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Chapter One: Autism and related Disorders

Disorders mentioned in this chapter:

Autistic disorder: Presentence of at least 6 of the diagnostic criteria listed by the DMV criteria. For a child to be diagnosed the following must be determined: ( APA, 2000, p. 75)

1.At least 2 of the social impairments criteria are met

2.At least one of the communication impairments criteria met

3.At least one of the restricted repetitive and stereotyped patterns of behavior, interest, and activities criteria met

Rhetts’s disorder ( APA, 2000, p. 77)
- a rare genetic neurological and developmental disorder that affects the way the brain develops and causes a progressive loss of motor and speech abilities

Childhood disintegrative disorder- A disorder in which children develop normally through the ages of 3-4 and then over the next few months they lose language, motor, social and other skills they have already learned.

Asperger’s disorder- a type of ASD. It is mild on the spectrum and people with this disorder display three primary symptoms:  having difficulty with social interaction, engaging in repetitive behavior, standing firm on what they think, focusing on rules and routines

Pervasive disorder not otherwise specified
- Can be placed in subgroups: high functioning, a second group and a third group.  There is severe and pervasive impairment in the development of reciprocal social interaction associated with impairment in either verbal or nonverbal communication skills or with the presence of stereotyped behavior, interests, and activities, but the criteria are not met for a specific Pervasive Developmental Disorder, Schizophrenia, Schizotypal Personality Disorder, or Avoidant Personality Disorder

Childhood Disintegrative Disorder:  CDD
- Referred to as Heller's Syndrome, dementia infantilism, or degenerative psychosis
- " CDD has a later onset ( after 2 years of age) than Rett's Disorder and ASD" ( APA, 2000, p.79)
- The following must be present for a diagnosis to be made:  ( APA, 2000, p.79)
" - at least 2 years of normal development"
"- Marked regression in at least 2 areas of development, including receptive or expressive language skills, social or adaptive skills, bowel or bladder control, play skills, or motor skills.
"- no specific medical cause or neurodegernatice syndrome to explain the marked regressed noted"

Early indicators of ASD
- Two approaches for identifying ASD ( Prelock, 2006):
Retrospective video analysis and follow- up of early screenings in at-risk populations.

Roles of Practitioners in Diagnosis
- Prationers have a big role in the diagnosis of ASD as well "as educators, families and doctors" ( Filipek, et al., 2000). A board certified makes the formal diagnosis but the process of diagnosing is very interdisciplinary.

Language Impairment in ASD:
- hard to distinguish between a language disorder vs language impairment symptoms in ASD
- "Children with specific language language impairment and autism may have similarities in early language delay and aquistition, but the language of children with Autism is often more disordered in its pattern of expression" ( Noterdame, Sitter, Mildenberger, & Amorosa, 2000).

Language Disabilities and Autistic Disorder
- Syndrome of nonverbal learning disability ( NLD) and right hemisphere dysfunction are being recognized as having a profound impact on visual-spatial abilities" ( Manoach, Sandson, & Weintraub, 1995 ; Rourke, 1989; Semrud-Clikeman & Hand, 1990)
- Cognitive testing for IQ can help distinguish between an NLD and ASD ( Prelock, 2006)

Mental Retardation And Autism
- mental retardation is a separate disorder from Autism based off research that indicates that about 25% of people with ASD display normal ranges of intellectual ability ( Klinger & Dawson, 1996)

OCD In ASD
- OCD is defined as the presence  of obsessions and compulsions"
- In general OCD tendencies are seen in people with ASD, but those characteristics also meet the diagnosis of ASD and OSD is defined as a seperate disorder. ( APA, 2000)

ADD and ADHD in ASD

- There is a different onset in these disorders
- Children with ASD also exhibit behaviors associated with ADHD/ADD such as "being aloof, and inattention to the detail in their environment to being hyper alert or hyper focused on areas of narrowed interest in the exclusion of other stimuli" ( Allen & Courchesne, 2001).

Personality Disorders and ASD

- a personality disorder is described as a " maladaptive pattern for coping, experiencing and relating" ( APA, 1994; Bleiberg, 2001)
- People with ASD are at a higher risk to develop this disorder ( Ghaiuddin, Weider-Mikhail, & Ghaziuddin, 1998; gill berg & Billstedt, 2000; Volkmar, Cook, Pomeroy, Realmuto, & Tanguay, 1999; Wolf, 1973, 1989)

Schizophrenia and ASD
- Autism was once thought to be Schizophrenia
- Schizophrenia is characterized by " Normal or near norm development, less impaired intellectual abilities, and a gradual or sudden onset os psychotic symptoms inclusion delusions, hallucinations, disorganized speech and unusual behavior appearing later in development" ( American Academy of Child and Adolescent Psychiatry, 1999)
- Symptoms of ASD are very different than Schizophrenia( Volkmar & Wiesner, 2004)

Neurobiological Considerations
Anatomical Abnormalities
- large brain size
- complex neurobiological pattern
- The brain structures involved in these complex patterns are the cerebellum, the limbic system, the cerebrum and the basal ganglia, the superior olive and the facial motor nucleus ( Courchesne and Pierce, 2000)
- It was found that "there were fewer Purkinje neurons which are important communication catalysts in the brain.
- increase of neurons and reduction of density in limbic system in individuals with autism ( Bauman & Kemper, 1988, 1994)
- reducation of size in cerebellum and increase in volume in cerebrum as well ( Bauman & Kemper, 1988, 1994)
Brain-Behavior Findings
-MRI and FMRI are used to obtain real time images of the brain
- These images have been used to study 3 main abnormalities in the brain: social, attention, and restricted interests
- "Social abnormalities have been reported in the face perception, emotion processing, social cue orientation and attention regulation of individuals with autism ( Abell et al., 1999; Aylward et al., 1999; Baron-Cohen et al., 1999), and reduced activation of the fusiform gyrus while viewing pictures of the face" ( Courchesne & Pierce, 2000; Pierce & Courchesne, 2000; Schultz et al., 2000).

Speculated Etiology
- " 5% to 10% of autism is secondary to a chromosome abnormality or a single gene disorder" ( Muhle, Trentacoste, & Rapin, 2004)
- Several genes may be involved
- Some research indicates that teratogens could be a cause of autism such as alcohol exposure during pregnancy.
- CMV or cytomegalovirus " interfere with cerebellar development and has impacted the play and social behavior of animals" ( Prelock, 2006)
- Theories about food allergies, immunizations, gastrointestinal abnormality, vitamin deficiency have all be debunked ( Prelock, 2006)

Chapter Two: Learning To Work With Families To Support Children With ASD

Tenets of Family- Centered Care
- "Families are a constant in the care provided for their children with special needs" ( Giangreco, Edelman, Nelson, Young, & Kiefer- O'Donnell, 1999)
-Recognition of the diversity of families ( Shelton & Stepanek, 1994, 1995)
- "all family members have strengths ( Ahmann, 1998; Dunst & Trivette, & Hamby, 1996; Kavanagh, 1994; Patterson, 1995, Weick & Saleebey, 1995)
Role of Cultural Competence
- "Family centered care requires that professionals be culturally competent" ( Prelock, 2006)
- Cultural competence is defined as " the ability to collaborate across cultures in a respectful manner, leading to mutually desired outcomes (McCubbin, Thompson, Thompson, & Katson, 1993)
- "Individuals with disabilities Education ACT of 1990 provides one vehicle that can be used to require service systems to respond to individual needs"
- IDEA contains 6 principles of law: zero reject, non-discriminatory assessment, individualized and appropriate education, least restrictive environment, due process and parent participation." ( Prelock, 2006)
- "There is a limited amount of services offered to children with ASD and other special needs"  (Prelock, 2006)

Barriers to Family-Professional Collaboration: What are they and how should we respond
- There are many challenges that include "stress when family or other team members are stretched beyond their comfort zone, negotiation problems when there is a breakdown in communication" ( Prelock, 2006 pg. 72)
- "the real barrier to family-professional collaboration, however arises when assumptions are made about what families believe and value or when diverse beliefs or values are disrespected ( Fadiman, 1997; Kalyanpur & Harry, 1994; Kleinman et al., 1978)

Honor the Families culture and Strengths
- responsibility of the practitioner to take into account the families culture and respect it.
- The families should not have to adapt to the culture of the professionals ( Prelock, 2006)

Understand Skills for Listening and Speaking
- "Working together as equal partners is also a barrier to family professional collaboration" ( Kalyanpur & harry, 1999)

Effective listening components ( Prelock, 2006)

1.     Paying attention to relevant verbal and nonverbal information

2.     Interpreting information

3.     Addressing questions prosed

4.     Giving feedback on information shared

5.     Eliciting information

Effective speaking components ( Prelock, 2006)

1.     Clear state of point of view

2.     Simple presentation of meaningful information

3.     Use of feedback to ensure information presented is understood

4.     Summarization

Recognize Team Culture
- "professional have to understand their culture biases before they can be flexible and open minded about the families cultures" ( Prelock, 2006)
- Several reasons to recognize culture: "helps frame roles and responsibilities and create a context for team members to interprets what is occurring and what will occur" ( Briggs, 1999; Westby & Ford, 1993b

Share an Understanding of Rights and Responsibilities
- " Team cultures allows a group to differentiate between members and nonmembers and helps to differentiate between members and nonmembers and helps to determine the specific philosophical orientation held by the group" ( Briggs, 1997).

Building Professional Relationships with Families Affected by ASD
- Four step guide:
1. Professionals increase their knowledge about the cultural beliefs and values embedded in their own perspectives
2/3. professionals find out whether the family shares their values
4 "all information is taken and collaborations are made with the family to create a plan that adapts professional and systemic values with those of the family" ( kalyanpur & Harry , 1999)

Implications for Professionals and families
- "when families and professionals bridge cultures, children are privy to a world that makes more sense for to them" ( Prelock, 2006)
- have families participate and address all their questions especially in the IEP meetings

Chapter 3- An Interdisciplinary Family centered and community-based assessment model for children with ASD

A disablement framework to guide assessment

-Medical and social views. Medical views see it as “individual problem created by disease, trauma or health conditions, with management directed at making personal adjustments and behavior changes” ( WHO, 1999)

- Social view sees it as the society’s problem and management is centered around “social action and environmental changes” ( Perlock, pg. 94)

- ICF defines dimensions of classification as “impairments, activities, and participation” ( Perlock, 95)

- environemental factors are “outside or extrinsic to the child and might include societal attitudes, cultural norms, laws, educational systems and architechural considerations” ( Perlock pg, 95)

- personal factors are “specific to the child and might include age gender and other health condition, past and current experiences” ( Perlock, pg. 95)

Ecological and Dynamic Assessment Approaches

- “considers the broader aspects of a childs environment” ( perlock, pg.95),

- observing the child in the day to day lives and learning about how they develop and their skills

- Helps the assessment team find the strengths and weaknesses of the child

- Community-based assessment model integrates the dynamic assessment approach ( perlock, pg. 96)

- Dynamic approach “gathers structured and systemic observations withing functional context-bound activities in multiple settings” ( Perlock, pg.96)

- examiners role is teacher-observer, child’s role is learner-performer ( Perlock, pg. 96)

Role of families and Practioners in assessment

-       “A paradigm shift from the practioner as experts to practionaers to partners or families” (Perlock, pg. 98)

-       The most effective team with have people who are working side by side with each other

An Interdisciplinary Assessment Model for Children with ASD

-       Intake- includes family support parent and an assessment coordination ( perlock, pg. 101)

-       Interviews- face to face interviews with parents in a location of their choice. Allowing the family to choose the location can take away from accidentally picking a location that family may have difficulties with

-       Questionnaires or information forms- Background information

-       Genograms and ecomps- “maps family structure, record family information and delineate family relationships” ( Perlock, pg. 103)

-       Preassessment Planning Meeting- facilitated by the assessment coordinator assigned to the family

-       Roles and Rules for participation- roles are assigned to each team member and the coordinator facilitates the meeting

-       Presentation of Intake information- all information collected from intake such as history and interview information are shared

-       Planning the Assessment- from the information presented, all team members start to define aspects of the child’s development that needs to be assessed.

Community based assessment

-  The family is briefed on what the assessment process and what to expect from it

- families are involved in interviews and filling out checklists and paperwork

Records review

-       “Review of medical records, questions asked by physicians, educational case manager” ( Perlock, pg. 112)

Observations

-       During this part, roles are assigned for who will watch the child throughout his/her day

-       the family can choose not to have an assessment team at their home, the family guides the assessment team in this section.

-       Team members will write about what they observed and “how it may or may not fit the diagnostic criteria for Autism

Postassessment Planning Meeting

-       Happens after the assessment is completed

-       “Similar to preassessment, roles and responsibilities are assigned and the family leads this meeting” ( Perlock, pg. 115)

-       “Recommendations are made to meet the needs of the family and child” ( Perlock, pg.115)

-       *Recommendations should focus on the 3 areas of impairment*

Report Write Up

-       Report designed to answer the families’ questions and to provides recommendations

-       The coordinator will also develop a notebook with resources for the family and community team members ( Perlock, pg. 116)

Care Coordination

-       In this step, the family is responsible for following through with the recommendations, “Care coordination is to support not supplant the efforts of in-place teams working to best meet the child’s needs of children with ASD and their families” ( Perlock, pg.119)

-       Limitations can include commitment of all team members to put in the time and commitment from the admin. Team to take the necessary steps from their stand point

Chapter 4 : Understanding and Assessing the communication of children with ASD
Theoretical Views of Language impairment in children with ASD
- Some researchers believe theory of mind impairment is used to explain language and communication impairment in children with ASD ( Happe, 1993, 1994, Tager-Flusberg, 199, 1996, 1997a, 1997b)
- An example of language development impairment in children with ASD is how they develop functional language but do not have difficulty with the form of language ( Prelock, 2006)

Early Communication Challenges
- " Nearly half of children with ASD never develop speech or demonstrate limited speech and language development ( Lord & Paul, 1997; Lotter, 1978)

- There are three specific areas of communication challenges described in children with ASD: development of internal communication, gesture use, and the use of unconventional verbal behavior ( Camaion, Perucchini, Muratori, & Milone, 1997; Mundy, Sigman, & Kasari, 1990; Peck & Schuler, 1987; Prizant, 1987; Prizant & Rydell , 1993; Wetherby & Prizant, 1996; Wetherby et al., 2000)

Intentional Communication
- Three specific communication intentions emerge in children during their first year of life which are behavior regulation, social interaction, and joint attention, children with ASD have deficits in these areas. ( Wetherby & Prizant, 1992)
Gesture Use
- Children with ASD do not develop gestural use early on in life like normally developing children
- In fact, they demonstrate "less frequent eye contact, decreased pointing to and showing of objects, and fewer gestures combined with meaningful vocalizations" ( Wetherby et al., 1998)
- Children with ASD use a higher number of isolated gestures and a lower use of gesture plus vocalization in comparison to their typical peers ( Wetherby et al. 1998)

Unconventional Verbal Behavior
- Children with ASD exhibit echolalia, perforative speech or excessive questioning ( Prizant & Rydell, 1993)
- "Echolalia is the repetition of exactly what is said or heard" and mitigated echolalia is described as " a modification in the words used, the prosody of the utterances, or the context in which it occurs" ( Prizant & Rydell, 1993).
- Pervasive speech is characterized "by either imitated or self-regulated utterances that are produced repeatedly by a child with ASD with no real evidence of intent" ( Prizant & Rydell, 1993)
Pragmatic Challenges for Verbal Children with ASD
- Pragmatics is the use of language in social contexts ( Prelock, 2006)
- Signiciant area of weakness for children with ASD especially Aspergers ( Church, Alianski, & Amanullah, 2000, Twachtman-Cullen, 1998)
Paralinguistic Features
- Speakers speech intelligibility and prosody
- Shriberg et al. ( 2001) found an increase in the distortions in speech of adolescents and adults with ASD
- Children with ASD also display monotoned speech and a failure to use pitch, intonation or intensity in their speech ( Baltaxe & Simmon, 1985; Fay & Schuler, 1980 )

Extralinguistic Features
- nonverbal pragmatics
- gestures and body movements when communicating
- Children with ASD lack this especially arm and hand movements, facial expressions, and head nods ( Ricks & Wing, 1975)

Lingusitic Features
- Utterances that demonstrate what they know and understand about the listener is important in the development of children
- 2 primary areas of difficulty:" the ability to attend to their communicative partner and a deficit in expressing linguistic intent" ( Prelock, 2006)

Conversational Features
The verbal aspects that are important to conversations include: "selecting, maintaining and changing topics, taking turns, initiating topics of conversation topics presented by another, knowing when and where not to pause, interrupt or overlap, giving feedback to the listener or speaker, providing responses contingent on those of the conversational partner, using concise utterances"  ( Twachtmacn-cullen, 1998)
- "Verbal children with ASD appear to struggle with conversational interaction, and verbal children with ASD are unable to judge conversational cues to tell them when they have said too much or too little" ( Lord & Paul, 1997)

Other language challenges
- difficulties in word choice and meaning in children with ASD
- they also have difficulty with "metaphoric language, literal meanings, gestalt processing, theme building, and inference making" ( Prelock, 2006)

Metaphoric Language
- "children with ASD have been observed to assign words to the same categories as other children, some use metaphoric language which they make associations with that through private meanings" (Prelock, 2006)

Literal Meaning
- "Responding to literal versus implied meaning also poses challenges for children with ASD" ( Landa, 2000; Twachtman, 1995)
- Literal interpretation is reflective of a cognitive style that is inflexible even when the contexts suggests an alternative interpretation ( Ozonoff & Miller, 1996; Twachtman-Cullen, 1998)

