situations, the tests used for pre- and post-assessment are different, due to the child’s increasing age, making interpretation of results difficult.

Another major purpose of assessment is to provide information for educational planning that can be directly translated into goals, strategies, and outcome measures for communication enhancement. Several communication abilities have been identified as important to assess for children with autism: use of eye gaze and facial expression for social referencing and to regulate interaction, range of communicative functions expressed, rate of communicating, use of gestures and vocal/verbalizations, use of repair strategies, understanding of conventional meanings, and ability to engage in conversation (Schuler et al., 1997; Wetherby et al., 2000). Wetherby et al. (1997) point out that communicative abilities of children with autism should be documented in natural communicative exchanges, with a child’s symbolic abilities serving as a developmental frame of reference. To supplement formal measures, the systematic use of informal procedures to assess language and communication is needed. In order to gather an accurate picture of the communication and symbolic abilities of children with autism, a combination of assessment strategies has been recommended, including interviewing significant others (i.e., parents, teachers) and observing in everyday situations to find out how a child communicates in the home, classroom, and other daily settings (Wetherby and Prizant, 1999).

INTERVENTION APPROACHES

Although there is consensus on the importance of enhancing communication abilities for children with autism, intervention approaches vary greatly, and some even appear to be diametrically opposed. The methodological rigor in communication intervention studies in terms of internal and external validity and measures of generalization has been stronger than in many other areas of autism intervention studies. Nevertheless, there have been relatively few prospective studies with controls for maturation, expectancy, or experimenter artifacts. The strongest studies in terms of internal validity have been multiple baseline, ABAB, or similar designs that have included controls for blindness of evaluations (see Figure 1–1 in Chapter 1). There have been almost no studies with random assignment, although about 70 percent of the studies included well-defined cohorts of adequate sample size or replication across three or more subjects in single subject designs (see Figure 1–2 in Chapter 1). A substantial proportion of communication interventions have also included some assessment of generalization, though most often not in a natural setting (see Figure 1–3 in Chapter 1).

In order to examine the critical elements of treatment programs that affect the speech, language, and communication skills of children with



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