Running head: History and Behavioral impact of computer on individual with Autism

History and Behavioral Impact of Computer on Individual with Autism.

Edrian M. Sani

Presented to: Dr. Claudia E. McDade

10-11-99

Independent Research Readings

Jacksonville State University

The History of Autism

Autism can be identified in written history according Uta Frith (1989a) from very early times, as far back as several hundred years B.C.. Likewise, autistic children and adults have been at various times in history held in high esteem, (e.g., Africa, Europe, the movie-Rain Man), and at others have been the victims of infanticide (e.g., China, India, Indonesia, Scotland, Spartans). Folktales and stories that have been handed down from generation to generation tell a story of some naive or simple odd individuals with a Astriking lack of common sense with an over literal understanding of communication - a very characteristic feature of high functioning individuals with autism.@ (Happe, 1995). Examples of names revered by people ranges from moon child, changling, blessed fools and fairy child. In contrast, to those who feared them, they are called as the lost soul, demons possessed, wild child, or children whose spirits have been stolen by spirits. In the past and even in the present, autistic individuals who are feared are killed, caged, or left alone in isolated islands, mountains or hidden by families for humane reasons from society.

Autism is a "syndrome@ or a collection of characteristics. Some of these may be less pronounced in some persons, while obvious in others. It is now recognized that autism is a biological condition caused by brain damage or abnormalities and not the result of parental personalities.

The term Aautism@ comes from Eugen Bleuler (1908), who used the Greek word "AUTOS,@ meaning "SELF" to describe the social withdrawal seen with adults with dementia praecox , now known as schizophrenia. (Happe, 1995) That describes the principal characteristics of autism: withdrawal into self, self-centeredness, lack of focus on others, and disturbed social interaction patterns with others.

Definition of Autism. According to the Autism Society of America (1996), autism is defined as:

A severally incapacitating, lifelong developmental disability that typically appears during the first three years of life. The result of a neurological disorder that affects functioning of the brain, autism, and its behavioral symptoms, occur in approximately fifteen out of every 10,000 births. Autism is four times more common in boys than girls. It has been found throughout the world in families of all racial, ethnic, and social backgrounds. No known factor in the psychological environment has been shown to cause autism.

The delusional thinking of some schizophrenia individuals was described: AThe reality of the autistic world may also be seemed more valid than that of reality itself; the patients then hold their fantasy world for the real, reality for an illusion. The autistic world has as much reality for the patient as the true one, but his is a different kind of reality. Frequently, they cannot keep the two kinds of reality separated from each other even though they can make the distinction in principle.@ (Blueler, 1950; Kanner, 1973).

Early infantile autism was first described in the literature when Autistic Disturbance of Affective Contact was published in 1943 by Dr. Leo Kanner, a psychiatrist. The early research by Kanner concluded that Athe emotional coldness and obsessive qualities he saw in parents@ might be one of the possible causes of autism. A primary diagnosis made by Kanner was that autism should be regarded as partly a psychogenic disorder due to Aemotional refrigeration@ of parental care of the children (Rutter, 1968). In a general, his paper categories autistic individuals with the following: Aextreme autistic aloneness; anxiously obsessive desire for the presentation of sameness; excellent rote memory; delayed echolalia; over-sentivity to stimuli; limitation in variety of spontaneous activity; good cognitive potentialities; highly intelligent families.@ (Kanner, 1943; Happe. 1995). However, in his later paper, Kanner & Eisenberg, (1956), Kanner isolated the primary features of autism as A extreme isolation and the obsessive insistence on the preservation of sameness.@ The other symptom was considered as a secondary condition that is characteristic to some but not all autistic individuals.

In 1944, an Austrian physician, Hans Asperger, published a paper concerning Aautistic psychopathy @ in childhood. Even though his paper took nearly fifty years to be translated to English (Frith, 1991), it allows a different perspective that Kanner (1943) lacks. Asperger. and Kanner agreed that such characteristics as poor eye contact, social withdrawal, obsessive routines, and the term autism seemed to describe the patients precisely. The two authors reported a common finding of obsessive interaction and isolated the trait of special interest to innate objects or topic. (e.g., twirling a toy or repetitive conversation).

According to the literature, Kanner and Asperger on three main areas -

1. Language abilities - Kanner believes that language ability does not exist, while Asperger by contrast, reported that most of his clients spoke fluently.

2. Motor abilities and coordination - Kanner views motor coordination as clumsy and uncoordinated, but a finer muscle coordination. Asperger by contrast, concluded his clients to have poor muscle, gross and fine motor coordination.

3. Learning abilities - Kanner believes that his patients were best at learning rote fashion (memory for unconnected facts), but Asperger felt that his patients performed Abest when the children can produce spontaneously@, and suggests that they were visual thinkers.

(Happe, 1995)

With regards to their insight, both authors had a valid point of view as autistic individuals differ - not all autistic people are the same. Each one has some unique characteristics which may benefit from either theories or a combination of both.

Asperger=s account contains patient information that contrasts totally to Kanner=s. His cases appear to have some better language abilities, better motor skills, and a highly creative thinking process. This trait leads to describing a special subgroup of autistic individuals commonly called the savants, or idiot savants, or the Asperger syndrome. The term AAsperger syndrome@ was first used by Lorna Wing (1981) in her attempt to classify autistic individuals who do not conform to Kanner stereotypes.

There are great differences among individuals who are diagnosed with autism. There is a wide continuum of autism, and actually one could say that no two autistic persons are alike, although they will certainly share some similarities. Autistic individuals had a wide spectrum of behaviors ranging from those of a genius (savant) to those of the intellectually or physically disabled. Some autistic individuals who are mildly affected may exhibit slight delays in language, gross or fine motor skills; however, these individuals may have average or above average spatial skills, memory, and verbal skills. Despite their intellectual potential, the majority of them lack the ability to interact in some pro-social activities with their peers or social groups. However, at the opposite end of the spectrum, the severely affected may need greater assistance and care to the point of being totally immobile socially, physically, intellectually, and emotionally. Albert Einstein, Ludwig Wittgenstein, and Vincent Van Gogh are likely examples of autistic individuals who fall under the category of idiot savants or savant, as described by Asperger, Wing, (1981), and Grandin, (1995).

