This chapter provides a brief introduction to instructional strategies for young children with autistic spectrum disorders. In Chapter 12 we discuss ten representative comprehensive programs. Many instructional strategies summarized in Chapter 11 are used by most of those programs.
TYPES OF INSTRUCTIONAL STRATEGIES
Teaching New Behaviors
The continuum of behavioral teaching approaches has been carefully described (Anderson and Romanczyk, 1999; Prizant and Wetherby, 1998; Schreibman, 2000). Behavioral strategies take various approaches to the concepts of discrete trials, massed trials, naturalistic behavior, and peer mediation.
A discrete trial is defined as a set of acts that includes a stimulus or antecedent, a behavior, and a consequence. Differences in the delivery of a discrete trial (e.g., selecting different settings for the trials) mark different uses and styles of behavioral teaching.
Massed trials (see, e.g., Lovaas et al., 1981) are adult-directed (adult leads, child responds) teaching episodes in which a child responds to a teacher or to environmental instructions (antecedents). Consequences, or reinforcers, are not necessarily related to the child’s activity or action. Each skill being taught is initially repeated several times in succession.
Naturalistic behavioral strategies are forms of discrete-trial teaching in which the child’s own motives or behavior initiate the instruction and lead to a reinforcing event (“natural reinforcer”). These approaches are more child-centered than massed trial teaching, in that children’s motivations, interests, favored activities, and choices figure strongly in the teaching. Two examples of naturalistic strategies are pivotal response training and incidental teaching.
Incidental teaching consists of a chain of prespecified child-tutor interactions. The interactions involve materials that are highly preferred by the child, prompting and shaping techniques embedded in natural contexts, and child-initiated (“natural”) interactions. Incidental teaching has been demonstrated, with replication, to be an effective technique for increasing language learning in both typical children (Hart and Risley, 1975) and in children with autism (McGee et al., 1983, 1999).
In pivotal response training (Koegel et al., 1999), certain behaviors are seen as central to wide areas of functioning. Changing these pivotal behaviors is thought to change other associated behaviors without specifically targeting the associated behaviors. Pivotal response techniques include child choice, reinforcement, and correcting behaviors.
Peer-mediated strategies (e.g., Strain and Kohler, 1998) also demonstrate a naturalistic application of behavioral teaching. The typical peers of a child with an autistic spectrum disorder are instructed in a more adult-centered, mass-trial approach, while children with autistic spectrum disorders are taught by their peers in a more child-centered, naturalistic type of approach.
Decreasing or Altering Existing Behaviors
These strategies may include aversive approaches, functional analysis, differential reinforcement of other behaviors, extinction, antecedent manipulation, and combinations of these strategies (Dunlap et al., 1994. Aversive approaches involve administration of an aversive stimulus, or punisher, which, according to behavioral terminology, is an event to which a person responds by escaping or avoiding the stimulus. When an aversive stimulus is used as a consequence in the antecedent-behavior-consequence chain, the frequency of the behavior decreases over time. Mildly aversive approaches are commonly used with all children (e.g., saying “no”), but most strategies aimed at decreasing the frequency of unwanted behaviors currently emphasize the use of positive reinforcement strategies, which reward a child for performing more appropriate behaviors in place of the unwanted behaviors. In order to plan an effective intervention, one needs to know what current reinforcing consequences (both positive and negative reinforcers) are maintaining the unwanted behavior. This requires a functional analysis of behavior.
A functional analysis of a behavior is an assessment procedure that yields an understanding of how the unwanted behavior functions for a child—what needs the child is addressing through the use of the behavior (what reinforcements are maintaining it). This evaluation involves interviews and observations to develop a hypothesis about the functions of the behavior and then controlled manipulations to test the hypotheses. Detailed procedures for performing a functional assessment of behavior are available to practitioners (O’Neill et al., 1990).
The approach generally referred to as differential reinforcement of other behaviors, or differential reinforcement of incompatible behaviors, involves replacing the unwanted behavior with a more desirable behavior, built on the same reinforcing consequence that is currently supporting the unwanted behavior. This approach requires that the replacement behavior is just as powerful (quick, easy, efficient, and successful at gaining the reinforcement) as the unwanted behavior. For young children, the replacement behavior is very often a conventional social-communicative behavior (“functional communication”).
Extinction involves the removal of the consequence from an antecedent-behavior-consequence chain. It is often used in combination with a differential reinforcement approaches, so that the unwanted behavior is no longer followed by the reinforcing consequence (extinction), while the new, adaptive behavior, is followed by the reinforcing consequence. This results in an increase in the frequency of the adaptive behavior.
