Harris 2024 Autism Interventions PDF

Effective Interventions for Students With Autism and Asperger’s Syndrome Michelle S. Ballan Copyright © 2024. Oxford University Press, Incorporated. All rights reserved. Getting Started Autism is a complex disorder deﬁned by numerous developmental and behavioral features.The canopy of the autism spectrum is far reaching, with schoolaged children and adolescents ranging from nonverbal with multiple developmental disabilities to mild Asperger’s syndrome with advanced capabilities for mathematics and science. Autism spectrum disorders (ASDs), termed pervasive developmental disorders (PDDs) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR;American Psychiatric Association, 2000) and in the International Classiﬁcation of Diseases (ICD-10; World Health Organization, 1992), is a term often used in educational and clinical settings to refer to various disorders spanning a severe form known as autistic disorder (AD), to a milder form called Asperger’s syndrome or disorder (AS). If a child exhibits symptoms of AD or AS, but does not meet the speciﬁc criteria for either disorder, the child is diagnosed with an ASD identiﬁed as pervasive developmental disorder not otherwise speciﬁed (PDD-NOS) (American Psychiatric Association, 2000; Strock, 2004). Less common are two additional acute ASDs known as Rett’s syndrome or disorder (RS) and childhood disintegrative disorder (CDD). Students identiﬁed as having an ASD exhibit a tremendous range in symptoms and characteristics due to developmental maturity and varying degrees of associated cognitive limitations (Filipek et al., 1999). Many school social workers, psychologists, and special educators are familiar with the primary clinical symptomatology of the majority of ASDs, which typically falls within three major categories: (1) qualitative impairment in social interaction, such as gaze aversion or the absence of communication; (2) impairments in communication, such as mutism and lack of pretend play; and (3) restricted, repeti- chapter 12 Karen S. Hoban tive, stereotyped behavior, interests, and activities, such as retentive motor mannerisms (American Psychiatric Association, 2000; Bregman, 2005). Autism spectrum disorders vary with respect to age of onset and associations with other disorders. Differences among ASDs appear to be linked to intelligence, level of adaptive functioning, and number of autistic symptoms rather than to the presence of distinct symptoms (Hollander & Nowinski, 2003, p. 17). Since the 1990s, research has revealed an upward trend in the prevalence rate for ASDs (Fombonne, 2005; Fombonne, Du Mazaubrun, Cans, & Grandjean, 1997; Fombonne, Simmons, Ford, Meltzer, & Goodman, 2001;Yeargin-Allsopp et al., 2003) due largely in part to issues regarding diagnosis. An increase in the prevalence rate may be attributable to a diverse range of factors, such as the broadening of diagnostic concepts to include milder and more atypical variants (Bregman, 2005), greater awareness among parents and professionals, the prospect of securing specialized services or beneﬁts for children due to educational funding formulas, and the extent to which families advocate for the diagnosis during assessment (Scott, Clark, & Brady, 2000). Fombonne (2005) reported an estimate of 60 out of 10,000 for the prevalence of all ASDs.The majority of studies report that ASDs are four times more common in boys than girls (Fombonne, 1999), and approximately 75% of all individuals classiﬁed with autism have measured intelligence in the range of mental retardation (Bryson & Smith, 1998). Autism spectrum disorders are often accompanied by a range of abnormalities within cognitive, adaptive, affective, and behavioral domains of development, deﬁcits in executive functions, limitations in adaptive skills, learning disabilities, mood instability, stereotypic and self-injurious behaviors, anxiety disorders, and aggression (Bregman, 2005). One in four children with an ASD develops seizures, often beginning in either early childhood or adolescence (Volkmar, 147 Franklin, C., Harris, M. B., & Allen-Meares, P. (Eds.). (2024). The school services sourcebook : A guide for school-based professionals. Oxford University Press, Incorporated. Created from bibliovirtualuide-ebooks on 2024-02-08 19:50:41. 148 Part I Best Direct Practice Interventions With Student Populations 2000), and the rate of tuberous sclerosis appears to be 100 times higher among children with ASDs (Fombonne, 2005). An increase or variation in prevalence rates may also be due largely in part to the utilization of different diagnostic criteria for ASDs across research studies.There are varying diagnostic groups within ASDs and varying diagnostic criteria for assessment. However, the DSM-IV-TR (2000) and the ICD-10 (1992) share general agreement regarding the almost identical criteria for the diagnosis of the ﬁve subtypes of PDDs or ASDs (AD, AS, PDD-NOS, RS, and CDD).1 For the purpose of this chapter, two of the more common ASDs (AD and AS) seen among school-aged children and adolescents will be the focus. The DSM-IVTR (2000) outlines speciﬁc criteria for AD (see Table 12.1) and AS (see Table 12.2). The most notable difference between AD and AS involves age-appropriate communication skills. Communication is presumed to be within normal limits in children with AS, although as one might expect of a school-aged youth with severe limitations in recognizing and interpreting social messages, pragmatic deﬁcits are frequent (Scott et al., 2000). Because pragmatic deﬁcits constitute a core area of communication functioning, this minimizes the true differences between children diagnosed with AS and AD (Scott et al., 2000). The DSM IV-TR (2000) speciﬁes a set of criteria for AS and AD which might lead one to believe that diagnosis of such disorders is made with ease. However, diagnosis can be difﬁcult due in part to the lack of deﬁnitive diagnostic tests for AD or AS. There are currently no reliable physiological markers for diagnosis as there are in Table 12.1 DSM-IV Diagnostic Criteria for Autistic Disorder A. A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3): Copyright © 2024. Oxford University Press, Incorporated. All rights reserved. (1) qualitative impairment in social interaction, as manifested by at least two of the following: (a) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction (b) failure to develop peer relationships appropriate to developmental level (c) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest) (d) lack of social or emotional reciprocity (2) qualitative impairments in communication as manifested by at least one of the following: (a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime) (b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others (c) stereotyped and repetitive use of language or idiosyncratic language (d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level (3) restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following: (a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus (b) apparently inﬂexible adherence to speciﬁc, nonfunctional routines or rituals (c) stereotyped and repetitive motor mannerisms (e.g., hand or ﬁnger ﬂapping or twisting, or complex whole-body movements) (d) persistent preoccupation with parts of objects B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play C. The disturbance is not better accounted for by Rett’s disorder or childhood disintegrative disorder. Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders. Copyright 2000. American Psychiatric Association. Franklin, C., Harris, M. B., & Allen-Meares, P. (Eds.). (2024). The school services sourcebook : A guide for school-based professionals. Oxford University Press, Incorporated. Created from bibliovirtualuide-ebooks on 2024-02-08 19:50:41. Chapter 12 Effective Interventions for Students With Autism and Asperger’s Syndrome 149 Table 12.2 DSM-IV-TR Diagnostic Criteria for Asperger’s Syndrome A. Qualitative impairment in social interaction, as manifested by at least two of the following: (1) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction (2) failure to develop peer relationships appropriate to developmental level (3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people) (4) lack of social or emotional reciprocity B. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following: (1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus (2) apparently inﬂexible adherence to speciﬁc, nonfunctional routines or rituals (3) stereotyped and repetitive motor mannerisms (e.g., hand or ﬁnger ﬂapping or twisting, or complex whole-body movements) (4) persistent preoccupation with parts of objects C. The disturbance causes clinically signiﬁcant impairment in social, occupational, or other important areas of functioning. D. There is no clinically signiﬁcant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years). E. There is no clinically signiﬁcant delay in cognitive development or in the development of ageappropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood. F. Criteria are not met for another speciﬁc pervasive developmental disorder or schizophrenia. Copyright © 2024. Oxford University Press, Incorporated. All rights reserved. Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders. Copyright 2000. American Psychiatric Association. some other disabilities (i.e., the genetic markers associated with Fragile X syndrome). To make a diagnosis, clinicians frequently rely heavily on behavioral characteristics, which may be apparent in the ﬁrst few months of a child’s life or appear during the early years. The diagnosis of AD or AS necessitates a two-stage process composed of a developmental screening during “well child” checkups and a comprehensive evaluation by a multidisciplinary team (Filipek et al., 2000).Among the most promising ﬁrst- and second-degree screening tools for AD are the Modiﬁed Checklist for Autism in Toddlers (M-CHAT; Robins, Fein, Barton, & Green, 2001) and the Screening Tool for Autism in Two-Year-Olds (STAT; Stone, Coonrod, & Ousley, 2000). For AS, the tools are the Autism Spectrum Screening Questionnaire (ASSQ; Ehlers, Gillberg, & Wing, 1999) and the Krug’s Asperger’s Disorder Index (KADI; Krug & Arick, 2003)2 (see Table 12.3). These screening instruments do not provide a diagnosis; instead they aim to assess the need for referral for possible diagnosis of AS or AD. The second stage of diagnosing AD or AS should include a formal multidisciplinary evaluation of social behavior, language and nonverbal communication, adaptive behavior, motor skills, atypical behaviors, and cognitive status made ideally by an experienced multidisciplinary team composed of social workers, psychologists, speech language pathologists, psychiatrists, pediatricians, educators, and family members (Howlin, 1998; National Research Council, 2001). Autistic disorder and AS often involve other neurological or genetic problems, thereby necessitating a ﬁrst-line comprehensive assessment of medical conditions (Filipek et al., 2000).The diagnosis of AD or AS often entails a school-based social worker gathering information on developmental history, medical background, psychiatric or health disorders of family members, and psychosocial factors. Additionally, a social worker typically conducts a social family history by assessing the child’s parents, caregivers, and environmental setting (McCarton, 2003). Psychological assessment and communicative assessment via testing, direct observation, and interviews should also inform the Franklin, C., Harris, M. B., & Allen-Meares, P. (Eds.). (2024). The school services sourcebook : A guide for school-based professionals. Oxford University Press, Incorporated. Created from bibliovirtualuide-ebooks on 2024-02-08 19:50:41. 150 Part I Best Direct Practice Interventions With Student Populations Table 12.3 Screening Instruments for Autistic Disorder and Asperger’s Syndrome Instrument Autistic Disorder M-CHAT (Robins et al., 2001) STAT (Stone et al., 2004) Asperger’s Syndrome ASSQ (Ehlers et al., 1999) Copyright © 2024. Oxford University Press, Incorporated. All rights reserved. KADI (Krug & Arick, 2003) Type of Screening Age Level Informant Characteristics Level 1 24 months Parent 23-item checklist to examine child’s developmental milestones Level 2 24–35 months Clinician 12 activities for observing child’s early social/communicative behaviors Level 1 > 6 years Parent/ Teacher 27-item checklist for assessing symptoms characteristic of Asperger’s syndrome Levels 1 & 2 > 6 years Individual with daily and regular contact with child for at least a few weeks 32-item norm-referenced rating scale for presence or absence of behaviors indicative of Asperger’s syndrome diagnosis.The psychological assessment helps to develop an understanding of the cognitive functioning and should address adaptive functioning, motor and visual skills, play, and social cognition (National Research Council, 2001). Communicative assessment should address communication skills in the context of a child’s development (Lord & Paul, 1997) and assess expressive language and language comprehension. Additionally, diagnostic instruments can be used to help structure and quantify clinical observations. The Childhood Autism Rating Scale (CARS; Schopler, Reichler, & Renner, 1986) is the strongest, best-documented, and most widely used clinical rating scale for behaviors associated with autism (Lord & Cosello, 2005, p. 748). Other instruments with strong psychometric data to support their use as a component of the diagnostic process include the Autism Diagnostic Interview-Revised (ADI-R; Lord, Rutter, & Le Couteur, 1994) and the Autism Diagnostic Observation Schedule (ADOS; Lord, Rutter, DiLavore, & Risi, 1999). One promising instrument for measuring symptom severity is the Social Responsiveness Scale (SRS; Constantino, 2002). No diagnosis would be complete without documentation of a child’s unique strengths and weaknesses, as this component is critical to designing an effective intervention program since unusual developmental proﬁles are typical (National Research Council, 2001). Although several instruments have been proposed to formally substantiate a diagnosis of AS,3 these instruments have little relationship to each other and have not been found to be reliable (Lord & Cosello, 2005). In addition to the aforementioned categories, when diagnosing AS, attention and mental control, auditory and visual perception, and memory should be assessed (DuCharme & McGrady, 2003).Additional observations may address components of topic management and conversational ability, ability to deal with nonliteral language, and language ﬂexibility (National Research Council, 2001). In regard to diagnosis, parents and professionals should serve as partners in reaching the best possible understanding of the child.The developmental, medical, and family histories that parents provide are crucial components of a diagnosis. Their description of their child’s behavior across multiple settings is essential.The role of the professionals on the multidisciplinary team is to interpret the information that parents provide. Parents know their Franklin, C., Harris, M. B., & Allen-Meares, P. (Eds.). (2024). The school services sourcebook : A guide for school-based professionals. Oxford University Press, Incorporated. Created from bibliovirtualuide-ebooks on 2024-02-08 19:50:41. Chapter 12 Effective Interventions for Students With Autism and Asperger’s Syndrome 151 Copyright © 2024. Oxford University Press, Incorporated. All rights reserved. Table 12.4 Diagnostic Instruments for Autistic Disorder Instrument Characteristics CARS (Schopler et al., 1986) 15-item rating scale covering a particular characteristic, ability, or behavior on which children are rated after observation; can be administered by clinician or educator, and some studies have demonstrated use by parents ADI-R (Lord et al., 1994) 93-item semistructured interview composed of three subscales (social reciprocity, communication, and restricted, repetitive behaviors); administered by a clinician to caregivers ADOS (Lord et al., 1999) Standardized protocol for the observation of social and communicative behavior of children who may have an ASD; administered by a clinician individual child better than anyone, but professionals can offer a broad view of what is typical and where the child might differ from the norm (Wagner & McGrady, 2003). Once a diagnosis of AD or AS is provided, parents begin to explore early intervention services to treat their child. Although early intervention has been shown to have a dramatic impact on reducing symptoms and increasing a child’s ability to develop and gain new skills,4 it is estimated that only 50% of children are diagnosed with an ASD before kindergarten (Strock, 2004).Thus, upon diagnosis, school-based interventions for youth with AD or AS often become the immediate focus of parents. Unfortunately, parents are soon faced with a proliﬁc body of literature and disparate professional advice composed to some extent of ineffective approaches and treatment fads. Among the recommended treatments are facilitated communication, holding therapy, auditory integration training, gentle teaching, and hormone therapies, such as secretin, which are not adequately supported by scientiﬁc evidence for practice, and research has actually demonstrated some of these treatments to be harmful ( Jacobson, Foxx, & Mulick, 2005; Simpson et al., 2004; Smith, 1996). Part of the problem is that research has not demonstrated a single best treatment program for children with ASDs. Gresham, Beebe-Frankenberger, and MacMillan (1999) used conventional standards of research design and methodology and the Division 12 Task Force on Empirically Supported Treatments for Childhood Disorders of the American Psychological Association to evaluate the empirical evidence for the efﬁcacy and effectiveness of several of the most visible and frequently cited treatment programs for children with autism: the UCLA Young Autism Project, Project TEACCH, LEAP, applied behavior analysis programs, and the Denver Health Science Program (p. 559). Their evaluation documented no wellestablished or probably efﬁcacious treatments for autism; however, almost all programs demonstrated signiﬁcant developmental gains, particularly in measured IQ. Rogers (1998), however, aptly noted that it is essential to recognize that the lack of empirical demonstration of efﬁcacy does not necessarily signify that a particular treatment is ineffective. Instead, it means that the treatment’s efﬁcacy has not been demonstrated in a carefully controlled and objective way (Gresham et al., 1999). What We Know School-aged children with ASDs face transitions to a new learning environment, socialization with new peers and adults, and departures from familiar routines and settings. Thus, many professionals agree that a highly structured, specialized program is optimal for this transition to an individualized learning environment. Among the many methods available for treatment and education of schoolaged children with AD or AS, applied behavior analysis (ABA) has become the most widely accepted effective intervention model (Strock, 2004). A recent U.S. surgeon general’s report (U.S. Department of Health and Human Services, 1999) noted that 3 decades of research has led to the demonstrated efﬁcacy of applied behavioral Franklin, C., Harris, M. B., & Allen-Meares, P. (Eds.). (2024). The school services sourcebook : A guide for school-based professionals. Oxford University Press, Incorporated. Created from bibliovirtualuide-ebooks on 2024-02-08 19:50:41. Copyright © 2024. Oxford University Press, Incorporated. All rights reserved. 