FREQUENTLY ASKED QUESTIONS

Section 1:  BASIC AUTISM INFORMATION

What are Autism Spectrum Disorders (ASDs)?

Autism is a pervasive developmental disorder that affects the functioning of the brain. Autism Spectrum Disorder (ASD) is actually not one single disorder with a well-defined set of symptoms, but rather, a group of disorders that affect an individual's behavior, social interactions, and communication skills. The most common ASDs include Autistic Disorder, Asperger's's Syndrome, and Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS).  Childhood Disintegrative Disorder and Rett's Syndrome are severe, but rare disorders included within the Autism Spectrum Disorders. These five conditions have many overlapping symptoms but differ with respect to onset, severity and exact nature of the symptoms.

Because of the significant variability in how ASDs present themselves, any two individuals diagnosed with an ASD may act quite differently and have strikingly different skills and deficits.  Signs of Autism Spectrum Disorders are evident before the age of three (typically earlier), with the condition being life-long for many individuals. Research has shown that a sizable minority of children with autism who received high quality, intensive early behavioral intervention may enter public schools requiring little to no special education supports. Many of these children no longer meet the diagnostic criteria for an ASD.

What are the characteristics of autism?

Individuals with autism display difficulties in three broad areas of development: social interactions, language and communication, and behavior. Other features that may be associated with ASDs include oversensitivity or undersensitivity to environmental stimuli (such as  taste, texture, light, sound, touch, or pain), rigidity, hyperactivity, short attention span, aggressive or self-injurious behavior, tantrum behavior, sleeping/eating difficulties, or lack of awareness of dangerous situations.

What are examples of social skill deficits seen in autism?

Significant social deficits are necessary for a diagnosis of autism.

• An individual may have poor eye contact, be unresponsive to social cues, or act as though he / she is not able to hear.

• He or she may have a lack of, or limited, joint attention. This may be demonstrated by a lack of showing, bringing or pointing out objects of interest to other people.

• There may be a lack of or diminished spontaneous efforts to share experiences, enjoyment or interests with other people.

• There may be a lack of, or limited, social and emotional reciprocity.

• Many individuals with autism do not actively participate in simple social play or games (preferring solitary activities) or may not effectively use or understand facial expressions, gestures, or other non-verbal cues. 

• There may be a failure to develop appropriate peer relationships, such as when a child may prefer (or appear to prefer) being alone and have difficulty interacting with other children.

• Another social deficit may be difficulty in recognizing the thoughts and feelings of others and/or understanding that others may have different perspectives.

What are communication and language difficulties found in autism?

As is the case with social deficits, significant language deficits are necessary for a diagnosis of autism.

• Individuals with autism may use little to no spoken language. In other cases, there may be delayed or disordered speech.
• If an individual does have speech, he or she may not be able to initiate or sustain a conversation. Individuals with autism often do not understand how to hold a conversation, are not able to consider what the other person in a conversation understands, perceives, and believes (i.e., difficulty with perspective taking), and may not tune in to non-verbal cues like facial expression, tone of voice and body language. It is important to remember that communication is as much nonverbal as it is verbal, and people with ASD have great difficulty understanding nonverbal language.
• Individuals with autism may display echolalia (repeating previously heard words or phrases in place of spontaneous language); they may not be able to use language appropriately or in context; and they may not be able to understand idioms or figurative language (i.e., interpret words and phrases literally). In addition, there may be a lack of, or limited, imaginative or cooperative play.

What are the behavioral characteristics of individuals with autism?

Behavioral characteristics vary widely both with respect to nature and degree. The diagnostic criteria for autism define (the) odd mannerisms as "restricted, repetitive and stereotyped patterns of behavior". This may include a persistent preoccupation with, or attachment to, unusual objects, parts of objects, or topics of interest.  An individual may have difficulty engaging in activities other than those within the range of his/her intense special interests.

Individuals with ASD may display stereotyped and repetitive motor movements (also called "stereotypy"), such as body rocking, spinning, hand flapping or finger flicking. Individuals with autism may engage in these behaviors excessively and with significant disruption to their learning.

Other behaviors may include an inflexible adherence to routines or rituals. Individuals with autism may resist changes in routine. They may insist on performing activities in unusual and specific ways. They may display obsessive and/or compulsive behaviors. They may have difficulty transitioning away from preferred activities and/or transitioning to less preferred activities.

It is important to note that the vast majority of behavior problems exhibited by individuals with autism serve a purpose and most have communicative intent (with the exception of those with a primary medical or sensory basis).

What is Asperger's Syndrome?

Individuals diagnosed with Asperger's Syndrome exhibit impairments in social interaction, including impairments in the use of nonverbal behaviors such as eye contact, facial expressions, body language, and social gestures.  They may fail to develop peer relationships appropriate to their developmental level.  They often lack spontaneous seeking to share enjoyment, interests, or achievements with other people, and do not engage in social or emotional reciprocity. Often, they display restricted, repetitive and stereotyped patterns of behavior, interests, and activities. Frequently, this is displayed through a persistent preoccupation with a topic or object of interest and/or excessive adherence to routines.

Individuals diagnosed with Asperger's Syndrome do not display a clinically significant delay in language or cognitive development, or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), or curiosity about the environment. This is the primary distinction between Asperger's Syndrome and Autism.

What is the difference between Autism and PDD-NOS?

A child who does not meet enough of the criteria for a diagnosis of one of the ASDs, but displays similar behaviors, or displays these behaviors at sub-threshold levels, may receive a diagnosis of Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS). In terms of interventions, PDD-NOS should, for all intents and purposes, be treated just as you would treat a diagnosis of Autistic Disorder.  The treatment should be comprehensive, intensive, and individualized to the child.

What is the relationship between Autism and IQ?

When tests of intellectual functioning ("IQ") are administered prior to intensive behavioral intervention, many children with autism receive scores that fall in the range of mental retardation. When such intellectual deficits are observed along with deficits in adaptive living skills (e.g., dressing, self care, toileting, motor skills) and when these deficits are observed prior to age 18, a diagnosis of mental retardation is given.  Tremendous scatter in the profiles of individuals with autism is often seen, marked by areas of significant deficit, as well as areas depicting average to well above average performance.  However, the overall IQ scores, taken together, may fall within the range of mental retardation. This is often in contrast to individuals with other developmental disabilities who show more flattened performance (no significant scatter across subtests).  It is for this reason that one should always examine subtest performance when evaluating or program planning for a person with autism

For some individuals with autism a secondary diagnosis of mental retardation is appropriate.  However, for other individuals, it may be the case that the IQ testing was not a true representation of their intellectual functioning. This can be based on the specific test chosen (some tests rely heavily on language and require verbal responses, as well as the ability to follow verbally presented directions) or the nature of the testing experience (was the evaluator able to establish rapport? did the child exhibit behaviors that made it difficult to follow through with the test?).  It is important to consider that the deficits in communication and social skills, along with the presence of any challenging behaviors, may make it difficult to assess intellectual functioning in a valid manner (i.e., using standardized testing). An experienced evaluator will take steps to overcome these obstacles and will likely address these issues in his/her report, particularly if the results need to be interpreted with caution. Furthermore, the evaluator will likely describe patterns in the results since IQ tests are comprised of numerous subtests, each assessing a different area.  Finally, it is recommended that intellectual testing be carried out every few years, particularly following onset of intervention, when there are improvements in communication skills or behavior.

Do individuals with ASD live a typical lifespan?

Yes, they do. There is no difference between the expected lifespan for individuals with ASD versus those without. However, it is important to acknowledge that some individuals with autism may also have significant medical problems, such as a seizure disorder, or may engage in behaviors that pose greater risk for accidents and serious injury.

Do children with ASD look different from other children?

No, in general they don't, with the exception of Rett's disorder or other conditions often associated with autism such as Fragile-X. There is no way to tell by a child's physical appearance that he/she may have any other ASD.

Do children with ASD play differently than other children?

Yes, lack of (or limited) appropriate play is definitely one of the hallmark signs to look for in a young child. A typical two-year-old will generally play alongside another child, rather than with him/her, but there is nevertheless a great deal of social interaction occurring.  Children on the autism spectrum may have a preference to be alone.  They may play with toys in an unusual manner, rather than as they were designed (e.g., a child with ASD may be more interested in turning a toy car upside down and spinning the wheels than in pushing the car back and forth. Children with ASD often engage in little to no pretend or imaginative play. The child's intervention program should target these deficit areas.

How prevalent is ASD?

Currently, the Center for Disease Control estimates that ASD occurs in 1 of every 150 individuals.  This number is in stark contrast to what has been reported in years past.

How many individuals nationwide are affected by the disorder?

Hundreds of thousands of  Americans are directly affected. In addition to those affected with autism, parents, and siblings are impacted and should receive training, education and support.

When my child was diagnosed, autism was fairly rare, or so it seemed since I had never heard of it and neither had anyone I knew.  Has it become more prevalent in recent years?

Levels of ASD appear to be rising and speculation about this increase abounds. Some argue that increase may solely be the result of improved detection, identification and diagnosis.  Autism was first added as a diagnostic category in 1980 and the definition and criteria have become more inclusive over the years. Autism is more common than childhood cancer, Down's Syndrome and diabetes combined.  In terms of number of diagnoses given, autism is the fastest growing developmental disability.   

Are gender or nationality factors in ASD?

Gender is definitely a factor, as autism is four times more likely to strike boys than girls.  ASD occurs in all racial, ethnic, and social groups, worldwide at seemingly equal rates.

If we have a child who has been diagnosed with ASD, is it more likely that our next child have autism too?

