CHAPTER IV (continued)

Because communication deficits are a core element defining autism, specific language and communication training is often an important component of the curriculum in intervention programs for children with autism. Basic communication training for a child with autism often emphasizes functional use of language development (the use of language in context; nonverbal communication such as intonation, communicative gestures, and facial expressions; and social aspects of communication such as turn-taking).

Many behavioral techniques are used in teaching communication and language skills to young children with autism. The specific strategies for language training vary depending on the individual child.

Since many young children with autism are functionally mute, many clinicians have tried approaches such as manual signing or visual communication systems in an effort to improve communication and language development.

Evidence Ratings: [A] = Strong [B] = Moderate [C] = Limited [D1] = Opinion/No evidence meeting criteria [D2] = Literature not reviewed

Recommendations

Behavioral and educational interventions for improving communication

1. It is recommended that interventions focused on development of communication be included as a part of the total intervention program for young children with autism. [D1]
2. In developing a behavioral or educational strategy for improving communication, it is important to consider:

• the skills and abilities of the child
• the child's age, developmental level, skills, and abilities
• the child's environment
• the child's need for functional communication within his/her current environment [D1]

3. It is important to concentrate on the use of language in social situations, including functional use of communication to obtain desired objects or results. [D1]
4. It is recommended that the precise number of hours of communication intervention vary depending on the characteristics of the child and family. Considerations in determining the frequency and intensity include:

• age
• severity of autistic symptoms
• rate of progress
• health considerations
• child's tolerance for the intervention
• family participation [D1]

Using specific behavioral or educational techniques

5. A variety of behavioral techniques may be useful for increasing and improving communication in young children with autism. [A]
6. Prompting the child for a response or modeling correct responses, followed by reinforcement, may be especially useful techniques for improving language skills. [C]
7. It may be useful to use a systematic method of increasing time-delay of prompts to facilitate spontaneous speech. [C]

Including parents and peers in the intervention

8. It is important that parents be included as active participants in the communication intervention to the extent of their interests, resources, and abilities. [A]
9. It is important that parents be involved in interventions to improve communication in order to:

• ensure that the communication and language goals and strategies most important to the family are incorporated in the intervention
• help the family incorporate the communication intervention strategies into the daily routines of the child and family
• ensure consistency in the intervention approach [A]

10. It may be useful to train parents in procedures that explicitly prompt and reinforce the child's attempts at appropriate verbalization in the daily environment. [C]
11. It may be useful to train peers to model correct verbal responses. [C]

Using sign language and augmentative communication systems

12. The temporary use of sign language may be a useful tool in facilitating language and communication development for some children with autism. [C]
13. Augmentative communications systems (such as picture boards, visual aids, computers, etc.) may sometimes be useful for aiding communication and language in children with autism. [D1]
14. It is important that parents not view using sign language or augmentative communication methods and systems as giving up on verbal language development. [C]

Behavioral and Educational Intervention Techniques to Improve Social Interactions

Because impaired social interactions are a characteristic of children with autism, behavioral techniques are often applied to increase a child's social initiations and appropriate responses, particularly with other children. Techniques may include prompting the child to respond appropriately and reinforcing reciprocal social interactions and responses. Peers with age-appropriate development who are able to work with or provide peer modeling for children with autism are sometimes given training in behavioral procedures.

Evidence Ratings: [A] = Strong [B] = Moderate [C] = Limited [D1] = Opinion/No evidence meeting criteria [D2] = Literature not reviewed

Recommendations

Behavioral/educational interventions for improving social interactions

1. It is recommended that interventions focused on improving social interactions be included as a part of the total intervention program for young children with autism. [D1]
2. In developing a behavioral or educational strategy for improving social interaction, it is important to consider:

• the skills and abilities of the child
• interventions that are developmentally appropriate for the child
• the child's environment
• the child's need for social interaction in his/her current environment [D1]

Using specific behavioral or educational techniques

3. A variety of behavioral techniques may be useful for increasing and improving social interactions of children with autism. [A]
4. Prompting the child for a response or modeling correct responses, followed by reinforcement, may be especially useful techniques for improving social skills. [C]

Training peers to assist in interventions

5. It may be useful to train peers who are able to provide prompts, peer modeling, and reinforcement to increase social interactions for children with autism. [A]

Including parents in the intervention

6. It is important that parents be informed about interventions to improve social interactions in order to:

• ensure that the overall goals and strategies most important to the family are incorporated in the intervention
• help the family incorporate the intervention strategies into the daily routines of the child and family
• ensure consistency in the intervention approach [D1]

Parent Training as Part of Behavioral and Educational Programs

Many intervention programs include a component of parent training. The intensive behavioral intervention programs discussed previously all included parent training as an integral part of the entire program. Many typical and specialized preschools also include parent training as a part of their programs. The specific behavioral strategies taught to parents vary depending upon the particular program. Siblings may also be taught behavioral principles.

Evidence Ratings: [A] = Strong [B] = Moderate [C] = Limited [D1] = Opinion/No evidence meeting criteria [D2] = Literature not reviewed

Recommendations

1. It is recommended that parent training be included as an important component of comprehensive intervention programs for children with autism. Parent training programs may be useful because they:

• help support the family in caring for the child
• involve the parents in choosing intervention outcomes, goals, and strategies that are important to the family
• help the family incorporate the intervention strategies into the daily routines of the child and family
• help to ensure consistency in the intervention approach
• improve the interaction between the parents and their child
• increase parent satisfaction and reduce parent stress [D1]

2. It is recommended that consideration be given to how to include siblings and other family members in the parent training program. [C]

Send questions or comments to: bei@health.state.ny.us
Revised: November 1999