Journal of School Psychology

43 (2005) 117 – 136

The role of the school psychologist in the inclusive

education of school-age children with autism
spectrum disorders
Susan K. Williamsa,T, Cynthia Johnsonb, Denis G. Sukhodolskya
a
Child Study Center, Yale University School of Medicine, United States
b
Department of Pediatrics, University of Pittsburgh School of Medicine, United States
Received 20 July 2004; received in revised form 26 January 2005; accepted 31 January 2005

Abstract

Two independent trends are impacting school psychologists with regard to their involvement in
the education of students with autism spectrum disorders (ASDs): increasing prevalence estimates of
ASDs and an emphasis on the inclusion of students with special needs in regular education
classrooms. In light of these trends and growing awareness of the need for evidence-based practices
in the field, school psychologists can expect to be involved in the educational programming of
students with ASDs and should be knowledgeable about empirically supported strategies relevant to
inclusive education of these children. The purpose of this review is to familiarize school
psychologists with currently available intervention techniques by describing each strategy and
outlining the degree of empirical support for each. Strategies for managing disruptive behaviors,
promoting learning, and facilitating social integration are reviewed.
D 2005 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

Keywords: Autism; Autism spectrum disorders; Inclusion; Education; School

Autism spectrum disorders (ASDs), including Asperger’s disorder, pervasive devel-

opmental disorder—not otherwise specified (PDD-NOS), and autistic disorder, are

T Corresponding author. Yale University Child Study Center, P.O. Box 207900, New Haven, CT 06520-7900,
United States. Tel.: +203 785 3449; fax: +203 737 5104.
E-mail address: Susan.williams@yale.edu (S.K. Williams).

0022-4405/$ - see front matter D 2005 Society for the Study of School Psychology. Published by Elsevier Ltd.
All rights reserved.
doi:10.1016/j.jsp.2005.01.002
118 S.K. Williams et al. / Journal of School Psychology 43 (2005) 117–136

disorders of childhood onset characterized by significant impairment in social interaction

and communication as well as restricted or stereotyped patterns of behavior and interests
(American Psychiatric Association, 2000). These disorders affect between 34 and 60
children per 10,000 (Yeargin-Alsopp, Rice, Karapurkan, Boyle, & Murphy, 2003) and
recent reports have declared a dramatic rise in prevalence rates (Ozonoff & Rogers, 2003).
In schools, children classified with ASDs are receiving special education services in
greater numbers than ever before. According to the U.S. Department of Education (DOE),
from the 1991–1992 to the 2001–2002 school-year, the number of students with ASDs
served in special education increased by over 1300%, from 5415 to 78,749 children.
Concurrently, the placement of students with ASDs in mainstream settings is increasing
(US DOE, 2002).
Evidence-based practices (EBPs) are interventions, which have a knowledge-base
attesting to their quality and efficacy (Hoagwood & Johnson, 2003). The use of school-
based EBPs for special populations such as children with learning disorders and autism has
been emphasized in both the mental health and education sectors (Kratochwill & Shernoff,
2004; Kratochwill & Stoiber, 2002). Department of Education Secretary Paige recently
released a set of principles to guide the Education Department in its work on the pending
reauthorization of IDEA. Central to these guiding principles is an increased focus on
accountability and educational practices that are based on scientific evidence, stipulating
that schools should bquickly adopt research and evidence-based practicesQ (p. 2) and that
too often, bchoices for students with disabilities are limited by arbitrary decisionsQ (p. 3;
US DOE, 2004). As described by Hoagwood and Johnson (2003), school psychologists
can play a central role in bridging the gap between research and practice, through the use
of EBPs in schools for students with disabilities, including those with autism spectrum
disorders.
Given that approximately 1 in 200 children are identified as falling on the autism
spectrum (Fombonne, 2003), that these students are increasingly being placed in regular
classes (US DOE, 2002), and that classification rates in schools continue to rise (Croen,
Grether, Hoogstrate, & Selvin, 2002), it is inevitable that school psychologists will be
increasingly involved in facilitating the inclusion and integration of students with ASDs
into general education classes. The popularity of inclusive education, in which children
with special needs are placed primarily in regular education classrooms (Mesibov & Shea,
1996), is motivated largely by ethical and legal factors (e.g., least restrictive environment
and the principle that separate cannot be equal). Lending pragmatic potency to the
dinclusion movementT is the fact that placement in a general education class is less
expensive than placement in a full-time specialized education program (Putnam, Luiselli,
& Jefferson, 2002) and also that specialized educational programs for children with autism
are not available in every community. These factors, along with the call for greater use of
empirically derived approaches in schools, result in increased demands on school
psychologists to be knowledgeable of empirically supported assessment and intervention
strategies for children with ASDs.
Educators and school-based professionals often report feeling incapable of adequately
serving the needs of students with ASDs (Simpson, de Boer-Ott, & Smith-Myles, 2003)
and most feel that they could benefit from further training (Williams & Scahill, 2004). As
more students are being placed in regular education settings (Simpson et al., 2003),
 S.K. Williams et al. / Journal of School Psychology 43 (2005) 117–136 119

