Bringing ABA to Home, School, and Play for Young Children with Autism Spectrum Disorders and Other Disabilities
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Applied behavior analysis (ABA) is one of the most effective interventions for children with autism spectrum disorders and other disabilities. Now you can bring ABA best practices into any early childhood setting with this book—your complete guide to using ABA within everyday routines to support children’s learning, participation, and development.
Ideal for use with children birth to five, this practical, reader-friendly guidebook is the first to combine ABA with natural environment intervention, the widely used, research-supported approach to meeting the needs of children with disabilities. You’ll learn the fundamental principles and research behind ABA and natural environment intervention, and you’ll get one clear and practical framework forsetting meaningful goals that increase the child’s active participation in routines
addressing the goals with tailored ABA teaching procedures
creating powerful intervention plans that support children in specific developmental domains and routines
selecting an appropriate data collection method
monitoring progress toward goals and making adjustments as needed
ensuring consistent implementation of ABA interventions
coaching other professionals and caregivers in the ABA approach
of behavior, skills, routines, and caregiver priorities
- conducting effective assessment
To get you started with ABA, the book gives you 25 sample teaching plans that strengthen communication, social interaction, positive behavior, independent play and daily living skills, cognitive skills, and participation in everyday routines. Vivid, realistic case studies of diverse children walk you through the ABA process from start to finish. And with the blank forms and data sheets, you’ll easily assess children’s skills and participation and monitor their progress toward goals.
With this comprehensive guide to a proven intervention approach, you’ll help young children with ASD and other disabilities make lasting improvements and participate fully at home, at school, and in their community.
A featured book in our Better Behavior Kit!
See how this product helps strengthen Head Start program quality and school readiness.
Review: California Bookwatch, Education Shelf
“Packed with exercises that can help young children with disabilities make lasting social improvements and is a top pick for any education collection strong in disabilities management.”
Review by: Mary Weiss, Director, Autism and Applied Behavior Analysis Program & Professor, Endicott College, MA
“Fills a gap in the implementation literature . . . The author has taken great care to decipher the maze of the treatment options world.”
Review by: Lynn Koegel, Clinical Director, Koegel Autism Center; Director, Eli and Edythe L. Broad Center for Asperger Research, University of California, Santa Barbara
“A comprehensive and practical guide to many important intervention issues . . . both positive and informative, with recommendations that will help a child with autism reach his or her potential.”
Review by: Mary Noonan, Professor, Department of Special Education, University of Hawaii
“Too often behavioral interventions for young children with autism are implemented in isolated and artificial situations that result in a child's failure to acquire new skills. This book provides the much-needed framework for how to implement these proven methods in inclusive settings to promote generalization.”
- Overview of Natural
- Understanding Applied
- Assessment for Planning ABA
Interventions in the Natural
- Goal Setting for
ABA Interventions in
the Natural Environment
- Developing Teaching Procedures
for ABA Interventions in the
- Data Collection and Analysis
- Putting It All Together
- Reader’s Guide
Appendix A: Sample Communication
Skills Teaching Plans
Appendix B: Sample Social Interaction
Skills Teaching Plans
Appendix C: Sample Independent Play and
Daily Living Skills Teaching Plans
Appendix D: Sample Cognitive
Skills Teaching Plans
Appendix E: Sample Positive
Behaviors Teaching Plans
Appendix F: Sample Intervention
Plans for Targeted Routines
Appendix G: Blank Forms for Assessment,
Goal Setting, and Data Collection
Excerpted from Chapter 1 of Bringing ABA to Home, School, and Play for Young Children with Autism Spectrum Disorders and Other Disabilities, by Debra Leach, Ed.D., BCBA
Overview of Natural
Copyright© 2012 by Paul H. Brookes Publishing Co. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
This chapter provides an overview of the use of natural environment intervention
(NEI) for young children with disabilities. Coverage of the topic includes
NEI’s legal foundations and a review of literature on the principles of effective
practice when implementing NEI. An overview of autism spectrum disorder (ASD)
is offered, together with a discussion of research specifically related to NEI for young
children with ASD.
