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

Self-Help

The behavioral programs use an array of procedures of demonstrated efficacy in teaching self-help skills. The developmental programs tend to place less emphasis on self-help skills, probably because self-help skills are not viewed as core autism deficits. Although there are relatively few published studies on self-help skills that are specific to young children with autism, virtually all of the selected model programs were found to track the development of independent daily living skills.

Behavioral Challenges

To a growing extent, strategies for promoting engagement have become nearly synonymous with methods of preventing challenging behaviors, because the behavioral challenges presented by young children with autistic spectrum disorders are usually not of a severity to warrant more intrusive intervention procedures. However, the Young Autism Project acknowledged use of aversive procedures with children participating in a 1987 outcome study.

At least five approaches (i.e., Denver, Individualized Support Program, LEAP, Pivotal Response Model, and Walden) rely exclusively on positive procedures for preventing challenging behaviors or for building incompatible appropriate behaviors. Because the Individualized Support Program model is a more short-term, problem resolution approach, a comprehensive positive behavior support strategy has been developed to accomplish demonstrable improvements in relatively short time-frames.

Motor Skills

The Developmental Intervention Model places a major emphasis on motor skills, including motor planning and sequencing. Most of the programs teach age-appropriate gross and fine motor skills. The UCLA program encourages gestural and vocal imitation. The Denver Model emphasizes motor imitation and motor planning.

Carefully Planned, Research-Based, Teaching Procedures Include Plans for Generalization and Maintenance of Skills

The sample representative programs discussed here use a range of research-based teaching procedures. The behavioral programs use procedures based on principles of learning, but the format of instruction falls along a continuum of discrete-trial procedures to incidental teaching. At the ends of the continuum, the Young Autism Project has historically used discrete-trial procedures nearly exclusively while Walden provides all instruction using an incidental teaching approach.

The other five behavioral programs use a mixture of discrete-trial and naturalistic teaching procedures, although the Individualized Support Program, LEAP models use predominately natural context procedures, and the Children 's Unit most commonly uses a highly structured discrete-trial approach. The Douglass Center's treatment continuum moves children from discrete-trial instruction to eventual placement in a classroom that uses mostly natural contexts teaching formats.

A method called structured teaching is used at TEACCH. Structured teaching shares features common to discrete-trial instructional procedures but also emphasizes instructional formats derived from the developmental literature and psycholinguistics, as well as some incidental teaching. The focus is on environmental structure, visual schedules, routines, organizational strategies (e.g., working from left to right), and visual work systems that help a child achieve independence in various skills.

With respect to reinforcement, the TEACCH model works from the idea that task performance and task completion will be motivating for children if they understand a task that is at an appropriate developmental level (e.g., supporting the development of emerging skills) and that builds on individual interests. The TEACCH structured teaching approach focuses on helping parents and teachers adapt the environment while helping children to develop skills. The two developmental programs use somewhat different approaches, although both are delivered during play interactions between adults and children.

In summary, the trend toward use of naturalistic teaching procedures began as an attempt to improve generalization of skills to use in everyday life, which has been the subject of a major criticism of ABA. Procedural comparisons of discrete-trial instruction and incidental teaching have indicated that, given comparable reinforcement procedures, acquisition occurs at approximately the same pace for both of the procedures. However, generalization or transfer of skills from the teaching setting to unprompted use in new settings or with new people is enhanced when skills have been learned through incidental teaching. Incidental teaching is a systematic protocol of instruction derived from principles of behavior analysis, and haphazard or unplanned instruction of any type is unlikely to produce acquisition of needed skills in children with autism.

Individualized Intervention Plans (IEP) are Needed to Adjust for the Wide Range of Children 's Strengths and Needs

All programs reviewed here give explicit attention to the importance of individualizing treatment; their methods vary. In general, the procedural approaches tend to be entirely custom-designed for each child, while the "programs" provide for individual adjustments within an overall packaged curriculum.

Transitions from Preschool to School Are Planned and Supported

Most of the selected programs report specific preparation for children's transition from intensive intervention into school programs. For example, Douglass reports a process that occurs across the child's last 9 months prior to program exit. Transition preparation begins with staff visits to future schools to assess the match of child with placement and to determine specific skills the child will need to function successfully in the next environment. Receiving teachers are invited to visit Douglass to get an understanding of the child's intervention history, and follow-up consultation is offered to receiving classrooms. In some cases, children make transitions gradually, with either partial-day placements or accompaniment by familiar staff.

Nearly all of the programs report placement outcomes, although it is recognized that a childs's progress is not the sole determining factor in placement decisions. The range of children going to typical classrooms following intervention differs widely across the programs, with program evaluation data reporting a range from 15 percent of children treated at the Children's Unit to 79 percent of the children from Walden. Walden recommends inclusion for nearly all children with autistic spectrum disorders, irrespective of level of functioning, due to a program policy emphasizing that all children with autistic spectrum disorders have social needs that require exposure to normal social behavior.

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