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Methods for Teaching
Students with Autism
Spectrum Disorders
Evidence-Based Practices
John J. Wheeler
East Tennessee State University
Michael R. Mayton
West Virginia University
Stacy L. Carter
Texas Tech University
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Library of Congress Cataloging-in-Publication Data

Wheeler, John J.
Methods for teaching students with autism spectrum disorders : evidence-based practices /
John J. Wheeler, Michael R. Mayton, Stacy L. Carter.
pages cm
ISBN 978-0-13-707171-5
1. Autistic children—Education. 2. Autistic children—Research. I. Title.
LC4717.W445 2014
371.94—dc23
2013046086
10 9 8 7 6 5 4 3 2 1
ISBN 10: 0-13-707171-X

ISBN 13: 978-0-13-707171-5
Dedications
To my former colleagues of long ago on the South Dakota Autism Project Team:
Dr. Tom Stanage, Wendy Polsky-Pearlman, MS, CCC-SLP, and Dr. Phil Hall;
to the many children and families who have blessed my professional life over the
years; and to my family for their love and support—thank you Karen, Alli, Ben,
John, Callie, Jason, Stella, Evelyn, and Scout.
John J. Wheeler
To my dear wife and son: Thank you for sacrificing some of your time with
me so that I could complete this project. I hope that our combined efforts
can eventually help many other families like ours.
Michael R. Mayton
To my parents, Tracy and Judy, for always supporting me in every way,

and to my sons Ezra and Zavin for the inspiration they offer
and the joy they bring.
Stacy L. Carter
This page intentionally left blank
A b o ut the A uth o rs
John J. Wheeler currently serves as Director of the Center of Excellence in Early

Childhood Learning and Development and Professor of Special Education at East
Tennessee State University. He has had over 25 years of experience in working with
children with autism spectrum disorders and their families throughout his career
in special education. He has authored/co-authored numerous research articles and
book chapters in the education and treatment of children with ASD and serves on
editorial boards for professional journals in the field. Most recently, he and Dr. David
Dean Richey completed the third edition of their text entitled Behavior Management:
Principles and Practices of Positive Behavior Supports, also published by Pearson. In addi-
tion, he has been actively involved throughout his career in program development
activities that have included the development of a regional technical assistance project
in the area of positive behavior supports designed to serve children with ASD and
other developmental and behavioral disabilities and similar programs during his ser-
vice as a principal investigator and college-level administrator.
Michael R. Mayton is an Assistant Professor of Special Education at West Virginia

University, where he teaches courses in applied behavior analysis for teachers and
supervises the graduate certification program in autism. He is a board-certified behav-
ior analyst who has worked with children in public schools and adults with develop-
mental disabilities in community settings. He has had the honor of being the founding
director of the Kelly Autism Program in Bowling Green, Kentucky, and providing a
range of workshop supports to educators on topics such as identifying and teaching
positive replacement behaviors, reducing aggression in young adults with autism, and
antecedent management for students with developmental disabilities. His research
interests include evidence-based practice assessment and development for people with
autism, professional development in special education, and intrusiveness of behavioral
treatments for students and adults with disabilities.
Stacy Carter is an Associate Professor in the Special Education Program at Texas

Tech University, where he coordinates the Graduate Certificate Program in Applied
Behavior Analysis. He is a board-certified behavior analyst, a nationally certified
school psychologist, and a licensed special education teacher. He has over 15 years
of experience working with individuals with autism spectrum disorders in develop-
mental centers, psychiatric hospitals, community living situations, and school settings.
His research has focused on the development and evaluation of behavior intervention
programs for individuals with developmental disabilities and autism. He has published
numerous peer-reviewed journal articles, book chapters, and a scholarly reference
book on social validity.
v
P reface
Methods for Teaching Students with Autism Spectrum Disorders: Evidence-Based Practices
is our attempt to introduce the professional knowledge and skill competencies that
teachers need in serving individuals with autism spectrum disorders (ASD) across the
age span into young adulthood. This introduction and methods textbook provides an
overview of the etiology and characteristics of ASD and introduces evidence-based
practices in the education of persons with ASD. The application of these practices is
explored across three critical periods in the lives of children and families that include
early childhood, the school years, and moving from school to adult life. The text
examines how evidence-based practices are applied in identification and early inter-
vention, when teaming with families, teaching communication skills, promoting social
competence, building school-based behavioral repertoires, engaging in collaboration
and consultation, developing academic skills, fostering self-determination, transition-
ing to adulthood, and enhancing quality of life.
This book is timely given the increased need for building capacity to address the
educational and life support needs of persons with ASD. More teachers and related
service professionals trained in the field of autism are needed, and increased compe-
tencies on the part of special and general educators are becoming a growing priority.
This book attempts to provide preservice and in-service teachers and related profes-
sionals with an understanding of how to teach students with ASD across educational
settings and within specific content areas.
Organization of the Text

The book is organized into four sections. Section I, “Introduction” is intended to pro-
vide students with a broad overview and understanding of autism spectrum disorders
(ASD). The origins of ASD, causes, and etiology are presented as a brief history of
autism and in terms of the treatment models that have been most commonly used.
Finally, this section presents students with an introduction to evidence-based practices
used in the education and treatment of ASD and presents a decision model for profes-
sionals to use in their work. Section II is directed toward the early childhood years,
the importance of screening and early identification, and the importance of early
intervention and partnering with families in the design and delivery of interventions.
Section III examines the school years for children with ASD and explores relevant
areas such as building behavioral repertoires needed for success in school, collabora-
tion and consultation among professionals and families, and the development of aca-
demic skills. The final section, Section IV, targets the transition to postschool settings
for these students and presents material on building self-determination skills, the key
elements associated with transition planning and meaningful postschool outcomes,
and the importance of quality of life for adults with ASD.
vii
viii P reface
New! Pearson eText Available

To enhance affordability and portability this exciting new edition is avail-
■
able as a Pearson eText. With the eText students can easily take and share notes,
highlight, and search for key concepts. To learn more about the Pearson eText,
go to www.pearsonhighered.com/etextbooks.
Acknowledgments
We would like to sincerely thank all of our colleagues at Pearson/Merrill who have
provided us with continued support and direction on this project. Thank you to Steve
Dragin, our editor, who has provided us with guidance and leadership throughout this
creative process, and to Annette Joseph and Carrie Fox for helping us shepherd the
project through to completion. We would also like to thank the reviewers who shared
their expertise in providing us with guidance in the development of the text: Jonna L.
Bobzien, Old Dominion University; Stacy L. Dean, University of Virginia; Tina T.
Dyches, Brigham Young University; Katherine C. Holman, Towson University; and
Kathi Wilhite, East Carolina University.
And, finally, our heartfelt thanks to our families for their continued love, sup-
port, and encouragement that made the completion of this text possible. In closing, we
hope that this text will serve a need in the preparation of those serving persons with
ASD and their families.
C o ntents
S ecti o n I Introduction
1
Understanding Autism 1
Concepts to Understand 1
Chapter 1 Mind Map 2
Causes of Autism 3
Autism Spectrum Disorders (ASD) 4
Increased Prevalence Rates 5
Importance of Early Detection 5
Diagnosis and Treatment 6
The Role of Early Intervention 8
A Brief History of Treatment 9
■ A pplied V i g nette 1 . 1 : The Importance of Early
Identification: Matthew’s Story 10
Designing Effective Longitudinal Educational Plans 11
The Importance of Evidence-Based Practices 12
Common Approaches Used in Education and Treatment 13
Applied Behavior Analysis 13
Naturalistic Approaches 15
Developmental Approaches 17
Multicomponent Approaches 18
■ C o nsider T his 20
Sensory Integration Therapy 21
Complementary and Alternative Medicine Approaches 21
Service Delivery Models 23
Home-Based Intervention 23
School-Based Models 25
Post-School and Community Options for Adults with ASD 27
■ A pplied V i g nette 1 . 2 : Family/Professional
Partnerships 27
Exemplary Programs and Practices 28
Chapter Summary 28
Activities to Extend Your Learning 29
Resources to Consult 29
ix
x C ontents
2
Determining Evidence-Based Interventions 30
■ A pplied V i g nette 2 . 1 : The Trial-and-Error
Treatment 31
Why Is Evidence-Based Practice Important? 33
Consumer Viewpoint 33
A Community of Professionals 34
History 36
What Is Sufficient Evidence? 37
Social Learning and Professional Practice 37
■ A pplied V i g nette 2 . 2 : The Hearsay Dilemma 39
A Call for More Skeptics 40
Levels of Evidence 42
Think Like a Scientist 48
■ A pplied V i g nette 2 . 3 : Subjectivity, Superstition,
and Mr. Gullible 49
Making Treatment Decisions 51
Proceed with Caution 51
Alternative and Emerging Treatments 53
Risk-Versus-Benefit Analysis 57
Assessing the Quality of a Research Base 58
Utilizing an EBP Research Base 61
Chapter Summary 69
S ecti o n I I Early Childhood
3
Assessment and Early Intervention 72
Characteristics and Early Signs of ASD 73
Recent Changes in the Classification of ASD 74
Developmental Screening 75
Multidisciplinary Assessment 76
contents xi
■ A pplied V i g nette 3 . 1 : The Evaluation

Process 77
Parent and Family Needs 78
Information Collected as Part of the Process 79
Developmental History 79
Autism Screening Instruments 79
Assessment Instruments 80
Autism Diagnostic Interview-Revised (ADI-R) 80
Autism Behavior Checklist (ABC) 80
Autism Spectrum Rating Scale 81
Behavioral Assessment 81
Functional Behavior Assessment 81
Supporting Children and Families through the Assessment Process
and Beyond 83
Linking Assessment to Intervention 85
Chapter Summary 87
4
Teaming with Families 89
Why “Teaming with” Families? 91
Understanding the Familial Challenges Often Associated
with ASD 91
Fostering a Sense of Commitment Through Building Trust 92
Understanding the Perspectives of Families 94
■ Applied V i g nette 4 . 1 : Natasha Describes the
Challenges Faced by Her Family 94
Common Needs Associated with ASD 95
Two Prominent Theories of Family Operation 102
■ A pplied V i g nette 4 . 2 : Mary Jane Describes the Needs
of Her Family 103
Methods for Fostering Successful Teams 106
Well-Grounded Philosophies, Procedures, and Practices 107
Family Team Building 112
xii C ontents
Enhancing Communication among Team Members 116

How to Communicate 117
Providing for Information Needs 118
Multicultural Considerations 120
Making a Communication Plan 122
Chapter Summary 125
5
Teaching Communication Skills 127
Communication Needs across the Lifespan 130
Typical Language Development 131
Communication and Language Development for Individuals with ASD 131
Communication and Language Assessment 133
Teaching Prerequisite Communication Skills 134
Methods for Promoting Prelinguistic and Emergent Language Skills 134
Parent-Implemented Social Communication Interventions 136
Picture Exchange Communication System (PECS) 137
Classroom Applications 138
Augmentive and Alternative Communication 139
Tools 139
Learner Preference 145
Communication in Inclusive Education Settings 148
Preparing Students to Communicate 148
Creating Opportunities to Communicate 148
Communicating with Peers 151
Future Directions: Teaching Communication in Community
Settings 152
■ A pplied V i g nette 5 . 1 : Andrea 153
Employment 154
Recreation and Leisure 159
Postsecondary Education and Training 161
Chapter Summary 162
contents xiii
6
Methods for Developing Social Competence 166
The Importance of Social Skills and Social Competence 167
Social Skills and Social Competence Defined 167
The Importance of Social Competence in Daily Life 168
Understanding Social Skill Difficulties in Persons with ASD 169
Neurodevelopmental Perspective 169
Cognitive Perspective 170
Behavioral Perspective 172
Evidence-Based Practices in the Development of Social Skills 172
EBP Methods Identified 173
Parent Partnerships 174
Peer-Mediated Interventions 175
Social Skills Training Groups 176
■ A pplied V i g nette 6 . 1 : An Example of a Social Skills
Training and Support Group 178
Video Modeling 178
Social Narratives 181
Self-Management 183
Naturalistic Interventions 185
■ C o nsider T his 1 8 6
Chapter Summary 187
S ecti o n I I I The School Years
7
Building School-Based Behavioral Repertoires 189
Underlying Principles of Positive Behavior Supports 190
Functional Behavior Assessment 192
Indirect/Naturalistic Assessment 193
Direct/Naturalistic Assessment 194
Indirect/Analog Assessment 196
Direct/Analog Assessment 197
Development of Behavior Support Plans 199
xiv C ontents
Engineering Learning Environments for Learners with ASD 200

Antecedent-Management Strategies 200
Environmental Variables 201
Instructional Approaches 202
Task-Related Variables 204
Teaching Replacement Behaviors 206
■ A pplied V i g nette 7 . 1 : Daniel 207
Chapter Summary 209
8
Collaboration and Consultation 211
Collaboration Defined 212
Formal and Informal Collaboration 213
Types of Collaboration 214
Models of Collaboration 215
Consultation Defined 215
Characteristics of Consultation 216
Approaches to Consultation 217
Positive and Negative Aspects of Consultation Approaches 218
Matching Consultation Approaches to the Needs of Individuals
Diagnosed with ASD 219
Problem Solving in Consultation 220
■ A pplied V i g nette 8 . 1 : Making a “Work System”
Work 220
Team-Based Services and Supports for Individuals with ASD
and Their Families 225
Team-Based Consultation and Collaboration 225
Components of Effective Collaboration and Consultation Across
Learning Environments 228
Environmental Factors Influencing Collaboration and Consultation 229
Effective Collaboration Practices 229
Recognizing Strengths and Needs of Team Members 230
Allocating Responsibilities to Team Members 230
Interpersonal Communication Skills 231
Administrative Support 231
contents xv
Effective Consultation Practices 231

Facilitation Skills 232
Organization Skills 233
Assessment Knowledge 233
Intervention Knowledge 234
Role Valorization in the Collaboration and Consultation Process 235
Applications of Collaboration and Consultation Across the Lifespan 235
Summary 238
9
Facilitating Academic Skills 240
A Population with Diverse Learning Characteristics 242
Intellectual Ability 243
Attention and Processing 245
■ A pplied V i g nette 9 . 1 : Jared 247
Academic Achievement 247
Instructional Contexts 250
Skills Prerequisite to Academic Learning 251
Self-Regulation 252
Working Independently 260
Expected Social Behavior 260
Addressing Significant Challenges and Needs Within Learning
Contexts 261
Stereotypy 261
Visual Learning Needs 263
Challenging Behavior 264
Increasing Motivation, Compliance, and Engagement 265
Motivation 265
Compliance 267
Engagement 269
Selected Academic Methods 270
Reading Instruction 270
Teaching Mathematics 271
Science Instruction 274
xvi C ontents
Applied Behavior Analysis for Academic Instruction 277

Chapter Summary 279
S ecti o n I V Moving from School to Life
10 Fostering Self-Determination Skills 281

Defining Self-Determination 282
Barriers to Self-Determination for Individuals
with ASD 283
Personal Characteristics 283
Environment 286
Social Variables 286
■ A pplied V i g nette 1 0 . 1 : Video Game
Enthusiast 287
Teaching Essential Components of Self-Determination 288
Making Decisions and Deriving Solutions to Problems 289
Monitoring Self 290
Accurately Appraising Skills 292
Adapting to Environments 292
EBP Methods for Teaching Self-Determination Skills 293
Practicing Self-Determination Skills 294
Self-Determined Model of Instruction 295
Chapter Summary 296
11 Transition to Adulthood 298
contents xvii
The Importance of Transition Planning 299

Transition Planning Process 302
Person-Centered Planning 302
Providing Training Across All Relevant Domains 307
Employment 307
Community Integration and Recreation 308
Postsecondary Education 309
■ A pplied V i g nette 1 1 . 1 : Life Decisions 310
Community Living 311
Promoting Self-Determination and Choice Making in the Planning
Process 312
Building Interagency Collaboration and Partnerships 313
Promoting Quality Assurance in the Transition Process 314
Chapter Summary 316
12 Enhancing Quality of Life for Persons with Autism

Spectrum Disorders 318
Quality of Life and Access to Services 319
Defining Quality of Life 322
Evaluating QOL Outcomes for Persons with ASD 323
Community/Residential Outcomes 324
Employment Outcomes 325
Recommendations for Enhancing Quality of Life 327
Transition Services 328
Effective Transition Planning 328
Promoting Successful Post-School Options Through Effective
Supports 329
Formal and Informal Supports 329
Determining Requisite Skills 330
Home and Community Living 331
xviii C ontents
■ A pplied V i g nette 1 2 . 1 : Teaching a Functional Skill

Sequence 332
Integrated Employment 333
Recommendations for Future Research on Promoting Successful
Life Outcomes for Persons with ASD 335
Chapter Summary 337
References 339
Name Index 365
Subject Index 371
1
chapter
Understanding Autism
Concepts to Understand
After reading this chapter you should be able to:

■ Describe the characteristics of autism.
■ Discuss the importance of early detection and identification of autism spectrum disorders (ASD).
■ Discuss the role of early intervention in the treatment of young children with ASD and the
importance of family partnerships.
1
2 S e c t i o n I / Introduction
■ Describe the concept of longitudinal education planning (LEP) as a method for devising long-term
treatment and educational programming for children with ASD.
■ Discuss the approaches most commonly used in the treatment of ASD.
■ Applied behavior analysis
■ Naturalistic
■ Developmental
■ Multi-component
■ Sensory integration training
■ Medical and alternative health approaches
Chapter 1 Mind Map

Causes of Autism
Autism Spectrum Disorders (ASD)
Increasing Prevalence Rates of ASD
Importance of Early Detection
Diagnosis & Treatment
A Brief History of Treatment The Role of Applied Behavior Analysis
Designing Effective Longitudinal Treatment Plans Early Intervention Understanding
Autism Naturalistic Approaches
The Importance of Evidence-Based Treatment Common Approaches in
the Treatment of ASD Developmental Approaches
Home-Based Intervention Service
Multicomponent Approaches
School-Based Models Delivery Models
Sensory Integration Therapy
Post-School & Community
Options for Adults with ASD Complementary & Alternative
Medicine Approaches
Autism is a complex neurodevelopmental disorder with no precise cause. This means

that autism involves an impairment of the brain in a way that can be observed through
the behavior and emotional characteristics of a person. Currently 1 in 50 children
are affected by autism (Blumberg et al., 2013), with the risk for boys being nearly five
times greater than for girls. Autism occurs during childhood, and therefore can have
an impact on how a child develops and matures. There have been several proposed
reasons for what causes autism, but there is currently no clearly known cause for the
disorder.
Autism ranges from mild to severe and impacts the degree to which a person’s
development is impaired. Those individuals who are higher functioning on the autism
spectrum may: display only minimal impairments in their intellectual processes, expe-
rience some motor difficulties, have an obsession with a particular area of interest,
have difficulty understanding and communicating feelings such as humor or empathy,
have an inability to discern subtle cues, have difficulties with pragmatic or functional
language, and have a hypersensitivity to certain noises, light, smells, and textures
found in clothes or food. Individuals with more severe forms of autism can have intel-
lectual impairments; significant language delays or be nonverbal; engage in stereo-
typical behavior such as hand flapping, pacing, rocking; or aggressive behavior toward
themselves or others.
Leo Kanner (1894–1981) was an Austrian born psychiatrist who published a well-
known paper entitled “Autistic Disturbances of Affective Contact” (Kanner, 1943). His
c hap t e r o n e / Understanding Autism 3
paper provided detailed case studies of 11 children with whom he worked. Kanner
was the first to describe children with autism in the research literature. Kanner’s study
documented in great detail the behavioral characteristics of these children, including
their insistence on sameness, their obsession with routine, their desire to be alone, and
their language and communication difficulties, including, in some children, their lack
of speech or presence of echolalia (e.g., repeating words, phrases, or sentences that
they have heard).
Before Kanner’s case study, children and adults with autism were mislabeled as
either having some form of mental illness or intellectual disability, as no previous work
in the area had been conducted. Kanner believed that all of the children with autism
in his original treatment group were of normal intelligence, largely because these
children did not display the same characteristics of children with mental retardation.
Kanner’s views supported the theory of the day that held to the belief that autism was
of a psychological origin rather than a developmental disorder.
Causes of Autism
Currently many theories exist as to the causes of autism, but to date there is no consen-
sus as to one specific cause to explain this complex disorder. Experts point to genetic
influences that may leave some children predisposed to developing autism; research
into the role of genetics and autism is ongoing. Many authorities believe that the
limitation of the genetic theory is that although genetic differences have been linked
to autism, they account for only a minimal number of total cases (Landrigan, 2010).
In fact, Landrigan (2010) cites numerous examples from the literature where children
diagnosed with autism have a high co-occurrence of autoimmune disorders, point-
ing to involvement beyond the neurological system. The extent of the relationship
of autism spectrum disorders to autoimmune disorders remains unclear, yet Persico,
Van de Water, and Pardo (2012) point to the role of the immune system in early neu-
rodevelopment, where these systems interact through the release of neurochemicals
that bridge communication between the immune and nervous systems during early
development.
Other theories on causation include the relationship of environmental toxins
with the pre- and postnatal development of infants and toddlers. One controver-
sial theory along these lines was the role of immunizations containing Thimersol
(a mercury-based preservative once used to prevent bacterial and fungal contami-
nation in vaccines) and the relationship of the measles, mumps, rubella vaccine to
autism. Independent research has not demonstrated any evidence at all to support
these claims, though it has received a great deal of media attention. Because there is
no clear scientific evidence to confirm a specific cause–effect relationship between
these theories and the onset of autism, public speculation remains rampant, as many
parents still remain open to numerous possible factors that could cause autism. A
subsequent development regarding the possible link of vaccines to autism was the
ruling by the U.S. Court of Appeals for the Federal Circuit Court who, on August
27, 2010, upheld a ruling denying a link between vaccines and autism (Shaw, 2010).
Despite the lack of empirical evidence to support these relationships, many parents
remain resistant toward obtaining vaccinations for their children due to the fear that
their child will have adverse reactions that will result in the onset of the disorder.
For many families affected by autism, legal findings do not remove the lifetime of
challenges they may likely face in addressing this condition. As one might expect,
there has been a considerable amount of controversy surrounding the validity of
these theories, as the general public seeks answers to explain the origins of autism
and the reason for its increasing global prevalence.
Research continues to increase as scientists try to identify the cause(s) of autism.
New evidence continues to emerge that suggests an interaction between environmen-
tal and biological factors paired with genetic mutations that may affect development
and result in the diagnosis of autism in some children (Altevogt, Hanson, & Leshner,
2009). This aligns with the theory that some children have a genetic susceptibility
and, when paired with exposure to agents such as environmental toxins, a threshold
is exceeded and atypical development ensues consistent with the diagnosis of autism
(Jepson, 2007). See Figure 1.1 to better understand this interaction. More research
in this area is needed to ascertain the precise relationship of these variables and their
interactive effects on the development of young children.
Autism Spectrum Disorders (ASD)

Autism was for many years considered to be one of five disorders characterized
as a pervasive developmental disorder (PDD), as defined by the Diagnostic and
Statistical Manual of Mental Disorders (4th edition), or DSM-IV, published by the
Figure 1.1 Diagram of interaction between genetic susceptibility and

environmental toxins
Environmental
Toxins Toxin
Threshold
Reached &
Autism
Expressed
Genetic
Susceptibility
American Psychiatric Association. Pervasive developmental disorders were defined

by delays in social-communicative development and include autism, pervasive
developmental disorders not otherwise specified (PDD-NOS), Asperger’s syn-
drome, Rett syndrome, and childhood disintegrative disorder (CDD). Autism spec-
trum disorders is now the correct term as recognized by the Diagnostic and Statistical
Manual of Mental Disorders (5th edition). The term autism spectrum disorders is
inclusive of a range of autism or autism-related symptoms from mild to severe
forms on the spectrum.
Autism has become a growing health concern globally in recent years given the
increase in prevalence rates. With the increased prevalence, educational and health
care systems must be prepared to address the educational and health care needs of the
growing population of children, youth, and adults identified with ASD and the long-
term implications in terms of service delivery systems. It has been estimated that the
costs to society exceed $35 billion in direct and indirect medical and nonmedical costs
to care for all individuals each year across their lifetimes (Ganz, 2007), not to men-
tion the emotional and human costs in terms of quality of life challenges faced by the
children and families affected by this condition.
Increased Prevalence Rates

A question that many are asking is why there is a continued increase in the number
of children being identified with autism. It has been speculated that a number of
factors should be considered to help explain the rise in the numbers of children
identified. These include the refined assessment methods now being used, which
allow professionals to be more adept at identifying the disorder earlier in the life
of a child; a broader definition of autism, which is now inclusive of a spectrum
of disorders; and greater public awareness that has, in turn, made families, edu-
cators, and physicians (such as pediatricians) more attuned to the symptoms of
ASD, making it more likely that a young child who may be exhibiting atypical pat-
terns of development consistent with autism will be identified. The importance of
early detection and diagnosis is crucial in order to develop early intervention
treatments aimed at minimizing the impact of the disorder on the future develop-
ment of the child.
Importance of Early Detection

Given the fact that autism has no obvious physical characteristics, if parents are con-
cerned about their child’s behavior and development, a developmental screening
should be conducted to ensure the child is not exhibiting characteristics consistent
with autism.
Because autism has garnered much of the media spotlight in recent years, the
general public has become more aware of the importance of early detection and
Figure 1.2 Early developmental indicators of autism in toddlers
■ The child avoids eye contact.

■ He/she does not smile when smiled at.
■ He/she fails to respond to his/her name.
■ The child does not engage in pretend or imaginative play.
■ He/she does not visually track objects.
■ He/she does not look when you point to an object.
■ The child fails to use gestures to communicate.
■ He/she does not initiate or respond to displays of affection such as hugs.
diagnosis of young children with autism. There is evidence to suggest that chil-
dren can be diagnosed with autism before the age of 24 months, yet there has not
been an instrument designed for this population of children. Stone, McMahon, and
Henderson (2008) have developed the Screening Tool for Autism in Two-Year-Olds
(STAT), which is designed to assess the social and communicative behavior of these
children across the domains of play, imitation, and communication. Parents usually
first consult the child’s pediatrician if they have concerns about their child’s develop-
ment, with pediatricians regularly conducting developmental surveillance at well-baby
visits from infancy through early childhood.
In an effort to better inform pediatricians of the symptoms associated with
autism, the American Academy of Pediatrics developed a series of materials to support
primary care physicians in the early identification of autism (Johnson & Myers, 2007).
Some early developmental signs to be concerned about are illustrated in Figure 1.2.
Should a toddler display these characteristics, it would be most advisable for parents to
schedule an appointment with their pediatrician.
Diagnosis and Treatment

If children are suspected of having autism following the screening process, a psycho-
educational evaluation is conducted for the purpose of determining the diagnosis
of autism. The evaluation is also aimed at identifying the child’s individual learning
strengths, the areas of greatest need, and to assist in the design of evidence-based
interventions and supports to assist the child and family. The psychoeducational eval-
uation process typically involves a team of professionals that most often includes a
psychologist, behavior analyst, speech/language pathologist, special education pro-
fessional trained in autism, occupational therapist, and physical therapist. Figure 1.3
provides an illustration of how these professionals might typically be involved in this
process.
Figure 1.3 Multidisciplinary evaluation team members
• Behavior
Social
Specialists
Behavior
• Psychologists
Cognitive
• Psychologists
Functioning
Psychoeducational • Speech/Language
Communication
Evaluation Pathologists
Adaptive • Special Education

Behavior Professionals
• Occupational
Motor Skills
Therapists
It is not uncommon for children and their families to seek the assistance of med-
ical specialists, which may include pediatric neurologists, developmental pediatricians,
child psychiatrists, and geneticists, should they be available to consult with parents
concerning their child’s development. This is often the case with clinics that are affili-
ated with universities and medical schools, where specialists are accessible and can be
involved in the evaluation process.
The evaluation process allows for team members to share their expertise and
gather information about the child and his/her family through informal and for-
mal means. Informal measures, such as parent interviews, are conducted, as are a
battery of more formalized assessments aimed at identifying the child’s levels and
abilities in the areas of cognitive functioning, social behavior, speech/language and
communication, adaptive behavior, motor skills, and performance. More impor-

tantly, the comprehensive evaluation seeks to capture as complete a picture as is
possible of the child and family to better aid in determining the diagnosis of autism.
Of equal importance, however, is the design of educational and lifestyle supports to
assist the family. This process seeks to better understand the child’s developmental
history, the environments that comprise the life of the child and his/her family,
and the strengths and support needs of the child and family. A child’s social and
behavioral dimensions are also very important in the diagnosis of autism. Autism
generally consists of core deficits in the areas of cognition and executive function-
ing (the cognitive ability to connect past experiences in our lives with present day
events), an area with which children with ASD have difficulty; challenges in the
areas of social emotional development and feelings; and problems with attention
and imitation (Schreibman, 2005). It is important to recognize the significant role
that early detection and diagnosis play in addressing these deficits. Researchers
point to behaviors during the first year of life that are highly correlated with the
later onset of autism.
The Role of Early Intervention

Once families learn that their child has been diagnosed with autism, it is important
that they obtain the support and assistance of skilled early intervention profes-
sionals who are family centered. Early interventionists are educators and therapists
trained to assist young children and families in the design and delivery of educa-
tional and related supports aimed at improving the quality of life for all. Family-
centered professionals believe in partnering with parents and families and solicit
input from parents and families, acknowledging the important role they play in the
life of their child.
Early intervention allows for home- and/or center-based services and supports
as mandated by the Individuals with Disabilities Act (Part C). These services are part
of the individualized family service plan (IFSP). The IFSP is a document that outlines
the services and supports that a child and family will receive. Note the importance on
the family; early intervention is geared toward the family and recognizes their promi-
nent role in the life of their child, and thus they are viewed as partners in the IFSP
planning and implementation process.
The IFSP includes statements relative to the following:
1. The present level of functioning of the child in terms of physical, cognitive,

social/emotional, communication, and adaptive behavior levels
2. Family information, including the needs and resources and concerns of the par-
ents and family members involved in the care and support of the child
3. The services that the child and family will receive and the expected outcome
measures based on these services
4. The location(s) in which the services and supports will be provided, be they the
home or natural environment or the community, and if services should not be
provided in the child’s natural environment, a statement must be included as

to why
5. When and where services will be received
6. The duration that services will be provided and also the length of sessions
7. Whether services will be provided to the child individually or as part of a
group
8. Who will be responsible for paying for services
9. The name of the service coordinator responsible for implementing and moni-
toring the IFSP
10. A plan for the transition of the child from early intervention to school-
based services when the time arrives (Individuals with Disabilities Education
Improvement Act, 2004)
A Brief History of Treatment

The contemporary research supporting the efficacy of intensive early intervention
with children diagnosed with ASD has been substantial. Prior to these treatment in-
roads, children affected by autism and their families were often afforded marginal
treatment that was frequently unsupported by scientific evidence. Historically, chil-
dren with autism were thought to suffer from the condition as a direct result of their
mothers being emotionally distant (Kanner, 1943), referred to as “refrigerator moth-
ers” by the psychoanalyst Bettelheim (1967). These theories were based on conjec-
ture rather than on any scientific evidence. They were psychodynamic in origin and
held to the belief that the source of the child’s autism was due to the parents. It was
generally recommended that children be placed in special schools. One such exam-
ple was the Orthogenic School, a special school that was designed for emotionally
troubled children (as children with autism were once classified). Unfortunately, such
thinking only served to foster a myth that virtually destroyed people’s lives and led
to valuable time lost that could have been used for meaningful treatment. Mothers
bore the guilt of being falsely labeled as the cause of their children’s conditions and,
sadly, reflected a view that was widely regarded at that time in history. Thankfully,
the field has progressed to the point that we now understand just how important
evidence-based practice (practice based on scientific evidence) is when designing
effective treatment plans for persons with autism. Figure 1.4 provides an example of
evidence-based treatment.
The window of opportunity that is provided during the early childhood years
offers us an access point to initiate the design and implementation of effective educa-
tional programs and individualized treatment plans aimed at maximizing the potential
of every child and, in turn, providing meaningful supports to the family. When we are
positioned to capitalize on these opportunities, we can often realize significant treat-
ment gains for young children as demonstrated in the research.
Applied Vignette 1.1 provides an example of the importance of early identifica-
tion and evidence-based treatment for young children with autism.
Figure 1.4 Evidence-based practices
Non-Evidence-Based Emerging Evidence-Based
Grounded primarily in Some grounding in scientific Clearly grounded in scientific

speculation, superstition, myth, research research
word of mouth, or cultural These approaches have These approaches involve
influences shown some evidence of their repeated demonstration of
These may not have been effectiveness in published the influence of a treatment in
exposed to rigorous scientific scientific research, but they may multiple examples of research
examination or may have been need to be studied further or published in scientific journals.
proven to be ineffective or even there may be some research
harmful. findings that are contradictory. Examples:
■ Discrete trial training
Examples: Examples: ■ Applied behavior analysis
■ Dietary restrictions ■ Picture exchange ■ Pivotal response training
■ Facilitated communication communication
■ Holding therapy ■ Social stories
■ Structured teaching
Applied Vignette 1.1

The Importance of Early Identification: Matthew’s Story
Matthew was just shy of his 3rd birthday when foster the acquisition of some new skills largely
his parents learned that he was diagnosed with aimed at reinforcing language and social inter-
autism. Needless to say, the word autism, at action. The remaining children in the class were
the time in their lives, was completely foreign typical same-aged peers. It was a small group of
to them. They had heard mention of it, but only 10 children in a remote and rural area. His
this was the early 90s. His parents had never teacher and paraprofessional were exceptionally
known of any child with this condition. They dedicated and were assisted by a technical assis-
understood that Matthew would behave differ- tance team trained in autism from the regional
ently than children his age and he did not seem university. This relationship proved beneficial,
to process language the same way when he was in that Matthew’s educational team and fam-
spoken to, nor did he play the same way. Shortly ily received professional development and sup-
after diagnosis, he began to receive inten- port and Matthew’s educational plan was greatly
sive behavioral intervention at home and then shaped by the team and their expertise in autism.
began a preschool program at age 3. His pro- As he progressed to kindergarten, Matthew
gram combined the elements of the TEACCH had mastered the use of his activity schedule and
model, such as an individualized photo activity work system and his language began to rap-
schedule, paired with structured work systems idly emerge. The teachers were systematic in
and a classroom designed especially for foster- their presentation of instruction and made sure
ing visual clarity for Matthew and one other boy to adhere to the instructional plan each day.
in his class also diagnosed with autism. Matthew Matthew’s social pragmatic skills began to develop
also received some discrete trial training to as a result of his practice on these skills through
the use of peer modeling and reinforcement which point they were told by the team that he
from his teachers. Eventually, as he became no longer met the criteria for autism but did
more proficient in his language and social skills, maintain some characteristics consistent with
he began to make eye contact with strangers attention deficit disorder (ADD). He continued
and would respond to others’ verbalizations. to perform at average levels in school, and yet
As he advanced in elementary school, he was his development continued to refine and grow
included into the general education classroom in the areas of language and social skills. Several
and began to utilize the structured teach- years later, Matthew successfully completed
ing approach to academic tasks as his teachers high school, began a job, and started attending
maintained the mantra of visual clarity within a community college. His parents spoke often
their respective activities and classrooms. His of the value that early diagnosis and treatment
language was becoming increasingly more flu- provided him. Also critical to his success was a
ent and his social skills more refined. By the age longitudinal plan facilitated by his small rural
of 9, Matthew was taken by his parents for an school district and supportive family, school
independent psychoeducational evaluation, at team, and community.
Designing Effective Longitudinal

Educational Plans
When designing educational programs for a young child with autism and his/her fam-
ily, it is important that professionals not only consider the immediate needs of the
child and family, but also provide attention to the long-term scope of services and
supports that will extend across critical transition points during the child’s life. This
process should keep in mind the partnership and try to design services around the
goals of the family. Such an approach not only asks questions relative to current needs
and present levels of functioning, but also examines skills needed in subsequent educa-
tional environments such as preschool and kindergarten, for example.
Transition teams within schools should work closely to coordinate these edu-
cational and life passages for the children they serve and their families. It is impor-
tant to recognize not only the academic and educational implications, but also the
social/emotional aspects for families, as these transitions can create anxiety relative to
ensuring that children receive continuity of services and supports.
By practicing longitudinal educational planning, we stay engaged with the
questions of why, what, and how we are doing in terms of programming, with the
expectation that we are building the skills needed for children to have success in future
environments. Given that autism frequently implies a lifelong condition, it is impor-
tant that we have a lifespan focus to support children and families across the span of
services and supports that will be needed to afford them a meaningful quality of life.
Longitudinal treatment plans serve as bridges to ensure that children and families
receive the best possible education and related services and supports necessary to sup-
port them from birth through adulthood. These respective transitions are represented
in Figure 1.5.
Figure 1.5 Transition points across the lifespan for persons with ASD
CHALLENGES
AHEAD
Appropriate Services & Supports
• Diagnosis • Preschool • Developmental
Associated Life Challenges

• Early • Elementary milestones
intervention school • Social &
Delivery Points
• Educational & • Middle school communicative
behavioral integration
services • High school • Academic &
• Postsecondary • Universities behavior
education • Support agencies challenges
• Employment • Assisted living • Puberty
• Community arrangements • Transition
living to adult
independence
These transition points are consistent with those that children who are typi-
cally developing experience throughout their lives. The commonality of all parents
and families is that they seek the very best in terms of quality-of-life experiences for
their children. The difference for parents and families affected by autism is that these
life transitions can pose even greater challenges with respect to ensuring meaningful
and consistent educational services for their children. Granted, no one can predict
the degree to which educational treatment programs can reliably address these for
individual children and families, but programs that recognize the importance of these
transitions and that provide mechanisms for ensuring that educational goals and treat-
ment programs address the longitudinal needs of the learner can make a difference in
the long-term outcomes for these individuals and their families.
The Importance of Evidence-Based Practices

What education or treatment options exist for children initially diagnosed with autism,
and their families? There are numerous treatments that are available, some better than
others, and often it is a difficult chore for families to discern which direction to go.
First, do programs and services exist? What is available? Based on what is available, do
programs subscribe to the use of evidence-based practices? These are just some of the
questions that a family will need to confront.
What exactly is an evidence-based practice (EBP)? The term EBP originated
in the field of medicine in the early 1970s (Odom, Brantlinger, Gersten, Horner,
Thompson, & Harris, 2005), was conceptualized as a method to minimize the gap
between research and practice for primary care physicians, and became an essential
component of medical education. This practice has extended into the field of educa-
tion as part of the No Child Left Behind Act of 2001, and has subsequently become
an integral part of evaluating the education and treatment of autism. This movement
has continued to gain momentum in large part from the substantial increase in the
prevalence of autism and to better inform practitioners as a means of promoting effec-
tive practice.
Along these lines, it is important for professionals to be discerning consumers of
research and understand how research influences practice. We know, for example, that
there are effective practices in the education and treatment of autism that do not have
sufficient amounts of empirical or science-based support to qualify as evidence-based
practices. We must use our professional judgment to assess the efficacy of these tools
and their use in the education of children with autism. An important question to ask
is: Why would a professional even consider using a treatment that was not evidence
based?
The professional competence and judgment of teachers and related professionals
is most important when implementing individualized educational plans for children
with ASD, and must certainly be considered in the selection of interventions. Also
important is input from parents and families as to what they think would be of value
to their child, otherwise known as social validity. Social validity—what is of value to
the learner, his/her family, and members of the classroom, school, and community—is
important to consider when devising educational plans (Carter, 2010). Another final
consideration is whether the interventions will promote meaningful outcomes for
learners that will generalize across environments and maintain over time. These are all
very important to planning and implementing successful interventions.
Common Approaches Used in Education

and Treatment
There are numerous approaches in the education and treatment of children with
autism. These treatment approaches could be classified into four categories, namely
behavioral, naturalistic, developmental, and hybrid programs, or those that represent
a blend between naturalistic and behavioral methods. Let’s examine each of these
approaches as a means of providing an overview.
Applied Behavior Analysis

Applied behavior analysis (ABA) has the distinction of having the longest history
and the most extensively documented evidence base to support its efficacy in the
treatment of autism. ABA dates back to the 1960s and early 1970s, when behavioral
approaches formed the basis for active treatment for individuals with autism and men-
tal retardation who, at that time, were institutionalized in state residential facilities.
The use of ABA in the education and treatment of these individuals resulted in the
development of functional skills and demonstrated that the application of learning
principles could be applied to persons with the most severe disabilities. The work
on operant conditioning pioneered by B. F. Skinner (1904–1991) was influential in
the application of these intervention approaches. Prior to this discovery and use of
behavioral treatment, persons who were institutionalized often received little in the
way of meaningful education or “active” treatment, and were essentially warehoused
(Blatt & Kaplan, 1974).
The use of ABA in the treatment of autism was advanced in more recent times
by psychologist Ivar Lovaas (1927–2010), a prominent researcher in the field of autism
who examined the use of ABA in the education and treatment of autism for over three
decades. His research originated in the 1960s among children with mental retarda-
tion and those diagnosed as psychotic (a diagnosis often given to children who we
now know to be on the autism spectrum) who were often dealing with serious and
challenging behaviors such as self-injurious behavior. Lovaas began to disseminate
findings from his work with 20 children with autism, using a behavioral treatment
approach (Lovaas, Koegal, Simmons, & Long, 1973). Findings from this study demon-
strated a reduction in challenging behaviors, including self-stimulation and echolalia
(repetitious speech of sounds or words), whereas play and social behaviors increased.
In addition, the results indicated that there was an increase in social interactions and
language with maintenance of these skills over time among those children who resided
with their parents and who had also received training in the behavioral methods as
a means of promoting maintenance and generalization. In contrast, these meaning-
ful outcomes were not the case for those children who participated in the study and
remained in the institutional setting, as the maintenance of skills was unfortunately
not durable and lasting for these children. This supports the importance of nurturance
in the environment and consistency in the care of children as critical in their early
development.
Further advances in ABA with young children with autism were realized with
the use of these methods. Lovaas (1987), in a follow-up study of 19 children diagnosed
with autism, demonstrated that behavioral treatment with an individual therapist for
40 hours per week was successful in teaching children diagnosed with autism; nearly
half of the children who participated in the study achieved normal intellectual and
educational performance. It is important to also note that these children although
diagnosed with autism did not have mental retardation. This was one of the ground-
breaking studies that demonstrated the efficacy of intensive behavioral therapy with
young children diagnosed with autism.
The discrete trial training (DTT) method is a form of intensive behavioral treat-
ment designed to facilitate the acquisition of skills among young children diagnosed
with autism. This form of treatment was pioneered by Lovaas and is most often linked
to him, with some referring to it as the “Lovaas Method.” This approach to treatment
places emphasis on organizing the teaching and learning environment for the child
and emphasizes structure in all phases of instruction. Discrete trial training (DTT)
involves the presentation of simple tasks to the child with a distinct beginning and
end, such as “Touch your nose,” “Look at me,” and “Point to cookie.” These are fol-
lowed by verbal and tangible reinforcement that include statements like “Good saying
apple” and the use of edibles as reinforcement for correct responses.
For example, the teacher might say to the child “Look at me” and, upon the
child looking at the teacher, the teacher would respond, “Good looking at me” and
then the teacher might also pair this verbal praise with an edible reinforcer. As prog-
ress ensues, these initial simple tasks are gradually replaced with more advanced skills
as the child becomes comfortable with the teaching presentation and general format,
and more primary reinforcers (edibles, for example) are replaced with newly learned
or more naturally occurring reinforcers (verbal praise, for example). As their abilities
increase, the concepts incorporate more of a focus on language and social behavior
across academic and play settings. Essential to the use of this format is a logbook so
that data can be recorded on the child’s performance at every session; this is termed
continuous measurement and allows for tracking the performance of the learner on each
trial (Lovaas, 2003).
Naturalistic Approaches
A contrasting form of treatment is the naturalistic approach. Naturalistic approaches
for teaching children with autism have foundations in both the developmental and
behavioral models, yet adhere to the philosophy that children should be taught
within relevant contexts, such as their natural environments, to ensure fluency and
maintenance and generalization of skills. The rationale for this is that it will pro-
vide greater and more relevant opportunities for learning with naturally occurring
stimuli and reinforcers found within a child’s daily routine. This largely stems from
the criticism by some that discrete trial training is too rigid and fosters robotic
responding in children that does not sync with their natural environments. One
example of a naturalistic approach used for teaching children with autism is pivotal
response training (PRT) (Koegel, Koegel, Harrower, & Carter, 1999; Koegel &
Koegel, 2006).
PRT is focused on helping teach children with autism in three areas:
(1) 
motivation—the ability to engage in social-communicative interactions;
(2) initiation—the ability to foster social initiations on the part of the child, especially
in activities that promote joint attention; and (3) self-regulation of behavior. The
development of these core areas is enabled through PRT interventions. The com-
ponents of PRT interventions are linked to (a) family involvement in the design and
delivery of interventions; (b) carrying out all treatment in the context of the child’s
natural environments, such as home and school settings; and (c) treatment of pivotal
behaviors that have a far-reaching impact on the child’s overall behavior (Koegel &
Koegel, 2006). The PRT model relies on functional and naturally occurring reinforc-
ers found within these natural settings, and also builds choice-making opportunities
for the child (Koegel et al., 1999).
For example, after a child washes his hands, he receives his snack as part of the
behavioral chain that links these two activities together. Naturally occurring rein-
forcement is tied directly to an activity as the consequence, thus reinforcing cause
and effect for the child, which promotes learning. If this sequence is repeated daily,
the child begins to anticipate it, and as it is reinforced daily, it provides the child with
predictability and some sense of control within his/her environment.
Incidental teaching represents yet another popular method of naturalistic treat-

ment for children with autism, and it was developed by Hart and Risely (1975) as a
process for teaching language—more specifically, labeling and describing. Incidental
teaching refers to the interactions that occur between a child and an adult in an
unstructured setting. The teaching component occurs when the adult uses this natu-
rally occurring framework to provide information to the child or give the child an
opportunity to practice a developing skill. Incidental teaching uses some behavioral
approaches, such as errorless learning (using prompts provided by the teacher to pre-
vent students from making errors and thus learning incorrect patterns for performing
a task) and reinforcement to assist in the development of skills. One very interest-
ing component of incidental teaching is that it places emphasis on a child’s interests
within the natural environment. This is reinforcing to the child and serves to promote
engagement.
The general method for implementing incidental teaching (McGee, Almeida,
Sulzer-Azaroff, & Feldman, 1992) with a learner is:
a. The teacher waits for the child to self-initiate.

b. The teacher asks the child to label or identify what he/she wants or what he/she
needs (with a prompt if needed).
c. The teacher responds to the child’s directive by either giving the object requested
or facilitating the request.
d. The teacher should always reinforce the child’s attempt by praising him/her for
correct performance.
McGee et al. (1992) recommended that when considering incidental teaching

as a method of instruction, you should also consider that it is a systematic approach
to instruction designed for natural settings found within the child’s environment. The
child’s environment should be arranged to draw the child’s attention to preferred toys
and activities. Children initiate incidental teaching sessions by requesting an item or
activity of choice, whereby the teacher prompts the child to provide an elaboration,
and, upon producing the desired response, the child is given the desired item or activ-
ity and praised for providing the correct response.
Another form of treatment, the early start Denver model (ESDM), represents a
comprehensive developmental and behavioral model for treating children with autism
(Rogers, Munson, Smith, Winter, Greenson, Donaldson, & Varley, 2010). The ESDM
is an interdisciplinary program that combines both developmental and behavioral
approaches and thus could qualify in the eyes of many as a hybrid form of treatment. In
fact, the ESDM combines both constructivist and transactional models of child devel-
opment directed toward the active involvement of infants and toddlers in the formation
of their behavioral development within their environments (Rogers & Dawson, 2010).
Many of the teaching methods used in the ESDM are behaviorally based, thus the
consideration for the label of hybrid to describe the methodology used in the ESDM.
The ESDM approach is aimed at developing a sense of empowerment through
the active engagement of young children with their respective environments. In
order to accomplish this, the ESDM is comprised of an interdisciplinary team that is

responsible for the design and delivery of interventions to children with autism. Team
members come from related disciplines such as psychology, speech/language pathol-
ogy, applied behavior analysis, and special education. The ESDM strives to embed
teaching and learning within the natural ebb and flow of a child’s daily activities. In
order to accomplish this, the ESDM utilizes a range of teaching methodologies from
applied behavior analysis, pivotal response training, and the Denver model (the origi-
nal model that was designed exclusively for preschoolers). These strategies include
basic behavioral concepts such as the use of prompts and graduated guidance paired
with naturally occurring reinforcement in the shaping of desired behaviors. Lastly, the
original Denver model dictates the importance of the teacher or adult in the teacher/
learner dyad. The importance of the teacher in modulating the affect and attention of
the learner, paired with the use of language that is consistent with the child’s develop-
mental level, is stressed. The adult also facilitates learner performance by arranging
the environment to promote learner success through the facilitation of smooth and
efficient transitions between activities (Rogers & Dawson, 2010).
Developmental Approaches
One of the more prominent developmentally based approaches that has been used in the
treatment of autism has been a method often referred to as FloortimeTM. In actuality, the
method’s complete reference is the developmental individual difference relationship-
based model (or DIR/Floortime). Dr. Stanley Greenspan (1941–2010), a clinical
professor of psychiatry and pediatrics at George Washington University School of
Medicine, and his associate, Serena Weider, developed Floortime.
Floortime is rooted in the foundations of developmental psychology and is
designed to assist children with autism in making developmental progress and attain-
ing mastery of developmental milestones by attempting to minimize the sensory
processing disorders they often experience. The model attempts to examine the devel-
opmental capacity of the individual child identified with ASD. This is accomplished
through a thorough assessment of each child’s typical interactive patterns within natu-
ral environments and with family. Assessment consists of two or more clinical observa-
tions, each 45 minutes in length, of child–caregiver interactions or clinician and child
interactions; the collection of a developmental history; review of the child’s current
functioning levels; a review of family and caregivers; a review of current treatment
programs; consultation with educators and related personnel on the child’s team; and,
finally, a biomedical evaluation (Greenspan & Wieder, 1999). The aim of this assess-
ment is to provide the therapist with a functional understanding of the child’s abilities
and observed symptoms. Greenspan and Wieder (1999) acknowledged the sensory
processing difficulties of children with ASD and how the relationship between social
affect, motor planning, sequencing, and symbol formation are jointly affected. These
deficit areas found among children with ASD impact their ability to problem solve,
use meaningful language, and perform sequencing tasks. These findings are consis-
tent with neuropsychological research findings that have indicated that executive
functioning in children with autism is impaired, thus explaining their difficulty with
understanding greater degrees of abstraction, such as concept formation and complex
language.
Greenspan and Wieder (1999) based Floortime on the premise of “understand-
ing children and families by identifying, systematizing and integrating the essential
functional developmental capacities” (p. 148). Floortime attempts to identify where
children are in terms of their functional developmental capacities, such as in the areas
of emotional development, sensory, modulation, processing, and motor planning, and
in terms of social relationships and interactions.
Greenspan and Wieder (1999) reinforced that floor time was neither an assess-
ment method nor a discrete form of treatment, but was instead a comprehensive
approach for assisting the child in progressing through the six functional develop-
mental capacities. These developmental capacities include abilities to: (1) attend to
multisensory input and remain engaged and attentive; (2) demonstrate appropriate
affect toward caregivers, for example, smiles and displays of affection; (3) initiate and
respond to presymbolic communication, such as gestures and reciprocal smiles and
sounds; (4) reciprocal social interaction and joint attention, such as recruiting a par-
ent or sibling in an activity; (5) using ideas, such as imaginative play, or engaging
in expressive language to meet needs; and (6) building bridges between ideas as a
basis for logic, reality testing, thinking, and judgment, for example, using more elabo-
rate forms of communicative expression, such as voicing opinions and exchanging
viewpoints.
Floortime has three treatment components. The first of these treatment com-
ponents is that parents engage with their children in activities aimed at formulat-
ing the emotional experiences needed for mastering the six developmental capacities
previously described. The second treatment component involves the use of more
complex activities that are implemented by interdisciplinary team members including
speech language pathologists, physical and occupational therapists, and educators.
Lastly, parents and family members work on their skills in relation to the six devel-
opmental milestones as a means of facilitating consistency within their respective
families.
Multicomponent Approaches
One of the longest-standing models used in the education and treatment of children
and adults with autism is the TEACCH method. TEACCH (Teaching, Expanding,
Appreciating, Collaborating and Cooperating, Holistic) originated at the University
of North Carolina–Chapel Hill under the direction of Dr. Eric Shopler (1927–2006).
The TEACCH program is a comprehensive statewide network for the provision of
services and supports to children and adults diagnosed with autism, and their families,
and utilizes the branch campuses within the University of North Carolina system as
regional centers.
The TEACCH program has historically been one of the most influential pro-
grams in the country for providing services to families and extensive professional
development for teachers and related service professionals. It is our opinion that the
TEACCH program represents a multicomponent treatment approach in that, embed-
ded within the tenants of the TEACCH model, one witnesses the use of behavioral,
developmental, naturalistic, and ecological treatment practices at work in a most effec-
tive manner.
Some of the basic assumptions that distinguish TEACCH from other treatment
approaches are that it acknowledges that autism is a lifelong developmental disorder
that affects not only the individual, but also the family. Families are viewed as partners
in the treatment process and TEACCH maintains a lifespan and longitudinal per-
spective in terms of treatment; thus, support for children throughout the schooling
years also extends into the adult service realm working in partnership with school and
community providers alongside families aiming for optimal quality-of-life outcomes
for the individual. The core components of the TEACCH model are the focus on the
individual and acknowledging the strengths of the child or adult, as opposed to work-
ing from a deficit model.
At the core of the TEACCH model is an approach called “structured teach-
ing,” which takes into account the individual learner’s strengths and support needs
and designs an individualized model of instruction aimed at developing indepen-
dent skills. Structured teaching (Mesibov & Shea, 2010) is characterized by four
distinct features: (1) structuring the physical and learning environment in a way that
is understandable to the learner, (2) placing an emphasis on the learner’s strengths
and abilities to process information visually, (3) incorporating the special inter-
ests of the learner to engage him/her, and (4) reinforcing attempts at meaningful
communication.
Another distinct feature of the TEACCH model is that, unlike some other
treatment models, it does recognize autism as a distinct culture of its own given the
lifelong implications of the disorder. Mesibov and Shea (2010) have identified eight
features of what they term the “culture of autism.” These include characteristics that
are generally consistent in varying degrees across individuals diagnosed with autism.
They include: (1) an ability to efficiently process visual stimuli and difficulty with
language and auditory processing; (2) difficulty focusing attention in a consistent man-
ner; (3) difficulties with expressive language and social communication; (4) problems
with understanding and applying concepts of time and sequencing; (5) an insistence
on routines and an inherent difficulty making transitions; (6) difficulty generaliz-
ing routines to new enviroments; (7) a narrow range of interests or activities; and
(8) sensory difficulties.
The TEACCH model uses the concept of “structured teaching” to provide
learners with physical structure, consistency, and embedded cues designed to capital-
ize on the individual’s strengths. This structure consists of physical arrangement of the
child’s work area, organizing the sequence of the day, and the organization of the work
tasks (Mesibov & Shea, 2010).
The model within a classroom begins by providing an organized and individu-
alized work area for the child, placing the child’s desk to minimize distractions, and
teaching the child how to use an individualized activity schedule (as used in Massey &
Wheeler, 2000), which could be comprised of either objects, pictures, symbols, or

words, given the developmental level of the child. The activity schedule would have a
sequenced list of activities to be done either as part of a half or whole day, with detach-
able cards (pictures, symbols, words) that the child would move from left to right, pro-
ceeding from top to bottom. In addition, accompanying work baskets are organized
containing relevant work tasks and located near the child’s desk or designated work
area. The schedule provides the child with visual clarity, the work structure provides
the environmental or physical structure, and the clarity found within the schedule
communicates to the child a sequence for his/her day of requisite activities, including
breaks and leisure time. It is the view of TEACCH proponents that such structure
minimizes the occurrence of challenging behavior and promotes meaningful engage-
ment (Hume & Odom, 2007; Massey & Wheeler, 2000).
Mesibov and Shea (2010) recently completed an analysis of the TEACCH model
in the wake of the evidence-based practice movement, with the purpose of providing
some perspective on how the TEACCH model serves as an example of EBP given the
application of these principles within extant research studies. The TEACCH model
has a great deal to offer teachers, related professionals, and families with respect to
the education and treatment of children and adults with autism. It is perhaps one of
the most portable models of delivery, in that it adapts well to school or other related
learning environments and is also adaptable to home and community settings. It also
maintains a longitudinal perspective across the lifespan of the individual and prepares
the learner and his/her family and team of professionals for transitions. This is done
through the use of environmental supports in the form of structure, thus providing a
mechanism for supporting the individual strengths of the child and serving as a form
of antecedent management (Wheeler, Carter, Mayton, & Thomas, 2002), and serving
as a practice that, once learned, can be adapted and generalized across the lifespan of
the individual.
Consider This
In the preceding paragraph, a reference was were made to the use of his schedule as he pro-
made as to how the concept of structure is a gressed in age and grade level. Originally he
major component of the TEACCH program had a large schedule posted at his desk with
that can be adapted and generalized across the two columns—“to do” and “finished”—with
lifespan of the child; for example, when first pictures attached by Velcro. He then moved to
introducing a picture schedule with a 4-year- a smaller version of this that had words paired
old with autism in his preschool classroom, the with pictures. Then, as a secondary-level stu-
child began to become more engaged in mean- dent, he had a pocket daily reminder calendar,
ingful activity. One reason was that the struc- just like many adults carry. Ultimately he had
ture provided an order to his day, helped him an iPhone, as he advanced from secondary edu-
in organizing his daily routine, and provided cation to postsecondary education at a local
him with a sense of predictability. Adaptations community college.
Sensory Integration Therapy

Another form of treatment that you will often see referred to in the treatment of
autism is sensory integration therapy. This form of treatment has strong advocates,
largely because children with autism may often exhibit atypical sensory responses such
as exaggerated or hyper responses to auditory stimuli or little, or no response, termed
hypo response. They also exhibit behaviors that are inconsistent with typical develop-
ment, which may include, for example, repeatedly smelling particular objects that they
frequently become fixated on. The literature suggests that the prevalence of sensory
processing disorders in persons with autism is high (Dawson & Watling, 2000). Earlier
studies suggest that the presence of sensory processing disorders often co-occur with
the presence of stereotypical behavior in children with autism, thus fostering compet-
ing behaviors that interfere with learning.
Sensory integration therapy as a treatment option for children with autism has
been somewhat controversial at times, and incomplete in terms of research evidence
to support this treatment approach as evidence based. Auditory integration therapy
has been most frequently cited as a method used to treat the auditory processing
disorders associated with autism. The treatment concept asserts that electronically
modulated or filtered music streamed in through headphones will be helpful in desen-
sitizing a child with autism to auditory stimuli. A French otolaryngologist, Dr. Guy
Berard, developed auditory integration therapy and it was most prevalent from the
1960s through the 1990s (Baranek, 2002).
Other forms of sensory integration therapy include, but are not limited to, visual
stimulation and “brushing,” whereby a child’s arm is brushed as a means of desen-
sitizing them to touch. Dawson and Watling (2000) conducted a review of clinical
and applied studies designed to evaluate the efficacy of sensory integration interven-
tions among individuals with autism. Their findings concluded, based on the studies
reviewed, that sensory integration therapy intervention methods on the whole were
not well validated given the limited number of controlled research studies conducted.
There was no evidence to suggest which interventions were most appropriate by age(s)
and levels of involvement. In a subsequent review conducted by Baranek (2002), simi-
lar findings were revealed and it was determined that the majority of studies reviewed
failed to adequately demonstrate a relationship between the interventions employed
and changes in behavior on the part of the participants. In conclusion, the importance
of designing interventions aimed at minimizing the effects of sensory processing diffi-
culties experienced by persons with autism is apparent, yet one should be mindful that
the efficacy of these methods is still questionable given the lack of empirical studies to
support their use among children and adults with ASD.
Complementary and Alternative Medicine Approaches

Complementary and alternative medicine (CAM) approaches to autism have been
increasing in the past few years as the prevalence of autism has increased. Current
estimates are that 52 to 95% of children diagnosed with autism are receiving CAM
therapies (Golnik & Ireland, 2009).
CAM has been defined as a group of diverse medical and health care systems,
practices, and products that are not generally considered part of conventional medi-
cine. Generally, CAM approaches are designed to complement conventional meth-
ods of treatment or to provide patients an alternative form of treatment (Wong &
Smith, 2006). Wong and Smith (2006) reveal that they are on the increase, are often
used by parents who are highly educated, and are often not reported to conventional
medical providers for fear of disapproval. One of the earliest proponents of this
practice was Dr. Bernard Rimland. Rimland was a man of science and also a father of
a child with autism. He was the founder of the Autism Research Institute, which was
a privately funded initiative comprised of scientists, physicians, and families whose
goal was to study and disseminate treatment alternatives, including integrative
medicine. Alternative medicine and other forms of alternative treatment approaches
have been given a great deal of media attention, given the prevalence of autism and
that media figures who are parents of children with autism have been outspoken
proponents for looking at alternative health approaches as a means of preventing
and even, in some cases, curing autism.
Kidd (2002), in a review of medical management of autism, highlighted the fre-
quent course of treatments when one adopts an integrative medicine approach. This
approach typically involves a dietary overhaul as the first course of action. The ratio-
nale for this action is that children with autism often have reported food sensitivi-
ties and allergies. This phase systematically eliminates food additives, food colorings,
artificial sweeteners, and preservatives from the child’s daily intake. Casein is found in
milk and dairy products, and gluten is found in breads and cereals. The use of vitamin
and mineral supplements is also a component of this treatment approach. The second
phase of this treatment model is a medical workup, including an analysis of blood
chemistry, amino acid screening, and organic acid screening. The goal, of course, is to
identify all potential correlates suspected of contributing to the child’s condition and
then, based on these findings, constructing an integrated treatment plan comprised of
conventional medicine and alternative medicine.
Of course these approaches are not met without controversy in the conven-
tional medical community as being void of scientific evidence to support their effi-
cacy. Nonetheless, the general public has enthusiastically embraced access to these
and other materials aimed at disseminating a heightened public awareness regarding
autism. Alternative medicine has become much more popular in our society, and peo-
ple are generally more informed about such matters. Therefore, interest on the part of
parents is certainly understandable, as they seek to improve the quality of life for their
child though the current scientific evidence to substantiate this form of treatment
does not clearly support many of these methods.
In summarizing the use of CAM therapies or treatment approaches, one can
understand the desire of parents to seek out all possibilities that may offer hope for
their child. The caveat is, often these approaches have yet to be validated and could in
some cases be ill advised for the health and well-being of the child or his/her condi-
tion. It is important as professionals to understand the response of families but also to
be prudent in recommending treatments that have yet to demonstrate efficacy.
Frankly, the lack of studies examining the applied use of these therapies under
controlled conditions and even in documented case studies is currently limited. More
research is needed to explore the potential contribution of these approaches in the
treatment of ASD. Kidd (2002) has recommended that research address: the relation-
ship between genetic predispositions and the role of toxins as causal factors; maternal
toxins as a prenatal consideration and risk factor; the relationship between the cen-
tral nervous system (CNS) and immune abnormalities; and the role of autoimmune
mechanisms to the overall condition.
Service Delivery Models
Home-Based Intervention
As previously mentioned, home-based early intervention programs for young chil-
dren diagnosed with autism have become increasingly prevalent. This movement was
largely influenced, at least initially, by the work of Lovaas (1981). His book was entitled
Teaching Developmentally Disabled Children: The ME Book (referred to as The ME Book).
This text outlined all components of the Lovaas method for teaching children with
autism and other developmental disabilities. His work in a later study (Lovaas, 1987),
which served as the stimulus for advocating the use of intense behavioral treatments
conducted within the home with trained behavior analysts and parents as colleagues,
promoted the results of this approach. Lovaas (1987) demonstrated that early inten-
sive behavioral intervention (EIBI) was effective as a method for enhancing learning
and long-term development in young children with autism. He examined the use of
intensive behavioral intervention on the cognitive development of children diagnosed
with autism and mental retardation who were receiving behavioral treatment for 40
hours per week across two years. The results revealed that 47% of participants in the
experimental group achieved normal intellectual and educational functioning, with
normal-range IQ scores and successful performance in first-grade classrooms within
the public schools. This methodology has been extrapolated, but not completely rep-
licated, across various settings. Luiselli, Cannon, Ellis, & Sisson (2000) concluded,
from their study using intense behavioral treatments with young children diagnosed
with autism, that implementing these methods with children before the age of 3 had
greater likelihood of long-term gains on development and IQ than perhaps with chil-
dren beyond age 3. Eikeseth, Smith, Jahr, & Eldevik (2002) replicated the treatment
approach advocated by Lovaas but did so in a school setting and found favorable gains.
Sallows and Graupner (2005) utilized the behavioral treatment approach with young
children within a clinic setting with consistent findings in terms of increased IQ and
developmental gains. These are only a few studies that have replicated or expanded
on the initial research of Lovaas using the intense behavioral treatment method, but
all have pointed to having merit if used early enough in the child’s life immediately
following the diagnosis. The components of the early intensive behavioral treatment
approach are identified in Figure 1.6.
Home-based treatment programs were criticized at first by many because they

competed with school-based programs and potentially posed threats to existing school
programs in terms of availability and potential costs imposed on school systems in
that parents of young children with autism were hopeful given the results of intensive
early behavioral treatment. Subsequently, many parents sought these services within
schools and early on these programs were in direct contrast to some school-based
programs by virtue of their treatment intensity, that is, 40 hours per week of one-
on-one intervention and the fact that they were home-based. Many school districts
faced litigation on this issue as services for children with autism were developed and
expanded on within schools during the mid to late 1990s. Thankfully, early interven-
tion program offerings have expanded, but still many parents are burdened with the
lack of services or how to pay for services such as intensive early intervention within
the home as these services can be very expensive. Until recently, many states did not
have allowable coverage for these services through health insurance and the bur-
den fell upon families. Medicaid waivers are available in a number of states through
the Social Security Act. This means that states can choose to waive income when
determining Medicaid eligibility. Thirty-seven states have passed insurance reform
measures improving coverage for services to children with autism. Such coverage
requires that health insurers cover behavior analysis for children with autism; the
amount of coverage varies by state. This could certainly serve as a needed support
for families struggling to meet the costs of providing their child with intensive early
intervention services. Given the data that has been reported, it would seem a worth-
while investment for states because service delivery systems are going to increasingly
Figure 1.6 Components of the Early Intensive Behavioral Intervention
■ Treatment is conducted within the home setting for young children with autism who are
generally between the ages of 2 to 4 years.
■ It is recommended that these programs adhere to a consistent treatment protocol.
■ This protocol generally involves 30 to 40 hours per week in the child’s home with a
behavior analyst and parents to assist with implementation.
■ The treatment plan usually involves getting the child ready to learn through learning to
sit, attending to directions, and minimizing competing behaviors.
■ Skills in the areas of imitation, matching, and early language, and basic self-help skills
such as eating, toileting, dressing, and brushing teeth, are first identified.
■ Language goals are expanded to include intermediate and advanced skills as the pro-
gram progresses.
■ Discrete trial training consists of teaching repeated trials to a child and reinforcing his/
her performance until skills are mastered.
Source: Persico et al. (2012).

feel the pinch to provide appropriate services given the ever-increasing numbers of
children being identified with autism.
Given the success of EIBI for young children with autism, many ask about the
success of these children as they enter schooling. There have been references made to
children being “recovered” from autism as a result of receiving early intensive behav-
ioral treatment. There have been a few case studies reported in the literature, but
no large-scale controlled studies. Butter, Mulick, and Metz (2006) provided a case
study of eight students who, after receiving EIBI, no longer met the criteria for mental
retardation or pervasive developmental disorder (PDD). They found meaningful gains
in IQ standard scores, adaptive behavior standard scores, and nonverbal IQ standard
scores, and academic achievement scores were in the average range. However, seven of
the eight children continued to have language impairments. More research is needed
under controlled conditions to fully surmise the long-term implications of EIBI on
the development of children diagnosed with autism. To date, these types of investiga-
tions have not been extensive within the literature.
School-Based Models
The importance of facilitating successful transitions for all children upon entry into
formal schooling is fundamental to promoting a point of connection needed for
long-term success. For children with autism, this is even a greater concern given the
learning and behavioral challenges experienced by many of these children. School
programs for children with autism appear to have a great deal of variance. This
could be in part due to the belief that no one single form of treatment is considered
the best for the treatment of autism (Simpson, 2005). Because autism represents
a spectrum with degrees of variance involved, the range of differences within the
population makes the identification of a single treatment nearly impossible; thus,
treatment packages that combine multiple methods of support are frequently the
norm. Keeping with this theme, more often than not, school-based models for serv-
ing children with autism take on various forms and are frequently comprised of
integrative approaches.
Another aspect that contributes to the degree of variance in the education and
treatment received by children with ASD is the lack of standardization and availabil-
ity of personnel preparation programs designed to prepare teachers and related ser-
vice professionals. How well professionals have been trained to meet the educational,
behavioral, and other related support needs of children with autism and families has
an impact on the type and quality of treatments that children with autism receive.
Typically, schools provide children with a cadre of intervention methods includ-
ing developmental, some behavioral, and TEACCH methods. School programs must
be in compliance with the Individuals with Education Act. Perhaps the greatest chal-
lenge in terms of providing school-based services is the degree to which these practices
reflect best and effective practices (at a minimum), if not evidence-based practices.
The second challenge is delivery of these practices with fidelity, a term that refers to
whether interventions are consistently implemented by all teachers and caregivers as
they were designed. Many states have program quality indicators that are applied to
their respective programs and services to children with autism.
Central components of school-based practices should be the use of data to
inform decision making as per the child’s daily progress on IEP goals and objec-
tives, the use of longitudinal curriculum planning, and partnering with families,
which should be at the core of the philosophy that undergirds school-based prac-
tices. The use of behavioral and other forms of treatment, such as TEACCH meth-
ods, should be reflective of the individual child’s strengths and needs as reflected
on the IEP. Any quality program should have extensive l anguage-/communication-
based therapy coordinated within the context of the child’s educational program.
The use of positive behavior supports as a method for promoting and teaching
positive behaviors is not only mandated by the IDEA, but is also considered best
and effective practice.
Simpson (2005) provided an evaluation of treatment options used in the educa-
tion and treatment of children with autism; many of these are found within school-
based programs. He organized these treatments into the following categories:
(a) scientifically-based, which was comprised of applied behavior analysis, discrete
trial teaching, and pivotal response training; (b) promising practices, which con-
sisted of picture exchange communication systems (PECS), incidental teaching,
structured teaching as part of the TEACCH model, augmentative and alternative
forms of communication, and assistive technology; (c) limited supporting informa-
tion for practice, which was comprised of Floortime, gentle teaching, pet therapy,
and fast forward; and finally, (d) practices not recommended, which included hold-
ing therapy and facilitated communication. In subsequent work conducted by three
university-based programs, the National Professional Development Center on
Autism was created. The initiative was led by the University of North Carolina’s
Frank Porter Graham Center, The University of California at Davis’s MIND
Institute, and the Waisman Center at the University of Wisconsin. This initiative
was designed to promote the use of evidence-based practices for teaching children
with ASD. Though evidence-based practices used in the education and treatment of
children identified with ASD have been identified from research, many questions
still remain as to the capacity and infrastructure within schools needed to implement
these practices.
We have addressed interventions used within school programs, so now let’s
examine where instruction occurs for children with ASD. Children are assessed and
treatment is based on the individual needs of the child; the least restrictive placement
option is identified as mandated by the IDEA concerning the continuum of place-
ments for children with special needs. This means that instruction and educational
services can be received in a variety of settings, including inclusion classrooms, where
children with ASD are educated with their non-ASD peers; partial pull-out programs,
where they attend some classes with their non-ASD peers; self-contained classrooms
designed for children with autism; and specialized schools, where deemed necessary
for children with greater levels of involvement. This placement continuum is consis-
tent throughout primary, middle, and secondary educational settings for children with
ASD. As children enter high school, some children with ASD may receive training in
the community on job skills or other functional skills, such as orientation and mobility
in the community, leisure skills, and shopping skills, among others, as deemed appro-
priate for the individual child and as reflected on his/her IEP.
Post-School and Community Options

for Adults with ASD
Post-school options refer to post K–12 schooling. For young adults with ASD, there
are a variety of options depending on their levels of ability or challenges. For young
adults with ASD who are high functioning, options can include higher education
within colleges and universities or employment in the community. For others who
are more involved with more severe levels of disabilities, this could mean placement
within adult service settings such as community-based workshops or day programs.
As parents age, their concern for the long-term well-being of their children often
becomes most apparent, and for parents of adult children with ASD, it is important
to know there are safety nets of familial and related services and supports available to
their children beyond their lives. Refer to Applied Vignette 1.2 as an example.
Successful post-school transition and community living are essential outcome
measures for young adults with ASD. Education, employment, and the development
of essential life skills, including the pursuit of leisure activities, all serve to comprise a
meaningful quality of life for many. The attainment of these is contingent upon suc-
cessful transition planning that is fostered through an enriched collaboration between
the student, his/her family, education professionals, community service providers, and
potential employers who are dedicated and engaged in providing young adults with
ASD with real opportunities for successful adult lives.

Family/Professional Partnerships
Dale was a 21-year-old young man with high- and supportive family. His parents had planned
functioning autism. As he ages out of his school- to add an additional two rooms onto their exist-
based program, his local education agency (LEA) ing house to accommodate more independence
has worked in collaboration with the local adult for Dale given his age, and they had made provi-
service provider for persons with developmental sions in their will that Dale’s sister, Sarah, would
disabilities to ensure a smooth transition if ser- become his guardian upon their passing. The
vices are needed. Dale was employed 20 hours community school system was also very sup-
per week as a bagger and stock clerk at the local portive and monitored Dale for a year after his
grocery store in his small town. He lived with departure from school to ensure his success in
his parents and older sister in a very close-knit his job setting.
Exemplary Programs and Practices

This chapter’s segment on exemplary programs and practices highlights the work
of the Princeton Child Development Institute (PCDI), a nonprofit program that
provides an array of services to persons with autism across the lifespan. PCDI was
founded in 1970 and provides evidence-based practices in the education and treat-
ment of autism from early intervention through adulthood. For more information
consult their website at: www.pcdi.org/home.html.
Chapter Summary
The purpose of this chapter was to serve as the beginning of your study in the area
of autism spectrum disorders (ASD). Key topics and terms were introduced, as was
the field of autism from a historical perspective. In addition, we discussed the rise
in prevalence of autism rates, which has made autism a global concern. The impor-
tance of early detection and early intervention was presented, and the concept of
longitudinal curriculum planning as a fundamental element of designing educational
and long-term treatment plans for children with ASD was discussed. We stressed the
importance of building successful transitions across educational settings across the
lifespan of the child in order to sustain and maximize treatment gains, foster greater
levels of development, and also as a means of maintaining momentum for the child
and his/her family.
The chapter also discussed the importance of evidence-based practices in the
treatment of ASD. As scientific evidence emerges regarding the efficacy of treatment,
practitioners must use the methods that have been demonstrated to be most effective
under controlled study. The point was made that some treatments have yet to mount
the degrees of scientific evidence to qualify them as evidence-based practice (EBP),
and debate remains as to the operational definition of what precisely constitutes EBP.
The important point here is that some treatments, although not yet considered EBP,
show promise in the demonstration of their day-to-day effectiveness.
Various models of treatment were discussed, including applied behavior analysis
and naturalistic, developmental, multicomponent, and sensory integration models.
The components and basic tenants of each of these were presented. In addition, com-
plementary and alternative medical practices were discussed as forms of treatment for
children with ASD.
The final section of the chapter examined home-based treatment, including
early intensive behavioral intervention (EIBI) therapy, school-based programs for
school-aged children with ASD, and post-school and community options for young
adults with ASD.
In summary, this chapter was designed to provide you with an introduction to
the field of autism and many of the important facets related to providing a meaningful
education to children with ASD and their families.
Activities to Extend Your Learning
1. Select one form of treatment described in this chapter and conduct a brief literature
search on it in the library, selecting five to seven research articles that examine the use
of this form of treatment with children with ASD.
2. Conduct an observation at two or more school-based programs serving children with
autism and identify the classroom characteristics, educational practices, and treatment
forms. Assess the consistency of these across two or more environments and note the
degree to which you recognize the use of evidence-based practices within these settings.
3. Meet and interact with families of children with autism through a community fundraising
activity during National Autism Awareness month, held each April. Be a participant in the
annual walk or volunteer to help plan and participate in this important awareness event.
4. Select one aspect of one of the topics presented in this chapter and allow for an in-
depth examination of this topic to increase your knowledge base.
5. Talk with as many interdisciplinary professionals working in the field of autism that
you possibly can to gain a more enlightened understanding of their respective roles
as professionals dedicated to helping children and families affected by autism. These
professionals could be special education teachers, behavior analysts, speech language
pathologists, and/or other related professionals such as occupational therapists or
physical therapists.
R e s o u r c e s t o C o n s u lt
Some valuable resources to consult for further information on the material covered in this chapter
include the following:
Websites
Age of Autism Healing Thresholds Autism Therapy Homepage
www.ageofautism.com http://autism.healingthresholds.com
Autism Research Institute National Autism Association
www.autism.com www.nationalautismassociation.org
Autism Society of America National Professional Development Center on
www.autism-society.org Autism Spectrum Disorders
http://autismpdc.fpg.unc.edu
AutismToday.com
www.autismtoday.com
Books
Frith, U. (1991). Autism and Asperger syndrome. London: Cambridge University Press.
Goldstein, S., Naglieri, J. A., & Ozonoff, S. (2009). Assessment of autism spectrum disorders. New York:
Guilford.
Jepson, B. (2007). Changing the course of autism. Boulder, CO: Sentient.
Klin, A., Volkmar, F., & Sparrow, S. S. (2000). Asperger syndrome. New York: Guilford.
2
chapter
Determining
Evidence-Based
Interventions

■ Describe a series of compelling arguments for why professionals should seek out and use evidence-
based practices (EBPs).
■ Understand and apply four prerequisite skills for beginning to identify and apply EBPs, including
how to assess the strength of evidence supporting an intervention.
■ Build nonjudgmental relationships with parents who may wish to seek out and use non-EBP
(alternative) interventions for their family members with ASD.
■ Conduct a risk versus benefit analysis of an intervention as it applies to the life of an individual with ASD.
30
c h ap t e r t w o / Determining Evidence-Based Interventions 31
■ Assess the quality of a research base using a series of informational resources.

■ Assess the quality of individual studies using EBP criteria.
■ Integrate the skills and approaches included throughout the chapter into a step-by-step system for
making treatment decisions regarding individuals with ASD.
Chapter 2 Mind Map

Consumer Viewpoint
Why Is Evidence-Based Practice Important? A Community of Professionals
Social Learning & Professional Practice History
A Call for More Skeptics Proceed with Caution

What Is Sufficient Evidence? Determining Evidence-Based Interventions
Levels of Evidence Alternative & Emerging Treatments
Think Like a Scientist Making Treatment Decisions Risk-Versus-Benefit Analysis
Assessing the Quality of a Research Base

Utilizing an EBP Research Base
As a foundation to begin your exploration of the concepts found within this chapter,
please consider Applied Vignette 2.1. Discussion with your instructor and peers will
best assist you in establishing this foundation, and discussion questions have been pro-
vided to facilitate this process.

The Trial-and-Error Treatment
Imagine that you are visiting a physician for we will progress in this direction, down the row,
the first time, and that your goal is to find some taking one of each type of medication each day.
relief from a painful condition that is beginning In the process of trying these medications, you
to negatively impact your overall quality of life. may get better, stay the same, get worse, or per-
When you are brought in to the examination haps even die. Or course, we certainly hope for
room, you open your mouth to begin explaining the ‘get better’ option to occur—and soon. I’ve
your symptoms to the physician, but he holds found that the longer this goes on, the worse the
up his hand to silence you. Then, he produces a patient’s chances of recovery. Shall we begin?”
large tray with many rows of small, square com-
partments and holds it out before you. Within
Discussion Questions
each compartment is what looks like a type of
pill. There are capsules, tablets, and caplets of all 1. This scenario seems utterly impossible in
sizes, shapes, and colors—a dizzying variety of our modern society of informed consumers,
medications. He points to the leftmost compart- ethics, laws, and highly trained, licensed,
ment in the row closest to you and he says, “We and regulated professionals. However, does
will start here with this blue, round one, and then the approach of the physician have any
(continued)
32 S ec t i o n I / Introduction
A p p l i e d V I GNETTE 2.1 Continued
parallels to what is sometimes done with beings, what does it suggest for how we
individuals with ASDs in schools and should behave in choosing and applying
other settings in which education and such treatments?
treatment take place? If so, what are the 3. The next time you think about flying on
factors that contribute to the use of this a plane, taking a prescription drug, hav-
undesirable approach? If not, what are the ing a surgical procedure, or even using a
factors that prevent this approach from specific kind of toothpaste, ask yourself if
being used? rigorous scientific testing is just a cerebral,
2. Most of us should be able to agree that the academic pursuit, or if it really matters in
trial and error approach used in the sce- the activities and outcomes we experience
nario is dangerous and unethical (as well in our daily lives. Considering this idea,
as illegal). Keeping this in mind, what is what are the consequences if science “gets
the best alternative? If this scenario rep- it wrong”? What are the consequences if
resents how we should not behave in science gets it right, but we ignore or do
choosing treatments for our fellow human not seek out the findings?
Within the last few years, practitioners working in the education and treatment
of persons with autism have been increasingly bombarded with trainings, articles,
and presentations involving a concept referred to as evidence-based practice (EBP). The
range of information and the many perspectives that are available on this topic can
make it seem inaccessible or even impractical to many of the professionals who work
each day in applied ways to improve the lives of persons with ASD. However, the con-
cept is one that can fundamentally affect our applied practice in positive, measurable
ways, and it is therefore ideal that practitioners make the attempt to incorporate prin-
ciples of EBP into everything they do, from identification, to assessment, to program
planning, to program implementation. Paring it down to the essential components,
EBP can be described in this way: Evidence-based practice involves selecting and using
interventions for which there is enough quality evidence of effectiveness, efficiency, safety, and
societal and consumer acceptance.
Though attractive in its simplicity, this definition raises some questions, espe-
cially if practitioners are going to directly apply it to what they do for and with indi-
viduals with ASD:
Of course we don’t want to hurt anyone with what we do as professionals, but

■
most of us have avoided that without discussing EBP thus far. So, why is EBP so
important now?
I understand effectiveness, but what is involved in efficiency?
■
What constitutes sufficient evidence, and what constitutes quality evidence?

■
If a treatment is effective and efficient, why is it important that it also be accept-

■
able to society and consumers?

Is there a process we can use to select interventions that are considered to be
■
EBP, and is there a way to match the characteristics and needs of specific indi-
viduals with the treatments that are most likely to work for them?
Why Is Evidence-Based Practice Important?

Modern professionals work within an increasing range of ethical, legal, and practical
constraints that at times seem as if they might strangle productivity and effectiveness.
However, when preservice or veteran professionals begin to consider these safeguards
as constraints to their practice, it is recommended that they (a) begin to look at such
practices from the point of view of the consumer, (b) formulate personal principles
of practice that are based on standards communicated by the wider community of
professional colleagues, and (c) review the origins and history underlying their con-
ception. When professionals orient (or reorient) themselves in this way, it can provide
a renewed resolve to engage in the evaluation, incorporation, and implementation of
practices that are considered to be evidence-based. In terms of consumer viewpoint,
relevant areas for consideration can include time, financial resources, and efficiency. In
terms of history, relevant areas can include the history of fraudulent ASD treatment
and the formation of various legal considerations. Important messages from the wider
community of professionals include ideas about ethical responsibility, identifying and
acting upon training deficiencies, and continuing education.
Consumer Viewpoint
Time. Evidence has supported the idea that greater longitudinal gains in essential
areas of functioning for young children with ASD are associated with the receipt of
earlier and more intensive intervention (Goin-Kochel, Myers, Hendricks, Carr, &
Wiley, 2007; Valenti, Cerbo, Masedu, De Caris, & Sorge, 2010; Virues-Ortega,
Rodriguez, & Yu, 2013). Further evidence suggests that the adaptive behavior skills
of adults with developmental and intellectual disability may tend to plateau and even
regress when certain types of activities and interventions become unavailable to them
(Felce & Emerson, 2001). In addition, parents and families with members who have
ASD may exist in a state of “just trying to cope,” as they experience a child, young
adult, or adult who is physically aggressive, engages in stereotypy for hours a day,
attempts to escape without regard for personal safety, or does not sleep on a consis-
tent schedule (see Chapter 4 for a greater understanding of the challenges and needs
experienced by these families). These facts add up to the conclusion that time is of the
essence when it comes to finding and applying the treatments that are most likely to
be effective in producing positive outcomes for people with ASD. Even if done within
safe limits, there is no time for experimentation, trial, or guesswork. Individuals and
families need what works, and they need it now.
Financial resources. It has been estimated that the global market for autism treat-
ments is anywhere from $2.2 billion to $3.5 billion (Siegel, 2012), and, as compared
to other children, children with ASDs: (a) are prescribed medication more often
(Logan, Nicholas, Carpenter, King, Mayer, & Charles, 2012), (b) have more visits to
the physician (Liptak, Stuart, & Auinger, 2006), (c) access services such as speech and
occupational therapies and behavior intervention more often (Wang, Mandell, Lawer,
Cidav, & Leslie, 2013), and (d) incur as much as six times more in health care costs
(Shimabukuro, Grosse, & Rice, 2008). It is evident that time is money in ASD treat-
ment, and, because private citizens both directly (e.g., as parents) and indirectly (e.g., as
taxpayers) fund the vast majority of this treatment, the responsibility is placed squarely
upon professionals to find and use the treatments that will work quickest and best.
Efficiency. Regarding treatments for autism, efficiency is often discussed in terms

of comparing the effects of one treatment to another (e.g., West, 2008). The term has
also been associated with the practice of individualizing treatments to increase the
likelihood that they are effective and use resources wisely (Stahmer, Schreibman, &
Cunningham, 2011). Putting these ideas together, being efficient within this context
could be defined as: using the fewest resources to identify, choose, and implement the
treatment that produces the best outcomes for individuals with an ASD. Especially
when one considers the potential time, effort, and financial costs for all involved, it is
this need to be efficient that should move professionals toward the use of EBPs.
A Community of Professionals
Classroom teachers and other professionals can feel isolated in terms of how often
they get to meaningfully interact with colleagues, or even with other typically devel-
oping adults in general. However, members of the helping professions must remember
that they are always part of a wider community of professionals (e.g., teachers, psy-
chologists, occupational therapists), and a healthy relationship with this community
requires maintenance. Connection with this community usually comes through face-
to-face activities with professional organizations at all levels, from agency-based teams
to large national organizations, but it can also come through Internet-based activities,
as well as those that are text based (e.g., reading the latest peer-reviewed professional
journals in one’s field). When professionals engage in establishing and maintaining
these connections at multiple levels (e.g., local, state, and national), they increase the
likelihood that they will also engage in learning and performance that promote the use
of EBPs. In addition, engaging in EBPs within relevant aspects of professional activity
demonstrates to consumers and colleagues that a healthy, beneficial connection to the
wider community of professionals is being maintained. Membership within this type
of community often requires professionals to: (a) engage in practices that align with
the ethical principles of their field, ( b) recognize and seek support for ongoing train-
ing needs, and (c) participate in opportunities for continuing education. All of these
activities promote the use of EBPs.
Ethical responsibility. Most modern professional organizations have added lan-

guage related to the use of EBPs within their ethical principles or guidelines for prac-
tice (see Figure 2.1 for examples). Using EBPs within professional practice has become
an expectation in regard to protecting individuals with disabilities from harm and
providing the best possible education and treatment to them. It is therefore recom-
mended that professionals know and understand the ethical principles and guidelines
of their main professional organization(s). Though it is not practical to provide here
the complete ethical principles of all potentially relevant organizations, professionals
Figure 2.1 A sample of ethical principles regarding the use of evidence-based practices
Professional Ethical Principles Regarding Evidence-Based

Organization Practice Source
American “Occupational therapy personnel shall: Use, to the Occupational Therapy

Occupational extent possible, evaluation, planning, intervention Code of Ethics and
Therapy Association techniques, and therapeutic equipment that are Ethics Standards
(2010) evidence-based and within the recognized scope of
occupational therapy practice.” (Principle 1,
Part F, p.3)
American “Psychologists’ work is based upon established Ethical Principles of

Psychological scientific and professional knowledge of the discipline.” Psychologists and Code
Association (2013) (Standard 2: Competence, Part 2.04: Bases for of Conduct
Scientific and Professional Judgments, p. 5)
Behavior Analyst “The behavior analyst always has the responsibility BACB Guidelines for
Certification Board to recommend scientifically supported most Responsible Conduct for
(2010) effective treatment procedures. Effective treatment Behavior Analysts
procedures have been validated as having both
long-term and short-term benefits to clients and
society.” (Section 2: The Behavior Analyst’s
Responsibility to Clients, Part 2.10: Treatment
Efficacy)
Council for “They [special educators] are committed to upholding Special Education
Exceptional Children and advancing the following principles: Using Professional Ethical
(2013) evidence, instructional data, research, and Principles
professional knowledge to inform practice.” (Part F)
National Association “To base program practices upon current knowledge Code of Ethical Conduct
for the Education and research in the field of early childhood and Statement of
of Young Children education, child development, and related disciplines, Commitment
(2005) as well as on particular knowledge of each child.”
(Section 1: Ethical Responsibilities to Children,
Ideals: I-1.2, p. 2)
who work with people with ASD should, in terms of EBP, do the following (Post et al.,
2013; Schreck & Miller, 2010):
Make treatment decisions that are fully informed from the research literature
■
and indicative of data-based, systematic, professional applications.

Communicate to individuals and families evidence-based information regarding
■
the effectiveness of specific treatments.

Be clear about the known risks of alternative treatments (those not classified as
■
EBPs).
Recognizing training deficiencies. Important connections have been identified

among teacher beliefs, sense of self-efficacy, emotional responses to challenges, and
level of professional knowledge (Hastings & Brown, 2002), suggesting that educators
tend to be more effective and emotionally able to handle teaching students with autism
and intellectual disability when their beliefs and knowledge are shaped by training and
education in EBPs. Adequate training for teachers of children with autism has also
been identified as one possible way to avoid burnout and reduce teacher attrition in
the profession ( Jennett, Harris, & Mesibov, 2003), and inadequate professional train-
ing can have the ultimate effect of limiting options and outcomes for people with
ASD. Therefore, it is essential to (a) remind ourselves that no one knows everything
useful that there is to know, regardless of number of years of experience; (b) adopt an
attitude of lifelong learning and professional growth; and (c) identify personal, colle-
gial, and institutional training deficiencies through maintenance of current knowledge
regarding EBPs. Ideally, within the community of professionals, this process should
be encouraged and implemented across all personnel, from administration to service
delivery.
Seeking continuing education. Most modern professions require service provid-

ers for people with disabilities to obtain some type and extent of continuing educa-
tion, and obtaining ongoing education throughout one’s professional career is often
tied to pay increases or the maintenance of licensure or certification, indicating the
nearly universal importance placed on this activity. There is evidence that even a
limited amount of professional development for educators can significantly increase
knowledge of ASD and EBPs (Leblanc, Richardson, & Burns, 2009), and it is there-
fore recommended that the selection of topics for this education (both by seekers and
providers) be guided by the current directions of EBP within one’s field. It is often the
case that as EBP influences the content of continuing education, continuing education
influences the knowledge and application of EBP. Within this type of cyclical relation-
ship, the benefit of successfully completing and implementing continuing education
activities is a major driver for professionals to learn about and use EBPs.
History
Fraudulent treatment. The vast differences among people with ASD can not only
make finding an effective treatment difficult, but these differences can also produce a
wide range of responses to the application of a particular treatment across individuals.
These and other factors, combined with the strong desire of caregivers to find effec-
tive treatment, can lead to an increased susceptibility to the offer of treatments that
are fraudulent ( Herbert, Sharp, & Gaudiano, 2002), whether by intended design or
simple negligence in applying the rigors of adequate scientific testing. Unfortunately,
ASD treatments that rush to address the need for universally effective applications and
promise amazing results, but then fail to deliver as promised, are often not widely dis-
credited until after caregivers have lost precious time and financial resources in pur-
suing them. Although no one knows an exact dollar amount for how much money is
wasted annually on fraudulent ASD treatments, the cost of certain well-known treat-
ments for which there is little or no supporting scientific evidence has been estimated
from $10,000 to $16,500 per year per child (Zane, Davis, & Rosswurm, 2008).
Legal considerations. For professionals who work with students in school settings,
one important legal consideration is the emphasis placed on EBPs within the No Child
Left Behind Act (NCLB) and the Individuals with Disabilities Education Improvement
Act (IDEIA). Browder and Cooper-Duffy (2003) point out that the text of NCLB
makes reference to the term “scientifically based research” more than 100 times, and
requires that those receiving grant funding from federal sources use the money to
research intervention strategies that are evidence based. In addition, Cook, Tankersley,
Cook, and Landrum (2008) emphasized the language in IDEIA that promotes teacher
training in evidence-based methods that are likely to have the best effect on the school
performance of students with disabilities. Therefore, school-based professionals should
be motivated to use EBPs because their use is quite literally the law.
Closely related to education law is another important legal consideration that
involves litigation in schools. Within the autism litigation research, a picture is pre-
sented of steadily increasing parent litigation against schools regarding the children
with autism educated there (e.g., compare Zirkel, 2003, to Zirkel, 2011), with current
estimates that autism-related litigation makes up nearly one-third of the IDEIA court
cases across all students with disabilities. The focus of the cases within this body of
litigation can often be associated with breakdowns in knowledge and practice regarding
EBPs, such as failure to provide services, services resulting in no progress with the IEP,
problems with evaluation and assessment, the use of personnel thought to be unquali-
fied, and educational placement thought to be incongruent with the doctrine of least
restrictive environment (Hill & Kearley, 2013; Zirkel, 2011). The increase in this type
of litigation should be a major impetus for schools and school personnel to both seek
and provide training in EBPs and integrate the implementation of this training into
everything they do for and with students with ASD. For an integrated pictorial over-
view of the rationale for using EBPs in professional practice, see Figure 2.2.
What Is Sufficient Evidence?
Social Learning and Professional Practice

Social learning theory is based on the premise that many of our experiences within
social contexts influence in powerful ways what we profess to know and how we behave
(Chavis, 2011). In most typically developing humans, there appears to be an intercon-
nection among repeatedly watching what others do, hearing what they say, and speak-
ing and acting in similar ways. In this type of process, the practices and testimonials of
our peers can become powerful influences on, for instance, the types of interventions
that we choose to implement with individuals with ASD (refer to Applied Vignette 2.2
for an illustration). This is especially true if such testimonials can in any way be viewed
as providing the answer to one or more of our current, pressing needs, such as the
need to decrease a student’s aggressive behavior and increase the time he spends learn-
ing. Although it at first may seem that there is a kind of “safety in numbers” with
blindly following the practices of others, the actual result could be that professionals
(a) give up direct control over their personal and ethical responsibility for selecting
Figure 2.2 Why seek to use evidence-based practices?
COMMUNITY OF PROFESSIONALS
Ethical Training
Responsibility Deficiencies
Continuing
Education
CONSUMER HISTORY
Time Efficiency
Fraudulent Legal
Financial Treatment Considerations
Resources
WHY SEEK TO USE

EVIDENCE-BASED
PRACTICES?
and using EBPs, and (b) begin to trust the critical review of their practices to others
who may or may not examine interventions in terms of being EBPs. Although social
learning can be a powerful influence on what we do as professionals, saying that you
were “only doing what everyone else was doing” is still a weak argument to present
to a professional review board or due process court proceeding during which your
practices are being investigated. In other words, regardless of what others may or may
not be doing, you are ultimately responsible for the outcomes of your professional
practices conducted for and with other people, and you should therefore be an active
participant in choosing the interventions that you will and will not implement.
It is also possible, however, that social learning can lead us to desirable ways
of behaving that we may not have otherwise discovered. So, rather than avoiding
altogether what other professionals are doing within the work environment, a better
approach might be connected to addressing this question: Within our social learning,
how do we tell the difference between the professional practices that are risky, those
that should be avoided altogether, and those that we should definitely learn about

The Hearsay Dilemma
Ms. McGill seems to be having more behavioral account of any harm coming from using it. She
outbursts in her autism class this year, and she thinks, “That means that I am okay using it too.
consults her fellow teacher, Mr. Hogue, to see Doesn’t it? What more evidence could I possibly
if she can get any advice about what to do. Last need?”
year was her first year in the school system, and
she is still a bit unsure about what sources of
assistance might be available to her. Mr. Hogue Discussion Questions
recommends that she begin using something 1. Imagine that you are a teacher in
called “sensory integration therapy,” and she Ms. McGill’s school and that her question
is very curious to know how the intervention is directed to you. What more evidence
works. “Sensory integration has helped reduce could she possibly need?
the behavior problems in my class by half or
2. In your opinion, are professionals in
more. In fact, there is a trainer from the central
Ms. McGill’s school system doing some-
office who will come to your classroom and help
thing wrong or unethical by choosing
you learn how to do it. I’ll give you her email
to use sensory integration therapy for
address.”
students with autism? If so, how could
The school year ends before Ms. McGill
they possibly have made such a decision,
can schedule the training, but she has checked
assuming that they all have the best inter-
into what schools and teachers in her district are
ests of students and families in mind? If
doing with the therapy and is now resolved to
not, why do you think there is a difference
contact the trainer sometime during the sum-
between what professionals in the school
mer to see if something can be arranged for the
system say about the therapy and what
next school year. In the meantime, she attends
researchers and national autism organiza-
a professional conference and finds a session on
tions say about it?
evidence-based practices in teaching children
with autism. During the session, she learns more 3. If you were Ms. McGill, what would
about the importance of using EBPs in the class- you do in regard to using the therapy in
room and hears of a classification system that your classroom? If you decided not to
ranges from non-evidence-based, to emerging, use it, how would you explain your deci-
to evidence based. She is shocked to hear that sion to others who might ask (e.g., to
sensory integration therapy is considered to be Mr. Hogue and the parents of your stu-
“non-evidence-based” by two different national dents with autism)? If you decided to use
autism organizations, as well as the American it, how would you explain your decision to
Occupational Therapy Association. Ms. McGill anyone who asked why you chose to use a
ponders what this might mean in the context non-evidence-based practice in your class-
of her students and classroom. Quite a few of room (e.g., to a member of the IEP team)?
the teachers of students with autism in her dis- 4. What if an intervention has not yet been
trict use sensory integration therapy every day, classified as an EBP but still seems to
and the central office even has someone who be safe and effective? Should it be used
trains teachers to use it. Mr. Hogue said that it or not? After all, how does an interven-
had dramatically reduced behavior problems in tion become an EBP if it is never used by
his class, and Ms. McGill had never heard an teachers and interventionists?
and adopt? Responding to a historical shift in the policy and practice of their profes-
sion, Woodrow and Fasoli (1998) recommended that professionals critically reflect on
their collective, collaborative practices, especially when confronted by the potential
for change in their current approaches, because “critical collaborative relationships
provide supportive and potentially productive sites for the examination of the struc-
tures and assumptions that underpin practices” (p. 40). They provided some guidelines
for this type of critical reflection within collaborative relationships:
Be aware of political, institutional, peer, and administrative pressure to adopt

■
certain practices and ways of thinking, especially when they have the potential to
negatively impact the ability to benefit service recipients or their families.
Realize that merely collaborating with professional peers does not necessarily
■
produce a positive result, or any result at all. Collaboration must be critical, or

carefully and continually examined in terms of (a) institutional and individual
outcomes; (b) validated, research-based practices; and (c) directionality of effort
(i.e., Whom are we trying to please and benefit with the bulk of our professional
efforts? Is it truly our service recipients and their families, or is it, for instance, a
set of bureaucratic requirements or one or more overly biased administrators?).
Within your collaborative relationships, promote adherence to the code of eth-
■
ics of your profession, especially as it relates to working with peers and service
recipients.
Periodically review common past experiences with professional peers, with the
■
intent of improving the current (and future) quality of service provision.

