MESSAGE FROM THE President
OAR Presents Its Top 10 for '08

Dr. Peter Gerhardt President

The holidays are once again upon us and another year is quickly drawing to close. While we at OAR are already busy working and planning for the coming 12 months, the time is also right for us to briefly look back over 2008 at what we, with your help, were able to accomplish. So, with absolutely no claim to originality, I am pleased to present the Organization for Autism Research’s Top 10 Accomplishments for 2008:

• Raised over $600,000 through the RUN FOR AUTISM in direct support of OAR’s research programs and related services.

• Awarded $300,000 to fund seven applied autism research studies across the United States. In addition, OAR funded eight graduate research studies for a total of $16,000. Between the two programs, OAR has now funded over $1,700,000 in applied autism research in the United States, Canada, Africa, and Europe since 2002.

• Held the second Biennial Autism Research Convocation in June at the Carter Center in Atlanta, GA. This event, which was held in collaboration with the Marcus Institute, focused on the latest research in the area of social skills and adaptive behavior. OAR will publish an edited book, based on the reports of those in attendance, in late 2009.

• Held the sixth Annual Applied Autism Research and Intervention Conference, featuring over 21 nationally and internationally recognized speakers across two days. With just over 200 parents, professionals, and adults on the spectrum in attendance, this was one of our most successful conferences to date.

• Published, in partnership with the Southwest Autism Research and Resource Center, the fifth installment in our Life Journey through Autism guidebook series, A Parent’s Guide to Assessment.

• Translated our four earlier Life Journey through Autism guidebooks into Spanish as part of OAR’s Latino Outreach Program supported by an Autism Speaks Family Services Community Grant.

• Began the development of a Web site and Life Journey through Autism guidebook specifically for military families with a child with autism as the result of a $40,980 grant from the American Legion Child Welfare Foundation.

• Completed production of the second Asperger Syndrome DVD, this addressing issues related to dorm living for both the students on the spectrum and those charged with supporting them (e.g., resident advisors), to be released next month.

• Awarded five new Schwallie Family scholarships totaling $15,000 to deserving scholars with an autism diagnosis who were enrolled in an accredited program of post-secondary education and made second-year awards to the original three recipients.

• Added new RUN FOR AUTISM events in Cleveland, San Antonio, and Virginia Beach which will allow us to do even more in 2009!

While I could easily go into much greater detail on any of these “Top 10” items, much of that can be found in either this, or previous, editions of The OARacle. I do, however, want to provide some additional information into OAR’s signature program, the annual Applied Autism Research Competition.

This year’s competition began, in earnest, with the receipt of 63 pre-proposal submissions from researchers in the United States, Canada, and Australia. As each pre-proposal is reviewed by a minimum of three doctoral-level reviewers (including at least one member of the OAR Scientific Council), OAR requires a pool of slightly over 50 volunteer reviewers to complete the initial review process. Reviewers are asked to evaluate each pre-proposal for overall research design and the potential importance of the outcomes to the autism community. After all the reviews were tabulated, OAR invited 37 applicants to submit a full research proposal for consideration in the next stage of the review process.

Upon receipt of the full proposals, copies are once again sent out to our corps of reviewers. This review, however, is much more in depth and includes a budgetary review, a comprehensive review of the specific research methodology, and a review of the supporting research as well of the credentials of the principal investigator. As with the pre-proposals, each full proposal is reviewed by a minimum of three reviewers but this time, at least two of the reviewers are members of OAR’s Scientific Council. For the 2008 competition, this resulted in 16 full proposals being referred to the full Scientific Council for final review.

On Thursday, October 23, the Scientific Council held its annual in-person meeting, the primary purpose of which was to review the final research proposals and, based upon that review, make funding recommendations to  OAR’s Board of Directors. Following much debate and discussion, the Scientific Council referred a slate of 12 final research proposals to the Board for its consideration. I briefed the Board on each study and the review committee’s recommendations at its annual meeting the following Saturday. The Board considered the merits of each study and OAR’s available funds and voted to fund seven of the recommended proposals. Over the course of the next week, OAR notified all applicants as to the status of their proposals (either funded or not) and the process by which funding is to be made available to the winners began. An overview of each the funded research projects, each slated to beginning in early 2009, can be found on page 1 of this edition of The OARacle.

As you can see, the process is both time-consuming and very comprehensive, allowing for only the “best of the best” to be funded by OAR. And this is only one of OAR’s “Top Ten” accomplishments this past year, making 2008 one of our most productive and busiest years to date.

With that, I wish to thank all of our dedicated, generous, and caring supporters who helped make 2008 possible. Whether by participating in the RUN FOR AUTISM, donating in support of OAR runners, reviewing research proposals, volunteering at any number of OAR events, responding to our annual appeal, or simply forwarding an e-copy of The OARacle to friends, family, or other interested parties, your support is critical to the success of OAR. Our success is your success and, ultimately, the success of individuals with autism and their families.

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Annual Conference Earns High Marks

On October 24 and 25, OAR hosted its sixth annual Autism Research and Intervention Conference in Arlington, VA. For the second year in a row, this event was held at the Westin Arlington Gateway. Over 200 parents, professionals, and individuals with ASD from across the United States and Canada attended what was one of OAR’s best conferences to date, according to the attendees. Nancy Eisenreich, a third-year attendee who is a teacher and parent of a child on the spectrum, said, “Each year the variety of topics selected… is great – well-chosen.”

Thanks to the generous help of sponsors, OAR was able to keep the conference both informative and affordable to educators and parents who have already seen their budgets stretched by caring for individuals with autism. One conference sponsor included the University of North Texas Department of Behavior Analysis, Distance Learning, which contributed money to offset the cost of the continental breakfast on both days. The University of Miami/Nova Southeastern University Center for Autism and Related Disabilities (UM-NSU CARD) also helped by sponsoring the “Meet the Speakers” reception held at the close of Friday’s events. The Daniel Jordan Fiddle Foundation and the Lisa Higgins-Hussman Foundation, Inc. provided funding for scholarships and aided with conference costs.