Gestalt Processing
- Children with this style exhibit more conversational features  and tend to produce multiple syllable words. This is a challenge for children with ASD ( Prelock, 2006). "The ones that may occur include single utterances, events or discourse scripts that follow a routine

Theme Building
- "language use in conversational exchanges is not just about introducing a topic. It often facilitates a cognitive process of theme building that individuals use to make sense of the world ( Twatchman, 1995).
- The challenges of conversational speech and theme building in children with ASD is described as " when the adolescent is unable to divert his attention to consider other activities or the young child limits his ability to learn and talk about other objects that can do similar or different things" ( Prelock, 2006)

Inference Making
- Children with ASD are often known to have difficulty making judgements ( Landa, 2000; Twachtman-Cullen, 1998)
- There is also difficulty with complex information
Creating Profiles of Communication Strength and Challenges
- Once a diagnosis is made, it is time to come up with a comprehensive treatment plan so the strengths and weaknesses of the child are assessed. First, "situations need to be designed to that will foster observations of a child's strengths and weaknesses" ( Wetherby & Prizant, 1992, 1993: Wetherby et al., 1998; Wetherby et al., 2000). The use of communication temptations can help with this  which is for example " placing desirable objects in a closed container near a child". The second consideration is "that practitioners must observe a child does to communicate verbally and nonverbally" ( Prelock, 2006), and the third consideration is to observe and assess the use of joint attention. A fourth consideration is the "repertoire of gestures, sounds, and words should be defined" ( prelock, 2006) and finally "inspection of the child's echolalia or other unconventional verbal behavior should be completed" ( Prelock, 2006)

Communication Assessment for Nonverbal Children with ASD
3 important areas that clinicians should assess:
1. assess the presence of communication functions in the nonverbal behaviors of children with ASD ( Wetherby & Prizant, 1993)
2. the means to communicate across 3 categories of communicative function: contact, distal gestures, and vocalizations.
3. assess nonlinguistic comprehension

Communication assessment for children with ASD who exhibit unconventional verbal behavior
- "Important to gather a complete history of the unconventional verbal behavior from the family, as well as those who have experience with the child" ( Prelock, 2006)

Semantic Assessment in Verbal Children with ASD
-Assessment of both receptive and expressive language is suggested by Landa ( 2000)
- Should include an assessment of narrative and discourse comprehension as well
Pragmatic Assessment in Verbal Children with ASD
- "Practitioners should consider levels of analysis assessment contexts, and the specific pragmatic parameters examined" ( Prelock, 2006)
Levels of analysis ( Roth and Spekman, 1984a)
1. intent of speaker's message 2. communication focus is broader to include the speakers intent and what the listener needs 3. ability to maintain and sustain dialogue.
Pragmatic Parameter: Communicative Intentions
- this can be explored by examining " linguistic, paralinguistic, and other nonverbal means used to communicate a message" ( Prelock, 2006)
Presupposition
- "speakers infer information about their listeners just as listeners inter the intentions of speakers ( Roth & Spekman, 1984a)
Social Organization of Discourse
-  observe child's talking time and turn taking abilities and if they or how they initiate conversation
Observation
- "Hobson and Lee ( 1998) suggest that behavior be systemically observed in social significant settings that the child is familiar with"
- Quill ( 1995) suggests that if one of the goals of communication assessment is to identify relationships between children communicative behavior and that of their communication partners, then the child's skills must be observed in a meaningful context.
Finnerty and Quill ( 1991) created a questionnaire that focuses on the kinds of opportunities children have to initiate conversation .
Standardized and Non-standardized Tools
- Communication Symbolic behavior scales ( Wetherby & Prizant, 1993) uses communication temptations within semistructed play.
- MacArthur Communicative Development inventories ( Fenson et al., 1993) : 2 parts, one is for 8-16 months to yield information on vocabulary comprehension and production and gesture use, the other part is for 16-30 months to generate information for vocabulary production and several aspects of grammatical development, including meaning length of utterances and sentence complexity
Ages and stages questionnaire ( Squires, Potter & Bricker, 1995)  Parent completed assessment to provide information on developmental delays
Evaluating Acquired Skills in Communication  ( EASIc; Riley, 1991)
- assess five levels of relevant communication in preschool children: paralanguage, receptive, expressive
Communication Assessment ( Watson et al. 1989)
- analyzes a communication sample that leads to setting intervention goals

Chapter Five: Understanding And Assessing the Play of Children with ASD

Principles of play development
- Voluntary, Pleasurable, and intrinsically motivated
- Children learn play through physical experiences through manipulation of smell, taste, and performing actions on objects (Prelock, 2006)

Classifications of Play
Piaget's 3 sequences of play starts with sensiormotor practice, to symbolic play then to games

Similisky’s stages (1968)

-Functional- simple motor activities similar to stage one of piaget

-Constructive- sustained creative activity around a similar theme

-Dramatic- also described as symbolic, similar to year 2 of piagets theory

-Games with rules- play organized around rules and requiring a child ability to adjust, similar to year 4 of piagets theory

Belsky and Most’s ( 1981)  stages:

-Mouthing

-Simple manipulation

-Functional

-Relational

-Functional-relational

-Pretend self

-Pretend other

Challenges in play for children with ASD- children with asd may not realize the pleasurable, voluntary and motivating aspects of play like other children do. Additionally, being flexibile, nonliteral, and requiring engagement are aspects of play that children with ASD have difficulties with. They also exhibit less diverse functional play
Relationship among play, language, and cognition
- a developmental sequence between play and language development
- Under the age of 12 months, children tend to explore objects and perform actions on objects
- "18-24 months a child uses realistic objects directed towards others and demonstrate single-action schemes with several objects and receivers of actions, combining at least four objects" ( Bates et al., 1987 Wetherby, 1992)

Assessments

-       Play assessment- useful to see how children play in the real world. Can come in a few forms: record review, interview, observation in structured or natural environment and the use of formal assessment tools

-       TPBA- Transdisciplinary play based assessment- a dynamic assessment that considers the total child and requires practitioners to share information and roles across discipline. It examines 6 developmental play levels from 6 months to 6 years:

birth to 24 months- exploratory play

9 to 24 months- functional play

24+ months- constructive play

21- 72 months- symbolic play

36+ months- rough and tumble play

60+ months- games with rules
Explanations for Impairments in Play in Children with ASD
Deficits in competence, performance, or even both. They also lack of symbol system necessary to form second order representations and solve problems that require and understanding of the mental state of others ( Brook & Bowler, 1992)
Creating Profile of Play Strengths and Challenges
- a child's understanding of the world must be defined to start creating a profile. The child's understand and ability to explore and experiment with objects is needed. The practitioners must also establish what may stress the child in the environment

Play Assessment Across Impairment, Activity, and Participation
- Very helpful to learn how a child plays with practitioners vs. how they play in real life.
- The Who (2001) established a few forms of play assessment such as record review, interviews and observations.

Assessment Tools
Play based tools include:
Linder's ( 1993) Transdiciplinary Play based assessment is a dynamic assessment tool that " considers the total child and requires practitioners to share information and roles across disciplines" ( Linder, 1993)

Westby's (1980) Symbolic Play Scale Checklist:
A tool used to "examine not only the play of children with ASD but also the relevant language observed at each stage"

Chapter 6: Understaning and Assessing the Social- Emotional Development of Children with ASD

3 identified areas of impairment for diagnosing ASD:

Social Functioning, Social- emotional development

Social function is:

Social- emotional development is: child’s capacity to experience and express variety of emotional states to regulate emotional arousal and to establish secure and positive relations and to develop a sense of self.

Face Perception and Emotion Recognition
- being able to recognize or distinguish "self" or "non self" ( Prelock, 2006)
- Inability to recognize the faces of others and used the lower face as a way to recognize others ( Langdell, 1978). Older children may be able to find ways to compensate over time ( Klin, 1999)

Gesture and Imitation
- imitation deficit in individuals with ASD which also shows a deficit in executive  theory of mind ( Roger et al., 1998)

Neurotypical children’s development of social emotional development

-       Preference for human voice and face over other object and sounds and an ability to orient themselves towards their parents

-       3 months is when children can start differentiating between emotions

-       At 1 year they can differiente who is their caregiver

-       At 2 years they demonstrate an increase to coordinate their behaviors with others in their environment

-       By toddler age, start engaging in parallel play

-       Imitation skills should be examined

Children with asd social emotional development

-       Lack of recipricol eye contanct

-       Infrewuent or abcesne of social smile

-       Less interest in the human face

-       Less pleasure from social interactions

-       Form attachments to caregivers

-       Unresponsiveness to name

-       Socially isolated

-       Difficulty with recipricol interactions

-       Focus on their own interests

-       Lack of joint attention( can be one of the most prevalent signs of ASD)

Theory of Mind

-       Can be impaired in children with ASD and this can cause difficutlies in multiple areas such as: inferring mental states, predicting behavior, playing symbolically, understaning deceptions, using pragmatic language skills, taking turns and creating communicative circles ( Baron- Cohen, Leslie, Firth, 1985)

Executive Function
-  Impairments in this area "allows individuals to shirt their attention with flexibility and to solve problems in an organized, strange manner" ( Twatchtman- Cullen, 2000)
- Children with ASD have difficulty with executive tasks as well

Impact of Deficits in Arousal and Attention
- Response thresholds are usually lower in children with ASD , they also fail to attend to social stimuli ( Dawson & Lewy, 1989)

Creating Profiles
joint attention- Prizant and Meyer ( 1993) considerations: " does the child observe other Children or adult's activities? Does the child follow other's visual line of regard? Does the child respond to the signals of others to establish shared attention?
Imitation -  "Practitioners should look for the childs ability to imitate in the context of social experiences"  ( Prizant & Meyer, 1993)
Social responsiveness -" Practitioners should look for attempts made by the child to engage with other children and consider the social context, including the environment, its predictability and familiarity"  ( Prizant & Meyer 1993)

Pivotal Response Behavior
- important intervention target area for children with ASD as well as self regulation, initiation, and social interaction.
- "Practitioners should identify the motivators of the child as well as an examination of both real and potential intrinsic motivators" ( Prelock, 2006)

Social behaviors: eye gaze, social smile, face perception, joint attention, initiation, social gestures, imitation, theory of mind, execturive function, motivation. ( Prizant & Meyer, 1993)

Chapter 7- Sensory Motor Considerations in the Assessment of Children with ASD

Diagnostic literature
- current literature states that a diagnosis should be made " on the observation of present or absent characteristics" ( Prelock, 2006, pg. 305)

Definitional Literature
-
-IDEA’s (1997) description of sensory and motor behaviors: engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines and usual responses to sensory experience

- The Autisms society of America (2001) description of sensory and motor behaviors: disturbances in rate of appearance of physical, social, and language skills and abnormal responses to sensation
Personal Accounts
- Stories often relate to "sound, vision, touch, taste, and smell as well as kinesthetics and proprioceptive sensations" ( Prelock, 2006, pg. 307)
Relationships Between Sensory and Motor Characteristics
- 2 models to explain relationship: Neuromaturational model, and dynamic systems
- Neuromaturational model 'describes the function of the CNS and the changes and function that occur over the course of typical development". Also describes hierarchical levels of CNS functioning

- Sensory input
"generated through the stimulation of sensory receptors and transmitted via peripheral nerves and cranial nerves" (Prelock, 2006, pg. 312)
- important to note if sensory input receptors are working in children with ASD
CNS integration
- "role is to interpret, prioritize and use input to generate adaptive responses" (Prelock, 2006, pg. 314)
Motor response
- Motor issues are seen in atypical "muscle tone, posture, strength, endurance, patterns of movement, balance and coordination" ( Prelock, 2006, pg. 315)
_ "motor responses work by transmitting messages down through lower levels of the brain, cross over the opposite side of the body and brainstem and connect with motor neurons."  (Prelock, 2006, pg. 317)

Neuromaturation model:

Describes hierarchical levels of CNS functioning from lower levels of the spinal cord and brain stem through midbrain structures to the cerebrum which involves attention, memory, and voluntary motor activity. It suggests that sensory and motor differences in development are the result of a typical nervous system functioning

-       4 components: sensory input, central nervous system integration, motor response, and feedback

Dynamic Systems model:

Based on theory described by Thelon, Kelso, and Fogel and is reflective of more contemporary ideas about brain functioning and motor development. They differ in several ways:

Assumptions about sensory - motor functioning and implications for assessing and interventions
- "Few studies of the sensory and motor characteristics of children with autism, and no longitudinal studies, the prevalence of both sensory and motor differences are reported as possible early signs of ASD" ( Lord & MCGee, 2001; Waitling et al., 2000)

- "The WHO developed and redefined a sociomedical model of disability that incorporates elements of both traditions deficits perspective and strength perspectives" ( Verbrugg & Jette, 1994)

Dimensions of Disability and Aspects of sensory- motor function to be asses in children with ASD

- include: impairment, activity, participation, and contextual factors
Impairment refers to "functions and structures at the body level and include some difference from the norm and are detectable by others" ( Prelock, 2006, pg. 324)

Activity- considers whole body and person, attend to everyday life activities and how a child performs them

Participation- Childs involvement in life activities on a social level
Considerations for Assessment
- requires and interdisciplinary team, should include record review, forms, interviews, observations and standardized and non standardized assessments.

Standardized Assessments
Law and collaborators (1999) complied resources and questions to ask including:
1. For what purpose
2. What dominions would you like to have an impact on
3. where do you want to have and impact
4. what perspectives
are the measures individualized or standard
5. What age?
- The Sensiormotor History questionnaire for preschoolers ( DeGangi & Blazer-Martin, 2000)- parent and child interview questions for sensory processing, movement, touch, and emotional maturity
- The sensory profile( Dunn, 1999) - caregiver interview questions which measures sensory processing, sensory modulation and behavioral and emotional responses
- The Peabody Motor developmental scale- second edition ( Folio & Fewell, 2000),measures gross motor and find motor functioning
- The motor free visual perception test- Revised ( Calorusso & Hammill, 1996)- norm-referenced that assess visual-motor skills with drawing or copying requirements
- The School function assessment ( Coster, Deeney, Haltwangerm & Haley, 1998)

Chapter 8: Making intervention decisions to better serve children with ASD and their families

Current interventions:

Relationship based interventions ex. Floortime ( Greenspan and Wieder, 1998)- focus on facilitating child’s attachment, affect, or relatedness

Skill-basis intervention- support the development of specific skills ex. Picture exchange communication system

Physiologically oriented interventions- focuses on how information is received and processed by the brain. Includes sensory and auditory integration and psychopharmacological and dietary treatments

Programs that combine intervention approaches- addresses all aspects of the child’s behavior ex. Project TEACCH ( Watson et. Al., 1989)

Roger’s Framework: ( 1998)

Focal treatment ( Strain,Kohler, and Goldstein, 1996) - like skill-based interventions, focuses on specific learning needs

Comprehensive program - reduces impairment across several ability areas and improve long-term outcomes

Continuum of interventional approaches from traditional behavioral to more pragmaticdevelopmental (Prizant and Wetherby, 1998)

-       One end of continuum has discreet trial learning ( Lovaas, 1987), represents a traditional behavioral approach

-       Floortime ( Greenspan and Wieder, 1998), is on the other side of the continuum, a more developmental approach

Efficacy and Effectiveness

-       Should be considered alone 2 dimensions

Efficacy- the ability of an intervention to change behavior in a specific disorder area in a clinical research setting

-       Effectiveness- the ability of the intervention to work in a real world setting ( Chorpita et al., 2002)

Prizant and Rubin ( 1999) caveat’s to be aware of:

-       No single approach should be the primary or only recommendation

-       Comparisons have not been made between the available interventions

-       Benefits are variable for individual children

-       Design problems plague the research

-       Intervention emphasis has been narrowly defined to include child outcomes while failing to consider the valued outcomes of families

-       No clear method is used to determine intervention

-       Communication and social-emotional development outcomes in natural contexts are often excluded

-       Limited considerations is given to what is known about child development and a child’s developmental level

-       Some interventions fail to address the core deficits in autism

-       The process for evaluating valued outcomes over time is poorly defined

National Research Council (2001) Best Practice Considerations For ASD

-       Immediate

-       Involve approx. 25 a week of intervention

-       Occur throughout the year

-       Collaborative planning and goal setting with the families and practitioners, an assessment of available resources, a clear understanding of the individual characteristics of the child with ASD that can affect intervention ( The American Academy of Child and Adolescent Psychiatry, 1999 )

Chorpita and Collegues (2002) Framework

Level One

-       Either two or more examples exist in the literature of between-grownup designs that lead to better performance than a placebo or other treatment or demonstrate effects equivalent to an established treatment with adequate statistical powe’ or a large series of case studies have been done with strong experimental designs Chorpita et al., 2002, p. 169)

-       Treatment manuals exist for the experiment procedures Chorpita et al., 2002, p. 169)

-       Participants samples are clearly defined Chorpita et al., 2002, p. 169)

-       Two or more researchers have reported significant effects Chorpita et al., 2002, p. 169)

Level Two

-       Intervention is found to be superior to a control group in at least two studies

-       Between group design that leads to better performance than a placebo or other treatment or demonstrate effects equivalent to an established treatment

-       A small series of case studies have been done with clear participant Chorpita et al., 2002, p. 169) description, strong experiment designs, and use of procedural manuals for intervention compared to a placebo or other intervention. (Chorpita et al., 2002, p. 169)

Level three

-       One examples exists in the literature of a between- group design that leads to better performance that a placebo or other treatment or demonstrates effect equivalent to an established treatment with adequate statistical power. (Chorpita et al., 2002, p. 169)

-       A series of case studies have been done with clear participant and treatment description, strong experimental designs, two or more researchers reporting similar effects and comparison to a placebo or other intervention.(Chorpita et al., 2002, p. 169)

Level Fours

-       “unsupported treatments” (Chorpita et al., 2002, p. 169)

Level Five
- “possibly harmful treatments” (Chorpita et al., 2002, p. 169)

The parameters

-       Feasibility, generalizability, and cost and benefit ( Chorpita et al., 2002, p. 169)

Strategies for Difficult Decision Making ( Freeman, 1997; Nickel, 1996)

-       Approach all treatment with a clear and open mind

-       Determine the goals you are trying to meet and base your intervention selections on the treatment most likely to meet those goals

-       Select treatments that support the individuals quality of life needs

-       Consider cultural priorities

-       Be aware of which treatments recognize that all individuals may not respond to the proposed intervention the same way

-       Consider an eclectic approach to treatment and be aware of programs that encourage the use of several treatments

-       Use assessment information to help determine which treatment approaches respond to the needs of the individual

-       Select treatment approaches that include procedures for evaluating whether the treatment is appropriate and effective for a particular child

-       Be aware of your philosophical bias when considering different treatments for autism

Creative Problem Solving

Six Steps

1.    Objective findings ( Giangreco, Cloninger, et al., 1994, 2000)

2.    Fact finding ( Giangreco, Cloninger, et al., 1994, 2000)

3.    Problem finding ( Giangreco, Cloninger, et al., 1994, 2000)

4.    Idea finding ( Giangreco, Cloninger, et al., 1994, 2000)

5.    Solution finding ( Giangreco, Cloninger, et al., 1994, 2000)

6.    Acceptance finding ( Giangreco, Cloninger, et al., 1994, 2000)

Mediating Conflict

What issues may arise

-       Complexity of needs, limited resources, poor understanind and intervention practices, the individual nature of autism lead to expected and unexpected conflict ( Perlock, )

How to mediate these

-       Clearly define the problem ( perlocck, )

-       Gather additional information if the team feels like they don’t have enough

-       Gather some protentional options for managing problems

-       Response is monitored to determine whether the desire results have been achieved.

