Education and Training in Developmental Disabilities, 2007, 42(4), 398–409 © Division on Developmental Disabilities

Planning a Comprehensive Program for Students with Spectrum Disorders Using Evidence-Based Practices

Brenda Smith Myles Barry G. Grossman and Ruth Aspy University of Kansas The Ziggurat Group

Shawn A. Henry and Amy Bixler Coffin Ohio Center for Autism and Low Incidence

Abstract: This article outlines two compatible models of planning and implementing programs for students with disorders (ASD). The Ziggurat Model begins the process with an assessment of student strengths and concerns related specifically to ASD and identifies interventions across five tiers that match these strengths and concerns: (a) sensory and biological, (b) reinforcement, (c) structural and visual/tactile supports, (d) task demands, and (e) skills to teach. Content from the Ziggurat Model is then placed with the Comprehensive Autism Planning System (CAPS) to allow the student’s day to be operationalized and matched to student goals, state standards, and related benchmarks. This article overviews this process and offers a brief case study as an example.

As educators and parents strive to develop with NCLB are the (a) Response to Instruc- meaningful educational opportunities for in- tion (RTI) movement, which emphasizes da- dividuals with autism spectrum disorders ta-based decision making and problem solv- (ASD), it is important to begin with a thor- ing, evidence-based interventions, student ough understanding of the student’s needs, performance, and continuous progress; and especially those related to the underlying (b) Statewide Positive Behavior Supports characteristics of ASD. Next, a comprehensive (SWPBS), whose goals are to support (a) daily schedule for the student is critical. A students’ social and academic competence, schedule should embed the supports needed (b) student behavior, (c) staff behavior, and for success as well as continual development (d) decision making (Sugai & Horner, of student skills and measurement of those 2007). skills with a vision of how this will affect the Fundamental to these recent educational student now and in the future (Mesibov & mandated movements is comprehensive plan- Shea, 2006; National Research Council, 2001) ning, program implementation, and monitor- This is achieved through well-organized plan- ing of student progress. To date, no system ning with clearly defined objectives and goals. has existed that can accomplish these lofty Far-reaching changes have occurred in the goals. The purpose of this article is to intro- educational system in recent years, beginning duce two linked comprehensive planning with the No Child Left Behind (NCLB) Act. models that meet the rigor required by NCLB, This legislation was designed to increase stu- RTI, and SWPBS: the Ziggurat Model (Aspy & dent achievement through accountability and Grossman, 2007) and the Comprehensive Au- scientifically based instruction provided by tism Planning System (CAPS; Henry & Myles, highly qualified and effective teachers (U.S. 2007). Figure 1 depicts the process of compre- Department of Education, 2002). Compatible hensive planning using the Ziggurat Model and CAPS.

Correspondence concerning this article should What Is the Ziggurat Model? be addressed to Brenda Smith Myles, Ohio Center for Autism and Low Incidence, 5220 N. High Street, The Ziggurat Model is a guide for designing Building C1, Columbus, OH 43221. comprehensive interventions for individuals

398 / Education and Training in Developmental Disabilities-December 2007 Figure 1. The process of comprehensive planning for students with autism spectrum disorders using the Ziggurat Model and CAPS. with ASD. The premise of this model is that needs leads to interventions that are more underlying needs and characteristics related proactive and fundamental. In comparison, to the autism spectrum must be addressed. interventions that are solely designed to ad- Therefore, the Ziggurat Model is designed to dress surface behavior without consideration utilize students’ strengths to address true of the underlying ASD are potentially less ef- needs or underlying deficits that result in so- fective and less likely to result in sustained cial, emotional, and behavioral concerns. The behavior change. Ziggurat approach centers on a hierarchical As mentioned earlier, the process of inter- system, consisting of five levels that must be vention design should begin with an assess- addressed for an intervention plan to be com- ment of the presenting characteristics of ASD prehensive (see Figure 2). (see Figure 1). A thorough assessment of un- When designing a comprehensive program, derlying characteristics helps parents and pro- it is essential to consider the context of the un- fessionals to plan a program that takes into derlying autism spectrum disorder. This is over- account the individual’s strengths and needs. looked all too often. Targeting underlying Further, assessment of underlying characteris-

Figure 2. The five levels of the Intervention Ziggurat.

