Autism Handbook

Autism
Spectrum
Disorders
handbook
A U n i ve r s i t y Ce n te r fo r E xce l l e n ce i n D e ve l o p m e n t a l D i s a b i l i t i e s E d u c a t i o n , R e s e a rc h a n d S e r v i ce
Originally compiled by Julie Christian and Autism Program Staff
Autism Spectrum Disorders Program

Center for Disabilities
Department of Pediatrics
Sanford School of Medicine of The University of South Dakota
1400 West 22nd Street
Sioux Falls, South Dakota 57105
(605) 357-1439 or 1-800-658-3080 (Voice/TTY)
www.usd.ed/cd
The Autism Spectrum Disorders Handbook is available in alternate format upon request.
The Autism Spectrum Disorders Handbook was developed using federal funds as
part of a grant from the South Dakota Council on Developmental Disabilities.
Updated Fall 2006

Table of Contents
Center for Disabilities Autism Spectrum Disorders Program ........................... 1
Introduction to Autism Spectrum Disorders ..................................................... 2

Pervasive Developmental Disorders or Autism Spectrum Disorders: An Overview ......... 3
Pervasive Developmental Disorders.................................................................................. 6
Diagnostic Criteria ............................................................................................................ 7
Aspergers Disorder........................................................................................................... 10
Legal Definition of Autism in South Dakota ..................................................................... 13
Characteristics and Early Indicators of Autism ................................................................. 15
Modified Checklist for Autism in Toddlers (M-CHAT) - Description .............................. 16
M-CHAT (Modified Checklist for Autism in Toddlers) .................................................... 17
M-CHAT Scoring Instructions .......................................................................................... 18
Intervention ....................................................................................................... 20
Characteristics of Effective Intervention ........................................................................... 21
Ten Things Every Child with Autism Wishes You Knew by Ellen Notbohm .................... 22
Evaluating Interventions.................................................................................................... 25
Characteristics of Individuals with Autism and Support Strategies ................................... 28
Understanding and Supporting Individuals with Autism: What You Can Do.................... 34
Applied Behavior Analysis (ABA) .................................................................................... 35
Discrete Trial Training....................................................................................................... 36
Structured Teaching ........................................................................................................... 37
Visual Schedules ............................................................................................................... 38
Enhancing Language and Communication in Individuals with Autism ............................ 40
Strategies to Address Echolalia: Modeling Functional Communication ........................... 42
Communication Temptations ............................................................................................. 44
Picture Exchange Communication System (PECS) ................................................... 45
Functional Assessment of Challenging Behaviors ............................................................ 46
Positive Behavioral Support (PBS) ................................................................................... 47
Antecedent, Behavior, Consequence Form: Example of a Completed Form .................... 49
Antecedent, Behavior, Consequence Form: Blank Form .................................................. 50
General Recommendations for Promoting and Enhancing Socialization .......................... 51
Social Stories ................................................................................................................. 52
Comic Strip Conversations ................................................................................................ 53
Sensory Integration ........................................................................................................... 54
Pharmacological Interventions .......................................................................................... 54
General Programming and Caregiving Information ......................................... 58
Educational Issues ............................................................................................................. 59
Child Care ......................................................................................................................... 60
Safety in the Home ............................................................................................................ 62
Person Centered Planning and Transition .......................................................................... 63
Sibling Issues ..................................................................................................................... 64
Bibliography and Appendixes ........................................................................... 66

Bibliography ...................................................................................................................... 67
Appendix A - Glossary of Terms ....................................................................................... 71
Appendix B - Glossary of Acronyms................................................................................. 77
Appendix C - Organizations .............................................................................................. 81
Appendix D - Websites ...................................................................................................... 83
Appendix E - Journals and Newsletters ............................................................................. 84
Appendix F - Recommended Readings on Autism Spectrum Disorders ........................... 85
Appendix G - Publishers ................................................................................................... 86
The Center for Disabilities Autism Spectrum Disorders Program was established through the efforts of
parents of Individuals with Autism Spectrum Disorders throughout South Dakota in 1989. These parents
convinced state legislators of their need for independent interdisciplinary assessments and individualized
educational and behavioral training for professionals. The Autism Spectrum Disorders Program is funded
in part by the South Dakota Department of Human Services, Division of Developmental Disabilities and is
administered through the Center for Disabilities, Department of Pediatrics, Sanford School of Medicine of
The University of South Dakota.
Autism is a complex developmental disability that typically appears during the first three years of life.
The result of a neurological disorder that affects the functioning of the brain, Autism Spectrum Disorders
are estimated to occur in as many as 1 in 166 individuals (US Centers for Disease Control, 2004). Autism
is four times more prevalent in boys than girls.
Services available through the Autism Spectrum Disorders Program

A variety of services are provided to individuals with Autism Spectrum Disorders, their families, local
schools, adult service agencies, and communities in South Dakota at a minimal cost. These services
include:
Observation and informal assessment of learning, communication, social skills, and daily living
skills.
Clinical evaluation by an interdisciplinary team
Functional assessment of behavior
Hands-on training for parents and educators regarding specific techniques and strategies
Participation in individualized program development including IEP, IFSP and IHP meetings
Assistance with inclusion and disability awareness
Family, professional, and adult service agency email lists for frequent updates and information
Local and national resources available as well as books and videotapes at the Wegner Health
Science Information Center
If you would like to make a referral or have any questions, please contact:

Sanford School of Medicine of The University of South Dakota
Sioux Falls, South Dakota 57105
(605) 357-1439 or 800-658-3080 (V/TTY)
Email: cd@usd.edu or visit our website at www.usd.edu/cd/autism

1
Introduction to Autism Spectrum Disorders
2
Pervasive Developmental Disorders or
Autism Spectrum Disorders: An Overview
According to the American Psychiatric Association: Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition (DSM-IV-TR), Pervasive Developmental Disorder (PDD) is not a specific
diagnosis, but an umbrella term under which specific diagnoses are defined: Autistic Disorder, Aspergers
Disorder, Retts Disorder, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder-Not
Otherwise Specified (PDD-NOS). These disorders are grouped together because they share common
qualitative impairments in the areas of social interaction, communication, and range of activities and
interests. When an individual is suspected of having an Autism Spectrum Disorder, a review of the
persons developmental history in areas such as speech, communication, social and play skills is critical as
part of an evaluation. Ideally, an interdisciplinary team of professionals including, but not limited to, a
psychologist, an educator, a speech language pathologist, an audiologist, and in some cases a physician,
should evaluate the person and work together to determine an appropriate diagnosis.
Autistic Disorder
Autism is a lifelong developmental disorder that affects an individuals abilities
in the areas of communication and social interaction. Leo Kanner first
We truly see
described it in 1943. In his study of eleven boys, he distinguished it from
childhood schizophrenia. Criteria for diagnosis are arranged under three our son as a
categories: social interaction; communication; and restricted, repetitive and blessing, and
stereotyped behaviors and interests. An additional criterion specifies the onset his disability has
to have occurred before the age of three years. One in 166 children are helped us marvel at
diagnosed with an Autism Spectrum Disorder (Centers for Disease Control and the small things in
Prevention, 2004). Autism occurs four times more often in boys than girls. It is life. He is going to
the third most common developmental disability. Cognitive impairment often
co-occurs with autism; 70-75% of people with autism also have mental
have a purposeful
retardation (IQ below 70). Fifty percent of individuals with autism develop life if for no other
functional communicative language. Autism is a spectrum disorder with reason than he adds
symptoms ranging from mild to severe. The term high functioning autism is meaning and
not a diagnostic term, but is used to refer to individuals who have autism and purpose to those
normal to above normal intelligence. The exact cause of autism is unknown; around him.
however, research has determined that it has a biological cause and it is not
psychological. While there are many strategies that assist an individual to learn
Parent of a four-year
important functional skills, there is no treatment or intervention strategy that old child with autism
cures autism.
For more information:

Autism Society of America
7910 Woodmont Avenue, Suite 300
Bethesda, MD 20814-3067
(800) 3-AUTISM
www.autism-society.org
3
Aspergers Disorder
Aspergers Disorder is a developmental disorder that is characterized by a severe
impairment in the areas of social interaction and restricted and unusual patterns When our
of interest and behavior. Dr. Hans Asperger, a pediatrician from Vienna, son was small
Austria, first described this disorder in 1944, one year after Leo Kanner first he was stung
wrote about autism. At the time they were unaware of each others work, but by a bee. He didn't
their patients shared many commonalities. However, the children that Asperger
cry, he didnt even
observed were not as delayed in speech, and the onset seemed to be later than
the children studied by Kanner. Aspergers Disorder was not officially seem to notice. But
recognized as a diagnosis until 1994 when it was included in the DSM-IV. he would cry as if
he were in intense
For more information: pain if he didnt get
O.A.S.I.S. (Online Asperger Syndrome Information and Support) exactly ten pushes
http://www.udel.edu/bkirby/asperger on the swing. We
MAAP Services for Autism and Asperger Syndrome think it really did
PO Box 524 hurt him.
Crown Point, IN 46307
www.maapservices.org
Retts Disorder (Rett Syndrome)

Retts Disorder is a developmental disorder that occurs almost exclusively in females in 1 per 22,800 live
female births. Severe impairment of receptive and expressive communication and apraxia (dyspraxia) are
characteristic of Retts Disorder. The child has a period of normal development until age 5 months.
Within 6-30 months the childs development stops or regresses. The child loses communication skills,
which may be mistaken for hearing loss, and purposeful use of the hands. Stereotyped hand movements
(hand wringing or hand washing), poor coordination of gait, and a slowing of the rate of head growth
appear following the regression. Seizures and disorganized breathing patterns may also occur. Retts
Disorder is most often misdiagnosed as autism, cerebral palsy, or non-specific developmental delay. It
was first described by Dr. Andreas Rett from Vienna, Austria and was recognized throughout the world in
1983. The October 1999 issue of Nature Genetics (Vol. 23) reports that the protein MeCP2 is responsible
for Retts Disorder. This establishes Retts Disorder as the first human disease caused by defects in a
protein involved in DNA methylation. The research also supports Retts Disorder being added to a small
but growing number of human genetic disorders that involve abnormal chromatin packaging and gene
expression.
For more information:

International Rett Syndrome Association
9121 Piscataway Road
Clinton, MD 20735
(800) 818-RETT
www.rettsyndrome.org
4
Childhood Disintegrative Disorder
Dr. Theodore Heller first identified Childhood Disintegrative Disorder (CDD), also known as Hellers
Syndrome, in 1908 in Vienna, Austria. CDD is characterized by regression in development after at least
two years of normal development. Prior to the regression, the child exhibits age-appropriate play and
communication skills. The loss of skills usually develops gradually before the age of 10 years in at least
two of the following areas: expressive or receptive language, social skills, bowel or bladder control, play
skills, or motor skills. A period of unspecified anxiety or agitation may occur prior to the regression.
Generally, the regression occurs between the ages of three and five years. Following the loss of skills,
CDD is difficult to distinguish from autism. Therefore, the history of the childs development is critical to
an accurate diagnosis. Childhood Disintegrative Disorder has a prevalence rate of 1 per 100,000 births,
affecting more males than females.
Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS)

Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) is diagnosed when an individual
has a severe and pervasive impairment in the development of reciprocal social interaction or verbal and
nonverbal communication skills, or when behavior, interests, and activities are present, but the criteria are
not met for a specific Pervasive Developmental Disorder. This category also includes atypical autism,
for example, presentations that do not meet the criteria for Autistic Disorder because of late age of onset,
atypical symptomatology, or subthreshold symptomatology. A common misunderstanding about PDD-
NOS is that it is mild autism. This is not accurate. Although PDD-NOS is a separate diagnosis from
autism, the same interventions may be effective for both diagnoses.
5
Pervasive Developmental Disorders
Autism Spectrum Disorders (ASD) = Pervasive Developmental Disorders (PDD)
Autism Spectrum Disorders

or
Pervasive Developmental Disorders
Autism Aspergers Retts Childhood Pervasive

Disorder Syndrome Disintegrative Developmental
Disorder Disorder - Not
Otherwise
Specified
(PDD-NOS)
Pattern of Deficits
Social, Communication, Behavior/Interests,

Onset Prior to 3 Years of Age
6
Diagnostic Criteria
The following is taken from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition,
Text Revision (DSM-IV-TR) published in 2000 by the American Psychiatric Association.
299.00 Autistic Disorder

(A) A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (3):
(1) qualitative impairment in social interaction, as manifested by at least two of the following:
(a) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze,
facial expression, body postures, and gestures to regulate social interaction
(b) failure to develop peer relationships appropriate to developmental level
(c) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other
people (e.g., by a lack of showing, bringing, or pointing out objects of interest)
(d) lack of social or emotional reciprocity
(2) qualitative impairment in communication as manifested by at least one of the following:

(a) delay in, or total lack of, the development of spoke language (not accompanied by an
attempt to compensate through alternative modes of communication such as gesture or
mime)
(b) in individuals with adequate speech, marked impairment in the ability to initiate or
sustain a conversation with others
(c) stereotyped and repetitive use of language or idiosyncratic language
(d) lack of varied, spontaneous make-believe play or social imitative play appropriate to
developmental level
(3) restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested
by at least one of the following:
(a) encompassing preoccupation with one or more stereotyped and restricted patterns of
interest that is abnormal either in intensity or focus
(b) apparently inflexible adherence to specific, nonfunctional routines or rituals
(c) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting,
or complex whole-body movements)
(d) persisitent preoccupation with parts of objects
(B) Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:
(1) social interaction

(2) language as used in social communication, or
(3) symbolic or imaginative play
(C) The disturbance is not better accounted for by Retts Disorder or Childhood Disintegrative
Disorder.
7
299.80 Retts Disorder
(A) All of the following:
(1) apparently normal prenatal and perinatal development

(2) apparently normal psychomotor development through the first 5 months after birth
(3) normal head circumference at birth
(B) Onset of all of the following after the period of normal development:
(1) deceleration of head growth between ages 5 and 48 months

(2) loss of previously acquired purposeful hand skills between ages 5 and 30 months with the
subsequent development of stereotyped hand movements (e.g., hand-wringing or hand
washing)
(3) loss of social engagement early in the course (although often social interaction develops later)
(4) appearance of poorly coordinated gait or trunk movements
(5) severely impaired expressive and receptive language development with severe psychomotor
retardation
299.10 Childhood Disintegrative Disorder

(A) Apparently normal development for at least the first 2 years after birth as manifested by the presence
of age-appropriate verbal and nonverbal communication, social relationships, play, and adaptive
behavior.
(B) Clinically significant loss of previously acquired skills (before age 10 years) in at least two of the
following areas:
(1) expressive or receptive language

(2) social skills or adaptive behavior
(3) bowel or bladder control
(4) play
(5) motor skills
(C) Abnormalities of functioning in at least two of the following areas:
(1) qualitative impairment in social interaction (e.g., impairment in nonverbal behaviors, failure to
develop peer relationships, lack of social or emotional reciprocity)
(2) qualitative impairment in communication (e.g., delay or lack of spoken language, inability to
initiate or sustain a conversation, stereotyped and repetitive use of language, lack of varied
make-believe play)
(3) restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, including
motor stereotypies and mannerisms
(D) The disturbance is not better accounted for by another specific Pervasive Developmental
Disorder or by Schizophrenia.
8
299.80 Aspergers Disorder
(A) Qualitative impairment in social interaction, as manifested by at least two of the following:
(1) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial
expression, body postures, and gestures to regulate social interaction
(2) failure to develop peer relationships appropriate to developmental level
(3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people
(e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
(4) lack of social or emotional reciprocity
(B) Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at
least one of the following:
(1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest
that is abnormal either in intensity or focus
(2) apparently inflexible adherence to specific, nonfunctional routines or rituals
(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or
complex whole-body movements)
(4) persistent preoccupation with parts of objects
(C) The disturbance causes clinically significant impairment in social, occupational, or other impairment
areas of functioning.
(D) There is no clinically significant general delay in language (e.g., single words used by age 2 years,
communicative phrases used by age 3 years).
(E) There is no clinically significant delay in cognitive development or in the development of age-
appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about
the environment in childhood.
(F) Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.
299.80 Pervasive Developmental Disorder Not Otherwise Specified

(Including Atypical Autism)
This category should be used when there is a 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. For example, this category includes atypical autism - presentations that
do not meet the criteria for Autistic Disorder because of late age at onset, atypical symptomatology, or
subthreshold symptomatology, or all of these.
9
Aspergers Disorder
Aspergers Disorder (also known as Asperger Syndrome) is a newly recognized neuro-biological disorder
that is a part of the Autism Spectrum (Pervasive Developmental Disorders). The disorder is named for the
Viennese physician, Hans Asperger. In a 1944 paper, he described a group of young boys who displayed
normal intelligence and language development, but who also demonstrated serious social, behavioral and
communication impairments. Hans Aspergers paper was not translated until the 1980s. Hence,
Asperger Syndrome was not added to the Diagnostic and Statistical Manual of Mental Disorders-Fourth
Edition (DSM-IV) until 1994. The number of individuals affected is approximately within the range of 1
in 200 or 250 individuals (Kadesjo, Gillberg, and Hagberg, 1999).
Kids with Asperger Syndrome (AS) Typically:

