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Paul H. Brookes Publishing Co.
Post Office Box 10624
Baltimore, Maryland 21285-0624
USA

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Copyright © 2017 by Paul H. Brookes Publishing Co., Inc.

All rights reserved.
Previous edition copyright © 2000

“Paul H. Brookes Publishing Co.” is a registered trademark of

Paul H. Brookes Publishing Co., Inc.

All examples in this book are composites. Any similarity to actual individuals or circumstances is coincidental, and no implications should be
inferred.

Purchasers of DO-WATCH-LISTEN-SAY: Social and Communication Intervention for Autism Spectrum Disorder, Second Edition are granted
permission to download, print, and photocopy the assessment tool, any blank forms appearing in the appendixes, and the activity sheets. Please
visit brookespublishing.com/downloads with (case sensitive) keycode: 78ilKaT02. These forms may not be reproduced to generate revenue for
any program or individual. Photocopies may only be made from an original book. Unauthorized use beyond this privilege may be prosecutable under
federal law. You will see the copyright protection notice at the bottom of each photocopiable page.

Library of Congress Cataloging-in-Publication Data

Names: Quill, Kathleen Ann, 1952- author. | Stansberry Brusnahan, L. Lynn., author.
Title: Do-watch-listen-say : social and communication intervention for autism spectrum disorder / by Kathleen Ann Quill, Ed.D., BCBA-D,
The Autism Institute, Essex, Massachusetts and L. Lynn Stansberry Brusnahan, Ph.D., University of St. Thomas, Minneapolis,
Minnesota.
Other titles: Do watch listen say
Description: Second edition. | Baltimore : Paul H. Brookes Publishing Co., [2017] | Includes bibliographical references and index. Identifiers:
LCCN 2016050144| ISBN 9781598579802 (pbk.) | ISBN 9781681252322 (epub) | ISBN 9781681252339 (pdf)
Subjects: LCSH: Autistic children—Rehabilitation. | Autistic children—Education.
Classification: LCC RJ506.A9 Q55 2017 | DDC 618.92/85882—dc23
LC record available at https://lccn.loc.gov/2016050144

British Library Cataloguing in Publication data are available from the British Library.

Version 1.0

4
Contents

About the Online Materials

About the Authors
The DO-WATCH-LISTEN-SAY Approach to Assessment and Intervention
The Emotional Needs of the Child
1. Understanding the Complexity of Autism
Historical Overview and Contemporary Implications of Autism
Identifying and Diagnosing Autism
Cognition in Autism
Summary
2. Understanding Social and Communication Development and Challenges
Core Skills for Social and Communication Development
Social Skill Development
Communication Skill Development
Restricted, Repetitive Behavior in Autism
Summary
3. Assessing Social and Communication Skills
Understanding Educational Assessments
Assessment of Social and Communication Skills in Autism
The Assessment of Social and Communication Skills for Individuals with Autism Spectrum Disorder,
Revised (ASCS-2)
Summary
Appendix: Assessment of Social and Communication Skills for Individuals with Autism Spectrum
Disorder, Revised (ASCS-2)
4. Designing Intervention
Intervention Planning: An Overview
Framework for Targeting Skills
Framework for Intervention: Core Skills
Framework for Intervention: Social Skills
Framework for Intervention: Communication Skills
Framework for Intervention: Community Skills
Framework for Intervention: Restricted and Repetitive Behaviors
Summary
5. Selecting Evidence-Based Practices to Enhance Social and Communication Skills
Evidence-Based Intervention Practices
Intervention Approaches

5
 Summary
6. Instructional Strategies to Enhance Social and Communication Skills
Teaching Opportunities
Explicit Instruction and Interactions
Summary
7. Instructional Supports to Enhance Social and Communication Skills
Organizational Supports
Social Supports
Communication Supports
Behavioral Supports
Summary
8. Activities to Promote Skill Development
Activity Strategies
Using the Sample Activity Sheets
Core Skills Activity Sheets
Social Skills Activity Sheets
Communication Skills Activity Sheets
9. Collecting Data to Measure Authentic Progress
Overview of Progress Monitoring
Monitoring Skill Emergence, Mastery, and Generalization
Data Collection Forms
Using Data to Make Intervention Decisions
Summary
Appendix A: Progress Monitoring Forms—Quantitative Data Collection Forms
Appendix B: Progress Monitoring Forms—Qualitative Data Collection Forms

References
Index

6
About the Online Materials

THE FORMS, ASSESSMENT TOOL, AND ACTIVITY SHEETS:

Purchasers of this book may download, print, and/or photocopy the assessment tool, any blank forms
appearing in the appendixes, and activity sheets for professional and educational use. These materials are
included with the print book and e-book and are also available at brookespublishing.com/downloads with
(case sensitive) keycode: 78ilKaT02.

