Public Organization Review

Sigafoos J., Lancioni G.E., O’Reilly M.F.

The term severe disability is primarily used in reference to people with severe to profound cognitive and adaptive functioning impairments associated with intellectual disability, autism spectrum disorder, and/or cerebral palsy. However, the term severe disability could also be applied to some individuals with traumatic brain injury and various neurodegenerative conditions, such as Alzheimer’s, amyotrophic lateral sclerosis, and other motor neuron diseases. This chapter describes a range of conditions associated with severe disability. The cognitive and adaptive functioning limitations of people with severe disabilities, and associated learning and behavioral characteristics, are also reviewed.

Sigafoos J., Lancioni G.E., O’Reilly M.F.

Pictures and related types of communication symbols (e.g., line drawings, photographs) represent forms of aided augmentative and alternative communication that are widely used with individuals with severe disabilities and limited or no speech. This chapter will describe how pictures have been used to enhance the communicative functioning of nonverbal and minimally verbal individuals with severe disabilities. Key aspects of the extensive research on the use of picture exchange as a form of communication for people with severe disabilities are reviewed. Strengths and limitations of using pictures as a mode of communication will also be addressed. What research can affirm about picture communication and where further research may be needed are also discussed.

Sigafoos J., Lancioni G.E., O’Reilly M.F.

Use of natural gestures—such as pointing, head nodding, and waving—may represent a viable and effective communication strategy for some people with severe disabilities. The chapter describes different types of natural gestures and reviews intervention literature aimed at teaching and enhancing the use of natural gestures for communication purposes for people with severe disabilities. The reviewed literature indicates that natural gestures can be taught and enhanced by the application of systematic instructional tactics, such as verbal prompting, response shaping, and reinforcement. Limitations of the literature are discussed and indications for the use of natural gestures are considered.

Sigafoos J., Lancioni G.E., O’Reilly M.F.

Speech-generating devices are increasingly being used as an alternative to speech for nonverbal individuals and to augment natural speech production in minimally verbal people. This chapter describes speech-generating devices and provides an overview of the intervention literature on teaching speech-generating device use to people with different disability conditions. Indications, potential advantages, and contraindications for the use of speech-generating devices are delineated. Factors to consider when implementing an intervention aimed at teaching functional use of speech-generating devices are discussed.

Sigafoos J., Lancioni G.E., O’Reilly M.F.

Tangible symbol sets typically consist of three-dimensional miniature objects or parts of objects that relate in some way to corresponding real-world referents. Various types of tangible objects have been used as communication symbols for nonverbal and minimally verbal people with severe disabilities. This chapter provides an overview of the literature on teaching people with severe disabilities to communicate using tangible symbols. Indications and contraindications for the use of tangible symbols are delineated. Factors to consider when implementing an intervention aimed at teaching the functional use of tangible symbols are discussed.

Sigafoos J., Lancioni G.E., O’Reilly M.F.

The chapter reviews the use of assistive technology in intervention programs to make communication events accessible to people with intellectual, motor, or sensory-motor disabilities. The first three sections of the chapter focus on programs for people with the most difficult conditions and most limited communication options. The fourth section of the chapter focuses on programs for people who would be capable of making multiple requests if provided with adequate request tools. The fifth section of the chapter focuses on programs directed at helping people interact with distant partners and engage in other types of functional activity. The final three sections of the chapter analyze (a) the conditions necessary to make the programs and related technology solutions applicable and effective, (b) the level of accessibility and practicality of the programs, and (c) the question of whether the programs are temporary or long-term solutions.

Sigafoos J., Lancioni G.E., O’Reilly M.F.

Visual strategies are widely used to support the receptive communication of individuals with severe disabilities. This chapter describes various forms of visual strategies that have been used to enhance receptive communication with nonverbal and minimally verbal individuals with severe disabilities. The strengths and limitations of these visual strategies to support receptive communication are addressed. This chapter also provides a selective overview of research on the use of three strategies (i.e., augmented input, Social Stories™, and visual activity schedules) that have been used to enhance receptive communication skills of people with limited or no speech. Directions for future research in this area will be discussed.

Sigafoos J., Lancioni G.E., O’Reilly M.F.

Manual signing is a type of unaided communication strategy that is frequently considered for nonverbal and minimally verbal people with severe disabilities. A considerable amount of research has focused on evaluating procedures for teaching manual signing as an alternative or supplement to speech. This chapter provides an overview of the literature on teaching manual sign-based communication strategies to people with severe disabilities. Indications and contraindications for the use of manual signing are delineated. Factors to consider when implementing manual signing interventions are discussed.

