, but are
regulatory capacities, and mutual regulatory not limited to, environmental characteristics
capacities, which both serve to aid in modu- (eg, types and intensity of environmental stim-
lating emotional arousal. Self-regulatory strate- ulation), social context, (eg, availability of fa-
gies are self-initiated and self-directed; mutual miliar communicative partners), and internal
regulatory strategies occur in the context of or constitutional variables (eg, illness, level
social interaction and involve a child’s ability of fatigue, and pain). Pert (1997) argued that
to respond to assistance from others in help- physiological state and emotional state are in-
ing to maintain a state of optimal arousal. In terdependent: “Every change in the physio-
early stages of development, mutual regula- logical state is accompanied by an appropriate
tion is characterized by a caregiver sensitively change in the mental emotional state, and ev-
reading and responding to a child’s behaviors, ery change in the mental emotional state (con-
which are not directed purposefully to the scious or unconscious) is accompanied by a
caregiver, but nonetheless signal to the care- change in the physiological state.”
giver the child’s emotional state and level of It has been well documented that children
arousal. A partner must interpret a child’s sig- with ASD have significant difficulties with
nals and provide appropriate support if and arousal modulation, and therefore, emotional
when needed. Therefore, this type of mutual regulation, due to neurophysiological factors
(Anzalone & Williamson, 2000; Dawson & tively on the development of “inner language.”
Lewy, 1989; DeGangi, 2000; Kientz & Dunn, It has long been understood that inner lan-
1997; Ornitz, 1989). This may take the form guage (Vygotsky, 1978), or the ability to rep-
of a low threshold for physiological and emo- resent events in memory and problem solve
tional reactivity, resulting in being “at risk”for through inner symbolic means, serves an im-
experiencing heightened states of arousal and portant cognitive function of organizing expe-
emotion (ie, hyperreactivity), causing anxiety, rience and behavior, thinking about and learn-
agitation, and a limited ability to be “available” ing from past events, and planning for future
for learning and interacting. In these height- events. With limited ability to use inner lan-
ened states of arousal, children often exhibit guage for these cognitive functions, it is less
flight, fright, and fight reactions, which are possible to plan for dysregulating and poten-
frequently misinterpreted and treated as “be- tially threatening events, or to reflect on past
havior problems.”Thus, when a child exhibits events in a manner that supports emotional
these reactions, he or she may be described as regulation when faced with stressful events.
being aggressive, noncompliant, or intention- These difficulties may contribute to the un-
ally manipulative. For instance, a child with a predictable reactions to daily events observed
hyperreactive response to tactile stimulation in many children with ASD.
may push or hit other children in a defensive Mutual regulation may be compromised
reaction to being inadvertently touched or in because of difficulties with joint attention,
anticipation of being touched. A child who is which is considered to underlie the develop-
hyperreactive to visual and auditory stimula- ment of secure relationships (Stern, 1985),
tion may attempt to “escape”from overly stim- and related social-communication difficulties.
ulating environments or activities. For other A caregiver may not be viewed as a poten-
children, persistent states of underarousal (ie, tial source for mutual regulation, thus limiting
hyporeactivity) secondary to high thresholds the strategies a child develops and employs to
for physiological and emotional reactivity may maintain a well-regulated emotional state. For
result in passivity, lethargy, and a similar in- example, a child may not “know,”that another
ability to be available for processing social person can provide comfort through physical
and environmental experiences. These chil- or verbal means, and therefore, does not seek
dren are often described as unmotivated, self- others out. Even for a child with this “knowl-
absorbed, nonfocused, or “spacey.”Some chil- edge” mutual regulatory strategies may be sig-
dren may experience shifting states of over- or nificantly compromised or absent at higher
underarousal that occur cyclically (eg, accord- levels of arousal because of a more limited
ing to time of day), or unpredictably, result- ability to engage in communicative interac-
ing in a complex pattern that is challenging to tions in states of high arousal and emotional
both families and professionals (see Anzalone dysregulation. In addition to the impact of lim-
& Williamson, 2000, for further discussion). itations in expressive communication, limita-
tions in receptive language and communica-
Communication, arousal, and emotional tion may also detrimentally affect the capacity
regulation to maintain a well-regulated state. For exam-