The detachment from social and physical interaction allows a funnel type concentration or focus thinking causing absolute concentration on a problem or work. Examples would be the

account of Albert Einstein is unique abilities and his comments as describe by his peers.

In Einstein Lived Here, Abraham Pais wrote:

A To be creative in establishing lasting deep human relations demands efforts that Einstein was simply never willing to make@. The similarity in most autistic (Savant) individuals, the inability to maintain social interaction with peers, isolation, and the need to keep to oneself is self evident. In The Private Lives of Albert Einstein, Roger Highfield and Paul Garter wrote, AEinstein described his dedication to science as an attempt to escape the merely personal by fixing his gaze on the objective universe. The desire to locate a reality free of human uncertainties was fundamental to his most important work (theory of relativity).@ (Highfield & Gater, )

In the same way that Einstein=s feelings were detached from ordinary reality, autistic thinking obeys it own special laws. According to Bleuler (1950), autistic thinking makes use of the customary logical connections that are directed by affective needs: one thinks in symbols, in analogies, in fragmentary concepts, and in accidental connections. According to Max Wertheimer, a friend of Einstein, he developed the theory of relativity, by imagining himself on a beam of light. These are examples of visual thinkers compared to those who put thoughts in words.

Generally, there are many characteristics of autism, with the following areas:

(Brimer, 1997; Happe, 1995)

1. Language/Communication:

Language skills range from nonverbal to highly verbal. Verbal skills are characterized by Aecholalia@ and difficulty with pronouns. Voice often lack affect, and are very monotone and without inflection. Difficulties in monitoring how voice sounds to others are evident Avisual thinkers@ vs. Athought in words@; Thinking is very concrete and literal, with problems in thinking abstractly.

2. Social Interaction:

Spends time alone rather than with others; very concrete, literal; difficulty understanding new and unpredictable information, and this causes a preference for routine and structure; has the ability to learn rules, but finds problems in applying rules in slightly different context; tied to routine and resistant to change; lack of reciprocal social interaction; lack of spontaneous sharing of interests; preoccupation with a topic; failure to develop peer relationships; exhibits obsessive ritualistic behaviors that make these individuals extremely resistant to change

3 Interactions with Objects/Play:

Lack of spontaneous or imaginative play; repetitive spinning of toys or objects; perseverative movement or manipulation of objects; inordinate fixation on or fascination with objects; flipping or flapping of objects; does not imitate others= actions; does not initiate pretend games; engage in repetitive self-stimulatory behaviors that can interfere notably with learning; failure to develop normal appropriate play behaviors

4. Sensory Impairment/Perception:

Unusual reactions to physical or sensory reactions either hypersensitive or hypo-sensitive: sight, hearing, touch, pain, smell, and taste may be affected to a lesser or greater degree;

5. Behaviors :

Exhibits either inappropriate behavior (serious, prolong temper tantrums) or flat affect; maybe overactive or very passive; throws frequent tantrums for no apparent reason; may perseverate on a single item, idea, or person; apparent lack of common sense; may show aggression or violent behavior, or injure self.

6. Motility (movement) :

Hand flapping in visual field; body rocking; body posturing; hand waving; darting movements; chin popping.

There are currently no known medical tests for diagnosing autism. The most accurate diagnosis would consist of some multi-disciplinary professionals (e.g., neurologist, psychologist, developmental pediatrician, speech/language therapist, learning consultant or other professional knowledgeable about autism) with specific speciality that evaluates the child=s communication, behavior, and developmental levels. Since many behaviors and symptoms associated with autism are shared by other disorders, a doctor should complete various tests to rule out other possible causes. Some of the current diagnostic tools used by professionals to make an accurate diagnosis include :

ADOS-G Autism Diagnostic Observation Schedule - Generic (Lord, Rutter, & Dilavore, 1998)

ADI-R Autism Diagnostic Interview (Lord et al., 1994)

BRIAC Behavior Rating Instrument for Autistic and other Atypical Children (Ruttenberg, et al., 1977)

CHAT Checklist for Autism in Toddlers (Baron-Cohen et al., 1992)

CARS Childhood Autism Rating Scale (Schopler et al., 1988)

PIA Parent Interviews for Autism

GARS Gilliam Autism Rating Scale (Gilliam, 1995)

In general, professionals define autism or pervasive developmental disorder (PDD) based on a diagnostic manual - The Diagnostic and Statistical Manual of the American Psychiatric Association, the 4^th edition(DSM-IV), and International Classification of Diseases, 10^th revision, Clinical Modification (ICD-10-CM) are currently used internationally to set the criteria for the diagnosis of autism. Several autism-related disorders are grouped under the broad heading - Pervasive Developmental Disorder (PDD), or Autism, pervasive developmental disorder - not otherwise specified (PDD-NOS). The term PDD is not a specific diagnosis, but an umbrella term under the following specific diagnosis - Autistic disorder, Rett=s disorder, Childhood Disintegrative disorder, and Asperger=s disorder.

Pervasive Developmental Disorder (P.D.D)

Childhood Retts Autism Asperger Syndrome

Disintegrative

Disorder

Pervasive Development Disorder- Not Otherwise Specified

See appendix A .

Most autistic individuals live a normal life span, and associated behaviors may change or improve over time. Those with autism have been known to live and work independently in the community, while others depend on professionals, family and group home settings, or institutions. Intervention at an early age, with structured and specialized education and behavior modification programs tailored to their needs, allows a better chance for normalization to society, as well as a better chance to fend for themselves.

