+

Providing Support for Individuals with Autism Spectrum Disorders and Significant Disabilities

Angela JohnstonSuzanne Holmes-BundeWendy Acri

+By the end of this training, all participants will:

Know Understand Do

+Characteristics:

Autism Spectrum Disorders

Autistic DisorderAsperger’s SyndromePervasive Developmental Disorder Not Otherwise Specified (PDD-NOS)Rett’s SyndromeChildren’s Disintegrative Disorder

+ Characteristics of Autism Video

Characteristics

+

Developmental Rate and Sequences:Implications• May have unusual or peak skills• Uneven skill development• Skill development may not follow normal

developmental patterns

+Cognition:Implications• Inconsistent

intellectual responses• May function nearly

normally in one or more intellectual areas

• Difficulties with imitation

• Low cognitive skills

+Communication: Implications• Lacks understanding of body language,

gestures, facial expressions and hand signals

• Difficulties with conversational turn-taking• May use immediate or delayed echolalia;

repeats questions• Unusual language structure• Unusual intonation, tone, pitch, rate and/or

rhythm• Speech can be literal or concrete (doesn’t

understand metaphors, jokes, idioms, sarcasm or humor)

• Deficits in expressive/receptive language; skills range from no communication to adequate speech with idiosyncrasies

+

Sensory Processing: Implications

• Appears to be hearing impaired; unpredictable response to sounds

• Difficulty filtering out extraneous sensory information

• Tactile defensiveness• Sensitivity to smells, tastes, and

textures; licks, chews, mouths, smells objects

• Avoids looking at people; views things at unusual angles

• Stares through people/space; strange responses to mirrors/lights

+ Social Participation: Implications• Difficulty understanding

another person’s perspective

• Difficulty establishing or maintaining relationships

• Difficulties with imagination

• Inappropriate/odd play• Lacks understanding of

reciprocity (turn taking)• Lack of eye gaze• Prefers solitary play or

work

+Repertoire of Activities: Implications

Difficulty with change/transitions Need for routine and sameness, may

have rituals May use toys in inappropriate or odd

ways. Repetitive, non-functional movements

that serve no purpose (body rocking, finger and hand posturing, spinning)

Displays behaviors characterized as self-stimulatory (paper flapping)

Stereotypical patterns of behavior; strong attachment to particular objects

+Facts About ASD Developmental disability that is life long

Occurs in approximately 1/88 births

Ratio of males to females is 4:1 Occurs on a continuum from

mild to severe Some children appear to be

developing normally until they are about 18 months of age

Many parents report that they knew something was different about their child as an infant

Lifetime costs associates with ASD are high – reduce costs by choosing effective treatments

+

Evid

ence

-Bas

ed P

ract

ice

and

Auti

sm in

the

Sch

ools

: N

AC

Repo

rt (

2009

)1. Antecedent Package

2. Behavioral Package

3. Comprehensive Behavioral Treatment for Young Children

4. Joint Attention Intervention

5. Modeling

6. Naturalistic Teaching Strategies

7. Peer Training Package

8. Pivotal Response Treatment

9. Schedules

10.Self-management:

11.Story-based Intervention Package

+Research from the University of Chicago – warning signs

no eye contact at 3 to 4 month no babbling, pointing, or

gesturing by age 12 months no single words spoken by age

16 months no two-word spontaneous (non-

echolalic, or not merely repeating the sounds of others) expressions by age 24 months

loss of any language or social skills at any age

+

By a child’s first birthday she/he should:•Turn to look at you when you call their name?

•Seem bothered by loud sounds?

•Should look at a familiar face for comfort in a new or unfamiliar situation?

•Be content to play alone for an hour or more at a time?

+ Infant Brain Imaging- Emerging Longitudinal Study

Differences evident in communication pathways between parts of the brain

+

SUPPORTS AND STRUCTURE

+ Basic Assumptions A cookbook approach DOES NOT work If universal interventions and targeted group

interventions are not successful, a student with ASD may require individualized interventions.

Current literature suggests need for VISUAL SUPPORTS for student with autism.