Social-communicative and language diffi- ple, a child’s emotional reaction to problems
culties experienced by children with ASD in comprehending gestures or language may
significantly impact their arousal modula- cause confusion and/or frustration, resulting
tion abilities and behavioral organization, and in an increase in arousal.
therefore, their emotional regulation, in ref- In summary, there is a clear interdepen-
erence to the development of both self- and dent relationship among the development of
mutual regulatory abilities. Regarding self- mutual and self-regulatory capacities, commu-
regulation, difficulties with symbolic capac- nication, language, and other aspects of so-
ities, as described earlier, may impact nega- cioemotional development (Prizant & Meyer,
1993; Prizant & Wetherby, 1990). While self- binations of strategies, an individual child
and mutual-regulatory capacities support de- employs.
velopment in these related domains, increas- An essential component of the SCERTS
ing abilities in language and communication, Model is initially to assess a child’s capacities
in turn, are considered to play an important to maintain well-regulated states of arousal
role in the development of more sophisticated across contexts, by documenting the primary
strategies for emotional regulation. factors supporting or interfering with emo-
tional regulation, and the specific signals that
Addressing emotional regulation a child gives when he or she needs support.
challenges in the SCERTS model Different behavioral signals are categorized
Because of the interdependency between according to different levels of arousal, rang-
social communication and emotional regula- ing from calm and well-regulated to extremely
tion, the SCERTS Model incorporates an inte- dysregulated, with gradations in between.
grative approach when difficulties are present Next, specific goals and a plan are developed
in both developmental domains as is com- for supporting a child in acquiring and apply-
monly observed in ASD. The SCERTS Model ing self-regulatory or mutual-regulatory strate-
directly addresses emotional regulation by gies that are indexed to each level of arousal.
targeting goals for the development of self- As emotional regulatory strategies are imple-
regulatory and mutual-regulatory capacities. mented, the efficacy of such strategies are
In determining individualized goals, these ca- documented with adjustments made to the
pacities must be understood from a develop- plan as needed.
mental perspective. That is, emotional regu- Table 3 provides sample goals at sensory
lation may be facilitated through presymbolic motor and cognitive-linguistic levels for self-
sensory-motor means, or through higher level and mutual regulation. Self-regulatory strate-
cognitive-linguistic means, consistent with a gies may include helping a child to discover
child’s developmental profile and skill acquisi- ways to maintain an organized state in which
tion (DeGangi, 2000; Prizant & Meyer, 1993). he or she is available for active learning. For
For instance, an infant first develops sensory instance, self-regulatory, sensory motor strate-
motor, self-regulating abilities, such as suck- gies for self-soothing when a child is in a
ing a thumb, averting gaze, or engaging in heightened state of arousal may include focus-
repetitive motor activity. Likewise, as a child ing on a particular calming activity (eg, listen-
matures and develops greater cognitive and ing to music, holding a favorite toy), or, for
linguistic skills, the ability to employ these more able children, taking a break from an
skills for emotional regulatory functions de- activity. Self-regulatory strategies may also in-
velops as well (eg, the ability to use “self talk” clude initiating and engaging in alerting sen-
to regulate one’s arousal during an anxiety sory motor activities, such as increased phys-
arousing situation). Therefore, while the reg- ical activity, when a child is in a low state
ulatory abilities of a young child are limited of arousal and not optimally engaged in ac-
based on his or her developmental level (eg, a tivities and interactions. At a cognitive level,
presymbolic child cannot use language-based helping children to develop an awareness of
or other symbolic strategies), the abilities of the activity schedule, steps within activities
an older more able child consist of both ear- or the duration of activities, transitions be-
lier developing sensory-motor strategies and tween activities, and unexpected changes in
higher level cognitive-linguistic strategies (eg, routines may preclude negative reactions due
a symbolic child can use language as well as to confusion or a lack of predictability, and
engage in repetitive motor activity to remain therefore promote greater self-regulation abil-
well-regulated). State of arousal and environ- ities. Helping to develop an awareness of
mental demands often contribute to which time concepts as well as the ability to under-
of these specific types of strategies, or com- stand language about past and future events
Table 3. SCERTS Model: Emotional regulation goals∗
Goals for self-regulation Goals for mutual regulation