Are visual thinkers and learners Have difficulty understanding anothers point of
Are very literal in their thoughts and view and ideas
interpretations Have difficulty reading the behavior of others
Have average to above average IQs Find eye contact a difficult skill to master
Have strong verbal skills Are uncoordinated and dislike physical activity
Are routine oriented and rule-based in their including sports
behavior Are very vulnerable to stress and high levels of
Are often inflexible in their thinking anxiety
Have difficulty socializing with others Find emotions difficult to discuss or understand
Obsess around their favorite things and interests Have sensory integration difficulties and seek
sensory stimulation and input
Real World Examples

Young people and adults with AS may display some or all of the following characteristics:
Socially awkward Limited or immature conversation skills

Nave and gullible (easy target for bullies) (difficulties with give and take)
Often unaware of others feelings Unusual or conflicting body language or facial
expressions (e.g., smiling when telling
Limited play and leisure skills
something sad)
Unusually accurate memory for details
Unusual speech patterns (repetitive and/or
Difficulty with sleeping or eating irrelevant remarks)
Trouble with organizational skills Unusually loud, high or monotone voice or
Easily upset by changes in routines stilted manner of speaking
Unusual and very intense areas of interest Difficulty managing stress or frustration
Lack peer and friendship establishment
10
Overview of DSM-IV-TR Diagnostic Criteria
Impairment in social interaction No clinically significant general delay in
Difficulty initiating and maintaining language (single words by age 2 and phrases by
conversations age 3)
Restricted repetitive and stereotyped patters of No clinically significant delay in cognitive
behavior, interests, and activities development or adaptive skills (besides social)
Clinically significant impairment in social,
occupational or other areas
Top 10 Intervention Strategies

1. Provide environmental supports (visual and 7. Program and assist the student in planning for
organizational supports, preferential seating, unstructured times (hallway transitions, recess,
travel card, and a home base/safe person). PE, bus rides, before and after school wait times).
2. Set clear expectations and boundaries. Post them 8. Facilitate social memberships (program for daily
on the wall opportunities for the individual to interact and
3. Provide instructions in verbal and written form as develop relationships/friendships). Provide social
much as possible skill instruction on a consistent basis and use
4. Modify assignments and homework for length, practice/modeling/role-playing.
quantity and amount of written language 9. Act as an interpreter; find out what the current
required. Provide homework checklists and an social topics and slang are and teach these to the
extra set of text books. individual with AS.
5. Augment curriculum with enrichment activities 10.Teach peers how to interact appropriately and
and other high interest materials. understand the individual.
6. Allow the individual to have free-time daily to be
used as he/she wants.
AS Resources
Aspergers Syndrome: A Guide for Parents and Professionals by Tony Attwood (also on video)
What Does It Mean to Me? A workbook Explaining Self Awareness and Life Lessons to the Child or
Youth with High Functioning Autism or Asperger by Catherine Faherty
Life Journey Through Autism: An Educators Guide to Asperger Syndrome by Brenda Smith Myles,
Dian Adveon, et al., www.researchautism.org/uploads/OAR_Guide_Asperger.pdf
Asperger Syndrome: A Guide for Educators and Parents by Brenda Smith Myles and Richard L.
Simpson
Asperger Syndrome and Difficult Moments by Brenda Smith Myles
Making Visual Supports Work in the Home and the Community: Strategies for Individuals with Autism
and Asperger Syndrome by Jennifer Savner and Brenda Smith Myles
Navigating the Social World by Jeanette McAfee
The Other Half of Asperger Syndrome: A Guide to Living in an Intimate Relationship
with a Partner Who Has Asperger Syndrome by Maxine Aston
11
Aspergers Syndrome and Adolescence by Teresa Bolick
Everybody Is Different: A Book for Young People Who Have Brothers or Sisters with Autism by Fiona
Bleach
Right Address - - Wrong Planet: Children with Asperger Syndrome Becoming Adults by Gena P.
Barnhill
Asperger Syndrome and Adolescence: Practical Solutions for School Success by Brenda Smith Myles
and Diane Adreon
AS Websites
www.udel.edu/bkirby/asperger
www.aspie.com
www.tonyattwood.com
www.asperger.org
www.asperger.net
www.egroups.com/group/AS-and-proud-of-it
The information in Aspergers Disorder was adapted from Supporting the Adolescent with Asperger
Syndrome (presentation) by Brenda Smith Myles; 20 Ways to Ensure Successful Inclusion, edited by
Robin H. Lock; Fast Facts for Those New to ASPIE World by L.H. Willey (2001); and Asperger
Syndrome and Adolescence by Teresa Bolick.
12
Legal Definition of Autism in South Dakota
Following are the South Dakota Administrative Rules pertaining to eligibility criteria for autism. Please
refer to http://legis.state.sd.us/rules/DisplayRule.aspx?Rule=24:05:24.01 for updates to these rules.
24:05:24.01:02. Screening procedures for autism

If a student is suspected of having autism, screening procedures for autism shall include a review of any
medical, hearing, and vision data on the student; the history of the students behavior; and the students
current patterns of behavior related to autism.
24:05:24.01:03. Autism defined

Autism is a developmental disability that significantly affects verbal and nonverbal communication and
social interaction and results in adverse effects on the students 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 the students educational performance is adversely affected primarily because
the student has a serious emotional disturbance as defined under Part B of the Individuals with Disabilities
Education Act.
24:05:24.01:05. Diagnostic procedures for autism

School districts shall refer students suspected as having autism for a diagnostic evaluation to an agency
specializing in the diagnostic and educational evaluation of autism or to another multidisciplinary team or
group of persons who are trained and experienced in the diagnosis and educational evaluation of persons
with autism.
A student suspected of autism must be evaluated in all areas related to the suspected disability, including,
where appropriate, health, vision, hearing, social and emotional status, general intelligence, academic
performance, communicative status, and motor abilities.
The evaluation shall utilize multiple sources of data, including information from parents and other
caretakers, direct observation, performance on standardized tests of language/communication and
cognitive functioning and other tests of skills and performance, including specialized instruments
specifically developed for the evaluation of students with autism.
24:05:24.01:06. Instruments used in diagnosis of autism

Instruments used in the diagnosis of students suspected of having autism include those which are based on
structured interviews with parents and other caregivers, behavior rating scales, and other
objective behavior assessment systems.
13
Instruments used in the diagnosis of students with autism must be administered by trained personnel in
conformance with the instructions provided by their producer.
No single instrument or test may be used in determining diagnosis or educational need. Specific
consideration must be given to the following issues in choosing instruments or methods to use in
evaluating students who are suspected of having autism:
(1) The students developmental level and possible deviations from normal development
across developmental domains;
(2) The students primary mode of communication;
(3) The extent to which instruments and methods identify strengths as well as deficits; and
(4) The extent that instruments and methods are tailored to assess skills in relationship to
everyday activities and settings.
14
Characteristics and Early Indicators of Autism
Communication Social Interaction
(relating to adults, interacting with peers, and
Uses behavior to express feelings. imitating the actions of others)
Lack of development or delayed development Lacks understanding of social cues.
of speech.
Inability to engage in simple social games
Loss of speech. such as pat-a-cake or peek-a-boo.
Echolalia (questions, statements, sounds): Difficulty in forming interpersonal
repeats either directly after hearing it or with relationships.
a time delay.
Avoids or uses eye contact in odd ways.
Perseverates on one topic.
Looks through people.
Atypical tone or rhythm of speech.
Prefers to be alone or plays parallel to others.
Lack of or infrequent initiation.
Lack of pretend or symbolic play.
Expresses emotions inappropriately.
Deficit in the ability to pay attention to an
Displays a narrow range of emotion, may interesting object or event with another
have a flat affect. person.
Lack of conventional nonverbal meaningful Inability to imitate (body movement, vocal,
gestures (i.e., pointing, head shakes and nods, motor).
eye contact).
Loss of social skills.
Doesnt orientate to another person speaking
or respond to name.
Behavior
(play and use of objects, insistence on sameness and
routines, stereotyped body movements, unusual
sensory interests)
Excessively uses toys in odd ways such as
lining them up, spinning.
Doesnt seem to know how to play with toys.
Engages in perseverative/repetitive,
unconstructive play.
Engages in repetitive body movements such
as rocking, pacing, hand flapping, toe
walking, twirling, spinning.
Develops attachments to inanimate objects.
At times seems hearing impaired.
Doesnt smile.
15
Modified Checklist for Autism in Toddlers
(M-CHAT)* - Description
Diana L. Robins, Ph.D.,1 Deborah Fein, Ph.D.,2 Marianne L. Barton, Ph.D.,2
& James A. Green, Ph.D.2
1
Georgia State University 2University of Connecticut
*The full text may be obtained through the Journal of Autism and Developmental Disorders, April 2001
PLEASE NOTE: The M-CHAT was not designed to be scored by the person taking it. In the validation
sample, the authors of the M-CHAT scored all checklists. If parents are concerned, they should contact
their childs physician.
Abstract
Autism, a severe disorder of development, is difficult to detect in very young children. However, children
who receive early intervention have improved long-term prognoses. The Modified Checklist for Autism in
Toddlers (M-CHAT), consisting of 23 yes/no items, was used to screen 1,293 children. Of the 58 children
given a diagnostic/developmental evaluation, 39 were diagnosed with a disorder on the autism spectrum.
Six items pertaining to social relatedness and communication were found to have the best discriminability
between children diagnosed with and without autism/PDD. Cutoff scores were created for the best items
and the total checklist. Results indicate that the M-CHAT is a promising instrument for the early detection
of autism.
Background
The M-CHAT is an expanded American version of the original CHAT from the U.K. (Baron-Cohen et al.,
1992; 1996). The M-CHAT has 23 questions using the original nine from the CHAT as its basis. The goal
of the ongoing M-CHAT research is to demonstrate adequate psychometric properties of the M-CHAT
(sensitivity, specificity, positive and negative predictive power). The M-CHAT is available for clinical
and research use, with the following caveats:
1. Clinical use should proceed with caution, given that the current scoring system is designed to
maximize sensitivity (i.e., identify as many children with autism spectrum disorders as possible),
which results in a number of false positive cases (i.e., children who will not be diagnosed with
an autism spectrum disorder, although they fail the M-CHAT). Once cross-validation of the M-
CHAT is complete, the scoring may be revised.
2. The M-CHAT is not designed to detect all possible developmental disorders. Any parents who
have concerns about their child should see their childs physician, regardless on the childs score
on the M-CHAT.
M-CHAT research is ongoing at the University of Connecticut and Georgia State University. The follow-
up study of the initial sample is expected to be published in the near future. This research is supported by
funding from the National Institute of Child Health and Development, the Maternal and Child
Health Bureau, and the National Alliance for Autism Research. For more information,
please contact Diana Robins at drobins@gsu.edu or Deborah Fein at
Deborah.Fein@uconn.edu.
16
M-CHAT
(Modified Checklist for Autism in Toddlers)
Please fill out the following about how your child usually is. Please try to answer every question. If the behavior
is rare (e.g., youve seen it only once or twice), please answer as if the child does not do it.
1. Does your child enjoy being swung, bounced on your knee, etc.? Yes No
2. Does your child take an interest in other children? Yes No
3. Does your child like climbing on things, such as up stairs? Yes No
4. Does your child enjoy playing peek-a-boo/hide-and-seek? Yes No
5. Does your child ever pretend, for example, to talk on the phone or take care of
dolls, or pretend other things? Yes No
6. Does your child ever use his/her index finger to point, to ask for something? Yes No
7. Does your child ever use his/her index finger to point, to indicate interest in something? Yes No
8. Can your child play properly with small toys, e.g., cars or blocks, without just mouthing,
fiddling or dropping them? Yes No
9. Does your child ever bring objects over to you (parent) to show you something? Yes No
10. Does your child look you in the eye for more than a second or two? Yes No
11. Does your child ever seem oversensitive to noise (e.g., plugging ears)? Yes No
12. Does your child smile in response to your face or your smile? Yes No
13. Does your child imitate you, e.g., if you make a face, will your child imitate it? Yes No
14. Does your child respond to his/her name when you call? Yes No
15. If you point at a toy across the room, does your child look at it? Yes No
16. Does your child walk? Yes No
17. Does you child look at things you are looking at? Yes No
18. Does your child make unusual finger movements near his/her face? Yes No
19. Does your child try to attract your attention to his/her own activity? Yes No
20. Have you ever wondered if your child is deaf? Yes No
21. Does your child understand what people say? Yes No
22. Does your child sometimes stare at nothing or wander with no purpose? Yes No
23. Does your child look at your face to check your reaction when faced with something
unfamiliar? Yes No
1999 Diana Robins, Deborah Fein, & Marianne Barton. Please refer to: Robins, D., Fein, D., Barton, M., &
Green, J. (2001). The Modified Checklist for Autism in Toddlers: An initial study investigating the early detection
of autism and pervasive developmental disorders. Journal of Autism and Developmental Disorders, 31 (2), 131-
144. Reprinted from www.firstsigns.org/downloads/m-chat.
17
M-CHAT Scoring Instructions
A child fails the checklist when 2 or more critical items are failed OR when any three items are failed.
Yes/no answers convert to pass/fail responses. Below are listed the failed responses for each item on the
M-CHAT. Bold capitalized items are CRITICAL items. Not all children who fail the checklist
will meet criteria for a diagnosis on the autism spectrum. However, children who fail the checklist should
be evaluated in more depth by the physician or referred for a developmental evaluation with a specialist.
1. No 6. No 11. Yes 16. No 21. No

2. NO 7. NO 12. No 17. No 22. Yes
3. No 8. No 13. NO 18. Yes 23. No
4. No 9. NO 14. NO 19. No
5. No 10. No 15. NO 20. Yes
Reprinted from www.firstsigns.org/downloads/m-chat.
18
19
Intervention
20
Characteristics of Effective Interventions
Characteristics of the most appropriate intervention for a given child must be tied to that childs family
and familys needs. There is a strong consensus that the following features are critical:
Entry into intervention programs as soon as an autism spectrum disorder diagnosis is seriously
considered;
Active engagement in intensive instructional programming for a minimum of the equivalent of a

full school day, 5 days (at least 25 hours) a week, with full year programming varied according
to the childs chronological age and developmental level;
Repeated, planned teaching opportunities generally organized around relatively brief periods of
time for the youngest children (e.g., 15-20 minute intervals), including sufficient amounts of
adult attention in one-to-one and very small group instruction to meet individualized goals;
Inclusion of a family component, including parent training;
Low student/teacher ratios (no more than two young children with autism spectrum disorders
per adult in the classroom); and
Mechanisms for ongoing program evaluation and assessment of individual childrens progress,
with results translated into adjustments in programming.
The key to any childs education program lies in the objectives specified in the IEP (Individualized
Education Plan) and the ways they are addressed. Effective services will vary considerably across
individual children, depending on the childs age, cognitive and language levels, behavioral needs and
family priorities.
Adapted from National Research Council (2001) Educating Children with Autism. Committee on
Educational Interventions for Children with Autism. Catherine Lord and James P. McGee, eds. Division
of Behavioral and Social Sciences and Education. Washington DC: National Academy Press, pp. 218-
220.
21
Ten Things Every Child with Autism Wishes You Knew
By Ellen Notbohm
Some days it seems the only predictable thing about it is the unpredictability. The only consistent
attribute, the inconsistency. There is little argument on any level but that autism is baffling, even to those
who spend their lives around it.
Equipping those around our children with a simple understanding of autism's most basic elements has a
tremendous effect on the children's journey towards productive, independent adulthood. Autism is an
extremely complex disorder, but we can distill it to three critical components: sensory processing
difficulties, speech/language delays and impairments, and whole child/social interaction issues.
Here are 10 things every child with autism wishes you knew.
1. I am a child with autism. I am not autistic. My autism is one aspect of my total character.
It does not define me as a person. Are you a person with thoughts, feelings and many talents, or are you
just fat (overweight), myopic (wear glasses) or klutzy (uncoordinated, not good at sports)?
2. My sensory perceptions are disordered. This means the ordinary sights, sounds, smells,
tastes and touches of everyday life that you may not even notice can be downright painful for me. The
very environment in which I have to live often seems hostile. I may appear withdrawn or belligerent to
you, but I am really just trying to defend myself.
A simple trip to the grocery store may be hell for me. My hearing may be hyperacute. Dozens of
people are talking at once. The meat cutter screeches, babies wail, carts creak, the fluorescent lighting
hums. My brain can't filter all the input, and I'm in overload! My sense of smell may be highly sensitive.
The fish at the meat counter isn't quite fresh, the guy standing next to us hasn't showered today, the deli is
handing out sausage samples... I can't sort it all out, I'm too nauseous.
Because I am visually oriented, this may be my first sense to become overstimulated. The fluorescent
light is too bright. Sometimes the pulsating light bounces off everything and distorts what I am seeing.
The space seems to be constantly changing. There's glare from windows, moving fans on the ceiling, so
many bodies in constant motion, too many items for me to be able to focus - and I may compensate with
tunnel vision. All this affects my vestibular sense, and now I can't even tell where my body is in space. I
may stumble, bump into things, or simply lay down to try and regroup.
3. Please remember to distinguish between won't (I choose not to) and can't
(I'm not able to). Receptive and expressive language are both difficult for me. It isn't that I don't
listen to instructions. It's that I can't understand you. When you call to me from across the room, this is
what I hear: *&^%$#@, Billy. #$%^*&^%$&*. Instead, come speak directly to me in plain words:
Please put your book in your desk, Billy. It's time to go to lunch. This tells me what you want
me to do and what is going to happen next. Now it's much easier for me to comply.
22
4. I am a concrete thinker. I interpret language literally. It's very confusing for me when you
say, Hold your horses, cowboy! when what you really mean is Please stop running. Don't tell me
something is a piece of cake when there is no dessert in sight and what you really mean is, This will be
easy for you to do. Idioms, puns, nuances, double entendres and sarcasm are lost on me.
5. Be patient with my limited vocabulary. It's hard for me to tell you what I need when I
don't know the words to describe my feelings. I may be hungry, frustrated, frightened or confused, but
right now those words are beyond my ability to express. Be alert for body language, withdrawal,
agitation, or other signs that something is wrong. There's a flip side to this: I may sound like a little
professor or a movie star, rattling off words or whole scripts well beyond my developmental age. These
are messages I have memorized from the world around me to compensate for my language deficits,
because I know I am expected to respond when spoken to. They may come from books, television or the
speech of other people. It's called echolalia. I don't necessarily understand the context or the terminology
I'm using, I just know it gets me off the hook for coming up with a reply.
6. Because language is so difficult for me, I am very visually oriented. Show me

how to do something rather than just telling me. And please be prepared to show me many times. Lots of
patient repetition helps me learn. A visual schedule is extremely helpful as I move through my day. Like
your day planner, it relieves me of the stress of having to remember what comes next, makes for smooth
transitions between activities, and helps me manage my time and meet your expectations. Here's a great
web site for learning more about visual schedules www.cesa7.k12.wi.us/newweb/content/rsn/autism.asp
7. Focus and build on what I can do rather than what I can't do. Like any other
human, I can't learn in an environment where I'm constantly made to feel that I'm not good enough or that
I need fixing. Trying anything new when I am almost sure to be met with criticism, however constructive,
becomes something to be avoided. Look for my strengths and you'll find them. There's more than one
right way to do most things.
8. Help me with social interactions. It may look like I don't want to play with the other kids
on the playground, but sometimes it's just that I simply don't know how to start a conversation or enter a
play situation. If you can encourage other children to invite me to join them at kickball or shooting
baskets, I may be delighted to be included.
9. Try to identify what triggers my meltdowns. This is termed the antecedent.

