Key Learning Skills for Children with Autism Spectrum
Disorders A Blueprint for Life
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Key
Learning
Skills
for Children with
Autism Spectrum
Disorders
by the same author
The Development of Autism
A Self-Regulatory Perspective
Thomas L. Whitman
ISBN 978 1 84310 735 4
of related interest
A Best Practice Guide to Assessment and Intervention for Autism and Asperger
Syndrome in Schools
Lee A. Wilkinson
Foreword by Diane Twachtman-Cullen
ISBN 978 1 84905 811 7
First Steps in Intervention with Your Child with Autism
Frameworks for Communication
Phil Christie, Elizabeth Newson, Wendy Prevezer and Susie Chandler
Illustrated by Pamela Venus
ISBN 978 1 84905 011 1
Social Communication Cues for Young Children with Autism Spectrum Disorders
and Related Conditions
How to Give Great Greetings, Pay Cool Compliments and Have Fun with Friends
Tarin Varughese
ISBN 978 1 84905 870 4
The Complete Guide to Asperger’s Syndrome
Tony Attwood
ISBN 978 1 84310 495 7 (hardback)
ISBN 978 1 84310 669 2 (paperback)
Thomas L. Whitman and Nicole DeWitt
Key
Learning
Skills
for Children with
Autism Spectrum
Disorders
A Blueprint for Life
Jessica Kingsley Publishers
London and Philadelphia
First published in 2011
by Jessica Kingsley Publishers
116 Pentonville Road
London N1 9JB, UK
and
400 Market Street, Suite 400
Philadelphia, PA 19106, USA
www.jkp.com
Copyright © Thomas L. Whitman and Nicole DeWitt 2011
All rights reserved. No part of this publication may be reproduced in any material
form (including photocopying or storing it in any medium by electronic means and
whether or not transiently for incidentally to some other use of this publication)
without the written permission of the copyright owner except in accordance with the
provisions of the Copyright, Designs and Patents Act 1988 or under the terms of a
licence issued by the Copyright Licensing Agency Ltd, Saffron House, 6–10 Kirby
Street, London EC1N 8TS. Applications for the copyright owner’s written permission
to reproduce any part of this publication should be addressed to the publisher.
Warning: The doing of an unauthorised act in relation to a copyright work
may result in both a civil claim for damages and criminal prosecution.
Library of Congress Cataloging in Publication Data
Whitman, Thomas L.
Key learning skills for children with autism spectrum disorders : a
blueprint for life / Thomas L. Whitman and Nicole DeWitt.
p. cm.
Includes bibliographical references and index.
ISBN 978-1-84905-864-3 (alk. paper)
1. Autistic children--Education. 2. Autistic children--Behavior
modification. I. DeWitt, Nicole. II. Title.
LC4717.W45 2011
371.94--dc22
2010053636
British Library Cataloguing in Publication Data
A CIP catalogue record for this book is available from the British Library
ISBN 978 1 84905 864 3
ISBN pdf eBook 978 0 85700 467 3
Contents
Preface 7
1. Selection of Appropriate Interventions 11
2. Interventions 32
3. Core Learning Skills 64
4. Emotion-Related Problems 103
5. Sensory Problems 132
6. Sensorimotor Deficiencies 154
7. Language and Communication Problems 181
8. Cognitive Deficiencies 211
9. Social Interaction Problems 242
10. Self-Regulation Deficiencies 273
11. Behavioral Problems, Developmental
Challenges, and Medical Issues 297
About the authors 328
Subject Index 329
Author Index 334
For the many students who have taken our courses,
participated in home and school-based intervention
programs for children with autism and been
part of our research groups. Thank you for your
support, service to families, and stimulation.
Preface
Autism spectrum disorders (ASD) are characterized by a diverse set of symptoms
that vary in the way they are manifested across individuals. In addition to the social
interaction deficiencies, language/communication delays, and repetitive, restricted,
and stereotyped behavior patterns that diagnostically characterize these disorders,
a variety of sensory, motor, emotional, and behavioral problems frequently co-
occur. Because of the complexity of ASD, a broad range of intervention approaches
have evolved. Such interventions have varied considerably in their focus, structure,
and comprehensiveness.