The likelihood of having a second child with autism depends upon a number of different variables.  Research continues to investigate these statistics in search of a definitive answer.  The most convincing evidence that autism is strongly genetic comes from studies of siblings.  Some studies indicate that if a family has one boy with autism, the likelihood that the next child will be born with autism is about three percent and that if the first child with autism is a girl, the possibility that another child will have ASD is as high as 12 percent (Siegel, 2003).  Other research cites somewhat higher numbers identifying an "overall recurrence risk estimate (the chance that each sibling born after an autistic child will develop autism) is 8.6%" (Ritvo et al., 1989).  Again, this research distinguishes the recurrence risks based on the gender of the first child identifying a 7% risk of having a second child on the autism spectrum if the first child is a male and 14.5% if the first child is female (Ritvo et al., 1989).  Additionally, if a family has two children with ASD, the risk that a third child will have autism is about one in three (Siegel, 2003).  It should be noted that there are clinicians who stipulate that all parents run a risk of approximately 5% for having a child with some type of developmental delay (Cook, E. as cited in Siegel, 2003).

Ritvo, E. R., Jorde, L. B., Mason-Brothers, A., Freeman, B. J., Pingree, C., Jones, M. B., McMahon, W. M., Petersen, P. B., Jenson, W. R., & Mo,  A. (1989). The UCLA-University of Utah epidemiologic survey of autism: Recurrence risk estimates and genetic counseling. American Journal of Psychiatry, 146, 1032-1036.

Siegel, B., (2003). Helping children with autism learn: Treatment approaches for parents and professionals. US: Oxford University Press.

Section 2:  EARLY DETECTION / DIAGNOSIS

When do parents usually begin to be concerned that something may be wrong?

It varies, with some parents reporting that they had concerns very early in a baby's life. Many children may show developmental differences throughout infancy, especially in social and language skills; but because they usually sit, crawl, and walk on time, these more subtle differences in social and language skills often go unnoticed, particularly when the child is a first born.  Most parents begin to be concerned that something may be wrong between the age of 12 and 18 months. Some children with ASD appear on target developmentally before age 1 or 2 and then suddenly "regress" and lose language or social skills they had previously gained.

What are some of the early signs and symptoms of ASD?

Typical infants are socially responsive to others. They smile when others smile at them and initiate smiles and laughs when playing with toys or people. By 6 months or so, babies typically respond to their own name by orienting toward the person when called. Typically developing babies are very responsive to the voices of familiar people, and often respond with smiles, looks, and facial expression. In contrast, a baby or toddler with ASD may not smile back or may smile less often than expected. He/she may not seek out cuddling like other children, may not make much eye contact with others, and/or may not respond when his/her name is called. Parents often first suspect a hearing or vision impairment.

When typical infants observe other children crying, they may pucker up join in crying. In contrast, children with ASD may seem unaware of the emotional expressions of others.  A child with ASD may appear to "tune others out". 

Failing to engage in joint or shared attention is a very important warning sign. From 10 months (or even earlier), most infants begin to join with their caregivers in looking at the same object or event. They turn to look when a parent points and says, "Look!"  By 18 months, they themselves point to show parents an interesting object or event, or pull a parent over to show them something that has caught their attention.  In contrast, young children with autism have particular difficulties in jointly attending with others. They rarely follow another person's point, and do not often shift their gaze back and forth between objects and people.

By 12 months, babies are usually babbling, even if they cannot say any understandable or intelligible words. Language delays usually prompt parents to share concerns with their child's pediatrician (often around 18 months of age). All children with autism show significant language delays.  Individuals diagnosed with Asperger's Syndrome at a later age will seem to have met language milestones during the toddler years, but their use of language may be rigid or unusual.

Imitation is a major part of baby games, such as pat-a-cake.  Young children with autism, however, may not imitate others. There may also be a lack of, or limited, pretend play. Around the end of the first year of typical development, play takes on a pretend quality; toddlers pretend to feed themselves, feed a doll, or brush a doll's hair.  Around the age of 2, children begin to engage in truly imaginative play.  In contrast, the play of children with autism may be lacking in several ways. A child with ASD may not be interested in objects, paying more attention to the movement of his / her hands, or a piece of string. If interested in toys, they may not play with them as designed.  Imaginative play does not develop.

A red flag that indicates the need for immediate evaluation is regression at any age. Many children with ASD will seem to have normal development until about 15-18 months, after which they will gradually or suddenly stop talking (if they had begun to say a few words), stop waving goodbye, stop turning their heads when their names are called, and may seem more distant and less interested in their surroundings.

Although some signs or slight delays may not be an indication of a bigger problem after all, if concerned about any aspect of your child's development, you should talk to your doctor for advice and information. Don't wait! For further information go to: www.cdc.gov/ncbddd/autism/ActEarly. 

What should I do if I suspect that something is wrong with my child?

Most parents begin to be concerned when their child is between 12 and 18 months of age. Parents should start with a screening by their child's pediatrician or nurse practitioner. If those professionals do not have experience diagnosing ASD, seek out an evaluation from a developmental pediatrician who is knowledgeable about ASD.  If autism is even a possibility, you do not want to delay the diagnosis. 70% of children who have developmental disabilities are not identified first by pediatricians, but rather by parents or caregivers.  Parents must bring their concerns to their pediatrician.  Research has shown that most parents who feel that something is wrong with their child may be quite accurate in their perceptions. If your pediatrician discounts your concerns seek a second opinion. Because best prognosis is associated with early, intensive behavioral intervention, early diagnosis and evaluation is critical!  More information about screening can be found elsewhere in this section.

At what age can a child be diagnosed with ASD?

Autism can be detected as early as 18 months (or earlier), but is often not diagnosed until later. While all children should be watched to make sure they are reaching developmental milestones on time, children in high-risk groups, such as children who have a parent or brother or sister with an ASD, should be watched even more closely. A child with any of the warning signs of ASD should be referred to a health care professional.

Autism is often diagnosed when the child is 2 to 3 years old, and the diagnosis may not occur until a child begins attending school.  However, parents often sense that something is wrong much earlier. On average, parents report that they start to worry about their child's development by 18 months of age and voice some of their concerns to a doctor or another professional by age 2.  Yet in many cases, social signs show up as early as 6 to 9 months of age, if parents and health professionals know what to look for in assessing the child.

Why is it important to get a diagnosis as early as possible?

Diagnosis is needed in order to begin intervention.  Research shows that the earlier intervention is started, the better the outcomes are for the child.  Delaying screening and referral wastes valuable intervention time when the child's brain is still forming and teaching can be most effective. Without intervention, a child's frustration in his / her inability to communicate can grow and manifest itself in behaviors such as tantrums and self-injury. Experts say that earlier treatment means a much more capable child in the years to come.

Why do pediatricians sometimes delay diagnosis?  Is there any harm in delaying diagnosis?

Some physicians and professionals are hesitant to diagnose autism at very early ages because they see many children who have slight or brief delays, and then appear to catch up and develop normally. As parents or caregivers, you see your child every day. Where you may see a pattern or ongoing concern, your pediatrician may only see shyness during the course of a brief office visit, or a mild delay. There may also be a belief that if the child is labeled with a problem too early, parents may reduce expectations for the child and restrict the child's access to typical experiences and opportunities. Thus, professionals may take a "wait and see" stance which delays diagnosis. Although such concerns may seem valid, the benefits of early diagnosis vastly outweigh the risks. These benefits include the relief parents may feel in having their concerns validated and in their ability to address the problem as early as possible. 

Many experts agree that it is harmful to delay a diagnosis. Time is of the essence, in terms of beginning intervention. Only with a diagnosis can parents begin to obtain necessary intervention services for their child.  In the preschool years, brain development is still occurring.  Many studies have now shown, early intervention is critical for the best outcomes in children with autism - indicating the earlier the intervention, the better.

With an early diagnosis, is it possible that a child will grow out of ASD? Is there a cure?

This is an area for great debate. For most children with ASD, there is no cure but children can reach their cognitive and emotional potential by starting education early. Several studies have shown that best outcomes are achieved through early intensive behavioral intervention; and with such intervention, some children have been able to achieve normal intellectual and educational functioning.  For more information, please see http://www.opposingviews.com/questions/can-autism-be-cured-or-managed).

How is ASD diagnosed? Is there a medical test?

There are no biological tests to confirm a diagnosis of autism. Identification of the condition is based on observed behaviors. In the diagnostic manual used to classify disabilities, the Diagnostic and Statistical Manual, 4th edition, (or DSM-IV), "Autistic Disorder" is listed as a category under the heading of "Pervasive Developmental Disorders." A diagnosis of Autistic Disorder is made when an individual displays 6 or more of 12 symptoms listed across three major areas: social interaction, communication, and behavior.  A child must display at least two impairments in social interaction, with at least one each in communication and in restricted, repetitive, and stereotyped patterns of behavior.  Each of the ASDs (including autism, PDD-NOS, and Asperger's Syndrome) has its own diagnostic criteria.

Why don't pediatricians screen all infants and toddlers for ASD during their well child visits?

The American Academy of Pediatrics (AAP) is urging pediatricians to do just that, and routinely screen all children for signs of autism at 18 and 24 months of age. Thus, by the age of 2, every child would receive two screenings. In November of 2007 a new clinical report was published by the American Academy of Pediatrics stating that pediatricians must be able to recognize the signs and symptoms of autism spectrum disorders and have a strategy to systematically address them. The report stated that pediatricians must also be aware of local resources that can assist in the diagnosis and management of ASD. In order to do this, pediatricians must be familiar with developmental, educational, and community resources.  The document provides a surveillance and screening method to be used by pediatricians to help them develop a strategy for early identification of children with ASD.  It is complemented by a toolkit titled, "Autism: Caring for Children with Autism Spectrum Disorders: A Resource Toolkit for Clinicians", which contains screening and surveillance tools, forms, tables, and parent handouts to assist the pediatrician in identifying, evaluating, and managing children with ASD.