Meltdowns, blowups, tantrums or whatever you want to call them are even more horrid for me than they
are for you. They occur because one or more of my senses has gone into overload. If you can figure out
why my meltdowns occur, they can be prevented.
23
10. If you are a family member, please love me unconditionally. Banish thoughts
such as, If he would just and Why can't she ... ? I didn't choose to have autism. Remember that it's
happening to me, not you. Without your support, my chances of successful, self-reliant adulthood are
slim. With your support and guidance, the possibilities are broader than you might think. I promise you
I'm worth it.
It all comes down to three words: Patience. Patience. Patience.

Work to view my autism as a different ability rather than a disability. Look past what you may see as
limitations and see the gifts autism has given me. I may not be good at eye contact or conversation, but
have you noticed I don't lie, cheat at games, tattle on my classmates, or pass judgment on other people?
You are my foundation. Think through some of those societal rules, and if they don't make sense for me,
let them go. Be my advocate, be my friend, and we'll see just how far I can go.
Reprinted in part from South Florida Parenting www.southflorida.com/sfparenting. See Ellen Notbohms
book with the same title.
24
Evaluating Interventions
Treatment approaches and nontraditional therapies identified for Autism Spectrum Disorders are debated
by researchers, parents and professionals on a regular basis. Many approaches exist that promise cures or,
at the very least, dramatic improvement. While some of these strategies are effective for some, there is no
one approach that is effective for all people with Autism Spectrum Disorders.
Most importantly, autism cannot be cured. But early intervention and appropriate educational planning
can minimize the effects of autism on the lives of individuals with autism by teaching them skills to
enhance their ability to communicate and socialize.
Parents are strongly encouraged to investigate thoroughly any treatment approaches or nontraditional
therapies prior to implementing them with their child. The following is a list of questions that should be
considered:
1. What is the treatment/therapy?

Is there written information, a program description, or detailed brochure?
Exactly what is involved for the family and the child?
Will the treatment result in harm to my child?
What is the length of treatment?
What is the frequency of sessions?
How much parent time is required?
What are the financial costs?
Is there training required for parents, care providers, teachers and others?
Is there follow-up and/or support after treatment termination?
2. Is there reliable evidence of the effectiveness of the technique/

intervention?
Does the treatment promise a cure?
Does the treatment claim to be effective and appropriate for everyone?
Does research support these claims? Is there quality empirical evidence?
Do the claims made correspond to what is known about autism, language, and neurological
functioning?
3. What is the rationale, philosophy, or underlying purpose of the treatment

program?
Does the treatment address important aspects of the autistic disorder (e.g., social
interaction, cognitive issues, and language)?
25
How is the philosophy tied to the specific treatment techniques?
How were the philosophy and treatment methods developed (e.g., scientific research or clinical
experience)?
4. How is the determination made that the treatment/therapy is warranted

and appropriate?
Are there assessment procedures specified?
5. Does the treatment focus on one particular aspect or is

it a general comprehensive approach? There is so
Does it allow the integration of other techniques? much
How will the treatment be integrated into my childs program? information
Are the components of the treatment program out there. It is so
compatible? important to talk
Are the treatment goals individualized for each person and their with families who
family? have children with
autism. It is also
important to have a
6. What are the credentials of the program director and doctor who
the staff? supports your
What are the background, training and credentials of the program choices and is not
staff? judgmental.
What are the staffs understanding, training and experience in autism?
How much experience have they had in providing the treatment?
Are they open to questions and input from family members and other professionals involved
with the child?
7. Is there evidence that supports the effectiveness of the treatment/

therapy?
Is there independent confirmation of the effectiveness?
What are the possible negative effects or side effects of the treatment?
What impact might the treatment have on the familys lifestyle (e.g., time, finances)?
8. Does the treatment/therapy promise a cure?
26
9. Is there excessive hype surrounding the treatment?
There are many people who claim to have a cure for autism. However, the majority of treatments and
claims of cures that exist have yet to be scientifically documented. Treatment decisions are best made
following a comprehensive assessment and after thorough investigation of the various treatment options
being considered.
The National Institute of Mental Health suggests an additional list of questions parents should ask when
planning for their child:
How successful has the program been for other children?
How many children have gone on to placement in a general classroom and how have they
performed?
How are activities planned and organized?
Are there predictable daily schedules and routines?
How much individual attention will my child receive?
How is progress measured?
Will my child be given tasks and rewards that are personally motivating?
Is the environment designed to minimize distractions?
Will the program prepare me to continue the therapy at home?
What is the cost, time commitment, and location of the programming?
Education and investigation will help parents arrive at the conclusion of what is the best treatment option
for their child and family.
References:
Sasso, G. (1995, November). Choosing Interventions for Individuals with Autism. Presentation at the
Midwest Autism Conference.
National Institute for Mental Health. www.nimh.nih.gov
27
Characteristics of Individuals with Autism
and Support Strategies
Cognitive/Learning Style
Characteristics Support Strategies
1. Developmental discontinuity 1.Use gestures, demonstrate and provide physical
a. Strengths prompts, use visual clues.
1. Understanding visual information 2. Be organized, help learner organize.
2. Understanding special information 3. Be direct, be clear, be consistent.
3. Understanding concrete rules and 4. Keep motor patterns predictable.
information 5. Reinforce it.
4. Motor memory
5. Good rote memory
b. Weaknesses 1. Teach symbols very systematically, pair symbols
1. Understanding symbols with words.
2. Understanding means-end and cause-effect 2. Have very clear beginnings and ends to activities,
3. Understanding time-based information teach routines.
4. Understanding abstract concepts and abstract 3. Use visual and auditory cues for time issues,
information picture schedules, written schedules, have learner
5. Imitation involved in setting up and using schedule (have
6. Ability to generalize some motor aspect involved.
4. Use concrete, visual cues to illustrate concepts,
relate concepts to personal experience.
5. Give time to respond, may need physical cue to
begin, imitate the learner (playfully).
6. Use consistent cues, prompts, and consequences;
teach in natural environments; teach
(systematically) across a variety of places, people,
and materials; with new skills, change one
dimension of task at a time.
2. Typically learns things as wholes Whole task presentation, global chaining, prompt
placement, discrete trial format for instruction.
3. Difficulty identifying relevant cues Highlight relevant cues.
4. Concern with maintaining sameness Respect it, help the learner feel safe, teach strategies
to manage change gradually.
5. For some, verbal IQ equals or exceeds Find opportunity for learner to use and be valued for
performance IQ those verbal skills.
6. May have talent in art, music or mathematics Capitalize on that talent. Use it as an entry into
various social groups.
28
Sensory Processing
1. Extremely passive or hyperactive Be a detective - observe what kinds of places,
people, activities, stimuli, seem to make the learner
more or less active and attentive.
2. May experience sensory input differently (either Be sensitive to the kind of sensory input the learner
more or less sensitive) seems to seek out and avoid. Provide opportunities
for the learner to get the kind of stimulation she/he
seeks (sensory diet). Try to minimize contact with
stimuli that are aversive. Teach coping skills for
when she/he, must experience stimuli that are
irritating or painful.
3. May have unusual sleep patterns Help families establish bedtime routines, possibly
including direct reinforcement for participating in
routine.
4. Frequently handles objects in unusual ways Provide objects that cay be handled in learners
preferred manner or provide same/similar input/
feedback. Find activities that incorporate learners
movements. Teach functional use of objects.
5. May have some excessive self-stimulatory Use sensory diet. Try to find ways for the
behaviors individual to experience the stimulus (e.g., using a
fan, a rocking chair). Teach when and where the
behavior is okay. Reduce or increase other
stimulation. Use prompts, cues and behavioral
intervention to reduce the frequency of the behavior.
6. Changing levels of arousal Be aware of it - watch for signs of arousal. Assign
meaning to the behavior. Develop and teach use of
communication system. Use sensory diet.
Movement
1. Starting Physical prompts. Prompt placement. Visual cues
Difficulties may be seen as frustration, and within-stimulus prompts. Systematic
avoidance, noncompliance, not understanding, instruction. Reasonable accommodations.
cognitive challenge, nonverbal, rituals Routines. Clear (dramatic in some cases) beginning
points.
2. Executing Physical prompts. Prompt placement. Visual cues
Difficulties may be seen as noncompliance, and within-stimulus prompts. Systematic
echolalia, rituals, rigidity instruction. Reasonable accommodations.
Routines.
29
Movement, continued
3. Continuing Use of individualized schedules. Frequent change
Difficulties may be seen as prompt dependent, of activities and/or materials. Minimize transitions
noncompliance, short attention span, (time and movement). Physical prompts. Visual
distractibility cues and within-stimulus prompts. Systematic
instruction. Reasonable accommodations.
Routines.
4. Stopping Provide similar alternative activities and/or objects.
Difficulties may be seen as perseveration, rituals, Clear (dramatic at times) end points. Teach coping
self-stimulatory, rigidity strategies. Physical prompts. Visual cues and
within-stimulus prompts. Systematic instruction.
Reasonable accommodations. Routines.
5. Combining Chaining. Physical prompts. Visual cues and
Difficulties may be seen as prompt dependent, within-stimulus prompts. Systematic instruction.
processing problem Reasonable accommodations. Routines.
6. Switching Teach coping skills when switches need to occur.
Difficulties with transitions Provide sufficient time to make switches. Physical
prompts. Routines.
7. Variable performance Recognize and accommodate for varied
performance.
Communication Skills: Expressive

1. Nonverbal (approximately 50%) Develop and use augmentative communication
systems. Encourage learner to show you or
take you.
2. If talking, may not readily use speech to Acknowledge nonverbal attempts. Present
communicate communicative temptations. Use natural/
meaningful contexts and materials. Assess
communicative functions.
3. Echolalic (repeats what has been said, Simple language, avoid excessive talking, assess
immediately or delayed) functions, segment utterances by using stress,
intonation, and pause, relate echolalia to aspects of
the environment, use and teach gestures.
4. Language use give the impression of being Model and reinforce creative language, provide
learned by rote regular and systematic access to competent peer
models.
5. Pedantic (rhythmic and/or varied intonation), Teach appropriate time and place. Dont
may also include repetitive questions on topics. take it personally.
30
Communication Skills: Expressive, continued
6. Repetitive speech Redirect and refocus. Introduce and expand topic
repertoire.
7. Literal Recognize and respond to way the learner
communicates.
8. Abnormal voice modulation Model, dramatic mode, direct instruction.
9. Pronoun reversal Teach use of names instead.
10. Hyperverbal Stimulus control (teach time and place), concrete
visual cues and feedback.
11. Poor nonverbal communication Respond to any attempts at communication, use and
teach gestures.
12. Difficulty expressing emotions conventionally Teach coping strategies. Assess meaning of
behavior.
13. Limited two-way conversation: turn taking, Direct instruction. Take responsibility for repair
topic maintenance, lack of referents strategies. Communication dictionary. Train peers
to accommodate and make repair strategies.
Communication Skills: Receptive

1. Often appears selectively deaf Provide physical touch prior to or paired with
verbal input.
2. Requires additional time to understand or Provide time (up to 30 seconds), pair verbal input
respond to verbal input alone with visual cues and material.
3. Difficulty responding to and interpreting social Exaggerate cues, draw attention to social
gestures/information information, provide direct social skills instruction.
4. Literal Limit use of idioms, double-meanings, and
colloquialisms.
Social/Emotional
1. Often appears more interested in objects than Be open to and share interest in objects. Show how
people objects can be shared or used cooperatively.
2. Imaginative play is limited, lacks creativity, Choose simple schemes at first and encourage
flexibility, and spontaneity participation. Teach schemes then
gradually expand.
31
Social/Emotional, continued
3. May demonstrate attachment in unique ways Recognize and respond to the way the learner
demonstrates attachment.
4. Apparent lack of shared reference Provide feedback when it does not occur. Model it,
emphasize establishing joint reference if necessary.
Provide visual cues (written or other). Instruct
directly. Have good models. PRACTICE!
5. Sometimes difficult to console Move gently, be sensitive, and do the best you can.
Some learners may need space, some touch, some
quiet, and some may need you to talk/sing.
6. Frequent repetitive, ritualistic play; limited range Choose simple schemes at first and encourage
of interests/activities participation. Teach schemes, then gradually
expand.
7. Demonstrates lack of anticipatory response Establish routines and practice them. Role play may
help with some learners. Provide additional cues.
Foreshadow.
8. Difficulty with change and transitions Use visual schedules and other visual and motor
organizers. Use foreshadowing. Make beginnings
and endings of activities and transitions clear. Help
the learner organize for and during the transition.
9. May demonstrate self-stimulatory or stereotypic Provide objects that can be handled in learners
behaviors preferred manner or provide same/similar input/
feedback. Find activities that incorporate learners
movements. Teach when and where the behavior is
okay. Reduce or increase other stimulation. Use
prompts, cues and behavioral intervention to reduce
the frequency of the behavior.
10. Experiences entire range of emotions Work at recognizing and interpreting how the
learner expresses various emotions.
11. One-sided social interaction Work on turn-taking, use of concrete visual cues,
dramatic modeling, coaching, provide regular
opportunities to be with socially competent peers.
12. Demonstrates difficulty learning and using the Make rules as clear and concrete as possible.
rules of social interaction Provide good models (younger, same-aged, and
older). Provide direct instruction in social skills.
use dramatic modeling. Use coaching and
foreshadowing. Have the student practice (usually
in natural settings. Teach peers about differences.
Use and teach peers to use reasonable
accommodations.
32
Social/Emotional, continued
13. May demonstrate apparent lack of empathy Coach and teach expressions of empathy. Allow
sufficient time for expression.
14. Nave, inappropriate, lack of intuition Be sensitive to the difficulty. Foreshadow about a
situation when possible. Allow sufficient time for
person to express intuition
15. Perspective-taking Teach cues to which the learner should attend.
Teach responses to cues. Teach others to
communicate their feelings/needs immediately,
directly and concretely
16. May demonstrate high levels of anxious Systematically teach coping and relaxation
behaviors strategies. Make reasonable accommodations. Use
systematic desensitization.
17. Seen as eccentric in school Teach peers about differences. Encourage and
model acceptance and celebration of difference.
Frame eccentricities as talents when possible.
18. Awareness of being different from others, Create supportive social network. Listen and be
usually around puberty, bringing on over- supportive. May need counseling, help student
sensitivity to criticism, anxiousness, and/or contact a therapist.
depression
19. Expresses a desire to make social contact, but Help learner establish a social network. Provide
no/few or unconventional attempts regular and systematic opportunities for interaction
with peers. Directly and systematically teach social
skills. Act as an interpreter for the learner.
Sensitize peers to learners needs.
33
Understanding and Supporting Individuals with Autism:
What You Can Do
Use simple language (vocabulary and structure) that is familiar to the individual.
Allow for processing time needed by the student (this can often be as much as 30 seconds!)
Use and teach conventional gestures and/or functional communication for the individual, for example,
teach ways for the individual to communicate I need help, No, thanks, I dont know.
Do not always require eye contact. We spent

