Cover illustration by Alfredo “Freddy” Mondragon · Freddy would draw exit signs, merging...

Cover illustration by Alfredo “Freddy” Mondragon

Summer / Fall 2005 Volume 2, Issue 2

2 Autism News of Orange County – RW Summer / Fall 2005

C O V E R F E AT U R E

Editorial TeamVera Bernard-Opitz, Ph.D., EditorTresa Oliveri, Associate Editor

Editorial BoardTeri M. Book, RN, MSN, CPNPJoe Donnelly, M.D.Andrea Walker, M.A.Janis White, Ed.D.

Advisory BoardLOCALPauline A. Filipek, M.D.

University of California, IrvineFor OC Kids

BJ Freeman, Ph.D.Autism Consultant

Wendy Goldberg, Ph.D.University of California, Irvine

Belinda Karge, Ph.D.Cal State University, Fullerton

Connie Kasari, Ph.D.University of California, Los Angeles

Marian Sigman, Ph.D.University of California, Los Angeles

Becky TouchetteSaddleback Valley Unified School District

NATIONAL/INTERNATIONALJay Birnbrauer, Ph.D.

Murdoch University, Australia

V. Mark Durand, Ph.D.University of South Florida, St. Petersberg

Patricia Howlin, Ph.D.St. Georges’s Hospital London, England

David Leach, Ph.D.Murdoch University, Australia

Gary Mesibov, Ph.D.University of North Carolina,Chapel Hill Division TEACCH

Fritz Poustka, M.D.University of Frankfurt, Germany

Salwanizah Bte Moh.SaidEarly Intervention, Autism Association, Singapore

Diane Twachtman-Cullen, Ph.D., CCC-SLPADDCON Center, Higganum, Connecticut

We are pleased to feature one of our local artists, FreddyMondragon. Read more about Freddy on page 4.

Mission StatementAutism News Orange County & the Rest of the World

is a collaborative publication for parents and professionalsdedicated to sharing research-based strategies, innovativeeducational approaches, best practices and experiences inthe area of autism.

Submission PolicyThe Autism News of Orange County RW is available free

of charge to parents and professionals of children with autism.The opinions expressed in the newsletter do not necessarilyrepresent the official view of the agencies involved.

Contributions from teachers, therapists, researchers andrelatives/children of/with autism are welcome. The editorsselect articles and make necessary changes.

Please submit articles in Microsoft Word using font size12, double spaced, and no more than four pages in length(2600 words). Photos are encouraged and when submittedwith articles the permission to include is assumed.

Please email all correspondence to: Dr. Vera Bernard-Opitz

[email protected] visit our website: www.autismnewsoc.org

C O N T E N T S

Editorial ...........................................................3

ResearchInnovative Treatment Approaches for Children with Autism ..........................................5

Precision Teaching: Making Learning Effortless ...9

Case Study Precision Teaching: Helping Roby ...11

Education/TherapyShoeboxTasks .....................................................13

Video Modeling: A Fun and Effective Approachto Teaching Appropriate Behavior .......................15

Early Intervention Services in Orange County ...17

The Interagency Assessment Centers of Orange County, California..............................18

Parent/FamilyCranpa, How’re You Feeling? ..............................21

Local Artist: Alfredo “Freddy” Mondragon............4

NewsCalender of Events ..............................................23

Summer / Fall 2005 Autism News of Orange County – RW 3

EditorialBy Vera Bernard-Opitz

Just as a very specific key is needed to open avery specific lock, treatment approaches for individ-uals with Autism Spectrum Disorders (ASD) needto be matched to the unique profile of each person.Therapists, educators and parents have to considerthe children’s/youth’s/adult’s strengths and deficits,developmental characteristics, interests, learningchannels, teaching targets and – last not least – theenvironmental context.

Instead of earlier assumptions that “one treat-ment fits all,” we now have a range of interventionsthat have become “best practices.” Still empiricalsupport for many of these interventions is scarce.Treatment comparison studies and research to opti-mize treatment to patient matches are still lonelyexceptions. What is innovative in the current appliedresearch and practice field for people with ASD? Ourpresent newsletter tries to shed some light on thisquestion. While we cannot possibly cover the exist-ing multitude of treatment and educational options,we have managed to get important contributionsfrom a wide spectrum of people involved: fromrenowned researchers and autism centers to caringprofessionals involved in developing and applyingeducational strategies and optimizing teachingmethods, materials and learning environments. Asalways, the perspective of people with ASD and theirfamilies is a crucial component of our newsletter.

The following articles can be considered highlights:• Candace Wilkinson and Marian Sigman

(University of California, Los Angeles) sum-marize the innovative treatment research pro-jects conducted at the UCLA Center forAutism Research and Treatment. In collabora-

tion with seven other autism centers in thecountry, their efforts aim at understanding theunderlying problems of autism and identifyingeffective treatments. Questions such as the fol-lowing have immediate application:

o How can repetitive behavior be con-trolled through medical interventions?

o How can children be effectively inte-grated through social skills training?

o How can parent training contribute tothe development of friendships?

o How can specific methods enhance lan-guage development?

• Judy Sylva (California State University,Fullerton) and Vera Bernard-Opitz (Editor)introduce Precision Teaching or FluencyTraining, an innovative teaching method forchildren and adolescents with ASD and otherdisabilites. Autism frequently includes a lackof spontaneity and motivation, as well as insuf-ficient generalization of learned skills.Therefore a method which breaks tasks downinto small steps, makes behavior automatic,and stresses self-motivated learning is animportant adjunct to current instruction.

• Ron Larsen, a former therapist in theTEACCH program, describes a simple idea,which has traveled to many autism centersaround the world. Known as “ShoeboxTasks,”an impressive array of work activities isdescribed, which aim at independent perfor-mance in pre-academic, fine-motor and voca-tional tasks.

• Morgan Pasqualetto and Bill Thompson(Orange County Department of Education)share their exciting work with video modelingin the Special Class at Reilly ElementarySchool. Confirming previous research, stu-dents showed a high level of interest andincreased learning in selected social skills.

• Cinda Bottorf and Janis White (RegionalCenter of Orange County) summarize excit-ing trends noted in early intervention pro-grams in Orange County. Increased emphasis

E D I T O R I A L


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By Melissa StonemanIt is not unusual for people with autism to

demonstrate a strong interest in a particular topic.For some children, it is trains, and for others, Disneycharacters. However, for Freddy, freeways reallypique his interest. Freddy has shown an attraction tofreeway systems since he was six years old. He usedto take sidewalk chalk and draw freeways on thecement outside his classroom. The detail that wasincluded in these early drawings was incredible.Freddy would draw exit signs, merging lanes, andspeed limit signs. Freddy then amused us all byinsisting the other students should follow his free-ways and road signs as they rode their bikes.

Although we all acknowledged Freddy’s out-standing artistic ability and his affinity for memoriz-ing details about freeways, we were shocked whenFreddy began drawing a freeway map of OrangeCounty on the classroom white board. The mapwas extremely detailed and surprisingly accurate.We could hardly believe it!

Since his original freeway map three years ago,Freddy has continued to expand his maps to includefreeway maps of the entire state of California, theUnited States, and Hawaii (yes, there are freeways inHawaii). He has become the “Thomas Guide” oncampus, and the staff frequently consults Freddywhen they need to know how to get somewhere.

We hope that Freddy will be able to functional-ly use these skills as an adult, perhaps working forthe OnStar Corporation.

Freddy is eleven years old and currently attendsCalifornia Elementary School in Costa Mesa,California.

Melissa StonemanTeacher – Special Schools ProgramOrange County Department of Education

Artist: Alfredo “Freddy”Mondragon

has been placed on optimizing services, involv-ing parents and providing specialized assis-tance for transitions.

• Christina Romanosky, Mark Akstinas andAndrea Walker (Orange County Departmentof Education) present the InteragencyAssessment Centers, which have become amodel in Orange County for helping childrenunder the age of 36 months. Multi-discipli-nary assessment and individualized instructionusing a range of best practices and opennessfor applied research are some of the crucialcomponents.

• Teri Book (For OC Kids) describes the per-spective of a youngster with ASD coping withthe death of his beloved grandfather. Heraccount provides an important insight intothe often hidden emotional world of peoplewith autism.

• Our artist for this newsletter is FreddyMondragon. Freddy has a special affinity fordrawing maps. Many thanks to his parentsand teacher for sharing his talents with us.

As before, we thank all our contributors for shar-ing an important aspect of their knowledge andexperience with the population we are dedicated to.We invite our readers to send in manuscripts for thecoming issue, which will focus on Integration andTransition. Hoping you all had a great summer andwill have a wonderful fall!