NATURAL ENVIRONMENT INTERVENTION
NEI is a federally mandated early intervention approach for young children with disabilities
that systematically maximizes teaching and learning opportunities throughout
the day by embedding interventions within naturally occurring routines. Caregivers
spend many hours with their child throughout the day, and this time can and should
be used for interventions that will enhance the child’s development. In using NEI,
caregivers are not required to set aside extra time in their day to provide “therapy.” Instead,
they receive training and support from professionals to provide evidence-based
interventions within the context of their daily routines. Thus, NEI doesn’t require
extra time, but it does require a more systematic use of time spent with the child to
optimize learning opportunities throughout the day.
According to federal special education law (Part C of the Individuals with Disabilities
Education Improvement Act [IDEA]), natural environments are defined
as home and community settings in which children without disabilities participate (IDEIA, 2004). The law requires that early intervention services for infants and toddlers
with disabilities be implemented in natural environments to the maximum extent
appropriate. This stipulation reflects research indicating that everyday family and
community routines and activities provide young children with an optimal variety
of learning opportunities (Dunst, Hamby, Trivette, Raab, & Bruder, 2000). Natural
environments include a variety of home-, school-, and community-based routines.
Examples of home-based routines may include dressing, bathing, eating, cleaning the
house, playing outdoors or inside, and reading books. Community-based routines
may include going to the grocery store, beach, library, and park. School-based routines
may include circle time, lunch, centers, recess, library, small-group instruction,
and whole-group instruction. These everyday home, school, and community routines
provide young children with many different learning opportunities. When children
are actively engaged in everyday routines, they have multiple opportunities to apply
their existing skills and acquire new ones.
The National Association for the Education of Young Children (NAEYC), the
world’s largest organization working on behalf of young children, uses the developmentally
appropriate practice (DAP) framework as the foundation of all its work. The core
principles of DAP in early childhood education are that knowledge must inform decision
making, goals must be challenging and achievable, and teaching must be intentional
to be effective (NAEYC, 2012). These guiding principles also provide the framework for
NEI through all phases of intervention, including assessment, goal setting, designing
and implementing instruction, and evaluating the effects of instruction. When applying
DAP to NEI for young children with disabilities, caregivers are heavily involved in
the assessment process to identify the child’s strengths, interests, everyday routines, and
present abilities and needs so that early intervention teams are equipped with knowledge
about the child and family. The team works collaboratively with caregivers to set goals
based on what the child can currently do and what the child can be challenged to achieve
next. Finally, with NEI, instruction is carefully designed using research-supported strategies
to intentionally utilize everyday routines to maximize learning by embedding effective
instruction within natural contexts. NEI and DAP differ in that NEI focuses on
providing specific strategies and suggestions for how to intervene with young children
during their everyday routines, whereas DAP provides more general guidelines for interacting
with young children (Pretti-Frontczak & Bricker, 2004).
RESEARCH ON NATURAL ENVIRONMENT INTERVENTION
Professionals must think of NEI as involving not only where but how services are
provided (Shelden & Rush, 2001). NEI is often misinterpreted as solely focusing
on inclusion with typically developing peers rather than on the benefits of inclusive
environments for interventions with young children with disabilities (Chai, Zhang,
& Bisberg, 2006). Thus, it is essential for caregivers and early intervention providers
to understand that NEI is not just about including young children with disabilities
in naturally occurring everyday routines and activities but also about planning and
implementing purposeful interventions within those contexts. Researchers have conceptualized the delivery of NEI in a variety of ways to guide
early intervention providers in their service delivery. Dunst and colleagues (2001)
describe NEI as contextually based, child-initiated, and adult-directed learning opportunities
provided by caregivers and mediated by professionals. In other words, professionals
should recognize the natural learning opportunities that occur in a child’s
daily life and use those opportunities to implement interventions. NEI strongly emphasizes
tapping into children’s interests to increase their active participation in everyday
activities (Dunst, Trivette, & Masiello, 2011).
