Pergamon

Research in Developmental Disabilities, Vol. 17, No. 6, pp. 433-465, 1996

Copyright 1996 Elsevier Science Ltd
Printed in the USA. All rights reserved
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Behavioral Treatment of Autistic Persons"

A Review of Research From 1980 to
the Present
Johnny L. Matson
Louisiana State University

Debra A. Benavidez
Baylor College of Medicine

Lesley Stabinsky Compton

University of Denver

Theodosia Paclawskyj and Chris Baglio

Louisiana State University

Studies evaluating behavioral treatment of autism from 1980 to the present were
reviewed. Studies included were published in journal articles and utilized behavioral methodology. A total of 251 studies were included in the review. Each study
was analyzed f o r target behaviors and behavioral techniques implemented.
Target behaviors were divided into categories, which included aberrant behaviors, social skills, language, daily living skills, and academic skills. Behavioral
techniques were classified as positive, negative, extinction, or combined. Results
were presented for each category. Recent trends in the treatment literature were
alsoreviewed, andrecommendationsforfumreresearchwerepresented. Copyright
1996 Elsevier Science Ltd
Requests for reprints should be sent to Johnny L. Matson, Department of Psychology, Louisiana
State University, Baton Rouge, LA 70803.
433

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J. L Matson et al.

The syndrome of autism has been the object of much research interest since
Kanner published a description of early infantile autism in 1943. Subsequent
research on the etiology and treatment of autism were based primarily on psychoanalytic theory, which was prevalent during the 1O40s and 1950s. According
to psychodynamic theories of etiology, the autistic child's parents were responsible for the disorder. Parents were described as cold and emotionally reserved,
and the autistic child was merely reacting to the parents' behavior by withdrawing into his/her own world. Bettelheim (1967) pioneered psychodynamic
treatment techniques. Psychodynamic treatment focused on creating a nonthreatening environment for the child and encouraging the child to express
feelings and actions. In response to this approach, researchers conducting
empirical studies evaluating the efficacy of psychodynamic treatment concluded that these techniques are not effective with autistic children (National
Institute of Mental Health, 1975).
In the 1960s, as learning theory became more prominent, researchers began
developing treatment techniques based on the principles of operant learning theory. Over 100 behavioral treatment studies had appeared in the literature by 1970
(DeMyer, Hingtgen, & Jackson, 1981). Ferster (1961) hypothesized that the
behavioral excesses and deficits observed in autistic children were operant and
therefore controlled by environmental consequences, including reinforcement,
punishment, and extinction. In order to change the behavior of these children, it
was necessary to modify these environmental consequences. Subsequent
researchers published studies in which operant techniques were used to modify
behaviors of autistic children. With regard to language, researchers began using
behavioral techniques to increase speech. For example, Lovaas, Berberich,
Perloff, and Schaeffer (1966) successfully shaped autistic children's vocalizations by reinforcing the children's responses when they approximated verbalizations by the therapist. Researchers also taught autistic subjects more complex
language skills, including semantics and syntax (Risley & Wolf, 1967). The
aberrant behaviors often displayed by autistic children were addressed during the
1960s. Lovaas and Simmons (1969) treated self-injurious behavior through the
use of extinction, in which they ignored the behavior when it occurred, producing gradual decreases. These researchers also administered electric shock contingent on self-injurious behavior and produced a rapid decrease in the behavior.
Researchers have also developed treatment strategies for stereotypy. Mulhern
and Baumeister (1969) utilized differential reinforcement to treat targeted stereotyped behaviors, by reinforcing subjects when they were not engaging in target
behaviors. Lovaas, Schaeffer, and Simmons (1965) and Risley (1968) implemented contingent electric shock, producing rapid decreases in stereotypy.
During the 1970s the amount of research on behavioral treatment of autism
continued to increase as researchers addressed more target behaviors and developed increasingly sophisticated behavioral techniques. Over 200 studies were
published from 1970 to 1980 (DeMyer, Hingtgen, & Jackson, 1981). In the area
of language, reinforcement-based methods were utilized to teach abstract con-

Behavioral Treatment of Autism

435

cepts, such as prepositions, pronouns, time, yes/no, and same/different 0_.,ovaas,

1977). Researchers also decreased echolalia by teaching appropriate verbal
responses (e.g., Carr, Schreibman & Lovaas, 1975; Freeman, Ritvo, & Miller,
1975; Schreibman & Carr, 1978). Researchers also addressed social skills difficulties in autistic children. Studies focused on increasing social initiations and
responses (Ragland, Kerr, & Strain, 1978; Strain, Kerr, & Ragland, 1979).
Academic interventions were also developed, as researchers sought to decrease
stimulus overselectivity by teaching autistic children to respond to multiple
stimulus cues (e.g., Koegel & Schreibman, 1977). With regard to aberrant
behaviors, researchers continued to examine the use of extinction (Carr,
Newsom, & Binkoff, 1976) and differential reinforcement (Favell, McGirnsey,
& Jones, 1978) for decreasing self-injurious behavior. Researchers also evaluated aversive procedures for self-injurious behavior, focusing on those that were
increasingly less intrusive. Tanner and Zeiler (1975) successfully used aromatic
ammonia to decrease self-injurious behavior, and Azrin, Gottlieb, Hughart,
Wesolowski, and Rahn (1975) implemented an overcorrection procedure.
Treatment strategies were also developed for stereotypy. Researchers evaluated
positive procedures, including differential reinforcement (Dietz & Repp, 1973;
Herendeen, Jeffrey, & Graham, 1974) and sensory extinction, in which reinforcement through sensory feedback from the stereotyped behavior was prevented (Rincover, 1978). Aversive procedures for stereotypy have included
restraint contingent on emission of the targeted stereotyped behavior (Koegel,
Firestone, Kramme, & Dunlap, 1974) and positive practice overcorrection
(Foxx & Azrin, 1973; Epstein, Doke, Sajwaj, Sorell, & Rimmer, 1974).
From 1980 to the present, the area of behavioral treatment research has continued to expand, addressing a multitude of target behaviors. Comprehensive
reviews of treatment studies of autism during the 1960s (Hingtgen & Bryson,
1972) and 1970s (DeMyer et al., 1981) have been published. However, there is
a need for review and evaluation of the behavioral treatment research since
1980. The purpose of the present study was to evaluate behavioral treatments
of the excesses and deficits characterizing autism from 1980 to 1995. Behavioral
treatment studies published in psychological, psychiatric, and educational journals were evaluated. Target behaviors and behavioral techniques were evaluated in each study. Using this approach, it was intended to determine how the
treatment of autistic individuals has progressed, in terms of type and complexity of target behaviors and behavioral techniques.
METHOD
Procedure

Studies included in this review were published in scientific journal articles and
were implemented using single-case methodology. Articles were located through
hand and computer searches using Psychological Abstracts and cross-checking

436

J. L. Matson et al.

references. A total of 251 studies were included in this review. The studies were
reviewed by the second and third authors, Ph.D. students in clinical psychology,
with master's degrees. Rules governing the collapsing of data across variables
were adapted from Matson and Taras (1989): (a) if several experiments were
described in a study, each experiment was classified separately; (b) when the
effectiveness of two or more treatments were compared, the study was classified
based on the most effective treatment; (c) if different treatments were used for
different problem behaviors, the study would be classified more than once. The
text of each study was examined for the following variables:

Category of Target Behaviors. Target behaviors were divided into five categories, including aberrant behaviors, social skills, language, daily living
skills, and academic skills. Operational def'mitions of each category are presented in the Results and Discussion section.
Target Behaviors. Target behaviors explicitly described by the authors were
included and classified under one of the five behavior categories. For studies
addressing target behaviors in more than one category, it was possible to
classify the study more than once (e.g., a study targeting an aberrant behavior
and a language-related behavior may be classified under both categories).
Behavioral Techniques. Techniques explicitly described by the authors were
included. For this analysis, they were categorized as positive, aversive, combined, or extinction. Positive procedures consist of those in which nonaversive
methods were used. Aversive procedures refer to those in which punishment
was administered to subjects contingent upon emission of the target behavior.
Extinction refers to procedures in which reinforcement for the emission of the
target behavior was withdrawn. Combined procedures involve the application
of a combination of two or more of the previously described methods.
Raters and Reliability
Reliability for number of studies obtained was established by having a
Ph.D. student in clinical psychology with a master's degree conduct a search
of studies for 2 years. Using the standard percent agreement formula, agreement on number of studies per year averaged 81%, using the standard percent
agreement formula. Individual reliablities were 83% and 89%.
Reliability for article ratings was established by having a third reviewer, a
Ph.D. student in clinical psychology with a bachelor's degree, review 13% of the
same studies. Agreement on study variables averaged 84%, using the standard
percent agreement formula. Individual reliabilities ranged from 80% to 90%.
RESULTS AND DISCUSSION
Results for each category are presented below, along with a review of relevant studies and prevalent trends constituting each category. A review of

Behavioral Treatment of Autism

437

recent trends in behavioral research with autistic persons is also presented.

This paper will conclude with a summary of the results and suggestions for
future research.

Aberrant Behaviors

Aberrant behaviors, including stereotypy and self-injurious behavior, are

frequently seen in autistic individuals (Schreibman, 1988). Target behaviors in
this category were grouped together because they all have the following commonalities: they are behavioral excesses, they interfere with opportunities for
interaction within the environment, and they deter the individual from learning
functional behaviors. The most frequently addressed aberrant behaviors
included stereotypy (22%), aggression (17%), and self-injurious behavior
(14%). Target behaviors and procedures implemented are shown in Table 1.
As shown in Table 1, the categories of behavioral techniques addressing
aberrant behaviors included positive (53%), aversive (20%), extinction (1%),

TABLE 1
Target Behaviors and Procedures for Aberrant Behaviors

Procedure
Target Behavior
Aggression
Stereotypy
Self-injurious behavior
Repetitive/Inappropriate
vocalizations
Destroying property
Tantrums
Noncompliance
Pica
Grabbing
Physical withdrawal
Diurnal bruxism
Spitting
Inappropriate touching
Out-of-seat
Anorexia nervosa
Phobias
Grimacing
Visual overselectivity
Off-task
Falling
Stealing
Tensing body
Body rocking
Mouthing objects