Vera Bernard-Opitz, Ph.D.Clin. Psych., Editorhttp://verabernard.org

Visit us online @

www.autismnewsoc.org and share it with friends and colleagues!


1. IntroductionOver the past 20 years, there has been significant

progress in identifying the core deficits in autism, inarriving at criteria for the diagnosis, and in creating andtesting diagnostic instruments that are reliable and valid.In contrast, much less progress has been made in design-ing and evaluating interventions aimed at the remedia-tion of the deficits in autism. This is true for the amelio-ration of both the core deficits and associated symptomsmanifested by individuals with autism. According to arecent survey (Green, et al., in press), parents of childrenwith autism reported using a large number of treat-ments, many of which lack empirical support. A majoraim of the UCLA Center for Autism Research andTreatment (CART) is to create and assess a set of effec-tive interventions that address the core deficits (in social,communicative, and language skills) and associatedproblem behaviors that interfere with the adaptive func-tioning of children with autism.

2. UCLA CARTThe research and treatment conducted over the past

50 years at UCLA has set the standard for many of theresearch models currently used to understand autism andidentify effective treatments. TheUCLA CART was established in2003 as part of the Studies toAdvance Autism Research andTreatment (STAART) program,funded by the National Institutesof Health (NIH). UCLA is one ofeight STAART Centers in thecountry as well as one of nine sitesin the Collaborative Programs ofExcellence in Autism (CPEA) net-work. With an emphasis on col-laboration, CART scientists con-sist of leading autism experts in avariety of areas including genetics,psychopharmacology, brain imag-ing, developmental psychologyand psychosocial interventions.

3. Summary of Treatment studiesAs shown in Table 1, the scope of current CART

research studies is wide-ranging and includes focusingon genetic risk at the molecular level to investigatinginfant-caregiver interactions as well as social interac-tions of the children with their peers and in main-stream school settings.

These studies cover nearly all of the areas outlinedin the NIH Roadmap for autism research. For exam-ple, the studies address the Autism Roadmap aim to“identify individual characteristics that predict responseto behavioral, pharmacological and other treatments.”Three studies focus on the characterization of the earlysigns of autism, genetic susceptibility and brain func-tions that underlie social communication – all are areasthat are relevant for the design of innovative treatments.The six projects that are treatment studies are describedbelow. Following the best practice guidelines for assess-ment, the Autism Diagnostic Observation Scale

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Innovative Treatment Approaches for Children with AutismBy Candace J. Wilkinson and Marian Sigman

Candace J. Wilkinson Marian Sigman

TABLE 1 Levels of investigation of CART research studiesLevel of focus

Molecular – genes

Brain function – MRI

Drug response *

Early signs of language and cognitive delay

Child’s anxiety *symptoms

Parent-child **

Parent-child-peers *

Child-peers at school *

*Treatment study

CART study (Principal Investigator)

Speech and language genetic markers in autism(Geschwind)

Functional imaging of social communication in autism(Bookheimer)

Citalopram treatment in children with ASD(McCracken)

Infants at risk of autism: a longitudinal study (Sigman)

Cognitive-behavioral treatment of anxiety in childrenwith autism (Wood)

Facilitating caregiver-child communication (Sigman); Joint attention and symbolic play intervention (Kasari)

Parent-assisted friendship training in autism (Frankel)

Peer-related school interventions in autism (Kasari)


(ADOS; Lord et al., 1999) and the Autism DiagnosticInterview-Revised (ADI-R; Lord et al., 1994) areemployed to confirm the autism diagnosis for the chil-dren enrolled in these studies.

3.1 Extension of joint attention and symbolic playintervention

It is well know that delays and deficits in jointattention and symbolic play constitute two importantdevelopmental problems in young children with autism.A recently completed study, directed by Connie Kasari,Ph.D., provides some very encouraging findings thatjoint attention and symbolic play interventions canimprove subsequent language development for chil-dren with autism (Kasari et al, in press). It examined theefficacy of targeted interventions of joint attention andsymbolic play in 58 children with autism between theages of 3 and 4 years (46 boys). Children were random-ized to a joint attention intervention, a symbolic playintervention, or a control group. Interventions wereconducted 30 minutes daily for 5-6 weeks (see ANOCOct. 2004-Vol. 1, Issue 3: Kasari C).

Results show that relative to the control group,children in the treatment groups improved significant-ly: those who received the joint attention interventionimproved in joint attention, whereas the children inthe play group intervention improved in symbolic playskills. Importantly, skills were generalized from theexperimenter to the parent and maintained over oneyear. Moreover, children in both experimental groupsmade significantly greater gains than the control groupin language development over the one-year follow-upperiod (15-17 months language gain compared to 7.5months in the control group). Language developmentby age 5 or 6 remains one of the most powerful predic-tors of good social outcome for children with autism.Thus, interventions as the one described here holdmuch promise for improvements in developmentaloutcome for children with autism.

3.2 Facilitating caregiver-child communicationWe know that the lack of joint attention character-

istic for many children with autism interferes withtheir access to the kinds of reciprocal social interactionsthat have been shown to benefit language develop-ment. The aim of the study, directed by MarianSigman, Ph.D., is to learn more about how the inter-active behavior of caregivers affects the development of

communication skills in children with autism. Thestudy includes an evaluation of a parent-training inter-vention, randomly assigned to half the subjects, thattargets communication in the context of parent-childplay interactions. The study is enrolling 80 familieswith young, nonverbal children with autism (age 6 andyounger) in one of two parent-training interventions.One group receives an intervention designed to helpparents secure the best and most appropriate servicesfor their child with autism from the State RegionalCenters and the public school system. The other groupreceives this services intervention plus specific trainingto improve playtime interactions between the motherand her child with autism.

This study builds on previous similar research inthis lab that has provided evidence for a link betweenchildren’s early nonverbal communication and subse-quent language gains over a period of 4-16 years.Language outcome of children with autism was pre-dicted by:

1) Early responsiveness to an adult’s offer forjoint attention, and

2) Parental behaviors observed during the earlyplay interactions.

That is, the children who developed superior lan-guage skills as they grew older were those with parentswho were more responsive to their children’s interestand activity during the early play interactions, as com-pared to the children of parents who were less respon-sive initially. Clearly, these findings have importantimplications for parent training, but also may be help-ful in designing more effective interventions for chil-dren with limited joint attention skills.

3.3 Peer-related school interventions in autismRegardless of age and ability, most children with

autism suffer from poor or absent peer relationshipsacross their life span. Although a number of peer inter-vention models have been employed, these models havenot been subjected to systematic comparison, nor havethey been implemented in regular school programs. Thetreatment study, directed by Connie Kasari, Ph.D.,covers a 6-week period with a 3-month post treatmentfollow-up assessment. It looks at new interventions thatcan be used in the regular school setting to improve thesocial skills and interactions of 60 higher-functioningchildren with autism (i.e., IQ of 70 or higher) who are

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integrated in typical elementary school classrooms(grades 1-5). The study’s aim is to examine the socialinclusion of children with autism in the classroom as aresult of two different targeted peer interventions, acombined intervention condition, or no treatment.Eligible children are assigned randomly to one of thefour conditions. One treatment focuses on specificallyimproving the social skills of the child with autism. Theother treatment focuses on peer engagement skills oftypical classmates with the target child with autism. Thecombined condition offers a more comprehensive inter-vention, working with both the child with autism andtheir typical peers. The no-treatment comparison groupreflects the current state of practice in local school dis-tricts, in which there are no systematic peer-relatedinterventions, just exposure to typical models. Findingswill help inform both schools and researchers about thebest methods of intervention, as well as identify whichsubsets of children might be most helped with eachintervention method. The study also will determine theindividual characteristics of child, teacher and classroomthat predict better social inclusion outcomes.

3.4 Parent-assisted friendship training in autismSocial problems are life-long problems for children

with autism and other social communication disorders,yet few effective treatments exist. Customary counselinggiven to help these children has not focused on facilitat-ing their development of friendships, because the skillsthey may learn in therapy often are not used at home orin school. Moreover, of the interventions commonlyused to improve children’s peer relations, almost nonehave used parents to promote skills at home or school.The intervention study, directed by Fred Frankel,Ph.D., focuses on improving the friendships of 100high-functioning children with autism (or Asperger’sdisorder) who are included in typical elementary schoolclassrooms from grades 1-5. This study looks at the effi-cacy of parent-assisted friendship training in compari-son with a wait-list control group over a 12-week inter-vention period and 12-week follow-up period. It isbased upon the published treatment manual, Children’sFriendship Training (Frankel, 2002).

