the science behind the growth through play system

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SCIENCEBEHINDGROWTHTHROUGHPLAYSYSTEMEmpoweringParentsandProfessionals

relatetoautismTM

- 2 - Relate to Autism, Inc © 2010 all rights reserved

CONTENT

Overview...........................................................................................................................................................3CurrentNeuroscienceandAutism ................................................................................................. 3ApproachestoAutismTreatment.................................................................................................. 3TheRoleofParents ....................................................................................................................... 3

Autism:TheViewfromCurrentNeuroscience ...................................................................................................4BrainsDevelopThroughDynamicInteractionwiththeEnvironment ............................................. 5TheBrainisMalleable ................................................................................................................... 5

AutismTreatment:WhatWorks ........................................................................................................................6NaturalisticBehavioralApproaches ................................................................................................. 6DevelopmentalApproaches ............................................................................................................. 6Convergence..................................................................................................................................... 7

ComparingApproaches ................................................................................................................. 7InteractiveStyle................................................................................................................................ 7Curriculum ........................................................................................................................................ 8

AutismTreatmentSummary ......................................................................................................... 8

Parents:TheMissingLink ..................................................................................................................................9ParentsareEssential ..................................................................................................................... 9ParentalWell‐BeingisCritical........................................................................................................ 9

TheGrowththroughPlaySystem ....................................................................................................................10

References ......................................................................................................................................................11


Relate to Autism, Inc © 2010 all rights reserved - 3 -

OVERVIEW

Current Neuroscience and Autism Neurosciencehasshownusthatautismisnotcausedbyafundamentaldifferenceordeficitinbrainstructureas

previouslyassumed.Instead,currentresearchtellsusthatautismisthebehaviorallevelmanifestationofa“miss‐

wired”brain,abrainwithinsufficientinterconnectivityandsynchronizationamongmultiple,disparateregions.

Asaresultofthis,childrenwithautismtendtofocusonactivitiesthatrequireminimalcoordinationamongbrain

regions(e.g.,recitingisolatedwordsanddetails,orfocusingonstaticstimuliandrepetitivetasks)andavoid

activitiesthatrequiredcoordinationofmultiplebrainregions(e.g.,comprehendingstories,seeingthe‘bigpicture’,

orlearningnewtaskswherepreviouslylearnedrulesdon’tapply.)

Thisfocusinturnreinforcesthepartsofthebrainthatfacilitatelocalinterconnectivityattheexpenseoftheparts

ofthebrainthatfacilitateglobalinterconnectivity;anacceleratingfeedbackloop.

Thegoodnewsisthatresearchhasshownthatthefeedbackloopcanbereversed;throughvariousformsof

interaction,childrencanrewiretheirbrainstoimproveglobalinterconnectivityandtheircommensurateabilityto

performtasksthatinvolvemultipleregionsofthebrain.Aconvergingbodyofevidencefrompsychologyis

showinguswhattypesofinteractions(withpeopleandobjects)helpreducethecoresymptomsofAutismand

facilitateincreasedsocialinteraction,communicationandrangeofinterests.

Approaches to Autism Treatment Whileresearchersworkonidentifyingwhysomanychildrenhavemiss‐wiredbrains,thoseofusworkingdirectly

withfamiliesaffectedbyautismcanapplythisunderstandingtohelpingchildrennow.Basedontheneuroscience

ofautism,theeffectivenessofatreatmentapproachcanbegaugedbyitsabilitytocausethedesiredchangeinthe

interconnectivityandsynchronizationofdisparateregionsofthebrain.

Therearefundamentallytwoschoolsofthoughtregardingautismtreatment,BehavioralistApproachesand

DevelopmentalApproaches.Themostsignificantdifferencesamongtheseapproachescanbecalibratedinterms

ofprescribedinteractivestyleandthecriteriabywhichcurriculaareselected.Interactivestylesvaryfromhighly

directivetohighlyresponsive.Curriculaselectionvariesfromage‐appropriatecriteriatodevelopmentally

appropriatecriteria.

The Role of Parents Therapidlyescalatingnumberofcasesofautismhasmadethepreviouspractitioner‐centeredmodelofautism

treatmentimpracticalinmostregions.Tobeeffective,childrenrequireintensive,dailyinputfromemotionally

attunedanddevelopmentallyinformedadults.

