ASAT
Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment

Science in Autism Treatment
Newsletter of the
Association for Science inAutism Treatment

O

Volume 15, Issue 1 | Winter 2018

n behalf of ASAT, I hope 2018 has brought you good things thus far. I also hope that this year willbring to all a deeper appreciation for the relevance of science in both grounding and guiding autism
treatment, greater expectations of accountability from treatment providers regardless of theirdiscipline, and greater accuracy within media portrayals of autism treatment. Collectively, I hope this would
result in heightened awareness of the pitfalls, costs, and risks of pseudoscience; for there are, sadly, quitemany.
The sad reality is that in contrast to many other disorders, parents of children with autism continue to have towork harder to identify and access effective interventions supported by scientific research. The Internet has anabundance of misinformation, marketing ploys, and media representations that are sometimes inaccurate and,at times, misleading. At ASAT, we truly believe that parents deserve access to a community that values
science over profit, expects accountability fromtreatment providers, and gravitates towards methods
Table of Contents
already proven to be effective.

As you may recall, I shared many of our 2017
accomplishments in the Fall 2017 issue of Science inAutism Treatment (SIAT). As we welcome in the newyear, we are anticipating an even more productive 2018.
Therefore, it is with great pride and optimism that I
outline an array of goals and initiatives for 2018:•

Increase SIAT subscribers to 13,000 targeting
underserved areas in the US and abroad.

•

Increase our Facebook fans and Twitter followers.

•

Expand ASAT’s presence on quality autism
community blogs.

••

Identify and develop collaborative relationships withother organizations that share our values andcommitment to science.

Celebrating 20 years Together in Science

3

Clinical Corner: Problem Behavior Triggered bySpecific Words

5

From the Archives: Discussing Medication
Recommendations With the Doctor

9

Research Summaries:
Atomoxetine and Parent Training Early
Intervention and Normalized Brain Activity

13

Fundraising: Victoria Autism Expo

16

Media Watch
ASAT Responds to The Inquirer’s, “Falling Off
the Cliff”

18

Is There Science Behind That?: Autism andTreatment with DIR/Floor Time

20

How ASAT Supports Column

24

Our Volunteers

25

Sponsorship Campaign

26

Increase ASAT’s presence at state, regional, national,
Professional Sponsors
and international conferences.
Donor Wall 201727
28
(Continued on page 2)

Science in Autism Treatment | Volume 15, Issue 1 | Winter 2018
Page 1ASAT
Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment(Continued from page 1)•

Continue to develop our website and newsletter content
specific to medical providers, particularly pediatricians andfamily practice doctors.

• Continue to provide information regarding ASAT andautism to ABA faculty, special education, psychology, andspeech pathology programs nationwide.
• Continue to publish synopses of research to keep up withthe growing number of studies on interventions for autism.
• Continue to expand treatment summaries.
• Develop a resource booklet for parents of newly diagnosed
children with autism available free online and in print anddistribute a resource booklet to international journalists.
• Continue to expand our website pages for parents with a
newly-diagnosed child, parents of older children and adults,
and media professionals.
• Create Public Service Announcements in Spanish.
• Increase grant submissions to support our work.

• Tap more extensively into the wealth of experience andexpertise of our Advisory Board members.
• Increase number of Media Alert posts in response toaccurate/inaccurate portrayals of autism treatment, withheightened focus on international topics, biomedical
advances and lifespan considerations.
• Prepare new monthly blogs with Different Roads toLearning (DRL).
•

Implement 2018 strategic plan for our 20th anniversary.

Thank you for your support in the year ahead.
Yours in science,David Celiberti, PhD, BCBA-D
Executive Director and
Co-Editor of Science in Autism Treatment

EXECUTIVE DIRECTORDavid Celiberti, PhD, BCBA-D
BOARD OF DIRECTORS
Zachary Houston, MS, BCBAPRESIDENT
Leigh Broughan, MA, BCBA, Sibling
VICE-PRESIDENT
Barbara Wells Reimann, DTR, SNS, Parent
TREASURER
Leanne Tull, MADS, BCBA
SECRETARY
Julie Azuma, BFA, Parent
Preeti Chojar, MCA, Parent
Ruth Donlin, MS
Joanna Dotts, DO
Elizabeth Dyer, MA, CCC-SLP
Daniela Fazzio, PhD, BCBA-D
Joseph Forgione, MBA (Emeritus)
Sabrina Freeman, PhD, Parent
Karen Fried PsyD, BCBA-D
Peggy Halliday, MEd, BCBA
Eric Larsson, PhD, BCBA-D
Renita Paranjape, MEd, BCBA
Franca Pastro, BA, Parent
Tristram Smith, PhD
Sarah Treadaway, MEd, BCBA
Renee Wozniak, PhD, BCBA-D
PROFESSIONAL ADVISORY BOARD
Jane Asher
F. J. Barrera, PhD, BCBA-D
Stephen Barrett, MD
Martha Bridge Denckla, MD
Kathryn Dobel, JD
Curtis Deutsch, PhD
Deborah Fein, PhD
Eric Fombonne, MD
Richard Foxx, PhD, BCBA-D
Gina Green, PhD, BCBA-D
William Heward, Ed.D., BCBA-D
Ronald Kallen, MD
Robert LaRue, PhD, BCBA-D
Alan Leslie, PhD
Bennett Leventhal, MD
Tracie Lindblad, MSc, MEd, SLP. BCBA
Johnny L. Matson, PhD
Catherine Maurice, PhD
Joyce E. Mauk, MD
Bobby Newman, PhD, BCBA-D
Sharon Reeve, PhD, BCBA-D
Joyce Rosenfeld, M.D., FACEP
Bridget Taylor, PsyD, BCBA-D
Arthur Toga, PhD
Paul Touchette, PhD
Roberto Tuchman, MD
Paul Yellin, M.D.
NOT-FOR-PROFIT 501(c)3 CORPORATION

Science in Autism Treatment | Volume 15, Issue 1 | Winter 2018
Page 2

Celebrating 20 years Together in Science
Zachary Houston, MS, BCBAF

or two decades we have stood together in support of science. Since our firstissue in 1999 we have worked with you to adopt higher standards of accountability for the care, education, and treatment of individuals with
autism.

Since ASAT’s inception, our all volunteer board has published 43 newsletters with the latest information for
individuals with autism, their families, and the practitioners who support them. Today, we continue this tradition with an issue that facilitates conversations between adolescents and providers, explores trigger words
plaguing our community, and delves into the extent of the scientific support for Floortime.
Twenty years and dozens of newsletters later, the Science in Autism Treatment newsletter remains an irreplaceable resource for learning more about the different treatments available for autism. More importantly,
as new fad treatments are “discovered” every day, we are reminded that our vigilance cannot waver. With500 “treatments” marketed to people with autism and their families, we know that our shared efforts
are of critical importance. To date, our impacts include:

178 Media Watch articles published, holding the media accountable for responsible reporting of autism
issues and applauding those that highlight science in their writing;

100 countries represented in our subscriber base, ensuring safe, effective, science-based treatments arereaching the far corners of the worl

Over 12,000 Facebook fans, advocating and engaging around the importance of science in autism.

This year, you will see exciting new initiatives from ASAT and continued progress with our ongoing projects, including a Public Service Announcement on ASAT’s work and resources, a resource booklet forparents of newly diagnosed individuals with autism, and a journalist’s resource booklet. We also continue to expand our reach through the newsletter, social media, and website.
None of this work would be possible without the support of our donors and subscribers. As one subscriber
recently commented, “This is the way to improve lives.” Or, as put by another commenter, “A diagnosis ofautism comes with so many worries and questions...it's nice to have a place to go for some science anddata-based answers.” Our success is your success, and together we will continue to promote safe, effective,
science-based treatments for people with autism. Here’s to another 20 years together!

Zachary Houston, MS, BCBA
President, ASAT
Science in Autism Treatment | Volume 15, Issue 1 | Winter 2018
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Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment

Science in Autism Treatment | Volume 15, Issue 1 | Winter 2018
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Clinical Corner
Problem Behavior Triggered by Specific Words
Mary E. McDonald, PhD, BCBA-D, LBA

Many families and professionals encounter situations in which
they must manage challenging behaviors in response to
seemingly innocuous and idiosyncratic situations. Determining
how best to address these challenges can be difficult without aresource for clinical direction. Here, Dr. Mary McDonald
provides expert advice on the assessment and treatment ofproblem behaviors that occur in response to "trigger words"
an individual hears in the environment.
Kate Fiske, PhD, BCBA-D
Clinical Corner Co-CoordinatorI

have an adolescent with autism in myclass who responds negatively when people say certain words. He seems to have asensitivity to them and may respond with abehavioral outburst. Have you heard of thishappening with other students with autism
and do you have any thoughts on intervention?

others, participate in social situations, and be involved in the community or at a job site.

