Summer 2006 Volume 3, Issue 1€¦ · Evidence-Based Practices By Vera Bernard-Opitz The term...

Cover illustration by Chris Barajas

Summer 2006 Volume 3, Issue 1

2 Autism News of Orange County – RW Summer 2006

C O V E R F E AT U R E

Editorial TeamVera Bernard-Opitz, Ph.D., EditorSachiko Galassetti, Associate Editor

Editorial BoardTeri M. Book, RN, MSN, CPNPJoe Donnelly, M.D.Andrea Walker, M.A.Janis White, Ed.D.

Advisory BoardLOCALPauline A. Filipek, M.D.

University of California, IrvineFor OC Kids

BJ Freeman, Ph.D.Autism Consultant

Wendy Goldberg, Ph.D.University of California, Irvine

Belinda Karge, Ph.D.Cal State University, Fullerton

Jennifer McIlwee MyersOrange County, California

Connie Kasari, Ph.D.University of California, Los Angeles

Marian Sigman, Ph.D.University of California, Los Angeles

Becky TouchetteSaddleback Valley Unified School District

NATIONAL/INTERNATIONALJay Birnbrauer, Ph.D.

Murdoch University, Australia

V. Mark Durand, Ph.D.University of South Florida, St. Petersberg

Patricia Howlin, Ph.D.St. Georges’s Hospital London, England

David Leach, Ph.D.Murdoch University, Australia

Gary Mesibov, Ph.D.University of North Carolina,Chapel Hill Division TEACCH

Fritz Poustka, M.D.University of Frankfurt, Germany

Salwanizah Bte Moh.SaidEarly Intervention, Autism Association, Singapore

Diane Twachtman-Cullen, Ph.D., CCC-SLPADDCON Center, Higganum, Connecticut

We are pleased to feature one of our local artists, Chris Barajas.Read more about Chris on page 11.

Mission StatementAutism News of Orange County & the Rest of the World

is a collaborative publication for parents and professionalsdedicated to sharing research-based strategies, innovativeeducational approaches, best practices and experiences inthe area of autism.

Submission PolicyThe Autism News of Orange County RW is available free

of charge to parents and professionals of children with autism.The opinions expressed in the newsletter do not necessarilyrepresent the official view of the agencies involved.

Contributions from teachers, therapists, researchers andrelatives/children of/with autism are welcome. The editorsselect articles and make necessary changes.

Please submit articles in Microsoft Word using font size12, double spaced, and no more than four pages in length(2600 words). Photos are encouraged and when submittedwith articles the permission to include is assumed.

Please email all correspondence to: Dr. Vera Bernard-Opitz

[email protected] visit our website: www.autismnewsoc.org

C O N T E N T S

Editorial Beyond Buzzwords: Evidence-Based Practices .... 3

ResearchIndividualized Treatment .................................... 7Activity-Based Intervention Approach ............... 12

Education/TherapyTEACCHing Teachers ...................................... 15Teaching Narrative Skills ................................... 19Video Modeling Program .................................. 25

Parent/FamilyTen Things Every Child with Autism Wishes You Knew ............................................. 28Local Artist: Chris Barajas ................................. 11

News/HighlightsThe National Standards Project ......................... 18Effective Instruction .......................................... 18Task of the Month ............................................ 24Calender of Events ............................................ 31

Summer 2006 Autism News of Orange County – RW 3

Beyond Buzzwords:

Evidence-Based PracticesBy Vera Bernard-Opitz

The term ‘evidence-based practices’ has become abuzzword in conferences, articles and educationalsettings for children with autism, indicating thattreatment should be based on methods with con-firmed scientific evidence combined with clinicalexpertise. It clearly makes sense to develop guidelinesto filter out questionable treatments, which give falsehope to parents and professionals and which wasteenergy, resources and the child’s time. Having a cata-log of validated interventions for children withautism would definitely be helpful to consumers, aswell as service providers.

So far – so good, but what exactly is ‘evidence’for treatment success; what can be considered a positive treatment outcome and which research evidence is sufficient? Some may argue that behav-ioral interventions have demonstrated their effec-tiveness, in sound singlecase and group studies,over the last forty yearsand that placement inless restrictive settingscan be seen as a long-term success. In this con-text the Intensive EarlyIntervention study byLovaas at UCLA is usually cited, indicating that47% of the participating two to four year old chil-dren were integrated into regular classes after twoyears of forty hour per week behavioral intervention(Lovaas, 1987). Over the past years, several replica-tions of this project have been reported with mostunfortunately not achieving the extent of the origi-nal research findings (e.g., Eikeseth, Smith Jahr, &Eldevik, 2002; Birnbrauer, & Leach, 1993). Theseand other studies suggest that the impact of inten-sive intervention can vary considerably, dependingon the scope of the program, the fidelity of theimplemented treatment, staff and parent involve-ment and the intensity of the program.

Other colleagues may point to widely acceptededucational interventions, which are considered‘Best Practice’ methods, such as the TEACCH pro-gram (Mesibov et al, 1994). While some argue thisprogram is less backed by research, good empirical

support for its foundations has beendemonstrated (Mesibov & Shea, in prepa-ration). The structured teaching method,characteristic for TEACCH, is clearlymatched to the needs of the individualswith autism for clear visual support, func-tional tasks and predictable work environ-ments. Furthermore it is obvious, thatthis method has been the chosen treat-

ment in many autism centers around the world.There is no question that interventions such as this,based on matching treatments to core deficits ofchildren with ASD, replications of positive out-comes over varying autism centers as well as provid-ing wide appreciation for an approach, qualify as a‘Best Practice’ methods.

There are other ‘camps’, which have specificintervention targets in mind, such as ‘AugmentativeCommunication’, ‘Verbal Behavior’, ‘SCERTS’,‘Integrated Play’, ‘Social Perspective Taking’ or even‘Parent Training’ to name just a few. They all touchon components of treatment, which are importantfor many individuals with ASD. With the wideselection of treatment options, parents are in a

E D I T O R I A L

Evidence-Based Intervention is related to

• Research support• Theoretical underpinning• Causal relation to

treatment success


quandary when facing the difficult task of selectingthe best treatment for their child, while researchers,clinicians and educators struggle with the decisionwhich method has sufficient evidence. Should mynon-verbal child be in a PECS program (PictureExchange Communicative System) or should we aim forVerbal Behavior Intervention? In addition to school ser-vices should I take a parent training course, enroll mychild in Integrated Play Groups or invest in additionalhome interventions through trained professionals?Questions such as these require extensive clinicalexpertise, good understanding of the child withASD, the family and cultural context as well as thetreatment paradigm in question.

It should meanwhile be clear that anecdotalaccounts of improvement in treated areas alone areno longer sufficient. Positive expectancy, novelty oruncontrolled external factors all threaten the validityof individual case reports. Social validity data alsoseem insufficient by themselves, such as parents rav-ing about positive changes, since they might bebiased, having spent effort, money and hope on atreatment method. So again different argumentsmay need to be combined: if a treatment has a clearrelation to established theories (such as the Theoryof Mind), demonstrates effectiveness in treating spe-cific individual problems and is acknowledged ashaving caused the changes, then it can be considered‘preliminary evidence’ that this method can be help-ful to a comparable individual.

The above does not imply that we should stand stilland be content with basing our decisions for treatmenton a collection of eclectic arguments. A continuum ofstandards may be helpful to discriminate treatments,which are unacceptable to ideal interventions based onsufficient empirical evidence and application.

While it may sound easy to parents/consumers,to find which treatment works the best and fastest for

their individual child, we stand before atremendous task, which may need to betackled by a representative panel ofexperts from different professions anddifferent treatment directions.

Among others, the following ques-tions need to be clarified:

• What group of individuals with ASD are wefocusing on? (individuals with autism/AspergerSyndrome? What is their age range, IQ range,skill profile, interest/motivation etc?)

• What goals are targeted in specific interven-tions? (Long/short term goals; skill/education-al/behavioral goals; individual/family/commu-nity goals etc)

• What are selection criteria and cut-offs for inter-ventions? (unacceptable/acceptable/ideal criteria)

• What are necessary components of treatment pack-ages, such as Pivotal Response Training, TEACCHor social skill training?

• What are crucial treatment factors, which affectchange in programs as different as ABA, VerbalBehavior, Pivotal Response Training, IntegratedPlaygroups, TEACCH or the SCERTS model?(Prizant, Wetherby, Rubin, Laurent & Rydell 1999)

• What external factors contribute to treatmentsuccess? (parent involvement/integration/supportsystems, etc)

• What are predictors for treatment success, such ascharacteristics of children, who require certaininterventions? (Schreibman & Stahmer, See thisissue; Sherer & Schreibman, 2005)

• Does a certain sequence of specific treatments(e.g. ABA before play) enhance developments?(Bernard-Opitz et al, 2004).

In addition to theabove, we also needmore knowledge aboutthe effectiveness oftreatments at bothends of the spectrum.There is an urgent

E D I T O R I A L

Treatments based on Best Practice Methods

• Theoretical rational• Matched treatment• Preliminary evidence• Social validity data

Quality of Interventions

UNACCEPTABLE ACCEPTABLE IDEAL

Anecdotal Preliminary Replicated evidence evidence research evidence


E D I T O R I A L

need to understand why somechildren with ASD do not ben-efit from intensive interven-tions. We also should make surethat some of the outstandingtreatment successes pointed outby their proponents are notrelated to maturational changesin children less severely disabledor external factors not associat-ed with the treatment. We needmore treatment studies compar-ing control subjects on waitinglists to specific interventions, as well as differenttreatment components to each other (Howard et al,2005). While these studies pose enormous method-ological challenges, guidelines for dealing with theproblems have been outlined (Schreiber, 2006; Lord,C. et al, 2005; Kazdin & Nock, 2003).

Most critical clinicians and educators have longmoved beyond a ‘one size fits all’ attitude when itcomes to deciding on treatments for children withASD. They are aware that we are dealing with awide spectrum of problems, which requires a spec-trum of interventions. Not every child with autismfits the characteristics of the participants in theabove-cited Early Intervention studies by the ABApioneers – so not everybody needs thequoted forty hours of weekly, one-to-onediscrete trial intervention, just as well asnot everybody requires an augmentativecommunication device, PECS training, a TEACCH environment or Social Per-spective Intervention.

We need to remember that even if a treatmenthas demonstrated its effectiveness for a certaingroup, this does not imply that every individual ben-efits. Instead of the top down question, ‘Which childcan benefit from Precision Training, Peer MediatedLearning or Activity-Based Instruction?’ Bottom-upquestions should be asked, which aim at the needs ofthe individual with autism. Which treatmentmatches the individual’s needs, for what teachingtarget, at what time in his development in whatcontext? In discussions for standards regarding evi-

dence-based interventions guidelinesare crucial for decision making toassure the most effective treatment ofindividuals with ASD.