The diagnosis of autism is frequently associated with other disorders which affect the function of the brain (e.g., epilepsy), sensory deficits (e.g., deafness, and blindness), genetic disorders (e.g., fragile X syndrome), mental retardation or physical abnormalities. Approximately 25 - 40 % of autistic individuals develop a seizure pattern at some period during their lifetime. Seizure activities have a higher rate of occurrence in most autistic children, due to some biological changes in their bodies in connection with other medical problems.

As discussed earlier, no two autistic individuals are the same. Contrary to popular belief autistic individual do make eye contact, show affection, smile and laugh, and display a variety of emotions, but in varying degrees. Like other individuals, they respond to different environments in positive or negative ways depending on circumstances. The autism may affect their range of emotions, but that does not restrict their movements their emotional expressions.

Autism is a fascinating, yet perplexing disorder that continues to intrigue researchers and professionals. Working with an autistic child is a challenge that can be summarized in two words, love and endurance. Working with an autistic child takes a lot of endurance, patience, firmness, love, and courage; only then can a teacher or professional succeed in achieving the goals and expectations of an autistic child. An autistic child holds a lot of potential that needs to be tapped with persistency and tenacity. The unique aspect of an autistic child is that in order to teach him or her, the teacher must gain his respect, even if this means allowing oneself to being bitten, scratched, kicked or physically injured. No matter how long an individual works with an autistic child there, will be moments when an autistic child can teach, instead of being taught. Autistic individuals are simply individuals who are rich in unique talents and gifts who are too often left untapped and unchallenged. Autistic level of ability to concentrate on an idea or visualize the mechanism of an object is outstanding, it allows a complex problem to be solved in a structured and simple format only to be understood by them, examples of individuals with such abilities are Temple Grandin, Albert Einstein, Van Gogh and others.

Behavioral Impacts of Computers on Autistic Individuals

The impact of computers on daily lives has affected virtually everybody. Technology today has allowed anyone with a disability easy access to the world at large (Kinsey, 1995). Interactive software programs could enhance the educational ability of children or adults with disabilities (Kinsley, 1995; Colby, 1973; Geoffrion, & Goldenberg, 1981; Wehmeyer, 1989; Dude, Moniz, & Gomes, 1995).

According to the Finding and Purpose section of the Technology-Related Assistance for Individuals with Disability Act of 1988 (Tech Act, PL.100-407), Congress stated that the provision of assistive technology devices and services to individuals with disabilities enables individuals to:

1. have greater control over their own lives,

2. participate in and contribute more fully to activities in their home, school and work environments, and in their communities,

3. interact to a greater extent with non disabled individuals,

4. otherwise benefit from opportunities that are taken for granted by individuals who do not have disabilities. (pp. 1044)

The significance of assistive technology was further recognized in the federal regulation for Individuals with Disabilities Education Act (PL.101-476); an assistive technology device is defined as:

Assistive technology means any device, pieces of equipment, or product system whether acquired commercially or off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities. (Federal Register, August 19, 1991, pp. 41272).

This Act illustrates the potential of assistive technology with autistic individuals, including enhancing the potential of its use as a reinforcer for stimulating learning interest, increasing self-determination, promoting independence, and independence.

APresentation of reinforcers on the microcomputers offers limitless variations while simultaneously fulfilling the basic rules of immediacy and consistency. The images and sounds may be changed as the task proceeds, or when the stimuli begin to lose their reinforcing qualities. Additionally, the delivery of reinforcement would not disrupt ongoing instruction, and could serve to make the entire learning experience a conditioned reinforcer.@ (Panyan, 1984).

The debate over the use of computer technology by students with autism ranges from very optimistic (Hedbring, 1985; Levine, 1986; Panyan, 1984) to very cautious (Romanczyk et al., 1992). However, there is an increasing interest in the area of autism in using computers as a general source both for communication (Colby, 1973; Frost, 1981; Geoffrion & Goldenberg, 1981; Plienes & Romancyzk, 1985; Heiman, Nelson, Gillberg & Margareta, 1993; Powell & Jordan, 1993) and as an educational tool (Jordan, 1993; Panyan, 1984). There appear to be three main reasons children with autism are attracted to computers: (1) they involve no social factors; (2) they are consistent and predictable; and (3) they allow a child to take active control and work at his/her own pace (Swettenham, 1996)

One of the first experiments used with autistic children was reported by Colby (1973). Interactive software programs were used to stimulate speech with 17 nonspeaking autistic children, and 13 out of 17 nonspeaking children began to use speech. Goldenberg (1979), Frost (1981), Geoffrion and Goldberg (1981), Pleinis and Romanczyk (1983) provided evidence that a computer-based exploratory learning system can result in increased responsivity in students with autism.

In addition to stereotypic behaviors in autism, resistance to change and language delays further impede the developmental stages of individuals. Collectively, these components contribute to learning problems. Several recent studies provided evidence and more systematic evaluation on the influence of computers on students with autism. Chen and Bernard-Opitz (1993), Pleinis and Romanczyk (1983), Lahm (1996), Higgins, and Boone (1996) indicate that the uses of interactive software programs have positive effects on the attention and performance of students with autism, compared with other forms of instruction. These authors also noted that a marked improvement in social skills derived from computer use extended to other situations as well. Koegel, Rincover, & Egel (1982) trace the inability of autistic students to learn academic and social skills to attentional and motivational deficits.

Anderson and Rincover (1982) researched the issue of over-selectivity and have indicated that autistic individuals are capable of responding to one or more cues at a time, if the cues are relatively close in physical proximity to the trained stimuli. They view the response pattern as similar to tunnel vision, since the stimuli that become functional for an autistic child are those in his or her restricted field or Atunnel@ of vision. Thus, stimulus control may not be solely a function of the number of cues, but rather may be the relative location of cues

(Panyan, 1984). Interactive software programs may help alleviate this type of stimulus control problem. Computer monitors enable many cues to be positioned relatively closely to one another, as well as to restrict field of vision to the screen, eliminating any possible visual distractions. Thus, if the stimulus control is achieved to a cue on one portion of the screen, there is a good probability that the individual tunnel of vision can be extended on other proximity stimuli within the monitor. In contrast, noncomputer instructional situations spread separate stimulus items across greater physical distance and vision scope.