Thanks to these wonderful sponsors, OAR was able to provide what Amy Jablonski, from Getzville, NY, described as “an excellent overall conference, value for the money, and materials.”

The conference opened with a keynote address by Ami Klin, Ph.D., the Harris Associate Professor of Child Psychology and Psychiatry at the Yale Child Study Center, who spoke on “Social Engagement in the First Two Years of Life in Autism Spectrum Disorders.” Dr. Klin provided an overview of new research focusing on the social engagement and development of infants and toddlers on the spectrum. He also described how this information can help to identify indicators of social delays that are associated with a later diagnosis.

After attending the first set of breakout sessions, attendees reconvened in a plenary session to listen to a unique viewpoint from autism father and anthropologist Roy Richard Grinker, Ph.D., author of Unstrange Minds: Remapping the World of Autism. His closing keynote presentation “What in the World is Autism? How Culture Shaped a Disability” provided a look into how different cultures throughout the world see this disorder. This refreshingly new perspective caused many attendees to stop and reconsider how they viewed autism. According to one attendee from Queens, NY, “I found Dr. Grinker’s talk very eye-opening in putting into words that autism can be seen as part of human diversity and can be well-integrated into society.”

Friday’s activities ended with a “Meet the Speakers” reception with cocktails and hors d’oeuvres in the main exhibit area where attendees, speakers, exhibitors, and members of OAR’s Board of Directors and Scientific Council had the opportunity to mix and participate in networking and conversation. After spending a day immersed in new research, attendees appreciated the time to relax and enjoy meeting other attendees. “Attendance at this conference gives me a nice chance to mingle with other professionals. I feel very ‘current’ on what is going on in the field now,” said Peggy Halliday, a past conference presenter and professional from the Virginia Autism Institute in Charlottesville, VA.

Saturday’s schedule began with the conference’s third keynote speaker, Joanne Gerenser, Ph.D, CCC-SLP, who is also a member of OAR’s Scientific Council. In her one-hour presentation, “The Key to a Quality of Life: Effective Communication,” Dr. Gerenser reviewed the core issues that impact the development of effective communication and the effect communication has on all other aspects of functioning. Another set of breakout sessions followed.

Thanks to a partnership with the Eden II Programs in New York and the Maryland Association for Behavior Analysis (MABA), attendees were able to earn both American Speech-Language Hearing Association (ASHA) and Behavior Analyst Certification Board (BACB) Continuing Education Units (CEUs) by attending this year’s conference. OAR once again would like to thank those partner organizations for their invaluable support.

OAR’s conference has a reputation for quality speakers and relevant topics. As shown in the scores and comments provided on the feedback forms, this year’s conference reinforces that belief. “I am highly inspired by the level of care and concern I’ve observed in the professionals I’ve spent the last two days with,” wrote Elizabeth “Betsie” Walter from Kent, WA.

Overall, the speakers earned an average quality rating of 3.52 out of a possible 4 points; individually, each earned an average rating above a 3. Another attendee, Eve Bisard from Warwick, RI, summed it up this way: “Dr. Gerhardt does an amazing job with this event as does the rest of the OAR team. Thank you for supporting parents and professionals who need this information.”

For those unable to attend the conference, OAR is offering sets of the Conference Manual and an audio CD on a first-come, first-served basis after a donation of $25.00. This 342-page manual includes slides from each presentation, and the audio disk includes all but one. To order these resources, please e-mail conference@researchautism.org or contact Alyssa Kruszyna at (703) 243-9717.

Next Year

Planning is already under way for next year’s conference to be held October 23 and 24, 2009, once again at the Westin Arlington Gateway. OAR will continue to offer four different topic tracks over the two-day conference.

OAR will post the list of speakers and schedule for next year’s conference on its Web site, www.researchautism.org, by the end of January 2009.

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OAR FUnds $300,000 In New Research

OAR completed its sixth Applied Autism Research Competition in October, awarding $300,000 in total grants for seven new studies scheduled to begin next month. After a thorough review of 62 pre-proposals in a process outlined in this month’s “Message,” 12 finalists were referred to OAR’s Board of Directors for funding consideration. After careful deliberation, the Board voted to fund the seven studies summarized below, bringing OAR’s total funding for new research to just over $1.7 million since 2002.

Building Tacting and Joint Attention Skills with the Use of an Augmentative Device
Mary Jane Weiss, Ph.D., BCBA
Rutgers, The State University of New Jersey
Douglass Developmental Disabilities Center
Ivy Feldman, Ph.D., BCBA
The McCarton School, New York, NY

One-year; $30,000

Individuals with autism spectrum disorders (ASD) often rely on augmentative and alternative communication (AAC) devices to communicate their wants and needs. While there is widespread use of these systems and some clarity as to how to teach manding using AAC, effective instruction in other skills such as tacting or recruiting joint attention are less well understood. This study will explore how to teach students to tact and to recruit joint attention in the context of tacting using AAC devices. In addition, it will assess the transfer of these skills to interactions with a caregiver in their neighborhood. The study will also discuss implications for using these devices to teach critical social skills and for methods to increase the generalization of such skills to the natural environment..

Examination of Prerequisite Skills for Learning Using Video Modeling
Rebecca P. F. MacDonald, Ph.D., BCBA
William H. Ahearn, Ph.D., BCBA
New England Center for Children

One-year; $30,000

While video modeling is an effective and efficient instructional technique for many children with autism, others do not learn using video modeling. In a previous pilot study, these researchers found that poor responding on delayed match-to-sample tasks was associated with failure to learn using video modeling. Delayed matching-to-sample (DMTS) is a widely used procedure to measure short-term memory and it appears that memory may play an important role in learning to use video modeling. In the first of two project studies, the researchers will evaluate the relation between delayed match-to-sample performance and imitation of a video model. In the second study they will teach delayed match-to-sample to see if this could translate into the child learning through video modeling. This research could lead to a quick way for educators to assess whether video modeling is an appropriate teaching procedure for a specific child and a prescribed teaching method for preparing children to learn using video modeling.