152 Part I Best Direct Practice Interventions With Student Populations methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior for children with ASDs.Two evidence-based practices, discrete trial training or teaching (DTT) and pivotal response training (PRT), which use the principles of ABA, have been demonstrated as effective skill-based and behavioral treatment strategies. For the purpose of this chapter, evidence-based practice is deﬁned as “the integration of best research evidence with clinical expertise and [client] values” (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000, p. 1). Hundreds of scientiﬁc studies have demonstrated the effectiveness of ABA in building important skills and in reducing problem behaviors in children with ASDs (e.g., Jacobson et al., 1998; Lovaas, 1987; McEachin, Smith, & Lovaas, 1993; Smith, Groen, & Wynn, 2000), yet due to ethical and practical considerations (such as small sample size and the heterogeneity of participants), well-controlled studies with random assignment have been nearly impossible to conduct (National Research Council, 2001). Studies of ABA’s effectiveness are primarily based on single-case design, with close to 100 published on children with autism since 1980. Applied behavior analysis as an umbrella term includes “numerous measurement procedures and many behavior-increase and behavior-decrease procedures that can be used singly or in combination to remediate various skill deﬁcits and behavior problems” (McClannahan & Krantz, 2004, p. 93). The effectiveness of these more broadly deﬁned ABA interventions for eliciting new skills and reducing problematic behavior has been documented by numerous studies (Anderson & Romanczyk, 1999; Harris, Handleman, Gordon, Kristoff, & Fuentes, 1991; Smith, 2001; Smith et al., 2000; Yoder & Layton, 1988, as cited in Paul & Sutherland, 2005, p. 949); however, this variation of treatment strategies causes problems with comparisons of ABA techniques. For this reason, the primary educational and treatment techniques of DTT and PRT are reviewed as important instructional systems of ABA (Arick, Krug, Fullerton, Loos, & Falco, 2005). What We Can Do Applied Behavior Analysis Applied behavior analysis (ABA) is a discipline devoted to understanding the function behind human behavior and ﬁnding ways of altering or improving behaviors (Cooper, Heron, & Heward, 1987). Applied behavior analysis involves systematically applying learning theory–based interventions to improve socially signiﬁcant observable behaviors to a meaningful degree and seeks to demonstrate that the improvement in behavior stems directly from the interventions that are utilized (Anderson, Taras, & Cannon, 1996; Baer,Wolf, & Risley, 1968; Sulzer-Azaroff & Mayer, 1991).The emphasis is on teaching the student how to learn from the environment and how to act on the environment in order to produce positive outcomes for himself and those around him (Harris & Handleman, 1994; Koegel & Koegel, 1995; Lovaas, 1993, 1981; Lovaas & Smith, 1989; Maurice, Green, & Luce, 1996; Schreibman, Charlop, & Milstein, 1993). Behavior analytic treatment systematically teaches measurable units of a behavior or skill. Skills that a student with autism needs to learn are broken down into small steps.This form of teaching can be utilized for simple skills, such as making eye contact, to complex skills, like social interactions. Each step is initially taught by using a speciﬁc cue and pairing that cue with a prompt. Prompts range from physical guidance to verbal cues to very discrete gestures. Prompts should be faded out systematically by decreasing the level of prompt needed for the student to perform the target skill until, ideally, the student can perform the skill independently. In addition, skills should be taught by a variety of individuals, including teachers, aides, social workers, speech pathologists, and parents.There is strong evidence that parents can learn to employ ABA techniques and that doing so helps them to feel better in general and more satisﬁed and conﬁdent in their parenting role (Koegel et al., 1996; Ozonoff & Cathcart, 1998; Schreibman, 1997; Sofronoff & Farbotko, 2002, as cited in Wagner & McGrady, 2003). However, students should not become dependent on a particular individual or prompt.The student should be reinforced immediately after responding appropriately.The reinforcement should be a consequence that has been shown to increase the likelihood of the student responding appropriately again (Cooper et al., 1987). Reinforcements will vary from student to student. Inappropriate behavioral responses (such as tantrums, aggressive acts, screaming/yelling, stereotypic behaviors) are purposely not reinforced. Often, a functional analysis of antecedents and consequences is performed to determine what environmental reactions are reinforcing such behaviors (Cooper et al., 1987). Franklin, C., Harris, M. B., & Allen-Meares, P. (Eds.). (2024). The school services sourcebook : A guide for school-based professionals. Oxford University Press, Incorporated. Created from bibliovirtualuide-ebooks on 2024-02-08 19:50:41. Chapter 12 Effective Interventions for Students With Autism and Asperger’s Syndrome 153 Applied behavior analysis has been proven effective across different providers (parents, teachers, therapists), different settings (schools, homes, hospitals, recreational areas), and behaviors (social, academic, and functional life skills; language; selfstimulatory, aggressive, and oppositional behaviors). Professionals who use ABA systematically and regularly measure progress on behavioral targets, leading to numerous studies of the effectiveness of ABA approaches. However, as Green (1996) pointed out, it is still unclear what variables are critical to intervention intensity (number of hours, length of the intervention, proportion of one-to-one to group instruction) and what are the expected outcomes when intervention intensity varies. It is also unclear what particular behavioral techniques (discrete trials, incidental teaching, pivotal response training) are most likely to be successful for a given child with an ASD and in what proportions particular techniques should be used (Anderson & Romanczyk, 1999). The current research is limited in that it does not allow us to draw comparisons across studies. For a review of the effectiveness of more broadly deﬁned ABA intervention studies, see Anderson and Romanczyk (1999); Matson, Benavidez, Compton, Paclawskyj, and Baglio (1996); National Research Council (2001); New York State Department of Health (1999a); and Simpson et al. (2004). Copyright © 2024. Oxford University Press, Incorporated. All rights reserved. Discrete Trial Training It is important to understand that ABA is a framework for the practice of a science and not a speciﬁc program. Programs using ABA often utilize discrete trial training or teaching (DTT), which represents a speciﬁc type of presentation of opportunities to respond. Discrete trial training is a specialized teaching technique or process used to develop many new forms of behavior (Smith, 2001) and skills, including cognitive, communication, play, social, readiness, receptive-language, and self-help skills (Newsome, 1998). In addition, DTT can be used to reduce self-stimulatory responses and aggressive behaviors (Lovaas, 1981; Smith, 2001). Discrete trial training involves breaking skills into the smallest steps, teaching each step of the skill until mastery, providing lots of repetition, prompting the correct response and fading the prompts as soon as possible, and using positive reinforcement procedures. Each discrete trial has ﬁve separate parts: (1) cue: the social worker presents a brief clear instruction or question; (2) prompt: at the same time as the cue or immediately thereafter, the social worker assists the child in responding correctly to the cue; (3) response: the child gives a correct or incorrect answer to the social worker’s cue; (4) consequence: if the child has given a correct response, the social worker immediately reinforces the response with praise, access to toys, or other activities that the child enjoys. If the child has given an incorrect response, the social worker says “no,” looks away, removes teaching materials, or otherwise signals that the response was incorrect; and (5) intertrial interval: after giving the consequence, the social worker pauses brieﬂy (1–5 seconds) before presenting the cue for the next trial (Smith, 2001, p. 86).The following is an example of DTT: The social worker says, “Touch your nose.” (verbal cue) The student does not respond (response). After a few seconds, the social worker places her hand on the student’s hand. (prompt) The child extends his index ﬁnger himself, and the social worker helps the child to touch his nose. (response) The social worker says, “Yes, that is your nose. Good job touching your nose.” (consequence) This is an example of one trial.The correct response is considered a measurable unit of a skill. Data can be collected on the number of correct versus incorrect responses to chart a student’s progress. This trial would be repeated approximately ﬁve times, as repetition of skills is a component of discrete trial teaching. The social worker says, “What’s your address?” (verbal cue) The student says, “My address is 123 House Street, Maywood, New Jersey.” (response) The instructor gives the student behaviordescriptive praise (i.e., “Good, you said your address correctly”) and 30 seconds to play with a toy of his choice. (consequence) As one can see from the examples above, DTT can be used to teach the most basic information up to slightly more advanced knowledge. Discrete trial teaching affords children with AS and AD opportunities to respond which have been linked with improved performance on measures of academic achievement (Delquadri, Greenwood, Stretton, & Hall, 1983). This approach has also been credited with impressive gains in children with otherwise poor prognoses (Lovaas, 1987) and Franklin, C., Harris, M. B., & Allen-Meares, P. (Eds.). (2024). The school services sourcebook : A guide for school-based professionals. Oxford University Press, Incorporated. Created from bibliovirtualuide-ebooks on 2024-02-08 19:50:41. 