weeks
Always ask, What could she be saying with this behavior? preparing our
son for his school
Provide definite visual structure and a visual schedule throughout the day pictures. We
and during each activity. practiced Say
cheese and then he
Be sure activities have clear beginnings and endings. would smile. The
photographer
Identify activities that give the individual opportunities to use her/his insisted on saying,
interests and highest level skills. Say pizza. Our
son had the worst
Avoid changing the rules whenever possible. photograph ever.
We never did see it,
Make rules as clear, specific and concrete as possible. he wouldnt bring it
home.
Establish routines to assist in making daily activities predictable.
Only use prompts that can be easily faded.
To facilitate social play, identify simple, age appropriate activities that are of high interest to peers.
Choose activities that require simple social interactions.
Be creative.
Be flexible.
Maintain a sense of compassion and a sense of humor.
34
Applied Behavior Analysis (ABA)
Applied means practice, rather than research or philosophy. Behavior analysis may be read as
learning theory, that is, understanding what leads to (or doesn't lead to) new skills. (ABA is just as much
about maintaining and using skills as about learning.) It may seem odd to use the word behavior when
talking about learning to talk, play, and live as a complex social being, but all these can be taught.
Typically developing children learn without specific intervention--that is, the typical environment they
are born into provides the right conditions to learn language, play, and social skills in early development.
Children with autism learn much, much less from the environment. They are often capable of learning, but
it takes a very structured environment, one where conditions are optimized for acquiring the same skills
that typical children learn naturally. ABA is all about the rules for setting up the environment to enable
children with autism to learn.
Behavior analysis dates back at least to B.F. Skinner, who performed animal experiments showing that
food rewards (immediate positive consequences to a target behavior) lead to behavior changes.
Conversely, any new behavior that an animal (or you or I) may try, but is never rewarded, is likely to die
out after a while (How often will you dial that busy number?).
And, as common sense would have it, a behavior that results in something unpleasant (an aversive) is even
less likely to be repeated. These are the basics of behavioral learning theory. ABA uses these principles to
set up an environment in which kids learn as much as they can as quickly as possible. It is a science, not a
philosophy.
The most common and distinguishing type of intervention based on applied behavior analysis is discrete
trial teaching. It is what people most often think of when you say ABA or Lovaas method. This is
partly because there are so many hundreds of hours of DT teaching, and partly because it looks so odd.
But it is what it is because that's what works--every aspect has been refined (and is still being refined) to
result in maximum learning efficiency.
[Briefly: the student is given a stimulus--e.g., a question, a set of blocks and a pattern, a request to go ask
Mom for a glass of water--along with the correct response, or a strong hint at what the response should
be. He is rewarded (an M&M, a piggy-back ride, a happy "good job!") for the correct response; anything
else is ignored or corrected very neutrally. As his response becomes more reliable, the clues are
withdrawn until he can respond independently. This is usually done one-on-one at a table (thus the term
table-top work), with detailed planning of the requests, timing, wording, and the therapists reaction to the
students responses.]
It is a mistake, however, to think of an ABA program as just DT teaching. Ivar Lovaas (among others)
notes very clearly that a behavioral program is a comprehensive intervention, carried out in every setting,
every available moment. The skills that are taught so efficiently in discrete trial drills must be practiced
and generalized in natural settings.
Taken from http://rsaffran.tripod.com/whatisaba.html.

See also http://rsaffran.tripod.com/faq.html#q8.
35
Discrete Trial Training
Discrete trial training is usually associated with the work of O. Ivar Lovaas, a professor of psychology at
the University of California, Los Angeles (UCLA), which he began in the 1960s. It is based upon the
principles of Applied Behavior Analysis (ABA), which may also be referred to as behavior modification,
behavior therapy, or behavioral intervention. Discrete trial training consists of a series of distinct repeated
lessons or trials taught one-to-one. Each trial consists of an antecedent, a directive or request for the
child to perform an action; the behavior, a response from the child; and the consequence, a reaction
from the therapist based upon the response of the child. Positive reinforcers are selected by evaluating the
childs preferences. Many children initially respond to tangible or concrete reinforcers such as food items.
These concrete rewards are faded as fast as possible and replaced with rewards such as praise, tickles, and
hugs. The final part of a discrete trial is a short pause between the consequence and the next instruction
called the between-trials interval.
Early intensive behavioral intervention such as the Lovaas program is usually implemented when the child
is young, before the age of six. Services are highly intensive, typically 30-40 hours per week, and
conducted on a one-to-one basis by a trained therapist in the familys home. Another component of the
program is parent training. The childs progress is closely monitored by the collection of data on the
performance of each trial. After a skill has been mastered, another skill is introduced, and the mastered
skill is placed on a maintenance schedule. A maintenance schedule allows for periodic checking so the
child does not regress in mastered skills. Advantages and disadvantages to this intensive approach have
been the subject of debate in literature and should be researched carefully before implementation.
Discrete trial training is a technique that can be an important element of a comprehensive educational
program for the child with an Autism Spectrum Disorder. In some cases, a much less intensive, informal
approach may be implemented by a knowledgeable professional to teach specific skills such as sitting and
attending.
36
Structured Teaching
Structured teaching is an intervention philosophy developed in the early 1970s by Eric Schopler and Gary
Mesibov at the University of North Carolina, Chapel Hill, Division TEACCH (Treatment and Education
of Autistic and related Communication Handicapped Children) (www.teacch.com). It is an approach for
teaching individuals with Autism Spectrum Disorders.
Structured teaching is a system for organizing the environment, developing appropriate activities, and
helping people with autism understand what is expected of them. Structured teaching uses visual cues,
which help individuals with autism focus on the relevant information, which can, at times, be difficult for
the person with autism to distinguish from the non-relevant information.
There are four components of structured teaching that are incorporated into any educational program:
1. Physical structure: physical arrangement, learning
areas, clear boundaries, accessible materials.
2. Daily schedules: will add predictability, organization
and clarity.
3. Work systems: will communicate to the individual
What work he is supposed to do
How much work will be required at this time
How she know when she is finished
What happens when the work is completed
4. Visual structure: will minimize anxiety and
maximize clarity, understanding and interest.
Structured teaching enhances participation, independence Work Area Example
and success for the individual with autism.
References:
Structured Teaching: Strategies for Supporting Students with Autism by Susan Stokes, written under a
contract with CESA 7 and funded by a discretionary grant from the Wisconsin Department of Public
Instruction.
Accesing the Curriculum for Pupils with ASD. Gary Mesibov and Marie Howley (2003)
Hodgdon, L. (1995).
Visual Strategies for Improving Communication: Practical Supports for School and Home. Troy, MI:
QuirkRoberts Publishing.
Understanding the Nature of Autism: A Practical Guide. Janzen, J. (1996). San Antonio:
Therapy Skill Builders.
Learning and Cognition in Autism. Schopler, E., and Mesibov, G. (1995). New York:
Plenum Press.
37
Visual Schedules
A visual schedule presents the abstract concept of time in a concrete form. The schedule communicates to
people Autism Spectrum Disorders (ASD) when events/activities will take place and what will come next
in a clear, stable, concrete and uncluttered manner. This strategy assists persons with ASD in predicting
and planning. As a result of the increase in effective communication, successful implementation of a
visual schedule will often decrease challenging behaviors
There are several steps to implementing an effective individual visual schedule. The first step is to assess
the individuals level of understanding of different forms of visual communication. If, for example, the
individual understands some photos, but generally is at an object level, the schedule may consist of a
combination of objects and photos.
As the individual demonstrates understanding of the objects, they may be paired with the photo to teach
the individual the meaning of the photo. The object may be faded or removed when the individual is able
to demonstrate understanding of the photo. Always pair the written word with photos and picture
symbols.
The hierarchy of visual communication (least abstract to most abstract):

1. Objects (whole object, miniature object, partial object)
2. Photos or labels from the item
3. Picture Symbols (line drawings such as Mayer Johnson Picture Symbols)
4. Written Words
Once the type of visual communication has been selected, the schedule can be constructed. Specific
information, such as how the schedule will be used, should first be considered. Where will it be managed?
Who will manage it? How will the individual transition between the schedule and the activities/places on
the schedule?
The schedule should be easy to create and use, accessible to the individual, durable, flexible, inexpensive,
visually clear (free of unnecessary details and decoration), and appropriate to the individuals age and skill
level. Depending on the skill level of the individual, the schedule may need to be presented in parts rather
than the whole day at once.
The individual may need the schedule posted on the wall or may need to be able to carry the schedule in a
binder with him wherever he goes. The schedule may be arranged left to right or top to bottom. The
variety of materials that can be used to create a schedule is endless. Individual schedules may look very
different and be implemented very differently depending upon the person using it.
A visual cue is necessary to communicate to the individual when it is time to check the schedule. For
example, this may be an arbitrary object such as a red block or a koosh ball for the individual who needs
objects. Another example is a 3 x 5 index card with the persons name written on it. This is always paired
with the verbal phrase, Check schedule. A person who is able to follow a written schedule may
need only the verbal phrase; however, for anyone who is not at this level, a transition object
is critical to the successful implementation of the schedule.
38
The following is an example of the implementation of a schedule. Joes schedule is mounted on the wall
just inside the classroom door. Joe is given an index card with his name on it that indicates he needs to
check his schedule. When he arrives at the schedule, there is a place for him to put the card.
The schedule is arranged left to right, and the picture symbols are attached with Velcro. He removes the
picture symbol farthest to the left that says it is time for P.E. class. Joe takes the picture symbol with him
to class and when he arrives at the gym, there is a place for him to match the symbol. When class is over,
the teacher gives him another card with his name on it, which takes him back to the schedule and the
process begins again.
Mini-schedules are used to supplement the daily schedule. For example, the daily schedule indicates that
it is time for reading class. The mini-schedule tells the individual that he is going to 1) read a book, 2)
listen to the teacher, and 3) do a worksheet. When the person has completed the activities on the mini-
schedule, he is prompted to transition back to the daily schedule.
Joes Schedule (an example of a visual schedule)
References:
Hodgdon, L. (1995). Visual Strategies for Improving Communication: Practical Supports for School and
Home. Troy, MI: QuirkRoberts Publishing.
Janzen, J. (1996). Understanding the Nature of Autism: A Practical Guide. San Antonio: Therapy Skill
Builders.
Schopler, E., and Mesibov, G. (1995). Learning and Cognition in Autism. New York: Plenum
Press.
Quill, K. (1995). Teaching Children with Autism: Strategies to Enhance Communication

and Socialization. New York: Delmar Publishers, Inc.
39
Enhancing Language and Communication
in Individuals with Autism
General Strategies
Minimize asking the individual direct questions.
Watch what the individual is doing and make appropriate comments. For example, when a child puts a
doll in the cradle, say Baby is going to sleep.
Wait for the individual to respond with clear visible anticipation of their response. Look expectantly
by establishing eye contact, with lips slightly apart, eyebrows raised and lean your head and body
slightly toward the individual.
Create communication temptations. Set up situations where the individual will have to talk to get their
needs met.
Use exaggerated facial features and gestures.
Provide a model of appropriate language.
Speak in concise, concrete language that is appropriate to the individuals level of language.
Try using exaggerated intonation, volume (soft or loud) and rate of speech. This will capture the
attention of the individual.
Encourage eye contact, but do not force the individual to give eye contact.
Respond to any of the individuals verbal and nonverbal attempts to communicate. Responding
consistently reinforces the individuals effort to communicate and helps to establish motivation.
Individuals who are Nonverbal

Teach joint attention by engaging the individual with toys and motivating
activities. Our child is
Teach imitation skills. non-verbal.
Develop turn-taking skills. One thing I
Teach gestures associated with greetings. dont understand is
Teach pointing skills. why doctors talk
Teach functional communication skills to replace unconventional louder to him. They
communication such as screaming, aggressive behavior or throwing objects. know he is not
Create opportunities for the individual to initiate communication (also called deaf.
communication temptations.)
Encourage eye contact, but do not force the individual to give eye contact.
Talk to the individual on his/her physical level.
Teach the child to initiate by first engaging him/her in a social interactive game such as peek-a-boo,
hide-and-seek, or a tickle game and then waiting for him/her to initiate a continuation of the game or to
begin the game.
40
Individuals who are Using Minimal Language
Keep language learning fun!
Use gestures and facial expression.
Use gestures to teach pronouns.
Fade prompts quickly to reduce the occurrence of prompt dependency.
Expand language by adding another word to the individuals one word utterance, and then prompt
them to repeat the entire expanded utterance.
Comment about what the individual is doing.
Speak to the individual in short, concise sentences and phrases. This will maximize comprehension
and provide a model for him/her to imitate.
Use exaggerated intonation, volume and rate of speech; however, be careful that the individual does
not echo the language inappropriately.
Use singing and music.
Individuals who are Verbal

Teach vocabulary through joint activities and routines.
In familiar contexts, substitute higher level vocabulary for a familiar word. Use the word repeatedly
while demonstrating the meaning.
Use photo albums to discuss past events and calendars to discuss future events.
Introduce new topics of conversation.
Expand the individuals pragmatic language skills.
Teach conversational rules such as initiating, terminating a conversation, changing topics, signaling,
and repairing communication breakdown.
Assist the individual to understand and anticipate the perspectives of others.
Expand the individuals language functions, i.e., understanding humor, sarcasm, and idioms, the use of
figurative language, problem solving with language, narration, and language to compare and contrast.
41
Strategies to Address Echolalia:
Modeling Functional Communication
Echolalia is the repetition of previously heard words or phrases. There are two basic types of echolalia:
immediate and delayed. Immediate echolalia is the repetition of words and phrases that occurs
immediately or very soon after the original words. Delayed echolalia is the repetition of words or phrases
that are echoed hours, days, or weeks after they were originally heard. Both may serve a variety of
functions for communication for the individual. Echolalia occurs in approximately 85% of children with
autism who eventually develop speech. In many cases, the individual may learn to use echolalia in a
functional way.
REQUESTING If the child reaches for, points to or moves your hand

toward a ball, model ball or want the ball or Sarah wants the ball as you Our child
give it to her. If he says, You want a cookie? you say David wants a cookie started to
as you give it to him. He may later spontaneously say, David wants a cookie, really talk
which is still a delayed echo but provides a more appropriate intermediate step when he was 4 to
between the echoed question as request and the more natural form, I want a 5 years old. Of
cookie. Avoid direct praise such as good talking, which is likely to be echoed
course, one of his
without comprehension.
first phrases he said
CHOOSING For the child who cannot respond to a verbal choice such as was Shut up! We
Do you want crackers or an apple? omit the question for a while. Show the would them tell him,
two items and say, CrackersappleMatthew wants. If he names one and No, no, be quiet.
reaches for it, confirm his choice and give it to him, saying something like He would then say,
Matthew wants an apple. Avoid saying You want an apple or Okay, heres Shut up, no, no, be
your apple, as he may use your statement as a spontaneous request next time he quiet. He still does
wants an apple. If he says nothing and just grabs one, name it for him as you
this.
give it to him, saying apple, and pausing to see if he echoes before you release
the apple. If he doesnt, just say it again and give it to him. When hes reliably choosing with a fill-in-the
-blank format, you can gradually build back up to the natural question form.
GREETING Avoid saying Hi, Andrew, to a child who repeats back Hi, Andrew. Just say Hi
or Bye without adding his name. If you need to get his attention first, say Andrew! and then Bye.
He may be more likely to respond if you bridge the gap between you and him by bending down and
putting his hand on your shoulder to direct his attention. Encourage others to use words and phrases that
will be acceptable if echoed, such as See you later rather than farewells like Come again soon, Honey,
that are inappropriate if echoed by the person who is leaving.
REJECTING/PROHIBITING If the child pushes away food or screams at having her face
washed, help her push the food away, or back off and say, No cake! Dont want cake! or Stop! or
No washing face! Sometimes you can accept the refusal, but in other cases, you will have to overrule
the child. If so, pause, say something empathetic like Dont like face washing, and then go on, Beccas
face is dirty. Mommy has to wash it. If someone takes her toy, help her pull it back and model
Stop! or No! or Dont take it!
42
DIRECTING If he hands you objects to fix or open, puts your hand on an object, or just screams in
frustration, you can say Please help or Need help or Open it, as if directing yourself. Dont say it
with a questioning intonation like Need help? or else the child will probably say it that way. Depending
on the childs readiness and state of attention at the moment, you can wait for him to echo or just proceed
to the needed action. Be careful how you respond when the child does repeat your model. If you say
OK several different times, he may begin to say Please help OK. To avoid creating an inappropriate
pattern, either do the requested action without comment or vary your verbal response.
COMMENTING Modeling comments is useful not only for building vocabulary and concepts, but
also as an early social and pre-conversational activity. It provides many opportunities to use echoing as a
teaching tool and supplies the child with appropriate language to practice as he does the same actions
during solitary play. When doing a puzzle, you could say, Heres the horsegoing to put it inuh-oh,
doesnt fitthere, its in! Time your words to match the childs independent or assisted action. If
youre looking at a book together, start with wordbooks because noun vocabulary is often a strength and
understanding of stories is apt to be weak. To encourage visual focusing, use the childs finger to point to
pictures as you model comments depending on the childs level of comprehension, like Shoeshat,
Heres the brown puppy, The girl is painting a picture, Flowers on the table, The baby is crying,
hes sad. If he does not spontaneously name some, put his finger on a picture so he knowsand pause.
The established pattern of point and name, and your silence, will often elicit a spontaneous label from the
child.
Some Important Points to Remember