Robin McWilliam (2010) uses an NEI model that revolves around the use of
routines-based interviews (RBIs). RBIs are semi-structured interviews that early intervention
providers conduct with caregivers to determine the main concerns of the
family, the family’s everyday routines, the extent of the child’s participation in everyday
routines, the family’s satisfaction during each of the routines, and the family’s
desired outcomes related to child-level needs, child-related family needs, and family-level
needs. In a study comparing individualized family service plan (IFSP) outcomes
using the RBI versus the business-as-usual IFSP development process, the outcomes
written as a result of the RBI were more functional than outcomes written as a result
of the standard process (McWilliam, Casey, & Sims, 2009).
Diane Bricker (2001) suggests that naturalistic teaching approaches, such as
activity-based interventions (ABI), can be used across a range of settings to address
a child’s goals and objectives by implementing interventions during daily routines
and activities. The ABI approach capitalizes on the child’s motivation and the use of
daily activities to embed multiple, varied, and authentic learning opportunities. ABI
focuses on the attainment of functional skills that can be used across environments
and situations (Pretti-Frontczak & Bricker, 2004).
While there are a variety of approaches to NEI, these approaches share several
features. Using a family-centered approach that is individualized, strength based, capacity
building, and reflective of the family’s culture and values is the foundation of all
NEI approaches (Atkins-Burnett & Allen-Meares, 2000; Woods, Wilcox, Friedman,
& Murch, 2011). Providing ongoing coaching to caregivers to deliver the level of support
they need to effectively implement interventions in the natural environment is
an essential component of NEI, regardless of the approach used (Rush, Shelden, &
Hanft, 2003). Using evidence-based methods and strategies to promote the child’s development during naturally occurring family and community routines and activities
is also a common emphasis of the NEI approaches.
NATURAL ENVIRONMENT INTERVENTION
FOR YOUNG CHILDREN WITH ASD
Before discussing how to apply NEI for young children with ASD and related disorders,
an overview of ASD will be provided for the benefit of readers who may not
be familiar with ASD. It is crucial for early intervention providers to understand the
characteristics of young children with ASD so they can address the children’s core
impairments within the context of NEI.
Overview of Autism Spectrum Disorders
The term ASD often is used quite loosely. You may hear some people say that a child
doesn’t have autism but is definitely on the spectrum. If a child has some characteristics
associated with autism, it does not necessarily mean the child is on the spectrum.
A child who is on the autism spectrum either has autism, Asperger syndrome, or
pervasive developmental disorder-not otherwise specified (PDD-NOS). These three
disorders are the only autism spectrum disorders. They belong to the larger category
of pervasive developmental disorders (PDD), which also includes Rett syndrome and
childhood disintegrative disorder (CDD), according to the Diagnostic and Statistical
Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR; APA, 2000).
For the purposes of this book, characteristics of children with ASD will be discussed
without pinpointing the differences among these disorders.
Before discussing the impairments that children with ASD are likely to display,
it is important to stress that children with ASD all possess unique strengths and talents.
Because ASDs are neurological disorders, the brains of people with ASD are not
necessarily “wired” the same way as in typically developing individuals. Thus, children
with ASD may be able to do many things that most of their peers cannot do. Some
children with ASD learn literacy skills such as letter and sound recognition and early
sight word recognition well before their same-age typically developing peers. Some
young children with ASD have extraordinary visual-spatial strengths that allow them
to complete puzzles, use shape sorters, and engage in other constructive play activities
that are designed for children who are much older. Children with ASD may also have
special talents related to music and art. While not every young child with ASD will
have a special talent, all children have strengths and interests that should be tapped
into when planning interventions. Caregivers and early intervention providers should
focus on and value these strengths rather than solely targeting children’s impairments.
