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Treatment of
Autism Spectrum Disorder
Evidence-Based Intervention Strategies
for Communication & Social Interactions
Second Edition

edited by
Patricia A. Prelock, Ph.D.
Provost and Senior Vice President
Department of Communication Sciences and Disorders
University of Vermont
Burlington

and
Rebecca J. McCauley, Ph.D.
Professor
Department of Speech and Hearing Science
The Ohio State University
Columbus

Baltimore • London • Sydney

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Evidence-Based Intervention Strategies for Communication & Social Interactions, Second Edition
by Patricia A. Prelock, Ph.D., CCC-SLP, BCS-CL, Rebecca J. McCauley, Ph.D., CCC-SLP

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Paul H. Brookes Publishing Co.

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Copyright © 2021 by Paul H. Brookes Publishing Co., Inc.

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The accompanying video clips that illustrate the interventions discussed in Treatment of Autism
Spectrum Disorder: Evidence-Based Intervention Strategies for Communication & Social
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Library of Congress Cataloging-­in-Publication Data

Names: Prelock, Patricia A., editor. | McCauley, Rebecca Joan,
1952– editor.
Title: Treatment of autism spectrum disorder : evidence-­based intervention
strategies for communication & social interactions / edited by Patricia
A. Prelock, Provost and Senior Vice President, University of Vermont, Department of
Communication Sciences and Disorders, Burlington and Rebecca J. McCauley, Ph.D.,
Professor, Department of Speech and Hearing Science, The Ohio State University, Columbus.
Other titles: Treatment of autism spectrum disorders
Description: Second edition. | Baltimore, MD : Paul H. Brookes Publishing Co., [2021] |
Series: Communication and language intervention series |
Includes bibliographical references and index.
Identifiers: LCCN 2020056439 (print) | LCCN 2020056440 (ebook) |
ISBN 9781681253985 (paperback) | ISBN 9781681254852 (epub) |
ISBN 9781681254869 (pdf)
Subjects: LCSH: Autism spectrum disorders—Treatment. | Autism spectrum
disorders in children—Treatment.
Classification: LCC RC553.A88 T735 2021 (print) | LCC RC553.A88 (ebook) |
DDC 616.85/88200835— ­dc23
LC record available at https://lccn.loc.gov/2020056439
LC ebook record available at https://lccn.loc.gov/2020056440

British Library Cataloguing in Publication data are available from the British Library.

2025 2024 2023 2022 2021

10  9  8  7  6  5  4  3  2  1

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Contents

About the Videos and Downloads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii

Series Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x
Editorial Advisory Board . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
About the Editors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xii
About the Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiv
Foreword  Tony Charman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiii
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxxi

Chapter 1 Introduction to Treatment of Autism Spectrum

Disorder (ASD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Patricia A. Prelock and Rebecca J. McCauley

Chapter 2 Assessment for Treatment Planning and

Progress Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Rebecca J. McCauley, Allison Bean,
and Patricia A. Prelock

Chapter 3 Language and Communication in ASD:

Implications for Intervention . . . . . . . . . . . . . . . . . . . . . . . . . 51
Ashley R. Brien and Patricia A. Prelock

Chapter 4 Augmentative and Alternative Communication

Strategies: Manual Signs, Picture Communication,
and Speech-Generating Devices . . . . . . . . . . . . . . . . . . . . . . . 81
Jane R. Wegner

Chapter 5 The Early Start Denver Model (ESDM):

Promoting Social Communication in Young
Children With ASD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Jill Howard and Geraldine Dawson

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vi Contents

Chapter 6 Discrete Trial Instruction . . . . . . . . . . . . . . . . . . . . . . . . . . 133

Amanda Kazee, Susan M. Wilczynski,
Maria Martino, Shawnna Sundberg,
Molly Quinn, and Nicholas L. Mundell

Chapter 7 The Developmental, Individual-Difference,

Relationship-Based (DIR) Model and
Its Application to Children With ASD . . . . . . . . . . . . . . . . . 163
Sima Gerber

Chapter 8 Functional Communication Training: Treating

Challenging Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
V. Mark Durand and Lauren J. Moskowitz

Chapter 9 The JASPER Model for Children With Autism:

Improving Play, Social Communication,
and Engagement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Connie Kasari and Kyle Sterrett

Chapter 10 Enhanced Milieu Teaching . . . . . . . . . . . . . . . . . . . . . . . . . . 255

Ann P. Kaiser, Elizabeth A. Fuller,
and Jodi K. Heidlage

Chapter 11 Early Social Interaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287

Juliann J. Woods, Amy Wetherby, Abigail Delehanty,
Shubha Kashinath, and Renee Daly Holland

Chapter 12 Peer-Mediated Support Interventions for

Students With ASD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
Erik W. Carter

Chapter 13 Pivotal Response Treatment . . . . . . . . . . . . . . . . . . . . . . . . . 353

Lynn Kern Koegel, Kristen Strong,
and Elizabeth Ponder

Chapter 14 The SCERTS® Model: Social Communication,

Emotional Regulation, and Transactional
Supports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381
Amy C. Laurent, Emily Rubin, and Barry M. Prizant

Chapter 15 Social Skills Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . 413

Patricia A. Prelock and Ashley Brien

Chapter 16 Social StoriesTM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 459

Tiffany L. Hutchins

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Contents vii

Chapter 17 Video Modeling for Persons With ASD . . . . . . . . . . . . . . . . 491

Tom Buggey

Chapter 18 Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 523

Rebecca J. McCauley and Patricia A. Prelock

Glossary . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 569
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 583

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Evidence-Based Intervention Strategies for Communication & Social Interactions, Second Edition
by Patricia A. Prelock, Ph.D., CCC-SLP, BCS-CL, Rebecca J. McCauley, Ph.D., CCC-SLP

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About the Editors

Patricia A. Prelock, Ph.D., Provost and Senior Vice-President, University of

Vermont, Burlington

Dr. Prelock is Provost and Senior Vice-­President, University of Vermont. Formerly,

she was the dean of the College of Nursing and Health Sciences at the University
of Vermont for 10 years. She is also a professor of communication sciences and dis-
orders and professor of pediatrics in the College of Medicine at the University of
Vermont. Dr. Prelock has been awarded more than $11.9 million in university, state,
and federal funding as a principal investigator (PI) or co-PI to develop innovations
in interdisciplinary training supporting children and youth with neurodevelopmen-
tal disabilities and their families, to facilitate training in speech-­language pathology,
and to support her intervention work in ASD. She has more than 195 publications and
566 peer-­reviewed and invited presentations/keynotes in the areas of autism and
other neurodevelopmental disabilities, collaboration, interprofessional education,
leadership, and language learning disabilities.
In 2019, she was named associate editor for the Journal of Autism and Devel-
opmental Disorders. Dr. Prelock received the University of Vermont’s Kroepsch-
Maurice Excellence in Teaching Award in 2000 and was named an ASHA Fellow
in 2000 and a University of Vermont Scholar in 2003. In 2011, she was named the
Cecil & Ida Green Honors Professor Visiting Scholar at Texas Christian University,
and in 2015 Dr. Prelock was named a Distinguished Alumna of the University
of Pittsburgh. In 2016, she received the ASHA Honors of the association, and in
2017, she was named a Distinguished Alumna of Cardinal Mooney High School.
Dr. Prelock also received the 2018 Jackie M. Gribbons Leadership Award from
Vermont Women in Higher Education. Dr. Prelock is a board-­certified specialist in
child language and was named a fellow in the National Academies of Practice (NAP)
in speech-­language pathology in 2018. She was the 2013 president for the American
Speech-Language Hearing Association.

xii

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About the Editors xiii

Rebecca J. McCauley, Ph.D., Professor, The Ohio State University, Columbus

Dr. McCauley is Professor in the Department of Speech and Hearing Sciences at

the Ohio State University. Her research and writing have focused on assessment
and treatment of pediatric communication disorders, with a special focus on speech
sound disorders, including childhood apraxia of speech. She has authored or edited
seven books on these topics and coauthored a test designed to aid in the differential
diagnosis of childhood apraxia of speech. Dr. McCauley is a Fellow of the American
Speech-Language-Hearing Association, has received honors of that association, and
has served two terms as an associate editor of the American Journal of Speech-
Language Pathology.