Work together in ways that maintain open communication, minimize power
■
relations, share professional knowledge, and value individual roles and talents.
A Call for More Skeptics

It is good professional practice to be a skeptic, or one who delays innovative action in
favor of systematically gathering the best supporting evidence. In some social con-
texts, being a practicing skeptic can sabotage relationships and create doubt as to our
sincerity and beneficence toward others. However, we should not confuse the often
negative outcomes of being skeptical in our social relationships with the often reward-
ing practice of being a skeptic in our professional practice, even if others around us
tend to confuse the two. Especially in the field of education, there has often been a
rush to embrace the “fad of the day” without first considering the potentially negative
outcomes within an objective, risk-versus-benefit analysis. The result of this can be
(a) the increased expenditure of time and resources for a reduced return in terms of
outcomes, (b) what some have described as a “fire, ready, aim” approach that consid-
ers the excitement and desires of professionals ahead of the long-term best interests
of the individuals to be served, and (c) perpetuation of the confusion between educa-
tional and technological tools and evidence-based procedures and practices. In the same
way that having the best quality and range of carpentry tools cannot be equated with
the acquired skill and experience of a successful house builder, the use of an iPad or
SMART Board cannot be equated with empirically identified, effective teaching pro-
cedures and practices. Great tools assist great skill, but they cannot replace it.
The next time that you are confronted by an overly enthusiastic or emotional
push to adopt some new tool or procedure about which you are unsure, it is recom-
mended that you follow one or more of the following six practices of professional
skepticism:
1. Ask for the research. Use your best social skills to enquire about the range of
published, peer-reviewed studies that have been conducted on the topic. Do this by
expressing interest rather than doubt. If there is little knowledge or cooperation con-
cerning your request, politely offer to do your own independent search and report
back to the group, as an extension of your interest in the topic. In your quest for a
research base, make sure to use the EBP resources and evaluation criteria given in this
chapter.
2. Communicate the shortcomings. Within a context of facilitating the innovation
process and working toward an increased probability of success, look for and clearly
outline (a) areas in which problems are likely to occur, (b) incomplete plans for pro-
active and contingency management, and (c) similar efforts that have failed or had
inconsistent results. In the short term, this will not make you more popular with those
who are pushing for this innovation, but in the long term it will tend to give you the
reputation of being a valuable resource person when thoughtful analysis and planning
are required, especially if you project an attitude of working to improve practice rather
than simply trying to be a speed bump on the road to progress.
3. Propose limited-scope action research or pilot study. Rather than jumping straight to
full-blown, system-wide implementation, suggest that the innovation first be tested
on a limited basis. Advocate for the gathering and report of data on effectiveness and
outcomes, as well as undesired effects and problems, and propose to use these data for
either (a) determining that the innovation is impractical or ineffective (e.g., by setting
minimal acceptance criteria prior to testing), or (b) replacing or fine-tuning proce-
dures and practices for a larger-scale implementation to occur at a later date.
4. Create an investigative committee. Propose heading up a committee that will con-
duct a feasibility study or needs assessment, investigate the success of similar pro-
grams, conduct a review of related professional literature, or evaluate the innovation
using a predefined instrument, preferably one substantiated with quality research. Try
to secure for the committee a defined timeline for conducting the review, a reporting
method for communicating results to the group, and, if possible, the power of making
a final determination or recommendation on use of the innovation.
5. Attempt to identify and isolate the true “active ingredients.” When use of a specific
tool is confused with EBP, there is often an accompanying confusion concerning what
is truly producing a desired behavioral or educational effect. If this situation is sus-
pected, propose trying the same intervention procedure without the tool. For example,
if the excitement is over a picture communication application used on a touch tablet
computer, propose the use of the same intervention procedure with laminated picture
cards, and systematically evaluate individual outcomes using both the tablet and the
cards. However, keep in mind that any newly introduced tool can produce a novelty
effect, making it at least temporarily more motivating to use, and thus any such inves-
tigation should be of sufficient duration to overcome this effect.
6. Compare with less complex and expensive alternatives. When confronted with a new
device, piece of software, assessment tool, or intervention procedure, ask the following
question: Is this just as easy to use and just as effective, reliable, and cost efficient as
what I am already using or have used in the past? If the answer to this question is no,
carefully consider the true reasons that the tool or procedure is being promoted for
use, and, if those reasons are tangential to or completely disconnected from promoting
the best outcomes for individuals with ASD, consider staying with what you already
use. For example, if you can inexpensively produce, use, and maintain an instructional
material that is just as efficient and effective as an electronic device that can crash,
break when thrown across the room, or require recharging, why use the device?
Levels of Evidence
We begin this section with the idea that all evidence is not created equal, and that we
therefore should refrain from acting with the same intensity, frequency, and duration
in response to all types of evidence. When we wish to examine a collection of evidence
to determine its strength, validity, and reliability, determining the types of evidence it
embodies is a good way to begin. In conducting such an examination, it is often useful
to think of the highest levels of evidence as the ultimate goal to be reached, though it
should be remembered that this is only one stage of a process for identifying an EBP (see
Figure 2.3 for one model that presents levels of evidence, from strongest to weakest).
Next, we must attempt to be reconciled with what might be a counterintuitive
leap for some people: Eternal evidence from a large number of sources should be
considered as stronger proof of the efficacy of an intervention than an individual’s pro-
fessional experience. Personal experience does shape our responses in powerful ways,
and that fact is not being disputed here, nor is the fact that our personal experience
is a valuable source of information and learning in terms of the accuracy and stability
of our ongoing professional practice. After all, secondhand knowledge can only get us
so far toward the goal of expertise, and applied experience is the best teacher of what
actually happens when theory meets the real world. Note that levels of professional
experience are included in Figure 2.3 as the foundation in the progression toward
developing the strongest levels of evidence. The idea within the figure is not that
external evidence is more valuable than an individual’s professional experience. Both
are considered necessary in building the required evidence base for an intervention.
Rather, the idea is that, as we build greater proof of generalizability and systematic
replication for an intervention, we make evidence stronger for justifying the safe and
effective application of the intervention across greater numbers of potential beneficia-
ries. For example, would you feel safer receiving a treatment that has been successfully
Figure 2.3 Levels of evidence regarding intervention practices
Strength of
General
Evidence
Type of Level of Evidence Description Example
for the
Evidence
Intervention
STRONG A double-blind,
(use widely randomized, placebo-
with controlled, multi-week
appropriate, External study in which children
intended evidence with a clinical diagnosis
individuals) of autism were randomly
assigned to three groups,
Research reports on
with two groups receiving
groups of individuals
different dosages and
using control groups,
combinations of
randomized controlled
Experimental control medications and one
trials, random stratified
studies receiving only placebos.
sampling, and other
At weekly intervals,
systematic controls to
participants’ blood
reduce the potential for
chemistry was assessed
error
and a behavior rating
scale was administered.
Inferential statistical
analyses were conducted
to compare differences in
blood chemistry and
scores on the scale.
Participants were
randomly selected,
equated across important
variables regarding
cognitive functioning and
Research reports communication ability,
within which participants and randomly placed into
are equated across two treatment groups.
Matched pairs
important variables and Rates of self-initiated
studies
randomly placed in a communication were
number of conditions/ measured for both groups.
groups for study Inferential statistics
indicated a significantly
higher rate of self-
initiated communication
in the group receiving
treatment one.
Autism diagnostic scores
for a group of children
Research reports that were obtained at age 3
document repeated, and later at age 5
regular measures Though scores in
taken over some repetitive behavior
Longitudinal significant time period decreased significantly,
comparisons to show change in no significant difference
individuals, groups, was found in
systems, trends, etc. communication scores.
(continued )
Figure 2.3 Continued
Although social skills

scores did show
improvement, the
change was not
statistically significant.
One form of a behavior
rating scale is
administered prior to
teaching a behavior
Research reports reduction strategy to
that statistically an individual with ASD,
Pre- and post-
compare before and and an equivalent form
comparison
after measurements of the scale is
studies
to test the impact of administered a few days
an intervention afterward. A statistical test
indicates significantly
lower scores (indicating
improvement) on the after
measure.
An article in a peer-
reviewed, professional
Research reports on
journal that evaluates a
single individuals using
peer-mediated intervention
participants as their own
by using a multiple
Single-case designs control, for example,
baseline design
through systematic
conducted across three
baseline and
individuals who do not
intervention measures
engage in appropriate
social interaction.
Intervention studies
published across a five-
year period were analyzed
to test for significant
effects in peer-based
Research reports on
versus teacher-delivered
multiple studies using
social skills interventions
descriptive statistics,
Meta-analyses for children with autism.
statistical regression
Effects for peer-based
methods, and/or effect
interventions were larger
size computations
than those for teacher-
delivered systems, though
teacher-delivered
systems did produce a
significant effect.
A peer-reviewed study
that describes relevant
Research reports on
features and outcomes of
Extensive reviews of multiple studies using
all of the video-modeling
literature descriptive or peer-
studies conducted and
review/rating methods
published across the last
ten years.
The characteristics of a
student with autism and
Research reports on an intervention
single individuals implemented to reduce
Case studies using quasi- or repetitive behavior are
(continued )
non-experimental described, and data are

methods provided that show
MODERATE reduction in rates of
(supervised, repetitive behavior over
controlled time (a “treatment only”
use with design).
relatively The district behavior
small numbers specialist provides
of individuals) A group of individuals technical assistance and
Professional implements training with evaluation to members of
experience Group implemented service recipients and is a behavior support team
training supervised by a certified, as they implement a
licensed, credentialed three-tiered behavior
professional. intervention system
across students within an
elementary school.
The assessment, planning,
and treatment
An individual implements
implementation work of a
training with service
board-certified assistant
Personally implemented recipients and is
behavior analyst is guided,
training supervised by a certified,
supervised, and evaluated
licensed, and/or
by a board-certified
credentialed professional.
behavior analyst.
Professional development
provided by a licensed
speech-language
A certified, licensed, pathologist in which
and/or credentialed special educators are
Training received from
professional provides trained to set up situations
qualified, credible
comprehensive training that will make it more
sources
in applying an evidence- likely that students with
based intervention. severe disabilities will
practice the
communication skills
they have learned.
A school district uses a
A group of practitioners series of A-B single case
conducts action research designs within a response
Group conducted with one or more to intervention program to
small N research individuals or small gauge the effectiveness
groups of their service of a particular intervention
recipients. for students with reading
difficulties.
A practitioner conducts An A-B single case

action research with one design is used by a
Personally conducted or more individuals or teacher to measure a
small N research small groups of his/her student’s progress toward
service recipients. his/her IEP goals.
Professional colleagues Within a graduate course,

Critical, systematic are observed students must observe a
implementing an practicing professional
(continued )
review of peer practices intervention, and work with a child, and

evaluative notes/ these students complete
activities are completed. assigned activities.
A colleague or
Verbal or written acquaintance tells you
Hearsay, level 2 anecdotal report from a about an intervention
primary source he/she has found to be
effective.
A colleague or
acquaintance tells you
Verbal or written
WEAK about an intervention that
Hearsay, level 1 anecdotal report from a
(do not use his/her colleague or
secondary source
the friend has found to be
intervention) effective.
tested with the relatively small number of people that can be impacted by a single
professional or agency, or one tested with thousands of people across a wide range of
geographic locations, professionals/researchers, and facets of investigation? Not only
might you feel safer about the treatment, but you might also agree that as generaliz-
ability and replication increase, so does the probability that the same treatment will be
safe and effective for a wider range of other people. In this type of analysis, we must
therefore think beyond the limits of our own experience to the collective experience
of mankind, for this is the population that any treatment has the potential to impact.
Therefore, the strongest and most highly acceptable indicator in this type of
examination is an external evidence base that includes (a) a traceable history of devel-
opment that contains valid examples within each level of evidence, and (b) quality
examples at the highest level. There are few cautions in this case, though mainte-
nance of evidence quality should be monitored in subsequent additions to the base.
Second strongest, but also acceptable, is an external evidence base that includes quality
examples at the highest level but few or no examples at lower levels. The main caution
in this second case deals with a critical examination of (a) the extent of the evidence
(How much?); (b) the length of time during which the base has been created, added
to, and critically examined (How long?); and (c) the number of researchers, groups, or
organizations involved in producing the evidence (How many?). In each of these areas,
more is better (refer to Figure 2.4 for a graphic model of these and other factors).
Debatably unacceptable, and the third strongest, is an external evidence base with
nothing at the highest levels but with valid examples at all lower levels. One caution in
this case is to avoid confusing personal enthusiasm for a treatment with an objective
examination of the adequacy of the evidence base. Because we wish the evidence to be
fully adequate, and because it seems to be on the cusp of crossing the line of accept-
ability, this does not justify use of the rationalization that “it is good enough for me,”
especially when we must foremost consider what is “good” for people with ASDs and
their families. Another caution comes in being able to recognize an emerging treat-
ment, or one that is in the process of building toward a sufficient evidence base, from
a treatment that is ready for use with a broad range of service recipients.
Figure 2.4 General factors impacting an evidence base
X X
Number of Different Researchers &

Unsupported Optimal
Geographical Locations
Number of Studies
Unacceptable
Emerging Acceptable
0 0
Low High
Quality of Research Base
Consider This
It’s the age-old question: “Which came first, to en vivo applications, or within, for instance, a
the chicken or the egg?” One might apply this typical public elementary school. At some point,
same type of question when trying to deter- professionals would get directly involved and be
mine how professional experience and external trained to use the now-EBP intervention. In sce-
evidence work together to form EBP. Which nario B (the professional comes first), we might
comes first? One might speculate that the pro- reasonably imagine that the same progression
cess should work something like it does in the occurs but starts with, for instance, classroom
field of medicine, with small-scale controlled case studies involving only a few students (stud-
trials that progress to larger-scale applications ies that professionals present and publish),
and finally to widespread use, as safety and ultimately progressing to school-wide and sys-
effectiveness become more firmly established. tem-wide implementations in which research-
However, this logical-sounding comparison ers get involved and start further documenting
does not resolve the dilemma that arises with results by publishing studies. Again, at some
the application of the chicken and egg analysis, point, other professionals would get involved
as follows: Must professionals wait for research- and be trained to use the now-EBP intervention.
ers to classify a potentially effective intervention Or, could both be first at one time or another,
as EBP before they can use it in their practice, depending on the situation, making the whole
or should researchers wait for professionals to “egg” question inapplicable to the situation? If
begin limited testing as the first step in building this is true, does the type of intervention have
toward stronger levels of evidence? In scenario anything to do with which person starts the pro-
A (the researcher comes first), we might reason- cess? What do you think? Consider the question
ably imagine that things progress from clinical both in terms of what does happen and what
applications with very tight controls, ultimately should happen.
Think Like a Scientist

Subjectivity and superstition. Bain, Brown, and Jordan (2009) provided to 351 teacher
candidates a series of brief, neutral descriptions about potential interventions for child-
hood disorders (including autism) and asked whether the candidates believed each inter-
vention would be effective. It was found that preservice teachers tended to recommend
interventions whether or not the interventions were labeled as “evidence based” (other
intervention labels provided for them were “controversial” and “anecdotal,” as based on
specific definitions), or whether or not they had prior experience and sufficient informa-
tion regarding the interventions. The authors concluded that teacher candidates seemed
to choose interventions, at least in part, because of the logical or scientific sounding
descriptions that were provided. Among other suggestions, the authors recommended
that increased instruction be provided in the advantages of skepticism, critically evaluat-
ing information in the media, and techniques for judging potential interventions.
The findings in Bain et al. (2009) illustrate one example of how to avoid think-
ing like a scientist—by being overly subjective in one’s determinations. Subjectivity
involves making important decisions and responses based solely on intuition, bias,
potentially flawed human perception, or unreliable or limited types of evidence, such
as the inclusion of technical-sounding jargon. The premise used in this type of deter-
mination usually comes quickly to mind, and the subsequent conclusion seems to
neatly fit the current situation; for example, “If it sounds complicated, then it must be
scientific, and if it is scientific, then it must be effective.” Throughout human history
many such errors of subjectivity have been caused by flawed human perception, mostly
because of the seemingly irrefutable premise that if our perception tells us something,
then it must be correct. Though lumpy and irregular, the Earth does appear to be
mostly flat, and, in observing the skies, it does appear that the stars, sun, and moon
all orbit the Earth. It also seems to make a kind of intuitive sense that heavier objects
would tend to fall faster than lighter objects. It has taken scientific thinking and inves-
tigation to prove that none of these conclusions is correct.
Working with subjectivity to inaccurately skew our conclusions is superstition.
Once we have a subjective determination in mind, superstition can then seem to con-
firm it for us. This type of accidental association (or superstition) is formed when two
events occur relatively close together in time, and it is then erroneously assumed that
the first event has caused the second event (for further information on superstitious
behavior see Skinner, 1953). Without scientific thinking placed at the forefront of
what we do as professionals, the work of these two human tendencies could unfold in
a way that is illustrated in Applied Vignette 2.3.
The scientific method. It could be assumed that the scientific method is a basic
form of learning that had its relevance in completing elementary school science fair
projects and is therefore no longer applicable to what we do as adult professionals.
However, rather than dismissing this method as too basic to be currently applicable to
our lives, it is recommended that as we mature, learn, and become more sophisticated
in our thinking, so should our depth of understanding and application of the method.
Therefore, if the method seems too basic to apply, perhaps this indicates a need to

Subjectivity, Superstition, and Mr. Gullible
Mr. Gullible, a teacher of students with autism, 2. At what points does superstition seem to
hears from a colleague that a certain intervention be at work?
meant to decrease aggression in adolescents with 3. Could anything other than the inter-
ASD is effective, and he decides to implement it vention be responsible for the reduced
with two students in his classroom. However, he aggression of both students? How could
does not research the intervention for himself, we know this with more certainty?
nor does he decide to systematically record data
4. Is it possible that the aggression of both
on rates of aggression. He implements the inter-
students was not actually reduced at all, or
vention in the way it was described to him. “After
at least not by enough to make a positive
all,” he reasons, “the aggression is mild right now,
difference? How could we know this with
but it could escalate and become more dangerous
more certainty?
very quickly. I just don’t have time for things like
research and data collection.” Across the follow- 5. By failing to think and act scientifically,
ing two weeks, Mr. Gullible perceives that the what is the potential risk to Mr. Gullible,
aggression of the two students has indeed been his colleagues, and his students and their
reduced, and he therefore concludes that the families?
intervention is effective. He immediately recom- 6. How might you argue the point that fail-
mends its use to all of his other colleagues. ing to take a scientific approach to the
problem could cost Mr. Gullible more
Discussion Questions time in the long run than it seems to
1. At what points within the scenario does have saved for him at the start of the
subjectivity come into play? process?
investigate its potential application in more depth, in order to break the association
with cardboard posters and projects made from two-liter bottles and reestablish its
tenets as a grounding philosophy of professional practice. Although they are presented
in varying forms, the main steps of the scientific method can be presented as follows,
with associated skills and approaches necessary for school-based professionals:
1. Gather preliminary knowledge, and make preliminary observations. Related skills to

develop in this area include the ability to (a) write detailed anecdotal records of stu-
dent behavior and performance, (b) search a database for related professional literature,
(c) summarize findings across studies, (d) synthesize an intervention protocol from a
written description of an experimental procedure, and (e) accurately match the most
relevant student characteristics to those of participants included in published studies.
2. Identify a problem of interest. Skills of relevance are: (a) writing observable, mea-
surable operational definitions of performance; (b) gathering and displaying quantifi-
able baseline data regarding current student performance; (c) using techniques such as
interrater reliability to ensure the accuracy of data; and (d) administering any prelimi-
nary assessment tools, as well as scoring and interpreting the results.
3. Formulate a hypothesis. Skills to be developed here include the ability to
(a) predict probable future performance from an analysis of baseline data trends,
(b) objectively connect specific environmental variables to specific instances of stu-
dent behavior through systematic observation and data gathering, and (c) propose a
method for removing, altering, or replacing associated environmental variables in a
prescribed way (e.g., through the use of a single subject experimental design) that
makes it more probable that the intentional manipulation of variables is responsible
for any associated change in behavior.
4. Conduct an experiment. Many skills are required in this area, including: (a) accu-
rately following the steps of a treatment protocol (maintaining treatment fidelity/
treatment integrity); (b) maintaining validity of ongoing measurements by strictly
adhering to predefined definitions, procedures, and checks on data reliability;
(c) implementing controls to ensure that any changes in student performance are
likely due to the intervention being implemented rather than the result of unintended
variables (e.g., restricting access to supplemental materials or peer or adult assistance
during the experimental phase); and (d) replicating results under the same experimen-
tal conditions to verify the reliability of the results.
5. Formulate conclusions. Skills include the ability to (a) quantifiably, objectively, and
visually analyze intervention data; (b) accurately connect results to both intentional and
unintentional manipulations of features of the learning environment; and (c) make further
treatment decisions based on these findings (i.e., engage in data-based decision making).
Thinking like a scientist, along with the other prerequisite skills discussed in this
section, are displayed in Figure 2.5 as an integrated overview, to increase your review
and assimilation of these ideas.
Figure 2.5 Overview of prerequisite knowledge and skills for beginning to identify
and apply evidence-based practices
• Know how to critically examine

1. social learning contexts.
• Apply a healthy, professional

2. skepticism.
• Determine existing levels of

3. evidence.
• Apply the standards of scientific

4. reasoning.
Making Treatment Decisions
Proceed with Caution

Just as we should read food labels to identify unhealthy products or obey road signs
that warn of hazards ahead, we need to also be able to read caution signs indicating
that certain treatments or practitioners should be avoided. While this is not an exact
science, it attempts to err on the side of caution, go with the most likely probability,
and avoid the majority of treatments and practitioners that are, at best, ineffective.
The uninformed are especially vulnerable to misinformation and misguided practices,
and one way to avoid being uninformed is to know the following warning signs and do
some preliminary research related to each of them.
Nonstandard names. Consumers should be familiar with the way that profession-
als within a particular field of expertise discuss their own profession, some of the ter-
minology commonly used by these professionals, and how their publications most
often characterize and refer to treatments and the common components of them. In
short, it takes some research to find the standard names and definitions of relevance.
One prominent example of the use of nonstandard terminology that could signal the
potential for problems is the use of the term ABA therapy to refer to the science of
applied behavior analysis. Behavior analysts are very clear that ABA is a science-based
approach to treatment, not a specific type of therapy in and of itself (Bailey & Burch,
2006), and that characterizing ABA as a “therapy” could indicate a lack of understand-
ing and perhaps even a training deficiency regarding the implementation of this type
of behavioral technology.
Nonstandard applications. Although correct terminology is used to refer to and

discuss a particular type of treatment, the actual implementation steps or processes
may not adhere to the known, specific tenets or “active ingredients” of that treatment.
This practice is analogous to putting the wrong label on a can of food. Initial expecta-
tions do not match what is actually found inside, and the only way to be aware of the
problem is to be familiar with the ingredients that should be inside. Pay close atten-
tion to what reputable professionals say about the necessary components and required
implementation procedures of a particular treatment, and get as many examples as you
can of the treatment in action before adopting it.
Exclusive use of secondary sources. If you see cited as evidence articles that dis-
cuss, explain, or refer to research studies, and the studies themselves are not provided
(or no indication is given of where they may be found), this may be an indicator of
intentional or unintentional misinformation. If the distance from the direct source is
even greater (e.g., an indirect source that refers to other indirect sources), avoid this
information altogether, or read it only for context within a wider search for more reli-
able sources. Treat information that, for instance, refers to “an article about a study”
as complete hearsay that is unfit for evidence. Then, proceed to find the real evidence
(i.e., the primary sources) for yourself.
Claims of miraculous results not seen elsewhere. Receive claims that a remark-

ably effective treatment is available “only from us” with great skepticism. For example,
if one person or organization finds a cure for autism in our modern world of the
Internet, email, text messaging, and the 24/7 news cycle, is it not reasonable to assume
that at least one of the other 7 billion people in the world might have also heard of it
and communicated about it? It is certainly possible that a highly effective, innovative
treatment can be discovered by only one person or organization, but how long might
that treatment remain exclusive to the discoverer and completely unreplicated by
others? Many large, highly funded, and well-equipped laboratories around the world
are currently working on parallel projects in many fields of study, and when a cure
is found for any debilitating disorder or disease, it will be well publicized and many
others will rush to replicate it.
A clear lack of evidence or peer review. Claims that “studies are ongoing” or that
“preliminary results look good” are not sound bases for adopting a treatment. View
these phrases as a promise that has not yet been delivered. Even if one or two supporting
studies are provided, the evidence base may not be sufficient to take the chance of using
the treatment, especially if the studies provided have not been subjected to wide peer
review (e.g., published in a peer-reviewed professional journal, which, of course, is still
not a guarantee). Anything self-published or published solely in an opinion or editorial
format should be viewed with a high level of skepticism, as should any claims associated
with statements that traditional organizations and professionals have unfairly rejected
a treatment without seriously investigating it. If it has been rejected by a significant
number of professionals over a significant span of time, there is probably a good reason.
Evidence is based solely on testimonials or case studies. Have the personal testi-

monies in an infomercial ever inspired you to buy a product, and you then discovered
that the product was not as fantastic as was suggested? This is the danger of basing
treatment decisions solely on testimonials, although this is one level of evidence that
should be given consideration, among others. While the intent of the people making
the testimonials may not be to mislead, and although the treatment may have seemed
to be what improved things for some of the children or their family members, this is no
substitute for wide, systematic application and replication (hence the typical warning
“Results may vary”). Similarly, the sole use of one or more case studies to justify efficacy
and safety presents within each example a single person as evidence and does not take
into account the many human and environmental differences that can affect results.
Professional credentials do not match the expressed area of “expertise.” Seek

valid indications of experience, training, and credentials that fit closely with what is
being sold or promoted. For example, a warning signal warranting further investiga-
tion might be that an educator promoting a program for children with autism has a
degree and license for working with students who have mild learning disabilities. In
addition, look for areas of expertise and specialization within degrees or credentials.
For example, many consumers stop their evaluation when they see “MD” or “licensed
psychologist,” without checking to see the professional’s specific areas of training and
expertise. Behavior analysts, physicians, and psychologists can and do specialize in

specific areas of practice; for example, a Board-Certified Behavior Analyst who has
specialized in working with adults who have intellectual disabilities may not neces-
sarily have training and experience in working with children with autism. Likewise, it
is possible that a psychologist who gives advice on working with children with ASD
could actually be licensed in marriage and family counseling, though this would be a
clear violation of the ethical guidelines of his/her profession. Be aware that there are
a handful of professionals who continually “reinvent” themselves based on current
trends and treatment needs, and these professionals should be avoided at all costs.
No consumer references or examples of work are provided. Professionals should

either be able to provide a list of parents, guardians, conservators, or agencies who
have agreed to serve as references and tell others about how services were provided, or
they should be able to provide data-based case examples of treatment, for which prior
permission to disclose has been received and confidentiality is maintained. Inability
to provide either of these indicators should be viewed as a potential sign that a pro-
fessional may not be completely legitimate, especially when other warning signs are
present or requests for such information are met with surprise or offense. One alter-
native to these two types of information might be a curriculum vitae (CV) or resume
that clearly outlines professional activities, such as presentations at professional con-
ferences, articles published in peer-reviewed professional journals, and professional
service activities conducted with the population of relevance. However, information
in this and other sources should be verified by at least one other source (e.g., indepen-
dent verbal report or confirmation found on an independent Internet-based source).
Alternative and Emerging Treatments

Know the destination and current location. It is recommended that profession-
als understand the difference between treatments that are considered “alternative”
and those labeled “emerging.” The difference is in the evidence base. If we imagine
the EBP label as being the ultimate destination toward which a prospective treatment
should be heading, we can imagine an emerging treatment as a train that has left the
station on time and is so far making good time and progress traveling on the right train
line, but it has not yet gone far enough along that line that we can say within a reason-
able probability that it will actually arrive at the correct station on time. In many cases,
the “alternative train” has not yet left the station, at least that we can verify, nor is there
any reliable evidence of its true destination once it does leave the station. There may
be stories of a train moving full speed down the line, or even testimonials that the train
has already arrived at its destination, but in reality, it may not even be at the stage of
construction within which we can say that it is truly a “train,” much less that it is on its
way anywhere that we can objectively verify. Although in most cases it does not seem
very probable, the “alternative train” may be in fine working order and effectively mov-
ing passengers from one place to the next, but, due to a current lack of scientific evi-
dence, it has never actually arrived at the EBP station. Therefore, the evidence base for
alternative treatments is likely to embody one or more of the “proceed with caution”
warning signs discussed previously, while emerging treatments will, by definition, have
a limited but quality scientific evidence base. One should note, however, that an evi-
dence base that seems of sufficient quality today can be revealed as a complete sham
tomorrow (for examples, see Garfield, 1990, and Ratzan, 2010). This is why continual
review and replication across multiple researchers is so important, especially with the
current proliferation of treatments being suggested for use with people who have ASD
(see Figure 2.6 for a noncomprehensive list of emerging and alternative treatments).
Figure 2.6 Autism treatments that have been categorized by researchers as

emerging, alternative, and not recommended
Emerging Treatments Alternative Treatments Treatments Not Recommended
(Lofthouse, Hendren, Hurt,

Arnold, & Butter, 2012; (Levy & Hyman, 2005; (Lofthouse et al., 2012;
Rossignol, 2009†) Lofthouse, et al., 2012) Umbarger, 2007)
Acetylcholinesterase Inhibitors Allithiamine: N Auditory Integration Training*

Acupuncture Animal-Assisted Therapy*: P Dietary Interventions*
Alpha-2 Adrenergic Agonists Antibiotic Therapy: P/N Dolphin Assisted Therapy (a.k.a.,
Anti-Inflammatory Treatments* Antifungal Agents/Yeast-Free dolphin–human therapy)
Carnitine Diets*: N Facilitated Communication*
Exercise Antiviral Agents: N Faradic Skin Shock
Hyperbaric Oxygen Treatments* Atkins Diet*: N Heavy-Metal Chelation*
Immunomodulation Auditory Integration Training*: I Packing Therapy
Massage Therapy B6 and Magnesium: P/I Secretin
Melatonin* B12: N
Music Therapy Behavioral Optometry: N
Naltrexone Betaine: N
Oxytocin* Bethanechol: N
Tetrahydrobiopterin Bolles Sensory Learning Method: N
Vision Therapy* Calcium: N
Vitamin C* Carnosine: N/P
Chelation Therapy*: N
Colostrum: N
Craniosacral Manipulation: N/I
Cyproheptadine: N
Cysteine: N
D-Cycloserine: N/P
Daily Life Therapy: N
Deep Pressure Therapy: N
Digestive Enzymes: P
Dimethylgycine (DMG): I
Doman-Delacato Patterning: N
Facilitated Communication*: P/I
Fast ForWord: N
Feingold Diet: N
Flexyx Neuropathy System: N
Fluconazole: N
Folic Acid: N
Gentle Teaching: N
Giant Steps: N
Glutathione: N
Gluten-Free/Casein-Free Diets*: P/I
Homeopathy: N
Hyperbaric Oxygen Therapy*: N/P
Integrated Movement Therapy: N
Interactive Metronome: N
Intravenous Immunoglobulins
(IVIG): I
Irlen Method/Lenses: N
Ketogenic Diet*: N
(continued )
L-Glutamine: N
Lindamood-Bell Learning
Processes: N
Melatonin*: P/I
Miller Method: N
Movement/Dance Therapy: N
Neural Therapy: N
Neurofeedback: N
Omega-3 Fatty Acids/
Polyunsaturated Fatty Acid
(PUFA): N/P
Osteopathic Manipulation: N
Oxytocin Infusion*: N
Reduced L-Glutathione: N
Rhythmic Entrainment: N
Rolfing/Structural Integration: N
Secretin Treatments*: I
Selenium: N
Sensory Integration Therapy: N
Specific Carb Diet (SCD)*: N
Sporanox: N
St. John’s Wort: N
Transfer Factor: N
Tryptophan & Tyrosine: N
Urecholine: N
Vagal Nerve Stimulation: N
Vision Therapy*: N
Vitamin A: N
Vitamin C*: N
Vitamin E (alpha-tocopherol): N
Vivitrol: N
Watsu: N
Weighted Blankets/Vests: N
Zinc: N
* These treatments are dually listed within the table (e.g., within both emerging and alternative categories) because different researchers have
classified them differently. One hallmark of such treatments is the pervasive uncertainty about them across professionals. Therefore, it is
recommended that potential consumers consult various direct sources to gain as much information as possible.
† Treatments listed here are only those that Rossignol (2009) designated as grade A or grade B, indicating that these treatments were represented
by studies that used (a) from one to two randomized control trials (RCTs), (b) one systematic review, or (c) two nonrandomized controlled trials.
N = either no research or too few studies in peer-reviewed journals

P = either poor quality research or non-experimental research only, such as case studies
I = inconsistent, inconclusive, or ineffective results
Final Note: This figure does not represent a comprehensive list of treatments for ASD, nor is it a recommendation for the use of any treatment. Any
and all treatment should be selected and administered with the consent and oversight of a licensed, qualified professional, and any treatment
listed here should be considered with extreme caution, if at all.
Relevant areas of purview. An area of purview is a range within which one has
concern or authority to operate. Since recommending and implementing alterna-
tive treatments can involve a significant amount of uncertainty and risk, and since
that uncertainty and risk are often focused on a person from a potentially vulnerable
population (such as a child with ASD), this is absolutely not a relevant area of purview
for practicing professionals. Although a professional may have one or more family
members with ASD for whom he/she provides some type of alternative treatment,
this is a personal decision that should not impact professional practice. No matter
how strongly a professional may feel in regard to the effectiveness of an alternative
treatment, it should be remembered that a professional’s area of purview is to know
the current state of the relevant evidence base and to provide for individuals the most
effective and efficient research-based treatments that are available. The choice to
select and implement alternative treatments (within legal and ethical boundaries, of
course) falls squarely within the area of purview of parents, guardians, and conserva-
tors, for they assume the ultimate responsibility and risk for the livelihood of their
family members, potentially across their entire lifespans. In addition to this, other
points to remember include the following:
■ Even though the choice to use alternative treatments is solely within the purview
of legal guardians, professionals should remember that they can be held responsible for
failure to report anything that reasonably falls within the area of child abuse or neglect.
■ An emerging treatment is one without an extensive evidence base, and the deci-
sion to use such a treatment should therefore require informed consent of all legal
guardians, initial peer review, and ongoing review and monitoring. Initial review may
include a human rights board, institutional review board, multidisciplinary team, or
another body of professionals who must first approve use of the treatment. Once
approved, the professional may be required to periodically provide evidence of posi-
tive, measurable outcomes in order to continue using the treatment.
■ Although legal representatives of people with ASD may choose to use alterna-
tive treatments at home or in the community, professionals may or may not be legally
required to implement such treatments as part of their practice. For example, if a treat-
ment originates from a licensed medical professional or psychologist and is defined
as a related service within an approved IEP, members of the IEP team are required
by education law (Individuals with Disabilities Education Improvement Act, 2004) to
cooperate with application of that treatment. One important implication of this situ-
ation is that if inclusion of a treatment is going to be effectively challenged, IEP team
members should do so in the planning and program approval stage, and this implies
that professionals on the team must have a prior understanding of what constitutes an
alternative treatment to even be able to do so. Although the recommendation of and
decision to use alternative treatments for ASD does not fall into the purview of profes-
sional practice, professionals should have an extensive knowledge of such treatments,
including the state of the evidence base for each type (even if no evidence exists), to
help others with making informed treatment decisions.
Parent use and professional response. Christon, Mackintosh, and Myers (2010)
reported that more than 70% of the 248 parents of children with ASD who partici-
pated in their survey had at some point used an alternative treatment, and approxi-
mately half were currently using at least one alternative treatment with their child.
In a larger sample of participants (n = 3,173), Perrin et al. (2012) found that 28% of
parents had used alternative treatments for their children with ASD and were more
likely to seek out and use such treatments when disorders in addition to ASD were
present. Whatever the true proportion of parents who seek out and use alternative
treatments for ASD, the pressure for professionals to do likewise is immense and
growing. As suggested by the findings of Perrin et al. (2012), the intense need for
treatment created by the symptoms of ASD combined with other serious behavioral
and medical conditions seems to influence parents’ treatment decisions, as do other
factors such as (a) severity of disability, (b) the child’s acceptance of the treatment,
(c) marital status, and (d) parent educational level (Hall & Riccio, 2012). However,
it is also true that Bowker, D’Angelo, Hicks, and Wells (2011) found that parents
were most likely to stop using alternative treatments when they discovered a lack
of discernible, positive change in their child. The picture painted by these studies
seems to be one of parents’ intense need and the resulting intense desire to find what
will work in helping their children. Before being confronted with the parental desire
for alternative treatment approaches, Gupta (2010) recommended that professionals
begin with the following assumptions:
Parents tend to behave in ways that they believe are the most beneficial for their
■
children.
In our free and democratic society, parents have the right to seek multiple opin-
■
ions regarding treatment and to choose accordingly.

Professionals have a primary obligation to do the following for their clients/
■
students/patients: (a) avoid harm, and (b) promote that which is likely to be the
most helpful.
Once equipped with these assumptions, Gupta further suggested that profes-
sionals use PEARLS to build positive, nonjudgmental relationships with parents (also
see Barrier, Li, & Jensen, 2003):
P = partnership: Communicate that professionals and parents should work

together as a team for the ultimate benefit of the child, adult, or young adult.
E = empathy: Acknowledge parents’ feelings, especially in regard to frustration
resulting from a lack of effective intervention and the desire to find what works.
A = apology: Communicate that you recognize and regret the necessary but
often negative impact on families caused by treatment logistics, procedures,
delays, and so forth.
R = respect: Refrain from making judgments. Communicate what parents have
done and are doing well. Acknowledge the nature of the difficulties in areas
where parents are seeking assistance or feel that they may have failed.
L = legitimization: Professionals should understand that parents often have
good cause to react emotionally or experience depressed moods. Do this
verbally and also by reacting to anger or depression in kind, understanding
ways (e.g., listen to frustrations without commenting and, when appropri-
ate, use eye contact and a low voice tone to communicate understanding of
what has been said).
S = support: Use word and deed to communicate that you will provide ongoing
help to the family as long as parents wish to seek it from you. Support can
come in various forms, such as providing needed information and connect-
ing parents to needed resources.
Risk-Versus-Benefit Analysis
Before adopting a specific treatment for any individual, it is advisable to complete
a thorough risk-versus-benefit analysis. It should not be presumed that any treat-
ment is safe, efficient, and lacking in unwanted side effects for all individuals, espe-
cially treatments without a sound and extensive evidence base. The introduction of
an intervention procedure into the mix of varying environmental variables, personal
characteristics of the individual, resources, and levels of professional training and

experience can produce risks to positive growth and development, even with the use of
seemingly benign treatments.
Although there is no universally accepted way of performing such an analysis
currently in widespread use, it is prudent to assess at least two main areas of potential
concern: (1) factors that place individuals at increased risk for intensified symptoms
and poorer outcomes, and (2) factors that increase the likelihood of reduced symp-
toms and improved outcomes. By directly and positively impacting identified factors
that increase the likelihood of intensified symptoms and poorer outcomes, certain
treatments can be said to greatly reduce risk for an individual. In addition, by increas-
ing factors that have been found to reduce symptoms and improve outcomes, certain
treatments can be said to greatly increase benefits for an individual. Once the risk and
benefit factors most pertinent to an individual have been identified within a search of
the peer-reviewed, professional literature, members of a multidisciplinary team can
catalog this information and weigh it in terms of potential impact. Figure 2.7 provides
one example of completing this type of process using a form-driven method.
Assessing the Quality of a Research Base

Although the generalized definition of EBP provided earlier in this chapter can serve
as a beginning guide for practitioners who wish to begin exploring the concept more
fully, it is not meant to be a precise operational definition for specifically determining
which collections of research-based interventions should receive the label “EBP.” It
is important to point out that multiple directions have been and are being pursued in
the formation of the evaluative EBP concept by researchers, and there is currently no
single, universally accepted definition for designating an intervention as an EBP in the
field of disability studies. (For a detailed discussion of varying definitions of EBP see
Reed & Reed, 2008.) Competition and collaboration in the formation and testing of
new ideas is a necessary part of increasing knowledge in any field of study, but it can
be confusing in trying to determine suitable guidelines for our own operation as such
a process of discovery plays out across various approaches and researchers. Although
it is true that this varying landscape of ideas and approaches can make the formation
of a practical understanding seem overly complex, it is also true that the information
becomes more manageable when one observes the commonalities across evaluation
approaches, which are in reality quite basic. Determining the quality of an aggregation
of research studies (a research base) in order for it to potentially attain the designa-
tion “EBP” has often been approached in terms of the intersection of the strength
and quality of individual studies, along with the demonstrated replication of expected
effects (see Figure 2.8 for examples). Simply put, the quality of an entire research base
is built from the collective quality of the individual studies within that base. Specific
approaches within this overarching concept may vary, but one or more of the three
evaluation components (strength, quality, and replication) tend to be present.
As can be inferred from the examples within Figure 2.8, interpreting strength
has tended to involve examining the type of research design that is used (e.g., levels of
external evidence, as presented in Figure 2.3), while evaluations of study quality tend
to look at specific components or conventions within research reports (e.g., inclusion
Figure 2.7 Example of assessing the risks and benefits of a specific treatment for
an individual with ASD
INDIVIDUAL: __________________________________________________ DATE OF ASSESSMENT: __________________________

BRIEF DESCRIPTION OF TREATMENT: _________________________________________________________________________________
TEAM MEMBERS PRESENT: __________________________________________________________________________________________
THE TREATMENT’S
POTENTIAL LEVEL OF
KNOWN RISK FACTORS SOURCE POSITIVE IMPACT
LOW MEDIUM HIGH
1 2 3 4 5
1. Differences in sensory processing 1
2. Need for sameness 1
3. Impaired cognitive ability 1
4. Social functioning 1,2
5. Communicative functioning 2
6. Repetitive behaviors 2
7.
8.
9.
10.
0 1 1 1 3
SUBTOTAL FOR EACH COLUMN
DESIRED BENEFITS
1. Access to activities, materials, and places 3

2. Support needs (behavioral, communication, sensory) 4
3. Safety and health (general quality of life) 4
4. Social validity (cost, time, efficiency, outcomes similar to those of peers) 5
5. Maintaining the least intrusiveness/restrictiveness 3
6. Treatment acceptability (teacher experience, possible side effects, severity of 5
autism)
7.
8.
9.
10.
0 1 2 4 5
FINAL TOTAL FOR EACH COLUMN
Shade the number of blocks that equals the final total for each column.
List sources here:

1. Duerden, Oatley, Mak-Fan, McGrath, Taylor, Szatmari, & Roberts (2012)
2. Kanne & Mazurek (2011)
3. Mayton, Carter, Zhang, & Wheeler (in press)
4. Verdugo, Navas, Gomez, & Schalock (2012)
5. Carter (2010)
6.
7.
8.
RISKY BENEFICIAL
Should any risks or benefits be weighted more heavily in this analysis? (circle one): YES / NO If YES, then list and describe risks/benefits:
RISK OR BENEFIT REASON FOR WEIGHTING MORE HEAVILY IMPACT SCORE = 4 OR 5?*
Benefit 3: Safety and health Maintaining the health and safety of the individual is paramount, for
he sometimes endangers himself through inattentiveness to dangerous YES / NO
situations, such as crossing the street without looking both ways.
Benefit 5: Maintaining the least Past treatments have unnecessarily restricted access to the school
intrusiveness/restrictiveness environments that most other children enjoy. YES / NO
Risk 5: Communicative Inability to communicate wants and needs has been a precursor to
functioning challenging behavior in the past. YES / NO
*If the impact score is not 4 or more, other planning should take place to directly address this critical need.
of measures of treatment integrity and adequate descriptions of participant character-

istics). Replication has not only been examined within individual studies (e.g., across
students, settings, or types of tasks), but it has also been applied across more global
features within a research base, such as numbers of researchers who are contribut-
ing to the research base, geographic locations in which studies are conducted, and
Figure 2.8 Example commonalities in a sample of EBP determinate criteria.
Source Strength Quality Replication
Gersten, Fuchs, The authors state “Adequate interscorer “Multiple measures are used
Compton, Coyne, that the impact of the agreement is to provide balance between
Greenwood, & research design on documented” (p. 160). measures closely aligned with
Innocenti (2005) the size of the effect the intervention and
should be emphasized measures of generalized
in determining when an performance” (p.158).
intervention is EBP.
Horner, Carr, The authors use the It is stated that “External validity of results
Halle, McGee, single-subject reversal participants and from single-subject research
Odom, & Wolery design as an example settings should be is enhanced through
(2005) of establishing thoroughly described, to replication of the effects
adequate experimental the extent that they can across different participants,
control within a study. be closely approximated different conditions, and/
in the application of the or different measures of the
intervention. dependent variable” (p. 171).
Reichow, Criteria were provided “Procedural fidelity or “An established EBP is a

Volkmar, & for classifying group treatment fidelity was treatment shown to be
Cicchetti (2008) and single-subject continuously assessed effective across multiple
research designs as across participants, methodologically sound
strong, adequate, or conditions, and studies conducted by at least
weak, in terms of how implementers, and if two independent research
well each presented applicable, had groups” (p. 1315).
evidence of soundness. measurement statistics
at or greater than .80”
(p. 1313).
Byiers, Reichle, & The author discusses “The first quality of ideal “An intervention cannot be
Symons (2012) various single-subject baseline data is considered evidence based
designs in terms of the stability, meaning that following the results of a
strength of the evidence they display limited single study” (p. 400).
presented by each. variability” (p. 398).
participants across (as opposed to within) studies. Understanding this provides a good
foundation for the study of EBPs, but what does all of it mean for practicing pro-
fessionals who seem to be expected to apply these concepts? In reality, it is unlikely
that most professionals currently engaging in applied intervention practice will have
the time and resources needed to conduct their own comprehensive quality investiga-
tions of potentially large collections of ASD intervention research, and it is reason-
ably questionable whether doing so even falls into the range of expectations within
their given roles. So, how do professionals practically apply these ideas to their every-
day work with people who have an ASD? Many journals, scholarly books, websites,
and other sources of information written for practitioners have tried to answer these
tough questions, but the growing number of voices and methods out there can pro-
pose vastly different and sometimes contradictory approaches. The following section
attempts to redefine the basic premises of this discussion by (a) suggesting appropriate
roles for types of professionals operating within the EBP process, from determination
to utilization; (b) explaining the difference between the formation and utilization of
EBP information regarding a research base; and (c) providing a list of straightforward,
useful guidelines for practitioners.
Utilizing an EBP Research Base

Appropriate roles. Some of the confusion, dismay, and paralysis for practitioners
who wish to search out and use EBPs comes from the expectation (whether directly
communicated to them or perceived through misunderstanding) that it is their
responsibility to understand and use potentially complex methods for evaluating an
entire research base prior to using a related intervention. Sometimes it is the case that
a complex evaluation method is presented specifically for practitioners to use, or there
may be confusion created as to the appropriate audience for the EBP guidance that is
provided (“This article says that it is meant for me [a practitioner], but it seems to be
written for a researcher!”), especially when the content is highly specialized (e.g., in
the area of research design) and there is a mainly theoretical focus of the application.
However, no matter the origin of the confusion, it is proposed here that “in addition
to increasing scrutiny at the level of the consumer [or, practitioner], we must also:
(a) increase scrutiny at the researcher and peer-review levels, and (b) vary the extent
and type of scrutiny at each of these levels in accordance with the roles and respon-
sibilities of those who work within them” (Mayton, Wheeler, Menendez, & Zhang,
2010, p. 550). In other words, different types of professionals should have different
roles in the EBP process, from determination of the designation EBP for a research
base, to the utilization of that research base by practitioners. It should be the respon-
sibility of researchers to apply their specialized and highly technical knowledge in
areas such as research design, internal and external validity and reliability, and scien-
tific replication of effects to move from the formal evaluation of individual studies (or
applied interventions) to the formal evaluation of an entire research base (forming an
EBP determination). It should be the responsibility of the practitioner to apply his/
her knowledge of all the topics presented in this chapter, as follows:
Professional skepticism (“Where’s the proof ?”)

■
Levels of evidence (“How strong is the proof ?”)

■
How to proceed with caution (“Are any warning signs present?”)

■
Alternative and emerging treatments (“How potentially safe is the treatment?”)

■
Risk versus benefit for individuals (“How might the effects of the treatment be
■
different for this person with ASD?”)
This knowledge should be applied in an informal evaluation of a research base

that takes up where the researchers left off. This type of evaluation usually involves
the examination of extensive reviews of literature, meta-analyses, and organizational
databases and clearinghouses, which all provide research base evaluations (see the
end of this chapter for a list of print and Internet resources to consult). Although
researchers have worked to produce a determination, they too are mortal (and
hence fallible), and it is therefore up to the practitioner to perform “quality con-

trol” regarding this information by applying his/her knowledge in the manner previ-
ously described. Practitioners might think of their role as the “distributor” who must
make sure that the product (the intervention labeled as EBP) from the manufacturer
(the researcher) is of sufficient quality before it can be provided to the consumer
(the person with ASD).
Evaluating individual studies. Once it has been determined through informal

evaluation that the research base is of sufficient quality, it is then the role of the prac-
titioner to evaluate the quality of individual studies within that base, in the context of
determining whether these studies may or may not be used to guide the provision of
specific interventions for specific people with ASD (see Figure 2.9 for a visual depict-
ing the differentiation of roles among two types of professionals). The rationale for
this can be illustrated using the following apple barrel analogy: Though the inspector
has pronounced the entire barrel of apples (the research base comprised of individual
studies) to be of sufficient quality for consumption, that does not mean that an indi-
vidual apple from that barrel should be eaten by a customer without first inspect-
ing it. Minor or major flaws may have been missed due to error, hidden from view,
or deemed acceptable for all individuals, although individual preferences may dictate
otherwise. It is not recommended for anyone to blindly eat an apple without at least
Figure 2.9 Researcher versus practitioner roles in forming and utilizing an EBP
research base
RESEARCHERS PRACTITIONERS
Forming an EBP Determination Utilization of an EBP

VS
Regarding a Research Base Research Base
Formal evaluation of Informal evaluation

individual studies of research base
Formal evaluation of Formal evaluation of

research base individual studies
looking for surface blemishes or rotten spots, and it would be ideal to first cut into it
and know about any interior problems with quality, instead of discovering them by
simply taking a bite.
This type of analysis should be approached with more than a rudimentary knowl-
edge of the expected conventions of research (see Reichow, Volkmar, & Cicchetti,
2008, for an excellent rubric of quality indicators for both group and single-subject
research), but it is recommended for practitioners that evaluation of study “quality”
mainly focus on the fit of relevant features of the intervention (as described in a study)
with characteristics of the learner, the learning environment, and the professional
(Torres, Farley, & Cook, 2012). Using this approach, the following questions and steps
are recommended for practitioners to perform in the quality evaluation of an inter-
vention as described within a specific study. Within each of the three areas, impor-
tant connections are indicated among associated learning topics from other courses/
sources.
The learner: Do the most relevant learner characteristics and needs closely match those of the
participants in the study? Ideally, the study should describe levels of functioning in all
areas that directly relate to the need for the intervention (e.g., some formal measure of
participants’ current social functioning should be provided if the intervention is one
meant to increase social functioning), as well as characteristics such as age, gender,
specific disability category (e.g., the provision of more meaningful diagnostic informa-
tion than just the descriptor “autism”), level of intellectual functioning (especially if
atypical), a brief learning history describing participants’ need for the intervention,
and any problematic differences that could have interfered with the implementation
or effectiveness of the intervention (e.g., particularly severe disability symptomol-
ogy, an attention deficit, or behavior disorder). In comparing study participants and
the learner, features such as the need for intervention, specific disability category and
severity, and level of cognitive functioning must all have an identical match. There
can be an allowable amount of leeway in matching some characteristics such as years
of age, though not so much difference that the intervention is not age appropriate or
is a poor match with the current developmental level of the learner. Other character-
istics, such as gender, may or may not require that a match be confirmed, although,
depending on the intended features and focus of the intervention (e.g., providing sex
education to adolescent males with Asperger syndrome), ensuring such a match could
be critical for the correct application and ultimate success of the intervention. The
goal is to match all critical features and as many of the remaining features as is pos-
sible. Altering the essential, active features of an intervention to make a better fit with
the learner may move the intervention into uncharted, non-EBP territory, though
altering nonessential aspects to better fit learner preferences is a recommended prac-
tice (e.g., use of a reinforcer as in the study procedure, but a reinforcer that is better
suited to the individual learner). Studies that do not adequately describe participants
and the participant selection process (to demonstrate that certain types of participants
were purposefully chosen for testing with the specialized intervention) may have to
be rejected because it is unlikely that an adequate match with a specific learner can
be made.
Steps to follow:
1. Conduct an informal evaluation of the entire research base associated with the
intervention of interest by consulting the resources previously mentioned (also see
“Resources to Consult” at the end of the chapter). Note that you may have to research
additional resources beyond the examples provided in order to get the information
needed to complete this step. Complete all items in the “Research Base Evaluation”
section of Figure 2.10, “Intervention Evaluation Worksheet.”
2. Find an intervention study of interest. Search your favorite article data-
bases (e.g., Education Research Complete, ERIC, MEDLINE, PsyARTICLES,
Social Work Abstracts, or a database that can search multiple databases, such as
EbscoHost), making sure to select search options that will (a) guide you toward
professional journals that are peer reviewed, (b) search within a time period that
does not extend back more than 10 years, and (c) give access to full-text articles
as opposed to only abstracts. (Although abstracts should be sought out in addition
to full-text articles, doing so is for the purpose of trying to later locate full-text
articles of potential interest, not to try to “wing it” by reading only the abstract.) Use
search terms that will be likely to return at least some studies that are experimental
investigations of specific interventions for specific people (rather than, for instance,
reviews of literature that do not recruit participants, systematically implement an
intervention, gather and analyze data, and make conclusions about the intervention’s
effectiveness), such as indicated by the following basic search term formula: the
most common name of the intervention (this is derived from your informal evalu-
ation of the research base, which may have contained multiple terms for the same
intervention but probably indicated that one or two terms are used by researchers
more often than others), the age category of the target learner (e.g., “preschool chil-
dren” or “young children”), and, the primary disability category of the target learner
(e.g., “pervasive developmental disorder not otherwise specified” or “PDD-NOS”).
Keep in mind that eliminating or broadening search terms will increase the number
of articles that you find, but it will also increase the number of inapplicable articles
that you find (and have to sort through). Conversely, adding or narrowing search
terms will return fewer “hits,” but the articles you find will tend to be more useful
and applicable, up to the point that nothing at all can be found. Database searching
is an art that requires much trial and error, though it should be trial and error guided
by information you have discovered from the informal evaluation of the research
base (such as standard terms, professional journals and authors that tend to be asso-
ciated with the general type of intervention, and institutions or programs that are
known for their use of the intervention approach). Also keep in mind differences in
how you interpret “relevance” pertaining to your search results and how database
search engines interpret it. You simply want access to the articles that best fit your
search terms, but most database search engines tend to include first in their search
results lists the articles that are most often cited by other researchers. This means
that patience and persistence in searching through multiple pages of search results
can sometimes return a gem far down the list, where you have been told that the
results are less “relevant.”
Figure 2.10 Intervention evaluation worksheet
Name of Intervention:_____________________________________________________
NOTE: Do not attempt to use this form without first reading the guidance and explanation in Chapter 2, as well as consult-
ing the list of resources provided at the end of the chapter, to be used for the completion of a research base evaluation.
I. Research Base Evaluation

Check one per item: NO YES
1. At least one extensive review of related literature indicates that the research
base for this intervention is of sufficient quality to be classified as an EBP.
2. At least one meta-analysis indicates that the research base for this interven-
tion is of sufficient quality to be classified as an EBP.
3. More than one organization or clearinghouse indicates that the research

base for this intervention is of sufficient quality to be classified as an EBP.
4. No current mention (e.g., written within the past two to three years) was found
within these sources that the treatment is classified as “alternative” or “emerging.”
Total for each column =
unacceptable = total of 1 or 2 responses in the YES column

acceptable = total of 3 responses in the YES column
high quality = total of 4 responses in the YES column
II. Study Evaluation

1. Participant characteristics and needs that directly relate to the need for the
intervention are adequately described and match those of the target learner.
2. All other, less critical participant characteristics and needs also match those
of the target learner.
3. Features of the environment (setting) that are required for the complete/
correct implementation of the intervention are adequately described and match
those of the target learner.
4. All other, less critical features of the environment (setting) also match those
of the target learner.
5. The implementation procedures are described in enough detail that they can
be carried out systematically and with sufficient integrity.
6. The described intervention can be practically and efficiently translated to

real-world practice within an authentic environment (it has adequate “portability”).
unacceptable = NO for any one of the following items: 1, 3, 5, 6

acceptable = YES for items 1, 3, 5, and 6 (2 and 4 are NO)
high quality = total of 6 responses in the YES column
(continued )
III. Risk-Versus-Benefit Analysis (see separate form)

1. All risk ratings were in the 3 to 5 range.
2. All benefit ratings were in the 3 to 5 range.
3. No more than one rating was a 2 or below.
4. All risks and benefits deemed as critical for the individual (i.e., those
weighted more heavily) were rated as a 4 or 5.
unacceptable = NO for any one of the following items: 1, 4, or a total of 2 responses in the YES column
acceptable = a total of 3 responses in the YES column (including items 1 and 4)
highly acceptable = total of 4 in the YES column
IV. Final Determination (transfer ratings from sections I–III)

Quality of Research Base (check one): unacceptable acceptable high quality
Quality of Study (check one): unacceptable acceptable high quality
Risk-Versus-Benefit Analysis (check one): unacceptable acceptable highly acceptable
Final Determination:
■ 2 or 3 unacceptable ratings = do not use the treatment
■ 1 unacceptable rating = further, more intensive analysis and evidence are required to proceed;
unless this is possible/feasible, do not use the treatment
■ 3 acceptable ratings = use with caution (increased permissions and monitoring)
■ all other combinations = use as described/indicated in study, unless/until contraindicated by poor
or negative results, unwanted side effects, and/or poor treatment acceptability among stakeholders
3. After reading through the entire article that you have selected, carefully reread
the description of participants.
4. Apply the evaluation criteria and examples described in this section (above),
and complete items 1 and 2 of the “Study Evaluation” section of the Intervention
Evaluation Worksheet.
Learning connections to make:

1. Instructional skills: interpreting the implications of assessment data, planning
for differentiated instruction that best fits a specific learner, writing and assessing
goals and objectives for learning
2. Knowledge of sound research design: external validity, methods for the identifi-
cation and selection of participants, population sampling
The learning environment/setting: Are pertinent features of the learning environment con-
ducive to implementing the intervention? Ideally, the study should describe features of
the setting that can impact the implementation of the intervention in both direct and
indirect ways. Setting features that should be fully described and have a direct impact
on implementation include required intervention materials, the number and type of
interventionists, and any intentional cues or prompts imbedded in the environment,
such as the ringing of the school’s bell or an arrangement of desks that facilitates social
interaction among students. Setting features that should be fully described and can
have an indirect impact on implementation include the presence or absence of people
or objects not directly involved in the study (such as an implementation setting that
is a workshop full of other adult individuals with ASD) and the use of a physical envi-
ronment that (a) makes implementation of the study more convenient for research-
ers; ( b) is not specifically required for implementing the intervention; and (c) makes
the study setting less like the setting where the intervention is expected to be used
(e.g., a peer-mediated intervention meant to be used anywhere in a school is imple-
mented in a treatment room with the participant, a teacher, and two student peers who
serve as mediators). As with the characteristics and needs of the learner, the goal here
is to closely match the most relevant features of the learner’s environment with those
described in a study in order to increase the potential for similar outcomes for the
learner. Also, as with the characteristics and needs of the learner, altering the essential,
active features of the intervention setting as described in a study may move the inter-
vention into uncharted, non-EBP territory, although altering nonessential aspects of
the setting to better fit learner preferences can be allowable if such alterations have low
or no potential to impact intervention outcomes. Unfortunately, studies that do not
adequately describe essential features of the setting may have to be rejected because it
is unlikely that an adequate match with a specific learning environment can be made.
Steps to follow:
1. Carefully reread the description of setting as described in the study.
and complete items 3 and 4 of the “Study Evaluation” section of the Intervention

1. Instructional skills: planning for the arrangement of instructional variables that
will increase the probability of occurrence of desired learning and performance
2. Knowledge of sound research design: external validity, treatment integrity/fidel-
ity, experimental controls, extraneous environmental variables (especially reactivity),
adequately defining independent variables
The professional: Does the proposed implementer possess the necessary training and experience
to carry out the intervention, and does he/she have parental and administrative approval and
support to do so? Ideally, the study should describe the implementation procedure with
enough detail that it can be systematically carried out by the practitioner with suffi-
cient integrity. Specific intervention techniques, required interventionist skills, backup
procedures to use if initial procedures fail, data collection procedures, and all neces-
sary personnel support and materials should be included in this description, with pic-
torial representations or completed examples when appropriate and necessary. Highly
desirable are descriptions of any method used to assess data reliability and treatment
integrity/fidelity, with accompanying results reported across all experimental condi-
tions and interventionists. The first goal here is to assess the completeness and clar-
ity of the procedural description in order to determine the fit between the specific
requirements of procedural implementation and the skills, training, and experience of
the practitioner/intended implementer. The second goal is to assess the portability of
the intervention, or the ease with which it can be practically and efficiently translated
(in terms of effort, cost, complexity, and applicability) to real-world practice within
an authentic environment, such as a classroom or school (Wheeler & Mayton, 2013).
The final goal is to perform a risk-versus-benefit analysis (as previously described)
regarding the potential applicability to and effects on the unique learner, with a special
emphasis on social validity and treatment acceptability (see content and citations on
these two topics presented within Figure 2.7), as each applies to the individual, his/
her family, and other relevant professionals (such as administrators). Such an analysis
should incorporate professional literature beyond the study in question that informs
the investigation of likely risks and benefits when considering the behavior and learn-
ing characteristics of the individual (e.g., an analysis for an individual prone to self-
injury should be informed from the professional literature of likely risks and benefits
of treatment for this disorder, as well as known issues from the learner’s behavior
and learning history). By altering any essential, active features of the intervention as
described in a study, a practitioner is in effect conducting a separate study of his/her
own, rather than applying an EBP. Interventions within studies that are not adequately
described or that present critical portability issues may have to be rejected, especially
if resolving these problems necessitates that substantial changes or additions be made
to the intervention procedure.
Steps to follow:
1. Carefully reread the procedure for implementing the intervention as described
in the study.
and complete items 5 and 6 in the “Study Evaluation” section of the Intervention
3. Complete a risk-versus-benefit analysis, as described in this chapter (also see
Figure 2.7).
4. Complete the “Risk-Versus-Benefit Analysis” section of the Intervention
5. Complete the “Final Determination” section of the Intervention Evaluation
Worksheet to assist with making the decision whether to adopt the intervention for
the target learner.

1. Instructional skills: designing instructional approaches to be implemented across
the stages of learning, systematic presentation of learning, formative and summative
performance monitoring, data-based decision making, promoting and assessing main-
tenance and generalization of skills
2. Knowledge of sound research design: internal validity, experimental controls,
valid and reliable measurement of independent variables, treatment integrity/fidel-
ity of independent variables, social validity, treatment acceptability, measurement and
quantification of the dependent variable, determining the significance (statistical and/
or social) or effect size of an experimental effect

This chapter’s segment on exemplary programs and practices highlights the work of
the Ohio Center for Autism and Low Incidence (OCALI), a nonprofit information
clearinghouse that provides training, technical assistance, resources, and consulta-
tion in evidence-based practices for professionals and families of people with ASD.
Among other free services, OCALI provides online training modules for families to
learn more about implementing EBP strategies. For more information, consult their
website at: www.ocali.org/center/autism.
Chapter Summary
The purpose of this chapter was to serve as the beginning of your approach to under-
standing and applying evidence-based practices (EBPs) to the education and treat-
ment of people with ASD. The rationale for why professionals should discover and use
EBPs for people with ASD was explored across consumer, professional, and historical
perspectives, and the guidelines and concepts for determining what constitutes suf-
ficient evidence were provided, including how to use critical reflection within col-
laborative relationships as well as how to display a healthy skepticism in conducting
your professional practice. Determining the strength of existing levels of evidence
was discussed, and information was provided on how to think like a scientist when
approaching the identification and application of specific treatments.
The final segment of the chapter explored practical methods for making treat-
ment decisions, including warning signs indicating when to “proceed with caution”
and information on what constitutes “alternative” and “emerging” treatments for ASD.
How to conduct a risk-versus-benefit analysis of possible intervention effects for an
individual was demonstrated, and the roles of two types of professionals who operate
within the EBP process were described. Finally, practitioners were instructed in how
to define and assess quality, both of an entire research base and of individual studies.
One of the main goals of this chapter was to provide you with an introduc-
tion to the understanding and application of the concept of EBP in regard to the
education and treatment of people with autism. Also provided was a practical system
for evaluating specific interventions as EBPs, so that they may be applied or rejected
within your professional practice.
Ac t ivi t i e s t o E x t e n d Y o u r L e a r n i n g
1. Look up the ethical principles of one or more of the professional organizations in

your field. Catalog and categorize the principles that (a) directly deal with EBP, and
(b) those that may not mention the term but are related in the ideas that they promote.
Also catalog any principles that deal with training requirements and continuing educa-
tion for professionals. Report back to the class with your findings.
2. Rewrite Applied Vignette 2.3 using Ms. Prudent as the main character, and outline
a scenario in which she applies the five principles of the scientific method from this
chapter to select and implement an intervention for the same two students.
3. Conduct an Internet search to find websites about ASD treatment that reflect one or
more of the “proceed with caution” warning signs found in this chapter.
4. Use the information in Figure 2.7 to write up a risk-versus-benefit analysis regarding
the application of a specific intervention for an individual with ASD who is real (be
careful to maintain confidentiality) or described in a case study.
5. Complete an entire evaluation of an intervention in the manner described in the later
part of this chapter, using a real person with ASD or a case study description.
Websites
Best Evidence Encyclopedia National Secondary Transition Technical
www.bestevidence.org Assistance Center ( NSTTAC)
www.nsttac.org
National Autism Center
www.nationalautismcenter.org What Works Clearinghouse
http://ies.ed.gov/ncee/wwc
National Professional Development Center
( NPDC) on Autism Spectrum Disorders
http://autismpdc.fpg.unc.edu
Free e-Books
The National Autism Center’s publication Evidence-Based Practice and Autism in the Schools can be
retrieved from www.nationalautismcenter.org/pdf/NAC%20Ed%20Manual_FINAL.pdf
The National Autism Center’s publication A Parent’s Guide to Evidence-Based Practice and Autism can
be retrieved from www.nationalautismcenter.org/pdf/nac_parent_manual.pdf
Example Evidence-Based Reviews of the Literature

Mayton, M. R., Wheeler, J. J., Menendez, A. L., & Zhang, J. (2010). An analysis of evidence-based
practices in the education and treatment of learners with autism spectrum disorders. Education
and Training in Autism and Developmental Disabilities, 45, 539–551.
Odom, S. L., Klingenberg, L. C., Rogers, S. J., & Hatton, D. D. (2010). Evidence-based practices in
interventions for children and youth with autism spectrum disorders. Preventing School Failure,
54(4), 275–282.
Reichow, B., & Volkmar, F. R. (2010). Social skills interventions for individuals with autism: Evaluation
for evidence-based practices within a best evidence synthesis framework. Journal of Autism and
Developmental Disorders, 40, 149–166.
Siegel, M., & Beaulieu, A. A. (2012). Psychotropic medications in children with autism spectrum
disorders: A systematic review and synthesis for evidence-based practice. Journal of Autism and
Example Meta-Analyses
Ganz, J. B., Vollrath, T. L. E., Heath, A. K., Parker, R. I., Rispoli, M. J., & Duran, J. B. (2012). A meta-
analysis of single case research studies on aided augmentative and alternative communication
systems with individuals with autism spectrum disorders. Journal of Autism and Developmental
Disorders, 42, 60–74.
Reichow, B. (2012). Overview of meta-analyses on early intensive behavioral intervention for young
children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42,
512–520.
Uljarevic, M., & Hamilton, A. (2013). Recognition of emotions in autism: A formal meta-analysis.
Journal of Autism and Developmental Disorders, 43, 1517–1526.
Wang, S., Parrila, R., & Cui, Y. (2013). Meta-analysis of social skills interventions of single-case
research for individuals with autism spectrum disorders: Results from three-level HLM.
3
chapter
Assessment and Early

Intervention

■ Describe the early symptoms and characteristics associated with autism spectrum disorders (ASD).
■ Understand the various methods and practices used in the screening and assessment of children with
ASD.
■ Describe the importance of linking assessment results with the design of individualized intervention
plans.
72
c h a p t e r t h r e e / Assessment and Early Intervention 73
Chapter 3 Mind Map

Autism
The Classification of Autism Asperger’s Syndrome
Characteristics &
How the Evaluation Process Unfolds Early Signs of ASD PDD-NOS
Multidisciplinary Assessment Proposed Changes in Classification
Parent & Family Needs Identification & Developmental Screening
Functional Behavior Assessment Behavioral Assessment Early Intervention
Level II Screening & Diagnostic Assessment of Autism
Extent of Services & Supports Under Early Intervention Linking Assessment to Early Intervention Assessment Autism Diagnostic Interview-Revised
Instruments Autism Behavior Checklist
Autism Rating Scale
Support Children & Families Through the Assessment Process & Beyond
Characteristics and Early Signs of ASD

Often families of children with ASD will share their experiences of how they had con-
cerns about their child’s early development. Some parents may even describe how their
child’s behavior differed dramatically from his/her same-aged peers. You might hear
them say how their child preferred to play alone; that the child didn’t enjoy joint activi-
ties, such as playing or interacting with peers or with parents; that he/she even dis-
played some more divergent behaviors, such as hand flapping or body rocking; and/or
the child engaged in perseveration about certain objects or had an insistence on rou-
tines. These and similar concerns are often expressed by parents for the first time dur-
ing check-ups to the family’s pediatrician. Concerns shared by parents may center on
their child’s lack of communication, unusual behavior or mannerisms, and limited dis-
plays of affection. These behavioral traits are consistent with the diagnosis of ASD.
Children with ASD demonstrate behaviors and characteristics that fall outside
those of typical development. They experience what has been termed splintered or
uneven development. This means that the child excels in some developmental domains,
but falls below age levels in others. Most often for children with ASD, the areas of
language, communication, and social interpersonal skills fall below age-level expecta-
tions. Some of the behaviors exhibited include a lack of social reciprocity, appearing
to be aloof and distant, having little or no joint attention in sharing an activity with
someone else, avoiding eye contact, and only making attempts at communication to
obtain their needs. Consider that typically developing children first engage in joint
attention between the ages of 10 to 12 months by following a cue provided by a parent
or caregiver. By approximately 12 to 14 months, the child will initiate by pointing to
a desired object with words or an utterance, and by 16 months a typically developing
toddler will point in a purposeful manner at an object of interest with the intention
of sharing this wonderful experience with someone; this is termed “protodeclarative
pointing” ( Johnson & Myers, 2007). See Figure 3.1 to better understand an example
of how typical child development ensues across critical domains.
Approximately 25 to 30% of the children that are diagnosed with ASD appear
to be developing typically during their infancy and early childhood years. They
even develop language, but unfortunately regress and begin to lose their language
and ultimately stop speaking and even lose the use of gestural communication, social
74 S e c t io n I I / Early Childhood
Figure 3.1 Example of typical child development across interrelated critical domains
• Attend to • Points to
primary desired object
caregivers’ 12–14 months
interactions
Language Communication
Social
Interpersonal Interest Level
Skills
• Demonstrate
• Joint attention a relatively
by 10–12 broad array
months of interests
interpersonal skills, and diminished eye contact (Johnson & Myers, 2007). When these
difficulties persist, many parents obviously become alarmed and first bring these con-
cerns to the attention of their pediatricians. For purposes of review, the signs of which
parents and caregivers should be aware are:
Delays in the development of language

■
Difficulty in establishing relationships

■
Narrow and preservative interests

■
Inability to share
■
Lack of eye contact

■
Inability to engage in joint attention

■
Lack of imaginative play

■
Obsession with objects

■
Unusual responses to sensory stimuli

■
See Figure 3.2 as an illustration of how developmental domains are affected for
a child diagnosed with ASD.
Recent Changes in the Classification of ASD

The recently published Diagnostic and Statistical Manual (DSM-V) included changes to
the criteria used for diagnosing autism spectrum disorders. The recent change recog-
nizes the single category of ASD, rather than the previously listed five disorders, which
included: classic autism, Asperger’s syndrome, pervasive developmental disorder not
Figure 3.2 Example of development across interrelated critical domains for a child
with ASD
• Limited social reciprocity • Limited or no

with others communication
Language Communication
Social
Interpersonal Interest Level
• Little or no joint Skills • Narrow perspective
attention of interests
• Inability to share • Unusual responses
• Lack of eye contact to sensory stimuli
• Lack of imaginative
play
• Obsession with objects
otherwise specified, Rett’s syndrome, and childhood disintegrative disorder. In other

words, these will no longer be considered separate diagnoses. There has been con-
cern expressed on the part of some parents and professionals about the reclassification
system and how it could diminish services for some individuals who were previously
recognized with Asperger’s syndrome, given the new classification of a single diag-
nosis of ASD. As with any change, there will be time needed to adjust to the nuances
of the new diagnostic criteria. Previously, the diagnostic criteria included deficits in
three core areas: language delays, social skill deficits, and stereotypical behaviors. The
revised criteria include two core areas that include communication and social skill
deficits and fixed or repetitive behaviors (APA, 2013).
Developmental Screening
Developmental screening is generally used as a method of surveillance aimed at deter-
mining the health and well being of the developing infant or toddler and is designed
to alert physicians as to the presence of developmental delays or more specific condi-
tions, such as autism. Should a child display characteristics consistent with autism, a
more comprehensive evaluation is warranted. Screening is conducted as part of well-
child visits for all infants and toddlers and includes the use of developmental screening
instruments that are broad based and designed for use with large numbers of children
within pediatric offices. There are screening tools typically used as part of this process,
such as the Brigance Early Childhood Screen (Brigance, 2010), which is a nationally
normed and standardized screening tool that is designed for three age levels, includ-
ing children ages 0 to 35 months, 3 to 5 years, and those in kindergarten and first
grade. The Brigance Early Childhood Screen allows for the detection of early learning
delays across the cognitive, language, social/emotional, motor, and self-help domains.
There are also screening tools that can be used as part of the screening process
that are specific to autism. Some of the most commonly used screening tools include
the CHAT (Checklist for Autism in Toddlers). The CHAT (Baron-Cohen et al., 2000)
is appropriate for use at the child’s 18-month checkup. The first section is completed
by the parents and asks questions related to the child’s interests in joint attention,
his/her ability to point or gesture for an object of desire, the child’s play behaviors and
habits, his/her capability for imaginative play, and whether the child derives pleasure
from being with other children or receiving joint attention and affection from the par-
ents. The second portion of the CHAT is completed by the physician and centers on
whether the child made eye contact; his/her ability to follow a cue or gesture concern-
ing a toy or object of interest; his/her ability to engage in imaginative or pretend play,
and follow simple directions; and, when given blocks, whether the child built a tower
of blocks, as examples (Baron-Cohen et al., 2000).
Once the items are scored, the subsequent cumulative score on these items
places the child within the high, medium, or low risk for autism group. Those children
who score at the high or moderate levels are referred for a comprehensive evaluation,
whereas those who score on the low risk are simply followed for rescreening.
The M-CHAT, or Modified Checklist for Autism in Toddlers (Robins, Ferris,
Barton, & Green, 2001), is another screening device designed for young children
ages 16 to 30 months of age. It is intended for use as part of a routine well-child visit,
or it can be used by early childhood professionals if they have concerns about a child
exhibiting atypical development consistent with autism. One feature of the M-CHAT is
that it was designed to identify children at risk for any form of ASD. Another screening
tool that has been developed for children ages 24 to 36 months is the STAT (Screening
Tool for Autism Spectrum Disorders in Toddlers and Young Children) (Stone, Conrad,
Turner, & Pozdol, 2004), which consists of 12 items and takes approximately 20 min-
utes to complete and addresses critical social and communicative skills. Figure 3.3 pro-
vides an illustration of the developmental screening process.
Multidisciplinary Assessment
After the initial screening process is conducted, and if there are any immediate con-
cerns about a child’s development in light of symptoms that are consistent with ASD,
a comprehensive evaluation is generally scheduled. The purpose of the evaluation is to
confirm the diagnosis and, under ideal circumstances, it results in recommendations
that can be incorporated as part of an intervention plan and help in addressing the
child and family’s needs. It is important to remember that a comprehensive evaluation
Figure 3.3 The developmental screening process
Developmental Screening Process
Level One: Routine Surveillance
Conducted during well-baby visits to the pediatrician
Level Two: Specific Evaluation for Autism
Screening and diagnostic evaluation by interdisciplinary

professionals in the field of autism
attempts to capture an overview of the individual child’s life, pertinent information

about his/her development and changes that have ensued over time, and an under-
standing of the environments that comprise the child’s life (Goldstein, Naglieri, &
Ozonoff, 2009). A multidisciplinary evaluation is conducted by a team of professionals
trained in a variety of related disciplines and can often include representatives from
pediatric medicine, developmental and clinical psychology, special education, speech
language pathology, audiology, physical therapy, and occupational therapy, depending
on the presenting concerns and needs of the child. An example of how the evaluation
process is conducted under ideal circumstances is provided in Applied Vignette 3.1.

The Evaluation Process
If parents are referred to a clinic affiliated with Upon arrival, the team greets the fam-
a hospital or university, the following scenario ily and general pleasantries and introductions
might take place. The child’s evaluation is sched- are the first order of business with the intent of
uled with a clinic coordinator who works in making the child and family feel comfortable.
unison with the family and the referring agency The team goes over the schedule with the fam-
or physician. Prior to the evaluation, the child’s ily and any remaining paperwork that needs to
medical and school records (if the child is school be completed gets wrapped up. The schedule
aged) are obtained. The evaluation team would ensues, with the child and family being accom-
then schedule a meeting to familiarize them- panied by specific team members for the evalu-
selves with the child and family and to determine ation. If there are moments when it is just the
the team’s projected course of action before the child alone with the examiner, parents joined by
family’s arrival. The schedule to be followed on a team member observe through an observation
the clinic day is also determined at this time. booth. As the child and family complete each
(continued)
Applied Vignette 3.1 Continued

phase of the evaluation process, they are tran- findings in areas such as speech and language,
sitioned by team members to the next point on psychoeducational aspects, medical finding, and
the schedule and always kept informed of the so forth, until all findings are presented. The
process throughout. The child is given times family is then brought in to meet with the team
throughout the day for snacks and leisure time; for the final portion of the evaluation—the par-
these not only provide the child with needed ent interpretive. It is during this session that the
breaks, but also provide the team with meaning- day is reviewed with the family and all findings
ful opportunities to observe the child in a non- are presented, with time allotted for questions
structured situation. This is important, given the by the parents. The child’s strengths are empha-
general difficulty experienced by most children sized and areas of need also discussed.
with ASD with activity transitions and unstruc- This information is then assembled and
tured situations. The team may even orchestrate compiled to determine the diagnosis of autism.
opportunities for the child to ask for help or Findings are presented at the parent interpre-
engage in joint attention. As each phase of the tive. Reports are provided containing results and
evaluation is completed, the team members dis- recommendations for intervention, and these are
cuss some of their initial impressions with one incorporated into the child and family’s individu-
another and then, at the close of the evaluation, alized treatment plan that can be transported into
team members will reconvene to discuss their the child’s IFSP or IEP, depending on his/her age.
Parent and Family Needs

The assessment process can be an emotionally draining experience for a family. It is
important for professionals to establish a relationship with the family to allay their
fears to the greatest extent possible, and to support them throughout the assessment
process. It is considered best and effective practice to have a professional with the fam-
ily at all times throughout the process, as well as a professional with the child; during
downtimes, and arrange for some respite support for the family by having a trained
caregiver provide opportunities for leisure and play activities with the child.
Baird, Cass, and Slonims (2003) identified a list of expressed needs of parents and
families during the assessment process. Parents stated a desire for (a) access and a prompt
response from trained and competent professionals concerning the diagnosis of autism,
(b) prompt access to educational and related interventions that are deemed appropri-
ate and that model best practices, (c) the coordination of multiple agencies/schools for
assessment processes to ensure streamlining and minimizing further emotional trauma
to the family, (d) the provision of supports to the family and siblings as part of the pro-
cess, (e) the identification of a case or family service coordinator to assist the family
through the beauracracy, and (f ) ongoing follow-along through the lifespan, if possible,
to facilitate the provision of services throughout key transition points in the child’s life.
It is important that, as part of the assessment process, the support needs for the
child and family are viewed as interconnected. Families are too often left out of the
process rather than being viewed as partners. For the family, it is a lifelong and last-
ing commitment to their child. It is also very important that the connection between
assessment and intervention be emphasized through recommendations aimed at
developing an effective treatment plan for the child and family.
Information Collected as Part of the Process
Developmental History
Initially, a developmental history is compiled as part of the intake or beginning of
the process, in which parents are interviewed by a trained professional using a ques-
tionnaire that is designed to better understand the child’s early development from
prenatal to current state. Medical/health history, family history, and current ques-
tions pertaining to development are identified. This descriptive form of assessment
allows professionals to capture a glimpse of the child and family as portrayed from
the family’s perspective. Parents and families know their children, whereas pro-
fessionals may enter their lives at points where their expertise is most needed; it
is, therefore, most important to gain an understanding of the child through the
parents’ eyes as part of the diagnostic assessment process. Some examples of this
information could include: (a) basic information on the child and family; (b) devel-
opmental milestones and at what age the child reached these (e.g., smiled, sat with-
out support, followed with eyes, crawled, stood with support); (c) medical/health
history; (d) current levels of functioning in areas like being able to follow instruc-
tions, listening in a group, effectively being able to communicate his/her desires or
needs, to name a few; and (e) other areas of functioning, such as motor and social/
emotional skills.
Autism Screening Instruments

Following the developmental history, most often a specific screening tool is used as
part of the evaluation process. One widely used screening instrument for children
suspected of having autism is the Childhood Autism Rating Scale (CARS) (Schopler,
Reichler, DeVellis, & Daly, 1980). The CARS is a behavioral rating scale consisting
of 15 items, and it is designed to identify children with autism and is appropriate for
use with children ages 2 and beyond. The 15 items are scored through observation
by a trained evaluator. A common approach is to observe the child while engaged in
tasks associated with their typical routines, either in the home or classroom, and score
the CARS. Another method is to use it as part of a more comprehensive assessment
while administering the Psychoeducational Profile, third edition, or PEP-3 (Schopler,
Lansing, Reichler, & Marcus, 2005), a developmental play-based assessment. The
PEP-3 is a standardized and norm-referenced assessment designed specifically for
children with ASD. The assessment evaluates seven different developmental domain
areas and gathers information about idiosyncratic (i.e., characteristic motor and verbal
behaviors) and maladaptive behaviors.
The PEP-3 is designed to assess the skills and behaviors of children with autism
with developmental ages ranging between 6 months and 7 years. The profile that
results from the PEP-3 will reveal any patterns of uneven and atypical development,
emerging skill areas, and behavioral characteristics consistent with ASD. The PEP-3
is individually administered and usually takes between 60 and 90 minutes to complete.
The scoring of the PEP-3 allows for a comparison of the child with a same-aged
normed sample of typically developing children.
The PEP-3 is a very useful tool for the development of appropriate program-
ming for young children with autism between the ages of 3 and 5 years, so it is not
considered a screening tool, although, as stated, it can be used in conjunction with
the CARS. The cumulative results of the CARS will indicate whether a child is in the
mild, moderate, or severe range of autism, whereas the PEP-3 provides a comparison
of where the child is against typical norms.
Assessment Instruments
In terms of psychoeducational assessment, there are numerous instruments that can
be used. We will examine some of the most popular and highly regarded; however, this
list is not inclusive of all instruments used in the assessment and diagnosis of children
and adults with autism. The reader is encouraged to consult further information on
the assessment and diagnosis of autism and ASD for additional resources on assess-
ment instruments.
Autism Diagnostic Interview-Revised (ADI-R)

The Autism Diagnostic Interview-Revised (ADI-R) has been deemed the “industry
standard” among assessment scales for diagnosing autism (Matson, Scwalm, & Matson,
2006) because it has some features that are unique, such as a more extensive range of
age norms and a substantial amount of psychometric data published. The ADI-R (Lord,
Rutter, & LeCouteur, 1994) is designed to be used as a semi-structured interview given
to parents and caregivers of children, whereby the potential diagnosis for autism is a
possible consideration. It can also be used to assist in the design of treatment plans. This
assessment tool has also been created for an expanded age group of children and adults
as long as their mental age is at or above 2 years. It takes approximately two hours to
complete and is comprised of 93 items, which include the three domains: (1) language
and communication, (2) reciprocal social interactions, and (3) restricted, repetitive, and
stereotyped behaviors and interests. The questions contained in this structured inter-
view are aimed at providing the interviewer with a more detailed background of the
child, including his/her developmental history, behavioral repertoire, language and
social functioning, and other areas of concern that might include self-injurious behavior,
aggression, and medical/health concerns, including the presence of seizure disorders.
Autism Behavior Checklist (ABC)

The Autism Behavior Checklist (ABC) is a component of the Autism Screening
Instrument for Educational Planning (ASIEP). The ABC profiles a child’s abilities in
the areas of spontaneous verbal behavior, social interaction, education level, and indi-
vidual learning characteristics. The ABC is completed by either the child’s parents or
a teacher familiar with the child, and it is useful for identifying target behaviors and
for intervention planning. The ABC is comprised of 57 questions divided into five
categories of behavior: (1) sensory, (2) relating, (3) body and object use, (4) language,
and (5) social and self-help.
Autism Spectrum Rating Scale

The Autism Spectrum Rating Scale (ASRS) (Goldstein & Naglieri, 2010) is a rating
scale designed to assist in the diagnosis of autism. The ASRS is completed by parents,
teachers, or caregivers and is designed to allow observers to rate behavioral charac-
teristics of children ages 2 to 6 years in an early childhood version of the instrument,
and also children ages 7 to 18 years as part of the school-age version. There are three
scales provided in the areas of self-regulation, social/communication, and stereotypi-
cal behaviors, and it is designed to assist in the differential diagnosis process and in the
design of formal intervention plans.
Behavioral Assessment
Social and behavioral assessment is of vital importance to understanding a child with
ASD. Individualized evaluation allows for this during the administration of assessment
tools, but it is also important to have a thorough understanding of a child in his/her
natural environments. For those children who exhibit more severe and challenging
forms of behavior, it is advisable to conduct a functional behavior assessment to gain
a more fluent understanding of the child’s behavior relevant to his/her environments.
Functional Behavior Assessment

It is not uncommon during the initial parent interview that parents and fami-
lies will express that their child may have experienced challenging behavior and in
some instances these behaviors may be quite severe, such as self-injurious behavior.
Oftentimes children with ASD experience challenging forms of behavior as a result of
their communication challenges.
One of the assumptions of challenging forms of behavior is that these responses
serve a function for the child. The functions of these behaviors include: (a) escape/
avoidance, (b) access to tangibles, (c) access to social reinforcement, and (d) sensory
needs. These behaviors are often triggered by setting events. Setting events consist of
three distinct classes: (1) biological setting events, such as hunger, thirst, and fatigue;
(2) environmental setting events, such as an environment being too noisy, too hot,
too cold, or overcrowded; and (3) social and interpersonal setting events, such as a
personal disagreement or need for socialization. For children with autism, given their
communication challenges, simple things such as communicating their needs or get-
ting their basic needs met can be challenges that, if not met, can result in some form of
challenging behavior. It is best to view these occurrences in the absence of alternative
skills that would be more appropriate.
Functional behavior assessment (FBA) serves as an appropriate option to help
in understanding these behavioral challenges. The FBA can be used within the child’s
home or educational setting and can occur at any point that the child’s needs war-
rant this. It can be included in the initial assessment process and conducted during
the course of the child’s day-to-day functioning within educational or home settings.
Functional behavior assessment is a form of behavioral assessment that has been
widely documented in the literature as an evidence-based practice for understanding

the function such behaviors serve for the individual, and the antecedent and maintain-
ing variables that trigger and reinforce these responses (Wheeler & Richey, 2013).
The initial step in an FBA involves the use of a structured interview with the
child’s parents, teachers, and/or caregivers. The purpose of the interview is to identify
the target behavior, the antecedents or triggers that precipitate the response, and the
consequences or maintaining variables associated with it. Once identified, these behav-
iors are then put into operational terms that are observable and measurable. This is
called an operational definition, from which team members can work and attend to in the
data collection process. The second step in the FBA process is to collect some obser-
vational data on the frequency of the behavior across relevant points in the child’s day.
One method that has been successful in gathering such data in educational settings has
been the use of a scatterplot, on which the frequency of the behavior is recorded across
15-minute intervals throughout the child’s day. This will allow one to identify at which
points within the child’s daily routine he/she has the most difficulty. It also allows the
team to identify patterns of behavior associated with specific activities and/or transitions
throughout the child’s daily schedule. It allows for some examination of the contextual
variables that surround the child’s behavior through this process. Another important
piece of the FBA is the collection of A-ntecedent B-ehavior C-onsequence data. Also
an observational recording method, A-B-C recording is concerned with identifying the
antecedents that trigger behavioral responses in children and youngsters, the behaviors
that follow these triggers, and the consequences of the behavior.
Other forms of observational recording include interval recording—usually par-
tial interval recording, whereby a child is observed for 15-second intervals across blocks
of time, such as 10-minute periods. If the behavior occurs at any point during that inter-
val, it is scored as an occurrence. After the collection of behavioral observation data, the
third step of the FBA is the development of hypotheses or probable estimates as to the
cause-and-effect scenarios surrounding a behavior (e.g., the child, when presented with
an auditory prompt to sit down and take out his work, fails to do so and the teacher
removes him from the group, at which point he becomes aggressive toward her). Note
that an experienced professional would realize that the child’s communication difficul-
ties would warrant the use of a picture/symbol or activity schedule to serve as a reliable
prompt for the child. This level of analysis helps in identifying the triggers or antecedent
variables we spoke of earlier and the consequences that serve to maintain such behaviors.
The last step of the FBA process is about identifying replacement behaviors that serve
the same function for the child. Often replacement behaviors for children with autism
are grounded in functional communication, given the extent of their communication
difficulties. These replacement behaviors will be the basis for the behavior support plan.
Finally, the FBA concludes with a plan of action that is inclusive of:
The operationally defined target behavior and the identified contextual vari-
■
ables, including antecedent and consequences

Behavioral observation data collected, including Antecedent-Behavior-
■
Consequences data
Hypothesis statements regarding the function of the behavior
■
■ Replacement behavior(s) identified

■ Recommendations for the design of the behavior support plan (BSP)
Supporting Children and Families through

the Assessment Process and Beyond
As has been alluded to previously in the chapter, the need to provide parents and
families with answers concerning their child’s development and potential diagnosis
is only one piece of the process. This is vitally important, and many parents have
expressed that obtaining the diagnosis of autism for their child is perhaps the most
difficult task of all. Siklos and Kerns (2007) surveyed parents (n=56) in Canada as to
their experiences and they reported that, on average, the parents saw 4.5 professionals
and waited nearly three years to obtain the diagnosis of autism after their first visit
to professionals. This is not uncommon for parents seeking a differential diagnosis
for children with developmental disabilities, and they cite their need for diagnosis to
enable them to better understand the developmental challenges their child is experi-
encing and to gather information on the cause of the disorder, the treatment options
that exist, and the future prognosis for their child’s development (Watson, 2008).
It is also important to remember that families need support before, during, and
after this process has been concluded. Often missing is that continuation of support
during the transition following diagnosis, as families attempt to connect with provid-
ers to begin the intervention phase for the child. Let us begin with better under-
standing the importance of the parent interpretive during the assessment phase. In
the professional literature, there has not been much attention given to the needs of
parents and families nor the skills needed by professionals in addressing parent and
family support needs during the parent interpretive conference.
Nissenbaum, Tollefson, and Reese (2002) conducted a study of professionals and
parents to ascertain their perceptions about giving and receiving the diagnosis of autism
at the interpretive conference following a formal interdisciplinary evaluation. Based on
their findings, they have recommended the following practices for professionals when
working with families and in sharing the diagnosis of autism:
Professionals must be fluent in their understanding concerning the assessment,

■
diagnosis, and treatment of autism as a means of providing parents with comfort

in knowing their child’s needs are being addressed by someone of professional
credibility.
The team must ensure a family-friendly setting so that families are comfortable
■
and feel supported throughout the evaluation process and during the interpre-
tive conference.
The team should get to know the family from an empathic view and try to
■
understand their unique challenges and circumstances as a family, to help in pro-

viding needed information to the family during the interpretive conference.
Professionals should assist the family by ensuring that the recommendations for
■
interventions provided in the interpretive will be carried out through connecting

the family, providers, and resources together on the front end to the greatest
extent possible.
The team should provide extended communication with families who wish to
■
engage in discussions about prognosis for their child.

Professionals should provide the family with a sense of hope by being optimis-
■
tic about the possibilities for the child, rather than focusing on the limitations
imposed by the diagnosis.
For families, the period following the diagnosis can often be difficult as they
attempt to transition between receiving a diagnosis and accessing effective treatment
with hopes for an optimistic prognosis for their child’s future. It is important that pro-
fessionals involved in the assessment process link families to the appropriate providers
to initiate services and to supports for the child and family. If possible, this network-
ing can occur as part of the assessment process following the parent interpretive. Too
often families, upon receiving a diagnosis of autism for their child, are confronted
with where and how to get the necessary services and supports for their child. It is also
important that the assessment process provide families with a set of recommendations
for treatment, based on the findings from the evaluation.
This point is best illustrated by a study conducted by Renty and Roeyers (2006)
of parents of children with autism (n = 244) who identified their perceptions of sup-
ports to their children and families. The study’s findings revealed that parents were
frustrated and challenged by the diagnostic process, lack of knowledge and familiarity
with available service and support options, and their access to autism-specific profes-
sionals and services. Predictors of successful experiences were parental support and
involvement from the moment of first consultation through diagnosis and in securing
viable treatment options for the child.
The importance of post-diagnostic support for families of children with autism is
vital to the probability of realizing more successful outcomes for all concerned. Families
need the emotional reassurance that is gained from competent professionals who are
committed to the treatment of the child through meaningful partnership with families.
One such mechanism would be the involvement of families in a positive behavior sup-
port program designed for children with autism and their families. Such programs are
often located and operated by universities and colleges, educational service agencies, or
through statewide early intervention systems. Such programs are helpful to families in
understanding how to develop prosocial and meaningful replacement behaviors in their
children with autism. Family members also gain from the support of professionals in
attempting to better understand the challenging behaviors often experienced by chil-
dren with ASD, and how positive behavior supports can assist them in addressing these.
Whatever the nature of the program, most have similar components in an effort
to assist families. Generally, these include information sharing by professionals and
from families on information relative to general awareness about autism spectrum dis-
orders, modes of treatment, and alternative strategies and methods, including in the
areas of communication and language development and positive behavior supports.
Such programs will also have access to resource manuals on everything needed by a
family, from educational resources to health care and related service areas. The impor-
tant thing to remember is that families need professionals to facilitate support and
provide linkages to access the resources needed by them to benefit their children. It
is also therapeutic and helpful for families to be able to gather together as parents to
discuss and share their respective stories and serve as supports to one another. Research
has demonstrated that mothers of children with autism are at greater risk for psycho-
logical distress than the parents of children diagnosed with other forms of develop-
mental disabilities (Bromley, Hare, Davison, & Emerson, 2004), so these peer-to-peer
and professional/family linkages are very critical to sustaining the optimism needed to
address the long-term needs of children with autism. Another key feature that families
have found useful is a family coordinator who oversees the coordination of services and
supports to the child and family. These roles are common among early intervention
programs, but there has been some evidence to support the use of similar profession-
als within educational settings serving school-aged children with autism. Finally, it is
important to provide children and families with evidence-based practices in the assess-
ment and diagnosis of ASD, and it is equally as critical to provide the post-diagnostic
support services needed by these individuals in sustaining the course of treatment and
hopefully in ensuring optimal prognostic outcomes over time. It is important that ser-
vice delivery systems consider this in the design of services to children and families and
that policymakers comprehend the rationale behind such a model.
Linking Assessment to Intervention

The assessment process should yield some important derivatives for children, families,
and professionals. These outcomes are highlighted in Figure 3.4.
The assessment process should confirm the diagnosis of ASD for the child and fam-
ily. Although this is a difficult process as parents hear such news, it does lead to a better
Figure 3.4 Outcomes derived from the assessment process
Outcomes Derived from the Assessment Process
Current Levels of Functioning Across

Confirmation of the Diagnosis of ASD
Developmental Domains
Development of Goals and Objectives Establishment of an IFSP or IEP

Consider This
There were two children, Ethan and Amy, who responsible for the design of interventions for
were diagnosed with autism at young ages. the home and served as consultants to the school
Ethan was diagnosed at age 3, and Amy was personnel in the design of school-based treat-
diagnosed some years later, by the age of 6. ment. The team recommended the use of indi-
Both Ethan and Amy were assessed by a uni- vidualized activity schedules both at home and
versity technical assistance project specializing school for each of the children. Ethan’s sched-
in the diagnosis and treatment of children with ule was comprised of pictures and Amy’s was a
autism. Ethan’s pediatrician referred him to the combination of pictures and words. One of the
project, and Amy was referred by her local edu- critical elements for both children was the level
cational agency. Ethan was diagnosed with mod- of partnership between the family and the pro-
erate autism, and Amy had been diagnosed with fessionals, the competence of the professionals
Asperger’s syndrome and was in need of support involved, and the ongoing support given to the
in terms of intervention planning and imple- family and school personnel by the technical
mentation. Ethan was significantly language assistance team. Ethan made a successful transi-
delayed for a child his age. He was 3 years old tion to an inclusive kindergarten by age 6, and
at the time of his referral and the team recog- Amy was fully included in the general classroom
nizing his needs began to conduct an assessment with supports in the areas of language, commu-
aimed at developing an appropriate and indi- nication, and social skills training.
vidualized intervention to assist Ethan’s family Over time, both children continued to
and educational team. Amy appeared to be much receive ongoing services, and by age 10, Ethan
higher functioning in terms of her language and was fluent in language and, upon a reevaluation
socialization skills, consistent with the diagnosis by an independent evaluation team, displayed
of Asperger’s, but she lacked pragmatic skills in only mild autism. In high school, Amy was fully
terms of her socialization. Her parents had com- included in general classes with some instruc-
mented that often when playing with others, tional and social supports and was preparing
she would abruptly dismiss them when she was to enroll in the local community college when
finished and that she demonstrated no fear or she graduated. The families frequently cited
apprehension with strangers. Upon receiving the importance of early identification, intensive
the diagnosis, each child’s family was connected treatment, and consistency across team mem-
to a treatment team that worked in conjunction bers as being critical to their child’s success, and
with the school systems as part of the univer- ongoing collaboration with the family as the key
sity’s technical assistance team. This group was element in facilitating the family’s success.
understanding of the child’s individual strengths and areas of greatest challenge. The diag-
nosis also determines that the child is eligible to receive services and supports. Parents and
professionals can then begin the process of establishing goals and objectives for the child.

The featured exemplary program in this chapter is OU Cares Oakland University
Center for Autism Research, Education, and Support in Rochester, Michigan. Oakland
University began offering an autism endorsement certificate for teachers and other
professionals almost thirty years ago. The program provides innovative programs for
teachers and programming and counseling for individuals and their families living
with ASD. The multifaceted approach includes education for professionals, research
in the field of autism education and daily living, as well as support services for families,
with an emphasis on quality of life for individuals with ASD and their families across
the lifespan.
Chapter Summary
The purpose of this chapter was to familiarize you with the screening and assessment
process for children with autism and how these should link to the development of
interventions and supports for children and their families. The chapter began with an
introduction into the classification systems used for ASD. A brief review of the etiol-
ogy and characteristics associated with pervasive developmental disorders was pro-
vided, as were the criteria used in the identification and diagnosis of autism. Issues and
challenges relative to the classification of ASD were also described.
Much attention was also given to understanding how to support families in this
process and the importance in partnering with families as team members in the care
and support of the child and family, respectively. Care was given to understanding
child development and the warning signs that families most often encounter when
they suspect their child has autism.
The screening and assessment processes were broken down and discussed in a
stepwise manner from early identification, screening, parent interview, assessment, and
diagnosis. Individual screening and assessment tools were introduced and described as
part of this chapter, as were other critical elements of the assessment process. These
components included the use of functional behavior assessment as a means by which
to ascertain the function(s) and contributing variables related to challenging behavior
experienced by some children with autism.
Finally, the chapter provided an in-depth summary complete with suggestions
as to the importance of supporting parents and families through the assessment pro-
cess and beyond. Too often, as we learned, families are virtually at their wit’s end as
to what to do after an autism diagnosis and precisely to whom they can turn. It is
extremely important that they are supported through the process and connected to
highly trained professionals who are capable of providing meaningful and individual-
ized early intervention and supports to their child.
1. If possible, contact a local chapter of a parents’ support network for families of children
with autism and attend one of their meetings as a means of familiarizing yourself with
the joys and challenges experienced by these families in raising their children with
autism.
2. Attempt to serve as an observer at a clinic specializing in the assessment of children

with autism. Take in the work of individualized specialists through your observa-
tions and learn through watching how the process works for children, families, and
professionals.
3. Interact with one or more of the assessment tools described in this chapter, most espe-
cially after observing an interdisciplinary assessment.
4. Interview a parent or family about their experiences in obtaining a differential diag-
nosis for their child and the degree to which they were supported within and after the
process.
5. Observe children with autism at various stages of their early development to gain an
understanding as to effective assessment and intervention practices across the lifespan.
6. Practice, under supervision, giving one or more of the instruments to a classmate to
better understand the instrument and protocol used in delivering an assessment to a
child with autism.
7. Interview a variety of interdisciplinary professionals who work in the field of autism
and gauge their thoughts and perspectives on the assessment and diagnostic process for
identifying children with autism.
Websites
American Psychiatric Publishing Autism Speaks Tools for Professionals
http://www.appi.org/Pages/DSM.aspx http://www.autismspeaks.org/family-services/
resource-library/tools-professionals
Life Journey through Autism: A Parent’s Guide
to Assessment from the Organization for Autism
Research
http://www.researchautism.org/resources/
reading/documents/AssessmentGuide.pdf
4
chapter
Teaming with Families

■ Describe some of the common challenges faced by families with members who have ASD.
■ Discuss essential needs experienced by families with members who have ASD.
■ Understand two prominent theories of family operation and their implications for teaming with
families affected by ASD.
■ See the important connections for team building that occur among aspects of well-grounded
professional procedure and practice with families.
89
90 S e c t i o n II / Early Childhood
■ Apply methods for shaping effective communication with families.