Withprofessionalguidance,parentscanbecomethebesttherapistsandprogramcoordinatorsfortheirchildren

withautism.

relatetoautismTM


AUTISM: THE VIEW FROM CURRENT NEUROSCIENCE Autismresultsfromapoorlyconnectedandpoorlysynchronizedbrain.

Themostrobustfindingintheneuro‐anatomyregardingautismisthatpeoplewithautismhaveincreasedbrain

volume.Thisincreasedbrainvolumeiscomposedprimarilyofcerebralwhitematter,thematerialthat

interconnectsdifferentregionsofthebrain.Cerebralwhitemattercanbedividedintoanouterzonecontaining

theradiatecompartment(thematerialthatinterconnectslocalbrainregions)andaninnerzonecontainingsagittal

andbridgingsystemcompartments(thatinterconnectdistantregionsofthebrain).Inautism,enlargementis

localizedtotheradiatewhitematter,whereasinnerzone

whitemattercompartmentsshowednovolume

differencesfromcontrols.Inotherwords,peoplewith

autismhavebrainswiredinawaythatfavorslocal

communicationoverglobalcommunication.

Inpeoplewithautism,thispatternofincreasedlocal

interconnectivityanddecreasedglobalinterconnectivityis

evenmorepronouncedinpre‐frontalareas,theareasof

thebrainthataretypicallymostgloballyinterconnectedas

theyareresponsibleforintegratinginformationfrom

multiplebrainregionsforhigher‐orderorabstractprocessing(seeHerbert,2005).

Brainareasthatareunder‐connecteddonotprocessinformationinamannerthatissynchronizedwithotherbrain

areas,aprocessthatisnecessaryforprocessingmulti‐sensoryinformation.Mostrecentreviewssuggestthatthe

symptomsofautismmaythereforebetheresultofbrainsthatareunder‐connectedandpoorlysynchronized(see

Gepner&Féron,2009).

Intheabsenceofstrongglobalinterconnectivityandsynchronization,tasksthatrequireintegrationofdynamic

informationfrommultiplechannels(suchassocialinteraction,communicationandabstractreasoning)arevery

challengingforpeoplewithautism.Whereastasksthatinvolveprocessingofmorestaticinformationfrom

minimalchannelscomesmoreeasilyduetotherelativelystrongerlocalizedinterconnectivity.

ChallengesforPeoplewithAutism

Activitiesthatrequiresignificantcoordinationamong

regionsofthebrain

• Higher‐orderprocessingchallenges,suchasstory

comprehension

• Noveltaskswhichrequirenewprocesses

becausepreviouslylearnedrulesdon’tapply

• Shiftingtonewtasksorstrategies

• Activitiessuchassocialinteractionthatinvolve

integrationofmulti‐sensory,dynamicstimuli,in

particular,eyemovements,facialexpressions

andspeechsounds.

StrengthsofPeoplewithAutism

Activitiesthatrequireminimalcoordinationamong

regionsofthebrain

• Encapsulatedcognitivestrengths,suchas

hyperlexic(isolated)wordreadingorfocusingon

individualdetails(ratherthanthebiggerpicture)

• Hyper‐focusonstaticstimuli,suchasphysical

objectsorhighlyrepetitivetasks

• Tasksthatrequirelearningrules

• Stickingtoandcompletingrepetitivetasks

• Excellenceinvisuo‐spatialormemorytasks



Brains Develop Through Dynamic Interaction with the Environment Asinfantsinteractwiththeworldofpeopleandobjects,theirbrainsorganizeandwirethemselvestosupport

adaptivebehavior.Achildwho’sbraindoesnoteasilyprocessmulti‐sensorydynamicinformationrequiring

integrationwillinteractwithpeopleandobjectsinatypicalways.Thismaybeverysubtleatfirstbutbeginsto

becomenoticeablebytwelvetoeighteenmonthsofagewhenmajorcommunicationmilestonesaremissed.

Asaninfantspendslesstimeprocessingmulti‐sensory,socialinformationandsubsequentlymoretimeprocessing

lesscomplex(usuallynon‐social)information,hemissesoutonthe“socialeducation”beinggainedbyhistypically

developingpeers(seeMundyandAcra,2007).

Astimegoeson,thischild’sdevelopmentaltrajectorybecomesincreasinglyremovedfromthatofhisorhermore

typicalpeers.Thealteredpatternsofinteractionwiththeworldleadtothedevelopmentofneuralcircuitrythat

supportsmoreofthebehaviorsymptomaticofautisminarapidlyacceleratingfeedbackloop.

