Community Autism Intervention Program 1
RUNNING HEAD: COMMUNITY AUTISM INTERVENTION PROGRAM
Innovative Practices Award Proposal
Patricia McKnight, MA
Community Autism Intervention Program 2
The Community Autism Intervention Program’s Preschool Demonstration Program at Brewer-Porch Children’s
Center of the University of Alabama employs a holistic, eclectic approach to comprehensive treatment. This
unique program employs the use of positive, research-based interventions and best practices which are essential
in meeting the needs of children with a medical diagnosis of an Autism Spectrum Disorder. Steadily increasing
prevalence rates in the Autism population necessitate the need for services. The program follows the research
depicting the most intensive services at the youngest age possible will assist the child’s progress and encourage
independence at an earlier age. This paper outlines the various interventions implemented to reach each
individual served. Multiple interventions provided by an interdisciplinary team aim at similar outcomes and
increased success rates. The attached case study supplements this paper by depicting the potential for increased
progress and independence.
Community Autism Intervention Program 3
Innovative Practices Award Proposal
Autism Spectrum Disorders (ASDs) are neurological disorders which are characterized by deficits in
communication and language, impaired social skills, and the existence of restrictive, repetitive, or stereotyped
patterns of behavior or interests. Prevalence rates have increased from 1:10,000 in the late 1970’s to 1:110 in
2010. (Catherine Lord, 2010) Causation and cures are unknown at this point in time. Recent research and
neurological studies indicate there is a genetic component which serves as a predisposition. This predisposition
may then be activated by environmental stressors such as exposure to environmental chemicals, allergens,
increased infections, and subsequent antibiotics. Medical treatments are not established at this time. (Risperdal
and Abilify are the only medications approved by the Food and Drug Administration for the treatment of secondary
symptoms such as aggression, irritability, and self-injurious behaviors.)
Prior research has validated a variety of positive evidence based interventions which are educational and
behavioral in nature. As with any educational or behavioral intervention, not all are successful for all children, all
of the time. Therefore, it is important that a program employ multiple approaches concurrently in order to create
an environment that maximizes the potential for each individual child to succeed. Another key aspect of early
intervention is the quantity of hours served. It is optimal for a child to receive forty hours, or more, of services per
week. This type of program is defined by Social Policy as Comprehensive Treatment. Comprehensive treatments
are a set of practices designed to have a broader impact on core features of ASD. “These treatments are
characterized by their intensity, involving substantial amounts of time and service. Comprehensive treatment
programs usually incorporate a set of specific focused intervention techniques organized within a conceptual
framework” (Catherine Lord, 2010). The Community Autism Intervention Program (CAIP) utilizes holistic, eclectic
methods based on the Comprehensive Treatment approach.
The following is an account of the Autism specific services provided for children ages three through five in
the CAIP Program at Brewer-Porch Children’s Center, through the University of Alabama. The Preschool
Demonstration Program was developed in 2003, and is based on research that supported the most intensive
services at the youngest age possible. This program provides the child with a greater opportunity to be more
independent and successful at an earlier age. Children with a medical diagnosis of an ASD are referred by the local
Community Autism Intervention Program 4
These intensive services are successfully implemented with small ratios of students to highly trained staff.
One certified teacher per classroom of six children with a minimum of four trained Mental Health Workers per
classroom is a best practice approach that is employed. Multiple approaches focusing on each child’s strengths
and deficits are implemented in order to reach each individually.
CAIP provides strict structure and routine within each classroom. The classrooms are physically designed
to follow the TEACCH structured teaching approach. According to TEACCH staff, “The physical layout of the
classroom is an important consideration in planning learning experiences for autistic students. Even the
arrangement of the classroom furniture can help or hinder a student’s independent functioning and his recognition
and compliance with rules and limits.” (TEACCH Staff, 2011) Children quickly identify what to expect and what is
expected from them in each area of the classroom.
Individual schedules are implemented for each child, with routines that include work tasks as well as
rewards. With these schedules, they can identify changes in the routine such as field trips, special programs, or
weekly therapies. which will assist in avoiding tantrums related to unexpected changes in routines and transitions.
