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An Expert Discussion on Strengths-Based Approaches in Autism

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An Expert Discussion on Strengths-Based Approaches in Autism

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Urbanowicz et al. - An expert discussion on strengths-based approaches in autism

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Social conformity and autism spectrum disorder: a child-friendly take on a classic study

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Social conformity and autism spectrum disorder: a child-friendly take on a classic study

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Social conformity and autism spectrum disorder: a child-friendly take on a classic study. - PubMed - NCBI

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Special Interests and Subjective Wellbeing in Autistic Adults

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Special Interests and Subjective Wellbeing in Autistic Adults

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The Survey of Favorite Interests and Activities: Assessing and understanding restricted interests in children with ASD

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The Survey of Favorite Interests and Activities: Assessing and understanding restricted interests in children with ASD

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The Survey of Favorite Interests and Activities

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Teaching Children with ASD with Restricted Interests: A Review of Evidence for Best Practice

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Teaching Children with ASD with Restricted Interests: A Review of Evidence for Best Practice

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Gunn & Delafield Butt_Teaching children with asd with restricted interests_review of evidence for bp

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Prevalence of Clinically and Empirically Defined Talents and Strengths in Autism

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Prevalence of Clinically and Empirically Defined Talents and Strengths in Autism

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Prevalence of Clinically and Empirically Defined Talents and Strengths in Autism

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Outstanding skills, including special isolated skills (SIS) and perceptual peaks (PP) are frequent features of autism. However, their reported prevalence varies between studies and their co-occurrence

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A Strength-Based Approach to Parent Education for Children With Autism

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A Strength-Based Approach to Parent Education for Children With Autism

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SAGE Journals: Your gateway to world-class journal research

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Subscription and open access journals from SAGE Publishing, the world's leading independent academic publisher.

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Known for My Strengths: Positive Traits of Transition-Age Youth With Intellectual Disability and/or Autism

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Known for My Strengths: Positive Traits of Transition-Age Youth With Intellectual Disability and/or Autism

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SAGE Journals: Your gateway to world-class journal research

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Subscription and open access journals from SAGE Publishing, the world's leading independent academic publisher.

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DINOSAURS 24/7: UNDERSTANDING THE SPECIAL INTERESTS OF CHILDREN WITH ASPERGER'S

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DINOSAURS 24/7: UNDERSTANDING THE SPECIAL INTERESTS OF CHILDREN WITH ASPERGER'S

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What do a quirky lawyer, a child lost during a museum field trip, a family who needs a new home, a boy who witnessed the murder of his parents, a doctor who bonds with a mysterious young patient, an 18 year old woman dealing with the sensory chaos of New York City, and an out-of-control toddler have in common? All were featured in prime time television programs in 2006, fictional or reality-based, which centered on a character with Asperger's Syndrome. Boston Legal, Without a Trace, Extreme Makeover Home Edition, Cold Case, House, All My Children, and Supernanny each ran episodes in 2006 focusing on Asperger's Syndrome. The Apprentice, Numb3rs, the Discovery Channel, the Jane Pauley Show, ER, and The Closer also featured programs on this syndrome. Christian Clemenson, the actor who plays a gifted lawyer with Asperger's Syndrome on Boston Legal, won an Emmy for Best Guest Actor in a Drama Series this year. In October, comedian Jon Stewart hosted a Comedy Central Benefit for Autism Education at New York's Beacon Theatre.

Clearly, the media and the prime time public are spellbound by Asperger's Syndrome. Some programs presented factual representations, others wildly fictional, but the theme draws viewers, especially when the story line includes the unusual special interest of the central character. While television producers benefit from this attractive topic, however, thousands of real families live every minute of their lives caring for their children with Asperger's Syndrome. One of the most fascinating aspects of Asperger's Syndrome is the special interest areas in which over 90% of individuals with Asperger's Syndrome engage. ¹

Little research has been conducted into the special interests of children and youth with Asperger's Syndrome. Although parents, educators, and experts in the field of Asperger's seem well aware of the existence of these special interests, our review of the literature indicates that no one has researched the origin and development of such interests in children and youth with the Syndrome. 2,3,4,5,6,7 Nor has anyone explored the effect of special interests on the social, communication, and emotional skills and deficits of children and youth with Asperger's, or how special interests might be integrated most effectively into school, home, and community.

The purpose of our exploratory study was to evaluate the impact of special interest areas (SIAs) on children and youth with Asperger's, as well as on their families. ⁸ The lead author and her graduate students began this study in January, 2005 with a methodical search of the existing literature on the special interests individuals with Asperger's. The research team then identified a research question, designed an appropriate study, and obtained university and school district approval to conduct the study. We defined SIAs as those passions that capture the mind, heart, time, and attention of individuals with Asperger's, providing the lens through which they view the world. ⁹

During the summer of 2005, the research team conducted the study and gathered both qualitative and quantitative data from the study participants and their parents/guardians. The research team then spent the fall and winter of 2005 analyzing the data they had obtained. Various members of the research team presented the results of the study at two national conferences: the National Council for Exceptional Children conference in Salt Lake City, Utah in April, 2006 and the National Autism Society of America conference in Providence, Rhode Island in July, 2006.

How Did We Conduct This Study?

This section summarizes the methods used to conduct the study including how participants were selected, demographic information about the participants and their parents/guardians, the development of the interview instruments, and the conduct of the interviews. 10,11

With school districts' permission, we contacted the parents/guardians of children and youth who were scheduled to participate in one of two summer extended school year (ESY) programs for students with Asperger's Syndrome. All of the children and youth had a diagnosis of Asperger's and were on individualized education programs (IEPs) which included ESY participation. Five districts in the Pacific Northwest gave us permission to contact the parents or guardians of their 30 ESY students. We sent letters to all 30 parents/guardians inviting them and their children and youth to participate in our study. Twenty-six of the 30 parents/guardians agreed to allow their children to participate, a response rate of 87%. Of those 26 children and youth who received permission to participate, 24 agreed to be interviewed for a response rate of 92%. Twenty-one participants were male and three were female, and they ranged in age from 7 to 21 years. Twenty-two children and youth were Non-Hispanic White and two were Native American/Alaskan. After completing the interviews, we determined that one of the 24 participants did not have a diagnosis of Asperger's, and her data was excluded.

We also invited the participants' parent or guardians to respond to a written survey whether or not they gave permission for their children and youth to participate in the study. Eighteen parents returned their surveys, a response rate of 63%. Fifteen of the 18 parents had some college education or held college degrees. Ten of the 18 parents earned an annual salary of $40,000 or more. Sixteen parents identified as Non-Hispanic White, two identified as Native American/Alaskan, and one declined to disclose his/her ethnicity. Parents reported spending between $100 and $5,000 annually on their child's special interest, including expenses such as related clothing, personal items, toys or objects, books, software, supplies, classes, outings, and overnight trips.

The research team designed two sets of questions to be used to collect data. The questionnaire used for the interviews with participants consisted of a set of 14 items with clarifying questions to be used as needed. The items were designed to gather information about the participants' special interest areas (SIAs), the length of time participants had engaged in their SIAs, participants' chosen method of learning about their SIAs, and how much time participants' spent on their SIAs.

The second questionnaire was a 40-item survey for parents or guardians who had the option of requesting an anonymous telephone interview instead of completing the written survey. Personnel from the participating districts mailed the surveys to the participants' homes, and parents or guardians returned them in envelopes with no identifying marks so that they were anonymous. Survey themes reflected in the questions included (a) the developmental history of the participant's SIA, (b) family history of similar interests, (c) the amount of time that the student spent daily and weekly in pursuing the interest, (d) the impact of the interest on siblings and family life, (e) ways in which parents supported their children and youth's SIAs, and (f) parents' attitudes and beliefs about their child's or youth's SIAs.