Excerpted from Treatment of Autism Spectrum Disorder:

Evidence-Based Intervention Strategies for Communication & Social Interactions, Second Edition
by Patricia A. Prelock, Ph.D., CCC-SLP, BCS-CL, Rebecca J. McCauley, Ph.D., CCC-SLP

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About the Contributors

Allison Bean, Ph.D., Associate Professor, The Ohio State University, Columbus

Allison Bean is an associate professor at The Ohio State University. Dr. Bean’s
research focuses on investigating the mechanisms underlying language develop-
ment in minimally verbal children with autism. The ultimate goal for this work is to
improve intervention for minimally verbal children with autism.

Ashley R. Brien, CCC-SLP, Speech-Language Pathologist and Doctoral Candi-

date, University of Vermont, Burlington

Ashley R. Brien is a speech-­language pathologist in Vermont. She is pursuing her

doctorate in interprofessional health sciences at the University of Vermont under the
mentorship of Dr. Tiffany Hutchins and Dr. Patricia Prelock. Her research focuses
on episodic memory and its relationship to theory of mind. She is currently design-
ing interventions and treatment materials to support episodic memory and social
cognition in children with ASD.

Tom Buggey, Ph.D., Retired, Siskin Chair of Excellence in Early Childhood Special
Education, University of Tennessee at Chattanooga

Tom Buggey began research on self-­modeling at Penn State in 1992, working with
preschoolers with language delays. Following the urgings of two gifted gradu-
ate assistants, together they conducted their first research with children on the
autism spectrum in 1995 with very positive results. Thereafter, children with autism
became the focus of his research. Dr. Buggey was recruited to serve as the Siskin
Chair of Excellence in the Special Education Department at UTC in 2007. The next
7 years were devoted to research on developing language and social skills with
preschool-­age children with autism. In his career as a researcher, he has conducted
more than a dozen studies on the use of self-­modeling, all which have appeared in
major journals; published several book chapters of self-­modeling and other aspects
of early intervention; and published the only book on self-­modeling, Seeing is

xiv

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About the Contributors xv

Believing (Woodbine House, 2007), which is currently being translated and pub-
lished in Russia.

Erik W. Carter, Ph.D., Cornelius Vanderbilt Professor of Special Education,

Vanderbilt University, Nashville, Tennessee

Erik W. Carter is Cornelius Vanderbilt Professor of Special Education at Vanderbilt

University. Dr. Carter’s research and writing focus on promoting inclusion and val-
ued roles in school, work, community, and congregational settings for children and
adults with intellectual disability, autism, and multiple disabilities.

Geraldine Dawson, Ph.D., Professor of Psychiatry and Behavioral Sciences, Duke

University School of Medicine, Durham, North Carolina

Geraldine Dawson is the William Cleland Professor of Psychiatry and Behavioral

Sciences at Duke University, director of the Duke Institute for Brain Sciences, and
director of the Duke Center for Autism and Brain Development. Dawson is a licensed,
practicing clinical psychologist and internationally renowned scientist whose work
has focused on early detection and treatment of autism and brain development.

Abigail Delehanty, Ph.D., CCC-SLP, Assistant Professor, Duquesne University,

Pittsburgh, Pennsylvania

Abigail (Abby) Delehanty is an assistant professor and program director for

the Language Disorders and Autism Clinic in the Department of Speech-Language
Pathology at Duquesne University. Dr. Delehanty has extensive clinical experience
serving preschoolers, school-­age children, and adolescents with communication dis-
orders in a public-­school setting. For the last 5 years of her career in the schools, she
served as a speech-­language pathologist on a multidisciplinary autism evaluation
team, conducting weekly developmental screenings in the community and connect-
ing more than 100 children with school-­based services each year. Dr. Delehanty’s
research interests include studying and promoting social communication develop-
ment in children with communication delays and autism and reducing the age of
identification of communication delays and autism in young children from diverse
cultural backgrounds and underserved areas.

V. Mark Durand, Ph.D., Professor of Psychology, University of South Florida

St. Petersburg

V. Mark Durand is known worldwide as an authority in the area of ASD. He is professor

of psychology at the University of South Florida–St. Petersburg, where he was the found-
ing dean of Arts and Sciences and vice chancellor for Academic Affairs. He has authored
more than 145 publications and more than a dozen books, including Optimistic
Parenting: Hope and Help for You and Your Challenging Child and, most recently,
Autism Spectrum Disorder: A Clinical Guide for General Practitioners.

Excerpted from Treatment of Autism Spectrum Disorder:

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by Patricia A. Prelock, Ph.D., CCC-SLP, BCS-CL, Rebecca J. McCauley, Ph.D., CCC-SLP

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xvi About the Contributors

Elizabeth A. Fuller, Ph.D., Vanderbilt University, Nashville, Tennessee

Dr. Fuller specializes in early intervention and behavioral therapy for children
with autism and developmental disabilities. She received her doctorate from
Vanderbilt University in early childhood special education and is a board-­certified
behavior analyst (BCBA). She has over ten years of experience in play and behav-
ior therapies and in coaching parents to implement effective strategies with their
children.

Sima Gerber, Ph.D., CCC-SLP, Professor, Queens College, City University of

New York

Sima Gerber is a professor of speech-­language pathology in the Department of Lin-

guistics and Communication Disorders of Queens College, City University of New York.
She has been a speech-­language pathologist for more than 40 years, specializing in the
treatment of children with ASD and other developmental challenges. Dr. Gerber has
presented nationally and abroad (China, Italy, The Netherlands, South Africa, Israel,
Georgia) on language acquisition and developmental approaches to assessment and
intervention for children with language and communication disorders. Dr. Gerber is a
Fellow of the American Speech-Language-Hearing Association.

Jodi K. Heidlage, Ph.D., BCBA, Project Director, Vanderbilt University, Nashville,

Tennessee

Jodi K. Heidlage is a special educator with expertise in behavioral and naturalis-

tic interventions for children with autism and significant learning challenges. She
has more than 10 years of experience providing direct services for young children
with ASD and has served as a therapist and parent interventionist on several
clinical trials. She currently is the project director for an early reading interven-
tion for children with intellectual and developmental disabilities at Vanderbilt
University.

Renee Daly Holland, M.S., CCC-SLP, Assistant Director of Early Intervention

Services Research, Florida State University, Tallahassee

Renee Daly Holland is the assistant director of Early Intervention Services Research
for the Autism Institute in the College of Medicine at Florida State University.
Mrs. Holland’s clinical experience over the past 27 years has focused on home- and
community-­based early intervention for children with autism spectrum and speech
and language disorders. As the lead interventionist for the Early Social Interaction
Project (ESI), she currently oversees the fidelity implementation and supervision of
the ESI model used in randomized controlled trials across multiple sites. An author
of the Autism Navigator collection of Web-­based courses and tools, Mrs. Holland
also serves as an Autism Navigator Global Trainer and supports professionals within
early intervention systems to deliver effective, evidence-­ based intervention in
natural environments.

Excerpted from Treatment of Autism Spectrum Disorder:

Evidence-Based Intervention Strategies for Communication & Social Interactions, Second Edition
by Patricia A. Prelock, Ph.D., CCC-SLP, BCS-CL, Rebecca J. McCauley, Ph.D., CCC-SLP

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About the Contributors xvii

Jill Howard, Ph.D., Assistant Professor, Licensed Psychologist, Duke University

School of Medicine, Durham, North Carolina

Jill Howard is a licensed psychologist and assistant professor at the Duke Center
for Autism and Brain Development in the Department of Psychiatry and Behav-
ioral Sciences. She specializes in conducting comprehensive diagnostic assess-
ments and delivering intervention services to individuals and families affected by
ASD. Dr. Howard’s primary research interests involve the early identification of and
evidence-­based treatments for ASD, as well as the development of social attention and
behavior. Dr. Howard is certified as an Early Start Denver Model therapist and trainer.

Tiffany L. Hutchins, Ph.D., Associate Professor, University of Vermont, Burlington

Dr. Hutchins conducts research in social cognition and language development in

autism, attention-­deficit/hyperactivity disorder, hearing loss, and childhood trauma.
She also teaches courses in measurement, language disorders, and psycholinguis-
tics. Dr. Hutchins is primary author of the Theory of Mind Inventory and the Theory
of Mind Atlas.

Ann P. Kaiser, Ph.D., Susan W. Gray Professor of Education and Human Develop­
ment, Department of Special Education, Peabody College, Vanderbilt University,
Nashville, Tennessee

Ann P. Kaiser is the Susan W. Gray Professor of Education and Human Development
at Vanderbilt University. She is the author of more than 175 articles on early interven-
tion for children with autism and other development communication disabilities. Her
research focuses on therapist- and parent-­i mplemented naturalistic interventions.

