From Goals to Data and Back Again: Adding Backbone to Developmental Intervention for Children With Autism

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From Goals to Data and Back Again: Adding Backbone to Developmental Intervention for Children With Autism

From Goals to Data and Back Again of related interest Giggle Time – Establishing the Social Connection A Program to De

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From Goals to Data and Back Again

of related interest Giggle Time – Establishing the Social Connection A Program to Develop the Communication Skills of Children with Autism Susan Aud Sonders ISBN 1 84310 716 3

Playing, Laughing and Learning with Children on the Autism Spectrum A Practical Resource of Play Ideas for Parents and Carers Julia Moor ISBN 1 84310 060 6

Demystifying the Autistic Experience A Humanistic Introduction for Parents, Caregivers and Educators William Stillman ISBN 1 84310 726 0

Addressing the Challenging Behavior of Children with High-Functioning Autism/ Asperger Syndrome in the Classroom A Guide for Teachers and Parents Rebecca A. Moyes ISBN 1 84310 719 8

Freaks, Geeks and Asperger Syndrome A User Guide to Adolescence Luke Jackson ISBN 1 84310 098 3

From Goals to Data and Back Again Adding Backbone to Developmental Intervention for Children with Autism Jill Fain Lehman and Rebecca Klaw

Jessica Kingsley Publishers London and New York

All rights reserved. Except for the quotation of short passages for the purposes of criticism and review, no part of this book or the accompanying CD-ROM except those portions appearing in the appendices may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher. Material that appears in the appendices of this book may be reproduced without modification by educational institutions. Warning: The doing of an unauthorised act in relation to a copyright work may result in both a civil claim for damages and criminal prosecution. The right of Jill Fain Lehman and Rebecca Klaw to be identified as authors of this work has been asserted by them in accordance with the Copyright, Designs and Patents Act 1988. First published in the United Kingdom in 2003 by Jessica Kingsley Publishers Ltd 116 Pentonville Road London N1 9JB, England and th th 29 West 35 Street, 10 fl. New York, NY 10001-2299, USA Copyright © 2003 Jill Fain Lehman and Rebecca Klaw Library of Congress Cataloging in Publication Data Lehman, Jill Fain. From goals to data and back again : adding backbone to developmental intervention for children with autism/Jill Fain Lehman, Rebecca Klaw. Includes bibliographical references and index. ISBN 1-84310-753-8 (alk.paper) 1. Autism in children. 2. Autism in children--Treatment. 3. Children with disabilities--Rehabilitation. I. Klaw, Rebecca, 1952- II. Title. RJ506.A9L446 2003 618.92’898206--dc21 2003041614

British Library Cataloguing in Publication Data A CIP catalogue record for this book is available from the British Library ISBN 1 84310 753 8 Printed and Bound in Great Britain by Athenaeum Press, Gateshead, Tyne and Wear

For Philip, Charles, and Sarah Kaye


For Art, Ben, Jeremy, and Bram

— RK




List of Exercises


List of Figures and Tables




Why We Wrote This Book


The Big Picture


How to use this book


Identifying Goals


Attention and basic social relatedness










Social play


Pretend play






Eye gaze


Receptive communication (understanding language)


Expressive communication: body language and affect


Expressive communication: the use of symbols


Conversationsl skills/pragmatics


Sensory issues


Restricted interests and perseverative behaviors


Concept development


Increasing awareness of others


Social skills with peers


Respecting social norms


School and camp skills




Things to remember



Writing Measurable Goals Change in the child and change in the goals




41 42

Phase 1: Emergence


Phase 2: Consistency


Phase 3: Extension


Writing goals that can be measured


Ways of recording increasing or decreasing frequency


Using quantitative scales


Using a qualitative scale


Ways of recording increasing or decreasing duration


Ways of recording an increasing range of behavior


Ways of recording a decreasing prompt level


Considering goal-independent factors


Things to remember


Collecting the Data


Data questions


Formatting the data sheet


Frequency of data collection


Special suggestions for teachers


Monitoring goal-independent factors


Things to remember


Putting It All Together — Joey, Tyler, and Mai Lin






Mai Lin


Things to remember


From Data Collection to Data Analysis


Types of data


Translating words to numbers to create raw data


Transferring the raw data to spreadsheets


Keeping in mind what the numbers really mean


First impressions: numbers versus pictures


Creating simple line graphs



Real data is not pretty


Things to remember


Detecting Change — The Mean Patterns of change


Computing the mean


Evaluating change using mean values


Step 1: Dividing the data for the goal


Step 2: Computing the means and charting bar graphs


Step 3: Comparing the means


Things to remember




Measuring Reliability — The Standard Deviation



Distance as a measure of representation


Computing and graphing the standard deviation


Evaluating change using mean and standard deviation


Things to remember


Exceptions That Prove the Rule — Factor Data


Identifying an outlier in the data set


Predicting sub-patterns of behavior from factors


Correlation is not cause


Translating factor data to numbers and computing correlation


Negative correlation


You get what you ask for


Data analysis, revisited


Things to remember


10. Coming Full Circle — Joey, Tyler, and Mai Lin






Mai Lin


Things to remember


11. Conclusions


Appendix A Basic Intervention Goals for Children with Autism Attention and basic social relatedness Imitation Affect Self-regulation Play Increasing the play repetoire Pretend play Drawing Communication Receptive communication (understanding language) Eye gaze Expressive communication (body language and affect) Expressive communication (the use of symbols for communication) Conversational skills/Pragmatics Sensory issues Restricted interests and perseverative behaviors Concept development Increasing social awareness Social skills with peers Social norms School and camp skills Leisure

Appendix B Charts and Handouts The Three Phases of Intervention How Do We Know When Goals Are Complete? Writing Measurable Goals Detecting Change Using The Comparison of Means Sample Data Sheet — 2-year-old, more compromised Sample Data Sheet — 4-year-old, more compromised Sample Data Sheet — 6-year-old, moderately compromised Sample Data Sheet — school-aged child, more able Glossary Directions for Using Excel A very quick reference guide Selecting Deleting Inserting Changing or modifying Copying and Pasting Miscellaneous

Appendix C Exercises

183 183 184 184 185 185 185 185 186 186 186 187 188 188 190 191 191 192 193 193 194 195 195

197 198 199 200 201 202 203 204 205 206 211 211 211 211 211 212 212 213


Exercises 3.1

What’s wrong?



Creating data sheets using tables



Writing goals for Joey



Making Joey’s goals measurable



Writing data questions for Joey’s goals



Writing goals for Tyler



Making Tyler’s goals measurable



Writing data questions for Tyler’s goals



Writing measurable goals for Mai Lin



Writing data questions for Mai Lin’s goals



How to produce a line graph



Graphing shortcuts



Computing the mean



Computing multiple means on a single sheet



Computing “before” and “after” means



Producing a bar graph from data for a single goal



Producing a bar graph with multiple goals for one child



Computing the standard deviation



Adding standard deviation information to a bar graph



Experimenting with raw data, mean, and standard deviation in the Statistics Lab



Experimenting with outliers in the Statistics Lab



Computing correlations with the Pearson r



Understanding negative correlation


Figures and Tables Figures 4.1

A sample data collection sheet in an easy-to-use format



A sample data collection sheet for multiple children working at the same time on different goals



A sample data collection sheet for multiple children working at the same time on the same goal



A sample data collection sheet showing goal-independent factors marked by an asterisk



The data collection sheet from Figure 4.2 with additional goal-independent factors



Every item on a data collection sheet has two independent properties. We note the first property—whether it’s a goal data or factor data—at the left. The second property—whether the item results in a categorical, ordinal, or interval data set—is labeled on the right. Both properties are used to determine the appropriate statistical tests to apply to the data.



Joey’s data sheet after translation



A portion of Joey’s raw data after it has been entered on a spreadsheet



A portion of Anton’s data from the ABC Workbook



The line graph for Anton’s raw data shows a “rising stairs” pattern



The legend box is necessary when you combine data for two children receiving group intervention on the same dates



The line graph for Anton’s raw data for goal Y



The line graph for Becca’s raw data. Has she made progress on goal X?



The line graph for Celeste’s raw data. Has she made progress?



A single regular pattern of behavior versus two different regular patterns of behavior



One pattern of behavior (pre-transformation) followed by a period of transformation followed by a new pattern of behavior (post-transformation)



The line graph for Anton’s data for goal X



Is this a case of change or not?



With more data before and after, the pattern of change emerges



Our model of cognition assumes that if change occurred within the intervention period then behavior went through three phases: pre-transformation (“BEFORE”), when old patterns dominate; transformation, when learning occurs; and post-transformation (“AFTER”), when behavior is best characterized by the new patterns learned during intervention



Anton’s performance on goal X “before” and “after” intervention



Celeste’s performance on goal X “before” and “after” intervention



Becca’s performance on goal X “before” and “after” intervention



Good representation displayed as a tight clustering of data points around the mean line



The more data points spread out around the mean line the poorer the mean is as a representative value



Standard deviations displayed as error bars around the means. The bar extends both above and below the mean by the amount of the standard deviation. The oval indicates the area of overlap between the bars 124


The more overlap in the error bars, the less reliable the change indicated by the difference in means



A clear example of change



The large standard deviations argue against the evidence of change provided by the difference in the means



Comparison of means for Celeste



Overlap in the error bars suggests we look further



Post-transformation behavior looks regular except for a single unexpected low value in Session 27



The expected pattern becomes clear after removing the outlier



Translation of the categorical factor specifying location into numbers



Is Becca still learning or is there something interfering systematically with her performance?



