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Research-BasedEducational Practicesfor Students With AutismSpectrum DisordersJoseph B. Ryan Elizabeth M. Hughes Antonis Katsiyannis

Melanie McDaniei Cynthia Sprinkle

Autism spectrum disorder (ASD) hasbecome the fastest growing disabilityin the United States, with currentprevalence rates estimated at as manyas I in no children (CDC, 2010). Thisincrease in the number of studentsidentified with ASD has significantimplications for public schools. Themost popular research-based edtica-tional practices for teaching this popu-lation, explored in the pages that fol-low, include applied behavior analysis(ABA); the Developmental, Individual-Difference, Relationship-Based model(DIR/Floonime): the Picture ExchangeCotnmunication Systetn (PECS): socialstories; and "Reatment and Educationof Autistic and Cotnmunication relatedhandicapped CHildren (TEACCH).

In 1990, while amending the Educa-tion for All Handicapped Children Act,Congress expanded the number of dis-ability categories eligible to receivespecial education services in publicschools by including autism. Autism is

: a developmental disability that signifl-cantly affects an individual's verbal

56 COUNCIL FOR EXCEPTIONAL CHILDREN

and nonverbal communication as wellas social interaction. It is typically evi-dent before age 3 and adverselyimpacts a child's educational perform-ance. Other characteristics commonlyassociated with autism include:(a) engagement in repetitive activitiesand stereotyped movements, (b) pooreye contact, (c) difflculty socializingwith others, (d) resistance to changesin daily routines, and (e) unusualresponses to sensory experiences suchas loud noises (Individuals With Dis-abilities Education Act [IDEA], 2008).Although the intelligence quotient (IQ)distribution for speciflc types of autismresembles that of the general popula-tion, there appears to always be signifi-cant differentiation between writtenand oral language skills, marked emo-tional difflculties recognized by parentsand teachers but not by the studentsthemselves, and sensory problems sim-ilar to persons who function at a muchlower cognitive level (Barnhill, Hagi-wara, Myles, & Simpson, 2000). As aresult, children with autism, regardlessof whether they are high or low func-

tioning, have difflculty with peer rela-tionships and understanding social sit-uations (Kasari, Freeman, Bauminger,& Alkin, 1999).

Autistic Spectrum Disorders

Autism is a disorder that adverselyaffects a child's communication, social-ization, and interests prior to age 3,with the average onset at 15 months(Hutton & Caron, 2005). One aspect ofautism that distinguishes it from otherdisabilities is that the term refers to aspectrum or multiple types of similarlyrelated disorders. Hence, the disabilityis more commonly referred to asautism spectrum disorder (ASD), withsymptoms ranging from mild cognitive,social, and behavioral deflcits to moresevere symptoms in which childrenmay suffer from intellectual disabilitiesand be nonverbal. There are flve sub-types of ASD.

Autistic Disorder

Approximately one third (35%-40%)of children with autism are nonverbal(Mesibov, Adams, & Klinger, 1997).

The majority of students diagnosedwith autism have IQ scores categoriz-ing them with intellectual disability,with only one third (25%-33%) havingan IQ in the average or above-averagerange (Heflin & Alaimo, 2007).

Asperger's Syndrome

Individuals with Asperger's syndrometypically do not exhibit delays in thearea of verbal communication, andoften develop large vocabularies. How-ever, they do show impairments intheir ability to understand nonverbalcommunication or the pragmatics oflanguage. As a result, even thoughmany individuals may be very highfunctioning cognitively (e.g.. TempleGrandin, an internationally renownedauthor) they often experience signifl-cant social skill deflcits.

Childhood DisintegrativeDisorder (CDD)

CDD is a very rare disorder (1/50,000)that typically affects males. It is charac-terized by a period of normal develop-ment followed by an onset of autism-related symptoms, including markedlosses of motor, language, and socialskills. Symptoms may appear as earlyas age 2, although most develop thesymptoms between 3 and 4 years ofage (National Institute of MentalHealth, 2008).