Positive

Aversive

Combined

13
12
9

5
14
2

7
4
9

1
1

3
2

Extinction

438

J. L. Matson et al.

and combined (26%). It is apparent from the inclusion of positive and negative
procedures that treatment goals focused on decreasing maladaptive behaviors
and increasing functionally appropriate behaviors.
Using methodologies derived from the principles of operant conditioning,
researchers have developed the functional analysis model of assessment and
treatment. This technique typically addresses aberrant behaviors and provides
a means by which antecedents and consequences for a particular behavior are
arranged in highly controlled assessment conditions. High rates of behavior
occurring during a particular assessment condition are indicative of a specific
functional property of the behavior. Interventions matching the contingencies
governing the behavior are then designed (Neef & Iwata, 1994). In one of the
earliest applications of functional analysis, Iwata, Dorsey, Slifer, Bauman, and
Richman (1982) hypothesized that self-injurious behavior served multiple
functions for certain individuals with severe developmental disabilities. These
researchers presented a methodology for assessment of self-injurious behavior.
They utilized assessment conditions based on empirically-derived functions of
self-injurious behavior, including contingent attention, self-stimulation, and
demands. Based on the results of their assessments, the researchers prescribed
successful interventions. Hating and Kennedy (1990) analyzed the problem
behaviors (spitting, loud vocalizations, stereotypy) of two autistic subjects
across differing contexts, including instructional task sessions and leisure
activity sessions. Differential reinforcement of other behavior (DRO) and
time-out were implemented in these settings. The researchers found that these
interventions produced different outcomes, depending on environmental context. The researchers concluded that although the problem behaviors appeared
to be topographically similar, their functional control was not. Consequently,
functional analysis within only one environmental context may provide insufficient data for an effective behavior management program. In addition, Sasso
et al. (1992) compared experimental analyses of aberrant behavior with
descriptive analyses by teachers to determine the utility of functional analysis
implemented in the school setting. The researchers found that these assessment
methods yielded comparable findings, which supports the validity of functional analysis across settings and therapists. Interventions based on assessment
results were also successful in reducing aberrant behaviors. Functional analysis is a technique that holds much promise for the development of effective
assessment and treatment techniques for aberrant behaviors.
Functional communication training is a treatment technique based on the
principles of functional analysis. This is an intervention designed to reduce
aberrant behaviors by teaching subjects communicative responses that are
functionally equivalent to the aberrant behavior. Carr and Durand (1985) systematically assessed the functions of aberrant behavior and successfully
implemented functional communication training with subjects with mental
retardation. Bird, Dores, Moniz, and Robinson, (1989) compared functional
communication training to DRO with people with autism and mental retarda-

Behavioral Treatment of Autism

439

tion who demonstrated aggression and self-injury. They postulated that functional communication training would be a more effective treatment because
subjects would be taught responses that are functionally equivalent to the aberrant behaviors, as reinforcers obtained by functional communication would be
the same as those obtained by the aberrant behavior. For example, the authors
determined through functional analysis that the function of one subject's selfinjurious behavior was escape from task demands. They subsequently trained
the subject to request a break from task demands and dramatically reduced the
incidence of self-injurious behavior. Durand and Cart (1992) found that functional communication training evoked desired consequences from others in the
environment who were unfamiliar with the student and the procedure. When
compared with time-out from positive reinforcement, functional communication training produced more appropriate behavior when the subject was around
persons unfamiliar with existing contingencies. Functional communication
training is therefore a technique that can provide an efficient, nonaversive
means of reducing aberrant behaviors, even among others who are unaware of
the procedure.
In recent years, there has been much debate over the appropriateness of
aversive procedures for individuals with handicaps. Critics of aversive procedures have stated that nonaversive procedures are effective treatments for the
majority of aberrant behaviors (LaVigna & Donnellan, 1986). However, some
aberrant behaviors, such as aggression and self-injurious behavior, in their
most severe form can be extremely destructive and harmful. These behaviors
often require immediate treatment to prevent serious injury to the individual
and others. Researchers have demonstrated that rapid decreases in aberrant
behaviors may be achieved by using aversive procedures (Matson & Taras,
1989). When severe, harmful aberrant behaviors are treated, the use of a less
intrusive procedure with more gradual effects may be considered unethical
(Repp & Deitz, 1978). Nevertheless, there is potential for abuse of aversive
interventions; it is essential that appropriate procedures for regulating the use
of aversives are in place (Matson & Kazdin, 1981). These procedures may
specify patient consent, qualified professionals, and peer reviews. When aversives are incorporated in a treatment plan, it is generally recommended that the
least intrusive procedure possible be utilized for a target behavior (Repp &
Deitz, 1978). The question of whether less intrusive procedures may be implemented in a program that is as effective as a single, more intrusive procedure
has been addressed by researchers. Charlop, Burgio, Iwata, and Ivancic (1988)
conducted a study to evaluate the possibility of utilizing a variety of less intrusive aversive procedures to reduce aberrant behaviors rather than a single,
more intrusive aversive procedure. The varied presentation enhanced the effectiveness of the less intrusive procedures.
Researchers have developed effective strategies for treating aberrant behaviors, in spite of the lingering controversy surrounding strategies involving the use
of aversives. The goal of treatment strategies has become twofold, incorporating

440

J. L. Matson et al.

decreases in aberrant behavior and increases in positive behavior. This is accomplished through the use of reinforcement-based strategies in conjunction with
aversive procedures or extinction. Recent investigators have devised more
sophisticated assessment methodologies, such as functional analysis, to ensure
implementation of appropriate treatments. Researchers have also focused on less
intrusive aversive procedures, evaluating ways to generate more powerful effects.
These are areas for continuing research, as investigators develop more efficient
and socially acceptable methods for treating aberrant behaviors.
Social Skills

The inability to develop normal social relationships is described as one of

the most pervasive deficits of autism (Newsom, Hovanitz, & Rincover, 1988;
Schreibman, 1988). All studies which addressed behaviors comprising appropriate interactions with others were included in this category. The most frequent
target behaviors included initiations (32%), responses (23%), and reciprocal
interactions (15%). Target behaviors and behavioral techniques are presented in
Table 2.
As shown in Table 2, these behaviors were increased using positive (98%)
and combined (2%) procedures. It is evident that nearly all studies focused on
increasing appropriate behaviors, rather than decreasing inappropriate behaviors.
Target behaviors ranged from simple to complex, with simple behaviors
functioning as precursors to more complex social behaviors. Holding a conversation, for example, requires the prerequisite skills of attending, eye contact,
appropriate voice tone, and asking and responding to questions. Often the
social skills deficits of autistic persons are so pervasive that instruction in simple behaviors is necessary before behaviors encompassing more complex interactions can be introduced (Newsom & Rincover, 1989). For the majority of
studies, treatment consisted of direct training of socially appropriate behaviors
using positive reinforcement techniques.
In many of the studies addressing social skills, peers served as confederates
during training, as they were taught to initiate social interactions with autistic
children. Researchers using peer confederates reported that the number of
responses and duration of interactions significantly increased for both peers
and target children (Goldstein & Wickstrom, 1986; Shafer, Egel, & Neef,
1984). However, Odom and Strain (1986) compared a treatment program training normal peers to initiate interactions with autistic children with another program training teachers to prompt autistic children to initiate to peers. The
researchers found that normal peer initiations increased the autistic children's
social responses, but teacher prompting increased the autistic children's social
responses and initiations. One problem facing researchers was the issue of
generalization: how to train autistic subjects to generalize learned social
behaviors to persons other than peer confederates. Strain (1983) and Haring
and Lovinger (1989) discussed the importance of considering the reciprocal

Behavioral Treatment of Autism

441

TABLE 2
Target Behaviors and Procedures for Social Skills

Procedure
Target Behavior

Positive

Social Interactions:
Initiations + Responses
+ Reciprocal interactions
Initiations + Responses
Initiations + Reciprocal
interactions
Initiations
Responses

Eye contact
Play skills
Offering/Requesting/Providing
assistance
Sharing
Conversational skills
Greeting
Terminating social exchanges
Expressing affection
Decreasing avoidance
Physical approach
Appropriate affect
Appropriate sitting
Recruiting praise
Requests
Appropriate speech content
Appropriate voice tone
Appropriate gestures
Imitation

Aversive

Combined Extinction

7
2
2
9
5
5
3
3
3
2
2
2
2
2
2

nature of social interactions. These researchers emphasized the importance of

ensuring peer responses to the initiations of autistic subjects, otherwise the
subjects initiations will extinguish. They advocated training autistic children to
initiate interactions with peers taught to respond appropriately.
Several studies evaluated the technique of "loose training," or reducing
instructional control over a subject by training the subject with more than one
peer confederate. In these studies, it was postulated that if autistic subjects were
exposed to more than one peer during training, they would be more likely to
generalize their newly learned skills to peers not involved in training (Campbell
& Stremel-Campbell, 1982). Accordingly, researchers utilizing loose training
taught autistic youths to initiate and sustain social interactions with various
nonhandicapped peers. These researchers found that autistic subjects learned
and generalized these skills to other peers in the same setting (Brady, McEvoy,
Wehby, & Ellis, 1987; Brady, Shores, McEvoy, Ellis, & Fox, 1987; GaylordRoss, Haring, Breen, & Pitts-Conway, 1984; McEvoy, et al., 1988).

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Z LMa~on etaL

Recent researchers addressing treatment of social skills in autistic persons

have evaluated the effects of treating pivotal social behaviors. According to
Koegel, Koegel, and Schreibman (1991), pivotal behaviors refer to behaviors
that, when modified, result in collateral changes in other behaviors constituting
the same response class as the pivotal behaviors. Consequently the treatment of
pivotal behaviors has the potential to produce changes in multiple areas of functioning in autistic persons. Findings by Koegel, Koegel, Hurley, and Frea (1992)
provide support for this hypothesis. These researchers used a self-management
strategy to teach autistic children social communication skills and found collateral increases in social behaviors not targeted for treatment and decreases in disruptive behavior. The authors concluded that in these subjects, the social behaviors
and disruptive behaviors were part of a larger class of behaviors serving similar
functions. Koegel and Frea (1993) extended these findings by using self-management strategies to change one or two social communicative behaviors (e.g., eye
gaze, gestures). They hypothesized that these behavior changes would result in
improvements in social communicative behaviors not targeted for treatment (e.g.,
voice volume, facial expression, and affect). These researchers reported collateral
behavior changes and concluded that all behaviors modified by the treatment program comstituted the same response class. Results of these studies provide support for the identification and treatment of pivotal social behaviors, as changes in
a social behaviors targeted for treatment may result in modification of a broader
range of social and disruptive behaviors.
Researchers have developed techniques to improve the social behavior of
autistic children. There is a growing emphasis on the dynamic nature of social
interactions, as treatments focus on teaching autistic subjects to engage in
reciprocal interactions. Autistic subjects are thereby taught to extend social
interactions beyond initiations and single responses. Investigators have also
devised methods to facilitate generalization of social skills. Studies have
included peer confederates, so that autistic subjects can learn appropriate
behaviors with individuals who part of the subjects' natural environment. The
technique of loose training was also developed to facilitate generalization of
social behaviors to peers not involved in training. Investigators have recently
begun treating social skills as pivotal behaviors, constituting a single response
class. They found that by changing a single behavior during treatment, it is
possible to produce collateral changes in other behaviors in the same response
class. This technique has important implications for treatment, as it is clearly
more efficient than teaching multiple behaviors. Future research is needed to
continue evaluating the relationships among social behaviors, in order to determine how changes in one behavior affect others.
Language