Training Paraprofessional Staff to Provide Proactive Support for Individuals with Severe Autism in Inclusive Settings
Dennis H. Reid, Ph.D., BCBA
Carolina Behavior Analysis and Support Center, Ltd.

One-year; $30,000

A common strategy of agencies providing support in inclusive settings for individuals with autism at the severe end of the spectrum is to assign a staff person to provide 1:1 support. This study will evaluate a means of training such staff to provide proactive support to individuals with severe autism in inclusive settings, including school classrooms, an adult education program, and supported work. Individual staff members (Experiment 1) and small groups of staff (Experiment 2) will receive a performance- and competency-based training program  in a classroom format, followed by on-the-job feedback. The researcher  anticipates that the training will result in improved support provided by staff with corresponding improvement in the functioning of the individuals with severe autism.

Feeding Problems among Children with Autism: The Impact of Parent Education in Modifying Aberrant Eating Habits
William G. Sharp, Ph.D.
David L. Jaquess, Ph.D.
The Marcus Autism Center, Atlanta, GA

One-year; $30,000

The purpose of this study is to investigate the topography and treatment of feeding difficulties related to ASD. Drs. Sharp and Jaquess propose to: (a) assess the types of feeding difficulties exhibited by children with ASD, as well as the effect that these difficulties have on a child’s nutritional status and family functioning; and (b) evaluate the impact of a parent-education intervention targeting problematic feeding behavior and related sequelae among children with ASD. This study seeks to test whether it is possible to extend the benefits of therapist-mediated behavioral feeding interventions to parents of children with ASD.

Transporting Evidence-Based Practices from the Academy to the Community: School-Based Cognitive Behavioral Therapy for Children with Autism Spectrum Disorders
Jeffrey J. Wood, Ph.D.
Marilyn Van Dyke, M.A., CCC-SLP
University of California, Los Angeles, and The Help Group

Two-years; $60,000

Dr. Wood’s and Ms. Van Dyke’s study will involve training community practitioners to implement a cognitive behavioral intervention for the treatment of anxiety in children with autism. The practitioners, who will consist of therapists and speech-language pathologists, will be selected from the Help Group’s Village Glen School, a Los Angeles-area school specializing in the education of children with autism. The on-site school practitioners will be trained to conduct weekly cognitive behavioral therapy sessions with children and their parents and other family members. The intervention incorporates traditional anxiety treatment components including coping skills training (e.g., cognitive restructuring), in-vivo exposure, operant procedures, and parent communication techniques. The research team will assess children’s outcomes through parent, teacher and child reports as well as in-vivo behavioral playground observations to determine if the treatment is having the expected positive impact, and to guide further training and supervision efforts.

Measuring the Effects of Training Parents to Provide Intervention via the Arizona Telemedicine Program
Daniel Openden, Ph.D., BCBA
Christopher J. Smith, Ph.D.
Southwest Autism Research and Resource Center
Phoenix, AZ

Two-years; $60,000

With the dramatic increase in children diagnosed with autism spectrum disorders (ASD) has come a shortage of qualified interventionists to provide services. The lack of interventionists is even more of a challenge for those who reside in rural or remote regions. Using a randomized clinical trial, Drs. Openden and Smith will evaluate the efficacy of using telemedicine as a tool for providing immediate feedback and continued support for parents in more rural areas. The dependent measures, parent fidelity of implementation of Pivotal Response Treatment (PRT), and functional verbalizations produced by the child, will be collected by each parent-child dyad at baseline, post initial in-vivo parent training and again at follow-up. The results of this study may have important implications for the delivery of cost-effective and efficacious intervention for families in rural or remote areas.

Transition to Adulthood: Service Utilization and Determinants of Functional Outcomes
Paul T. Shattuck, Ph.D.
Washington University
St. Louis, MO

Two-years; $60,000

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Research Feature:
Multi-tiered Systems for Preventing Behavior Problems of CHildren with ASD

By Glen Dunlap, Ph.D.

A professor in the Division of Applied Research and Educational Support at the University of South Florida, Glen Dunlap, Ph.D. works on research, training, and demonstration projects in the areas of positive behavior support, early intervention, and family support. Currently a member of OAR’s Scientific Council, he has been involved with individuals with disabilities for more than 30 years. He helped establish the West Virginia Autism Training Center and Florida’s Center for Autism and Related Disabilities. Dr. Dunlap has directed numerous research and training projects, authored more than 170 articles and book chapters and co-edited four books, and served on 15 editorial boards.

Autism spectrum disorders (ASD) are a collection of developmental disabilities in which there is a great range of severity. Some children with ASD have severe intellectual disabilities, have no conventional communication skills, and require full-time supervision. On the other end of the continuum, there are children with ASD who have challenges with social connectedness but function well within (or above) the typical range in academic and functional life competencies.

Regardless of their level of functioning, children with ASD are at serious risk for the development of problem behaviors. Risk is manifested as difficulties in understanding and managing the social environment, challenges in getting needs met, and problems in communicating physiological and interpersonal discomfort. Such difficulties and frustrations are readily expressed in the form of problem behaviors such as prolonged and violent tantrums, property destruction, excessive stereotypic behaviors, aggression, and self-injury. These problem repertoires can be shaped (inadvertently) into intensive and chronic patterns of behavior that are increasingly resistant to intervention as children grow older without effective alternatives having been established.

The presence of serious problem behaviors is arguably the most significant impediment to learning and healthy social-emotional development for children with ASD. Problem behaviors are common reasons for excluding children from general education settings and other inclusionary opportunities, and they constitute a primary reason for limiting community participation, social interaction, and direct instructional interactions. Parents are understandably reluctant to include their children with ASD in community outings if their children are likely to engage in conspicuous problem behavior. Problem behaviors are also major sources of parent stress, as well as stress for teachers and other caregivers. As children proceed through their pre-school years and enter childhood and adolescence, the effects of serious problem behaviors can accumulate so that it can be extremely difficult to envision a life that is not constrained by highly restrictive living arrangements and very few opportunities for developing relationships or meaningful skills related to social interaction, community participation, or independent functioning. For these reasons, the vital importance of early detection, assessment, and remediation of problem behaviors has been increasingly appreciated. And a great deal of applied research on ASD has focused on problem behaviors (Horner, Carr, Strain, Todd, & Reed, 2002).