educators and families are left with the task of making inclusion work in the absence of
clear guidelines or information on how to do so. This review is intended to provide school
psychologists with information about interventions that can be used in the regular
education classroom for children with ASDs. We have focused on intervention techniques
that have been empirically studied, though not all of the strategies covered can be
considered EBPs at this time (Kratochwill & Stoiber, 2002). A very large percentage of
intervention studies in ASD have been single subject design, thus limiting their
interpretation to individuals with ASD in general. Also, many of these interventions have
been developed in specialized clinical settings but are now beginning to be applied in
classrooms. The interventions covered fall into three broad areas: (1) strategies to manage
disruptive behaviors, (2) strategies to promote academic competencies, and (3) strategies
to encourage social integration. After defining each approach and describing how it might
be applied in the classroom, we provide an overview of the available empirical support for
the strategies in each area. While the research base is admittedly limited for many of the
strategies, knowledge of these strategies and how to implement them in regular education
classrooms can be beneficial for practicing school psychologists and the students they
serve as we await further research.

Disruptive behavior: support and consultation

In addition to characteristic deficits in socialization and communication, children with

ASDs often display severe behavior problems including tantrums, aggression, self-
injurious behavior, disruptive and destructive behaviors, and noncompliance (Arbelle,
Sigman, & Kasari, 1994; McClintock, Hall, & Oliver, 2003). These problems interfere
with learning and can impede the teacher’s ability to manage the classroom. Thus, the
school psychologist is often called upon to provide interventions and/or recommendations
in this area.

Applied behavior analysis and functional assessment

The applied behavior analysis (ABA) literature is replete with studies demonstrating the
effectiveness of these procedures for individuals with ASDs (Matson et al., 1996;
Schreibman, 2000). This model, based on operant learning theory, presumes that
antecedent stimuli and consequences influence both the acquisition and maintenance of
behaviors. Investigations embracing this approach have demonstrated attenuation of
problematic behaviors (e.g., aggression, self-injury, tantrums, noncompliance, ritualistic
behaviors) as well as the acquisition of skills (Lovaas, 1987; Maurice & Green, 1996;
Schreibman, 1997).
The critical first step in developing a behavior plan is completion of a functional
assessment (Gresham, Beebe-Frankenberger, & MacMillan, 1999). The Individuals with
Disabilities Education Act (IDEA) requires such an assessment for all students with
significant behavior problems. Behavioral interventions should be formulated based on
what is learned from a comprehensive functional assessment of the behavior, and the goal
of the functional assessment is to identify the variables that contribute to the target
120 S.K. Williams et al. / Journal of School Psychology 43 (2005) 117–136

behavior (Carr et al., 1999; Horner & Carr, 1997; Horner, Carr, Strain, Todd, & Reed,
2002). This involves comprehensive examination of the underlying motivations, or
functions, of the child’s interfering behaviors. A functional assessment should identify
environmental influences for particular, well-defined target behaviors. The environmental
variables assessed include antecedents and consequences that may be maintaining the
behaviors. Antecedents assessed include details on what is occurring before the behavior
(e.g., who is present, what activity is taking place), what the setting is (e.g., classroom,
recess), and possible physiological influences (e.g., illness, hunger). Consequences
assessed include the outcome of the behavior, such as whether the child bescapesQ the
situation, receives the attention of adults or others, receives a preferred object, or is
allowed to continue with an activity.
A functional assessment involves multiple components, which can be conducted in a
series of steps. A first step is to conduct a functional assessment interview with teachers,
parents, and others involved with the child to begin to ascertain their views on possible
antecedents and consequences maintaining a problematic behavior. Formats for these
interviews can be found in several texts (McComas, Hoch, & Mace, 2000; O’Neill et al.,
1997). A feasible next step in the functional assessment process involves direct
observation of the child in the classroom where and when the target behavior(s) is most
likely to occur. This allows for the direct assessment of contributing antecedents and
consequences of the behavior as it is naturally occurring in the school environment. The
school psychologist is a likely choice for conducting these observations. While other direct
observation is focused on such variables as on-task behavior, the purpose of the functional
assessment of a target behavior is to analyze the variables possibly influencing and
maintaining the behavior. The functional assessment can be used to analyze the target
behavior even further. At this level of analysis, environmental variables are controlled and
manipulated to determine how they are maintaining a behavior or a group of behaviors and
if altering them affects the behavior. For example, the teacher can be instructed to ignore
the target behavior rather than responding as she normally might, to determine if attention
might be motivating for the child and thus maintaining the behavior.
Functional analysis procedures were first described in a seminal article by Iwata,
Dorsey, Slifer, Bauman, and Richman (1982). Since this time, these procedures have
received considerable attention in the ABA literature using single subject methodology.
Common analogue observations include the following conditions: (a) free play or control
condition (no demands are placed on the child and preferred toys are available), (b)
attention (where an adult is instructed to attend to the child when engaging in the target
behavior), (c) demand (where the adult makes requests of the child), and (d) tangible
restriction (where the child is faced with the removal of a highly desirable toy). A highly
applicable review of functional analysis methodology is provided in Hanley, Iwata, and
McCord (2003). While school settings may not allow for this level of individual
assessment, variations to these procedures may be considered. That is, the school
psychologist may manipulate particular variables that are of interest such as asking the
teacher to allow the child to bescapeQ a certain task or to attend to a certain behavior but to
ignore others.
Once a functional assessment has discerned what antecedents and consequences are
operating, behavioral interventions can be developed to target the problem behavior by
 S.K. Williams et al. / Journal of School Psychology 43 (2005) 117–136 121