Framework for Mediating Conflict

Mediation Model ( Lahar, 1996)

-       Moves away from a position framework to a more interest-based framework ( Lahar, 1996)

Considerations for Nonstandard Interventions

-       Nonstandard interventions or CAM are not consistent with medical research, but can be beneficial to some children ( Nickel, 1996, Starret, 1996)

Divided into several ways ( Nickel, 1996, Starret, 1996)

-       Dietary treatments-modifying a childs diet to change behavior (Nickel, 1996, Starret, 1996)

-       Neurophysiological retraining- using certain motor patterns and or stimulating certain sensory inputs to improve central nervous system function ( Nickel, 1996, Starret, 1996)

-       “other” – includes controversial approaches ( Nickel, 1996, Starret, 1996)

Curriculum Analysis and Intervention Planning

-       Assessment and intervention planning that has relevance for meeting the educational programming needs of children with ASD is language-based curriculum analysis (LBCA)

-       Used to ensure that children with ASD have the same curriculum as their peers, a process for systemically reviewing the curriculum, including identifying demands and expectations, defining potential breakdowns and brainstorming modifications ( Perlock)

-       LBCA framework is for younger children with ASD who have limited verbal and cognitive function, requires family members and SLP and special and general education teachers

-       Four steps which include: step one- consider the child’s strengths and weaknesses Step 2: consider the general expectations or curriculum requirements in communication, social interaction and play and sensory skills. Step 3: team determines exceptions and considerations and the learning environment that may be problematic for a child with ASD ( Perlock, Miller and Reed, 1993)

Stating Objectives for the Curriculum (Perlock and colleagues, 1993)

“A defined amount of time and amount of material to cover is more effective for students with language disorders” (Perlock and colleagues, 1993)

Specific objectives to look for: ( Perlock and colleagues, 1003)

-       Evidence of student’s confusion with content area concept

-       Learning outcomes that are prerequisites got later learning

-       Standards or benchmarks for performance required by the school district

Reviewing Requirements

-       Determine vocabulary needed for that grade and courses ( Perlock, 1997)

Evaluating Needs

-       Define areas that students need support in vocabulary, language, and social discourse needs ( Perlock, 1997)

Making Modifications

-       Allows the team members to think of any changes they could apply to curriculum ( Perlock, 1997)

What are the advantages of LBCA?

-       Student performance is the objective

-       Increased awareness of the classroom language allows teachers to respond to specific needs

-       Prior knowledge of kids with ASDs strengths and weaknesses helps teachers predict which areas the students will have difficulty in these areas

Chapter 9: Interventions to support the Communication of Children with ASD

Interventions for supporting limited verbal skills

-       It is critical for practitioners to pay attention to the communication needs of children with ASD because the way they communicate may be different than traditional communication ways ( perlock, book citation)

augmentative communication strategies and visual superscript

-       Visual supports prompt joint attention established conversational reference promote recall enhance attention to and understanding of social messages increases comprehension of language concepts and facilitates communicative intent and social initiative ( Johnston Nelson, Evans, & Palazolo, 2003)

-       Augmentative devices don't replace communication but they add some support to the goal of facilitating communication

-        two primary augmentative devices aided an unaided ( Perlock, book citation)

-       Aided- requires the use of devices like communication books or voice output communication aids ( Perlock, book citation)

-       Unaided- requires no equipment external to the individual and instead incorporate signs and gestures and pantomime( Mirenda, 2003)

Intervention Goals pg. 400

-       Teaching the child to become a better communication partner  ( Hodgen, 1995, 1999)

-       creating an environment that lessens the child's communication social and behavioral difficulties ( Hodgen, 1995, 1999)

-       find ways to focus the attention of the child with ASD to help the child manage transitions to provide opportunities for the child to make choices and to help the child except changes to routines ( Hodgen, 1995, 1999)

Value for the Children with ASD pg. 401

-       Offer visual support because children with autism are particularly responsible to it ( Beuklelman & Mirenda, 1992)

-       Because AAC devices are predictable have a structure that can be learned in steps and does not require interaction” ( Beuklelman & Mirenda, 1992)

-       Electronic devices should be considered when communication between individuals with ASD and their communication partners would benefit from printed or voiced output( Beuklelman & Mirenda, 1992)

Efficacy pg. 401

-       Two kinds of stimuli: Stimulus generalization and Response generalization

-       Stimulus generalization- “requires transferring what has been learned to stimulus conditions where training has not occurred” ( Perlock, book citation, pg 401)

-       Response generalization- “describes behavior changes that occur in one class of responses when another class of responses is manipulated through training” (Schlosser & Braun, 1994, pg. 209)

-       “Johnston and colleagues investigation of visual symbols to gain entrance into play situations to increase spoken language and decrease problem behavior in three young boys. this investigation consisted of four steps establishing communication opportunities modeling via peer or teacher guidance using a least to most prompting hierarchy and natural consequences for correct responses”. Results of this investigation showed that there was an increase in correct unprompted visual symbols in all the children ( Johnston and collegues, Perlock, book citation)

Picture Exchange Communication System

-       Developed at the Delaware Autism Institute for children with ASD( Frost & Bondy, 1994)

-       The point of this system is to teach funcational communication within a social context ( Frost & Bondy, 1994)

-       6 Phases of PECS ( Frost & Bondy, 1996)

1.     Phase 1: Teaching the physically assisted exchange- requires 2 trainers, one to receive the pictures and one to provide them, goal is to have the child pick a picture on their own with spontaneity

2.     Phase II: Expanding spontaneity- distance between communication board and child is increased

3.     Phase III: Simultaneous Discrimination of Pictures-teaches discrimination between pictures

4.     Phase IV: Building Sentence Structure- teaches the ability to make a request

5.     Phase V: Responding to “What do you want”- respond to questions

6.     Phase VI: Commenting in Response to questions-taught a variety of language

Goals of PECS:

“Support the use of functional activities that lead to independence” (Frost & Bondy, 1996). They serve in two different ways: directive and social consequence

How is it valuable?

Services as a catalyst for the development of children communicative competence

Joint Attention Routines

-       Requires two or more individuals in an activity that occurs in a familiar environment with a logical and predictable routine ( Snyder-Mclean, Solomonson, McLean & Sack, 1984)

-       There are 3 types: themes designed a story-line, story or theme around  operative turn taking skills, or routines with a specificed outcome

-       2 definable and predictiable roles should be assigned ( Perlock, book citation)

-       Repetion is very important

-       Goal is establish joint attention and interaction amongst the partners ( perlock, book citation)

-       Valuable because the routines can be revolved around the child’s interests, and the nature of establishing joint attention, the clearly defined roles there is predicable structure which children with ASD need.

Minimal Speech and Proximal Communication

-       Developed by Potter and Whittaker ( 2001) and is founded in the idea that:

1.the child with limited speech can communicate

2.that children need to be taught to communicate spontaneously

3.the environment and social factors should affect communication

4.communication is enhanced when integrated strategies are used

How it works?

-       Uses short 3 word sentences in combination with nonverbal ways of interacting ( interacting with as little speech as possible) ( Potter and Whittaker, 2001)

-       Engage child in playful and pleasurable nonverbal interaction to develop social communication skills ( Potter & Whittaker, 2001 pg. 62)

-       Proximal communication is an enabler to a child’s communication abilities by engaging the child

-       Active burst phases: “interventionist exaggerates facila expressions, vocalizations, and physical responses during the ticking event” ( Potter and Whittaker, 2001)

Passive Burst phases: “Interventionist remains quiet, watches child, and responds to the child attempt to communicate” ( Potter and Whittaker, 2001)

*Make sure there is a clear divide between these two phases*
* Make sure to have clear goals for communication*

* Get lower than eye level of the child*

Goals of minimal speech and proximal communication

-       Several goals are established but specifically: “Intentionality, social timing, spontaneous communication, turn taking, social anticipation, communication use of eye gaze, vocalizations, and gestures, reciprocity and joint attention” ) ( Potter and Whittaker, 2001)

How effective is it?

-       In Potter and Whittaker’s research on this, communication in children became more spontaneous and social responsiveness also increases.

The Natural Language Paradigm

-       Is a type of ABA therapy approach and integrated more discrete trial programs with naturalistic program ( CITE, pg 412)

-       Requires a clear plan and targets are acquired at a slower pace   ( perlock, book citation)

-       According to Delprato ( 2001), when this is done correctly anyone casually observing would not know intervention is taking place

Milieu Teaching

-       Intervention approach that incorporates the principles of the natural language paradigm and specifies key teaching strategies to be used in the natural environment when facilitating language ( Perlock, book citation)

-       Child-directed modeling which focuses on a child’s interest and using joint attention and a verbal model related to the child interest ( Kaiser et al., 1987).

-       “Mand-model procedure focuses on the child’s interest and joint attention before showing a verbal mand” (Kaiser et al., 1987)

-       Time delay procedure- provides pauses between providing mands (Kaiser et al., 1987)

-       Incidental teaching- builds more elaborate language use to facilitate conversation (Kaiser et al., 1987)

Intervention Goal?

-       Teaching functional language, and to make choices for themselves

-       Value of Milieu teaching: positive effect on social and behavioral which teaches independence as well (McCormick et al., 2003)

-       Efficacy: Increases language skills and depress inappropriate behavior using the natural language teaching paradigm ( Deprato, 2001; R.L. Koegel, & Surrant, 1992; Sundberg & Partington, 1998) . Increase in noun acquisition, and social play

Time Delay

-       A delay between presenting a target and the response, use of gradual time delay for children with little spontaneous speech   ( Christy and Kelso, 1997)

-       The goal is to increase spontaneous speech, its valuable because it teaches communication without a verbal prompt ( Christy and Kelso, 1997)

Modeling

-       “One person observing another person engaged in an activity” ( Perlock, book citation)

-       Observer creates idea of what should be done which gives them the knowledge to perform the task ( Charlop- Christy & Kelso, 1997)

-       Influencing factors include: number of times the observer sees a task ( Bandrua, 1965)

-       In vivo model known as live modeling and video modeling is used “to demonstrate a specific behavior for the child to imitate” ( Perlock, book citation)

-       Values to child provides multiple times for the child to see behavior that needs to be imitated, often times children with ASD have attention issues so this is a good way to get them to see it more than once if they missed it the first time

-       Efficacy: several studies have seen gains using modeling. A 10 year old child had an increase in language skills and vocal volume level, sometimes other children with autism can be used as peer models and there is research that suggests this works too ( Charlop- Christy & Kelso, 1997)

Chapter 10: Interventions to Support the Play of Children with ASD

Questions to consider:

1.)   What strategies could be effective in supporting the imitative and independent play of children with ASD?

2.)   How can pretend or sociodramatic play be developed for children with ASD

3.)   What is the role of peer-supported play in facilitating the social play of children with ASD?

Teaching Play

-       To teach play, the child must have already been taught how to engage ( ex. floortime )

-       Enticement is the next step, meaning that the child is enticed to join activities with other peers

-       Cooperative play activities, provides flexibility in the childs play time

-       Using social stories to each play ( Gray, 1995, 1998)

Imitative and independent Play Strategies

-       “Increases attentive and social responsiveness of children with autism”( Dawson and Lewy, 1989)

-       Dawson and Lewy found that children with autisms’ eye gaze increased when using this approach as well as their social responsiveness, touching and gesturing

-       To teach a child this, “model the activity then immediately give the child and opportunity to imitate” ( Dawson and Lewy, 1989)

-       This is valuable to the child because it teaches them independence in their daily lives

-       Self-management strategies also improve independence, “children are taught to distinguish appropriate from inappropriate behavior” ( Stahmer and Schreibman, 1992)

Intervention Goal

-       “ goals for imitative and independent play should include establishing joint attention around desired objects and actions, prompting and modeling lay behaviors and creating variations of those behaviors” ( Perlock, pg.464)

Pretend of Sociodramatic Play Strategies

-       “Children with disabilities establish more social behaviors when they play with more social toys like balls, puppets,  and toy cars” ( Perlock, pg. 466)

-       Use open-ended questions**

-       Use miniature props to act out scenes

-       Floor time and Pivotal response training support social- emotional development in children with ASD

-       Teaching play scripts supports the social and communicative play behavior of children

Intervention Goal

-       To increase language and cognitive development, make successful peer relationships and to teach sociodramatic play

Efficacy

-       Throp and colleagues (1995) found that children increased the amount of time they exhibit sociodramatic play and their language skills improved as well.  Children also learned critical behaviors for playing (Goldstein, Wickstorm. Hoyson, Jamieson & Odom. 1988)

Peer Supported Play Strategies

-       Teaches children with ASD to engage in joint attention

-       To do this “the interventionalist will introduce a story in small sequential steps through symbolic play using circles of communication” (Densmore, 2000)

-       6 levels and goals for establishing this: Level 1: “peer partner learns to comment verbally” (Densmore, 2000), Level 2: teaching child with ASD to look at the peer partner who commented and continually prompting the child to make comments” (Densmore, 2000). Level 3: Child may be asked to hold object and to ask questions about it. Level 4: Engage in back-and-forth conversation. Level 5: “Play partners are left to play on their own” (Densmore, 2000). Level 6: “Play partner is prompted to move objects toward to child with ASD and verbally prompt or gesture to get the child with ASD to respond” (Densmore, 2000). Level 7: “prompting the child with ASD and the play partner to create a story about an object of play” (Densmore, 2000). Level 8: what the children say is rephrased to support the development of a story. Level 9: “Child’s narrative is placed on the computer and more pictures are added to the story which is also placed in a small book” (Densmore, 2000). Level 10: “ a videotape is made of the play partners as they create a story about they are doing” (Densmore, 2000). Level 11 and 12: interventionalist finds other areas that they can join the child in play.

Intervention Goals

-       Establishing joint attention with peers, developing a sense of story with peer partners in play and learning to use narrative language to support play activities.

Value

-       Builds and established circle of communication and moves on to introduce a play theme to teach specific language or social communication using peer support.