"A.L.A.R.M." bullets were developed to raise physician awareness, promote surveillance and screening and ensure that all children receive early diagnosis and intervention.  The bullet points are:

• Autism is prevalent

• Listen to parents

• Act early (make screening and surveillance an important part of your practice)

• Refer to early intervention

• Monitor (through continued surveillance and follow-up)

An important distinction is made between surveillance and screening.  The AAP recommends that through surveillance, pediatricians look for risk factors at every office visit, whether it is a sick visit or a preventive care visit. ASD-specific screening tools are administered at any time if there are risk factors present. The screening tool is to be routinely administered at 18 months of age at the preventive care visit, and again at 24 months of age, to identify those who may regress after the age of 18 months.

(Complete details of the AAP recommendations may be found in Pediatrics, November 2007: Identification and Evaluation of Children with Autism Spectrum Disorders; www.pediatrics.org)

Are there other conditions that can "mimic" autism?

Yes, there are numerous characteristics and symptoms that occur in other conditions, particularly with the other pervasive developmental disorders, such as Rett's Disorder, Childhood Disintegrative Disorder, Asperger's Syndrome, and Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS). 

The DSM-IV (The Diagnostic and Statistical Manual of Mental Disorders) uses a multi-axial system that provides distinctions of criteria between disorders.  This is referred to as differential diagnosis.  When considering a diagnosis, ruling out others is an important part of the process. 

Severe or profound mental retardation may involve stereotypy and may resemble autism, however; the social and communicative functioning remains intact relative to the individual's overall level of functioning. Language and communication issues complicate the issue of differential diagnosis of autism, including Selective Mutism, Obsessive Compulsive Disorder, Reactive Attachment Disorder, Social Phobia, and Expressive Language Disorder. Other disorders in which the symptoms may mimic aspects of autism include untreated seizure disorders, stereotyped movement disorders, and other psychotic disorders.

Individuals with Asperger's Syndrome are often misdiagnosed with Attention-Deficit Hyperactivity Disorder (ADHD).  Although attentional difficulties are associated with children with an ASD, these two diagnoses cannot both be given. 

While labile mood (unstable mood) and anxiety are not uncommon in individuals with an ASD, some individuals have a co-morbid condition, meaning two or more conditions occurring within one person, such as Asperger's Syndrome and Bipolar Disorder. 

Section 3:  EVALUATING TREATMENT OPTIONS

If a child receives a diagnosis of ASD, what are the first steps parents should take?

Years ago, parents of newly diagnosed children often felt quite isolated after their child was diagnosed and found few resources to aid in helping their child.  Fortunately, things have changed dramatically. Bear in mind that obtaining a diagnosis will pave the way for treatment to commence. The sooner your child receives treatment, the better his/her outcome.

To date, applied behavior analysis (ABA) is the most effective research-based intervention for individuals with autism. Treatment can either be center-based, where your child attends a program during the day, or home-based, where trained instructors come to your home to provide service. 

Find out what programs in your area provide treatment and education based on the principles of ABA, schedule a tour of those facilities, and get your child's name on the waiting lists.  Unfortunately, you may find that your child does not receive services right away.  Time is of the essence so we encourage you to learn as much as you can about ABA.  This will allow you to be a better consumer when choosing the right program for your child; and when your child does start to receive treatment the knowledge you will gain will help you better understand the treatment provided.  Some of the other questions on this site will provide you with some specific suggestions for how to learn more about ABA. 

You may also want to think about starting a home program.  To do this you will need to find an ABA home provider, preferably a board certified behavior analyst (BCBA) that will develop and monitor the implementation of your home program.  To find a BCBA in your area, go to the behavior analyst certification board website: www.bacb.com.  In addition to the BCBA who will likely develop and oversee the treatment program, you will require several instructors to implement the program on a daily basis.  These individuals may or may not be board certified associate behavior analysts (BCaBA).  We encourage parents to learn all they can and even consider serving as an instructor.

How does educating a child with autism differ from educating a typically developing child?

Educating a child with autism is different from educating a typically developing child in many important ways.  Children with autism have difficulty learning from observation in a large group context, whereas typical children learn in this manner all the time and often with great ease. Specifically, children with autism have difficulty selecting between relevant stimuli in the environment (e.g., the teacher conducting a lesson) that should be attended to, and irrelevant stimuli that should be ignored (e.g., the hum of an air conditioner unit in the classroom). 

To help children with autism learn from their environment, tasks are broken down into smaller, more manageable units to make learning more attainable and to facilitate success.  Although regular education curricula may also reflect a careful sequence, the learning process for children with autism often needs to be developed very carefully and systematically. For instance, some children with autism may require that several prerequisite skills be targeted before they can learn to respond to directions such as, "Tell me 4 foods."  For other students with autism, skills such as color identification may require that new colors are targeted a few at a time.

When teaching children with autism, the impact of the environment (the way we teach) is continuously assessed to determine its influence on a child's behavior and acquisition of new skills.  Specifically, within an ABA program, all teaching objectives are observable and measurable to ensure that behavior change is occurring.  Data are collected to chart student progress and are analyzed daily.  This level and intensity of data analysis and modification is not usually necessary for typically developing children.

Where a typically developing child can commonly learn after one or two presentations of material, children with autism need frequent, repeated, and consistent exposure with learning materials to acquire skills.  Even after a skill has been mastered children with autism may still require repeated practice and exposure to the materials over time to ensure they maintain the skills learned.

Where typically developing children do require some level of reinforcement, usually in the form of social approval, children with autism may not respond sufficiently to social praise in the beginning of treatment. Instead, children with autism may require a continuous schedule of reinforcement when learning new skills (in the form of toys, games, preferred edibles, movies, etc.).  Initially reinforcement may need to be contingent upon every correct response to facilitate learning.  Only systematically (over time and after repeated pairings) does social praise act as a reinforcer; and sometimes, it may not take on reinforcing properties for some children with autism.

How can parents determine which treatment options are best for their child? If using multiple treatments how can I know which treatment is helping?

This is a very common dilemma, as treatment options abound and claims of success are rampant.  Parents are faced with extremely difficult choices about which treatments to pursue and about how to coordinate different treatment approaches.  The variability in how ASDs present and the range of outcomes possible with intervention make it difficult for parents to evaluate treatment claims.  Parents, understandably, are also reluctant to dismiss a claim of effectiveness, even in the absence of supporting data.  They wonder, "What if this turns out to be an important treatment and I didn't do it?" 

Yet, every treatment requires resources, including the most precious resource of time.  Time spent in ineffective intervention is also time lost to effective intervention.  This is especially relevant for young learners, considering the importance of early effective intervention.  Most families have limited financial resources as well, and need to decide what therapies to invest in, given the likelihood of success. 

Consider what research is available for any treatment you consider.  A treatment that has been proven effective for treatment of autism is a more responsible choice than one whose efficacy has not been scientifically proven.  A summary of research related to many treatment options is available through the Association for Science in Autism Treatment: www.asatonline.org. 

Behavior analysis can help with these treatment decisions, as data can be collected on a particular treatment's merit for an individual learner.  Since each learner with autism is different from every other, each learner's treatment decisions should be individualized.  Objective data is the best means of deciding on whether a particular treatment is crucial for a particular learner. 

Section 4:  APPLIED BEHAVIOR ANALYSIS (ABA)

What is Applied Behavior Analysis?

The field of behavior analysis is the science on the study of behavior.  Applied behavior analysis (ABA) is the process of using behavioral principles to study and teach socially relevant behavior, by teaching new skills and increasing desirable behaviors. ABA methods break skills down into small, measurable units and use high rates of positive reinforcement to teach each skill.  In contrast to many other treatment approaches, ABA is committed to objective measurement and data driven analysis of behavior within relevant settings, like home, school, and the community.  ABA uses many different teaching strategies to increase and maintain desirable behaviors, teach new skills, and generalize desired behaviors to new environments or situations.

The effectiveness of ABA-based intervention in ASD has been well documented through decades of research.  Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior.  Statistically, their outcomes have been significantly better than those of children in control groups.

Although ABA has received much research support as an intervention for individuals with ASD, it has also been broadly applied to general and special education, vocational skills training, self-care skill acquisition, parenting, behavioral safety, employee performance management, behavioral medicine, sports training, and providing meaningful outcomes to everyday problems in a variety of environments. Applied behavior analysis is a powerful technology of behavior change because it is ethical, conceptually sound, produces meaningful differences in peoples' lives, and is empirically validated.

What skills can be taught using the principles of Applied Behavior Analysis?

ABA uses many different teaching strategies to increase and maintain desirable behaviors, teach new skills, and generalize behaviors to new environments or situations. Beginning with very young children in early intervention programs, ABA can be extremely effective in teaching early learning skills, starting with functional communication. 

Everyone needs an effective, efficient way to request things they want and need, whether it is through speech, sign language, picture communication systems, or a more complex augmentative or alternative communication system. Other early learning skills that are the building blocks for more complex skills include imitation, receptive direction following, compliance, and joint attention. Imitation is important to target because the ability to imitate is a critical prerequisite for more complex learning.  Recent research shows that children who learn to engage in joint or shared attention do better in terms of improving IQ scores and developing functional language, so it is one of the most important skills to emphasize in early education.  Using ABA, these skills may be taught in a variety of settings through repetition and practice, using high rates of positive reinforcement.