Research has demonstrated that students with ASD tended to perform better in a STRUCTURED teaching situation compared to unstructured environments.

Changing the environment is easier than changing the person.

+

Physical Environment Routines and Procedures Activities and Schedules Visually-Cued Instruction

Elements of the Environment

+National Autism Center Standards Report (2009): Antecedent Package (Established Practice)“These interventions involve the modification of situational events that typically precede the occurrence of a target behavior. These alterations are made to increase the likelihood of success or reduce the likelihood of problems occurring. Treatments falling into this category reflect research representing the fields of applied behavior analysis (ABA), behavioral psychology, and positive behavior supports. ” (NAC, page 44)

EVIDENCE-BASE: Antecedent Strategies

+

Physical Environment

The physical structure of an area establishes the basic foundation for the learning space and can have tremendous influence on student behavior, thus it is an ANTECEDENT.

+

+ How do you know if you need to modify the physical environment?

Child may be wanderingChild may spend a lot of

time self-stimulatingLeaving the area or roomDistractibilityLack of engagementUnaware of spatial

boundaries

+ Setting up the Environment to meet Your Child’s Needs

Things needed to meet your child’s needs:Visual Cues

Predictability

Structure

+Visual Cues assist in providing Predictability

and Structure*People with autism learn by seeingThey help your child know:

What to do When to do itWhere to do it How to do itWhat will happen when it is done

+ Packaging Groceries

+

Stranger Test

THINK OF YOUR CURRENT ROOM ARRANGEMENT:Does it pass the

stranger test?If a stranger walked

in, is it visually clear where different activities occur?

+ How do we know that a person may need support while working?

Not starting or completing work Not moving on to the next

activity Work is done incorrectly Adult prompt dependent Stereotypy/self-stim Disorganized, can’t find

materials

+ Considerations Level of functioning and age of person Prompts needed Reinforcers that support independent

work Life skills Need to match work content to

student’s ability level

+

Promoting Social Competence and Interaction Skills for People with Autism Spectrum Disorder

+ Common Difficulties N

onverbal com

munication

Social initiation

Reciprocity and term

inating interactions

Social cognition

Behaviors associated w

ith perspective taking and self-aw

areness

Social anxiety and social w

ithdrawal

Bellini, Building Social Relationships, 2006

People with Autism Spectrum Disorders

Social dysfunction is the single most defining feature of autism and arguably its most handicapping as well.

+

+

Social Skills are Learned Behaviors Related to Getting Along in

Everyday Life.

Life Implications

How can we help people with Autism Spectrum Disorder increase meaningful social interactions and social competence?

+Social Skills5 Step Model in Assessing/Intervening1. Assess Social Functioning2. Distinguish Between Skill Acquisition and

Performance Deficits3. Select Intervention Strategies

• Strategies That Promote Skill Acquisition• Strategies That Enhance Performance

4. Implement Intervention5. Evaluate and Monitor Progress

Scott Bellini, Building Social Relationships

+Strategies to Enhance Socialization and Social Competence

“Students with Autism Spectrum Disorder may lack the prerequisite skills imitation, play, and attending/engagement, which facilitate the development of appropriate social skills. These students need direct instruction to remediate these skill deficits.”( National research council, 2001;Wolery and Garfinkle,2002)

+ Social Skill DifferencesAreas to Consider When Assessing

Social Interaction and Competence

+Areas to Consider When Assessing

AcquisitionCan They Do It?

Performance / FluencyWill They Do It?

Three Areas of Social Skills Deficits

Acquisition – “Can’t Do”

Performance – “Won’t Do”

Fluency – “Might Do”

+ I Know the Difficulties, Now What?

+Matching Intervention to Problem

+Acquisition Deficits

Results from lack of knowledge about social skills.

Teach skill using effective instruction guidelines.

Reinforcement of skill.

Generalization – practice in multiple settings.

Effective Instruction for Acquisition Deficits Review and check Present new content or skill (I do it)

Provide guided student practice (We do it)

Provide feedback and correction Independent practice (You Do it)

Frequent review

Teaching Social SkillsAcquisition Deficits

Social Skills should be taught explicitly

(Good Direct Instruction Strategies)!