Model language structures that are only slightly longer and more complex than those youve heard the
child use meaningfully.
Say things that match whats happening from the childs point of view.
Avoid questions and verbal instructions.
Use peoples names if pronouns are confusing.
Use words and intonation that will be appropriate and accurate if echoed.
Respond to the childs speech with words and actions that confirm your understanding of the message,
not with praise, which may be echoed.
Relax, enjoy yourself, join the childs activity and follow his lead in play while gradually encouraging
more varied and appropriate use of toys.
Remember that most children who echo are actively trying to communicate despite their confusion
about communicative functions, conversational roles and the meanings of concepts that vary as
speakers and situations change. The procedures suggested here tap their strong memories, need for
predictable patterns and echoic tendencies to begin to establish a basis of meaningful,
functional communication.
43
Communication Temptations
Communication temptations are structured 10. Engage the child in putting together a puzzle.
situations that are designed to tempt child- After the child has put in three pieces, offer the
initiated communication. Feel free to be playful and child a piece that does not fit.
silly and use gentle humor. Here are some things
you can try to get a child to communicate. 11. Engage the child in an activity with a substance
that can be easily spilled (or dropped, broken,
1. Forget to give the child a cookie or food that he torn); suddenly spill some of the substance on
likes and start eating it yourself. the table or floor in front of the child and wait.
2. Activate a wind-up toy, let it deactivate, and hand 12. Put an object that makes noise in an opaque
it to the child. container and shake; hold up the container and
wait.
3. Give the child four blocks to drop in a box, one at
a time (or use some other action the child will 13. Give the child materials for an activity of
repeat, such as stacking the blocks or dropping interest that necessitates the use of an instrument
the blocks on the floor); then immediately give for completion (e.g. a piece of paper to draw on
the child a small animal figure to drop into the or cut; a bowl of pudding or soup); hold the
box. instrument out of the childs reach and wait.
4. Open a jar of bubbles, blow bubbles, and then 14. Engage the child in an activity of interest that
close the jar tightly and give the closed jar to the necessitates the use of an instrument for
child. completion (e.g., pen, crayon, scissors, stapler,
wand for bubbles, spoon); have a third person
5. Initiate a familiar social game with the child until come over and take the instrument, go sit on the
the child expresses pleasure, then stop the game distant side of the room while holding the
and wait. instrument within the childs sight, and wait.
6. Blow up a balloon and slowly deflate it; then 15. Wave and say bye to an object and remove it
hand the deflated balloon to the child or hold the from the play area. Repeat this for a second and
deflated balloon up to your mouth and wait. third situation, then do nothing when removing
an object from a fourth situation.
7. Offer the child a food item or toy that he or she
dislikes. 16. Hide a stuffed animal under the table, knock,
and then bring out the animal. Have the animal
8. Place a desired food item in a clear container that greet the child the first time. Repeat this for a
the child cannot open; then put the container in second and third time, then do nothing when
front of the child and wait. bringing out the animal for the fourth time.
9. Roll a ball to the child; after the child returns the

ball three times, immediately roll a different toy Adapted from Wetherby & Prizant, 1989
to the child.
44
Picture Exchange Communication System
(PECS)
The Picture Exchange Communication System (PECS) was developed in 1987 by Lori Frost, MS,
CCC/SLP, and Dr. Andrew Bondy. PECS is primarily used with individuals who are nonverbal or who
use speech with limited effectiveness to assist them in acquiring functional communication skills.
PECS has received international recognition. It does not require complex or expensive materials and
can be easily implemented by educators and family members.
The system emphasizes the importance of an individual with a communication deficit learning to approach
a communicative partner. A variety of prompting, shaping, and fading techniques are incorporated to
gradually improve and modify an individuals use of the system.
PECS begins with teaching the person to make an exchange with another person--a communication
partner--who immediately honors the request. Verbal prompts are not used, thus building immediate
initiation and avoiding prompt dependency.
Once this step is mastered, the individual advances to the next phase of the system, which teaches
discrimination of symbols, and then puts them together in simple sentences, such as I want _______.
The final of the six phases teaches the individual to respond to a question.
The system can be successfully implemented with people as young as two years old. Some parents worry
that the introduction of a communication system other than speech will interfere with the individuals
development of speech. However, research demonstrates that the opposite is true. The implementation of
the PECS enhances the persons language development.
In summary, there are many advantages to PECS, including:

1) the communication exchange is clearly understood,
2) the individual initiates the interaction, therefore eliminating prompt dependency, and
3) the communication is meaningful and highly motivating.
References and Resources:

Frost, L. and Bondy, A. (1994). The Picture Exchange Communication System Training Manual. Cherry
Hill, NJ: PECS, Inc.
Bondy, A. and Frost, L. (1994). The Picture Exchange Communication System. Focus on Autistic
Behavior 9, 1-19
Bondy, A. and Frost, L. (1998, September October). The Picture Exchange Communication System.
Advocate, 31 (5), 7-9.
www.PECS.com: Pyramid Education Consultants, inventors of the Picture Exchange Communication

System
45
Functional Assessment of Challenging Behaviors
Challenging or problem behaviors result when an individual is not able to communicate his needs or
desires effectively. Therefore, the challenging behavior most often serves a purpose for communicating,
or a communicative function. Generally, there are two categories of functions that a challenging behavior
serves: 1) to obtain something, or 2) to avoid something. Challenging behaviors often interfere with an
individuals learning, social acceptance and opportunities for inclusion in their community. Extreme
challenging behaviors can be dangerous or even life threatening to an individual and others.
Functional assessment is a process for examining the relationship between a persons challenging
behavior and the environment. One goal of a functional assessment is to identify antecedents or
environmental situations that will predict the occurrence and nonoccurrence of the challenging behavior.
Another goal is to gain information that will improve the effectiveness and efficiency of intervention
strategies. Finally, a functional assessment should identify the functions the behaviors appear to serve for
the person allowing us to teach an alternative replacement behavior.
A functional assessment can be conducted in a variety of ways. There are three general methods for
collecting functional assessment information. The first is interviews and rating scales that provide
information by talking with the individual and/or to the people who know the individual best. The second
method is direct observation of the individual in her normal daily environments. Direct observation
confirms information gathered in the interview. One strategy for collecting information is the A-B-C
format. The observer records the antecedent to the behavior (what happened immediately before the
behavior), description of the behavior, and the consequence of the behavior (what happened immediately
after). By analyzing the information obtained through these two methods, a hypothesis is developed. The
hypothesis is a best guess as to the function that the behavior serves for the individual based on actual
data. Interventions and behavior plans should be written based on the function of the behavior. These
interventions typically involve teaching an alternative replacement behavior that serves the same purpose
as the challenging behavior and usually is communication based.
The third method of functional assessment is functional analysis. Functional analysis is the actual
manipulation of environmental variables that reduce, eliminate or provoke the behavior to verify that the
hypothesis is correct. A functional analysis is the most precise and controlled method for conducting a
functional assessment. However, functional analyses are typically conducted in a controlled clinic
environment and are more challenging to conduct in a classroom, although this has been done.
Functional assessment has been established as a professional standard. In 1988, the Association for
Behavior Analysis published A Right to Effective Treatment (Van Houten, et al.), which includes the
right of all individuals who receive behavioral intervention to a professionally competent functional
assessment. In 1989, the National Institutes of Health strongly endorsed the use of functional assessment
procedures. Several states have since instituted laws or state regulations that require a functional
assessment prior to the implementation of significant behavioral interventions. The 1997 revisions to the
Individuals with Disabilities Education Act (IDEA) stipulate that a functional assessment be completed
and a behavioral intervention plan be implemented for a student prior to a suspension or making an
alternative placement.
Web resources: www.apbs.org; www.pbis.org.
46
Positive Behavioral Support (PBS)
Challenging or problem behaviors result when individuals are not able to communicate their needs or
desires effectively. Behaviors are messages. Therefore, the challenging behavior serves a purpose for
communicating, or a communicative function. Generally, there are two categories of functions that a
challenging behavior serves: 1) to obtain something, or 2) to avoid something. The behavior becomes a
very effective means of communication and to the individual seems very reasonable and logical.
Challenging behaviors significantly interfere with an individuals learning, social acceptance and
opportunities for inclusion in the community. Extreme challenging behaviors can be dangerous or even
life threatening to an individual and others. Challenging behavior that occurs over a long span of time
often results in punitive interventions and segregation.
Positive Behavioral Support (PBS) is an approach that has evolved from

the traditional behavioral management approaches. Rather than attempting to My son has
eliminate the challenging behavior, the PBS process results in a multi-component autism and is
behavioral plan that seeks first to understand the communicative function of the very high-
behavior. The plan incorporates methods for changing the behavior that respect functioning. He
the persons dignity, enhance the persons strengths and capabilities, and expand plays a musical
the persons opportunities, while overall enhancing the quality of the persons
instrument. If he
life.
needs help while he
The process is team-driven and person-centered. Therefore, any outcomes are is playing, he will
meaningful from the perspective of the persons likes and dislikes, strengths and not call out for me,
weaknesses. A persons team should not only consist of professionals, but but instead will play
should include family members and anyone who can assist in providing support his instrument in a
such as community members, employers, or even peers.
pleading or
insistent melody. I
There are five phases necessary to develop a comprehensive positive
behavioral support plan. have learned that
this means that he
1. First, it must begin with a functional assessment of the problem needs me and I
behavior. The goal of a functional assessment is to understand the person and should come to his
the nature of the challenging behavior in the context of the environment. There room.
are several assessment tools to aid in the collection of information about the
variable and events that surround the occurrence (or nonoccurrence) of the challenging behavior. When
conducting a functional assessment, it is also necessary to examine the persons likes, dislikes, strengths,
weaknesses, quality of life, program issues, and dreams and expectations for the future.
2-3. Next, the team gathers to examine the results of the functional assessment and develop
hypothesis statements based upon the information. In other words, the hypothesis is the teams best
guess as to why the person engages in the challenging behavior.
47
4-5. Once the hypothesis is developed, it must be tested to ensure that the plan will address the function
(s) the behavior is serving. The functional assessment and hypothesis provide the foundation for the
development of intervention strategies.
The focus of intervention is not only behavior reduction. There are various intervention strategies to make
the challenging behavior ineffective and inefficient and to teach the person new skills that serve the same
communicative function as the behavior. Therefore, the need for the person to engage in the challenging
behavior is eliminated. Once the plan has been implemented, the team constantly evaluates the
effectiveness of the plan and makes modifications as needed.
Our son has
Websites
www.pbis.org a very
www.apbs.org identifiable
www.pbsga.org chain of behaviors
www.behaviordoctor.org that occur when he
is getting frustrated
References: or angry. I have
Carr, E.G., Levin, L., McConnachie, G., Carlson, J.I., Kemp, D.C., and Smith,
C.E. (1994). Communication-based Intervention for Problem Behavior: A
written these
Users Guide for Producing Positive Change. Baltimore, MD. Paul H. Brookes. behaviors down for
all the people who
Fleming, S., and George, H. (1997). Louisiana Positive Behavioral Support: work with him so
Participant Manual. Unpublished manuscript, Louisiana State University at that they can help
Baton Rogue interfere with the
Koegel, L.k., Koegel, R.L., and Dunlap, G. (Eds.). (1996). Positive Behavioral
chain to avoid his
Support: Including People with Difficult Behavior in the Community. self-injurious
Baltimore: Paul H. Brookes. behaviors. The
problem is,
Pennsylvania Department of Education. (1995). Guidelines: Effective sometimes they
Behavioral Support. Harrisburg, PA: Pennsylvania Department of Education, occur so fast that
Bureau of Special Education.
the whole chain is
Reichle, J., and Wacker, D.P. (1993). Communicative Alternatives to done in a matter of
Challenging Behavior: Integrating Functional Assessment and Intervention seconds.
Strategies. Baltimore: Paul H. Brookes.
48
Antecedent, Behavior ,Consequence Form
Student: William Circle One: Mon Tues Wed Thurs Fri Page 1 of 1
Full Day Absent Partial Day: In ___ Out ___ Date: 2/1/06
Time Context Activity Antecedent/ Identified Target Consequences- Student Reaction Staff Initials
(Begin - End) The students Setting Events Behaviors Outcome How did the
environmental Describe exactly List type(s) of What happed in student react
surroundings what occurred in behavior the environment immediately
(people, places, the environment displayed during immediately after following the
events) just before this incident. behavior was initial
targeted behavior exhibited? consequence
was exhibited. being delivered?
9:00 - 9:01 B B A A A MBS
10:00 - 10:30 H C A B A MBS
10:40 - 10:41 C B B A,B B,A MBS
10:55-10:56 H C B C A TLH
1:00 - 1:02 B B C A A MBS
49
2:00 - 2:01 G C C A A MBS
A. Breakfast A. Teacher giving A. Tantrum A. Ignore A. Stopped

attention to
another student
B. Centers B. Transition B. Biting B. Redirection B. Continued
>>> C. Snack C. Teacher C. Hitting C. Verbal C. Intensified
Team Request Reprimand
Example of a Completed Form
fills in
D. Lunch D. Verbal D. Remove D. Moved Away
these
Correction Materials
values.
>>> E. Functional E. Down Time
Math
F. Bus Area F Told No
G. Reading
H. Leisure
Antecedent, Behavior, Consequence Form
Note: The Target Behaviors must be clearly defined and specific to the individual student.
Antecedent, Behavior ,Consequence Form
Student: __________________ Circle One: Mon Tues Wed Thurs Fri Page _ _of __
Full Day Absent Partial Day: In ___ Out ___ Date: _________
Time Context Activity Antecedent/ Identified Target Consequences- Student Reaction Staff Initials
(Begin - End) The students en- Setting Events Behaviors Outcome How did the stu-
vironmental sur- Describe exactly List type(s) of be- What happed in dent react imme-
roundings (people, what occurred in havior displayed the environment diately following
places, events) the environment during this inci- immediately after the initial conse-
just before tar- dent. behavior was ex- quence being de-
geted behavior hibited? livered?
was exhibited.
Blank Form
50
A. A. A. A. A.
B. B. B. B. B.
>>> <<<
Team C. C. C. C. C. Team
fills in D. D. D. D. fills in
these these
values. E. E. E. values.
>>> F. F. F. <<<
G. G. G.
H. H. H.
Note: The Target Behaviors must be clearly defined and specific to the individual student.
Antecedent, Behavior, Consequence Form
General Recommendations for Promoting and
Enhancing Socialization
Structure and facilitate opportunities for social interaction in natural We have a
environments with typically developing peers that are consistent and daughter
predictable. whose main
job is to make sure I
Guide the childs play and provide support as needed by modeling and dont dress our son
directing play or giving verbal prompts.
with autism like a
geek (her words).
Teach the social rules of play: how to start, maintain and end; how to be
flexible and cooperative; how to share; and how to maintain solitude without
Our son doesnt
offending others. care how he looks
and I dont pay
Use other children as cues to indicate what to do. much attention to
the styles. Her
Encourage participation in social interactive games such as hide and seek, advice is invaluable
peek-a-boo, and pat-a-cake. to his social
position at school!
Play areas should be structured to promote interaction. Avoid large open
spaces. The space should be clearly defined by boundaries. Toys and materials should be visible and
easily accessible.
Create a social support group that consists of the individuals peers.
Provide detailed scripts for the individual to follow.
Teach the individual strategies to help him express and understand emotion.
Teach the individual to read social situations by using techniques such as Social Stories, Social
Review, and Social Assistance Activities.
Facilitate a social skills group to teach important appropriate social behaviors through role playing and
modeling.
Seek out clubs or groups for the individual to participate in that center on her interests.
Teach the individual how to make and maintain friendships.
51
Social Stories
Social Stories are written by parents or While Social Stories are a generic strategy,
professionals to assist individuals with impairment following Carol Grays guidelines can increase the
in the ability to mind read. They assist the quality and effectiveness of the story. Many times
individual by identifying important cues, describing these stories are used by individuals to negotiate
abstract concepts or another point of view, defining their way through each day, so take care in writing
a routine or rule, explaining the rationale behind them.
expectations, outlining an upcoming event, or
applauding accomplishments. Carol Gray has The following example of a Social Story, taken
developed the following criteria and guidelines. from My Social Stories Book by Carol Gray and
Abbie Leigh White, p. 76:
1. A Social Story meaningfully shares social
information using a patient and reassuring What are unexpected noises?
quality, and at least 50% of all Social Stories There are many noises. Sometimes noises
applaud achievements. surprise me. They are unexpected. Some
2. A Social Story has an introduction that clearly unexpected noises are: telephones,
identifies the topic, a body that adds detail, and a doorbells, barking dogs, breaking glass,
conclusion that reinforces and summarizes the
information.
vacuum cleaners, slamming doors, honking
3. A Social Story answers wh questions. horns, and thunder. These sounds are okay.
4. A Social Story is written from a first or third I will try to stay calm when I hear
person perspective unexpected noises. Adults can tell me when
5. A Social Story uses positive language. the noise will stop.
6. A Social Story always contains descriptive
sentences, with an option to include any one or References:
more of the five remaining sentence types-- Gray, C. (2004). Social Stories 10.0. Jenison Autism
perspective, cooperative, directive, affirmative, Journal, Volume 15, #4.
and/or control sentences.
7. A Social Story describes more than directs, Gray, C. (1995). Social Stories and Comic Strip
following this Social Story Formula: The Conversations: Unique Methods to Improve Social
number of sentences that describe is divided by Understanding. Arlington, TX: Future Horizons,
the number of sentences that direct/control. This Inc.
number needs to be greater than or equal to 2. If
there are no directives and/or control sentences, Fullerton, A., Stratton, J., Coyne, P., and Gray, C.
use the number 1 in the denominator. (1996). Higher Functioning Adolescents and Young
8. A Social Story has a format that is tailored to Adults with Autism. Austin, TX: Pro-Ed, Inc.
the abilities and interests of its audience and is
usually literally accurate. Quill, K. (1995). Teaching Children with Autism:
9. A Social Story may include individually Strategies to Enhance Communication and
tailored illustrations that enhance the meaning of Socialization. New York: Delmar Publishers, Inc.
the text.
10. A Social Story title meets all applicable Social The Gray Center for Social Learning and
Story criteria. Understanding--Official Home of
Carol Gray and Social Stories
www.thegraycenter.org
52
Comic Strip Conversations
Developed by Carol Gray, a Comic Strip Conversation is a conversation between two or more people that
incorporates the use of simple drawings. They provide a visual representation of a conversation in order
to enhance the persons understanding and comprehension. While the conversation takes place or a
situation is recounted, illustration is added. The illustration can include symbols, drawings and written
words. The joint attention of the individuals involved with the conversation is focused on the drawing
surface. While this strategy is helpful in sharing information with the person with autism, it is also helpful
in obtaining their perspective, and assisting them in communicating their own feelings and ideas.
A specific structure is followed to organize a social exchange, and build in predictability. Comic Strip
Conversations are not intended to be used for every conversation. They are most helpful when there is a
need to convey important information, when there is a misunderstanding, or to solve a problem. A Comic
Strip Conversation may also be used to teach a social skill. The illustrations usually consist of stick
figures and bubbles where the figures words and thoughts are written. When a person gains experience
with using Comic Strip Conversations, colors can be associated to express feelings such as green for
happy, blue for sad, or black for anger.
The conversation usually begins with small talk, just as any conversation usually does. The person with
autism takes the lead in a Comic Strip Conversation, and the parent, professional, or peer serves as a guide
to the conversation. The interaction is illustrated as it progresses. The conversation then moves from
small talk to talking about the situation. Information such as where and when the situation takes place,
and who is there, what is done and said is covered. Next, Comic Strip Conversations focus on what
people in the situation may be thinking. Often the person with autism may have difficulty interpreting
what someone else may be thinking, or they may interpret something that was said literally. This presents
an opportunity to assist them in understanding the situation, or another persons perspective. Finally, the
conversation is summarized, and, if necessary, concluded with the identification of new solutions.
See: Carol Gray, Comic Strip Conversations, Future Horizons, 1994. www.thegraycenter.org
Example of a Comic Strip Conversation
I am bored. I love talking about