Efficacy

-       Not too much empirical evidence is available, but (Densmore, 2000) has reported success with the use of narrative play
Chapter 11 : Interventions to Support the Social-Emotional Needs of Children with ASD
Models of Intervention
- 4 main frameworks that are useful in building a meaningful connection with children with ASD: DIR ( Greenspan & Wieder, 1998), RDI ( Gutstein & Sheely, 2002a, 2002b, SCERTS( Prizant, Wetherby, Rubin & Laurent, 2003; Prizant, Wetherby, Rubin Laurent, & Rydell) do-watch-listen-say ( Quill, 2000)
Developmental Individual-Difference Relationship-Based Model
-this is described as " to facilitate affect, attachment and a sense of relatedness between a child with special needs and a caregiver or interaction partner" ( Greenspan & Wieder, 1997a, 1998, 2000,2001)
- There are four major goals for DIR: "to encourage attention and intimacy, to establish tow-way communication, to cultivate the expression ideas and feelings, and to connect logical thought"( Prelock, pg. 481).
- Involves 20 to 30 minutes interaction periods 6 to 10 times throughout the day in which the parent or interventionist gets down to the floor with the child and engages in activity with them
- Circle of communication are "when a child or adult intiantes and interaction or tries to engage in another and close when there is a response to the initiation or when the interaction ends"( Greenspan & Wieder, 1998).
- Efficacy: "through a series of circles of communications, interaction partners help the child to master each emotional milestone, ensuring that the child is able to demonstrate target behaviors even when experiencing emotional extremes" ( Stacey, 2003)
Intervention Goals
- "Encourage attention and intimacy " ( Prelock, pg.482, 2006)
- "establish two way communication" ( Prelock, pg. 482, 2006)
- "to encourage the expression and use of feelings and ideas" ( Prelock, pg. 482, 2006)
- "link ideas to feelings, connect thoughts in logical ways" ( Prelock, pg.482, 2006)
Relationship Development Intervention Model
-"Similar to DIR because it uses joint attention and sharing" ( precook, pg. 486)
- 3 key principles: to teach function before skills, social referencing and the ability to perceive and process information important in social relationships( Gutstein, 2000). The final principle is " developing frameworks for sharing experiencing is a key experience" ( Gutstein, 2000)
Intervention Goals
- For emotional attunement or attention, the goal is to "seek the child's face to face gazing through sharing joy and laughter or soothing distress" ( Prelock, pg. 489, 2006)
- For social referencing, the goal is "to have the child seek the adult's face as a referencing point for determining what to do next." ( Prelock pg. 489, 2006)
- For excitement sharing or regulating, the "goal is to facilitate a preference for increased challenge and excitement by providing novel elements and versions of experiencing sharing frameworks" ( Prelock pg. 489, 2006).
- For coordinated actions, the goal is " to have the child enjoy coordinating his or her actions with the adult while engaging in simple shared-activity frameworks" (Prelock, pg. 489, 2006)
Value and Efficacy
- The efficacy of these frameworks can be seen in research done on it. From the Prelock book, the researched stated that there were "notable improvements in desire to be with others, sharing emotions, paying attention, and behavior" (Prelock, pg. 491, 2006)
The Social Communication, Emotional Regulation and Transactional Supports Model
- Known as The SCERTS model, developed by Prizant and colleagues.
- "a comprehensive approach to facilitating the social- emotional and communication abilities of children with ASD in their home and school setting" ( Prizant et al.; 2003; Prizant et al., 2004)
Goals- Emotional regulation, joint attention use, and symbol use
Value to child- Prizant his colleagues have described this as "value based, in that it is grounded in explicitly stated principles that guide their intervention efforts"
Efficacy- It has been shown that there are "gains in spontaneous intention to communicate in functional ways and generalizing abilities across tasks, interactive partners and settings" ( Prizant et al., 2003)

Do-Watch-Listen-Say Framework
- " this engages the child with ASD at cognitive, social, linguistic, and communicative levels" ( Quill, 2000)
- The ability to listen to language
Goal of intervention:
4 domains to use
1. Watch area- "to help the child learn to share physical space , then to share toys and materials" ( Quill, 2000)
2. Listen area- "involve teaching the child to respond to gestural messages" ( Quill, 2000)
3. Say area- "goal is to focus on initiating nonverbal social messages" ( Quill, 2000)
Cognitive Behavioral Interventions
- used on children who have higher cognitive skills
- Interpersonal problem solving- "used to facilitate cognitive  behavioral intervention that is used to facilitate a child's ability to attend to both internal and external factors" ( Prelock, 2006, pg. 506)
- Goals: Bauminger (2002) and Howlin (1998), say there are 2 major goals: 1. to expand child's understanding of higher functioning. 2. to scaffold children's ability to apply what they know so they can establish reciprocal social interactions.
Pivotal Response Training
- behaviors that are central to child's day-to day life functioning are taught in this training
- there are two main behaviors taught: "motivation and responsively to multiple cues" ( Koegel, 1989)
- "visual competent are improved" ( Koegel, 1989)
- Shared control is also used in this training. This is when a child is given a choice on what to do next.
- Koegels et al. (1989), says to consider three areas of reinforcement: Reinforcement should be contingent on the child's actual behavior. Next, "all goal-directed attempts at responding to questions, instructions or opportunities to respond should be reinforced" ( Koegel et al., 1989). Finally, reinforce the target behavior
Comic Strips
- Uses visual supports to help child with ASD who have difficulty with back and forth exchange of information ( Gray, 1994, 1998)
-Goal is to clarify information that may be confusing to kids with ASD
Social stories
- Children with ASD social deficits in many areas. Some children may require more visual support to manage their behavior( Kuttler, Mylers, & Carlson, 1998). Social stories work by "incorporating directs and explicitly stated guidelines to support the social behavior of children with ASD" ( Gray, 1995b)
Goals- to facilitate social interaction, play, and pragmatic communication
Other intervention strategies:
- "cueing in" child on what and why you are doing something and using natural consequences
- Power card intervention ( Gagnon, 2001), "a visually based strategy designed to promoted desired skills by relating them to the special interest of a child with ASD."
Not in Book: Pediatric Feed

-       “Feeding disorders are common in early childhood. Anatomic or function disorder can make feeding difficult or uncomfortable”  ( Rudolph et al. , 2002)

-       Delays in initiation of feeding

-       Very complex

Clinical questions to ask

-       Is there a tonic bite

-       Is the child arching

-       Are the oral reflexes intact

-       Assess cranial nerves

-       Can child open and close mouth completely

-       What does the tongue look like?

-       Can the child form a bolus

-       When the swallow is triggered does the child sound clear afterwards
Anatomical differences in newborn and infants, child and adults

-       Oral cavity is small in a new born

-       New borns have sucking pads

Soft palate and epiglottis are in contact at rest which makes an additional valve in the back

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Table 9.3

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ASD- Autism Spectrum Disorder
ABA- Applied behavior analysis
CAM-  Complementary and Alternative Medicine
CMV-   Cytomegalovirus

NLD - Nonverbal learning disability
TPBA-  Transdiciplinary Play based Assessment
SLP- Speech- Language Pathology/Pathologist
ADOS- Autism Diagnostic Observation Schedule
IEP- Individualized education program
RDI- Relationship development intervention
SCERTS-  Social communication, emotional regulation, and transactional support model
COMPASS- Collaborative Model for Competence and Success

ICF- International Classification of Functioning

PECS- Picture exchange communication system

TEACCH- Treatment and education of Autistic and related communications handicapped children
EASIC- Evaluating Acquired skills in autism
ASQ- The ages and stages questionnaire
WHO- World Health Organization

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Observations from my feeding/swallowing rotation and ASD and related disorders 

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Observations from my feeding/swallowing rotation and ASD and related disorders 

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Client is young with autism and a rare genetic disorder (Syngap-1)

How has his diagnosis of ASD affected his eating and feeding abilities?
- Client has many deficits in sensory processing and does not like to touch wet textures.
- Client drinks with tongue protrusion
- Has weak right side jaw muscles
- overstuffs mouth when he eats
- Client is a picky eater
- difficulty sucking
- frequent seizures while eating
- client also has sleep and behavior issues

Techniques I used in clinic:
- Sensory activities with food and wet textures like water and shaving cream
- using chewy tubes from talk tools kit to strengthen jaw muscles
- also used twizlers and had client chew on them
- straw and bubbling blowing activies from talk tools

What is SYNGAP- 1
a neurological disorder characterized by moderate to severe intellectual disability that is evident in early childhood. Causes developmental delay in speech and motor skills also causes weak muscles tone.( maybe why client has weak jaw muscles). This genetic mutation can also cause autism

Prognosis:
After almost a full semester, this client has improved drastically and will most likely not need feed/swallowing therapy next semester. Client no longer has tongue protrusion, his jaw muscles have strengthened, and he has almost completed the straw hierarchy. The clients behavior issues have subsided with the use of several techniques such as setting a time during each therapy session. Seizures have also decreased. Client may undergo surgery for SYNGAP-1 to make the body produce that protein. This will not occur anytime in the near future. I  see a lot of promise in this client and the family. They have worked really hard at home and the effects of it have shown.
https://medlineplus.gov/genetics/condition/syngap1-related-intellectual-disability/

Cerebral Palsy
Client is a young and has spastic cerebral palsy. Also is cortically blind and may have a hearing loss in one ear

Difficulties with feeding/swallowing because of CP:
- Unable to swallow without being told
- tongue protrusion when swallowing
- Aspirates with liquids
- Cannot keep head up to feed or swallow ( unsafe)
- Cannot feed self and uses a feeding tube at home
- Muscles in hands are too weak to grab, and muscles in jaw are too weak to chew
-Tonic bite
Techniques I used:
- z-vibe activity
- jaw grading hierarchy
- pushed down on medial portion of tongue to trigger swallow
- LSVT- Loud techniques such as "say ahhhhh and then say ahhh *lower pitch*
Prognosis and outcomes:
After almost a semester of feeding therapy, our shift is moving towards communication abilities instead. Client did not meet goals and has not improved (in fact, has gone backwards). Reintroduce communicative device built by second year ( client seems to have communicative intent when device is present).

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SYNGAP1 -related intellectual disability is a neurological disorder characterized by moderate to severe intellectual disability that is evident in early childhood. Explore symptoms, inheritance, genetics of this condition.

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Table 7.1

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ABA therapy:
(1) Autism and ABA:

https://www.youtube.com/watch?v=RBB_81ao7uo

(2) Families and ABA:

https://www.youtube.com/watch?v=JnmuRBH-UxI&t=72s

(3) Duke University Research Program : ASD

https://www.youtube.com/watch?v=-OUdPfbDhCo
Outline for AAC assessment:
Click here

Videos on SCERTS model:
(1) https://www.youtube.com/watch?v=srJ2BnR-Qp8&t=454s

(2) https://www.youtube.com/watch?v=OLr6wreEiqg

Autism In Toddlers:
Handout, click here

AAC:
Research article on AAC assessment--- Click here
Roles and Responibilites: PDF at the top

A guide for families with children with ASD: Click Here

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DSM-5 Diagnostic Criteria For Disorders 

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DSM-5 Diagnostic Criteria For Disorders 

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Autistic disorder: ( APA, 2000, p. 75)

1. At least 2 of the social impairments criteria are met

2.  At least one of the communication impairments criteria met

3.   At least one of the restricted repetitive and stereotyped patterns of behavior, interest, and activities criteria met

Rett's Disorder : ( APA, 2000, p. 77)
1. "Apparently normal, prenatal, perinatal, and postnatal development up to the first 5 months of life
2. " Normal head size up to 5 months, with a decrease in head growth between 5 and 48 months
3. " loss of hand skills between 5 and 30 months and the presence of unusual behaviors such as hand wringing
4" normal psychomotor development up to 5 months, with significant deficits after onset
5" Severe communication deficits"
6. " decreased interest in social interaction at onset, which develops later in the course of the disorder"

Asperger's Disorder: ( APA, 2000, p. 84)

1 "no significant delays in language development"
2. " no significant delays in cognitive development prior to age 3
3. " severe and sustained deficits in social interaction
4. " development of restricted repetitive and sterotyped patterns of behavior, interest, or activities"
5. " significant deficits in social, occupational or other areas of functioning"

Pervasive Developmental Disorder Not Otherwise Specifies ( PDD-NOS)
1. " pervasive impairment in social interaction"
2. " pervasive impairment in communication skills or presence of stereotyped patterns of behavior, interest, or activities, which does not meet the criteria for a specific Pervasive Development Disorder"
3. " Presence of impairments that do not meet the criteria for ASD because of late age at onset, atypical symptoms, or sub-threshold symptoms"
Childhood Disintegrative Disorder : CDD
1. Marked regression in at least 2 areas of development, including receptive or expressive language skills, social or adaptive skills, bowel or bladder control, play skills, or motor skills.
2. no specific medical cause or neurodegernatice syndrome to explain the marked regressed noted"

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Textbook citation:
Prelock, P. A. (2006). Autism spectrum disorders: Issues in assessment and Intervention. Pro-Ed.

Chapter 1
Allen. G., Buxton, R. B., Wong, E. C., & Courchesne, E. ( 1997) Attentional activation of the cerebellum independent of motor involvement, Science, 275, 1940- 1943

Allen. G., & Courchesne E., (2001). Attention function and dysfunction in autism. Frontiers in bioscience, 6, 105-119

American Academy of Pediatrics, Committee on Children with Disabilties (2001). Teachincal report: The pediatrician’s role in the diagnosis and management

Baurman, M. L., & Kemper, T. (1988). Limbiv and cerebellar abnormalities: Consistent finding in infantile autism. Journal of Neuropathology and Experimental Neurology 47, 369

Bauman, M. L., & Kemper, T ( 1994). The neurobiology of autism. Baltimore: John Hopkins University Press

Courchesne, E., & Pierce, K ( 2000). An Inside look at the neurobiology, etiology and future research of autism. Advocate, 33(4), 18-22, 35

Filipek, P. A, Accardo, P. J., Ashwal, S., Barnek, G. T., Cook, E., H., Dawson, G., et al. (2000). Practice parameter: screening and diagnosis of autism report of the quality standards committee of the American academy of neurology and the child neurology society, neurology, 55, 468-479

Ghziuddin, M., Wieder-Mikhail , E., & Ghaziuddin, N. (1998) Co-morbidty of Aspergers syndrome: A preliminary report. Journal of intellectural disabily research, 42(4) 2790283

Klinger, L. G. & Dawson, G. (1996). Autisitc disorder. In E. Mash & R Barkley (Eds.), Child psychopathology (pp.311-339). New York: Guildford Press

Monoach. D., Sandson., T & Weintraub, S. (1995). The developmental social-emotional processing disorder is associated with right hemisphere abnormalities. Neuropsychiatry. Neurophysiology, behavioral neurology, 8, 99-105

Noterdaeme. M., Sitter, S., Mildenberger, K., & Amoroas, H. (2000). Diagnostic assessment of communicative and interactive behaviours in children with autism and receptive language disorder. Eupropena child and adolescent psychiatry, 9(4), 295-300

Volkmar, F. R., & Wiesner, L. A. (2004) Healthcare for children on the autism spectrum. A guide to medical, nutritional and bheavioral issues. Bethesda, MD: Woodbine House

Chapter 2

Ahmann, E. (1998). Examining Assumptopms underlying nursing practices with children and families. Pediatric Nursing, 23, 467-469

Briggs, M. (1997) Team Culture. In M. H. Briggs. Building early intervention teams: working together for children and families (pp. 23-24). Gathersburg, MD: Aspen

Fadiman, A. (1997) The spirit catches you and you fall down: A Hmong child, her American doctors, and the collison of two cultures. New York: farrar, Straus and Giroux

Giangreco, M. F., Edelman, S. W., Nelson, C., Young, M. R., & Kiefer- O’Donnell, R. (1999, March). Changes in educational team membership for students who are deaf-blind in general education classes. Journal of visual impairment and blindness. Pp. 166-173

Kalyanpur, M., & Harry, B ( 1999). Culture in special education: building reciprocal family provider relationships: Baltimore: Brooks

McCubbin, H I., Thompson, E, A., Thompson, M. A & Katson, A. J (1993). Culture ethnicity and the family: Critical Factors in childhood chronic illnesses and disabilities pediatrics, 91. 1063-1070

Shelton, Y., L., & Stepneck, J. S. (1994). Family-centered care for children needing specialized health and developmental services. Bethesda, MD: association for the care of childrens health

Chapter 3

World Health Organization. (20010. ICF: International Classification of Functioning. Disability and Health. Geneva, Switzerland

Chapter 4

Baltaxe, C. M., & Simmons, J. Q. (1985). Prosidic development in normal and autistic children. In E. Schopler & G. Mesibov ( Eds.), Communication problems in autism ( pp. 95-126). New York: Plenum Press

Camioni  L., Perucchini, P., Muratori, F., & Milone, A. ( 1997). Brief report: A longitudinal examination of the communicative gestures deficits in young children with autism . Journal of autism and developmental disorders, 27(6), 715-725

Church, G., Alisanski, S., & Amanullah, S. (2006). The social behaviroal and academic experience of children with Aspergers syndrome. Focus on Autism and other developmental disabilities, 15(1), 12-20

Fenson, L., Dale P. S. Reznik, J. S., Thal, D., Bates E., Hartung, J. P., et al., (1993). MacArthur Communicative Development inventories: User’s guild and techinal manuel. San Diego: Singular

Happe, F. (1994). An Advanced test of theory of mind: Understanding of story characters thoughts and feelings by able autistic, mentally hanicapped and normal children and adults. Journal of Autism and Developmental Disorders, 24, 129-154

Hobson, R. P., & Lee, A. (1998). Hello and goodbye: A study of social engagement in autism. Journal of autism and childhood schizophreni, 1(2), 119-145

Landa. R. (2000). Social language use in Aspergers syndrome and high functioning autism. In A. Klin, F. R. Volksmar, & S. S. Sparrow (eds), Aspergers syndrome (pp. 125-155) New York: Guildford Press

Lord, C., & Paul, R. (1997) Language and communication in autism. In D. Cohen & F. Volksmar (eds.), Handbook of autism and pervasive developmental disorders (2nd ed. Pp. 195-225)

Ozonoff, S., & Miller, J. (1996). An exploration of right hemisphere contribution to the pragmatics impairments of autism. Brain and language, 52, 411-434

Prizant, B. M., & Rydell, P. J.( 1993). Assessment and Intervention considerations for unconventional verbal behavior. In S. F. Warren & J. Riechie (Series Eds.) & J. Reichle & D. Wacker ( Vol. Eds.), Communication and languge intervention series: Vol. 3. Communication alternatives to challenging behavior: Integrating functional assessment and intervention strategies ( pp. 263-297). Baltimore: Brooks

Ricks. D., & Wing. , L (1975). Language communication and the use of symbols in normal and autistic children. Journal of Autism and Childhool Schizophrenia, 5, 191-220

Riley, A. M. (1991). Evaluating Acquired Skills in Communication-Revised. Tuscan, AZ : Communication disorders, 49, 2-11

Roth, F. P., & Spekman, N. J. (1994b). Assessing the pragmatic abilties of children: part 2. Guidelines, considerations and specific evalutions procedures. Journal of speech and hearing disorders, 49, 12-17

Shriberg, L. D., Paul, R., McSweeny, J. L., Klin, A ., Cohen, D. J., & Volkmar, F, R. (20010. Speech and prosody characteristics of adolescents and adults with high functioning autism and Aspergers syndrome: Jounral of Speech, language and hearing research 44(5), 1097-1115