Celeste seems to show a systematic regression (followed by recoupment) after every 5 sessions



There is no way to ask the general question, “Does performance vary with location?” Instead, the Pearson r forces us to test a set of more specific questions, each reflecting a different assignment of locations to numbers



Joey’s data collection sheet, as created in Chapter 5



Change in Joey’s ability to show preferences



Change in Joey’s ability to match a photo to an item



Apparent change in Joey’s ability to approximate the word “go”



Lack of change in Joey’s ability to pull an adult to a desired object



Lack of change in Joey’s ability to imitate mouth movements



Tyler’s data collection sheet, as created in Chapter 5



A case of poorer performance after intervention?



Possible change in Tyler’s conversational ability


10.10 Mai Lin’s data collection sheet, as created in Chapter 5


10.11 Possible change in Mai Lin’s ability to control her voice


10.12 Lack of change in appropriate facial orientation


10.13 Change in Mai Lin’s ability to form requests as questions



The icon to start the Chart Wizard in Excel 97 is circled in black



The options to select the Chart Type dialog box. Also note the tabs circled at the top of the dialoge box. Each tab gives you access to a different view of some or all of the information to be specified at the step. 230


When you select the whole chart the data is highlighted on the spreadsheet and a pull-down menu for the chart appears.


The locations of the function symbol, the rounding up symbol, and the formula bar. 237


Tables 10.1

The statistical information for Joey’s goals over a three-month period



The statistical information for Tyler’s goals



The statistical information for Mai Lin’s goals


Acknowledgments Writing a book that is intended for both parents and professionals presents unique challenges. Meeting those challenges would not have been possible without the help of Ivie Torres, our parent reader, who reviewed the manuscript with intelligence, honesty, and dedication. Her words of praise, suggestions for improvement, and sense of humor made this project considerably more enjoyable. Our professional reviewers, Stanley Greenspan, Lee Marcus, Diane Twachtman-Cullen, Susan Izeman, and Cory Shulman, were no less helpful. We are particularly grateful to them for providing us with comments in the all too brief time we gave them. Thanks must also go to Mary Hart and Renee Porterfield for lending their expertise in step-by-step reviews of the spreadsheet exercises. Content is one thing, clarity and style another. Philip Lehman was painstaking in his role as editor and heroic in his role as document formatter. Rosann Lehman also read the entire manuscript, searching for inconsistencies, incoherence, and typographical errors. We are grateful for every minute of their time, effort, and patience. Finally, we would like to acknowledge the special roles played by Karen Berkman, Raj Reddy, and Richard Wyckoff in the writing of this book. Each was responsible in his or her own way for professional support or guidance at a critical juncture on the path to its publication.

Chapter 1

Why We Wrote This Book

Intervention for children with autism has come a long way in the last half century. In the early years after Kanner recognized the disorder, the diagnosis went hand in hand with terms like “unreachable” and “uneducable” and with recommendations like “institutionalize.” With the work of Lovaas and others in the 1970s that view began to change. It was finally demonstrated that children with Autistic Spectrum Disorders (referred to as “ASD” throughout this book) could learn, could respond, could even engage effectively (and “affectively”) in the neurotypical world. Since the 1970s many other types of intervention have been used with children with ASD, each based on a particular medical, nutritional, or psychological theory, each with supporters and detractors. Despite the differences among interventionists, the importance of intervention itself is no longer doubted. Parents and professionals know that providing intervention is critical in helping the child with autism cope with the demands of daily living, access education, and achieve long-term independence. If we knew what every child needed, if in fact every child needed exactly the same thing, intervention would be a relatively simple matter. But the last half-century has also shown us that the skills and deficits that can accompany autism are complex. What benefits one child may have little or no impact on the symptoms of another. As a result, at least for now, there is no single intervention or set of interventions that works for every child. All of which leaves us with a fundamental question: how do you choose among interventions for a child? How do you choose among interventions for your child? We believe that whether you are a professional service provider or a family member/service consumer, you answer that question in two steps. The first step is taken when you choose a theoretical approach to intervention. Theory provides the framework or general point of view for structuring the overall program of intervention. As a professional your choice of approach might be based on prior training, an assessment of your own strengths and weaknesses, passionate personal belief, or combinations of these. As a family member your choice might be based on what fits into your family culture, what matches your 15


own observations about your child’s learning style, the recommendations of professionals and other parents, and, frankly, how you feel about the people who represent the service options in your community. However you make the decision, the choice of theoretical approach is an important one, but it is not the final one. Once the first step is taken, hundreds upon hundreds of “second steps” must follow. Every day, every therapeutic session, every class period, choices must be made about what to teach and how to teach it now. And here is where the problem occurs, because although theory is a wonderful “top down” organizer, it still leaves a lot to the imagination. Theory lays out a set of possible interventions bounded by principles and guidelines. It may even dictate some specific methods and curricula. But a child—your child—may need help learning almost anything. Theory cannot cover all the possibilities. There is no curriculum for life. If we can’t take the everyday steps of intervention based on theory alone, what other source of information is there to help us? Within the framework of any particular approach, how do you choose which goals to work on and which methods to use during this moment of intervention? We believe the answer to that question is only partly determined by theory. The other crucial factor in making those intervention choices is data. If theory is top down, data is bottom up. Theory says “Choose your goals from column A and your methods from column B,” and “Don’t attempt the third one on the left until you cover the two before it.” Data adds a different voice, saying, “It’s time to move on, that concept is mastered,” and “This child responds best to the second method in the third row.” The two types of information—theoretical and empirical (data-driven)—work together. Time is too short to wander through the vast set of all the things you could possibly do until your data tells you what works. That’s why you need theory. But theory doesn’t cut down the possibilities enough to tell you the best choice for each individual child. And that is why you need data. There is, of course, a third type of information that is critical to making intervention choices: the intangible sources, intuition and feeling. We don’t mean to discount these sources when we focus on the theoretical and empirical. After all, how many of us have believed in a child’s potential despite every objective measure to the contrary? How many of us have watched children do what the theory or data said they couldn’t? While there is no question that intuition and feeling count, sometimes what we feel is uncertainty. For every person who has trusted his or her instinct there is another person who has wondered, “Is this really working?” Subjective information—intuition and feeling—works best when it is tempered by objectivity, and vice versa. We must listen to what theory and data have to tell us but, at the same time, understand the limitations of what they can say.



Everybody we know who works with children with ASD has a theoretical position. Some use TEACCH, some use a Floor-time model, some use ABA or a discrete trial approach, some use special education curricula, and some mix and match. This book does not assume that you are using any particular model. It does assume, however, that your approach is consistent with a developmental perspective. In other words, we (the authors) have theoretical positions, too. One of us (Rebecca) was trained as a developmentalist. The other (Jill) was trained as a cognitive scientist. Our theoretical biases were evident long before we started to work with children with autism. When these children captured our hearts and minds we saw a chance to apply what we knew in ways that made sense to us, based on our theoretical “upbringings.” In this respect our experiences are not so different from those of our colleagues. What we have found to be different, however, is our attitude toward data. We often come across the belief that developmentally based intervention is incompatible with an empirical mindset. Interestingly, we encounter this belief about as often from those who are empiricists as from those who are developmentalists. But as far as we can see, there is nothing incompatible between the decision to use any particular theory and the decision to use data. When we first came across the notion that there was, we were surprised. When we came across it again and again we were dismayed. That is why we wrote this book. In some sense having a cognitive or developmental predisposition is superfluous to what follows because we can state the ideas behind this book without any mention of cognitive or developmental principles: · Theory alone is not enough. · Data alone is not enough. · If you are a service provider, you need both sources of information to

make good decisions.

· If you are a service consumer, you should expect that both sources will

be used by those who offer intervention for your child.

On the other hand, just saying that data is good doesn’t tell you how to collect good data. And saying that data should inform intervention isn’t the same as telling you how to extract something informative from a pile of numbers. The specifics—the how tos—require an empirical method and the nature of that method is profoundly affected by your approach to intervention. What kind of data you can collect, what statistics you can use, what measurements of progress apply—all of these things depend on the assumptions and expectations that are part of your theory. We are committed to a form of intervention that is based on the use of both theory and data because we know from experience that decisions based on their combination are more powerful than decisions based on either alone. Moreover, 17


we want to show you that, contrary to popular belief, such an approach is possible, even straightforward, when the framework for intervention is developmental theory. For the past six years it has worked for us and for our staff. It can work for you. In this book we want to show you the power of empirical developmental intervention.

