Excerpted from Chapter 1 of Autism Spectrum Disorders: A Transactional Developmental Perspective, edited by Amy M. Wetherby, Ph.D., & Barry M. Prizant, Ph.D.

Copyright © 2000 by Paul H. Brookes Publishing Co. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

The terms autism spectrum disorders (ASDs) and pervasive developmental disorders (PDDs) currently are used synonymously to refer to a wide spectrum of neurodevelopmental disorders that have three core features: impairments in social interaction, impairments in verbal and nonverbal communication, and restricted and repetitive patterns of behavior (American Psychiatric Association, 1994). Major advances have been made since the 1980s in understanding the social and communication difficulties of children with ASD or PDD. This progress has resulted in a greater emphasis on early sociocommunicative patterns in the diagnostic criteria for the generic category of PDDs, which includes the subcategory of autistic disorder (American Psychiatric Association, 1994). More specifically, the following essential features for autistic disorder compose the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition:

1. Impairment in social interaction, manifested by impairment in the use of nonverbal behavior, lack of spontaneous sharing, lack of socioemotional reciprocity, and/or failure to develop peer relationships
   
   
2. Impairment in communication, manifested by delay in or lack of development of spoken language and gestures, impairment in the ability to initiate or maintain conversation, repetitive and idiosyncratic use of language, and/or lack of pretend play
   
   
3. Restricted repertoire of activities and interests, manifested in preoccupation with restricted patterns of interest, inflexible adherence to routines, repetitive movements, and/or preoccupation with parts of objects

Because language and communication difficulties are essential features of this syndrome, educators and practitioners need to have current understanding of these characteristics and issues pertaining both to assessment and to intervention programs for children with ASD.

Autism is now understood to be of neurogenic origin and can have a dramatic impact on the family members of individuals with ASD. New treatment strategies are frequently introduced and discussed in the media and the professional literature; however, there is great variability regarding the extent to which treatments address the core characteristics of ASDs. In fact, much disagreement remains as to the nature of the core characteristics as opposed to secondary or frequently observed associated characteristics. Furthermore, most published intervention studies fail to employ meaningful outcome measures that document changes in barriers to learning that are characteristic of ASDs or meaningful lifestyle changes for the individual or family.

This volume provides a theoretical and research foundation for understanding the nature of the communication and language problems experienced by children with ASD and for guiding decision making in educational programming and, in particular, communication assessment and intervention. The first part (Chapters 2 through 8) examines the developmental context of children and their families and explores the underpinnings of ASDs and how these relate to communication and language problems. The second part (Chapters 9 through 15) examines issues pertaining to education and treatment for children with ASD. Because the topic of autism is so broad across the life span, this volume focuses on the first decade of life, spanning infancy, childhood, and elementary school age.

A Developmental Transactional Perspective

The theoretical and research framework underlying this book draws heavily from the transactional model of child development. That is, child developmentis viewed as a transactional process that involves a developmental interaction vis-à-vis the child and communicative partners (McLean, 1990; McLean & Snyder- McLean, 1978). Developmental outcomes at any point in time are seen as a result of a continuous dynamic interplay among child behavior (which is greatly influenced by neurophysiological variables), caregiver responses to the child's behavior, and environmental variables that may influence both the child and the caregiver (Sameroff, 1987; Sameroff & Chandler, 1975; Sameroff & Fiese, 1990). Over time, when a young child's social behavior can be accurately interpreted or read by a caregiver and the caregiver is able to respond in such a way as to meet the child's needs or to support social exchange, both caregiver and child develop a sense of efficacy (Dunst, Lowe, & Bartholomew, 1990; Goldberg, 1977). A cumulative effect of positive contingent responsiveness is that interactions become more predictable as expectancies and contingencies increase. This perspective emphasizes the reciprocal, bidirectional influence of the child's social environment, the responsiveness of communicative partners, and the child's own developing communicative competence.

A child's emotional and physiological regulation, which underlies the capacity to be "available" for learning and participating actively in a social context, is seen as an essential foundation within the transactional model. Development is therefore influenced by a child's ability to maintain some degree of emotional and physiological regulation and to produce increasingly readable and conventional signals, as well as by a caregiver's ability to respond effectively to the child's signals and to embed reciprocal and mutually satisfying transactions in everyday activities and routines. We believe that the nature of the social, communication, and language impairments in autism can best be understood by reflecting on the acquisition process from a transactional developmental perspective and have invited distinguished researchers and clinicians to contribute toward this end.

Current Issues in Communication and Language of Children with Autism

Dawson and Osterling (1997) reviewed eight early intervention programs for preschool children with autism, ranging from intensive, one-to-one discrete trial approaches to programs in inclusive environments using naturalistic procedures. They concluded that the level of success achieved across these programs was fairly similar; these programs generally were effective for about half of the children. Effectiveness was determined based on changes in measures such as IQ scores and classroom placement. They noted that few of these programs documented progress on goals addressing social and communicative aspects of development.

Their conclusions provide important implications for intervention programs and directions for future research. First, no evidence indicates that one program or approach works better than others, and, therefore, caution is warranted in drawing conclusions about intervention efficacy. Second, there is much to be learned about effective programs to enhance social and communication skills in children with autism because little empirical data are available. These findings underscore the need to better understand which specific intervention methods work best to accomplish which goals for which children. We contend that directions for future research, particularly intervention studies, should be rooted in theory and research about the nature of ASDs and of the developmental process.