Connie Kasari, Ph.D., Professor of Human Development and Psychiatry, University

of California Los Angeles

Dr. Kasari received her doctorate from the University of North Carolina at ­Chapel Hill
and was a National Institute of Mental Health postdoctoral fellow at the Neuropsychi-
atric Institute at UCLA. Since 1990, she has been on the faculty at UCLA, where she
teaches both graduate and undergraduate courses and has been the primary advi-
sor to more than 60 doctoral students. She is a founding member of the Center for
Autism Research and Treatment at UCLA. Her research aims to development novel,
evidence-­tested interventions implemented in community settings. Recent projects
include targeted treatments for early social-­communication development in at-­risk
infants, toddlers, and preschoolers with autism and peer relationships for school-­age
children with autism. She leads several large multisite studies, including a network
on interventions for minimally verbal school-­age children with ASD, and a network
that aims to decrease disparities in interventions for children with ASD who are
underrepresented in research trials. She is on the science advisory board of the
Autism Speaks Foundation and regularly presents to both academic and practitioner
audiences locally, nationally, and internationally.

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xviii About the Contributors

Shubha Kashinath, Ph.D., CCC-SLP, Associate Professor, California State

University, East Bay, Hayward

Shubha Kashinath is currently chair of the Department of Speech Language and

Hearing Sciences at Cal State East Bay. Her academic and professional interests
focus on autism across the life span, treatment efficacy, caregiver-­focused interven-
tions, and personnel preparation. She has more than 20 years of experience as a
speech language pathologist serving individuals with disabilities and their families.

Amanda Kazee, M.A., School Psychology Extern, Registered Behavior Technician,

Ball State University, Muncie, Indiana

Amanda Kazee is a doctoral candidate in the School Psychology program with a

specialization in applied behavior analysis at Ball State University. Amanda has pre-
sented and published scholarly work alongside Dr. Susan Wilczynski on evidence-­
based practice. She currently serves as a registered behavior technician and school
psychology extern at a local school district.

Lynn Kern Koegel, Ph.D., CCC-SLP, Clinical Professor, Stanford University

School of Medicine, California

Dr. Lynn Kern Koegel and her husband developed Pivotal Response Treatment®, an
intervention used worldwide for the treatment of ASD. She has published well over
100 articles and chapters, field manuals, and eight books, including Overcoming
Autism and Growing Up on the Spectrum with parent Claire LaZebnik, published
by Viking/Penguin and available in most bookstores. The Koegels have received
many awards, including the first annual Children’s Television Workshop Sesame
Street Award for Brightening the Lives of Children, the first annual Autism Speaks
award for Science and Research, and the International ABA award for enduring
programmatic contributions in behavior analysis. Dr. Lynn Koegel has appeared on
numerous television and radio shows discussing autism, including the Discovery
Channel, and ABC’s hit show Supernanny, working with a child with autism. The
Koegels’ work has also been showcased on ABC, CBS, NBC, and PBS, and they are
the recipients of many state, federal, and private foundation gifts and grants for
developing interventions and helping families with ASD.

Amy C. Laurent, Ph.D., OTR/L, Developmental Psychologist, Educational

Consultant, Pediatric Occupational Therapist, Autism Level UP!, North Kingston,
Rhode Island

Amy Laurent specializes in the education of autistic children. Her work involves
creating learning environments designed to facilitate children’s active engagement
at home, in schools, and throughout their communities. She is a coauthor of The
SCERTS Model and frequently lectures around the globe. She is passionate about
neurodiversity and helping others to honor and understand the implications of
“different ways of being” in relation to navigating the physical and social world.

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About the Contributors xix

Maria Martino, M.A., Clinical Project Coordinator, University of Alabama,

Tuscaloosa

Maria Martino received her master’s in clinical psychology from Ball State Univer-
sity. Maria has focused on evidence-­based practice and identifying abuse for popu-
lations with ASD under the supervision of Dr. Susan Wilczynski. Maria is currently
coordinating an NIH-­funded study examining reading comprehension and neu-
ral connectivity in children with ASD under Dr. Rajesh Kana at the University of
Alabama.

Lauren J. Moskowitz, Ph.D., Assistant Professor, St. John’s University, Queens,

New York

Lauren Moskowitz is an associate professor in the Department of Psychology

at St. John’s University. She earned her bachelor of science degree from Cornell
University, her master’s and doctorate in clinical psychology from Stony Brook
University, and completed her clinical internship and postdoctoral fellowship at
NYU Child Study Center. Her research focuses on behavioral assessment and inter-
vention for problem behavior and anxiety in children with ASD and developmental
disabilities. Dr. Moskowitz has coauthored several papers and book chapters; has
presented at numerous international, national, and regional conferences; has taught
several undergraduate and graduate courses covering ASD and developmental dis-
abilities, applied behavior analysis, and positive behavior support, and has been on
the editorial board for the Journal of Positive Behavior Interventions since 2013.

Nicholas L. Mundell, B.S., Graduate Research Assistant, Ball State University,

Muncie, Indiana

Nicholas (Nick) Mundell is a dual-­degree master’s student in the Clinical and Quan-
titative Psychology programs at Ball State University. Nick serves as a graduate
research assistant in the Department of Special Education. In his spare time, Nick
enjoys playing videogames, watching movies, and playing disc golf.

Elizabeth Ponder, M.A., BCBA, Clinical Supervisor, PRT Trainer, Stanford

Autism Center, California

Elizabeth began her training in Pivotal Response Treatment (PRT) as a research

assistant at the Koegel Autism Center while completing her bachelor of arts in psy-
chology at the University of California, Santa Barbara. After graduating, Elizabeth
expanded her knowledge and skills pertaining to ASD and PRT by working as an
interventionist. In 2009, she entered the Special Education, Disabilities and Devel-
opmental Risk Studies (SPEDDR) graduate program at the University of California,
Santa Barbara, with Dr. Robert Koegel as her advisor. After receiving her master’s
degree in 2011, she went on to become a BCBA and has continued her work with
individuals on the spectrum, with a focus on parent and professional education
and training.

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xx About the Contributors

Barry M. Prizant, Ph.D., CCC-SLP, Adjunct Professor, Brown University,

Director, Childhood Communication Services, Providence, Rhode Island

Dr. Barry Prizant has 45 years’ experience as a speech-­language pathologist, author,

researcher, and international consultant. He is an adjunct professor at Brown
University and director at Childhood Communication Services, a private practice.
Barry is a codeveloper of The SCERTS Model, an educational framework now being
implemented in more than a dozen countries. His recent book is Uniquely Human:
A Different Way of Seeing Autism (Simon & Schuster, 2015), which has received
the Autism Society of America’s Dr. Temple Grandin Award for the Outstanding
Literary work in autism and is published in 16 languages.

Molly Quinn, M.A., Behavior Analyst, Ball State, University, Muncie, Indiana

As a professional, Molly Quinn has been defined as a teacher, a behavior analyst, a

parent-­training consultant, and a researcher. She has worked with people between
the ages of 2 years and 30 years who were diagnosed with a developmental disability,
within their homes, schools, and communities, for the last 15 years. In her personal
life, Molly is a mother of three and a foster mom to two children, living in Plainfield,
Indiana. If given the opportunity for leisure, Molly enjoys reading and is passionate
about traveling and interior decorating.

Emily Rubin, M.S., CCC-SLP, Director, Educational Outreach Program, Marcus

Autism Center, Atlanta, Georgia

Emily Rubin is the director of the Educational Outreach Program at the Marcus
Autism Center in Atlanta, Georgia. She is a speech-­language pathologist spe-
cializing in autism, Asperger syndrome, and social-­emotional learning. She is
a coauthor of The SCERTS Model, a criterion-­referenced assessment tool and
educational framework for social communication and emotional regulation. Her
current work is focused on building the capacity of public-­school systems to
embed interpersonal and learning supports that benefit all students and young
children.

Kyle Sterrett, M.A., Doctoral Candidate, University of California Los Angeles

Kyle Sterrett’s research interest lies in the optimization of evidence-­based inter-

ventions through the understanding of their active ingredients using quanti-
tative methods—­for example, understanding of the role of speech-­generating
devices within efficacious interventions for language learners with autism.
He has been involved as a clinician in a number of recent intervention trials,
implementing interventions for children with autism and developmental delays
within schools and in home settings through parent training in the JASPER
intervention model.