The Big Picture What we describe in this book is the empirical piece of an empirical developmental approach to intervention. This book is not about child development, or child development in autism, or how to do developmental intervention per se. This book is about collecting and analyzing valid and reliable data in a way that makes sense if you are a developmental interventionist. To that end, the book is organized to follow the flow of intervention from goals to data and back to goals. In Chapter 2 we start by reviewing the sorts of goals that are commonly found in a developmental approach. These are the basis for our examples in all the other chapters. Chapters 3 and 4 focus on how to take a goal and turn it into a statement that describes activity or behavior that is both observable and measurable. The key feature of this process is that the goal always comes first. We don’t ask what we can measure and then choose our goals; we choose our goals and then transform them into data questions in a way that preserves their connection to the underlying theory. By the end of Chapter 4 you will know how to write goals addressing typical developmental issues for children with autism. You will also know how to create an easy-to-use data collection sheet that helps measure a child’s progress on these goals. In Chapter 5 you have the opportunity to practice those skills in the context of case histories for three children: Joey, Tyler, and Mai Lin. Of course, data collection is only half the story. Data analysis is the other half. Chapter 6 begins the process of taking the observations collected during intervention and producing an objective measure of the child’s progress. In this day and age there is no reason why data analysis needs to be a burdensome or mathematically complex chore. Computer spreadsheet programs can be used to organize data efficiently and perform the statistical computations easily. We know the idea of “going on-line” may seem intimidating to some, so Chapter 6 takes you step-by-step through the process of setting your data up on the computer and creating an initial representation of progress in the form of a line graph. Chapters 7, 8, and 9 form the core of the section on data analysis. Each chapter introduces a different statistical tool to the analytical toolbox. Since we have developed a method that relies on spreadsheet functions to do the computational work, however, our focus in these chapters is not on developing the 18


mathematical ideas behind the statistics. Instead, the major portion of each chapter discusses what role its statistic plays in interpreting data within a developmental framework. By the end of Chapter 9 you will understand a great deal about how both cognitive and developmental theories characterize a child’s progress toward a goal and about how that characterization can be detected in your data. Chapter 10 takes the analytical methods we’ve developed and applies them to the case histories of Joey, Tyler, and Mai Lin. By revisiting their stories we have the opportunity to close the loop started in Chapter 2, demonstrating not just how analysis is done but also how it feeds back into the next round of intervention decisions and goals. After this exercise, Chapter 11 steps back to review briefly where we are and how we got there. A final point before you get started: the methods we describe are not the kind used in academic research. They are not the stuff of higher mathematics or the ones used by statisticians. The methods are practical and designed for use in the real world with real kids. They are designed to be used by educators, clinicians, and parents even when tired, rushed, and overworked. We believe that using them should be part of your everyday routine. They cannot replace theory and they cannot replace intuition, but they can help to make sense of both.

How to use this book People read books like this one for a lot of different reasons. Although no book can be all things to all readers, we would like to make it as easy as possible for you to use the book in whatever way it serves you best. If you want to learn to use data as part of a developmental approach to intervention, we suggest you read the chapters in order. In addition, we urge you to do each exercise when it is mentioned in the text. The exercises themselves have been separated from the main text as Appendix C so that the casual reader is not distracted. Nevertheless, they offer an opportunity to practice the methods we discuss and are integral to using this book as a self-teaching guide. To use the exercises and other interactive materials on the CD-ROM effectively you should read Chapters 5 through 10 with a computer that has Microsoft® Excel (97 or higher) and Word (97 or higher) programs available. Some of you may be interested in only the data collection method we describe. For you, Chapters 3, 4, and 5 are the most relevant. Those who are interested in only our approach to data analysis will find the relevant material in Chapters 6 through 9. Individuals who do not need to learn to apply the methods in a practical sense should feel free to skip over the exercises and ignore suggestions in the text to open files on the CD-ROM. Teachers or administrators who want to use this book with their students or staff may find the charts and handouts in the three appendices particularly useful, as they summarize various aspects of our approach in a convenient form. 19


Although the text of this book is copyrighted, permission is granted for the copying and distribution of material in the appendices for educational purposes. To make distribution easier, the appendices are also available as Microsoft® Word files on the CD-ROM. Finally, all readers should note the existence of a Glossary in Appendix B. In the main body of the book, a new term or idea is identified by boldface italics the first time it is discussed. The Glossary reorganizes all such terms alphabetically so that you can review a definition as needed without having to find the initial occurrence in the text.


Chapter 2

Identifying Goals

A great deal has been written both about typical development and about how it is compromised by the symptoms of ASD. We assume that readers of this book are already knowledgeable about these topics (or will learn about them from another source). Our purpose is to teach you how to translate basic developmental growth, as it occurs in children with autism, into measurable goals. Before we can begin to explore the measurement and analysis of progress over time, however, we have to establish a common vocabulary. This chapter reviews areas of developmental focus that are essential to remediation in order to introduce the basic set of topics from which we will create individually designed goals in the examples that follow. Is this basic set of topics or goals adequate to pinpoint areas of need in every child with ASD? Of course not. Each child presents a unique profile of strengths and areas of compromise. Each child requires a team of parents and/or professionals to work and rework the targeted areas of development until the goals match the child’s needs. To be clear, then, the following set of topics is included in this guide in order to ground our discussion in concrete and realistic examples. It is not intended to be an exhaustive list, curriculum, or intervention plan. Not every goal on this list is appropriate for every child and many goals appropriate for your child may not be included. For those who wish to use this framework as a starting point in their discussions with the rest of the team responsible for designing intervention for their children, a listing of basic developmental goals is available as Appendix A.

Attention and basic social relatedness Attending and relating to others is a skill that serves as the precursor to nearly all forms of early learning. This basic skill is often compromised in children with autism. If you don’t attend to the world of people that surround you, you are quite limited in your opportunities for learning. In designing goals that target this area, you need to look for markers of emerging social skills and figure out what typically developing children do to 21


indicate that they are willingly attending to social opportunities. These markers, then, become the outcomes that measure progress in growing attention and sociability. For example, a developmentally early goal in this area might be the following: Child will respond to the overtures of familiar/preferred adults with smile, frown, reach, vocalization, or other intentional behavior.

Here you have decided that this child needs to learn to intentionally acknowledge the overtures of familiar people. The child just needs to react when approached by familiar and loving adults. This predictable social acknowledgment can be painfully absent in children with ASD. Another goal at this stage in the development of social awareness might be: Child will stay engaged with familiar adults for increasing lengths of time before attempting to leave or becoming disengaged.

After the child is beginning to socialize with key adults, you look for social interaction to get easier and easier for the child over time. How do you know it is getting easier? By tracking the amount of time that the child can tolerate social give-and-take before attempting to retreat to more solitary activities. Another goal might target more sophisticated acknowledgment of the key players in the child’s life: Child will call family members/teacher and aides by name.

We know from research that individuals with autism have a poorly developed system for recognizing faces. Researchers have suggested that typically developing people have a special center in the brain that distinguishes one face from another in order to help us define, label, and remember others in our world. We are keenly aware of tiny details when it comes to the people in our communities. Individuals with ASD, on the other hand, seem to lack this refined ability to recognize faces. Therefore, learning the names of specific individuals, which is cued by facial recognition, is often very difficult for children with ASD. To address this area of compromise, we write a goal that measures an outcome behavior (calling family members or teachers by name). This is our developmental marker that indicates growing social awareness. Although our goals measure a certain behavior, it is always important to remember what that behavior really means in terms of the child’s social, emotional, and cognitive development. The goals used as examples in this section are merely suggestions. They are intended to give the reader an idea about how to address early skills that fall under the heading of social attention (more advanced skills that mark social awareness are addressed under the heading “Increasing awareness of others,” 22


below). Remember that even the full list, “Basic Intervention Goals for Children with Autism,” in Appendix A is not intended to be all encompassing. Each child you meet will have his or her own set of skills and deficits in the area of basic social attention.

Imitation Imitating what someone else is doing is the most basic way a child picks up skills. Long before children can manipulate symbols, long before they comprehend a complex communication system, children imitate the actions of others. In children who develop typically (and seemingly effortlessly), imitation is usually motivated by a desire to do just what their siblings, their mothers, or their fathers are doing. It is actually “social imitation” and it leads swiftly to the use of facial expression, gesture, and finally symbols as a means of communication. In many children with ASD, however, imitation is not predominantly social. It is often more mechanical (learning to open a door, fix a toy, or unwrap a candy bar) and thus does not aid in the development of communication and socialization. It is important, therefore, to help children with ASD practice and expand upon this primary technique for acquiring skills. In order to do this, we break down the imitation process into small steps and teach each step, if need be, one at a time: ° Child will imitate with object after demonstration of use of object. ° Child will simultaneously imitate with objects. ° Child will imitate hand movements. ° Child will imitate body movements. ° Child will imitate mouth movements. ° Child will imitate sounds. ° Child will imitate words.

As the child progresses through these steps he or she gains important methods for learning about both the physical and social mechanics of our complex worlds.

Affect What is “affect?” It is the expression of emotion. It is behavior that involves all or some of the following: facial expression; body language; gesture; tone, pace, and volume of communication; and content of communication. Affect has the capacity to influence, impress, touch, and move others. It has social consequence.



Typically developing children reliably express emotion and appear to understand emotional expression in others. Children with ASD, however, often have great difficulty with both the expression of their own emotions and the understanding of emotional expression in others. It is important, therefore, in the course of designing intervention for children with ASD to find ways to teach the complex components of emotional expression. You might begin with the following goal: Child will look up to caregiver/teacher using a smile as a way of securing ongoing adult attention.