Speech deficits and unusual speech and language patterns are identifying
characteristics of autistic persons; approximately 50% of these individuals lack

Behavioral Treatment of Autism

443

expressive and receptive language (Schreibman, 1988). Researchers have conducted studies evaluating methods to r e m e d i a t e l a n g u a g e deficits. Target
behaviors comprising both expressive (87%) and receptive (11%) language, as
well as both combined (2%), were addressed in this category. Target behaviors
and behavioral techniques are presented in Table 3.
Behavioral techniques consisted of positive (89%) and combined (11%) procedures. Most studies evaluated direct instruction of language using reinforcement

TABLE 3
Target Behaviors and Procedures for Language

Preccdure
Target Behavior
Expressive
Verbal
Answering questions
Labeling
Spontaneous verbalizations
Prompted verbalizations
P r o n o u n use

Answers to "Wh-" questions

Sentence use
"Yes" and "No" as mands
Multiple descriptors
Verbalizingpast events
"I/You" responses
Verbal tacts
"Give me-" as mands
Naming pictures
Preposition use
Adjective use
Nonverbal
Prompted sign use
Spontaneous sign use
Pointing
Requesting
Answering questions
Alternative communication
Mixed
Labeling
Pronoun use

"Yes/No" Responses
Preposition use
Articulation
Receptive
Labeling
Noun/Verb/Adjectiveuse
Preposition use
Receptive + Expressive
Sign language

Positive

Aversive

Combined Extinction

444

J. L. Matson et al.

techniques. As shown in Table 3, the majority of studies addressed expressive

language, which is typically trained after the individual demonstrates a receptive
vocabulary of at least l0 words (Lovaas, 1981). Two modalities of expressive language were addressed, including oral and sign.
Researchers have evaluated procedures for increasing expressive language.
In the 1960s and 1970s, researchers developed effective programs for training
verbal imitation, expressive labeling, answering questions, and requests (Lovaas,
1977, 1981). However, researchers found that autistic children frequently fail
to generalize their speech to unfamiliar persons and settings, possibly because
of their overly selective attention (Lovaas, Koegel, & Schreibman, 1979).
More recent research has address methods to facilitate generalization of expressive language by autistic subjects. These methods include incidental teaching,
the natural language paradigm, and time delay.
Schepis et al. (1982) introduced incidental teaching, a procedure used successfully with preschoolers (Hart & Risley, 1975). Incidental teaching is a
technique of increasing language by using naturally occurring interactions
between the client and the caregiver. Schepis et al. (1982) evaluated an incidental teaching program to increase expressive sign language in nonverbal
adults with autism. In this study, incidental teaching was implemented by
arranging the physical environment in a manner encouraging the subject to use
signs. This was done by placing preferred items on a shelf and allowing subjects to request these items using signs. Caregivers reinforced subjects for sign
use by giving them the requested item. Staff members also prompted and reinforced sign use when appropriate during naturally occurring interactions (e.g.,
when a subject wanted to drink from a water fountain, the caregiver prompted
the subject to sign the word drink and provided access to the water fountain as
a reinforcer for sign use). In addition, caregivers conducted brief training sessions, in which they presented objects and prompted subjects to sign the names
of the objects. The researchers reported a significant increase in sign use by
subjects. Carr and Kologinsky (1983) trained autistic children to sign words
spontaneously for reinforcer items. During the training component, subjects
were presented with an item, prompted to sign the appropriate label, then
given the item as a reinforcer. During the maintenance component, experimenters did not prompt subjects to use signs. However, they were reinforced
for spontaneously signing an object label by being allowed access to the
object. The researchers reported a significant increase in spontaneous sign use.
McGee, Krantz, and McClannahan (1985) compared discrete-trial teaching to
incidental teaching procedures for increasing appropriate preposition use in
autistic children. In the discrete-trial format, teachers presented two stimulus
items to subjects, then prompted correct preposition use. Subjects were reinforced with praise and access to one of the stimuli. In the incidental teaching
format, stimulus materials were displayed in the training area and teachers
prompted and praised appropriate preposition use after subjects named or
requested one of the items. The researchers found that the incidental teaching

Behavioral Treatment of Autism

445

procedure promoted more appropriate preposition use and greater generalization across settings, teachers, and positions of training stimuli.
The natural language teaching paradigm for increasing verbal language in
nonverbal autistic children was introduced by Koegel, O'Dell, and Koegel
(1987). This paradigm incorporates a discrete-trial language training program
with incidental teaching techniques, thereby promoting more natural speaking
situations during training. Koegel et al. (1987) compared a natural language
program with an analogue discrete-trial program. In the natural language program, these researchers began sessions by allowing the child to select a stimulus object, then modeled the name of the object. The child was reinforced for
any verbal response with praise and an opportunity to play with the object.
Koegel et al. (1987) found that the children exhibited more verbalizations and
displayed more generalization to spontaneous verbalizations with the natural
language teaching program. Elliott, Hall, and Soper (1991) compared discretetrial language teaching to natural language teaching by implementing both procedures with two groups in a multiple baseline, crossover design. These
researchers found that both techniques produced significant increases in spontaneous verbalizations in both groups. They also found that neither method
was superior. However, the researchers hypothesized that natural language
teaching is a better choice because the technique is implemented in a less artificial teaching environment and effectively facilitates generalization.
The time delay procedure for increasing expressive language was introduced
by Halle, Marshall, and Spradlin (1979), who implemented this procedure with
institutionalized mentally retarded persons. Time delay is a technique in which
the teacher presents a target stimulus (e.g., soda) to the subject and prompts the
appropriate response (e.g., "I want soda.") The onset of the prompt is subsequently delayed for increasing amounts of time until the subject spontaneously
requests the item. Charlop, Schreibman, and Thibodeau (1985) used the time
delay procedure to increase expressive language in autistic children. Using this
procedure, the subjects were taught to request desired objects in the absence of
verbal cues. The researchers reported generalization of spontaneous requesting
from the training environment to unfamiliar persons, settings, and stimuli.
Ingenmey and VanHouten (1991) successfully implemented a time delay procedure with an autistic child to increase spontaneous speech during play activities,
including playing with cars and drawing. These researchers also reported generalization across stimulus items constituting the same behavioral class (e.g., cars
that were not used as stimuli for training car play) and across different settings.
Studies evaluating techniques for increasing expressive language have
focused on verbal language (62%), nonverbal language (25%), and total communication (both forms combined) (13%). One question that has been
addressed by researchers is which language modality is most appropriate for
autistic individuals. Barrera, Lobato-Barrera, and Sulzer-Azaroff (1980) compared the uses of oral language, sign language, and total communication in
teaching expressive language to a mute autistic child. These researchers found

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J. L. Matson et al.

that total communication training was superior to oral or sign language training. Cohen (1981) used total communication training to teach an autistic child
to sign a word and simultaneously say the corresponding spoken word.
Increases in unprompted vocal labeling, simultaneous vocal and signed phrases, and a reduction in echolalia were reported. Barrera and Sulzer-Azaroff
(1983) used an alternating treatment design to compare the effectiveness of
oral and total communication training for increasing expressive labeling in
echolalic autistic children. These researchers found that total communication
was more effective in teaching expressive labeling. Newsom and Rincover
(1989) recommend teaching language using the total communication approach
when it is unclear as to which modality is most appropriate. These authors also
recommend conducting regular, objective assessments to determine the effectiveness of the approach being implemented.
Few studies were found using evaluation techniques for increasing receptive language. For the studies that did so, positive (71%) and combined (29%)
behavioral techniques were used. For example, Egel, Shafer, and Neef (1984)
used positive techniques (modeling and positive reinforcement) to teach receptive preposition use to autistic children. Specifically, they taught the children
two responses to prompts containing prepositions: placing themselves in relationship to objects on a table (e.g., standing behind/beside/in front of a chair),
and placing objects in positional relationship to others on a table (e.g., putting
a sock behind/beside/in front of a shoe). These researchers found that teaching
the children to respond by positioning objects increased receptive preposition
use more quickly than teaching them to respond by positioning themselves.
Researchers addressing behavioral treatment of language deficits in autistic
children have primarily investigated methods for increasing expressive language.
Studies have documented techniques that not only increase language production
but also facilitate generalization of language. Several methods of producing generalization were developed. Incidental teaching is a technique in which autistic
children are taught expressive language in the context of naturally occurring
interactions with the teacher. The natural language paradigm also promotes language teaching in a natural context, as it combines discrete trials with incidental
teaching. In time delay, subjects learn to use expressive language in the absence of
verbal cues, as prompts are delayed for increasing amounts of time. Researchers
have addressed the question of whether to teach speech or sign language, and conchided that the total communication method (teaching both language forms simultaneously) should be used when it is not clear as to which technique is best. Few
studies addressed receptive language with autistic children. Because these children
often have deficits in receptive language, this is an area for future research.
Daily Living Skills

Individuals with autism are often challenged by deficits in dally living skills
(Harris, 1988). These skills consist of behaviors that are necessary for success-

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447

ful day-to-day functioning. Target behaviors and behavioral techniques are

shown in Table 4.
Behavioral techniques used to increase daily living skills consisted of positive (83%) and combined (17%) techniques. The majority of studies appeared
to focus on using positive reinforcement techniques to teach specific behaviors
constituting the aforementioned areas. A few studies employed aversives in
conjunction with positive reinforcement to decrease the frequency of problem
behaviors interfering with learning. Target behaviors were divided into four
areas containing distinct groups of skills including self-help, community,
leisure, and vocational.
Self-help skills (53%) are defined as behaviors enabling individuals to care
independently for their own bodily needs (Taras & Matese, 1990). This is a
widespread area of deficit for persons with developmental disabilities (Lovaas,
1981). The benefits of teaching self-help skills to autistic persons are twofold.
First, learning self-help skills will enable the autistic individual to become
more independent. In addition, if the individual is able to provide basic care on
TABLE 4
Target Behaviors and Procedures For Daily Living Skills
Procedure
Target Behavior

Positive

Self-help skills
Dressing
Tying shoes
Brushing teeth
Food preparation
Eating
Washing face
Combing hair
Drinking
Setting table
Cleaning sink
Doing laundry
Making bed
Deodorant application
Toileting
Community skills
Crossing street
Purchases
Checking out books
Leisure skills
Toy play
Ball play
Choosing recreational activities
Vocational skills
Cleaning restroom
Increasing production rate