Acquisition Deficits: Instructional Strategies

Direct teaching of social skillsI Do, We Do, You DoFeedback/CorrectionFrequent Review/Opportunities to Practice

Facilitating expected behavior

Methods to supplement direct instruction

Social stories Video Modeling Comic strip conversations Concept mastery Social autopsies Cost/payoff

+

+Performance Deficits

Occurs when student has been taught a behavior, but does not consistently use the behavior. The problem behavior is more effective than the appropriate social skill in getting the student’s needs met.

Effective Instruction for Performance Deficits – 4 steps

1. Provide guided practice • “We do it”

2. Provide feedback and correction

• reinforcement of appropriate behavior

• withholding of reinforcement for displays of inappropriate behavior

3. Independent practice “You do it”

4. Frequent review

Priming Performance Deficits

Focus on Enhancing Performance of Existing Skills

*Remove barriers that impede performance

Performance Deficits:Instructional Strategies

Facilitate Expected Behavior

Peer Training

Methods to supplement Direct Instruction Social Narratives (social stories, scripts and action Cards” Video Modeling Comic strip conversations Cognitive Mapping Social autopsies Cost/payoffVisual Supports (cues, “Action Cards”)

+Fluency Deficits

Know the correct response, have exhibited the correct response in the past, but have not practiced to the point of mastery. Practice of skills in multiple settings Reinforcement of skills

Effective Instruction for Fluency Deficits – 3 steps

1. Provide feedback and correction

reinforcement of appropriate behavior

withholding of reinforcement for displays of inappropriate behavior

2. Independent practice

3. Frequent review

+

From “Using key instructional elements to systematically promote social skill generalization for students with challenging behavior” by S. W. Smith and D. L. Gilles, 2003, Intervention in School and Clinic, 39, pp. 30-37. Copyright (2003) by PRO-ED, Inc. Reprinted with permission.

Generalizing Social Skills-an example

+Social Stories Presents information visually

Describes expected behavior

Helps student see social situations from another person’s perspective

Proactive strategy

Designed to reduce future social dilemmas

Developed by Carol Gray

+ Social Stories – type of sentences

Descriptive sentences- describes the situation Directive sentences-explains the expected behavior Perspective sentences-what people might be thinking, feeling, or believing Affirmative sentences- helps identify important concepts

Cooperative sentences-a description of roles others play in a situation Control sentences-written by student to assist in recall

When I Am Angry or Frustrated

Sometimes I get angry or frustrated when I don’t get all my

points .

It’s okay to get angry or frustrated .

I shouldn’t hurt someone with my words or body when I am

angry or frustrated .

+ Social ScriptsProvide pre-taught language for specific situations based around social interactions.

When I go to a fast food restaurant I stand in line until it is my time to order. The person taking the order will say something like, “Hi, what would you like to order?” I will say, “I want a cheeseburger, a small order of fries and a small coke.” If he asks me if I want anything else, I will say “No.” I will then hand him a five dollar bill and will be given some change. I will say, “Thank you,” when I get my food.

+

+Video Modeling

Involves the presentation and observation of a videotaped episode of target behaviors being completed by a model or by the student themselves (Video Self-Modeling)

Comic Strip Conversations

Allows the person to see the invisible thoughts and reactions of others.

Adult encourages and prompts student to consider situational features of a specific conversation.

+

+Peer Training

Teaching others without disabilities strategies (initiation and peer training) for facilitating leisure and social interactions with people on the autism spectrum.

+ Behavior

+ Activity: What is challenging behavior? What words come to mind

when you think of challenging behavior? Tantrums Stress Fighting Ignoring directions Others????

+ Challenging Behavior Defined

“Any repeated pattern of behavior that interferes with or is at risk of interfering with optimal learning or engagement in pro-social interactions with peers and adults.” Smith & Fox (2003)

+Behaviors are actions we can see and they have purpose….