Reft Syndrome

In contrast to CDD, Rett's is a raregenetic disorder (1/15,000) that almostexclusively affects females. The disor-der is characterized by a period of nor-mal development followed by a decel-eration of head growth accompaniedby an increase in autism-related symp-toms (between 6 and 18 months).Other symptoms include regression inmental and social development, loss oflanguage, seizures, and loss of handskills that results in a constant hand-wringing motion (Heward, 2009).

Pervasive DevelopmentalDisorder Not OtherwiseSpecified (PDD-NOS)

l'DD-NOS is most commonly used todescribe children who exhibit at least

one characteristic of an ASD subtype,

but do not meet all of the specific diag-

nostic criteria (American Psychiatric

Association, 2000). As a result, chil-

dren who suffer from a qualitative dif-

ference from their peers in communica-

tion, socialization, or interests and

activities may receive a diagnosis of

PDD-NOS.

Increase in PrevalenceRates of ASD

Perhaps the most alarming aspect of

ASD for school systems has been the

dramatic and continued increase in

prevalence rates of ASD across the

United States over the past 2 decades.

When a new disability flrst becomes

eligible for special education services,

it is often anticipated prevalence rates

will rise as school systems begin to

actively screen children for the disabili-

ty. This increase in numbers of chil-

dren served should be expected within

the first several years, as was seen with

the increased prevalence of traumatic

brain injury (TBI), which was added as

a disability category the same year as

autism. However, after 2 years, the

growth rate for children identifled with

TEACHING EXCEPTIONAL CHILDREN ¡ JAN/FEB 2011 57

TBl began to plateau, while the preva-lence rate for children with ASD hascontinued to grow nearly 2 decadeslater (Newschaffer, Falb, & Gurney,2005).

In 1992, the year following ASD eli-gibility under IDEA, only 5,415 stu-dents with ASD were declared ehgiblefor IDEA services (U.S. Department ofEducation, 1995), representing lessthan one percent (.1%) of all studentswith disabilities. A decade later thenumber of students receiving specialeducation services for ASD reached97,204 (1.66% of all students with dis-abilities; U.S. Department of Education,2003) an increase of 1,708%. In com-parison, the percentage increase for alldisabilities during this same period wasjust 30.38%. By the last count, theprevalence rate has continued toincrease, surpassing a quarter millionstudents (292,818), and now accountsfor 4.97% of all students with disabili-ties (U.S. Department of Education,2008). This represents a dramaticincrease of 201.24% since 2002, and a5,307.53% increase since the categorywas flrst established. The Centers forDisease Control and Prevention(CDC) 's Autism and DevelopmentalDisabilities Monitoring Network esti-mated that approximately 1 in 110children may have ASD (CDC, 2010).

Causes of Autism

The etiology of ASD is currentlyunknown. The combination of skyrock-eting prevalence rates and lack ofknowledge regarding the cause of ASDhas sent concerned parents and educa-tors searching for answers throughboth traditional (e.g., news media andprofessional journals) and informal(e.g.. World Wide Web blogging) infor-mational outlets. Unfortunately, thishas sometimes resulted in further con-fusion as consumers are left to siftthrough a combination of research,speculation, and misinformation foranswers. Given that ASD is a spectrumof disorders, it is very likely there aremultiple causes (Halsey, Hyman, & theConference Writing Panel, 2001); cur-rent research focuses on both biologi-cal and environmental factors. From abiological or genetic perspective.

researchers have observed structural

and chemical differences in the brain

of children with ASD as early as the

flrst trimester's development of the

fetus (Halsey et a l , 2001). These flnd-

ings, coupled with increased preva-

lence rates among family members

with a history of the disorder, add cre-

dence to possible genetic causes.

Related to the biological theory is

the controversial view that ASD is

caused by a compromised immune sys-

tem resulting from exposure to vacci-

nations. As a result, there has been sig-

niflcant concern over the use of child-

hood vaccinations, specifically those

containing thimerosal, a mercury-

based preservative. The National Insti-

tutes of Health (NIH), the American

Academy of Pediatrics, and several

other medical organizations stress

there is no research to support this

link (Halsey et al., 2001). Medical pro-

fessionals emphasize that most vacci-

nations developed afler 2001 no longer

contain thimerosal, and caution that

the increasing trend of parental refusal

to vaccinate their children has resulted

in increased outbreaks of the potential-

ly fatal childhood diseases these vacci-

nations were designed to prevent. Still,

there is a continued call for research to

further explore if certain children are

more susceptible to developing degen-

erating types of ASD after being admin-

istered vaccinations, especially because

the age at which many vaccinations

are administered correlates with the

onset of the degenerative forms of

ASD.