Aversive

Combined

Extinction

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his or her own, there will be additional time for caregivers to focus on teaching
other necessary skills (Reid, Wilson, & Faw, 1991). Researchers have evaluated methods for teaching autistic persons self-help skills. For example, Pierce
and Schreibman (1994) used picture prompts, positive reinforcement, modeling, and fading to successfully teach autistic children dressing, food preparation, setting the table, doing laundry, and making beds.
Another area of daily living skills is community skills (14%), which allow
persons to function successfully in community settings (Danforth & Drabman,
1990). Over the last 20 years, there has been an increasing trend towards community placement of persons with developmental disabilities. This trend has
resulted from court cases, such as Wyatt v. Stickney, which prompted the transfer
of individuals from state institutions to community settings. However, persons
with developmental disabilities often do not have the necessary skills to function
independently in the community. Researchers have investigated techniques for
teaching community skills to autistic individuals. Steinborn and Knapp (1982)
taught an autistic child pedestrian skills using prompts, modeling and positive
reinforcement. Haring, Kennedy, Adams, and Pitts-Conway (1987) taught autistic adults to purchase items using prompts and positive reinforcement.
A third area of dally living skills included studies evaluating methods of
increasing leisure skills (28%), defined as behaviors allowing individuals to
engage in recreational activities (Hawkins, 1982). Autistic individuals typically engage in fewer leisure activities when compared to their nonhandicapped
counterparts (Schreibman, 1988). These individuals often fail to learn the necessary skills to engage in a leisure activity, and they frequently engage in
behaviors that interfere with these activities, including stereotypy and selfinjurious behavior. Researchers have attempted to increase leisure skills by
directly teaching persons with autism specific activities such as playing with
toys. For example, using modeling and positive reinforcement, Tryon and
Keane (1986) taught autistic children to play with toys. Researchers have also
implemented both positive and negative behavioral procedures to produce a
decrease in negative behaviors while increasing leisure skills. Coe, Matson,
Fee, Manikam, and Linarello (1990) used prompts, feedback, and positive
reinforcement to teach autistic children to play ball. These researchers also
implemented time-out to decrease disruptive behaviors occurring during training sessions.
A fourth area of daily living skills consists of vocational skills (5%), which
include behaviors necessary for successful adjustment to job settings (Smith &
Coleman, 1986). Because of the behavioral excesses and deficits that often characterize persons with autism, it is important that they be taught the skills necessary
to function successfully in a vocational setting. A few researchers have investigated the efficacy of behavioral interventions. For example, Smith and Coleman
(1986) successfully utilized positive reinforcement procedures to teach job skills
(e.g., increasing production rate) to autistic persons. These researchers also utilized combined procedures to decrease inappropriate behaviors in the job setting.

Behavioral Treatment of Autism

449

It is apparent that relatively few researchers have evaluated techniques for

teaching daily living skills to autistic persons. Teaching daily living skills to
autistic persons is particularly difficult because of the language problems,
stimulus overselectivity, and aberrant behaviors that characterize a significant
part of this population (Schreibman, 1988). Accordingly, the majority of treatment studies with autistic children focus on remediating these more salient
behavioral excesses and deficits, rather than on activities of daily living. The
database on techniques for teaching daily living skills to mentally retarded persons, however, is quite extensive (e.g., Danforth & Drabman, 1990; Taras &
Matese, 1990). As a result, research is necessary to determine whether techniques proven successful with mentally retarded persons are appropriate for
autistic persons. A few studies have done this using single-case methodology.
One technique that has proven effective with mentally retarded persons is task
analysis (Homer & Keilitz, 1975). Task analysis is a procedure in which a complex behavior is broken down into simpler component behaviors (Sulzer-Azaroff
& Mayer, 1977). The process of task analysis begins with observation of the target behavior, listing specific components in order of occurrence, and listing subskills required for successful performance (Huguenin, Weidenman, & Mulick,
1991). For example the behavior of cleaning the sink can be broken down into
the following steps: (a) turn on water, (b) dampen sponge, (c) turn off water,
(d) apply small amount of cleaning agent to sink, (e) scrub inside of sink with
damp sponge, (f) turn on water, (g) rinse sponge, (h) rinse sink thoroughly so no
cleaner is left, (i) squeeze sponge, (j) put sponge away (Smith & Belcher, 1985).
A subskill necessary for successful completion of these tasks may include fine
motor dexterity sufficient for turning the water faucet on and off. Task analysis
has several advantages, particularly when used with autistic persons. Training
programs developed by this method may be tailored for individual students and
modified according to intellectual level. This may be done by skipping steps or
breaking steps down further. Task analysis may also be used for behaviors constituting many different skills areas. Skills may be subsequently taught by using
chaining. In chaining, each component behavior is considered part of a behavioral
chain. These component behaviors are taught to subjects one at a time, either in
forward order (forward chaining) or in backward order (backward chaining).
Studies on self-help and community skills incorporated task analysis and chaining with autistic persons. Matson, Taras, Sevin, Love, and Fridley (1990) taught
autistic children self-help skills including shoe tying, hair combing, dressing, eating, and drinking. Task analysis was utilized to break down target behaviors.
These researchers subsequently used a forward chaining procedure incorporating
modeling, instructions, and positive reinforcement to teach these behaviors. Blew,
Schwartz, and Luce (1985) used peer models to teach autistic children community skills including crossing the street, making purchases, and checking out books
from the library. Each behavior was task analyzed into component behaviors,
then a forward chaining procedure including modeling and positive reinforcement was used to teach subjects these behaviors.

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J. L. Matson et al.

In the area of daily living skills, target behaviors comprised four skill categories, including self-help, community, leisure, and vocational skills. Most of
the studies addressed self-help skills. However, with the continued emphasis
on community placement of individuals with developmental disabilities, the
remaining skill categories are important areas for future research. The number
of studies addressing daily living skills in mentally retarded subjects is significantly greater than in autistic subjects. Consequently there is a need to determine whether treatment strategies effective with mentally retarded persons are
equally effective with autistic persons. Investigators have found that one strategy, task analysis, is appropriate for both populations. Future research is needed to increase the number of effective techniques for teaching daily living
skills to autistic persons.
A c a d e m i c Skills

Research in this category included studies that addressed behaviors typically taught in academic and physical education settings. Behavioral techniques
consisted of positive (88%) and combined (12%) procedures. A wide range of
behaviors were addressed in this category, as shown in Table 5.
Behaviors addressed included discrimination (58%) and task acquisition
and performance (9%). Researchers have evaluated methods for facilitating
autistic children's learning in academic settings. One technique is task variation. Dunlap and Koegel (1980) compared two methods of teaching autistic
children specific tasks (e.g., color/object identification, counting objects). In
the constant task method, they utilized a single task throughout a training session. In the varied task method, they utilized a target task interspersed with a
variety of different tasks. The researchers found that the varied task method
was more effective, and they hypothesized that the stimulus variation may
have increased the children's responsivity. Weber and Thorpe (I 989) also compared constant task presentation with task variation, finding that task variation
was more effective in teaching gross motor skills.
Researchers have also evaluated the effects of reinforcer variation and reinforcer type on learning. Egel (1981) compared the effects of constant and varied reinforcer presentation on discrimination tasks and on-task behavior. This
researcher found that varied reinforcer presentation produced greater increases
in target behaviors than constant reinforcer presentation. Egel (1981) hypothesized that repeatedly presenting the same reinforcer may cause satiation. With
regard to reinforcer type, Ferrari and Harris (1981) hypothesized that sensory
reinforcers (e.g., vibration, music, light) may function as appropriate reinforcers for some autistic children. They compared the use of sensory reinforcers (vibration, music, strobe light) with edible and social reinforcers when
teaching object discrimination to autistic children. These authors found that
sensory reinforcers were as effective as edible and social reinforcers. Rincover
and Newsom (1985) compared a sensory reinforcer with an edible reinforcer.

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TABLE 5
Target Behaviors and Procedures for Academic Interventions

Procedure
Target Behavior
Discrimination
Object
Picture
Color
Shape
Letter/Word
Number
Body part
Task acquisition/Performance
Gross motor skills
On-task behavior
Object manipulation
Reading
Matching
Categorization
Visual orientation
Number identification
Mathematics
Handwriting
Recall
Transitions between activities
On-schedule behavior
Spelling
Memory

Positive
9
7
7
7
3
2
1
6
3
3
2
2
1
1
1
1
1
1
1
1
1

Aversive

Combined Extinction
2

1
1
1
1

1
1

They found that the sensory reinforcer produced a higher percentage of correct
responding. These researchers hypothesized that sensory reinforcers were more
resistant to satiation. Wolery, Kirk, and Gast (1985) assessed the effectiveness
of using stereotypic behavior as a reinforcer. Subjects were cued by a model to
engage in stereotypic behaviors after responding correctly on matching and
labeling tasks. The researchers reported a significant increase in percentage of
correct responses and no significant increase in the rate of stereotypic behavior
in other settings.
Many studies evaluated methods to remediate stimulus overselectivity, a
problem commonly found in autistic children. Stimulus overselectivity interferes with learning because autistic persons with this characteristic often
respond to a restricted number of cues available during learning situations
(Schreibman, 1988). Researchers frequently used discrimination tasks when
evaluating treatment strategies. According to Lovaas, Koegel, and Schreibman
(1979), when presented with multiple cues (i.e., a stimulus with visual, auditory, and motor components), autistic children tend to respond to only one cue.
They have difficulty discriminating between complex stimuli, even when multiple cues are presented in the same modality (e.g., multiple visual, auditory, or

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J. L. Matson et al.