Traditional teaching practices, such as physical prompting, can impede learning for students with autism with an over-selective style (Rincover, 1978; Hermelin, & Frith, 1991; Hedbring, & Newson, 1985; Schreibman, 1975; Reed & Peterson, 1990; Hermelin, 1972; Leslie, & Frith, 1988). The individual=s attention may become fixed on these extra prompts rather than focused on the relevant stimulus. Irrelevant cues present in common materials can interfere with the learning process (e.g., the color or the shape of a card as opposed to the picture on the card). An autistic student may be distracted by the color or even the tattered edge of the card, rather than by the educational content of the cards.

Microcomputers and interactive software programs can be reliable and consistent because they are free of the idiosyncratic and incidental behaviors that accompany instructors. In addition, interactive software programs present a limited and predictable sameness in movement and response, indirectly allowing a degree of consistency that minimizes distractions. Thus, irrelevant cues could be identified early in the training sequence and be eliminated.

Another issue that interferes with learning is lack of motivation. Many reinforcers (sensory, activity, token and social) have proven to be preferable reinforcer alternatives to consumable reinforcers (Rincover, Cook, Peoples, & Packard, 1979; Egel, 1981; Ferrari, & Harris, 1981; Mason, McGee, Farmer-Dougan, & Risley,1989; Cook, 1990). Presentation of reinforcers on interactive software programs offers limitless variations, while simultaneously fulfilling the basic rules of immediacy and consistency. Additionally, the delivery of reinforcement does not disrupt ongoing instruction and could serve to make the entire learning experience a conditioned reinforcer (Williams, Koegel, & Egel, 1981;Bailey & Meyerson, 1969; Rincover, & Newson, 1985; Rincover, Newson, Lovaas, & Koegel, 1977).

In a study done by Rincover et al (1979) with four autistic children, the power of perceptual stimulation to maintain appropriate behaviors was used. They found that each child=s stereotypic behavior was maintained by different forms of sensory reinforcement, which were later used to increase appropriate toy play. Interactive software programs could provide auditory, visual, or tactile reinforcement, depending on the individual=s preference. They can analyze and integrate new information as soon as it is entered. The speed at which computers process information on a response and provide immediate feedback is one of their most valuable attributes (Eisle, 1990; Kinsley, & Langone, 1995).

Pleinis and Romanczyk (1985) concluded that children with autism tended to be less disruptive and less distracted by external stimuli when engaged on a computer than when involved in teacher-directed activities. They also found that undesirable self-stimulation occurred more often in teacher-directed activities than when the students interacted with

software. In research done by Levine (1986) and Chen and Bernard-Opitz (1993), students exhibited increases in attention to the task at hand, response rate, intentionality, problem solving, and referential communication when interacting with the software. Levine (1986) noted the change of behavior occurs in both low and high autistic functioning students.

The consistency and reliability of presentation and predictability of outcomes with interactive software programs should address needs of most individuals with autism. Programs being developed better accommodate the needs of autistic individuals by overcoming barriers in traditional learning which make it difficult for them to comprehend. Even if computer-delivered instruction is only as effective as that delivered by a teacher, the computer should be viewed as an effective tool for reinforcing or practicing skills currently being taught by a teacher. This means that teachers of students with autism have another resource for developing academic skills (Hedbring, 1985; Higgins, & Boone, 1996). The use of computer as a tool for learning has the potential to assist individuals with autism another opportunity to learn and communicate.

APPENDIX A:

The full diagnostic criteria for Pervasive Developmental Disorder in DSM-IV :

299.00 Autistic disorder

A A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):

(1) Qualitative impairment in social interaction, as manifested by at least two of the following:

(1) Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction

(2) Failure to develop peer relationship appropriate to develop mental level

(3) A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)

(4) Lack of social or emotional reciprocity

(2) Qualitative impairments in communications as manifested by at least one of the following:

(1) Delay in, or total lack of, the developmental of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gestures or mime).

(2) In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others.

(3) Stereotyped and repetitive use of language or idiosyncratic language

(4) Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

(3) Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

(1) Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

(2) Apparently inflexible adherence to specific, nonfunctional routines or rituals

(3) Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)

(4) Persistent preoccupations with parts of objects

2. Delays or abnormal functioning in at least one of the following areas, with an onset prior to age 3 years:

(1) Social interaction

(2) Language as used in social communication

(3) Symbolic or imaginative play

3. The disturbance is not better accounted for by Rett=s Disorder or Childhood Disintegrative Disorder.

299.80 Rett=s Disorder:

(1) All of the following:

(1) Apparently normal prenatal and perinatal development

(2) Apparently normal psychomotor developmental through the first 5 months after birth

(3) Normal head circumference at birth

(2) Onset of all of the following after the period of normal development:

(1) Deceleration of head growth between ages 5 and 48 months

(2) Loss of previously acquired purposeful hand skills between ages 5 and 30 months with the subsequent developmental of stereotyped hand movements (e.g., hand-wringing or hand washing)

(3) Loss of social engagement early in the course (although often social interaction develops later)

(4) Appearance of poorly coordinated gait or trunk movements

(5) Severely impaired expressive and receptive language development with severe psychomotor retardation.

299.10 Childhood Disintegrative Disorder:

(1) Apparently normal development for at least the first 2 years after birth as manifested by the presence of age-appropriate verbal and nonverbal, social relationship, play and adaptive behavior.

(2) Clinically significant loss of previously acquired skills (before the age 10 years) in the least two of the following areas:

(1) Expressive or receptive language

(2) Social skills or adaptive behavior

(3) Bowel or bladder control

(4) Play

(5) Motor Skills

(3) Abnormalities of functioning in at least two of the following areas:

(1) Qualitative impairment in social interaction (e.g., impairment in nonverbal behaviors, failures to develop peer relationships, lack of social or emotional reciprocity)

(2) Qualitative impairments in communications (e.g., delay or lack of spoken language, inability to initiate or sustain a conversation, stereotyped and repetitive use of language, lack of varied make-believe play)

(3) Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, including motor stereotypes and mannerisms.

