Enhancing the communication development of toddlers with autism spectrum disorders

The earliest intervention models were primarily behavioral in nature and focused on mass discrete trial methods (Lovaas, 1977). The idea behind these types of therapies was that children with autism could not benefit from teaching that occurred in their natural environments due to significant difficulties with attention and learning abilities (Prizant, Wetherby, & Rydell, 2000). Unfortunately, early behavioral methods that focused on discrete trial training often resulted in limited generalization. Children with autism who were involved in this type of therapy became passive recipients of communication primarily acting as responders to the communication initiations of others. In an effort to acknowledge the weaknesses of this type of strict behavioral approach, researchers began to search for more naturalistic methods of intervention for children with autism. This has led to the recent shift over the last two decades regarding the conceptualization of intervention for children with autism. This movement resulted in a focus on more naturalistic approaches that consider social interactions as critical to learning language and communication. In this type of model, children take on a more active role in the learning process as opposed to the earlier emphasis on children with autism as passive recipients of language.
Two programs that are described in the current literature and designed primarily for toddlers with ASD illustrate this shift in approach. The intervention models of these two programs were distinctly different from one another in several respects, and yet both incorporate more naturalistic approaches that engage the child in social interactions as a context for promoting the acquisition of targeted skills. In the Walden Toddler Program, McGee, Morrier and Daly (1999) enrolled toddlers with ASD in a center-based program for 3.5 hours per day, 5 days per week. Each classroom served 4 toddlers with ASD and 8 children who were typically developing. In addition, a family program supplemented the classroom intervention with up to 4 hours per week of intervention demonstration in the home with parents required to commit to providing a minimum of 10 additional hours of home-based instruction to their child each week. An interdisciplinary team provided input to the program goals for toddlers with ASD. These included goals for increasing expressive verbal language, engagement with toys, social responsiveness to adults, social tolerance and imitation of peers, and independence in daily living. Classroom teachers were taught to embed incidental teaching activities in naturally occurring activities, to supplement incidental teaching with one-to-one instruction when the child has limited opportunities to learn a skill in naturally occurring activities, to use the child’s preferred toys and activities to increase motivation, and to systematically rotate toys in order to maintain novelty and match toys to current goals. In addition, the classroom staff learned specific strategies for creating incidental learning opportunities, shaping behavior, actively teaching appropriate social engagement with peers, and promoting ongoing engagement with classroom activities and toys.
The outcomes reported by McGee et al. (1999) are based on 28 children with autism who participated in the intervention program for at least 6 months. At program entry (mean age of 29 months), 36% of the children used verbalizations, although it was reported that much of the language used was echolalic or perseverative. At the time of exit from the program (mean age of 41 months) 82% of the children were using meaningful verbal language. The other outcome measure related to peer proximity. Twenty of 28 children showed improvements in measures of peer proximity from the time of program entry to the time of program exit with 7 additional children exhibiting acceptable peer proximity at the time of program entry (i.e., comparable to peers without disabilities) with levels of peer proximity being maintained over the course of the children’s enrollment.