Squires, J., Potter, L., & Bricker, D. (1995). The ASQ users guide for the ages and stages questionnaire. A parent-completed, child monitoring system. Baltimore: Brookes

Twachtman-Cullen, D. (1998). Language and communication in high functioning autism and aspergers syndrome. In E., Schopler, G. Mesibov & I., J. Kunce ( Eds). Aspergers syndrome or high functioning autism? (pp. 199-225). New York. Plenum Press

Watson, L., R., Lord, C., Schaffer, B., & Schopler, E. (1989). Teaching spontaneous communication to autistic and developmentally handicapped children. New York, Irvington

Wetherby, A. M., & Prizant, B. M. (1992) Profiling young childrens communication competence, In S. F. Warren & J . Reichle ( Series & Vol, Eds). Communication and language intervention series: Vol. 1. Causes and effects in communication and language intervention ( pp. 217-235)

Wetherby A. M., Prizant, B.M., & Hutchinson, T. A. (1998) Communciative social/affective and symbolic profiles of young children with autism and prevavisve developmental disorders: A transactional devleopmengtal perspective ( pp. 109-141)

Chapter 5

Baron- Cohen, S., Leslie A., & Frith. U., (1985). Does the autistic child have a “theory” of mine? Cognition, 21, 37-46

Dawson, G., & Lewy. A (1989). Arousal, attention, and the socioemotional impairments of individuals with autism. In G. Dawson ( Ed.). Autism: Nature, diagnosis and treatment (pp. 49-74). New York

Klin. A., Sparrow, S. S., de Blidt, A., Cicchetti, D. V., Cohen, D. J., & Volksmar, F. R (1999). A normal study of face recogonition in autism and related disorders. Journal of Autism and Developmental Disorders. 29(6), 499-508

Langdell, T. ( 1978). Recogonition of faces: An approach to the study of autism. Journal of child psychology and psychiatry, 19, 255-268

Prizant, B. M., & Meyer, E. C.( 1993). Socialemotional aspects of language and social communication disorders in young children and their families. American Journal of Speech-Language Pathology, 3, 56-71

Roeyers H., van Oost, P., & Bothuyne, S. (1998). Immediate imitation and joint attention in young children with autism. Developmental and psychopathology, 10, 441-450

Twatchtman-Cullen, D. (2000). More able children with autism spectrum disorders. Sociocommunicative challenges and guidelines for enhancing abilties. In A. M. Wetherby & B. M. Prizant (Eds). Autism spectrum disorder. A transactional developmental approach (pp. 225- 249). Baltimore:B rookes

Chapter 7

Autism Society of America (2001). What is Autism? Retrieved April 27, 2005

Colarusso, R. R., & Hammill, D. D. (1996). Motor Free Visual perception test-revised manual. Novato, CA: Academic Therapy Publication

Coster, W., Deeney, T., Haltiwanger, J., & Haley, S. (1998). School function assessment. San Antonio, TX: Psychological Corps

Folio, M. R., & Fewell, R. R.( 2000). Peabody Motor developmental scales ( 2nd ed.). Austin TX: PRO-ED

Individuals with Disabilties Education ACT Amendments of 1997, 20 U.S.C

Law, M., King, G .,Mackinnon, E., Russel, D., Murphy, C., Hurley, P., et al. (1999) . All about outcomes. An educational to help you understand, evaluate, and choose pediatric outcome measures, Version 1.0, Thorofare, NJ: Slack

Lord, C., & Risi, S. (2000). Early diagnosis in children with autism spectrum disorder. Advocate, 33, 23-26

Verbugge. L. M., & Jette, A. M. (1994). The disablement processes. Social Science medicine, 38, 1-14

Chapter 8

American Academy of Child & Adolescents Psychiatry : (1999). Practice parameters for the assessment and treatment of children with autism and other pervasive developmental disorders. Journal of the American Acadmey of child and Adolescents psychiatry, 38 ( suppl.) 32S- 54S

Chorpita, B. F., Yim, L. M., Donkervoer, J. C., Arensdorf, A., Amundsen, M. J., McGee, C., et al. (2002). Toward large scale implementations of empiraically supported treatments for children: A review and observations by the Hawaii Empirical Basis to Services Task Force. Clinical Psychology: sciences and practice, 9(2), 165-190

Giangreco, M. F., Cloninger, C. J., Dennis, B. E., & Edelman, S. W. (2000). Problem solving methods to facilitate inclusive education. In R. A. Villa & J. S. Thousand (Eds.) Restructuring for caring and effective education. Piecing the puzzle together (pp.293-327). Baltimore: Brookes

Giangreco, M. F., Dennis, R. E. Edelman, S. W. & Cloninger. C, (1994). Dressing your IEPs for the general education climate: Analysis of IEP goals and objectives for students with multiple disabilities. Remedial and special education, 15(5), 288-296

Giangreco, S. L. & Wieder, S. ( 1998). The child with special needs. Encouraging intellectual and emotional growth. Reading. MA: Addison Wesley

Lahar, S. ( 1996, October). Conflict resolution using a mediation framework. Presentation for the Vermont Interdisciplinary Leadership Education for Health Professionals Program, Burlington

Lovaas, O. I. & Smith, T. (1988). Intensive behavioral treatment for young autistic children. In B. B. Lahay & A. E. Kazdin (Eds.). Advances in clinical child psychology (pp.285-324). New York: Plenum Press.

Nickel, R. E. ( 1996). Controversial Therapies for young children with developmental disabilities. Infants and young children, 8(4), 29-40

Prelock, P. A. (1997). Language based curriculum analysis. A collaborative assessment and intervention process. Journal of childrens communication development, 19(1), 35-42

Prelock, P. A. Miller, B. L. & Reed, N. L. (1993) Working with the classroom curriculum. A guide for analysis and use in speech therapy, Tuscon AZ. Communication Skill Builder

Prizant, B. M. & Wetherby, A. M. (1998). Understanding the continuum of discrete-trial traditional behavioral to social-pragmatic developmental approaches in communication enhancement for young children with autism/PDD. Seminars in speech and language, 19, 329-352

Strain. P. S, Kohler, F. W. & Goldstein, H ( 1996). Learning experiences… An alternative program. Peer mediated interventions for young children with autism. In E. Hibbs & P Jensen ( Eds). Psychosocial treatments for child and adolescent disorders. Empirically based strategies for clinical practice (pp. 573-586). Washington DC. American Psychological Association.

Chapter 9

Bandura, A (1965). Influence of models’ reinforcement contingencies on the acquisition of imitative responses. Jounral of Personality and Social psychology, 1, 589-595

Beukelman. D, & Mirenda, P(1992). Augemntative and alternative communication management of severe communication disorders in children and adults. Baltimore, Brookes

Charlop-Christy, M. H., & Kelso, S. E. (1997). How to treat the child with autism. Claremont, CA. Authors

Delprato, D. J. (2001). Comparisons of discrete trial teaching and normalized behavioral language intervention for young children with autism. Journal of autism and developmental disorders

Frost. L., & Bondy, A (1994). The picture exchange communication system traning manual. Cherry Hill, NJ., Pyramid Educational Consultants

Hodgon, L. A. (1995). Visual Strategies for improving communication. Practical supports for school and home. Troy, MI: Quick Roberts

Hodgon, L., A. ( 1999). Solving behavior problems in autism: Improving communication with visual strategies. Troy, MI: Quirk Roberts

Johnston, S., Nelson, C., Evans, J, & Palazolo, K (2003). The use of visual supports in teaching young children with autism spectrum disorder to initiate interactions. Augmentative and Alternative Communication, 19(2), 86-103

Kaiser A. P. Alpert, C. L., & Warren, S. F. (1987). Teaching functional language. Stratiegies for language intervention. In M. E. Snell (Ed.), Systemic instructions for persons with severe handicaps ( pp. 247-271). Columbus, OH: Charles Merrill

McCormick, K. M., Jolivette, K., &  Ridgely, R. (2003). Choice making intervention strategies for young children. Young exceptional children , 6(2), 3-10

McLean, J., & Snyder-Mclean, L. (1978). A transactional approach to early language training: Derivationa of a model system. Columbus. OH: Charles Merrill

Mirenda, P. (2003). Toward functional augmentative and alternative communication for students with autism: Manuel Signs, Graphic symbols, a voice output communication aids. Language, Speech, and hearing servives in schools, 34, 203-216

Potter, C., & Whittaker. C. (2001). Enabling communication in children with autism. Philidephia: Jessica Kingsley

Schossler, R. W., & Braun, U. (1994). Efficacy of AAC interventions. Methodologies issues in evaluating behavior change, generalizations and effects. AAC augmentative and alternative communication

Chapter 10

Dawson, G., & Lewy, A. (1989). Arousal, attention and social-emotional impairments of individuals with autism. In G. Dawson (Ed.), Autism: Nature, diagnosis, and treatment (pp. 49-74). New York: Guilford Press

Densmore. A., (2000). Speech on location: A narrative play technique to teach expressive language and communication to children with PDD/ Autism/language delay. Journal of developmental and learning disabilities. 4(2), 209-239

Goldstein, H., Wickstorm, S., Hoyson, M., Jamieson, B., & Odom, S. L (1998). Effects of sociodramatic script training on social and communicative interaction. Education and treatment of Children, 11(2), 97-117

Gray, C. A. ( 1995). Teaching children with autism to “read” social situations. In K. A. Quill (Eds.), Teaching children with autism: strategies to enhance communication and socialization  (pp. 219-242). New York: Delmar

Stahmer. A. C., & Shreibman, L., (1992). Teaching children with autism appropriate play and unsupervised environment using a self-management treatment package. Jounral of applied behavior analysis, 25(2), 447-459

Chapter 11
Gagnon, E., (2001). Power cards: Using special interests to motivate children and youth with aspergers syndrome and autism. Shawnee Mission, KS: Autism Asperger Publishing

Gray, C. A. (1994). Comic strip conversatins. Arlington, TX: Furutre Education

Greenspan, S. I., & Wieder, S. (1998). The child with special needs: Encourage intellectual and emotional growth. Reading, MA: Addison- Wesley

Greenspan, S. I., & Wieder, S. ( 2000). A developmental approach to difficulties in relating and communicating in autism spectrum disorders and related syndrome. In A. M., Wetherby & B. M. Prizant (Eds.). Autism spectrum disorders. A transactional developmental perspective (pp. 279-306). Baltimore: Brookes

Gustein, S. E.,& Sheely, R. K. (2002a). Relationship development intervention with children, adolescents & adults: Social developmental activities for Aspergers syndrome, autism , PDD & NLD. Philedephia: Jessica Kingsley

Koegel, R. L., Schreibman. L., Good, A., Cerniglia L., Murphy, C., & Koegel, L., K. (1989). How to teach pivotal behaviors to children with autism : A training manual: Santa Barbra. University of California

Kuttler., S., Myles, B. S., & Carlson, J. K. (1998). The use of social stories to reduce precursors to tantrum behavior in a student with autism. Focus on Autism and Other Developmental disabilities, 13(3), 176-182

Prizant, B. M., Wetherby, A. M., Rubin, E., & Laurent, A. C. (2003). The SCERTS model. A transactional, family-centered approach to enhancing communication and socioemotional abilities of children with autism spectrum disorder. Infant and Young Children, 16(4), 296-316

Prizant, B. M., Wetherby, A. M., Rubin, E., Laurent, A C., &

Rydell, P. (2004). The SCERTS model: Enhanching communication and socieoemotional abilities of children with autism spectrum disorder. Port Chester, NY: National Professional Resource

Prizant, B. M., Wethersby, A. M., Rubin, E., Laurent, A, C., & Rydell, P. (2004). The SCERTS mode: Enhancing communication and sociemotional abilities of children with autism spectrum disorder. Port Chester, NY: National Professional Research

Quill, K. A. (2000). Do-watch-listen-say: Social and communication intervention for children with autism. Baltimore: Brookes

Stacey, P. (2003. January/February). Floor time. The Atlantic Monthly, pp. 127-134
Pediatric Feeding
- Rudolph C, Link D: Feeding Disorders in Infants and Children. Pediatric Clinics of North America. Volume 49,            Number 1, February 2002

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GLOSSARY

Disclaimer: This information is for my educational purposes only and will not be reduplicated

Chapter One (Prelock, 2006, Pg. 54)

Amygdala- “An almond shaped mass of gray matter in the anterior medial portion of the temporal lobe; it’s part of the limbic system and is implicated in emotion”

Basal ganglia- Located in the floor of the lateral ventricles near the base of the cerebrum; includes areas important for movement”

Cerebellar Vermis- “Midline portion of the cerebellum that has a wormlike look”

Cerebellum- “The small area of the brain above the pons and medulla that is important for balance”

Cerebrum- “The principal hemisphere of the brain”

CMV – “Cytomegalovirus; a common, acquired virus that typically causes a benign nucleosis-like illness with fever and sore throat; can infect fetus of a mother with no prior exposure or antibody response and cause microcephaly, deafness, and developmental delays”

Construct validity- “Evidence supporting the theoretical framework or construct being measured by a test”

Content validity- “Evidence substantiating that the test items sampled are representative of the area or domain being assessed and interpreted.”

Cortex- “Outermost layer (the gray matter) of the cerebral hemisphere”

Criterion validity- “Correlation between scores on tests assessing similar or dissimilar constructs”

Disengaging- “Ability to respond to unexpected information outside the immediate attentional focus”.

Dominant mutation- “A faulty gene inherited from one parent”

Embryogenesis- “Pertaining to the development of the embryo and all embryonic structures from fertilization to the end of the 8th week of gestation, by which time rudiments of all major organ systems (including the nervous system) have developed”

Facial nucleus- “Found in the brain stem; controls the muscles of facial expression”

Functional brain imaging- “Research techniques (i.e., functional MRI, single-photon emission CT, and positron-emission tomography) that use differences in cellular metabolism to document "real-time" pictures of regional brain function during specific developmental activities; can show areas of dysfunction within the brain”

Fusiform gyrus- “Temporal lobe structure involved in face perception”

Internal consistency reliability- “Evidence that test items are homogeneous over the domain being assessed”

Limbic System- “Borders the thalamus and the hypothalamus; formed of all the medial deep structures and includes the cingulate gyrus, the hippocampal formation, the amygdala, and the infraorbital cortex”

MMR- “Mumps—measles—rubella vaccine, which is often given at a toddler's 12-month pediatric checkup”

Orienting- “Ability to focus on places where information occurs”

Parietal lobe- “Lies between the frontal and occipital lobes”

Polymorphism- “Changes in the genetic code”

Purkinje neurons- “Neurons that send projections out of the
cerebellar cortex to deep cerebellar nuclei, from which areas messages go to other areas of the brain that influence movement”

Recessive mutation- “An altered gene that requires two copies (from both parents) to represent itself”

Shifting attention- “Ability to quickly change attention from one source to another”

Superior olive- “Found in the brain stem; serves as a relay station for auditory information”

Teratogens- “Anything that can cause disruption to the developing embryo or fetus, including infections, chemical agents, medications, temperature (high fever), or radiation”

Test-retest reliability-“Stability of scores on a test from one time period to another”

Tuberous sclerosis complex {TSC)- “A neurocutaneous disorder that produces lesions or tubers affecting several organs, including the skin, heart, kidneys, brain, and lungs; often, children affected by this disorder have autism or display autistic characteristics”

Validity- “The extent to which an instrument measures what it purports to measure”

Valproic acid- “Brand name Depakote; an antiseizure medication that can have "terato- genic" effects on the developing embryo and fetus”

Chapter Two (Prelock, 2006, pg. 90)

Collaborative teaming- “An interactive process that enables individuals with different backgrounds and expertise to organize and work together to define and creatively solve problems as a team, recognizing that no single person could have produced such solutions”

Cultural competence- “The ability to collaborate across cultures in a respectful manner leading to mutually desired outcomes”

Cultural reciprocity- “A way to move from overt cultural awareness, noticing obvious differences in dress and language, to covert cultural awareness, noticing differences that are not easily seen, and then to subtle cultural awareness”

Culture- “The learned and shared rules and traditions that express the values and beliefs of a group and the individuals within that group”

Family-centered care- “Recognition of the family as a constant in the child's life, with a set of values and diverse beliefs, which are understood and respected in the care provided to the child”

IDEA- “Individuals with Disabilities Education Act, a federal law designed to require educational service systems to be responsive to the individual needs of children and youth with disabilities”

VT-RAP- “Vermont Rural Autism Project, a federally funded program (1997—2001) designed to train speech—language pathologists, early childhood special educators, and other related service providers to better meet the needs of children with ASD and their families in their home communities”

Chapter Three ( Prelock, 2006, pg. 162)

Activity- “one of the three dimensions of the ICF, refers to the whole person”

Dynamic assessment- “Gathering structured and systematic observations Within functional activities across several settings on an ongoing basis”

Ecological assessment- “An approach to assessment that provides information about the environmental variables that influences the child’s performance and the particular skills needed in the specific context”

EcoMap- “Paper-and-pencil simulation that maps a family's ecological system”

Genogram-“Format used for drawing a family tree that records information about family members and their relationships over at least three generations”

Grand tour questions- “Used in interviews to probe descriptions of broad experiences or events

ICF- “International Classification of Functioning, Disability and Health; revision of the International Classification of Impairments, Disabilities and Handicaps; a classification of disablement that defines the consequences of health condition across the dimensions of impairment, activity, and participation”

Impairment- “One of the three dimensions of the ICF; refers to the body structure and function”

Medical model- “View of disablement as person related, caused by a health condition that requires individual treatment”

Mini tour questions- “Used in interviews to probe descriptions of specific activities events”

Participation- “One of the three dimensions of the ICF; refers to the individual's involvement in life activities on the societal level”

Social model- “View of disablement that sees health conditions as society's problem, goal of integrating individuals with disabilities into society”