Some examples are:•A student is with his class shopping at the supermarket and the cashier says, “Thank you.” The
student stomps his feet in reaction to hearing“thank you” and the staff quickly escorts himfrom the store before the behavior escalates.

•

A family is at a restaurant and someone at another table says “Wow, that’s beautiful” in conversation. The child starts to yell in response to
the word “wow” and the parents attempt to distract the child from the conversation at the othertable.

Answered by:
Mary E. McDonald, PhD, BCBA-D, LBA
Hofstra University/Eden II Genesis Programs

This negative response to certain words, or “trigger
words,” that you describe can be a real problem forindividuals with autism and their families. Individuals with autism may react to a particular word or set
of words when they are said by familiar and unfamiliar people in their environment. The way in which
they react may vary and can range from verbal protesting or body tensing to an extreme behavioral outburst including aggression, self-injury, or destructive
behavior. This response to trigger words can have agreat impact on the person’s ability to interact with

Assessment
As with any behavior, it is important to assess thesituation to be better able to provide an appropriate
intervention. The function of the problem behavior
can be assessed through a functional behavior assessment (FBA) (Alter, Conroy, Mancil, & Haydon,
2008). Function of behavior can be determinedthrough interviews, structured observations and theScience in Autism Treatment | Volume 15, Issue 1 | Winter 2018
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ASAT
Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment(Continued from page 5)collection and analysis of data to identify patterns in
the behavior. Data can also be recorded on possible
trigger words to determine the frequency, intensity
and latency of behavior in response to various words(data collection considerations will be shared later).
If you have already conducted an FBA and determined that the trigger words have frequently been
the antecedent to the behavior of concern, the question then becomes why do these words serve as anantecedent to this behavior? While it is true that
there may be a reason, it is not always apparent what
the reason is. For example, it may be that the student
had a history with denial of a reinforcer paired with a
specific word such as “later,” or demands that wereconsistently paired with words such as “Let’s go.” Inthese cases, the words could have become aversiveto the student through frequent pairings. However,
you may not be able to determine what caused theword to become a “trigger word.” While knowing
the history can be helpful for preventing future trigger words from developing, it is still possible to treat
the behavior without knowing the initial reason theword became an antecedent for challenging behavior.
To further assess, you may want to observe how thestudent responds to the trigger word in various conditions. For example, you can analyze the occurrenceof behavior based on who says the word (familiar or
unfamiliar person), if it is spoken directly to the student or overheard, the setting in which the student
reacts to a trigger word, and the ongoing activity(preferred or non-preferred). You can also assess thestudent’s reaction to various forms of the word
(written word, spoken word, word in a sentence) tohelp plan for desensitization training. One can also
assess whether a cumulative effect is observed (i.e.,
the first instance of the trigger word does not occasion the behavior; however, multiple instances of thetrigger word cause the student to react). All of thesefactors can be reflected as columns on your ABC
data sheet.
Comorbidity. The complexity of this behavior requires us to look at other factors that may affect its
occurrence. Considerable evidence suggests thatchildren and adolescents with autism spectrum disorders (ASD) are at increased risk of anxiety and anxiety disorders (Ghaziuddin, 2002) and this may wors-

en during adolescence. Children with autism may
display problematic emotional reactions and behaviors when faced with social situations (Lainhart,1999). It is important to consider the possibility thatthe trigger words function as stimuli that increase thestudent’s anxiety. Behaviors associated with anxiety
can appear on your ABC data sheet.
Researchers are attempting to study co-morbidity inindividuals with autism. Leyfer et al. (2006) studied
various disorders associated with autism. They foundthat specific phobia was the most common disorder(in 44% of participants) found in individuals with
ASD, and even higher prevalence rates have beenreported in other studies (Muris et al., 1998). There
are a number of specific phobias that relate to words,
including nomotophobia (fear of names) and verbophobia (fear of words). Onomatophobia is an irrational or compulsive fear of hearing certain words.
However, there is little research on this phobia andno research in relation to individuals with autism todate.
The second most frequent disorder found in the
study was obsessive compulsive disorder (OCD),
diagnosed in 37% of the children with autism(Leyfer et al., 2006). The most common type ofcompulsion was a ritual involving others. About
50% of the children diagnosed with OCD had compulsions that involved others having to do things acertain way. Examples included:•

Parents having to perform certain daily routines•

An adult having to act or respond in a certainway•

An adult having to respond to repeated questions

What was most interesting about the findings is thatthe two most frequent compulsions involved attempts to control the behavior of others. Given this,
it is plausible that for some children with autism and
OCD, the problem behavior that occurs in responseto the trigger words may be attempts to control what
is said by others. However, again, no research specifically addresses trigger words as an antecedent tobehavior in children with OCD or autism.

Science in Autism Treatment | Volume 15, Issue 1 | Winter 2018
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Data Collection
When collecting data on behavior in reaction to trigger words, a frequency measure can be used but it
may not provide you with the most accurate data.
These data may be misleading as it can depend on
how often the trigger word is heard by the student.
Instead, it may be more accurate to record occurrence as a percent per opportunity, where an opportunity is when the trigger word is heard by the student. With this data, one can see the percentage ofthe time the student responds to the trigger word. It
may also be helpful to note the time that the student
hears each instance of the trigger word to determine
if the student’s reaction occurs after the first occurrence or after a number of occurrences indicating amore cumulative effect of the words on behavior.
Treatment Considerations
Prevention. Often the first reaction to increased
problem behavior in response to trigger words is toprevent the behavior from occurring by avoiding theantecedent entirely. Therefore, adults may refrainfrom saying trigger words or reacting negatively totrigger words when they are spoken. However, theissue in this case is that it is not so easy to simply
remove the antecedent from the environment. First,
it is unlikely that someone can truly remove a wordfrom their vocabulary consistently. Second, outsideof the small circle of family and therapists, there aremany people the individual will come in contact withwhose behavior is not easily controlled.
Predictability and preparation. Predictability andpreparation may be more viable options in reducing
behavior. Predictability can be used by letting theindividual know that the word is going to be used,similar to how you would warn a student with autismthat the fire alarm is going to ring if preparing him
for the aversive stimulus. This can be done verballyor with a non-verbal signal or visual cue. This warning may be one part of an intervention package.
Preparation can also be used to prepare the student
for when he/she is going to be in a community location where it may be likely that the student will heara trigger word. For example, a student may choose
to wear headphones while in the community.

sponses may be controlled not only by the original
stimulus but also by others resembling those stimuli(Stokes & Baer, 1977). Therefore, it is possible thatthe problem behavior may generalize from the original trigger word to new but similar words. As a result, assessing responses to similar words could also
be important so that generalized words can also be
included in treatment from the onset. Generalization
can also occur from one person to another and tonovel settings, which could be considered during assessment.
Interventions
Systematic desensitization/exposure. The student
may be able to learn to better tolerate the trigger
words through systematic desensitization (Grös &Antony, 2006). In this behavioral intervention, thestudent is gradually exposed to the stimulus througha hierarchy of antecedents that increase in aversiveness based on the individual’s behavioral response to
the various steps. For example, desensitization may
begin with the use of technology in the form of video
or a virtual environment in cases where this presentation is more tolerable for the individual (Mager,
Bullinger, Mueller-Spahn, Kuntze, & Stoermer,
2001). Providing reinforcement for successfully tolerating aversive stimuli is a key component of thisprocedure.
Sample desensitization steps for a student:•

Student hears audio recording of trigger word byunfamiliar person•

Student hears an app label the trigger wordpaired with a sight word presentation•

Student reads trigger word presented on a flashcard•

Student hears the trigger word stated aloud by afamiliar staff person

Stimulus pairing and reconditioning. Another approach is to recondition the trigger words so thatthey do not evoke a negative behavioral response.
One can attempt to do this by pairing the trigger

Generalization. We know that newly acquired reScience in Autism Treatment | Volume 15, Issue 1 | Winter 2018
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Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment(Continued from page 7)

words with a preferred stimulus. For example, aslideshow in which videos of someone saying trigger
words are interspersed with preferred videos (music,
movie clips) could be used to pair the aversive stimulus with more preferred stimuli. Alternatively, thestudent could be engaged in a preferred activity
when the trigger word is used (e.g., student is playing on the iPad) or the trigger word can be said while
presenting a preferred item to the student (e.g.,“Wow, I love chocolate, too”).