Prelinguistic/sensory-motor level goals
• Increase child’s ability to acquire and use • Increase child’s ability to maintain engagement
sensory-motor strategies to support and attention to activities by responding to
engagement and attention to daily behavioral signs of dysregulation (eg, decrease
activities (eg, for a child who is typically in the amount of environmental stimulation
a low state of arousal, expand his/her when a child exhibits “fright and flight”
repertoire of alerting strategies—jumping, reactions; increase the amount of stimulation
random movement, etc; for a child who is embedded in activities when a child appears
typically in a high state of arousal, expand hyporesponsive to the environment)
his/her repertoire of calming • Increase child’s ability to use socially
strategies—holding favorite object, acceptable gestures for social control
rhythmic motion, etc functions requesting and protesting (eg, head
• Expand the child’s use of sensory-motor nod, head shake, push away, point, etc)
strategies to support transitions within • Develop strategies through nonspeech
daily routines (eg, use of transition transactional supports to assist the child with
objects, embed organizing sensory-motor expression of arousal and emotional state (eg,
supports within transition activities) visual supports)
Cognitive-linguistic level goals
• Increase the child’s ability to initiate and • Increase the child’s acquisition of vocabulary
utilize cognitive-linguistic strategies to to be able to request assistance and organizing
support his/her attention to activities and supports when he/she experiences
daily routines (eg, through the use of dysregulating events (eg, requesting “help,” a
rehearsal and self-regulatory language) break from an activity, etc)
• Expand the child’s use of • Increase the child’s ability to use specific
cognitive-linguistic strategies to support vocabulary to express emotional state and
transitions throughout daily routines (eg, arousal level
introduce visual schedules to symbolize • Increase ability to identify and express
activity sequence and transitions, increase emotional state and arousal level as well as use
the child’s awareness of temporal regulating strategies with and without the use
concepts, etc) of visual supports
∗ Actual goals will vary depending on child’s needs and family priorities.
also contribute to cognitive self-regulation In the SCERTS Model, capacities for initiated
strategies. mutual-regulation strategies are also fostered
In addition to self-regulatory capacities, the in ways that best fit a child’s developmental
SCERTS Model targets the development of profile and needs. Children may be taught to
mutual-regulatory strategies. When a child is request assistance or protest in socially ac-
experiencing a high degree of arousal, or is ceptable ways through nonverbal means (eg,
underaroused, partners need to read those sig- acquiring and using early developing gestures
nals indicative of different states, and then to request, protest, or reject) or verbal means
support mutual regulation by responding in (eg, acquiring and using specific vocabulary
ways that promote a child’s ability to focus, for expressing emotions, or to indicate re-
engage, and be in a state more conducive fusal). These abilities have been demonstrated
to relating, learning, and processing informa- to be effective preventive measures to pre-
tion. This is consistent with a respondent clude problem behaviors precipitated by emo-
form of mutual-regulation discussed earlier. tional dysregulation (Carr et al., 1994).
The plan also includes proactive and pre- 1984) underscore the challenges experienced
ventative measures to support emotionl reg- by children with ASD in engaging success-
ulation (eg, alternating sedentary activities fully in interpersonal interactions, and de-
with movement activities, reducing the level veloping emotionally fulfilling relationships.
of sensory input), as well as reactive strate- It is now understood that these challenges
gies when faced with potentially dysregulat- are among the core, definitive characteris-
ing experiences (eg, allowing a child access tics of ASD. That is, children are not “choos-
to a quiet space or calming activity, simplify- ing” to be disengaged from social interac-
ing a task, reducing the duration of an activ- tion and relationships due to a primary lack
ity). Dysregulating experiences may include of interest or desire. Because of challenges
overwhelming sensory input, changes in rou- in social-communicative, social-cognitive, and
tine, inappropriate task demands related to emotional-regulatory capacities, they are lim-
difficulty or duration of an activity, and disor- ited in the requisite abilities and skills to be
ganizing social and linguistic input. The use more successful, active participants. Addition-
of transactional supports, such as nonspeech ally, some communicative partners who reg-
communication systems and visual supports, ularly interact with children may also lack
play important roles in these efforts, and thus, the knowledge and skills to support their ef-
we now will shift our attention to the “TS” of forts. Therefore, children with ASD are at
the SCERTS Model. risk for developing a sense of interpersonal
interaction as overwhelming, confusing, and
TRANSACTIONAL SUPPORT stressful based on a history of repeated un-
successful experiences, while others are at
Due in large part to the difficulties in social risk for limited engagement and low motiva-
communication and emotional regulation, the tion to participate in social interactions sec-
majority of children with ASD require a va- ondary to processing difficulties and hypore-
riety of supports to participate optimally in sponsive bias toward interpersonal events. In