In antecedent manipulation approaches, instead of manipulating the behavior-consequence part of the chain, the focus is on the antecedent-behavior links. In some functional analyses, a very specific antecedent can be identified, and this antecedent can be manipulated in such a way that the behavior is not performed (and therefore not reinforced). For example, if an analysis reveals that a child hits in response to an adult saying “Don’t__”, the adult may change the antecedent instruction to “Would you please__”. Use of prompts is a common way of performing antecedent manipulations.
Behavioral instruction of young children with autistic spectrum disorders often involves use of multiple interventions in an environment. One example might be the use of clearly marked visual cues (antecedent interventions) along with communication training to make requests and refusals (intervention by differential reinforcement of incompatible behaviors) (Watson et al., 1989).
Developmental Strategies for Building New Skills
In a developmental approach, the skills of a child with an autistic spectrum disorder are compared with the skills of a developmental sequence seen in typical children. Patterns of typical development for each
skill area are established by the many early childhood assessment tools. The skills that a child demonstrates (“passes” on the assessment tools) indicate the child’s current developmental level. As part of goal development for a child, failed or partially accomplished items then become the targets of teaching.
A developmental approach to teaching generally refers to a child-centered approach (child leads, adult follows) that uses materials and tasks that fit a child’s developmental level in a particular area. Materials are provided to the child, and the child’s behavior with the materials is scaffolded by the teacher along the lines of the targeted developmental skill. Children’s behaviors and initiative with materials guide the adult, who may use modeling or demonstration, prompting, or hand-over-hand instruction. Children’s preferences guide the selection of materials; adults provide support and encourage, but do not require, that materials are used and activities are carried out in the desired way. Rather than adult-supplied consequences for certain behaviors, internal, naturally occurring reinforcers are assumed to provide the motivation for learning. An example of an internal reinforcer is a sense of mastery and efficacy in functioning (e.g., pleasure in completing a puzzle).
Augmentative and Alternative Strategies
Augmentative and alternative strategies use assistive devices that provide a symbolic communication system other than speech (as described in Chapter 5). Examples are the use of visual systems like the Picture Exchange System, visual schedules, computerized communication systems, and manual language in place of verbal language. Although there are sometimes concerns voiced by parents and teachers that using an augmentative or alternative strategy may prevent a child with an autistic spectrum disorder from developing more conventional skills in that area (e.g. using manual signs might slow the acquisition of speech), there is no empirical evidence that demonstrates a negative result from using alternative strategies. Rather, there is some evidence that alternative strategies may assist development in some areas (Bondy and Frost, 1994).
Current practices in education of young children with autistic spectrum disorders generally support the tailored use of alternative and augmentative communication strategies, where appropriate, to facilitate participation in the educational environment by some children with autistic spectrum disorders. While some educational approaches gain maximal participation with carefully structured teaching and without much use of alternative or augmentative systems (e.g., the Walden preschool program), other approaches emphasize the use of strategies such as schedules or picture systems, along with many other methods to assist children with autism (e.g., the TEACCH program [Treatment and Education of
Autistic and Related Communication Handicapped Children]). In part, these results may be affected by how children are selected for the programs. There is no available empirical evidence that compares the gains made with and without such systems, but the best-documented approaches are uniform in their emphasis on maximizing child participation in educational experiences.
INDIVIDUAL VERSUS GROUP INSTRUCTION
Because young children with autistic spectrum disorders lack social and communicative skills necessary for attending to an adult and learning from distal instruction, it is generally assumed that initial skill development will be accomplished from individual instruction. Providing children with autistic spectrum disorders the language, social, and attentional behaviors needed to learn from an adult in a group situation is, in fact, a goal of early intervention for young children with autistic spectrum disorders.
Delivery of individual instruction episodes can take place in a variety of settings, including situations in which only a child and teacher are present (model of initial instruction at the University of California at Los Angeles program) and situations in which a child is in a typical group setting with a fairly large number of peers, but adults or peers join the child to deliver a discrete trial within the group situation. The various empirically supported models vary widely in the amount of time children are alone in a space with a teacher, compared with the amount of time they are in a group of peers, but these programs are quite similar in the use of individual teaching episodes to establish basic language, social, and cognitive skills.