Through the forty-year history ofautism treatment we have learned a lotabout highly specific interventions thattend to be successful with certain chil-dren. Especially in the behavioral fieldsingle subject designs have clearlydemonstrated the effect of componenttechniques, be it interrupting behaviorchains, time delay or sensory reinforce-

ment. We now are entering the exciting phase ofmatching treatments to learning features, interests andtherapy goals of individuals with autism (Bernard-Opitz. 2005 & in print). Comparable to designerdrugs, designer treatments should be an aim in ser-vices for children with autism: just as an Aspirin cannot cure every single headache, a multitude of proveninterventions is required, which can be matched to theindividual needs of the child with ASD.

Preliminary guidelines for effective treatmentprograms, such as the one by the National Instituteof Mental Health can give parents and professionalssome directions with making the right choices(NIMH, 2004).

“An effective treatment pro-gram will build on the child’sinterests, offer a predictableschedule, teach tasks as a seriesof simple steps, actively engagethe child’s attention in highly

structured activities, and provide regular reinforce-ment of behavior. Parental involvement has emergedas a major factor in treatment success.”

While guidelines and standards for evidence-basedinterventions are discussed and developed in variouscountries (Wilczynski, 2006, US National StandardProject; Jordan, UK, 2005; Perry & Condillac, 2003,Canada; Hoagwood et al, 2001, US), we will contin-ue our commitment to evidence-based/best practicesby disseminating articles, which are either based onscientific evidence, have a scientific foundation or

More research is neededto understand

• Common factors indifferent treatmentmethods

• Crucial componentsof treatment packages

• Predictors for treatment success

• Maturational factors

• External influences

The wide spectrum ofproblems of individualswith ASD requires a widespectrum of interventions.


have the support of parents and experienced profes-sionals. And hopefully this will contribute to bringingbest practices to the children we care about.

As such we are delighted to present the followingarticles in our current issue of the Autism News:

• Laura Schreibman and Aubyn Stahmer, fromthe University of California, San Diego, sharetheir innovative research about predictors for thesuccess of Pivotal Response Training.

• Marisa Macy, Helen Sharp and Ruby Chan, fromthe University of Oregon, describe and exemplifyActivity-Based Intervention as an approach rootedin established developmental theories, which caneasily be implemented in the school and homeenvironment.

• Galene Fraley (TEACCH Center, Asheville, NorthCarolina) and Andrea Walker (S.U.C.S.E.S.S.Project, Orange County, CA) describe the annualTEACCH workshop held locally, where teacherslearn to link challenges in teaching individualswith ASD to solutions through structured teach-ing methods.

• Lauren Franke (Scottish Rite Clinic, Long Beach)and Christine Durbin (CA Pacific MedicalCenter) give concrete ideas for the developmentand expansion of narrative skills, a crucial basis forsocial and academic success.

• Tamara Fortney (Interagency Autism Center,Orange County, CA) shares her exciting experi-ence with teaching a 26 months old boy imitativeplay through Video Modeling.

• Last, but not least, we are very grateful that Ellen Notbohm contributes her highly acclaimedthoughts on ‘Ten Things Every Child with AutismWishes You Knew.’

We are grateful to our authors and everybodyinvolved in making this new issue of the AutismNews possible. We also want to express our gratitudeto Tresa Oliveri, who had to resign from her volun-teer position as the Associate Editor. Thanks, Tresa,for all your late hours in helping make the issues ‘per-fect’! We welcome Sachiko Galassetti as the newAssociate Editor, who will leave her traces behind as

an artist, scientist and high-school teacher. A specialwelcome also goes to Jennifer McIlwee Myers, whohas recently joined our local Advisory Board. With abackground in computer science and a family historyof ASD, she represents the bright and kind individu-als with Asperger Syndrome.

We very much hope that you will enjoy the pre-sent issue of the Autism News and invite you to con-tribute articles for the coming newsletter, which willfocus on Family Issues in ASD.

Vera Bernard-Opitz, Ph.D. Clin. Psych., EditorWebsite: http://verabernard.orgEmail: [email protected]

Selected References• Bernard-Opitz, V. (2005) Children with Autism Spectrum

Disorders: A Structured Teaching and Experience-BasedProgram for Therapists, Teachers, and Parents, Kohlhammer(in German), in print in Pro Ed.

• Bernard-Opitz, V. Siow Ing & Tan, Y. K. (2004).Comparison of behaviorual and natural play interventionsfor young children with autism, Autism, 8 (3), 319-333.

• Hoagwood, K. et al (2001) Evidence-Based Practice in childand adolescent mental health services, Psychiatric Services,52: 1179-1189.

• Jordan, R. (2005) Evidence-Based Practice in education inASD, 4th International Symposium for Intervention inASD, Editor: S. Bölte, Frankfurt University.

• Lovaas, O. I. (1987) Behavioral treatment and normal educa-tional and intellectual functioning in young autistic children.Journal of Consulting and Clinical Psychology, 55, 3-9.

• Mesibov, G. & Shea, V. Evidence-Based Practices, autismand the TEACCH Program, in preparation.

• Perry, A. & Condillac, R. (2003) Evidence-Based Practicesfor children and adolescents with autism spectrum disor-ders, Children’s Menal Health, Ontario.

• Sherer, M. R. & Schreibman L. (2005) Individual behav-ioral profiles and predictors of treatment effectiveness forchildren with autism. Journal of Consultating and ClinicalPsychology. 73(3), 525-38.

• Wilczynski, S. M. (2006) The National Standards Project:Part II: The project and its goals. Second Annual BestPractices in Autism Treatment & Methodologies EducationConference 2006, San Jose, California.

E D I T O R I A L

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The field of autism has been subject to contro-versies, debates, and arguments almost since the dayLeo Kanner identified the disorder in 1943.Controversies continue because, to date, we reallyhave relatively few answers to the many questionsautism poses. Controversies abound relating to eti-ology, core deficits, educational policies, and thelike. However, in recent years one of the most con-tentious aspects of autism has enjoyed some consen-sus in the area of treatment. Thus, while there is stillno shortage of scientifically unproven, blatantlybogus, or other ineffective treatment options totempt parents and others, those with a critical eyenow agree that, so far, the only form of treatmentthat has been empirically demonstrated to be effec-tive in treating individuals with autistic disorder aretreatments based upon a behavioral model (e.g.,National Research Council, 2001; Schreibman,2005). These are treatments that apply the principlesof learning and which have been experimentally val-idated through applied behavior analysis. They areall founded in behavioral principles but differ interms of the strictness of structure, naturalistic pro-cedures, and other variables. Although there aremany brand names for treatments based on theseprinciples, the major behavioral treatments areDiscrete Trial Training (DTT, Lovaas, 1987), PivotalResponse Training (PRT, Schreibman & Koegel,2005), Incidental Teaching, and the augmentativePicture Exchange Communication System (PECS,Bondy & Frost, 1994).

While these treatments are all somewhat effec-tive with the majority of the children, one problemthat has bedeviled the field is that none of these ismaximally effective for all children with autism. Thenotorious variability in treatment outcome with thispopulation suggests that other variables are involvedin affecting treatment response. This means that

the usual arguments about which behavioraltreatment is best are essentially meaningless inthat there is no one behavioral treatment that fitsall of the children. Thus, to be maximally benefi-cial with children with autism, we need to under-stand the variables affecting treatment effectivenessso we can tailor treatment to the needs of the indi-vidual child.

What kinds of variables must we consider? Webelieve that the following variables are importantfor treatment:

(1) Child variables(2) Parent variables(3) Cultural variables, and (4) Treatment/behavior interactions.

Ideally we would be able to understand how thesevariables impact outcome and approach each child’streatment from a very informed position. Ideally wecould take a child and family, conduct assessments ofthese variables, and come up with a formula fordesigning the best behavioral treatment program.

We have just begun to conduct research in thisarea by starting with identifying child characteristicsthat predict treatment outcome.

Pilot StudySherer and Schreibman (2005) conducted the

first study to identify a behavioral profile of childrenwith autism that predicted the effectiveness of onebehavioral intervention, Pivotal Response Training(PRT, Koegel et al., 1989). PRT is a method that hasbridged the gap between highly structured discretetrial training (DTT) (which typically uses analog ordrill-oriented teaching) and very naturalistic meth-ods such as Incidental Teaching (which is highlydependent upon the environment and the child’sactions for each teaching opportunity). PRT grewout of DTT and can be used in a structured or natu-ralistic format. PRT is specifically designed to

R E S E A R C H

Individualized Treatment for Children with Autism By Laura Schreibman and Aubyn Stahmer

“Treatments based upon behavioral principles have proven to be effective.”

“No one behavioral treatment fits all children.”


R E S E A R C H

increase a child’s motivation to participate in learningnew skills, and training involves specific strategiessuch as: 1) clear instructions and questions presentedby the therapist; 2) child choice of stimuli (based onchoices offered by the therapist); 3) interspersal ofmaintenance tasks (previously mastered tasks); 4)direct reinforcement (the chosen stimuli is the rein-forcer); 5) reinforcement of reasonable, purposefulattempts at correct responding; 6) turn taking toallow modeling and appropriate pace of interaction.

In the behavioral profile study we looked at pre-treatment behavioral observations of children whosubsequently either made substantial progress withPRT or responded minimally to the treatment. Abehavioral profile was identified that differentiatedthe “Responders” from the “Nonresponders.” Theresponders engaged in more interaction with toys,were not very socially avoidant, would approachadults, had moderate to low rates of nonverbal self-stimulation, and had higher rates of verbal self-stim-ulation. In contrast, nonresponders had low rates oftoy interaction, were very socially avoidant, rarelyapproached adults, had high rates of nonverbal self-stimulation, and low rates of verbal self-stimulation(See Figure 1).

Experiment 1In the prospective phase of this study, six new

children were enrolled (age range 3-5 yrs; IQ range:<50 to 78, language age range: 8 - 44 mos, andsymptom severity ChildhoodAutism Rating Scale Scoresrange: 35-43), three who fitthe responder profile and threewho fit the nonresponder pro-file (See Table 1). Two of theresponders used single wordsvery infrequently and one usedsimple phrases for requesting.All of the responders exhibiteda great deal of verbal self-stim-ulation, difficulty with eyecontact and poor transitioningskills. Similarly, two of thenonresponders had minimallanguage and one had phrase

speech. The nonresponders tended to engage in agreat deal of nonverbal self-stimulatory behavior andto actively avoid interaction with adults. These chil-dren underwent intensive (90-minute 1:1 sessions,4-5 times per week for six months) PRT treatment.As we predicted, those children who matched thePRT responder profile improved substantially in theareas of communication, social behavior, and play.Examples of improvement were increases in vocabu-lary and complexity of language and improvementin the variety and complexity of play activities. Alsoas we predicted, those children who matched thePRT nonresponder profile failed to show improve-ment. (In fact, for these children treatment wasended after five weeks due to ethical considerationsrelating to continuing an ineffective treatment.) Theresults of this study on communication behaviors arepresented in Figure 2.