interpersonal interactions and relationships, the SCERTS Model, there is a priority placed
and to understand and derive enjoyment from on supporting children to be as successful as
everyday activities. Supports are also needed possible in experiencing a sense of efficacy in
to maximize learning in educational settings communicating their intentions, and in partic-
and participation in daily living activities and ipating in affectively charged and emotionally
events. The notion of transactional support fulfilling social engagement with a variety of
in the SCERTS Model emphasizes that sup- partners. We believe an important key to such
ports must be flexible and responsive to dif- success is interpersonal support.
ferent social contexts and learning environ- The greater the abilities in social communi-
ments, and to the changing needs of children cation and emotional regulation, the greater
and families. Most important, however, is that the potential for a youngster to experience
both children and family members develop a frequent successful and joyful interactions,
sense of confidence and competence in uti- which provide the foundation for the de-
lizing and responding to supports. Transac- velopment of emotionally satisfying relation-
tional support is addressed in 3 major domains ships. Interwoven throughout interpersonal
in the SCERTS Model—interpersonal support, exchange and sharing of experiences is the
educational support, and family support (see communication of emotional states through
Table 4). the medium of verbal and nonverbal signals.
Sensitive partners attune affectively and cali-
Interpersonal support brate their emotional tone to that of the less
The daily experiences of professionals and able partner, in order (1) to acknowledge their
family members (Domingue et al., 2000), as appreciation of the subjective emotional state
well as empirical research (Bristol & Schopler, of the child, (2) to attempt to motivate further
Table 4. SCERTS Model: Transactional support goals
I. Interpersonal support
1. Identify specific features of communicative partners’ interactive styles and language use that
either support or are barriers to successful interactions (eg, expression of emotion, language
complexity and style, vocal volume, rate, physical proximity, physical contact, use of visual
supports). An optimal style is one that provides enough structure to support a child’s
attentional focus, situational understanding, emotional regulation, and positive emotional
experience, but that also fosters initiation, spontaneity, flexibility and self-determination
2. Coordinate efforts across different partners in developing strategies to use more those
specific features that support more successful interaction
3. Design and implement learning experiences with peers so that the child with ASD may
benefit optimally from good language, social, and play models. Design motivating activities,
organize supportive environments, and incorporate visual supports. Teach both typical
children and children with ASD specific strategies for success in daily interactions
II. Educational and learning supports
1. Design and implement visual and organizational supports for
a. expanding and enhancing the development of a child’s expressive communication
system, either as a primary modality or as an augmentative system that is one part of a
child’s multimodal communication system;
b. supporting a child’s understanding of language as well as others’ nonverbal behavior;
c. supporting a child’s sense of organization, activity structure, and understanding of time;
and
d. supporting the development and use of cognitive-linguistic emotional regulatory
strategies.
e. Adapt and/or modify curriculum goals that are primarily language-based to enable the
child to succeed to the extent possible.
2. Design living and learning environments to support social communication and emotional
regulation.
III. Family support (ie, support to parents, siblings, extended family members)
1. Provide families with educational support including information, knowledge, and skills to
understand the nature of their child’s disability and to support their child’s development.
Support that is provided, must be based on family priorities, and offered through a variety of
options such as educational support activities (eg, lectures, discussion groups), direct
training of skills, observation of educational/treatment programming, and interactive
guidance in natural activities
2. Provide emotional support in one to one and group settings to
a. enhance family members abilities to cope with the stresses and challenges of raising a
child with ASD
b. help parents to identify their priorities, and develop appropriate expectations and
realistic, achievable goals for their child’s development and for family life
social and emotional engagement, and (3) to nicative partners are assessed for the quali-
attempt to support the child during disorga- ties that enhance or inhibit successful inter-
nizing and emotionally arousing experiences actions. Interaction style variables that war-
(Greenspan & Wieder, 1997; Stern, 1985). rant assessment are those that may influence
Interpersonal support is addressed in a va- a child’s response to others’ attempts to en-
riety of ways in the SCERTS Model. First, the gage in social exchange. These include, but
interactive styles and language use of commu- are not limited to, expression of emotion,
language complexity and style, volume and Second, opportunities for play interactions
rate of speech, physical proximity, and phys- with other children (including siblings) are
ical contact. For example, a well-intentioned assessed, with the goal of designing and im-
partner may use too loud a voice and exag- plementing learning experiences so that the
