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The Power of Parent Supports for Children with
Autism Spectrum Disorders: Parents’ Handbook (English)
The Power of Parent Supports for Children with
Autism Spectrum Disorders: Parents’ Handbook (English)
The Power of Parent Supports for Children with
Autism Spectrum Disorders: Parents’ Handbook (English)
The Power of Parent Supports for Children with
Autism Spectrum Disorders: Parents’ Handbook (English)
The Power of Parent Supports for Children with
Autism Spectrum Disorders: Parents’ Handbook (English)
Providing Information and Resources for Families of Children with Autism Spectrum Disorders in Japan
Introduction2University of Tsukuba
If you suspect that your child has autism, you may not know what to do with this and go through many challenges throughout your life. The first and the foremost priority is to get your child assessed and evaluated by professionals as soon as you detect your child’s conditions. With an accurate evaluation, you will be able to plan for effective services and education for your child. Once your child gets evaluated, you should find out what to and how to provide the best treatment to your child in order to improve the quality of your child’s life as well as your family’s life. To make your life easier, as a parent of a child with autism, you should educate yourself and collaborate with other family members, teachers, and service providers. Upon receiving a diagnosis of ASD, parents may experience emotional challenges. There are some common reactions of the parents.
Shock or denial: Parents may think, “How can this be happening to me?” or “No way. My child has no problem!”
Anger: Parents may be angry at themselves or other for causing ASD.
Guilt: Parents may think there was something they could have done that would have prevented the diagnosis.
Rejection: Some parents report having a “death wish” for their child.
Confusion: Parents may not be able to make a choice about treatment for their child.
Fear: Parents may fear of their life. Isolation: Parents may feel isolated with conditions that their child
show. Envy: Parents may be jealous of others who have typical children.
These are common feelings that parents and families have experienced after their child gets a diagnosis of ASD. Stressors can be present regardless of the severity of a child’s symptoms. Not only on parents, but a diagnosis of ASD tends to affect siblings as well. Parents may need to learn effective strategies for coping with their own and families’ emotional distress. This parent training manual is developed to provide some basic and useful information to parents who have a child with autism.
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About UsEe Rea Hong, PhD, BACB-D, is an assistant professor in Faculty of Human Sciences at University of Tsukuba in Japan. She received her doctoral degree in Special Education at Texas A&M University in the United States. Dr. Hong is a Board Certified Behavior Analyst-Doctoral level. Her primary research interests are in Autism Spectrum Disorder and Applied Behavior Analysis. Dr. Hong has been working with family members and proving them with training in behavior, social, and communication skills of their children with autism spectrum disorder.
Li-yuan Gong, MEd, is a doctoral student in Disability Sciences at University of Tsukuba in Japan. She received her Master’s degree in special education at University of Tsukuba. She has conducted several single-case studies on the acquisition of question-asking behavior in Japanese children with Autism Spectrum Disorder.
Ana Kanaoka is a graduate student in Disability Sciences at University of Tsukuba in Japan. Her research interests are in Autism Spectrum Disorder, Applied Behavior Analysis, and Bilingual children with Autism Spectrum Disorder. She is passionate about developing effective and empirically supported treatments for children with Autism Spectrum Disorder in Japan.
AcknowledgementsJapan Society for the Promotion of Science, Japan: Grants-in-Aid for Young Researcher (B) (Grant number: 16K20944). The Power of Parent Supports: The Effectiveness of Caregiver Training in Improving Social and Communication Skills of Children with Autism Spectrum Disorders. Role: Principle Investigator
What is Autism Spectrum Disorder (ASD)?4
Autism is a complex neurobiological condition that leads to difficulties in communication, social ability and repetitive behaviors or restricted interests. Symptoms range from mild to severe and individuals can present any combination of the behaviors in any degree of severity. Studies indicated that approximately one in every 68 children has autism. ASD usually appears early in life, often before the age of three, and is four to five times more common in boys than in girls.
ASD is diagnosed according to guidelines listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. In DSM-IV, individuals could be diagnosed with four separate disorders: autistic disorder. Asperger’s disorder, Rett’s disorder, childhood disintegrative disorder, or pervasive developmental disorder-not otherwise specified. However, in DSM-V, except for Rett’s disorder, the other four separate disorders have been replaced by the collective term ‘autism spectrum disorder’. The DSM-V criteria include “severity levels” which describe different levels of support and impact on an individual’s functioning level. To be diagnosed with ASD, individuals with ASD must show autism-related symptoms from early childhood, even if those symptoms are not recognized until later.
Facts about Autism:
1. It affects 1 in every 68 children nationwide (Centers for Disease Control and Prevention, 2014). Up to date no exact information on the prevalence of ASD exists in Japan, but its overall prevalence rate for ASD is estimated to be ranged from 1 to 2.6 percent of all children and has increased across countries including this country. (Elsabbagh et al., 2012; Kim et al., 2011)
2. It is almost four to five times more likely to occur in boys than girls.3. Approximately 10% of children with ASD have an identifiable genetic or
chromosomal disorder (i.e., fragile X or tuberous sclerosis).4. It has no known cause or cure. 5. About 41% of children with ASD also have an intellectual disability.6. About 40% of children with ASD do not develop verbal skills.
What are the Symptoms of ASD?
Symptoms of ASD vary from one child to the next, but in general, they fall into two areas:1. Deficits in social communication and interaction2. Restrictive, repetitive patterns of behavior, interests or activities Children with ASD do not follow typical patterns when developing social and communication behaviors. In many cases, certain behaviors become more recognizable when comparing children of the same age.
Early Indicators of ASD
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A child does not need to demonstrate all of the indicated behaviors in order to be referred for an assessment. The lists below represents not all but some of the early signs of ASD that may concern parents and indicate the needs for professional evaluation.
1. Impairment in Social Interaction with othersLack of eye contactLack of imitation of facial expressionsLack of response to his or her name calledLack of sharing interestLack of social engagement
2. Impairment in CommunicationLack of speechImmediate or delayed echoing of others’ wordsLack of use of gesturesPoor understanding of abstract conceptsLack of understanding jokes or humors
3. Restricted, repetitive behaviors, interests, or activitiesRepetitive motor movements (e.g., hand-flapping, rocking, etc.)Line up toys Categorize toys instead of playing functionally with themMay have hard time when his or her routine has changed
4. OthersTantrumsSensitive to light or soundSafety concernsMay eat limited types of foodAcademic challengesMay experience difficulties with sleepMay have symptoms of depression or anxietyActing out
A screening tool called the Modified Checklist for Autism in Toddlers (M-CHAT) can help parents determine if a child needs to be referred for a professional assessment. This is available on online at www.m-chat.org and takes a few minutes to complete the checklist. If a result shows that the child is at risk for autism, then parents should consult with the child’s doctor.
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What is the Process of Getting a Diagnosis?If parents think the child may have autism, then follow the steps presented below.
Evaluation is Essential.
No medical tests can be used for diagnosing ASD, however, parents should consult a physician when they have concerns about their children. By checking up with a physician, various medical causes related to ASD symptoms can be ruled out. For example, if your child has a hearing problem, he or she might experience delays in communication, along with a number of other symptoms related to ASD. The diagnostician (e.g., psychologist, psychiatrist, pediatric neurologist, developmental pediatrician) should use the information based on this comprehensive evaluation and look at the criteria developed in the DSM-V.1. Interview with parent or caregiver.
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Continue to monitor the child’s behavioral progress. If you still have concerns about your child, let the doctor know.
Prepare for getting the child to receive related services.