Parents and professionals who must make decisions about intervention programs
for children with autism spectrum disorders are confronted with a major challenge
because of the multitude of interventions available and a lack of consensus about
which are most appropriate. This lack of consensus has arisen in part because the
causes and exact nature of autism have not yet been clearly delineated. Controversy
has also been generated because many interventions have been developed outside
of a scientific framework. Such interventions often do not have a standardized
protocol; as a consequence they are difficult to replicate for either empirical or
clinical purposes. These interventions have typically been designed by individuals
who have not known how or thought it unnecessary to evaluate their effectiveness.
Sometimes parents and professionals searching for appropriate interventions feel
they are being forced into making a decision between doing nothing, which is
unacceptable, or adopting untested interventions.
The present book presents an intervention program for teaching children with
ASD that is comprehensive in scope and consists of techniques that are evidence-
based. These techniques have been derived from extensive basic research that has
uncovered fundamental principles guiding behavioral, cognitive, and emotional
development. Applied research in turn has developed, based on these principles,
educational procedures that have been employed and evaluated with both
neurotypical and atypical children and adults.
The purpose of this book is to present a blueprint for developing a
comprehensive intervention program for children with autism spectrum disorders.
This book is directed at parents as well as professionals from various disciplines,
including education, clinical psychology, speech therapy, occupational therapy,
physical therapy, and medicine, who are searching for a better way to address
the needs of children with ASD. In addition, this book is appropriate for college
courses in autism that have a practicum component.
7
8 Key Learning Skills for Children with Autism Spectrum Disorders
In Chapter 1, the assumptions and general principles that guided the
formulation of this comprehensive intervention program are examined, followed
by a discussion of characteristics considered critical for such a program to be
successful. Chapter 2 describes evidence-based techniques for promoting adaptive
behavior development, behavior maintenance, and behavior generalization, as
well as techniques for dealing with behavior problems associated with autism
spectrum disorders. From a theoretical perspective, these techniques are derived
from ecological, classical conditioning, operant, social, and cognitive-behavioral
learning theories. All of these theories emphasize the important role that the
environment plays in human development. For purposes of discussion, the
techniques are grouped into several categories: ecologically focused, behavior-
oriented, emotion-focused, cognitively oriented, and behavior reduction. The
effectiveness of these techniques have been empirically established for use with
a wide range of behaviors and clinical populations, including children with ASD.
Chapters 3 to 10 describe interventions for addressing deficiencies and delays
and developing competencies in core learning skills and emotional, sensory,
motor, language, cognitive, social, and self-regulatory functioning. The structure
of these chapters is similar. Each chapter begins by examining basic symptoms,
delays, and deficiencies associated with autism spectrum disorders as well as the
causes of these problems, their impact on development, and behaviors that need
to be targeted for intervention. Then basic strategies for creating behavior change
are described. Finally, examples of specific intervention programs are presented.
Chapter 3 describes intervention programs for establishing core skills,
behaviors that provide a basic foundation for learning and development. The core
skills discussed include: attention, joint attention, and social referencing, imitation,
request-making, labeling, instruction-following, matching, and sequencing. In
Chapter 4, skills necessary for developing emotional competence, specifically
emotion awareness, emotion expression, and emotion regulation, are described. In
addition, emotion-based problems, including hyperarousal, hypoarousal, anxiety/
fear, and anger, are discussed. Chapter 5 examines sensory problems commonly
displayed by children with autism, specifically hypersensitivity, sensory overload,
hyposensitivity, and sensory integration deficiencies. Chapter 6 focuses on
sensorimotor impairments, including delays and deficiencies in gross and fine
motor skills, which affect personal, academic, and community functioning.
In Chapter 7, language behaviors that are critical for communication competency
are discussed, ranging from simple gestural responses and sound production to
conversational speech. Chapter 8 examines key cognitive processes that need to be
targeted for intervention, including holistic processing, memory, abstract thinking,
and pretend play as well as the use of these processes in academic situations.
The importance of intervention programs building on cognitive strengths is
also emphasized. In Chapter 9, social behaviors are discussed, including the
Preface 9
importance of developing social play, friendships, theory of mind, empathy, rule-
governed behavior (e.g. following social protocols), and community engagement
skills. Chapter 10 looks at the relationship between self-regulation deficiencies
and stereotyped, repetitive, and restricted behaviors. Components of executive-
functioning processes, that are critical for the development of self-regulation and
independent functioning are examined, including impulse control, self and other
awareness, flexible action, verbal control of behavior, and problem-solving.
Finally, Chapter 11 begins with a discussion of common co-morbid symptoms
diagnosed in children with autism, including attention deficit hyperactivity,
anxiety, and depressive symptoms. It also describes an array of other behavioral
and developmental problems that frequently occur in this population, specifically
repetitive, restricted and stereotyped behaviors, self-injurious behaviors,
noncompliance, temper tantrums, aggression, self-toileting delays, eating problems,
and sleeping problems. For each of these problems, intervention strategies are
discussed. The chapter then examines the relationship between medical problems
and autism and the various ways that biological and environmental factors might
influence this relationship. This chapter also concludes with the presentation of
specific intervention examples.
Although considerable information is presented in this book concerning how
the goals and techniques of this comprehensive intervention program should be
structured and implemented, we recommend that the actual implementation of
this program be coordinated with qualified professionals who have appropriate
educational credentials and professional certifications. With a few exceptions, the
book does not discuss biological treatments, but rather emphasizes, because of
the absence of curative medical treatments for ASD, the critical importance of
educational interventions for developing adaptive behavior.
A number of people have been very helpful in preparing this book. In
particular, we owe a debt of gratitude to Kristin Wier who generously shared her
clinical expertize and experience with us throughout the writing of this book.
Special thanks are also due to Judy Stewart for her considerable assistance in the
preparation of this manuscript. Finally, we would like to thank our students, past
and present, and the many families who have taught us so much about teaching
and supporting the development of children with autism. In recognition of their
contributions to this book, all royalties will be used to support intervention
programs provided by the Sonia Ansari Regional Autism Center at Logan in South
Bend, Indiana.
Chapter 1
Selection of Appropriate
Interventions
Parents raising a child with an autism spectrum disorder are confronted with a
variety of personal, familial, vocational, and financial challenges. After a diagnosis
of autism is given to their child, they struggle to understand the implications of
this event for themselves and their family (Milshtein, Yirmiya, Oppenheim, Koren-
Karie, & Levi, 2010). They search for information about autism and its complex
and mysterious symptomatology as well as for appropriate intervention programs
for their children. The search for services is particularly time-consuming and often
frustrating. Due to the wide variety of interventions available, parents wonder
which would be best for their child (Whitman, 2004).
The different schools of thought regarding intervention programs for children
with autism spectrum disorders (ASD) often engenders passionate discussion and
disagreement among both service providers and parents regarding best practices.
As parents search for appropriate programs, they are confronted with the myriad
of choices, sales pitches, and testimonials from therapists and satisfied consumers.
As a consequence, it is not uncommon for them to become hopelessly confused.
Rationales are provided by service providers to convince parents of the validity of
a particular approach or approaches, sometimes accompanied by arguments as to
why other interventions are ineffective and to be avoided. Not surprisingly, parents
are often drawn to interventions that are intuitively appealing, easy to administer,
emotionally satisfying, “natural,” and promise cures.
In response to the increasing diversification of treatments, a call for a new
approach has been put forth by the scientific community, emphasizing the
development of an evidence-based approach and a merging of programs from
various disciplines, such as psychology, speech pathology, occupational therapy
and education (Feinberg & Vacca, 2000). However, for such an integration to be
successful and to avoid being arbitrary and chaotic, it needs to be formulated in a
manner that makes theoretical, empirical, and practical sense.
The present book describes an educational intervention program that is
designed to be both comprehensive in scope and integrative in its approach. In
this chapter assumptions that guided the formulation of this intervention program
are discussed, followed by a description of characteristics considered to be critical
11
12 Key Learning Skills for Children with Autism Spectrum Disorders
for such a program to be successful. Subsequent chapters will describe the specific
goals of this intervention program, the rationales for pursuing these objectives,
along with specific techniques for accomplishing these goals.
Program assumptions
Autism is a developmental disorder
The examination of autism within a developmental context makes sense because it
emerges early in life, with symptoms gradually unfolding as development occurs.
Formally, autism is classified as a developmental disability (Whitman, 2004).
Although developmental psychologists conceptualize development as a process
that occurs across the lifespan, the term developmental disability typically refers
to a dysfunction that emerges during the early portion of the lifespan. The
Developmental Disabilities Assistance and Bill of Rights Act of 1990 defines
a developmental disability as a severe, chronic disability that: 1) is attributable
to a mental or physical impairment, or a combination of mental and physical
impairments; 2) is manifest before 22 years of age and is likely to continue
indefinitely; 3) results in substantial functional limitations in three or more of
areas of major life activities, including self-care, receptive and expressive language,
learning, mobility, self-direction, capacity for independent living and economic
self-sufficiency; and 4) reflects the person’s need for a combination of individualized
and coordinated services that are of lifelong or extended duration. This definition
originated as part of an effort by the federal government in the United States to
identify and assist people in need of support services through federal legislation.
Using this definition, most individuals with an autistic disorder would be
defined as having a developmental disability; certainly early in their life, and often
later as well. Because persons labeled as autistic have deficiencies in the areas of
language and social interaction, they usually experience problems in other areas,
such as academic and vocational functioning and independent living, all of which
are central to the definition of developmental disabilities. Viewing autism from a
developmental perspective has important intervention implications. Three of these
implications, relating to the importance of the social environment, the timing of
intervention, and the multidimensional and dynamic nature of autism, are briefly
discussed in the following sections.
The impact of the environment is substantial
Figure 1.1 shows the relationship between biological and environmental factors
and their influences on the development of autism. As shown in this figure,
one pathway of influence is from genes, which affect the development of the
Selection of Appropriate Interventions 13
neurobiological substrate, which in turn influences the emergence of behaviors
associated with autism. Other (non-autism) genes influence through this same
general pathway neurotypical characteristics of the child, such as temperament
and personality.
Figure 1.1 also shows two important pathways from the environment. In one
pathway the environment influences the development of the behavioral phenotype
of children with ASD, including behaviors diagnostically associated with autism
spectrum disorders (e.g. language delays), other related autism symptoms (e.g.
motor delays), behavior problems (e.g. temper tantrums, aggression, eating and
sleeping problems), and other non-autistic more normative characteristics. In
the other pathway the environment (e.g. prenatal) influences the neurobiological
substrate underlying these behaviors, including how brain connections develop.
Some of the changes in the biological substrate are also mediated by changes
in behavior produced by the environment. The social and physical factors that
make up this environment are quite diverse. They include the influence of parents,
family, teachers, specific educational interventions, environmental stressors, the
restrictive environments that children with autism create for themselves, the
prenatal environment, and toxic substances in the air, water, and soil.
Other interesting pathways, from genes to environment and environment to
genes, are also shown in Figure 1.1. For example, the genes of both children and
their parents may affect how they interact with one another; for example there is a
genetic foundation for parenting style and child activity level. Moreover, the physical
environment may under certain circumstances influence the child at the genetic
level, through agents, such as x-rays, which can cause gene mutation. Finally, the
physical environment, through its impact on the underlying biochemical substrate,
can influence which genes are turned on, that is expressed and become operational,
and which genes turn off. More generally, what Figure 1.1 shows is that there is a
complex and interactive relationship between the environment, biological factors
and the development of children with autism. Educational interventions that focus
on changing the physical and social environments of children with autism can and
do have profound influences on the child’s biological and behavioral development.