gerated facial expression to express delight child with ASD may benefit optimally from
to a hyperreactive child, or another partner good language, social, and play models. The
may use language that is too complex, result- goal is to develop a history of successful ex-
ing in confusion or nonresponsiveness. An in- periences for a child with ASD to further moti-
teractive style that is too directive and con- vate a child to seek out other children, leading
trolling (eg, excessive physical prompting or to the development of positive relationships
correcting) may result in a hyporeactive child and increased social motivation. Because chil-
developing an even more passive and respon- dren tend to be less predictable than adults, it
dent style of relating or communicating. Con- is commonly observed that interactions with
versely, a child with a bias toward sensory other children may be avoided by children
hyperreactivity may respond by frequent at- with ASD. Supporting successful peer inter-
tempts to protest or escape from a highly actions involves designing motivating activi-
directive partner. On the other end of the ties, organizing supportive environments, and
continuum, a partner who provides too little teaching both typical children and children
consistency, structure, or clarity of expecta- with ASD specific strategies for success.
tions through language or other means may
not be able to support a child who needs Educational and environmental
a greater degree of external scaffolding for supports
emotional regulation and social participation. Because of the nature of learning differ-
Based on an assessment of partners’ styles ences in ASD and the complexity of learning
across contexts, and a child’s reaction to dif- environments, a variety of educational sup-
ferent styles, educational/treatment goals may ports are typically needed to optimize success
include determining the features of commu- in school, and other learning environments.
nicative and interactive styles most support- Although it is acknowledged some children
ive for a child in different settings. In the with the most extreme challenges may re-
SCERTS Model, an optimal style is one that quire significant modifications to support ac-
provides enough structure to support a child’s tive learning, the SCERTS Model prioritizes
attentional focus, situational understanding, learning in a variety of settings from the out-
emotional regulation, and positive emotional set. The justification is that generalization of
experience, but that also fosters initiation, abilities is best accomplished when children
spontaneity, flexibility, problem-solving, and learn skills in settings that occur naturally as
self-determination. With the important prior- part of their daily routine. Additionally, differ-
ities of building self-determination and initia- ent social settings provide more varied learn-
tion, a predominant behavioral pattern of pas- ing opportunities that cannot be replicated
sive compliance in a child is as undesirable in highly repetitive one-to-one drill practice.
as “difficult to control” behavior. Efforts must For example, treatment limited primarily to
be coordinated across different partners in de- adult-child 1:1 interaction cannot address the
veloping strategies to use more optimal styles goal of enhancing a child’s capacity to shift
of interaction, to support children’s indepen- attention to follow the flow of interaction in
dence and development of a sense of self. Al- a small group, to tolerate proximity to other
though some degree of variability across part- children, and/or to anticipate one’s turn in
ners is natural and is to be expected, too great ongoing reciprocal interactions. These goals
a discrepancy may result in confusion for a not only require well-designed, semistruc-
child trying to learn the very rudiments of so- tured activities, but also more varied social
cial engagement, and social expectations. contexts.
In the SCERTS Model, educational and en- curriculum modification also is often neces-
vironmental supports are developed and uti- sary to support a preschool child’s success.
lized to enable children to be more actively en- For preschool children with more significant
gaged by supporting social communication, language processing limitations, curriculum
emotional regulation, and learning. First, it is goals that are primarily language-based may
necessary to assess the barriers to active en- have to be adjusted and or modified, with
gagement in reference to the learning style of appropriate supports (eg, visual supports)
children with ASD. For example, it is well ac- added to enable the child to succeed to the
cepted that most children with ASD are more extent possible in the preschool curriculum.
effective at processing and retrieving visual in-
formation than auditory information (Prizant, Support to families
1983; Wetherby et al., 1997). Therefore, visual Support to families can be conceptual-
supports may be helpful in ized in reference to educational support (ie,
1. expanding and enhancing a child’s ex- providing families with the information,
pressive communication system, either knowledge, and skills to support their child’s
as a primary modality or as an augmen- development) and emotional support (ie, en-
tative system comprising one compo- hancing family members abilities to cope with
nent of a child’s multimodal communica- the inevitable stresses and challenges of rais-
tion system (eg, pictures, gestures, signs, ing a child with ASD). In the SCERTS Model, it
speech); also is recognized that many stresses and chal-
2. supporting children’s understanding of lenges experienced by family members may
language as well as others’ nonverbal be- not be attributed directly to the child’s behav-