The child receives a diagnosis of ASD.
The child does not have ASD, then…
If the doctor makes a referral for assessment, get the assessment.
If the doctor does not make a referral for assessment, then…
Consult with the child’s doctor and discuss your concerns.
Review early indicators of ASD
2. Review of relevant documents including medical, psychological, and/or school records.
3. Evaluate a child with cognitive and developmental assessment.4. Observe a child’s play directly.5. Measure a child’s adaptive behavior.6. Conduct a comprehensive medical examination.
When Does the Child Seem to Have Comorbid Diagnoses?
Some individuals with ASD often have comorbid diagnoses. In these cases, it is appropriate for children to be diagnosed with ASD and with an additional disorder, called a comorbid condition. The exact prevalence of comorbid conditions in ASD is not known, but approximately from 11 to 72% of individuals with ASD appear to have at least one comorbid psychiatric disorder (Mazefsky, 2012).
It is well documented that ASD can co-exist with other conditions.
1. Mental Health: Children with ASD can develop mental disorders such as anxiety disorders, attention deficit hyperactivity disorder, or depression.
Bipolar disorderGeneralized anxietyObsessive compulsive disorderOppositional-defiant disorderDepressionSchizophreniaMood disorder
2. NeurologicalSeizure disorder (up to 25% of individuals with ASD)Tourette’s syndromeSleep disorderLearning disabilitiesAttention deficit disorder (ADD or ADHD)Sensory integration disorderExecutive functioning disorder
3. PhysicalCerebral palsyMuscular dystrophyAbnormal gaitPoor coordination
4. MedicalDiabetesAsthmaHeart conditions
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Visual impairmentHearing impairmentAllergiesGastrointestinal conditionsHypoglycemia
As a parent, if you suspect that your child who has a diagnosis of ASD also shows some traits or behaviors of another developmental disability, you should make sure that your child gets an evaluation from a qualified professional. Having an accurate diagnosis of ASD for a child with a co-morbid disability can help make appropriate decision for treatment and education.
What are the Treatments for ASD?The lifetime costs associated with ASD are approximately $3.2 million per individual (Ganz, 2007). We can reduce these costs by selecting optimal treatments that affect important life skills while decreasing problem behaviors of individuals with ASD. While there is no proven cure yet for ASD, treating ASD early using appropriate treatments can reduce ASD symptoms
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and increase children’s ability to acquire new skills. The types of services and supports that will benefit children with ASD can vary according to the type or degree of autism and severity. Professionals agree that early intervention is important.
How Do You Choose Interventions?
Choosing appropriate interventions for your child can be confusing. There are some strategies to determine the effectiveness of the interventions (Stephen M. Edelson, PhD, Center for the Study of Autism, OR, 2007).1. Implement one treatment at a time: Change one thing at a time to allow
enough time to see the effects of a treatment.2. Keep data while a treatment is being implemented: Keep a daily record
prior to and during the intervention. By looking at the data, you will be able to determine the effects of a treatment.
3. Seek objective information: Don’t tell other service providers about the services or treatments that your child receives to prevent biased feedback.
4. Collect data from the service providers: Ask the service providers to keep written data and compare with data you collect.
5. Keep recording unexpected or unanticipated changes in your child: Keep recording any events or changes that your child presents.
6. Educate yourself about a treatment: Be sure you learn as much as you can about the treatment before beginning.
Since each type of treatment has different effects on each individual with ASD, it is critical to make informed choices and keep recording data to monitor effectiveness of the treatment being implemented.
Professionals
1. Speech-Language Pathologists (SLPs): SLPs are trained in the assessment, treatment and prevention of communication disorders. They usually assess and treat difficulties in language understanding and expression and also problems with speech (e.g., articulation, fluency). For individuals with ASD, SLPs play an important role as an intervention team member. Sometimes, SLPs also have training and experience in training eating disorders.
2. Occupational Therapists (OTs): OTs usually focus on helping individuals develop fine motor skills (i.e., movements involving the smaller muscles of the arms), process information from their senses, and carry out daily living activities, such as eating, dressing, and grooming. For young children with ASD, OTs are often helpful in building their play skills, learning self-care skills, and coping with their sensory processing differences.
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3. Physical Therapists (PTs): PTs focus on gross motor skills (i.e., movements involving the larger muscles of the arms and legs) and treat problems with movement and posture of individuals with disabilities. For individuals with ASD, PTs can be helpful in developing coordination, balance, or motor movement.
4. Behavior Therapists: Behavior therapists use a therapeutic approach called Applied Behavior Analysis (ABA). ABA is an approach used to increase and teach appropriate behaviors while decreasing problem behaviors.
5. Recreational Therapists: Recreational therapy is the practice of using leisure activities as therapeutic interventions, including aquatic therapy, art therapy, music therapy and therapeutic horseback riding.
Treatments with Evidence
There are several treatments considered evidence-based practices (EBPs) for individuals with ASD (Wong et al., 2014).
1. Antecedent-based intervention: Arrangement of environments and/or events to decrease the occurrence of problem behaviors. Antecedents can be manipulated to specify the situations in which problem behaviors occur and situations in which those behaviors are reinforced, as well as to modify the environment so that such behavior would not occur again. Manipulating antecedents is effective with small children (0-2 years old) to young adults (19-22 years old) with ASD. It can be effectively used for improving sociability, communication, behavior, play, academic skills, and adaptability, among others.
Example: When Julia enters a new place, she might feel anxious and might tend to get irritated. It could be difficult for Julia to predict the new environment and what to do in it only by listening to parents’ verbal explanations. One technique of manipulating antecedents is to show Julia photos and picture cards of the new place. Using pictures and letters would show her what to do in the new place and allows Julia to develop a future prospect before leaving home.
2. Cognitive behavioral intervention: Management or control of cognitive processes to change overt behaviors.Not only direct interventions for emotions and behaviors but also cognitive factors that affect emotions and behaviors can be utilized as targets of treatment. Moreover, emotional stability and behavior modification can be achieved by changing emotions and behaviors into adaptive cognition. When clients repeatedly experience changes in feelings and behaviors resulting from changes in their way of thinking, they become aware that they are able to control their emotions and behaviors. That is to say; cognitive behavioral therapy is a treatment method for acquiring self-
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control. Cognitive behavioral therapy is effective for elementary school children (6-11 years old) to high school students (15-18 years old) with ASD. It can be effectively used for improving sociability, communication, behavior, cognition, adaptability, and mental health, among others.
Example: When Konan spoke to his friends, he often made them angry. After returning home, Konan got depressed about this, because he thought that others might dislike him and he would be unable to communicate with others. As a result, Konan gradually came to avoid speaking with other people. In this case, it was necessary to change Konan’s thought that he is unable to communicate with others. Observations of situations in which he talked with his friends made it clear that he sometimes interrupted other people while they were speaking. In this case, Konan had to be informed that his friends do not dislike him, but that he must wait until the other person finishes speaking before he starts to speak. When Konan changed the thought that he was disliked by others, he stopped avoiding communicating with others and came to enjoy talking with his friends. He also became careful about the timing of his speech.
3. Differential reinforcement of alternative, incompatible, or other behavior: Present a reinforcer upon either a desired behavior, alternative behavior, or incompatible behavior. A variety of differential reinforcement strategies can be used to increase positive behaviors and decrease interfering behaviors. This intervention method is effective for preschool children (3-5 years old) and young adults (19-22 years old) with ASD. It is effectively used for improving sociability, communication, and joint attention, among others.