The graduate students on the research team conducted all of the interviews under the supervision of the authors. The interviewers worked in teams with one interviewer responsible for conducting an interview with a participant while the second interviewer was responsible for monitoring time limits, preparing forms, running the tape recorders, and taking field notes. The members of an interview team traded roles after each interview. Interviews lasted for 20-25 minutes. After all of the interviews were concluded, the research team provided an ice cream party for the participants and for the ESY program staff.

Analyzing the Children's Interviews

Working in teams, we transcribed all of the interviews and then coded the transcripts for themes. We identified 75 sub-themes such as specific types of strategies participants used to learn about their SIAs, including reading about their SIAs, researching online or at a library, talking to experts or exchanging email with professionals in their SIAs, watching videos, or taking classes relevant to their SIAs. We organized these 75 themes into related groups, and in teams of two, the researchers wrote memos, or series of paragraphs, that paraphrased the essential ideas from each grouped theme. Concurrent with this activity, interview field notes and parent surveys were also transcribed. The research team discussed this data and how it impacted, supported, or contradicted the content of the interviews.

Throughout each step of the research process, team members exchanged their work to critique the accuracy, quality, integrity, reliability, and validity of each person's work. No evidence-based conclusions were decided upon until team members agreed that the conclusions accurately represented the data to the best of our ability.

What Did We Learn?

We organized our findings into the following areas: (a) categories of SIAs, (b) the fusion of SIAs and identity, (c) gender differences in SIAs, (d) parents' knowledge about and feelings towards SIAs, (e) peers' perceptions of SIAs and how those perceptions negatively affect children and youth with Asperger's, and (f) the impact of SIAs on classic Asperger's deficits.

Categories of SIAs
Note: Although N=23 in our study, the interests do not total 23 because two participants shared the same special interest.
Although 7 of the boys in our study identified video games as their SIA, further analysis of the interviews revealed that often the boys hid their true SIAs in order to gain social acceptance from their peers. Participants often used video games or other popular interests as a social bridge, even if these interests were not their true SIAs. We labeled this practice the masking of special interests because we found that participants used this technique to hide perceived socially unacceptable SIAs from their peers while still interacting with them. For example, Tom said that video games were his SIA, but later revealed his passion for woodworking. ¹⁵ Peter revealed his masking process when he told us, "Uh, I'm a gamer, uh, but my favorite video game, the only one I am actually good at, would be First Person Shooters...But the truth is, I like frogs...frogsfrogsfrogsfrogs! I have, like, so many frogs at both my mom and dad's houses and I'm not going to ever sell them or give them away or stuff like that. If I was going to sell them, which I'm not, I'd be rich! Really, really, RICH!" ¹⁶

The Fusion of SIAs and Identity

It was clear from our data that participants' positive self-images were inextricably woven into their SIAs. The participants strongly identified with their SIAs and saw themselves defined by their SIAs. SIAs are critically important to children and youth with Asperger's. Though participants' self-images apart from their SIAs were strongly negative, we found that when they were involved in activities related to their SIAs, they felt more positive about themselves. They demonstrated expertise in their SIAs, control over their knowledge and involvement in their SIAs, and increased self-confidence. One participant, Ryan, confided, "I think I've got a lot more understanding on how things work than most people. I've got a corner in the back of my brain that allows me to perfectly simulate almost anything." ¹⁷ Steve told us, "I'm the main customer at a place called Hollywood Video. I am a movie whiz!" ¹⁸

Gender Differences in SIAs

Our female participants validated the research of Cohen ¹⁹ on the interests of girls with Asperger's in which she found that the most popular interests among her participants were art, primarily drawing and cartooning, and animals. The interests of the two girls in our study were manga and horses. Sarah, one of the two girls in our study, firmly stated "I'm an animal person. [People] can sense that I am an animal person." ²⁰

Parents' Knowledge of and Feelings Toward SIAs

Most parents who completed a survey were very aware of their children's SIAs, and were able to correctly identify them. Parents saw the purpose of SIAs as having fun, relaxing, avoiding doing another task, avoiding thinking about something else, calming down, and reducing stress or anxiety. Parents acknowledged their children's expertise in their SIAs. Nearly all the parents surveyed correctly identified their children's SIAs. Most children and youth participants reported that their interactions with their parents concerning their SIAs were positive.

Some children and youth expressed frustration with their parents, too. Peter confided, "My Dad...did not really accept that I am, um, a gamer." When asked what he thought his parents thought his SIA was, he replied, "I don't think they've really got a clue. They'd probably think the video games 'cause they're always tellin' me to get off my butt and go do somethin'." ³⁰

Peers' Perceptions of SIAs

Participants expressed reluctance to tell others about their SIAs due to rejection from their peers. Participants also noted that they were frustrated at being misunderstood by others. Their SIAs were often seen as socially unacceptable, and their peers lacked understanding and interest in the participants' SIAs. Charlie wanted to clarify, "I also make dragons, not just dinosaurs, everyone needs to know what they are....dragons, Dragons, DRAGONS!" ³¹ Brock admitted, "I just wish they'd think planes were cool." ³²

Brock also revealed his feeling of peer rejection, as well as his desire to be the expert, when he told one interviewer, "I wish [kids at school] would accept planes and, uh, not always pretend to throw up about it...I just wish they knew as much about it as I do, maybe even ... no, maybe not even more." ³³

Participants clearly wanted to be recognized as experts, and accepted by their peers. "Well I first like tell 'em I'm talented, but then I like wanna prove, I mean PROVE, that I can do it." ³⁴ Another participant stated, "Yeah...wulll...apparently, like, when I make something very good, then they'll be impressed." ³⁵

Many participants, such as Brock, revealed social awareness in their cautious dealings with peers, testing the waters before revealing their SIAs. "First, I usually don't talk about it... and if I have a really good friend... they might come over to my house and then they'll see all these planes around and they'll tell me that planes are a really cool thing... and then I'll know." ³⁶ Justin told us, "Video games used to be at the top of my list. Now I always put girls at the top of my list. If it's a girl, I'll hang back, observe, see what kinda things she likes and I'll move in slow and steady. One could say that I like to buy lunch for pretty girls." ³⁷

The Impact of SIAs on Classic Asperger's Deficits

We discovered that SIAs had some very positive effects on some of the classic deficits of children and youth with Asperger's. Traditionally, children and youth with Asperger's exhibit deficits in the areas of language, social communication, emotions, and problems with sensory stimuli and fine motor activities. However, we found that these deficits were diminished when participants were engaged in their SIAs. ⁴¹

As we interviewed participants and later listened to the taped interviews, we noticed distinct changes in the participants' speech whenever they talked about their SIAs. Some participants began to show significantly more enthusiasm and emotion when asked about their SIAs. In some participants, we noted that their speech was much clearer and they used more advanced vocabulary when talking about their SIAs. For example, when responding to general questions, Charlie repeatedly gave answers such as "Uh, I don't think so, I just, whatever," consisting of simple one or two syllable words with no clear content. When asked about his favorite thing to play with, however, his speech pattern changed instantly as he confidently replied, "My favorite is a Yu-Gi-Oh™ card that combines with three Blue-Eyed White Dragons, and due to polymerization it forms those three into a three-headed dragon." ⁴²

Our team also observed improvement in body language, particularly an increase in eye contact and expressive gestures that accompanied speech. Further, we noticed a remarkable decrease in self-stimulation, distraction, and body movement in and around the tables and the participants' chairs.