Although there is also concern that

ASD may result from environmental

toxins, there has been no empirical

research to support this claitn. Heflin

and Alaimo (2007) cautioned that

although it has been observed that spe-

ciflc geographical areas have been

shown to contain higher concentrations

of ASD, this may be the result of fami-

lies either (a) moving to areas that pro-

vide better educational services for

their children with ASD, or (b) these

locales are more effective at screening

and identifying the disorder.

Impliccrtions for Schools

The continued increase of studentsidentifled with ASD has placed signifi-cant Stressors on public schools andthe educators that serve them. Pointsof contention between parents andschool districts include (a) eligibilityand services provided, (b) educationalplacement (e.g., least-restrictive envi-ronment), and (c) instructionalmethodologies (Yell, Katsiyannis, Dras-gow, & Herbst, 2003; Zirkel, 2002).

In respect to eligibility and services.Yell and Drasgow (2000, p. 213) recom-mended that (a) school districts ensuretimely eligibility decisions based onevaluations by professionals with expe-rience in ASD, (b) educators developindividualized education programs(IEPs) that address all the areas ofneed identifled in the evaluation, and(c) services identifled in the IEP resultin meaningful educational beneflt tothe student (e.g., districts must moni-tor student progress toward IEP goalsand objectives). In accordance withfederal law, districts must place stu-dents with disabilities in integratedsettings to the maximum extent appro-priate and adopt empirically validatedinstructional strategies and programs.In addition, using empirically validatedmethodologies is particularly importantgiven the emphasis of the No ChildLeft Behind Act of 2001 on incorporat-ing evidence-based methodologies andrelated provisions in IDEA regardingservices outlined in a student's IEP(see Simpson, 2005). Specifically, IEPsrequire "a statetnent of the special edu-cation and related services and supple-mentary aids and services, based onpeer-reviewed research to the extentpracticable" (IDEA, 20 U.S.C. & 1414

Unfortunately, given the number ofnon-evidence-based interventions cur-rently marketed for the treatment ofASD (e.g., facilitated communication,holding therapy, secretin therapy),selecting efflcacious interventions canbe a challenging proposition for boththe lay and professional consumeralike. Table 1 summarizes the tnostpopular research-based educationalpractices for teaching students with

58 COUNCIL FOR EXCEPTIONAL CHILDREN

Table 1 . Evidence-Based Interventions for Students With Autism Spectrum Disorders

I Intervention Program Description Demonstrated Efficacy internet Link

DevolopiiuMit.il.Individual-Difference.Relcitionship-BasecModel (DIR/Flooriime; Wieder& Greenspan,2001)

Discrete THalTi-aining (DTT;Lovaas, 1987)

Lovaas Method(Lovaas, 1987)

Picture ExchangeCommunicationSystem (PECS;Bondy & Frost,1994)

Social stories(Gray & Garand,1993)

TVeatment andEducation ofAutistic aiuiCoiiuriunicationrelatedlwiuiicippedCllildien(TKACCH;Schopler &Reichler, 1971)

Through challenging yet child-friendly playexperiences, clinicians, parents, and educa-tors learn about the strengths and limitationsof the child, therefore gaining the ability totailor interventions as necessary whilestrengthening the bond between the parentand child and fostering social and emotionaldevelopment of the child.

Time requirement: 14-35 hours per week

Intervention that focuses on managing achild's learning opportunities by teachingspecific, manageable tasks until masteryin a continued effort to build upon themastered skills.

Time requirement: 20-30 hours per weekacross settings

Intervention that focuses on managing achild's learning opportunities hy teachingspecific, manageable tasks until masteryin a continued effort to build upon themastered skills.