Experiment 2These data led us to a new study focusing on the

next logical step in treatment development. Giventhat PRT is not the best treatment option for childrenwith autism, who present with the nonresponder pro-file, what treatment would likely be an effective treat-ment option? In other words, how could we make atreatment nonresponder a treatment responder?Importantly we also hoped to determine whetherour profile was specific to PRT (i.e., not just a pro-file predictive of outcome to any treatment).

(Sherer, M. R., & Schreibman, L. (2005). Individual behavioral profiles and predictors of treatmenteffectiveness for children with autism. Journal of Consulting and Clinical Psychology, 73, 525-538,American Psychological Association, reprinted with permission.)

Table 1.


R E S E A R C H

As we began to enroll children we realized thatthe profile may need to be individualized even fur-ther, as a majority of children we screened did notprecisely fit the profile for all five of the behaviors.Therefore, we wished to see if it was necessary, oreven desirable, to base treatment decisions on theaggregate of all five behaviors in the original profile.To that end, we prospectively enrolled six childrenwho were identified as nonresponders on four out offive of the original profile behaviors. That is, threechildren met the nonresponder profile on all cate-gories except toy contact (i.e., these children had‘high toy contact’), and three children met all cate-gories except avoidance (i.e., these children had ‘lowavoidance’). We provided these children first withPRT treatment to determine the predictability ofthe modified profile for response to PRT, and subse-quently with Discrete Trial Training (DTT) treat-ment to determine if the profile predicted responseto DTT.

Several interesting results came out of this second study (Schreibman, Stahmer, Dufek, &Jennings, 2003).

(1) First, a complete profile match is not necessaryfor the profile to be predictive of outcome.Children in this second study who met a par-tial profile responded at levels that werebetween that of full responders and full nonre-sponders. Additionally, the PRT profile didnot predict responding to the more structuredbehavioral program, DTT, indicating speci-ficity to PRT.

(2) Second, children with high interest in toys per-formed better during PRT than children withless toy interest. The profile is robust in thatthese children did not perform as well as chil-dren who were ‘responders’ in all areas. Thesechildren may take longer to respond to PRT.

(3) Third, lack of avoidance did not appear tohelp children respond to PRT. This group per-formed essentially identically to the nonre-sponders in the original study.

(4) Fourth, one child did respond very well toPRT even though he met the nonrespondercriteria in the initial assessment, therefore theprofile cannot be a replacement for clinical

“A complete profile match is not necessaryfor the profile to be predictive of outcome.”

“Interest in objects may be a key characteristic for responders to PRT.”

Category Mean Percentage of Standard CutoffInterval Occurrence Deviation Ranges

Toy Play 70.8 9.56 61-80

Avoidant 10.0 2.88 7-13

Approach 23.3 8.49 15-32

Nonverbal Stim. 23.3 10.74 13-34

Verbal Stim. 25.0 8.16 17-33

Responders

Category Mean Percentage of Standard CutoffInterval Occurrence Deviation Ranges

Toy Play 27 10.29 17-37

Avoidant 36 10.67 25-47

Approach 17 9.27 8-26

Nonverbal Stim. 32 12.88 19-49

Verbal Stim. 18 4.0 14-22

Nonresponders

Responders Profile Nonresponders Profile

Figure 1. Behavioral profiles of predicted responders and nonresponders to Pivotal Response Training. Numbers represent percentage of 30-sec.intervals in which behavior occurred. Stim. = self-stimulation. (Sherer, M. R., & Schreibman, L. (2005). Individual behavioral profiles and predic-tors of treatment effectiveness for children with autism. Journal of Consulting and Clinical Psychology, 73, 525-538, American PsychologicalAssociation, reprinted with permission.)

judgment but rather should be used a tool toguide treatment options.

(5) Finally, the use of DTT may facilitate laterresponse to PRT for some children. Preliminarydata indicate that for some children, exposureto DTT may improve later response to PRT;

however more research isneeded in this area due toorder effects in the currentstudy.This research furthers the

understanding of the treatmentof autism by refining a detailedprofile to determine a prioriwhether a child will respond toPRT, and by delineating alterna-tive treatments for a subset ofchildren who do not respond tonaturalistic behavioral methods.Continued refinement is need-ed, as well as the development ofmethods which can be used incommunity settings by teachersand other program providers.

We feel this line of researchis fundamentally important forseveral reasons. Obviouslysuch tailoring of treatmentsto individual children holdspromise for increasing theoverall rate of substantialtreatment effectiveness forthese children. Also, given theacknowledged importance ofearly intervention, it is impor-tant that we provide the besttreatment at the outset and notmiss this important develop-mental window. Such researchis also important in that it pro-vides first steps towards thecumulative knowledge thatwill allow us to understandother important variables thatwill lead us closer and closer to

the ultimate goal of full understanding of variablesthat can be incorporated in treatment decisions forthese children.

Laura Schreibman, ProfessorUniversity of California, San DiegoEmail: [email protected]


R E S E A R C H

Figure 2. The percentage of 30-s intervals that contained appropriate communication for responders(Rs; Figure A) and nonresponders (NRs; Figure B) during baseline, treatment, and generalization ses-sions. These data are a summation of data collected across four individual communication behaviorsexhibited by each participant, therefore, they frequently total greater than 100%. Shading indicates 5thweek of treatment and mean appropriate communication. BL = baseline; GS = generalization settings;GT = generalization to novel therapist. Gray shading marks end of 5 weeks of treatment for each group.The break at session 160 for responders represents the follow-up period. Generalization probes were notconducted during early treatment phases. (Sherer, M. R., & Schreibman, L. (2005). Individual behav-ioral profiles and predictors of treatment effectiveness for children with autism. Journal of Consultingand Clinical Psychology, 73, 525-538, American Psychological Association, reprinted with permission.)


R E S E A R C H

Aubyn Stahmer, Research ScientistUniversity of California, San DiegoChildren’s Hospital and Health Center, San DiegoEmail: [email protected]

References• Bondy, A. S., & Frost, L. A. (1994). The picture exchange com-

munication system. Focus on Autistic Behavior, 9(3), 1-19.• Koegel, R. L., Schreibman, L., Good, A., Cerniglia, L.,

Murphy, C., & Koegel, L. K. (1989). How to teach pivotalbehaviors to children with autism: A training manual. SantaBarbara, CA.

• Lovaas, O. I. (1987). Behavioral treatment and normal edu-cational and intellectual functioning in young autistic chil-dren. Journal of Consulting & Clinical Psychology, 55, 3-9.

• National Research Council (2001) Educating children withautism. Committee on Educational Interventions forChildren with Autism. C. Lord & J. P. McGee (Eds.).Division of Behavioral and Social Sciences and Education.Washington, DC: National Academy Press.

• Schreibman, L. (2005). The science and fiction of autism.Cambridge, MA: Harvard University Press.

• Schreibman, L., & Koegel, R. L. (2005). Training for par-ents of children with autism: Pivotal responses, generaliza-tion, and individualization of interventions. In ED Hibbs,& PS Jensen (Eds.) Psychosocial treatments for child andadolescent disorders: Empirically based strategies for clini-cal practice (2nd ed., pp. 605-631). Washington, DC:American Psychological Association.

• Schreibman, L., Stahmer, A. C., Dufek, S., & Jennings, J.(2003). Examining the differential effects of specific behav-iors in a predictive profile for pivotal response training.Paper presented at the Association for Behavior Analysis,San Francisco, CA.

• Sherer, M. R., & Schreibman, L. (2005). Individual behav-ioral profiles and predictors of treatment effectiveness forchildren with autism. Journal of Consulting and ClinicalPsychology, 73, 525-538.

Chris is a nine year old, who currentlyattends California Elementary School in CostaMesa. He first began to show us his flair andinterest in creative drawing on a small whiteboard, during structured playtime. We all encour-aged him to expand his skill, by offering a largerdrawing area, such as the main classroom board.In addition, he utilized computer art programs,that he has learned to master and greatly enjoys.We can always tell when Chris is having a goodtime drawing because this usually quiet boybecomes vocally animated as his pictures. If Chrisdraws Homer Simpson, he will speak in the style ofthat famous character to match.

Among the favorite items that Chris lovesmost to draw are the action heroes from Spidermanand The Incredibles. When it comes to drawingsports, we can always count on Chris to use his tal-ents to show his interpretation of the Angels’ base-ball team. He loves to repeat “Angels’ baseball!”

The drawing on this cover is a favorite activityfor Chris while at school – “to ride the bike fast!”

Sally FloraTeacher – California Elementary SchoolOrange County Department of Education,Special Schools Program

Artist: Chris BarajasBy Sally Flora

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http://verabernard.org

An Overview of ABIDevelopment of an activity-based approach to

early intervention was first initiated in the early1970’s at Peabody College, by Dr. Diane Bricker andher colleagues. The approach was inspired by obser-vations that a didactic approach facilitated skillacquisition, but did not lead to maintaining andgeneralizing desired outcomes. From this initialwork, an Activity-Based Intervention (ABI)approach was born and has over the years evolvedinto a set of carefully detailed procedures, which isused today with young children with and withoutdisabilities. The hallmark of ABI is the use of dailyactivities and transactions to facilitate children’sdevelopmental and/or educational goals. ABI isbased on the theoretical position that children andtheir social environment have a bidirectional rela-tionship where both are significantly influenced bythe other (Sameroff & Chandler, 1975). In addition,the ABI approach has incorporated ideas from thehistorical work of Dewey, Piaget, and Vygotsky, aswell as ideas from more recent writings focused ondevelopmental stages, social learning, and situatedcognitive theory.

ABI is composed of four major elements:

(1) Functional and generative goals(2) Child-directed, routine, and planned activities(3) Timely and integral feedback or

consequences, and (4) Multiple and varied learning opportunities

(Pretti-Frontczak, & Bricker, 2004).

Practitioners may use ABI for goal development,creating individual and group embedding schedulesto identify logistics related to individualizinginstruction/therapy writing activity plans, and devel-oping intervention guides for children. ABI can beused in a variety of settings (e.g., home, day care,preschools) with a variety of children (e.g., those at

risk and with specific disabilities, such as autism).ABI can be used to address content in all majordomains of development.

The following describes how ABI has been usedwith a child with Autism Spectrum Disorders whois receiving early childhood special education ser-vices in a classroom setting. Examples are offered bydescribing interventions designed to address a spe-cific goal.

Description of ABI in a Classroom Serving a Child with Autism

Kevin is a three year old boy, who has been diag-nosed with Autism Spectrum Disorder (ASD). HisIndividualized Education Program (IEP) consists ofgoals that include five developmental areas (i.e.,adaptive, communication, social, fine motor andgross motor). The following functional goal wasselected to illustrate how embedded learning oppor-tunities can be created during classroom routines:

Kevin will use utensils to transfer food andliquid from one container to another.