(4) The disturbance is not better accounted for by another specific Pervasive Developmental Disorder or by Schizophrenia.

299.80 Asperger=s Disorder

(1) Qualitative impairment in social interaction, as manifested by at least two of the following:

1. Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body gestures, and gestures to regulate social interaction.

1. Failure to develop peer relationship appropriate to developmental level.

2. A lack of spontaneously seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)

3. Lack of social or emotional reciprocity.

(2) Restricted repetitive and stereotyped patterns of behaviors, interests, and activities, as manifested by at least one of the following:

1. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus.

2. Apparently inflexible adherence to specific, nonfunctional routines or rituals.

3. Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole body movements)

4. Persistent preoccupation with parts of objects.

(3) The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

(4) There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years)

(5) There is no clinically significant delay in cognitive developmental or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

(6) Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia

299.80 Pervasive Developmental Disorder Not Otherwise Specified (Including Atypical Autism

This category should be used when there is a severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills, or when stereotyped behaviors, interests, and activities are present, but the criteria are not met for a specific Pervasive Developmental Disorder, Schizophrenia, Schizotypal Personalities Disorder, or Avoidant Personality Disorder. For example, this category includes ATYPICAL AUTISM B presentations that do not meet the criteria for Autistic Disorder because of late age of onset, atypical symptomatology, or sub threshold symptomatology, or all of these.

References

Anderson, N. B., & Rincover, A. (1982). The generality of over selectivity in developmentally disabled children. Journal of Experimental Psychology, 34, 217-230.

Azrin, N. H., & Lindsley, O. R.. (1956). The reinforcement of cooperation between children. Journal of Abnormal Social Psychology, 52, 100-102.

American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: Author.

Autism Society of America. (1996). What is Autism (Internet Address : www.autism-society.org/autism.html). Bethesda, MD.

Baer, D. M.., Wolf, M. M.., Risley, T. R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1, 91-97.

Bailey, J., & Meyerson, L. (1969). Vibration as a reinforcer with profoundly retarded child. Journal of Applied Behavior Analysis, 2, 135-137.

Brinker, R. P., & Lewis, M. (1982). Making the world work with microcomputers: A learning prosthesis for handicapped infants. Exceptional Children, 49, 163-170.

Blackhurst, A. E., & Morse, T. E. (1996, Fall). Using anchored instruction to teach about assistive technology. Focus on Autism and Other Developmental Disabilities, 11(3), 131-141.

Bleuler, E. (1908). The prognosis of dementia praecox. The group of schizophrenias English translation in The Clinical Roots of the Schizophrenia Concept. Cutting, J. & Sheperd (eds) (1987). Cambridge: Cambridge University Press.

Bleuler, E. (1911). Dementia Praecox or the Group of Schizophrenias. Zinkin, J. &Lewis, N. D. C. (1950). New York: International University Press.

Boer, A. P. (1968). Application of a simple recording system to the analysis of free-play behavior in autistic children. Journal of Applied Behavior Analysis, 1(4), 335-340.

Brotherson, M. J., Cook, C., & Parette, H. P. Jr. (1996). A home-centered approach to assistive technology provision for young children with disabilities. Focus on Autism and Other Development Disabilities, 11(2), 86-95.

Brimer, J. (1997). Autism : A General Overview. Paper presented at the In-service

in The Learning Tree, Inc., Jacksonville, AL.

Brimer, J. & Murphy, P. Autism and deafness: A case study of a deaf and autistic boy. Prickett, H. T., & Duncan, E.(1988). Coping with the Multiple-Handicapped Hearing Impaired; A practical approach (pp. 45-61). Springfield, Illinois: Charles C. Thomas.

Campbell, D. T., & Stanley, J. C. (1963). Experimental and Quasi-experimental Designs for Research. Boston: Houghton Mifflin Company.

Carr, E. G., & Durand , M.. V. (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.

Cavalier, A. R. & Ferretti R. P. (1996, Summer). Talking instead of typing: Alternate access to computers via speech recognition technology. Focus on Autism and Other Development Disabilities, 11(2), 79-85.

Chen, S. H. A. & Bernard-Opitz, V.(1993, December). Comparison of personal and computer-assisted instruction for children with autism. Mental Retardation, 31(6), 368-376.

Creak, M. (1972). Reflections on communication and autistic children. Journal of Autism and Childhood Schizophrenia, 2(1), 1-8.

Colby, K. (1973). The rationale for computer-based treatment of language difficulties in non-speaking autistic children. Journal of Autism and Childhood Schizophrenia, 3, 455-463.

Cook, D. G.(1990, February). A sensory approach to the treatment and management of children with autism. Focus on Autistic Behavior, 6(5), 1-16.

Datillo, J. (1986). Computerized assessment of preference for severely handicapped individuals. Journal of Applied Behavior Analysis, 19, 445-448.

Doke, L. A., & Risley, T. R. (1972). The organization of day-care environments: Required versus optional activities. Journal of Applied Behavior Analysis, 5, 405-420.

Domina, B. S. (1994). Autistic Impaired, A Book for Educators and Parents New York: Grandville.

Dube, V. W., Moniz, D. H., & Gomes, J. F.(1995). Use of computer and teacher delivered prompts in discrimination training with individuals who have mental retardation. American Journal on Mental Retardation, 100(3), 253-261.

Dunlap, G., & Koegel, R. L. (1980, Winter). Motivating autistic children through stimulus variation. Journal of Applied Behavior Analysis 13(4), 619-627.

Dunn, L. M., & Dunn, L. M. (1981). Peabody Picture Vocabulary Test-Revised. Circle Pines, MN: American Guidance Service.