The vast majority of efforts in the literature to resolve problem behaviors have been initiated after the behaviors have already become frequent occurrences with serious implications. That is, most efforts to resolve problem behaviors are not initiated until the problem is fully developed and, presumably, highly resistant to remediation. Little research has focused on prevention of problem behaviors or on intervention at early stages in problem behaviors’ development. This is understandable for many reasons (including the methodological difficulties associated with prevention research), but it is also inefficient and, arguably, less effective than an approach that emphasizes early strategies of prevention.

An alternative approach centers around the thesis that problem behaviors of children with ASD can be addressed more satisfactorily if dedicated prevention efforts are undertaken before problem behaviors emerge, and on a continuum of prevention and intervention strategies geared to the degree of risk and chronicity-severity of the problem behavior. This article promotes a three-tiered prevention model as a framework for a hierarchy of strategies differing in their intensity and the resources needed for their implementation, and balanced against the status of the problem behavior(s) exhibited by the child with ASD.

A Model of Prevention

The prevention model being advanced for children with ASD is based on the three-tiered model of prevention that has been increasingly common in many arenas of social services including public health and education (e.g., Fox, Dunlap, Hemmeter, Joseph, & Strain, 2003; Sugai et al., 2000; Walker et al., 1996). The model begins by defining a target behavior in need of prevention, such as smoking cigarettes or destructive/disruptive behaviors. Strategies intended to prevent the occurrence or further development of the target behavior are then categorized along a hierarchy related to the proportion of the population for whom the strategy would be pertinent, the intensity of the strategy, and in terms of the stage of the target behavior’s development.

Level 1 strategies are intended for the entire population of interest (e.g., all children with ASD). The strategies are geared to an early stage of prevention and are relatively inexpensive and easy to implement. This level is referred to as primary prevention, involving universal applications. For instance, for smoking prevention, universal strategies might include public service announcements on television; for school-wide discipline, universal strategies might include posters promoting awareness of expected behavior, simple instruction for the entire student body, and a system of acknowledgement for students who follow school rules. Universal strategies for children with ASD would be implemented for all children, as young as possible, who are diagnosed or described as having ASD.

Level 2 is referred to as secondary prevention, and is intended for individuals for whom Level 1 is insufficient and who are clearly at risk for, or who are already demonstrating, early indications of the target behavior. Level 2 strategies for smoking prevention might focus on teenagers and include, as one example, lectures and films in secondary schools depicting the health dangers of smoking. For school-wide discipline, Level 2 might include social skills groups or special reinforcement contingencies for targeted groups of students identified as being at particular risk for school behavior problems.

For children with ASD, Level 2 might include specific procedures designed to teach appropriate problem solving and to divert children from using problem behavior. Level 2 strategies are more focused than Level 1, involve a smaller proportion of the population, and are less intensive and costly than Level 3 strategies. Still, for children with ASD, due to their substantial risk factors, it is likely that a relatively large segment of the population will require and benefit from Level 2 strategies.

Level 3 is for individuals who are already displaying the target behavior and require relatively intensive and individualized interventions. This level is referred to as tertiary prevention, with individualized, intensive intervention procedures. For smokers, strategies might include individualized counseling or therapy, nicotine patches or gum, and other techniques (e.g., self-management) demonstrated to be effective in such circumstances. For school-wide discipline, Level 3 could include functional assessment of the target behavior followed by individualized, behavioral interventions that might incorporate, for chronic cases, wraparound procedures involving families and community agencies.

For children with ASD, Level 3 involves individualized assessment and assessment-based interventions that are relatively well-represented in the current literature on positive behavior support and applied behavior analysis. These strategies are markedly more expensive in terms of resources and time required than Levels 1 or 2.

It is important to clarify that Level 3 for children with ASD is not just one level of intensity. It is actually a set of procedures on a continuum of intensity that is based on the extent to which the child’s problem behaviors are severe, long-lasting, and demonstrably resistant to change. That is, if a child is beginning to display tantrums at school, but the tantrums are limited to one or two classes and have not been exhibited at home or in the community, then the procedures need not be time consuming or especially effortful (though they may still require individualized assessment and an individualized intervention plan). Similarly, if the child is only 2 or 3 years old with problem behaviors that have functions that are easily understood, then they might call for a relatively straightforward and efficient process of intervention development and implementation. On the other hand, if a child has demonstrated severe problem behaviors for several years, and the problems have persisted in many environments despite multiple efforts of remediation, then the Level 3 process is likely to require a considerable investment of time and resources to be effective.

A Brief Synopsis of Strategies

Level 1 Strategies: Level 1, or primary prevention, strategies are intended for all children with an ASD diagnosis, and should be implemented as soon as the diagnosis is suspected. Two major objectives of Level 1 strategies are to: (1) provide a comprehensible, stimulating and non-irritating environment for the child, and (2) teach the child, from a very early age, that interacting with the social environment is a pleasurable and satisfying enterprise.

General strategies that are part of Level 1 include:

• Developing strong, positive relationships between parents (and other family members and caregivers) and the child. The intent is to teach the child that parents and caregivers are stable, secure, and safe figures that provide nurturance, comfort, pleasure, and guidance. Developing attachments is a challenge for children with ASD, so special efforts are required, even when signs of a child’s interest are not apparent.

• Providing a safe, comprehensible, stimulating, and responsive environment. As children with ASD often have difficulty navigating their surroundings, it is useful to be sure that clear physical cues are consistently available to help the child locate desired items and to make appropriate requests. A correlate of this strategy is that a child with ASD should be exposed to a variety of community and social contexts, while being supported by assistance and positive guidance to insure that these experiences are enjoyable and successful for the child.