Excerpted from Treatment of Autism Spectrum Disorder:

Evidence-Based Intervention Strategies for Communication & Social Interactions, Second Edition
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About the Contributors xxi

Kristen Strong, Ph.D., Psychologist, Acacia Counseling and Wellness, Isla Vista,
California

Dr. Strong is a clinical psychologist and received her doctoral degree from the Uni-
versity of California at Santa Barbara. She worked with Drs. Robert and Lynn Koegel
and has significant experience working with individuals with ASD across the life
span.

Shawnna Sundberg, M.A., Ball State University, Muncie, Indiana

Shawnna received a bachelor of arts degree in psychology from Purdue University

in 2008, and a master’s degree in special education with certifications in applied
behavior analysis (ABA) and autism from Ball State University in 2015. Shawnna is
a board-­certified behavior analyst with more than 10 years of experience working
in the mental health and ABA/verbal behavior (VB) field. Shawnna has worked as
a child and adolescent home-­based case manager, ABA/VB therapist, training spe-
cialist, parent-­training coordinator, and behavior consultant.

Jane R. Wegner, Ph.D., Clinical Professor, Clinic Director, Schiefelbusch Speech-

Language-Hearing Clinic, University of Kansas, Lawrence

Dr. Wegner is a clinical professor and director of the Schiefelbusch Speech-Lan-

guage-Hearing Clinic at the University of Kansas (KU). She directs the Pardee
Augmentative and Alternative Communication Resource and Research Laboratory
on the Lawrence campus of KU. Dr. Wegner directed numerous personnel prepara-
tion projects funded by the U.S. Department of Education, Office of Special Edu-
cation Programs, including the Communication, Autism, and Technology Project
and the Augmentative Communication in the Schools Project. She has authored
numerous articles and book chapters on Augmentative and Alternative Communi-
cation. Dr. Wegner is a Fellow of the American Speech-Language-Hearing Associa-
tion and served on the ASHA Ad Hoc Committee on Autism Spectrum Disorders
that developed the ASHA policy documents for practice with people with ASD.

Amy Wetherby, Ph.D., CCC-SLP, Distinguished Research Professor, Department

of Clinical Sciences, College of Medicine, Florida State University

Amy M. Wetherby is a Distinguished Research Professor in the Department of

Clinical Sciences, director of the Autism Institute in the Florida State University
College of Medicine, and the Laurel Schendel Professor of Communication Disor-
ders in the Florida State University College of Communication and Information.
She has 30 years of clinical experience and is a Fellow of the American Speech-
Language-Hearing Association. Dr. Wetherby has published extensively and gives
presentations regularly at national conventions on early detection of children with
ASD and intervention for children with ASD using The SCERTS Model. She is the

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xxii About the Contributors

project director of a doctoral leadership training grant specializing in autism and

funded by the U.S. Department of Education. She served on the National Academy
of Sciences Committee for Educational Interventions for Children with Autism and
is executive director of the Florida State University Center for Autism and Related
Disabilities. Dr. Wetherby is project director of the FIRST WORDS Project, a lon-
gitudinal research investigation on early detection of ASD and other communica-
tion disorders, funded by the U.S. Department of Education, National Institutes
of Health, and Centers for Disease Control and Prevention. She is also the prin-
cipal investigator of an early treatment study, funded by Autism Speaks and the
National Institutes of Health, teaching parents of toddlers with ASD how to support
social communication and play in everyday activities.

Susan M. Wilczynski, Ph.D., BCBA-D, Professor, Ball State University, Muncie,

Indiana

Dr. Wilczynski is the Plassman Family Distinguished Professor of Special Education

and Applied Behavior Analysis and the former executive director of the National
Autism Center. Dr. Wilczynski has edited or written multiple books and published
scholarly works in Behavior Analysis in Practice, Journal of Applied Behav-
ior Analysis, Behavior Modification, Focus on Autism and Other Develop-
mental Disabilities, and Psychology in the Schools. Dr. Wilczynski is a licensed
psychologist and a board-­certified behavior analyst.

Juliann J. Woods, Ph.D., CCC-SLP, Professor Emeritus, Florida State University,

Tallahassee

Juliann J. Woods is professor emeritus and consultant, Communication and Early

Childhood Research and Practice Center in the School of Communication Science
and Disorders, and associate director of research to practice in the Autism Institute
at Florida State University. Throughout her career, she has emphasized the trans-
lation of research to practice, has published extensively, and presents regularly at
national conferences on early communication and intervention for young children
and their families, early identification and intervention in autism, coaching and
professional development, and the use of technology.

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Introduction to Treatment
of Autism Spectrum Disorder (ASD)
Patricia A. Prelock and Rebecca J. McCauley

INTRODUCTION
This book is intended to introduce readers who have some familiarity with autism
spectrum disorder (ASD) and its core impairments to a group of interventions
focused on social communication and social interaction. Because the diagnostic
category for autism has undergone modification since the first edition of this text,
this chapter describes these changes and briefly highlights some implications for
these changes. The chapter then provides updates on national reviews of inter-
ventions considered to be established in support of the social communication and
social interaction of children with ASD.

CHANGES TO THE DSM-5

When the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edi-
tion-Text Revision (DSM-IV-TR; American Psychiatric Association [APA], 2000)
was updated to DSM-5 (APA, 2013), pervasive developmental disorder/autism, with
its subthreshold diagnoses, changed to autism spectrum disorder. The diagnostic
criteria also moved from three primary diagnostic categories to two: 1) social com-
munication and social interaction and 2) restricted, repetitive, and stereotyped
patterns of behavior. Expansion within each category also occurred. Table 1.1a sum-
marizes differences between the earlier (DSM-IV-TR, APA, 2000) and the current
characterization of ASD (DSM-5; APA, 2013). A particularly significant change is
that language and cognition are now considered to be potential comorbid condi-
tions and require a separate assessment to ensure deficits in these areas cannot be
better explained by an intellectual disability (ID) or a global developmental delay.

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2 Prelock and McCauley

Table 1.1a. A summary of changes associated with autism spectrum disorder (ASD) diagnoses
based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision
(DSM-IV-TR; American Psychiatric Association [APA], 2000) and Fifth Edition (DSM-5; APA, 2013)
DSM-IV-TR DSM-5
Possible Autism spectrum disorders with Autism spectrum disorder is the
diagnoses pervasive developmental sole diagnosis and should be
disorder-­not otherwise used for individuals with well-­
specified (PDD-NOS), autistic established diagnoses of autistic
disorder, Asperger disorder, disorder, Asperger disorder, or
childhood disintegrative PDD-NOS by using the DSM-IV-TR
disorder criteria.
Diagnostic Clinically significant, persistent Deficits in social communication/
criteria for deficits in social communication interaction (must meet all three
ASD and interactions (must meet of the social criteria)
two of the social and one of Restricted and repetitive interests
the communication criteria) (must meet two of the four
Restricted repetitive patterns behavior criteria)
of behavior, interests, and
activities (must meet one of the
behavior criteria)
Symptoms must be present in
early childhood (but may not
become fully manifest until
social demands exceed limited
capacities).
Onset Must have been seen before Symptoms must have been present
age 8 since early development, even if
only recognized later.
Possible — Attention-deficit/hyperactivity
­co-­occurring disorder; speech sound
diagnoses disorder, language disorder,
childhood-­onset fluency
disorder; NOT social (pragmatic)
communication disorder
Possible — With or without accompanying
specifications intellectual impairment
With or without accompanying
language impairment
Associated with a known medical
or genetic condition or
environmental factor
Severity level Severity level description was not Severity level described in three
description specified. levels. See Table 1.1b for a
description of each level.
Source: American Psychiatric Association [APA], 2000 and 2013.