This action, meaning, “I like this…please continue,” is an early social skill upon which survival depends. It is the way that human infants and children engage others in interaction that comforts, excites, interests, and teaches. It is essential for ongoing development. Children with ASD often have difficulty using affect (in this case, a smile) to continue a pleasurable or interesting social experience. They are often ineffectual in their expression of pleasure. Therefore, it may be important to target this skill at the beginning of your intervention. For a child who is developmentally more advanced, you might write the following goal: Child will respond appropriately to common expressions of emotion in family members/familiar individuals in the classroom.

Many children with ASD have difficulty knowing how to respond when someone in their life is angry or sad or excited or scared. They might become distraught when someone is happy or become silly when someone is sad. They might become withdrawn at the expression of any strong emotion. Learning to react appropriately and with some social grace is an important skill not only within one’s family but also at school and in the community. As a final example, consider this goal as representing advanced work in developing appropriate affect: To achieve precision and subtlety in the expression of emotion, Child will use qualifiers to describe gradation of emotional experience (e.g., really disappointed versus a little disappointed).

In learning to understand affect in self and others, it is important not only to learn the basics but also the gradation of each emotion. Emotions occur on a scale for most people. Sometimes they are a little happy, sometimes very happy, and sometimes ecstatically happy. Typically developing children figure out common emotional scales without difficulty. Children with ASD don’t. They tend to see things as black or white, good or bad, always or never. It is important to help children with ASD develop the skills for understanding and regulating



emotional response according to a scale that is similar to the scales of their families and school friends.

Self-regulation Having difficulty remaining alert, focused, and available for learning is a well-studied component of ASD. The ability to control the flood of emotional response when angry or sad or frustrated is also compromised in many of our children. There are entire curricula that help teach children to regulate their state of arousal. Your child may be getting extensive help with this area of difficulty from another professional. However, you might want to include goals from this area in your work with the child as well because difficulty with self-regulation affects your child in the home or in the classroom. Prior to writing this kind of goal, imagine that your team commented on how long it takes the child in question to recover after becoming distressed. The behaviors that express distress in this child linger long after the distressing event is over, interfering with the learning process. So your team decides to target this problem. The team may have collectively figured out four different strategies for calming. They will, perhaps, rock the child in a rocker. They will also repeat calming phrases, such as “It’s okay,” many times. They will give the child a stress ball to squeeze and will help the child focus on a favorite picture. After introducing these strategies to the child, the team can then measure the success of this process by looking for a decrease in the time it takes the child to recover and regroup after an incident that caused distress. Thus, you might write a goal such as: Child will recover from distress within 5 minutes with help from a familiar adult.

Over time, however, you might want to see this child become more independent in his or her self-calming. So a later goal might be: Independently using any or all of four different self-calming strategies, Child will recover from distress within 5 minutes.

Self-regulation is a problem in children with autism. Each child you meet may have a different set of challenges in this area. In Appendix A there is a brief list of suggestions pulled from intervention plans that the authors reviewed. These goals are basic enough to be useful in a number of cases, particularly since they are written in general terms. Of course, you must figure out what each child’s exact areas of difficulty are and create specific goals that reflect the needs of that child.



Play Children with ASD often have significant difficulty with all or most aspects of play. Play is a pivotal skill in young children. It provides the content of learning and the method by which children practice and solidify information. As a designer of intervention, you need to approach this topic wholeheartedly. In general, you might consider the following areas as targets for intervention: · Learning to enjoy social play. · Developing a repertoire of playful activities. · Beginning to pretend. · Moving from concrete to abstract thinking. · Using drawing as a vehicle for creativity.

A list of common goals that correspond to these general topics is collected in Appendix A. For the purposes of discussion, however, we’ll just look at how to write goals that target social play, pretend play, and drawing.

Social play

Let’s consider a developmentally early goal: Child will joyfully participate in sensory-motor play with a familiar adult.

Sensory-motor play is the earliest form of social play in early childhood. It is not dependent on language or on rules. It rarely depends on sophisticated routine. It is just joyous, sensory-based interaction. Every child needs to begin here—even the child who is good at puzzles or computer games. A more advanced goal might focus on the need to expand the child’s repertoire of playful activities. Children with ASD can be very narrow in their interests. To explore the world in all its complexity, a child needs to get involved with a wide range of playful activities. A goal that reflects this might be: Child will expand his/her play repertoire to include manipulation, sensory-motor activities, art, music, building/construction activities, and early cognitive activities (matching, sorting, and puzzles).

This goal is designed to measure a steadily expanding “vocabulary” of behavior. Progress is indicated by an increasing range of skills. This method of measuring progress is discussed in Chapter 3. The purpose of the goal, however, should be clear. It is important to expand your child’s horizons, giving him or her a myriad of opportunities that promote learning.



Pretend play

Pretend play is a complex skill that is noticeably compromised in most children with ASD. Lack of pretend play is, in fact, a diagnostic marker of autism. In order to teach a child to pretend you need to be aware of the typical sequence with which this skill emerges in young children. Starting at the beginning, your first goal might be something like this: Child will develop interest in the content of pretend play as opposed to the simple mechanics (e.g., interest will move from how the bottle fits into baby’s mouth to helping hungry baby).

Many children with ASD are fascinated by the way things work. They examine toys with the eye of an engineer and the skill of a mechanic. It is a difficult step to move from interest in the movements of a little train’s wheels, for instance, to moving the train around the room making train noises and imagining a real train experience. Children with ASD need help with this transition. When they have achieved this goal with your persistent modeling and encouragement, a new world becomes available to them. Later in the process of promoting pretend play skills with a child, you might write the following: Child will participate, with adults, in increasingly elaborate make-believe, moving from concrete themes (involving everyday, common experience) to abstract themes (involving material never experienced).

This represents a shift into fantasy—the ability to create a mental image of something new and different. This skill is needed for all later learning when the school-age child is presented with information foreign to his or her experiences. In order to learn about pioneer life, for example, a child needs to be able to conjure up a life that has little relationship to the child’s own experience. School-age children learning about pioneers must be able to imagine a world without electricity or cars. Typically developing children can do this, some better than others, because of the imagination that has been developing from the time they were 18 months old. Many children with ASD, however, need to be taught how to pretend. It doesn’t just happen.


A final area that might be targeted in your attempt to promote play skills in children with ASD is drawing. Drawing is important because it is another vehicle for creativity and abstract thinking. It is an activity that children often do together and it is a requirement for most children who enter kindergarten. For a variety of reasons, children with ASD are often stunted in their ability to draw and create representations (some children with ASD, however, are very gifted in this area). If your team decides that this skill needs to be strengthened in a partic27


ular child, they should be aware of how drawing progresses in the typically developing child. For example, your goals could progress in the following sequence: ° Child will scribble with crayon. ° Child will imitate drawing of vertical line. ° Child will imitate drawing of circle. ° Child will add three parts to incomplete human drawing. ° Child will copy drawing of square. ° Child will draw unmistakable human with body, arms, legs, feet, nose,

eyes, and mouth.

Communication For many children with autistic spectrum disorders, learning to communicate meaningfully and effectively opens the door to the social world. But learning to communicate is often a huge challenge. As educators, parents, and therapists, we are aware of the complexity of teaching someone to communicate. We are also aware that children with ASD don’t always respond to the cues that allow a typically developing child to acquire communication so easily. We can’t just provide an environment rich in language. We can’t simply count on incidental learning of language. There are too many barriers for children with autism. What we can do to teach children with ASD to communicate is break down the process of becoming an effective communicator into small steps and explicitly teach the steps one at a time. This process is not, however, just about the production of language. It is about social connection, all the way from a meaningful look to a whole sentence. In teaching children to communicate, it is helpful to divide the communication goals into the following categories that address the particular problems associated with the diagnosis of ASD: · eye gaze · receptive communication (understanding language) · expressive communication: body language and affect · expressive communication: using symbols · conversational skills (pragmatics).

A lengthy list of common goals that correspond to these sections is provided in Appendix A. For the purpose of discussion, however, let’s look at the categories listed above in greater detail.



Eye gaze

Eye gaze is an early and effective means of communicating. It is the vehicle for two processes known to be problematic in children with autism—joint attention (“Hey, look at that…Did you see that?”) and social referencing (“Is this stranger at the door safe? Is it okay to climb on this shelf ?”). These two processes are thought by some to be the key areas of compromise in children with ASD because it is through joint attention and social referencing that we learn to establish meaning for events. Meaning is constructed, researchers tell us, from three sources of information: 1.

what we see, hear, and feel


what we remember and


what we learn from the feedback our parents, teachers, and therapists give us about a situation.

Consider this: you are a very young child. A stranger comes to your home. Your senses tell you there is someone new in the room. Your memory tells you that this person is unfamiliar, which creates feelings of unease. You then seek more information by looking at Grandma. She is smiling. She looks at you and the stranger and continues to smile. Her feedback interprets the event for you as safe. You adjust your initial reaction and welcome the new person into your environment. How did you construct meaning for this event? You used your senses, your memory, and social referencing. Looking at other people to see if they are experiencing what you are experiencing is a crucial mechanism for attaching common meaning to your world. Attuning your reactions to the reactions of others is a key process in the development of social and emotional skills. Both of the above require consistent eye gaze, which is often difficult for children with ASD. To begin to address this complex area of deficit, you might consider writing the following goal: Child will look back and forth to make sure adult sees what child sees in order to share enjoyment.

or: Child will look towards adult to make sense of an ambiguous situation.