■ Employ strategies for the provision of needed information to families.
■ Incorporate relevant multicultural considerations into communication with families regarding the
diagnosis and treatment of ASD.
Chapter 4 Mind Map

Common Needs Social/Emotional Needs
Understanding the Associated with ASD Health-Related Needs
Perspective of Families Daily Living Needs
Two Prominent Theories Family Systems Approach
of Family Operation
Ecological Approach
Family-Centered Philosophy of Care Well-Grounded Philosophies,
Progressive
Establishing Appropriate Principles of Operation Procedures, & Practices
Methods for Fostering Aware
Engaging in Effective Practices How to Communicate
Successful Teams Face-to-Face
Cultivating Leadership
Teaming with Families Sensitive & Supportive
Developing Programs of Education & Treatment Family Team Building Providing for Information Presentation
Implementing Programs Enhancing Communication Informational Needs
Why “Teaming with” Among Team Members Information Formats
Understanding the Familial Challenges Often Associated with ASD
Families? Multicultural Diagnosis & Multicultural Communication
Fostering a Sense of Commitment Through Building Trust
Considerations Treatment & Multicultural Communication
Strategies
Making a Communication Format
Plan Frequency
Feedback
Teaming with families touched by ASD is in some ways both an art and a science,
pairing the interpersonal and intervention. Professionals may be experts in their fields,
and yet fail in implementing interventions because of an inability to gain the trust of
family members. Quite a few teachers, physicians, and related service professionals
have been heard to exclaim, “Why won’t they just do what I have asked them to do?
It’s for the ultimate good of their family member!” Therefore, it is relevant to ask:
How do we begin to develop the art of “teaming with families” that so well comple-
ments the effectiveness of our applied science, in order to benefit children and families
affected by ASD? What are the necessary first steps in this process?
Blue-Banning, Summers, Frankland, Nelson, and Beegle (2004) conducted a
qualitative study that sought to determine the factors essential for the formation of
effective partnerships between families and professionals. Through a series of focus
groups and interviews of parents and adult family members of children with disabili-
ties and professionals from education, health, and social services agencies, six main
themes emerged, as well as a set of indicators within each of these themes. Among
themes such as respect and communication was the theme of commitment, which
was found to include indicators such as: (a) “regarding work as more than a job,”
( b) “regarding child and family as more than a case,” and (c) “being sensitive to emo-
tions” (p. 174). The findings of Blue-Banning et al. (2004) suggest that a wide range of
stakeholders recognize that, in addition to technical skill, effective professionals must
also bring to the process of teaming with families a healthy dose of empathy, or under-
standing obtained from a common perspective.
Semantics (the study of the meaning of words/terms and the interpretation of
that meaning) can be considered a first, basic step for professionals in beginning to
work toward a sense of commitment in teaming with families. It is useful to begin
with basic terminology in seeking an appropriate direction and purpose well suited
c hap t e r F o u r / Teaming with Families 91
to professionals whose practices are intended to positively impact the lives of family
members. It is also useful to develop an understanding of the daily challenges faced
by many families with members who are diagnosed with ASD. Such challenges go
beyond the features of a diagnosis in that they are manifested in the physical and emo-
tional well-being and, ultimately, the overall quality of life of real people.
Why “Teaming with” Families?

First of all, it is important to distinguish the phrase “teaming with” from phrases
such as “collaborating with” or “consulting with.” Integral ideas to teaming are:
(a) a family-centered approach on the part of professionals (e.g., Stoneman & Rugg,
2004); (b) shared vision, goals, and responsibilities among team members (e.g.,
Nassar-McMillan & Algozzine, 2001); (c) the use of informed, ethical practices
(e.g., Wheeler & Richey, 2010); and (d) systems of effective and responsive commu-
nication (e.g., Rao & Kalyanpur, 2002). How are these ideas radically different from
literature discussing, for instance, “collaboration with” families? The answer is: They
are not. What is different is not the overarching philosophy, but the stage of devel-
opment for professionals. Within this chapter, the topic of teaming with families is
presented as establishing the foundation from which professionals can begin work-
ing toward building strong collaborative relationships, as discussed in Chapter 8.
Therefore, the focus within the current chapter is on establishing ways of think-
ing and basic procedures that are vital for the formation and cultivation of family-
centered, collaborative practices.
Second, it is important to note that the everyday terms we use to speak about our
work for and with families may have an effect on how our thinking and even our prac-
tices are shaped over time. For example, use of the term “dealing with families” may
influence our thoughts about service provision more toward organization- or profes-
sional-centered kinds of approaches that can place the needs of agencies, clinicians,
schools, or school personnel before the needs of the families they intend to serve (see
Figure 4.1). On the other hand, speaking of “teaming with/partnering with families”
may continually serve to prompt or remind us to go in directions more in line with
family-centered approaches that consider family needs first. How we refer to things
on a regular basis does matter, even if we only consider the effect that our speech can
have on the people with whom we work. In order to move all team members closer to
the shared goal of responsive, family-centered treatment and intervention, it is useful
for professionals to begin by speaking in the terms considered appropriate and widely
accepted by most professionals in our field.
Understanding the Familial Challenges Often

Associated with ASD
In developing a sensitivity toward families and their needs, it is also useful for profes-
sionals to move beyond what they know about the disorder itself (e.g., diagnostic cri-
teria, how these criteria are commonly manifested across age and severity groupings,
Figure 4.1 Semantic gradient of terms related to professional relationships with

families
Teaming with/ Collaborating with Consulting with Working with Dealing with
Partnering with
Personal, empathetic, Neutral Impersonal, objective,

formative formal
Note: Formal implies a deductive, prescriptive, predetermined set of premises, beliefs, and processes (e.g.,
“We already know what you need, and we will provide it how we think best.”), while formative implies an
inductive process of discovering individualized characteristics and seeking to meet associated needs (e.g.,
“Let’s find out what you need, and we will work together to accomplish it.”).
and evidence-based practices that can be used to provide treatment) toward a greater
understanding of the challenges that family members often face as a result of the dis-
order. One way this process can be initiated prior to professional contact with families
(e.g., within a training program for preprofessionals) or even after such contact has
formally begun (e.g., within an externship or internship) is through an informal survey
of the literature (see Figure 4.2). General categories of challenges encountered by
families can be identified from the specific challenges discussed within the literature.
The emphasis of engaging in such an activity for professionals at any level should be
that of preliminary discovery and analysis. The challenges faced by specific families
that professionals will encounter (see Applied Vignette 4.1 for an example) may or
may not fit nicely within the framework that is constructed, but the exercise of exam-
ining the collected information of literature published over decades will help to widen
professionals’ perspectives across a broad range of challenges within a relatively brief
period of time. Lifelong learning and maintaining current knowledge within one’s
profession serve many purposes, from the mechanical act of keeping a license or cer-
tification, to the practical act of applying the most current, evidence-based knowledge
within one’s daily practice. One of the most important purposes that this ongoing
process can serve, however, is to remind professionals of why they chose their profes-
sions in the first place, by reorienting them toward the real people with real challenges
whom they serve.
Fostering a Sense of Commitment

Through Building Trust
In addition to speaking as caring professionals and understanding the particular chal-
lenges faced by families, another prerequisite to teaming that will enhance the art
behind the science for professionals is in the area of understanding how to build trust.
Although building trust is often viewed as a process that is complex and difficult to
implement, it is best built and realized over time, as professionals consistently address
the support needs of families. Working within this point of view does not mean that
professionals must learn and implement a series of competing behaviors and responsi-
bilities that will add to the overall workload and make one’s job more difficult to suc-
cessfully complete. Basically, it means that continually working to be better within one’s
Figure 4.2 Family challenges associated with ASD from a sampling of the literature
Phelps, Hodgson, McCammon,

Lockshin, Gillis, & Romanczyk
Scott, Clark, & Brady (2000)

Luther, Canham, & Cureton
Schopler & Mesibov (1984)

Mesibov, Shea, & Schopler
Altiere & von Kluge (2009)
O’Brien & Daggett (2006)

Koegel & Koegel (1995)
Rao & Beidel (2009)

Kogan et al. (2008)
& Lamson (2009)

Category Family
Challenge
Harris (1994)
(2005)
(2005)
(2009)
Maintaining sufficient income
(e.g., keeping both parents
working, job mobility)
Economic Increased economic burden
due to the need for therapy,
medical, and/or support
services
Maintaining friendships/
relationships outside the family
Maintaining a satisfying
Social relationship with a spouse or
partner and/or emotional
bonding among family
members
Maintaining satisfying levels of
recreation and leisure activity
Effectively managing
General depression, stress, and anxiety
Quality of Successfully completing daily
Life routines (e.g., self-care,
chores, shopping)
Managing coexisting medical
and/or psychological
conditions
Maintaining sufficient levels of
energy and effort across time
Resources Finding, accessing, and
maintaining efficient and
effective sources of formal and
informal supports
Managing sibling issues (e.g.,
reduction in quantity and/or
quality of interaction)
Managing the effects of ASD in
conjunction with the challenges
Parenting of typical development (e.g.,
the onset of puberty)
Planning for the future (e.g.,
long-term care, estate
planning, guardianship)
Note: Areas more often found in the random sample of professional literature are shaded for emphasis.
already defined roles and responsibilities will, in itself, tend to build trust with the fami-
lies one serves. Therefore, it is often best to concentrate on behaviors that (a) occur at
meaningful points of contact with the family and child/young adult, (b) relate directly
to the processes and procedures of service provision, and (c) transcend what is often
perceived as minimally acceptable performance. Figure 4.3 provides some practical
suggestions for building trust through the application of five basic precepts.
Understanding the Perspectives of Families

Children and adults with ASD operate within communities, clinics, schools, work-
places, support agencies, and many other settings, but their performance within and
across these settings is often regulated and influenced by one overarching factor: how
they operate within home and family (Lucyshyn, Horner, Dunlap, Albin, & Ben, 2002).
Adherence to the medical treatment, work with the clinician-initiated social skills
program, and continued practice of the functional academic skill are all ultimately
overseen by caregivers and family members, and the values, behavioral influences, and
routines that are originated and perpetuated within home and family tend to influence

Natasha Describes the Challenges Faced by Her Family
There were times I wondered how life would his language has improved tremendously. He
be different if my youngest child, Kevin, did not becomes frustrated when he is “doing work,”
have a disability. There certainly would have but his brother will remind him how well he is
been less or at least a different kind of stress. doing and how smart he is. The feeling of obliga-
From early on, sleep and my son were not on tion to get Kevin access to as many services and
the same page. He was 6 months old before he programs as possible is overwhelming at times.
ever slept 4 hours straight. That duration has So, I try to ensure that his brother has access to
not improved over the last six years and, in fact, activities and places he likes as well. This means
he requires medicine every night to fall asleep we are always on the go, but ultimately, if any-
before 12:30 or 1:00 a.m. His lack of sleep and thing must be sacrificed, it is seldom Kevin’s
inability to sooth or comfort himself took a appointments. Even though Kevin’s strengths
great toll on my husband’s and my mental and and needs have varied over the years, there was
physical stamina. We would take turns getting very little question that he would need sub-
up with him at night. Now that his dad and I stantial support to be successful in school. He
are divorced, I struggle with balancing my son’s is ending his kindergarten year, and my happy
need for comfort and my need for rest. Many little boy now becomes angry and frustrated
families struggle with the challenge of a child’s every morning that is not an “S-day” (Saturday/
atypical sleep pattern, but for us, there was no Sunday) because it means that he has to go to
relief. His behavior was too demanding and school. He must transfer to a new school next
intense to ignore. Safety was an issue, but luck- year since his present school faculty has said
ily that is not as much of a concern now. Our that they cannot meet his needs. The conver-
home became an additional place of therapy, as sation from their side was very matter-of-fact,
much as we tried for our house to just be our yet it broke my heart. Their words stung, and
home. Kevin’s brother has always been his big- there was little recognition of this on their part.
gest fan and cheered even his smallest accom- This left me with the option of acceptance or
plishments. Still, there were times that practices fighting for my son all over again. There always
or downtime at home were missed so that Kevin seem to be battles, and, to keep my sanity, I
could make a therapy session or clinic time. have to very carefully choose the ones to fight.
If there was resentment or jealously over this, Therefore, Kevin is being transferred, and his
his brother has never said. Kevin is now 6, and older brother has to decide if he wants to attend
school in his current setting with his established Discussion Questions

set of friends or switch schools so that he can
1. What have been the longitudinal chal-
be with his brother. I have no doubt he will
lenges faced by this family, as described by
select to attend school with Kevin, which means
Natasha?
that his brother must now lose his established
friends, teachers, and school. I no longer won- 2. What additional challenges might a family
der what it would be like for Kevin to be any with a member who has a disability expe-
different than just who he is. He is an amazing rience when there is a transition from two
little boy, and though there are many challenges caregivers to one caregiver (e.g., as in a
that we face as a family, we each deal with many divorce)?
of the same issues. These challenges seem mag- 3. What sacrifices might family members have
nified at times because there does not appear to to make for one another’s well-being, and
be an end in sight, and the stakes are so high. I how might these sacrifices impact the fam-
place additional guilt on myself because I want ily’s interactions with the outside world?
for him to have everything. Then, I realize that 4. What factors allow some so-called “services
he has the love of his family and a joy that is and supports” to become burdens and chal-
contagious, and that my life is exactly how it lenges for families?
should be.
to a marked degree what occurs in other settings (Kenney & LaMontagne, 2001). It
therefore becomes essential that professionals seek to understand the perspectives of
family members in order to (a) better understand what may motivate the preferences
and actions of individual members, (b) get a “big picture” overview of the dynamics
that will blend with professional approaches and perhaps determine the efficacy of
these approaches, and (c) shape services and supports to better serve what families see
as their greatest needs. In beginning the process of seeking to understand the per-
spectives of families, it is expedient to first understand some of the needs commonly
associated with ASD, as well as several major theories regarding how families operate.
Common Needs Associated with ASD

Primary caregivers of children with autism may not differ significantly from caregivers
of children with other development disabilities in the number of needs (both met and
unmet) that they identify, but limited evidence suggests that, as compared with families
with members who have other types of developmental disabilities, they do vary in the
specific types of needs that they identify as most important, such as needs relating to
(a) personal effectiveness in obtaining, maintaining, and applying education and treat-
ment; and (b) professional effectiveness in teaming with the entire family (Siklos &
Kerns, 2006). In addition, parents with adolescent and adult family members with
ASD have been found to spend more time engaging in domestic and care activities
and less time engaging in leisure as compared with profiles of typical families (Smith,
Hong, Seltzer, Greenberg, Almeida, & Bishop, 2010), and families with preschool-age
members with ASD have reported a broad range of developmental characteristics that
emphasize the pervasive need for functional, family-centered intervention services
Figure 4.3 Five precepts for fostering a sense of commitment and building trust with families
96
Precept Definition Associated Challenges Practical Suggestions
1. Follow Do what you say you will Sometimes busy Keep on your person at all times a pen and a pocket-sized
S e c t i o n II / Early Childhood
through do. Even small lapses professionals are pulled “promises to keep” notepad, in which you can immediately
will tend to violate this in so many directions write each thing that you agree or offer to do. Set aside
precept in ways very that they simply forget to some small portion of your day to open the pad and
noticeable to families, do what they have said complete the brief tasks listed therein.
such as failure to email the they will do. Keep two lists in your daily planner: (a) short-term tasks
additional information you With good intentions and and (b) long-term tasks. Review the lists daily so that when
said you would provide. a desire to be helpful, confronted with a request to do something in addition to
It is often perceived that professionals sometimes your regular responsibilities, you can immediately make
failure to address the over-promise in relation a realistic assessment of your available time. Then,
small details places in to their workload communicate specifically how soon (or if) you can complete
question one’s ability to and what they can the task, and enter it in your “promises to keep” notepad,
address larger concerns realistically deliver. along with the communicated deadline.
and responsibilities, thus
placing trust at risk. Larger
lapses, such as missing
an appointment, can
substantially impact levels of
trust in unwanted ways.
2. Be consistent Whether challenged daily Repetitive, low-interest Use the completion of more motivating tasks as a type of
or completely ignored, tasks are often the least self-reward for completing mundane, repetitive tasks. Or,
perform at an expected motivating to complete, if possible, maintain your momentum by beginning with a
level. Sometimes we are and we therefore highly motivating task and alternating high- and low-interest
tempted to do less in terms sacrifice them first when tasks throughout the day. In this way, try to avoid allowing
of detail when no one seems challenged for time or low-interest tasks to accumulate to levels that make the
to care or be monitoring our when more motivating thought of having to complete them nearly intolerable.
performance. However, one’s tasks are at the forefront
record of performance is of our attention.
often examined in retrospect,
and reasons for altering
one’s responses can sound
very compelling at the time
they are altered but sound
very hollow later, even if only
related to a small detail such
as sending an expected but
noncritical update.
(continued)

3. Be proactive Look ahead to counter We are often subject to The reality is that beginning to be proactive can be extra
potential problems the misperception that work and effort at first, but once proactive measures are in
c hap t e r F o u r / Teaming with Families

and challenges. This the completion of current place, we often find that the current load of what we have to
is an important aspect demands completely do is pleasantly reduced. So, follow this procedure:
of leadership and drains the levels of (1) Identify and record problems or difficulties that seem to
professionalism that energy, time, and focus repetitively occur in your work and/or within the education
communicates, “I know my needed to look ahead and treatment of your students/clients; (2) identify and
profession well, and I am and act accordingly. In record the pattern(s) of circumstances, events, and/or
looking out for your welfare.” other words, “Taking actions that seem to precipitate/precede/trigger/contribute
Once potential difficulties care of today is as much to the onset of each difficulty; (3) plan how you can
are identified, provide the as I can handle. Please responsibly eliminate, modify, or decrease the effects of
support and information don’t give me one more the precipitating events or actions in order to prevent the
needed to navigate around thing to do.” difficulties from occurring in the first place.
or through them.
4. Be caring Take care of needs beyond Overly legalistic Continually apply the “What if this was my child?” test. For
those minimally required. interpretations of policies example, before applying your school’s “we do not wipe
Even small extra efforts go or requirements can runny noses” policy with a child who has a particularly severe
a long way toward building lead to unnecessarily cold or allergy, imagine that you are a parent who arrives to
trust. First, think from the restrictive behavior pick up your child, and the first thing that you notice is that
family’s perspective. Then, toward families. his face and shirt sleeves are encrusted with dried mucus.
act to make things more Perceived difficulties How would this affect your trust that the school, classroom,
convenient, less stressful, or in the workplace can and teacher will take care of your child’s daily needs?
more pleasant. be overgeneralized or Redirect thinking patterns that tend to lump all individuals
misapplied to families into a single response category (e.g., “all those parents”)
who have nothing to do or that foster a combative, “us against them” attitude. One
with them. way to do this is by first visualizing how you would most
likely respond to the individual parent/guardian/family
member of relevance while in a meeting with other parents
and professionals. Next, in responding to one or a few
individuals, resist the urge to create new rules or restrictions
that will affect all members of the larger group, by following
two rules of your own (in order of relevance and criticality):
(1) the prevention rule: “Is there more that we can do to
alter our own procedures and processes in order to assist
parents in preventing similar problems in the future?” and
(2) the critical mass rule: “Is the problem so widespread
97
and/or frequent that a new policy or rule is really necessary,
or can it be best handled on an individualized basis?”
(continued)
98
5. Be open Share information; invite Professionals can be so Start with the most basic level of information delivery;
S e c t i o n II / Early Childhood
participation; make experienced and familiar frequently check for understanding, and adjust the
processes and procedures with the aspects of their level of delivery accordingly as you proceed. Make few
transparent. Deconstruct profession that they tend assumptions, even if family members say that they are
situations and procedures to assume too much in already familiar with a concept or procedure. Rely on the
in straightforward language, regard to what parents results of direct checks of understanding before you adjust
and show the “inner and families must up or down.
workings” of potentially already know. Remember that you need variety and creativity to maintain
confusing, complex Professionals can be your own interest. So, vary delivery modes (e.g., multimedia
processes. Provide clear, required to repeat versus a handout or brochure), and periodically revise
compelling rationales for specific information presentation materials with graphics and new information.
expected effort, and involve and instructions so
families in education and Collaborate with colleagues to distribute the workload
often that they begin to and create a more friendly, cooperative atmosphere. For
treatment in meaningful slip in the integrity and
ways, being sensitive example, rather than instructing a family in a particular
completeness of what intervention technique by yourself, get the cooperation of
to their capacities and they deliver and forget
tolerances. your colleagues to conduct a joint training for all parents
that each family is a who might need it.
brand new group that
needs to be approached
as such.
It often requires more
planning and effort to
include family members
in meaningful ways than
to just “do it myself.”
that serve the twin goals of helping children who happen to be at a critical stage of
development and helping families operate more efficiently on a daily basis (Cassidy,
McConkey, Truesdale-Kennedy, & Slevin, 2008). Typically developing siblings of indi-
viduals with ASD also go through a range of reactions and needs as they age, which
may include protective responses, resentment, and worry about the future (Ferraioli &
Harris, 2010). Medical and mental health disorders add yet another dimension to this
growing picture of family needs, as the presence of these difficulties can negatively
impact the overall health outcomes for an individual with ASD and increase parental
reports of challenges in obtaining adequate treatment (Ahmedani & Hock, 2012). To
add to the difficulties often presented by the scope and number of such needs, family
characteristics such as educational level, annual income, racial and ethnic composi-
tion, stress level, age and disability severity level of service recipients, and residence in
metropolitan and nonmetropolitan areas have been found to significantly impact how
families affected by ASD access and use services to meet their needs (Thomas, Ellis,
McLaurin, Daniels, & Morrissey, 2007). See Applied Vignette 4.2 for an example of
one family’s needs.
Increasingly within the literature, components of various quality of life (QOL)
models originally created for individuals with disabilities are being applied to how pro-
fessionals assess and understand the types of needs experienced by families impacted
by disabilities. Family QOL models vary in the types of needs that they suggest, but
the range of needs within various models can be placed into three broad areas of fam-
ily functioning: social/emotional, personal/daily living, and health (see Figure 4.4 for
several QOL models and some associated family needs). This type of model provides
a useful framework for organizing and understanding the needs of families impacted
by ASD.
Social/emotional needs. Because families are made up of individuals, the over-

all social and emotional well-being of a family is, in theory, the sum of the social
and emotional well-being of its individual members. The need for meaningful social
interaction with those outside of the family, as well as the need for personal ful-
fillment in the areas of work and play, are therefore both critical to sustaining an
adequate family QOL. It could be said that well-spent time away from family respon-
sibilities makes a person more motivated and “recharged” to fulfill these responsibili-
ties upon his/her return. Although healthy interaction with other family members is
integral to fulfilling the social/emotional needs of individual family members, also
needed is positive, productive interaction with people and activities outside the realm
of family operations. These two realms of operation should ideally be balanced for
each member of the family unit according to individual and developmental needs.
Although maintaining this balance is not under the direct control of professionals
who work with families, professionals can have a significant impact on this aspect of
family QOL. Based on the findings of Davis and Gavidia-Payne (2009), it is recom-
mended that professionals:
■ Involve caregivers/parents in meaningful ways.

■ Treat caregivers as an essential part of the helping process for their children.
Figure 4.4 Quality of life models and associated family needs
General Category Model Domains Associated Family Needs
Poston et al. (2003) Emotional well-being ■ A safe, caring, responsive

Environmental home, school, and/or work life
well-being ■ Opportunities for choice and
Social well-being celebrating accomplishments
within the family
Roth, Perkins, Social contact ■ Meaningful, supportive social
Social/emotional Wadley, Temple, & interactions with person(s)
Haley (2009) valued by family members
■ Ongoing access to needed
Schippers & van Emotional well-being professional services and
Boheemen (2009) Social network supports
■ Respected roles outside of
the family
Poston et al. (2003) Child advocacy ■ The child with a disability re-
Productivity ceives appropriate educational
programming and support
Roth et al. (2009) Caregiving strain ■ Engaging in purposeful
activity with expected goals
Schippers & van Inclusion and outcomes, as well as
Boheemen (2009) Personal development hobbies and pleasurable leisure
Daily living Material well-being activities
Autonomy ■ Assistance with caregiving that
Rights allows time for personal growth
and socialization
■ Access to materials, privileges,
and opportunities like those of
one’s peers
Poston et al. (2003) Physical and mental ■ Ready access to health care
health ■ Close friends or relatives with
whom to discuss personal
Roth et al. (2009) Psychological and issues
Health physical health ■ Opportunities for enjoyable
physical exercise and a
Schippers & van Physical well-being healthy diet
Boheemen (2009) ■ Activities to relieve stress and
promote relaxation
■ Communicate respect and a supportive intent (and actively follow through).

■ Encourage families to seek out and secure available emotional support from
extended family and friends.
Health-related needs. Holistic health can involve the physical, emotional, intellec-
tual, and spiritual aspects of the human experience and is directly connected to a fam-
ily’s ability to be resilient and responsive to changes and challenges from within and
external to the family unit ( Jonas, O’Connor, Deuster, Peck, Shake, & Frost, 2010;
Westphal & Woodward, 2010). Within families, the effects of imbalances in one or
more aspects of holistic health are not isolated to the individual family member who is
directly affected. For example, Mulvihill et al. (2005) found that the severity of a family
member’s health condition negatively affected important aspects of overall family
functioning, as well as the family’s relationship with health care providers. In addition,
Montes, Halterman, and Magyar (2009) examined survey data collected from families
representing over 40,000 children and discovered that families of children with ASD
(representing more than 2,000 children) reported difficulty with obtaining school and
community health services at a rate over three times that of other families. These
same families reported a dissatisfaction with health services at a rate more than double
that of other families. These findings suggest that families with members affected by
ASD could be at greater risk for negative health-related effects, and a lack of satisfac-
tory health services can impact the health of an individual, which can then impact the
holistic health and functioning of the entire family.
Daily living needs. Daily living needs go beyond the provision of things such as
food, shelter, and safety. Not only must these things be delivered in a regular, expected
fashion, but they must also be delivered in the quality and quantity that both maintain
and maximize one’s ability to successfully meet life demands both large and small.
A child needs breakfast in order to start the day with sufficient energy and focus, but
the same child also needs a breakfast that is palatable, ready on time, and scheduled in
such a way that he/she can efficiently and effectively be on time and in place for the
start of the school day. Daily living needs are associated with the life routines integral
to the completion of the “higher-level” activities required in one’s life. For example,
one must shower, dress, eat, brush teeth, and so forth before one can be ready to
leave home, arrive at school, and begin to learn, and caregivers must establish trust
and positive rapport with a child before making significant learning and skill-based
demands. The efficiency and completeness with which these routines are completed
can often impact, for better or worse, other broad areas of life such as one’s health and
emotional well-being (e.g., the habit of hurried, incomplete morning tooth brushing
can result in both poor dental health and an emotional conflict with caregivers who are
trying to get the child to school on time), as well as more immediate demands, such as
being ready to appropriately engage in required learning and social activities.
The following suggestions for professionals are offered to assist families who are
impacted by disability in the area of daily living needs:
Listen carefully to caregivers’ stories to better discern the areas of daily opera-
■
tion that present the greatest sense of need and concern for them (Sorrell, 2007).
Resist the urge to define areas of need for families, as based on current knowl-
edge of the field or past experiences with other families.
Train caregivers in effective parenting practices through direct instruction,
■
role play, and interactive, child–caregiver–professional sessions (Brotman et al.,

2011). Helping family members act as direct intervention agents can relieve
stress and increase their sense of efficacy/empowerment.
■ Provide services in a consistent, predictable manner, organizing them to best

accommodate established family routines (Schneider, Wedgewood, Llewellyn, &
McConnell, 2006). Remember that the provision of unpredictable, logistically
inconvenient, or poorly timed services can become another unwanted stressor
for families rather than a stress reliever.
Two Prominent Theories of Family Operation

Part of understanding family viewpoints in order to provide services and supports in
the ways that families need them is having a grounded understanding of how families
operate. Although theories in themselves do not provide the practical, daily proce-
dures for accomplishing service delivery that is effective, efficient, evidence-based, and
relevant to specific needs, they can set the groundwork for how professionals view and
approach information gathering, the planning of interventions, and the delivery of
services to families.
Family systems approach. According to Turnbull and Turnbull (2001), one major
principle of the systems approach is that a family should be considered a unit that is
distinctly separate from the individuals who make it up. In other words, the opera-
tion of the family group is something very different in terms of characteristics and
behavior than the characteristics and behavior of any one individual within it. The
sum (the family unit) is different than the parts (individual family members). The
social interactions of individual members create a separate system, a family system,
of behavior and beliefs that goes beyond those of its individual members. Another
principle of this approach is that interactions among individual family members and
interactions between the family unit and those outside it create behavioral rules
known as boundaries. Boundaries tend to act as rules that allow some things into the
family unit and prevent other things from entering. The interaction of family char-
acteristics, the challenges and victories experienced by individual members, and the
formation and use of boundaries produce unique systems of family operation that
can determine how efforts on the part of professionals will be perceived, received,
and acted upon.
Implications for teaming with families. Head and Abbeduto (2007) have advo-
cated for the expansion of the model of child evaluation and treatment for ASD and
other developmental disabilities to include a systems approach. Beginning with the
premise that all family members are affected in some way by the diagnosis of ASD for
one member, they acknowledge that parents and siblings also have needs that should
be met throughout the entire process, from diagnosis to treatment and beyond. They
further propose that intervention should be designed to meet the needs of all family
members and that multidisciplinary teams are the best equipped to assess and address
the full range of these needs. In evaluating the system of a family affected by ASD, they
suggest that the following aspects be assessed: (a) the behavioral profile of the child
with ASD, (b) the impact that the child’s behavior has on overall family functioning,
and (c) how family operations and boundaries are shaped by factors such as availability

Mary Jane Describes the Needs of Her Family
When our oldest son, Rick, was 3½ years old, our were not able to give him the love and support
pediatrician suggested we have him evaluated in that a 5-year-old desires, because we were so
a developmental clinic. At that point Rick had a busy focusing on Brian’s needs.
significant speech delay, was inattentive, and was After visiting a family therapist, we real-
very “active.” The day at the clinic changed our ized that we needed to make time to enjoy being
lives, but not for the reason one may expect. It a family. We had to remember to have fun, even
was during this appointment that we discovered while engaging in the everyday, monotonous
our son did have autism. However, it was not routines of life. We started to pursue activities
Rick that had autism, but our 16-month-old son, again as a family, everything from going to the
Brian. As the appointment for Rick progressed grocery store, to eating at restaurants, to tak-
with tons of questions, observations, and so ing vacations. It isn’t always easy, but being able
forth, my husband and I came to realize that the to spend time together is precious in our fam-
picture these specialists were painting of a child ily. You see, my husband is in the Navy and he
with an ASD perfectly described our son Brian. spends several weeks or months at a time away
The next few months brought an onslaught from home.
of questions, frustrations, and realizations. We Overall, we feel that the challenges we face
were instructed to contact the community ser- are unique but not overwhelming. We found
vices board, the local public school, and private it necessary to move from the city to a small,
occupational and speech therapists. In addition, rural community. In this community, our sons
although my husband and I were both employed, go to school in a very small district with a low
we were advised to apply for financial assistance teacher-to-student ratio. In addition, we were
and Medicaid. Even for me, a veteran special able to buy a house with a substantial amount
educator, the first two years of therapy, meetings, of land to allow our sons to run and play with-
early education, and doctor’s appointments were out the risks of high traffic volume. Recently,
overwhelming. Fortunately, with the assistance our oldest son Rick was diagnosed with ADHD,
of the community services board, early interven- anxiety disorder, and Asperger’s syndrome. This
tion, and dedicated therapists, we were able to revelation has not altered our lives. Actually, it
positively address many of the initial obstacles has made life a bit easier because we were able
that families encounter when they have a child to provide Rick with the additional assistance he
with special needs. needed.
However, as Brian grew, more obstacles Brian’s and Rick’s disabilities have vastly
sprang up. Problems with the school program, limited the number of military assignments my
availability of support services, and a lack of husband can apply for because he must be sta-
appropriate after-school activities provided con- tioned within close proximity to a major naval
stant challenges. As a family, we began to feel medical facility so that the boys continue to
the strain of these battles. We found that most receive the services they require. Despite their
nights we were so exhausted from working, unique needs, our sons are progressing quite
emailing, letter writing, and providing therapy well. They are each able to speak about their
that we didn’t even have time to play with our “quirks” in a positive manner in order to assist
sons. In addition, Brian began to sleep less than others in understanding their differences. My
three hours each night, greatly depleting our husband and I are excited for the future, and we
levels of energy and patience. Rick seemed to hope that with continued assistance from the
suffer the most during this period. Overall, we schools, specialists, and therapist, both our sons
(continued)

will grow up to be happy, contributing members their definitions of the family’s needs over
of society. time?
3. What professionals, services, and/or sup-
Discussion Questions
ports (e.g., extended family and friends)
1. What have been the longitudinal needs of might best provide for the needs identi-
this family, as described by Mary Jane? fied in items 1 and 2?
2. This vignette is written from the point of 4. What can professionals do to help fami-
view of the family’s mother. How do you lies through the onslaught of questions,
think the father, the oldest son (Rick), and frustrations, and realizations that often
the youngest son (Brian) might differ in accompany a diagnosis of ASD?
of and access to services and supports for their child. Other implications of viewing
the process of teaming with families in terms of a systems approach are as follows:
■ Experiences with past therapists/interventionists/medical personnel/teachers can

affect the ways in which families work with or refuse to work with current profession-
als. Negative past experiences may require a significant period of trust and rapport
building on the part of current professionals before families provide their full coopera-
tion and allow professionals to have extensive access to the family system.
■ Professionals may find that a sole focus on the service recipient that ignores the
unmet needs of other family members will tend to maintain a “barrier” to the most
efficient/effective levels of service provision and family follow through.
■ Professionals may find resistance to changes in family functioning that has
developed in response to the behavioral profile of the child with ASD, even though
this functioning is known by the family to be radically different from the norm. For
example, a family who rarely or never goes on outings to restaurants or other public
places because of their child’s behavior may need significant support to begin doing so
as part of an intervention to increase social engagement.
The ecological approach. This approach was conceived by psychologist and child

development researcher Urie Bronfenbrenner, who proposed that the needs of fami-
lies can be viewed in terms of a series of systems of ever-widening scope within which
families live and operate (Bronfenbrenner, 1986). These systems were labeled (from
small to large) micro-, meso-, exo-, and macrosystems. At the microsystem level, fam-
ily needs are defined within home and community settings, and relevant areas of oper-
ation include interactions with, for example, immediate family, school, neighborhood
friends, and church. At the mesosystem level are the interactions and relationships
among microsystems, such as the ways in which school and home experiences affect
one another. The exosystem level consists of social agencies in which the target indi-
vidual has no active part, yet these agencies directly influence the individual’s life, for
example, a parent’s level, type, schedule, and location of employment. Macrosystems

represent the broadest context of Bronfenbrenner’s original theory and encompass
cultural beliefs, values, and attitudes of the broader society that can impact social func-
tioning, such as the system of government, laws, or organized religion.
Implications for teaming with families. Swick and Williams (2006) outlined some
important implications for families with young children who are currently experi-
encing the effects of one or more stressors in their lives. First of all, microsystem
elements can provide the ultimate base of stability for child and family or, at the oppo-
site extreme, be the ultimate source of introducing instability into the mesosystem.
Second, positive interactions within the mesosystem can work to provide structure
and stability to the microsystem. One can think of these two ideas in terms of home
(microsystem) and school interactions (mesosystem: the interaction between home
and school). Chaos or stability at home can easily be translated to school, and effective
or ineffective educational programs can greatly impact life at home, which can also
be translated back to school in a type of response feedback loop. Although one may
tend to compartmentalize thinking about these systems as a convenient way of easily
managing complex ideas, in terms of the ecological approach, it is nearly impossible to
separate these contexts of operation from one another in terms of their overall effects
on family. In addition, experiences within the exosystem have great power to influence
families, as the stress or calmness communicated from, for instance, adult experiences
with employment and financial issues can affect the emotional climate within which
family members operate. At home, there may be problems with trying to budget the
extra expense of a special school for a child, and at school, there may be a teaching staff
that is overworked and underpaid. Although a child may have no influence over either
of these areas of difficulty, he/she can certainly be impacted by them, as can the func-
tioning of the family as a whole. Macrosystems are often the source of needed services
and supports for families, and family members may therefore find layers of protection
from harm within these systems, though the policies, laws, and procedures originating
there can also impact the exosystem in positive or negative ways. For example, state
government law and policy (macrosystem) could provide either relief or further pay
cuts to the overworked, underpaid teacher (exosystem). It is therefore important that
professionals of every type and at every level be mindful of the following:
■ From the passage of relevant federal and state laws, all the way down to the avail-
ability of an “ASD friendly” dentist or babysitter, child care workers and other profession-
als must work in accord to address the needs of families who have members with ASD.
■ Whether they work directly with one another or not, professionals do not operate
in isolation. The effects of one program or service can greatly impact the functioning of
the family in regard to how they access or operate within other programs and services.
■ Families can be empowered through the use of an ecological perspective by
professionals seeking to give them skills for self-advocacy and recruiting needed sup-
port. For example, parenting and ASD intervention skills (microsystem), educational
and programmatic advocacy with schools (mesosystem), how to seek stress relief and
Consider This
Though professionals may not have direct con- this disorder, consider the roles that siblings and
tact with or influence upon siblings and extended extended family members, such as uncles, aunts,
family, these family members can be an integral and grandparents, might play in care giving, deci-
part of the operation and support that directly sion making, and the application of education and
influences what professionals can and should do treatment. Also consider the possible effects upon
when teaming to provide services for an individual these members, especially as their expectations
with ASD. In attempting to more fully understand and emotions come into play throughout the life
the perspectives and needs of families touched by span of their family member with ASD.
emotional support from others (exosystem), and ASD policy and law advocacy (e.g.,
for the availability of autism health insurance) at the local, state, or federal level (mac-
rosystem) can each be taught as part of a comprehensive program for assisting families.
Methods for Fostering Successful Teams

Successful team building should begin with establishing a shared set of beliefs from
which all else within the organization will originate and emanate—a set of beliefs that
successfully integrates and encompasses education law, principles of professional ethics,
and best and effective practices. How important is taking this step within the process
of fostering successful teams? If we imagine the organization, school, clinic, practice,
or agency as an actual building, these shared beliefs would not only be the foundation
that holds up and stabilizes the rest of the structure, but they would also be the rivets,
nails, and cement that permeate the entire structure and hold all of its parts together.
Therefore, establishing a shared set of beliefs within an organization means establishing
a coherent set of programmatic philosophies, procedures, and practices that can (a) be
systematically taught to faculty and staff, (b) be used to effectively secure family buy-in
and cooperation, (c) be easily reconciled with the current ethics of the profession and
best and effective practices in the field, and (d) serve as the starting point for all else that
is planned and implemented within and across all aspects of the program. The ultimate
goal is to be able to walk up to several employees within the school, organization, or
clinic, ask about relevant programmatic philosophies and procedures, and receive across
all respondents the same answers with the same levels of detail and quality (or, at the
very least, be guided to another reliable source for the answers). If this foundation is not
defined, taught, and tied to expected outcomes for all involved, faculty and staff patterns
of speaking and behaving within the setting will still tend to be shaped by something, and
if that something is left to chance, it could be connected to undesired attitudes, philoso-
phies, and personal contingencies that run counter to building and sustaining effective,
efficient teams. Ultimately, the members or employees of an organization should begin
with identifying their driving philosophy (ways of thinking), use this philosophy to define
specific operating procedures (using ways of thinking to guide our planning), and use the
procedures to define how specific practices will be implemented (using philosophy-based
planning in our everyday actions). Using this process of development makes it much
less likely that a disconnect will occur between what organizations say they should do
(e.g., expressed philosophy, as found within a brochure or on a website) and what is actu-
ally performed on a day-to-day basis. Ideally, the actual demonstration and impact of a
grounding philosophy should be evaluated throughout all parts of the program, from
evaluating those who apply for employment, to monitoring daily operations, to assessing
individual outcomes of service recipients. (For an example and counterexample of this
progression within a public school environment, please see Figure 4.5.)
Well-Grounded Philosophies, Procedures,

and Practices
Facilitating the teaming process also means that the specific philosophies, procedures,
and practices adopted and implemented must be specifically focused on serving fami-
lies and their members with ASD, as well as on fostering true partnerships. As dis-
cussed elsewhere in this chapter, ASDs bring with them many challenges, needs, and
treatments that are often unique in type, intensity, and scope as compared with other
disabilities, and this means that a “one size fits all” approach to service delivery for stu-
dents with disabilities probably will not translate well to best serving families affected
by an ASD. When we begin with a philosophy of family-centered care, move to the
design of appropriate principles of operation (procedures), and end with the imple-
mentation of effective practices, it should be within the context of the knowledge and
understanding we have already built in regard to the needs and challenges of families
impacted by ASD, as well as the specific features of the diagnosis itself.
Family-centered philosophy of care. Beatson (2006) recommended that a family-

centered philosophy of care be taught to teachers and other professionals through
the intervention and leadership skills addressed within training programs, as well as
through the direct experiences with families provided as a part of such programs.
These recommendations were derived from a concept of family-centered care that
involves components such as those described here in terms of “the three Rs”:
Receptivity: Professionals should be continually open to and seek to promote

■
(a) avenues of clear communication, (b) methods for meaningful inclusion, and
(c) the realization that family members are the “main authorities” on the student.
Responsiveness: Professionals must learn to respond appropriately and effectively
■
to issues of diversity, the need for flexibility in approaches and methods, and the
various ways that families have developed to manage the day-to-day operations
associated with having a child with ASD.
Responsibility: Making important decisions should be a shared effort among fam-
■
ily members and professionals, to the full extent that families can and are willing
to participate. Family involvement in decision making should be a given, and
professionals should make this process part of all aspects of their service delivery.
Figure 4.5 Example and counterexample of the conceptual movement from grounding phi-
losophy to actual practice
Defining Philosophy Procedural Planning Specific Practices

Example: * ~Within educational settings, Part of the special education * ~A more parent-friendly
Parent & Student Rights parents and students with intake process will information packet is
disabilities have important involve a ^meeting with developed,~ and specific
rights~ to ensure fair treatment, parents,^ during which information is included on the
the implementation of best !instruction and review! !school website,! along with
practices, and the increased of a ~printed document !important links to sources of
probability of positive outcomes, describing parental and related information.!
~and parents should be student rights~ will take * A brief ^multimedia
informed of these rights~ (basis place. +All members of the presentation^ is developed for
for this philosophy: federal special education faculty+ the parent and student rights
education law). should at some point meeting, along with the
* +Schools and school participate in conducting ^addition of a question and
personnel+ should strive to these meetings. answer session^ at the end.
provide family-centered * +A small group of teachers+
services that are both team teach the presentation to
!informative! and ^supportive^ parents, and +the members
for families and their of this group are rotated
individual members (basis periodically.+
for this philosophy: ethical
principles of
Counter Example The resulting school The implementation of the
professional teaching policy is not systematically
organizations). policy is that parents/
guardians should be monitored and enforced.
provided with a ~document Since no specific person(s)
outlining student and parent are responsible for the
rights~ as outlined throughout policy, all special education
the special education process. teachers are not given
copies of the document to
distribute on a regular basis.
Philosophy disconnect 1
Some teachers distribute them
(partial): This policy represents
only if parents/guardians know
planning that takes the
to ask for a copy, and others
minimalist approach of simply
“forget” to distribute them to
handing a document to
parents/guardians considered
parents, instead of also
to be particularly “bothersome.”
addressing the ethical
Therefore, it is often the case
standard of being fully
that if/when parents do request
“informative” and “supportive”
a copy of the document, the
in aspects of service delivery
response they receive is, “Oh,
to families. It also ignores any
I’ll have to see if I can go make
type of meaningful
you a copy,” or “Let me send
participation by school
you one. What is your email
personnel.
address?”
Philosophy disconnect 2 (full):

The error in disconnect 1 is
made worse by a lack of
(a) procedural integrity, and
(b) peer group and administra-
tor monitoring, and what occurs
in regard to implementing the
school’s policy is now totally
disconnected from the
appropriate grounding
philosophy.
Note: The defining philosophies are the same for both the example and counterexample. However, in the counterexample,
a disconnect from the defining philosophy occurs at multiple points, starting at the point in which procedural planning
begins. You may follow elements of the grounding philosophy throughout the process by focusing on content that is
bracketed by the following symbols: ˜, +, !, and ^.
In learning to apply the three Rs of a family-centered philosophy of care, professionals

who will work with persons with ASD should seek out and even construct their own
meaningful, authentic family interactions in which assessment, program development,
and intervention are integrated with direct demonstrations of the Rs in action. It is rein-
forcing for the learner to connect a growing professional competence and effectiveness
with a growing sense of what it means to, for instance, respond directly to the specific
needs and challenges of a particular family in how services are conceived and delivered.
Layered kinds of approaches, or those in which learning about the theory behind the
Rs is only provided within separate educational contexts or courses, tend to produce
learners who later “shed” layers that do not seem relevant to the current requirements
of a new environment, for example, a new job taken after college graduation. Figure 4.6
incorporates the implications that Beatson (2006) listed for establishing the necessary
connection between a family-centered philosophy and the components and approaches
of training programs for professionals who will work with persons with ASD.
Establishing appropriate principles of operation. Planning principles and proce-

dures of operation is a vital part of what professionals do in the process of designing and
implementing effective services for families affected by an ASD. It is sometimes assumed
that this type of planning can be accomplished through the use of highly structured
forms or manuals detailing procedural requirements, and that this will be enough to
ensure planning that is both legally and educationally sound. However, there is no sub-
stitute for planning that originates from a grounded understanding of the why behind
Figure 4.6 Necessary connections for establishing and learning a family-centered

philosophy of practice
Three Rs Connection:
1. Receptivity: Effectively
addressing family questions
and concerns
ASD Connection: Responsiveness: Designing
1. Core symptoms of ASD, treatment programs that
evidence-based practices incorporate family
for education and treatment preferences and culture
Responsibility: Family
2. Wide range of involvement in assessment
characteristics and needs and intervention planning
Training Program within and across 2. Receptivity: Developing
Component: individuals, requiring a effective listening and
range of professionals speaking skills
1. Assessment and
Responsiveness: Setting
intervention process
agendas and facilitating
2. Interdisciplinary meetings
collaborative teams Responsibility: Sharing
leadership and empowering
families to effectively
address a range of
characteristics and needs
Source: Based on Beatson (2006).

foundational principles, which implies that one knows both the letter and intent of these
principles. Zirkel (2011) studied court decisions under the Individuals with Disabilities
Education Act (IDEA) published across a 14-year period (1993 to 2006) and found that
nearly one-third of these cases (a) involved students with autism, and (b) were related
to foundational principles dealing with free and appropriate education (often referred
to as FAPE) and least restrictive environment (often referred to as LRE). Perhaps
more importantly, he also found a 10 to 1 ratio when the proportions of court cases
and students with autism in special education were compared across the same review
period. As illustrated within this review, failure to understand and correctly apply legal
and educational principles governing how (FAPE) and where (LRE) individual students
with ASD should receive services can have real, high-stakes outcomes for all involved.
The key to understanding these principles is in the diligent study of informa-
tional resources, such as those previously mentioned, but the key to applying them
appropriately (i.e., establishing appropriate principles of operation) is in the incorpo-
ration of (a) a family-centered philosophy of practice, and (b) up-to-date knowledge
and skills in the assessment and treatment of students with ASD. For example, Yell,
Katsiyannis, Drasgow, and Herbst (2003) derived from their review of ASD litigation
the following guidelines for program planning, summarized here in terms of family-
centered philosophy and current knowledge and skills:
Family-centered philosophy of practice:

■ Meaningful involvement of parents in the planning and implementation process. Ensure
adequate quality and quantity of parent participation in the individualized education
plan (IEP) process by: (a) fully informing parents of due process rights, (b) being timely
in responding to requests for assessment and evaluation, and (c) working efficiently and
effectively toward cooperative completion of IEP design and implementation.
■ Accountability to parents and other stakeholders. Collect and share relevant student
data to demonstrate to parents and other team members that these data are being used
in data-based decision making in the design, delivery, and ongoing revision of instruc-
tional practices.
Up-to-date knowledge and skills:

■ Use of qualified personnel. Student evaluations should be comprehensive and con-
ducted by professionals with specific experience and training in ASD. These profes-
sionals can be employed by the school district or contracted specially for this purpose.
■ Systematic, comprehensive planning. The process from evaluation results, to interven-
tion ( IEP development), to appropriate educational placement must be followed system-
atically (e.g., all areas of need identified in evaluation must be directly addressed in IEP
development and taken into account in placement decisions) and comprehensively (e.g.,
academic, social, communication, and behavior skills should be addressed, as needed).
■ Use of research-validated practices. Programs of education and treatment should
be based on methods and strategies readily identifiable as evidence-based practice,
meaning that there is a sufficient quantity and quality of research in the field of ASD
that substantiates the program design.
Engaging in effective practices. Despite the growing body of books and research
articles that discuss various elements of effective practices for students with ASD,
few attempts have been made to produce “big picture” conclusions from all of these
sources. It is difficult for teachers and clinicians to locate, access, and integrate the
findings and recommendations from the many available sources of ASD-related litera-
ture, and the question for many schools and school districts therefore remains: “What
exactly is effective practice for students with ASD?”
From their review of ASD research, Iovannone, Dunlap, Huber, and Kincaid
(2003) identified six “core elements” of instructional programs that have been found
to be effective in the education of students with ASD. Similarly, O’Brien and Daggett
(2006) discussed eight “characteristics of effective intervention” for children with
ASD. Overlapping areas across these two analyses are: (a) family involvement, (b) sys-
tematic instruction, (c) structured/predictable learning environments, (d) specialized
curriculum content, and (e) a functional approach to challenging behavior. Additional
areas from the two analyses are individualized supports and services for students and
families (Iovannone et al., 2003) and early, intensive intervention (O’Brien & Daggett,
2006). Within Figure 4.7, these educational practices for students with ASD are illus-
trated in terms of the “Three Pillars of Effective Practices.”
Figure 4.7 The Three Pillars of Effective Practices in programs for students with ASD
Effective Practices for Students with ASD
Core Symptoms Instructional Behavior

Environment
• Early intervention • Individualized goals, • Functional approach to

instruction, & supports challenging behavior
• Intensive intervention
• Structure & predictability • Reducing problematic
• Specialized curriculum behavior
content: social and • Systematic instruction
communication skills • Building appropriate
replacement behaviors
Source: Based on Iovannone et al. (2003) and O’Brien & Daggett (2006).
Family Team Building

Building teams made up of professionals and families should be an action-oriented
task, meaning that teams are defined by what they do and that team members must
be active participants who value the roles and responsibilities of other team members.
Otherwise, the risk is that an individual will be a member in name only, without a
purposeful, respected role in the process. Part of the construction of teams is assess-
ing the strengths and motivation levels of members in order to define the roles and
responsibilities with the best fit for each individual, thereby maximizing the potential
for active participation across all members.
However, at the teaming with families stage of professional collaborative develop-
ment, too much emphasis can be placed on defining for families how they “should”
interact within the teaming process, and too little emphasis can be placed on the
learned and demonstrated behaviors of professionals, where it should be placed at
this stage. Therefore, the following team building components are discussed from the
professional point of emphasis, with added information on implementing each com-
ponent in a family-centered manner that will increase the likelihood of meaningful
family involvement and participation. The ultimate goal is to create an intersection of
ASD-focused leadership, program development, and program implementation, with
the family at its center, as graphically depicted in Figure 4.8.
Cultivating leadership. It is important to understand that effective leaders do

not push others from behind or simply move ahead and wonder why no one else is
following. True leaders motivate others to follow their demonstrated lead, provide a
Figure 4.8 Family-centered philosophies, procedures, and practices Methods for

fostering successful teams include a foundation of well-grounded philosophies, procedures,
and practices upon which is built an intersection of ASD-focused leadership, program devel-
opment, and program implementation, with the family at its center.
Well‐Grounded Philosophies, Procedures, & Practices
Leadership Program Development
Program Implementation
level of support and training to others that is equal to or greater than the demands
of the task, and follow through by assessing, reporting, and being responsive to con-
nections among specific actions of the team and specific, goal-related outcomes. In
fact, sometimes the best leaders are not recognized as being “in charge” at all, at
least not in the sense often conjured up by the words “supervisor” or “administra-
tor.” Yet, it is often difficult for anyone to argue that effective leaders have no signifi-
cant, positive impact on the direction, style, and effectiveness of the team. They tend
to do so by empowering others rather than by trying to promote the illusion of control
over others.
Rafoth and Foriska (2006) proposed a model of educational leadership that, in
line with their analysis of the relevant professional literature, includes the key com-
ponents required for establishing the most effective teams. First of all, they proposed
an “interactive model of influence” within which leaders and other team members
communicate with and respond to each other regarding their needs in doing the work
of the team and the appropriate supports required to meet these needs. Second, they
proposed a component of “shared leadership” in which those identified as leaders rec-
ognize the appropriate ways they can invite other team members to share in decision
making and effectively make them leaders too. Last, they included the component of
“administrative support” in which recognized leaders provide to team members such
things as training, emotional support, and coordination of the efforts and inputs of
team members. So, the progression of the leadership cycle within a team might look
something like the following “identify, plan, provide” model: (a) Identify and com-
municate team members’ needs and supports, including your own; (b) plan avenues
for sharing leadership; and (c) provide needed supports to members for accomplishing
team goals (repeat cycle on a regular basis as the team evolves). Within the implemen-
tation of this cycle, professionals should also seek to provide leadership through the
following general activities:
Promote research-validated interventions for students with ASD, explaining to

■
families the rationale behind the use of such methods.

Motivate families by sharing successes in the treatment programs of other stu-
■
dents (with permission, and within the legal and ethical boundaries of confiden-
tiality). Also address student self-determination and family needs by teaching
functional skills that will facilitate successful completion of daily activities.
Summarize data graphically, and use it to demonstrate how data-based treat-
■
ment decisions are made.

Repeatedly model any treatment method or component to families before ask-
■
ing them to think about implementing it with their child. Then, provide guided
assistance to them as they attempt it, and gradually fade assistance as their confi-
dence and skill improve. The “here, go try it” approach is not leadership.
Developing programs of education and treatment. There is much to do in

the process of developing programs of education and treatment for students with
ASD—much that is required by federal and state law, school and agency policy, and
professional standards of practice. Within this complex process, much of which is on

a timeline with limited flexibility from start to completion of almost every step, the
goal of teaming with the families of students with ASD can get minimized, or even
completely lost. The required, procedural steps of family involvement at critical points
in the process may still be followed, but they may be followed in terms of the child and
family being “just another case” that must be methodically addressed in order to avoid
litigation and keep the intake process moving along smoothly. It is also easy to slip
into thinking about educational programs solely in terms of assessment results, critical
domains of functioning, specific skills and subskills, and educational and behavioral
goals and objectives. Although these areas are vital aspects of program development
for students with ASD, school and support agency personnel should remember the
“with” in “teaming with families,” which implies that there is mutual, two-way agree-
ment between professionals and families to be engaged in the range of activities that
define “teaming.” Professionals who mechanically move through a set of requirements
without fully engaging or meaningfully involving families in the process are perhaps
involved in “teaming near families,” or “teaming at families,” but they are certainly not
engaged in “teaming with families.”
Ruble, McGrew, Dalrymple, and Jung (2010) used specific IDEA provisions and
recommendations from the National Research Council to assess the quality of the
IEPs of young children with autism. They found that the IEPs they obtained had low
to inadequate quality across all student, teacher, and school characteristics, in areas
such as the “measurability” of learning goals and objectives and descriptions of spe-
cially designed teaching methods. In addition, they found that only about half of the
IEPs included descriptions of identified parent concerns, raising the question of the
level and quality of active family involvement in the IEP creation process.
In consideration of these findings, it is important to consider how best to individ-
ualize for families the following critical concepts, and incorporate them in the process
of developing programs of education and treatment for students with ASD:
■ The concept of social validity refers to the significance, appropriateness, and

importance of treatment procedures and goals, as judged by those socially connected
to the individual receiving the treatment (Wolf, 1978). Informally measuring the
social validity of programmatic features as implemented can involve asking about
things such as time commitment, convenience, monetary cost, perceived effective-
ness, and ease of implementation associated with a particular treatment or edu-
cational program. Responding to family opinions and concerns in these areas can
positively affect their levels of participation and motivation in regard to a particular
treatment or program.
■ Prior to initial IEP meetings, explain to parents the expertise of each profes-
sional member of the team, and end with the explanation that parents and family
are included as (a) experts on the student who have unique, important knowledge
about and experience with him or her; (b) advocates for the student’s specialized
needs; and (c) active participants in the design of the student’s educational program,
roles that are vital to the functioning of the team. Regarding each of these roles,
structure for families a series of questions (about the student and his/her strengths
and needs) to think about prior to the meeting, which they can address in writing,
if they so wish.
■ During initial IEP meetings, organize time and opportunity for parent partici-
pation that is at least equal to that planned for each of the professionals in attendance
(more is better, however). A greater proportion of professionals “talking at” parents
may indicate the need to more regularly and directly ask for parent comments and
input (perhaps by asking for their answers to the questions that were provided prior to
the meeting). Make notes of parent concerns, ideas, and preferences, and repeat infor-
mation back to the parents for a check on understanding. Follow their lead by using
their comments and suggestions within the programmatic recommendations put forth
by professionals during the meeting.
■ After IEP meetings, follow up with families using your notes on their prefer-
ences, and remind them of how their preferences were incorporated within recom-
mendations for the IEP. At this time, check for further parent recommendations and
confirmation of previous recommendations.
Implementing programs. Family involvement in the sound conceptualization and

planning of educational programs for students with ASD is essential, but it is impor-
tant to remember that a mere plan is not an active program. Much can change in
unintended, unwanted ways when plans are actually executed in complex educational
environments, and professionals must therefore be diligent in monitoring and evalu-
ating how specific features of programs are actually implemented, how student out-
comes are affected, and the quality and quantity of ongoing family involvement in the
implementation process.
Stichter, Crider, Moody, and Kay (2007) described a project conducted with
an educational agency that provided services for students with disabilities in a
group of independent school districts. Among other aspects of the project, a multi-
disciplinary team was created to design and implement a curricular framework for
students with ASD, a framework that served as a guide for developing effective
educational programs for these students. As a result of the project, family par-
ticipation increased, and the number of complaints and lawsuits decreased. This
additional outcome of the project was attributed to increased informational and
educational support provided to families through a range of materials and meetings
that explained ideas integral to the project, such as curriculum and IEP develop-
ment for students with ASD. The design of educational services for students with
ASD was much improved, but this alone did not result in the improved relation-
ships with families. Families were involved in and informed about the project in
ways that were meaningful to them, and this made them members of a team with
shared goals, rather than a group given the option of accepting or rejecting the
goals formulated by an educational agency.
Therefore, it is important to consider how best to individualize for families the

following critical concepts, and incorporate them in the process of implementing pro-
grams of education and treatment for students with ASDs:
■ Treatment integrity: Monitoring the implementation of educational procedures to

ensure that they are implemented as originally intended and designed (Sanetti &
Kratochwill, 2009). Monitoring treatment integrity can be as simple as complet-
ing a checklist of required activities or as complex as making detailed observa-
tions of teacher and student behavior during instruction.
■ Fostering buy-in and involvement through accessible instruction and informational
support: It is often the case that people are cautious about, and even distrustful
toward, what they do not fully understand, especially when there is potential
for a loved one to be directly impacted. Using varied informational materials,
formats, and instructional methods to demystify, define, and deconstruct the
ongoing approaches used in program implementation can go a long way toward
preventing misunderstanding and conflict.
■ Engaging in organized, group-oriented social interactions: Meetings, conferences,
round table discussions, focus groups, and so forth that bring families together
so that professionals can request input and provide information and support
involve a direct demonstration of professional accountability and accessibility.
It is recommended that such interactions involve the formation of measurable
action steps, the assignment of responsibilities to specific persons or groups,
and the scheduling of follow-up activities to assess effectiveness. Without these
components, organized group interactions can quickly become disorganized and
produce frustration due to the perception of ineffectiveness or inaction.
Enhancing Communication among

Team Members
For team members to be informed and act in concerted, efficient ways in regard to
one another and the goals and objectives of the team, a sufficient quality and quan-
tity of communication must occur. The form(s) that this communication takes should
be dictated by the individual preferences of team members, the type and quantity of
the information to be shared, and the urgency with which ideas must be communi-
cated in order for prompt action to occur. Though communication should be initi-
ated, facilitated, and organized by professionals, it should be open to initiation by and
access to all members of the team, especially to the family members being served. Risk
factors hampering the provision of clear communication by professionals include:
(a) provision of a series of “lectures” or directives, rather than responsive, two-way
communication; (b) the overuse of jargon and other technical terms, making infor-
mation inaccessible to nonprofessionals; and (c) acting on preconceived assumptions
regarding how and when communication should take place in order to be most effi-
cient/effective. Effective communication with families should therefore be useful in
regard to the specific needs of all members, delivered in a positive and reinforcing
manner, sensitive to multicultural concerns, and part of a preestablished plan.
How to Communicate
Professionals are often busy people, and being overextended with work responsibilities
sometimes contributes to a lack of forethought in how important information will be
delivered across team members. It is therefore important to be continually mindful of
audience and intended purpose when communicating. While a brief note containing pro-
fessional jargon and acronyms of the names of various diagnostic instruments may be
efficient and effective communication when sent to an informed colleague, the same note
may spark confusion and even panic when sent to a parent or guardian. In addition, being
“too busy” is no excuse for failure to regularly communicate with the family of a service
recipient, for systematic, clear communication with stakeholders is one of the expecta-
tions across all helping professions. In their discussion of communicating with family
members of service recipients, Siemens and Hazelton (2011) recommended that com-
munication with families be progressive, aware, face-to-face, sensitive, and supportive.
Progressive. Although families need relevant and useful information from profes-
sionals on a regular basis, providing too much information at one time can actually
be a potential barrier to clear communication. Initially, family members dealing with
the meaning and implications of a new diagnosis often need help with next steps
rather than a titanic download of all information regarding the disability and its treat-
ment options. One must have a good understanding of the progression from diag-
nosis, to effective treatment, to meeting changing needs throughout the lifespan in
order to gauge the right timing, amount, and type of information to be provided. This
approach in no way implies that relevant information should be held back from fami-
lies that are in need of it. Rather, it suggests that professionals become more aware of
the individual capacities of families to assimilate and accommodate information that is
often radically new to them. When families indicate readiness to engage in their own
information seeking and retrieval, the professional should act as facilitator in guiding
them toward appropriate sources and types of information that will ensure both the
integrity and soundness of the information, as well as its usefulness in meeting their
expressed needs.
Aware. Communication that is aware tends to go beyond the communicative task at

hand (e.g., filling in the report or discussing assessment results) by overtly seeking to
follow up on any signs of stress, difficulty, or impaired quality of life associated with
providing care and support to a family member with ASD. The process of following
up on directly or indirectly communicated difficulties can be more formal, such as
administering a depression screening tool, or more informal, such as referring some-
one to an appropriate, qualified professional, program, or service that can provide spe-
cialized help. It is therefore recommended that professionals make themselves aware
of available supports and services for families and have this information handy before
it is needed.
Face-to-face. It is understood that all communication between professionals and

families cannot be face-to-face, but a regularly scheduled portion should be. Talking
in the presence of family members allows for the interpretation of facial expressions
and voice inflection and tone that email and other written communications do not. In
addition, this type of meeting may be more conducive to sharing sensitive informa-
tion, evaluating the integrity of family-implemented interventions, or observing new
developments in client/student behavior or health.
One suggestion for busy professionals is to use email, phone calls, and other
types of non-face-to-face communication for the delivery of formative information,
or the smaller “chunks” of information that stakeholders need on a regular basis, such
as daily or weekly progress reports. Face-to-face meetings can then be used for the
delivery of summative information, or the larger, more high-stakes information that
stakeholders need much less frequently, such as monthly or biannual goal evaluation
sessions. However, with the increased availability of affordable high-speed Internet,
web cams, and free videoconferencing software, it is conceivable that virtual face-to-
face meetings could occur with much greater frequency.
Sensitive and supportive. Communication that is sensitive tends to be patient and

attentive, with a greater proportion of listening than speaking, and is a prerequisite
to supportive communication. Once professionals have been patiently attentive, they
are in a position to be supportive in their communication by affirming the efforts of
caregivers and acknowledging caregiver feelings (e.g., feeling overwhelmed), efforts
for their family member with ASD, and areas of competence in their provision of
direct care. It is recommended that only at this point should professionals begin to
be prescriptive, offer coaching, and provide useful methods of further intervention or
necessary adjustment of established procedures, for the door of receptiveness is more
likely to have been opened through the communication of caring responsiveness. This
is in effect the quid pro quo (or give and take) of effective professional communica-
tion with families: “I have willingly accepted and understood your communication and
offered support and positive reinforcement for your efforts. Now, I hope that you will
accept my offer of help in trying to make things better for your family.” It is not such
an improbable hypothesis that knowledgeable professionals who practice these simple
rules of communication will experience greater success in meeting the needs of the
families in their care.
Providing for Information Needs

Although families of children with autism vary in (a) how they acquire and use infor-
mation regarding ASD, (b) their level of involvement in acquiring this information,
and (c) perceptions of their own expertise in the area of ASD, they tend to have one
thing in common: Their desire and need for new information regarding the disability
tends to be relatively constant across progressive aspects of diagnosis and treatment

(Hall & Graff, 2010). In order to best ensure that family members in various stages
of mental and emotional readiness can benefit from the delivery of needed informa-
tion, it is recommended that professionals present this information in a specifically
organized manner and in a varying range of formats (Friedemann-Sanchez, Griffin,
Rettmann, Rittman, & Partin, 2008).
Information presentation. Information about ASD should be presented in an hon-

est and thorough manner, though the straightforwardness and comprehensive nature of
the information should be tempered by kindness and sensitivity in regard to the weight
of the potential impact it could have on the well-being of family members. For example,
in an attempt to be honest with a family, rather than making a negative prediction
simply because it is the most probable outcome for a particular set of characteristics
and circumstances, it may be better to present the full range of possible outcomes (both
positive and negative) with associated probabilities, because professional predictions,
no matter how well grounded in research-based probability, have the potential to be
confounded by the unknown limits of human resilience. Professional jargon should not
be avoided altogether, for this may limit a family’s ability to later conduct research for
further information or to completely understand verbal or written references regarding
their family member. Rather, in association with terms and conditions discussed in the
simplest language possible, provide limited jargon that will create a bridge of under-
standing for families. Strive to educate, not obfuscate (or confuse). Other suggestions
are to use visual aids whenever possible and to organize the delivery of information into
“currently useful” and “for future reference” categories for families.
Information formats. Some professionals rely solely on verbal delivery when

providing information, for the level of their knowledge and familiarity with the
subject matter make this the easiest and most convenient mode of delivery for
them. Many others use verbal delivery and supplement it with printed material,
such as technical reports or text-based brochures, thinking that this will better
communicate needed information to families. While this is a step in the right direc-
tion, it does not fully comprise the journey toward varying and interconnecting
multiple formats for the most effective information delivery. The use of models,
diagrams, photos, written materials, verbal instruction, movies, and Internet-based
resources is encouraged, as is integrating as many of these formats as possible. For
example, one can easily include all of these elements within a presentation created
using one of the free or commercially available presentation software programs,
and supplemental handouts or brochures containing Internet links to relevant web-
sites/resources, definitions of technical terms, illustrations, and/or summaries of
slide information can also be provided. Preparation of informational materials can
be somewhat time consuming on the front end, but maintenance and updating of
these materials is relatively easy once they are created. In addition, the associated
benefits of increased understanding and potential for positive action on the part of
families cannot be overestimated.
Multicultural Considerations
Within a multicultural context, all points of professional contact with families present
challenges to clear and efficient communication that must be considered, especially in
regard to the fact that multicultural learners with disabilities are often at risk for being
incorrectly/inappropriately identified, categorized, placed, and instructed (Wilder,
Dyches, Obiakor, & Algozzine, 2004). In order to reduce the potential for error that
could adversely impact diagnosis and treatment, professionals must understand critical
points within diagnosis and treatment at which communication can go awry, as well as
specific strategies for clear communication within these contexts.
Diagnosis and multicultural communication. El-Ghoroury and Krackow (2012)

identified several culturally sensitive considerations to make during the ASD assess-
ment process. Among these are parental understanding of assessment procedures and
results, child language issues during assessment, and parental and cultural expectations
of child development and behavior.
Cultural differences alone can affect communication during implementation
and delivery of results from a diagnostic assessment, and language differences can
further complicate the provision of clear communication during this process. One
potential communicative problem area for family members during assessment is in
the vocabulary and sentence structure within assessment items administered to them
regarding their child, either written or spoken. With too many assumptions regarding
level of comprehension and without sufficient controls (e.g., ongoing comprehension
checks made by the professional), assessment data gathered from family members can
be invalid and unreliable. During the discussion and delivery of assessment results,
family members with cultural and language differences may be at risk for failure to
comprehend concepts of evaluation, diagnostic criteria, and constructs of disability,
for these are often difficult for the layperson who is a member of the dominant U.S.
culture and fluent in the English language. Understanding the assessment process and
results are fundamental to understanding the rationale for treatment, and understand-
ing the rationale for treatment is often fundamental to cooperation and active involve-
ment with subsequent intervention procedures.
Communicating with children whose first language is not English can confound
assessment results and produce unwanted, inappropriate outcomes for them. Assessing
language development is integral to an evaluation for detecting the presence of an
ASD. Language delays in typically developing, bilingual children are often present
and are usually small, but one of the only ways to be more certain about the ori-
gin of delays is to assess children using both languages in order to compare results
(El-Ghoroury & Krackow, 2012).
Family members’ levels of acculturation, or adoption of behavior and beliefs
from a culture other than their primary culture, can affect their awareness and
adoption of the behavioral expectations of the secondary culture (e.g., the domi-
nant U.S. culture), and this can impact how, when, and if their family member
with ASD is identified and categorized for service delivery. Professionals may find
that the combination of differing cultural expectations for behavior (e.g., in regard
to reasons for referral) and insufficient or inaccurate communication regarding

the exact nature of a child’s behavior (e.g., presenting symptoms) can lead them
in incorrect directions, such as behavioral considerations other than those directly
associated with a diagnosis of ASD when ASD is present (a false negative). Clear
communication is therefore necessary to avoid misdiagnosis and ensure the provi-
sion of needed services.
Treatment and multicultural communication. During treatment, critical areas

where good communication with families from diverse cultures can avoid problematic
situations include the way in which (a) services are characterized and explained by
professionals (e.g., in terms of rationale, or purpose), potentially affecting how they
are perceived by families; (b) the range of service options is presented, potentially
affecting the extent to which services are accessed; and (c) professionals understand
how family expectations may differ from those of the dominant culture, potentially
affecting conflicts in performance expectations across environments (Wilder et al.,
2004). Ensuring that families fully understand the necessity for and components of
specific interventions, the treatment options that can potentially meet their needs and
fit comfortably within their lifestyles, and the expectations of the dominant culture
can better ensure that professionals are successfully communicating the playing field
within which family-centered intervention decisions will take place.
Strategies. Eberly, Joshi, and Konzal (2007) concluded that professional develop-

ment for the purpose of providing an increased understanding of one’s own ingrained,
culturally based biases in regard to “best” practices in raising and working with chil-
dren has great potential for promoting better communication across cultures and
between professionals and families. They assert that once professionals begin to accept
the idea that the same desirable outcomes in education and treatment can often be
arrived at though different methods (e.g., those employed by members of other cul-
tures), it will help them to communicate more meaningfully with families from diverse
backgrounds and approach deeper levels of trust and cooperation. Similarly, Araujo
(2009) cited the lack of culturally relevant professional development as one of the
reasons for the often inadequate education of second-language learners and warned
that an insufficient amount or quality of communication could lead professionals to
make incorrect assumptions and think only in terms of what they perceive children
and families were unable or unwilling to do, rather than how to best discover their
skills, talents, and abilities. Therefore, she recommended that schools increase posi-
tive opportunities for communication with professionals by (a) having school person-
nel inform families of community resources and services for addressing unmet needs,
(b) integrate community members and resources into school-based programs serving
both children and adults from diverse cultural backgrounds, (c) installing communica-
tive parent programs that involve parents in schools and school personnel in homes,
and (d) making meaningful learning connections between the home and school envi-
ronments of children from other cultures (e.g., through the use of culturally inclusive
curricula).
Byrd (2012) recommended that communication with culturally and linguis-

tically diverse families be preceded by an understanding of the specific beliefs and
practices common to people of the relevant culture and that professionals discover all
of the primary caregivers for the child among immediate and extended family. Also
recommended was a prior determination regarding the need for a translator and, if a
translator is deemed necessary, whether he/she would be supplied by the professional’s
agency or school or be recruited from the community.
In communicating with and providing services for culturally and linguistically
diverse families, Westby (2009) called for three main approaches to be used by profes-
sionals. First, professionals are encouraged to develop an understanding of the cultural
beliefs and values of families that is experienced-based rather than solely based on
secondhand knowledge. Second, when contradictions arise between the ideas and val-
ues of professionals and those of diverse families, it is recommended that professionals
create a “third space,” by attempting to rethink the contradiction in terms of a blend
of professional and family viewpoints and practices that can be mutually agreed upon.
Last, professional communication should (a) openly discuss knowledge and acceptance
of cultural differences, (b) promote the idea that families are as important as profes-
sionals in the collaborative process, and (c) contain nonjudgmental explorations of the
meaning and purpose behind the messages sent by family members. These practices
can maximize clarity of input and minimize the potential for developing stereotypical
thinking when communicating with diverse families.
Making a Communication Plan

Early in the establishment of their relationships with families, professionals should
work with members to identify the three Fs of communication (format, frequency, and
feedback) that best meet family lifestyles, schedules, and ongoing needs and desires
for information. Professionals have some information that they must deliver and some
feedback that they must receive as part of the fulfillment of their required responsibili-
ties. Families need data-based progress updates, descriptions of and rationales for any
proposed changes in treatment, and continued input and involvement in the relevant
decision-making details of the education and treatment of their family member(s) with
ASD. Therefore, the plan for communication should take into account all of these
stakeholder needs (see Figure 4.9 for an example plan). Communication that serves
only the needs of one party is merely directive/descriptive and is communication in
name only.
Format. Provide technological as well as low-tech alternatives for sending and

receiving communication between family members and professionals. The use of
email and informational websites should not be the only choices offered, for ongo-
ing Internet access is not a given for all families and therefore should not be assumed.
Low-tech alternatives can travel back and forth with individuals (e.g., through the use
of a communication folder), be delivered through the U.S. Postal System, or be picked
up at a mutually accessible drop location, such as a box or basket in an office. Examples
Figure 4.9 Family communication plan The written family communication plan can be crafted
during a meeting with the family, and both the family and professional should then retain a copy for
future reference. Establishing ongoing expectations and routines in communication with families is a
practice that is likely to increase levels of collaboration and cooperation among team members.
Family Communication Plan
Parent(s)/Guardian(s)/Child: Mr. & Mrs. Freeman / Roger
My Communication
Method (check all that apply) Schedule Type
Low-tech daily weekly: M-W-F Updated monthly event calendar,
communication folder monthly: homework to complete, graded assignments
To whom? home: both parents
communication journal daily weekly:
To whom?_________________________ monthly:
teacher-created form: behavior rating checklist daily weekly: Frequency data on problematic and
To whom? Mrs. Freeman: deliver each morning at drop off monthly: replacement behaviors
drop location: daily weekly:
To whom? monthly:
other: daily weekly:
To/with whom? monthly:
High-tech daily weekly: Monthly spreadsheet/graph of progress
email: fredfreeman642@*****.com monthly: last weekday of the month toward IEP goals
To whom? Mr. Freeman: family email address
online video conference daily weekly:
With whom? monthly:
live text chat on website daily weekly:
With whom? monthly:
private discussion posting on website daily weekly:
With whom? monthly:
other: daily weekly:
To/with whom? monthly:
Requested Parent Feedback

My Communication Requested Feedback Rationale
Communication folder Completed homework, initials on newly listed calendar Parents initial new events and graded assignments to
events and graded assignments indicate that they have reviewed them
Behavior rating checklist Written comments on behavior at home To associate daily differences and similarities in
behavior across home and school environments
Email Email reply with comments To keep parents involved in progress in order to
potentially justify any required changes to IEP
include responsive communication journals, printed forms designed by professionals

(e.g., for recording data and making written comments), and typed memos/reports
with lines for written replies, each of which can serve multiple informational purposes
and allow for two-way communication to occur on a regular basis.
Frequency. Although professional reporting requirements and family involvement

in education and treatment will dictate the frequency with which most communica-
tion will occur, the expected frequency of known communication events should be
directly described for families and agreed upon by all team members. For instance, it
may be planned beforehand that a monthly progress report will be delivered on the
last work day of each month or expected that evaluative comments and preferences
from the family regarding each round of intervention be delivered to the professional
on Fridays. Whatever the needed communication schedule for all stakeholders, the
plan should specify the times, days, and frequencies that each specific type of com-
munication will occur.
Feedback. In order for communication to occur, responsive feedback must be deliv-

ered between parties. Feedback can be as simple as writing one’s initials to indicate
receipt of a report, or as complex as a point-by-point written commentary on the
details of a proposed treatment plan. The who, what, when, and why of feedback should
be part of the initial communication plan; for example:
Who will send and receive the feedback? Will the professional or a member of his/
■
her staff contact family members for information? Should professional feedback
be sent only to one family member who will then report it to the rest of the fam-
ily, or should it be sent to multiple family members?
What type of information will be required? Describe it, and provide specific, applied
■
examples for clarity.

When is feedback needed? Establish an agreed-upon schedule of receipt and delivery.
■
Why is the feedback being requested? Provide a clear rationale for the necessity of
■
the information.

This chapter’s segment on exemplary programs and practices highlights the work
of the Treatment and Education of Autistic Communication Handicapped Children
(TEACCH) program for their work in providing a range of intervention services
that incorporate parents and their children with autism, including in-home sessions,
parent–child teaching sessions, and social skills groups for individuals with autism,
across birth to 5, school-age, and adult age groups.
TEACCH was founded by Dr. Eric Schopler in 1972 and provides diagnostic
evaluations, conducts research and national and international training in a wide range
of autism-related topics, and works to train professionals, families, and people with
autism. For more information, consult their website at: http://teacch.com.
Chapter Summary
The purpose of this chapter was to describe some of the key aspects of teaming with
families in order to provide for professionals an increased awareness of issues and prac-
tices that can positively affect their efficacy in planning and providing intervention and
treatment for persons with ASD. The use of appropriate terminology and development
of an understanding of the challenges faced by families when confronted with a diag-
nosis of ASD were discussed within the context of cultivating a healthy, caring attitude.
Next, family perspectives were discussed in terms of commonly reported needs
and how these needs can impact overall family quality of life in three vital areas. Two
prominent theories of family operation were discussed, as well as the implications for
these theories with and across relevant aspects of the assessment and treatment of ASD.
Methods for fostering successful family/professional teams were also provided.
These included establishing a foundation of well-grounded philosophies, procedures,
and practices upon which is built an intersection of ASD-focused leadership, program
development, and program implementation, with the family at its center.
The final section of the chapter examined methods for enhancing communi-
cation among team members and provided some guiding characteristics of effective
professional communication with families. Also discussed was how to use important
aspects of presentation and format to provide for the information needs of families
and multicultural considerations across critical points of communication, as well as
strategies for improving the quality and quantity of communication with diverse fami-
lies. Also provided was a description of the considerations in creating a communica-
tion plan with families in order to ensure that regular, useful communication occurs.
Ac t i v i t i e s t o E x t e n d Y o u r L e a r n i n g
1. Using a blank version of Figure 4.2 on page 93, conduct your own literature review of
family challenges associated with ASD. Use your new information to confirm or add to
the general categories of challenge listed (e.g., economic challenges).
2. Conduct an interview with a parent or other adult family member of a person with
ASD, and discuss the historical challenges that family members have faced as a result of
the disorder. (Make sure to get the interviewee’s permission to share information with
your class before you proceed with the interview, and remember to maintain confiden-
tiality by excluding any identifying family information or details when you report to
the class.)
3. Conduct your own literature review of family-based needs associated with ASD. Use
your new information to add to the general categories of need listed (e.g., health-
related needs).
4. Discover/research another theory of family operation and consider the implications of
the theory for professionals who work with families affected by ASD.
5. Based on a case study or details of an actual family, write a communication plan that
addresses with specific details all of the features outlined in the chapter.
Websites
Autism Speaks National Dissemination Center for Children
www.autismspeaks.org with Disabilities (NICHCY)
http://nichcy.org
National Autism Center
www.nationalautismcenter.org/index.php
National Center for Family/Professional
Partnerships
www.fv-ncfpp.org
Books
Correa, V., Jones, H., Thomas, C., & Morsink, C. (2005). Interactive teaming: Enhancing programs for
students with special needs. Upper Saddle River, NJ: Merrill/Prentice Hall.
Gorman, J. (2004). Working with challenging parents of students with special needs. Thousand Oaks, CA:
Corwin Press.
Overton, S. (2005). Collaborating with families: A case study approach. Upper Saddle River, NJ: Merrill/
Prentice Hall.
Richey, D. D., & Wheeler, J. J. (2000). Inclusive early childhood education: Merging positive behavior sup-
ports, activity-based intervention, and developmentally appropriate practice. Albany, NY: Delmar.
Smith, T., Gartin, B., Murdick, N., & Hilton, A. (2006). Families and children with special needs:
Professional and family partnerships. Upper Saddle River, NJ: Merrill/Prentice Hall.
Turnbull, A., Turnbull, R., Erwin, E., Soodak, L., & Shogren, K. (2011). Families, professionals, and
exceptionality: Positive outcomes through partnerships and trust (6th ed.). Boston: Pearson.
5
chapter
Teaching Communication
Skills

■ Describe key aspects of typical language development and explain how learners with ASD deviate
from expected development in this area.
■ Begin planning for how to promote prelinguistic and emergent language in the daily activities of
learners with ASD.
■ Assess the need for appropriate, individualized applications of augmentative and alternative
communication tools across prominent types, available features, and required communication
contexts.
127
■ Explain techniques for assisting learner communication in inclusive education settings.

■ Outline essential components for teaching and promoting communication in community settings
and contexts, such as working on the job, engaging in recreation and leisure, and participating in
postsecondary education and training.
Chapter 5 Mind Map

Typical Language Development
Communication Needs
Across the Lifespan Communication & Language Development for Individuals with ASD
Methods for Promoting Prelinguistic & Emergent Language Skills Communication & Language Assessment
Parent-Implemented Social Communication Interventions Teaching Prerequisite Manual Signs
Communication Skills
Picture Exchange Communication System (PECS) Speech-Generating Devices & Applications
Augmentative & Alternative Tools
Classroom Applications Teaching Communication Skills Communication Graphic Symbols
Preparing Students to Communicate Aided Versus Unaided
Communication in Inclusive
Creating Opportunities to Communicate Education Settings Learner Preference
Communicating with Peers Employment
Future Directions: Teaching Communication
in Community Settings Recreation & Leisure
Postsecondary Education & Training
Many individuals with ASD do not speak in ways that meet their needs (i.e., the use of
functional communication), and many others do not speak at all. As you will see empha-
sized within the material presented in this chapter, communication is essential to building
social skills, preventing challenging behavior, and increasing self-determination, among
a range of other key skills. Thus, the provision of new ways to communicate can act as
“behavioral cusps” for individuals with ASD, or new gateways to previously inaccessible
learning, expanded skill sets, and additional, beneficial environments in which they can
operate (Bosch & Fuqua, 2001; Smith, McDougall, & Smith, 2006). Skills that typically
developing people may take for granted (such as expressing choice/preference, request-
ing desired activities and materials, and indicating basic biological and social needs) can
be made available to individuals with ASD, often with amazing results (see Figure 5.1 for
examples). It is not an exaggeration to say that instruction producing an enhanced ability
to communicate can open up new worlds of opportunity for people with ASD.
However, for those who seek to instruct people with ASD for the purpose of
increasing their ability to effectively communicate, there are some significant chal-
lenges to be faced, as well as some important questions that need to be answered. Some
of the challenges come with a population of learners who (a) do not develop expres-
sive communication uniformly across individuals, interventions, and settings (Chiang
& Lin, 2008); (b) often do not spontaneously initiate communication (Chiang &
Carter, 2008), even when they have intensive needs; and (c) can have significant dif-
ficulty with adapting to changes in the direction and content of communication initi-
ated by others, as well as understanding the social and symbolic content often present
in language (Landa, 2007). In addition to the potential challenges, approaching the
topic of teaching communication to people with ASD can present a number of essen-
tial questions for which professionals need practical answers, such as:
■ How might individual communication needs differ across the lifespan?

■ What skills should I make sure are in place before I begin instruction?
c ha p t e r f i v e / Teaching Communication Skills 129
What alternative and augmentative communication (AAC) tools and techniques

■
are available, and how can they be used in instruction?

How do I prepare students to effectively communicate in an inclusive education
■
environment?
How do I prepare students to effectively communicate in community settings
■
that are critical to enhancing their overall quality of life?
Figure 5.1 Examples of new systems of communication acting as behavioral cusps for individuals
with ASD
Initial Situation Communication Instruction Expanded Outcomes
Larry is a 12-year-old Larry is provided with an 1. Access to new social opportunities:

student with severe inexpensive alternative Rates of aggression and property
autism who can communication system for making destruction are significantly reduced.
use a few functional food and activity choices after Discussion has started about
signs (American completing required work tasks: including Larry in more activities
Sign Language) to He is taught to use a touch-to- within the school.
communicate basic talk application installed on his 2. Access to new learning: Larry
needs such as “hungry” iPad. (Access to the desired food is able to make a clearer more
or “hurt,” but he often or activity acts as a naturally predictable if/then connection
acts in aggressive or occurring reinforcer for Larry to between the completion of required
destructive ways that continue to engage in using the work and access to preferred
serve the function of system.) materials and activities.
getting him access
to desired objects or 3. Improved quality of life: Larry
activities (according to has more direct control over
the results of an FBA). his environment, increasing
his satisfaction and sense of
competence with many school-
related tasks.
Mandy is a 6-year-old For the immediate need, Mandy 1. Improved quality of life: Mandy’s
child with mild/moderate is taught to use an inexpensive, self-determination skills and person-
autism and limited verbal teacher-made, augmentative al hygiene are improved.
language who, despite communication system to indicate 2. Access to new social opportunities:
being fully toilet trained, that she feels the urge to use Other children no longer refuse
will periodically use the the bathroom and needs a break to play with her because she is
bathroom in her pull- from the current activity: She “stinky.”
up training underwear, places a laminated picture on her
which she still wears communication board. For her 3. Access to new learning: Acquisition
in case of “accidents.” longer-term need, appropriate of the new skill serves as a basis
Although a bathroom bathroom vocabulary is being added for expanding Mandy’s functional
use prompting system is to her speech/language instruction. vocabulary.
in place as a preventive (Use of the picture system is
measure, her “accidents” reinforced with verbal praise and
still periodically occur. immediate relief of her discomfort.
Verbal praise is faded from
continuous to intermittent as
Mandy begins using the system
more consistently.)
(continued )
Initial Situation Communication Instruction Expanded Outcomes
Roger is a young Roger is instructed in procedures 1. Access to new learning: Roger

adult with Asperger’s for appropriately starting, is now more “tuned in” to what
syndrome who has few maintaining, and ending can be learned from engaging in
friends, none of whom conversations; for example, he is appropriate social contacts with
are close. His restricted taught to use directly observable others.
topic of primary interest or historical facts about people to 2. Improved quality of life: Roger is
is the history of trains start conversations with them (e.g., now able to recruit more support
in America, and he “How is that new puppy doing that from others, and his sense of
“introduces” himself you got last week?”). (Increased belonging and involvement at
to new acquaintances frequency and duration of desired school have increased markedly.
by beginning to talk social contact with others act as
about this topic. If a naturally occurring reinforcers that 3. Access to new social opportunities:
conversation is already in help Roger practice and maintain Roger’s cadre of friends and
progress, he will highjack use of the new skills.) acquaintances has grown now
it by simply starting to that he has learned the power of
talk about trains, and reciprocal interaction.
he will often walk away
when he is done talking,
while someone is in the
process of talking to him.
Communication Needs across the Lifespan

As you know, social communication deficits, along with repetitive behaviors and
restricted interests, are core deficits used in the diagnosis of autism spectrum disor-
ders (ASD). Communication is a broad term that encompasses verbal behavior (speech
or spoken language) and nonverbal behavior (gestures, expressions, sign language).
Communication is an essential skill across one’s lifespan. The ability to communicate
allows an individual to interact with his/her world. It permits people the opportunity
to express their needs, to make choices, to spontaneously interact with others, and to
develop relationships with family and friends. The inability to communicate for a per-
son with ASD can create a great deal of frustration for the individual, often resulting in
severe and challenging forms of behavior that may include self-injury and aggression
toward others. Couple one’s inability to communicate with environments that are not
intuitive or sensitive to the needs of others, and these behaviors will escalate and only get
worse over time. So, it is important to recognize the significance of communication and
language in the lives of our students with ASD, across their lifespans.
Consider how communication and language play a role in the development of
a young child. Each provides a cornerstone for subsequent development for the child
and in the establishment of relationships with the child’s parents, siblings, and other
family members. Communication is critical for socialization and essential for success
in school and other relevant environments. As the child ages, communication and lan-
guage skills are necessary for access to the community and for important social events,
community employment, and self-determination. For adults with ASD, communica-
tion and language skills are important for self-advocacy within residential, community,
and employment environments. These skills are vital to an adult when attempting to
navigate, for example, functioning in a postsecondary educational setting or on the job
in a competitive employment setting. When considering the sheer range and impor-
tance of such factors, it is easy to understand why communication skills are essential
across the lifespan for ensuring one’s independence and quality of life.
Typical Language Development

In order to gain a more accurate understanding of the communication and language
difficulties experienced by children with ASD, it is useful to provide a brief summary
of how language development occurs for children who are typically developing. As
Hoff (2009) summarizes, a child still within the first year of life will be able to recog-
nize his/her name by the age of 6 months, and will be able to understand some words
between 8 and 10 months. At 2 years of age, a child begins to develop a more extensive
vocabulary, and by his/her third birthday the child will have a vocabulary of approxi-
mately 300 words. By the age of 3, typically developing children begin to understand
grammar and produce sentences, resulting in conversations, while continuing to make
gains in their vocabulary. As Hoff (2009) asserts, after the age of 4 years, language
development continues to occur as articulation, vocabulary and sentence structure are
further developed and refined. Research in the area of language acquisition points
to the role of social-cognitive development that serves as a prerequisite for develop-
ing vocabulary and language milestones such as joint attention, tracking, imitation,
gesture use, and pretend play. Studies have also demonstrated that language develop-
ment in children with ASD is predicted by the following factors: early joint attention,
imitation, and reciprocal play (Luyster, Kadlec, Carter, & Flusberg, 2008). Children
with ASD experience atypical development in general and display splinter skills that
represent strengths, but communication and language are areas in which development
is consistently delayed or functionally limited in some way (e.g., in the area of prag-
matics, or using language appropriately in social situations).
Communication and Language Development

for Individuals with ASD
Communication and language delays are common among persons with ASD and
noted early on in their development. The failure to meet developmental milestones
in language as a result of delays is most often the reason that parents refer their child
for an evaluation (Eigsti, Marchena, Schuh, & Kelley, 2011). There are marked differ-
ences in the communication development of children with ASD from that of typically
developing children. Steiner, Goldsmith, Snow, and Chawarska (2012) point out that
vocalizations in infants with ASD are typically delayed, and, by the age of 2 years,
these delays become more noticeable, with the child having difficulty in understand-
ing gestures and imitating others. As children with ASD become toddlers, they less
often use gestures such as pointing and have difficulties with voice intonation and
joint attention. These delays are a major concern, especially because language devel-
opment prior to and throughout the fifth year of age has been linked to long-term
outcomes for children with ASD (Eigsti et al., 2011).
Communication and language development in children with ASD are linked

to thinking and reasoning, but researchers assert that differences in cognition alone
cannot fully explain the delays in communication and language that are experienced
by children with ASD (Kjellmer, Hedvall, Fernell, Gillberg, & Norrelgen, 2012). In
their review, Eigsti et al. (2011) indicate that language impairments are present in all
individuals with ASD, and that approximately 25 to 50% (depending on the source) of
the population will never acquire functional speech. It is also quite common for many
children with ASD to display echolalia (echoing language they have heard), usually
present by the age of 3 years, in either immediate or delayed forms. Although these
responses may not advance a child’s grammatical development, they are believed to
serve a communicative function for these children (Eigsti et al., 2011).
Consider the following example of Tom, a 15-year-old with ASD and intel-
lectual disabilities, who arrived late to school one day due to inclement weather.
When asked by his teacher why he was late, Tom continued to repeat, “Better get the
jumper cables,” a phrase he probably heard prior to coming to school that morning.
His teacher understood and acknowledged that Tom’s dad most likely had to use the
jumper cables to start his car on that very cold morning before he could bring Tom
to school. Not only is this an example of the presence of delayed echolalia, but it also
exemplifies how echolalia served a communicative function for Tom.
Alpern and Zager (2007) reported in their review the efficacy of interventions
for improving communication and language skills in persons with ASD who are on the
higher end of the autism spectrum. Despite such improvements, however, communica-
tion and language skills remain a core deficit as children age into adolescence and young
adulthood. These communication and language difficulties can have a substantial and
challenging impact on adult life roles and domains. In a summary of the research find-
ings in this area, Alpern and Zager indicate that language functioning plays a key role in
social conventions and supports, such as friendship formation, and that the increasing
complexities of expected verbal communication create a set of challenges that tend to
intensify as individuals with ASD age. One example of these challenges falls in the area
of pragmatic language.
Pragmatics is the functional use of language within social situations. Eigsti et al.
(2011) emphasize that pragmatics include linguistic elements like turn taking when
interacting with others and nonlinguistic behaviors such as making eye contact, use of
body language, and facial expressions. Given that learners with ASD often experience
significant difficulties within social settings, the importance of pragmatics in the devel-
opment of language and social skills cannot be overstated. When one considers the com-
plexities of social interactions that include many linguistic and nonlinguistic elements,
as previously noted, pragmatic language skills can be seen to play a key role in meeting
daily needs, especially when communicating to successfully navigate one’s environment,
establish meaningful social relationships, and maintain a minimal quality of life.
Another common challenge observed among many high-functioning learners
with ASD is that they appear precocious in terms of their extensive vocabulary and
sentence structure, but lack the appropriate use of nonlinguistic elements such as eye
contact and body language (Eigsti et al., 2011). When one observes their social interac-
tions, these individuals may appear awkward and lacking in the social fluidity needed to
communicate fully and effectively. Some examples of these pragmatic elements include
skills such as entering a conversation in an appropriate manner, turn taking, and con-
versation repair, for example, when an individual appears to misunderstand something
that has been said and seeks clarification or further explanation. All of these skills can
pose challenges for learners with ASD, and current thinking suggests that these learn-
ers have difficulties in acquiring these skills because of a lack of “Theory of Mind,” a
term by which Baron-Cohen (1988) suggests that persons with ASD have an impaired
ability to recognize that other people have thoughts, desires, and emotions similar to
their own. Another plausible explanation is that these difficulties are due to deficits in
executive functioning, or higher-order thinking and processing abilities associated with
the neural circuitry in the frontal lobe of the brain (Eigsti et al., 2011). In differing
ways, these theories can advance our understanding of the social communication dif-
ficulties experienced by persons with ASD. In turn, this knowledge should advance our
methods of instruction aimed at compensating for these skill deficits through building
an increased proficiency in the use of functional communication skills.
Communication and Language Assessment

The first step toward understanding communication and language delays begins with
assessment. Assessment seeks to find the answers to questions concerning delays in
communication, language, and overall development. The assessment approaches most
commonly used have involved parent report and formal assessment. This approach can
yield multiple sources of data gathered from standardized instruments and language
samples that often correlate to provide relevant insights into the child’s receptive and
expressive communication areas and overall development. It is important to note that
children with ASD often have difficulty in testing situations, especially if instruments
utilize more auditory stimuli than visual. Children with ASD may experience diffi-
culties with attention and motivation during testing, thus impacting results and the
provision of a clear and accurate picture of the child (Eigsti et al., 2011). For example,
the use of some conventional assessment approaches that are not geared to the specific
needs of learners with ASD can result in the complete disengagement of the individual
and lead assessors to the erroneous conclusion that the child is “untestable.” So, it is
vital to use instruments and methods intended for use with children with ASD.
One example of an assessment tool that can provide measures of a young child’s
verbal and nonverbal communication skills is the Communication and Symbolic
Behavior Scales Developmental Profile (CSBS-DBP; Weatherby & Prizant, 2002).
This assessment examines a child’s functional ability to communicate by examining
abilities in the areas of eye gaze and the use of gestures, sounds, words, and play. It is a
well-regarded instrument for children with ASD and is therefore widely used.
Communication and language assessment can also offer a prognosis regarding
a child’s long-term outlook in the area of communication. Assessment measures can
and should provide an accurate picture of the child’s communication and language
development that translates into the development of interventions aimed at improv-
ing the child’s development in these areas. The need to assess young children does
not end with obtaining the diagnosis of ASD, but is important throughout the life of
the child as he/she grows and matures. For older students in secondary school pro-
grams who are entering the transition planning stage, the speech/language pathologist
plays an important role in helping to provide useful assessment-based information
regarding the student’s language and communication skills. At this stage of develop-
ment, it is recommended that the following critical areas be assessed by a speech/lan-
guage pathologist (Alpern & Zager, 2007): (a) conversational skills, with emphasis on
turn-taking, remaining engaged with another person on a topic, and repair strategies
within the context of conversation; (b) narrative skills, such as the ability to tell a story;
(c) metalinguistic skills, or one’s ability to understand figurative language; (d) the abil-
ity to decipher meaning from written stories or assignments; (e) understanding social
pragmatics across relevant social, academic, and employment settings; (f) nonverbal
communication; and (g) speech and voice intonation.
Teaching Prerequisite Communication Skills
Methods for Promoting Prelinguistic and Emergent

Language Skills
It is important to understand ways to promote prelinguistic and emergent literacy
skills in young children with ASD. Paul (2008) summarizes the characteristics of early
communication delays experienced by children with ASD. These delays include the
fact that young children with ASD often (a) display limited attentiveness to speech
that is sometimes characterized by a failure to respond to their names; (b) have dem-
onstrated difficulties with joint attention skills, including coordinating attention
among people and objects, eliciting the attention of others related to toys or things
of interest, and directing eye gaze and tracking; (c) display lower rates of communica-
tion, with some remaining nonverbal; (d) experience difficulty with communicative
intent, as in a lacking effort to seek assistance from others; (e) use gestures far less
than typically developing children; and (f ) fail to engage in imitation, pretend play,
or other symbolic behaviors that can serve as precursors to communication develop-
ment. Given these presenting concerns, it is important that interventions are designed
to address these challenges. In a review on communication interventions, Paul (2008)
states that interventions directed toward prelinguistic and emergent communica-
tion can be separated into three distinct categories : (1) didactic, (2) naturalistic, and
(3) developmental.
Didactic interventions are based in applied behavior analysis and use such meth-
ods as discrete trial training (DTT), whereby skills are systematically broken down
into steps and taught individually, in a very structured format. Skills such as mak-
ing eye contact and imitation are taught using modeling, shaping (i.e., the prompting
and reinforcement of performance that increasingly improves in accuracy as the ulti-
mate goal is approached), and levels of assistance that are gradually faded as the child
acquires the skill. DTT is directed by the teacher or therapist, and given its level of
intense structure, some have leveled the criticism that it may promote a more repeti-
tious form of responding that has limited generalization to the changing demands of
natural environments. However, these methods have been most successful in promot-
ing imitation and improving expressive language in young children with ASD (Paul,
2008), especially when used within a comprehensive program that increasingly and
systematically promotes flexibility and generalization in learner responses as progress
in skill performance is made.
Naturalistic interventions include methods that are based on behavioral approaches,
but they are provided within functional contexts, such as the typical environments within
which a child learns and plays. An illustration of this type of intervention is to embed
instruction in communication and language skill areas not only at school but also through-
out the child’s day, including his/her time spent at home and in leisure settings, such as
playgrounds or restaurants. This method uses preferred activities and toys to increase par-
ticipation, with the basis for activities being more child-initiated rather than being solely
directed by the teacher or therapist. Naturalistic strategies are aimed at enhancing oppor-
tunities for the child to initiate functional communication and respond to naturally occur-
ring reinforcers following attempts at communication. One example of this is: If the child
requests a drink of water, the adult would simply give the child a drink of water instead of
using an artificial reward such as a sticker or treat (Paul, 2008). In this way, the value that
the child places on the activity or item makes it more likely that he or she will initiate com-
munication in the future, when that activity or item is presented as contingent upon his/
her communication.
Developmental methods for addressing prelinguistic and emergent language
assume that children with ASD will develop language (though delayed) in the same
sequential fashion as typically developing peers. For those children who have yet to
develop speech, signs can be used to encourage language development. This method
allows for the child to lead in interactions, and goals are developed around the normal
sequence of language development and providing activities that are essentially the same
as those of nondisabled peers, to provide a meaningful context in which to learn. These
activities form the basis for teaching opportunities that have relevance and interest
for the child. Building functional communication around these routines and activities
will reinforce for the child the use of skills within meaningful contexts and nonverbal
communication, including the use of gestures and gaze, which are often encouraged as
precursors to the development of language (Paul, 2008).
One of the most important things to consider when devising communication
interventions is that currently there are no guidelines as to which communication
strategy will be effective for a child with ASD (Flippin, Reszka, & Watson, 2010). This
is due in part to the wide variance of characteristics that comprise the population of
children with ASD, which presents no assurance as to the predictive value of a specific
intervention with a given child. The best approach to take in these matters is one that
is driven by assessment data, including child performance data, behavioral observa-
tion, and parent report. These data, when summarized, should provide the basis for an
intervention plan that is child- and family-specific, individualized to capitalize on the
child’s strengths, and helpful in the design of intervention strategies aimed at promot-
ing communication and language development in the child. Following assessment,
one important phase of intervention development for young children is working on
prelinguistic and emergent language skills, and critical to the success of fostering
prelinguistic and emergent language skills are parent-implemented social communi-

cation interventions.
Parent-Implemented Social Communication

Interventions
Research findings support the use of parent-implemented interventions for promot-
ing social communication gains in children with ASD. These findings have included
parent-implemented interventions on a variety of skills including joint attention and
social communication. Based on Woods and Brown (2011), areas within which parents
can effectively work include (a) joint attention or shared focus between parent and
child on an activity or an object of interest, and (b) social communication within the
context of natural routines in the home.
Joint attention can be defined in simple terms as shared attention between a par-
ent and child that is social in nature and can include either initiating, such as sharing
a toy of interest with a parent, or responding, as exemplified by the child reacting to
a toy the parent has presented. A specific scenario of parent-initiated joint attention
is when a parent and a child are out walking and the father says to the child, “Listen.
I hear a train coming. Let’s watch,” while pointing in the direction of the railroad
track, as he and the child wait for the train to appear.
Scherz and Odom (2007) state that there are precursors to joint attention dur-
ing the typically developing child’s first year of life, such as face-to-face engagement,
interacting with objects, and responding to attention given by caregivers. Scherz and
Odom (2007) conducted a study with three toddlers with ASD and their parents to
investigate parent-implemented joint attention activities. The intervention was con-
ducted in the homes of the children and focused on increasing each child’s toler-
ance for looking at faces through a series of interactive, face-oriented vocal games
with rhythms. Other activities included turn-taking and encouraging joint attention
through the presentation of toys or wrapped objects of interest, paired with the parent
holding the object in front of the child’s face while modeling excitement and enthu-
siasm. The parents spent one hour a day with their children initiating these activities
and recounting the children’s responses in short daily notes as a way of monitoring
progress. The outcomes of Scherz and Odom resulted in two of the three toddlers
demonstrating joint attention and the remaining child showing considerable progress
in the areas of focusing on faces and turn-taking.
This study serves as one example of how the consistent and systematic imple-
mentation of communication interventions by parents who are given the support of
professionals can make a difference in promoting social communicative skills in young
children with ASD. Some general guidelines for promoting social communication in
these young children are as follows:
Encourage face-to-face activities.