motor cues). In the 1970s, researchers began teaching autistic children with
stimulus overselectivity to respond to simultaneous multiple cues presented in
discrimination tasks. Schreibman, Koegel, and Craig (1977) taught autistic
children to respond correctly during discrimination tasks involving stimuli
with two available cues. These researchers then engaged the children in prolonged testing by interspersing unreinforced trials with reinforced trials.
Eventually most of the children were able to respond appropriately to both
stimulus cues. Koegel and Schreibman (1977) also successfully taught autistic
children a discrimination task requiring a response to multiple cues. More
recently researchers have utilized discrimination tasks to teach autistic children
learning strategies that are similar to those used by nonhandicapped children.
Schreibman, Charlop, and Koegel (1982) taught autistic children with a history
of overselectivity to respond to multiple cues and utilize an extra-stimulus
prompt. Children were presented with stimuli, each with distinct multiple cues
(e.g., color, shape, size). They were instructed to use these multiple cues when
selecting stimuli. Subjects were subsequently taught to use an extra-stimulus
prompt, consisting of the teacher pointing to a model of the correct stimulus.
Burke and Cerniglia (1990) instructed autistic children in responding to multiple stimulus components. They taught the children to follow one-, two-, three-,
and four-component instructions and discriminate among objects of different
types, sizes, and colors. These researchers then assessed generalization of the
newly taught skills by presenting subjects with multicomponent stimuli in naturalistic settings. The researchers found that after discrimination training, subjects responded more often to multicomponent stimuli in other settings. Burke
and Cerniglia (1990) viewed stimulus overselectivity as a pivotal behavior,
hypothesizing that teaching autistic children to respond to multiple cues will
facilitate their acquisition of other advanced learning strategies such as observational learning.
Researchers have developed behavioral methods to enhance learning in
autistic persons. These methods include task variation, reinforcer type, and
reinforcer variation. Investigators have found that the learning of autistic children is enhanced when they vary tasks during learning sessions. Reinforcer
type differentially affects learning, as sensory reinforcers produce a higher percentage of correct responding than other types of reinforcers. Reinforcer variation, presenting a variety of reinforcers during a treatment session, also
enhances learning. It was hypothesized that these three techniques improve
learning because they are resistant to satiation. The literature on academic
skills training with mentally retarded persons is more extensive than literature
on academic skills training with autistic persons (Weisberg, 1990). However,
autistic children often have unique behaviors that interfere with learning.
Stimulus overselectivity is one such behavior; researchers have successfully
reduced its effects by teaching autistic children to respond to multiple cues.
Recent researchers (Burke & Cerniglia, 1990) hypothesized that stimulus overselectivity is a pivotal behavior. Future studies are needed to evaluate this

Behavioral Treatment of Autism

453

hypothesis, and thereby develop more efficient learning strategies to enhance

the training of autistic persons.
Other Recent Trends in Behavioral Treatment With Autistic Persons

In addition to the aforementioned treatment studies, several trends in behavioral treatment with autistic children have recently emerged. These trends
include specific behavioral strategies that have successfully altered target behaviors. For each trend, target behaviors are not limited to single subject areas, as
each technique was found effective with behaviors across different categories.
Several trends are described below, in conjunction with relevant research.
Empirically derived consequences. Researchers have recently begun evaluating methodologies for developing empirically derived consequences for target
behaviors. These methodologies are based on the principles of functional analysis. They include techniques for assessing reinforcers for use in teaching sessions. Pace, Ivancic, Edwards, Iwata, and Page (1985) developed a two-step
process for assessing reinforcers. Subjects were exposed to 16 stimuli while
observers recorded which stimuli the subjects approached. The potency of the
stimuli as reinforcers was then determined by recording how frequently each
stimulus was approached. Mason, McGee, Farmer-Dougan, and Risley (1989)
developed a reinforcer assessment package with autistic children in which they
implemented the Pace et al. (1985) two-step procedure and conducted daily
mini-assessments by presenting items that had been designated as preferred
reinforcers during the initial comprehensive assessment. The child was
prompted to choose from two items, and the selected items were used as reinforcers for subsequent teaching sessions. Using children with severe handicaps, Fisher et al. (1992) compared the Pace et al. (1985) two-step procedure
with another procedure employing a forced-choice format in which all stimuli
were presented in pairs and the student was prompted to select one of the pair
of stimuli. These researchers found that the forced-choice assessment better
predicted which stimuli would function as more potent reinforcers in a subsequent treatment program. Researchers have recently begun to use empirical
approaches to assess punishers systematically. Fisher et al. (1994) described a
strategy for assessing punishers when they treated children with pervasive
developmental disorders and severe pica. These researchers identified reinforcers using the procedure described by Fisher et al. (1992). To identify punishers, these researchers described a two-step process consisting of a stimulus
avoidance assessment and a punisher assessment. In the stimulus avoidance
assessment, nine potential punishers were presented noncontingently to each
subject in individual sessions. To determine the amount of nonpreference for
each procedure, researchers measured negative vocalizations and avoidance
movements. During the punisher assessment, subjects were presented with
each of three selected punishers (those with the lowest, median, and highest

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J. L. Matson et al.

amount of nonpreference) contingent on target behaviors. The punisher that

produced the greatest reduction in target behaviors was selected as the punisher for subsequent treatment sessions.
B e h a v i o r a l m o m e n t u m . Nevin, Mandell, and Atak (1983) postulated that

learned behavior has momentum: behavior maintained by a schedule of reinforcement may persist over time after reinforcement conditions are changed.
This momentum may be created by increasing the response and reinforcement
rate of a behavior in a particular response class. Mace et al. (1988) applied this
principle when designing an intervention for noncompliance, finding that presenting a series of instructions with a high probability of compliance immediately before an instruction with a low probability of compliance increased the
rate of compliance with the low probability instruction. These researchers concluded that this increase in compliance resulted from the behavioral momentum
created by the series of high probability instructions. Davis, Brady, Williams,
and Hamilton (1992) used a similar methodology, presenting low probability
requests after a series of high probability requests, and successfully used multiple trainers to produce generalized responding. Houlihan, Jacobson, and
Brandon (1994) treated noncompliance in an autistic child by presenting a
series of high probability requests followed by a low probability request, comparing the effectiveness of presenting the low probability request 5 s and 20 s
after the high probability sequence. These researchers found that the shorter
(5 s) interval between high probability and low probability requests produced
significant improvement over baseline, whereas the longer (20 s) interval produced no improvement over baseline. Therefore the length between prompts is
crucial, possibly because the shorter interval increases the rate of reinforcement
for compliance. Davis, Brady, Hamilton, McEvoy, and Williams (1994) gave
autistic children requests with a low probability of response (e.g., share toy)
grouped with high probability requests (e.g., point to toy). Subjects' responsiveness to low probability requests increased, unprompted initiations and
extended interactions to the training peers increased, and levels of initiations or
interactions with peers were maintained even when prompts were removed.
Peer/Sibling interventions. As mentioned previously, treatment studies using

social skills as target behaviors with autistic children have successfully incorporated peers as confederates. Studies addressing other types of target behaviors have successfully used peers as models or as trainers for autistic children.
Researchers began in the 1970s by developing treatment programs based on
the principles of observational learning that incorporated adults as models of
desired behavior (Barry & Overmann, 1977; Varni, Lovaas, Koegel, & Everett,
1979). However studies employing normal peers as models reported more successful results. For example, Coleman and Stedman (1974) reported that an
autistic child appeared to use more appropriate voice tone when exposed to a
normal peer model. In the 1980s, researchers continued to evaluate treatments

Behavioral Treatment of Autism

455

based on observational learning with peer models. Specifically, autistic subjects observed peer models being reinforced for performing target behaviors
(Charlop, Schreibman, & Tryon, 1983; Egel, Richman, & Koegel, 1981).
However, researchers found that treatment strategies that directly taught target
behaviors to autistic subjects were superior to those that merely exposed subjects to peer models (Blew, Schwartz, & Luce, 1985; Charlop & Walsh, 1986).
Researchers have also used peers and siblings as trainers for autistic subjects
by teaching the peer or sibling to implement various behavioral procedures. For
example, Schreibman, O'Neill, and Koegel (1983) taught siblings of autistic
children to implement behavior modification procedures, including reinforcement and extinction, to teach behaviors such as discrimination and expressive
labeling. The siblings were able to elicit significant increases in target behaviors. Mangus, Henderson, and French (1986) successfully taught peer tutors to
implement a token economy with autistic children to increase on-task behavior.
Coe, Matson, Craigie, and Gossen (199 l) taught siblings of autistic children to
prompt and reinforce play skills, producing significant increases in these skills.
Kamps, Barbetta, Leonard, and Delquadri (1994) trained nonhandicapped peers
to serve as tutors to autistic students and found significant increases in reading
fluency, correct responses to comprehension questions, and duration of social
interactions. Researchers have also taught peers to implement incidental teaching procedures with autistic subjects. McGee, Almeida, Sulzer-Azaroff, and
Feldman (1992) successfully instructed nonhandicapped peers to use incidental
teaching to increase labeling of preferred toys. Handicapped peers have also
been successfully taught to use incidental teaching procedures. Farmer-Dougan
(1994) taught group home residents to use incidental teaching procedures to
increase the number of appropriate requests and verbalizations by fellow residents with mental retardation and autism.
Parent-mediated interventions. Since the 1970s, a number of studies have

evaluated the effectiveness of teaching parents behavioral principles and techniques in working with their autistic children. These have included studies
reporting outcome of parent training groups. Koegel, Schreibman, Britten,
Burke, and O'Neill (1982) provided a group of parents of autistic children with
25 to 50 hr of training in behavior modification. The researchers then compared these children with a group of autistic children receiving 4 to 5 hr of outpatient treatment. They found that only the children whose parents received
training generalized improvements in appropriate behavior to the home setting.
Harris, Wolchik, and Milch (1982) also trained groups of parents of autistic
children in behavior modification, finding significant improvements in the
children's language and in the parents' behavior modification skills. Lovaas
(1987) reported the results of a comprehensive early intervention program for
children with autism, in which parents were trained to be the primary therapists in an intensive home-based training program for young autistic children.
Treatment was conducted for approximately 40 hr a week for at least 2 years.

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J. L. Matson et al.

Intellectual level and educational placements of these children were compared

to children who received approximately 10 hr of individual treatment or no
treatment. According to outcome data, 47% of the children receiving intensive
treatment were educationally and intellectually normal, whereas in the control
groups, only one child was placed in a regular class. Despite the success of
these group outcome studies, Koegel, Glahn, and Nieminen (1978) found that
parents of autistic children successfully learned skills to teach specific behaviors to their children, but were unable to generalize these skills to teach other
behaviors not originally targeted for training. A number of studies utilizing
single-case methodology, in which parents were instructed in treating specific
skills, have been published. Laski, Charlop, and Schreibman (1988) trained
parents to use the natural language paradigm to increase speech in their autistic
children. These researchers found that the training program produced significant increases in parent's requests for verbalizations and in the autistic children's appropriate speech. Love, Matson, and West (1990) trained mothers of
autistic children with phobias to implement a treatment program utilizing participant modeling procedures. These researchers reported a significant increase
in approach behaviors and decreases in verbalizations and vocalizations of
fear. Charlop and Trasowech (1991) trained parents of autistic children to use a
time delay procedure to increase spontaneous speech in naturally occurring
settings. This approach yielded rapid increases in spontaneous speech, and the
researchers reported maintenance of up to 30 months. Finally, Krantz, MacDuff,
and McClannahan (1993) taught parents of autistic children to help their children follow photographic schedules depicting various activities, including
leisure, social interaction, self-care, and housekeeping tasks. The researchers
found significant increases in social engagement and decreases in disruptive
behavior. The results of studies thus far are promising and show that parents of
autistic children are capable of learning behavioral techniques to increase and
decrease their children's target behaviors.
Self-management. Self-management is a treatment technique that has been found

effective with persons with and without disabilities (O'Leary & Dubey, 1979).
This technique consists of teaching subjects to monitor occurrences of appropriate behavior and nonoccurrences of inappropriate behavior and of reinforcing
subjects who do so accurately. The schedule of reinforcement is gradually
thinned. In children without disabilities, researchers have successfully used this
technique to increase speech sounds (Koegel, Koegel, & Ingham, 1986) and academic skills (Harris, 1986). According to Koegel and Koegel (1990), self-management is beneficial because this procedure may be used for extended time
periods without the presence of a treatment provider, and self-management techniques may be employed in a variety of settings. Koegel and Koegel (1990)
evaluated the use of self-management in treating the stereotypic behavior of
autistic children. These researchers taught subjects at school and other community settings to record nonoccurrences of stereotypic behavior and reinforced sub-