+

Behavior is Observable

Prove it’s

Existence

See It

Hear it

Touch it

+

Behavior is MeasurableIf a behavior is measurable you can determine:

How many (frequency) How long (duration) How severe/forceful (intensity) How long between (latency) How accurate

+ Behavior Examples

Examples: Hitting Crying Throwing Not following

directions Running away

Non-examples: Angry Depression Autism Sad

+ Challenging Behavior Communicates a Message

Behavior = communication

Used instead of language when people have limited communication skills, social skills, or has learned that behavior will result in meeting his/her needs

+ Challenging Behavior Works

People engage in behavior because it “works” for them Challenging behaviors result in the person “gaining” or

“escaping” something or someone Challenging behavior is functional

+ Basic Three-Term ContingencyA (antecedent) -> B (behavior) -> C (consequence)

The Three-Term Contingency is used to: Teach new behaviors/skills in any domain Understand and decrease problem behaviors

Antecedent-Behavior-Consequence (ABC) Relationship Antecedent = environment and what happens before

a target behavior Behavior = the observable actions an individual

displays Consequence = responses to the target behavior

that determine whether or not the behavior will occur in the future (reinforcement) or not (punishment)

+ How Do We Learn?

+How Do We Learn?I want “it”!!

It worked!!

+How Do We Learn?I don’t know how to do it.

It worked!!

+How Do We Learn?I don’t want to work!!

It worked!!

+ Information for an FBA

Antecedents Behavior Consequences

Data

Behavior Problem

Underlying Purpose (Function) (usually Escape from… or Gain access to…)

Skill deficits, neurological differences, and learning history combine to lead to problem behavior.

+

While multiple factors contribute to the development of these behaviors, understanding their purpose or function is the key to addressing the problem.

GAIN:Activity, Toy or

ItemParent’s Attention

orFamily Member’s

attention

ESCAPE/AVOID:Unwanted AttentionNon-Preferred Activities, Items or Objects, Difficult Tasks

AUTOMATIC:

+ Functions of Challenging Behavior Gain

Things (money, food, toys, etc.)

Attention (smiles, conversations, reprimands, etc.)

Escape Things (unwanted

tasks, something scary, etc.)

Attention (reprimands, conversation, hugs, etc.)

Function = Purpose

Negative reinforcement

70-75%

Escape :

Positive Reinforcement

20-25%

Gain:

Automatic Reinforcement

Less than 2%*Can only be identified through a functional analysis

Automatic:

+ Process for Behavior Support

Step 1: Gathering information (Functional Behavior Assessment)

Step 2: Develop a hypothesis (best guess)

Step 3: Design a Behavior Intervention Plan

Step 4: Implement, monitor, evaluate outcomes

Step 5: Revise plan, generalize plan into other environments

+ What is a Functional Behavior Assessment (FBA)? “Identify the function(s) of an individual student’s

behavior and provide information leading to effective interventions and needed supports” (State Special Education Manual)

A process for developing an understanding of challenging behavior and how the behavior is governed by environmental events. Results in the identification of the “purpose” or “function”

of the challenging behavior.

+ Step 1: Gathering Information

Review records Interview those who interact with the child Observe the child in target routines and settings Collect data on challenging behavior

Situations/settings that likely result in the behavior occurring (triggers)

Situations/settings that are linked with appropriate behavior occurring

What changes to the environment immediately occur as a result of the behavior occurring

+

Define behavior (describe what you see) Behavior measurement (frequency, intensity, duration,

etc.) Identify predictors (triggers) Identify immediate environmental changes due to behavior Identify current communicative functions Identify how fast the behavior “works” Identify previous efforts for intervention Identify possible reinforcers

+ Step 2: Develop a Hypothesis

Putting ALL the information together A hypothesis includes:

Antecedents: Triggers of the challenging behavior Consequences: Responses that maintain the challenging

behavior (why behavior increases or decreases) Function: Purpose of the behavior

+

Possible antecedents/triggers: Type of work/direction Difficulty of work Quality of attention Communication skills Availability of preferred

items

Possible consequences/responses: Adult or peer gives

attention Adult or peer gives help Toys or items are

provided Work/direction is removed

or temporarily delayed NOTE: consequences do

NOT always equate to punishment

+ Example: Ethan

Ethan is playing with Legos. He tries to attach a block to his stack of 3. He can’t quite get the blocks to connect. He looks up at the adult and begins fussing. He holds the stack of blocks up, looks at the blocks, and looks at the adult. The adult helps him put the blocks together.