With that said, the impairments of young children with ASD must be assessed and
addressed to enable them to actively participate in home, school, and community
routines and make developmental gains.
Impairments in Social Interaction Children with ASD all have impairments
in social interaction. However, not all children will have the same types of difficulties. Some children may have impairments in the use of nonverbal behaviors such
as eye contact, facial expressions, body posture, and social gestures. Children with
ASD may not spontaneously seek opportunities to interact with other people. This
does not necessarily mean that these children “prefer to be alone,” which is a descriptive
characteristic that may be seen on a variety of informational materials related to
ASD. When children with ASD receive the supports they need to learn how to respond
to the initiations of others, to initiate interactions with others, and to maintain
interactions with others, they may prefer social interactions to being alone. These skills
related to interacting with others are referred to as joint attention and social reciprocity
skills, which are core impairments in children with ASD (Jones & Carr, 2004;
MacDonald et al., 2006; Mundy, 1995).
Joint attention entails two or more individuals sharing attention with one another
related to a specific object, activity, or idea. Joint attention can consist of coordinating
attention between people and objects, attending to a social partner, shifting
gaze between people and objects, sharing emotional states with another person, and
being able to draw another person’s attention to objects or events for the purpose of
sharing experiences (Baldwin, 1995; Mundy, Sigman, & Kasari, 1990). This type of
interaction can be as simple as a child pointing to a bird in the tree with the caregiver
responding, “Oh, wow! It’s a blue jay!” Joint attention skills are also needed to engage
in more complex social interactions. A basic way to understand joint attention is to
think of it as the feeling that you are “in it together” that you might get when interacting
with someone. Even when you try hard to interact and connect with a child
on the autism spectrum, you may not feel the same sense of connectedness that you
experience with typically developing children.
Once a child with ASD is connected with someone by establishing joint attention,
the child then needs to use social reciprocity skills to engage in “the dance of
human interaction,” which involves long chains of back-and-forth interactions related
to the object, activity, or idea in which they are sharing attention. Social reciprocity
entails being aware of the emotional and interpersonal cues of others, appropriately
interpreting those cues, responding appropriately to what is interpreted, and being
motivated to engage in social interactions with others (Constantino et al., 2003).
Below is an example of social reciprocity being shared between a mother and her
2-year-old daughter, Rebecca.
Mother: It’s time for breakfast, Rebecca.
In this example Rebecca and her mother shared many back-and-forth exchanges.
Notice that some exchanges were not verbal but were actions conducted in response
to the initiation or response of the other person. That is still a reciprocal exchange.
Exchanges can be verbal or can entail the use of facial expressions, gestures, or actions.
Also, social reciprocity entails making initiations and responding to the initiations
of others. In the example provided, Rebecca was able to respond to her mother’s initiations
(i.e., “It’s time for breakfast”), and she also initiated an interaction (“I want pancakes”). Although social reciprocity skills develop naturally in typically developing
children, children with ASD often require intensive interventions to learn how to
engage in reciprocal social interactions.
(Rebecca walks over to the kitchen table and stands by her booster seat.)
Mother: Do you want to get in your chair?
Rebecca: Help me up.
(Mother picks up Rebecca and puts her in her chair.)
Rebecca: I want pancakes.
Mother: Okay. Do you want bananas with your pancakes?
(Mother gives Rebecca pancakes and bananas.)
Impairments in Communication Children with ASD may have difficulty
sending information and receiving information when interacting with communication
partners. To engage in reciprocal social interactions, individuals need to use
nonverbal and verbal receptive and expressive communication skills. Nonverbal communication
can entail the use of eye contact, facial expressions, body posture, social
gestures, actions, and the ability to interpret nonverbal behaviors displayed by others.