Table 1.1b describes the severity levels now associated with each of the two primary
diagnostic categories (DSM-5; APA, 2013).
Several implications are discussed in the literature regarding the application
of the new DSM-5 criteria. For example, Young and Rodi (2014) found only 57.1% of
those with pervasive developmental disorders (PDDs) on the DSM-IV met the cri-
teria for DSM-5, whereas 50%–75% maintained diagnoses in a review completed by
Smith and colleagues (2015). In both studies, children with a diagnosis of PDD-­not
otherwise specified (PDD-NOS) and Asperger’s disorder were less likely to meet the
DSM-5 criteria, specifically all three social communication and social interaction
criteria. However, a case was made to ensure students who may not qualify under

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Introduction 3

Table 1.1b. Severity levels associated with the two diagnostic criteria for autism spectrum
­disorder in the DSM-5
Restricted, repetitive
Severity level Social communication behaviors
Level 3: Requiring Severe deficits in verbal and nonverbal Inflexibility of behavior,
very substantial social communication skills cause extreme difficulty
support severe impairments in functioning, coping with change,
very limited initiation of social or other restricted/
interactions, and minimal response to repetitive behaviors
social overtures from others (e.g., a markedly interfere
person with few words of intelligible with functioning in all
speech who rarely initiates interaction spheres
and, when he or she does, makes Great distress/difficulty
unusual approaches to meet needs changing focus or action
only and responds to only very direct
social approaches)
Level 2: Requiring Marked deficits in verbal and nonverbal Inflexibility of behavior,
substantial social communication skills difficulty coping with
support Social impairments apparent even with change, or other
supports in place restricted/repetitive
behaviors appear
Limited initiation of social interactions;
frequently enough to
and reduced or abnormal responses
be obvious to the casual
to social overtures from others (e.g., a
observer and interfere
person who speaks simple sentences,
with functioning in a
whose interaction is limited to narrow
variety of contexts
special interests, and has markedly
odd nonverbal communication Distress and/or difficulty
changing focus or action
Level 1: Requiring Without supports in place, deficits in Inflexibility of behavior
support social communication cause noticeable causes significant
impairments interference with
Difficulty initiating social interactions, functioning in one or
and clear examples of atypical or more contexts
unsuccessful response to social Difficulty switching
overtures of others between activities
May appear to have decreased interest Problems of organization
in social interactions (e.g., a person and planning hamper
who is able to speak in full sentences independence
and engages in communication but
whose to-­and-­fro conversation with
others fails and whose attempts to
make friends are odd and typically
unsuccessful)
Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition,
(Copyright © 2013). American Psychiatric Association. All Rights Reserved.

the new criteria continue to receive the intervention services they require (Smith
et al., 2015; Young & Rodi, 2014).
A study with 185 children under 5 years old indicated that children with autism
on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition,
Text Revision (DSM-IV-TR; APA, 2000) were also diagnosed with ASD on the DSM-5,
but children with previous PDD-NOS diagnoses had fewer comorbid and emotional
behaviors and insufficient symptoms in the restricted repetitive patterns of behav-
ior category to qualify for an ASD diagnosis (Christiansz et al., 2016). Another
study (Zander & Bolte, 2015) of younger children between 20 and 47 months found
that 12%–67% of the children who met the DSM-IV-TR criteria did not meet the
DSM-5 criteria, although diagnosis was influenced by severity level, leading to less

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4 Prelock and McCauley

consistent diagnosis. Reports by the Centers for Disease Control and Prevention
(Baio et al., 2018), however, indicate the number of children meeting the DSM-5 cri-
teria for ASD as compared to the DSM-IV-TR criteria are fairly similar, with DSM-IV-
TR cases exceeding DSM-5 cases by less than 5% and with an 86% overlap between
the two definitions. It remains unclear what the impact has been or will be to the
prevalence of ASD diagnoses with the addition of social communication disorder
(APA, 2013). Although this disorder is characterized by challenges in the social use
of both verbal and nonverbal communication similar to ASD, there is no evidence of
restricted and repetitive patterns of behaviors, interests, or activities. Whatever the
ultimate impact is of the application of the DSM-5 on the diagnosis of ASD, children
still require evidence-­based interventions that address their social communication
and social interaction impairments, as prevalence numbers continue to rise with 1
in 59 children receiving a diagnosis (Baio et al., 2018).

BACKGROUND ON INTERVENTION STRATEGIES

FOR COMMUNICATION AND SOCIAL INTERACTION
Since 2000, thinking has evolved about which intervention approaches are most
appropriate for supporting the social interaction and communication needs of chil-
dren with ASD as well as children with social pragmatic disorders who may not
meet the ASD diagnosis. Although traditional behavioral interventions are
plentiful in the literature (e.g., Cooper et al., 2007) and tremendously influential in
a variety of settings (Downs et al., 2007; Lafasakis & Sturmey, 2007; Taubman et al.,
2001), social-­pragmatic developmental interventions continue to gain traction,
including those that involve parent training, in part because they emphasize oppor-
tunities for people with ASD to establish positive social connections and generalize
their skills in the natural environment. Interest in these approaches has also arisen
in response to limitations identified in traditional behavioral approaches to ASD in
terms of generalization of targeted behaviors, particularly those related to the social
use of communication and language (Wetherby & Woods, 2006, 2008). This book
focuses primarily on such approaches because of their special promise in addressing
the social communication and social interaction challenges at the core of ASD and
their potential to minimize barriers to the functional application of learning.
In the traditional behavioral approach, practitioners teach skills one-­to-­one
with a predetermined correct response (Karsten & Carr, 2009; Newman et al., 2009;
Prelock & Nelson, 2012) and a highly prescribed teaching structure (e.g., discrete
trial training [Cooper et al., 2007]). In contrast, in a social-­pragmatic developmental
approach, the interventionist follows the child’s lead, fosters initiation and sponta-
neity, and reinforces contingent responses. Several strategies consistent with these
approaches have long been implemented as part of naturalistic communication and
language interventions for children with a variety of communication and language
challenges (Girolametto et al., 1996; Kaiser et al., 2000; Kaiser & Hester, 1994) and
have more recently been elaborated upon and modified to address the special chal-
lenges presented by ASD.
Several of the interventions described in this text capitalize on the value of
integrating the best of behavioral and developmental approaches to achieve func-
tional and relevant social and communicative outcomes for children, adolescents,
and adults with ASD. For example, Prizant and Wetherby (1998), recognizing the
contributions of both a traditional behavioral and older developmental approaches

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Introduction 5

to intervention, proposed contemporary behavioral interventions (i.e., middle

ground interventions) to support the communication and social interaction needs
of children with ASD. In particular, they described the value of giving children
choices, sharing communication opportunities between the interventionist and the
child, and using preferred activities and materials—­strategies that characterize piv-
otal response training (Koegel, Koegel, Harrower, & Carter, 1999; Koegel, Koegel,
Shoshan, & McNerney, 1999).
As intervention approaches have evolved, so too have comprehensive guide-
lines for best practices. In 2001, the National Research Council (NRC) offered a
description of best practices for children with ASD through the early childhood
years. A number of intervention guidelines emerged from a comprehensive review
of the literature, including initiating treatment as soon as possible; ensuring active
engagement during intensive instruction; using developmentally appropriate,
goal-­based, and systematically planned activities; implementing planned teaching
opportunities throughout the day; and involving families and peers in the interven-
tion to facilitate generalized skill learning. Many early intervention programs have
used these best practices to design comprehensive educational programs for young
children with ASD.
As a follow-­up to the NRC (2001) description, Iovannone and colleagues (2003)
proposed six educational practices as appropriate and effective for school-­age chil-
dren with ASD: 1) providing individualized supports and services that matched a
student’s profile as defined through the individualized education program (IEP)
process; 2) offering systematic, carefully planned, and defined instructional proce-
dures to achieve valid goals with a process for measuring outcomes; 3) creating a
structured learning environment; 4) adding specialized curriculum content in the
area of social engagement and recreation and leisure skills; 5) defining a functional
approach to problem behaviors; and 6) engaging families in their student’s educa-
tional success. Challenges remained, however, in determining the most effective
instructional procedures for children of varying ages, language abilities, and cogni-
tive levels with diagnoses of autism and subthreshold diagnoses, such as Asperger
syndrome and PDD-NOS.
To address the gaps in the intervention effectiveness literature for the large
heterogeneous group of children with ASD, in 2009 the National Autism Center
(NAC) (https://www.nationalautismcenter.org) released a report of a compre-
hensive review of 775 intervention studies since 1957. In that report, the authors
categorized the current level of evidence for several interventions typically used
in the treatment of individuals with ASD (0–21 years). The interventions fell into
one of four groups: established, emerging, unestablished, or ineffective/harmful,
although no interventions were identified in the ineffective/harmful group. Behav-
ioral treatments were identified as having the strongest support, and nonbehavioral
approaches were identified as making a significant contribution but requiring more
research (NAC, 2009).
In 2015, the NAC published a second report, examining research from 2007 to
2012, including any intervention research for those with ASD over 22 years of age
(from 1987 to 2012), collapsing a couple of the behavioral packages under behavioral
interventions and adding a couple of intervention categories. Their findings con-
tinued to support behaviorally based interventions, although limited research was
found for adults over 22, with only 28 studies meeting the inclusion criteria, find-
ing one established, one emerging, and four unestablished interventions for adults