3.5 Cognitive behavior treatment of anxiety in chil-dren with autism

As anxiety disorders are commonly diagnosed inchildren with high functioning autism (HFA), investi-gators have called for the development of anxiety treat-

ments for this specific population. Cognitive behavioraltherapy (CBT) has been found to be efficacious foranxiety disorders in typically developing children. Aunique feature of the UCLA CART is a pilot researchprogram to help fund autism projects for investigatorsnew to the autism field. The aim of a current pilotgrant study, directed by Jeffrey Wood, Ph.D., is tomodify and apply a validated cognitive behavioral treat-ment for anxiety to children with autism who also havesignificant anxiety symptoms. The study is enrolling16 children aged 7-13 years who have both HFA andan anxiety disorder. Children will be randomly assignedto immediate treatment or a 3-month wait list, thus allstudy participants eventually will receive the treatment.Using a well-designed treatment manual, the CBT pro-gram includes traditional anxiety treatment compo-nents as well as new modules specific to HFA, includ-ing emotion education, social skills/friendship skillstraining, and peer tutoring/mentoring. In addition tomultiple measures of children’s anxiety, children’s socialfunctioning and service use will be assessed to see ifCBT can also positively impact these outcomes. If CBTis found to be efficacious, it will be the first evidence-based psychological treatment to be successfully adapt-ed for children with HFA.

3.6 Citalopram treatment in children with autismspectrum disorders and high levels of repetitivebehavior

For children with autism, symptoms of repetitivebehaviors are common and frequently form a source ofsignificant interference in adapting to educational andsocial settings. These repetitive movements are also com-monly associated with emotional distress and mayinvolve tantrums and self-injurious behaviors. Whilesuch behaviors can be responsive to behavioral treat-ments, they are often difficult to manage by psychosocialefforts alone and so lead clinicians to attempt trials oftreatment with medications. Because of the success ofdrug treatment for the management of repetitive behav-iors in obsessive-compulsive disorder, and evidence sup-porting abnormalities in the serotonin system in autism,researchers have called for studies to explore the possiblebenefits of serotonergic-acting medications, such ascitalopram, for the control of these repetitive movementsassociated with autism spectrum disorders (ASD).

Directed by Dr. James McCracken at UCLA (andalso at four other sites in the STAART network), this

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research involves a 12-week, double-blind, placebo-con-trolled trial of citalopram in a sample of 144 childrenand adolescents (5-17 years old) with ASD and a highlevel of repetitive behaviors. Specifically, this treatmentstudy focuses on the frequency and severity of suchrepetitive behaviors as stereotypic movements, repeti-tion of routine behaviors, repetitive play, perseverativespeech, and over-focus on restricted interests. The studyassesses individual differences seen inthe improvement in controllingthese repetitive behaviors with suc-cessful dose response to citalopramtreatment. The study also will evalu-ate longer-term safety and tolerabili-ty of citalopram for up to 28 weeksof medication exposure.

4. ConclusionsIn conclusion, the innovative

treatment approaches being studiedwith increasingly rigorous researchdesigns are quite promising. The pre-liminary findings of the studiesreviewed here offer much hope for advancing effectivetreatments for children with autism.

As summarized in Table 2, autism treatment researchdesigns are enhanced for evaluating treatment outcomesby including key elements in the studies, namely a focuson developmental processes, individual differences, mul-timodal outcome measures and efforts to generalizeresults to wider, naturalistic settings.

While the current CART studies necessarily arelong-term research efforts, more immediate benefitsalso are available to families with children with autism(or with infants who have an older sibling with autism)who may be eligible to participate in the studies andreceive free evaluations, feedback and treatment trials.In addition to the research program, and an autismevaluation clinic (founded by Dr. B.J. Freeman), theCART mission also is to serve as a community resourceand forum for exchange among researchers, serviceagencies, practitioners and families. Additional infor-mation about all current studies, as well as details aboutthe mission and activities of the UCLA CART, can befound at the CART website (www.autism.ucla.edu).Selected References:

• Baranek GT. Autism during infancy: a retrospective videoanalysis of sensory-motor and social behaviors at 9-12

months of age. J Autism Dev Disord 29(3):213-24, 1999.• Bono MA, Daly T, Sigman M. Relations among joint atten-

tion, amount of intervention and language gain in autism.J Autism Dev Disord 34: 495-505, 2004.

• Frankel F, Myatt R. Children’s Friendship Training. New York:Brunner/Mazel Publishers, 2002.

• Green VA, Pituch KA, Itchon J, et al. Internet survey oftreatments used by parents of children with autism. Res DevDisabil., in press.

• Kasari C. Assessing change in early intervention programs forchildren with autism. J Autism Dev Disord 32: 447-461, 2002.

• Kasari C, Freeman S, Paparella T. Joint attention and sym-bolic play in young children with autism: a randomized con-trolled intervention study. J Child Psychol Psychiatr, in press.

• Lord C, Rutter M, LeCouteur A. Autism diagnostic inter-view – revised: A revised version of a diagnostic interview forcaregivers of individuals with possible pervasive develop-mental disorders. J Autism Dev Disord 24: 659-685, 1994.

• Sigman M, McGovern C. Improvement in cognitive andlanguage skills from preschool to adolescence in autism. JAutism Dev Disord 35(1):15-23, 2005.

• Siller M, Sigman M. The behaviors of parents of childrenwith autism predict the subsequent development of their chil-dren’s communication. J Autism Dev Disord 32: 77-89, 2002.

Candace J. Wilkinson, Ph.D.Director, Operations and Outreach, UCLA Center for Autism Research and TreatmentSemel Institute for Neuroscience and HumanBehavior at UCLA

Marian Sigman, Ph.D.Director, UCLA Center for Autism Research and TreatmentSemel Institute for Neuroscience and Human Behavior at UCLAProfessor, Dept. of Psychiatry and Biobehavioral Sciences and UCLA Dept. of Psychology

TABLE 2: Innovative elements for autism treatment research modelsDevelopmentalfocus:

Infants

Early childhood

School age

Adolescence

Adults

Individual differences:

Employ bestpractice mea-sures for earlydiagnosis

Match besttreatments forspecific needsof each child

Identify autismsubgroups

Generalize to widersettings:

Apply findings to naturalistic settings:

• Home• Therapy• Peers• School

Parent and caregivertraining to maximizechild’s development

Multimodal outcomemeasures:

Evaluate full range ofabilities and skills:

• Social• Language• Cognition• Emotion

Include measures toassess interactionsbetween child andcaregivers & teachers


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Seven year old Erin shuffles the stack ofsight words, takes a deep breath, sets the timerto 20 seconds and reads card after card as fastas she can: “EXIT, STOP, WOMEN, ENTER,PULL, STOP, WOMEN, .... PUSH ....” Whenshe hesitates on a card, she tosses it aside. Afterthe sound of the beeper she counts the labeledcards and adds the number to a celerationchart. She compares it to the session goal, sighs,reads the missed cards and starts all overagain. When the timer beeps the next time, shebeams, since she has reached her frequencygoal. Her therapist beams along with her andgives her a “high five”.

A timer, standard celeration charts and self-mon-itoring are some of the crucial components ofPrecision Teaching, a method, which stresses theneed for the learner to become automatic, fluent andeffortless in what he does. It can help teachers, ther-apists and parents enhance the outcome for studentswith autism, and other disabilites, as well as help thechildren have fun going fast, beating their own per-formance standards and experiencing mastery andefficacy instead of effort or failure (Kubina, et al,2002). As I write this I can concentrate on mythoughts and don’t have to worry about my fingerposition and the right letters finding the way to thecomputer screen. Such automatic production is nec-essary to do most things in life, be it talking, socialgreetings, calculating, brushing teeth or riding abike. If we stumble over words in a foreign language,chances are, that we rather refrain from talking orreading in that language and spend more time onmore familiar ways to communicate. Lack of sponta-neous speech, problems with generalization andnoted effort in a wide range of behaviors are obviouschallenges for children with Autism SpectrumDisorder (ASD).

Precision Teaching can be a helpful adjunct tocurrent instruction since it breaks teaching goalsdown into manageable components, making learn-

ing easy, enhancing speed of production, enduranceand generalizing behavior across learning channelsand settings. It is characterized by basic small teach-ing steps, which must be attained within short peri-ods of time - 10, 20, 30 or 60 seconds. Teaching ses-sions should be carried out several times a day so thatthe learned response becomes automatic and enduresover time (Pennypacker, Koenig and Lindsley, 1972;White and Haring, 1980).