Verbal communication skills can entail responding to or initiating interactions
with others through the use of verbal responses, sign language, picture exchange, or
augmentative communication devices. Expressive language skills consist of the use of
language to share knowledge, thoughts, and ideas with others. When children have
impairments in expressive communication, they may have difficulty expressing their
wants and needs, commenting, answering and asking questions, and engaging in conversations.
When children with ASD do use expressive language, their words may
be difficult to understand due to poor articulation. They may have trouble using appropriate
volume, or they may display irregular prosody that may result in sounding
nasal or robotic. Receptive language skills consist of demonstrating understanding of
language. When children have impairments in receptive communication, they may
have difficulty responding to directions that require comprehension of language that
is beyond their level of understanding.
Typically developing children supplement verbal communication with nonverbal
communication by using gestures, eye contact, facial expressions, and body
posture to send messages to others. Many children with disabilities who lack verbal
communication skills often use even more of these nonverbal communication skills
to compensate for their lack of verbal skills, but children with ASD often do not do
this. In fact, many times their lack of nonverbal communication skills sends the wrong
message to their communication partners. For example, many children with ASD do
not use appropriate eye contact when speaking with others. That may send the message
that they are not talking to someone in particular when in fact they are. Also, if
they do not use facial expressions to communicate their thoughts and feelings, they
may be misinterpreted as being disengaged or uninterested when that is not the case.
When children engage with their peers, many times it is nonverbal communication
such as eye contact, gestures, and facial expressions that help them connect with one
another. Th us, children with ASD often miss out on opportunities to establish connections
with peers due to their limited nonverbal communication skills.
Some children with ASD may display stereotyped and repetitive use of language,
which encompasses a variety of idiosyncratic uses of language. This can include echolalia,
or repeating what was heard previously in exactly the same way at a later time.
Echolalia is often considered a nonfunctional use of language; however, a child with
ASD may use echolalia as a means of communication. For example, a 3-year-old girl
with autism engaged in echolalia at dismissal from preschool by repeatedly saying, “Dirty. Take a bath.” The teacher and the parents were eager to get her to stop this
“nonfunctional” use of language. However, the early interventionist hypothesized that
the little girl was saying that phrase repeatedly because she always wore pretty dresses
and didn’t want to sit on the sidewalk during dismissal time because it would mean
getting her dress dirty. The early interventionist suggested that instead of asking the
child to sit on the sidewalk with the other students, the teacher might provide a chair
for her to sit in while she waited to be picked up. When this change was made, the
child stopped saying, “Dirty. Take a bath.” This shows that her echolalia was actually
serving a communicative function. She didn’t have the expressive language skills to
say, “I don’t want to sit on the sidewalk because I don’t want my dress to get dirty,”
so she used a phrase she often heard her mother say at home when she was dirty.
Some children may use echolalia because they want to interact with others but do
not have the social communication skills needed to initiate an interaction. Thus, they
use echolalia to attempt to initiate interactions with others. Other children with ASD
may have verbal self-stimulatory behaviors, or stims, in which they verbalize certain
sounds, words, phrases, or sentences in a nonfunctional manner. Often children who
use verbal stims do so when they are not engaged in a meaningful interaction or activity.
Therefore, it is important to get children actively engaged when they do begin to
use verbal stims as opposed to simply trying to stop the behavior from occurring.
Restricted Interests and Repetitive Behaviors According to the DSMIV-
TR (APA, 2000), an individual with ASD has at least one of the following characteristics:
The first indicator refers to children with ASD who have a special interest in something
that limits the individual’s capacity for a variety of interests. For example, a child
may have a passion for trains and only want to play with trains and talk about trains.
Some individuals with ASD will have a need for sameness in which they have a strong
urge for certain things to be done a certain way each time. For example, a child may
have a strong desire to follow a specific routine before bedtime by reading a specific
book followed by singing a specific song, and even the slightest change in that routine
may cause the child to engage in challenging behaviors. It is best to teach children who
have these needs for sameness how to handle small changes as opposed to “walking on
eggshells” to keep them from getting upset.