suspension bridges.
53
Sensory Integration
Sensory integration is the process by which the intervention based upon the test results. Sensory
nervous system receives, organizes, files, and integration therapy does not usually focus on the
integrates sensory information in order to make an development of specific skills. Rather, therapy
appropriate response to a particular situation. The involves a variety of activities that provide sensory
development of the sensory integrative process stimulation to aid in the maturation of the sensory
begins in utero and continues after birth through systems to make appropriate automatic responses.
ordinary childhood activities.
References:
There are three major sensory systems: vestibular Anderson, E., and Emmons, P. (1996). Unlocking
(response to movement and gravity), tactile (touch), the Mysteries of Sensory Dysfunction. Arlington,
and proprioceptive (muscle and joint input). TX: Future Horizons, Inc.
Sensory integration provides a foundation for more
complex learning and behavior. Ayres, J. (1979). Sensory Integration and the
Child. Los Angeles, CA: Western Psychological
People respond to touch, movement, sights, smells Services.
and sounds. Some self-stimulation behaviors such
as spinning, rocking, and hand flapping, that are Sensory Integration International, Inc. (1991). A
common for individuals with autism, may also be Parents Guide to Understanding Sensory
the result of sensory integrative dysfunction. Integration. Torrance, CA: Sensory Integration
International.
Dr. A. Jean Ayres, an occupational therapist,
developed the theory of sensory integration to Trott, M.C., Laurel, M.K., and Windeck, S.L.
explain a variety of neurological disorders in (1993). SenseAbilities: Understanding Sensory
children. Literature from the fields of Integration. Tucson, AZ: Therapy Skill Builders.
neuropsychology, neurology, physiology, child Resources:
development and psychology has contributed to the
development of the theory and resultant intervention Asperger Syndrome and Sensory Issues by Brenda
strategies. Smith Myles, PhD
Sensory integration is just a theory, and there is Teachers Ask About Sensory Integration by Carol S.
limited research that supports it. However, there is Kranowitz
a vast amount of anecdotal support that sensory
integration therapy does work for some individuals.
If an individual is suspected of having difficulty

processing sensory information correctly, a
qualified occupational or physical therapist can
conduct an evaluation. An evaluation usually
consists of both standardized testing and structured
observations of responses to sensory stimulation,
posture, balance, coordination, and eye movements.
If necessary, the therapist will make

recommendations for appropriate therapy
54
Pharmacological Interventions
Taken from National Research Council (2001) Educating Children With Autism. Committee on
Educational Interventions for Children with Autism. Catherine Lord and James P. McGee, eds. Division
of Behavioral and Social Sciences and Education. Washington, D.C.: National Academy Press, pp.128-
130.
There are currently no medications that effectively treat the core symptoms of autism, but there are
medications that can reduce problematic symptoms and some that play critical roles in severe, even life-
threatening situations, such as self-injurious behavior. Just as autism coexists with mental retardation,
Autism Spectrum Disorders may coexist with treatable psychiatric and neurological disorders (Tuchman,
2000). Treatment of such diagnosed disorders will not cure autism, but can, in some cases, enable a child
to remain in less restrictive community placements and enhance the childs ability to benefit from
educational interventions (Cohen and Volkmar, 1997). Medications have been shown in some instances
to enhance and to be enhanced by systematic, individualized behavioral intervention programs (Durand,
1982; Symons and Thompson, 1997).
More than 100 articles have been published on the use of psychoactive medications for Autism Spectrum
DisordersThe key findings from the published studies include:
Haloperidol was effective in reducing aggression and agitation and had mixed results for
improving learning with long-term users, but it carries significant risk of involuntary muscular
movements (dyskinesias).
Naltrexone-treated groups showed less irritability and hyperactivity than placebo groups on
some measures, particularly global ratings; did not differ from placebo groups on others; and
showed increases in particular problem behaviors in some instances.
Clonidine-treated subjects showed improvements in hyperarousal but reported increased

drowsiness, decreased activity; they showed increasing tolerance when used to treat attention
deficit disorders.
Risperidone shows promise in treating aggression and agitation with less concern about the
development of dyskinesias than for the older neuroleptics.
Open trials of serotonin selective uptake inhibitors have shown promise in treating stereotypic
or perseverative behavior, possibly because of effects on anxiety.
Stimulants may affect sleep and growth in developing children and, in some cases, may worse
autistic symptoms, especially self-stimulation behaviors.
Secretin-treated children did not differ from placebo-treated children.
55
Functional behavioral assessment to determine the function(s) of the problem behaviors
increases the likelihood of choosing the correct medication and behavioral interventions.
Childrens responses to medication must be monitored very carefully.
Children with Autism Spectrum Disorders are also at increased risk for certain medical conditions, notably
seizure disordersSchool personnel need training in recognizing the symptoms of seizures and other
medical problems and in monitoring the effects of medications over time.
Except in unusual medical circumstances, medications are usually not considered first-line interventions
for behavior problems in young children, but an exception, for example, would be behavioral
manifestations of seizure disorder. In addition to a functional behavioral analysis of the problem behavior,
medication for behavioral intervention should be based on knowledge of medical pathology, psychosocial
and environmental conditions, health status, current medications, history, previous intervention, and
parental concerns and desires (New York State Department of Health, 1999).
For more information see: Taking the Mystery Out of Medication by Luke Tsai, M.D.
56
57
General Programming and Caregiving
Information
58
Educational Issues
Education is the most effective treatment for children with autism. However, autism presents educators
with some unique challenges. Children with autism have unusual intellectual and academic profiles that
vary. No two children are alike. Therefore, no one program exists that will meet the needs of every
individual with autism. Additionally, children with autism learn very differently than typical children or
children with other types of developmental disabilities. To meet the needs of the individual child, it is
critical to examine the childs strengths, weaknesses and unique needs when determining an appropriate
educational placement and developing an Individualized Educational Plan (IEP). The following are key
components of a comprehensive, individualized program for a child with autism:
1.Most importantly, an effective, comprehensive program should reflect an understanding and awareness
of the challenges presented by autism.
2.Parent-professional communication and collaboration are key components for making decisions and
dealing with issues that may arise.
3.On-going training and education in autism are important for both parents and professionals who work
with individuals with autism. Professionals who are trained in specific methodology and techniques for
autism will be most effective in implementing appropriate interventions. They will also be effective in
modifying curriculum based upon the characteristics of autism and the individual child.
4.Inclusion with typically developing peers is important for a child with autism. Peers are the best models
for language and social/play skills. However, the child will not learn by simply being in the
environment. It is also necessary to facilitate activities that will address specific skills.
5.Formal assessment or re-evaluation of a child with autism is best done by a multidisciplinary team of
professionals who have experience in the area of autism.
6.A comprehensive IEP should be based on the childs strengths and weaknesses. Goals for a child with
autism usually include the areas of communication, social behavior, challenging behavior, and academic
and functional skills. Transition goals must be addressed when the child reaches 16 years of age.
Modifications of instruction that the child needs must be included. The IEP also must address related
services, for example, occupational therapy to address fine motor or sensory needs, speech therapy,
physical therapy or transportation to name a few.
7.Teaching skills in the environment in which they would naturally occur is most effective. Additionally,
teaching skills in their natural sequence with natural consequences will assist generalization of the skills
to new environments.
8.No one methodology is effective for all children with autism. Generally, it is best to integrate
approaches according to a childs needs and responses.
9.Careful planning for transitions from year to year will help the child adapt to change.
59
Child Care
In any family, finding appropriate child care can be a challenge. Having a child or children with autism
often makes this even more complicated. Individuals with autism often require closer supervision, and
providers need to understand their different learning styles. It is helpful for families to put together a
packet about their child for the child care provider. Suggestions of information to include:
Health issues such as medicines, diet issues and allergies
Particular sensory issues and environmental concerns, like lighting and sound level
Regular routines
Family rules and safety concerns (these could include restrictions on TV or items that are off
limits)
Problem behaviors/crisis management, what are known triggers and intervention methods
Any methods of discipline used and how applied
Emergency contact information
Whether outings are permitted and appropriate transportation issues
Level of supervision expected (for example, does someone need to be in the same room with your
child at all times)
Help needed in eating, using bathroom, other self-care needs
Social/communication issues interacting with others (friends, siblings, others)
It is important to address the above areas with anyone providing care to your child, including relatives.
Child care options include:
1. In-home child care. The Department of Social Services Child Care Services can provide you with
a list of licensed providers at www.state.sd.us/social/ccs/parents/requestprovider or 800/227-3020.
Other number to call to locate child care are:
a. Helpline at 211 in Sioux Falls

b. Pierre Area Referral Service at 605/224-8731
c. Early Childhood Partners Presentation College in Aberdeen at 605/229-8505 or
Aberdeen Department of Social Services Child Care Services at 605/626-2345
60
d. Yankton Department of Social Services Child Care Services at 605/668-3030
e. Rapid City Department of Social Services Child Care Services at 605/355-3545
f. Brookings Department of Social Services Child Care Services at 605/688-4334 or Child Care
Locator Database Family Resource Network at 605/688-5730
2. Center-based child care. The Liberty Center at the Childrens Care Hospital and School in Sioux
Falls (782-2386) focuses on children with special needs. They have a 1 to 4 ratio of adults to children
and take persons ages 3 to 21. The rate (as of fall 2005) is $5.50 an hour but check with them about
scholarships or other funding options if necessary.
3. School programs. Many school districts provide after school and summer programs. Contact your
local school district to find out your options. Also check out www.state.sd.us/social/ccs/ost/map to find
a phone number for your region of Out of School Time programs. The Sioux Falls School District
maintains a 1 to 15 ratio of adults to children in their program--contact them through Kids, Inc., 367-
4491.
4. Hire a teenager or college student to work in your home. This could be helpful in giving your
child the comfort of your home environment.
5. Use a relative or form a co-op with other families to share child care responsibilities.
61
Safety in the Home
Parents and caregivers view their childs safety in the home environment as a significant concern. Parents
of children with an Autism Spectrum Disorder have additional issues to consider when addressing safety,
often throughout the lifespan of an individual. The following suggestions may be helpful in ensuring a
safer environment: Establish priority areas for modification. These are the areas where the individual
spends the most time. Also consider the behaviors to be modified in relationship to these environments.
Arrange the furniture appropriately. Arrange the furniture in a way that makes sense for the activities
the individual is expected to do in each environment.
Use locks where appropriate (exterior doors, bedroom, cabinets and drawers).
Safeguard your windows (locks, Plexiglass).
Make electrical outlets and appliances safe (outlet covers, conceal wiring).
Lock dangerous items away (detergents, chemicals, cleaning supplies, pesticides, medications, small
items, firearms, hunting and fishing equipment).
Secure items/materials (scissors, knifes, razor blades) that are dangerous or unsafe if used without
supervision.
Visually label everyday items--use symbols, photos, words, textures. This will help the individual
understand what is expected and she/he may be less likely to engage in undesirable behaviors.
Organize everyday items. The more organization, order and structure in the environment, the more
likely it will reduce the frustration level of the individual.
Institute appropriate seating. Proper seating will help facilitate better learning and eating behaviors.
Use visual signs (tape boundaries, STOP sign) as needed for setting expectations and reminding the
individual where they are supposed to stay.
Secure eating utensils and place settings (plastic/rubber dishes).
Safeguard bath items/toys. To help the individual focus on bathing and prevent power struggles while
in the tub, keep bath toys out of sight and unavailable until after bathing is completed.
Remember fire safety. Develop social stories about smoke detectors, fire drills, fire alarms, and
touching fire.
Consider identification options. It is important that each individual has proper identification in the
event that he/she runs away or is lost and is unable to communicate effectively.
Use the following augmentative interventions to teach safety to your child: Social Stories, activity
schedules, visual rules, signs and charts, peer and adult modeling, reinforcement for appropriate safety
behavior and consistent consequences for unsafe or inappropriate behavior.
Introducing these home modifications and intervention techniques will help keep your child
and your family out of harms way. Source: Autism Society of America website,
62
Person-Centered Planning and Transition
Person-centered planning is a process through which individuals with a disability and the persons relevant
to their lives (family, friends, neighbors, community members) gather with a facilitator to contribute
information about the persons history, abilities, preferences, and interests. They also share their dreams,
fears, expectations, and ideas to help create a vision for the persons future. There are many different
tools available to facilitate person-centered planning including Individual Service Design, Lifestyle
Planning, Personal Futures Planning, Essential Lifestyle Planning, MAPS, and PATH.
Once the information is compiled, a plan is developed to assist the person in Our son
obtaining his goals such as the type of work he wants to do, where he wants raises guinea
to live, and what kind of recreation he wants to do in the community by
pigs and
incorporating appropriate supports. The planning is centered on the person and
is an ongoing process. rabbits. He has
won several blue
While person-centered planning is beneficial for any individual of any age, it and purple ribbons
complements the transition process to adulthood. Plans for adulthood must be in the state fair. He
based on the persons abilities, preferences, interests and needs. Transition really wants to
planning usually begins between the ages of 14 and 16 as a part of the IEP
develop this skill
process. The transition process serves many purposes. Mainly it introduces the
family to the adult service system and determines the support systems that the into a job when he
person will need to work, live and recreate in the community as an adult. graduate and his
Critical information is provided to assist the persons team in determining support system is
appropriate goals that target skills she will need as an adult. It also provides helping him to
information to the adult service providers to assist them in planning for services accomplish this
and implementing programs. goal.
There is a range of employment and residential options for an adult with autism. When planning for
employment, it is important to consider the characteristics of autism and their implications for vocational
choice and development. The social and communication deficits associated with autism present some
unique challenges for employment. However, there are also characteristics of autism that can be
considered strengths such as splinter skills or intense interest areas, attention to detail, and willingness to
do repetitive tasks. Often times the person will need appropriate supports to be successful in a work
environment. Supports including job coaching, structure, and behavior management are implemented
based upon assessment of his skills and needs.
63
Sibling Issues
Raising a child with autism places some extraordinary demands on parents and the family as whole. The
suggestions provided here are things parents can do within the family to help siblings understand autism.
Positive Qualities Gained

Increased patience, ability to nurture, acceptance and tolerance of others.
Increased compassion and empathy.
What can you do to help?

