“Well, do you want your DS?” asks a one-on-one worker at an activity group I’m leading for the Autism Community Center of Asheville.
“Yeah”, is the response.
“Ok, it’s in the car. Do you want me to get it for you?”

…and this is when I start grinding my teeth. There are a lot of wonderful things about 1:1 services, but an over-dependence on constantly having a personal adult is not one of them. I am too-often reminded of governesses and servants when I watch these failed attempts at professional relationships unfold. Adults who are supposed to be teaching, guiding, and demonstrating independence end up descending into the role of carrier-of-stuff, fetcher-of-forgotten objects, and fall-guy for bad tempers.

To be fair, I’ve totally found myself in this all-purpose, waitress type of role in several of my early direct care jobs. Most places don’t train you how to stay professional, and to empower individuals in 100 small ways each day, instead of taking over.

Saying ‘YOU do it’, is empowering for both sides of a relationship. Should the direct care staff in the example above notice that a kid left his DS behind? Yes. Should said staff be able to predict later trauma when the missing DS is discovered. Yes. Does that mean the direct care staff should trot off to produce the thing? Definitely not.

Instead, consider the following:
“Well, do you want your DS?” asks a one-on-one worker at an activity group I’m leading for the Autism Community Center of Asheville.
“Yeah”, is the response.
“Cool. Go get it.”

In this scenario, the kid is encouraged for knowing what he wants, and empowered to do something about it.
If this conversation is (later) followed up with the implementation of some system for remembering items, then THAT is something I’m totally willing to pay tax dollars for. I’m not as interested in paying for endless babysitting.

I have seen many, many healthy direct care scenario’s (especially at the Autism Society of NC), with professional staff, and good supervision, and I believe that having really good one-on-one support can help people learn to do stuff for themselves…but only when we refrain from doing stuff for them.

In much of my work, I am asked to facilitate or design activities that are accessible to people on the Autism Spectrum. As it happens, this is not rocket science. People with autism do not need to play ‘autism soccer’ or play the ‘autism guitar’. I have not had to create a whole world of activities that did not previously exist. Instead, I tend to support activities that are already fun with clear expectations, and structured choices.

Visual support, or visually based expectations is a way of being respectful to a variety of learning and communication methods. However, all the visual support in the world cannot make a lame activity fun, and planning activities that are actually fun is also a sign of respect.

In the photo above, I am explaining how I want group members to act, using a list of expectations. This particular group of kids can read, and have done groups like this before, so the list is targeted towards them. As they read the expectations, we run through scenarios that could happen, such as not wanting to play a game that is on the schedule. When we read the part that says ‘we can choose which activities we want to do’, I ask them to demonstrate various methods for opting out, such as verbalizing ‘I don’t want to play this one’, or sitting in a place we’ve designated as an ‘I’m not participating right now’ place. These opt-out methods can be supported visually as well.

Usually, allowing participation to be optional is respectful in a recreation setting. However, I have known individuals who respond better to different kinds of choices, such as “what you eat for snack is a choice, but soccer practice is not a choice”.

I’ve found that most people with autism can enjoy a huge variety of activities, despite their purported rigidity and restricted interests, when the activities are explained clearly, and they are empowered with choices about their level of participation.

As you may know, I work for Dragonfly Forest, a free camp for kids who have autism. This year, we are presenting at several conferences about campers with autism, and making a typical camp setting more accessible for kids with autism. Here is one of my main points about the difference between a camper with autism and a neurotypical campers.

Self Referencing vs Social Referencing

You and I and other neurotypical people are constantly social-referencing. That means we are using other people’s behavior to guide our own behavior. In a group, we look at other people to see what they are doing. If everyone heads over to look out the window, we sort of want to do that too.

We study each other’s tone of voice and facial expressions closely, and use that information as a social cue for own behavior. In fact, we even mirror other peoples facial expressions when they speak to us (imagine a friend telling you they got some sad news, your mouth will turn down, and your eyes get soft, almost as if you had received the sad news yourself). We ‘instinctively’ know when a class or meeting is almost over because everyone starts rustling their papers and gathering their bags. In contrast, people with autism are often self-referencing, which means they are checking in on themselves, and using their own feelings to guide their behavior instead of using others behavior to guide them.