All of our participants enthusiastically talked at length about their SIAs. The participants noted that they saw nothing unusual or extraordinary about their SIAs. Participants shared that they felt positive emotions when actively engaged in their SIAs, including enthusiasm, pride, and happiness. Danny could barely contain his joy in repeatedly telling the interviewers, "I was born to like...Walt Disney. Walt Disney is my life. Disney has been my most happiest hope in my whole life." ⁴³ Nate, whose SIA was musical composition, proudly told the interviewers, "My parents think I'm an unbelievable, amazing drummer." ⁴⁴ Convinced of his successful future in composing music scores for film, Nate confidently declared, "The reason I wanna move back there [to Hollywood] is, I wanna be a composer and, and just take over John William's job, get into that job, and compose Harry Potter, The Terminal...just, before I do that, I have to learn the notes". Nate described how the music made him feel. "I like composing music for movies so that I have a good feeling...I like feeling sad, happy, scared, sneaky." ⁴⁵

Individuals with Asperger's often find intense smells, loud sounds, or personal touch highly unpleasant. ⁴⁶ Rising to these sensory challenges, our participants persevered for hours at a time when involved in their SIAs in spite of intense stimulation from model airplane glue, modeling clay, horse manure, goat odors, sawdust, sweat, sticky or dirty hands, and the bright lights, rapid movements, and loud, startling sounds of video games.

Though children and youth with Asperger's typically have acknowledged difficulties in tying shoelaces, fastening buttons, and handwriting, 47,48 our participants spoke not only of their advanced fine motor skills, but of extreme perseverance and patience in the fine motor skills that their SIAs required such as drawing, building, sculpting, creating models, playing keyboards, using video controllers, and playing musical instruments.

SIAs clearly serve a very positive purpose for children and youth with Asperger's. SIAs are vital to their well being; they are viewed by children and youth not as a hobby or leisure activity or interest, but as an integral part of who they are. In their special interest, these children and youth acquire clear focus, a way to organize the world, a social approach, and a way to interpret life. SIAs are not taken lightly by children and youth with Asperger's, and neither should they be taken lightly by parents and teachers.

How Can Parents and Teachers Get the Most Out of Children's SIAs?

SIAs can be powerful motivators for children and youth with Asperger's. Parents can take advantage of the strong connection their children have with their SIAs by using them to motivate or to reinforce children for completing or trying less desirable activities such as chores or to entice children to engage in social activities with the family. For example, a child with an SIA in horses might earn a horseback riding lesson for keeping her room clean for a week, or a student with an SIA in aviation might earn a trip to the local airport after helping his parents wash the family car.

SIAs provide children with Asperger's with a way to relax, de-stress, and cope with the world. Children and youth with Asperger's often arrive home after school tired and stressed after a day of working hard to stay calm and focused at school. Allowing a child to spend some time engaging in her SIA after school can help reduce her stress level so that the child can then participate more willingly in the family's evening activities.

In order to facilitate communication and encourage interaction between the child with Asperger's and his family, parents could arrange outings focused on the child's SIA or arrange for friends who share an interest in the child's SIA to participate with the family in an activity focused on the child's SIA. Parents could encourage a child to participate in a community organization that is related to his/her SIA as a way of increasing the child's socialization skills. For example, a youth who is interested in farm animals might join a local 4-H group and learn how to raise and care for a lamb, cow, or pig. A child with an SIA in trains could join a local model railroad group and learn about and share his/her own expertise about trains.

Parents could use a child's SIA to motivate the child to cooperate with necessary daily living activities such as going to the dentist, shopping for groceries, or getting a haircut. Following such stressful events with free time to engage in the child's SIA may encourage the child to behave appropriately in order to hasten access to the SIA.

Because SIAs are such a vital element in the self-image and motivation of children and youth with Asperger's, it is imperative that they be welcomed and encouraged at school. From our data we learned how deeply participants and parents feel about educators respecting their insights concerning making room for SIAs at school. We also learned how strongly the participants wanted teachers to incorporate their preferred methods of gathering information, particularly reading, into the curricula. We cannot afford to ignore students' SIAs, or withhold engagement with them as punishment for misbehavior. With little additional effort, teachers can integrate SIAs into all core academic areas, including English, reading, writing, spelling, math, science, speech, and history. Students with Asperger's are much more likely to demonstrate their true levels of ability in academic assignments when SIAs can be included in the assignments. For example, students can be encouraged to practice reading skills by reading books about their SIAs. Teachers, with parents' help, can embed areas of special interests into assignments such as math problems that use examples from a child's SIA in order to motivate the child to practice solving math story problems.

For a middle school or high school student with Asperger's, an opportunity to shadow a professional in a field related to the student's SIA could promote a career interest for the student. For example, the student who is an expert on Disney films might shadow or interview a character animator to learn how animated movies are created and what kind of training is required for a career in film-making.

Students can also benefit from simplified versions of their SIAs to deal with negative emotions, reduce anxiety, and calm themselves in stressful situations. Students identify with their SIAs; therefore, a favorite small airplane, stuffed frog, photograph of a prized goat, sheet music of a revered composer, cover from a preferred DVD or video, or recent anime drawing may help the child in calming himself and reducing disruptive anxiety-driven self-stimulation or other behaviors. We must see SIAs for the gold mine they are in helping our students progress toward their academic, social, emotional, communication, and behavioral goals.

Unquestionably, making the shift to inviting SIAs into the academic arena requires effort on the part of parents and teachers. They must each be willing to think creatively to find ways in which to insert the SIA effectively and appropriately into the curriculum. Parents and teachers must be flexible, looking beyond the strict limits of the lesson plans and assignments to ask, "Is it our goal that Samantha write about summer vacation, or is it that she learn to write, even if she chooses to write about carnivorous plants?" Teachers must partner with parents, seeking their input on their children's SIAs, their ideas for how to integrate the SIAs into the curricula, and even their practical help in modifying assignments to incorporate the SIAs. Parents can integrate SIAs into countless areas of their children's home and community lives, increasing children's motivation, interest, and cooperation. (See Table 2, below.)

Reading

Read three chapters that interest you in Astronomy: The Solar System and Beyond by Michael A. Seeds. ⁵²

Writing

Have you ever dreamed of discovering a planet or a galaxy? Imagine you found one. Name it after yourself and write a newspaper article announcing your discovery to the world! Where did you find it? How did you discover it? How will your discovery change astronomy?

Spelling

Read Chapter 3, Astronomical Tools, in Astronomy: The Solar System and Beyond, above. List your favorite tools, such as "optical telescope," and learn to spell them. You might want to draw pictures of them, too.

History

Nicolaus Copernicus, a Polish astronomer, lived in 1473 - 1543. He was a brilliant scientist, but he paid a high price for his belief that the earth rotated around the sun. Read Copernicus: Founder of Modern Astronomy (Great Minds of Science) ⁵³ by Catherine M. Andronik to find out what so enraged his critics. Think about this: if you had been Copernicus, do you think you would have changed your theory?

Speech

Dress as and present the passion and work of Charles Messier, French astronomer born in 1730. Explain to your audience what is meant by the "Messier Number."

Math

Find out how far each of the eight planets in our solar system are from earth. Now calculate how far they are from each other. Which one is furthest from any other planet? Which two are closest together? What is the average distance of all the planets from the earth?