Planning / 399 tics provides insight into which skills should The Intervention Ziggurat be taught and how to design instruction in order to facilitate learning and bring about The Intervention Ziggurat (IZ) is the center- meaningful and long-lasting change. The Un- piece of the Ziggurat Model and is the frame- derlying Characteristics Checklist (UCC) of- work on which comprehensive interventions fers a comprehensive perspective as a basis for are built. The IZ is comprised of five critical program planning. levels structured into a hierarchy: Sensory Dif- ferences and Biological Needs, Reinforce- ment, Structure and Visual/Tactile Supports, The Underlying Characteristics Checklist Task Demands, and Skills to Teach (see Fig- ure 2). The first level, Sensory Differences and The UCC is an informal assessment designed Biological Needs, addresses basic internal fac- to identify ASD characteristics for the purpose tors that impact functioning. The second level of intervention. There are two versions of the addresses motivational needs prerequisite to UCC, one intended for use with individuals skill development. The third level draws on who are high functioning (UCC-HF), includ- individuals’ strength of visual processing and ing those with (AS), and addresses their fundamental need for order one for use with those with a more classic and routine. The final two levels of the IZ presentation (UCC-CL) in cognition and emphasize the importance of expectations speech-language skills. The UCC is comprised and skill development in light of the charac- of eight areas. The first three represent the teristics of individuals with ASD. autism spectrum triad, social, restricted pat- The IZ helps parents and educators avoid terns of behavior interests and activities, and overlooking critical areas that impact the ef- communication. Characteristics often associ- fectiveness of any intervention plan. Each of ated with ASD are addressed in the next four the levels is essential and contributes to the areas: sensory differences, cognitive differ- effectiveness of the others. Thus, if needs on ences, motor differences, and emotional vul- all levels are not addressed, the intervention nerability. The eighth underlying area is will not be as effective and skills will not de- known medical and other biological factors. Based on the results of completing the velop. The following is a brief discussion of UCC, a comprehensive intervention plan is the five levels of the Intervention Ziggurat. developed that targets ASD characteristics by Sensory differences and biological needs. The incorporating each of the five levels of the first level of the IZ represents what is, in one Ziggurat. The UCC may be completed by par- sense, the basis of all behavior—biology. Con- ents, teachers, or other service providers, in- sideration of biological factors is especially dividually or as a team. important in the case of ASD due to the strong genetic and neurological underpinnings of this disorder. Unmet sensory and biological needs will result in changes in behavior, high- The Individual Strengths and Skills Inventory lighting the importance of including strate- The Individual Strengths and Skills Inventory gies to address these needs. (ISSI) was designed to accompany the UCC. While sensory differences and biological The ISSI parallels the first seven areas of the needs are not included as symptoms of ASD in UCC. The purpose of this tool is to ensure the current diagnostic manual (Diagnostic and that underlying strengths and skills are incor- Statistical Manual of Mental Disorders of the porated in the intervention design process. American Psychiatric Association [APA], For example, one student may have a strength 2000), they often present some of the greatest in imitation whereas another has an intense challenges for individuals on the spectrum. interest in and knowledge of animals. These For example, anxiety (Pfeiffer & Kinnealey, assets can easily become keys to addressing 2003), distractibility, overactivity, impulsivity, underlying skill deficits. An example of a com- perseveration, delayed receptive and expres- pleted ISSI is provided in the case example of sive language skills, poor social skill develop- Michael. ment, and poor eye contact have all been