Precision Teaching is a method developed in the1960s, at Harvard University, by Ogden Lindsey(Lindsley, 1990). It grew out of the tradition ofbehaviorism and direct instructions and was firsttested in a Montessori class for children with learn-ing difficulties. It is also called ‘Fluency Learning’ andhas been used successfully with university graduates,as well as students with diverse problems such asautism, attention deficit or severe intellectual disabil-ities (White, 1986). Individuals with ASD havebenefited by enhanced communication, reading,writing, play and many other skills (Leach, 1999,Leach et al, 2003; Fabrizio & Moors, 2003). Fromthe original training center at Morningside Academyin Seattle, Washington, programs have been import-ed into research centers, schools, private practicesand the homes of children (Johnson & Street, 2004).While involved teachers and parents rave aboutimproved learning, less effort in spontaneousresponding and better generalization, research docu-mentation for children with ASD is only now begin-ning and has not reached the mainstream journals.

Examples of teaching targets (Bernard-Opitz, 2005)• To develop legible handwriting, the student

practices drawing slashes, semicircles or circlesin various directions for periods of 20 or 30seconds (Vargas & Vargas, 1991). This ensuresthat the child has automated the principles ofwriting before he/she attempts to master themuch more complex task of forming letters.Based on the frequency of correct responsesduring the first 10 trials the child sets his own

Precision Teaching: Making Learning EffortlessBy Vera Bernard-Opitz


performance standards. For each improve-ment, he/she receives or – at a later stage –gives him/herself a “token”, such as a sticker, astar or a smiley face.

• Imitation is a core skill, which isdelayed or even deficient in manychildren with ASD (Sigman &Ungerer, 1983; Williams, Whiten& Singh, 2004). Getting childrento be proficient in imitation hasclear advantages, one being anincrease in observing others, whichis a basic component of social skillsand peer play (Leach, 1999). Againfluency is a main component.

• In a more advanced stage of con-cept acquisition, the children aretaught to achieve preset goalssuch as answering 20 questionsabout the calendar in one minute.They enter the number of cor-rect/incorrect responses on a loga-rithmic learning curve and try toimprove their answering rateevery day until they reach the pre-determined standard.

• Even various aspects of socialbehavior can be enhanced great-ly by using Precision Teaching,such as eye contact, joint atten-tion, social scripts or peer play.

Teaching targets requiring fluencytraining cover all curriculum areas,from matching objects into categories,talking to peers or playing a variety ofsports. Presently task sequences, mate-rials and fluency standards for personswith ASD are developed (Bernard-Opitz, 2005, Fabrizio & Moors, 2003).While case studies are promising regarding the effectof fluency training on spontaneity and generaliza-tion, more research is urgently required.

Children with Autism Spectrum Disorders pre-sent with a spectrum of challenges, which require avariety of teaching methods. Precision teaching is

one of the methods, which can helpfacilitate curricular decisions, maketeaching steps smaller and more pre-cise learning less of an effort andlearners more successful. The follow-ing case exemplifies this.

Selected References:The complete list of references can be requestedfrom the Editor at [email protected].• Bernard-Opitz, V. (2005) Autism Spec-

trum Disorders: A training manual for par-ents, teachers and therapists, (German:Kohlhammer publication; English in printin Pro Ed).

• Fabrizio, M. A. & Moors, A. L. (2003)Evaluating Mastery: Measuring Instruc-tional Outcomes for Children with Autism.European Journal of Behavior Analysis.

• Johnson, K. & Street, E.M. (2004) TheMorningside model of generative instruc-tion, Concord, Cambridge Center forBehavioral Studies.

• Kubina, R.M., Morrison, R. & Lea, D.L.(2002) Benefits of adding precision teach-ing to behavioral interventions for studentswith autism. Behavioral Interventions, 17,233-246.

• Leach, D., Coyle, C.A. & Cole, P. G. (2003) Fluency in the Classroom. In:Waugh, R. F. On the Forefront ofEducational Psychology, New York:Nova Science Publishers, Inc.

• Lindsley, O.R. (1990) Precision teach-ing: By children for teachers. TeachingExceptional Children, 22 (3), 10-15.

Vera Bernard-Opitz, Ph.D.Clin. Psych., Editorhttp://verabernard.org

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Figure 1: Fast imitation of various movements canenhance social awareness *)

Figure 2: Greeting peoplewith eye contact can bepracticed as a fluency program *)

*) Reprinted with permission fromBernard-Opitz, V. (2005) Autism SpectrumDisorders: A training manual for parents,teachers and therapists, (German:Kohlhammer publication “Kinder mitAutismus-Spektrum-Störungen”; English inprint in Pro Ed).


R E S E A R C H

Roby is a seven-year old boy in thesecond grade. At the age of four hereceived a diagnosis of autism and hasreceived services for the last three yearsunder the Individuals with DisabilitiesEducation Act (IDEA). Being the youngerof two children and the only son, he fre-quently had his needs met before he evenknew he had them! He was first placed ina special day class in a program for stu-dents with severe speech and language dis-orders at a special education preschoolcenter. He continued in a kindergarten-level special day class, but showed limitedprogress on his language and communica-tion development. At the end of kindergarten, theIEP team, including his parents, decided to fullyinclude Roby with his peers in the first grade at hisneighborhood school. In many novel situations,Roby withdraws and behaves as an on-looker. Whenhe is confronted with a somewhat unfamiliar situa-tion where he is expected to respond, he may resortto tears or quiet echolalia. He currently has the sup-port of an individual instructional assistant, a

resource specialist, a behavioral program supervisorand the general education teacher. The interventionis closely linked to the school program and substan-tially supported by his parents.

Roby’s intervention program was developed toincrease (a) meaningful and spontaneous expressiveand receptive language, (b) appropriate social inter-action with teachers, peers, and other adults, and (c)school success with typical peers. Several behavioral

Case Study Precision Teaching: Helping RobyBy Judy Sylva

Table 1: Concepts currently in fluency training

Adjectives

Addition

Subtraction

Hockey

Echoic

What...? questions

Prepositions

Receptive compliance

• Retention test (needs to be within 10% of average responding)• If retention test meets criterion then use endurance test (40 second probe)

• Endurance test (1 minute)• Depending on the results the sum will increase by one or up to 3 more

• Drop any number minus 3• For any number minus two divide into slices/lessons (e.g. 8-2)

• Give extra practice taking the ball/puck away• Put into fluency (20 sec. probes) starting easy

• Continue doing 8 and 9 syllables• Add some new cards; some with questions

• Endurance test (40 sec. probe)

• Add on top and under

• Increase to one minute• More prepositions; more complex; more actions

Roby preparing for a fluency lesson


R E S E A R C H

intervention strategies have been used to promotethese program goals; however, the purpose of thiscase study is to briefly describe the implementationand effect of precision teaching. It was hypothesizedthat the most salient barrier between Roby’s knowl-edge and its application is fluency. He doesnot have access to his fund of knowl-edge at a rate that allows him to use itin a meaningful way. Here PrecisionTeaching was considered to be help-ful (Kubina & Wolfe, 2005).

The previous overview showsRoby’s targets in fluency teaching(Table 1). The materials used are eitherflashcards, made by the therapist andRoby’s family, or actual objects from theenvironment. Most fluency probes are com-pleted in 20-second segments except for (a) those uti-lizing objects in the environment which require one-minute probes to account for movement within theenvironment and (b) echoic probes that require Robyto listen to a verbal utterance and repeat it.

The results of the probes are charted on a stan-dard celeration chart (SCC), which is used in preci-sion teaching to monitor student progress in terms ofreaching a target rate of performance and to monitor

the rate of errors (Potts, Eshleman, & Cooper, 1993).Training is required to teach paraprofessionals andteachers to utilize and interpret the SCC. They enterthe results of his fluency probes on the SCC everysession. A performance criterion is set based on thechild’s performance of each skill under a variety ofconditions.

Roby’s fluency on echoic phrases was identifiedbecause he was not making progress as quick-

ly as might be anticipated by mea-sures of accuracy and percent

correct. In order to be suc-cessful and to have theskills necessary for day-to-

day classroom activities agoal of increased fluency was

developed. In the echoic fluency example, theresponse for lesson 1 was a 6 syllable phrase, lesson 2was a 7 syllable phrase, lesson 3 was an 8 syllablephrase, and lesson 4 was a 9 syllable phrase. Examplesof the 9 syllable phrases are: “I like to ride my bike inthe park” and “The cat is under the blue table.”