Appropriate responding in a group situation is a specific part of the curriculum in empirically supported models. Carefully planned and implemented instruction is used to teach children to participate independently in typical classroom routines like hanging up a coat, sitting in a circle with a small group, moving from one center to another, getting materials, using them appropriately, putting them away, and lining up for outdoor time. Instruction in these group routines is usually delivered like other areas of instruction for children with autistic spectrum disorders: the initial teaching is provided with maximal individual instruction and support, and then adult instruction and prompting are gradually faded as the child learns to carry out the routine independently. Task analysis is often used to identify the specific skills involved in classroom routines and to develop teaching strategies.
Visual strategies, like the use of picture schedules and picture communication systems, visually structured independent work schedules, visual organization and cueing of the environment (names on chairs, coat
hooks, and cubbies), are also used by many programs of both behavioral and developmental orientation to support children with autistic spectrum disorders in group situations. Group instruction provides an important environment for maintenance, generalization, and normalization of skills that may have first been taught individually.
THE USE OF PEERS AS INSTRUCTORS
Studies have demonstrated that interactions established between children with autism and adults do not easily generalize to peer partners. However, typical peers have been shown to be effective intervention agents for young children with autism. In these approaches, the peers are taught particular strategies for eliciting social, play, and communicative responses from a young child with autism. Most of these procedures have also been demonstrated to be effective when used in an inclusive setting, in which most of the children present are typically developing (Goldstein et al., 1992; Strain et al., 1977, 1979; Oke and Schreibman, 1990; McGee et al., 1992; Odom and Strain, 1986). However, it is important to note that, though these approaches are intended to be used in inclusive settings, they require planning and implementation by well-trained staff, as they would in any setting.
Variables found to be important in maintenance and generalization include characteristics of the peers, methods of prompting and reinforcing peers, fading reinforcers, ages of children, and characteristics of the setting, as well as the use of multiple peer trainers (Brady et al., 1987; Sainato et al., 1992). Self-monitoring systems for the peers have also been used successfully (Strain et al., 1994). These interventions have been found to be most powerful when delivered in inclusive preschools, but they have also been used successfully by parents and siblings in homes (Strain and Danko, 1995; Strain et al., 1994; parent training is discussed in detail in Chapter 3). These highly effective peer-mediation approaches are complex to deliver, requiring socially skilled typical peers and precise adult control in training peers, managing and fading reinforcement, and monitoring ongoing child interaction data. However, the approach is manualized and well described in many publications (Danko et al., 1998).
THE ROLES OF SELECTED DISCIPLINES
Provision of evaluation and treatment by occupational, physical, and speech and language therapists is mandated by the Individuals with Disabilities Education Act when speech and language and motor deficits are impeding a child’s educational progress. The knowledge held by speech and language therapists and motor therapists is crucial for evaluating the needs of young children with autistic spectrum disorders and developing
goals and objectives, as well as assessing progress. These therapists can have an important role in identifying appropriate goals and teaching techniques in their area of expertise. They can teach classroom staff and parents to use those techniques and to identify learning opportunities for the child in the classroom, community, and home. Speech/language and motor therapists are also carefully trained in specific treatment techniques in their individual areas.
The current role of psychologists and behavior specialists as interventionists in the education of young children with autistic spectrum disorders most often involves assessment, consultation, and development of intervention strategies. Psychologists and behavior specialists are often involved in providing functional analyses of problem behaviors; designing behavioral interventions; providing cognitive, adaptive, and social assessments; guiding the educational curriculum in these areas; and consulting with the rest of the educational team about educational strategies and interventions. Psychologists, social workers, and speech language therapists are sometimes involved in carrying out social skills groups, generally for older school age children. Psychologists and behavior specialists are often involved in parent training and support as well.
Whatever the discipline involved, justification for individual therapy as part of an educational program should be based on the use of particular intervention strategies in which the therapist is skilled. The research literature suggests that the greatest effects of any direct treatment for young children with autistic spectrum disorders lie in the generalization of learning achieved through working with classroom personnel and parents. There is little reason to believe that individual therapies carried out infrequently (e.g., once or twice a week) have a unique long-term value for young children, unless the techniques are taught to and used regularly by the child and the people who are with him or her in natural contexts. The value of one-on-one therapy lies in generalization, which must be planned and directly addressed. On the other hand, the assumption in all of the model programs is that skill development begins in individual instruction that may occur in the classroom or in individual treatment. Adequate amounts of individual instruction, whether by a teacher or parent or therapist, are crucial to early learning.