Three snapshots of Kevin’s day are presented todemonstrate how Kevin’s teacher, Ms. Martinez,incorporates the four elements of ABI into dailyclassroom activities.

Snapshot #1: Outside Free Play focused on a childdirected activity. When the children go outside, Kevingoes to the sandbox and begins to scoop sand withhis hands into the back of a toy dump truck. Ms.Martinez picks up a large spoon and begins to spoon,sand into a bucket and then scoops sand from thebucket to the dump truck. Kevin picks up a spoonand Ms. Martinez supports him by providing hand-over-hand assistance and modeling. Kevin transfersthe material from one container to the other. This isan example of a child directed activity. That is, Kevinchose to play in the sandbox and his teacher followed


R E S E A R C H

An Activity-Based Intervention Approach for Young Children with AutismBy Marisa G. Macy, Helen L. Sharp and Ruby J. Chan


R E S E A R C H

his lead and provided an embedded learning oppor-tunity to practice his target goal by modeling forKevin how to use the spoon to scoop the sand fromthe bucket to the dump truck.

Snapshot #2: Snack focused on a routine activity.Ms. Martinez sets out applesauce for snack time.Rather than putting applesauce into bowls for thechildren, the teacher asks Kevin to do it. The teacherplaces a serving bowl of applesauce in front of Kevinand puts a serving spoon into his hand and says“scoop.” Kevin scoops applesauce from the servingbowl to each child’s individual bowl. Snack time isan example of a routine activity that occurs dailyduring the program. Embedded into the activity wasthe opportunity to work on Kevin’s goal by scoopingthe applesauce from the serving bowl to the otherchildren’s bowls.

Snapshot #3: Circle Time focused on a plannedactivity. In the middle of the circle area Ms. Martinezhas a water wheel in a tub with a bucket of waternext to it. Kevin and the other children take turnsusing a small pitcher to scoop water from the buck-et to pour onto the water wheel. This is an example

of a planned activity because the teacher specificallyplanned the time, place, and actions for the waterwheel activity. Kevin was provided the opportunityto address his goal by using the water pitcher totransfer liquid from the bucket to the water wheel.

The snapshots show how the four elements ofABI were incorporated into Kevin’s daily classroomroutines. First, a functional and generative adaptive

goal was selected, whichinvolved Kevin usingobjects to transfer foodand liquid from onecontainer to another.Second, child directed,routine, and plannedactivities were designedfor Kevin and his class-mates. Third, timelyintegral feedback andconsequences providedimmediate outcomes ofKevin’s actions duringthe activities. Fourth,Ms. Martinez providedmultiple and varied

Learning is embeddedduring play and routine activity.

(i.e., sandbox, snack and circle time) learning oppor-tunities throughout the day to address Kevin’s goals.

Research on ABI for Children with AutismAs noted, the ABI approach has been described

in detail elsewhere (Pretti-Frontczak, & Bricker,2004), and journal articles have addressed the com-ponents of ABI (Apache & Goyakla, 2005; Block &Davis, 1996; Grisham-Brown, Schuster, Hemmeter,& Collins, 2001; Johnson, McDonnell, Holzwarth,& Hunter, 2004; Losardo & Bricker, 1994). Whilethere is extensive research focused on ABI or embed-ded learning opportunities (Pretti-Frontczak, Barr,Macy & Carter, 2003), literature on the use of ABIwith ASD is limited (Schwartz, Billingsley, &McBride, 1998). Consequently, more research inthis area would be useful to explore the benefit ofusing naturalistic approaches in children with ASD.

Future directions for research could focus on atleast three areas:

(1) It would be useful to explore how childrenwith ASD acquire, maintain, and generalizeskills when ABI is used as the primaryapproach. Many professionals who work withyoung children with ASD blend ABI withother approaches and strategies.

(2) A second and complementary line of researchmight examine the effectiveness of ABI in con-junction with other intervention approaches(e.g., both didactic and naturalistic).

(3) A third line of research should address issues ofprofessional development, such as traininginservice and preservice teachers to use ABIwith children with ASD.

An increase in research on the use of ABI with chil-dren with ASD will not only help inform early child-hood practices (Bredekamp & Copple, 1997; Sandall,Hemmeter, Smith, & McLean, 2005), but will help toadvance intervention approaches thereby improvingoutcomes for children with ASD and their families.

Marisa G. Macy, Ph.D.College of EducationUniversity of OregonEmail: [email protected]

Helen L. Sharp, M.A.T.Email: [email protected]

Ruby J. Chan, B.A./B.S.Email: [email protected]

References• Apache, R. R. Goyakla (2005). Activity-Based Intervention

in motor skill development. Perceptual & Motor Skills,100(3), 1011-1020.

• Block, M. E., & Davis, T. (1996). An activity-based approachto physical education for preschool children with disabilities.Adapted Physical Activity Quarterly, 13, 230-246.

• Bredekamp, S., & Copple, C. (Eds.) (1997). Developmen-tally appropriate practice in early childhood programs (Rev.ed.). Washington, DC: National Association for theEducation of Young Children.

• Grisham-Brown, J., Schuster, J. W., Hemmeter, M. L., &Collins, B. C. (2001). Using an embedding strategy toteach preschoolers with significant disabilities. Journal ofBehavioral Education, 10, 139-162.

• Johnson, J. W., McDonnell, J., Holzwarth, V. N., &Hunter, K. (2004). The efficacy of embedded instructionfor students with developmental disabilities enrolled ingeneral education classes. Journal of Positive BehaviorInterventions, 6(4), 214-227.

• Losardo, A., & Bricker, D. D. (1994). Activity-BasedIntervention and direct instruction: A comparison study.American Journal on Mental Retardation, 98, 744-765.

• Pretti-Frontczak, K., & Bricker, D. (2004). An activity-basedapproach to early intervention (3rd ed.). Baltimore: Brookes.

• Pretti-Frontczak, K. L., Barr, D. M., Macy, M., & Carter,A. (2003). Research and resources related to activity-basedintervention, embedded learning opportunities, and rou-tines-based instruction: An annotated bibliography. Topicsin Early Childhood Special Education, 23, 29-39.

• Sameroff, A. J., & Chandler, M. J. (1975). Reproductive riskand the continuum of caretaking casualty. In F. D.Horowitz, E. M. Hetherington, S. Scarr-Salapatek, & G. M.Siegel (Eds.), Review of Child Development Research (Vol. 4,pp. 187-244). Chicago: University of Chicago Press.

• Sandall, S., Hemmeter, M. L., Smith, B. J., & McLean, M. E.(Eds.) (2005). DEC recommended practices: A comprehensiveguide for practical application in early intervention/early child-hood special education. Longmont: Sopris West.

• Schwartz, I. S., Billingsley, F. F., & McBride, B. M. (1998).Including children with autism in inclusive preschools:Strategies that work. Young Exceptional Children, 1(2), 19-26.

AcknowledgmentsWe would like to thank Diane Bricker, Jane

Squires, and Florien Duerloo for their valuable contri-butions to this article.


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TEACCH workshops have been offered through-out the U.S. and abroad for many years. Training inOrange County has been made possible through theefforts of the S.U.C.S.E.S.S. Project and most recently, the Southern California Autism TrainingCollaborative. TEACCH methods have been consid-ered among the ‘Best Practice’ Interventions for indi-viduals with Autism Spectrum Disorder.

A little historyAlmost 40 years ago the

University of North Carolinawas awarded a federal grant tostudy children with autism.Six years later, state legislationcreated Division TEACCH tocontinue and expand the ser-vices and research provided inthe grant. TEACCH was man-dated to provide statewideservices to children withautism and their families;money was allocated to establish a center and aclassroom in the three geographic regions of thestate. In 1972, federal legislation required schoolsto provide education to all children, but there wasvirtually no information on how to teach childrenwith autism. The question at that time was not“how to teach children with autism”(as it is now), but “can children withautism learn in a classroom?”

In expanding the availability of ser-vices to individuals with autism,TEACCH also engaged in research tostudy how children with autism learn.As a statewide agency, informationgained from one center or one class-room was shared with others in thestate, allowing information, skills, andstrategies to be tried and tested across alarge population. Most people withautism have no inhibitions about let-

ting others know what they like and don’t like, andclinicians and teachers across the state were quick toadopt strategies that worked.

Annual training workshops facilitated a sharing ofknowledge for new employees ofTEACCH. At that time, therewas little information about thelearning style of autism, and thistraining was invaluable. As thenumbers of classrooms and clin-ics within the state grew, theknowledge base expanded rapid-ly. As early as the mid-to-late 70’sschool systems in other stateswere requesting the opportunityto attend the summer training.

Currently, Division TEACCHoffers a variety of workshops, from intensive four orfive day CORE to two, three or four day trainings.In-state seminars are listed on the TEACCH website(www.teacch.com). In addition, TEACCH is invitedto train in many other states and countries.

E D U C AT I O N / T H E R A P Y

TEACCHing TeachersBy Galene Fraley and Andrea Walker

Effective components of the TEACCH program:

• Funding support • Connection to applied research• Collaboration of various centers• Adaptation of the environment to individuals• Matching interventions to learning style

Some Challenges in Teaching

• Individuals with autismare less likely to let socialexpectations shape theirbehaviors.

• It is often difficult to findmeaningful reinforcers.

• Persons with ASD are lesslikely to ask for help.

• The world around them is often confusing, andtalking about problems seldom works.

Some Solutions

• Provide visual supports to clarifyexpectations.

• Determine a varietyof functional reinforcers.

• Organize the physical environment.

• Offer visual communication systems.

Dr. Steve Love provides feedback to participants.



Scope and Focus of trainingFrom the beginning, TEACCH based its approach

to autism on the behavioral sciences (beginning withconducting a comprehensive assessment, definingappropriate goals and objectives, identifying and usingreinforcers, and taking data). These strategies werevery helpful, but some students continued to displaybehaviors that interfered with learning and that weresometimes harmful to themselves and others.

When TEACCH goes to an out-of-state site fora Core (hands-on) training, local staff is asked toselect five students, of varying ages and abilities, toattend a “classroom” each day of the training. This isnot a model classroom, but rather one that isdesigned to demonstrate the basic componentsimportant to students with autism. The students arechosen carefully, selecting those who can tolerate anovel situation with 30 to 35 adults who will be inand out the room. TEACCH and local staff puttogether a demonstration classroom, beginning withphysical organization individualized for the five stu-dents. Each child’s unique needs are considered,using furniture to provide clear visual boundaries andto minimize auditory and visual distractions.Additional areas provided in a demonstration class-room are leisure/play, staff tables, independent work,transition, and eating areas.

Once the physical organization is in place, staffbegins to develop additional strategies, again indi-vidualizing for each student. Each student has aschedule, designed to visually let him know where

he is to be, whathe will be doing,and the sequenceof the events ofthe day. Somestudents beginwith only onepiece of infor-mation at a time,while others have

the entire day on their schedule. Some schedules uti-lize concrete symbols or objects; others use picturesor written words.