Functional communication training. Functional
communication training (FCT) has been a highly
successful approach for replacing challenging behavior with communication in students with ASD. As an
example, Rispoli, Camargo, Machalicek, Lang, andSigafoos (2014) demonstrated the effectiveness of
FCT with students with ASD for behavior that was
ritualistic in nature. It may be possible to teach thestudent some form of communication that may help
him or her to communicate rather than engage inchallenging behavior when a trigger word is heard.
The individual may not be able to completely avoid
hearing trigger words, but may be able to ask toleave a particular area, such as a crowded area withhigh probability of trigger words.
Summary
When working with a student with ASD who engages in behavior related to trigger words, it will be important to acknowledge the complexity of this behavior. Consider conducting a thorough and ongoingassessment to determine the most appropriate interventions to best meet the needs of the individual,
while always remembering the importance of datacollection and data analysis to help guide decision
making.

References

Ghaziuddin, M. (2002). Asperger syndrome: Associated psychiatric and medical conditions. Focus on
Autism and Other Developmental Disabilities, 17(3), 138-144.
Grös, D. F., & Antony, M. M. (2006). The assessment and treatment of specific phobias: A review. Current psychiatry reports, 8(4), 298-303.
Lainhart, J. E. (1999). Psychiatric problems in individuals with autism, their parents and siblings. International Review of Psychiatry, 11(4),278-298.
Leyfer, O. T., Folstein, S. E., Bacalman, S., Davis,
N. O., Dinh, E., Morgan, J., ... & Lainhart, J. E.
(2006). Comorbid psychiatric disorders in children with autism: interview development andrates of disorders. Journal of Autism and Developmental dDsorders, 36(7), 849-861.
Mager, R., Bullinger, A., H., Mueller-Spahn, F.,
Kuntze, M. F., & Stoermer, R. (2001). Real-timemonitoring of brain activity in patients with Specific Phobia during exposure therapy, Employing a stereoscopic virtual environment.CyberPsychology and Behavior 4(4), 465–469.
Muris, P., Steerneman, P., Merckelbach, H.,
Holdrinet, I., & Meesters, C. (1998). Comorbid
anxiety symptoms in children with pervasive developmental disorders. Journal of Anxiety Disorders, 12(4), 387-393.
Rispoli, M., Camargo, S., Machalicek, W., Lang, R.,& Sigafoos, J. (2014). Functional communication
training in the treatment of problem behavior
maintained by access to rituals. Journal of Applied Behavior Analysis, 47(3), 580-593.
Stokes, T. F., & Baer, D. M. (1977). An implicit
technology of generalization. Journal of Applied
Behavior Analysis, 10(2), 349-367.

Alter, P. J., Conroy, M. A., Mancil, G. R., & Haydon, T. (2008). A comparison of functional behavior assessment methodologies with young
children: Descriptive methods and functional
analysis. Journal of Behavioral Education, 17(2),200-219.
Science in Autism Treatment | Volume 15, Issue 1 | Winter 2018
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From The Archives
Clinical Corner: Discussing Medication Recommendations for Your Child
With Your Healthcare Provider
Megan Atthowe, MSN, RN, BCBA

What should you do when your child’s doctor recommends
trying medication? For a parent of a child with ASD, it can be
extremely difficult to know the questions to ask and what
information should be prepared in order to have theseimportant discussions with your child’s physician. In thisinstallment of From the Archives, Megan Atthowe, a Registered
Nurse and Board Certified Behavior Analyst, provides insightfor parents and professionals on a variety of approaches thatparents can take when medication is recommended for theirchild. Included, you will find a helpful list of key questions to
ask and recommendations on how to best prepare.
Caroline Simard, MS, BCBA
From the Archives CoordinatorMy son, who has been diagnosed with
autism, has been struggling with
self-injury. His doctor is considering whether medication could help. What can
I do to prepare for this conversation?
Answered by Megan Atthowe, MSN, RN,
BCBAFirst, you should know that there is no medicationthat specifically treats autism. Medications approvedby the United States Food and Drug Administration(FDA) for other conditions can be useful only tolessen certain symptoms. That said, off-label use ofpharmaceuticals is by no means unique to autism andis common practice for many health conditions.
While research on the use of medications with individuals with autism is growing, our body ofknowledge is still limited. In addition, medications
affect every individual differently. Children can respond differently to medications as they grow anddevelop, so it is likely to take time to find the best
medication at the appropriate dose. In other words,
medication management is a highly individualized,

complex, and continual process. It is a good idea tobe prepared with the right information before yourvisit to your healthcare provider.
Second, you should know that if a child with autismshows a sudden onset of self-injurious behavior, it isurgent to rule out a medical explanation. The behavior may relate to pain from a medical issue (e.g., ear
infection, reflux, constipation, dental pain). Please
discuss this with your son’s health care provider.
Third, do you know how often the self-injurious behavior occurs and what function(s) it may serve foryour son? Frequency and/or intensity data, a specificdefinition of what the behavior looks like, and anunderstanding of the behavior's function will enable
your child's team to treat the behavior more effectively, and it is helpful to share this information with
Medication management is a highly
individualized, complex, and continual
process.

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havior reduction plan?

(Continued from page 9)

your son’s health care provider.
I encourage you to ask your son’s teachers to shareany information they have about the self-injurious
behavior with your healthcare provider. For example, your son’s teacher could provide the data gathered in the classroom for you to bring to your visit.
Note that he or she would need your consent to talkto your healthcare provider or to share any confidential information such as behavior data. If your son’s
educational team is not already collecting data on
this behavior, please ask them to start right away.

•

Is your son receiving other therapies (e.g., speechtherapy, physical therapy, occupational therapy)?
Are those providers collecting data and/or implementing coordinated behavior management strategies?

Research supports ABA as an effective intervention
for decreasing problem behaviors, such as selfinjury, as well as for teaching new skills to children
with autism. It is important to ensure that a qualified
behavior analyst is supervising all ABA interventions, as they must be implemented correctly to beeffective and safe. Your healthcare provider may beable to refer you to a local ABA provider, or you canfind a list of Board Certified Behavior Analysts(BCBAs) at the Behavior Analyst Certification
Board’s website.

If you have not been keeping track of the selfinjurious behavior at home, please start right away,even if there are only a few days until your visit. An
easy way to do this would be to use a calendar or
notebook. Record specifics about the incidents. You
can do this by describing the behavior, listing specif- Before your visit to the healthcare provider, prepare
ic triggers or antecedents that may have been present a list of names and doses of any medications your(i.e., what happened rightson takes, as well as any
before the behavior), reover-the-counter medicaResearch supports ABA as an effective
cording how long each epitions, vitamins, or other supintervention for decreasing problem
sode lasts, recording theplements. If your son retime of day they occur, andceives any therapies such as
behaviors, such as self-injury, as well as
indicating how you respondABA, speech therapy, etc.,
for teaching new skills to children withed to it. Your son’s teacher
share that information too.
autism.
likely has a form that you
The health care provider
can use and may have sugwill want to ensure that any
gestions on how to carry out
new medication is safe togood record taking. Include any recent changes intake and will not interact negatively with other medithe behavior you have noticed. It is difficult for anycations or therapies.
one to recall these details accurately, especially if the
If you and your healthcare provider decide to startbehavior happens frequently, so writing them down
your son on medication, decide beforehand what theright after the behavior occurs will help you sharegoal is for the course of the medication. How will
the most meaningful information you can with your
you know when the medication has been effective?
healthcare provider.
How will you know if it is ineffective? Be specific
In addition to writing down information about theand write the goal(s) down. Schedule a follow up
current levels of the behavior, be prepared to deappointment where you will check in with yourscribe how the school and your family are addressing healthcare provider on your son’s progress. He or
the behavior and how long that plan has been inshe may have specific suggestions about what typeplace. Some questions that would be helpful to conof data to keep.
sider include:
There are some important questions you should have
• Has your son’s educational team considered aanswered before you leave the medical office. Make
functional behavior assessment or used applied
sure you ask any questions you have and restate thebehavior analysis (ABA) to target the behavior?
doctor's recommendations; a responsible health careprovider will want to know you understand how to(Continued on page 11)• Does your child have an IEP (Individualized Education Program)? Does it include a formal beScience in Autism Treatment | Volume 15, Issue 1 | Winter 2018
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the medication, what should I do?

(Continued from page 10)

What should I do if I miss a dose?

use the new medication correctly.

•

Key Questions:

Although you did not mention if your son is on any
other medication, again, it would be important to ask
about any drug interactions that may occur. In addition, ask your health care provider to provide a notefor your son's school describing any new medication
or treatment. Teachers, therapists, and other members of the team should be informed to watch out forpotential side effects. There may also be other aspects of the self-injurious behavior to assess andtrack through ongoing data collection.