Time requirement: 20-40 hours per week

Communication system developed to assiststudents in building fundamental languageskills, eventually leading to spontaneouscommunication. The tiered interventionsupports the learner in learning to identify,discriminate between, and then exchangedifferent .symbols with a partner as a meansto communicate a want.Time requirement: As long as the child isengaged, typically 20-30 minutes per session

Personalized stories that systematicallydescribe a situation, skill, or concept interms of relevant social cues, perspectives,and common responses, modeling and3roviding a socially accepted behavioroption.

Time requirement: Time requirements varyper story; approximately 5-10 min prior todifficult situation

Intervention that supports task completion)y providing explicit instruction and visualsupports in a purposefully structuredenvironment, planned to meet the uniqueask needs of the student.

Time requirement: Up to 25 hours per week(during the school day)

Increased levels of:• Social functioning• Emotional functioning• Information gatheringFor ages: Approximately 2-5years

Increased levels of:• Cognitive skills• Language skills

; • Adaptive skills• Compliance skills

fbr ages: Approximately 2-6years

Increased levels of:• Adaptive skills• Cognitive skills• Compliance skills• Language skills• IQ• Social functioning

Fbr ages: Approximately2-12 years

Increased levels of:• Speech and language

development• Social-communicative

behaviors

For ages: Approximately 2years-adult

Increased levels of:• Prosocial behaviorsFor ages: Approximately2-12 years

Increased levels of:• Imitation• Perception• Gross motor skills• Hand-eye coordination• Cognitive performanceFor ages: Approximately 6years-adult

www.icdl.comThis Interdisciplinary Council onDevelopmental and LearningDisorders site allows professionalsto learn more about the DIR/Floortinie model, DIR institutionsand workshops, and currentresearch regarding DIR/Floortime.

www.helpingtogrow.istores.comwww.aba.insightcommerce.netwww.adaptivechild.com

These commercial sites provideopportunities to purchase programsand adaptive equipment.

www.lovaas.comOfficial site for Lovaas Institutethat provides detailed informationabout Lovaas method, successstories, services, and productsavailable.

www.PECS.com

Official site; provides informationregarding PECS training courses,consultation, certification, andproducts.

www.thegraycenter.orgThis site provides informationabout resources available throughthe Center, including products onlow to make and use social stories.The site also provides generalinformation about autistn andresearch that supports the useof social stories.

www.teacch.comThe site is operated through adivision of the University ofvlorth Carolina Department ofPsychology and provides links toregional centers, programs andservices, as well as access tocurrent research and publicationssupporting the method.

TEACHING EXCEPTIONAL CHILDREN | JAN/FEB 2011 59

ASD, a good starting point for educa-tors seeking effective interventions.

Evidence-Based EducationalPrograms for StvdentsWith ASD

Applied Behavior Analysis(Lovaas/Discrete Trial Training)

In 1957, noted behaviorist B. F. Skinnerextended the concept of opérant condi-tioning and rewarding positive behav-iors to verbal behavior—meaningbehavior is under the control of conse-quences mediated by other people.Skinner's research shaped the wayresearchers and educators alike lookedat behavior. His research became a cat-alyst for further investigation into howtheories of behavior, referred to asapplied behavior analysis (ABA), couldbe used within educational settings.Generally speaking, ABA is a systemat-ic process of studying and modifyingobservable behavior through a manipu-lation of the environment (Chiesa,2004). The theory characterizes thecomponents of any behavior by an A-B-C model: the antecedent to thebehavior (A; stimulus/event thatoccurs prior to the behavior), thebehavior itself (B; child's action inresponse to a stimulus), and the conse-quence (C; outcome or result of thebehavior). In recent years, the princi-ples of this theory of behavior havebeen used to create a behavior modifi-cation program sharing the samename, designed for the treatment ofindividuals with cognitive and behav-ioral deficits, including ASD.

Clinical psychologist Ivar Lovaasfirst provided evidence of the effective-ness of ABA programs for childrenwith ASD. In this seminal study(Lovaas, 1987), one group of childrenless than 4 years old received an inten-sive treatment of ABA called discretetrial training (DTT) over a span of 2 to3 years. DTT is an instructional strate-gy in which a specific task (also calleda trial) is isolated and taught by beingrepeatedly presented to the student.Responses are recorded for each com-mand and the trial is continued untilthe student demonstrates mastery ofthe task. Specifically, DTT consists of

(a) presenting a discriminative stimu-lus to the student (e.g., teacher asksstudent what sound the letter pmakes), (b) occurrence or approxima-tion of target response from the student(e.g., student attempts to make the psound), (c) delivery of reinforcing con-sequence (e.g., teacher claps handsand smiles replying with the propersound of the letter p), and (d) specifiedintertriai interval (e.g., teacher repeatsrequest after specific lapsed time).