Chapter Four (Prelock, 2006, pg. 213)

Affect- “The emotion component of communication”

Analytic processing- “Recognizing, analyzing, and producing individual words or parts of language”

Behavior regulation- “Intentional communication acts used to regulate or control the behavior of others for the purpose of obtaining something desirable”

Delayed echolalia- “Delay in the repetition of what has been said or heard”

Extralinguistic features- “Gestures and body movement used to signal intentional communication”

Gestalt processing- “Processing language and experience as "whole units" rather than segmenting language into meaningful rule-based components”

Immediate echolalia- “Immediate repetition of what has been said or heard”

Joint attention- “Intentional communication acts used to direct the attention of others for the purpose of sharing an event”

Metaphorical language- “Making associations that have private meanings”

Mitigated echolalia- “Can be immediate or delayed and involves variation in the repetition the form of a modification in the words used, the prosody of the utterance, or the context in which it occurs”

Over selectivity- “Rigid focus on a theme or topic of interest”

Paralinguistic characteristics- “a component of pragmatics involving the prosody and intelligibility of speech”

Perseverative speech- “Imitated or self-generated utterances that are produced repeatedly without evidence of intent”

Pragmatics- “the use of language in social contexts”

Prosody- “Rhythm of speech involving intonation and the emphasis on particular words that signals meaning or adds emotion”

Semantics- “the meaning component of language”

Social interaction- “intentional communication acts used to call attention, to greet another, or to sustain a social routine”

Chapter Five ( Prelock, 2006, pg. 246)

Associative play- “Play that is loosely organized around shared interests, materials, or activities”

Cooperative play- “Play that is sustained and complex, including common goals and a variety of roles among players”

Decentration- “In pretend, moving from self to other as agent”

Decontextualization- “In pretend, moving away from using real objects”

Functional play- “Play that includes appropriate use of an object or the conventional association of two or more objects”

Game- “Play that includes understanding of rule-governed behavior”

Onlooking- “Observing but not participating in play”

Parallel- “Play among children using similar materials but with no interaction”

Practice play- “Play involving fine-motor (e.g., stringing beads, putting together puzzles) and gross-motor (e.g., running, bike riding) activities”

Solitary play- “Playing alone”

Symbolic imitative play- “Pretend play initiated or guided by another”

Symbolic/pretend play- “Play behavior that is nonliteral, acting as if something is the case when in reality it is not”

Symbolic spontaneous play- “Pretend play that a child initiates on his or her own”

Chapter Six ( Prelock, 2006, pg. 294)

Affect- “Emotion shown through vocalizations, facial expressions, posture, and gestures” Executive function- “Mental processes needed to control actions and oversee goal-directed behavior”

Eye-Direction Detector- “Mechanism that identifies the movement of eyes toward an object action, or person”

First-order theory of mind tasks- “Tasks that reveal whether the individual is able to perceive the predictable thoughts of another person”

Friendship- “Mutual liking between two children”

Intentionality Detector- “Mechanism that reads the intention or mental state of others. Joint

attention. The ability to use gesture, body language, facial expression, or verbal communication, such as commenting or labeling, to direct another's attention to or share interest in objects or events and their properties”

Learned helplessness- “Thinking and acting as if one cannot do something, when in fact one can”

Line of regard- “The direction of another's gaze”

Mentalizing- “Representing mental states”

Peer Acceptance- “Extent to which children are liked and accepted by each other”

Reciprocal social behavior- “Engaging and taking turns in social interactions that are emotionally appropriate”

Referential looking- “Looking back and forth between a person and an interesting object or event”

Second-Order Theory of Mind Tasks- “Tasks that reveal whether the individual is able to perceive the predictable thoughts of another person about what a third person knows. Self-recognition. Distinguishing between "self" and "no self" or discriminating a change in one's mirror image”

Self-regulation- “Taking an interest in the world and taking control of one's emotions and feelings”

Shared Attention Mechanism- “Mechanism that links the Intentionality and Eye Direction Detectors so that connections can be made about who is sharing their attention to what.

Social behavior. Individual action of one child directed to another (e.g., gesturing, responding to a question).”

Social competence- “The knowledge, skills, and behaviors needed to meet social expectations at any point in development, including initiating, developing, and maintaining relationships”

Social goals- “Intended outcomes of a social interaction”

Social interaction. Reciprocal exchange among two or more children.

Theory of mind- “Recognizing the mental state of others as well as self so that predictions and explanations of action can occur”

Theory of mind mechanism. Mechanism that represents knowledge states (e.g., believing, pretending, deceiving) and infers the relationship between those mental states and actions.

Chapter Seven (Prelock, 2006 pg.338)

Action. - “Goal-directed motor activity”

Affect- “Emotional response to sensory input”

Apraxia. - “Difficulty in the generation, timing, and sequencing of voluntary movement responses in the performance of new skills or previously demonstrated skills in a new context”

Arousal- “An alert state”

Attention- “Focus on relevant sensory information for an adequate amount of time”

Deficit perspective- “view of an individual's difference as a challenge that needs to be overcome or corrected”

Dynamic systems model- “Describes the function of the brain as an ecosystem of interdependent and interrelated components that ebb and flow together”

Engrams- “Efficient, practiced, and automatic movement neural sequences and patterns that can be tapped as needed for motor performance”

Exteroceptive receptors- “Sensory receptors used to respond to information from the outside world; includes the five senses—vision, hearing, taste, smell, and touch”

Hypersensitivity- “A response to lower than normal amounts of sensory input”

Hyposensitivity- “A response to higher than normal amounts of sensory input”

Impairment- “One of the dimensions of the ICF; refers to body function and structure”

Interoceptive receptors- “Sensory receptors located in the innermost body structures that contribute to the regulation of vital systems and maintenance of homeostasis in the body. Motor planning. Voluntary initiation of movement toward a cognitively generated goal, and spatial and temporal synchronization of movement based on body scheme”

Myelin- “Mucopolysaccharide sheath that coats the axons of neurons”

Neuromaturation model- “Describes the function of the central nervous system and the changes in function that occur with typical maturation”

Chapter Eight (Prelock, 2006, pg. 391)

Autocratic- “Individual authority over decision making”

COACH- “Choosing Outcomes and Accommodations for Children, a process for identifying priority outcomes for children with disabilities and guiding the individual education planning process.”

Consensus building- “Achieving general agreement”

Convergent thinking- “Identifying the most rational result or solution when problem solving”

Democratic. Decision-making process in which each person votes and the majority rules.

Divergent thinking- “Identifying a variety of possible solutions when problem solving”

Effectiveness- “The ability of intervention to work in a real-world setting”

Efficacy- “The ability of intervention to change behavior in a specific disorder area in a clinical research setting”

MAPS- “Making Action Plans, a visioning process for future personal planning for individuals with disabilities”

VISTA- “Vermont Interdependent Services Team Approach, a process for determining which support services is educationally relevant and necessary”

Chapter Nine (Prelock, 2006, pg. 451)

Antecedent- “Event that occurs prior to a behavior, providing an opportunity to intervene or change an undesired behavior before it occurs”

Applied behavior analysis procedures- “Strategies derived from the principles of behavior that are systematically applied to increase socially appropriate behavior in meaningful contexts”

Backstepping-“Error correction procedure in which a prompter takes a child back in the sequence of trained behaviors to the last step completed correctly and then provides assistance to complete the sequence”

Backward chaining- “Teaching a sequence of behaviors by reinforcing mastery of the last step, followed by the next to the last step, and so forth

consequence. Event that follows a behavior and determines whether that behavior occurs again”

Delayed prompting- “Pairing a prompt with the natural cue that should control the target behavior; presenting the natural cue and after a predetermined time presenting the helping prompt if the desired behavior has not been exhibited”

Differential reinforcement- “Greater reinforcement of one response over another”

Discrete trial teaching- “Teaching technique that breaks down skills into smaller parts, teaching one skill at a time until the skill is mastered, using prompting, reinforcement, and one-on-one teaching”

Extinction- “Withholding reinforcement to reduce the occurrence of a behavior”

Mand- “Verbal instruction or request”

Milieu teaching- “Natural language intervention technique emphasizing the teaching of functional communication skills in social contexts”

Modeling- “When used in language instruction, providing examples of targeted verbalizations”

Multipointing- “Pointing more than once following a sequence to communicate a message”

Prompts- “Verbal, gestural, or physical stimuli used to produce a target behavior”

Reinforcement- “A stimulus that is a consequence of a particular behavior and increases the likelihood that that behavior will occur again”

Response generalization- “The occurrence of a response in a category other than the one in which training was receive”

Responses- “Behaviors that can be observed and measured and occur following a particular stimulus “

Routine- “specific aspects of scripts that remain constant and can be identified and taught”

Schema – “a plan for representing and organizing information “

Script – “A schema for a particular event that specifies the actions, actors and props.

Script fading- “removing sections of a written script until no written cue remains”

Shaping- “reinforcing behavior that is closer to the target behavior than the behavior displayed previously”

Stimulus- “An activity, event, or object that occurs within the environment and serves as an antecedent or consequence”

Stimulus control- “control over a particular behavior by a stimulus or cue”

Stimulus generalization- “transfer of learned behavior to stimulus conditions different from those in which training occurred”

Two -person prompting – prompting in which one trainer interacts with the child while another physically prompts from behind without interacting

Chapter Ten (Prelock, 2006, pg. 476)

Cooperative play- “two or more children engaged in the same activity and interacting in a cooperative manner”

Group Play- “Play activities with multiple participants. Like groups sports, games of tag, and board games”

Imaginative play- “play involving pretend play, also known as creative or sociodramatic play”

Independent play- “solitary play consisting of such activities as black building, coloring, puzzle building, and playing with cars or dolls”

Passivity- “not looking at, searching for, touching, or responding to objects of play”

Stereotypy- “repetitive movements without apparent consequences for the person displaying the behaviors”

Chapter Eleven ( Prelock, 2006, pg. 479)
Checklist stories. “Social story variations used to teach new routines”
Circle of communication- “A critical component of floor time intervention involving initiation of an interaction either verbally or nonverbally and a response to the initiation”

Control sentences- “Sentences used in a social story that identify strategies to recall information in the story”

Descriptive sentences- “Sentences used in a social story to provide information about a particular social situation”

Directive sentences- “Sentences used in a social story to provide information about what to do in a particular social situation”

False-belief task-  “Telling a story in which an object is moved from an original location to a new location without the knowledge of the main protagonist and asking the observer to predict where the protagonist will search for the object”

Floor time- “A child-centered intervention approach involving 20- to 30-minute interaction periods that occur throughout the day, in which an interaction partner gets down on the floor with a child and engages in activities that range from rough-and-tumble play to acting out adventures with toys”

Judgment stories-“ Social story variations used to teach ways to make appropriate judgments”

Perspective sentences- “Sentences used in a social story to provide information about the thoughts, feelings, moods, and beliefs of others.”

Skills stories-“Social story variations used to teach specific social skills”

Social review- “Using videotaping to assess student perception of a social event and assist in developing social skills appropriate to that event”

# data[].attributes.body
Informal
- The Sensiormotor History Questionnaire for Preschoolers ( DeGangi & Blazer-Martin, 2000)- parent and child interview questions for sensory processing, movement, touch, and emotional maturity
- The Sensory Profile( Dunn, 1999) - caregiver interview questions which measures sensory processing, sensory modulation and behavioral and emotional responses

Play Assessment Interview
- assesses play in all contexts
Checklist for autism in toddlers

Age- 18 months

Type of tools- Screening

Mode of assessment- interview questions asked of parents, observation by practitioner

Areas of assessment- Probe areas- pretend play, taking an interest in other children, pointing and gaze monitoring

Relability and validity- Readministration of CHAT found that children who failed the criterion items received a diagnosis of autism between 20 and 42 months

Less sensitive to milder symptoms

The Autism Behavioral Checklist
- used in both diagnosing and program planning
- Can be administered repeatedly
- Contains items related to areas of relating and social interaction
Feeding Evaluation Checklist
- Talktools checklist- sensory-motor approach
Achenback system of Empirically Based Assessment ( ASEBA)
- contains checklists and forms and helps practitioners to "determine the similarities and differences in how children function under different conditions and with different interactive parteners" (Prelock, 2006, pg. 287)
Child Behavior Checklist
- Ages 1 1/2 - 5 years and 6-18 years
- Completed by parents or caregivers in home setting
Caregiver-Teacher Report Form
- assess problem behaviors
Teacher Report Form
-assess problem behaviors
Language Development Survey  (LDS)
- for children 1 1/2 to 5 years
Youth Self Report
- For children 11 to 18 years old
Formal:
Diagnostic criteria checklist for Autistic disorder

Age- 6-17 years

Type of tools- Screening

Mode of assessment- 27 items checklist completed by parents or teachers

Areas of assessment- Assess symptoms of ASD in children and adolescents with strong or mildly impaired cognitive skills. Uses a 3-point scale

Reliability and validity- Test-retest reliability: strong correlation coefficient of .94 for teacher sample, .96 for parent samples

Interrater reliability- acceptable coefficient of .66

Divergent Validity- High correlation Coefficient of .75 and .77 with Rutter scale, .58 and .70 for parents and teachers with conners scale

Australian scale for Asperger’s syndrome

Age- 5 to 18 years

Types of tools- diagnostic

Mode of assessment- Observational tool used by having sustained contact with the individual being assessed for at least 2 weeks

Areas of assessment- probe areas- language, social, maladaptive, cognitive, and sensiormotor

Reliability and Validity- Internal consisitencity: strong with alpha of .83 for the ASQ, Interrater realibility: strong, correclation coefficient of .93 for the ASQ, content description validity: acceptable cofficent (.47-.67), Criterion prediction validity- accurate in distinguishing individuals with and without AS, Construct indentification validity- all items significantly related to the ASQ, making strong contributions to the measured construct
-Social Skills Rating System ( SSRS; Gresham & Elliot, 1990)
- used to gather information on social behaviors in children with special needs ( Prelock, 2006)
Assessment of Friendship Behaviors (Strain, 2001)
- " May be used to assess children with ASD as well as typical pees who may serve possible peer coaches for children with ASD" ( Prelock, 2006, pg. 272)
Theory of Mind Test
- assesses aspects of theory of mind
Test of pragmatic skills revised

-Age: 3-8 years

Descriptions: “using 4 different tasks and examiner probes in a play-based format, this tool attempt to elicit the following conversation intentions: answering, informing, naming, rejecting, requesting, reasoning, closing, calling”

Reliability and validity- none

Test of pragmatic language

Age: 5- 13 years

Description: “using pictures to establish a social context, this tool assesses a child's use of pragmatic language including abstraction, topic selection and use, speech acts visual-gestural cues”

Reliability and Validity- internal consistency- “.82 average across age groups, interscorer” reliability- .99, Content validity- model created to construct and control test item selection, concurrent validity- measured against teacher ratings of pragmatic skills and yielded a coefficient of .82

Ages and Stages Questionnaire
- developmental and socioemotional screening for children between birth and 6 years

Assessment of Pragmatic Language in Children with ASD:

Assessment of Pivotal Response Behaviors ( R. L. Kogel, 1996,2001)
- Key social behaviors that have long term developmental significance and should be examined ( Strain, 2001)
- Allows for practitioners to examine which behaviors may or may not occur. ( Strain, 2001)

Transdiciplinary Play based Assessment ( TPBA)
6 developmental play levels are assessed:
- Birth to 24 months- exploratory play
- 9 to 24 months- functional play
- 24+ months- constructive play
- 21- 72 months- symbolic play
- 36+ months- games and rules

The Peabody Motor developmental scale
- second edition ( Folio & Fewell, 2000),measures gross motor and find motor functioning
The motor free visual perception test- Revised ( Calorusso & Hammill, 1996)
- norm-referenced that assess visual-motor skills with drawing or copying requirements
- The School function assessment ( Coster, Deeney, Haltwangerm & Haley, 1998

Notes on Assessments:
The following additional notes were provided on blackboard and I attached them for educational purposes and will not be reduplicated:

In most cases, a stable diagnosis of ASD is possible before or around a child's second birthday (Chawarska, Klin, Paul, Macari, & Volkmar, 2009). An early, accurate diagnosis can help families access appropriate services, provide a common language across interdisciplinary teams, and establish a framework for families and caregivers within which to understand the child's difficulties. Any diagnosis of ASD, particularly of young children, is periodically reviewed, as diagnostic categories and conclusions may change as the child develops.

Interdisciplinary collaboration and family involvement are essential in assessing and diagnosing ASD; the SLP is a key member of a multidisciplinary team. In diagnosing ASD, it is important to have clinical experts agree that assessment results are consistent with the diagnostic characteristics of the disorder.

Assessment, intervention, and support for individuals receiving speech and language services are consistent with the World Health Organization's International Classification of Functioning, Disability, and Health (2001) framework. This framework considers impairments in body structures/functions, the individual's communication activities and participation, and contextual factors, including environmental barriers/facilitators and personal identity.

Early Indicators

There is evidence to suggest that diagnostic features of ASD are evident in very young children. Most families/caregivers report observing symptoms within the first 2 years of life and typically express concern by 18 months of age. Studies of children with ASD have found

parental reports of abnormalities in their children's language development and social relatedness were first noticed at about 14 months of age (Chawarska et al., 2007);

displays of significantly fewer joint attention and communication behaviors at 1 year of age than shown by their typically developing same-age peers (Osterling & Dawson, 1994; Werner & Dawson, 2005);

demonstrated atypical eye contact, passivity, decreased activity level, and delayed language by 12 months of age (Zwaigenbaum et al., 2005);

subtle differences in sensory-motor and social behavior (Baranek, 1999) as well as differences in the use of communicative gestures (Watson et al., 2013) by 9 to 12 months of age;

a decline (from normative levels) in eye fixation from 2 to 6 months of age not observed in infants who did not develop autism (Jones & Klin, 2013).