• Ensuring that the child’s physical health is sound, that somatic complaints are understood and addressed, and that the child consumes food and beverages that are nutritious. A child’s physiological well being is an important factor in preventing the emergence of problem behaviors.

• Providing intentional instruction to help the child acquire functional communication skills needed to effectively and conventionally control aspects of the child’s interactions with his environment.

Level 2 Strategies: Level 2 strategies involve specific procedures designed to enhance a child with ASD’s social competencies and, indirectly, help prevent the development or display of problem behaviors. Level 2 is for children with ASD for whom Level 1 is insufficient and who have risk factors that indicate a need for more deliberate strategies. Such risk factors include obvious delays in language development, notable avoidance of social interactions, and a failure to acquire functional skills. These criteria suggest that a large proportion of children with ASD may require Level 2 supports, though the actual proportions are unknown and must await the completion of considerable research.

The ASD literature offers many examples of Level 2 strategies, including elements of specialized programs (National Research Council, 2001). An excellent example is provided by Strain and Schwartz (in press) who describe a strategy referred to as “appropriate engagement intervention,” in which the procedural focus is on increasing children’s appropriate engagement with classroom materials and activities. Although not designed explicitly as an intervention for problem behaviors, increases in engagement tend to covary negatively with occurrences of problem behavior and, thus, the engagement intervention serves well as a strategy for preventing problems without an intensive behavior intervention plan.

Another set of strategies is found in “Pivotal Response Treatment (PRT)” (Koegel & Koegel, 2006). Included within PRT are numerous variables that are useful for increasing the motivation and engagement of children with ASD, and such variables serve not only to enhance children’s academic, communicative, and social development, they also serve to prevent problem behaviors. Such procedures involve less effort and intensity than Level 3 strategies, yet they can be extremely useful for encouraging pro-social development and preventing the development of problems.

Level 3 Strategies: Level 3 is comprised of procedures that are most readily associated with interventions for problem behaviors because these are the strategies that are deployed after problem behaviors have developed to the point that they present obstacles to education and healthy social-emotional development, and present threats to the physical and emotional safety of the child with ASD, his peers, or others in the vicinity. At one time, the predominant approach for such problem behaviors was based almost entirely on contingency management, in which interventions consisted of manipulations of rewards and punishers.

While contingency management is still important, Level 3 strategies have broadened considerably over the past two decades and now include a focus on rearrangements of the antecedent environment and instruction on functional alternatives to the problem behaviors. Level 3 strategies now place a strong emphasis on education rather than suppression. In addition, Level 3 interventions are generally preceded by a process of functional assessment, designed to identify intervention components that address the individualized functions of the particular child’s problem behaviors. The overall process of assessment and intervention is based on applied behavior analysis and commonly referred to as positive behavior support (Dunlap & Carr, 2007; Sailor, Dunlap, Sugai, & Horner, in press).

The process for implementing individualized Level 3 strategies generally consists of five steps:

1.   Establishing a team and gaining a unified understanding of the child and an agreement on the short and long-term goals of intervention

2.   Conducting a functional assessment of problem behavior

3.   Developing an individualized intervention plan

4.   Implementing the intervention plan

5.   Evaluating the effects of the intervention

This process of positive behavior support (PBS) has been demonstrated in numerous studies, literature reviews, and syntheses to be effective in building desirable skills and reducing or eliminating problem behaviors (Carr et al., 1999; Dunlap & Carr, 2007). As testimony to its effectiveness, the methods and outcomes of PBS have been described in numerous Web sites, articles, manuals, and books, and the vast majority of these resources offer information and guidance that is evidence-based, credible, and useful.


Summary

The purpose of this article was to describe a multi-tiered approach to the problem behaviors of children with ASD. The emphasis of the framework, at all levels, is on prevention. Children with ASD present such a large number and complexity of risk factors that complete prevention of problem behaviors is not always realistic, at least for some children. However, it is expected that careful attention to the strategies at the primary and secondary tiers of the model (Levels 1 and 2 of intervention) will effectively prevent the development of problem behaviors for some children and at least mitigate the need for highly intensive Level 3 interventions for the remainder.

Carr, E. G., Horner, R. H., Turnbull, A. P., Marquis, J., Magito-Mclaughlin, D., McAtee, M. L., Smith, C. E., Anderson-Ryan, K., Ruef, M. B., & Doolabh, A. (1999). Positive Behavior Support for People with Developmental Disabilities: A research synthesis. Washington, DC: American Association on Mental Retardation.

Dunlap, G., & Carr, E.G. (2007). Positive behavior support and developmental disabilities: A summary and analysis of research. In S.L. Odom, R.H. Horner, M. Snell, & J. Blacher (Eds), Handbook of Developmental Disabilities (pp. 469-482). New York: Guilford Publications.

Fox, L., Dunlap, G., Hemmeter, M. L., Joseph, G. E., and Strain, P. S. (2003). The teaching pyramid:  A model for supporting social competence and preventing challenging behavior in young children. Young Children, 58, 48-52.

Horner, R.H., Carr, E.G., Strain, P.S., Todd, A.W., & Reed, H.K. (2002). Problem behavior interventions for young children with autism: A research synthesis. Journal of Autism and Developmental Disorders, 32, 423-446,

Kincaid, D. & Fox, L. (2002). Person-centered planning and positive behavior support. In S. Holburn & P. M. Vietze (Eds.), Person-Centered Planning. Research, Practice, and Future Directions (pp. 29-50). Baltimore: Paul H. Brookes.

Koegel, R. L., & Koegel, L. K. (2006). Pivotal Response Treatments for Autism: Communication, Social, and Academic Development. Baltimore, MD: Brookes Publishing Company.

National Research Council (2001). Educating Children with Autism. Committee on Educational Interventions for Children with Autism. Catherine Lord and James P. McGee (eds). Division of Social Sciences and Education. Washington DC: National Academcy Press.