The next strategy developed is the work system,designed to let each student know visually what workam I going to do?, how much work am I going to do?,how will I know when I am finished?, and what do I donext? Again, this is individualized, with some stu-dents using a left to right system (based on our left-to-right society): activities to be done are placed onthe left of the student and finished activities onplaced on the right. Some students may use a match-ing work system, while others may use an assignmentlist like those given in a regular ed classroom but withthe addition of the answer to what do I do next.

Visual organization of activities and assignmentscapitalizes on students’ attention to visual information.To eliminate the need to organize materials (difficultfor many students with autism), activities may be self-contained, with materials organized to visually indicatewhat to do. Minimizing the amount of materials,placing materials in containers one by one instead ofall together, and using materials that are self-explanato-ry are strategies that help many children. Because stu-dents with autism often don’t discriminate betweenrelevant and irrelevant information, teachers mayhighlight the important information.

Other visual strategies that may be demon-strated during a Core training are communicationsystems, Social Stories and Cartoon Conversations(from Carol Gray’s work), emotional thermometers(Tony Attwood), and other Best Practice interventionsfrom other recognized experts in the field.

Each day of the training has a specific focus, includ-ing an introduction to the characteristics of autism;

A complicated assembly task is made clear.

Tasks are developed to address students’ needs.



family issues and perspectives; assessment issues; com-munication; behavior strategies; developing goals; andthe implementation of teaching activities.

The day begins with a lecture, followed by obser-vations in the demonstration classroom, student assess-ment on the focus topic of the day, andgroup activities to design, create, andteach a task. Participants are placed in agroup, with each group member havinga specific role that changes every day.They stay with one student for a day,led and supported by that student’steacher/trainer. The day ends withsmall and large groups, to discuss the challenges andsuccesses of the day and address any additional topics.

This training is designed to be practical and toaddress specific educational and behavioral needs ofstudents with autism. With activities based on the-ory and practice, participants leave with ideas thatcan be implemented immediately. Not a cookbookof activities, this training sends participants back totheir jobs with new questions to ask, options to try,and strategies to consider as they address the needsof their often puzzling and challenging students.

TEACCH and the Southern California AutismTraining Collaborative (SCATC)

SCATC is a collaborative of educators who areinterested in coordinating autism-training opportuni-ties in Southern California. The group’s goal is toprovide equitable access to high demand, nationaltraining programs on the topic of autism. Additionalgoals include gathering and disseminating informa-tion regarding teacher competencies, the use of

Evidence-Based Interventions and ‘Best Practices’ inour educational service delivery models, accountabil-ity systems, and collaboration with local institutes ofhigher learning. The SCATC addresses the needs ofschool districts as far north as San Luis Obispo, Kern,and Mono Counties, and as far south as San Diegoand Imperial Counties, and everything in between.

Since 2000, SCATC and Division TEACCHhave organized several opportunities for training.These range from one-day presentations to a four-day“hands-on” type session, like the CORE training.

Most recently, the Fountain Valley SchoolDistrict, at Newland Elementary School, in conjunc-tion with SCATC, hosted a local TEACCH training.The participants came from all over SouthernCalifornia. The training staff consisted of Steve Love

and Galene Fraley (Asheville, NorthCarolina, TEACCH Center), alongwith three local TEACCH trainers,Stefanie Chiljian (Saddleback ValleyUSD), Kim Doyle (Ocean ViewSD), and Analee Kredel (OrangeCounty Department of Education).Local support continues through the

S.U.C.S.E.S.S. Project and within local school districts.

One highlight of the training was the talk by for-mer student participant, Greg Tamkoc, who did anoutstanding job assisting the organizers. He sharedhis post high school plans and his perspectives onautism. Greg gave the participants some suggestionsfor making this a successful experience for everyone.“... ask lots of questions and have fun with the kids.”He has contributed an article for Autism News ofOrange County (October 2004 issue).

Galene FraleyPsychoeducation Specialist, Asheville, TEACCH Center, North CarolinaEmail: [email protected]

Andrea WalkerS.U.C.S.E.S.S. Project Coordinator,Orange County Department of EducationEmail: [email protected]

Greg was interviewed by Andrea.

Individual and group schedules help to know what comesnext in class, music or P.E. sessions.



Andrea Walker’s comments:

Within our educational programs, we deal witha wide array of student needs during their tenurewith us – from early intervention to the rigorousdemands of secondary programs. As teachers, we arechallenged with requests for competing, and occa-sionally, incompatible methodologies, and a cadre ofoptions to consider. There are many “camps” in thefield of Autism. There are brand names, differentprofessional orientations with long lists of buzz-words, lack of continuity and new developments onthe horizon. Education, for all students, is changingand to do it well – a challenge.

Yet while brainstorming “what is good teachingfor our students with ASD?” we must think critical-ly and rely on what we know as special educationteachers and therapists. One of my SCATCcolleagues, Leslie Fagan, drafted the above list as away to evaluate... no brand names, no conflict ofinterest... just what the focus needs to be when providing effective instruction.

Effective Instruction? If it’s GOOD, it...

• respects the neurology of autism

• is structured

• is developmental and hierarchical

• is individualized (based on data)

• facilitates independence

• builds “internal” competence motivation

• transitions across contexts (is generalized)

• includes practice of learned skills

• provides positive behavioral supports

• maintains active engagement

• promotes social interactions

Leslie Fagan – District Program SpecialistABC Unified School District – Cerritos, CAFounding member of SCATC & Co-Chairperson

The National Standards Project of the National Autism Center

On March 21, 2006, Regional Center of OrangeCounty invited Dennis Russo, Ph.D., ABPP andEthan Long, Ph.D., BCBA to present informationabout The National Standards Project of the NationalAutism Center. Dr. Russo is the Clinical Director ofthe National Autism Center and Chief ClinicalDirector of The May Institute in Randolph,Massachusetts. Dr. Long is the Executive Director ofThe Bay School in Santa Cruz, California

As the number of individuals diagnosed with autismhas increased, the search for successful treatments hasintensified. The options are abundant, but the choicesare often unclear. Families, practitioners, and other deci-sion-makers are in urgent need of reliable tools to helpthem distinguish between experimental or anecdotaltreatment approaches and those approaches that havebeen proven effective and are backed by scientificresearch. As reported by Drs. Russo and Long, TheNational Standards Project has brought together someof leading experts in autism treatment with the goal ofevaluating treatment literature and assessing best practicesfor the treatment of individuals (birth through 22 years)on the autism spectrum. This panel is currently workingtogether to establish and ratify the set of standards. Theiraim is “to create an evidence-based practice guideline forautism intervention (in the areas of educational practicesand procedures, and treatment intervention).” Once thestandards have been approved, the panel will present andwidely disseminate them, providing guidance resource tohelp families, practitioners, policy-makers, and fundingagencies make informed decisions and choose evidence-based treatments. While many approaches to the treat-ment of autism are currently available, all may not beequally beneficial in helping individuals with autism.

To learn more about the National Autism Centerand the National Standards Project, go to www.nation-alautismcenter.org.

To receive information about future workshopsoffered by Regional Center of Orange County, emailKaren Schaeffer at [email protected] with yourname and mailing address.



Narrative DevelopmentSimply put, a narrative is a story. Children’s early

narratives involve relating past experiences and retellingstories. Researchers tell us that children usually beginto construct simple narratives at age two (Fivush,1994). The earliest narratives are often just one or twowords to tell someone about something that is not pre-sent. For example, a toddler who was excited abouthaving had an encounter with a friendly dog while tak-ing a walk with Mom might, upon returning home toDad, smile and say “doggie.”

Between the ages of two and five, children’s narra-tives progress from simple phrases about past events tomore elaborate personal stories (like what happened atschool) to episodes from familiar children’s books, andon to creating stories of their own.

Importance of Narrative SkillsNarratives are what we use to understand, remem-

ber and recount experience. As children progressthrough the preschool years, narratives play a key role inhow they learn about themselves and others. The impor-tance of narrative skills for school success has beenreported in the research literature. Bishop andEdmundson (1987), in a prospective, longitudinal studyof language-impaired children, found that the best pre-dictor of a positive outcome during the elementaryschool years was a preschooler’s ability to retell a simplestory while viewing the pictures from the story. Others

who have documentedthe importance of oralnarrative skills for socialand school successinclude McCabe andRollins (1994) andWestby (1991).

For preschool children and early readers, under-standing and retelling familiar stories are abilities whichlead to later text comprehension. These abilities areamong a group of skills that are referred to as emergentliteracy. They lay the foundation for school literacy astext comprehension has been identified by the NationalReading Panel in Put Reading First (2000) as one of thefive building blocks of reading.

Narrative Development and AutismChildren with autism have particular problems

learning to tell stories. The extent and nature of theirnarrative difficulties vary according to the levels of theircognitive and language skills. Problems learning to tellstories can stem from general difficulties with languagelearning related to morphosyntax, vocabulary knowledge,word-finding, language comprehension and/or orga-nizing thoughts into words.

Common to many children with autism is the dis-inclination to verbally share their experiences and tooffer narratives to others spontaneously (Capps, Kehres,& Sigman, 1998). They may tell stories, which containunusual and irrelevant comments, or may be obliviousto the needs of their listeners. For example, they mayprovide information the listener already has or theymight fail to relate enough critical or specific informa-tion for the listener to follow what is being said.

Even high-functioning children with autism gener-ally have difficulty with the abstract aspects of lan-guage. They have trouble making inferences or “read-ing between the lines”. They also tend to take languagevery literally which can lead to misinterpretation of fig-urative language such as idioms.

Many children with autism have excellent memo-ries for rote information. However, even though theymay be able to remember and recite the lines of a storyverbatim, they often have difficulty telling a summaryof the story which “captures” it adequately.

Evidence-Based Practice - Narrative Intervention The research on narrative skill intervention has

demonstrated that directly teaching narrative skillsresults in improved comprehension and production oforal narratives and improved reading comprehension

Teaching Narrative Skills to Children with AutismBy Lauren Franke and Christine Durbin

“...the best predictorof a positive outcome

was a preschooler’sability to retell a

simple story whileviewing the pictures...”



(Hayward & Schneider, 2000; Klecan-Aker, 1993;Swanson & Fey, 2003). To date, most narrative inter-vention research has focused on the acquisition of storygrammar as it is widely believed that if children knowthe underlying framework for stories, they will demon-strate better comprehension and production of stories.The basic components of story grammar include thesetting, problem, and outcome.