154 Part I Best Direct Practice Interventions With Student Populations in accelerated skill acquisition (Miranda-Linne & Melin, 1992). An effective school-based intervention should prioritize discrimination issues by using DTT strategies that (1) carefully present stimuli in a systematic manner and with planned repetition; (2) provide a planned process for teaching the relationship of words to functional objects, people, and other important concepts; and (3) use systematic visual stimuli to teach important functional auditory discriminations (Arick et al., 2005, p. 1007). For studies documenting the effectiveness of DTT, see Cummings and Williams (2000); Dawson and Osterling (1997); Goldstein (2002); National Research Council (2001); Odom et al. (2003); Simpson et al. (2004); and Smith (2001). Copyright © 2024. Oxford University Press, Incorporated. All rights reserved. Pivotal Response Training Pivotal response training (PRT) is a model that aims to apply educational techniques in pivotal areas that affect target behaviors (Koegel, Koegel, Harrower, & Carter, 1999). Pivotal areas when effectively targeted result in substantial collateral gains in numerous developmental domains. Pivotal areas of primary focus include (a) responding to multiple cues and stimuli (i.e., decreasing overselectivity by distinguishing relevant features); (b) improving child motivation (i.e., increasing appropriate responses, decreasing response latency, and improving affect); (c) increasing selfmanagement capacity (i.e., teaching children to be aware of their aberrant behaviors to selfmonitor and to self-reinforce); and (d) increasing self-initiations (i.e., teaching children to respond to natural cues in the environment) (Simpson et al., 2004, pp. 114–115). The goals of intervention in pivotal areas are “(1) to teach the child to be responsive to the many learning opportunities and social interactions that occur in the natural environment, (2) to decrease the need for constant supervision by an intervention provider, and (3) to decrease the number of services that remove the child from the natural environment” (Koegel et al., 1999, p. 174). Thus the primary purpose of PRT is to provide children with the social and educational proﬁciency to participate in inclusive settings. Designed based on a series of studies identifying important treatment components, PRT in its ﬂedgling stages used a discrete trial, applied behavior analysis approach. Currently, PRT uses the principles of applied behavior analysis (ABA) in a manner that excludes negative interactions, reduces dependence on artiﬁcial prompts, and is family centered (Simpson et al., 2004, p. 114). Utilizing the strategies of PRT, target behaviors are taught in natural settings with items that are ageappropriate and meaningful as well as reinforcing to the child. Pivotal response training involves speciﬁc strategies such as (1) clear instructions and questions presented by the social worker, (2) child choice of stimuli (based on choices offered by the social worker), (3) integration of maintenance tasks (previously mastered tasks) (Dunlap, 1984), (4) direct reinforcement (the chosen stimuli is the reinforcer) (Koegel & Williams, 1980), (5) reinforcement of reasonable purposeful attempts at correct responding (Koegel, O’Dell, & Dunlap, 1988), and (6) turn taking to allow modeling and appropriate pace of interaction (Stahmer, Ingersoll, & Carter, 2003, p. 404). An example of using the speciﬁc steps of PRT to teach symbolic play might be as follows: A child may choose to play with a doll. (choice) The child is then given an empty cup and saucer, and asked,“What can we do with these toys?” (acquisition task) The child is expected to use the teacup in some symbolic manner, such as having a tea party. If the child does not respond, the social worker would model the symbolic behavior. (turn taking) The teacup would then be returned to the child. If the child still does not respond, a new toy would be selected, or the social worker could assist the child. When the child does respond, many of the child’s dolls would be given to him to play with in any manner chosen, thus reinforcing the new behavior. A more detailed description of using PRT to teach complex skills can be found in Stahmer (1999) and in How to Teach Pivotal Behaviors to Children With Autism: A Training Manual (Koegel, Schrefﬁrnan, Good, Cerniglia, Murphy, & Koegel, n.d.). PRT has been adapted to teach a variety of skills, including social skills (Koegel & Frea, 1993), symbolic (Stahmer, 1995) and sociodramatic play (Thorpe, Stahmer, & Schreibman, 1995), and joint attention (Whalen & Schreibman, 2003). Parents have been trained to successfully implement PRT. Schreibman, Kaneko, and Koegel (1991) found that parents appeared happier and more relaxed Franklin, C., Harris, M. B., & Allen-Meares, P. (Eds.). (2024). The school services sourcebook : A guide for school-based professionals. Oxford University Press, Incorporated. Created from bibliovirtualuide-ebooks on 2024-02-08 19:50:41. Chapter 12 Effective Interventions for Students With Autism and Asperger’s Syndrome 155 when they used PRT methods with their children than when they used more structured teaching techniques (Bregman, Zager, & Gerdtz, 2005). For studies documenting the effectiveness of PRT, see Koegel, Koegel, Shoshan, and McNerney (1999); National Research Council (2001); and Simpson et al. (2004). Last, due to the widespread use of various medications for symptoms associated with autism, a review of interventions for school-aged children would not be complete without a brief discussion of psychopharmacology. Copyright © 2024. Oxford University Press, Incorporated. All rights reserved. Psychopharmacology Psychopharmacological treatment of children with ASDs appears to be common in clinical practice via the use of atypical antipsychotics, serotonin reuptake inhibitors, stimulants, and mood stabilizers (Aman, Collier-Crespin, & Lindsay, 2000; Martin, Scahill, Klin, & Volkmar, 1999). It is estimated that as many as half of all individuals with a diagnosis of an ASD are treated with one or more psychotropic medications (Martin et al., 1999). However, few studies speciﬁcally targeting a sample of children with ASDs and adhering to conventional standards of research design and methodology with efﬁcacious results were found. The Research Units on Pediatric Psychopharmacology Autism Network (2002) and Shea et al. (2004) completed large-scale multisite, randomized, double-blind, placebo-controlled clinical trials of risperidone in children with autism. Risperidone is known as an atypical antipsychotic and is frequently used for treating severe maladaptive behavior and symptoms associated with AD (McDougle et al., 2000), such as aggression, self-injury, property destruction, or severe tantrums. The studies provided convincing evidence that risperidone is safe and effective for the short-term treatment of severe behavioral problems.The focus on severe behavior problems leaves an open question about possible additive effects of medication and applied behavioral interventions (Scahill & Martin, 2005). For example, the improvement in serious behavior problems associated with risperidone may enable a child to participate in an inclusive setting with DTT techniques employed. Additional randomized, double-blind, placebocontrolled clinical trials have been conducted to test the effects of liquid ﬂuoxetine, donepezil hydrochloride, and amantadine. All three had efﬁcacious ﬁndings to some extent. The clinical trial conducted to examine the selective serotonin reuptake inhibitor liquid ﬂuoxetine yielded results which indicate that a low dose is more effective than a placebo in the treatment of repetitive behaviors in childhood and adolescents with ASDs (Hollander et al., 2005). The study of donepezil hydrochloride found expressive and receptive speech gains, as well as decreases in severity of overall autistic behavior after 6 weeks for the treatment group (Chez et al., 2003). Last, a randomized control trial of amantadine for childhood autism reported clinician-rated improvements on behavioral ratings but showed no difference between the placebo and the active drug for parent ratings (King et al., 2001). However, a large placebo response was also found in this group. It is important to strongly caution professionals and family members that there are no medications speciﬁcally targeting the core symptoms of social and language impairments of autism in children. Tools and Practice Example Increasingly, school-based social workers and other mental health professionals are providing collaborative consultation (Idol, 1988; Idol, Paolucci-Whitcomb, & Nevin, 1986) to general education teachers of students with disabilities, focused on problem-solving efforts to identify students’ behavioral difﬁculties and to devise strategies to reduce the problems (Curtis & Myers, 1988, as cited in Pryor, Kent, McGunn, & LeRoy, 1996). The following case example illustrates a school social worker employing ABA and DTT to address the classroom behavior of a child with AD in an inclusive setting. Practice Example John is an 11-year-old Caucasian male currently enrolled in a public middle school in a blueribbon school district on the East Coast. John comes from an upper-middle-class family. Though John has no siblings, he has many relatives, including cousins in his peer group, with whom he interacts frequently. Between the ages of 2 and 21⁄2 years old, John’s language development regressed signiﬁcantly. His parents noticed that he was not utilizing his functional language at Franklin, C., Harris, M. B., & Allen-Meares, P. (Eds.). (2024). The school services sourcebook : A guide for school-based professionals. Oxford University Press, Incorporated. Created from bibliovirtualuide-ebooks on 2024-02-08 19:50:41. Copyright © 2024. Oxford University Press, Incorporated. All rights reserved. 