Roby’s performance can also be graphed on a linechart (See Figure 1). It is clear that the boy can imi-tate phrases with eight syllables or less at an increas-ing rate without errors; however, his performance

Figure 1: Illustration of performance across and within lessons.

rate

per

min

ute

rate of errors

Lesson 27 syllables

Echoic Fluency

Lesson 38 syllables

Lesson 49 syllables

Lesson 16 syllables

rate of responding


E D U C AT I O N / T H E R A P Y

rate at nine syllables drops, and the error rate increas-es to the highest rate of any other lesson. One wouldexpect the performance rate to be at least as high asthe shorter syllable phrases. This finding indicatesthat Roby should continue to practice the longerphrases until he reaches the same performance rate asfor the shorter phrases or plateaus and reduces hisrate of errors.

In precision teaching, performance rate targets aredetermined empirically based on the student’s ownperformance (Binder, 1996). On a first-time probe anage-matched peer was shown to accurately imitate126 syllables in a series of nine syllable phrases perminute. While Roby has obviously made improve-ments in echoic fluency, he still needs some practice toexpress longer sentences more clearly and quickly.

The use of Precision Teaching in Roby’s programhas been beneficial in teaching him to use languagein a variety of settings in two different ways. First,the echoic fluency example is based on the hypothe-sis that as Roby’s fluency at echoing longer utterancesbecomes stronger he will begin to spontaneouslyexpress longer sentences in instructional and socialcontexts. Second, the use of celeration charting anddecision rules in precision teaching allow the educa-tional team to quickly identify problems and toprogress the child’s lessons at a pace that is consistentwith his learning. This improves communicationamong the educators and family members withregard to lesson planning and daily expectations forRoby’s performance in the classroom.

References• Binder, C. (1996). Behavioral fluency: Evolution of a new

paradigm. Behavior Analyst, 19 (2), 163-197.• Kubina, R.M. Jr., & Wolfe, P. (2005). Potential applications

of behavioral fluency for students with autism.Exceptionality, 13(1), 35-44.

• Potts, L., Eshleman, J.W., & Cooper, J.O. (1993). OgdenR. Lindsley and the historical development of precisionteaching. Behavior Analyst, 16(2), 177-189.

Judy Sylva, Ph.D.California State University, FullertonDepartment of Special Education

ShoeboxTasksBy Ron Larsen

The idea for ShoeboxTasks originated about 9years ago during a time when I was working as a ther-apist for the North Carolina TEACCH program, astate funded agency serving the needs of individualswith autism, their families, and involved professionals.At that time, a good portion of my work involved one-on-one sessions with young, newly diagnosed children.As you might imagine, as a fairly new therapist to theworld of autism, I learned by making many mistakesand acting upon false assumptions. Quite often, thesebeautiful young children would deconstruct myattempts to engage them in activities quicker than Icould intervene.

Despite a highly structured setting with the studentsitting opposite myself, it was often difficult to arrangethe various elements of the activity completely withoutthe student focusing on one aspect of it and acting uponit. I found out rather quickly that I did not haveenough hands to control the distinct parts of the activ-ity until such time that it could be presented to the stu-dent fully and its purpose demonstrated. It was out ofthis frustration that ShoeboxTasks began to take form.If we can accept the fact that there are no new ideas, wemight say these tasks were adaptations of many proto-types preceding them. It can also be said, at this time,that the simple, structural format of the ShoeboxTaskshas benefited many young students with autism who arebeginning the process of learning how to learn.

What are the elements that have contributed to thesuccess of using the Tasks?



• ShoeboxTasks simple, one-unit constructioneliminates the need for a teacher to set up anactivity with multiple components. Everythingneeded to complete the task is already in place,ready for the student to use.

• The clear, visual lines help to eliminate distrac-tions. The student is more apt to see the wholeunit, thereby more easily discerning the intendedpurpose of the task. By appealing to the visualstrengths of the student, the tasks are designedwith clarity of purpose in mind, attempting toeliminate confusion. The entire task becomes thefocal point of the student.

• Many of the tasks involve putting objects intoholes and watching them disappear. According toparents, this appears to be a high-interest activityfor young children with autism; however, in thehome, it comes in the form of things disappearinginto heating grates and AC units.

• Some of the tasks involve separating out the indi-vidual pieces on the lid enabling the student todeal with each piece separately. This design helpsthe student who may become confused by takinga handful of items from a container with the endresult of not knowing what to do with them. Inaddition, this design eliminates the potential forthe student to turn the task into a sensory feed-back opportunity, which can happen when smallhands come in contact with small objects.

ShoeboxTasks answer important questions for indi-viduals with autism, and they do so in a visual manner:

• What is the work? As stated before, simplicityof design makes the tasks self-explanatory or inneed of very little demonstration.

• How much work is there to do? Each task hasa set number of pieces to be manipulated. Thestudent can see these pieces and take comfort inknowing how much s/he will be working with.

• When is the work finished? When each of thepieces has been put into the designated openingand there are no pieces left to deal with the activ-ity is finished. It can then be placed into a “fin-ished basket” (a learned routine) and the studentcan enjoy a sense of completion.

• What happens next? There may be additionalactivities visible to the student’s left or it may betime for a fun activity such as computer time ordinosaur puzzles that immediately follow thework session. This is a learned routine built intothe student’s work setting.

ShoeboxTasks are being used as beginning levelactivities for young students who are beginning theprocess of learning. Individuals with autism, have moreto deal with than just doing an activity. These mayinclude the a new setting, the activity, an adult and thepresence or absence of motivation to complete the task.The learning process in life is a two-way street. This

might be a radical change in perspective for a child withautism who has been on a one-way street since birth.When considering all of the learning and adaptations,starting the structured learning experience with tasksthat are simple and lend themselves to increased inde-pendence can be helpful. It is much easier to build aprogram of learning upon layers of success.

In addition to being used as One-on-One levelactivities, ShoeboxTasks provide excellent introductionsto children learning to work independently. It is impor-



tant that students learn very early how to work inde-pendently, without the help of a teacher or peer.ShoeboxTasks allow the development of independentwork habits. The student learns to perform a numberof work activities, using a system that enables them tounderstand how much work they are to do, where they getit from, where it goes when finished, and what they willdo next. The simplicity of ShoeboxTasks helps facilitatethe process of becoming independent in such a setting.

Experience has shown that a variety of tasks ofshort duration is important to the student in the edu-cational settings.

In addition to being used by young students whoare new to the learning process, ShoeboxTasks are usedby older, more severely challenged individuals, as a wayto begin developing rudimentary vocational skills.They have also been used successfully by visuallyimpaired students who learn through touch. Researchhas not been done to establish the effectiveness ofShoeboxTasks in educational settings, although anumber of therapists are using them informally toassess a variety of instructional skills for children.

And finally, the task, Red Buttons in Water, epito-mizes why ShoeboxTasks exists. Designed in Texasduring a TEACCH training, the activity first consist-ed of a tennis ball container, an upside down card-board shoebox, and an assortment of buttons. It wasput together for a young man who resisted doing any-thing for the training team. We knew he liked waterso the idea for dropping buttons in the containerfilled with water presented itself. After watching onebutton float down the tube and disappear, he could-n’t resist doing it himself. The student liked it somuch, he became willing to perform other workactivities in order to get another turn with the but-tons. This task opened a learning door for him.ShoeboxTasks are reportedly opening doors for otherchildren on their paths to independent learning.

For further information, contact Ron Larsen, www.shoeboxtasks.com

Video Modeling: A Fun andEffective Approach to TeachingAppropriate BehaviorsBy Morgan Pasqualetto and Bill Thompson

In working with students with autism, we are alwaystrying to incorporate their unique interests and learningmodalities. It has intrigued us that while many studentsoften struggle in attending to instruction, these same stu-dents become fascinated when a video or some form ofinstructional programming is featured on TV.

One student, in our Orange County Department ofEducation’s Special Classes program at ReillyElementary School – Mission Viejo, California, reallyexemplified this fascination. “James” is a student whostruggles to remain on task in the group setting. He hasa hard time keeping his hands off instructional materials.Before you can explain the function of the items, hewants to manipulate them. Even more problematic, hewill often refuse to participate in taking turns, ratherwanting every interaction to be “his turn.” At home, he isenthralled with videos and is quick to memorize the inter-actions. At school, this tendency is also observed, as he isinstantly “locked in” to a video activity.

In reviewing the interests of James, as well as otherstudents in our program, we considered video modelingas a possible strategy. Video modeling is a method wherestudents observe filmed models “correctly” performing anidentified skill or activity. Short video clips clarify visual-ly what sequences and reinforcers to expect.

