University of Southern California Dissertations and Theses

Modifying Appropriate And Interfering Behaviors In Autistic Children Using A System Of Behavior Modification, Therapeutic Teaching

(USC Thesis Other)

Modifying Appropriate And Interfering Behaviors In Autistic Children Using A System Of Behavior Modification, Therapeutic Teaching

PDF

Download

Open document

Flip pages

Download a page range

Download transcript

Copy asset link

Request this asset

Transcript (if available)

Content MODIFYING APPROPRIATE AND INTERFERING BEHAVIORS IN
AUTISTIC CHILDREN USING A SYSTEM OF BEHAVIOR
MODIFICATION, THERAPEUTIC TEACHING
by
Richard Marion Deatherage
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(Education)
August 1971
72-17,463
DEATHERAGE, Richard Marion, 1943-
MODIFYING APPROPRIATE AND INTERFERING BEHAVIORS
IN AUTISTIC CHILDREN USING A SYSTEM OF
BEHAVIOR MODIFICATION, THERAPEUTIC TEACHING.
University of Southern California, Ph.D., 1972
Education, special
University Microfilms. A XEROX Company, Ann Arbor, Michigan
©Copyright by
RICHARD MARIOiJ DEATHERAGE
1972
THIS DISSERTATION HAS BEEN MICROFILMED EXACTLY AS RECEIVED.
UNIVERSITY O F SO U T H E R N CALIFORNIA
TH E GRADUATE SC H O O L
U N IV ER SITY PARK
LO S A N G ELES. C A LIFO R N IA 9 0 0 0 7
This dissertation, written by
RICHARD MARION[ VEATffiRAGE
under the direction of Dissertation Com
mittee, and approved by all its members, has
been presented to and accepted by The Gradu
ate School, in partial fulfillment of require
ments of the degree of
D O C T O R O F P H I L O S O P H Y
O
Dean
D ate..
DISSERTATION COMMITTEE
Chairman _ \ J
£ ..
Chairman
PLEASE NOTE:
Some pages may have
indistinct print.
Filmed as received.
University Microfilms, A Xerox Education Company
ACKNOWLEDGMENTS
The writer wishes to express his appreciation to
his dissertation chairman, Dr. James Magary, for his
helpful advice, criticism, and support during the study,
and to the other committee members, Dr. Prank Pox and
Dr. Gerald Lubin, for their interest and guidance in the
experiment.
The writer also wishes to acknowledge the ideas of
Dr. Laurence Peter who aided in the formulation of the
present study. The counsel of Dr. Roy Adamson and
Dr. Joseph Coss was especially helpful in the initial
states of research. Also, the interest and patience of
my wife Judy, aided me throughout the entire dissertation.
ii
TABLE OP CONTENTS
Page
ACKNOWLEDGMENTS ....................................... ii
LIST OF TABLES......................................... v
LIST OP FIGURES....................................... vi
Chapter
I. INTRODUCTION ................................... 1
Definitions..... .............................. 6
Experimental Questions ....................... 8
Hypotheses................... 12
Hypothesis 1
Hypothesis 2
II. CRITIQUE AND REVIEW OF LITERATURE............ 13
Etiology................................ 13
Psychogenic Viewpoint
Abnormality of the Central Nervous
System
Autism as a Cognitive Language Disorder
Autism as a Genetic Disorder
Perceptual Disorders in Autism
Epidemiology of Infantile Autism ........... 24
Follow-Up Studies of Infantile Psychosis . . 26
Education and Treatment of Autistic
Children................................... 28
Conclusion................................... 41
III. PROCEDURE..................................... 44
Subjects .............................. 44
Situation Variables ........................ 44
Systems Design .............................. 45
Therapeutic Teaching System ............... 47
Components of the Therapeutic Teaching
System
iii
Chapter Page
IV. RESULTS ................................. 56
Trend Analysis.......... 59
Results..................................... 60
Hypotheses................................... 76
Hypothesis 1
Hypothesis 2
V. DISCUSSION..................................... 77
Summary of the Results .............. 77
Implications for Further Study .............. 80
BIBLIOGRAPHY ............................................ 84
APPENDIX.................................................. 100
iv
LIST OP TABLES
Table Page
1. Therapeutic teaching system .................... 50
2. Behaviors studied ............................... 58
3. Table of trend analysis for
interfering behaviors ........................ 63
4. Trend analysis for appropriate behaviors . . . 70
v
LIST OF FIGURES
Figure Page
1. Interfering and appropriate behaviors ......... 62
2. Trend analysis of interfering behaviors .... 65
3. Trend analysis of interfering behaviors .... 66
4. Trend analysis of interfering behaviors .... 67
5. Trend analysis of interfering behaviors .... 69
6. Trend analysis of appropriate behaviors .... 72
7. Trend analysis of appropriate behaviors .... 73
8. Trend analysis of appropriate behaviors .... 74
9. Trend analysis of appropriate behaviors .... 75
vi
CHAPTER I
INTRODUCTION
Leo Kanner first described a group of children in
19^3 whose condition differed so markedly and uniquely from
anything previously reported in the scientific literature
that this syndrome was first labeled Kannerfs Syndrome and
only later called infantile autism. Kanner postulated
that, prior to his grouping of these behavioral charac
teristics into a unique syndrome, these children previously
had been viewed as feeble-minded or schizophrenic. In
fact, In Kanner's original study, he found many of his
children were first introduced to him as idiots or imbe
ciles and were often found in state schools for the
feebleminded (Kanner, 19^3).
Kanner found the outstanding, "pathognomonic
disorder" to be the way in which a child failed to relate
to himself and others in an ordinary way from the beginning
of life. In Kanner's original group of children, the
parents referred to their children as having always been
"self-sufficient," "like in a shell," "happiest when left
alone," "acting as if people were not there," "perfectly
oblivious to everything about [them]," "giving the
1
impression of silent wisdom," "failing to develop the usual
amount of social awareness," "acting almost as if hypno
tized." Kanner contrasted this condition with schizo
phrenic children and adults and stated that it was not a
withdrawal from a formerly existing participation; he
emphasized that it was, from the start, an "extreme autis
tic aloneness" that caused the child to disregard, shut
out, and ignore things from the outside world (Kanner,
19^3, P. 242).
Many of the children described by Kanner made no
anticipatory motor adjustment when they were picked up or
lifted from a table by their parents. Also, in his
original study, Kanner found that while average infants
learn to adjust their bodies very readily to the posture
of the person who picks them up, the children described by
Kanner were not able to do so. Furthermore, Kanner
described children with the syndrome of Infantile autism as
having difficulties in verbal communication. Some of the
children Kanner described were mute and others had the
ability to speak although not in a communicative fashion.
They would name objects, repeat nursery rhymes, prayers,
lists of animals and lullabies, but their language con
sisted mainly of naming things in a simple, rote fashion.
They did not use language in any other way. This often
"led the parents to stuff them with more and more verses,
theological and botanical names, titles and composers of
3
Victrola records. Thus from the start, language, which the
children did not use for the purpose of communication, was
deflected in a considerable measure to a self-sufficient,
semantically, and conversationally valueless or grossly
distorted memory exercise" (Kanner, 19^3, p. 2*13) • Some
times a child would echo words immediately but more often,
the words seemed to be stored somewhere in the child only
to be spoken at a later date. This type of delayed
echolalia and affirmation by literal repetition of a ques
tion were primary indicators of Kanner's syndrome, infan
tile autism.
Difficulties in communication were also noted in
extreme concrete literality. Once a meaning or a word had
become memorized, that word would have an inflexible
meaning and would not be used with any but the original
meaning. For some reason, personal pronouns were repeated
just as heard. There was no change to suit a situation. A
child once told by his mother, "Now I will give you your
milk," would express the desire for milk in exactly the
same words. The same child and other children with the
same verbal level speak of themselves always as "you," and
never address themselves as "I," or "me." Many of the
children have been thought to be deaf or hard of hearing
because, while they may repeat a sentence, they do not
attend when spoken to. Kanner stated "There is an all-
powerful need for being left undisturbed. Everything that
is brought to the child from the outside, everything that
changes his external or even internal environment, repre
sents a dreaded intrusion” (Kanner, 1943, p. 244).
The desire tc remain alone and to keep the outside
world from intruding in this aloneness are evidenced by the
child's rejection of food. Many of Kanner's original
children presented severe feeding difficulties from the
very beginning of life. Loud noises and moving blankets
brought panic and horror to the children. Kanner inter
preted this by stating that the children were afraid of
these objects because they intruded on their aloneless. He
stated, "It is not the motion or the noise that is dreaded;
it is the motion and noise that intrudes itself or threat
ens to intrude itself upon the child's aloneless that
causes the child dread" (Kanner, 1943, p. 245).
The autistic child's motor movements were found to
be "monotonously repetitious" just as verbal responses
were. There seemed to be a great lessening of spontaneous
activity and all the child's behavior seemed to be governed
by "an anxiously obsessive desire for the maintenance of
sameness. Changes of routine, of movements of furniture,
or change in a pattern in which everyday acts are carried
out would drive the child to despair." Kanner explained
the dread of change and incompleteness to be "a major
factor in the explanation cf the monotonous repetitious and
resulting limitation in the variety of spontaneous
activity. A situation, a performance, a sentence is not
regarded as complete if it is not made up of exactly the
same elements that were present the first time the child
was confronted with it. If the slightest ingredient is
altered or removed, the total situation is no longer the
same and is therefore not accepted as such or it is
resented with impatience or even with a reaction of pro
found frustration. Kanner stated that the child is
attracted to those objects which do not change their
appearance or position. This is the reason that the child
will play with them happily for hours, twirling objects,
spinning them, or simply jumping up and down (Kanner, 1943,
p. 245).
Kanner found that autistic children relate to
people differently. He noted that an autistic child would
come into a room and play with blocks or toys but would not
pay the slightest attention to people who were present. It
seemed that as long as people left the child alone, they
had the same degree of importance as the wall, the floor,
the bookshelf or a watch. Conversations going on in the
room seemed to elicit no response and did not enter the
child's domain of thought. Kanner found that the
children may pat a hand or a knee but only in the same
way that they would pat the desk or the couch. They
never looked into anyone's face. If an adult forcibly
intruded himself by taking a block away or by stepping
on an object the child needed, the child struggled and
became angry with the hand or the foot but not with the
person. When the needed object was retrieved, the
6
child’s mood changed abruptly to one of passivity.
(Kanner, 1943, p. 2*17)
Kanner found that while autistic children have "strikingly
intelligent physiognomies, their faces at the same time
give the impression of serious mindedness and in the
presence of others an anxious tenseness." Kanner also
found many of the children to have a plastic smile on their
faces and seemed sometimes to be quite happy in a monoto
nous fashion. Many of the children had a big vocabulary,
an excellent memory for a specific event and a memory for
forms or names (Kanner, 1943, p. 248).
In conclusion, Kanner stated, "We must, then,
assume that these children had come into the world with an
innate inability to form the usual, biologically provided
affective contact with people, just as other children come
into the world with innate physical or intellectual handi
caps" (Kanner, 1943* p. 250).
Definitions
Behavior— the activity of a person which is
observable and measurable that Involves action in response
to stimulation.
Appropriate behavior— is one which is not destruc
tive but is constructive to the child. Examples of appro
priate behaviors are reading, speaking, following direc
tions, looking at people, smiling, socializing, etc.
7
Behavioral analysis— the study of behavior through
a direct observation or measurement of that behavior.
Behavior modification— the application of learning
theory to treatment.
Dally objective— the behavioral objectives which
the teacher has as a goal for a particular child on a
particular day.
Elicltors— events or stimuli which immediately
proceed and bring forth a behavior.
Enroute objective— any behavioral objective on the
way from the entering behavior to the terminal objective.
Infantile autism— Kanner's syndrome, emphasizing a
disturbance of affect and a failure of the child to relate
to himself in an ordinary way from infancy.
Interfering behavior— one which keeps a child from
learning a new behavior. Examples of interfering behaviors
are looking away, biting, kicking, spitting, hitting,
screaming, running away, head banging, twirling, spinning,
etc.
Negative reinforcers— are those which come after a
behavior and cause the rate of the behavior to decrease.
Examples are those of punishment, pain, or withdrawal of a
positive reinforcement.
Primary reinforcers— are those things or events
which come after a behavior and cause it to be repeated.
They are thought to be biologically Inherent from birth and
are not the product of learning. Examples are food, water,
and warmth.
Secondary reinforcers— or acquired reinforcers are
those which take the place or addition of primary rein
forcers, praise, smiling, grades.
Stimulus— the event or sequence of events which
immediately precedes a behavior.
System— a unity formed by many diverse parts having
a common plan, an organized procedure or method.
Terminal objective— the stated projected behavior
of the child at the termination of the program of treat
ment .
Therapeutic teaching— a system of instruction
utilizing behavior modification developed by Peter (1970).
Trend analysis— the statistical prediction of a
trend by analyzing the means from the observed data
(Edwards, 1968).
Experimental Questions
The experimental questions of this study were
organized around the learning theory model of behavior
based upon the theoretical works of Thorndike, Watson, and
Skinner. Operant conditioning, reinforcement therapy, and
behavior modification are words used somewhat interchange
ably as descriptors of the process of learning based on
the ideas of these learning theorists. The studies of
Haring and Phillips (1962), Penichel (1969), Wolf (1964),
Ferster (1968), Jensen (1966), Shell (1967), Stark (1968),
Hartung (1970), Lovaas (1966, 1968), Risley (1967), and
Halpern (1970) were viewed as efforts to identify and
modify the factors that contributed to the interfering or
appropriate behaviors in autistic children. Once the
behaviors were identified, behavior modification was then
used to implement the desired changes in the observed
behaviors. The goal of this total research effort was thus
conceived, as an empirically established sequence of
behaviors to be modified, so that the autistic child would
have the optimal chance for future growth and development.
1. Should conventional psychotherapy be the treat
ment method to be used in changing the behaviors of the
autistic child? Hamblin (1967) found in reviewing the
success of psychotherapy with autistic children that the
rates of success were indistinguishable from the rates of
spontaneous remission. Kanner (1954) notes that those
autistic children who received the most intensive psychi
atric care have been the ones to show the poorer recovery
records. Eisenberg (1956), in a study of sixty-three
autistic children who had received extensive but mixed psy
chotherapy, found that 27 percent achieved a fair or good
level of socialization. Bettelheim (1967) reported a
success rate of 42 percent after working with his cases
nine to twelve years. With the exception of Bettelheim,
psychotherapy has not proved effective, and in Bettelheim’s
case, it is difficult for the outside observer to determine
if the outcomes of his treatment are due to the variable of
psychotherapy or the variable of "Bettelheim the great
Teacher." Psychotherapy was not the writer's choice of
treatment method because of the doubtfulness of its effec
tiveness in treating autistic children, and because of the
length of time required in treatment.
2. Would the elimination or reduction of inter
fering behaviors by behavior modification help the autistic
child to learn appropriate behaviors? Wolf (1964) used
behavior modification on a three-year-old psychotic child
who had to be restrained at his bed, and did not sleep or
eat normally. Through the learning theory principle of
extinction, the destructive behaviors were eliminated.
Jensen (1966) set up a schedule of operant conditioning
techniques for an autistic child. The child's behaviors
included temper tantrums, screaming, hyperkinesis, and
avoidance of all persons. At the end of a ten-week period,
all of the child's destructive behaviors had decreased
significantly. Shell (1967) established a therapeutic
setting based on behavior modification to first develop
attention and later develop speech in an autistic child.
Lovaas (1966, 1968) used extinction and negative reinforce
ment to eliminate head banging and biting in an autistic
child. In conclusion, behavior modification has reduced
11
destructive Interfering behaviors In autistic children.
3. Could appropriate behaviors be increased by
behavior modification in autistic children? Halpern
(1970), Lovaas (1966, 1968), Hartung (1970), Stark (1968),
Ferster (1968), and Shell (1967) found that through
behavior modification techniques, appropriate behavior
increased significantly.
4. Would the systematic application of behavior
modification prove to be more effective in modifying
desired behaviors? Kaufman (1968) stated that it is the
desire of education to meet the needs of society and be
responsive to its needs. Systems is a procedure which
helps us to best meet those needs. By first identifying a
problem, determining the needs, and then assessing how to
meet those needs, Kaufman feels that we can solve our
complex problems. Corrigan (1966) stated that systems is
an approach and a tool which minimizes the chance of
accepting solutions before we know what the requirements
of those solutions are.
There have been no studies, to the writer's
knowledge, which have incorporated the use of systems in
a learning theory model. Peter (1970) has developed a
system of therapeutic teaching, and he is in the process of
developing a teaching system for all levels of education,
but no report on its effectiveness is as yet reported in
the literature.
12
These experimental questions yielded the following
specific hypotheses, each of which is stated in terms of
its research expectation.
Hypotheses
Hypothesis 1
A system of behavior modification (therapeutic
teaching) will result in a downward trend of interfering
behaviors in the cases of autistic children studied.
Hypothesis 2
A system of behavior modification (therapeutic
teaching) will result in an upward trend in the rate of
appropriate behaviors in the cases of autistic children
studied.
CHAPTER II
CRITIQUE AND REVIEW OF LITERATURE
Etiology
Psychogenic Viewpoint
In 19^9* Mahler and Furr Introduced the concept of
symbiotic psychosis, an illness which they felt would occur
