Effective Intervention Program features
Interventions Supported by Research
Examples of Therapeutic Intervention Programs
Other Models of Intervention
Goals for Educational Services
Key Points and Next Steps

Families Are Actively Involved in Their Children's Intervention

All of the models explicitly acknowledge the importance of having parents play a central role in their children's intervention, although how parents are asked to participate differs across programs and approaches. Virtually all of the programs provide parents with at least the opportunity to be trained in specialized skills in teaching their children with autistic spectrum disorders. However, there is a wide range of how many hours parents are asked to participate and whether or not that participation is optional or required.

At least three of the programs (Developmental Intervention Model, Walden, and the Young Autism Project) require a parental commitment to deliver at least 10 hours of intervention per week in their homes or community settings. These programs provide parents with extensive instruction and supervision on the specialized skills needed to effectively teach their child with an autistic spectrum disorder. The Douglass and LEAP programs strongly recommend parent participation for 10 to 15 hours per week, but they do not require completion of the assignments to parents. The format of parent participation varies considerably across programs, but all provide for some individual meetings with professionals at a clinic, center, or home. In some programs (Developmental Intervention Model, Young Autism Project), family intervention requires that parents set aside time to work intensively with their child in a one-on-one format.

In others (Individualized Support Program, Pivotal Response Training, Walden), parental instruction is blended into normal daily home and community activities.

There is an increasing trend toward providing families with support to deal with the considerable emotional and logistical stresses of raising a child with an autistic spectrum disorder, so that intervention goes beyond parent training.

In sum, all of the model programs reviewed placed a high priority on parental involvement in the early education of their children with autistic spectrum disorders. Parental involvement is a crucial component of their child's intervention program and a good predictor of their future success.

Staff Are Highly Trained and Specialized in Autism

All of the programs are directed by at least one doctoral-level professional with a long-standing reputation in the treatment of autistic spectrum disorders. All the program developers have demonstrated academic productivity as evidenced by their status on a university faculty.

Professional staff members in the selected programs are broadly interdisciplinary, and staffing patterns vary according to local licensing and accreditation guidelines. The two certified school programs (Children's Unit and Douglass) have staff with the most traditional credentials, including certificated teachers, speech and language pathologists, and an adaptive physical education instructor. The Children's Unit has a social worker, school psychologist, art and music therapists, and a consulting occupational therapist.

There is ongoing Objective Assessment of a Child's Progress

All of the programs reviewed have a mechanism for tracking the progress of individual children, and the systems for ongoing assessment permit timely adjustments in the child's intervention plan. This is another crucial component of any intervention plan. Without thorough, sensitive assessment of a child's progress in verbal and nonverbal communication, motor, behavior, cognition, and adaptive behavior (self-help skills), it is impossible to optimize their improvement and learning. It has been hypothesized by many professionals in autism, that regular systematic data collection and interpretation has been largely responsible for the gains observed in children in an ABA program.

There are many issues pertaining to regular assessment. Standardized assessments, or those measures that compare a child's performance to others their age, are useful for assessing the magnitude of strengths and weaknesses of a particular child as compared to others. They become quite problematic, however, when used for measuring personal growth and may even give the false impression that a child is losing skills when, in fact, they are making reasonable growth. Selection and interpretation of tests needs to be conducted by a psychologist or similarly trained professional.

To summarize, ongoing assessment of children's progress is viewed as a hallmark of each of the model programs, although the methods of measurement logically vary with the curriculum emphasis. Virtually all of the model programs assess cognitive functioning, while relatively few directly assess the effects of intervention on a child's everyday social functioning.

Each of the program models described in the previous section has a custom-designed curriculum, a term used broadly here to refer to the environment, staffing, materials, and teaching interactions. Several of the programs have commercially packaged portions of their curriculum, including the Children's Unit, the Developmental, Individual Difference, Relationship-based, and the Young Autism Project The other models have unpublished program manuals for use in staff training and program replication activities.