Schedules are an example of a normative assistive device that an individual on the Autism Spectrum can use to
function successfully, even as an adult. The difference between the schedule of a person with an ASD and a typical
person’s schedule is that the schedule for a person with an ASD might include task breakdowns, visual supports, or
activities of daily living. Instrumental activities of daily living are not automatic for the person with an ASD; they
need to schedule when to do laundry, pay bills, and other activities outside of regular daily routines.
CAIP services focus on communication assistance, which is offered through intensive Speech and
Language Therapy, Picture Exchange Communication Systems (PECS), Sign Language, and Augmentative
Communication Devices. Touch screen devices with the Proloquo2go application, have been implemented within
the past year. Communication is a vital aspect throughout the classroom and throughout the school day. While
the ultimate goal for each child is to communicate through the use of verbal speech, they must have some form of
alternative communication to use on an immediate basis. This is critical to effectively reduce anxiety and
frustration which in turn, could lead to maladaptive behaviors. The alternative forms of communication, such as
PECS, sign language, and augmentative communication devices, assist visual thinkers. According to Temple
Community Autism Intervention Program 5
Grandin (2006), individuals on the spectrum have “specialized brains” which often make them visual thinkers who
think in images.
Social Deficits are addressed with daily social skills groups within the CAIP Preschool Demonstration
Program classrooms. Individual social stories are designed specifically for special events or situations in the child’s
life. Carol Gray (2011), the developer of Social Stories, has defined a Social Story as describing “a situation, skill, or
concept in terms of relevant social cues, perspectives, and common responses in a specifically defined style and
format.” Social Stories share accurate social information in a manner that is easily understood by its audience.
Half of all Social Stories developed should focus on something that an individual does well. The goal of a Story is
not to directly change the individual’s behavior, but rather to improve the understanding of events and
expectations leading to more effective responses. (Gray, 2011) Monthly community outings are provided to help
with the generalization of those social skills in various activities and settings.
CAIP also implements the Greenspan ‘Floortime’ intervention, which employs an individualized approach
to interactively playing with the child for the purpose of facilitating development. Staff help create the kinds of
experiences that promote mastery of the milestones of development. The Floortime Foundation notes:
“Once a child has mastered all six milestones, he has critical basic tools for communicating, thinking, and
emotional coping. He has a positive sense of self. He is capable of warm and loving relationships. He is
able to relate logically to the outside world. He can express in words a wide range of emotions (including
love, happiness, anger, frustration, fear, anxiety, jealous, and others) and is able to recover from strong
emotions without losing control. He can use his imagination to create new ideas. He is flexible in his
dealings with people and situations, able to tolerate changes and even some disappointments and bounce
back. Obviously not all children do these things equally well, but a child who has mastered the milestones
will have important foundations for loving and learning.” (Wilson, 2011)
Recreational Therapy is also provided twice per week focusing on sharing and taking turns with staff and peers. It
is also a time that is used to reinforce play skills developed in Floortime.
Certified Teachers in the CAIP Program provide educational interventions, including Direct Instruction (DI).
In DI, teachers provide one on one education based on the goals of each child’s Individual Education Plan. Teachers
focus on the child’s individual learning modalities during this time. Frequent individualized rewards are provided
on an intermittent basis. Discrete Trials (a Lovaas approach from Applied Behavior Analysis) are used individually
on a daily basis through the Discrete Trial Trainer computer software developed by Accelerations Educational
Software. Discrete Trials are a means of teaching children with autism specific skills, such as paying attention,
Community Autism Intervention Program 6
making eye contact, and language and social skills. A behavior is broken down to its basic function, with each
function taught in a progressive manner. (James Ball, 2008) Once these skills are mastered then focus shifts to the
generalization of these skills across environments.
Structured Teaching (TEACCH) is employed through the use of Basketwork in the CAIP Program. The skills
each child has been taught through Direct Instruction are practiced repetitively, initially to improve proficiency and
then later to maintain mastery of the skill. A basket work approach is used to maintain structure, routine, and
reinforcement in completion of these tasks. The approach consists of developing one task that reinforces a skill
which has been initially taught in Direct Instruction, and then placing that task in a basket or drawer system. A
visual mini-schedule identifies the set of tasks for the child to complete during each Basketwork period. The child
will match a picture from the mini schedule to the appropriate basket or drawer. The child pulls the activity out
and completes the task. The level of assistance provided (monitoring, verbal cues, hand over hand techniques) is
dependent upon the child’s retained knowledge of that skill. When the activity is completed, the child places the
parts to the task back in the basket or drawer and moves that basket off the table or closes the drawer. The same
procedure continues with the next item on the visual mini schedule until all tasks are completed. The child is then
provided with a reinforcement of choice. Repetitive behaviors or interests may be engaged during this point.