As children age, they must be taught academic skills, self-help skills, classroom readiness, fine and gross motor skills, appropriate community behavior, play and leisure skills, pre-vocational and vocational skills, and increasingly complex social interactions.  All of these can be addressed through the principles of ABA.  The setting, the teaching ratios, and the schedule of reinforcement may change to address the age of the students, but behavioral principles are effective at teaching the full array of learning that students with ASD must incorporate into their repertoire of behaviors.  It is important to note that goals and priorities will shift as the child approaches adolescence and progresses through school.

What is "early intensive behavioral intervention" and what should it consist of?

Early intensive behavioral intervention consists of treatment and education based on the principles of applied behavior analysis (ABA).  Specifically, it should consist of a comprehensive, individualized education plan that addresses the needs of the student and includes all areas of deficits that the child displays.

• Initially foundational skills are taught (e.g., imitation, attending, matching, etc.) to provide the framework for more complex programming; and a large part of programming should be targeting the concept of learning how to learn. 

• Specific skills to be targeted should be selected with respect to whether they are developmentally appropriate, as well as whether they will be meaningful and functional for the student. 

• All facets of the program, such as the selection of target objectives, the way instructions are delivered, the rewards or methods of encouragement given, and the type of assistance or prompting provided to correct errors should be individualized to the needs and learning style of the particular child. 

• All skills taught are broken down into small, teachable units to facilitate learning.  Positive reinforcement is used to develop new skills, and data are collected to ensure the student is learning in a timely manner. 

• Teaching strategies must be modified if data analysis shows lack of student progress. 

• Additionally, generalization of skills to more natural settings (e.g., home, community, etc.), with relevant caregivers is an explicit part of a comprehensive early intensive behavioral intervention program.

• Finally, it can not be overstated that steps need to be taken to ensure that the child's motivation to learn is maximized (e.g., instructor is paired with reinforcement, effective reinforcers are well selected, reinforcement is used strategically).

I've been told that a good ABA program needs to offer my child 40 hours of therapy each week.  Is all this therapy really necessary?  How much ABA is enough?

Because autism is present 24 hours a day, 7 days a week, it requires round the clock intervention.  To ensure generalization of skills learned everyone involved in the child's life needs to maintain consistency.  Research indicates that 40 hours per week of instruction based on the principles of ABA is effective in achieving favorable outcomes for the child (i.e., transition to less restrictive settings).  Studies have shown that children receiving less than 40 hours per week did not achieve as favorable outcomes as children who received 40 hours per week for at least 2 years. 

Instruction is individualized with the child's age influencing the number of hours recommended (e.g., if a young child still requires naps 40 hours is difficult to carry out). To achieve the best outcome 40 hours is the standard from which to deviate.  The purpose of 40 hours is to provide your child with a structured teaching environment throughout the day.  Specifically, instruction based on the principles of ABA teaches your child to engage actively with his/her environment, essentially learning how to learn, whether it be at school, at home, at a recreational setting, or at a peer play date.  In summary, ABA teaches your child to learn and benefit from their environment all of their waking hours. 

Don't young children resist such structured teaching?

If the teaching truly follows the principles of ABA, there should be minimal resistance.  To achieve this, before starting to implement the structured teaching sessions, it's important that everyone working with the child establish rapport with him or her.  This procedure is also called pairing.  Specifically, if working with a young child, this pairing may involve a lot of play, singing songs, playing games, eating delicious snacks - basically having lots of fun!  With an older child pairing can involve playing video games, listening to music, completing artwork, etc.  This process is done so that the child is more apt to work with you when the structured programming begins and so that he/she knows that good things are coming.  Of utmost importance, this establishment of rapport should be ongoing as part of a good ABA program, so the child will enjoy learning and continue to want to work with you. Otherwise, task avoidance and escape issues may emerge.

In addition, to minimize resistance to the structured teaching program, targeted goals should be selected according to whether they are developmentally appropriate, meaningful and functional for the student.  Furthermore, all skills taught are broken down into teachable units to facilitate learning.  Errorless teaching (which involves immediately prompting a correct response, then systematically fading prompts to promote independence) and high rates of positive reinforcement are used to strengthen new skills and essentially create an enjoyable learning environment.  Finally, providing choice throughout the student's day (e.g., choice of rewards, activities, order of programming, teaching environment, etc.) and frequent breaks from task demands make it less likely that the student will resist structured teaching.

Can families implement intensive behavioral intervention in their homes?  If I want to implement an ABA home program, where do I begin?

Families can certainly implement intensive behavioral treatment interventions in their homes.  ABA is the treatment that has amassed the most scientific evidence of its effectiveness, and it is clearly the treatment of choice for individuals with ASD. 

ABA is implemented in a highly individualized manner.  Furthermore, behavior analysts value effectiveness of intervention greatly, and make their treatment decisions based on evaluation of objective data.  If a teaching procedure is not effective with a particular child, it is changed to ensure learner success.  So, while ABA is implemented differently and while learner outcome is variable, ABA is an effective approach across children with ASD. 

Since children are being diagnosed at such young ages, many families do consider creating home-based programs for their newly diagnosed children.  Home programs afford many advantages.  Parents can create individualized schedules that match their child's needs, with accommodations for events such as nap times.  In addition, a home-based program is usually implemented at a high level of intensity (i.e., many hours per day).  Generally, a child receives the hours of instruction that are intended, with little time lost to transitional activities that are a natural part of any classroom experience.  Parents can also be more centrally involved in programming, and can observe and participate in many of the instructional sessions (promoting opportunities for generalization of learned skills).  Furthermore, siblings can be involved in the sessions which can help them understand their sibling's special needs, and provide them with skills to interact effectively with their brother or sister. 

Disadvantages of an intensive home-based program include the actual mechanics of organizing and supervising an educational program and a limited availability of supervisory resources.  While some parents thrive on such experiences, many do not enjoy becoming the employer and manager as well as the parent.  In addition, many parents worry that they need more ongoing expertise than a home-program affords.  Even when a qualified behavior analyst can be found to supervise the program, supervision is generally less frequent than is typical in a center-based program.  Many hours of instruction take place in the absence of on-site supervision.  For children with special behavioral or learning challenges, delays in supervision can be problematic.  Finally, many families find the presence of professionals in the home to be intrusive.  Even when the presence of a professional in the home is comfortable, the home setting itself can sometimes create challenges.  Interactions between therapists and parents will likely be less formal than they would be in a school setting, which may be difficult for parents and professionals to navigate (especially if differences of opinion arise). 

I've heard that ABA can be successful for young children.  Can ABA help adolescents and adults as well?

Absolutely.  Although many people are familiar with some of the more prominent research studies that included younger children, there is an abundant and growing body of research that includes older learners. The body of ABA research that includes older children, adolescents, and young adults by far surpasses the research available for any of the other treatments for autism.

As is the case with younger children, ABA with adolescents and young adults has been used to address both the acquisition of skills and the management of challenging behaviors.  However, the focus may be on content areas that may be more relevant to older children and adults. Below you will find a list of some examples (please bear in mind that the skills that are listed in the "adult" column may be targeted with adolescents as well):

The same ABA principles are used to target various skills (such as those listed above) regardless of the age of the learner.  Although what may serve as appropriate reinforcers for a 36 year old with autism will differ from that used with a 6 year old, the principles of reinforcement are identical.  It may also be the case that we emphasize other ABA teaching strategies with adults such as task analysis and chaining as we often are attempting to teach complex chains of behaviors (e.g., at a worksite).  This may be in contrast to using procedures such as discrete trial instruction with early learners to target the acquisition of foundation skills such as matching and imitation.

Can an individual on the spectrum be too "high functioning" for ABA?

This question is often posed by individuals who may not completely understand the range of techniques that fall under the umbrella of ABA.  In fact, there are dozens of teaching strategies within ABA. A competent behavior analyst is able to make good choices about which techniques are appropriate given the characteristics of the learner and the skill being targeted. Some teaching procedures, such as discrete trial instruction, may be better suited for younger or more impaired children with autism. Clearly, individuals who are higher functioning, or who have acquired foundation skills, will likely no longer require the same level of structure, consistency, and repetition in their instruction. Nonetheless, ABA would still bear tremendous relevance. For instance:

• Fluency based instruction may be used to promote more accurate and rapid reading

• Self monitoring may be used to improve on-task performance

• Least to most prompting may be used when shadowing the individual in the  regular education classroom

• Video modeling may be used to promote social interaction

• Incidental teaching may be used to develop richer, age-appropriate conversation skills

• Shaping may be used to target appropriate hand raising in group settings

• And even Discrete Trial Instruction may be used to strengthen weak or missing foundation skills and prerequisites.

As is the case with more impaired individuals, "higher functioning" individuals with ASDs are also entitled to the benefits of an objective, individualized, and comprehensive teaching program. 

Can ABA cure my child's autism?

There are children who respond very favorably to intensive intervention using ABA.  In many cases, these children no longer meet the diagnostic criteria for any of the ASDs (some lose the diagnosis altogether).  Some people would say that these individuals are "cured" of their autism or have "recovered."  There are many children with ASD who respond very well to treatment and may be included in regular education and community activities with little to no support. In these cases, there may be some residual signs of autism, perhaps in the areas of social relatedness.  Other children will not lose the autism diagnosis, but nevertheless make substantial, meaningful progress through ABA.

This question may not be the best way to address the issue.  "Cure" versus "improvement" might be better explained from the following perspective:

1)    There is no medical test for ASD, so there is no way to prove medically that the condition of ASD has been eradicated. For other conditions such as cancer or a bacterial infection there are ways to measure the degree of the illness and to document a cure. ASD is diagnosed based on behavior so the term "cure" is problematic. 