+ The “ABC’s”

Antecedent/Trigger Behavior

Consequence/Resp

onse

Playing alone, can’t get blocks to work

Looks at adult and starts fussing

Adult provides assistance

Function: gain adult attention/assistance

+ Example: Claire

Claire is playing in her room. Her mom says, “Come on Claire. Time to go to brush your teeth.” Her mom pulls on her arm to try to get Claire to stand and go to the bathroom. Claire yells, screams, and begins throwing her toys. Her father says, “All right, 5 more minutes. But then we have to brush teeth.” Claire’s dad walks away, and Claire continues playing with her toys.

+ The “ABC’s”

Antecedent/Trigger Behavior

Consequence/Resp

onse

Playing with toys and Dad gives direction to “brush teeth”

Yelling, screaming, throwing toys

Dad gives 5 more minutes to play, delays brushing teethFunction: escape

direction, gain access to toys

+Let’s Practice: ABC Data Collection

+ Step 3: Develop a Behavior Intervention Plan Prevention

Strategies New skills New responses to

challenging behavior

+ EVIDENCE-BASE: Antecedent Strategies National Autism Center Standards Report (2009):

Antecedent Package (Established Practice) “These interventions involve the modification of

situational events that typically precede the occurrence of a target behavior. These alterations are made to increase the likelihood of success or reduce the likelihood of problems occurring. Treatments falling into this category reflect research representing the fields of applied behavior analysis (ABA), behavioral psychology, and positive behavior supports.” (NAC, page 44)

+ EVIDENCE-BASE: Consequence Strategies National Autism Center Standards Report (2009):

Behavioral Package (Established Practice) “These interventions are designed to reduce problem

behavior and teach functional alternative behaviors or skills through the application of basic principles of behavior change. Treatments falling into this category reflect research representing the fields of applied behavior analysis, behavioral psychology, and positive behavior supports. Treatments involving a complex combination of behavioral procedures that may be listed elsewhere in this document are also included in the behavioral package category..” (NAC, page 45)

+ Prevention Strategies

Ways to make events and interactions that trigger challenging behavior easier for the person to manage How can the environment be changed to reduce the

likelihood that challenging behavior will occur? What can be done to make challenging behavior

irrelevant? What procedures can I select that fit in the natural

routines and structure of the home or family? How can I build on what works? What can be done to help the person not respond to

the trigger or change the trigger so it does not cause challenging behavior?

+ Sample Prevention Strategies

Modify instruction, materials, or activities “Catch them being good” Remind of rules/expectations prior to behavior

occurring Use visual supports: schedules, timers, first/then, etc. Provide choices

+ New Skills

New skills to teach throughout the day to replace the challenging behavior Replacement skills

must be efficient and effective (i.e., work quickly for the child).

Consider skills that the person already has

Make sure the response for appropriate behavior is consistent

+ Does it feed the function?

Identify an acceptable way that the person can deliver the same message.

Make sure that the new response is socially appropriate and will access the person’s desired outcome.

Teach the person a skill that honors that function of the behavior (e.g., if the person wants out of activity, teach child to gesture “finished”).

+ Sample Replacement Behavior

Gain Request leisure

items Request more time Ask for

help/attention Ask for a turn Raise hand

Escape Request a break Say “all done” Request “a minute” Say “no” or protest

+ Response Strategies

What adults will do when the challenging behavior occurs to ensure that the challenging behavior is not maintained and the new skill is learned Respond in a way that will

make challenging behavior ineffective.

Make sure responses for appropriate behavior are equal to or exceed responses for challenging behavior.