Educate your children.
Developmental considerations
Open discussion
Encourage talking about feelings, wishes/fears, sibling self-stimulation, aggression
Okay to wish sibling werent there, seizures very scary
Allow the sibling to observe child with autism at his school and in therapies
Kids books and resources
Balance Time - Arrange for help around the house, sibling support groups, pen pals.
Set time every week that is their time
Let them help and teach the child with the disability.
Privacy safe place to keep belongings/replace damaged possessions.
Need time for self
Bringing friends home to play (arrange time for them to play by themselves)
Beware of placing too much responsibility and independence.
Dont pressure them or make them feel guilty for not helping
Encourage open discussions about guardianship of the sibling with autism
Encourage writing, i.e., journal, diary, story.
Celebrate sibling successes, too.
Make a list of things the siblings do together already or can do together.
Teach how to respond to teasing/bullying; embarrassment.
Watch for signs of depression, anxiety, increased stress, lower grades.
Concern for parents emotional state, marriage
Inside the family wants to be special and unique; outside wants to be like everyone else and fit in
Seek counseling
64
Sibling Resources
Siblings of Children with Autism: A Guide for Families by Sandra L. Harris
Everybody is Different: A Book for Young People Who Have a Brother or Sister with Autism and Autism
by Fiona Beach
All About my Brother by Sara Peralta
Joey & Sam by Illana Katz
Brothers and Sisters of Children with ASD, The Morning News Vol 13(3), Jenison Public
Schools, Michigan
Children with Autism: A Parents Guide by Michael D. Powers
Effects of Autism on the Family by Eric Schopler and Gary Mesibov
Raising a Child with Autism: A Guide to ABA for Parents by Shira Richman
Sibshops: Workshops for Siblings of Children with Special Needs by Donald Meyer & Patricia Vadasy
Helpful Websites
www.autism.ca/siblings.pdf
Information to help siblings understand autism and encourage positive relationships between siblings
www.angelfire.com/bc/autism/index.html
Great interactive website with a chat room, pen pals, bulletin boards and pictures
www.autism.org/sibling/blabby.html
The Center for the Study of Autism created Aunt Blabby and the sibshop by Donald Mayer.
www.thearc.org/siblingsupport
The ARC of the United States supports siblings
65
Bibliography and Appendixes
66
Bibliography
Characteristics of Effective Interventions

National Research Council (2001). Educating Children with Autism. Committee on Educational
Interventions for Children with Autism. Catherine Lord and James P. McGee, eds. Division of
Behavioral and Social Sciences and Education. Washington, DC: National Academy Press.
Evaluating Treatment Approaches and Nontraditional Therapies

Sasso, G. (1995, November). Choosing Interventions for Individuals with Autism. Presentation
conducted at the Midwest Autism Conference.
Applied Behavior Analysis (ABA)

Maurice, C., Green, and Luce, Eds. (1996). Behavioral Intervention for Young Children with Autism. Pro-
Ed.
Maurice, C., Green, and Foxx, Eds. (2001). Making a Difference: Behavioral Intervention for Autism. Pro
-Ed.
Lovaas, O. Ivar. (2002). Teaching Children with Developmental Delays: Basic Intervention Techniques.
Pro-Ed.
Harris, Sandra and Weiss, Mary Jane (1998). Right From the Start: Behavioral Intervention for Young
Children with Autism. Woodbine Press.
Leaf, Ron, and McEachin, John, Eds. (1999). A Work in Progress: Behavior Management Strategies and a
Curriculum for Intensive Behavioral Treatment of Autism. DRL Book.
Discrete Trial Training

Cohen, S. (1998). Targeting Autism: What We Know, Dont Know, and Can Do to Help Young Children
with Autism and Related Disorders. Berkley, CA: University of California Press.
Harris, S., & Weiss, M.J. (1998). Right from the Start: Behavioral Intervention for Young Children with
Autism. Bethesda, MD: Woodbine House, Inc.
Maurice, C. (1996). Behavioral Interventions for Young Children with Autism: A Manual for Parents
and Professionals. Austin, TX: Pro-ed, Inc.
Structured Teaching
Hodgdon, L. (1995). Visual Strategies for Improving Communication: Practical Supports for
School and Home. Troy, MI: QuirkRoberts Publishing.
67
Builders.
Schopler, E., & Mesibov, G. (1995) Learning and Cognition in Autism. New York: Plenum Press.
Visual Schedules
Hodgdon, L. (1995). Visual Strategies for Improving Communication: Practical Supports for School and
Home. Troy, MI: QuirkRoberts Publishing.
Builders.
Schopler, E., & Mesibov, G. (1995) Learning and Cognition in Autism. New York: Plenum Press.
Quill, K. (1995). Teaching Children with Autism: Strategies to Enhance Communication and
Socialization. New York: Delmar Publishers, Inc.
Enhancing Language and Communication in Children with Autism

Adapted from Maurice, C. (1996). Behavioral Interventions for Young Children with Autism: A Manual
for Parents and Professionals. Austin, TX: Pro-ed, Inc.
Strategies to Address Echolalia: Modeling Functional Communication

Adapted from: Echolalia: Modeling Functional Communication, by Elizabeth Ives Field, M.Ed., CCC-SP
Communication Temptations
Based on Weatherby, Amy and Prizant, Barry, ASHA TeleSeminar (1994).
Picture Exchange Communication System

Frost, L., & Bondy, A. (1994). The Picture Exchange Communication System Training Manual. Cherry
Hill, NJ: PECs Inc.
Bondy, A., & Frost, L. (1994). The Picture Exchange Communication System. Focus on Autistic
Behavior 9, 1-19.
Bondy, A., & Frost, L. (1998, September-October). The Picture Exchange Communication System.
Advocate, 31, (5), 7-9.
68
Functional Assessment of Challenging Behaviors
Carr, E.G., Levin, L., McConnachie, G., Carlson, J.I., Kemp, D.C., & Smith, C.E. (1994).
Communication-based Intervention for Problem Behavior: A Users Guide for Producing Positive
Change. Baltimore: Paul H. Brookes.
ONeill, R.E., Horner, R.H., Albin, R.W., Sprague, J.R., Storey, K., & Newton, J.S. (1997). Functional
Assessment and Program Development for Problem Behavior: A Practical Handbook (2nd ed.). Pacific
Grove, CA: Brooks/Cole Publishing Company.
Reichle, J., & Wacker, D.P. (1993). Communicative Alternatives to Challenging Behavior: Integrating
Functional Assessment and Intervention Strategies. Baltimore: Paul H. Brookes.
Positive Behavioral Support

Koegel, L.K., Koegel, R.L., & Dunlap, G. (Eds.). (1996). Positive Behavioral Support: Including People
with Difficult Behavior in the Community. Baltimore: Paul H. Brookes.
ONeill, R.E., Horner, R.H., Albin, R.W., Sprague, J.R., Storey, K., & Newton, J.S. (1997). Functional
Assessment and Program Development for Problem Behavior: A Practical Handbook (2nd ed.). Pacific
Grove, CA: Brooks/Cole Publishing Company.
Reichle, J., & Wacker, D.P. (1993). Communicative Alternatives to Challenging Behavior: Integrating
Functional Assessment and Intervention Strategies. Baltimore: Paul H. Brookes.
Social Stories
Gray, C. (1995). Social Stories and Comic Strip Conversations: Unique Methods to Improve Social
Understanding. Arlington,TX: Future Horizons, Inc.
Fullerton, A., Stratton, J., Coyne, P., & Gray, C. (1996). Higher Functioning Adolescents and Young
Adults with Autism. Austin, TX: Pro-Ed, Inc.
Comic Strip Conversations

Gray, C. (1994). Comic Strip Conversations. Arlington,TX: Future Horizons, Inc.
Fullerton, A., Stratton, J., Coyne, P., & Gray, C. (1996). Higher Functioning Adolescents and Young
Adults with Autism. Austin, TX: Pro-Ed, Inc.
Sensory Integration
Anderson, E., & Emmons, P. (1996). Unlocking the Mysteries of Sensory Dysfunction.
Arlington, TX: Future Horizons, Inc.
69
Ayres, J. (1979). Sensory Integration and the Child. Los Angeles: Western Psychological Services.
Sensory Integration International, Inc. (1991). A Parents Guide to Understanding Sensory Integration.
Torrance, CA: Sensory Integration International.
Trott, M.C., Laurel, M.K., & Windeck, S.L. (1993). SenseAbilities: Understanding Sensory Integration.
Tucson, AZ: Therapy Skill Builders.
Person-Centered Planning and Transition to Adulthood

Smith, M.D., Belcher, R. G., and Juhrs, P.D. A Guide to Successful Employment for Individuals with
Autism. 1995. Paul H. Brookes: Baltimore.
Siblings
Harris, Sandra L. and Glasberg, Beth A. (2003) Siblings of Children with Autism: A Guide for Families.
Bethesda, MD: Woodbine House.
Beach, Fiona (2005). Everybody Is Different: A Book for Young People Who Have a Brother or Sister
with Autism. Shawnee Mission, KS: Autism Asperger Publishing Company.
70
Appendix A - Glossary of Terms
ABA (Applied Behavior Analysis) ABA is a therapeutic intervention for children with Autism
Spectrum Disorders. Applied behavior analysis means to apply the theory of behavior analysis to an
individual's behaviors in order to teach skills, from the most basic like getting dressed and getting ready
for school, to more complex skills like social interaction. It can also be used to correct behaviors, e.g.,
teaching a child with autism to ask for a break instead of throwing a temper tantrum. It is widely
considered the most researched intervention in teaching individuals with autism. Discrete trial teaching is
a specific treatment approach based on the theory of ABA.
Activities of daily living usually include activities that are typically associated with self-help tasks
such as eating, dressing, grooming or domestic activities such as cooking and cleaning.
Adaptations modifications or alterations of the curriculum, the support systems, the environments, or
the teaching strategies to match individual needs (strengths and deficits). The adaptations ensure that the
student can participate actively and as independently as possible.
Adaptive behavior refers to the individuals ability to adjust to and apply new skills to other
situations (i.e., different environments, tasks, objects and people).
Apraxia 1. able to understand spoken language and sometimes written text, but unable to speak. 2. the
lack of praxis or motor planning. When seen in children, a sensory integrative dysfunction that interferes
with planning and executing an unfamiliar task.
Auditory pertaining to the sense of hearing.
Behavior observable actions and responses to environmental stimuli. These actions and responses are
also influenced by internal factors such as understanding, feelings, and emotions related to stimuli.
Brushing therapy a special type of therapy developed by Patricia and Julia Willbarger designed for
reducing tactile defensiveness by using a soft surgical brush to brush the arms, back and legs of
individuals who exhibit tactile defensiveness. The stomach should never be brushed and this therapy
should always be supervised by an occupational therapist or physical therapist trained in sensory
integration therapy.
Communication an interactive process that conveys information and ideas from one person to another.
Communication is a social skill that has the potential for influencing others and gaining some control over
ones environment.
Community-based instruction refers to instruction which occurs in the community instead of on the
school campus. Recreation/leisure, vocational, community, and domestic activities may take place in
community settings. The advantage of this instruction is that the student learns skills in the
natural context in which they are to be used.
71
Consequence something that occurs as a direct result of action or effort. Consequences can be
pleasant and reinforcing or unpleasant and punishing. Some consequences occur naturally, e.g., when you
touch a hot stove, you get burned.
Consultant therapy a form of delivery of related services in which the related service provider (e.g.,
speech therapist, occupational therapist) acts as a consultant to the classroom teacher or other
professionals to help meet a students IEP goals and objectives. Generally the classroom teacher works
directly with the student using the expertise and recommendations provided by the therapist in the natural
context of the classroom.
Delayed echolalia see, echolalia.
Developmental disability a disabling condition that affects intellectual, functional and / or academic
development of a person before age 22.
Direct therapy provided when the therapist works directly with the child. It may occur in the
classroom or in a pull-out program with the child going to another room for therapy.
Discrete trial training a specific method of instruction in which a task is isolated and taught to an
individual by repeatedly presenting the same task to the person. For example, the individual is given a red
block and a blue block. The instructor will then repeatedly ask the individual to point to or pick up the red
block. Responses are recorded for each trial (command). The individual generally continues to work on
the specific task until mastery is demonstrated.
Dyspraxia 1. difficulty with smooth, coordinated voluntary movements involved in speech. 2. poor
praxis or motor planning. A less severe, but more common dysfunction than apraxia.
Echolalia the repetition of speech produced by others. The echoed words or phrases can include the
same words and exact inflections as originally heard, or they may be slightly modified. Immediate
echolalia refers to echoed words spoken immediately or a very brief time after they were heard. Delayed
echolalia refers to echoed tapes that are repeated at a much later time days or even years later.
Expressive language refers to the language that the individual can communicate to others. Generally,
when referring to oral expressive language, it indicates the individuals ability to express thoughts,
feelings, wants, and desires through oral speech. Expressive language may also refer to gestures, signing,
communicating through pictures and objects, and writing.
Functional academics refers to academic skills that individuals need to function as contributing
members of their communities. They include skills such as telling time, measurement, and basic money
management.
Functional analysis (assessment) of behavior a method of evaluating behaviors exhibited by an

individual by carefully observing what happens before and after the behavior occurs. Specific behaviors
are looked at in terms of the purposes of the behavior and what functions the behaviors are
serving for the individual exhibiting the behavior.
72
Functional routines the set or sequence of steps or procedures directed to achievement of a practical
purpose; for example, a routine for washing dishes or for going to a movie.
Functional communication the purpose or reasons to communicate; for example, to request, to

protest, to comment, to get/give information.
Generalize, generalization terms used to describe the ability to learn a skill or a rule in one situation
and be able to use or apply it flexibly to other similar but different situations. The term overgeneralize
refers to the tendency of those with autism to use a skill in all settings just as it was taught, without
modifications that reflect the differences in a situation
Gestalt, holistic terms used to describe the distinctive processing mode common in autism.
Information is taken in (recorded) and stored quickly in whole unites or chunks, without analysis for
meaning. These chunks are stored directly in the long-term-memory system
Hyperlexia an ability to learn to read at an early age and advanced level without instruction.
Hypersensitivity acute, often painful, reaction to sensory input.
Hyposensitivity little or no reaction to sensory input.
Immediate echolalia see, echolalia.
Inclusion a situation in a school or community setting where children with disabilities are included
with children without disabilities.
Individual Education Program (IEP) an individualized special education program designed to meet
each childs educational needs.
Individualized Family Support Plan (IFSP) a support plan designed to meet the individual needs
of children (birth to three) and their families who qualify as eligible for early intervention services.
Joint compression a technique used by occupational therapists in which various joints are pushed
together to meet the need for deep pressure exhibited by many individuals with autism. Joint
compression should only be used when carefully supervised by an occupational therapist.
Joint attention when an infant and caregiver coordinate their attention about an object of mutual
interest. This involves shifting their attentions from each other to an object and back. Joint attention is
sometimes called referential looking.
Lovaas Method an intensive behavioral therapy that often requires a minimum of 40 hours per week
in one-on-one therapy. Discrete trial formats are one technique used to provide the intensive behavioral
therapy.
Motor planning the ability of the brain to conceive of, organize, and carry out a
sequence of unfamiliar actions. Also know as praxis.
73
Multidisciplinary team refers to an assessment team which has professional members from various
disciplines (education, speech pathology, psychology, medicine) to evaluate the total child.
Natural cue an object or event that is always present or always occurs as part of the natural
environment and that stimulates or triggers a response or action. (A full laundry basket is a signal that it is
time to do the laundry; the sound of the cash register ringing up the total is a signal to pay.)
Neurobiological disorder a disorder which has its origin in the neurological or biological functioning
of the body.
Occupational therapist (OT) therapist who specializes in improving the development of the fine
motor and adaptive skills.
Perseveration repetitive movement or speech, or sticking to one idea or task.
Physical therapist (PT) a specialist who addresses motor skills to help children move in a more
efficient and coordinated manner.
Pragmatics the practical aspects of using language to communicate in a natural context. It includes the
rules about eye contact between speaker and listener, how close to stand, taking turns, selecting topics of
conversation, and other requirements to ensure that satisfactory communication occurs. Many of these
rules have a cultural base.
Perseveration the redundant repetition of a word, thought, or action without the ability to stop or move
on. For example, when a person steps through the door, then rocks back and forth, seemingly unable to
follow through with the other foot; or when one erases a mistake until the paper is worn through.
Punishment an unpleasant event that occurs as a direct consequence of a behavior and that decreases
the strength of the behavior or the likelihood that it will be repeated.
Receptive language refers to the ability to understand what is being said, signed, or read.
Reinforcement a pleasant event that occurs immediately as a direct result of an action and that
increases the strength of the action or the likelihood that the action will be repeated.
Respite care skilled adult supervision and child care that can be provided in your home or the home of
the respite provider. Respite services offer the primary care givers (parents) an opportunity to get
temporary relief from the demands of living with a person with severe disabilities. In some areas, this
service may be provided at low or no cost through various funding agencies.
Response an action or behavior that is triggered by a preceding cue or stimulus (object, action, or
event).
Scheduling a planning process that organized a sequence of events to achieve a goal. A

schedule is the
product of that planning process a plan or an arrangement of events to accomplish goals.
74
Self-regulatory and self-stimulatory behavior (stimming) self-initiated, repetitive movements
performed (presumably) to relieve stress (i.e., rocking, flapping, spinning, finger-flicking, and/or unusual
manipulation of inanimate objects).
Sensory defensiveness refers to a group of symptoms that are indicative of over reactions of our
normal protective senses across sensory modalities. Individuals my exhibit patterns of avoidance, sensory
seeking, fear, anxiety, and even aggression in reaction to certain sensory stimuli.
Sensory diet according to Patricia and Julia Willbarger, an activity plan that includes specific
activities designed to decrease sensory defensiveness. Timing, intensity, and sensory qualities of these
activities are highlighted. Jumping on a trampoline or swinging are examples of activities that might be
part of a sensory diet.
Sensory integration the organization of sensory input for use by the individual. Parts of the nervous
system work together through sensory integration so that an individual can effectively interact with the
environment.
Sensory Integration Therapy (SI) treatment involving sensory stimulation and adaptive responses
to it according to the childs neurologic needs. Therapy is implemented by an occupational therapist and
usually involves full body movements that provide vestibular, proprioceptive and tactile stimulation. The
goal of therapy is to improve the way the brain processes and organizes sensations.
Sensory integrative dysfunctions (disorders) refers to irregularities in brain functioning that make
it difficult for the individual to integrate sensory input. Sensory integrative dysfunctions or disorders may
be the basis for difficulties experienced by individuals with autism as they interpret the world around
them.
Social skills positive, appropriate, social behaviors that are generally considered necessary to
communicate and interact with other.
Speech and language pathologist/therapist (SLP/T) therapist who works to improve speech and
language skills as well as oral-motor activities.
Stereotypy prolonged repetition of a behavior.
Support systems the adaptations and assistance required to ensure increasing independence. (One
learners support system may include a daily calendar, transition cues, a 1:1 interpreter for some classes,
and a consulting occupational therapist.)
Syndrome a condition characterized by a cluster of co-occurring symptoms that have a specific effect
on a group of individuals, for example, Fetal Alcohol Syndrome, Down Syndrome, autism.
Tactile pertaining to the sense of touch on the skin.
75
Tactile defensiveness a sensory integrative dysfunction in which tactile sensations create discomfort
for an individual with autism. Lightly touching the individual with autism may cause excessive emotional
reactions or other behavior problems because of tactile defensiveness.
TEACCH a structured teaching intervention developed by Division TEACCH of the University of

