There is strong empirical support for the efficacy of functional communication training to replace challenging behaviors. This approach includes a functional assessment of the particular behavior to determine its function for a child (e.g., desire for tangible or sensory item, attention, or to escape a situation or demand) and teaching communication skills that serve efficiently and effectively as functional equivalents to challenging behaviors, a method that has been documented to be the most effective for reductions in challenging behavior (Horner et al., 1990; see Horner et al., 2000).
There are also some findings concerning the use of augmentative communication strategies. In a literature review of the functional communication training research, Mirenda (1997) found that eight children with autism, three of whom were under 8 years of age, were able to learn to use AAC to replace challenging behaviors. Their problem behaviors included self-injurious behavior, aggression, crying, screaming, property destruction, tantrums, non-compliance, and self-stimulatory behaviors. These children were systematically taught to use AAC with messages congruent with the function of the behavior, such as “Look at me” (attention); “I want__” (tangible); “I need a break” (escape). This intervention resulted in a substantial and immediate decrease in the problem behaviors, and the use of AAC for functional communication training was maintained over the course of a year. Naturalistic behavioral language interventions leading to improved communicative skills have also been associated with reductions in disruptive behavior (Koegel et al., 1992) and provide further evidence supporting the relationship between communication and behavior.
There is a growing body of research on increasing the initiation of communication in children with autism. Initiation of communication has been described as a pivotal behavior: the more often a child initiates communication, the more often it will trigger responses from others, which will in turn enhance and expedite the improvement of other communication and language skills (Koegel, 1995). Two important findings have been reported (Koegel et al., 1999). First, children who show more spontaneous, self-initiated communication at the beginning of treatment show more favorable language treatment outcomes. Second, in specific contexts, self-initiated communication can be taught to children with autism who show few or no spontaneous communication and has been associated with favorable treatment outcomes (Charlop et al., 1985; Charlop and Trasowech, 1991). In general, truly spontaneous, self-initiated, socially directed behaviors are much more difficult, though not impossible, to teach (Watson et al., 1989) and require a combination of developmental and naturalistic teaching methods.
In spite of the large number of studies documenting the core communication deficits associated with autism (i.e., joint attention and symbolic