Autism Intervention Every Day!

Embedding Activities in Daily Routines for Young Children and Their Families

by Merle J. Crawford, M.S., OTR/L, BCBA, CIMI
and

Barbara Weber, M.S., CCC-SLP, BCBA

About the Authors

Merle J. Crawford, M.S., OTR/L, BCBA, CIMI is an occupational therapist who has a private practice in central Pennsylvania. She has a bachelor of science degree in special education and elementary education and a master’s degree in occupational therapy. In addition, Ms. Crawford has graduate certificates in applied behavior analysis and autism. She has extensive training in relationship-based interventions and is a Board Certified Behavior Analyst and a Certified Infant Massage Instructor. Ms. Crawford works primarily with infants and toddlers in early intervention, integrating strategies from her varied training when coaching families and working with young children.

Barbara Weber, M.S., CCC-SLP, BCBA is a speech-language pathologist who has a private practice in central Pennsylvania. She received her bachelor of science degree and master’s degree in communication disorders. Ms. Weber has a graduate certificate in applied behavior analysis. She holds the Certificate of Clinical Competence from the American Speech-Language-Hearing Association and is a Board Certified Behavior Analyst. She has worked with children and adults with a variety of disabilities for more than 30 years in school, clinic, and home settings. Ms. Weber works with infants and toddlers as her primary clinical focus and concentrates on collaborative processes to help families.

Autism and Early Intervention

Early intervention (EI) providers bring unique expertise and experience to the children and families with whom they work. Knowledge about and experience in working with young children who are on the autism spectrum vary. Some providers feel quite comfortable working with children on the autism spectrum, whereas others do not believe they have the needed skills.

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; American Psychiatric Association [APA], 2013), diagnostic criteria for ASD include “persistent deficits in social communication and social interaction” and “restricted, repetitive patterns of behavior, interests, or activities,” with symptoms that are not explained solely by an intellectual disability or global developmental delay.

Many studies have looked at red flags in order to identify infants and toddlers who have ASD. For example, Wetherby, Watt, Morgan, and Shumway (2007) found that by 18–24 months, there are five social communication core deficits in children with autism: “gaze shift, gaze point/follow, rate of communicating, acts for joint attention, and inventory of gestures” (p. 973).

Autism Speaks, an advocacy organization whose web site contains a great deal of information for parents and professionals, presented a list of red flags, including the following (2015b):

• No big smiles or other warm, joyful expressions by six months or thereafter
• No back-and-forth sharing of sounds, smiles, or other facial expressions by nine months
• No babbling by 12 months
• No back-and-forth gestures such as pointing, showing, reaching, or waving by 12 months
• No words by 16 months
• No meaningful two-word phrases (not including imitating or repeating) by 24 months
• Any loss of speech, babbling, or social skills at any age

The Centers for Disease Control and Prevention (CDC; 2014) delineates other red flags, advising that people with autism might exhibit the following behaviors at an early age:

• Not respond to their name by 12 months of age
• Flap their hands, rock their body, or spin in circles
• Have unusual reactions to the way things sound, smell, taste, look, or feel

Recommended Practices in Early Intervention

Recommended practice dictates that intervention be evidence based, and both the American Academy of Pediatrics (Myers & Johnson, 2007) and the National Research Council (2001) have published research regarding which methods from both comprehensive treatment models and focused intervention practices are considered evidence based. These publications are quite useful for professionals and for families; however, as Strain, Schwartz, and Barton (2011) pointed out, the publications do not ensure that children with ASD have access to systematic and effective instruction.

One of the recommended practices in EI is coaching. According to Rogers and Vismara (2014), the birth-to-3 world of public intervention services is currently working from a client-centered, adult-learning framework rather than an expertise-driven framework, reflecting the family-centered values explicit in IDEA. Coaching entails using adult learning strategies to promote the caregiver’s ability to reflect upon their actions for effective change and to create a plan for further development through joint planning with the provider, observation of the child, and feedback between the caregiver and the provider.

This caregiver-focused model requires the provider to know evidence-based interventions that help support child development and to be skilled in using the coaching process in collaboration with important caregivers of infants and toddlers. Children learn through participating in their everyday activities, which provides multiple opportunities for intervention throughout each day (Woods, 2008).

In working with children with ASD, coaches help translate effective strategies into real-life routines, enabling caregivers to address everyday challenges, enhance engagement, and facilitate skill development.