•

Have medical factors that may cause or worsen
self-injury been considered and ideally ruled out?

•

What is the name of the medication?

•

What is the medication used for?

•

When and how should I give it to my son, andhow much do I give?

•

Should I give this medication with food?

•

What desired effects should I expect to see?

•

What are the common side effects?

•

How long will it be until I notice the desired effects and side effects?

•

What side effects are serious, and what should I
do if I notice them?

•Will side effects lessen over time?

•

Are there any food or drinks I should avoid giving my son while he is on this medication?

•

If I decide that I would like to stop giving him

Finally, if you think of questions later, do not hesitate to call and ask your physician, nurse, or pharmacist. Please note that there is information about research related to medications on the ASAT website.
Please visit our ‘Treatment Summaries’ page on
medication for more details. Again, I encourage yourson’s team to conduct a functional behavior assessment and develop a formal behavior plan as needed
based on the assessment findings.
Megan Atthowe, MSN, RN, BCBA, LBA, is a registered nurse and behavior analyst who has worked
with people with autism and other special needs ineducational, home, and healthcare settings for over
15 years. She currently provides behavioral consultation and specialist services for students with autism
served in a public school district.

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Science in Autism Treatment | Volume 15, Issue 1 | Winter 2018
Page 12

Research Summaries
Atomoxetine, Parent Training and Their Combination in Children With Autism
Spectrum and ADHD.
&
Early Behavioral Intervention is Associated With Normalized Brain Activity in
Young Children With AutismIn this issue of SIAT, we summarize two studies. The first looks
at the effects of a non-stimulant medication on treating ADHD
symptoms in children with ADHD co-occurring with ASD. The
second looks at the impact of the Early Start Denver Model (ESDM),
a developmental behavioral intervention, on brain activity intoddlers with ASD. This ESDM study was already summarized in
our Summer 2017 newsletter. Here, it is summarized by a second
reviewer. We thought it might be interesting to see a second take on
an important article. As always, we hope the information is useful toyou.
Karen Fried, PsyD, BCBA-D
Research Synopses Co-Coordinator
Handen, B. L., Aman, M. G., Arnold, L. E.,
Hyman, S. L., Tumuluru, R., Lecavalier, L., . . . &Smith, T. (2015). Atomoxetine, parent training andtheir combination in children with autism
spectrum and ADHD. Journal of the American
Academy of Child and Adolescent Psychiatry, 54(11),905-915.

effectiveness of atomoxetine, a non-stimulant
medication for ADHD, in isolation and incombination with parent training for treating ADHD
symptoms in children with ADHD co-occurring with
ASD.

Reviewed by:
Jennifer A. Scalera, Seton Hall University

The researchers examined the individual andcombined effectiveness of atomoxetine andindividualized, one-on-one parent training for
ADHD symptoms and noncompliance in children
also diagnosed with ASD. All participants in the
study exhibited symptoms of overactivity and/or
inattention, and met criteria for ASD. 128 children(ages 5-14), both male and female, were randomly
assigned to one of four treatment groups:
atomoxetine alone, atomoxetine + parent training,
placebo + parent training, or placebo alone. The
study was conducted for 10 weeks across threedifferent sites. Families who were assigned to parent
training met with a clinician for 60-90 minutes
weekly, and sessions covered topics such as
preventing problem behaviors, reinforcement, timeout procedures, and planned ignoring. Medication
dosages were monitored/adjusted accordingly by thestudy medical providers, and families kept a daily

Why research this topic?
Observed in about one-third of cases, attention
deficit/hyperactivity disorder (ADHD) is one of themost common co-occurring conditions in children
with autism spectrum disorder (ASD). Previous
studies have demonstrated that children with ASD
are being treated for ADHD symptoms, often
accompanied by noncompliance, oppositional
behavior and irritability, using stimulant medication.
However, data show that the effectiveness rates ofstimulants in children with ADHD and ASD are well
below effectiveness rates in typically developingchildren with ADHD without ASD. In addition, side
effects to stimulants are four times higher in the
ASD population. The current study investigated theWhat did the researchers do?

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who disagree with the use of pharmacologicalintervention should investigate the possibility ofusing a psychosocial intervention such as parent
training for the treatment of co-occurring ADHD
symptoms.

medication log to assess medication compliance.
Parents and teachers completed behavior rating
scales prior to intervention to assess their child’s pretreatment symptoms and levels of noncomplianceand again at the completion of the intervention
Dawson, G., Jones, E. J., Merkle, K., Venema, K.,phase.
Lowy, R., Faja, S., . . . Webb, S. J. (2012). Early
behavioral intervention is associated with
What did the researchers find?
normalized brain activity in young children with
autism. Journal of the American Academy of Child
After concluding the study, researchers found thatand Adolescent Psychiatry, 51(11), 1150-1159.
atomoxetine was an effective, non-stimulant
treatment for ADHD symptoms in children with
Reviewed by:
ASD, though it was associated with decreased
Audrey Torricelli, Rutgers University
appetite and abdominal pain in some children. In
addition, parent training showed greater
effectiveness than placebo alone. Contrary to the
hypothesis of the researchers, the combination of
Why study this topic?
parent training and atomoxetine was no more
effective than atomoxetine alone. Since parent
The Early Start Denver Model (ESDM) is a
training alone was beneficial to the participants, isbehavioral intervention for toddlers diagnosed withcost efficient, and can be used in an outpatient
autism spectrum disorder (ASD). A previous
setting, it might be a viable treatment option for
randomized control trial demonstrated that children
children with ASD and ADHD symptoms whose
who received EDSM for two years improved in IQ,
parents are not interested in pharmacologicallanguage, adaptive behavior, and ASD diagnosis
treatment.
compared to children who received a morecommonly available community intervention. The
What are the strengths and limitations of thisresearchers of the current study were interested instudy?
how early intervention with ESDM can alter the
trajectory of brain development. They hypothesizedThis study was the first to investigate the separatethat the lack of affective and social engagement inand combined effects of a non-stimulant medication
children with ASD may hinder behavioral and brain
and a psychosocial intervention on the treatment ofdevelopment, and that increasing such engagement
ADHD symptoms and noncompliance in children
through early intervention could lead to a morewith ADHD and ASD through a large sample,
typical trajectory of brain development.
double-blind, group design. Limitations of the study
included a lack of ethnic and cultural diversity of the What did the researcher do?
participants, reliance on parent rating scales insteadof data-based observations of behavior and the
The researchers recruited young children with aparent training intervention being limited to only adiagnosis of ASD or Pervasive Developmental
10-week trial.
Disorder (PDD) as well as age-matched typicallydeveloping peers. The children with ASD were
What do the results mean?
randomly assigned into either the ESDM group or acommunity intervention (CI) group. ESDM is a
Overall, based on the results of the study, thetreatment that combines developmental and appliedresearchers suggest that the use of the non-stimulant
behavior analysis strategies and that involves trained
medication, atomoxetine, may be a viable alternative therapists – with experienced PhD-level supervisors
to stimulant medication in the treatment of ADHD
– following a manual and curriculum providing 4
symptoms in children with a diagnosis of ASD. In
hours of intervention twice a day, five days a week,
addition, because the results showed benefits fromfor two years, with additional parent training. The CI
parent training alone, parents of children with ASD(Continued on page 15)
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group received comprehensive diagnostic
evaluations with intervention recommendations,community referrals, and other resources. The
researchers also used behavioral measures like theAutism Diagnostic Interview (ADI)-Revised, theAutism Diagnostic Observation Schedule (ADOS),
the Mullen Scales of Early Learning (MSEL), theVineland Scales of Adaptive Behavior, and thePervasive Developmental Disorder Behavior
Inventory (PDDBI) before and after the intervention
to assess ASD symptoms and adaptive skills. All
child participants in the study also underwent
electroencephalography (EEG) observation, with
60% of the participants providing artifact-free (i.e.,
useable) data. Artifacts were caused primarily byexcessive movement or inability to comply with theprocedure. During the EEG procedure, children
observed unique color photographs of toys anddiverse female faces presented randomly on a screen.
Researchers were interested in the neural activity inseveral brain areas while participants engaged in thetask.
What did the researchers find?