These goals can be shaped into measurable objectives, as discussed in the next chapter. Don’t ignore them because they seem hard to measure. They are, perhaps, the crux of intervention. The lack of joint attention and social referencing may be the point of divergence between typical and atypical development in the young child with autism.



Receptive communication (understanding language)

It is quite easy to write goals that track language understanding in highly practiced tasks or highly simplified environments. What is less straightforward, however, is writing goals that look for the emergence of language understanding in context. Despite the difficulty of measuring progress in this way, we must keep in mind that the underlying cognitive change we want is not well characterized by behavior in which a child points to a picture in response to a familiar question. The goal of language intervention is increased understanding as part of the child’s natural world. That is where behavior that indicates underlying change will emerge. As an example: Child will look for family members when asked, “Where is Mommy?” or “Where is Daddy?”

This goal not only highlights an early step in the development of receptive language, it also puts that step in the context of the child’s social world. The typically developing child is driven to keep track of important people. This is part of normal social and emotional development. Teaching a child with ASD to understand “Where is Mommy?” or “Where is Daddy?” not only supports the development of communication but heightens the child’s awareness of his/her parents. To further illustrate this point, here are more goals that measure progress in receptive skills as they occur in a situation that is meaningful to both the child and the caregivers. ° Child will respond to his/her name. ° Child will stop action in response to “No!” ° Child will appropriately respond to the command “Stop!” ° Child will move in response to a one-step direction. ° Child will take object or food to someone when requested. ° Child will indicate approval when asked a “Do you want?” question. ° Child will appropriately respond to simple and familiar “Where?” ques-

tions with searching movements.

Expressive communication: body language and affect

It is important to target expressive communication as it occurs before symbolic language develops. Babies, for instance, are great communicators. They use body language and facial expression to communicate complex ideas. There is much to learn about communication before we use words. Consider this goal, for example:



Child will respond to gestures with intentional gestures of his/her own (e.g., reaches out in response to outstretched arms).

or: Child will indicate disapproval using gestures and body language.

Both of these highlight the need to communicate effectively long before language is expected. It is important to work on improving communication while respecting the developmental process. If you emphasize the use of words, for instance, when there is little to no non-verbal expression, you may create communicators that are rote and ineffective in the real world.

Expressive communication: the use of symbols

Typically developing children begin to communicate using symbols with apparent ease. We label things for children and praise them for their fine efforts in repeating those labels, but beyond that, we are merely amused observers of the process. Typically developing children simply begin to talk one day and keep on practicing until they have perfected the process. Children with autism, however, often have great difficulty learning to use symbols for communication. Whether you are using signs, pictures, or words, you are essentially teaching that these almost random items represent real objects or actions in the world. The word “chair” represents all those things you sit upon. The word “swing” represents that wonderful activity you do with Dad. Does it make sense? It doesn’t, really. It is simply a system of symbolic representation upon which society depends. So how do we begin to teach symbolic communication? We teach symbolic communication in the context of the child’s daily life, duplicating, as best we can, the typical developmental process. We teach in small steps, with meaningful strategies. We help the child with autism understand the fundamental concept of symbolic reference through actions that are meaningful to that particular child. The following list represents a small sample of developmentally early goals that target the process of learning to communicate with symbols. Additional goals are included in Appendix A. ° Child will learn fill-in-the-blanks of familiar songs, rhymes, and/or

familiar verbal routines (e.g., “Ready, set, go”).

° Child will use word/sign/picture for “more.” ° Child will indicate that he/she is done with an activity by saying or

signing, “All done.”

° Child will develop consistent vocabulary of symbols used in the absence

of concrete gestures (e.g., child will come into the dining room and say “juice” to mother to request juice without needing to take mother to refrigerator and touch the juice bottle). 31


° Child will respond to question, “What’s this?” ° Child will ask question, “What’s this?” ° Child will spontaneously add single words to play, beginning to narrate

play actions.

° Child will ask for help.

Conversational skills/pragmatics

Just because a child with ASD can use many words does not necessarily mean that he or she can use these words meaningfully in conversation. The art of reciprocity is a separate and vital part of mastering language. Choosing the right words and saying them the right way so that you and your conversational partner remain “in sync” is something most of us do relatively easily. Individuals with autism rarely, if ever, find this process effortless. We teach social reciprocity the same way we teach everything else, by breaking it down into manageable pieces of learning, and writing goals that represent small, developmentally sequenced steps. For example, we might begin with something as simple as: Child will use attention-getting words such as “Hey!” when beginning a conversation with a peer in school.

or: Child will use appropriate distance between self and conversational partner.

As the child is becoming a more proficient communicator, we might add the following: Child will use eye contact to signal that he/she is finished talking and that it is now the partner’s turn to talk.

Finally, as the child is becoming quite skilled, you may still have to refine his or her skills with goals such as: Child will initiate conversation that is of interest to social partner.

or: Child will ask questions that are related to the topic, even when the topic is not a preferred subject, to maintain the conversational flow.



Sensory issues In children with autism, there are many differences in the functioning of the central nervous system. For the purpose of this section, the relevant differences relate to how a child reacts to and processes sensory experience as well as how a child plans and organizes responses. Children with ASD typically have difficulty with the following: · Sensory modulation: they might be over- or under-reactive to touch,

sight, or sound.

· Sensory processing: they might have difficulty understanding language

or interpreting visual-spatial, tactile, vestibular, or proprioceptive information.

· Motor planning: they might have difficulty carrying out movement


As developmental interventionists, we need to write goals for children who are experiencing difficulties with sensory issues in their home, in their school, and in the community. As we target the impact of sensory issues in the child’s environment, other professionals might be building skills in a more isolated context such as a therapy room. With intervention concerning sensory issues, and perhaps in all types of intervention, a team approach is essential because there are often two avenues for teaching skills. On the one hand, the child needs to learn and practice, one by one, the specific sub-skills that are embedded in each complex task. On the other hand, the child needs to learn when and how to use those sub-skills together and in the actual contexts in which they are required. It’s like teaching someone to play basketball. First you teach the person to dribble, to shoot foul shots, and to do lay-ups. You might need to teach him or her how to defend the basket and how to score. But that is only part of what the person needs to learn. The other piece he or she needs to become proficient in is the experience of putting the bits of learning into action in the appropriate situations. The person needs to practice playing the game. As a teacher, parent, or therapist, you are the one that helps the child “play the game” with sensory issues. You need to identify the areas of compromise and while your team members work to teach isolated skills in their therapy rooms with special equipment or exercises, you help the child put those skills to use together. As a result, your goals might look like the following examples: ° Child will eat a greater variety of foods. ° Child will gain comfort with activities in which his/her feet are off the


° Child will tolerate proximity of other children. ° Child will become sensitized to, and appropriately label, hot/cold/pain. 33


° Child will walk around toys, pets, and people on floor. ° Child will successfully avoid bumping into people. ° Child will develop compensatory strategies for feeling comfort while in

large, open spaces.

° Child will become more comfortable with activities that involve hands

and face.

° Child will become more comfortable with multiple voices singing.

Restricted interests and perseverative behaviors Having restricted interests and/or perseverative behaviors is one of the hallmarks of ASD. Children at both ends of the spectrum can exhibit a need for sameness and a need for ritual, repetition, and control. Many researchers have documented that the incidence of idiosyncratic, solitary behavior decreases as the child becomes more invested in, and comfortable with, the social world. The more the child is engaged, the less the child perseverates on solitary activities. What is our role, then, as interventionists, in this particular phenomenon of autism? We must work to make the child’s world more comfortable. Sometimes we need to alter the environment so that the barriers to overcoming sensory differences are lowered. Sometimes we need to give the child other actions that comfort, yet are interactive. But we always keep the child engaged. Two examples of goals addressing perseverative or idiosyncratic behavior are: Reciting passages from books, videos, TV, and/or radio will decrease. Child will stay focused on shared conversation with caregivers instead of lapsing into private reference.

We write goals like these because we want the idiosyncratic behaviors to decrease. That is the change we want to observe over time. What that change should indicate, however, is not that we have finally eradicated a strange behavior, but that we have increased the child’s comfort and willingness to remain connected to his or her social world.

Concept development There are many concepts that we assume will come into focus if we simply give a child enough opportunities to experience information. But what educators, parents, and therapists have noted is that providing a concept-rich environment isn’t enough for some children with autism. Concept learning typically happens as a by-product of social interaction, something that is difficult for children with ASD. Therefore it takes structured, creative, and strategic teaching to help a child with autism learn common concepts such as time, quantity, or emotions. 34


As interventionists, we target these apparent gaps in the cognitive profiles of our children. We note that although they can, perhaps, read and do math, they don’t categorize information in common ways, they don’t understand the passage of time, and they remain very puzzled by “Why?” questions. We therefore write goals that highlight the gaps in understanding that we observe in each child. We might write the following: Child will demonstrate understanding of function of familiar objects by selecting the correct item or insisting on the correct item when “mistakenly” given the wrong item.

This goal seeks to teach the function of familiar objects as these functions arise over the course of the child’s day. Perhaps the parent begins to brush the child’s hair with a shoe. What does the child do? Perhaps the therapist puts on slippers when getting ready to go outside, or attempts to open the door with a spoon. What does the child do? According to numerous theorists, the child will more easily retrieve this information in the future when both active problem solving and humor have been involved in the initial learning phase. Consider this goal: To demonstrate an understanding of locative state and prepositions, Child will be able to answer “Where?” questions.

This is a sizable task. It is not the beginning step in teaching the child about where things exist in his or her world; it is a final goal that targets the consistent and meaningful use of these skills. When you ask Johnny where his Woody doll is because together you need him for the house you just built out of Lincoln Logs, his answer will alert you to how well he understands the concept of locative state. That is what you are measuring—language that indicates a comprehension of certain concepts.

Increasing awareness of others This section is a follow-up to the first area for intervention, “Attention and basic social relatedness.” The goals discussed here target more developmentally advanced skills along this dimension. So, while before we were concerned with the child in the small, sheltered world of his or her home or classroom, now our expectations concern a larger world—one that includes various adults, neighbors, and peers. As interventionists, we need to alert the children with whom we work to the various facets of social reciprocity. In order to be truly connected to another human, one needs to be aware of what that other person is doing, is feeling, is seeing, and is hearing. One needs to have clues into what that other person might be thinking and what he or she probably knows. These are essential skills for the child within the family, school, and neighborhood. 35


Goals for this topic might include the following: ° Child will note what others are doing and shape his/her behaviors


° Child will predict what others might see or hear in a given situation. ° Child will demonstrate an awareness of the needs of others by spontane-

ously offering help.

° Child will receive a daily compliment for being considerate. ° Child will predict what others might think or feel in a given situation.

Social skills with peers What a formidable task it is to figure out how to break down the process of making and keeping friends into little goals! Making friends is a complex human phenomenon with a rich array of skills required at every step. Some of the children with whom you work may need extensive help in developing social skills with peers and some may need just a few refinements to modesty or bossiness or empathy. You may, for example, need to target the following: Child will successfully initiate conversation/play with peer.

Such a goal is appropriate for children who don’t know how to begin. Even though they may be skilled at asking their parents or siblings to play or talk, these children become uneasy when confronted with kids on a playground or in a classroom. They need, with your help, to learn to invite another child into interaction. They need to make an overture to another that is effective and successful. As you help them learn to do this, you can measure their progress. Later, you may designate the following as the next step: Child will be able to join others already engaged in a play activity or in a conversation (as opposed to having a peer join him or her).

This seems to be a much harder skill for children with ASD. Joining something that is already happening takes a certain melding of behavior. You need to slide in, making few, if any ripples. You need to do what the others are doing so that you are included in their activity. How very difficult for children who feel more comfortable when they have some degree of control. Another aspect of social skills with peers is learning behavior that is conventional in a social setting. You might need, for instance, to teach the child the following: Child will apologize when he/she bumps into someone.

or: 36


Child will develop tactful responses to describe dislikes and disagreements as they arise during interaction with peers.

This entire topic, “social skills with peers,” is vast and complex. Keep in mind that many of the other sections target related skills; look in the areas of play, expressive communication, conversational skills, respecting social norms, and school and camp skills. Finally (and always), remember that the team that surrounds the child will be the best designer of intervention. Goals may well emerge from the team that are better suited for a particular child than the goals highlighted above or those found in Appendix A.

Respecting social norms Hand in hand with increasing social awareness and developing social skills, most children with autistic spectrum disorders need to be taught standard social expectations. It is easy to assume that the children with whom we work will figure out what they should do and what they shouldn’t. After all, they are surrounded in school by children who know these basic rules, so won’t they learn them, too? The answer is often “no.” Learning to conform to the unwritten rules of social behavior is difficult. It is difficult because children with autistic spectrum disorders are not always aware of common expectations, and if they are aware of these social conventions they may not be motivated to restrain an impulse that runs counter to convention just because their friends might not approve. Think about nose picking, for example. In our experience, a certain child may be aware that a friend frowned upon his or her nose picking last time. But if his or her nose is uncomfortable, that feeling seems to take precedence over any social obligation to follow the rule “Don’t pick your nose in public.” For this rule and others, parents, teachers, and therapists end up teaching the rules of social conformity as the need arises. A formal goal for this particular issue might be: Child will wipe nose on tissue and throw tissue away.

You might find yourself needing to teach lessons in ownership and/or privacy, as demonstrated in the following goals: Child will demonstrate an understanding of ownership by refraining from taking someone else’s food or belongings.

or: Child will demonstrate an understanding of modesty and/or privacy by being fully clothed when leaving the bathroom in public places.

More goals that address common problems in learning about social norms can be found in Appendix A. 37


School and camp skills As designers of intervention, we are often in the position of helping children learn a set of skills for successful functioning in a variety of environments. One of the greatest developmental challenges for all children is learning to move from the security and predictability of one’s home and family to the new demands created by multiple environments with multiple caregivers. The skills that are required in school, at camp, or in the community are often unlike skills needed at home or in a quiet, familiar setting. New environments mean new demands. What parents, teachers, and therapists need to do, once again, is figure out together which new demands are posing particular strain on the child in question and design intervention accordingly. You might need to target basic group skills such as: Child will raise hand when wishing to speak and will wait until he/she is called on before speaking out loud.

You might need to target skills specific to the difficulties commonly experienced by children with autistic spectrum disorders, such as: Child will tolerate changes in the schedule when prepared for these changes.

Finally, you might need to design goals that are specific to one child only because no one child with autism is ever identical to another child with autism. Your goal could look like this: Child will tolerate being at both the middle and the end of the line.

This child obviously had difficulty with line position. Is this true for many children? No. Is it true for many children with autism? Probably not. Is it true for at least one child with autism? Yes.

Leisure Leisure is defined by the American Heritage Dictionary as a noun meaning “rest” or “freedom from time-consuming duties, responsibilities, or activities.” If our American concept of leisure were just that, children with autistic spectrum disorders would be skillful masters of leisure time. In America, however, our concept of leisure time for a child is partly defined by doing things with family. Usually, children with autism are not skillful masters of the family trip. The family outing lacks predictability and the presence of novelty can be alarming. Simply leaving the house on the weekend can be irritating for some children with ASD. It is usually the parents of the children with whom we work that define leisure goals. They are the ones that know what needs to be learned so that the 38


child can experience life as the rest of the family experiences it. They are the ones that point out the skills, big or little, that seem to be missing. We can help families improve leisure skills in their children. It takes the same strategy that everything takes—breaking down expectations into little steps and working on them one by one. Leisure time skills, like everything else, can be written into goals that can then be measured to mark progress over time. Here are a few examples: ° Child will increase repertoire of tolerable family outings. ° Child will keep caregivers informed of where he/she is going during


° Child will join routine family activities, from start to finish, without

needing to be continually prompted to stay involved.

° Child will join non-routine family activities, from start to finish, without

needing to be coerced.

° Child will be able to tolerate winning and losing.

Things to remember This was a long chapter with a lot of information to absorb. Still, the key ideas are straightforward: T Goals must be written in a way that reflects basic development growth. T Even though we are measuring small behavioral changes, these

behavioral changes represent shifts in the child’s social, emotional, and cognitive development.

T The goals suggested here and in Appendix A are only a beginning in the

process of designing intervention. The actual goals for an individual child are always a team effort that pinpoints specific and often unique areas of need.


Chapter 3

Writing Measurable Goals

Recognizing and writing developmentally appropriate goals, like those in the previous chapter, isn’t the same thing as recognizing and writing measurable goals. In our experience even the most well-meaning intervention teams often write goals or objectives that don’t mean what the team intends the goals to mean, and/or can’t be measured in a meaningful way. For example, we recently came across a goal that was written for a young boy who was receiving home-based services. The goal read: George will not be aggressive 80% of the time.

The flip side of this statement is that George can be aggressive 20% of the time and still meet the goal! Twenty percent of a 24-hour day is 4 hours and 48 minutes—meaning 4 hours and 48 minutes of aggression each day was OK. This child, we knew, slept 12 hours a night. He obviously wasn’t aggressive while sleeping. He also went to school for 7 out of the remaining 12 hours of the day and we knew that he wasn’t having any difficulties with aggression in school. So out of the 5 hours of time he was awake and not in school, George would have reached his in-home therapy goal if he remained non-aggressive for a mere 12 minutes. Is this what the team intended? We don’t think so. They may have meant: George will refrain from becoming aggressive with the therapist (kicking, biting, or hitting) four out of every five times he has an emotional outburst in the home.

or they may have meant: During therapy in the home, the frequency of physical aggression towards the therapist will diminish to only one aggressive act (hitting, biting, or kicking) every five sessions.

Or they may have meant something else altogether. If George’s team had written the goal in a clear, specific way, there would have been no confusion concerning 41


either the meaning of the goal or how to measure it. That’s what this chapter is about: giving you the skills you need to write goals that reflect the actual behavior you want to measure in a meaningful way.