(1) Differential Reinforcement of Alternative Behaviors (DRA): When playing alone at home Katie often uttered strange sounds. Although her parents had scolded Katie many times, the symptoms got worse. Differential reinforcement of alternative behaviors is a useful measure for reducing the strange sounds made by Katie. Concretely, ① the parents talked to her about what she is playing with. ② When Katie is playing quietly or when she talked to her parents about her play, the parents stopped what they are doing and smiled at Katie and made comments about her play, listened to what Katie was saying and actively got involved with her. ③ When Katie started making the strange cry, the parents pretend to be busy with housework. When she stopped the cry, the parents immediately stopped what they were doing and paid attention to her.
(2) Differential Reinforcement of Incompatible Behaviors (DRI): Making strange cries and talking cannot be done at the same time. When Mika stopped uttering the strange noise and talked to his parents, the
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parents praised Mika and actively got involved with her. When she started making strange cries, the parents tried not to pay attention to Mika.
(3) Differential Reinforcement of Other Behaviors (DRO): When Masato went to bed, he often bit or played with his fingers and didn’t fall asleep quickly. Differential reinforcement can be tried to reduce the finger play before sleeping. Masato liked listening to his parents reading him picture books. Therefore, reading aloud could be regarded as a reinforcer. In differential reinforcement of other behaviors, the parents sat next to Masato on the bed and continued to read picture books aloud, so long as he was not playing with his fingers. If Masato started his finger play, the parents immediately stopped reading. As a result of reinforcing “not playing with the fingers,” finger play before sleeping was gradually reduced.
4. Discrete trial training (DTT): One-on-one instruction to teach appropriate behaviors and/or skills. A trial consists of the task presentation, the child’s response, a consequence, and a pause prior to presenting the next task. Discrete Trial Training is effective with preschool children (3-5 years old) and elementary school students (6-11 years old) with ASD. It can be effectively used for improving sociability, communication, behavior, joint attention, preparation for school, academic skills, adaptability, and occupational skills, among others.
Example: If you (the parent or the instructor) want to teach your child a target behavior, e.g., “Give me XX,” place the object that the child likes where s/he can see it, but cannot reach it. When the child says “Give me XX,” you can immediately give it to the child. If the child does not make a request, you can model for the child (“Give me XX”) and when the child imitates you, you can give it to the child at once. The same procedure can be repeated after a certain interval after the child obtains what he or she wants. A contingency between the verbal expression (“Give me XX”) and the object, which is the reinforcement can be formed by continuously repeating this procedure for a certain period.
5. Exercise: Increase in physical exertion to reduce problem behaviors while increasing appropriate behaviors. This intervention is effective for preschool children (3-5 years old) to junior high school students (12-14 years old) with ASD. It can be used effectively for improving behaviors, preparation for school, academic skills, and exercise abilities, among others.
Example: Haru was restless and often panicked, and rarely interacted with others. Dohsa-hou was implemented with Haru following the trainer’s instructions. Haru raised his arms and stretched her shoulders as well as her back after being helped by the trainer and gradually became able to control his own body.
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6. Extinction: Withdrawal or removal of reinforcers to reduce problem behaviors. A behavior previously reinforced is no longer reinforced when extinction is in effect. This intervention is effective for preschool children (3-5 years old) and senior high school students (15-18 years old) with ASD. It has been used effectively for improving communication, behavior, preparation for school, and adaptability, among others. Example: When Kenta drops beads on the floor, this behavior is
reinforced by its sound. However, the sound disappears as a result of carpeting the floor. Then, he stops engaging in this behavior.
7. Functional behavior assessment: Systematic data collection of information about problem behavior to identify functions of the behavior. It is the first step for the problem behavior intervention. This intervention is effective for small children aged 0-2 years of age and young adults aged 19-22 years with ASD. It has been effectively used for improving communication, behavior, preparation for school, academic skills, and adaptability, among others.
Example: Functional assessment is useful for reducing problem behaviors such as a child hitting his/her siblings or shouting. The child is reinforced by parents’ attention given to him/her when he/she engages in the problem behavior. It has hypothesized that problem behaviors tend to be caused when parents do not pay attention to their child and this hypothesis has been experimentally supported.
8. Functional communication training: Replacement of problem behavior with more appropriate communication that has the same function with the problem behavior.This intervention is effective for preschool children (3-5 years old) and senior high school students (15-18 years of age) with ASD. It is effectively used for improving sociability, communication, behavior, play, preparation for school, and adaptability, among others.
Example: Tasuke often utters a strange sound for attracting the attention of others. In this case, training to replace this behavior with some other appropriate behaviors, such as calling someone’s name, is an effective intervention.
9. Modeling: Demonstration of a desired behavior that leads to imitation of the behavior by the learner. This intervention is effective for small children (0-2 years old) and young adults (19-22 years old) with ASD. It has been effectively used for improving sociability, communication, joint attention, play, reading skills, academic skills, and occupational skills, among others.
Example: When an instructor wants to teach a child how to “clap hands”, the instructor can clap his/her hands and make the child
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imitate this action. It is necessary that the child looks at the instructor when he/she performs the action that is modeled.
10. Naturalistic intervention: Instructions occur in the learner’s naturalistic environments. The setting are arranged in a way to motivate the learner’s interests.This intervention is effective for small children (0-2 years old) to elementary school children (6-11 years old) with ASD. It has been effectively used for improving sociability, communication, behavior, joint attention, play, and academic skills, among others.
Example: First, the instructor must understand what the child likes, such as snacks, or toys, among others. The intervention is implemented where the child usually plays or eats, and the child takes initiatives. For example, when the child is approaching a table where chocolates had been placed, the instructor takes half of the chocolate in advance. When the child finishes eating his/her chocolate, the instructor shows the saved half of the chocolate and asks, “Do you want this?” Thus, creating an opportunity for communication. If the child says, “I want it,” the instructor immediately gives it to the child. If the child does not make a request, the instructor presents verbal and physical prompts to the child. If the child doesn’t want the chocolate and approaches another place, the instructor follows the child and creates an opportunity for communication, again by using the child’s favorite things.
11. Parent-implemented intervention: Parents participate in educational programs as an instructor. Parent training is delivered by various methods including didactic instruction, discussions, modeling, coaching, or performance feedback. The following six steps are in the parents’ intervention system. ① Clarifying family needs, ② deciding on the goal, ③ making an intervention plan, ④ receiving training for parents, ⑤ executing the intervention, and ➅ monitoring progress.
*Each step includes concrete practice measures and procedures for effectively guiding parents and instructors. This intervention is effective for small children (0-2 years old) to elementary school children (6-11 years old) with ASD. It has been effectively used for improving sociability, communication, behavior, joint attention, play, cognition, preparation for school, academic skills, and adaptability, among others. First children’s needs must be clarified when parents teach their child the picture exchange communication system (see 13). Next, the word that they want to teach the child, i.e., the target behavior, is decided. Parents can receive training on this intervention by consulting a specialist. When they sufficiently understand the intervention, they can teach their child picture exchange communication at home. When doing this intervention, the parents need to check if they are correctly following the six steps.
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12. Peer-mediated instruction: Typically developing peers participate in educational programs to interact with and help learners acquire new behavior, communication, and social skills within naturalistic settings. Peer training is delivered systematically to improve social engagement of the learners. This intervention method was effective for preschool children (3-5 years old) and senior high school children (15-18 years old) with ASD. It is effectively used for improving sociability, communication, joint attention, play, reading at school, and academic skills, among others.