Examples of social cues (things that you know how to interpret even though no one ever explained them to you):

facial expressions

body positioning

tone of voice

Self-referencing (and missing social cues) can lead a camper with autism to

have awkward social interactions because they ‘miss the hint’ from other campers.

be uninterested in certain activities, regardless how excited the counselors and other campers are

appear to ignore cues from counselors about when an activity is becoming too rowdy or when it is time to transition to another activity

You can help a camper who is self-referencing by:

‘Scaffolding’ a conversation between two campers by making interpretive comments such as, “Billy seems like he wants to play warriors, too.” or, “I think James is tired of talking about World War II now”.

Explaining activities clearly and then providing structured alternative choices if a camper with autism doesn’t want to do them. Don’t be offended if they do not respond to your own excitement.

Speaking literally when giving directions or setting expectations. Do not take it personally if your social cues are misinterpreted, or not interpreted. Work to make yourself clear without having to ‘hint’ with your facial expression and body language.

Today’s post is for parents of children with autism, people who work with kids in the autism field, and anyone else who has to walk a fine line between pushing boundaries to teach skills, and making room for people to be just be who they are.

I’ll start by saying that I do not have a child with autism, so I can’t relate to the full scope of your situation. However, most of my kid-related autism jobs involve working closely with families, and I’ve spent significant time with about 50 families. What does ‘significant time’ mean? That means I’m that overly-chipper girl that shows up in the kitchen when you’re still groggy in the morning to help make a ‘morning routine’ schedule. It means I’m the girl who knows the details of the potty struggles. I have had to frantically search the yard with a flashlight to find Thomas the Train, and I cringe when strangers act like autism meltdowns=bad parenting. I know that most parents of a child with autism are sleep deprived, financially concerned, and in hot pursuit of reliable information.

I’m saying all this because I generally think that advice from people who don’t know what you’re going through is condescending, and relatively useless…and there is no getting around it: what I’m about to say can only be categorized as unsolicited advice.

The only thing I can say in my defense is that I made these lists for myself, for when I forget the important stuff about teaching a kid (with or without autism) to be a grown up.

Enough disclaiming. Here it is. Two short, sweet, lists that bring me back to basics:

Do:

1. Address anxiety directly. I don’t always know what makes other people anxious, but I can make some good guesses: transitions, new stuff, and confusing expectations. What should I do for myself when I’m anxious about unavoidable stuff? I should prepare for it, usually in a visual format (think planner, journal, diary or sketchbook). I can prepare kids for this stuff too. When I start dropping the ball on setting clear expectations, complete with transition warnings, everything falls apart.

2. Remember sensory sensitivity. Again, I don’t always know what icks people out, but I can make some good guesses: too much light or noise, crowds, itchy clothes, and too much to look at. I can adjust my own perspective, based on the environment, and I should.

3. Sit back and appreciate the true character of the kid under your care. This one is so important to me, that I wrote a whole post just on this topic.

Don’t:

1. Nitpick. Figure out the one, or occasionally two, most important things for the next three hours, and hush up about everything else. It’s tempting to over-correct, or to feel embarrassed about someone else’s manners and critique them, but 100% of Empower Autism authors agree, it’s a bad idea to nitpick. In the long run, the child will suffer from insecurity, and I will suffer from frazzled nitpicker syndrome (a condition immediately obvious to those around me).

2. Talk too much. For Pete’s sake, I’ve been doing this for years! Why can’t I just remember to give a short verbal explanation, and back it up with visuals? Instead I sometimes find myself blathering on as if I was making sense.

On the occasions that I can keep all of these things in mind, I have more fun, and so does everyone around me. As simple as they sound, these four things are definitely not easy. However, I believe that each one is a concrete way to be respectful of autism.

What are your Autism ‘do’s and don’ts’?

This is part of a paper I wrote about Early Intervention. It’s a little long, and a little wordy for the casual internet reader, but, every once in awhile, it’s important to nerd out and get intellectual and precise. There is a link to my citations at the end.

Here we go.