Science

Just what is Halley's Comet, and who was Halley? Go to the library to find out exactly what a comet is and why Halley's Comet is so important. How do comets differ from stars? Will Halley's Comet come through again in your lifetime?

Art

Choose your favorite Messier Deep Space Object and make it come alive with paint, clay, fabric, recycled objects, or another medium that you choose.

Internet Skills

Where in the world is the Kuiper Belt? When does NASA plan to go there? What do the Oort Cloud and some really cold bodies have in common? To find out, research NASA's amazing website at solarsystem.nasa.gov/planets/index.cfm.

Surfing NASA's site or other federal or university websites, find an astronomer and write him or her with your most burning questions about the stars!

Children with Asperger's Syndrome can achieve far beyond expectations when they are allowed to be involved in their SIAs. Educators and parents must embrace SIAs as a means to an end, not an end in themselves. Over fifty years ago, Hans Asperger (1991/1944) already knew what we are just coming to see: special interests are the key to fulfillment and maximized potential in children and youth with Asperger's Syndrome. We can find reason to hope for significant and meaningful futures for children with Asperger's in his stirring words that call so clearly to us today:

"Able autistic individuals can rise to eminent positions and perform with such outstanding success that one may even conclude that only such people are capable of certain achievements. It is as if they had compensatory ability to counter-balance their deficiencies. Their unswerving determination and penetrating intellectual powers, part of their spontaneous and original mental activity, their narrowness and single-mindedness, as manifested in their special interests, can be immensely valuable and can lead to outstanding achievements in their chosen areas." ⁵⁴

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Dinosaurs 24/7: Understanding the Special Interests of Children with Asperger's

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What do a quirky lawyer, a child lost during a museum field trip, a family who needs a new home, a boy who witnessed the murder of his parents, a doctor who bonds with a mysterious young patient, an 18 year old woman dealing with the sensory chaos of New York City, and an out-of-control toddler have in common?

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Should we change targets and methods of early intervention in autism, in favor of a strengths-based education?

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Should we change targets and methods of early intervention in autism, in favor of a strengths-based education?

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A brief history of early, intensive behavioral intervention for autistic preschoolers: where are we now?

In developed countries, autism can be diagnosed at approximately 2 years of age, making it possible to intervene before the child starts school. The interventions employed worldwide are grouped under the umbrella term "early, intensive behavioral intervention" (EIBI) in meta-analyses and practice guidelines for psychosocial interventions targeting the "core autism feature of impaired reciprocal social communication and interaction" []. The learning models, techniques, and targets of EIBI have been strongly influenced throughout its existence by methods inspired from studies of animal behavior. The interventions developed, initially known as applied behavioral analysis or ABA [], were also delivered professionally and face-to-face. Following the landmark study by [], the publication of short-term empirical measures of the effect of intervention on IQ, autistic signs, and adaptation led to the integration of ABA into evidence-based practices, as well as the cliché of ABA being the only "scientifically proven" intervention (see [] for an opinion).

Several aspects of ABA intervention have evolved. Naturalistic developmental behavioral interventions (NDBI), which are peer-mediated, community-based interventions delivered by a child's parents in natural settings, address the lack of generalization and the laboratory style of initial ABA interventions. They are still largely faithful to operant conditioning learning procedures, whereas some have distanced themselves from it (see [, ] for a review). Another recent approach, the Denver model [, ], aims to combine ABA with knowledge about the developmental psychology of the typical child. This approach has led to a shift in the focus of ABA techniques and targets, from the learning of autonomy through conditioning, to the enrichment of the prerequisites of typical social communication routines (joint attention, imitation) through a combination of play and conditioning procedures.

An apparent consensus has emerged over the last 40 years concerning the principles, targets, and efficacy measures of EIBI [], with only a few exceptions (e.g., []). Despite their differences and apparent or claimed evolution, the various types of EIBI "are firmly grounded in principle and the science of learning and (...) fully meet criteria as ABA techniques" []. Therefore, the various currents of EIBI display a considerable overlap in terms of the techniques used and the underlying principles: precocity (the earlier the intervention is applied, the more effective it is likely to be), intensity (more intensive interventions are preferred, with as many as 25 h/week frequently recommended), highly structured and constantly monitored interventions, normativity (the less autistic the child is at the end of the intervention, the more successful the intervention is considered to have been), task-decomposition (information to be learned is broken down), the use of external or natural reinforcement, and extinction procedures. Intervention targets map the definition of a combination of negative socio-communicative symptoms ("lack" or limitation of socially oriented behaviors) and positive, non-social symptoms (an "excess" of restricted interests and repetitive behaviors). EIBI aims to render this bumpy profile flat and less autistic: increase prerequisites of typical socially oriented behaviors and communication, while suppressing repetitive behaviors and autistic interests. EIBI has been recommended worldwide, and most national guidelines for autism even specify the amount of therapy (e.g., USA: [, , ]; France: []; Quebec: []), often as a means of opposing non-scientific interventions, with the remarkable exception of the UK.

However, the early twenty-first century has seen the emergence of critics of EIBI. An influential autism research expert [] questioned the presuppositions and ethical issues related to EIBI, and criticized the use of low standards in autism intervention research. Its underlying principles and targets, the empirical demonstration of its efficacy, its cost-efficiency, and ethical justification are now widely questioned ([]; see [] for a review). Careful studies of the variables used to assess the effects of intervention have highlighted their inadequacy for detecting changes []. In the UK, a series of studies has emerged on communication-based, parental guidance interventions (e.g., PACT; []). In striking contrast to both the ABA and the Denver model, these interventions are based on low-intensity parental guidance while retaining the same underlying assumptions as ABA interventions, except for intensity. They have considerably improved the scientific standards of intervention studies. This line of research led to the first large-scale ( N = 152) randomized controlled trial on early intervention [], showing weak, but demonstrable, effects on autistic symptoms 6 years after the intervention [].

Meta-analyses of intervention studies (see [] for an example) continue to perpetuate the consensual view that EIBI is effective, whereas UK experts have produced a practice guide [] that assesses the strength of proof for all available early intervention studies. NICE practice guides are based on standards common to other health disciplines. Their quality standards are, therefore, substantially higher than those of other autism practice guides. The NICE guide highlights the limited nature of the changes that can be unambiguously attributed to the intervention itself. One of the major conclusions of this guide is that the quality of intervention research has been low or very low, and that it is therefore not possible to recommend ABA, or, more generally, EIBI. This conclusion contrasts strongly with those put forward in the US, French, and Canadian recommendations.

Our aim here was to question EIBI from another angle, that of its targets and principles. We will discuss the following issues: the legitimacy of targeting the prerequisites of learning or typical social functioning; whether the timing of the intervention and the techniques used improve the way autistic children learn language; and whether autistic repetitive behavior and restricted interests can be used as cognitive strengths, rather than as a motivator or suppressed as disturbing behaviors. We will then propose a series of alternative intervention principles, with the aim of inspiring a new generation of clinical trials.

Given the heterogeneity of individuals diagnosed with autism, according to current definitions, we will limit our discussion to the core autistic phenotype: idiopathic (or primary, or non-syndromic) autistic preschool children with strong, unambiguous and reliable autistic phenotypes, in general functionally non-verbal, referred to here as "prototypical" autism. Our discussion and predictions do not, therefore, necessarily apply to early verbal or mild autistic phenotypes, or, at the other end of the spectrum, to "syndromic" autism accompanied by an identifiable neurodevelopmental condition and unquestionable non-verbal intellectual disability.