Video modeling has been used to teach a variety ofskills such as shopping (Haring et. al, 1987), conversation(Charlop & Milstein, 1989), and social skills (Quill,2000). These methods appear to enhance the speed oflearning, and lead to a higher level of generalization ofskills (Charlop, Le, and Freeman, 2000). We decided thatimplementing this tool might be of benefit, especiallywith James’ specific skill base and interests.

To put this plan into action during our social skillstraining group, the so-called “Social Club,” we sought outthe assistance of general education peers at our site.These students were excited at the opportunity of being“on film” and with their parents’ consent they acted outspecific skill sequences for the “Social Club” students.The selected social skills were taking turns during the



game of Jenga™ as well as a sharing exercise that focusedon using Legos™ to construct a tower.

We also developed video modeling snippets in thearea of critical (self help) skills such as tooth brushing, nailclipping, and walking in a line. These students performedthe exercises and we were able to edit the program so theinstructions were clear.

After we captured these specific skills on video, weshowed them to our Social Club group members. Thestudents in the group, including James, were asked towatch the short video (1 to 2 minutes) where their ‘typi-cal’ peers had acted out the selected activity. In watchingthe peers on video, our students were immediately capti-vated, displaying high levels of interest.

To reinforce the video, we presented correspondingcards featuring the photographed sequences of the activity.This provided a future outlet to fade the video instructionand access the photo sequences as the cue for the activity.

Prior to the video modeling program, a game such asJenga™ appeared to be an immense challenge for James.It is necessary for the “player” to access precise fine motorskills, problem solving, patience and restraint as one triesto remove one block from within the unstable set ofblocks and then place it on top of the tower. These sameskills are often observed as areas of weakness for James.After reviewing the videotaped model, he appeared toshow outstanding patience, even when competing in thisunfamiliar game. In addition, he kept his hands to him-self, waited for his turn, and showed outstanding problemsolving in maintaining the game.

While James made progress, there were still areaswhere he struggled in the game setting. At times, he maybecome frustrated if he is not given a specific marker or if

he is not selected to go first. Just the same, the videoshave proven to be a valuable source of information forus in continuing to refine specific activities as a way tohelp James. It also allowed us to consider what addi-tional supports might be necessary or helpful to furtheradvance James’ skills.

Viewing video segments depicting correct behav-iors and responses has had a notable impact on James.We recognize that there are a multitude of approachesfor students with autism. What works well for one stu-dent, may have a less positive effects for another. Asalways, one needs to consider the match between thestudent’s interest and learning needs when selecting

educational methods. Just the same, it appears thataccessing visual supports and integrating visual modelshas been helpful for out students.

Fortunately, this can also be a source of academicgrowth as well as fun!

Morgan PasqualettoSpeech and Language Pathologist, OCDEBill ThompsonSchool Psychologist, OCDE

With clear expectations, some students with autism are learning to enjoy games such as Jenga™.

VIDEO MODELING SUGGESTIONS

Tooth brushing1. Play the video with the students watching and

imitating the hand motions for tooth brushingwith the song (Brush your Teeth by Raffi).

2. Play the video and slowly introduce having thestudents hold their own toothbrush using theirtoothbrushes to perform the hand motionswith the song.

3. Ask the students to practice brushing the teethof a stuffed animal or baby doll.

4. Request that they brush their teeth while look-ing in a mirror. Gradually introduce toothpaste.

5. Keep the music playing and encourage to brushtheir teeth without forcing them to do so.

6. Ultimately the video and song are faded as thestudents learn to tolerate tooth brushing.

Tamara FortneySpeech and Language Pathologist, OCDE

Theresa RandallOccupational Therapist, OCDE



Early Intervention Programs that Make A Difference While current research is still being conducted, pro-

fessional opinion world-wide indicates great potentialfor early intervention services as a key to helping chil-dren with autism develop social, communication, andbehavioral skills which facilitates learning in a variety ofenvironments.

Regional Center of Orange County (RCOC) providestwo separate service streams:

• Early Start – I.D.E.A. Part C is a service forinfants and toddlers under the age of three,whose developmental skills are evaluated at one-third below typically developing peers; or chil-dren who are born with other high-risk factors orbirth events.

• Ongoing – Lanterman is the other service forthose over three who have a diagnosis of mentalretardation, autism, cerebral palsy, or uncontrolledseizures, presenting with significant disabilities.

Currently, over 2900 children are being served bythe Early Start program at RCOC. RCOC vendors 38infant programs in addition to individual therapies andApplied Behavioral Analysis (ABA) programs. FromDecember 2003 to March 2005, 83 percent of childrenexiting the Early Start program did not continue to qual-ify for RCOC services. A list of these young children ismaintained in order to track and monitor their specificprogress as they receive individualized services address-ing their unique needs. Details of this tracking list arecurrently being expanded to include outcomes informa-tion for the current 390 Early Start children on that list.Out of all the Early Start children who are determined tobe eligible for ongoing services at the age of three, 56percent have autism as part of the diagnosis.

The increasing number of toddlers and young chil-dren being identified with autism has certainly changedthe focus of many early intervention efforts in OrangeCounty over the last four years. At RCOC, substantialchanges have been made in the ways children’s develop-ment is assessed, services are provided, and families sup-ported. A team approach is utilized to determine the bestintervention plan for each child, with a focus on specificareas of delay and concern, realistic and measurablegoals, and overall child and family needs. The multidis-

ciplinary team includes the parents, the RCOC servicecoordinator, a behavior specialist, a speech-languagepathologist, along with an occupational or physical ther-apist. All members of the team participate in develop-ing and revising program plans that will provide maxi-mum benefit for each child. The plans outline develop-mentally appropriate goals which are designed tostrengthen fundamental, core learning and communica-tion abilities and social reciprocity.

RCOC specialists have also worked attentively withearly intervention program staff to set quality standardsof instruction, therapy, parent training and reporting.Regular reviews of child progress are maintained;together, we continue to develop reliable measurementtools so that we can get a true picture of a child’sprogress at frequent intervals. By looking at both devel-opmental progress and measurable outcomes, we canrefine the child’s service plan by making adjustmentsalong the way. These adjustments often improve theeffectiveness of the treatment program.

Important Components for Early Intervention ProgramsParent education and involvement - It is important for

parents to be equipped with the knowledge of characteris-tics of autism enabling them to set appropriate and realis-tic expectations. Children with autism do best with maxi-mized engagement – in other words, getting them to inter-act with people around them. Parents need to learn how toincorporate their child’s emerging skills into their family’sdaily routines, as well as how to respond appropriately toany behavioral challenges that occur.

Understanding of normal child development - Avaluable component of early intervention programs isto understand the process of typical development andcommunication, in addition to developmental mile-stones. This perspective helps understand if a behavioris really different from the norm.

Focus on the core deficits of learning - Very youngchildren with autism require specific training to learnto imitate others, to understand and use non-verbalcommunication signals, and to develop an awareness

Early Intervention Services in Orange CountyBy Cinda Bottorf and Janis White

83% of children exiting the early start program did not continue to qualify for Regional Center services.



of how their actions impact the emotions of others;they often require specific experiences to generalizenew skills to a variety of settings.

Principles of applied behavioral analysis (ABA) -ABA is a valuable tool when determining a child’s basicskill levels, the behaviors that are necessary to performfunctional tasks and the consequences to behavior thatwill help promote continued skill development.

Understanding the role of play skills in communica-tion and learning - In addition to addressing measur-able, often structured goals, intervention must also fos-ter the development of the child’s play skills and sym-bolic learning in more typical settings.

Smooth transition from early intervention programsto school and other settings is critical. To this end,RCOC provides a Transition Specialist to avoid any gapsor barriers from inhibiting the continuation of a child’sprogress. We inform and support families as childrenmove to the pre-school environment at age three and goon to work cooperatively with community preschoolsand school district programs with family approval.

Current professional consensus is that early inter-vention sets the stage for continued positive outcomesfor children with autism spectrum disorder. Early inter-vention can assist children on the spectrum in improv-ing social understanding and communication tech-niques and begin to “close the gap” in developmentaldelays. Ongoing efforts by RCOC staff and plans forthe future include continued focus on the whole fami-ly in order to provide the support, knowledge, andskills that they need for helping their child with autismgrow to his or her potential. At RCOC, we watch thetrends, monitor the latest research, and respond bydeveloping new service resources based on a best-prac-tices approach. It is important to continually seek tounderstand how autism affects the development ofyoung children and the dynamic within the family sowe can provide quality services and supports.

