plications reported for young children with autism. Thus, a variety of approaches have been used to increase engagement both with adult-directed tasks and in general attending to the environment; these include delayed contingency management (Dunlap et al., 1987), self-management techniques (Callahan and Rademacher, 1998), and strategies for environmental arrangement (McGee et al., 1991). Inclusion and interaction with typically developing peers (Kohler et al., 1997) have been used as a medium for increasing engagement and play skills (Strain et al., 1994; Wolfberg and Schuler, 1993). Now that children with autism are beginning to gain access to regular preschool and elementary school settings, there has developed a need for teaching them to transition smoothly across educational activities (Venn et al., in press).

As discussed earlier, there have been demonstrations that young children with autism can be taught to increase the frequency and variety of their play skills. Such interventions are expedited by pivotal response training and by targeting the skills displayed by typical children at similar developmental levels (Lifter et al., 1993, Stahmer, 1995). Young children with autism have been taught peer imitation abilities in the course of Follow the Leader games (Carr and Darcy, 1990).


Virtually all of the well-known programs for young children with autism provide instruction in adaptive daily living skills, which often form the basis for development of communication, social, and even motor skills. Several published program outcome evaluations have specifically examined progress in adaptive skills as measured on the Vineland. For example, 20 children with autism enrolled in the Douglass Developmental Disabilities Center showed better-than-average progress in all four domains assessed on the Vineland, but the most marked progress was in communication skills (Harris et al., 1995). Similarly, the Walden family program component was shown to yield developmental gains that were larger than those expected in typical development (i.e., greater than one month gain per month), and children’s progress at home corresponded closely to the intervention priorities selected by parents (McGee et al., 1993).

The Vineland results were less robust for children treated in the Young Autism Project at the University of California at Los Angeles, although the children were described as “indistinguishable from average children in adaptive behavior” (McEachin et al., 1993). The nine children with best outcomes in the 1987 treatment outcome study (Lovaas, 1987) were reassessed at an average age of 11.5 years. Although their overall composite scores were within the normal range, five of the nine had marginal or clinically significant scores in one more domain. Results were

The National Academies of Sciences, Engineering, and Medicine
500 Fifth St. N.W. | Washington, D.C. 20001

Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement