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Family Involvement in Intervention Delivery
With respect to the development of parent education programs, several important themes are emerging in the literature. First, it is well documented that the demands associated with having a child with a disability greatly increase parental stress (Bristol & Schopler, 1983; Moes, Koegel, Schreibman, & Loos, 1992). In our society, there is a lack of preparation, assistance, and opportunities for socialization for parents of children with disabilities. Many parents of children with autism experience a lack of welcome in public places, and their families’ social circles may change or decrease significantly because of the challenging behaviors and delays their child exhibits.
Lord and O’Neill (1983) pointed out that programming for children with autism is particularly difficult because many of their deficits, such as language development and socialization, are learned by typically developing children with little or no direct intervention. Research has demonstrated that parent education programs that obligate the parents to designate certain time periods to work one-on-one with their children increase parental stress. However, parent education programs, when implemented properly, can help to reduce parent stress while greatly improving communication (Moes, 1995). Programs designed to fit into families’ lifestyles and routines, so that teaching can occur on an ongoing basis throughout the day in natural settings, actually decrease family stress while resulting in greater gains in child communication (Koegel, Bimbela, & Schreibman, 1996; Schreibman, Kaneko & Koegel, 1991).
In light of the documented need for coordinated efforts with family members, some areas appear highly likely to benefit from further research. For example, individualizing the intervention to adjust for contextual variables that may result in less effective parent education programs, such as poverty, social isolation, depression, stress, and marital discord, may be of great importance (Baker, 1984; Dumas & Wahler, 1983; Forehand, Furey, & McMahon, 1984; Plienis, Robbins, & Dunlap, 1988; Robbins, Dunlap, & Plienis, 1991). In addition, with increases in cultural diversity in our society, parent education programs that develop culturally and linguistically sensitive intervention plans might also benefit from further research. Research regarding the concepts of "goodness of fit" and "contextual fit" (Bailey et al., 1990), when incorporated into research on intervention plans, may improve parent education programs, benefit the general family system, and the child’s overall functioning.
Implementation (When, Where, What, and How Much)
Best practices and procedures, so that children with autism progress toward connected coherent social discourse for communicative competence, are unknown at this time, and thus comprehensive investigation of this area is needed. Research regarding when intervention for linguistic and social development should take place, where or in what settings intervention should occur, how much intervention is optimal, and what types of interventions need to be implemented for accelerated social and linguistic gains and communicative competence may be of considerable benefit to the field. Certainly this issue relates to the individualization of intervention, as responsivity to different types of interventions are likely to depend on particular child and family characteristics.
Interrelationship Between Language and Other Areas
Research relating to the understanding and assessment of interrelationships between communication and behavior has been prolific in the last decade and has created numerous new research opportunities for promoting communication in autism. Assessing the functions of behavior problems is now a common practice and an essential component of most behavioral support plans, and a number of tools are readily available through direct observation (Frea, Koegel, & Koegel, 1993), interviews (O’Neill, Horner, Albin, Storey, & Newton, 1990), and review of records. However, the science of teaching functionally equivalent behaviors is less well defined. How often and at what times practitioners need to prompt functionally equivalent replacement behaviors before behavior problems are eliminated is not yet clear. In addition, studies that improve our understanding of the social contexts that support problem behaviors, particularly when there are multiple maintaining variables, are needed. The relationship between the acquisition and spontaneity of functionally equivalent replacement behaviors is not well understood. There appears to be an inverse relationship between the acquisition of a functionally equivalent replacement behavior and the decrease of problem behaviors. However, the exact interaction between the appropriate and inappropriate behaviors may be complex and dependent on how well established the problem behavior is, the context in which the behavior problems occur, the child’s level of functioning, and other variables. The issue of transfer of intervention gains across community settings may be better understood with additional research. Although the essence of teaching a functionally equivalent behavior is to provide a socially appropriate mode of communication, aggression and self-injury often are effective and efficient in terms of communication. Therefore, even though inappropriate, they may be well established in terms of producing desired outcomes. Areas such as efficiency of communicative responses, reinforcement schedules, and delayed consequences are likely to have a direct relationship with the use, generalization, and maintenance of functionally equivalent behaviors.
The Social/Pragmatic Use of Language
Children, adolescents, and adults with autism who are able to formulate syntactically correct sentences often display difficulties in areas of pragmatics, such as eye gaze, expression of affect, prosody, topic shifting and maintenance, and nonverbal mannerisms (Frea, 1995). These pragmatic difficulties create a risk of rejection, which has been documented to correlate with behavior problems, depression and other maladjustments later in life (Dodge, 1983; Roff, Sells, & Golden, 1972). The lack of social and peer acceptance that may result from inappropriate pragmatics reduce learning opportunities that contribute to social and emotional development and may have long-term implications for interpersonal relationships and career development (cf. Amado, 1993; Dodge, 1983; Strayhorn & Strain, 1986).
Although a growing number of studies have assessed and developed interventions for improving social interaction between typically developing and disabled children (also see review in this issue by Rogers), social- pragmatic areas of communication remain an area in need of further research. Similarly, research relating to long-term socialization and the development of friendships appears to be important (Hurley-Geffner, 1995). For example, does the child have friends and go to birthday parties? Does she or he talk on the telephone, have and go to sleepovers? Is she or he engaged in after-school programs and family activities? What are the social areas that need to be developed so that adults with autism are able to be productive at work and in careers? Research regarding the important social and pragmatic areas that lead to communicative competence in community settings, in addition to developing procedures to teach these complex and comprehensive social domains, is likely to improve the quality of life and development for individuals with autism and their families.
Communicative competence requires that children must "learn the rules of language use for deciding which forms to use in different contexts, for learning when and how to say what to whom" (Bloom & Lahey, 1978). Communicative isolation, which is common for children with autism, does not lead to adequate communicative development and social competence. Researchers have progressed in both assessment and intervention in the area of communication, but many important research gaps still exist. Future research designed to determine key "pivotal areas," such as child self-initiations (L. Koegel et al., 1999; Yoder & Warren, 1999), that produce generalized and widespread changes in behavior and have positive effects on other untreated areas (Matson, Benavidez, Compton, Paclawskyj, & Baglio, 1996) will likely improve outcomes for children and adults with autism.
Reflection Exercise #11
Online Continuing Education QUESTION 25
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