400 / Education and Training in Developmental Disabilities-December 2007 related to impaired sensory functioning effective reinforcement systems are in place. (Stackhouse, Graham, & Laschober, 2002). Other students may suffer as well due to the Research exists on sensory interventions for time spent addressing behavioral difficulties individuals with ASD. In 2002, Baranek iden- in the classroom that would be prevented if tified 22 studies conducted on sensory and replacement behaviors were mastered. Effec- motor interventions. Additional studies have tive intervention programs deliver reinforce- been conducted since then (cf., Kaplan, Clop- ment for positive behaviors and limit access to ton, Kaplan, Messbauer, & McPherson, 2006). reinforcement of problem behaviors (cf., Hor- Much of the research on biological inter- ner, Carr, Strain, Todd, & Reed, 2002). ventions has centered on the use of medi- Structure and visual/tactile supports. The cations. There is support for three classes third level of the IZ is a direct response to the of drugs, including antidepressants (cf., core characteristics of ASD. That is, individu- Namerow, Thomas, Bostic, Prince, & Monute- als with ASD function best when predictability aux, 2003); (cf., Erickson, Stig- is established across the school day, including ler, Posey, & McDougle, 2005); and stimulants schedules, routines, environments, behavioral (cf., Di Martino, Melis, Cianchetti, & Zuddas, and academic expectations, and interpersonal 2004). interactions. If changes in routine occur, Reinforcement. All intervention plans ulti- preparation for such change should be incor- mately target the development or increase of a porated into the intervention plan. In addi- behavior or skill. This goal can only be accom- tion, verbal communication deficits are pri- plished by incorporating reinforcement into mary characteristics of ASD, leading to a the comprehensive plan. Without reinforce- disadvantage in the school setting where most ment, there is no intervention. Because of its communication takes place through talking fundamental nature, reinforcement is in- and listening. In contrast, visual processing is cluded as the second level of the Intervention often a strength for students with ASD; there- Ziggurat. fore, visual supports are critical aspects of in- It may be necessary to think creatively about tervention plans. Tactile supports are an addi- reinforcement for students with ASD. While tional alternative to verbal communication social opportunities are often reinforcing for and should be considered, especially for stu- typically developing students, these may be dents with a vision impairment. some of the most challenging situations the The areas of structure and Visual/Tactile same is usually not the case for students with Supports often overlap. Visual supports such ASD for whom social competence presents as pictures, written schedules, and task strips challenges. In seeking to identify effective re- may be used as tools to clarify the structure of inforcers, it is often helpful to consider the an activity. For example, visual schedules have student’s preoccupations (Sakai, 2005). In- been shown to be effective for improving the deed, research has found that activities or ob- speed of transitions (cf., Dettmer, Simpson, jects related to obsessions are often more ef- Myles, & Ganz, 2000); decreasing behavior fective reinforcers than food (cf., Charlop- problems during transition (cf., Dooley, Wilc- Christy, Kurtz, & Casey, 1990) for individuals zenski, & Torem, 2001); increasing on task on the autism spectrum. behavior (cf., Bryan & Gast, 2000); and en- The principles of effective reinforcement hancing independence (c.f., Pierce & Schreib- are well established in the research literature. man, 1994). There is substantial research sup- At times there seems to be an unfortunate port for other visual strategies, such as Social tendency within the education system towards StoriesTM (cf., Sansosti, Powell-Smith, & Kin- “stinginess” in providing reinforcement. Hes- caid, 2004) and video modeling (cf., Nikopou- itation to deliver reinforcers may be related to los & Keenan, 2004). a concern about “fairness”; that is same-aged Task demands. Task Demands with the IZ peers have already mastered the skills and- include academic demands but go beyond, to therefore, are not reinforced for exhibiting include social, communication, organiza- them. However, these and similar concerns tional, sensory, and other demands. For exam- are short-sighted and unfair to the student ple, recess may be exceedingly difficult given with ASD, who will only gain new skills when social and communication requirements (e.g.,

Planning / 401 Figure 3. Three levels of task demands and applications. From The Ziggurat Model: A Framework for Designing Comprehensive Interventions for Individuals with High-Functioning Autism and Asperger Syndrome (p. 77), by R. Aspy & B. Grossman, 2007, Shawnee Mission, KS: Autism Asperger Publishing Company. Copyright 2007 by AAPC. Reprinted with permission. join activities, initiate conversations, resolve flict, he will be provided a trained peer peer conflict). For the purpose of designing “buddy” during group activities until he is able quality interventions, expectations must be to master strategies for compromise. Nu- reasonable; that is, an individual must be ca- merous evidence-based interventions re- pable of succeeding either independently or duce demands. For example, peer networks with assistance. This is known as the zone of (cf., Kamps, Dugan, Potucek, & Collins, proximal development (ZPD; Vygotsky, 1978, 1999), circle of friends (cf., Frederickson, as cited in Miller, 1993). The ZPD refers to Warren, & Turner, 2005), and peer buddies skills that can only be accomplished with as- (cf., Laushey & Heflin, 2000) have been sistance. By acknowledging and carefully ad- found to be beneficial in promoting social justing task demands, we can often prevent skills. problems. Thus, it is essential to match the Skills to teach. The first four levels of the demand of a task to the ability of a student. Ziggurat set the stage for skill acquisition. It is The ZPD represents an optimal level for new possible to resolve many behavior concerns learning (challenging with assistance). As de- using strategies on the first four levels without picted in Figure 3, there are three levels of ever teaching skills. Indeed, many improve- Task Demands: easy, challenging/emerging, ments may be seen as a direct result of attend- and too demanding. Tasks that are too easy ing to an individual’s biological needs, provid- are appropriate when independent function is ing meaningful reinforcers, addressing the desired; however, it must be kept in mind that need for structure and predictability, and skills will not expand. At the other extreme, if carefully matching demands to ability. Com- a task is too demanding, the individual will fail fortable with behavior gain, intervention or become overwhelmed and quit. Behavior teams may overlook this crucial last level. problems are often observed when task de- However, such a “partial” approach to inter- mands exceed the student’s ability. In either vention will have negative long-term outcomes case, skills will not expand. because it does not allow for independence or One aspect of intervening at the Task De- promote generalization or growth. It is for this mands level, therefore, is to identify skill def- reason that the authors view Skills to Teach as icits to target for skill development. Once def- the ultimate goal of any intervention plan. icits have been identified, decisions can be Several approaches to teaching skills to in- made on how to match demands to ability. For dividuals with ASD have been supported in example, a team may recognize that because a the literature, including priming (cf., Zanolli, student lacks the skills to negotiate peer con- Daggett, & Adams, 1996); formal social skills