A dubious intervention target: prerequisites of learning and typical social functioning

Despite supposed differences in techniques and underlying philosophy, the two principal forms of EIBI, ABA and the Denver model, both target the prerequisites of the abilities they want to help the child master [, ]. This notion of a "prerequisite" implies that the typical, non-autistic early manifestations of the targeted function must be mastered before the autistic child can develop more complex, or mature non-autistic behaviors. For example, looking into the eyes of the person with whom the child is interacting is considered to be a prerequisite for his future abilities in reciprocal social interaction, or for language and learning in general. Interventions therefore focus on training the autistic child to do this.

In the ABA approach, the notion of "prerequisites" is summed up in the "learn to learn" principle []. In practical terms, before the ABA technique can be used for vocabulary training, for example, an autistic toddler must be trained to accept the format of the personalized, face-to-face training sessions through which ABA training is achieved. This intervention sequence is justified by the argument that autistic children would not learn by themselves, because they lack the innate ability and disposition to learn spontaneously, which must therefore be constructed artificially. This involves training the child to look at the teacher, to remain seated on a chair, face-to-face with the teacher, and to stop making repetitive movements or spontaneously focusing on a preferred object of interest, all of which is considered to be essential for the child to be able to benefit from what he or she is learning. The same rationale applies to the ABA interventions themselves, which take the form of graduated steps, from the simplest to the most complex. Each step must be performed without error before the next teaching target is attempted.

The main objection to Lovaas "learn to learn" principle is that speech, motor skills, and many cognitive abilities are not-even typically-learned through directed, hierarchical, reinforced training sessions. Behaviorism is a restricted, simplified model of typical behavior that does not consider either genetic constraints on developmental pathways or non-contingent, unfragmented, non-hierarchical, non-error-free forms of learning. The behaviorist model misses a dozen other learning mechanisms, particularly implicit learning. The assumption that autistic children do not learn by themselves is clearly untrue. Implicit learning has repeatedly been demonstrated in autistic individuals [, ] and is actually slowed down by explicit instructions []. Autistic children, and not only savants, can spontaneously learn large amounts of complex information. The immediate value of the information they choose to learn may not be obvious, but autistic children resist conventional ways of learning, precisely because they learn by themselves, rather than because they are "incapable of learning" (see Dawson et al., 2008 for an informed discussion). However, behaviorists claim to have elucidated learning rules that apply across a continuum extending from young mice to old men. Proponents of this school of thought are not ready to accept the possibility that learning constraints may be species-specific, or differ between neurodevelopmental variants, to such a point that the very principles of behaviorism may be undermined.

In the Denver model targets, the alleged "prerequisites" for the subsequent mastering of socio-communicative abilities are joint attention, shared emotion, pointing, and face-to-face imitation. The justification of this intervention strategy is that these behaviors precede more complex socio-communicative behaviors in typical children. Their presence and magnitude may be predictive of the subsequent development of socio-communicative abilities. The Denver program involves intensive training in these behaviors, with the aim of "kick-starting" an underdeveloped function that may, through "brain plasticity" and intensive training, catch up to levels similar to those of typical children.

The assumption that not reaching a developmental milestone at the age at which it is typically attained precludes the further development of a given function may, however, not be valid if the trainee follows a specific developmental route which does not cross typical prerequisites. While this notion of prerequisites applies correctly to the ordered sequence of certain species-specific behaviors, its generalization to education is limited by the existence of several different, possibly incompatible developmental routes to the same milestone, even in typical individuals. Some steps may be delayed, missing, or their order reversed. For example, not all children crawl before walking [], and typical children follow diverse routes to reading [].

A related objection to the "prerequisite" rationale used to favor routine social targets in the Denver model is that typical socio-communication prerequisites are indices of a function, rather than the function itself. For example, smiling may only loosely reflect altruistic intentions, whereas, conversely, intense socialization is possible without smiling. Reduced socio-communicative behaviors are a key element in the early diagnosis of prototypical autism, but it remains unclear to what extent such behavior reflects actual peer bonding, as autistic toddlers have been shown to display typical attachment. A large range of social variables reflecting social abilities are actually normal when empirically measured in isolation in autistic adults. This finding is potentially disappointing for social cognitive neuroscientists trying to identify endophenotypes, but it may be good news for autistic individuals. Indeed, there is a major discrepancy between the oddity of autistic social behaviors, clinically measurable through standardized diagnostic instruments, the brain correlates of social competence in autistic individuals [], and the actual ability of these individuals to perform tasks by assessing key components of human social bonding. Such discrepancies have been reported, for example, for mimetic desire [], social orientation [], social facilitation [], and the automatic facial mimicry response []. These negative findings suggest that a clear distinction should be made between an abstract function of socialization, common to all members of the human species, and its visible manifestations, which may vary between subgroups of humans. It may, therefore, be inappropriate to evaluate socialization through their visible manifestations. Conversely, evaluations of socialization should focus on actual integration into the ordinary world rather than on indices and predictors of these abilities in non-autistic subjects. Socialization is a legitimate target, but its abstraction is required. Indices of socialization in autistic people are so different from those in non-autistic individuals that we may be missing the point by concentrating on non-autistic repertoires of socio-communicative behaviors.

The external validity of the "prerequisite" framework is even more limited if extended to encompass developmental variants, such as autism. Approaches targeting the prerequisites for attainment of a typical function assume that autistic children can become competent in the function concerned only if they follow the same steps as typical children, because these steps are simply delayed. We favor the view that autistic people follow a different pathway through the developmental sequences that result in maturation and social and language acquisition. Concerning early manifestations of peer relations, the "negative symptoms" of autistic individuals in the social domain may reflect the replacement of these manifestations by others within the developmental sequence of acquiring social competence. For example, reduced spontaneous immediate face-to-face imitation may be replaced by delayed imitation, without a detrimental influence on long-term competence. In the domain of communication, discussed below, the delay in speech development may reflect a greater interest in written material, supplanting efforts to speak, and an absence of overt social overtures between the ages of 2 and 5 years may reflect the use of non-social and non-communicative routes as the principal mans of language learning.

Finally, studies indicating, for example, that good pointing behavior during infancy is predictive of good verbal abilities later in life [, ] may simply be showing that the people farthest from an autistic phenotype during infancy are also those farthest from an autistic phenotype in adulthood. It does not necessarily mean that improving the pointing ability of a specific autistic child results in more typical socio-communicative abilities in adulthood. Metaphorically, more puppies than kittens swim, but training a cat to swim at a young age will not make that cat any more like a dog as an adult. Moreover, the late mastering of speech in strong autistic phenotypes [], which, by definition, lack typical socio-communicative indices, demonstrates the absence of a direct relationship between these indices and the level of speech attained by the time an individual reaches adulthood. No valid information is available concerning the adaptive value of the EIBI strategy for the well-being of autistic adults. The focus on "prerequisites" of typical social function, even if relevant for typical children, cannot be used to prioritize socially oriented behavioral targets. We propose, therefore, to focus parent-child and caretaker-child interactions on the enrichment of and access to the child's non-social interests as a goal of intervention, in place of the focus on the enrichment of typical socio-communicative prerequisites. Focussing on actual exchange, however, atypical its form may appear, follows Vigotsky's "zone of proximal development" [] while allowing, even belatedly, autistic children to converge towards more typical socio-communicative routines.

Would it not be better to work with the autistic pathway for language development, rather than against it?