In order to promote success, ABAprograms require consistent, intense,sometimes almost constant feedback

children who received ABA therapywere eventually able to attend classeswith their nondisabled peers. Thisresearch suggests intensive ABA inter-ventions implemented early in a child'sdevelopment can result in long-termpositive outcomes. ABA and DTT havean extensive body of research that sup-ports its use in academic and behaviorinterventions for children with ASD(Simpson, 2004) as well as other intel-lectual disabilities (Iwata et al., 1997),and are considered to be scientificallybased practices for treating individualswith ASD (Simpson, 2005).

The DIR model serves as a framework to understand thedevelopmental profile of an infant or child and the family.

and correction of a child's behavior.Therefore, intense one-on-one instruc-tion is recommended at the beginningof the intervention (e.g., 20-30 hoursper week), and parent participation iscrucial to help ensure learned behav-iors generalize across environments(e.g., home and school). As the newbehavior replaces the old behavior andbecomes more automatic, the parent orteacher implementing the interventionmust methodically lessen interactionand feedback with the child during thetargeted behavior.

Lovaas (1987) reported that nearlyhalf (47%) of the children in the ABAprogram achieved higher functioning incomparison to only 2% of the controlgroup not receiving treatment. Thoughthis particular study was criticized forquestionable research practices, it hassince been replicated with similarresults (Cohen, Atnerine-Dickins, &Smith, 2006; Howard, Sparkman,Cohen, Green, & Sanislaw, 2005). Thisbody of research includes several stud-ies which reported half (50%) of thechildren with ASD treated with ABAprior to age 4 showed significantincreases in 10, verbal ability, and/orsocial functioning (Lovaas, 1987). Eventhose who did not show dramaticimprovements had significantly betterimprovement than matched children inthe control groups. In addition, some

Developmental, Individual-Difference, Relationship-BasedApproach Model/Floortime

The Developtiiental, Individual Differ-ences, Relationship-Based model (DIR;Wieder & Greenspan, 2001) is a cotTi-prehensive, interdisciplinary approachto treating children with disabilities,specifically those with ASD. It focuseson the child's individual developmen-tal needs, including social-emotionalfunctioning, communication skills,thinking and learning processes, motorskills, body awareness, and attentionspan. The DIR rnodel serves as aframework to understand the develop-mental profile of an infant or child andthe family by developing relationshipsand interactions between the child andparent. It enables caregivers, educa-tors, and clinicians to plan an assess-ment and intervention program that istailored to the specific needs of thechild and their family. It is not neces-sarily an intervention, but rather amethod of analysis and understandingthat helps organize the many interven-tion components into a comprehensiveprogram (Wieder & Greenspan, 2001).

A vital element of the DIR model isFloortime (Wieder & Greenspan, 2001).Floortitne serves both as an interven-tion and as a philosophy for interactingwith children. It aims to create oppor-tunities for children to experience the

60 COUNCIL FOR ExcEPTtoNAL CHILDREN

critical developmental stages they arelacking through intensive play experi-ences. It can be implemented as a pro-cedure within the home, school, or asa part of a child's different therapies. AFloortime program initially involvesone-on-one experiences between theparent or caregiver and the child.These experiences are typically 20- to30-minute periods when parents literal-ly get on the floor with their childrenand interact and play in a way thatchallenges typical behaviors (e.g.,repetitive movements, isolation, inap-propriate play) and encourages appro-priate, interactive play and socializa-tion through parent-directed modelingand prompting.