In the United States, the idea of ‘early intervention’ (EI) arose in the late 1950’s, and early 1960’s amidst the fallout of Brown vs. the Board of Education. At the time, many people believed humans inherited their intelligence genetically, and that differences in standardized scores could be explained by race or heritage (Ramey & Ramey, 1998). Against this backdrop of inherited intelligence, several learning theorists began to focus their research on the significance of the first few years of life (Harlow, 1958, Hunt, 1961). Additionally, a study done by Skeels and Dye (both named Harold) influenced the psychological community about intelligence development in children with mental retardation, and the potential intelligence-development of all children (Skeels & Dye, 1939).

As the idea of a mutable, developable intelligence grew, several researches performed pivotal, successful, randomized early intervention trials on young children (Caldwell, 1973), which provided the basis for the federally funded Head Start program in the United States (Zigler & Muenchow 1992). Incidentally, Sputnik, the Russian satellite launched in 1957, had just trumped the United States in the technological innovation category, and it is rumored that programs like Head Start were more willingly funded in the hopes of creating smarter students, more quickly (Ramey & Ramey, 1998).

The Head Start program set the precedent for other government funded interventions, including early intervention programs for children with disabilities (Ramey & Ramey, 1998). Each state is now required to provide early intervention for those who qualify using, “services which are designed to meet the developmental needs of an infant or toddler with a disability, as identified by the individualized family service plan (IFSP) team, in any one or more of the following areas: physical development, cognitive development, communication development, social or emotional development, or adaptive development “(IDEA, 2004).

For children with autism, early intervention began in the 1980’s after Eric Schopler revealed that outcomes for children on the spectrum could be improved through direct teaching (Schopler, 1987). Researchers then studied outcomes for younger children, and found that, with proper techniques, many children who receive early intervention services make measurable developmental gains (Bryson, Rogers, & Fombonn 2003, Dawson, 2008). Early intervention is now considered a best-practice in the autism field (Woods & Wetherby, 2003, Stahmer, & Aarons, 2009), and each state is mandated though the Individuals with Disabilities Education Improvement Act (IDEA) to provide free early intervention services (IDEA, 2004). However, the precise method by which these services are presented differs throughout the nation (Odom, & Wolery 2003).

Although each early intervention service may feature a different array of treatments, the most effective early intervention programs for children with autism are behaviorally-based (Dawson, 2008, Sallows & Graupner, 2005), family-oriented (Schreibman, 2000, Odom & Wolery, 2003), focused on joint attention and language-learning (Kasari, Paparella, Freeman, & Jahromi, 2008) , and engage the child for at least 25 hours per week (Cohen, Amerine-Dickens, & Smith, 2006, National Research Council, 2001).

Read More…..

Look at my Citations

In my quest to encourage people to simply appreciate their co-workers, friends, and loved ones with autism, I sometimes come across this reaction:

“…but my child doesn’t know how to brush his teeth/take a bath/play independently. If I don’t make him learn, how will he ever be independent?”

I also struggle with this dilemma. When we actively teach skills to people with autism, we are walking a tightrope between creating eventual independence, and squashing someone’s true nature. How far should we push someone to do something new, before we are infringing on their dignity?

Here is what I say: If we can make appreciating the true character of the child central to our daily practice, we will keep the equilibrium we need to make solid moment-to-moment decisions. We can take time to plan stuff for them that they will LOVE, even if it’s not therapeutic. If a child loves bright colors, and could use some practice on personal hygiene skills, we can bring some bright paper or cloth out in the yard, play with it, and leave the skills for another time. We can find ways for her/him to get the sensory feedback they crave. Sometimes, we don’t have to practice anything hard.

The Pressure of the Future:

Many parents of children with autism feel as if the entire burden of their child’s future rests with them, and if they could find the right therapy, the right combination of supplements, the right helper, then their child would be OK. This may or not be true. What is certainly true is that if you and your child don’t share some joyful moments, you will both feel frustrated, and under-appreciated.

When I center some of my daily musings on creating big fun (whatever that means for each child), l feel some weight lift off my shoulders. It’s not like I’m going to just stop teaching kids anything, but I’ve found that creating joy, just for fun’s sake, can center my mind to be able to take on the daily challenge of deciding moment-by-moment which battles to pick, and how to stick with them. Creating eventual independence for a child is truly an act of love, but we don’t have to wait until they are ‘finished learning’ to spend some time enjoying them, enjoying life.

This post is in process!