- Restricted range of interests; intense fascination with a particular interest
- Need for sameness; repetitive routines
- Self-stimulatory motor movements
- Strong interest in objects or parts of objects
Stereotyped and repetitive movements can include behaviors such as rocking,
hand flapping, spinning objects, lining things up, or any other movement that the
child displays often without a functional purpose. Some children with ASD are interested in parts of objects such as wheels on a toy car. Thus, when they pick up a toy car
they do not necessarily play with it as other children might play, but instead they focus
on spinning and examining the wheels and exploring how they work. These types of
stereotyped behaviors usually occur when the child is disengaged from meaningful
activities, as was discussed with verbal self-stimulatory behaviors. Thus, it is crucial
to positively redirect children to engaging activities when these behaviors arise as opposed
to simply trying to get children to stop doing them.
Other Characteristics of Young Children with ASD In addition to impairments
in social interaction, impairments in communication, and the presence of
stereotypic behaviors and/or restricted interests, some children with ASD may have a
variety of other challenges. Some additional challenges that children with ASD and
their families may face include extreme anxiety and fear, sensory sensitivities, food allergies,
sleep disorders, gastrointestinal issues, attention difficulties, feeding disorders,
severe challenging behaviors, seizures, cognitive impairments, fi ne motor difficulties,
and gross motor difficulties. Because caregivers of young children with ASD may be
dealing with a wide range of challenges, it is essential for early intervention providers
to assess what challenges exist and develop interventions that caregivers can implement
to address specific challenges.
It is important for readers to understand that even though children with ASD share
common characteristics, there is great variability in the profiles of these children. A
profile is a pattern of characteristics along several dimensions that distinguishes one
child with autism from another in important ways (Thompson, 2011). Travis Thompson
(2011) discussed autism variability in great detail in his book Individualized Autism
Intervention for Young Children: Blending Discrete Trial and Naturalistic Strategies.
It is well documented that children with ASD have impairments in social interaction
and communication skills and that they are likely to engage in nonfunctional repetitive
behaviors or have a restricted range of interests. Thompson discussed factors that
moderate or intensify the expression of these autism symptoms including the child’s
intellectual ability, language skills, attention deficit and hyperactivity symptoms, and
anxiety challenges. Each child’s profile should be thoroughly examined when planning
early intervention services and supports to ensure appropriate individualization to address
the unique needs of each child.
Rationale for Using Natural Environment
Interaction with Young Children with ASD
Although young children with ASD and their families face many challenges, there is
mounting evidence demonstrating the effectiveness of intensive early intervention for
a substantial proportion of these children (National Research Council, 2001; Woods
& Wetherby, 2003). In 2001, the National Research Council (NRC) conducted a
review of research on educational interventions for children with ASD from birth through age 8. Following a thorough literature review, the council identified the essential
active ingredients of effective interventions for children with ASD. According
to Wetherby and Woods (2006), the essential active ingredients suggested by the NRC
(2001) that specifically support the effectiveness of NEI include the following:
In the years following the NRC recommendations, researchers implemented
studies examining the effects of NEI on young children with ASD. Today there is
a growing body of evidence supporting caregiver-implemented interventions in the
natural environment for young children with ASD. A study of five preschool children
with autism showed that parents were able to demonstrate proficient use of
evidence-based teaching strategies during their everyday routines (Kashinath, Woods,
& Goldstein, 2006). A study of 17 children with ASD using a parent-implemented
intervention that trained parents to embed naturalistic teaching strategies in their
everyday routines showed that the children made significant gains in social communication
skills as a result of the interventions (Wetherby & Woods, 2006). A study of
preschoolers with autism showed that when children were engaged in interest-based
activities during everyday family and community activities they made more progress
in language, social, and motor development than children with autism who did not
engage in interest-based activities (Dunst, Trivette, & Masiello, 2011). Project DATA
(Developmentally Appropriate Treatment for Autism), an inclusive preschool program
for children with ASD between 1 year and 3 years old, shows positive outcome
data of teachers using evidence-based instructional strategies to embed instruction
into the ongoing classroom routines and activities to improve social communication
skills, cognitive development, and self-regulation skills (Boulware, Schwartz, Sandall,
& McBride, 2006).