■
Gradually increase the child’s tolerance for these activities.

■
Be emotive and use voice intonation when presenting an activity or when ver-
■
bally communicating with the child in other situations.

Encourage joint attention by presenting the child with objects of interest, and
■
setting up opportunities to encourage the child to seek assistance to promote

joint attention; for example, a see-through jar with a preferred toy inside is pre-
sented to the child, but the lid has been screwed on too tight, creating an oppor-
tunity for the child to seek help from the teacher/parent/caregiver. This situation
could then be expanded into a joint attention opportunity surrounding the toy.
Use daily routines to consistently provide opportunities for developing social
■
communication with the child, such as mealtime setup routines or shopping

trips in the community. These provide structure and consistency and promote
learning through expanded trials over time.
Try to use the child’s attentiveness directed toward an object or activity of inter-
■
est within a routine and as a cue for the teacher to promote joint attention.
Model emotions such as excitement about an activity or a point of interest to
■
help reinforce value and meaning for the child.

Structure activities to promote the communicative behavior you are trying to
■
facilitate. For example, if the end goal is for the child to engage in social com-
munication with adults, activities should be structured with examples (especially
pictorial) of communicating with adults, child-centered reasons for engaging in
this type of communication, and peer and adult models engaging in the behavior.
Picture Exchange Communication System (PECS)

For children who have delayed spoken language or are nonverbal, one form of inter-
vention that appears to be effective is the Picture Exchange Communication System,
or PECS. PECS is a program for teaching children who are nonverbal to use a picture
system that involves the child handing a picture to an adult in exchange for an object.
PECS is behaviorally based, and it initially teaches single words and expressive com-
munication that is child initiated (Flippin et al., 2010). As Flippen et al. (2010) have
summarized, there are six phases that comprise PECS. In phase 1, the PECS training
begins with the child presenting a single picture in exchange for a single object. The
child presents the card to the teacher or parent, with assistance as needed from a sec-
ond adult and, upon receiving the card, the teacher or parent names the object and
gives the object to the child. In phase 2, the child is given a book containing picture
symbols for communication. At this stage, there is also an increased proximity between
the child and the teacher or parent. In this phase the child goes to select a picture from
the book and returns to present it for the desired object. In phase 3, the child is taught
to discriminate picture symbols for desired versus undesired items. Phase 4 builds in a
sentence starter strip for the child with content such as “I want ______,” with the pic-
ture of the desired item following. In phase 5, the child is prompted by the teacher or
parent with the query “What do you want?” prompting the child’s response. Gestures
might also be used by the teacher or parent if needed. Finally, in phase 6, the child is
taught to generalize to multiple prompts, such as, “What do you want?” and “What do
you have?” to expand their repertoire (Flippen et al., 2010).
PECS uses behavioral methods such as prompting and reinforcement over time
to systematically increase the child’s communication repertoire from single words to
ultimately building sentences (Paul, 2008). It promotes the generalization of these

skills across multiple environments, people, and reinforcers. From a classroom per-
spective, PECS is relatively portable, easy to implement, and also works well in the
home environment, thus providing the child with consistency across environments.
PECS has been considered by some researchers to be a promising practice, or a prac-
tice with a research evidence base that is growing but not yet developed enough to be
called an evidence-based practice in the area of communication for children with ASD
(Flippin et al., 2010). Based on their meta-analysis, Flippin et al. (2010) concluded
that PECS has small to moderate effects in improving communication in children
with ASD. They concluded from their analysis that there is not a sufficient body of
evidence in the research literature for the intervention to be considered an evidence-
based practice. However, this conclusion is not universally agreed upon. For example,
Odom, Kligenberg, Rogers and Hatton (2010) list PECS as one of 24 evidence-based
intervention practices for the treatment of ASD. PECS is a method widely used by
many teachers and has been demonstrated to be practical and yield meaningful out-
comes within applied settings. More research is needed on PECS to ascertain its effi-
cacy across various children with ASD, to determine for whom it works best. In other
words, we need research that more fully answers the question, “What are the charac-
teristics of children for whom PECS results in greater communication and language
outcomes?”
Classroom Applications
As with any application, it is often difficult to translate research-based practices into
classroom or other applied settings due to several mitigating factors. These factors
may include things like staffing capabilities, both in terms of numbers of staff available
and the presence or absence of professional knowledge and skills needed to implement
the practice. These are preintervention considerations that should be addressed before
embarking on the design and implementation of PECS or any other communication
intervention. It is important to also consider those factors that enhance or impede the
implementation of the intervention in order to focus on setting up the child for suc-
cess. In terms of implementation, it is important to design and implement PECS as
designed, to the greatest extent possible, and to evaluate the consistency or fidelity of
the intervention as it is implemented to ensure that it is consistently delivered across
sessions, caregivers, and settings. It is also important that the intervention is evaluated
not only in terms of implementation, but also in terms of child progress and perfor-
mance outcomes. This requires that the teacher design and develop a data recording
system that can assist in the evaluation of things such as the number of trials to crite-
rion, number of correct/incorrect responses, and level of prompting (e.g., a progres-
sion from verbal prompt, to gestural prompt, to graduated physical guidance) provided
by trial and across sessions. It is also important to plot these data to get a visual graphic
display to help in evaluating student progress. These data should be recorded daily by
session and evaluated weekly so that professionals can be vigilant in efforts to ensure
quality in the delivery of effective practice to students. It is also important for all team
members and parents to have input in planning and implementation, as well as an
understanding of the intervention and the plan for implementation and evaluation.
They should be kept abreast of student performance and progress. It is only through
such systematic design, implementation, and coordinated effort that interventions will
be assistive to children in this crucial area.
Augmentative and Alternative Communication

Alternative and augmentative tools and methods are an integral part of teaching com-
munication skills to many learners with ASD. Learners who engage in little or no
expressive language need to learn primary ways in which to communicate, referred to as
alternative communication (alternative to the natural development of spoken language
skills). Learners who engage in some level of functional, expressive language use may
need to learn additional ways to communicate more efficiently/effectively, referred to
as augmentative communication. Although augmentative and alternative communica-
tion (AAC) tools and methods are nearly indispensable in teaching communication
skills to these learners, it is currently the case that work toward determining whether
most technology-based/computer-based AAC interventions for people with ASD can
be classified as evidence-based practice (EBP) has not caught up with the growing need
for the application of these interventions (e.g., initiating conversation [Reed, Hyman, &
Hirst, 2011]; communicative and language development [Ramdoss et al., 2011];
increasing various communication skills [Ploog, Scharf, Nelson, & Brooks, 2013]).
It is therefore strongly recommended that, in making decisions about how to best
apply chosen AAC tools in the context of instruction and intervention, the services
of a licensed speech/language pathologist with demonstrable training and experience
in working with people with ASD be sought out and utilized. It is also recommended
that the topic of AAC tools be considered separately from the topic of research-based
methods used for their application. One erroneous assumption to be avoided is that
the inherent characteristics and features of specific AAC tools serve as the “active
ingredients” that produce communicative gains, rather than the EBP methods applied
in using these tools (see Chapter 2 for a more detailed discussion of considering inter-
vention tools as separate from EBP intervention techniques).
Tools
Due in part to the relatively rapid emergence and replacement of AAC tools, and
due in part to the many that currently exist, it is not feasible to present every avail-
able tool within this section. However, it is possible to present example AAC tools
that fall into three common categories often discussed for learners with ASD (e.g.,
in van der Meer, Didden, Sutherland, O’Reilly, Lancioni, & Sigafoos, 2012): manual
signs, speech generating devices (also known as VOCAs, or voice output communica-
tion aids), and graphic symbols (usually involving some type of system for mediating
a social exchange between communicative partners). Tools can further be classified
as “unaided,” meaning that no additional equipment or materials are required, or
“aided,” meaning that additional devices or equipment are necessary (Mirenda, 2003).
Manual signs. These signs are an unaided form of communication generated

by the individual (using hands, hence the term manual ) and can be in the form of
(a) fingerspelling, in which each sign represents a letter of the alphabet; (b) American
Sign Language (ASL) or an equivalent system, such as British Sign Language (BSL),
in which standardized signs represent objects, ideas, and actions; or (c) pantomimes
and gestures, in which signs are nonstandard movements meant to look similar in
some way to the performance of a real action (e.g., pretending to shoot a basketball to
indicate choice of play activity), look like the use of a real object (e.g., crossed arms at
chest level, as if holding a doll, to indicate choice of toy), or indicate an object, place,
or activity of interest, such as pointing to the color of crayon that one wishes to use.
Potential positives of teaching manual signing are (a) no external devices are needed
that can be broken or lost, require charging, use batteries, or take time to be started up
or shut down; (b) manual signing can be taught using a wide variety of effective meth-
ods; and (c) signs can be easily perceived in noisy environments. Potential negatives
include the fact that (a) not everyone in the learner’s “universe of daily operation” may
understand signing, although the use of standardized systems such as ASL increase
the likelihood of understanding, especially as compared with the use of gestures or
pantomimes that are unique to the individual; (b) signing can interfere with the need
to simultaneously perform other manual tasks, such as writing; and (c) learners with
motor impairments may have difficulty in precisely forming manual signs. Since the
latter part of the 1980s, there has been relatively little high-quality experimental
research conducted that strongly supports teaching this method of communication to
learners with ASD (Millar, Light, & Schlosser, 2006; Mirenda, 2003; Schwartz & Nye,
2006). However, based on current evidence, research has suggested that the best can-
didates for learning, acquiring, and using manual signs may be people with ASD who:
Are already in possession of good motor-imitation skills (Gregory, DeLeon, &

■
Richman, 2009; also see the commentary on Gregory et al. by Ogletree, 2010;
Shield & Meier, 2012)
Have adequate memory skills, both in the areas of recall and working memory
■
(van der Meer et al., 2012)

Emit relatively few vocal responses (Carbone, Kerwin, Attanasio, & Kasper, 2010)
■
Practically speaking, aided devices and systems need funding to acquire and
training and technical support to use, some of which may not be available to pro-
fessionals, agencies, families, and school districts located in rural areas or with lim-
ited funding. Other practical decision factors are localized to the learner, especially
those centered on challenging behavior. Supplying even a relatively inexpensive elec-
tronic device can become costly in terms of both time and money when it is repeat-
edly destroyed and replaced. Although there are funding sources such as public and
private grants that can help with expense, and although it may be required that an
aided device or system be purchased by an organization (e.g., if included as necessary
to a student’s educational progress within his/her IEP), limiting factors such as those
described above may necessitate the teaching and use of manual signs. Doing so may
be justified for the following reasons: (a) Even if access to an aided device or system
is in the process of being acquired, instruction in a method of communication should

take place immediately to avoid lost instructional time and improve learner outcomes
as soon as possible; and (b) evidence that suggests pairing manual signs with other
efforts to increase the use of natural speech can have a synergistic effect on improving
communicative ability (Millar et al, 2006; Mirenda, 2003).
Speech-generating devices and applications. These devices and applications are

an aided form of communication comprised of a wide range of hardware and software,
some of which is designed for dedicated use as an AAC system (e.g., an electronic
“talker,” or electronic speech output device), and some of which has been adapted to
include this type of use (e.g., downloadable communication “apps” for a smartphone).
In tandem with the growing availability of less expensive and more powerful com-
puter memory and processor technology, tools in this area have developed quickly,
an effect that has produced the benefit of a less expensive, more readily available set
of communication tools for potential users. However, along with this benefit comes
the risk of an unchecked proliferation of both free and commercially available tools
that are essentially untested and completely lacking in any evidence supporting their
effectiveness and efficiency in better facilitating communication for people with ASD.
In choosing a dedicated speech-generating device for an individual, it is therefore rec-
ommended that the following factors be carefully considered in the context of an indi-
vidual’s characteristics and communication needs:
■ Cost. Speech-generating devices can cost anywhere from around $100 to thou-
sands of dollars. Therefore, unless money is no object, features, functionality, and
durability should be carefully reviewed in terms of what is most necessary and critical
for the user.
■ Presentation of language choices. Choice of displays for the user can be electronic,
such as a touch screen, or mechanical, such as an array of buttons on a keyboard. One
obvious advantage of many electronic displays is that they can be instantly changed or
updated with new choices for selection, and the display therefore does not have to be
large enough to include all possible choices, as with mechanical versions. Factors to
be considered in choosing the type of choice display for an individual are durability
(especially if rough handling is likely), the differing skill sets for using each type of
choice display, the learner’s range of language expression, and the individual’s capacity
for the number and range of choice types that he/she can effectively process, recall,
and utilize.
■ Coding of selections. It is also important to consider how language will be retrieved
by the user. Devices can use pictures, numbers, words/phrases/sentences, or letters as
codes associated with desired language output, and therefore the individual’s develop-
mental level of understanding abstract representation should be taken into account
when choosing such a device.
■ The need for additional, adaptive devices. If the individual’s physical or other limita-
tions make the use of typical input methods difficult or impossible, a speech-generating
device may need to be accessed by an adaptive control device, such as a pointer, stylus,
adaptive switch (e.g., a sip or puff switch), or eye-gaze controller. The types and sub-
types of adaptive device controllers are vast, and will therefore not be discussed here.
The main goal is to make sure that the speech-generating device will accommodate
the type of adaptive controller that is required by the target individual.
It is also recommended that professionals address the following general questions when
considering the purchase of a speech-generating device. In behavioral terms, a form
of communication that (a) requires increased effort on the part of the individual, (b)
produces desired results less often or to a lower degree of quality, or (c) does not work
at all to meet the needs viewed as most critical by the individual, has a high probability
of being discarded for a mode of communication that is more efficient and effective for
him/her (e.g., certain forms of challenging behavior that have a communicative intent).
Remember that the ideal device will promote for the individual, as well as for those
who must set up and maintain it, ease of ongoing functionality and usefulness:
Does the device’s range of available vocabulary match the environmental

■
demands and individualized needs associated with the learner?

How easy will it be to add or remove vocabulary as the learner’s communicative
■
needs change?
Does the required user input of the device (spelling, use of syntax/grammar/
■
sentence structure, or direct selection using displayed words or pictures) match

the skills, preferences, and current curriculum of the learner?
Have a range of factors been tested/considered that could result in the eventual
■
non-use of the device if not directly addressed (physical portability, length of

charge duration or battery life, technical knowledge of support professionals and
staff, durability of device construction, etc.)?
Can the funding source (e.g., the school, parent, or support agency) afford to
■
replace the device if it is lost or destroyed?

Will the communicative function of the device be truly alternative or augmen-
■
tative for the individual, or will the nature of its function tend to replace any
natural communication already in use?
It may be that instead of purchasing a dedicated device, one may wish to save money,
increase convenience, and reduce the learning curve related to the introduction of
new technology by using a speech-generating application on an electronic device
already in use by an individual, such as a smartphone or tablet computer. This is
a viable choice, but one that should not be made without adequate effort toward
obtaining professional consultation and conducting personal research. Reviews from
professionals, consumers, and families of consumers should be consulted before mak-
ing this type of purchase, and an evidence-based implementation protocol for the
teaching and use of the new application should be identified and learned by the pro-
fessional prior to use of the application: What have other professionals and users said
about the utility and efficacy of the application, and how will I use evidence-based
methods to teach its use and implement it with the individual?
Graphic symbols. Graphic symbols (the tool) should not be confused with graphic
symbol systems (the teaching technique, or instructional method). Consumers should
be mindful when purchasing and using sets of graphic symbols that refer to well-
known instructional techniques but do not include any evidence-based operational
procedures for their use. The analogy here is purchasing a new sports car without an
engine. The purchase may be a good deal, as long as the lack of an engine is disclosed
up front, and as long as the consumer makes the purchase with the intent to later
acquire and install the engine. Otherwise, the car as purchased will not get one very
far, except maybe when used as an expensive coaster wagon (which, for obvious safety
reasons, is not recommended). For example, Andy Bondy (2012), one of the develop-
ers of PECS, warned in a discussion of the most common misconceptions about the
system that, apart from the application of the behavioral technology embedded within
the PECS procedural implementation protocol, the mere use of pictures (e.g., within
low-tech applications such as laminated pictures, or within high-tech applications
such as an app for an iPad or smartphone) is not synonymous with PECS.
In selecting sets of graphic symbols to use on communication boards or with
symbol systems such as PECS, there are some important predeterminations to make
regarding the individuals who will use them:
■ Level of abstraction (also referred to as “iconicity”). An individual’s developmental

understanding of the communication hierarchy must be considered. This hierarchy
within graphic symbols can be described in terms of “level of abstraction,” meaning
the conceptual distance of the symbol from the actual person, place, or thing that it
is meant to represent. The lowest level of abstraction within a hierarchy could be
an actual object (such as a brand of breakfast cereal) that is wrapped or encased in a
see-through substance and attached to a communication board. Although this is not
a “graphic” symbol in itself, its use may be a necessary step in moving toward the
use of graphic symbols, similar to the developmental progression in mathematics in
which a learner moves from the concrete stage (counting actual objects) to the more
symbolic stage of understanding the quantity represented by a numeral. Within an
example hierarchy, use of an actual object could be followed by (from lowest to highest
level of abstraction): a photograph of the object, a line drawing of the object, and the
printed word for the object. Learners who respond to only lower levels of abstrac-
tion within a communication hierarchy can be taught to respond to higher levels by
pairing currently used symbols with symbols that are a step higher in level, and then
gradually fading use of the previous symbol. For example, using this type of associative
approach, some learners with severe autism can eventually respond to the pattern of
shapes that make up a printed word, even though they may not be able to read sight
words or identify individual letters of the alphabet.
■ Color. Preliminary evidence suggests that although the use of color versus
black and white symbols tends to produce similar effects on learning, some learn-
ers with autism may better generalize learning when taught black and white symbols
before moving to color (Hetzroni & Ne’eman, 2013). Color may also act as one of
the symbol characteristics that learners use for memory and recall, and the use of
color should therefore be consistent across symbols of equivalent meaning, unless the
learner is working on being able to systematically generalize between varying symbols
with the same meanings, which should occur within comprehensive communication
instruction.
■ Complexity. This element can be represented within the characteristics inherent
to the graphic symbol itself (e.g., in the number of pictorial elements used in creating
the image) or in the message that the symbol is meant to communicate (e.g., in the
number of words, phrases, sentences, or ideas that it represents). Although research
in this area of investigation has historically been scant and sometimes contradictory
(Koul, Schlosser, & Sancibrian, 2001), there are some general rules that should be fol-
lowed regarding complexity. First of all, the content of individual symbols should be
limited as closely as possible to the elements that are most relevant to the intended
message. For example, a poor choice for “tree” would be a picture of a picnic area
within a forest setting, while the best choice would be a close-up picture of an indi-
vidual tree. Second, to reduce complexity and thereby help with acquisition, it is most
often a good idea to begin by assigning each symbol to represent a single unit of lan-
guage (noun, verb, etc.). Symbols can later be learned in chains of increasing length
to increase semantic complexity, and once learned, chains of symbols can by direct
association be replaced by individual symbols. However, this increase in complexity
has its highly variable limits across individuals. Last, some professionals like to include
images of the learner within graphic symbols for communication (e.g., a picture of the
learner interacting on the playground to represent “running”) because they believe
that doing so will increase understanding and motivation for learning. However, doing
this may add a level of complexity for which many learners may not be ready (e.g.,
in terms of generalization: “I see myself in the picture performing the act, and that
in reality means the act as performed by anyone, for example, I run; he runs; she
runs; they run.”). Doing so may also become a distractor to the learning process, as an
inherently egocentric person focuses on him-/herself to the exclusion of the elements
within the symbol that are more relevant to the intended meaning. Inclusion of the
learner within graphic symbols should therefore be considered carefully, as based on
prior experiences with him or her.
Aided versus unaided tools. The question may arise: “Which general type of com-
munication tool should we teach learners to use, aided or unaided?” Assuming that a
learner has the ability to use both, on the one hand, it seems that unaided tools would
be a better fit with curricular goals aimed at increasing self-determination and inde-
pendence, while on the other hand, it seems that aided tools may present a wider range
of communicative options and modes that would be a better fit with curricular goals
aimed at increased socialization and community involvement. Sigafoos and Drasgow
(2001) were of the opinion that if people with ASD are to gain the widest range of com-
municative access across people, situations, and environments, they should be taught
to use both types and be shown how to discriminate between situations within which
one type may be more effective or appropriate than the other. It was recommended
that learners be taught to use aided or unaided tools based upon an assessment of the
surrounding environment, communicative partners, and the current availability of
Figure 5.2 Examples of responding to relevant variables in making the decision to use aided
versus unaided AAC tools
Relevant Variable Example Decision
Surrounding envi- 1. The person is in a well-lit classroom. 1. Unaided: The person uses manual
ronment 2. The person is outside at dusk, and it signing to greet a classmate.
is starting to get hard to see things in 2. Aided: The person decides not to
much detail. use manual signing and instead uses
a voice output communication aid
(VOCA) with a lighted touch display.
Communicative 1. The person runs into a close friend 1. Unaided: The person uses gestures
partner while shopping for groceries. unique to himself to indicate his current
2. The person must communicate with mood after being asked, “How are you
a new cashier that he has never met today?”
before. 2. Aided: The person shows the cashier
a picture that he has taken with his
smartphone to indicate the item he
wishes to purchase.
Availability of aided 1. The person has ready access to 1. Unaided: The person signs, “Help,”
tools his communication picture book, but and points to the books he wishes to
there are no pictures in it for use in the return.
library. 2. Aided: The person shows the librar-
2. The person has ready access to his ian his picture of the book return slot
communication picture book, including and points to the books he wishes to
pictures for use in the library. return.
aided tools. Figure 5.2 provides examples of how a person with ASD might respond to
changes in these variables when deciding to use one type of tool over another.
Learner Preference
Apart from the idea of utilizing the tools that are the most convenient and appropriate
for a learner, preference can be an important factor in whether a learner will work to
become fluent in using a particular tool, and whether he/she will maintain the use of
it over time. Van der Meer et al. (2012) assessed the preferences of four children (one
with ASD, one with childhood disintegrative disorder, one with Angelman syndrome,
and one with pervasive developmental disorder not otherwise specified) for using a
speech-generating device, graphic symbols (specifically, picture exchange), and manual
signing. Three participants chose the speech-generating device most frequently, and
the remaining participant chose to use the graphic symbols most often. Even though
the results replicate those of several similar studies, the outcome of one study based
on only a few participants (not all with ASD) should not be used to make broadly
generalized conclusions about groups of learners and their preferences for AAC tools.
However, the study does illustrate another important idea: Even if a majority of learn-
ers in a group tend to prefer one type of AAC tool, we should not assume that all
learners in that group will do the same. Preference should be approached and assessed
individually and without the application of prior assumption. In addition, and perhaps
more importantly, van der Meer et al. (2012) described their systematic protocol used
to assess which type of tool each learner preferred. The following generalized steps
are based on their description of this preference determination method and incorpo-
rate ideas previously discussed in this section:
1. Consider and apply acceptability factors for each type of AAC tool to be taught.
For example, take into consideration: (a) basic prerequisite skills needed (e.g., for man-
ual signing); (b) practical considerations, such as available funding; (c) fit of learner
characteristics and needs with tool attributes and features; (d) level of learner language
development and understanding (to be reflected within use of the tool); and (e) ability
to discriminate abstraction, color, and complexity.
2. Teach (to initial criterion) the use of available, viable, applicable AAC options.
For example, manual signs, use of a speech-generating device, and use of a system using
graphic symbols are each taught, reinforced, and practiced (with most to least prompt-
ing for error correction) until the individual can use each with at least 80% accuracy.
3. The learner is taught to select and use aided versus unaided AAC based on the
requirements dictated by the current environment, communicative partner(s), and
availability of needed AAC tools (i.e., discrimination training).
4. Within daily activities that have flexible communication requirements (e.g.,
classroom learning contexts with a professional instructor), choice of AAC options (as
taught in step 2) is provided by (a) displaying choices (e.g., a VOCA, a set of graphic
symbols, and a book of ASL signs) in random order each time; (b) pointing to each
choice and saying, “Would you like to use ________ ?”; (c) asking the learner to make
a choice by pointing or touching the appropriate item; (d) providing an appropriate
amount of wait time for a choice to be made (e.g., a learner experienced in making
choices may require only three to five seconds, while someone who processes lan-
guage more slowly or is learning to make choices may require as much as twice that
amount or more, with prompts); and (e) proceeding with a preselected option (e.g.,
the option with which the learner needs the most practice and improvement) if the
learner does not make a choice within the maximum time allotted.
5. Within daily activities that have inflexible communication requirements (e.g.,
community learning contexts or social skills exercises conducted with peers), appro-
priate aided or unaided AAC selection (as taught in step 3) is made by the learner, in
regard to relevant variables (e.g., communicative partner).
In addition to this informal process, it is recommended that practitioners take into

account the following factors that may influence preference for individuals and posi-
tively or negatively impact any stigma that may be associated with using an AAC tool:
■ In regard to the preference for a particular speech-generating device, the type

of voice output may be a factor. Synthesized speech is sound electronically generated
by a machine that mimics human speech sounds as closely as possible. Digitized

speech is an electronic recording of actual human speech. Although the quality of
synthesized speech has greatly improved over the years, including the available range
of accents and gender-representative voice tones, there are still discernible quality
differences between synthesized and digitized speech that could impact selection. In
addition, the speculative match of accent, voice tone, and inflection to that of the
individual may also be a relevant factor. For example, a poor match that is some-
times seen in practice is represented by a young adult male with autism who uses a
speech-generating device with digitized speech that was recorded by an adult female
professional.
■ The novelty effect might also be a consideration in determining preference. For
example, some individuals may respond less intensely to using manual signs than to
using an electronic device with a colorful display and buttons that activate a highly
stimulating voice output when pressed. However, although it is true that preference
should be incorporated into which AAC tools are used within daily communicative
contexts, individuals should also be equipped with the skill to use a range of aided and
unaided tools for maximum flexibility and efficacy in communicating across different
people, situations, and environments. Incorporate preference everywhere allowable
and teach a range of tools everywhere needed.
Consider This
Grayson is a 7-year-old boy with autism who reached a basic proficiency in using it before his
has no spoken language skills and communi- training ceased. Now, as the district is looking
cates mainly by grunting and using from one to for a new SLP, Grayson’s teacher is reporting his
three manual signs that he has learned. He can refusal to use the device during school activities.
also point to pictures to indicate preference, but When asked why Grayson has made no prog-
this is an emerging skill for him, making his cur- ress on his goal to effectively use the device, his
rent use of the skill somewhat unreliable. After teacher replies, “He just doesn’t like using it. I
going through an initial mediation process with can’t get him to use it without insisting, and that
the legal representative of Grayson’s parents, the usually leads to a tantrum.” So, at least for now,
public school district purchased a VOCA device Grayson continues to grunt and use his handful
for him, spending thousands of dollars on one of signs to communicate, a system that contin-
of the best models. Initially, Grayson received ues to meet his basic needs, but only when used
several weeks of training with the device, but with the people who know him well. In regard to
training abruptly ceased when the school system Grayson’s situation, consider this: What relevant
lost its only itinerant speech/language patholo- questions could you ask of school personnel, and
gist (SLP). During his training, Grayson had what guidance could you give them, for helping
trouble discriminating among the many keys Grayson? In attempting to answer these ques-
on the device (each with a picture representing tions, reflect on the five steps and two factors
the intended message to be delivered), but he regarding preference, as given above.
Communication in Inclusive Education Settings

Students diagnosed with an ASD who are included in regular education settings need
to have a variety of functional skills in order to be successful. An inclusive educational
setting places a great number of expectations on a student, and adequate supports
need to be evaluated and incorporated. One of the most essential supports that a stu-
dent diagnosed with an ASD may need in an inclusive setting is the ability to effec-
tively communicate. Without the ability to understand basic language and respond
accordingly, a student in an inclusive setting may experience difficulties that can be
readily avoided if appropriate attention is given toward developing a useful means of
communication. There are several ways to directly address communication deficits
and enhance opportunities to become more fluent in necessary communication skills,
and some of the more common approaches will now be discussed.
Preparing Students to Communicate

Before communication skills can be taught directly, attention should be given to assess-
ing the functional level and form of communication that is most appropriate for the stu-
dent. The functional level of communication can be viewed as a continuum within which
students begin responding to and utilizing communication at a very basic concrete level
that may involve the use of tangible items to receive information and/or express them-
selves. For example, a student who expressively communicates at a concrete functioning
level may pick up a paint brush and show it to an adult in an attempt to communicate
that he would like to paint, or he might bring a cup to an adult in an attempt to request
something to drink. The communication continuum moves beyond the concrete level to
a more advanced level in which photographs can be used to communicate, and then on
to such forms of communication as line drawings, written words, sign language, spoken
words, and phrases. A student diagnosed with an ASD who does not speak needs to be
taught communication that appropriately matches his/her functional level of communi-
cation. This can be determined by observing the student to determine how he/she suc-
cessfully communicates and how he/she may be attempting to communicate. Once the
functional level of communication is known, consideration should be given to the form
of communication that the student can best utilize within an inclusive educational set-
ting. For some students, photographs can be incorporated into an inclusive classroom,
such as those utilized within PECS ( Bondy & Frost, 1994), while others may prefer to
utilize sign language or augmentative communication devices.
Creating Opportunities to Communicate

Students diagnosed with an ASD need to have supports in place to assist them with
communication, but, in addition, these students need to be provided with opportuni-
ties to use communication skills. There are several ways that educators can promote
opportunities for students diagnosed with an ASD to engage in communication. Some
of the methods for promoting opportunities to communicate that will be described
here are outlined in Figure 5.3: minimizing, sabotaging, partnering, and scripting.
Figure 5.3 Sample of methods for creating opportunities to communicate
Minimizing
• Providing very little information, assistance, or materials to create the need to

request more
Sabotaging
• Removing essential components of a task in an effort to promote requesting for

assistance to complete the task
Partnering
• Pairing a student diagnosed with an ASD with a peer model who can offer
assistance and demonstrate communication skills
Scripting
• Providing written dialogue and action cues that can be performed during role-
playing in simulated situations
Minimizing method. Communication is frequently used to make requests to oth-

ers for assistance, information, or materials. With this considered, a person who has an
abundance of assistance, information, and materials may be less likely to make requests
than someone who has very little. A teacher can utilize this method by limiting the
availability of assistance, information, or materials that are offered, or by providing
these in very small increments that are only available upon request. For example, a
scenario that is frequently seen in preschool settings occurs during snack time, when a
teacher is pouring juice or distributing crackers to the children. The teacher may pour
only a very small amount of juice or provide a single cracker to each child. The teacher
then watches the children and waits for requests for more juice or more crackers, and
in some cases may prompt a child to request more. When a child asks for more, the
teacher again provides a very small amount, thus establishing the need for the children
to make multiple requests for more. This same approach can be utilized by a teacher
in other classroom settings in which only limited pieces of information or assistance
are offered in order to encourage students to request more information or assistance.
Sabotage method. Another method that can be useful for encouraging students
to practice using communication skills that they have learned is to sabotage a task
that is familiar to the student or pause a routine in which he/she often engages. By
sabotaging a familiar task, a teacher can create a situation in which a student must
use communication skills in to continue or complete the task. For example, a student
who frequently engages in activities that require coloring, cutting, and gluing can be
asked to complete the activity but find that the scissors are not where they are nor-
mally stored. The teacher can sabotage the activity by hiding the scissors in an attempt
to encourage the student to initiate a request for them. When choosing to use this
method, it is important to know the student well and make sure that the procedure
will not result in unnecessary challenging behaviors. The teacher should monitor the
student closely in these situations and offer prompts if needed to guide the student
in the direction of asking for assistance. For example, if the teacher notices that the
student is becoming highly frustrated because he/she is not able to independently
locate the scissors, the teacher may offer a prompt such as, “You look like you need
something. Can you tell me what you need?” Being readily available to offer such
prompts is a necessary component of using this procedure, along with being able to
offer assistance immediately once the student makes the request.
Partnering method. Pairing a student diagnosed with an ASD with another student

who can facilitate communication is another method for creating opportunities for
communication to take place. A student who can communicate well can be used as a
peer model for a student diagnosed with an ASD who has a limited ability to commu-
nicate. In addition, these partnerships can involve teaching communication prompting
techniques to the peer model so that this person can encourage the student diagnosed
with an ASD to use communication. For example, a student diagnosed with an ASD
who uses pictures to communicate may be paired with a peer model who also uses pic-
tures but combines this approach with spoken language, in order to demonstrate how
to use both these forms of communication to accomplish a task. The student diagnosed
with an ASD could observe the peer model use the combined methods and attempt to
replicate the peer model. This type of partnership can provide several opportunities
for both communication and observational learning to take place. However, it should
be noted that some learners with ASD have difficulty with initiating imitation and may
require added assistance or a different method altogether.
Scripting method. A very direct approach toward creating opportunities to commu-

nicate can be arranged by using the scripting method. This method involves providing
written scripts that students use during prearranged interactions. This method is simi-
lar to performing a play and involves reading a specific, prewritten dialogue and car-
rying out predetermined actions. For example, a scene could be written that involves
dialogue and actions for two students to perform. The scene could involve meeting a
new person and finding out something about this person. The script could be writ-
ten to include opening statements such as, “Hello, my name is ______. What is your
name?” It could also include directions such as: (a) Walk up to the person; (b) look the
person in the eye; (c) put out your hand; and (d) shake the person’s hand. These types
of scenarios can be memorized and practiced by the student with the teacher provid-
ing formative performance feedback, instruction for generalizing learning to new and
unscripted situations, discrimination training for recognizing when it is appropriate
to perform scripted actions or speak lines, and “contingency plans” to execute when
a communicative partner does not behave as expected. The scenarios can be repeated
until the student becomes proficient in performing the scene, and then the situations
can be generalized to actual situations beyond the initial simulations.
Communicating with Peers

An important area to consider within educational settings for individuals diagnosed
with an ASD goes beyond traditional academic tasks. These students frequently have
difficulties with socialization, and so an important skill to teach is socialization with
peers. Students diagnosed with an ASD frequently have limited or no communication
with peers; they may display challenging behavior in an attempt to communicate with
peers, or they may have other interactions with peers that are ineffective. Improving
these types of communicative interactions with peers is essential for enhancing the
integration and acceptance of these students. There are some techniques that educators
can use to promote communication, such as systematically developing peer groups for
communication (Kalyva & Avramidis, 2005), utilizing specialized interests of students
diagnosed with an ASD to develop communicative partners (Koegel, Vernon, Koegel,
Koegel, & Paullin, 2012), and peer tutoring.
Kalyva and Avramidis (2005) demonstrated how implementing a “circle of
friends” for five young children diagnosed with autism improved both their commu-
nicative initiations and responses with their peers. The circle of friends is a systematic
approach to developing specific peer groups for individuals diagnosed with an ASD.
The approach identifies peers who could be potentially supportive to the student
diagnosed with an ASD and provide him/her with ongoing guidance and instruction.
In Kalyva and Avramidis, the focus was primarily on promoting communication. The
intervention consisted of 30-minute sessions conducted weekly for three months, but
the results were shown to be maintained at a two month follow-up. This intervention
needs to be evaluated further with students of different ages and with a focus on addi-
tional skills, but its potential seems promising.
Another technique for encouraging communication between students diagnosed
with an ASD and their typically developing peers involves utilizing the specialized
interests of the students diagnosed with an ASD. A frequently reported characteristic
of these individuals is that they display a limited range of interests. For instance, a
young child may show an unusually high interest in trains and may spend dispro-
portionate amounts of time engaged with trains while ignoring other toys or other
activities occurring around him/her. Other students with more highly developed com-
munication skills may demonstrate limited interests through their conversations with
others, such that all they tend to discuss revolves around a specific topic in which they
are interested. For instance, if a peer approaches the person and asks him how he is
doing today, the person may respond by immediately discussing how he just finished
reading the most recent issue of a car racing magazine, describing which race drivers
he thinks are the best, and describing the type of race car specifications used by the
drivers. In this scenario, the peer initially asked a personal question for a social reason
but received a response that was mostly focused on a specialized topic of interest for
the person diagnosed with an ASD.
Koegel et al. (2012) demonstrated how the specialized interests of children diag-
nosed with an ASD could be utilized to promote communication between them and
their typically developing peers. They assessed the specialized interests of three chil-
dren diagnosed with autism and used these interests to develop special interest clubs
held twice weekly during lunch periods with an adult facilitator. They found that this
type of intervention increased both the communication and amount of time spent
with typically developing peers for all three of the participants.
The techniques described thus far for promoting communication among peers
require the use of an adult facilitator. Another technique that attempts to remove the
need for an adult facilitator involves peer tutoring. With peer tutoring, students are
taught to take on specific roles to accomplish a task with the initial help of an adult
facilitator who then eventually removes him-/herself once the students achieve a level
of fluency with their roles. However, using peers in this way requires professionals to
identify students with a disposition for the task, provide intensive training to tutors
on how to interact appropriately, and closely monitor tutor and tutee interactions to
know when correction or assistance may be needed.
Future Directions: Teaching Communication

in Community Settings
The extent and quality of community participation for an individual is often closely
correlated with the extent and quality of that individual’s ability to effectively com-
municate with others. On the one hand, even though community participation within
most societies involves unwritten rules of compliance with expected social norms and
some demonstrated level of contribution to the “common good,” failure to comply with
such expectations can sometimes be excused or even remediated when an individual
engages in effective communication. On the other hand, a lack of attention to social
expectations and contribution to the group, combined with a lack of effective com-
munication, can be doubly detrimental to an individual’s ability to access community-
based benefits such as employment, recreation and leisure activities, and postsecondary
education and training. As Bolick (2008) pointed out, the very accommodations put in
place to help people with ASD participate in community activities can unintention-
ally emphasize the mistaken idea that the effort of having them included outweighs
the benefit to the group generated by their contributions (which can, in reality, be
valuable and extensive). However, Bolick also pointed out that positive perceptions,
opportunities to participate, and individual benefits can be created and maintained
for people with ASD through the implementation of interventions that increase their
ability to effectively communicate within these settings (read Applied Vignette 5.1 to
begin thinking more in depth on this topic).
Although this premise and goal are sound, the applied evidence base for accom-
plishing the stated task may not currently be sufficient as compared, for example, with
the theoretical evidence base. Shattuck, Roux, Hudson, Taylor, Maenner, and Trani
(2012) concluded that research in the area of services for supporting the community
participation of adults with ASD is “underdeveloped and can be considered a field of
inquiry that is relatively unformed” (p. 288), especially in terms of the wide range of
differences represented within the population of people with ASD and their families.
One of the authors’ recommendations was that researchers should work directly with
providers of direct, community-based services to speed up the movement from theory
to application in this area. Because the applied evidence base for increasing the com-
munity participation of adults with ASD through methods such as enhancing commu-
nicative ability can at best be described as “emerging,” professionals are encouraged to
proceed with caution as they interpret and apply the often isolated and limited find-
ings of studies in this area. As with many other areas of applied intervention for and
with adults with ASD, the level of need far outstrips the ability of the current evidence
base to adequately address the need—a need that is evident in the poor community-
based outcomes that are often reported for members of this population.

Andrea
Andrea is an adult with severe autism who has merely overwhelmed with the change in routine
some verbal language and skill in manual signing. and had not yet learned and practiced a method
She works evenings at a local restaurant, where for performing the new job. Her situation was
she busses tables and runs the dishwasher. During further aggravated by the increased noise and
a busy shift, one of the kitchen staff fails to show activity of the busy, understaffed kitchen.
up for work, and Andrea is asked to restock sup-
plies for the cooks during the times she is waiting Discussion Questions
for a load of dishes to finish washing. Andrea has 1. From the viewpoint of the manager, what
never been trained to do this additional job, but is the nature of the difficulty in this sce-
the newly hired evening manager assumes that nario? How does his viewpoint illustrate
simply being told what to retrieve from the stock the unintended impact on adults with
room or freezer is a job that anyone can do with- ASD of (a) expected compliance with soci-
out training or experience. However, when asked etal norms, and (b) the desire for individu-
to get supplies, Andrea crouches beside the dish- als to contribute to the common good in
washer and looks down at the floor, seemingly the context of community participation?
ignoring the requests. When the shift gets even
2. How could Andrea have been taught to
busier, the requests for supplies become more
maintain the stability of her work envi-
frequent and persistent, and Andrea covers her
ronment by appropriately and effectively
ears with her hands and begins to yell above the
using her communicative ability?
noise of the hectic kitchen. The evening manager
assumes that she has willfully refused to comply 3. Considering that communication is a two-
with his request for extra help and tells her to go way endeavor, what does the new evening
back to bussing and dishwashing only. He keeps manager need to learn to effectively com-
her working because he needs her labor dur- municate with Andrea (assuming that he is
ing the busy shift, but he is determined to later willing to do so)?
reduce her weekly hours and eventually replace 4. If Andrea’s weekly work hours in the res-
her with someone who is more “cooperative.” taurant are indeed reduced until they are
However, what the manager does not know is essentially at zero, how can her job coach
that Andrea was not being uncooperative and was prepare her to be successful in her next
not willfully refusing to perform the task. She was work environment?
Employment
Many adult and young adult people with developmental disabilities suffer the negative,
collateral outcomes of a lack of daily, purposeful activity—activity that can help regulate
the balance of a normalized life, provide a sense of competence and achievement, and
alleviate the boredom that can lead to unproductive or even self-destructive tenden-
cies. Employment can supply part of the need for useful activity, as well as open roads
to increased social contact and greater financial independence. However, people with
ASD have traditionally experienced disproportionately high rates of unemployment
and underemployment, and limited communication and social skill repertoires (e.g.,
for use when change, conflict, or misunderstanding occur) present the most significant
barriers to gaining and maintaining employment for the members of this diverse group
(Hendricks, 2010). Within their description of how to implement a model transition
program to help students who have ASD to gain employment, Wehman et al. (2012)
described a three-component problem-solving model involving the use of antecedent-
based strategies, instructional strategies, and consequence-based strategies. Once a stu-
dent in the program displayed challenging behavior, the model was used to construct a
support plan for promoting ongoing success in the employment setting. Based on the
three components of the Wehman et al. model, Figure 5.4 presents a communication
problem-solving model for use in the supported employment of people with ASD.
In addition to being equipped with a problem-solving model for the prevention
and remediation of communication difficulties on the job, it is also recommended that
professionals keep in mind some prominent strategies for promoting communication
success in the workplace. Hendricks (2010) discussed strategies for the successful sup-
ported employment of people with ASD in terms of the following main areas: job
Figure 5.4 Communication problem solving in the supported employment of people with ASD
Level I: Prevention (Address these items prior to the start of work, and revisit as necessary.)
A. Can the need to regularly communicate with others be reduced or eliminated within the daily
responsibilities of the job?
B. Can current methods of communication be altered to better match the strengths and needs of the
individual?
C. Can the effects of any known barriers to effective communication be reduced?
Examples:
A. Each day at the same time, the shift leader delivers a verbal reminder to begin a specific work
task to a worker with limited receptive language skills. The verbal reminder is replaced by setting
the worker’s digital watch alarm to go off five minutes prior to the necessary start time of the task
(to give the worker enough time to get his work materials ready).
B. An office mail clerk is provided with a visual display (a map of the hallways and offices, with
color-coded paths to and from delivery areas) instead of the usual written directions to each
delivery area.
C. An individual is known to display challenging behavior when presented with too many options or
given too many directives at one time. Staff and administration are instructed to provide choices
and directives to the individual in limited numbers (batches of no more than three at a time).
(continued )
Level II: Instruction (Address these items when challenging behavior or lapse in performance occur
on the job.)
A. Has the worker previously demonstrated mastery of the extent and quality of communication
being required of him/her?
B. Have all forms and contexts of the required communication been taught and practiced?
C. Are all communicative partners aware of how to best communicate with the worker?
Examples:
A. New employees and job responsibilities have introduced new requirements for communicating.
Instruction in the new requirements (and how to discriminate when it is necessary or desirable to
use each) must take place as soon as possible.
B. An initial assessment of the job omitted defining how the worker would respond to customer
requests for additional dining items (e.g., condiments, drinking straws, etc.), and she currently
goes strictly by the rule she was taught: Give one per customer. The worker needs instruction in
when she must “give one per customer” (e.g., during initial service) and when it is okay to give
additional items (e.g., upon request, after initial service).
C. A co-worker often attempts to be friendly and joke with the worker by using sarcasm when
responding to the worker’s questions, which sometimes leads to displays of challenging behavior
on the worker’s part. For example, if the worker were to ask, “How many guests should I allow
in meeting room one?” his coworker might respond with something like, “Oh, stop letting them
in when they start spilling out the windows,” thinking that the posted room capacity and number
of seats are self-explanatory. The worker should be instructed on how to recognize and receive
sarcasm, as well as how to effectively and appropriately follow up for more accurate information.
The co-worker should be instructed on how to interpret and respond to the worker’s questions in
a more literal fashion and make it more apparent when something is meant as a joke.
Level III: Intervention (Address these items if communication-related problems persist beyond levels
I and II.)
A. Does communication lead to predictable outcomes for the worker?
B. Is the connection between communication and expected action clear to the worker?
C. Does communication result in any desirable outcomes for the individual?
Examples:
A. The worker completely stops working as instructed when he wants to restock the supply bins, asks
for “part number 6,” and does not get the exact part that he expects. The facility makes a number of
items of increasing complexity, all of which use the same four basic parts, but after part 4, a range of
different parts may have the same number. After number 4, to know the exact part to which someone
is referring, one has to know the specific item that is being assembled that day (e.g., parts 1 through
4 for items A and B are the same, but part 5 for item A is different from part 5 for item B). Intervention
must take place that creates for the worker a greater understanding of this process.
B. The supervisor is frustrated because each time she delivers the directive, “It’s time to clean up,” the
worker goes to the break room, no matter where in the building the directive is delivered. However, it
is soon determined that the break room is the only place that the worker has been taught to initiate
this directive. He has not learned to discriminate one specific set of required behaviors (e.g., cleaning
up in the lobby) from another (e.g., cleaning up in the break room). So, a new set of specific directives
are taught (e.g., “It’s time to clean the lobby”), each associated with a different cleaning procedure.
C. The worker enjoys discussing the outcomes of recent sporting events. It is therefore desirable
that at least some of the individual’s attempts at communicating in social contexts (e.g., greeting
fellow employees upon entering) and communicating in work contexts (e.g., reminding others
that it is break time) be reinforced with this type of conversation, perhaps by identifying other
employees who enjoy similar pursuits.
placement, supervisors and co-workers, on-the-job training, workplace modifications,

and long-term support. Each of these areas presents some important implications for
teaching communication skills within an employment setting, and some of the main
considerations within three of the most vital areas (job placement, on-the-job training,
and long-term support) are presented in the following discussion of relevant skills and
questions to ask in the planning process.
Job placement. Along with other placement considerations that strive to match the
abilities of the individual to the requirements of the job, communication ability and
requirements must also be considered in finding the best employment fit. Associated
communication skills can include resume writing, interviewing, job-related exchanges
with co-workers and supervisors, and interacting with customers. Some relevant ques-
tions to ask when considering the amount and type of communication that must take
place are as follows:
■ Is a resume required for the application process? If so, to what extent will the
individual be involved with the resume writing process, in the range from partial to
full independence? For example, one individual may be involved to the extent that
he types his first name into the document, while another may, with formative guid-
ance in composition and final editing assistance, produce the entire document on her
own. Some may only be able to dictate material, make choices regarding the inclusion
or exclusion of predefined content or formatting, or provide relevant facts, such as
contact information, but all should participate in the process, to the highest level of
independence possible and appropriate.
■ Is an interview part of the application process? If so, to what extent will the indi-
vidual participate in the job interview? The individual’s role in an interview should be
considered similarly to his/her role in, for example, participating in an IEP meeting, in
which it is a given that the individual will be present, but his/her level of participation
may vary according to individual skills and level of developmental functioning. As in the
IEP meeting, the goal for professionals is to make sure that the individual meaningfully
participates to the fullest extent possible. Participation activities may range from the
very passive (e.g., watching a current employee perform the job that the individual may
perform, if hired) to the very active (e.g., answering a series of interview questions), but
the individual should be involved in indicating preferences for any allowable choices
(e.g., choosing from a range of suitable tasks that all need to be done) and providing final
approval of whether to work at the proposed employment site, at the very least.
■ What is the frequency, duration, and type of job-related communication that
must occur between the individual and co-workers? Failure to define the full range
of needed communication in this area can result in a mismatch between an individual
and a specific job, as in the example of an employee placed in a fast-paced assembly job.
The worker, who is verbal but does not tend to initiate conversation with others, simply
stops working and stands idle when he runs out of assembly components in his supply
bin, which causes a series of long delays in the rest of the assembly process down the
line. Further training can correct this type of problem once it occurs, but this assumes
that the employee will remain employed and get subsequent chances to improve per-
formance. It is therefore better to be proactive by closely matching the communication
ability of the individual to the predefined communication requirements of the potential
job. Time and resource limitations may not allow pretraining to make the individual
ready to communicate with co-workers as required, especially considering the fact that
most employers want workers who, from the start, are as ready for the job as is possible.
must occur between the individual and supervisors? Are there written checklists to
submit, or is frequent supervisor feedback delivered, to which an appropriate employee
action or communicative response must be made? Do not assume that fully defin-
ing the range of required co-worker communication will also adequately address the
required communication with supervisors, which is often very different. Poor commu-
nication with supervisors can endanger employment stability, even when communica-
tion with co-workers and job performance are excellent.
must occur between the individual and customers/clients? Even if communication with
customers is not a defined part of the job, all potential for such communication should
be considered. For example, some employers expect all employees to address any cus-
tomer requests made to them, whether or not an employee’s job description includes
working directly with customers. For example, imagine that a manager observes Andrea
(see Applied Vignette 5.1) simply walk back into the kitchen when a customer in the
dining room asks her to bus a specific table so that he can be seated more quickly.
On-the-job training. Once employed and working, it is vital that the individual

receive on-the-job training to adequately address changes in work responsibilities, as
well as to firmly establish personal readiness and stability in work performance (e.g.,
in the area of social skills development). Associated communication skills for use dur-
ing this initial work period can include incorporating the use of AAC tools and sys-
tems into training contexts, indicating preferences in a self-determined manner, and
responding with appropriate feedback. Some relevant questions to ask when consider-
ing the amount and type of communication that must take place are as follows:
Has the individual fully generalized the use of AAC across environments (e.g.,
■
school, home, and work) and people? If not, why not?

Where within the individual’s employment situation is it expected for him/her
■
to make choices (e.g., choosing work days or shifts), and where is it appropriate
for other choices to be defined (e.g., choosing among options of what to do dur-
ing scheduled breaks)?
Has the individual learned to provide meaningful feedback (i.e., feedback that is
■
not merely an expression of acquiescence or echolalic in nature)?

Where within the individual’s employment situation is it expected for him/her
■
to provide feedback (e.g., when asked for an evaluation of a new work tool), and
where is it appropriate for additional feedback to be provided (e.g., identifying
where additional training is needed)?
Long-term support. For maintaining employment over time, it is vital that the
individual receive both natural and external long-term supports. Natural supports
are those provided within the employment setting, such as the designation of specific
employees to assist the individual in adapting to change and problem solving. External
supports are those that are, for example, provided during follow-up phone interviews
with the individual, supervisor, or other employees, as well as periodic site visits for
performance observation (though much less frequently than in the initial stages of
employment, when the individual was acquiring new job skills). Associated communi-
cation skills useful in maintaining employment can include the ability to (a) identify
challenges for the information of others, in order to recruit assistance; (b) recruit and
maintain social support from co-workers; and (c) self-evaluate in terms of work per-
formance, as an extension of ongoing self-monitoring and self-regulation. Some rel-
evant questions to ask when considering the amount and type of communication that
must take place are as follows:
■ What is the individual’s current ability to identify difficulties, describe them for
others, and ask for help? If deficiencies exist, what supports and additional training
are needed? Fojut, Reeve, Townsend, and Progar (2011) provide an example of how
scripts (described earlier in this chapter) and script fading could be used to teach
employees with autism to engage in these adaptive behaviors, and they recommended
the use of: (a) multiple examples of relevant stimuli within each problem type (e.g.,
use scenarios with a range of broken machinery, as used by the individual on the job)
to better promote generalization of the skill, and ( b) training situations within which
it is necessary for the individual to ask for assistance and situations when it is not, to
better promote the ability to discriminate between the two situations. ( Note that the
Fojut et al. study was conducted with only four participants and within a simulated
work environment.)
■ What is the frequency, duration, and type of social communication that must
occur between the individual and others in order to maintain good working relation-
ships and active social support? Building and maintaining camaraderie with other
workers can promote an individual’s long-term success within an employment situa-
tion, especially in terms of increasing the willingness of others to provide assistance or
excuse episodes of problematic behavior. The importance of social interactions such
as greeting co-workers, participating in informal group conversations (e.g., during
breaks), and appropriately responding to humor or sarcasm can be easily overlooked
by the individual and his/her job coach or teacher. However, systematic failure to
engage in these interactions can socially isolate the individual and thereby compro-
mise co-worker support over time.
■ Is self-monitoring being taught in order to promote self-regulation, and, once
the individual increases his/her ability to self-regulate, is he/she regularly engaging
in self-evaluation? For example, Mary Lee has been taught to use a picture checklist
to monitor her completion of a task as well as make a comparison to a predefined
quality standard (e.g., pictures represent steps within a task, and each picture shows
the desired final state of the assembly or cleanup for comparison to the employee’s
work). To promote self-regulation, task completion is organized around and associ-

ated with engaging in work breaks (during which Mary Lee can do favorite activities,
such as play a video game, listen to music on a portable device, or have a snack) and
presented within a schedule of daily activities. Once these skills have been established,
self-evaluation can be taught, in which she can be shown how to examine self-moni-
toring data taken over time (e.g., from the checklists, as described above), preferably
in visual form (e.g., within a line or bar graph), in order to compare her performance
with preset goals for sustained or improved performance (also presented visually, such
as a goal line drawn on a line graph representing percent of correct task completion
over time). This type of self-evaluation can then be tied to supervisor evaluations of
the employee’s performance, and preferably to any associated increases in pay, making
that process much more transparent for the individual. Communication within these
activities can focus on indicating understanding of the procedures and process, report-
ing evaluation results, and affirming how results relate to goals and any associated
reinforcement of desired behavior.
In addition to these considerations, Hagner and Cooney (2005) presented rec-

ommendations that the communication of supervisors be direct, precise, and include
reminders and reassurances. For the required communication of employees with ASD,
this implies the need for appropriate, reciprocal communication, such as the ability to
(a) accurately respond to supervisor questions in order to communicate, for example,
understanding of any correction or direction (in addition to performing required or
requested actions); and (b) indicate affirmation and acceptance (or disagreement and
the need for problem solving, as previously described) of reassurances. The context
for this communication should be within normalized employee–employer relations.
In other words, communication and interaction involving the employee with ASD
should be like that involving any other employee, or as closely approximated as is
possible. This includes communication such as the provision of commendations or
corrective feedback, requests for self-reports of performance, and engaging in daily
social interaction.
Recreation and Leisure

Identifying and supporting opportunities for recreation and leisure for people with
ASD are essential activities in promoting longitudinal quality of life for these indi-
viduals, and the possession of an adequate ability to communicate tends to sustain
this type of ongoing involvement in the community, hopefully to the point of greater
independence and satisfaction for an individual. A range of factors have been shown
to effectively support the leisure activities of people with ASD, such as family involve-
ment in the activities (Lock, Hendricks, Bradley, & Layton, 2010), training of com-
municative partners (Sack & McLean, 1997), and collaborative efforts among family
members and professionals (Polvin, Prelock, & Snider, 2008). However, it is also true
that identification of the communication skills needed within an environment can
influence the number and type of communicative opportunities in which these indi-
viduals may or may not choose to engage (Sack & McLean, 1997). Therefore, it is
recommended that communication skills be identified within the contexts of interac-

tions with family, friends, and support professionals, rather than solely focusing on
communication that deals with the procedure of a particular activity, such as com-
municating with the person at the ticket counter of a certain event (which is also
necessary to learn, of course). There are certainly solitary leisure activities that lend
themselves to this type of singular focus, but a mix of leisure and group activities
(which are often recreational in nature, such as competitive games requiring teams of
participants) is recommended for anyone seeking a healthy balance in the develop-
ment of recreational skills.
Based on some of the recommendations of Polvin et al. (2008), an interac-
tive, person-contextual approach to identifying recreation- and leisure-based com-
munication needs of an individual should focus on answering questions such as the
following:
■ In addition to any outcomes identified by the individual, what are the main com-
munication outcomes identified by the individual’s family, and how can they be effec-
tively incorporated into the recreational activity to make it more enjoyable for the
individual and efficient in meeting his/her needs and preferences? Family identified
goals for communication can be taught and learned in the enjoyable atmosphere of
participating in preferred forms of recreation and then generalized to other environ-
ments within which the family operates (e.g., at home).
■ How will the individual be expected to communicate with friends or other par-
ticipants during the activity, and, if applicable, how will the individual’s method of
AAC be efficiently incorporated into this task (efficient = beneficial in facilitating the
activity rather than, for example, slowing it down or making it less fun)? Engaging in
fun recreation is a great situation for training communicative partners, as well as the
individual. Both parties are likely to be highly motivated to learn to effectively com-
municate with one another in order to move the activity along to the next most enjoy-
able point.
■ How will the individual be expected to communicate with any support profes-
sionals who are present, especially during the use of any teaching methodologies
and tools? This is a great area within which to learn the procedure of a particular
activity, which may include communication with a person other than those discussed
here (such as a vendor or a participant not in the individual’s group). However, keep
in mind that communication with the professional is the basic necessity for learn-
ing and practice during the activity, and this communication should be well-defined
and designed to be as efficient as possible so that it does not unnecessarily interfere
with engaging in the activity itself, which is the whole point of being there. This
is why quickly delivered, visual forms of communication are often preferable, such
as gestures, manual signals, and picture prompts, all of which must be learned and
practiced beforehand. For instance, the individual can be taught to request from
the professional a prompt for a next step in the game, an assist in communicating
with another person, or a reminder of a particular rule, but doing so may be as
quick as pointing to a picture on a communication board or using a particular hand
gesture.
Postsecondary Education and Training

College. For many students with Asperger’s syndrome or high-functioning autism
who seek to attend or are attending college, it is not the difficulty of the coursework
that presents the major challenge in determining their level of overall success. The most
powerful determinate in the success equation for many of these students is more often
the social barriers that they encounter, whether self-imposed or imposed upon them
by others. For example, Nevill and White (2011) found that college students’ levels of
acceptance of individuals with ASD varied significantly across a number of variables
including whether students had a relative with ASD, and the authors recommended that
colleges adopt programs to prevent the social isolation of students with ASD.
As with other areas of community-based activity, effectively and appropriately
communicating with people in a college setting is a skill that, if developed, can greatly
diminish stigma and increase acceptance. Adreon and Durocher (2007) defined some
of the communication difficulties that students with ASD may experience within a
college setting, including (a) producing effective written communication (e.g., within
assignments, emails, and messaging applications), (b) self-advocacy in seeking supports
from the college and its faculty, and (c) maintaining supportive contact with parents.
Two important recommendations from the authors were the use of a “point person”
or liaison and identification of a mentor. Figure 5.5 provides information on possible
roles and responsibilities associated with these people.
Figure 5.5 College liaison and mentor roles and example responsibilities regarding the
facilitation of communication in a university setting
Assisting with Communication: Example

Role Responsibilities
Liaison ■ Assist the student with A faculty or staff liaison may:

meeting academic demands.
■ Deconstruct bureaucratic/ ■ Help the student contact a professor to inquire
administrative requirements about the availability of additional study materi-
for the student. als, tutoring services, or learning aids regarding a
■ Keep track of the student’s particular academic topic.
stress level. ■ Assist the student in contacting a university office,
explaining what is needed, and requesting to meet
with a specific staff person who knows how to
perform the required task.
■ Help the student with contacting university counseling
services or notifying his/her parents or guardians
when increased stress levels are suspected.
Mentor ■ Provide support with A peer mentor may:

organizing college life and
responsibilities. ■ Assist the student with clarifying assignment due
■ Help the student integrate dates or exam schedules with the instructor.
with campus social life. ■ Help the student make and maintain social contacts
■ Help the student problem within classes and his/her academic major.
solve social difficulties. ■ Assist the student with contacting the appropriate
university office to report ongoing harassment by
another student.
In seeking the people who will potentially fill these roles (e.g., other college
students or university faculty), it is important to consider the areas within which they
will primarily operate and the access to people, knowledge, and resources within the
college that they will need. For example, a willing faculty member, such as the stu-
dent’s academic advisor, may be best for the role of liaison because he/she already has
working professional relationships with university offices and other teaching faculty.
However, for the role of mentor, a fellow student may be best because he/she will have
the perspective and knowledge of how a student needs to effectively operate on that
particular campus.
Vocational training. In a recent systematic review of the professional literature on

vocational interventions for young adults with ASD (Taylor, McPheeters, Sathe, Dove,
VanderWeele, & Warren, 2012), an extensive search revealed relatively few studies, all
of which: (a) were assessed by the authors to be of poor quality, and (b) dealt with the
provision of employment supports. Within this limited but growing pool of research,
evidence-based information on teaching communication skills within the context of
vocational training is one pressing need among many, especially considering how
critical communication skills have been found to be in promoting success the people
with ASD operating in community environments. However, there are some interest-
ing investigations that suggest avenues for applied exploration in the types of com-
munication used within vocational training for members of this population. Figure 5.6
presents several examples of these studies and suggests directions for practitioners
who wish to explore relevant and emerging needs in teaching communication skills to
young adults and adults with ASD currently receiving vocational training.

the Autism Language Program (ALP) at Boston Children’s Hospital, a program that
specializes in increasing the communicative ability of children with ASD. The ALP
provides services that include language evaluation and construction of individual-
ized home and school communication plans for families, covering both receptive and
expressive language abilities. For more information, consult their website at: www
.childrenshospital.org/clinicalservices/Site1850/mainpageS1850P0.html.
Chapter Summary
standing and addressing communication skills in the education and treatment of people
with ASD. The communication needs of people with ASD were explored within a
lifespan perspective, and typical language development was briefly compared with the
communication and language development of people with ASD.
Figure 5.6 Implications for teaching communication skills to people with ASD, as derived from
a sample of vocational training research
Implied Communication
Level of Brief Description Needs and Approaches for
Study Evidence* of Intervention Vocational Training
Allen, Wallace, & Single-case Video modeling was used Communication skill: Use of
Renes (2010) design (multiple to increase interactions with nonverbal communication
baseline) with customers (waving, shaking skills to appropriately inter-
four participants hands, giving high-fives, and act with others (e.g., greeting
manipulating the costume others and expressing emo-
controls, e.g., for the face) of tions), request assistance, or
workers with ASD in an animal express choice or opinion
character costume.
Gentry, Lau, Case study Within three different job Communication skill:
Molinelli, with three settings, participants used Responding to prompts and
Fallen, & Kriner participants personal data assistants (PDAs) scripts related to expected
(2012) that delivered video prompts, communication within a
provided reminders for task training situation (as presented
completion, and presented task through the use of portable
lists, among other supports. technology)
Hillier, Fish, Pre/post com- Within a self-directed group Communication skill:

Cloppert, & parison with 13 format (with facilitators Communication of personal
Beversdorf participants present), participants shared and social difficulties,
(2007) experiences and created engaging in problem solving
problem-solving strategies in with peers
regard to a range of social topics
(including vocational issues and
communication).
Hillier, Fish, Pre/post com- The same programmatic Communication skill:

Siegel, & Bev- parison with 49 intervention in Hillier et al. Expressing personal emotions
ersdorf (2011) participants (2007) was used, but pre/ and attitudes toward others in
post measures of anxiety, order to recruit assistance
depression, and peer relations
were completed by participants.
Robinson Case study with Prompting, scheduling, Communication skill:

(2010) one participant reinforcement, and simulation Appropriately communicating
were used to teach an with customers (e.g., to
adolescent with autism to change services or collect
complete various tasks related payment)
to a running a paper route.
*Refer to Chapter 2 (Determining Evidence-Based Interventions) for an extensive discussion/explanation of this topic.
Next, the topic of teaching prerequisite communication skills was addressed

across home and school settings, with special emphasis placed on translating research-
based practices to applied settings and teaching within the context of daily activity/
routines. Readers were also provided with methods for informally assessing a learner’s
readiness to engage with some common types of augmentative and alternative com-
munication (AAC) tools, and aspects of learner preference were explored as a means of
ensuring the frequent and appropriate use of both aided and unaided AAC tools across
various communicative contexts.
Methods for preparing students to communicate in inclusive education set-
tings were presented, along with methods for creating opportunities to commu-
nicate and teaching communication with peers. The final segment of the chapter
explored communication in terms of future directions, in regard to the future life
pathways of individuals, as well as the future directions of communication research
and applied practice in the community settings where these individuals work, play,
and learn.
One of the main goals of this chapter was to provide you with an introduction to
the understanding and application of a complex topic—teaching communication skills
to people with ASD across the changing needs that arise throughout their lifespans.
Embedded throughout the chapter was a strong rationale for teaching these skills, in
order to increase successful interactions at home, in school, and in the community and
decrease problematic behavior, dependence on others, and social stigma.
Ac t i v i t i e s t o E x t e n d Y o u r L e a r n i n g
1. Prepare your own case study for presentation to the class. First, investigate more fully
the aspects of typical language development. Next (with the necessary parent/guardian
permission and the use of confidentiality), examine the language development of a per-
son with ASD, in terms of your findings regarding typical development. Last, research
communication interventions that fit the needs of this individual, and write an informal
plan for building his/her communication skills in beneficial ways.
2. Conduct an online search for instructional materials, devices, and manuals for using
the three main types of AAC tools (manual signs, speech-generating devices, and
graphic symbol systems) used in teaching communication skills to learners with ASD.
Within your results, make a distinction between (a) the various characteristics of the
tools themselves, and (b) the methods used to teach with these tools.
3. Select one of the specific tools or methods that you found in your online search in
activity 2. Search a database of peer-reviewed literature to locate any studies published
in professional journals that were conducted with people with ASD to investigate the
effectiveness of the tool or method. Report on the number, quality, and usefulness (to
practitioners) of the studies you found.
4. Using a case study or actual student (with permission), apply the guidelines, steps, and
questions found in this chapter to conduct an informal assessment of fit with learner
characteristics and preferences regarding one or more AAC tools that may appropriate
for this individual.
5. Using a case study or actual student (with permission), write an individualized plan
(one that takes into account the specific characteristics and needs of the individual)
for (a) preparing him/her to communicate, ( b) creating school-based opportunities for
communication, and (c) teaching communication with peers.
R e s o u r c e s t o C o n s ul t
Websites
Autism Community National Institute on Deafness and Other
www.autism-community.com/ Communication Disorders (NIDCD)
communication www.nidcd.nih.gov/health/voice/pages/
communication-problems-in-children-with-
The National Autistic Society autism-spectrum-disorder.aspx
www.autism.org.uk/living-with-autism/
communicating-and-interacting/
communication-and-interaction.aspx
Books
Baker, J. (2001). The social skills picture book: Teaching play, emotion, and communication to children with
autism. Arlington, TX: Future Horizons.
Mirenda, P., & Iacono, T. (Eds.). (2009). Autism spectrum disorders and AAC. Baltimore, MD: Paul H.
Brookes.
Prelock, P. A., & McCauley, R. J. (Eds.). (2012). Treatment of autism spectrum disorders: Evidence-based
intervention strategies for communication and social interactions. Baltimore, MD: Paul H. Brookes.
6
chapter
Methods for Developing

Social Competence

■ Comprehend the challenges that learners with ASD experience in the area of social competence, and
how these challenges interfere with their development.
■ Describe how the neurodevelopmental, cognitive, and behavioral viewpoints explain the social and
communicative challenges experienced by learners with ASD.
■ Identify and demonstrate an understanding of evidence-based practice (EBP) in the areas of social
skills and social competence.
166
c h ap t e r si x / Methods for Developing Social Competence 167
Chapter 6 Mind Map

The Importance of Social Social Skills & Social Competence Defined
Skills & Social Competence
The Importance of Social Competence in Daily Life
EBP Methods Identified
Parent Partnerships
Neurodevelopmental Perspective
Understanding Social Skill Peer-Mediated Interventions
Cognitive Perspective Difficulties in Persons with ASD Methods for Developing Social Competence
Evidence-Based Practices in the Social Skills Training Groups
Behavioral Perspective Development of Social Skills
Video Modeling
Social Stories
Self-Management
Naturalistic Interventions
The Importance of Social Skills

and Social Competence
One of the core deficits associated with autism spectrum disorders (ASD) is in the area
of social skills. These chronic social difficulties, paired with challenges in the area of
communication (both areas now combined in the new diagnostic criteria), often pose
significant hardships for individuals with ASD because social skills are essential in all
aspects of life. Social skills are critical for navigating environments such as school,
the community, and work settings, and in the building of meaningful social networks
including relationships with family, friends, and others. These skills are vitally impor-
tant for all children to learn early on in their development. For children with ASD,
delays in social skills, paired with difficulties in language and communication, create
great hardships in the broader area of social competence.
Social Skills and Social Competence Defined

Social skills can be defined as a group of discrete or individual and separate skills used
daily in our interactions with others. Examples include skills such as greeting others,
saying thank you or excuse me, or asking for help. Social competence, however, is an inte-
gration or broader application of these discrete skills and processing components, such
as the ability to discern subtle nonverbal social cues and recognizing emotions to achieve
one’s social goals (Chasson, Timpano, Greenberg, Shaw, Singer, & Wilhelm, 2011).
Now consider how social emotional development ensues for children who are
typically developing. Children at the infant and toddler stage will typically develop
an emotional bond with their parents and, provided that the relationship is a nurtur-
ing one, they will deepen these emotional bonds and the parent–child interactions
and interactions found within the family will enhance the child’s social communi-
cation. As children enter preschool, they will expand these skills through play and
the formation of friendships, which are important for the child in learning to regu-
late his/her behavior through activities such as cooperative play with others and in
learning to identify one’s feelings. As children enter early elementary programs, they
will expand on these play skills to include games (structured play), providing further
168 S ec t ion I I / Early Childhood
opportunities for the development of social skills, and they will begin to communi-
cate more openly about their feelings. These developmental progressions help teach
and refine discrete social behaviors and foster social competence in children who are
typically developing. For children with ASD, we see a marked difference in terms of
development with respect to the formation of these skills and, subsequently, these
children experience difficulty in the areas of communication and in the performance
of social skills.
The Importance of Social Competence in Daily Life

Here is an example of social competence as it concerns a relevant high-frequency
activity for most of us in our day-to-day lives: going into a fast food restaurant and
ordering a meal. There are several discrete or individual social skills that comprise this
activity. These include such skills as waiting in line appropriately, being courteous to
others, awaiting your turn, placing your order, paying for your order, collecting your
food, saying thank you, and finding your way from the line to a vacant seat to eat and
enjoy your meal. Now pair these discrete social skills with the ability to discern the
subtleties involved in demonstrating these skills in a competent and fluent manner,
given the context of a fast food restaurant, and this would constitute one’s social com-
petence in this particular situation.
Consider the subtle cues that one must be aware of when waiting in line. You
must be able to discern where the line begins and ends, wait patiently, allow personal
space for others in line, await your turn to order, and place your order (waiting for the
cue from the server “May I take your order please?”). Next, consider making eye con-
tact, a skill that is often very difficult for learners with ASD. Upon making eye contact,
you communicate in an appropriate tone placing your order as you pause and wait
for the server’s prompt “Will there be anything else?” Next, you pay the appropriate
amount. If the learner doesn’t have fluency with money skills, then using a compen-
satory approach such as the dollar more method (whereby you count up by a dollar
and pay the cashier) may be a strategy worth trying. For example, if your food cost
totals $4.50, give the cashier $5.00, thus alleviating the need for counting change. Now
you must wait for your change, your food, and of course say “thank you.” By now you
understand the complexities involved in such a social interaction and how these indi-
vidual discrete skills, though important, must be integrated within a larger context to
promote social competency.
The social skill difficulties experienced by persons with ASD have been described
from the earliest of accounts in the research literature. One often hears the terms
socially aloof, withdrawn, internalized, and other such words used to describe the atypi-
cal social behavior often observed among persons with ASD. In fact, the word autism,
translated from ancient Greek authos, means self (Lombardo & Baron-Cohen, 2011),
and was first used in the research literature by Swiss psychiatrist Eugen Bleuler as
early as 1910 (Kuhn, 2004). The idea of “self ” has been consistently referenced since
the earliest accounts of the literature involving individuals with autism. In his seminal
paper, Kanner (1943) describes how many of the children he observed were with-
drawn and happiest when they were alone, and living within themselves.
Persons with ASD do experience difficulties in their social interactions with

thers. Evidence of this often includes difficulties with such skills as turn-taking when
o
conversing with others, or what is referred to as social reciprocity; attending to sub-
tle social cues; avoiding eye contact; difficulties in understanding nonverbal behav-
iors in others; a lack of interest in peer interaction; a lack of enjoyment from social
opportunities; repetitive and stereotypical behaviors; and insistence on routines. All of
these pose challenges in the development of social competence in learners with ASD
(Cotugno, 2009). These social limitations greatly impact the ability of individuals with
ASD to establish friendships, often pose limitations on the quality of their experiences
while in school, and can often pose challenges to successful employment and commu-
nity living. Mackay, Knott, and Dunlop (2007) indicated that children and adolescents
with ASD reported having fewer friends and experienced bullying while in school, and
that adults with ASD who are high functioning are less likely than typically developing
peers to live and work independently. These are indeed substantial challenges for a
child and family to face across a lifespan, and it speaks to the need for effective inter-
ventions to address these challenges.
Understanding Social Skill Difficulties in Persons

with ASD
Research has critically examined the social and communication difficulties experi-
enced by persons with ASD. There are basically three theoretical frameworks from
which these difficulties have been examined and studied to better understand them in
persons with ASD: (1) the neurodevelopmental, or brain-based, perspective; (2) the
cognitive perspective; and (3) the behavioral perspective. Let’s examine each of these
in more detail to provide you with a reference point.
Neurodevelopmental Perspective
The neurodevelopmental perspective seeks to determine why persons with ASD have
difficulties with social skills as a result of atypical brain development. Recent research
in this area has identified the executive functioning or “high order” cognitive pro-
cesses associated with the prefontal cortex of the brain, which controls and regulates
behavior (Pellicano, 2012), as being underdeveloped and a potential explanation for
the social skill deficits experienced by persons with ASD. Other research findings sup-
port that individuals with ASD depend on the brain regions associated with processing
low-level perceptual information, including social and nonsocial information, rather
than the temporal-occipital regions of the brain, which are used for the higher-order
processing (Bhatia, Rajender, Malhotra, Kanwai, & Chaudhary, 2010).
What does all of this mean and how is it useful to you, the aspiring classroom
teacher? We know that autism is a neurodevelopmental disorder and we understand as a
result that neurodevelopment is adversely affected, which results in atypical development
across all developmental domains, including the social and behavioral development of
children identified with ASD. As educators it is important to understand the underlying
factors that influence development, and how neurodevelopment in children with ASD
influences social behavior and other areas of learning.
Research continues in trying to forge a better understanding of how the brain
functions in persons with ASD through the use of functional magnetic resonance
imaging (MRI). Consider Gotts, Simmons, Milbury, Wallace, Cox, and Martin (2012)
who, using a whole-brain connectivity approach to functional MRI, revealed that
there was impaired connectivity not only in the “social brain,” which refers to areas of
the brain that are coactivated across social tasks, but also in the limbic-related regions
of the brain, which are associated in affective aspects of social processing. Scientific
research on the brain provides practitioners with a greater understanding as to the
origins of social skills challenges faced by persons with ASD. In time, such research
will hopefully yield enough conclusive information that will guide our treatment ini-
tiatives more directly in meeting these challenges faced by learners with ASD.
Cognitive Perspective
A cognitive theory for understanding social skills and social competence in persons
with ASD that has drawn a great deal of attention is “theory of mind” (Baron-Cohen,
Leslie, & Frith, 1985). Basically, the theory of mind proposes that individuals with
ASD have an inability to understand the feelings of others, or, as Baron-Cohen (2009)
described it, they lack the ability “to put oneself into someone else’s shoes” (p. 68). As
a result, individuals with ASD are challenged in how to initiate, maintain, and repair
social interactions because they lack the ability to read and interpret nonverbal cues
from their interactions with others. As Baron-Cohen (2009) further explains, these
difficulties result in children with ASD having “mind blindness,” thus inhibiting their
ability to imagine another person’s thoughts or feelings. Mind blindness is the inability
to read meaning from someone’s eye gaze, facial expression, gesture, body language,
and intonation (Minshew & Keller, 2010). Consider the examples in Figure 6.1 of how
social skill interactions typically occur.
In Figure 6.1 you see two examples that are distinctly different from one another
to illustrate how difficult it is for children with ASD to discern social cues. In the
first example, Amy is greeted by her teacher, Ms. Dotson, with an engaging smile
and a handshake as she welcomes Amy into her new class. In turn, Amy responds
to the greeting from Ms. Dotson with a smile and handshake, replying “thank you.”
In the second example we see Kara, who is the same age, going with her parents to
meet her new teacher. Though the cues are slightly different—Ms. Allison, Kara’s new
teacher, is sitting in a chair—the social context is the same. But instead of responding
appropriately, we see Kara attempting to sit on Ms. Allison’s lap as she says “hello.”
Note the distinctly different responses on the part of these two children as merely one
example of how these social difficulties can manifest for children with ASD. In fact, it
is quite common for many children on the high end of the autism spectrum (formerly
referred to as Asperger’s syndrome) to exhibit no fear in interacting with complete
strangers in such a social situation. The depiction of this scenario in the figure is illus-
trative of mind blindness, as described by Baron-Cohen (2009). Baron-Cohen (2009)
has expanded on this to form a theory that examines how empathy (one’s ability to
Figure 6.1 An illustrated comparison of greeting skills
A parent introduces Amy, her

9-year-old child, to her new
teacher, Ms. Dotson. Ms. Dotson Amy smiles, makes eye
extends her hand and makes eye contact with Ms. Dotson, and
contact, shaking Amy’s hand shakes her hand while saying
and saying “Welcome to our class. “thank you.”
We are glad you are joining us.”
Kara, a 9-year-old child with Upon seeing Ms. Allison, Kara

Asperger’s, and her parents arrive walks up to her chair and tries
at her new classroom. As they to sit on her lap, saying “hello.”
arrive, the teacher, Ms. Allison, Her parents redirect her and have
is seated at her desk. When they her stand at their side while they
walk in, she turns and says greet Ms. Allison.
“good morning.”
respond to the emotions of others) paired with systems or rules one uses within social
situations can be understood as a means of better understanding the social difficulties
experienced by persons with ASD.
“Empathizing-systemizing theory,” developed by Baron-Cohen (2009), sup-
ports the need for systematically teaching affective skills such as empathy, a skill that
is traditionally challenging for learners with ASD within the context of a structure
or system, as a high degree of structure is something that learners with ASD respond
well to. The strength of this theory from an applied or classroom teacher’s point of
view is that you are not exclusively working on skill deficits, in this case empathy, but
as Baron-Cohen (2009) points out, you are instead addressing it from a strengths-
based approach within a framework or system that accommodates the learning style
of the individual. He goes on to explain how the use of technology can help provide
learners with videos used to depict emotions and facial expressions as examples of
using a teaching approach that accommodates the needs and learning styles of learners
with ASD. The evidence base to support the empathizing-systemizing theory and its
efficacy in the treatment of social skills and social competence among children with
ASD is limited at this point in time.
Behavioral Perspective
Finally, the behavioral model of intervention and treatment has been actively engaged
in the delivery of treatment programs designed to improve the social skills of individu-
als with ASD for a very long time through the use of applied behavior analysis. These
interventions have been largely successful in helping learners with ASD develop dis-
crete social skills. Examples of these include greetings, making eye contact, holding the
door for another person, and saying “thank you,” “please” and “excuse me.” Behavioral
interventions have been successful in allowing us to teach these skills to learners with
ASD, but using them over time within social settings has remained difficult for these
individuals. Persons with ASD have a difficulty with generalizing these skills across
settings and maintaining them over time, which results in serious challenges in the
area of social competency. Consider in your typical day all of the social opportunities
and the skills required to successfully navigate these in your life. Well, for learners
with ASD, each of these demands poses a real challenge and may even invoke anxiety,
especially if they represent new social situations in which the learner has had little or
no previous training or experience. The behavioral model has been largely responsible
for furthering the evidence base in terms of methods for successfully teaching appro-
priate social skills to individuals with ASD.
Evidence-Based Practices in the Development

of Social Skills
There have been reviews conducted in the research literature that have examined
evidence-based practices (EBP) in the area of social skills for persons with ASD. One
of the most thorough reviews, conducted by Reichow and Volkmar (2010), consisted
of a synthesis of best evidence in which they examined 66 studies conducted across
the years 2001 to 2008, with a total of 513 participants diagnosed with autism. They
presented their findings by age categories and found the following results from their
analysis. The interventions for preschool children consisted of 35 studies imple-
mented across a total of 186 children with the majority of children being 4 years of
age. The findings revealed that the majority of interventions were based in applied
behavior analysis (ABA), implemented by professionals, largely within school settings,
and generally consisted of naturalistic approaches or involved the use of peer training.
They involved multiple sessions per week, for as long as 12 weeks. Results indicated
increased social communication.
In their review, they found that the studies conducted with school-aged children
included a total of 28 studies with 291 participants. Similar findings to that of the
preschool group were reported. The most frequently used intervention types were
ABA involving the use of peers and video modeling techniques, with schools being the
most common intervention setting.
With regard to adolescents and adults, there were fewer studies completed—
only 3 studies and a total of 36 participants, with one of the studies being conducted
using a group design. The treatment approach used in one study was video modeling
and the two remaining studies were approaches based in ABA. Based on this review,
we see that the major portion of research on methods for teaching social skills to stu-
dents with ASD has been from the field of applied behavior analysis.
In summary, Reichow and Volkmar (2010) summarized the following findings
relative to their study pertaining to social skill interventions for individuals with ASD.
The most widely used intervention method of choice was ABA, in which the studies
reviewed incorporated a variety of methods for teaching social skills that included
prompting, reinforcement, modeling, and imitation. Naturalistic methods were also
popular, in which interventions were delivered in the context of the natural environ-
ment and with the use of naturally occurring reinforcement. As Reichow and Volkmar
(2010) have indicated, the majority of the studies that utilized naturalistic methods
were used largely with preschool children, with only one study involving older chil-
dren. The authors recommend the exploration of these methods with older children
diagnosed with ASD. Other findings included the need for more research on parent
training as a means by which to improve social skills in individuals with ASD, but once
again there is not a lot of research that addresses this for parents of adolescents and
adults with ASD.
EBP Methods Identified

So what are the evidence-based methods used in teaching social skills to students with
ASD? Let’s first reintroduce the definition of evidence-based practices. There have
been different views expressed in the literature on what constitutes evidence-based
practice in ASD; however, most recently, the National Professional Development
Center on Autism Spectrum Disorders (2013) defined evidence-based practice as
efficacy that must be established through peer-reviewed research in scientific jour-
nals using either randomized or quasi-experimental design studies. This can consist
of two high-quality experimental or quasi-experimental group design studies and/
or single-subject design studies conducted by at least three different investigators or
research groups, one high-quality randomized or quasi-experimental group design
study, and three high-quality, single-subject design studies conducted by at least three
different investigators or research groups. In short, what this definition does is estab-
lish guidelines for determining what qualifies as an evidence-based practice. What
does this all mean for you as a teacher or related professional serving children with
ASD? It provides you with a guidepost of recommended practices for instructing
learners with ASD that have been demonstrated to be effective through experimental
research.
With respect to the evidence-based practices and social skills as of this writ-
ing, the NPDC on ASD has identified 24 total practices across multiple domains that
meet the criteria described above as EBP. Within the area of social skills there are five
categories of intervention that have been demonstrated to be effective and also that
qualify as evidence-based interventions as determined by the NPDC on ASD. These
include: (1) social skills training groups, (2) video modeling, (3) social narratives,
(4) self-management, and (5) naturalistic intervention. However, it should be noted
that in a separate analysis conducted by Reichow and Volkmar (2010) the authors also
identified only three of these five (social skills groups, video modeling, and naturalistic
interventions) as meeting their framework for EBP so there is some debate as to these.
We will provide an overview of the following forms of interventions aimed at enhanc-
ing the social competence of learners with ASD: (1) parent partnerships, (2) peer-
mediated interventions, (3) social skills training groups, (4) video modeling, (5) social
narratives (or Social Stories), (6) self-management, and (7) naturalistic interventions.
Parent Partnerships
Rather than reinforce the idea that we as professionals “train” parents in the imple-
mentation of interventions aimed at increasing the social skills and ultimately social
competence of their children with ASD, we would prefer to think of these relation-
ships as partnerships. You will undoubtedly read in the literature much on parent
training, yet really our work as teachers rests on having developed a sound partnership
with parents and families. In turn, these relationships often result in parent-assisted
interventions. We recognize that for such interventions to be truly effective they must
rely on the input and collaboration of all concerned with the well-being of the learner,
and the learner’s parents at the top of this list.
There are many strengths to parent collaboration in the design and delivery of
social skill interventions. One of the most obvious is that parent-assisted interventions
increase the likelihood of generalization because not only is the learner being taught
to perform the skill at school, but also within the home and community environments.
Parent-assisted interventions reinforce the learner’s acquisition and fluency of new
skills, given that the learner has increased reps or opportunities for practicing the skill
in multiple settings. Also, working on social skills within family settings provides a
comfortable setting for learning and it hopefully reduces the anxiety that some learn-
ers experience when learning a new social skill. Social situations can invoke a height-
ened level of anxiety for some learners with ASD, so working on these skills alongside
parents and families can serve to naturally dissipate some of this.
There are examples within the research literature that support parent-assisted
social skill interventions, but there is not a large body of work in this area. The research
that does exist speaks to the efficacy of parent-assisted social skill interventions largely
with young children and teenagers. Ingersoll and Gergans (2007) successfully used
parent-implemented imitation to increase imitation in young children with ASD (ages 31
to 42 months) as part of a naturalistic intervention designed to teach spontaneous
imitation skills during play. In older children, Laugeson, Frankel, Mogil, and Dillon
(2009) utilized parent and teen groups directed toward increasing the friendships
of 33 teenagers with ASD. The intervention consisted of twelve 90-minute sessions
offered weekly over the span of 12 weeks. Some examples of the items covered in the
12-week intervention included social skills aimed at increasing friendships and social
networks, such as conversational skills, electronic communication, choosing friends,
peer entry and exit strategies, and handling teasing and bullying, among others. The
results indicated improvement in social skills and an increase in peer get-togethers as
reported by parents. More research is needed to help in advancing the role of parents
as partners in the delivery of social skill interventions across all age groups of individu-
als with ASD.
Peer-Mediated Interventions
Peer-mediated interventions are social skill interventions that enable typically devel-
oping peers the opportunity to model and reinforce appropriate social interactions for
students with ASD. Peer-mediated social skill interventions promote the interaction
of learners with ASD with typically developing peers or siblings within the context of
natural environments (Zhang & Wheeler, 2011). This form of intervention can also
incorporate video modeling using peers, and has been demonstrated to be even more
effective when using siblings as peer models (Zhang & Wheeler, 2011).
Sperry, Neitzel, and Wells (2010) outlined the steps in the implementation of
peer-mediated instruction for use within the classroom: (a) the selection of peers,
(b) the training of peers, (c) implementation of the peer-mediated instruction, and
(d) promoting generalization. As Sperry et al. (2010) have indicated it is most impor-
tant to select peers who exhibit good social skills, who are well liked by others, and who
respond favorably to supervision from the teacher. In training peers it is important to
help children better understand the commonalities they share rather than focusing on
the differences. But, as Sperry et al. (2010) emphasize, it is important for the classroom
teacher to help them delight in individual differences. It is also important to provide
peers with strategies for implementation and to allow peers to exchange their ideas
so they feel a part of the process. As pointed out by Sperry et al. (2010), with younger
children ages 3 to 8 years it is important to teach basic play behaviors such as selecting
a play activity, sharing with others, and helping and providing assistance during play-
time. During the implementation of the activity, the teacher will introduce and pro-
vide support to the peers and to the child or children with ASD with needed prompts
when appropriate. It is important that these sessions be consistently scheduled within
a quiet area of the classroom. Careful consideration should be given to the materials
selected for the activity, and it is a good idea to limit the number of play materials
and select those that will promote the greatest amount of social interaction. Another
important consideration is that teachers and/or paraprofessionals provide prompting
when necessary and social reinforcement to promote engagement on the part of the
children (Sperry et al., 2010).
Loosely structured times during the day, such as leisure or playtime and time in
learning centers (where children interact with materials and their own pace), serve as
great opportunities to introduce peer-mediated social skills instruction. These typi-
cally unstructured times often pose the greatest challenges for children with ASD
because they lack predictability and embedded cues of other academic and struc-
tured learning times. In fact, peer-mediated intervention has generally centered on
the development of social skills during the context of play-based activities. Banda,
Hart, and Gitz (2010), however, demonstrated the use of this method applied within
an academic-related center. The purpose of the study was to investigate the effects of
training students with ASD and their typical same-aged peers to improve their social
initiations and responses in general education settings. The study involved two chil-
dren, both 6 years old, with ASD and two to three typical peers per child. It was con-
ducted in two general education kindergarten classrooms during center time. Note
that these were academic-related centers where the tasks were independent or group
tasks with approximately 3 to 5 students per group engaged in activities relevant
to material that was previously taught in the areas of math, language, writing, and
fine motor skills. For purposes of this study, the students were only observed during
activities that required sharing or cooperative play. The activities in which the chil-
dren were engaged included writing and coloring activities (tracing words and draw-
ing or coloring a picture), fine motor skills (manipulating small objects), and simple
board games. Banda et al. (2010) measured initiations and responses or peer-to-peer
interactions that involved the student engaging in an interaction or responding to
one. The participants and peers were trained together on how to ask questions of
one another, such as in the sharing of materials at the center. The questions were
then modeled for the children and the children were prompted to ask/respond to one
another’s questions by the researcher. The results of the study demonstrated immedi-
ate and substantial improvement in both social initiations and responses. There were
two features of this study to consider. The first is that the center time activities were
academic in nature and that the researcher trained both the participants and the peers
simultaneously within the inclusive kindergarten classrooms. Implications that Banda
et al. (2010) recommend are to consider the activities that are selected within learning
centers with emphasis given to activities that present more social opportunities for
students to interact. Activities that require collaboration on the part of the children to
complete also foster opportunities for students to engage in joint attention activities
and promote social opportunities.
In conclusion, peer-mediated strategies offer much strength to the classroom
teacher in working toward promoting social competency in learners with ASD.
Children learn effectively through modeling or social learning and, in the case of
peer-mediated interventions, typically developing peers serve as models. Some things
to consider when embarking on this strategy are focusing on the design of the activ-
ity and the proximity that peers have to children with ASD within these contexts. As
a teacher you may choose to train peers exclusively on how to model, reinforce, and
engage in desired behaviors such as eye contact, task engagement, asking for help, and
sharing or turn-taking, or you may select to model and teach themes simultaneously
to both peers and students with ASD.
Social Skills Training Groups