7
About the Authors

Kathleen Ann Quill, Ed.D., BCBA-D, The Autism Institute, Essex, Massachusetts
Kathleen Ann Quill, Ed.D., BCBA-D, is a compassionate professional who has spent 40 years supporting
individuals with autism spectrum disorder. She is a developmental psycholinguist, educator, and board
certified behavior analyst (BCBA-D). Dr. Quill has conducted trainings in more than 20 countries, given the
keynote address for 10 international organizations, and presented at more than 200 conferences. She discusses
how to integrate behavioral (applied behavior analysis) and developmental treatment models to enhance
language, communication, and social learning. Dr. Quill promotes innovative solutions that bridge the gap
between research and practice in order to sustain quality education for all students with autism.
Prior to founding the Autism Institute, Dr. Quill was a professor at the University of Massachusetts and
Lesley University in Boston and conducted applied research on developmental differences in autism. She is
the author of two seminal texts, numerous publications, and online resources on the topic. She is also on the
editorial board for Journal of Autism and Developmental Disorders and Focus on Autism and Other Developmental
Disabilities. She facilitates Professional Learning Communities through regional and national partnerships
and collaborates with companies to design technology solutions for educators.

L. Lynn Stansberry Brusnahan, Ph.D., Associate Professor, Teacher Education, University of St. Thomas,
Minneapolis, Minnesota
Laroye “Lynn” Stansberry Brusnahan, Ph.D., is the parent of an adult with autism and an associate professor
in teacher education at the University of St. Thomas in Minnesota. She coordinates the autism spectrum
disorder certificate, license, and master’s program. She was the 2012 Autism Society of America Professional
of the Year. Dr. Stansberry Brusnahan has a doctorate from the University of Wisconsin-Milwaukee in
Exceptional Education. She has served on numerous boards including the Autism Society of America
National Board, the Council for Exceptional Children’s Division on Autism and Development Disabilities
Board, and Minnesota Life College’s professional advisory board. She worked with the Minnesota
Department of Education, where she helped craft an autism spectrum disorder special education license for
educators. She has an active agenda as an invited speaker at the local, national, and international level.

8
The DO-WATCH-LISTEN-SAY Approach to
Assessment and Intervention

Autism is a disorder of social, communicative, and repetitive behaviors. Because communication and social
development challenges are defining characteristics of autism, assessing and teaching social and
communication skills should be a priority for children on the spectrum. It can be a formidable task to build
these skills in children with autism, who frequently display behaviors that are perplexing and seem
inconsistent with what is understood about childhood development. It is generally assumed, particularly in
education, that all children follow a similar developmental path. Yet children with autism display patterns of
communication and social development that can follow a uniquely different path. These developmental
differences were considered in the design of this second edition of DO-WATCH-LISTEN-SAY.
Social activities are complex and dynamic, so intervention to teach social and communication skills should
be equally dynamic. This book’s approach is that assessment and intervention for social and communication
skills should help children with autism coordinate what to DO, who to WATCH, how to LISTEN, and
what to SAY in a variety of social situations. The purpose of this edition of DO-WATCH-LISTEN-SAY is to
provide assessment and intervention guidelines that specifically address building these critical skills and more.
It is an attempt to guide the thinking of educators, clinicians, and parents who are urgently working to bring
out the best in their students, clients, and children.

WHAT’S NEW IN THIS EDITION

The first edition of DO-WATCH-LISTEN-SAY was published 16 years ago. It continues to be sold
worldwide, translated into nine languages. The book was the first of its kind in the year 2000, offering
professionals and parents a means to understand, assess, and teach social and communication skills to children
of all developmental levels on the autism spectrum. After many requests for an updated edition, we are pleased
to share this second edition.
While our understanding of autism is always evolving, many of the fundamental principles and practices
that guided intervention 16 years ago continue to apply today. The major intervention shift has been twofold:
First, a stronger emphasis on data-based assessment and progress monitoring; and second, greater clarity
regarding which evidence-based practices benefit specific areas of social and communication development.
This second edition of DO-WATCH-LISTEN-SAY reflects these major intervention shifts. First, there are
many revisions to the comprehensive assessment tool included with this book, The Assessment of Social and
Communication Skills for Individuals with Autism Spectrum Disorder, Revised (ASCS-2). This assessment
evolved substantially from the Assessment of Social and Communication Skills for Children with Autism that
appeared in the 2000 edition. The ASCS-2 is now structured to allow for quantitative tracking of an
individual’s skill development over time. Additionally, a critical distinction is now made between skill mastery
and the child’s ability to demonstrate authentic skill generalization across persons and settings. It is our goal to
standardize the ASCS-2 in the next 2 years. There are also two complete chapters devoted to assessment and
progress monitoring, with printable data collection forms that the reader can duplicate. Second, this edition
contains a review of evidence-based practices for fostering social and communication development that is
linked to current research, as well as chapters on proven intervention strategies and intervention supports.

BOOK OVERVIEW

9
The book is divided into nine chapters:
1. Understanding the Complexity of Autism: Chapter 1 introduces the complexity of autism spectrum
disorder. Readers will acquire a historical and contemporary overview of autism spectrum disorder; learn
how our understanding of autism has evolved; and become familiar with the social, communication, and
behavioral characteristics typically associated with autism.
2. Understanding Social and Communication Development and Challenges: In Chapter 2, readers will
learn about the typical development of core nonverbal social communication skills, social skills, and
communication skills and the associated developmental challenges in autism spectrum disorder. Readers
will also be introduced to the restricted and repetitive behaviors related to autism.
3. Assessing Social and Communication Skills: In Chapter 3, readers will learn a comprehensive assessment
process to identify social and communication challenges in children and youth with autism spectrum
disorder. The assessment tool introduced (ASCS-2) is designed to identify the presence of core
foundation skills, functional social and communication skills, and behavioral obstacles that interfere with
learning and development. The ASCS-2 is structured to track skill acquisition and functional skill use
separately.
4. Designing Intervention: In Chapter 4, readers will learn to design intervention plans utilizing systematic
frameworks to assess, target, and teach social and communication skills and address restricted and
repetitive patterns of behavior that interfere with learning and development. The DO-WATCH-
LISTEN-SAY framework is introduced, which provides general guidelines for teaching children with
autism what to DO, who to WATCH, how to LISTEN, and what to SAY in a variety of social
situations.
5. Selecting Evidence-Based Practices to Enhance Social and Communication Skills: In Chapter 5, readers
will learn how to select evidence-based practices to enhance social and communication skills.
6. Instructional Strategies to Enhance Social and Communication Skills: In Chapter 6, readers will learn
how to use instructional strategies to enhance social and communication skills and meet the needs of
children with autism.
7. Instructional Supports to Enhance Social and Communication Skills: In Chapter 7, readers will learn
how to use instructional and behavioral supports to enhance social and communication skills and meet the
needs of children with autism.
8. Activities to Promote Skill Development: In Chapter 8, readers will learn how to develop and implement
creative, motivating, and meaningful activities to meet an individual learner’s goals and objectives.
9. Collecting Data to Measure Authentic Progress: In Chapter 9, readers will learn how to collect ongoing
data to measure the acquisition and functional generalization of social and communication skills.
The first two chapters of this book discuss the developmental characteristics of autism. A thorough review
of the literature acquaints the reader with relevant findings on the complex relationship between cognitive,
social, and communication differences and repetitive and restricted behavior in autism. These foundational
chapters guide the reader to understand the complex developmental profiles of children with autism and
identify social and communication challenges. The behaviors and characteristics associated with autism are
made real and relevant through vignettes describing the perspectives and experiences of children on the
spectrum. Understanding and respect for the complexity of autism and the uniqueness of each child are
necessary to effectively use the assessment and treatment guidelines that follow.
Chapter 3 centers on social and communication skills assessment for children with autism and presents the
ASCS-2. This informal, criterion-referenced assessment is designed for both individuals who are verbal and
those who use an augmentative communication system and is used to create a comprehensive profile of a
child’s functional social and communication skills. The assessment is designed as a rating scale and checklist
that can be completed through interview, observation, or direct sampling. It was designed to assist in the
development of educational goals and objectives. The reader is provided with detailed guidelines for using the
assessment in Chapter 3, with the complete ASCS-2 provided in an Appendix and downloadable at
brookespublishing.com/downloads with (case sensitive) keycode: 78ilKaT02.
Chapters 4 and 5 review the current research on evidence-based practices and describe the continuum of
intervention options to build social and communication skills. The reader is given a framework for
systematically designing an intervention plan to be implemented across multiple settings. An eclectic approach
is described that interfaces best practices in contemporary behaviorism and developmental approaches.

10
Emphasis is given to the importance of systematically applying behavioral principles, while at the same time
building skills within the context of natural social experiences and developmentally age-appropriate
environments.
Chapters 6 and 7 explain how to use various evidence-based instructional strategies and supports to
enhance the acquisition and functional generalization of social and communication skills. The evidence-based
strategies are classified as traditional behavioral, developmental, and contemporary naturalistic strategies. The
evidence-based instructional supports are classified as organizational supports, social supports, communication
supports, and behavioral supports.
Chapter 8 presents sample activities to build the skills addressed in the ASCS-2. The collection of activity
sheets contains sample goals and behavioral objectives, functional activity ideas, and suggestions on how to
promote generalization of skills. The activity sheets in this chapter can be used with children and adolescents,
but the principles and practices apply to all individuals with autism.
Chapter 9 is devoted to progress monitoring and data collection. Through a series of case studies, the
reader is guided through the process of tracking the acquisition and generalization of social and
communication skills across home, school, and community settings. There are a number of data collection
forms that can be used for purposes of ongoing accountability and program review. Emphasis is placed on
means to measure authentic functional progress.

HOW TO USE THIS BOOK

This second edition of DO-WATCH-LISTEN-SAY offers the reader a thorough review of intervention for
children and youth with autism ages 3–18 years, with an emphasis on assessment and progress monitoring.
We encourage the reader to keep in mind that this and any other communication and social skills guide risk
minimizing the complexity and richness of these developmental areas. All social interactions require the ability
to simultaneously and flexibly understand what to DO, who to WATCH, how to LISTEN, and what to
SAY. The assessment tool (ASCS-2), guidelines to design intervention, and evidence-based teaching
practices are built upon the child’s struggle to integrate these four aspects of fluid social interaction. We hope
that the assessment and intervention approaches discussed in this book will not be applied too rigidly, and that
they are used with respect and consideration for the children they are intended to help.
We struggled with the book because the emotional complexity of relationships can never be truly captured
in writing. The importance of relationships to optimize social and communication development must be
inferred between the lines, and we hope that this cardinal rule is not forgotten. In the first edition, a reminder
of the emotional needs of a child was embedded into the discussion of challenging behaviors. In this edition, the
reader will find this summary at the very beginning of the book.
It is our hope that this book will expand and refine your approach to intervention, and that these ideas will
interface with other treatment options available. It is important that this text be viewed as a set of guidelines
and not a dogma of must do. Please use this information flexibly, and let intuition lead your efforts. If this is
done for the children, we will feel more satisfied with this finished product.

11
The Emotional Needs of the Child

Although it is very tempting to outline a course of strategies for teaching social and communication skills to
children with autism, it is unreasonable to assume that the path of intervention will be straight or easy.
Meeting each child’s emotional needs ultimately drives the development of socialization and communication.
Socialization and communication are the products of relationships.
The basic emotional needs of all individuals include forming attachments and experiencing affection,
respect, empathy, comfort, compromise, safety, success, and joy. One’s emotional well-being must always be
considered during intervention. In order to meet the emotional needs of children and youth with autism, it is
essential to understand their sometimes unique ways of communicating and forming relationships. This is not
an easy task, as it is often difficult to interpret their emotional signals. Unlike typically developing children,
there is sometimes a mismatch between their behaviors and feelings. For example, someone with autism may
repeatedly ask a question that appears merely to be a perseverative inquiry. Nonetheless, the accompanying
behavior may actually indicate that he or she is feeling an intense amount of anxiety and is unable to
communicate his or her feelings in another way. Only through careful observation and sensitive listening can
each child’s emotional needs be understood over time. When working with children and youth with autism,
consider the following nine important areas for emotional well-being:
1. Attachments: Children with autism are often asked to work and interact with many different adults in
many different settings. This usually exceeds what is expected of typically developing children. The
number of people and settings in the child’s life, as well as the impact this has on his or her level of
comfort, need to be examined. Relationships take time.
2. Affection: There are many ways of communicating affection. It can be expressed through touch, a song, or
a smile. Individuals with autism sometimes respond to affection in unusual ways. One child may seek a
hug one minute, then pull away in the next minute. It is important to note the types of social feedback
each child enjoys. A match between the child’s personal preferences and the way in which affection is
expressed will enhance his or her social relationships.
3. Respect: Respect can be expressed through careful observation, astute listening, and flexibility.
Acknowledge all of a child’s efforts, even those that lack social appropriateness. Respect the child with
autism by offering choices whenever possible. Respect that some social situations are very difficult for
them by providing instructional supports. Balance the day’s activities between those that build self-esteem
and those that are difficult. Realize that more intervention is not always better on a particular day.
4. Empathy: Empathy is expressed by focusing on each child’s strengths, establishing realistic expectations,
and understanding the source of his or her confusion and discomfort. Empathy is expressed by including
emotional needs in the functional analysis of behavior and by teaching peers to be sensitive to others. In
addition, empathy is expressed by accepting that children do the best they can at the moment.
5. Comfort: Children learn in situations where they are comfortable. Intervention that diminishes the chaos
will comfort those with autism. They are further comforted when their feelings are acknowledged and
labeled. In addition, providing them with a private place to relax supports and comforts them.
6. Compromise: Imagine being a child with autism for one minute. Imagine the perceived confusion, the
overwhelming fear. Imagine not understanding the perspective of adults who control the day’s activities.
Imagine not understanding how to ask them to stop. It is essential to learn how much to push, when to
balance the needs of the child with autism with the needs of others, and when to compromise

12
 expectations. Compromise is possible when intervention is approached from a sympathetic point of view.
7. Safety: This is a promise to the child that “I will not let you hurt yourself or others” and “I will only use
physical prompting if necessary.” It also provides reasonable rules and boundaries.
8. Success: Feelings of mastery contribute to emotional well-being. It is important to balance the day
between pleasurable, mastered activities and challenging situations. All small successes and efforts need to
be acknowledged and praised. There are a thousand ways to praise someone. It is important to avoid the
habit of empty praise; instead, use praise that is genuine and natural. Social success is also defined by social
acceptance. Teach peers altruistic behaviors. Find opportunities for the child with autism to give and be
thanked by others. Encourage relationships with peers that are mutually satisfying.
9. Joy: What makes this child happiest? Allow him or her moments of joy that are independent of social
appropriateness every day. This ensures that communication, social, and emotional development will
continue.

13
To all the individuals who have touched our lives for so many years, thank you.

Kathleen Ann Quill, Ed.D., BCBA-D

and
L. Lynn Stansberry Brusnahan, Ph.D.

14
 CHAPTER 1

Understanding the Complexity of Autism

LEARNING GOALS:
1. Acquire a historical overview and learn the contemporary implications of autism spectrum disorder and
how our understanding of autism has evolved.
• Provide a timeline of the history of autism spectrum disorder that includes seminal researchers and
their contributions.
• Describe how theoretical perspectives can guide intervention (e.g., how the “refrigerator mother”
mindset led to institutionalization).
• Recognize how society has moved philosophically from providing interventions through an exclusion
model to the more contemporary model of inclusion.
• Report the possible etiology (i.e., cause) of autism spectrum disorder.
• Discuss the prevalence of individuals identified with autism spectrum disorder.
2. Understand the process of identifying and diagnosing autism spectrum disorder.
• Define autism spectrum disorder.
• Describe the key feature areas used in the medical criteria for diagnosing autism spectrum disorder.
• Explain how education needs must be identified to qualify for special education services.
• Compare the similarities and differences between a medical diagnosis and meeting criteria for special
education services under the educational category of autism spectrum disorder.
• Identify the common types of comorbidity that can accompany autism spectrum disorder.
3. Identify the social, communication, and behavioral characteristics typically associated with autism
spectrum disorder.
• Describe the cognitive features associated with autism with regard to attention, information
processing, and social cognition challenges.
• Understand satisfactory working theoretical explanations for the core features of autism, specifically
theory of executive dysfunction, weak central coherence, and mindblindness.

4. Articulate the complexity of autism spectrum disorder.

A utism is a lifelong disorder characterized by challenges in the areas of social interaction and
communication along with restricted, repetitive behavior, interests, or actions (American Psychiatric
Association [APA], 2013). This edition will describe the complexity of typical social and
communication development and articulate the challenges that individuals with autism spectrum disorder
(ASD) experience in these areas. In this edition, individuals with autism are referred to using a variety of
terms (e.g., child, youth, student, learner). The characteristics and strategies highlighted in this edition may be
applicable for individuals with autism across the lifespan regardless of age. This first chapter lays the

15
foundation for understanding ASD, providing a historical and contemporary overview, identification and
diagnosis criteria, and some of the major satisfactory working theories and cognitive explanations related to
ASD.

HISTORICAL OVERVIEW AND CONTEMPORARY

IMPLICATIONS OF AUTISM
This section includes a brief historical overview and discussion of etiology, prognosis, and prevalence of ASD.
Philosophical views on the disorder have an impact on intervention practices, so it is important to understand
how our perceptions, theories, and understanding of autism have evolved over time. Through the years,
society has moved philosophically from an exclusion model to the more contemporary model of inclusion.

Historical Overview of Autism

Autism is derived from the Greek word autos, meaning self. Autism was not recognized as a distinct disability
until the mid-20th century. In 1943, Leo Kanner, a psychiatrist at Johns Hopkins University, described the
challenges inherent in 11 of his patients. In this seminal study, Kanner noted that his patients shared similar
characteristics but their pattern of challenges appeared different from other conditions. Dr. Kanner considered
social withdrawal to be one of the primary features and labeled the disorder early infantile autism. Kanner
referred to the “autistic aloneness” in his patients as the inability to relate to people and situations. Kanner also
noted an obsessive insistence on sameness and included this trait in his descriptions of autism. The current
definition of autism and the diagnostic criteria remain consistent with many of the characteristics first
described by Kanner.
Around the same time, Hans Asperger (1944), a pediatrician at Vienna University Hospital, identified
patients with characteristics that included an absence of empathy for others, one-sided conversations, and
intense interests; his patients also demonstrated marked social challenges. Asperger’s patients possessed
average to above-average intellectual (cognitive) skills with no significant delays in language development.
Asperger used the term “autistic psychopathy” when referring to these patients. Through the 1960s, the
medical community thought of autism as a form of psychosis linked to “childhood schizophrenia” and
excluded individuals from society through institutionalization.

Etiology and Medical History Since autism was first identified, our understanding of the disorder has
grown, and the medical community continues to conduct research on the etiology (i.e., cause). Historically,
there have been a number of theories regarding the etiology of autism. Throughout the 1950s and 1960s,
autism was attributed to an absence of adequate environmental support. In his book An Empty Fortress (1967),
psychologist Bruno Bettelheim advanced this emotional deprivation theory and wrote about the cold and
rejecting upper-middle-class parents who were unable to psychologically bond with their children. This
psychogenic (i.e., of mental origin) theory placed blame for autism specifically on the mother of the child, who
was referred to as a “refrigerator mother” (Pollak, 1997). It was speculated that the parents’ withholding of
affection or negative feelings toward their child caused the child to retreat into autism. During this period,
medical professionals recommended children be removed from their homes and institutionalized, along with
the parents receiving psychoanalysis.
In 1964, Bernard Rimland, a psychologist and parent of a son with autism, presented the first solid
argument to refute the blame on the parent–child bond and published Infantile Autism and Its Implications for a
Neural Theory of Behavior, stressing the plausibility of a biological causation. To advocate for education and
end institutionalization, Dr. Rimland joined together with parents of children with autism across the country
and founded the Autism Society of America (formerly the National Society for Autistic Children). Since
1965, this grassroots organization has grown into a leading source of information and support to improve the
lives of all affected by autism.
In 1980, the APA defined infantile autism as a cluster of pervasive development disorders (PDDs) and
declared it a separate category from childhood schizophrenia in the Diagnostic and Statistical Manual of Mental
Disorders, Third Edition (DSM-III). In a 1987 revision, infantile autism was changed to autistic disorder. In
1994, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) added the category
of PDDs with five subtypes, which included autistic disorder, Asperger’s disorder, PDDs-not otherwise
specified (PDD-NOS), Rett disorder, and childhood disintegrative disorder. In 2013, the Diagnostic and
Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) consolidated the previous subtypes under the
broader heading autism spectrum disorder, which replaced the term PDDs. In this text, the terms autism
spectrum disorder, ASD, and autism will be used interchangeably.

16
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