Cinda Bottorf, M.S., CCC-SpDirector, Developmental Assessment and Resources, Regional Center of Orange County

Janis B. White, Ed.D., CCC-SpChief Operating Officer, Regional Center of Orange County

The Interagency AssessmentCenters of Orange County,CaliforniaBy Christina Romanosky, Andrea Walker andMark Akstinas

Program OverviewThe Interagency Assessment Centers (IAC) are

one of many early intervention programs serving thespecial learning needs of children with autism. Theseprograms, which first began in South OrangeCounty, in Laguna Niguel, have become a model forinteragency collaboration. The Orange CountyDepartment of Education (OCDE), Regional Centerof Orange County (RCOC) and local school districtsare involved.

The IACs offer an extended assessment andintervention program for children 24 to 36 monthsof age with an autism spectrum disorder or a suspi-cion of the diagnosis. The program includes inten-sive classroom instruction and support services forfamilies referred by Regional Center of OrangeCounty (RCOC). The Crown Valley-IAC firstopened its doors in September 1997 in the SouthCounty area. In the early years, the program ranthree days per week for 2.5 hours. It accommodat-ed 12 children from the ages of 30-36 months whoattended either an A.M. or P.M. session. Later afourth instructional day was added. One day wasset aside to accommodate parent trainings, consul-tations, and home visits. The classroom was staffedby an Educational Specialist/Teacher and fourParaeducators providing a 5:6 adult to child ratio.To accommodate the growth in referrals the IACshave gradually expanded in the number of classesand the creation of a second center, North OrangeCounty-IAC, in Buena Park.

As a result of recommended guidelines (e.g.,Educating Children with Autism- National ResearchCouncil, 2001) in the field and support from RCOC,the IAC has evolved into a 20 hour per week pro-gram. In addition, to accommodate the high demandfor such early intervention programs, the ratio was

A team approach including parents is needed to provide the best possible Early Intervention.



modified to its current 5:7 adult tochild ratio. The program is sup-ported by a School Psychologist,Speech and Language Pathologist,Occupational Therapist, and aProgram Administrator.

Children are provided withintensive instruction in both indi-vidual and small group settings.Upon entry into the program,children are assessed by the multi-disciplinary team to obtain a base-line level of performance anddetermine programming needs.Skills are measured in the areas ofcognition, communication, adap-tive development, social-emotion-al functioning, fine and grossmotor skills, as well as sensory processing.Individualized outcomes or learning objectives arethen determined based on the unique needs of eachchild. A variety of instructional strategies andmethodologies are utilized that address the uniquelearning style of children with autism as specifiedwithin an Individualized Family Service Plan (IFSP).Some include the principles of Applied BehavioralAnalysis (ABA), positive behavioral supports, func-tional analysis, structured teaching, visual supportsand various communication strategies. While thechildren are taught new skills through direct 1:1instruction, emphasis is also placed on generalizingmastered skills across environments. In addition,classroom instruction focuses on developing eachchild’s skills in the areas of communication, play,social interaction, and self-help. Progress is measureddaily through a variety of data collection methodssuch as instructional plan sheets, behavioral chart-ing, and anecdotal notes. This data is used to helpmonitor each child’s individual gains and help iden-tify areas of need.

Parent Training and SupportParents are a critical part in the success and

growth of their child. As a result, parent training andsupport continues to be an integral part of the IAC.Parents receive monthly individual consultation

from all involved specialists. Inaddition, support staff providescenter-based trainings. Thesetrainings address topics such ascommunication and languagedevelopment, behavioral support,play-based interventions, commu-nity resources, and program tran-sition issues. In addition, parentsare encouraged to take advantageof the resources and trainings pro-vided through Regional Centerand the S.U.C.S.E.S.S. Project ofOrange County.

A Parent Support Group isconducted monthly by a ClinicalPsychologist in cooperation withOrange County Health Care

Agency. The Centers also maintain a variety ofresources for parents in the form of books, articles,and videotapes to help increase their understandingof autism, child development, and speech and lan-guage development.

Child TransitionApproximately three months prior to a child’s

third birthday, the multi-disciplinary team beginstheir final assessment. For the children who enteredthe program before 32 months of age, this reviewserves as a post-test in which families and staff canevaluate the progress the children have made. Theresults are shared not only with families, but also

September 1997:Crown Valley IAC opened

with one class

December 2001:Crown Valley IAC expanded

into second class

September 2002:North Orange County IAC

opened with one class

October 2004:North Orange County IACexpanded into second class

Tentative 2006:Central Orange County IAC

currently being planned



with districts in which the children reside. Testresults, as well as information regarding strategiesand interventions used within the IAC are critical inhelping to determine an appropriate school place-ment. Throughout the process, the preschool teamworks to ease the transition from a program thatfocuses on family needs (IFSP) to one that focuseson the students unique educational needs. At agethree an Individualized Education Program (IEP) isdeveloped. The IAC team works closely with fami-lies, receiving districts, and Regional Center to helpcreate a smooth educational transition.

Program EvaluationThe IAC uses a variety of evaluation methods

that include parent needs assessment, parent satisfac-tion surveys as well as and pre and post testing datafrom standardized instruments across the areas ofcognitive development, speech and communication,social-emotional development, adaptive behaviorand motor skills. In addition, information gatheredregarding instructional strategies and analysis ofclassroom data is utilized to help determine andmodify individual goals. The goal of early interven-tion is to give our children the necessary skills forfuture success in the least restrictive environment.Program evaluation data collected indicates thatchildren who enter the IAC demonstrate substantialgrowth in a number of developmental areas. In addi-tion, feedback from both parents and RCOC ServiceCoordinators confirm an overall high level of satis-faction with the IAC program and staff.

Community OutreachThe IAC staff has also done Ground Round pre-

sentations at local hospitals for physicians and resi-dents in training regarding early autism diagnosis andtreatment. These presentations typically include aparent of a child with autism to discuss their experi-ence with early diagnosis and intervention. This hasserved to help physicians learn how to deal more sen-sitively to early parental concerns regarding theirchild’s delays in development. The IAC also serves asa fieldwork site for physicians in training to help inunderstanding early signs of autism and effective earlyintervention strategies.

Last year, Connie Kasari, Ph.D. Professor,Graduate School of Education and InformationStudies, UCLA and her doctorial student, ConnieWong, conducted a research project which focused onfacilitating joint attention and play. Ongoing parenttraining and support was provided and will be evaluat-ed (See ANOC-Oct. 2004-Vo1. 1, Issue 3, pgs. 4-7;see also page 23 of this issue for upcoming schedule).

The Future of the Program As the rate of newly diagnosed autism cases con-

tinue to rise, the demand for quality early interven-tion programs, such as the IAC, will grow.

To help meet this need, plans are in place to cre-ate an IAC program to serve Central Orange County.The Santa Ana Unified School District, in collabora-tion with OCDE and RCOC, is currently workingtowards creating a third IAC center in Santa Ana.While each of our programs shares a common philos-ophy and vision, we also have adapted our programsto meet the unique needs of the communities weserve. OCDE and RCOC continue to be dedicatedto provide strong programs, and to work collabora-tively with families and school districts so that chil-dren with autism can realize their full potential.

Christina Romanosky, M.S.Principal, North Orange County IAC

Andrea Walker, M.A.S.U.C.S.E.S.S Project Coordinator

Mark Akstinas, M.S.School Psychologist, Crown Valley IAC


PA R E N T / FA M I L Y

Over several years Roben and David Head haveadopted four children who were exposed to illegal drugsduring the prenatal period. I know for sure they neverintended to adopt an entire brood of autistic children, butthat is exactly what happened. To say that there is nevera dull day in the Head household is an understatement.In addition to these four children, they have adopted twoadditional children, as well as having their own two bio-logical children, who are grown and living at home. Untilrecently Roben’s father also lived with the family.

Over the Christmas holidays in December 2004,Roben’s father died somewhat un-expectantly, although hehad been infirm for many years. Evan, the oldest of thechildren diagnosed with autism, had developed a specialbond with his grandfather, starting from the time he firstcame to the Head family. Roben’s dad would sit and holdEvan for hours when he was a young child as he copedwith symptoms of withdrawal.

Many people believe that children with autism are notaffectionate and do not show love and concern for otherpeople. Many people also think that these children lack asense of humor or compassion; they also believe that chil-dren with autism don’t feel emotions felt by typicallydeveloping children. Sometimes it may be hard to see thatchildren with autism do have emotion and humor.However, it’s been my experience they do have them, butthey may appear to express them differently from typical-ly developing individuals.