402 / Education and Training in Developmental Disabilities-December 2007 groups (cf., Barry et al., 2003); and pivotal Thus, the CAPS enables professionals and par- response training (PRT; cf., Koegel, Carter, & ents to answer the fundamental question: Koegel, 1998). What supports does the student need for each activity? Once a multidisciplinary team, including Ziggurat Worksheet the parents, has identified the student’s needs The Ziggurat Worksheet guides the team through completion of the UCC (CL or HF) through the development of a comprehensive and ISSI and has developed interventions intervention plan. With a new understanding across the six areas of the Ziggurat that match of the student’s needs based on completion of the student’s UCC- and ISSI-identified the UCC and the information on strengths strengths and concerns, the team is ready to and current skill level provided through com- complete the CAPS. That is, based on infor- pletion of the ISSI, the team is now prepared mation developed using the Ziggurat Model, to design an intervention plan that is targeted the CAPS is a list of a student’s tasks and to the individual student. Areas of the UCC activities, the times they occur, along with a are prioritized and specific UCC items are delineation of the supports needed for suc- selected. All interventions incorporated into cess. In addition, the CAPS includes a place the plan must address underlying needs from for recording the results of ongoing data col- the UCC. This provides a safeguard from de- lection and consideration of how skills are to veloping a plan that addresses only surface be generalized to others settings. concerns or from recycling interventions that have been used with other students with ASD Components of CAPS without careful consideration of the specific student. Further, the Ziggurat Worksheet pro- The CAPS contains the following compo- motes collaboration by helping parents and nents: professionals to understand their part in the 1. Time. This section indicates the clock larger intervention picture. time of each activity that the student en- An intervention plan is truly comprehensive gages in throughout the day. when interventions address each of the five 2. Activity. Activities include all tasks and levels of the Intervention Ziggurat, three activities throughout the day in which points of intervention—antecedent, behavior, the student requires support. Academic and consequence—and when each interven- periods (e.g., reading), nonacademic tion strategy addresses underlying characteris- times (e.g., recess, lunch) as well as tran- tics from the UCC. The Ziggurat Worksheet sitions between classes are all be consid- provides a structure for verifying that the in- ered activities. tervention plan is indeed comprehensive. In- 3. Targeted Skills to Teach. This may include terventions that are not comprehensive leave IEP goals, state standards, and/or skills unnecessary “holes” where difficulties may oc- that lead to school success for a given cur and begin to undermine the effectiveness student. of the intervention techniques that are put 4. Structure/Modifications. Structures/modi- into place. After completion of the Ziggurat fications can consist of a wide variety of Worksheet, the team is ready to complete the supports, including placement in the CAPS. While the Ziggurat Worksheet allows a classroom, visual supports, peer net- team to know that the intervention plan is works and instructional strategies (e.g., thorough and targeted, the CAPS provides a priming, self-monitoring). structure for implementation. 5. Reinforcement. Student access to specific types of reinforcement as well as rein- forcement schedules are listed here. What Is the Comprehensive Autism Planning 6. Sensory Strategies. Sensory supports and System (CAPS)? strategies identified by an occupational CAPS provides an overview of a student’s daily therapist or others are listed in this CAPS schedule by time and activity and specifies of area. supports that he needs during each period. 7. Communication/Social Skills. Specific com-