156 Part I Best Direct Practice Interventions With Student Populations the same level he had in the past, and he began to consistently make syntactic and pragmatic errors, such as pronoun reversal, and experienced difﬁculty answering simple what, where, when, and why questions. In addition, John began to exhibit strange behaviors, such as placing his toys in perfectly straight lines and verbally repeating television shows and commercials out of context. He exhibited additional impairments in his social interactions, including difﬁculty making and maintaining eye contact and an inability to understand nonverbal social cues, such as the curling of one’s ﬁnger to mean “come here.” John also exhibited a lack of social reciprocity. At this time, John’s parents consulted a myriad of specialists to search for an explanation for their son’s changes in behavior and speech. John was eventually assessed by a multidisciplinary team of professionals, which resulted in an Axis I diagnosis of 299.00 Autistic Disorder. In concert with the parents’ preference, John’s school district enrolled him in a school that specialized in educating young children with autism. Due to the research evidence demonstrating the effectiveness of ABA methods with young children with AD in preschool settings, the school he attended utilized this systematic approach to teach students a continuum of skills and behaviors. A school social worker was assigned to support John in the school and home, guiding him in the areas of social interaction, functional language, academic skills, and decreasing inappropriate behaviors. She worked closely with the parents to further reinforce their instruction of the structured approach in an effort to incorporate ABA techniques into their everyday routine, thereby reinforcing John’s skill set across persons and settings. During his kindergarten year, John was enrolled part time in a regular public school. He went to his specialized school for children with autism in the morning, where he received intensive skill training through discrete trial teaching. In the afternoon, John was integrated into a regular kindergarten class in a public school. The school social worker stayed in this class with John for 1 hour per day to aid in generalization of the skills taught in his specialized school and in the home setting. Generalization of skills has been deﬁned as an important aspect to consider in designing any intervention for children with autism (Prizant & Wetherby, 1998; Smith, 2001). Two advantages to John’s social worker shadowing him in the public school class were the opportunity to train the school staff in ABA principles and instruction and to gather data on John’s behaviors and skill level in the school setting. For example, the social worker took occurrence/nonoccurrence data on John’s “TV talk” (verbal repetition of lines from his favorite television shows). On a data sheet, she divided the school day into 5-minute intervals and took data on whether John exhibited TV talk or did not. The social worker marked each 5-minute interval with a “+” if John demonstrated TV talk or a “−” if no TV talk occurred.This type of data was collected over a 3-day period during a 1-week interval. After the data collection was completed and the frequency of the behavior was established, the social worker performed a functional analysis of the behavior.The purpose of a functional analysis is to determine what environmental element is encouraging the student to engage in a particular behavior.To perform a functional analysis, the social worker took “ABC data.” At each instance of the behavior, the social worker wrote down the (A) antecedent to the behavior: what occurred in the environment directly prior to the behavior being exhibited; the (B) behavior itself: exactly how the behavior was manifested, what the student said and did while participating in the behavior; and the (C) consequence(s) to the behavior: how the individuals in the environment responded to the behavior. Did the student receive attention? Was the student removed from a demanding task? After a functional analysis was performed on John’s TV talk, the social worker established that John participated in the behavior to “escape” demanding social situations. At this time, John was exhibiting noncontextual speech in the form of TV talk habitually throughout the day. The educator requested that the school social worker assist with the reduction of this behavior as it prevented John from interacting in a reciprocal way with his peers and caused many distractions for both John and his peers in relation to their learning. His social worker wrote a behavior modiﬁcation plan to target this behavior.The plan was a differential reinforcement of appropriate behaviors (DRA). The DRA was selected as a treatment strategy as it enabled other school staff to be trained in the intervention techniques and built upon John’s strengths by encouraging his appropriate behaviors. The DRA was executed throughout his day. When John would engage in appropriate activities without exhibiting TV talk, the social worker Franklin, C., Harris, M. B., & Allen-Meares, P. (Eds.). (2024). The school services sourcebook : A guide for school-based professionals. Oxford University Press, Incorporated. Created from bibliovirtualuide-ebooks on 2024-02-08 19:50:41. Copyright © 2024. Oxford University Press, Incorporated. All rights reserved. Chapter 12 Effective Interventions for Students With Autism and Asperger’s Syndrome 157 (or whoever was with him at the time) would sporadically give him a happy-face token, paired with social praise (“You’re doing a nice job working on the puzzle”).When John would engage in TV talk, the social worker would give him a sadface token paired with the verbal cue, “Tell me what you’re doing now.” This verbal cue taught John to comment on a present task rather than to perseverate on television shows. When John earned ﬁve happy-face tokens, he was able to choose a preferred activity (e.g., working on the computer) to engage in for a 3-minute period. If John received ﬁve sad-face tokens before earning ﬁve happy-face tokens, he was given a verbal prompt,“You need to talk about what is going on in the [classroom], not about TV.” The staff of both his specialized and inclusive schools was trained to implement the plan, as were his parents. John exhibited this behavior very frequently (some instance of TV talk occurred in 80% of the 5-minute intervals during data collection) when the behavior plan was initially implemented.With the consistency of the implementation, the behavior was reduced to one or two instances a day after 6 months and was eventually eliminated by the end of the school year. John was mainstreamed into the public school, full time, with a one-to-one aide at the start of his ﬁrst-grade year. He was able to complete the full curriculum with the help of the school staff, who worked with the school social worker to learn how to break down John’s assignments into manageable steps. For example, stories read in class were broken down into “chunks” and paired with visual cues to aid in comprehension. He continued to receive ABA instruction and DTT after school with the social worker.The social worker utilized role-play techniques to teach social skills, breaking down the skills into manageable steps: SW: I’m going to pretend to be Kyle. I’m on the playground with a soccer ball.You’re going to walk up to me, tap me on the shoulder, look in my eyes and say,“Can I play soccer with you?” Get ready. Go! John: [walks up, taps the social worker on the shoulder, looks in her eyes, but says nothing] SW: Say, “Can I play soccer with you?” (verbal cue) John: Can I play soccer with you? SW: That was great! Let’s try it again. (social praise used as positive reinforcement) In the example, the social worker is breaking down a social interaction into small, teachable steps. After John mastered this ﬁrst step of playground interaction (initiating play) in several different play scenarios, the social worker expanded the recess role-play scenes to teach John how to maintain extended play periods. During lunch time and recess at the school, John’s social worker would shadow him and deliver verbal cues such as “Ask Kyle, ‘Can I play with you?’ ” or gestural prompts (i.e., point at a peer with whom he can play).The verbal cue was also paired with the gestural prompt: pointing at the peer while modeling “Can I play with you?” These strategies aimed to help John generalize the skills he learned during his therapy sessions.Again, the school staff was also taught these prompts to assist with John’s socialization throughout the school day. For a child with AD to be included in a mainstream setting, he needs to be able to manage social experiences (National Research Council, 2001). John’s social worker continued to consult in the school setting. John was taught to respond to discrete hand gestures to help him to refocus on the teacher when environmental distractions would impede his concentration. If John would look out the window when his teacher was speaking, the social worker would touch his shoulder, and when John looked up, she would tap her ear twice and point to the teacher. John was taught that this gesture meant “listen to the teacher.” The school staff was taught to utilize these hand gestures as well.These discrete gestures kept John from standing out too much from his peers, as verbal redirecting would draw attention to him.Through the use of such gestures by various staff members, John’s classmates also began to respond to the gestures when they became unfocused. John is currently enrolled in a public middle school. He continues to complete the full curriculum and plays on his town soccer and basketball teams. John does continue to experience difﬁculty in the area of reading comprehension and in assessing social cues at times. However, the progress John has made is quite noteworthy. He is a friendly and empathic boy who excels in math and enjoys athletic activities. John’s success could not have been accomplished without the support of a multidisciplinary team effort. John’s school social worker, teachers, speech therapist, and occupational therapist all collaborated through the years to utilize similar strategies and target compatible Franklin, C., Harris, M. B., & Allen-Meares, P. (Eds.). (2024). The school services sourcebook : A guide for school-based professionals. Oxford University Press, Incorporated. Created from bibliovirtualuide-ebooks on 2024-02-08 19:50:41. 