Change in the child and change in the goals What are we measuring when we write developmental goals for children with autism? Only one thing: change over time. When we work with a child what we want to see is a change in targeted skills and behaviors that may take days, weeks, or months to produce. We are not comparing groups of children to each other or comparing a child to some standard. We are concerned only with a single child’s progress over time. Much of the difficulty in understanding how to approach data collection for developmentally based intervention comes from two different ideas of “progress over time.” On the one hand we need to write goals that reflect changes in small, concrete pieces of behavior. We expect that these kinds of changes can be accomplished in a modest amount of time; this is progress on a small time scale. On the other hand, the knowledge and skills that underlie the behaviors—what we’re most interested in—may take a longer time to change in a general and lasting way. This is progress on a larger time scale. We unify the two time scales by realizing that every large-scale skill or behavioral change must be led through three distinct phases. In the first phase, the child demonstrates certain small-scale behaviors in a single, familiar environment with one teacher or caregiver. Then the child must progress to the second phase in which he or she demonstrates consistent use of the behavior whenever it’s appropriate. Finally, the child must progress again to a phase in which he or she is consistently using the skill in multiple environments with multiple caregivers and natural distractions. This means that each small, concrete goal we write is actually related to other goals in the child’s past and future as part of a deeper, more lasting kind of change. By viewing progress against this backdrop we begin to see how to take large developmental changes and make them measurable. What does the process of balancing small-scale and large-scale progress look like? You and your team begin by figuring out what the child needs to learn next. To help with this decision you might use a curriculum or a set of developmental guidelines. Suppose, for example, that Johnny’s team decides to target the social practice of waving goodbye. Within this large-scale goal there are at least three small-scale goals that follow the child’s progression through the phases of learning. Let’s look at that progression for Johnny, and for Johnny’s goals.



Phase 1: Emergence

In Phase 1 the goal statement describes the emergence of a skill given multiple and supported opportunities in a sheltered, consistent, therapeutic environment. So the first concrete instance of a small-scale goal contributing towards Johnny’s large-scale goal might be written: With multiple prompts and frequent modeling, Johnny will begin to wave goodbye to family members and caregivers leaving his home.

Because learning is most challenging in this phase, you begin at home or in a small classroom with a consistent caregiver. To the extent possible the interactions are based around the child’s interests and natural pursuits. You begin to work with the child in a manner that is tailored to his/her particular learning needs. You offer rigorous support and constant rewards in an effort to help the child move into new skill areas. In short, during the emergence phase, the targeted skills are taught and re-taught, supported and maintained. Only when a child shows progress in this setting under these circumstances does the purpose of intervention refocus.

Phase 2: Consistency

In Phase 2 the goal statements focus on consistency: the frequent and repeated practice of the behavior given specific surroundings. The next concrete instance of a small-scale goal contributing toward Johnny’s large-scale goal might be written: With a decreasing need for prompts, Johnny will wave goodbye to familiar adults and his siblings.

Phase 2 statements reflect your aim to have the child be able to retrieve the skill predictably and reliably. At first you might prompt for the new behavior at every possible opportunity, but once the child easily retrieves that piece of learning when it is needed, you pull back on your prompting so that the child becomes more independent. You may use drills for teaching, you may set up situations for learning within the child’s natural environment, or you may rely on incidental “teachable moments.” However you do it, this is the stage for practice. When a child shows consistency and independence in this setting and under these circumstances, the purpose of intervention is refocused again.

Phase 3: Extension

In the final phase of large-scale progress on this goal, Johnny’s team might write:



With decreasing need for all prompts, Johnny will wave goodbye in home and school environments when someone who is leaving waves to him or says “goodbye” first.

Followed sometime later by: In all environments, Johnny will consistently wave goodbye when someone who is leaving waves to him or says “goodbye.”

In other words, in Phase 3 the small-scale goals target the extension of the skill to multiple environments and the degree of independence in those environments. You need to make sure the child can do whatever you expect him to do in the grocery store, at the playground, and in school. You also make sure the child can do whatever you expect him to do with other adults, siblings, cousins, neighbors, and peers. Increased support may be required temporarily in each new environment just as familiarity of environment may be required temporarily with each new person. But the temporary reintroduction of support should not be considered a step “backward.” It is part of the natural progression of large-scale change. Overall, the final phase of intervention helps the child take an independent and consistent skill out into the world. Only then is the large-scale goal complete. In designing developmentally based intervention, there is clearly a flow to the learning process that must be reflected in the goals you write. Charts 3.1 and 3.2 in Appendix B summarize the process visually. While understanding the flow is critical, it is not enough. To write small-scale measurable goals (like the examples in this section) we need to know more than just the phase of the large-scale goal they represent. We need to know both if we are looking for emergence, consistency, or extension and under what conditions we should see the emergence, consistency, or extension. We need to know the Who, What, When, and Where of each small-scale step. To get measurable we need to get specific.

Writing goals that can be measured Chapter 2 gave you some ideas about how to write goals that reflect both typical development and the areas of compromise in children with autistic spectrum disorders. The first section of this chapter demonstrated how to set the small concrete goals we work with day-to-day into a larger perspective. But once the team has created a list of objectives that represent the current needs of a certain child—each objective clearly identified as being in a particular phase—how do you shape each goal so that it can be measured reliably? You shape a goal first by qualifying each behavioral outcome and then by quantifying it. To qualify a goal you must be specific about the variables that surround the desired outcome. If you are unclear about the specific conditions under which the



behavior is to occur, the meaning of your data will be unclear as well. In particular, to qualify a goal you must add language that designates: · Where the behavior is to occur. Do you expect the child to exhibit

this behavior in a sheltered and familiar environment? If so, which environment? Do you mean familiar environments that are free of unexpected events? Or do you expect the child to show this behavior in community settings where things can be unpredictable? Qualifying where the behavior should occur means including phrases like “at home,” “in the regular classroom,” or “in multiple community settings.”

· When the behavior is to occur. It might be difficult to measure a new

behavior over a long period of time (like an entire school day) so you should limit the time that you measure a particular goal. Sometimes you might need to measure a targeted behavior during the same time each day to control for changing variables. Other times you might need to measure something in intervals throughout the day to look at the effect of changing variables. In either case, you need to be specific about your time segment. This type of qualification is made by phrases like “during ‘free play’,” “during transitions between classes,” or “in the 2-hour period before bed when Johnny is playing with his siblings.”

· Who observes the desired behavior. Do you expect it to emerge only

with the most trusted adults (“with Mom or Dad” or “with the instructional aide”)? Or do you think the child is ready to show that behavior to many people in his or her community (“with any child on the playground”)? You need to be specific.

· The level of support the child needs to demonstrate the behavior.

Demonstrating a behavior with multiple prompts is a very different skill from demonstrating that same behavior spontaneously. Although the degree of prompting is intimately tied to where the small-scale goal falls in the larger learning progression, specificity is still important. Do you expect the child to need multiple prompts because it is a new and difficult skill (“with multiple prompts”)? Do you expect that the child will need only a single prompt? Or are you intending that the child demonstrate the desired behavior independently, using only natural cues (for example, “when someone waves first”)?

· The type of measurement to be collected. Are you asking the person

collecting the data to estimate? Do you want to know what the best outcome was for the day’s work or do you want to know what the average outcome was? The more specific your goal statement is, the more certain the meaning of the measurements.



After you’ve qualified it, you need to quantify the goal by choosing a system for measuring progress. Having reviewed many treatment plans for children with ASD, we have identified the following systems of measurement as both practical and meaningful for developmental outcomes. For each goal, choose one of the following types of quantification: · Increasing or decreasing frequency of behavior. You might want to

see a child wave goodbye more and more often when Mom leaves for work. You might want to see fewer and fewer incidents of self-talk in the middle of social play at school. This is the most common system for measurement. It is not, however, the only option you have.

· Increasing or decreasing duration of behavior. You might want to

see a child sustain attention to playful encounters for longer and longer periods of time. You might want to see a gradual reduction in the amount of time it takes a child to respond to his or her name.

· Increasing a range of behavior. This type of measurement is used

when you want to see the gradual acquisition of a set of skills over time. You use this system when you are looking for a child to expand his or her repertoire of play, or when you are measuring, over time, a child’s ability to respond favorably to a variety of people. However, a growing vocabulary—linguistic or behavioral—can’t be measured on a single day. This is a system that measures an accumulation of skills over time.

· Decreasing need for assistance/prompts. This is often the system of

measurement that is used when it is time for the large-scale goal to move from emergence to improvement and finally to consistency. If a child previously needed multiple prompts in order to answer a “Why” question, for example, and now only needs an expectant pause, that is progress! If a child used to need hand-over-hand assistance to wash his or her hands and can now do it with only a set of visual reminders, that is progress! A bonus to using this method of marking progress is that it makes the team aware of how they prompt. Becoming complacent with your level of support is never good for the child.

The process of qualifying and quantifying your goal statement makes it clear to everyone on the team both what you are measuring and how you are measuring it. To complete the process, however, you must choose a specific scale, unit, or quantity that will be used to record the child’s behavior. Each method of quantification allows for different types of observations, as we detail in the following sections.



Ways of recording increasing or decreasing frequency Frequency can be measured in one of three ways: by tally of occurrence (a quantitative scale), by percentage (another quantitative scale), or by a qualitative scale. Each method has appropriate circumstances for its use, as explained below.

