Including children with autism in general education classrooms. A review of effective strategies.

Children with autism can benefit from participation in inclusive classroom environments, and many experts assert that inclusion is a civil right and is responsible for nurturing appropriate social development. However, most children with autism require specialized supports to experience success in these educational contexts. This article provides a review of the empirical research that has addressed procedures for promoting successful inclusion of students with autism. Strategies reviewed include antecedent manipulations, delayed contingencies, self-management, peer-mediated interventions, and other approaches that have been demonstrated in the literature to be useful. The article concludes with a discussion of future research needs.

Construction of adulthood and disability.

A discussion of adulthood in general and that of individuals with severe cognitive impairments was presented. The meaning of adulthood in our culture raises issues regarding the disparity between status as an adult and status as a person with a severe cognitive impairment. An examination of the traditional roles, rites, and rituals of adulthood (e.g., voting, marriage, consensual sex, and moving out of the family home) was provided. Personal deliberations on how the first author intends to assist her daughter in accessing these markers of adulthood are included. Our overall goal in this article is to promote discussion regarding adulthood and significant disabilities and to encourage additional movement toward full societal membership of adults with severe cognitive impairments.

International publication trends of JABA authorship.

The present study addressed international publication trends in JABA authorship between 1970 and 1999. First, we analyzed authorship patterns to identify trends in the appearance of new first authors, unfamiliar authors, and frequent contributors. Second, articles were assigned to either a North American or an international category. The data show a decline in the number of articles by new authors and an increase in the publications of frequent contributors from North America. Trends are shown in comparison to those from the American Journal on Mental Retardation.

Assessment-based intervention for severe behavior problems in a natural family context.

Functional assessments and assessment-based interventions were conducted with a boy with disabilities and severe problem behavior in the context of two family routines: using the bathroom in the family home and dining in a fast-food restaurant. A multiple baseline design demonstrated the effectiveness of the intervention package as implemented by the boy's mother in the two routines. The results provide a systematic replication and extension of behavior-analytic interventions in natural family contexts.

Relation between curricular activities and problem behaviors of students with mental retardation.

The correlations between students' problem and appropriate behaviors and characteristics of the curricular activities in which they were engaged was examined. Curricular activities were rated to determine whether they were socially functional, peer-referenced, and behaviorally functional. Students' behaviors and curricular activities in 64 classrooms were directly observed during the regular daily routine. Results showed a significant negative correlation between ratings of the characteristics of curricular activities and students' problem behaviors and a significant positive correlation between ratings of curricular activities and students' appropriate behaviors. The pattern of significant correlations was also reflected in individual subscale scores. Implications of these results for classroom practice and the remediation of problem behaviors were discussed.

Improving the peer interactions of students with emotional and behavioral disorders through self-evaluation procedures: a component analysis and group application.

We conducted two experiments examining the effects of a self-evaluation package on the peer interactions of students described as emotionally or behaviorally disordered. Experiment 1 assessed the additive effects of various components of a self-evaluation package on the frequency of inappropriate and appropriate peer interactions. The components assessed were rewards alone, rewards plus discussion, and self-evaluation plus rewards. Results showed limited effectiveness when rewards alone and rewards plus discussion were implemented. However, substantial improvements in peer interactions were observed when the self-evaluation component was added. Experiment 2 examined the efficacy and feasibility of the procedures when implemented in a group setting. Students in three classrooms served as participants. Direct observation data collected for 8 of the participants showed the procedures to be effective in improving peer interactions when implemented in a group context.

Parents' reports of their children's challenging behaviors: results of a statewide survey.

Parents of children with autism and related disabilities were surveyed about their children's challenging behaviors and resources they felt would be helpful in managing these behaviors. Responses indicated a high frequency of challenging behaviors, including many aggressive and other destructive behaviors occurring more frequently than once per day. Teachers, family members, and published materials were identified as the most helpful of currently available resources; contingency management, as the most successful management approach. Respondents noted many additional needed resources. Results were discussed in relation to continuing research on families' needs, strengths, and judgments pertaining to the demands related to disabilities and challenging behaviors.

Preferred curricular activities and reduced problem behaviors in students with intellectual disabilities.

This research examined the relation between students' preferences for curricular activities and the occurrence of problem and desirable behaviors in 3 students with moderate intellectual disabilities. Activity preference was determined with a systematic assessment procedure. Subsequently, the influence of activity preference on student behavior was evaluated using a reversal design. Results showed that preferred activities were associated with reduced levels of problem behavior and increased levels of desirable behaviors. The findings of this investigation contribute to the applied literature on activity preference and suggest directions for future research in the areas of curriculum design, preference, and curricular modifications as a viable behavior-management strategy.

Choice making to promote adaptive behavior for students with emotional and behavioral challenges.

Two analyses investigated the effects of choice making on the responding of elementary school students with emotional and behavioral challenges. In the first analysis, 2 participants were given choices from menus of academic tasks, all of which were pertinent to their educational objectives in English and spelling, respectively. Reversal designs showed that the choice-making conditions increased task engagement and reduced disruptive behavior for both students. An additional analysis was performed with a 3rd student in an effort to further distinguish the effects of choice making from preference. In this study, one of the no-choice phases was yoked to a previous choice-making condition. This analysis demonstrated that the choice-making condition was superior to baseline and yoked control phases as determined by levels of task engagement and disruptive behavior. The findings of the two analyses contribute information relevant to students with emotional and behavioral disorders, and to a growing literature on the desirable effects of choice making for students with disabilities and challenging behaviors.

Using assessment-based curricular intervention to improve the classroom behavior of a student with emotional and behavioral challenges.

We evaluated a process of descriptive assessment, functional assessment, and assessment-based intervention with an elementary-school child who was described as having emotional and behavioral challenges, but who also exhibited above-average intelligence and communication skills. During a hypothesis-development phase, information was gathered from several sources including an interview that was conducted directly with the participant. Descriptive information collected during this phase produced five hypotheses about variables maintaining the problem behavior that were then tested experimentally in the classroom environment. The resulting functional assessment data supported the hypotheses. Intervention packages based on the hypotheses were implemented sequentially across English, spelling, and math classes. The interventions were successful in increasing on-task behavior, and the improvements were maintained for the remainder of the school year.

Consistent stress profiles in mothers of children with autism.

The present study extends the area of research on stress in parents of autistic children. In this study we used the Questionnaire on Resources and Stress (Holroyd, 1987) to compare the stress profiles across mothers (a) who lived in different cultural and geographic environments; (b) who had children of different ages; and (c) who had children with different functioning levels. Results showed a characteristic profile that was highly consistent across each of these subgroups. Major differences from the normative data occurred on scales measuring stress associated with dependency and management, cognitive impairment, limits on family opportunity, and life-span care. Results suggest the importance of developing treatment programs aimed at reducing stress in specific areas in families with autistic children.

Effects of task difficulty on parent teaching skills and behavior problems of young children with autism.

Responses of 15 young children with autism and their mothers were analyzed as these families proceeded through a program of skill training and family support. The influence of task difficulty on the children's behavior problems and on the mother's teaching skills was evaluated at three distinct points over a one-year period. Results showed that (a) behavior problems were significantly reduced and teaching skills were significantly improved over the course of training and (b) the difficulty of the task was related to behavior problems and teaching skills. Findings were discussed in relation to implications for assessment and intervention with young children who have autism.

Transmetatarsal amputation. A successful approach to limb salvage.

To assess the outcome of transmetatarsal amputations of the foot, data were analyzed for all transmetatarsal and midfoot amputations performed at the Lebanon Veterans Health Administration Medical Center for the period 1984 to 1990. During this 6-year period, 42 consecutive transmetatarsal and midfoot amputations were performed on 39 patients. Patient demographics, factors leading to amputation, level of amputation, outcome, function, and long-term complications were analyzed. Overall healing rate was 83.3%, with an average length of hospital stay of 35.7 days (range 3 to 96 days). Average follow-up period was 30.2 months (range 2 to 65 months).

Effects of a videotape feedback package on the peer interactions of children with serious behavioral and emotional challenges.

Peer interactions are among the greatest challenges experienced by children who have severe emotional and behavioral problems. This study evaluated an intervention package designed to increase the ratio of these children's desirable to undesirable interactions. The package included three principal components: (a) observation of videotapes following regularly scheduled peer activity sessions; (b) self-evaluation of the children's peer interactions observed on the videotapes; and (c) delayed feedback and reinforcement for desirable peer interactions. Five students from two elementary schools participated. Multiple baseline designs and one reversal were used to evaluate the effects of the intervention package. The results showed that the intervention produced lower levels of undesirable peer interactions and higher ratios of desirable to undesirable interactions for all participants. The results are discussed in regard to their conceptual and applied implications and in terms of specific directions for future research.