O'Neill, R.E., Horner, R.H., Albin, R.W., Storey, K., Sprague, J.R., & Newton, J.S. (1997). Functional Assessment of Problem Behavior: A Practical Assessment Guide. Pacific Grove, CA: Brooks/Cole.

Sailor, W., Dunlap, G.,  Sugai, G., & Horner (Eds). Handbook of Positive Behavior Support. New York: Springer.

Strain, P., & Schwartz, I. (in press). Positive behavior support and early intervention for young children with autism: Case studies on the efficacy of proactive treatment of problem behavior. In W. Sailor, G. Dunlap, G. Sugai, & R.H. Horner (Eds). Handbook of Positive Behavior Support. New York: Springer.

Sugai, G., Horner, R.H., Dunlap, G., Hieneman, M., Lewis, T.J., Nelson, C.M., Scott, T., Liaupsin, C., Sailor, W., Turnbull, A.P., Turnbull, H.R. III, Wickham, D., Ruef, M., & Wilcox, B. (2000). Applying positive behavior support and functional behavioral assessment in schools. Journal of Positive Behavior Interventions, 2, 131-143.

Walker, H. M., Horner, R.H., Sugai, G., Bullis, M., Sprague, J.R., Bricker, D. et al. (1996). Integrated approaches to preventing antisocial behavior patterns among school-age children and youth. Journal of Emotional and Behavioral Disorders, 4, 194-209.

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NEWs from OAR

OAR’s Life Journey Guides Now Offered en Español

Thanks to a Family Services Community Grant from Autism Speaks, OAR now has the first four guides in its Life Journey through Autism available in Spanish. The guides offered are:

• A Parent’s Guide to Research
• An Educator’s Guide to Autism
• An Educator’s Guide to Asperger Syndrome
• A Guide for Transition to Adulthood

The translation was done by Fusión mc communications, a small, Hispanic, and woman- owned and -managed marketing and advertising agency located in Arlington, VA, that specializes in creating culturally insightful, effective campaigns. In addition to translating existing OAR resources, Fusion is assisting OAR in developing new resources specifically intended for the Latino community.

As with the English versions, the Spanish guides will be available online at http://www.researchautism.org/resources/reading/index.asp and in hard copy. A donation of $5.00 per guidebook is required.

OAR applied for a grant in the very first round of the Family Services Community Grants competition sponsored by Autism Speaks. The $20,000 award provided funds for translating, graphic design, and layout for three of the four guides and publishing 1,000 copies of all four. OAR is presently seeking funds to do the same translation, adaptation, and publishing for its latest guide, A Parent’s Guide to Assessment to the inventory of guides in Spanish.

OAR Makes Second Appearance at DC Latino Community Health Fair

In each of the last six years, Telemundo Washington DC has sponsored La Feria de la Familia, an event for the Latino community offering health screenings, information, and the opportunity to meet Latino TV and news personalities, all set in the atmosphere of a community festival. La Feria de la Familia is the Capital Region's first and largest expo for Latino families. Attendees have the opportunity to enjoy a fun-filled day of family entertainment, games, and prizes while learning about the services provided by more than 100 of the region's business and organizations-all at no cost. For the second year in a row, OAR participated as part of its Latino Outreach program.

This year’s Feria, held at the DC Armory, November 2, attracted more than 27,000 people of all ages throughout the day. In the course of the six-hour event, more than 1,500 people, many parents with young children, visited OAR’s exhibit booth to receive information about early childhood developmental milestones and the warning signs of autism. Volunteers Cynthia Valdes, Maeve O’Neill, and Megan Johncox, all conversant in Spanish, joined OAR’s Mike Maloney and Jessica Hopey for the event. Thanks to the volunteers’ language proficiency and knowledge of autism and OAR, OAR’s outreach this day was particularly effective.

Valdes, who has a son with autism, participated for the second year in a row. Commenting on her experience, she says, “For many of these families an event like this provides health information and services they may not receive anywhere else throughout the year. The young parents I met seemed especially interested and appreciative of the information and materials we provided.”

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RUN FOR AUTISM NEWS

Have A Rockin’ Good Time When You Roll With OAR

RUN FOR AUTISM is striving to have team representation at all of the Rock ‘n’ Roll series events in 2009. These races are known for their live bands, entertainment along the course, and a free post-race concert event. Each one is directed by Elite Racing Inc., the highly regarded Events Management Division of Competitor Group, which owns a number of popular races across the country.

Fifteen runners are slated to participate in the RUN FOR AUTISM – Phoenix at the P.F. Chang’s Rock ‘n’ Roll Arizona Marathon and Half Marathon on January 18. If you’d like to be a part of this sunny destination marathon, book your flight to Phoenix and sign up with OAR today. It’s a great opportunity to support autism research and enjoy the perfect Arizona running weather

It’s also a great time to start training for a spring marathon. Signing up for the Rock ‘n’ Roll Country Music Marathon and ½ Marathon in Nashville, TN, on April 25 will provide motivation to train through the winter months. Another spring option is the original Rock ‘n’ Roll Marathon event in San Diego, CA, on May 31.

Summer brings two inaugural events to choose from:  Rock ‘n’ Roll Seattle Marathon and ½ Marathon on June 27, and the Rock ‘n’ Roll Chicago Half Marathon (formerly The Chicago Distance Classic) on August 6. Or celebrate the Labor Day weekend and the end of the season with the Rock ‘n’ Roll ½ Marathon Virginia Beach on September 6.

Looking further into the future, other events include the ING Philadelphia Distance Run on September 20, Rock ‘n’ Roll San Antonio Marathon & ½ Marathon on November 16, and the Rock ‘n’ Roll Las Vegas Marathon & ½ Marathon December 6.

With locations all over the country, there is something in the Rock ‘n’ Roll series for everyone. Join the RUN FOR AUTISM team at any of these events and help us meet our goal of representation at every event in 2009.

If you are interested in joining the RUN FOR AUTISM in any Rock ‘n’ Roll series event, email  run@researchautism.org or visit www.researchautism.org/news/run/index.asp.