Go back to Early Intervention is an Autism Best Practice
Go to citations list

Behaviorally Based Programming

Behaviorally-based autism interventions are widely popular, and have a large body of supporting evidence (Simpson, 2005). In the year 2000, Laura Schreibman wrote that “it is now widely acknowledged that, to date, the forms of treatment enjoying the broadest empirical validation for effectiveness with individuals with autism are those treatments based upon a behavioral model.” (Schreibman, 2000). Jonathan Campbell’s 2003 review of autism interventions found that, “First and foremost, behavioral treatments were found to be significantly effective in reducing problem behavior in individuals with autism” (Campbell, 2003). In addition to being valuable for autism interventions at any age, behaviorally-based interventions are also shown to be effective specifically for children age 0-3 (Sallows & Graupner, 2005Weiss, 1999).
In 1993, McEachin, Smith and Lovaas found early intensive behavioral intervention to have successful long term outcomes for young children with autism (McEachin, Smith & Lovaas, 1993). Jane Weiss took clinical data on 20 children with autism in 1999, each of which were involved in a home early intensive behavioral intervention (EIBI) programs, and found that their mean Childhood Autism Rating Scale (CARS) score decreased significantly after 2 years of treatment (Weiss, 1999). In 2002, Jenson and Sinclair wrote a review of Early Intensive Behavioral Intervention programs (EIBI), stating, “Research regarding the use of applied behavior analysis in EIBI programs for children with autism has consistently shown significant positive benefits including an overall increase in functional skills and cognitive performance and a decrease in autistic symptoms (2002)”. In 2006, Cohen, Amerine-Dickens, & Smith replicated Lovaas’ method of Early Intensive Intervention Therapy in a community-based study, and found it to be effective for infants and toddlers with autism (Cohen, Amerine-Dickens, & Smith, 2006). Behavioral techniques in early intervention programs are well supported (Jenson & Sinclair, Cohen & Sloan, 2007), and popular (Stahmer, 2007)

Parental Involvement

While some researchers studied behaviorally-based autism programs, other researchers studied the effects of parent education, or family participation, on outcomes for children with autism. Intervention with parents has been studied on multiple levels, including how parent education effects outcomes for the child, as well as how it effects the wellbeing of the parent themselves, which is also shown to be beneficial for the child (Schreibman, 2000). Several studies have found that having a child with autism contributes to parental stress (Howlin, Goode, Hutton, & Rutter, 2004). In fact, some studies have even stated that parents of children with autism experience more stress, and higher divorce rates than parents of children with other special needs (Dunn, Burbine, Bowers, & Tantleff-Dunn, 2001).
Parent education programs are reported to have a positive effect on target behaviors for special needs children, including children with autism (Brookman-Frazee, 2004, Feldman & Werner, 2002). Moes and Frea found that by addressing (with parents) the specific context in which problem behaviors occurred, therapists could help families to decrease these behaviors in children with autism 0-3 years old (Moes & Frea, 2002). They also found that functional communication between parents and their young children with autism improved using parent training programs (Moes & Frea, 2002). Additionally, after participating in parent education programs, parents of children with developmental disabilities reported increased quality of family life, and greater self-efficacy(Feldman & Werner, 2002), and family function (Tonge et al., 2006). In England, the National Autistic Society has developed The Early Bird Programme (Shields, 2001), which offers a 3-month program, including education on behavior management training, and parent support groups, with simultaneous early intervention therapy for the child with autism. This program was successful in decreasing parent stress at follow up (Sheilds, 2001). Sallows & Graupner (2005) found that the parent-managed treatment group in their behavioral program study achieved similar results to the clinic-managed group, even though they were administrating fewer hours of therapy each week (Sallows & Graupner, 2005). They write that, “Although many parent-directed parents initially made decisions regarding treatment that resulted in their children progressing slowly (e.g., using their treatment hours for ineffective interventions or pushing children to learn advanced skills before they were ready), resulting in frustration and occasionally “shutting down,” many parents then sought input from treatment supervisors and rapidly learned to avoid making the same mistake twice, becoming quite skillful after a few months.” (Sallows & Graupner, 2005).
The TEACCH program has involved parents in the clinical process since its inception, and credits its success, in part, to this (Mesibov, Shea, & Schopler, p. 10, 2005). Due, in part, to the aforementioned list of positive outcomes for parents and children with autism, parental self-efficacy, and parental empowerment have become ideal objectives in the mental health world (Dawson, 2008). In 2004, Brookman-Frazee summarizes the most effective ways for professionals to collaborate with parents of children with autism.“Overall, the literature has suggested a number of necessary components for effective partnerships: a) mutually agreed upon goals, b) shared expertise, c) shared responsibility, d) eco-culural fit, e) collaborative problem solving, f) a strength-based approach.”(Brookman-Frazee, 2004). Despite this helpful list, and its implied call for standardization, early intervention programs continue to collaborate with parents in varying degrees, using a wide variety of methods (Stahmer, 2007).