The Brain is Malleable Muchresearchhasbeenpublishedoverthelasttwodecadestotellusthatourbrainsaremalleableandthat

neuronsre‐wiretheirconnectionsinresponsetoourinteractionswithourenvironment(Doidge,2007).

ArecentfMRI(functionalMagneticResonance

Imaging)studycapturedimagesofwhitematter

growingtoformmoretypicalconnectivity

betweenpreviouslyunder‐connectedbrain

regionsinchildrenwithlearningdifficulties.After

intensivereadinginstructionthesechildren

showedincreasedwhitematterconnectivityand

significantlyimprovedreadingability(Keller&

Just,2009).

Studiessuchasthisandothersindicatethatby

regularlyandconsistentlyprovidingchildrenwith

autisminputthatstimulatesprocessingof

dynamic,multisensoryinformation,wecanhelpthemtorewiretheirbrainsinawaythatimprovesglobal

interconnectivityandsynchronization.

Toeffectsignificantneurologicalchange,autisminterventionsmust:impacthowachildinteractswithhisorher

physicalandsocialenvironmentbyprovidingfocused,intensivemultisensoryinputandstimulationonaregular

(daily)basis.

relatetoautismTM


AUTISM TREATMENT: WHAT WORKS Autismtreatmentisadynamicandevolvingfieldwithmanyapproachesthatvaryinmanyways.However,ata

highleveleachoftheseapproachesfallsintooneoftwocategories:BehavioralandDevelopmental.Themost

recentevolutionoftheBehavioralApproachesasknownasNaturalisticBehavioralApproaches.

Naturalistic Behavioral Approaches Autismtreatmentbeganinthe1960swithbehavioralbasedmodelsthatevolvedintowhatwenowknowas

AppliedBehaviorAnalysis(ABA).Theseapproachesarebasedontheassumptionsoflearningtheory,thatall

voluntarybehaviors(e.g.play,socialinteractionandcommunication)arelearnedandmaintainedthrough

antecedents(whathappensbeforethebehavior)andconsequences(whathappensafter).Newskillsaretaught

throughmanipulationoftheantecedentsandsystematicapplicationofreinforcementoftargetedbehaviors.Early

behavioralapproacheswerehighlystructuredandadultdirected(e.g.

Lovaas,1973)andincludetheuseofdiscrete‐trialtraining.Sincethen

thefieldhasevolvedtoimprovechildoutcomesandgeneralizationof

skills.Newerversionsofbehavioraltreatmentsareemployingmore

naturalisticenvironmentsandmorechild‐centeredapproaches.

ResearchonboththeearlierstructuredABAprograms(Rogersand

Vismara,2008)andthelaternaturalisticapproaches(Schreibman,

2005)havefoundpositiveoutcomesforabouthalfthechildren

involved.Generalizationandmaintenanceofskillshasbeenfoundto

improvewhenparentsaretrainedinsupportingbehavioral

techniques(IngersollandGergans,2007).

Developmental Approaches Anothergroupoftreatmentshasemergedinparallelsincethe1980s,theseareknownasdevelopmental

approaches.ThesetreatmentsemergedfromacombinationofPiagetiandevelopmentaltheoryand

psychoanalysis(e.g.GreenspanandLourie,1981)andsocial‐pragmatictheoriesoflanguagedevelopment(Bruner,

1983).Theyarebasedonthecoreassumptionsthat:

• Social‐communicationskillsarelearnedinasimilardevelopmentalsequencebyallchildrenregardlessof

theirability

• Childrenlearnprimarilythroughaffect‐ladenrelationshipswithresponsiveprimarycaregivers

Beingnewer,lessresearchhasbeenperformedondevelopmentalapproachesthanbehavioralapproaches.

Studiesthathaveassessedtheefficacyofdevelopmentalapproacheshavefoundpositiveresults(e.g.Aldred,etal,

2004;Kasarietal,2008;Gerber,2003;MahoneyandPerales,2003;DawsonandGalpert,1990).