Social skills training groups represent one evidence-based method for teaching learn-
ers with ASD social skills. This method has typically been focused on individuals who
are higher functioning on the autism spectrum (Cappadochia & Weiss, 2011) with
individuals spanning from young children as early as 4 years of age (Kroeger, Schultz, &
Newsom, 2007) into adulthood. Most often the teaching format for providing social
skills instruction involves a structured learning model that uses modeling of the skill
to be taught by the teacher (the teacher models for the learner how to perform the
skill), rehearsal on the part of the learner with feedback (the learner essentially prac-
tices the skill as modeled with role playing), and sufficient practice by the learner
(the learner engages in repeated practice trials) with feedback and reinforcement (per-
formance feedback and verbal reinforcement provided by the teacher). Social skills
training groups typically involve instruction conducted within a classroom or clinical
setting. The skills taught within these sessions vary accordingly given the age of the
participants. The sessions can include a combination of discrete skills such as making
eye contact, introducing oneself, and initiating a conversation, or social conversation
about a specific topic or issue. The focus on these isolated skills can then be care-
fully integrated and expanded upon with the aim of building social competence. It can
be useful to pair this training with generalization probes (an assessment) to ascertain
the student’s ability to transfer the skill to actual settings, such as in the community.
This allows the students the opportunity to practice the skill in actual environments
beyond the classroom. It is also very important to work in partnership with families
so that parents and other family members can be a part of modeling and reinforcing
these important social skills beyond the classroom or training settings. Consider the
number of opportunities outside a classroom or instructional setting that a learner has
with their family in the community, such as shopping trips, dining out, and worship
services. These all serve as opportunities for reinforcing learning within the context of
relevant environments.
When using social skills training groups, the targeted skill is broken down into
its component parts. This method is good for isolating the component parts of a
particular social skill, such as when and how to make eye contact, or what to do when
saying “hello” and introducing oneself to another. Tse, Strulovitch, Taglakis, Meng,
and Fombonne (2007) conducted a social skills training group for students with ASD
who were higher functioning on the spectrum. The students ranged in age from 13
to 18 years and the group sessions included (a) the students checking in, (b) a review
of the previous week’s skill, (c) the introduction of the skill to be taught within the
session, (d) role play, (e) a break for snack, (f) group activity, and (g) session closing.
The skills that were targeted during these sessions included recognition and expres-
sion of feelings, making eye contact, understanding nonverbal communication, being
polite, making introductions, initiating and maintaining a conversation, making small
talk, and how to respond to things like bullying and teasing. Parent reports indi-
cated significant improvements in social competence based on pre-and post-training
assessment.
Reports from research findings indicate that when using social skills training
groups it is important to be consistent. For learners with ASD, repetition and intensity
have been demonstrated to be most effective, as has direct instruction for teaching
social skills to students with ASD (Kroeger, Schultz, & Newsom, 2007). The use of
role-playing and video modeling have also been effective in promoting skill develop-
ment in learners with ASD as illustrated in Applied Vignette 6.1.
A p p li e d V i g n e t t e 6.1
An Example of a Social Skills Training
and Support Group
Mr. Benjamin, a teacher of secondary-aged students Mr. Benjamin has recently introduced
with ASD, ages 14 to 16, conducts a social skills to the class a video model of himself going
training group with his six students. He has targeted into the donut shop and performing each of
a set of skills aimed at a community-based outing the social skills in the sequence. His students
for his class at the local donut shop just a block have viewed the video and practiced the steps
from school. While in class, Mr. Benjamin and in sequence through role play until reaching an
his students have been working on a set of skills acceptable level of performance criteria on each
that includes making eye contact, greeting one of the skills. Mr. Benjamin and his paraprofes-
another, using appropriate voice intonation, sional have collected data on each student’s
placing an order, paying for the order, waiting performance on each skill over the course of
patiently for the order to be filled, saying thank each training s ession. This has included record-
you, and finding a table and sitting down to enjoy ing the student’s need for prompts and assis-
their donut and milk. In addition, he has paired tance from the teacher and paraprofessional
a functional math exercise with this activity so in performing each skill. As the sessions have
that students have both the ability and comfort continued, students have demonstrated less reli-
level in paying for their purchase. Two of his ance on teacher prompts and are more readily
students have difficulty with money, so they are approximating attempts at performing each
working on the “dollar more” principle for pur- of the skills in the sequence. The next phase
chasing their respective orders. Mr. Benjamin of Mr. Benjamin’s social skill training group
has used modeling, student rehearsal or practice, involves having the class walk to the donut shop
providing students with feedback on their per- and practice performing the skills in the actual
formance, and reinforcement. Mr. Benjamin has environment. Each student, with assistance as
communicated to the parents of his students what needed from Mr. Benjamin and his parapro-
they are working on in class and has asked par- fessional, goes through the sequence of steps.
ents for their support and to comment on their Upon obtaining their orders, the students in
child’s performance throughout the training as to two groups with one professional each work on
whether they perceive any increased socialization making small talk.
on the part of their child.
In summary, Figure 6.2 provides a review of key points to remember when using
social skills training groups.
Video Modeling
Modeling or observational learning originates from the work of Albert Bandura on
social learning theory (Bandura, 1977). We know modeling to be an effective method for
learning for all, but for individuals with ASD, visual input has traditionally been a very
effective method for promoting learning. Consider Temple Grandin, the famous animal
behaviorist with autism who has described how she thinks in pictures (Grandin, 2010).
Figure 6.2 A summary of key points for social skills training groups
■ Organize and decide upon the format for the group to follow.
■ Meet consistently at the same time and follow the prescribed format.
■ Be sure to assess the frequency of meetings and the intensity of sessions (the number of trials for
presenting and practicing each skill).
■ Identify relevant social skills to be taught.
■ Determine the starting point or baseline for each of your students in performing the target skill (what
skills are currently in their repertoire).
■ Use a direct instruction method.
■ Identify the skill(s) to be taught.
■ Model the skill to be taught or use video models.
■ Student(s) practice and rehearse the skill(s) through role playing and video modeling.
■ The teacher provides performance feedback and social reinforcement to the student.
■ Work in partnership with parents and families in reinforcing the methods of teaching the skills within
relevant environments.
■ Provide homework assignments on relevant topics such as greeting skills and interacting
in the community.
■ Focus on the development of social skills most relevant to the students’ individual needs and that
reflect age-appropriate and functional skills needed in multiple environments.
■ Use video models if deemed appropriate and evaluate the methods used in class and student per-
formance to assess their effectiveness with individual students.
■ Review the previous week’s lesson and all homework assignments.
■ Maintain evaluative data on student performance.
We know that individuals with ASD process visual stimuli more efficiently, so visual
learning is an individual learning strength on which to build. Children learn through
observation, with imitation of the observed behaviors soon following. Video modeling
is an evidence-based method for teaching students with ASD. Basically, video model-
ing consists of a student watching a video recording of a person performing the target
behavior, followed by the child imitating the performance of the target behavior as wit-
nessed in the video.
Video modeling has many applications and can be used with peers, siblings,
adults, and individual students—a variation referred to as video self-modeling (VSM).
VSM is another form of video modeling that allows the learner to imitate and per-
form a behavior himself/herself and then review the video as a form of feedback
aimed at improving his/her performance. It is also more effective if the child can
observe a video of someone similar in age performing the desired behavior (Bellini &
Akullian, 2007).
The merits of video modeling are that it may be more effective than live model-
ing with some children. Video modeling provides learners with ASD with a visually
cued model of instruction, thus building upon the visual learning styles most com-
monly associated with students with ASD. Video modeling also allows for portrayal of
the target behavior in a manner that emphasizes performance of the behavior void of
irrelevant stimuli, thus minimizing distraction. Perhaps one of the greatest strengths
associated with video modeling is that minimizes the amount of human interaction,
and thus reduces anxiety on the part of the child with ASD during the acquisition
stage of learning a new social skill (Bellini & Akullian, 2007).
A recent development in the application of this intervention within applied
settings for learners with ASD is the application of iPad technology. These devices
allow students to view video models of various social skills and rehearse in a portable
manner. One illustration of this from the research literature is the use of iPad video
modeling imitation training (VMIT) with child caregivers and young children with
ASD (Cardon, 2012). The purpose of this research study was to determine whether
there was a functional relationship between caregiver-implemented VMIT via the
iPad and increased imitation skills in four children with ASD ranging in age from 24
to 50 months. Results concluded that all four of the children who participated dem-
onstrated an increased level of initiations. More research is needed to examine how
this form of technology can be fully utilized in promoting video modeling and video
self-modeling among learners with ASD. The utility of the iPad within classroom and
other learning settings appears promising, and the portability of this powerful form of
technology has great potential as a modality for promoting video modeling to learners
with ASD.
When implementing video modeling the teacher must first decide on whether
the student will view existing videos of others performing the target behavior or videos
of themselves, such as in the case of VSM. There are a number of commercially pro-
duced videos that a teacher can draw from when teaching social skills. In either case,
the teacher and student arrive at the target behavior for instruction. The target behav-
ior that is selected should have some social value to the student. After selecting the
target behavior, it should be operationally defined in measurable and observable terms.
Upon determining the target behavior, assess the student’s ability to perform the
behavior and determine his/her level of proficiency. This will serve as baseline data.
This assessment can be recorded on video to serve as a marker for progress. Note the
student’s strengths and areas of need relative to performance of the skill. Establish
a training schedule to identify how frequently the student will view the video and
practice performing the target behavior. Allow the student to watch the video and
have practice sessions. During these times, record data regarding the student’s per-
formance, being sure to use instructional prompting and specific feedback and praise
for approximating the target behavior. Over time, as the student achieves acquisition
of the behavior and reaches fluency in their ability to perform the behavior, begin to
reduce the number of sessions the student watches the video and continue to monitor
the student’s performance of the target behavior. Gradually begin to fade the amount
of social reinforcement as the student begins to maintain the behavior. At this point,
if you are certain based on your monitoring of student performance that the student
is fluent in the target behavior, you may choose to assess the student performing
the target behavior in an environment beyond the training setting—perhaps in the
classroom, around school, or in the community. One form of data that can be very
helpful to collect is a measure of social validity that is given to the student’s parents or
other team members to offer their thoughts on the student’s performance of the social
skills being trained through video modeling. An example of a social validity checklist
is displayed in Figure 6.3.
Social Narratives
Social Stories™ (Gray, 2004) was developed as a method for developing social aware-
ness in persons with ASD. In this chapter we used the term social narratives, which
includes Social Stories, to describe this form of intervention. Basically, Social Stories
involves the use of a story or narrative describing a social situation. Within the narra-
tive, attention is given to the cues and responses desired by the individual within that
social context. Gray (2004) asserts that Social Stories must encompass 10 principles
that, broadly paraphrased, include an introduction, a body, and conclusion—a format
that places emphasis on context, voice, and vocabulary, and descriptive sentences.
Social Stories are short narratives that describe a social situation, concept, or
social skill. Essentially the skill is broken down into understandable steps, with any
extraneous details or information removed. The narrative may include clues such as
who, what, where, when, and how, and other embedded cues with the intention of
Figure 6.3 An example of a social validity measure for evaluating student

progress
Scoring Key: 4-Strongly disagree

3-Disagree
2-Agree
1-Strongly agree
1. The video modeling (VM) or video self-modeling (VSM) intervention was acceptable
to you.
2. The design of the VM or VSM intervention was individualized and addressed the
needs of your child/student.
3. The VM or VSM was easy to implement within the classroom and/or home.
4. In your opinion, your child/student appeared to enjoy the VM or VSM intervention.
5. In your opinion, your child/student has made significant progress during this intervention.
6. In your opinion, your child/student increased his/her social skills in the targeted areas
will experience expanded opportunities within his/her home, school, and community
environments.
7. Since the introduction of the VM or VSM intervention in your child’s/student’s educa-
tional program, you have witnessed measurable improvements in his/her skills.
8. Overall, please rate your level of satisfaction with the outcome of this intervention on
behalf of your child/student.
providing the student with insights for responding. In terms of how Social Stories are
used, they can be read independently by a student or to the student by a teacher, and
delivered on either a computer or tablet device that includes graphics (Reynhout &
Carter, 2006).
Given the current technology, there are some excellent apps that can be down-
loaded to a portable device like the iPad that allow one to infuse pictures, photographs,
videos, and contextual backdrop for social narratives. These apps offer user-friendly
tools for providing an enriched and interactive learning experience for children with
ASD. Learner appeal with this method of instruction appears to be quite good, and the
use of technology only seems to enhance this.
There is some debate about whether Social Stories qualifies as an evidence-based
practice. A review conducted by Test, Richter, Knight and Spooner (2011) examined
a total of 28 studies in the area of Social Stories and conducted a meta-analysis on 18
of these studies. Their findings indicated several limitations in terms of methodol-
ogy from the studies reviewed. These limitations were namely related to the fidelity
of implementation or how reliably the interventions or independent variables were
implemented. The majority of studies lacked measures of social validity, or whether
the effects of the intervention had any meaningful impact, as perceived by the indi-
viduals, their families, and/or the teachers.
In a subsequent review, Mayton, Menendez, Wheeler, Carter, and Chitiyo
(2012) systematically examined 33 studies across a 12-year period and indicated that
findings included on- or above-standard acceptability in EBP indicators related to
important aspects of dependent variables within studies, and below-standard accept-
ability in indicators related to both internal and external validity of studies. The results
indicated that the studies reviewed were weak on internal and external validity, thus
making replication of these investigations more difficult to carry out among other
researchers and also in terms of the application of findings to practice. The findings
from Mayton et al. (2012) were similar to that of Test et al. (2011) with regard to
the rigor of the research and the subsequent difficulties in attempting to validate this
practice as an EBP. However, the NPDC on ASD has endorsed social narratives as
an evidence-based practice. The difficulty in discerning Social Stories as an EBP has
been that they have often been included as a component of a treatment package, thus
making it hard to identify specific impact exclusive from other treatment components.
Social Stories appear to offer classroom teachers an intervention with great
appeal and functional utility for enhancing social skill development in their students.
Social Stories have been used to teach social skill development and foster relevant
social communication skills. When preparing to use Social Stories, you must first tar-
get the social skill and context to be addressed. This should be deemed a socially valid
goal by the individual, his/her family, and the educational team. It will hopefully result
in greater personal skill attainment and enhanced lifestyle options. Upon identify-
ing the targeted social skill, the skill must be operationally defined and broken down
into its components in a manner that allows you to both observe and measure perfor-
mance. Initiating the intervention means that first you must collect a measure of the
student’s baseline performance levels of the targeted skill within the natural context.
The task of preparing the Social Story as part of the intervention means that the story
selected should coincide with the target behavior, and it should be written in a manner
that uses developmentally appropriate language given the age of the learner. Social
Stories can be written in either the first or second person, and the length of the story
can be determined by the age of the student and his/her ability level.
As mentioned earlier, technology allows for creating stories that are contextu-
ally relevant using pictures, videos, and icons. This is a format that should be consid-
ered depending on the student’s individual learning style and the availability of such
technology. The iPad is one example of a device that is both age-appropriate and
portable and can provide students, parents, and teachers with a viable tool for teach-
ing and practicing Social Stories on a frequent basis. Once you initiate the interven-
tion, decide when in the student’s daily program you will conduct training and if
you will require out-of-class homework sessions with assistance from the student’s
parents. In addition, determine the performance criteria that you seek to develop
in the student and at what point you will consider the skill mastered by the student
before deciding to move on to a new skill. Remember that the acquisition stage of
learning, or initial learning, will require you to provide more prompting for student
performance and more reinforcing feedback for the student’s attempts at approxi-
mating the desired skill. As the student becomes more fluent, he/she will progress at
a faster rate, respond with fewer errors, and hopefully maintain the skill over time.
Lastly, it is hoped that the Social Story intervention will ultimately result in the stu-
dent being able to manifest these skills in relevant environments such as the class-
room, home, and community settings. This, of course, demonstrates generalization
of learning that is being able to take the learned social skill and apply it in real-word
settings, ultimately resulting in greater personal freedoms and quality of life for the
student. It is important to monitor student progress by collecting data on correct/
incorrect responses, the number of teacher prompts used (hopefully you will see the
level of teacher assistance diminishing over time), and the student’s ability to apply
the social skill once learned from the social story intervention to relevant social situ-
ations across environments. This is the ultimate measure of social validity—that an
intervention has positively impacted the student’s life.
Self-Management
Self-management is an umbrella term used to describe interventions aimed at teaching
self-regulation to learners. It has been successfully used with typical learners, as well
as among learners with behavioral, learning, and developmental disabilities, including
individuals with ASD. It represents a cognitive-behavioral method for teaching self-
regulation of behavior. Traditionally, self-management has included three forms of
intervention: self-monitoring/self-recording, self-instruction, and self-reinforcement.
Self-management has been successfully applied since the 1970s, and involves the learner
in the selection of goal and monitoring of his/her behavior. Most typically it is used as
part of a treatment package, which makes the task of isolating and measuring the impact
of the self-management intervention more challenging (Wheeler & Richey, 2014).
Self-monitoring/self-recording is one method of self-management that has been
used extensively to teach social skills. The intervention is aimed at teaching students
to monitor the occurrence and performance of their behavior and generally pairs with
self-recording. The range of possibilities for self-recording behavior include the use
of checklists that can be attached to a student’s desk or wall, to the use of a portable
technology device, such as a tablet. Ultimately, once the targeted social behavior has
reached a point of maintenance, you would hope to fade the need for recording the
occurrence of the target behavior.
When teaching self-monitoring/self-recording after arriving at the targeted
social skill to be taught, you must identify and operationally define the social skill,
breaking the skill down and determining how you will teach the student to record his/
her behavior. As an example, say you would like to teach a student with ASD who is
high on the spectrum to control their frustration. You could begin by identifying the
times the student has difficulty with controlling his/her frustration. Is it more prevalent
during academic times or social settings? In this case, let’s say the student has difficulty
in social situations during lunch and it stems largely from a lack of social approach
skills when trying to enter a conversation with peers. You would define the appropriate
social skill for the student that would help him/her engage other students in conversa-
tion and teach the response through direct instruction. Through direct instruction,
you would define the skill. An example of the skill might be to say “Hi, would you
mind if I sit here with you?” or “Hi, how’s your day going?” Next, identify when that
entry statement would be appropriate, and allow the student to practice with feedback.
Provide the student with cues, such as “after going through the lunch line, I begin to
look for a place to sit, when I see an available opening at a table with someone I know,
I approach the table, and ask ‘Hi, mind if I sit here?’” Practice the sequence and, when
trying the intervention within the context of daily lunch, observe the student to evalu-
ate his/her performance. Following lunch, have the student self-record whether he/she
engaged in the target behavior and perhaps even graph performance on a daily basis.
Another example of self-monitoring/self-recording would consist of a daily schedule
that is either written, or uses words paired with visual symbols or pictures depicting the
daily routine for a student. As the student progresses through the schedule, he/she is
reminded or prompted to the next activity throughout the schedule until completion
(Massey & Wheeler, 2000). This schedule can be on paper or on a portable device.
Self-instruction is another form of self-management intervention. It is a method
by which individual learners are taught a set of instructions for performing a social
skill, with emphasis placed on cues that the learner can recall. These cues become self-
instructional verbalizations the learner uses to assist in performing the skill. This is
most appropriate for learners with ASD who are high functioning. When implement-
ing self-instruction, learners are taught a social skill and given verbal statements about
performing the skill. The teacher initiates teaching the skill by modeling the perfor-
mance of the skill paired with the verbalizations. The learner then rehearses the skills
while reciting the steps aloud until the verbal cues become less obvious as the learner
quietly whispers them. Ultimately, the learner performs the skill without the need for
the verbalizations.
An example might be teaching Jack, a 10-year-old boy with ASD, how to ask for
help. The teacher would begin by introducing the target behavior and the importance
of this skill. As the teacher identifies for Jack all of the relevant contexts in which this
skill will be helpful, she specifically targets asking for help in the library, because this
is Jack’s favorite activity. The teacher breaks down the task and frames it within the
context of Jack’s typical visit to the library:
Upon needing help in the library to locate a book or to log on to a computer, I will
(a) pause and locate the librarian, (b) walk to the librarian’s desk, (c) say excuse me and
wait for the librarian to respond, and then (d) say “I need help [finding a book or log-
ging on to a computer] or [other].” Next, I will (e) wait for the librarian to assist me,
and when she assists me, I will (f) say “thank you very much.”
The teacher would then role-play and rehearse this scenario with Jack. She
would whisper each of the steps aloud as she modeled the steps for Jack. Then Jack
would rehearse the steps as modeled for him by his teacher, while she verbally rein-
forces his performance attempts and provides instructive feedback when Jack needs
to modify a step. She would repeat these trials until Jack feels a comfort level and
has reached fluency. The next phase would be performing them while in the library.
Initially, the teacher had a paraprofessional go to the library with Jack during a period
where it was not being used to rehearse the steps until eventually he could perform
the exercise independently, quietly whispering the steps aloud as he self-instructed
through the process. After successfully performing the skill a few times, Jack was at
ease without needing to whisper the steps because he had mastered the skill.
Naturalistic Interventions
Naturalistic interventions are aimed at enhancing the social communication skills of
children with ASD. They represent a broad and encompassing set of child-centered
interventions that focus on implementation in natural settings, whereby learning oppor-
tunities are embedded within environments that are natural for the child. Most notable
among these methods is pivotal response training (PRT) (Koegel, Koegel, Harrower, &
Carter, 1999). Naturalistic interventions are infused within the context of daily rou-
tines and allow for child-directed activities aimed at building functional communica-
tion (Webb & Robbins, 2012). Naturalistic interventions also focus on environmental
arrangement to facilitate opportunities for skill development. Allowing the child to lead
activities can be difficult for some teachers, depending on the type of learning environ-
ment. One example found in the literature is a study conducted by Webb & Robbins
(2012) aimed at increasing the expressive language of a preschool aged boy with ASD.
This naturalistic intervention used the following strategies: (a) commenting, labeling,
and modeling; (b) imitating; (c) expanding; (d) positive feedback and praise; (e) asking
questions and providing choices; (f) responding; (g) following the child’s lead and joint
attention; and (h) turn-taking and time delay. The results were positive—the more teach-
ers used the naturalistic teaching strategies, the better children demonstrated increased
levels of expressive language. An inherent difficulty associated with this approach is that
when interventions are offered as a treatment package, it is difficult to identify the role
that specific elements within the package play in the net gain in performance exhibited
by the students. Another difficulty with naturalistic approaches is that many teachers
may be unfamiliar with these approaches and may simply not have instructional support
to assist with implementation within the classroom.
The need to better understand how to assist teachers in the delivery of these
practices within the classroom has become a more pertinent topic as of late. One more
current study examined how pivotal response training (PRT) could be more fully
utilized by teachers for classroom use (Stahmer, Suhrheinrich, Reed, & Schreibman,
2012). The authors point out how many teachers of children with ASD are skeptical
about the functional utility of evidence-based practices within the classroom, and
they attempted to address these concerns relative to teacher recommendations on
how to adapt PRT procedures for classroom use. The purpose of their study was to
collaborate with teachers in order to obtain teacher feedback gathered through focus
groups on the benefits and barriers of using PRT in their programs, as well as to
obtain their recommendations for potential modifications to these methods. Stahmer
et al. (2012) used focus groups to gather teacher input on how to increase the utility
of PRT in classroom settings. The results from this investigation indicated that the
teacher participants perceived PRT as an intervention practice that was useful and
practical for classroom. There were components of PRT that teachers deemed more
challenging to implement, and they provided thoughts on how to modify these for
classroom use and also indicated that they would need more training in autism inter-
ventions in general.
As you reflect on the Consider This feature below, what concerns do you have
relative to the probability of success for Andrew while in school, and more importantly
for his overall quality of life and level of satisfaction with his social needs while a stu-
dent at the university? What suggestions might you make to enhance Andrew’s prob-
ability of success? Identify some formal and informal supports that could be effective
in promoting Andrew’s social support needs.
Consider This
Andrew is a 19-year-old college sophomore for children with ASD, but in high school he
attending a large state university and major- preferred to socialize through an academic club
ing in bioengineering. He is extremely bright in science. He enjoys technology, movies, and
and gifted in terms of his intellect, but he has reading comics and graphic novels. He currently
a very difficult time socially and in managing lives at home with his parents while attending
the day-to-day demands of his life. Andrew has the university, but he would like to live with
Asperger’s syndrome and he was not diagnosed classmates in an apartment setting. The chal-
until the age of 10. His parents were always lenge for Andrew is finding peers who will be
concerned with his social development and as both accepting and accommodating of his social
he grew into preadolescence, they realized his limitations. He has expressed his frustrations to
increasing difficulties because he lacked friends his mother, and she has tried to link Andrew up
and preferred to avoid social situations. He is with the Office of Student Disability Services at
strong academically but has difficulties in main- his university for assistance. Unfortunately, they
taining his organization and in communicating do not have a social support network for stu-
when he has difficulties. While in junior high dents with ASD, nor supports to assist students
school, he participated in social support groups with ASD with specific social competency needs.

The Virginia Commonwealth University Autism Center for Excellence (VCU-ACE)
located in Richmond, Virginia, is a technical assistance, professional development, and
educational research center for autism spectrum disorders in the Commonwealth of
Virginia. It is dedicated to improving services to individuals with autism spectrum
disorders and to the implementation of evidence-based practices in schools and the
community. The program is led by Dr. Paul Wehman. You can locate their program
through the following website: www.vcuautismcenter.org/index.cfm
Chapter Summary
The purpose of this chapter was to present an overview of evidence-based practices
designed for developing social skills and social competence in learners with ASD
across the lifespan. The chapter introduced the importance of social skills and social
competence in the lives of individuals with ASD as critical core competencies for one’s
overall development and well-being. Social skills were recognized as those important
discrete skills needed by students for social exchanges, whereas social competence was
defined as an integration of these discrete skills paired with the ability to read and
discern more elaborate social cues to obtain one’s goals within relevant social contexts.
The chapter identified the importance of social competence for persons with ASD in
their attempts to have meaningful lives within home, school, community, and employ-
ment settings. The theories that are used to help explain the social skill difficulties
experienced by persons with ASD were introduced. These included brain-based, cog-
nitive, and behavioral perspectives.
Lastly, the chapter identified evidence-based practices that have been identi-
fied for developing social skills in learners with ASD. Each method was introduced,
and research-based and applied examples of how these practices can be implemented
within classroom settings were presented. The EBP methods discussed in the chap-
ter included parent partnerships, peer-mediated interventions, social skills training
groups, video modeling, Social Stories/social narratives, self-management, and natu-
ralistic interventions.
1. Build a resource file of games and activities that you can adapt for teaching social skills
across play, school, home, and community domains to learners with ASD, as well as in
a peer support setting with typical same-age peers.
2. Visit a social skills training group for adolescents and young adults with ASD and
observe how it works. Try contacting your local or regional state autism society to see
if they can refer you to a program, and ask if you could volunteer and be an observer.
3. Experiment with some of the downloadable apps for portable electronic devices and
evaluate their content for teaching social skills through video modeling.
4. Search for social skill apps for the iPad or other portable electronic devices and exam-
ine their user friendliness and functional utility within your current teaching assign-
ment. A couple of examples include:
http://thesocialexpress.com/what-is-the-social-express/try-it
http://locomotivelabs.com
http://pinterest.com/dmspiller/autism-spd-social-skills
R e s o u r c e s t o C o n sul t
1. Healing Thresholds, a web-based resource for and developed by a collaboration of multiple

families and professionals: investigators:
http://autism.healingthresholds.com/ http://www.interactingwithautism.com/
therapy
3. National Professional Development Center
2. A weblink funded by the U.S. Government on Autism Spectrum Disorders
Agency for Healthcare Research and Quality http://autismpdc.fpg.unc.edu
7
chapter
Building School-Based
Behavioral Repertoires

■ Define positive behavior supports.
■ Discuss the characteristics and importance of school-based repertoires.
■ Describe the major characteristics of positive behavior supports.
■ Discuss the instructional components of positive behavior supports.
■ Describe how to engineer a learning environment for a student diagnosed with an autism spectrum
disorder.
■ Describe several methods for monitoring and measuring the effectiveness of positive behavior supports.
■ Discuss methods for promoting the long-term maintenance of behavioral supports.
189
190 S e c t i o n III / The School Years
Chapter 7 Mind Map

Indirect/Naturalistic Assessment
Direct/Naturalistic Assessment
Underlying Principles of Positive Behavior Supports
Indirect/Analog Assessment
Functional Behavior Assessment Environmental Variables
Direct/Analog Assessment Building School-Based Behavioral Repertoires
Antecedent-Management Strategies Instructional Approaches
Development of Behavior Support Plans
Task-Related Variables
Engineering Learning Environments for Learners with ASD
Teaching Replacement Behaviors
Underlying Principles of Positive Behavior Supports

Behavior is something that is discussed most every day, and most everyone seems to
have something to say. The prevalence with which behavior is discussed indicates
how important and relevant behavior can be in numerous situations. One of the
most important situations in which behavior can be of critical importance is within
school settings. Students in classrooms are confronted with numerous behavioral
expectations, and thus have to either meet these behavioral expectations or be con-
sidered atypical. For students diagnosed with an ASD, these behavioral expectations
may be especially difficult and lead to frustration for them personally and for others
such as teachers, peers, parents, and others. Positive behavior supports (PBS) are
a compilation of techniques that are designed to offer assistance to individuals in
schools and other settings to find methods of meeting situational behavior expecta-
tions in their own way. These supports can be compared to the structural supports
of an office building. An office building relies on a sound foundational structure that
might consist of concrete flooring, steel walls, and a strong roof. These supports
typically go unnoticed, and the main concern of the office building is the business
that takes place within the walls. The floors, walls, and ceilings provide a setting
in which daily business can occur; without these basic supports, the daily business
could be difficult. When working with people and their behavior, the basic supports
that need to be considered go beyond the basic elements of a building and could
involve arrangement of the environment, training of teachers and support staff, and
involvement of peers.
Carr et al. (2002) defined PBS as “an applied science that uses educational and
systems change methods (environmental redesign) to enhance quality of life and mini-
mize problem behavior.” For the purposes of this chapter, PBS can be defined as a
technology used to engineer learning environments for students to help them achieve
enhanced life outcomes. Carr et al. (2002) described PBS as having developed out of
three areas: applied behavior analysis (ABA), the inclusion movement for individuals
with disabilities, and the values that placed the person at the center of concern. While
c h ap t e r s e v e n / Building School-Based Behavioral Repertoires 191
many of the specific strategies utilized within the PBS approach are derived from
ABA, the PBS approach differs from the ABA approach by promoting the idea that
behavior can be changed without resorting to the use of punishment procedures.
Whereas an ABA approach focuses on the individual’s right to effective treatment,
which may include punishment techniques when appropriate, the PBS approach only
relies on reinforcement-based approaches in combination with elaborate environmen-
tal changes, if necessary. In addition, as noted by Carr (1977) and Carr et al. (2002),
there are differences in the way that assessments are conducted, changes in how inter-
ventions are designed and implemented, and changes in how behaviors are measured.
All of these differences are considered valuable to promoting the widespread accep-
tance of PBS and to fully advocate for the inclusion of individuals with disabilities
while focusing on their personal values and beliefs.
Within school settings, PBS has been adopted as a school-wide intervention to
offer supports on an as-needed basis for all students within a school. These supports
are available not only to students with disabilities, but also provided to all students
to differing degrees in order to ensure they are reinforced for engaging in behaviors
that promote their development and maintain a proper school environment. Supports
are distributed at varying intensities among groups of students as the students dem-
onstrate the need for specific levels of support. This type of school-wide implemen-
tation has been frequently explained using a model of a pyramid divided into three
levels: (1) primary intervention, (2) secondary intervention, and (3) tertiary interven-
tion (Sugai et al., 2000). Sugai et al. indicated the majority of students within a school
need only very mild supports (primary intervention), and they are viewed as being
at the base of the pyramid. Students who are more at risk for displaying challenging
behaviors would be a medium-sized group represented in the middle of the pyramid
(secondary intervention). Those students with the highest risk for displaying challeng-
ing behaviors could be represented by the top of the pyramid as the smallest group
(tertiary intervention).
As each of these levels of intervention move from primary, to secondary, and
then to tertiary, the types of supports become increasingly more comprehensive and
intense to match the comprehensiveness and intensity of the challenging behaviors.
For example, a student who is considered to be at the primary level of intervention
might very rarely display any challenging behavior and the behaviors may only be, for
example, tardiness, talking at inappropriate times, and others that are very infrequent
and do not result in significant disruption to the classroom or school environment.
This student could be supported by teachers providing him/her with acknowledge-
ment for following classroom and school rules. Subsequently, a student who is in need
of tertiary level supports may frequently display intense aggressive behaviors that
disrupt classrooms and the school environment. This student may require rigorous
supports that are specifically designed for the student and could involve participa-
tion from several school personnel to ensure consistency in various school settings.
Students diagnosed with an ASD could be provided appropriate supports at any of
the three levels of prevention depending upon the presence or absence of challenging
behaviors that they might display.
Functional Behavior Assessment

The first step toward designing behavior supports should involve some efforts toward
gaining an understanding of the person for whom the supports will be developed and
the specific behaviors that need to be addressed. Wheeler and Richey (2014) described
how challenging behaviors continue to be displayed by students in school settings
because educators unknowingly reinforce the challenging behaviors, educators do not
understand how to manipulate antecedents that promote challenging behaviors, and
because students have not been taught behavioral repertoires that allow them to deal
with challenging situations. An assessment can reveal information that can then be
used to develop behavior supports that may be better and more effective than sup-
ports developed without an assessment. Through the assessment process, detailed
information about a person diagnosed with an ASD may be clarified and then used
to develop very specific behavior supports that are unique to the individual. Similarly,
detailed information about the behaviors targeted for change may also be determined
and then used to develop behavior supports that have a higher likelihood of chang-
ing the behavior than supports developed without the information obtained from the
assessment. In other words, the assessment process drives the development of positive
behavior supports by providing valuable information that tailors the supports to the
individual and increases the potential effectiveness of the supports.
Within school settings, the term functional behavior assessment (FBA) has been
used in educational law. FBA is not clearly defined within the law, and therefore the
definition is fluid and somewhat dependent upon legal precedence determined through
legal decisions involving these assessments. While FBA may have been fairly recently
introduced into special education law, the process of FBA has been around and func-
tioning for several years. Probably the most prominent and influential example of FBA
upon current practice was provided in the seminal article “Toward an Analysis of Self-
Injury” (Iwata, Dorsey, Slifer, Bauman, & Richman, 1994). This article demonstrated
how assessment could be designed to gain a clear understanding of why individuals
engaged in specific problem behaviors. Why individuals repeatedly engage in certain
behaviors can be thought of as synonymous with the function of a behavior. The ratio-
nale is that behavior functions upon the environment in a way that offers some type
of reward or reinforcement. For example, a student in a classroom may raise his/her
hand in order to gain the attention of the teacher. The student raising his/her hand is
the behavior that functions upon the environment to obtain a specific result, which is
the teacher providing attention. The primary goal of functional behavior assessment
is to determine why the individual engages in a particular behavior by gaining insight
into how the behavior functions on the environment.
There are several ways to go about conducting an FBA, which, within this text-
book, is defined as all the efforts and activities that are used to determine the function
that a behavior has on the environment. Figure 7.1 provides a breakdown of activities
that might be included in an FBA across four typical categories that are frequently
used for conducting these assessments. These assessments can occur in the natural
environment (naturalistic assessment) or they can occur under circumstances that
are simulated and highly controlled by an experimenter (analog assessment). These
Figure 7.1 Types of functional assessment activities
Naturalistic (conducted in Analog (conducted in simulated/con-

typical settings) trolled conditions)
Indirect assessment of Record Review Structural Analysis
function of behavior and
■ Previous assessments ■ Controlled manipulation of selected
related variables
■ Anecdotal comments antecedents and some relevant
consequences
Structured Interview ■ Brief exposure to conditions (e.g.,
5 minutes)
■ FAI
■ Single exposure to conditions
■ SA-FAI
■ Replication of most relevant antecedents
Rating Scales
■ MAS
■ FAIR-T
Scatterplot
Direct assessment of Antecedent-Behavior-Conse- Brief Functional Analysis
consequences asso- quence (ABC) Observation
ciated with function of ■ Controlled manipulation of selected
behavior consequences
■ Short time exposed to consequences
(e.g., 5 minutes)
■ Single exposure to conditions
■ Replication of condition considered most
relevant
Functional Analysis
■ Extended time exposed to conditions
(e.g., 10–15 minutes)
■ Repeated exposure to conditions
assessments in some cases directly evaluate the potential function of a specific behav-
ior displayed by a person diagnosed with an ASD (direct assessment), or they may
involve assessing other variables that may provide some indication of the potential
function of the behavior (indirect assessment).
Indirect/Naturalistic Assessment
An assessment that is both indirect and naturalistic can offer information from a large
number of sources and can be obtained very quickly. Some examples of these indirect/
naturalistic assessments include reviews of records such as previous assessment, anec-
dotal notes made by teachers, structured interviews, and rating scales. The Functional
Assessment Interview Record for Teachers (FAIR-T; Doggett, Mueller, & Moore,
2002) is a typical example of a structured interview that teachers can complete that can
provide some possible insight into the function of a specific behavior. The FAIR-T may
be given to a teacher or potentially to several teachers who know a student diagnosed
with an ASD who is displaying a challenging behavior, and the teacher(s) can complete
the form quickly and return it to the person conducting the assessment. The assessor
can then review the information and follow up with the teacher to clarify any of the
information and ask additional questions to gain as much insight as possible toward
identifying the function of the challenging behavior. In addition, the structured inter-
views can be completed by not only teachers, but also by others who are highly famil-
iar with the challenging behaviors of a student diagnosed with an ASD. The FAIR-T
has an alternative format designed specifically for parents, called the Functional
Assessment Informant Record for Parents (FAIR-P). Similarly, structured interviews
have been developed to be used directly with a student who is displaying a challeng-
ing behavior, such as the Student-Assisted Functional Assessment Interview (SAFAI),
which was developed to conduct interviews with students diagnosed with an emotional
disturbance. While these types of structured interviews can be an efficient means of
gathering a great deal of information from several different people, these types of
assessments have several limitations. The information obtained from structured inter-
views can frequently be difficult to interpret because those being interviewed may not
be familiar with the typical functions that behaviors may have upon the environment.
This can lead to information that may focus on all types of alternative explanations
for the occurrence of behaviors such as “the devil made him do it” and may offer little
toward the development of a behavior intervention. Another limitation of structured
interviews is that when information is gathered from several different people, there
may be substantial disagreement among these different informants, thus leaving the
assessor questioning the reliability and/or validity of the information. In addition, the
information from structured interviews may not always be in agreement with informa-
tion obtained via more rigorous evaluations.
Direct/Naturalistic Assessment
Directly observing a student diagnosed with an ASD in typical settings can be a
useful means for gathering information about the student and can lead to a better
understanding of what function a specific challenging behavior may have upon the
environment. One very common method for completing these types of descriptive
observations was first recommended by Bijou, Peterson, and Ault (1968) and is fre-
quently referred to as antecedent-behavior-consequence (ABC) observations. This type of
observation would occur in environments in which a student diagnosed with an ASD
would be engaging in routine activities and instructors would be interacting with the
students as they typically would without trying anything out of the ordinary. This
allows the observer to see the student respond to cues and stimuli in the environment
that they are familiar with and it also allows for observation of how the instructors
typically interact with the student. These types of observation can be elaborate, or
the observer could simply divide a sheet of paper into three columns labeled A for
antecedent, B for behavior, and C for consequence. When a specific target behav-
ior is displayed by the student, the observer can write down the behavior, along with
what happened immediately before the behavior was displayed (antecedent), and what
occurred immediately after the behavior (consequence). After documenting several of
these observations, the observer can review the data to identify any trends that appear.
For example, the observer might find that a student whose target behavior is push-
ing other students near him might display this behavior immediately after a teacher
tells him to begin working on a mathematics worksheet. The data might also indicate
that when the observed student pushes another student, the teacher responds by mak-
ing them go sit in a corner by themselves facing the wall. If this type of pattern is
observed in the data, it might be indicative that the pushing behavior functions on the
environment as a means for the student to escape doing the mathematics worksheet.
Figure 7.2 provides an example of a completed ABC observation.
There are several strengths to conducting ABC observations. These strengths
include having the opportunity to observe how a student responds to naturally occur-
ring situations in his/her environment as they develop, rather than having to simu-
late situations. By conducting these naturalistic observations, an observer can gain
an understanding of the specific daily requirements and expectations that are placed
upon a student and achieve insight into exactly how the student needs to respond in
order to be successful. In addition, these types of observations can be conducted quite
easily and do not require extensive training in order to collect quality data. The limi-
tations of ABC observations involve the amount of time required to collect enough
data to provide an accurate evaluation and the training required to evaluate the data
adequately. When conducting ABC observations in naturalistic settings, there is the
possibility that the challenging behavior may not occur or may not occur frequently
enough to allow for an analysis of the data to be done. This may require an observer
to spend a large amount of time observing in order to gather enough data, especially
if the behavior only occurs a small number of times each day. The observer also has
to be present when the behavior does occur; if the occurrence is random, it may be
difficult for an observer to be present. Also, since the assessment is being conducted
in a naturalistic environment, there is no way to control for extraneous variables that
might make the data confusing. For example, an observer may be present during fire
Figure 7.2 Example of antecedent-behavior-consequence data collection
Student: Shannon Observer: Teacher Date: xx/xx/xx

Time Setting Antecedent Behavior Consequence Possible
Function
10:05 Free play area Teacher asks Shannon to Shannon turns Teacher Escape
come to his desk for work time away from teacher ignores from work
10:08 Free play area Teacher asks Shannon to Shannon moves to Teacher Escape
come to his desk for work time corner of play area ignores from work
10:15 Free play area Teacher tells Shannon to Shannon yells “No!” Teacher Escape
come to his desk for work time ignores from work
10:27 Free play area Teacher touches Shannon on Shannon yells “No!” Teacher takes Escape
the shoulder and tells Shan- and spits at teacher Shannon to from work
non to come to his desk for time-out area
work time
drills, school assemblies, and other situations that disrupt the typical daily routine and
may increase or decrease the potential occurrence of challenging behaviors. Knowing
when enough data has been collected in order to develop a hypothesis about the func-
tion of the challenging behavior can also be difficult, and extensive training may be
needed to accurately interpret the data that is collected. Finally, ABC observation
assessments do not result in a clear demonstration of the function of a challenging
behavior; rather, they offer an overall probability of the function and may require
additional computations to produce conditional probability estimates that are more
reliable (McKerchar & Thompson, 2004; Vollmer, Borrero, Wright, Van Camp, &
Lalli, 2001).
Indirect/Analog Assessment
Analog assessment involves the development of circumstances that are highly con-
trolled so that assessments are clearly measuring the influence of certain situational
variables while excluding other influences. These types of analog assessments are usu-
ally planned in advance so that the conditions presented to a student are highly con-
sistent. This consistency improves the reliability of the assessment results and can lead
to the development of high-quality behavior supports. One type of indirect/analog
assessment is known as a structural assessment (Wacker, Cooper, Peck, Derby, & Berg,
1999; Wheeler, Carter, Mayton, & Thomas, 2002). A structural assessment can be con-
sidered an indirect assessment of the function of a behavior because although it does
include direct observations of the student, it does not directly observe the functional
consequences that maintain a specific target behavior. Rather, a structural assessment
involves directly observing the antecedent variables (in highly controlled analog set-
tings) that promote the occurrence of problematic behaviors. For example, a structural
assessment might involve a condition in which a student is presented with a teacher-
selected task, then observing the student for the occurrence of off-task type behaviors.
This condition could then be compared to a condition in which a student is offered a
choice in the task that he/she is asked to complete and then observing for the occur-
rence of off-task behaviors. The two different conditions would only manipulate the
antecedents to the challenging behavior and could then be compared to determine
which style of task presentation resulted in the lowest occurrence of off-task behaviors.
Wheeler et al. (2002) conducted a structural analysis in a school classroom with the
classroom teacher offering different instructional approaches to a young child diag-
nosed with an ASD and visual impairment who engaged in off-task behavior and self-
aggression. Their structural analysis of various instructional approaches was able to
determine a specific instructional approach that could be used by the teacher to present
work tasks that resulted in high percentages of task engagement and low percentages
of self-aggression that were comparable to levels observed when the child was engaged
in a play activity. While these procedures did not directly observe the consequences
maintaining the challenging behaviors, they indirectly provided some indication that
the child’s behaviors were functioning as a means of avoiding certain work activities
or demanding situations. The manipulation of the instructional variables appeared to
reduce the aversion to the work demands that were placed on the child.
Structural analyses offer an assessment method that in many ways is very adapt-
able to classroom settings. Structural analyses can provide rigorous data collection
because they are conducted within highly controlled situations and they often uti-
lize instructional approaches that teachers are very comfortable with implementing.
Different instructional approaches can be directly compared and evaluated according
to how the student responds to the approaches. The instructional approach that is
found to be most effective for a particular student can become the intervention, so
there is no need to develop a new intervention once the assessment is completed. This
can lead to an intervention that can be implemented immediately because it would
already be a part of the teacher’s repertoire and would require no additional training
for the teacher to begin implementing it. The limitations of using a structural assess-
ment are that these assessments do not offer a clear indication of what the function of
a challenging behavior may be serving within the environment, and thus the challeng-
ing behavior may not be completely extinguished. In addition, this type of assessment
might not provide enough information to develop interventions that can be used in
multiple settings or situations.
Direct/Analog Assessment
The “gold standard” of functional behavior assessment is considered to be the ana-
log functional assessment. This type of assessment is considered to provide the most
accurate results regarding determination of how a challenging behavior functions
upon the environment. The reason this type of assessment is considered the best is
that it directly manipulates the consequences and provides a demonstration of how
a person displays a challenging behavior to manipulate his/her environment. These
types of assessments typically consist of conditions that manipulate both the anteced-
ents and consequences that a student experiences within a highly controlled situation.
The conditions that are frequently evaluated include those that control for the escape
from a demanding situation or task and those that control for the provision of atten-
tion from another person. Figure 7.3 provides the basic steps involved in conducting
various functional analysis conditions. For example, a condition that examines for a
possible escape-maintained behavioral function might involve presenting a student
with a work task that is considered difficult and, if a challenging behavior is displayed,
offering the student a break from the work task. After the student has a short break
from the work task, the process would be repeated. A condition that evaluates for
an attention-seeking function might involve ignoring a student unless the student
engages in a challenging behavior, at which point the student would be provided
briefly with attention before repeating the sequence. A tangible condition can be used
to determine if the student is engaging in the challenging behavior to gain access to
some tangible item and an alone condition can be used to determine if a student is
engaging in a challenging behavior to serve some type of sensory function. A play
condition can also be used as a control to determine how a student functions when
there is no apparent need for him/her to engage in a challenging behavior to obtain
or avoid anything. The conditions of the functional analysis would be compared to
determine which condition produced the most challenging behaviors. Conducting a
Figure 7.3 Basic steps for conducting selected functional analysis conditions
• Present student with difficult task

Escape • Provide a brief break if challenging behavior occurs
Condition • Represent task after break
• Repeat steps until condition time ends
• Ignore student
Attention • Provide attention if challenging behavior occurs
Condition • Ignore student after brief attention
• Provide student with preferred tangible for brief time period

Tangible • Remove tangible
• If challenging behavior occurs, provide student with tangible
Condition for brief period
• Place student in an area where he/she is alone but can be

Alone observed
Condition • Document challenging behaviors until the condition
time ends
• Provide student with preferred items and offer brief attention

Play at regular intervals throughout condition
Condition • Document challenging behaviors until the condition
time ends
functional analysis can be a complex process, and the information provided here is
simply an overview. Additional training is recommended before attempting to con-
duct a functional analysis in order to ensure the safety of the student and to ensure
the best results.
A functional analysis is beneficial in that it can provide the most precise evalu-
ation of the function of a challenging behavior and can thus lead to the most effec-
tive intervention development because the intervention can accurately address the
function of the behavior. The limitations of functional analyses can include the need
to develop highly controlled situations that may be difficult to achieve, especially in
school settings. These procedures often require several people to conduct the assess-
ment, collect data, and arrange the environment. The procedures may also require
a substantial amount of training to ensure the integrity of the assessment to deter-
mine the assessment results. While this type of assessment does produce the most
accurate evaluation of the function of challenging behaviors, it does require that an
intervention be developed once the assessment is completed. The intervention that

is developed needs to adequately address the function of the behavior, and if it does
not, the potential effectiveness of the intervention is decreased. This may also require
additional training to ensure that the interventions developed from functional analysis
data are appropriate.
Development of Behavior Support Plans

Once assessment information has been gathered and analyzed, the development of a
behavior support plan can begin. The behavior support plan should draw from the
information obtained in the assessment. Historically, behavior plans have been devel-
oped using strategies that were demonstrated to be effective for other similar types
of behaviors rather than basing the strategies upon the function the behavior has on
the environment. For instance, a procedure such as time out has been used frequently
within classrooms for numerous types of behaviors. The time-out procedure involves
requiring a student to possibly move away from other students so that he/she does
not get to participate in ongoing activities. The problem with using this type of pro-
cedure for any or all types of behaviors is that if a student does not want to participate
in an activity, he/she may engage in challenging behavior so he/she can go to time
out and thereby avoid the activity. If a student engages in a challenging behavior
because he/she wants to obtain attention from the teacher, and the teacher provides
attention to the student while implementing a time-out procedure, the challenging
behaviors may increase because the student enjoys the attention provided while being
placed in time out.
Since the improvement of strategies to determine the function of challenging
behaviors (Iwata et al., 1994) and the inclusion of functional behavioral assessment
into the Individuals with Disabilities Education Act (IDEA, 1997), best practice has
supported the consideration of the function of the behavior when developing a behav-
ior support plan. Subsequent research has determined that when the function of the
behavior has been included in the development of support strategies, the likelihood of
an effective intervention is increased. So if the assessment results indicate that a stu-
dent diagnosed with an ASD is engaging in challenging behavior to obtain attention
from the teacher, the behavior support plan should involve strategies designed to assist
the student in obtaining teacher attention in an appropriate manner. This matching of
function to intervention strategy is a highly important component when selecting an
intervention strategy.
Once an intervention strategy has been selected, consideration needs to be
given to writing a clear behavioral objective that encompasses what the intervention
is intended to accomplish. A behavioral objective should provide details about how,
when, what, where, and to what extent a behavior will be changed. For example, a
behavioral objective might be stated as such: “Larson will begin putting his toys away
within 10 seconds of being told to do so on 9 out of 10 occasions for two weeks.”
A well-written behavioral objective should provide enough information to make a
clear determination about whether the behavior intervention is working and when the
intervention can be considered successful.
Engineering Learning Environments for Learners with ASD

Within a positive behavior support approach, consideration should be given to writing
down the span of supports that are being developed. The “span of supports” refers to
everything that is necessary to assist a student toward successful outcomes within the
school setting and beyond. These supports can be very technical and involve com-
plicated techniques and schedules, but they may also involve very simplistic types
of supports, such as making sure that the student has an opportunity to say “good
morning” to his favorite teacher each day or has time to sharpen pencils before class
starts. For some students, the simple supports can be very important and contribute
a great deal toward ensuring that the student is prepared to function at his/her best.
Considering the span of supports is especially important for students diagnosed with
ASD because they may display comprehensive challenges that go beyond a classroom
setting and encompass all aspects of their lives. While a behavior change objective may
be beneficial for changing a behavior during specific situations or in certain settings, a
positive behavior support plan also needs to describe additional environmental modi-
fications that will be necessary to ensure that a behavior change can be generalized
and maintained for extended periods of time. In addition, objectives should be written
to describe how the plan will promote opportunities for the student and incorporate
the student’s individual values. These types of objectives might be referred to as com-
prehensive support objectives and they may be highly beneficial, especially for develop-
ing support plans for students diagnosed with an ASD. These comprehensive support
objectives should identify individuals who are willing to offer assistance and support
to the student with an ASD across various settings and at different times of the day.
For instance, a student who transfers from class to class might be provided needed
supports by a teacher while in the classroom, be offered needed assistance from a hall
monitor while walking from class to class, and might have an identified peer group to
sit with during lunch time. Each of these individuals should be included in the devel-
opment of a support plan and be in agreement to take on certain responsibilities to
provide certain supports to the student diagnosed with an ASD. This type of learning
environment engineering can lead toward more acceptance among all the stakehold-
ers supporting a student diagnosed with an ASD and enhance his/her overall quality
of life. Chapter 11 focuses extensively on transitioning and the use of person-centered
planning procedures that can prove beneficial for creating a well-rounded array of
supports for a student diagnosed with an ASD.
Antecedent-Management Strategies
One approach that can be highly valuable toward developing positive behavior sup-
ports for individuals diagnosed with an ASD is examining the situations and factors
that are more or less problematic for these individuals. Developing antecedent-
management strategies for students diagnosed with ASD involves determining
variables in the environment that can promote success and eliminating or avoiding
environmental variables that lead to challenges. For example, a student diagnosed
with an ASD who does not like crowded situations or environments that are very
noisy might be provided with activities that involve minimal crowding and noise,
while avoiding situations that are known for being noisy and crowded. Assessing the
environment and variables that are related to challenging behaviors can be an effi-
cient method for determining specific antecedent variables to manage. Assessment in
an educational setting for a student diagnosed with an ASD might take place across
at least three different areas, such as the educational environment, the instructional
approaches utilized, and the task-related variables. Some examples of each of these
areas are provided in Figure 7.4.
Environmental Variables
Assessing environmental variables in educational settings is a good starting point
when developing antecedent-management strategies. An educational environment
should provide an inviting atmosphere that considers variables such as temperature,
lighting, space, and so forth. A student should be able to feel comfortable in his/her
classroom, and whenever a student has specific needs, such as the need for privacy,
the classroom should attempt to offer these types of accommodations. Partitions or
study carrels could be useful for a student who is easily distracted or needs privacy.
Carpet, rugs, or placing tennis balls on the bottom of chair legs could help to reduce
noise in a classroom. Other factors to consider might be the lighting available in the
classroom, which could be altered somewhat by moving a student closer to or away
from a window or providing a lamp near a work station. The temperature in the room
could be adjusted to make the room more comfortable, or a student might keep a
sweater in the classroom that could be readily available if needed. Another factor to
consider in a classroom might be the feeling of having an individualized space to keep
personal items such as jackets, book bags, and so on. This could be expanded to having
an assigned seat in the classroom or arranging for a student diagnosed with an ASD
to sit next to a classmate who can offer support as needed. In addition to classroom
Figure 7.4 Three areas for educational assessment and intervention
Educational Environment Instructional Approach Task-related Variables
• Temperature • Loudness of voice • Length of task

• Lighting • Use of directives • Difficulty of task
• Space • Use of questioning • Arrangement/scheduling
• Noise level • Nonverbal behaviors of tasks
• Use of choice • Meaningfulness of task
• Use of “if, then” • Use of cues or prompts
statements
• Individualized activity
schedules
• Structured work
systems
variables, there are several other settings in educational environments that can be con-
sidered, such as transitions made in hallways, lunch room seating arrangements, seat-
ing during school assemblies, and so forth. Numerous variables within educational
environments can be reviewed and modified to help a student diagnosed with an ASD
to feel more comfortable and avoid encountering situations in which he/she has dis-
played challenging behaviors in the past.
Instructional Approaches
The manner in which an educator presents instructions to a student diagnosed with
an ASD can influence the response that the student demonstrates. There are several
different ways that instructions can be altered, including the loudness of the teacher’s
voice, the use of directives versus questioning, and the use of nonverbal behaviors. For
example, a teacher may choose to tell a student to begin working on a task in a very
loud voice or in a very soft voice. Some students may respond to a loud voice and may
require a loud voice in order to hear the instruction. Other students may respond to
a loud voice by being startled, by feeling that they are being yelled at, or by showing
some fear of the person using a loud voice. The loudness at which instructions are
provided needs to be adjusted to the volume that works best for a student diagnosed
with an ASD.
The use of directives versus questioning can also sometimes result in different
responses from students. For example, a teacher may say “Put away your toys and
come sit in your desk,” or ask “Could you put away your toys and come sit in your
desk?” In both interactions the teacher is attempting to get the student to do the
same activity, but the first is more of a directive and the second involves questioning.
The first statement could be seen as more authoritative, with the implication that the
student must respond appropriately, while the second request could be viewed as hav-
ing a level of uncertainty and the student is being given an option of choosing not to
Consider This
Above, the loudness of a teacher’s voice was dis- to hear what she was saying. Once the audience
cussed and it was noted that this could be some- got close, she stopped and explained that as a
thing a teacher could adjust to best address a teacher she always spoke very softly because it
student diagnosed with an ASD. Several years resulted in the students moving closer to her
ago, one of the authors of this text attended a and listening very carefully. She was using this
presentation by a retired teacher who was in her same approach in her presentation and it worked
eighties and began her teaching career in a one- quite effectively to get the attention of the audi-
room school house. As this teacher began her ence. This was an interesting approach because
presentation, she spoke very softly. Almost no frequently those speaking to a group will try to
one in the audience could hear her speak, and raise their voices in attempts to get the attention
everyone began moving so they could get closer of the audience.
comply with the request. Sometimes these types of fine adjustments can lead toward
more or less appropriate responses from students diagnosed with ASD. It is important
to determine whether these types of interactions can be used to improve the desired
responses from students.
The use of nonverbal behaviors can be another variable to consider when inter-
acting with students diagnosed with ASD. Nonverbal behaviors could include the use
of hand gestures when speaking, the distance between the speaker and the student, or
even the facial expressions displayed by an educator when interacting with a student.
An educator could utilize hand gestures when speaking or providing instructions to
a student in order to convey the meaning of his/her message. For example, a teacher
who is asking students to stand in a straight line might extend her/his arms outward
to form a straight line, or if the teacher is telling a student to go down the hallway
and turn right, he/she might point one arm down the hallway and then point to the
right. The use of hand gestures can, for some students, assist in enhancing under-
standing of what is being said, but for other students the same hand gestures might
lead to more confusion. Another type of nonverbal behavior frequently displayed in
classrooms involves the distance between a teacher and a student. For some students,
the teacher may need to move close so that the student realizes the teacher is interact-
ing with him/her and not with someone else in the classroom. Other students may
perceive a teacher coming close as threatening and may not respond appropriately.
Teachers need to be aware of how distance may play a role in how a student responds
to interactions. Another nonverbal behavior that could influence how a student diag-
nosed with an ASD responds might involve the type of facial expression displayed by
the teacher. Some students may respond more appropriately to a teacher who smiles
and displays a friendly look, while others may respond better to a teacher who displays
a stern look that indicates seriousness. While students diagnosed with ASD frequently
do not appear to respond to different types of mannerisms displayed by others, their
reliance on these nonverbal indicators can be taught, so these types of mannerisms can
be important for some students.
Another instructional approach that an educator can utilize involves providing
the student with opportunities to choose the activity in which he/she would like to
participate. Incorporating choice into the instructional approach has been shown
to be beneficial in enhancing appropriate behaviors (Rispoli et al., 2013; Romaniuk
& Miltenberger, 2001; Ulke-Kurkcuoglu & Kircaali-Iftar, 2010). These types of
choices do not have to be significantly different in the skill that is being learned or
practiced. For instance, a teacher might ask a student if he/she wants to do a math-
ematics worksheet or complete a mathematics activity on a computer. The skill of
mathematics would be the same for both activities. Another type of instructional
approach could be the use of “if, then” statements to encourage engagement and
completion of a task. Providing these types of statements has been shown to be use-
ful when working with children diagnosed with ASD (Tarbox, Zuckerman, Bishop,
Olive, & O’Hora, 2011). When using an “if, then” statement, an educator tells a
student if he/she completes a task, then he/she will receive a reward; for example, a
teacher might say: “If you complete the mathematics problems, then you can work
on the computer.”
All of the instructional approaches discussed so far have involved ways that an
educator could modify the way that he/she presents instructions. Another way that an
educator can modify the instructional approach is by teaching the student a method for
managing some of his/her own instruction. One such method was developed as part of
the TEACCH program based out of the University of North Carolina-Chapel Hill and
focuses on using individualized activity schedules and structured work systems (Lord &
Schopler, 1994). The individualized activity schedule outlines the specific tasks that a
student should complete during a specified time period. The activity schedule could
cover a full school day, a half day, or any other period of time throughout the day. The
activity schedule is developed using a form of communication that a student can com-
fortably understand. A student might begin with an activity schedule that incorporates
tangible items used in an activity, then progress to photos of activities, then progress
to line drawings of symbols related to activities, and then eventually progress to words
indicating the activity. For example, a student might initially have an activity schedule
that utilizes a spoon to indicate snack or lunch. The same student may then progress
to using a photo of the lunch room to indicate lunch, then he/she could progress to a
line drawing of a place setting to indicate lunch, and then eventually progress to using
the word “lunch.” The activity schedules should progress from very concrete levels of
communication to more abstract forms of communication in order to meet the student
at his/her current level of understanding. In addition, the activity schedules should con-
sider interspersing less-preferred tasks with those that the student finds more enjoyable.
In addition to using an individualized activity schedule, a teacher can modify the
instructional approach by teaching the student to use a structured work system. These
work systems promote independent engagement by students on tasks in which they are
fluent but need to continually practice to maintain their skills level (Lord & Schopler,
1994). Structured work systems are similar to individualized activity schedules, but
rather than help a student move through his/her daily activities, they are designed to
assist a student in completing a specific work task or a series of related work tasks. For
example, an individualized activity schedule would help a student identify when read-
ing time, computer time, and lunch time occur. A structured work system would help
a student to complete a series of mathematics tasks, such as a mathematics worksheet,
a mathematics manipulative activity, and a cut and paste mathematics task. One com-
mon method for designing structured work systems involves using baskets labeled one,
two, and three or A, B, and C. The baskets are filled with work tasks and the student is
taught to complete the tasks in order. The student is also provided with a specific loca-
tion to place the completed work. Structured work systems are intended to be used for
tasks that are familiar to the student and that the student can complete fluently without
assistance. For tasks that are new to the student and involve learning new skills, the
student would need to be provided direct instruction on how to complete the task.
Task-Related Variables
Some of the variables that are related to tasks include the length of the task, the dif-
ficulty level of the task, and the arrangement of the task, and the cues or prompts
available to assist with task completion. Educators can choose to vary each of these
variables in attempts make tasks more appropriate and more meaningful for the stu-
dents. Each of these variables will now be briefly discussed.
Length of task. The length of a task can be manipulated in order to promote more

appropriate on-task behaviors. While it is important to consider the age and develop-
mental level of the student, it is also important to factor in the type of task, the dif-
ficulty of the task, the energy level of the student, and the preferences of the student,
for example, young students need to be presented with shorter task lengths than older
students. Similarly, students with higher developmental levels can be presented with
longer tasks than students with lower developmental levels. In addition, it is important
to consider the type of task and the difficulty level of the task that is being presented.
For example, a mathematics worksheet involving word problems may be more diffi-
cult and need to be shorter than a computer task involving matching presidents with
their home state. Adjusting the length of a task should also involve consideration of
characteristics of the students, such as when they display the most energy and the pref-
erences that they have for certain tasks. For example, a student who is usually more
active and energetic in the morning and typically appears tired in the afternoon could
be given a lengthier task in the morning and briefer tasks in the afternoon. Similarly, if
a student has a preference for a certain type of task such as reading, the reading tasks
could be designed to be longer than other less-preferred tasks.
Difficulty of task. The difficulty of a task should be determined in relation to the

student’s level of mastery of the skills involved in the task. One way to determine this
is to track the skill development of a student and then compare the skills needed to
complete the task and decide whether the student has previously mastered the skills,
is displaying some emerging fluency with the skills, or if the skills require the student
to first learn prerequisite skills. By considering these factors, a teacher can categorize
tasks into three categories so that appropriate tasks can be readily organized. A prac-
tice category can be used to label those tasks that are relatively easy for the student and
can be presented to the student to complete independently. An instructional category
can be used to label those tasks that develop and expand upon some of the skills that a
student already displays but which require some direct instruction to ensure the stu-
dent develops the skills efficiently. A third category can include those tasks that may be
incorporated later once certain prerequisite skills are developed.
Arrangement of tasks. Considering how tasks are arranged can be a useful method

for varying the presentation of tasks to students. One method for doing this is to inter-
sperse activities that are considered more difficult or less preferred for a student with
tasks that are considered less difficult or more preferred. For example, a student who
enjoys and performs well at mathematics and science, but who does not prefer or per-
form well in reading and social studies, could have a schedule that first presents a math
task, then a reading task, then a science task, then a social studies task, and then ends
with a math or science task. The important thing to consider is that less-preferred and
more difficult tasks are interspersed with more-preferred and easier tasks with the
student beginning and ending with an activity that they find enjoyable.
Cues or prompts available for task. The availability of cues or prompts while per-
forming a task can alter the difficulty and the success rate of a task. A worksheet that
offers arrows to point the student in the correct direction, or that has several examples,
or that partially provides answers, could promote more diligence toward completing
the worksheet. In other types of tasks, a teacher could offer prompts by providing ver-
bal comments, using gestures, or physically assisting the student to complete a task.
Avoiding situations and variables that are known to be associated with challeng-
ing behaviors is a quick way to minimize challenging behavior, but it does not allow
for opportunities to learn management of difficult situations or variables. Since not
all challenging situations or variables can be avoided, it is important to consider how
a student will manage themselves in these situations. In order to ensure that students
are not limited in the type or frequency of experiences that they are offered, it is
necessary to find ways to allow them to participate in more appropriate ways. This is
where teaching replacement behaviors becomes necessary.
Teaching Replacement Behaviors

Since students cannot always avoid situations or tasks that they find unpleasant, and
since they have to interact with numerous different people, they should be provided
with appropriate techniques for obtaining the things they need and communicating
their needs to others. Teaching replacement behaviors is one method for promoting
appropriate behaviors from students while still allowing them to gain access to the
things and situations that they need. This is a method that intends to expand upon
the behavior repertoire that students have available to them to deal with situations
that they find challenging. A student who has never been taught how to behave in a
socially acceptable manner during difficult situations may not automatically display
these behaviors. Some students are able to observe their peers managing difficult sit-
uations and can, in turn, model these behaviors without direct instruction from an
educator or other person. For students diagnosed with an ASD, this type of observ-
able learning may not occur without some direct instructional assistance that guides
toward what to observe and how to respond appropriately in various situations. For
example, some students are able to watch others standing in a lunch line waiting for
their turn and, in turn, begin standing in line themselves to wait for their turn to get
their lunch. Students diagnosed with an ASD may not focus on the social etiquette of
standing in line waiting for a turn, but rather focus on solving the problem in a way
that meets their immediate needs by cutting in front of those standing in line and
going straight to where they can access the food. This is where the student could ben-
efit from instruction that demonstrates to them how they can stand in line and wait
their turn to get their food. Without the appropriate behavioral repertoires, students
with ASD may respond to challenging situations with equally challenging behaviors.
Replacement behaviors offer a way to respond to challenging situations with effective,
appropriate behaviors.
The term replacement behavior is used because it is intended to offer an appro-
priate replacement behavior to an inappropriate behavior while still allowing the
student to gain access to what he/she needs or wants. Moreover, a replacement

behavior serves the same function as a challenging behavior. For example, a student
diagnosed with an ASD whose assessment results indicate that he engages in mild
self-injurious behavior in order to gain attention from a teacher might be taught
to raise his hand to obtain the teacher’s attention. This would be an example of a
replacement behavior that could compete with a challenging behavior for gaining
attention from the teacher.
For many students diagnosed with ASD, communication is a difficulty that
can result in challenging behaviors. Students diagnosed with ASD frequently cannot
express themselves through their words, verbally convey to others what they need, or
vocally respond to others who are interacting with them. A student who is unable to
communicate with others effectively may resort to communicating in a manner that is
unusual, inappropriate, or even destructive. For example, a student who lacks effective
communication skills might be thirsty and need a drink of water, but be unable to ask
for a drink. If no one is offering the student a drink, he/she may leave an assigned area
without permission to search for a drink, might try to drink something that is not for
human consumption, or might steal a drink from someone else. For the thirsty stu-
dent, all of these behaviors would be an attempt to satisfy his/her thirst in ways that do
not require communication with someone else. In contrast, a student who could com-
municate well would most likely just ask someone for a drink. Asking for a drink would
be the easiest method for obtaining the drink and the student with limited communi-
cation could be taught to communicate when they want a drink through verbalization,
sign language, using symbols, and so on, rather than engaging in some inappropriate
behavior to obtain the drink. Applied Vignette 7.1 provides an example of a young
student diagnosed with an ASD who lacked some necessary communication skills to
get the attention he required.

Daniel
Daniel was an 8-year-old diagnosed with autism work. After their winter break, Daniel’s inclusive
who spent his school day in an inclusive class- teacher began reporting that Daniel was hitting
room. Daniel was nonverbal but could use some other students in the classroom. The teacher
basic sign language. He was able to do a number could not understand why he had started hitting
of academic tasks at grade level and his regular other students, but she made sure that whenever
education teacher and special education teacher she saw this occur, she would break it up and
worked together closely to make some modifi- make Daniel go sit in a corner of the room away
cations to the work activities he was assigned from other students. Hearing of this challeng-
in class. In most cases, the activities they devel- ing behavior, the special education teacher came
oped were easy for Daniel to complete, but at to the classroom on several occasions to observe
times they were still difficult. The special edu- Daniel and attempt to determine why he might
cation teacher would also spend some time in be hitting others. She collected data on what
the classroom assisting Daniel with some of his was happening immediately before Daniel hit
(continued )

a classmate and what happened immediately skills that were probably quite difficult for him.
after he hit a classmate. When she evaluated the The special education teacher then realized that
data she had collected, she noticed that Daniel Daniel probably needed some help in order to
would hit his classmates when he was given a complete the tasks. She then looked at the data
seatwork assignment and the teacher would she had collected again and realized that what
immediately approach him and move him to Daniel was getting from hitting his classmates
another location with his seatwork assignment was some individualized attention from the
and make sure he was doing his work. The teacher who helped him with the difficult work
special education teacher had suspected that assignments. In other words, Daniel appeared
Daniel was hitting others to get out of doing his to be hitting his peers in order to obtain help
work, but this never occurred since the teacher from his teacher with his seatwork assignment.
always got him started back on the assignment. The special education teacher immediately met
The special education teacher then went and with the inclusive teacher and they devised a
evaluated the assignments that were being given plan to teach Daniel to raise his hand to request
to Daniel and noticed that the assignments help when he had difficulty with one of his
required Daniel to use some newly learned assignments.
Teaching a student to communicate seems like a very reasonable technique to

reduce inappropriate behaviors related to needing a drink, but educators must first
determine through assessment that the challenging behaviors are related to needing a
drink. Failure to recognize the reason a challenging behavior is occurring frequently
results in interventions that are ineffective. Carr and Durand (1977) were some of the
first to recognize that certain communication deficits were responsible for individu-
als displaying a wide range of challenging behaviors. They developed a technique for
teaching communication skills to replace challenging behaviors that were related to
attempts to communicate, which they called functional communication training (FCT).
The FCT technique involved first determining what a challenging behavior was
attempting to communicate and then finding a suitable way for a student to commu-
nicate the same need or want. A suitable communication method would be one that
an individual could perform easily, such as a sign, and it would also need to be easily
recognized by others so that they could respond appropriately. FCT involved using
practice sessions intended to teach a person to use a communication method and then
prompting the person to display the communication in natural settings where chal-
lenging behaviors had occurred previously. FCT has been proven highly useful for
reducing challenging behaviors in a number of research studies (Kelley, Lerman, &
Van Camp, 2002; Wordsell, Iwata, Hanley, Thompson, & Kahng, 2000). Similar to
FCT, a communication system using pictures was developed by Frost and Bondy
(1994) and called the Picture Exchange Communication System (PECS). This system
utilizes pictures for communication and attempts to teach a student to accomplish
communication across six different phases of increasingly more sophisticated levels
of learning. PECS has been found to be a useful strategy for reducing challenging
behaviors among individuals diagnosed with ASD (Charlop-Christy, Carpenter, Le,
LeBlanc, & Kellet, 2002; Machalicek, O’Reilly, Beretvas, Sigafoos, & Lancioni, 2007).

Florida’s Positive Behavior Support Project: A Multi-Tiered Support System offers
information and support at several levels to school districts in Florida. Their website
(http://flpbs.fmhi.usf.edu) offers online training, chat sessions, and videos for coordi-
nators and coaches implementing positive behavior supports in Florida schools. They
also provide a list of schools in Florida that have been rated according to their level of
performance on implementation of school-wide positive behavior supports.
Chapter Summary
This chapter has focused on how positive behavior supports can be developed for
students in classroom settings and beyond. We stressed the need for incorporating
supports that can be well rounded and long lasting. The importance of functional
assessment was discussed with regards to how valuable the information obtained from
such assessments can be toward improving the effectiveness of interventions. Both
direct and indirect methods of functional assessment were discussed, along with the
benefits and limitations of each approach. Antecedent-management strategies were
described, including how these strategies could be manipulated both formally with a
written plan, and informally as a means of everyday interactions. These antecedent-
management strategies could involve manipulating the classroom environment, vary-
ing instructional approaches, or modifying variables related to the task that a student
is given to perform. In addition, the value of incorporating replacement behaviors was
discussed, including techniques such as FCT and PECS.
1. Search online for examples of functional assessment interviews and rating scales.
Compare the information contained in some of the instruments and determine which
appear to be more comprehensive and which appear to be designed for specific uses,
such as teachers or parents. Discuss with classmates how the information derived from
these instruments could be useful toward making determinations about the function of
a challenging behavior.
2. Find some journal articles that focus on specific function-based challenging behav-
iors. The journal articles might include phrases in the titles such as “attention-seeking
behavior” or escape-maintained behavior.” Look through several of these articles and
see what types of behaviors were actually being displayed and what type of interven-
tions were developed to address the behaviors.
3. Make a list of possible interventions that might be appropriate to use for addressing
attention-seeking behaviors, escape-maintained behaviors, and automatically rein-
forced behaviors. Look through journal articles to get ideas about what interventions
might be most appropriate.
4. Try to accomplish a routine daily activity without using your typical method of com-
munication. For example, go to the coffee shop and try to place your usual order with-
out speaking or writing down the order. Note how this caused difficulty for you and
whether it appeared to be frustrating for those attempting to take your order. Think
about how difficult it could be for someone who has very limited communication to
obtain the items that they want and need.
Websites
Association for Positive Behavior Support OSEP Technical Assistance Center on Positive
(APBS) Behavioral Intervention and Supports
http://apbs.org www.pbis.org
Educational and Community Supports— PBIS Maryland
University of Oregon http://pbismaryland.org
www.uoecs.org
Books
Durand, V. M. (1990). Severe behavior problems: A functional communication training approach. New York:
Guilford Press.
Sailor, W., Dunlap, G., Sugai, G., & Horner, R. (2009) (Eds). Handbook of positive behavior support. New
York: Springer.
Wheeler, J. J., & Richey, D. D. (2014). Behavior management: Principles and practices of positive behavior
supports (3rd ed.). Upper Saddle River, NJ: Pearson.
8
chapter
Collaboration
and Consultation

■ Describe the key features of collaborative relationships.
■ Discuss the importance of collaboration for individuals diagnosed with an ASD.
■ Describe the consultation process.
■ Discuss the use of team-based collaborative consultation for individuals diagnosed with ASD.
211
Chapter 8 Mind Map

Characteristics of Consultation
Approaches to Consultation
Positive & Negative Aspects of Consultation Approaches
Matching Consultation Approaches to the Needs of Individuals Diagnosed with an ASD
Consultation Defined
Phase 1: Problem Identification
Problem Solving in
Phase 2: Problem Analysis
Consultation
Phase 3: Plan Implementation
Phase 4: Plan Evaluation Formal & Informal Collaboration
Collaboration & Collaboration Defined Types of Collaboration

Environmental Factors Influencing Collaboration & Consultation
Consultation Models of Collaboration
Effective Collaboration Practices
Recognizing Strengths & Needs of Team Members Team-Based Services & Supports for Team-Based Consultation & Collaboration
Individuals with ASD & Their Families
Allocating Responsibilities to Team Members
Interpersonal Communication Skills
Administrative Support Components of Effective Collaboration & Consultation
Effective Consultation Practices Across Learning Environments
Facilitation Skills
Organization Skills
Assessment Knowledge
Intervention Knowledge
Role Valorization in the Collaboration & Consultation Process
Applications of Collaboration & Consultation Across the Lifespan
Collaboration Defined
Collaboration has been defined by Fishbough (1997) as a group of two or more
autonomous people working to achieve goals that could not be accomplished inde-
pendently. Curtis and Stollar (2002) defined collaboration as “two or more p eople
working together, using systematic planning and problem solving procedures,
to achieve desired outcomes” (p. 226). Each of these definitions of collaboration
involves at least two people engaging in interactions designed to produce a mutually
desired result. Collaboration among those working for individuals with ASD can be
an essential component for achieving successful outcomes. Working and partnering
together can be a difficult task, but when it is done well, it can result in outcomes
that exceed many of the individual efforts made by service providers. Collaboration
takes planning and an emphasis on supports needed by the individual diagnosed
with an ASD. This planning is often driven by various documents produced as part
of the collaboration; for example, preschool children with diagnosed disabilities are
provided an IFSP, while school-age students with disabilities are required to have an
IEP, and many older individuals with disabilities can be provided with an individual-
ized service plan (ISP). Development of each of these programs requires a collab-
orative effort from a group of individuals who have a role to play in the life of the
person with a disability. In each of these instances, parties involved may include fam-
ily, guardians, friends, early intervention support personnel, teachers, social service
workers, mental health workers, employers, and so forth. Figure 8.1 outlines some
potential members who might collaborate on the development of each of these types
of plans/programs.
c h ap t e r E i g h t / Collaboration and Consultation 213
Figure 8.1 Potential members who might collaborate on the development of plans/programs
for individuals diagnosed with an Asd across the life span
Potential Members of a Collaborative Team
Individualized Family Service Individualized Education Individualized Service

Plan (IFSP) Program (IEP) Plan (ISP)
■ Preschool child diagnosed ■ School-age student diag- ■ Adult diagnosed with an ASD
with an ASD nosed with an ASD ■ Family member/guardian
■ Parent/guardian ■ Parent/guardian ■ Friend
■ Extended family ■ Special education teacher ■ Direct support personnel
■ Friends ■ General education teachers ■ Program coordinator
■ Program coordinator ■ Paraeducator ■ Advocate
■ Early intervention support ■ School principal ■ Psychological service
personnel ■ School counselor personnel
■ Speech therapist ■ School psychologist ■ Behavior support personnel
■ Occupational therapist ■ School nurse ■ Medical personnel
■ Physical therapist ■ Transition support personnel ■ Employer
■ Behavior specialist ■ Occupational therapist ■ Rehabilitation service
■ Nurses ■ Speech therapist personnel
■ Behavior specialist
■ Other related service
personnel
Formal and Informal Collaboration

Collaborations can be described as either formal, informal, or a combination of both.
Formal collaborations are those that involve individuals who are required to partici-
pate as part of their job duties, while informal collaborations may involve participants
who voluntarily participate. Some examples of formal and informal collaborative
relationships are presented in Figure 8.2.
Specialized plans/programs such as an IFSP, an IEP, an ISP, and so forth may
involve a formal collaborative relationship to be developed in order to select needed
services and conduct supportive and intervention-based activities for the individual
diagnosed with an ASD. Formal collaborative relationships may include more struc-
tured efforts to establish a group and follow a format designed to achieve higher levels
of collaboration. In addition to these formalized collaborative relationships, there are
also several informal collaborative relationships that can be beneficial for an individual
diagnosed with an ASD. Some of these types of collaborations for preschool children
may involve organizing activities such as “play dates” with parents of similar-age chil-
dren, developing relationships with other parents of children diagnosed with ASD, or
interacting with agencies or associations that provide information about ASD. At the
school-age level, these informal collaborations might involve planning with a teacher
about how best to interact with the student diagnosed with an ASD, recruiting class-
mates to provide support to the student diagnosed with an ASD, or speaking with a
coach or director of extracurricular activities to determine how a student diagnosed
with an ASD might participate in a sport or other activity. For adults, these informal
Figure 8.2 Examples of formal and informal collaborative relationships across three age groups
Informal Collaborative
Age Group Formal Collaborative Relationships Relationships
Early childhood Individualized family service plan (IFSP) ■ Arranging “play dates”
with similar age children
■ Developing relationships
with other parents
■ Interacting with various
agency/association
members
School-age Individualized education program (IEP) ■ Talking with various

school personnel
■ Talking with or recruiting
support from classmates
■ Speaking with an athletics
coach
Adulthood Individualized service plan (ISP) ■ Talking with or recruiting

support from co-workers
■ Interacting with various
community agencies
■ Developing relationships
with various members of
the community
collaborations might involve talking with co-workers about how to improve the per-
formance of a person diagnosed with an ASD, contacting community agencies to
determine ways for individuals to participate in recreational activities, or finding indi-
viduals in the community who may offer support for a special interest that a person
diagnosed with an ASD might want to pursue.
Types of Collaboration
Heward (2009) described three types of collaboration that included coordination,
consultation, and teaming. Coordination was described as the simplest form of collabo-
ration that only involves service providers making arrangements to ensure services are
provided, but not sharing other information. Consultation typically involves experts
providing information and suggestions to a nonexpert. Teaming is the most complex
form of collaboration and involves a group of individuals working together, sharing
information, and making decisions as a group.
The complex array of services needed by many children and adults diagnosed
with ASD may require collaboration in the form of teaming with several experts from
a variety of varying backgrounds. In addition to experts in the area of autism, input
from specialists in social skill development, behavior analysis, speech/language pathol-

ogy, occupational therapy, and other areas may prove valuable toward developing
appropriate services for individuals diagnosed with ASD. These specialists must work
together with regular education teachers, special education teachers, and parents to
ensure that everyone has the same agenda and that recommended strategies do not
conflict with each other. This requires a substantial amount of interaction and col-
laboration among everyone involved, in a number of different ways.
Models of Collaboration
The literature on collaboration has identified a large number of ways that collabora-
tion can take place both formally and informally. Fishbough (1997) outlined three
models of formal collaboration that included a coaching model, a teaming model, and
a consultation model. In a coaching model, someone with specific knowledge or expe-
rience may provide ongoing support to a peer or other person who may require assis-
tance to overcome a specific challenge. Senior teachers often are paired with junior
teachers to offer support and information based on their own prior experiences. This
type of collaboration might involve the senior teacher coaching a junior teacher on
classroom management strategies, how to implement a reading program, time man-
agement, or recommendations in numerous other areas. Coaching frequently occurs
among special education teachers who coach regular education teachers on how to
modify curricula to meet the needs of students diagnosed with ASD. Coaching may
continue for extended periods of time between two or three people on an as-needed
basis so that knowledge and skills can be shared between the individuals collaborating.
In team collaboration, several people are involved, and their input requires a great deal
of organization and mutual understanding. Collaboration among teams frequently
occurs during the development of large-scale plans such as IEPs and IFSPs that
require input from a large number of individuals with specific knowledge. The third
model of collaboration delineated by Fishbough, consultation, will now be described
in more detail.
Consultation Defined
Consultation has traditionally been viewed as a process in which assistance is provided
from a source outside of the immediate environment. Consultants are frequently
recruited when a problem occurs that is especially difficult for those attempting to
deal with the issue. Teachers, parents, or others working with individuals with an
ASD may at times come across situations or behaviors that go beyond their level of
expertise or that cause significant frustration. In such situations, a consultant with
some specialized skills or experiences may be valuable for providing novel strategies
or simply offering a unique perspective on the situation. For the purposes of this
chapter, focus will be given to those models of case-based consultation that appear
to be most relevant for working with individuals diagnosed with an ASD.
Characteristics of Consultation
Consultants for individuals with ASD may have varying backgrounds, but they often
include psychologists, behavior specialists, or highly experienced teachers. The type of
services that these consultants offer may vary widely and may be dependent upon the
referral that is presented to them and the amount of time that is allocated for the con-
sultation process to take place. Some consultants may only have a brief period of time,
such as a few hours, to complete the consultation process, while other consultants may
be contracted to offer consultation on an ongoing basis for weeks, months, or years
on an as-needed basis. In addition, the types of services that consultants may offer can
vary widely from providing some general recommendations, to developing a plan to
assist an individual with an ASD through a specific problem, to providing a compre-
hensive plan that includes all aspects of the life of the individual. Figure 8.3 provides
some examples of activities that a consultant might engage in to develop supports for
individuals diagnosed with ASD.
Consultation usually involves at least three parties that include the consultant,
the consultee, and the client. Traditionally, consultants work primarily with consultees
through verbal interactions (Bergan & Kratochwill, 1990; Gutkin & Curtis, 1990;
Rosenfield, 1991). The consultees then work directly with clients utilizing the strate-
gies that have been conveyed to them by the consultant. This approach to consultation
is the most predominant and can be considered an indirect method of consulting, due
to the reliance on verbal exchanges to disseminate information. Kratochwill, Elliott,
and Carrington-Rotto (1990) summarized behavioral consultation as “a model for
delivering psychoeducational assessment and intervention services to children via
teachers or parents through a series of interviews” (p. 150). An alternative consulta-
tion approach described by Watson and Robinson (1996) focuses less on the verbal
exchange between the consultant and the consultee and relies more on the consultant
directly teaching skills to the consultee. Kratochwill and Pittman (2002) revised some
Figure 8.3 Some possible activities of a consultant for individuals with ASD
Category Activity
Early childhood ■ Develop an in-home behavior plan

■ Provide parents with information about services
■ Train parents on strategies to improve interactions with
their child
School-age ■ Develop behavior plans

■ Formalize instructional programs
■ Recommend arrangements of classrooms
■ Develop specialized curriculums
■ Conduct specialized assessments
Adulthood ■ Develop leisure skill programs

■ Review/evaluate programs
■ Assess vocational aptitude/preferences
of the initial characteristics of behavioral consultation to include both direct and indi-
rect services provided by consultants, but not all consultation models follow these
characteristics. Given these different approaches, consultation can be categorized by
using four different descriptors that focus on the type of services offered and the range
that the services encompass. Consultation service types can be described using the two
categories of direct or indirect consultation. The range of consultation services pro-
vided may be described as within-systems approaches or across-systems approaches.
Figure 8.4 provides a visual representation that can be used to categorize the type and
range that a consultation approach may encompass. This figure can help to categorize
a consultation approach into one of the following four distinct categories: (1) within-
system direct consultation, (2) within-system indirect consultation, (3) across-system
direct consultation, and (4) across-system indirect consultation. In addition, a consul-
tation may at times incorporate both direct and indirect approaches. Each of these
descriptions of consultations will now be discussed.
Approaches to Consultation
Direct consultation (Watson & Robinson, 1996) consists of services rendered by a
consultant that involve some direct instruction to teach the consultee and/or the client
new skills. For example, a consultant who spends time demonstrating how to teach a
child diagnosed with autism a new skill, such as how to request a break from a difficult
task, and also directly trains the consultee to implement the procedure is engaging in
direct consultation. Alternatively, if the consultant developed a plan for teaching this
same skill to the same child and then provided the child’s teacher with the plan with-
out modeling or directly teaching how to implement the plan, it would be considered
Figure 8.4 Categories of consultation type and range
Direct Consultation Indirect Consultation

(consultant engages in some (consultant only interacts with
direct contact with the individual other professionals, service
diagnosed with an ASD) providers, or family members)
Within-Systems Consultation
(consultant may only provide
services in a limited number of
settings)
Across-Systems
Consultation
(consultant can provide ser-
vices in numerous settings that
apply to the person diagnosed
with an ASD)
a form of indirect consultation. With indirect consultation, the consultant does not
actively engage the client or directly teach new skills to the consultee, but rather pro-
vides strategies to the consultee using a didactic approach and expects him/her to
implement the strategies.
Positive and Negative Aspects of Consultation

Approaches
Each of these different approaches to conducting consultation activities may have
some positive and negative aspects (see Figure 8.5). One of the benefits of using
direct consultation may be that a consultant can have a high degree of control over
how strategies are utilized and can make changes to these strategies very quickly.
In addition, the consultant can easily monitor the effectiveness of the strategies
and troubleshoot any other problems that appear during implementation. In con-
trast, some detrimental aspects of direct consultation are that it can be very time
consuming for the consultant, which could minimize the number of individuals for
whom he/she can provide services. The consultation could also become very expen-
sive for the individual or agency due to the amount of time necessary to carry out
direct consultation services. In addition, if the consultant personally implements
strategies, there is the possibility that these strategies will not be maintained once the
consultant discontinues services.
Figure 8.5 Positive and negative aspects of direct and indirect consultation approaches
Direct Consultation Indirect Consultation Approach
Positive Aspects Negative Aspects Positive Aspects Negative Aspects
High degree of consult- Time consuming Less time consuming Difficulty closely moni-
ant control than direct consultation toring the success of
strategies
Changes can be made Potentially expensive More clients can Delays in making modi-
quickly to address other potentially receive fications to ineffective
issues consultations strategies
Consultant can thor- Potential lack of gener- Utilizes skills and Difficulties addressing
oughly monitor the alization of strategies to knowledge of others other problems that
integrity of strategies others arise
Provides direct instruc- Consultees may not be

tion of new skills that proficient at implement-
may be retained by ing strategies
consultee
Heavy emphasis on
verbal interaction rather
than on direct teaching
The benefits of indirect consultation include the potential for a consultant to

have an impact on several clients in a shorter period of time by utilizing the skills
of the people close to the individual with an ASD. In addition, the consultant can
focus more on developing intervention strategies and less on training the strategies
by utilizing the skills and knowledge of consultees. The negative aspects of indirect
consultation may include difficulties with monitoring the success of strategies that are
developed, delays in making changes to strategies that prove ineffective, and difficul-
ties addressing other problems that arise during implementation due to the consultant
being less directly involved in implementation.
Matching Consultation Approaches to the Needs

of Individuals Diagnosed with ASD
Individuals diagnosed with ASD may, at times, present problem behaviors that can
be difficult to treat. The types of assessments and interventions that are necessary to
address difficult behaviors may at times be quite complex and require a sophisticated
skill set to implement an effective treatment plan. The use of indirect or direct behav-
ioral consultation approaches may best be weighed against the severity of the behavior
and the complexity of the intervention. A direct behavioral consultation approach may
be most useful for addressing severe problem behaviors that involve complex inter-
ventions or that involve dangerous situations. Indirect consultation approaches may
be more suited for less severe behaviors that do not pose any risk of danger and that
involve intervention strategies that can be easily implemented by consultees. A consul-
tant needs to evaluate the referral and determine the approach to consultation that is
most appropriate for the situation.
Autism spectrum disorders are comprehensive conditions that exist across mul-
tiple environments. The behaviors characteristic of these disorders may be more or
less noticeable in some environments as compared to others, but the disorder is always
present. Therefore, appropriate supports should be available in all learning environ-
ments. The supports that are necessary may vary according to the individual and his/
her environment, as should the degree of consultation and collaboration that are nec-
essary to provide adequate supports. The most significant learning environments for
young children are school and home environments (Christenson & Conoley, 1992),
while for adults the focus may be on home and work.
When the range of a consultation approach focuses on only one setting (or sys-
tem), such as a school, it is considered to be a within-system approach to consultation.
For example, many times children diagnosed with ASD display similar difficulties both
at home and at school, but a consultant may only provide assistance in one of these
settings. There may be several potential reasons for this, such as contractual agree-
ments with a consultant, limitations of the job description of a consultant, consultant
liability issues, or parents who do not want a consultant to come to their home. When
a consultant offers services in multiple settings that are important to an individual with
an ASD, it is referred to as an across-systems consultation. Across-systems consultation
approaches include more than one environment such as school settings, home settings,
work settings, or other support settings. The appropriate range for consultation needs
to be determined according to the severity and range of the problem. If a problem

is only present in one setting and absent in all others, a within-systems consultation
approach may be sufficient. If a problem occurs in multiple settings, then an across-
systems approach to consultation may be more appropriate. Applied Vignette 8.1
considers the need for consultation and communication to be made available across
educational settings during transitions that occur for individuals diagnosed with ASD.
Problem Solving in Consultation

Regardless of the type or range of consultation, most of the activities in behavior con-
sultation follow a similar pattern. One of the most commonly used progressions of
activity sequences in behavioral consultation was initially developed by Bergan (1977)
and later expanded upon by Bergan and Kratochwill (1990). Their problem-solving
model within consultation generally consists of identifying and analyzing whatever

Making a “Work System” Work
Levi was a mostly nonverbal elementary student did not have further difficulties in the classroom
diagnosed with autism who was having signifi- and did not display any episodes of self-injury for
cant difficulties following directions in his class- the duration of the school year. Shortly after the
room. He was also displaying some episodes of next school year began, the consultant was con-
self-injury in the form of biting his hand and tacted and asked to provide another consultation
hitting himself in the face whenever his teacher for Levi who was displaying some self-injury and
attempted to get him to complete academic some severe difficulties in following directions
activities. A consultant was contacted who came with his new teacher at his new school. Once the
and observed Levi in his classroom and made consultant instructed the new teacher to reestab-
some recommendations to his teacher about lish the same procedures utilized the previous
establishing a work basket system. The system year by his former teacher, the problem behav-
involved having Levi take a number and match iors quickly subsided.
it to the same number affixed to a basket that
had an academic task inside that he could eas- Discussion Questions
ily and independently complete. The teacher was 1. How could collaboration have potentially
asked to implement the work system beginning avoided the reoccurrence of problems by
with only a few baskets of easy work and then Levi?
slowly increase the number of baskets Levi was
2. Who should have been involved in col-
required to complete before taking a break, and
laborating on Levi’s transition to a new
eventually increasing the difficulty of the tasks
school?
included in the baskets. This system proved to be
an effective means of directing Levi to complete 3. How could the consultant have helped to
some academic tasks, and the teacher slowly prevent these problems from reoccurring?
increased the difficulty and number of tasks 4. What type of consultation approach could
throughout the school year. Subsequently, Levi have been beneficial in this situation?
problems are considered most relevant and then devising a plan to address the prob-
lem that can be monitored and revised if necessary.
Figure 8.6 provides a general outline of some phases that might be important
when conducting a consultation for an individual diagnosed with an ASD. These
phases represent the overall process that a consultation could follow in order to pro-
mote the development of a long-term establishment of behavioral supports. Each of
these phases will now be described.
Information gathering and sharing stage. The first stage in conducting a consul-

tation for a person with an ASD would include meeting with the individuals who are
highly involved in the life of the individual (known as stakeholders) and meeting with
the individual, as appropriate. This step can be called the information gathering and
sharing phase, and is detailed in Figure 8.7. This type of meeting can help with identi-
fying, categorizing, and defining the issues that are most problematic for the person,
as well as his/her areas of strength. The consultant needs to gain an understanding
of the goals that the stakeholders expect the individual diagnosed with an ASD to
achieve. It is then important for the consultant to break these goals down into reason-
able objectives that will allow the person to move successively toward the long-term
goals. These goals should consider baseline performance and should be reasonable
Figure 8.6 General guidelines for conducting a consultation for an individual diagnosed with
an ASD
Stages General Description Requirements
Information gathering and shar- This stage involves getting to Meetings with stakeholders
ing stage know the individual targeted for Interviews with stakeholders
intervention and the interests of
the relevant stakeholders.
Gaining insight stage This stage involves assessing Assessment Interviews

why the person with an ASD Rating Scales
might engage in a challenging
behavior and determining some Observations
potential interventions that might Acceptability Evaluations
be appropriate.
Training and monitoring stage This stage involves preparing Training scripts
those who will implement the Data collection tools
intervention and observing the
effectiveness of the intervention. Integrity checklists
Graphing tools
Supervision and decision- This stage of the consultation All data gathered
making stage process involves supervising Meetings with stakeholders
intervention implementation,
determining if progress is being
made, and making decisions
about modifications if needed.
Figure 8.7 Steps for information gathering and sharing phase
1. Meet with stakeholders.

2. Identify overall goals for person.
3. Ensure goals are appropriate.
4. Develop achievable objectives.
5. Describe consultant role.
6. Explain expectations for stakeholders.
7. Describe how the consultation might progress.
8. Determine length of consultation and arrange for reimbursement for services.
9. Determine how consultation services will be discontinued.
with respect to expectations of all those involved in the consultation. In addition,

the goals should be aligned with performance expectations within the environment.
For example, a child with an ASD might need to increase his/her time spent working
on independent tasks, but in addition, the extra time spent on a task should result in
a quality outcome based on his/her performance level. The consultant should also
check to be sure that the goals developed are such that they will promote the inclu-
siveness of the person diagnosed with an ASD and encompass his/her personal values.
In addition, the consultant should clarify their role, explain how they may expect the
stakeholders to be involved, describe to the stakeholders how the consultation might
progress, convey the length of time they intend to provide consultation, clarify how
the consultant will be reimbursed for the services provided, and explain how they plan
to discontinue the consultation services.
Gaining insight stage. This stage of the consultation process revolves around

determining why the person targeted for intervention may be engaging in the target
behaviors and speculating about potentially useful interventions. The steps included
in this stage are outlined in Figure 8.8. It is during this stage that the consultant may
initiate baseline data collection and begin to assess how the challenging behavior func-
tions on the environment by conducting structured interviews, administering rating
scales, reviewing records, completing functional analyses, and so forth. An assessment
of the conditions surrounding the client should focus on examining the variables in
place to support appropriate behavior. For example, a consultant might collect data on
how frequently a teacher praises appropriate behavior, how often a student is provided
individualized instruction, or how frequently opportunities are provided for a student
to practice a task. This type of data can lead to strategies designed to restructure the
environment in a manner that increases opportunities to obtain reinforcement for
appropriate behavior. In many cases, the most appropriate assessment approach would
incorporate both analysis of client skills and the surrounding environment.
Figure 8.8 Steps for gaining insight stage
1. Conducting environmental assessments

2. Conducting functional assessment of challenging behavior
a) Structured interview
b) Rating scales
c) Record reviews
d) ABC observations
e) Functional analyses
3. Design appropriate intervention
4. Assess acceptability of potential interventions
a) Interviews with stakeholders
b) Questionnaires
Assessment procedures should inform the development of intervention strategies.