2)    Focusing on a "cure" may lead one to believe that anything less than a cure is a treatment failure. Many of us working with children with ASD see children making tremendous gains, gains that need to be viewed and celebrated as success.

Are there some children with autism who never learn to talk? What behavioral strategies are recommended for children who do not speak?

Many children with ASD have significantly limited spoken language skills, and some will not speak at all.  It is critical that all children learn a way to effectively communicate their wants and needs, and to engage in interactions with others.  For children who cannot speak (or whose speech is not intelligible enough to be readily understood by others), alternative methods for communication (such as a picture exchange communication system, sign language, or use of a voice output device) can be taught.   

How can parents determine what reinforces or discourages a particular problem behavior?

Keeping a simple log which details occurrences of the target problem behavior can often reveal patterns.  There may be specific setting events associated with the behavior (e.g., certain times of day when the behavior is more likely to occur, or certain people with whom the behavior is more likely to occur).  There may be certain antecedents (events which occur immediately before the target behavior) which correspond to occurrence of the behavior (e.g., demands being placed, or access to desired items being removed or denied).  Certain consequences (events which occur immediately after the target behavior) may be accidentally reinforcing the behavior, thereby maintaining its occurrence. 

Looking for patterns in the variables that correspond to problem behavior (a kind of "functional assessment") can yield important information, which can then be utilized to make important decisions about future treatment of that behavior.  For best results, enlist the help of a Board Certified Behavior Analyst (BCBA) who possesses experiences assessing and treating the challenging behaviors of persons with autism.

Section 5:  FUNDING

How expensive is it to educate a child with ASD?  Who pays for this treatment?

This varies greatly, from state-to-state and depending on the type and extent of programming.  Some school districts are able to offer an appropriate program or classroom within the district; however, many districts do not have this option.  The tuition at private schools serving children with autism may currently be as much as $60,000+ per year.  For children receiving their education through a home-based program, the cost may fluctuate considerably, depending upon number of hours of service and fees of the individual service providers (which vary widely depending on degree, qualifications, training, experience, and geographic location). 

All children are entitled to a free, appropriate public education by law from the age of 3.  The child's school district is responsible for providing this education.  If the parents and the professionals within the school district (who together comprise a team to develop an IEP - or Individualized Education Plan) agree on what the "appropriate" education entails, the IEP dictates services and placement which then obligates the school district to cover the related costs.  In some cases, the parents and the district may not agree on what a child needs educationally.  If this is the case, they must go through a process to reach some agreement regarding an appropriate services and/or placement for the child.  Some parents with financial means decide to privately pay for treatment services in the interim, to ensure their child is not losing valuable time until an agreement is reached.

Children under the age of three years are not yet eligible to receive educational services through their school district.  Funding for treatment prior to age 3 is provided through early intervention (EI).  EI services are available through various state offices (the exact office varies state to state, such as the Department of Health, Department of Health & Human Services, etc.). 

Section 6:  MEDICAL

How helpful are biomedical and drug interventions?  I've heard that the drug Risperdal is now officially sanctioned by the FDA as a treatment for autism.  How does it work?  Is it really safe for my child? How do I know if my child is a candidate?

To date, there are no biological interventions that have been shown to have a major impact for the majority of learners with ASD.  There are several, such as chelation and secretin, that have been shown to be ineffective or harmful.  The adage "buyer beware" is good advice in this context. 

It is important to remember that no drug can treat or cure autism itself and that medications are used only to treat the associated symptoms of the disorder. 

Risperdal is approved by the FDA as a treatment for autism, and is potentially relevant for learners with severely challenging behavior.  It is also, however, a very powerful drug with significant side effects, and should be used with extreme caution.

Is there any scientific evidence that autism can be linked to certain vaccinations?

The possibility of a link between autism and vaccinations has been a matter of great concern to parents. Because signs of autism may appear at around the same time children receive the MMR vaccine, some parents may worry that the vaccine causes autism. The MMR vaccine protects children against the dangerous, even deadly, diseases of measles, mumps, and rubella. Carefully performed scientific studies have found no relationship between the MMR vaccine and autism. Not vaccinating children against these potentially dangerous diseases does pose a significant risk to children.

Other concerns have centered around the preservative thimerosal, which has been used as a preservative in many vaccinations. Thimerosal is metabolized to methylmercury.  High levels of methylmercury are known to be toxic. The Institute of Medicine (IOM) Vaccine Safety Committee and multiple research studies have looked for a relationship between thimerosal and autism, and they have not found a relationship. In 2004, a report by the IOM concluded that there is no association between autism and the MMR vaccine, or vaccines that contain thimerosal as a preservative. Today, pediatric vaccines in infant schedules do not use thimerosal as a preservative. Vaccine lots containing thimerosal expired in January of 2003.

Section 7:  ADOLESCENCE

What amount of information is appropriate to share with my adolescent with autism about sexuality?

Sexual education is a crucial part of growing up and becoming an adult.  Determining how much information to share with your son or daughter about sexuality depends upon the appropriateness of the material relative to his/her needs and level of understanding.  Gather information and consider various presentation options.  Provide accurate terminology and information.  "Teaching appropriate behavior is an underlying foundation to any sexuality curriculum.  Students must learn appropriate expressions of physical affection, and should know the differences in private and public behavior" (Committee on Children with Disabilities, 1996). 

Early childhood and primary curricula often involve teaching children appropriate names for body parts, including sexual organs.  As children mature, teach skills which are individualized for your child's comprehension level.  Target skills may include correct names and functions of body parts, the differences between boys and girls, elements of reproduction and pregnancy, qualities of a good relationship, puberty and the bodily changes that arise, decision making skills and consequences, social responsibility, and avoiding and reporting sexual abuse. At the teenage years, teach your teen about self-care, communication, dating, love, abstinence and birth control, safe sex and STDs,  and responsibilities of child-bearing.

Proactive education is recommended.  Assertiveness training and learning about good versus bad touch can be important aspects of sexuality education.  Observe any behaviors that could be indicative of the need for sexual education (e.g., masturbation), and teach discrimination skills of where and when these behaviors can occur.  For example, telling individuals with an ASD that they can masturbate in the bathroom could become a serious problem if they engage in that behavior in a public bathroom.  Conversely, waiting until a problematic behavior occurs may make it more difficult to deal with.

Much sexuality education is based on preventing negative aspects of sexuality.  Although this is necessary, it is equally important to provide accurate information and appropriate skills to view sexuality as a natural and healthy part of life.  Finally, it is important to note that rates of homosexuality are likely the same in persons with ASD as they are in those without ASDs.

My child with autism is going through puberty.  Are there any resources to help get him/her through these impending changes?

Depending upon the type of information you choose to impart to your child, there are various books, videos, and websites with helpful information.  In general, it is recommended to present concrete (vs. abstract) material, that may include videos, photos or drawings.  Social stories and comic strip conversations similar to those created by Carol Gray (or the Gray Center, www.thegraycenter.org) can also be used to teach or emphasize key concepts.  Information is best presented in real-life settings with frequent repetition.  Individuals with an ASD will typically require some level of individualization to properly grasp the pertinent information. 

The following resources may be very helpful:

The article, Sex Education and Children and Young People with an ASD, found on the National Autistic Society website, covers a variety of commonly asked  questions such as "How do I explain puberty to my child?," and "When should I speak to my child?" as well as topics of masturbation, private versus public, personal hygiene, relationships, sensory issues, and inappropriate behaviors:  www.autism.org.uk/nas/jsp/polopoly.jsp?d=1064&a=6001.

The Organization for Autism Research (OAR) website (www.researchautism.org/resources) offers the following two downloadable guides:  Life journey through autism: An educator's guide. (2004) and Life journey through autism: A parent's guide to research (2003).

Downloadable sexual education manuals for parents or educators can be found at www.albany.edu/aging/IDD/docs.htm.  Materials can be hand selected to choose what is appropriate to teach.  The manuals provide information on numerous topics including masturbation, pictures of body parts, discussion of good/bad touch with photographs, and information about sexually transmitted diseases.

Various books with social stories and related materials are available through www.thegraycenter.org.  This website also provides some free social stories related to privacy and sexual development.

Additionally, the following three books may be helpful:

The Complete Guide for Transitioning to Adulthood for those with Autism and Asperger's Syndrome

Jed Baker (2005)

Autism, Asperger's, & Sexuality 

Jerry and Mary Newport (2002)

Asperger's Syndrome and Sexuality:  From Adolescence through Adulthood

I. Henault (2002)

Section 8:  FAMILY SUPPORT

How can I explain my child's diagnosis and specific needs to my extended family? 

Start with some basic information regarding autism. Provide extended family members with some written materials or ask them to visit a familiar website which provides basic autism information. Of course, we are biased toward our own website.  Discuss the information that you have shared or information they have heard through media or other means.  Talk about what an autism diagnosis means for your child and remind extended family that every individual with autism is an individual with unique needs.  Provide guidance about successful ways to facilitate interactions with the child with autism.  Discuss how autism has affected your family and in what ways it may change established family patterns.  Finally, be aware that they may have some misinformation about autism, its cause, and its treatment that may need to be clarified or corrected.

How can extended families best support their family members who have a child with autism?

