The SCERTS Model a Transactional, Family-Centered Approach to Enhancing Communication and Socioemotional Abilities of Children with Autism Spectrum Disorder
Total Page：16
File Type：pdf, Size：1020Kb
LWW/IYC AS213-03 August 11, 2003 8:50 Char Count= 0 Infants and Young Children Vol. 16, No. 4, pp. 296–316 c 2003 Lippincott Williams & Wilkins, Inc. The SCERTS Model A Transactional, Family-Centered Approach to Enhancing Communication and Socioemotional Abilities of Children With Autism Spectrum Disorder Barry M. Prizant, PhD; Amy M. Wetherby, PhD; Emily Rubin, MS; Amy C. Laurent, OTR-L A range of educational/treatment approaches is currently available for young children with autism spectrum disorders (ASD). A recent comprehensive review by an expert panel on ASD (National Research Council, 2001) concluded that a number of approaches have demonstrated positive out- comes, but nonetheless, not all children benefit equally from any one approach. Efforts to increase communicative and socioemotional abilities are widely regarded as among the most critical prior- ities, and growth in these areas is closely related to prognosis and long-term positive outcomes. However, some widely disseminated approaches are not based on the most contemporary de- velopmental research on social and communication development in children with and without disabilities, nor do they draw from current understanding of the learning style of children with ASD. This article describes the SCERTS Model, which prioritizes Social Communication, Emotional Regulation, and Transactional Support as the primary developmental dimensions that must be ad- dressed in a comprehensive program designed to support the development of young children with ASD and their families. The SCERTS Model has been derived from a theoretical as well as empirically based foundation and addresses core challenges of children with ASD as they relate to social communication, emotional regulation, and transactional support. The SCERTS Model also is consistent with empirically supported interventions and it reflects current and emerging “recom- mended practices” (National Research Council, 2001). Key words: autistic spectrum disorder, autism, developmental, early intervention, education, communication, emotional regulation, family support, social UTISM SPECTRUM DISORDER (ASD) or disability characterized by qualitative impair- APervasive Developmental Disorder (PDD) ments in social interaction and social related- (APA, 1994) is a category of developmental ness, difficulties in acquiring and using con- ventional communication and language abili- ties, and a restricted range of interests often co-occurring with an extreme need for con- From Childhood Communication Services and the Center for the Study of Human Development, Brown sistency and predictability in daily living rou- University, Providence, RI (Dr Prizant); the tines. Frequently co-occurring and associated Department of Communication Disorders, Center for characteristics include problems in sensory Autism and Related Disorders, Florida State University, Tallahassee, Fla (Dr Wetherby); the processing (Anzalone & Williamson, 2000; Communication Crossroads, Monterey, Calif Greenspan & Wieder, 1997), motor planning (Ms Rubin and Laurent); and the Yale University (Anzalone & Williamson, 2000; Prizant, 1996), Child Study Center, New Haven, Conn (Ms Rubin). emotional regulation and arousal modulation Corresponding author: Barry M. Prizant, PhD, (Cole, Michel, & Teti, 1994; Dawson and Childhood Communication Services, 2024 Broad St, Cranston, RI 02905 (e-mail: Barry Prizant@brown. Lewy, 1989; Prizant, Schuler, Wetherby, & edu). Rydell, 1997), and behavioral organization 296 LWW/IYC AS213-03 August 11, 2003 8:50 Char Count= 0 The SCERTS Model 297 (Ornitz, 1989). The learning profile of chil- tices derived from tenets of learning the- dren with ASD is typically uneven and inflex- ory and operant conditioning (Lovaas, 1981; ible, with relative strengths in “object knowl- Maurice, Green, & Luce, 1996) (see Prizant edge,”rote memory, and visual-spatial process- & Wetherby, 1998, for further discussion ing, and weaknesses in “social knowledge,”se- of the continuum of educational/treatment mantic and conceptual memory, and abstract approaches and the debate on efficacy of problem-solving (Prizant, 1983; Wetherby, intervention). Prizant, & Schuler, 1997). ASD is now under- Over the past 2 decades, there have been in- stood to be of neurogenic origin and is gener- creased attempts at “cross-fertilization,” with ally considered to be a lifelong disability that developmental research and “family-centered” can dramatically impact family members. Ad- and “child-centered” practice influencing the vances in research on early identification have content and teaching practices of traditional resulted in earlier diagnosis of ASD (Lord & ABA approaches (Strain et al., 1992), re- Risi, 2000). As a result, there is a great de- sulting in a clear distinction between con- mand for current information on education temporary ABA practice and traditional ABA and treatment for young children. practice. Similarly, developmental approaches A variety of treatment approaches currently are increasingly infusing tenets of ABA ap- are available, ranging from educational to clin- proaches to address the need for consistency, ical to biomedical (eg, psychopharmacolog- intensity, and accountability, which have ical, nutritional) (National Research Council been strengths of ABA practice (Prizant & [NRC], 2001). Within the category of edu- Wetherby, 1998). However, in our recent ex- cational and clinical strategies, efforts to in- perience, current educational/treatment pro- crease communication and socioemotional grams tend to fall into 1 of 2 categories. abilities are widely regarded as among the First, some programs continue to adhere to most critical priorities (NRC, 2001; Wetherby only 1 or 2 approaches, with little integra- & Prizant, 2000). These difficulties virtually tion of practices from different perspectives. define ASD, and progress in communication In contrast, other programs use a “patch- and socioemotional development is closely work quilt”strategy borrowing from different related to outcome and independent func- practices along the continuum, even when tioning. However, approaches to enhancing such practices are not easily integrated, re- these abilities vary greatly, resulting in con- sulting in a fragmented approach to program- fusion for caregivers and some professionals. ming. For example, a young child may re- One source of this variability is the extent ceive services in an integrated developmental to which educational/treatment approaches preschool setting focusing on communica- are based (1) on current understanding of the tion, play, and peer interaction, but also re- learning style and the nature of the disability ceive traditional ABA treatment in additional of ASD, and (2) on the most contemporary home-based therapy focusing on readiness research on communication and socioemo- skills and “compliance training,”with little co- tional development in children with and with- ordination between settings. Such fragmenta- out disabilities. On the one end of the con- tion may cause confusion for children who are tinuum, approaches that are developmentally exposed simultaneously to highly structured, based draw heavily from the knowledge base directive approaches based on repetitive on typical child development (eg, Greenspan teaching drills, as well as more loosely struc- & Wieder, 1997; Gutstein, 2000; Prizant, tured, child-centered approaches using more Wetherby, & Rydell, 2000; Rogers & Lewis, natural activities for teaching. It may also 1989; Wetherby et al., 1997). On the other result in considerable confusion for parents end of the continuum are more traditional and frustration for professionals who come ABA (applied behavior analysis) approaches, from different, and sometimes diametrically which are based primarily on teaching prac- opposed, orientations. Thus, there remains LWW/IYC AS213-03 August 11, 2003 8:50 Char Count= 0 298 INFANTS AND YOUNG CHILDREN/OCTOBER–DECEMBER 2003 a great need for a comprehensive educa- our previous empirical research and clini- tional/treatment model with the following fea- cal investigation in understanding conven- tures: (1) the model is based on the most cur- tional and unconventional communication in rent research in child development and ASD; ASD including communicative functions and (2) it is flexible enough to incorporate differ- intentions of behavior (Prizant & Duchan, ent perspectives (ie, developmental and con- 1981; Prizant & Rydell, 1984; Prizant & temporary ABA); (3) it can be applied in an Wetherby, 1987; Rydell & Prizant, 1985; individualized manner while addressing the Schuler & Prizant, 1985; Wetherby, 1986; “core deficits” of ASD; and (4) it is family- Wetherby & Prutting, 1984) and is philosoph- centered, taking into account critical individ- ically consistent with tenets of recent work ual differences across families in reference to in positive behavior supports (Fox, Dunlap, their priorities, and their involvement in criti- & Buschbacher, 2000; Koegel, Koegel, & cal programmatic decision-making. Dunlap, 1996; Lucyshyn, Dunlap, & Albin, This article provides an overview of the 2002). The model also is built upon our work SCERTS Model, a comprehensive, multidisci- addressing the relationships among commu- plinary approach to enhancing communica- nication, socioemotional development, and tion and socioemotional abilities of children emotional regulation (Prizant, 1999; Prizant from early intervention to the early school et al., 1990; Prizant & Meyer, 1993; Prizant years. The SCERTS Model was developed