in constitutionally vulnerable infants. In 1956, Goldfarb
described and contrasted "organic1 1 and ’ Yionorganic" infan
tile schizophrenia. Going beyond the generality of either
constitutionality or Innateness, Bender stated more
specifically that schizophrenia is
a psycho-biologic entity determined by an inherited
predisposition, an early physiological or organic
crisis, and a failure in adequate defense mechanisms;
schizophrenia persists for the lifetime of the indi
vidual but exhibits different clinical or behavioral or
psychiatric features at different epics in the indi
vidual’s development, in relationship to compensating
or decompensating defenses which can be Influenced by
environmental factors. (Bender, 1969, p. 210)
Rank created the concept of the "atypical child" as
a kind of designation for children that he felt had an "ego
fragmentation," he felt that this "ego fragmentation" was
In connection with internal psychopathology. Furthermore,
he felt that it was not necessary to question genetic,
metabolic, or organic causes and was necessary only to go
13
14
to the psychogenetlc factor common to all disturbances of
the ego. Rank, therefore, felt that the mother-infant
involvement was the only relationship that goes on within
or around the neonate (Rank, 1950).
Writing in 1971, Kanner stated that we are going
away from a "miasma-like" explanation which was probably
based upon some sort of armchair semantics, guessing at the
type of pathology and psychodynamics. Prom this, the move
ment is toward a great display of experimental and
heuristic endeavors which can be controlled by scientifi
cally determined experiments.
Bettelheim basically believes that autism is a
disturbance of the child's ability to reach out to the
world; it will tend to become most apparent during the
second year of life, when more complicated social inter
action with the world would normally take place. Bettel
heim believes that autism is caused by inappropriate
mothering occurring as early as the first week of life
(Bettelheim, 1956, 1967).
Mahler also espouses the psychogenetlc viewpoint
and states that if during the symbiotic phase, the child’s
defenses have already been built up against the maternal
object world, because it has been experienced as painfully
frustrating, then retreat into secondary autism can be
produced (Mahler, 1952, 1968). Bettelheim believes that
the dynamics of autism are caused when the infant, because
15
of pain or discomfort and from the anxiety It causes,
misreads the mother's actions or feelings or even correctly
reads her feelings, the infant retreats from the mother
and, correspondingly, from the world (Bettelheim, 1967).
Bettelheim sees the mother, frustrated in her attempt to
express her motherly feelings, becoming angry and rejecting
her infant. This rejection may create new anxiety in the
infant and add to his already hostile feelings toward the
world. Continuing, Bettelheim stated,
Any such retreat from the world tends to weaken the
baby's impulse to observe and to act upon the environ
ment though without such an impulse personality will
not develop. Retreat depletes the young ego barely
emerging from the undifferentiated stage, and leads to
psychic imbalance.
He goes on to say that in a situation of panic anxiety,
hostility is no longer felt and we tend to shut off the
world around us.
It is when we no longer recognize our hostility, and
the world remains utterly frightening, that reality
stops seeming reasonable. Living in such an unreason
able, unpredictable world, the best thing, the only
protection, lies in doing nothing. . . . To protect
such non-acting, the child's only safety lies in not
being provoked into action and since inner hostility
might also provoke him to act, he must make himself
insensitive to what comes from within his own psyche.
This is autism as seen from inside the person.
(Bettelheim, 1967, p. 74)
Eisenberg (1966) stated that if it can be argued
that autistic children's cognitive potentials were, from
the first, limited, it would seem inevitable that a child
whose contact with a human environment is so severely
16
restricted must undergo Irreversible Intellectual deterio
ration when opportunities for growth are barred by the
exclusion of normal experience.
Bender does not see autism as a strictly inborn
process of disturbance of the central nervous system but
as a defensive reaction to such a disturbance.
I have long argued that autism is a defense mechanism
frequently occurring in the young schizophrenic, or
brain damaged, or severely traumatized, or emotionally
deprived, who thereby withdraw to protect themselves
from the disorganization and anxiety arising from the
basic pathology . . . in their genes, brains, per
ceptual organs or social relationships. (Bender, 1959,
p. 8l)
As a result of a twelve-year study at the Day Care
Unit for Autistic Children in Philadelphia, Ruttenberg
stated:
Our observation indicated that the autistic child was
largely arrested and fixated at, or had regressed to a
very early level of relationship, ego, and psychosexual
functioning. He did not follow the normal pattern of
development as we understand it psychoanalytically but,
rather, he failed to develop object relationships,
extensive drive modulation, reaction formation and
other normal defensives. . . . Autism was thus con
ceptualized as a disorder of emotional development
affecting primarily the non-autonomic ego functions,
especially the development of object relationships and
interfering with the successful unfolding of the
psychosexual progression. (Ruttenberg, 1971, p. 146)
A summary of the psychogenic viewpoint starts with
Kanner (1943, p. 248) who mentions "an innate inability of
the inborn autistic disturbance of affective contact" and
stressed the "rejecting parent as a causative agent." Rank
(1950) stressed emotional deprivation from a rejecting or
17
unresponsive parent. However, Bettelheim (1967) questions
the findings of Kanner for an innate causation and implies
that autism is a reflection of parental pathology and
parental failure to respond to the needs of the child.
Mahler (1963) and Bettelheim (1967) have pointed out that
an overpossessive mother who anticipates the child's every
need, removes from the child the chance to explore, differ
entiate, and experiment with cause and effect, thereby
causing the child to give up, withdraw, and lose interest
in the world, can cause her child to become autistic.
Eckstein (1966) implicates a failure to communicate and a
counter-transference form of failure in understanding the
child's uniquely expressed messages. Eisenberg (1967)
suggests that intensive parental pressure may increase the
severity of the autism.
Abnormality of the Central
Nervous System
Wing suggests that the early onset of signs of
brain damage, such as difficulty in feeding, screaming, the
late improvement of secondary symptoms, the higher rate of
males, and the history of complications in pregnancy or
delivery point to an abnormality in the nervous system.
The reticular activating (RAS) system, has also
been implicated by Rimland (1964) and Hutt (1969) who
suggest that the RAS is not functioning properly and that
the autistic child is "over-aroused." This viewpoint is
18
based mainly upon the observation that autistic children
are hyperkinetic, twist their fingers and have some bizarre
behavior patterns.
Rutter and Bartak have found in a follow-up study,
that of sixty-four children, no less than 18 or 29 percent,
of these children who are not epileptic in early childhood
have, later on, developed seizures in adolescence (Rutter,
1971). These findings raise the question of whether autism
can be divided into those cases which may be due to organic
brain disease and those not due to organic brain disease.
In their study, that Rutter and Bartak found of the nine
children whose IQ'a were untestable (and who were therefore
presumed to be untestable) seven had had seizures in the
1970 follow-up; of the eighteen who developed seizures,
only two had an initial IQ of 65 or more. Rutter concluded
that "these findings strongly suggest that most, if not
all, autistic children with severe intellectual retardation
developed their disorder as a result of organic brain
dysfunction." Rutter also adds that a further indicator of
neurological disorder is the fact that in some autistic
children (seven out of sixty-four), there was a deteriora
tion of intellect in later adolescence. The deterioration
began with a loss of language skills; decreasing activity
was followed by a general intellectual decline (Rutter,
1971, p. 28).
19
In a study of the behavioral characteristics of
2^3 pre-school children with congenital rubella, Chess
noted that the syndrome of autism was found in ten chil
dren, with a partial syndrome of autism in an additional
eight. It was her conclusion that
the high prevalence of autism in a series of 2^3 chil
dren with congenital rubella Inevitably raises the
question of the etiology of childhood autism. Current
research appears to support the argument that favors an
organic etiology as opposed to other lines of inquiry.
No evidence supports the psychogenic hypothesis,
including the postulate of a schizophrenogenic mother
or refrigerator parents. (Chess, 1971, p. ^5)
Autism as a Cognitive
Language Disorder
Rutter (1968), in a review of the concepts of
autism, concluded that autistic children have a central
disorder of language both in comprehension and in the
utilization of the language. He suggested that this dis
order constituted the basic handicap to which the other
symptoms of autism were secondary.
Rutter and Bartak (1971, p. 26) found that "retar
dation of speech and language is an almost invariable mani
festation in infantile autism and the lack of response to
sounds is frequently the first symptom to be noted. Apart
from the level of IQ, language is also the most important
prognostic factor." They also found that the autistic
child is retarded in language but his pattern of linguistic
responses is very different from either the normal or
mentally retarded child. The autistic child was found to
have poor transfer in the perceptual areas of one sensory
modality to another. The autistic child was also unable to
differentiate the meaning of the spoken word and did not
use gestures. "The last feature also differentiates the
autistic child from the child with so-called developmental
aphasia" (Rutter, 1971, p. 27).
Autism as a Genetic Disorder
Rutter (19b7, 1968) found the rate of autism in
siblings to be rather low, giving contrary evidence to a
decisive hereditary element. However, the sibling rate was
higher than that in the general population as four to five
per 10,000. Rutter concluded that there may be a geneti
cally determined type of autism constituting a type of
sub-group of autistic disorders. Judd and Mandell (1968)
designed a study to do a complete chromosomal analysis of
a carefully selected group of eleven children affected with
early infantile autism. They found that three of the eight
boys had large Y chromosomes, and that studies of the non-
autistic fathers revealed a similarly large Y. Their con
clusion was that the normal variation in the size and shape
of the Y chromosome were within normal limits. They were
unable to find any significant or consistent chromosomal
abnormalities.
21
Perceptual Disorders In Autism
Ornitz and RItvo (1968c, p. 229) found that in a
group of sixteen autistic children "the amplitude of the
wave in Stage 2 during REM sleep was significantly greater
than a controlled group of normal children." They also
found that the relative amplitude of this wave during the
eye movements burst was greater than that of a controlled
group of normal children. "The phasic inhibition has been
shown to be mediated by the vestibular nuclei; the over
riding of phasic inhibition Jn the autistic children was
related to clinical observation suggesting faulty registra
tion of the significance of sensory input."
Ornitz and Ritvo in 1968 found in studying the
neurophysiologic mechanisms underlying perceptual inconsis
tency in autistic children, that REM sleep is composed of a
state of "tonic inhibition punctuated by episodes of phasic
excitation and inhibition. In the normal condition these
states are coupled and mutually self regulating." Neuro
physiologic studies of young autistic children implicated
disruption of the normal equilibrium between these states
and suggests
pathologic involvement of central vestibular
mechanisms. . . . The hypothesis is put forth that
these behavioral states may result from a pathologic
uncoupling and disruptive breaking to waking life of
the phasic excitory and the phasic inhibitory influ
ences of the neurophysiologic substratum of dreaming
sleep. (Ornitz and Ritvo, 1968b, p. 26)
22
Ornitz and Ritvo (1968) conclude that the syndrome
of early infantile autism, atypical development, symbiotic
psychosis and certain cases of childhood schizophrenia are
essentially a variance of what they consider to be the same
disease. They find that these diseases are disturbances of
perception and are fundamental to the other aspects of the
disease caused by an early developmental failure, which
distinguishes between the self and the environment, to
imitate and to modulate sensory input. It is their con
tention that the symptomatology is primarily expressive of
a type of underlying pathophysiology, and is therefore only
secondary and, later on, purposeful to the life of the
afflicted child. They have also found that this syndrome
occurs in children with specific organic brain dysfunction
or may in fact occur independently from birth. Ornitz and
Ritvo label the overall syndrome as one of perceptual
inconsistency and it is their conclusion that "it is
specific to the disease but may be activated in certain
cases by particular neuropathologic conditions" (Ornitz
and Ritvo, 1968a, p. 97).
Rutter and Bartak (1971) conclude that there is
still much of the cause of infantile autism that is unknown
although clinical, comparative and various experimental
studies have shown that there is a severe defect in
language and in central functions. Associated with
language, the circumstantial evidence shows that the social
23 |
and behavioral abnormalities arise as secondary conse
quences. Rutter (1971, p. 29) concludes,
The type of physiological dysfunction caused by the
disease is more important than the type of tissue
pathology. Among the intelligent autistic children,
the evidence for structual brain pathology is less
striking and remains possible that few cases arise on
the basis of maturation disorder. The rate of genetic
factors remains quite uncertain.
Goodwin and Cowan (1971) found a surprising number
of biological abnormalities in autistic children. They
found that these abnormalities were unrelated to those
usually found in adult schizophrenics and, from this, they
concluded that childhood autism is biologically distinct
from the large majority of the schizophrenias. Trans-
cephalic direct current baseline parameters (referred to as
TCDC) were found to be of a high nature in autistic chil
dren and "represent a gross instability in their system
relating to orientating, reality structure, and various
higher intellectual functions." They concluded that autism
is a disorder in which underlying cerebral defects tend to
be aggravated by normal chemical responses to stress and
can also be influenced by dietary factors. It is the con
clusion of Goodwin and Cowan that this response is very
suggestive of a correlation between autism and malab
sorption (or a sensitivity to food) (Goodwin, and Cowan,
1971, pp. 60-61).
Boullin, Coleman, O’Brien and Rimland found that it
was possible to make a diagnosis of autism on the basis of
24
an abnormally high release of C-5 hydroxytryptamine from
5-HT loaded blood platelets of children. It was found, on
the basis of the experimental data, that It was possible to
make a prediction of autism and also to differentiate for
nonautistic psychotics. In summary, they found
the efflux of C-5-HT blood platelets taken from a mixed
diagnostic group of ten disturbed children was found to
be a basis of prediction of primary infantile autism.
In nine of the children, the prediction of the presence
or absence of primary infantile autism correlated with
the E-2 score criteria for a positive or negative
diagnosis of primary infantile autism. (Boullin,
et al., 1971, p. 70)
Epidemiology of Infantile Autism
Treffert (1970) found that the prevalence of child
hood schizophrenia and infantile autism was 3.5 cases per
10.000 in a study of all of Wisconsin's Community Mental
Health Clinics. Wayne (1966) found that according to the
London County Counsel, children who have been given the
diagnostic label of infantile autism were about two per
10.000 general population.
Kanner (1943, 1944, and 1956), noted that children
diagnosed as infantile autistics appeared to come from
parents of high intelligence. This finding was later
criticized as merely a clinical artifact. However, in more
recent studies Lotter (1966, 1967) and Rutter (1967) have
found that autism is more prevalent in families of mental
or upper socioeconomic status and in families where the
parents are of above-average intelligence. Rutter (1971)
24
an abnormally high release of C-5 hydroxytryptamine from
5-HT loaded blood platelets of children. It was found, on
the basis of the experimental data, that It was possible to
make a prediction of autism and also to differentiate for
nonautlstic psychotics. In summary, they found
the efflux of C-5-HT blood platelets taken from a mixed
diagnostic group of ten disturbed children was found to
be a basis of prediction of primary infantile autism.
In nine of the children, the prediction of the presence
or absence of primary infantile autism correlated with
the E-2 score criteria for a positive or negative
diagnosis of primary infantile autism. (Boullin,
et al., 1971, p. 70)
Epidemiology of Infantile Autism
Treffert (1970) found that the prevalence of child
hood schizophrenia and infantile autism was 3.5 cases per
10.000 in a study of all of Wisconsin’s Community Mental
Health Clinics. Wayne (1966) found that according to the
London County Counsel, children who have been given the
diagnostic label of infantile autism were about two per
10.000 general population.
Kanner (1943, 1944, and 1956), noted that children
diagnosed as infantile autistics appeared to come from
parents of high intelligence. This finding was later
criticized as merely a clinical artifact. However, in more
recent studies Lotter (1966, 1967) and Rutter (1967) have
found that autism is more prevalent in families of mental
or upper socioeconomic status and in families where the
parents are of above-average intelligence. Rutter (1971)
25 !
stated that "In this respect autism differs from all other
known psychiatric disorders in childhood. Most other con
ditions show no particular association with social class"
(Rutter, 1971, p. 11).
Rimland (1965) stated that there is a higher inci
dence of autistic children in Jewish families than in the
general population. Wing (1966) stated that no intensive
study has yet been done on the incidence of autisism in
Jewish families. Rutter (1971) likewise leaves the ques
tion of a higher rate of autism in Jewish families
unanswered and stated that more research needs to be done
before the question can be answered satisfactorily.
Alpern (1971) found that infantile autism is
characterized by an early onset. Rutter (1971) agrees and
stated that it is essential to include the age of onset as
one of the diagnostic criteria for infantile autism. He
believes that the age of two years is not a good cut-off
point because It is In the middle of a period of great ;
change in the child’s development. Furthermore, Rutter
dislikes a cut-off point at a younger age because of his
observation that autism frequently begins between eighteen
and twenty-four months of age. As a result, he stated,
"Accordingly it is suggested that the diagnosis of infan
tile autism be restricted to disorders beginning before
thirty months of age and which have the required [sympto
matology]" (Rutter, 1971), p. 25).
26
Follow-Up Studies of Infantile Psychosis