Language development in autism is widely regarded to be extremely variable, to the point that dramatic differences in speech onset has determined DSM IV sub-grouping of the autism spectrum. Language abilities are now one of the "clinical specifiers" of an autism diagnosis in the DSM-5. However, this variability can be structured by a few prototypical pathways within the autism spectrum. In prototypical autism, with which we are concerned here, the developmental sequence of autistic speech follows a "bayonet"-shaped pathway ([]; see [] for a discussion and [] for a review). After the unremarkable acquisition of a handful of words at approximately 18 months of age, speech development appears to halt, reaching a plateau, or even regressing. Some children present echolalia during this period. Most of them just do not talk, whereas they may understand some instructions and written labels. This interruption of expected speech development coincides with the apparition of atypical socio-communicative behaviors. In most cases [], this non-verbal plateau is followed by relatively rapid, but atypical, speech development at the age of about 40-60 months, including immediate and delayed echolalia and pronoun reversals ("you" for "I"). These atypical features are transient, usually persisting for less than 2 years, and are gradually replaced by functional spoken language. Although functional speech is the most common outcome, speech levels at school age and during adulthood range from the total absence of speech, unresponsiveness to verbal overtures or questions, idiosyncratic semantic associations, and an apparent lack of speech comprehension to functional or fluent speech for most autistic people [].

Autistic speech development represents an altered developmental sequence, in which the apparently missing steps may be unnecessary, or manifest an inverse order of learning relative to that of typical preschoolers. First, intervention at this age has no significant, demonstrated influence on further speech development []. Second, speech levels and autistic signs between the ages of 2 and 4 years are not predictive of the levels of intelligence and adaptation subsequently attained. Individuals with strong autistic phenotypes and normal non-verbal intelligence generally end up speaking, even if they pass through unconventional steps. Non-verbal intelligence is predictive of future speech levels, whereas repetitive behaviors are not []. Third, attempts to drive autistic preschool children into typical socio-communicative routines is the least efficient and the most time-consuming way to provide them with information relevant for language acquisition. Autistic children are initially more focused on non-communicative speech, but use it for communicative purposes []. A substantial portion of them prefer written material over oral communication at this age. The detection and recognition of letters and numbers, and sometimes of complex written material, frequently occurs before the mastery of speech in autistic children [, , ]. Indeed, absent or atypical communicative oral language is commonly associated with hyperlexia, an early knowledge of written codes and intense interest in letters, which appears at the age of 2-3 years []. There are documented examples that hyperlexia leads to decoding abilities about 3 years ahead of those in typical children (see [] for a review). This development of reading before oral speech is another indication that children with prototypical autism do not follow the typical developmental sequence of babbling and communicative one and two word sentences, followed by speech, and then reading.

In summary, the reduced sequence of communicative overtures-delayed echolalia-enhanced decoding abilities-speech delay-late attainment of functional speech, suggests that autistic children mostly learn language in a non- communicative manner. This counterintuitive idea has major consequences for interventions targeting autistic preschool children. The normocentric, step-by-step, prerequisite approach of classical ABA to the prosthetic construction of language should be abandoned. The exclusive emphasis on language prerequisites in the hopes of favoring further speech of the Denver model and NDBI, and even the focus of PACT on communication synchrony, may miss the specific autistic orientation towards and facility for non-social language. This suggests that it may be more constructive to complement the natural communication routine with more exposure to non-social oral language and written linguistic structures, rather than trying to modify what may be a non-modifiable constraint. To use an analogy, one should still talk to deaf children, as they may still grasp lip movements and facial cues, and benefit from an interaction which is typical from the parent's point of view. However, if one wants to transmit sufficiently complex information, it is better to add sign language, even if it seems distant from typical communication.

Reconsideration of our attitude towards early repetitive behaviors

In addition to its socio-communicative aspects, autism is also characterized by "restricted interest and repetitive behaviors" (RIRBs). Some historical details are relevant here. In early editions of the DSM, RIRBs accounted for only one-third of the possible behaviors used to diagnose autism. Research on RIRBs lagged far behind that of the social, communicative, and imaginative aspects of autism. The overriding view of RIRBs in the 1990s was that they were apparently nonspecific and equally likely to be found in autism and various other intellectual disabilities. However, another line of research initiated in the UK by U. Frith and K. Plaisted, and in Canada by our group, focused on the intrinsic link between these behaviors and autism. The research focused on the possible association between RIRBs, such as intense interests and autistic peaks of ability, with cognitive strengths and atypical features of information processing, related, in particular, to perception. We developed the "enhanced perceptual functioning" (EPF) model to account for unique aspects of autistic perception. The EPF model highlights the role, performance, and autonomy of perception in autistic cognition, and its contribution to autistic expertise, our non-offensive term for autistic savant abilities. One of the main proposals emanating from this model is that perception influences overt behavior and contributes to intelligence to a much greater extent in autistic than non-autistic individuals. Some RIRBs (e.g., an early interest in letters, staring at objects for longer) are, thus, manifestations of sophisticated information processing, as concluded from their correlation with perceptual cognitive peaks in adults []. The heterogeneity of RIRBs became evident in multiple large-scale studies attempting to group these behaviors into more homogeneous subgroups. It was found that the degree of specificity to autism differed between RIRBs, with some behaviors, such as lateral glances and longer visual inspection, being more specific to autism than others. It is now accepted that RIRBs are heterogeneous, involving various mechanisms with contrasting relationships to intelligence [], but an intrinsic relationship to autism. In the latest edition of the DSM, RIRBs account for more than half of the possible manifestations of autism. Importantly, perception-related behaviors are now included among RIRBs, although unfortunately as "sensory" behaviors, a term that entirely ignores their relationship to intelligence and motivation.

Interventions have not been updated to take this new school of thought into account. There is no evidence to suggest that it is either possible [] or beneficial [] to globally reduce repetitive behaviors. The way in which most RIRBs continue to be seen in intervention programs is exemplified by their grouping with "problematic" behaviors in intervention studies, even being viewed as a justification for punishment []. Autistic interests are at best (NDBI) being used to increase engagement between the child and their parent/therapist as an opportunity to make requests or as positive reinforcement of social communication routines. Even the most recent adaptation of NDBI (see [] for a review) has amongst its aims "controlling access to material of interest, playful obstruction, expectant waiting, violating a routine, using material that require assistance" ([] pp 2419). Their behavioral manifestations are neither used nor, obviously, favored or enriched. Despite the relationship between RIRBs and positive emotions [], they are still seen in a negative light and are assimilated with egodystonic thoughts or actions in the wording of the DSM-V. The Denver model manual for parents unambiguously suggest that such behaviors should be eliminated if they hinder intervention: "stereotypies (...) can occupy children's attention so that they are not watching and learning from others. (...) They do not provide the child with any new information ability, so they do not promote learning" ([] pp 122). The example of a precocious interest in written material is difficult to reconcile with such statements.

Several types of RIRBs have now been distinguished. Some, such as echolalic or hyperlexical behaviors, as well as intense interests in general, are related to information processing and seeking and are highly specific to autism. Our position is that they should be encouraged and nurtured, as they are manifestation of interest in all children. We feel that it is unjustified to try to eliminate manifestations of interest, even if these RIRBs are "obsessive". To continue our autism-deafness analogy, we would suggest that the Denver model view of stereotypies is the modern equivalent of the repression of sign language commonly practiced in 19th century deaf-and-mute institutions. Others are emotion-related RIRBs, and are manifestations of positive (hand-flapping) or negative (minor self-injury) emotions related to this information. These RIRBs, observed in typical children as well as in multiple neurodevelopmental variants, should be accepted as such. Finally, the "captivity" subgroup of RIRBs (including rocking, or wandering in circles) is not specific to autism. Such behaviors are observed even in animals and are caused by information deprivation. We predict that feeding the first RIRB category, information-seeking behavior, should decrease "captivity" behaviors.