Let the child's parents know that you are available to help and ask how you can be supportive. Do not assume that you have a clear sense as to what it is like to raise a child with ASD.  Be prepared to be specific in the ways you can help, but be open to the possibility that there may be ways that you can be helpful that you have not considered. Only offer what you are able to provide so that there are no false expectations. Don't be offended if parents or caregivers are not able to take advantage of your offer.  What you are able to provide and what may be needed are not always a match.  Honor specific requests to be consistent with changing behaviors and expectations.  Parents are in the best position to know what will work to meet the current needs of their family.  Sometimes just being on the other end of the phone to listen, even when you don't have advice to offer, is a great help.

My grandchild has autism. What can I do to build a relationship with my grandchild with autism? 

Remember that your grandchild is a child first and a child with autism second.  Learn about any specific needs your grandchild may have through observation or asking his / her parents.  Respect boundaries parents may have regarding a relationship as parents know their children best.  If your grandchild is unable to communicate, let Mom and Dad know that you would like to build the relationship and ask their advice as to how you should proceed. As with typical children, sometimes parents learn as children develop.  Practice patience, parents may not have all the answers. A different approach may be necessary for building this unique relationship, but one well worth the extra effort and understanding.

How can I help my typical children to understand and cope with their sibling's diagnosis?

Talk about the diagnosis on a level your typical child can understand.  Share examples of the differences your typical child may see or hear including the fact that an individual with autism does not necessarily understand the world as most of us do.  They have much to learn about what is socially appropriate and relevant to others.  Let your typically-developing child know that you are available for any questions.  Obtain age appropriate reading material from libraries or autism agencies that discuss autism and read them together.  There is a guide specifically for siblings and peers that you can read about in the Resources section of our website.

 If possible, schedule alone time to spend with each of your children individually.  Share the positive moments and listen when your typical children experience situations where they become frustrated.  You may not be able to change a situation, but you can acknowledge that life with autism can be frustrating.  Be prepared for family outings.  Prior to an event discuss what other family members can do if the child with autism needs specific assistance or has a meltdown, or if your attention is needed elsewhere.  Embarrassment is a normal emotion for siblings, which can change over time.  If your child comes to you and is upset, listen and try to problem solve solutions together.  Talk about your children's strengths and strive to share common interests as a family. 

Are there any tips to help our family plan a successful vacation with our child with autism?

When planning a trip, take into consideration your child's specific needs.  Will there be food that he/she will eat?  Are travel arrangements satisfactory?  How far away are the bathrooms?

Discuss the upcoming trip with your child.  Prepare him / her by putting the information on your calendar.  Create a scrapbook with all the people and places you will be visiting and discuss with your child prior to leaving.  Take some time to visit an airport or train station prior to your departure to help your child become familiar with different surroundings.  This will also help him/her become familiar with the route and what is expected of him/her as a passenger once the departure date arrives. Bring a familiar toy or blanket if possible along with plenty of reinforcers for rewarding appropriate behavior. 

Once you arrive, a daily picture schedule of each day's activities may help your child adjust to the many changes taking place.  Try to maintain regular eating and sleeping schedules as much as possible.

Are there any tips or resources to help our family successfully manage the holidays?

Whether it's Halloween, Thanksgiving, Hanukkah, or Christmas, advanced preparation could reduce stress and bring many rewards for your family.  Prepare your child ahead of time.  If he/she has a picture schedule, a daily log, or a monthly calendar, use these tools to keep your child aware of upcoming events. 

Occasions such as Halloween might warrant careful planning and practice. Adapt the

costume to your child's needs before Halloween and have him/her practice wearing it. Pretend you are going door-to-door in an effort to teach the behavior you expect from your child.  Be mindful that many Halloween customs may have components that are physically uncomfortable for persons with ASD (e.g., hats, masks).

Thinking of attending a family gathering over the holidays?  Consider transportation first.  If your child has never been on a plane/train/bus before, visit an airport, ride a train or take a bus prior to the scheduled departure.  In these times of heightened national security, traveling can be very stressful.  Contact your travel agent or transportation department to find out if there are accommodations for children with special needs.  Prepare your own travel needs in advance so that if your child engages in unexpected or challenging behaviors, you can focus on the needs of your child without the added stress of what to pack, where to park or where to stay at the last minute.

Respond to invitations with open communication.  Let the host know of your child's special needs in advance.  Discuss behaviors that might occur and ask the host to consider letting other guests know what behaviors they may see. Consider asking the following questions:  Is there a quiet room where your child can watch a movie in the event that the party is overwhelming? Are there pets?  Think of questions that are specific to your child, such as would you mind not hugging my child?

Knowing what to expect and preparing your child with examples may prevent or minimize challenging behaviors. Remember to bring toys, videos, snacks, etc. that are familiar and rewarding for your child. Manipulating the environment may provide the comfort and security your child needs to enjoy the occasion.

If you are hosting an event and would like to invite a child with autism who has special needs, consider the following suggestions: 

• Arranging a child's environment can make all the difference in his ability to participate successfully. Talk with the parents ahead of time to see what they think their child may need. During the party, you may have your hands full entertaining and not be able to make the necessary accommodations so advance planning is quite helpful.
• Ask how you can make the event an enjoyable occasion for all who attend. You may need to make modifications for some of the activities. Parents will greatly appreciate you taking the time to find out more about what their child needs.
• Are there dietary concerns?  If so, invite the parent to bring special foods.  Display the special foods with as much care as you would other menu items. 
• Don't be offended if, after all your concern, the entire family does not attend.  Support their decision; sometimes a parent knows that their child just can't handle a social event on that particular day.
• Have a plan in place, or a special person the parent can turn to if a child is having a tough time adjusting to a different environment. 

Remember, invite the child first and the disability second. 

How do I broaden my knowledge as a parent?

There are a variety of ways that parents can broaden their knowledge base:

Are there ABA conferences I should attend as a parent? How do I find details about these events?

There are numerous conferences that are available to parents. Please note that many host presentations about autism treatments that have never been scientifically validated. The PPP SIG encourages parents and professionals to seek out information about treatments in which there exists scientific support. Conferences that emphasize science-based information about Autism treatment can be found by visiting the SIG website. Your local chapter of the Autism Society of America may post conference information but bear in mind that many of the topics presented may relate to treatments that have not been scientifically validated.

With respect to the behavior analytic treatment of Autism, the annual meeting of the Association for Behavior Analysis meets every year in late May. This conference is typically held on the Memorial Day weekend. There is a section of this website dedicated to that event (please view About the ABA Conference). Many of the state chapters of the Association for Behavior Analysis also host annual events (please view About Other Conferences).

There are so many ABA conferences out there. How do I choose a conference?

Carefully consider what you hope to gain from attending a conference. This will help you make a more informed decision about which type of conference will better meet your needs. Many organizations will indicate whether their event is geared toward parents in their promotional materials. You will also find listings of specific speakers and topics and both the speakers and the topics should factor into your decision making. Finally, bear in mind that many conferences present information that has not been scientifically validated and the information should be taken with caution.

Is there community help and support available to families?

If possible, don't reinvent the wheel.  Find other parents who are face a similar challenge and learn from their experience.  Attend a support group in your area for parents of children with autism or other developmental disabilities.  The Self-Help Group Clearinghouse offers information regarding support groups nationwide: www.selfhelpgroups.org.

School guidance counselors often have information regarding available community support.  State, county and local disability agencies publish referral lists which may have information regarding support services for individuals with autism and their families.  Local groups such as the ARC, the Rotary Club, Easter Seals, Knights of Columbus, the Elks, Jewish Family Services, or other community groups specific to your location may have information.  Reach out and ask.

Section 9:  QUESTIONS ABOUT THE AUTISM SIG CONSUMER GUIDELINES

I've heard that ABA is the best treatment for children with autism. How do I obtain ABA services for my child?

ABA, or Applied Behavior Analysis, programs have made remarkable differences in the lives of ,many individuals with ASDs. Finding a good ABA program is a bit like finding anything else.  It requires asking around, getting recommendations and checking out any prospective program to see if it might be a good match for your child.

However, as a potential consumer of ABA services, you need to learn what to look for in an ABA program in order to find the best fit for your child. The following list of questions was written to provide you with important tips on what to ask, what to look for, and how to choose an ABA program that would best benefit your son or daughter.

Where do I find a program?

ABA programs may be offered in various locations, including universities, hospitals, clinics, mental health services centers, public or private schools, or even in the home. Unless you live in a large city, choices may likely be very limited. In some rural areas, consumers may only have the option of bringing a consultant from another city in to supervise a program in the home. To get started, look at www.bacb.org. This is the website for the Behavior Analyst Certification Board. Look under the consumer section for a list of Behavior Analysts near you. You can also go to www.abainternational.org/chapters/uschapters.asp to find a local professional group.  Contacting a local chapter can be a very good way to meet some local or regional consultants.

How can I tell if a program will be good for my child?

To assure the best outcomes, the program director should have the proper training, skills, experience, and certification to run a program. To see the specific recommended skills in further detail, please read below. In addition, the program coordinator needs to have experience working with individuals with needs similar to your child's individual needs, while adhering to a set of ethical standards in the supervision of the overall program.

As the consumer, it is your responsibility to find the best professional for your child. This means you must ask the questions that will give you the information you need to make an informed decision. The first step is developing a clear picture of your child's most critical needs. A three-year-old learning to talk will require programming that differs considerably from that of an eight-year-old child who has severe self-injurious behavior. Does your child need to focus on social understanding in the classroom or need to stop hitting his head against the floor? You need to ensure that the person running the program has experience in the area of greatest need for your child.

Teaching children with autism can be challenging.  A professional that develops wonderful programs for a child with one set of needs may not be as effective working with children with different sets of needs. It is only upon gathering specific information from the provider that you may know whether or not the individual holds the skill set necessary to effectively work with your son or daughter.