Lockyer and Rutter (1969) studied sixty-three
children who were diagnosed as having Infantile psychosis
at Maudsley Hospital during 1950 and 1958; these children
were reexamined and evaluated In 1963 and 1964. Upon
reexamination Lockyer and Rutter found that children who
had no useful speech when first tested and children who had
been cared for in long-stay institutions tended to have a
stable social quotient and a follow-up well below their
initial IQ. The IQ of psychotic children at first hospital
attendance and at later hospital attendance correlated very
highly with their overall functioning level of intelligence
in social maturity. A quarter of both the psychotics and
the control group were found to be reading at an eight-year
level or better. The level of achievement seemed to
correlate very well with IQ, but, in some cases it was
found to be far below the expected on the basis of IQ and
chronological age. Lockyer and Rutter (1970) found that
the inferior social maturity of children who have been
labeled as infantile psychotics agree with those of previ
ous studies. They also found that the psychotic children's
lack of social competence could not be explained entirely
by low IQ. Lockyer and Rutter found that most of the
retardation was due to a lack of speech development and
that half of the children studied were still without useful
speech at five years of age. Rutter (1966) stated that
27
child psychosis exhibits considerable variability in its
course, especially in later childhood and adolescence.
Eisenberg (1956) traced sixty-three autistic children who
comprised 79 percent of those seen by Kanner to that date:
more than half of them were still in full-time residential
settings. Rutter (1966) found that the main follow-up
differences between psychotic children and other children
with the same IQ were in the number of those who were
employed. "Only 2 out of 38 psychotic children who had
passed their 16th birthday were employed compared with
12 controls" (Rutter, 1966, p. 85). Eisenberg (1956) found
that only three of sixty-three autistic children who
attained the age of nine years or more could be said to
function well academically and socially. A larger number
showed fair adjustment so that just over a quarter were
functioning at a fair level, but the majority had a poor
outcome. Creak's 1906 findings were very similar. He
found that of 100 autistic children only seventeen were
working or attending ordinary schools and coping with the
curriculum.
Rutter (1966) stated some of the differences in
outcome and gave the following case studies.
DP, aged 10 years, is the youngest child in the
series. He is of high intelligence and is making
excellent progress in ordinary school, especially in
math and music. He did not speak until he was over
three years, but now his speech is above average,
although he has difficulty with abstract concept
remains. He is friendly, indeed, rather uninhibited,
28
although he still has not made any close friends his
own age. Excessive characteristics and preoccupation
with numbers remain to a slight extent but he no longer
shows the great distress in any change in environment
which he had when he was younger. JD is age 20 years
and is a patient in a mental hospital. His inter
personal relationships are a little better than they
were but he remains strikingly autistic, aloof and
detached and shows no awareness of the feelings of
others. He is without any speech but hums much of the
time. He no longer shows a marked resistance to change
but he spends most of the day flipping the pages of a
magazine while he whirls a length of string so the end
flops against the pages, while watching the string out
of the corner of his eye as he does it. Head banging
is still a considerable problem, although less than it
was a year or so ago. DP is representative of children
rated as showing good adjustment and JD of those rated
poor. However, there are children who have done better
than DP and many worse than JD. (Rutter, 1966, pp. 86-
87)
Education and Treatment of
Autistic Children
One of the leading proponents of the psychogenetic
view of autism is Bruno Bettelheim who works with autistic
and other psychotic children in the Sonya Shankman Ortho
genic School. The school is a full-time residential
setting where every effort is made to have a psychothera
peutic milieu where the child will receive positive inter
actions with others and can interact positively with his
environment. In this way, the child will see that the
world is a safe place in which to live and that he does not
have to withdraw from it. Thus, he will give up his
autistic defenses, his repetitive gestures and his apathy,
which enable him to block out the world. Bettelheim1s
total interaction therapy requires that the child spend
29
many years engaged in close intimate relationships with
very few persons who become the child’s surrogate parents
in a controlled permissive environment (Bettelheim, 1967).
It is Bettelheim’s belief that the child becomes
autistic through his interaction with his parents very
early in his own life. Bettelheim sees the autistic
symptoms as only secondary problems; the real disorder is
thought to be an emotional disturbance, a sickness in the
child’s own personality. Since these causal factors have
produced the internal illness, psychotherapy is therefore
aimed at curing these internal conflicts through catharsis,
interpretation, body contact and play. Once the child's
ego has become recathected and he reexperiences the stages
of normal development, his inner illness can be cured and
the autistic symptoms gradually disappear over a period of
from nine to twelve years.
In Bettelheim's milieu therapy, 42 percent achieved
good socialization and 30 percent a fair social level in a
group of forty children. However, only fourteen of the
forty children were nonverbal. That is, only fourteen were
either mute or echolalic; Bettelheim did not indicate what
percentage of the nonverbal children were echolalic.
However, eight of the fourteen nonverbal children did make
good-to-fair progress over nine to twelve years in therapy
(Bettelheim, 1967).
30
Coffey, et al., established a group treatment pro
cedure for autistic children using the framework of psy
choanalysis as his point of departure. His basic aims were
to increase the child therapist's mode of social interac
tion and increase the autistic child's ego strength through
group catharsis, reality testing and insight. Much was
made of the process of group dynamics to bring about these
therapeutic aims. Play activity groups, under the guidance
of a group therapist, were established in which the inter
action of autistic children and of children less disturbed
were established, it was hoped that the nonautistic chil
dren would act as catalysts within the group and somehow
cause an interaction with the autistic child in his play
activity group. The results were somewhat mixed and it was
the author's opinion that possible progress had been made
in the areas of social Interaction. However, their general
conclusion was that autistic children seem to be suffering
from a basic organic disturbance and that prolonged indi
vidual treatment as well as the group method could achieve
considerable improvement. The results were limited by each
autistic child's basic, innate inability to respond in a
normal fashion (Coffey, 1967).
Ruttenberg uses the psychoanalytic concepts of
development of the origins and processes involved in the
syndrome of autism as the model for therapeutic principles
inferred in his treatment. He sees autism as "a disorder
31
of emotional development affecting primarily the non-
autonomous ego functions, especially the development of
object relationships and interfering with the successful
unfolding of the psychosexual progression" (Ruttenberg,
1971, p. 1^7). His process of treatment is to activate
the stalled developmental processes within the psyche of
the autistic child. Accordingly, the treatment program
provides a day care center which furnishes optimal gratifi
cation through
consistent, positive, mothering contact with individual
trained persons. An attempt is made to realize the
child's needs and to meet him on his own primitive
level of functioning in order to provide a high degree
of mothering contact. As much bodily, visual and oral
contact as the individual child can tolerate is made
through the means of holding, stroking, singing,
rocking, and feeding. Later, the worker moves on to
other levels of expectations and to some degree of
control over the child, such as expecting the child to
have impulse control, dressing and grooming and, at
various times, problem-solving. (Ruttenberg, 1971,
p. 1^9)
Ruttenberg concluded that "normal emotional development,
body mastery, and growth of perceptual and cognitive func
tions depend primarily on the establishment of the object
relationship with a human being derived from a consistent
and gratifying experience with a mother influence." He
also found that development did not occur until the autis
tic child had some degree of object relationship. Another
factor Ruttenberg thought necessary to overcome develop
mental arrest was an externalization of the aggressive
drive through "acceptance and stimulation of the expression
32 I
of aggression in a context of the object relationship,
later directing shaping, and shaping it rather than
extinguishing it" (Ruttenberg, 1971, p. 17^ ) .
Hamblin ( 1967) found in reviewing the success of
psychotherapy with autistic children that the rates of
success with psychotherapy were indistinguishable from the
rates of spontaneous remission. Kanner ( 195^0 notes that
these autistic children who received the most intensive
psychiatric care have been the ones to show poorer recovery
records. Eisenberg (1956) , in the study of sixty-three
autistic children who had received extensive but mixed
psychotherapy, found that 27 percent achieved a fair or
good social level. Wing ( 1966) notes that "the absence of
speech is still one of the major handicaps of the autistic
child which continues into adolescence and early adult
life." In Kanner's study ( 1956) thirty out of sixty-three
children remained mute. Rutter ( 1966) found a similar
proportion remained with useful speech: twenty-nine out of
sixty-three. Eisenberg (1956) found that mute autistic
children do not tend to respond to psychotherapy. One out
of thirty-one or about 3 percent in his nonverbal samples
showed good improvement. Rutter ( 1965) found that most of
the nonverbal children who do show some improvement with
psychotherapy are echolalic. Rutter, Greenfield, and
Lockyer (1967) have shown in a mixed therapy sample of
twenty-three echolalic children that 50 percent showed a
good or fair social adjustment as follow-up.
One of the strongest proponents of operant condi
tioning in the treatment of autistic children is Bernard
Rimland (1964, 1968). It is Rimland's contention that the
psychodynamic view of infantile autism is "probably
nonsence." Furthermore, Rimland does not accept an
eclectic position which might stress both organicity and
environment; he says, "The problem of educating children is
too important— especially educating children starting out
with two strikes against them— to settle for the easy,
middle-of-the-road, eclectic, wishy-washy solution, whose
main attraction seems to be that it saves the eclectic from
some hard thinking" (Rimland, 1970, p. 1).
Haring and Phillips (1962) formed a control group
study in which permissively taught autistic children were
compared with autistic children taught in a structured
setting. The results of this study favored a highly-
structured method. Levitt (1963) published a paper on the
reevaluation of psychotherapy. As the result of an experi
ment of fifty-seven matched control group studies, it was
his conclusion that the available evaluation studies do not
furnish a reasonable basis for the hypothesis that psycho
therapy facilitates recovery from emotional illness in
children (Levitt, 1963, p. 49).
Rutter stated (1965, pp. 521-522): "Whereas the
educational milieu seemed much related to outcome there was
little evidence that psychotherapeutic treatment of a child
influenced progress." In the same vein, Carl Fenichel
(1969) explained how, when he had first set up his school
for the emotionally disturbed, it was his contention that
the children needed love and affection in a permissive
environment. Later, he stated that he began to feel a need
for structure and now the curriculum of the League School
is well structured. "We have learned that disorganized
children need someone to organize their worlds for them
. . . what they needed was teachers who knew how to love as
well as accept them." Fenichel proposed an explanation and
said that the reason for the structure and the purposeful
instruction was that they gave order to disordered minds
(Fenichel, 1969, p. 3).
Rimland is in favor of operant conditioning and
does not feel that this stand is in opposition to his
dogmatic assertion that autism is of organic causation. He
stated that "operant conditioning can be used to teach a
mongoloid child to read. Does that mean that mongolism has
disappeared? Of course not, . . . it merely means that you
have found a way to bypass the difficulty" (Rimland, 1970,
p. 5).
Wolf, Risley and Mees (1964) used behavior modifi
cation on the behavior problems of a 3-1/2 year old
psychotic, retarded child who was without speech, did not
sleep or eat normally, and had to be restrained at his
bedside. Through the use of extinction, four of the
child’s destructive behaviors were eliminated. It was
necessary for this child to wear his glasses because, with
out them, his vision would become permanently impaired.
The child, however, refused to wear the glasses. The goal
of the experiment was to increase the amount of time that
the child wore his glasses to twelve hours a day, rein
forcing the behavior of the child when he wore the glasses.
The treatment goals were realized. A conclusion made of
this study was that change takes place in small increments
and, for some periods of time, there may be no detectable
change. Nevertheless, over an extended period of time,
change does take place, and behaviors are definitely
modified.
Ferster (1968) discusses how operant conditioning
can be used to establish primary and secondary reinforcers
for the autistic child. He also included procedures in
which the principles of reinforcement and observable
behavior can be taught in a training program. Ferster
stated that little behavior of the autistic child is main
tained by conditioned or delayed reinforcement, or sensi
tivity to the details of the environment. It was found in
comparing normal children with autistic children, that
autistic children had to be taught behaviors by very slow
and tedious procedures while normal children developed the
same behaviors spontaneously.
36
Ferster claims that the normal child exhibits
behavior in sequences which are maintained by conditioned
and generalized reinforcers. As an example he cites the
child who wants some cookies: the child gets a chair from
across the room, climbs onto the chair and reaches the
cookies. Ferster sees this as a complicated chain of
responses linked together by critical stimuli which have
the "dual function of sustaining the behavior they follow—
conditioned reinforcement— -and setting the occasion for the
subsequent act." Ferster goes on to say that
Generalized reinforcement has many of the connotations
of secondary processes. It may alter behavior regard
less of the individual's momentary state of depriva
tion. It is the uniquely human reinforcer that makes
possible much of verbal behavior, education in general
and self control. (Ferster, 1968, p. 12)
He goes on to say that it is the parent's interdictions
which act as a negative reinforcer and it is the parent's
attention, smiling words such as "That's right," "That's
O.K." and "That's fine," which act as conditioned and
generalized positive reinforcers. Ferster contrasts this
with the low frequency of stimuli which appear to act on
the physical and social environment of the autistic child.
He stated that it is necessary for behavior to be limited
in order to develop first and second order reinforcers. A
limited development of simple conditioned reinforcers "in
turn prevent the development of generalized reinforcers. .
. . Without conditioned and generalized reinforcers, there
37
is little change in the child's repertoire [of behaviors].”
This is why parental responses such as smiling or saying
"Good” or "Right" have absolutely little or no effect upon
the autistic child's behavior. "It is usually difficult to
determine how meaningful speech is to a child since the
total situation is usually so complex that many stimuli
could provide the basis for the simple performances"
(Ferster, 1968, pp. 15-16).
Jensen and Wolmak (1966) set up a schedule of
operant conditioning techniques for an autistic child in a
ward treatment program of milieu therapy. The child's
behaviors included temper tantrums, screaming, hyperkinesis
and avoidance of all persons. Using the primary rein
forcers of ice cream and potato chips and the secondary
social reinforcer of the attention of a nurse, rewards were
used to shape the appropriate behaviors. Behaviors which
were desired were socialization with peers, use of language
and group play. Behaviors that were to be minimized or
reduced were temper tantrums, spitting, and hitting people.
At the end of a ten-week period, it was the conclusion that
of the behaviors originally listed, there was a trend for
the appropriate behaviors to increase and the interfering
behaviors to decrease.
Shell and Giddan (1967) established a therapeutic
setting based on behavior modification to develop language
in an autistic child. The autistic boy was nonverbal and
38
was very unresponsive to any environmental stimulation.
The first step involved in teaching this child was to get
him to attend to people; the second step was to increase
his general responsiveness and the third step was to enable
him to discriminate between varying stimuli from auditory
and visual stimulations. Shell found that by increasing
the rate of the child’s vocal and nonvocal behavior and by
increasing the control of his motor behavior, the child
then responded to verbal commands. For example, a verbal
command was given, such as "Shut the door, open the door,
turn off the light." Questions would be given following
the desired behavior and then the child would be rewarded
when he made the appropriate response to the command.
Primary reinforcers of food and candy were paired with the
secondary reinforcers of social approval. At the conclu
sion of the experiment the child was responding to the
reinforcer of social approval, and the primary reinforcer
of candy was dropped. The conclusion of Shell and Giddan
was that the boy had shown a marked improvement in the
frequency and variety of his verbal and nonverbal behav
iors. His overall level of behavior seemed to be under
much more appropriate stimulus control and other persons
were sources of discriminative and reinforcing stimuli for
him. "He laughs and giggles, makes some sounds similar to
those made by others, responds to his name, pays attention,
asserts himself, successfully does simple tasks, and is
39
otherwise more aLert and responsive" (Shell and Giddan,
1967, p. 63).
Stark, Giddan and Meisel (1968) found that through
behavior modification techniques they could increase the
verbal behavior of an autistic child. Their first step was
to increase nonvocal imitation on the assumption that
children learn many activities, including speech, by
imitating the behavior they observe. The second step was
focused on vocal imitation where a game-like procedure was
established to prompt and shape the vocal production of the
child. The factors taken into account to select the sounds
which the child would imitate were those sounds which could
be prompted by manipulation of the tongue, lip and jaw.
Once the child's level of verbal imitation was high, the
next goal was to teach him that things have labels and the
movements and sounds he produced could represent actions