158 Part I Best Direct Practice Interventions With Student Populations goals. John’s parents employed reinforcement strategies in the home by carrying over the skills targeted in therapy and at school. Resources Overview of AD and AS http://www.autism-society.org http://www.autisminfo.com http://www.nichcy.org http://www.aspergers.com http://www.udel.edu/bkirby/asperger/ aslink.html http://www.autism-pdd.net/autism.htm http://www.autismwebsite.com/ari/index.htm Educational and Therapeutic Interventions http://www.teacch.com http://www.autism.org http://www.cabas.com Copyright © 2024. Oxford University Press, Incorporated. All rights reserved. Treatment Centers http://www.pcdi.org http://gsappweb.rutgers.edu/DDDC http://info.med.yale.edu/chldstdy/autism http://www.behavior.org http://www.son-rise.org Training Materials Arick, J. R., Loos, L., Falco, R., & Krug, D. A. (2004). Strategies for teaching based on autism research: STAR. Austin,TX: Pro-Ed. Freeman, S., & Dake, L. (1997). Teach me language. Langley, BC: SKF Books. Koegel, R. L., Koegel, L. K., & Parks, D. R. (1990). How to teach self-management skills to people with severe disabilities: A training manual. Santa Barbara: University of California. Leaf, R., & McEachin, J. (1999). A work in progress. New York: DRL Books. McClannahan, L. E., & Krantz, P. J. (1999). Activity schedules for children with autism: Teaching independent behavior. Bethesda, MD:Woodbine. http://www.dttrainer.com/pi_overview.htm http://www.nationalspeech.com http://rsaffran.tripod.com/ http://www.users.qwest.net/~tbharris/prt.htm http://www.education.ucsb.edu/autism/ behaviormanuals.html Suggested Practice Exercise Related to Intervention Consider that a parent has received a diagnosis of AD for his 5-year-old son. How would you begin to present the options for intervention? Describe your role as a social worker in providing the information. Key Points to Remember Autism spectrum disorders are deﬁned by clinical symptomatology which typically falls within three major categories: (1) qualitative impairment in social interaction; (2) impairments in communication; and (3) restricted, repetitive, stereotyped behavior, interests, and activities. One of the important characteristics of children with ASDs is uneven learning ability and skill levels, and as such, individualization of intervention is necessary. Applied behavior analysis is the most widely accepted effective intervention model for children and adolescents with AD and AS. Discrete trial training is a specialized teaching technique or process used to develop new forms of behavior and skills, including cognitive, communication, play, social, readiness, receptive-language, and self-help skills, as well as reducing self-stimulatory responses and aggressive behaviors. The primary purpose of pivotal response training is to provide children with the social and educational proﬁciency to participate in inclusive settings. Medication cannot be justiﬁed as the ﬁrst line of treatment for AD, AS, or the associated symptoms. Behavioral treatments are most successful when applied across settings and persons in the child’s life. Despite the promising treatment effects produced by the interventions reviewed above, existing treatments need to be reﬁned and evaluated Franklin, C., Harris, M. B., & Allen-Meares, P. (Eds.). (2024). The school services sourcebook : A guide for school-based professionals. Oxford University Press, Incorporated. Created from bibliovirtualuide-ebooks on 2024-02-08 19:50:41. Chapter 12 Effective Interventions for Students With Autism and Asperger’s Syndrome 159 with rigorous testing procedures to establish efﬁcacy. A primary goal of the research should be to determine the types of interventions that are most effective for children with different subtypes of ASDs and with speciﬁc characteristics, since the characteristics of children with ASDs and their life circumstances are exceedingly heterogeneous in nature (National Research Council, 2001). Regardless of the intervention selected, it is essential that strategies be devised to take advantage of the unique constellation of strengths and characteristics of the learner with AS or AD and to modify contexts to support the learning and behavioral style of the individual student (Klin, McPartland, & Volkmar, 2005). The focus in this chapter has been geared toward the school social worker and mental health practitioner working with individual students in school settings. Equally important in sustaining gains in behavior and skill acquisition with schoolaged children and adolescents with AD and AS are issues surrounding classroom management, group skill-based interventions, especially for students with AS, and working collaboratively with parents, teachers, peers, and school administrators to promote skill generalization across settings and persons in addition to sustaining change. Copyright © 2024. Oxford University Press, Incorporated. All rights reserved. Notes 1. It should be noted that in addition to the diagnostic criteria for AS delineated in the DSM-IV-TR (2000) and the ICD-10 (1992), there are at least ﬁve very different conceptualizations of AS (Ghaziuddin,Tsai, & Ghaziuddin, 1992; Klin & Volkmar, 1997; Leekam, Libby, Wing, Gould, & Gillberg, 2000; Szatmari, Bryson, Boyle, Streiner, & Duku, 2003), which represent to some extent the major differences in the conceptualization of this disorder (e.g., Asperger’s syndrome as a milder form of autism, different conceptions of the timing when motor skills should be taken into account, etc.). 2. Level-one screening measures for autism are used to identify children at risk for autism from the general population, while level-two screening involves the identiﬁcation of children at risk for autism from a population of children demonstrating a broad range of developmental concerns (Stone, Coonrod,Turner, & Pozdol, 2004). 3.There are two instruments speciﬁcally designed as diagnostic tools for Asperger’s syndrome: the Asperger’s Syndrome Diagnostic Interview and the Australian Scale for Asperger’s Syndrome. Both require further testing to determine their reliability and validity prior to use as diagnostic instruments. 4. See Rogers (1998); National Research Council (2001); and New York State Department of Health (1999b) for a complete review of evidence-based early intervention programs. References Aman, M. G., Collier-Crespin, A., & Lindsay, R. L. (2000). Pharmacotherapy of disorders in mental retardation. European Child and Adolescent Psychiatry, 9, 98–107. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision).Washington, DC:Author. Anderson, S. R., & Romanczyk, R. G. (1999). Early intervention for young children with autism: Continuum-based behavioral models. Journal of the Association for Persons With Severe Handicaps, 24(3), 162–173. Anderson, S. R., Taras, M., & Cannon, B. O. (1996). Teaching new skills to young children with autism. In C. Maurice, G. Green, & S. C. Luce (Eds.), Behavioral intervention for young children with autism: A manual for parents and professionals (pp. 181–194). Austin, TX: Pro-Ed. Arick, J. R., Krug, D.A., Fullerton,A., Loos, L., & Falco, R. (2005). School-based programs. In D. J. Cohen & F. R.Volkmar (Eds.), Handbook of autism and pervasive developmental disorders:Vol. 2, Assessment, interventions, and policy (3rd ed., 1003–1028). New York:Wiley. Baer, D., Wolf, M., & Risley, R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1, 91–97. Baker, L. J., & Welkowitz, L. A. (Eds.). (2005). Asperger’s syndrome: Intervening in schools, clinics and communities. Mahwah, NJ: Earlbaum. Bregman, J. (2005). Deﬁnitions and characteristics of the spectrum. In D. Zager (Ed.), Autism spectrum disorders: Identiﬁcation, education and treatment (3rd ed., pp. 3–46). Mahwah, NJ: Erlbaum. Bregman, J., Zager, D., & Gerdtz, J. (2005). Behavioral interventions. In F. R.Volkmar, R. Paul,A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders: Vol. 2. Assessment, interventions and policy (3rd ed., pp. 897–924). Hoboken, NJ: Wiley. Bryson, S., & Smith, I. M. (1998). Epidemiology of autism: Prevalence, associated characteristics, and implications for research and service delivery. Mental Retardation and Developmental Disabilities Research Reviews, 4(2), 97–103. Campbell, J. M. (2005). Diagnostic assessment of Asperger’s disorder: A review of ﬁve third-party rating scales. Journal of Autism and Developmental Disorders, 35(1), 25–35. Charman, T., & Baird, G. (2002). Practitioner review: Diagnosis of autism spectrum disorder in 2- and Franklin, C., Harris, M. B., & Allen-Meares, P. (Eds.). (2024). The school services sourcebook : A guide for school-based professionals. Oxford University Press, Incorporated. Created from bibliovirtualuide-ebooks on 2024-02-08 19:50:41. Copyright © 2024. Oxford University Press, Incorporated. All rights reserved. 160 Part I Best Direct Practice Interventions With Student Populations 3-year-old children. Journal of Child Psychology and Psychiatry and Allied Disciplines, 43(3), 289–305. Chez, M. G., Buchanan, T., Becker, M., Kessler, J., Aimonovitch, M. C., & Mrazek, S. R. (2003). Donepezil hydrochloride: A double-blind study in autistic children. Journal of Pediatric Neurology, 1(2), 83–88. Constantino, J. N. (2002). The social-responsiveness scale. Los Angeles:Western Psychological Services. Cooper, J. O., Heron, T., & Heward, W. (1987). Applied behavior analysis. Columbus, OH: Merrill. Courchesne, E. (2002). Abnormal early brain development in autism. Molecular Psychiatry, 7(Suppl. 