Some repetitive behaviors occupy much of the child's time, and when interrupted by daily routines, may be associated with tantrums or behaviors dangerous for the child or others (for example, running away). Autistic interests should therefore be included within an educational framework, consistent with safety and educational requirements. However, this does not modify our position: RIRBs that reflect the search for and processing of information relevant to the child's interest should be encouraged. They represent the motivational foundation on which the education of the autistic child should be based. This is a drastic departure from using them as a pretext for social routine, such as in NDBI.

What should future studies focus on?

The empirical program resulting from these position statements can be summarized in five testable predictions: (1) a large proportion of prototypical autistic children have normal non-verbal intelligence, despite presenting with a "frank" [] phenotype, and will develop communicative language later; (2) increasing the exposure of autistic children to non-social language material should favor their long-term linguistic development and (3) decrease their RIRBS and problematic behaviors; (4) lateral tutorship, favoring delayed imitation, should result in better adaptation as adults than the use of EIBI techniques; (5) inclusion in community daycare following these principles should result in greater and more cost-effective improvement of social abilities and child well-being than child-directed, individualized, professionalized, and specialized intervention.

Prediction 1: intellectual disability is associated with syndromic autism, not prototypical autism.

Based on the principles outlined above, we need to rethink the status of intelligence in the diverse children receiving diagnoses of autism. It is frequently overlooked that Kanner discarded intellectual disability in his first group of 11 autistic children, for whom he reported indices of normal intelligence. Actual intellectual disability is rare in non-syndromic autism, but can be confused with it. The early measurement of intelligence in institutionalized adults [] resulted in most being found to have an intellectual disability when tested with verbally loaded instruments. Even the non-verbal subscales of these instruments can yield deceptive results, as the instructions given are also heavily language-loaded []. A certain proportion of non-verbal autistic children may, indeed, have a false intellectual disability. Our group has provided substantial evidence that intelligence is "at risk of being underestimated" in young non-verbal autistic individuals []. This conclusion is supported by the absence of strong indicators of actual intellectual disability, such as late walking, in most prototypical autistic children. Accordingly, walking age is not related to Mullen-measured intelligence in autistic children, in contrast to findings for children with a non-autistic intellectual disability []. Reported rates of intellectual disability in autism vary by approximately 40% between US states providing data (Utah: 20%; South Carolina: 60%; []). This suggests that the proportion of autistic individuals with intellectual disability cannot be accurately determined with the instruments currently used for its measurement.

The reported rates of intellectual disability among individuals with an autistic phenotype may result from a combination of measurement error and the deleterious effects of the current definition of autism, which groups non-syndromic and syndromic autism neurodevelopmental disorders together. Identified neurogenetic conditions, as well as other childhood psychiatric and learning disabilities, reach the cut-off for an autism diagnosis due to their negative signs [], particularly in the social domain. There may be various reasons for not presenting typical social behaviors, which may result in a mistaken diagnosis of autism, due to the absence of exclusion criteria in the current definition.

The presumption of normal, non-verbal intelligence is at odds with the "learning to learn" behaviorist principle that currently dominates early intervention. It suggests that we should instead rely on autistic intelligence, the most frequent eventuality in prototypical autistic children. Future research on autistic intelligence should involve prospective studies of behavioral predictors of intelligence, and on the materials and information most likely to reveal these behaviors [].

In summary, prototypical autistic children presenting at least one domain of competence clearly above the baseline level, and who are functionally non-verbal between the ages of 2 and 4 years [], should not present any detectable de novo or inherited copy number variations [, , ]. They should also begin to walk within the normal age range [], and have non-verbal intelligence within the normal range at school age [, ], despite their strong past or current autistic phenotype.

Prediction 2: favoring access to written verbal material and auditory non-communicative language should favor the long-term development of speech

Speech development is generally delayed in autistic children, who frequently have no speech or speech limited echolalia []. In prototypical autism, there is a substantial delay in speech associated with normal non-verbal intelligence and a reorganization of brain allocation and function in favor of perception, particularly visual []. This results in autistic toddlers being particularly dependent on visual inputs to obtain the complex information they require. For example, a substantial proportion of nonverbal autistic preschoolers become interested in written material before communicative speech. Extensive reviews of autistic accomplishments [] have concluded that autistic expertise is based on the detection and manipulation of complex perceptual and formal structures. Relational and emotional components of education may plausibly favor speech development, but are not directly implicated in its mechanisms.

This suggests that autistic children go through an alternative sequence of learning, in which speech development occurs later than in typical children. Exposure to and active involvement in oral language, an essential step in the mastering of speech in non-autistic children, may initially be of little relevance to autistic children. In contrast, subtitles, continuous information on TV screens, YouTube URLs, film credits, magnetic boards, keyboards, and audio tapes of "Dora" programs may be much more pertinent. This does not mean that it is pointless to speak to autistic children, but rather that the capacity to process communicative speech and benefit from it may mature after noncommunicative speech and written language. Similarly, the oral component of speech is minimally relevant for congenitally deaf children born to hearing parents, but may become relevant once language has been learned by other ways.

The fact that autistic children do not primarily use oral language in a communicative way has important consequences for intervention. We predict that exposure to written and oral non- communicative speech will help autistic children to use speech once they develop the ability to map language structure onto oral speech []. We also predict that the bonding effect of interactive routines in typical children may have an equivalent in the explicit provision of materials of this type to autistic children by their caregivers. A bedtime book-reading routine, repeatedly watching video programs including subtitles with the child, and joint activities (categorizing by font, geometric arrangement, matching, ordering magnetic letters), may be the autistic prerequisites for the future use of speech in a social context. This prediction is based on our systematic review of hyperlexia []: the non-communicative use of letters is not a dead-end in the autistic pathway leading to the development of language use.

Prediction 3: including periods of free access to material of "special interest" in the child's time-schedule will decrease "captivity" RIRBs, and problematic behaviors.

We hypothesize that many of the autistic behaviors considered to be problematic, which most intervention techniques aim to suppress, are actually related to the search for information. In contrast, repression of the behaviors associated with this searching is likely to result in information deprivation in individuals seeking information through unconventional channels, such as autistic and deaf people. This, in turn, would lead to an increase in nonspecific captivity and repetitive behaviors associated with negative emotions.

One practical implication of this hypothesis is that autistic children should be exposed to material of interest, just as non-autistic children are exposed to situations and opportunities that will help them to develop their intelligence. The initial evaluation of repetitive behaviors for diagnostic purposes provides information about the domains in which the child has developed intense, focused interest. This information may be extended and expanded by observing searching behaviors, together with the emotions associated with the provision (flapping) or withdrawal (tantrums, with or without self-injury) of relevant information. The interests of the autistic child depend on the age at which the diagnosis is made. They may initially manifest as a search for a large class of objects with a specific physical characteristic, such as objects that shine, rotate, or can be lined up. Later, restricted interests may be overtly restricted to a specific class of objects (e.g., fire extinguishers, keys, wheels), or to the consistent use of instruments providing access to written numbers and letters, such as screens, computers, tablets, and magnetic letters. Free access to these objects could, therefore, be actively integrated into the child's daily schedule.

We predict that routinely providing autistic children with their objects of interest will decrease behaviors related to both the unsuccessful search for interesting information, and its withdrawal. We predict that knowing when this information will be accessible, through representation of the time window during which objects of interest will be provided on a visual timetable, for example, should alleviate the tantrums associated with its unpredictable withdrawal. This will help the child to understand that although the computer tablet is taken away when it is time for dinner, it will be returned the next day. If the material is sufficiently complex, this should also allow the autistic child to explore and manipulate it in the vicinity of his or her carers, thereby alleviating wandering/captivity behaviors, and favoring the further development of autistic expertise, as well as usable language.