The identification of early behavioral indicators can help families obtain appropriate diagnostic referrals and access early intervention services, even before a definitive diagnosis is made (Woods & Wetherby, 2003). Furthermore, early intervention can improve long-term outcomes for many children (Dawson & Osterling, 1997; Harris & Handleman, 2000; Landa & Kalb, 2012).

There is research on the use of screening tools, including a broadband screener to identify communication delays (including ASD) in children from 9 to 24 months of age (Pierce et al., 2011; Wetherby, Brosnan-Maddox, Peace, & Newton, 2008) and questionnaire-based tools to screen for children at risk for ASD as early as 12 months of age (Turner-Brown, Baranek, Reznick, Watson, & Crais, 2012). There are also a number of algorithms and tools available to help physicians develop a strategy for early identification of children with ASD (Johnson & Myers, 2007).

Cultural and Linguistic Considerations

Cultural and linguistic variables may contribute to challenges in identifying children with ASD and contribute to the disparity in the diagnosis of ASD among some racial/ethnic groups (Begeer, El Bouk, Boussaid, Terwogt, & Koot, 2009; Dyches, 2011). For example, Begeer et al. (2009) found that Dutch pediatricians might be inclined to attribute social and communication problems of non-European minority groups to their ethnic origin, while attributing these same characteristics to autistic disorders in children from majority groups.

While the core characteristics of ASD are common across cultures, parental response to the symptoms are not; these characteristics may be viewed through a cultural lens leading to under-, over-, or mis-diagnosis (Dyches, Wilder, & Obiakor, 2001). Signs and symptoms that are clearly "red flags" in the U.S. health care or educational system may not be viewed in the same way for someone from a culture that may not define the disorder.

One factor contributing to the inaccurate classification and diagnosis of students with autism is the "families' cultural and linguistic interpretation and reaction to receiving the diagnosis and to obtaining services" (Wilder, Dyches, Obiakor, & Algozzine, 2004, p. 106). Some cultures view disability in a negative light and feel that it is something that needs to be hidden from others, which may influence the type of care the family seeks. See cultural competence and the table of diverse perspectives on symptoms of autism (Dyches, 2011).

Screening

Screening for ASD includes broadband screeners designed to detect developmental delays in the general pediatric population and autism-specific screening tools designed for either the general population or high-risk populations, such as children referred to the early intervention system. Any screening tool should have strong psychometric features to support its accuracy and be culturally and linguistically appropriate.

Screening typically includes

norm-referenced parent and teacher report measures,

competency-based tools, such as interviews and observations,

hearing screening to rule out hearing loss as a contributing factor to communication and behavior difficulties.

Screening procedures evaluate the main characteristics that differentiate ASD from other developmental disorders, including difficulties in

eye gaze,

orienting to one's name,

pointing to or showing objects of interest,

pretend play,

imitation,

nonverbal communication,

language development.

Social communication norms vary across cultures. When screening is conducted for non-linguistic aspects of communication, it is important to recognize when differences are related to cultural variances rather than secondary to a communication disorder. See cultural competence.

Loss of language or social skills at any age should be considered grounds for screening. In cases where children are being raised in a bilingual environment, consider whether language loss is attributable to language attrition. See bilingual service delivery.

Because children with ASD are often initially suspected of having a hearing problem, audiologists play a critical role in recognizing possible signs of ASD in children whose hearing they test and making appropriate referrals for screening and diagnosis of ASD.

Comprehensive Assessment

Individuals suspected of having ASD based on screening results are referred to an SLP, and other professionals as needed, for a comprehensive assessment. Assessment of social communication skills should be culturally sensitive, functional, and sensitive to the wide range of acceptable social norms that exist within and across communities; and involve the collaborative efforts of families, caregivers, classroom teachers, SLPs, special educators, and psychologists as needed.

The SLP's role includes incorporating a family perspective into the assessment, effectively eliciting information from families about their concerns, beliefs, skills, and knowledge in relation to the individual being assessed. It is important to convey information to families clearly and empathetically, with an understanding that the assessment and diagnosis process is likely to be stressful and emotion-laden for family members (Marcus, Kunce, & Schopler, 2005).

The diagnostic evaluation for individuals at risk for ASD typically includes

relevant case history, including information related to the child's health, developmental and behavioral history, and current medical status;

a medical evaluation, including general physical and neurodevelopmental examination, as well as hearing and vision testing;

medical and mental health history of the family;

a comprehensive speech and language assessment.

Assessment may also include evaluation of the potential benefit of using augmentative and alternative communication (AAC) to facilitate functional improvements.  See ASHA's Practice Portal page on Augmentative and Alternative Communication.

In addition, diagnostic evaluation may include

genetic testing, particularly if there is a family history of intellectual disability or genetic conditions associated with ASD (e.g., fragile X, tuberous sclerosis) or if the child exhibits physical features suggestive of a possible genetic syndrome;

metabolic testing, if the child exhibits symptoms such as lethargy, cyclic vomiting, pica, or seizures.

Speech and Language Assessment

Depending on the individual's age and abilities, the SLP typically assesses

receptive language;

expressive language, including sound and word production and the frequency and function of verbal (vocalizations/verbalizations) and nonverbal (e.g., gestures) communication;

literacy skills;

social communication (See social communication disorder and social communication benchmarks [PDF]), including

use of gaze,

joint attention,

initiation of communication,

social reciprocity and the range of communicative functions,

sharing affect,

play behaviors,

use of gestures;

conversational skills, including

topic management (initiating, maintaining, and terminating relevant, shared topics);

turn-taking;

providing appropriate amounts of information in conversational contexts;

speech prosody.

Comprehensive assessment for ASD typically includes the following.

Standardized Assessment—an empirically developed evaluation tool with established reliability and validity. Formal testing may be useful for assessing the structure and form of language, but may not provide an accurate assessment of an individual's use of language (i.e., pragmatics). Standardized tests should be culturally and linguistically appropriate, and standard scores should not be determined if the norming sample is not representative of the individual assessed.

Parent/Teacher/Self-Report Measures—rating scales, checklists, and/or inventories completed by the family member(s)/caregiver, teacher, and/or individual. Findings from multiple sources (e.g., family vs. teacher vs. self-report) may be compared to obtain a comprehensive profile of communication skills. When possible, parent checklists should be provided in their native language to obtain the most accurate information.

Ethnographic Interviewing—an interview technique that uses open-ended questions, restatement, summarizing for clarification, and avoidance of leading questions and "why" questions in order to develop an understanding of the individual's and the family's perceptions, views, desires, and expectations. See cultural competence.

Analog Task(s)—observation of the individual in simulated or staged communication contexts that mimic real-world events, including peer-group activities and simulated workplace interactions.

Naturalistic Observation—observation of the individual in everyday social settings with others. Criterion-referenced assessments may be used during naturalistic observations to document an individual's functional use of language across social situations.

Dynamic Assessment—a method that seeks to identify an individual's skills as well as his or her learning potential. Dynamic assessment is highly interactive and emphasizes the learning process over time. It can be used in conjunction with standardized assessments and for ongoing assessment following the diagnosis of ASD.

Assessment may result in

data that contribute to the diagnosis of ASD;

description of the characteristics and severity of communication-related symptoms;

recommendations for intervention, priorities and goals, and supports;

referral to other professionals for further testing if other disorders/conditions are suspected or for additional data to confirm the diagnosis of ASD.

Need For Ongoing Assessment

Following a diagnosis of ASD, ongoing assessment focusing on the skills most essential for social and communication development is conducted to

determine an individual's current profile of social communication skills,

identify priority learning objectives within natural communication contexts,

examine the influence of the communication partner and the environment on communication competence.

As part of the ongoing assessment process, dynamic assessment procedures can be used to identify the skills that an individual has achieved, those that may be emerging, and the contextual supports that enhance communication skills (e.g., AAC or modeling). Seeintervention goals associated with core challenges [PDF].

Special Considerations: Audiologic Assessment

Individuals with hearing loss may present with symptoms similar to those of ASD, particularly within the communication and socialization domains. For example, in the case of children with significant hearing loss or deafness,

when compared to peers with normal hearing, their speech may differ, and they may rely more heavily on gestures (Worley, Matson, & Kozlowski, 2011);

the inability to hear may limit social interaction with peers and lead to the kind of deficits in social skills often seen in children with ASD.

It is also possible for an individual to have both ASD and hearing impairment (Easterbrooks & Handley, 2005; Malandraki & Okalidou, 2007; Szymanski & Brice, 2008). The similarities in communication and socialization symptoms between hearing impairment and ASD populations, along with the possibility of dual diagnosis, can present challenges for differential diagnosis. An audiologic assessment is conducted when hearing loss and/or ASD are suspected.

Some characteristic behaviors associated with ASD may make it challenging to obtain valid and reliable hearing assessment results. These include comfort with sameness and aversion to novel situations; hypersensitivity to sensory input and negative behavioral responses; and communication differences, such as receptive language deficits and unreliable pointing gestures (Davis & Stiegler, 2010). Suggestions for assessing hearing in individuals with these and other challenging behaviors include

minimizing distractions in the test suite;

using visual schedules to support audiological testing sequence;

partnering with parents and the managing SLP, who are more familiar with the individual's behaviors, interests, and needs;

using the individual's primary/preferred language form (e.g., spoken language, sign, AAC devices, or picture symbols);

increasing the individual's familiarity with assessment procedures prior to testing, such as through the use of social stories (Gray, White, & McAndrew, 2002), a visual schedule, and/or practicing with a favorite doll or stuffed animal;

allowing the individual to touch and explore earphones that will be used during testing to help him or her overcome tactile sensitivity and related anxiety;

incorporating flexibility in the assessment situation (e.g., testing order or earphone type);

practicing appropriate motor movements in response to test stimuli;

knowing what is reinforcing to the individual (e.g., food, clips from favorite videos, playing with a favorite toy) and using these reinforcers to reward appropriate behavioral responses to test stimuli;

considering the use of multiple sessions to obtain complete results;

being aware of the individual's signs of distress and terminating testing before the situation escalates (Brueggeman, 2012; Davis & Stieger, 2010);

considering the need for auditory brainstem response (ABR) testing when behavioral audiometry is not possible.

Special Considerations in the School Setting

Within a public school setting, eligibility for services under the disability category of autism is based on the definition provided in the Individuals with Disabilities Education Improvement Act of 2004 (IDEA, 2004):

Autism means a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age 3, which adversely affects a child's educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences. The term does not apply if a child's educational performance is adversely affected primarily because the child has an emotional disturbance as defined by IDEA criteria.

A child who manifests the characteristics of "autism" after age 3 could be diagnosed as having "autism" if the criteria in the preceding paragraph are met.

34 C.F.R. ß 300.7(c)(1)

By their very nature, severe social communication challenges impinge on participation and progress in the general education curriculum, extracurricular settings, and other nonacademic settings, as specified as the basis for eligibility of services by IDEA. Therefore, the pervasive nature of the social communication challenges in individuals with ASD supports the decision-making process to determine eligibility for language services in the schools (IDEA, 2004).

Individuals diagnosed with an ASD by means of other sources of clinical criteria, such as the DSM-5 (American Psychiatric Association, 2013), are likely to be eligible for special education services under the category of autism as defined above, due to the common challenges and deficits in social communication functioning across the various severity levels on the autism spectrum.

Inappropriate Exclusion of Services

As mandated by IDEA, a priori criteria should be avoided when making decisions regarding eligibility for services. Such criteria include the following.

Cognitive referencing. This practice of comparing IQ scores and language scores to determine eligibility for speech-language intervention is based on the assumption that language functioning cannot surpass cognitive levels.

Chronological age. Research has shown that infants, toddlers, and preschoolers with ASD do benefit from communication services and supports ( Garfinkle & Schwartz, 2002; Lawton & Kasari, 2012; Pierce et al., 2011). In addition, individuals with autism can continue to develop communication abilities across their lifespan (Hamilton & Snell, 1993; Pickett, Pullary, O'Grady, & Gordon, 2009; Watanabe & Sturmey, 2003).

Diagnostic label. A diagnostic label on its own typically reveals very little about the individual's communication abilities; however, in the case of the autism spectrum, social communication impairment is encompassed in its very definition (Baron-Cohen, Allen, & Gillberg, 1992; DiLavore, Lord, & Rutter, 1995; Lord & Corsello, 2005). Therefore, the diagnosis of ASD indicates the inclusion of communication services and supports rather than the exclusion of services.

Absence of cognitive or other prerequisite skills. Research has shown that individuals (including those with ASD) who do not demonstrate supposed prerequisites can benefit from appropriate communication services and supports (Amato, Barrow, & Domingo, 1999; Bondy & Frost, 1998; Moes & Frea, 2002);

Failure to benefit from previous communication services. Lack of progress may be tied to issues other than factors associated with the individual, such as inappropriate goals, unsuitable intervention methods, failure to incorporate assistive technology, or insufficient methods in measuring outcomes (National Joint Committee, 2003). Access to communication services and supports should not be denied merely because an individual failed to progress as a function of prior therapy; rather, previous experiences should be examined in order to determine ways in which communication services and supports could be better tailored to meet the individual's unique communication needs.

Lack of funding or adequately trained personnel. Lack of funding and expertise often fuels exclusionary practices. If trained personnel are not available, there is an obligation either to find trained personnel or to train existing personnel (Timothy W. v. Rochester, NH School District, 1989). Similarly, lack of funding does not constitute a reason for exclusion from communication services and supports. IDEA states that identified needs have to be met.

Challenges of Identifying Higher Functioning Individuals

High-functioning individuals with ASD pose particular challenges both for identification and for determining eligibility for services. These individuals often have either verbal or nonverbal intelligence within normal limits and appear to succeed in some or most academic subjects, particularly in early school years. As a result, many are not diagnosed until later school age, adolescence, or even adulthood. Long-term outcomes research for these individuals has shown that social communication deficits significantly affect their ability to adjust to new social demands in later academic and community settings and to achieve vocational goals (Gilchrist et al., 2001; Mueller, Schuler, Burton, & Yates, 2003; Tsatsanis, Foley, & Donehower, 2004). These findings suggest that it is important to provide intervention to address the gap between cognitive potential and social adaptive functioning.

Determining an individual's eligibility for educational services necessitates the use of a variety of strategies for gathering information, including standardized measures of social adaptive functioning, naturalistic observation across a range of social settings, and caregiver/teacher interviews or questionnaires. However, regardless of the assessment measures or tools used, the clinician needs to be aware of any subtle signs and symptoms consistent with a diagnosis of ASD.

Treatment strategies

Individuals with ASD have unique needs with respect to learning independence and self-advocacy due to their core challenges in social interaction and verbal and nonverbal communication. SLPs can contribute to the independence and self-advocacy of individuals with ASD by ensuring each individual has a functional communication system (including AAC) and by supporting communication in different social settings with a variety of partners to promote generalization of skills.

Treatment for individuals with ASD typically includes

setting goals based on assessment data that target the core deficits in ASD and focus on initiating spontaneous communication in functional activities, engaging in reciprocal communication interactions, and generalizing gains across activities, environments, and communication partners;

using a multimodal communication system (e.g., spoken language, gestures, sign language, picture communication, speech-generating devices [SGDs], and/or written language) that is individualized according to the individual's abilities and the contexts of communication;

considering family priorities when selecting intervention goals—meaningful outcomes are strongly correlated with communication competence across functional social contexts (e.g., home, school, vocational, and community settings);

incorporating cultural, linguistic, and personal values and attributes unique to each individual into therapeutic activities;

using a range of approaches for enhancing communication skills along a continuum from behavioral to developmental;

using developmental sequences and processes of language development to provide a framework for determining baselines and implications for intervention goals;

measuring progress using systematic methods to determine whether an individual with ASD is benefiting from a particular treatment program or strategy.

Core challenges of ASD take different forms as an individual responds to intervention and progresses through developmental stages from prelinguistic to emerging language and advanced language stages. Actual goals will vary based on those aspects of development that are consistent with family priorities and with the individual's functional needs within his or her current social contexts.

A number of treatment modes/modalities and options are described below. When selecting a treatment mode/modality or option, the SLP matches the treatment with the intervention goals and priorities appropriate for the individual's developmental stage. For example, a treatment that is evidence-based for an individual at the emerging language stage may not be evidence-based for an individual at the prelinguistic stage.

Treatment Modes/Modalities

Treatment modes and modalities are technologies or other support systems that can be used in conjunction with or in the implementation of various treatment options. For example, video-based instruction can be used in peer-mediated interventions to address social skills and other target behaviors.

Augmentative and Alternative Communication (AAC)

AAC involves supplementing or replacing natural speech and/or writing with aided (e.g., Picture Exchange Communication System [PECS], line drawings, Blissymbols, speech generating devices, and tangible objects) and/or unaided (e.g., manual signs, gestures, and finger spelling) symbols. Whereas aided symbols require some type of transmission device, production of unaided symbols only requires body movements. For more information on speech-generating devices for children with autism, see van der Meer and Rispoli (2010).

Activity Schedules/Visual Supports

Activity schedules/visual supports include objects, photographs, drawings, or written words that act as cues or prompts to help individuals complete a sequence of tasks/activities, attend to tasks, transition from one task to another, or behave appropriately in various settings. Written and/or visual prompts that initiate or sustain interaction are called scripts. Scripts are often used to promote social interaction, but can also be used in a classroom setting to facilitate academic interactions and promote academic engagement (Hart & Whalon, 2008).

Computer-Based Instruction

Computer-based instruction involves the use of computer technology (e.g., iPADs) and/or computerized programs for teaching language skills, including vocabulary, social skills, social understanding, and social problem solving.