modifying these environmental influences (Olley, 1999). For example, through a

functional analysis it may be learned that a student screams and tantrums when faced
with challenging work in class. When the student tantrums, the teacher sends the student to
time-out in the back of classroom. This student learns that tantruming is an effective way
to escape the unpleasant task of challenging work (maintenance of tantruming through
negative reinforcement). Using behavioral strategies (e.g., ignoring tantrum and changing
the reinforcer), the school psychologist and teacher can teach the student a more
acceptable, replacement behavior such as asking for a break (or signaling the teacher
nonverbally that she needs a break). Such an intervention is dfunctionally derivedT in that it
allows the child to meet his or her needs/desires through more acceptable behaviors (i.e.,
the function of the behavior does not change). Many helpful resources on conducting
functional assessments are available, including Repp and Horner (1999) and LaBelle and
Charlop-Christy (2002).

Managing antecedents

Along with an increased emphasis on first completing a functional assessment in the

development of a behavior plan, there has been a shift in the applied behavior analysis
field away from reliance on consequence management strategies and toward the
identification of contributing environmental conditions, so that interventions are often
directed at prevention and antecedent management strategies (Luiselli & Cameron,
1998). Luiselli and Cameron (1998) provide a thorough overview of antecedent
strategies in their text. Interventions in this area often used with students with ASDs
include use of visual cues and schedules, modification of daily schedules, and
rearranging of the physical setting (Duker & Rasing, 1989; Dyer, Dunlap, & Winterling,
1990; Mesibov, Browder, & Kirkland, 2002). The use of visual cues and prompts is
often a component of behavioral interventions for individuals with ASDs (McClannahan
& Krantz, 1999). Earlier studies demonstrated the efficacy of using picture cues to teach
independency during activity changes (transitions) and to teach daily living skills to
children with autism (Pierce & Schreibman, 1994). Visual schedules have been used to
improve on-task behavior as well as enhance the ability of children with ASDs to follow
the classroom schedule (Bryan & Gast, 2000). While the empirical base for use of visual
cues with autism is limited, there is strong empirical support for this type of skill-
teaching approach in the mental retardation literature (Frank, Wacher, Berg, &
McMahon, 1985; Hall, McClannahan, & Krantz, 1995; Johnson & Cuvo, 1991).
Hopefully, future research will expand our knowledge about the efficacy of visual
supports more specifically for children with ASDs in the educational setting.
Environmental adaptations are often made in the classrooms of children with ASDs,
including modification of lighting and sound, and physical re-arrangement of materials
and furniture. There is some empirical support for a positive impact on three students’
behavior in a reversal design, single subject study (Duker & Rasing, 1989) by making
modifications such as limiting the light in the room, removing visual stimuli from the
walls, and having the teacher wear neutral clothing. With these environmental
modifications, decreases in self-stimulatory and disruptive behaviors were observed along
with an increase in on task behavior. Much of the support for such environmental changes
122 S.K. Williams et al. / Journal of School Psychology 43 (2005) 117–136

has come from the personal accounts of individuals with autism (Grandin, 1995;
Robinson, 1999; Williams, 1996) along with anecdotal reports and observations. A
valuable discussion about environmental considerations is provided in a recent text by
Kluth (2003). School psychologists may want to try these antecedent strategies with
students with ASDs, including visual schedules and environmental modification, but
should be aware that at this time these approaches are not considered EBPs. Well-
controlled, randomized studies are woefully needed to more closely examine the impact of
such strategies.