The researchers found group differences in thecentral and anterior brain regions of participants
when looking at people as compared to objects. The
ESDM and typically developing groups showed
greater cortical activation for and faster attention to
faces, whereas the CI group showed greater
activation for and faster attention to objects. These
results did not differ by age. While ESDM andtypical groups did not differ from one another, the
ESDM and CI groups did differ. The researchers also

found that ESDM children who provided usable
EEG data demonstrated improved autism symptoms,
higher verbal and nonverbal IQ, better adaptive
skills, and more social behavior with intervention.
Greater attention to faces in the ASD groups (ESDM
and CI) during the EEG task was correlated with
better social communication abilities, and greater
brain activation was correlated with fewer social
pragmatic problems (like understanding social
convention and initiating social interactions).
What were the strengths and limitations of thestudy? What do the results mean?

The authors suggest that children with ASD may
have a delay in developing expertise for faceacquisition, but that high rates of intervention canhelp these children acquire the face-processing
abilities of their typically developing peers. This
study supports the effectiveness of the ESDM modelin developing social attention engagement, as
evidenced on both the neural and behavioral levels.
There are some limitations to this study: Only about
60% of children with ASD provided artifact-free
EEG data, which limits the strength of the study’s
conclusions and its applicability to a wide range ofchildren with ASD. Additionally, there was only one
time point for EEG measurements; having a pre- andpost-intervention design would enable researchers to
examine to what degree changes may be attributable
to the intervention. Finally, larger samples areneeded, and the strength of these findings needs tobe verified through replication. Even so, this study
suggests that early interventions may have a positiveeffect on the social development of children with
ASD.

Science in Autism Treatment | Volume 15, Issue 1 | Winter 2018
Page 15

ASAT Participates in Victoria Autism Expo
Franca Pastro, BA

T

he Victoria Autism Expo in British Columbia,
Canada, was held on February 3rd, with a great
turn out of parents, grandparents and professionals
attending. It was an emotional experience for me to meetso many parents and family members who had their own
individual stories to share. These stories not only showed
their strong commitment to helping their children
diagnosed with autism, but also their frustration andconfusion in trying to navigate through the overwhelming
myriad of information about therapies and services. This
experience made me even more passionate about thework we do at ASAT. It further reinforced my belief inthe value of ASAT's resources to these individuals.
Board Member and Perspectives Coordinator,
Franca Pastro at the Fair representing ASAT.

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Science in Autism Treatment Team

Elena M. Escalona, MSEd

Caroline Simard, MS, BCBA

Sarah Treadaway, MEd, BCBA
LayoutDaniela Fazzio, PhD, BCBA-D

Kelley L. Harrison, MA, BCBA

Science in Autism Treatment | Volume 15, Issue 1 | Winter 2018
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Media Watch Featured Letter
ASAT Responds to The Inquirer’s, “Falling Off the Cliff”
Mary Jane Weiss, PhD, BCBA-D
Maggie Haag, LSW
Rita M. Gardner, MPH, LABA, BCBA

Through our Media Watch initiative, we provide written
feedback to journalists and other media professionals who write
about autism and its treatment. We strive to acknowledge theefforts of those individuals responsible for educating the publicwith sound, accurate information. When an autism intervention
is portrayed inaccurately, we provide feedback to encouragecorrection and suggest consideration when writing future
articles. In this issue we feature a letter to The Inquirer about
services for individuals with disabilities post school-age. You
can check all past letters here: www.asatonline.org/for-mediaprofessionals/media-watch/.
Renee Wozniak, PhD, BCBA-D, LBA
Media Watch LeadD

ear Ms. Polaneczky,

In response to your four-part series titled “Falling Off the Cliff,” that was recently published in The
Inquirer, we would like to share our feedback regarding several main points of your article. You
highlighted important experiences of adults with disabilities and their families, including the long wait list
for funding resources for adults in Pennsylvania, the barriers that occur when school-aged entitlements end
and the Adult Services system begins, and the need for better trained and better paid direct support staff, toname a few.
While we emphatically agree with all of these points, and are equally concerned about the difficulties that are
faced by adults with disabilities and their caregivers, we also feel it is important to point out that there is abody of literature that exists to inform the field of how to address many of these issues, including staff
training, professional development, and transition services for students with disabilities, that should be
adopted as industry standards. Additionally, there are federally funded programs of which all school districts
need to be aware to support the transition process for their students as outlined below.
Your article rightfully points out the perils of adults with disabilities and their families when school-aged
entitlements end. However, it is important to note that the ending of these entitlements can be planned forwith appropriate attention to transitional needs. The Federal law, entitled Individuals with Disabilities
Education Act (IDEA) [1], requires schools to provide transition planning for students with disabilities.
IDEA “includes instruction, related services, community experiences, the development of employment andother post-school adult living objectives, and, when appropriate, acquisition of daily living skills andfunctional vocational evaluation” (IDEA, 2004). Furthermore, research supports practices that aid in
successful transition services for students, including use of scientifically-based strategies to promoteindependence (Schall, Wehman, & McDonough, 2012). Providing students with the skills necessary for
adulthood can decrease the crisis families face as they wait for access to funding. Additionally, school(Continued on page 19)

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districts becoming educated on the funding options for adults with disabilities to help families prepare is
critical, including not only an understanding of Medicaid Waiver options, but also Vocational Rehabilitation
funding [2]. This requires that PA school districts provide educational services to students with disabilities
that give each student the opportunity to make meaningful and “appropriately ambitious” progress as
indicated in the recent Supreme Court decision Endrew F.v. Douglas County School District during their IEP
years. The absolute best preparation for a meaningful life starts with providing an exceptional education for
all children [3].
Your article also discusses the challenges of “finding good help,” and the low wages of the direct support
staff. While we support the need for a better-paid work force, it is important to point out that it will takemore than better pay to have a highly skilled workforce, in addition to the professional career path you
wisely point out is missing in many organizations. Better education, credentials, training and supervision for
direct support staff, and more training and support for front line managers, are critical to improve the qualityof care for adults with disabilities. Fortunately, there is sound research supporting best practices in staff
training and supervision. Ensuring employees have been trained to competency on their job responsibilities isa very important process in direct care staff training (Reid, Parsons & Green, 1989; Chok, Shlesinger, Studer,& Bird, 2013), however, traditional classroom-based training has been shown to be ineffective by itself(Fleming & Sulzer-Azaroff, 1989). Research indicates that classroom-based training, such as lectures andpresentation of written material, is not effective in permanently changing or improving workplace behaviors(Alavosius & Sulzer-Azaroff, 1990), yet many organizations continue to use didactic, classroom training
with little generalization to on-the-job work skills (Parsons, Rollyson, & Reid, 2012). While training usingpresentations and written materials can increase knowledge in certain areas, and can be important for certain
knowledge requirements, it does not typically increase performance in targeted skills, which is the biggest
need area for direct support staff (Parsons, Rollyson, & Reid, 2012). Skill-based competency training that
includes modeling and performance feedback is necessary for effectively teaching skills (Roscoe, Fisher,
Glover, & Volkert, 2006; Maguire, Weiss, & Bird, 2015). More support and funding for human services
organizations to implement effective staff training, professional development, and management systems are
critical for quality service delivery and prevention of serious incidents, and can decrease the amount of
resources devoted to investigating these types of incidents after it has already happened. It is a more effective
use of resources to develop high quality services to prevent poor, and in some cases tragic, outcomes, thanmoney spent after these serious incidents occur.
In conclusion, your article highlighted important experiences of families and adults with disabilities thatcannot be discounted. Further, you discussed important areas of need within the field of Human Services thatare not currently being effectively addressed, but that certainly have the capacity to be addressed given thebreadth of literature related to these issues. It cannot fall on one service system to address these enormous
needs, and all service systems need to work together to ensure student and adult needs are adequately
addressed, starting at the beginning of service delivery. Falling off of a services cliff is not an inevitableoutcome for adults with disabilities and their families. Appropriate planning and preparation for adulthoodcan help to prevent these types of crises from occurring.
Sincerely,
Mary Jane Weiss, Ph.D. BCBA-D
Maggie Haag, LSW
Lifespan Content Co-Coordinators, ASAT
& Rita M. Gardner, M.P.H., LABA, BCB* References available on the website: www.asatonline.org/media-watch/asat-responds-inquirers-falling-offcliff/
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Is There Science Behind That?
Autism and Treatment with DIR/FloorTime
Robert K. Ross, EdD, BCBA-D, LABA
Beacon ABA Services of MA and CT
Kelley L. Harrison, MA, BCBA, LBA-KS
Thomas Zane, PhD, BCBA-D
Department of Applied Behavioral Science, University of KansasResearch has repeatedly demonstrated the benefits of early intensive behavioral intervention (EIBI) for children diagnosed with autism spectrum disorders (ASD; e.g., Lovaas 1993).
Behavior therapists who provide EIBI often work insettings where a multi-disciplinary approach to treatment is used. It is not uncommon for behavior therapists to collaborate with colleagues from other disciplines (e.g., speech and language, physical therapy,
occupational therapy). Although the multidisciplinary approach can be beneficial, it may be
detrimental if the proposed treatment in addition to
EIBI is provided for multiple hours on a daily basis,as this can diminish available time for EIBI treatment. One increasingly popular approach to working
with children with autism is the Developmental, Individual Difference, Relationship-based/Floortime(i.e., DIR/Floortime) model.
What is the conceptual link between ASD and
DIR/Floortime?
The DIR/Floortime model was developed by Dr.
Stanley Greenspan and Dr. Serena Weider(Greenspan & Wieder, 1999). It is based on a hypothesis that ASD is acquired as a result of a child’s
early environment not providing specific kinds ofemotional nurturing. This leads to them missing one
or more of the six hypothesized emotional developmental milestones. DIR is described by proponents
as a child directed “process or concept, throughwhich therapists, parents, and other caregivers makea special effort to tailor interactions to meet the childat his unique functional developmental level andwithin the context of his processing differences” (Hess, 2009). It considers the “Developmentof functional emotional capacities, Individual processing differences, and the parent or caregiver-child
Relationship” to create new learning opportunities
and centers around circles of communication. A circle of communication involves two participants who
respond to each other verbally or nonverbally(Dionne & Martini, 2011). DIR
proposes six
developmental
milestones thatcreate the foundation for achild’s learningand development. Specifically, the milestones are 1)
self-regulation
or interest in theworld, 2) engagement and relating, 3) two-way intentional communication, 4) purposeful complex
problem solving communication, 5) creating andelaborating ideas, and 6) building bridges between
ideas (Wieder & Greenspan 2003).
Each milestone increases the length and complexityof the circle of communication. Floortime is the intervention technique used to facilitate mastery of the
DIR developmental milestones. Specifically, Floortime involves guiding the child through the developmental milestones by following the child’s leadthrough play. That is, the therapist or caregiver willbuild on the child’s current skills to create more
complex circles of communication. Proponents of
Floortime suggest it facilitates generalization because each interactive circle of communication iscreated in a natural environment. Additionally, family involvement is a large component of Floortime,again to facilitate generalization (Dionne & Martini,2011). Proponents recommend that DIR/Floortime
be implemented in 20-minute blocks of time for six
to ten sessions per day.
Is there any research to support Floortime?
Currently, research is limited on the use of Floortime