Language Learning

In addition to being behaviorally-based (Dawson, 2008, Sallows & Graupner, 2005), and family oriented (Schreibman, 2000, Odom & Wolery, 2003), quality early intervention programs should also focus their daily curriculum on language learning (Landa, 2007). For children with autism, language development is a significant predictor of independence and happiness later in life (Lord, 2000, Rogers, Hepburn, Stackhouse & Wehner, 2003), and by age 10-13, one quarter to one half of people with autism will not have acquired functional language (Sigman & Ruskin, 1999). This makes language curriculum vital for early intervention programs.
Joint attention has been widely established as a pre-requisite for acquiring verbal language (Kasari, Paparella, Freeman, & Jahromi, 2008). Defined as a “set of nonverbal, social-communication skills (Mundy & Crowson, 1997)”, joint attention behaviors, include imitation, social referencing, communicative gestures, and early productive language (Tomasello, 1995). At the age of early intervention (0-3), many children with autism are still learning this cluster of behaviors which professionals refer to as joint attention (Landa, 2007). Children who demonstrate joint attention, in the form of synchronized gaze with another, or pointing to an object of interest, also demonstrate more developed language skills at the time of the interaction (Dawson et. al., 2004).
Several measures of joint attention have been found to be predictive of language skill gain, including responding to pointing (Sigman & Ruskin, 1999), the frequency of joint attention interactions (Charman et. al., 2005), and the duration of those interactions (Adamson, Bakeman, & Deckner, (2004). It is possible that the attentiveness to another person, in which the child must engage, is what improves language skills in any of these scenarios (Kasari, Paparella, Freeman, & Jahromi, 2008). In any event, joint attention behaviors can be taught to young children with autism in an early intervention setting (Kasari, Paparella, Freeman, & Jahromi, 2008, McEachin, Smith & Lovaas, 1993, Whalen & Schreibman, 2003).
Joint attention skills also predict later language development (Charman et. al., 2003). Sigman & Ruskin indicate that joint attention skills measured at 4 years old (just past early intervention age), are associated with social and peer group behavior eight years later (Sigman & Ruskin, 1999). For children with autism, expressive language at 4 years is predicted by imitation skills at 2 years old (Stone & Yoder, 2001). Intervention programs that have access to children with autism 0-3 year old, should focus on language learning, because children who learn to use language, are shown to report increased happiness and independence as older children and adults (Lord, 2000, Rogers, Hepburn, Stackhouse & Wehner, 2003).

Intensity (hours per week) of programming

One of the most difficult early intervention best-practices to achieve, according to service providers, is the time requirement of at least 25 hours per week (Stahmer, 2007). This therapy duration recommendation has its roots in behavior analysis, a regimented, practice-based intervention utilized by Ivar Lovaas in the 1980’s (Lovaas, 1987). Several studies have tested the amount of time therapy time required to achieve increased IQ. (Anderson et al., 1987) provided 15 hours per week for 1 to 2 years (parents provided another 5 hours) and found that only 4 of 14 children achieved an IQ over 80 and were in regular classes, and all needed some support. (Erikeseth et al., 2002) provided 28 hours per week for 1 year. In their sample, 7 of 13 children with pretreatment IQ over 50 achieved IQ over 85 and were in regular classes with some support. (Sallows & Graupner, 2005) did a study observing the effects of 39 hours per week of clinic-provided treatment, and 32 hours per week of similar, parent-provided treatment, and found that in both groups, about half the participants increase their IQ scores from about 50 to 100. Currently, most early behavioral intervention programs call for 25-40 per week of intense interaction, and 50-100 learning opportunities per hour (Howard et al., 2005). In 2001, The National Research Council recommended that all children with an autism spectrum disorder receive:
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 child’s chronological age and developmental level
(NRC, 2001)