havior through the use of topic boards, ior or needs. Great stress may be induced by
cue cards, etc; systems of service delivery that parents ex-
3. supporting a child’s sense of organiza- perience as nonsupportive, disorganized, and
tion, activity structure, and understand- in general, not helpful (Domingue, Cutler, &
ing of time through the use of picture McTarnaghan, 2000).
schedules and activity sequences; and The great majority of caregivers of chil-
4. supporting the development and use of dren with ASD have had little formal train-
cognitive-linguistic emotional regulatory ing in child development. However, the most
strategies through the use of picture se- critical social-communicative and socioemo-
quences, break cards, personal organiz- tional experiences for most children occur
ers, and so forth (Groden & LeVasseur, in their interactions with family members,
1995; Quill, 1998; Schuler, Wetherby, & when youngsters are developing the founda-
Prizant, 1997). tions of relationships, are learning the basic
In the SCERTS Model it is essential to specifi- elements of communicative exchange, and,
cally identify the types of visual and organiza- eventually, are acquiring more sophisticated
tional supports that may be helpful based on socioemotional and communicative abilities.
a child’s developmental capacities and needs, Daily routines and family events provide the
and relative to activities and social contexts in experiential opportunities in which children
a child’s life. Furthermore, efforts are made to learn and practice these abilities and develop
modify and calibrate supports as a child de- secure and trusting relationships (Prizant &
velops, with the goal of greater efficiency and Meyer, 1993). As noted, however, children
functionality in the use of supports over time. with ASD are greatly challenged in socioe-
In educational environments, another es- motional and communicative development,
sential transactional support is curriculum despite the best efforts of loving and well-
modification. Although this is not as cru- intentioned family members. Thus, family
cial for children in the preschool and early members are likely to experience frustration
childhood years as it is for older children, and confusion as they try their intuitive best to
engage their children. In the SCERTS Model, mutual-regulatory capacities within the con-
efforts are made to mitigate these challenges text of the family structure and routine are
to family members by addressing causal fac- also addressed.
tors related to limitations in social commu- In the SCERTS Model, it also is emphasized
nication and emotional regulation directly that clinicians and educators understand vari-
through supportive education/treatment and ous family structures and functions, and how
sharing of resources with families. these can be influenced by economic, ethnic,
In the SCERTS Model, it is emphasized that and cultural factors. For example, because
clinicians and educators must be cognizant of cultural and pragmatic factors, biologi-
of the whole range of possible reactions that cal parents may not necessarily be the pri-
family members may experience in raising mary caregivers in some families, and thus,
a child with ASD, in order to best support other family members such as grandparents
their efforts. The SCERTS Model is a devel- or older siblings may play a more active role
opmental model for caregivers as well as for in education/treatment. When designing ed-
children, as it is recognized that the nature ucational/treatment strategies to be utilized
and types of emotional support will need to by family members and integrated into daily
change as caregivers progress in their under- family routines, it is critical that recommenda-
standing of and ability to support their child. tions must be compatible with the family’s be-
Parents and caregivers are encouraged to dis- lief systems and sociocultural characteristics
cuss their child’s strengths and difficulties, (Lynch & Hanson, 1998).
and to articulate the primary concerns and Another important dimension of transac-
expectations regarding their child’s develop- tional support in the SCERTS Model is help-
ment. When appropriate, caregivers may be ing parents to think clearly about their pri-
asked to share their sense of competence as orities, and develop appropriate expectations
well as limitations in fostering communicative and realistic, achievable goals for their child’s
and socioemotional development. Successful development. Parents are not dictated to,
and unsuccessful strategies that family mem- they are respected as having ultimate “own-
bers may have employed to promote social ership” of the decisions that must be made
and communicative interactions must also be for both the child and family. Professionals
explored. Information about a child and fam- have the responsibility of “keeping hope alive”
ily’s strengths and needs, and family priori- by emphasizing a child’s strengths as well
ties, as gathered in assessment, form the ba- as needs, highlighting the potential for pos-
sis from which specific educational/treatment itive development and change, and helping
goals are derived. Caregivers are supported to identify developmentally appropriate “next
in reference to communicative and interactive steps.” This involves helping parents to learn
styles that are most appropriate in enhancing to recognize and celebrate even the smallest
their child’s development. Issues discussed meaningful gains in social-communicative and
earlier such as degree of directiveness and de- socioemotional development. The more care-
velopmentally appropriate language and com- givers are attuned to positive change, the
municative modeling in everyday routines are more they are likely to become invested in be-