This intervention aims to train par-ents and teachers to engage the emo-tions of even the most withdrawn tod-dler by entering the child's world.School systems sometimes incorporateaspects of this model into their pro-grams but generally do not make thistheir primary means of educatingyoung children with ASD. Controlledresearch supporting Floortime is limit-ed, but supports a positive outcome forchildren with ASD. A pilot study usingthe PLAY Project Home Consultationprogram (see http://www.playproject.org/), a training program for parents ofyoung children with ASD incorporatingFloortime (Wieder & Greenspan, 2001),found that nearly half (45.5%) of thechildren made signiflcant functionaldevelopmental progress through theprogram and reported a 90% approvalrating from parents involved in the pro-gram (Solomon, Necheles, Ferch, &Bruckman, 2007).

With its strong emphasis on socialand emotional development, the Floor-time model (Wieder & Greenspan,2001 ) may be a natural complement toa behavioral teaching program. Furtherresearch is needed promoting Floor-time, but it is currently being used suc-cessfully by families who prefer a play-based therapy as a primary or second-ary treatment, especially for toddlersand preschoolers (Wieder & Green-span, 2001).

Picture ExchongeCommunication System

Typical learners are constantly commu-nicating needs, wants, and desiresthrough socially acceptable verbalexpressions and physical gestures thatmay not come naturally to individualswith ASD. An increasingly commonintervention used to enhance commu-nication skills of children with ASD isthe Picture Exchange CommunicationSystem (PECS; Bondy & Frost, 1994).PECS is a multitiered program that pro-motes communication through theexchange of tactile symbols andobjects. Symbols may include photo-graphs, drawings, pictures of objects,or objects that a child is taught to asso-ciate with a desirable toy, person, oractivity.

The three instructional phases ofPECS teach a child to (a) request anitem or activity by giving a correspon-ding picture, symbol, or object tohis/her partner, (b) generalize theactivity by bringing the request symbolto the partner who may be located indifferent areas of the room, and (c)discriminate between two differentrequest symbols before bringing it tothe partner (Lund & TYoha, 2008). Thesix-phase PECS program extendsbeyond discrimination of two symbolsto the discrimination of many symbolsand incorporates more complex lan-guage exchange between intervention-ist and student (Bondy & Frost, 1994).

PECS (Bondy & Frost, 1994)requires the instructor to teach thechild to request a desired activitythrough modeling (i.e., demonstrationof desired behavior). The child isprompted by the teacher to use the tac-tile symbols to make a speciflc request(e.g., student points to picture of glassof water to express desire for a drink).It is important to create symbols thatare signiflcant and personal to thechild, which will accurately communi-cate what the child is requesting. Thechild is positively reinforced for cor-rectly using the appropriate symbolsand essentially associates the symbolwith a desired activity. This in turnincreases the probability the child willcontinue to use the symbol to requestthat speciflc activity (e.g., water break)

in the future. It is equally importantthat the child is corrected wheneverthe symbols are used incorrectly (e.g.,the child screams for drink), thereforedecreasing the chances that an inap-propriate method of communicationwill be repeated.

The various tiers of PECS (Bondy &Frost, 1994) gradually increase in com-plexity as tasks become more difflcult.Although verbal and gestural prompt-ing (e.g., pointing) may be necessaryat the beginning of each phase, itshould be faded as the student demon-strates mastery of the skill (e.g.,teacher refrains from asking the childwhich picture will ask for water oncethe child consistently uses the objectcorrectly). Teaching the child to generalize the behavior learned is criticalfor the behavior to be functional andapplicable to daily life. Behavior gener-alization is naturally incorporated intoPECS during the second stage whenthe partner physically moves fartheraway from the child, and during thethird stage when the child is taught todiscriminate between different symbols(e.g., glass of water and glass of milk).

Research supports PECS (Bondy &Frost, 1994) as a promising practice forteaching individuals with ASD how tomore appropriately communicaterequests (Carr & Felce, 2006; Ganz &Simpson, 2004; Simpson, 2005). Due inpart to the prescribed order of teach-ing, PECS may be very beneficial forindividuals who are either nonverbalor have limited communication skills.Lund and TVoha (2008) also providedpreliminary evidence that a modifledversion of PECS using objects as sym-bols in the place of pictures may beused successfully to facilitate commu-nication skills for children who havethe comorbid condition of ASD andblindness.