Dyer, K. I. (1987). The competition of autistic sterotyped behavior with usual and specially assessed reinforcers. Research in Developmental Disabilities, 8, 607-626.

Egel, A. L. (1980). The effects of constant versus varied reinforcer presentation on responding by autistic children. Journal of Exceptional Child Psychology, 30, 455-463.

Egel, A. L. (1981). Reinforcers variation: Implications for motivating developmentally disabled children. Journal of Applied Behavior Analysis, 14, 345-350.

Eisele, J. (1980). A case for computers in instruction. Journal of Research and Developmental in Education, 14(1), 1-8.

Etzel, B., & LeBlanc, J. M. (1979). The simplest treatment alternative: The law of parsimony applied to choosing appropriate instructional control and errorless-learning procedures for the difficult-to-teach child. Journal of Autism and Developmental Disorders, 9(4), 361-382.

Ferrari, M., & Harris, S. (1981). The limits and motivating potential of sensory stimuli as reinforcers for autistic children. Journal of Applied Behavior Analysis 14, 339-343.

Frank, A., Wacker, D.., Berg, W., & McMahon., C. (1985). Teaching selected microcomputer skills to retarded students via picture prompts. Journal of Applied Behavior Analysis, 18, 179-185.

Frith, U. & Leslie, A. M. (1988). Autistic children=s understanding of seeing, knowing and believing. British Journal of Developmental Psychology2,(6), 315-324.

Frith, U. (1972). Cognitive mechanisms in autism: Experiments with color and tone sequence production. Journal of Autism and Childhood Schizophrenia, 2(2), 160-173.

Frith, U. (1989a). Autism: Explaining the Enigma. Oxford: Basil Blackwell

Frith, U. (1991). Autism and Asper Syndrome. Cambridge: Cambridge University Press

Frith, U. & Happe, F. (1994). Autism: beyond Atheory of mind@. Cognition, 50, 115-132.

Frost, R. E. (1981). An interactive computer environment for autistic children. In Proceedings of the John Hopkins First National Search for Applications of Personal Computing to Aid the Handicapped. Los Angeles: IEEE Computer Society.

Geoffrion, L. D., & Goldenberg, E. P. (1981). Computer-based exploratory learning systems for communication-handicapped children. Journal of Special Education, 15(3), 325-332.

Geren, M. A., Stromer, R., & Mackay, H. A. (1997). Picture naming, matching to sample and Head Injury: A stimulus control analysis. Journal of Applied Behavior Analysis, 30, 339-342.

Goldenberg, E. P. (1979). Special Technology for Special Children. Baltimore: University Park Press.

Hart, B. M., & Risley, T. R. (1968). Establishing the use of descriptive adjectives in the spontaneous speech of disadvantaged children. Journal of Applied Behavior Analysis, 1,

109-120.

Hart, B. M., & Risley, T. R. (1974). Using preschool materials to modify the language of disadvantaged children. Journal of Applied Behavior Analysis, 7, 243-256.

Hart, B. M., & Risley, T. R. (1975). Incidental teaching of language in the preschool. Journal of Applied Behavior Analysis, 8, 411-420.

.Hart, B. M., & Risley, T. R. (1980). In vivo language intervention: Unanticipated general effects. Journal of Applied Behavior Analysis, 13, 407-432.

Happe, F. (1995). Autism and Introduction to Psychological Theory. Massachusetts: Cambridge.

Hedbring, C. (1985). Computers and autistic learners: An evolving technology. Australian Journal of Human Communication Disorders,2(13), 169-191.

Hedbring, C. & Newsom, C. (1985). Visual overselectivity: A comparison of two instructional remediation procedures with autistic children. Journal of Autism and Developmental Disorders 15(1), 9-22.

Heimann, M., Nelson , K. E., Tjus, T., & Gillberg, C. (1995). Increasing reading and communication skills in children with autism through an intercative multimedia computer program. Journal of Autism and Developmental Disorders, 25(5), 459-480.

Hermelin, B. (1972). Locating events in space and time: Experiments with autistic, blind and deaf children. Journal of Autism and Childhood Schizophrenia, 2(3), 288-298.

Hermelin, B. & Frith, U. (1991). Psychological studies of childhood autism: Can autistic children make sense of what they see and hear. Focus on Autistic Behavior, 6(1), 6-13.

Highfield, R., and Garter, P. (1993). The private lives of Albert Einstein. St Martin=s, New York.

Higgins. K. & Boone. R. (1996, Summer). Creating Individualized computer-assisted instruction for students with autism using multimedia authoring software. Focus on Autism and Other Developmental Disabilities, 11(2), 69-78.

Hutinger P. L. (1996, Summer). Computer applications in programs for young children with disabilities: Recurring themes. Focus on Autism and Other Development Disabilities, 11(2), 105-114).

Individuals with Disabilities Education Act of 1990, 20 U.S.C. ' 1400 et seq.

Individuals with Disabilities Education Act Amendments of 1990, 20 U.S.C. ' 1400 et seq.

Kanner, L. (1943). Autistic disturbances of affective contact. The Nervous Child , 2 , 217-250.

Kanner, L. (1971). Follow-up study of eleven autistic children originally reported in 1943. Journal of Autism and Schizophrenia, 1(2), 119-145.

Kanner, L. (1973). The birth of early infantile autism. Journal of Autism and Childhood Schizophrenia, 3(2), 93-95.

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, R. L., Rincover, A. & Egel, A. L.(1982). Educating the Understanding Autistic Children. San Diego: College Hill.

Koegel, R. L. & Wilhelm, H. (1973). Selective responding to the components of multiple visual cues by autistic children. Journal of Experimental Child Psychology, 77, 211-222.

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.

Kinsley, T. C., & Langone, J. (1995, Spring). Applications of technology for infants , toddlers, and preschoolers with disabilities. Journal of Special Education Technology, XII(4), 312-324.