Using quantitative scales

A quantitative scale measures progress by recording increasing or decreasing quantity. One type of quantitative scale, the tally of occurrence, is used for measuring progress in the development of a skill when opportunity is constant. Let us show you an example of such a goal. Goal: With increasing frequency, Peter will show pleasure by smiling during structured play with his aide and a small group of peers. Data question: How many times in a ½ hour of structured play did Peter smile to indicate pleasure? 0 1 2 3 4 5 >5

Each example in this section has one part labeled “goal” and one part labeled “data question.” The data question lays out the scale or set of alternatives for the way of measuring progress specified in the goal. We will explain data questions more fully in Chapter 4; for now we are focusing on the bigger picture. In Peter’s case, the team wants to see the emergence of a new behavior. Since a new behavior is most easily learned in a familiar environment the qualifying phrases “with his aide and a small group of peers” and “during structured play” are added to detail the specifics. The general quantifying phrase in the goal statement (“with increasing frequency”) is made specific in the data question (“times in a ½ hour of structured play”). Since there are unlimited opportunities for Peter to smile within the specified environment, a tally of occurrence is an appropriate system of measurement for this goal at this stage. Now let’s think about how this qualified and quantified goal relates to intervention with Peter…maybe Peter only rarely showed pleasure when this goal was written. During the first week of intervention, perhaps Peter smiles only once. The next week, there are three times when he smiles. The following week, Peter not only smiles at his aide, but begins to smile at the other children as well. Do you see what is happening? If you were keeping tallies of occurrence, your data would have registered change over time. Let’s think about another example. Shawnna is a child who has a very difficult time pretending to be anyone other than Shawnna. Her sisters want to play dress-up and Shawnna never joins them. Shawnna is awkward with little figures and doesn’t join her sisters when they play with dolls. A goal is written for Shawnna that is paired appropriately with a quantitative scale:



Goal: With regular modeling from siblings and adults during therapy sessions in the home, Shawnna will take on the role of another person in play with increasing frequency. Data question: How many times did Shawnna pretend to be someone else while engaged in pretend play with siblings and therapist? 0 1 2 3 4 5 >5

Here again the focus is on the emergence of a new behavior. The goal statement is qualified with phrases indicating where and when (“during therapy sessions in the home”), who (“siblings and adults”), and level of support (“with regular modeling”). Within those constraints, Shawnna has a constant opportunity to initiate the new behavior, so the team chooses a tally of occurrence. The quantifier in the goal statement (“with increasing frequency”) is made specific in the data question. How does this goal relate to intervention and change in Shawnna’s behavior? The team wants to see if they can expand Shawnna’s play skills with modeling so that she can play more easily with her sisters. They set out to work on this every session, modeling and encouraging. The individual collecting data looks for incidents in which Shawnna participates in or initiates some form of role-playing and tallies the occurrences. As Shawnna’s comfort with role-playing increases so will her tally. In contrast to the tally of occurrences, the second type of quantitative scale, percentage, is used for any desired behavioral change in which frequency of opportunity is also measurable. Percentage is calculated by dividing the number of times a behavior does occur by the number of opportunities in which it might have occurred. For example: Goal: With increasing frequency, Peter will respond by saying “Hi” when familiar people say “Hi” to him. Data question: What percentage of the time did Peter respond by saying “Hi” to familiar people who came to his home during his morning therapy session? How many people came to his home? ______ How many times did Peter say “Hi”? ______ Calculate # of greetings ÷ # of opportunities x 100 = ______%

or: Goal: Needing only a single verbal prompt, Shawnna will wait appropriately for her turn on the playground equipment. Data question: What percentage of the time was Shawnna able to wait for her turn at the playground, needing only a single verbal prompt?



# of opportunities: ______ # of times Shawnna waited: ______ Calculate # of waits ÷ # of opportunities x 100 = ______%

Be aware that using percentages as your method of measurement in marking progress can be problematic in many instances. We have observed too often that teams rely on taking a percentage measurement even when it doesn’t make sense. We want you to be familiar with the four serious problems that can be associated with collecting data in this way: 1.

With goals that focus on frequently occurring behaviors, it is unlikely that a therapist or teacher has the luxury of counting all of the opportunities for the behavior in order to calculate the percentage correctly. Each time the observer fails to note that the child missed an opportunity the percentage becomes a little less accurate. Under these circumstances the ratio of successes to opportunities becomes inflated; the child appears to be far more masterful than he or she truly is. Estimating percentages is a common practice that is almost guaranteed to produce inaccurate data. If your team needs to estimate a percentage because counting the child’s successes and dividing them by the number of opportunities for success is too cumbersome, then you should use another method of measuring progress.


Percentages can also be problematic for infrequently occurring behaviors. If there are only one or two opportunities for the target behavior each time you work with the child, the child’s behavior will be easy to record but the percentage data will be too crude to be informative. Why? Consider this: if there is only one opportunity, the child either behaves as desired (receives 100%) or does not behave as desired (receives 0%). If there are two opportunities, the child can score 0%, 50%, or 100%. These figures simply do not give enough gradation to accurately represent the child’s behavior in a meaningful way because the large jump between the possible values does not correspond to large differences in the child’s mastery. As the number of opportunities grows, the use of percentages does become more appropriate…but only until the opportunities become too frequent to count, as explained in 1.


If the number of opportunities fluctuates due to the nature of the developmental skill you are trying to teach, percentages may be misleading. Perhaps Shawnna got a 50% one day and a 40% the next 49


day. On paper, this looks like she is regressing slightly. But perhaps she showed a certain new behavior once on the first day (out of two opportunities) and four times on the second day (out of ten opportunities). Even though the percentage dropped, we might want to consider this progress simply because Shawnna managed to show the behavior four times. That information was lost when you calculated the percentages. 4.

It is possible to write goals that try to compensate for problems 1–3 by targeting behaviors that can be measured frequently but not too frequently, and by making sure each session with the child has about the same number of opportunities. Such an approach means letting your data analysis method determine your intervention style. The premise of this book is that the decision of intervention style must come first and is independent of the decision to collect data. Once the commitment to a particular style of intervention has been made then data collection and analysis methods appropriate to that intervention can be learned and practiced.

Using a qualitative scale

A qualitative scale is used for rating behavior that exists on a continuum. Of all the methods we discuss in this chapter, this technique for collecting data on developmental progress can result in the most specific and useful data. Yet we have found that teachers, parents, and therapists rarely use it. Why is this method under-utilized? Perhaps teachers and therapists worry that only a scale that has been established independently can be valid. This is not correct. You know the particular child in question and you understand that development is a process. So put those two areas of knowledge together to devise a series of steps that goes from not being able to do something all the way to being able to do something. By creating a scale of steps that is individualized to a specific child, the data you collect will be more valuable than data collected on a general scale. The four examples that follow are intended to give a feel for how to use qualitative scales to measure progress: Example 1: Goal: With increasing frequency, Peter will match his behavior to the behavior of his peers. Data question: How often did Peter watch what his friends were doing and do it too?



Rarely, even when prompted 1 About half the time, prompted Most of the time, prompted A few times, independently Many times, independently

Example 2: Goal: Shawnna will become more comfortable with messy art activities, that involve using her hands, when they are presented to her in the classroom. Data question: Please rate Shawnna’s participation level with activities involving tactile experiences. Very resistant Somewhat resistant A little resistant Guarded participation Full participation

Example 3: Goal: Isaac will begin to engage in parallel play during “free play” at preschool. Data question: Did Isaac engage in parallel play? Isolative throughout “free play” During gross motor activities only During gross motor and sensory activities During all activities, including playing with trains

Example 4: Goal: With increasing frequency, Beth will learn to use words to describe her distress while completing homework and chores in the evening. Data question: For the majority of the time, how did Beth communicate distress? TANTRUM 1




We hear you asking yourself, “Why is it all right to estimate a percentage (‘about half the time’) here when you just finished telling me it was bad practice?” Excellent question! The estimate asked for on this qualitative scale is a choice among a set of broad categories that can be judged accurately. Most adults can accurately distinguish between events that have occurred rarely, about half the time, and most of the time. This is a very different sort of judgment than distinguishing accurately if an event occurred 25% of the time or 30% of the time or 60% of the time. (We’ll explain the difference between qualitative scales and percentages in more technical terms in Chapter 6.)



As the examples show, the more specific you are about what you expect in the way of progress, the more informative your data results will be. Most systems of measurement look at whether the child did or did not do something with little regard for the process of going from A to Z. If you take the time to figure out the steps that the child will take to accomplish a new skill, you educate everyone who uses the scale. Further, when you look back on the child’s progress and your team notes that the goal has not yet been achieved, a qualitative scale gives you considerable feedback about where the child has stopped progressing. A good team takes this information seriously and plans new strategies accordingly.

Ways of recording increasing or decreasing duration Frequency is not the only aspect of learning that is important. Even a child who shows progress in knowing how and when to use a skill may not participate in the activity or behavior for a long enough period to fully benefit from its rewards. For this child, the team may decide that it is time to focus on duration. When we want to see behavior demonstrated for either longer or shorter periods of time we need quantitative scales that measure duration. Such scales need to be paired with qualifying phrases that clearly ask for average, longest, or shortest instances of the target behavior. The following examples are presented to give you a feel for measuring progress in this way: Example 1: Goal: In the home environment, Peter will stay engaged with familiar adults for increasing lengths of time. Data question: On the average, how long was Peter able to stay engaged with you today? 2–4 min.

5–7 min.

8–10 min.

>10 min.

Example 2: Goal: As Shawnna becomes more social, periods of time in which she chooses to remain self-absorbed and self-contained will diminish. Data question: When given a choice to be alone, what was the longest time before Shawnna sought the company of her mother or therapist? >15 min.

~15 min.2

~10 min.

The symbol “~” means “about” or “approximately.”



~5 min.