Example: During playtime, Yuri was always with adults and did not approach other children. Her parents were worried that she would have no friends. In this case, an intervention mediated by a peer was conducted to help Yuri understand others’ intentions, respond to others, and acquire skills of interacting with others. As a result, a setting in which Yuri, and Mia, a typically developing child draw a picture together was set up. In this setting, Mia says to Yuri, “What is your favorite color?” or “Can I use your red crayon?” After Yuri responds, Mia actively reacts and interacts with Yuri. As a result of enjoying interacting with a friend, Yuri can acquire social skills such as alternating and sharing, among others.
13. Picture exchange communication system: Learners learn how to make an exchange a picture for an item in a social context. Instructions include: (1) how to communicate, (2) distance and persistence, (3) picture discrimination (4) sentence structure, (5) responsive requesting and (6) commenting. This intervention is effective for preschool children (3-5 years old) to junior high school students (12-14 years old) with ASD. It has been effectively used for improving sociability, communication, and joint attention, among others.
Example: Masaki did not utter any words. When he wants something, Masaki always used his parent’s hands to get it. When an object that he wanted was not in front of him, he could not express his demand well enough and often lost his temper. It was decided to teach the picture exchange communication system to Masaki, so that he could learn to express his demands clearly. He learned to bring a picture card indicating what he wanted to his parents and exchanged the card with the corresponding object. Skills of expressing demands using picture cards can be acquired by following the six steps described above.
14. Pivotal response training: Pivotal behaviors include (1) motivation, (2) response to multiple cues, (3) self-management, and (4) self-initiations of social interactions. Instructions are planned based on the principles of applied behavior analysis and carried out in a naturalistic setting. A setting in which an adult and a child played freely with toys was developed. In this
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environment, spontaneous responses were made to multiple social cues, and natural and diversified reinforcing stimuli were given to the responses. As a result of maintaining a state in which one’s behaviors are managed through stable positive reinforcing stimuli, the child can learn various communication functions. Characteristics of Pivotal Response Treatment (PRT) are as follows: drawing out a repertoire of behaviors that a child originally has and providing support in maintaining procedures in which any type of communication is immediately reinforced. PRT is especially effective for acquiring joint attention, imitation, and spoken language for communication. This intervention is effective for small children (0-2 years old) and junior high school students (12-14 years old) with ASD. It is effectively used for improving sociability, communication, joint attention, and play skills, among others.
Example: An environment where Jake and his father interacted in the usual play setting was developed to increase the frequency of eye contact between Jake and others. Jake’s father showed Jake’s favorite toys to him and made comments regarding his play. When Jake looked at his father, his father immediately provided reinforcement such as praising or tickling Jake. The frequency of eye contact increased by using these opportunities.
15. Prompting: Prompting includes verbal, gestural, and physical assistance given to learners to assist them in acquiring or engaging in an appropriate behavior or skills.This intervention method has been used effectively with little children (0-2 years old) and young adults (19-22 years old) with ASD for improving sociability, communication, behavior, joint attention, play, cognition, preparation for school, academic skills, exercise, and adaptability, among others.
Example: When a child is learning a word such as “Sakana (fish),” the teacher shows a flash card with the letters “Sakana” and pronounces “Sa-ka-na” as a verbal prompt. After the child learns the pronunciation of the word the teacher shows the flash card, and gradually fades the verbal prompt, such as “Saka” “Sa” na prompt.
16. Task analysis: Learners learn how to perform individual steps of a complex behavioral skill. This intervention is effective with preschool children (3-5 years old) and junior high school students (12-14 years old) with ASD. It has been effectively used for improving sociability, communication, joint attention, academic skills, exercise, and adaptability, among others. There are three measures for classifying behavior processes.(1) Observing the person doing a task.(2) Asking questions from people that are doing the task well.(3) The learner, him/herself, conducts the task and individual responses are recorded.
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*The table below shows task analysis when teaching how to eat by using a spoon to a child with profound intellectual disabilities.
Discriminative stimulus Response1. A spoon placed on the table and a bowl in which food is served
Hold the spoon and put it into the food in the bowl
2. The spoon in the food Spoon-up the food3. Food on the spoon Spoon-up food and put it into the
mouthreinforcer (food)
17. Technology-aided instruction: Instructions involve any electronic item, equipment, application and/or virtual network. Technology is the central feature of an intervention. Technical support can be provided by using various devices, such as speech generating devices, smartphones, tablets, computer educational support programs, and networks, among others. What is common to these interventions is providing support for learning the technologies, learning how to use the technologies, and appropriately using the technologies. This intervention has been effective with preschool children (3-5 years old) and young adults (19-22 years old) with ASD. It can be effectively used for improving sociability, communication, behavior, joint attention, cognition, preparation for school, academic skills, exercise, adaptability, and occupational skills, among others.
Example: It was difficult for A to verbally express his needs. By using a speech generation device and tablet, he could record the names of objects and tell others by tapping.
18. Time delay: A brief delay occurs between the opportunity to use the skill and any additional instructions or prompts. This practice focuses on fading the use of prompts during instructional activities. This intervention has been effective for preschool children (3-5 years old) and young adults (19-22 years old) with ASD. It has been effectively used for improving sociability, communication, behavior, joint attention, play, cognition, preparation for school, academic skills, exercise, and adaptability, among others. Several studies have focused on two types of time delay procedures; progressive time delay and constant time delay.(1) In progressive time delay, a teacher or an instructor gradually increase the time between an instruction and the prompt in one-second intervals.(2) In constant time delay, a constant delay (3-5 seconds) is used.
Example: Erika was taught to vocally imitate “Give me.” After the instructor presented a vocal model once, Erika waited for three seconds until A said “Give me.” If she said so after three seconds, the instructor immediately praised Erika. If she did not say “Give me” after three
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seconds, the instructor presented the vocal model again. If the delay had been determined in advance as one-second, the vocal model was presented every one second. Progressive time delay is a procedure for gradually increasing the waiting time to enable the acquisition of vocal imitation skills.
19. Video modeling: A visual model of the targeted behavior or skills is provided via video recording to assist learners to engage in the targeted behavior or skill.There are several types of video monitoring: (1) basic video monitoring in which the model is someone other than the learner, (2) video self-modeling in which the video, edited by parents or experimenters displays the scene where the learner demonstrates a desirable behavior, and the learner him/herself watches the video, (3) point-of-view video modeling in which experimenters carry or hold the video camera at the eye level of the leaner, and (4) video prompting in which the contents of a task is divided into several steps. The learner is shown a video clip of one step, executes that step of the task, and then the next step is shown. This intervention has been effective for small children (0-2 years old) and young adults (19-22 years old) with ASD. It has been effectively used for improving sociability, communication, behavior, joint attention, play, cognition, preparation for school, academic skills, exercise, adaptability, and occupational skills, among others.
Example: In teaching “washing hands” to a child with difficulties in understanding verbal instructions, the parent or trainer could take a video and divide the action into several steps. When showing the video to the child to teaching the action, the trainer models each step or all the steps.
20. Visual support: Instructions include pictures, written words, objects, schedules, maps, labels, and timelines. This intervention has been effective for small children (0-2 years old) and young adults (19-22 years old) with ASD. It has been effectively used for improving sociability, communication, behavior, play, cognition, preparation for school, academic skills, exercise, and adaptability, among others.
Example: To teach “washing hands” to a child with difficulties in understanding verbal instructions, the parent or trainer can take step by step pictures of washing hands, and put up the pictures on the wall beside the wash basin. When the child washes his/her hands, he/she can look at the pictures and gradually become able to wash his/her hands. Depending on the needs of the child, letters and maps can also be used.