Jarrod, C., & Russell, J. (1997). Counting abilities in Autism: Possible implications for central coherence theory. Journal of Autism and Developmental Disorders, 27(1), 25-37

Lahm, E. A. (1996, Summer). Software that engages young children with disabilities: A study of design features. Focus on Autism and Other Development Disabilities, 11(2), 115-126.

Lane, S. J. & Mistrett, S. G. (1996). Play and assistive technology issues for infants and young children with disabilities : a preliminary examination. Focus on Autism and Other Development Disabilities, 11(2), 96- 104.

Levine, J. C. (1986). Software for the atypical and severely handicapped students. Northridge, CA: Conference on Computer Technology, Special Education, Rehabilitation. (ERIC Document Reproduction Service No. ED 290 267)

Lindsley, O. R. (1968). Teaching note: A reliable wrist counter for recording behavior rates. Journal of Applied Behavior Analysis, 1(1), 77-78.

Lindsley, O. R. (1992). Precision teaching: Discoveries and effects. Journal of Applied Behavior Analysis, 25(1), 51-57.

Lovaas, I. O., Berberich, J. P., Bernard, F. P., & Schaeffer, B.(1991, April). Acquisition of imitative speech by schizophrenic children. Focus on Autistic Behavior, 6(1), 1-5.

Lovaas, I. O., Schreibman, L., Koegel, R., & Rehm, R. (1971). Selective responding by autistic children to multiple sensory input. Journal of Abnormal Psychology, 77(3), 211-222.

Manning, A. L. & Katz, K. B.(1991, August). Facilitating functional communication with echolalia language users. Focus on Autistic Behavior, 6(3), 1-7.

MacDuff, G. S., Krantz, P. J., & McClannahan, L. E., (1993). Teaching children with autism to use photographic activity schedules: Maintenance and generalization of complex response chains. Journal of Applied Behavior Analysis, 26, 89-97.

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(2),

171-179.

McClannahan, L. E., & Risley, T. R. (1975). Design of living environments for nursing home residents: Increasing participation in recreational activities. Journal of Applied Behavior Analysis, 8, 261-268.

McGee, G. G., Daly, T., Izeman, S. G., Mann, L. H., & Risley, T. R. (1991). Use of classroom materials to promote preschool engagement. Teaching Exceptional Children, 23(4), 43-47.

McGee, G. G., Feldman, R. S., & Chernin, L. (1991). A comparison of emotional facial display by children with autism and typical preschoolers. Journal of Early Intervention, 15(3), 237-245.

McGee, G. G., Feldman, R. S., & Morrier, M. J. (1997). Benchmarks of social treatment for children with autism. Journal of Applied Behavior Analysis, 27, 353-364.

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.

McGee, G. G., & McCoy, J. F. (1981). Training procedures for acquisition and retention of reading in retarded youth. Applied Research in Mental Retardation, 2, 263-276.

McGee, G. G., Paradis, T., & Feldman, R. S. (1993). Free effects of integration on levels of autistic behavior. Topic in Early Childhood Special Education, 13, 57-67.

Merbitz, C., & Morrell, R. (1996). Electronic behavior-event counters. Journal of Precision Teaching and Celeration, XIII(2), 71-74.

Miller, A., & Miller, E. E. (1973). Cognitive -developmental training with elevated boards and sign language. Journal of Autism and Childhood Schizophrenia, 3(1), 65-85.

Mundy, P., Sigman, M., & Kasari, C. (1990). A longitudinal study of joint attention and language development in autistic children. Journal of Autism and Developmental Disorders, 20, 115-128.

Mundy, P., Sigman, M., Ungerer, J., & Sherman, T. (1987). Nonverbal communication and play correlates of language development in autistic children. Journal of Autism and developmental Disorders, 17, 349-364.

Myles, B. S., Simpson, R. L., & Smith, S. M. (1996, Fall). Collateral behavioral and social effects of using facilitated communication with individuals with autism. Focus on Autism and Other Development Disabilities, 11(3), 163-169.

Myles, B. S., Ormsbee, C. K., & Simpson, R. L. (1991). Autism and stress: An individualized intervention plan for teachers. Focus on Autistic Behavior, 6(3), 8-16.

O=Leary, S. G., & Dubey, D. R. (1979). Applications of self-control procedures by children: A review. Journal of Behavioral Analysis, 12, 449-465.

Pais, A. 1994. Einstein lived here. Oxford University Press, New York.

Panyan, M. (1983, May). Microcomputers= application for special populations. Paper presented at the Applied Behavior Analysis Conference, Milwaukee.

Panyan, M. V. (1984). Computer technology for autistic students. Journal of Autism and Developmental Disorders, 14(4), 375-382.

Panyan, M. V., McGregor, G., Bennett, A., Rysticken, N., & Spurr, A. (1984, January). The effects of microcomputer-based instructions on the academic and social progress of autistic students. Paper presented at the CEC Technology in Special Education Conference, Reno, Nevada.

Pleinis, A., & Romanczyk, R. G. (May, 1983). Computer-assisted instruction for atypical children: Attention, performance, collateral behavior. Paper presented at the Applied Behavior Analysis Conference, Milwaukee.

Pleinis, A. & Romanczyk, R. (1985). Analysis of performance, behavior and predictors for severally disturbed children; a comparison of adult versus computer instruction. Analysis and Intervention in Developmentally Disabled, 5, 345-356.

Prinz, P. M. (1991). Literacy and language Development within microcomputer-videodisc-assisted interactive contexts. Journal of Childhood Communication Disorders, 14(1), 67-80.

Prior, M., & MacMillian, M. (1973). Maintenance of sameness in children with Kanner=s syndrome. Journal of Autism and Childhood Schizophrenia, 3(1), 154-167.

Pollard, J. P. (February, 1984). Adaptive Device for Special Education: Electronic Learning. New York: International University Press.

Reed, T., & Peterson, C. (1990). A comparative study of autistic subjects' performance at two levels of visual and cognitive perspective taking. Journal of Autism and Developmental Disorders, 20(4), 555-567.