Behavioral Treatment of Autism

457

jects for accuracy. Prompts were eventually faded and the schedule of reinforcement was thinned. The researchers found that the subjects were able to record
nonoccurrences of stereotypic behavior accurately and decreased the number of
occurrences of this behavior. Koegel, Koegel, Hurley, and Frea (1992) used selfmanagement to increase social skills in autistic children and found that the procedure simultaneously decreased disruptive behavior. The authors hypothesized
that as the children leamed to interact more effectively with others, conversational interactions became less aversive and less likely to result in disruptive behavior motivated by escape or avoidance. Stahmer and Schreibman (1992) used
self-management to increase appropriate play in children with autism and found
that as play skills increased, self-stimulatory behaviors decreased. Subjects also
generalized play behavior to multiple settings. Koegel and Frea (1993) utilized
self-management to increase social behavior in children with autism and found
that technique resulted in improvements in social behavior, as well as generalized changes in social behaviors not targeted for treatment. Finally, Pierce and
Schreibman (1994) successfully implemented pictorial self-management, a technique in which children with autism were trained to use picture prompts to perform daily living skills and to self-reinforce upon completion of tasks. The
authors concluded that this procedure was effective in the absence of supervision, and was useful for young, low-functioning children with autism.
SUMMARY AND FUTURE DIRECTIONS
Since 1980 the database on behavioral treatment of autism has increased
dramatically. Categories of target behaviors addressed include aberrant behaviors, social skills, language, daily living skills, and academic skills. In the area
of aberrant behaviors, researchers have developed functional analysis, a
sophisticated method for determining the most effective treatment. Researchers
are also developing ways to enhance the effectiveness of reinforcement-based
and less intrusive aversive treatment procedures. In the area of social skills,
investigators are focusing on methods to facilitate generalization of social
behaviors. These methods include use of peer confederates, loose training, and
changing pivotal behaviors. With regard to language interventions, the primary
focus has been on generalization. Techniques for enhancing generalization
include incidental teaching, the natural language paradigm, and time delay.
The majority of language interventions have targeted expressive language. In
the area of dally living skills, four skill categories were identified, including
self-help, community, leisure, and vocational skills. Using autistic subjects,
researchers have evaluated techniques for increasing daily living skills proven
effective with mentally retarded persons. One technique is task analysis. With
regard to academic skills, investigators have evaluated techniques for facilitating learning in autistic children. Techniques include task variation, reinforcer
type, and reinforcer variation. Methods to remediate stimulus overselectivity
have also been developed.

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J. L. Matson et al.

Several trends in behavioral treatment research have become prominent

since 1980. Researchers began using consequences derived using the principles
of functional analysis for target behaviors. They found that empirically derived
consequences produced more potent treatment effects. Researchers also documented the concept of behavioral momentum, reporting that behavior may persist for a period of time after the schedule of reinforcement has been changed.
This led to new treatments for noncompliance and social skills deficits. There
is also a growing trend for investigators to use peers, siblings, and parents as
models or trainers of appropriate behavior. Researchers have reported that
involving these significant others enhanced treatment effects and promoted
generalization. Finally, investigators have evaluated the use of self-management, a treatment technique proven effective with children without disabilities.
Recent studies have proven that this technique can produce significant changes
in the behavior of autistic children.
Since 1980, research on behavioral treatment of autistic children has
become increasingly sophisticated. Researchers have addressed a multitude of
target behaviors and developed more efficient methods to modify these behaviors. Yet there is a need for continued research in this area. Researchers have
found that many techniques that are effective with mentally retarded persons
are equally appropriate for autistic persons. However, many areas of behavioral treatment addressed extensively with mentally retarded persons have yet
to be thoroughly evaluated with autistic persons. This is particularly true in the
areas of daily living skills and academic interventions.
Investigators have recognized the need for effective assessment techniques
to ensure implementation of the most appropriate treatment. Functional analysis is one assessment technique; researchers have found that it is a powerful
tool for efficient treatment selection. This technique has proven successful
with autistic persons and should be investigated further. Researchers have
already documented well the success of this technique with aberrant behaviors.
However, future studies should determine whether functional analysis may be
applied to other categories of behavior.
Generalization is one of the most difficult challenges facing teachers of
autistic persons. Numerous studies have evaluated techniques for increasing
generalization of newly learned behaviors. Studies have shown that generalization is enhanced when autistic subjects are trained in their natural environments, as demonstrated by the successes of incidental teaching and the natural
language paradigm. The use of peers, siblings, or parents in treatment also
facilitates generalization, as the autistic child learns to emit target behavior
around others who are part of the child's environment.
In addition, there is also a growing trend towards streamlining treatment
methods to conserve time and effort. Researchers developed treatments based
on the concept of pivotal behaviors, which postulates that changes in one
behavior may produce changes in collateral behaviors. This procedure holds
great potential for autistic children, as this may significantly decrease the num-

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459

ber of behaviors requiring direct treatment. Self-management is another procedure that may significantly increase treatment efficiency. Since the subject is
taught to monitor his or her own behavior, implementation of this technique
may decrease the amount of time the therapist is required to be present. Future
studies should continue to evaluate these techniques, particularly by further
classifying groups of collateral behaviors and determining which behaviors are
best targeted for these methods.
The amount of research on behavioral treatment with autistic persons has
significantly increased since 1980 and will continue to do so. Treatment techniques have become increasingly sophisticated and efficient. Consequently
there are many areas in this field which will benefit from continued research.
REFERENCES
Azrin, N. H., Gottlieb, L., Hughart, L., Wesolowski, M. D., & Rahn, T. (1975). Eliminating selfinjurious behavior by educative procedures. Behaviour Research and Therapy, 13, 101-111.
Bah'era, R. D., Lobato-Barrera, D., & Sulzer-Azaroff, B. (1980). A simultaneous treatment comparison of three expressive language training programs with a mute autistic child. Journal of
Autism and Developmental Disorders, 10, 21-37.
Barrera, R. D., & Sulzer-Azaroff, B. (1983). An alternating treatment comparison of oral and total
communication training programs with echolalic autistic children. Journal of Applied Behavior
Analysis, 16, 379-394.
Barry, N. J., & Overman, P. B. (1977). Comparison of the effectiveness of adult and peer models
with EMR children. American Journal of Mental Deficiency, 82, 33-36.
Bettelheim, B. (1967). The empty fortress. NY: Free Press.
Bird, E, Dotes, P. A., Moniz, D., & Robinson, J. (1989). Reducing severe aggressive and self-injurious behaviors with functional communication training. American Journal on Mental Retardation,
94, 37-48.
Blew, P. E, Schwartz, I. S., &Luce, S. C. (1985). Teaching functional community skills to autistic
children using nonhandicapped peer tutors. Journal of Applied Behavior Analysis, 18, 337-342.
Brady, M. P., McEvoy, M. A., Wehby, J., & Ellis, D. (1987). Using peers as trainers to increase an
autistic child's social interactions. The Exceptional Child, 34, 213-219.
Brady, M. P., Shores, R. E., McEvoy, M. A., Ellis, D., & Fox, J. J. (1987). Increasing social interactions of severely handicapped autistic children. Journal of Autism and Developmental
Disorders, 17, 375-390.
Burke, J. C., & Cerniglia, L. (1990). Stimulus complexity and autistic children's responsivity:
Assessing and training a pivotal behavior. Journal of Autism and Developmental Disorders, 20,
233-353.
Campbell, C. R., & StremeI-Campbell, K. (1982). Programming Loose Training as a strategy to
facilitate language acquisition. Journal of Applied Behavior Analysis, 15, 295-301.
Can-, E. G., & Durand, V. M. (1985). Reducing behavior problems through functional communication training. Journal of Applied Behavior Analysis, 18, 111-126.
Carr, E. G., & Kologinsky, E. (1983). Acquisition of sign language by autistic children: II.
Spontaneity and generalization effects. Journal of Applied Behavior Analysis, 16, 297-314.
Carr, E. G., Newsom, C. D., & Binkoff, J. A. (1976). Stimulus control of self-destructive behavior
in a psychotic child. Journal of Abnormal Child Psychology, 4, 139-153.
Carr, E. G., Schreibman, L., & Lovaas, O. I. (1975). Control of echolalic speech in psychotic children. Journal of Abnormal Child Psychology, 3, 331-351.
Charlop, M. H., Burgio, L. D., Iwata, B. A., & Ivancic, M. T. (1988). Stimulus variation as a
means of enhancing punishment effects. Journal of Applied Behavior Analysis, 18, 89-95.