and objects. The final stage was reached when the child
had to make verbal discriminations of complex stimuli in
order to be reinforced for his response. The child's
mother had observed "many of our procedures [and] then was
able to practice with him for several hours each day." In
addition to language learned at the clinic, more functional
responses to commands, such as "Brush your teeth," "Get
your coat," and "Close the door" were continually rein
forced. Stark concluded by saying that the child had
developed secondary reinforcers and no longer needed to be
40
given the candy used in the earlier training sessions.
However, Stark did state that the child was still pro
foundly disturbed and was functioning far below his age
level (Stark, 1968, p. 47).
Hartung (1970) found in a review of the literature
on the conditioning of verbal behavior that there are only
a few articles which present systematic account of speech
development in nonspeaking children (Lovaas, 1966; Lovaas,
1968; Risley and Wolfe, 1967). Hartman reviews the
literature and restated the importance of speech in the
prognosis for change in an autistic child (Rimland, 1964;
Kanner and Eisenberg, 1955, 1956). It is their finding
that it is the child who fails to use speech before the age
of five who is the one with the worst social adjustment and
who suffers the most in later years.
Halpern (1970) found that without special help,
autistic children were unable to experience much beyond
very primitive organizational levels of development.
Halpern presents a model whereby structured language
training can take place in small groups of young autistic
children. Halpern works with autistic children who are
responding to a secondary reinforcer, social approval and
praise. By pairing this praise with the successful manipu
lation of a child's sound and by the successful pairing of
the sound to an object, speech was developed. Once speech
was developed, a wider variety of behavioral responses was
41
available to the autistic child. Follow-up studies showed
73 percent of the children studied between 1964 and 1968
had been placed in public schools or special education
classes.
Conclusion
Welland (1971) in a critique of the operant theory
of learning, stated that all learned behavior can be
explained by a conditioning paradigm.
This is most useful in designing treatment efforts
where the goal is to implement more or less discrete
responses. . . . However, as more complex behaviors are
acquired and in increasing numbers, they tend to inter
relate and form new psychological structures or
schemata which obey not only the laws of learning
theory but evolve according to the laws appropriate to
the particular system. (Welland, 1971, p. 200)
Weiland is also critical of the psychoanalytic
viewpoint and stated that 111 have not been convinced that
available psychoanalytic theories of neurogenesis or ego
development adequately explain the pathology of childhood
psychosis nor does treatment based on psychoanalytic theory
offer a hopeful prognosis" (Weiland, 1971, p. 201).
Weiland feels instead that the outcomes of both behavior
modification and the psychoanalytic viewpoints are almost
identical but that the results are much more rapid in the
formal operant situation. He goes on to state that "I have
seen occasional dramatic recoveries of children treated in
institutions of both types, but after years of treatment
most such patients, will improve but would be clearly
identified by most of us as still psychotic" (Weiland,
1971, p. 201). In a comparison of the methods of Lovaas,
Hingtgen and Ruttenberg in controlling a psychotic behav
ior, Welland makes the following statement: Lovaas "avoids
reinforcing, by intentionally withdrawing reinforcers, plus
the aversive conditioning, punishment." In contrasts,
Hingtgen would not directly approach the child, but would
isolate the child and, as a result, not reinforce his
behavior. Ruttenberg, on the other hand, relies on the
intuition of the child care worker not to intrude on the
behavior of the child (Weiland, 1971, p. 202).
Weiland sees Lovaas treating the category of
"initiating social awareness or developing a relationship"
as manipulating the autistic child to look first to the
therapist as a source of gratification and reward. The
primary reinforcement is "biological— food— later social
contact— limited generalization— or secondary reinforce
ment." Hingtgen uses the same treatment as Lovaas and also
uses relief from restraint to develop social awareness.
Ruttenberg uses in his program, though not specifically
designed "in detail as the other two; the child care worker
to reward a child for the . . . desired behavior." "Per
haps the reasons this stage apparently took longer for
Ruttenberg is that he did not require the child to dis
criminate, i.e., he did not make the rewarded behavior
discrete and clear" (Weiland, 1971, p. 203).
In the use of aversive stimuli Weiland found that
Lovaas used aversive conditioning by Inflicting pain,
restraint, or withdrawal of a positive reinforcement.
Hingtgen on the other hand, would only use aversive
stimuli in the form of a restraint or social withdrawal.
Ruttenberg's treatment is summarized by Weiland as "the
only aversive stimulus used is social withdrawal, Rutten
berg describes it as demanding or requiring behavior when
the child is ready in small amounts. This again may be why
the stage takes longer too" (Weiland, 1971, p. 202) .
It becomes increasingly clear that we cannot afford to
direct our treatment efforts and even more, our explan
atory efforts, on the basis of one or another theory.
We must develop means of refining our ability to dis
criminate among the varieties of autism with which we
are dealing and use therapies and theoretical explana
tion with much more selectively. It is not a question
of whether children, autistic or otherwise, learn as a
result of discrete reinforcement experiences. Or
whether they learn as a result of biologically ordained
progression of drives leading to the evolution of cer
tain interpsychic organizations and interaction with
gratifying objects— persons. (Weiland, 1971, p. 210)
CHAPTER III
PROCEDURE
i
Subjects
The subjects were all diagnosed as autistic by i
board certified child psychiatrists at either Neuro Psy
chiatric Institute, Los Angeles, or Children's Hospital,
Los Angeles. The girl, Lori, was nine years of age, Kevin
was five years old and Robert was nine years of age at the
I
time of this study. All children were Caucasian and from
middle-class families. Because of the few cases of chil
dren classified as autistic, no attempt was made to secure
a completely homogeneous group.
Situation Variables
All subjects were taught on a one to one basis by a i
teacher trained in the principles of behavior modification. !
Lori and Kevin were seen at the Evelyn Prieden Center,
School of Education, University of Southern California, and
Robert was seen at the University Affliated Project,
Children's Hospital, Los Angeles. The teaching rooms at
both institutions were very similar. They were free of
44
45
distracting stimuli, had a small table and chairs, a one
way mirror, and were equipped for video tape recording.
Systems Design
Within the field of education the terms system and
system approach are becoming more popular within the liter
ature of education (Bern, 1967; Mauch, 1962; Silvern, 1968;
Kaufman, 1968).
"As background, it may be beneficial to review what
we are trying to do in education." Kaufman stated that,
"we are attempting to meet the needs of our society, of our
students, and as educators to be responsive to requirements
placed upon us by those we strive to serve" (1968, p. 4l4).
We can determine that a need is a measurable distance
between "a present condition and what is required to be
accomplished" (1968, p. 414). Our problem in education is
then to reduce or eliminate the discrepancy between what is
today and what is required to meet a specified level of
accomplishment. "In this context, then, needs are identi
fied as discrepancies, and problems are derived by the
identified needs" (1968, p. 415). An example of this dis
crepancy in education would be, autistic children do not
have communicative language abilities approximating their
developmental age equivalents. Our problem would then be
to raise the communicative skills of the autistic children
so that they would be on a level equal to their develop
mental level. The needs of the autistic child are then
identified through a process called need assessment, where
in all discrepancies are identified relative to a given
area. Once the needs for the individual child are
determined, then the priority would be placed on the needs
relative to one another.
If we think of a problem as having both a beginning
and an end then we can see that the beginning is what
presently exists, or what is, and that the end is the
observable conditions that will be, when the problem is
solved or when we have come to the termination of our
goals.
1. The first step in a system approach to educa
tion is to identify and define behavior as it is for the
given day,
2. The second step is to then identify and define
what is required to get from where the child is today to
where we would like for him to be at the conclusion of our
teaching sequence.
3. The third step is to select the process that we
will use to get from step one to step two.
4. The fourth step in the system is to implement
the process whereby specific selected methods are imple
mented, and the product of the processes of education are
produced.
5. The fifth step is to determine the validity of
the product as compared to what extent the outcome of the
47 ;
product meets the criteria that we established in our
second step.
6. The sixth step is the critical feature of self
correction so that any or all of the steps in getting from
what is, to what is required, may be redone or changed, so
that the required output will meet our established and
defined needs (Kaufman, 1968; Bern, 1967; Corrigan, 1966;
Mauch, 1962).
The systems approach minimizes the chance of
accepting foregone conclusions or solutions before we know
what the requirements of those solutions are. Within this
systems approach we first have to know what the problem is
and specify what our solution will be, before we try to
implement the solution. Systems and systems design are an
approach to problem solving that seeks to incorporate with
in itself relevant theories of education which seem to be
able to solve the needs of the specified problem. Systems
is an organizational framework which forces the teacher and
educator to make decisions and plans about treatment before
the treatment is implemented.
Therapeutic Teaching System
The Therapeutic Teaching System is a systems
approach developed by Peter ( 1970l) to utilize the concepts
of systems design in an organized package. The most
important component of the Therapeutic Teaching System is a
4 8 i
teacher who has a knowledge of child development, for it is
the teacher who is responsible for arranging the stimulus
events to elicit the progressive changes in behavior, and
for providing the reinforcing events which will strengthen
these changes.
Behavioral analysis is the study of behavior
through a direct observation or a measurement of that
behavior. Care is taken to avoid inference concerning the
behavior and only the objective diagnosis of the child's
problems based on the empirical data, is considered. The
entering behavior of a child consists of a description of
the child's level of functioning at the time that he enters
the program. This description is the result of direct
observations of the child in the therapeutic setting and
also of observations of the child in his natural setting,
in other words, the classroom, institution or home. The
terminal objective is a description of the projected
behavior of the child at the termination of the program of
treatment or the end of the course of study. It is the
long term goal towards which all teaching procedures are
aimed. The enroute objective is any objective on the way
from the entering behavior to the terminal objective, the
enroute objectives are usually thought of as the daily
objective that the teacher has for the particular child for
the particular day. However, more than one enroute objec
tive can be given for each individual teaching session
(Peter, 1971).
Components of the Therapeutic
Teaching System (See Table 1~~
and Appendix for Case Studies)
1. The first component of the Therapeutic Teaching
System Is the referral of the child to the center engaged
in therapeutic teaching. Referrals are made by parents,
school districts, and various professional organizations.
2. The next step is the filling of an application
form. Of primary importance is a brief description of what
the parents consider to be the child's problem.
3. The third step is the gathering of para educa
tional information, all reports of prior professionals who
have dealt with the child, and their conclusions and
evaluations of their progress.
4. The fourth step is the initial behavioral
observation of the child. An observation is made of the
child in his everyday setting, either school, home, or
institution. The observations are made in a strict behav
ioral sense, and a specific list of the variety of behav
iors emitted are observed. After the observation is
completed, one to four critical behaviors are selected by
the teacher to be modified. These behaviors can be classi
fied into either appropriate behaviors or interfering
behaviors. Appropriate behaviors are those which are
desired and considered normal for the child's developmental
level. Included in this classification are communicative
o
ITi
TABLE 1.— Therapeutic teaching system
INITIAL
BEHAV
IORAL
OBSERVAH
TION
PARAEDU-
flflTTflNAJi..
APPLI
CATION
REFERRAL
----
DIAGNOS
TIC
TEACHING
ELICITORS
RATED
REINFORC-
ERS RATED
TERMINAL
lOBJECTIVE
TEACHING
RECORD
LESSON 1
T I T
ENROUTE
lOBJECTIVE
T
PROGRESS
REPORT
J
Referral
Source
ELICITORS "
METHOD OF
PRESENT
ING
BEHAV
IORAL H
I RESPONSE
REIN
FORCERS
Strength
of
Response
Interfering
Behavior
Concomitant
Development
TEACHING
RECORD
Lesson ’n*
Same as
#1
10
EVALUA
TION
RECORD
Observa
tion
11
REFER
RECYCLE
BEHAV- H
IORS
INTER
FERING
APPRO
PRIATE
FREQUENCY RATE
TERMINAL
OBJECTIVE
11
Evalua
tion
RECOMMEN-
DATTON
__*
speech, looking, attending, socialization, dressing self,
reading, writing, copying forms, stacking blocks, etc.
Interfering behaviors on the other hand, are those which
keep the child from a given task or keep the child from
attending to an appropriate behavior. If the interfering
behaviors can be reduced, then the child’s attention can be
more readily focused to the establishment of appropriate
behaviors. Interfering behaviors are those such as biting,
kicking, screaming, throwing food, tantrums, eating off the
floor, spitting, throwing objects, looking away, gazing,
etc. The judgment of whether a behavior is inappropriate
or interfering is determined by an evaluation of the child
in comparison with the developmental levels of Gesell,
Erickson, and Piaget.
5. The next step is that of diagnostic teaching.
The first sessions with the child are purely exploratory to
see what types of elicitors the child responds to best.
Here through prior conversations with the teachers,
parents, and workers, the objects are brought before the
child to see if they do elicit a response. As an example,
a book about automobile racing may elicit attention from a
ten year old boy, while a book on automobile racing may not
elicit a response and attention from a ten year old girl.
Lists of various elicitors are brought before the child,
and are rated at their level of effectiveness. Likewise,
various reinforcers are used and rated in their level of
52 |
effectiveness. First, secondary reinforcers are utilized.
The child is spoken to, praised, smiled, or given stars,
and the level of reinforcement is noticed. If the child
does not respond to these secondary reinforcers then pri
mary reinforcers are used and these are rated in their
level of effectiveness. As an example, one child may like
M & M’s, another potato chips, another coke, or another
mouthwash. The primary reinforcers used do not depend on
any value of the reinforcer per se, but only as they prove
to be reinforcing to the behavior of the child.
6. At the conclusion of the diagnostic teaching
session an evaluation of the various elicitors and rein
forcers is made. Based on the assessment of initial needs,
the terminal objective is decided upon. The terminal
objective is then the target or goal of a specific behavior
toward which each daily teaching session is directed. If
we are working with a mute autistic child, our terminal
objective may be that at the end of thirty teaching ses
sions the child will be able to verbalize thirty sounds.
At the conclusion of the thirty teaching sessions we can
then evaluate our stated objectives in terms of our desired
results and see if the needs which we initially identified
have been met.
7. The next step in the Therapeutic Teaching Sys
tem is the teaching record. Each day a daily enroute
objective is stated in behavioristic terms. For example,
53
"Lori will sit in her chair and match names to objects."
The type of elicitor used in the daily lesson is given
"Montessori form board"; the type of reinforcement used is
listed, "social approval— say that is good and smile," and
an evaluation of the elicitors and reinforcers used is then
made. Also included on the teaching form, is a record of
the rate of the child’s response to the elicitors and rein
forcers. Behavior rates are taken by the teacher and by an
observer through the one-way mirror.
8. At the end of the teaching sequence, usually
three days, a written progress report is made, and the
level of the behavioral response is given. "Lori matched
fifty forms correctly this week." Also included are nota
tions of any interfering or concomitant behaviors. As an
example, a child has never been seen to socialize with any
one, and this has not been one of the stated behavioral
objectives, however, concomitantly as the level of eye
contact increases, the child reaches out and takes the
teacher’s hand, an act of socialization. This concomitant
development is noted. As a few behaviors are isolated, and
the rates are increased, new behaviors not under experi
mental control, often develop.
9. The daily teaching sequence is continued until
the prescribed time set by the terminal objective. During
the teaching procedure, a feed back loop is incorporated so
that the behaviors of the child influence the next daily
54
enroute objective. Also in communicating to the parents
about the progress of the child, information can be
gathered which will effect the next teaching day’s enroute
objective. For example, Robert has been taught to say the
word "me." Robert's mother reported that at home when he
wants anything, he says "me." Accordingly, in the next
day's enroute objective, the teacher will state as his
objective. "Robert will ask for food reinforcement by
saying "me." In the same way by constantly evaluating
elicitors, reinforcers, and enroute objectives, the teacher
can remain flexible and utilize the past behaviors to
influence future progress.
10. Once the series of teaching sessions are com
pleted the next step in the system is evaluation. The
teacher returns to the original setting in which the child
was observed in the Initial Behavioral Observation. While
the child is engaged in a somewhat similar activity as was
noted in the initial observation, a behavioral analysis is
made. All behaviors are listed and a rate is recorded. A
comparison is made of the initial behavior, and the final
observed behavior, with an evaluation made as to whether
the terminal objectives have been met. The behavioral
change is then rated as significant or not significant.
11. Based upon the behavioral observations, recom
mendations toward future objectives are made. The child
can be referred for another cycle of teaching, or referred
to another agency.
The focus of Therapeutic Teaching is not on a
behavioral deficiency or difficulty, but upon the behaviors
of the child as a whole. Each individual child has varying