Functional communication

Another advancement in antecedent management has been the focus on communication

interventions. Functional communication, or equivalence training, is an empirically based
approach designed to attenuate challenging behaviors. The premise of a functional
communication approach is that problematic behaviors often serve as maladaptive, but
effective, forms of communication (Johnson, 2002). Over 40 single subject studies have
examined the impact of functional communication and have concluded it to be an effective
approach to teaching children more appropriate ways to get their needs and desires met. If
children with autism are taught more appropriate and functional means of communicating
their needs, it may decrease the need for maladaptive behavior (Koegel, Koegel, & Surratt,
1992; Wacker et al., 1998).
A seminal article by Carr and Durand (1985) stimulated strong interest in this approach.
In the 20 years since, many single subject studies have demonstrated that functional
communication interventions are effective in decreasing challenging behaviors (Day,
Horner, & O’Neill, 1994; Hanley, Iwata, & Thompson, 2001). General guidelines for this
approach include choosing a functional communication behavior that is less effortful and
more efficient than the problem behavior, and that will result in more reinforcement than
the problem behavior. A risk raised with using this approach is that the newly mastered
functional communication skill may be overused. That is, a child may be taught to ask for
a bbreakQ either verbally or using a manual sign when a functional assessment has
indicated the child is aggressive in response to classroom demands. Allowing the child to
consistently escape would result in lack of learning and classroom participation. However,
this has been addressed by using a functional communication approach in concert with a
planned fading system. Lalli, Casey, and Kates (1995) demonstrated the efficacy of this
approach. First, the child is taught the functional communication behavior and, once the
child masters the behavior and begins using it proficiently, s/he is then required to
complete increasing steps involved in the disliked task before being allowed to take a
break from it (Lalli et al., 1995). There are many excellent texts available that can be
useful to school psychologists interested in exploring this type of intervention more fully
(Carr et al., 1994; Repp & Horner, 1999).

Errorless compliance training and reinforcement

Antecedent approaches have received a great deal of support in addressing

noncompliance and oppositional behaviors. It has been shown (Horner, Day, Sprague,
 S.K. Williams et al. / Journal of School Psychology 43 (2005) 117–136 123

O’Brien, & Heathfield, 1991; Kennedy, 1994; Mace et al., 1988) that problem behavior
can be decreased and appropriate behavior increased by interspersing low-probability
commands (e.g., start your math sheet) with high-probability commands (e.g., get a
snack). More recently, a very similar approach to compliance training termed
berrorlessQ has been demonstrated to increase overall compliance in four young
children with autism using a multiple baseline single subject design (Ducharme &
Drain, 2004). This approach involves beginning with high-probability commands (i.e.,
those that are likely to be complied with) and gradually introducing more demanding
commands so that the child experiences success and reinforcement. This antecedent
approach to improving compliance provides an alternative to the manual guidance often
used with individuals with autism and other consequent management approaches such
as timeout (Howlin, 1998). While the procedures were implemented by parents
(Ducharme & Drain, 2004), this is an approach teachers could easily be trained in as
well.
Antecedent management approaches are most effective when implemented in concert
with traditional behavioral strategies such as the systematic reinforcement of alternative
behaviors. A number of seminal studies have demonstrated the efficacy of both positive
and negative reinforcement in altering challenging behaviors in children with autism
(Carr, Newsom, & Binkoff, 1976; Wolf, Risley, & Meese, 1964). Investigations have
highlighted the importance of carefully selecting reinforcers to be used for children with
ASDs (Charlop, Kurtz, & Casey, 1990; Mason et al., 1989). Charlop-Christy and
Haymes (1996, 1998), and Charlop et al. (1990) have demonstrated the effectiveness of
using the atypical behaviors the children chose to engage in on their own (obsessions,
stereotypical behaviors such as spinning) as reinforcers in children with autism. School
psychologist may play a pivotal role in helping identify reinforcers for students with
ASDs who may seem to be unresponsive to more traditional reinforcers and developing
a reinforcement system for a particular student or classroom.

Improving academic competencies

Cognitively, children with ASDs often exhibit unique strengths and weaknesses that
impact their ability to succeed academically in the general education curriculum. It has
been reported that between 26% and 75% of autistic children also meet criteria for
mental retardation (Chakrabarti & Fombonne, 2001; Joseph, Tager-Flusberg, & Lord,
2002). On the other hand, many children with ASDs, such as Asperger disorder and
high-functioning autism, have average to superior cognitive abilities. Many, though not
all, children with ASDs also possess stronger spatial and nonverbal abilities in
comparison to verbally mediated abilities (Joseph et al., 2002; National Research
Council, 2001). Other difficulties commonly seen in these students include deficits in
planning, cognitive flexibility, and attention (National Research Council, 2001). While
the research has attempted to assemble a unique dASD cognitive profileT, it would be a
mistake to assume that any given child with an ASD possesses such a profile. The
school psychologist should therefore use both quantitative (e.g., test scores, discrep-
ancies) and qualitative data (e.g., anxiety level, response to encouragement and verbal
124 S.K. Williams et al. / Journal of School Psychology 43 (2005) 117–136

praise) from the formal psychoeducational evaluation as well as classroom observations

in helping the teacher to modify the teaching curricula.