Social Stories

Social stories (Gray & Garand, 1993)provide a brief descriptive story forchildren to help them better under-stand speciflc social situations. Socialstories describe "a situation, skill, orconcept in terms of relevant socialcues, perspectives, and commonresponses in a speciflcally deflned

TEACHING EXCEPTIONAL CHILDREN | JAN/FEB 2011 61

style and format" (The Gray Center forSocial Learning and Understanding,n.d.). The goal of social stories is notto change an individual's behavior butrather to expose the individual to abetter understanding of an event,thereby encouraging an alternative andproper response. Less formally, theteacher and student may create per-sonalized stories that explicitly informthe child what to expect in a given sit-uation that has proven to be difflcultin the past (e.g., riding the school bus,participating in an assembly), and inturn how the child should act in theparticular situation. Social stories canbe used either to encourage replace-ment of a child's maladaptive behav-iors (e.g., screaming to get a teacher'sattention) or to promote prosocialbehaviors (e.g., introducing yourself toperson entering a room; Spencer,Simpson, & Lynch, 2008).

Social stories are typically presentedto the child before the situation occursas a way to help rehearse the scenario.For example, if a child has difflcultyriding the school bus, the teacher andstudent could develop a social storyregarding how the student shouldboard and ride the bus, and why thatbehavior is necessary. The storyshould also include positive behaviorsthat the child does well, other eventsthat may serve as behavioral triggers(e.g., other children violating student'spersonal space), and how the individ-ual could best respond to each situa-tion (Sansosti, Powell-Smith, & Kin-caid, 2004; Scattone, Wilczynski,Edwards, & Rabian, 2002). In additionto reading the story, the child mayrequire prompting during social situa-tions, and may need to practice theskill presented in the story. Recogni-tion of appropriate behavior by thestudent is vital, reinforcing appropriatebehaviors with an ultimate goal ofself-regulation and management (Spen-cer et al, 2008).

Social stories should be written andillustrated at a level in keeping withthe cognitive ability of the student theyserve. Gray developed clear guidelines(see The Gray Center for Social Learn-ing and Understanding, n.d.) for devel-oping a story, which typically ranges

from 5 to 10 sentences. Stories should:(a) deflne a speciflc target behavior ofconcern, (b) identify an appropriatereplacement behavior, (c) be writtenfrom the child's perspective, (d)include pictures or drawings to helpthe child relate to the desired behavior,and (e) include a ratio of one directivesentence for every two to flve sen-tences that are either descriptive, per-spective, or both.

Speciflcally, directive sentencesdeflne the goal of the story and provideresponses or behaviors the student isexpected to perform. Descriptive sen-

hand washing, delayed echolalia, fol-lowing directions, and usitig a quietvoice (as reviewed by Sansosti et al.,2004) ; and to decrease undesirable,maladaptive behaviors such as callingout in class (Crozier & Tincani, 2005),hitting, screaming, falling from a chair,and crying while completing home-work (Adams, Gouvousis, VanLue, &Waldron, 2004). Although full conflr-mation supporting the efflcacy of socialstories for children with ASD is prema-ture until larger scale research studiesare conducted, early flndings appear tobe very promising.

Social stories can be used either to encourage replacement of achild's maladaptive behaviors . . . or to promote prosocial behaviors.

tences provide details regarding theevent, setting, thoughts, or actions ofpeople in a similar situation. Perspec-tive sentences are usually related toconsequences or outcomes of the situa-tion and describe how other peoplemay react or feel based on the actionor inaction of the main character of thestory. Additionally, stories may includeafftrmative sentences that providestatements of social value (Ali & Fred-erickson, 2006; Sansosti et al., 2004),control sentences that reinforce the stu-dent's method of self-regulation andafflrm the right to choose, and coopera-tive sentences that provide names ofresponsive people who may assist inthe student's efforts or may be impact-ed by their choices. Some of the sen-tences may also have blanks for thestudent to fill in (AH & Frederickson,2006). As with any good story, a title,introduction, body, and conclusion areimportant elements (Ouilty, 2007). Theformat of the social story should bepredictable. It should not merely be alist of tasks, but should describebehaviors rather than simply directingthe child.