behaviors which are unique for that individual child. By
first making a detailed behavioral analysis on each child,
then by building the appropriate behaviors and then by
eliminating the interfering behaviors, a truly individually
human and unique program can be designed for each child.
CHAPTER IV
RESULTS
In this study, three autistic children were taught
by a system of behavior modification— therapeutic teaching
(see Appendix for case studies). After a systematic
assessment of the child's individual needs, behaviors were
selected for modification. They were classified Into two
/ ;
categories— those of appropriate behaviors and those of
interfering behaviors. Behavior modification was then used !
as the tool to implement the desired behavioral change, an
increase in appropriate behaviors, and a decrease in inter
fering behaviors. After the teaching sessions for each
child were terminated, the child's final behaviors were
observed and evaluated.
Each time a new appropriate or interfering behavior
was modified a count of that behavior by two independent
i
observers was made. All behavioral rates were taken from
the first session in which that behavior was modified. In
that way, the behavior rates could be added since they had
the same starting point.
The appropriate behaviors to be modified for Lori
were, "looking at the teacher" and "looking at her mother";
56
57
for Kevin, "the number of words read"; and for Robert,
"saying the sounds pu, put, and me." The interfering
behaviors modified for Lori were "tantrums, and getting out
of her seat"; for Kevin "running away"; and for Robert
"hitting his hand" (see Table 2).
For the three children studied, there were found to
be six appropriate behaviors and five interfering behaviors
selected to be modified. First, the mean of all sessions
labeled number one were found, then the mean for all ses
sions number two was calculated. This procedure was
continued until the means for the two series of teaching
sessions was completed. The results were two separate
series of means, one representing the category of appropri
ate behaviors and the other the category of interfering
behaviors.
Most case studies have ended previously with either
the plotting of the individual behaviors or with the means
of those behaviors. Just plotting data per se does not
give validity to the findings, nor does it allow the
experimenter to make valid statistical predictions regard
ing future trends. For by looking at a data plot, the
highs or lows, does not state if the trend produced is
meaningful, or if the changes are meaningful.
Data plotting can also be misleading, in that a
trend which may have surface validity may have no statis
tical validity. A data plot may suggest that if a
, CO
1 in
TABLE 2.— Behaviors studied
INTERFERING BEHAVIORS APPROPRIATE BEHAVIORS
Sessions Sessions
Lori I
Tantrums 20
12
12
12
O
15
C
11
10
7
14
O
17
0
2
10
q
5
n
11
0
2
1. Look at 5 15 10 25 33 75 55 100 65 75
(Mother)
3
7
J
8
J
1
5
0
c .
Teacher (12 mo. follow-up) 195
Out of 25
20 20 18
5 7
20 i 0 0 2. Look at 50 40 25 57 74 76 86
— — —
Seat 10
3
0 0 0 1 2 0 Mother
(Mother}
10 5 12 5 1 0 0
Kevin II
60
25 32 45 15
8 10 8
9
2 0 1. Number
nuns Away
0
3
4 1 0 0 0 0 0 4 0 of 0
3
2 8 11 11 12 13 14 14 14
0 Words 15 15 15 16 16
17
18 20
Read
Robert III
Bitting 1. say ee 0 4 13 20 6 7 22 19 22
his (Data not included in
83
Hand trend analysis) 2. say pu 0 12 80 190 160 216 201
3. say me 0 2 1 2 12 10 5 60 36
4 72 56 90 13 85
5 9 !
procedure is continued, a change will also continue. Yet,
when the procedure is continued no further change is noted.
By statistically evaluating a data plot as to its theoret
ical or predicted course of action, we can then state with
some degree of certainty what the future prediction for
that trend will be.
Trend Analysis
Trend analysis is the statistical procedure which
can greatly aid the experimenter by allowing him to deter
mine the validity of his trends. He can also make predic
tions on the future extrapolation of his data to see if he
should continue or stop a certain procedure.
Trend analysis is the analysis of variance for
experiments concerned with the trend of a series of means,
in which more than one observation is made in each cate
gory (Edwards, 1968). The primary objective is to study
the trend of the means over the successive sessions. The
observations for each session are obtained under standard
conditions, and it is therefore assumed that any differ
ences between the series of means are the result of the
treatment variable (Edwards, 1968).
By examining the means for the series of sessions,
labeled interfering and appropriate behavior, they may
reveal that the trend is either upward or downward. The
means may either increase or decrease with successive
60
sessions. However, such a trend can occur as a result of
random variation.
One important question to be determined is whether
the upward or downward trend is statistically significant,
or is the result of chance or random factors. Likewise,
the trend of the means, in addition to being downward or
upward, may also show bends or curvatures. If there is a
bend or curvature, we can also determine whether the
curvature as such, is to be statistically significant. We
can further determine what type of plotted equation will be
the best predictor of the trend of the means. In other
words, do the means best represent a straight line linear
relationship, a second degree parabola, a third degree
slope, or a fourth degree cycle. By determining what pre
dicted shape best represents the means of the teaching
sessions, we can make predictions on future rates with a
high degree of reliability based on the corresponding
degree of statistical significance (Edwards, 1968).
Results
The statistical trend analysis of the data was
performed on the series of means representing the cate
gories of interfering and appropriate behaviors.1
1The data were analyzed using program BMD 05R at
the Computer Center, University of Southern California, Los
Angeles.
61
Figure 1 shows the graphs of the series of means
for both the interfering and appropriate behaviors. The
trend of the interfering behaviors is first downward, then
increases to a plateau, then suddenly decreases. The
graph for the appropriate behaviors shows a very slight
increase, a slight decrease, and then a rapid Increase.
While both of these graphs suggest trends and variations
within the data plots, by observation it is impossible to
tell if the variation in the plots is due to random factors
or to the effects of the treatment.
The statistics for the entire trend analysis of
interfering behaviors are summarized in Table 3. Included
in the table are the predicted types of equations, linear
through fourth degree. The trend was analyzed to see which
equation best fit the means of the interfering behaviors.
All of the equations showed a good deal of significance,
but the linear equation showed the highest level of signif
icance— .005. The second degree polynomial was next
highest in level of significance at .025, followed by the
fourth degree polynomial equation at .05, and finally by
the third degree polynomial at the .10 level. While the
linear equation best predicts the overall trend and shape
of the data plot, the fourth degree polynomial equation is
also significant, especially when viewed in the first
initial sessions. The tendency of the curve to initially
level off, is significant at the .05 level. This leveling
Rate
Pig. 1.— Interfering and appropriate behaviors
Interfering
Appropriate
Sessions
on
TABLE 3.— Table of trend analysis for interfering behaviors
Type of
Polynomial
Equation
Source of
Variation
Degree
of
Freedom
Sum of
Squares
Mean
Squares
F
Value
Level of
Signifi
cance
Due to
regression 1 6820.324 6820.324
Linear Deviation about 44.488 .005
regression
5
766.532 153.306
Total 6 7586.856
Due to
Second degree regression 2 6827.761 3413.880
polynomial Deviation about 17.989 .025
regression 4
759.095 189.773
Total 6 7586.856
Due to
Third degree regression
3
6841.262 2280.420
polynomial Deviation about 9.175
.10
regression
3 7^5.595
248.532
Total 6 7586.855
Due to
Fourth degree regression 4 7453.266 1863.316 27.896 .05
polynomial Deviation about
regression 2
133.589 66.791 *
Total 6 7586.852
off in the initial sessions, might be a peculiarity of the
learning pattern of autistic children. That is, there is a
greater period of time for the initial information to be
processed, and when it is finally processed, learning takes
place. It is very important for the teacher of the autis
tic child to realize that although the child may look like
he is not learning initially, if the treatment is con
tinued, then the child will learn. However, the teacher
may be misled by the initial failure in his procedure and
give up. If he would patiently wait, however, the trend
analysis predicts that the interfering behaviors will be
reduced significantly.
The trend analysis as shown in Figure 2 indicates
that a straight line in a decreasing trend is the best
predictor of interfering behaviors. This means that when a
behavior is reduced it can predictably be expected to
remain at a lower level and that if a behavior is extin
guished the behavior will remain extinguished. The level
of significance is a high .005.
Figure 3 is the graphical representation of the
second degree polynomial equation. While this equation can
allow for a great degree of curvature, it does not curve in
this case. Instead, it is only slightly bent from a
straight line. Because the line so closely resembles the
linear equation, added significance is given to the linear
trend. Figure 4 is the plot of the third degree polynomial
Rate
Fig. 2.— Trend analysis of interfering
behaviors
Rate
Pig. 3.— Trend analysis of interfering
behaviors
second degree polynomial (X )
significant at .025
Predicted •
Observed A
Sessions
Rate
Fig. 4.— Trend analysis of interfering
behaviors
third degree polynomial (X )
significant at .10
68
which could allow for a greater degree of variation in the
shape of the curve, but it does not and closely resembles
the linear equation. The level of significance is poorest
of the four equations being .10. The fourth degree poly
nomial is significant at the .05 level, as shown in
Figure 5, and the predicted plot is more similar in shape
to the observed data than any of the other equations.
While the linear equation gives the highest level of
significance for overall prediction, the fourth degree
polynomial equation in Figure 5 is the best predictor of
initial learning.
The statistics for the entire trend analysis of
appropriate behaviors, are summarized in Table 4. Included
in the table are the types of equations, linear through
fourth degree. The trend was analyzed to see which equa
tion best fits the observed means of the appropriate
behaviors. All of the equations showed a good deal of
significance, but the linear and second degree polynomial
equations showed the greatest level of significance, .005.
The third and fourth degree polynomials were next highest
in level of significance being at the .05 level. The
linear and second degree polynomial are therefore the best
predictors of the trend, and of the predicted shape of the
data curves.
The trend analysis of the appropriate behaviors, as
shown in Figure 6, indicates that a straight line or linear
Rate
Pig. 5.— Trend analysis of interfering
behaviors
fourth degree polynomial (X )
significant at .05
Predicted #
Observed
Sessions
. » . * » *
o
TABLE 4.— Trend analysis for appropriate behaviors
Type of
Poly Source of
Degree
Sum of Mean F Level of
nomial Variation
QI
Freedom
Squares Squares Value Significance
Equation
Due to regression i 23897.269 23897.269
Linear
Deviation about
36.411 .005
regression 5 3281.585
656.316
Total 6 27178.854
Due to regression 2 25937.711 12968.855
Second
41.796 .005
degree
Deviation about
poly
regression 4 1241.143 310.286
nomial
Total 6 27178.854
Third
Due to regression
3 25941.879 8647.293
degree
Deviation about
20.972
.05
poly
nomial
regression
3
1236.976
412.325
Total 6
27178.855
Fourth Due to regression 4 26214.769 6553.691
degree
Deviation about
13.595 .05
poly
nomial
regression 2 964.086 482.043
Total 6 27178.855
71
relationship In an upward direction is one of the best
equations of fit representing the predicted trends. It is
significant at the .005 level.
Figure 7 is the graphical representation of the
second degree polynomial and shows that the curve is not
linear but is curving up. Learning seems to start slowly,
then accelerates, with the overall effect being a predict
able upward trend of appropriate behaviors.
The third degree polynomial, as shown in Figure 8,
is also significant at the .05 level, but not at the same
level of significance as the linear and second degree poly
nomials. The shape of the curve is definitely upward and
accelerating. This adds emphasis to the second degree
polynomial as being the best equation to predict the rate
of the building of appropriate behaviors. Initial learning
is slow, but is followed by an increase in the rate of
behavior. When building a new appropriate behavior, we can
then predict that initial learning will be slow but later
learning will be more rapid. Figure 9 is the trend
analysis of the fourth degree polynomial, and is signifi
cant at the .05 level. The shape of this curve is very
interesting. Initial learning is slow and may even proceed
in a negative direction and then turn positive and remain
in an upward trend. This presents a very confusing pattern
for the teacher. When a behavior is first being introduced,
the autistic child may do poorer initially, than he did
Rate Pig. 6.— Trend analysis of appropriate behaviors
linear (X)
significant at .005
Predicted •
Observed A
Sessions
Rate
73
Pig. 7.---Trend analysis of appropriate behaviors
2
second degree polynomial (X )
significant at .005
Predicted •
Observed A
Sessions
— ■ - ■» ■ m _ ... a _> — a .
Rate
Pig. 8.— Trend analysis of appropriate behaviors
O
third degree polynomial (XJ)
significant at .05
Predicted 4)
Observed A
Sessions
Rate
75
Pig. 9.— Trend analysis of appropriate behaviors
i \
fourth degree polynomial (X )
significant at .05
Observed ▲
Sessions
J i I _ _ _ _ _ _ _ I _ _ _ _ _ _ _ I _ _ _ _ _ _ _ L .
7 6 !
before any sessions were started. But, if the teacher ;
persists then positive appropriate behaviors can be
learned.
Hypotheses
Hypothesis 1
The hypothesis, a system of behavior modification-
therapeutic teaching, would result in a positive trend of
appropriate behaviors, has been accepted at the .005 level
of significance.
Hypothesis 2
The hypothesis, a system of behavior modification-
therapeutic teaching would result in a negative trend of
interfering behaviors, has been accepted at the .005 level
of significance.
CHAPTER V
DISCUSSION
Summary of the Results
The present study investigated the effects of a
system of behavior modification on autistic children in an
attempt to establish a system of education which would be
of practical use to teachers of all children with behav
ioral difficulties. The results suggest the following
conclusions and recommendation.
1. Autistic children can be taught and they can be
given new useful behaviors which are not only helpful to
themselves, but to those persons responsible for their
care. The children included in this study were not border
line autistic cases, but were those who had had severe
behavioral problems for years, and had all been given a
very poor prognosis for positive change. Two of the chil- j
dren were without any speech; one was severely echolalic;
all three had numerous destructive patterns, and had an
attention span of only a few moments. At the conclusion of
this study, and of successive follow-up studies, all of the
children were still severely disturbed.
77
2. Of the behaviors selected initially for study,
on follow-up evaluations, there has been no regressions of
the rates of those behaviors. In fact, the trends which
were started under treatment have continued. This finding
validates the trend analysis which predicted that once the
trends were started they would continue.
3. The trend analysis of both the interfering
behaviors and of the appropriate behaviors suggests that
autistic children may learn in a unique manner. When first
introduced to new stimuli, they may not respond appropri
ately or may respond at a lower rate than the base rate.
As-an example, a child may say the "p" sound at the rate of
twelve times per hour. For the next few sessions the rate
may stay the same or may actually decrease. However, the
trend analysis predicts that if the teacher will continue
past the initial sessions, the child will start to respond
at a higher rate, and the rate will continue positively.
The danger here, is that the teacher may be misled by
initial failures, halt his current procedures, and initiate
new ones. The child would take time to respond to the
second ones and probably not respond to these either. The
teacher would then come to the conclusion that the child
does not learn and, in fact, regresses. The trend analysis
predicts that a new procedure should be continued for at
least three sessions, to see if the child will respond.
There seems to be an initial few sessions when the child
requires a "learning to learn period."
4. If the time between sessions is great, then
this initial learning plateau will be repeated and progress
may not be resumed until the fourth or fifth session (see
data, Table 2).
5. One of the reasons autistic children may fail
to learn new behaviors may be the result of the teacher and
not solely that of the child. The teacher may not be
giving the child enough time to respond to his demands,
switch demands and have the child not respond again. The
teacher must persist in his efforts if behavioral change is
to occur. The teacher's own impatience and frustration may
be the variables which cause the teacher to change from
item to item, for he may get the feeling of throwing
pebbles into a bottomless well. However, the trend analy
sis shows that the child is processing material from each
session and will finally respond.
6. Autistic children's behavior can be modified
successfully by systematic behavior modification. Those
behaviors labeled as interfering will decrease and those
behaviors labeled as appropriate will increase. They will
change in a straight line fashion, meaning that therapeutic
teaching is helpful and should be continued in order to
increase the rates of these selected behaviors.
7. The statistically procedure trend analysis has
proven to be very helpful in predicting future behavior
rates. It is this writer's experience that a great deal of
i
time and effort have been utilized by remaining with one
procedure for a considerable period because the experi
menter did not know if his procedures were working. By
using a trend analysis, instead of months, sometimes as
soon as the seventh session, a trend will develop which
will be significant and reflect accurately, future learn
ing. In teaching a child the word "me” for example, the
following "means" were found for a series of teaching
sessions: 1, 0, 1, 4, 3, 5. Is this trend significant?
Without using trend analysis, the procedure would have to
be carried out over an extended period of time. By using
a trend analysis, if the trend was meaningful, then the
word "me" would be learned and should be continued. If the
trend was not significant, then the word "me" was too hard,
and should be dropped. Trend analysis is an extremely
useful tool for the researcher and can be used to save a
great deal of time and effort.
Implications for Further Study
The finding of this study raises questions of
theoretical interest: (1) if systematic behavior modifica
tion-therapeutic teaching, is successful in modifying the
behavior of autistic children, will it also be helpful in
modifying behavior of other disturbed children? (2) Can
therapeutic teaching be used to teach all children?
81
(3) Is therapeutic teaching better than no system of
behavior modification?
The literature is full of cases where all types of
behavior problems are handled through behavior modification
(Ulman and Krasner, 1965). There is every indication that
a systematic presentation of modification should result in