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In 2007, Solomon, Necheles, Ferch, and Bruckman
evaluated the effects of parents using the DIR/
to treat ASD (National Research Council, 2001). Ad- Floortime model with 68 children over an 8-12 monthditionally, the available research findings lack empiri- period. Floortime was delivered 15 hours per week.
cal validity (i.e., the experimental rigor of the availaTreatment outcomes were determined using blind
ble research is weak). In general, Floortime studies
focus on training parents and therapist to implement raters who scored videos of each child before and afFloortime interventions and evaluating the fidelity of ter treatment using the FEAS (again no standardized
the training on the interventions (e.g., Solomon, Van measures of development were assessed). Results
suggested 45% of the children made good to very
Egeren, Mahoney, Quon Huber, & Zimmerman,2014). Although many of the studies look at changes good functional developmental progress on thein the hypothesized milestones developed by Green- FEAS. However, much like Greenspan and Wieder
span and colleagues, to date none of the studies have (1997), Solomon and colleagues (2007) were lacking
a control group and used a subjective measuring tool.
evaluated the effects of Floortime on standardized
Additionally, many of the participants in this study
measures of development or language. The studies
were simultaneously enrolled in other early educahave additional concerns. For example, one of thefirst studies to evaluate Floortime as an intervention tional programs. Therefore, it is unclear whether thefor children with ASD was completed by Greenspan increase in functional development should be attributed to Floortime or other outside educational pro& Wieder in 1997. These authors retrospectively
grams.
evaluated the charts of 200 children ages 22 to 48
months, who were diagnosed with ASD or pervasive
developmental disorder not otherwise specified (PDD In 2011, Dionne and Martini attempted to control for-NOS). All children were provided the Floortime in- several of the limitations present in previous researchby evaluating Floortime using a single-subject AB
tervention for two to five hours per day for two or
more years by family or professionals. Outcomes of design with one boy age 3 years and 6 months with athe intervention were determined using parental and diagnosis of autism. During Phase A (observation),therapist report to complete the Functional Emotional the parent simply interacted with the child naturally
Assessment Scale (FEAS), a nonstandardized obser- and did not implement Floortime. During Phase B(intervention), Floortime was implemented by thevation tool created by Greenspan and Wieder to assess the emotional functioning of a child based on the parent. Phase A and Phase B were completed back-to
six developmental milestones that guide treatment in -back a total of 28 times. Two blind observers
watched 20 minutes of each phase for all 28 sessions
DIR. Greenspan and Wieder suggested 58% of thechildren had “good to outstanding” outcomes. That is, and coded the number of circles of communication
during each phase. Results were evaluated using visu58% of the children demonstrated 50 spontaneousal analysis as well as statistical analysis. The authorscircles of communication, mastered all six mileconcluded that the results of the visual analysis
stones, and created or participated in pretend playdemonstrated great variability in the number of cir(Greenspan & Wieder, 1997). These results may atfirst glance seem promising; however, the lack of ex- cles of communication observed during Phase A andperimental control, experimenter bias, and use of non Phase B, making a trend difficult to determine. However, there was a slight increase in the number of cir-standard measures greatly limits these findings.
First, all outcomes were based on information found cles of communication observed during Phase B as
compared to Phase A. Additionally, a statistical analin a child’s chart (i.e., therapist and parental report)
as opposed to direct observation. Second, a subjective ysis of the number of circles of communication in
Phase A as compared to Phase B showed a significant
observational tool was used to determine treatment
outcomes. Both the reliance on anecdotal report and increase during Phase B as compared with Phase A.
Although the use of the AB design increases experithe use of a subjective observational tool allow for
results to be greatly affected by biases. Third, the au- mental control as compared to previous research, it isstill extremely limited because the results were neverthors do not clearly describe the comparison group
replicated either with the current participant or acrossthat was meant to serve as a control. Therefore, it isother participants. Therefore, additional research that
unclear if any treatment gains on standardized
evaluates the effects of Floortime on standardized
measures of development and language actually occurred due to the Floortime treatment.
(Continued on page 22)(Continued from page 20)

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experimental control and empirical validity and objective measurement of treatment effects. Therefore,
measures of development and language is still needed future research is needed to evaluate the efficacy of
to determine if the Floortime treatment model has any DIR/Floortime as a treatment for children with ASD.
significant impacts on the core diagnostic features of One major barrier to evaluating DIR/Floortime as a
ASD, particularly when compared to treatments that treatment is the subjectivity of the treatment itself.
have already been shown to have such effects. Pajar- Currently, operational definitions/descriptions of botheya and Nopmaneejumruslers (2011) conducted what the procedures and the outcome measures are lacking
they described as a pilot study to assess the extent (if and are inherently subjective, making replicating ofany) to which DIR/Floortime would enhance client
identical procedures almost impossible. However, if
outcomes of children with autism who were already more objective procedures could be identified, more
involved in other clinical interventions. The research- research like Dionne and Martini (2011) may lend
ers trained parents to conduct the treatment. Two
information on the effects of DIR/Floortime as agroups of participants were involved – both groups
treatment for ASD. Specifically, future researchwere already receiving one-to-one behavioral treatshould continue to utilize the within-subject researchment (discrete trial teaching); the experimental group design to control for individual differences across
supplemented that treatment with DIR/Floortime
participants and continue to measure results by colhours. The experimental design was pre/post test (or lecting data on the effects of observable behaviors
AB), with global assessments being made at the start such as circles of communication or standardized
and end of the experiment. The results showed a sig- measures of learner development. Additionally, funificant improvement in scores in the children who
ture research should replicate results both within andwere treated by both DIR/Floortime and behavioral
across participants. Finally, future research may coninterventions. However, there were several methodo- sider replicating results using different populations
logical flaws that suggest skepticism in any causal
such as different age groups or different severities ofrelationship between DIR/Floortime and a reduction delay as well as replicating results when treatment is
in autistic symptomology. First, there is the obvious delivered by trained therapists or caregivers.
influence of behavioral treatment in the group of chilConcerns with the DIR/Floortime Model
dren receiving DIR/Floortime. Second, the authors
admitted that some of the parents of these children
had to be taught how to play with their children, irre- Floortime may seem like an attractive treatment on
the surface. For example, following a child’s lead raspective of the DIR/Floortime procedures. Third,
there was no direct observation check on the fidelity ther than directing or controlling them as some perof the parents implementing the DIR/Floortime pro- ceive to be the case in applied-behavior-analytic
cedures. That is, there is no proof that parents actual- based treatment may appear more progressive. Howly implemented the Floortime procedures as required. ever, inherent in the model are several concerns.
First, Greenspan explicitly warns against rigidity andIn a related study, Solomon and colleagues (2014)
repetitive routines, instead encouraging variability ofrecently investigated the impact of DIR-type procedures when training parents to implement with their teacher behavior. For learners whose strengths are inyoung children diagnosed with autism. Mixed results creating and learning from routine, DIR/Floortime
were obtained, with the strongest data showing supe- may be frustrating or confusing. Procedures such asriority of DIR coming from changes in scores on the those modeled by Dr. Greenspan in a video training
series (Floortime DVD Training Guide) can also poAutism Diagnostic Observation Schedule-Generic(ADOS-G). However, there were several limitations tentially cause greater levels of problem behavior or
shape progressively lower levels of response effort inwith this research, including the use of statisticalanalyses as opposed to direct observation of behavior, communication and in skills due to how those behavuse of self-report survey data of questionable reliabil- iors access reinforcement over time. Second, propoity and validity, and a lack of verification that parents nents of the DIR/Floortime model often cite the factthat they “follow the child’s lead” rather than require
actually implemented the required protocols.
“compliance” to adult directions (Greenspan & Wieder, 2009). This is described as preferable because it
Future Researchallows for more creativity and flexibility on the partThe current research on DIR/Floortime is lacking in(Continued on page 23)(Continued from page 21)