What credentials should a professional have to direct an ABA program for children with autism?

A professional who is responsible for an ABA program should be:

1. A Board Certified Behavior Analyst (BCBA) or

2. A Board Certified Associate Behavior Analyst (BCaBA), being supervised by a BCBA.

However, if you are considering a professional who is NOT a BCBA you need to ask:

1. Does he or she have a Master's or PhD in behavior analysis or a closely related field like psychology?

2. Is he or she a current "Full" member in the Association for Behavior Analysis International (ABAI) and possibly one of its regional chapters (to see a list of regional chapters, go to this link:  www.abainternational.org/Chapters/USchapters.asp)?

3. Does he or she have at least ten years experience starting, designing, and/or overseeing ABA services for individuals with autism?

4. Has he or she published research articles in a peer reviewed journal like the Journal of Applied Behavior Analysis or Research in Developmental Disabilities? Publishing a book or articles on a website or blog does not count as published, peer reviewed research.

5. Has he or she made presentations about ABA treatment programs at state or national ABA conferences? Please note that conference presentations are not substitutes for published articles in a peer-reviewed journal.

What's the difference between a behavior analyst (BCBA) and an associate behavior analyst (BCaBA)?

A BCBA has completed a higher level of education (holding a minimum of a master's degree), gained more experience in the field, and obtained more supervised time working directly with individuals, thereby indicating a more comprehensive knowledge of how to apply the principles of behavior across environments. 

Specifically a BCBA, or Board Certified Behavior Analyst, has obtained:

1. Minimum of a Master's degree

2. Minimum of 225 hours of graduate level coursework in approved courses

3. Supervised, independent experience in designing and using behavioral interventions

4. Passing score on BCBA exam.

A BCaBA, or associate, has obtained:

1. Bachelor's degree

2. 135 hours of undergraduate or graduate coursework in approved courses

3. Supervised, independent experience in using behavioral interventions

4. Passing score on the BCaBA exam.

You can find out more about the differences by visiting www.bacb.com. In the consumer guidelines section, you will find a detailed description of standards for certification for both behavior analysts (BCBAs) and associates (BCaBAs). It's a good idea It is recommended that you check the website periodically because the standards do change over time. You can also check on a specific person by e-mailing info@BACB.com to request their certification status.

What kinds of questions are important to ask a potential provider?

You can and should ask about the following:

1. Do you have your certification as a behavior analyst (BCBA) or associate behavior analyst (BCaBA)?

2. How much time will you spend supervising each of the therapists who will work directly with my child?

3. How will you supervise them?

4. Are you a member of the Association for Behavior Analysis International (ABAI), the national professional organization?

5. Are you a member of the local ABAI chapter? For example, in Texas, the local chapter is called the Texas Association for Behavior Analysis (TxABA for short). To find a local chapter, go to www.abainternational.org/Chapters/USchapters.asp.

6. When was the last local chapter meeting that you attended?

7. What undergraduate, graduate, and post-graduate training in behavior analysis do you have? (Coursework focusing on behavior theory and practice is different from coursework in general psychology, special education, education, etc.)

8. Do you have letters of reference from supervisors and/or client families? (Note whether privacy and confidentiality are assured.)

9. Have you published any peer-reviewed research articles in behavior analysis? (This may be applicable for a minority of behavior analysts.  Look for a recognized journal like the Journal of Applied Behavior Analysis.)

Does holding BCBA or BCaBA certification guarantee that the individual is an expert in treating autism using ABA?

No, absolutely not. The field of behavior analysis is very broad. Some behavior analysts (BCBAs) may still have little or no experience providing services to individuals with autism. The Autism SIG (Special Interest Group) asserts that BCBA certification is only a part of the training. The Autism SIG references a number of skills that a program director should have to be effective. Please use the items on this list as a foundation towards developing questions that you will ask a potential program director when interviewing them.  This will help you determine whether the behavior analyst (BCBA) has the training and experience to create an effective ABA program based on proven methods or is offering substandard services.

It is important to keep in mind that those providers offering substandard services will likely find parents who will be willing to pay for even poor services.  

A BCBA who wants to direct an ABA program for individuals with autism, particularly children, also needs:

1. five years experience in ABA programming for persons with autism

2. an additional year (1000 clock hours) of supervised, hands-on training while providing ABA to persons with autism.

During the aforementioned, minimum five years working directly with persons with autism, a program director should have learned how to:

1. Use proven interventions and scientifically evaluate newly developed interventions that have not yet been studied thoroughly.
2. Assume the lead in designing and using comprehensive programming specifically for persons with autism to build skills and teach independence in these areas:

a.    Learning to learn (teaching the skills of observation, listening, following directions, and imitation, for example)

b.    Communication, both verbal and non-verbal

c.    Social interaction

d.    Self care

e.    School readiness

f.     Academics

g.    Safety

h.    Gross and fine motor skills

i.      Play and leisure activities

j.      Community living

k.    Self-control or self-monitoring

l.      Pre-vocational and vocational skills

3. Provide ABA programming to at least eight individuals with autism who represent a range of ages, abilities, and needs.
   NOTE: Items D through P contain many technical terms specific to ABA. Consumers of ABA services should, at minimum, know the definitions of the words on this list to better assist in understanding their son or daughter's program.
4. Use a variety of behavior analytic teaching procedures such as discrete trial instruction, modeling, incidental teaching, natural environment teaching, discrimination training, activity schedules, task analysis, shaping, and chaining. 
5. Be fluent in different techniques such as prompting, errorless teaching and error correction, maximizing learning opportunities, effective reinforcement and motivation, establishing stimulus control, performing preference assessments. 
6. Use ABA methods in a variety of settings: one-to-one instruction, small and large group instruction, and in transitions across these situations. 
7. Use a wide range of behavioral strategies to best address skill acquisition and generalization over time and across people, settings, situations, and materials as needed by that individual's skill level. 
8. Systematically evaluate data and modify instructional programs based on the data.
9. Conduct functional assessments of challenging behavior and proficiently select the appropriate assessment methods suited to the behavior and situation. 
10. Design and implement programs to reduce stereotypic, disruptive, and destructive behavior, based on systematic analysis of the antecedents and consequences that cause and maintain the behavior. Match treatment to the determined function(s) of the behavior.
11. Incorporate extinction and differential reinforcement procedures into behavior reduction programs.
12. Modify behavior reduction programs based on frequent, systematic evaluation of direct observational data.
13. Provide training in ABA methods and other support services to family members of at least five individuals with autism.
14. Provide training and supervision to at least eight professionals, paraprofessionals, or students providing ABA services to individuals with autism.
15. Collaborate effectively with professionals from other disciplines and with family members to promote consistent intervention and to maximize outcomes, while maintaining a commitment to scientifically validated interventions and data-based decision making.

A program director should also have ongoing training in directing and supervising ABA programs. Formal training and/or self-study should strive to develop:

1. Knowledge of trends in the latest research on the characteristics of autism and related disorders. How do these discoveries affect program design and implementation? How does the research impact family and community life?

2. Knowledge of at least one curriculum for learners with autism consisting of:

a.    a scope and sequence of skills based on normal developmental milestones. The sequence breaks down milestones into component skills based on research of teaching individuals with autism and related disorders;

b.    prototype programs for teaching each skill in the curriculum, using behavior analytic methods;

c.    data recording and tracking systems; and

d.    materials that go along with the curriculum.

1. Skills in using proven, behaviorally-sound methods to assess and build verbal and nonverbal communication repertoires in people with autism. This includes individualized augmentative and alternative communication systems for individuals with limited vocal repertoires. 

2. Knowledge of the best available research from behavior analysis and other scientific disciplines as it relates to autism treatment. The Autism SIG encourages consumers to ask prospective directors of ABA services for evidence that they have recently participated in continuing education activities relevant to the treatment of individuals with autism like those they will be serving (e.g., preschoolers, adults, individuals with limited vocal-verbal repertoires, etc.).

Why are some professionals who don't have a BCBA or BCaBA certification qualified to run an ABA program for a person with autism?

The Behavior Analyst Certification Board (BACB), the national organization that issues certification in behavior analysis, is a relatively new entity. There is a small group of competent and well-trained professionals who completed their training and education long before the BACB certification program began and are in the later stages of their careers. Some of these professionals may be excellent clinicians who have served hundreds of individuals with autism. The Autism SIG recognizes that it can be difficult to make certain that a professional without a behavior certification from the BACB has the necessary skills and experience to provide good programming. The Autism SIG strongly recommends that consumers examine the resumes of non-certified individuals for evidence of the following:

1. Completion of at least a master's degree in behavior analysis or a closely related field

2. Current "Full" membership in the Association for Behavior Analysis International and possibly one of its regional chapters

3. At least ten years of professional experience post-master's or doctoral degree in implementing, designing, and overseeing behavior analysis services for individuals with autism

4. Publications of research on the behavior analytic treatment of autism in peer-reviewed professional journals (as opposed to self-published books and journals, websites, and the like)

5. Presentations on the behavior analytic treatment of autism at behavior analysis conferences (but note that conference presentations are not equivalent to peer-reviewed research).

Why must an associate (BCaBA) always be supervised by a behavior analyst (BCBA)?

The Behavior Analyst Certification Board (BACB) does not consider the requirements for earning a BCaBA to be sufficient to take responsibility for all aspects of running a behavior program. If you hire a BCaBA, the Autism SIG encourages you to ask very specific questions related to who, what kind, and how much supervision the BCaBA receives.

What type of supervision should I expect to see the associate (BCaBA) getting?

There should be a behavior analyst (BCBA) who oversees and takes full responsibility for any programming started by the BCaBA. The BCBA should directly and closely observe the client either in person or via video, meet frequently in person or by phone, and take the lead in clinical decision-making. If the BCaBA is working towards full certification, you should ask the BCBA supervisor about the progress on a regular basis, even asking to see course transcripts and how many of the required supervised field hours have been completed.

Can a BCaBA develop programming for persons with autism?

An associate behavior analyst (BCaBA) usually has completed fewer hours of undergraduate classroom instruction in behavior analysis and less supervised experience in implementing applied behavior analytic interventions. The Autism SIG strongly recommends that BCaBAs deliver behavior analytic intervention and assist with program design for persons with whom they are familiar ONLY with a BCBA adequately supervising them. If you decide to hire a BCaBA to provide for your child's program, you should ask for the name and contact information of the BCBA supervisor and check with that BCBA periodically regarding your child's case. Ask that BCBA detailed questions related to the amount and type of supervision they are providing the BCaBA. If the BCaBA currently doesn't have a BCBA to regularly supervise his work and isn't actively working towards getting a BCBA certification, then you may want to look elsewhere for someone to direct your child's programming.

How do I know what kind of training the BCBA has?

You have the right to and should always ask the BCBA. A good BCBA has a resume prepared to give to potential clients who do ask. If they don't, that may be an indicator that you may need to look elsewhere.

How do I find a BCBA in my area?

The Behavior Analyst Certification Board maintains a list of individuals who have earned his/her certification. If you go to www.BACB.com, there is a section for consumers where you can type in your zip code to locate the names of certified behavior professionals near you.

Certified? Aren't BCBAs and BCaBAs licensed? 

No. The national certification of behavior analysts is relatively new (since 2000). Only in the last several years has there been a tremendous increase in demand for the behavior analyst. There are not enough behavior analysts to support the cost of a state licensing board, which can run over $100,000 a year. License fees pay for the cost of operating a licensing board. 

However, the certification board has established rigorous and uniform professional standards so that someone who has earned their certification can be counted on to have a minimum knowledge about the principles of behavior.

Currently there is a national certification board that gives the examinations and sets the requirements for certification.

What is the difference between getting a certificate and getting a license?

When a profession is licensed, a licensing board is created at the state level.  That board then oversees the profession. Anyone who wishes to practice within a profession, like lawyers and doctors for example, MUST obtain a license in order to conduct business within that field.  Also, anyone that is not a licensed professional and who does practice within that field can be charged with a crime.

Behavior analysts are certified instead of licensed. Certification is not mandatory in order to design and use behavior programming.  Also anyone can call themselves a behavior analyst despite having very little relevant training or experience.  Unfortunately, at this point, there is little action that can be taken formally to address this matter.  Nevertheless, the Behavior Analyst Certification Board (BACB), which is based in Florida, maintains nationwide standards. Go to www.bacb.com.

Do behavior analysts only need to earn their certification once?

No, it is an ongoing process because the field of behavior analysis keeps improving as more research is done. The certificate must be renewed annually by participating in continuing education activities that meet BACB standards. BCBAs and BCaBAs must be recertified every three years by retaking the exam, if they have not completed the yearly number of training hours.

I recently saw a workshop from a person with a PhD. Is that the same as a BCBA?

No. Though some BCBAs might also have PhDs, a PhD alone is not necessarily equivalent to the knowledge required to earn BCBA certification. The BCBA certification assures that a behavior consultant has a minimum level of understanding of and experience using the principles of behavior. A PhD in another subject area may have a different area of focus. Please refer to FAQ #4 to learn more about what you should look for in a PhD who does not also have a BCBA.

My children's teacher recently attended an all day workshop. Is that enough for her to develop my child's programs at school?

No. It gives her enough training and experience to begin to understand and use programs under the regular weekly, bi-weekly or monthly supervision of a BCBA. Attending or delivering some workshops, taking some courses, or getting brief hands-on experiences does NOT qualify anyone to practice applied behavior analysis effectively and adequately. Unfortunately, there may be some individuals who either don't understand how much training they need to effectively use the principles of ABA to create and/or run programming for a child with autism, misrepresent their training, skills, and experiences, or inappropriately guarantee certain outcomes.

I had a bad experience with a behavior consultant. What can I do?

Behavior analysts (BCBAs) and associates (BCaBAs) are on their honor to follow the Guidelines for Responsible Conduct for Behavior Analysts©.  The Behavior Analyst Certification Board (BACB) does not enforce these guidelines at this time. However, the BACB does enforce Professional Disciplinary Standards© for BCBAs and BCaBAs. Consumers are encouraged to become familiar with those Guidelines and Standards, available at www.BACB.com.

If you have concerns about the ethical behavior of individuals providing ABA services, you are strongly encouraged to contact the BACB, if the individual is a BCBA or BCaBA.

If the individual holds other licenses (e.g., Psychiatrist, speech pathologist, doctor, etc.), you are encouraged to contact the respective licensing boards.

How can I be sure the behavior consultant will spend time working directly on my child's program and training the therapists who work directly with him?

There is a lack of qualified behavior analysts to work in the area of autism, and many providers are overextended. The Autism SIG believes that professionals should ensure that they do not accept more clients than they can handle. Although neither the Autism SIG nor the BACB have developed guidelines for how many clients is the right number per BCBA, we encourage consumers to ask prospective providers of ABA services about their availability and responsiveness. Important questions include:

1. How much hands-on time each week will a qualified behavior analyst dedicate to the individual with autism?

2. How will this change if we have a behavior crisis?

3. What is the typical response time (in hours) to a crisis?

4. Is the amount of available time adequate to meet the needs of the individual?

5. How often will the behavior analyst communicate directly with the consumer rather than through the lead therapist or BCaBA?

6. How will the behavior analyst communicate (i.e., face-to-face meetings, phone conversations, email)?

Where can I go to learn more?

Check out the following websites:

• The Association for Behavior Analysis International www.abainternational.org

• The Association for Science in Autism Treatment www.asatonline.org

• The ABA Autism Special Interest Group www.autismsig.org

• The ABA Parent Professional Partnership Special Interest Group www.autismsig.org

• The Behavior Analyst Certification Board www.bacb.com

• The Cambridge Center for Behavioral Studies www.behavior.org

The following three documents are available from the Behavior Analyst Certification Board free online at www.bacb.com:  
 

BCBA and BCABA Behavior Analyst Task List (3^rd Ed.) 
Guidelines for Responsible Conduct for Behavior Analysts 
Professional Disciplinary Standards

Celiberti, D., Buchanan, S., Bleecker, F., Kreiss, D., & Rosenfeld, D. (2004). The road less traveled: Charting a clear course for autism treatment. Arlington, VA: The Organization for Autism Research (OAR). 
(Available free online at www.researchautism.org/uploads/roadless.pdf.)

Cooper, J.O., Heron, T.E., & Heward, W.L. (2007). Applied Behavior Analysis (2^nd ed). Upper Saddler River, NJ: Prentice Hall.

COSAC (The New Jersey Center for Outreach and Services for the Autism Community). (2004). Position statement on treatment recommendations. Ewing, NJ: Author. (Available free online at www.njcosac.org.)

Green, G. (1996). Evaluating claims about treatment for autism. In C. Maurice (Ed.), G. Green, & S.C. Luce (Co-Eds.), Behavioral Interventions for young children with autism: A manual for parents and professionals (pp. 15-28). Austin, TX: PRO-ED.

Howard, J.S., Sparkman, C.R., Cohen, H.G., Green, G., & Stanislaw, H. (2005). A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Research in Developmental Disabilities, 26, 359-383.

Jacobson, J.W., Foxx, R., & Mulick, J.A. (2005). Controversial therapies for developmental disabilities. Mahwah, JF: Lawrence Erlbaum Associates.

Lovaas, O.I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology. 55. 3-9.

MADSEC Autism Taskforce. (1999). Executive summary. Portland, ME: Department of Education, State of Maine.

Matson, J.L., Benavidez, D.A., Compton, L.S. Paclawskyj, T., & Baglio (1996). Behavioral treatment of autistic persons: A review of research from 1980 to the present. Research in Developmental Disabilities, 17, 433-465.

New York State Department of Health Early Intervention Program. (1999). Clinical Practice Guideline Quick Reference Guide: Autism/Pervasive Developmental Disorders - Assessment and Intervention for Young Children (age 0 - 3 Years). Health Education Services, PO Box 7126, Albany, NY 12224 (1999 Publication No. 4216).

Sallows, G.O., & Graupner, T.D. (2005). Intensive behavioral treatment for children with autism: Four-year outcome and predictors. American Journal on Mental Retardation, 110, 417-438.

Smith, T., (1996). Are other treatments effective? In C. Maurice, G. Green & S. Luce (Eds.), Behavioral intervention for young children with autism: A manual for parents and professionals (pp. 45-49). Austin, TX: PRO-ED.

US Department of Health and Human Services. (1999). Mental health: A report of the surgeon general. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.

Section 10:  ADDITIONAL RESOURCES

If you are interested in responses to other frequently asked questions, please visit the following websites:

• Association for Behavior Analysis

(Behavior Analysis section)

abainternational.org/ba.asp

• Maryland Association for Behavior Analysis

(Parents Corner) 

www.marylandaba.org/parents.jsp

• Association for Science in Autism Treatment

(FAQ)

www.asatonline.org/helpdesk/faq.htm

• Association for Science in Autism Treatment

(Clinician's Corner)

www.asatonline.org/helpdesk/clinician.htm

• Cambridge Center for Behavioral Studies

(Autism section)

www.behavior.org/autism

April 29, 2009