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Educating Children with Autism
the use of single-subject designs across many applications. A number of interventions have demonstrated that adolescents or adults with autism can be taught purchasing skills and other community living skills, such as ordering food in a restaurant (Haring et al., 1987). However, most applications of instruction in community living skills have been developed for children and adults with mental retardation. Daily living skills targeted have ranged from appropriate mealtime behaviors (O’Brien et al., 1972; Wilson et al., 1984), to eating in public places (van den Pol et al., 1981). Proactive approaches to promoting community access include instruction in clothing selection skills (Nutter and Reid, 1978), pedestrian safety (Page et al., 1976), nondisruptive bus riding (Neef et al., 1978), vending machine use (Sprague and Horner, 1984), and coin summation (Lowe and Cuvo, 1976; Miller et al., 1977; Trace et al., 1977). Additionally, procedures for teaching leisure skills have targeted independent walking (Gruber et al., 1979) and soccer (Luyben et al., 1986).
Another area of widespread application is found in investigations on the remediation of eating disorders. For example, various approaches have been documented as effective in controlling rumination, or persistent vomiting (Kohlenberg, 1970; Rast et al., 1981; Sajwaj et al., 1974), pica (Mace and Knight, 1986), and diurnal bruxism (Blount et al., 1982). Skill-based interventions have been aimed at promoting oral hygiene (Singh et al., 1982) and food acceptance by a child with a gastrointestinal feeding tube (Riordan et al., 1984). A simple procedure of requiring placement of the fork down between bites was shown to reduce the pacing and quantity of food intake by obese children (Epstein et al., 1976).
Behavioral medicine, or the application of behavioral principles to medical problems, includes an experimental case study with a child with autism, whose seizure disorder was ameliorated by a technique involving interruption early in an identified behavioral chain (Zlutnick et al., 1975). Procedures that have been developed for teaching generalized toy play skills to children with mental retardation should translate to use with children with autism (Haring, 1985). Of additional relevance to children with autism are applications of operant procedures to the assessment of hearing in persons with profound mental retardation (Woolcock and Alferink, 1982), as well as the assessment of visual acuity in nonverbal children (Macht, 1971; Newsom and Simon, 1977).
The bulk of the literature cited above was derived from research in which the subjects were described as having mental retardation, and early applications of behavior analysis were conducted primarily with adults in residential settings. However, it is likely that some of the subjects in these early applications also had undiagnosed autism. There was little attention to diagnostic precision in the early behavioral research, though the brief subject descriptions provided often mentioned behaviors com-