North Carolina at Chapel Hill. The components of the program include physical structure, schedules,
individual work systems, visual structure, and routines.
Transition cue an object that serves as a reminder of the targeted destination. (The car keys held in
the hand trigger or cue moving to the car; a 3x5 card with a drawing of the gym serves as a reminder to
continue moving to the gym.)
Transitions may refer to changes from one environment to another such as from an early childhood
program to a kindergarten or first grade class or from a secondary program to the world of work.
Transitions may also refer to changes from one activity to another. Transitions are typically very difficult
for individuals with autism.
Visual adaptations, visual support systems written schedules, lists, charts, picture sequence, and
other visuals that convey meaningful information in a permanent format for later reference. Visual
adaptations allow the person with autism to function more independently without constant verbal
directions.
Work system the visual organization of directions, materials, and environments to clarify expectations.
This clear visual organization promotes independence from another person to provide verbal prompts and
cues.
76
Appendix B - Glossary of Acronyms
AAC ...................... Alternative and Augmentative Communication
AAPEP .................. Adolescent and Adult Psychoeducational Profile
ABA ...................... Applied Behavior Analysis
ADA ...................... Americans with Disabilities Act
ADI-R ................... Autism Diagnostic Interview Revised
ADOS.................... Autism Diagnostic Observation Schedule
ADL ...................... Activities of Daily Living
AIT ........................ Auditory Integration Training
APE ....................... Adapted Physical Education
AS ......................... Aspergers Syndrome
ASA ...................... Autism Society of America
ASDS .................... Asperger Syndrome Diagnostic Scale
CA ......................... Chronological Age
CARS .................... Childhood Autism Rating Scale
CDD ...................... Childhood Disintegrative Disorder (Hellers Syndrome)
CELF-4 ................. Clinical Evaluation of Language Fundamentals-4th Edition
CSBS ..................... Communication and Symbolic Behavior Scales
DD ......................... Developmental Disability
77
DOB ...................... Date of Birth
DSM-IV-TR .......... Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision
DTF ....................... Discrete Trial Format
ERIC ..................... Education Resources Information Center
ESY ....................... Extended School Year
FA ......................... Functional Assessment or Functional Analysis
FAPE ..................... Free Appropriate Public Education
FC.......................... Facilitated Communication
FERPA .................. Family Education Rights and Privacy Act
GADS.................... Gilliam Aspergers Disorder Scale
GARS-2 ................ Gilliam Autism Rating Scale-2nd Edition
HFA ...................... High Functioning Autism
IDEA ..................... Individuals with Disabilities Education Act
IEP ........................ Individual Educational Plan
IFSP ...................... Individual Family Service Plan
IHP ........................ Individualized Habilitation Plan
IQ .......................... Intelligence Quotient
ISP ......................... Individual Service Plan
JADD .................... Journal of Autism and Developmental Disorders
KABC ................... Kaufman Assessment Battery for Children
78
LRE ....................... Least Restrictive Environment
M-CHAT ............... Modified Checklist for Autism in Toddlers
MDT...................... Multidisciplinary Team
MLU...................... Mean Length of Utterance
MR ........................ Mental Retardation
NICHCY ............... National Information Center for Children and Youth with Disabilities
NIH ....................... National Institutes of Health
OCD ...................... Obsessive Compulsive Disorder
ODD ...................... Oppositional Defiant Disorder
OSEP ..................... Office of Special Education Programs
OSERS .................. Office of Special Education Rehabilitative Services
OT ......................... Occupational Therapist, Occupational Therapy
P & A .................... Protection and Advocacy
Part C .................... Refers to the Early Childhood portion of IDEA
PBS ....................... Positive Behavioral Supports
PDD ...................... Pervasive Developmental Disorder
PDD-NOS ............. Pervasive Developmental Disorder Not Otherwise Specified
PECS ..................... Picture Exchange Communication System
PEP-3 .................... Psychoeducational Profile-3rd Edition
PLS-4 .................... Preschool Language Scale-4th Edition
79
PPVT-3 ................. Peabody Picture Vocabulary Test-3rd Edition
PT .......................... Physical Therapist, Physical Therapy
SI ........................... Sensory Integration
SIB ........................ Self-injurious Behavior
SLP........................ Speech-Language Pathologist
SSI ......................... Supplemental Security Income
SSDI ...................... Social Security Disability Income
SSRI ...................... Selective Serotonin Reuptake Inhibitor
TARPS .................. Test of Auditory Reasoning and Processing Skills
TEACCH .............. Treatment and Education of Autistic and related Communication handicapped
CHildren
TOPS ..................... Test of Problem Solving
WPPSI-R ............... Wechsler Preschool and Primary Scale of Intelligence Revised
WISC-III ............... Wechsler Intelligence Scales for Children, 3rd Edition
80
Appendix C - Organizations
Autism Society of America (ASA)
Bethesda, MD 20814
800-3-AUTISM or 301-657-0881

Sanford School of Medicine
The University of South Dakota
Sioux Falls, SD 57105
800-658-3080 (Voice/TTY) or 605-357-1439
www.usd.edu/cd/autism
Indiana Resource Center for Autism (IRCA)

Indiana Institute on Disability and Community
2853 East 10th Street
Bloomington, IN 47408
812-855-6508
www.iidc.indiana.edu/~irca
Autism Research Institute (ARI)

4182 Adams Avenue
San Diego, CA 92116
619-281-7165
www.autism.com
TEACCH (Division for Treatment and Education of Autistic and Related

Communication Handicapped Children)
CB #7180; 100 Renee Lynne Court
The University of North Carolina at Chapel Hill
Chapel Hill, NC 27599-7180
919-966-2174
www.teacch.com
81
Clinic for the Behavioral Treatment of Asperger Syndrome Coalition of United
Children States
O. Ivar Lovaas, Director P.O. Box 351268
University of California, Los Angeles Jacksonville, FL 32235
Department of Psychology 866-4-ASPRGR (866-427-7747)
1282A Franz Hall, P.O. Box 951563 www.asperger.org
Los Angeles, CA 90095-1563
310-825-2319 The Family Connection
Beach Center on Families and Disability
South Dakota Parent Connection University of Kansas
3701 W. 49th Street, Suite 200B Haworth Hall Room 3136
Sioux Falls, SD 57106 1200 Sunnyside Ave.
800-640-4553 (in South Dakota) or 605-361-3171 Lawrence, KS 66045
www.sdparent.org 785-864-7600
www.beachcenter.org
Autism National Committee (AUTCOM)
PO Box 6175 National Information Center for Children
North Plymouth, MA 02362 and Youth with Disabilities (NICHCY)
www.autcom.org Box 1492
Washington, DC 20013
National Alliance for Autism Research 800-695-0285 (Voice/TTY)
(NAAR) www.nichcy.org
99 Wall Street, Research Park
Princeton, NJ 08540
Phone (888)777-NAAR
www.naar.org
Pyramid Educational Consultants

226 W. Park Place Ste. 1
Newark, DE 19711
888-PECS INC (888-732-7462)
www.pecs.com
Sensory Integration International

1602 Cabrillo Avenue
Torrence, CA 90501-2701
310-787-8805
www.sensoryint.com
Autism Resource Network

904 Mainstreet #100
Hopkins, MN 55343
952-988-0088
82
Appendix D - Websites
Center for Disabilities Asperger Syndrome/Asperger Disorder
www.usd.edu/cd/autism Online Aspergers Syndrome Information
and Support
The Autism Society of America www.udel.edu/bkirby/asperger
Aspie.com
Autism Resources www.aspie.com
www.autism-resources.com
Tony Attwood
National Alliance for Autism Research www.tonyattwood.com
www.naar.org
Asperger Syndrome Coalition of the U.S.
Autism Frequently Asked Questions www.asperger.org
(FAQ)
www.autism-resources.com/autims.faq.html Asperger Syndrome Listserv
www.egroups.com/group/AS-and-proud-of-it
Center for the Study of Autism
www.autism.com MAAP Services for the Autism Spectrum
Different Roads to Learning-ABA Resource
http://www.difflearn.com Asperger Syndrome Education Network
www.aspennj.org
Division TEACCH
www.unc.edu/depts/teacch Asperger Information
www.aspergerinformation.org
The Lovaas Institute for Early
Intervention
www.lovaas.com
Family Village
www.familyvillage.wisc.edu
Sibling Support Project

www.thearc.org/siblingsupport/
Autism Online
www.autismonline.org
Indiana Resource Center for Autism

www.iidc.indiana.edu/irca
83
Appendix E - Journals and Newsletters
Journal of Autism and Developmental Disorders
Kluwer Academic Publishers
233 Spring Street F17
New York, NY 10012-1578
212-620-8000
www.springerlink.com
FOCUS on Autism and Other Developmental Disabilities

Pro-Ed
8700 Shoal Creek Boulevard
Austin, TX 78757-6897
www.proedinc.com/store
The Advocate
Autism Society of America
Bethesda, MD 20814
800-3-AUTISM
The Autism Research Review International

Autism Research Institute
4182 Adams Avenue
San Diego, CA 92116
619-563-6840
www.autism.com/ari
The Source-MAAP Quarterly Newsletter

More Advanced Individuals with Autism, Aspergers Syndrome and PDD
P.O. Box 524
Crown Point, IN 46307
219-662-1311
Autism Spectrum Quarterly

Starfish Specialty Press, LLC
P.O. Box 799
Higganum, CT 06441
1-877-STARFISH
www.asquarterly.com
84
Appendix F - Recommended Readings
on Autism Spectrum Disorders
Visual Strategies for Improving Communication, Autism: Understanding the Disorder by Gary
Volume 1: Practical Supports for School and Home Mesibov, et al.
by Linda A. Hodgdon, M.Ed., CCC-SLP
Positive Behavioral Support: Including People With
Solving Behavior Problems in Autism by Linda A. Difficult Behavior in the Community by Koegel,
Hodgdon, M.Ed., CCC-SLP Koegel and Dunlap
Thinking About You Thinking About Me by Do, Watch, Listen, Say by Kathleen Quill
Michelle Garcia Winner, SLP
What Does It Mean to Be Me? By Catherine
Understanding the Nature of Autism, A Practical Flaherty
Guide by Janice E. Janzen, MS
Visual Supports in the Classroom (video)
Teaching Children with Autism by Kathleen Quill
Autism: Learning to Live (video) by Indiana
Crossing Bridges by Viki Satkiewicz-Gayhardt et al. Resource Center
(pamphlet)
A Mind Apart by Peter Szatmari
Thinking in Pictures by Temple Grandin
These resources are available for check-out from
Picture Exchange Communication System by the Wegner Health Science Information Center,
Andrew Bondy, Ph.D. and Lori Frost, MA-CCC/ 800-521-2987 or www.usd.edu/wegner. You do
SLP (manual) not have to live in Sioux Falls to check out
resources; the Wegner Center will mail resources
Social Stories, More Social Stories and Comic Strip to you. Please identify yourself as a Center for
Conversations3 books by Carol Gray Disabilities consumer when requesting materials
from the Wegner Center.
Aspergers Syndrome: A Guide for Parents and
Professionals by Tony Attwood (book or video)
Behavioral Intervention for Young Children with

Autism, ed. Catherine Maurice, Gina Green and
Stephen Luce
The Hidden Curriculum by Brenda Smith Myles
Steps to Independence by Bruce L. Baker and Allan

Brightman
Parent Survival Manual by Eric Shopler
Siblings of Children with Autism: A Guide for

Families by Sandra L. Harris
85
Appendix G - Publishers
Autism Asperger Publishing Co.
P.O. Box 23173
Shawnee Mission, KS 66283-0173
877-277-8254
www.asperger.net
Autism Resource Network, Inc.

Nonprofit Featuring Books and Educational Items
904 Mainstreet, Ste. 100
Hopkins, MN 55343
952-988-0088
www.autismbooks.com
Childswork Childsplay
Resources for Social and Emotional Needs
PO Box 760
Plainview, NY 11803
800-962-1141
GuidanceChannel.com
Different Roads to Learning

Your Complete ABA Resource
12 W. 18th St. Ste. 3E
New York, NY 10011
800-853-1057
http://www.difflearn.com
Four Leaf Press

Autism Is Our Specialty
PO Box 23502
Eugene, OR 97402
800-322-1883
Future Horizons, Inc.

Publications on Autism/Asperger's Syndrome
720 N. Fielder Road
Arlington, TX 76012
800-489-0727
www.FutureHorizons-autism.com
86
Imaginart Communication Products Quirk Roberts Publishing
307 Arizona St. PO Box 71
Bisbee, AZ 85603 Troy, MI 48099-0071
800-828-1376 248-879-2598
www.imaginartonline.com www.visualstrategies.com
Indiana Resource Center for Autism Thinking Publications

Indiana Institue on Disability and Community Communication Solutions That Change Lives
2853 E. Tenth St. PO Box 163
Bloomington, IN 47408-2696 Eau Claire, WI 54702-0163
812-855-6508 800-225-GROW (4769)
www.iidc.indiana.edu/~irca. www.ThinkingPublications.com
Laureate
Special Needs Software
110 E. Spring St.
Winooski, VT 05404-1898
800-562-6801
www.LaureateLearning.com
LinguiSystems, Inc.
Speech and Language Resources
3100 4th Ave.
East Moline, IL 61244-9700
800-PRO IDEA (800-776-4332)
www.linguisystems.com
Mayer-Johnson Company
PO Box 1579
Solana Beach, CA 92075-7579
800-588-4548
www.mayer-johnson.com
PRO-ED
8700 Shoal Creek Blvd.
Autsin, TX 78757
800-897-3202
www.proedinc.com
87
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Autism

Autism Spectrum Disorders Program

Updated Fall 2006

Introduction to Autism Spectrum Disorders ..................................................... 2

Bibliography and Appendixes ........................................................................... 66

Services available through the Autism Spectrum Disorders Program

Autism Spectrum Disorders Program

(605) 357-1439 or 800-658-3080 (V/TTY)

Email: cd@usd.edu or visit our website at www.usd.edu/cd/autism

For more information:

Retts Disorder (Rett Syndrome)

For more information:

Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS)

Autism Spectrum Disorders

Autism Aspergers Retts Childhood Pervasive

Social, Communication, Behavior/Interests,

299.00 Autistic Disorder

(2) qualitative impairment in communication as manifested by at least one of the following:

(1) social interaction

(1) apparently normal prenatal and perinatal development

(1) deceleration of head growth between ages 5 and 48 months

299.10 Childhood Disintegrative Disorder

(1) expressive or receptive language

(C) Abnormalities of functioning in at least two of the following areas:

299.80 Pervasive Developmental Disorder Not Otherwise Specified

Kids with Asperger Syndrome (AS) Typically:

Real World Examples

Socially awkward Limited or immature conversation skills

Top 10 Intervention Strategies

24:05:24.01:02. Screening procedures for autism

24:05:24.01:03. Autism defined

24:05:24.01:05. Diagnostic procedures for autism

24:05:24.01:06. Instruments used in diagnosis of autism

1. No 6. No 11. Yes 16. No 21. No

Reprinted from www.firstsigns.org/downloads/m-chat.

Active engagement in intensive instructional programming for a minimum of the equivalent of a

Inclusion of a family component, including parent training;

6. Because language is so difficult for me, I am very visually oriented. Show me

9. Try to identify what triggers my meltdowns. This is termed the antecedent.

It all comes down to three words: Patience. Patience. Patience.

1. What is the treatment/therapy?

2. Is there reliable evidence of the effectiveness of the technique/

3. What is the rationale, philosophy, or underlying purpose of the treatment

4. How is the determination made that the treatment/therapy is warranted

5. Does the treatment focus on one particular aspect or is

7. Is there evidence that supports the effectiveness of the treatment/

8. Does the treatment/therapy promise a cure?

National Institute for Mental Health. www.nimh.nih.gov

Communication Skills: Expressive

Communication Skills: Receptive

Do not always require eye contact. We spent

Only use prompts that can be easily faded.

Choose activities that require simple social interactions.

Maintain a sense of compassion and a sense of humor.

Taken from http://rsaffran.tripod.com/whatisaba.html.

The hierarchy of visual communication (least abstract to most abstract):