Video-Based Instruction

Video-based instruction (also called video modeling) is an observational mode of teaching that uses video recordings to provide a model of the target behavior or skill. Video recordings of desired behaviors are observed and then imitated by the individual. The learner's self-modeling can be videotaped for later review.

Treatment Options

There are many different intervention approaches and strategies for individuals with ASD. Programs differ in the method used to address goals; approaches range from discrete trial, traditional behavioral therapies to social-pragmatic, developmental therapies (Prizant & Wetherby, 1998). Programs also differ in how goals are prioritized and addressed; focused interventions rely heavily on individual strategies, used alone or in combination, to target specific skills or behaviors (e.g., to increase verbalization), while comprehensive interventions involve multiple treatment strategies/treatment packages to target a broad range of skills or behaviors (e.g., to enhance learning).

SLPs and educators determine which methods and strategies are effective for a particular student/client by taking into consideration the individual's level of social and linguistic development, cultural background and values, personal preferences, family resources, learning style, behavior repertoire, and communication needs.

Below are brief descriptions of both general and specific treatments for addressing ASD. Some attempt has been made to organize treatment options into broader categories, recognizing that several approaches have components of more than one broader category (e.g., the Early Start Denver model combines developmental approaches with behavioral teaching strategies).

Auditory/Sensory Integration Training

Broadly speaking, sensory integration therapies are used to treat integration dysfunction in one or more sensory systems. Treatments can include physical exercise, sensory/tactile stimulation, and auditory integration training. Auditory integration therapy (e.g., the Berard method) involves exercising the middle ear muscles and auditory nervous system to treat distortions/dysfunctions of the auditory system (Berard, 1993).

Behavioral Interventions/Techniques

Behavioral interventions and techniques are designed to reduce problem behaviors and teach functional alternative behaviors using the basic principles of behavior change. These methods are based on behavioral/operant principles of learning; they involve examining the antecedents that elicit a certain behavior, along with the consequences that follow that behavior, and then making adjustments in this chain to increase desired behaviors and/or decrease inappropriate ones.

Behavioral interventions range from one-to-one discrete trial instruction to naturalistic approaches that focus only on communication, on communication as well as other aspects of educational programming, or on replacing maladaptive behaviors that are being used for communication.

Examples of behavioral interventions include the following:

Applied Behavior Analysis (ABA)—a treatment approach that utilizes principles of learning theory to bring about meaningful and positive change in behavior. ABA techniques have been developed for individuals with autism to help build a variety of skills (e.g., communication, social skills, self-control, and self-monitoring) and help generalize these skills to other situations. The techniques can be used in both structured (e.g., classroom) and everyday (e.g., family dinnertime) settings and in one-on-one or group instruction.

Intervention is customized, based on the individual's needs, interests, and family situation. ABA techniques are often used in intensive, early intervention (below age 4 years) programs to address a full range of life skills. Intensive programs total from 25 to 40 hours per week for 1 to 3 years. Qualifications for providing ABA therapy to individuals with autism may vary by state; check with your state, as this may have an impact on reimbursement.

Discrete Trial Training (DTT)—a one-to-one instructional approach utilizing behavioral methods to teach skills in small, incremental steps in a systematic, controlled fashion. The teaching opportunity is a discrete trial with a clearly identified antecedent and consequence (e.g., reinforcement in the form of praise or tangible rewards) for desired behaviors. DTT is most often used for skills that learners are not initiating on their own, have a clear, correct procedure, and can be taught in a one-to-one setting.

Functional Communication Training (FCT)—a behavioral intervention program that combines the assessment of the communicative functions of maladaptive behavior with ABA procedures to teach alternative responses. Problem behaviors can be eliminated through extinction and replaced with alternate, more appropriate forms of communicating needs or wants. FCT can be used with children with ASD across a range of ages and regardless of cognitive level or expressive communication abilities (Carr & Durand, 1985).]

Incidental Teaching—a teaching technique that utilizes behavioral procedures; naturally occurring teaching opportunities are provided, based on the child's interests. Following the child's lead, attempts to communicate are reinforced as these attempts get closer to the desired communication behavior (McGee, Morrier, & Daly, 1999)

Milieu Therapy—a range of methods (including incidental teaching) that are integrated into a child's natural environment. It includes training in everyday environments and during activities that take place throughout the day, rather than only at "therapy time" (Kaiser, Yoder, & Keetz, 1992).

Pivotal Response Treatment (PRT)—a play-based, child-initiated behavioral treatment. Formerly referred to as Natural Language Paradigm (NLP), PRT has as its goals to teach language, decrease disruptive behaviors, and increase social, communication, and academic skills. Rather than target specific behaviors, PRT targets pivotal areas of development (response to multiple cues, motivation, self-regulation, and initiation of social interactions) that are central to—and result in improvements across—a wide range of skills (Koegel & Koegel, 2006). PRT emphasizes natural reinforcement (e.g., the child is rewarded with an item when a meaningful attempt is made to request that item).

Positive Behavior Support (PBS)—uses functional assessment of problem behaviors to target the relationship between challenging behavior and communication. It integrates principles of applied behavior analysis with person-centered values to foster skills that replace challenging behaviors. The clinician carefully analyzes the functions of the behavior(s) and develops and implements prevention strategies (i.e., antecedent packages) to foster the client's successful use of replacement skills to produce positive response in social interactions. PBS can be used to support children and adults with autism who demonstrate problem behaviors (Carr et al., 2002).

Self-Management—an approach that involves interventions aimed at helping individuals learn to independently regulate their behaviors and behave appropriately in a variety of contexts. Individuals learn to tell the difference between appropriate and inappropriate behaviors, monitor and record their behaviors, and reward themselves for using appropriate behaviors. Self-management interventions can be used across a wide range of ages from early childhood through adulthood.

Time Delay—a behavioral method of teaching that fades the use of prompts during instruction. For example, the time delay between initial instruction and any additional instruction or prompting is gradually increased as the individual becomes more proficient at the skill being taught. Time delay can be used with individuals regardless of cognitive level or expressive communication abilities.

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is an intervention approach that combines cognitive and behavioral learning principles to shape and encourage desired behaviors. The underlying assumptions of CBT are that an individual's behavior is mediated by maladaptive patterns of thought or understanding and that change in thinking or cognitive patterns can lead to changes in behavior. CBT is used primarily to help individuals with ASD improve behavior by learning to regulate emotions and control impulses. Examples of programs/approaches that incorporate CBT principles include the following.

Exploring Feelings—a structured cognitive behavior therapy program designed to encourage the cognitive control of emotions (anxiety and anger). Sessions include activities to explore specific feelings (e.g., being happy, relaxed, anxious or angry). A follow-up implementation project is completed by the child prior to the next session. The Explore Feelings program was designed for small groups of children between the ages of 9 and 12, but it can be modified for use with only one child (Attwood, 2004).

Rational Emotive Behavioral Therapy—a therapy approach that focuses on helping the individual acknowledge the problems that are upsetting him/her, accept emotional responsibility for these problems, and be empowered to change. The ultimate goal is to be able to lead a happier, more fulfilling life (Ellis & Dryden, 1997).

Social Thinking®—a cognitive-based treatment framework for preschool and school-age children and adults with social learning challenges (including ASD, social communication disorder, and other related diagnoses). It comprises strategies to target pragmatic language, social emotional learning, perspective taking, and social skills. The framework, based in CBT, teaches individuals to understand the "thinking" underlying the production (Lee et al., 2009; Winner & Crooke, 2009, 2011).

Denver Model

The Denver Model is a child-led, play-based treatment approach that focuses on the development of social communication skills through intensive one-on-one therapy, peer interactions in the school setting, and home-based teaching (Rogers & Dawson, 2009). The Early Start Denver Model for toddlers is an extension of the Denver Model; it combines developmental approaches with behavioral teaching strategies and can be delivered in a variety of settings (e.g., by the therapist and/or parents in group or individual sessions in the clinic or at home).

Gentle Teaching

Gentle Teaching is a framework for serving individuals with special needs that focuses on providing companionship and open, loving support and guidance. Gentle teaching uses the relationship between the individual and his/her caregiver as the foundation for teaching. The aim is to develop a safe and loving environment in which the individual can develop talents and reach his/her full potential. This approach eliminates punishment as a way to control behavior; it includes errorless learning, choice making, and fading prompts (Jones & McCaughey, 1992; McGee, 1990).

Literacy Intervention

Literacy intervention approaches incorporate a variety of instructional strategies to improve word decoding, word identification, reading fluency, reading vocabulary, and reading comprehension across a variety of materials and in a number of contexts. Depending on the student's skill level, instructional strategies might include engaging in shared book reading, teaching literacy in natural contexts, labeling objects/pictures to promote sight word reading, reading and writing about personal experiences, promoting phonological awareness, and teaching the student how to monitor comprehension while reading. For a review of strategies for promoting literacy, see Lanter and Watson (2008).

Parent-Mediated/Implemented Intervention

Parent-mediated or implemented intervention consists of parents' using direct, individualized intervention practices with their child to increase positive learning opportunities and acquisition of skills.

More Than Words—a Hanen Program® that offers a parent-directed approach focusing on day-to-day life, taking advantage of everyday activities to help the child improve communication and social skills (Sussman, 1999). This program is typically used for early language intervention with young children with ASD.

Talkability™—a Hanen Program® for parents of verbal children with ASD. The program teaches parents practical ways to help their child learn people skills, such as "tuning in" to the feelings and thoughts of others by attending to nonverbal cues, such as body language, facial expressions, and tone of voice. The ability to consider the point of view of others and have empathy are considered essential for successful conversation and for making friends (Sussman, 2006).

Son-Rise—a child-centered, parent-directed, and relationship-based approach, based on the view that autism is a social connecting disorder (Kaufman, 1995). Parents and facilitators join in the child's repetitive behaviors until the child demonstrates a willingness to engage in play; more complex social interactions are then encouraged in a nonthreatening way. The Son-Rise program is used with children and adults with ASD and other developmental difficulties.

Peer-Mediated/Implemented Treatment

Peer-mediated or implemented treatment approaches incorporate peers as communication partners for children with ASD in an effort to minimize isolation, provide effective role models, and boost communication competence. Typically developing peers are taught strategies to facilitate play and social interactions; interventions are commonly carried out in inclusive settings where play with typically developing peers naturally occurs (e.g., preschool setting).

LEAP—a multi-faceted program for preschool children with ASD (Hoyson, Jamieson, & Strain, 1984). LEAP utilizes a variety of strategies and methods, including ABA, peer-mediated instruction, self-management training, prompting, and parent training. LEAP is implemented in a classroom setting consisting of children with ASD and typically developing peers and designed to support child-directed play.

Circle Of Friends—a treatment approach that uses the classroom peer group to improve the social acceptance of a classmate with special needs by setting up a special group or "circle" of friends. The focus is on building behaviors that are valued in everyday settings. The application of skills to new and appropriate situations is reinforced as naturally as possible as they occur (Whitaker, Barratt, Joy, Potter, & Thomas, 1998).

Integrated Play Groups—a therapy model designed to support children of different ages and abilities with ASD in mutually enjoyed play experiences with typical peers and siblings. Small groups of children play together under the guidance of an adult facilitator. The focus is on maximizing the child's potential and his/her intrinsic desire to socialize with peers (Wolfberg & Schuler, 1993).

SCERTS

SCERTS—social communication (SC), emotional regulation (ER), and transactional support (TS)—is a comprehensive framework for targeting critical intervention goals relevant to the individual's stage of social, emotional, and communication development. The supports integrated into this framework fall under the transactional support process and are focused on enabling families, service providers, and members of the community to effectively implement evidenced-based teaching strategies in "real world" activities. The SCERTS Model is a comprehensive educational approach used with children of various ages, from preschool through school age (Prizant, Wetherby, Rubin, Laurent, & Rydell, 2006).

Social Communication Interventions

Social communication treatment approaches and frameworks are designed to increase social skills, using social group settings and other platforms to teach peer interaction skills and promote socially appropriate behaviors and communication. There continues to be research in the development of social communication treatment approaches (Adams et al., 2012). The following is not an exhaustive list; SLPs are encouraged to research additional social communication treatment programs and approaches.

JASPER (Joint Attention Symbolic Play Engagement Regulation)—a treatment approach that combines developmental and behavioral principles. This approach targets the foundations of social communication (joint attention, imitation, play) and uses naturalistic strategies to increase the rate and complexity of social communication. The approach incorporates parents and teachers into implementation of intervention to promote generalization across settings and activities and to ensure maintenance over time (Kasari, Paparella, Freeman, & Jahromi, 2008).

Score Skills Strategy—a social skills program that takes place in a cooperative small group and focuses on five social skills: (S) share ideas, (C) compliment others, (O) offer help or encouragement, (R) recommend changes nicely, and (E) exercise self-control (Vernon, Schumaker, & Deshler, 1996).

Social Scripts—a prompting strategy used to teach children to use a variety of language skills during social interactions. Scripted prompts (visual and or verbal) are gradually faded out as children use new language skills more spontaneously (Nelson, 1978).

Social Skills Groups—groups in which appropriate ways of interacting with typically developing peers are taught through direct instruction, role-playing, and feedback. Groups typically consist of two to eight individuals with social communication disorders and a teacher or adult facilitator.

Social Stories™—a highly structured intervention that uses stories to explain social situations to children and to help them learn socially appropriate behaviors and responses (Gray et al., 2002).

Relationship-Based Intervention

Relationship-based practices in early intervention are aimed at supporting parent-child relationships (Edelman, 2004; Gutstein, Burgess, & Montfort, 2007).

Greenspan/Dir/Floortime—a model that promotes development by encouraging children to interact with parents and others through play. The model focuses on following the child's lead; challenging the child to be creative and spontaneous; and involving the child's senses, motor skills, and emotions (Greenspan, Weider, & Simons, 1998).

Project Data (Developmentally Appropriate Treatment For Autism)—a model for developing, implementing, evaluating, and disseminating a program for young children with autism and their families. The project emphasizes best practice from early childhood special education combined with applied behavioral analysis to develop intervention strategies for the classroom and community settings (Center on Human Development and Disability, n.d.).

Relationship Development Intervention® (RDI)—a family-based, behavioral treatment designed to address the core symptoms of autism. It is based on the theory that dynamic intelligence (the ability to think flexibly) is the key to improving the quality of life for individuals with ASD. RDI helps individuals form personal relationships by strengthening the building blocks of social connections, including the ability to form emotional bonds and share experiences. Parents, teachers, and other caregivers can be involved in the implementation of RDI (Gutstein & Gutstein, 2009).

TEACCH

TEACCH (Treatment and Education of Autistic and Related Communication Handicapped Children) is a university-based system of community regional centers that provides clinical services, such as diagnostic evaluations, parent training and parent support groups, social play and recreation groups, individual counseling, and supported employment (Mesibov, Shea, & Schopler, 2007). TEACCH combines developmentally appropriate practice with behavioral techniques (e.g., environmental control/structure) and family collaboration and involvement.

Special Consideration For Transitioning Youth And Post-Secondary Students

The transition from adolescence to young adulthood can be challenging for individuals with or without disabilities. The core challenges associated with ASD can present added challenges to success in post-secondary educational programs, employment, maintaining relationships, and acquiring the skills necessary for independent living (Howlin & Moss, 2012; Zager & Alpern, 2010). These findings highlight the need for continued support to facilitate a successful transition to adulthood. SLPs are involved in transition planning and may be involved to varying degrees in other support services beyond high school.

Support for transitioning individuals with ASD includes, but is not limited to, the following.

Transition Planning—the development of a formal plan during the transition year of high school that includes identifying career goals and educational needs; providing career counseling and opportunities for work experiences; and providing training in communication skills unique to academic, employment, and community settings. Effective transition planning involves the student as an active, respected participant of the team (Wehman, 2006) as well as his/her family, who can provide valuable information about the student's needs.

Disability Support Services—individualized support for college-level students that can include academic accommodations if needed and social communication supports (e.g., counseling, support groups).

Vocational Support Services—including assessments to identify vocational strengths, career counseling, training in social skills for the workplace, vocational training, résumé preparation, interview practice, job search and job placement, and on-the-job supports such as reasonable workplace modifications and job coaching (Hendricks, 2010; Van Bourgondien & Woods, 1992)

Housing—including transition from the family home to a group home, semi-independent residence, or independent living environment (Lawrence, Alleckson, & Bjorklund, 2010). Residential settings are often small, community-based settings designed to support independence, community living skills, and continued collaboration between persons with autism and their family members, residential staff, case managers, SLPs, job coaches, etc.

Community Integration—providing opportunities for social involvement and the development of friendships. A peer mentor can serve as a role model and source of social skills information and feedback in these settings (Lawrence, Alleckson, & Bjorklund, 2010).

Service Delivery Options

In addition to determining the type of speech and language treatment that is optimal for children with social communication disorders, SLPs consider other service delivery variables—including format, provider, dosage, and timing—that may impact treatment outcomes.

Format: whether a person is seen for treatment one-on-one (i.e., individual) or as part of a group

Provider: the person providing treatment (e.g., SLP, trained volunteer, caregiver)

Dosage: the frequency, intensity, and duration of service

Timing: the timing of intervention relative to the diagnosis

Setting: the location of treatment (e.g., home, community-based, school)

Learning in natural learning environments appears to be the most effective intervention approach. Not only do such environments invite higher rates of initiation and generalization, they also enhance the ecological validity of the intervention (NRC, 2001).

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Additional Disorders Discussed: Cerebral Palsy 

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Cerebral Palsy

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Additional Disorders Discussed: Fetal Alcohol Syndrome 

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Additional Disorders Discussed: Fetal Alcohol Syndrome 