beneficial changes. Whether behavior modification should
be used with any or all children raises many questions.
Does behavior modification manipulate a child and not let
him express his inner feelings? By concentrating on just
the observable behavior, are we neglecting the child as a
wholly unique individual? By the coercive fashion with
which behavior modification is applied, are we violating
the individual's freedoms and creating an environment
reminiscent of "1984"? If we accept the behavioral
approach totally, how do we determine normal child develop
ment, and how do we make value judgments? Who is to decide
what child will be forced into a corner, yelled at,
shocked, starved, told what to do and when to do it? The
answers are easier when we have to answer these questions
for the autistic child. He has been judged, and condemned,
to remain in his concrete shell of isolation, and refuses
to acknowledge our existence. Or, does he even have the
power to judge and evaluate? How can we know what he
thinks, unless he can tell us? Do all of our higher powers
of thought, all of our words and sympathies, all of those
82
things which we hold dear and remind us of our own human
ity, help the severely disturbed child? If so, how and in
what way?
When communicating with our peers, analyzing data,
evaluating and conceptualizing problems, we frequently need
to function at a high level of abstraction. But, when
teaching a child, we need to be involved at the same level
of processing as the child. If we were to say to a non
speaking autistic child, "You are not speaking to me
because of a blockage of ego involvement based on your own
sensitivity to your environment," the child would remain
silent because our words have no meaning. Communication
must then be on the child’s level— the behavioral. Concep
tualization, insight, and creativity are in the domain of
the adult in selecting the proper elicitors and reinforcers
to modify the behaviors of the child. As the child moves
away from strict associative thinking, and starts to func
tion on a conceptual level, then behavior modification can
be utilized less and conceptualization more.
However, by blocking ourselves from the inner
experiences of others, disregarding our own inferences and
inner thoughts, judging others only by their robotized
behavior, do we not in some measure make machines of our
selves? We have developed a system that works very well,
may we continue to educate teachers in the values of
humanity so that they can be the indispensable component
of the system which makes the necessary value judgments.
For as long as we do, then we can have a system which
strives to educate all persons to their fullest potential,
even if that potential for an autistic child is merely the
saying of his own name.
BIBLIOGRAPHY
84
BIBLIOGRAPHY
BOOKS
Bandura, A., and Walters, R. H. Social Learning and Per
sonality Development. New York: Holt.Rinehart
and Winston, Inc., 1965.
Bettelheim, B. Love is Not Enough. Glencoe, Illinois:
Free Press7 19^0.
________ . The Empty Fortress: Infantile Autism and the
Birth of the Self. fTevTTorkl R. Brunner. Inc..
T w r .--------------
Birch, H. Brain Damage in Children. New York: Williams
and Wilkins, 1965.
Blackham, Garth J. The Deviant Child In the Classroom.
Belmont, California: Wadsworth Publishing Company,
1967.
Bowley, Agatha, and Gardner, L. The Young Handicapped
Child: Educational Guidance for the Young Cerebral
Palsied, Deaf, Blind, and Autistic Child. London:
E. "SV Livingston, Ltd., I9b9.
Churchill, Don W.; Alpern, G. D.; and DeMyer, M.K.
Infantile Autism; Proceedings of the Indiana Uni
versity Colloquium. Springfield, Illinois:
Charles C. Thomas, 1971.
Coffey, Hurbert S. Group Treatment of Autistic Children.
Englewood, New Jersey: Prentice Hall, l£b7.
Conner, N., and Hermelin, B. Psychological Experiments
with Autistic Children. Elmsford, New York:
Pergamon Press, 1970.
Corrigan, Robert E., and Kaufman, Roger M. Why System
Engineering. Palo Alto, California: Fearon, 1966.
85
Des Launers, A. M., and Carlson, C. P. Your Child Is
Asleep-Early Infantile Autism. Homewood. Illinois:
Dorsey Press, 1969.
Dixon, W. F., and Massey, P. J. Introduction to Statistl-
cal Analysis. 3rd ed. New York: McGraw-Hill.
19W . ----
Edwards, A. L. Experimental Design in Psychological
Research. New York: Holt, Rinehart, and Winston,
W
English, H. B., and English, A. C. A Comprehensive Dic
tionary of Psychological and ftsycnoanalyticaT
Terms. New York: David McKay, 1964.
Eysenck, H. J. Experiments In Behavior Therapy, Readings
in Modern Methods of Treatment of Mental Disorders
Derived from Learning Theory" Oxford: Pergamon
Press, 1967.
Flavell, J. M. The Developmental Psychology of Jean
Piaget. New York: Van Nostrand, 1963.
Franks, A. Behavior Therapy, Appraisal and Status. New
York! McGraw-Hill, 1969.
Gayne, Robert M., ed. Psychological Principles in System
Development. New York: Holt, Rinehart and
Winston, 1962.
Gellner, L. A Neurophysiologlcal Concept of Mental
Retardation and Its Educational Implications.
Chicago, Illinois: The Dr. Julian D. Levinson
Research, 1965.
Goldfarb, W. Childhood Schizophrenia. Cambridge, Massa
chusetts: Harvard University Press, 1961.
Guilford, J. P. Fundamental Statistics in Psychology and
Education! fliti ed. Mew ¥ork: McGraw-Hill, I9b5.
Gunzburg, H. C. Social Competence and Mental Handicap.
London: Bailliere, Tindall alnd Cassell, 1368.
Haring, N., and Phillips, E. Educating Emotionally Dis
turbed Children. New York: McGraw-Hill, 1962.
Hermelin, B. Psychological Experiments with Autistic
Chi ldren. London: f’ergamon, 1970.
Hewett, Prank M. The Emotionally Disturbed Child In the
Classroom. Boston: Allyn and Bacon, 1968.
Krasner*. L., and Ullman, L. P. Research in Behavior Modl-
ficatlon. New York: Holt, Rinehart, and Winston,
19F5.
Kugelmass, I. Newton. The Autistic Child. Springfield,
Illinois: Charles C. ¥homas, 1970.
Lehman, R. S., and Bailey, D. E. Digital Computing. New
York: Wiley, 1968.
Mager, Robert E. Preparing Instructional Obj ectives.
Palo Alto: Fearon Publishers, Inc., 1965.
Mahler, M. S. On Human Symbiosis and the Vicissitudes of
Individuation, Infantile Psychosis. Vol. 1. Hew
York: International University £ress, Inc., 1968.
O'Gorman, Gerald. The Nature of Childhood Autism. 2nd ed.
New York: Appleton-Century-Crofts, 1970.
Peter, Laurence J. Prescriptive Teaching. New York:
McGraw-Hill, 1965.
Rimland, Bernard. Infantile Autism. New York: Appleton-
Century-Crofts, Meredith Publishing Company, 1964.
Skinner, B, F. The Behavior of Organisms. New York:
D. Appleton Century, 1938.
________ . Science and Human Behavior. New York:
Macmillan, 1953.
Verbal Behavior. New York: Appleton-Century-
--------- Crofts” T"957.------
Sloane, Howard N., and Macaulay, Barbara D., ed. Operant
Procedures in Remedial Speech and Language Train^
ing. Boston, Massachusetts: Houghton Mifflin
Company, i960.
Strauss, A., and Lehtinen, L. E. Psychopathology and Edu
cation of the Brain Injured Child". New York: —
Grune and Stratton, I9B0.
Van Dalen. Understanding Educational Research. New York:
McGraw-Hill, i960.
88
Weston, P. T. Some Approaches to Teaching Autistic Chil
dren. Elmsford, New York: Pergamon Press, Inc.,
T97TF.
Wing, J. K. Early Childhood Autism. Elmsford, New York:
Pergamon Press, Inc., 1970.
ARTICLES
Albee, George W. "Emerging Concepts of Mental Illness and
Models of Treatment: The Psychological Point of
View." The American Journal of Psychiatry, CXXV
(1969), B70-U76.--------^ '------ * -
Allen, Eileen K„; Hart, Betty K.; Buell, Joan S.; Harris,
Florence R.j and Wolf, Montrose M. "Effects of
Social Reinforcement on Isolate Behavior of a
Nursery School Child." Child Development, XXXV
(1964), 511-518. ------------------
Amarel, Marianne, and Cheek, Francis. "Some Effects of
LSD-25 on Verbal Communication." Journal of
Abnormal Psychology. LXX (June, 1966), 453-456.
Ayllon, T. "Intensive Treatment of Psychotic Behavior by
Stimulus Satiation and Food Reinforcement."
Behavioral Research Therapy, I (January, 1963).
53-61. ‘
________ , and Azrin, N. "The Measurement of Reinforcement
of Behavior of Psychotics." Journal of the Experi-
mental Analysis of Behavior, Vlll (June, 1965).
567-358.
Azrin, N. R., and Lindsley, 0. R. "The Reinforcement of
Cooperation Between Children." Journal of Abnormal
and Social Psychology, LII (1956), 106-102.
Baer, Donald M. "The Control of Thumbsucking by Withdrawal
and Representation of Reinforcement." Journal of
the Experimental Analysis of Behavior. V (October,
1962), 525-529.
________ . "A Technique of Social Reinforcement for the
Study of Child Behavior. Behavior Avoiding Rein
forcement Withdrawal." Child Development, XXXIII
(1962), 847-858.
Bender, Lauretta. "Childhood Schizophrenia." Psychiatric
Quarterly, XXVII (1953) , 663-681.
Bender, Lauretta. "Treatment of Juvenile Schizophrenia.1 1
Association for the Research of Nervous and Mental
Dfs'orders ' ; 'ffllV X l ^ T r ^ ' ^ 7 7 . ------------------
________ . "Schizophrenia in Childhood: Its Recognition,
Description and Treatment." American Journal of
Orthopsychiatry. XXVI (1956) ,“49'9-T0'6“;
________ . "Autism in Children with Mental Deficiency."
American Journal of Mental Deficiency, LXIII (1959)a
81—86.
________ . "The Nature of Childhood Psychosis." Modern
Perspectives in International Child Psychiatry.
Edited by d. G. Howells. Edinburgh: Oliver and
Boyd, 1969.
Bern, H. A. "Wanted: Educational Engineers." Phi Delta
Kappan. XLVIII (1967), 230-236.
Bettelheim, Bruno. "Schizophrenia as a Reaction to Extreme
Situations." American Journal of Orthopsychiatry,
XXVI (July, 19567,"307-518.---- ----------------
"Feral Children and Autistic Children." Ameri-
can Journal Sociology. LXIV (1959), 455-467.
Betz, Barbara. "Study of Tactics for Resolving the Autis
tic Barrier in the Psychotherapy of the Schizo
phrenic Personality." American Journal of Psy
chiatry, CIV (1947), 267=275.
Biesele, J. J.; Schmid, W.; and Lawlis, M. D. "Mentally
Retarded Schizoid Twin Girls with 47 Chromosomes."
Lancet, I (1962), 403-405.
Bijou, S. W. "Experimental Studies of Child Behavior,
Normal and Deviant." Research in Behavior Modifi
cation: New Developments and Implications*!
Edited by L. Krasner and L. P. Ollmann. ITew York:
Holt, Rinehart and Winston, 1965.
Birch, H. G., and Lefford, A. "Intersensory Development in
Children." Monographs of Social Research in Child
Development, XXViII (19b5), No. 69.
Blackman, Leonard S. "Research Needs in the Special Educa
tion of the Mentally Retarded." Exceptional
Children, XXIX, No. 8 (1963).
90
Boatman, Maleta J., and Szurek, S. A. "Clinical Study of
Childhood Schizophrenia." The Etiology of Schizo
phrenia. Edited by D. J. Jackson. New York:
Basic Books, Inc., I960.
Boullin, D. J.j Coleman, M.; and O'Brien, R. A. "Abnormal
ities in Platelet 5-Hydroxytryptamine Efflux in
Patients with Infantile Autism." Nature, CCXXVI
(1970), 371-372.
________ ; Coleman, M.; O'Brien, R.; and Rinland, B.
"Laboratory Predictions of Infantile Autism Based
on 5-Hydroxytryptamine Efflux from Blood Platelets
and Their Correlation with the Rinland E-2 Score."
Journal of Autism and Childhood Schizophrenia, I
(1971), 63-71.
Brawley, E. R.; Harris, P. R.j Allen, J. E.j Fleming, R.
S.; and Peterson, R. F. "Behavior Modification of
an Autistic Child." Behavioral Science, XIV
(1969), 87-97.
Brody, Sylvia. "Preventive Intervention In Current Prob
lems of Early Childhood." Prevention of Mental
Disorders in Children. Edited by Gerald Caplan.
New York: Basic Books, Inc., 1961.
Carlson, C. F. "A Neurological Model of Early Infantile
Autism and Its Therapeutic Implications." American
Journal of Orthopsychiatry. XXVI (1967), 556-366.
Chapman, A. H. "Early Infantile Autism in Identical
Twins." American Journal of Neurological Psychi
atry, LXXVITTTSipte'mber, 1957T,” 6?T-623':
Chess, Stella. "Autism in Children with Congenital
Rub ella." Journal of Autism and Childhood
SchlzophrenlaT I (1971). 33-^7.
Churchman, C. West. "On the Design of Educational Sys
tems." Audio Visual Instruction, X (May, 1965),
361-365. '
Clancy, Helen, and McBride, Glen. "The Autistic Process
and Its Treatment." Journal of Child Psychology
and Psychiatry and Allied Disciplines, X, No. f t
91
Cowan, Philip A.; Hoddlnott, B. A.; and Wright, Barbara
Anne. "Compliance and Resistance in the Condition
ing of Autistic Children: An Exploratory Study."
Child Development, XXXVI (December, 1965), 913-923.
Dagoni-Weinberg, Elise. "Prom Total Isolation to Social
Communication: Treatment of a Case of Early
Infantile Autism." Acta Paedopsychiatrics.
XXXVI, No. 5 (1969).
Davidson, G. "A Social Learning Therapy Programme With an
Autistic Child." Behavior Research Therapy, II
(1964), 149-159.
Dubnoff, B. "The Habitation and Education of the Autistic
Child in a Therapeutic Day School." Journal of
School Psychology. IV (1965), 52-59.
Eisenberg, Leon. "The Fathers of Autistic Children."
American Journal of Orthopsychiatry, XVII (Septem
ber," 'i9'477, 7T5-724.---- ------
________ . "The Autistic Child in Adolescence." American
Journal of Psychiatry, CXII (1956), 607.
________ . "Psychotic Disorders in Childhood." Classifica
tion of Behavior Disorders. Edited by L. D. Eron.
Chicago: Aldine Press, 1967.
________ , and Kanner, Leo. "Early Infantile Autism."
American Journal of Orthopsychiatry, XXVI (1956),
556-564.
Ekstein, Rudolph; Bryant, Keith; and Friedman, Seymour W.
"Childhood Schizophrenia and Allied Conditions."
Schizophrenia. Edited by Leopold Beliak. New
York: Logos Press, 1958.
Escalona, Sibylle. "Some Considerations Regarding Psycho
therapy with Psychotic Children." Child Psycho
therapy. Edited by Mary R. Haworth" Mew YorK:
Basic Books, Inc., 1964.
Eveloff, H. H. "The Autistic Child." Archives of General
Psychiatry, IV (April, I960), 366-368.
Fenichel, C. Keynote Address. Annual Meeting of the
National Society for Autistic Children, Washington,
D.C., July 17-18, 1969.
92
Ferritor, Daniel E. "Modifying Interaction Patterns: An
Experimental Training Program for Parents of
Autistic Children." Dissertation Abstracts Inter
national, xxx (i97o),“O T^rra:
Ferster, C. B. "Increased Performances of an Autistic
Child with Prochloreprizine Administration."
Journal of the Experimental Analysis of Behavior.
WTMarch',' 1961) , 484-487. ----------------
________ . "Positive Reinforcement and Behavioral Deficits
of Autistic Children: An Exploratory Study."
Child Development. XXXII (June, 1961), 437-456.
________ . "A Method for the Experimental Analysis of
Behavior of Autistic Children." American Journal
of Orthopsychiatry. XXXII (January, '1962), 89-9^
________ . "Teaching and Education of Autistic Children:
Combined Application of Clinical and Laboratory
Methods." Institute for Behavioral Research,
Silver Springs, Maryland, 1968. (Mimeographed.)
________ , and DeMyer, M. "The Development of Performances
in Autistic Children in an Automatically Controlled
Environment." Journal of Chronic Diseases, XIII
(April, 1961), 312-345.
________ , and DeMeyer, M. "A Method for the Experimental
Analysis of Autistic Children." Case Studies in
Behavior Modification. Edited by L. P. Ullman.and
L. Krasner. New York: Holt, Rinehart and Winston,
1966.
Frank, G. H. "The Role of the Family in the Development of
Psychopathology." Psychology Bulletin, LXIV
(1965), 199-205.
Freedman, Alfred, and Ginsberg, V. "Exchange Transfusions
in Schizophrenic Patients." Journal of Neurologi-
cal and Medical Diseases, CXXVI (March, 1956),
294-301.
________ ; Ebin, Eva; and Ethel, A. "Autistic Schizophrenic
Children: An Experiment in the Use of D-lysergic
Acid Diethylamide (LSD-25)." Archives of General
Psychiatry. VI (March, 1962), 263-213".
93
Freitag, Gilbert. "An Experimental Study of the Social
Responsiveness of Children with Autistic Behav
iors." Journal of Experimental Child Psychology,
IX, No. 3 (1970).
Frith, Uta, and Hermelin, Beate. "The Role of Visual and
Motor Cues for Normal, Subnormal and Autistic
Children." Journal of Child Psychology and Psychi
atry and AllTed Disciplines, X, No. 3 (1969).
Garcia, Blancho, and Sarvis, Mary. "Evaluation and Treat
ment Planning for Autistic Children." Archives of
General Psychiatry. X (May, 1964), 530-541.
Gaudia, Sister. "Handling of Children with an Autistic
Condition." Infantile Autisme. Edited by F.
Growel, and J. Muuses I - ’urmeuend. Amsterdam,
Netherlands, 1954. Translated from the Dutch by
Professor Gerard Baenends, 1954.
Goldfarb, W. "Report on Neurophysiological Correlates of
Apparent Defects of Sensori-Motor Integration in
Autistic Children." Mental Health Research Fund,
1964. (Mimeographed.)
Goodwin, M. S.; Cowen, M. A.; and Goodwin, T. C. "Mal
absorption and Cerebral Dysfunction: A Multi
variate and Comparative Study of Autistic Chil
dren." Journal of Autism and Childhood Schizo-
phrenla. I (1971). 48-62.
Graziano, A. M. "Group Treatment Approach to Multiple
Problem Behaviors of Autistic Children." Excep-
tional Children. XXXVI (Summer, 1970), 765-770.
Halpern, H. "Schooling of Autistic Children." American
Journal of Orthopsychiatry, XL (July, 1970), 665-
W T .
Hamblin, R. L. "Structured Exchange and Childhood Learn
ing: The Severely Retarded Child." Central Mid
western Regional Educational Laboratory, St. Ann,
Missouri, 1967. (Mimeographed.)
Hartung, J. R. "Review of Procedures to Increase Verbal
Imitation Skills and Functional Speech in Autistic
Children." Journal of Speech and Hearing Dis
ability, xxxv TAugusT,"^§7(7 )7T 0 3-21T.'" ----
94
Heinich, Robert. "The System Engineering of Education:
II. Application of Systems Thinking to Instruc
tion." Instructional Technology and Media Project,
School of Education, University of Souther Cali
fornia, 1965. (Mimeographed.)
Hermelin, B., and O’Conner, N. "Effects of Sensory Input
and Sensory Dominance on Severely Disturbed,
Autistic Children and on Subnormal Controls."
British Journal of Psychology, LV (February, 1964),
201-266.
"Measures of the Occipital Alpha Rhythm in
Normal, Subnormal and Autistic Children." British
Journal of Psychiatry. CXIV (1968), 603-610.
Hewitt, Frank. "Teaching Reading to an Autistic Boy
Through Operant Conditioning." Reading Teacher,
XVII (October, 1964), 6l3-6l8.
________ . "Teaching Speech to an Autistic Child Through
Operant Conditioning." American Journal of Ortho
psychology. XXXV (October, 1^65), 92?-636.
Hingtgen, Joseph N., and Churchill, Don W. "Identification
of Perceptual Limitations in Mute Autistic Chil
dren: Identification by Use of Behavior Modifica
tion." Archives of General Psychiatry, XXI, No. 1
U969). ----------------------- -------
Hutt, Corinne. "Exploration, Arousal and Autism." Psy-
chologische Forschung. XXX, No. 1 (1969).
Isaacs, W.; Thomas, J.; and Goldiamond, I. "Application of
Operant Conditioning to Reinstate Verbal Behavior
in Psychotics." Journal of Speech and Hearing
Disorders, XXV (February, 1$605, 8-l2.
Judd, L. L., and Mandell, A. J. "Chromosome Studies in
Early Infantile Autism." Archives of General
Psychiatry. XVIII (1968), 450-457.
Kanner, Leo. "Autistic Disturbances of Affective Contact.
Nervous Child. II (1943), 217-250.
________ . "Irrelevant and Metaphorical Language in Early
Infantile Autism." American Journal of Psychiatry,
CIII (September, 1946)", 242-2TJF:
95
Kanner, Leo. "Problems of Nosology and Psychodynamics of
Early Infantile Autism." American Journal of
Orthopsychiatry. XIX (19^9), 416-426.
________ . "The Conception of Wholes and Parts in Early
Infantile Autism." American Journal of Psychiatry,
CVIII (1951), 23-26. -------
________ • "Childhood Psychosis; A Historical Overview."
Journal of Autism and Childhood Schizophrenia. I
(1971), 14-19.
_______ , and Lesser, L. I. "Early Infantile Autism."
Pediatric Clinics in North America, V (1958), 711-
7 W .
Kaufman, Roger A. "A System Approach to Education:
Derivation and Definition." A. V. Communication
Review. XVI (Winter, 1968), 415-425.
Lockyer, L., and Rutter, M. "A Five to Fifteen Year Follow-
Up Study of Infantile Psychosis: III. Psycho
logical Aspects." British Journal of Psychiatry.
CXV (1969), 865-882":
________ . Five to Fifteen Year Follow-Up Study of
Infantile Psychosis: IV. Patterns of Cognitive
Ability." British Journal of Social and Clinical
Psychology. H'TOTO). TO'-IST. --------------