Teaching story grammar has been shown to beeffective with children with language impairment(Hayward & Schneider, 2000) and youngsters withPervasive Developmental Disorder (Klecan-Aker &Gill, 2005), but there are some young children withautism who are not yet ready to benefit from narrativeinstruction based on story grammar. The concepts ofstory grammar might be too complex for them tograsp. Popular children’s story plots are often difficultif they have not had comparable experiences. Complexsentences and abstract vocabulary can pose difficulties.These children may not yet be producing the sentencepatterns that are needed to tell stories or they mightnot have developed the ability to refer to prior eventsusing past tense language. Some childrens’ languagemay lack organization and contain irrelevant informa-tion. As narrative skills play such an important role inchildhood development, we should not wait until thesechildren are able to comprehend story grammar beforebeginning narrative intervention. One alternative nar-rative intervention approach, which has been devel-oped at the Scottish Rite Clinic in Long Beach and theChild Development Center at California PacificMedical Center in San Francisco, Story LessonIntervention, has been found to be effective with thispopulation of children.

Story Lesson Intervention Story Lesson Intervention combines principles from

Narrative-Based Language Intervention (Swanson, L.A., Fay, M. E., et al., 2005) and Contextualized Skill

Intervention (Ukrainetz, 2005). Naturalistic activities,such as story sharing, are combined with skill-basedmethods like the use of verb tense forms or pronouns.The goal of Story Lesson Intervention is to help chil-dren develop skills for generating narratives while at thesame time developing crucial underlying language skills.

In a typical Story Lesson, the child is helped tounderstand and retell a specially designed “elaboratedstory”. Grammatical forms, vocabulary and pragmaticskills specified in the child’s language therapy goals areincorporated into the stories and side lessons. Sidelessons are short breaks from the story to provideintensive practice of a particular skill or a vocabularyneeded to retell the story.

During Story Lesson Intervention, children firstlearn to tell personal narratives and retell simple storieswith two to four pictures. They then retell longer sto-ries that resemble children’s literature but have textwhich has been “elaborated”. Finally, children retell sto-ries from children’s books which have unrevised texts.

Prerequisite SkillsPrerequisite skills for this intervention include

being able to: 1) understand and use a variety of nounsand verbs in simple sentences, 2) follow simple direc-tions, 3) answer basic wh-question forms such as who,what and what...doing, and 4) identify and nameobjects and actions when looking at pictures in books.

Elaborated StoriesThe “elaborated stories” in Story Lesson Intervention

incorporate characteristics of parent-child conversa-tions, which have been shown to facilitate memoriesand story telling skills in children. Haden andOrnstein (2003) reported that children with lowlevel language skills improved in their ability torecount past events in response to their mothers’ useof “highly elaborative language” in conversations withtheir children.

The primary goal of elaborated stories is to makenarratives available to and manageable for studentswith language learning problems. False stories aredevelopmentally appropriate, based on events or rou-tines the child is familiar with, and easy to understand.They provide a context for learning new vocabulary.Elaborated stories contain simple sentence patternsthat increase in complexity as the child’s understandingand production of language improve. To reduce the



cognitive complexity of the stories, Blank, McKirdy,and Payne, authors of Teaching Tales (1997), suggestthat the time span of stories be short. Pictures for elab-orated stories are clear and uncluttered with details thatare irrelevant to the story.

Since stories like this are difficult to find, we havewritten our own stories for 2-, 3-, and 4-picture sequences,which are similar to the model presented in Teaching Tales(Blank, McKirdy and Payne, 1997). Following are guide-lines for writing scaffolded stories of your own.

Story Writing Guidelines Compose developmentally appropriate stories that

contain concepts the child understands or that can betaught using pictures, toys and other manipulatives.

• Use explicit language that reduces the need for“reading between the lines” and offers the back-ground information needed to build under-standing of the story events and vocabulary.

• Use sentence patterns at slightly above thechild’s developmental level.

• Write three to six sentences per picture.

• Intermix these types of stories:

° Event Stories are stories that simply describean event without referring to characters’mental states.

° “Understanding Others” Stories have refer-ences to characters’ mental states such astheir intentions and wishes.

° Personal Narratives are about the child’s ownexperiences.

• Write syntactically easier or more advancedstories depending on the child’s level.

Story PicturesPictures for stories can come from a variety of

sources. Digital photos of the child participating in anactivity can be the starting place for personal narra-tives. You may choose to draw your own pictures.There are also a variety of sequence picture sets avail-able for purchase.

SAMPLE STORIES

• Event Story

Unelaborated Story:A dad and a boy aregoing to wash the car.

They are washing the car. Now they are washingthe windows.

The car is clean.

Elaborated Story:A dad and a boy have ahose and a bucket.Their car is dirty.And they want to washthe car.They are going to dothat.

The dad has the hose.Water is coming out ofthe hose.The boy has a sponge.The boy and his dad canclean the car with waterand a sponge.

They finished cleaningthe outside of the car.Now the boy and his dadcan wash the inside.Soon the car will be allclean.

The boy and his dadwere cleaning the car.Now they are done.The car is all clean.



Conducting a Story Lesson Step 1 – Listening: The adult places one picture at

a time in front of the child and reads three to six sen-tences related to it. When the sentences for a pictureare completed, the adult turns that picture face downand goes on to the next picture. During this step thechild just listens to the story.

Step 2 – Imitation: The adult repeats Step 1, butthis time the child imitates each sentence if he or she isworking on expanding or strengthening syntactic pat-terns. If the child imitates incorrectly, the sentence isrepeated and the child is asked to imitate it again untilhe or she is able to produce it correctly.

Step 3 – Shared Retelling: The child is asked to tellthe story with the adult. The pictures are left facedown on the table. The adult retells the story, pausesbefore key words, and encourages the child to fill-in-the-blank or finish the sentence. Step 3 is repeated sev-

eral times as needed to help the child with recallingstory information.

Step 4 – Independent Retelling: The child is askedto retell the story on his or her own. The picturesremain face down on the table.

If the retelling is adequate (see Criteria forAcceptable Story Retelling below), the child is finishedwith the story. If the retelling does not meet criteria, thefollowing prompts are offered to facilitate the child’sproduction of an acceptable summary of the story.

Prompts1. Visual Scaffolds: For children, who are readers,

the printed text of the story can be presented as a visu-al support while the story is repeated by the adult;alternatively, stickwriting (Ukrainetz, 1998) can beused. Stickwriting involves drawing sketches with sim-ple stick figures as a means to provide a visual reminder

Easier Syntax:Here is a cat.There is some milk.The cat is looking at the milk.The cat wants some milk.

More Advanced Syntax:Here is a cat next to some milk on the floor.The cat is looking at the milk.The cat is thinking it wants some milk.

Easier Syntax:The cat walked over to the milk.It is drinking some milk.The cat likes the milk.

More Advanced Syntax:The cat walked over to the milk.Now the cat can drink some milk.The cat likes the milk.It will drink all of the milk.

I went to the races with my family. Number 3 won. Then we had French fries.

• “Understanding Others” Story

• Personal Narrative



of the story content and sequence. After the story isretold with visual support, the child is again asked totell the story independently. If the retelling is still notadequate, the adult moves on to Prompt 2.

2. Modeling Two Summaries: The adult offerstwo slightly different examples of succinct, past tensesummaries of the story. Visual support can be provid-ed by presenting print versions of the summaries or bystickwriting while the sample summaries are read bythe adult. After the two summaries are modeled, thechild is again asked to tell the story independently. Ifthe retelling is not adequate, Prompt 3 is presented.

3. Modeling One Summary: Prompt 2 is repeat-ed, however this time only one succinct summary ismodeled for the child. If the child is still not able toproduce an adequate independent retelling of the story,the adult repeats the story and asks the child to imitateit in manageable segments.

Case exampleOne five year old autistic boy, named Bobby, was read

the scaffolded version of the car washing story (sample storiessection above). Since Bobby’s syntax skills were weak, he wasasked to repeat each story sentence. When he had some dif-ficulty imitating some of the longer sentences, a procedurecalled “chunking” was utilized. Chunking involves havingthe child first imitate sentence segments and then buildtoward imitation of the complete sentence. One sentencefrom the car washing story was chunked in this manner:“The boy and his dad – were washing – the car.” Bobby firstimitated each segment separately, then the first two segmentstogether, and finally the full sentence.

Bobby’s first retelling of the story did not meet criteriafor an acceptable story retelling. However, after viewingthe story in stickwriting format and retelling the story fivemore times with prompts offered as needed, Bobby proud-ly produced the following independent retelling:

“The dad and his son were washing the car. They used a sponge and a hose and they got the car clean.”

Progression in Story Lesson InterventionIn Story Lesson Intervention we begin with personal

narratives and 2-picture stories. As these are mastered wemove on to 3- and 4-picture stories. When children mas-ter retelling 4-picture stories independently, slightly longerstories that are more like children’s literature are practiced.

A computerized narrative intervention programcalled “Timo Stories - Launching Literacy” was devel-oped for use at this stage of intervention. Here, sixelaborated six-picture stories, comprehension questions,story picture sequencing activities and six vocabularytasks center around ten vocabulary words from eachstory. The vocabulary activities range in level of cogni-tive difficulty and include object name recognition,comprehension of adjective-noun phrases, word associ-ations, categorization, comprehension of negative state-ments and verbal reasoning. This level provides a bridgefor moving to longer, unelaborated stories in children’sbooks and videos. During the final level of Story Lesson

Visual ScaffoldsShow the written story text or use stickwriting toprovide visual support as needed. The visual sup-port is removed for the final retelling of the story.

MasteryPractice continues until the child can give an ade-quate summary without prompts or visual support!



Intervention, children enter the stage of emergent liter-acy, retelling familiar story books.

To learn more about Story Lesson Intervention,attend a “Coaching Comprehension and CreatingConversation” seminar taught by Lauren Frankethrough the Orange County Department of Education.For information about this seminar, contact AndreaWalker at (714) 966-4198.

Lauren Franke, Psy.D., CCC/SPScottish Rite Clinic, Long Beach, [email protected]

Christine Durbin, MA, SLPCalifornia Pacific Medical [email protected]

References • Blank, M., McKirdy, L., & Payne, P. 1997. Teaching Tales.

HELP Associates. www.linkstolanguage.com.• Boland, A. M., Haden, C. A., & Ornstein, P. A. (2003).

Boosting children’s memory by training mothers in the useof an elaborative conversational style as an event unfolds.Journal of Cognition and Development, 4 (1), 39-65.

• Capps, L., Kehres, J., & Sigman, M. (1998). Conversationalabilities among children with autism and developmental

delay, Autism, 2, 325-344.• Fivush, R. (1994). Constructing Narrative, Emotion, and

Self in Parent-Child Conversations about the Past. In U.Neisser & R. Fivush (Eds.), The Remembering Self:Construction and Accuracy in the Self-Narrative. Cambridge:Cambridge University Press.

• Hayward, D. and P. Schnieder (2000). “Effectiveness ofteaching story grammar knowledge to pre-school childrenwith language impairment. An exploratory study”. ChildLanguage Teaching and Therapy, 255-284 (30).