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6 Prelock and McCauley

with ASD. Notably, however, the 2015 NAC report added three interventions to the
established category for individuals from birth to age 21: 1) language training (spe-
cifically language production using behavioral principles); 2) parent training; and
3) a social skills package. The report’s chapter on behavioral interventions speaks
to some of the more recent work in language production training. This second edi-
tion of Treatment of Autism Spectrum Disorder includes two new chapters that
involve parent training, which adds to the three chapters from the first edition that
already focus on the value of parent training, and this edition also features a new
chapter on social skills training.
Table 1.2 lists the 14 interventions included in this book according to their level
of evidence at the time of the most recent publication of the National Standards
Project (NAC, 2015). Established treatments are those identified with sufficient evi-
dence leading to positive outcomes. Emerging treatments are those with one or more
studies yielding positive outcomes but requiring additional high-­quality studies to
show consistent results. Unestablished treatments are those with little evidence and
that consequently require additional research. No treatments are those judged to be
ineffective or harmful. Interventions described in this book fall primarily within the
top two categories of evidence—­established and emerging; only one intervention
(DIRFloortime, Chapter 7) is considered unestablished, although it involves parent

Table 1.2. Levels of evidence for interventions included in this book based on the National Stan-
dards Project
Level of evidence Level description Chapter Intervention
Established Sufficient 6 Behavioral intervention strategies
(14 interventions evidence that 9 Joint attention intervention
identified) the intervention
leads to positive 10 Enhanced Milieu Teaching (EMT)
outcomes 12 Peer-­mediated support strategies
13 Pivotal Response Treatment (PRT)
15 Social skills training
16 Social Stories
17 Video modeling
Emerging One or more studies 4 Augmentative and alternative
(18 interventions yielding positive communication (AAC), including
identified) outcomes, but study Picture Exchange Communication
quality and results System (PECS)
are inconsistent
8 Functional communication
training
Unestablished Little evidence and 7 Floortime and the Developmental,
(13 interventions requiring additional Individual-­difference,
identified) research Relationship-based (DIR) model
Not specifically — 5 Early Start Denver Model
named in the 11 Early Social Interaction Project
NAC report 14 The SCERTS® Model
but all involve
parent training,
which is an
established
intervention
From National Autism Center (2009). National Standards Project—­findings and conclusions: Addressing the
needs for evidence-­based practice guidelines for autism spectrum disorders. Randolph, MA: Author; adapted
by permission.

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Introduction 7

training, which is an established intervention. Also, three interventions are included

that relate specifically to parent training (i.e., Early Denver Start Model [Chapter 5],
Early Social Interaction Project [Chapter 11], and The SCERTS® Model [Chapter 14])
that were not specifically named in the 2015 NAC National Standards Project report.
With the National Standards Project as a guide for evidence-­based practice with
children and youth affected by ASD, this text is timely because it emphasizes key
established and emerging interventions used to facilitate the communication and
social interaction of individuals with ASD and highlights those interventions with
parents playing a key role.

PURPOSE OF THE BOOK

This book describes and critically analyzes specific treatment approaches used to
address the communication and social interaction challenges of children, adoles-
cents, and adults with ASD. Although these challenges are of specific interest to
speech-­language pathologists, providers across disciplines have a stake in using
evidence-­ based intervention to respond to these core areas of impairment for
individuals with ASD. Approaches selected for inclusion have empirical evidence
of efficacy or effectiveness established through systematic reviews or at least two
peer-­reviewed articles that indicate the approaches are well-­established, probably
efficacious or promising emerging interventions (e.g., Chambless et al., 1998; Chor-
pita et al., 2002; NAC, 2015).
Traditionally, randomized control trials (RCTs) are considered the gold stan-
dard for evaluating treatment efficacy. RCTs, however, are rare in many clinical
fields. In contrast, single-­subject experimental designs are underacknowledged in
evaluating treatment efficacy (Barlow et al., 2009; Perdices & Tate, 2009), yet they
constitute the majority of credible evidence in the intervention research in autism
(Debodinance et al., 2017; Odom et al., 2003). Single-­subject designs make impor-
tant contributions to the research base on treatment when they 1) are replicated
across behaviors, participants, and contexts; 2) measure change reliably and sys-
tematically; 3) have established implementation fidelity; and 4) are socially valid. In
fact, results from many single-­subject designs indicate that specific interventions
are associated with positive learning outcomes for individuals with ASD (Lord et al.,
2005). Therefore, the effectiveness of selected treatments included in this book has
been established primarily through single-­subject experimental designs, although
instances of randomized control trials do exist (e.g., joint attention training using
the JASPER model).
Table 1.3 provides a summary to facilitate the reader’s understanding of the
similarities and differences among the interventions in terms of basic principles,
techniques, teaching methods, treatment targets, and ages for which evidence has
been established. This table also identifies the evidence rating provided by the
National Autism Center (2015). In addition, to make the treatments accessible to
the reader and to facilitate their comparison, the table’s descriptions were standard-
ized using a template adapted from that used in McCauley and Fey (2006) in which
critical features of each treatment are highlighted. Treatments are also illustrated
by a short video example, which can be accessed on the Brookes Download Hub (see
the About the Videos and Downloads page in the front matter for guidance on how
to access the video clips).
Readers will learn that the interventions emphasize somewhat different prin-
ciples, techniques, and teaching methods to foster communication and social

Excerpted from Treatment of Autism Spectrum Disorder:

Evidence-Based Intervention Strategies for Communication & Social Interactions, Second Edition
by Patricia A. Prelock, Ph.D., CCC-SLP, BCS-CL, Rebecca J. McCauley, Ph.D., CCC-SLP

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 8
Table 1.3. National Autism Center (2015) categorization of featured interventions

Prelock_Ch01_1-18.indd 8
NSP
Interventions ratinga Basic principles Methods Targets Ages
AAC including Emerging Social-­pragmatic Assessment of partner and Enhance existing communication skills Toddler
PECS and behavioral environmental influence Expand language through
(Chapter 4) AAC system and target vocabulary adult
Replace speech
selection Provide structure to support language
Meaningful contexts development
Responsive partners Initiate requests spontaneously
Natural environment Request reinforcing items or
Family and person centered activities, help, or a break
Systematic teaching Reject offers for undesired items or
Time delay activities
Direct, natural reinforcement Affirm offers for desired items or
activities
Shaping
Follow a direction to wait
Modeling
Respond to directions
Prompting
Follow transitional cues and visual
Visually based
schedules
Early Start Not specifically Developmental Play Receptive and expressive language 1–5 years
Denver Model reported and behavioral Relationship building Social skills with adults and peers
(Chapter 5) but is parent Applied behavior analysis techniques Joint attention
training
focused, Naturalistic developmental behavioral Imitation
which is techniques including natural Play
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established interactions, shared control, natural

contingencies

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Group-­delivered ESDM
Parent-­delivered ESDM
Implementation fidelity

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Evidence-Based Intervention Strategies for Communication & Social Interactions, Second Edition

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 Behavioral Established Behavioral Adult-­directed, individualized Communication, social, and 3–21 years

Prelock_Ch01_1-18.indd 9
intervention one-­to-­one instruction adaptive skills
strategies: Predetermined correct responses Use of verbal operants (e.g., mands,
discrete trial tacts, echoics, intraverbals)
Contingent or differential reinforcement
learning,
differential Shaping behaviors
reinforcement, Operant conditioning
and shaping Massed trials
(Chapter 6) Maintenance trials
Mand-­modeling
DIR Floortime Unestablished Developmental Family based Shared attention and regulation 18 months–
(Chapter 7) Child directed Engagement and relating 9 years
Interpersonal development Two-­way intentional communication
Individual differences Complex problem solving
Caregiver–child relationships Creative representations and
Parent and clinician implemented elaboration
Representational and emotional
thinking
Functional Emerging Behavioral Functional behavior assessment Replacement of aggression, 3–21 years
communication Selection of an alternative behavior self-­injury, elopement, and
training inappropriate sexual behavior with
Fading prompts
(Chapter 8) functional communication forms
Response match, success, efficiency,
acceptability, recognizability, and milieu
Natural communities of reinforcement
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Joint attention: Established Behavioral and Directed instruction Response to and spontaneous 3–5 years
JASPER Model developmental Individualized initiation of joint attention

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(Chapter 9) Intensive
Milieu teaching
Parent and clinician implemented
Enhanced Milieu Established Behavioral and Environmental arrangement Productive, spontaneous, and 3–9 years
Teaching developmental Responsive interaction meaningful use of new language
(Chapter 10) forms
Language modeling

by Patricia A. Prelock, Ph.D., CCC-SLP, BCS-CL, Rebecca J. McCauley, Ph.D., CCC-SLP