Indirect behavioral consultation procedures may involve interviews, rating scales, or
naturalistic observations, while direct behavioral consultation approaches might include
assessment procedures that involve more interaction with the client, such as analog
structural analysis (Stichter, Sasso, Jolivette, & Carr, 2004) or functional analysis proce-
dures (Iwata, Dorsey, Slifer, Bauman, & Richman, 1994). All of these types of assessment
procedures have been discussed extensively elsewhere and will not be described in detail
here (see Chitiyo, 2005, for a more detailed discussion of these types of procedures).
In addition to assessing the function of a challenging behavior, the consultant
needs to begin to determine the potential acceptability of potential interventions
among the various stakeholders. For example, a consultant may design an intervention
that is highly detailed and requires a considerable amount of time to implement, but
when the intervention is provided to a teacher to implement there could be consider-
able resistance because of the complexity or time issues. The consultant could contin-
ually discuss components of potential interventions with stakeholders and/or possibly
design a questionnaire that gathers input about the types of interventions that would
be more or less acceptable among the stakeholders. Regardless of the method chosen,
the intervention needs to address the hypothesis function of the behavior, offer suit-
able replacement behaviors, be potentially effective from an evidence-based practices
standpoint, be comprehensive enough to meet behavioral objectives and approximate
overall goals, and be acceptable to the stakeholders.
Training and monitoring stage. The third stage of consultation is that those who
will be implementing the intervention receive training on the intervention and the
implementation of the intervention begins. The steps involved in this stage are out-
lined in Figure 8.9. The consultant needs to offer those implementing the intervention
an opportunity to practice the intervention and achieve a level of competency prior to
initiating the intervention with the individual diagnosed with an ASD. The consultant
may model how the intervention should be implemented in simulated trainings or

with the person actually targeted for intervention. The extent of training will vary
depending on the complexity of the intervention and the previous experiences of those
implementing the intervention. The consultant may need to develop training scripts
to ensure that everyone is trained consistently on the intervention. In addition, a data
collection system should be developed and everyone should receive training on how to
collect data appropriately. In order to ensure that the intervention is implemented as it
is written, treatment integrity checklists should be developed and used to monitor the
integrity of the intervention as it is implemented by different instructors and across
different settings. A method for graphing the data collected should also be devised in
order to visually evaluate the changes in data from baseline to intervention.
Supervision and decision-making stage. The final stage of a consultation may

involve supervising the implementation of an intervention, determining the progress
that is being made, and making decisions about any modifications that might be neces-
sary. Figure 8.10 outlines the general steps for this stage of consultation. A consultant
in this stage has trained others to implement an intervention and now must provide
them with supervisory feedback on their performance. Treatment integrity checklists
can be useful to refer to when offering performance feedback to those implementing
Figure 8.9 Steps in the training and monitoring stage of consultation
1. Training those who will be implementing the intervention

a) Modeling
b) Developing training scripts
c) Competency training
2. Develop data collection sheets
3. Develop treatment integrity monitoring tools
4. Design a method for graphing data
Figure 8.10 Steps for the supervision and decision-making stage of consultation
1. Supervise intervention implementation

a) Evaluate treatment integrity checklists
b) Observe others implementing intervention
c) Provide performance feedback to those implementing the intervention
2. Evaluate data collected
a) Review graphed data
b) Determine trends in data
c) Determine if behavior change is adequate to meet objectives
3. Determine if intervention modifications are needed
4. Meet with stakeholders as needed
5. Determine when to discontinue consultation services
an intervention. In some cases, retraining may be necessary to ensure that an interven-

tion is implemented with integrity. High treatment integrity is necessary to ensure
that when the data are examined that the intervention is truly responsible for any
changes in the behavior. Without high levels of treatment integrity, any changes in
behavior observed or lack of change in behavior observed cannot be attributed to the
intervention with any degree of certainty. Once an acceptable level of treatment integ-
rity is established, the data can be monitored to determine whether a change in behav-
ior is occurring, the change is occurring quickly enough, and the behavior change is
occurring in the direction (increase or decrease) that was expected. If the behavior
change is not as expected, the consultant must make a decision about any modifica-
tions that may be necessary. In addition, the consultant must consider whether the
intervention will require expanding to encompass other settings and if generaliza-
tion of the behavior change is occurring as it should. The decisions made during this
phase should be based on data that are collected and should also include other, more
informal evaluation measures, such as asking other stakeholders in the consultation
for feedback about the results of the intervention. Each of these factors should be a
resource for determining whether the overall goals of the consultation have been met,
whether interventions need to be expanded, or whether adjustments are needed to
enhance the strategies developed. It may be necessary for the consultant to again meet
with the relevant stakeholders and discuss the progress being made, any modifications
that may be necessary, and/or the potential for discontinuing the consultation services,
if deemed appropriate.
Team-Based Services and Supports for

Individuals with Asd and Their Families
There are several different ways to establish collaborative relationships and conduct
consultations. Professionals will develop their own unique style for ensuring that the
best relationships are developed and strategies are designed for addressing problems.
While there are many ways to achieve some of the same outcomes, there are some
characteristics and procedures that can be utilized to improve the effectiveness of
collaboration and consultation across multiple learning environments for individuals
diagnosed with ASD.
Team-Based Consultation and Collaboration

Wheeler and Redinius (1994) and Wheeler and Hoover (1997) described a team-
based model for providing consultation and promoting collaboration among educa-
tors. Their model focused on the use of a consultant to develop school-based teams
that could learn new skills to address problem behaviors displayed by students with
disabilities. The model consisted of six components that transferred the skills of a
behavior consultant to a team of educators who generalized the skills to novel behav-
ior problems. See Figure 8.11 for some characteristics of team-based consultation.
Figure 8.11 Some characteristics of team-based consultation
1. Team conjointly identifies and operationally defines behavior to be targeted for intervention
2. Team determines who will be responsible for each step of the consultation
3. Team determines any overall group deficiencies and plans to remediate any deficiencies
through training
4. Responsible team members conduct assessments, collect baseline data, and identify
some potential interventions
5. Team reviews assessment data and determines the most appropriate intervention
6. Responsible team members implement the intervention
7. Team reviews intervention data and makes decisions about intervention effectiveness
and determines next steps
8. Team focuses on a different individual in need of behavior intervention and repeats
steps 1 through 7 with minimal or no assistance from outside consultant
9. Team functions completely independently and trains other similar teams
Team-based consultation component one. Component one focused on identifying

problem behaviors and developing clear objectives that could be measured and agreed
upon by team members. The problem behaviors need to be operationally defined so that
everyone involved in the consultation process can easily recognize the behaviors targeted
for intervention. In addition, the goals and objectives of the consultation should be estab-
lished in a manner that is achievable within a reasonable period of time and that all team
members would consider to be a reasonable improvement over their current concerns.
Team-based consultation component two. The second component involved clarify-

ing the roles of team members and agreeing upon how each team role would function
within the development of an intervention. The team that Wheeler and Redinius (1994)
suggested would be comprised not only of teachers dealing directly with a student dis-
playing problem behavior, but also of professionals from other backgrounds and with
other specialized training. These professionals might include school counselors, school
psychologists, principals, and related service personnel. The parent of the child who is
the focus of the consultation is also considered a valuable member of the team. Each of
these team members clarifies how and to what degree they will be involved in the con-
sultation process. Some members would take on more active roles, such as conducting
specific behavior assessments and implementing interventions, while others would only
be providing input and making recommendations about how to individualize interven-
tions to meet the specific needs of a student. The roles of team members are written
out and provided to all members of the team so that everyone involved knows who is
responsible for specific components of an intervention, and so they can hold each other
accountable for completing their assigned responsibilities.
Team-based consultation component three. The third component of the team-

based consultation model is to identify what competencies each team member needs
in order to complete his/her assigned function on the team. Some team members
might be highly competent in developing and implementing behavior interventions,

while others may need a great deal of information to allow them to feel competent in
the process. Some team members may have a great number of questions about work-
ing with the behavior problems of a specific child, and especially about how to effec-
tively teach a child diagnosed with an ASD. The level of competency of team members
could be assessed by conducting an interview and asking them about their knowledge
of and experiences with specific assessment and intervention strategies. Other meth-
ods might involve asking team members to write down the information that they think
they would like to know more about or having team members complete a brief assess-
ment on their knowledge of specific intervention strategies.
Team-based consultation component four. The fourth component of the team-

based consultation model offers team members training on general knowledge of
behavior interventions and on specific competencies that will be needed to fulfill their
roles on the team. This might be accomplished through a general in-service training
that could be attended by team members and others from the school. Most likely, the
team will need some individualized training sessions that include several opportuni-
ties to practice certain applied skills necessary to complete a behavior assessment or
to become competent at implementing a specific behavior intervention. This type of
small-group team training may be the best option for establishing a highly skilled,
school-based team that will eventually be expected to function independently of an
outside consultant. In addition, Wheeler and Redinius (1994) recommended that team
members be provided with training on how to work together efficiently as a team
by using effective communication skills, conflict resolution strategies, and expertise
among individual team members. All of these strategies were deemed necessary to
ensure a commitment to the school-based team and allow the team to function in a
highly efficient manner while becoming a role model for other school-based teams.
Team-based consultation component five. The fifth component of the team-based

consultation model requires team members to begin planning for how the behavior
program will be developed and implemented for a specific child. This involves devel-
oping timelines for completing specific activities, determining methods to evaluate
the intervention, and scheduling specific meeting times to discuss team progress. The
interventions that the team develops need to include methods for monitoring not only
the progress attained by the student, but also the integrity of the implementation of
the strategies developed. In addition, the team should consider methods for evaluating
the strengths and weaknesses of the team so that the team can improve and function
more independently in the future.
Team-based consultation component six. The sixth component involves the pro-

vision of ongoing follow-along support to team members by the consultant and from
others on the team. This follow-along process is deemed necessary to offer support
to the team when new situations with other children needed to be addressed and the
team has not achieved a level of competency to generalize their acquired skills to
these novel situations. In many cases the educators are capable of generalizing the
skills and using the combined skills of the team to address novel situations, but the
consultant still needs to be available if necessary, to offer suggestions and encourage-
ment. The ultimate goal of this type of team-based consultation approach is that the
school-based team would function independently to address multiple behavior prob-
lems effectively within a school and become responsible for training additional teams
within the school district. This would eventually remove the outside consultant from
the consultation process, and the school-based teams would become internal consul-
tants to provide assistance to other teams or individual educators.
Wheeler and Redinius (1994) indicated that consultation is a time-limited process
and that the formation of school-based teams is an essential component for assisting
schools to become more independent and less reliant over time on outside consultants
who may have varying approaches to consultation. The utilization of various outside
consultants with different educational training, background experiences, and methods
for conducting consultations can cause educators to become confused over time about
the steps for addressing problem behaviors. Through the development of a school-
based team with highly specialized skills in behavior management, and especially skills
for working with students diagnosed with an ASD, the team can remain consistent in
their practices and can support each other to address the needs of other students with
similar concerns. These teams can confront issues with treatment integrity and trouble-
shoot problems with behavior plans as they arise. By being a part of the entire behavior
assessment and development process, the team can develop some highly refined skills
and be capable of passing these skills along to other teams.
The team-based model of consultation appears to have a great deal to offer
across learning environments for individuals diagnosed with an ASD. But for a team
to function as a role model for other teams, individual members need to be capable
of functioning together as a group, which involves sharing responsibilities, communi-
cating effectively with each other, and respecting the input of others. Collaboration
is interwoven among most aspects of team-based consultation, and factors that can
enhance the effectiveness of collaboration are therefore of vital importance.
Components of Effective Collaboration and

Consultation Across Learning Environments
There are several factors that contribute to the effective application of consulta-
tion and collaboration across different learning environments. Learning environ-
ments for individuals diagnosed with ASD may vary considerably and are not just
limited to school settings. Learning environments for students diagnosed with ASD
may include regular education classrooms; special education classrooms; classrooms
for delivery of related services, such as speech or occupational therapy; cafeterias;
school buses; after-school extracurricular activity settings; and home settings. As
these individuals transition out of school, these learning environments may continu-
ally expand to include work settings, recreational settings, independent living set-
tings, and community settings (e.g., public transportation, retail/grocery stores, post
offices, medical offices), among others. Each of these settings could be considered
a different learning environment and may require some form of consultation and
collaboration among those who are attempting to provide support for the individual
diagnosed with an ASD.
Environmental Factors Influencing Collaboration

and Consultation
Some factors influencing the success of consultation and collaboration can be attributed
to the characteristics of the environment in which the consultation or collaboration is
taking place. For example, consultation and collaboration that takes place in a school
setting may be easier to accomplish than consultation and collaboration that takes place
in a dentist’s office, because the dentist’s office may have limited space for conducting
meetings, and these meetings could interfere with normal business operations. In addi-
tion, a dentist’s office setting may not provide as much flexibility in gathering several
employees together for a meeting because of limited staffing and very tight sched-
ules. School personnel are generally more familiar with attempts to develop specific
intervention protocols to support individuals with special needs, such as those often
displayed by individuals diagnosed with an ASD. The personnel in a dentist’s office are
generally familiar with some types of individualized protocols necessary to minimize
anxiety among patients, but these protocols are typically less extensive than the type of
intervention protocols necessary to support individuals diagnosed with an ASD.
Other, similar, associated factors may include the distance that a consultant has
to travel to provide an onsite visit, the availability of time that a consultant and others
involved can dedicate toward supporting the consultation and collaboration, and the
skills of the consultant. In addition, those receiving consultation services may in some
cases be skeptical or resistant to working with someone who may be considered to be
only a temporary employee of an agency. Consultees may have experienced previous
consultation and collaboration efforts that were unsuccessful or that were quickly for-
gotten once the consultant’s contract was terminated. These types of experiences can
lead some consultees to avoid full participation in the steps outlined in a consultation
or collaboration effort.
Bock, Michalak, and Brownlee (2011) indicated that two of the most cited barri-
ers to effective collaboration in school settings included insufficient time in the daily
schedule for meetings and a lack of teacher preparation. They suggested that col-
laboration should occur at least weekly and in a face-to-face manner. In addition, they
indicated that most teachers do not receive training in collaboration and that general
educators are typically only exposed to one course that focuses on characteristics of
disabilities. They emphasized that this type of training often does not provide pro-
spective teachers with the necessary skills to function as highly proficient collabo-
rators. All of these environmental variables and background experiences combine to
contribute toward the overall effectiveness of a consultation or collaboration.
Effective Collaboration Practices

While many environmental factors are difficult to control, there are several com-
ponents of consultation and collaboration that can enhance the potential success
of associated outcomes. Collaboration is considered an important component of
consultation, and there are some clear ways to enhance the success of collaborative
endeavors. Bock et al. (2011) described six steps to consider when developing collab-
orative teams related to minimizing jargon, developing committed relationships from
all who were involved, and providing adequate training. Figure 8.12 outlines some
additional components of collaboration that can lead to successful outcomes.
Recognizing Strengths and Needs of Team Members

Clarifying the strengths and identifying the needs of the members involved in a col-
laborative effort is an important component of successful collaboration. Members in
collaboration come to the table with different experiences, concerns, skills, and needs.
In order for collaboration to be successful, the members involved need to be open and
honest about what they feel competent with and where they feel support is needed.
By doing this, arrangements can be made to remediate any existing deficits and utilize
apparent strengths. For example, a group that is meeting to address the communi-
cation problems experienced by a young child diagnosed with an ASD may clearly
identify that the child needs some form of alternative communication but may not be
familiar with what options are available. If a member of the group has some special-
ized knowledge of alternative communication devices, it would be beneficial for the
other members of the group to be aware of this and defer to this person for recom-
mendations on the options that may be available. Once the strengths of individual
group members are understood, the assignment of specific roles to members may be
more easily accomplished.
Allocating Responsibilities to Team Members

Assigning roles to members of a collaborative group should take into consideration
the relative strengths and needs of each of the members. It may be very difficult for
a group member to be assigned a responsibility with which he/she has no previous
experience or that he/she does not clearly understand. Utilizing the strengths of mem-
bers of a collaborative group and making accommodations to address group member
needs can lead to more effective collaboration efforts just as it can when developing
Figure 8.12 Components of successful collaboration
■ Clarifying the needs of everyone involved

■ Identifying the strengths of those involved
■ Allocating responsibilities to collaborative members
■ Utilizing effective interpersonal communication skills
■ Administrative support
• Provision of time and place for meetings
• Allowances for professional development and other resources
• Promotion of culture change
• Backing to address resistance
interventions for individuals diagnosed with ASD. Bock et al. (2011) recommend the
use of a “consultative coach” for enhancing collaboration and consultation. The con-
sultative coach serves as a facilitator for promoting collaboration among the group’s
members by utilizing active listening skills that promote an environment in which
teaching and learning can take place.
Interpersonal Communication Skills

Utilizing effective interpersonal communication skills is highly important for effective
collaboration to occur (Kratochwill et al., 1990). Collaboration involves developing a
relationship with other people in a manner that is productive, and interpersonal com-
munication can quickly enhance or diminish relationships. Punyanunt-Carter (2010)
outlined some characteristics of beneficial interpersonal communication that are fre-
quently displayed by highly competent communicators. These characteristics involved
having a generally well-developed repertoire of communication skills that could be
quickly adapted to various situations, and also included the ability to get others excited
about a topic and the ability to present information at multiple levels of complexity.
In other words, the same information might be first presented in a very general man-
ner using very simplistic terms or analogies. Then, the same information could be
represented focusing on very specific details and using more complex language. These
types of communication competencies may not come naturally but can be learned by
observing others and practicing good techniques.
Administrative Support
Administrative support is another important component for promoting effective
collaboration. This type of support can include basic provisions, such as arranging
schedules so that there is sufficient time to meet and ensuring that groups have a defi-
nite place to meet. In addition, administration can support effective collaboration by
arranging for professional development in collaborative practices to occur. This could
involve attending a conference or arranging for an expert to come and provide training
on collaborative practices. These types of professional training should occur together
in order to allow groups to bond as a unit and begin practicing specific skills that can
be utilized later. Providing a budget to cover the cost of training or other resources
may be another beneficial way that administration can offer support for collaboration.
One highly important component for ensuring effective collaboration that adminis-
tration needs to provide is the promotion of culture change, to incorporate collabora-
tive practices and backing to address resistance that may occur. Administration should
clearly point out that collaborative efforts will be valued. This type of administrative
clarity will help everyone involved move toward acceptance of collaborative practices.
Effective Consultation Practices

Collaboration is frequently an embedded component within consultation approaches.
The consultative coach described by Bock et al. (2011) can serve as facilitator for col-
laboration and for specific competency training to those involved in consultation. The
consultative coach is someone who demonstrates expertise in content area knowledge

and instructional practice so that they can model and demonstrate techniques for
other members in a collaborative group. Many consultants provide coaching and lead-
ership in collaboration during consultation practices. Figure 8.13 outlines four broad
categories of important skills that consultants should possess in order to be effective:
(1) strong facilitation skills, (2) organization skills, (3) assessment knowledge and skills,
and (4) intervention knowledge and skills.
Facilitation Skills
In order for a collaborative consultation approach to be effective, consultants need
to demonstrate a vast array of facilitation skills. These skills need to allow a consul-
tant, when necessary, to function as a leader, a group member, a teacher, a listener, a
mediator, and in any number of other potential roles. Strong facilitation skills involve
Figure 8.13 Consultant skill areas for effective consultation
■ Strong facilitation skills

• Interpersonal communication skills
• Understanding specific goals of consultee
■ Organization skills
• Ability to arrange for meetings
• Ability to regulate a meeting (make sure what needs to be covered is covered)
• Ability to assign and track responsibilities of others
• Ability to systematize information from multiple sources
• Ability to categorize behaviors according to severity
■ Assessment knowledge
• Knowledge of functional assessment
• Selecting appropriate methods
Interviews
Rating scales
Direct observation
Analog sessions (structural and functional)
• Conducting assessment
• Interpreting assessment
• Conveying assessment information
■ Intervention knowledge
• Knowledge of various interventions
• Matching intervention to function of problem behavior
• Data collection systems
• Knowledge of generalization and maintenance procedures
• Knowledge of treatment acceptability
• Knowledge of treatment intrusiveness
• Monitoring effectiveness of intervention
• Ability to troubleshoot problematic issues
effectively utilizing some basic communication skills such as active listening, appro-
priate body language, and clear verbalization (Fulk, 2011). Facilitators know how to
listen to others for understanding and utilize clearly spoken clarifying summaries to
ensure that others are understood accurately. They also recognize other people’s body
language to detect openness and resistance to ideas and proposals. In addition, being
a strong facilitator often requires knowledge of and use of problem-solving models, as
well as an ability to negotiate to resolve conflicts.
Organization Skills
Effective consultants need to be highly efficient at organizing and tracking informa-
tion. They need be competent at arranging meeting times that are suitable for most
everyone involved and developing agendas that cover necessary information in an effi-
cient manner. They need to be able to assign responsibilities to those who are compe-
tent and develop a system of accountability to ensure that members accomplish their
assignments. Consultants have to be able to take information from a variety of sources
and systematize the information in a manner that is understandable and that recog-
nizes both conflicting and corresponding information. Consultants need to have the
ability to discriminate between more or less important goals for a team. Sometimes a
consultant can be faced with a barrage of potential goals to accomplish, behaviors to
address, or directives to follow. The consultant must be skilled at finding methods for
arranging these goals, behaviors, and so forth into categories of what is most to least
important to address. Sometimes by addressing the most severe problems first, other
less important issues can resolve independently, and the consultant can spend more
time focusing on those issues that are most relevant.
Assessment Knowledge
Consultants need to have a thorough understanding of how to develop a functional
assessment. They should be proficient at selecting the most appropriate methods for
gathering the most relevant information about a behavior in a timely manner for indi-
viduals of different ages and with different diagnoses. This requires that they have
expert knowledge of the different diagnoses, characteristics, prognoses, and other fac-
tors associated with ASD. They should be knowledgeable of and skilled at using several
different types of interviews, rating scales, and methods of observation. When neces-
sary, they should be capable of developing protocols for conducting analog assessment
conditions to examine both the structural and functional variables associated with a
specific behavior.
Consultants should be capable of not only implementing the entire assessment
process themselves, but also of providing competency training to others so that they
may carry out these assessment techniques. Conducting assessments, interpreting
assessment data, and conveying assessment information are all skills that can be con-
veyed to consultees and allow them to function more independently. The collabora-
tive consultation model of Wheeler and Redinius (1994) emphasizes this training of
skills to teams of individuals in school settings who can then begin to function inde-
pendently and in an advisory role to other, similar teams.
Intervention Knowledge
In addition to assessment procedures, consultants need to be highly familiar with various
intervention techniques. They need to have a working knowledge of interventions that
have an evidence base that is supported in the research literature. Also, they need to be
familiar with the numerous alternative treatments, especially for individuals diagnosed
with ASD. These alternative treatments may be a frequent topic of discussion, since
some of them can be very popular and can offer some tremendous results. Consultants
need to be aware that incorporating techniques that do not have an evidence base sup-
porting their effectiveness can lead to delays in individuals diagnosed with ASD receiv-
ing effective treatments, and in some cases may lead to detrimental effects.
Consultants need the capacity to match intervention procedures to functional
assessment data. They need to develop and train replacement behaviors that provide
individuals with opportunities to obtain reinforcement in appropriate ways. Individuals
diagnosed with an ASD may display inappropriate behaviors to obtain reinforcement,
and they need to be taught to use more appropriate behaviors to obtain the same
reinforcement. Utilizing these types of functionally equivalent replacement behaviors
is important to keep newly taught appropriate behaviors from competing with pre-
viously displayed inappropriate behaviors for the same reinforcement. A consultant
should be able to design an effective intervention by minimizing the reinforcement a
person obtains for inappropriate behavior and maximizing the reinforcement a person
receives for engaging in appropriate behaviors.
Along with designing effective intervention programs, a consultant should be
knowledgeable and be able to offer support regarding a number of other areas that
are integrally associated with intervention development. A consultant should be aware
of several methods for collecting data on the effectiveness of interventions, and they
should be proficient at monitoring an intervention for effectiveness. These are all
basic skills that should be taught to consultees so that they can quickly observe the
influence that an intervention has once implemented.
Consultants should also be proficient at planning for the generalization and
maintenance of skills that are taught during an intervention. This type of planning
may require a great deal of input from consultees who have a thorough understanding
of novel environments that the person diagnosed with an ASD may encounter. There
also needs to be some planning for how to incorporate more naturally occurring rein-
forcement to encourage long-term maintenance of the skills.
Other aspects of intervention development that consultants should consider
include treatment acceptability and treatment intrusiveness. Treatment acceptabil-
ity has been defined by (Kazdin, 1980) as judgments of treatments made by actual or
potential consumers of the treatments, such as nonprofessionals, clients, laypersons,
and others. Consultants should be aware of both informal methods for examining
treatment acceptability and more formal instruments for this purpose. By identifying
which treatments are more acceptable to the consultee, the consultant may have more
potential approval from those who are asked to implement the treatment, and they may
be more willing to implement the treatment with integrity for longer periods of time.
Treatment intrusiveness is related to the concept of least-restrictive environ-
ment and has been described as the degree to which an intervention interferes with an
individual or the individual’s environment (Carter, Mayton, & Wheeler, 2009, 2011).
Consultants should be capable of identifying components of a treatment program that
interfere with an individual’s environment, and instruments have been developed for
evaluating treatment intrusiveness for individuals with severe disabilities (Carter et al.,
2009) and specifically for use in school settings (Carter et al., 2011).
Role Valorization in the Collaboration

and Consultation Process
Defining specific roles is a necessary component of consultation to ensure that all par-
ties involved are given an opportunity to provide input into the consultation process
as appropriate. Within a collaborative consultation approach, all parties are considered
to have valuable information that can assist in directing the formulation of interven-
tions. From an expert consultation approach, the consultant is considered the expert
who makes recommendations about the most appropriate intervention that should
be implemented. Dougherty (2009) described six common roles of a consultant that
included being an advocate of people’s rights, an expert in some area of knowledge, a
trainer/educator, a collaborator, a fact finder, and a process specialist to facilitate the
problem-solving process. Similarly, Kratochwill and Bergan (1990) clarified several
roles for consultants, consultees and clients. The roles they described for consultants
included thoroughly understanding the four stages of consultation and ensuring that
the consultee provides services that will benefit the client. Consultees were expected
to describe the problem, implement the intervention, and supervise others who may
work with a client, evaluating whether the intervention was satisfactory. The client
could participate in the design, implementation, and goal establishment when appro-
priate, as well as benefit from the intervention developed.
Watson and Robinson (1996) expanded on the role of the consultant in their
description of the direct behavioral consultation. They indicated that the consultant
would not only explain the intervention to the consultee as with an indirect consul-
tation approach, but should also model the intervention with the client and provide
performance feedback while the consultee implements the procedure with the client.
Wheeler and Redinius (1994) stressed the need for consultees to clarify their roles
as members of a school-based team. Team members were encouraged to determine how
they would participate in a behavior consultation and were held accountable by other
members of the team for completing their assignments. This model also encouraged
participation by parents as a part of a school-based team. The parents were only involved
in team activities that concerned their child but were provided training to improve their
knowledge and skills regarding behavior assessment and intervention.
Applications of Collaboration and Consultation

Across the Lifespan
Two of the most important environments for children diagnosed with ASD are school
and home. Children spend a large portion of their time in these environments, and
these therefore become some of the most important environments within which
consultation and collaboration take place. One model of consultation that encour-
ages connections between schools and families is called conjoint behavioral consulta-
tion, or CBC (Sheridan and Kratochwill, 2008). Sheridan and Kratochwill stated that
CBC helps professionals recognize that families and schools have a shared respon-
sibility in ensuring that children receive an effective education. They defined CBC
as “a strength-based, cross system problem-solving and decision-making model
wherein parents, teachers, and other caregivers or service providers work as partners
and share responsibility for promoting positive and consistent outcomes related to
a child’s academic, behavioral, and social-emotional development” (p. 25). CBC fol-
lows a typical four-stage problem-solving process that includes problem identification,
problem analysis, plan implementation, and plan evaluation, but emphasizes a collab-
orative effort among educators and family members within each of these stages. CBC
has been found to be effective as a consultation model for collaboratively working
with schools and homes (Guli, 2005; Kratochwill & Stoiber, 2002; Sheridan, Eagle,
Cowan, & Mickelson, 2001).
Wilkinson (2005) presented a case study describing the impact of CBC in a
mainstream classroom for a 9-year-old boy diagnosed with Asperger’s syndrome. The
student displayed off-task and noncompliant behaviors that interfered with his fourth-
grade mainstream classroom placement and hindered his academic achievement. The
process included four interviews lasting 45 to 60 minutes in length, with the entire
consultation process lasting six weeks. The treatment developed with a parent and a
teacher included a self-management procedure and a home/school note that allowed
for rewards to be obtained by the student at school and at home for attaining specified
criteria. The results indicated an increase in on-task behaviors and a reduction in non-
compliant behaviors. In addition, the CBC process was considered a highly acceptable
approach for addressing the problem behaviors. This study was limited due to the use
of a case study design, but it does demonstrate how CBC could be utilized for a child
diagnosed with an ASD.
While CBC may hold a great deal of promise for working with children
diagnosed with an ASD, it has not been demonstrated as an effective consultation
model for adults diagnosed with an ASD. Although most of the forms and inter-
views developed for CBC have been for school and home settings, many of the
components of CBC could be adapted for use with adults diagnosed with an ASD
in various settings. There does not appear to be a predominant model described
in the literature for conducting consultations with adults diagnosed with an ASD.
An option for offering consultation and collaboration to adults diagnosed
with an ASD may be the team-based consultation approach described by Wheeler
and Redinius (1994). Their model focuses more on team development for various
stakeholders. These teams could be developed to include most anyone who works
with an adult diagnosed with an ASD. This might include community members;
residential care providers; service personnel, such as various therapists, medical
providers, and direct service providers; or family members. The main variables
that need to be emphasized for collaboration and consultation with adults include
extensive knowledge of the regulations in place to support adults with disabilities
and knowledge of multiple service providers for adults with disabilities. The rules
and regulations in place to offer support to individuals with disabilities can vary
from those in place to support children. Adults are afforded more independence
and responsibilities than children, and for individuals with disabilities, these some-
times require a team of individuals to assist in helping adults with a disability to
make decisions that are beneficial to their life goals, promote safety, and contribute
toward a generally healthy lifestyle. Adults with disabilities may require assistance
in securing residential settings that are affordable and amenable to their lifestyles.
In addition, adults diagnosed with ASD may require direct assistance with their
daily activities, employment, health care, and finances. All of these areas may need
to be addressed during a consultation effort and may require collaborative efforts
from a wide range of individuals who may not typically be involved in school and
home settings.
Consider This
A consultant was contacted to provide some with attention by talking with him while he
recommendations toward reducing the inap- worked. The consultant then asked the support
propriate behavior of a student who attended a person to make some brief changes to his pro-
sheltered workshop. The student, who worked cedures for 10 continuous minutes, by having
on sorting and folding small towels, had recently the support person first stand near the student
started yelling, throwing items, turning over fur- and praise him for working hard. Then, the sup-
niture, and hitting other workers. The consul- port person was told to move away from the stu-
tant was provided with some basic background dent for approximately 30 seconds and quickly
information and then went to the workshop. At return near the student and praise him as soon
the workshop the consultant briefly interviewed as he began working. Then the support person
two support staff who worked with the student was asked to follow the same procedure but wait
and then began observing the student at work. one minute before returning near the student.
The consultant documented that the student This same procedure was replicated using a two-
worked rather diligently while his support per- minute wait time, a three-minute wait time, a
son was standing close to him, but whenever four-minute wait time, and a five-minute wait
the support person walked away he would stop time. During these replications the consultant
work and eventually begin throwing items, yell- collected data on the inappropriate behaviors
ing, and attempting to hit other employees. and did not observe any occurrences of the inap-
When the support staff returned he would be propriate behaviors. The consultant discussed
scolded for his inappropriate behavior and then the procedure with the support personnel, who
he would begin working again. The consultant agreed they could easily approach the student
saw this routine frequently repeated in a very and praise his work every five minutes. At that
brief period of time and quickly hypothesized point, the consultant asked them to implement
that the student was engaging in these inap- the procedure for the next few days and then
propriate behaviors in order to get the support report back on the frequency of the inappropri-
person to return near to him and provide him ate behaviors.

The Nebraska Center for Research on Children, Youth, Families and Schools (CYFS) is
a program located at the University of Nebraska under the directorship of Dr. Susan M.
Sheridan. The CYFS is involved in numerous grant-funded research activities that involve
expanding knowledge of consultation and collaboration practices. Their research focuses
on the following five themes: (1) early education, (2) academic interventions, (3) social-
emotional development, (4) rural education, and (5) research and evaluation methods.
More information can be found on the CYFS website at http://cyfs.unl.edu/index.shtml.
Summary
This chapter has focused on the need for collaboration and consultation when working
with individuals diagnosed with an ASD. The potential members of a collaborative team
were discussed and a description was given of both formal and informal collaborations.
Consultation was discussed as involving working directly or indirectly with individuals
diagnosed with an ASD and occurring within or across systems. A general model for
providing a behavior support–focused consultation was provided and other models were
described. In addition, the roles and characteristics of effective consultants were discussed.
A c t ivi t i e s t o E x t e n d Y o u r L e a r n i n g
1. Search for the websites of educational or behavioral consultants. List the types of ser-
vices that they offer and the costs for their services. Categorize the types of services
that they provide into direct, indirect, within-system, and across-system approaches
using Figure 8.4.
2. Interview a school psychologist or other educational/behavioral consultant. Ask him/her
about how frequently he/she provides consultations, the typical length of consultations,
the types of referrals typically received, the difficulties encountered during consultations,
the typical caseload, the type of consultation approach typically provided (direct, indirect,
within systems, across systems), the types of ongoing assistance offered, and what the
most important components of a successful consultation are considered to be.
Websites
Center for Effective Collaboration and National Association of School Psychologists
Practice document on culturally competent consultation
http://cecp.air.org practices
www.nasponline.org/resources/culturalcom
petence
The National Center on Dispute Resolution in The University of Florida digital video archive
Special Education provides commentary from parents and profes-
www.directionservice.org/cadre sionals about their experiences with consultation
and collaboration
http://education.ufl.edu/families-professionals
Books
Dettmer, P., Thurston, L. P., & Dyck, N. J. (2005). Consultation, collaboration, and teamwork for students
with special needs. Boston: Allyn and Bacon.
Dougherty, A. M. (2009). Psychological consultation and collaboration in school and community set-
tings. Belmont, CA: Brooks/Cole.
Simpson, C. G., & Bakken, J. P. (2011) Collaboration: A multidisciplinary approach to educating students with
disabilities. Waco, TX: Prufrock Press.
9
chapter
Facilitating Academic
Skills

■ Describe how the diverse learning characteristics of students with ASD interact with instructional
contexts to influence academic achievement.
■ Better approach the task of teaching skills that are prerequisite to academic learning.
■ Summarize techniques for addressing primary areas of challenging behavior that can occur within
learning contexts.
■ Plan ways to increase student motivation, compliance, and engagement in regard to the completion of
academic tasks.
240
c h ap t e r n i n e / Facilitating Academic Skills 241
■ Move closer to comprehending and assimilating the challenges inherent to teaching major academic
content areas to students with ASD, as well as some of the research-based approaches for doing so.
Chapter 9 Mind Map

Intellectual Ability
Attention & Processing

A Population with Diverse Learning Characteristics
Academic Achievement
Self-Regulation
Instructional Contexts
Working Independently Skills Prerequisite to Academic Learning
Stereotypy
Expected Social Behavior
Facilitating Academic Skills Addressing Significant Challenges & Needs Within Learning Contexts Visual Learning Needs
Motivation
Challenging Behavior
Compliance Increasing Motivation, Compliance, & Engagement
Reading Instruction
Engagement
Teaching Mathematics
Selected Academic Methods
Science Instruction
Applied Behavior Analysis for Academic Instruction
There has been considerable debate among researchers over the needed propor-
tional mix and primary emphasis of teaching both functional skills and academic skills
within the educational programs of students with ASD. Some (e.g., Ayres, Lowrey,
Douglas, & Sievers, 2011) argue that essential curricula will inherently assist students
in attaining important life skills such as self-care, successful employment, and active
community participation (functional curricula), and that such teaching and interven-
tion should therefore be primary within individualized programs of education. Others
(e.g., Courtade, Spooner, Browder, & Jimenez, 2012) argue that functional skills are
not a prerequisite to academic skills, that an individualized curriculum alone (i.e., one
without standards-based academic components) is unnecessarily and inappropriately
limited, and that such teaching and intervention should therefore hold a prominent
place within the educational programs of students with ASD. Completely resolving
this debate may not be possible across all professionals, but a move toward appropriate
action seems to lie in two important areas of discussion: (1) the points of agreement
between these two arguments, and (2) using the learner and his/her family as the pri-
mary sources for determining critical areas of current need.
It is possible that finding agreement on the extremes of this debate can lead
toward a movement to the middle in order to also find a valid, reasonable application
of the resulting philosophy of practice. In one extreme example, imagine teaching
Shakespeare to a student who does not (a) initiate social contact, (b) use some form
of functional communication, or (c) use educational materials for purposes other than
repetitive activities that provide sensory stimulation. This extreme is one formed from
the idea that the needs defined by society are more valuable than the apparent critical
need of the individual (e.g., concentrating on the academic skills needed to be flu-
ent within society and ignoring the functional skills required for access to vital parts
of that society). From this example, it is obvious that some functional utility within
the student’s curriculum is essential for his/her progress, quality of life, and ultimate
ell-being. It is also obvious that, at some point, we must consider the well-being of
w
society to be made of the cumulative well-being of the individuals that it contains.
In an example from the other extreme, imagine using discrete trial teaching to
work on locating an open position of employment and interviewing for a job (one that
requires a certain proficiency level of reading and mathematics skills) with a student
who has (a) an above average IQ, (b) a demonstrated understanding of the expectations
for appropriate social interaction, and (c) advanced receptive and expressive language
skills. One idea within this extreme is that sacrificing part of one’s holistic health and
development now can, in the long term, produce greater gains than doing otherwise
(e.g., concentrating on the functional skills needed to obtain a job and ignoring the
academic skills ultimately needed to be successful within it). It is obvious from this
example that some academic content within the student’s curriculum is essential for
his/her overall progress, quality of life, and ultimate well-being. It is also obvious that,
at some point, we must consider the well-being of individuals to be impacted by how
well they can enter into and operate within society.
In the context of these extremes, it is likely that agreement can be found on the
point that we need both functional and academic curricula for students with ASD.
However, this does not answer the question of emphasis, or how to provide for the
needs of students through finding a proportional balance appropriate to the individual.
These questions are perhaps best addressed by using the learner and his/her family as
the primary sources for determining current critical areas of need, as opposed to the
sole use of external sources, such as sets of academic standards, which seem best for use
in the context of determining what to teach rather than how to teach. One important
idea here is that the pressing and h ighly-intensive needs of the individual (e.g., as pre-
sented by the severity of core autistic symptoms) can in some cases trump the longer
term goal of addressing societal norms. After all, how can we even begin to prepare the
learner to better approximate these norms if we do not begin at the point where he/she
is currently functioning? Another important idea is that in seeking what is most benefi-
cial for an individual in the longer term, pressing and pervasive societal expectations can
in some cases trump personal educational preferences (including those of researchers,
teachers, and students). After all, one main goal of instruction is to make learners more
self-determined and independent, not always reliant on the opinions and approaches
of others for determining the ultimate direction of their lives. In the overall context
of merging these two important ideas, neither emphasis should be totally absent from
a student’s program of instruction, though the strength of each may change according
to the current characteristics and needs of the learner. (See Figure 9.1 for a pictorial
representation of this idea.) It is with these foundational, philosophical approaches that
we begin our discussion of facilitating academic skills for learners with ASD.
A Population with Diverse Learning Characteristics

With the theoretically infinite number of learning characteristics that can emerge as
relevant to the design of an individual’s instructional program, and with the wide range
of diverse learning characteristics represented across learners with ASD, it is often
difficult to know where to begin in terms of instructional design. This section will focus
Figure 9.1 Weight of emphasis of functional versus academic skills, based on

individual-and family-defined needs and impact of core autistic symptoms
Severity of core autistic symptoms Overall functional ability exceeds

impacts overall functioning to severity of core autistic symptoms
a larger degree to a larger degree
Academics Functional
Skills
Functional Academics
Skills
Individual- and Individual- and
Family-Defined Family-Defined
Needs Needs
Academics are taught in the Functional skills are taught in the

context of functional skills context of academics
on three areas of development that can have a significant impact on learning, particularly
the learning of academic skills: intellectual ability, attention, and processing. Along with
the discussion of learner characteristics is content on academic achievement and instruc-
tional contexts (or, contrived situations in which teaching and learning are intended to
take place). These last two topics may at first seem out of place within a section on student
learning characteristics, but it is a premise here that (a) learner characteristics cannot be
effectively addressed without also considering the environmental variables and demands
that can be responsible for the application of labels such as “functional” or “challenging,”
and (b) the combination of student characteristics and environmental variables tends to
mediate the shape of important outcomes (e.g., academic achievement). In providing an
overall framework for your reading, it may be useful to think of the interconnections
among these areas in terms of the information presented in Figure 9.2.
Intellectual Ability
Persons with ASD vary in terms of their intellectual functioning, as approximately 70
to 75% of persons with ASD also have an intellectual disability. Although individuals
on the autism spectrum represent a heterogeneous population, some developmental
characteristics are consistent across individuals but vary in terms of their intensity.
A diagnosis of ASD is most often accompanied by associated symptoms, including psy-
chiatric disturbances and challenging behaviors (Estes, Dawson, Sterlin, & Munson,
2007). The effect of these associated symptoms varies across individuals on the spec-
trum, but it can remain problematic for individuals to manage. For example, Estes
et al. (2007) reported that lower intellectual functioning on the part of individuals
Figure 9.2 Individual academic achievement as influenced by diverse learning

characteristics manifested within a specific instructional context
Instructional
Context
Diverse
Learning
Characteristics
Academic
Achievement
Note: One may nest all of these factors within an additional major area of influence labeled “Learning
Environment.” For example, environmental variables such as the presence or absence of needed structure and
predictability will directly impact and influence the shape and efficacy of a specific instructional context, such
as the teaching techniques used within a lesson on identifying functional sight words. In turn, an individual’s
differing characteristics and needs will interact with the instructional context to produce some individualized
outcome related to, in this case, academic achievement. The goal in applying this type of model is to “reverse
engineer” learning environments, individualized programs, and supports, starting with the characteristics and
needs of the learner and radiating outward to the design of (a) effective instructional contexts, (b) functional
learning environments, and (c) academic goals and objectives appropriate to the learner.
with ASD may result in more externalized symptoms, or observable behaviors con-
sistent with the diagnosis (e.g., stereotypical behaviors such as rocking or severe and
challenging forms of behavior, such as self-injury). Individuals with ASD who are
higher functioning in terms of intellectual ability may manifest more internalizing
behaviors, such as anxiety (Estes et al., 2007). Estes et al. also concluded from their
study that the children with higher intellectual functioning and ASD tended to pres-
ent higher scores for depression and anxiety by the age of 9 years, whereas children
with lower intellectual functioning and ASD tended to display hyperactivity, attention
problems, and greater levels of irritability by the age of 9. Some of the more impor-
tant information that can be gleaned from this study is the need to be aware of the
behavioral dimensions associated with the diagnosis of ASD. Most often we are called
to address the obvious, more externalized behaviors, such as aggression toward self or
others, though the less obvious behaviors (usually the internalized behaviors) can pose
significant barriers for learners with ASD within academic settings. Often the students
who bring little attention to self and who, for the most part, internalize their behaviors
will pose fewer challenges for a teacher in the classroom but in turn may be at risk for
academic and social challenges that interfere with their ability to learn, often resulting
in academic failure and social isolation. It is often not until the child has failed repeat-
edly that he/she finally garners attention to the unique challenges related to learning.
Some in the field argue that students who are diagnosed with ASD and who have high
IQs are at-risk for not being referred or assessed and that this, paired with any associ-
ated symptoms, could put these students at an even higher risk (Assouline, Nicpon, &
Dockery, 2012). The added risks that associated conditions such as psychiatric distur-
bances pose for learners with ASD are cause for concern and should be treated accord-
ingly by medical practitioners who specialize in these areas, as a means by which to
reduce further challenges for these learners and their families (Estes et al., 2007).
The role of intellectual functioning and ASD and its impact on academic achieve-
ment is an area currently in need of greater study. Students with ASD who are intel-
lectually gifted are often referred to as “twice exceptional.” Research on students with
ASD with high cognitive ability has demonstrated that these students experience prob-
lems with higher-order thinking, problem-solving skills, executive functioning, and
self-initiating theory of mind viewpoints (Nicpon, Allmon, Sieck, & Stinson, 2011).
Authors also state that because these students are intellectually gifted, the challenges
associated with the diagnosis of ASD leave them at risk for not being referred for ser-
vices in school, in some cases placing them at greater risk for experiencing academic
and social challenges. For many of those who are identified as gifted students with ASD,
a discrepancy between performance and potential will often exist, and students will
ultimately fail to reach their academic potentials (Nicpon et al., 2011). Many teachers
might confuse these difficulties with neglect or willful intent on the part of the student,
but a more useful approach is to consider them part of the diagnosis, a part that is an
indicator of unfulfilled need. Underperformance is often a problem experienced by
many children who are intellectually gifted and talented for a variety of reasons, includ-
ing things like lack of a curriculum designed to challenge their interests and abilities
and lack of access to enrichment programs, to name a few. As with any student, it is
crucial that we understand how each student learns, including learning strengths and
limitations, and that teachers begin teaching at the identified level of need and connect
with students using meaningful content that promotes engagement and subsequent
learning. Thus, difficulties may lie in obtaining an accurate picture of the student and
having an in-depth understanding of how he/she best learns.
Attention and Processing

A learner’s ability to attend to a stimulus or multiple stimuli is greatly influenced by her
ability to efficiently process incoming information. For learners with ASD, this kind
of information processing can be a difficult task. Learners with ASD have a predispo-
sition to being visual learners, due to their challenges in processing auditory stimuli
such as the verbal instructions from a teacher. Many have suggested that central audi-
tory processing difficulties among individuals within the population is one issue that
confounds the ability of students with ASD to effectively respond to verbal cues.
Undoubtedly, attending to relevant stimuli and processing incoming informa-
tion are areas with which these students experience great challenges. For teachers
and related learning specialists, it is important to have a better understanding of how
learners with ASD attend to incoming stimuli and decide on what is important, what
information is not pertinent, and how they will respond to external stimuli under a
variety of conditions in their daily lives (Marco, Hinkley, Hill, & Nagarjan, 2011).
These questions are most relevant given the rapid pace of our society and the e ver-
mounting demand to process incoming stimuli in an efficient manner, for these skills
appear to be crucial to success in most mainstream environments, yet remain a sig-
nificant challenge for learners with ASD. Marco et al. (2011) provide an illustration of
how these children can perform well in controlled environments but may rapidly fail
to compensate for stress generated in environments that present high levels of sensory
stimulation, such as restaurants and grocery stores, where there are many competing
stimuli that must be attended to or filtered/ignored. The ability of these children to
process incoming stimuli varies by individual, but it appears that many have a thresh-
old or capacity that, once breached, results in behavioral breakdown. Difficulties in
processing, paired with the lack of structure typical of life surroundings, can create a
formidable challenge for any person with ASD. Within academic settings these issues
can be minimized depending on several variables, including (a) how thoroughly the
student’s condition has been diagnosed and is understood by his/her educational team,
(b) the presence or absence of appropriate instructional modifications designed to
enhance student performance, and (c) the degree of structure in the life of the student
both within and outside of school. If learning and living environments are predictable
and structured, it will serve to enhance the child’s performance in school, providing
instructional adaptations are utilized. The seemingly a ge-old question remains: How
can we enhance the generalization of learning for students with ASD to untrained
and often disorganized natural environments? The need for structure and supports is
something that individuals with ASD will need throughout their lives to enhance their
abilities, but it is most important early on in the education of these children. Accurate
and reliable diagnosis, paired with programming designed to enhance skills such as
attending and processing, must be addressed early on and throughout the academic
preparation of these children. Refer to Applied Vignette 9.1 for an example of a stu-
dent with attention and processing difficulties.
Given these difficulties with processing and attending, it is useful to discuss
some ways through which classroom teachers and related professionals can enhance
the learning of students with ASD. The use of visual cues, such as pairing pictures to
written cues, will assist in attaining this goal, in that the student’s primary input mode
is being utilized. Graphic organizers are also helpful because they represent a visual
presentation of pertinent information and how it is integrated (e.g., how it represents
the big picture or main ideas). Gestural cues are also helpful to assist the student with
attending and processing. Although it may sound counterintuitive to language devel-
opment, one should minimize the amount of verbal prompting and instruction, as
well as the number of words used during each communication, when providing ver-
bal directives to students with ASD. Another important consideration is to recognize
that learners who are high on the autism spectrum respond favorably to factual con-
tent and information. Their abilities to recall facts can sometimes be quite astound-
ing, whereas processing tasks, such as communicating about feelings on a topic, are
significantly more challenging. Therefore, when presenting instructional tasks, it is

Jared
Jared (who has average intelligence, is 14 years paraprofessional used more visual cues, includ-
of age, is diagnosed with ASD, and is a recent ing graphic organizers and manual signs. Most
transfer to a new school) was demonstrating notable during this type of instruction was Jared’s
some challenging behavior in the classroom. His increased level of engagement. Not only did he
primary classroom was a self-contained resource maintain engagement during these times, but
classroom; he was placed there while he was he did so with zero occurrences of challenging
being assessed to determine a finalized, appropri- behavior. His academic performance was at or
ate placement within the new school. His teacher above satisfactory levels on work within the indi-
observed that Jared would have intermittent vidual and small-group contexts.
periods throughout the day in which he would
be out of his seat and disengaged from assigned Discussion Questions
tasks. She sought assistance in determining the 1. What role did Jared’s attention and pro-
function of these behaviors, as he recently had cessing abilities play in this scenario?
an episode of aggression toward another student.
2. Although Jared was increasingly at risk for
Jared’s difficulties with communication created
experiencing negative teacher attention for
an additional challenge. On a few occasions, a
his escalating levels of challenging behavior
consulting teacher observed during both class-
during large group instruction time, what
wide and individual instructional periods, and

is the case for the idea that the teacher was
she noted that during the class- wide instruc-
also contributing to the problem?
tion, Jared was often disengaged. The consulting
teacher noted the content during the class-wide 3. During large group instructional time,
instruction was mostly teacher presentation how could input and response modes be
with a lot of verbal instructions and very little altered for Jared, so that active participa-
interaction among teacher and students. Use of tion and response are increased and chal-
visual stimuli, such as graphic organizers or pic- lenging behavior is decreased?
tures, was also very limited during this type of 4. What type of systematic approach could
instruction. During individual or small-group be put into place to prevent similar sce-
instruction in academic subject areas, the con- narios from occurring with other new stu-
sulting teacher observed that the teacher or dents who have ASD?
important to play to students’ strengths by recognizing how the design of instruction,

the presentation of material, and the required modes of responding can enhance their
ability to attend to and process relevant information needed for learning.
Academic Achievement
Federal mandates require that schools be held accountable for student achievement
in the areas of math, language arts, and science. This law, paired with access to the
general curriculum for students with disabilities, makes it ever so important that the
area of academic achievement receive prominence as it relates to serving students with
ASD in general education settings.
As has been noted, students with ASD are a heterogeneous group, and this
diversity is witnessed among those students who are on the higher end of the autism
spectrum, formerly recognized as students diagnosed with high functioning autism
(HFA) or Asperger’s syndrome. It has been estimated that 52 to 70% of individu-
als with ASD have intellectual ability in the average to above average range (Estes,
Rivera, Bryan, Cali, & Dawson, 2011; S chaefer-Whitby & Mancil, 2009). In spite
of these estimates, the academic achievement and outcomes of individuals who are
higher functioning are not well documented or understood (Estes et al., 2011). In
fact, there are some students with ASD who have average or above average intel-
ligence and specific learning disabilities that can potentially impact their academic
performance, once again illustrating the degree of variability that can be found across
students with ASD.
The social and communication difficulties that children with ASD experience
can also serve, in some cases, to mask the academic difficulties or proclivities pos-
sessed by many students. Estes et al. (2011) cited social functioning as another factor
important to academic success. The authors explain that there is a strong correlation
between social functioning and academic achievement in students without cognitive
impairments, as children with more friends have been shown to be more engaged and
perform better in school than those students with fewer friendships. More study is
needed to gain a better understanding of the variables that influence academic perfor-
mance in students with ASD and their impact on post-school performance outcomes.
Some have argued that the reason we know so little about how students with ASD
learn core academic skills is because emphasis has traditionally been placed on the
development of functional curricula to serve these students (Kurth & Mastergeorge,
2012). This is an important area of inquiry because performance while in school does
tend to have an impact on p ost-school outcomes. Along these lines, S
chaefer-Whitby
and Mancil (2009) reported that 51% of students with ASD graduated with a standard
high school diploma; 17.6% intended on attending college, and 17.5% dropped out of
school. These data provide a limited perspective on the outcomes realized by students
with ASD upon exiting high school, and a greater understanding is therefore needed.
It is expected that with the increasing numbers of children being identified with ASD,
we will see a growth in the numbers of children being served in general education
settings. It is therefore vitally important that we gain a better understanding of the
academic potential of these students, as well as their thresholds for academic perfor-
mance, so that development of interventions aimed at maximizing both their potential
and performance can routinely take place.
Schaefer-Whitby and Mancil (2009) found that students with HFA and Asperger’s
experienced difficulties in the areas of comprehension, written expression, graphomo-
tor skills, complex processing, and problem solving across domains. The authors indi-
cated that these deficits most often appeared when learning objectives advanced from
concrete concepts toward greater degrees of abstraction, revealing possible deficits in
reading, writing, and math. Schaefer-Whitby and Mancil (2009) also surmised from
the literature that basic reading and decoding skills tend to be intact for these higher-
functioning students and that, during the early years, these students perform at or
above their same age peers in reading, until around age 8. As material becomes more
abstract and comprehension is stressed, a breakdown in academic performance tends

to begin, as the processing threshold is breached. The areas of written expression and
graphomotor skills have also been identified as areas of difficulty for these students.
It has been indicated that these areas of difficulty may be attributed to challenges
presented by lacking organizational skills, attention deficits, and motor coordination
deficits. In math, the same issues with organizational ability affect performance for
students with ASD, most especially in the case of multistep problem solving (Schaefer-
Whitby & Mancil, 2009).
These findings are most helpful in gaining a general perspective on the academic
achievement of higher functioning students. However, teachers should also consider
the implications from research that they need to be aware of in order to enhance the
academic performance of students with the disorder:
■ It is important to develop a learning profile for every student you teach. Several
sources of data can be helpful in identifying the student’s individual learning strengths
and areas in need of academic, social, and or behavioral support. Schaefer-Whitby
and Mancil (2009) provide some important points along these lines. First, understand
the whole child. This can be accomplished only through developing a relationship
with the student and his/her family, and in gaining an understanding of the student’s
strengths and areas of challenge. Schaefer-Whitby and Mancil contend that global
scores gleaned from testing will not identify student weaknesses, but item analysis on
subtest performances by the student will yield vitally important information about
the areas within which the student performs well and areas in which instructional
assistance is needed. This form of analysis will provide data needed for the design of
individualized interventions using evidence-based practices to enhance student per-
formance. Parents and families are another vital source of information in creating
such a profile, which can include such information as the following: (a) communica-
tion input methods that have been successful; (b) learner response methods that are
currently in his/her repertoire; (c) a description of events or activities that have been
known to trigger episodes of challenging behavior (known antecedents to challenging
behavior); (d) academic performance across major subject areas; (e) preferred activi-
ties, foods, and objects; (f ) level of guided assistance needed during practice of previ-
ous learning, ranging from full, to partial, to none; and (g) repetitive interests (that can
be incorporated into instructional contexts as motivating operations).
■ Next, it is most important to promote student task engagement, for student
engagement is strongly correlated with academic outcomes (Kurth & Mastergeorge,
2012). In achieving this goal, a strong association must be created for the student
between adequate academic performance and access to outcomes desired by the stu-
dent. Adults do this for themselves by (a) structuring work time to include necessary
breaks for completing routine tasks or engaging in physical activity, thus creating a
kind of behavioral momentum that can sustain longer periods of work; (b) using self-
reinforcement by purposely scheduling fun activities that will occur anyway so that
they follow periods of productivity; and (c) setting performance goals (as simple as a
to-do checklist and as complex as an instructional objective) and recording progress in
quantifiable ways, such as pages written (frequency), time spent on task (duration), or
number of problems solved per minute (rate).
■ Ongoing evaluation of student academic performance is also critical. One way
this can be achieved is through the use of student portfolios. This method provides a
running account of student performance through the collection of a series of student
artifacts. These artifacts gathered and evaluated over time will serve as a performance
feedback loop between the teacher and the student’s parents and provide a useful tool
for identifying areas within which the student may require additional teaching support.
Instructional Contexts
Specific questions pertaining to individual student learning and achievement and the role
that instructional contexts play in promoting learning in students with ASD are areas in
need of greater exploration. General education teachers are besieged with increasing
mandates to address within the classroom and are under greater external scrutiny to
realize achievement gains in learning across all children. This is a noble idea requir-
ing the provision of pervasive support to realize, but unfortunately, support is often the
missing ingredient at both the preservice and in-service levels. For instance, general
education teachers receive little training in how to teach children with disabilities within
the general education environment and typically are required to take a single special
education course during their preservice preparation, hopefully paired with experi-
ences while in practica or student teaching. The need exists for support through either
co-teaching with special educators or assistance from consultative teachers trained in
special education to provide assistance to students with ASD in the general education
setting. We should not limit the educational opportunities of any learner based on a
perceived lack of potential, merely because they are labeled as having an ASD and the
system is ill-prepared to accommodate associated needs. Rather, we need to identify how
to retrofit instruction to the learner instead of expecting the learner to fit in and “get it.”
Kurth and Mastergeorge (2010) studied educational programs for adolescents
with ASD who were of ages 12 to 16 years. They asked about the focus of IEP goals
for these students, and whether the goals and objectives varied by placement in an
inclusion classroom or noninclusive setting. Their findings revealed that (a) students
with ASD in elementary school had more goals than did students in middle school,
and (b) students with ASD in elementary school had more related services, such as
occupational therapy. In addition, middle school students were found to have greater
supports from behavior specialists and paraprofessionals. It was concluded that as stu-
dents with ASD grow older, the teams tended to have fewer expectations that students
would participate in the core academic curriculum. We know that as students enter
middle school the curricular expectations in terms of academic content increase dra-
matically. If students with ASD do not have either the requisite skills or appropriate
supports needed to make this transition, there will be performance deficits. In terms
of educational placement, Kurth and Mastergeorge (2010) found that there were cur-
ricular differences for students based on where they were educated. Students with
ASD who were in inclusive settings had a greater number of IEP goals aimed at higher
level academic skills, whereas students in noninclusive settings tended to have more
goals aimed at functional academic skill development.
In a subsequent study, Kurth and Mastergeorge (2012) described the instruc-
tional contexts and activities during the math and language arts instruction of 15 ado-
lescents with ASD and 30 peers within inclusive and s elf-contained settings. Within
the inclusive educational setting, the following elements were observed: (a) teacher-
directed instruction across the whole class was the primary format used for the major-
ity of time, followed in frequency by seatwork; (b) grade-level materials and adapted
materials were used; and (c) students with ASD were more passively engaged in these
settings. The findings were quite different for students with ASD served within non-
inclusion settings. Within these settings (a) teachers utilized individualized instruction
the majority of the time; (b) students worked individually with teachers or partnered
with other students; (c) students worked on more remedial activities versus core
academic content; and (d) many of the activities were activities in which no student
engagement was required.
To conclude, instructional context is most important for all children and youth.
It is important that classrooms be sensitive to the needs of individual learners and
promote meaningful engagement that results in positive learning outcomes for all stu-
dents. Aside from academic skills, it is also important that these settings be nurturing
and support the social and emotional development of students. It may be beneficial for
general education teachers who have students with ASD in their classrooms to develop
a learner profile, as previously discussed. The learner profile can help a teacher under-
stand a student’s learning strengths and nuances, identify areas in need of instructional
or social support, and modify instruction and adapt curricular materials to accom-
modate learning needs. Critical to the student’s academic success in the classroom is
maintaining an ongoing dialogue with parents to ensure everyone is aware of the stu-
dent’s performance and enhancing professional and family partnerships. Instructional
design around learner strengths can promote engagement and achievement outcomes,
minimize challenging behavior, and serve to prevent academic failure.
Skills Prerequisite to Academic Learning

Prerequisite academic skills should not be confused with p re-academic skills, or those
skills that serve as a foundation for shaping later academic performance. Skills that are
prerequisite to academic learning center more on one’s ability to successfully attend
to work prompts, engage in the task at hand with sufficient duration and intensity,
and produce an expected product of adequate quality, attain a measurable outcome or
goal, or demonstrate an observable skill. Learners with ASD may have initial difficulty
engaging in behaviors that are conducive to the study of academics, or to any type of
socially mediated learning in general. While there are many potential behaviors that
can be classified within the category of prerequisite need, there are three main types
of behavior that tend to set the stage for the acquisition of all others: self-regulation,
being able to work independently, and the ability to engage in the type of social behav-
ior required to operate within most learning contexts.
Self-Regulation
elf-regulation is the ability to regulate one’s emotional state across varying situations.
S
The ability to respond appropriately to a teacher’s directive, to handle disappoint-
ment, and to redirect one’s behavior when angry or frustrated all serve as examples
of self-regulation. Critical to self-regulation is the ability to (a) process the most rel-
evant aspects of the environment (e.g., within the setting or specific learning situa-
tion), (b) self-evaluate, and (c) select the appropriate response, given these contextual
variables. For children with ASD, these can be quite difficult. Individuals with ASD
may have a difficulty in the area of mind-blindness, or their ability to discern how
others feel in social situations. Such an individual is likely to have difficulty in terms
of his/her perception of a situation, and that can lead to difficulties in responding
appropriately. Self-regulation is an important component of effective performance
in all aspects of life, including academic performance (Shogren, Lang, Machalicek,
Rispoli, & O’Reilly, 2011). Neurodevelopmentally, persons with ASD often have
challenges with executive functioning (higher order abilities such as planning and
goal-directed behavior, which serve to regulate other abilities such as attention and
memory), resulting in difficulties with attention, organization, and goal completion.
In order to adequately address the needs indicated by these characteristics, profes-
sionals will need to provide (a) environmental or classroom supports, (b) instructional
supports, and (c) individual supports varying by degree and specific to the individual
strengths and needs of the learner. Although teachers will design and construct the
environmental and instructional supports that serve to elicit appropriate responses
from learners, students with ASD can and should be taught effective s elf-management
skills designed to assist with self-regulation.
Multiple examples in research have presented and discussed the merits of envi-
ronmental supports at the classroom and instructional levels for students with ASD.
We have discussed the importance of visual clarity as a learning modality when provid-
ing instruction to these students, as it serves to effectively communicate performance
expectations, aid in organization, and promote task engagement. Common examples of
how to promote s elf-regulation for these students in the general education classroom
are the use of classroom rules and classroom visual activity schedules. These meth-
ods can serve as reminders of classroom performance expectations, assist in sequencing
classroom activities and events, and aid in transition across activities within the class
period (Dorminy, Luscre, & Gast, 2009). It is true that a student’s need for structure,
predictability, and sameness can often lead to displays of challenging behavior when
things do not go as expected, but remember that these needs can also be strengths
when appropriate environmental modifications are made. For example, classroom rules
that incorporate graphical elements and defined consequences can be taught, practiced,
and reviewed, just like any other important school-based skill, and, once learned by
the student with ASD, will tend to fit nicely with the student’s expectations for same-
ness and discernible structure (see Figure 9.3). Remember that the structure has to
be discernible, or perceivable, by the student for it to be effective (e.g., the colors red
and green within a classroom rules document may initially mean nothing to a student
unless he/she is taught their significance); what makes sense to the teacher may not
necessarily incorporate the visual and conceptual components that are accessible to the
student. However, be aware that once the student learns the rules and practices compli-
ance, the situation may then shift from the need to help the student s elf-regulate by fol-
lowing the rules to the need to help the student (a) begin to comply with updated rules,
(b) refrain from becoming an amateur legalist in pointing out/reporting the infractions
of other students, or (c) interpret rules less literally when necessary.
Figure 9.3 Classroom rules with embedded visual cues and associated consequences for
appropriate and inappropriate behavior
CLASSROOM RULES WHAT HAPPENS WHEN. . .?

1. HAVE YOUR LEARNING
YOU FOLLOW THE RULE:
MATERIALS READY FOR THE
START OF CLASS. The green “ready to learn” stamp will be put on
your daily calendar in your homework folder, for
your parents to sign and return.
READY TO LEARN!
YOU DON’T FOLLOW THE RULE:
The note “no class materials” will be written in
red on your daily calendar in your homework
folder, for your parents to sign and return.
NO CLASS MATERIALS
2. RAISE YOUR HAND TO
ANSWER QUESTIONS. YOU FOLLOW THE RULE:
You will receive one checkmark on your Peace
Keeper form for the day.

You will receive one X on your Peace Keeper form
for the day. X
3. KEEP YOUR HANDS
AND FEET TO YOURSELF. YOU FOLLOW THE RULE:

for the day. X
4. TALK WITH OTHERS
ONLY DURING GREEN YOU FOLLOW THE RULE:
LIGHT ACTIVITIES. You will receive one checkmark on your Peace

for the day. X
5. USE POLITE WORDS.
YOU FOLLOW THE RULE:

for the day. X
(continued )
Elements of well-written classroom rules:
■ Rules are stated positively. They clearly tell students what to do, as opposed to telling them what to
avoid doing (i.e., negatively stated, such as “Do not…”).
■ Rule statements are brief. One short sentence per rule usually works well. (Remember that you will
later define sets of consequences for following/not following each rule, so this information should not
be included in the rule statement itself, thus making it less complex and easier to understand.)
■ Each rule statement is general enough to cover many situations, activities, and interactions. For
example, “Use polite words” applies to interactions with everyone and in every school situation,
whereas “Use polite words when talking with the teacher” limits applicability and invites junior lawyers
to challenge the letter of the rule if the teacher attempts to apply it to, for example, inappropriate inter-
actions with another student.
■ The number of rules makes it easy to remember them all. The general rule about rules is to include no
more than five total rules, if possible. (Remember that each rule should be stated generally enough to
cover many situations, and creating a long list of highly specific rules can thereby be avoided.)
■ Teacher-delivered consequences for following each rule are clearly stated and consistently applied.
■ Teacher-delivered consequences for breaking each rule are clearly stated and consistently applied.
■ Use graphical elements such as colors, photos, clip art, icons, and symbols that are embedded within
the rules document to cue appropriate responses at appropriate points.
Other important considerations about classroom rules:
■ Once graphical elements have been embedded in the rules document, taught, and reviewed for under-
standing, the elements themselves can serve as cues/prompts for expected behavior throughout the
school day. For example, the graphic for Rule 2 could be displayed prior to a q
uestion-and-answer ses-
sion. Rather than verbally reminding students to raise their hands, the teacher could simply pause the
session and point to the graphic (immediately followed by calling on a student who has his/her hand
raised). Inconsistent or lacking student responses to graphical cues/prompts throughout the day can
indicate the need to schedule review and practice of the rules.
■ Graphical elements can also be used in conjunction with working toward behavior goals. For example, be-
haviors listed in the “What happens when…?” column could be highlighted with red (undesired) and green
(desired). Then, students could accumulate red and green cards throughout the day, with numbers of each
tied to goals and consequences stated within a behavior contract. For example, in order to earn desired
activities at the end of the day, the student must have two or fewer red cards and five or more green cards.
■ Periodically review and revise rules. When new situations or difficulties arise that are not covered by
the current rules, make a note for later revision. One general rule is to revise/rewrite rules at least once
every school year (see below).
■ Get some type of student input concerning the rules, preferably at the beginning of each school year
when rules are revised. Gaining student input promotes buy-in/ownership of the rules, and even if teach-
ers choose all the rules and only allow their young students to vote on teacher-made versions of how they
will be applied, some level of student input should be sought. Older students may even (with facilitated
adult guidance and teacher-defined limits) construct the rules to be voted on and approved by the group.
■ Make this type of document readily available/accessible to all students in the classroom, not just to the
students with ASD, and teach, reinforce, practice, and review the rules with all students present. The in-
formation and visual format will assist all students in remembering and adhering to the classroom rules.
Meadan, Ostrosky, Triplett, Michna, and Fettig (2011) identified several com-
mon uses for classroom visual activity schedules, including to: (a) indicate the current
activity, (b) cue the student as to what activity to expect next, (c) show activity comple-
tion, and (d) cue the student that a change in the expected routine will be coming
up. Good classroom schedules will incorporate as many of these functions as possible
because promoting self-regulation works best when predictive and organizational ele-
ments cover all reasonable areas where a breakdown might occur. (See Figure 9.4 for
an example classroom activity schedule.)
Figure 9.4 Example activity schedule with predictive elements and completed tasks
MONDAY DONE
CIRCLE TIME 11 12 1
10 2
9 3
8 4
7 6 5
CENTERS 11 12 1
10 2
9 3
8 4
7 6 5
BREAK 11 12 1
10 2
9 3
8 4
7 6 5
STORY 11 12 1
10 2
9 3
8 4
7 6 5
(continued )
Visual schedule features:
■ The day of the week is prominently displayed. If children can identify and comprehend day of the
week words, this is a useful feature to cue children about what might be different on the current day as
opposed to others (e.g., Wednesday is always gym day). Even if children do not currently know day of
the week words, it is useful to go ahead and incorporate them, especially if this is something they are
beginning to learn about elsewhere.
■ Activity pictures should be those students can readily identify with instruction (see Chapter 5: Teach-
ing Communication Skills, for a discussion of “iconicity” regarding graphical symbol use). Pictures are
arranged from top to bottom, in the order that activities will occur.
■ Predictive elements include: (a) the day of the week (as described above); (b) indicators for the time
of day that activities will occur (note that some children can identify the position of the hands on an
actual clock as compared with the picture in the schedule, without being able to actually tell time
on an analog clock; also note that numerals can be used if the classroom has a digital clock); and
(c) pictures of the teacher and paraprofessional, according to who will be supervising each activity.
■ Activity completion is indicated by moving activity pictures to the “done” column. The example in the
figure indicates that circle time and centers are over, and that break will be next. Note that the visual
cue of the hands signing “done” should not be overgeneralized and used with children who have no
prior experience with symbols of this type (this would be more confusing than helpful). However, try to
use some visual cue with which the child is familiar, such as a stop sign or other symbol.
At the instructional level, teachers can focus on management of instructional

antecedents (the stimuli that immediately precede expected academic behaviors) to
ensure that (a) students with ASD recognize the nature of the task, (b) performance
expectations are clear, and (c) task engagement is more likely to occur. One way that
clearly communicated instructional antecedents can be presented to the student is
through structured work systems. Once designed and implemented, such work systems
can provide students with sufficient cues to elicit target behaviors and task engage-
ment, while also promoting independent responding, which is often an elusive goal for
these students. As educators seek to move students with ASD from being dependent
on cues from their teachers, they can begin by evaluating the presence or absence of
visual cues inherent to how tasks are currently being presented to the learner. For
example, if the teacher is presenting a task, he or she may ask:
Are there currently a sufficient number of examples of the steps involved in per-
■
forming the task?

Do the examples help to systematically define the work to be done so that the
■
student can make a reasonable attempt at performance?

Is the amount of work in each session manageable for the student to complete so
■
that he/she perceives a clear beginning and end to the task?
Teachers can also use additional visual cues for passages to be read or problems to
be completed by indicating with a mark or highlighter where to begin and where to
end. Sequencing is also important when providing instructional supports to learners
with ASD. An illustration of this is the use of colored folders to organize academic

work so that students readily discriminate among separate tasks and complete the
assigned work in the expected sequence of colors. As each folder is completed, stu-
dents can deposit the folder containing the assigned work in a finished tray. This
indicates the task has been completed. As these examples suggest, most visual work
systems include the following features:
■ A structure based on a r ight-to-left movement pattern: Movement can be within

an activity, structured within a work area, or be throughout an entire classroom.
■ The use of visual elements to organize segments of learning content, tasks, or
activities: Taped lines on the floor, signs, picture symbols, and posters can all be used
to organize student placement and access to classroom spaces, while icons, colors, and
lines can prompt certain behaviors within assignments, indicate starting and stopping
points, and create points of emphasis for focusing student attention.
■ The use of physical elements to organize segments of learning content, tasks, or
activities: Bookcases, rugs, and room dividers can be used to define work areas, and
baskets, shelves, and drawers can structure how work is ordered, segmented, and deliv-
ered for completion.
■ Dedicated areas for specific activities: Similar to the idea of centers, this approach
moves even further in the direction of organization and specialization within physical
areas of the classroom. There may be an area dedicated to snack time, one for writing,
and another for reading or nap time. When students report to a certain area, it is clear
what they will be doing next.
At the individual student level, there are several things along the lines of interven-
tion strategies that can be employed. These include the use of individual activity schedules
(not to be confused with classroom activity schedules, as discussed previously) that are visual
reminders for the student that are directed toward following a personal daily schedule
across the whole day (e.g., from taking the bus to school through taking the bus home
from school), within a certain class, or specific to a single task within a respective class.
As with classroom activity schedules, the use of individual activity schedules will tend to
promote increased independence and greater levels of task engagement, both of which can
significantly reduce the level and frequency of teacher-delivered prompts. These sched-
ules should incorporate the same essential characteristics as classroom schedules (e.g., cue
the student as to what to expect next) but also be portable, easy to use, and able to be
changed, reorganized, or added to as is necessary. Small fl ip-books with hook-and-loop
fasteners and laminated pictures bound with a chain or metal ring that can be opened for
access work well for these purposes. Also note the personal focus of individual schedules.
Whereas classroom schedules provide predictability and structure within that environ-
ment, individual schedules can order and prompt activities in all the environments that a
student will move through each day, a veritable picture roadmap to life outside of home.
Though two students may follow the same ordered map of locations throughout a school
day, they are likely to have very different visual schedules, for the needs and abilities of
individual students will necessitate the creation of highly customized schedules.
Self-management strategies have also been demonstrated to be an effective class

of interventions for students with ASD. Self-management is an umbrella term used to
describe a set of cognitive–behavioral intervention techniques designed for teaching
learners to s elf-direct their behavior. S
elf-management was very popular in the 1980s
and is making a comeback as professionals once again see the utility of these meth-
ods for promoting self-regulation and improved performance on the part of learn-
ers. Self-management consists of three techniques: self-monitoring, self-recording,
and self-reinforcement. Perhaps the most popular of these methods selected for use
within school settings is self-monitoring. Self-monitoring generally is directed toward
teaching students to take note of their own behaviors, focusing on the occurrence or
non-occurrence of certain target behaviors. This method can include self-recording,
which requires the student to make written note of occurrence or n on-occurrence
of behavior by making a checkmark or some other entry on a teacher-created form.
Self-regulation is often an implied part of this teaching model, but the s elf-adjustment
or initiation of student behavior is certainly the goal. (See Figure 9.5 for a conceptual
model of this process.)
Figure 9.5 The self-management process for promoting self-regulation
Self- Self- Self-

Self-Recording
Monitoring Regulation Reinforcement
The student first learns to monitor his/her own behavior and make written note of the fre-
quency of discrete behaviors identified for increase and/or reduction. Recording is tied to
preset increase and decrease goals, which motivate the student to self-regulate behavior in
order to access preferred reinforcers that are contingently delivered on goal attainment. Last,
teacher-delivered reinforcement is faded and gradually replaced with the student indepen-
dently assessing goal attainment and delivering reinforcement. For example, the student may
(a) record during a session that he/she only talked out twice (goal = 3 or fewer times per
session) and answered appropriately during 7 out of 10 opportunities (goal = 6 or more per
session); (b) determine after the session that he/she has met both goals necessary to access
reinforcement; (c) consult a reinforcer menu to choose an item or activity of the appropriate
level (e.g., meeting a session goal may allow access to a less preferred reinforcer than meeting
a daily or weekly goal); and (d) go to the designated place to obtain the object or engage in the
activity, with the complete process observed/spot-checked by the teacher to promote accuracy.
Self-monitoring is an effective tool for promoting task engagement and improv-

ing performance in the areas of productivity and accuracy. This form of interven-
tion with students with ASD has increased in popularity and has largely been aimed
at improving attention to tasks among students and linked to self-recording, which
has the student acknowledge the occurrence or non-occurrence of a behavior. It has
been demonstrated to be an evidence-based practice and found to be effective for stu-
dents with ASD largely in the development of social skills and appropriate behaviors
(Holifield, Goodman, Hazelkorn, & Heflin, 2010).
When implementing self-
monitoring and self-
recording, it is best for the
teacher to (a) determine and operationally define the target behavior (in terms that
are directly observable and measurable); (b) outline the steps for implementing the
self-monitoring and self-recording procedure with the student; (c) (when presenting
the intervention to the student) provide the student with a rationale as to why he/she
is being taught the skill and the importance of it; and (d) model how to s elf-monitor
and self-record. There are multiple ways to model this behavior. One method is for
the teacher to ask the student, “Are you paying attention?” at which point the stu-
dent checks “yes” or “no” on a self-monitoring form. Another way to do it is to have
an auditory prompt of some kind, such as a bell, at which point the student records
whether he/she was working as expected at that time. After determining which method
to use, model for the student each of the steps and (a) allow the student to practice
the corresponding method with the teacher, and (b) provide performance feedback
and positive praise for the student’s efforts. After a few practice sessions, the teacher
should implement the procedure within the context of the classroom and monitor
student performance. For students on the higher end of the autism spectrum or who
are older, the teacher can teach graphing performance data, which can be as simple as
shading in squares on a premade graph to create bars of varying heights. This serves
as a powerful feedback mechanism and a visual means by which the student can chart
his/her progress.
The challenges that generally are forthcoming when using such an inter-
vention in the general education classroom include how a teacher can implement
such an individualized model of instruction within a large general education set-
ting. This is a genuine concern, and one possible solution may come through the
provision of assistance by a paraprofessional or through collaborative c o-teaching
with a resource special education teacher who could assist with implementation.
Ultimately, the challenge among teachers is how they can implement evidence-
based practices within their respective classrooms with competing mandates and
initiatives, and with a range of diverse learners, some of whom may be students
with ASD. However, in the defense of self-management as a viable tool for every
teacher’s tool kit, although it does require a lot of initial effort to design, developing
and implementing these interventions over time will have great returns for students.
Promoting student self-management of behavior versus teacher-directed behavior
will in turn promote facilitated skill development in students, as well as create more
freedom for the teacher. Thus, the formula is similar to that required of most forms
of behavioral intervention in the classroom: Increased effort for a relatively short
period can produce greater gains in the long run and reduce effort for significant
periods thereafter.
Working Independently
For students within general education settings it is important to be able to process,
remain engaged, and be s elf-directed. These skills hopefully lend themselves well to
working independently. However, as we have learned thus far, these skills can be diffi-
cult for students with ASD. We have discussed compensatory methods for promoting
all of the above and have stressed the importance of visual clarity, the use of embedded
visual cues in learning tasks, and methods for promoting self-management of behav-
ior, including the use of structured work systems. Structured work systems, when
designed and paired with the methods previously mentioned in the chapter, can foster
greater degrees of independence for students with ASD. We know that active student
engagement is required for learning to occur, and, to review, adaptations and instruc-
tional modifications are required to present curricular and instructional expectations
to learners with ASD in a format that they can more readily process and to which they
can more accurately respond.
Carnahan, Hume, Clarke, and Borders (2009) remind us of the learning needs
we must attend to when teaching our students with ASD. These areas (attention, orga-
nization and sequencing, initiation, and generalization) are all ones with which learn-
ers with ASD experience difficulties. Carnahan et al. remind us that in the area of
attention, students with ASD cannot attend to multiple stimuli very well, and so our
cues must be limited. These students also have difficulties with being over-selective
in attending to one aspect of a problem or situation versus seeing the bigger picture
or broader context that is being presented. This can often result in a student spend-
ing much too much time on one aspect of an assignment and overlooking other parts
completely (as those of us who are extreme perfectionists may be able to understand).
Scheduling is also difficult because students will often randomly attend to environ-
mental stimuli and fail to understand the consequences of doing so.
Students with ASD can have difficulties in organizing and sequencing tasks from
start to finish. This trait, paired with difficulties with attending to the most relevant
stimuli within a learning context, can create difficulties with task initiation, sustained
engagement, and task completion. Some have argued that problems with initiation
are a result of being prompt dependent, or waiting for a cue from the teacher before
initiating (Carnahan et al., 2009). This can certainly be the case, but the difficulty can
also be a result of skill deficiencies and simply being unable to approach and request
assistance from the teacher. This can evoke extreme anxiety in some students with
ASD that in turn results in challenging behavior. One danger is that this behavior can
then be misinterpreted as being escape-motivated, which can then lead to the applica-
tion of unnecessary treatments or interventions.
Expected Social Behavior

Social behaviors pose significant challenges for children with ASD (for a more in-
depth discussion of this topic, please refer to Chapter 6: Methods for Developing
Social Competence). These challenges can impede a student’s progress in establishing
social interactions with peers and adults and thereby impact the assessment of aca-
demic performance that is tied to socially mediated responses. Though the display
of social skills (loosely defined as “appropriate classroom behavior”) is an expectation
within all classroom environments, it can be an area that receives less attention unless
and until lacking skills significantly disrupt the desired flow of classroom activities.
This is due in part to the curricular and instructional expectations that teachers have
placed on students, as tied to student achievement. Academic performance often takes
top priority because teachers and schools may be under considerable pressure to per-
form or face punishing consequences, such as demotions, lost employment, or having
a school taken over by the state. That point made, it is also true that teachers can
provide models of support for developing social behaviors in students with ASD that
will enhance their experience in the general education classroom. Schaefer-Whitby,
Ogilvie, and Mancil (2012) recommend the use of direct instruction as one method
for teaching these students relevant social skills for the classroom. They also recom-
mend contextualizing social skill practice within the natural setting, a process that
can be achieved through pairing a student with ASD with a peer model in a coopera-
tive learning situation. These experiences can extend across academic areas, as well as
other areas such as lunch, to provide students with ASD access to socialization oppor-
tunities with peers, and with peers as models, to reinforce social skill development.
Addressing Significant Challenges and Needs

Within Learning Contexts
Stereotypy
Stereotypical behavior is a characteristic associated with ASD. Stereotypy refers to motor
and vocal behavior in which persons with ASD may repetitively engage for significant
periods of time, if left to do so. The intensity and severity of these behaviors will vary
across individuals, but the presence of stereotypy can result in negative outcomes for
these individuals, including task disengagement, delays in skill acquisition, and stig-
matizing and impaired social interactions (Reed, Hirst, & Hyman, 2012). For indi-
viduals with more severe autism and accompanying intellectual disability, stereotypy
can include behaviors such as hand flapping (in which the individual fixates on repeat-
edly flapping his/her hands in front of his/her face/eyes), repeated vocalizations, body
rocking, or spinning of objects. For those individuals higher on the autism spectrum,
stereotypy may take the form of nonfunctional speech and vocalizations. This form of
behavior can become quite reinforcing and habitual over time, thus negatively impact-
ing the quality of life for an individual and making appropriate social interactions dif-
ficult. Researchers have pointed to a correlation between (a) individuals with severe
autism and lower measured IQs, and (b) more frequent engagement in stereotypy, as
compared with individuals with ASD with higher IQs.
Reed et al. (2012) indicated that stereotypy is often maintained by the conse-
quences that follow engagement in it, including automatic, positive reinforcement
(or, reinforcement that follows from engaging in the act itself, without the aid of
any outside agency). Researchers have also concluded that the function, or purpose,
of stereotypy for individuals with ASD can include the need for attention or escape
from demands. For learners with ASD who are in general education settings, the pres-
ence of stereotypy can pose challenges to their learning and to the learning of oth-
ers. Methods for addressing these behaviors in the classroom have relied on a mixed
assortment of strategies that examine the antecedents and consequences associated
with the behavior, paired with the use of differential reinforcement aimed at providing
reinforcement to the student in the absence of these behaviors.
Haley, Heick, and Luiselli (2010) implemented an antecedent-based interven-
tion with an 8-year-old boy with ASD in a general education classroom. The par-
ticipant spent the majority of his school day in the general classroom and engaged in
vocal stereotypy, which included audible vocalizing of nonfunctional speech, making
repetitive sounds, singing, humming, and the use of nonsense phrases that were unre-
lated to the classroom activity. An intervention consisting of cue cards was designed to
assist the student in modifying these behaviors. A red card placed on his desk meant he
was not to speak out, and a green card meant that it was okay for him to speak out. The
student received instruction in the use of the cards each day in the special education
classroom, before he attended his general education program. The results were posi-
tive, with the stereotypy decreasing during the use of the red card.
Following are some points to consider if stereotypy is encountered among your
students with ASD in the context of the general education classroom:
Work to understanding the function(s) of the behavior. What function or pur-

■
pose does the behavior serve for the individual? Evidence-based practice dic-
tates the use of functional behavior assessment and/or functional analysis of
behavior.
Is it a case of automatic reinforcement for the student, or does the student seek
■
attention for the behavior? Systematically gather behavior data to discern a

common pattern in the consequences delivered immediately after occurrences
of the behavior. Do they show no discernible pattern? Does the student continue
to engage in the behavior despite the differing consequences delivered by the
people around him/her? If so, automatic reinforcement may be at work. Does
the pattern of consequences tend to include those delivered by others, such as
speaking to the individual, offering activities, or attempting to redirect him/
her? If so, the function of the behavior may be attention seeking. However, this
is a complex process of discernment that can be misleading for the layperson.
Therefore, consultation with a b oard-certified behavior analyst who has experi-
ence with ASD is highly recommended.
Does the student engage in the behavior to avoid or escape task demands that he/
■
she might perceive as less than preferred? To better understand this relationship,
it is advisable to conduct a brief functional assessment to ascertain the frequency
of the behavior, the context(s) in which the behavior most often occurs, the ante-
cedents (or “triggers”) associated with the behavior, and the consequences that
most likely reinforce the behavior. This can be done through completing a brief
structured interview with the primary classroom teacher and any instructional
assistants, paired with a scatterplot to connect occurrence and frequency of the
behavior with time of day, activity, and other relevant environmental variables
that are present (e.g., the presence or absence or certain people and educational
or behavioral supports).
After compiling this information, decide on an intervention plan that is most appro-
priate. This may include the use of a treatment package involving antecedent man-
agement strategies (like the previous example of the colored cue cards), paired with
a strategy aimed at redirection, should the behavior occur despite attempts at pre-
vention. Also applicable is the use of differential reinforcement, either focusing on
lower rates of behavior or absence of the behavior. A functional assessment will pro-
vide valuable insights into the behavior and the context(s) surrounding it, and will
assist in identifying an evidence-and function-based intervention aimed at behavior
reduction.
Visual Learning Needs

Individuals with ASD tend to process visual cues much more efficiently than, for
example, auditory cues. When presenting academic tasks, the emphasis should be
placed on visual clarity because the use of visual supports within the instructional con-
text promotes engagement on the part of the learner. Rao and Gagie (2006) defended
the importance of visual supports because they represent a part of everyone’s com-
munication system. They promote increased attention, predictability, and decreased
anxiety, and they make abstract concepts more concrete for students. Visual supports
are appropriate for use across the lifespan of learners and can be used in multiple
settings.
In an early example of using these supports, Massey and Wheeler (2000) dem-
onstrated the efficacy of using visual supports for a 4-year-old child with ASD in an
inclusive preschool setting. They demonstrated acquisition of attending to tasks across
classwork and leisure activities using a photo activity schedule. More importantly,
their study demonstrated generalization to a new untrained environment (the school
cafeteria during lunch) using a picture/symbol schedule (a more abstract version) with
minimal training. This study reminds us of the efficacy of this intervention and illus-
trates how rapidly a learner can acquire these skills.
Visual supports provide structure, organize a learning task into a format that stu-
dents can more fully comprehend and process, and consist of photographs, pictures,
symbols, and icons. These will vary according to the individual needs of the learner,
but when introducing visual supports to students with ASD in the context of the gen-
eral education setting, the following recommendations should be considered:
■ Break the task(s) to be taught into small, teachable components by developing a

task analysis.
Determine the level of visual supports most appropriate for the student and the
■
task, and ask yourself whether the student comprehends pictures/symbols or

needs more concrete visual supports.
Model for the student the use of the visual support.
■
Allow the student to practice using the visual supports as the teacher provides
■
verbal and gestural prompts to assist with correct performance.

Provide the student with verbal reinforcement (paired with a form of reinforce-
■
ment to which he/she already responds, if he/she has not yet learned to respond
to verbal praise) for reasonable approximations of correct performance.
Many teachers point to the time investment involved in designing visual sup-
ports for learners with ASD. The return on that investment will more than pay for
itself in terms of enhancing the quality of life for the student in the general education
classroom and elsewhere. The level of engagement and independence that visual sup-
ports provide for learners of all abilities is noteworthy, and for students with ASD,
they are essential. Visual supports provide a sense of routine and predictability and
communicate to the learner a sequence of what is first, second, next, and so on, even-
tually communicating when a task is finished.
Challenging Behavior
Challenging behavior is something that all teachers will have to address at some point
in their careers, and sadly, for many, it occurs all too often. For learners with ASD
placed in general education settings, there is a need for understanding problem behav-
ior from a broad context. When challenging behaviors occur, we must remember that
they happen for a reason. They may occur as a result of skill deficits or be linked to
performance or motivation problems, or be due to a combination of both skill defi-
ciencies and motivation. For these learners, challenging behaviors most often occur
when demands exceed their capacity to respond or their repertoire of skills. The stu-
dent’s inability to perform to a specified standard, be it academic or social (two areas
that often overlap), could be related to (a) deficits in understanding the performance
expectation, (b) a lack of skills in the given area, or (c) a lack of perceived relevance and
motivation inherent in completing the task. The purpose of citing performance and
motivation issues is not to focus on the fact that students may fail to even attempt a
task, have a tantrum during it, or refuse to perform it consistently on subsequent trials,
as this behavior does not completely tell the story. Rather, when performance prob-
lems occur, one should consider that they can be a result of anxiety paired with skill
limitations for some students. Many students with ASD have difficulties with anxiety
in certain situations, and for some, performance anxiety with academic tasks results in
disengagement or escape from the demand, almost as a form of self-preservation, to
prevent what seems like a complete breakdown in neural stability. Others may attempt
to escape from academic tasks by engaging in challenging behavior that seems highly
emotive and even painful, accompanied by screaming, crying real tears, and physical
convulsions, only to instantly present a calm, attentive exterior once the offending task
is removed or a preferred item or activity is presented.
Increasing Motivation, Compliance, and Engagement
Motivation
Most everyone has heard a teacher or parent proclaim about a child something
like, “She is just not motivated!” While the issue of motivation has been discussed
by numerous experts, and a plethora of ideas have been generated regarding ways
to motivate students, many of these efforts have been futile and have lacked endur-
ance over time. Regardless of this outcome, there are some promising techniques that
have been shown to increase motivation. These approaches have in many cases been
tailored toward helping students diagnosed with an ASD, and some of these will be
discussed here. However, it may first be helpful to better understand what exactly is
implied by the term motivation.
Motivation has traditionally been defined as independently engaging in an activ-
ity. A motivated person will engage in an activity more readily or with some appar-
ent enthusiasm, while a person who is not motivated will demonstrate some form of
reluctance or resistance to doing so. Given this type of general descriptor, there are
some different methods for how motivated behavior might be objectively observed
and measured. One measure of motivation has been to assess the amount of time it
takes for a person to initiate an activity. This is referred to as a measure of latency.
This is useful for making comparisons about the level or degree of motivation that a
person may possess in regard to a range of activities, from preferred to nonpreferred.
In general, and while controlling for other factors such as delayed processing by the
individual, the longer it takes a person to begin an activity, the lower his/her level of
implied motivation for engaging in that activity. For example, when Mitch is asked by
his mother to take out the garbage, he waits a long time before he gets started gather-
ing the trash (and only does so after multiple prompts), but when his mother asks him
to come and have some ice cream, he immediately jumps up and runs to get the treat.
It would seem that Mitch is highly motivated to have ice cream, but quite unmotivated
to take out the garbage.
Another indication of motivation can be obtained by looking at how long it takes
for a person to stop engaging in a task. For example, when Mitch is playing with his
toy trucks and his mother asks him to put them away, he is very slow to do so and
pretends to ignore her request. However, when Mitch is sweeping the floor and his
mother asks him to put away the broom, he does so very quickly, perhaps hoping that
another such task will not soon be assigned. In this case, the comparatively different
periods of time that it took for Mitch to stop each activity may indicate that he is more
motivated to play with the toy trucks than he is to sweep the floor. Another time-
based measure that can be indicative of a level of motivation is simply the cumulative
amount of time that a person chooses to spend engaging in an activity. Mitch spends
more time playing with his toy cars than he spends playing with his action figures. In
this case, the comparison might indicate that he is more motivated to play with toy
cars than he is to play with action figures. These measures consider the amount of
time associated with engaging in an activity, but there are other factors that might also
be relevant to this type of analysis, such as the intensity with which a person engages
in an activity or the comments he makes about activities. For example, Mitch may say,
“I love playing with my toy trucks,” display a lot of vigorous movement, and make a lot
of noise when playing with them. In contrast, Mitch may say, “I hate sweeping,” appear
very lethargic in his movements, have a downcast facial expression, and attempt to
take frequent breaks during the task. These and other factors can be indicators that a
person is more or less motivated to engage in an activity.
While measuring the presence of motivation is useful, identifying strategies that
can influence motivation may be even more relevant and useful, especially for indi-
viduals diagnosed with an ASD. Frequently, individuals diagnosed with an ASD will
display very limited interests, which can make motivating them to do other activities
outside of their interest zone quite difficult. Many typically developing students also
struggle with being motivated to complete academic tasks. While specific techniques
for increasing motivation have not been clearly demonstrated in the professional lit-
erature, there are some techniques that have promise for increasing the motivation
of some individuals diagnosed with an ASD. One method that can be useful is to
incorporate the specialized interests of individuals in ways that can motivate them to
engage in other activities outside of their usual repertoire. Mancil and Pearl (2008)
demonstrated that the restricted interests of three students diagnosed with an ASD
could be used to increase motivation for completing academic tasks. For one student
who had a restricted interest regarding trains, interventionists embedded trains into
the academic activity by having the student complete math activities involving count-
ing trains. For a middle school student with a restricted interest in hurricanes, they
found that academic subjects (such as history, English, math, and others) that involved
hurricanes could be used to increase the student’s motivation to complete the associ-
ated tasks. Similarly, Lanou, Hough, and Powell (2012) described how incorporating
student interests into activities can enhance motivation and reduce some of the chal-
lenging behaviors displayed by these students. They developed a chart that outlines
steps for planning tasks that build in the specialized interests of students, while also
considering the strengths and talents that a student displays. Embedding the special-
ized interests of students into activities may be one method for improving student
motivation to engage in some undesirable activities, but developing these activities
does require some creativity on the part of the teacher.
Mancil and Pearl’s (2008) findings revealed that motivation could be increased
using embedded restricted interests for most but not all academic tasks. For the
other tasks, they found that another technique resulted in an increase in motivation.
They began incorporating access to the restricted interest once the student com-
pleted an activity. This technique is referred to as the Premack principle (Premack,
1959), which involves using behaviors in which the student is very likely to engage
in order to increase the probability of him/her engaging in less likely, or less
probable, behaviors. Mancil and Pearl’s study offers a couple of different strategies
that can be used to increase engagement and motivation for students diagnosed
with ASD, but these techniques may not always be effective, meaning that a teacher
must do some experimentation to determine which strategy will work best for a
specific student.
Koegel, Singh, and Koegel (2010) examined several motivational strategies

to determine whether the strategies could improve academic engagement and also
reduce the occurrence of challenging behavior. The motivational strategies that they
examined included choice, interspersed preferred activities, and the use of natural
reinforcement. Choice as a motivational strategy simply involves allowing a student to
have an option between at least two activities that have essentially the same focus. For
example, a child who is required to complete a book report might be given a choice
of completing the book report by writing the report using a pencil and paper or by
writing it on a computer. Choosing the order in which tasks are to be completed is
also a commonly used and effective strategy. Interspersed requesting is a technique that
involves breaking a task or schedule into small segments that can be alternated with
the presentation of preferred activities to create behavioral momentum for complet-
ing the task. For example, the schedule for a school day could be broken down into
segments that involve alternating more and less demanding activities such as playtime,
academics, snack time, academics, and so on throughout the day. The use of natural
reinforcers involves identifying reinforcers that are a logical result of engaging in the
task, making these reinforcers available to students after completion of the specified
task or activity, and teaching the association between the two. For example, a student
may be shown that learning and engaging in the math skill of computing averages can
be used during free time, when he enjoys engaging in the specialized interest of learn-
ing the baseball stats of his favorite players. Koegel, Singh, and Koegel (2010) found
that incorporating natural reinforcement, choice, and interspersed preferred activities
into math and writing tasks improved engagement and reduced the disruptive behav-
iors of four children diagnosed with autism. They also concluded that the strategies
resulted in an increased interest among the children regarding math and writing tasks.
The study demonstrated that focusing on motivational strategies could be beneficial
toward not only enhancing motivation but also on reducing disruptive behaviors dis-
played by students when presented with academic tasks.
Compliance
Motivation and compliance are closely related and, in some cases, are interconnected.
If a student is highly motivated, then he/she is more likely to comply with requests.
While motivation can play a part in gaining compliance, there are also instances in
which a person may be very unmotivated to participate in a task but will comply with
completing the task anyway. For example, a child may be unmotivated to clean up his
toys, but he may comply with the cleaning activity in order to avoid being scolded by
a parent. Compliance can be assessed by measuring the number of activities assigned
by a teacher and the number of activities that a student actually completes. For
example, a teacher assigns four worksheets. However, if the student completes only
two of the worksheets, then he/she could be considered to be 50% compliant with
the teacher assignments. Another way that compliance can be evaluated is by measur-
ing the amount of time that a student takes to begin a task after a teacher gives the
student a directive (latency). For example, a teacher tells Amy to go to the reading
center in the classroom, and it takes Amy 25 minutes to go there. Since Amy eventu-
ally made it there, could this be considered compliance on Amy’s part? In most cases,
compliance is considered to be present if a student initiates a task very shortly after
the request by a teacher is made, such as if Amy went to the center within 15 seconds
of the teacher’s request. Unless a time limit is specified (e.g., “Be at the reading center
in 25 minutes.”), it is usually implied that one means right away. However, it should
not be assumed that a student with ASD will be aware of this type of implication,
and directives may have to be more specific or nuances of language may have to be
directly taught.
Some interesting techniques have been shown to influence compliance with aca-
demic tasks among students. One such technique was demonstrated by Banda and
Kubina (2010) with a 13-year-old middle school student diagnosed with autism. The
student was resistant to completing some types of mathematics problems, although
there were indicators that he had the skills to complete the problems. Banda and
Kubina utilized an intervention to increase compliance that was called the high-
preference strategy (or high-p strategy). The technique involved determining which
mathematics problems were highly preferred by the student (high-p problems) and
which problems were less preferred (low-p problems). The math problems were then
arranged so that the student was prompted to complete two h igh-p problems before
being asked to complete a low-p problem. This arrangement resulted in the student
more readily beginning the less preferred mathematics problems (low-p). When the
arrangement was removed and the student was asked to complete only low-p prob-
lems, he was more resistant to completing them. This intervention utilized what is
referred to as behavior momentum (Nevin, Mandell, & Atak, 1983), which suggests that
a person is more likely to comply with a difficult request if it is preceded by some
number of easier requests. For example, a teacher may ask a student who does not like
to transition to new locations to first show a smile and give a high five to “warm the
student up” before asking her to move to a new location. Behavior momentum basi-
cally involves getting a person involved in a task they find to be less difficult before
introducing the more difficult task. In the case of the Banda and Kubina (2010) study,
this technique involved preferred mathematics problems being presented before less-
preferred mathematics problems.
Another approach to increasing compliance with academic tasks is called error-
less academic compliance training (EACT) (Ducharme & Drain, 2004; Ducharme & Ng,
2012). Ducharme and Ng demonstrated how EACT was beneficial for increasing aca-
demic compliance among three e lementary-age students diagnosed with ASD. The
technique involved first presenting students with teacher-initiated academic requests
with which the students were very likely to comply, and then slowly introducing aca-
demic requests with which the students were less likely to comply, based on past per-
formance. The students were given tokens for compliance with all requests, and the
results indicated that this slow introduction of more difficult tasks produced more
compliance in regard to task completion among the students. In addition, the students
engaged in fewer off-task behaviors and reduced the number of disruptive behaviors
they displayed. Ducharme and Ng indicated that the EACT procedure shows promise
toward increasing the cooperation of students diagnosed with ASD, as well as the
completion of academic requests made by teachers.
Engagement
Engagement in academic activities can occur in several ways, and students diagnosed
with ASD may have difficulties with any number of the different types of academic
engagement. Goodman and Williams (2007) identified several types of academic
engagement and described several ways that students with ASD could be encour-
aged to increase their academic engagement. They considered academic engagement
to encompass auditory engagement, visual engagement, physical engagement, and
social engagement. The techniques they described to increase engagement were
designed to address these specific types. For example, auditory engagement can be
addressed by incorporating songs into activities. Visual engagement can be addressed
by using pictures or visual prompts, and physical engagement can be addressed by
using tangible objects. Similarly, social engagement can be addressed by facilitat-
ing peer interactions. Leach and Duffy (2009) categorized strategies for engaging
these students in academics in terms of being preventative, supportive, and correc-
tive. They indicated that preventative strategies consist of (a) planning activities that
encourage engagement, and (b) arranging the environment in a manner that will
facilitate engagement. Supportive activities consist of developing prompts and cues
that encourage students to remain engaged in an activity, and corrective activities
involve designing a plan to be used when students refuse to engage in an activity or
engage in inappropriate activities. Each of these categories can be helpful toward
developing a comprehensive plan to promote engagement in academic activities
among students diagnosed with an ASD.
Some specific strategies that can be helpful for promoting academic engagement
for these learners can include offering clear instructions, providing access to rewards
upon completion of an activity, providing students with partners or work groups,
conducting role playing of necessary social skills, and embedding cues in the work
task. Each of these strategies can be beneficial toward enhancing academic engage-
ment, but a teacher must determine which strategy works best for a particular student.
Teachers can do this by trying different techniques and collecting data on how a stu-
dent responds. Various techniques can be tried in isolation and in combination and
then compared to see which technique results in the best academic engagement for a
particular student.
In addition, some research has shown that children diagnosed with an ASD
may be able to improve their academic engagement if they are allowed to engage
in challenging behavior for a period of time before being given academic tasks to
complete. Rispoli et al. (2011) demonstrated how academic engagement was increased
for three young boys diagnosed with autism when they were given an opportunity
to engage in challenging behaviors immediately before presentation of an academic
activity. The researchers found that the three boys were more engaged in academic
activities after a p
re-session of engaging in challenging behaviors as compared with
academic engagement levels when no p re-session was provided. They explained that
allowing the participants to satiate on (or get enough of) the challenging behaviors
prior to engaging in academics was beneficial. Similarly, Nicholson, Kehle, Bray,
and Van Heest (2011) demonstrated that academic engagement could be increased
among four elementary-aged children diagnosed with autism when they were first
given an opportunity to engage in physical exercise. They had the four students jog for
12 minutes, have a 5-minute cool down, and then engage in a mathematics or English
lesson. Their findings revealed that the exercise resulted in improvements in academic
engagement, but they indicated that further studies were needed to better understand
the technique.
Selected Academic Methods
Reading Instruction
Learning to read and to read well is perhaps one of the most important skills an
individual can possess. It opens up limitless possibilities for learning and is vital to
lifelong success. For students with ASD, seeking reading prowess has been character-
ized by difficulties, primarily in the area of reading comprehension, with secondary
concerns in the area of word recognition. Research has demonstrated a discrepancy
between word recognition and comprehension in learners with ASD (Ricketts, Jones,
Happe, & Charman, 2013). The difficulties in reading comprehension experienced by
these learners have been linked to problems with integrating information, verbal skill
deficiencies, and overall language ability (Huemer & Mann, 2010). Given the chal-
lenges that these learners face in the area of processing and the skills used in reading
comprehension, it is easy to understand the difficulties they experience in this area.
To ensure a reasonable level of success, one needs to understand the concrete
to abstract continuum used in instruction. For reading it is important to begin with
decoding. Decoding refers to the ability of the learner to translate or decode writ-
ten words. As part of decoding, learners need to be able to recognize words. This is
known as word identification. One method used to assist learners in decoding words is
to build word attack skills. This method teaches students to look at a word and use
their knowledge of phonetics to sound it out. For example, Ms. Allison might pres-
ent a student with the word “dog,” at which point the student may pause, begin with
the initial d sound, and then pronounce the rest of the word: “d—og.” Ms. Allison
may then reinforce the student’s attempt by saying, “Yes, Logan. Good job saying the
sounds. What word is this?” The student then replies “dog,” and Ms. Allison says “Yes,
Logan. Dog. Good job sounding out your words.” Teachers will often use words that
students may not currently have in their skill repertoires to assess their ability to use
word attack skills. This method is an example of a p honics-based approach for pro-
moting word identification.
Contrast this approach with sight word instruction. Sight word instruction has
been successfully used to teach students with intellectual disabilities (Browder & Xin,
1998) and teaches students to identify words without an emphasis on the letters and
sounds. Spector (2011), in a systematic review of research evidence regarding the effi-
cacy of sight word instruction for ASD, ascertained that massed trials (repeated pre-
sentation of sight words) appeared to be successful in promoting skill acquisition in
these learners, but the limitation of the research in this area is that the effects of sight
word instruction on overall literacy are unknown. Sight word instruction, though a
helpful tool, is limited in terms of addressing the curricular demands placed on stu-
dents with ASD in the general education setting. Huemer and Mann (2010) stated that
learners with ASD appear to perform well with the phonetic structure of words but
have greater degrees of difficulty in decoding more complex grammatical structures
or contextual decoding.
Moving from word identification to comprehension, it is important to consider
teaching methods to augment the abilities of learners with ASD to aid in this area.
The use of graphic organizers can be an effective tool for promoting comprehension.
One example of a graphic organizer that can be helpful is a story map. A story map is
a visual or graphic organizer that depicts the main features of a story, such as setting
(where the story took place), characters (who the story is about), the beginning (events
that start off the plot), the middle (usually the climax of the story), end (usually the
resolution of the climax), and other pertinent features such as plot (the main theme of
the story), summary, and conclusion to assist learners with recall and comprehension.
Stringfield, Luscre, and Gast (2011) used a story map with three elementary-aged boys
with high functioning autism (HFA) to assist them with recall. The authors found that
the story map assisted the learners during language arts instruction, as evidenced by
their improved recall and as measured by their performances on accelerated reader
quizzes. The authors also discovered that two of the participants s elf-faded the use of
the story map over time (gradually using it less often until discarding it altogether).
The merits of graphic organizers, such as story maps, is that they complement the
visual learning style of individuals with ASD. When paired with effective instruction,
such as the use of teacher prompts and reinforcement, they may for some students be
faded as the acquisition and fluency of comprehension skills increase.
Teaching Mathematics
Mathematics has always been a pillar of schooling, but since the design of the Common
Core State Standards, even greater emphasis has been placed on this academic sub-
ject. The Common Core Standards represent an initiative launched by state governors
and state officers as a guideline for curricular development. It is designed to outline
standards by grade level that align with college and work expectations, and currently
45 states are participating. This infusion of policy paired with other policies, most
notably the reauthorization of the Elementary and Secondary Education Act (previ-
ously known as the No Child Left Behind Act), requires that all students participate
in each state’s system of accountability. This means that students are tested in grades
3 through 8 using academic achievement tests, and they are also tested during high
school, in the areas of mathematics, reading, and science. Schools must then report
adequate yearly progress as a measure of accountability within their respective states
(Hord & Bouck, 2012).
Given these changes, the performance expectations placed on teachers and

students are considerable and create an increased pressure to perform. For students
with disabilities, including students with ASD, this is a dramatic shift, given that the
reauthorization of the Individuals with Disabilities Education Act of 2004 (IDEA) is
aligned with No Child Left Behind, thus requiring that students with disabilities be a
part of the system of accountability recording (Hord & Bouck, 2012). How does this
affect students with ASD in terms of access to the general curriculum and in the area
of performance in mathematics? It results in the introduction of h igh-stakes testing
for students, with increased pressure on teachers to perform and produce learning
outcomes in their students as measured on these tests. There are many that criticize
this movement, but regardless of its true validity, it is the present standard by which
teachers and students are held accountable. This means that teachers must implement
instruction according to s tate-mandated curricular standards and that all students in
their charge are expected to learn in accordance with these standards. This will require
that teachers be given access to professional development designed to address build-
ing math competencies across learners, including those with disabilities. For learn-
ers with disabilities placed in the general education setting, this will mean increased
performance expectations tied to state standards and graduation requirements. The
challenge lies in the delivery of instruction and the acquisition of skills on the part
of learners given the accelerated delivery schedule to which teachers are pressed to
adhere. This could be challenging, as past research has indicated that students with
ASD at the middle school level are, on average, five years below nondisabled peers in
the area of mathematics (Wagner et al., 2003). Additional data show that nearly 25%
of students with ASD have a learning disability in the area of math that is approxi-
mately three times greater than other children (Schaefer-Whitby, 2013). Schaefer-
Whitby (2013) further explains that one plausible reason for this is that middle school
math becomes more abstract and less applied, thus requiring h igher-level thinking
and processing abilities. New research reports on the abilities of some children with
ASD to outperform typically developing peers in mathematics problem solving, given
a unique pattern of brain organization (Iuculano et al., 2013). More research is needed
on a broader scale to better understand these relationships and their potential applica-
tions in classroom settings.
There has not been a large volume of research on delivering instruction to stu-
dents with ASD in the area of mathematics. A related review conducted by Hord and
Bouck (2012) on mathematics instruction for students with mild intellectual disabili-
ties (MID) pointed to methods studied across seven studies involving these students,
with four of these investigations examining the efficacy of flashcards designed to teach
math facts and two studies examining the use of teacher prompting and technology
in improving students’ computational skills. Another review, conducted by Donaldson
and Zager (2010), draws the comparison between students with nonverbal learning
disabilities and those with ASD (more specifically, students formerly diagnosed with
HFA and Asperger’s syndrome). Noted was their similar learning profiles based on the
presenting characteristics of both disorders, most notably social and behavioral char-
acteristics and how they relate to instructional strategies in the area of mathematics.
Consider This
Abstract reasoning can be an area of difficulty question, consider the case of Lara, a student in
for students with ASD, and abstract reason- fourth grade who attends a special education
ing is inherent to most mathematical learning. resource room for math and reading, and who
Sometimes language ability can also impact also has Asperger’s syndrome. Lara’s parapro-
math performance, especially as students move fessional announces to you that Lara has had a
from more concrete, computational learning breakthrough in her mathematics performance:
(e.g., grouping and removing physical objects) She is now borrowing and carrying to complete
to concepts such as the basic mathematical sen- two-digit subtraction problems. However, when
tence (e.g., “Five plus three equals six”), a gram- you enter the classroom and begin working with
matical sentence that is more often represented Lara, you discover that she borrows and carries
in symbols that must first be decoded, adding on every two-digit subtraction problem that she
yet another layer of complexity to the task. It is given, even when it is not required. Further
has been said that a child’s difficulty with tasks, informal testing reveals that she cannot reliably
such as coming up with rhyming words and identify certain symbols, such as the equal sign
demonstrating phonetic awareness in spelling and minus sign, or use them appropriately on
words for which the true spellings are unknown every occasion. She is usually given work that
(e.g., “lurn” as a spelling of the word “learn”), has these symbols already in place for her and, in
can be a powerful early indicator that the child approaching the task, she is probably respond-
will have difficulty learning to read. This raises ing to cues other than the symbols themselves
the question, what are the “powerful early indi- (e.g., the teacher announces, “It’s time to work
cators” that a child may need more intensive on your subtraction.”). How should you pro-
instruction in mathematics in order to be succeed with her instruction? Should you begin by
cessful, especially as academic content moves reteaching borrowing and carrying in t wo-digit
more into the representational and abstract subtraction problems, or begin by doing some-
and away from the concrete? In answering this thing else?
Donaldson and Zager (2010) provide recommendations for instruction in mathemat-

ics designed for students with learning disabilities. These strategies attempt to pro-
mote self-regulation by providing students with checklists as instructional prompts
to use while performing math computations. Direct instruction was another method
presented, and it is designed to teach through modeling, active student rehearsal,
and reinforcement aimed at teaching skills needed in the area of math. The utility of
applying methods across learners with varying levels of disabilities, including students
with ASD, has yet to be fully understood from existing research.
Methods from existing research that have been applied to students with ASD
include metacognitive strategies, as used by Schaefer-Whitby (2013) with three middle
school students with ASD. The “Solve It!” approach they used included the following
phases to implement for solving word problems: (a) Read (to understand the problem),
(b) paraphrase (put the problem in your own words), (c) visualize the problem (draw a
picture or diagram), (d) hypothesize (develop a plan to solve the problem), (e) estimate
(predict the right answer), (f) compute the problem, and (g) check your answer. This
investigation, conducted in two middle schools, resulted in students with ASD improv-
ing their skills in problem solving and outperforming their peers on word problem–
solving accuracy. However, the author points out that one of the inherent challenges
encountered was related to the language difficulties experienced by these learners,
which created some difficulties with the processing of the prompting strategies.
Finally, given the idiosyncratic nature of learners and learner preferences, it
is important to remember to address each child as an individual and to assess and
ascertain each child’s strengths and attributes, as well as challenges. Mathematics is no
different in this respect. Banda, McAfee, Lee, and Kubina (2007) examined the rela-
tionship of math preference and mastery for five middle school students with ASD.
Their findings were that preference is idiosyncratic across students and not necessar-
ily related to mastery in some students. It is important to recognize the goodness of
fit between instruction and the individual child and to evaluate the supports needed
to foster learning and acquisition of skills. One size does not fit all. More conclusive
research is needed to better understand the methods most applicable across learners
with ASD within general education settings. Additional study should examine the fac-
tors that serve as impediments and facilitators to teachers when attempting to imple-
ment these strategies with learners identified with ASD.
Science Instruction
As with other content areas, much of the research on science instruction draws on
comparisons with other disability groups with characteristics thought to overlap those
of individuals with ASD. In the case of science instruction, much of the small body of
research examines teaching science concepts to students with developmental disability,
although it is difficult to make generalizations across unique and diverse groups of stu-
dents with disabilities, and, in the case of students with ASD, the heterogeneity of the
population creates a level of diversity that does not necessarily apply in a universal sense.
So, the basic rule of thumb is to consider the individual in terms of his/her strengths,
areas of challenge, and previous learning history, to determine previous experience levels
with the content to be taught, as well as to create a general learning profile.
Science requires one to be literate in content through the acquisition of termi-
nology, but also through understanding the concepts, and can often be quite complex
given the highly specialized nature of the subject matter. It is also an academic subject
that draws on previously learned information to aid in comprehension, and this is an
area within which some students with ASD may have difficulty, due in part to limited
experiences from which to draw or to unique learning style differences (Carnahan &
Williamson, 2013). Preliminary research conducted by Williamson, Carnahan, and
Jacobs (2012) examined the reading profiles of high functioning students on the
autism spectrum. Their findings identified three reading profiles across participants,
identified as:
1. Text-bound: Students in this group had poor comprehension and often did not
activate background information and were simply focused on the words printed
on the page.
2. Imaginative: Students that fit the imaginative profile also had poor comprehen-
sion and were thought to activate their use of background knowledge, but this
frequently included the addition of many personal experiences unrelated to the
content.
3. Strategic: Students who fit the strategic profile tended to effectively use back-
ground knowledge that enhanced their comprehension.
The study, although small in terms of sample size, addresses an important question as
to the nature of the relationship between previous learning history and reading com-
prehension in students with ASD, and its bearing on learning in content areas such as
science.
In terms of content standards in science, the National Science Education
Standards (National Research Council, 1996) consist of eight areas: (1) unifying con-
cepts and processes in science, (2) science as inquiry, (3) physical science, (4) life sci-
ence, (5) earth and space science, (6) science and technology, (7) science in personal
and social perspectives, and (8) history and nature of science. In addition to this broad
range of topic areas, science instruction involves a subject matter with an intense
vocabulary component and some degree of memorization of terms and concepts. As
you will recall from the previous section, students with ASD have difficulty with read-
ing comprehension, which can serve to create greater challenges in a content area
such as science. We also learned of the potential utility of graphic organizers as a
learning enhancement tool for students with ASD. This method has been successfully
used in conjunction with systematic instruction to teach science concepts to students
with ASD and intellectual disabilities. Knight, Spooner, Browder, Smith, and Wood
(2013) studied three students with ASD and moderate intellectual disability who were
from an urban middle school and received educational services in a special education
resource room. The researchers utilized a treatment package that combined system-
atic instruction with constant time delay (a fixed period of time between the instruc-
tional cue for initial performance and a prompt delivered to elicit a response) and
graphic organizers to measure conceptual knowledge in the area of convection. Based
on student performance, the study was deemed successful in using graphic organiz-
ers to teach science vocabulary and science concepts. (See Figure 9.6 for an example
science lab graphic organizer.) As with many school-based interventions, this study
utilized a treatment package, thus making it difficult to discern what elements of the
treatment had the greatest influence on the student’s skill acquisition.
Direct and systematic instruction, paired with educational accommodations,
is necessary to assist learners with ASD in the acquisition, fluency, and generaliza-
tion of science terminology and concepts. Intervention studies have examined the use
of a compare–contrast strategy designed to assist in comprehension of science text
(Carnahan & Williamson, 2013) and embedded computer-assisted instruction to teach
science terms (Smith, Spooner, & Wood, 2013), both presenting promising results.
More research is needed across greater numbers of participants with ASD to ascertain
the use of portable technology devices, such as tablets, as methods for constructing
and providing students with graphic organizers and embedded prompts to enhance
the probability of academic success. In turn, more studies conducted within inclusive
Figure 9.6 Graphic organizer to structure observations for a science lab on parts

of plants
Your name: Date of observation:
Name of plant observed:
Observation 1:
Leaves
Observation 2:
Observation 1:
Fruit
Observation 2:
PARTS OF A PLANT
Observation 1:
Flowers
Observation 2:
Observation 1:
Seeds
Observation 2:
Observation 1:
Stem
Observation 2:
Observation 1:
Roots
Observation 2:
general education settings are needed to ascertain the challenges associated with eval-
uating the efficacy of such methodologies, as well as factors relating to implementa-
tion and fidelity for teachers and other school personnel. This is a critical area in need
of a deeper understanding, as it is likely that increasing numbers of students with
ASD will be in general settings. We must validate instructional methodologies across
content areas, such as science education, that are effective in advancing the learning
outcomes for these students across all relevant educational settings.
Applied Behavior Analysis for Academic Instruction