460

J. L. Matson et al.

Charlop, M. H., Schreibman, L., & Thibodeau, M. G. (1985). Increasing spontaneously verbal
responding in autistic children using a time delay procedure. Journal ofApplied Behavior Analysis,
18, 155-166.
Charlop, M. H., Schreibman, L., & Tryon, A. S. (1983). Learning through observation: The effects
of peer modeling on acquisition and generalization in autistic children. Journal of Abnormal
Child Psychology, U, 355-366.
Charlop, M. H., & Trasowech, J. E. (1991). Increasing autistic children's daily spontaneous
speech. Journal of Applied Behavior Analysis, 24, 747-761.
Charlop, M. H., & Walsh, M. E. (1986). Increasing autistic children's spontaneous verbalizations
of affection: An assessment of time delay and peer modeling procedures. Journal of Applied
Behavior Analysis, 19, 307-314.
Coe, D. A., Matson, J. L., Craigie, C. J., & Gossen, M. A. (1991). Play skills of autistic children:
Assessment and instruction. Ctu'ld & Family Behavior Therapy, 13, 13-40.
Coe, D., Matson, J., Fee, V., Manikam, R., & Linarello, C. (1990). Training nonverbal and verbal
play skills in mentally retarded and autistic children. Journal of Autism and Developmental
Disorders, 20, 177-187.
Cohen, M. (1981). Development of language behavior in an autistic child using total communication. Exceptional Children, 47, 379-381.
Coleman, S. L., & Stedman, J. M. (1974). Use of a peer model in language training in an echolalic
child. Journal of Behavior Therapy and Experimental Psychiatry, 5, 275-279.
Danforth, J. S., & Drabman, R. S. (1990). Community living skills. In J. L. Matson (Ed.), Handbook
of behavior modification with the mentally retarded (2nd ed., pp. 305-329). NY: Plenum.
Davis, C. A., Brady, M. P., Hamilton, R., McEvoy, M. A., & Williams, R. E. (1994). Effects of
high-probability requests on the social interactions of young children with severe disabilities.
Journal of Applied Behavior Analysis, 27, 619-637.
Davis, C. A., Brady, M. P., Williams, R. E., & Hamilton, R. (1992). Effects of high-probability
requests on the acquisition and generalization of responses to requests in young children with
behavior disorders. Journal of Applied Behavior Analysis, 25, 905-916.
DeMyer, M. K., Hingtgen, J. N., & Jackson, R. K. (1981). Infantile autism reviewed: A decade of
research. Schizophrenia Bulletin, 7, 388-451.
Dietz, S. M., & Repp, A. L. (1973). Decreasing classroom misbehavior through the use of DRL
schedules of reinforcement. Journal of Applied Behavior Analysis, 6, 457-463.
Dunlap, G., and Koegel, R. L. (1980). Motivating autistic children through stimulus variation.
Journal of Applied Behavior Analysis, 13, 619-627.
Durand, V. M., & Carr, E. G. (1992). An analysis of maintenance following functional communication training. Journal of Applied Behavior Analysis, 25, 777-794.
Egel, A. L. (1981). Reinforcer variation: Implications for motivating developmentally disabled
children. Journal of Applied Behavior Analysis, 14, 345-350.
Egel, A. L., Richman, G. S., & Koegel, R. L. (1981). Normal peer models and autistic children's
learning. Journal of Applied Behavior Analysis, 14, 3-12.
Egel, A. L., Shafer, M. S., & Neef, N. A. (1984). Receptive acquisition and generalization of
prepositional responding in autistic children: A comparison of two procedures. Analysis and
Intervention in Developmental Disabilities, 4,285-298.
Elliott, R. O., Hall, K., & Soper, H. V. (1991). Analog language teaching versus natural language
teaching: Generalization and retention of language learning for adults with autism and mental
retardation. Journal of Autism and Developmental Disorders, 21, 433-447.
Epstein, L. H., Doke, L. A., Sajwaj, T. E., Sorell, S., & Rimmer, B. (1974). Generality and side
effects of overcorrection. Journal of Applied Behavior Analysis, 7, 385-390.
Farmer-Dougan, V. (1994). Increasing requests by adults with developmental disabilities using
incidental teaching by peers. Journal of Applied Behavior Analysis, 27, 533-544
Favell, J. E., McGimsey, J. E, & Jones, M. L. (1978). The use of physical restraint in the treatment
of self-injury and as positive reinforcement. Journal of Applied Behavior Analysis, 11, 225-241.

Behavioral Treatment of Autism

461

Ferrari, M., & Harris, S. L. (1981). The limits and motivating potential of sensory stimuli as reinforcers for autistic children. Journal of Applied Behavior Analysis, 14, 339-343.
Ferster, C. B. (1961). Positive reinforcement and behavioral deficits in autistic children. ChiM
Development, 32, 437-456.
Fisher, W., Piazza, C., Bowman, L. G., Hagopian, L. P., Owens, J. C., & Slevin, I. (1992). A comparison of two approaches for identifying reinforcers for persons with severe to profound disabilities. Journal of Applied Behavior Analysis, 25, 491-498.
Fisher, W. W., Piazza, C. C., Bowman, L. G., Kurtz, P. F., Sherer, M. R., & Lachman, S. R. (1994).
Preliminary evaluation of empirically derived consequences for the treatment of pica. Journal
of Applied Behavior Analysis, 27, 447-457.
Foxx, R. M., & Azrin, N. H. (1973). The elimination of autistic self-stimulatory behavior by over
correction. Journal of Applied Behavior Analysis, 6, 1-14.
Freeman, B. J., Ritvo, E., & Miller, R, (1975). An operant procedure to teach an echolalic, autistic
child to answer questions appropriately. Journal of Autism and Childhood Schizophrenia, 5,
169-176.
Gaylord-Ross, R. J., Hating, T. G., Breen, C., & Pitts-Conway, V. (1984). The training and generalization of social interaction skills with autistic youth. Journal of Applied Behavior Analysis,
17, 229-247.
Goldstein, H., & Wickstrom, S. (1986). Peer intervention effects on communicative interaction
among handicapped and nonhandicapped preschoolers. Journal of Applied Behavior Analysis,
19, 209-214.
Halle, J. W., Marshall, A. M., & Spradlin, J. E. (1979). Time delay: A technique to increase language use and facilitate generalization in retarded children. Journal of Applied Behavior
Analysis, 12, 431-439.
Haring, T. G., & Kennedy, C. H. (1990). Contextual control of problem behavior in students with
severe disabilities. Journal of Applied Behavior Analysis, 23B, 235-243,
Hating, T. G., Kennedy, C. H., Adams, M. J., & Pitts-Cnnway, V. (1987). Teaching generalization
of purchasing skills across community settings to autistic youth using videotape modeling.
Journal of Applied Behavior Analysis, 20, 89-96.
Hating, T. G., & Lovinger, L. (1989). Promoting social interaction through teaching generalized
play initiation responses to preschool children with autism. Journal of the Association for
Persons With Severe Handicaps, 14, 58-67.
Harris, K. R. (1986). Self-monitoring of attentional behavior versus self-monitoring of productivity: Effects on on-task behavior and academic response rate among learning disabled children.
Journal of Applied Behavior Analysis, 19, 417-423.
Harris, S. L. (1988). Autism and schizophrenia: Psychological therapies. In J. L. Matson (Ed.),
Handbook of treatment approaches in childhood psychopathology (pp. 279-300). NY: Plenum.
Harris, S. L., Wolchik, S. A., & Milch, R. E. (1982). Changing the speech of autistic children and
their parents. Child and Family Behavior Therapy, 4, 15 I-173.
Hart, B. M., & Risley, T. R. (1975). Incidental teaching of language in the preschool. Journal of
Applied Behavior Analysis, 8, 411-420.
Hawkins, A. H. (1982). Influencing leisure choices of autistic-like children. Journal of Autism and
Developmental Disorders, 12, 359-366.
Herendeen, D. L., Jeffrey, D. B., & Graham, M. C. (1974, November). Reduction of self-stimulation in institutionalized children: Overcorrection and reinforcement for nonresponding. Paper
presented at the eighth annual meeting of the Association for the Advancement of Behavior
Therapy, Chicago.
Hingtgen, J. N., & Bryson, C. Q. (1972). Recent developments in the study of early childhood psychoses: Infantile autism, childhood schizophrenia, and related disorders. Schizophrenia
Bulletin, 5, 8-54.
Homer, R. D., & Keilitz, I. (1975). Training mentally retarded adolescents to brush their teeth.
Journal of Applied Behavior Analysis, 8, 301-309.

462

J. L. Matson et al.

Houlihan, D., Jacobson, L., & Brandon, E K. (1994). Replication of a high-probability request
sequence with varied interprompt times in a preschool setting. Journal of Applied Behavior
Analysis, 27, 737-738.
Huguenin, N. H., Weidenman, L. E., & Mulick, J. A. (1991). Programmed instruction. In J. L.
Matson & J. A. Mulick (Eds.), Handbook of mental retardation (2nd ed., pp. 451-467). NY:
Plenum.
Ingenmey, R., & VanHouten, R. (1991). Using time delay to promote spontaneous speech in an
autistic child. Journal of Applied Behavior Analysis, 24, 591-596.
Iwata, B. A., Dorsey, M. E, Slifer, K. J., Bauman, K. E., & Richman, G. S. (1982). Toward a functional analysis of self-injury. Analysis and Intervention in Developmental Disabilities, 2, 3-20.
Kamps, D. M., Barbetta, P. M., Leonard, B. R., & Delquadri, J. (1994). Classwide peer tutoring:
An integration strategy to improve reading skills and promote peer interactions among students
with autism and general education peers. Journal of Applied Behavior Analysis, 27, 49-61.
Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2, 217-250.
Koegel, R. L., Firestone, P. B., Kramme, K. W., & Dunlap, G. (1974). Increasing spontaneous play
by suppressing self-stimulation in autistic children. Journal of Applied Behavior Analysis, 7,
521-528.
Koegel, R. L., & Frea, W. D. (1993). Treatment of social behavior in autism through the modification of pivotal social skills. Journal of Applied Behavior Analysis, 26, 369-377.
Koegel, R. L., Glahn, T. J., & Nieminen, G. S. (1978). Generalization of parent training results.
Journal of Applied Behavior Analysis, 11, 95-109.
Koegel, R. L., & Koegel, L. K. (1990). Extended reductions in stereotypic behavior of students
with autism through a self-management treatment package. Journal of Applied Behavior
Analysis, 23, 119-127.
Koegel, L. K., Koegel, R. L., Hurley, C., & Frea, W. D. (1992). Improving social skills and disruptive behavior in children with autism through self-management. Journal of Applied Behavior
Analysis, 25, 341-353.
Koegel, L. K., Koegel, R. L., & Ingham, J. C. (1986). Programming rapid generalization of correct
articulation through self-monitoring procedures. Journal of Speech and Hearing Disorders, 51,
24-32.
Koegel, R. L., Koegel, L. K., & Schreibman, L. (1991). Assessing and training parents in teaching
pivotal behaviors. In R. J. Prinz (Ed.), Advances in behavioral assessment of chiMren and families (Vol. 5, pp. 65-82). London: Jessica Kingsley.
Koegel, R. L., O'Dell, M. C., & Koegel, L. K. (1987). A natural language teaching paradigm for
nonverbal autistic children. Journal of Autism and Developmental Disorders, 17, 187-200.
Koegel, R. L., & Schreibman, L. (1977). Teaching autistic children to respond to simultaneous
multiple cues. Journal of Experimental Child Psychology, 24, 299-311.
Koegel, R. L., Schreibman, L., Britten, K. R., Burke, J. C., & O'Neill, R. E. (1982). A comparison
of parent training to direct child treatment. In R. L. Koegel, A. Rincover, & A. L. Egel (Eds.),
Educating and understanding autistic children (pp. 65-77). San Diego: College-Hill Press.
Krantz, P. J., MacDuff, M. T., & McClannahan, L. E. (1993). Programming participation in family
activities for children with autism: Parents use of photographic activity schedules. Journal of
Applied Behavior Analysis, 26, 137-138.
Laski, K. E., Charlop, M. H., & Schreibman, L. (1988). Training parents to use the natural language paradigm to increase their autistic children's speech. Journal of Applied Behavior
Analysis, 21, 391-400.
LaVigna, G. W., & Donnellan, A. M. (1986). Alternatives to punishment: Solving behaviorproblems with nonaversive strategies. NY: Irvington
Lovaas, O. I. (1977). The autistic child: Language development through behavior modification.
NY: Irvington Publishers.
Lovaas, O. I. (1981). Teaching developmentally disabled children. Baltimore: University Park
Press.