2), S21–23. Cummings,A. R., & Williams,W. L. (2000).Visual identity matching and vocal imitation training with children with autism: A surprising ﬁnding. Journal on Developmental Disabilities, 7(2), 109–122. Dawson, G., & Osterling, J. (1997). Early intervention in autism. In M. Guralnick (Ed.), The effectiveness of early intervention (pp. 307–326). Baltimore: Brookes. Delquadri, J. C., Greenwood, C. R., Stretton, K., & Hall, R. V. (1983). The peer tutoring spelling game: A classroom procedure for increasing opportunity to respond and spelling performance. Education and Treatment of Children, 6(3), 225–239. DuCharme, R. W., & McGrady, K. A. (2003). What is Asperger syndrome? In R. W. DuCharme & T. P. Gullotta (Eds.), Asperger syndrome: A guide for professionals and families (pp. 1–20). New York: Kluwer Academic/Plenum. Dunlap, G. (1984). The inﬂuence of task variation and maintenance tasks on the learning and affect of autistic children. Journal of Experimental Child Psychology, 31, 41–64. Ehlers, S., Gillberg, C., & Wing, L. (1999). A screening questionnaire for Asperger syndrome and other high-functioning autism spectrum disorders in school-age children. Journal of Autism and Developmental Disabilities, 29(2), 129–141. Filipek, P. A., Accardo, P. J., Ashwal, S., Baranek, G. T., Cook, E. H., Dawson G., et al. (2000). Practice parameter: Screening and diagnosis of autism. Neurology, 55, 468–479. Filipek, P. A., Accardo, P. J., Baranek, G.T., Cook, E. H., Jr., Dawson, G., Gordon B., et al. (1999).The screening and diagnosis of autism spectrum disorders. Journal of Autism and Developmental Disorders, 29(6), 439–484. Fombonne, E. (1999). The epidemiology of autism: A review. Psychological Medicine, 29, 769–786. Fombonne, E. (2005). Epidemiological studies of pervasive developmental disorders. In F. R. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders: Vol. 1. Diagnosis, development, neurobiology and behavior (3rd ed., pp. 42–69). Hoboken, NJ:Wiley. Fombonne, E., Du Mazaubrun, C., Cans, C., & Grandjean, H. (1997). Autism and associated medical disorders in a French survey. Journal of the American Academy of Child and Adolescent Psychiatry, 36(11), 1561–1569. Fombonne, E., Simmons, H., Ford, T., Meltzer, H., & Goodman, R. (2001). Prevalence of pervasive developmental disorders in the British Nationwide Survey of Child Mental Health. Journal of the American Academy of Child and Adolescent Psychiatry, 40(7), 820–827. Ghaziuddin, M.,Tsai, L., & Ghaziuddin, N. (1992). Brief report: A comparison of the diagnostic criteria for Asperger’s syndrome. Journal of Autism and Developmental Disorders, 22(4), 643–649. Goldstein, H. (2002). Communication intervention for children with autism:A review of treatment efﬁcacy. Journal of Autism and Developmental Disorders, 35(2), 373–396. Green, G. (1996). Early behavioral intervention for autism:What does research tell us? In C. Maurice, G. Green, & S. C. Luce (Eds.), Behavioral intervention for young children with autism (pp. 29–44). Austin, TX: Pro-Ed. Gresham, F. M., Beebe-Frankenberger, M. E., & MacMillan, D. L. (1999). A selective review of treatments for children with autism: Description and methodological considerations. School Psychology Review, 28(4), 559–575. Harris, S. L., & Handleman, J. S. (1994). Preschool education programs for children with autism. Austin,TX: ProEd. Harris, S. L., Handleman, J. S., Gordon, R., Kristoff, B., & Fuentes, F. (1991). Changes in cognitive and language functioning of preschool children with autism. Journal of Autism and Developmental Disorders, 21, 281–290. Hollander, E., & Nowinski, C. V. (2003). Core symptoms, related disorders and course of autism. In E. Hollander (Ed.), Autism spectrum disorders (pp. 15–38). New York: Dekker. Hollander, E., Phillips, A., Chaplin, W., Zagursky, K., Novotny, S., Wasserman, S., et al. (2005). A placebo controlled crossover trial of liquid ﬂuoxetine on repetitive behaviors in childhood and adolescent autism. Neuropsychopharmacology, 30(3), 582–589. Howlin, P. (1998). Children with autism and Asperger syndrome: A guide for practitioners and carers. Chichester, UK:Wiley. Idol, L. (1988). A rationale and guidelines for establishing special education consultation programs. Remedial and Special Education, 9(6), 48–58. Idol, L., Paolucci-Whitcomb, P., & Nevin, A. (1986). Collaboration consultation. Austin,TX: Pro-Ed. Jacobson, J. W., Foxx, R. M., & Mulick, J. A. (Eds.). (2005). Controversial therapies for developmental disabilities: Fad, fashion and science in professional practice. Mahwah, NJ: Erlbaum. Jacobson, J.W., Mulick, J. A., & Green, G. (1998). Costbeneﬁt estimates for early intensive behavioral intervention for young children with autism: General Franklin, C., Harris, M. B., & Allen-Meares, P. (Eds.). (2024). The school services sourcebook : A guide for school-based professionals. Oxford University Press, Incorporated. Created from bibliovirtualuide-ebooks on 2024-02-08 19:50:41. Copyright © 2024. Oxford University Press, Incorporated. All rights reserved. Chapter 12 Effective Interventions for Students With Autism and Asperger’s Syndrome 161 model and single state case. Behavioral Interventions, 13, 201–206. King, B. H., Wright, D. M., Handen, B. L., Sikich, L., Zimmerman, A., McMahon, W., et al. (2001). Double-blind, placebo-controlled study of amantadine hydrochloride in the treatment of children with autistic disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 40(6), 658–665. Klin, A., McPartland, J., & Volkmar, F. R. (2005). Asperger syndrome. In F. R.Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders: Vol. 1. Diagnosis, development, neurobiology and behavior (3rd ed., pp. 88–125). Hoboken, NJ:Wiley. Klin,A., & Volkmar, F. R. (1997).The pervasive developmental disorders: Nosology and proﬁles of development. In S. Luthar, J. Burack, D. Cicchetti, & J.Weisz (Eds.), Developmental psychopathology: Perspectives on adjustment, risk, and disorder (pp. 208–226). New York: Cambridge University Press. Koegel, L. K., Koegel, R. L., Harrower, J. K., & Carter, C. M. (1999). Pivotal response intervention I: Overview of approach. Journal of the Association for Persons With Severe Handicaps, 24(3), 174–185. Koegel, L. K., Koegel, R. L., Shoshan,Y., & McNerney, E. (1999). Pivotal response intervention II: Preliminary long-term outcome data. Journal of the Association for Persons with Severe Handicaps, 24(3), 186–198. Koegel, R. L., O’Dell, M., & Dunlap, G. (1988). Producing speech use in nonverbal autistic children by reinforcing attempts. Journal of Autism and Developmental Disorders, 18, 525–538. Koegel, R. L., & Frea,W. D. (1993).Treatment of social behavior in autism through the modiﬁcation of pivotal social skills. Journal of Applied Behavior Analysis, 26(3), 369–377. Koegel, R. L., & Koegel, L. K. (Eds.). (1995). Teaching children with autism: Strategies for initiating positive interactions and improving learning opportunities. Baltimore: Brookes. Koegel, R. L., Schrefﬁrnan, L., Good, A., Cerniglia, L., Murphy, C., & Koegel, L. K. (n.d.). How to teach pivotal behaviors to children with autism: A training manual. Available: http://www.users.qwest.net/~tbharris/prt. htm. Koegel, R. L., & Williams, J. A. (1980). Direct versus indirect response-reinforcer relationships in teaching autistic children. Journal of Abnormal Child Psychology, 8, 537–547. Krug, D. A., & Arick, J. R. (2003). Krug Asperger’s Disorder Index.Austin,TX: Pro-Ed. Leekam, S. R., Libby, S. J., Wing, L., Gould, J., & Gillberg, C. (2000). Comparison of ICD-10 and Gillberg’s criteria for Asperger syndrome. Autism, 4(1), 11–28. Lord, C., & Cosello, C. (2005). Diagnostic instruments in autistic spectrum disorders. In F. R.Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders:Vol. 2.Assessment, interventions and policy (3rd ed., pp. 730–771). Hoboken, NJ:Wiley. Lord, C., & Paul, R. (1997). Language and communication in autism. In D. J. Cohen & F. R. Volkmar (Eds.), Handbook of autism and pervasive developmental disorders (2nd ed., pp. 460–483). New York:Wiley. Lord, C., Rutter, M. L., DiLavore, P. C., & Risi, S. (1999). Autism Diagnostic Observation Schedule-WPS (WPS ed.). Los Angeles:Western Psychological Services. Lord, C., Rutter, M. L., & Le Couteur, A. (1994). The Autism Diagnostic Interview-Revised: A revised version of the diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24(5), 659–685. Lovaas, O. (1993). The development of a treatmentresearch project for developmentally disabled and autistic children. Journal of Applied Behavior Analysis, 26(4), 617–630. Lovaas, O. I. (1981). Teaching developmentally disabled children:The me book. Austin,TX: Pro-Ed. Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3–9. Lovaas, O. I., & Smith, T. (1989). A comprehensive behavioral theory of autistic children: Paradigm for research and treatment. Journal of Behavior Therapy and Experimental Psychology, 20, 17–29. Loveland, K. A., & Tunali-Kotoski, B. (2005). The school-age child with an autistic spectrum disorder. In F. R.Volkmar, R. Paul,A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders:Vol. 1. Diagnosis, development, neurobiology and behavior (3rd ed., pp. 247–287). Hoboken, NJ:Wiley. Martin, A., Scahill, L., Klin, A., & Volkmar, F. R. (1999). Higher functioning pervasive developmental disorders: Rates and patterns of psychotropic drug use. Journal of the American Academy of Child and Adolescent Psychiatry, 38(7), 923–931. Matson, J. L., Benavidez, D. A., Compton, L. S., Paclawskyj, T., & Baglio, C. (1996). Behavioral treatment of autistic persons: A review of research from 1980 to the present. Research in Developmental Disabilities, 17, 433–465. Maurice, C., Green, G., & Luce, S. C. (Eds.). (1996). Behavioral intervention for young children with autism: A manual for parents and professionals. Austin,TX: Pro-Ed. McCarton, C. (2003). Assessment and diagnosis of pervasive developmental disorder. In E. Hollander (Ed.), Autism spectrum disorders (pp. 101–132). New York: Dekker. McClannahan, L. E., & Krantz, P. J. (2004). Selecting behavioral intervention programs for children with autism. In H. E. Briggs & T. L. Rzepnicki (Eds.), Using evidence in social work practice: Behavioral perspectives. Chicago: Lyceum. McDougle, C. J., Scahill, L., McCracken, J. T., Aman, M. G., Tierney, E., Arnold, L. E., et al. (2000). Franklin, C., Harris, M. B., & Allen-Meares, P. (Eds.). (2024). The school services sourcebook : A guide for school-based professionals. Oxford University Press, Incorporated. Created from bibliovirtualuide-ebooks on 2024-02-08 19:50:41. Copyright © 2024. Oxford University Press, Incorporated. All rights reserved. 