+ Sample Response Strategies

Gain Planned ignoring Restrict access to the

preferred item Redirect to use

replacement behavior that allows gain

Use “wait time”

Escape Avoid removing the

demand Redirect to use

replacement behavior that allows for escape

Break activity down into smaller steps

Avoid using time-out

+Trigger Behavior Maintaining Consequence

•Playing alone: can’t get toys to work

Looking at adult, fussing •Adults provided assistance

Preventions New Skills New Responses• Adult remains

within close proximity during play

• Prior to play review new skill

• Provide toys that he is more likely successful with

•Request adult help when he is unable to work a toy (individualized dependent on current verbal skills such as sign, picture card, gesture, etc.)

• Ignore fussing but prompt to request help

• Provide immediate attention for appropriate help request

Ethan’s Behavior Intervention

Function:gain attention

+Trigger Behavior Maintaining Consequence

•Playing with toys: Dad gives direction to brush teeth

Screams, yells, throws toys •Dad gives 5 more minutes•Temporarily delays brushing teeth

Preventions New Skills New Responses• Use visual cues of

timer; provide transition warning

• Have her clean up prior to giving the direction to brush teeth

• First/then: first brush teeth, then play with toys again

•Request more time with toys (i.e., one more minutes)

•Request to take a toy with her to brush teeth

• Restrict access to toys during challenging behavior

• Continue to provide the direction to brush teeth

• Prompt to use new skill(s)

• Immediately honor appropriate use of new skill

Claire’s Behavior Intervention

Function:gain access to

toys, delay direction

+ Step 4:

Identify outcomes valued by the team “KIS it” (Keep It Simple) Create simple, user-

friendly forms to monitor outcomes (e.g., rating scales, check sheets)

Schedule dates for check-ins

+ If Challenging Behavior Returns: First,

Review plan and make sure it is being implemented as planned.

Review evaluation data to determine if the pattern is an extinction burst (worse before it gets better).

Examine events to see if there are new triggers for behavior.

+ If Challenging Behavior Returns (cont.)

Then, Restore support plan

and implement with fidelity

Continue plan through extinction burst

Add components to plan to address new triggers

Conduct a new functional assessment and develop new support strategies.

+ Step 5: Revise plan, generalize plan into other environments Teach student to wait Reduce supports Increase expectations Practice in new settings Gradually decrease levels of reinforcement

**NOTE: These changes should be made utilizing a planful team decision making process

+

How to Intervene with Escape/Avoid Behaviors

Teach an alternative acceptable way to escape/avoid:

• Ask for break or ALL DONE• This is too difficult• I need HELP

+How to Intervene with Escape/Avoid Behaviors

Provide break from nonpreferred following appropriate request or appropriate behavior.

Proactively decrease or eliminate the demand and gradually increase demand once successful (shaping).

Break an activity down into smaller steps.Teacher should avoid removing demand (e.g.,

assignment) immediately following problem behavior.

+

How to Intervene with Attention-Maintained Behaviors

Teach an alternative acceptable way to gain attention:

• Ask for ADULT attention• Request to talk• I need HELP• I want to play

+ References Cooper, J. O., Heron, T. E., & Heward, W., L. (2007). Applied

behavior analysis 2nd edition. Upper Saddle River, New Jersey: Pearson Education, Inc.

Dooley, P., Wilczenski, F. L., & Torem, C. (2001). Using an activity schedule to smooth school transitions. Journal of Positive Behavior Interventions, 3(1), 57-61.

Heflin, L.J. & Alaimo, D.F. (2007). Students with autism spectrum disorders: Effective instructional practices. Upper Saddle River, NJ: Pearson Education, Inc.

Hume, K. & Odom, S. (2007). Effects of an individual work system on the independent functioning of students with autism. Journal of Autism and Developmental Disorders, 37, 1166-1180.

+ReferencesKanner, 1943

Bellini,S (2006), Building Social Relationships, Autism Asperger Publishing Co.