important considerations in ongoing support ing actively involved in educational/treatment
of caregivers. In addition to assistance ad- efforts.
dressing social communication skills, care- In summary, transactional supports ad-
givers are supported in helping their children dressed in the SCERTS Model are designed
to develop emotional regulation capabilities. to enhance children’s communication and so-
Ongoing assessment of and dialogue with cioemotional abilities in everyday social con-
caregivers about a child’s reactive style to texts that a child experiences. Supports may
physiological and emotional factors is crucial. include interpersonal supports, educational
Strategies for the development of self- and supports, and support to family members,
who play such an important role in fostering tests or school placement, to include broader
a child’s development. Because of the trans- and more dynamic measures, such as degree
actional nature of development (Sameroff of success in communicative exchange, re-
& Fiese, 1990), the crucial role played by lated dimensions of emotional expression and
all caregivers and partners is recognized, regulation, social-communicative motivation,
with specific efforts directed to development social competence, peer relationships, and
of mutually satisfying and effective social- the child’s competence and active participa-
emotional experiences based on an under- tion in natural activities and environments.
standing of a child’s and family’s needs. Therefore, assessment cannot be limited to
the evaluation of child variables only; it should
ASSURING ECOLOGICAL VALIDITY be extended to contextual and interactional
IN SERVICE DELIVERY variables (see Prizant & Wetherby, 1998, for
further discussion). Service providers need to
In the SCERTS Model, it is recognized gather meaningful measures of a child’s abil-
that a primary challenge for service delivery ities in order to guide educational/treatment
providers is to address the complex relation- decisions and to determine whether educa-
ships among the acquisition of communica- tional/treatment effects are being achieved.
tive abilities, socioemotional factors (eg, This need for more meaningful outcome mea-
emotional regulation, development of rela- sures in research on children with ASD was
tionships), and types of transactional supports recently recognized by the NRC (2001). It
that predict better social-communicative out- recommended that as priorities, such mea-
comes for children with ASD. On the ba- sures should include (1) gains in initiation of
sis of a comprehensive review of interven- spontaneous communication in functional ac-
tion research on children with ASD, the tivities and (2) generalization of gains across
NRC (2001) concluded that research has activities, interactants, and environments. In
demonstrated substantial changes in large other words, enhancing communication and
numbers of children receiving a variety socioemotional abilities for children with ASD
of educational/treatment approaches, rang- entails not only increasing vocal and verbal
ing from behavioral to developmental. How- repertoires, but also increasing many of the
ever, even in treatment studies with the dynamic aspects of social communication and
strongest gains, children’s outcomes were social relationships that are targeted as high
variable. Service providers are thus faced priorities in the SCERTS Model, so that chil-
with the need to determine which educa- dren are able to participate more success-
tional/treatment approaches or combinations fully in developmentally appropriate activi-
of educational/treatment strategies may be ties with caregivers and peers in a variety of
most effective for particular children and fam- contexts.
ilies (Prizant & Wetherby, 1998). In summary, the SCERTS Model offers
The most common reported outcome mea- a framework to directly address the core
sures for children with ASD are changes in challenges of ASD, focusing on building a
IQ scores and postintervention placement child’s capacity to initiate communication
(NRC, 2001). These measures may not be with a conventional, symbolic system, and
ecologically valid, because they do not mea- to develop self- and mutual-regulatory ca-
sure changes within natural environments, do pacities to regulate attention, arousal, and
not address the core “deficits” in ASD, and emotional state. The model provides indi-
are particularly problematic for infants and vidualized education/treatment based on a
young children. In determining if an educa- child’s strengths and weaknesses guided by re-
tional/treatment approach is effective, it is im- search on the development of children with
portant to go beyond traditional “static” mea- and without disabilities. It incorporates ed-
sures such as improvement on standardized ucational/treatment strategies derived from
evidence-based practice of contemporary be- and the absolute necessity for supporting
havioral and developmental social-pragmatic communication and socioemotional develop-
approaches. Transactional supports are iden- ment in everyday activities and routines. It
tified and implemented to support young chil- is hoped that the SCERTS Model will pro-
dren and their caregivers and to promote gen- vide a vehicle to motivate professionals to
eralization of acquired abilities. Progress is focus efforts on the core challenges faced
measured in functional activities with a vari- by children with ASD and their caregivers,
ety of partners in the SCERTS Model; thus, and to help to move the field to a new gen-
the broader context of a child’s development eration of more integrated, comprehensive
is recognized, including family involvement, programs.
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The SCERTS Model: A Transactional Approach to Enhancing Communication