Nutrition Management19
There are no specific causes of autism, but some individuals with ASD may have low tolerance or allergies to certain foods or chemicals, leading to behavioral issues. To reduce those behavioral issues, nutritional therapies are often used for a variety of reasons. Nutritional and dietary interventions include the gluten-free/casein-free diet, Feingold diet, specific carbohydrate diet, anti-yeast diet, and use of supplements (e.g., B6, Magnesium, Vitamin B12, Dimethylglycine, tri-methyl-glycine, Melatonin, Vitamin A, Vitamin C, Folic acid). Parents should consult a gastroenterologist or nutritionist who can help them determine proper nutrition for children with ASD. Some children don’t eat a well-balanced diet. For example, one eight-year-old boy with severe ASD and intellectual disabilities in Japan had an extremely unbalanced diet. He ate only rice, beans, tuna, beef, chicken, French fries, and chocolate. He didn’t drink much water and drank only juices and Coca-Cola, which has a high sugar content. As a result of this unbalanced diet, he was at risk for getting ill. Recently, his parents have tried to cook rice with beans and vegetables to help him get vitamins. Moreover, they added water to his juice to reduce the sugar intake. This is one example of how to deal with a child eating an unbalanced diet.
Medication Management
No medicine can cure autism, but some medicines may be helpful to treat some of the symptoms. Some children can benefit from medication for sleep problems, anxiety, hyperactivity, self-injurious behavior, and mood swings. Parents should be cautious when using such medicines and talk to physician about possible side effects beforehand. Biomedical treatments are often used to reduce some symptoms, such as anxiety, hyperactivity, sleep problem, and self-injurious behavior. Hoffman et al. (2011) identified a number of biomedical interventions with evidence supported or with marginal evidence.
1. Treatments with Evidence Risperidone is used to reduce maladaptive behavior, hyperactivity,
and/or irritability. This is sometimes used to alleviate sleep problems but has a marginal evidence. Risperidone is the only medication approved by the FDA for the treatment and young adults with ASD. Some side effects can occur while taking this medication including weight gain and sedation.
Methylphenidate is mainly used to alleviate a symptom of inattention and hyperactivity. This medication is known to be ineffective with restricted and repetitive behavior and irritability. Significant agitation can occur as a side effect of this medication.
Atomoxetine (aka Strattera) it has been shown to significantly reduce inattentive and hyperactive symptoms. It is approved for the treatment of attention deficit hyperactivity disorder (ADHD). In Japan it is recommended for the treatment of ASD as well.
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2. Treatments with Marginal Evidence
NRI anti-depressants are used to reduce hyperactivity. Some side effects can occur, such as dry mouth, insomnia, nausea, headaches, and/or stomach upset.
SSRI anti-depressants are used to restricted and repetitive behaviors. As a side effect, nausea, diarrhea, headache, and/or agitation can occur.
Certain proteins and amino acids are used to increase social interaction skills. No side effect is identified.
Atypical antipsychotics are used to reduce some behavioral symptoms including maladaptive behaviors and/or hyperactivity.
Automatic cognition enhancers are used to increase social interactions. No side effect is identified.
Naltrexone is used to reduce maladaptive behaviors. As a side effect, several symptoms can occur including anxiety, appetite loss, constipation, delayed ejaculation, diarrhea, dizziness, drowsiness, feeling down, headache, irritability, joint and muscle pain, low energy, nausea, nervousness, sleep problem, and/or vomiting.
Psychostimulants are used to reduce maladaptive behaviors. Agitation can occur as a side effect.
Secretin is used to reduce hyperactivity. Several side effects can occur, such as breathing problem, dizziness, headache, rash or itching, irregular heart rate, stomach upset, diarrhea, and/or sweating.
Anti-epileptics are used to reduce hyperactivity. As a side effect, several symptoms can occur including dizziness, drowsiness, mental slowing, weight gain, metabolic acidosis, skin rash, and/or movement and behavioral disorders.
Supporting Family Involvement in Evidence-Based PracticeA number of interventions exist for individuals with ASD. However, scientific research has found only some of these interventions to be effective. The interventions that researchers have demonstrated to be effective are called Evidence-Based Practices (EBPs). When selecting an intervention for a certain behavior or skill of children with ASD, it is important to consider what type of interventional technique is effective in improving or reducing the behavior in order to lead to the best outcome.
Considerations before choosing interventions
What behaviors or skills do you want to target for your child? Does the intervention or program address the targeted behaviors?
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Does the intervention procedures meet the needs of your child and your family?
Are there any harmful side effects associated with the intervention? Is there any risk of continuing or discontinuing the intervention?
What are the short-term and long-term effects? Can the intervention be integrated into your child’s and family’s
routines? How are you going to monitor and evaluate your child’s progress? Is there any cost of the intervention? Are you affordable for the
treatment? How long is the intervention going to be implemented? Has this intervention been scientifically proven?
Advocate for Yourself and Your Child
Advocacy by parents is important to ensure that children with ASD receive appropriate services for their quality of life. To advocate for yourself and your child:
1. Advocating for your child by educating yourself about your child’s disability. You can find such information by reading practitioner and research articles, books, and websites. Also, you should participate in developing intervention/education plans for your child. It is always good to share the information with other parents who also have a child with ASD or professionals who work with your child.
2. Sharing information about your child and your feelings with other parents and professionals is also essential. As a parent of child with ASD, you may experience emotional distress. Don’t hesitate to talk about your condition and feelings to other family members or other people.
3. Participating in your child’s educational activities can make positive outcomes for your child as well as yourself. Your presence can influence how services are delivered.
4. Teaching your child how to advocate for him or herself. It is critical that your child can advocate for him or herself to make communities to have better understanding about ASD and what your child can contribute to the communities. Parents should keep encouraging their children to share their strengths and what they can do with others.
Japanese Education Systems and related education services
The education system for individuals with disabilities in Japan: special needs education schools, and special needs classes, among others.
1. Education System in Japan22
The education system for those with disabilities in Japan consists of four facilities. Parents are the most important people in deciding the type of school appropriate for their children to attend. Therefore, it is essential for parents to know about the choices they have.
(1) Special needs education schoolsChildren attending special needs education schools must be enrolled in these schools. Teachers in special needs education schools usually have certification in special education, in addition to the general teacher’s license.
(2) Special needs education classesChildren attending special needs education classes are enrolled in schools that have special needs classes, and they take lessons in special needs classrooms. They can also take certain lessons such as physical education and music lessons and have lunch with children in regular classes. Special education teachers are in charge of their classes. Moreover, parents of children with disabilities can consult the education division of the nearest town office if no special needs classes are available in their school district.
(3) Resource roomsChildren attending resource rooms are enrolled in regular classes. They go to resource rooms only for taking special classes. If there are no resource rooms in the school, children can go to another school where resource
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rooms are available, just for the special classes. In both cases, regular class teachers would be in charge of such classes.
(4) Regular classes
Children attending regular classes would be enrolled in regular schools. When it is difficult for them to keep up with a class, they can ask for special support from support staff.
2. Education for children with ASD
According to Hirose and Sasamori (2010), education for children with autism in Japan had been provided by special needs schools, special needs classes, resource rooms, and regular classes in elementary and junior high schools, based on the degree of the disability. It is estimated that there are approximately 20,000 children with autism in special needs schools, 48,000 in special needs classes, 7,000 in resource rooms, and 84,000 in regular classes. Special needs education schools have been established for providing an education similar to general schools and to reduce difficulties in living and learning by children with relatively severe disabilities. Autistic students with intellectual disabilities are often enrolled in elementary, junior
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high, and senior high school courses in special needs schools for children with intellectual disabilities. The educational content provided at these schools for autistic students differ, depending on their life stage, though the main goal of these schools is to teach skills useful for leading an independent life and finding an occupation in the future.
3. Issues of autism education in Japan
Hirose and Sasamori (2010) indicated that education for autistic children with intellectual disabilities had been provided in the field of education for intellectually challenged children. Moreover, Japanese autism education started mainly for the education of emotionally challenged children. Therefore, special needs classes have been providing these types of education. National Institute of Special Needs Education implemented a survey in 2006 on conditions of autistic students enrolled in special needs classes for emotionally disturbed children. This survey reported that approximately 75% of children with ASD were enrolled in classes at elementary schools, and 60% at junior high schools. Educational conditions of students with autism are related to the levels of their intellectual development. Therefore, special needs schools and classes provide different types of education for different types of students, ranging from those having intellectual disabilities to those having high-functioning autism without intellectual disabilities. It is an important issue whether the content and of education and educational measures that have been taken are suitable for different students with different types of autistic traits.
Another problemThe specialties of teachers in charge of special needs classes and resource rooms is another significant issue. To date, teachers having a license to teach elementary or junior high school students can be put in charge of special needs classes, without a special licensing for special needs education. As a result, some teachers might teach autistic students for the first time, without having a deep understanding of the characteristics of autism (Hirose & Sasamori, 2010).
4. Future education of students with autism
Autistic children in Japan have been educated through different systems, such as special needs schools, special needs classes, resource rooms, and regular classes. There is an urgent need to develop systems for training teachers for acquiring specialized knowledge and skills for designing
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educational plans tailored for the conditions and characteristics of each student, regardless of them having intellectual disabilities (Hirose & Sasamori, 2010).
(1) How to get a diagnosis?Please contactIf you feel that your child might be autistic, please contact a consulting center. There are different consulting centers in Japan with different names depending on the region (Figure 3). If you cannot find a center in your town, you should make inquiries at the city hall, especially in the welfare division. They will introduce you the nearest center. Please note that consultation counters would be different depending on the age of your child.
Consulting specialistsYou should make an appointment before the consultation. Sometimes it takes a few months to get a consultation. After the consultation, if your child is suspected of having autism, the consulting staff will introduce you to medical specialists. Usually, the diagnosis is made at the department of pediatrics, cranial nerve pediatrics, or child psychiatry. If your child is over 18 years of age, specialists in psychiatry or psychosomatic medicine will make the diagnosis. The number of specialists and specialized facilities that can diagnose autism is rather small, though it is gradually increasing. On the other hand, intellectual tests and adaptation tests related to diagnoses are conducted at several health centers. Parents have a right to decide whether their children should be diagnosed or not. Though they might be afraid, it is important to know whether a child might have autism. When children are diagnosed as autistic, they are eligible for different support services. Even when they are not eligible for support, they can get much useful advice for dealing with the difficulties of that they face with their child.
(2) How long does it take to be diagnosed? What should you bring?You should make an appointment soon after you are introduced to medical specialists. It might sometimes take a few months, or even about a year to see a medical specialist, depending on the demand for appointments and the region. A diagnosis is made after the medical examination, interviews, and tests, through a careful process. It might sometimes take a few months to two years to be diagnosed. If you have kept a diary about your child’s condition, you should bring it when you come to the interview. Voice recordings and videos that have been taken with your smartphone are also useful information for making the diagnosis. Please do not forget to bring your maternal and child health handbook. You should be prepared to explain your child’s behaviors in detail. Moreover, you should take your child with you so that medical specialists could directly examine your child.
(3) Assessment of autism and future developments
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Children’s health check-ups are regularly conducted in Japan. It is one of the measures taken for the early detection of autism and other disorders. There are health check-ups for 1~12-month-old, 1.5-year-old, 3-year-old, and 5-year-old children. You can make an appointment for these checkups on the day, directly at the health center in the area where you live. Figure 4 shows the process of early detection. Usually, a diagnosis is given by a doctor. However, there few doctors with specialized knowledge on autism. To increase the reliability and the validity of assessments and diagnoses in the future, it would be necessary to use international assessment tools and increase knowledge about autism.
(4) What should you do after being diagnosed?After the diagnosisAfter the diagnosis, the doctor will give you a letter of introduction and refer you to go to the city hall, where you can apply for disability certification. There is no disability certificate specific to autism. Therefore, the certificate that is issued would differ depending on the region. Based on the type of diagnosis, you can apply for Special Child Rearing Allowance, which is provided to families caring for children under 20 years of age with physical or intellectual disabilities. It is provided upon obtaining the prefectural governor’s approval, after being examined at the local welfare division. Payments are made three times a year (April, August, and December) by bank transfer. The Special Child Rearing Allowance is not provided under the following conditions. When the income of the recipient or the person supporting the child
exceeds a limit. When the child enters child welfare facilities other than supported
mother-child living facilities, nursery schools, and daycare facilities. When the child starts to receive a disability pension.
(5) Disability certificatesThere are three types of disability certificates (see the figure on the right). The red booklet is the physical disability certificate, designed for people with physical disabilities. Children with autism can obtain the certificate if they have physical disabilities. The green booklet is the rehabilitation certificate, intended for providing appropriate support for people with intellectual disabilities. Children with autism can obtain this certificate if they also have intellectual disabilities. The blue booklet is the certificate for persons with mental disorders. Children with autism can obtain this certificate if they show certain behavioral or emotional symptoms, without physical or intellectual disabilities. If your child is diagnosed as autistic with intellectual disabilities, you should first consult the local welfare division in charge of persons with disabilities. After sending the necessary documents, you should make an appointment for an interview with a medical specialist. At the interview, more detailed information would be inquired. Based on the results, children are classified into three levels based on their IQ: A; severe, B; moderate, or C; mild. If your child is diagnosed as having autism with
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mental and emotional disorders, the above procedures would be identical, although an interview with a psychologist is required to evaluate the level of the disability. Different types of support are provided depending on the level of the disability.
(5) Support services related to ASDA welfare division is available in each local welfare center. You can obtain information about treatment and support for your child at this division, although this division might differ depending on the region. In Japan, mainly speech and occupational therapists might provide support. You can directly ask, “Where can my child receive treatment?” Please note that the word “rehabilitation” is more often used with regard to support for children with autism, rather than the word “treatment.” General support and service for children with autism are as follows. OBS: The cost might be different depending on the region.
Economic support1. Child allowance: A child allowance is paid to families raising children
under 15 years of age, for supporting the stability of their life and for bringing up children, regardless of having disabilities.
① Under three years of age: 15,000 yen a month② From three years of age to graduation from elementary school: 10,000
yen a month③ Junior high school: 10.000 yen a month
2. Special Child Rearing Allowance:① Severe conditions: 51,500 yen a month: Children with physical disabilities
of Levels 1 or 2 and those with intellectual disabilities classified as Category A are eligible for this payment.
② Moderate conditions: 34,300 yen a month: Children with physical disabilities of Levels 3 or 4 are eligible for this payment. Moreover, those that have been diagnosed by a doctor as having Category B intellectual disabilities might also be eligible for this payment.
3. Special Disability Allowance: Persons for those people over 20 years of age with severe physical or mental disorders, living in their homes are eligible for a monthly payment of 26,830 yen.
Transportation support1. 50% discount on the rail fares (also applied to attendants)2. Welfare taxi tickets, discount on taxi fares3. Reduction or exemption from the motor tax
Educational support1. After-school care for school children with disabilities (after-school day
service)2. Exemption from school expenses (education allowance)
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For more information: The Center for Developmental Disabilities in Japan
Prefecture Name of the Developmental Disability Support Center
Phone Number
Postal Code
1. Hokkaido 北海道発達障害者支援センター「あおいそら」Hokkaido Hattatsu Shougai-sha Shien Senta "AOISORA"
013-846-0851
〒041-0802
2. Aomori 青森県発達障害者支援センター「ステップ」Aomori-ken Hattatsu Shougai-sha Shien Senta "STEP"
017-777-8201
〒030-0822
3. Iwate 岩手県発達障がい者支援センター「ウィズ」 Iwate-ken Hattatsu Shougai-sha Shien Senta "WEIZU"
019-601-2115
〒020-0401
4. Miyagi 宮城県発達障害者支援センター「えくぼ」Miyagi-ken Hattatsu Shougai-sha Shien Senta "EKUBO"
022-376-5306
〒981-3213
5. Akita 秋田県発達障害者支援センター「ふきのとう秋田」Akita-ken Hattatsu Shougai-sha Shien Senta "FUKINOTOU-AKITA"
018-826-8030
〒010-1407
6. Yamagata 山形県発達障がい者支援センター Yamagata-ken Hattatsu Shougai-sha Shien Senta
023-673-3314
〒999-3145
7. Fukushima 福島県発達障がい者支援センターFukushima-ken Hattatsu Shougai-sha Shien Senta
024-951-0352
〒963-8041
8. Ibaraki 茨城県発達障害者支援センターIbaraki-ken Hattatsu Shougai-sha Shien Senta
029-219-1222
〒311-3157
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9. Tochigi 栃木県発達障害者支援センター「ふぉーゆう」 Tochigi-ken Hattatsu Shougai-sha Shien Senta "FOR YOU"
028-623-6111
〒320-8503
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10. Gunma 群馬県発達障害者支援センター Gunma-ken Hattatsu Shougai-sha Shien Senta
027-254-5380
〒371-0843
11. Saitama 埼玉県発達障害者支援センター「まほろば」Saitama-ken Hattatsu Shougai-sha Shien Senta "MAHOROBA"
049-239-3553
〒350-0813
12. Chiba 千葉県発達障害者支援センター「CAS（きゃす）」Chiba-ken Hattatsu Shougai-sha Shien Senta "CAS"
043-227-8557
〒260-0856
13. Tokyo 東京都発達障害者支援センター「TOSCA（トスカ）」Tokyo-to Hattatsu Shougai-sha Shien Senta "TOSCA"
033-426-2318
〒156-0055
14. Kanagawa 神奈川県発達障害支援センター「かながわＡ（エース）」 Kanagawa-ken Hattatsu Shougai-sha Shien Senta "KANAGAWA A"
046-581-3717
〒259-0157
15. Niigata 新潟県発達障がい者支援センター「ＲＩＳＥ（ライズ）」 Niigata-ken Hattatsu Shougai-sha Shien Senta "RISE"
025-266-7033
〒951-8121
16. Toyama 富山県発達障害者支援センター「ほっぷ」 Toyama-ken Hattatsu Shougai-sha Shien Senta "HOPPU"
076-438-8415
〒931-8517
17. Ishikawa 石川県発達障害支援センターIshikawa-ken Hattatsu Shougai-sha Shien Senta
076-238-5557
〒920-8201
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18. Fukui 福井県発達障害児者支援センター「スクラム福井」嶺南（敦賀） Fukui-ken Hattatsu Shougai-sha Shien Senta "SUKURAMU-FUKUI"
077-021-2346
〒914-0144
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19. Yamanashi 山梨県立こころの発達総合支援センター Yamanashi-ken Hattatsu Shougai-sha Shien Senta
055-254-8631
〒400-0005
20. Nagano 長野県発達障がい者支援センター Nagano-ken Hattatsu Shougai-sha Shien Senta
026-227-1810
〒380-0928
21. Gifu 岐阜県発達障害者支援センター「のぞみ」 Gifu-ken Hattatsu Shougai-sha Shien Senta "NOZOMI"
058-233-5116
〒502-0854
22. Shizuoka 静岡県発達障害者支援センター「あいら」 Shizuoka-ken Hattatsu Shougai-sha Shien Senta "AIRA"
054-286-9038
〒422-8031
23. Aichi あいち発達障害者支援センター Aichi Hattatsu Shougai-sha Shien Senta
056-888-0811
〒480-0392
24. Mie 三重県自閉症・発達障害支援センター「あさけ」Mie-ken Jihei-shou Hattatsu Shougai Shien Senta "ASAKE"
059-394-3412
〒510-1326
25. Shiga 滋賀県発達障害者支援センター Shiga-ken Hattatsu Shougai-sha Shien Senta
077-561-2522
〒525-0072
26. Kyoto 京都府発達障害者支援センター「はばたき」Kyoto-fu Hattatsu Shougai-sha Shien Senta "HABATAKI"
075-644-6565
〒612-8416
27. Osaka 大阪府発達障がい者支援センター「アクトおおさか」Osaka-fu Hattatsu Shougai-sha Shien Senta "ACT OSAKA"
066-966-1313
〒540-0026
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28. Hyogo ひょうご発達障害者支援センター「クローバー」 Hyogo-ken Hattatsu Shougai-sha Shien Senta "CLOVER"
079-254-3601
〒671-0122
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29. Nara 奈良県発達障害支援センター「でぃあー」Nara-ken Hattatsu Shougai-sha Shien Senta "DIA"
074-262-7746
〒630-8424
30. Wakayama 和歌山県発達障害者支援センター「ポラリス」Wakayama-ken Hattatsu Shougai-sha Shien Senta "PARARISU"
073-413-3200
〒641-0044
31. Tottori 「エール」鳥取県発達障がい者支援センター "YELL" Tottori-ken Hattatsu Shougai-sha Shien Senta
085-822-7208
〒682-0854
32. Shimane 島根県東部発達障害者支援センター「ウィッシュ」Shimane-ken Toubu Hattatsu Shougai-sha Shien Senta "WISH"
050-3387-8699
〒699-0822
33. Okayama おかやま発達障害者支援センター（本所）Okayama-ken Hattatsu Shougai-sha Shien Senta (Honsho)
086-275-9277
〒703-8555
34. Hiroshima 広島県発達障害者支援センター Hiroshima-ken Hattatsu Shougai-sha Shien Senta
082-490-3455
〒739-0001
35. Yamaguchi 山口県発達障害者支援センター「まっぷ」Yamaguchi-ken Hattatsu Shougai-sha Shien Senta "MAPPU"
083-929-5012
〒753-0302
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36. Tokushima 徳島県発達障がい者総合支援センター「ハナミズキ」Tokushima-ken Hattatsu Shougai-sha Sougou Shien Senta "HANAMIZUKI"
088-534-9001
〒773-0015
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37. Kagawa 香川県発達障害者支援センター「アルプスかがわ」 Kagawa-ken Hattatsu Shougai-sha Shien Senta "ARUPUSU-KAGAWA"
087-866-6001
〒761-8057
38. Ehime 愛媛県発達障害者支援センター「あい・ゆう」 Ehime-ken Hattatsu Shougai-sha Shien Senta "AI-YU"
089-955-5532
〒791-0212
39. Kochi 高知県立療育福祉センター発達支援部Kochi-kenritsu Ryouiku Fukushi Senta Hattatsu Shien-bu
088-844-1247
〒780-8081
40. Fukuoka 福岡県発達障害者支援センター「ゆう・もあ」Fukuoka-ken Hattatsu Shougai-sha Shien Senta "YU-MOA"
094-746-9505
〒825-0004
41. Saga 佐賀県東部発達障害者支援センター「結」 Saga-ken Toubu Hattatsu Shougai-sha Shien Senta "YUI"
094-281-5728
〒841-0073
42. Nagasaki 長崎県発達障害者支援センター「しおさい(潮彩)」Nagasaki-ken Hattatsu Shougai-sha Shien Senta "SHIOSAI"
095-722-1802
〒854-0071
43. Kumamoto 熊本県北部発達障がい者支援センター「わっふる」 Kumamoto-ken Hokubu Hattatsu Shougai-sha Shien Senta "WAFFURU"
096-293-8189
〒869-1235