Regardless of how difficult it is to implement, several research groups clearly state that young children with autism benefit from intense, lengthy, direct intervention. (Amerine-Dickens, & Smith, 2006, Howard et al., 2005)

Theory and Practice

While establishing best-practices for early intervention programs is difficult, it is arguably more difficult to interpret and implement those practices into a practical, therapeutic setting. This difficulty is increased if an intervention program has been running for some time, and needs to adapt in order to better meet the current best practices. Apparently, there is a divide in the autism community, between researchers and service providers (Bondy, & Brownell, 2004). Some researches doubt the willingness or ability of service providers to update their practices to reflect current best-practices, and some service providers feel that best-practices developed in research settings, with no thought to current practice, are not useful without methods to implement those practices (Stahmer, Collings, Palinkas, 2005).
In 2007, Aubyn Stahmer studied 80 early intervention programs in the United States, and found that while many of them implement some of the current evidence-based best-practices, most of them do not implement them all, and the ‘depth and quality of use’ of those practices were variable (Stahmer, 2007). For example, while many (96%) providers reported that they incorporated families of participants in their programs, only 73% of those offered parent education in the form of workshops or seminars, with the rest offering parents a chance to observe the program (Stahmer, 2007). A small 16% of programs offered parents feedback on their parent-child interactions, 14% included parents at team meetings, and only 10% used some form of communication, such as a communication book, or behavior log, between the program and the home (Stahmer, 2007). In general, Stahmer found that all but 2 of the programs she interviewed provided less than the 25 hours of treatment time recommended by the National Research Council (NRC, 2001). Since many children with autism receive additional services outside of their early intervention program, this might not be a problem, but since only about half of the programs Stahmer surveyed collaborate with other agencies, continuity characteristics such as similar goals, overlapping behavioral expectations, and communication systems might be occurring (Stahmer, 2007).

Conclusion

Interestingly, several studies state that certain characteristics of a child with autism can predict how much progress they make in early intervention programs (Ben-Itzchak, & Zachor, 2006). Harris and Handleman (2000) found that beginning therapy at or before 42 months, and having an IQ around 78 at initial intervention are predictive of being placed in a regular education setting after treatment (Harris & Handleman, 2000). Eaves and Ho (2004) found that 2 year olds with milder autism achieved more progress than their severely affected counterparts, regardless of the type, and amount of intervention received, and Tager-Flusberg and Joseph (2003) found that initial language ability predicts greater gains for children with autism, across several interventions (Tager-Flusberg and Joseph, 2003). Ben-Itzchak and Zachor (2006) wrote the following about their 2006 study of young children with autism:
Our findings reveal that children with higher initial cognitive levels and children with fewer measured early social interaction deficits show better acquisition of developmental skills. This is especially noted in three developmental areas: receptive language, expressive language, and play skills. In this study, the progress in receptive language domain is highly related to pre-treatment cognitive abilities and social abilities. Children with higher pre-treatment cognitive levels or with better measured social reciprocal abilities advance more in their receptive language than do children with lower pre-treatment cognitive levels and social abilities. Progress in expressive language is associated to a greater degree with the child’s social abilities, while progress in play skills is related to a greater degree to cognitive level. (Ben-Itzchak, & Zachor, 2006)
Ben-Itzchak and Zachor’s findings are consistent with those of Harris and Handleman (2000), and Howard et al., 2005), and indicate that there may be a profiles of characteristics in young children with autism which are more likely to benefit from specific types of early intervention (Ben-Itzchak, & Zachor, 2006).
In 2008, Development and Psychopathology published a summary of early intervention research for autism, written by Geraldine Dawson. Her article indicates that EIBI improves IQ, language skills, educational placement for children with autism (Dawson, 2008). Dawson writes,
“common features of successful early intensive behavioral interventions are, (a) a comprehensive curriculum focusing on imitation, language, toy play, social interaction, motor and adaptive behavior; (b) sensitivity to developmental sequence; (c) supportive, empirically validated teaching strategies (applied behavioral analysis); (d) behavior strategies for reducing interfering behaviors; (e) involvement of parents; (f) gradual transition to more naturalistic environments; (g) highly trained staff; (h) supervisory and review mechanisms; (i) intensive delivery of treatment (25 hr/week for at least 2 years); (j) initiation by 2-4 years” (Dawson, 2008).
Dawson writes that if all of these criteria are met, 50% of children with ASD will have ‘remarkable’ results (Dawson, 2008). Other researchers agree with Dawson on many of these points. Kasari, Paparella, Freeman, & Jahromi (2008), Landa (2007), and Sigman & Ruskin (1999) agree that early intervention programs achieve better outcomes when they focus on imitation, and other joint attention behaviors, to stimulate language development. Cohen, Amerine-Dickens, & Smith (2006), Jenson and Sinclair (2002), Sallows & Graupner, (2005), and Weiss (1999), agree with Dawson on the points that successful early intervention programs utilize evidence-based behavioral therapy for teaching, and for reducing behaviors that are incongruous with learning. Moes & Frea (2002) Feldman & Werner, (2002), Tonge et al., (2006) and Brookman-Frazee (2004), all show definitive research in favor of parent involvement in programs for young children with autism. Stahmer (2007), Erikeseth et al. (2002), and Howard et al.(2005), have established that treatment for early intervention programs should be delivered at the rate of at least 25 hours per week. Stahmer points out that while each of these elements of a successful program (behaviorally-based, family-oriented, focused on language learning, and delivered 25 or more hours per week), has been established theoretically, the practical application of these best-practices remains a challenge to the early intervention community (Stahmer, 2007).