Lovaas, 0. Ivar. "Control of Food Intake in Children by
Reinforcement of Relevant Verbal Behavior."
Journal of Abnormal Social Psychology. LXVIII
T O W , 5 7 2 = 6 7 8 -----------------
________ . "Recording Apparatus and Procedure for Observa
tions of Behavior of Children in Free Play Set
ting." Journal of Experimental Child Psychology,
II (February lb6-l20.
________ . "A Behavior Therapy Approach to Treatment of
Childhood Schizophrenia." Minnesota Symposium on
Child Psychology. Minneapolis': University of
Minneapolis Press, 1967.
________ ; Freitag, Gilbert; Gold, Vivian; and Kassorla,
Irene. "Experimental Studies In Childhood Schizo
phrenia: Analysis of Self-Destructive Behavior."
Journal of Experimental Child Psychology, II
(January, 1065), 67-04.
96
Lovaas, 0. Ivarj Schaeffer, B.j and Simmons, J. Q. "Ex
perimental Studies in Childhood Schizophrenia:
Building Social Behavior in Autistic Children by
Use ofElectric Shock." Journal of Experimental
Research in Personality, if (19b5). 99-109.
Mahler, Margaret S. "On Child Psychosis and Schizophrenia.
Autistic and Symbiotic Infantile Psychoses."
Vol. VII: The Psychoanalytic Study of the Child.
New York: International Universities ’ Press,' 1952.
Marshall, Nancy R., and Hegrenes, Jack R. "Programmed
Communication Therapy for Autistic Mentally
Retarded Children." Journal of Speech and
Hearing Disorders. XXVil (1970), 70-83.
Masters, John C., and Miller, Dick E. Early Infantile
Autism: A Methodological Critique." Journal of
Abnormal Psychology, LXXV, No. 3 (197071
Mauch, J. "A Systems Analysis Approach to Education." Phi
Delta Kappan. XLIII (1962), 158-161.
Meller, Nandeen. "Language Therapy with an Autistic non
verbal Boy." Exceptional Chi:- Iren. XXXV, No. 7
(1969). --------------------
Metz, Richard J. "Conditioning Generalized Imitation in
Autistic Children." Journal of Experimental Child
Psychology, II (April, 19&B), 380-399.
________ . "Stimulation Level Preferences of Autistic
Children." Journal of Abnormal Psychology, LXXII
(1967), 529-537:
Ornitz, Edward M., and Ritvo, F. "Perceptual Inconstancy
in Early Infantile Autism." Archives of General
Psychiatry. Vol. XVIII (January, 19b8a), 40-97.
________ , and Ritvo, F. "Naurophysiologic Mechanisms
Underlying Perceptual Inconstancy In Autistic and
Schizophrenic Children." Archives of General
Psychiatry, Vol. XIX (July, 1968b), 1-26.
_______; Ritvo, F.; and Walter, Richard. "Dreaming Sleep
in Autistic and Schizophrenic Children." American
Journal of Psychiatry, CII (October, 1965), 419-
v f t . ------ *
97
Ornitz, Edward M.; Ritvo, F.; Panman, L. M.; Lee, Y. H.;
Carr, E. M.; and Walter, R. D. "The Auditory-
Evoked Response in Normal and Autistic Children
During Sleep." Electroencephalography and Clinical
Neurophysiology, XXV (T^bBc), £21-230.
Peter, Laurence. "Therapeutic Teaching." Unpublished
paper, University of Southern California, 1970.
Rabinovltch, Ralph D. "An Evaluation of Present Trends in
Psychotherapy with Children." Child Psychotherapy.
Edited by Mary R. Haworth. New York: Basic Boods,
Inc., 1964.
Rank B. "Intensive Study and Treatment of Preschool
Children Who Show Marked Personality Deviations or
’Atypical Development' and Their Parents." Emo
tional Problems of Early Childhood. Edited by
G. Caplan. New York: Basic Books, Inc., 1955.
________ , and McNaughton, D. "A Clinical Contribution to
Early Ego Development." Vol. V: Psychoanalic
Study of the Child. New York: International
tJniversity Press, 1950.
Risley, T. "The Effects and Side Effects of Punishing the
Autistic Beahvior of a Deviant Child." Journal of
Applied Behavior Analysis. I (Spring, 1958), 23-35.
________ , and Wolfe, M. "Establishing Functional Speech in
Echolalic Children." Behavior Research and
Therapy. V (1967), 73-8FI
Ruttenberg, B. A. "A Psychoanalytic Understanding of
Infantile Autism and Its Treatment." Infantile
Autism. Edited by D. Churchill, G. Alpern, and
M. Detoyer. Springfield, Illinois: Charles C.
Thomas, 1971.
Rutter, M. "Behavioral and Cognitive Characteristics."
Early Childhood Autism. Edited by J. K. Wing.
London: Pergamon Press, Ltd., 1966.
________ . "Concepts of Autism." Journal of Child Psychol
ogy and Psychiatry. IX (196B), i-2b.
________ , and Bartak, L. "Causes of Infantile Autism:
Some Considerations from Recent Research." Journal
of Autism and Childhood Schizophrenia, I (1971)*
20-33.
98
Rutter, M., and Greenfield, D. "Children with Early Onset
Psychosis: 5 to 15 Years Later: II. Behavioral
and Social Outcomes." Early Childhood Autism.
Edited by J. K. Wing. London: Pergamon Rress,
Ltd., 1966.
________ , and Lockyer, L. "A Five to Fifteen-Year Follow-
Up Study of Infantile Psychosis: I. Description
of Sample." British Journal of Psychiatry, CXIII
(1967), 1169-TIH?: ------------
Schopler, E. "Parents of Psychotic Children as Scape
goats." Paper presented at Symposium of the
American Psychological Association, Washington,
D.C., September, 1969. (Mimeographed.)
________ , and Reichler, R. J. "Psychobiological Referents
for the Treatment of Autism." Proceedings of the
Indiana University Colloquium on Infantile Autism.
Springfield, Illinois: Charles C. Thomas, 1^70.
________ , and Reichler, R. J. "Parents as Cotherapists in
the Treatment of Psychotic Children." Journal of
Autism and Childhood Schizophrenia, I (1971), 67-
1 T I 3 T
Shell, R. E.; Stark, J.; and Giddan, J. "Development of
Language Behavior in an Autistic Child." Journal
of Speech and Hearing Disorders. XXXII (1967),51-
Stark, J.; Giddan, J. J.; and Meisel, J. "Increasing
Verbal Behavior in an Autistic Child." Journal of
Speech and Hearing Disorders. XXX (1968), *12-47.
Sulzbacker, S. J., and Costello, J. M. "Behavior Strategy
for Language Training of a Child with Autistic
Behaviors." Journal of Speech and Hearing Dis
orders , XXXV (August, 19?0), 256-276.
Treffert, Donald A. "Epidemiology of Infantile Autism."
Archives of General Psychiatry, XXII, No. 5 (1970).
Vaillant, George E. "Twins Discordant for Early Infantile
Autism." Archives of General Psychiatry, IX
(February, 1963), 163-167.
Van Krevelen, D. A. "Early Infantile Autism and Autistic
Psychopathy." Journal of Autism and Childhood
Schizophrenia. I (1971), 8S-87.
99
Ward, A. J. "Early Infantile Autism: Diagnosis, Etiology,
and Treatment." Psychological Bulletin, LXXIII
(1970), 350-362.
Weiland, H. I. "Discussion of Treatment Approaches."
Infantile Autism. Edited by D. Churchill, G.
Alpern, and M. DeMyer. Springfield, Illinois:
Charles C. Thomas, 1971.
Weiner, S. G., and McLaughlin, J. "Psychotherapy with an
Autistic Girl." Gaebler Unit, Metropolitan State
Hospital. Waltham, Massachusetts, I960. (Mimeo
graphed .)
Wing, J. K., ed. "Diagnosis, Epidemiology, Aetiology."
Early Childhood Autism. London: Pergamon Press,
Ltd., 19bb.
Wolf, E. G. "Communication Therapy for the Autistic
Child." Journal of Speech and Hearing Disorders,
xxxn (1967), "m=135.--- - - - - - -------
Wolf, Montrose; Risley, Todd; and Mees, Hayden. "Applica
tion of Operant Procedures to the Behavioral
Problems of an Autistic Child." Behavioral
Research Therapy, I (1964), 305-312™
I
APPENDIX
100
CASE STUDY 1— LORI
Lori is a nine year old girl who became deaf in I
infancy due to illness and was found to be autistic in i
early childhood. She was brought to the Evelyn Frieden
Center at the University of Southern California by her
mother. Here the initial observations were made. When j
Lori first came to the Center, the secretary's desk cap- j
tured her attention,, Lori bolted away from her mother, j
threw open the desk and began throwing papers to the floor.
She quickly found a stencil knife, grabbed it and gently
began to feel the blade. By this time, staff members had
managed to grab Lori's hands and arms and pulled the knife
from her grasp. Thereupon, Lori began to scream, cry and
stamp her feet, trying to jerk herself free. After a
cooling off period, Lori was firmly led to a teaching booth
equipped with a one-way mirror. Here Lori was given toys,
food and games. We instructed her mother to try to make j
Lori play with some of the toys while we made our behav
ioral observations. Her observable behavior problems were
divided into behavioral deficits and interfering behaviors. :
Lori exhibited the following behavioral deficits during
our observation:
1. Does not speak or attempt speech
2. Does not comprehend words, letters or numbers
3. Does not follow directions whether given by
hand or through imitation
4. Does not look at people or focus attention on
people
5. Does not respond to others or show any behavior
which could be labelled as socialization
6. Will not remain seated
Lori also exhibited the following interfering
behaviors during the observation period:
1. Dashes toward the door to get out of the room
2. Throws tantrums
3. Throws glass and then plays with the pieces
4. Eats with hands from the floor and trash
5. Throws food and toys when not satisfied
6. Bites and kicks
7. When touched while being instructed, pulls away
101
102
As a result of our observations, we decided to
modify two behaviors which were Interfering with Lori's
learning; to attempt to change all of Lori's behaviors
simultaneously would be too confusing. Those we chose to
modify were her "getting out of her seat" and her "tan
trums." A record was made of these behaviors. For "out of |
seat" behavior, the base rate was found to be twenty-four
times per hour and for "tantrums," eighteen times per hour, j
Our next step was to determine which elicitors
brought forth positive behaviors and which brought forth
undesired behaviors. We found that blocks, chalk and cards j
elicited positive behaviors. Next, we observed which rein- i
forcers strengthened or weakened responses and found that |
Lori responded favorably to food.
Terminal objectives are those goals toward which we
direct our teaching throughout the teaching sequence. In
other words, the terminal objective is a target toward
which to direct our teaching. Our terminal objective for j
Lori was to teach her "to write three and four letter words |
with chalk at the board for a period of five minutes with
out being physically restrained." Arrangements were then
made with the mother to bring Lori to the Center for one
hour, three times weekly for the remainder of the semester. j
During the first five sessions our enroute objec- |
tive was to have Lori trace the letters of her name with
her finger over beaded letters. She was reinforced each
time she allowed us to take her hand and rub it over the
letters. Then she was reinforced each time she would touch
one of the letters and, finally, she was reinforced when
she would trace all of the letters of her name. To keep
Lori in her seat and make it impossible for her to run out
of the room, she was placed in a high chair. In this way,
her feet did not touch the floor; to get down, she would
have to make a bodily movement forward. This movement was
the teacher's cue that Lori was going to leave her seat.
When she moved forward in her chair, the teacher would
grasp her and push her back. At first, she was never given
any reinforcer unless she was seated on the chair in the
corner of the room. This routine was followed throughout
the teaching sessions and, by the time of the tenth ses
sion, Lori's "out of seat" behavior was at the rate of once
per hour. By the twentieth teaching session, this behavior
was extinguished in the teaching room. This behavior was
generalized to other situations at home, in special classes
and while waiting for someone. However, her "out of seat"
behavior was never completely extinguished away from the
Frieden Center, although it did remain at a base rate of
zero per hour from the twentieth session until the end of
the semester.
Lori had learned to trace the letters of her name
and point to herself but only in a very mechanical fashion. ,
103
She showed no awareness or realization of what she was
doing. At this point we decided to change elicitors and
took Lori to the chalkboard. Here she was to trace the
letters of her name in chalk. The chalk and board proved
to be better elicitors and Lori seemed to have a longer
attention span while at the chalkboard. By the end of the
fifteenth session, Lori could copy the letters of the words
"food," "Ma-ma," "Lori," and "eat." An attempt was made to
pair the words with their objects but at no time did Lori
show any recognition of the meaning of the words.
Our next enroute objective was for Lori to look at
people. Her attention rarely focused on any person or
object for more than a few seconds. The teacher and any
other person, with the exception of her mother, received as
much attention as the walls of the room, the ceiling or the
dirt on the floor. People had no meaning for her.
If Lori was to receive instruction from other
people, she had to look at them. In an attempt to estab
lish communication with Lori, we decided to use eye con
tact. Speaking or yelling could not reach her because she
was deaf so our next recourse was an attempt to establish
visual communication. We felt that visual contact was
paramount in Lori's learning priorities if she was to be
taught the deaf signs or the matching of words and their
representative objects.
Starting with session number ten, our enroute ob
jective became "Lori will look at her teacher."
Lori still responded well to food so we chose to
use pieces of food as elicitors for establishing eye con
tact. The food was extended on a fork in front of her face
and, as Lori turned to look at the food, the fork was moved
until her line of sight extended from the food to the
teacher's eyes. Lori was then reinforced with the food as
soon as eye contact was established. Prom that point on,
no food reinforcement was given unless Lori was looking
directly at the teacher’s eyes.
In the middle of lesson fourteen, Lori looked
directly at the teacher, gave him a piece of food and
smiled. This was the first sign of any socialization on
Lori's part. Socialization continued on an irregular
pattern throughout the remainder of the semester.
Prom a base rate of zero times per hour at lesson
one, Lori's rate of eye contact proceeded to a base rate of
eighty-five times per hour at lesson number twenty-six. By
that time, Lori was looking at other people and would
follow their pointing instructions. A means had been
established whereby Lori could focus her attention on other
people and communication could be attempted.
Lori still was autistic. She showed no real under
standing for the words she had written or for any instruc
tions that had been given her. She still had a fascination
for bright things, had tantrums (although less frequently),
grabbed things and had few socialization behaviors. How
ever, a path had been established for future communication
as well as instruction and her case could no longer be
classified as entirely hopeless.
A twelve-month followup study was done on Lori at
the Riverside School for the Deaf. Every behavior which
was modified showed continued increase. Her attention span
was very large, she followed directions, was easy to con
trol, and her rate of eye contacts had increased to a
spontaneous 195 per hour.
105
CASE STUDY 2— KEVIN
Kevin was five years of age when first seen at the
Evelyn Frieden Center at the University of Southern Cali
fornia. He had been abnormal since birth and had bizarre
motor behavior, an abnormal motor discharge, withdrawal
from others and failed to communicate meaningfully to
others. When he spoke he did so in a high squeeky mono
tone. When asked to pick out children in a storybook he
was unable to but could assemble blocks and puzzles. Kevin
was first diagnosed as autistic by a marine psychiatrist
and this finding was later confirmed when his parents took
Kevin to N.P.I, in Los Angeles.
After a behavioral observation and a determination
of his behavioral deficits terminal objectives for Kevin
were established. They were:
1. "Kevin shall learn to volunteer speech and imi
tate speech without prompts."
2. "Kevin will identify ten words taken from a
reader."
3. "Kevin will attend to an assigned task without
out trying to escape."
In the period of diagnostic teaching the rein
forcers which worked well for Kevin were spray mouthwash
and to some extent praise. He did not respond to tokens
and responded only moderately well to candy. The elicitors j
which proved most effective were the books "The Cat in the
Hat," "Stop that Ball," and the "Sullivan 1 A."
In the first teaching sessions Kevin's objective
was to assemble puzzles. His attention span was noted as
very brief.
In session number seven Kevin first identified
words and received mouthwash spray as a reinforcer. In
session number nine Kevin was found to run away ten times.
By rewarding for the times when he was still and by isolat
ing in a corner where running away was difficult, his
interfering behavior had decreased to two in session
twelve, and to zero in session number fourteen. By teach
ing session number twenty-seven Kevin had read twenty words
from the Sullivan reader, was being reinforced by both
praise and spray, and had ceased running away.
Kevin was still a very disturbed child. He did
communicate more, had a longer span of attention, but still
spoke in a noncommunicative fashion using a high pitched
voice and had many strange behaviors. He would still be
classified as autistic.
CASE STUDY 3--ROBERT
Robert was first diagnosed as autistic when he was
just over two years of age. He had had some meaningful
speech and when he started to lose it, his parents became
concerned and received outside help. He was later diag
nosed at Children's Hospital in Los Aigeles as autistic by
several members of the psychiatric staff, Robert continued
without speech until he was seen at the University Affli-
ated Project at Children's Hospital at the age of nine.
The result of the behavioral observation showed
that Robert "makes no speech or speech sounds," "looks
away," "moves his fingers in front of his eyes," and "rocks
back and forth in his chair." The reinforcers which
Robert responded to best were coke, potato chips, and
candy. He would look when his name was called but would
then immediately look away. The terminal objective was
then set that "Bobby would stay in his chair, follow oral
directions, and will say twenty-five words in a period of
forty-five minutes."
By session number five Bobby was saying the "pu"
sound. By session number nine the word "me" and by session
number sixteen was saying "put" and by session forty-five
was saying "Ba Ba." Building speech was an extremely slow
and frustrating experience. Many times the rate would
increase then decrease and then increase and the teacher
did not know if progress was being made.
By session number twenty Robert's mother had taken
over most of the teaching responsibility and was continuing
her work at home. As a prelude to building speech behav
iors, attention was established. The same procedure which
was used in Case 1 was followed here.
Some examples of concommitant behavior which was
seen to develop after Robert's attention was focused and
he had a few words with which to communicate to others.
4/1/71
Robert was sick and became very constipated. In
our teaching sessions we had taught Robert to say "me."
One day while sick and feeling poorly, he pointed to his
belly and said spontaneously in a sad voice "me." His
mother then realized he was in pain and gave him some medi
cine whereby he improved. This was the first time in seven
years that Robert used speech to communicate with another
person.
107
4/27/71
His teacher visited Robert at his school and for
the first time looked at his teacher and did not move away
when his hand was placed on Robert's shoulder. In the next
teaching session Robert for the first time reached out
across the table, took his teacher's hand, and pulled him
into the playroom. This was the first time his teacher had
seen him respond as a normal child would.
Robert did not meet all of his objectives. He
still can say only a few words but has started to relate
to people as people rather than objects. He is also easier
to control, follows directions, and looks at other people.
Robert's father stated "for the first time in nine years,
I heard Robert speak, I didn't know if he had a voice or
not."