Planning / 403 munication goals or activities as well as Case Study for Michael: From Ziggurat to supports are delineated in this section. CAPS Goals or activities may include (a) re- questing for help, (b) taking turns in Michael is a 16-year-old young man diagnosed conversation, or (c) protesting appropri- with AS. He lives with his mother and two ately. Supports may encompass language younger brothers; one is diagnosed with atten- boards or augmentative communication tion deficit hyperactivity disorder (ADHD) systems. and obsessive-compulsive disorder, and the 8. Data Collection. This space is for record- other has learning disabilities. Michael is cur- ing the type of data as well as the behav- rently taking medication. Although Michael’s ior to be documented during a specific mother noticed already when he was 3 years activity. Typically, this section relates di- old that he was developing differently from his rectly to IEP goals and objectives. same-age peers, it was not until Michael 9. Generalization Plan. Because individuals turned 6 that he was diagnosed with AS. Throughout elementary school he received with ASD often have problems generaliz- special education services including speech ing information across settings, this sec- and language therapy focused on pragmatic tion of the CAPS was developed to en- language, and social skills and occupational sure that generalization of skills is built therapy. After transitioning to middle school, into the child’s program. Michael no longer received direct therapy ser- When students transition to middle and vices. Michael is currently in the second quar- high school, the daily structure of school ter of his sophomore year of high school. He changes. Students may have as many as nine attends all general education classes, includ- teachers in nine different classrooms. Despite ing biology, history, English literature, alge- their movement from classroom to classroom, bra, composition, and physical education the activities in which the students participate (PE). His schedule also includes a daily sup- in each academic class is similar, however. port period where he is given assistance with That is, in each class students are likely to be organizational skills and social skills. required to participate in (a) independent Michael is motivated by things, not by peo- work, (b) group work, (c) tests, (d) lectures, ple. He does not process what is said to him as and (e) homework. From this standpoint, the well as when things are presented to him visu- ally, and he has difficulty reading facial ex- activities in English class and geometry are the pressions and body language. Although he is same. very bright, Michael receives mostly C’s on his Due to the fundamental differences be- report card due to the fact that 25% of grades tween the structure of elementary school and for all academic classes are based on home- middle/high school, the CAPS must be mod- work assignments that he often forgets to ified accordingly. The Modified Comprehen- record in his planner, and therefore fails to sive Autism Planning System (M-CAPS) is an complete and turn in. In addition, he does not effective means of communicating to educa- bring home materials needed to complete as- tors who teach academic subjects the types of signments. supports that students need during each activ- Michael prefers looking at sports magazines ity (Sue Klingshirn, personal communication, over interacting with peers. Due to excellent April, 2006). The multidisciplinary team that rote memory skills, Michael can quickly mem- plans the program for a high school student orize the most recent statistics of any Major with ASD who spends extensive time in gen- League baseball player and can easily recall eral education classrooms develops the stu- those statistics in conversation. dent’s program using the M-CAPS. As a result, Michael excels in math and in history; how- each of the student’s academic teachers shares ever, he struggles in literature and composi- the same document. The M-CAPS used in bi- tion class. His fine-motor skills are delayed, ology is the same as the M-CAPS used in soci- and writing is laborious for him. He also has ology. Likewise, the supports for a given stu- difficulty interpreting concepts covered in his dent are the same. literature class. Both subject-area teachers re-

404 / Education and Training in Developmental Disabilities-December 2007 Figure 4. Michael’s ISSI. From The Ziggurat Model: A Framework for Designing Comprehensive Interventions for Individuals with High-Functioning Autism and Asperger Syndrome by R. Aspy & B. Grossman, 2007, Shawnee Mission, KS: Autism Asperger Publishing Company. Copyright 2007 by AAPC. Reprinted with permission. port that he is anxious in their classes. Michael on a test and frequently argues with his teach- also has difficulty tolerating mistakes. He of- ers over the reasoning behind the grade. ten gets upset when he receives a poor grade Over the past several weeks, Michael has