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ported for ASD.

(Continued from page 22)of the child and teacher. This lack of formal structure
is reputed to be “good” for children, and in particular
for children with ASD as it addresses their reported
tendencies toward rigidity of routine. However, in aschool, one of the most critical skills needed in achild’s repertoire is the ability to follow the direction(lead) of the teacher. Children who do not respond to
the teacher’s directions and remain on their own
agenda are unlikely to be successful in a classroom
environment. To date, no studies have shown a correlation between correct implementation of Floortimeand success in a regular education setting. Third, the
DIR/Floortime interaction style of following thechild’s lead can result in the child practicing playskills that are non-functional and inappropriate. Dr.
Greenspan in Engaging Autism repeats the mantrathat “Floortime is not about doing the right or wrong
thing,” “There is no right or wrong answer,” and“Vary what you do” (p. 181-185). This approach islikely to interfere with any program that attempts toestablish specific functional play skills.
What is the bottom line?

References

Dionne, M., & Martini, R. (2011). Floortime playwith a child with autism: A single-subject study.
Canadian Journal of Occupational Therapy, 78(3), 196-203.
Greenspan, S. I., & Wieder, S. (1997). Developmental patterns and outcomes in infants and children
with disorders in relating and communicating: A
chart review of 200 cases of children with autistic
spectrum diagnoses. Journal of Developmental
and Learning Disorders, 1, 87-141.
Greenspan, S. I., & Wieder, S. (1999). A functional
developmental approach to autism spectrum disorders. The Journal of the Association for Persons
with Severe Handicaps, 24(3), 147-161.
Greenspan, S. I., & Wieder, S. (2009). Engaging autism: Using the Floortime approach to help children relate, communicate, and think. Philadelphia,
PA: A Merloyd Lawrence Book.

Hess, E.B. (2009). Floortime: A play intervention for
Currently, DIR/Floortime simply does not meet thechildren with autism. California APT Newsletter,basic standards of care for use as a treatment inter16-19.
vention. Specifically, there is little to no objective
evidence of effectiveness. No one has demonstrated Lovaas, O. I. (1993). The development of a treatmentthat results can be replicated across a range of chil-research project for developmentally disabled anddren with ASD. And, no one has demonstrated reliaautistic children. Journal of Applied Behavior
ble implementation of treatment procedures because
Analysis, 26(4), 617-630.
treatment procedures are individualized based on thechild’s behavior during treatment. Finally measureNational Research Council, Division of Behavioral
ment of treatment effects has been limited to evaluaand Social Sciences and Education, Committee ontions of DIR/Floortime procedures and effects on the
Educational Interventions for Children with AuDIR/Floortime created measures (Functional Emotism (2001). Educating children with autism.
tional levels) rather than standardized assessments ofWashington, DC: National Academy Press.
development and language.
Pajareya, K., & Nopmaneejumruslers, K. (2011). A
On the contrary, there is objective evidence of thepilot randomized controlled trial of DIR/
effectiveness of EIBI (e.g., Lovaas 1993) that has
FloortimeTM parent training intervention for prebeen replicated across a wide range of children withschool children with autistic spectrum disorders.
ASD and can be reliably implemented while still inAutism, 15(5), 563-577.
dividualized to the child’s specific needs. Because
DIR/Floortime is a time consuming treatment (i.e., it Solomon, R., Nechels, J., Ferch, C., & Bruckman, D.
is recommended that Floortime be implemented at(2007). Pilot study of a parent training program forleast 20 hours a week), it may be detrimental to imyoung children with autism: The PLAY Projectplement DIR/Floortime as a treatment for ASD as it
Home Consultation program. Autism, 11(3), 205greatly decreases the amount of time the child can be224.
exposed to EIBI, a treatment that is empirically sup(Continued on page 24)
Science in Autism Treatment | Volume 15, Issue 1 | Winter 2018
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ASAT
Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment(Continued from page 23)

Solomon, R., Van Egeren, L. A., Mahoney, G., Quon Huber, M. S., & Zimmerna, P. (2014). PLAY projecthome consultation intervention program for young children with autism spectrum disorders: A randomized controlled trial. Journal of Developmental Behavioral Pediatrics, 35(8), 475-485.
Wieder, S., & Greenspan, S. I. (2003). Climbing the symbolic ladder in the DIR model through floortime/interactive play. Autism, 7(4), 425-435.

How ASAT Supports
An Update on our “How ASAT supports ______” Column
David Celiberti, PhD, BCBA-D, Executive DirectorAs our readers know from prior issues, we launched a series of articles early last year that showcases the
myriad ways that ASAT supports key groups within the autism community. We invite our readers toshare links to these articles as they are published.

To date, we have published three such articles:
How ASAT supports behavior analysts
How ASAT supports teaching faculty members (Summer 2017 issue)
How ASAT supports parents of older children and adults with ASD (Fall 2017 issue)

In 2018 and early 2019, we plan to publish the following:
How ASAT supports members of the journalism community (Summer 2018)
How ASAT supports center-based programs (Fall 2018)
How ASAT supports special education and general education teachers (Winter 2019)
How ASAT supports speech pathologists (Spring 2019)

Thereafter, this series of article will highlight:
How ASAT supports pediatricians and medical providers
How ASAT supports parents of newly diagnosed children with autism
How ASAT supports occupational therapists
Science in Autism Treatment | Volume 15, Issue 1 | Winter 2018
Page 24

ASAT
Liaisons, Coordinators, Externs, & Other Committee Members

In addition to our Advisory Board, a number of Coordinators, Externs, and other Volunteers lend their time and talents to support ASAT's mission and initiatives. These
are our helping hands:
Advisory Board Liaison
Allison Parker, MA, BCBA

Website Content Co-Coordinator
Sunita Chhatwani, MSc, MEd————————————————Media Watch Coordinator
Erin Leif, PhD, BCBA-D

Faculty Liaison
Amanda Guld, PhD, BCBA-D

Fundraising Coordinator
Catherine Rooney, BA, BCaBAMedia Watch Writers
Emily H. Callahan, PhD, BCBA-D
Justin DiScalfani, PhD, BCBA-D
Deborah Finkelstein, MADS, BCBA
Anya K. Silver, MA, BCBA
Chris E. Smith, PhD, BCBA-D

Grant Research Coordinator
Carolyn Sniezyk, MS, BCBA
International Dissemination
Coordinator
Maithri Sivaraman, MSc, BCBA
Lifespan Content Co-Coordinators
Mary Jane Weiss, PhD, BCBA-D
Maggie Haag, LSW
Newsletter Content
Coordinator
Caroline Simard, MS, BCBA
Social Media Coordinator
Alice Bravo, MEd, BCBA
Sponsorship Co-Coordinators
Melissa Taylor, BCaBAMay Chrisline Beaubrun, MEd, BCBA
Subscriptions Coordinator
Elena M. Escalona, MSEd
Treatment Summaries Co-Coordinators
Helen Bloomer, MS, BCBA, LBA
Laurent Schnell, PhD, BCBA————————————————–—
Externship Co-Coordinators
Amanda Bueno dos Santos, BS, BCaBA
Allison Parker, MA, BCBA
Lori Bechner, MA, BCBA
Current Externs
Sam Blanco, PhD, LBA, BCBA
Amanda Bueno dos Santos, BS, BCaBA
Elena M. Escalona, MSEd
Elise Geither, PhD
Karrie Lindeman, EdD, SBL, BCBA-D
Aubrey Miller, BS
Uma Patil (High school student)
Laura Shay, MEd, SLPA
Brizida Vinjau, MS, BCBA