Applied behavior analysis

Applied behavior analysis procedures are not solely the mainstay for the amelioration
of challenging behaviors. The field also has a long history of contributing to instructional
procedures for students with autism and other developmental disabilities (Alberto &
Troutman, 1999; Dunlap, Kern, & Worcester, 2001; Heflin & Alberto, 2001). These
procedures include the systematic task analysis of skills to be taught, direct instruction
and discrete trial instruction, and other behavioral techniques such as prompting,
shaping, chaining, and fading. While teachers receive training in many of these
instructional approaches, actual application for students with ASDs may need to be
individualized.
The school psychologist can provide information as well as modeling and feedback to
the teachers regarding the design and implementation of ABA-based adaptations for a
student with ASD in the general education classroom. For example, some children with
ASDs may not learn efficiently by modeling alone and need additional prompts (e.g., a
physical prompt for each component of a task analysis) to acquire a new skill. The school
psychologist can also participate in evaluating instructional modifications using individual
assessments, classroom observation, or curriculum-based measurement (Stoner, Scarpati,
Phaneuf, & Hintze, 2002).
The empirical support for instructional and curricular support and interventions stems
from case reports and single-subject design studies. Some of these studies have been
conducted with children with ASDs, but studies conducted with students with other
developmental disabilities may inform curriculum modifications for children with ASDs
(Dunlap et al., 2001; Gresham et al., 2004). In adapting the literature on developmental
disabilities and designing techniques for students with ASDs, the school psychologist
should take into consideration the child’s profile of academic and cognitive abilities and
deficits (Siegal, Goldstein, & Minshew, 1996). In addition, as this research base is
developing, school psychologists should bear in mind potential difficulties that may arise
in adapting them for students with ASDs (e.g., uneven cognitive profiles and the need for
extra help in certain areas and not in others). Future work should be done to apply these
strategies for students with ASDs in inclusive classrooms.

Environmental modification, task sequencing, and peer tutoring

Many other techniques related to environmental/classroom modification and how

instructions are issued are derived from the ABA literature. Some instructional
modifications that have been systematically evaluated include modifications of
curriculum content, curriculum delivery, and prompting and reinforcement for being
on task. For example, modification of academic tasks based on the functional assessment
of specific variables that affected performance of three students with disabilities resulted
in improved work productivity (Dunlap, White, Vera, Wilson, & Panacek, 1996). A
combination of delayed reinforcement for being on task with the fading of prompts was
 S.K. Williams et al. / Journal of School Psychology 43 (2005) 117–136 125

reported to have a positive effect on academic work skills in three children with autism
(Pelios, MacDuff, & Axelrod, 2003). Conroy, Asmus, Ladwig, Sellers, and Valcante
(2004) observed that the teacher’s proximity to the student was related to increased rates
of academic engagement in six students with autism educated in the general education
classroom. The rate at which instructions are issued is an important variable as well; the
reduction of time between prompts has been shown to increase the likelihood of a
correct response (Repp & Karsh, 1992).
Other interventions that have been evaluated in single-subject studies and may be
relevant to the academic instruction of children with ASDs in general education classes
include embedded instruction and peer tutoring. Embedded instruction is a type of
academic instruction that is intended to combine the goals of general education
curriculum with the child’s Individualized Education Plan by incorporating the principles
of incidental teaching and distributed learning opportunities. Specifically, instruction in a
particular skill for a child with disability is embedded within other routines and activities
of the class. For example, tasks could be arranged so that instructional trials for the child
are delivered during natural breaks in the activities or when the student is in transition
from one activity to another. Two recent multiple-baseline design studies demonstrated
that embedded instruction was helpful for students with developmental disabilities in the
acquisition of knowledge from the general science and reading curricula (Johnson,
McDonnell, Holzwarth, & Hunter, 2004; McDonnell, Johnson, Polychronis, & Riesen,
2002). Class-wide peer tutoring was associated with increased reading fluency and
reading comprehension questions in three students with autism (Kamps, Barbetta,
Leonard, & Delquadri, 1994). Similarly, peer tutoring was reported to be effective in
improving spelling accuracy in four children with intellectual disabilities who were
educated in general education setting (Mortweet et al., 1999). The results of these single-
subject studies provide promising guidelines for school psychologists but should be
considered in light of limitations inherent to studies with small samples and
heterogeneous populations. At the same time, environmental modification, task
sequencing, and peer tutoring interventions should be strongly considered for future
randomized studies with larger samples, independent evaluators, and carefully described
quality assurance procedures.
For students with ASDs, close attention to curriculum and instructional variables is
important as they are closely tied the reduction of behavioral concerns as well as learning
acquisition. A large body of literature has shown that improved student performance is
correlated with improved behavior in the classroom (Munk & Repp, 1994). Student
selection of tasks has been shown to be associated with increased on-task responding and
decreased behavioral concerns (Dunlap, Kern-Dunlap, Clarke, & Robbins, 1991; Dyer et
al., 1990). Variation in tasks has also been shown to have similar effects (Kern, Childs,
Dunlap, Clarke, & Falk, 1994). Not surprisingly, having preferred activities follow less
desirable tasks leads to better student performance. Thus, through careful attention to the
child’s preferred activities (observing what the child does when allowed to choose) and
modifying his or her daily schedule accordingly, interspersing preferred and nonpreferred
activities can prove to have a powerful effect on student performance and behavior.
Finally, examination of task difficulty should be considered as this variable has been found
to be related to increased behavioral concerns (Kern & Dunlap, 1998).
126 S.K. Williams et al. / Journal of School Psychology 43 (2005) 117–136

