Center-Based Early Intervention for Toddlers with Autism
Linda Watson1, Mark Wolery2, and Kathleen Davis1
ASHA Convention, 2001
1University of North Carolina at Chapel Hill
- Discuss the philosophy and operating principles of this intervention model for toddlers with autism
- Describe types of family support and strategies for providing support
- Describe key curricular components for toddlers with autism
- Apply strategies for implementing intervention in inclusive classrooms
Goals of Family Component
- To assist families in enhancing their children’s learning, development, and participation in society.
- To assist families in promoting the well-being of all family members, including siblings, grandparents, and other relevant extended family members.
- To assist families in being skilled and knowledgeable consumers of, and advocates for, information and services related to their children with autism and their families.
- To assist families in being optimally independent, resourceful, and confident in making decisions (with input from professionals as desired) and taking actions rather than being dependent upon professionals for decision-making and action.
- To assist families in understanding the service system, laws and regulations, and their rights.
Goals of Classroom Component
To create and maintain an inclusive classroom
- environment and teaching practices that are effective in supporting children’s learning, development, and participation in society;
- in which the physical structure, daily schedule, and teaching practices are responsive to and purposefully designed for each individual child (those with autism, without disabilities, and those with disabilities other than autism);
- environment and teaching practices in which decisions about children’s instructional programs are empirically based (based on sound clinical evidence, research, and principles derived from research);
- environment and teaching practices in which all children are participating in, and learning from, each activity;
- environment and teaching practices that are in accordance with the Operating Principles for the Family Component and support the goals of the families;
- environment and teaching practices in which other early intervention personnel can receive training;
- environment and teaching practices which include collaboration with other agencies who provide services (or will provide services in the future) for the children and families involved with the project.
Operating Principles—Decision-Making Foundation for the Project
Operating Principles for the Family Component
- Staff members are knowledgeable about autism and about community services and supports, and they share the information they have with families, and find resources and information for the knowledge they lack.
- Establishing and maintaining a positive partnership (i.e., an equal relationship with value given to different types of expertise) with families is central and foundational to providing information, support, and training.
- Staff members preserve confidentiality at all times.
- Staff members interact with families in ways that communicate hope for positive child learning and outcomes without communicating an expectation that the child will be cured of autism.
- Staff members seek and act on input from families about the program in ways that strengthen rather than weaken program-family relationships and without making families feel fearful of negative consequences.
- Information, support, and training are provided based on families’ identification of their concerns and priorities; thus, the information, support, and training must be individualized and may be delivered in
- a variety of ways, including but not limited to providing opportunities for
- families (parents, siblings, and others) to observe the child in the classroom—with and without staff interpretation of what is occurring;
- direct instruction on teaching the child at home when requested;
- talking with other parents for support;
- participating in support groups for mothers, fathers, siblings, grandparents, and others;
- visiting other programs to get information on alternative interventions;
- visiting other programs as future sites of services (e.g., transitioning to the school system);
- participating in assessments and evaluations through observation, giving information about child functioning and behavior, and discussing and interpreting the results;
(b) a variety of contexts, including in
- the home,
- the classroom and center,
- other community settings (grocery store, religious center, etc.)
- The manner in which information, support, training, and other help are provided is as important in determining its effectiveness as is the fact of its provision.
- Information, support, and training are provided using effective help-giving practices; these include (adapted from Dunst, Trivette, & Deal, 1994):
- Staff members display positive "attitudes" (e.g., warmth, honesty, caring, empathy) toward families when communicating and interacting with them.
- Staff members assume families are capable of understanding and managing their own situation and have high expectations for parents to do so.
- Staff members assist families in acquiring knowledge and capabilities and gaining access to resources by focusing on family strengths.
- Staff members are proactive (anticipate needed knowledge, capabilities, and resources) rather than being reactive (dealing with negative events).
- Staff members use active and reflective listening to assist them in understanding families’ needs, concerns, and priorities.
- Staff members assist families in identifying and clarifying their aspirations and priorities as well as their needs and concerns.
- Staff members communicate cooperation and joint responsibility with the family for addressing needs and concerns.
- Staff members encourage families to make decisions about whether to address a need, concern, or priority and about which option(s) to use if it is to be addressed; however, staff openly discuss different treatments and therapies, provide honest and accurate descriptions of them, including the potential for benefits and harms.
- Staff members accept in non-judgmental ways, families’ beliefs, views, actions, and decisions about whether and how to address needs and goals.
- Staff members are proactive in offering information, support, and training rather than waiting for families to request it; such offers include siblings and the extended family when appropriate.
- Staff members offer information, support, and training that
- is individualized for the family,
- is sensitive to and seen as typical for the families’ culture and social network,
- is congruent with the families’ view of their needs and issues,
- helps families be actively involved in improving their own lives,
- reduces families’ need for help and facilitates/enhances their abilities, independence, and feelings of competence and confidence,
- is repeated and conducted in various ways as needed, and
- does not impose a sense of indebtedness in families.