Peterson and Haralick, 1977;Mundy et al., 1987;Wetherby and Prutting, 1984;Corona et al., 1988

Dawson, Meltzoff, Osterling, Rinaldi, and Brown, 1998

National research council, 2001;Wolery and Garfinkle, 2002

Terpstera et al., 2002

Gray,

Bulgren and Lenz,1996

Winner

Utley and Mortweet, 1997

+ References Lequia, J., Machalicek, W., & Rispoli, M. J. (2012). Effects of

activity schedules on challenging behavior exhibited in children with autism spectrum disorders: A systematic review. Research in Autism Spectrum Disorders, 6, 480-492.

MacDuff, G., Krantz, P., & McClannahan, L. (1993). Teaching children with autism to use pictographic activity schedules: Maintenance and generalization of complex response chains. Journal of Applied Behavior Analysis, 26, 89-97.

Mayer, G. R., Sulzer-Azaroff, B., Wallace. M. (2012). Behavior analysis for lasting change (2nd Ed.) Cornwall-on-Hudson, NY: Sloan Publishing.

National Autism Center (2009). National standards report. The national standards project: Addressing the need for evidence-based practice guidelines for autism spectrum disorders. Randolph, MA: National Autism Center.

+ References O’Reilly, M., Sigafoos, J., Lancioni, G., Edrisinha, C., &

Andrews, A. (2005). An examination of the effects of a classroom activity schedule on levels of self-injury and engagement for a child with severe autism. Journal of Autism and Developmental Disorders, 35, 305-311.

Panerai, S., Ferrante, L., & Zingale, M. (2002). Benefits of the treatment and education of autistic and communication handicapped children (TEACCH) program as compared with a non-specific approach. Journal of Intellectual Disability Research, 46(4), 318-327.

Quill, K. (1995b). Visually-cued instruction for children with autism and pervasive developmental disorders.. Focus on Autistic Behavior, 10, 10-20.

Saunders, R. R., Saunders, M. D., Brewer, A., & Roach, T. (1996). Reduction of self injury in two adolescents with profound retardation by the establishment of a supported routine. Behavioral Interventions, 11(2), 59-86.

+ References

National Research Council (2002) Educating Children with Autism. Committee on Education 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.

Osterling, J., Dawson, G. & Munson, J. (2002). Early recognition of one year old infants with autism spectrum disorder versus mental retardation: A study of first birthday party home videotapes. Development and Psychopathology, 14: 239-252.

Wolff, J.J., Piven, J. & et al. (2012)Differences in White Matter Fiber Tract Development Present From 6 to 24 Months in Infants With Autism. American Journal of Psychiatry, 169: 6.

Watson, L. R., Crais, E.R., Translating Between Research and Practice in Serving Infants at Risk for ASD: Perspectives on Language Learning and Education February 2013 vol. 20 no. 1 4-1

+References Alberto, P. A. & Troutman, A. C. (2012). Applied behavior analysis for

teachers, 9th Edition. Columbus, OH: Merrill Prentice Hall. Cooper, J. O., Heron, T. E., & Heward, W., L. (2007). Applied behavior

analysis 2nd edition. Upper Saddle River, New Jersey: Pearson Education, Inc.

Crone, D. A. & Horner, R. H. (2003). Building positive behavior supports in schools: functional behavior assessment. New York, NY: Guilford Press.

Gage, N. A., Lewis, T. J., & Stichter, J. P. (2012). Functional behavioral assessment-based interventions for students with or at risk for emotional and/or behavioral disorders in school: A hierarchical linear modeling meta-analysis. Behavioral Disorders, 37 (2), 55-77.

Knoster, T., Wells, T., & McDowell, K. C. (2003). Using timeout in an effective and ethical manner. Des Moines, IA: Iowa Department of Education.

Mayer, G. R., Sulzer-Azaroff, B., Wallace. M. (2012). Behavior analysis for lasting change (2nd Ed.) Cornwall-on-Hudson, NY: Sloan Publishing.

National Autism Center (2009). National standards report. The national standards project: Addressing the need for evidence-based practice guidelines for autism spectrum disorders. Randolph, MA: National Autism Center.