Come with Us to Houston for a 5K or to Volunteer

On January 18, the RUN FOR AUTISM will kick off its 2009 season at the Chevron Houston Marathon. Although the Marathon and Half Marathon are sold out, you can still be part of the team in the 5K event or participate as an OAR volunteer.

This marks the fourth year that OAR will field a RUN FOR AUTISM team as one of the race’s official charity partners. Led by the efforts of Reverend James Grace, who raised $9,400, the 2008 team broke the $30,000 mark for the first time. Grace, who is an Episcopal priest, is running again on behalf of his son, James, who has autism. Joining him on the course is Scott Lowry, back again from the 2007 team.  Along the course, Patti Breaux, who got the team started in Houston, will be on hand to lend support and cheer the OAR team in.  Breaux  recently finished the Nike Women's Marathon in San Francisco, and became OAR’s top fundraiser in 2008 in the process.

The activities commence with a two-day expo featuring running seminars and the latest in fitness equipment at the Brown Center on Friday and Saturday. The Marathon, Half, and 5K all take place on Sunday morning.

For more information on how to join the RUN FOR AUTISM team, please call (703) 243-9710, x224 or send an email to: run@researchautism.org

On January 18, the RUN FOR AUTISM will kick off its 2009 season at the Chevron Houston Marathon. Although the Marathon and Half Marathon are sold out, you can still be part of the team in the 5K event or as a volunteer to OAR’s Houston team.

This marks the fourth year that OAR will field a RUN FOR AUTISM team to be one of the races official charity partners. Led by James Grace, who raised $9,400, the 2008 team broke the $30,000 mark for the first time. Grace, who is an Episcopal priest, is running on behalf of his son, James, who has autism. Scott Lowry is back again from the 2007 team and Patti Breaux, who got the team started in Houston, will be on hand to lend support after recently finishing the Nike Women's Marathon in San Francisco.

A two-day expo with running seminars and the latest in fitness equipment will take place on Friday and Saturday at the Brown Center. The Marathon, Half, and 5K all take place on Sunday morning.

For more information on how to join the RUN FOR AUTISM team, please call (703) 243-9710, x224 or send an email to: run@researchautism.org

The People’s Race: 110 OAR Runners Toe the Start Line

Runners looking to run in a fall marathon on the East coast have many choices when it comes to where they will toe the start line. Among the favorites is the Marine Corps Marathon. Often referred to as “The People’s Race,” the 33rd annual event in October had a representative from every state and many countries among its 30,000 registered runners. Celebrating OAR’s sixth year as an official Charity Partner, the RUN FOR AUTISM team had 110 runners participate in the marathon and associated 10K.

At 8:00 a.m. sharp, the booming sound of a 155mm howitzer signaled the start of the race and runners began their 26.2-mile journey. This scenic path starts at the base of the Memorial Bridge and leads into Arlington National Cemetery. Along the way, runners pass through Rock Creek Park and Georgetown, by the Kennedy Center, and then loop around Haines Point before entering the District of Columbia and the famed National Mall. A pleasant change in this year’s course allowed participants to run down Constitution Avenue during the second half of the race. Seeing the Lincoln, Jefferson, and WWI memorials, as well as the Washington Monument and Capital Building later in the event, provided runners with the inspiration needed to overcome the “wall” that hits around the 20-mile mark. After coming back across the Potomac River and completing a loop through the Pentagon parking lot, the only challenge that remained was crossing the finish line with its spectacular backdrop of the Marine Corps War Memorial.

Presented with the first day of pleasant weather after several days of rain, the RUN FOR AUTISM team was lead by Georgetown students Daniel DeGuisto (3:05) and Joseph Letzelter (3:07), followed closely by Navy Commander Scott Jones (3:14). On the women's side, Janine Fitzgerald’s outstanding time of 3:09 put her in the top 25 overall in the race. She was followed by Teresa Rider at 3:21 (2nd 50-54) and Debra Drengenberg at 3:22. Twenty members of this year’s team had previously run with OAR, including veteran Greg Beeker, the only runner to have participated in the race every year since the RUN FOR AUTISM was created in 2003.

Approximately 20 minutes after the marathon started, the Marine Corps Marathon 10K was off with another 5,000 runners on a course taking them from the Pentagon, through Crystal City and finishing with the last three miles of the marathon course. Among the first OAR runners to the tent was OAR board member Greg Smith. This also marked Smith’s sixth consecutive year participating with the team in the shorter distance race that started as a 5k, moved to 8K and is now set at 10K (6.2 miles). OAR leaders took to the course too. Joining Smith on the 10K course were Executive Director and four-time runner Mike Maloney, President Peter Gerhardt, Ed.D. making his second run ever, and first-time runner and board member, Bill Donlon. After the marathon, which can take anywhere from three to seven hours, the celebration began in full as the team members reached the RUN FOR AUTISM tent in the Charity Village. Upon their arrival, runners reunited with waiting friends and family and a rousing OAR reception. An OAR staff member presented each runner with an OAR runner’s medallion with a colorful puzzle pattern ribbon to signify their effort in support of autism.

Chicago Runners Break Record for Numbers and Fundraising

The RUN FOR AUTISM fielded its largest and most successful team ever as 223 runners ran and raised over $270,000 through their participation in the 31st annual Bank of America Chicago Marathon.

As one of the most popular marathons in the world, the event drew a record 45,000 registered runners and an estimated 1.5 million spectators. Of the OAR runners who completed the 26.2 mile course, Shane Smith led the way with a 3:04:41 finish time, with Luis Menendez just a few seconds behind at 3:04:44. Karie Smith was first among RUN FOR AUTISM women, completing the course in 3:17:14, with Julie Sapper following at 3:31:45.