• Klecan-Aker & Gill (2005). Teaching language organiza-tion to a child with pervasive developmental disorder: a casestudy. Child Language Teaching and Therapy, Vol. 21, 60-74.

• Swanson, L. A., (M. E.) Fey, M. E., et al. (2005). “Use ofnarrative-based language intervention with children whohave specific language impairment.” American Journal ofSpeech Language Pathology 14(2): 131-43.

• Stein, N. L., & Glenn, C. G. (1979). An analysis of story com-prehension in elementary school children. In R. O. Freedle(Ed.), New directions in discourse processing: Vol. 2. Advancesin discourse processing (pp. 53-120). Norwood, NJ: Ablex.

• Timo Stories: Launching Literacy. www.animatedspeech.com• Ukrainetz, T. A. (1998). Stickwriting stories: A quick and

easy narrative notation strategy. Language, Speech, andHearing Services in the Schools, 29, 197-207.

• Ukrainetz, T. A. (2005) Contextualized language interven-tion. Thinking Publications.

Good Idea Corner H I G H L I G H T

Task of the Month

Task Galore produces a series of “How to” bookswith creative photo material based on the TEACCHtradition. Monthly tasks such as the above are sharedunder http://www.tasksgalore.com/Task_of_the_Month_May06.htm.

This task shows the beginning steps of literacydevelopment, one of which is learning letters andwords, how these letters are sequenced and that theycome together to create words. Students may beginspelling words by matching the letters. As the studentbegins to demonstrate confidence in the task, letterprompts can be removed until the words are correctlyspelled independently.

Good idea spotted in the Interagency Assessment Center, Orange County...

Taping a train track on the floor in front of theclassroom exit helped a young fan of Thomas theTank to wait patiently while lining up with his peersfor outside play.



IntroductionPrevalence rates for autism spectrum disorders

(ASD) have increased significantly over the last sever-al decades. The Center for Disease Control (CDC)found prevalence rates for ASD to be between 1 and3 per 500 individuals. Although individuals withASD vary in their severity of symptoms and co-exist-ing features, common to this disorder are impairmentsin social interaction, communication, and restrictedpatterns of behavior. Presently, there is no cure forautism, however, experts agree that family-based earlyintervention services are imperative for young childrenwith autism (Koegel & LaZebnik, 2004).

In structured educational environments all chil-dren will hopefully learn how to sit and attend,remain on task during “teaching”, process what theyperceive, and understand cause and effect. For manykinds of learning, children naturally and spontaneous-ly imitate behaviors of adults and peers in their envi-ronment. However, imitation is often a difficult taskfor many children with autism. The NationalResearch Council (2001) lists deficits in the ability toimitate as a one of the main characteristics that differ-entiates autism from other developmental disorders inthe 20-month to 36-month age range. It has been the-orized that imitation is difficult for children withautism because of impairments in social interaction.

One potential solution for teaching new behav-iors to students with autism while reducing the stressof social interaction and proximity is video modeling.The video modeling paradigm requires a child towatch a videotape of a person performing a targetbehavior and subsequently, to imitate the behavior.Haring, Kennedy, Adams, and Pitts-Conway (1987)demonstrated the usefulness of using video modelingto teach young adults with autism community pur-chasing skills. Charlop-Christy, Le, and Freeman(2000) reported the efficacy of video modeling overin vivo (live) modeling for teaching developmentalskills to children with autism. Despite the effective-

ness of video model-ing in older individu-als, less attention hasbeen paid to the use ofthis technique for veryyoung children with autism.

The purpose of this paper is to describe the effi-cacy of video modeling for teaching imitation behav-iors to a young boy with autism. Hayden, the par-ticipant chosen for the video modeling program,demonstrated difficulties acquiring imitative behav-iors using traditional live modeling methods. Inaddition, parents reported that he met criteria forvideo modeling in that he usually watched at least30-60 minutes of television or videos per day(Charlop-Christy, et. al. 2000).

The ParticipantHayden was 26-months old when he began

attending the North Orange County InteragencyAssessment Center (NOC-IAC). He appearedunaware of what other children and staff around himwere doing and he rarely imitated adults or peersduring the school day. Hayden’s cognitive develop-ment on the Bayley Scales of Infant Development IIwas estimated at 22-months. Performance on lan-guage-based tasks was significantly less developed; hedid not receptively identify or expressively labelfamiliar objects, and primarily communicated hiswants and needs using body language and limitedgestures (i.e., hand leading).

Traditional Live ModelingNonverbal imitation was chosen as a goal to help

Hayden build an awareness of the environment, aswell as establish and maintain attention. Three play-based behaviors were initially targeted for imitation:shaking a maraca, rolling a toy car, and banging adrum. Live modeling instruction consisted of staffdemonstrating an action (i.e., rolling a toy car), say-ing, “do this,” and then providing the student withthe appropriate materials.

A Video Modeling Program for Teaching a Young Child with Autism By Tamara Fortney

Hayden imitated rolling a car after seeing a peer on thevideo model it.



Each behavior was presented three times to provideHayden with multiple trials for each request. It mustbe noted that although Hayden appeared to enjoyopen-ended activities, transitioning to the work area forstructured activities was difficult. He frequently threwhimself on the floor and attempted to scatter workmaterials or throw objects. Because of Hayden’s occa-sional success and the importance of learning to imitateothers, we persisted in using live modeling for 31 ses-sions. When it was determined that Hayden was onlytolerating 8-10 trials per session, the decision was madeto plan and implement a video modeling program.

Video ModelingA peer male model (age 3-years, 10-months) was

selected to perform play-based behaviors while seatedin front of a digital video camera. Tasks preformedincluded the original behaviors presented in live mod-eling and nine additional behaviors (banging a toyhammer, spinning a top, putting a toy phone to ear,pretending to drink from a cup, feeding a toy baby,blowing into a harmonica, clapping hands, stompingfeet, and waving goodbye). The video was initiallyedited using a television/VCR and a digital videocamera. Each behavior was edited three times onto avideotape to provide multiple trials for each request.

Video modeling involved Hayden sitting at aworktable with a 9-inch television approximately threefeet in front of him. While watching the video model

perform a target behavior, staff handedHayden the appropriate materials and said,“Do the same.”

After informal testing of Hayden’sresponses to video modeling, it was decidedthat in addition to the original three behav-iors presented with live modeling proce-dures, the nine behaviors formerly men-tioned would be targeted. Formal data col-lection began for video modeling at the onsetof the program.

Experimental Data Design and Collection

A total of four experimental phases werereported. As noted previously, 31 sessions ofdata were collected during the initial livemodeling procedure (Phase I). This was fol-lowed by 19 sessions of the video modelingapproach just described (Phase II). A returnto live modeling procedures was implement-ed for 16 sessions (Phase III). Finally, 17 ses-sions of data involving video modeling wascollected (Phase IV). Two measures wereobtained for each phase: number of trialsand percent correct. A correct response wasrecorded when Hayden initiated the accurateimitation of the target behavior within fiveseconds after presentation. The number oftrials was based on student behavior andserved as an indicator of Hayden’s ability totolerate the activity. That is, the staff had the



freedom to terminate the training session if theydetermined that Hayden was unable to be redirectedback to task due to behavioral difficulties.

Results and Discussion The data collected for the four phases of the

instructional program are reported in Figures 1 and 2.Figure 1 presents the number of trials tolerated.During Phase I of live modeling, Hayden averagedless than ten tolerated trials per session. Introductionto video modeling (Phase II) shows that his responseto video modeling was almost immediate and pro-gressed over the next 12 sessions. Phase III re-institut-ed live modeling procedures: behaviors targeted wereidentical to behaviors during Phase II. This was doneto investigate the possibility that Hayden would gen-eralize the ability to tolerate structured teachingactivities from the video modeling condition to livemodels. Because there is high variability in the data ofPhase III, the number of tolerated trials in Figure 1 does not strongly support generalization.Improvement was noted relative to baseline and theoverall average for Phase III is greater than the base-line condition (Phase I). Next, a return to videomodeling conditions (Phase IV) was implementedusing a 4-year-old female video model. Changing themodel from male to female triggered an immediate

increase in the number of toleratedtrials. The data for Phase IV supporta reduction in variability and aplateau just below 50 trials.

The percent correct data, present-ed in Figure 2, show relatively largevariability overall. However, examina-tion of overall averages for each phasesupport the conclusion that videomodeling was an effective interventionfor this specific student. Although gen-eralization was not shown in our data,it is important to note informalobservations strongly suggest thatthis intervention led to an increasein spontaneous imitation of adultsand peers. Additionally, staff reportedincreased sustained attention during

structured adult directed activities. Hopefully videomodeling can be effectively implemented for other stu-dents with autism to teach a variety of behaviors. Quill(2000) suggests video modeling can be used to teachsocial play, community expectations (child watches peergo to the dentist), and conversational skills. Moreresearch is required to expand our findings to other chil-dren with autism and other curriculum areas.

Tamara Fortney, SLP-CCCInteragency Assessment Center – OCDEEmail: [email protected]

References: • Center for Disease Control and Prevention– Autism Informa-

tion Center. http://www.cdc.gov/ ncbddd/autism/.• Charlop-Christy, M., Le, L., & Freeman, K. A. (2000). A

comparison of video modeling with in vivo modeling forteaching children with autism. Journal of Autism andDevelopmental Disorders, 30, (6), 537-552.

• Haring, T. G., Kennedy, C. H., Adams, M. J., & Pitts-Conway, V. (1987). Teaching generalization of purchasingskills across community settings to autistic youth using video-tape modeling. Journal of Applied Behavior Analysis, 20, 89-96.

• Koegel, L. & LaZebnik, C. (2004). Overcoming Autism.New York: Penguin Group.

• National Research Council. (2001). Educating Childrenwith Autism. National Academy Press: Washington, DC.

• Quill, K. A. (2000). Do-Watch-Listen-Say: Social andCommunication Intervention for Children with Autism.Baltimore: Paul H. Brookes Publishers.

A video model helps Hayden imitate toy play.


T PA R E N T / FA M I L Y

Some days it seems the only predictable thingabout it is the unpredictability. The only consis-tent attribute – the inconsistency. Autism is oftenbaffling, the behaviors perplexing and downrightdifficult, even to those who spend their livesaround it.

Autism was once thought “incurable,” but everyday now, individuals with autism are showing us thatthey can overcome, compensate for and otherwisemanage many of its most challenging aspects. Abasic understanding of autism gives us the ability tohave tremendous impact on their journey towardsproductive, independent adulthood.

Here are ten things every child with autism wish-es you knew:

1. I am first and foremost a child – a childwith autism. I am not primarily “autistic.”My autism is only one aspect of my total char-acter. It does not define me as a person. Areyou a person with thoughts, feelings and manytalents, or are you just fat (overweight),myopic (wear glasses) or klutzy (uncoordinat-ed, not good at sports)? Those may be thingsthat I see first when I meet you, but they arenot really what you are all about.