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Citations:

Adamson, L., Bakeman, R., & Deckner, D. (2004). The Development of Symbol-Infused Joint Engagement. Child Development, 75(4), 1171-1187.

Anderson, S. R., Avery, D. L., DiPietro, E. K., Edwards, G. L., & Christian, W. P. (1987). Intensive home-based intervention with autistic children. Education and Treatment of Children, 10, 352–366.

Ben-Itzchak, E., Zachor, D.A. (2006) The effects of intellectual functioning and autism severity on outcome of early behavioral intervention for children with autism. Research in Developmental Disabilities, 28(3), 287-303.

Bondy, E., & Brownell, M. T. (2004). Getting beyond theresearch to practice gap: Researching against the grain. Teacher Education and Special Education, 27, 47–56.

Bryson, S., Rogers, S., & Fombonne, E. (2003). Autism Spectrum Disorders: Early Detection, Intervention, Education, and Psychopharmacological Management. Canadian Journal of Psychiatry, 48(8), 506.

Brookman-Frazee, L. (2004). Using Parent/Clinician Partnerships in Parent Education Programs for Children with Autism. Journal of Positive Behavior Interventions, 6(4), 195-213.

Caldwell, B. M. (1973). Infant day care-The outcast gains respectability. In P.Robey (Ed.), Child care—Who cares? Foreign and domestic infant and early child development policies New York: Basic Books.

Campbell, M. (2003) Efficacy of Behavioral Interventions for Reducing Problem Behavior in Persons with Autism: a quantitative synthesis of single-subject research. Research in Developmental Disabilities 24(3) 120-138.

Charman, T., Baron-Cohen, S., Swettenham, J., Baird, G., Drew, A., & Cox, A. (2003). Predicting language outcome in infants with autism and pervasive developmental
disorder. International Journal of Language and Communication Disorders, 38, 265-285.

Charman, T., Taylor, E., Drew, A., Cockerill, H., Brown, J., & Baird, G. (2005). Outcome at 7 years of children diagnosed with autism at age 2: Predictive validity of assessments conducted at 2 and 3 years of age and pattern of symptom change over time. Journal of Child Psychology and Psychiatry, 46, 500-513.

Cohen, H.,Amerine-Dickens, M., Smith, T. (2006). Early Intensive Behavioral Treatment: Replication of the UCLA Model in a Community Setting. Journal of Developmental & Behavioral Pediatrics, 27(2), 145-155.

Cohen, M. J., & Sloan, D. L. (2007). Visual supports for people with autism: A guide for parents and professionals. Topics in autism. Bethesda, MD: Woodbine House.

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