Utilizing applied behavior analytic techniques to teach appropriate social behaviors
to individuals diagnosed with an ASD has proven to be an approach with some strong
evidence to support its effectiveness. Within this empirically supported evidence is
a movement toward utilizing more reinforcement-based approaches and increased
utilization of functional assessment information to design interventions (Carter,
Wheeler, & Mayton, 2004). In addition, a model for incorporating functional assess-
ment information into the development of applied behavior analytic techniques has
been formulated that can provide some direction toward choosing an effective inter-
vention to improve academic behaviors. Daly, Witt, Martens, and Dool (1997) offered
a model for developing functional explanations for s tudent-demonstrated difficulties
with academic performance in oral reading. Their model included five reasons why
students did not perform well on academic tasks, reasons that revolved around deficits
that students may have in relation to the task, such as lack of motivation, required
knowledge, ability to generalize, or prerequisite skills needed to attempt acquisition of
the academic task. Their model built upon and expanded the dyadic model of academic
performance problems that indicated academic difficulties were a result of either a per-
formance deficit or a skill deficit (Shapiro, 1996). The dyadic model indicated that if a
student had a performance deficit, the teacher should develop techniques to increase
the student’s motivation to complete a task, and if a student displayed skill deficits, the
focus of the teacher should be to teach the prerequisite and requisite skills needed to
perform the task. The model described by Daly et al. recommends matching interven-
tions to hypothesized student deficits and can involve incorporating strategies such as
motivational techniques, teaching necessary skills to perform the task, offering more
opportunities to practice skills, modifying the materials, and supporting generaliza-
tion of previously learned skills. Models of this type focus on the reasons that students
have difficulty with academic performance and attempt to match academic instruction
with the presumed deficit. In the development of instruction procedures, the mod-
els draw heavily from the instructional hierarchy model (Haring, Lovitt, Eaton, &
Hansen, 1978), which basically states that the level of assistance that a student needs
is dependent upon the skill level displayed by the student. If a student has minimal
skills, then he/she will require more substantial instruction to perform a task. If a
student has a great number of skills or a number of strongly developed skills, he/she
will need a minimal amount of instruction to perform a task. While these models were
not specifically developed for students diagnosed with ASD, they do provide a helpful
framework for understanding how academic instruction can be designed in a way that
focuses on the reason why a student is having difficulty and could be a beneficial start-
ing point for developing effective techniques for students diagnosed with ASD. (Refer
to Figure 9.7 for connections among these topics.)
Applied behavior analysis represents an empirically based scientific method for
improving academic instruction and learning outcomes for students with ASD. Many
of the studies cited within this chapter used interventions classified as ABA approaches
and were generally part of a treatment package that involved a combination of direct
or systematic instruction, modeling, prompting, embedded cues, and reinforcement, to
name a few. It is important that these methods make it into the hands of practitioners
Figure 9.7 Stages of learning, areas of student need, and a sample of Aba teaching tools
General Areas of Sample Menu of Applicable ABA

Stage of Learning Student Need Teaching Methods and Techniques
Acquisition (getting it): The Skill deficits ■ Use of reinforcement strategies (e.g.,
learner is just beginning to varying schedules of reinforcement,
approach a new source of differential reinforcement, positive and
instruction. negative reinforcement)
■ Shaping
■ Modeling
■ Prompting
Fluency (doing it faster/better): Skill deficits,
■ Task analysis
Fluency building usually involves performance deficits
■ Forward and backward chaining
both accuracy and speed and
■ Discrete trial training
can be measured using rate
■ Systematic data collection and analysis/
(e.g., words read correctly per
data-based decision making
minute).
■ Antecedent assessment and intervention
■ Functional behavior assessment
■ Functional analysis of behavior
Generalization (using it): This Skill deficits, ■ Extinction, response cost, overcorrection
involves using learning across performance deficits ■ Use of motivating operations
multiple persons, places, ■ Analysis of verbal behavior
examples, and situations. ■ Response-deprivation procedures (e.g.,
use of the Premack principle)
■ Precision teaching and direct instruction
Maintenance (keeping it): “Use Performance deficits ■ Contingency contracting (e.g., behavior
it, or lose it,” as they say. Ongoing contracts)
practice and actively connecting ■ Token economy procedures
new learning with old are two ■ Behavioral momentum techniques
ways to promote maintenance. ■ Self-management strategies
■ Stimulus and response generalization
procedures
through meaningful professional development, which in turn will build capacity and
enhance the professional lives of teachers and students alike. For this to occur, sub-
stantial research is needed that addresses the applied utility of these methods relative
to academic instruction, the efficacy of these methods, data on learner outcomes, and
social validity measures that address ease and functionality of implementation among
learners with ASD in general education settings.

the Autism Academy of Learning (AAL) in Toledo, Ohio, a publicly funded charter
school dedicated to teaching students with ASD. The AAL was founded by parents
of children with ASD, and their facility provides educational services in the areas of
academics, behavior, daily living skills, and vocational skills. For more information,
consult their website at: www.theautismacademy.org/Home_Page.html.
Chapter Summary
standing and addressing academic skills in the education and treatment of people
with ASD. The diverse learning characteristics of people with ASD were explored
within a framework that included instructional context and academic achievement,
and some skills prerequisite to academic learning were described, along with methods
to promote their development in these learners.
Next, some of the prominent challenges and needs faced by learners with ASD
were addressed within the context of inclusive school settings, with special empha-
sis placed on the use of visual cues and seeking the possible functions of behavior.
Readers were also provided with methods for measuring levels of motivation, compli-
ance, and engagement in regard to academic tasks, as well as methods for increasing
them in learners who may not fully engage in academic tasks.
The final segment of the chapter explored a sample of instructional methods
across three academic subject areas: reading, math, and science. In addition to these,
applied behavior analysis was discussed as a viable, effective science with great poten-
tial to positively impact how students with ASD benefit from academic instruction.
One of the main goals of this chapter was to provide you with an introduction
to the understanding and application of a complex topic: teaching academic skills to
people with ASD within instructional contexts often designed for typically developing
learners. The intersection of these multifaceted instructional environments with stu-
dents who have a diverse range of learning characteristics and individual needs indeed
produces a series of challenges for students and educators. Discovering and using
evidence-based practices to improve learning and quality of life for these students
therefore becomes of paramount importance in seeking to facilitate their acquisition
of academic skills.
1. Research examples and types of student s elf-monitoring forms, and then design your
own self-monitoring form for a student with ASD, incorporating the most relevant
features from examples. Include features such as visual cues, counts of appropriate and
inappropriate behavior, connections to behavior increase/decrease goals, and the rein-
forcers that can be delivered for meeting these goals.
2. Create a graphic organizer to promote desired behavior in some academic subject area.
Make sure the organizer visually structures the activity/lesson for all students, not just
students with ASD.
3. Write a mathematics lesson plan that incorporates/integrates the restricted interest of
a student with ASD who tends to focus on all aspects of the Civil War.
4. Use your knowledge of a past or present classroom practicum placement to create a
visual classroom schedule for all students in an inclusive general education classroom.
Make sure to include elements that will make the schedule accessible to students with
ASD, as well as all other students.
5. Write a plan for increasing the motivation, compliance, and engagement in regard
to academic tasks for a student with ASD. (The use of written case studies, personal
knowledge and experience with an individual student with ASD, or a purely hypotheti-
cal student based on a common profile are all recommended, as long as confidentiality
is maintained.)
Websites
ABA Math (free, open-source software) K5 Learning (an online, computer-based math
http://abamath.sourceforge.net and reading program for K–5 students)
www.k5learning.com/autism-education-
Do2Learn (strategies for teachers, free aspergers
materials, items for purchase)
www.dotolearn.com/academics/overview.html National Library of Virtual Manipulatives
(many Internet-based math activities)
http://nlvm.usu.edu/en/nav/vlibrary.html
Books
Adkins, J., & Larkey, S. (2013). Practical mathematics for children with an autism spectrum disorder and
other developmental delays. London: Jessica Kingsley Publishers.
Browder, D. M., & Spooner, F. (2011). Teaching students with moderate and severe disabilities. New York:
The Guilford Press.
Porter, J. (2011). Autism and reading comprehension: Ready-to-use lessons for teachers. Arlington, TX:
Future Horizons.
10
chapter
Fostering Self-
Determination Skills


■ Define self-determination.
■ Describe the major characteristics of self-determination.
■ Discuss the essential components that support self-determination.
■ Describe several methods for promoting self-determination skills.
■ Discuss methods for teaching self-determination skills for individuals diagnosed with ASD.
281
282 S e c t i o n I v / Moving from School to Life
Chapter 10 Mind Map

Personal Characteristics
Defining Self-Determination Social Skills
Making Decisions & Deriving Solutions to Problems Limited Repertoires

Barriers to Self-Determination for Individuals with ASD
Monitoring Self Health
Teaching Essential Components of Self-Determination Fostering Self-Determination Skills
Appraising Skills Accurately Environment
Adapting to Environments Social Variables
Practicing Self-Determination Skills Evidence-Based Practice Methods for Teaching Self-Determination Skills
Self-Determined Model of Instruction
Defining Self-Determination
The term self-determination implies a multitude of meanings for different people.
Within the field of special education, self-determination has been rigorously devel-
oped into a composite set of skills that is a necessary part of an appropriate educa-
tion for individuals with disabilities. For an extensive history of the development of
the term self-determination, see Wehmeyer (1998). Wehmeyer (1999) stated that self-
determination had been defined in the disability literature in a number of different
ways. These included self-determination being identified as a basic human right, as
a group of specific behaviors that result in similar consequences (response class), and
as a product of the functional properties of a set of behaviors. He went on to discuss
how each of these was an inadequate description of the concept of self-determination.
In general, there is not a single definition of self-determination that is uniformly
accepted among researchers, and there are numerous definitions and curriculums that
have been developed (Karvonen, Test, Wood, Browder, & Algozzine, 2004). One of
the most appropriate definitions appears to come from Wehmeyer (1996) who defined
self-determination as “acting as the primary causal agent in one’s life and making
choices and decisions regarding one’s quality of life free from undue external influence
or interference” (p. 22). This is the definition of self-determination that will be used
throughout this chapter.
Wehmeyer, Kelchner, and Richards (1996) conducted a study with 407 individu-
als with intellectual disabilities and concluded that there were some essential char-
acteristics to self-determination that included individuals empowering themselves,
becoming autonomous, and understanding their personal selves. These characteris-
tics were considered an essential part of functioning in a way that allows a person to
function in an independent and self-reliant manner. They stressed that individuals
with intellectual disabilities not only needed specific skills training to become self-
determined individuals, but that they also needed exposure to a multitude of environ-
ments that allow for greater choice and control of their lives. Figure 10.1 offers some
basic characteristics of self-determination for individuals diagnosed with ASD.
Based on his continuing research, Wehmeyer (1999) proposed a functional
model of self-determination. This model derived self-determination as developing
from input from different areas that included instruction, development, environment,
c ha p t e r t e n / Fostering Self-Determination Skills 283
Figure 10.1 Some basic characteristics of self-determination for individuals diagnosed with ASD
Category Description
Communication The ability to express personal desires, preferences, and interact effectively with others
Mobility The ability to move around his/her environment as desired and gain access to preferred
settings and situations
Psychological Having an understanding of personal limitations and weaknesses and achieving an atti-
tude of personal value
Supports Being able to identify and utilize the available resources and supports that are available
such as family, peers, community resources, and so on
and experience. These areas interact with the individual’s capacity for learning and
development, their opportunities for interacting with the environment, and their per-
sonal beliefs. This model has permitted researchers to further their understanding
of the degree to which individuals with disabilities are self-determined and to move
toward the development of instructional strategies to promote self-determination
among individuals with disabilities. This chapter will focus on strategies for teaching
the skills and arranging the supports necessary to become self-determined along with
examining the barriers to becoming self-determined.
Barriers to Self-Determination for Individuals with ASD

There are several types of barriers that can hinder the efforts of individuals with ASD
toward becoming self-determined. Figure 10.2 provides a list of some potential bar-
riers that individuals diagnosed with ASD may have to overcome in order to become
self-determined. This is not an exhaustive list but provides some indication of the
types of obstacles that may exist.
Personal Characteristics
Communication. Individuals diagnosed with ASD frequently have difficulties com-

municating. These communication difficulties can lead to frustration, inappropriate
behaviors, and cause difficulties interacting with others. If you have ever traveled to a
country where you did not speak the language, you may have experienced some dif-
ficulties in even very simple activities because of language barriers. For example, if you
want to make a purchase and you do not speak the same language as the person who is
selling the item, you may not be able to find out specific information about the item,
you may have difficulty explaining which item you would like to purchase, you may
have difficulty determining the price of the item, and so forth. If communication is an
issue, it can definitely be a barrier to engaging in self-determined behavior. In order to
express their preferences, wants, and desires, individuals diagnosed with ASD need to
Figure 10.2 Some potential barriers to self-determination for individuals with ASD
Personal Social
Environment
Characteristics Variables
Integration with Lack of social

Communication
peers support
Insufficient
Social skills Abuse
curriculum
Limited Limited
Neglect
repertoires opportunities
Over-
Health protectiveness of
significant others
be provided a clear method for sharing these with others. To overcome communica-
tion barriers, it may be necessary for individuals with ASD to utilize different methods
of communicating, such as writing down their ideas, making videos of themselves, or
using photos, drawings, or even objects so that others can understand them. If you are
attempting to make a purchase from someone who does not speak the same language
you do, then you may need to utilize various alternative strategies for communicat-
ing such as pointing to an item, holding up your fingers to indicate an amount, using
pictures from a book or magazine, or attempting to use a book or device to help you
translate. Communication issues can be a barrier to becoming self-determined and
need to be addressed on an individual basis to develop the most appropriate methods
to overcome these types of barriers.
Social skills. Interacting with other people can be difficult for most anyone depend-
ing on the situation, the circumstances, and various personality characteristics, such
as being extraverted or introverted. Interacting with others can prove to be especially
problematic for some individuals with ASD because of a limited repertoire of social-
ization skills that they may have available to them. They may also frequently engage
in behaviors that others do not find appealing or they may choose to avoid socializing
with others as much as possible. For example, some individuals diagnosed with ASD
may display stereotypical behaviors such as body rocking, hand flapping, limited eye
contact, and so on. Others with ASD may have very limited interests or may display
behaviors that seem rude or offensive to others. Some individuals diagnosed with ASD
may engage others in conversation, but the conversation may be focused on topics
that are very specialized and that only individuals with knowledge of the topic can
understand. For example, a person diagnosed with an ASD who has an interest in
professional wrestling may begin talking to a stranger about the most recent profes-
sional wrestling match, even though the other person has no knowledge or interest in
the topic. In addition, the person diagnosed with an ASD may not recognize that the
other person is not interested or does not want to talk about the topic and thus contin-
ues to talk about the topic until the other person moves away from him/her. In other
instances, a person diagnosed with an ASD may stand too close to someone when
speaking to them, may engage in excessive bragging about him-/herself, or may ask
inappropriate personal questions of others. These are just a few examples of behaviors
that may preclude individuals diagnosed with ASD from developing substantial peer
relationships and can be definite barriers toward becoming a self-determined individ-
ual. Without necessary social skills, efforts toward self-determination can be hindered.
Limited repertoires. Individuals diagnosed with ASD can have very limited skill
sets that do not provide much variation in how they behave. This can include lack
of variation in conversation, highly restricted interests, or very repetitive patterns of
behavior or rigidity of thought. As mentioned previously, a person diagnosed with
an ASD may have a very intense interest in a subject, such as professional wrestling,
which can result in frequent discussions about the topic to others who are not inter-
ested. One method for assisting the person with the interest in professional wres-
tling would be to help him/her find others who have similar interests and who enjoy
discussing the topic. Another method would be to help the individual develop other
interests so that he/she can carry on discussions about topics that have a wider appeal
to others and can therefore support relationship development with a greater variety of
people. Expanding upon behavioral repertoires can be a part of becoming self-aware
of both strengths and weaknesses. A person diagnosed with an ASD may need to focus
on becoming aware of his/her own well-developed skills and where his/her skills may
be lacking, and use this as a means for expanding behavior repertoires. Narrow reper-
toires can prove difficult for individuals diagnosed with ASD when they are learning
to become self-determined, as they may need to expose themselves to various options
and settings in order to make informed decisions that reflect their true desires.
It may be difficult for a person diagnosed with an ASD to make decisions about
careers or living arrangements if he/she has never had opportunities to learn about
differing career choices or to experience living in different types of settings. For an
example, making a career choice might involve gathering information about different
jobs, the type of training needed for the job, learning about the specific skills needed
for the job, evaluating the potential pay range associated with the job, determining the
opportunities available for specific jobs, and so forth. Without an expansive repertoire
of experiences and knowledge, informed decision making is limited and therefore self-
determined actions are hindered.
Health. Heller et al. (2011) pointed out that individuals with developmental disabil-
ities have higher rates of health problems than their typically developing peers, which
can be a barrier to self-determination. In addition, it was noted that this is an area
where self-determination could be highly needed in order to obtain necessary health
care. Individuals diagnosed with ASD may have difficulty seeking out the health care
that they need, letting others know when they have health problems, or understanding
the need to care for themselves. In addition, they may display such limited interests
that they neglect any interest in caring for themselves. Similarly, their limited interests
may lead to health problems such as a diet that does not include enough variety to
incorporate adequate nutrition, or a restrictive pattern of activities that does not pro-
vide an adequate amount of exercise. Teaching self-determination skills to individuals
diagnosed with autism could help them to self-manage their health care and lead to
improved health-related outcomes.
Environment
The environment may serve as a barrier to the development of self-determined behav-
ior. Environments that do not provide integrated activities for individuals diagnosed
with ASD can limit their opportunities to learn from others. Many schools do not
teach the essential components of self-determination, such as problem solving and
goal setting (Agran & Wehmeyer, 1999; Agran, Blanchard, Wehmeyer, & Hughes,
2002). A curriculum is needed that supports the development of self-determined
behavior; otherwise this can be a barrier. Other environmental barriers can be based
in the limited opportunities available. Sometimes these limitations may be due to the
lack of established relationships between schools and community agencies, or in other
cases it may be a result of isolated communities with very limited resources.
Social Variables
The need for social support in the form of teachers, parents, peers, and others can play
a significant role in the development of self-determined behavior. The absence of a
teacher, role model, or supportive person to provide some form of direction toward
becoming self-determined can be a definite barrier. Parents and teachers need to be
willing to allow the person with an ASD to make his/her own choices and express
desires to a degree that allows him/her to make mistakes. In many cases, individuals
with ASD may need to act upon some of their own decisions, even if the result is not
what is desired. Some of the best lessons that a person can learn may come from expe-
riences in which he/she fails. If individuals are sheltered from failure and not allowed
to act upon their own decisions, they may never come to understand the importance
of the decisions they make. While it is also important for those supporting an indi-
vidual with an ASD to ensure the safety of the person, they also need to evaluate and
allow for the experience of failure in some cases.
This type of well-rounded support from others can sometimes prove very dif-
ficult, especially when significant others do not view the person as competent at mak-
ing his/her own choices. It can in many cases also be easier to just make decisions for
a person with an ASD rather than trying to encourage the individual to act on his/
her own behalf. In addition, individuals with developmental disabilities are at higher
risks for abuse and neglect from others than their typically developing peers (Powers
et al., 2002). Allowing individuals diagnosed with ASD to act upon their own deci-
sions may expose them to some situations in which they could be at risk for some
problems. These factors need to be considered and the potential benefits versus the
associated risks should be evaluated. When the potential benefits are greater than the
potential risks, the decision of the person diagnosed with an ASD should be highly
considered. These factors can sometimes lead significant others to become overly
protective of the person with an ASD, and thus be a barrier to the person becoming
self-determined.

Video Game Enthusiast
Charles is a 17-year-old who has a diagno- club, which in reality did not exist. Charles was
sis of high-functioning autism. Most anyone willing to do these types of demeaning activities
who has ever spoken with him knows that he repeatedly and never seemed to really under-
has a fascination with video games because he stand that his classmates were using him for
always seems to direct the conversation toward their entertainment. His teachers say that he is
the topic of video games. He has a very diffi- actually a good student in his classes, although
cult time maintaining relationships with his he causes problems during group work activities
peers because they consider him to be obsessed because he has difficulty staying on the assigned
with video games. Most of his peers consider topic and continually initiates conversations
him to behave very strangely because when- about video games. His parents would like for
ever they speak with him he talks about video him to attend college and his teachers say that
games even though they may not be interested his grades are good enough for him to be admit-
in the topic. Some of his peers have also been ted to college and be successful. Charles has a
known to encourage him to do things that can part-time job that he obtained completely on
get him in trouble because he does not seem to his own; he works at a store that sells new and
mind doing things that others find embarrassing used video games as well as other items such as
as long as his friends tell him he is involved in movies and books. He always spent a great deal
a sort of role-playing game. On one occasion, of time in the store and the owner asked him
his classmates talked him into running through if he would like a job working there. Charles
the school in only his underwear while carry- stocks shelves, prices items, and answers ques-
ing a plastic sword and shouting, “I am here to tions for customers about video games. The job
slay the dragon.” They told him if he did this allows him to earn money to buy video games,
then he could be a part of their secret gaming get discounts on his purchases, and see the
(continued)

newest video games as soon as they are released. Discussion Questions
Charles feels this is his dream job and says that
1. Pretend that you are a facilitator at a tran-
he wants to work that job forever.
sition planning meeting and you are try-
Charles has told his parents and his
ing to work with Charles, his parents, and
teachers that he does not want to go to college
his teachers to resolve what he should do
because he can work more hours at the video
after his graduation. How would you work
game store once he finishes high school. His
with Charles and others around him to
parents and teachers feel that he needs to take
come to a decision?
some college courses or at least complete a trade
school so that he could get a job that could pay 2. How would you support Charles to be a
him more money, since his current job only pays self-determined individual in his decision
very minimal wages. His parents have stated that making?
as long as he works at the video game store, he 3. Who should have the most input
will never earn enough money to live indepen- toward deciding what Charles does after
dently, and as long as he stays at their house, graduation?
they should have input on what he does with his
4. Would you consider Charles to be
life. Charles does not seem interested in con-
self-determined?
tinuing his education or looking for other jobs,
but those around him are continually trying to 5. Is Charles making the most appropriate
encourage him to change his mind. life decisions?
Teaching Essential Components

of Self-Determination
Self-determination is a broad skill that can be learned and can have a significant influ-
ence on outcomes for students. Wehmeyer and Schwartz (1997) investigated the out-
comes of youth with intellectual or learning disabilities into adulthood and found
that those who were self-determined were more likely to achieve positive outcomes.
They administered self-determination scales to 80 students with cognitive disabili-
ties who were close to graduation from high school, and then conducted a follow-up
survey a year later with the same group after they had graduated. They found that
self-determined adults with cognitive disabilities had higher rates of employment
and higher earnings than their non-self-determined peers with cognitive disabilities.
These findings stress the importance of providing appropriate programs to teach self-
determination to individuals diagnosed with ASD early in life so that they can utilize
these skills to improve their future outcomes.
Teaching self-determination can be enhanced by breaking it down into some com-
ponent parts. Wehmeyer (1996) stated there were several component elements from
which self-determination emerged (see Figure 10.3). These component elements cover
skills, attitudes, and beliefs that could be taught in order to promote self-determined
behavior. Some of the most relevant elements for teaching self-determination skills to
individuals diagnosed with ASD are listed in Figure 10.3 and will now be discussed.
Figure 10.3 Some considerations for teaching self-determination skills to individuals

diagnosed with ASD
Deriving
Making Monitoring
Solutions to
Decisions Self
Problems
Appraising
Adapting to
Skills
Environments
Accurately
Making Decisions and Deriving Solutions to Problems

Wehmeyer and Schalock (2001) indicated that self-determination needs to have a
basis that begins early in life. While some components of self-determination may be
connected to maturity level, some of the more basic elements can be learned at a very
early age. Some important components of self-determination that can be important at
an early age include making choices and solving problems (Heller et al., 2011). Very
young children can be exposed to situations in which they can make choices or deci-
sions and they can learn from these experiences their own preferences and become
more efficient in these situations.
Three 2-year-old children diagnosed with autism were the subjects of a study
on choice making conducted by Reinhartsen, Garfinkle, and Wolery (2002). They
compared the effects of having a teacher select a toy for the children versus allowing
the children to make a toy choice. They found that toy play increased and problem-
atic behavior decreased for two of the three boys when they were allowed to make a
choice. Similarly, Tiger, Toussaint, and Roath (2010) found choice-making opportu-
nities improved rates of responding for two out of three young children diagnosed
with ASD. They concluded that choice may be beneficial for some children with ASD,
while others may need additional interventions to increase their responding. Another
study by Koegel, Singh, and Koegel (2010) evaluated the influence of choice-making
opportunities on four young children diagnosed with ASD. They compared situations
in which the children were offered no choices in the task to situations in which the
children could make a choice in the activities to complete. They found that when the
children were provided with choices, the rate of disruptive behaviors decreased and
the rate of task engagement increased. These studies show that offering choices to
young children diagnosed with ASD may provide some beneficial outcomes for some,
but not all, of these children.
Agran et al. (2002) taught four middle school students diagnosed with autism
to set goals and use problem solving to achieve the goals. The students were assisted
in establishing goals for themselves and then were taught a problem-solving program
that they were to use to help them meet their goals. All of the students were able to
exceed their personally set goals during the course of the study.
Monitoring Self
Self-management is usually composed of a package of techniques used by learners to
manage their own behaviors (Alberto & Troutman, 2013). The most widely used tech-
niques in self-management are self-monitoring and self-evaluation (Heward, 2009),
but other techniques such as self-instruction, self-reinforcement, and goal setting may
also be included in a self-management package. Figure 10.4 provides some defini-
tions and examples of some possible components of a self-management package used
for learning to safely clean a spill in a public place. Self-monitoring can be defined as
when a person watches him-/herself as he/she performs a task (self-observation), and
then documents what he/she observed (self-recording). Self-evaluation can be defined
as when a person compares his/her performance to some standard or goal he/she has
set and judges whether he/she is performing adequately or if improvement is needed.
Goal setting involves establishing criteria for one’s self that the person would like to
meet. Self-instruction involves providing one’s self with prompts to assist with accom-
plishing a task. Self-reinforcement involves a person providing him-/herself with a
reward for accomplishing some preset criteria. Each of these techniques can be useful
for individuals with disabilities and can lead toward increased self-determination.
Newman and colleagues have developed a line of research demonstrating the
effectiveness of self-management techniques for individuals diagnosed with autism.
They stress that self-management techniques shift control away from a teacher to a stu-
dent and thus promote independence for the student. This is an important factor that
supports both the autonomy and self-regulation characteristics of self-determination.
Newman, Buffington, O’Grady, McDonald, Poulson, and Hemmes (1995) evaluated
a self-management package that included self-reinforcement used by three teenagers
with autism. The participants had difficulty transitioning according to a schedule of
daily activities. The participants were taught to accurately identify when transitions
should take place and then self-reinforce appropriately. The self-management pack-
age was demonstrated as maintaining effectiveness after one month of discontinuation
of the treatment. Similarly, Newman, Tuntigian, Ryan, and Reinecke (1997) demon-
strated how a self-management procedure could be used to reduce disruptive behav-
iors displayed by three students diagnosed with autism. These students were taught
to self-reinforce with tokens following a period of time during which they did not
display targeted inappropriate behaviors. The students were able to maintain the self-
management procedures after prompts were removed.
Newman, Reinecke, and Meinberg (2000) demonstrated that self-management
procedures could be used to increase variability in language and play skills for stu-
dents with autism. They taught self-management skills to three children with autism
who engaged in perseverative patterns of play or language skills. The children self-
reinforced with tokens whenever they engaged in a variation of behavior that was
observed during baseline conditions. The procedure was effective for all three partici-
pants and maintained at a one month follow-up.
Figure 10.4 Some possible components of a self-management package for cleaning

a spill
Self-Management Package
Goal Setting
Goal: Complete all steps necessary to safely clean a spill in a public place.
Self-Instruction
List all the steps necessary to complete the task. Read each step and complete each
step in order using the list.
Self-Monitoring/Self-Observation
Check to see if all steps in the process have been completed. Video the task as it is
being completed, and then watch the video.
Self-Recording
Develop a scoring rubric to allow each step in the process to be checked off as
it is completed.
Self-Evaluation/Self-Reinforcement
Evaluate the accuracy and efficiency with which the task is completed. If the task
completion is evaluated as having high quality then provide reinforcement.
These series of studies on self-management by Newman and colleagues dem-

onstrate that self-management can be a very useful technique for individuals diag-
nosed with autism. Following activity schedules, decreasing disruptive behaviors, and
increasing variability in responding are all important skills and they can be barriers
for individuals with autism. Learning self-management skills can move individuals
with autism toward becoming more self-determined individuals. In addition, self-
management techniques can be developed in several different formats in order to
meet the needs of the person utilizing the self-management system. Visuals can be
developed in the form of pictures, drawings, or written sentences that can be used
depending on the skills of the person using the self-management system. These sys-
tems can include auditory prompts for a person to observe his/her own behaviors,
or they could involve a physical prompt such as a vibration that alerts the person to
document his/her behaviors. While a self-management system could involve having
another person providing the prompts to someone else by telling them, making a
noise, or providing a physical prompt, these types of systems can usually be developed
to function independently from reliance on others. The use of technological devices,
such as timers, vibrating alarms, or software notification programs, can allow these
types of self-management systems to function independently. The most appropriate
type of self-management system would be one that functions well and allows a person
to utilize the system as independently and as discreetly as possible.
Several other studies have also shown that self-management strategies can be
beneficial for individuals with autism in a variety of settings to address a wide range
of behaviors (e.g., Koegel, Koegel, Hurley, & Frea, 1992; Mancina, Tankersley,
Kamps, Kravits, & Parrett, 2000; Pierce & Schreibman, 1994). Lee, Simpson, and
Shogren (2007) conducted a meta-analysis of single-subject research that utilized self-
management strategies with individuals diagnosed with autism. They determined that,
overall, the research has demonstrated that self-management procedures are an effec-
tive method for increasing the frequency of appropriate behavior among those diag-
nosed with autism.
Accurately Appraising Skills

A great deal of research has been conducted on self-efficacy as a variable related to
performance outcomes, but little research has been done on how self-efficacy influ-
ences individuals diagnosed with ASD. Self-efficacy has been defined as self-appraisal
of capabilities (Bandura, 1984). The presence of strong self-efficacy has been associ-
ated with how much persistence a person displays when attempting to overcome some
obstacle and what type of coping skills the person may utilize. Bandura (1989) has
pointed out that when self-efficacy is stronger, a person will be more likely to establish
higher goals for him-/herself and, in addition, be more likely to attain the goals set.
While limited research has been conducted on the self-efficacy construct with individ-
uals diagnosed with ASD, it would appear that as they become more confident about
their abilities, they would in turn be more capable of setting realistic goals and attain-
ing those goals. Myers, Ladner, and Koger (2011) expanded on this by suggesting that
individuals with autism who are taught to appreciate their autistic identities could be
more successful in mainstream society. Individuals with ASD may need to be taught to
gain better understandings of themselves and how they belong within society. Myers
et al. (2011) indicated that individuals with autism have a bicultural identity and they
need to be taught how autism is perceived within society and how they can enhance
their potential to belong within society.
Adapting to Environments
Some of the components of self-regulated behaviors include self-evaluation, self-
reinforcement, and self-advocacy. Self-evaluation consists of rating one’s behav-
iors according to some criteria that indicates whether the behaviors were desirable.
Sainato, Goldstein, and Strain (1992) taught preschoolers with autism to self-evaluate
their social interactions with peers. They found that the self-evaluation improved
the social behaviors of the children with autism and increased their interactions with
peers. Similarly, Stahmer and Schreibman (1992) used self-evaluation to teach three
children with autism to play appropriately in unsupervised settings while simultane-
ously decreasing self-stimulatory behaviors displayed by the children. Video feedback
is another medium that has been used to promote self-evaluation by students with
autism. Theimann and Goldstein (2001) used video feedback as a method for children
with autism to self-evaluate their social communication. They allowed the children to
evaluate their social interactions by watching themselves on video and then critiquing
their performances. This self-evaluation, along with the use of Social Stories and writ-
ten prompts, was effective toward improving their social communication skills.
Self-reinforcement consists of providing one’s self with a reward for accomplish-
ing a task, so as to increase the likelihood of the task being completed again in the
future. Self-reinforcement has been shown as an effective strategy for individuals diag-
nosed with ASD (Newman, Buffington, & Hemmes, 1996; Southall & Gast, 2011).
Singh, Lancioni, Manikam, Winton, Singh, and Singh (2011) described a mindfulness
strategy for addressing aggressive behavior that included a self-reinforcement compo-
nent. Adolescents diagnosed with autism were taught a self-management strategy and
how to self-reinforce in the absence of aggressive behaviors. The treatment was found
to be effective for self-managing the participants’ aggression.
EBP Methods for Teaching Self-Determination Skills

The component elements of self-determination could be initially taught in isolation,
but need to eventually be synthesized so that they can be supportive of other ele-
ments. In addition, as mentioned by Wehmeyer et al. (1996), individuals with intel-
lectual disabilities need to be exposed to environments that allow them to utilize
self-determination skills. This could involve allowing a person diagnosed with an
ASD to sit in temporarily on various types of optional classes, providing him/her with
opportunities to work in different types of jobs, or taking him/her to view several dif-
ferent types of possible living situations. After each of these different types of oppor-
tunities, the person diagnosed with an ASD would need to be asked about how he/she
enjoyed the experience and if he/she would like to become more involved in similar
situations. For those who are limited in their ability to express themselves, efforts can
be taken to observe how they react to different environments and compare reactions
to various settings.
While a large number of studies have been published on the topic of self-
determination, Algozzine, Browder, Karvonen, Test, and Wood (2001) conducted a
meta-analysis that determined that few studies met their analysis criteria, and these
studies reflected an overall moderate effect size for instructional interventions. The
Algozzine et al. study found that the majority of the self-determination research
focused on teaching choice making, self-advocacy, decision making, and problem solv-
ing. The strategies can be taught in a variety of ways, but may be enhanced by using
some basic principles of learning and by incorporating available technology. A few of
these strategies will now be discussed.
Modeling is a method that has been utilized for teaching self-determination skills.
Modeling may occur in vivo or through the use of video. In vivo modeling involves hav-
ing a person perform a behavior while another person who is attempting to learn the
behavior watches and then attempts to perform the same behavior. The video model-
ing process is similar, but involves recording a model perform some task on video and
then the person who is attempting to learn the task will watch the video. If the model
in the video is the same as the person watching the video, it is then referred to as video
self-modeling. The person watching the video will then attempt to perform the task in
a manner similar to the model in the video or attempt to perform the task more effi-
ciently than the model in the video. The process is grounded in Bandura’s (1977) social
learning theory, which posits that people learn behaviors by watching others perform
the behaviors. Some of the requirements for social learning to take place include the
ability to attend to details of a model, remembering the behavior of the model, the
capacity to duplicate the physical movements of the model, and motivation to observe
the model. While these may at times be difficult for individuals diagnosed with ASD,
there have been some studies indicating that the process can be successful. Mechling
(2005) reviewed the literature on the use of video to teach students with disabilities
and determined that the process appeared to be effective especially for individuals
diagnosed with ASD because the technology could be highly appealing for these indi-
viduals. Similarly, Bellini and Akullian (2007) conducted a meta-analysis of 23 single-
subject research design studies that utilized video modeling or video self-modeling for
teaching children and adolescents diagnosed with ASD. They found these techniques
to be effective for teaching social-communication skills, functional skills, and appro-
priate behaviors to children and adolescents diagnosed with ASD.
Practicing Self-Determination Skills

One method for promoting self-determination skills among students diagnosed with
ASD is to arrange for opportunities for them to practice these skills. One occasion for
practicing self-determination skills is within the IEP development. Students should
be involved in their IEP development to the level that is appropriate for them. In
Consider This
The Self-Determination Synthesis Project as well as parent information and professional
sponsored through the University of North organizations. They also have developed lesson
Carolina–Charlotte and directed by David Test plan starters for teaching self-determination
and colleagues developed a website (http://sdsp skills. These lesson plan starters were developed
.uncc.edu) that offers numerous links to resources by reviewing data-based research studies and can
on self-determination. The website provides be modified by teachers when developing cur-
syntheses of research on self-determination, riculums that focus on self-determination.
many cases, these students can not only be present for the meetings, but also provide
meaningful contributions to the discussions and offer useful insight into their personal
concerns and desires. In other cases, this may be an opportunity for the individual
diagnosed with an ASD to lead the IEP meeting and/or write the IEP document. The
National Information Center for Children and Youth with Disabilities (2002a, 2002b)
has developed materials for helping students learn more about the IEP process,
including terminology, laws, and requirements. In addition, these materials provide
a set of steps that a student can use as a guide to help him/her lead the IEP meeting
and write his/her own IEPs. Similarly, Field, Martin, Miller, Ward, and Wehmeyer
(1998) outlined several exemplary educational activities that teachers could use to
promote self-determination among students with disabilities. They provided several
specific activities arranged by categories such as assessment, IEP development, and
transitioning.
Self-Determined Model of Instruction

Another more formalized model for teaching self-determination has been developed
that is based on problem solving and self-regulation theory and is called the Self-
Determined Model of Instruction (Mithaug, Wehmeyer, Agran, Martin, & Palmer,
1998; Wehmeyer, Palmer, Agran, Mithaug, & Martin, 2000). This model was devel-
oped for students with or without disabilities and emphasizes self-directed learn-
ing (Wehmeyer et al., 2000). As described by Wehmeyer et al. (2000) the model is
comprised of a three-phase instructional process with each phase presenting a prob-
lem that is solved by answering four questions. The model is designed to be used by
teachers whose teaching objectives are achieved by the student engaging in a self-
directed problem-solving sequence with educational supports as needed. Wehmeyer
et al. (2000) field tested the model across two states with 21 teachers and 40 students
diagnosed with disabilities. They determined that the model could be effectively used
with student diagnosed with different disabilities across a wide range of different edu-
cational content areas.
Subsequent research on the effectiveness of the Self-Determined Model of
Instruction has shown that the model can be utilized effectively in several different
ways. Agran, Blanchard, and Wehmeyer (2000) found that the model could be effec-
tive for promoting transition goals for middle- and high-level students diagnosed with
disabilities. They examined the effectiveness of the model implemented by six teach-
ers using a delayed multiple baseline across three groups of the students for teaching
student-selected transition goals. They found that 17 of the 19 students in the study
achieved substantial gains from baseline to intervention. The gains were such that they
exceeded the expectations of the teachers and the students reportedly liked the process.
Similarly, Agran et al. (2002) taught four students with disabilities, including one
diagnosed with autism, to use problem-solving skills to achieve self-set goals. They
utilized the Self-Determined Model of Instruction within a multiple baseline design
across participants. Their findings indicated that the students were able to use the
model entirely within a general education classroom setting to attain self-selected
goals. The model has also been shown by McGlashing-Johnson, Agran, Sitlington,
Cavin, and Wehmeyer (2003) to be effective at enhancing self-selected job skills
for students with moderate to severe disabilities. Another study by Agran, Cavin,
Wehmeyer, and Palmer (2006) used the Self-Determined Model of Instruction to
teach academic tasks from the general curriculum for three junior high students with
moderate to severe intellectual disabilities. All three students were able to master the
academic tasks and reported satisfaction with the program.
Several other studies have demonstrated the effectiveness of the Self-Determined
Model of Instruction in various ways. Palmer (2003) demonstrated its usefulness for
teaching elementary-age children. Palmer, Wehmeyer, Gipson, and Agran (2004)
taught middle school students using the model to gain greater access to the gen-
eral curriculum. In addition, the model has been modified into the Self-Determined
Career Development Model to focus more specifically on career goal attainment
(Benitez, Lattimore, & Wehmeyer, 2005; Wehmeyer, Lattimore, Jorgensen, Palmer,
Thompson, & Schumaker, 2003).
Overall, the Self-Determined Model of Instruction has been shown to be effec-
tive with several different populations of students for teaching several different tasks.
While some of these studies show great promise for using the model with individu-
als with disabilities, it appears relatively few of the participants in the studies were
diagnosed with ASD. The model could be an effective tool for promoting self-deter-
mination among individuals diagnosed with ASD, but more research is needed to
demonstrate its effectiveness with this specific population.

The University of Alaska–Anchorage Center for Human Development has devel-
oped a self-determination tool kit that offers curriculum, activities, lessons plans, and
other materials for teaching self-determination. Their tool kit focuses on the Alaska
Content Standards and provides teachers with a comprehensive resource for incorpo-
rating self-determination in classroom settings. They provide some video testimonials
of students discussing their journeys toward self-determination. In addition, they are
developing a set of comic books that describe a person who becomes self-determined.
Their website can be viewed at: www.uaa.alaska.edu/centerforhumandevelopment
Chapter Summary
This chapter has focused on describing the skills that can help people diagnosed with
ASD to become the “primary causal agents” of their life. Students who become involved
in directing their education have better outcomes after graduation. They can use their
self-determination skills throughout their lives in order to achieve their desired goals.
The skills that encompass self-determination can include self-management, goal set-
ting, self-efficacy, and several other components. These are skills that can be taught in
isolation or combined within an overall self-determination curriculum.
1. Research a component skill of self-determination and describe how it could be taught

to an individual diagnosed with an ASD and how the skill could be used to improve
some area of his/her life.
2. Attend an IEP meeting for a student diagnosed with an ASD. Write down how the
student displayed some aspects of self-determination. Determine some additional ways
that the student could display self-determination skills.
3. Find an article that utilizes a component skill of self-determination. Use the article to
develop a lesson plan that focuses on enhancing self-determination skills.
R e s o u r c e s t o C o n su l t
Websites
Alaska Center for Human Development The Self-Determination Synthesis Project
www.uaa.alaska.edu/centerforhuman http://sdsp.uncc.edu
development
Book
Gordon, J., Kantor, A., Woodard, C. R., & Lipsitt, L. P. (2011). How everyone on the autism spectrum
young and old can . . . become more resilient, be more optimistic, enjoy humor, be kind, and increase self-
efficacy: A positive psychology approach. Philadelphia, PA: Jessica Kingsley.
11
chapter
Transition to Adulthood

■ Discuss the relevance of transition planning for individuals diagnosed with ASD.
■ Describe individuals who should potentially be involved in the transition process.
■ Discuss areas relevant for inclusion in the transition process.
■ Describe the person-centered planning process as a component of transition planning.
■ Identify methods for promoting interagency collaboration and partnerships useful in transition
planning.
■ Recognize the components necessary for a quality transition plan.
298
c h a p t e r e l e v e n / Transition to Adulthood 299
Chapter 11 Mind Map

Identifying Learner & Family Goals, Hopes, & Dreams The Importance of Transition Planning
Identifying Individual Strengths, Capacities, & Supports Employment

Person-Centered Planning Transition Planning Process
Identifying Challenges That Pose Barriers & Formulating Solutions Transition to Community Integration & Recreation
Adulthood Providing Training Across All Relevant Domains
Determine Types & Intensity of Supports Needed Postsecondary Education
Promoting Self-Determination & Choice Making in the Planning Process Community Living
Promoting Quality Assurance in the Transition Process Building Interagency Collaboration & Partnerships
The Importance of Transition Planning

Transition planning is important for individuals diagnosed with ASD not only because
of the legal requirements, but also as a means for them to achieve lives that are sub-
stantial and meaningful. A transition can be viewed as a point in the life of an individual
at which he/she moves from one set of circumstances to another set of substantially
different circumstances. These “transition points” may include minor changes, or
they may involve major changes that are highly comprehensive and impact numerous
aspects of a person’s life and welfare. Figure 11.1 provides some examples of some
minor and major transition points. A minor transition point for a child could involve a
transition from the playground back into a classroom setting. A major transition point
for a child might be moving from a first-grade classroom to a second-grade class-
room that introduces a new teacher, new peers, a new classroom, new curriculum, new
expectations, and so forth. Individuals diagnosed with ASD may experience extreme
difficulty with even some minor transition points, and major transitions points can
lead them to experience some very poor long-term outcomes. Minor and major tran-
sition points can be categorized into some broad developmental categories through
which everyone must progress, such as preschool to school-age to adulthood. Each of
these broad categories can involve numerous transitions and may require various types
of transition planning to assist individuals diagnosed with ASD.
One very important and frequently difficult transition point that is the focus
of this chapter is the transition from adolescence to adulthood. This transition point
Figure 11.1 Examples of minor and major transition points
Broad Developmental Minor Transition Points Major Transition Points

Category
Preschool ■ Introducing variety in foods ■ Beginning solid food
■ Interacting with novel people ■ Changes in opportunities to sleep,
■ Interacting with novel equipment eat, play, etc.
(cribs, toys, spoons, chairs, etc.) ■ Learning to sit up, crawl, walk
■ Moving to new environments for ■ Moving to new environments for
brief periods of time extended periods of time
■ Changing clothes ■ Changes in caregivers
■ Potty training
(continued )
300 S e c t io n I v / Moving from School to Life
Broad Developmental Minor Transition Points Major Transition Points

Category
School-age ■ Walking from school bus into school ■ Changes in teachers
■ Moving from playground into school ■ Changes in peers
■ Moving to various locations in a ■ Moving to a new classroom
school (cafeteria, gymnasium, ■ Moving to new curriculum
library, etc.) expectations
■ Finishing one task and beginning a ■ Graduating to a new grade level
new task ■ Moving to a new school
■ Moving from one seat to another
seat
■ Putting away materials and taking
out other materials
Adulthood ■ Generalizing a job skill in a novel ■ Beginning a new job
setting ■ Beginning or ending personal
■ Changes in daily routine relationships
■ Changes in daily interactions with ■ Moving to a new home
others ■ Pursuing additional education
■ Utilizing novel methods for
transportation (driving car, riding
public transportation, etc.)
■ Changes in responsibilities
(cleaning, cooking, health care, etc.)
■ Changes in money management
frequently involves making decisions about employment, further education or train-

ing, and living situations. Adults with disabilities are twice as likely to be unemployed
and three times as likely to live in poverty when compared to nondisabled adults
(National Organization on Disability, 2004). A follow-up study by Billstedt, Gillberg,
and Gillberg (2005) of 120 individuals diagnosed with autism in childhood determined
that 78% had overall poor outcomes in adulthood, such as difficulty finding appro-
priate employment and developing social relationships. A similar study by Cedrlund,
Hagberg, Billstedt, Gillberg, and Gillberg (2008) found that individuals with a diag-
nosis of Asperger’s syndrome achieved better outcomes in adulthood, such as par-
ticipation in postsecondary education and independent living, than those diagnosed
with autism, but their outcomes were still below what would be expected given their
enhanced cognitive abilities. More specifically, Shogren and Plotner (2012) reported
that students with autism and intellectual disabilities had more recognized require-
ments for supports in postsecondary situations than students with other disabilities.
Taylor and Seltzer (2011) researched a sample of 66 young adults diagnosed with ASD
and reported that 56% were employed in sheltered workshops or day activity centers.
Similarly, Howlin, Goode, Hutton, and Rutter (2004) reported approximately 31% of
a United Kingdom sample of 68 young adults with ASD were employed, while Eaves
and Ho (2008) reported from a similar-sized Canadian sample that 45% of young
adults diagnosed with ASD had never been employed. These studies indicate very
discouraging outcomes for individuals diagnosed with ASD, which could potentially
be avoided with some well-developed transition planning.
Given the disparity between postsecondary outcomes for adults with and with-
out disabilities, it is apparent that there is a need for rigorous planning to avoid these
types of outcomes. Amendments to the Individuals with Disabilities Education Act in
1997 and in 2004 have increased the focus on transition planning for individuals with
disabilities by specifying an age for transition services to begin, offering a definition
of transition services, and incorporating content in the IEP related to postsecondary
goals.
Legislation helps to pave the path toward future activities beyond the tradi-
tional school years by requiring educators to begin thinking about how the experi-
ences in school will influence and support subsequent activities after high school.
Preparing students with disabilities, including those with ASD, with a framework to
use in subsequent environments may help them avoid a state of turmoil upon gradu-
ation from high school and ensure that they have some skills necessary to succeed in
the novel environments they will encounter. This type of planning needs to be initi-
ated early on to avoid a last-minute scramble to make decisions, gather information,
offer training, develop relationships, and so forth. IDEA 2004 requires a statement
on transition be included in IEPs for all students by age 16, or earlier if necessary.
These statements also require a focus on postsecondary activities such as employ-
ment, specialized training, further education, and independent living. Figure 11.2
outlines some areas that might be considered important when helping individuals
with ASD prepare for adult roles.
Figure 11.2 Some potential areas to consider when planning adult roles for individuals
with ASD
Work Leisure Housing Relationships Health

College course- Interests Location of residence Family Hygiene
work
Specialized Skills for searching for Type of residence pre- Friends Diet
training leisure activities ferred (house, apartment,
etc.)
Resume Activities frequently Living arrangements Co-workers Exercise
development available locally (family, roommates, etc.)
Interview skills Community leisure Supports needed in home Neighbors Medication
resources (parks, regimen
swimming pools, etc.)
Job search skills Availability of leisure Group home possibilities Community Routine medical
equipment agencies services
Job interest Residential facilities Dating Emergency
evaluation services
Job skill Sexual
assessment relationships
Billstedt et al. (2005) categorized individuals previously diagnosed with autism

in childhood as having a good outcome in adulthood if they were employed or were
receiving vocational training. In addition, if they were more than 23 years old, they
needed to be living independently, and if they were younger than 23 they had to have
at least two friends. They categorized these same adults as having very poor outcomes
if they had an obvious severe disability, an inability to lead an independent existence,
and no clear verbal or nonverbal communication. All of these areas and several others
may have a substantial influence on the quality of lifestyle that a person with an ASD
may experience. Each of these areas needs to be discussed to determine how they can
be designed to meet the preferences of individuals with ASD, occur within their avail-
able finances, and move them toward their long-term life goals.
Transition Planning Process

Assisting individuals diagnosed with ASD typically requires some planning to ensure
that they are prepared to function as adults. The transition planning process involves
designing transition services that are individualized and appropriate to support the
development that needs to occur when a student diagnosed with an ASD moves into
adult life roles. IDEA 2004 mandates that transition planning include specific transi-
tion services and that these services be based on assessment and planning that incorpo-
rates the specific needs, interests, skills, and values of individuals diagnosed with ASD.
Assessments within transition planning might focus on areas such as vocational abili-
ties, academic competencies, recreational interests, social skills, and so forth. These
assessments can help identify domains that require development of specific transition
services to promote access and success with future environments. Wehman, Targett,
and Richardson (2012) indicated that transition curriculums should be individualized,
functional, adaptive, and ecologically oriented. These components should be applied
toward the development of a curriculum that addresses a wide range of possibilities
for individuals diagnosed with ASD. One frequently used method for developing these
types of transition plans is the use of person-centered planning, which will now be
discussed.
Person-Centered Planning
Westgate and Blessing (2005) discussed how person-centered planning has been
around since the 1980s. They defined person-centered planning as “a template for
assisting the individual with disabilities to express and document a living portfolio
and plan for meaningful action toward one’s lifelong goals and desires” (p. 2). Wells
and Sheehey (2012) describe person-centered planning as a process for developing a
profile and future vision for a person with a disability by obtaining input from family
and friends. Each of these descriptions involves placing the individual with a dis-
ability at the center of attention and looking at possibilities for his/her future in an
optimistic manner.
Several models of person-centered planning have been developed, such as the

McGill Action Planning System (MAPS) (Vandercook, York, & Forest, 1989), Personal
Futures Planning (Mount, 2000), and Essential Lifestyle Planning (Smull & Harrison,
1992). Most models follow a similar process that includes organizing a group meeting
among those who know the person with a disability well. Figure 11.3 outlines some
individuals who might be involved in a person-centered planning meeting for an indi-
vidual diagnosed with an ASD.
Everyone attending a person-centered planning meeting is guided by a facilita-
tor to discuss the person’s interests, desires, strengths, weaknesses, and goals for the
future. Once goals are established, a list of steps needed to help the person achieve his/
Figure 11.3 Potential individuals involved in person-centered planning
Parents
Community
Agency Siblings
Representatives
Related Service
Professionals
(speech/language Grandparents
pathologists,
counselors, etc.)
Individual
Coaches (job, Diagnosed Friends
athletic, etc.) with an
ASD
Principals Peers
Special
Teaching
Education
Assistants Regular Teachers
Education
Teachers
her goals is developed, and specific strategies are considered to help the person with
a disability move through each of the steps toward identified goals. In addition, roles
and responsibilities are assigned to those in attendance to monitor progress toward
the goals.
Any number of specific areas can be discussed at a person-centered planning
meeting, but some areas that should be considered include: vocational options, liv-
ing arrangements, leisure activities, health-related needs, socialization opportunities,
financial necessities, and community integration. The strengths and weaknesses that
the person has in each of these areas should be discussed, and areas in need of develop-
ment or expansion should be identified. The attendees should be encouraged to brain-
storm potential options to help the person with a disability progress toward desired
outcomes. This could include creating opportunities for further skill development or
exploration related to expanding a range of interests.
At the close of a person-centered planning meeting, the attendees should be
aware of the goals that have been established, the steps involved in achieving goals,
the strategies that will be implemented, the individuals responsible for monitoring
achievements, and the timelines for meeting goals (Wehman, Targett, & Richardson,
2012). Figure 11.4 outlines some important areas to address when conducting a
person-centered planning meeting for individuals diagnosed with ASD. The types of
information relevant to each of these areas are discussed in the following sections.
Figure 11.4 Important areas to address when conducting a person-centered planning meeting
Goals Steps to
Achieve
Goals
Strategies
Responsible
Individuals
Timelines
Identifying learner and family goals, hopes, and dreams. Individuals diagnosed
with ASD may display a wide range of ideas about what they want to do during their
lifetimes. Similarly, the families of these individuals may also have a wide range of expec-
tations regarding what they would like for their children. Traditionally, person-centered
planning has focused on the wishes of the person diagnosed with an ASD, but it can
potentially be beneficial to also include some of the wishes presented by family members
into planning for the future. In many cases, the family members may be highly involved
in the life of the person diagnosed with an ASD, and any plans that are made may have a
direct impact on their lives.
Hagner, Kurtz, Cloutier, Arakelian, Brucker, and May (2012) found that expand-
ing the person-centered planning process to a more family-centered planning transi-
tion process might be beneficial for individuals diagnosed with ASD. Their research
model involved providing training to individuals diagnosed with ASD and their fami-
lies with an emphasis on educating and empowering participants about the transition
process. They looked at family expectations, self-determination, and career decision-
making abilities for two groups of families and found statistically significant improve-
ments on these variables for one of the two groups.
Frequently, individuals diagnosed with ASD may have some clearly identified
areas of interest that are known to those who are close to them. In some cases, they
may be capable of discussing these interests, and in other cases these interests may
need to be observed by others. Perseveration on certain activities or topics of conver-
sation is characteristic of individuals diagnosed with ASD and may be a starting point
for planning out their future goals, hopes, and dreams. If an individual diagnosed with
an ASD has a repetitive and restricted focus on a certain activity or topic, it may be
beneficial to find some appropriate ways in which this could be incorporated into
planning for his/her future. For example, a person diagnosed with an ASD who fre-
quently discusses horses may need to discuss ways that access to horses could be a pri-
mary component in his/her future vocation, leisure activity, community participation,
and so on. While not all activities or topics may be appropriate, it may still be benefi-
cial to discuss how or if these areas of interest may positively influence the future life
of the person diagnosed with an ASD.
Identifying individual strengths, capacities, and supports. Gaining an under-

standing of how a person diagnosed with an ASD functions is an important part of
person-centered planning. Determining individual strengths and weaknesses can assist
in planning out the type of activities that may offer a “best fit” for future lifestyle. For
example, a person diagnosed with an ASD who has good verbal skills may do well in
a vocational setting that requires frequent verbal interactions. For someone who does
not have well-developed verbal skills, this type of job may not be a best match without
building in some additional supports to ensure success. If there are questions about
the specific strengths of an individual and the types of supports he/she needs, then it
may be necessary to utilize some skill assessments.
Some assessments that can provide useful information on transitions for indi-
viduals diagnosed with ASD are the TEACCH Transition Assessment Profile (TTAP)
(Mesibov, Thomas, Chapman, & Schopler, 2007), the Transition Planning Inventory
(Clark & Patton, 2009), and the Transition to Work Inventory (Liptak, 2008). Each of
these assessments may prove informative for gaining an understanding of strengths
and challenges related to development of future goals for an individual diagnosed with
an ASD.
Identifying challenges that pose barriers and formulating solutions. The

recognition of challenges specific to the individual diagnosed with an ASD is an
important component of the person-centered planning process. Only by identi-
fying and acknowledging barriers can steps be taken to address these challenges.
One method for promoting success when the individual has known limitations is to
simply avoid circumstances that present expectations the person finds difficult. For
example, some individuals diagnosed with ASD display sensitivity to various stimuli,
such as noise, lighting, and crowded locations. Planning future goals for someone
who has these sensitivities could involve, for example, finding a living arrangement
that is quiet, planning shopping excursions during less crowded times of day, or
replacing light bulbs in the work setting. While it may be easiest to avoid exposing
a person to known sensitivities, in some cases it may be beneficial develop a plan
that will assist the individual toward becoming more tolerant of certain difficult
situations or events. This might involve repeated exposure to such situations while
utilizing relaxation techniques or other procedures, and should be supervised by a
professional with training in these techniques. The person-centered planning pro-
cess should promote discussion of such barriers, and potential solutions should be
considered.
Other types of barriers might involve communication skills. Individuals diag-
nosed with ASD may have limited receptive and or expressive communication skills,
or they may have difficulty with the pragmatics involved with communication, such
as how to communicate effectively in social situations. Someone who has limited ver-
bal communication may benefit from the use of augmentative communication that
relies on the use of technology and allows more productive interactions with oth-
ers. Someone who has pragmatic communication deficits may benefit from training
that emphasizes communication competency related to future goals. In workplace set-
tings these are sometimes referred to as soft skills that can be directly taught through
repeated practice, such as shaking hands and looking at someone when they are speak-
ing. These types of barriers and any others that are present should comprise the details
of developing future goals during person-centered planning.
Determine types and intensity of supports needed. In some cases, the formula-
tion of solutions to existing barriers may involve integrating various types of supports.
These supports may include specialized equipment, specialized support personnel,
behavior management plans, or health care regimens. The need for these types of
supports should be considered during the person-centered planning process, and ben-
eficial supports should be procured. In addition to the type of supports that a person
may need, it is important to consider the intensity of the support.
A person diagnosed with an ASD may require someone to assist him/her with
independent living arrangements, but this type of support needs to include consider-
ation of how much assistance is needed. Some individuals diagnosed with ASD may
only need someone to check on them once a week to enable them to live indepen-
dently, while others may need assistance 24 hours per day to ensure they can succeed
in their living arrangements. Similarly, some individuals diagnosed with ASD may be
able to function completely independently at a job, while others may require a full-
time job coach. These types and degrees of support should be discussed during the
person-centered planning meeting, and plans should be made to move the individual
toward a situation that promotes as much independence as possible while ensuring
that he/she has what is needed to be successful.
Providing Training Across All Relevant Domains

Since individuals diagnosed with ASD may display a wide range of abilities, and their
training needs may vary greatly from person to person, the need for training in numer-
ous domains should be considered and addressed in a transition plan, with consider-
ation given to the intensity of the training. A number of different potential training
domains will now be discussed.
Employment
Getting a job after high school can be a difficult task for many people, and for indi-
viduals diagnosed with ASD, these difficulties can be heightened. Training for a job
while still in secondary education can be beneficial toward gaining an informed per-
spective about different vocations and acquiring skills that are valued in the work-
place. Vocational training in secondary schools needs to incorporate a wide array of
opportunities that not only focus on specialized vocational competency, but should
also include several other areas that can enhance adult employment outcomes. Test,
Fowler, et al. (2009) and the National Secondary Transition Technical Assistance
Center (2010) have identified 16 evidence-based predictors of successful post-school
employment (see Figure 11.5). These predictors are not comprised solely of specific
vocational training activities, but encompass other factors such as parent involvement,
self-advocacy, self-care, and social skills. Factors other than work productivity may be
related to successfully acquiring a job and maintaining employment. A person diag-
nosed with an ASD could demonstrate highly competent work skills and be highly
productive, but if he/she is not able to get along with fellow employees, the individual
may have difficulty maintaining a job. Similarly, a person diagnosed with an ASD who
does not engage in self-care and some level of independence may experience job-
related difficulties due to health issues, inadequate hygiene, or tardiness. All of these
are important aspects related to employment, and individuals diagnosed with ASD
need to be provided training to ensure that they are competent in these areas or are
provided with the support to allow them to meet employers’ expectations.
Figure 11.5 Sixteen evidence-based predictors of successful post-school employment
1. Career awareness
2. Community experiences
3. Exit exam requirements/high school diploma status
4. Inclusion in general education
5. Interagency collaboration
6. Occupational courses
7. Paid employment/work experience
8. Parental involvement
9. Program of study
10. Self-advocacy/self-determination
11. Self-care/independent living
12. Social skills
13. Student support
14. Transition program
15. Vocational education
16. Work study
Source: National Secondary Transition Technical Assistance Center (2010)
Community Integration and Recreation

Being involved in the community is an important part of being an adult and may
involve utilizing resources that an individual might not otherwise be able to access
on his/her own. For example, a person who enjoys swimming could buy his/her own
swimming pool, which could be an expensive investment, or the person could find
a community swimming pool that could be used for a much smaller investment.
Individuals diagnosed with ASD need to be provided with the appropriate supports to
ensure they are able to take advantage of the resources that their communities have to
offer. In some cases, this might involve ensuring that individuals diagnosed with ASD
are able to identify resources that they need by searching through available materi-
als such as newspapers and telephone books, or by noting certain radio or television
shows that focus on community activities or resources. The individual diagnosed with
an ASD may also need to arrange for transportation to various locations throughout
the community by learning to follow a map, learning to ride a bicycle, or using public
transportation.
Once resources are identified and transportation is arranged, consideration
should be given to the interactions that may be involved with particular activities. In
order to take full advantage of community opportunities and be accepted into certain
community groups, the person diagnosed with an ASD may need preparation on the
expectations, both for the activity and social aspects. For example, when attending a
public lecture, the audience members are expected to remain fairly quiet, listen to the
directions of the facilitator and/or presenter, and ask questions when they are pro-
vided the opportunity. Someone who distracts others during the presentation, walks
onto the stage during the presentation, or begins interrupting the speaker with ques-
tions or comments could be asked to leave. These types of social expectations may be
important components of ensuring that a person diagnosed with an ASD is integrated
into the community as fully as possible.
Recreational opportunities may be a key way to promote integration of the indi-
vidual diagnosed with an ASD into the community. If the person has some well-defined
interests, he/she may be highly motivated to engage in community activities related to
these. For example, a person who has a high level of interest in sporting events might
attend various sporting events, join a local sports team, or go to restaurants or bars
that show sporting events. For individuals who have very limited interests, it may be
necessary to expose them to a wide range of different recreational activities to evaluate
how well they may enjoy each activity.
Postsecondary Education
For many individuals diagnosed with ASD, the ability to succeed in adult life may
be enhanced through additional education beyond what they receive in high school.
The job market is continually in need of individuals with specialized skills, and
through appropriate education and training, individuals diagnosed with ASD can
potentially increase their marketability in the workplace. Postsecondary education
can be categorized into three broad areas that include college/university level edu-
cation, adult education, and vocational education. Colleges and universities provide
traditional coursework leading toward a formal degree. Adult education courses
can be offered by colleges and universities or may take place in other settings, such
as learning centers. Adult education typically focuses on increasing literacy, pro-
moting life skills, or teaching basic skills related to seeking employment. In addi-
tion, vocational education primarily emphasizes training to engage in a specific
trade. This training focuses on a very specific set of skills necessary to function in
a specific vocational field and may involve apprenticeships to acquire these skills.
Figure 11.6 outlines some postsecondary education opportunities for individuals
diagnosed with ASD.
College-/university-level education is becoming more available to individuals
diagnosed with ASD due to the development of specific programs that offer support
related to the needs of specific individuals. Adreon and Durocher (2007) pointed out
that with the increasing prevalence of high-functioning individuals diagnosed with
ASD, there will be an increased need for these individuals to attend colleges and uni-
versities. Several colleges and universities are now providing some level of support spe-
cifically designed to support the needs of students diagnosed with ASD. The Rochester
Figure 11.6 Postsecondary education opportunities for individuals diagnosed with ASD
College/University Education Adult Education

University of Alabama Autism Spectrum College Living Experience www.experiencecle.com
Disorders College Transition and Support Program
http://autism-clinic.ua.edu
University of Connecticut—Strategic Education College Internship Program www.collegeinternship
for Students with Autism Spectrum Disorder program.com
www.csd.uconn.edu
Drexel University Autism Support Program STRIVE U www.pslstrive.org
www.pages.drexel.edu
Marshall University—College Program for Students CareerOneStop www.careeronestop.org/
with Asperger’s Syndrome www.marshall.edu/atc
The Rochester Institute of Technology Spectrum Do2Learn—Job Tips www.do2learn.com
Support Program www.rit.edu/studentaffairs
University of Tennessee–Chattanooga MoSAIC
Program www.utc.edu/Administration/OfficeFor
StudentsWithDisabilities
Institute of Technology Spectrum Support Program (www.rit.edu/ studentaffairs)

offers individualized supports to college students diagnosed with ASD in the areas of
transitioning to college life, developing self-awareness and self-determination skills,
and fostering social skills. They offer peer coaches and case managers and provide
opportunities for college students to participate in seminars designed to facilitate skills
necessary for interviewing and maintaining employment. Similarly, the University
of Alabama Autism Spectrum Disorders College Transition and Support Program
(http://autism-clinic.ua.edu) provides weekly sessions focusing on academics, social
skills, and daily living supports to college students diagnosed with ASD. In addition,
they have efforts designed to educate the university community about college students
diagnosed with ASD. Applied Vignette 11.1 describes how making decisions about
college could be difficult.

Life Decisions
Jennifer is a high school student who is sched- courses, she considers her high school experi-
uled to graduate in two months. She has a ence to have been very difficult because of her
diagnosis of Asperger’s syndrome and has very relationships with her peers. She has a tendency
well-developed skills in mathematics. Although to discuss topics that others find very uninterest-
she has received very high grades in her math ing; she appears to many of her peers to be very
insensitive to others’ feelings; and she sometimes to mature and become more responsible. While
does not maintain her appearance in ways s imilar attending the community college, her parents
to her peers, such as having uncombed hair and believe she could work with her father at his
dressing in mismatched clothing. In addition, business where she could manage his record-
Jennifer has demonstrated some tendencies keeping system.
to allow others to manipulate her in ways that
she later states that she regrets. This has been Discussion Questions
particularly evident with her male peers, who
1. Pretend that you are a facilitator at a tran-
have talked her into doing things that have sition planning meeting and you are try-
caused her to be excluded by her female peers. ing to work with both Jennifer and her
When questioned about this, Jennifer has stated parents to resolve what she should do after
that she felt she needed to do these things to her graduation. How would you work
make her “boyfriends” like her. with Jennifer and her parents to come to
Jennifer wants to attend college and live a decision?
independently in a dorm room with a room-
2. Who should have the most input toward
mate. Because of her mathematical skills, she has
deciding what Jennifer does after
been admitted into a fairly prestigious univer-
graduation?
sity that is approximately a five-hour drive from
her parent’s home. She is excited about being 3. How might you ensure that Jennifer is
admitted to this university and believes that this able to demonstrate self-determination
is the right place for her to attend. Her parents during the meeting?
are highly concerned that Jennifer is not mature 4. What strengths and weaknesses about
enough to handle the various pressures, influ- Jennifer should be discussed?
ences, and responsibilities associated with liv- 5. What are the risks involved with the
ing independently on a university campus. Her potential choices available to Jennifer?
parents would prefer that she live with them and
attend a local community college to allow her 6. What should Jennifer do after graduation?
Community Living
Living situations for individuals diagnosed with ASD can range from those that are
highly restrictive, such as institutional placements, to moderately restrictive settings
such as group homes, to autonomous home ownership (Hagner, Snow, & Klein, 2006).
Steere, Burcroff, and DiPipi-Hoy (2012) provided nine key curriculum areas that
should be considered when planning independent living arrangements for individu-
als with disabilities. These focused on self-care activities such as preparing/obtaining
meals; taking care of basic needs such as living environment, clothing, time manage-
ment; and maintaining personal safety. Steere et al. recommended using ecological
inventories to evaluate the type of training curriculum that might be needed in a home
setting. Ecological inventories primarily consist of checklists and questions designed to
provide information about a specific environment, such as a workplace or living envi-
ronment. They can be useful toward identifying what the environment provides and
what skills or supports are needed to function sufficiently within the environment. For
example, an ecological inventory of an apartment might identify that the apartment
provides a washing machine and a clothes dryer. This information would be helpful for
determining that it may not be necessary to visit a laundry for washing clothes if the
person can learn to wash his/her clothes in the apartment. In addition, task analyses
were suggested as a means of structuring training activities related to the areas of need
identified through the ecological inventory. For example, a task analysis could list the
steps involved in operating the washing machine in the apartment, such as step 1: turn
on washing machine; step 2: add laundry detergent; step 3: put in clothes, and so forth.
Person-centered planning should involve a great deal of discussion about poten-
tial living arrangements for individuals diagnosed with ASD and the minimal amount
of support that they will need in various living situations. Consideration should be
given to the person’s preferences in housing, to available finances, and toward the
location of the residence in relation to preferred places to visit. The home is a place
where the individual may spend a great deal of time, and as such, considerable steps
should be taken to optimize preparation to be successful in a residential setting that is
most appropriate for the person.
Promoting Self-Determination and Choice

Making in the Planning Process
Shogren and Plotner (2012) reported that students with autism and intellectual dis-
abilities were less likely to take a leadership role in their transition planning than were
students with other disabilities. Advocating for self is a skill that can be learned and
Consider This
Justin is a young adult male diagnosed with but it is also near a very busy intersection where
autism who has very limited verbal skills, numerous vehicles travel at high speeds. The
requires full-time assistance to ensure his per- other apartment is located in a rural area where
sonal care, and has an extreme fascination with there is very little traffic and very few opportuni-
airplanes and helicopters that leads him to fre- ties for Justin to view airplanes or helicopters.
quently run out of his house or front yard and
into the street in order to get a better view of ■ Based on Justin’s preferences, which apart-
an airplane or helicopter that he hears. In addi- ment would he most likely prefer?
tion, Justin has a history of becoming extremely ■ Based on the concerns of the staff working
aggressive toward others whenever they attempt with Justin, which apartment would they
to stop him from running into the street to look be most likely to recommend for Justin?
for the airplanes. The home that Justin currently ■ What are some other considerations that
rents is being sold, and he needs to move to a should be discussed regarding choosing
new location. Two different apartments within the best apartment for Justin? Think of
his economic range are available for Justin as many areas of concern as possible that
to move into immediately. One apartment is should be discussed prior to making a
located near an airport where Justin could fre- decision about which apartment would be
quently watch airplanes and helicopters pass by, best for Justin.
is part of a larger set of self-determination skills. Wehmeyer (2001) described self-

determination as a skill that requires direct training, just as any other instructional
domain. Wehmeyer, Agran, Hughes, Martin, Mithaug, and Palmer (2007) described
self-determination as having distinct characteristics that include areas such as being
self-efficient, having personal autonomy, and being aware of personal strengths and
weaknesses. Thoma (2005) described how transition planning could appear exemplary
on the surface but in reality involve professionals and others making decisions with
very limited input from the student. This type of scenario can be avoided by teaching
individuals diagnosed with ASD to engage in self-advocacy and self-determination
skills during the transition planning process. In addition, it may be beneficial to offer
training to other members of the transition team to ensure that they understand that
part of becoming an adult is taking ownership in your personal life choices. Smith and
Nevin (2005) suggested that, in order for individuals with disabilities to act as self-
determined individuals within a person-centered planning process, the other mem-
bers of the planning team should put aside their personal agendas and listen closely to
the wants and needs of the person.
Building Interagency Collaboration and Partnerships

Some important tasks during the transition process include developing, utilizing, and
maintaining relationships with organizations in the community. The resources that
are available to members of a community are frequently unknown to many of the
members of the community and can be underutilized. Individuals diagnosed with
ASD need to become familiar with what is available for them in their communities
and then access those resources. This can be supported by interagency collabora-
tion and the development of partnerships to ensure that opportunities are easy to
access. The person-centered planning process can be an appropriate time to sort out
the potential agencies that may offer valuable assistance to a person diagnosed with
an ASD. In addition, schools need to actively pursue and develop relationships with
businesses in order to expand the opportunities available to their students. Kellems
and Morningstar (2010) offered some tips regarding how schools could promote
interagency collaboration, as follows: Encourage nurses to participate in the develop-
ment of health care related goals; have a transition fair each year and invite commu-
nity agency representatives to serve on a panel presentation; conduct a social security
application workshop; and organize a district-level transition team to recommend
transition strategies for all students.
Wehman, Targett, and Green (2012) reported that an increasing number of
employers are partnering with schools to provide mentoring activities for individu-
als with disabilities. They described how the U.S. Business Leadership Network had
promoted National Mentoring Day, during which students with disabilities could be
involved in interviews and discuss potential careers with employers. Wehman, Targett,
and Green recommend some strategies for schools to become more connected with the
business community that include getting to know the businesses well, attending business
meetings, volunteering at business meetings, becoming a member of a business-related

committee, and making presentations to businesses. All of these activities can be starting
points for the development of interagency partnerships that open up new opportuni-
ties for individuals diagnosed with ASD and provide valuable resources for businesses.
Wehman, Targett, and Green reported that a human resource manager for Pitney Bowes
stated that the individuals with disabilities employed by their company have almost per-
fect attendance and, when compared to other employees, had above average productiv-
ity. Siperstein, Romano, Mohler, and Parker (2006) conducted a national survey and
found that 87% of consumers would prefer to frequent businesses that hire individuals
with disabilities. These types of input that demonstrate the value of hiring individuals
with disabilities can be quite valuable for schools to emphasize when developing rela-
tionships with businesses. Schools can work to educate businesses about the potential
benefits of hiring individuals with disabilities to meet the needs of the business, in an
effort to develop collaborative relationships within and across agencies.
Another important feature for developing partnerships with various vocational
agencies may involve arranging for individuals diagnosed with ASD to engage in “voca-
tional sampling.” This could involve developing opportunities for individuals to spend
short periods of time learning and working on a job in order to determine whether the
job may be appropriate in the long term. During this trial work period, the individual
can become familiar with the job, evaluate his/her skill level at completing the job,
become familiar with other employees, and express interest in continuing with the job.
If, after the trial period of job sampling, the person is still highly interested in working
at the job, more permanent employment can be sought with the agency or at an agency
where the person could perform a similar job. Depending on the varying interests and
skills of individuals, it may be prudent to first expose them to several different types of
jobs before they make a final decision about their most preferred vocation.
Promoting Quality Assurance in the Transition Process

The quality of transition services provided to students diagnosed with ASD needs to
be of concern to everyone involved in the process. Outlining a smooth and secure path
for these individuals to follow may be of critical importance to their future success.
This cannot be stressed enough, considering how students from special education
programs typically have very poor outcomes in adult life when compared to their typi-
cally developing peers. Without a quality transition plan, the student diagnosed with
an ASD may be at substantial risk for never achieving their full potential in adulthood.
One method for promoting quality within secondary-level transition planning
is to adhere to practices that are evidence based. Expanding upon research by Test,
Mazzotti, Mustian, Fowler, Kortering, and Kohler (2009), the National Secondary
Transition Technical Assistance Center (2010) conducted a review of the literature
and determined 33 evidence-based practices in secondary transition (see Figure 11.7).
These practices are considered to be based on rigorous research designs demon-
strating a record of success in improving student outcomes and have undergone a
Figure 11.7 List of 33 evidence-based practices in secondary transition identified by NSTTAC
1. Involving students in the IEP process

2. Using the self-advocacy strategy
3. Using the self-directed IEP
4. Teaching functional life skills
5. Teaching restaurant purchasing skills
6. Teaching employment skills using computer-assisted instruction
7. Teaching grocery shopping skills
8. Teaching home maintenance
9. Teaching leisure skills
10. Teaching personal health skills
11. Teaching job-specific employment skills
12. Teaching purchasing using the “one more than” strategy
13. Teaching life skills using computer-assisted instruction
14. Teaching life skills using community-based instruction
15. Teaching self-care skills
16. Teaching safety skills
17. Teaching self-determination skills
18. Teaching banking skills
19. Teaching self-management for life skills
20. Teaching self-management for employment
21. Teaching self-advocacy skills
22. Teaching functional reading skills
23. Teaching functional math skills
24. Teaching social skills
25. Teaching purchasing skills
26. Teaching completing a job application
27. Teaching job-related social communication skills
28. Teaching cooking and food prep skills
29. Teaching employment skills using community-based instruction
30. Training parents about transition issues
31. Providing community-based instruction
32. Extending services beyond secondary school
33. Using “check and connect”
Source: National Secondary Transition Technical Assistance Center (2010). Evidence-Based Practices and Predictors
in Secondary Transition: What We Know and What We Still Need to Know, Charlotte, NC, NSTTAC. Reprinted by
permission.
systematic review process. Utilizing these evidence-based practices when developing

transition programs can be one method for improving the quality of the program.
Individuals diagnosed with ASD in secondary programs display a wide level of skill
variation, and it is important to consider which of these practices may be beneficial for
students when developing their specific transition plans.
Another method that may be useful for ensuring the quality of transition plan-
ning is the use of a self-evaluation of the transition process. Morningstar (2011) has
developed an instrument that allows secondary programs to evaluate the quality of
their transition programs according to several quality indicators. The instrument cov-
ers 40 items across domains such as involvement with family, planning for transitions,
involvement in education, and interactions with the community. A school or agency
can use the instrument to compare the value of specific items or domains to their cur-
rent status of incorporating these quality indicators within their transition programs.
By utilizing an instrument such as this, a school or agency can identify their strengths
and weaknesses and make improvements to their programs.
Wehman (2002) offered three suggestions for enhancing the quality of post-
secondary education opportunities for individuals with disabilities. First, he recom-
mended that postsecondary educators and administrators be provided professional
development opportunities that focus on how to provide instruction to individuals
diagnosed with ASD using technology, universal design options, and distance learn-
ing. His second recommendation involved providing financial incentives for colleges
that provide supported opportunities for individuals with disabilities to attend. The
third recommendation he offered was for the development of comprehensive career-
planning strategies to assist individuals with disabilities as they prepare for employ-
ment. These recommendations are just a few ways that postsecondary education could
enhance services for individuals diagnosed with ASD. In addition, postsecondary ser-
vices should engage in efforts to inform all students and faculty about the charac-
teristics of individuals with ASD and how they can be valuable contributors to the
workforce and to the community as a whole.