NaturalisticBehaviorApproaches

• Incidentalteaching• Milieuteaching• Naturallanguageparadigm• PivotalResponseTraining

DevelopmentalApproaches

• SCERTS• DenverModel• Floortime/DIR• ResponsiveTeaching



Convergence Thesetwofieldsofautismtreatmenthavedevelopedoverthepasttwentyyearslargelyindependentlyofone

anotherduetodifferingphilosophicalbackgrounds.However,recently,peoplerepresentingeitherperspectiveare

comingtomutualrecognitionofthecommonalitiesinimplementation.Asaresult,newhybridapproachesare

emerging.

PositiveresultsarebeingfoundinapproachessuchasEnhancedMilieuTeaching(KaiserandHester,1994),

ResponsivityTrainingandPre‐linguisticMilieuTraining(YoderandWarren,2002),Parent‐mediatedApproaches

(IngersollandDvortcsak,2006)andmostrecentlytherandomizedcontroltrialoftheEarlyStartDenverModel

(Dawson,etal,2009).

Comparing Approaches Althoughdevelopmentalandnaturalisticbehavioralapproachestoautismcomefromdifferentphilosophiesand

researchtraditions,inpracticethereislittledifferenceintheirgeneralimplementation(Ingersoll,2010).The

primarydifferencescanbecalibratedintermsof:

• InteractiveStyle:Themannerinwhichanadultworkswithachild

• Curriculum:Thecriteriabywhichgoals,metricsandactivitiesareselected

Interactive Style Althoughmostpractitionersengagechildreninavarietyofways,InteractiveStylecanbedividedintoto

fundamentalcategories:aDirectiveStyleandaResponsiveStyle.Thesearecharacterizedbelow.

Noapproachtoautismtreatmentprescribesoneortheotheroftheseinteractivestylesexclusively.However,

variousapproachestendalignmorewithonethantheotherinamannerconsistentwiththegoalsofthe

treatmentprogram.Notably,aresponsivestyleofinteractionhasbeenfoundtoincreasechildren’ssocial,

emotional,communicativeandcognitivedevelopmentinnumerousstudies(Trivette,2003).

AResponsiveStyle

• Allowingabalanceofchildandadultinitiationsandresponses

• Teachingepisodesfocusonchild‐selectedobjects,activitiesortopics

• Emphasisplacedonaffectandemotion‐sharing

• Pausingorindirectinvitationsforchildtoperform

targetbehaviors

• Higherratioofdeclarative(“Whatanicetruck!”)

toimperative(“Givemethetruck”)adultlanguage

use

• Adultbehaviorsensitivetochild’sdevelopmental

levelandcurrentstateofsensory‐regulation

ADirectiveStyle

• Emphasisonadultinitiationsandchildresponses

• Teachingepisodesfocusonadult‐selected

objects,activitiesortopics

• Emphasisongoalachievementandtask

accomplishment

• Promptingordirectrequestingoftarget

behaviorsfromchild

• Higherratioofimperative(“Givemethetruck”)

todeclarative(“Whatanicetruck!”)adult

languageuse

• Adultbehaviorgoal‐directed

relatetoautismTM


Curriculum Anothersignificantdifferenceamongvarioustreatmentapproachesliesinthecriteriabywhichacurriculum(aset

ofgoals,activitiesandmetrics)isestablishedforaspecificchild.Criteriafortheselectionofcurriculafallinto

basiccategories:

• AgeAppropriate:activitiesandgoalsdeterminedbyachild’schronologicalage

• DevelopmentallyAppropriate:activitiesandgoalsdeterminedbytypicaldevelopmentalsequence

Researchinchilddevelopmenthasshownthatchildrenwithautismfollowadevelopmentalpathsimilartothatof

typicallydevelopingchildren.However,childrenwithautismaredelayedintheirprogressalongthispath(not

deficientaspreviouslyassumed).Studieshavefoundthistobethecaseforsuchkeysocialdevelopmentareasas

expressivelanguage(Tager‐Flusburg,etal,1990),imitation(Rogersetal.,2008)andsymbolicplay(Lifter,etal,93).

Typically,thesetofskillsbeingtaughttoachildis

age‐appropriate(definedbyhisorher

chronologicalage).Achildatagefouristaughtone

setofskillsandachildatagesevenanother.

Childrenwithautismoftenskipdevelopmental

stepsmakingitdifficulttolearnskillsdefinedby

theirage.Therefore,teachingchildrenwithautism

skillsthataredevelopmentallyappropriate(i.e.,

skillsdefinedbythetypicalsequenceof

developmentalstepsratherthanchronologicalage)

allowsforfasterlearningandamoreenjoyable

learningexperienceforbothchildandadult.Forexample,teachingverballanguageskillstoachildnotyetusing

gesturesisnotdevelopmentallyappropriate(regardlessofhisage)asalltypicalchildrendevelopgestural

communicationbeforeverballanguage.

Furthermore,ongoingresearchisidentifyingafew“pivotal”skillsonwhichmanyotherskillsdepend.Acquisition

ofthesesskillsimpactswiderareasofdevelopment.Forexample,teachingsymbolicplayskillsorjointattention

skillsproducesincreasesinexpressivelanguageevenwhenexpressivelanguageisnotdirectlytargeted(Kasariet

al,2008).

Autism Treatment Summary Modernapproachestoautismtreatmentcanbedividedintotwobasiccategories,NaturalisticBehavioral

ApproachesandDevelopmentalApproaches.Althoughphilosophicallydifferent,inpracticethesetwoschoolsof

thoughtareonaconvergencepath.Acrossthesecategories,variousapproachestoautismtreatmentcanbe

distinguishedintermsoftheirprescribedInteractiveStyleandCurriculum.Interactivestylesvaryfromhighly

directivetohighlyresponsive.Selectionofcurriculavariesfromcurriculathatareage‐appropriatetocurricula

thataredevelopmentallyappropriate.



THE MISSING LINK

Parents are Essential Toaccessitsinnateneuroplasticity(changeability)adisconnected,unsynchronizedbrainrequiresregular

engagementinmotivating,meaningful,affect‐ladenactivitieswithamoreadvancedsocialpartner.

TheNationalResearchCouncil(2001)recommendedthatparentsbeincludedintheirchildren’streatment.Siller

andSigman(2002)foundthat,whenmotherswerenaturallymoreresponsive,theirchildrenwithautismmade

significantlygreaterimprovementsinjointattentionandlanguageoverperiodsofone,tenandsixteenyearsthan

didchildrenwhosemotherswerelessresponsive.

Areviewofthirteenseparatestudiesfoundthat

caregiverresponsivestyleofinteractionfacilitated

significantimprovementsincognitiveandemotional‐

socialdevelopmentforchildrenwith,oratriskof,

developmentaldelays(Trivette,2003).

Parentsareessentialtothesocial,emotional,

communicationandcognitivedevelopmentoftheir

children.Numerousstudieshavefoundthatparents

canbetrainedtoeffectivelydeliverinterventionsfor

theirchildren(e.g.Ingersoll,2007;Solomon,etal.,2007;Solomon,2008).Giventhelackofqualifiedprofessional

providersandthealarmingincidencerateofautism,andotherneurobiologicaldisordersofchildhood,theroleof

parentsasprimarytherapistscannotbeunderestimated.

Parental Well-Being is Critical Parentsofchildrenwithautismhavebeenfoundtosuffermorestressthanparentsofchildrenwithother

diagnosesorthosewhoaredevelopingtypically(Estes,2009).

Aparent’semotionalstateaffectstheirchild

througheveryinteraction.Infact,thepositive

benefitofprofessionallydeliveredtreatmentsis

reducedforchildrenwhoseparentshavethe

higheststresslevels(Osborneetal,2008).

Parentswhohavecometoanemotionalresolution

abouttheirchild’sdiagnosisaremorelikelytouse

ajoyful,playful,supportiveandresponsive

parentingstylewiththeirchildren(Wachteland

Carter,2008).

TheGrowththroughPlaySystemsupportsparents

tohelpthem:

• Gainemotionalresolutionaboutthediagnosis

• Reducestressandincreasewell‐being

• Adapttheirparentingstyletofacilitatetheir

child’sdevelopment

• Identifypivotalsocial‐communicationmilestones

fortheirchild

• Engagetheirchildinjoyful,meaningful,

reciprocalinteractionstoincreasechildlearning

relatetoautismTM


THE GROWTH THROUGH PLAY SYSTEM TheGrowththroughPlaySystem(GPS)isdesignedtooptimizetherewiringofachild’sbraintofacilitateimproved

globalinterconnectivityandsynchronizationbyfocusingonintensive,multisensory,interactiveactivitiesthat

stimulatehighlevelsofinter‐regionbrainactivity.Thesystemhelpsparentsandpractitionerstoidentifypivotal

developmentalstepsthatachildhasmissedandthenprescribesactivitiesthatcanbeconductedbyparentswith

thechildinaresponsiveinteractivemannertohelpthechildfilldevelopmentalgaps.