For more information about ourExternship program, please see:www.asatonline.org/description-applicationprocess/#externshipThank You!
Science in Autism Treatment | Volume 15, Issue 1 | Winter 2018
Page 25

OUR REAL SCIENCE, REAL HOPE
PROFESSIONAL SPONSORSHIP INITIATIVE
Does Your Agency Share
ASAT’s Values?
ASAT believes that
individuals with autism havethe right to effective
treatments that are
scientifically-demonstrated tomake meaningful, positivechange in their lives.
We believe that it should not
be so challenging for families
to find accurate information
about the efficacy of various
autism interventions. ASAT
works toward a time when: All families will beempowered with skills in
identifying and choosing themost effective, scientifically-validated interventions fortheir child.
 The media will educate andnot confuse parents byproviding accurate
information and asking theright questions.
 All providers will be guided
by science when selecting
and implementing
interventions and use data
to demonstrateeffectiveness.

What It Means to Be a
Sponsor:
ASAT’s Sponsors indicate
their support of the following
tenets:1. All treatments forindividuals with autism
should be guided by the best
available scientificinformation.
2. Service providers have a
responsibility to rely on
science-based treatments.
3. Service providers shouldtake steps necessary to help
consumers differentiate
between scientificallyvalidated treatments andtreatments that lackscientific validation.
4. Consumers should be
informed that any
treatment lacking scientificsupport should be pursued
with great caution.
5. Objective data should be
used when making clinicaldecisions.

Become a Sponsor Now!
These sponsorships not only
provide financial support used
specifically for our
dissemination efforts, but also
send a clear message that
ASAT's vision is shared byothers within the professional
community.
The tasks of educating the
public about scientificallyvalidated intervention andcountering pseudoscience aredaunting ones, and ASAT
appreciates the support of allof our sponsors.

Please visit our
website to learn about
the SponsorshipBenefits for
Sustaining, Partner,
Champion,
Benefactor, Allianceand Patron levels:
www.asatonline.org/
direct-financialsupport/

IMPORTANT DISCLAIMER: ASAT has no formal relationship with any of the sponsor organizations. Furthermore, their stated endorsement of the above
tenets is not verified or monitored by ASAT. Although ASAT expects that all sponsoring organizations will act in accordance with the above statements, ASAT
does not assume responsibility for ensuring that sponsoring organizations engage in behavior that is consistently congruent with the statements above.

Science in Autism Treatment | Volume 15, Issue 1 | Winter 2018
Page 26

Our Professional Sponsors
We thank our 2017 and 2018 sponsors for their generous support of ASAT’s mission and initiatives todisseminate science in autism treatment. Please click on the names to access their webpages.
PARTNER $5,000
Pacific Autism Learning Services
SUPPORTING STAR $3,500
Autism New Jersey
CentralReach
Monarch House
CHAMPION $2,000
ACE ABA Software System
Autism Partnership Foundation
Coyne and Associates
Eden II Programs
Lovaas Midwest
Melmark New England
Melmark Pennsylvania
Summit Center
BENEFACTOR $1,000
Accelerations Educational Software
Alcanzando
Behavior Analysis Online
Behavior Development Solutions
Crossroads
Different Roads to Learning ($1,500)
Geneva Centre
New Direction ABA
Preparing Adolescents and Adults for Life
Rethink
Step by Step Learning Group
Therapeutic Pathways, Inc.
Total Spectrum
Verbal Beginnings
ZABA Therapy
ALLIANCE $500
Behavior Analysis Center for Autism
Breakthrough Autism
EPIC
Garden Academy
Hybridge Learning Group
Nassau Suffolk Services for Autism
Quality Services for the Autism Community

Southwest Autism Research and Resource Center
STE Consultants
Virginia Institute of Autism

PATRON $200

Applied Behavior Analysis Center
Access Behavior Analysis
Alpine Learning Group
ASAP– A Step Ahead Program LLC
Asperger Syndrome and High Functioning
Autism Association (AHA), Inc.
Autism Awareness Australia
Autism Early Intervention Clinics
Autism Intervention Services
Autism Wellbeing
ABATestPrep.com
Beanstalk Child Psychology
Behavior Analysis Center for Autism
Behavior Therapy Associates
Behavioral Directions LLC
BIA
Breakthrough Learning Group
Bright Eyes Early Intervention
Child Study Center of Fort Worth
Dower and Associates
ELIJA ($250)
Gary Mayerson & Associates
Gold Coast Children’s Center, LLC
Hugo Science Press / DTT Manual
Institute for Educational Achievement
Kansas City Autism Training Center
Lizard Children’s Learning Centre
Milestones Behavioral Services
New York Center for Autism Charter School
PALS Autism Society School Program
Pyramid Educational Consultants, Inc.
Reaching Potentials
SKF Books
Somerset Hills
Wirth Behavioural Health Services

DISCLAIMER: ASAT has no formal relationship with any of the sponsor organizations. Furthermore, their stated endorsement of the above tenets is not verified or monitored by
ASAT. Although ASAT expects that all sponsoring organizations will act in accordance with the above statements, ASAT does not assume responsibility for ensuring that sponsoringorganizations engage in behavior that is consistently congruent with the statements above.

Science in Autism Treatment | Volume 15, Issue 1 | Winter 2018
Page 27

Donor Wall 2017

In addition to our entire Board of Directors, we acknowledge the following 2017 donors. Without
their support our important work could not be carried out.

Benefactor $1,000 – $1,999
Peter and Karen Young
Kathryn Dobel
Eric Lane
Alliance $500 - $999
Phyllis Freidt1
Sara Stojkvic
Ali and Bernie Webb
Patron $100 - $499
Girish Chhatwani2
Cheryl Davis
Eduardo Gonzalez
Gina Green
William Heward
Joyce Mauk
Mary McDonald
Leandra Stoeckley
Kelly Windsor1
Mike and Kelly Windsor
Alice Walkup

Friend | $1-$100
Nina Adelson-Yan
Krista Armbruster
Marin Askins
Marina Azimova
Robert A Babcock
Susan Bardet
Alejandra Barerra
Ken Bateman
Dana Battaglia
Tanya Baynham
Patricia M Berezny
Susan Bergman
Laura Betters
Gordon Bourland
Alice Bravo
Marlene Breitenbach
Cindy Brylinsky
Kelly Bussiere
Nicole Cammarota
Guadalupe Castaneda
Douglas & Josette Celiberti7

Philip Coffey
Susan Copeland
Catherine Cote
Helen Culhane McCarthy
Michael Cummins3
David Diosi
Corrine Donley
Leslie Feinberg
Harriet Fitzpatrick
Richard Foxx
Maureen Gallagher
Maggie Grace
James Grochowski
Ann Halliday
Marie Halliday1
Bethany Halliday Vana
Michael Houston
KC Jackson
Amanda Kelly
Jessica Krakower
Pamela Lameiras

In honor of:
1.Peggy Halliday
2.Sunita Chhatwani
3.Kara Brooklier
4.Sabrina Freeman and Isaac Tamir
5.Serena Costacurta
6.Laura Shay

Robert LaRue
Hillary Letourrneau
Bennett Leventhal
Shannon Lewis
Erik Lovaas
Jane McCabe
Luke McCannell
John McElwees
Janet Morrison
Julian Nancy
Cindie Neilson
Renee NeriAmy Oakes
Chrissy O’Brien
Allison Parker
Diana Parisy
Kristine Quinby
Kenneth Reeve
James Rodgers
David Rourke
Brett Russell

Angela Saturno
Evan Scott
Beverley Sharpe4
Caroline Simard
Veronica Sommariva5
Julie Stackpole-Barry
Linda Strand
John Streyle
Danielle Tarantino
David Tornabene
Rachel Trotta6
Steve Trumbull
Katherine Vanpage
Mary Walsh
Nancy Walton
Barbara Weber
Nicole Weingart
Patricia WrightJohn YoungRS Precision Industries, Inc.

In Memory of:
7. Ann, Jim, & Carol Celiberti