Linked assets

University of Southern California Dissertations and Theses

Conceptually similar

PDF

The Effects Of Early Educational Stimulation On Selected Characteristics Of Kindergarten Children

PDF

An exploratory study of the psychological sequelae of surgery and hospitalization in male children

PDF

Susceptibility To Associative Inhibition Development Of Construct Validity Through A Paper And Pencil Encoding Task Given To Children, Adolescents And Adults

PDF

The Development And Evaluation Of A Personal Management Program And Its Effects Upon The Self-Concept And Perceived Locus-Of-Control Of Blind Adolescent Females

PDF

The Use Of Behavior Rating As An Indicator Of Concomitant Development In A Prescriptive Teaching Program

PDF

Prescriptive Teaching As A Supplement To Behavior Modification In The Remediation Of Learning Disorders

PDF

Contents Of Mathematics Curriculum For Seventh Grade: Practices And Recommended Program In Los Angeles

PDF

The Laboratory Method And Behavior Change In A Religious Institution: An Exploratory Study

PDF

An Experimental Study Of The Effectiveness Of Special Classes Using Behavior Modification Techniques

PDF

The Relative Effectiveness Of Three Methods Of Teaching Elementary Algebra In Community Colleges When Sex And Abilities Of The Student Are Considered

PDF

A Study Of Financial Aids Programs In California Community Colleges

PDF

Differences Among Junior College Transfer Students, Four-Year College Transfer Students, And Native Students In Academic Performance And Attitudes In Home Economics At A Selected California State...

PDF

A Study Of Relationships Between Grades And Measures Of Scholastic Aptitude, Creativity, And Attitudes In Junior College Students

PDF

A Psychometric Investigation Of Identification Of Learning Disabled Children

PDF

The Elementary Principal'S Leader Behavior And Teacher Morale

PDF

An Experiment With Early Group-Counseling Practicum In A Chicano Counselor Training Program

PDF

A Study Of Relationships Between Group Test Of Creativity (Gtoc) Scores And Achievement Test Scores Of Students With Spanish And Non-Spanish Surnames

PDF

Color Vision Deficiency In Third And Sixth Grade Boys In Association To Academic Achievement And Descriptive Behavioral Patterns

PDF

Variations In Population Characteristics And Outcome Criteria In The Evaluation Of Outpatient Alcoholism Treatment

PDF

Approach Teaching Of Educationally Handicapped Students In The Torrance Unified School District

Asset Metadata

Creator Deatherage, Richard Marion (author)

Core Title Modifying Appropriate And Interfering Behaviors In Autistic Children Using A System Of Behavior Modification, Therapeutic Teaching

Degree Doctor of Philosophy

Degree Program Education

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag education, special,OAI-PMH Harvest

Language English

Contributor Digitized by ProQuest (provenance)

Advisor Magary, James F. (committee chair), Fox, Frank H. (committee member), Lubin, Gerald I. (committee member)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c18-572583

Unique identifier UC11363303

Identifier 7217463.pdf (filename),usctheses-c18-572583 (legacy record id)

Legacy Identifier 7217463

Dmrecord 572583

Document Type Dissertation

Rights Deatherage, Richard Marion

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA