Abstract
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 outcomes, 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 priorities, 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 developmental 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 addressed 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 "recommended practices" (National Research Council, 2001).
AUTISM SPECTRUM DISORDER (ASD) or Pervasive Developmental Disorder (PDD) (APA, 1994) is a category of developmental disability characterized by qualitative impairments in social interaction and social relatedness, difficulties in acquiring and using conventional communication and language abilities, and a restricted range of interests often co-occurring with an extreme need for consistency and predictability in daily living routines. Frequently co-occurring and associated characteristics include problems in sensory processing (Anzalone & Williamson, 2000; Greenspan & Wieder, 1997), motor planning (Anzalone & Williamson, 2000; Prizant, 1996), emotional regulation and arousal modulation (Cole, Michel, & Teti, 1994; Dawson and Lewy, 1989; Prizant, Schuler, Wetherby, & Rydell, 1997), and behavioral organization (Ornitz, 1989). The learning profile of children with ASD is typically uneven and inflexible, with relative strengths in "object knowledge," rote memory, and visual-spatial processing, and weaknesses in "social knowledge," semantic and conceptual memory, and abstract problem-solving (Prizant, 1983; Wetherby, Prizant, & Schuler, 1997). ASD is now understood to be of neurogenic origin and is generally considered to be a lifelong disability that can dramatically impact family members. Advances in research on early identification have resulted in earlier diagnosis of ASD (Lord & Risi, 2000). As a result, there is a great demand for current information on education and treatment for young children.
A variety of treatment approaches currently are available, ranging from educational to clinical to biomedical (eg, psychopharmacological, nutritional) (National Research Council [NRC], 2001). Within the category of educational and clinical strategies, efforts to increase communication and socioemotional abilities are widely regarded as among the most critical priorities (NRC, 2001; Wetherby & Prizant, 2000). These difficulties virtually define ASD, and progress in communication and socioemotional development is closely related to outcome and independent functioning. However, approaches to enhancing these abilities vary greatly, resulting in confusion for caregivers and some professionals. One source of this variability is the extent to which educational/treatment approaches are based (1) on current understanding of the learning style and the nature of the disability of ASD, and (2) on the most contemporary research on communication and socioemotional development in children with and without disabilities. On the one end of the continuum, approaches that are developmentally based draw heavily from the knowledge base on typical child development (eg, Greenspan & Wieder, 1997; Gutstein, 2000; Prizant, Wetherby, & Rydell, 2000; Rogers & Lewis, 1989; Wetherby et al., 1997). On the other end of the continuum are more traditional ABA (applied behavior analysis) approaches, which are based primarily on teaching practices derived from tenets of learning theory and operant conditioning (Lovaas, 1981; Maurice, Green, & Luce, 1996) (see Prizant & Wetherby, 1998, for further discussion of the continuum of educational/treatment approaches and the debate on efficacy of intervention).
Over the past 2 decades, there have been increased attempts at "cross-fertilization," with developmental research and "family-centered" and "child-centered" practice influencing the content and teaching practices of traditional ABA approaches (Strain et al., 1992), resulting in a clear distinction between contemporary ABA practice and traditional ABA practice. Similarly, developmental approaches are increasingly infusing tenets of ABA approaches to address the need for consistency, intensity, and accountability, which have been strengths of ABA practice (Prizant & Wetherby, 1998). However, in our recent experience, current educational/treatment programs tend to fall into 1 of 2 categories. First, some programs continue to adhere to only 1 or 2 approaches, with little integration of practices from different perspectives. In contrast, other programs use a "patchwork quilt" strategy borrowing from different practices along the continuum, even when such practices are not easily integrated, resulting in a fragmented approach to programming. For example, a young child may receive services in an integrated developmental preschool setting focusing on communication, play, and peer interaction, but also receive traditional ABA treatment in additional home-based therapy focusing on readiness skills and "compliance training," with little coordination between settings. Such fragmentation may cause confusion for children who are exposed simultaneously to highly structured, directive approaches based on repetitive teaching drills, as well as more loosely structured, child-centered approaches using more natural activities for teaching. It may also result in considerable confusion for parents and frustration for professionals who come from different, and sometimes diametrically opposed, orientations. Thus, there remains a great need for a comprehensive educational/treatment model with the following features: (1) the model is based on the most current research in child development and ASD; (2) it is flexible enough to incorporate different perspectives (ie, developmental and contemporary ABA); (3) it can be applied in an individualized manner while addressing the "core deficits" of ASD; and (4) it is family-centered, taking into account critical individual differences across families in reference to their priorities, and their involvement in critical programmatic decision-making.
This article provides an overview of the SCERTS Model, a comprehensive, multidisciplinary approach to enhancing communication and socioemotional abilities of children from early intervention to the early school years. The SCERTS Model was developed to directly address the limitations of available approaches noted above. The model prioritizes Social Communication, Emotional Regulation, and Transactional Support as the primary developmental dimensions that must be addressed in a comprehensive program designed to support the development of children with ASD. Because the model addresses core deficits or challenges definitive of ASD, it can be applied flexibly to a range of children who have varying degrees of disability (ie, mild to severe) in cognitive, communicative, sensory processing, and regulatory capacities.
The SCERTS Model is derived from over 2 decades of empirical and clinical work, and is consistent with recommended tenets of "evidence-based" practice espoused by researchers and clinical scholars in ASD and related disabilities (NRC, 2001; Prizant & Rubin, 1999). More specifically, the developmental, social-pragmatic focus of the model has been the hallmark of our work for many years (Prizant, 1982a; Prizant et al., 1997; Prizant & Wetherby, 1985, 1987; Wetherby et al., 1997; Wetherby & Prutting, 1984) and has been influenced by other developmentally based communication intervention models outside of ASD (Bricker, Pretti-Frontczak, & McComas, 1998; McLean & Snyder-McLean, 1978). The model reflects and integrates our previous empirical research and clinical investigation in understanding conventional and unconventional communication in ASD including communicative functions and intentions of behavior (Prizant & Duchan, 1981; Prizant & Rydell, 1984; Prizant & Wetherby, 1987; Rydell & Prizant, 1985; Schuler & Prizant, 1985; Wetherby, 1986; Wetherby & Prutting, 1984) and is philosophically consistent with tenets of recent work in positive behavior supports (Fox, Dunlap, & Buschbacher, 2000; Koegel, Koegel, & Dunlap, 1996; Lucyshyn, Dunlap, & Albin, 2002). The model also is built upon our work addressing the relationships among communication, socioemotional development, and emotional regulation (Prizant, 1999; Prizant et al., 1990; Prizant & Meyer, 1993; Prizant & Wetherby, 1990) and is consistent with the work of Rogers and Lewis (1989) and Greenspan and Wieder (1998, 2000) addressing socioemotional factors, and DeGangi (2000) and Tronick (1989) addressing arousal modulation and emotional regulation.
The SCERTS Model also integrates contemporary understanding of the learning style of persons with ASD as addressed in our previous work (Prizant, 1982b, 1983; Prizant & Wetherby, 1998; Wetherby et al., 1997), and as reflected in the current emphasis on the use of visual supports in educational programming (Hodgdon, 1995; Quill, 1998). Finally, the family-centered philosophy espoused in the model draws from the work of Bailey and colleagues (Bailey & Simeonsson, 1988) and Dunst and colleagues in early intervention (Dunst, Trivette, & Deal, 1988), and has been greatly influenced by the Hanen Early Language Centre Model for supporting parents of children with language disabilities (Manolson, 1992) and ASD (Sussman, 1999). Our previous work that addresses our interpretation and application of family-centered research and practice, both within and outside the ASD literature (Prizant & Bailey, 1992; Prizant & Meyer, 1993; Prizant, Meyer, & Lobato, 1997, Prizant & Wetherby, 1993), is infused in all aspects of the model.
Thus, the SCERTS Model clearly is consistent with, or has been directly influenced by, contemporary practices and education/treatment approaches noted above. However, we believe it offers an important and novel contribution to currently available approaches by establishing clear priorities in the areas of social communication, emotional regulation, and transactional support, in a manner that addresses the complex interdependencies among these most crucial areas. In this manner, the model reflects a new conceptualization of education/treatment that most closely addresses the core deficits observed in ASD, and therefore represents an example of what we believe to be the "next generation" of treatment approaches for ASD. In the following discussion, we will define the core components of the SCERTS Model (see Table 1 for an overview), provide sample goals for each component, and conclude by considering the overriding importance of ecological validity in programs for young children with ASD.