Dunst, C. J., Trivette, C. M., & Deal, A. G. (1994). Supporting and strengthening families: Vol. 1: Methods, strategies and practices. Cambridge, MA: Brookline Books.
Operating Principles for the Classroom Component
1. The intervention team uses a range of appropriate assessment tools and activities to identify goals that are relevant to the child’s developmental levels, meaningful, and functional (useful) in his/her home, classroom, and community activities.
2. The intervention team develops the IFSP or IEP so that it addresses the family’s concerns and priorities and has goals in, at least, the following key areas of functioning for young children with autism (a) attention and engagement; (b) language and communication; (c) social interaction and social skills, including proximity; (d) play’; (e) imitation; (f) self-care skills; and (g) community participation skills;
- The intervention team communicates regularly with families (a) to report on child accomplishments and progress, (b) to identify strategies that are effective in the home and potentially useful in the classroom, (c) to describe strategies that are effective in the classroom and potentially useful in the home, and (d) to identify issues and concerns raised by the family.
- Classroom staff members ensure that all children with and without autism participate successfully in all aspects of the general classroom routine (e.g., children with autism follow the same classroom activity schedule as children without autism).
- Classroom staff members work from the child’s perspective to determine structures and supports that will provide answers to questions such as, "What am I supposed to do?", "How will I know when I’m done?", and "What will I do next?"
- Classroom staff members provide structures, supports, adaptations, and instruction to promote participation and engagement (i.e., actively manipulating toys/materials in non-stereotypic ways or interacting with others or events) during all activities and routines, including child-directed activities (e.g., free play, out-door play).
- Classroom staff members engage in ongoing and informal assessment practices (e.g., using observations to write anecdotal notes as well as systematic data collection) to monitor child progress, evaluate the effectiveness of practices, and make decisions about adjusting practices.
- Classroom staff members provide specialized direct instruction and therapy to address individual goals, for the most part, in the context of ongoing classroom routines and activities.
- Classroom staff members ensure children’s individualized goals are addressed through all phases of learning, including acquisition (learning how to do skills), fluency (learning to do skills smoothly and at natural rates), maintenance (learning to use the skills after instruction has stopped), and generalization (learning to apply the skills when and wherever they are needed).
- Classroom staff members use a balance of activities throughout the day, including but not limited to the following (a) child-directed and teacher-directed, (b) acquisition and fluency, (c) individual and group, (d) mobile and stationary, (e) challenging and easy, (f) social and non-social, and (g) outdoor/community environments and indoor/classroom environments
- Classroom staff members use a variety of intervention strategies to promote the learning of individualized goals, including but not limited to the following:
- Classroom staff members use strategies such as providing choices, using the child’s interests and preferences, following the child’s lead, and expanding the child’s play to promote engagement.
- Classroom staff members use visual cues to increase children’s understanding of classroom routines and expectations.
- Classroom staff members use classroom routines and meaningful activities to promote independence and assist children in learning new skills.
- Classroom staff members use a variety of strategies (e.g., using children’s preferences, rotating toys, direct teaching, peer participation) to teach children to play with a wide range of different toys, to play with toys in a variety of ways (e.g., functionally, symbolically, constructively), and to play appropriately for extended periods of time.
- Classroom staff members recognize a range of child behaviors as communicative and place emphasis on spontaneous, independent, and socially appropriate communication by helping the child use and expand current forms of communication (e.g., speech, natural gestures, augmentative systems) to express multiple intentions (e.g., protesting, requesting, commenting, greeting) about an array of topics and content with a range of relevant partners.
- Classroom staff members use social situations, activities, and intervention strategies to promote proximity, initiation of proximity, imitation, giving and taking, game playing, reciprocal interactions, and social play with peers and adults.
- Classroom staff members use teacher assistance (e.g., prompts such as models, gestures, picture cues, verbal cues, and physical guidance) and fade those prompts using systematic strategies (e.g., graduated guidance, constant and progressive time delay, increasing assistance, simultaneous prompting, and most-to-least prompting) to teach children desired skills.
- Classroom staff members address problem behaviors by designing interventions and adapting existing structures and practices based on an assessment of the factors that are associated with the problem behavior (e.g., they recognize that tantrum behaviors may occur because of communication deficits
Family Component Arrangements and Structures
- Home visits
- Classroom observation and participation by family members
- Individual and group educational and support sessions
- Individual discussions and communications (phone, e-mail) between family, staff, and consultants
- Collaboration of staff with family, other service providers, and support systems
- Development, implementation, and review of the individualized family service plan (IFSP)
- Initiation and development of transition plans to the 3- and 4-year old service system (i.e., Part B services from the local public schools)
- Provision of feedback (in different ways) by the family to the program
- Attention and engagement
- Communication, including communicative intention, communicative means, communicative comprehension,
- Social interaction and social skills, including promoting proximity
- Play with toys/objects, equipment on the playground, and with adults and peers
- Imitation of adults and peers
- Self-care skills, including eating and self-feeding, toileting, and grooming (hand washing, bathing)
- Community participation skills