Sigafoos J., Lancioni G.E., O’Reilly M.F.

Sigafoos J., Lancioni G.E., O’Reilly M.F.

Pascarella L., Erickson C., Minshawi N.F.

This chapter provides a comprehensive historical overview of the evolution of the autism diagnosis from its initial identification by Leo Kanner in 1943, through various Diagnostic and Statistical Manual of Mental Disorders (DSM) editions, to its current conceptualization in the DSM-5. It highlights Kanner’s groundbreaking work in distinguishing autism from childhood schizophrenia and traces the subsequent refinements in diagnostic criteria, reflecting a growing understanding and differentiation of autism spectrum disorders (ASDs). Additionally, it discusses the challenges of diagnosis and the implications of the changing criteria for both prevalence and services. This chapter emphasizes the importance of early and accurate diagnosis for effective intervention and the ongoing debate around diagnostic standards in the DSM-5.

Rentschler L.F., Hume K.A., Wong C., Plavnic J., Schultz T.

This updated chapter presents the research-base and new directions for visual supports, a commonly used intervention strategy for people with autism. Broadly defined as “a visual display that supports the learner engaging in a desired behavior or skills independent of additional prompts” (Hume et al., J Autism Dev Disord 51:4013–4032. https://doi.org/10.1007/s10803-020-04844-2 , 2021, p. 4026), visual supports take on a number of forms and functions. These include, but are not limited to, photographs, icons, written words, objects, furniture arrangement, schedules, videos, maps, labels, organizational systems, timelines, and scripts (Hume, Overview of visual supports. National Professional Development Center on Autism Spectrum Disorders, Frank Porter Graham Child Development Institute, The University of North Carolina, Chapel Hill. https://autismpdc.fpg.unc.edu/sites/autismpdc.fpg.unc.edu/files/imce/documents/VisualSupports_Complete.pdf , 2008) and have proven effective in both supporting skill acquisition (i.e., task engagement, independent performance) and decreasing maladaptive behavior (i.e., self-injurious behavior) across age ranges and settings. Visual supports are recognized as an evidence-based practice by the National Clearinghouse on Autism Evidence & Practice (NCAEP; Hume et al., J Autism Dev Disord 51:4013–4032. https://doi.org/10.1007/s10803-020-04844-2 , 2021). However, the application of visual supports, the efficacy of their application, as well as the appropriateness of their use with very young children with autism remains less understood and less studied than their application to the school-age population. This updated chapter reviews the most recent literature and describes the rationale for the use of visual supports in the broader early intervention field and the application to early intervention settings with young children with autism. Specific supports identified in the literature will be highlighted, including environmental supports, visual schedules, visual cues, scripts, electronic visual supports, and video-based instruction, along with recommendations for future use and study.

Tevis C., Matson J.L.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social interaction and communication as well as the presence of restricted and repetitive behaviors (RRBs). The onset of these symptoms occurs in early development, and early identification is often crucial to obtaining timely intervention services. As a result, several level 1 and level 2 screening tools are available to determine whether a child may be at risk for ASD, thus requiring further assessment. If an assessment is warranted, then measures utilizing clinician-rated observations, diagnostic interviews, or informant-based checklists can provide information on social and behavioral functioning across multiple contexts. Reviews of the psychometric properties, strengths and limitations, and recommendations of various screening and diagnostic measures will be discussed.

Lequia J., Machalicek W., Didden R., Lang R., Green V., Sigafoos J., Lancioni G., O’Reilly M.F., Watson L.

This chapter highlights the unique challenges and needs of families with autistic children, emphasizing the critical role of parental involvement and sibling engagement in early interventions. It reviews evidence-based practices for parent- and sibling-mediated interventions, family support mechanisms, and strategies to improve parental mental health. The chapter underscores the importance of personalized, family-centered approaches that address the diverse needs of family members, advocating for future research to further enhance support systems and intervention strategies for these families.

Avila-Pons V.M., Rogers S.J.

Naturalistic Developmental Behavioral Interventions (NDBIs) are a class of interventions that result from integrating behavioral and developmental sciences, building on evidence from the science of learning and the development of infants, toddlers, and young children across various domains. This chapter discusses the common elements and procedures that comprise the defining characteristics of NDBIs; examines the efficacy of these interventions as a class by conducting a systematic review of the findings from clinical trials of NDBI studies; and aims to assist practitioners, parents, and researchers to distinguish NDBIs from other treatments in their efforts to find and deliver sound, evidence-based intervention approaches for young autistic children.