Functional assessment, curricular revision, and severe behavior problems.

An adolescent female with multiple handicaps and a long history of severely disruptive behavior participated in a functional assessment linked directly to specific revisions in her school curriculum. During Phase 1, reversal designs were used to test hypotheses pertaining to antecedent and curricular influences on problem behavior. During Phase 2, a multiple baseline across afternoon and morning time periods demonstrated that the curricular revisions were effective in eliminating severely disruptive behavior and increasing on-task responding. Data also showed that inappropriate "psychotic" speech was reduced and appropriate social interactions were increased. Follow-up results showed that the changes were maintained throughout the school year. Questionnaire data provided social validation of the procedures and outcomes. The findings are discussed in relation to their implications for functional assessment, individualized curricula, and positive programming for students with disabilities and serious behavior problems.

Effects of choice making on the serious problem behaviors of students with severe handicaps.

This study assessed the impact of choice making on the serious problem behaviors of 3 students with severe autism and/or mental retardation. In the context of within-subject reversal designs, the results showed consistently reduced levels of problem behaviors (e.g., aggression) when the students were given opportunities to make choices among instructional tasks and reinforcers. Additional data showed no systematic differences in the rate of correct responding between the two conditions. The results are discussed in relation to the continuing search for effective, nonintrusive solutions to the occurrence of serious problem behavior.

A self-monitoring package for teaching subtraction with regrouping to students with learning disabilities.

In this investigation, we evaluated the effectiveness of a self-monitoring package with 3 learning disabled students whose responding to subtraction problems had been highly inconsistent and unsuccessful. Following a two-phase baseline of didactic instruction and special incentives, an error analysis was used to develop individualized self-monitoring checklists that the students then responded to as they completed their subtraction assignments. In the context of a multiple baseline design, the self-monitoring procedures produced immediate gains in correct responding, with more stable levels of successful performance occurring across sessions. In a subsequent maintenance phase, the checklists were removed and the previous incentives condition was reinstated, resulting in continued levels of successful responding. The results are compared to the literature on self-monitoring and learning disabilities and discussed in terms of the continuing need for effective and efficient instructional strategies.

Producing speech use in nonverbal autistic children by reinforcing attempts.

It has been extremely difficult to teach speech to severely handicapped nonverbal autistic children. However, an overview of the literature suggests the possibility that selecting aspects of motivation as a central target behavior, rather than concentrating on motor speech production per se, may improve the effectiveness of teaching speech to these children. Therefore, the purpose of this experiment was to compare two different reinforcement conditions; one in which successive motor approximations of speech sounds were reinforced; and a "motivation" condition in which attempts to produce speech sounds were reinforced, without any motor shaping of speech. The results, replicated within a repeated reversal disign, showed that reinforcing speech attempts was more effective than reinforcing motor speech sounds with respect to (a) the children's interest, enthusiasm, happiness, and general behavior during treatment; and (b) improvements in the children's speech production. The results are discussed in terms of their relationship to the literature on normal parent-child speech interaction, success and failure, and learned helplessness.

Maintaining performance of autistic clients in community settings with delayed contingencies.

To facilitate the classroom and workshop integration of three autistic clients, we examined the feasibility of teaching them to respond appropriately without the continual presence of specially trained treatment providers. Within a multiple baseline design, a 4-step treatment process was implemented to promote durable responsive performance. Results indicated that the therapist could be removed from the treatment environment and that appropriate behavior could be successfully maintained in community settings with only infrequent and delayed contingencies.

Increasing the independent responding of autistic children with unpredictable supervision.

We investigated the role of predictable versus unpredictable supervision on the independent task responding of three autistic children. In a predictable supervision condition, the therapist was present in the setting for a regular period of time and then was absent for the remainder of the session. In an unpredictable supervision condition, the therapist's presence was scheduled on a random, intermittent, and unpredictable basis throughout the session. The multiple baseline analysis showed that the unpredictable supervision produced much higher levels of on-task responding during the therapist's absence for all three children. Analysis of work completed during the therapist's absence also favored the unpredictable supervision condition. The results are discussed in relation to the literature on generalization and educational practice.