The Transition Coalition (http://transitioncoalition.org/transition) is an association
that offers information, support, and professional development for preparing youth
with disabilities to transition from school to adult living situations. A number of dif-
ferent resources are provided for conducting assessments related to transitioning and
for identifying opportunities to promote successful transitions to adulthood.
Chapter Summary
This chapter focused on the importance of developing transition services for indi-
viduals diagnosed with ASD. Numerous areas are considered important to plan for
when moving into adult roles, and several have been described, such as postsecondary
education, independent living, community integration, and employment. Techniques

have been discussed for assisting individuals diagnosed with ASD to plan for their
futures in ways that maximize their opportunities and encourage successful outcomes.
The person-centered planning process was discussed in detail as a method for design-
ing strategies and recruiting support from various stakeholders in the life of a person
diagnosed with an ASD. Several strategies have been found to be beneficial toward
tipping the balance of success in favor of those with disabilities, and these have been
discussed with a consideration toward the varying skill levels displayed by those diag-
nosed with ASD. In addition, information has been provided to allow for an evaluation
of the quality of programs developed to assist in the transition process.
1. Make arrangements to attend a person-centered planning meeting, and take notice of

all the different areas and strategies that are utilized to organize and outline a direction
for the person of interest.
2. Conduct an interview with a current or former student who has an ASD diagnosis.
Ask about how he/she plans for major life transitions and about some experiences with
transitioning. Write a report that describes how the person manages transitions and
his/her experiences.
3. Interview a transition coordinator from a high school. Ask about how he/she pre-
pares students for transition to adulthood. Write a report that details this process,
and develop some possible ideas about how they might expand upon the services that
they offer.
Websites
College Autism Spectrum website The Person-Centered Planning Education Site
http://collegeautismspectrum.com/index www.ilr.cornell.edu/edi/pcp
.html
University of Minnesota Check and Connect
National Center on Workforce and Disability Program
www.onestops.info www.checkandconnect.umn.edu
Books
Freedman, S. (2010). Developing college skills in students with autism and Asperger’s syndrome. Philadelphia,
PA: Jessica Kingsley.
Harper, J., Lawlor, M., & Fitzgerald, M. (2004). Succeeding in college with Asperger syndrome: A student
guide. New York: Jessica Kingsley.
12
chapter
Enhancing Quality of Life

for Persons with Autism
Spectrum Disorders

■ Define quality of life (QOL) and discuss its importance to persons with ASD and their families.
■ Describe from the research literature the current state of QOL for persons with ASD and the
importance of the concept in designing interventions and supports for persons with ASD and their
families.
■ Recommend how QOL for persons with ASD and their families can be enhanced in the future
through research and improved service delivery.
■ Provide recommendations for future research on promoting successful life outcomes for individuals
with ASD.
318
c h ap t e r T w e l v e / Enhancing Quality of Life 319
Chapter 12 Mind Map

QOL & Access to Services
Community/Residential Outcomes
Defining QOL
Evaluating QOL Outcomes for Persons with ASD Employment Outcomes
Transition Services Enhancing Quality of Life (QOL) for Persons
Recommendations for Enhancing QOL with ASD
Effective Transition Planning
Recommendations for Future Research on Promoting

Successful Life Outcomes for Persons with ASD Formal & Informal Supports
Determining Requisite Skills
Promoting Successful Post-School Options Through Effective Supports Home & Community Living
Integrated Employment
What is quality of life (QOL), and how does one truly measure it for another human
being? While it is up to each one of us as individuals to determine the quality of our
life, there are nonetheless some aspects of a “quality life” that we all share in common,
such as a safe place to live, personal independence, the love of our family, a network
of friends, the ability to choose and enjoy activities we value, a job that we enjoy and
that provides us a livable wage, access to quality and affordable health care, engage-
ment in a community, and a sense of belonging, to name just a few. For persons with
ASD and their families, realizing some of these important QOL outcomes can often
remain challenging given the impact of a disability such as ASD. One’s QOL can be
influenced by a variety of life stressors associated with disability, such as obtaining
quality services and supports for the child and family and the costs associated with
caring for a child with special needs. This is especially challenging given issues with
insurance coverage for some families and the lifelong commitment to caring for an
adult child with ASD, which is often the case for many families. The financial costs can
be staggering for families, not to mention the stressors associated with such financial
strain. Given the increasing numbers of children being identified with ASD and the
availability of limited resources to address these needs through program delivery, the
costs to provide care are significant. Ganz (2009) reported that the annual estimated
costs for society in terms of medical and nonmedical and indirect costs associated with
caring for all individuals diagnosed with ASD across their lifetimes was in excess of
$35 billion. However, finances alone do not tell the story. The costs in terms of human
life and suffering and the potential debilitating impact of trying to ensure meaningful
services and supports for a child cannot be minimized.
Quality of Life and Access to Services

For many years, QOL for citizens with developmental disabilities (including ASD) was
of little concern. It was common practice for persons with disabilities to be committed
to institutions at an early age and remain there for the duration of their lives, where little
attention was given to anything except custodial care. A day in the life for a resident in
one of these facilities largely consisted of little or no privacy and very limited choices,
with day after day spent in “day rooms” that consisted of large gathering spaces where
people would sit for hours, engaged in little or no structured activity. It was common
to see people rocking or pacing back and forth, engaged in stereotypical behavior due
to the absence of appropriate stimulation, often sitting in their own urine or feces. The
evening programs in these facilities were most often limited in the way of stimulating
activities, and it was common practice once the evening meal was consumed to begin the
administration of medications that were designed to induce sleep, thus alleviating any
management challenges for the attending staff. One of the most significant publications
during this period was the exposé of institutionalization entitled Christmas in Purgatory,
by Burton Blatt and Fred Kaplan (1974). The book was shocking in its depiction of
graphic images of children and adults with developmental disabilities living in crowded,
run-down, unclean, and often prison-like conditions. The shocking images contained in
the book served to expose to the world the inhumanity of these facilities.
When the public began to realize the stark conditions and inhumanity of these
facilities, active programs of training and treatment were developed whereby func-
tional skills were systematically taught to the residents. Following this came the emer-
gence of special education programs and community-based support services designed
to foster increasing levels of independence for individuals with disabilities, including
individuals with ASD and their families.
Despite these and the many other advances that have occurred up to this point,
work remains to be done in bettering our understanding of how to address the lifespan
support needs of persons with ASD and their families. Within this process of change,
our focus has ultimately been directed toward how, through the delivery of early iden-
tification, intensive early intervention, and special education services, we can improve
the lives of these individuals, hopefully resulting in enhanced QOL. A key to ensuring
meaningful QOL outcomes is a service delivery system committed to this multifaceted
philosophy of care and service provision. There has been a shift within service delivery
for persons with developmental disabilities and ASD, whereby emphasis is placed on
an individual’s strengths, and needed supports are designed to enhance the likelihood
of the individual’s success across relevant aspects of life (e.g., school, home, and com-
munity), rather than focusing on the individual’s deficits and limitations. However, gaps
remain in the implementation of such a philosophy in actual practice. Designing better
systems of service delivery is perhaps most crucial at this juncture, given the current
times in which we live. Looming economic challenges and an increasing number of
children being identified with ASD have had significant impacts on a service deliv-
ery system that is already taxed in terms of infrastructure, and this is creating a gap
in service delivery for many families. Improvements must be focused on providing a
bridge from school to p ost-school settings for young adults with ASD, because the
future QOL for many of these individuals does not look promising, as will be discussed.
You may be asking, “How does this chapter relate to my role as a professional edu-
cator in service to learners with ASD?” One answer to this question is that it is important
to always remember the big picture in what we do as educators and how our practices
can influence the lives of all we teach and their families, including important influences
on current and future QOL. The ultimate aim of education should be to prepare the
learner to reach his/her potential in life. We can facilitate this through recognizing the
human potential in each of our students, working in partnership with their families on
socially valid goals, and never losing sight of the importance of every child or individual,
as well as the significance that a teacher can have in the lives of students. The role that
one plays in this process is crucial, as are the systems in which we work, so that together
we can better address this important lifespan issue for learners with ASD and promote
meaningful life outcomes for these individuals through our coordinated efforts.
Autism research has been largely focused on children and adolescents, with
little attention being given to understanding how to intervene across the lifespan into
adulthood, perhaps contributing to the lack of research on QOL outcomes for indi-
viduals with ASD. Autism is a disability that is persistent, and it therefore impacts each
affected individual and family across the lifespan, most certainly having a measurable,
longitudinal impact on QOL. The focus of this chapter will be on understanding how
to define and assess QOL for persons with ASD and to provide an understanding of
what we currently know about QOL for persons with ASD. Also provided are recom-
mendations on furthering our understanding of how to enhance QOL for persons
with ASD and their families across the lifespan. The components of QOL and the
factors that impact it are illustrated in Figure 12.1.
Figure 12.1 Potential quality-of-life components and impact factors
COMMON PROGRAMMATIC
STRESSORS SUPPORTS
Gaining access Early

to quality Community identification
services belonging &
involvement
Ability to Beneficial
choose valued employment
Significant activities
Quality Intensive
costs of early
associated Life intervention
with care
Affordable,
A network of
quality
friends
healthcare
A safe place to
live Special
Limited family education
resources services
Defining Quality of Life

Defining QOL is an important starting point. The World Health Organization (1995)
defined QOL as an individual’s perception of where he/she finds him-/herself in life
regarding culture and value system and in relation to individual goals, personal expec-
tations, and concerns. As attention mounted on the growing need for increasing global
awareness on issues relative to QOL, the United Nations Convention on the Rights
of Persons with Disabilities (UNCRPD) (United Nations, 2006) moved to author 25
individual articles in their document on the topic, many of which dealt with QOL
issues. Some of these QOL issues included: equality and nondiscrimination; acces-
sibility; right-to-life; equal recognition before the law; access to justice; liberty and
security of person; personal mobility; freedom of expression, education, work, and
employment; adequate standard of living and social protection; and participation in
cultural life, recreation, leisure, and sport.
Schalock, Keith, Verdugo, and Gomez (2010) have addressed QOL as it pertains
to individuals with intellectual disabilities and define the concept as a multidimen-
sional phenomenon composed of core domains and influenced by personal charac-
teristics and environmental domains that are culturally sensitive. Verdugo, Navas,
Gomez, and Scalock (2012) later examined the relationship between the UNCRPD
(United Nations, 2006) and their seven dimensions of QOL: (1) personal develop-
ment, (2) self-determination, (3) social inclusion, (4) human and legal rights, (5) emo-
tional well-being, (6) physical well-being, and (7) material well-being. It is the view
of Verdugo et al. (2012) that this framework needs to be used for evaluating QOL
elements in relation to the home, family, peer groups, and job setting, as well as their
impact on the individual. The important point here is to recognize and understand the
persons (be they children, adults, or families) whom we serve on the human level, to
better ascertain the impact of our services on the QOL of these individuals.
As mentioned earlier, the difficulty in reaching consensus on a definition of
QOL that is mutually inclusive of all has been a large, ongoing task. Unfortunately,
there is not a substantial body of research on QOL for persons with ASD; however,
it is anticipated that more research will emerge given the increasing numbers of chil-
dren being identified. Burgess and Gutstein (2007) concluded that the QOL domains
most commonly agreed upon for adults with ASD included elements such as friends
and interpersonal relationships, social inclusion, personal development, physical w ell-
being, civil rights, a safe environment, support of a family, access to leisure and recre-
ation, and overall safety and security. In turn, the authors indicated that for children
with ASD, the QOL domains have typically included physical, emotional, and social
and school functioning. Physical and emotional functioning imply overall well-being
in terms of physical and emotional health, such as being happy and having good self-
esteem. Social functioning of course alludes to a social network, meaningful friend-
ships and school functioning, meaning one’s general happiness and satisfaction with
school. Unfortunately, as we will discuss, the outcomes for adults with ASD have been
less than optimal, and many children with ASD in school are still being subjected
to bullying and teasing and, as they age, often experience difficulties in maintaining
social support networks, which tends to lead to social isolation.
Consider This
Those who conceptualize, research, and write within each disability category (even though indi-
about QOL for persons with disabilities have viduals within a particular category must meet the
been resistant to the idea of defining a QOL for same identification criteria). However, consider
persons within each specific disability category, the wide range of unique characteristics that exist
such as a “QOL for persons with learning dis- within each of the categories of the ASD, as well
abilities.” This resistance has been due in part to as the radically different characteristics across
the very valid idea that people with disabilities individuals with ASD who are classified within
are humans and that humans are also individuals, each of these categories. This “diversity within
meaning that, on one hand, QOL will have some diversity” that makes individuals with ASD so
very general but universal dimensions that are different from the individuals classified in almost
applicable to all of humanity, and, on the other every other disability category could necessitate
hand, will also have dimensions that are very spe- that the “no QOL definitions for specific disabil-
cific to unique individuals. The reasoning follows ity categories” rule be reconsidered. What do you
that we can therefore only validly and reliably think? Would it be useful or counterproductive to
assess the universal dimensions as they may apply pursue the creation of a “QOL for people with
to the general situations likely for persons with ASD,” and what would be the pros and cons of
disabilities, for there is much diversity represented doing so (or failing to do so)?
Evaluating QOL Outcomes for Persons with ASD

QOL for persons with ASD has been largely linked to the study of outcomes for
those exiting school and entering adulthood. Historically, these outcomes have
looked bleak on a global scale for adults with ASD. Consider one major study con-
ducted in Great Britain (Barnhardt, Harvey, Potter, & Prior, 2001) that surveyed
450 adults with autism across all levels on the spectrum. The survey questioned these
individuals regarding their education, with whom they lived, and the status of their
mental health. The results indicated that only 3% of individuals on the highest end
of the spectrum were reported to be living completely independently, and almost
half of the respondents lived at home. Approximately 10% of respondents reported
being able to perform tasks associated with independent living without assistance,
and only 12% of respondents on the high end of the spectrum were employed full
time. The results of this study indicated that individuals who were higher function-
ing on the autism spectrum realized better outcomes. This is a fact that seems to
reinforce previous research that has identified predictors of successful outcomes for
adults with ASD, such as level of intellectual ability and the development of early
communication skills.
More recent findings associated with outcomes for persons with ASD have
indicated that, of those individuals identified and diagnosed early, there are often,
by late adolescence, comparative improvements in social communication and behav-
ior (Levy & Perry, 2011). For those individuals with severe and challenging forms
of behavior, this was not the case. If such behaviors remain chronic and attempts at
remediating them unsuccessful, they will continue to pose significant challenges as the
individual ages into adulthood, thus creating more difficulties. Studies report that a
majority of persons with ASD who experience persistent difficulties in communication
and socialization also often experience difficulties with employment and community
living (Piven & Rabins, 2011). The next section will provide an overview on what the
prevailing research reports regarding community/residential, employment, and post-
secondary education outcomes for persons with ASD.
Community/Residential Outcomes
One of the challenges facing adolescents with ASD is that, in comparison with early
childhood, the social divide between them and their typical peers widens. Many ado-
lescents and young adults with ASD experience difficulties in establishing friends and
social networks. Some of this can be attributed to lack of opportunity, paired with skill
deficits in the areas of communication and social skills. This mix of difficulties can lead
to loneliness and isolation. Hendricks and Wehman (2009) point to the leisure prefer-
ences of many individuals with ASD as being non-community-based, such as playing
video games or viewing television. This type of restricted repertoire of interests can
minimize opportunities for community participation and social networking on the
part of adults with ASD. Finding common points of interest and ways to connect ado-
lescents with ASD to their typical peers becomes more difficult as they age in school.
Conformity among peer groups at this stage of development becomes a priority and
for students with ASD who may lack critical socialization capabilities, and connecting
to social cliques can pose a significant challenge. In fact, bullying is a common prob-
lem experienced by adolescents with ASD, as reported by many parents, largely due
to the difficulties they experience in forming relationships, as well as their difficulty
in understanding the feelings of others (Van Roekel, Scholte, & Didden, 2010). The
authors Van Roekel et al. (2010) also indicated that adolescents with ASD can fall prey
to victimization from bullies, as they do not necessarily recognize bullying behavior
due to their inherent challenges with overly literal thinking, reading the emotions of
others, and decoding social situations. These experiences can further serve to socially
isolate adolescents from forming lasting friendships and social networks that extend
beyond school.
As these adolescents emerge into young adulthood, the social gaps tend to widen
even further, largely from lack of opportunity within community settings. The attain-
ment of satisfying community living can also be confounded for young adults with
ASD by the lack of services and supports available to them. Further contributing to
these issues is the lack of case coordination found within many communities for young
adults with ASD after they leave school. Shattuck, Wagner, Narendorf, Sterzing,
and Hensley (2011), in their national study of young adults with ASD ages 19 to 23,
revealed that overall rates of service use for those surveyed were 23% for medical ser-
vices, 35% for mental health services, 41.9% for case management, and 9% for speech
therapy. For young adults with ASD who were African American, the likelihood of
failure to access services was three times higher than that of Caucasians. The lack of
established programs and services in tandem with the increased volume of persons
with ASD does not contribute to enhanced community outcomes for these individuals.
Young adults with ASD, including those with and without intellectual dis-
abilities, tend to face their own set of unique challenges relative to community life.
Taylor and Seltzer (2011) examined the post-school adjustment for 66 young adults
with ASD. Their study reported low rates of employment, with over half the individu-
als (those individuals who were lower functioning) attending day programs affiliated
within sheltered workshops or day activity centers. Those young adults with ASD who
did not have intellectual disabilities were three times more likely to have no formal
daytime activity. This alarming fact points to the challenges faced by those individuals
who are higher on the spectrum, as well as the lack of formal service delivery options
that exist to help accommodate their needs upon exiting public school. With little or
no active engagement in the community, individuals with ASD who are higher func-
tioning can experience greater degrees of longitudinal decline in social interaction and
meaningful activity. Sadly this group of young people seems to be the most vulnerable
for falling through the cracks without a formal connection to postsecondary higher
education and/or competitive employment.
In terms of residential options for adults with ASD, the reality is that a large
majority will continue to live at home with their parents. A small percentage of adults
with ASD live alone in the community or within state facilities, such as institutions
for persons with developmental disabilities (Hendricks & Wehman, 2009). Shattuck
et al. (2011) confirmed this in a study of young adults with ASD ages 19 to 23 and
found that 79% of those surveyed lived at home with their parents. Given that a large
percentage of adult children with ASD continue to live with their parents, a concern
expressed by many families is having an appointed guardian or conservator who will
be available to make important decisions and provide guidance if parents are incapaci-
tated or die. Piven and Rabins (2011) pointed out that because the majority of adults
with ASD do not marry, the responsibility of providing long-term residential supports
is often shifted to siblings or other family members in the absence of parents.
Employment Outcomes
Supported employment for individuals with disabilities has existed since the mid-80s,
and one may therefore expect that employment outcomes for adults with ASD have
greatly increased since that time. However, the current reality is that the majority of
persons with ASD are unemployed (Hendricks & Wehman, 2009). Underemployment
is an issue for many potential workers today, especially given current economic condi-
tions. For persons with ASD this is also a major problem, as those who do find and
maintain employment often find themselves performing duties and earning pay at less
than their potential.
There is hope that people will see the merits of hiring persons with ASD, as
evidenced by the Danish company Specialsterne (translated as “The Specialists”). The
company was established by a parent of a child with autism (Cook, 2012) and was
intended to draw attention to the talents of persons with ASD, especially for working
in high-tech areas. The company has experienced global success in facilitating the
hiring of individuals with ASD by high-tech firms for jobs such as software testing,
computer programming, and data quality assurance, and it has a branch based in the
United States (in Delaware).
The challenge facing many adults with ASD in employment settings is a com-
bination of behavioral skill deficits paired with a lack of job fit or design that seeks
to accommodate the individuals’ strengths versus drawing attention to their deficits.
Through job matching and job design this problem can be minimized, but it takes ini-
tiative and planning. The model that Specialsterne provides is one that seeks to match
talented individuals who are high on the autism spectrum with jobs that emphasize
their strengths, such as a keen sense for detail or an aptitude for science, technology,
engineering, and math (STEM), and related disciplines. So, rather than looking at an
individual’s abilities in terms of deficits, the focus is aimed at matching their abilities to
meaningful jobs where such skills are needed and therefore valued.
The success of Specialsterne is noteworthy and tied to the importance of job
design and an openness in terms of a guiding philosophy that emphasizes fit between
an individual’s talents and skills with a viable job. The importance of work in the lives
of people cannot be taken for granted. For many young people with ASD who have
experienced a lack of success with being matched to a job and given the support to be
successful in that job, this type of program is a dream come true. The difficulty with
realizing this type of outcome for more individuals lies in applying such a progressive
philosophy of practice more broadly within and across current service delivery sys-
tems. This is a pressing question in need of further study.
Historically, there has not been a large amount of in-depth research on the participa-
tion of young adults with ASD in postsecondary education, although one may get some
ongoing idea of postsecondary status for this group from sources such as the National
Longitudinal Transition Study 2 (2013). Although estimates across sources tend to vary,
all are usually relatively low in terms of the reported numbers of individuals with ASD
participating in some form of postsecondary education. The NLTS 2 reports that in
2009, 12.4% of individuals with autism were enrolled in a postsecondary institution of
any type, and only 1.6% currently attended a vocational school. In a recent study con-
ducted by Taylor and Seltzer (2011), 50% of young adults with ASD who did not have
intellectual disability were pursuing postsecondary education, however the sample size
of the study was quite small. More research is needed to ascertain the numbers of these
individuals nationwide to gauge the trend and to help in preparing the needed supports
to promote their successful enrollment in post-secondary education.
As with employment, success for individuals with ASD in postsecondary educa-
tion is contingent on a good match in terms of the individual’s abilities and inter-
ests with available options. For many students with ASD and their families, this may
result in attending the local college or university to maintain proximity to a place to
live and in terms of overall social and emotional support. Something important to
consider is the degree of support available through the university, college, or techni-
cal school. An office for students with disabilities is a good place to begin seeking
Figure 12.2 Essential QOL outcome goal areas with brief considerations for
evaluation
Community/ Postsecondary
Employment
Residential Education
Pay and job Close match

Development of between
responsibilities:
community-based educational options
Under-
(as opposed to solo) and interests/
employment?
leisure preferences abilities
Match between Availability of

Development of
responsibilities and social, emotional, and
socialization and
strengths/abilities academic supports
emotion
recognition skills
Availability of
Proximity of Integrated additional program
needed services supports for options (employment
(medical, mental employment training, counseling
health, case maintenance and services, health
management, etc.) ongoing success supports)
information regarding the level of support available for students with ASD. Generally,
these offices, though well intentioned, may not have any specific training or prior
experience in providing academic and student-life supports for adults with ASD. The
academic demands paired with the social challenges will require a coordinated effort
among all to foster the greatest probability of success, but a lack of trained staff can
negatively affect development of a cohesive and operational plan to assist the student
with coordination of services and supports needed for successful campus life integra-
tion and academic success.
In addition to these important concerns is the potential availability of pro-
gram options, should they be needed for adults with ASD. These services can include
employment training, job coaching, counseling, and mental health and medical spe-
cialists with expertise in serving adults with ASD. Figure 12.2 unifies and summarizes
the QOL outcome goal areas, as presented within this section.
Recommendations for Enhancing Quality of Life

The QOL of young people with ASD and their families is contingent on planning
and preparation prior to leaving public schooling, to ensure a seamless transition into
adulthood. This planning and preparation must take into account the elements of
e vidence-based transition planning practices and s chool-based preparation for ensur-

ing a successful transition into domestic living, employment, postsecondary education,
and inclusion within the community.
Transition Services
Transition services are mandated to occur by the age of 16 for children with special
needs, but they can be initiated earlier if determined appropriate by the IEP team.
The plan must include postsecondary goals related to training, education, employ-
ment, and, when appropriate, independent living skills, as well as include courses of
study that will assist the student in reaching these goals. Transition services refers to a
set of coordinated activities that are designed to be a process aimed at facilitating an
effective and seamless transition for a student to move from a secondary educational
setting to post-school environments. These post-school environments may include
postsecondary education (including technical and/or vocational education), meaning-
ful employment, adult services, independent living, and community participation. It
is important that the IEP team coordinate with others from these respective agencies
and post-school alternatives to ensure a seamless process. Also critical to the transi-
tion process is the input and participation of the student and family regarding their
needs and respective interests as a means of developing a person-centered plan. Too
often student input is not fully considered in planning, which is in direct opposition to
how IDEA mandates the practice be done (NICHCY, 2010). Coordination between
the student, family, IEP team, and outside agencies cannot be stressed enough, as this
helps in developing linkages with external agencies and solidifies the planning process
with respect to targeted options and experiences to consider for the w ell-being of the
student.
Effective Transition Planning

As a method for promoting meaningful post-school options, the transition planning
process is very important. Hendricks and Wehman (2009) have summarized some key
points to consider when developing transition plans:
The student and family need to be at the center of the process, as stated stu-
■
dent input is needed to ensure life options that are consistent with the goals and
desires of the student.
Every effort should be made on behalf of the student to ensure a seamless transi-
■
tion and interface with post-school options that have been identified as part of
the IEP process.
Effective instruction should be provided to the student in the context of natural
■
domains such as employment, community, home, and leisure environments to

ascertain both student skills and areas of need.
This last point poses some challenges given the logistical supports that are needed for
providing instruction in the community and does conflict in some ways with the push
toward increased academic content in educational planning. Students with ASD will
need exposure to these environments beyond school and will need skills to be taught
within the context of these settings, paired with instructional supports and coordina-
tion between the school and community agencies to promote success.
Effective transition planning requires meaningful and ongoing communication
between the student, family, IEP team members, and external agencies. The process
should also be stepwise and systematic to promote increased exposure for the student
to these options and directed toward building the competencies needed to succeed in
these settings as well as in identifying the formal and informal supports needed.
Promoting Successful Post-School Options

Through Effective Supports
As you have read, the p ost-school outcomes for young adults with ASD have not
looked very promising overall. Part of the dilemma is access to options that are limited
in some areas and prevent young adults from having many choices. Additional issues,
as were discussed, relate to linkages with adult agencies, postsecondary educational
institutions, and employers, and lack of instructional supports needed to foster suc-
cess. One point in need of further consideration is that the research on evidence-based
practices can point to numerous examples that support the teaching of a plethora of
meaningful skills to learners with ASD. The difficulty for our students is their ability
to maintain and generalize some of these skills, most notably in the areas of communi-
cation and social engagement. Essentially, the long-term success of learners with ASD
is contingent on effective instruction using e vidence-based practices that will result in
the development of skills, followed by ongoing intermittent supports to assist with any
modifications and adaptations that will need to take place in the context of the natural
settings, such as on the job or within a community setting. Figure 12.3 summarizes the
steps of this basic process.
Formal and Informal Supports

In life we all experience the need for support at various intervals throughout our devel-
opment. As children we need support from our parents and extended family mem-
bers such as grandparents and aunts and uncles, as well as our teachers and coaches.
Additional supports can come from our physicians, dentists, and a host of people that
we interact with in our communities. As we age on our journey toward the other end
of the lifespan, we will all lend assistance to our parents or grandparents in their senior
years, as they may need help with a variety of things such as transportation, mobil-
ity, and basic life care needs. The bottom line is that we all need support in our lives
to function and flourish to our potential. These supports can be formal or informal.
Formal supports consist of those professional people and services that are a part of
our daily lives. For learners with ASD, these could include teachers, therapists, teach-
ing assistants, school nurses, bus drivers, cafeteria workers, and school psychologists,
and the services that each of these people provide for the learner. Informal supports
Figure 12.3 Integrated instruction, skill development, and intermittent supports

produce important gains over time
Skill Development Intermittent Supports

Instruction
Facilitated generalization Modifications in
Evidence-based
across relevant community placement,
practices are used in
environments will ensure employment, and so
teaching skills that
that skills are practiced, forth necessitate
will promote learner
remain functional, and are temporarily increased
quality of life.
maintained over time. supports.
Increasing longitudinal success and access to normalized lifestyle
are those that a child received from his/her family and friends. Most certainly these
individuals would include the learner’s parents or guardians, siblings, extended family,
and friends.
One challenge for young adults with ASD is gaining access to formal supports
within employment, postsecondary education, and community settings, as well as
developing a social network of informal supports beyond immediate family. These
are areas in need of greater attention on all levels, including at the transition planning
stage, within secondary education, and across the provision of adult services.
Determining Requisite Skills

As the transition to adult life progresses for young adults with ASD, it is important
to consider the skills needed for promoting independence. An ecological inventory
is a good method for determining the individual learner’s strengths and areas of need
across relevant domains such as home, community, employment, postsecondary edu-
cation, leisure, and self-help, to name a few. After identifying the relevant domains,
determine the essential skills needed by the student to live or function well in each
kind of environment. Upon identifying these skills, assess, based on your observations
with the learner, individual strengths and limitations relative to the skills identified.
It is advisable to assess the learner in performing these skills to gain firsthand knowl-
edge of his/her abilities and limitations. This provides you with an assessment of the
learner’s performance and becomes the basis for developing instructional plans that
will target the teaching of these relevant skills.
Recommendations for enhancing these QOL outcomes across relevant life

domains will now be explored. The domains of home and community living, inte-
grated employment, and postsecondary education will be examined.
Home and Community Living

As we presented earlier, community living outside the family home has been an area
of great difficulty for persons with ASD. There are potentially a few reasons to explain
this. First, students with ASD need greater exposure to exploring residential alterna-
tives at some point during the transition planning process, with priority given to alter-
natives they or their family members have identified. There is, of course, a continuum
of living options in many locales available for individuals with ASD to consider. These
include independent living, either alone or with a roommate, and other supported
living options. Often for young adults with ASD who are higher functioning on the
autism spectrum, the desire to live independently, hold a job, or attend postsecondary
education is dependent on the availability of these options, existing opportunities, and
degrees of formal and informal supports that are available. Realizing these outcomes
is also dependent on the skills these young people have developed for living and func-
tioning independently.
A wide range of skills is essential for living independently. Cooking, cleaning,
paying bills, shopping for groceries, and maintaining one’s health makes up only a
small list of the essential skills that at some point need to be taught to foster inde-
pendence in the young person with ASD. Of course the foundation for develop-
ing these skills should begin at home, when at all possible, and within the school
program as transition planning ensues, but for some this will be too late for full
acquisition to occur. There are variables that can impede the development of these
skills in learners with ASD, including the absence of genuine opportunities to learn,
the presence of competing behaviors that make it difficult to attend to these skills
during instruction, and inadequate instruction that results in the student not fully
learning the skill.
Aside from the skills required to live independently in a home is the ability to
integrate within the community and develop leisure pastimes. Both of these pose seri-
ous challenges to individuals with ASD. Community participation can be difficult
because establishing routines and structure is very important for many persons with
ASD, and having supports to assist with this around community pursuits can be dif-
ficult without assistance from a life coach or family member. Establishing routines
could involve personal planning, such as what day the grocery shopping will occur.
This would then require making a grocery list, locating and lining up public trans-
portation, traveling to the grocery store, finding desired items in the store, and having
the skills and money to pay for groceries. These are some of the functional consider-
ations we must take into account in our daily lives. These considerations taken in the
absence of structure, routine, and needed support can be overwhelming to the indi-
vidual with ASD and have a low probability of success in some cases. Consider Applied
Vignette 12.1 as an example of how important supports are for success.

Teaching a Functional Skill Sequence
Kathy is a 21-year-old woman with ASD and including the selection of items and learning
mild intellectual disability. She is completing to pay for her groceries, as well as the prepa-
her last year of eligibility for special educa- ration of her meal. Kathy’s mother has incor-
tion services, and as part of her transition plan, porated the same sequence for Kathy while at
she is developing skills to assist with semi- home and has allowed Kathy to prepare her
independent living and supported employment own meals on occasion. The shopping trips
in the community. She is currently living at occur once per week and allow Kathy an oppor-
home with her parents, but Kathy and her par- tunity for a community-based outing, provide
ents targeted these skills as important in pre- her with choices, and foster independence and
paring her to assume more independent roles the development of needed skills. Ms. Thomas
and, ultimately, semi-independent living. Some provides Kathy with instruction and reinforce-
of the skills Kathy has been working on consist ment that aid in the ongoing maintenance of
of developing a photo-based shopping list using the skills, and Kathy’s mother promotes the
her iPad and learning to make microwaveable generalization of these skills across settings,
meals as a means for promoting her indepen- further reinforcing the learning. Kathy and
dence. Her transition specialist, Ms. Thomas, her family are making strides toward building
who is from the local adult services agency, the skills she needs to live more independently,
provides assistance to Kathy in determining but, for now, that is a hope and a future to plan.
what items she would like to purchase, and each She will live with her parents until they feel
week they purchase a microwaveable meal of assured that she has both the skills and the nec-
Kathy’s choice. Upon returning to the agency, essary formal supports to promote her success
Ms. Thomas then provides instruction and in the community. Specifically, Kathy’s parents
review in how to prepare the microwaveable would like to see her living with a roommate in
meal. Ms. Thomas has taught Kathy to read an apartment setting that is supervised by staff
the instructions and has helped her develop flu- who would also do overnight stays and provide
ency in performing the directions for preparing transportation for work, grocery shopping, and
the meal. In addition, she has provided Kathy other community-based needs. Attaining this is
with instruction in the use of the microwave dependent upon the availability of an opening
and cleanup. This has been valuable for Kathy, with the agency. In the meantime, they will con-
as well as her parents. It has provided Kathy tinue to do all they can to enhance Kathy’s skill
with functional skills such as grocery shopping, levels to prepare for such an opportunity.
Leisure is something we all value as a break from work and school, but it can
also pose significant challenges for persons with ASD because leisure is generally
unstructured and requires choice. Leisure can also be difficult because of the narrow
and repetitive range of interests displayed by persons with ASD. Typically developing
young adults will often consider the amount of free time available, determine options
for the use of leisure time, make choices based on what seems enjoyable to them, and
participate in these activities either alone or in the company of others. These same
skills need to be taught to persons with ASD. For promoting success in these areas, it
is recommended that instruction begin early in the life of a child with ASD, as this is
often critical to long-term success. Structured play and scheduled leisure pursuits can
add predictability for the learner and incorporate practice in making choices, though
one should try to carefully and slowly expand the range of choices to the learner
through exploration of activities. These are all constructive examples of what to do in
your classroom and also in the home or community. So, increasing opportunity, paired
with instruction and followed up by informal or formal supports from family, friends,
teachers, and life coaches, will assist the learner with ASD in developing and maintain-
ing a repertoire of healthy, enjoyable leisure pursuits. One final point to consider is
that engaging in leisure, like all of the other life domains that we have discussed for
young adults with ASD, is often accompanied by the need for ongoing support (both
formal and informal) as life changes occur and transitions ensue.
Integrated Employment
Integrated employment is an important goal to attain for many people, and this is also
the case for many individuals with ASD. Successful employment for persons with ASD
is contingent on training paired with opportunity and support, to help in preparing
an individual for a job and providing intermittent supports. Each of these elements
(training, opportunity, and support) is critical to the success of the individual in an
employment setting.
Job training and career exploration should begin early in the life of the student
and be included as part of the transition planning process. Students can be provided
opportunities for shadowing jobs that are compatible with their interests, as well as
job coaching through supported employment in work co-ops through their schools or
part-time jobs. This phase should include an assessment of the individual’s vocational
interests and job availability, and it should determine whether redesign of the job is
at all possible to better fit the individual and accommodate his/her needs. The most
advisable approach is determining a job match between the individual and the job
setting. An example of this is to provide a young adult with ASD the opportunity to
work within a setting that he/she enjoys, that fits his/her interests and skill levels,
and is focused on maximizing his/her individual strengths and minimizing limitations.
Consider Paul, a young man with ASD who is 20 years of age and works in the mail-
room of a local hospital, sorting high volumes of mail each day by department. His
skills for reading and scanning are impeccable, for he attends to details very well. He
enjoys working hard and has the social skills that fit the demands of the job, which
include some, but minimal, interaction with others throughout the day.
Technical job skills and s ocial-interpersonal skills are both essential for job success,
and these are skills that a job coach will assist with as the individual initiates employ-
ment. The support from the job coach will tend to be intense during the initial stages of
employment and will diminish over time (or be “faded”) as the individual acquires and
becomes fluent in the performance of the job and the necessary social skills. Intermittent
follow-along is most typically provided by the job coach to ensure the individual is con-
tinuing to do well in both the technical and social aspects of the job.
This is, of course, the ideal circumstance and the recommended practice for
promoting job placement and successful employment for persons with ASD. It is
recommended that for us to improve the employment outcomes for young adults with
ASD, we need to (a) promote career and job exploration early on in their lives, (b) plan
well as part of the transition planning process to facilitate increasing exposure and
opportunities for competitive work experiences within integrated settings through the
job matching process, (c) actively teach both the technical job skills and relevant social
skills needed, and (d) provide ongoing job coaching to assist the individual in acquir-
ing the necessary job and social skills and performing any job redesign if necessary,
while fading to intermittent assistance over time, as a method of providing formal
supports to the individual.
As has been referenced earlier in the chapter, there are limits to data reporting the
numbers of students with ASD who, upon their exit from secondary education, move
on to postsecondary education. In order to improve this trend, it is important that
potential career paths be determined early and that academic training be provided
to align with each of these paths. In addition, postsecondary options should be care-
fully explored, allowing the student and family to interface with them as a means
for determining goodness of fit both in terms of career path and supports available.
Postsecondary educational options can include technical or vocational school, com-
munity college, or a four-year college or university.
Each option provides both unique opportunities and challenges for the aspiring
student with ASD. Roberts (2013) points out that when considering the best post-
secondary option that is aligned to career and educational goals, it is also important
that students with ASD achieve grade-level academic achievement at a minimum.
Strategies may need to be employed to assist students in reaching academic goals, such
as the use of peer tutoring and the use of academic accommodations such as allowing
more time to take exams, the use of assistive technology, and modifying assignments.
Other important points that should be considered that will promote success at
the postsecondary education level involve (a) assessing and understanding the individ-
ual’s learning style, (b) teaching the learner self-advocacy skills, (c) making reasonable
accommodations, and (d) ensuring the provision of academic supports (Roberts, 2013).
In regard to learning styles, it is very important to consider the learner’s strengths in
terms of efficiency. Educators must discover the learning modalities that serve stu-
dents the best, such as their primary information input modes or how they process
information. Many learners with ASD process visual stimuli more effectively than
verbal instructions, and lectures without the use of visual aids and embedded cues to
maintain the attention of the learner with ASD will most likely be less than effective.
This is only one illustration of identifying and accommodating an individual’s learning
style. The difficulty within most postsecondary educational settings is that the level
of adult attention and support needed for students with ASD may be insufficient or
unavailable. As an example, one common challenge found within postsecondary insti-
tutions is that faculty members may have had limited training in addressing the diverse
learning needs of students with disabilities and may also have a limited understanding
of persons with ASD. These factors can lead to a lack of willingness to implement
recommended accommodations within their classrooms. Faculty, by law, must be will-

ing to provide reasonable accommodations to students with disabilities, but this may
pose difficulties for some instructors if they do not understand how to adapt instruc-
tion or if they lack an open-mindedness to providing such accommodations.
For those individuals with ASD who have both the desire and the skills to con-
sider postsecondary education as an option, it is very important to begin planning
early in terms of the academic content and in the areas of self-determination and
self-advocacy. Self-determination and self-advocacy refer to an individual’s ability to
identify options, set goals, make choices, and to advocate for getting his/her needs
met. For example, when considering a postsecondary educational setting, a student
must decide on a major, meet with an advisor, select classes he/she wishes to take,
and interface with financial aid, student life, and the list goes on and on. Some of the
requisite skills for these activities include the ability to schedule one’s time, make and
attend appointments, communicate needs for instructional accommodations, respond
to questions asked, and ask for help or clarification if needed. From this example you
can see that communication and social skills, paired with the ability to be assertive
at the appropriate times, could present significant challenges to some learners with
ASD who are prone to be more socially withdrawn. For students to be successful in
postsecondary education, their goals should be clearly understood, and their aptitudes
and interests need to be aligned with these goals. To be successful, students will need
to receive early planning, coordinated efforts by their team on their behalf at the sec-
ondary education level, and increased exposure to postsecondary institutions to assess
their goodness of fit and the availability of formal and informal supports.
Recommendations for Future Research on

Promoting Successful Life Outcomes for
Persons with ASD
Future research must be conducted on how we can promote and realize better life
outcomes for adults with ASD. Currently, the trend does not look promising in the
areas of employment, independent living, community integration, postsecondary edu-
cation, and overall QOL. There are high rates of unemployment and underemploy-
ment among individuals with ASD, and these are exemplified by those individuals who
may give up on finding employment or who have skill levels clearly exceeding the
menial jobs that they can obtain. As we have learned, many students with ASD leaving
high school have a difficult transition to the community. This difficulty is not only evi-
dent in terms of levels of integration, belonging, and social supports, such as forming
lasting friendships, but also in terms of living independently, for many will continue
to live at home with their parents, and few students with ASD attend postsecondary
education. The attainment of QOL outcomes for these individuals often seems bleak,
and underattainment is too often the case. What can future research do to reverse
this trend? There appear to be three areas in need of investigation along these lines:
(1) increasing quality assurance in service delivery across the lifespan, (2) improving
transition planning and implementation, and (3) enhancing post-school outcomes

through policy formation, establishment of better service delivery alternatives, and
professional intervention.
Future research needs to address the issue of quality assurance in the delivery of
services to persons with ASD and their families across the lifespan. Currently, gaps exist
in both the availability and quality of services received across the country by persons
with ASD and their families. Continuity of basic service delivery that is not only merely
compliant with laws, but also grounded in evidence-based practices (EBPs), is needed to
provide early identification, intensive early intervention, and linkages to public school
programs that will provide individualized educational and behavior supports to indi-
viduals. Building consistent, quality services to individuals at an early age and during
school years is critical to their long-term success. Research needs to examine all aspects
of service delivery in terms of capacity and infrastructure and how to meet the demand
for services by a growing population of persons with ASD. Issues such as improving
professional development, examining the portability of EBPs in applied settings, and
developing continuity in programming are merely examples of the many areas that
need to be considered. Research relating to family partnerships in the delivery of ser-
vices and addressing the service delivery needs of families from diverse cultures is also
sorely needed. Expanded adult service options and funding for these services is another
critical need to aid in providing lifespan supports to individuals and families.
A second area in need of further research as it relates to improving individ-
ual outcomes is the area of transition planning. Components of transition planning,
including the degree of student and family involvement, are elements in need of fur-
ther examination. Does student and family engagement in the transition planning
process have a substantial impact on quality outcomes, or is this engagement minimal
and solely based on service availability? Aside from student and family involvement,
research needs to explore the quality of experiences for the student during the transi-
tion process to fully evaluate how early experiences of quality translate to skill devel-
opment and generalization to life outcomes beyond school.
Finally, a national task force should examine how to improve post-school out-
comes through policy and practice, as the number of students with ASD who will be
exiting into the adult sector will be a vast increase in years to come given the increases
in the prevalence of ASD diagnoses. Factors related to cost, quality, and availability all
need to be addressed in a comprehensive manner to meet the rapidly expanding need.
Research aimed at answering applied questions relating to policy, practice, and service
are needed to improve outcomes.

the Foundation for Autism Support and Training (FAST), a n ot-for-profit organiza-
tion whose stated mission it is to provide people with autism with opportunities and
support for meaningful community living and involvement, with the goal of enhancing
important QOL components such as choice and independence. Among other services,
FAST connects people to community living options and life planning resources, and
it promotes p
erson-centered planning and the provision of QOL supports. For more
information, consult their website at: www.foundationforautismsupportandtraining
.org/home.html
Chapter Summary
This chapter examined quality-of-life outcomes for persons with ASD. Data from
existing studies was shared, highlighting the less than optimal outcomes too often
experienced by persons with ASD in the adult post-school sector. Quality-of-life and
post-school outcomes were examined across various domains including home, com-
munity living, employment, and postsecondary education. As emphasized throughout
the chapter, these outcomes have been less than satisfactory for most young adults
with ASD, for a host of reasons. Finally, the area of future research delving into these
important questions was examined.
1. Visit your local school system and ask to shadow their transition coordinator, specifi-
cally in regard to students with ASD, to better understand the role and functions of this
important professional.
2. Interview an adult with ASD or a family member, and ask about his/her life and how
they feel about matters relating to their QOL, their joys, their challenges, their hopes,
and so forth.
3. Visit an employer and a postsecondary educational institution, and ask about their
experiences with workers or students with ASD. Assess their attitude and their willing-
ness and experiences in this area.
Websites
Advancing Futures for Adults with Autism Ontario Adult Autism Research and Support
www.afaa-us.org/site/c.llIYIkNZJuE Network
/b.5063941/k.E26E/Overview.htm www.ont-autism.uoguelph.ca/STRATEGIES4
.shtml
Center for Excellence in Developmental Disabilities
www.ucdmc.ucdavis.edu/ddcenter TERi
www.teriinc.org/life-quality-services/about-
Foundation for Autism Support and Training lqs.html
www.foundationforautismsupportandtraining
.org/home.html
Articles
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Renty, J. O., & Roeyers, H. (2006). Quality of life in high-functioning adults with autism spectrum
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White, C. T., Pham, A. N. T., & Vassos, M. V. (2012). A systematic review of quality of life mea-
sures for people with intellectual disabilities and challenging behaviours. Journal of Intellectual
Disability Research, 56, 270–284.
Books
Greenbaum, J. (2007). Life planning for adults with developmental disabilities: A guide for parents and fam-
ily members. Oakland, CA: New Harbinger.
Tommey, P., & Tommey, J. (2011). Autism: A practical guide for improving your child’s quality of life.
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Free Chapter Excerpt

Schalock, R. L., Alonso, M. A. V., & Braddock, D. L. (2002). Handbook on quality of life for human
service practitioners. Washington, DC: American Association on Mental Retardation. Chapter
excerpt available at: http://bookstore.aaidd.org/BookChapterExcerpt%5CHandbk_Human
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Name Index
Abbeduto, L., 102 Bellini, S., 179–180, 294 Burgess, A. F., 322
Adreon, D., 161, 310 Ben, K. R., 94 Burns, K. A., 36
Agran, M., 286, 289, 295, 296, 313 Benitez, D. T., 296 Butter, E., 25, 54
Ahmedani, B. K., 99 Berard, G., 21 Byiers, B. J., 60
Akullian, J., 179–180, 294 Beretvas, N., 208 Byrd, D. R., 122
Alberto, P. A., 290 Berg, W. K., 196
Albin, R. W., 94 Bergan, J. R., 216, 220, 235 Cali, P., 248
Algozzine, B., 91, 120, 282, 293 Bettelheim, B., 9 Canham, D. L., 93
Allen, K. D., 163 Beversdorf, D. Q., 163 Cannon, B., 23
Allmon, A., 245 Bhatia, M. S., 169 Cappadocia, M. C., 176–177
Almeida, C., 16 Bijou, S. W., 194 Carbone, V. J., 140
Almeida, D. M., 95 Billstedt, E., 300, 302 Cardon, T. A., 180
Alpern, C. S., 132, 134 Bishop, M. R., 203 Carnahan, C. R., 260, 274–275
Altevogt, B. M., 4 Bishop, S. L., 95 Carpenter, L. A., 33
Altiere, M. J., 93 Blanchard, C., 286, 295 Carpenter, M., 208
American Occupational Blatt, B., 14, 320 Carr, E. G., 60, 190, 191, 208, 223
Therapy Association, 35 Blessing, C., 302 Carr, S. E., 33
American Psychiatric Association, 75 Bleuler, E., 168 Carrington-Rotto, P., 216
American Psychological Blue-Banning, M., 90 Carter, A., 131
Association, 35 Blumberg, S. J., 2 Carter, C. M., 15
Arakelian, C., 305 Bock, S. J., 229, 230, 231 Carter, C.M., 185
Araujo, B. E., 121 Bolick, T., 152 Carter, M., 128, 182
Arnold, L. E., 54 Bondy, A., 143, 148, 208 Carter, S. L., 13, 20, 61, 182, 196,
Assouline, S. G., 245 Borders, C., 260 234–235, 277
Atak, J. R., 268 Borrero, J. C., 196 Cass, H., 78
Attanasio, V., 140 Bosch, S., 128 Cassidy, A., 95, 99
Auinger, P., 33 Bouck, E., 271, 272 Cavin, M., 296
Ault, M. H., 194 Bowker, A., 56–57 Cederlund, M., 300
Avramidis, E., 151 Bradley, L. J., 159 Cerbo, R., 33
Ayres, K. M., 241 Brady, M., 93 Chapman, S. M., 306
Brantlinger, E., 12–13 Charles, J. M., 33
Bailey, J., 51 Bray, M., 270 Charlop-Christy, M. H., 208
Bain, S. K., 48 BRIGANCE, 76 Charman, T., 270
Baird, G., 78 Bromley, J., 85 Chasson, G. S., 167
Banda, D. R., 176, 268, 274 Bronfenbrenner, U., 104–105 Chaudhary, D., 169
Bandura, A., 178, 292, 294 Brooks, P. J., 139 Chavis, A. M., 37
Baranek, G. T., 21 Brotman, L. M., 101 Chawarska, K., 131
Barnardt, J., 323 Browder, D., 37, 241, 270–271, 275, Chiang, H., 128
Baron-Cohen, S., 76, 133, 168, 282, 293 Chitiyo, M., 182, 223
170–172 Brown, J. A., 136 Christenson, S., 219
Barrier, P. A., 57 Brown, K. S., 48 Christon, L. M., 56
Barton, M. L., 76 Brown, T., 35–36 Cicchetti, D. V., 60, 63
Bauman, K. E., 192, 223 Brownlee, S., 229 Cidav, Z., 33
Beatson, J. E., 107, 109 Brucker, D. L., 305 Clark, C., 93
Beegle, G., 90 Bryan, M., 248 Clark, G. M., 306
Behavior Analyst Certification Buffington, D. M., 290, 293 Clarke, L., 260
Board, 35 Burch, M., 51 Cloppert, P., 163
Beidel, D. C., 93 Burcroff, T. L., 311 Cloutier, H., 305
365
366 N ame I nde x
Compton, D., 60 Dunlop, A. W., 169 Gaudiano, B. A., 36

Conoley, J., 219 Durand, V. M., 208 Gavidia-Payne, S., 99–100
Conrad, E. E., 77 Durocher, J. S., 161, 310 Gentry, T., 163
Cook, B. G., 37, 63 Dyches, T. T., 120 Gergans, S., 174
Cook, G., 325 Gersten, R., 12–13, 60
Cook, L., 37 Eagle, J. W., 236 Gillberg, C., 132, 300
Cooney, B. F., 159 Eaton, M. D., 277 Gillberg, I. C., 300
Cooper, L. J., 196 Eaves, L. C., 300 Gillis, J. M., 93
Cooper-Duffy, K., 37 Eberly, J. L., 121 Gipson, K., 296
Cotugno, A. J., 169 Eigsti, I. M., 131, 132 Gitz, L. L., 176
Council for Exceptional Eikseth, S., 23 Goin-Kochel, R. P., 33
Children, 35 Eldevik, S., 23 Goldsmith, T. R., 131
Courtade, G., 241 El-Ghoroury, N. H., 120 Goldstein, H., 292, 293
Cowan, R. J., 236 Elliott, S. N., 216 Goldstein, S., 77, 81
Cox, R. W., 170 Ellis, A. R., 99 Golnik, A. E., 21
Coyne, M., 60 Ellis, J. T., 23 Gomez, L. E., 322
Crider, G., 115 Emerson, E., 33, 85 Goode, S., 300
Cunningham, A. B., 34 Estes, A.M., 243–244, 248 Goodman, G., 269
Cureton, V. Y., 93 Goodman, J., 259
Curtis, M. J., 212, 216 Fallen, A., 163 Gotts, S. J., 170
Farley, C. A., 63 Graff, J. C., 119
Daggett, J. A., 93, 111, 112 Fasoli, L., 40 Grandin, T., 178
Dalrymple, N., 114 Felce, D., 33 Graupner, T. D., 23
Daly, E. J., 277 Feldman, R. S., 16 Gray, C., 181
Daly, K., 79 Fernell, E., 132 Green, H., 313–314
D’Angelo, N. M., 56–57 Ferraioli, S. J., 99 Green, J. A., 76
Daniels, J., 99 Ferris, D., 76 Greenberg, J. L., 167
Davis, C. L., 36 Fettig, A., 255 Greenberg, J. S., 95
Davis, K., 99–100 Field, S., 295 Greenson, J., 16
Davison, K., 85 Fish, T., 163 Greenspan, S., 17–18
Dawson, G., 17, 21, 243, 248 Fishbough, M., 212, 215 Greenwood, C., 60
De Caris, M., 33 Flippin, M., 135, 137, 138 Gregory, M. K., 140
DeLeon, I. G., 140 Flusberg, H. T., 131 Griffin, J. M., 119
de Marchena, A. B., 131 Fojut, K. M. D., 158 Grosse, S. D., 33–34
Derby, K. M., 196 Fombonne, E., 177 Guli, L. A., 236
Deuster, P., 100–101 Forest, M., 303 Gupta, V. B., 57
DeVellis, R. F., 79 Foriska, T., 113 Gutkin, T. B., 216
Didden, R., 139, 324 Fowler, C. H., 307, 314 Gutstein, S. E., 322
Dillon, A. R., 174 Frankel, F., 174
DiPipi-Hoy, C., 311 Frankland, H. C., 90 Hagberg, B., 300
Dockery, L., 245 Frea, W. D., 292 Hagner, D., 159, 305, 311
Donaldson, A., 16 Friedemann-Sanchez, G., 119 Haley, J. L., 262
Donaldson, J. B., 272, 273 Frith, U., 170 Haley, W. E., 100
Dool, E. J., 277 Frost, L. A., 148, 208 Hall, H. R., 119
Dorminy, K. P., 252 Frost, S. S., 100–101 Hall, S. E., 56
Dorsey, M. F., 192, 223 Fuchs, L. S., 60 Halle, J., 60
Dougherty, A. M., 235 Fulk, B. M., 233 Halterman, J. S., 101
Douglas, K. H., 241 Fuqua, R. W., 128 Hanley G. P., 208
Dove, D., 162 Hansen, C. L., 277
Drain, T. L., 268 Gagie, B., 263 Hanson, S., 4
Drasgow, E., 110, 144 Ganz, M. L., 5, 319 Happe, F., 270
Ducharme, J. M., 268–269 Garfield, E., 54 Hare, D. J., 85
Duffy, M. L., 269 Garfinkle, A. N., 289 Haring, N. G., 277
Dunlap, G., 94, 111 Gast, D. L., 252, 271, 293 Harris, K., 12–13
N ame I nde x 367
Harris, S. L., 36, 93, 99 Individuals with Disabilities Klingenberg, L. C., 138
Harrison, S. B., 303 Education Act (IDEA), 199 Knight, V., 182, 275
Harrower, J., 15 Ingersoll, B., 174 Knott, F., 169
Harrower, J.K., 185 Innocenti, M. S., 60 Koegal, L. K., 15
Hart, S. L., 176 Iovannone, R., 111–112 Koegal, R., 14
Hart. B., 16 Ireland, M., 21 Koegel, B. L., 151
Harvey, V., 323 Iuculano, T., 272 Koegel, L. K., 15, 93, 151, 152, 185,
Hastings, R. P., 35–36 Iwata, B. A., 192, 199, 208, 223 267, 289, 292
Hatton, D. D., 138 Koegel, R. L., 15, 93, 151, 185, 267,
Hazelkorn, M., 259 Jacobs, J., 274–275 289, 292
Hazelton, L., 117 Jahr, E., 23 Kogan, M. D., 93
Head, L. S., 102 Jennett, H. K., 36 Koger, S. M., 292
Hedvall, A., 132 Jensen, N. M., 57 Kohler, P. H., 314
Heflin, L. J., 259 Jepson, B., 4 Konzal, J., 121
Heick, P. F., 262 Jimenez, B., 241 Kortering, L. J., 314
Heller, T., 286, 289 Johnson, C. P., 6, 73–74 Koul, R. K., 144
Hemmes, N. S., 290, 293 Jolivette, K., 223 Krackow, E., 120
Henderson, L. M., 6 Jonas, W. B., 100–101 Kratochwill, T. R., 116, 216–217,
Hendren, R., 54 Jones, C., 270 220, 231, 236
Hendricks, C. B., 159 Jordan, K. R., 48 Kravits, T., 292
Hendricks, D., 33, 154, 324, Jorgensen, J. D., 296 Kriner, R., 163
325, 328 Joshi, A., 121 Kroeger, K. A., 176–177
Hensley, M., 324 Jung, L. A., 114 Kubina, R. M., 268, 274
Herbert, J. D., 36 Kuhn, R., 168
Herbst, M., 110 Kadlec, M. B., 131 Kurth, J., 248, 249, 250–251
Hetzroni, O. E., 143 Kahng, S., 208 Kurtz, A., 305
Heward, W. L., 214, 290 Kalyanpur, M., 91
Hicks, R., 56–57 Kalyva, E., 151 Ladner, J., 292
Hill, D. A., 37 Kamps, D., 292 Lalli, J. S., 196
Hill, S. S., 246 Kanner, L., 2–3, 9, 168 LaMontagne, M. J., 95
Hillier, A., 163 Kanwai, K., 169 Lamson, A. L., 93
Hinkley, L. B. N., 246 Kaplan, F., 14, 320 Lancioni, G. E., 139, 208, 293
Hirst, J. M., 139, 261–262 Karvonen, M., 282, 293 Landa, R., 128
Ho, H. H., 300 Kasper, T., 140 Landrigan, P. J., 3
Hock, R. M., 99 Katsiyannis, A., 110 Landrum, T. J., 37
Hodgson, J. L., 93 Kay, D., 115 Lang, R., 252
Hoff, R., 131 Kearley, R., 37 Lanou, A., 266
Holifield, C., 259 Kehle, T. J., 270 Lansing, M. D., 79
Hong, J., 95 Keith, K. D., 322 Lattimore, J., 296
Hoover, J. H., 225 Kelchner, K., 282 Lau, S., 163
Hord, C., 271, 272 Kellems, R. O., 313 Laugeson, E. A., 174
Horner, R. H., 12–13, 60, 94 Keller, T. A., 170 Lawer, L., 33
Hough, L., 266 Kellet, K., 208 Layton, C. A., 159
Howlin, P., 300 Kelley, E., 131 Le, L., 208
Huber, H., 111 Kelley, M. E., 208 Leach, D., 269
Hudson, L. E., 152–153 Kenney, S. L., 95 LeBlanc, L., 36, 208
Huemer, S.V., 270, 271 Kerns, K. A., 83, 95 LeCouteur, A., 80
Hughes, C., 286, 313 Kerwin, E. J. S., 140 Lee, D. L., 274
Hume, K., 20, 260 Kicaali-Iftar, G., 203 Lee, S., 292
Hurley, C., 292 Kidd, P. M., 22, 23 Lerman, D. C., 208
Hurt, E., 54 Kincaid, D., 111 Leshner, A. I., 4
Hutton, J., 300 King, L. B., 33 Leslie, A. M., 170
Hyman, S. L., 54 Kjellmer, L., 132 Leslie, D. L., 33
Hyman, S. R., 139, 261–262 Klein, J., 311 Levy, A., 323
368 N ame I nde x
Levy, S. E., 54 McConkey, R., 95, 99 National Information Center

Li, J., 57 McConnell, D., 102 for Children and Youth with
Light, J. C., 140 McDonald, M. E., 290 Disabilities, 295
Lin, Y., 128 McDougall, D., 128 National Longitudinal Transition
Liptak, G. S., 33 McGee, G., 60 Study 2, 326
Liptak, J., 306 McGee, G. G., 16 National Organization on
Llewellyn, G., 102 McGlashing-Johnson, J., 296 Disability, 300
Lock, R. H., 159 McGrew, J., 114 National Professional Development
Lockshin, S. B., 93 McKerchar, P. M., 196 Center (NPDC), 173–174, 182
Lofthouse, N., 54 McLaurin, C., 99 National Research Council, 275
Logan, S. L., 33 McLean, L. K., 159 National Secondary Transition
Lombardo, M. V., 168 McMahon, C. R., 6 Technical Assistance Center,
Long, J. S., 14 McPheeters, M. L., 162 307, 308, 314–315
Lord, C., 80, 204 Meadan, H., 255 Navas, P., 322
Lovaas, I., 14, 15, 23–24 Mechling, L., 294 Ne’eman, A., 143
Lovitt, T. C., 277 Meier, R. P., 140 Neitzel, J., 175
Lowrey, K. A., 241 Meinberg, D. L., 290 Nelson, D., 139
Lucyshyn, J. M., 94 Menendez, A. L., 182 Nelson, L. L., 90
Luiselli, J. K., 23, 262 Meng, L., 177 Nevill, R. E. A., 161
Luscre, D., 252, 271 Mesibov, G., 20, 36, 93, 306 Nevin, A., 313
Luther, E. H., 93 Metz, B., 25 Nevin, J. R., 268
Luyster, R. J., 131 Michalak, N., 229 Newman, B., 290, 293
Michna, A., 255 Newsom, C., 176–177
Machalicek, W., 208, 252 Mickelson, W., 236 Ng, O., 268–269
Mackay, T., 169 Milbury, L. A., 170 NICHCY, 328
Mackintosh, V. H., 56 Millar, D. C., 140, 141 Nicholas, J. S., 33
Maenner, M. J., 152–153 Miller, R., 295 Nicholson, H., 270
Magyar, C. I., 101 Miller, V. A., 35 Nicpon, M., 245
Malhotra, S., 169 Miltenberger, R. G., 203 Nissenbaum, M. S., 83–84
Mancil, G. R., 248–249, 261, 266 Minshew, N. J., 170 Norrelgen, F., 132
Mancina, C., 292 Mirenda, P., 139, 140, 141 Nye, C., 140
Mandell, C., 268 Mithaug, D. E., 295, 313
Mandell, D. S., 33 Mogil, C., 174 Obiakor, F. E., 120
Manikam, R., 293 Mohler, A., 314 O’Brien, M., 93, 111, 112
Mann, V., 270, 271 Molinelli, A., 163 O’Connor, F. G., 100–101
Marco, E. J., 246 Montes, G., 101 Odom, S., 60, 136, 138
Marcus, L. M., 79 Moody, M., 115 Odom, S. L., 12–13, 20
Martens, B. K., 277 Morningstar, M., 313, 316 Ogilvie, C., 261
Martin, A., 170 Morrissey, J. P., 99 Ogletree, B. T., 140
Martin, J., 295, 313 Mount, B., 303 O’Grady, M. A., 290
Masedu, F., 33 Mulick, J. A., 25 O’Hora, D. P., 203
Massey, N. G., 19–20, 184, 263 Mulvihill, B. A., 101 Olive, M. L., 203
Mastergeorge, A. M., 248, 249, Munson, J., 16, 243 O’Reilly, M. F., 139, 208, 252
250–251 Mustian, A. L., 314 Ostrosky, M. M., 255
Matson, J. L., 80 Myers, B. J., 33, 56 Ozonoff, S., 77
Matson, M. L., 80 Myers, J. A., 292
May, J., 305 Myers, S. M., 6, 73–74 Palmer, S., 295, 296, 313
Mayer, E. G., 33 Pardo, C. A., 3
Mayton, M. R., 20, 61, 68, 182, 196, Nagarajan, S. S., 246 Parker, R., 314
234–235, 277 Naglieri, J., 77, 81 Parrett, J., 292
Mazzotti, V. L., 314 Narendorf, S., 324 Partin, M. R., 119
McAfee, J. K., 274 Nassar-McMillan, S., 91 Patton, J. R., 306
McCammon, S. L., 93 National Association for the Paul, R., 134, 135, 137–138
McCarthy, J., 22 Education of Young Children, 35 Paulin, A. W., 151
N ame I nde x 369
Pearl, C. E., 266 Reynhout, G., 182 Schopler, E., 79, 93, 124, 204, 306
Peck, J., 100–101 Riccio, C. A., 56 Schreck, K. A., 35
Peck, S. M., 196 Rice, C., 33–34 Schreibman, L., 8, 34, 186,
Pellicano, E., 169 Richards, S., 282 292, 293
Perkins, M., 100 Richardson, M., 302, 304 Schuh, J. M., 131
Perrin, J. M., 56 Richardson, W., 36 Schultz, J. R., 176–177
Perry, A., 323 Richey, D. D., 81–82, 91, 183, 192 Schumaker, K. M., 296
Persico, A., 3 Richman, D. M., 140 Schwartz, J. B., 140
Peterson, R. F., 194 Richman, G. S., 192, 223 Schwartz, M., 288
Phelps, K. W., 93 Richter, S., 182 Scott, J., 93
Pierce, K. L., 292 Ricketts, J., 270 Scwalm, M. N., 80
Pittman, P. H., 216–217 Rimland, B., 22 Seltzer, M. M., 95, 300, 325, 326
Piven, J., 324, 325 Risely, T. R., 16 Shake, C., 100–101
Ploog, B. O., 139 Rispoli, M., 203, 252, 269 Shapiro, E. S., 277
Plotner, A. J., 300, 312 Rittman, M., 119 Sharp, I. R., 36
Polvin, M. C., 159, 160 Rivera, V., 248 Shattuck, P. T., 152–153, 324, 325
Post, S. G., 35 Roath, C. T., 289 Shaw, A., 167
Poston, D., 100 Robbins, S. H., 185 Shaw, G., 4
Potter, D., 323 Roberts, K. D., 334 Shea, V., 20, 93
Poulson, C. L., 290 Robins, D. L., 76 Sheehey, P. H., 302
Powell, E., 266 Robinson, K. A., 163 Sheridan, S. M., 236, 238
Powers, L., 287 Robinson, S. L., 216, 217, 235 Shield, A., 140
Pozdol, S. L., 77 Rodriguez, V., 33 Shimabukuro, T. T., 33–34
Prelock, P. A., 159 Roeyers, H., 84 Shogren, K. A., 252, 292, 300, 312
Premack, D., 266 Rogers, S. J., 16, 17, 138 Sieck, R., 245
Prior, A., 323 Romanczyk, R. G., 93 Siegel, J. H., 163
Prizant, B. M., 133 Romaniuk, C., 203 Siegel, M., 33
Progar, P. R., 158 Romano, N., 314 Siemens, I., 117
Punyanunt-Carter, N. M., 231 Rosenfield, S., 216 Sievers, C., 241
Rossignol, D. A., 55 Sigafoos, J., 139, 144, 208
Rabins, P., 324, 325 Rosswurm, M., 36 Siklos, S., 83, 95
Rafoth, M. A., 113 Roth, D. L., 100 Simmons, J. Q., 14
Rajender, G., 169 Roux, A. M., 152–153 Simmons, W. K., 170
Ramdoss, S., 139 Ruble, L. A., 114 Simpson, R., 25, 26
Rao, P. A., 93 Rugg, M. E., 91 Simpson, R. L., 292
Rao, S. M., 91, 263 Rutter, M., 80, 300 Singer, T., 167
Ratzan, S. C., 54 Ryan, C. S., 290 Singh, A. D. A., 293
Redinius, P., 225, 226, 227, 228, Singh, A. K., 267, 289
233, 235, 236 Sack, S. H., 159 Singh, A. N. A., 293
Reed, D. D., 58 Sainato, D. M., 292 Singh, N. N., 293
Reed, F.D., 261–262 Sallows, G. O., 23 Siperstein, G. N., 314
Reed, F. D. D., 58, 139 Sancibrian, S., 144 Sisson, R., 23
Reed, S., 186 Sanetti, L., 116 Sitlington, P., 296
Reese, R. M., 83–84 Sasso, G. M., 223 Skinner, B. F., 14, 48
Reeve, K. F., 158 Sathe, N. A., 162 Slevin, E., 95, 99
Reichle, J., 60 Schaefer-Whitby, P. J., 248–249, Slifer, K. J., 192, 223
Reichler, R. J., 79 261, 272, 273 Slonims, V., 78
Reichow, B., 60, 63, 172, 173, 174 Schalock, R. L., 289, 322 Smith, B. R., 275
Reinecke, D. R., 290 Scharf, A., 139 Smith, G. J., 128
Reinhartsen, D. B., 289 Scherz, H. H., 136 Smith, L. E., 95
Renes, D., 163 Schippers, A., 100 Smith, M., 16
Renty, J., 84 Schlosser, R. W., 140, 144 Smith, P. E., 128
Reszka, S., 135 Schneider, J., 102 Smith, R. G., 22
Rettmann, N. A., 119 Scholte, R. H. J., 324 Smith, R. M., 313
370 N ame I nde x
Smith, T., 23 Timpano, K. R., 167 Wedgewood, N., 102

Smull, M. W., 303 Tollefson, N., 83–84 Wehman, P., 154, 187, 302,
Snider, L., 159 Torres, C., 63 304, 313–314, 316, 324,
Snow, A. V., 131 Toussaint, K. A., 289 325, 328
Snow, J., 311 Townsend, D. B., 158 Wehmeyer, M., 282, 286, 288, 289,
Sorge, G., 33 Trani, J. F., 152–153 293, 295, 296, 313
Sorrell, J. M., 101 Transition Coalition, 316 Weider, S., 17–18
Southall, C., 293 Triplett, B., 255 Weiss, J. A., 176–177
Spector, J. E., 271 Troutman, A. C., 290 Wells, J. C., 302
Sperry, L., 175 Truesdale-Kennedy, M., 95, 99 Wells, K., 56–57, 175
Spooner, F., 182, 241, 275 Tse, J., 177 West, E. A., 34
Stahmer, A. C., 34, 186, 293 Tuntigian, L., 290 Westby, C., 122
Steere, D. E., 311 Turnbull, A. P., 102 Westgate, R. J., 302
Steiner, A. M., 131 Turnbull, H. R., 102 Westphal, R. J., 100–101
Sterling, L., 243 Turner, L. M., 77 Wheeler, J. J., 19–20, 20, 61, 68,
Sterzing, P., 324 81–82, 91, 175, 182, 183, 184,
Stichter, J. P., 115, 223 Ulke-Kurkcuoglu, B., 203 192, 196, 225, 226, 227, 228, 233,
Stinson, R. D., 245 Umbarger, G. T., 54 234–235, 236, 263, 277
Stoiber, K. C., 236 United Nations, 322 White, S. W., 161
Stollar, S. A., 212 Wilder, L. K., 120, 121
Stone, W. L., 6, 77 Valenti, M., 33 Wiley, S. B., 33
Stoneman, Z., 91 van Boheemen, M., 100 Wilhelm, S., 167
Strain, P. S., 292 Van Camp, C., 196, 208 Wilkinson, L. A., 236
Stringfield, S. G., 271 Vandercook, T., 303 Williams, C. M., 269
Strulovitch, J., 177 van der Meer, L., 139, 140, Williams, R. D., 105
Stuart, T., 33 145, 146 Williamson, P., 274–275
Sugai, G., 191 VanderWeele, J. V., 162 Winter, J., 16
Suhrheinrich, J., 186 Van de Water, J., 3 Winton, A. S. W., 293
Sulzer-Azaroff, B., 16 Van Heest, J., 270 Witt, J. C., 277
Summers, J. A., 90 Van Roekel, E., 324 Wolery, M., 60, 289
Sutherland, D., 139 Varley, J., 16 Wolf, M. M., 114
Swick, K. J., 105 Verdugo, M. A., 322 Wong, H. H., 22
Symons, F. J., 60 Vernon, T. W., 151 Wood, C. L., 275
Virues-Ortega, J., 33 Wood, W., 282, 293
Tagalakis, V., 177 Volkmar, F. R., 60, 63, 172, Woodrow, C., 40
Tankersley, M., 37, 292 173, 174 Woods, J. J., 136
Tarbox, J., 203 Vollmer, T. R., 196 Woodward, K. R., 100–101
Targett, P., 302, 304, 313–314 von Kluge, S., 93 World Health Organization,
Taylor, J. L., 152–153, 162, 300, 322
325, 326 Wacker, D. P., 196 Worsdell, A. S., 208
Temple, E. M., 100 Wadley, V. G., 100 Wright, C. S., 196
Test, D., 182, 282, 293, 294, 307, 314 Wagner, M., 272, 324
Thiemann, K., 293 Wallace, D. P., 163 Xin, Y., 270–271
Thimersol, 3 Wallace, G., 170
Thoma, C. A., 313 Wang, L., 33 Yell, M. L., 110
Thomas, J. B., 306 Ward, M., 295 York, J., 303
Thomas, K. C., 99 Warren, Z., 162 Yu, C. T., 33
Thomas, R., 196 Watling, R., 21
Thomas, R. A., 20 Watson, L. R., 135 Zager, D., 132, 134, 272, 273
Thompson, B., 12–13 Watson, S., 83 Zane, T., 36
Thompson, E., 296 Watson, T. S., 216, 217, 235 Zhang, J., 61, 175
Thompson, R. H., 196, 208 Weatherby, A. M., 133 Zirkel, P. A., 37, 110
Tiger, J. H., 289 Webb, S. M., 185 Zuckerman, C. K., 203
Subject Index
academic learning, 240–280 destination and current location, Subjectivity, Superstition, and
academic achievement in, 247–250 53–55 Mr. Gullible, 49
high functioning autism and, list of, 54–55 Teaching a Functional Skill
248–249 parent use and professional Sequence, 332
learning profiles and, 249 response, 56–57 The Trial-and-Error Treatment,
ongoing evaluation and, 250 alternative communication, 139. 31–32
student task engagement and, See also augmentative and Video Game Enthusiast, 287–288
249–250 alternative communication areas of purview, treatment decisions
challenges and needs in, 261–264 (AAC) and, 55–56
challenging behavior, 264 American Academy of Pediatrics, 6 Asperger’s syndrome, 5, 74, 170,
stereotypy, 261–263 American Psychiatric Association 248–249, 272, 273. See also
visual learning needs, 263–264 (APA), 4–5, 75 high functioning autism
characteristics of, diverse, American Sign Language (ASL), 140 (HFA)
242–251 antecedent-behavior-consequence assessment
academic achievement, (ABC), 82, 194–196 behavioral, 81–83
247–250 antecedent-management strategies, characteristics and early signs of
attention and processing, 200–206 ASD, 73–77
245–247 environmental variables, 201–202 exemplary programs and practices,
instructional contexts, 250–251 instructional approaches, 201, 86–87
intellectual ability, 243–245 202–204 information collected as part of
compliance in, 267–269 task-related variables, 204–206 process, 79–80
engagement in, 269–270 applied behavior analysis (ABA), instruments, 80–81
exemplary programs and 13–15 intervention linked to, 85–86
practices, 278 social skills interventions, 172–173 multidisciplinary, 77–78
instruction in, selected teaching methods and techniques, outcomes derived from, 85
methods of 277–278 overview of, 72–73
behavior analysis for, 277–278 as therapy, 51 supporting children and families
mathematics, 271–274 Applied Vignettes through, 83–85
reading, 270–271 Andrea, 153 assessment instruments, 80–81. See
science, 274–276 An Example of a Social Skills also screening instruments
motivation in, 265–267 Training and Support Group, Autism Behavior Checklist
overview of, 240–242 178 (ABC), 80
skills prerequisite to, 251–261 Daniel, 207–208 Autism Diagnostic Interview-
expected social behavior, The Evaluation Process, 77–78 Revised (ADI-R), 80
260–261 Family/Professional Partnerships, Autism Spectrum Rating Scale
self-regulation, 252–259 27 (ASRS), 81
working independently, 260 The Hearsay Dilemma, 39 assessment knowledge, in
across-systems consultation, 217, The Importance of Early consultation, 233
219, 220 Identification: Matthew’s attention deficit disorder (ADD), 11
administrative support, collaboration Story, 10–11 attention in academic learning,
and, 231 Jared, 247 245–247
adulthood, transition to. See Life Decisions, 310–311 auditory integration therapy, 21
transition planning Making a “Work System” Work, augmentative and alternative
aggressive behavior, 2 220 communication (AAC),
aided versus unaided tools, 144–145 Mary Jane Describes the Needs of 139–148
alternative and emerging treatments, Her Family, 103–104 defined, 139
53–57 Natasha Describes the Challenges learner preference, 145–147
areas of purview, relevant, 55–56 Faced by Her Family, 94–95 tools, 139–145
371
372 S u bject I nde x
autism. See also autism spectrum self-regulation, 252–259 collaboration

disorders (ASD) visual cues, 252–257 across life span, applications of,
causes of, 3–4 applied behavior analysis, social 235–237
characteristics of, 2–3 skills and, 172–173 defined, 212
culture of, 19 cause-and-effect scenarios effective, components of, 229–231
overview of, 1–3 surrounding, 82 administrative support, 231
Autism Academy of Learning (AAL), communication and, 128, 129–130 allocating responsibilities to
278 functions of, 81 team members, 230–231
Autism Behavior Checklist (ABC), 80 replacement, 82–83 environmental factors, 229
Autism Diagnostic Interview-Revised support plans, 199 interpersonal communication
(ADI-R), 80 behavioral assessment, 81–83 skills, 231
Autism Language Program (ALP), behavioral characteristics, 2–3, 14, 21 overview of, 230
162 behavioral model of intervention, 172 recognizing strengths and needs
Autism Research Institute, 22 behavior momentum, 268 of team members, 230
Autism Screening Instrument behaviors exemplary programs and practices,
for Educational Planning nonverbal instructional approaches 238
(ASIEP), 80 to, 203 formal, 213–214
autism spectrum disorders (ASD) replacement, 206–208 informal, 213–214
characteristics of, 73–77 biological factors, 4 members involved in, 212–213
classification of, recent changes in, boundaries, 102 models of, 215
74–75 Brigance Early Childhood Screen, 76 overview of, 211–212
detection of, importance of early, British Sign Language (BSL), 140 role valorization in, 235
5–6, 10–11 transition planning and, 313–314
developmental screening, 75–77 case studies types of, 214–215
diagnosis of, 6–8 levels of evidence and, 44–45 college-level education. See
educational programs for, 11–12 treatment decisions and, 52 postsecondary education and
family challenges associated with, characteristics of ASD, 73–77 training
91–92, 93 CHAT (Checklist for Autism in commitment, trust and, 92, 93,
intervention, role of early, 8–9 Toddlers), 76 96–98
overview of, 4–5 child development across critical communication
prevalence rates, 5 domains, 73–74 behavioral and, 128, 129–130
signs of, early, 73–77 Childhood Autism Rating Scale defined, 130
transistion points across lifespan (CARS), 79, 80 interpersonal skills, collaboration
for persons with, 11–12 childhood disintegrative disorder and, 231
treatment of, 6–8, 9–10 (CDD), 5, 75 language assessment and,
Autism Spectrum Rating Scale choice 133–134
(ASRS), 81 incorporating in instructional opportunities, creating, 148–151
“Autistic Disturbances of Affective approaches, 203 minimizing method, 149
Contact” (Kanner), 2–3 transition planning and, 312–313 partnering method, 149, 150
autoimmune disorders, 3 Christmas in Purgatory (Blatt and sabotage method, 149–150
aware communication among team Kaplan), 320 scripting method, 149, 150–151
members, 117–118 claims, treatment decisions and, 52 self-determination and, 283–284
classification of ASD, recent changes team members and, 116–124
behavior. See also functional behavior in, 74–75 communication plan,
assessment (FBA); positive classroom 122–124
behavior supports (PBS) activity schedules, 252–253, information needs, providing for,
academic learning and 255–256, 257 118–119
behavior analysis for, 277–278 applications, 138–139 methods of, 117–118
challenging behavior, 264 rules, 252, 253, 254 multicultural, 120–122
classroom rules, 252–254 client, in consultation, 216 Communication and Symbolic
expected social behavior, cognitive functioning, 7–8 Behavior Scales
260–261 cognitive theory for understanding Developmental Profile
self-monitoring, 259 social skills, 170–172 (CSBS-DP), 133
S u bject I nde x 373
communication skills, teaching, facilitation skills, 232–233 multicultural communication and,

127–165 intervention knowledge, 120–121
augmentative and alternative 234–235 psycho-educational evaluation, 6–8
(AAC), 139–148 organization skills, 233 screening process, 5–6
in education settings, 148–152 overview of, 231–232 Diagnostic and Statistical Manual of
employment and, 154–159 exemplary programs and practices, Mental Disorders (APA)
exemplary programs and practices, 238 4th edition (DSM-IV), 4–5
162 guidelines for conducting, 221 5th edition (DSM-V), 5, 74–75
needs across lifespan, 130–134 (See overview of, 211–212 direct/analog assessment, 197–198
also language development) parties in, 216 direct consultation, 217–218
overview of, 127–130 problem solving in, 220–225 directives versus questioning,
postsecondary education and gaining insight stage, 222–223 202, 203
training and, 161–162, 163 information gathering and direct/naturalistic assessment,
prerequisite skills, 134–139 sharing stage, 221–222 194–196
recreation and leisure and, 159–160 overview of, 221 discrete trial training (DTT), 14–15,
community living supervision and decision-making 23, 134–135
communication skills and, 152–162 stage, 224–225 dyadic model, 277
employment, 154–159 training and monitoring stage,
postsecondary education and 223–224 early intensive behavioral
training, 161–162, 163 role valorization in, 235 intervention (EIBI), 23–25
recreation and leisure, 159–160 team-based, 225–228 early start Denver model (ESDM),
outcomes, QOL and, 324–325 consultee, 216 16–17
postsecondary education and, consumer viewpoints on EBP, 33–34 echolalia, 132
331–333 efficiency, 34 ecological approach, 104–105
service delivery models and, 27 financial resources, 33–34 education programs. See also
transition planning and, 304, time, 33 postsecondary education and
308–309, 311–312 continuing education, professional training
complementary and alternative viewpoints on, 36 approaches used in, 13–23 (See also
medicine (CAM), 21–23 continuous measurement, 15 treatment approaches)
compliance in academic learning, coordination, 214. See also communication skills and, 148–152
267–269 collaboration communicating with peers,
comprehension, 271 credentials, treatment decisions and, 151–152
comprehensive support objectives, 52–53 creating opportunities to
200 culture of autism, 19 communicate, 148–151
conjoint behavioral consultation preparing students to
(CBC), 236 daily living needs associated with communicate, 148
consultant, required skills of, 231–237 ASD, 100, 101–102 in family team building, 113–115
assessment knowledge, 233 decision making, self-determination longitudinal, designing, 11–12
facilitation skills, 232–233 and, 289–290 efficiency, consumer
intervention knowledge, 234–235 decoding, 270 viewpoints on, 34
organization skills, 233 destination, treatment decisions and, electronic speech output device, 141
overview of, 231–232 53–55 electronic “talker,” 141
consultation. See also collaboration detection of ASD, importance of Elementary and Secondary Education
across life span, applications early, 5–6, 10–11 Act, 271. See also No Child
of, 235–237 developmental approaches, 17–18 Left Behind Act (NCLB)
approaches to, 217–220 developmental history, in assessment emerging approaches to treatment of
aspects of, positive and negative, process, 79 ASD, 10
218–219 developmental individual difference emerging treatments. See alternative
matching to needs, 219–220 relationship-based model and emerging treatments
characteristics of, 216–217 (DIR/floortime), 17–18 emotional needs associated with ASD,
defined, 215 developmental screening, 75–77. See 99, 100
effective, components of, 231–237 also screening instruments empathizing-systemizing theory,
assessment knowledge, 233 diagnosis, 5–8 171–172
employment social skills interventions, Virginia Commonwealth

communication skills and, 172–186 University Autism Center
154–159 methods identified, 173–174 for Excellence (VCU-ACE),
job placement, 156–157 naturalistic interventions, 187
long-term support, 158–159 185–186 experimental control studies, 43
on-the-job training, 157 parent partnerships, 174–175
problem-solving in people with peer-mediated interventions, face-to-face communication among
ASD, 154–155 175–176 team members, 118
outcomes, QOL and, 325–326 self-management, 183–185 facilitation skills, in consultation,
postsecondary education and, social narratives, 181–183 232–233
333–334 social skills training groups, family. See also family team building
transition planning and, 307–308 176–178, 179 multidisciplinary assessment and,
engagement in academic learning, video modeling, 178, 179–181 78
269–270 sufficient, 37–50 operation, theories of, 102–106
environment evidence, levels of, 42–47 ecological approach, 104–105
collaboration and, 229 scientific method, 48, 49–50 family systems approach, 102
educational settings and, 201–202 skepticism, 40–42 implications for teaming with
self-determination and, 286 social learning and professional families, 102, 104, 105, 106
environmental toxins, 3, 4, 23 practice, 37–40 perspectives, understanding,
errorless academic compliance subjectivity and superstition, 94–106
training (EACT), 268–269 48, 49 needs associated with ASD, 95,
errorless learning, 16 treatment decisions, 51–69 99–102
Essential Lifestyle Planning, 303 evidence-based treatment. See theories of family operation,
ethical responsibilities, professional evidence-based practice (EBP) 102–106
viewpoints on, 34–35 evidence regarding EBP, levels of, supporting through assessment,
evidence 42–47 83–85
factors impacting, 47 exemplary programs and practices, family systems approach, 102
levels of, 42–47 28 family team building, 89–126,
treatment decisions and, 52 Autism Academy of Learning 112–116
evidence-based practice (EBP), 9–10, (AAL), 278 commitment, fostering through
12–13 Autism Language Program (ALP), building trust, 92, 93, 96–98
AAC interventions, 139–147 162 communication among team
basic service delivery and, Florida’s Positive Behavior Support members, 116–124
continuity of, 336 Project: A Multi-Tiered education and treatment programs,
consumer viewpoints on, 33–34 Support System, 209 developing, 113–115
efficiency, 34 Foundation for Autism Support exemplary programs and practices,
financial resources, 33–34 and Training (FAST), 124
time, 33 336–337 family challenges associated with
defined, 32 Nebraska Center for Research on ASD, 91–92, 93
determining, 30–71 Children, Youth, Families and implications for, 102, 104, 105, 106
exemplary programs and practices, Schools (CYFS), 238 importance of, 91
69 Ohio Center for Autism and Low leadership, cultivating, 113
importance of, viewpoints on, Incidence (OCALI), 69 overview of, 89–91
33–37 OUCares, 86–87 programs, implementing, 115–116
consumer, 33–34 Princeton Child Development successful teams, methods for
historical, 36–37 Institute (PCDI), 28 fostering, 106–116
professional, 34–36 Transition Coalition, 316 buy-in and involvement, 116
overview of, 30–32 Treatment and Education of critical concepts in, 116
professional viewpoints on, 34–36 Autistic Communication effective practices, engaging in,
continuing education, seeking, Handicapped Children 111–112
36 (TEACCH), 124 family-centered philosophy of
ethical responsibilities, 34–35 University of Alaska-Anchorage care, 107, 109
training deficiencies, Center for Human family-centered philosophy of
recognizing, 35–36 Development, 296 practice, 110
family team building, 112–116 indirect/naturalistic assessment, individualized education plan (IEP)
knowledge and skills, up-to-date, 192–194 academic goals and, 250–251, 301,
110–111 span of supports, 200 315
operation, principles of, functional communication training assessment process and, 85
109, 110 (FCT), 208 collaboration and, 212, 213, 214,
social interactions, organized 215
and group-oriented, 116 gaining insight stage, in consultation, in family-centered philosophy of
“Three Pillars of Effective 222–223 practice, 110
Practices,” 111, 112 genetics, 3, 4, 23 family-centered philosophy of
treatment integrity, 116 gestural cues, 246 practice and, 110
feedback, in communication graphic organizers, 246, 247, 271, IDEA provisions and, 37, 56, 114,
plan, 124 275, 276 301, 328
fidelity, 25–26 graphic symbols, 139, 143–144 job placement and, 156
financial necessities, person-centered color, 143–144 manual signs and, 140
planning and, 304 complexity, 144 materials for helping students learn
financial resources, consumer level of abstraction (iconicity), 143 more about, 295
viewpoints on, 33–34 PECS and, 143 in programs of education and
fingerspelling, 140 greeting skills, 170–171 treatment, 114–115
Floortime, 17–18 group conducted small N research, 45 school-based practices and, 26–27
Florida’s Positive Behavior Support group implemented training, 45 self-determination skills and,
Project: A Multi-Tiered 294–295
Support System, 209 hand flapping, 2 in systematic, comprehensive
formal collaboration, 213–214 health, self-determination and, 286 planning, 110
formal supports, postsecondary health-related needs transition planning and, 328–329
education and, 329–330 associated with ASD, 100–101 transition services and, 328
format, in communication plan, person-centered planning and, 304 individualized family service plan
122, 124 hearsay, levels of evidence (IFSP), 8–9, 212, 213, 214, 215
Foundation for Autism Support and and, 39, 46 individualized service plan (ISP), 212,
Training (FAST), 336–337 high functioning autism (HFA) 213, 214
Frank Porter Graham Center, 26 academic achievement and, Individuals with Disabilities
fraudulent treatment, historical 248–249 Education Act (IDEA),
viewpoints on, 36 intellectual ability and, 244–247 8, 9, 26, 37, 110, 114, 199, 272,
free and appropriate education mathematics and, 272 301, 302, 328
(FAPE), 110 reading instruction and, 271 informal collaboration, 213–214
frequency, in communication plan, reading profiles and, 274–275 informal supports, postsecondary
124 high-preference strategy (high-p education and, 329–330
Functional Assessment Informant strategy), 268 information
Record for Parents (FAIR-P), historical viewpoints on EBPs, 36–37 in assessment process, 79–80
194 fraudulent treatment, 36 autism screening instruments,
Functional Assessment Interview legal considerations, 37 79–80
Record for Teachers home-based intervention, 8, 23–25 developmental history, 79
(FAIR-T), 193–194 home living, postsecondary education formats, 119
functional behavior assessment and, 331–333 gathering and sharing stage, in
(FBA), 81–83, 192–200 hyper/hypo responses, 21 consultation, 221–222
behavior support plans and, 199 needs, providing for, 118–119
benefits of, 198–199 iconicity (level of abstraction), 143 presentation, 119
conducting, basic steps for, 197, imaginative reading profile, 275 instructional approaches, 201,
198 immunizations, 3–4 202–204
direct/analog assessment, incidental teaching, 16, 26 directives versus questioning, 202,
197–198 indirect/analog assessment, 196–197 203
direct/naturalistic assessment, indirect consultation, 217–218, 235 incorporating choice, 203
194–196 indirect/naturalistic assessment, nonverbal behaviors, 203
indirect/analog assessment, 192–194 self-management, 204
196–197 individual activity schedules, 257 structured work system, 204
instructional contexts in academic location, treatment decisions and, National Longitudinal Transition
learning, 250–251 53–55 Study 2, 326
intellectual ability in academic longitudinal comparisons, 43–44 National Mentoring Day, 313
learning, 243–245 longitudinal educational programs, National Professional Development
intellectually gifted students with designing, 11–12 Center (NPDC), 26, 173–174,
ASD, 245 Lovaas Method. See discrete trial 182
interpersonal communication skills, training (DTT) National Science Education
collaboration and, 231 Standards, 275
interspersed requesting, 267 magnetic resonance imaging (MRI), National Secondary Transition
interval recording, 82 170 Technical Assistance Center
intervention manual signs, 140–141 (NSTTAC), 307, 308,
assessment linked to, 85–86 matched pair studies, 43 314–315
early, role of, 8–9 mathematics instruction, 271–274 naturalistic approaches, 15–17
home-based, 8, 23–25 McGill Action Planning System naturalistic interventions, social skills
intervention evaluation worksheet, (MAPS), 303 and, 185–186
65–66 M-CHAT (Modified Checklist for Nebraska Center for Research on
intervention knowledge, in Autism in Toddlers), 76–77 Children, Youth, Families and
consultation, 234–235 measure of latency, 265 Schools (CYFS), 238
interviews, structured, 82 The ME Book (Lovaas), 23 needs associated with ASD, 95,
IQ scores, 23–24, 25 Medicaid, 24 99–102
meta-analyses, 44 communication needs across
job placement, 156–157 mild intellectual disabilities (MID), lifespan, 130–134 (See also
job training, 333 272 language development)
joint attention, 136–137 MIND Institute, 26 daily living needs, 100,
minimizing method, 149 101–102
knowledge and skills, up-to-date, models health-related, 100–101
110–111 collaboration, 215 QOL models associated with, 99,
person-centered planning, 303 100
language development quality of life, 99, 100 social/emotional, 99, 100
assessment of, 133–134 school-based, 25–27 neurodevelopmental perspective of
in high-functioning learners, self-determination social skills, 169–170
132–133 Self-Determined Model of No Child Left Behind Act (NCLB),
for individuals with ASD, 131–133 Instruction, 295–296 13, 37, 271–272
prelinguistic and emergent, video modeling, 294 non-evidence-based treatment of
134–136 service delivery, 23–27 ASD, 10
typical, 131 community options, 27 nonstandard applications, treatment
leadership, in family team building, exemplary programs and decisions and, 51
113 practices, 28 nonstandard names, treatment
learner preference, in ACC, 145–147 home-based intervention, decisions and, 51
least restrictive environment (LRE), 8, 23–25 nonverbal behaviors, in instructional
110 post-school options, 27 approaches, 203
legal considerations, historical school-based models, 25–27
viewpoints on, 37 multicomponent approaches, 18–20 Oakland University Center for
leisure activities multicultural communication, Autism Research, Education,
communication skills and, 159–160 120–122 and Support, 86–87
person-centered planning and, 304, diagnosis and, 120–121 observational recording, 82
308–309 strategies, 121–122 Ohio Center for Autism and Low
level of abstraction (iconicity), 143 treatment and, 121 Incidence (OCALI), 69
limited repertoires, self- multidisciplinary assessment, on-the-job training, 157
determination and, 285–286 77–78 operational definition, 82
literature, extensive reviews of, 44 evaluation process, 77–78 organization skills, in consultation,
litigation research, 37 parent and family needs, 78 233
living arrangements, person-centered multidisciplinary evaluation team Orthogenic School, 9
planning and, 304 members, 6–8 OUCares, 86–87
pacing, 2 exemplary programs and practices, supervision and decision-making

pantomimes, 140 209 stage, 224–225
parents functional behavior assessment, training and monitoring stage,
multidisciplinary assessment 192–200 223–224
and, 78 overview of, 189–190 processing in academic learning,
partnerships in social skill principles of, 190–191 245–247
interventions, 174–175 replacement behaviors, teaching, professional practice, social learning
PEARLS and, 57 206–208 and, 37–40
social communication interventions post-comparison studies, 44 professional response, treatment
implemented by, 136–137 postnatal development, 3 decisions and, 56–57
supporting through assessment, postsecondary education and training, professional viewpoints on EBP,
83–85 161–162, 163 34–36
treatment decisions and, 56–57 college, 161–162 continuing education,
partnering method, 149, 150 communication skills and, seeking, 36
partnerships, transition planning and, 161–162, 163 ethical responsibilities, 34–35
313–314 options, 27 training deficiencies, recognizing,
PEARLS, 57 quality of life and 35–36
peers formal and informal supports, programs, in family team building,
communicating with, in inclusive 329–330 115–116
education settings, 151–152 home and community living, progressive communication among
levels of evidence and, 45–46 331–333 team members, 117
social skill interventions mediated integrated employment, prompts, 16, 17
by, 175–176 333–334 protodeclarative pointing, 73
treatment decisions and, 52 other points to promote success, psycho-educational evaluation,
Personal Futures Planning, 303 334–335 6–8
personally conducted small N outcomes, 326–327 Psychoeducational Profile, third
research, 45 requisite skills, determining, edition (PEP-3), 79–80
personally implemented training, 45 330–331
person-centered planning, 302–307 self-determination/self-advocacy quality assurance in transition
areas to address, 304–306 and, 335 planning, 314–316
independent living arrangements transition planning and, 309–311 quality of life (QOL), 318–338
and, 307 vocational training, 162, 163 components and impact factors,
models of, 303 pragmatics, 132 321
pervasive developmental disorder pre-comparison studies, 44 defining, 322
(PDD), 4, 25 Premack principle, 266 enhancing, recommendations for,
pervasive developmental disorders not prenatal development, 3, 23 327–329
otherwise specified (PDD- prerequisite skills, 134–139 transition planning, effective,
NOS), 5, 74–75 classroom applications, 138–139 328–329
philosophy of care, family centered, parent-implemented social transition services, 328
107, 109 communication interventions, exemplary programs and practices,
philosophy of practice, 136–137 336–337
family-centered, 110 Picture Exchange Communication models, 99, 100
phonics-based approach to word System (PECS), 137–138 outcomes, 323–327
identification, 270 prelinguistic and emergent community/residential, 324–325
picture exchange communication language skills, 134–136 employment, 325–326
systems (PECS), 26, prevalence rates of ASD, 5 overview of goals, 327
137–138, 143, 208 Princeton Child Development postsecondary education,
pivotal response training (PRT), 15, Institute (PCDI), 28 326–327
185, 186 problem solving in consultation, overview of, 318–319
positive behavior supports (PBS), 220–225 postsecondary education and
189–210 gaining insight stage, 222–223 formal and informal supports,
antecedent-management strategies, information gathering and sharing 329–330
200–206 stage, 221–222 home and community living,
defined, 190–191 overview of, 221 331–333
quality of life (continued ) residential outcomes, QOL and, Psychoeducational Profile, third
integrated employment, 324–325 edition (PEP-3), 79–80
333–334 responsibility, in philosophy of care, Screening Tool for Autism in
other points to promote success, 107, 109 Two-Year-Olds (STAT), 6
334–335 responsiveness, in philosophy of care, scripting method, 149, 150–151
outcomes, 326–327 107, 109 secondary sources, treatment
requisite skills, determining, Rett’s syndrome, 5, 75 decisions and, 51
330–331 risk-versus-benefit analysis, treatment self-advocacy, postsecondary
self-determination/self-advocacy decisions and, 57–58 education and, 335
and, 335 Rochester Institute of Technology self-determination, 281–297
research on successful Spectrum Support Program, barriers to, 283–288
life outcomes and, 310 communication, 283–284
recommendations for future, rocking, 2 environment, 286
335–336 roles, treatment decisions and, health, 286
services and, access to, 319–322 61–62 limited repertoires, 285–286
quality of research base, treatment role valorization in collaboration and social skills, 284–285
decisions and, 58–61 consultation, 235 social variables, 286–288
questioning, directives versus, 202, defining, 282–283
203 sabotage method, 149–150 EBP methods for teaching,
school-based behavioral repertoires. 293–294
reading instruction, 270–271 See positive behavior supports exemplary programs and practices,
receptivity, in philosophy of care, (PBS) 296
107, 109 school-based models, 25–27 overview of, 281–282
recreation and leisure science, technology, engineering, and postsecondary education and, 335
communication skills and, math (STEM), 326 practicing, 294–295
159–160 science instruction, 274–276 Self-Determined Model of
transition planning and, 304, scientifically based research, 37 Instruction, 295–296
308–309 scientific method, 48, 49–50 teaching components of, 288–293
references, treatment decisions and, overview of, 48, 49 deriving solutions, 289–290
53 steps in, 49–50 making decisions, 289–290
refrigerator mothers, 9 screening self-efficacy, 292
replacement behaviors developmental, 75–77 self-evaluation, 292–293
defined, 206–207 process, for early detection, 5–6 self-management, 290–292
teaching, 206–208 screening instruments, 79–80. See also self-reinforcement, 293
requisite skills, postsecondary assessment instruments transition planning and, 312–313
education and, 330–331 Autism Screening Instrument Self-Determined Model of
research. See also studies for Educational Planning Instruction, 295–296
on brain functions in persons with (ASIEP), 80 self-efficacy, 292
ASD, 170 Childhood Autism Rating Scale self-evaluation, 292–293, 316
litigation, 37 (CARS), 79, 80 self-management
scientifically based, 37 in developmental screening, for promoting self-regulation,
small N, 45 75–77 258
on successful life outcomes, Brigance Early Childhood self-determination and, 290–292
recommendations for future, Screen, 76 self-management intervention,
335–336 CHAT (Checklist for Autism in 183–185
research base, treatment decisions Toddlers), 76 self-instruction, 184–185, 204
and M-CHAT (Modified Checklist self-monitoring/self-recording,
quality of, assessing, 58–61 for Autism in Toddlers), 183–184
utilizing, 61–69 76–77 self-reinforcement, 183
intervention evaluation STAT (Screening Tool for self-monitoring, 259, 290–292
worksheet, 65–66 Autism Spectrum Disorders self-recording, 259
roles, appropriate, 61–62 in Toddlers and Young self-regulation, in academic learning,
studies, evaluating, 62–69 Children), 77 252–259
classroom activity schedules, defined, 167–168 STAT (Screening Tool for Autism
252–253, 255–256, 257 difficulties in persons with ASD, Spectrum Disorders in
classroom rules, 252, 253, 254 169–172 Toddlers and Young
defined, 252 behavioral perspective, 172 Children), 77
individual activity schedules, 257 cognitive perspective, stereotypical behavior, 2, 21
self-management process, 258 170–172 stereotypy, 261–263
self-monitoring process, 259 neurodevelopmental perspective, story map, 271
self-recording process, 259 169–170 strategic reading profile, 275
visual work systems, 256–257 EBP in development of, 172–186 structural assessment, 196–197
self-reinforcement, 293 methods identified, 173–174 structured interviews, 82
sensitive communication among team naturalistic interventions, structured teaching approach, 10, 11,
members, 118 185–186 19, 26
sensory integration therapy, 21, 39 parent partnerships, 174–175 structured work system, 204
service delivery models, 23–27 peer-mediated interventions, Student-Assisted Functional Assessment
community options, 27 175–176 Interview (SAFAI), 194
exemplary programs and practices, self-management, 183–185 studies. See also research
28 social narratives, 181–183 case, 44–45, 52
home-based intervention, 8, 23–25 social skills training groups, experimental control, 43
post-school options, 27 176–178, 179 matched pair, 43
school-based models, 25–27 video modeling, 178, 179–181 post-comparison, 44
setting events, 81 exemplary programs and practices, pre-comparison, 44
sight word instruction, 270–271 187 treatment decisions and, 62–69
sign language, 140 greeting skills, 170–171 subjectivity, EBP and, 48, 49
signs of ASD, early, 73–77 importance of, 168–169 superstition, EBP and, 48, 49
single-case designs, 44 overview of, 166–167 supervision and decision-making
skepticism, professional, 40–42 self-determination and, 284–285 stage, in consultation,
importance of, 40–41 social competence versus, 167 224–225
practices of, 41–42 training groups, 176–178, 179 supporting children and families
skills, up-to-date, 110–111 Social Stories™, 181–183 through assessment, 83–85
small N research, 45 social validity, 13, 114 supportive communication among
smartphone, downloadable measures, 181 team members, 118
communication “apps” social variables, self-determination
for, 141 and, 286–288 task-related variables in educational
social behavior, 7–8, 14, 15 soft skills, 306 settings, 204–206
social competence solutions in self-determination, arrangement of tasks, 205
defined, 167–168 deriving, 289–290 cues or prompts available for task,
importance of, 167, 168–169 “Solve It!” approach, 273–274 206
overview of, 166–167 span of supports, 200 difficulty of task, 205
versus social skills, 167 Specialsterne, 325–326 length of task, 205
socialization opportunities, speech-generating devices and TEACCH (Teaching, Expanding,
person-centered planning applications, 141–142 Appreciating, Collaborating
and, 304 coding of selections, 141 and Cooperating, Holistic),
social learning and professional costs, 141 10, 18–20, 25, 26
practice, 37–40 need for additional, adaptive Teaching Developmentally Disabled
social narratives, social skills and, devices, 141–142 Children: The ME Book
181–183 presentation of language choices, (Lovaas), 23
social needs associated with ASD, 141 team-based consultation, 225–228
99, 100 questions to ask before purchasing, characteristics of, 225–226
social reciprocity, 169 142 components of, 226–228
Social Security Act, 24 speech/language pathology, 6, 7, 17 teaming, 214. See also collaboration
social skills splintered development, 73 team members, communication
applied behavior analysis and, stakeholders, 221–222, 223, 224, 225, among, 116–124
172–173 236 communication plan, 122–124
team members, communication exemplary programs and practices, cautions in, 51–53
among (continued ) 316 claims, miraculous, 52
feedback, 124 importance of, 299–302 credentials, 52–53
format, 122, 124 overview of, 298–299 evidence and peer review, lack
frequency, 124 process, 302–307 (See also of, 52
information needs, providing for, person-centered planning) nonstandard applications, 51
118–119 quality assurance in, 314–316 nonstandard names, 51
methods of, 117–118 quality of life and, 328–329 references, 53
aware, 117–118 self-determination and, 312–313 secondary sources, 51
face-to-face, 118 training across domains, 307–312 testimonials or case studies, 52
progressive, 117 community integration and research base, assessing quality of,
multicultural, 120–122 recreation, 308–309 58–61
team members in collaboration community living, 311–312 research base, utilizing, 61–69
allocating responsibilities to, employment, 307–308 roles, appropriate, 61–62
230–231 postsecondary education, studies, evaluating, 62–69
recognizing strengths and needs 309–311 risk-versus-benefit analysis,
of, 230 transition points, 11–12, 299–300 57–58
testimonials, treatment decisions transition services, QOL and, 328 treatment programs, in family team
and, 52 Treatment and Education of Autistic building, 113–115
text-bound reading profile, 274 Communication Handicapped treatments not recommended,
theories of family operation. See Children (TEACCH), 124, 54–55. See also alternative and
under family 204 emerging treatments
theory of mind, 133, 170, 245 treatment approaches. See also twice exceptional, 245
“Three Pillars of Effective Practices,” alternative and emerging
111, 112 treatments; service delivery uneven development, 73
time, consumer viewpoints on, 33 models United Nations Convention on
tools, in AAC, 139–145 applied behavior analysis (ABA), the Rights of Persons with
aided versus unaided tools, 13–15 Disabilities (UNCRPD),
144–145 complementary and alternative 322
graphic symbols, 143–144 medicine (CAM), 21–23 U.S. Business Leadership Network,
manual signs, 140–141 developmental approaches, 17–18 313
speech-generating devices and diagnosis and, 6–8 U.S. Court of Appeals for the Federal
applications, 141–142 emerging approaches to, 10 Circuit Court, 3–4
toxins, 3, 4, 23 evidence-based treatment (EBT), university-level education. See
training 9–10, 12–13 postsecondary education and
deficiencies, professional history of, 9–10 training
viewpoints on, 35–36 multicomponent approaches, University of Alabama Autism
levels of evidence and, 45 18–20 Spectrum Disorders College
in transition planning, multicultural communication and, Transition and Support
307–312 121 Program, 310
community integration and naturalistic approaches, 15–17 University of Alaska-Anchorage
recreation, 308–309 non-evidence-based, 10 Center for Human
community living, 311–312 sensory integration therapy, 21 Development, 296
employment, 307–308 structured teaching approach, 10, University of California at Davis, 26
postsecondary education, 11, 19, 26 University of North Carolina, 26
309–311 treatment decisions, 51–69 University of Wisconsin, 26
training and monitoring stage, in alternative and emerging, 53–57
consultation, 223–224 destination and current location, vaccinations, 3–4
Transition Coalition, 316 53–55 video modeling (VM), 178, 179–181
transition planning, 298–317 parent use and professional video modeling imitation training
areas of consideration in, 301 response, 56–57 (VMIT), 180, 181
choice making and, 312–313 purview, relevant areas of, video self-modeling (VSM),
collaboration and, 313–314 55–56 179, 180, 181, 294
Virginia Commonwealth University vocational options, person-centered Waisman Center, 26

Autism Center for Excellence planning and, 304 within-systems consultation, 217,
(VCU-ACE), 187 vocational sampling, 314 219, 220
visual cues in classroom, 252–257 vocational training, 162, 163 word identification, 270–271
visual learning needs, 263–264 voice output communication aids working independently, in academic
visual supports, 263–264 (VOCAs), 139 learning, 260
visual work systems, 256–257
Response to Intervention Models: Curricular A Teacher’s Guide to Preventing Behavior Problems
Implications and Interventions, John J. Hoover, in the Elementary Classroom, Stephen W. Smith and
© 2011, ISBN: 0137034830 Mitchell L. Yell, © 2013, ISBN: 0137147414
Collaborative Consultation in the Schools: Effective Including Adolescents with Disabilities in

Practices for Students with Learning and Behavior General Education Classrooms, Tom E. C. Smith,
Problems, 4/e, Thomas J. Kampwirth and Kristin M. Barbara Gartin, and Nikki L. Murdick, © 2012,
Powers, © 2012, ISBN: 0132596776 ISBN: 0135014964
Characteristics of Emotional and Behavioral Disorders Instruction of Students with Severe Disabilities, 7/e,
of Children and Youth, 10/e, James M. Kauffman and Martha E. Snell and Fredda Brown, © 2011,
Timothy J. Landrum, © 2013, ISBN: 0132658089 ISBN: 0137075464
Foundations of Assessment in Early Childhood Special Linking Assessment to Instructional Strategies:

Education, Effie P. Kritikos, Phyllis L. LeDosquet, and A Guide for Teachers, Cathleen G. Spinelli,
Mark Melton, © 2012, ISBN: 013606423X © 2011, ISBN: 0137146248
Single Case Research Designs in Educational Families, Professionals, and Exceptionality: Positive
and Community Settings, Robert E. O’Neill, Outcomes Through Partnerships and Trust, 6/e,
John J. McDonnell, Felix F. Billingsley, and Ann Turnbull, Rud Turnbull, Elizabeth J. Erwin,
William R. Jenson, © 2011, ISBN: 0130623210 Leslie C. Soodak, and Karrie A. Shogren, © 2011,
ISBN: 0137070489
Learners with Mild Disabilities: A Characteristics
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Methods For Teaching Students With Autism Spectrum Disorders With Access Code Evidence-Based Practices by John J. Wheeler Michael R. Mayton Stacy L Carter

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Methods For Teaching Students With Autism Spectrum Disorders With Access Code Evidence-Based Practices by John J. Wheeler Michael R. Mayton Stacy L Carter

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for Classroom Use and Professional Development

Photo Credits: p. 1 (left to right): Peter Galbraith/Fotolia; Dmitry Naumov/­Fotolia;

Library of Congress Cataloging-in-Publication Data

ISBN 10: 0-13-707171-X

To my parents, Tracy and Judy, for always supporting me in every way,

John J. Wheeler currently serves as Director of the Center of Excellence in Early

Michael R. Mayton is an Assistant Professor of Special Education at West Virginia

Stacy Carter is an Associate Professor in the Special Education Program at Texas

Organization of the Text

New! Pearson eText Available

S ecti o n I I Early Childhood

■ A pplied V i g nette 3 . 1 : The Evaluation

Enhancing Communication among Team Members 116

S ecti o n I I I The School Years

Engineering Learning Environments for Learners with ASD 200

Effective Consultation Practices 231

Applied Behavior Analysis for Academic Instruction 277

S ecti o n I V Moving from School to Life

10 Fostering Self-Determination Skills 281

The Importance of Transition Planning 299

12 Enhancing Quality of Life for Persons with Autism

■ A pplied V i g nette 1 2 . 1 : Teaching a Functional Skill

After reading this chapter you should be able to:

Chapter 1 Mind Map

Autism is a complex neurodevelopmental disorder with no precise cause. This means

Autism Spectrum Disorders (ASD)

Figure 1.1 Diagram of interaction between genetic susceptibility and

American Psychiatric Association. Pervasive developmental disorders were defined

Increased Prevalence Rates

Importance of Early Detection

Figure 1.2 Early developmental indicators of autism in toddlers

■ The child avoids eye contact.

Diagnosis and Treatment

Figure 1.3 Multidisciplinary evaluation team members

Adaptive • Special Education

communication, adaptive behavior, motor skills, and performance. More impor-

The Role of Early Intervention

1. The present level of functioning of the child in terms of physical, cognitive,

provided in the child’s natural environment, a statement must be included as

A Brief History of Treatment

Figure 1.4 Evidence-based practices

Non-Evidence-Based Emerging Evidence-Based

Grounded primarily in Some grounding in scientific Clearly grounded in scientific

Applied Vignette 1.1

Designing Effective Longitudinal

• Diagnosis • Preschool • Developmental

Associated Life Challenges

The Importance of Evidence-Based Practices

Common Approaches Used in Education

Applied Behavior Analysis

Incidental teaching represents yet another popular method of naturalistic treat-

a. The teacher waits for the child to self-initiate.

McGee et al. (1992) recommended that when considering incidental teaching

order to accomplish this, the ESDM is comprised of an interdisciplinary team that is

Wheeler, 2000), which could be comprised of either objects, pictures, symbols, or

Sensory Integration Therapy

Complementary and Alternative Medicine Approaches

Service Delivery Models

Home-based treatment programs were criticized at first by many because they

Figure 1.6 Components of the Early Intensive Behavioral Intervention

Source: Persico et al. (2012).

Post-School and Community Options

Photo Credits: p. 1 (left to right): Peter Galbraith/Fotolia; Dmitry Naumov/Fotolia;

■ A pplied V i g nette 3 . 1 : The Evaluation

12 Enhancing Quality of Life for Persons with Autism

■ A pplied V i g nette 1 2 . 1 : Teaching a Functional Skill

P = partnership: Communicate that professionals and parents should work