Behavioral Treatment of Autism

463

Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in
young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9.
Lovaas, O. I., Berberich, J. P., Perloff, B. F., & Schaeffer, B. (1966). Acquisition of imitative
speech in schizophrenic children. Science, 151, 705-707.
Lovaas, O. I., Koegel, R. L., & Schreibman, L. (1979). Stimulus overselectivity in autism: A
review of research. Psychological Bulletin, 86, 1236-1254.
Lovaas, O. I., Schaeffer, B., & Simmons, J. Q. (1965). Building social behavior in autistic children
by use of electric shock. Journal of Experimental Research and Personality, 1, 99-109.
Lovaas, O. I., & Simmons, J. Q. (1969). Manipulation of self-destruction in three retarded children. Journal of Applied Behavior Analysis, 2, 143-157.
Love, S. R., Matson, J. L., & West, D. (1990). Mothers as effective therapists for autistic children's phobias. Journal of Applied Behavior Analysis, 23, 379-385.
Mace, E, Hoch, M., Lalli, J., West, B., Belfiore, P., Pinter, E., & Brown, D. (1988). Behavioral
momentum in the treatment of noncompliance. Journal of Applied Behavior Analysis, 21,
123-141.
Mangus, B., Henderson, H., & French, R. (1986). Implementation of a token economy by peer
tutors to increase on-task physical activity time of autistic children. Perceptual and Motor
Skills, 63, 97-98.
Mason, S. A., McGee, G. G., Farmer-Dougan, V., & Risley, T .R. (1989). A practical strategy for
ongoing reinforcer assessment. Journal of Applied Behavior Analysis, 22, 171-179.
Matson, J. L., & Kazdin, A. E. (1981). Punishment in behavior modification: Pragmatic, ethical
and legal issues. Clinical Psychology Review, 1, 197-210.
Matson, J. L., & Taras, M. E. (1989). A 20 year review of punishment and alternative methods to
treat problem behaviors in developmentally delayed persons. Research in Developmental
Disabilities, 10, 85-104.
Matson, J. L., Taras, M. E., Sevin, J. A., Love, S. R., & Fridley, D. (1990). Teaching self-help
skills to autistic and mentally retarded children. Research in Developmental Disabilities, 11,
361-378.
McEvoy, M. A., Nordquist, V. M., Twardosz, S., Heckaman, K. A., Wehby, J. H., & Denny, R. K.
(1988). Promoting autistic children's peer interaction in an integrated early childhood setting
using affection activities. Journal ofApplied Behavior Analysis, 21, 193-200.
McGee, G. G., Almeida, C., Sulzer-Azaroff, B., & Feldman, R. S. (1992). Promoting reciprocal
interactions via peer incidental teaching. Journal of Applied Behavior Analysis, 25, 117-126.
McGee, G. G., Krantz, P. J., & McClannahan, L. E. (1985). The facilitative effects of incidental
teaching on preposition use by autistic children. Journal of Applied Behavior Analysis, 18, 17-31.
Mulhern, I., & Baumeister, A. A. (1969). An experimental attempt to reduce stereotypy by reinforcement procedures. American Journal of Mental Defic&ncy, 74, 69-74.
National Institute of Mental Health (1975). Research in the service of mental health. Rockville,
MD: Author.
Neef, N. A., & Iwata, B. A. (1994). Current research on functional analysis methodologies: An
introduction. Journal of Applied Behavior Analysis, 27, 211-214.
Nevin, J., Mandell, C., & Atak, J. (1983). The analysis of behavioral momentum. Journal of the
Experimental Analysis of Behavior, 39, 49-59.
Newsom, C., Hovanitz, C., & Rincover, A. (1988). Autism. In E. J. Mash & L. G. Terdal (Eds.),
Behavioral assessment of childhood disorders (pp. 355--401). NY: Guilford.
Newsom, C., & Rincover, A. (1989). Autism. In E. J. Mash & R. A. Barkley (Eds.), Treatment of
childhood disorders (pp. 286-346). NY: Guilford.
Odom, S. L., & Strain, P. S. (1986). A comparison of peer-initiation and teacher-antecedent interventions for promoting reciprocal social interaction of autistic preschoolers. Journal of Applied
Behavior Analysis, 19, 59-71.
O'Leary, S. G., & Dubey, D. R. (1979). Applications of self-procedures by children: A review.
Journal of Applied Behavior Analysis, 12, 449--465.

464

J. L. Matson et al.

Pace, G. M., Ivancic, M. T., Edwards, G. L., Iwata, B., & Page, T. J. (1985). Assessment of stimulus preference and reinforcer value with profoundly retarded indivduals. Journal of Applied
Behavior Analysis, 18, 249-255.
Pierce, K. L., & Schreibman, L. (1994). Teaching daily living skills to children with autism in unsupervised settings through pictorial self-management. Journal of Applied Behavior Analysis, 27,
471-481.
Ragland, E. U., Kerr, M. M., & Strain, P. S. (1978). Effects of peer social initiations on the behavior of withdrawn autistic children. Behavior Modification, 2, 565-578.
Reid, D. H., Wilson, P. G., & Faw, G. D. (1991). Programmed instruction. In J. L. Matson & J. A.
Mulick (Eds.), Handbook of mental retardation (2nd ed., pp. 436~150). NY: Plenum.
Repp, A. C., & Deitz, D. E. (1978). On the selective use of punishment - - suggested guidelines
for administrators. Mental Retardation, 16, 250-254.
Rincover, A. (1978). Variables affecting stimulus-fading and discriminative responding in psychotic children. Journal of Abnormal Psychology, 87, 541-553.
Rincover, A., & Newsom, C. D. 0985). The relative motivational properties of sensory and edible
reinforcers in teaching autistic children. Journal of Applied Behavior Analysis, 18, 237-248.
Risley, T. R. (1968). The effects and side effects of punishing the autistic behaviors of a deviant
child. Journal of Applied Behavior Analysis, 1, 21-34.
Risley, T. R., & Wolf, M. (1967). Establishing functional speech in echolalic children. Behaviour
Research and Therapy, 5, 73-88.
Sasso, G. M., Reimers, T. M., Cooper, L. J., Wacker, D., Berg, W., Steege, M., Kelly, L., &
Allaire, A. (1992). Use of descriptive and experimental analyses to identify the functional properties of aberrant behavior in school settings. Journal of Applied Behavior Analysis, 25,
809-821.
Schepis, M. M., Reid, D. H., Fitzgerald, J. R., Faw, G. D., VanDenPol, R. A., & Welty, P. (1982).
A program for increasing manual signing by autistic and profoundly retarded youth within the
dally environment. Journal of Applied Behavior Analysis, 15, 363-379.
Schreibman, L. (1988). Autism. NY: Sage.
Schreibman, L., & Carr, E. G. (1978). Elimination of echolalic responding to questions through
the training of a generalized verbal response. Journal of Applied Behavior Analysis, 11,
453-463.
Schreibman, L., Charlop, M. H., & Koegel, R. L. (1982). Teaching autistic children to use extrastimulus prompts. Journal of Experimental Child Psychology, 33, 475-491.
Schreibman, L., Koegel, R. L., & Craig, M. S. (1977). Reducing stimulus overselectivity in autistic children. Journal of Abnormal Child Psychology, 5, 425-436.
Schreibman, L., O'Neill, R. E., & Koegel, R. L. (1983). Behavioral training for siblings of autistic
children. Journal of Applied Behavior Analysis, 16, 129-138.
Shafer, M. S., Egel, A. L., & Neef, N. A. (1984). Training mildly handicapped peers to facilitate
changes in the social interaction skills of autistic children. Journal of Applied Behavior Analysis,
17, 461-476.
Smith, M. D., & Belcher, R. (1985). Teaching life skills to adults disabled by autism. Journal of
Autism and Developmental Disorders, 15, 163-175.
Smith, M. D., & Coleman, D. (1986). Managing the behavior of adults with autism in the job setting. Journal of Autism and Developmental Disorders, 16, 145-154.
Stahmer, A. C., & Schreibman, L. (1992). Teaching children with autism appropriate play in unsupervised environments using a self-management treatment package. Journal of Applied Behavior
Analysis, 25, 447-459.
Steinborn, M., & Knapp, T. J. (1982). Teaching an autistic child pedestrian skills. Journal of
Behavior Therapy and Experimental Psychiatry, 13, 347-351.
Strain, E S. (1983). Generalization of autistic children's social behavior change: Effects of
developmentally integrated and segregated settings. Analysis and Intervention in Developmental

Disabilities, 3, 23-34.

Behavioral Treatment of Autism

465

Strain, P. S., Kerr, M. M., & Ragland, E. U. (1979). Effects of peer-mediated social interactions
and prompting/reinforcement procedures on the social behavior of autistic children. Journal of
Autism and Developmental Disorders, 9, 41-54.
Sulzer-Azaroff, B., & Mayer, G. R. (1977). Applying behavior analysis procedures with children
and youth. NY: Holt, Rinehart and Winston.
Tanner, B. A., & Zeiler, M. (1975). Punishment of self-injurious behavior using aromatic ammonia
as the aversive stimulus. Journal of Applied Behavior Analysis, 8, 53-57.
Taras, M. E., & Matese, M. (1990). Acquisition of self-help skills. In J. L. Matson (Ed.), Handbook
of behavior modification with the mentally retarded (2nd ed., pp. 273-303). NY: Plenum.
Tryon, A. S., & Keane, S. P. (1986). Promoting imitative play through generalized observational
learning in autisticlike children. Journal of Abnormal Child Psychology, 14, 537-549.
Varni, J., Lovaas, O. I., Koegel, R. L., & Everett, N. L. (1979). An analysis of observational learning in autistic and normal children. Journal of Abnormal Child Psychology, 7, 31-43.
Weber, R. C., & Thorpe, J. (1989). Comparison of task variation and constant task methods for
severely disabled in physical education. Adapted Physical Activity Quarterly, 6, 338-353.
Weisberg, P. (1990). Academic training. In J. L. Matson (Ed.), Handbook of behavior modification
with the mentally retarded. NY: Plenum.
Wolery, M., Kirk, K., & Gast, D. L. (1985). Stereotypic behavior as a reinforcer: Effects and side
effects. Journal of Autism and Developmental Disorders, 15, 149-161.