162 Part I Best Direct Practice Interventions With Student Populations Research units on pediatric psychopharmacology (RUPP) autism network: Background and rationale for an initial controlled study of risperidone. Child and Adolescent Psychiatric Clinics of North America, 9, 201–224. McEachin, J. J., Smith,T., & Lovaas, O. I. (1993). Longterm outcome for children with autism who received early intensive behavioral treatment. American Journal of Mental Retardation, 4, 359–372. Miranda-Linne, F., & Melin, L. (1992).Acquisition, generalization and spontaneous use of color adjectives: A comparison of incidental teaching and traditional discrete-trial procedures for children with autism. Research in Developmental Disabilities, 13, 191–210. National Research Council. (2001). Educating children with autism. Washington, DC: National Academy Press. Newsome, C. B. (1998). Autistic disorder. In E. J. Mash & R.A. Barkley (Eds.), Treatment of childhood disorders (2nd ed., pp. 416–467). New York: Guilford. New York State Department of Health, Early Intervention Program. (1999a). Clinical practice guideline: Guideline technical report: Autism/pervasive developmental disorders, assessment and intervention for young children (ages 0–3 years) (No. 4217).Albany, NY:Author. New York State Department of Health, Early Intervention Program. (1999b). Clinical practice guideline: Report of the recommendations: Autism/PDD, assessment and intervention in young children (age 0–3 years) (No. 4215).Albany, NY:Author. Odom, S. L., Brown, W. H., Frey, T., Karasu, N., SmithCanter, L. L., & Strain, P. S. (2003). Evidence-based practices for young children with autism: Contributions for single-subject design research. Focus on Autism and Other Developmental Disabilities, 18(3), 166–175. Paul, R., & Sutherland, D. (2005). Enhancing early language in children with autism spectrum disorders. In F. R.Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders:Vol. 2.Assessment, interventions and policy (3rd ed., pp. 946–976). Hoboken, NJ:Wiley. Prizant, B. M., & Wetherby, A. (1998). Understanding the continuum of discrete-trial traditional behavioral to social-pragmatic developmental approaches in communication enhancement for young children with autism/PDD. Seminars in Speech and Language, 19, 329–353. Pryor, C. B., Kent, C., McGunn, C., & LeRoy, B. (1996). Redesigning social work in inclusive schools. Social Work, 41, 668–676. Research Units on Pediatric Psychopharmacology Autism Network. (2002). Risperidone in children with autism and serious behavioral problems. New England Journal of Medicine, 347, 314–321. Robins, D. L., Fein, D., Barton, M. L., & Green, J. A. (2001). The Modiﬁed Checklist for Autism in Toddlers:An initial study investigating the early detection of autism and pervasive developmental disorders. Journal of Autism and Developmental Disorders, 31(2), 131–145. Rogers, S. (1998). Empirically supported comprehensive treatments for young children with autism. Journal of Clinical Child Psychology, 27, 168–179. Sackett, D. L., Straus, S. E., Richardson, W. C., Rosenberg,W., & Haynes, R. M. (2000). Evidence-based medicine: How to practice and teach EBM (2nd ed.). New York: Churchill Livingstone. Safran, S. P. (2005). Diagnosis. In L. J. Baker & L. A. Welkowitz (Eds.), Asperger’s syndrome: Intervening in schools, clinics and communities (pp. 43–61). Mahwah, NJ: Erlbaum. Scahill, L., & Martin, A. (2005). Psychopharmacology. In F. R.Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders:Vol. 2. Assessment, interventions and policy (3rd ed., pp. 1102–1117). Hoboken, NJ:Wiley. Schopler, E., Reichler, R. J., & Renner, B. R. (1986). The Childhood Autism Rating Scale (CARS) for diagnostic screening and classiﬁcation of autism. New York: Irvington. Schreibman, L., Charlop, M. H., & Milstein, J. P. (1993). Autism: Behavioral treatment. In V. P. VanHasselt & M. Hersen (Eds.), Handbook of behavior therapy and pharmacotherapy of children: A comparative analysis (pp. 149–170). Needham Heights, MA: Allyn & Bacon. Schreibman, L., Kaneko,W. M., & Koegel, R. L. (1991). Positive affect of parents of autistic children: Comparison across two teaching techniques. Behavior Therapy, 22, 479–490. Scott, J., Clark, C., & Brady, M. P. (2000). Students with autism: Characteristics and instructional programming for special educators. San Diego, CA: Singular. Shea, S., Turgay, A., Carroll, A., Schulz, M., Orlik, H., Smith, I., et al. (2004). Risperidone in the treatment of disruptive behavioral symptoms in children with autistic and other pervasive developmental disorders. Pediatrics, 114(5), 634–641. Simpson, R. L., de Boer-Ott, S. R., Griswold, D. E., Myles, B. S., Byrd, S. E., Ganz, J. B., et al. (2004). Autism spectrum disorders: Interventions and treatments for children and youth. Thousand Oaks, CA: Corwin. Smith, T. (1996). Are other treatments effective? In C. Maurice, G. Green, & S. C. Luce (Eds.), Behavioral intervention for young children with autism (pp. 45–59). Austin,TX: Pro-Ed. Smith,T. (2001). Discrete trial training in the treatment of autism. Focus on Autism and Other Developmental Disabilities, 16(2), 86–92. Smith,T., Groen, A. D., & Wynn, J.W. (2000). Randomized trial of intensive early intervention for children with pervasive developmental disorder. American Journal on Mental Retardation, 105(4), 269–285. Stahmer, A. C. (1995). Teaching symbolic play skills to children with autism using pivotal response training. Journal of Autism and Developmental Disorders, 25, 123–141. Stahmer, A. C. (1999). Using pivotal response training to facilitate appropriate play in children with autistic Franklin, C., Harris, M. B., & Allen-Meares, P. (Eds.). (2024). The school services sourcebook : A guide for school-based professionals. Oxford University Press, Incorporated. Created from bibliovirtualuide-ebooks on 2024-02-08 19:50:41. Chapter 12 Effective Interventions for Students With Autism and Asperger’s Syndrome 163 U.S. Department of Health and Human Services. (1999). Mental health: A report of the surgeon general. Rockville, MD:Author. Volkmar, F. R. (2000). Medical problems, treatments, and professionals. In M. D. Powers (Ed.), Children with autism: A parent’s guide (2nd ed., pp. 67–90). Bethesda, MD:Woodbine House. Volkmar, F. R., Koenig, K., & McCarthy, M. (2003). Autism: Diagnosis and epidemiology. In E. Hollander (Ed.), Autism spectrum disorders (pp. 1–14). New York: Dekker. Wagner, A., & McGrady, K. A. (2003). Counseling and other therapeutic strategies for children with Asperger syndrome and their families. In R. W. DuCharme & T. P. Gullotta (Eds.), Asperger syndrome: A guide for professionals and families (pp. 83–134). New York: Kluwer Academic/Plenum. Whalen, C., & Schreibman, L. (2003). Joint attention training for children with autism using behavior modiﬁcation procedures. Journal of Child Psychology and Psychiatry, 44, 456–468. World Health Organization. (1992). International classiﬁcation of diseases: Diagnostic criteria for research (10th ed.). Geneva, Switzerland:Author. Yeargin-Allsopp, M., Rice, C., Karapurkar, T., Doernberg, N., Boyle, C., & Murphy, C. (2003). Prevalence of autism in a U.S. metropolitan area [comment]. Journal of the American Medical Association, 289(1), 49–55. Copyright © 2024. Oxford University Press, Incorporated. All rights reserved. spectrum disorders. Child Language Teaching and Therapy, 15(1), 29–40. Stahmer, A. C., Ingersoll, B., & Carter, C. (2003). Behavioral approaches to promoting play. Autism, 7(4), 401–413. Stone,W. L., Coonrod, E. E., & Ousley, O. Y. (2000). Brief report: Screening tool for autism in two-year-olds (STAT): Development and preliminary data. Journal of Autism and Developmental Disorders, 30(6), 607–612. Stone,W. L., Coonrod, E. E.,Turner, L. M., & Pozdol, S. L. (2004). Psychometric properties of the STAT for early autism screening. Journal of Autism and Developmental Disorders, 34(6), 691–701. Strock, M. (2004). Autism spectrum disorders (pervasive developmental disorders) (NIH Publication No. 04–5511, pp. 1–40). Bethesda, MD: U.S. Department of Health and Human Services. Sulzer-Azaroff, B., & Mayer, R. (1991). Behavior analysis for lasting change. Fort Worth, TX: Holt, Rinehart & Winston. Szatmari, P., Bryson, S. E., Boyle, M. H., Streiner, D. L., & Duku, E. (2003). Predictors of outcome among high functioning children with autism and Asperger syndrome. Journal of Child Psychology and Psychiatry, 44(4), 520–528. Thorpe, D. M., Stahmer,A. C., & Schreibman, L. (1995). Effects of sociodramatic play training on children with autism. Journal of Autism and Developmental Disorders, 25, 265–281. Franklin, C., Harris, M. B., & Allen-Meares, P. (Eds.). (2024). The school services sourcebook : A guide for school-based professionals. Oxford University Press, Incorporated. Created from bibliovirtualuide-ebooks on 2024-02-08 19:50:41. Copyright © 2024. Oxford University Press, Incorporated. All rights reserved. This page intentionally left blank Franklin, C., Harris, M. B., & Allen-Meares, P. (Eds.). (2024). The school services sourcebook : A guide for school-based professionals. Oxford University Press, Incorporated. Created from bibliovirtualuide-ebooks on 2024-02-08 19:50:41.

Harris 2024 Autism Interventions PDF

Document Details

Tags

Related

Summary

Full Transcript

Upgrade to continue