Prediction 4: lateral tutorship of autistic preschoolers in natural parental and daycare settings improves the well-being of parents and school age children more than early, personalized, professional, face-to-face intervention.

The active avoidance of peers is the exception, not the rule, in autism. When left to move freely, except for a minority of escape behaviors, autistic toddlers occupy themselves among other people, despite not overtly interacting with them. Autistic children have an obvious preference for parallel play over interactive play. However, parallel play may be the paradigm in autistic social bonding, providing the child with an opportunity to learn from other human beings. If autistic children are allowed to use their own material of interest, they may display delayed imitation of behaviors they have observed []. We define "lateral tutorship" as the autistic equivalent of face-to face play interaction of non-autistic children. In lateral tutorship, an adult performs an activity on a material selected from among the child's interests, such as manipulating a tablet application while the child manipulates, at his side, the same application on his or her own tablet. Lateral tutorship involves actively providing the autistic child with material enriching the dimensions he or she is initially attracted to, and working on that material in parallel with the child. It is based on the observation that autistic toddlers actively reproduce what they have seen within their domain of interest, albeit with a delay. Last, lateral tutorship exposes the child to finalized, completed, and contextualized actions, whereas AIBI learning techniques consist of prompting, shaping, fading, chaining, differential reinforcement discrimination training, and errorless learning of mostly fragmented actions.

We predict that activities carried out in parallel with the child, without the child being addressed directly through gestures or speech, may favor the development of a type of social interaction based on a common interest rather than on a common appearance. There is no need for the child to master the "prerequisites" of typical face-to-face interaction (smile, overt joint attention, pointing) for this purpose. Instead of focusing on the overt indices of typical socialization, lateral tutorship favors actual social bonding with the parents: doing something close to someone else that is protective and cares for you. We predict that lateral tutorship will result in the incidental learning of new manipulations and uses of the material provided. We also predict that studies of the active elements of intervention will show that, in the long term, lateral tutorship results in a level of actual social integration that is at least as good as that achieved with face-to-face, EIBI-type, socially oriented educational interaction or play sessions.

Prediction 5: inclusion in regular, but supervised daycare centers and parental support, associated with on-site crisis solving, is a more cost-effective educational intervention than EIBI/NDBI.

There is no demonstrated dose-dependent effect for the efficacy of EIBI in terms of the number of hours/week or the number of years of therapy. The reported changes are common to different techniques, and reach a plateau within the first year of therapy []. This raises questions as to why the practice guidelines of developed countries, except for the UK, continue to recommend, while failing to provide, 20-25 h per week of intervention by autism professionals. This recommendation defines an unreachable and unjustified target that is used secondarily to calculate the alleged social "cost" of autism. We, therefore, strongly recommend including most autistic children in regular daycare centers that receive additional financial and professional on-site support when they accept a certain proportion of children with neurodevelopmental variants, including autism. Over and above the issue of cost, this inclusion in regular settings provides autistic children with information about the real social world and allows them to participate, even if only minimally, in real social routines. We predict that the indirect tolerance of non-autistic socialization observed when prototypical autistic children are integrated into regular daycare centers, will later help these children to better integrate into the school environment. Inclusion also provides non-autistic children with an opportunity to see that not everybody is like themselves, with potential societal benefits for the future. Finally, concerning true problematic behaviors, such as intractable tantrums, running away, or ultra-aggressive behaviors, only those that cannot be dealt with by preventive adaptation to the autistic child by on-site professionals, or those exceeding the tolerance levels accepted for other children, justify focused intervention and transient withdrawal of the child.

The balance between the time spent interacting with adults and the time in which the child decides on his own activities under adult supervision should not differ between autistic and non-autistic children. The cliché that an autistic child playing with his object of interest does not learn, confuses restricted interest with no interests at all. The combination of regular daycare integration with family and individual activities, involving material that is interesting to an autistic child, is of similar intensity to an autism-tailored intervention. Concerning methodology, assessment of the true validity and efficiency of a specific intervention should include optimal and inclusive "untreated" comparison groups in non-segregated settings in which "untreated" children are included in high-quality, regular daycare centers, selected on a voluntary basis, rather than less-demanding, therapeutic settings or disorganized private sessions.

We predict that such comparison groups will, in the long term, be shown to result in measurable well-being that is at least as good as that for EIBI-treated groups. The supposed benefit of a 1:1 ratio of autism professionals to children recommended for EIBI should be compared to that of opportunistic access to neurodevelopmental professionals, working in a 1:8 ratio in association with typical childcare professionals in regular daycare centers. The fact that the Denver model is "fun to apply" does not justify its cost and level of "professionalization", exceeding 30 h/week.

In conclusion

There is currently no scientific, ethical, or societal justification for EIBI. The degree of improvement in the well-being and adaptive abilities of autistic children and adults does not justify the withdrawal of autistic children from the regular educational system and culture provided by their families and countries. However, recent contestations of the scientific value of EIBI and the magnitude of changes due to this approach, and its rejection by many members of the adult autistic community have not yet had any marked influence on public health policies, intervention targets, or scientific understanding of autism. The aims of autism science are still normative and normocentric, from suppressing autism itself to mimicking non-autistic social behavior. As highlighted by autistic adults, autism is part of the human condition and is here to stay, despite the triumphalism of some scientists. The purpose of educational and child psychiatry interventions should rather be to allow the individual to achieve an abstract level of happiness, personal accomplishment, access to cultural material, and social integration, an essential human right, regardless of the way in which this is achieved and the form that it takes. An acceptation of autistic humanity begins by changing targets, methods, and efficiency variables of the education offered to autistic children, in favor of a strengths-informed education. Science should follow societal evolution, as for other neurodevelopmental variants, now accepted as full members of the human community. Whether our discipline, child psychiatry, supports or slows this movement will be severely judged in the future.

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Should we change targets and methods of early intervention in autism, in favor of a strengths-based education?

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In developed countries, autism can be diagnosed at approximately 2 years of age, making it possible to intervene before the child starts school. The interventions employed worldwide are grouped under the umbrella term "early, intensive behavioral intervention" (EIBI) in meta-analyses and practice guidelines for psychosocial interventions targeting the "core autism feature of impaired reciprocal social communication and interaction" [].

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Characterization and Utilization of Preferred Interests: A Survey of Adults on the Autism Spectrum

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Characterization and Utilization of Preferred Interests: A Survey of Adults on the Autism Spectrum

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This descriptive study examined the role that preferred interests played in an adult population with autism spectrum disorders-how preferred interests are viewed retrospectively during childhood, as well as how adults on the spectrum have incorporated these interests into their current lives. Results showed that participants have a positive view of preferred interests, view preferred interests as a way to mitigate anxiety, and engage in vocational and avocational pursuits around their preferred interests. Findings support a strength-based view of preferred interests with the majority of participants articulating that their areas of interest were positive, beneficial, and should be encouraged.

# data[].attributes.attachment_link.title
Characterization and Utilization of Preferred Interests: A Survey of Adults on the Autism Spectrum

# data[].attributes.attachment_link.description
This descriptive study examined the role that preferred interests played in an adult population with autism spectrum disorders-how preferred interests are viewed retrospectively during childhood, as well as how adults on the spectrum have incorporated these interests into their current lives.