Rimland, B. (1964). Infantile Autism. New York: Appleton-Century-Crofts

Rincover, A. (1978). Variables affecting stimulus fading and discriminative responding in psychotic children. Journal of Abnormal Psychology, 2(8), 235-246.

Rincover, A,. Cook, R., Peoples, A., & Packard, D. (1976, Summer). Sensory extinction and sensory reinforcement principles for programming multiple adaptive behavior change. Journal of Applied Behavior Analysis 12(2), 221-233.

Rincover, A. & Koegel, R. (1975) Setting generality and stimulus control in autistic children. Journal of Applied Behavior Analysis, 2(8) 235-246.

Rincover, A, & Newson, C.D. (1985. The relative motivational properties of sensory and edible reinforcers in teaching autistic children. Journal of Applied Behavior Analysis, 18, 237-248.

Rincover, A., Newson, C. D., Lovaas, O. I., & Koegel, R. L. (1977). Some motivational properties of sensory stimulation in psychotic children. Journal of Experimental Child Psychology, 24, 312-323.

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.

Ritvo, M..D., & Freeman, B. J. (1978). National Society of Autistic Children definition of the syndrome of autism. Journal of Autism and Childhood Schizophrenia, 8, 162-167.

Romanczyk, R.G., Ekdahl, M., & Lockshin, S. B. (1992). Perspectives on research in autism: Current trends and future directions. In D. E. Berkell (Ed.), Autism: Identification, Education and Treatment (pp 21-51). Hillsdale, NJ: Erlbaum.

Rutter, M. (1968). Concepts of autism: A review of research. Journal of Child Psychology and Psychiatry, 9, (1-25).

Rutter, M. (1972). Childhood schizophrenia reconsidered. Journal of Autism and Childhood Schizophrenia 2(4), 315-337.

Schreibman, L. (1975, Spring). Effects of within-stimulus and extra stimulus prompting on discriminated learning in Autistic children. Journal of Applied Behavior Analysis 8,(1), 91-112.

Scholer, E., Reichler, R.J., De Vellis, R. F., & Daly, K. (1980). Toward objective classification of childhood autism: Childhood Autism Rating Scale (CARS). Journal of Autism and Developmental Disorders, 10, 91-103.

Scholer, E., Reichler, R.J., De Vellis, R. F., & Daly, K. (1988). The Childhood Autism Rating Scale. Los Angeles: Western Psychological Services.

Sidman, M. (1960). Tactics of Scientific Research (1^st ed.). New York: Basic Book, Inc.

Spiker, D., & Ricks, M. (1984). Visual self-recognition in autistic children: Developmental relationships. Child Development, 55, 214-225.

Sparrow, S. S., Balla, D. A., & Cicchetti, D. V. (1984). Vineland Adaptive Behavior Scales: Interview Edition. Cicrle Pines, MN: American Guidance Service.

Stahmer, A., & Schreibman, L. (1992). Teaching children with autism appropriate play in unsupervised settings using self-management treatment package. Journal of Applied Behavior Analysis, 25, 447-459.

Stone, W. L., Lemanek, K. L., Fishel, P.T., Fernandez, M. C., & Altemeir, W. A. (1990). Play and imitation skills in the diagnosis of autism in young children. Pediatrics, 86,267-272.

Streifel, S., Bryan, K. S., & Aikens, D. A. (1974). Transfer of stimulus control from motor to verbal stimuli. Journal of Applied Behavior Analysis, 7, 123-135.

Streifel, S., & Wetherby, B. (1973). Instruction-following behavior of a retarded child and its controlling stimuli. Journal of Applied Behavior Analysis,6, 663-670.

Stokes, T. F., & Baer, D. M. (1977). An implicit technology of generalization. Journal of Applied Behavior Analysis, 10, 349-367.

Sutker, P. & Adams, H. E.(1993). Comprehensive Handbook of Psychopathology (2^nd ed.). New York: Plenum Press.

Swettenham, J. (1996). Can children with autism be taught to understand false belief using computers? Journal of Child Psychology and Psychiatry, 37(2), 157-165.

Technology-Related Assistance for Individuals with Disabilities Act of 1988, PL. 100-407. (August 19, 1988). Title 29, U.S.C. 2201 et seq: U.S. Statutes at Large, 102, 1044-1065. Thorndike, R. L., Hagen, E. R., & Sattler, J. M., (1986). The Standard-Binet Intelligence Scale, 4^th ed. Chicago: The Riverside Publishing Co.

Volkmar, F. R. (1987). Annotation: Diagnostic issues in the pervasive developmental disorders. Journal of Child Psychology and Psychiatry, 28, 365-369.

Volkmar, F. R., & Cohen, D. J. (1988). Classification and diagnosis of childhood autism. In E. Schopler & G. Mesibov (Eds), Diagnosis and assessment in autism (pp. 71-89). New York: Plenum Press.

Volkmar, F. R., Hoder, E. L., & Cohen, D. J. (1985). Compliance, `Negativism=, and the effects of treatment structure in autism: A naturalistic, behavioral study. Journal of Child Psychology and Psychiatry, 26, 865-877.

Wacker, D., & Berg, W. (1983). Effects of picture prompts on the acquisition of complex

vocational tasks by mentally retarded adults. Journal of Applied Behavior Analysis, 16,

417-433.

Wacker, D., & Berg, W. (1984). Training adolescents with severe handicaps to set up job tasks independently using picture prompts. Analysis and Intervention in Developmental Disabilities, 4, 353-365.

Wehmeyer, M. L. (1995). The use of assistive technology by people with mental retardation and barriers to this outcome: A pilot study. Technology and Disability, 4, 195-204.

Wehmeyer, M. L. (1998). National survey of the use of assistive technology by adults with mental retardation. Mental Retardation, 36(1), 44-51.

Williams, J. A., Koegel, R. L., &Egel, A. L. (1981) Response-reinforcer relationships and improved learning in autistic children. Journal of Applied Behavior Analysis, 14, 53-60.