Byfocusingonmissingpivotalskillsanddevelopmentalsteps,theGPSindirectlyaddressesothermissingor

challengedskillsthatdependonthepivotalskillsmakingthoseskillseasiertoacquireanddevelop.

TheGPSisfocusedonenablingandempoweringparentsasprimarytherapistsintheirchild’streatmentprogram

byprovidingsimpleandeasy‐to‐implementguidelinesrelativetocurriculumandinteractivestyle.Itconsiders

parentalwell‐beingtobeacriticalsuccessfactorinchilddevelopment.

FormoreinformationonthescientificfoundationsoftheGrowththroughPlaySystemoraboutrelateto

autism,pleasevisitwww.relatetoautism.comorwriteusatsupport@relatetoautism.com.

GETTING STARTED • Tolearnmorevisitwww.relatetoautism.comandsignupforafreetrial30‐daymembership

• Read“TherelatetoautismMemberTools”

• Read“TheGrowththroughPlaySystemforParents”



REFERENCESAldred,C.,Gree,J.,Adans,C.(2004)Anewsocialcommunicationinterventionforchildrenwithautism:Pilotrandomizedcontrolledtreatmentstudysuggestingeffectiveness.JournalofChildPsychologyandPsychiatry,45(8),1420‐1430.Abstract

Bruner,J.(1983)Child’sTalk:Learningtouselanguage.Oxford:OxfordUniversityPress.

Dawson,G.(2008)Earlybehavioralintervention,brainplasticity,andthepreventionofautismspectrumdisorder.DevelopmentandPsychopathology,20,775‐803.FullText

Dawson,G.andGalpert,L.(1990)Mothers’useofimitativeplayforfacilitatingsocialresponsivenessandtoyplayinyoungautisticchildren.DevelopmentandPsychopathology;2:151‐162.Abstract

Dawson,G.,Rogers,S.,Munson,J.,Smith,M.,Winter,J.,Greenson,J.,Donaldson,A.,andVarley,J.,(2009)Randomized,controlledtrialofaninterventionforToddlerswithautism:TheEarlyStartDenverModel.Pediatrics,125(1),17‐23FullText

Doidge,N.(2007).Thebrainthatchangesitself:Storiesofpersonaltriumphfromthefrontiersofbrainscience.NewYork:Viking.

Estes,A.,Munson,J.,Dawson,G.,Koehler,E.,Zhou,X.,Abbot,R.(2009)Parentingstressandpsychologicalfunctioningamongmothersofpreschoolchildrenwithautismanddevelopmentaldelay.Autism,13(4)375‐387.Abstract

Gerber,S.(2003)Adevelopmentalperspectiveonlanguageassessmentandinterventionforchildrenontheautisticspectrum.TopicsinLanguageDisorders,23,74‐94.Abstract

Gepner,B.andFéron,F.(2009)Autism:Aworldchangingtoofastforamis‐wiredbrain?NeuroscienceandbiobehavioralReviews,33,1227‐1242.Abstract

Greenspan,S.I.andLourie,R.S.(1981)Developmentalstructuralistapproachtotheclassificationofadaptiveandpathologicalpersonalityorganizations:Infancyandearlychildhood.AmericanJournalofPsychiatry,138,725‐735.Abstract

Herbert,M.R.(2005)Autism:Abraindisorderoradisorderthataffectsthebrain?ClinicalNeuropsychiatry,2(6),354‐379.FullText

Ingersoll,B.andGergens,S.(2007)Theeffectofaparent‐implementedimitationinterventiononspontaneousimitationskillsinyoungchildrenwithautism.ResearchinDevelopmentalDisabilities,28,163‐165.Abstract

Ingersoll,B.(2010)Teachingsocialcommunication:Acomparisonofnaturalisticbehavioralanddevelopmental,social‐pragmaticapproachesforchildrenwithautismspectrumdisorders.JournalofPositiveBehavioralInterventions,12(1),33‐43.FullText

Ingersoll,B.andDvortcsak,A.(2006)IncludingparentstrainingintheearlychildhoodspecialeducationcurriculumforchildrenwithASDspectrumdisorders.JournalofPositiveBehaviorInterventions,8,79‐87.Abstract