As an adult, you have some control over howyou define yourself. If you want to single outone characteristic, you can make that known.As a child, I am still unfolding. Neither younor I yet know what I may be capable of.Defining me by one characteristic runs thedanger of setting up an expectation that maybe too low. And if I get a sense that you don’tthink I “can do it,” my natural response willbe: Why try?

2. My sensory perceptionsare disordered. The ordi-nary sights, sounds, smells and touches ofeveryday life that you may not even notice canbe downright painful for me. I may appearwithdrawn or belligerent to you but I am real-ly just trying to defend myself. Here is why a“simple” trip to the grocery store may be hellfor me:

My hearing may be hyper-acute. The loud-speaker booms today’s special. Musak whinesfrom the sound system. Cash registers beep;the coffee grinder chugs. The meat cutterscreeches, babies wail, carts creak. My braincan’t filter all the input and I’m in overload!

My sense of smell may be highly sensitive.The fish at the meat counter isn’t quite fresh,the guy standing next to us hasn’t showeredtoday, the deli is handing out sausage samples,the baby in line ahead of us has a poopy dia-per, they’re mopping up pickles on aisle 3.... Iam dangerously nauseated.

I am very visually oriented and because of this,vision may be my first sense to become over-stimulated. Fluorescent lights hum andvibrate. The light appears to pulsate; itbounces off everything and distorts what I amseeing – the space seems to be constantlychanging. There are moving fans on the ceil-ing, too many items for me to be able to focus(I may compensate with “tunnel vision”), somany bodies in constant motion. All thisaffects my vestibular sense, and now I can’teven tell where my body is in space.

Ten Things Every Child with Autism Wishes You KnewBy Ellen Notbohm


3. Please remember to distinguish betweenwon’t (I choose not to) and can’t (I am not able to).

It isn’t that I don’t listen to instructions. It’sthat I can’t understand you. When you call tome from across the room, this is what I hear:“*&^%@, Billy. #$%&*...” Instead, comespeak directly to me in plain words: “Pleaseput your book in your desk, Billy. It’s time togo to lunch.” This tells me what you want meto do and what is going to happen next. Nowit is much easier for me to comply.

4. I am a concrete thinker. I interpret languagevery literally. It’s confusing for me when yousay, “Hold your horses, cowboy!” when whatyou really mean is “Please stop running.”Don’t tell me something is a “piece of cake”when there is no dessert in sight and what youreally mean is “this will be easy for you to do.”

Idioms, puns, nuances and sarcasm are lost on me.

5. Be patient with my limited vocabulary. It’shard for me to tell you what I need when Idon’t know the words to describe my feelings.I may be hungry, frustrated, frightened or con-fused but right now those words are beyondmy ability to express. Be alert for body lan-guage, withdrawal, agitation or other signsthat something is wrong.

There’s a flip side to this: I may sound like a“little professor” or movie star, rattling offwords or whole scripts well beyond my devel-opmental age. These are messages I have mem-orized from books, TV or other people tocompensate for my language deficits because Iknow I am expected to respond when spokento. I don’t really understand the context or theterminology I’m using. I just know that it getsme off the hook for coming up with a reply.

6. Because language is so difficult for me, I amvery visually oriented. Show me how to dosomething rather than just telling me. Showme many times. Patient repetition helps melearn.

A visual schedule is extremely helpful as I move through my day. Like your day-timer, itrelieves me of the stress of having to rememberwhat comes next and makes for smooth transi-tions between activities. Here’s a great website:www.cesa7.k12.wi.us/sped/autism/structure/str11.htm.

7. Focus and build on what I can do ratherthan what I can’t do. Like you, I can’t learn ifI’m constantly made to feel that I’m not goodenough and that I need “fixing”. Trying any-thing new when I am almost sure to be metwith criticism becomes something to be avoid-ed. Look for my strengths and you will findthem. There is more than one “right” way todo most things.

8. Help me with social interactions. It maylook like I don’t want to play with the otherkids on the playground, but it’s just that I sim-ply do not know how to start a conversation orenter a play situation. Encourage other chil-dren to invite me to join them at kickball orshooting baskets; it may be that I’m delightedto be included.

9. Try to identify what triggers my meltdowns.Meltdowns and blow-ups are even more horridfor me than they are for you. They occurbecause one or more of my senses has goneinto overload. If you can figure out why mymeltdowns occur, they can be prevented.

PA R E N T / FA M I L Y

10. If you are a family member, please love meunconditionally. Banish thoughts like, “Whycan’t he just... .” You did not fulfill every expec-tation your parents had for you, and you would-n’t like being constantly reminded of it. I didnot choose to have autism. But remember thatit is happening to me, not you. Without yoursupport, my chances of successful, self-reliantadulthood are slim. With it, the possibilities arebroader than you might think.

View my autism as a different ability rather thana disability. Look past what you may see as lim-itations and see the gifts autism has given me. Imay not be good at eye contact or conversation,but have you noticed that I don’t lie, cheat atgames or pass judgment on other people? Alsotrue that I probably won’t be the next MichaelJordan. But with my attention to fine detail andcapacity for extraordinary focus, I might be thenext Einstein. Or Mozart. Or Van Gogh.

They had autism too.

It won’t happen without you as my founda-tion. Think through some of those societal‘rules’ and if they don’t make sense for me, letthem go. Be my advocate, be my friend, andwe’ll see just how far I can go.


We are grateful for the ongoing sponsorship ofthis newsletter by the following agencies:

T PA R E N T / FA M I L Y

What do polar bears have for lunch?

Ice Burgers

Ellen Notbohm is author of the book Ten ThingsEvery Child with Autism Wishes You Knew, win-ner of iParenting Media’s Greatest Products of2005 Award, and a ForeWord 2005 Book of theYear finalist. She is co-author of 1001 Great Ideasfor Teaching and Raising Children with AutismSpectrum Disorders, winner of LearningMagazine’s 2006 Teacher’s Choice Award, and acolumnist for Autism Asperger’s Digest andChildren’s Voice. Your comments and requests forreprint permission are welcome at [email protected]. For more information please visitwww.ellennotbohm.com.

Children with ASD tend to have a hard time understanding jokes.Visual presentation can make the difference between being lostand having a good laugh. Thanks to Cindy Mapes, Stein Center,San Diego, for another creative teaching idea.


Upcoming Staff Development, Conferences and Parent Trainings(Partial Listing — June to September 2006)

There are several opportunities for continuing education and support that will be offered by variousorganizations. For OC Kids, the Regional Center of Orange County (RCOC), and the S.U.C.S.E.S.S.Project of Orange County strive to provide affordable fees to both families and staff. Each session has a specificfocus, some pertaining to early interventions, some with more of an emphasis on the older aged student.Registrations may be very limited, therefore call early! Other sessions will be available throughout the year.

Date/Time/Place Topic/Speaker Dev. level Approximate Fee Contact

N E W S / H I G H L I G H T S

Locations: OCDE = Orange County Department of Education – 200 Kalmus Drive, Costa Mesa, CA 92628RCOC = Regional Center of Orange County – 801 Civic Center Drive, Santa Ana, CA 92702

June 7, 14, 21 & 28Wed. evenings 6:30 – 9:00 PMRCOC – Santa Ana

July 11, 18, 25,Aug. 1 & 86:30 – 9:00 PMRCOC – South office

Aug. 8, 15, 22, 29& Sept. 56:30 – 9:00 PMRCOC – Westminster

Fall series to be determine Tuesdays6:00 – 8:00 PM

Sept. 134:00 – 8:00 PMOCDE

Sept. 148:30 – 3:00 PMOCDE

Sept. 158:30 – 3:30 PMOCDE

Sept. 25 & 268:30 – 3:30 PMOCDE

Sept. 278:30 – 3:30 PMOCDE

Behavior ManagementWorkshops for ParentsJose Rios, BCBA

Behavior Managementand Toilet TrainingWorkshops for ParentsPaul Coyne, PhD.

Behavior Managementand Toilet TrainingJoyce Tu, EdD, BCBA

SEE-PAC Parent Education Series

Overview:“Social Thinking – I LAUGH Model”Michelle Garcia Winner

Day One:“Social Thinking – I LAUGH Model”Michelle Garcia Winner

Day Two:“Social Thinking – I LAUGH Model”Michelle Garcia Winner

“Links to Language”2-Day training session Pam Payne and Lauren Franke, Ph.D.

“Paragraphs Program”Pam Payne

All Ages

Early to middle agedevelopmental levels

Early to middle agedevelopmental levels

Early

Developmental ages 8+



All Ages

For those who havepreviously attended the “Links” training

Free

Free

Free

$25 per family

$30Includes a boxed meal

Approximately $65

Approximately $65

Approximately $255Includes the “Links toLanguage” TrainingManual

Approximately $100

RCOCThelma Day (714) 796-5223



Call For OC Kids(714) 939-6118For specific information

S.U.C.S.E.S.S. Project(714) 966-4137

S.U.C.S.E.S.S. Project(714) 966-4137

S.U.C.S.E.S.S. Project(714) 966-4137

S.U.C.S.E.S.S. Project(714) 966-4137

S.U.C.S.E.S.S. Project(714) 966-4137

Avoids eye contactEvita el contacto visual

Lacks creative “pretend” playCarece el juego creativo

Shows indifferenceDemuestra indiferéncia

Copies words like a parrot (“echolalic”)Repíte las palabras como un loro(“en forma de echo”)

Shows preoccupation with onlyone topicDemuestra preocupación/interésen solo un tema/asunto

Does not like variety: it’s not thespice of lifeNo demuestra interés en variedad

Shows fear of, or fascination withcertain soundsDemuestra miedo de/ó fascinación con ciertos sonidosLaughs or giggles inappropriately

Risa/reír inadecuadamente

Displays special abilities in music,art, memory, or manual dexterity Demuestra capacidades especialesen musica, arte, memoria ordestreza manual

Shows fascination with spinningobjectsDemuestra fascinación con objetosque gíran

Does not play with other childrenNo juega con otros niños

Some Examples of Autistic BehaviorAlgunos ejemplos del comportamiento de personas con autismo

• Difficulty with social interactions.Tienen dificultad para socializar con otras personas.

• Problems with speech. Tienen problemas con su lenguaje.

• Disturbed perception.Tienen una percepción anormal de los sucesos que acontecen a su alrededor.

• Abnormal play.Su forma de jugar es anormal.

• Resistance to change in routine or environment.Se resisten a cambios en sus actividad rutinarias ó a su medio ambiente.

SOME EXAMPLES OF AUTISTIC BEHAVIORALGUNOS EJEMPLOS DEL COMPORTAMIENTO DE PERSONAS CON AUTISMO

Shows one-sided interactionDemuestra interacción que es unilateral

Summer 2006 Volume 3, Issue 1€¦ · Evidence-Based Practices By Vera Bernard-Opitz The term...

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