Planning / 405 Figure 5. Michael’s UCC-HF (partial view only). From The Ziggurat Model: A Framework for Designing Compre- hensive Interventions for Individuals with High-Functioning Autism and Asperger Syndrome (p. 77), by R. Aspy and B. Grossman, 2007, Shawnee Mission, KS: Autism Asperger Publishing Company. Copy- right 2007 by AAPC. Reprinted with permission. become increasingly anxious in PE class where sidelines. When his teacher approaches him the noise level is often extremely loud. When to discuss the situation, Michael frantically participating in team contact sports, he re- tells him that his peers are intentionally trying moves himself from the game and sits on the to hurt him. In such situation, Michael’s be-

406 / Education and Training in Developmental Disabilities-December 2007 Figure 6. Michael’s Ziggurat Worksheet (Task Demands and Skills to Teach only). From The Ziggurat Model: A Framework for Designing Comprehensive Interventions for Individuals with High-Functioning Autism and Asperger Syndrome (p. 77), by R. Aspy and B. Grossman, 2007, Shawnee Mission, KS: Autism Asperger Publishing Company. Copyright 2007 by AAPC. Reprinted with permission.

Figure 7. Michael’s M-CAPS (partial only).

Planning / 407 Figure 8. Michael’s CAPS for physical education. havior typically is to leave the gym. His teacher interventions for children with autism. Journal of thinks that Michael is a “sore loser.” Autism and Developmental Disorders, 32, 397–422. Michael’s multidisciplinary team, including Barry, T. D., Klinger, L. G., Lee, J. M., Palardy, N., his parents, met to develop his program. They Gilmore, T., & Bodin, D. (2003). Examining the completed a UCC-HF (see Figure 4 for a por- effectiveness of an outpatient clinic-based social tion of Michael’s UCC) and ISSI (see Figure skills group for high-functioning children with autism. Journal of Autism and Developmental Disor- 5). Using information from these activities, ders, 33, 685–701. Michael’s team completed the Ziggurat Work- Bryan, L. C., & Gast, D. L. (2000). Teaching on-task sheet (see partial copy in Figure 6). Finally, and on-schedule behaviors to high-functioning they created a M-CAPS for his general educa- children with autism via picture activity schedules. tion classes (see partial copy in Figure 7) and Journal of Autism and Developmental Disorders, 30, a traditional CAPS for his PE class (see Figure 553–567. 8). Charlop-Christy, M. H., Kurtz, P. F., & Casey, F. (1990). Using aberrant behaviors as reinforcers for autistic children. Journal of Applied Behavior Summary Analysis, 23, 163–181. The Ziggurat Model and CAPS provide a Dettmer, S., Simpson, R. L., Myles, B. S., & Ganz, unique way to develop and implement a J. B. (2000). The use of visual supports to facili- meaningful program and comprehensive for a tate transitions of students with autism. Focus on Autism and Other Developmental Disabilities, 15, 163– student with ASD. The structure fosters con- 169. sistent use of supports to ensure student suc- Di Martino, A., Melis, G., Cianchetti, C., & Zuddas, cess as well as data collection to measure that A. (2004). for pervasive devel- success. Compatible with current trends in opmental disorders: Safety and efficacy of acute education, including NCLB, RTI, and SWPBS, single dose test and ongoing therapy: An open- the Ziggurat Model and CAPS are also easy to pilot study. Journal of Child and Adolescent Psychop- use. harmacology, 14, 207–218. Dooley, P., Wilczenski, F. L., & Torem, C. (2001). Using an activity schedule to smooth school tran- References sitions. Journal of Positive Behavior Interventions, 3, American Psychiatric Association. (2000). Diagnostic 57–61. and statistical manual for mental disorders (4th ed., Erickson, C. A., Stigler, K. A., Posey, D. J., & Mc- text revision). Washington, DC: Author. Dougle, C. J. (2005). in pervasive Aspy, R., & Grossman, B. G. (2007). The Ziggurat developmental disorders. Expert Review of Neuro- model: A framework for designing comprehensive inter- therapeutics, 5, 713–719. ventions for individuals with high-functioning autism Frederickson, N., Warren, L., & Turner, J. (2005). and Asperger Syndrome. Shawnee Mission, KS: Au- “Circle of friends”—an exploration of impact tism Asperger Publishing Company. over time. Educational Psychology in Practice, 21, Baranek, G.T. (2002). Efficacy of sensory and motor 197–217.

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