Tasks are relatively simple and can be rotated out based on the child’s current skills and needs.
Some children with an ASD diagnosis have impaired sensory systems. Some senses may be overactive and
some may be underactive. All systems are interconnected in the brain. Sensory Integration methods are employed
through weekly sessions with an Occupational Therapist. An individual session focuses on fine motor skills. Whole
group sessions focus on the vestibular system (which involves movement) and the proprioceptive system (which
involves the body’s position in space) deficiencies. The use of trampolines, swings, sensory socks, weighted
devices, and balance boards are materials used on a regular basis. In addition, a separate sensory room is
accessed daily by students for free sensory exploration. Sensory manipulates are available in each classroom for
use when a child becomes frustrated or anxious. This is supported by J. B. Ball (2008) who noted, “Sensory
Integration Therapy attempts to help children become aware of different sensory input, when they need more or
less in order to stay in optimal learning mode, and give them appropriate ways to acquire the input they may be
Community Autism Intervention Program 7
Adjunctive Therapies have been most recently added within the past year. This Therapy is three-fold
incorporating the use of Music, Physical, and Dance Therapies. Predictions for the effectiveness of those therapies
include increases in communicative attempts, social skills development, reduced maladaptive behaviors, and
decreased frustration and anxiety. Recent research has advocated the use of these adjunctive therapies.
The American Music Therapy Association, Inc. (2006) noted that “music is a universal language that create
non-threatening bridges between people and their environments, helps to maintain attention, express emotions,
and a means to express emotions”. Autism expert Catherine Lord from the University of Michigan, believes that
music therapy is helpful; although more research is always needed to determine exactly why and how it helps.
(Hwang, 2009) Music therapy is provided in conjunction with Dance Therapy. Individual Music Instruction is
provided on a one to one basis weekly. Although more research is needed to determine the true effectiveness of
music instruction, the potential benefits make it a valuable endeavor, particularly within a comprehensive
Physical Therapy is provided in small groups on a weekly basis and on an individual basis weekly. Recent
research has shown that aerobic exercise which requires more cognitive thinking promotes children’s executive
functioning which is necessary in problem solving (Best, 2010). Similarly, “preschool interventions that create
student-centered, action-based classrooms environments positively impact Executive Functioning in comparison to
more traditional, teacher-centered classroom environments.” (Best, 2010)
Dance Therapy is also provided weekly in small groups. It is also provided individually when a child
indicates a need for more intensive vestibular activities. Maxine Sheets-Johnson (2010) noted in the Keynote
Address of the 44 American Dance Therapy Association Conference in Portland, Oregon:
‘Movement is the core of life…the chronological epistemological development of all humans, their
learning on all fronts, is first by movement, and then by word of mouth…movement is indeed life-
proclaiming’ which can be threatening and/or overwhelming even in individuals who are psychologically
normal. ..movement is indeed the basis of our experience of ourselves, as capable and effective agents
against the world …emotion and movement go hand in hand’. (Johnson, 2010)
Levy concurs with this statement emphasizing that dance therapy forms trusting relationships. (Johnson, 2010)
Repetitive and restrictive patterns of behaviors and interests as well as maladaptive behaviors are
addressed individually through Individual Behavior Management Plans. Staff focus on the program-wide positive
behavior management CAP (Calm, Assisted Communication, and Proactive) Program. Restrictive and Repetitive
Community Autism Intervention Program 8
behaviors are shaped as rewards. Self- injurious behaviors and aggression are addressed through ignoring and/or
redirecting until extinction. Through the use of these techniques, more intrusive interventions such as restraints
or basket holds are rarely needed to keep a child safe.
One of the most important components of the CAIP Preschool Demonstration Program is parent
involvement and training. While early, intensive treatment is imperative, intensive parental involvement is
equally important. Parents are required to attend monthly Treatment Plan Review meetings, monthly parent
meetings, and parent training on the techniques used in this program. Parents are provided materials for use in
the home such as picture schedules, visual mini schedules, transition picture rings, social stories, sensory
integration materials, augmentative communication devices as needed, behavior management programs such as
token systems and reinforcements, and clinical support in order to emphasize the importance of continuity across
John D.: A Case Study
John D. was diagnosed by a clinical psychologist on April 30, 2009 at the age of 2 years, 6 months.
Assessment measures included the Autism Diagnostic Observation Scale (ADOS-G Module I) and Autism Diagnostic
Interview (ADI). Parents had been concerned since the child was eighteen months old due to lack of typical
language skills. At 24 months, parents were still concerned about the lack of verbal communication.
The examiner identified background information including divorced parents with joint custody. Both
parents were well educated, and John attended daycare at the time of the evaluation. The daycare provider
described John as needing more personnel time and lack of peer play.
The pregnancy was described as uncomplicated. John Doe slept no longer than three hours per night
during the neonatal period. Motor development was typical, and vaccinations were current. Medical history
included multiple ear infections and a febrile seizure at 11 months of age.
John‘s language skills were delayed. Single words abruptly stopped at age X. His method of
communication then was leading others by the hand to desired items and screaming. He used idiosyncratic
language and babbling. He loved to sing songs from videos, but would not imitate sounds.
John was described by the parents as having multiple sensory idiosyncrasies such as reactions to various
sounds, hand flapping, lining up his toys, and a self restrictive diet. Mother reported that a gluten-casein free diet
Community Autism Intervention Program 9
had recently been implemented. Social skills were delayed and unusual at the time of the assessment. He would
only engage in solitary play and rarely responded to his name.
Restrictive and repetitive patterns of behaviors and interests included toe walking, reciting movies and re-
enacting movements in the movies. Mother reported that John loved music. He wanted his parents to sing along
and when they did not meet his expectations; he became aggressive with them. John exhibited no coordination
difficulties; he enjoyed drawing and writing his name. Behavioral observations throughout the assessment period
included the following: no response to his name, babbled, brief and infrequent eye contact, and did not attempt
to play with the examiner or the parents.
The examiner recommended that John attend a full-day, year-round, highly structured educational
program with small ration of students to trained staff. A referral to the CAIP Preschool Demonstration Program
was initiated by the local school system in conjunction with the parents was generated in September 2009. John
was subsequently accepted into the CAIP Preschool Demonstration Program and an intake was held following his
third birthday. A psychosocial intake at that time was consistent with the information from his Autism evaluation.
CAIP services began in October 2009 along with the development of an Individual Education Plan (IEP). An
Initial Treatment Plan was developed on October 5, 2009 during John Doe’s first Treatment Team meeting. The
Treatment Team identified the following goals and objectives as a starting point for treatment: improving
communication attempts beginning with a nonverbal communicative greeting such as a wave, beginning basic peer
interactions with responding to an interaction by attending in the area of Social Skills, and increasing Independent
Living by initiating Autism specific teaching methods.
An Individual Behavior Management Plan was developed at the same time, indicating following the
strategies for the CAP Program (Calm, Assistive Communication, Pro-active) as identified in the services area.
A Childhood Autism Rating Scale completed in November 2009 was consistent with Mild to Moderate
Autism symptoms. Throughout the course of treatment, John participated in the above described evidence-based
interventions with a 97% attendance rate. His parents were also very involved, attending 95% of all Treatment
Team and monthly parent meetings. Although his mother remarried during this time period, his parents and step-
father were all actively involved in treatment. John’s Treatment Plan is reviewed monthly by an interdisciplinary
Community Autism Intervention Program 10
team representing psychiatry, clinical care, nursing, educational staff and the parents when possible. When
parents are unable to attend in person, they are contacted by phone
While in CAIP, John participates in structured, supervised therapeutic interventions including applied
behavioral techniques. Specifically, he receives interventions that follow the philosophies of the University of
North Carolina’s Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH)
which follow structured teaching and behavioral modification principles. Visual supports in the form of schedules
and calendars are used to increase the predictability and structure in the classroom and other environments.
Social skills are facilitated through the use of planned interactions with the staff and peers. Also in use are social
stories/scripts and prompting for appropriate behavior during social activities. Modeling, prompting, and visual
and verbal cues are used to teach independent living skills. Relaxation techniques are taught and utilized when
John Doe becomes frustrated or upset. These include but are not limited to taking a deep breath, taking a very
short walk, playing “scared turtle” or manipulation of sensory objects. The CAIP CAP Program is also implemented.
This program encourages staff to use calming techniques, assist the child with communication efforts, and provide
proactive techniques to encourage self regulation. Frequent verbal reinforcement as well as tangible rewards are
used to positively reinforce appropriate behavior.
Fifteen months into the program, John Doe is now working on the following Treatment Plan objectives:
communicating verbally using three to four word answers in response to questions 4/5 times or 80% accuracy,
respond and/or initiating a peer interaction at least one time per day, and engaging in Autism specific learning
activities 5/5 times or 100% of the day. All of these represent substantial improvements over his original
objectives, which emphasized single words and only occasional peer interactions.
The following depicts scores on the Social Responsiveness Scale (SRS) and the Social Communication
Questionnaire (SCQ) from the time John Doe entered the CAIP Program to the current time:
November 2009 April 2010 January 2011
General Adaptive Composite 68 81 82
Social Responsiveness Scale 64 Not Assessed 71
Social Communication Questionnaire 23 30 30
The following graphs depict progress in each area of the Pychoeducational Profile-Revised (PEP-R)
Community Autism Intervention Program 11
Developmental Scale Profile - John Doe
2009 2010 2011
Developmental Level (in months)
The results of the above scores represent the effectiveness of a holistic, eclectic approach for Preschool Autism
Programs. John’s skills show a steady progression across time in all areas of functioning and development. The
use of multiple positive interventions, provide the ability for a program to be as intensive as possible. The multi-
disciplinary Treatment Team in conjunction with teachers and parents provide the expertise needed in each area
of development. The use of multiple communication avenues, schedules, individually structured educational
interventions, social groups, Sensory Integration, and Adjunctive Therapies (Dance Therapy, Physical Therapy,
Music Therapy, and Music Instruction) have proven to meet the needs of children with an Autism Spectrum
Disorder. An additional, essential aspect of the CAIP Preschool Demonstration Program is the level of parental
training and participation. Through all of these disciplines, interventions, and personnel, we make a difference in
the rate of progress and level of independence.
Community Autism Intervention Program 12
American Music Therapy Association, I. (2006). Music Therapy and individuals with Diagnosis on the Autism
Spectrum. Retrieved 12 5, 2010, from www.musictherapy.org/fact sheets.
Ball, James E. B. (2008). Early Intervention & Autism. In E. B. James Ball, Early Intervention & Autism (pp. 150-155).
Arlington: Future Horizons, Inc.
Best, J. R. (2010). Effects of physical activity on children's executive function: Contributions of experimental
research on aerobic exercise. Develpmental Review , 1-20.
Grandin, D. T. (2006). http://www.grandin.com/inc/visual.thinking.html. Retrieved 01 20, 2011, from THINKING IN
PICTURES: Autism and Visual Thought.
Gray, C. (Unknown). http://www.thegraycenteer.org/social-stories/what-are-social-stories. Retrieved 01 20, 2011,
from What Are Social Stories?
Hwang, J. (2009, 03 03). Evidence is Slim, but Experts Say Music Therapy is Valuable in Address... Retrieved 11 11,
2010, from http://www.washingtonpost.com/wp-dyn/content/article/2009/03/02/A.
Johnson, M.-S. (2010). Why Is Movement Therapeutic? American journal of Dance Therapy , 2-15.
Lord, Catherine, P. a. (2010). Autism Spectrum Disorders Diagnosis, Prevalence, and Services to Children and
Families. Sharing Child and Youth Development , 1-26.
TEACCH Staff. (2011). Structured Teaching: TEACCH Staff. Retrieved 01 20, 2011, from
Wilson, P. (2011). http://www.floortime.org. Retrieved 01 10, 2011, from The Floortime Foundation.