The emerging evidence in support for instructional accommodations for children with
ASDs should be considered in light of dangers associated with improper implementation
and dissemination of techniques from university labs to real-life settings (Scott et al., 2004;
Weisz, Donnenberg, Weiss, & Han, 1995). Dissemination research suggests that
knowledge about an intervention is not the same as competent implementation of the
intervention. For example, clinicians in a large clinical trial of an evidence-based
psychotherapy perceived having continuous supervision to be more important than having
a manual (Najavits et al., 2004). By analogy, the role of the school psychologist may go
beyond informing teachers about possible instructional modifications to include modeling,
feedback, and monitoring for the duration of implementation.

Facilitating social integration and acceptance

A primary reason cited for placing students on the spectrum in mainstream classes is
to improve their opportunity to interact with typical peers (Dahle, 2003), though research
on outcomes related to inclusive placements has yielded mixed results. Children with
ASDs have been found to be more socially involved with peers when placed in
mainstream classes (Robertson, Chamberlain, & Kasari, 2003). Other studies, however,
indicate that students with ASDs typically have few reciprocal friendships with same-age
peers (Orsmond, Krauss, & Seltzer, 2004) and are not well-accepted (Chamberlain,
2001). Children with ASDs often display certain characteristics that make smooth social
interactions with peers difficult, such as a fundamental deficit in social skills, a need for
sameness and difficulty adjusting to changes in their routine, and restricted interests and
unusual, sometimes bizarre, behaviors (Simpson et al., 2003). School psychologists may
be called upon to play a role in helping students meet goals related to social
development.

Antecedent strategies

Brown, Odom, and Conroy (2001) recommended that socialization interventions be

delivered hierarchically, starting with the least intrusive and progressing to more
intensive and individualized interventions as dictated by observations of the children’s
social skill development. One of the least intrusive, yet often overlooked, strategies
involves environmental (antecedent) manipulation to promote social integration.
Teachers can structure the curriculum to promote social interaction by providing lots
of opportunities for cooperative learning and mixed social group activities (Kamps et al.,
1994), and by pairing the student with socially skilled peers (peer buddies) during play
and academic work (Terpstra, Higgins, & Pierce, 2002). In a multiple-baseline study of
three children with autism, Wolfberg and Schuler (1993) demonstrated that the children
with autism involved in integrated peer groups with non-disabled and autistic peers
showed decreased levels of isolated play and stereotypic behavior and increased
functional play.
The school psychologist can also coach the teacher on the use of strategies such as
modeling, prompting, and reinforcing appropriate prosocial behaviors during interactive
 S.K. Williams et al. / Journal of School Psychology 43 (2005) 117–136 127

activities for both typical peers and the student with ASD (Kamps et al., 2002), while
discouraging activities that might lead to social isolation or rejection (e.g., allowing
children to pick their own teams, inevitably leaving one child as the last one dpickedT).
Free time in class or play periods should be structured to promote interaction between the
child with ASD and his or her peers (Dahle, 2003). Such interaction should not be
expected to occur on its own; without structured intervention typical children are likely to
interact with other typical children, not their autistic peer (Goldstein, Kaczmarek,
Pennington, & Shafer, 1992). Although these relatively simple strategies have a good deal
of dcommon senseT appeal, they lack a strong empirical support base. They have often
been implemented in conjunction with other techniques, rather than being evaluated
independently. Some single case studies of children with ASDs that incorporated these
strategies, however, have demonstrated positive effects in terms of increases in social
involvement with peers (Cooper, Griffith, & Filer, 1999).

Peer-mediated strategies

In a review of empirically supported interventions designed to facilitate the

socialization of children with autism, Rogers (2000) concluded that peer-mediated
approaches using typical peers who work with the child with ASD are well supported.
One of the strongest arguments for the use of peer-mediated interventions is their
ability to promote generalization and maintenance of skills, as opposed to interventions
using adult partners, which do not easily generalize. Further, peer-mediated strategies
are proactive, require little planning time, and can be easily adapted to the classroom
and teacher. However, most of the studies of peer-mediated approaches have been
conducted with preschool-age children (e.g., Kohler & Strain, 1999). Only relatively
recently have studies of peer-mediated approaches been conducted with elementary
school children.
There are many formats for peer-mediated and class-wide interventions. Pierce and
Schreibman (1997), for example, reported increased levels of interactions, initiations,
varied toy play, and language use in two children with autism after peers were trained in
Pivotal Response Training (PRT), a teaching technique designed to increase a child’s
motivation to interact that capitalizes on child-choice of activities. The peer trainers
received individual training from two therapists in a classroom format. One possible
drawback of such a training approach is the time taken away from the classroom
instruction for the peer trainers. Approaches vary in the time they require outside of the
academic curriculum.
Owen-DeSchryver (2003) used a small group peer-training design for three elementary
students with ASDs in inclusive classes and found increased initiations and responses in
the trained peers, the untrained peers, and the students with ASDs. In this study, over
three training sessions, peer trainers were pulled from class and provided with
information on children with disabilities, specific information on the strengths and
weaknesses of their peer with an ASD, and given suggestions about how to interact with
the child (e.g., what to talk about, teaching the child the rules of a game). Kamps et al.
(2002) implemented peer training with five elementary age children with autism using
cooperative learning groups and social skill groups. Peers were trained to tutor their
128 S.K. Williams et al. / Journal of School Psychology 43 (2005) 117–136

partners during cooperative learning groups on academic subjects and also taught group
social skills, alongside their peers with ASDs. The social skill group training involved
adult-directed instruction in targeted social skills followed by free play during which the
students received points for using the appropriate social skills. Results indicated that peer
mediation increased social interaction between students with autism and their peers and
facilitated generalization of skills to other settings. In a second study with 34 autistic,
school-age students in public school, Kamps et al. (2002) found that peer training was
associated with increased duration of peer interaction and reciprocal interaction for the
students with autism. In this study, peers received a variety of peer mediation programs
including social skills/play groups, buddy programs (e.g., lunch-buddies), and tutoring
activities over the course of 2 years.
The available evidence on peer-mediated strategies indicates that having trained
peers promotes both acceptance of the child with the ASD and skill development in all
children. Kamps et al. (1998) also found that the trained peers had favorable attitudes
about their participation in such programs. Regardless of type of intervention (e.g.,
buddy program versus PRT), effective peer training programs include modeling,
prompting, and reinforcement techniques during multiple activities and employ many
peers (Kamps et al., 2002). Future studies should evaluate these approaches in fully
inclusive elementary classrooms and should compare various peer mediation strategies
in order to determine which approach is best in a given situation or classroom. When
designing a peer-mediated or peer-training intervention, the school psychologist should
adapt the approach to the children’s skill level and learning environment and may often
need to supplement this approach with more intensive, targeted interventions designed
to foster the autistic child’s skill growth, such as direct social skills training. In sum,
although there is at least preliminary evidence that getting typically developing peers
involved socially with the student with autism can be helpful in improving social
interaction in mainstream classes, there are many questions yet to be answered,
including how many peers should be involved, how to pick the most appropriate peers
for training, and who should conduct the training over what time period. A related
issue that may come up in initiating such a program, although it has not thoroughly
been addressed in the research literature, is related to parents’ concerns and opinions.
The school psychologist would need to determine if parents want their children to be
involved in a peer training program and then be prepared to answer questions related to
how much time away from class may be required.

Social skills training

In addition to providing information on antecedent management and peer-training

approaches, school psychologists are frequently asked to provide more intensive, student-
targeted interventions, such as social skills training for the child with an ASD. Social skills
training involves teaching specific skills (e.g., maintaining eye contact, initiating
conversation) through behavioral and social learning techniques (Cooper et al., 1999).
Delivering direct social skills interventions in the school setting has some obvious benefits
over programs delivered in clinical or outpatient settings, such as the availability of typical
peers as mentors, the regularity with which intervention can occur (5 days a week), and
 S.K. Williams et al. / Journal of School Psychology 43 (2005) 117–136 129

that the skills can be taught and practiced in the environment in which they are targeted to
occur in dreal lifeT (Barry et al., 2003).
It is therefore surprising that relatively few school-based social skills programs have
been designed for elementary school children with ASDs. One program designed to
promote positive social behaviors in general education classrooms in Taiwan reported
small to moderate improvement (Yang, Schaller, Huang, Wang, & Tsai, 2003) in four
children who received the intervention compared to two children who did not. The
structured curriculum comprised 12 teaching units (e.g., paying attention, expressing
preferences, emotion recognition) delivered in a small group format using direct
instruction, modeling, role-play, rehearsal, and reinforcement. Yang et al. (2003) noted
that such adult-delivered approaches may be successful in promoting skill generalization
when they are delivered in a setting that is similar to the target setting, such as the school.
Bauminger (2002) implemented a program designed to promote social–emotional
understanding and social interaction in high-functioning autistic children. This cogni-
tive-behaviorally based program employed two basic methods: training in social–
interpersonal problem solving (e.g., interpreting social cues) and training in affective
education (e.g., emotion recognition), was implemented by the child’s teachers at school,
and included a typically developing peer and the child’s parents. Bauminger (2002)
reported that after the training, the 15 children with autism in the study demonstrated
improvement in social cognition/social problem-solving, emotion understanding, and
social interaction with peers. It should be noted that this study did not include a control
group and, like the Yang et al. (2003) study, it is impossible to delineate the factor(s)
directly responsible for observed improvements. Finally, although not widely available,
computer-based social skills training has achieved some success. Simpson, Langone, and
Ayres (2004) reported that four students with autism demonstrated improvements in
targeted social skills in the natural school environment after intervention with a computer-
based program in which the students had to discriminate targeted social skills, such as
sharing and social greetings.
Kransny, Williams, Provencal, and Ozonoff (2003) summarized several important
elements for programs that promote social skill development for children with ASDs,
including breaking down complex social behaviors into simple steps that can be
memorized and practiced, instruction and activities that fit the children’s language
abilities, encouraging participants to observe peers and develop self-awareness, and use of
individual behavioral goals and rewards. To maximize generalization of skills learned
through a social skills training approach, children should have ample opportunity to
practice the skills in natural settings, such as at school (Cooper et al., 1999) and the
program should be designed to match the student’s developmental level. In conclusion,
researchers have implemented social skills training for children with ASDs with some
success and there are guidelines for implementing similar programs in schools. However,
evaluation studies using matched control groups, larger well-characterized sample sizes,
manualized curricula, and long-term follow-up assessment to determine the degree to
which skills are maintained and generalized are sorely needed.
For any given child, it is likely that a combination of several of the described
interventions can be integrated successfully. Indeed, efforts targeted at promoting social
acceptance often adopt a multi-dimensional intervention (e.g., Cooper et al., 1999).
130 S.K. Williams et al. / Journal of School Psychology 43 (2005) 117–136

Regarding how to explain ASDs to peers and whether or not to tell students about a given
child’s diagnosis, there is conflicting evidence. Ochs, Kremer-Sadlik, Solomon, and Sirota
(2001) found that students who were informed of a child’s ASD diagnosis and provided
with information about ASDs were more accepting and tolerant. Swaim and Morgan
(2001), however, reported that education did not have any positive impact on attitudes or
behavioral intentions. Ultimately, deciding on whether or not disclose a child’s diagnosis is
a delicate subject that should be made by the parents in collaboration with the school, with
consideration given to possible benefits as well as potential drawbacks. In deciding which
social skill approach(es) to use, the school psychologist must consider both the possible
benefits and associated costs (e.g., time spent away from academics, teacher’s required
involvement) as well as the empirical support.

Conclusion

In including children with ASDs in the regular education classroom, sheer proximity to
normally developing peers may be somewhat beneficial, but it is insufficient for achieving
optimal educational and inclusion goals (Harrower & Dunlap, 2001). This review has
summarized strategies designed to decrease disruptive behavior, improve academic skills,
and promote social integration and acceptance of students with ASDs who are included in
general education classrooms. While the initial evidence for implementing these strategies
in inclusive classrooms has begun to be accumulated, generalization of findings is
restricted due to some consistent limitations in this literature. The findings of several
single-case studies, for example, require replication with larger, well-characterized
samples. Studies investigating the mechanisms of efficacy, the context of delivery, and
the child variables that moderate response are needed. Just as important, more studies need
to be conducted in the natural environment—in inclusive, regular education classrooms.
Thus, although all of the strategies reviewed in this paper are empirically derived, not all
of the strategies can be considered EBPs at this time.
As knowledge of strategies with at least emerging support in promoting successful
inclusion of students with ASDs continues to develop, school psychologists can provide
valuable consultation to teachers who are seeing increasing numbers of children with ASDs
in their general education classrooms. Teachers are now expected to teach children with
special needs who are included in their classroom, although they often do not receive formal
training in educating and intervening with children with ASDs and may be unfamiliar with
educational and behavioral issues associated with these disorders. School psychologists
play an important role in the inclusion process by offering support, information, and
recommendations to teachers, school personnel and administration, and families. With their
training and skills, and their positioning within school systems, school psychologists have
the ability to help form cohesive educational support networks for children with ASDs. The
inclusion of students with ASDs can be challenging, exciting, and even frightening—often
depending on how much information one has about children with these disorders. As more
children are being identified with ASDs and placed in general education classrooms, school
psychologists will increasingly be called upon to intervene and provide appropriate
consultation and intervention. Thus, school psychologists should remain abreast of
 S.K. Williams et al. / Journal of School Psychology 43 (2005) 117–136 131

empirically derived approaches that have application to the educational setting. By being
knowledgeable of such approaches, including their strengths and limitations, school
psychologists can play a very pivotal role in assisting in the educational programming of
children with ASDs in general education.

Acknowledgement

This project was supported by a grant from the National Institute of Mental Health
(#MH66764), awarded to the Research Units on Pediatric Psychopharmacology—
Psychosocial Interventions (RUPP-PI) Autism Network. Yale University Principal
Investigator Lawrence Scahill, MSN, PhD.

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