Although the research is not yetextensive, the use of social stories isconsidered a promising behavioralintervention for children with ASD(Simpson, 2005), helping to increasedesirable prosocial behaviors such as

Treatment and Educationof Autistic and CommunicationRelated Handicapped CHildren(TEACCH)

The TEACCH program has been usedto educate children with ASD for over3 decades. Based on Eric Schopler'swork in the 1970s (e.g., Schopler &Reichler, 1971), TEACCH uses struc-tured teaching, which highlights theuse of visual supports, to maximize theindependent functioning of a childwith ASD and/or other related disor-ders (Hume & Odem, 2007). TEACCHis composed of four critical, structuredteaching components: (a) physicalstructure and organization of the workspace, (b) schedules indicating detailsabout the required task, (c) work sys-tems depicting detailed expectations ofthe individual during the task, and(d) task organization explicitly describ-ing the learning task. The TEACCHsystem requires the environment to bearranged to meet the unique needs ofthe child in a given situation. Forexample, if a child is expected to per-form speciflc homework tasks, theTEACCH program requires the deskarea at home be set up in a way thatprompts the child to self-monitor per-sonal behavior while working throughthe tasks necessary to complete thehomework assignment (e.g., take outhomework, put name on page, read

62 COUNCIL FOR EXCEPTIONAL CHILDREN

directions, ask for assistance, put com-pleted homework in folder, place folderin book bag). TEACCH may also beused with older students to help pre-pare them for the workplace by maxi-mizing task independence. For exam-ple, a worker whose task it is to sortand stack different materials can useTEACCH to remain on task and effi-ciently perform the responsibilitiesrequired with minimum supervision.

TEACCH requires that the childreceive explicit instruction on how tomaximize the use of the physical workspace through either physical or visualprompts. The adult supervisor maymodel how the organized space isused to cue different performancesteps and monitor the individual asthese tasks are being mastered.Primary reinforces are frequently usedto increase desired behavior (e.g., ver-bal praise, recognition, time fordesired activity). Staff should promptand reward the student as necessary,decreasing prompts as the studentbecomes more self-sufflcient andrequires less adult supervision.

Although there have been no large-scale studies to date investigatingTEACCH, it has been found to be apromising intervention for studentswith ASD (Simpson, 2005). Studieshave demonstrated increases in fineand gross motor skills, functional inde-pendence, on-task behavior, playbehavior, imitation behavior, and otherfunctional living skills, while reducingthe need for teacher prompts (Hume &Odom, 2007; Tsang, Shek, Lam, Tang,& Cheung, 2007). TEACCH has demon-strated efficacy for children with ASDacross various ages and ability levels.

Final Tiioughts

Identifying effective interventions touse with children who have ASD canbe challenging for educators and par-ents alike, especially when various fadsand "quick-flx" solutions may receiveas much if not more press than evi-dence-based approaches. The currentemphasis on implementing evidence-based interventions leads educatorsand parents to seek out programs sup-ported by data from empirical research.Although there is a growing body of

quality research available on effectiveinterventions for children with ASD, itis still fairly limited, especially giventhe increasing prevalence rates andwide range of educational, verbal, andsocial skill deficits associated with thisdisability.

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Joseph B. Ryan (South Carolina CEC),

Associate Professor of Special Education,

School of Education, Clemson University,

South Carolina. Elizabeth M. Hughes(South Carolina CEC), Doctoral Student,

Curriculum and Instruction: School of

Education, Clemson University. South

Carolina. Antonis Katsiyannis (South

Carolina CEC), Professor of Special Edu-

cation, School of Education, Clemson

University, South Carolina. MelanieMcDaniel (Tennessee CEC), Graduate Stu-

dent, Speech and Language Pathology,

School of Medicine, Vanderbili University,

Nashville, Tennessee. Cynthia Sprinkle(South Carolina CEC), Substitute Teacher,

Hart Academy, Hartwell, Georgia.

Correspondence concerning this article

should be addressed to .ioseph Ryan,

Department of Special Education, 102

Tillman Hall Clemson University, Clemson,

SC 29634-0702 (e-mail: Jbryan@

clemson.edu).

TEAGHING Exceptional Children. Vol 43,

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Copyright 2011 CEC.

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