Some of the programs make use of other commercially packaged curriculum materials. For example, LEAP uses the Creative Curriculum to organize activities of interest to typical children as well as children with autistic spectrum disorders, although these materials are only one component of the overall LEAP curricula.

Highly Supportive Physical, Temporal and Staffing Environments

As described above, the model programs are implemented in a wide range of environments, including classrooms, homes, clinics, and community settings. The programs also vary on dimensions of environmental stimulation, with traditional behavioral programs generally conducted in distraction-free settings and more naturalistic procedures being implemented in more "everyday" environments. However, even in the most natural environments, it is common that the curriculum specifies certain environmental arrangements.

For example, the early Denver classroom was described as being "choreographed" in a manner that reflected precise planning and coordination of physical space, equipment, materials, activities, staff roles, and timing. Consistent across programs is the existence of predictable daily routines, which are organized according to written schedules of activities. The center-based programs tend to vary activities from one-to-one to small group to large group, with goals addressed in the most compatible format. For center-based programs, the class size varies from 6 (Denver) to 18 (Walden pre-kindergarten), although there is variability across children's ages. Class size also varies, depending on the ratio of children with special needs to total number of children (e.g., the Walden preschool program has 18 children, but only 6 have autism).

Suitable Adult-Child Ratio

More relevant than the number of children with autistic spectrum disorders is the adult:child teacher ratio, which all of the programs keep high in order to ensure that each child's individualized needs can be met. Across the programs previously reviewed here, the adult-child staffing ratios range from 1:1 to 1:8, depending on the program format, class size, and children's developmental and chronological age.

The Developmental Intervention Model and the Young Autism Project remain nearly exclusively 1:1 throughout the intervention period, including the use of a one-on-one "shadow" if a child is eventually included in a regular early childhood center. Other programs offer staffing of approximately 1:3, although each of these provides for some 1:1 sessions in the course of each child's day. A number of programs (e.g., Children's Unit, Douglass, Walden) systematically and intentionally fade the adult:child ratios across time in intervention, in order to prepare children to function independently in future sites.

In summary, a high adult:child teacher ratio may contribute more to a child's progress and development than any particular program.

Focus on Communication Goals and Other Developmental Areas

All programs reviewed here explicitly address the communication irregularities associated with autistic spectrum disorders, although there is some variability in the specific target objectives and in the strategies for promoting communication. The programs also target other developmental domains, including engagement, social, play, cognitive and academic skills, self-help (adaptive behavior), behavioral challenges, and motor skills (these are described in more detail below).

The Pivotal Response Model takes the position that inclusion is most easily accomplished when children are in preschool because this is the period when academic demands are lowest. Although the Individualized Support Program is philosophically committed to inclusive education, the reality of very limited inclusion options for children with autistic spectrum disorders leads to a practical approach of providing intervention in the most natural settings available.

Play

Play skills are closely related to both social and communication domains, and the models previously discussed here vary considerably in how play is addressed. Thus, play is a major emphasis of the Denver approach. Teaching in the course of play activities is also intrinsic to the models that primarily use incidental teaching or other naturalistic instructional procedures (i.e., Individualized Support Program, LEAP, and Walden), and inclusive programs are most likely to target creative or interactive play with peers. In fact, most programs target goals related to recreation. A review of published curriculum materials and program descriptions suggests that basic functional play skills (such as stacking rings and putting pegs in a pegboard) are routine goals at the Children's Unit, Douglass, TEACCH, and the Young Autism Project.

Cognitive and Academic Skills

Virtually all of the programs teach cognitive skills, although the distribution of treatment time to this area varies considerably. Cognitive growth is a major emphasis of the Denver, Douglass, TEACCH, and Young Autism Project models. Although cognitive abilities tend not to be a major curriculum priority in programs that focus on peer interaction skills (i.e., LEAP, Pivotal Response Model, and Walden), skills such as mathematics, reading, and writing are taught because academic preparation may help secure a child's placement in a regular kindergarten classroom.

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