- Children must learn functional and meaningful skills.
- Learning should occur within daily caregiving, play, and social interactions
with caregivers that are repeated throughout the day.
- Caregivers should mediate the teaching and learning process for the child as
What Is Unique about Natural Environment
Interaction for Young Children with ASD?
The use of NEI for young children with ASD is somewhat controversial because of
the documented need for intensive interventions among this population of children.
Since 1987, with Lovaas’ landmark study of discrete trial training (DTT; see Chapter
2), there has been a push toward providing 40 hours per week of one-to-one DTT
professionally driven therapy for children with ASD. There is a general belief among
some caregivers and professionals that children with ASD cannot learn during naturally
occurring home and community routines in the way typically developing children
do. While it is true that children with ASD often do not learn in the same way
that typically developing children do and require alternative instructional strategies, it does not mean that children with ASD cannot learn during everyday routines. What
it does mean is that children with ASD require specialized interventions to be implemented
during their everyday routines to enable them to learn from those natural
In contrast with the 40-hours-of-DTT-per-week formula, the NRC (2001) recommended
that children with ASD receive at least 25 hours each week of active engagement
in intensive instructional programming. Many caregivers and professionals
mistakenly interpret that recommendation to mean that the child should receive at
least 25 hours of one-to-one instruction in therapeutic or clinical settings each week.
To the contrary, with carefully designed NEI, young children can receive the intensity
of interventions they need within their ongoing routines across home, school, and
community settings. Of course, some children may require one-to-one ABA interventions
in addition to NEI, depending on the profiles of the children. For example, if
a child has moderate to severe cognitive impairments, severe language impairments,
severe social impairments, severe attention-related difficulties, and/or severe anxiety
issues, the child may need some therapeutic ABA interventions to address these difficulties and to enable the child to fully benefit from NEI.
So, what is unique about the way NEI must be designed for young children with
ASD? First, using an interest-based approach to increasing the child’s active participation
in everyday routines is essential. At the same time, the skills that are targeted for
intervention during those routines must address the child’s core impairments. Specifically, joint attention, social reciprocity, and communication skills must continually be
targeted during NEI for young children with ASD.
Second, the instructional strategies selected for use within everyday routines must
have an evidence base specifically for children with ASD. Intervention approaches
that utilize principles of applied behavior analysis (ABA) have a strong research base
for their effectiveness with young children with ASD (Koegel, Koegel, Harrower, &
Carter, 1999; Lovaas, 1987; McGee, Morrier, & Daly, 1999; Pierce & Schreibman,
1997). Contrary to some misconceptions of caregivers and professionals, ABA teaching
strategies can and should be implemented within naturally occurring everyday
routines as opposed to one-to-one settings that remove the child from the natural
environment. Some of the drawbacks of one-to-one ABA therapy include difficulties
with child motivation and with generalization of learned skills. In contrast, when
young children are actively engaged in NEI, they have increased motivation due to the
emphasis on the children’s interests and participation in familiar and preferred routines;
and generalization is less of a difficulty due to the fact that children are learning
functional and meaningful skills in the very contexts where they are expected to use
Finally, planning for at least 25 hours each week of NEI is essential for young
children with ASD. Children with mild developmental delays may not necessarily
need the intensity of at least 25 hours of intervention each week. Because children
with ASD need this intensity, however, early intervention teams must consider this
requirement when conducting assessments and planning interventions.