The night before the race OAR treated members of the RUN FOR AUTISM team and their guests to a pre-race Runners’ Recognition Dinner at Harry Caray’s restaurant, a well known Chicago landmark. The highlight of the evening occurred after dinner when Kathryn Finney and Dan Padilla, both parents of children with autism, shared some of their personal perspectives and experiences with the rest of the team.  After the runners spoke, OAR President, Dr. Peter Gerhardt, thanked all the runners and took a moment to describe the types of research studies and programs the money they had raised would directly support.

At the OAR Charity Village tent on race day, Dr. Gerhardt, Executive Director, Mike Maloney, and the Run staff, Doug Marocco and Jessica Hopey welcomed and congratulated every runner and presented each with an OAR runner’s medallion. After a photograph set against the Chicago skyline and a chance to autograph the Runners’ Board, OAR’s team members used the tent as a meeting place for their friends and family and a place where everyone enjoyed refreshments while sharing their marathon experiences.

Beyond race day, the fundraising efforts of the RUN FOR AUTISM – Chicago participants contributed heavily towards the $610,000 total raised this year. Top fundraisers on the Chicago team utilized personal fundraising webpages, employee matching gift programs, and special events to raise their team record amount. Returning runner Kathryn Finney topped the Chicago fundraising list with an outstanding $10,200 in donations.  First-time OAR participant William Duff raised $9,000, and Gary and Beth Maus collected $7,800. The extraordinary effort and support of all RUN FOR AUTISM team members will have a positive impact on OAR’s research funding through the next year and beyond.

Consider running with OAR in 2009 and joining a team of people dedicating to funding autism research while participating in a world-class event. With the race’s continued popularity, entries will sell out quickly, so if you’re thinking about being part of the team and want to raise money for autism research, register early to reserve your spot with RUN FOR AUTISM.

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SALUTE
RUN FOR AUTISM’s Top Fundraisers Talk About How and Why They Raise Money for OAR

Running is only half of the challenge for those who RUN FOR AUTISM on OAR’s behalf. The OTHER half of the experience is fundraising. And it’s often the half that causes more anxiety than training to run 26.2 miles.

But, as OAR’s top two fundraisers can tell you, it doesn’t have to be.

“That Keeps Me Running”

Patti Breaux poses with Collin, one of her clients with autism and part of a family that has contributed to Breaux's fundraising for OAR.

Running for OAR is a natural fit for Patti Breaux, a speech-language pathologist in Houston, TX, who works with children with autism. “The families I work with have to struggle every day. One day, a running friend told me to think of one of my kids every time I hit a hill with a steep incline and think about what is tough for them. That keeps me running.”

And fundraising. Breaux is OAR’s top fundraiser for 2008, having raised $10,500. Breaux decided during training for the 2006 Houston marathon that she would “run for a reason,” as marathon organizers dubbed it. She looked at the list of causes and found OAR. “I think OAR is fabulous because of the research it does. It helps me as a professional with best practices.” Since that 2006 marathon, she has run the Marine Corps Marathon and San Francisco Marathon for OAR.

To raise money this year, Breaux decided to go beyond sending out e-mails and letters. She and a group of supporters organized a “Day at the Park,” that included a meal, a silent auction, and events for kids. As a result, she says, she raised more than double what she had the year before. “We had a moon bounce and a clown. A group of kids who are disabled gave a tae kwon do demonstration.”

Patti Breaux crosses the finish line after a marathon.

The families she works with have been a great support and inspiration. “I pick one client to dedicate the marathon to and ask them to help me raise money.” Sometimes, it’s a group of clients. One of the mothers was so excited by Breaux’s efforts on OAR’s behalf that she has given money every year since her son was first diagnosed with autism and now anticipates that Breaux will run for OAR every year.

Which is fine with Breaux since that’s her goal too. “I plan to continue running as long as I stay healthy and avoid injury. As long as I am running marathons and half-marathons. I will continue to raise money for OAR.” Breaux’s next RUN FOR AUTISM will be the Chicago Marathon in October 2009.

“I Don’t Keep It a Secret”

Kathryn Finney crosses the finish line at the Bank of America Chicago Marathon

For Kathryn Finney, the money she raises for OAR is an investment, in her son who is autistic and in the return that always seems to come with giving. “We get so much more back than we put in with what we’re doing,” says this two-time RUN FOR AUTISM runner.

Like many others, Finney took up running for fitness. “After two kids, I was out of shape. A friend told me about a marathon for women over 40—the MORE marathon in New York City. I ran a half marathon that got me started and then ran the full marathon two years later.” Finney was hooked. She signed up for the Chicago marathon so that her family—husband, Andrew; son, Arthur; and daughter, Madison--could come with her.

When she got an e-mail about running for a cause after signing up, it was an easy decision. She searched for the word “autism” and found OAR.

Fundraising has come naturally to Finney, who says she talks about her marathon experiences with everyone she knows--family, friends, co-workers, and others she meets through work, at marathons, and other events. “I don’t keep it a secret,” she laughs. Finney and OAR also benefit from the generosity of her employer, Meredith Corporation, which matches the funds she receives.

Kathryn Finney's family--husband, Andrew; son, Arthur; and daughter, Madison--join her after she completed the Bank of America Chicago Marathon

This year, she added a perk for her contributors. Anyone who contributed more than $50 received a print of one of her paintings. That really opened up her fundraising. “People who only gave $100 gave $500.” Her creativity helped make her the top Chicago fiundraiser and OAR’s second top fundraiser nationally, with a total raised of $10,200.

Finney, who is an art director for Country Home Magazine, expanded her own giving as well when she began teaching painting classes to adults with disabilities. “My husband and daughter both help out,” she adds, noting that the classes have given her family an insight into what the future might hold for her son. “These individuals are so kind and willing to try new things. They have so many valuable qualities. We hope and believe our son will have those same qualities when he is an adult. It’s an optimistic venture for us that makes us believe in the possibilities for Arthur.”

And that’s how she thinks of OAR too. “The contributions I make to OAR open up future possibilities for autistic individuals. Hearing Peter Gerhardt describe where the money goes makes me understand how valuable the small dollar is in the big picture of fundraising for autism. I look forward to seeing where the money goes and how our family can be a part of this success.”

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