Initiations and responses

Evidence-Based Intervention Strategies for Communication & Social Interactions, Second Edition
Milieu teaching

9
Parent and clinician implemented

(continued)

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 Table 1.3. (continued)

10

Prelock_Ch01_1-18.indd 10
NSP
Interventions ratinga Basic principles Methods Targets Ages
Early Social Not specifically Developmental Family based Social communication from preverbal 18 months–
Interaction reported Child directed to multiword stage 3 years
(Chapter 11) but is parent Gesture use
Environmental arrangement
training
Responsive interactions Initiation of and response to joint
focused attention
which is Preferred activities and materials
established Word knowledge
Routine based
Reciprocity
Natural environment
Peer mediation Established Behavioral Peer interaction training Initiating and maintaining 3–14 years
(Chapter 12) Peer network strategies conversation
Regular opportunities to interact within Exchanging compliments
and outside instructional settings Turn-­taking
Adult coaching, guidance, and support Helping behaviors
Inclusive environment Sharing materials
Communities of reinforcement Collaborating on assignments
Instructional arrangements (e.g., Making introductions
cooperative groups, peer support Conversing about shared interests
arrangements)
Pivotal Response Established Behavioral and Play based First words 3–9 years
Treatment developmental Family based Basic social skills
(Chapter 13)
Natural environment Sophisticated language and social
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Routine based skills

Child choice Pivotal behaviors (e.g., motivation,

Excerpted from Treatment of Autism Spectrum Disorder:

responsivity to multiple cues, self-­
Turn taking
management, self-­initiations)
Shared control of teaching opportunities
Direct and natural reinforcement
Reinforcing communication attempts
Preferred activities and materials

by Patricia A. Prelock, Ph.D., CCC-SLP, BCS-CL, Rebecca J. McCauley, Ph.D., CCC-SLP

Interspersing maintenance tasks within
teaching sessions

Evidence-Based Intervention Strategies for Communication & Social Interactions, Second Edition

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 Social Stories Established Social-­pragmatic Visually based Reduction of disruptive behaviors 6–14 years

Prelock_Ch01_1-18.indd 11
(Chapter 16) Situation specific (e.g., tantrums, aggression, self-­
injurious acts)
Individualized instructional strategy
(determine topic, gather information, Establish routines
develop the story, consider additional Introduce changes in routines
supports, critical review, introduce Understanding of a new or unfamiliar
story, generalization training, event
maintenance and fading) Social skills (e.g., getting a peer’s
attention, making choices, playing
independently, peer engagement
and participation)
Communication (e.g., reduction of
echolalia, interrupting, and loud
talking)
Video modeling Established Behavioral and Visually based Teach new skills or improve existing 3–18 years
(Chapter 17) developmental Viewing positive video models skills across developmental domains
(e.g., self-­help skills—­dressing,
Adult and peer modeling
feeding, washing; cognitive skills—­
Point-­of-­view modeling play, perspective taking, attention;
Self-­modeling including feed forward social skills—­conversation, prosody,
and positive self-­review turn-­taking; language skills—­
question asking and answering,
greeting, comprehending stories)
Replace or extinguish maladaptive
behavior
The SCERTS® Not specifically Developmental Collaboration Social communication Preschool
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Model reported Curriculum-­based assessment Emotion regulation through

(Chapter 14) but is parent school age
Natural routines Transactional supports

Excerpted from Treatment of Autism Spectrum Disorder:

training
focused
which is
established
Social skills Established Social-­pragmatic
interventions and behavioral
(Chapter 15)

by Patricia A. Prelock, Ph.D., CCC-SLP, BCS-CL, Rebecca J. McCauley, Ph.D., CCC-SLP

a

Evidence-Based Intervention Strategies for Communication & Social Interactions, Second Edition
Source: National Autism Center. (2015).

11
Key: AAC, augmentative and alternative communication; ESDM, Early Start Denver Model; JASPER, Joint Attention, Symbolic Play, Engagement, and Regulation; PECS, Picture Exchange
Communication System; SCERTS, Social Communication, Emotional Regulation, and Transactional Supports.

10/05/21 4:52 PM
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12 Prelock and McCauley

development in children, adolescents, and adults with ASD; therefore, there is

not one best approach for all individuals. Instead, there are profiles of individuals
affected by ASD who are likely to benefit most from each intervention guided by
the evidence. Early, intensive, and structured intervention as well as a collaborative
approach to working in home, educational, and community settings appear to be
critical features of effective intervention. Further, this book emphasizes the impor-
tance of addressing the core deficits of social interaction and social communication.

HOW TREATMENTS ARE DESCRIBED

Authors prepared their intervention chapters, Chapters 4–17, using a template, with
sections indicated by the headings provided in Table 1.4. Each chapter begins with a
brief introduction summarizing the treatment approach and defining the subgroups
of individuals with ASD for whom the treatment is designed. The chapter also
includes the age, developmental level, language level, and service delivery model the
treatment entails, including its basic focus and methods. In the description of the
subgroups for whom the intervention is appropriate, the authors consider not only
the specific diagnoses (e.g., autism spectrum disorder, social communication dis­
order) but also the individual’s level of verbal skills and cognitive abilities.
The next section in each chapter includes the theoretical basis for the treatment
approach. Here the authors discuss four main components. The first component is
a theoretical explanation or rationale for the treatment. The second component
includes underlying assumptions regarding the nature of the communication and
social interaction impairment being addressed by the treatment. The third compo-
nent describes the functional outcomes or desired consequences (e.g., increase joint
attention, facilitate social interaction, foster communication and symbol use) being
addressed. The final component highlights the treatment target (e.g., language or
social functioning).
The theoretical basis is followed by a summary of research providing an empiri-
cal basis for the treatment. In this section, the authors summarize and interpret
studies providing evidence that supports the use of the treatment. Authors have
prepared a level of evidence table in which they present the major research designs
used to examine the intervention and the outcomes reported for both group and
single-­subject research. Where possible, effect sizes are reported as originally pub-
lished or computed for the chapter when means and standard deviations were given.
To support practitioners’ use of the described interventions in their specific
settings, in the next section of each chapter, authors outline some practical require-
ments for implementing the treatment. This section of each chapter includes a
discussion of time demands, training, or expertise required by clinicians wish-
ing to use the intervention and any materials or equipment needed for treatment
implementation.
Practical requirements are followed by a description of the key components of
the intervention approach. The goal for this section is to ensure the reader has a
strong, preliminary understanding of the procedures. Authors provide information
about the nature of the goals addressed by the intervention, how multiple goals are
addressed over time (e.g., sequentially, simultaneously, cyclically), a procedural or
operational description of activities within which the goals are addressed, and the
nature of involvement of participants beyond the clinician and child (e.g., peers, sib-
lings, teachers, primary caregivers). (Several of the authors also reference training

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Introduction 13

Table 1.4. Description of the topics addressed in each section of the treatment chapters
Section Content
Introduction Overview of the intervention is provided, including the specific
individuals for whom it is designed and their age (i.e., infants/toddlers,
children, adolescents, adults), developmental level, and language
level. The service delivery model involved, the intervention’s basic
focus, and its primary methods are highlighted.
Target populations Description of those subgroups on the autism spectrum (i.e., autistic
disorder, Asperger disorder, pervasive developmental disorder-­not
otherwise specified, Rett disorder, and childhood disintegrative
disorder) for whom the intervention is primarily designed and for
whom there is empirical support for its use. Level of verbal skills and
cognitive abilities are also discussed. Assessment methods used to
establish the appropriateness of the treatment for an individual child,
adolescent, or adult with autism spectrum disorder (ASD) are presented.
Theoretical basis Description of the dominant theoretical explanation or rationale for
the treatment approach, underlying assumptions regarding the nature
of communication and social interaction impairment being addressed
by the treatment, the functional outcomes being addressed, and the
area of treatment being targeted.
Empirical basis Comprehensive summary and interpretation of studies providing
evidence that supports the use of the intervention, including
descriptions of the experimental design and treatment effects for
both group and single-­subject research, the nature of outcome
data reported (e.g., standardized testing vs. naturalistic probes),
intervention fidelity, maintenance and generalization of treatment
effects, and social validity
Practical Description of the time and personnel demands for the primary
requirements clinician and related other participants, whether or not a team
approach is used, required training of personnel involved, or materials
required
Key components Description of the goals addressed by the intervention, how multiple
goals are addressed over time (e.g., sequentially, simultaneously,
cyclically), activities within which the goals are addressed, and
involvement of participants beyond the clinician and child (e.g., peers,
siblings, teachers, primary caregivers)
Assessment for Description of the major assessments and assessment points used to
treatment planning reach decisions about 1) the appropriateness of the intervention;
and progress 2) initial and subsequent treatment targets, etc.; 3) advancement
monitoring through treatment; and 3) treatment termination
Considerations Discussion of the applicability of the intervention to children from
for children from linguistically and culturally diverse backgrounds and ways in which the
culturally and intervention might be modified to be most appropriate
linguistically diverse
backgrounds
Application to a Description of a real or hypothetical case of a child illustrating the
child implementation and effectiveness of the treatment approach
Application to an Description of a real or hypothetical case of an adolescent or an adult,
adolescent or adult illustrating the implementation and effectiveness of the treatment
approach
Future directions Discussion of additional research needed to advance the refinement
or ongoing validation of the intervention across populations of
individuals with ASD and related neurodevelopmental disabilities
Suggested readings Summary of a few readings of greatest use to readers who might
want to know more about the specific intervention
Learning activities Topics for further discussion, ideas for projects, questions to test
integration of the reading material, and possible writing assignments
to facilitate the readers’ learning