In the case of Evan and his grandfather, the story goesthat Evan was a frequent visitor in his Grandpa’s room.He would sit in the big, over-stuffed Lazy Boy recliner androck like crazy or watch one of a million Disney movieswith “Cranpa.” “Cranpa” enjoyed Evan’s company andwas always glad to see him and over time the two of themdeveloped a very special way to greeting each other. Evanwould see his Granddad and say “Cranpa, how you’re feel-ing?” and “Cranpa” would answer with “With my fingersson, how are you feeling?” and Evan would finish theinteraction with “With my toes, Cranpa.” This was justone of the many scripted exchanges the two of themwould have on a regular basis.

Everyone in the family got a real kick out of these lit-tle dialogues, and so it went until Grandpa passed awaysuddenly last December. After his death Roben andDavid became concerned because Evan decided to start

sleeping in his Grandfather’s bed. When the bed wasremoved Evan wanted to know why, and not wanting toupset the boy, his parents decided not to mention death,as they were unsure what Evan reaction would be. So, theytold Evan that Grandpa had moved out. “Where did hego?” asked Evan. “To heaven” was their reply. Withoutthem knowing it, Evan left the room ran down stairs andconfronted his much older sister Amy (one of the Head’sbiological children) and with plenty of drama said, “Amy,something terrible has happened, Cranpa died!”

Well this was big news to Evan’s parents who didn’tthink that he would make the connection between heav-en and death. Nor were they prepared for the depth of hisdespair. Evan insisted on sleeping on the floor in hisGranddad’s room and would wander the house recitingthe scripted conversations from his relationship with his“Cranpa.”

Roben was concerned about this unusual persevera-tive behavior but at first did not make the connectionbetween this behavior and an expression of grief. Whatshe eventually figured out was that this was Evan’s way ofexpressing loss, his remembering of his “Crandpa,” and anattempt to understand what had happened and to makesense of it in his world. The scripting was Evan’s way ofmourning his Grandfather, and keeping his memory alive.This is a more concrete way to try and remember andkeep alive the feeling they have for people that pass.Evan’s insistence on sleeping in his Grandfather’s roomallowed him, in some small way, to try and keep that veryspecial connection, a connection many people might nothave even realized existed.

Many people might wonder if a child with autismcould have appreciated the joke in the scripted interac-tion: “How are you feeling Crandpa?” This seems to meto be just the kind of joke a child with autism wouldenjoy. It is concrete, ritualistic, and can be done in manyvariations. My guess is that this was just a private jokebetween a special boy and his granddad. One of the mostimportant things to be sure of when interacting with chil-dren on the spectrum is to never underestimate them. Ifyou do, you will be caught off guard. Something I haveexperienced first hand - too many times to count.

Teri Book, RN, MSN, CPNPFor OC Kids

“Cranpa, How’re You Feeling?”By Teri Book


PA R E N T / FA M I L Y

Council for Exceptional Children (Chapter188) is the largest international professional organi-zation dedicated to improving educational outcomesfor individuals with exceptionalities, students withdisabilities, and/or the gifted. CEC advocates forappropriate governmental policies, sets of profes-sional standards, provides continual professionaldevelopment, advocates for newly and historicallyunderserved individuals with exceptionalities, andhelps professionals obtain conditions and resourcesnecessary for professional practice.

Orange County Department of Educationprovides ‘world-class’ educational programs for over163,000 students. These include General Education,Alternate and Correctional Education, OutdoorScience, Regional Occupational Program (ROP),and Special Education and Student Programs.OCDE partners with local school districts and com-munity college districts, as well as local, state andfederal governmental agencies. Staff Development,administrative, business, educational and supportservices are available.

For OC Kids is a UCI-CHOC collaborativeprogram dedicated to the earliest diagnosis and treat-ment of autism and related disorders. It is commit-ted to the support, education and empowerment offamilies and professionals. It is supported by theChildren and Families Commission of OrangeCounty.

The Regional Center of Orange County is anonprofit organization that coordinates services tomore than 14,000 Orange County residents whohave developmental disabilities. These disabilitiesinclude mental retardation, cerebral palsy, autism,epilepsy and related conditions. The RegionalCenter is operated by a volunteer board of directorsunder contract with the State of California’sDepartment of Developmental Services. The mis-sion of the Regional Center is to advocate, supportand provide services to people with developmentaldisabilities from birth through adulthood. TheRegional Center receives state and federal funding toprovide services to eligible individuals and families.

We are grateful for the ongoing sponsorship of this newsletterby the following agencies:


Upcoming Staff Development, Conferences and Parent Trainings(Partial Listing — September to December 2005)

There are several opportunities for continuing education and support that will be offered by variousorganizations. For OC Kids, the Regional Center of Orange County (RCOC), and the S.U.C.S.E.S.S.Project of Orange County strive to provide affordable fees to both families and staff. Each session has a specificfocus, some pertaining to early interventions, some with more of an emphasis on the older aged student.Registrations may be limited, therefore call early!

Date/Time/Place Topic/Speaker Dev. level Approximate Fee Contact

September 14 Overview Older students – $30 S.U.C.S.E.S.S. Project4:00 – 8:00 PM “Social Thinking– + 8 yrs and older (714) 966-4137O.C.D.E. I LAUGH Model”

M. Garcia-Winner

September 19 and 20 Links to Language Early to middle age $250 S.U.C.S.E.S.S. Project8:30 AM – 3:30 PM Training developmental levels (includes manual) (714) 966-4137O.C.D.E Pam Payne &

Lauren Franke, PhD

September 29 Transition Issues – Adolescents and $30 Regional Center of OC4:00 – 8:00 PM Adolescence into older aged students (714) 796-5330Regional Center Adulthood

Peter Gerhardt, EdD

Oct. 11 – Dec. 13 SEE-PAC - Early Materials fee only For OC KidsTuesdays, Parent Education Series (714) 939-61186:30 – 8:00 PMO.C.D.E.

October 21 Coaching Comprehension- All ages $60 S.U.C.S.E.S.S. Project8:30 AM – 3:30 PM Creating Conversation (714) 966-4137O.C.D.E. Lauren Franke, PhD

Oct. 31 and Nov. 1 “Icon to I Can” – All ages $160 S.U.C.S.E.S.S. Project8:30 AM – 3:30 PM Visual Supports within (714) 966-4137O.C.D.E. Structured Teaching

Barbara Bloomfield

November 2 Advanced Day for “Icon All ages $60 S.U.C.S.E.S.S. Project8:30 AM – 3:30 PM to I Can” (those who (714) 966-4137

have attended first level)O.C.D.E. Barbara Bloomfield

November 7 “Understanding Autism” Early to school age $25 Regional Center of OC4:00 – 8:00 PM Robert Koegel, PhD (714) 796-5330Regional Center & Lynn Koegel

December 5 Refresher Day for Links All ages $45 S.U.C.S.E.S.S. Project8:30 AM – 3:30 PM to Language (those (714) 966-4137O.C.D.E. trained in Links)

Lauren Franke, PhD

N E W S

Locations: O.C.D.E. = Orange County Department of Education – 200 Kalmus Drive, Costa Mesa, CA 92628Regional Center of Orange County – 801 Civic Center Drive, Santa Ana, CA 92702

Avoids eye contactEvita el contacto visual

Lacks creative “pretend” playCarece el juego creativo

Shows indifferenceDemuestra indiferéncia

Copies words like a parrot (“echolalic”)Repíte las palabras como un loro(“en forma de echo”)

Shows preoccupation with onlyone topicDemuestra preocupación/interésen solo un tema/asunto

Does not like variety: it’s not thespice of lifeNo demuestra interés en variedad

Shows fear of, or fascination withcertain soundsDemuestra miedo de/ó fascinación con ciertos sonidosLaughs or giggles inappropriately

Risa/reír inadecuadamente

Displays special abilities in music,art, memory, or manual dexterity Demuestra capacidades especialesen musica, arte, memoria ordestreza manual

Shows fascination with spinningobjectsDemuestra fascinación con objetosque gíran

Does not play with other childrenNo juega con otros niños

Some Examples of Autistic BehaviorAlgunos ejemplos del comportamiento de personas con autismo

• Difficulty with social interactions.Tienen dificultad para socializar con otras personas.

• Problems with speech. Tienen problemas con su lenguaje.

• Disturbed perception.Tienen una percepción anormal de los sucesos que acontecen a su alrededor.

• Abnormal play.Su forma de jugar es anormal.

• Resistance to change in routine or environment.Se resisten a cambios en sus actividad rutinarias ó a su medio ambiente.

SOME EXAMPLES OF AUTISTIC BEHAVIORALGUNOS EJEMPLOS DEL COMPORTAMIENTO DE PERSONAS CON AUTISMO

Shows one-sided interactionDemuestra interacción que es unilateral

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