44. Oita 大分県発達障がい者支援センター「ECOAL（イコール）」Oita-ken Hattatsu Shougai-sha Shien Senta "ECOAL"
097-513-1880
〒870-0047
45. Miyazaki 宮崎県中央発達障害者支援センター Miyazaki-ken Chuou Hattatsu Shougai-sha Shien Senta
098-585-7660
〒889-1601
46. Kagoshima 鹿児島県発達障害者支援センターKagoshima-ken Hattatsu Shougai-sha Shien Senta
099-264-3720
〒891-0175
47. Okinawa 沖縄県発達障害者支援センター「がじゅま～る」 Okinawa-ken Hattatsu Shougai-sha Shien Senta "GAJYUMA-RU"
098-982-2113
〒904-2173
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Recommended Readings
Free M-CHAT online with instant scoring: www.m-chat.org Autism Navigator: http://autismnavigator.com/ Autism Speaks: https://www.autismspeaks.org/ First Signs: http://www.firstsigns.org/ American Speech and Hearing Association: www.asha.org American Occupational Therapy: www.aota.org American Physical Therapy Association: www.apta.org ABA and other treatment approaches: www. autismspeaks.org Behavior Analyst Certification Board: www.BACB.com
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National Research Council: www.nap.edu/openbook.php?isbn=0309082697
American Academy of Pediatrics: www.aap.org/healthtopics/autism.cfm Evidence-Based Practices for Children, Youth, and Young Adults with
ASD: http://autismpdc.fpg.unc.edu/sites/autismpdc.fpg.unc.edu/files/2014-EBP-Report.pdf
The National Professional Development Center on Autism Spectrum Disorder: http://autismpdc.fpg.unc.edu/national-professional-development-center-autism-spectrum-disorder
Autism Internet Modules: http://www.autisminternetmodules.org/
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Awit Arzadon Dalusong, Ph.D., BCBA. State Trainer Overview of the24 Evidence-based Practices.
Centers for Disease Control and Prevention (2014). Prevalence of autism spectrum disorder
among children aged 8 years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2010. MMWR Surveillance Summary, 63, 1–21. Retrieved from: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6302a1.htm?s_cid=ss6302a1_w
Developmental Disability Support and Assessment Guideline (2012) file://sv-home01/vol_home01/home/s1721384/Documents/M1/assessment_guideline2013hong.pdf
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Ganz, M.L. (2007). The lifetime distribution of the incremental societal costs of autism. Arch Pediatr Adolesc Med, 161, 343-349. doi:10.1001/archpedi.161.4.343.
Hirose, Y. & Sasamori, H. (2010). Current Status and Issues of Autism Education in Japan - Autism Education Aiming at the Realization of a Cohesive Society. The 29th Asia-Pacific Seminar on Education for Children with Special Needs, Part 1, 5-6. http://www.nise.go.jp/kenshuka/josa/kankobutsu/pub_d/d-291/d-291_1_2.pdf
Hoffman, L. C., Sutcliffe, T. L., Tanner, I. S., & Feldman, H. M. (2011). Management of symptoms in children with autism spectrum disorders: A comprehensive review of pharmacologic and complementary-alternative medicine treatments. Journal of Developmental and Behavioral Pediatrics, 32(1), 56-68.
Information and Support Center for Persons with Developmental Disordershttp://www.rehab.go.jp/ddis/%E7%9B%B8%E8%AB%87%E7%AA%93%E5%8F%A3%E3%81%AE%E6%83%85%E5%A0%B1/?action=common_download_main&uploadid=2885
Mazefsky, C. A., Oswald, D. P., Day, T. N., Eack, S. M., Minshew, N. J., & Lainhart, J. E. (2012). ASD, a psychiatric disorder, or both? Psychiatric diagnoses in adolescents with high-functioning ASD. Journal of Clinical Child & Adolescent Psychology, 41, 516-523.
Miltenberger, R. G., 園山繁樹, 野呂文行, 渡部匡隆, & 大石幸二. (2006). 行動変容法入門.
Ministry of Health Labor and Welfare. “tokubetsu jidou fuyou teate ni tsuite”http://www.mhlw.go.jp/bunya/shougaihoken/jidou/huyou.html
Ministry of Health Labor and Welfare. “keido hattatsu shougai wo meguru shomondai”http://www.mhlw.go.jp/bunya/kodomo/boshi-hoken07/h7_01.html
Ministry of Health Labor and Welfare. “tokubetsu shougaisha teate ni tsuite”http://www.mhlw.go.jp/bunya/shougaihoken/jidou/tokubetsu.html
Ministry of Education, Culture Sports, Science and Technology (2015). http://www.mext.go.jp/b_menu/shingi/chukyo/chukyo3/053/siryo/__icsFiles/afieldfile/2015/05/25/1358061_03_03.pdf
Ritariko; Colum for Parents who has Children with Developmental Disabilities https://h-navi.jp/
Wong, C., Odom, S. L., Hume, K. A., Cox, C. W., Fettig, A., Kurcharczyk, S., et al. (2015). Evidence-based practices for children, youth, and young adults with autism spectrum
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disorder: A comprehensive review. Journal of Autism and Developmental Disorders, 45, 1951-1966. doi: 10.1007/s10803-014-2351-z
山本淳一. (2002). 自閉症スペクトラム障害への早期支援と脳機能: エビデンス・ベース研究. Developmental Neuroscience, 23, 51-52.
日本認知行動療法協会 https://www.jabct.org/home-japanese/認知行動療法とは/
一般社団法人 日本臨床心理士会 http://www.jsccp.jp/near/interview13.php
園山繁樹, 野呂文行, 渡辺匡隆・他 (共訳), 二瓶社, 大阪.159-170,179,240-248.
For more information on Autism Spectrum Disorders and Related Educational Services in Japan
[Website link]1. The Japanese Academy of Autistic Spectrum Disorders
http://www.autistic-spectrum.jp/
2. Information and Support Center for Persons with Developmental http://www.rehab.go.jp/ddis/
3. The Japanese Association for Behavior Analysishttp://www.j-aba.jp/
4. Autism Society Japan42
http://www.autism.or.jp/
5. World Autism Awareness Day Japanese Official Websitehttp://www.worldautismawarenessday.jp/htdocs/index.php?action=pages_view_main&page_id=170
6. Japan Developmental Disability Networkhttps://jddnet.jp/
7. Japanese Association of Autism Support http://zenjisyakyo.com/
8. Japanese Society of Certified Clinical Psychologistshttp://www.jsccp.jp/
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