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LWW/IYC AS213-03 August 11, 2003 8:50 Char Count= 0

Infants and Young Children

The SCERTS Model

A UTISM SPECTRUM DISORDER (ASD) or

The SCERTS Model 297

298 INFANTS AND YOUNG CHILDREN/OCTOBER–DECEMBER 2003

The SCERTS Model 299

Table 1. SCERTS Model—Summary of education/treatment priority goals

300 INFANTS AND YOUNG CHILDREN/OCTOBER–DECEMBER 2003

The SCERTS Model 301

302 INFANTS AND YOUNG CHILDREN/OCTOBER–DECEMBER 2003

1. Limitations in the use of conven- ties. An essential component of the SCERTS

The SCERTS Model 303

Table 2. SCERTS Model: Sample social communication goals∗

Goals for joint attention Goals for symbol use

304 INFANTS AND YOUNG CHILDREN/OCTOBER–DECEMBER 2003

EMOTIONAL REGULATION Emotional regulation and arousal

The SCERTS Model 305

306 INFANTS AND YOUNG CHILDREN/OCTOBER–DECEMBER 2003

The SCERTS Model 307

Table 3. SCERTS Model: Emotional regulation goals∗

Goals for self-regulation Goals for mutual regulation

308 INFANTS AND YOUNG CHILDREN/OCTOBER–DECEMBER 2003

The SCERTS Model 309

Table 4. SCERTS Model: Transactional support goals

310 INFANTS AND YOUNG CHILDREN/OCTOBER–DECEMBER 2003

The SCERTS Model 311

312 INFANTS AND YOUNG CHILDREN/OCTOBER–DECEMBER 2003

The SCERTS Model 313

314 INFANTS AND YOUNG CHILDREN/OCTOBER–DECEMBER 2003

The SCERTS Model 315

316 INFANTS AND YOUNG CHILDREN/OCTOBER–DECEMBER 2003

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