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14 Prelock and McCauley

manuals, which can support a more thorough understanding of the procedures

involved in the intervention they describe.)
Assessment methods used to establish the appropriateness of the treatment
plan and progress monitoring for an individual child, adolescent, or adult with ASD
are presented in the next section. Recognizing the critical role of data to guide prac-
tice, this section of each chapter also describes data collection methods to support
decision making. The authors provide descriptions of how data are collected, ways
to evaluate progress, strategies for determining when and how adjustments should
be made, and when the intervention approach should be terminated. They explain
how data collection is used to guide ongoing treatment decision making and to
assess immediate and long-­term outcomes.
This section is followed by implications for inclusive practice, offering examples
where the intervention can be applied in the home, school, work, and/or community
setting. Considerations for implementing the intervention for children from cultur-
ally and linguistically diverse backgrounds are described in the final section before
specific applications are made to children, adolescents, or adults. The authors offer
guidance in planning modifications related to the particular cultural and personal
factors affecting an individual child, adolescent, or adult while ensuring consistency
in the treatment approach.
In the next two sections, the authors provide a description of potential appli-
cations of the intervention to a child and to an adolescent or adult. They offer two
brief case studies: one of a younger individual with ASD for whom the treatment is
considered appropriate and effective and one of an adolescent or adult for whom
the treatment is considered appropriate and effective if, in fact, the intervention is
appropriate for older individuals.
The final content section of each chapter is a description of directions for future
research needed to advance the development or ongoing validation of the interven-
tion approach across populations of individuals with ASD and related neurodevelop-
mental disabilities. This is followed by three to five suggested readings the authors
believe represent important further details or background about the intervention as
well as learning activities the authors pose to facilitate further discussion, ideas for
projects, questions to test integration of the reading material, and possible writing
assignments. In addition to a comprehensive set of references at the end of each
chapter, a glossary of key words is provided at the end of the book, with these key
words bolded in the text to inform readers that more information about them is
available in the glossary. Finally, a summary of the video clip to illustrate the inter-
vention is provided.

NEW COMPONENTS
This book includes two new chapters beyond the intervention chapters to facili-
tate the reader’s use of the book. Chapter 2 highlights the importance of assess-
ment to treatment planning and progress monitoring. The context for assessment
is discussed recognizing the importance of a family-­centered, culturally informed
approach that is both interdisciplinary and comprehensive. The role of screening and
diagnostic testing to identify the presence of ASD and comorbid conditions is also
described, but more briefly. This chapter includes approaches to identifying severity
and creating profiles of social communication and social interaction challenges. Most
important, this chapter provides strategies for monitoring change over time.

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Introduction 15

Chapter 3 highlights the language and communication strengths and challenges

most often seen in children with ASD, as these have implications for intervention.
Early communication challenges are discussed, including intentional communica-
tion, gesture use, word learning, and the use of unconventional verbal behavior. The
chapter emphasizes those challenges that specifically impact language development,
social communication, and social interaction, such as impairments in joint attention,
play, and theory of mind. This chapter is designed to help the reader understand
what researchers know about the syntactic, semantic, phonological, and pragmatic
development of children with ASD and what the implications are for intervention.
In addition to these changes in the content included in this second edition, a
companion resource, Case Studies for the Treatment of Autism Spectrum Disor-
der (Prelock & McCauley, 2021), is offered as an optional supplementary resource.
Through 14 individual cases, readers are introduced to hypothetical but instruc-
tive scenarios posing the kinds of clinical problems that face clinicians who wish
to devise comprehensive services for clients with ASD. Although there is particular
focus on social communication and social interaction difficulties, the multitude of
co-­occurring problems that so often complicate the decision making required for
effective management in ASD are incorporated to provide a real-­world flavor. Along-
side decisions recommended by experts, the casebook includes decision-­making
exercises that can enrich readers’ understanding of social communication and social
interaction challenges as well as the possible strategies that can help address them.

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by Patricia A. Prelock, Ph.D., CCC-SLP, BCS-CL, Rebecca J. McCauley, Ph.D., CCC-SLP

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16 Prelock and McCauley

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Introduction 17

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C O M M UNI C AT I O N A N D L A NGUAGE / AUT ISM

McCauley
Prelock &
“Would make an excellent text for a course in treatment of ASD, as well as a
great resource for practitioners searching to find the most appropriate treatments
for a wide range of individuals with ASD.”
—Rhea Paul, Ph.D., CCC-SLP, HASHA, Professor and Chair, Evidence-Based
Department of Communication Disorders, Sacred Heart University

“No single book can possibly capture all one needs to know for supporting learners
Intervention
with autism, but this volume is an excellent foundation for the journey.”
—Mareile Koenig, Ph.D., CCC-SLP, BCBA, Professor and SLP Graduate Program Coordinator,
Strategies for
Communication
Communication Sciences and Disorders, West Chester University

& Social Interactions

Treatment of
T
o work effectively with individuals who have WHAT’S NEW:
autism spectrum disorder (ASD), SLPs and • New chapter on assessment for treatment
other practitioners need in-depth knowledge
on choosing and implementing interventions for
•
planning and progress monitoring
New chapter on language and
SECOND EDITION
communication and social challenges. This bestselling communication strengths and challenges
textbook gives professionals the foundation they often seen in children with ASD
need to evaluate and compare today’s widely used
• New in-depth profiles of the Early Start
interventions—and determine which ones will promote Denver Model, The SCERTS® Model, and

Autism Spectrum Disorder

the best outcomes for the people they serve. Social Skills Interventions
• Videos to demonstrate the newly added
Readers will get a thorough introduction to 14 interventions
evidence-based interventions, complete with key
• Updates to reflect the DSM-5
details on each intervention’s theoretical and empirical
basis, components, practical requirements, applications • More information on inclusive practices
for both children and adults, and considerations for • More on working with children from
children from diverse cultural and linguistic backgrounds. culturally and linguistically diverse
Twelve video clips (available for streaming) illustrate backgrounds
the interventions in action, and in-text learning activities • A sample syllabus that demonstrates how
prepare SLPs and other practitioners to make sound faculty can integrate this book into a course
decisions in scenarios they’re likely to encounter in
the field.

COMPANION CASEBOOK AVAILABLE: Available on its own or as a bundle with the

textbook, Case Studies for the Treatment of Autism Spectrum Disorder walks readers
through 14 realistic cases and helps them hone their decision-making skills.

Communication and Language Intervention Series

SECOND
EDITION
Series Editors: Alan G. Kamhi, Ph.D. & Rebecca J. McCauley, Ph.D.
This theory-to-practice, transdisciplinary series addresses the language problems associated with communication disorders
and developmental disabilities. Visit www.brookespublishing.com/cli for more on this series.

ABOUT THE EDITORS: Patricia A. Prelock, Ph.D., is Provost and Senior Vice President at University of Vermont. Rebecca J.
McCauley, Ph.D., is Professor in the Department of Speech and Hearing Sciences at the Ohio State University.

ISBN-13: 978-1-68125-398-5
ISBN-10: 1-68125-398-4
90000
Patricia A. Prelock
Rebecca J. McCauley
9 781681 253985 > Foreword by Tony Charman