Kaiser,A.P.andHester,P.P.(1994)Generalizedeffectsofenhancedmilieuteaching.JournalofSpeechandHearingResearch,37,1320‐1340.Abstract

Kasari,C.,Paparella,T.,Freeman,S.andJahromi,L.B.(2008)Languageoutcomeinautism:randomizedcomparisonofjointattentionandplayinterventions.JournalofConsultingandClinicalPsychology,76(1),125‐137.Abstract

Keller,T.A.andJust,M.A.(2009)Alteringcorticalconnectivity:Remediation‐inducedchangesinthewhitematterofpoorreaders.Neuron,64(5),624‐631.Abstract

relatetoautismTM


REFERENCES - CONTINUEDLifter,K.,Sulzer_Azaroff,B.,Anderson,S.RandCowdery,G.E.(1993)Teachingplayactivitiestopreschoolerswithdevelopmentaldisabilities:Theimportanceofdevelopmentalconsiderations.JournalofEarlyIntervention,17,139‐159.Abstract

Lovaas,O.I.,Koegal,R.L.,Simmons,J.Q.andLong,J.S.(1973)Somegeneralizationsandfollow‐upmeasuresonautisticchildreninbehaviortherapy.JournalofAppliedBehaviorAnalysis,6:131‐166.FullText

Mahoney,G.andPerales,F.(2003)Usingrelationship‐focusedinterventionstoenhancethesocial‐emotionalfunctioningofyoungchildrenwithautismspectrumdisorder.TopicsinEarlyChildhoodSpecialEducation,23(2),77‐89.Abstract

Mundy,P.,andAcra,F.(2006)Jointattention,socialengagementandthedevelopmentofsocialcompetence.In:P.MarshallandN.Fox(Eds.)TheDevelopmentofSocialEngagementNeurobiologicalPerspectives.OxfordUniversityPress;NewYork:pp.81–117.FullText

NationalResearchCouncil(2001)NationalResearchCouncil(2001).Educatingchildrenwithautism.Washington,DC:NationalAcademyPress.FullText

Osborne,L.A.,McHugh,L.,Saunders,J.andReed,P.(2008)Parentingstressreducestheeffectivenessofearlyteachinginterventionsforchildrenwithautismspectrumdisorders.JournalofAutismandDevelopmentalDisorders,38,1092‐1103.Abstract

Rogers,S.J.,Young,G.S.,Cook,I.,Giolzett,A.andOzonoff,S.(2008)Deferredandimmediateimitationinregressiveandearlyonsetautism.JournalofChildPsychologyandPsychiatry,49(4),449‐457.FullText

Rogers,S.J.andVismara,L.A.(2008)Evidencebasedcomprehensivetreatmentsforearlyautism.JournalofClinicalChildandAdolescentPsychology,37(1),8‐38.FullText

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Solomon,M.,Ono,N.,Timmer,S.,andGoodlin‐Jones,B.(2008)Theeffectivenessofparent‐childinteractiontherapyforfamiliesofchildrenontheautismspectrum.JournalofAutismandDevelopmentalDisorders,38,1767‐1776.Abstract

Solomon,R.,Necheles,J.,Ferch,C.,andBruckman,D.,(2007)Pilotstudyofaparenttrainingprogramforyoungchildrenwithautism:ThePLAYprojecthomeconsultationprogram.Autism,11(3),205‐224.FullText

Tager‐Flusberg,H.,Calkins,S.,Nolin,T.,Baumberger,T.,Anderson,M.andChadwick‐Dias,A.(1990).AlongitudinalstudyoflanguageacquisitioninautisticandDownsyndromechildren.JournalofAutismandDevelopmentalDisorders,20,1‐21.FullText

Trivette,C.M.(2003)Influenceofcaregiverresponsivenessonthedevelopmentofyoungchildrenwithoratriskfordevelopmentaldisabilities.Bridges;1(6):1‐13.Abstract

Wachtel,K.andCarter,A.S.,(2008)ReactiontodiagnosisandparentingstylesamongmothersofchildrenwithASDs.Autism,12(5),575‐594.Abstract

Yoder,P.J.,&Warren,S.F.(2002).Effectsofprelinguisticmilieuteachingandparentresponsivityeducationondyadsinvolvingchildrenwithintellectualdisabilities.JournalofSpeech,Language,andHearingResearch,45,1158–1174.Abstract

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